SB 139 — Requires certain health insurance to cover treatment of certain conditions relating to gender dysphoria. (BDR 57-54)

5.

- *SB139* – 5 – (6) A strong conviction of experiencing typical feelings and reactions of the opposite gender or a gender different from the sex assigned at birth.

- *SB139_R1* – 6 – (1) Provided in accordance with generally accepted standards of medical practice;

 A provider of health care prescribing, ordering, recommending or approving a health care service or product does not, by itself, make that health care service or product medically necessary.

(f) VoiceGynecologists; therapists;

(g) Gynecologists;Plastic surgeons;

and (h) PlasticAny surgeons;other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

and - *SB139* – 6 – (i) Any other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

A carrier shallthat ensureissues a health benefit plan may prescribe requirements that themust benefitsbe requiredsatisfied bybefore subsectionthe 1carrier arecovers madesurgical availabletreatment of conditions relating to angender insureddysphoria, throughgender aincongruence providerand other disorders of healthsexual caredevelopment - *SB139_R1* – 7 – for an insured who participatesis inless thethan network17 planyears of theage. carrier.

Such requirements may include, without limitation, requirements that:

(a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

(b) The treatment must be recommended by a physician;

(c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

and (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care.

A healthcarrier benefitshall planmake subjecta toreasonable theeffort provisionsto ofensure this chapter that isthe delivered,benefits issuedrequired forby deliverysubsection or1 renewedare onmade oravailable afterto Julyan 1,insured 2021,through hasa theprovider legal effect of includinghealth thecare coveragewho requiredparticipates byin subsectionthe 1,network andplan any provision of the plancarrier. that conflicts with the provisions of this section is void.

If, after a reasonable effort, the carrier is unable to make such benefits available through such a provider of health care, the carrier must cover the benefits when provided to an insured through a provider of health care who does not participate in the network of the plan of the carrier.

A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.

5.

- *SB139_R1* – 8 – (6) A strong conviction of experiencing typical feelings and reactions of the opposite gender or a gender different from the sex assigned at birth.

- *SB139* – 7 – (3) Not primarily provided for the convenience of the patient or provider of health care;

 A provider of health care prescribing, ordering, recommending or approving a health care service or product does not, by itself, make that health care service or product medically necessary.

- *SB139_R1* – 9 – (a) Endocrinologists;

(f) VoiceGynecologists; therapists;

(g) Gynecologists;Plastic surgeons;

and (h) PlasticAny surgeons;other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

and (i) Any other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

A society shallthat ensureissues a benefit contract may prescribe requirements that themust benefitsbe requiredsatisfied bybefore subsectionthe 1society arecovers madesurgical availabletreatment of conditions relating to angender insureddysphoria, throughgender aincongruence providerand other disorders of healthsexual caredevelopment for an insured who participatesis inless thethan network17 planyears of theage. society.

-Such *SB139*requirements –may 8include, –without 3.limitation, requirements that:

A(a) benefitThe contracttreatment subjectmust tobe therecommended provisionsby ofa thispsychologist, chapterpsychiatrist that is delivered, issued for delivery or renewedother onmental orhealth afterprofessional; July 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the benefit contract that conflicts with the provisions of this section is void.

(b) The treatment must be recommended by a physician;

(c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

and (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care.

3.

A society shall make a reasonable effort to ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the society.

If, after a reasonable effort, the society is unable to make such benefits available through such a provider of health care, the society must cover the benefits when provided to an insured through a provider of health care who does not participate in the network of the plan of the society.

A benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the benefit contract that conflicts with the provisions of this section is void.

5.

- *SB139_R1* – 10 – (2) A strong desire to be rid of primary or secondary sex characteristics because of a marked difference between such sex characteristics and gender identity or expression or a desire to prevent the development of anticipated secondary sex characteristics in young adolescents.

- *SB139*A –provider 9of –health (c)care “Networkprescribing, plan”ordering, meansrecommending aor benefitapproving contract offered by a societyhealth undercare whichservice theor financingproduct anddoes deliverynot, ofby medicalitself, care,make includingthat itemshealth andcare servicesservice paid for as medical care, are provided, in whole or inproduct part,medically throughnecessary. a defined set of providers under contract with the society.

(c) “Network plan” means a benefit contract offered by a society under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the society.

A hospital or medical services corporation that issues a policy of health insurance shall include in the policy coverage for - *SB139_R1* – 11 – the medically necessary treatment of conditions relating to gender dysphoria, gender incongruence and other disorders of sexual development.

(f) VoiceGynecologists; therapists;

(g) Gynecologists;Plastic surgeons;

and (h) PlasticAny surgeons;other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

and (i) Any other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

AAn hospital or medical services corporation shallthat ensureissues a policy of health insurance may prescribe requirements that must be satisfied before the benefitshospital requiredor bymedical subsectionservices 1corporation arecovers madesurgical availabletreatment of conditions relating to angender insureddysphoria, throughgender aincongruence providerand ofother healthdisorders careof whosexual participatesdevelopment infor thean networkinsured planwho ofis theless hospitalthan or17 medicalyears servicesof corporation.age.

Such requirements may include, without limitation, requirements that:

(a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

(b) The treatment must be recommended by a physician;

(c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

and (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care.

A policyhospital ofor healthmedical insuranceservices subjectcorporation toshall themake provisionsa ofreasonable thiseffort chapterto ensure that isthe delivered,benefits issuedrequired forby deliverysubsection or1 renewedare onmade oravailable afterto Julyan 1,insured 2021,through hasa theprovider legal effect of includinghealth thecare coveragewho requiredparticipates byin subsectionthe 1,network andplan any provision of the policyhospital thator conflictsmedical withservices thecorporation. provisions of this section is void.

If, after a reasonable effort, the hospital or medical services corporation is unable to make such benefits available through such a provider of health care, the hospital or medical services corporation must cover the benefits when provided to an insured through a provider of health care who does not participate in the network of the plan of the hospital or medical services corporation.

A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage - *SB139_R1* – 12 – required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.

5.

- *SB139* – 10 – (1) A marked difference between gender identity or expression and primary or secondary sex characteristics or anticipated secondary sex characteristics in young adolescents.

(c) “NetworkA plan”provider means a policy of health insurancecare offeredprescribing, byordering, arecommending hospital or medicalapproving servicesa corporationhealth undercare whichservice the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or inproduct part,does throughnot, aby defineditself, setmake ofthat providershealth undercare contractservice with the hospital or medicalproduct servicesmedically corporation.necessary.

- *SB139_R1* – 13 – (c) “Network plan” means a policy of health insurance offered by a hospital or medical services corporation under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the hospital or medical services corporation.

- *SB139* – 11 – Sec.

(f) VoiceGynecologists; therapists;

(g) Gynecologists;Plastic surgeons;

and (h) PlasticAny surgeons;other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

and (i) Any other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

A health maintenance organization mustthat ensureissues a health care plan may prescribe requirements that must be satisfied before the benefitshealth requiredmaintenance byorganization subsectioncovers 1surgical aretreatment madeof availableconditions relating to angender enrolleedysphoria, throughgender aincongruence providerand other disorders of healthsexual caredevelopment whofor participatesan inenrollee thewho networkis planless ofthan the17 healthyears maintenanceof organization.age.

Such requirements may include, without limitation, requirements that:

(a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

(b) The treatment must be recommended by a physician;

(c) The enrollee must provide a written expression of the desire of the enrollee to undergo the treatment;

and (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care.

A health caremaintenance planorganization subjectshall tomake thea provisionsreasonable ofeffort thisto chapterensure that isthe delivered,benefits issuedrequired forby deliverysubsection or- renewed*SB139_R1* on– or14 after– July1 1,are 2021,made hasavailable theto legalan effectenrollee ofthrough includinga theprovider coverageof requiredhealth bycare subsectionwho 1,participates andin any provision of the network plan thatof conflicts with the provisionshealth ofmaintenance thisorganization. section is void.

If, after a reasonable effort, the health maintenance organization is unable to make those benefits available through such a provider of health care, the health maintenance organization must cover the benefits when provided to an enrollee through a provider of health care who does not participate in the network of the plan of the health maintenance organization.

A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.

5.

- *SB139* – 12 – (3) A strong desire for the primary or secondary sex characteristics of the gender opposite from the sex assigned at birth.

- *SB139_R1* – 15 – (2) Clinically appropriate with regard to type, frequency, extent, location and duration;

 A provider of health care prescribing, ordering, recommending or approving a health care service or product does not, by itself, make that health care service or product medically necessary.

Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, - *SB139* – 13 – must not be construed to violate any provision of law relating to solicitation or advertising by practitioners of a healing art.

The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department - *SB139_R1* – 16 – of Health and Human Services.

or - *SB139* – 14 – (2) Is unable to fulfill its obligations to furnish health care services as required under its health care plan;

and - *SB139_R1* – 17 – (2) Conducting external reviews of adverse determinations that comply with the provisions of NRS 695G.241 to 695G.310, inclusive;

- *SB139* – 15 – Sec.

- *SB139_R1* – 18 – (e) Psychologists;

(f) VoiceGynecologists; therapists;

(g) Gynecologists;Plastic surgeons;

and (h) PlasticAny surgeons;other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

and (i) Any other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

A managed care organization shallthat ensureissues a health care plan may prescribe requirements that must be satisfied before the benefitsmanaged requiredcare byorganization subsectioncovers 1surgical aretreatment madeof availableconditions relating to angender insureddysphoria, throughgender aincongruence providerand other disorders of healthsexual caredevelopment whofor participatesan ininsured thewho networkis planless ofthan the17 managedyears careof organization.age.

Such requirements may include, without limitation, requirements that:

(a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

(b) The treatment must be recommended by a physician;

(c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

and (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care.

A healthmanaged care planorganization subjectshall tomake thea provisionsreasonable ofeffort thisto chapterensure that isthe delivered,benefits issuedrequired forby deliverysubsection or1 renewedare onmade oravailable afterto Julyan 1,insured 2021,through hasa theprovider legal effect of includinghealth thecare coveragewho requiredparticipates byin subsectionthe 1,network andplan any provision of the planmanaged thatcare conflictsorganization. with the provisions of this section is void.

If, after a reasonable effort, the managed care organization is unable to make such benefits available through such a provider of health care, the managed care organization must cover the benefits when provided to an insured through a provider of health care who does not participate in the network of the plan of the managed care organization.

A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.

5.

- *SB139_R1* – 19 – (2) A strong desire to be rid of primary or secondary sex characteristics because of a marked difference between such sex characteristics and gender identity or expression or a desire to prevent the development of anticipated secondary sex characteristics in young adolescents.

- *SB139* – 16 – (3) A strong desire for the primary or secondary sex characteristics of the gender opposite from the sex assigned at birth.

 A provider of health care prescribing, ordering, recommending or approving a health care service or product does not, by itself, make that health care service or product medically necessary.

- *SB139_R1* – 20 – (a) Shall appoint, with the consent of the Governor, administrators of the divisions of the Department, who are respectively designated as follows:

- *SB139* – 17 – (4) The Administrator of the Division of Health Care Financing and Policy;

- *SB139_R1* – 21 – (5) Set forth sufficient information to assist the Department in providing those services and in the planning and budgeting for the future provision of those services;

(e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding - *SB139* – 18 – detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

The money accumulated for this purpose through deductions from the compensation of officers and employees and contributions of the governing body must be maintained as an internal service fund as - *SB139_R1* – 22 – defined by NRS 354.543.

The provisions of NRS 687B.408, 689B.030 to 689B.050, inclusive, and section 3 of this act, 689B.287 and 689B.500 apply to coverage provided pursuant to this paragraph, - *SB139* – 19 – except that the provisions of NRS 689B.0378, 689B.03785 and 689B.500 only apply to coverage for active officers and employees of the governing body, or the dependents of such officers and employees.

(a) Shall be deemed, solely for the purposes of this section, to be officers and employees of the county, school district, municipal corporation, political subdivision, public corporation or other local - *SB139_R1* – 23 – governmental agency with which the legal services organization has contracted;

- *SB139* – 20 – (c) Shall be deemed to be approved if not disapproved by the Commissioner within 30 days after its submission.

(f) VoiceGynecologists; therapists;

(g) Gynecologists;Plastic surgeons;

and - *SB139_R1* – 24 – (h) PlasticAny surgeons;other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

and (i) Any other providers of medically necessary services for the treatment of gender dysphoria, gender incongruence and other disorders of sexual development.

- *SB139* – 21 – (1) A marked difference between gender identity or expression and primary or secondary sex characteristics or anticipated secondary sex characteristics in young adolescents.

(c) “ProviderA provider of health care”care hasprescribing, theordering, meaningrecommending ascribedor toapproving ita inhealth NRScare 629.031.service or product does not, by itself, make that health care service or product medically necessary.

- *SB139_R1* – 25 – (c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

additional expenses of a local government that are related to the provisions of this act.

16.

The provisions of NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.

Sec.

H - *SB139**SB139_R1*