AB 155 — Establishes provisions relating to biomarker testing. (BDR 40-305)

8.

(Deleted by amendment.) Sec.

9.

(Deleted by amendment.) Sec.

10.

(Deleted by amendment.) Sec.

11.

NRS 232.320 is hereby amended to read as follows:

232.320 1.

The Director:

(b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section 15 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of - *AB155_R1* – 3 – law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public and Behavioral Health or the professional line activities of the other divisions.

- 82nd Session (2023) – 3 – (d) Shall, after considering advice from agencies of local governments and nonprofit organizations which provide social services, adopt a master plan for the provision of human services in this State.

The Director shall revise the plan biennially and deliver a copy of the plan to the Governor and the Legislature at the beginning of each regular session.

The plan must:must:ure at the (1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplication of those services by federal, state and local agencies;

(1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplication of those services by federal, state and local agencies;

(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 detailed information relating to their budgets and payrolls, which the Directorupon deemshim necessaryor forher thepursuant performanceto this section.nce of the duties imposed upon(f) himHas orsuch herother pursuantpowers toand thisduties section.as are provided by law.

(f) Has such other powers and duties as are provided by law.

The governing body of any county, school district, municipal corporation, political subdivision, public - *AB155_R1* – 4 – corporation or other local governmental agency of the State of Nevada may:

(a) Adopt and carry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of its officers and employees, and the dependents of officers and employees who elect to accept the insurance and who, where - 82nd Session (2023) – 4 – necessary, have authorized the governing body to make deductions from their compensation for the payment of premiums on the insurance.

(b) Purchase group policies of life, accident or health insurance, or any combination thereof, for the benefit of such officers and employees, and the dependents of such officers and employees, as have authorized the purchase, from insurance companies authorized to transact the business of such insurance in the State of Nevada, and, where necessary, deduct from the compensation of officers and employees the premiums upon insurance and pay the deductions upon the premiums.

The provisions of NRS 686A.135, 687B.352, 687B.408, 687B.723, 687B.725, 689B.030 to 689B.050, inclusive, and section 19 of this act, 689B.265, 689B.287 and 689B.500 apply to coverage provided pursuant to this paragraph, 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.

- *AB155_R1* – 5 – 2.

If the amount of the deductions from compensation - 82nd Session (2023) – 5 – required to pay for the group insurance exceeds the compensation to which a trustee is entitled, the difference must be paid by the trustee.

In any county in which a legal services organization exists, the governing body of the county, or of any school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada in thetheion or county, may enter into a contract with the legal services organization pursuant to which the officers and employees of the legal services organization, and the dependents of those officers and employees, are eligible for any life, accident or health insurance provided pursuant to this section to the officers and employees, and the dependents of the officers and employees, of the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency.

(a) Must be submitted to the Commissioner of Insurance for approval not less than 30 days before the date on which the contract is to(b) Does not become effective.effective unless approved by the Commissioner.

(b) Does not become effective unless approved by the Commissioner.

287.04335 If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 686A.135, 687B.352, 687B.409, 687B.723, 687B.725, 689B.0353, 689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, - *AB155_R1* – 6 – 695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.1675, 695G.170 to 695G.174, inclusive, and section 27 of this- act,82nd 695G.176,Session 695G.177,(2023) 695G.200– to6 695G.230,– inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the samesameive, manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

Subject to the limitations prescribed by subsection 4, the Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of acancer disease or condition when such biomarker testing is supported by medical and scientific evidence.

(b) The indicated tests for a drug that has been approved by the United States Food and Drug Administration or the warningswarningsy and precautions included on the label of such a drug;

(1) Request an exception to a policy excluding coverage for biomarkerongoing testing;monitoring of cancer;

orsis, treatment, management or (2) Appeal a denial of coverage for such biomarker testing;

(a)- 82nd Session (2023) – 7 – (b) Within 2472 hours after receiving anany urgentother request;request.

or (b)4. Within 72 hours after receiving any other request.

- *AB155_R1* – 7 – 4.

or (c) That has not been determined to be medically necessary by a provider of health care for whom such a determination is within his or her scope of practice, training and experience;experience.

or (d) Where a more cost-effective test is equally capable of meeting the medical needs of the recipient of Medicaid.

(1) An interaction between a gene and a drug that is being used byby(2) orA consideredmutation foror usecharacteristic byof thea patient;gene;

(2) A mutation or characteristic of a gene;

and (4) Made using a transparent methodology and reporting procedure.pro(d) “Medically necessary” means health care services or products that a prudent provider of health care would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:

(d) “Medically necessary” means health care services or products that a prudent provider of health care would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:

(2) ClinicallyNot appropriateprimarily withprovided regardfor tothe type,convenience frequency,of extent,the locationpatient andor duration;provider of health care;

and - 82nd Session (2023) – 8 – (3) NotSignificant primarilyin providedguiding forand informing the convenienceprovider of health care in providing the most appropriate course of treatment for the patient in order to prevent, delay or providerlessen the magnitude of an adverse health care;outcome.

-evidence-based *AB155_R1*guidelines –establishing 8standards –of (4)care Requiredthateans toinclude, improvewithout alimitation, specificrecommendations healthintended condition of a patient or to preserveoptimize thecare existing state of healthpatients ofand theare: patient;

and (5) The most clinically appropriate level of health care that may be safely provided to the patient.

(e) “Nationally recognized clinical practice guidelines” means evidence-based guidelines establishing standards of care that include, without limitation, recommendations intended to optimize care of patients and are:

Except as otherwise provided in NRS 689A.0405, 689A.0412, 689A.0413, 689A.044, 689A.0445, 689B.031, 689B.0313, 689B.0315, 689B.0317, 689B.0374, 689C.1675, 695A.1856, 695B.1912, 695B.1913, 695B.1914, 695B.1925, 695B.1942, 695C.1713, 695C.1735, 695C.1737, 695C.1745, 695C.1751, 695G.170, 695G.171, 695G.1714 and 695G.177, any contract for group, blanket or individual health insurance or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care which provides for payment of a certain part of medical or dental care may require the insured or member to obtain prior authorization for that carecarere from the insurer or organization.

Subject to the limitations prescribed by subsection 4, an insurer that issues a policy of health insurance shall include in the policy- coverage82nd forSession medically(2023) necessary biomarker testing for the - *AB155_R1* – 9 – diagnosis, treatment, appropriate management and ongoingongoingg for the monitoring of acancer disease or condition when such biomarker testing is supported by medical and scientific evidence.

(a) Provide the coverage required by subsection 1 in a manner that limits disruptions in care and the need for multiple specimens.

(1) Request an exception to a policy excluding coverage for biomarker testing;testing for the diagnosis, treatment, management or ongoing monitoring of cancer;

or (2) Appeal a denial of coverage for such biomarker testing;

4.provide coverage of biomarker testing:

The provisions of this section do not require an insurer to provide(a) coverageFor ofscreening biomarkerpurposes; testing:

(a) For screening purposes;

(d)or That- has82nd notSession been(2023) determined– to10 be– medically necessary by a provider of health care for whom such a determination is within his or her scope of practice, training and experience;experience.

or (e) Where a more cost-effective test is equally capable of meeting the medical needs of the insured.

A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or - *AB155_R1* – 10 – after October 1, 2023, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal which is in conflict with the provisions of this section is void.

and (3)(b) The“Biomarker expressiontesting” means the analysis of the tissue, blood or other biospecimen of a protein.patient for the presentation of a biomarker and includes, without limitation, single-analyte tests, multiplex panel tests and whole genome, whole exome and whole transcriptome sequencing.

(b) “Biomarker testing” means the analysis of the tissue, blood or other biospecimen of a patient for the presentation of a biomarker and includes, without limitation, single-analyte tests, multiplex panel tests and whole genome, whole exome and whole transcriptome sequencing.

(d) “Medically necessary” means health care services or products that a prudent provider of health care would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:

(2) ClinicallyNot appropriateprimarily withprovided regardfor tothe type,convenience frequency,of extent,the locationpatient andor duration;provider of health care;

and (3) NotSignificant primarilyin providedguiding forand informing the convenienceprovider of health care in providing the patientmost orappropriate providercourse of treatment - 82nd Session (2023) – 11 – of an adverse health care;outcome.revent, delay or lessen the magnitude (e) “Nationally recognized clinical practice guidelines” means evidence-based guidelines establishing standards of care that include, without limitation, recommendations intended to optimize care of patients and are:

(4) Required to improve a specific health condition of a patient or to preserve the existing state of health of the patient;

and (5) The most clinically appropriate level of health care that may be safely provided to the patient.

(e) “Nationally recognized clinical practice guidelines” means evidence-based guidelines establishing standards of care that - *AB155_R1* – 11 – include, without limitation, recommendations intended to optimize care of patients and are:

(f) “Network plan” means a policy of health insurance offered by an insurer 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 underarrangement contractfor withthe financing of premiums.does not include an (g) “Provider of health care” has the insurer.meaning ascribed to it in NRS 629.031.

The term does not include an arrangement for the financing of premiums.

(g) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

Subject to the limitations prescribed by subsection 4, an insurer that issues a policy of group health insurance shall include in the policy coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of acancer disease or condition when such biomarker testing is supported by medical and scientific evidence.

- 82nd Session (2023) – 12 – (b) The indicated tests for a drug that has been approved by the United States Food and Drug Administration or the warnings and precautions included on the label of such a drug;

(c) A national coverage determination or local coverage determination,ortermination, as those terms are defined in 42 C.F.R.

or (d) Nationally recognized clinical practice guidelines or consensus statements.

- *AB155_R1* – 12 – 2.

(1) Request an exception to a policy excluding coverage for biomarker testing;testing for the diagnosis, treatment, management or ongoing monitoring of cancer;

or (2) Appeal a denial of coverage for such biomarker testing;

(a) For screening purposes;

or (d) That has not been determined to be medically necessary by a provider of health care for whom such a determination is within his or her scope of practice, training and experience;experience.

or (e) Where a more cost-effective test is equally capable of meeting the medical needs of the insured.

(a)- “Biomarker”82nd meansSession a(2023) characteristic– that13 is– objectively measured and evaluated as an indicator of a normal biological process, a pathogenic process or a pharmacological response to a specific therapeutic intervention and includes, without limitation:

(b) “Biomarker testing” means the analysis of the tissue, blood or other biospecimen of a patient for the presentation of a - *AB155_R1* – 13 – biomarker and includes, without limitation, single-analyte tests, multiplex panel tests and whole genome, whole exome and whole transcriptome sequencing.

(2) Made by an independent, multidisciplinary panel of experts that has established a policy to avoid conflicts of interest;

(2) ClinicallyNot appropriateprimarily withprovided regardfor tothe type,convenience frequency,of extent,the locationpatient andor duration;provider of health care;

and (3) NotSignificant primarilyin providedguiding forand informing the convenienceprovider of health care in providing the most appropriate course of treatment for the patient in order to prevent, delay or providerlessen the magnitude of health(e) care;“Nationally recognized clinical practice guidelines” means evidence-based guidelines establishing standards of care that include, without limitation, recommendations intended to optimize care of patients and are:

(4) Required to improve a specific health condition of a patient or to preserve the existing state of health of the patient;

and (5) The most clinically appropriate level of health care that may be safely provided to the patient.

(e) “Nationally recognized clinical practice guidelines” means evidence-based guidelines establishing standards of care that include, without limitation, recommendations intended to optimize care of patients and are:

and (2) Developed using a transparent methodology and reporting procedure by an independent organization or society of medical- professionals82nd thatSession (2023) – 14 – conflicts of interest.that has established a policy to avoid conflicts(f) “Network plan” means a policy of interest.group health insurance offered by an insurer 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 insurer.

(f) “Network plan” means a policy of group health insurance offered by an insurer 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 insurer.

- *AB155_R1* – 14 – (g) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

Subject to the limitations prescribed by subsection 4, a carrier that issues a health benefit plan shall include in the plan coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of acancer disease or condition when such biomarker testing is supported by medicallimitation: and scientific evidence.

Suchscientific evidenceevidence. includes, without limitation:

Such evidence includes, without (a) The labeled indications for a biomarker test or medication that has been approved or cleared by the United States Food and Drug Administration;

(b)insured Establishor aprovider clearof andhealth readilycare accessibleto:ccessible process for an insured(1) orRequest provideran ofexception healthto carea to:policy excluding coverage for biomarker testing for the diagnosis, treatment, management or ongoing monitoring of cancer;

(1)or Request(2) anAppeal exception to a policydenial excludingof coverage for such biomarker testing;

or (2) Appeal a denial of coverage for biomarker testing;

3.- 82nd Session (2023) – 15 – authorization for a biomarker test described in subsection 1, the carrier shall respond to a request for such prior authorization:

If a carrier requires an insured to obtain prior authorization for a biomarker test described in subsection 1, the carrier shall respond to a request for such prior authorization:

-or *AB155_R1* – 15 – (d) That has not been determined to be medically necessary by a provider of health care for whom such a determination is within his or her scope of practice, training and experience;experience.

or (e) Where a more cost-effective test is equally capable of meeting the medical needs of the insured.

A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2023, has the legal effect of including the coverage after required by this section, and any provision of the plan or renewal which is in conflict with the provisions of this section is void.

(b) “Biomarker testing” means the analysis of the tissue, blood or other biospecimen of a patient for the presentation of a biomarker and includes, without limitation, single-analyte tests, multiplex panel tests and whole genome, whole exome and whole transcriptome sequencing.

whole genome, whole exome and whole (c) “Consensus statement” means a statement aimed at a specific clinical circumstance that is:

and (4)- Made82nd Session (2023) – 16 – procedure.Made using a transparent methodology and reporting procedure.(d) “Medically necessary” means health care services or products that a prudent provider of health care would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:

(d) “Medically necessary” means health care services or products that a prudent provider of health care would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:

(2) ClinicallyNot appropriateprimarily withprovided regardfor tothe type,convenience frequency,of extent,the locationpatient andor duration;provider of health care;

and (3) NotSignificant primarilyin providedguiding forand informing the convenienceprovider of health care in providing the most appropriate course of treatment for the patient in order to prevent, delay or providerlessen the magnitude of an adverse health care;outcome.

-(e) *AB155_R1*“Nationally –recognized 16clinical –practice (4)guidelines” Requiredmeans toevidence-based improveguidelines aestablishing specificstandards healthof conditioncare ofthat ainclude, patientwithout orlimitation, recommendations intended to preserveoptimize thecare existingo(1) stateInformed by a systemic review of healthevidence and an assessment of the patient;risks and benefits of alternative options for care;

and (5) The most clinically appropriate level of health care that may be safely provided to the patient.

(e) “Nationally recognized clinical practice guidelines” means evidence-based guidelines establishing standards of care that include, without limitation, recommendations intended to optimize care of patients and are:

(1) Informed by a systemic review of evidence and an assessment of the risks and benefits of alternative options for care;

689C.425 A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to 689C.355, inclusive, and section 20 of this act, to the extent applicable and not in conflict with the express provisions of NRS 687B.408687Sec. and 689C.360 to 689C.600, inclusive.

Sec.

Subject to the limitations prescribed by subsection 4, a society that issues a benefit contract shall include in the contract coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of acancer disease or condition when such biomarker testing is supported by medical and scientific evidence.

- 82nd Session (2023) – 17 – (a) The labeled indications for a biomarker test or medication that has been approved or cleared by the United States Food and Drug Administration;

(b) The indicated tests for a drug that has been approved by the United States Food and Drug Administration or the warnings and precautions included on the label of such a drug;

warnings (c) A national coverage determination or local coverage determination, as those terms are defined in 42 C.F.R.

- *AB155_R1* – 17 – 2.

(1) Request an exception to a policy excluding coverage for biomarker testing;testing for the diagnosis, treatment, management or ongoing monitoring of cancer;

or (2) Appeal a denial of coverage for such biomarker testing;

or (b)4.) WithinWThe 72provisions hoursof afterthis receivingsection anydo othernot request.require a society to provide coverage of biomarker testing:

4.

The provisions of this section do not require a society to provide coverage of biomarker testing:

or (d) That has not been determined to be medically necessary by a provider of health care for whom such a determination is within his or her scope of practice, training and experience;experience.

or (e) Where a more cost-effective test is equally capable of meeting the medical needs of the insured.

A benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2023, has the legal effect of including the coverage required by this section, and any provision of the benefit contract or- renewal82nd Session (2023) – 18 – void.newal which is in conflict with the provisions of this section is void.6.

6.

(b) “Biomarker testing” means the analysis of the tissue, blood or other biospecimen of a patient for the presentation of a - *AB155_R1* – 18 – biomarker and includes, without limitation, single-analyte tests, multiplex panel tests and whole genome, whole exome and whole transcriptome sequencing.

(c) “Consensus statement” means a statement aimed at a specificspecif(1) clinicalMade circumstancefor thatthe is:purpose of optimizing the outcomes of clinical care;

(1) Made for the purpose of optimizing the outcomes of clinical care;

(2) ClinicallyNot appropriateprimarily withprovided regardfor tothe type,convenience frequency,of extent,the locationpatient andor duration;provider of health care;

(3)and Nothealth primarilycare providedin forproviding the conveniencemost appropriate course of treatment for the patient in order to prevent, delay or providerlessen the magnitude of an adverse health care;outcome.

(4) Required to improve a specific health condition of a patient or to preserve the existing state of health of the patient;

and (5) The most clinically appropriate level of health care that may be safely provided to the patient.

(1)- Informed82nd bySession a(2023) systemic– review19 of– evidence and an assessment of the risks and benefits of alternative options for care;

- *AB155_R1* – 19 – (g) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

1.hospital or medical service corporation that issues a policy of health insurance shall include in the policy coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of cancer when such biomarker testing is supported by medical and scientific evidence.

Subject to the limitations prescribed by subsection 4, a hospital or medical service corporation that issues a policy of health insurance shall include in the policy coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of a disease or condition when such biomarker testing is supported by medical and scientific evidence.

or (d)consensus Nationallystatements.ognized recognized clinical practice guidelines or consensus2. statements.

2.

(1) Request an exception to a policy excluding coverage for biomarker testing;testing for the diagnosis, treatment, management or ongoing monitoring of cancer;

or - 82nd Session (2023) – 20 – (2) Appeal a denial of coverage for such biomarker testing;

and (c) Make the process described in paragraph (b) available on an Internet website maintained by the hospital or medical service corporation.cor3.ratIf a hospital or medical service corporation requires an insured to obtain prior authorization for a biomarker test described in subsection 1, the hospital or medical service corporation shall respond to a request for such prior authorization:

3.

If a hospital or medical service corporation requires an insured to obtain prior authorization for a biomarker test described in subsection 1, the hospital or medical service corporation shall respond to a request for such prior authorization:

- *AB155_R1* – 20 – (b) Conducted by a provider of health care for whom the biomarker testing is not within his or her scope of practice, training and experience;

or (d) That has not been determined to be medically necessary by a provider of health care for whom such a determination is within his or her scope of practice, training and experience;experience.

or (e) Where a more cost-effective test is equally capable of meeting the medical needs of the insured.

A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2023, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal which is in conflict with the provisions of this section is void.

(b) “Biomarker testing” means the analysis of the tissue, blood or other biospecimen of a patient for the presentation of a biomarker and includes, without limitation, single-analyte tests, multiplex- panel82nd testsSession and(2023) whole– genome,21 whole– exome and whole transcriptome sequencing.

whole genome, whole exome and whole (c) “Consensus statement” means a statement aimed at a specific clinical circumstance that is:

- *AB155_R1* – 21 – (1) Provided in accordance with generally accepted standards of medical practice;

(2)patient Clinicallyor appropriateprovider withof regardhealth tocare; type, frequency, extent, location and duration;

ande convenience of the (3) NotSignificant primarilyin providedguiding forand informing the convenienceprovider of health care in providing the most appropriate course of treatment for the patient in order to prevent, delay or providerlessen the magnitude of an adverse health care;outcome.

(4) Required to improve a specific health condition of a patient or to preserve the existing state of health of the patient;

and (5) The most clinically appropriate level of health care that may be safely provided to the patient.

and (2) Developed using a transparent methodology and reporting procedure by an independent organization or society of medical professionals that has established a policy to avoid conflictscon(f) “Network plan” means a policy of interest.health insurance offered by a hospital or medical service 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 service corporation.

(f) “Network plan” means a policy of health insurance offered by a hospital or medical service 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 service corporation.

- 82nd Session (2023) – 22 – Sec.

Subject to the limitations prescribed by subsection 4, a health maintenance organization that issues a health care plan shall include in the plan coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of acancer disease or condition when such biomarker testing is supported by medical and scientific evidence.

- *AB155_R1* – 22 – (b) The indicated tests for a drug that has been approved by the United States Food and Drug Administration or the warnings and precautions included on the label of such a drug;

(1) Request an exception to a policy excluding coverage for biomarker testing for the diagnosis, treatment, management or ongoin(2) Appeal a denial of coverage for such biomarker testing;

or (2) Appeal a denial of coverage for biomarker testing;

(b)- Conducted82nd bySession a(2023) provider– of23 health– care for whom the biomarker testing is not within his or her scope of practice, training and experience;

or (d) That has not been determined to be medically necessary by a provider of health care for whom such a determination is within his or her scope of practice, training and experience;experience.

or (e) Where a more cost-effective test is equally capable of meeting the medical needs of the enrollee.

- *AB155_R1* – 23 – 6.

(a) “Biomarker” means a characteristic that is objectively measured and evaluated as an indicator of a normal biological process, a pathogenic process or a pharmacological response to a specific therapeutic intervention and includes, without limitation:

(2) Made by an independent, multidisciplinary panel of expertsexpert(3) thatBased hason establishedscientific aevidence; policy to avoid conflicts of interest;

(3)andoid Basedconflicts onof scientificinterest; evidence;

and (4) Made using a transparent methodology and reporting procedure.

- 82nd Session (2023) – 24 – (2) ClinicallyNot appropriateprimarily withprovided regardfor tothe type,convenience frequency,of extent,the locationpatient andor duration;provider of health care;

and (3) NotSignificant primarilyin providedguiding forand informing the convenienceprovider of health care in providing the patientmost orappropriate providercourse of treatment of an adverse health care;outcome.revent, delay or lessen the magnitude (e) “Nationally recognized clinical practice guidelines” means evidence-based guidelines establishing standards of care that include, without limitation, recommendations intended to optimize care of patients and are:

(4) Required to improve a specific health condition of a patient or to preserve the existing state of health of the patient;

and (5) The most clinically appropriate level of health care that may be safely provided to the patient.

(e) “Nationally recognized clinical practice guidelines” means evidence-based guidelines establishing standards of care that include, without limitation, recommendations intended to optimize care of patients and are:

and - *AB155_R1* – 24 – (2) Developed using a transparent methodology and reporting procedure by an independent organization or society of medical professionals that has established a policy to avoid conflicts of interest.

695C.050in 1.specific provisions of this title, the provisions of this title are not applicable to any health maintenance organization granted a certificate of authority under this chapter.

Except as otherwise provided in this chapter or in specific provisions of this title, the provisions of this title are not applicable to any health maintenance organization granted a certificate of authority under this chapter.

The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to - 82nd Session (2023) – 25 – 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.1759, 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 ProgramProgramaid or pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services.

The provisions of NRS 695C.1694 to 695C.1698, inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17333, 695C.17345, 695C.17347, 695C.1735, 695C.1737, 695C.1743, 695C.1745 and 695C.1757 and section 24 of this act apply to a - *AB155_R1* – 25 – health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.

(a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;

(e)- The82nd healthSession maintenance(2023) organization– is26 no– longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;

- *AB155_R1* – 26 – (i) The continued operation of the health maintenance organization would be hazardous to its enrollees or creditors or to the general public;

If the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and shall conduct no further business except as may bebend up its essential to the orderly conclusion of the affairs of the organization.

Sec.- 82nd Session (2023) – 27 – thereto a new section to read as follows:

27.amended by adding 1.

ChapterSubject 695Gto ofthe NRSlimitations isprescribed herebyby amendedsubsection by4, addinga theretomanaged care organization that issues a newhealth sectioncare toplan readshall asinclude follows:in the plan coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of cancer when such biomarker testing is supported by medical and scientific evidence.

1.

Subject to the limitations prescribed by subsection 4, a managed care organization that issues a health care plan shall include in the plan coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of a disease or condition when such biomarker testing is supported by medical and scientific evidence.

- *AB155_R1* – 27 – 2.

(1) Request an exception to a policy excluding coverage for biomarker testing;testing for the diagnosis, treatment, management or ongoing monitoring of cancer;

or (2) Appeal a denial of coverage for such biomarker testing;

If a managed care organization requires an insured to obtain prior authorization for a biomarker test described in subsection 1, the managed care organization shall respond to a request for such prior authorization:

(b)- Conducted82nd bySession a(2023) provider– of28 health– care for whom the biomarker testing is not within his or her scope of practice, training and experience;

or (d) That has not been determined to be medically necessary by a provider of health care for whom such a determination is within his or her scope of practice, training and experience;experience.

or (e) Where a more cost-effective test is equally capable of meeting the medical needs of the insured.

(a) “Biomarker” means a characteristic that is objectively measured and evaluated as an indicator of a normal biological process, a pathogenic process or a pharmacological response to a specific therapeutic intervention and includes, without limitation:

- *AB155_R1* – 28 – (b) “Biomarker testing” means the analysis of the tissue, blood or other biospecimen of a patient for the presentation of a biomarker and includes, without limitation, single-analyte tests, multiplex panel tests and whole genome, whole exome and whole transcriptome sequencing.

(2) Made by an independent, multidisciplinary panel of expertsexpert(3) thatBased hason establishedscientific aevidence; policy to avoid conflicts of interest;

(3)andoid Basedconflicts onof scientificinterest; evidence;

and (4) Made using a transparent methodology and reporting procedure.

(2)- Clinically82nd appropriateSession with(2023) regard– to29 type,– frequency,patient extent,or locationprovider andof duration;health care;

ande convenience of the (3) NotSignificant primarilyin providedguiding forand informing the convenienceprovider of health care in providing the most appropriate course of treatment for the patient in order to prevent, delay or providerlessen the magnitude of an adverse health care;outcome.

(4) Required to improve a specific health condition of a patient or to preserve the existing state of health of the patient;

and (5) The most clinically appropriate level of health care that may be safely provided to the patient.

(f) “Network plan” means a health care plan offered by a managed care organization under which the financing andandby a 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 managed care - *AB155_R1* – 29 – organization.

28.

(Deleted by amendment.) Sec.

28.5.

1.

There is hereby appropriated from the State General Fund to the Division of Health Care Financing and Policy of the Department of Health and Human Services the sum of $325,000 for the cost of contracting with a qualified person to determine the cost-effectiveness of providing coverage for biomarker testing under Medicaid for the diagnosis, treatment, than cancer.r ongoing monitoring of diseases or conditions other 2.

Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after June 30, 2025, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently - 82nd Session (2023) – 30 – granted or transferred, and must be reverted to the State General Fund on or before September 19, 2025.

3.

Expenditure of $325,000 not appropriated from the State General Fund or State Highway Fund is hereby authorized during of Health Care Financing and Policy of the Department of Health and Human Services for the same purpose as set forth in subsection 1.

4.

As used in this section:

(a) “Biomarker” means a characteristic that is objectively measured and evaluated as an indicator of a normal biological process, a pathogenic process or a pharmacological response to a specific therapeutic intervention and includes, without limitation:

(1) An interaction between a gene and a drug that is being used by or considered for use by the patient;

(2) A mutation or characteristic of a gene;

and (3) The expression of a protein.

(b) “Biomarker testing” means the analysis of the tissue, blood or other biospecimen of a patient for the presentation of a biomarker and includes, without limitation, single-analyte tests, multiplex panel tests and whole genome, whole exome and whole transcriptome sequencing.

Sec.

29.5.

1.

During the 2023-2024 interim, the Joint Interim Standing Committee on Health and Human Services, in coordination with the Department of Health and Human Services, shall study the cost-effectiveness of biomarker testing, including, without lim(a) For the diagnosis, treatment, management or ongoing monitoring of specific diseases or conditions;

and (b) To screen for specific diseases or conditions or traits associated with specific diseases or conditions.

2.

The Joint Interim Standing Committee on Health and Human Services shall submit a report of the results of the study, including any recommendations for legislation to the Director of the Legislative Counsel Bureau for transmission to the 83rd Session of the Nevada Legislature.

3.

As used in this section:

(a) “Biomarker” means a characteristic that is objectively measured and evaluated as an indicator of a normal biological process, a pathogenic process or a pharmacological response to a specific therapeutic intervention and includes, without limitation:

- 82nd Session (2023) – 31 – (1) An interaction between a gene and a drug that is being used by or considered for use by the patient;

(2) A mutation or characteristic of a gene;

and (3) The expression of a protein.

or other biospecimen of a patient for the presentation of a biomarker and includes, without limitation, single-analyte tests, multiplex panel tests and whole genome, whole exome and whole transcriptome sequencing.

Sec.

Sections 1 to 10, inclusive, 12, and 28 andto 2929.5, inclusive, of this act become effective on July 1, 2023.

H~~~~~ 23 - *AB155_R1*82nd Session (2023)