AB 85 — Establishes procedures to fix rates for certain health care goods and services. (BDR 40-169)

All rates fixed by the Independent CommissionCommission: are in force, and are prima facie lawful, from the date of the order until 1 year after that date.

-(a) *AB85*Must –be 8in –a 6.form described in paragraph (b) of subsection 2 of section 9 of this act;

and (b) Are in force, and are prima facie lawful, from the date of the order until 1 year after that date.

6.

11.5.

On or before July 30 of each even-numbered year, the Independent Commission shall:

1.

Review and study the impacts of the provisions of sections 2 to 13, inclusive, of this act;

2.

Compile a report with a summary of such information and any recommendations of the Independent Commission relating to the provisions of sections 2 to 13, inclusive, of this act;

and 3 Submit the report compiled pursuant to subsection 2 to the Director of the Legislative Counsel Bureau for transmittal to the Joint Interim Standing Committee on Health and Human Services.

Sec.

- *AB85_R1* – 9 – Sec.

- *AB85* – 9 – (a) Damages resulting from such failure;

NRS(Deleted 439B.260by isamendment.) herebySec. amended to read as follows:

439B.260 1.

A major hospital shall reduce or discount the total billed charge by at least 30 percent for hospital services , other than services subject to the provisions of sections 2 to 13, inclusive, of this act, provided to an inpatient who:

(a) Has no policy of health insurance or other contractual agreement with a third party that provides health coverage for the charge;

(b) Is not eligible for coverage by a state or federal program of public assistance that would provide for the payment of the charge;

and (c) Makes reasonable arrangements within 30 days after the date that notice was sent pursuant to subsection 2 to pay the hospital bill.

2.

A major hospital shall include on or with the first statement of the hospital bill provided to the patient after his or her discharge a notice of [the] any reduction or discount available pursuant to this section, including, without limitation, notice of the criteria a patient must satisfy to qualify for a reduction or discount.

3.

A major hospital or patient who disputes the reasonableness of arrangements made pursuant to paragraph (c) of subsection 1 may submit the dispute to the Bureau for Hospital Patients for resolution as provided in NRS 232.462.

4.

A major hospital shall reduce or discount the total billed charge of its outpatient pharmacy by at least 30 percent to a patient who is eligible for Medicare.

5.

As used in this section, “third party” means:

(a) An insurer, as that term is defined in NRS 679B.540;

(b) A health benefit plan, as that term is defined in NRS 687B.470, for employees which provides coverage for services and care at a hospital;

(c) A participating public agency, as that term is defined in NRS 287.04052, and any other local governmental agency of the State of Nevada which provides a system of health insurance for the benefit of its officers and employees, and the dependents of officers and employees, pursuant to chapter 287 of NRS;

or (d) Any other insurer or organization providing health coverage or benefits in accordance with state or federal law.

 The term does not include an insurer that provides coverage under a policy of casualty or property insurance.

Sec.

A hospital may not use a billed - *AB85* – 10 – charge for an inpatient that is different than the billed charge used for another inpatient for the same service or goods provided.

NRS(Deleted 439B.727by isamendment.) herebySec. amended to read as follows:

439B.727 “Provider of health care” has the meaning ascribed to it in NRS 695G.070 [.] , except that the term does not include a health care facility, as defined in section 4 of this act.

Sec.

439B.742 The provisions of NRS 439B.745 [andand 439B.748]439B.748 do not apply to [::

A]A a person who is covered by a policy of health insurance that was sold outside this StateState; .

[;[or] 3.

orAny 3.health care services provided more than 24 hours after notification is provided pursuant to NRS 439B.745 that a person has been stabilized [.] ;

Anyor health- care*AB85_R1* services– provided10 more– than4. 24 hours after notification is provided pursuant to NRS 439B.745 that a person has been stabilized.] Sec.

Any goods or services subject to the provisions of sections 2 to 13, inclusive, of this act.

Sec.

NRS(Deleted 439B.745by isamendment.) herebySec. amended to read as follows:

439B.745 [1.] An out-of-network provider shall not collect from a covered person for medically necessary emergency services, and a covered person is not responsible for paying, an amount that exceeds the copayment, coinsurance or deductible required for such services provided by an in-network provider by the coverage for that person.

[2.

An out-of-network emergency facility that provides medically necessary emergency services to a covered person shall:

(a) When possible, notify the third party that provides coverage for the covered person not later than 8 hours after the covered person presents at the out-of-network emergency facility to receive medically necessary emergency services;

and (b) Notify the third party that the condition of the covered person has stabilized to such a degree that the person may be transferred to an in-network emergency facility not later than 24 hours after the person’s emergency medical condition is stabilized.

Not later than 24 hours after the third party receives such notice, the third party shall arrange for the transfer of the person to such a facility.] - *AB85* – 11 – Sec.

NRS(Deleted 439B.751by isamendment.) herebySec. amended to read as follows:

439B.751 1.

If an out-of-network provider [, other than an out-of-network emergency facility,] had a provider contract as an in- network provider within the 12 months immediately preceding the date on which the medically necessary emergency services were rendered to a covered person and:

(a) The out-of-network provider terminated the most recent applicable provider contract between the third party that provides coverage for the covered person and the out-of-network provider without cause before it was scheduled to expire, the third party shall pay to the out-of-network provider for those services, and the out- of-network provider shall accept as payment in full for those services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider, the amount that would have been paid for those services pursuant to that provider contract, less the amount of the copayment, coinsurance or deductible, if applicable.

(b) The out-of-network provider terminated the most recent applicable provider contract between the third party that provides coverage for the covered person and the out-of-network provider for cause before it was scheduled to expire or the third party terminated the contract without cause, the third party shall pay to the out-of- network provider for those services, and the out-of-network provider shall accept as payment in full for those services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in- network provider, 108 percent of the amount that would have been paid for those services pursuant to the provider contract, less the amount of the copayment, coinsurance or deductible, if applicable.

(c) The third party that provides coverage for the covered person terminated the most recent applicable provider contract between the third party and the out-of-network provider for cause before it was scheduled to expire, the third party shall pay to the out-of-network provider an amount that the third party has determined to be fair and reasonable as payment for the medically necessary emergency services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider.

(d) The contract was not terminated by either party, the third party that provides coverage for the covered person shall pay to the out-of-network provider for those services, and the out-of-network provider shall accept as payment in full for those services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided - *AB85* – 12 – by an in-network provider, the amount that would have been paid for those services pursuant to the most recent applicable provider contract between the third party and the out-of-network provider plus an amount equal to the percentage of increase in the Consumer Price Index, Medical Care Component, during the immediately preceding calendar year, less the amount of the copayment, coinsurance or deductible, if applicable.

2.

If an out-of-network provider [, other than an out-of-network emergency facility,] did not have a provider contract as an in- network provider within the 12 months immediately preceding the date on which the medically necessary emergency services were rendered to a covered person, the third party that provides coverage to the covered person shall submit to the out-of-network provider an offer of payment in full for the medically necessary emergency services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider.

Sec.

NRS(Deleted 439B.754by isamendment.) herebySec. amended to read as follows:

439B.754 1.

An out-of-network provider shall accept or reject an amount paid pursuant to [subsection 2 of NRS 439B.748 or] paragraph (c) of subsection 1 or subsection 2 of NRS 439B.751 as payment in full for the medically necessary emergency services for which the payment was offered within 30 days after receiving the payment.

If an out-of-network provider fails to comply with the requirements of this section, the amount paid shall be deemed accepted as payment in full for the medically necessary emergency services for which the payment was offered 30 days after the out-of- network provider received the payment.

2.

If an out-of-network provider rejects the amount paid as payment in full, the out-of-network provider must request from the third party an additional amount which, when combined with the amount previously paid, the out-of-network provider is willing to accept as payment in full for the medically necessary emergency services.

3.

If the third party refuses to pay the additional amount requested by the out-of-network provider pursuant to subsection 2 or fails to pay that amount within 30 days after receiving the request for the additional amount, the out-of-network provider must request a list of five randomly selected arbitrators from an entity authorized by regulations of the Director of the Department to provide such arbitrators.

Such regulations must require:

(a) For claims of less than $5,000, the use of arbitrators who will conduct the arbitration in an economically efficient manner.

Such arbitrators may include, without limitation, qualified employees of the State and arbitrators from the voluntary program for the use of - *AB85* – 13 – binding arbitration established in the judicial district pursuant to NRS 38.255 or, if no such program has been established in the judicial district, from the program established in the nearest judicial district that has established such a program.

(b) For claims of $5,000 or more, the use of arbitrators from nationally recognized providers of arbitration services, which may include, without limitation, the American Arbitration Association, JAMS or their successor organizations.

4.

Upon receiving the list of randomly selected arbitrators pursuant to subsection 3, the out-of-network provider and the third party shall each strike two arbitrators from the list.

If one arbitrator remains, that arbitrator must arbitrate the dispute concerning the amount to be paid for the medically necessary emergency services.

If more than one arbitrator remains, an arbitrator randomly selected from the remaining arbitrators by the entity that provided the list of arbitrators pursuant to subsection 3 must arbitrate that dispute.

5.

The out-of-network provider and the third party shall participate in binding arbitration of the dispute concerning the amount to be paid for the medically necessary emergency services conducted by the arbitrator selected pursuant to subsection 4.

The out-of-network provider or third party may provide the arbitrator with any relevant information to assist the arbitrator in making a determination.

6.

The arbitrator shall require:

(a) The out-of-network provider to accept as payment in full for the provision of the medically necessary emergency services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider, the amount paid by the third party pursuant to [subsection 2 of NRS 439B.748 or] paragraph (c) of subsection 1 or subsection 2 of NRS 439B.751, as applicable;

or (b) The third party to pay the additional amount requested by the out-of-network provider pursuant to subsection 2.

7.

If the arbitrator requires:

(a) The out-of-network provider to accept the amount paid by the third party pursuant to [subsection 2 of NRS 439B.748 or] paragraph (c) of subsection 1 or subsection 2 of NRS 439B.751, as applicable, as payment in full for the provision of the medically necessary emergency services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider, the out-of-network provider must pay the costs of the arbitrator.

- *AB85* – 14 – (b) The third party to pay the additional amount requested by the out-of-network provider pursuant to subsection 2, the third party must pay the costs of the arbitrator.

8.

An out-of-network provider or a third party must pay its own attorney’s fees incurred during the process prescribed by this section.

9.

Interest does not accrue on any claim for which an offer of payment is rejected pursuant to subsection 1 for the period beginning on the date of the rejection and ending 30 days after the arbitrator renders a decision.

10.

Except as otherwise provided in this subsection and NRS 439B.760, any decision of an arbitrator pursuant to this section and any documents associated with such a decision are confidential and are not admissible as evidence during a legal proceeding, including, without limitation, a legal proceeding between the third party and the out-of-network provider.

The decision of an arbitrator and any documents associated with such a decision may be disclosed and are admissible as evidence during a legal proceeding to enforce the decision.

Sec.

- *AB85* – 15 – (h) Failure to comply with the provisions of sections 2 to 13, inclusive, of this act, any regulations adopted pursuant thereto or any order issued pursuant thereto.

- *AB85_R1* – 11 – 3.

- *AB85* – 16 – 3.

- *AB85_R1* – 12 – (e) A written disclosure approved by the Director of the Department of Health and Human Services, which written disclosure must set forth:

The notice required by this subparagraph must describe the criteria a patient must satisfy to qualify for the additional reduction or discount, including, without limitation, any relevant - *AB85* – 17 – limitations on income and any relevant requirements as to the period within which the patient must arrange to make payment.

In addition to the requirements of subsections 1 to 4, inclusive, every hospital shall post in a conspicuous place in each - *AB85_R1* – 13 – public waiting room in the hospital a legible sign or notice in 14- point type or larger, which sign or notice must:

- *AB85* – 18 – 3.

- *AB85_R1* – 14 – Sec.

24.23.5.

NRS 689A.041287.0434 is hereby amended to read as follows:

689A.041287.0434 1.The Board may:

A1. policy of health insurance which provides coverage for the surgical procedure known as a mastectomy must also provide commensurate coverage for:

(a)Use Reconstructionits ofassets only to pay the breastexpenses onof whichhealth thecare mastectomyfor hasits beenmembers performed;and covered dependents, to pay its employees’ salaries and to pay administrative and other expenses.

(b) Surgery and reconstruction of the other breast to produce a symmetrical structure;

and (c) Prostheses and physical complications for all stages of mastectomy, including lymphedemas.

TheEnter provisioninto ofcontracts servicesrelating mustto bethe determinedadministration byof the attendingProgram, physicianincluding, without limitation, contracts with licensed administrators and thequalified patient.actuaries.

Each such contract with a licensed administrator:

(a) Must be submitted to the Commissioner of Insurance not less than 30 days before the date on which the contract is to become effective for approval as to the licensing and fiscal status of the licensed administrator and status of any legal or administrative actions in this State against the licensed administrator that may impair his or her ability to provide the services in the contract.

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

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

TheEnter planinto orcontracts issuerwith mayphysicians, requiresurgeons, deductibleshospitals, health maintenance organizations and coinsurancerehabilitative paymentsfacilities iffor theymedical, aresurgical consistentand withrehabilitative thosecare establishedand forthe otherevaluation, benefits.treatment and nursing care of members and covered dependents.

4.The Board shall not enter into a contract pursuant to this subsection unless:

Written(a) noticeProvision ofis made by the availabilityBoard ofto offer all the coverageservices mustspecified bein giventhe uponrequest enrollmentfor andproposals, annuallyeither thereafter.by a health maintenance organization or through separate action of the Board.

(b) The noticerates mustset beforth sentin the contract for goods and services not subject to allthe participants:provisions of sections 2 to 13, inclusive, of this act are based on:

(a)(1) InFor theactive nextand mailingretired madestate byofficers and employees and their dependents, the plancommingled orclaims issuerexperience toof such active and retired officers and employees and their dependents for whom the participantProgram orprovides beneficiary;primary health insurance coverage in a single risk pool;

orand (b)(2) AsFor partactive and retired officers and employees of anypublic annualagencies informationenumerated packetin sentNRS 287.010 that contract with the Program to obtain group insurance by participation in the participantProgram orand beneficiary,their dependents, whicheverthe iscommingled earlier.claims experience of such active and retired officers and employees and their dependents for whom the Program provides primary health insurance coverage in a single risk pool.

- *AB85_R1* – 15 – 4.

Enter into contracts for the services of other experts and specialists as required by the Program.

ACharge planand collect from an insurer, health maintenance organization, organization for dental care or issuernonprofit maymedical not:service corporation, a fee for the actual expenses incurred by the Board or a participating public agency in administering a plan of insurance offered by that insurer, organization or corporation.

(a) Deny eligibility, or continued eligibility, to enroll or renew coverage, in order to avoid the requirements of subsections 1 to 4, inclusive;

or (b) Penalize, or limit reimbursement to, a provider of care, or provide incentives to a provider of care, in order to induce the - *AB85* – 19 – provider not to provide the care listed in subsections 1 to 4, inclusive.

[A]Charge Exceptand ascollect otherwisethe providedamount indue sectionfrom 8local ofgovernments thispursuant act,to aparagraph plan(b) or issuer may negotiate rates of reimbursementsubsection with4 providers of care.NRS 287.023.

7.If the payment of a local government pursuant to that provision is delinquent by more than 90 days, the Board shall notify the Executive Director of the Department of Taxation pursuant to NRS 354.671.

If reconstructive surgery is begun within 3 years after a mastectomy, the amount of the benefits for that surgery must equal the amounts provided for in the policy at the time of the mastectomy.

If the surgery is begun more than 3 years after the mastectomy, the benefits provided are subject to all of the terms, conditions and exclusions contained in the policy at the time of the reconstructive surgery.

8.

A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 1, 2001, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.

9.

For the purposes of this section, “reconstructive surgery” means a surgical procedure performed following a mastectomy on one breast or both breasts to re-establish symmetry between the two breasts.

The term includes augmentation mammoplasty, reduction mammoplasty and mastopexy.

24.

(Deleted by amendment.) Sec.

NRS(Deleted 689B.0375by isamendment.) herebySec. amended to read as follows:

689B.037526. 1.

A(Deleted policyby ofamendment.) groupSec. health insurance which provides coverage for the surgical procedure known as a mastectomy must also provide commensurate coverage for:

(a)27. Reconstruction of the breast on which the mastectomy has been performed;

(b)(Deleted Surgeryby andamendment.) reconstructionSec. of the other breast to produce a symmetrical structure;

and27.3. (c) Prostheses and physical complications for all stages of mastectomy, including lymphedemas.

NRS 695K.200 is hereby amended to read as follows:

695K.200 1.

The Director, in consultation with the Commissioner and the Executive Director of the Exchange, shall design, establish and operate a health benefit plan known as the Public Option.

The provisionDirector: of services must be determined by the attending physician and the patient.

(a) Shall make the Public Option available:

(1) As a qualified health plan through the Exchange to natural persons who reside in this State and are eligible to enroll in such a plan through the Exchange under the provisions of 45 C.F.R.

§ 155.305;

and (2) For direct purchase as a policy of individual health insurance by any natural person who resides in this State.

The provisions of chapter 689A of NRS and other applicable provisions of this title , except for any provisions authorizing an insurer to negotiate with providers of goods and services subject to the provisions of sections 2 to 13, inclusive, of this act, apply to the Public Option when offered as a policy of individual health insurance.

(b) May make the Public Option available to small employers in this State or their employees to the extent authorized by federal law.

The provisions of chapter 689C of NRS and other applicable provisions of this title , except for any provisions authorizing a carrier to negotiate with providers of goods and services subject to the provisions of sections 2 to 13, inclusive, of this act, apply to the Public Option when it is offered as a policy of health insurance for small employers.

- *AB85_R1* – 16 – (c) Shall comply with all state and federal laws and regulations applicable to insurers when carrying out the provisions of this chapter, to the extent that such laws and regulations are not waived.

The planPublic orOption issuermust: may require deductibles and coinsurance payments if they are consistent with those established for other benefits.

(a) Be a qualified health plan, as defined in 42 U.S.C.

§ 18021;

and (b) Provide at least levels of coverage consistent with the actuarial value of one silver plan and one gold plan.

WrittenExcept noticeas ofotherwise theprovided availabilityin ofthis section, the coveragepremiums mustfor bethe givenPublic uponOption: enrollment and annually thereafter.

The(a) noticeMust must be sentat toleast all5 participants:percent lower than the reference premium for that zip code;

(a)and In(b) theMust nextnot mailingincrease madein any year by thea planpercentage orgreater issuerthan tothe increase in the participantMedicare orEconomic beneficiary;Index for that year.

or - *AB85* – 20 – (b) As part of any annual information packet sent to the participant or beneficiary,  whichever is earlier.

AThe planDirector, orin issuerconsultation with the Commissioner and the Executive Director of the Exchange, may not:revise the requirements of subsection 4, provided that the average premiums for the Public Option must be at least 15 percent lower than the average reference premium in this State over the first 4 years in which the Public Option is in operation.

(a) Deny eligibility, or continued eligibility, to enroll or renew coverage, in order to avoid the requirements of subsections 1 to 4, inclusive;

or (b) Penalize, or limit reimbursement to, a provider of care, or provide incentives to a provider of care, in order to induce the provider not to provide the care listed in subsections 1 to 4, inclusive.

[A]As Exceptused as otherwise provided in section 8 of this act,section: a plan or issuer may negotiate rates of reimbursement with providers of care.

7.(a) “Carrier” has the meaning ascribed to it in NRS 689C.025.

If(b) reconstructive“Gold surgeryplan” ismeans begun within 3 years after a mastectomy,qualified thehealth amountplan of the benefits for that surgerymeets must equal those amounts provided for in the policyrequirements atestablished theby time42 ofU.S.C. the mastectomy.

If§ the18022 surgeryfor isa begungold morelevel thanplan. 3 years after the mastectomy, the benefits provided are subject to all of the terms, conditions and exclusions contained in the policy at the time of the reconstructive surgery.

8.[(b)] (c) “Health benefit plan” means a policy, contract, certificate or agreement to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.

A[(c)] policy(d) subject“Medicare toEconomic theIndex” provisionsmeans ofthe thisMedicare chapterEconomic whichIndex, isas delivered,designated issuedby for delivery or renewed on or after October 1, 2001, has the legalCenters effectfor ofMedicare including the coverage required by this section, and anyMedicaid provisionServices of the policyUnited orStates theDepartment renewalof whichHealth isand inHuman conflictServices withpursuant thisto section42 isC.F.R. void.

9.§ 405.504.

For[(d)] the(e) purposes“Reference ofpremium” thismeans, section,for “reconstructiveany surgery”zip meanscode, a surgical procedure performed following a mastectomy on one breast or both breasts to re-establish symmetry between the twolower breasts.of:

(1) The termpremium includesfor augmentationthe mammoplasty,second-lowest reductioncost mammoplastysilver level plan available through the Exchange in the zip code during the 2024 plan year, adjusted by the percentage change in the Medicare Economic Index between January 1, 2024, and mastopexy.January 1 of the year to which a premium applies;

or (2) The premium for the second-lowest cost silver level plan available through the Exchange in the zip code during the year immediately preceding the year to which a premium applies.

[(e)] (f) “Silver plan” means a qualified health plan that meets the requirements established by 42 U.S.C.

§ 18022 for a silver level plan.

- *AB85_R1* – 17 – [(f)] (g) “Small employer” has the meaning ascribed to it in 42 U.S.C.

§ 18024(b)(2).

26.27.4.

NRS 695B.191695K.240 is hereby amended to read as follows:

695B.191695K.240 1.

AIn policyestablishing ofnetworks healthfor insurance,the issuedPublic byOption aand medicalreimbursing serviceproviders corporation,of whichhealth providescare coveragethat forparticipate in the surgicalPublic procedureOption, knownthe asDirector ashall, mastectomyto mustthe alsoextent providepracticable: commensurate coverage for:

(a) ReconstructionEnsure ofthat care for persons who were previously covered by Medicaid or the breastChildren’s onHealth whichInsurance Program and enroll in the mastectomyPublic hasOption beenis performed;minimally disrupted;

(b) SurgeryEncourage andthe reconstructionuse of thepayment othermodels breastthat toincrease producevalue afor symmetricalpersons structure;enrolled in the Public Option and the State;

and (c) ProsthesesImprove andhealth physicaloutcomes complications for allpersons stagesenrolled ofin mastectomy,the includingPublic lymphedemas.Option;

(d) Reward providers of health care and medical facilities for delivering high-quality services;

and (e) Lower the cost of care in both urban and rural areas of this State.

TheExcept provisionas ofotherwise servicesprovided mustin besubsections determined3 byto 6, inclusive, reimbursement rates under the attendingPublic physicianOption andmust be, in the patient.aggregate, comparable to or better than reimbursement rates available under Medicare.

-For *AB85*the –purposes 21of –this 3.section, the aggregate reimbursement rate under Medicare:

The(a) planIncludes orany issueradd-on may require deductibles and coinsurance payments ifor theyother aresubsidies consistentthat witha thoseprovider establishedreceives forunder otherMedicare; benefits.

and (b) Does not include payments under Medicare for a patient encounter or a cost-based payment rate under Medicare.

3.

If a provider of health care currently receives reimbursement under Medicare at rates that are cost-based, the reimbursement rates for that provider of health care under the Public Option must be comparable to or better than the cost-based reimbursement rates provided for that provider of health care by Medicare.

WrittenThe noticereimbursement ofrates thefor availabilitya offederally-qualified health center or a rural health clinic under the coveragePublic Option must be givencomparable uponto enrollmentor better than the reimbursement rates established for patient encounters under the applicable Prospective Payment System established for Medicare by the Centers for Medicare and annuallyMedicaid thereafter.Services of the United States Department of Health and Human Services.

The notice must be sent to all participants:

(a) In the next mailing made by the plan or issuer to the participant or beneficiary;

or (b) As part of any annual information packet sent to the participant or beneficiary,  whichever is earlier.

AThe planreimbursement rates for a certified community behavioral health clinic under the Public Option must be comparable to or issuerbetter maythan not:the reimbursement rates established for community behavioral health clinics under the State Plan for Medicaid.

(a)- Deny*AB85_R1* eligibility,– or18 continued– eligibility,6. to enroll or renew coverage, in order to avoid the requirements of subsections 1 to 4, inclusive;

orThe (b)requirements Penalize, or limit reimbursement to, a provider of care,subsections or2 provide incentives to a5, providerinclusive, ofdo care,not inapply order to inducea thepayment providermodel notdescribed to provide the care listed in subsectionsparagraph 1(b) toof 4,subsection inclusive.1.

6.

[A] Except as otherwise provided in section 8 of this act, a plan or issuer may negotiate rates of reimbursement with providers of care.

IfThe reconstructiverequirements surgeryof isthis begunsection withindo 3not yearsapply afterto a mastectomy, the amountextent of the benefits for that surgerythey mustconflict equalwith thosethe amountsprovisions providedof forsections in2 theto policy13, atinclusive, the time of thethis mastectomy.act.

If the surgery is begun more than 3 years after the mastectomy, the benefits provided are subject to all of the terms, conditions and exclusions contained in the policy at the time of the reconstructive surgery.

AAs policyused subjectin to the provisions of this chaptersection, which“Medicare” ismeans delivered, issued for delivery or renewed on or after October 1, 2001, has the legalprogram effect of includinghealth theinsurance coveragefor requiredaged bypersons this section, and anypersons provisionwith ofdisabilities theestablished policypursuant orto theTitle renewalXVIII whichof isthe inSocial conflictSecurity withAct, this42 sectionU.S.C. is void.

9.§§ 1395 et seq.

For the purposes of this section, “reconstructive surgery” means a surgical procedure performed following a mastectomy on one breast or both breasts to re-establish symmetry between the two breasts.

The term includes augmentation mammoplasty, reduction mammoplasty and mastopexy.

27.27.5.

NRSSection 695C.1718 of this act is hereby amended to read as follows:

695C.171Sec. 1.

A8. health maintenance plan which provides coverage for the surgical procedure known as a mastectomy must also provide commensurate coverage for:

(a)1. Reconstruction of the breast on which the mastectomy has been performed;

-A *AB85*health –care 22facility –shall (b)charge Surgeryrates andfixed reconstructionin ofaccordance thewith othersections breast2 to produce13, inclusive, of this act for any goods or services described in subsection 2 that are provided to a symmetricalpatient structure;who is covered by the Public Employees’ Benefits Program [.] or the Public Option established pursuant to NRS 695K.200.

and (c) Prostheses and physical complications for all stages of mastectomy, including lymphedemas.

The provisionprovisions of servicessections must2 beto determined13, byinclusive, theof attendingthis physicianact apply to goods and theservices patient.that are reimbursable through Medicare.

As used in this subsection, “reimbursable” means that Medicare provides reimbursement for a good or service when that good or service is provided to a patient who is covered by Medicare.

TheA planhealth care facility shall not provide any person with a discount, incentive or issuerprice mayreduction requireor deductiblesenter andinto coinsuranceany paymentsarrangement ifwhere theythe areeffective consistentamount withpaid thoseto the health care facility for goods or services is different from the rate established for otherthose benefits.goods or services pursuant to sections 2 to 13, inclusive, of this act.

WrittenTo noticethe extent of their applicability, the availabilityprovisions of sections 2 to 13, inclusive, of this act supersede any other provision of law relating to the coveragerates mustcharged beby givena uponhealth enrollmentcare andfacility, annuallyincluding, thereafter.without limitation, provisions requiring or authorizing reduced or discounted rates.

TheSec. notice must be sent to all participants:

(a) In the next mailing made by the plan or issuer to the participant or beneficiary;

or (b) As part of any annual information packet sent to the participant or beneficiary,  whichever is earlier.

5.

A plan or issuer may not:

(a) Deny eligibility, or continued eligibility, to enroll or renew coverage, in order to avoid the requirements of subsections 1 to 4, inclusive;

or (b) Penalize, or limit reimbursement to, a provider of care, or provide incentives to a provider of care, in order to induce the provider not to provide the care listed in subsections 1 to 4, inclusive.

6.

[A] Except as otherwise provided in section 8 of this act, a plan or issuer may negotiate rates of reimbursement with providers of care.

7.

If reconstructive surgery is begun within 3 years after a mastectomy, the amount of the benefits for that surgery must equal those amounts provided for in the policy at the time of the mastectomy.

If the surgery is begun more than 3 years after the mastectomy, the benefits provided are subject to all of the terms, conditions and exclusions contained in the policy at the time of the reconstructive surgery.

8.

A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 1, 2001, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.

9.

For the purposes of this section, “reconstructive surgery” means a surgical procedure performed following a mastectomy on one breast or both breasts to re-establish symmetry between the two breasts.

The term includes, but is not limited to, augmentation mammoplasty, reduction mammoplasty and mastopexy.

- *AB85* – 23 – Sec.

or - *AB85_R1* – 19 – (b) One year after the date on which the regulations adopted pursuant to section 12 of this act become effective.

28.5.

The provisions of subsection 1 of NRS 218D.380 do not apply to any provision of this act which adds or revises a requirement to submit a report to the Legislature.

Sec.

NRS(Deleted 439B.706,by 439B.709,amendment.) 439B.718Sec. and 439B.748 are hereby repealed.

Sec.

Sections 1 to 12, inclusive, 28.5 and 29 of this act become effective:

-4. *AB85* – 24 – LEADLINES OF REPEALED SECTIONS 439B.706 “Independent center for emergency medical care” defined.

439B.718Sections “Out-of-network27.3, emergency27.4 facility”and defined.27.5 of this act becomes effective on January 1, 2026.

439B.748H Payment- to*AB85_R1* out-of-network emergency facility by third party.

H - *AB85*