Nevada 2025 Regular Session Status: Enacted 1 D cosponsors

AB 202 — Revises provisions relating to claims for dental care. (BDR 57-573)

Last action — Chapter 23.

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  1. ✓
    Introduced
  2. ✓
    In Committee
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    Passed Assembly
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced February 03, 2025. Enacted.

Signed by Governor Joe Lombardo (Republican) on May 26, 2025.

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Advancing 52% · moderate confidence

Where this bill stands today.

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High

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  • Enacted

    Current position in the legislative process.

  • 1 sponsor

    1 primary, 0 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (1 D).

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Bill Text

What changed in the latest version

754 added · 799 removed

754 line(s) added, 799 removed.

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(Reprinted with amendments adopted on April 21, 2025) FIRST REPRINT A.B.
Assembly Bill No.
202 ASSEMBLY B ILLN O.
202–Assemblymember Brown-May CHAPTER..........
202–A SSEMBLYMEMBER B ROWN -MAY P REFILED FEBRUARY 3, 2025 ____________ Referred to Committee on Commerce and Labor SUMMARY—Revises provisions relating to claims for dental care.
(BDR 57-573) FISCAL NOTE:
Effect on Local Government:
No.
Effect on the State:
Yes.
~ EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
revising the applicability of certain provisions requiring certain insurers to establish a system of procedures for resolving complaints of insured persons and providing for the external review of an adverse determination to include provide only dental coverage;
revising the applicability of certain provisions requiring certain insurers to establish a system of procedures for resolving complaints of insured persons and providing for the external review of an adverse determination to include certain insurers that issue policies or certificates that provide only dental coverage;
revising the informationhat which a health carrier is required to provide in a notice of an adverse determination;
revising the information which a health carrier is required to provide in a notice of an adverse determination;
- *AB202_R1* – 2 – LegExisting law requires each managed care organization to authorize coverage of a health care service that has been recommended for an insured by a provider of health care acting within the scope of his or her practice if that service is covered by the health care plan of the insured unless the decision not to authorize coverage is made by a physician who satisfies certain conditions.
Legislative Counsel’s Digest:
(NRS 695G.150) Section 2 of this bill provides that a managed care organization is also not required to authorize coverage if the decision not to authorize coverage is made by a dentist who satisfies certain conditions.
Existing law requires each managed care organization to authorize coverage of health care acting within the scope of his or her practice if that service is covered by the health care plan of the insured unless the decision not to authorize coverage is made by a physician who satisfies certain conditions.
procedures for resolving complaints of a person who is insured by a managed careof organization;
(NRS 695G.150) Section 2 of this bill provides that a managed care organization is also not required to authorize coverage if the decision not to authorize coverage is made by a dentist whoExisting law:
(1) requires a managed care organization to establish a system of procedures for resolving complaints of a person who is insured by a managed care organization;
(NRS 695G.200-695G.310) The requirement for the establishment of a system of procedures for resolving complaints and the provisions setting forth procedures for the external review of an adverse determination also apply to insurers that issue certain policies, plans, contracts and coverage for health insurance in this State that provide, deliver, arrange for, pay for or reimburse costs of health care through managed care, including:
(NRS 695G.200-695G.310) The requirement for the establishment of a system of procedures for resolving complaints and the provisions setting forth procedures for the external review of an adverse coverage for health insurance in this State that provide, deliver, arrange for, pay for or reimburse costs of health care through managed care, including:
(1) certain health insurance provided through a plan of self-insurance for officers and (4) health benefit plans of small employers;
(1) certain health insurance provided through a plan of self-insurance for officers and employees of this State;
(5) contracts for hospital or medicalce;
(2) individual health insurance;
services;
(3) group health insurance;
(4) health benefit plans of small employers;
(5) contracts for hospital or medical - 83rd Session (2025) – 2 – services;
(NRS 695G.243) Section 3 of this bill provides that the requirement for the establishment of a system of procedures for resolving complaints and the provisions setting forth procedures for the external review of an adverse determination apply to a policy or certificate that provides only dental covExisting law requires a health carrier to notify certain persons, including a covered person and his or her treating physician, of:
(NRS 695G.243) Section 3 of this bill provides that the requirement for the establishment of a system of procedures for resolving adverse determination apply to a policy or certificate that provides only dentalf an coverage.
Existing law requires a health carrier to notify certain persons, including a covered person and his or her treating physician, of:
authorized representative to submit a request to the Office for Consumer Health an Assistance in the Department of Health and Human Services for an external review of an adverse determination.
Existing law authorizes a covered person, a physician of a covered person or an authorized representative to submit a request to the Office for Consumer Health Assistance in the Department of Health and Human Services for an external review of an adverse determination.
Existing law requires an independent review organization that receives a request for an external review to:
request for an external review to:
and (3) notify the covered covered person and the health carrier of its determination and reasons therefor.e (NRS 695G.261) Section 6 of this bill requires the independent review organization to also:
and (3) notify the covered person, the physician of the covered person, the authorized representative of the covered person and the health carrier of its determination and reasons therefor.
(NRS 695G.261) Section 6 of this bill requires the independent review organization to also:
(2) forward to the health carrier any information - *AB202_R1* – 3 – received from the dentist of a covered person;
(2) forward to the health carrier any information received from the dentist of a covered person;
Existing law requires an independent review organization to notify a covered person, the physician of the covered person, the authorized representative, if any, review.
Existing law requires an independent review organization to notify a covered person, the physician of the covered person, the authorized representative, if any, and the health carrier by telephone and in writing after completing its external review.
(NRS 695G.271) Section 7 of this bill requires an independent reviewrnal organization to notify the dentist of a covered person, if applicable.
(NRS 695G.271) Section 7 of this bill requires an independent review organization to notify the dentist of a covered person, if applicable.
Existing law sets forth the process by which an external review of an adverse determination must be conducted.
Existing law sets forth the process by which an external review of an adverse provisions setting forth that process to provide a covered person’s treating dentist with the same powers and duties with respect to that process as a covered person’s treating physician.
(NRS 695G.275) Section 8 of this bill revises provisions setting forth that process to provide a covered person’s treating dentist with the same powers and duties with respect to that process as a covered person’s treExisting law requires the decision of an independent review organization concerning a request for an external review to be based, in part, on documentary evidence, including any recommendation of the physician of the insured.
Existing law requires the decision of an independent review organization concerning a request for an external review to be based, in part, on documentary evidence, including any recommendation of the physician of the insured.
Existing law provides a clinical peer who conducts or participates in an external relating to the external review under certain circumstances.
Existing law provides a clinical peer who conducts or participates in an external review of an adverse determination immunity from liability for certain damages relating to the external review under certain circumstances.
(NRS 695G.290)ges Section 1 of this bill revises the definition of “clinical peer” to include certain dentists.
(NRS 695G.290) - 83rd Session (2025) – 3 – dentists.
of this bill revises the definition of “clinical peer” to include certain EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
[1.] (a) Engaged in the practice of medicine;
[2.] (b) Certified or is eligible for certification by a member board of the American Board of Medical Specialties in the same or similar area of practice as is the health care service that is the subject of a final adverse determination [.] ;
and [2.] (b) Certified or is eligible for certification by a member board of the American Board of Medical Specialties in the same or similar area of practice as is the health care service that is the subject of a final adverse determination [.] ;
- *AB202_R1* – 4 – (a) Is licensed to practice medicine or dentistry in the State of Nevada pursuant to chapter 630 , 631 or 633 of NRS;
(a) Is licensed to practice medicine or dentistry in the State of Nevada pursuant to chapter 630 , 631 or 633 of NRS;
Show all 128 changed rows (88 more)
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Sec.
- 83rd Session (2025) – 4 – Sec.
2.
The provisions of subsection 1 do not apply to:
§§ 8901 et seq.;
§§ et seq.;
§§ 1071 et seq., and any coverage issued as supplemental to that coverage;
§§ et seq., and any coverage issued as supplemental to that coverage;
or (h) Any insurance under which benefits are payable with or without regard to fault, whether written on a group, blanket or individual basis.
or without regard to fault, whether written on a group, blanket or individual basis.
- *AB202_R1* – 5 – Sec.
Sec.
We have denied your request for the provision of or payment for a health care service or course of treatment.
- 83rd Session (2025) – 5 – for a health care service or course of treatment.
You may have the right to have our decision reviewed by health care professionals who have no association with us if our decision involved making a judgment as to the medical necessity, appropriateness, health care setting, level of care or effectiveness of the health care service or treatment you requested by submitting a request for external review to the Office for Consumer Health Assistance.
You maynt have the right to have our decision reviewed by health care professionals who have no association with us if our decision involved making a judgment as to the medical necessity, appropriateness, health care setting, level of care or effectiveness of the health care service or treatment you requested by submitting a request for external review to the Office for Consumer Health Assistance.
(a) If the covered person has a medical condition where the time frame for completion of an expedited review of a grievance involving an adverse determination set forth in NRS 695G.200 to 695G.230, inclusive, would seriously jeopardize the life or health of the covered person or would jeopardize the covered person’s ability to regain maximum function, the covered person or the covered person’s authorized representative may, at the same time the covered person or the covered person’s authorized representative files a request for an expedited review of a grievance involving an adverse determination as set forth in NRS 695G.210, file a request for an expedited external review to be conducted pursuant to NRS 695G.271 and 695G.275 if the adverse determination involves a denial of coverage based on a determination that the recommended or requested health care service or treatment is experimental or investigational and the covered person’s treating physician or dentist, as applicable, certifies in writing that the recommended or requested health care service or treatment that is the subject of the - *AB202_R1* – 6 – adverse determination would be significantly less effective if not promptly initiated, and the independent review organization assigned to conduct the expedited external review will determine whether the covered person will be required to complete the expedited review of the grievance before conducting the expedited external review;
(a) If the covered person has a medical condition where the time frame for completion of an expedited review of a grievance 695G.230, inclusive, would seriously jeopardize the life or health of the covered person or would jeopardize the covered person’s ability to regain maximum function, the covered person or the covered person’s authorized representative may, at the same time the covered person or the covered person’s authorized representative files a request for an expedited review of a grievance involving an adverse determination as set forth in NRS 695G.210, file a request for an expedited external review to be conducted pursuant to NRS 695G.271 and 695G.275 if the adverse determination involves a denial of coverage based on a determination that the recommended or requested health care service or treatment is experimental or investigational and the covered person’s treating physician or dentist, as applicable, certifies in writing that the recommended or requested health care service or treatment that is the subject of the adverse determination would be significantly less effective if not assigned to conduct the expedited external review will determine whether the covered person will be required to complete the expedited review of the grievance before conducting the expedited external review;
and (b) The covered person or the covered person’s authorized representative may file a grievance under the health carrier’s internal grievance process as set forth in NRS 695G.200 to 695G.230, inclusive, but if the health carrier has not issued a written decision to the covered person or the covered person’s authorized representative within 30 days after the date on which the covered person or the covered person’s authorized representative filed the grievance with the health carrier and the covered person or the covered person’s authorized representative has not requested or agreed to a delay, the covered person or the covered person’s authorized representative may file a request for external review pursuant to NRS 695G.251 and shall be considered to have exhausted the health carrier’s internal grievance process.
and (b) The covered person or the covered person’s authorized representative may file a grievance under the health carrier’s internal grievance process as set forth in NRS 695G.200 to 695G.230, inclusive, but if the health carrier has not issued a written decision to the covered person or the covered person’s authorized - 83rd Session (2025) – 6 – representative within 30 days after the date on which the covered person or the covered person’s authorized representative filed the grievance with the health carrier and the covered person or the covered person’s authorized representative has not requested or authorized representative may file a request for external review pursuant to NRS 695G.251 and shall be considered to have exhausted the health carrier’s internal grievance process.
Sec.
695G.251 NRS1.
5.
If a covered person or a physician or dentist of a covered person receives notice of an adverse determination from a health carrier concerning the covered person, the covered person, the physician or dentist, as applicable, of the covered person or an authorized representative may, within 4 months after receiving notice of the adverse determination, submit a request to the Office for Consumer Health Assistance for an external review of the adverse determination.
NRS 695G.251 is hereby amended to read as follows:
695G.251 1.
If a covered person or a physician or dentist of a covered person receives notice of an adverse determination from a health carrier concerning the covered person, the covered person, the physician or dentist, as applicable, of the covered person or an authorized representative may, within 4 months after receiving notice of the adverse determination, submit a request to the Office - *AB202_R1* – 7 – for Consumer Health Assistance for an external review of the adverse determination.
3.
- 83rd Session (2025) – 7 – 3.
Each assignment made pursuant to this subsection must be completed on a rotating basis.
Each assignment made pursuant to this sub4.ctiWithin 5 days after receiving notification from the Office for Consumer Health Assistance specifying the independent review organization assigned pursuant to subsection 3, the health carrier shall provide to the independent review organization all documents and materials relating to the adverse determination, including, without limitation:
4.
Within 5 days after receiving notification from the Office for Consumer Health Assistance specifying the independent review organization assigned pursuant to subsection 3, the health carrier shall provide to the independent review organization all documents and materials relating to the adverse determination, including, without limitation:
(a) Review the request and the documents and materials submitted pursuant to NRS 695G.251;
submitted pursuant to NRS 695G.251;
and (b) Notify the covered person, the physician or dentist, as applicable, of the covered person and the health carrier if any additional information is required to conduct a review of the adverse determination.
andents and materials (b) Notify the covered person, the physician or dentist, as applicable, of the covered person and the health carrier if any additional information is required to conduct a review of the adverse determination.
Such additional information must be provided within 5 days after receiving notice that the information is required to conduct a review of the adverse determination.
Such additional information must be provided within days after receiving notice that the information is required to conduct a review of the adverse determination.
The independent review organization shall forward to the health carrier, within 1 - *AB202_R1* – 8 – business day after receipt, any information received from a covered person or the physician or dentist of a covered person.
The independent review organization shall forward to the health carrier, within 1 business day after receipt, any information received from a covered person or the physician or dentist of a covered person.
The independent review organization shall submit a copy of its determination, including the reasons therefor, to:
The independent review organization shall - 83rd Session (2025) – 8 – submit a copy of its determination, including the reasons therefor, to:
(b) The physician or dentist, as applicable, of the covered person;
(b) The physician or dentist, as applicable, of the covered per(c) The authorized representative of the covered person, if any;
(c) The authorized representative of the covered person, if any;
Each assignment made by the Office for Consumer Health Assistance pursuant to this section must be completed on a rotating basis.
Each assignment made by the Office for Consumer Health Assistance pursuant to this section must be com3.eteWithin 24 hours after receiving notice of the Office for Consumer Health Assistance assigning the request, the health carrier shall provide to the independent review organization all documents and materials specified in subsection 4 of NRS 695G.251.
3.
Within 24 hours after receiving notice of the Office for Consumer Health Assistance assigning the request, the health carrier shall provide to the independent review organization all documents and materials specified in subsection 4 of NRS 695G.251.
- *AB202_R1* – 9 – (b) Not later than 24 hours after completing its external review, notify the covered person, the physician or dentist, as applicable, of the covered person, the authorized representative, if any, and the health carrier by telephone of its determination;
(b) Not later than 24 hours after completing its external review, notify the covered person, the physician or dentist, as applicable, of the covered person, the authorized representative, if any, and the health carrier by telephone of its determination;
and (c) Not later than 48 hours after completing its external review, submit a written decision of its external review to the covered person, the physician or dentist, as applicable, of the covered person, the authorized representative, if any, and the health carrier.
and - 83rd Session (2025) – 9 – (c) Not later than 48 hours after completing its external review, submit a written decision of its external review to the covered person, the physician or dentist, as applicable, of the covered person, the authorized representative, if any, and the health carrier.
Sec.
695G.275 NRS1.
8.
NRS 695G.275 is hereby amended to read as follows:
695G.275 1.
Immediately upon notice of a request for an expedited external review pursuant to subsection 2, the health carrier shall determine whether the request meets the requirements for review set forth in subsection 12.
Immediately upon notice of a request for an expedited external review pursuant to subsection 2, the health carrier shall forth in subsection 12.
The Office for Consumer Health Assistance may determine that a request for an expedited external review is eligible for - *AB202_R1* – 10 – external review pursuant to subsection 12 and require that it be referred for expedited external review notwithstanding a health carrier’s initial determination that the request is ineligible.
The Office for Consumer Health Assistance may determine that a request for an expedited external review is eligible for external review pursuant to subsection 12 and require that it be - 83rd Session (2025) – 10 – referred for expedited external review notwithstanding a health carrier’s initial determination that the request is ineligible.
In making a determination pursuant to subsection 7, the decision of the Office for Consumer Health Assistance must be made in accordance with the terms of the covered person’s health benefit plan and is subject to all applicable provisions of the external review process.
In making a determination pursuant to subsection 7, the decision of the Office for Consumer Health Assistance must be benefit plan and is subject to all applicable provisions of the external review process.
Within 5 business days after receipt of the notice sent pursuant to subsection 11, the health carrier shall conduct and complete a preliminary review of the request to determine whether:
Within 5 business days after receipt of the notice sent pursuant to subsection 11, the health carrier shall conduct and com(a) The person is or was a covered person in the health benefit plan at the time the health care service or treatment was recommended or requested or, in the case of a retrospective review, was a covered person in the health benefit plan at the time the health care service or treatment was provided;
(a) The person is or was a covered person in the health benefit plan at the time the health care service or treatment was recommended or requested or, in the case of a retrospective review, was a covered person in the health benefit plan at the time the health care service or treatment was provided;
- *AB202_R1* – 11 – (1) Standard health care services or treatments have not been effective in improving the condition of the covered person;
- 83rd Session (2025) – 11 – effective in improving the condition of the covered person;
(2) Standard health care services or treatments are not medically appropriate for the covered person;
not been (2) Standard health care services or treatments are not medically appropriate for the covered person;
or (2) Who is a licensed, board certified or board eligible physician or dentist qualified to practice in the area of medicine or dentistry appropriate to treat the covered person’s condition, has certified in writing that scientifically valid studies using accepted protocols demonstrate that the health care service or treatment requested by the covered person that is the subject of the adverse determination is likely to be more beneficial to the covered person than any available standard health care services or treatments;
or (2) Who is a licensed, board certified or board eligible physician or dentist qualified to practice in the area of medicine or dentistry appropriate to treat the covered person’s condition, has protocols demonstrate that the health care service or treatmentcepted requested by the covered person that is the subject of the adverse determination is likely to be more beneficial to the covered person than any available standard health care services or treatments;
Within 1 business day after completion of the preliminary review, the health carrier shall notify the Office for Consumer Health Assistance and the covered person, and, if applicable, the covered person’s authorized representative, in writing, whether the request is:
Within 1 business day after completion of the preliminary review, the health carrier shall notify the Office for Consumer Health Assistance and the covered person, and, if applicable, the request is:son’s authorized representative, in writing, whether the (a) Complete;
(a) Complete;
14.
- 83rd Session (2025) – 12 – 14.
- *AB202_R1* – 12 – 15.
15.
The notice of initial determination must include a statement informing the covered person and, if applicable, the covered person’s authorized representative that a health carrier’s initial determination that a request which is ineligible for external review may be appealed to the Office for Consumer Health Assistance.
The notice of initial determination must include a statement person’s authorized representative that a health carrier’s initial determination that a request which is ineligible for external review may be appealed to the Office for Consumer Health Assistance.
The Office for Consumer Health Assistance may determine that a request is eligible for external review pursuant to subsection 12 and require that it be referred for external review notwithstanding a health carrier’s initial determination that the request is ineligible.
The Office for Consumer Health Assistance may determine that a request is eligible for external review pursuant to subsection and require that it be referred for external review notwithstanding a health carrier’s initial determination that the request is ineligible.
(a) Assign an independent review organization from the list of approved independent review organizations compiled and maintained by the Commissioner pursuant to NRS 683A.3715 to conduct the external review;
(a) Assign an independent review organization from the list of maintained by the Commissioner pursuant to NRS 683A.3715 tod and conduct the external review;
The Office for Consumer Health Assistance shall include in the notice provided to the covered person and, if applicable, the covered person’s authorized representative pursuant to subsection 19 a statement that the covered person or the covered person’s authorized representative may submit in writing to the assigned independent review organization within 5 business days after receipt of the notice provided pursuant to subsection 19 additional information that the independent review organization shall consider when conducting the external review.
The Office for Consumer Health Assistance shall include in the notice provided to the covered person and, if applicable, the covered person’s authorized representative pursuant to subsection a statement that the covered person or the covered person’s authorized representative may submit in writing to the assigned independent review organization within 5 business days after receipt of the notice provided pursuant to subsection 19 additional - 83rd Session (2025) – 13 – information that the independent review organization shall consider when conducting the external review.
- *AB202_R1* – 13 – 21.
assignment to conduct the external review pursuant to subsection 19, the assigned independent review organization shall:
Within 1 business day after receipt of the notice of assignment to conduct the external review pursuant to subsection 19, the assigned independent review organization shall:
In accordance with subsections 37 to 41, inclusive, each clinical reviewer shall provide a written opinion to the assigned independent review organization regarding whether the recommended or requested health care service or treatment should be covered.
In accordance with subsections 37 to 41, inclusive, each clinical reviewer shall provide a written opinion to the assigned independent review organization regarding whether the be covered.
25.
or requested health care service or treatment should 25.
Except as otherwise provided in subsection 28, failure by the health carrier or utilization review organization to provide the documents and information within the time specified in subsection 26 must not delay the conduct of the external review.
Except as otherwise provided in subsection 28, failure by the health carrier or utilization review organization to provide the documents and information within the time specified in subsection must not delay the conduct of the external review.
28.
- 83rd Session (2025) – 14 – to provide the documents and information within the time specifiedils in subsection 26, the assigned independent review organization may terminate the external review and make a decision to reverse the adverse determination.
If the health carrier or utilization review organization fails to provide the documents and information within the time specified in subsection 26, the assigned independent review organization may terminate the external review and make a decision to reverse the adverse determination.
29.
- *AB202_R1* – 14 – 29.
The assigned independent review organization shall forward any information submitted by the covered person or the covered person’s authorized representative pursuant to subsection 20 to the health carrier within 1 business day after receipt of the information.
The assigned independent review organization shall forward any information submitted by the covered person or the covered person’s authorized representative pursuant to subsection information.alth carrier within 1 business day after receipt of the 32.
32.
If the health carrier reverses its adverse determination pursuant to subsection 28, the health carrier shall immediately notify the covered person, the covered person’s authorized representative, if applicable, the assigned independent review organization and the Office for Consumer Health Assistance in writing of its decision.
If the health carrier reverses its adverse determination pursuant to subsection 28, the health carrier shall immediately notify if applicable, the assigned independent review organization and the Office for Consumer Health Assistance in writing of its decision.
Except as otherwise provided in subsection 39, within 20 days after being selected in accordance with subsection 21 to conduct the external review, each clinical reviewer shall provide an opinion to the assigned independent review organization pursuant to subsection 41 regarding whether the recommended or requested health care service or treatment should be covered.
Except as otherwise provided in subsection 39, within 20 days after being selected in accordance with subsection 21 to conduct the external review, each clinical reviewer shall provide an opinion to the assigned independent review organization pursuant to - 83rd Session (2025) – 15 – health care service or treatment should be covered.requested 38.
38.
- *AB202_R1* – 15 – (b) A description of the indicators relevant to determine if there is sufficient evidence to demonstrate that the recommended or requested health care service or treatment is more likely to be beneficial to the covered person than any available standard health care services or treatments and the adverse risks of the recommended or requested health care service or treatment would not be substantially increased over those of available standard health care services or treatments;
(b) A description of the indicators relevant to determine if there is sufficient evidence to demonstrate that the recommended or requested health care service or treatment is more likely to be beneficial to the covered person than any available standard health care services or treatments and the adverse risks of the recommended or requested health care service or treatment would not be substantially increased over those of available standard health care services or treatments;
(d) A description and analysis of any evidence-based standards used as a basis for the opinion;
(d) A description and analysis of any evidence-based standards use(e) Information concerning whether the reviewer’s rationale for the opinion is based on the provisions of subsection 41.
and (e) Information concerning whether the reviewer’s rationale for the opinion is based on the provisions of subsection 41.
In addition to the documents and information provided pursuant to subsections 10 and 26, each clinical reviewer, to the extent the information or documents are available and the reviewer considers them appropriate, shall consider the following in reaching an opinion:
In addition to the documents and information provided pursuant to subsections 10 and 26, each clinical reviewer, to the considers them appropriate, shall consider the following in reaching an opinion:
(d) The terms of coverage under the covered person’s health benefit plan with the health carrier to ensure that, but for the health carrier’s determination that the recommended or requested health care service or treatment that is the subject of the opinion is experimental or investigational, the reviewer’s opinion is not contrary to the terms of coverage under the health benefit plan;
- 83rd Session (2025) – 16 – (d) The terms of coverage under the covered person’s health benefit plan with the health carrier to ensure that, but for the health carrier’s determination that the recommended or requested health care service or treatment that is the subject of the opinion is contrary to the terms of coverage under the health benefit plan;
- *AB202_R1* – 16 – (1) The recommended or requested health care service or treatment has been approved by the Food and Drug Administration, if applicable, for the condition;
(1) The recommended or requested health care service or treatment has been approved by the Food and Drug Administration, if applicable, for the condition;
For an expedited external review, within 48 hours after receipt of the opinion of each clinical reviewer pursuant to subsection 41, the assigned independent review organization, in accordance with subsection 45 or 46, shall make a decision and provide notice of the decision orally or in writing to the covered person, the covered person’s authorized representative, if applicable, the health carrier and the Office for Consumer Health Assistance.
For an expedited external review, within 48 hours after subsection 41, the assigned independent review organization, in accordance with subsection 45 or 46, shall make a decision and provide notice of the decision orally or in writing to the covered person, the covered person’s authorized representative, if applicable, the health carrier and the Office for Consumer Health Assistance.
If a majority of the clinical reviewers recommend that the recommended or requested health care service or treatment should be covered, the independent review organization shall make a decision to reverse the health carrier’s adverse determination.
If a majority of the clinical reviewers recommend that the recommended or requested health care service or treatment should - 83rd Session (2025) – 17 – decision to reverse the health carrier’s adverse determination.
If the clinical reviewers are evenly split as to whether the recommended or requested health care service or treatment should be covered, the independent review organization shall obtain the opinion of an additional clinical reviewer in order for the - *AB202_R1* – 17 – independent review organization to make a decision based on the opinions of a majority of the clinical reviewers pursuant to subsection 45 or 46.
If the clinical reviewers are evenly split as to whether the recommended or requested health care service or treatment should be covered, the independent review organization shall obtain the opinion of an additional clinical reviewer in order for the independent review organization to make a decision based on the opinions of a majority of the clinical reviewers pursuant to subsection 45 or 46.
49.
subsection 47 must not extend the time within which the assigned to independent review organization is required to make a decision based on the opinions of the clinical reviewers pursuant to subsection 42.
The selection of an additional clinical reviewer pursuant to subsection 47 must not extend the time within which the assigned independent review organization is required to make a decision based on the opinions of the clinical reviewers pursuant to subsection 42.
(d) The date on which the external review was conducted;
(e) The date of the decision;ernal review was conducted;
(e) The date of the decision;
52.
- 83rd Session (2025) – 18 – Assistance of an approved independent review organization to conduct an external review in accordance with this section must be done on a random basis among those approved independent review organizations qualified to conduct the particular external review based on the nature of the health care service or treatment that is the subject of the adverse determination and other circumstances, including concerns regarding conflicts of interest pursuant to subsection 4 of NRS 683A.372.
The assignment by the Office for Consumer Health Assistance of an approved independent review organization to conduct an external review in accordance with this section must be done on a random basis among those approved independent review organizations qualified to conduct the particular external review based on the nature of the health care service or treatment that is the subject of the adverse determination and other circumstances, including concerns regarding conflicts of interest pursuant to subsection 4 of NRS 683A.372.
- *AB202_R1* – 18 – (2) If randomized clinical trials are not available, cohort studies or case-control studies;
(2) If randomized clinical trials are not available, cohort studies or case-control studies;
or (4) If the methods described in subparagraphs (1), (2) and (3) are not available, expert opinion.
or (4) If the methods described in subparagraphs (1), (2) and (3) are(b) “Evidence-based standard” means the conscientious, explicit and judicious use of the current best evidence based on the overall systematic review of research in making decisions about the care of an individual patient.
(b) “Evidence-based standard” means the conscientious, explicit and judicious use of the current best evidence based on the overall systematic review of research in making decisions about the care of an individual patient.
Documentary evidence, including any recommendation of the physician or dentist of the insured submitted pursuant to NRS 695G.251;
Documentary evidence, including any recommendation of the physician or dentist of the insured submitted pursuant to NRS2.95GMedical or scientific evidence, including, without limitation:
2.
Medical or scientific evidence, including, without limitation:
and (d) An opinion of an independent physician or dentist who, as determined by the independent review organization, is an expert in the health specialty that is the subject of the independent review;
and - 83rd Session (2025) – 19 – (d) An opinion of an independent physician or dentist who, as determined by the independent review organization, is an expert in the health specialty that is the subject of the independent review;
H - *AB202_R1*
~~~~~ 25 - 83rd Session (2025)
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How this bill changes current law

7 changes Share ↗

Compared against the Nevada Revised Statutes as published AI-generated reading aid — verify against the official bill.

The bill expands the definitions and requirements regarding the authorization of health care services by managed care organizations, specifically including dentists in the decision-making process and extending certain provisions related to external reviews to dental coverage.

  • NRS 695G.016

    [a] physician who is: → A physician who is: or 2. A dentist who is: (a) Licensed by the Board of Dental Examiners of Nevada pursuant to chapter 631 of NRS; and (b) Engaged in the practice of dentistry.

    The definition of 'clinical peer' now includes licensed dentists in addition to physicians.

  • NRS 695G.150

    the decision not to authorize coverage is made by a physician who → the decision not to authorize coverage is made by a physician or dentist who

    Dentists are now included in the decision-making process for authorizing health care services that are covered by the health plan.

  • NRS 695G.243

    [Dental; → Dental,

    Polices providing only dental coverage are no longer exempt from certain established procedures for complaint resolution.

  • NRS 695G.245

    the health carrier shall include in the notice required pursuant to subsection 1 a statement informing the covered person that: → the health carrier shall include in the notice required pursuant to subsection 1 a statement informing the covered person and his or her treating physician or dentist that:

    The notification requirements now specifically mention dentists in relation to adverse determinations.

  • NRS 695G.251

    a covered person, a physician of a covered person or an authorized representative to submit a request → a covered person, a physician or dentist of a covered person or an authorized representative to submit a request

    Dentists can now also submit requests for external reviews of adverse determinations.

  • NRS 695G.261

    to notify the covered person, the physician of the covered person and the health carrier → to notify the covered person, the physician or dentist of the covered person and the health carrier

    Notification requirements for independent review organizations have been expanded to include dentists.

  • NRS 695G.280

    any recommendation of the physician of the insured. → any recommendation of the physician or dentist of the insured.

    Decisions made by independent review organizations must now consider recommendations from both physicians and dentists.

Amendments

1 amendment

Click Show changes on an amendment above to see how it modifies the bill.

Action History

  1. Chapter 23.

  2. Approved by the Governor.

  3. Enrolled and delivered to Governor.

  4. In Assembly. To enrollment.

  5. Read third time. Passed. Title approved. (Yeas: 20, Nays: None, Excused: 1.) To Assembly.

  6. Read second time.

  7. From committee: Do pass.

  8. Read first time. Referred to Committee on Commerce and Labor. To committee.

  9. In Senate.

  10. From printer. To engrossment. Engrossed. First reprint. To Senate.

  11. Read third time. Passed, as amended. Title approved. (Yeas: 42, Nays: None.) To printer.

  12. From committee: Amend, and do pass as amended. Placed on Second Reading File. Read second time. Amended. (Amend. No. 42.) Dispensed with reprinting.

  13. From printer. To committee.

  14. Read first time. To printer.

  15. Prefiled. Referred to Committee on Commerce and Labor.

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 66 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (66)

66 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

Who sponsors AB 202?
AB 202 is sponsored by Brown-May, Tracy (Democratic).
What is the current status of AB 202?
This bill has been enacted into law. Introduced February 03, 2025. Enacted.
Where can I track AB 202?
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