Nevada 2025 Regular Session Status: Enacted 1 D cosponsors

AB 463 — Revises provisions relating to prior authorization. (BDR 57-825)

Last action — Chapter 475.

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Assembly
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced March 17, 2025. Enacted.

Signed by Governor Joe Lombardo (Republican) on June 10, 2025.

Odds of enactment

High chance

Based on the sponsor, cosponsors, and committee posture, this bill has a high chance of becoming law.

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Prognosis

Advancing 52% · moderate confidence

  • 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).

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

Bill Text

What changed in the latest version

387 added · 1066 removed

Plain-language change summary

In the revised version of Assembly Bill No. 463, significant changes were made to how health insurers handle prior authorization for medical and dental care. Insurers are now required to respond to prior authorization requests within 2 business days, significantly speeding up the process compared to the previous 20-day requirement. Additionally, the bill prohibits insurers from needing prior authorization for specific services, such as certain preventive care and hospice care for children, which can help ensure timely access to essential medical treatments. These changes aim to make healthcare more accessible and efficient for patients.

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EXEMPT (Reprinted with amendments adopted on April 21, 2025) FIRST REPRINT A.B.
Assembly Bill No.
463 A SSEMBLY B ILLN O.
463–Assemblymember Backus CHAPTER..........
463–A SSEMBLYMEMBER B ACKUS M ARCH 17, 2025 ____________ Referred to Committee on Commerce and Labor SUMMARY—Revises provisions relating to prior authorization.
(BDR 57-825) FISCAL NOTE:
Effect on Local Government:
May have Fiscal Impact.
Effect on the State:
Yes.
CONTAINS UNFUNDED MANDATE (§ 30) (NOTR EQUESTED AFFECTEDLOCALGOVERNMENT) ~ EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
imposing requirements governing prior authorization for medical or dental care;
requiring certain health insurers to respond to requests for prior authorization for medical or dental care within a certain amount of time;
prohibiting an insurer from requiring prior authorization for covered emergency services or denying coverage for covered, medically necessary emergency services;
prohibiting certain insurers from requiring prior authorization for certain types of medical care;
prohibiting an insurer from requiring prior authorization for certain other medical care;
If an insurer requires prior authorization, existing law requires the insurer to:
If an insurer requires prior authorization, existing law requires the Commissioner of Insurance for approval;
(1) file its procedure for obtaining prior authorization with the Commissioner of Insurance for approval;
(NRS 687B.225) This bill establishes additional requirements relating to the use of prior authorization for Health Insurance Program and insurance for public employees.id, the Children’s Section 44 of this bill requires that the procedure for obtaining prior authorization for services reimbursable through Medicaid or the Children’s Health Insurance Program on a fee-for-service basis includes:
(NRS 687B.225) Sections and 45 of this bill require private insurers and insurers providing coverage for recipients of Medicaid and the Children’s Health Insurance Program, respectively, to respond to a request for prior authorization within 2 business days after receiving the request, unless certain nationally recognized operating rules governing prior authorization would allow the insurer to have additional time to respond to the particular request.
(1) a list of the specific goods and services for which the Department of Health and Human Services requires prior authorization;
In such a case, sections 27 and 45 authorize an insurer to respond to the request within the period of time prescribed by the operating rules, unless doing so would result in the insurer responding to the request more than 7 caleSections 19 and 48 of this bill prohibit insurers from requiring an insured to obtain prior authorization for:
and (2) the clinical review criteria used by the Department to evaluate requests for prior authorization.
(1) certain preventive care services;
Section 44 also requires the Department to publish its procedure for obtaining prior authorization on its Internet website and update that website as necessary to account for any changes in - *AB463_R1* – 2 – payment for medical or dental care because of the failure to obtain prioror authorization if the Department’s procedures for obtaining prior authorization in effect on the date on which the care was provided did not require prior authorization for that care.
(2) hospice care provided to pediatric patients;
Section 45 of this bill requires the Department to approve or deny such a request, or request additional, medically relevant information within 48 hours after receiving the request.
and (3) care provided to treat neonatal abstinence syndrome.
Section 46 of this bill requires any adverse determination on a request for prior authorization for services reimbursable through Medicaid or the physician or, for a request relating to dental care, a dentist, who is licensed in this State and possesses certain other qualifications.
Section 19 additionally prohibits insurers, other than those covering recipients of Medicaid or the Children’s Health Insurance Program, from requiring prior authorization for:
Section 46 requires the Department, in certain circumstances, to allow the provider of health care who requested the prior authorization to discuss the issues involved in the request with the physician or dentist who is responsible for making a determination on the request.
(1) outpatient services for the treatment of substance use disorder;
Section 46 requires the Department, upon making an adverse determination on a request for prior authorization, to transmit certain information to the recipient of benefits under Medicaid or the Children’s Health Insurance Program to whom the request pertains, including information relating to the right of the Department to establish a process for appeals that provides for the timely:
and (2) the prescription of test strips for measuring blood glucose in persons with diabetes.
(1) resolution of appeals submitted by recipients;
Section 27 makes conforming changes to clarify that a private insurer may not require prior authorization where prohibited by section 19.
and (2) a decision upholding an adverse determination on an appeal submitted by a recipient to be made by a physician or dentist who has qualifications beyond those required of a physician or dentist who evaluates initial requests for prior authorization.
Sections 4-15 and 35-42 of this bill define certain terms relating to the process of obtaining and processing requests for prior authorization, and sections 2 and 34 provides that if a private insurer violates any provision of section 19 or 27 withbill respect to a particular request for prior authorization, that the request is deemed approved.
If the Department approves a request for prior authorization, section 47 of this bill requires the Department to pay the provider of health care the full applicable rate for the relevant care, except in certain circumstances.
Section 28 of this bill requires a nonprofit hospital and medical or dental service corporation to comply with sections 2-26 of this bill.
Sections 18 and 47 of this bill provide that a request for prior authorization that Children’s Health Insurance Program, remains valid for:
Section 29 of this bill requires the Director of the Department to administer the provisions of sections 33- of this bill in the same manner as other provisions governing Medicaid.
(1) 12 months;
Section of this bill requires plans of self-insurance for private employers, respectively, to comply with the requirements of sections 19 and 27 to the extent applicable.
or (2) treatment related to a chronic condition, until the standard of treatment for that condition changes.
Section 15.5 of this bill provides that a health maintenance organization or other Children’s Health Insurance Program or members of the Public Employees’aid or the Benefits Program, or a utilization review organization that conducts utilization reviews for such entities, is not subject to sections 2-27.
Sections 19 and 48 of this bill prohibit an insurer from requiring an insured to obtain prior authorization for certain medical care, including certain preventive care services.
- 83rd Session (2025) – 2 – EXPLANATION – Matter in bolded italics is new;
Sections 20 and 49 of this bill prohibit an insurer from requiring prior authorization for covered emergency services.
matter between brackets [omitted material] is material to be omitted.
Sections 20 and 49 prohibit an insurer from requiring that an insured or provider of health care notify the insurer earlier than the end of the business day immediately following the date of and 49 also require an insurer to respond to a request for prior authorization for certain follow-up care relating to the emergency care received by an insured within 60 minutes after receiving the request.
Finally, Sections 20 and 49:
(1) prohibit an insurer from denying coverage for covered medically necessary emergency services;
and (2) establish a presumption of medical necessity under certain conditions.
Section 18 prohibits an insurer other than Medicaid from denying or imposing additional limits on a request for prior authorization that the insurer has previously approved if the care at issue in the request is provided within 45 business days after met.
Section 21 of this bill requires such an insurer to exempt providers of healthre care from the requirement to obtain prior authorization for specific goods and services if the insurer has granted requests for prior authorization for those goods or services submitted by the provider at a rate of 80 percent or more during the previous year.
Section 21 requires such an insurer to annually conduct reviews of - *AB463_R1* – 3 – each provider of health care in the network of the insurer to determine whether each such provider qualifies for an exemption.
If the provider qualifies for an exemption, section 21 requires the insurer to automatically grant the exemption for the applicable goods and services, without requiring the provider to affirmatively request an exemption.
Section 22 of this bill prescribes the requirements and health care.
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Section 22 also requires such an insurer to establish a procedure by which a provider of health care may appeal a revocation of an exemption.
Section 27 of this bill makes conforming changes to clarify that an insurer may not require prior authorization where prohibited by sections 19-21.
Sections 4-15 and 35-42 of this bill define certain terms relating to the process of obtaining and processing requests for prior authorization, and sections 2 and 34 of this bill establish the applicability of those definitions.
Sections 23 and 52 of section 18-20 or 44-49 with respect to a particular request for prior authorization, of that the request is deemed approved.
Section 28 of this bill requires a nonprofit hospital and medical or dental service corporation to comply with sections 2-23.
Section 29 of this bill requires the Director of the Department to administer the provisions of sections 33-52 of this bill in the same manner as other provisions governing Medicaid.
Sections 30, 31 and 56 of this bill require plans of self-insurance for employees of local for private employers, respectively, to comply with the requirements of sections 2- 27 to the extent applicable.
Section 33 provides that a managed care organization that provides services to recipients of Medicaid or the Children’s Health Insurance Program is not subject to sections 34-52, but must comply with sections 2-27.
Section 55 requires the policies and procedures for coverage for prescription drugs under Medicaid to comply with sections 34-52.
Sec.
Secs.
3.
3-6.
4.
“Approval” means a determination by a health carrier or a utilization review organization that the medical care or dental care furnished or proposed to be furnished to an insured has been reviewed and, based on the information provided to the health carrier, satisfies the health carrier’s criteria for medical necessity or appropriateness and the requested care or payment for the care is therefore approved.
Sec.
5.
(Deleted by amendment.) Sec.
6.
(Deleted by amendment.) - *AB463_R1* – 4 – Sec.
The term additionally includes a utilization review organization, as defined in NRS 695G.085.
The term additionally includes a utilization review capacity as a utilization review organization for a health carrier.
Sec.
Secs.
12.
12 and 13.
“Network” means a defined set of providers of health care who are under contract with a health carrier to provide health care services pursuant to a network plan offered or issued by the health carrier.
(Deleted by amendment.) Sec.
Sec.
13.
“Network plan” means a contract or policy of insurance offered by a health carrier under which the financing and delivery of medical or dental care is provided, in whole or in part, through a defined set of providers under contract with the health carrier.
Sec.
16.
15.5.
(Deleted by amendment.) Sec.
The provisions of NRS 687B.225 and sections 2 to 26, inclusive, of this act, do not apply to:
17.
(Deleted by amendment.) Sec.
18.
If a health carrier approves a request for prior authorization, the approval remains valid until:
A health maintenance organization or other managed care Health and Human Services or the Division of Health Carement of Financing and Policy of the Department pursuant to NRS 422.273 to provide health care services to recipients of Medicaid under the - 83rd Session (2025) – 3 – State Plan for Medicaid or insurance under the Children’s Health Insurance Program to the extent that the organization is providing such services.
(a) Twelve months after the date on which the request is approved;
or (b) If the approval relates to the treatment of a chronic condition, until the standard of treatment for that condition changes.
A health carrier shall not revoke or impose an additional limit, condition or restriction on a request for prior authorization that the health carrier has previously approved unless:
A managed care organization that provides health care utilization review organization that conducts utilization reviews for a managed care organization that provides health care services to members of the Public Employees’ Benefits Program while the utilization review organization is providing such services.
(a) The care at issue in the request is not provided to the insured within 45 business days after the date on which the health carrier received the request;
or - *AB463_R1* – 5 – (b) The health carrier determines that an insured or provider of health care procured the approval by fraud or material misrepresentation.
As used in this section, “chronic condition” means a condition that is expected to last 1 year or more and:
A utilization review organization that conducts utilization reviews for an entity described in subsection 1, while the utilization review organization is providing such services.
(a) Requires ongoing medical attention to effectively manage the condition or prevent an event that adversely affects the health of the person;
Secs.
or (b) Limits one or more activities of daily living.
16-18.
Sec.
(Deleted by amendment.) Sec.
(b) Antineoplastic treatment for cancer, other than prescription drugs, that is consistent with the guidelines established by the National Comprehensive Cancer Network, or its successor organization.
(b) Evidence-based goods or services for preventive care that have in effect a grade of “A” or “B” identified by the United States Preventive Services Task Force.
(c) Evidence-based goods or services for preventive care that have in effect a grade of “A” or “B” identified by the United States Preventive Services Task Force.
(c) Preventive care for women described in 45 C.F.R.
(d) Preventive care for women described in 45 C.F.R.
(e) Hospice care provided to pediatric patients in a facility for hospice care licensed pursuant to chapter 449 of NRS.
(d) Hospice care provided to pediatric patients in a facility for hospice care licensed pursuant to chapter 449 of NRS.
(f) Care provided to treat neonatal abstinence syndrome provided by a provider of health care who specializes in pain management for pediatric patients or palliative care provided to pediatric patients.
(e) Care provided to treat neonatal abstinence syndrome provided by a provider of health care who specializes in pain management for pediatric patients or palliative care provided to ped(f) The prescription of test strips for measuring blood glucose in persons with diabetes.
(g) The prescription of test strips for measuring blood glucose in persons with diabetes.
(h) Psychiatric care provided by a psychiatrist licensed to practice medicine in this State and certified by the American Board of Psychiatry and Neurology, Inc.
Sec.
Secs.
20.
20-22.
1.
(Deleted by amendment.) Sec.
A health carrier shall not require prior authorization for emergency medical services covered by the health carrier, including, where applicable, transportation by ambulance to a hospital or other medical facility.
2.
If a health carrier requires an insured or his or her provider of health care to notify the health carrier that the insured has been admitted to a hospital to receive emergency medical - *AB463_R1* – 6 – services or has received emergency medical services, the health carrier shall not require an insured or a provider of health care to transmit such a notice earlier than the end of the business day immediately following the date on which the insured was admitted or the emergency medical services were provided, as applicable.
3.
A health carrier shall not deny coverage for emergency medical services covered by the health carrier that are medically necessary.
Emergency medical services are presumed to be medically necessary if, within 72 hours after an insured is admitted to receive emergency medical services, the provider of health care of the insured transmits to the health carrier a certification, in writing, that the condition of the insured required emergency medical services.
The health carrier may rebut that presumption by establishing, by clear and convincing evidence, that the emergency medical services were not medically necessary.
4.
If an insured receives emergency medical services and must additionally receive post-evaluation or post-stabilization medical care, and a health carrier requires prior authorization for the post-evaluation or post-stabilization care, the health carrier shall approve or deny a request for prior authorization for such care within 60 minutes after receiving the request.
5.
A health carrier shall make all determinations for whether emergency medical services are medically necessary without regard to whether a provider of health care that provided or billed for those services participates in the network of the health carrier.
6.
As used in this section:
(a) “Emergency medical services” means health care services that are provided in a medical facility by a provider of health care to screen and to stabilize an insured after the sudden onset of a medical condition that manifests itself by symptoms of such sufficient severity that a prudent layperson who possesses average knowledge of health and medicine would believe that the absence of immediate medical attention could result in:
(1) Placing the health of the insured in serious jeopardy;
(2) Placing the health of an unborn child of the insured in serious jeopardy;
(3) A serious impairment of a bodily function of the insured;
or (4) A serious dysfunction of any bodily organ or part of the insured.
(b) “Medical facility” has the meaning ascribed to it in NRS 449.0151.
Sec.
21.
1.
A health carrier shall exempt a provider of health care who participates in the network of the health carrier from the requirement to obtain prior authorization for a specific - *AB463_R1* – 7 – good or service if, within the immediately preceding 12 months, the health carrier approved 80 percent or more of the requests for prior authorization for that specific good or service submitted by the provider of health care.
If a provider of health care qualifies for an exemption pursuant to this section, a health carrier shall:
(a) Automatically grant the exemption without requiring the provider of health care to submit a request for the exemption;
and (b) Transmit to the provider of health care after granting the exemption a notice that includes:
(1) A statement that the provider of health care has been granted an exemption from the requirement to obtain prior authorization from the health carrier for the specific goods and services listed pursuant to subparagraph (2);
(2) A list of goods and services to which the exemption applies;
and (3) The date on which the exemption expires, which must not be earlier than 12 months after the date on which the health carrier granted the exemption.
2.
A health carrier shall provide for an annual review of the requests for prior authorization submitted by providers of health care who participate in the network of the health carrier to determine whether those providers meet the criteria prescribed by subsection 1 for an exemption from the requirement to obtain prior authorization.
If a provider of health care is initially determined to be ineligible for an exemption based on such a review, the eligibility of the provider of health care to receive an exemption must be independently determined by a provider of health care who:
(a) Is licensed in this State;
(b) Is of the same or similar specialty as the provider of health care who is being evaluated for an exemption;
and (c) Has experience providing the good or service for which the exemption has been initially denied.
3.
A provider of health care who is not granted an exemption from the requirement to obtain prior authorization for a particular good or service may, for that specific good or service, request from the health carrier any evidence that supported the decision of the health carrier to not grant the exemption for that good or service.
A provider of health care may submit a request for supporting evidence pursuant to this subsection not more than once during a single 12-month period for each good or service for which the provider of health care has not been granted an exemption.
4.
An exemption from the requirement to obtain prior authorization pursuant to this section applies to the provision of any good or service covered by the exemption which is provided or - *AB463_R1* – 8 – ordered by the provider of health care to whom the exception applies.
5.
A health carrier shall not deny a claim or reduce the amount of payment paid under a claim for a good or service that is subject to an exemption pursuant to this section unless:
(a) The provider of health care who submitted the claim knowingly and materially misrepresented the goods or services actually provided to an insured, and the provider of health care made the misrepresentation with the specific intent to obtain a payment from the health carrier to which the provider of health care is not legally or contractually entitled;
or (b) The service or good for which payment is sought was not substantially performed or provided, as applicable.
Sec.
22.
1.
Not more than once during a single 12-month period, a health carrier may reevaluate the eligibility of a provider of health care to receive an exemption from the requirement to obtain prior authorization pursuant to section 21 of this act.
2.
A health carrier may, pursuant to subsection 1, revoke an exemption from the requirement to obtain prior authorization granted to a provider of health care only if the health carrier determines that the provider of health care would not have met the criteria prescribed in subsection 1 of section 21 of this act for the good or service to which the exemption applies based on:
(a) A retrospective review of claims submitted by the provider of health care for that good or service during the immediately preceding 3 months;
or (b) If the provider of health care did not submit at least 10 claims for that good or service during the immediately preceding 3 months, a retrospective review of at least the last 10 claims submitted by the provider of health care for that good or service.
3.
If it is initially determined that a provider of health care meets the criteria prescribed in subsection 2 for the revocation of an exemption based on a review conducted pursuant to that subsection, the satisfaction of those criteria must be independently determined by a provider of health care described in subsection 2 of section 21 of this act before the health carrier may revoke the exemption.
4.
A health carrier that revokes an exemption from the requirement to obtain prior authorization pursuant to subsection 2 shall transmit to the provider of health care to which the revocation pertains a notice that includes:
(a) The information that the health carrier relied upon when making the determination described in subsection 2;
(b) An identification of each good or service to which the revoked exemption applies;
- *AB463_R1* – 9 – (c) The date on which the revocation takes effect, which must not be earlier than 30 days after the date on which the health carrier transmits the notice;
and (d) A description, written in easily comprehensible language, of how the provider of health care may appeal the revocation pursuant to subsection 5.
5.
A health carrier shall adopt a procedure by which a provider of health care may appeal the revocation of an exemption from the requirement to obtain prior authorization.
If a provider of health care appeals a revocation of such exemption, the exemption must remain in effect:
(a) If the revocation is reversed on appeal, until the next reevaluation pursuant to subsection 1 of the eligibility of the provider of health care to continue receiving the exemption.
(b) If the revocation is upheld on appeal, until the later of the 5th calendar day after the revocation is upheld or the date contained within the notice sent to the provider of health care pursuant to subsection 4.
Sec.
If a health carrier violates NRS 687B.225 or sections 17 to 20, inclusive, of this act with respect to a particular request for prior authorization, the request shall be deemed approved.
If a health carrier violates NRS 687B.225 or section of this act with respect to a particular request for prior authorization, the request shall be deemed approved.
Sec.
Secs.
24.
24-26.
25.
(Deleted by amendment.) Sec.
26.
(Deleted by amendment.) Sec.
Except as otherwise provided in NRS 689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 695B.1925, 695B.1942, 695C.1696, 695C.1699, 695C.1713, 695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 695G.1719 and 695G.177, and sections 19, 20 and 21 of this act, any contract [for group, blanket or individual health] or policy of insurance [or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care] issued by a health carrier 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 care from the [insurer or organization.
Except as otherwise provided in NRS 689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, - 83rd Session (2025) – 4 – 689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 695B.1925, 69695B.1942,95B695C.1696,B.695C.1699,B.1695C.1713, 695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 695G.1719 and 695G.177, and section 19 of this act, any contract [for group, blanket or individual health] or policy of insurance [or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care] issued by a health carrier 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 care from the [insurer or organization.
- *AB463_R1* – 10 – (a) File its procedure for obtaining [approval of care] prior authorization pursuant to this section for approval by the Commissioner;
(a) File its procedure for obtaining [approval of care] prior authorization pursuant to this section for approval by the Commissioner;
and (b) Unless a shorter time period is prescribed by a specific statute, including, without limitation, NRS 689A.0446, 689B.0361, 689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703, respond to any request for approval by the insured [or member] pursuant to this section within 20 days after it receives the request.
and (b) Unless a shorter time period is prescribed by a specific statute, including, without limitation, NRS 689A.0446, 689B.0361, 689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703, and except as otherwise provided by subsection 2, respond to any request for [approval] prior authorization by the insured [or member] pursuant to this section within [20] :
(1) Two business days after it receives the request [.] ;
or (2) If the Prior Authorization and Referrals Operating Information Exchange of the Council for Affordable Quality Healthcare, or its successor organization, would allow the health carrier more than 2 business days to respond to a particular request for prior authorization after receiving the request, the time period prescribed by the Rules.
Notwithstanding any time period prescribed by the Rules described in subparagraph (2) of paragraph (b) of subsection 1, a health carrier shall respond to a request for prior authorization within 7 calendar days after receiving the request.
3.
The Commissioner, in collaboration with the Department of Health and Human Services, shall review each revision to the Rules described in subparagraph (2) of paragraph (b) of subsection 1 to ensure their suitability for this State.
If the Commissioner determines that a revision is not suitable for this State, the Commissioner shall give notice within 30 days after the - 83rd Session (2025) – 5 – hearing that the revisions are not suitable for this State.
If the Commissioner gives such notice, a health carrier shall respond to any request for prior authorization that is submitted to the health carrier after the date on which such notice is given within 2 bus4.
Nonprofit hospital and medical or dental service corporations are subject to the provisions of this chapter, and to the provisions of chapters 679A and 679B of NRS, subsections 2, 4, 17, 18 and 30 of NRS 680B.010, NRS 680B.025 to 680B.060, inclusive, chapter 681B of NRS, NRS 686A.010 to 686A.315, inclusive, 686B.010 to 686B.175, inclusive, 687B.010 to 687B.040, inclusive, 687B.070 to 687B.140, inclusive, 687B.150, 687B.160, 687B.180, 687B.200 to 687B.255, inclusive, and sections 2 to 26, inclusive, of this act, 687B.270, 687B.310 to 687B.380, inclusive, 687B.410, 687B.420, 687B.430, 687B.500 and chapters 692B, 692C, 693A and 696B of NRS, to the extent applicable and not in conflict with the express provisions of this chapter.
Nonprofit hospital and medical or dental service corporations are subject to the provisions of this chapter, and to the provisions of chapters 679A and 679B of NRS, subsections 2, 4, 17, and 30 of NRS 680B.010, NRS 680B.025 to 680B.060, inclusive, chapter 681B of NRS, NRS 686A.010 to 686A.315, inclusive, 686B.010 to 686B.175, inclusive, 687B.010 to 687B.040, inclusive, 687B.070 to 687B.140, inclusive, 687B.150, 687B.160, 687B.180, 687B.200 to 687B.255, inclusive, and sections 2 to 26, inclusive, of this act, 687B.270, 687B.310 to 687B.380, inclusive, 687B.410, 687B.420, 687B.430, 687B.500 and chapters 692B, 692C, 693A and 696B of NRS, to the extent applicable and not in conflict with the express provisions of this chapter.
(a) Shall appoint, with the consent of the Governor, administrators of the divisions of the Department, who are respectively designated as follows:
(a) Shall appoint, with the consent of the Governor, respectively designated as follows:the Department, who are (1) The Administrator of the Aging and Disability Services Division;
(1) The Administrator of the Aging and Disability Services Division;
(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, - *AB463_R1* – 11 – NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and sections 33 to 54, inclusive, 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 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.
(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 - 83rd Session (2025) – 6 – sections 33 to 54, inclusive, 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 law relating to the functions of the divisions of the Division of Public and Behavioral Health or the professional line activities of the other divisions.
(5) Set forth sufficient information to assist the Department in providing those services and in the planning and budgeting for the future provision of those services;
(5) Set forth sufficient information to assist the Department future provision of those services;
and (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department.
andplanning and budgeting for the (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department.
2.
- 83rd Session (2025) – 7 – 2.
- *AB463_R1* – 12 – Sec.
Secs.
30.
30 and 31.
NRS 287.010 is hereby amended to read as follows:
(Deleted by amendment.) thereto the provisions set forth as sections 33 to 54, inclusive, of this act.
287.010 1.
The governing body of any county, school district, municipal corporation, political subdivision, public 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 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.
(c) Provide group life, accident or health coverage through a self-insurance reserve fund and, where necessary, deduct contributions to the maintenance of the fund from the compensation of officers and employees and pay the deductions into the fund.
The money accumulated for this purpose through deductions from the compensation of officers and employees and contributions of the governing body must be maintained as an internal service fund as defined by NRS 354.543.
The money must be deposited in a state or national bank or credit union authorized to transact business in the State of Nevada.
Any independent administrator of a fund created under this section is subject to the licensing requirements of chapter 683A of NRS, and must be a resident of this State.
Any contract with an independent administrator must be approved by the Commissioner of Insurance as to the reasonableness of administrative charges in relation to contributions collected and benefits provided.
The provisions of NRS 439.581 to 439.597, inclusive, 686A.135, paragraph (b) of subsection 1 of NRS 687B.225, subsection 2 of NRS 687B.225, 687B.352, 687B.408, 687B.692, 687B.723, 687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, paragraphs (b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, 689B.0375 to 689B.050, inclusive, 689B.0675, 689B.265, 689B.287 and 689B.500 and sections 2 to 26, inclusive, of this act apply to coverage provided pursuant to this paragraph, except that the provisions of NRS 689B.0378, - *AB463_R1* – 13 – 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.
(d) Defray part or all of the cost of maintenance of a self- insurance fund or of the premiums upon insurance.
The money for contributions must be budgeted for in accordance with the laws governing the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada.
2.
If a school district offers group insurance to its officers and employees pursuant to this section, members of the board of trustees of the school district must not be excluded from participating in the group insurance.
If the amount of the deductions from compensation required to pay for the group insurance exceeds the compensation to which a trustee is entitled, the difference must be paid by the trustee.
3.
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 the 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.
4.
If a contract is entered into pursuant to subsection 3, the officers and employees of the legal services organization:
(a) Shall be deemed, solely for the purposes of this section, to be officers and employees of the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency with which the legal services organization has contracted;
and (b) Must be required by the contract to pay the premiums or contributions for all insurance which they elect to accept or of which they authorize the purchase.
5.
A contract that is entered into pursuant to subsection 3:
(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 become effective.
(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.
- *AB463_R1* – 14 – 6.
As used in this section, “legal services organization” means an organization that operates a program for legal aid and receives money pursuant to NRS 19.031.
31.
NRS 287.04335 is hereby amended to read as follows:
287.04335 If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 439.581 to 439.597, inclusive, 686A.135, paragraph (b) of subsection 1 of NRS 687B.225, subsection 2 of NRS 687B.225, 687B.352, 687B.409, 687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 695G.174, inclusive, 695G.176, 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, 695G.405 and 695G.415, and sections 2 to 26, inclusive, of this act in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.
Sec.
32.
Chapter 422 of NRS is hereby amended by adding thereto the provisions set forth as sections 33 to 54, inclusive, of this act.
Sec.
1.
(Deleted by amendment.) Sec.
The provisions of sections 34 to 54, inclusive, of this act and any policies developed pursuant thereto do not apply to the delivery of services to recipients of Medicaid or the Children’s Health Insurance Program through managed care in accordance with NRS 422.273.
2.
A health maintenance organization or other managed care organization that enters into a contract with the Department or the Division pursuant to NRS 422.273 to provide health care services to recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program shall comply with NRS 687B.225 and sections 2 to 26, inclusive, of this act.
Sec.
Sec.
Secs.
35.
35-39.
“Adverse determination”:
1.
Means a determination by the Department that the medical care or dental care furnished or proposed to be furnished to a recipient is not medically necessary, or is experimental or investigational, and the requested care or payment for the care is therefore denied, reduced or terminated.
2.
Does not include the denial, reduction or termination of coverage or payment for medical care or dental care for a reason other than the medical necessity or experimental or investigational - *AB463_R1* – 15 – nature of the medical care or dental care at issue in a request for prior authorization, including, without limitation, the denial of coverage for medical care or dental care that is not covered under Medicaid or the Children’s Health Insurance Program.
Sec.
36.
“Approval” means a determination by the Department that the medical care or dental care furnished or proposed to be furnished to a recipient has been reviewed and, based on the information provided to the Department, satisfies the Department’s criteria for medical necessity or appropriateness and the requested care or payment for the care is therefore approved.
Sec.
37.
38.
39.5.
(Deleted by amendment.) Sec.
“Medicaid managed care entity” means:
39.
(Deleted by amendment.) Sec.
40.
“Medically necessary” has the meaning ascribed to it in NRS 695G.055.
Sec.
41.
“Provider of health care” means a person who participates in the State Plan for Medicaid or the Children’s Health Insurance Program as a provider of goods or services.
Sec.
42.
“Recipient” means a natural person who receives benefits through Medicaid or the Children’s Health Insurance Program, as applicable.
Sec.
43.
(Deleted by amendment.) Sec.
44.
The Department, with respect to Medicaid and the Children’s Health Insurance Program, shall establish written procedures for obtaining prior authorization for medical or dental care which must include, without limitation:
A health maintenance organization or other managed care organization that enters into a contract with the Department or the Division pursuant to NRS 422.273 to provide health care services to recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program;
(a) Specific goods and services for which the Department requires prior authorization;
or 2.
and (b) Clinical review criteria used by the Department.
A utilization review organization, as defined in NRS 695G.085, that conducts utilization reviews for the Department or a health maintenance organization or managed care organization described in subsection 1 with respect to Medicaid or the Children’s Health Insurance Program, while acting in its capacity as a utilization review organization for the Department or the health maintenance organization or managed care organization.
2.
Secs.
The Department shall publish the written procedures for obtaining prior authorization established by the Department pursuant to subsection 1, including, without limitation, the clinical review criteria, on an Internet website maintained by the Department:
40 and 41.
(a) Using clear language that is understandable to an ordinary layperson, where practicable;
(Deleted by amendment.) benefits through Medicaid or the Children’s Health Insurance Program, as applicable.
and (b) In a place that is readily accessible and conspicuous to recipients and the public.
Secs.
3.
43 and 44.
If the Department amends the procedure for obtaining prior authorization established pursuant to subsection 1, including, without limitation, changing the goods and services for which the Department requires prior authorization or changing the clinical review criteria used by the Department, the Department shall:
(Deleted by amendment.) Sec.
- *AB463_R1* – 16 – (a) Transmit a notice containing a summary of the changes made to the procedure to each recipient and each provider of goods or services under Medicaid or the Children’s Health Insurance Program, as applicable;
and (b) Update the information published on its Internet website pursuant to subsection 2 to reflect the amended procedure for obtaining prior authorization and the date on which the amended procedure takes effect.
4.
A change to the Department’s procedure for obtaining prior authorization may not take effect until 60 days have passed after the later of:
(a) The date on which the Department transmitted the notice to recipients and providers of goods or services under Medicaid or the Children’s Health Insurance Program, as applicable, pursuant to paragraph (a) of subsection 3;
or (b) The date on which the Department updated the information published on its Internet website pursuant to paragraph (b) of subsection 3.
5.
The Department shall not deny a claim based on the failure of a recipient to obtain prior authorization for medical or dental care if the procedure for obtaining prior authorization established by the Department pursuant to this section did not require the recipient to obtain prior authorization for that medical or dental care on the date on which the medical or dental care was provided to the recipient.
6.
As used in this section, “clinical review criteria” means any written screening procedure, formulary decision abstract, clinical protocol, practice guideline or other criteria used by the Department to determine the necessity and appropriateness of medical or dental care.
Sec.
Unless a shorter time period is prescribed by a specific statute, and except as otherwise provided in subsection 2, the Department, with respect to Medicaid and the Children’s Health Insurance Program, shall approve or deny a request for prior authorization submitted by or on behalf of a recipient and notify the recipient and his or her provider of health care of the approval or denial within 48 hours after receiving the request.
Unless a shorter time period is prescribed by a specific statute, and except as otherwise provided in subsection 2, the Department or a Medicaid managed care entity, with respect to Medicaid and the Children’s Health Insurance Program, shall respond to a request for prior authorization submitted by or on behalf of a recipient within:
(a) Two business days after receiving the request;
or (b) If the Prior Authorization and Referrals Operating Rules prescribed by the Committee on Operating Rules for Information Exchange of the Council for Affordable Quality Healthcare, or its successor organization, would allow the Department or Medicaid managed care entity more than 2 business days to respond to a - 83rd Session (2025) – 8 – particular request for prior authorization after receiving the request, the period of time prescribed by the Rules.
If the Department requires additional, medically relevant information or documentation in order to adequately evaluate a request for prior authorization, the Department shall:
Notwithstanding any period of time prescribed by the Rules described in paragraph (b) of subsection 1, the Department or a authorization within 7 calendar days after receiving the request.
(a) Notify the recipient and the provider of health care who submitted the request within the applicable amount of time described in subsection 1 that additional information is required to evaluate the request;
- *AB463_R1* – 17 – (b) Include within the notification sent pursuant to paragraph (a) a description, with reasonable specificity, of the information that the Department requires to make a determination on the request for prior authorization;
and (c) Approve or deny the request within 48 hours after receiving the information.
Sec.
46.
1.
The Department, with respect to Medicaid and the Children’s Health Insurance Program, shall not make an adverse determination on a request for prior authorization unless the adverse determination is made by a physician licensed pursuant to chapter 630 or 633 of NRS or, for dental care, a dentist licensed in this State who:
(a) Is of the same or similar specialty as a physician or dentist, as applicable, who typically manages or treats the medical or dental condition or provides the medical or dental care involved in the request;
and (b) Has experience treating or managing the medical or dental condition involved in the request.
2.
If a physician or dentist described in subsection 1 is considering making an adverse determination on a request for prior authorization on the basis that the medical or dental care involved in the request is not medically necessary, the Department shall:
(a) Immediately notify the provider of health care who submitted the request that the medical necessity of the requested care is being questioned by the Department;
and (b) Offer the provider of health care an opportunity to speak with the physician or dentist, as applicable, over the telephone or by videoconference to discuss the clinical issues involved in the request before the physician or dentist renders an initial determination on the request.
Upon rendering an adverse determination on a request for prior authorization, the Department shall immediately transmit to the recipient to whom the request pertains a written notice that contains:
The Department, in collaboration with the Commissioner of Insurance, shall review each revision to the Rules described in paragraph (b) of subsection 1 to ensure their suitability for Medicaid coverage in this State.
(a) A specific description of all reasons that the Department made the adverse determination;
If the Department determines that a revision is not suitable for Medicaid coverage in this State, the Department shall give notice within 30 days after the hearing that the revisions are not suitable for Medicaid coverage in this State.
(b) A description of any documentation that the Department requested from the recipient or a provider of health care of the recipient and did not receive or deemed insufficient, if the failure to receive sufficient documentation contributed to the adverse determination;
If the Department gives such notice, the Department or a Medicaid managed care entity shall respond to any request for prior authorization that is submitted to the Department or Medicaid managed care entity, as applicable, after the date on which such notice is given within 2 business days after receiving the request.
(c) A statement that the recipient has the right to appeal the adverse determination;
Secs.
- *AB463_R1* – 18 – (d) Instructions, written in clear language that is understandable to an ordinary layperson, describing how the recipient can appeal the adverse determination through the process established pursuant to subsection 4;
46 and 47.
and (e) A description of any documentation that may be necessary or pertinent to a potential appeal.
(Deleted by amendment.) Sec.
4.
The Department shall establish a process that allows a recipient to appeal an adverse determination on a request for prior authorization.
The process must allow for the clear resolution of each appeal within a reasonable time.
5.
The Department shall not uphold on appeal an adverse determination pertaining to a request for prior authorization unless the decision on the appeal is made by a physician licensed pursuant to chapter 630 or 633 of NRS or, for dental care, a dentist licensed in this State, who:
(a) Is actively practicing medicine or dentistry, as applicable, within the same or similar specialty as a physician or dentist, as applicable, who typically manages or treats the medical or dental condition or provides the medical or dental care involved in the request and has been actively practicing in that specialty for at least 5 consecutive years preceding the date on which the physician or dentist, as applicable, makes the determination on the appeal;
(b) Is knowledgeable of and has experience treating or managing the medical or dental condition involved in the request;
(c) Was not involved in making the adverse determination that is the subject of the appeal;
(d) Has no financial interest in the outcome of the request for prior authorization that is the subject of the appeal;
(e) Is not employed by or contracted with the Department or any administrator contracted by the Department except:
(1) To participate in Medicaid or the Children’s Health Insurance Program as a provider of services;
(2) To make determinations on appeals of adverse determinations;
or (3) For the purposes described in both subparagraphs (1) and (2);
and (f) Considers all known clinical aspects of the medical or dental care involved in the request, including, without limitation:
(1) The medical records of the recipient that are provided or accessible to the Department, including those records provided to the Department by the recipient or a provider of health care of the recipient;
(2) The clinical review criteria adopted by the Department pursuant to section 44 of this act;
and - *AB463_R1* – 19 – (3) Medical or scientific evidence provided to the Department by the provider of health care who requested prior authorization for the care at issue.
6.
As used in this section:
(a) “Administrator” has the meaning ascribed to it in NRS 683A.025.
(b) “Medical or scientific evidence” has the meaning ascribed to it in NRS 695G.053.
Sec.
47.
1.
If the Department approves a request for prior authorization, the approval remains valid until the later of:
(a) Twelve months after the date on which the request is approved;
or (b) If the approval relates to the treatment of a chronic condition, until the standard of treatment for that condition changes.
2.
If the Department approves a request for prior authorization, the Department shall promptly pay a provider of health care for a claim for the approved medical or dental care at the full rate of reimbursement provided under Medicaid or the Children’s Health Insurance Program, as applicable, unless:
(a) The provider of health care knowingly and materially misrepresented the medical care or dental care contained in the request with the specific intent to deceive and obtain a payment from the Department to which the provider of health care was not entitled;
or (b) The provider of health care was not a participating provider of services under Medicaid or the Children’s Health Insurance Program, as applicable, on the date that the care was provided.
3.
As used in this section, “chronic condition” means a condition that is expected to last 1 year or more and:
(a) Requires ongoing medical attention to effectively manage the condition or prevent an event that adversely affects the health of the person;
or (b) Limits one or more activities of daily living.
Sec.
The Department, with respect to Medicaid and the Children’s Health Insurance Program, shall not require prior authorization for:
The Department or a Medicaid managed care entity, with respect to Medicaid and the Children’s Health Insurance Program, shall not require prior authorization for:
(a) Outpatient services for the treatment of a mental health condition or substance use disorder.
(a) Evidence-based goods or services for preventive care that have in effect a grade of “A” or “B” identified by the United States Preventive Services Task Force.
(b) Antineoplastic treatment for cancer, other than prescription drugs, that is consistent with the guidelines established by the National Comprehensive Cancer Network, or its successor organization.
(b) Preventive care for women described in 45 C.F.R.
- *AB463_R1* – 20 – (c) Evidence-based goods or services for preventive care that have in effect a grade of “A” or “B” identified by the United States Preventive Services Task Force.
§ 147(c) Hospice care provided to pediatric patients in a facility for hospice care licensed pursuant to chapter 449 of NRS.
(d) Preventive care for women described in 45 C.F.R.
(d) Care provided to treat neonatal abstinence syndrome provided by a provider of health care who specializes in pain management for pediatric patients or palliative care provided to pediatric patients.
§ 147.130(a)(iv).
(e) Hospice care provided to pediatric patients in a facility for hospice care licensed pursuant to chapter 449 of NRS.
(f) Care provided to treat neonatal abstinence syndrome provided by a provider of health care who specializes in pain management for pediatric patients or palliative care provided to pediatric patients.
(g) The prescription of test strips for measuring blood glucose in persons with diabetes.
(h) Psychiatric care provided by a psychiatrist licensed to practice medicine in this State and certified by the American Board of Psychiatry and Neurology, Inc.
Sec.
(c) “Provider of health care” means a person who participates in the State Plan for Medicaid or the Children’s Health Insurance Program as a provider of goods or services.
49.
Secs.
1.
49-51.
The Department, with respect to Medicaid and the Children’s Health Insurance Program, shall not require prior authorization for covered emergency services, including, where applicable, transportation by ambulance to a hospital or other medical facility.
(Deleted by amendment.) - 83rd Session (2025) – 9 – Sec.
2.
If the Department requires a recipient or his or her provider of health care to notify the Department that the recipient has been admitted to a hospital to receive emergency services or has received emergency services, the Department shall not require a recipient or a provider of health care to transmit such a notice earlier than the end of the business day immediately following the date on which the recipient was admitted or the emergency services were provided, as applicable.
3.
The Department shall not deny coverage for emergency services covered by Medicaid or the Children’s Health Insurance Program that are medically necessary.
Emergency services are presumed to be medically necessary if, within 72 hours after a recipient is admitted to receive emergency services, the provider of health care of the recipient transmits to the Department a certification, in writing, that the condition of the recipient required emergency services.
The Department may rebut that presumption by establishing, by clear and convincing evidence, that the emergency services were not medically necessary.
- *AB463_R1* – 21 – 4.
If a recipient receives emergency services and must additionally receive post-evaluation or post-stabilization medical care, and the Department requires prior authorization for the post- evaluation or post-stabilization care, the Department shall approve or deny a request for prior authorization for such care within 60 minutes after receiving the request.
5.
As used in this section:
(a) “Emergency services” means health care services that are provided in a medical facility by a provider of health care to screen and to stabilize a recipient after the sudden onset of a medical condition that manifests itself by symptoms of such sufficient severity that a prudent layperson who possesses average knowledge of health and medicine would believe that the absence of immediate medical attention could result in:
(1) Placing the health of the recipient in serious jeopardy;
(2) Placing the health of an unborn child of the recipient in serious jeopardy;
(3) A serious impairment of a bodily function of the recipient;
or (4) A serious dysfunction of any bodily organ or part of the recipient.
(b) “Medical facility” has the meaning ascribed to it in NRS 449.0151.
Sec.
50.
(Deleted by amendment.) Sec.
51.
(Deleted by amendment.) Sec.
Nothing in sections 44 to 51, inclusive, of this act shall be construed to require the Department or a Medicaid managed care entity to provide coverage:
If the Department violates sections 44 to 51, inclusive, of this act with respect to a particular request for prior authorization, the request shall be deemed approved.
For medical or dental care that, regardless of whether such the terms and conditions of Medicaid or the Children’s Healthnder Insurance Program, as applicable;
2.
or 2.
Nothing in sections 44 to 51, inclusive, of this act shall be construed to require the Department to provide coverage:
To a person who is not a recipient or is not otherwise eligible to receive coverage under Medicaid or the Children’s Health Insurance Program, as applicable, on the date on which medical or dental care is provided to the person.
(a) For medical or dental care that, regardless of whether such care is medically necessary, would not be a covered benefit under the terms and conditions of Medicaid or the Children’s Health Insurance Program, as applicable;
Secs.
or (b) To a person who is not a recipient or is not otherwise eligible to receive coverage under Medicaid or the Children’s Health Insurance Program, as applicable, on the date on which medical or dental care is provided to the person.
53-55.
Sec.
53.
54.
(Deleted by amendment.) Sec.
55.
NRS 422.403 is hereby amended to read as follows:
422.403 1.
The Department shall, by regulation, establish and manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs.
2.
The Drug Use Review Board shall:
- *AB463_R1* – 22 – (a) Advise the Department concerning the use by the Medicaid program of step therapy and prior authorization for prescription drugs;
(b) Develop step therapy protocols and prior authorization policies and procedures that comply with the provisions of sections 34 to 54, inclusive, of this act for use by the Medicaid program for prescription drugs;
and (c) Review and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols used by the Medicaid program for prescription drugs.
3.
The step therapy protocol established pursuant to this section must not apply to a drug approved by the Food and Drug Administration that is prescribed to treat a psychiatric condition of a recipient of Medicaid, if:
(a) The drug has been approved by the Food and Drug Administration with indications for the psychiatric condition of the insured or the use of the drug to treat that psychiatric condition is otherwise supported by medical or scientific evidence;
(b) The drug is prescribed by:
(1) A psychiatrist;
(2) A physician assistant under the supervision of a psychiatrist;
(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120;
or (4) A primary care provider that is providing care to an insured in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in Medicaid is located 60 miles or more from the residence of the recipient;
and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the recipient, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.
4.
The Department shall not require the Drug Use Review Board to develop, review or approve prior authorization policies or procedures necessary for the operation of the list of preferred prescription drugs developed pursuant to NRS 422.4025.
5.
The Department shall accept recommendations from the Drug Use Review Board as the basis for developing or revising step therapy protocols and prior authorization policies and procedures used by the Medicaid program for prescription drugs.
6.
As used in this section:
- *AB463_R1* – 23 – (a) “Medical or scientific evidence” has the meaning ascribed to it in NRS 695G.053.
(b) “Step therapy protocol” means a procedure that requires a recipient of Medicaid to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the recipient before Medicaid provides coverage for the recommended drug.
Sec.
608.1555 Any employer who provides benefits for health care to his or her employees shall provide the same benefits and pay providers of health care in the same manner as a policy of insurance pursuant to chapters 689A and 689B of NRS, including, without limitation, as required by paragraph (b) of subsection 1 of NRS 687B.225, subsection 2 of NRS 687B.225, NRS 687B.409, 687B.723 and 687B.725 [.] and sections 2 to 26, inclusive, of this act.
608.1555 Any employer who provides benefits for health care to his or her employees shall provide the same benefits and pay providers of health care in the same manner as a policy of insurance pursuant to chapters 689A and 689B of NRS, including, without limitation, as required by paragraph (b) of subsection 1 of NRS 687B.225, subsections 2, 3 and 4 of NRS 687B.225, NRS 687B.409, 687B.723 and 687B.725 [.] and sections 2 to 26, inclusive, of this act.
(b) To the Department of Health and Human Services before January 1, 2026, for medical or dental care provided to a recipient of Medicaid.
(b) To the Department of Health and Human Services or a or dental care provided to a recipient of Medicaid., for medical 2.
2.
As used in this section, “health carrier” has the meaning ascribed to it in section 7 of this act.
As used in this section:
Sec.
(a) “Health carrier” has the meaning ascribed to it in section 7 of this act.
58.
(b) “Medicaid managed care entity” has the meaning ascribed to it in section 39.5 of this act.
(Deleted by amendment.) Sec.
- 83rd Session (2025) – 10 – Sec.
59.
The provisions of NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.
Sec.
(a) Upon passage and approval for the purposes of adopting any regulations, performing any other preparatory administrative tasks - *AB463_R1* – 24 – that are necessary to carry out the provisions of this act and NRS 687B.225, as amended by section 27 of this act, and section 57 of this act;
(a) Upon passage and approval for the purposes of adopting any regulations, performing any other preparatory administrative tasks that are necessary to carry out the provisions of this act and approving procedures for obtaining prior authorization pursuant to NRS 687B.225, as amended by section 27 of this act, and section 57 of this act;
H - *AB463_R1*
~~~~~ 25 - 83rd Session (2025)
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Action History

  1. Chapter 475.

  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 printer. To reengrossment. Reengrossed. Second reprint. To Senate. In Senate. Read first time. Referred to Committee on Health and Human Services. To committee. From committee: Do pass.

  8. From committee: Amend, and do pass as amended. Placed on General File. Read third time. Amended. (Amend. No. 866.) Dispensed with reprinting. Read third time. Passed, as amended. Title approved, as amended. (Yeas: 42, Nays: None.) To printer.

  9. From printer. To engrossment. Engrossed. First reprint. To committee.

  10. From committee: Amend, and do pass as amended. Placed on Second Reading File. Read second time. Amended. (Amend. No. 480.) Taken from General File. Rereferred to Committee on Ways and Means. Exemption effective. To printer.

  11. Notice of eligibility for exemption.

  12. From printer. To committee.

  13. Read first time. Referred to Committee on Commerce and Labor. To printer.

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.

Show all 66 →

"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 463?
AB 463 is sponsored by Backus, Shea M. (Democratic).
What is the current status of AB 463?
This bill has been enacted into law. Introduced March 17, 2025. Enacted.
Where can I track AB 463?
Track AB 463 free on One Click Politics — get push/email alerts when it moves.

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