Existing law authorizes certain health insurers to require an insured to obtain prior authorization from the insurer before receiving certain care. (NRS 687B.225) Sections 1, 4, 5 and 8 of this bill prohibit certain health insurers, including Medicaid, the Children's Health Insurance Program and insurance for public employees, from using an artificial intelligence system or an automated decision tool to: (1) deny a request for prior authorization; (2) modify a request for prior authorization submitted by a provider of health care; (3) reduce the scope of services or amount of coverage for care that is included within a request for prior authorization; or (4) terminate, reduce or modify coverage for previously approved care. Sections 1, 4, 5 and 8 also prohibit such health insurers from denying or modifying a request for prior authorization on the grounds that the care requested is not medically necessary or is experimental or investigational, unless a licensed health care professional with the education, training and expertise necessary to evaluate the condition at issue first makes such a determination. Section 2 of this bill makes a conforming change to require the Director of the Department of Health and Human Services to administer the requirements set forth in section 8 in the same manner as other requirements governing Medicaid and the Children's Health Insurance Program. Sections 6 and 7 of this bill make conforming changes to clarify that certain provisions generally applicable to members of plans of self-insurance for employees of local governments and are applicable to the provisions of sections 4 and 5, respectively. Existing law requires a physician, physician assistant, advanced practice registered nurse or an osteopathic physician to counsel and provide certain information to a patient who is diagnosed with certain conditions. (NRS 630.3737, 632.2383, 633.6947) Sections 9-11 of this bill require a physician, physician assistant, advanced practice registered nurse or an osteopathic physician to: (1) discuss with a patient, upon diagnosing the patient with arthritis, osteoarthritis or any other condition that is regularly treated using stem cell therapy, the potential use of stem cell therapy to treat the condition; and (2) when acting as a provider of primary care during the first encounter with a new patient, inform the patient of options that may be available to the patient for donating, banking or storing stem cells for future use by the patient or a donee.

Statutes affected:
As Introduced: 687B.225, 232.320, 287.040, 287.0402
BDR: 687B.225, 232.320, 287.040, 287.0402