Existing law requires public and private policies of insurance regulated under Nevada law to include certain coverage. (NRS 287.010, 287.04335, 422.2717-422.27248, 689A.04033-689A.0465, 689B.0303-689B.0379, 689C.1655-689C.169, 689C.194-689C.195, 689C.425, 695A.184-695A.1875, 695B.1901-695B.1949, 695C.050, 695C.1691-695C.176, 695G.162-695G.177) Sections 13-15, 17, 19, 20, 22-25 and 27 of this bill require certain public and private health plans, including Medicaid and health plans for state and local government employees, to provide coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of cancer when such biomarker testing is supported by medical and scientific evidence. Sections 13-15, 17, 19, 20, 22-25 and 27 require such health plans to: (1) provide the required coverage in a manner that limits disruptions in care and the need for multiple specimens; and (2) establish a process for requesting an exception to a policy excluding coverage for biomarker testing for the diagnosis, treatment, management or ongoing monitoring of cancer or appealing a denial of coverage for such biomarker testing. Sections 13-17, 19, 20, 22-25 and 27 additionally require such health plans to respond to any request for preauthorization for such biomarker testing within: (1) 24 hours for urgent requests; or (2) 72 hours for all other requests. Sections 13-17, 19, 20, 22-25 and 27 clarify that an insurer is not required to cover biomarker testing for screening purposes or in certain circumstances. Sections 11, 18 and 21 of this bill make conforming changes to indicate the proper placement of sections 15, 17 and 20, respectively, in the Nevada Revised Statutes. Section 26 of this bill authorizes the Commissioner of Insurance to suspend or revoke the certificate of a health maintenance organization that fails to comply with the requirements of section 24 of this bill. The Commissioner would also be authorized to take such action against other private health insurers who fail to comply with the requirements of section 17, 19, 20, 22, 23 or 27 of this bill. (NRS 680A.200) Section 28.5 of this bill appropriates and authorizes the expenditure of money for the Division of Health Care Financing and Policy of the Department of Health and Human Services to contract with a qualified person to determine the cost-effectiveness of providing coverage for biomarker testing under Medicaid for the diagnosis, treatment, management or ongoing monitoring of diseases or conditions other than cancer. Section 29.5 of this bill requires the Joint Interim Standing Committee on Health and Human Services, in coordination with the Department of Health and Human Services, to conduct a study during the 2023-2024 interim concerning the cost-effectiveness of biomarker testing.

Statutes affected:
As Introduced: 232.320, 287.010, 287.04335, 687B.225, 689A.330, 689C.425, 695C.050, 695C.330
Reprint 1: 232.320, 287.010, 287.04335, 687B.225, 689A.330, 689C.425, 695C.050, 695C.330
Reprint 2: 232.320, 287.010, 287.04335, 687B.225, 689A.330, 689C.425, 695C.050, 695C.330
Reprint 3: 232.320, 287.010, 287.04335, 687B.225, 689A.330, 689C.425, 695C.050, 695C.330
As Enrolled: 232.320, 287.010, 287.04335, 687B.225, 689A.330, 689C.425, 695C.050, 695C.330
BDR: 232.320, 287.010, 287.04335, 687B.225, 689A.330, 689C.425, 695C.050, 695C.330