Text of NV SB 139 (2021)

S.B. 139 - *SB139* SENATE BILL NO. 139–SENATORS SCHEIBLE AND D. HARRIS FEBRUARY 22, 2021 ____________ Referred to Committee on Commerce and Labor SUMMARY—Requires certain health insurance to cover treatment of certain conditions relating to gender dysphoria. (BDR 57-54) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. CONTAINS UNFUNDED MANDATE (§§ 13, 14) (NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT) ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to insurance; requiring certain health insurance to include coverage for the treatment of conditions relating to gender dysphoria; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires public and private policies of health insurance regulated 1 under Nevada law to include certain coverage. (NRS 287.010, 287.04335, 2 422.2712-422.27241, 689A.04033-689A.0465, 689B.0303-689B.0379, 689C.1655- 3 689C.169, 689C.194, 689C.1945, 689C.195, 695A.184-695A.1875, 695B.1901- 4 695B.1948, 695C.1691-695C.176, 695G.162-695G.177) Existing law also requires 5 employers to provide certain benefits to employees, including the coverage required 6 for health insurers, if the employer provides health benefits for its employees. (NRS 7 608.1555) Sections 1, 3, 4, 6-8, 11 and 13-15 of this bill require certain public and 8 private policies of health insurance and health care plans, including Medicaid, to 9 cover the treatment of conditions relating to gender dysphoria, gender incongruence 10 and other disorders of sexual development. Sections 2, 5, 9, 10 and 12 of this bill 11 make conforming changes to indicate the placement of sections 1, 4, 8 and 15 in 12 the Nevada Revised Statutes. 13 – 2 – - *SB139* THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 689A of NRS is hereby amended by 1 adding thereto a new section to read as follows: 2 1. An insurer that issues a policy of health insurance shall 3 include in the policy coverage for the medically necessary 4 treatment of conditions relating to gender dysphoria, gender 5 incongruence and other disorders of sexual development. Such 6 coverage must include, without limitation, coverage of medically 7 necessary psychosocial and surgical intervention and any other 8 medically necessary treatment for such disorders provided by: 9 (a) Endocrinologists; 10 (b) Pediatric endocrinologists; 11 (c) Social workers; 12 (d) Psychiatrists; 13 (e) Psychologists; 14 (f) Voice therapists; 15 (g) Gynecologists; 16 (h) Plastic surgeons; and 17 (i) Any other providers of medically necessary services for the 18 treatment of gender dysphoria, gender incongruence and other 19 disorders of sexual development. 20 2. An insurer shall ensure that the benefits required by 21 subsection 1 are made available to an insured through a provider 22 of health care who participates in the network plan of the insurer. 23 3. A policy of health insurance subject to the provisions of 24 this chapter that is delivered, issued for delivery or renewed on or 25 after July 1, 2021, has the legal effect of including the coverage 26 required by subsection 1, and any provision of the policy that 27 conflicts with the provisions of this section is void. 28 4. As used in this section: 29 (a) “Gender dysphoria” means distress or impairment in 30 social, occupational or other areas of functioning caused by a 31 marked difference between the gender identity or expression of a 32 person and the sex assigned to the person at birth which lasts at 33 least 6 months and is shown by at least two of the following: 34 (1) A marked difference between gender identity or 35 expression and primary or secondary sex characteristics or 36 anticipated secondary sex characteristics in young adolescents. 37 (2) A strong desire to be rid of primary or secondary sex 38 characteristics because of a marked difference between such sex 39 characteristics and gender identity or expression or a desire to 40 prevent the development of anticipated secondary sex 41 characteristics in young adolescents. 42 – 3 – - *SB139* (3) A strong desire for the primary or secondary sex 1 characteristics of the gender opposite from the sex assigned at 2 birth. 3 (4) A strong desire to be of the opposite gender or a gender 4 different from the sex assigned at birth. 5 (5) A strong desire to be treated as the opposite gender or a 6 gender different from the sex assigned at birth. 7 (6) A strong conviction of experiencing typical feelings and 8 reactions of the opposite gender or a gender different from the sex 9 assigned at birth. 10 (b) “Medically necessary” means health care services or 11 products that a prudent provider of health care would provide to a 12 patient to prevent, diagnose or treat an illness, injury or disease, or 13 any symptoms thereof, that are necessary and: 14 (1) Provided in accordance with generally accepted 15 standards of medical practice; 16 (2) Clinically appropriate with regard to type, frequency, 17 extent, location and duration; 18 (3) Not primarily provided for the convenience of the 19 patient or provider of health care; 20 (4) Required to improve a specific health condition of a 21 patient or to preserve the existing state of health of the patient; 22 and 23 (5) The most clinically appropriate level of health care that 24 may be safely provided to the patient. 25 (c) “Network plan” means a policy of health insurance offered 26 by an insurer under which the financing and delivery of medical 27 care, including items and services paid for as medical care, are 28 provided, in whole or in part, through a defined set of providers 29 under contract with the insurer. The term does not include an 30 arrangement for the financing of premiums. 31 (d) “Provider of health care” has the meaning ascribed to it in 32 NRS 629.031. 33 Sec. 2. NRS 689A.330 is hereby amended to read as follows: 34 689A.330 If any policy is issued by a domestic insurer for 35 delivery to a person residing in another state, and if the insurance 36 commissioner or corresponding public officer of that other state has 37 informed the Commissioner that the policy is not subject to approval 38 or disapproval by that officer, the Commissioner may by ruling 39 require that the policy meet the standards set forth in NRS 689A.030 40 to 689A.320, inclusive [.] , and section 1 of this act. 41 Sec. 3. Chapter 689B of NRS is hereby amended by adding 42 thereto a new section to read as follows: 43 1. An insurer that issues a policy of group health insurance 44 shall include in the policy coverage for the medically necessary 45 – 4 – - *SB139* treatment of conditions relating to gender dysphoria, gender 1 incongruence and other disorders of sexual development. Such 2 coverage must include, without limitation, coverage of medically 3 necessary psychosocial and surgical intervention and any other 4 medically necessary treatment for such disorders provided by: 5 (a) Endocrinologists; 6 (b) Pediatric endocrinologists; 7 (c) Social workers; 8 (d) Psychiatrists; 9 (e) Psychologists; 10 (f) Voice therapists; 11 (g) Gynecologists; 12 (h) Plastic surgeons; and 13 (i) Any other providers of medically necessary services for the 14 treatment of gender dysphoria, gender incongruence and other 15 disorders of sexual development. 16 2. An insurer shall ensure that the benefits required by 17 subsection 1 are made available to an insured through a provider 18 of health care who participates in the network plan of the insurer. 19 3. A policy of group health insurance subject to the 20 provisions of this chapter that is delivered, issued for delivery or 21 renewed on or after July 1, 2021, has the legal effect of including 22 the coverage required by subsection 1, and any provision of the 23 policy that conflicts with the provisions of this section is void. 24 4. As used in this section: 25 (a) “Gender dysphoria” means distress or impairment in 26 social, occupational or other areas of functioning caused by a 27 marked difference between the gender identity or expression of a 28 person and the sex assigned to the person at birth which lasts at 29 least 6 months and is shown by at least two of the following: 30 (1) A marked difference between gender identity or 31 expression and primary or secondary sex characteristics or 32 anticipated secondary sex characteristics in young adolescents. 33 (2) A strong desire to be rid of primary or secondary sex 34 characteristics because of a marked difference between such sex 35 characteristics and gender identity or expression or a desire to 36 prevent the development of anticipated secondary sex 37 characteristics in young adolescents. 38 (3) A strong desire for the primary or secondary sex 39 characteristics of the gender opposite from the sex assigned at 40 birth. 41 (4) A strong desire to be of the opposite gender or a gender 42 different from the sex assigned at birth. 43 (5) A strong desire to be treated as the opposite gender or a 44 gender different from the sex assigned at birth. 45 – 5 – - *SB139* (6) A strong conviction of experiencing typical feelings and 1 reactions of the opposite gender or a gender different from the sex 2 assigned at birth. 3 (b) “Medically necessary” means health care services or 4 products that a prudent provider of health care would provide to a 5 patient to prevent, diagnose or treat an illness, injury or disease, or 6 any symptoms thereof, that are necessary and: 7 (1) Provided in accordance with generally accepted 8 standards of medical practice; 9 (2) Clinically appropriate with regard to type, frequency, 10 extent, location and duration; 11 (3) Not primarily provided for the convenience of the 12 patient or provider of health care; 13 (4) Required to improve a specific health condition of a 14 patient or to preserve the existing state of health of the patient; 15 and 16 (5) The most clinically appropriate level of health care that 17 may be safely provided to the patient. 18 (c) “Network plan” means a policy of group health insurance 19 offered by an insurer under which the financing and delivery of 20 medical care, including items and services paid for as medical 21 care, are provided, in whole or in part, through a defined set of 22 providers under contract with the insurer. The term does not 23 include an arrangement for the financing of premiums. 24 (d) “Provider of health care” has the meaning ascribed to it in 25 NRS 629.031. 26 Sec. 4. Chapter 689C of NRS is hereby amended by adding 27 thereto a new section to read as follows: 28 1. A carrier that issues a health benefit plan shall include in 29 the health benefit plan coverage for the medically necessary 30 treatment of conditions relating to gender dysphoria, gender 31 incongruence and other disorders of sexual development. Such 32 coverage must include, without limitation, coverage of medically 33 necessary psychosocial and surgical intervention and any other 34 medically necessary treatment for such disorders provided by: 35 (a) Endocrinologists; 36 (b) Pediatric endocrinologists; 37 (c) Social workers; 38 (d) Psychiatrists; 39 (e) Psychologists; 40 (f) Voice therapists; 41 (g) Gynecologists; 42 (h) Plastic surgeons; and 43 – 6 – - *SB139* (i) Any other providers of medically necessary services for the 1 treatment of gender dysphoria, gender incongruence and other 2 disorders of sexual development. 3 2. A carrier shall ensure that the benefits required by 4 subsection 1 are made available to an insured through a provider 5 of health care who participates in the network plan of the carrier. 6 3. A health benefit plan subject to the provisions of this 7 chapter that is delivered, issued for delivery or renewed on or after 8 July 1, 2021, has the legal effect of including the coverage 9 required by subsection 1, and any provision of the plan that 10 conflicts with the provisions of this section is void. 11 4. As used in this section: 12 (a) “Gender dysphoria” means distress or impairment in 13 social, occupational or other areas of functioning caused by a 14 marked difference between the gender identity or expression of a 15 person and the sex assigned to the person at birth which lasts at 16 least 6 months and is shown by at least two of the following: 17 (1) A marked difference between gender identity or 18 expression and primary or secondary sex characteristics or 19 anticipated secondary sex characteristics in young adolescents. 20 (2) A strong desire to be rid of primary or secondary sex 21 characteristics because of a marked difference between such sex 22 characteristics and gender identity or expression or a desire to 23 prevent the development of anticipated secondary sex 24 characteristics in young adolescents. 25 (3) A strong desire for the primary or secondary sex 26 characteristics of the gender opposite from the sex assigned at 27 birth. 28 (4) A strong desire to be of the opposite gender or a gender 29 different from the sex assigned at birth. 30 (5) A strong desire to be treated as the opposite gender or a 31 gender different from the sex assigned at birth. 32 (6) A strong conviction of experiencing typical feelings and 33 reactions of the opposite gender or a gender different from the sex 34 assigned at birth. 35 (b) “Medically necessary” means health care services or 36 products that a prudent provider of health care would provide to a 37 patient to prevent, diagnose or treat an illness, injury or disease, or 38 any symptoms thereof, that are necessary and: 39 (1) Provided in accordance with generally accepted 40 standards of medical practice; 41 (2) Clinically appropriate with regard to type, frequency, 42 extent, location and duration; 43 – 7 – - *SB139* (3) Not primarily provided for the convenience of the 1 patient or provider of health care; 2 (4) Required to improve a specific health condition of a 3 patient or to preserve the existing state of health of the patient; 4 and 5 (5) The most clinically appropriate level of health care that 6 may be safely provided to the patient. 7 (c) “Network plan” means a health benefit plan offered by a 8 carrier under which the financing and delivery of medical care, 9 including items and services paid for as medical care, are 10 provided, in whole or in part, through a defined set of providers 11 under contract with the carrier. The term does not include an 12 arrangement for the financing of premiums. 13 (d) “Provider of health care” has the meaning ascribed to it in 14 NRS 629.031. 15 Sec. 5. NRS 689C.425 is hereby amended to read as follows: 16 689C.425 A voluntary purchasing group and any contract 17 issued to such a group pursuant to NRS 689C.360 to 689C.600, 18 inclusive, are subject to the provisions of NRS 689C.015 to 19 689C.355, inclusive, and section 4 of this act, to the extent 20 applicable and not in conflict with the express provisions of NRS 21 687B.408 and 689C.360 to 689C.600, inclusive. 22 Sec. 6. Chapter 695A of NRS is hereby amended by adding 23 thereto a new section to read as follows: 24 1. A society that issues a benefit contract shall include in the 25 benefit contract coverage for the medically necessary treatment of 26 conditions relating to gender dysphoria, gender incongruence and 27 other disorders of sexual development. Such coverage must 28 include, without limitation, coverage of medically necessary 29 psychosocial and surgical intervention and any other medically 30 necessary treatment for such disorders provided by: 31 (a) Endocrinologists; 32 (b) Pediatric endocrinologists; 33 (c) Social workers; 34 (d) Psychiatrists; 35 (e) Psychologists; 36 (f) Voice therapists; 37 (g) Gynecologists; 38 (h) Plastic surgeons; and 39 (i) Any other providers of medically necessary services for the 40 treatment of gender dysphoria, gender incongruence and other 41 disorders of sexual development. 42 2. A society shall ensure that the benefits required by 43 subsection 1 are made available to an insured through a provider 44 of health care who participates in the network plan of the society. 45 – 8 – - *SB139* 3. A benefit contract subject to the provisions of this chapter 1 that is delivered, issued for delivery or renewed on or after July 1, 2 2021, has the legal effect of including the coverage required by 3 subsection 1, and any provision of the benefit contract that 4 conflicts with the provisions of this section is void. 5 4. As used in this section: 6 (a) “Gender dysphoria” means distress or impairment in 7 social, occupational or other areas of functioning caused by a 8 marked difference between the gender identity or expression of a 9 person and the sex assigned to the person at birth which lasts at 10 least 6 months and is shown by at least two of the following: 11 (1) A marked difference between gender identity or 12 expression and primary or secondary sex characteristics or 13 anticipated secondary sex characteristics in young adolescents. 14 (2) A strong desire to be rid of primary or secondary sex 15 characteristics because of a marked difference between such sex 16 characteristics and gender identity or expression or a desire to 17 prevent the development of anticipated secondary sex 18 characteristics in young adolescents. 19 (3) A strong desire for the primary or secondary sex 20 characteristics of the gender opposite from the sex assigned at 21 birth. 22 (4) A strong desire to be of the opposite gender or a gender 23 different from the sex assigned at birth. 24 (5) A strong desire to be treated as the opposite gender or a 25 gender different from the sex assigned at birth. 26 (6) A strong conviction of experiencing typical feelings and 27 reactions of the opposite gender or a gender different from the sex 28 assigned at birth. 29 (b) “Medically necessary” means health care services or 30 products that a prudent provider of health care would provide to a 31 patient to prevent, diagnose or treat an illness, injury or disease, or 32 any symptoms thereof, that are necessary and: 33 (1) Provided in accordance with generally accepted 34 standards of medical practice; 35 (2) Clinically appropriate with regard to type, frequency, 36 extent, location and duration; 37 (3) Not primarily provided for the convenience of the 38 patient or provider of health care; 39 (4) Required to improve a specific health condition of a 40 patient or to preserve the existing state of health of the patient; 41 and 42 (5) The most clinically appropriate level of health care that 43 may be safely provided to the patient. 44 – 9 – - *SB139* (c) “Network plan” means a benefit contract offered by a 1 society under which the financing and delivery of medical care, 2 including items and services paid for as medical care, are 3 provided, in whole or in part, through a defined set of providers 4 under contract with the society. The term does not include an 5 arrangement for the financing of premiums. 6 (d) “Provider of health care” has the meaning ascribed to it in 7 NRS 629.031. 8 Sec. 7. Chapter 695B of NRS is hereby amended by adding 9 thereto a new section to read as follows: 10 1. A hospital or medical services corporation that issues a 11 policy of health insurance shall include in the policy coverage for 12 the medically necessary treatment of conditions relating to gender 13 dysphoria, gender incongruence and other disorders of sexual 14 development. Such coverage must include, without limitation, 15 coverage of medically necessary psychosocial and surgical 16 intervention and any other medically necessary treatment for such 17 disorders provided by: 18 (a) Endocrinologists; 19 (b) Pediatric endocrinologists; 20 (c) Social workers; 21 (d) Psychiatrists; 22 (e) Psychologists; 23 (f) Voice therapists; 24 (g) Gynecologists; 25 (h) Plastic surgeons; and 26 (i) Any other providers of medically necessary services for the 27 treatment of gender dysphoria, gender incongruence and other 28 disorders of sexual development. 29 2. A hospital or medical services corporation shall ensure 30 that the benefits required by subsection 1 are made available to an 31 insured through a provider of health care who participates in the 32 network plan of the hospital or medical services corporation. 33 3. A policy of health insurance subject to the provisions of 34 this chapter that is delivered, issued for delivery or renewed on or 35 after July 1, 2021, has the legal effect of including the coverage 36 required by subsection 1, and any provision of the policy that 37 conflicts with the provisions of this section is void. 38 4. As used in this section: 39 (a) “Gender dysphoria” means distress or impairment in 40 social, occupational or other areas of functioning caused by a 41 marked difference between the gender identity or expression of a 42 person and the sex assigned to the person at birth which lasts at 43 least 6 months and is shown by at least two of the following: 44 – 10 – - *SB139* (1) A marked difference between gender identity or 1 expression and primary or secondary sex characteristics or 2 anticipated secondary sex characteristics in young adolescents. 3 (2) A strong desire to be rid of primary or secondary sex 4 characteristics because of a marked difference between such sex 5 characteristics and gender identity or expression or a desire to 6 prevent the development of anticipated secondary sex 7 characteristics in young adolescents. 8 (3) A strong desire for the primary or secondary sex 9 characteristics of the gender opposite from the sex assigned at 10 birth. 11 (4) A strong desire to be of the opposite gender or a gender 12 different from the sex assigned at birth. 13 (5) A strong desire to be treated as the opposite gender or a 14 gender different from the sex assigned at birth. 15 (6) A strong conviction of experiencing typical feelings and 16 reactions of the opposite gender or a gender different from the sex 17 assigned at birth. 18 (b) “Medically necessary” means health care services or 19 products that a prudent provider of health care would provide to a 20 patient to prevent, diagnose or treat an illness, injury or disease, or 21 any symptoms thereof, that are necessary and: 22 (1) Provided in accordance with generally accepted 23 standards of medical practice; 24 (2) Clinically appropriate with regard to type, frequency, 25 extent, location and duration; 26 (3) Not primarily provided for the convenience of the 27 patient or provider of health care; 28 (4) Required to improve a specific health condition of a 29 patient or to preserve the existing state of health of the patient; 30 and 31 (5) The most clinically appropriate level of health care that 32 may be safely provided to the patient. 33 (c) “Network plan” means a policy of health insurance offered 34 by a hospital or medical services corporation under which the 35 financing and delivery of medical care, including items and 36 services paid for as medical care, are provided, in whole or in part, 37 through a defined set of providers under contract with the hospital 38 or medical services corporation. The term does not include an 39 arrangement for the financing of premiums. 40 (d) “Provider of health care” has the meaning ascribed to it in 41 NRS 629.031. 42 – 11 – - *SB139* Sec. 8. Chapter 695C of NRS is hereby amended by adding 1 thereto a new section to read as follows: 2 1. A health maintenance organization that issues a health 3 care plan shall include in the health care plan coverage for the 4 medically necessary treatment of conditions relating to gender 5 dysphoria, gender incongruence and other disorders of sexual 6 development. Such coverage must include, without limitation, 7 coverage of medically necessary psychosocial and surgical 8 intervention and any other medically necessary treatment for such 9 disorders provided by: 10 (a) Endocrinologists; 11 (b) Pediatric endocrinologists; 12 (c) Social workers; 13 (d) Psychiatrists; 14 (e) Psychologists; 15 (f) Voice therapists; 16 (g) Gynecologists; 17 (h) Plastic surgeons; and 18 (i) Any other providers of medically necessary services for the 19 treatment of gender dysphoria, gender incongruence and other 20 disorders of sexual development. 21 2. A health maintenance organization must ensure that the 22 benefits required by subsection 1 are made available to an enrollee 23 through a provider of health care who participates in the network 24 plan of the health maintenance organization. 25 3. A health care plan subject to the provisions of this chapter 26 that is delivered, issued for delivery or renewed on or after July 1, 27 2021, has the legal effect of including the coverage required by 28 subsection 1, and any provision of the plan that conflicts with the 29 provisions of this section is void. 30 4. As used in this section: 31 (a) “Gender dysphoria” means distress or impairment in 32 social, occupational or other areas of functioning caused by a 33 marked difference between the gender identity or expression of a 34 person and the sex assigned to the person at birth which lasts at 35 least 6 months and is shown by at least two of the following: 36 (1) A marked difference between gender identity or 37 expression and primary or secondary sex characteristics or 38 anticipated secondary sex characteristics in young adolescents. 39 (2) A strong desire to be rid of primary or secondary sex 40 characteristics because of a marked difference between such sex 41 characteristics and gender identity or expression or a desire to 42 prevent the development of anticipated secondary sex 43 characteristics in young adolescents. 44 – 12 – - *SB139* (3) A strong desire for the primary or secondary sex 1 characteristics of the gender opposite from the sex assigned at 2 birth. 3 (4) A strong desire to be of the opposite gender or a gender 4 different from the sex assigned at birth. 5 (5) A strong desire to be treated as the opposite gender or a 6 gender different from the sex assigned at birth. 7 (6) A strong conviction of experiencing typical feelings and 8 reactions of the opposite gender or a gender different from the sex 9 assigned at birth. 10 (b) “Medically necessary” means health care services or 11 products that a prudent provider of health care would provide to a 12 patient to prevent, diagnose or treat an illness, injury or disease, or 13 any symptoms thereof, that are necessary and: 14 (1) Provided in accordance with generally accepted 15 standards of medical practice; 16 (2) Clinically appropriate with regard to type, frequency, 17 extent, location and duration; 18 (3) Not primarily provided for the convenience of the 19 patient or provider of health care; 20 (4) Required to improve a specific health condition of a 21 patient or to preserve the existing state of health of the patient; 22 and 23 (5) The most clinically appropriate level of health care that 24 may be safely provided to the patient. 25 (c) “Network plan” means a health care plan offered by a 26 health maintenance organization under which the financing and 27 delivery of medical care, including items and services paid for as 28 medical care, are provided, in whole or in part, through a defined 29 set of providers under contract with the health maintenance 30 organization. The term does not include an arrangement for the 31 financing of premiums. 32 (d) “Provider of health care” has the meaning ascribed to it in 33 NRS 629.031. 34 Sec. 9. NRS 695C.050 is hereby amended to read as follows: 35 695C.050 1. Except as otherwise provided in this chapter or 36 in specific provisions of this title, the provisions of this title are not 37 applicable to any health maintenance organization granted a 38 certificate of authority under this chapter. This provision does not 39 apply to an insurer licensed and regulated pursuant to this title 40 except with respect to its activities as a health maintenance 41 organization authorized and regulated pursuant to this chapter. 42 2. Solicitation of enrollees by a health maintenance 43 organization granted a certificate of authority, or its representatives, 44 – 13 – - *SB139* must not be construed to violate any provision of law relating to 1 solicitation or advertising by practitioners of a healing art. 2 3. Any health maintenance organization authorized under this 3 chapter shall not be deemed to be practicing medicine and is exempt 4 from the provisions of chapter 630 of NRS. 5 4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 6 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 7 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 8 695C.1751, 695C.1755, 695C.176 to 695C.200, inclusive, and 9 695C.265 do not apply to a health maintenance organization that 10 provides health care services through managed care to recipients of 11 Medicaid under the State Plan for Medicaid or insurance pursuant to 12 the Children’s Health Insurance Program pursuant to a contract with 13 the Division of Health Care Financing and Policy of the Department 14 of Health and Human Services. This subsection does not exempt a 15 health maintenance organization from any provision of this chapter 16 for services provided pursuant to any other contract. 17 5. The provisions of NRS 695C.1694 to 695C.1698, inclusive, 18 695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17345, 19 695C.1735, 695C.1745 and 695C.1757 and section 8 of this act 20 apply to a health maintenance organization that provides health care 21 services through managed care to recipients of Medicaid under the 22 State Plan for Medicaid. 23 Sec. 10. NRS 695C.330 is hereby amended to read as follows: 24 695C.330 1. The Commissioner may suspend or revoke any 25 certificate of authority issued to a health maintenance organization 26 pursuant to the provisions of this chapter if the Commissioner finds 27 that any of the following conditions exist: 28 (a) The health maintenance organization is operating 29 significantly in contravention of its basic organizational document, 30 its health care plan or in a manner contrary to that described in and 31 reasonably inferred from any other information submitted pursuant 32 to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 33 to those submissions have been filed with and approved by the 34 Commissioner; 35 (b) The health maintenance organization issues evidence of 36 coverage or uses a schedule of charges for health care services 37 which do not comply with the requirements of NRS 695C.1691 to 38 695C.200, inclusive, or 695C.207 [;] or section 8 of this act; 39 (c) The health care plan does not furnish comprehensive health 40 care services as provided for in NRS 695C.060; 41 (d) The Commissioner certifies that the health maintenance 42 organization: 43 (1) Does not meet the requirements of subsection 1 of NRS 44 695C.080; or 45 – 14 – - *SB139* (2) Is unable to fulfill its obligations to furnish health care 1 services as required under its health care plan; 2 (e) The health maintenance organization is no longer financially 3 responsible and may reasonably be expected to be unable to meet its 4 obligations to enrollees or prospective enrollees; 5 (f) The health maintenance organization has failed to put into 6 effect a mechanism affording the enrollees an opportunity to 7 participate in matters relating to the content of programs pursuant to 8 NRS 695C.110; 9 (g) The health maintenance organization has failed to put into 10 effect the system required by NRS 695C.260 for: 11 (1) Resolving complaints in a manner reasonably to dispose 12 of valid complaints; and 13 (2) Conducting external reviews of adverse determinations 14 that comply with the provisions of NRS 695G.241 to 695G.310, 15 inclusive; 16 (h) The health maintenance organization or any person on its 17 behalf has advertised or merchandised its services in an untrue, 18 misrepresentative, misleading, deceptive or unfair manner; 19 (i) The continued operation of the health maintenance 20 organization would be hazardous to its enrollees or creditors or to 21 the general public; 22 (j) The health maintenance organization fails to provide the 23 coverage required by NRS 695C.1691; or 24 (k) The health maintenance organization has otherwise failed to 25 comply substantially with the provisions of this chapter. 26 2. A certificate of authority must be suspended or revoked only 27 after compliance with the requirements of NRS 695C.340. 28 3. If the certificate of authority of a health maintenance 29 organization is suspended, the health maintenance organization shall 30 not, during the period of that suspension, enroll any additional 31 groups or new individual contracts, unless those groups or persons 32 were contracted for before the date of suspension. 33 4. If the certificate of authority of a health maintenance 34 organization is revoked, the organization shall proceed, immediately 35 following the effective date of the order of revocation, to wind up its 36 affairs and shall conduct no further business except as may be 37 essential to the orderly conclusion of the affairs of the organization. 38 It shall engage in no further advertising or solicitation of any kind. 39 The Commissioner may, by written order, permit such further 40 operation of the organization as the Commissioner may find to be in 41 the best interest of enrollees to the end that enrollees are afforded 42 the greatest practical opportunity to obtain continuing coverage for 43 health care. 44 – 15 – - *SB139* Sec. 11. Chapter 695G of NRS is hereby amended by adding 1 thereto a new section to read as follows: 2 1. A managed care organization that issues a health care 3 plan shall include in the health care plan coverage for the 4 medically necessary treatment of conditions relating to gender 5 dysphoria, gender incongruence and other disorders of sexual 6 development. Such coverage must include, without limitation, 7 coverage of medically necessary psychosocial and surgical 8 intervention and any other medically necessary treatment for such 9 disorders provided by: 10 (a) Endocrinologists; 11 (b) Pediatric endocrinologists; 12 (c) Social workers; 13 (d) Psychiatrists; 14 (e) Psychologists; 15 (f) Voice therapists; 16 (g) Gynecologists; 17 (h) Plastic surgeons; and 18 (i) Any other providers of medically necessary services for the 19 treatment of gender dysphoria, gender incongruence and other 20 disorders of sexual development. 21 2. A managed care organization shall ensure that the benefits 22 required by subsection 1 are made available to an insured through 23 a provider of health care who participates in the network plan of 24 the managed care organization. 25 3. A health care plan subject to the provisions of this chapter 26 that is delivered, issued for delivery or renewed on or after July 1, 27 2021, has the legal effect of including the coverage required by 28 subsection 1, and any provision of the plan that conflicts with the 29 provisions of this section is void. 30 4. As used in this section: 31 (a) “Gender dysphoria” means distress or impairment in 32 social, occupational or other areas of functioning caused by a 33 marked difference between the gender identity or expression of a 34 person and the sex assigned to the person at birth which lasts at 35 least 6 months and is shown by at least two of the following: 36 (1) A marked difference between gender identity or 37 expression and primary or secondary sex characteristics or 38 anticipated secondary sex characteristics in young adolescents. 39 (2) A strong desire to be rid of primary or secondary sex 40 characteristics because of a marked difference between such sex 41 characteristics and gender identity or expression or a desire to 42 prevent the development of anticipated secondary sex 43 characteristics in young adolescents. 44 – 16 – - *SB139* (3) A strong desire for the primary or secondary sex 1 characteristics of the gender opposite from the sex assigned at 2 birth. 3 (4) A strong desire to be of the opposite gender or a gender 4 different from the sex assigned at birth. 5 (5) A strong desire to be treated as the opposite gender or a 6 gender different from the sex assigned at birth. 7 (6) A strong conviction of experiencing typical feelings and 8 reactions of the opposite gender or a gender different from the sex 9 assigned at birth. 10 (b) “Medically necessary” means health care services or 11 products that a prudent provider of health care would provide to a 12 patient to prevent, diagnose or treat an illness, injury or disease, or 13 any symptoms thereof, that are necessary and: 14 (1) Provided in accordance with generally accepted 15 standards of medical practice; 16 (2) Clinically appropriate with regard to type, frequency, 17 extent, location and duration; 18 (3) Not primarily provided for the convenience of the 19 patient or provider of health care; 20 (4) Required to improve a specific health condition of a 21 patient or to preserve the existing state of health of the patient; 22 and 23 (5) The most clinically appropriate level of health care that 24 may be safely provided to the patient. 25 (c) “Network plan” means a health care plan offered by a 26 managed care organization under which the financing and 27 delivery of medical care, including items and services paid for as 28 medical care, are provided, in whole or in part, through a defined 29 set of providers under contract with the managed care 30 organization. The term does not include an arrangement for the 31 financing of premiums. 32 (d) “Provider of health care” has the meaning ascribed to it in 33 NRS 629.031. 34 Sec. 12. NRS 232.320 is hereby amended to read as follows: 35 232.320 1. The Director: 36 (a) Shall appoint, with the consent of the Governor, 37 administrators of the divisions of the Department, who are 38 respectively designated as follows: 39 (1) The Administrator of the Aging and Disability Services 40 Division; 41 (2) The Administrator of the Division of Welfare and 42 Supportive Services; 43 (3) The Administrator of the Division of Child and Family 44 Services; 45 – 17 – - *SB139* (4) The Administrator of the Division of Health Care 1 Financing and Policy; and 2 (5) The Administrator of the Division of Public and 3 Behavioral Health. 4 (b) Shall administer, through the divisions of the Department, 5 the provisions of chapters 63, 424, 425, 427A, 432A to 442, 6 inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 7 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 8 section 15 of this act, 422.580, 432.010 to 432.133, inclusive, 9 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 10 and 445A.010 to 445A.055, inclusive, and all other provisions of 11 law relating to the functions of the divisions of the Department, but 12 is not responsible for the clinical activities of the Division of Public 13 and Behavioral Health or the professional line activities of the other 14 divisions. 15 (c) Shall administer any state program for persons with 16 developmental disabilities established pursuant to the 17 Developmental Disabilities Assistance and Bill of Rights Act of 18 2000, 42 U.S.C. §§ 15001 et seq. 19 (d) Shall, after considering advice from agencies of local 20 governments and nonprofit organizations which provide social 21 services, adopt a master plan for the provision of human services in 22 this State. The Director shall revise the plan biennially and deliver a 23 copy of the plan to the Governor and the Legislature at the 24 beginning of each regular session. The plan must: 25 (1) Identify and assess the plans and programs of the 26 Department for the provision of human services, and any 27 duplication of those services by federal, state and local agencies; 28 (2) Set forth priorities for the provision of those services; 29 (3) Provide for communication and the coordination of those 30 services among nonprofit organizations, agencies of local 31 government, the State and the Federal Government; 32 (4) Identify the sources of funding for services provided by 33 the Department and the allocation of that funding; 34 (5) Set forth sufficient information to assist the Department 35 in providing those services and in the planning and budgeting for the 36 future provision of those services; and 37 (6) Contain any other information necessary for the 38 Department to communicate effectively with the Federal 39 Government concerning demographic trends, formulas for the 40 distribution of federal money and any need for the modification of 41 programs administered by the Department. 42 (e) May, by regulation, require nonprofit organizations and state 43 and local governmental agencies to provide information regarding 44 the programs of those organizations and agencies, excluding 45 – 18 – - *SB139* detailed information relating to their budgets and payrolls, which the 1 Director deems necessary for the performance of the duties imposed 2 upon him or her pursuant to this section. 3 (f) Has such other powers and duties as are provided by law. 4 2. Notwithstanding any other provision of law, the Director, or 5 the Director’s designee, is responsible for appointing and removing 6 subordinate officers and employees of the Department. 7 Sec. 13. NRS 287.010 is hereby amended to read as follows: 8 287.010 1. The governing body of any county, school 9 district, municipal corporation, political subdivision, public 10 corporation or other local governmental agency of the State of 11 Nevada may: 12 (a) Adopt and carry into effect a system of group life, accident 13 or health insurance, or any combination thereof, for the benefit of its 14 officers and employees, and the dependents of officers and 15 employees who elect to accept the insurance and who, where 16 necessary, have authorized the governing body to make deductions 17 from their compensation for the payment of premiums on the 18 insurance. 19 (b) Purchase group policies of life, accident or health insurance, 20 or any combination thereof, for the benefit of such officers and 21 employees, and the dependents of such officers and employees, as 22 have authorized the purchase, from insurance companies authorized 23 to transact the business of such insurance in the State of Nevada, 24 and, where necessary, deduct from the compensation of officers and 25 employees the premiums upon insurance and pay the deductions 26 upon the premiums. 27 (c) Provide group life, accident or health coverage through a 28 self-insurance reserve fund and, where necessary, deduct 29 contributions to the maintenance of the fund from the compensation 30 of officers and employees and pay the deductions into the fund. The 31 money accumulated for this purpose through deductions from the 32 compensation of officers and employees and contributions of the 33 governing body must be maintained as an internal service fund as 34 defined by NRS 354.543. The money must be deposited in a state or 35 national bank or credit union authorized to transact business in the 36 State of Nevada. Any independent administrator of a fund created 37 under this section is subject to the licensing requirements of chapter 38 683A of NRS, and must be a resident of this State. Any contract 39 with an independent administrator must be approved by the 40 Commissioner of Insurance as to the reasonableness of 41 administrative charges in relation to contributions collected and 42 benefits provided. The provisions of NRS 687B.408, 689B.030 to 43 689B.050, inclusive, and section 3 of this act, 689B.287 and 44 689B.500 apply to coverage provided pursuant to this paragraph, 45 – 19 – - *SB139* except that the provisions of NRS 689B.0378, 689B.03785 and 1 689B.500 only apply to coverage for active officers and employees 2 of the governing body, or the dependents of such officers and 3 employees. 4 (d) Defray part or all of the cost of maintenance of a self- 5 insurance fund or of the premiums upon insurance. The money for 6 contributions must be budgeted for in accordance with the laws 7 governing the county, school district, municipal corporation, 8 political subdivision, public corporation or other local governmental 9 agency of the State of Nevada. 10 2. If a school district offers group insurance to its officers and 11 employees pursuant to this section, members of the board of trustees 12 of the school district must not be excluded from participating in the 13 group insurance. If the amount of the deductions from compensation 14 required to pay for the group insurance exceeds the compensation to 15 which a trustee is entitled, the difference must be paid by the trustee. 16 3. In any county in which a legal services organization exists, 17 the governing body of the county, or of any school district, 18 municipal corporation, political subdivision, public corporation or 19 other local governmental agency of the State of Nevada in the 20 county, may enter into a contract with the legal services 21 organization pursuant to which the officers and employees of the 22 legal services organization, and the dependents of those officers and 23 employees, are eligible for any life, accident or health insurance 24 provided pursuant to this section to the officers and employees, and 25 the dependents of the officers and employees, of the county, school 26 district, municipal corporation, political subdivision, public 27 corporation or other local governmental agency. 28 4. If a contract is entered into pursuant to subsection 3, the 29 officers and employees of the legal services organization: 30 (a) Shall be deemed, solely for the purposes of this section, to be 31 officers and employees of the county, school district, municipal 32 corporation, political subdivision, public corporation or other local 33 governmental agency with which the legal services organization has 34 contracted; and 35 (b) Must be required by the contract to pay the premiums or 36 contributions for all insurance which they elect to accept or of which 37 they authorize the purchase. 38 5. A contract that is entered into pursuant to subsection 3: 39 (a) Must be submitted to the Commissioner of Insurance for 40 approval not less than 30 days before the date on which the contract 41 is to become effective. 42 (b) Does not become effective unless approved by the 43 Commissioner. 44 – 20 – - *SB139* (c) Shall be deemed to be approved if not disapproved by the 1 Commissioner within 30 days after its submission. 2 6. As used in this section, “legal services organization” means 3 an organization that operates a program for legal aid and receives 4 money pursuant to NRS 19.031. 5 Sec. 14. NRS 287.04335 is hereby amended to read as 6 follows: 7 287.04335 If the Board provides health insurance through a 8 plan of self-insurance, it shall comply with the provisions of NRS 9 687B.409, 689B.255, 695G.150, 695G.155, 695G.160, 695G.162, 10 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.170 to 11 695G.174, inclusive, and section 11 of this act, 695G.177, 12 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, 13 and 695G.405, in the same manner as an insurer that is licensed 14 pursuant to title 57 of NRS is required to comply with those 15 provisions. 16 Sec. 15. Chapter 422 of NRS is hereby amended by adding 17 thereto a new section to read as follows: 18 1. The Director shall include in the State Plan for Medicaid a 19 requirement that the State, to the extent authorized by federal law, 20 must pay the nonfederal share of expenditures incurred for the 21 medically necessary treatment of conditions relating to gender 22 dysphoria, gender incongruence and other disorders of sexual 23 development. Such treatment includes, without limitation, 24 psychosocial and surgical intervention and any other medically 25 necessary treatment for these disorders provided by: 26 (a) Endocrinologists; 27 (b) Pediatric endocrinologists; 28 (c) Social workers; 29 (d) Psychiatrists; 30 (e) Psychologists; 31 (f) Voice therapists; 32 (g) Gynecologists; 33 (h) Plastic surgeons; and 34 (i) Any other providers of medically necessary services for the 35 treatment of gender dysphoria, gender incongruence and other 36 disorders of sexual development. 37 2. As used in this section: 38 (a) “Gender dysphoria” means distress or impairment in 39 social, occupational or other areas of functioning caused by a 40 marked difference between the gender identity or expression of a 41 person and the sex assigned to the person at birth which lasts at 42 least 6 months and is shown by at least two of the following: 43 – 21 – - *SB139* (1) A marked difference between gender identity or 1 expression and primary or secondary sex characteristics or 2 anticipated secondary sex characteristics in young adolescents. 3 (2) A strong desire to be rid of primary or secondary sex 4 characteristics because of a marked difference between such sex 5 characteristics and gender identity or expression or a desire to 6 prevent the development of anticipated secondary sex 7 characteristics in young adolescents. 8 (3) A strong desire for the primary or secondary sex 9 characteristics of the gender opposite from the sex assigned at 10 birth. 11 (4) A strong desire to be of the opposite gender or a gender 12 different from the sex assigned at birth. 13 (5) A strong desire to be treated as the opposite gender or a 14 gender different from the sex assigned at birth. 15 (6) A strong conviction of experiencing typical feelings and 16 reactions of the opposite gender or a gender different from the sex 17 assigned at birth. 18 (b) “Medically necessary” means health care services or 19 products that a prudent provider of health care would provide to a 20 patient to prevent, diagnose or treat an illness, injury or disease, or 21 any symptoms thereof, that are necessary and: 22 (1) Provided in accordance with generally accepted 23 standards of medical practice; 24 (2) Clinically appropriate with regard to type, frequency, 25 extent, location and duration; 26 (3) Not primarily provided for the convenience of the 27 patient or provider of health care; 28 (4) Required to improve a specific health condition of a 29 patient or to preserve the existing state of health of the patient; 30 and 31 (5) The most clinically appropriate level of health care that 32 may be safely provided to the patient. 33 (c) “Provider of health care” has the meaning ascribed to it in 34 NRS 629.031. 35 Sec. 16. The provisions of NRS 354.599 do not apply to any 36 additional expenses of a local government that are related to the 37 provisions of this act. 38 Sec. 17. This act becomes effective on July 1, 2021. 39 H