NV SB398

Nevada Senate Bill 398 - Health Insurance Prior Authorization & Autism Coverage Reform

• Reduces prior authorization response deadlines from 20 days to 48 hours for non-urgent care and 24 hours for urgent care, requires adverse determinations to be made by licensed physicians/dentists in the same specialty as the treating provider, and prohibits denying claims when prior authorization wasn't required at the time of service

• Exempts healthcare providers from prior authorization requirements for specific services if the insurer approved 80% or more of their requests for those services in the previous year, with automatic annual reviews and appeals processes for revocations

• Expands mandatory autism spectrum disorder coverage from age 18 (or 22 if in high school) to age 27, removes the $72,000 annual cap on applied behavior analysis treatment, and prohibits excluding coverage for medically necessary autism care provided in school settings

• Prohibits health insurers from requiring prior authorization for emergency services, incidental procedures during already-authorized surgeries, and pain medication for terminally ill patients, and requires 60-minute response times for post-emergency follow-up care authorization

• Applies these prior authorization reforms to private health insurers, Medicaid, the Children's Health Insurance Program, and public employee benefit plans, with annual reporting requirements on approval rates, processing times, and use of artificial intelligence in authorization decisions