Signed by Governor Steve Sisolak

Vote Smart's Synopsis:

Vote to pass a bill that prohibits the practice of "surprise billing" for certain medically necessary emergency services.

Highlights:

• Defines “covered person” as a policyholder, subscriber, enrollee or other person covered by a third party (Sec. 3).

• Defines “in-network facility” as a hospital or independent center for emergency medical care that is an in-network provider and “In-facility provider” as a provider of health care for a covered person that has entered into a provider contract with a third party for the provision of health care to the covered person (Sec. 4-4.5).

• Defines “medically necessary emergency services” as health care services that are provided by a provider of health care to screen and stabilize a covered person after the sudden onset of a medical condition that manifests itself by symptoms of such sufficient severity that a prudent person would believe that the absence of immediate medical attention could result in (Sec. 6):

• Serious jeopardy to the health of the covered person;

• Serious jeopardy to the health of an unborn child of the covered person;

• Serious impairment of a bodily function of the covered person; or

• Serious dysfunction of any bodily organ or part of the covered person.

• Defines “out-of-network emergency facility” as a hospital or independent center for emergency medical care that is an out-of-network provider, and “out-of-facility provider” as a provider of health care for a covered person that has not entered into a provider contract with a third party for the provision of health care to the covered person (Sec. 6.5-7).

• Defines “provider contract” as a contract between a third party and an in-network provider to provide health care services to a covered person (Sec. 7.5).

• Defines “prudent person” as a person who is not a provider of healthcare, possesses an average knowledge of health and medicine, and is acting reasonably under the circumstances (Sec. 8.5). 

• Prohibits an out-of-network provider from not collecting from a covered person for medically necessary emergency services, and specifies that a covered person shall not be responsible for paying an amount that exceeds the copayment, coinsurance, or deductible required for such services provided by an in-network provider (Sec. 14).

• Authorizes an out-of-network emergency facility that provides medically necessary emergency services to notify a third party that provides coverage for the covered person no later than 8 hours after the covered person receives medically necessary emergency services and to specify that the condition of the covered person has stabilized to a degree where they may be transferred to an in-network emergency facility no later than 24 hours after the person’s emergency medical condition is stabilized (Sec. 14).

• Specifies that if an out-of-network emergency facility had a provider contract as an in-network emergency facility within 24 months immediately preceding the date on which the medically necessary emergency services were rendered to a covered person, then the third party shall pay the out-of-network emergency facility for those services (Sec. 15).

Full Bill Text