SB128

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 and 5 of this bill prohibit certain health insurers, including insurance for public employees, from solely using, employing or relying upon an artificial intelligence system or an automated decision tool to: (1) deny a request for prior authorization for medical or dental care; (2) modify a request for prior authorization for such care submitted by a provider of health care; (3) reduce the scope of services or amount of coverage for such care that is included within a request for prior authorization; or (4) terminate, reduce or modify coverage for previously approved medical or dental care. Sections 1, 4 and 5 also require such health insurers to approve a request for prior authorization for medical or dental care that is covered by the insurer, unless a licensed health care professional with the education, training and expertise necessary to evaluate the condition at issue determines that the care requested is not medically necessary or is experimental or investigational. 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 regist