NEVADA

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The Nevada SBL became effective January 1, 2020. Nevada Revised Statutes 439B.748, 751 and 754. The relevant provisions of the Nevada law include:

• A 30-day window to object to payment and go to arbitration.
• Absent recent contractual reimbursement rates (24 months for facilities and 12 months for practitioners), the standard of reimbursement is “fair and reasonable.”
• Claims below $5,000 are arbitrated locally; claims above are before AAA.

Regarding bifurcation, according to CMS,

Nevada does not have an applicable All-Payer Model Agreement that would determine the out-of-network rate. Based on the survey response and CMS communications with Nevada Department of Insurance staff, CMS understands that NRS 439B.748, 751 and 754 are specified state laws that will apply for purposes of determining the out-of-network rate with respect to medically necessary emergency services furnished to individuals in health benefit plans, the Public Employees’ Benefits Program and other organizations under NRS 439B.736(1)(c) in Nevada by an out-of-network emergency facility or out-of-network provider. Specifically, NRS 439B.748 provides predetermined payment amounts to out-of-network emergency facilities for emergency services if the facility had a provider contract as an in-network emergency facility within the 24 months immediately preceding the date on which the medically necessary emergency services were rendered to a covered person. NRS 439B.751 provides predetermined payment amounts to out-of-network providers that provide emergency services if the provider had a contract as an in-network provider within the 12 months immediately preceding the date on which the medically necessary emergency services were rendered to a covered person. NRS 439B.754 is a specified state law providing a method for determining the out of network rate when an out-of-network emergency facility did not have a contract 24 months prior to the rendering of the emergency services, an out-of-network provider did not have a contract 12months prior to the rendering of the emergency services, or if the third party that provides coverage for the covered person terminated the most recent applicable provider contract between the third party and the out-of-network provider for cause before it was scheduled to expire. The federal independent dispute resolution process under section 2799A-1(c) of the PHS Act and 45 CFR 149.510 will apply for purposes of determining the out-of-network rate with respect to any items and services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Nevada by nonparticipating providers and nonparticipating emergency facilities to which NRS 439B.748, 751 and 754 does not apply. The federal independent dispute resolution process under section 2799A-2(b) of the PHS Act and 45 CFR 149.520 will apply for purposes of determining the out-of-network rate with respect to services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Nevada by nonparticipating providers of air ambulance services. CMS will enforce the outcome of the federal independent dispute resolution process for cases in Nevada. Patient.

Letter from CMS to Governor of Nevada, dated February 24, 2022.