Nevada Health Reform Stalls: One Bill Advances Amidst Political Maneuvering

Prior Authorization Reforms Face Hurdles in Legislative Session

A critical effort to reform health insurance prior authorization processes in Nevada concluded with a surprising lack of significant change, as only one of nine proposed bills successfully navigated the legislative gauntlet.

Personal Stakes Drive Reform Push

Assemblywoman Heidi Kasama (R-Las Vegas) championed changes to the prior authorization system, a process requiring insurer approval before certain medical treatments or prescriptions. Her personal experience, waiting one to two months for her husband’s cancer treatment approval, underscored the urgency. She noted that her husband’s oncologist often spends more time battling insurers than treating patients.

“The cancer is just growing in him. It’s getting worse, and you’re helpless, because the sooner you can start treatment, the faster we have a chance at stopping this,” Kasama stated. “Time is critical with these terrible diseases.”

Widespread Frustration with System

This frustration is shared by many. Advocates, lawmakers, and federal officials alike have decried prior authorization as a major impediment to patient care, calling it a “huge frustration for patients” and “a pain point, a thorn in everyone’s side.” Insurers maintain the process is necessary to curb fraud and manage costs, particularly with increased advertising for treatments and drugs.

Governor’s Initiative Fails to Gain Traction

Governor Joe Lombardo had elevated the issue, pledging legislation for standardized, digitized prior authorization plans to expedite approvals. He highlighted the strain on Nevadans due to low provider-to-patient ratios. However, most of the nine measures, including proposals for faster response times, continuity of care, and exemptions for high-approval-rate doctors, were ultimately unsuccessful.

Legislative observers point to a complex mix of factors for the limited success: political maneuvering, state budget constraints, a lack of early coordination among bill proponents, and a rapidly evolving federal healthcare landscape. Insurers reportedly engaged in discussions for efficiency improvements but expressed reservations about mandates that could increase costs or prove impractical.

National Trends Mirror Nevada’s Challenges

The struggle with prior authorization is a nationwide issue. The process has garnered significant attention, amplified by a lawsuit against an algorithm used by Medicare Advantage enrollees for denying care and a notable incident involving the assassination of UnitedHealthcare CEO Brian Thompson. A 2023 report found that one in six insured adults had encountered difficulties with prior authorization in the preceding year. Nationally, 40 states considered over 110 pieces of legislation concerning prior authorization, with at least ten states enacting reforms in 2024.

Federal efforts under the Biden administration are being implemented to streamline prior authorization protocols. On June 23, Administrator of the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz, announced that major health insurers had voluntarily committed to reducing prior authorization requirements by January 2026, aiming for over 80 percent real-time electronic approvals by 2027. These pledges include standardizing electronic prior authorizations, reducing claims requiring pre-approval, and ensuring continuity of care.

The Centers for Medicare & Medicaid Services (CMS) is working to improve prior authorization, aiming for more electronic approvals by 2027. This comes after many states, including Nevada, saw reform efforts stall.#HealthcareReform #PriorAuthorization pic.twitter.com/0n0Q9vM7Xy

— World Today News (@WorldTodayNews) May 24, 2025

“This is not legislated,” Oz cautioned, emphasizing the voluntary nature of these industry commitments. “This is an opportunity for industry to show itself.” Michelle Long, a senior policy manager at KFF, noted that the effectiveness of these reforms hinges on the specifics of their implementation.

A Singular Success: AB463

The sole measure to survive the legislative session was Assembly Bill 463, sponsored by Assemblywoman Shea Backus (D-Las Vegas). This bill mandates that private insurers and Medicaid providers acknowledge prior authorization requests within two business days, with some exceptions. It also eliminates prior authorization for specific preventive care services, outpatient substance use disorder treatments, and glucose test strips for individuals with diabetes. These requirements are considered stricter than upcoming federal regulations.

“For me, this was personal, but after I realized the burdens that are placed on our doctors to almost be full-time claim processors to try to get patients needed care, I’m hoping this could ease some of the burdens, and hopefully we are moving in that right direction,” Backus commented on her bill’s passage.

Legislative Gridlock and Vetoes

Several other proposed bills failed to advance, including measures from minority party legislators that may have been overshadowed by Democratic priorities. Governor Lombardo also vetoed two bills: SB128, which aimed to limit AI in prior authorization denials, and SB217, which sought to remove prior authorization for fertility treatments. The governor cited concerns about hindering innovation and the cost of the fertility bill for Medicaid.

A notable casualty was SB495, the governor’s comprehensive reform bill. It included a ban on prior authorization for emergency services and a proposal for a “gold card” program for providers with high approval rates. The bill ultimately failed due to a contentious amendment introduced by Senator Fabian Doñate (D-Las Vegas) that restricted the licensing of freestanding emergency centers. Republicans opposed the amendment, viewing it as a de facto ban that could limit healthcare access, particularly in rural areas.

Senator Doñate defended the inclusion of the amendment, stating it aimed to address unregulated markets and fraud within freestanding emergency centers, which he believes overbill patients. He also indicated the amendment sought to unify regulations and establish checks on the governor’s proposed gold card program.