ACA In Nevada – 2019 Update

The current Nevada Legislative session passed AB469 regarding Surprise Billing in emergency situations and has been signed into law by the Governor. There has been a situation for many years whereby you went into the hospital and when you got the bill, there was balance billing. It relates to doctors that are not in your insurance plan but work on a contracted basis for the hospital. ER Doctors are one example of non-contracted personnel that creates balanced billing. The new law requires the prohibition of an out of network provider from charging the patient an amount that exceeds their policy amount requirements.

This bill prohibits Nevada Emergency Providers from charging Nevada patients, who are members of Nevada purchased insurance plans, amounts above their insurance policy responsibility (critical access hospitals are exempt as well as patients with insurance policy sold outside Nevada)

Facilities previously contracted within the prior 12 months with a health insurance plan will be reimbursed an amount based upon their prior contract (108%) and 115% if the contract ended more than 12 months but less than 24 months. for situations where no contract has been in place for more than 24 months, the insurer will make an offer of payment to the provider who either accepts or rejects/provides a counteroffer. If the counteroffer is rejected, then the provider and 3rd party payer enter into “baseball style binding arbitration”

Emergency care provider reimbursement is similarly based and also takes into consideration of the length of time since a prior contract, the reason the contract ended (with or without cause), who initiated the termination, and whether the contract was terminated at the expiration of the contract or if it was terminated early.

This law becomes effective January 1, 2020 to allow for the regulations and processes to be adopted during the 2019 interim session (July to Dec 2019)

Another major change for 2020 is that Nevada is going to use their own state-based exchange rather than use the website. The main reason is the cost to use the federal website is more than the state wants to pay for usage. So, Nevada Health link has had a new software program written to handle the open enrollment period for the Affordable Care Act. What isn’t apparent yet is will there be a transfer of all information now on or will clients have to start over again on the state website? We will keep you informed as things develop.

The Barend Agency Inc.

Len Barend, broker


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