Bill
AB 399
Requires health plans to cover medically necessary treatment for severe obesity, including bariatric surgery and related services, for eligible adults.
Status (recorded)
- Introduced: Feb 4, 2025. Passed both houses (Assembly and Senate); enrolled and presented to Governor Sept 15, 2025.
- Vetoed by Governor: Oct 1, 2025. Consideration of the Governor’s veto pending. (Record also notes “Pursuant to Joint Standing Rule No. 14.3.1, no further action allowed.”)
Purpose
- Require certain public and private health insurance plans (including Medicaid and many commercial plans regulated under Nevada law) to cover medically necessary treatment and care for diseases and conditions caused by severe obesity — explicitly including bariatric (metabolic) surgery and related pre‑ and post‑operative services — subject to defined clinical and administrative conditions.
Key provisions (major substantive elements)
- Required coverage: Medically necessary treatment and care for diseases/conditions caused by “severe obesity,” including:
- Bariatric surgery for enrollees age 18+ and
- Related preoperative and postoperative services (psychological screening, counseling, behavior modification, physical therapy, nutrition education).
- Clinical eligibility (defines “severe obesity”):
- BMI ≥ 40; or
- BMI ≥ 35 with at least one comorbidity (examples given: hypertension, cardiopulmonary conditions, sleep apnea, diabetes).
- Preoperative and provider requirements:
- Insurers may require completion of a preoperative period of no more than 3 months including services recommended by the American Society for Metabolic and Bariatric Surgery (ASMBS).
- Insurers may require surgery to be performed at a facility with Metabolic and Bariatric Surgery Accreditation (e.g., MBSAQIP).
- Insurer may require a written statement from the treating physician that the procedure is medically necessary and meets ASMBS/ACS standards.
- Limits and exclusions (as introduced):
- Insurers may limit the number of bariatric surgeries to not more than one procedure per lifetime. (A proposed amendment would prohibit single‑lifetime limits.)
- Section 5 (as introduced) excludes coverage for injected glucose‑lowering drugs or other medications prescribed for weight loss. (A proposed amendment sought to remove this exclusion.)
- Effective date: Policies delivered/issued/renewed on or after Jan 1, 2026 must comply.
- Enforcement: Commissioner of Insurance authorized to take disciplinary action (including suspension/revocation of HMO certificate) against entities that fail to comply; Commissioner may also require out‑of‑state domestic issuers to meet the new standards.
- Medicaid: Director of DHHS to administer Medicaid provisions in same manner as other Medicaid rules.
Who would be affected
- Primary: insured individuals who meet the BMI/comorbidity/age criteria and seek bariatric surgery and related services.
- Insurers: health insurers and health maintenance organizations regulated under multiple Nevada Revised Statutes chapters (listed in the bill — e.g., chapters 689A, 689B, 689C, 695B, 695C, 695G, etc.). Division of Insurance analysis indicates the bill largely mirrors Nevada’s 2017 EHB benchmark; therefore, it would likely have little practical effect on individual and small‑group plans (which already must match the benchmark) but would affect large‑group plans and other policies not constrained by the benchmark.
- State & local government: fiscal effects anticipated — bill contains an unfunded mandate; fiscal note indicates effect on the state and possible local fiscal impact.
Stakeholder position and evidence cited
- Testimony and exhibits show strong support from bariatric surgeons, behavioral health clinicians, the Obesity Action Coalition, and the Obesity Care Advocacy Network. Materials cite clinical studies and economic analyses claiming bariatric surgery reduces mortality, resolves many comorbidities, and produces downstream cost savings within years.
Procedural / legal notes
- The bill as introduced mirrored coverage language in Nevada’s 2017 EHB benchmark (Health Plan of Nevada HPN Solutions HMO Platinum), which already included a gastric restrictive surgical benefit subject to limits and criteria. The Division of Insurance concluded the bill would not trigger federal defrayal because it mirrors the benchmark.
- Amendments proposed during committee work sought to (1) prohibit lifetime limits (i.e., allow more than one procedure if medically necessary) and (2) eliminate the explicit exclusion for weight‑loss drugs; these were proposed but were not part of the original introduced language.
Potential impacts (concise)
- Access: Would broaden guaranteed access to surgical and multidisciplinary treatment for severe obesity for insured Nevadans meeting criteria.
- Costs: Likely increased near‑term insurer/plan costs for surgical care and associated services; proponents cite published studies estimating medium‑term (2–4 year) downstream savings from reduced diabetes and medication use.
- Coverage gaps: As introduced, pharmacologic obesity treatments (AOMs) would remain excluded, potentially limiting non‑surgical treatment access unless amendments or separate policy changes are adopted.
For more detail
- Bill references and full text, Division of Insurance testimony, committee exhibits, and supporting fact sheets (cited studies and sources) are part of the legislative file available via the Nevada Legislature / NELIS.
Compiled from official sources — confirm details with the bill’s official record.
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