Gov. Joe Lombardo’s bill overhauling the state’s health care system received its first hearing on Tuesday, with legislators acknowledging the need to improve the system but raising concerns about proposals to establish an alternative licensing path for dental hygienists and fast-track insurance authorizations for providers with strong track records.

An amendment to the legislation presented before the joint Senate and Assembly Committee on Health and Human Services — just six days before the end of the 120-day session — would remove some sections of the bill that either cost money or are similar to other measures currently making their way through the legislative process.

In introductory remarks on SB495, Lombardo shared a story about his grandson, who needed emergency surgery for a severe ear infection, but there wasn’t a doctor at any hospital in Southern Nevada who could perform the procedure.

“Mercifully, by chance, there was a visiting surgeon from Texas in town who was able to treat my grandson and help me get him on the road to recovery,” he said. “The need for more doctors, nurses, specialists and health care providers is increasingly evident.”

Read more about Lombardo’s bill in our earlier story here.

The joint committee also heard the governor’s proposal to split the Department of Health and Human Services into the Department of Human Services and the Nevada Health Authority in the form of SB494. Lawmakers seemed generally open to the proposal, applauding the reorganization’s intent to improve health care service delivery and give the state more leverage — and hopefully better deals —when negotiating with insurers. 

The amendment to Lombardo’s main health care measure would remove all sections relating to the creation of the Nevada Health Care Workforce and Access Program, a proposed competitive funding program designed to support projects that address critical shortages of health care providers. 

Other sections removed included a proposed $50 million appropriation over the two-year budget cycle and an additional transfer of $10 million from the prescription rebate budget account — expenditures that could have spelled trouble for the bill as lawmakers face budget cuts amid economic uncertainty.

However, Nevada Medicaid Administrator Stacie Weeks told the committee that those portions of the program will be moved out of the governor’s bill and into SB434, sponsored by Senate Majority Leader Nicole Cannizzaro (D-Las Vegas), which establishes a grant program to address health care provider shortages.

The amendment also deleted sections that changed the state’s graduate medical education program, which were nearly identical to SB262, a bill introduced by Sen. Julie Pazina (D-Las Vegas). Pazina began working on the legislation in 2023 with Sen. Robin Titus (R-Wellington).  However, Titus and other Republican lawmakers did not sign on as sponsors, in part because they had wanted to support Lombardo’s bill.

“My office has worked with Sen. Pazina to incorporate my proposal to increase graduate medical education residency programs into her legislation, which will help us attract top talent and address critical provider shortages in underserved areas,” Lombardo said.

Pushback on the legislation

Lawmakers on the joint committee applauded the intent of the legislation, but raised questions about aspects of Lombardo’s proposal and even proposed their own changes.

Assm. Tracy Brown-May (D-Las Vegas) brought forward a conceptual amendment focused on children’s behavioral health care. 

During the hearing, Brown-May asked how Lombardo’s bill anticipates including children in the new Office of Mental Health and what performance indicators are in place to assess success. Department of Health and Human Services Director Richard Whitley said the office is looking at an integrated approach, and focusing on one age group would not be inclusive of other issues within the mental health system more broadly.

“That is no way to say the intent is not to have a focus on children,” Whitley said, referring to a Department of Justice report showing Nevada’s inadequate system of care for children. “It doesn’t stop when a child or an adolescent ages out … There is a strong case to be made to have an office of behavioral health under it.”

Whitley noted that the office’s scope should include dementia, substance abuse and other problems, and the Department of Justice assessments will help ensure the state is making progress.

Lawmakers also raised concerns about the potential for fraud in the proposed gold card program, which would allow providers whose authorization requests are approved at least 95 percent of the time to perform certain services without requiring prior authorization or approval from insurers.

The issue of prior authorization — when an insurance plan requires approval for certain treatments or prescriptions — has been a hot topic this legislative session with at least eight bills introduced on the subject.

Weeks said that several health plans already use the gold card method with providers, and Texas has successfully implemented a similar gold card program. 

“You guys have heard me many times talk about fraud, waste and abuse and how important I do think prior authorizations are,” Weeks said. “This bill does a nice job of striking a balance there.” 

She added the state’s insurance division will regularly review gold card providers while implementing the program.

But the most significant pushback on the legislation surrounded the bill’s proposed alternative licensing path for dental hygienists, which would require Nevada’s Board of Dental Examiners to establish the pathway during times of shortage and call for training hours with a licensed dentist.

Committee chair Sen. Fabian Doñate (D-Las Vegas) said lawmakers had “heartburn” surrounding the idea.

Sen. Angie Taylor (D-Reno) added that she had received “more emails than I ever expected on this particular issue” from dental hygienists raising concerns about a lack of oversight for the alternative pathway and dentists not fully understanding all aspects of what it means to be a dental hygienist.

Weeks responded by saying the bill proposes only a provisional license, and the abbreviated process is intended to get services out the door “in a more feasible manner than they are today because we are not having the access that we need in this state.”

Reports from the Nevada State Board of Dental Examiners indicate that there are about 1,600 licensed hygienists in the state. A lobbyist for the Nevada Dental Association noted that there are an estimated 30 or so full-time hygienists per 100,000 residents — less than half the national average. Supporters of the alternative path say this leads to extended wait times for cleanings and other oral hygiene issues as a result.

Pressed by lawmakers about the requirements for the alternative licensure pathway, Amy Abatan, a representative of the Nevada Dental Association, said the program prescribed by the governor follows the model of Alabama, which has had the program in place for more than five decades. 

She described the bill as a “stop-gap measure” that would help augment the number of practicing dental hygienists in a state where all 17 counties are experiencing a dental hygienist shortage. 

Abatan added that the licensing board will implement a formal curriculum along with examinations. Still, she said, for the large part, the hands-on training would occur in the dental office under the supervision of a dentist.

“I know the expectations and the demands of the job,” Abatan said. “I can say that every dentist practicing should have a perfect grasp of what periodontal condition is, what appropriate treatment means, and ensure that all of their patients are receiving that.”