Gov. Joe Lombardo’s long-awaited health care policy proposal — initially hinted at in his January State of the State address — is set to be finally introduced with less than a month left in the state’s 120-day legislative session.

The legislation, SB495, previewed by The Nevada Independent before it was introduced Thursday, includes $50 million in appropriations for an expanded grant program for graduate medical education and policies aimed at alleviating the state’s provider shortage. It also proposes changing the state’s prior authorization process (where health plans require providers to obtain approval before delivering medical services or procedures), prohibiting noncompete clauses for providers and establishing an office of mental health.

Though the bill includes almost everything on health care that Lombardo mentioned during his January address, it did not address his call to split the Department of Health and Human Services into separate agencies: the Department of Human Services and the Nevada Health Authority.

Officials said Lombardo’s proposed budget includes the creation of the Nevada Health Authority, and Democratic and Republican legislative leaders in a recent IndyTalks panel indicated that a budget implementation bill recently arrived and will likely move forward.

While being introduced late in the session, Lombardo plans to hold a press conference highlighting the measure in Las Vegas on Thursday. Officials with the governor’s office said in interviews last week that providers and people from across the health care industry began working on the bill early last summer and that the Legislative Counsel Bureau has had draft language since the beginning of the session.

Nevada Medicaid Administrator Stacie Weeks told The Nevada Independent that the bill encompasses as much as it does because Lombardo was limited to five policy bills and wanted to ensure lawmakers made progress on his health care priorities.

Some of the bill’s individual proposals are present in other measures making their way through the legislative process — a sign that Weeks said represented bipartisan agreement that health care changes are needed. 

“There's clear frustration with prior authorizations, and there's clear desire from both parties, on both sides in Nevada, to do something different,” Weeks said. “These are separate ideas, but they're all similar … It just shows you that there's work to be done in that space.”

Though Lombardo’s bill is likely to be amended or tweaked if it advances in the Legislature,  Lindsey Miller, the governor's office’s health policy adviser, said the governor’s top goal is  passing good policy.

“Whoever that comes from that's not important to him,” Miller said. “He wants to work with members to get some of these things across the finish line.”

Details within the bill

As drafted, the legislation proposes the following:

• Creating a competitive grant program to address Nevada’s shortage of health care providers and funding it with $50 million over the two-year budget cycle and an additional transfer of $10 million from the Prescription Rebate budget account;
• Transferring authority of the state’s graduate medical education program from the Office of Science, Innovation and Technology to the Nevada Health Authority and requires the state to explore federal participation in Medicaid to support graduate medical education;
• Establishing an Office of Mental Health under the Department of Health and Human Services;
• Prohibiting noncompete clauses for health care providers;
• Prioritizing licensure applications from physicians who plan to work in underserved geographic areas or populations;
• Requiring Nevada’s Board of Dental Examiners to establish an alternative pathway to licensure as a dental hygienist during times of shortage that involves completing training hours with a licensed dentist;
• Allowing paramedics to serve as employees or volunteers in a hospital under certain circumstances;
• Requiring the Patient Protection Commission to study academic medical centers during the 2025-2026 interim and request no more than two legislative bills based on the results of the study;
• Expediting the process of credentialing providers of health care to participate in public and private health insurance plans;
• Standardizing new prior authorization timeline requirements for medical or dental care and payment of health insurance claims.

An earlier draft of the bill obtained by The Nevada Independent indicated that Lombardo’s office had considered allocating $35 million over the two-year budget cycle for the health care provider grant program. The draft included a legislative requirement for a two-thirds vote for passage — a requirement for any bill that raises or extends taxes. It was not immediately clear what provision triggered that requirement, but the bill as introduced no longer has that requirement.

The draft also included a now-axed provision to modify Nevada’s medical malpractice cap. The likely controversial proposal (which was debated extensively in 2023) would have set a cap on damages against physicians who serve as clinical faculty for postgraduate training programs to $200,000 — the existing cap for state and local government employees or officers.

Elements in Lombardo’s bill that are present in other measures include changes to prior authorizations, or when an insurance plan requires approval for certain treatments or prescriptions. At least eight bills on that topic have been proposed this session.

Lombardo’s bill would ban insurers and other entities from requiring prior authorization for covered emergency services and, by 2028, require insurers to implement an electronic system for receiving and processing prior authorization requests. It would also establish a gold card program for providers whose authorization requests are approved at least 95 percent of the time, allowing them to perform certain services without having to obtain prior authorization.

Weeks said the gold card program rewards high-performing, low-risk providers while protecting the system from fraud.

The bill would also prohibit insurers from revoking a prior authorization request that the carrier had previously approved, or delay or deny payment for medical or dental care unless the approval is fraudulent, a clerical error occurred or someone was not covered when the care was provided. The bill also stipulates that insurers will honor prior approved authorizations within the first 90 days of coverage.

There’s no time element in the bill for when prior approval for an approved procedure would run out, something that Assm. Duy Nguyen’s (D-Las Vegas) bill, AB290 sets at six months, and Assm. Heidi Kasama’s (R-Las Vegas) AB470 sets at 12 months.

The Lombardo bill’s sections on graduate medical education are also nearly identical to SB262, proposed by Sen. Julie Pazina (D-Las Vegas).

Pazina said in an earlier interview that she’s been working on her bill since 2023 and brought the legislation to address a critical shortage of providers.

“I think we all just want what's best, more accessible health care, and I'm happy that it's a priority for the governor's office because we need it,” Pazina said.

Both bills would place the existing Graduate Medical Education Grant Program under the Department of Health and Human Services and expand the grants that the program offers to include certain institutions that offer residency training programs. Lombardo’s proposal also requires the state to explore ways to use Medicaid to support graduate medical education.

Lombardo’s bill would direct the Department of Health and Human Services to explore ways to use participation in the federal Medicaid program to support grant programs, but does not allocate new funding.

The existing grant program established in 2015 has awarded 24 grants totaling $20 million to date with an annual training capacity of 132 physicians.

Pazina worked on the legislation with Sen. Robin Titus (R-Wellington), but Titus and other Republican lawmakers have not signed on as sponsors — in part because they wanted to support Lombardo’s bill.

Lombardo’s other major policy bills on housing, criminal justice, and economic development have already been introduced this session. As of Wednesday, only the housing bill has received a hearing.

This story was updated at 10:21 a.m. on 5/15/25 to clarify that the Legislative Counsel Bureau has had draft language of the measure since the beginning of the session and again at 1:22 p.m. to include the legislation after it was introduced on the Senate floor.