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Lawmakers weigh prior‑authorization and autism coverage changes in SB398 hearing
Summary
SB398 would tighten prior‑authorization timelines, require peer‑to‑peer reviews with same‑specialty clinicians, and address limits on coverage for applied behavior analysis (ABA) for autism; medical and disability advocates supported reform while insurers warned of cost and operational impacts.
Carson City — The Senate Commerce and Labor Committee heard testimony on SB398, a bill that aims to reform prior‑authorization processes across carriers and to modify coverage rules for therapies commonly used for autism spectrum disorder (ASD), including applied behavior analysis (ABA).
Sen. Lori Rogich described the bill as an effort to align state law with federal mental‑health parity standards and to reduce delays that stakeholders say harm patients. Dr. Samantha Schneider, a board‑certified dermatologist and Mohs surgeon, described clinical examples in which prior‑authorization delays affected cancer treatment and chronic dermatologic care and urged faster timelines and easier peer‑to‑peer reviews with appropriate specialists.
Families, autism providers and advocates emphasized the ABA provisions. Kim Mack Rosenberg, an attorney representing families and ABA providers, told the committee ABA is the accepted standard of care for ASD and said therapy should not be limited by age, arbitrary visit caps or place‑of‑service restrictions. Rosenberg argued such limits could violate federal parity rules and reduce functional gains for individuals who require therapy across settings.
Medical and mental‑health organizations — including the Nevada Psychiatric Association and the Nevada State Medical Association — supported prior‑authorization reform as a patient‑safety and access measure. Parents and provider groups urged removal of dollar and visit caps and an end to place‑of‑service exclusions that block school‑based or in‑community ABA when medically necessary.
Insurers and employer groups opposed broad prohibitions on prior authorization and raised operational concerns. The Nevada Association of Health Plans and AHIP said prior authorization is a tool to promote evidence‑based care and to reduce low‑value spending; they urged narrower, targeted reforms and asked for time to work with sponsors on operational details. The Division of Insurance explained that age alone cannot legally be used to terminate coverage and warned that removing statutory floors on maximum benefits could unintentionally reduce existing benefits unless the bill’s drafting is adjusted.
Several speakers asked the committee to reconcile SB398 with federal parity and Medicaid rules and to clarify whether removing a statutory $72,000 benchmark would alter existing coverage floors. The Division of Insurance recommended technical drafting fixes and offered to help the sponsor craft language that preserves or expands access without causing unintended reductions or fiscal consequences. The hearing record includes offers from insurers and advocates to continue negotiations.
