Nevada hearing on AB399 spotlights bariatric surgery coverage, insurers warn of cost impact on self-funded plans

A Nevada Assembly committee on Commerce and Labor heard testimony on Assembly Bill 399 on March 20, which would require certain public and private health insurance policies, including Medicaid and the state employee plan, to cover medically necessary treatments and care for diseases caused by severe obesity, including bariatric surgery.

The bill’s sponsor, Assemblymember Rebecca Edgeworth (Assembly District 35), said the measure focuses on ensuring access to bariatric surgery for adults with severe obesity, defined in bill language as a body-mass index of 40 or higher or 35 or higher with a related complication. “Bariatric surgery is one option that’s been tested over time and found to be very highly effective,” Edgeworth said.

Surgeons and patient advocates described clinical benefits and cost analyses. Dr. Pearl Ma, president-elect of the California and Nevada chapter of the American Society for Metabolic and Bariatric Surgery (ASMBS), said metabolic and bariatric surgery is a long‑term, evidence‑based treatment that can put type 2 diabetes and other conditions into remission. “On average, patients maintain about 60 percent excess weight loss at six months and 77 percent at 12 months,” Dr. Ma said. She cited typical procedural costs of $17,000 to $26,000 and said third‑party payers often recover those costs within two to four years because of reductions in comorbidities.

Chris Gallagher, federal policy consultant for the Obesity Action Coalition and a presenter for ASMBS, told lawmakers the bill aims to prohibit discriminatory utilization‑management practices some plans use, such as lengthy mandated preoperative weight‑loss periods. Gallagher described the legislation as allowing “reasonable prior authorization requirements,” including a surgeon’s attestation of medical necessity and a preoperative period capped at three months for required services.

Medical providers from Nevada hospitals supported the bill. Dr. Morgan Pomeranz, medical director of the bariatric surgery program at St. Rose Dominican’s San Martín campus, described typical length of stay as one day or outpatient and said preoperative and postoperative services are commonly bundled into global payment periods. Jacqueline Nguyen, representing the Nevada State Medical Association, said obesity is a disease and adding bariatric surgery as a covered option could reduce long‑term health care costs.

Self‑funded employer and trust plans testified in opposition or raised concerns about unfunded mandates. Ryan Beaman, representing the Professional Firefighters of Nevada and the Firefighters Health and Welfare Trust, said the bill would require trusts to absorb new coverage costs without additional funding. “Either we have to take pay decreases or provide these benefits,” Beaman said. John Abel, speaking for the Las Vegas Police Protective Association and the LVMPD Health Trust, said the trusts currently allow such surgeries under rules and worried that removing certain plan controls would be costly.

State agencies and insurers testified neutral or requested technical changes. Adam Plain of the Division of Insurance said aspects of the bill intersect with Nevada’s essential health benefits benchmark; the benchmark adopted in 2017 already included gastric restrictive surgical services for the individual and small‑group market. Shelly Caparo of the Nevada Association of Health Plans warned that benefit mandates can raise premiums, deductibles and out‑of‑pocket costs for consumers.

Committee members pressed on practical details: whether the bill would mandate coverage of GLP‑1 medications (sponsors said it would not and the focus is bariatric surgery), and how many states currently cover bariatric surgery in Medicaid and employer plans (Gallagher said roughly 47 state Medicaid programs and about 90 percent of commercial payers offer some coverage, while cautioning that utilization hurdles remain).

The hearing included patient and clinician testimony and questions about program design, prior authorization limits, the allowable preoperative period, and whether plans could continue to require accreditation by recognized surgical accreditation entities. No committee vote on the bill was recorded at the hearing.

The committee moved next to other measures. The bill’s sponsor asked the committee to consider amendments and to continue working with insurers and public plans on implementation language.

Votes or formal committee actions on AB399 were not recorded in the transcript of the hearing.