Assembly hears AB284 seeking Medicaid reimbursement rates for vagus nerve implants to restore coverage

Assembly Bill 284, sponsored by Assembly Chair Tracy Brown May, would require the director of the Division of Health and Human Services to request that the Centers for Medicare & Medicaid Services (CMS) establish Medicaid reimbursement rates for vagus nerve stimulation (VNS) implant devices and replacement generators used to treat epilepsy.

Brown May described cases where patients with implanted VNS devices need generator replacement every 5–7 years, but Nevada’s Medicaid state plan currently lacks a distinct, adequate reimbursement rate for the devices and replacement procedures. She told the committee that lack of a rate has led to situations where hospitals decline to perform replacements because the facility would sustain a net loss, and individual patients face delays in accessing maintenance for an implanted device that controls seizures.

Why it matters: witnesses and the sponsor told the committee that epilepsy care carries high costs for patients and hospitals — a claim illustrated by a witness who described significant medical debt after epilepsy care and by data the sponsor presented about implant counts and hospital losses.

Evidence presented Brown May provided utilization figures showing implants and replacements in 2022 and 2023: in 2022 Nevada recorded 26 implants (19 fee‑for‑service Medicaid; 7 managed care), including 10 new implants and 16 replacements; in 2023 there were 33 implants (16 fee‑for‑service; 17 managed care), including 9 new implants and 24 replacements. The sponsor told the committee a new implant cost $45,606 in 2022 and a generator priced at $34,985; she said hospitals experienced average losses of roughly $25,000 per patient under current rates and that total hospital spend was about $739,000 while Nevada fee‑for‑service Medicaid payments totaled $257,000 in the cited period.

Public testimony and supporters Health system and hospital representatives testified in support, as did individual patients. Catherine Nielsen, testifying in a personal capacity, described severe epilepsy care that required significant surgery and subsequent medical debt and urged coverage for device maintenance and replacement. Hospital advocacy (Hospital Corporation of America) and provider groups said restoring a separate rate would ensure continuity of care and sustain hospital willingness to perform replacement procedures.

Committee questions and next steps Members asked about specific rate calculations and referenced an 82% figure used in the draft language; Medicaid staff indicated the approach aligns with what other states have used when negotiating vendor pricing for expensive devices. The bill directs Nevada Medicaid to seek a rate from CMS and to ensure replacement devices are reimbursed separately from other medically necessary costs for the implantation procedure. The hearing closed with no vote recorded; the sponsor said the bill is intended to restore coverage and allow Medicaid to negotiate or secure an appropriate fee schedule entry through CMS.

Ending If enacted, AB284 would require Medicaid to pursue distinct CMS rates for VNS implants and replacement generators, a step supporters said is necessary to maintain access for patients who require generator replacement every several years.