Background, Structure, and Requirements
Passed during the 2021 Legislative Session and signed into law by Governor Steve Sisolak on June 9, 2021, Nevada Senate Bill 420 requires the Director of the Department of Health and Human Services (DHHS), in consultation with the Commissioner of Insurance and the Executive Director of the Silver State Health Insurance Exchange, to design, establish, and operate a public option health benefit plan in its nongroup markets.
- All public option products are to satisfy state and federal standards required by insurance products sold in the Nevada Health Link (i.e., a qualified health plan under the Affordable Care Act).
- This means low- and middle-income consumers qualifying for federal premium subsidies under the ACA could apply their subsidies to the new product if purchased through the Exchange.
- The new law allows Nevada to require all health insurers that want to continue to participate in the State’s Medicaid managed care program to submit a good faith bid to also contract with the State to offer and administer products for the public option. The State may also invite non-Medicaid insurers to submit bids.
- The Director of DHHS will oversee the bidding process, using a statewide competitive process in conjunction with the State’s next procurement process for Medicaid managed care, in order to align purchasing incentives and leverage existing provider networks.
- State-contracted health insurers for the public option will be required to pay providers in-network reimbursement rates at least comparable to, or better than, Medicare rates for covered services.
Goals of the Nevada Public Option
The Director is required to prioritize bids reflecting the new law’s statutory goals.
Key goals of the public option plan include:
- Leverage state purchasing power to lower premiums and costs for health care for all Nevadans.
- Improve access and reduce disparities related to quality of care and outcomes for historically marginalized communities.
- Increase competition in individual health insurance rating areas to improve availability of coverage for rural Nevadans.
- Promote value-based health care financing.
- Nevada Public Option stakeholder engagement and waiver design public meetings will be held November 2021-January 2022.
- Specific stakeholder meeting dates will be added to the Public Option Meetings page.
- Join the notification list for the Public Option, simply click here and send the email
- To submit questions or comments, write to NVpublicoption@dhhs.nv.gov
UPCOMING DESIGN SESSION MEETINGS
Meeting agendas, links and documents are available here
- December 8, 2-3 PM
- Goals and Guiding Principles
- Overview of Legislation and 1332 Waivers
- Overview of Public Option Designs in Other States
- December 22, 2-3 PM
- Stakeholder Priorities for the Design of This Public Option (e.g., affordability, networks, access, provider reimbursement, etc.)
- January 5, 2-3 PM
- Affordability: Cost-Sharing and Premiums
- Health Plan Rate-Setting
- January 13, 1-2 PM
- Provider Contracting and Networks
- Value-Based Payment / Cost Containment
- January 18, 12-1 PM
- Strengthening the Individual and Small Group Markets
- Licensure and Oversight
- January 28, 1-2 PM
- Recap / Open Questions
- Next Steps (actuarial analysis, subsequent opportunities for stakeholder feedback, waiver development)
- SB420 requires the Director of the Department of Health and Human Services to apply for a Section 1332 State Innovation Waiver. For more information, the Centers for Medicare & Medicaid Services has a page dedicated to Section 1332: State Innovation Waivers.
- This website will be updated with additional information and materials as they become available.