Background - Improving Health Care Coverage One Piece at a Time
Passed during the 2021 Legislative Session, 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 new health plans.
Under this new coverage program, the Director must contract with health issuers to offer new state-contracted health plans to individuals who purchase their own health insurance. These new plans will be referred to as Battle Born State Plans (BBSPs). To comply with state law, the Director must offer the new BBSPs to consumers for purchase at Nevada Health Link (Nevada's Health Insurance Exchange) no later than January 1, 2026.
The new BBSPs will, for the most part, mirror other health plans sold on Nevada Health Link, with the same minimum benefits and cost-sharing requirements. They must also meet all the same state and federal requirements as other non-group health plans. The major difference is that the BBSPs must meet a premium reduction target to improve consumer affordability and satisfy all state goals and requirements set forth in the new contracts with issuers for this market.
Market Stabilization Program
To mitigate risks to providers and the marketplace with this new reform, Governor Joe Lombardo is seeking all necessary federal authority and funding as described below to establish a Market Stabilization Program. These new initiatives aim to protect the State's marketplace and ensure it remains a healthy and stable marketplace for Nevadans.
The key components of this program, if approved, will include:
- State-Based Reinsurance Program: A reinsurance program acts as "insurance for the issuers", subsidizing the cost of high-cost claims in the market. The reinsurance program, as designed by Nevada's waiver, will be the first in the nation to be fully funded by the federal government. A reinsurance program will alleviate financial risk to health issuers and their provider networks with the introduction of the new BBSPs. If approved, this new program will begin no later than January 1, 2027.
- Quality Incentive Program (QIP) for Issuers: The QIP is designed to reward issuers and their provider networks with an annual bonus payment for utilizing value-based efforts to improve health outcomes and quality of care for consumers. Over time, these efforts are expected to lead to system savings with greater efficiencies and a healthier population.
- "Practice in Nevada" Incentive Program for Health Care Providers: This new program will offer loan repayment options to providers who are willing to live and work in Nevada for at least four years. If a provider does not stay for the full four years, then the provider must pay back the full amount of the loan repayment from the State.
For questions, write to 1332WaiverProgram@dhcfp.nv.gov.
1332 Waiver Application
State law requires the Director to seek a Section 1332 Waiver of the Affordable Care Act to implement the new BBSPs and to capture any savings to the federal government because of the BBSPs. The Director must submit this waiver no later than January 1, 2024. Below is a link the State's submitted 1332 Waiver Application on December 29, 2023.
As described above, any federal savings received by the State for the new BBSPs will be used to finance a new Market Stabilization Program. To be approved, the waiver must provide coverage that is at least as comprehensive as the coverage provided without the waiver; provide coverage and cost-sharing protections against excessive out-of-pocket spending that are at least as affordable as without the waiver; provide coverage to at least a comparable number of residents as without the waiver; and not increase the federal deficit.
Next Steps: 1332 Waiver Application
Update February 13, 2024: The federal Centers for Medicare & Medicaid Services (CMS) and the Department of the Treasury have determined Nevada’s Section 1332 waiver application complete and opened a 30-day federal public comment period. Due to web issues delaying federal posting until today, the 30-day federal public comment period has been extended to March 14, 2024. To submit a public comment, please email stateinnovationwaivers@cms.hhs.gov. The CMS notice is available for review here.
February 12, 2024: The federal Centers for Medicare & Medicaid Services (CMS) and the Department of the Treasury have determined Nevada’s Section 1332 waiver application complete and opened a 30-day federal public comment period.
Public Comment on the 1332 Waiver
The formal public comment period for the 1332 Waiver Application and Actuarial Analysis of the Nevada Coverage and Market Stabilization Program took place for a 30-day period, from November 20th, 2023 to December 20, 2023. Below is a link to view all written public comments received during this formal public comment period.
The Division of Health Care Financing and Policy (DHCFP, Nevada Medicaid) hosted two public meetings where state staff presented a summary of the 1332 Waiver Application and Actuarial Analysis and collected public feedback. The meetings offered both virtual and in-person options for attendance. Meeting information can be found below. To submit written comments on the 1332 Waiver Application and Actuarial Analysis, please email: 1332WaiverProgram@dhcfp.nv.gov
Stay Informed
Sign up for the Nevada Market Stabilization Program ListServ and receive emails regarding meetings, documents, and presentations. We will not share your information and the number of emails is minimal.
To join the notification list for the Nevada Market Stabilization Program, simply click here and send the email. If you experience challenges signing up, write to the Market Stabilization Team 1332WaiverProgram@DHCFP.nv.gov.
Additional Information
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.
Archive Materials
Starting in 2021, DHCFP hosted several public meetings, design sessions with stakeholders, weekly office hours, and produced presentations and reports for interested parties about the new plans.