Section 422.272362 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to gender dysphoria and gender incongruence1. Except as otherwise provided in this section, the Director shall include in the State Plan for Medicaid a requirement that the State, to the extent authorized by federal law, must pay the nonfederal share of expenditures incurred for the medically necessary treatment of conditions relating to gender dysphoria and gender incongruence. Such treatment includes medically necessary psychosocial and surgical intervention and any other medically necessary treatment for such disorders provided by:(b) Pediatric endocrinologists;(g) Speech-language pathologists;(h) Primary care physicians;(i) Advanced practice registered nurses;(j) Physician assistants; and(k) Any other providers of medically necessary services for the treatment of gender dysphoria or gender incongruence.2. This section does not require the Director to include in the State Plan for Medicaid coverage for cosmetic surgery performed by a plastic surgeon or reconstructive surgeon that is not medically necessary.3. The Department shall not categorically refuse to cover any medically necessary gender-affirming treatments or procedures or revisions to prior treatments if the State Plan for Medicaid provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.4. When determining whether treatment is medically necessary for the purposes of this section, the Department must consider the most recent Standards of Care published by the World Professional Association for Transgender Health, or its successor organization.5. If a person appeals the denial of a payment or coverage under this section on the grounds that the treatment requested by the person is not medically necessary, the Division must consult with a provider of health care who has experience in prescribing or delivering gender-affirming treatment concerning the medical necessity of the treatment requested by the person when considering the appeal.6. As used in this section: (a) "Cosmetic surgery": (1) Means a surgical procedure that: (I) Does not meaningfully promote the proper function of the body;(II) Does not prevent or treat illness or disease; and(III) Is primarily directed at improving the appearance of a person.(2) Includes, without limitation, cosmetic surgery directed at preserving beauty.(b) "Gender dysphoria" means distress or impairment in social, occupational or other areas of functioning caused by a marked difference between the gender identity or expression of a person and the sex assigned to the person at birth which lasts at least 6 months and is shown by at least two of the following: (1) A marked difference between gender identity or expression and primary or secondary sex characteristics or anticipated secondary sex characteristics in young adolescents.(2) A strong desire to be rid of primary or secondary sex characteristics because of a marked difference between such sex characteristics and gender identity or expression or a desire to prevent the development of anticipated secondary sex characteristics in young adolescents.(3) A strong desire for the primary or secondary sex characteristics of the gender opposite from the sex assigned at birth.(4) A strong desire to be of the opposite gender or a gender different from the sex assigned at birth.(5) A strong desire to be treated as the opposite gender or a gender different from the sex assigned at birth.(6) A strong conviction of experiencing typical feelings and reactions of the opposite gender or a gender different from the sex assigned at birth.(c) "Medically necessary" means health care services or products that a prudent provider of health care would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:(1) Provided in accordance with generally accepted standards of medical practice;(2) Clinically appropriate with regard to type, frequency, extent, location and duration;(3) Not provided primarily for the convenience of the patient or provider of health care;(4) Required to improve a specific health condition of a patient or to preserve the existing state of health of the patient; and(5) The most clinically appropriate level of health care that may be safely provided to the patient.A provider of health care prescribing, ordering, recommending or approving a health care service or product does not, by itself, make that health care service or product medically necessary.
(d) "Provider of health care" has the meaning ascribed to it in NRS 629.031.Added to NRS by 2023, 2051Added by 2023, Ch. 376,§15, eff. 7/1/2023.