Nevada § 422.272362 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to gender dysphoria and gender incongruence

§ 422.272362. State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to gender dysphoria and gender incongruence

1. 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: (a) Endocrinologists; (b) Pediatric endocrinologists; (c) Social workers; (d) Psychiatrists; (e) Psychologists; (f) Gynecologists; (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 .