Nye on Nevada, July 3

Private carriers must provide to transgender people

CARSON CITY — Private insurance carriers in Nevada cannot exclude or deny transgender people coverage for medically necessary treatments if such procedures are covered for other people, the state’s insurance commissioner said in a bulletin released Monday by a transgender advocacy group.

In the bulletin dated June 25, Insurance Commissioner Scott Kipper said both state law and administrative code “prohibit the denial, exclusion or limitation of benefits relating to coverage of medically necessary health care services on the basis of sex as it relates to gender identity or expression.”

Accordingly, the Division of Insurance, he said, will not approve policies with “exclusionary language” that deny such benefits or coverage.

The bulletin comes after the Nevada Public Employees Benefit Program voted in November to begin covering transgender health services on July 1 for state workers or their covered dependents insured through the state-funded program or affiliated Health Maintenance Organizations.

Previous language in the state insurance design plan excluded treatment designed to alter physical characteristics and any other treatment related to sex transformations. PEBP officials said an actuarial report concluded that providing coverage for transgender health procedures would have little to no impact on the program’s overall financial health or claims liabilities.

The city of Reno also recently began offering services for transgender procedures.

Mark Krueger, counsel for the Nevada Division of Insurance, said the bulletin “provides guidance for insurance carriers that they cannot any longer exclude any kind of medically necessary coverage based on gender identity or expression.”

Brock Maylath, president of the Transgender Allies Group, welcomed the directive.

“Most insurance have had language that denies coverage for certain medically necessary treatments for transgender people, based only on who they are, while covering identical procedures for others,” Maylath said. “This has been in violation of federal law, as well as the Nevada laws as indicated in this bulletin.”

The bulletin does not pertain to companies that have self-funded health plans, though Maylath said many big corporations provide transgender coverage.

Maylath said he is working with other state officials to expand transgender health benefits to Nevadans covered by Medicaid.

— Sandra Chereb

VA braces to bust its budget

WASHINGTON — The Veterans Affairs Department is bracing to bust its budget this year, partly because it has under­estimated the demand for care in places like Las Vegas, a House panel was told June 25.

Failure to predict workload increases in cities where more veterans are coming forward for services was just one of the reasons the VA is facing a $2.6 billion shortfall this year, officials told law­makers.

The VA has handled almost 3 million more appointments in the aftermath of scandal last year that found waiting lists were being manipulated to hide long waits for veterans to see doctors. The department expanded its capacity but still is being outstripped by demand.

“Clearly we are improving access, providing more care to more veterans. But the challenge is even more veterans are coming to VA for their care,” Deputy Secretary Sloan Gibson told the House Veterans Affairs Committee.

Costs for effective but expensive new drugs for hepatitis C also have overwhelmed the VA’s budget. And millions more veterans have been added to the medical rolls as the VA has pushed to speed processing of disability claims and appeals.

Gibson said the department also continues to be hampered by outdated technology that makes it difficult to predict demand and apportion resources.

The VA is facing a 10.5 percent workload increase while its budget in the past year was increased only 2.8 percent, according to an internal document examined by the Las Vegas Review-Journal.

In Southern Nevada, Gibson said the number of veterans receiving care since the new North Las Vegas VA Medical Center opened in 2013 has jumped 18 percent. In Phoenix, where the waiting list scandal first surfaced, the workload is up 11 percent while appointments for specialty care increased 16 percent.

At the hearing, Rep. Dina Titus, D-Nev., said it was not news that the number of Las Vegas veterans seeking care at the new medical center greatly exceeded expectations. The hospital’s emergency department already is being expanded.

Titus said the VA “doesn’t have a very good way to plan for demographic shifts or geographic shifts.

“I’ve been saying from the first day I worry about places like Las Vegas where the demand is increasing,” she said.

­— Steve Tetreault

Reid burns over burning man

U.S. Senate Minority Leader Harry Reid is weighing in on a flap between the U.S. Bureau of Land Management and organizers of Burning Man over the federal agency’s demand for VIP accommodations at this year’s free-expression and counterculture festival on the Black Rock Desert.

The Reno Gazette-Journal on Friday reported the BLM, which issues a permit for the event that draws tens of thousands of people to the remote desert, wants Burning Man to furnish flushing toilets, washers and dryers, hot running water and air conditioning for high-level government officials on the playa as a condition of the permit.

Burning Man organizers call the demand excessive and unprecedented. They also say it would cost the organization about $1 million to comply.

On Friday, Reid, D-Nev., sent a letter to Interior Secretary Sally Jewell calling the BLM’s requests “extravagant.”

“While I agree that the BLM should take its permitting duties seriously and work with Burning Man to both guarantee the safety of its participants and the protection of the environment, providing outlandishly unnecessary facilities for the BLM and its guests should be beyond the scope of the permitting requirements,” Reid wrote.

“Part of Burning Man’s philosophy is self-reliance and living with the elements is part of the experience,” he continued. “Flush toilets and laundry facilities can be found about 10 miles away in Gerlach, Nev., if BLM’s employees need such amenities.”

The festival has been held on the Black Rock Desert 100 miles north of Reno since the early 1990s, drawing tens of thousands of people from around the world. Last year about 65,000 attended.

Reid in his letter noted that the event brings “untold cultural benefits” to Nevada and contributes an estimated $35 million to the state’s economy each year.

This year’s festival runs Aug. 30 through Sept. 7.

— Sandra Chereb

Heller working on new relations with Cuba

WASHINGTON — Sen. Dean Heller, R-Nev., spent last weekend in Cuba, part of a delegation assessing progress in normalizing relations between the island nation and the United States.

Sen. Patrick Leahy, D-Vt., was leading a group of three senators during meetings in Havana and Santiago de Cuba, the country’s second-largest city.

The group, which also includes Sen. Ben Cardin, D-Md., met with Miguel Diaz-Canel, the first vice president and the heir apparent to Cuban leader Raul Castro.

The senators also were scheduled to meet with business representatives, religious leaders, foreign ambassadors, and local media at a press conference Saturday. The group arrived June 25 and was expected to return to Washington last Sunday.

“The delegation’s focus is on the unfolding progress toward normalization of relations between the United States and Cuba,” according to a press notice supplied by Heller’s office.

President Obama announced his intention last December to restore full relations with Cuba. The move signals an initial easing of some travel, banking and trade restrictions, and the possible consideration in Congress of lifting a trade embargo dating to the Cold War.

U.S. and Cuban officials also are in talks to reopen their embassies in Havana and Washington, respectively.

— Steve Tetreault

Sandra Chereb and Steve Tetreault are political reporters for the Las Vegas Review-Journal.