[Rev. 3/13/2024 9:50:59 AM]

Link to Page 1998

 

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ê2023 Statutes of Nevada, Page 1999ê

 

CHAPTER 370, SB 493

Senate Bill No. 493–Committee on Finance

 

CHAPTER 370

 

[Approved: June 12, 2023]

 

AN ACT making appropriations to and authorizing the expenditure of money by the Department of Health and Human Services for the replacement or purchase of computer hardware and associated software, data lines and software licenses; and providing other matters properly relating thereto.

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1.  There is hereby appropriated from the State General Fund to the Patient Protection Commission within the Office of the Director of the Department of Health and Human Services the sum of $8,613 for the replacement of computer hardware and associated software.

      Sec. 2.  1.  There is hereby appropriated from the State General Fund to the Department of Health and Human Services the sum of $45,220 for the Health and Human Services Administration budget account for the replacement of computer hardware and associated software.

      2.  Expenditure of $626 not appropriated from the State General Fund or the State Highway Fund is hereby authorized during Fiscal Year 2023-2024 and Fiscal Year 2024-2025 by the Department of Health and Human Services for the same purpose as set forth in subsection 1.

      Sec. 3.  1.  There is hereby appropriated from the State General Fund to the Department of Health and Human Services the sum of $3,779 for the State Council on Developmental Disabilities budget account for the replacement of computer hardware and associated software.

      2.  Expenditure of $11,337 not appropriated from the State General Fund or the State Highway Fund is hereby authorized during Fiscal Year 2023-2024 and Fiscal Year 2024-2025 by the Department of Health and Human Services for the same purpose as set forth in subsection 1.

      Sec. 4.  1.  There is hereby appropriated from the State General Fund to the Department of Health and Human Services the sum of $22,119 for the Data Analytics budget account for the replacement of computer hardware and associated software.

      2.  Expenditure of $21,764 not appropriated from the State General Fund or the State Highway Fund is hereby authorized during Fiscal Year 2023-2024 and Fiscal Year 2024-2025 by the Department of Health and Human Services for the same purpose as set forth in subsection 1.

      Sec. 5.  There is hereby appropriated from the State General Fund to the Department of Health and Human Services the sum of $4,444 for the Data Analytics budget account for additional data lines and software licenses.

      Sec. 6.  Any remaining balance of the appropriations made by sections 1 to 5, inclusive, of this act must not be committed for expenditure after June 30, 2025, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 19, 2025.

 


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ê2023 Statutes of Nevada, Page 2000 (CHAPTER 370, SB 493)ê

 

to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 19, 2025.

      Sec. 7.  This act becomes effective upon passage and approval.

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CHAPTER 371, SB 491

Senate Bill No. 491–Committee on Finance

 

CHAPTER 371

 

[Approved: June 12, 2023]

 

AN ACT relating to the Department of Business and Industry; extending the date of reversion of the appropriation made by the 81st Session of the Nevada Legislature to the Real Estate Division of the Department for an update of its licensing software system; making appropriations; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      During the 2021 Legislative Session, the Nevada Legislature appropriated $693,670 from the State General Fund to the Real Estate Division of the Department of Business and Industry for an update of its licensing software system. Any remaining balance of that appropriation was required to be reverted to the State General Fund on or before September 15, 2023. (Chapter 452, Statutes of Nevada 2021, at page 2866) Section 1 of this bill extends the reversion date to on or before September 19, 2025.

      Sections 2-6 of this bill make various appropriations to the Department of Business and Industry for the replacement or purchase of computer hardware, software and related licenses and certain equipment.

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. Section 1 of chapter 452, Statutes of Nevada 2021, at page 2866, is hereby amended to read as follows:

       Section 1.  1.  There is hereby appropriated from the State General Fund to the Real Estate Division of the Department of Business and Industry the sum of $693,670 for an update of its licensing software system.

       2.  Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after June 30, [2023,] 2025, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September [15, 2023,] 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September [15, 2023.]

 


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ê2023 Statutes of Nevada, Page 2001 (CHAPTER 371, SB 491)ê

 

granted or transferred, and must be reverted to the State General Fund on or before September [15, 2023.] 19, 2025.

      Sec. 2.  There is hereby appropriated from the State General Fund to the Office of Business Finance and Planning within the Department of Business and Industry the sum of $2,804 for the replacement of computer hardware and associated software.

      Sec. 3.  There is hereby appropriated from the State General Fund to the Department of Business and Industry the sum of $292,175 for the Business and Industry Administration budget account for the replacement of computer hardware and associated software and video conferencing equipment and for the purchase of recording software, backup data storage equipment and licenses for online training software.

      Sec. 4.  There is hereby appropriated from the State General Fund to the Real Estate Division of the Department of Business and Industry the sum of $75,986 for the replacement of computer hardware and associated software.

      Sec. 5.  There is hereby appropriated from the State Highway Fund to the Nevada Transportation Authority of the Department of Business and Industry the sum of $35,135 for the replacement of computer hardware and associated software.

      Sec. 6.  There is hereby appropriated from the State General Fund to the Office of Labor Commissioner of the Department of Business and Industry the sum of $144,853 for the replacement of computer hardware and associated software and equipment for servers and for the purchase of software for license applications by professional employer organizations, as defined in NRS 611.400.

      Sec. 7.  Any remaining balance of the appropriations made by sections 2 to 6, inclusive, of this act must not be committed for expenditure after June 30, 2025, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the fund from which it was appropriated on or before September 19, 2025.

      Sec. 8.  This act becomes effective upon passage and approval.

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ê2023 Statutes of Nevada, Page 2002ê

 

CHAPTER 372, SB 490

Senate Bill No. 490–Committee on Finance

 

CHAPTER 372

 

[Approved: June 12, 2023]

 

AN ACT making appropriations to the Nevada Gaming Control Board for the continuation of the replacement of the Board’s information technology system and for certain computer hardware, software, subscriptions, licenses and equipment and related employee training; and providing other matters properly relating thereto.

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1.  There is hereby appropriated from the State General Fund to the Nevada Gaming Control Board the sum of $8,000,000 for the continuation of the replacement of the Board’s information technology system.

      Sec. 1.5.  1.  There is hereby appropriated from the State General Fund to the Interim Finance Committee for allocation to the Nevada Gaming Control Board the sum of $5,500,000 to pay for the continuation of the replacement of the Board’s information technology system.

      2.  Money appropriated by subsection 1 may be allocated to the Nevada Gaming Control Board with the approval of the Interim Finance Committee, upon the recommendation of the Governor and submittal of documentation demonstrating progress towards the replacement of the Nevada Gaming Control Board’s information technology system.

      Sec. 2.  There is hereby appropriated from the State General Fund to the Nevada Gaming Control Board the sum of $1,731,841 for the replacement or purchase of computer hardware, software, subscriptions, licenses and equipment and related employee training.

      Sec. 3.  Any remaining balance of the appropriations made by sections 1, 1.5 and 2 of this act must not be committed for expenditure after June 30, 2025, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 19, 2025.

      Sec. 4.  This act becomes effective upon passage and approval.

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ê2023 Statutes of Nevada, Page 2003ê

 

CHAPTER 373, SB 412

Senate Bill No. 412–Committee on Judiciary

 

CHAPTER 373

 

[Approved: June 12, 2023]

 

AN ACT relating to criminal justice; revising provisions governing early discharge from probation; revising the definition of the term “strangulation” as it relates to the crime of battery; prohibiting certain acts involving the use, possession or carrying of a firearm during the commission of certain drug offenses; revising provisions relating to warnings against trespassing; providing a penalty; making an appropriation to the Department of Public Safety to purchase two machines capable of testing for fentanyl and its derivatives and measuring the concentration thereof in mixtures; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law requires the Division of Parole and Probation of the Department of Public Safety to petition the court to recommend the early discharge of a person from probation if the person satisfies certain requirements, including not having been convicted of a violent or sexual offense or abuse, neglect or endangerment of a child. (NRS 176A.840) Section 11 of this bill adds certain offenses involving a firearm and invasion of the home to such disqualifying offenses for purposes of the early discharge of a person from probation.

      Existing law establishes the definition of and the penalties for the crime of battery. (NRS 200.481) Section 14 of this bill revises the definition of the term “strangulation” as it relates to the crime of battery.

      Existing law prohibits the ownership or possession of firearms by certain persons. (NRS 202.360) Section 15 of this bill additionally prohibits a person from using or carrying a firearm during and in relation to, or possessing a firearm in furtherance of, the commission of certain drug offenses and provides that a person who violates any such provision is guilty of a category B felony.

      Existing law generally provides that a person who, under circumstances not amounting to a burglary, willfully goes or remains upon any land or in any building after having been warned by the owner or occupant thereof not to trespass is guilty of a misdemeanor. (NRS 207.200) Section 36.5 of this bill requires that such a warning by an owner or occupant must have been given during the previous 24 months.

      Section 57.5 of this bill makes an appropriation from the State General Fund to the Department of Public Safety for the purpose of purchasing two machines that are capable of testing for fentanyl and its derivatives and measuring the concentration thereof in mixtures.

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Sections 1-10. (Deleted by amendment.)

      Sec. 11. NRS 176A.840 is hereby amended to read as follows:

      176A.840  1.  The Division shall petition the court to recommend the early discharge of a person from probation if the person:

      (a) Has not violated any condition of probation during the immediately preceding 12 months;

 


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ê2023 Statutes of Nevada, Page 2004 (CHAPTER 373, SB 412)ê

 

      (b) Is current with any fee to defray the costs of his or her supervision charged by the Division pursuant to NRS 213.1076;

      (c) Has paid restitution ordered by the court in full or, because of economic hardship that is verified by the Division, has been unable to make restitution as ordered by the court;

      (d) Has completed any program of substance use treatment or mental health treatment or a specialty court program as mandated by the court or the Division; and

      (e) Has not been convicted of a violent or sexual offense as defined in NRS 202.876 or a violation of NRS 200.508 [.] or 205.067.

      2.  This section must not be construed to prohibit the court from allowing the early discharge of a person from probation if the person does not meet the requirements set forth in subsection 1.

      Secs. 12 and 13. (Deleted by amendment.)

      Sec. 14. NRS 200.481 is hereby amended to read as follows:

      200.481  1.  As used in this section:

      (a) “Battery” means any willful and unlawful use of force or violence upon the person of another.

      (b) “Child” means a person less than 18 years of age.

      (c) “Fire-fighting agency” has the meaning ascribed to it in NRS 239B.020.

      (d) “Officer” means:

             (1) A person who possesses some or all of the powers of a peace officer;

             (2) A person employed in a full-time salaried occupation of fire fighting for the benefit or safety of the public;

             (3) A member of a volunteer fire department;

             (4) A jailer, guard, matron or other correctional officer of a city or county jail or detention facility;

             (5) A prosecuting attorney of an agency or political subdivision of the United States or of this State;

             (6) A justice of the Supreme Court, judge of the Court of Appeals, district judge, justice of the peace, municipal judge, magistrate, court commissioner, master or referee, including, without limitation, a person acting pro tempore in a capacity listed in this subparagraph;

             (7) An employee of this State or a political subdivision of this State whose official duties require the employee to make home visits;

             (8) A civilian employee or a volunteer of a law enforcement agency whose official duties require the employee or volunteer to:

                   (I) Interact with the public;

                   (II) Perform tasks related to law enforcement; and

                   (III) Wear identification, clothing or a uniform that identifies the employee or volunteer as working or volunteering for the law enforcement agency;

             (9) A civilian employee or a volunteer of a fire-fighting agency whose official duties require the employee or volunteer to:

                   (I) Interact with the public;

                   (II) Perform tasks related to fire fighting or fire prevention; and

                   (III) Wear identification, clothing or a uniform that identifies the employee or volunteer as working or volunteering for the fire-fighting agency; or

 


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ê2023 Statutes of Nevada, Page 2005 (CHAPTER 373, SB 412)ê

 

             (10) A civilian employee or volunteer of this State or a political subdivision of this State whose official duties require the employee or volunteer to:

                   (I) Interact with the public;

                   (II) Perform tasks related to code enforcement; and

                   (III) Wear identification, clothing or a uniform that identifies the employee or volunteer as working or volunteering for this State or a political subdivision of this State.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 200.471.

      (f) “School employee” means a licensed or unlicensed person employed by a board of trustees of a school district pursuant to NRS 391.100 or 391.281.

      (g) “Sporting event” has the meaning ascribed to it in NRS 41.630.

      (h) “Sports official” has the meaning ascribed to it in NRS 41.630.

      (i) “Strangulation” means intentionally [impeding the normal breathing or circulation of the blood by] applying sufficient pressure [on the throat or neck or by blocking the nose or mouth of] to another person [in a manner that creates a risk of death or substantial bodily harm.] to make it difficult or impossible for the person to breathe, including, without limitation, applying pressure to the neck, throat or windpipe that may prevent or hinder breathing or reduce the intake of air, or applying any pressure to the neck on either side of the windpipe, but not the windpipe itself, to stop the flow of blood to the brain via the carotid arteries.

      (j) “Taxicab” has the meaning ascribed to it in NRS 706.8816.

      (k) “Taxicab driver” means a person who operates a taxicab.

      (l) “Transit operator” means a person who operates a bus or other vehicle as part of a public mass transportation system.

      2.  Except as otherwise provided in NRS 200.485, a person convicted of a battery, other than a battery committed by an adult upon a child which constitutes child abuse, shall be punished:

      (a) If the battery is not committed with a deadly weapon, and no substantial bodily harm to the victim results, except under circumstances where a greater penalty is provided in this section or NRS 197.090, for a misdemeanor.

      (b) If the battery is not committed with a deadly weapon, and either substantial bodily harm to the victim results or the battery is committed by strangulation, for a category C felony as provided in NRS 193.130.

      (c) If:

             (1) The battery is committed upon an officer, provider of health care, school employee, taxicab driver or transit operator who was performing his or her duty or upon a sports official based on the performance of his or her duties at a sporting event;

             (2) The officer, provider of health care, school employee, taxicab driver, transit operator or sports official suffers substantial bodily harm or the battery is committed by strangulation; and

             (3) The person charged knew or should have known that the victim was an officer, provider of health care, school employee, taxicab driver, transit operator or sports official,

Ê for a category B felony by imprisonment in the state prison for a minimum term of not less than 2 years and a maximum term of not more than 10 years, or by a fine of not more than $10,000, or by both fine and imprisonment.

 


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ê2023 Statutes of Nevada, Page 2006 (CHAPTER 373, SB 412)ê

 

      (d) If the battery is committed upon an officer, provider of health care, school employee, taxicab driver or transit operator who is performing his or her duty or upon a sports official based on the performance of his or her duties at a sporting event and the person charged knew or should have known that the victim was an officer, provider of health care, school employee, taxicab driver, transit operator or sports official, for a gross misdemeanor, except under circumstances where a greater penalty is provided in this section.

      (e) If the battery is committed with the use of a deadly weapon, and:

             (1) No substantial bodily harm to the victim results, for a category B felony by imprisonment in the state prison for a minimum term of not less than 2 years and a maximum term of not more than 10 years, and may be further punished by a fine of not more than $10,000.

             (2) Substantial bodily harm to the victim results or the battery is committed by strangulation, for a category B felony by imprisonment in the state prison for a minimum term of not less than 2 years and a maximum term of not more than 15 years, and may be further punished by a fine of not more than $10,000.

      (f) If the battery is committed by a probationer, a prisoner who is in lawful custody or confinement or a parolee, without the use of a deadly weapon, whether or not substantial bodily harm results and whether or not the battery is committed by strangulation, for a category B felony by imprisonment in the state prison for a minimum term of not less than 1 year and a maximum term of not more than 6 years.

      (g) If the battery is committed by a probationer, a prisoner who is in lawful custody or confinement or a parolee, with the use of a deadly weapon, and:

             (1) No substantial bodily harm to the victim results, for a category B felony by imprisonment in the state prison for a minimum term of not less than 2 years and a maximum term of not more than 10 years.

             (2) Substantial bodily harm to the victim results or the battery is committed by strangulation, for a category B felony by imprisonment in the state prison for a minimum term of not less than 2 years and a maximum term of not more than 15 years.

      Sec. 15. NRS 202.360 is hereby amended to read as follows:

      202.360  1.  A person shall not own or have in his or her possession or under his or her custody or control any firearm if the person:

      (a) Has been convicted of the crime of battery which constitutes domestic violence pursuant to NRS 200.485, or a law of any other jurisdiction that prohibits the same or substantially similar conduct, committed against or upon:

             (1) The spouse or former spouse of the person;

             (2) Any other person with whom the person has had or is having a dating relationship, as defined in NRS 33.018;

             (3) Any other person with whom the person has a child in common;

             (4) The parent of the person; or

             (5) The child of the person or a child for whom the person is the legal guardian.

      (b) Has been convicted of a felony in this State or any other state, or in any political subdivision thereof, or of a felony in violation of the laws of the United States of America, unless the person has received a pardon and the pardon does not restrict his or her right to bear arms;

 


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ê2023 Statutes of Nevada, Page 2007 (CHAPTER 373, SB 412)ê

 

      (c) Has been convicted of a violation of NRS 200.575 or a law of any other state that prohibits the same or substantially similar conduct and the court entered a finding in the judgment of conviction or admonishment of rights pursuant to subsection 7 of NRS 200.575;

      (d) Except as otherwise provided in NRS 33.031, is currently subject to:

             (1) An extended order for protection against domestic violence pursuant to NRS 33.017 to 33.100, inclusive, which includes a statement that the adverse party is prohibited from possessing or having under his or her custody or control any firearm while the order is in effect; or

             (2) An equivalent order in any other state;

      (e) Is a fugitive from justice;

      (f) Is an unlawful user of, or addicted to, any controlled substance; or

      (g) Is otherwise prohibited by federal law from having a firearm in his or her possession or under his or her custody or control.

Ê A person who violates the provisions of this subsection is guilty of a category B felony and shall be punished by imprisonment in the state prison for a minimum term of not less than 1 year and a maximum term of not more than 6 years, and may be further punished by a fine of not more than $5,000.

      2.  A person shall not own or have in his or her possession or under his or her custody or control any firearm if the person:

      (a) Has been adjudicated as mentally ill or has been committed to any mental health facility by a court of this State, any other state or the United States;

      (b) Has entered a plea of guilty but mentally ill in a court of this State, any other state or the United States;

      (c) Has been found guilty but mentally ill in a court of this State, any other state or the United States;

      (d) Has been acquitted by reason of insanity in a court of this State, any other state or the United States; or

      (e) Is illegally or unlawfully in the United States.

Ê A person who violates the provisions of this subsection is guilty of a category D felony and shall be punished as provided in NRS 193.130.

      3.  A person shall not use or carry a firearm during and in relation to, or possess a firearm in furtherance of, the commission of any act in violation of NRS 453.321, 453.322, 453.337, 453.3385 or 453.401. A person who violates the provisions of this subsection is guilty of a category B felony and shall be punished by imprisonment in the state prison for a minimum term of not less than 1 year and a maximum term of not more than 6 years, and may be further punished by a fine of not more than $5,000.

      4.  As used in this section:

      (a) “Controlled substance” has the meaning ascribed to it in 21 U.S.C. § 802(6).

      (b) “Firearm” includes any firearm that is loaded or unloaded and operable or inoperable.

      Secs. 16-36. (Deleted by amendment.)

      Sec. 36.5. NRS 207.200 is hereby amended to read as follows:

      207.200  1.  Unless a greater penalty is provided pursuant to NRS 200.603, any person who, under circumstances not amounting to a burglary:

      (a) Goes upon the land or into any building of another with intent to vex or annoy the owner or occupant thereof, or to commit any unlawful act; or

 


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ê2023 Statutes of Nevada, Page 2008 (CHAPTER 373, SB 412)ê

 

      (b) Willfully goes or remains upon any land or in any building after having been warned during the previous 24 months by the owner or occupant thereof not to trespass,

Ê is guilty of a misdemeanor. The meaning of this subsection is not limited by subsections 2 and 4.

      2.  A sufficient warning against trespassing, within the meaning of this section, is given by any of the following methods:

      (a) Painting with fluorescent orange paint:

             (1) Not less than 50 square inches of a structure or natural object or the top 12 inches of a post, whether made of wood, metal or other material, at:

                   (I) Intervals of such a distance as is necessary to ensure that at least one such structure, natural object or post would be within the direct line of sight of a person standing next to another such structure, natural object or post, but at intervals of not more than 1,000 feet; and

                   (II) Each corner of the land, upon or near the boundary; and

             (2) Each side of all gates, cattle guards and openings that are designed to allow human ingress to the area;

      (b) Fencing the area;

      (c) Posting “no trespassing” signs or other notice of like meaning at:

             (1) Intervals of such a distance as is necessary to ensure that at least one such sign would be within the direct line of sight of a person standing next to another such sign, but at intervals of not more than 500 feet; and

             (2) Each corner of the land, upon or near the boundary;

      (d) Using the area as cultivated land; or

      (e) By the owner or occupant of the land or building making an oral or written demand to any guest to vacate the land or building.

      3.  It is prima facie evidence of trespass for any person to be found on private or public property which is posted or fenced as provided in subsection 2 without lawful business with the owner or occupant of the property.

      4.  An entryman on land under the laws of the United States is an owner within the meaning of this section.

      5.  As used in this section:

      (a) “Cultivated land” means land that has been cleared of its natural vegetation and is presently planted with a crop.

      (b) “Fence” means a barrier sufficient to indicate an intent to restrict the area to human ingress, including, but not limited to, a wall, hedge or chain link or wire mesh fence. The term does not include a barrier made of barbed wire.

      (c) “Guest” means any person entertained or to whom hospitality is extended, including, but not limited to, any person who stays overnight. The term does not include a tenant as defined in NRS 118A.170.

      Secs. 37-57. (Deleted by amendment.)

      Sec. 57.5.  1.  There is hereby appropriated from the State General Fund to the Department of Public Safety the sum of $500,000 for the purchase of two machines that are capable of testing for fentanyl and its derivatives and measuring the concentration thereof in mixtures.

      2.  Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after June 30, 2025, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 19, 2025.

 


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ê2023 Statutes of Nevada, Page 2009 (CHAPTER 373, SB 412)ê

 

portion of the appropriated money remaining must not be spent for any purpose after September 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 19, 2025.

      Sec. 58.  1.  This section and sections 1 to 57, inclusive, of this act become effective upon passage and approval.

      2.  Section 57.5 of this act becomes effective on July 1, 2023.

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CHAPTER 374, SB 315

Senate Bill No. 315–Senators Scheible, Spearman; and D. Harris

 

CHAPTER 374

 

[Approved: June 12, 2023]

 

AN ACT relating to persons with disabilities; prescribing certain rights for persons with disabilities who are receiving certain home and community-based services and persons who are aged receiving such services; prescribing certain rights for pupils with disabilities who are receiving certain services through an individualized education program; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing federal law authorizes states to implement certain home and community-based services for persons who are elderly or disabled. (42 U.S.C. § 1396n) Section 1 of this bill prescribes certain rights for persons with an intellectual disability, developmental disability or physical disability who are receiving such services or who are aged and receiving such services. Section 2 of this bill makes a conforming change to indicate the proper placement of section 1 in the Nevada Revised Statutes.

      Existing law requires public schools to provide special programs and services for pupils with disabilities. (NRS 388.419, 388.429) Section 3 of this bill prescribes certain rights for pupils with disabilities who are enrolled in a public school or receiving services from a provider of special education and receiving transition services through an individualized education program. Section 4 of this bill makes a conforming change to indicate the proper placement of section 3 in the Nevada Revised Statutes.

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. Chapter 422 of NRS is hereby amended by adding thereto a new section to read as follows:

      1.  This section may be cited as the Bill of Rights for Persons with Intellectual, Developmental or Physical Disabilities or who are Aged.

      2.  Except as otherwise specifically provided by law, each person with an intellectual disability, developmental disability or physical disability who is receiving services pursuant to a home and community-based services waiver granted pursuant to 42 U.S.C. § 1396n, and each person who is aged and is receiving such services, has, to the extent applicable to the services received by the person and appropriate for the person pursuant to the home and community-based services waiver, the right to:

 


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ê2023 Statutes of Nevada, Page 2010 (CHAPTER 374, SB 315)ê

 

services received by the person and appropriate for the person pursuant to the home and community-based services waiver, the right to:

      (a) Participate in decisions that affect the life of the person, including, without limitation, decisions relating to:

             (1) The finances and personal property of the person;

             (2) The location where the person resides; and

             (3) The development and implementation of any plan for delivering services and the frequency with which services are delivered pursuant to the home and community-based services waiver.

      (b) Be treated with respect and dignity.

      (c) An appropriate, safe and sanitary living environment that complies with all local, state and federal standards and recognizes the needs of the person for privacy and independence.

      (d) Food that is adequate to meet the nutritional needs of the person.

      (e) Practice the religion of his or her choice or abstain from the practice of any religion.

      (f) Receive timely, effective and appropriate health care.

      (g) Receive ancillary services, to the extent necessary for the person.

      (h) Maintain privacy and confidentiality in personal matters.

      (i) Communicate freely with persons of his or her choice and in any reasonable manner he or she chooses.

      (j) Own and use personal property.

      (k) Have social interactions with persons of any sex or gender identity or expression.

      (l) Pursue vocational opportunities to promote and enhance the economic independence of the person.

      (m) Be treated as an equal citizen under the law.

      (n) Be free from emotional, psychological, physical and financial abuse.

      (o) Participate in appropriate programs of education, training, social development, habilitation and reasonable recreation, including, without limitation, a class at or other program administered by a university, college, community college or trade school.

      (p) Select a parent, family member, advocate, employee of this State or other person to act on his or her behalf, including, without limitation, by entering into a supported decision-making agreement pursuant to NRS 162C.200.

      (q) Manage his or her own personal finances.

      (r) Have his or her personal and medical records kept confidential to the extent provided by state and federal law.

      (s) Voice grievances and suggest changes in policies, services and providers of services without restraint, interference, coercion, discrimination or reprisal.

      (t) Be free from unnecessary chemical, physical or mechanical restraints.

      (u) Participate in the political process.

      (v) Refuse to participate in any medical, psychological or other research or experiment.

      3.  The rights set forth in subsection 2 do not abrogate any remedies provided by law.

 


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      4.  As used in this section:

      (a) “Developmental disability” has the meaning ascribed to it in NRS 435.007.

      (b) “Intellectual disability” has the meaning ascribed to it in NRS 435.007.

      Sec. 2. NRS 232.320 is hereby amended to read as follows:

      232.320  1.  The Director:

      (a) Shall appoint, with the consent of the Governor, administrators of the divisions of the Department, who are respectively designated as follows:

             (1) The Administrator of the Aging and Disability Services Division;

             (2) The Administrator of the Division of Welfare and Supportive Services;

             (3) The Administrator of the Division of Child and Family Services;

             (4) The Administrator of the Division of Health Care Financing and Policy; and

             (5) The Administrator of the Division of Public and Behavioral Health.

      (b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public and Behavioral Health or the professional line activities of the other divisions.

      (c) Shall administer any state program for persons with developmental disabilities established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C. §§ 15001 et seq.

      (d) Shall, after considering advice from agencies of local governments and nonprofit organizations which provide social services, adopt a master plan for the provision of human services in this State. The Director shall revise the plan biennially and deliver a copy of the plan to the Governor and the Legislature at the beginning of each regular session. The plan must:

             (1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplication of those services by federal, state and local agencies;

             (2) Set forth priorities for the provision of those services;

             (3) Provide for communication and the coordination of those services among nonprofit organizations, agencies of local government, the State and the Federal Government;

             (4) Identify the sources of funding for services provided by the Department and the allocation of that funding;

             (5) Set forth sufficient information to assist the Department in providing those services and in the planning and budgeting for the future provision of those services; and

             (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department.

      (e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

 


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of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

      (f) Has such other powers and duties as are provided by law.

      2.  Notwithstanding any other provision of law, the Director, or the Director’s designee, is responsible for appointing and removing subordinate officers and employees of the Department.

      Sec. 3. Chapter 388 of NRS is hereby amended by adding thereto a new section to read as follows:

      1.  This section may be cited as the Transition Bill of Rights for Pupils with Disabilities.

      2.  Except as otherwise specifically provided by law, each pupil with a disability who is enrolled in a public school or receiving services from a provider of special education and is receiving transition services through an individualized education program pursuant to 34 C.F.R. § 300.43 has the right to:

      (a) Be provided notice of and invited to any meeting concerning his or her individualized education program at which transition services will be discussed.

      (b) Attend all meetings concerning his or her individualized education program and be able to represent his or her desire concerning his or her:

             (1) Training or education;

             (2) Employment; and

             (3) If appropriate, independent living.

      (c) Be treated with respect and dignity by all teachers, paraprofessionals and other educational staff.

      (d) Assist in the development of realistic, specific and measurable post-secondary goals in training, education, employment and, if appropriate, independent living for the pupil.

      (e) Receive coordinated secondary transition services and related support services to help prepare the pupil to meet the measurable postsecondary goals established pursuant to paragraph (d). Such services must include, without limitation:

             (1) An age-appropriate transition assessment;

             (2) Instruction and related services;

             (3) Community experiences;

             (4) Assistance in developing objectives for employment and other life after the pupil ceases to attend school; and

             (5) If appropriate, services to aid in developing skills for daily living and an evaluation of functional vocational skills.

      (f) Communicate freely using methods of communication that are accessible to the pupil, including, without limitation, the preferred language of the pupil, concerning his or her strengths, interests, preferences and vision of his or her future for consideration when developing the transition plan.

      (g) Have access to social interactions in school-based settings that are common to pupils of a similar age with persons with whom he or she chooses to interact. Such access must be provided to the same extent as pupils not receiving transition services through an individualized education program.

 


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      (h) Assist in developing annual goals and objectives reasonably calculated to promote progress toward achieving the measurable postsecondary goals developed pursuant to paragraph (d).

      (i) Invite, or have assistance in inviting, appropriate outside agencies to any meeting concerning his or her individualized education program at which transition services will be discussed.

      (j) Receive information necessary to identify, explore and connect with outside agencies, as appropriate, including, without limitation:

             (1) The Bureau of Vocational Rehabilitation in the Rehabilitation Division of the Department of Employment, Training and Rehabilitation;

             (2) The Aging and Disability Services Division of the Department of Health and Human Services;

             (3) The Council on Developmental Disabilities established in this State pursuant to 42 U.S.C. § 15025; and

             (4) The Statewide Independent Living Council established in this State pursuant to 29 U.S.C. § 796d.

      (k) Receive information on appropriate programs of support, including, without limitation, the Supplemental Security Income Program, as defined in NRS 422A.075.

      (l) Select a parent, family member, advocate, employee of this State or other person to act on his or her behalf, including, without limitation, as prescribed in NRS 388.459.

      (m) As appropriate to his or her individualized education program, receive education in financial literacy, including, without limitation, information about the Nevada ABLE Savings Program established pursuant to NRS 427A.889, to assist the pupil in managing his or her financial affairs.

      (n) Receive, as appropriate, the pre-employment transition services required by 34 C.F.R. § 361.48.

      (o) Voice concerns and disagreements with his or her educational or transition services and suggest changes in policies, services and providers of services without restraint, interference, coercion, discrimination or reprisal.

      (p) Assist in the development of a course of study that is designed to provide the pupil with the ability to achieve his or her measurable post-secondary goals established pursuant to paragraph (d) and obtain a diploma.

      (q) Receive information regarding potential consequences of attaining a diploma accessible to pupils with disabilities.

      (r) As appropriate to his or her individualized education program, receive instruction in civil participation, including, without limitation, participation in the political process.

      (s) Be notified, not less than 1 year before the pupil reaches 18 years of age, that any right accorded to the parent of a pupil with a disability pursuant to Part B of the Individuals with Disabilities Education Act, 20 U.S.C. § 1411 et seq., and the regulations adopted pursuant thereto, transfer to the pupil when he or she reaches 18 years of age.

      3.  The rights of a pupil with a disability set forth in subsection 2 do not abrogate any remedies provided by law.

      Sec. 4. NRS 388.417 is hereby amended to read as follows:

      388.417  As used in NRS 388.417 to 388.515, inclusive [:] , and section 3 of this act:

 


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      1.  “Communication mode” means any system or method of communication used by a person with a disability, including, without limitation, a person who is deaf or whose hearing is impaired, to facilitate communication which may include, without limitation:

      (a) American Sign Language;

      (b) English-based manual or sign systems;

      (c) Oral and aural communication;

      (d) Spoken and written English, including speech reading or lip reading; and

      (e) Communication with assistive technology devices.

      2.  “Dyslexia” means a neurological learning disability characterized by difficulties with accurate and fluent word recognition and poor spelling and decoding abilities that typically result from a deficit in the phonological component of language.

      3.  “Dyslexia intervention” means systematic, multisensory intervention offered in an appropriate setting that is derived from evidence-based research.

      4.  “Individualized education program” has the meaning ascribed to it in 20 U.S.C. § 1414(d)(1)(A).

      5.  “Individualized education program team” has the meaning ascribed to it in 20 U.S.C. § 1414(d)(1)(B).

      6.  “Provider of special education” means a school within a school district or charter school that provides education or services to pupils with disabilities or any other entity that is responsible for providing education or services to a pupil with a disability for a school district or charter school.

      7.  “Pupil who receives early intervening services” means a person enrolled in kindergarten or grades 1 to 12, inclusive, who is not a pupil with a disability but who needs additional academic and behavioral support to succeed in a regular school program.

      8.  “Pupil with a disability” means a “child with a disability,” as that term is defined in 20 U.S.C. § 1401(3)(A), who is under 22 years of age.

      9.  “Response to scientific, research-based intervention” means a collaborative process which assesses a pupil’s response to scientific, research-based intervention that is matched to the needs of a pupil and that systematically monitors the level of performance and rate of learning of the pupil over time for the purpose of making data-based decisions concerning the need of the pupil for increasingly intensified services.

      10.  “Specific learning disability” means a disorder in one or more of the basic psychological processes involved in understanding or using spoken or written language which is not primarily the result of a visual, hearing or motor impairment, intellectual disability, serious emotional disturbance, or an environmental, cultural or economic disadvantage. Such a disorder may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or perform mathematical calculations. The term includes, without limitation, perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia and developmental aphasia.

      Sec. 5.  This act becomes effective on July 1, 2023.

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ê2023 Statutes of Nevada, Page 2015ê

 

CHAPTER 375, SB 348

Senate Bill No. 348–Senators Donate and Ohrenschall

 

Joint Sponsors: Assemblymen González; Carter, Duran, Mosca, Peters and Watts

 

CHAPTER 375

 

[Approved: June 12, 2023]

 

AN ACT relating to health care; requiring written approval to close certain hospitals or convert such a hospital into a different type of health facility; requiring certain facilities that provide emergency medical services to provide certain notice to patients; establishing and increasing certain civil penalties; requiring an off-campus location of a hospital that provides emergency medical services or an independent center for emergency medical care to include certain information on a claim for reimbursement or payment; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law requires a person to obtain the written approval of the: (1) Director of the Department of Health and Human Services before making certain capital expenditures for construction of a new health facility under certain circumstances; or (2) the Chief Medical Officer before operating or undertaking any expenditure for the operation of a new medical helicopter within 150 miles from the base of an existing medical helicopter. (NRS 439A.100, 439A.104) Section 2 of this bill similarly requires a person to obtain the written approval of the Director before closing a hospital in a county whose population is 100,000 or more (currently Clark and Washoe Counties) or converting such a hospital into a different type of health facility. Sections 2 and 7-9 of this bill provide that such approval is a condition to: (1) the issuance or renewal of a license for certain health facilities converted from a hospital; and (2) certain amendments to such a license. Sections 5 and 10 of this bill authorize the Department and the Division of Public and Behavioral Health of the Department to impose certain civil penalties and take certain other disciplinary action against a person who closes a hospital in a county whose population is 100,000 or more or converts a hospital in such a county to a different type of health facility without written approval in violation of section 2.

      Existing law requires: (1) a hospital to notify the Department of any merger, acquisition or similar transaction involving the hospital; and (2) a physician group practice or a person who owns all or substantially all of a physician group practice to notify the Department of certain similar transactions under certain circumstances. (NRS 439A.126) Section 4 of this bill authorizes the Department to impose an administrative penalty against a hospital that fails to provide timely notice of the information required by existing law. Section 4 also requires the Department to notify the Board of Medical Examiners or the State Board of Osteopathic Medicine, as appropriate, if a physician group practice or a person who owns all or substantially all of a physician group practice fails to provide such timely notice. Upon receiving notice of such failure from the Department, sections 10.7 and 11.5 of this bill require those boards to proceed as if a complaint had been filed. If, after conducting an investigation and a hearing, the Board of Medical Examiners or the State Board of Osteopathic Medicine determines that a physician group practice or a person who owns all or substantially all of a physician group practice has failed to provide timely notice to the Department of a transaction for which notice is required, sections 10.7 and 11.5 authorize the respective board to impose an administrative penalty.

 


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      Existing law requires each off-campus location of a hospital to obtain and use on all claims for reimbursement or payment a national provider identifier that is distinct from the national provider identifier used by the main campus and any other off-campus location of the hospital. (NRS 449.1818) Section 10.3 of this bill clarifies that the off-campus location: (1) is required to include the national provider identifier on each claim for reimbursement or payment; and (2) may additionally include on such a claim the national provider identifier for the main campus of the hospital. Section 10.3 also requires an independent center for emergency medical care to include its national provider identifier on all claims for reimbursement or payment.

      Among other sanctions, existing law authorizes the Division of Public and Behavioral Health to impose against a hospital that fails to obtain a national provider identifier for an off-campus location that is distinct from the national provider identifier used by the main campus and any other off-campus location of the hospital an administrative penalty of not more than $5,000 for each day of such failure, together with interest. (NRS 449.163) Section 10.2 of this bill doubles the amount of the administrative penalty that the Division is authorized to impose for such failure.

      Existing law provides every patient of a medical facility, including a hospital, with the right to receive certain information about the condition and care of the patient and the cost of such care. (NRS 449A.106) If an off-campus location of a hospital provides emergency medical services, section 10.5 of this bill requires the off-campus location to: (1) post conspicuous notice that the off-campus location is an emergency medical facility and will charge patients for an emergency room visit; and (2) provide each patient with certain notice concerning the rights of the patient upon registration. Section 10.5 also requires such an off-campus location to provide each patient with a more detailed notice concerning billing and payment after the patient is found not to have an emergency medical condition or after the emergency medical condition of the patient has been stabilized, as applicable.

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. Chapter 439A of NRS is hereby amended by adding thereto the provisions set forth as sections 2 and 3 of this act.

      Sec. 2. 1.  Except as otherwise provided in this section, no person may close a hospital in a county whose population is 100,000 or more or convert a hospital in such a county into a different type of health facility without first applying for and obtaining the written approval of the Director or the designee of the Director. The Division of Public and Behavioral Health of the Department shall not issue a new license or alter an existing license for conversion to a different type of health facility unless the Director or the designee of the Director has issued such an approval.

      2.  The Director may adopt regulations which prescribe the process to apply for written approval pursuant to this section.

      3.  An applicant must provide any information requested by the Director or the designee of the Director for consideration of an application, which must include, without limitation, information related to:

      (a) The location of the hospital;

      (b) The ownership structure of the hospital;

      (c) Whether the closure or conversion is likely to benefit any other health facility in the same geographic area as the hospital in which any person with an ownership interest in the hospital also has an ownership interest;

 


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      (d) An explanation of the need for the closure or conversion;

      (e) Data regarding the population served by the hospital in the 24 months immediately preceding the application; and

      (f) The manner in which and the locations where the population served by the hospital will be able to obtain the health services that were provided by the hospital during the 24 months following the closure or conversion of the hospital.

      4.  The Director or the designee of the Director shall not approve an application submitted pursuant to subsection 1 without considering the information required to be submitted pursuant to subsection 3.

      5.  The decision of the Director or the designee of the Director pursuant to this section is a final decision for the purposes of judicial review.

      6.  The provisions of this section do not apply to any person who ceases to operate hospitals in this State.

      Sec. 3.  (Deleted by amendment.)

      Sec. 4. NRS 439A.126 is hereby amended to read as follows:

      439A.126  1.  A hospital shall notify the Department of any merger, acquisition or joint venture with any entity, including, without limitation, a physician group practice, to which the hospital is a party or any contract for the management of the hospital not later than 60 days after the finalization of the transaction or execution of the contract for management, as applicable.

      2.  A physician group practice or a person who owns all or substantially all of a physician group practice shall notify the Department of a transaction described in subsection 3 to which the physician group practice or person, as applicable, is a party or any contract for the management of the physician group practice not later than 60 days after the finalization of the transaction or execution of the contract for management, as applicable, if:

      (a) The physician group practices that are parties to the transaction or contract for management or that are owned by those parties represent at least 20 percent of the physicians who practice any specialty in a primary service area; and

      (b) The physician group practice represents the largest number of physicians of any physician group practice that is a party to or owned by a party to the transaction or contract for management.

      3.  Notice must be provided pursuant to subsection 2 for any:

      (a) Merger of, consolidation of or other affiliation between physician group practices, persons who own physician group practices or any combination thereof;

      (b) The acquisition of all or substantially all of the properties and assets of a physician group practice;

      (c) The acquisition of all or substantially all of the capital stock, membership interests or other equity interests of a physician group practice;

      (d) The employment of all or substantially all of the physicians in a physician group practice; or

      (e) The acquisition of an insolvent physician group practice.

      4.  Notice pursuant to subsection 1 or 2 must be provided in the form prescribed by the Department and must include, without limitation:

      (a) The name of each party to the transaction or contract for management, as applicable;

      (b) A description of the nature of the proposed relationship of the parties to the transaction or contract for management, as applicable;

 


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      (c) The names and any specialties of each physician who is a party or employed by or affiliated with a physician group practice that is a party to or is owned by a party to the transaction or contract for management, as applicable;

      (d) The name and address of each business entity that will provide health services after the transaction or contract for management, as applicable;

      (e) A description of the health services to be provided at each location of a business entity described in paragraph (d); and

      (f) The primary service area to be served by each location of a business entity described in paragraph (d).

      5.  The Department shall:

      (a) Post the information contained in the notices provided pursuant to subsections 1 and 2 on an Internet website maintained by the Department; and

      (b) Annually prepare a report regarding market transactions and concentration in health care based on the information in the notices and post the report on an Internet website maintained by the Department.

      6.  If a hospital fails to provide timely notice to the Department pursuant to subsection 1 and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department may impose against the hospital an administrative penalty of not more than $5,000 for each day of such failure.

      7.  If a physician group practice or a person who owns all or substantially all of a physician group practice fails to provide timely notice to the Department pursuant to subsection 2 and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department shall notify the Board of Medical Examiners or the State Board of Osteopathic Medicine, or both, as applicable, of such failure.

      8.  Any money collected as administrative penalties pursuant to this section must be accounted for separately and used by the Department to carry out the provisions of NRS 439A.111 to 439A.126, inclusive, or for any other purpose authorized by the Legislature.

      9. As used in this section:

      (a) “Physician group practice” means any business entity organized for the purpose of the practice of medicine or osteopathic medicine by more than one physician.

      (b) “Primary service area” means an area comprising the smallest number of zip codes from which the hospital or physician group practice draws at least 75 percent of patients.

      Sec. 5. NRS 439A.310 is hereby amended to read as follows:

      439A.310  1.  Except as otherwise provided in subsection 2, any person who violates any of the provisions of this chapter is liable to the State for a civil penalty of:

      (a) Where the provision violated governs the licensing of a project which is required to be approved pursuant to NRS 439A.100 [,] or section 2 of this act, not more than 10 percent of the proposed expenditure for the project.

      (b) Where any other provision is violated, not more than $20,000 for each violation.

      2.  The Department shall not impose a penalty under this section if it applies for injunctive relief to prevent the same violation.

      Sec. 6. (Deleted by amendment.)

 


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ê2023 Statutes of Nevada, Page 2019 (CHAPTER 375, SB 348)ê

 

      Sec. 7. NRS 449.080 is hereby amended to read as follows:

      449.080  1.  If, after investigation, the Division finds that the:

      (a) Applicant is in full compliance with the provisions of NRS 449.029 to 449.2428, inclusive;

      (b) Applicant is in substantial compliance with the standards and regulations adopted by the Board;

      (c) Applicant, if he or she has undertaken a project for which approval is required pursuant to NRS 439A.100 [,] or section 2 of this act, has obtained the approval of the Director of the Department of Health and Human Services; and

      (d) Facility conforms to the applicable zoning regulations,

Ê the Division shall issue the license to the applicant.

      2.  Any investigation of an applicant for a license to provide community-based living arrangement services conducted pursuant to subsection 1 must include, without limitation, an inspection of any building operated by the applicant in which the applicant proposes to provide community-based living arrangement services.

      3.  A license applies only to the person to whom it is issued, is valid only for the premises described in the license and is not transferable.

      Sec. 8. NRS 449.087 is hereby amended to read as follows:

      449.087  1.  A licensee must obtain the approval of the Division to amend his or her license to operate a facility before the addition of any of the following services:

      (a) The intensive care of newborn babies.

      (b) The treatment of burns.

      (c) The transplant of organs.

      (d) The performance of open-heart surgery.

      (e) A center for the treatment of trauma.

      2.  The Division shall approve an application to amend a license to allow a facility to provide any of the services described in subsection 1 if:

      (a) The applicant satisfies the requirements contained in NRS 449.080;

      (b) The Division determines on the basis of the standards adopted by the Board pursuant to subsection 4 that there are an adequate number of cases in the community to be served to support amending the license to add the service; and

      (c) The Division determines that the applicant satisfies any other standards adopted by the Board pursuant to subsection 4.

      3.  The Division may revoke its approval if the licensee fails to maintain substantial compliance with the standards adopted by the Board pursuant to subsection 4 for the provision of such services, or with any conditions included in the written approval of the Director issued pursuant to the provisions of NRS 439A.100 [.] or section 2 of this act.

      4.  The Board shall:

      (a) Adopt standards which have been adopted by appropriate national organizations to be used by the Division in determining whether there are an adequate number of cases in the community to be served to support amending the license of a licensee to add a service pursuant to this section; and

      (b) Adopt such other standards as it deems necessary for determining whether to approve the provision of services pursuant to this section.

 


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      Sec. 9. NRS 449.089 is hereby amended to read as follows:

      449.089  1.  Each license issued pursuant to NRS 449.029 to 449.2428, inclusive, expires on December 31 following its issuance and is renewable for 1 year upon reapplication and payment of all fees required pursuant to subsection 4 and NRS 449.050, as applicable, unless the Division finds, after an investigation, that the facility has not:

      (a) Satisfactorily complied with the provisions of NRS 449.029 to 449.2428, inclusive, or the standards and regulations adopted by the Board;

      (b) Obtained the approval of the Director of the Department of Health and Human Services before undertaking a project, if such approval is required by NRS 439A.100 [;] or section 2 of this act; or

      (c) Conformed to all applicable local zoning regulations.

      2.  Each reapplication for an agency to provide personal care services in the home, an agency to provide nursing in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a provider of community-based living arrangement services, a hospital described in 42 U.S.C. § 1395ww(d)(1)(B)(iv), a psychiatric hospital that provides inpatient services to children, a psychiatric residential treatment facility, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 C.F.R. § 483.5, a hospital that provides swing-bed services as described in 42 C.F.R. § 482.58 or, if residential services are provided to children, a medical facility or facility for the treatment of alcohol or other substance use disorders must include, without limitation, a statement that the facility, hospital, agency, program, pool or home is in compliance with the provisions of NRS 449.115 to 449.125, inclusive, and 449.174.

      3.  Each reapplication for an agency to provide personal care services in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a facility for the care of adults during the day, a residential facility for groups or a home for individual residential care must include, without limitation, a statement that the holder of the license to operate, and the administrator or other person in charge and employees of, the facility, agency, pool or home are in compliance with the provisions of NRS 449.093.

      4.  Each reapplication for a surgical center for ambulatory patients, facility for the treatment of irreversible renal disease, facility for hospice care, program of hospice care, hospital, facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home or rural clinic must be accompanied by the fee prescribed by the State Board of Health pursuant to NRS 457.240, in addition to the fees imposed pursuant to NRS 449.050.

      Sec. 10. NRS 449.160 is hereby amended to read as follows:

      449.160  1.  The Division may deny an application for a license or may suspend or revoke any license issued under the provisions of NRS 449.029 to 449.2428, inclusive, upon any of the following grounds:

      (a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410 or 449.029 to 449.245, inclusive, or of any other law of this State or of the standards, rules and regulations adopted thereunder.

      (b) Aiding, abetting or permitting the commission of any illegal act.

 


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      (c) Conduct inimical to the public health, morals, welfare and safety of the people of the State of Nevada in the maintenance and operation of the premises for which a license is issued.

      (d) Conduct or practice detrimental to the health or safety of the occupants or employees of the facility.

      (e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or section 2 of this act or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required [.] , including, without limitation, the closure or conversion of any hospital in a county whose population is 100,000 or more that is owned by the licensee without approval pursuant to section 2 of this act.

      (f) Failure to comply with the provisions of NRS 441A.315 and any regulations adopted pursuant thereto or NRS 449.2486.

      (g) Violation of the provisions of NRS 458.112.

      2.  In addition to the provisions of subsection 1, the Division may revoke a license to operate a facility for the dependent if, with respect to that facility, the licensee that operates the facility, or an agent or employee of the licensee:

      (a) Is convicted of violating any of the provisions of NRS 202.470;

      (b) Is ordered to but fails to abate a nuisance pursuant to NRS 244.360, 244.3603 or 268.4124; or

      (c) Is ordered by the appropriate governmental agency to correct a violation of a building, safety or health code or regulation but fails to correct the violation.

      3.  The Division shall maintain a log of any complaints that it receives relating to activities for which the Division may revoke the license to operate a facility for the dependent pursuant to subsection 2. The Division shall provide to a facility for the care of adults during the day:

      (a) A summary of a complaint against the facility if the investigation of the complaint by the Division either substantiates the complaint or is inconclusive;

      (b) A report of any investigation conducted with respect to the complaint; and

      (c) A report of any disciplinary action taken against the facility.

Ê The facility shall make the information available to the public pursuant to NRS 449.2486.

      4.  On or before February 1 of each odd-numbered year, the Division shall submit to the Director of the Legislative Counsel Bureau a written report setting forth, for the previous biennium:

      (a) Any complaints included in the log maintained by the Division pursuant to subsection 3; and

      (b) Any disciplinary actions taken by the Division pursuant to subsection 2.

      Sec. 10.2. NRS 449.163 is hereby amended to read as follows:

      449.163  1.  In addition to the payment of the amount required by NRS 449.0308, if a medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed violates any provision related to its licensure, including any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

 


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condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

      (a) Prohibit the facility from admitting any patient until it determines that the facility has corrected the violation;

      (b) Limit the occupancy of the facility to the number of beds occupied when the violation occurred, until it determines that the facility has corrected the violation;

      (c) If the license of the facility limits the occupancy of the facility and the facility has exceeded the approved occupancy, require the facility, at its own expense, to move patients to another facility that is licensed;

      (d) [Impose] Except where a greater penalty is authorized by subsection 2, impose an administrative penalty of not more than $5,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum; and

      (e) Appoint temporary management to oversee the operation of the facility and to ensure the health and safety of the patients of the facility, until:

             (1) It determines that the facility has corrected the violation and has management which is capable of ensuring continued compliance with the applicable statutes, conditions, standards and regulations; or

             (2) Improvements are made to correct the violation.

      2.  If an off-campus location of a hospital fails to obtain a national provider identifier that is distinct from the national provider identifier used by the main campus and any other off-campus location of the hospital in violation of NRS 449.1818, the Division may impose against the hospital an administrative penalty of not more than $10,000 for each day of such failure, together with interest thereon at a rate not to exceed 10 percent per annum, in addition to any other action authorized by this chapter.

      3.  If the facility fails to pay any administrative penalty imposed pursuant to paragraph (d) of subsection 1 [,] or subsection 2, the Division may:

      (a) Suspend the license of the facility until the administrative penalty is paid; and

      (b) Collect court costs, reasonable attorney’s fees and other costs incurred to collect the administrative penalty.

      [3.]4.  The Division may require any facility that violates any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, or any condition, standard or regulation adopted by the Board to make any improvements necessary to correct the violation.

      [4.]5.  Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 or subsection 2 must be accounted for separately and used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, 449.435 to 449.531, inclusive, and chapter 449A of NRS to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards or for any other purpose authorized by the Legislature.

      Sec. 10.3.NRS 449.1818 is hereby amended to read as follows:

      449.1818  1.  Each off-campus location of a hospital [must] shall obtain and use and include on all claims for reimbursement or payment for health care services provided at the location a national provider identifier that is distinct from the national provider identifier used by the main campus and any other off-campus location of the hospital. If the off-campus location includes the national provider identifier on such a claim, the off-campus location may also include on the claim the national provider identifier used by the main campus of the hospital.

 


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includes the national provider identifier on such a claim, the off-campus location may also include on the claim the national provider identifier used by the main campus of the hospital. If the off-campus location includes both the national provider identifier used by the off-campus location and the national provider identifier used by the main campus on a claim, the claim must clearly identify which national provider identifier corresponds to the off-campus location and which national provider identifier corresponds to the main campus.

      2.  An independent center for emergency medical care shall include on all claims for reimbursement or payment for health care services provided at the independent center for emergency medical care the national provider identifier used by the independent center for emergency medical care.

      3.  As used in this section:

      (a) “National provider identifier” means the standard, unique health identifier for health care providers that is issued by the national provider system in accordance with 45 C.F.R. Part 162.

      (b) “Off-campus location” means a facility:

             (1) With operations that are directly or indirectly owned or controlled by, in whole or in part, a hospital or which is affiliated with a hospital, regardless of whether it is operated by the same governing body as the hospital;

             (2) That is located more than 250 yards from the main campus of the hospital;

             (3) That provides services which are organizationally and functionally integrated with the hospital; and

             (4) That is an outpatient facility providing ambulatory surgery, urgent care or emergency room services.

      Sec. 10.5. Chapter 449A of NRS is hereby amended by adding thereto a new section to read as follows:

      1.  An off-campus location shall post conspicuously in each location where patients are admitted and registered a sign, in not less than 24 point boldface type, which states in English and Spanish:

 

NOTICE

 

This is an emergency medical facility that treats emergency medical conditions. You will be charged for a visit to an emergency room and not for a visit to an urgent care center.

 

      2.  An off-campus location shall provide to each patient of the emergency department of the off-campus location and any adult accompanying such a patient who is less than 18 years of age immediately upon registration a written statement in substantially the following form:

 

PATIENT INFORMATION

 

This is an emergency medical facility that treats emergency medical conditions. You will be charged for a visit to an emergency room and not for a visit to an urgent care center.

 

We will screen and treat you regardless of your ability to pay.

 


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You have the right to ask questions regarding your treatment options and costs.

 

You have the right to receive prompt and reasonable responses to such questions and requests.

 

You have the right to reject treatment.

 

This is not a complete statement of patient information or rights. You will receive a more comprehensive statement after the completion of a medical screening examination that does not reveal an emergency medical condition or after your emergency medical condition has been stabilized.

 

      3.  To the extent practicable, a written statement provided pursuant to subsection 2 must be in the language requested by the patient or the adult accompanying the patient, as applicable.

      4.  After the completion of an appropriate medical screening examination of a patient of the emergency department of the off-campus location that does not reveal an emergency medical condition or after stabilizing the emergency medical condition of such a patient, an off-campus location shall provide the patient and, if the patient, is less than 18 years of age, any adult accompanying the patient, with written notice of:

      (a) The policies of the off-campus location concerning the acceptance of patients enrolled in Medicaid and Medicare;

      (b) The networks of third parties in which the off-campus location participates;

      (c) The possibility that the patient may be billed separately by providers of health care at the off-campus location;

      (d) The maximum price for emergency medical services that the off-campus location commonly provides; and

      (e) Any additional fees that the off-campus location charges.

      5.  As used in this section:

      (a) “Network” means a defined set of providers of health care who are under contract with a third party to provide health care services to persons covered by the third party.

      (b) “Off-campus location” means a facility:

             (1) With operations that are directly or indirectly owned or controlled by, in whole or in part, a hospital or which is affiliated with a hospital, regardless of whether it is operated by the same governing body as the hospital;

             (2) That is located more than 250 yards from the main campus of the hospital;

             (3) That provides services which are organizationally and functionally integrated with the hospital; and

             (4) That is an outpatient facility providing emergency room services.

      (c) “Third party” means any insurer, governmental entity or other organization providing health coverage or benefits in accordance with state or federal law.

 


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      Sec. 10.7.Chapter 630 of NRS is hereby amended by adding thereto a new section to read as follows:

      1.  Except as otherwise provided in this subsection, if the Board receives notice from the Department of Health and Human Services pursuant to NRS 439A.126 that a physician group practice or a person who owns all or substantially all of a physician group practice has failed to provide timely notice to the Department of a transaction described in subsection 3 of NRS 439A.126, the Board must proceed as if a complaint had been filed against the physician group practice or person, as applicable. If the report concerns a physician group practice that consists of physicians licensed pursuant to this chapter and osteopathic physicians licensed pursuant to chapter 633 of NRS, the Board shall consult with the State Board of Osteopathic Medicine to ensure that either the Board or the State Board of Osteopathic Medicine, but not both, investigates the notice.

      2.  If, after conducting an investigation and a hearing in accordance with the provisions of this chapter, the Board determines that a physician group practice or a person who owns all or substantially all of a physician group practice has failed to provide timely notice to the Department of Health and Human Services of a transaction described in subsection 3 of NRS 439A.126, the Board may impose an administrative penalty of not more than $5,000 for each day of such failure.

      3.  As used in this section, “physician group practice” has the meaning ascribed to it in NRS 439A.126.

      Sec. 11. (Deleted by amendment.)

      Sec. 11.5.Chapter 633 of NRS is hereby amended by adding thereto a new section to read as follows:

      1.  Except as otherwise provided in this subsection, if the Board receives notice from the Department of Health and Human Services pursuant to NRS 439A.126 that a physician group practice or a person who owns all or substantially all of a physician group practice has failed to provide timely notice to the Department of a transaction described in subsection 3 of NRS 439A.126, the Board must proceed as if a complaint had been filed against the physician group practice or person, as applicable. If the report concerns a physician group practice that consists of osteopathic physicians licensed pursuant to this chapter and physicians licensed pursuant to chapter 630 of NRS, the Board shall consult with the Board of Medical Examiners to ensure that either the Board or the Board of Medical Examiners, but not both, investigates the notice.

      2.  If, after conducting an investigation and a hearing in accordance with the provisions of this chapter, the Board determines that a physician group practice or a person who owns all or substantially all of a physician group practice has failed to provide timely notice to the Department of Health and Human Services of a transaction described in subsection 3 of NRS 439A.126, the Board may impose an administrative penalty of not more than $5,000 for each day of such failure.

      3.  As used in this section, “physician group practice” has the meaning ascribed to it in NRS 439A.126.

      Sec. 12.  1.  This section becomes effective upon passage and approval.

      2.  Sections 1 to 11.5, inclusive, of this act become effective:

 


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      (a) Upon passage and approval for the purpose of adopting any regulations and performing any other preparatory administrative tasks that are necessary to carry out the provisions of this act; and

      (b) On January 1, 2024, for all other purposes.

________

CHAPTER 376, SB 163

Senate Bill No. 163–Senators Scheible, D. Harris and Spearman

 

Joint Sponsor: Assemblywoman González

 

CHAPTER 376

 

[Approved: June 12, 2023]

 

AN ACT relating to insurance; requiring certain health insurance to include coverage for the treatment of conditions relating to gender dysphoria and gender incongruence; prohibiting such insurers from engaging in certain discrimination on the basis of gender identity or expression; making appropriations and authorizing certain expenditures; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law requires public and private policies of health insurance regulated under Nevada law to include certain coverage. (NRS 287.010, 287.04335, 422.2712-422.27241, 689A.04033-689A.0465, 689B.0303-689B.0379, 689C.1655-689C.169, 689C.194, 689C.1945, 689C.195, 695A.184-695A.1875, 695B.1901-695B.1948, 695C.1691-695C.176, 695G.162-695G.177) Existing law also requires employers to provide certain benefits for health care to employees, including the coverage required of health insurers, if the employer provides health benefits for its employees. (NRS 608.1555) Sections 1.3, 3, 4, 6, 7, 8, 11, 13, 14 and 15 of this bill: (1) require certain public and private policies of health insurance and health care plans, including Medicaid, to cover the treatment of conditions relating to gender dysphoria and gender incongruence; (2) authorize those policies and plans to prescribe requirements that must be satisfied before the insurer will cover surgical treatment for conditions relating to gender dysphoria or gender incongruence for persons who are less than 18 years of age; and (3) require an insurer to consult with a provider of health care with experience in prescribing or delivering gender-affirming treatment when considering certain appeals of a denial of coverage. Sections 1.6, 3.6, 4.6, 6.6, 7.6, 8.6, 11.6 and 15.6 of this bill prohibit an insurer from engaging in certain discrimination on the basis of gender identity or expression. Sections 2, 5, 9 and 12 of this bill make conforming changes to indicate the proper placement of sections 1.3, 1.6, 4, 4.6, 8, 8.6, 15 and 15.6 in the Nevada Revised Statutes.

      Section 10 of this bill authorizes the Commissioner of Insurance to suspend or revoke the certificate of a health maintenance organization that fails to comply with the requirements of sections 8 and 8.6. The Commissioner would also be authorized to take such action against other health insurers who fail to comply with the requirements of sections 1.3, 1.6, 3, 3.6, 4, 4.6, 6, 6.6, 7, 7.6, 11 and 11.6. (NRS 680A.200) Sections 16 and 17 of this bill make appropriations to the Division of Health Care Financing and Policy of the Department of Health and Human Services and authorize certain related expenditures for: (1) the costs of providing the coverage under Medicaid required by section 15; and (2) certain other costs associated with carrying out the provisions of this bill.

 


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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. Chapter 689A of NRS is hereby amended by adding thereto the provisions set forth as sections 1.3 and 1.6 of this act.

      Sec. 1.3. 1.  Except as otherwise provided in this section, an insurer that issues a policy of health insurance shall include in the policy coverage for the medically necessary treatment of conditions relating to gender dysphoria and gender incongruence. Such coverage must include coverage of 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 a policy of health insurance to include coverage for cosmetic surgery performed by a plastic surgeon or reconstructive surgeon that is not medically necessary.

      3.  An insurer that issues a policy of health insurance shall not categorically refuse to cover medically necessary gender-affirming treatments or procedures or revisions to prior treatments if the policy provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.

      4.  An insurer that issues a policy of health insurance may prescribe requirements that must be satisfied before the insurer covers surgical treatment of conditions relating to gender dysphoria or gender incongruence for an insured who is less than 18 years of age. Such requirements may include, without limitation, requirements that:

      (a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

      (b) The treatment must be recommended by a physician;

      (c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

      (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care; and

      (e) Parental consent is provided for the insured unless the insured is expressly authorized by law to consent on his or her own behalf.

      5.  When determining whether treatment is medically necessary for the purposes of this section, an insurer must consider the most recent Standards of Care published by the World Professional Association for Transgender Health, or its successor organization.

 


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      6.  An insurer shall make a reasonable effort to ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer. If, after a reasonable effort, the insurer is unable to make such benefits available through such a provider of health care, the insurer may treat the treatment that the insurer is unable to make available through such a provider of health care in the same manner as other services provided by a provider of health care who does not participate in the network plan of the insurer.

      7.  If an insured appeals the denial of a claim or coverage under this section on the grounds that the treatment requested by the insured is not medically necessary, the insurer 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 insured when considering the appeal.

      8.  A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.

      9.  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.

 


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      (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.

Ê 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) “Network plan” means a policy of health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      Sec. 1.6. An insurer that issues a policy of health insurance shall not discriminate against any person with respect to participation or coverage under the policy on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:

      1.  Denying, cancelling, limiting or refusing to issue or renew a policy of health insurance on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;

      2.  Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an insured or a family member of the insured;

      3.  Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and

      4.  Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:

      (a) Related to gender transition, provided that there is coverage under the policy for the services when the services are not related to gender transition; or

      (b) Ordinarily or exclusively available to persons of any sex.

      Sec. 2. NRS 689A.330 is hereby amended to read as follows:

      689A.330  If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding public officer of that other state has informed the Commissioner that the policy is not subject to approval or disapproval by that officer, the Commissioner may by ruling require that the policy meet the standards set forth in NRS 689A.030 to 689A.320, inclusive [.] , and sections 1.3 and 1.6 of this act.

 


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      Sec. 2.8. Chapter 689B of NRS is hereby amended by adding thereto the provisions set forth as sections 3 and 3.6 of this act.

      Sec. 3. 1.  Except as otherwise provided in this section, an insurer that issues a policy of group health insurance shall include in the policy coverage for the medically necessary treatment of conditions relating to gender dysphoria and gender incongruence. Such coverage must include coverage of 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 a policy of group health insurance to include coverage for cosmetic surgery performed by a plastic surgeon or reconstructive surgeon that is not medically necessary.

      3.  An insurer that issues a policy of group health insurance shall not categorically refuse to cover medically necessary gender-affirming treatments or procedures or revisions to prior treatments if the policy provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.

      4.  An insurer that issues a policy of group health insurance may prescribe requirements that must be satisfied before the insurer covers surgical treatment of conditions relating to gender dysphoria or gender incongruence for an insured who is less than 18 years of age. Such requirements may include, without limitation, requirements that:

      (a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

      (b) The treatment must be recommended by a physician;

      (c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

      (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care; and

      (e) Parental consent is provided for the insured unless the insured is expressly authorized by law to consent on his or her own behalf.

      5.  When determining whether treatment is medically necessary for the purposes of this section, an insurer must consider the most recent Standards of Care published by the World Professional Association for Transgender Health, or its successor organization.

      6.  An insurer shall make a reasonable effort to ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer. If, after a reasonable effort, the insurer is unable to make such benefits available through such a provider of health care, the insurer may treat the treatment that the insurer is unable to make available through such a provider of health care in the same manner as other services provided by a provider of health care who does not participate in the network plan of the insurer.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2031 (CHAPTER 376, SB 163)ê

 

such a provider of health care in the same manner as other services provided by a provider of health care who does not participate in the network plan of the insurer.

      7.  If an insured appeals the denial of a claim or coverage under this section on the grounds that the treatment requested by the insured is not medically necessary, the insurer 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 insured when considering the appeal.

      8.  A policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or renewal which is in conflict with the provisions of this section is void.

      9.  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;

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2032 (CHAPTER 376, SB 163)ê

 

             (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.

Ê 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) “Network plan” means a policy of group health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      Sec. 3.6. An insurer that issues a policy of group health insurance shall not discriminate against any person with respect to participation or coverage under the policy on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:

      1.  Denying, cancelling, limiting or refusing to issue or renew a policy of group health insurance on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;

      2.  Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an insured or a family member of the insured;

      3.  Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and

      4.  Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:

      (a) Related to gender transition, provided that there is coverage under the policy for the services when the services are not related to gender transition; or

      (b) Ordinarily or exclusively available to persons of any sex.

      Sec. 3.8. Chapter 689C of NRS is hereby amended by adding thereto the provisions set forth as sections 4 and 4.6 of this act.

      Sec. 4. 1.  Except as otherwise provided in this section, a carrier that issues a health benefit plan shall include in the health benefit plan coverage for the medically necessary treatment of conditions relating to gender dysphoria and gender incongruence. Such coverage must include coverage of medically necessary psychosocial and surgical intervention and any other medically necessary treatment for such disorders provided by:

      (a) Endocrinologists;

      (b) Pediatric endocrinologists;

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2033 (CHAPTER 376, SB 163)ê

 

      (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 a health benefit plan to include coverage for cosmetic surgery performed by a plastic surgeon or reconstructive surgeon that is not medically necessary.

      3.  A carrier that issues a health benefit plan shall not categorically refuse to cover medically necessary gender-affirming treatments or procedures or revisions to prior treatments if the plan provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.

      4.  A carrier that issues a health benefit plan may prescribe requirements that must be satisfied before the carrier covers surgical treatment of conditions relating to gender dysphoria or gender incongruence for an insured who is less than 18 years of age. Such requirements may include, without limitation, requirements that:

      (a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

      (b) The treatment must be recommended by a physician;

      (c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

      (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care; and

      (e) Parental consent is provided for the insured unless the insured is expressly authorized by law to consent on his or her own behalf.

      5.  When determining whether treatment is medically necessary for the purposes of this section, a carrier must consider the most recent Standards of Care published by the World Professional Association for Transgender Health, or its successor organization.

      6.  A carrier shall make a reasonable effort to ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the carrier. If, after a reasonable effort, the carrier is unable to make such benefits available through such a provider of health care, the carrier may treat the treatment that the carrier is unable to make available through such a provider of health care in the same manner as other services provided by a provider of health care who does not participate in the network plan of the carrier.

      7.  If an insured appeals the denial of a claim or coverage under this section on the grounds that the treatment requested by the insured is not medically necessary, the carrier 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 insured when considering the appeal.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2034 (CHAPTER 376, SB 163)ê

 

      8.  A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, has the legal effect of including the coverage required by subsection 1, and any provision of the plan or renewal which is in conflict with the provisions of this section is void.

      9.  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.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2035 (CHAPTER 376, SB 163)ê

 

Ê 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) “Network plan” means a health benefit plan offered by a carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the carrier. The term does not include an arrangement for the financing of premiums.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      Sec. 4.6. A carrier that issues a health benefit plan shall not discriminate against any person with respect to participation or coverage under the plan on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:

      1.  Denying, cancelling, limiting or refusing to issue or renew a health benefit plan on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;

      2.  Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an insured or a family member of the insured;

      3.  Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and

      4.  Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:

      (a) Related to gender transition, provided that there is coverage under the plan for the services when the services are not related to gender transition; or

      (b) Ordinarily or exclusively available to persons of any sex.

      Sec. 5. NRS 689C.425 is hereby amended to read as follows:

      689C.425  A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to 689C.355, inclusive, and sections 4 and 4.6 of this act, to the extent applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive.

      Sec. 5.8. Chapter 695A of NRS is hereby amended by adding thereto the provisions set forth as sections 6 and 6.6 of this act.

      Sec. 6. 1.  Except as otherwise provided in this section, a society that issues a benefit contract shall include in the benefit contract coverage for the medically necessary treatment of conditions relating to gender dysphoria and gender incongruence. Such coverage must include coverage of 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;

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2036 (CHAPTER 376, SB 163)ê

 

      (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 a benefit contract to include coverage for cosmetic surgery performed by a plastic surgeon or reconstructive surgeon that is not medically necessary.

      3.  A society that issues a benefit contract shall not categorically refuse to cover medically necessary gender-affirming treatments or procedures or revisions to prior treatments if the contract provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.

      4.  A society that issues a benefit contract may prescribe requirements that must be satisfied before the society covers surgical treatment of conditions relating to gender dysphoria or gender incongruence for an insured who is less than 18 years of age. Such requirements may include, without limitation, requirements that:

      (a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

      (b) The treatment must be recommended by a physician;

      (c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

      (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care; and

      (e) Parental consent is provided for the insured unless the insured is expressly authorized by law to consent on his or her own behalf.

      5.  When determining whether treatment is medically necessary for the purposes of this section, a society must consider the most recent Standards of Care published by the World Professional Association for Transgender Health, or its successor organization.

      6.  A society shall make a reasonable effort to ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the society. If, after a reasonable effort, the society is unable to make such benefits available through such a provider of health care, the society may treat the treatment that the society is unable to make available through such a provider of health care in the same manner as other services provided by a provider of health care who does not participate in the network plan of the society.

      7.  If an insured appeals the denial of a claim or coverage under this section on the grounds that the treatment requested by the insured is not medically necessary, the society 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 insured when considering the appeal.

      8.  A benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, has the legal effect of including the coverage required by subsection 1, and any provision of the benefit contract or renewal which is in conflict with the provisions of this section is void.

      9.  As used in this section:

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2037 (CHAPTER 376, SB 163)ê

 

      (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.

Ê 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) “Network plan” means a benefit contract offered by a society under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the society.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2038 (CHAPTER 376, SB 163)ê

 

a defined set of providers under contract with the society. The term does not include an arrangement for the financing of premiums.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      Sec. 6.6. A society that issues a benefit contract shall not discriminate against any person with respect to participation or coverage under the contract on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:

      1.  Denying, cancelling, limiting or refusing to issue or renew a benefit contract on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;

      2.  Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an insured or a family member of the insured;

      3.  Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and

      4.  Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:

      (a) Related to gender transition, provided that there is coverage under the contract for the services when the services are not related to gender transition; or

      (b) Ordinarily or exclusively available to persons of any sex.

      Sec. 6.8. Chapter 695B of NRS is hereby amended by adding thereto the provisions set forth as sections 7 and 7.6 of this act.

      Sec. 7. 1.  Except as otherwise provided in this section, a hospital or medical services corporation that issues a policy of health insurance shall include in the policy coverage for the medically necessary treatment of conditions relating to gender dysphoria and gender incongruence. Such coverage must include coverage of 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 a policy of health insurance to include coverage for cosmetic surgery performed by a plastic surgeon or reconstructive surgeon that is not medically necessary.

      3.  A hospital or medical services corporation that issues a policy of health insurance shall not categorically refuse to cover medically necessary gender-affirming treatments or procedures or revisions to prior treatments if the policy provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2039 (CHAPTER 376, SB 163)ê

 

treatments if the policy provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.

      4.  A hospital or medical services corporation that issues a policy of health insurance may prescribe requirements that must be satisfied before the hospital or medical services corporation covers surgical treatment of conditions relating to gender dysphoria or gender incongruence for an insured who is less than 18 years of age. Such requirements may include, without limitation, requirements that:

      (a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

      (b) The treatment must be recommended by a physician;

      (c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

      (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care; and

      (e) Parental consent is provided for the insured unless the insured is expressly authorized by law to consent on his or her own behalf.

      5.  When determining whether treatment is medically necessary for the purposes of this section, a hospital or medical services corporation must consider the most recent Standards of Care published by the World Professional Association for Transgender Health, or its successor organization.

      6.  A hospital or medical services corporation shall make a reasonable effort to ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the hospital or medical services corporation. If, after a reasonable effort, the hospital or medical services corporation is unable to make such benefits available through such a provider of health care, the hospital or medical services corporation may treat the treatment that the hospital or medical services corporation is unable to make available through such a provider of health care in the same manner as other services provided by a provider of health care who does not participate in the network plan of the hospital or medical services corporation.

      7.  If an insured appeals the denial of a claim or coverage under this section on the grounds that the treatment requested by the insured is not medically necessary, the hospital or medical services corporation 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 insured when considering the appeal.

      8.  A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or renewal which is in conflict with the provisions of this section is void.

      9.  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.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2040 (CHAPTER 376, SB 163)ê

 

             (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.

Ê 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) “Network plan” means a policy of health insurance offered by a hospital or medical services corporation under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the hospital or medical services corporation. The term does not include an arrangement for the financing of premiums.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      Sec. 7.6. A hospital or medical services corporation that issues a policy of health insurance shall not discriminate against any person with respect to participation or coverage under the policy on the basis of actual or perceived gender identity or expression.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2041 (CHAPTER 376, SB 163)ê

 

respect to participation or coverage under the policy on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:

      1.  Denying, cancelling, limiting or refusing to issue or renew a policy of health insurance on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;

      2.  Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an insured or a family member of the insured;

      3.  Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and

      4.  Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:

      (a) Related to gender transition, provided that there is coverage under the policy for the services when the services are not related to gender transition; or

      (b) Ordinarily or exclusively available to persons of any sex.

      Sec. 7.8. Chapter 695C of NRS is hereby amended by adding thereto the provisions set forth as sections 8 and 8.6 of this act.

      Sec. 8. 1.  Except as otherwise provided in this section, a health maintenance organization that issues a health care plan shall include in the health care plan coverage for the medically necessary treatment of conditions relating to gender dysphoria and gender incongruence. Such coverage must include coverage of 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 a health care plan to include coverage for cosmetic surgery performed by a plastic surgeon or reconstructive surgeon that is not medically necessary.

      3.  A health maintenance organization that issues a health care plan shall not categorically refuse to cover medically necessary gender-affirming treatments or procedures or revisions to prior treatments if the plan provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.

      4.  A health maintenance organization that issues a health care plan may prescribe requirements that must be satisfied before the health maintenance organization covers surgical treatment of conditions relating to gender dysphoria or gender incongruence for an enrollee who is less than 18 years of age.

 


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to gender dysphoria or gender incongruence for an enrollee who is less than 18 years of age. Such requirements may include, without limitation, requirements that:

      (a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

      (b) The treatment must be recommended by a physician;

      (c) The enrollee must provide a written expression of the desire of the enrollee to undergo the treatment;

      (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care; and

      (e) Parental consent is provided for the enrollee unless the enrollee is expressly authorized by law to consent on his or her own behalf.

      5.  When determining whether treatment is medically necessary for the purposes of this section, a health maintenance organization must consider the most recent Standards of Care prescribed by the World Professional Association for Transgender Health, or its successor organization.

      6.  A health maintenance organization shall make a reasonable effort to ensure that the benefits required by subsection 1 are made available to an enrollee through a provider of health care who participates in the network plan of the health maintenance organization. If, after a reasonable effort, the health maintenance organization is unable to make such benefits available through such a provider of health care, the health maintenance organization may treat the treatment that the health maintenance organization is unable to make available through such a provider of health care in the same manner as other services provided by a provider of health care who does not participate in the network plan of the health maintenance organization.

      7.  If an enrollee appeals the denial of a claim or coverage under this section on the grounds that the treatment requested by the enrollee is not medically necessary, the health maintenance organization 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 enrollee when considering the appeal.

      8.  A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, has the legal effect of including the coverage required by subsection 1, and any provision of the plan or renewal which is in conflict with the provisions of this section is void.

      9.  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:

 


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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.

Ê 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) “Network plan” means a health care plan offered by a health maintenance organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the health maintenance organization. The term does not include an arrangement for the financing of premiums.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      Sec. 8.6. A health maintenance organization that issues a health care plan shall not discriminate against any person with respect to participation or coverage under the plan on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:

      1.  Denying, cancelling, limiting or refusing to issue or renew a health care plan on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;

 


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ê2023 Statutes of Nevada, Page 2044 (CHAPTER 376, SB 163)ê

 

      2.  Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an enrollee or a family member of the enrollee;

      3.  Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and

      4.  Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:

      (a) Related to gender transition, provided that there is coverage under the plan for the services when the services are not related to gender transition; or

      (b) Ordinarily or exclusively available to persons of any sex.

      Sec. 9. NRS 695C.050 is hereby amended to read as follows:

      695C.050  1.  Except as otherwise provided in this chapter or in specific provisions of this title, the provisions of this title are not applicable to any health maintenance organization granted a certificate of authority under this chapter. This provision does not apply to an insurer licensed and regulated pursuant to this title except with respect to its activities as a health maintenance organization authorized and regulated pursuant to this chapter.

      2.  Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, must not be construed to violate any provision of law relating to solicitation or advertising by practitioners of a healing art.

      3.  Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and is exempt from the provisions of chapter 630 of NRS.

      4.  The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services. This subsection does not exempt a health maintenance organization from any provision of this chapter for services provided pursuant to any other contract.

      5.  The provisions of NRS 695C.1694 to 695C.1698, inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17333, 695C.17345, 695C.17347, 695C.1735, 695C.1737, 695C.1743, 695C.1745 and 695C.1757 and sections 8 and 8.6 of this act apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.

      Sec. 10. NRS 695C.330 is hereby amended to read as follows:

      695C.330  1.  The Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization pursuant to the provisions of this chapter if the Commissioner finds that any of the following conditions exist:

      (a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;

 


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ê2023 Statutes of Nevada, Page 2045 (CHAPTER 376, SB 163)ê

 

a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;

      (b) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with the requirements of NRS 695C.1691 to 695C.200, inclusive, or 695C.207 [;] or sections 8 and 8.6 of this act;

      (c) The health care plan does not furnish comprehensive health care services as provided for in NRS 695C.060;

      (d) The Commissioner certifies that the health maintenance organization:

             (1) Does not meet the requirements of subsection 1 of NRS 695C.080; or

             (2) Is unable to fulfill its obligations to furnish health care services as required under its health care plan;

      (e) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;

      (f) The health maintenance organization has failed to put into effect a mechanism affording the enrollees an opportunity to participate in matters relating to the content of programs pursuant to NRS 695C.110;

      (g) The health maintenance organization has failed to put into effect the system required by NRS 695C.260 for:

             (1) Resolving complaints in a manner reasonably to dispose of valid complaints; and

             (2) Conducting external reviews of adverse determinations that comply with the provisions of NRS 695G.241 to 695G.310, inclusive;

      (h) The health maintenance organization or any person on its behalf has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner;

      (i) The continued operation of the health maintenance organization would be hazardous to its enrollees or creditors or to the general public;

      (j) The health maintenance organization fails to provide the coverage required by NRS 695C.1691; or

      (k) The health maintenance organization has otherwise failed to comply substantially with the provisions of this chapter.

      2.  A certificate of authority must be suspended or revoked only after compliance with the requirements of NRS 695C.340.

      3.  If the certificate of authority of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of that suspension, enroll any additional groups or new individual contracts, unless those groups or persons were contracted for before the date of suspension.

      4.  If the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the organization. It shall engage in no further advertising or solicitation of any kind. The Commissioner may, by written order, permit such further operation of the organization as the Commissioner may find to be in the best interest of enrollees to the end that enrollees are afforded the greatest practical opportunity to obtain continuing coverage for health care.

 


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      Sec. 10.8. Chapter 695G of NRS is hereby amended by adding thereto the provisions set forth as sections 11 and 11.6 of this act.

      Sec. 11. 1.  Except as otherwise provided in this section, a managed care organization that issues a health care plan shall include in the health care plan coverage for the medically necessary treatment of conditions relating to gender dysphoria and gender incongruence. Such coverage must include coverage of 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 a health care plan to include coverage for cosmetic surgery performed by a plastic surgeon or reconstructive surgeon that is not medically necessary.

      3.  A managed care organization that issues a health care plan shall not categorically refuse to cover medically necessary gender-affirming treatments or procedures or revisions to prior treatments if the plan provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.

      4.  A managed care organization that issues a health care plan may prescribe requirements that must be satisfied before the managed care organization covers surgical treatment of conditions relating to gender dysphoria or gender incongruence for an insured who is less than 18 years of age. Such requirements may include, without limitation, requirements that:

      (a) The treatment must be recommended by a psychologist, psychiatrist or other mental health professional;

      (b) The treatment must be recommended by a physician;

      (c) The insured must provide a written expression of the desire of the insured to undergo the treatment;

      (d) A written plan for treatment that covers at least 1 year must be developed and approved by at least two providers of health care; and

      (e) Parental consent is provided for the insured unless the insured is expressly authorized by law to consent on his or her own behalf.

      5.  When determining whether treatment is medically necessary for the purposes of this section, a managed care organization must consider the most recent Standards of Care prescribed by the World Professional Association for Transgender Health, or its successor organization.

      6.  A managed care organization shall make a reasonable effort to ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the managed care organization. If, after a reasonable effort, the managed care organization is unable to make such benefits available through such a provider of health care, the managed care organization may treat the treatment that the managed care organization is unable to make available through such a provider of health care in the same manner as other services provided by a provider of health care who does not participate in the network plan of the managed care organization.

 


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ê2023 Statutes of Nevada, Page 2047 (CHAPTER 376, SB 163)ê

 

managed care organization is unable to make such benefits available through such a provider of health care, the managed care organization may treat the treatment that the managed care organization is unable to make available through such a provider of health care in the same manner as other services provided by a provider of health care who does not participate in the network plan of the managed care organization.

      7.  If an insured appeals the denial of a claim or coverage under this section on the grounds that the treatment requested by the insured is not medically necessary, the managed care organization 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 insured when considering the appeal.

      8.  Evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, has the legal effect of including the coverage required by subsection 1, and any provision of the plan or renewal which is in conflict with the provisions of this section is void.

      9.  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.

 


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ê2023 Statutes of Nevada, Page 2048 (CHAPTER 376, SB 163)ê

 

      (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.

Ê 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) “Network plan” means a health care plan offered by a managed care organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the managed care organization. The term does not include an arrangement for the financing of premiums.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      Sec. 11.6. A managed care organization that issues a health care plan shall not discriminate against any person with respect to participation or coverage under the plan on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:

      1.  Denying, cancelling, limiting or refusing to issue or renew a health care plan on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;

      2.  Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an insured or a family member of the insured;

      3.  Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and

      4.  Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:

      (a) Related to gender transition, provided that there is coverage under the plan for the services when the services are not related to gender transition; or

      (b) Ordinarily or exclusively available to persons of any sex.

      Sec. 12. NRS 232.320 is hereby amended to read as follows:

      232.320  1.  The Director:

      (a) Shall appoint, with the consent of the Governor, administrators of the divisions of the Department, who are respectively designated as follows:

 


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ê2023 Statutes of Nevada, Page 2049 (CHAPTER 376, SB 163)ê

 

             (1) The Administrator of the Aging and Disability Services Division;

             (2) The Administrator of the Division of Welfare and Supportive Services;

             (3) The Administrator of the Division of Child and Family Services;

             (4) The Administrator of the Division of Health Care Financing and Policy; and

             (5) The Administrator of the Division of Public and Behavioral Health.

      (b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and sections 15 and 15.6 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public and Behavioral Health or the professional line activities of the other divisions.

      (c) Shall administer any state program for persons with developmental disabilities established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C. §§ 15001 et seq.

      (d) Shall, after considering advice from agencies of local governments and nonprofit organizations which provide social services, adopt a master plan for the provision of human services in this State. The Director shall revise the plan biennially and deliver a copy of the plan to the Governor and the Legislature at the beginning of each regular session. The plan must:

             (1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplication of those services by federal, state and local agencies;

             (2) Set forth priorities for the provision of those services;

             (3) Provide for communication and the coordination of those services among nonprofit organizations, agencies of local government, the State and the Federal Government;

             (4) Identify the sources of funding for services provided by the Department and the allocation of that funding;

             (5) Set forth sufficient information to assist the Department in providing those services and in the planning and budgeting for the future provision of those services; and

             (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department.

      (e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

      (f) Has such other powers and duties as are provided by law.

      2.  Notwithstanding any other provision of law, the Director, or the Director’s designee, is responsible for appointing and removing subordinate officers and employees of the Department.

 


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      Sec. 13. NRS 287.010 is hereby amended to read as follows:

      287.010  1.  The governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada may:

      (a) Adopt and carry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of its officers and employees, and the dependents of officers and employees who elect to accept the insurance and who, where necessary, have authorized the governing body to make deductions from their compensation for the payment of premiums on the insurance.

      (b) Purchase group policies of life, accident or health insurance, or any combination thereof, for the benefit of such officers and employees, and the dependents of such officers and employees, as have authorized the purchase, from insurance companies authorized to transact the business of such insurance in the State of Nevada, and, where necessary, deduct from the compensation of officers and employees the premiums upon insurance and pay the deductions upon the premiums.

      (c) Provide group life, accident or health coverage through a self-insurance reserve fund and, where necessary, deduct contributions to the maintenance of the fund from the compensation of officers and employees and pay the deductions into the fund. The money accumulated for this purpose through deductions from the compensation of officers and employees and contributions of the governing body must be maintained as an internal service fund as defined by NRS 354.543. The money must be deposited in a state or national bank or credit union authorized to transact business in the State of Nevada. Any independent administrator of a fund created under this section is subject to the licensing requirements of chapter 683A of NRS, and must be a resident of this State. Any contract with an independent administrator must be approved by the Commissioner of Insurance as to the reasonableness of administrative charges in relation to contributions collected and benefits provided. The provisions of NRS 686A.135, 687B.352, 687B.408, 687B.723, 687B.725, 689B.030 to 689B.050, inclusive, and sections 3 and 3.6 of this act, 689B.265, 689B.287 and 689B.500 apply to coverage provided pursuant to this paragraph, except that the provisions of NRS 689B.0378, 689B.03785 and 689B.500 only apply to coverage for active officers and employees of the governing body, or the dependents of such officers and employees.

      (d) Defray part or all of the cost of maintenance of a self-insurance fund or of the premiums upon insurance. The money for contributions must be budgeted for in accordance with the laws governing the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada.

      2.  If a school district offers group insurance to its officers and employees pursuant to this section, members of the board of trustees of the school district must not be excluded from participating in the group insurance. If the amount of the deductions from compensation required to pay for the group insurance exceeds the compensation to which a trustee is entitled, the difference must be paid by the trustee.

      3.  In any county in which a legal services organization exists, the governing body of the county, or of any school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada in the county, may enter into a contract with the legal services organization pursuant to which the officers and employees of the legal services organization, and the dependents of those officers and employees, are eligible for any life, accident or health insurance provided pursuant to this section to the officers and employees, and the dependents of the officers and employees, of the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency.

 


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ê2023 Statutes of Nevada, Page 2051 (CHAPTER 376, SB 163)ê

 

contract with the legal services organization pursuant to which the officers and employees of the legal services organization, and the dependents of those officers and employees, are eligible for any life, accident or health insurance provided pursuant to this section to the officers and employees, and the dependents of the officers and employees, of the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency.

      4.  If a contract is entered into pursuant to subsection 3, the officers and employees of the legal services organization:

      (a) Shall be deemed, solely for the purposes of this section, to be officers and employees of the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency with which the legal services organization has contracted; and

      (b) Must be required by the contract to pay the premiums or contributions for all insurance which they elect to accept or of which they authorize the purchase.

      5.  A contract that is entered into pursuant to subsection 3:

      (a) Must be submitted to the Commissioner of Insurance for approval not less than 30 days before the date on which the contract is to become effective.

      (b) Does not become effective unless approved by the Commissioner.

      (c) Shall be deemed to be approved if not disapproved by the Commissioner within 30 days after its submission.

      6.  As used in this section, “legal services organization” means an organization that operates a program for legal aid and receives money pursuant to NRS 19.031.

      Sec. 14. NRS 287.04335 is hereby amended to read as follows:

      287.04335  If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 686A.135, 687B.352, 687B.409, 687B.723, 687B.725, 689B.0353, 689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.1675, 695G.170 to 695G.174, inclusive, and sections 11 and 11.6 of this act, 695G.176, 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

      Sec. 14.8. Chapter 422 of NRS is hereby amended by adding thereto the provisions set forth as sections 15 and 15.6 of this act.

      Sec. 15. 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;

 


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ê2023 Statutes of Nevada, Page 2052 (CHAPTER 376, SB 163)ê

 

      (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.

 


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ê2023 Statutes of Nevada, Page 2053 (CHAPTER 376, SB 163)ê

 

             (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.

Ê 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.

      Sec. 15.6. The Department shall not discriminate against any person with respect to participation or coverage under Medicaid on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:

      1.  Denying, cancelling, limiting or refusing to issue a payment or coverage on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;

      2.  Imposing a payment that is based on the actual or perceived gender identity or expression of a recipient of Medicaid or a family member of the recipient;

      3.  Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and

      4.  Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying payment or coverage for health care services that are:

      (a) Related to gender transition, provided that there is coverage under Medicaid for the services when the services are not related to gender transition; or

      (b) Ordinarily or exclusively available to persons of any sex.

      Sec. 16.  1.  There is hereby appropriated from the State General Fund to the Division of Health Care Financing and Policy of the Department of Health and Human Services for the costs of providing coverage under Medicaid for the treatment of conditions relating to gender dysphoria and gender incongruence required by section 15 of this act the following sums:

For the Fiscal Year 2023-2024.................................................... $162,926

For the Fiscal Year 2024-2025.................................................... $182,654

 


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ê2023 Statutes of Nevada, Page 2054 (CHAPTER 376, SB 163)ê

 

      2.  Any balance of the sums appropriated by subsection 1 remaining at the end of the respective fiscal years must not be committed for expenditure after June 30 of the respective fiscal years by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 20, 2024, and September 19, 2025, respectively, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 20, 2024, and September 19, 2025, respectively.

      3.  Expenditure of $1,239,172 not appropriated from the State General Fund or the State Highway Fund is hereby authorized during Fiscal Year 2023-2024 by the Division of Health Care Financing and Policy of the Department of Health and Human Services for the same purposes as set forth in subsection 1.

      4.  Expenditure of $1,076,246 not appropriated from the State General Fund or the State Highway Fund is hereby authorized during Fiscal Year 2024-2025 by the Division of Health Care Financing and Policy of the Department of Health and Human Services for the same purposes as set forth in subsection 1.

      Sec. 17.  1.  There is hereby appropriated from the State General Fund to the Division of Health Care Financing and Policy of the Department of Health and Human Services the sum of $19,500 for the costs of information system upgrades and actuarial rate setting associated with carrying out the provisions of this act.

      2.  Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after June 30, 2024, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 20, 2024, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 20, 2024.

      3.  Expenditure of $48,000 not appropriated from the State General Fund or the State Highway Fund is hereby authorized during Fiscal Year 2023-2024 by the Division of Health Care Financing and Policy of the Department of Health and Human Services for the same purposes as set forth in subsection 1.

      Sec. 18.  The provisions of NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.

      Sec. 19.  This act becomes effective on July 1, 2023.

________

 


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ê2023 Statutes of Nevada, Page 2055ê

 

CHAPTER 377, SB 242

Senate Bill No. 242–Senators Nguyen, Donate; Flores, Hansen, D. Harris, Ohrenschall and Stone

 

Joint Sponsors: Assemblymen Carter and Marzola

 

CHAPTER 377

 

[Approved: June 12, 2023]

 

AN ACT relating to controlled substances; requiring the Department of Health and Human Services to establish the Psychedelic Medicines Working Group to study certain issues relating to the therapeutic use of entheogens during the 2023-2024 interim; prescribing the membership and duties of the Working Group; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      This bill requires the Department of Health and Human Services to establish the Psychedelic Medicines Working Group to study certain issues relating to the therapeutic use of entheogens during the 2023-2024 interim. This bill defines “entheogen” to include, without limitation, psilocybin and psilocin. This bill also: (1) prescribes the membership and duties of the Working Group; and (2) requires the Department of Health and Human Services to submit a written report describing the activities, findings, conclusions and recommendations of the Working Group for transmittal to the 83rd Session of the Legislature.

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

      Whereas, Nevada has a high prevalence of adults with behavioral health conditions; and

      Whereas, Studies conducted by nationally and internationally recognized medical institutions indicate that psilocybin has shown efficacy and safety in the treatment of a variety of behavioral health conditions, including, without limitation, addiction, treatment-resistant depression, major depressive disorder, post-traumatic stress disorder and psychological distress relating to the end of life; and

      Whereas, The United States Food and Drug Administration has determined that preliminary clinical evidence indicates that psilocybin may demonstrate substantial improvement over available therapies for treatment-resistant depression and major depressive disorder and has accordingly granted Breakthrough Therapy designation for treatment that uses psilocybin as a therapy for treatment-resistant depression and major depressive disorder; and

      Whereas, Numerous state and local lawmaking bodies throughout the United States have already enacted or are currently considering legislation decriminalizing certain conduct by certain persons relating to psilocybin and psilocin; now, therefore

 


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ê2023 Statutes of Nevada, Page 2056 (CHAPTER 377, SB 242)ê

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Sections 1-3. (Deleted by amendment.)

      Sec. 3.5.  1.  The Department of Health and Human Services shall establish the Psychedelic Medicines Working Group to study certain issues relating to the therapeutic use of entheogens during the 2023-2024 interim. The Working Group must consist of:

      (a) The Director of the Department of Health and Human Services or his or her designee;

      (b) The Attorney General or his or her designee;

      (c) The Director of the Department of Veterans Services or his or her designee;

      (d) The President of the State Board of Pharmacy or his or her designee;

      (e) One member appointed by the Majority Leader of the Senate;

      (f) One member appointed by the Minority Leader of the Senate;

      (g) One member appointed by the Speaker of the Assembly;

      (h) One member appointed by the Minority Leader of the Assembly; and

      (i) The following members appointed by the Governor, each of whom must be a bona fide resident of this State for not less than 1 year immediately preceding his or her appointment:

             (1) One member who has received an honorable discharge from the Armed Forces of the United States and who has experience with the use of entheogens to address post-traumatic stress disorder;

             (2) One member who is a psychiatrist, or a psychologist with clinical experience, and who:

                   (I) Is licensed to practice in this State; and

                   (II) Has experience treating patients who have an alcohol or other substance use disorder;

             (3) One member who has experience treating post-traumatic stress disorder in a clinical setting;

             (4) One member who has experience researching the therapeutic use of entheogens pursuant to a license issued by the Drug Enforcement Administration of the United States Department of Justice;

             (5) One member who is a representative of a tribal government, as defined in NRS 239C.105, in this State;

             (6) One member who is a representative of an organization that advocates for and provides education to the public regarding the therapeutic use of entheogens; and

             (7) One member who is a representative of a law enforcement agency in this State.

      2.  The Working Group shall, during the 2023-2024 interim:

      (a) Examine various entheogens to determine which entheogens may be beneficial for therapeutic use in reducing suicidal ideation and improving mental health, including, without limitation, through the use of entheogens in the treatment of post-traumatic stress disorder, substance use disorder, major depressive disorder or psychological distress relating to the end of life;

 


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ê2023 Statutes of Nevada, Page 2057 (CHAPTER 377, SB 242)ê

 

      (b) Review federal, state and local laws and regulations concerning the therapeutic use of entheogens and identify any revisions to the laws and regulations of this State that may be necessary to enable entheogens to be used for therapeutic purposes in this State;

      (c) Review existing and ongoing research on the therapeutic use of entheogens; and

      (d) Develop a strategic, measurable and actionable plan to allow access to safe and affordable entheogens so that such entheogens may be used for therapeutic purposes.

      3.  The Director of the Department of Health and Human Services shall serve as Chair of the Working Group. The Attorney General or his or her designee shall serve as Vice Chair of the Working Group.

      4.  A majority of the members of the Working Group constitutes a quorum for the transaction of business, and a majority of those members present at any meeting is sufficient for any official action taken by the Working Group.

      5.  The Chair of the Working Group may appoint subcommittees composed of members of the public who have relevant experience or knowledge to consider specific issues or other matters relating to the therapeutic use of entheogens.

      6.  Each member of the Working Group:

      (a) Serves without compensation; and

      (b) While engaged in the business of the Working Group, is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally.

      7.  The Department of Health and Human Services shall provide the Working Group with such administrative support as is necessary to assist the Working Group in carrying out its duties pursuant to this section.

      8.  The Department of Health and Human Services shall, on or before December 31, 2024, prepare and submit a written report describing the activities, findings, conclusions and recommendations of the Working Group to the Director of the Legislative Counsel Bureau for transmittal to the 83rd Session of the Legislature.

      9.  As used in this section, “entheogen” includes, without limitation, psilocybin and psilocin.

      Sec. 4.  This act becomes effective upon passage and approval.

________

 


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ê2023 Statutes of Nevada, Page 2058ê

 

CHAPTER 378, SB 350

Senate Bill No. 350–Senators Pazina, Dondero Loop, Lange, Krasner, Donate; Hammond, Hansen, D. Harris, Neal, Nguyen, Ohrenschall, Scheible, Seevers Gansert, Spearman and Titus

 

Joint Sponsor: Assemblyman C.H. Miller

 

CHAPTER 378

 

[Approved: June 12, 2023]

 

AN ACT relating to health care; requiring the Office of Science, Innovation and Technology in the Office of the Governor to establish the Graduate Medical Education Grant Program for the purpose of awarding competitive grants to create, expand and retain residency and fellowship programs for physicians in this State; establishing and prescribing the duties of the Advisory Council on Graduate Medical Education; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law establishes the Office of Science, Innovation and Technology in the Office of the Governor. (NRS 232.600) Section 5 of this bill requires the Office to establish the Graduate Medical Education Grant Program for the purpose of awarding grants to institutions seeking to create, expand or retain accredited programs for residency training and postdoctoral fellowships for physicians. Section 2 of this bill creates the Account for the Graduate Medical Education Grant Program in the State General Fund, requires the Director of the Office to administer the Account and requires money in the Account to be used to award competitive grants pursuant to the Program. Section 3 of this bill establishes the Advisory Council on Graduate Medical Education, and section 4 of this bill requires the Council to make recommendations to the Office concerning applications for grants pursuant to the Program. Under sections 4 and 5, the Council and the Office are required to give priority to applications for grants made for the purpose of retaining programs of residency training and postdoctoral fellowships when the federal funding supporting such programs expires. Section 5 also requires the Office to establish a committee to develop a process, procedure and rubric for evaluating applications for grants pursuant to the Program. Section 6 of this bill requires the Office to submit an annual report to the Governor and the Legislature concerning the Program and any recommendations for the measures to create, expand and retain programs of residency training and postdoctoral fellowships. Sections 7 and 8 of this bill make conforming changes to, respectively: (1) require the Director to provide support for the Council and implement the Program; and (2) clarify that money for the Program is required to be deposited in the Account. Section 11 of this bill provides that this bill becomes effective upon passage and approval.

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1.  Chapter 223 of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 6, inclusive, of this act.

      Sec. 2. 1.  The Account for the Graduate Medical Education Grant Program is hereby created in the State General Fund. The Director of the Office of Science, Innovation and Technology shall administer the Account.

 


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ê2023 Statutes of Nevada, Page 2059 (CHAPTER 378, SB 350)ê

 

      2.  The Director of the Office of Science, Innovation and Technology may:

      (a) Accept any gift, donation, bequest or devise; and

      (b) Apply for and accept any grant, loan or other source of money,

Ê for deposit in the Account to assist the Director in carrying out the Graduate Medical Education Grant Program established pursuant to section 5 of this act.

      3.  The interest and income earned on the money in the Account, after deducting any applicable charges, must be credited to the Account.

      4.  The money in the Account must only be used to:

      (a) Award competitive grants to institutions in this State seeking to create, expand or retain programs for residency training and postdoctoral fellowships that are approved by the Accreditation Council for Graduate Medical Education or its successor organization; and

      (b) Defray the costs of establishing and administering the Graduate Medical Education Grant Program established pursuant to section 5 of this act.

      5.  Any money remaining in the Account at the end of the fiscal year does not revert to the State General Fund, and the balance in the Account must be carried forward to the next fiscal year.

      6.  Claims against the Account must be paid as other claims against the State are paid.

      Sec. 3. 1.  The Advisory Council on Graduate Medical Education is hereby created within the Office of Science, Innovation and Technology. The Council consists of:

      (a) The dean of each medical school in this State that is accredited by the Liaison Committee on Medical Education of the American Medical Association and the Association of American Medical Colleges or their successor organizations, or his or her designee;

      (b) The dean of each school of osteopathic medicine in this State that is accredited by the Commission on Osteopathic College Accreditation of the American Osteopathic Association or its successor organization, or his or her designee;

      (c) Two members appointed by the Governor who are physicians licensed pursuant to chapter 630 or 633 of NRS;

      (d) One member appointed by the Governor who represents hospitals located in counties whose population is less than 100,000;

      (e) One member appointed by the Governor who represents hospitals located in counties whose population is 100,000 or more but less than 700,000;

      (f) One member appointed by the Governor who represents hospitals located in a county whose population is 700,000 or more;

      (g) One member appointed by the Governor who represents the medical corps of any of the Armed Forces of the United States;

      (h) One member appointed by the Governor who represents the Department of Health and Human Services; and

      (i) One member appointed by the Governor who represents the Office of Economic Development in the Office of the Governor.

      2.  In addition to the members appointed by the Governor pursuant to subsection 1, the Governor may appoint two members as the Governor determines necessary to carry out the provisions of sections 2 to 6, inclusive, of this act.

 


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ê2023 Statutes of Nevada, Page 2060 (CHAPTER 378, SB 350)ê

 

      3.  After the initial terms, the term of each member of the Council is 3 years, and members shall serve at the pleasure of the Governor.

      4.  Any vacancy occurring in the membership of the Council must be filled in the same manner as the original appointment not later than 30 days after the vacancy occurs.

      5.  The Council shall select from its members a Chair and a Vice Chair who shall hold office for 1 year and who may be reselected.

      6.  The Council shall meet at the call of the Chair as often as necessary to evaluate applications for competitive grants for the Graduate Medical Education Grant Program established pursuant to section 5 of this act and make recommendations to the Office of Science, Innovation and Technology concerning the approval of applications for such grants.

      7.  A majority of the members of the Council constitutes a quorum for the transaction of business, and a majority of those members present at any meeting is sufficient for any official action taken by the Council.

      8.  The members of the Council serve without compensation, except that each member is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally while engaged in the official business of the Council.

      9.  A member of the Council who is an officer or employee of this State or a political subdivision of this State must be relieved from his or her duties without loss of regular compensation to prepare for and attend meetings of the Council and perform any work necessary to carry out the duties of the Council in the most timely manner practicable. A state agency or political subdivision of this State shall not require an officer or employee who is a member of the Council to:

      (a) Make up the time he or she is absent from work to carry out his or her duties as a member of the Council; or

      (b) Take annual leave or compensatory time for the absence.

      Sec. 4. The Advisory Council on Graduate Medical Education shall:

      1.  Evaluate applications for competitive grants for the Graduate Medical Education Grant Program established pursuant to section 5 of this act and make recommendations to the Office of Science, Innovation and Technology concerning the approval of applications for such grants. In evaluating and making recommendations concerning such applications, the Council shall give priority to the award of grants for the retention of programs in this State for residency training and postdoctoral fellows when the federal funding for the support of such programs expires.

      2.  Study and make recommendations to the Office of Science, Innovation and Technology, the Governor and the Legislature concerning:

      (a) The creation and retention of programs in this State for residency training and postdoctoral fellows that are approved by the Accreditation Council for Graduate Medical Education or its successor organization; and

      (b) The recruitment and retention of physicians necessary to meet the health care needs of the residents of this State, with the emphasis on those health care needs.

      Sec. 5. 1.  The Office of Science, Innovation and Technology shall establish and administer a Graduate Medical Education Grant Program as a competitive grant program to award grants to institutions in this State seeking to create, expand or retain programs for residency training and postdoctoral fellows that are approved by the Accreditation Council for Graduate Medical Education or its successor organization.

 


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ê2023 Statutes of Nevada, Page 2061 (CHAPTER 378, SB 350)ê

 

postdoctoral fellows that are approved by the Accreditation Council for Graduate Medical Education or its successor organization.

      2.  In awarding grants pursuant to the Program established pursuant to subsection 1, the Office of Science, Innovation and Technology shall consider the recommendations of the Advisory Council on Graduate Medical Education created by section 3 of this act and give priority to the award of grants for the retention of programs in this State for residency training and postdoctoral fellows when the federal funding for the support of such programs expires.

      3.  The Office of Science, Innovation and Technology shall establish a committee to develop a process, procedure and rubric for evaluating applications for grants pursuant to the Program established pursuant to subsection 1 to ensure that the process and procedure are transparent, without bias, fair, equitable and accessible. The committee established pursuant to this subsection must be composed of persons with expertise in subject matters related to graduate medical education who are not affiliated with any applicant for a grant pursuant to the Program established pursuant to subsection 1.

      4.  The Office of Science, Innovation and Technology may adopt regulations necessary to carry out the Program established pursuant to subsection 1. Such regulations may include, without limitation, the requirements to apply for and receive a grant.

      Sec. 6. 1.  On or before October 1 of each year, the Office of Science, Innovation and Technology shall submit a written report to:

      (a) The Governor; and

      (b) The Director of the Legislative Counsel Bureau for transmittal to:

             (1) The Interim Finance Committee in an odd-numbered year; or

             (2) The next regular session of the Legislature in an even-numbered year.

      2.  The report must include, without limitation:

      (a) Information on the Graduate Medical Education Grant Program established pursuant to section 5 of this act; and

      (b) Any recommendations regarding graduate medical education in this State, including, without limitation:

             (1) The creation, expansion and retention of programs in this State for residency training and postdoctoral fellows; and

             (2) Methods by which this State may recruit and retain physicians necessary to meet the health care needs of the residents of this State.

      Sec. 7. NRS 223.610 is hereby amended to read as follows:

      223.610  The Director of the Office of Science, Innovation and Technology shall:

      1.  Advise the Governor and the Executive Director of the Office of Economic Development on matters relating to science, innovation and technology.

      2.  Work in coordination with the Office of Economic Development to establish criteria and goals for economic development and diversification in this State in the areas of science, innovation and technology.

      3.  As directed by the Governor, identify, recommend and carry out policies related to science, innovation and technology.

      4.  Report periodically to the Executive Director of the Office of Economic Development concerning the administration of the policies and programs of the Office of Science, Innovation and Technology.

 


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ê2023 Statutes of Nevada, Page 2062 (CHAPTER 378, SB 350)ê

 

      5.  Coordinate activities in this State relating to the planning, mapping and procurement of broadband service in a competitively neutral and nondiscriminatory manner, which must include, without limitation:

      (a) Development of a strategic plan to improve the delivery of broadband services in this State to schools, libraries, providers of health care, transportation facilities, prisons and other community facilities;

      (b) Applying for state and federal grants on behalf of eligible entities and managing state matching money that has been appropriated by the Legislature;

      (c) Coordinating and processing applications for state and federal money relating to broadband services;

      (d) Prioritizing construction projects which affect or involve the expansion or deployment of broadband services in this State;

      (e) In consultation with providers of health care from various health care settings, the expansion of telehealth services to reduce health care costs and increase health care quality and access in this State, especially in rural, unserved and underserved areas of this State;

      (f) Expansion of the fiber optic infrastructure in this State for the benefit of the public safety radio and communications systems in this State;

      (g) Collection and storage of data relating to agreements and contracts entered into by the State for the provision of fiber optic assets in this State;

      (h) Administration of the trade policy for fiber optic infrastructure in this State; and

      (i) Establishing and administering a program of infrastructure grants for the development or improvement of broadband services for persons with low income and persons in rural areas of this State using money from the Account for the Grant Program for Broadband Infrastructure created by NRS 223.660. The Director may adopt regulations to carry out his or duties pursuant to this paragraph.

      6.  Provide support to the Advisory Council on Science, Technology, Engineering and Mathematics and direct the implementation in this State of plans developed by the Council concerning, without limitation, workforce development, college preparedness and economic development.

      7.  Provide support to the Advisory Council on Graduate Medical Education and implement the Graduate Medical Education Grant Program established pursuant to section 5 of this act.

      8.  In carrying out his or her duties pursuant to this section, consult with the Executive Director of the Office of Economic Development and cooperate with the Executive Director in implementing the State Plan for Economic Development developed by the Executive Director pursuant to subsection 2 of NRS 231.053.

      [8.]9.  Administer such grants as are provided by legislative appropriation.

      Sec. 8. NRS 223.630 is hereby amended to read as follows:

      223.630  1.  The Account for the Office of Science, Innovation and Technology is hereby created in the State General Fund. The Account must be administered by the Director of the Office of Science, Innovation and Technology.

      2.  Except as otherwise provided in NRS 223.660 [,] and section 2 of this act, any money accepted pursuant to NRS 223.620 must be deposited in the Account.

 


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ê2023 Statutes of Nevada, Page 2063 (CHAPTER 378, SB 350)ê

 

      3.  The interest and income earned on the money in the Account, after deducting any applicable charges, must be credited to the Account.

      4.  The money in the Account must only be used to carry out the duties of the Director.

      5.  Claims against the Account must be paid as other claims against the State are paid.

      Sec. 9.  (Deleted by amendment.)

      Sec. 10.  The provisions of subsection 1 of NRS 218D.380 do not apply to any provision of this act which adds or revises a requirement to submit a report to the Legislature.

      Sec. 11.  This act becomes effective upon passage and approval.

________

CHAPTER 379, SB 380

Senate Bill No. 380–Senator Nguyen

 

CHAPTER 379

 

[Approved: June 12, 2023]

 

AN ACT relating to child welfare; revising the date on which an agency which provides child welfare services is required to participate in the Extended Young Adult Support Services Program; authorizing an agency which provides child welfare services to request to participate in the Program before that date; requiring reporting concerning efforts to allow certain young adults to remain in foster care; making appropriations; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law authorizes a child whom a court places with a person or entity other than a parent and who reaches 18 years of age to request the court to retain jurisdiction over the child until the child reaches 21 years of age. If a court retains jurisdiction over a child in such circumstances, the child is required to enter into an agreement with the agency which provides child welfare services. Such an agreement is required to provide that the child is entitled to: (1) continue receiving services from the agency which provides child welfare services; and (2) receive monetary payments directly or to have such payments provided to another entity in an amount not to exceed the rate of payment for foster care. (NRS 432B.594) Existing law additionally requires the agency which provides child welfare services to develop a written plan to assist the child in transitioning into independent living. (NRS 432B.595)

      Senate Bill No. 397 of the 2021 Legislative Session revises those provisions, effective on January 1, 2024, to require the Division of Child and Family Services of the Department of Health and Human Services to establish the Extended Young Adult Support Services Program to provide extended youth support services to young adults who would have been eligible previously to receive services upon electing to remain under the jurisdiction of the court. (Section 25 of chapter 419, Statutes of Nevada 2021, at page 2728) Senate Bill No. 397 authorizes a young adult to decide to participate in the Program any time before his or her 21st birthday, notwithstanding any previous decision not to participate or to terminate participation. (Section 32 of chapter 419, Statutes of Nevada 2021, at page 2731) Senate Bill No. 397 requires a participant in the Program to: (1) enter into a written agreement with the agency

 


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ê2023 Statutes of Nevada, Page 2064 (CHAPTER 379, SB 380)ê

 

which provides child welfare services; and (2) be employed or enrolled in certain educational programs or programs to promote employment if the participant is capable of doing so. (Section 33 of chapter 419, Statutes of Nevada 2021, at page 2731) Senate Bill No. 397 requires: (1) the agency which provides child welfare services to develop a written extended youth support services plan to assist a participant in the Program in transitioning to self-sufficiency; and (2) the participant to make a good faith effort to achieve the goals set forth in the plan. (Sections 33 and 34 of chapter 419, Statutes of Nevada 2021, at pages 2731 and 2734) Senate Bill No. 397 requires a court that has jurisdiction over a participant to hold an annual hearing to: (1) review the plan developed for the participant; and (2) determine whether the agency which provides child welfare services has made reasonable efforts to assist the participant in meeting the goals prescribed by the plan. (Section 26 of chapter 419, Statutes of Nevada 2021, at page 2729) Senate Bill No. 397 additionally provides that a participant in the Program is entitled to continue to: (1) receive services from the agency which provides child welfare services; and (2) receive monetary payments from that agency or have those payments provided to another entity. (Sections 33 and 34 of chapter 419, Statutes of Nevada 2021, at pages 2731 and 2734)

      Section 1 of this bill revises the date on which an agency which provides child welfare services is required to participate in the Program from January 1, 2024, to July 1, 2025. However, section 2 of this bill authorizes an agency which provides child welfare services to submit a request to the Division to begin participating in the Program before that date. If sufficient money is available and the Division approves that request, section 2 requires the Division to notify the Governor and the Director of the Legislative Counsel Bureau. Section 2 requires the Division to begin reporting on December 31, 2023, and every 6 months thereafter until July 1, 2025, to the Interim Finance Committee and the Legislature on: (1) the status of the implementation of the Program and any requests to participate in the Program before July 1, 2025; (2) the progress of efforts to allow young adults to remain in foster care; (3) recommendations for additional programs to allow young adults to remain in foster care; and (4) the progress of efforts to secure federal funding for the Program. Sections 1.3 and 1.5 of this bill make appropriations to the Division for personnel costs to develop the Program.

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. Section 37 of chapter 419, Statutes of Nevada 2021, at page 2736, is hereby amended to read as follows:

       Sec. 37.  1.  This section and sections 34.5 and 36 of this act become effective upon passage and approval.

      2.  Sections 1 to 34, inclusive, and 35 of this act become effective on [January 1, 2024.] the earlier of July 1, 2025, or the date on which the Division of Child and Family Services of the Department of Health and Human Services notifies the Governor and the Director of the Legislative Counsel Bureau that there is sufficient money available to carry out the provisions of those sections and an agency which provides child welfare services, as defined in NRS 422B.030, is prepared to participate in the Extended Young Adult Support Services Program established pursuant to section 25 of this act (codified as NRS 432B.5919).

 


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      Sec. 1.3.  1.  There is hereby appropriated from the State General Fund to the Division of Child and Family Services of the Department of Health and Human Services the sum of $352,204 for Fiscal Year 2023-2024 for the Family Support Program budget account for personnel costs to develop a statewide Extended Young Adult Support Services Program.

      2.  Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after June 30, 2024, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 20, 2024, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 20, 2024.

      Sec. 1.5.  1.  There is hereby appropriated from the State General Fund to the Division of Child and Family Services of the Department of Health and Human Services the sum of $276,861 for Fiscal Year 2024-2025 for the Washoe County Child Welfare budget account for personnel costs to develop a statewide Extended Young Adult Support Services Program.

      2.  There is hereby appropriated from the State General Fund to the Division of Child and Family Services of the Department of Health and Human Services the sum of $886,126 for Fiscal Year 2024-2025 for the Clark County Child Welfare budget account for personnel costs to develop a statewide Extended Young Adult Support Services Program.

      3.  There is hereby appropriated from the State General Fund to the Division of Child and Family Services of the Department of Health and Human Services the sum of $49,232 for Fiscal Year 2024-2025 for the Children, Youth and Family Administration budget account for personnel costs to develop a statewide Extended Young Adult Support Services Program.

      4.  There is hereby appropriated from the State General Fund to the Division of Child and Family Services of the Department of Health and Human Services the sum of $162,683 for Fiscal Year 2024-2025 for the Rural Child Welfare budget account for personnel costs to develop a statewide Extended Young Adult Support Services Program.

      5.  Any remaining balance of the appropriations made by subsections 1 to 4, inclusive, must not be committed for expenditure after June 30, 2025, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 19, 2025.

      Sec. 2.  1.  An agency which provides child welfare services may submit a request to the Division to begin participating in the Program before July 1, 2025.

      2.  If the Division determines that an agency which provides child welfare services that submits a request pursuant to subsection 1 is prepared to begin participating in the Program before July 1, 2025, and there is sufficient money available to carry out such a request, the Division shall notify the Governor and the Director of the Legislative Counsel Bureau of that fact.

 


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sufficient money available to carry out such a request, the Division shall notify the Governor and the Director of the Legislative Counsel Bureau of that fact.

      3.  On or before December 31, 2023, and every 6 months thereafter until July 1, 2025, the Division shall submit a report to the Director of the Legislative Counsel Bureau for transmittal to the Interim Finance Committee. The report must include, without limitation:

      (a) The status of the implementation of the Program and any request made pursuant to subsection 1;

      (b) The progress of efforts to allow young adults to remain in foster care;

      (c) Recommendations concerning additional programs to allow young adults to remain in foster care, which may include, without limitation, authorizing assistance for young adults under the Kinship Guardianship Assistance Program or providing subsidies for the adoption of young adults;

      (d) Any other recommendations to allow young adults to remain in foster care; and

      (e) The progress of efforts to secure federal funding for the Program, including, without limitation, the status of any federal approval necessary to receive such funding.

      4.  As used in this section:

      (a) “Agency which provides child welfare services” has the meaning ascribed to it in NRS 432B.030.

      (b) “Division” means the Division of Child and Family Services of the Department of Health and Human Services.

      (c) “Kinship Guardianship Assistance Program” means the Kinship Guardianship Assistance Program established and administered by the Department of Health and Human Services pursuant to NRS 432B.622.

      (d) “Program” means the Extended Young Adult Support Services Program established pursuant to section 25 of chapter 419, Statutes of Nevada 2021, at page 2728 (codified as NRS 432B.5919).

      (e) “Young adult” means a person who is at least 18 years of age but less than 21 years of age and whose plan for permanent placement adopted pursuant to NRS 432B.553 was, on his or her 18th birthday, a permanent living arrangement other than reunification with his or her parents.

      Sec. 3.  1.  This section and sections 1 and 2 of this act become effective upon passage and approval.

      2.  Sections 1.3 and 1.5 of this act become effective on July 1, 2023.

________

 


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ê2023 Statutes of Nevada, Page 2067ê

 

CHAPTER 380, SB 390

Senate Bill No. 390–Senators Scheible, Neal; Daly, D. Harris and Ohrenschall

 

CHAPTER 380

 

[Approved: June 12, 2023]

 

AN ACT relating to health care; authorizing the Department of Brain Health at the University of Nevada, Las Vegas, to establish and maintain a system for the reporting and analysis of certain information on neurodegenerative diseases; authorizing a patient to opt in to the reporting of such information; requiring the establishment and maintenance of an Internet website for the system; making an appropriation; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law requires the Chief Medical Officer appointed by the Director of the Department of Health and Human Services to establish and maintain systems for the reporting of information on: (1) sickle cell disease and its variants; (2) lupus and its variants; and (3) cancer and other neoplasms. (NRS 439.4929, 439.4976, 457.230) Existing law requires the chief administrative officer of each health care facility in this State to make available to the Chief Medical Officer or his or her representative the records of the health care facility for each reportable incidence of sickle cell disease or a variant thereof, lupus or a variant thereof, or cancer or another neoplasm. (NRS 439.4933, 439.498, 457.250) Sections 2.5-8 of this bill define certain terms for the purposes of sections 2-17 of this bill. Section 9 of this bill authorizes the Department of Brain Health at the University of Nevada, Las Vegas, to establish and maintain a similar system for the reporting of information on Parkinson’s disease, Parkinsonisms, multiple sclerosis, Alzheimer’s disease and other neurodegenerative diseases. Section 9 requires the Department of Brain Health to provide the Chief Medical Officer and the Department of Health and Human Services with access to the data and reports provided to the Department of Brain Health for inclusion in the system. Section 10 of this bill requires the Department of Brain Health, in consultation with the Chief Medical Officer, to prescribe: (1) the neurodegenerative diseases for which information may be reported; (2) the form and manner of making such a report; and (3) the protocol for allowing access to and preserving the confidentiality of the records of patients needed for research into neurodegenerative diseases. Section 11 of this bill prescribes a procedure by which a patient may opt in to the reporting of information relating to him or her. If the patient opts in to such reporting, section 11 authorizes a hospital, medical laboratory, other facility or provider of health care to report information concerning the patient to the system. Section 14.5 of this bill requires the Department of Brain Health to: (1) establish and maintain an Internet website for the system; or (2) enter into an agreement for the Chief Medical Officer to perform those duties. Section 14.5 authorizes the Department of Brain Health or the Chief Medical Officer to post an annual report concerning the activities of the system on that Internet website. Section 15 of this bill authorizes the Department of Brain Health to apply for and accept gifts, grants and donations to carry out the provisions of sections 2-17. Sections 10, 16 and 18 of this bill provide for the confidentiality of the reported information concerning patients, providers of health care and facilities. Section 17 of this bill provides immunity from liability for any person or organization who discloses information in good faith to the Department of Brain Health in accordance with the provisions of sections 10 and 11. Section 18.5 of this bill appropriates money to the Department of Brain Health to establish and maintain: (1) the system for the reporting of information on neurodegenerative diseases pursuant to section 9; and (2) the Internet website for the system pursuant to section 14.5.

 


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ê2023 Statutes of Nevada, Page 2068 (CHAPTER 380, SB 390)ê

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. Chapter 439 of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 17, inclusive, of this act.

      Sec. 2. As used in sections 2 to 17, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 2.5 to 8, inclusive, of this act have the meanings ascribed to them in those sections.

      Sec. 2.5. “Designated department” means:

      1.  The Department of Brain Health at the University of Nevada, Las Vegas, or its successor department; or

      2.  If that department ceases to exist, another department at the University of Nevada, Las Vegas, designated by the Board of Regents of the University of Nevada to perform the functions prescribed by sections 2 to 17, inclusive, of this act.

      Sec. 3. “Health care facility” has the meaning ascribed to it in NRS 162A.740.

      Sec. 4.  (Deleted by amendment.)

      Sec. 5. “Neurodegenerative disease” means a chronic and progressive neurological disease that affects the central nervous system and causes neurons to stop working or die, including, without limitation, Parkinson’s disease, Parkinsonisms, multiple sclerosis and Alzheimer’s disease.

      Sec. 6. “Parkinsonisms” means conditions that cause a combination of the movement abnormalities seen in Parkinson’s disease which overlap with and evolve from Parkinson’s disease.

      Sec. 7. “Parkinson’s disease” means a chronic and progressive neurological disorder resulting from a deficiency of the neurotransmitter dopamine as a consequence of specific degenerative changes in the basal ganglia of the brain.

      Sec. 8. “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      Sec. 9. 1.  The designated department may establish and maintain a system for the reporting of information on neurodegenerative diseases.

      2.  If a system for the reporting of information on neurodegenerative diseases is established pursuant to subsection 1, the designated department shall provide the Chief Medical Officer and Department with access to all individual and aggregate data included in the system and all reports provided to or compiled by the designated department for inclusion in the system.

      Sec. 10. If a system for the reporting of information on neurodegenerative diseases is established pursuant to section 9 of this act, the designated department shall, in consultation with the Chief Medical Officer:

      1.  Prescribe the neurodegenerative diseases for which information may be reported in accordance with section 11 of this act, which may include, without limitation, Parkinson’s disease, Parkinsonisms, multiple sclerosis and Alzheimer’s disease;

 


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ê2023 Statutes of Nevada, Page 2069 (CHAPTER 380, SB 390)ê

 

      2.  Prescribe the form and manner for reporting information on cases of neurodegenerative diseases and the information that may be included in each report; and

      3.  Establish protocol for allowing access to and preserving the confidentiality of the records of patients needed for research into neurodegenerative diseases.

      Sec. 11. 1.  If a system for the reporting of information on neurodegenerative diseases is established pursuant to section 9 of this act, the designated department shall prescribe a form which provides a patient with:

      (a) Written notice concerning the collection of information pursuant to sections 2 to 17, inclusive, of this act and the purposes for which such information is collected; and

      (b) The opportunity to opt in to the collection of such information by executing the form.

      2.  If a system for the reporting of information on neurodegenerative diseases is established pursuant to section 9 of this act, a hospital, medical laboratory or other facility that provides screening, diagnostic or therapeutic services to patients with respect to neurodegenerative diseases or a provider of health care who diagnoses or provides treatment for neurodegenerative diseases may provide to a patient with a neurodegenerative disease for which reporting is authorized pursuant to section 10 of this act:

      (a) Oral notice concerning the collection of information pursuant to sections 2 to 17, inclusive, of this act and the purpose for which such information is collected; and

      (b) A copy of the form prescribed pursuant to subsection 1.

      3.  If a patient:

      (a) Executes the form provided to the patient pursuant to subsection 2, the hospital, medical laboratory, other facility or provider of health care, as applicable, may report information concerning the patient to the system established pursuant to section 9 of this act.

      (b) Does not execute the form provided to the patient pursuant to subsection 2, the hospital, medical laboratory, other facility or provider of health care, as applicable, shall not report any information concerning the patient to the system established pursuant to section 9 of this act.

      4.  As used in this section, “medical laboratory” has the meaning ascribed to it in NRS 652.060.

      Secs. 12-14.  (Deleted by amendment.)

      Sec. 14.5. 1.  If a system for the reporting of information on neurodegenerative diseases is established pursuant to section 9 of this act, the designated department shall, except as otherwise provided in subsection 2, establish and maintain an Internet website for the system that may include, without limitation:

      (a) An annual summary of the activities conducted pursuant to sections 2 to 17, inclusive, of this act, which may include, without limitation:

             (1) The incidence and prevalence of Parkinson’s disease, Parkinsonisms, multiple sclerosis and Alzheimer’s disease reported to the system during the immediately preceding year, in total and disaggregated for each county of this State;

 


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ê2023 Statutes of Nevada, Page 2070 (CHAPTER 380, SB 390)ê

 

             (2) The number of reports made to the system pursuant to section 11 of this act for the immediately preceding year; and

             (3) Demographic information concerning the patients to which the reports described in subparagraph (2) pertain, including, without limitation, information concerning the age, sex and race of such patients.

      (b) Other information relating to the system.

      2.  The designated department may enter into an agreement with the Chief Medical Officer and the Department for the Chief Medical Officer to establish and maintain the Internet website pursuant to subsection 1.

      Sec. 15. If a system for the reporting of information on neurodegenerative diseases is established pursuant to section 9 of this act, the designated department may apply for and accept any gifts, grants and donations available to:

      1.  Carry out the provisions of sections 2 to 17, inclusive, of this act;

      2.  Coordinate with any other state programs relating to research concerning neurodegenerative diseases or assistance to patients diagnosed with neurodegenerative diseases;

      3.  Pay for research concerning neurodegenerative diseases;

      4.  Provide education concerning neurodegenerative diseases; and

      5.  Provide support to persons diagnosed with neurodegenerative diseases.

      Sec. 16. If the system for the reporting of information on neurodegenerative diseases is established pursuant to section 9 of this act, the designated department, Chief Medical Officer and Department shall not reveal the identity of any patient, provider of health care or health care facility which is involved in the reporting of information to the system established pursuant to section 9 of this act, unless the patient, provider of health care or health care facility gives prior written consent to such a disclosure.

      Sec. 17. A person or governmental entity that provides information to the designated department in accordance with sections 10 and 11 of this act must not be held liable in a civil or criminal action for sharing confidential information unless the person or organization has done so in bad faith or with malicious purpose.

      Sec. 18. NRS 239.010 is hereby amended to read as follows:

      239.010  1.  Except as otherwise provided in this section and NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.0397, 41.071, 49.095, 49.293, 62D.420, 62D.440, 62E.516, 62E.620, 62H.025, 62H.030, 62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 80.113, 81.850, 82.183, 86.246, 86.54615, 87.515, 87.5413, 87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A.270, 116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 119A.280, 119A.653, 119A.677, 119B.370, 119B.382, 120A.640, 120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 130.712, 136.050, 159.044, 159A.044, 172.075, 172.245, 176.015, 176.0625, 176.09129, 176.156, 176A.630, 178.39801, 178.4715, 178.5691, 179.495, 179A.070, 179A.165, 179D.160, 200.3771, 200.3772, 200.5095, 200.604, 202.3662, 205.4651, 209.392, 209.3923, 209.3925, 209.419, 209.429, 209.521, 211A.140, 213.010, 213.040, 213.095, 213.131, 217.105, 217.110, 217.464, 217.475, 218A.350, 218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 224.240, 226.300, 228.270, 228.450, 228.495, 228.570, 231.069, 231.1473, 232.1369, 233.190, 237.300, 239.0105, 239.0113, 239.014, 239B.026, 239B.030, 239B.040, 239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 239C.420, 240.007, 241.

 


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ê2023 Statutes of Nevada, Page 2071 (CHAPTER 380, SB 390)ê

 

231.1473, 232.1369, 233.190, 237.300, 239.0105, 239.0113, 239.014, 239B.026, 239B.030, 239B.040, 239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 239C.420, 240.007, 241.020, 241.030, 241.039, 242.105, 244.264, 244.335, 247.540, 247.550, 247.560, 250.087, 250.130, 250.140, 250.150, 268.095, 268.0978, 268.490, 268.910, 269.174, 271A.105, 281.195, 281.805, 281A.350, 281A.680, 281A.685, 281A.750, 281A.755, 281A.780, 284.4068, 284.4086, 286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 293.906, 293.908, 293.910, 293B.135, 293D.510, 331.110, 332.061, 332.351, 333.333, 333.335, 338.070, 338.1379, 338.1593, 338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 353A.049, 353A.085, 353A.100, 353C.240, 360.240, 360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 387.631, 388.1455, 388.259, 388.501, 388.503, 388.513, 388.750, 388A.247, 388A.249, 391.033, 391.035, 391.0365, 391.120, 391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 394.1698, 394.447, 394.460, 394.465, 396.1415, 396.1425, 396.143, 396.159, 396.3295, 396.405, 396.525, 396.535, 396.9685, 398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 414.280, 416.070, 422.2749, 422.305, 422A.342, 422A.350, 425.400, 427A.1236, 427A.872, 432.028, 432.205, 432B.175, 432B.280, 432B.290, 432B.4018, 432B.407, 432B.430, 432B.560, 432B.5902, 432C.140, 432C.150, 433.534, 433A.360, 439.4941, 439.4988, 439.840, 439.914, 439A.116, 439A.124, 439B.420, 439B.754, 439B.760, 439B.845, 440.170, 441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 442.774, 445A.665, 445B.570, 445B.7773, 447.345, 449.209, 449.245, 449.4315, 449A.112, 450.140, 450B.188, 450B.805, 453.164, 453.720, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 463.790, 467.1005, 480.535, 480.545, 480.935, 480.940, 481.063, 481.091, 481.093, 482.170, 482.368, 482.5536, 483.340, 483.363, 483.575, 483.659, 483.800, 484A.469, 484B.830, 484B.833, 484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, 571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 598A.420, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 612.265, 616B.012, 616B.015, 616B.315, 616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 628B.760, 629.047, 629.069, 630.133, 630.2671, 630.2672, 630.2673, 630.30665, 630.336, 630A.327, 630A.555, 631.332, 631.368, 632.121, 632.125, 632.3415, 632.3423, 632.405, 633.283, 633.301, 633.4715, 633.4716, 633.4717, 633.524, 634.055, 634.1303, 634.214, 634A.169, 634A.185, 635.111, 635.158, 636.262, 636.342, 637.085, 637.145, 637B.192, 637B.288, 638.087, 638.089, 639.183, 639.2485, 639.570, 640.075, 640.152, 640A.185, 640A.220, 640B.405, 640B.730, 640C.580, 640C.600, 640C.620, 640C.745, 640C.760, 640D.135, 640D.190, 640E.225, 640E.340, 641.090, 641.221, 641.2215, 641.325, 641A.191, 641A.217, 641A.262, 641B.170, 641B.281, 641B.282, 641C.455, 641C.760, 641D.260, 641D.320, 642.524, 643.189, 644A.870, 645.180, 645.625, 645A.050, 645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 645D.135, 645G.510, 645H.320, 645H.330, 647.0945, 647.0947, 648.033, 648.197, 649.065, 649.067, 652.126, 652.228, 653.900, 654.110, 656.105, 657A.510, 661.115, 665.130, 665.133, 669.275, 669.285, 669A.310, 671.170, 673.450, 673.480, 675.380, 676A.340, 676A.370, 677.243, 678A.470, 678C.710, 678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 679B.285, 679B.690, 680A.

 


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ê2023 Statutes of Nevada, Page 2072 (CHAPTER 380, SB 390)ê

 

669A.310, 671.170, 673.450, 673.480, 675.380, 676A.340, 676A.370, 677.243, 678A.470, 678C.710, 678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 679B.285, 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 687A.060, 687A.115, 687B.404, 687C.010, 688C.230, 688C.480, 688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 692C.3538, 692C.354, 692C.420, 693A.480, 693A.615, 696B.550, 696C.120, 703.196, 704B.325, 706.1725, 706A.230, 710.159, 711.600, and section 16 of this act, sections 35, 38 and 41 of chapter 478, Statutes of Nevada 2011 and section 2 of chapter 391, Statutes of Nevada 2013 and unless otherwise declared by law to be confidential, all public books and public records of a governmental entity must be open at all times during office hours to inspection by any person, and may be fully copied or an abstract or memorandum may be prepared from those public books and public records. Any such copies, abstracts or memoranda may be used to supply the general public with copies, abstracts or memoranda of the records or may be used in any other way to the advantage of the governmental entity or of the general public. This section does not supersede or in any manner affect the federal laws governing copyrights or enlarge, diminish or affect in any other manner the rights of a person in any written book or record which is copyrighted pursuant to federal law.

      2.  A governmental entity may not reject a book or record which is copyrighted solely because it is copyrighted.

      3.  A governmental entity that has legal custody or control of a public book or record shall not deny a request made pursuant to subsection 1 to inspect or copy or receive a copy of a public book or record on the basis that the requested public book or record contains information that is confidential if the governmental entity can redact, delete, conceal or separate, including, without limitation, electronically, the confidential information from the information included in the public book or record that is not otherwise confidential.

      4.  If requested, a governmental entity shall provide a copy of a public record in an electronic format by means of an electronic medium. Nothing in this subsection requires a governmental entity to provide a copy of a public record in an electronic format or by means of an electronic medium if:

      (a) The public record:

             (1) Was not created or prepared in an electronic format; and

             (2) Is not available in an electronic format; or

      (b) Providing the public record in an electronic format or by means of an electronic medium would:

             (1) Give access to proprietary software; or

             (2) Require the production of information that is confidential and that cannot be redacted, deleted, concealed or separated from information that is not otherwise confidential.

      5.  An officer, employee or agent of a governmental entity who has legal custody or control of a public record:

      (a) Shall not refuse to provide a copy of that public record in the medium that is requested because the officer, employee or agent has already prepared or would prefer to provide the copy in a different medium.

      (b) Except as otherwise provided in NRS 239.030, shall, upon request, prepare the copy of the public record and shall not require the person who has requested the copy to prepare the copy himself or herself.

 


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ê2023 Statutes of Nevada, Page 2073 (CHAPTER 380, SB 390)ê

 

      Sec. 18.5.  1.  There is hereby appropriated from the State General Fund to the Department of Brain Health at the University of Nevada, Las Vegas, the sum of $150,000 for the purposes of:

      (a) Establishing and maintaining a system for the reporting of information on neurodegenerative diseases; and

      (b) Performing the activities required by section 14.5 of this act.

      2.  Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after June 30, 2025, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 19, 2025, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 19, 2025.

      Sec. 19.  This act becomes effective on July 1, 2023.

________

CHAPTER 381, SB 134

Senate Bill No. 134–Senators Seevers Gansert, Goicoechea, Titus, Buck, Stone; Daly, D. Harris and Pazina

 

Joint Sponsors: Assemblymen Kasama; Hibbetts and Koenig

 

CHAPTER 381

 

[Approved: June 12, 2023]

 

AN ACT relating to health care; prohibiting an insurer from entering into a contract with a provider of vision care that contains certain provisions; requiring a provider of vision care to make certain disclosures to a covered person; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law prohibits an insurer from entering into a contract with a provider of vision care that conditions any rate of reimbursement for vision care on the provider of vision care prescribing certain ophthalmic devices or materials or increases the rate of reimbursement if the provider of vision care prescribes such ophthalmic devices or materials. (NRS 686A.135) Section 1 of this bill additionally prohibits an insurer from entering into a contract with a provider of vision care that: (1) authorizes the insurer to set or limit the amount that the provider of vision care may charge for vision care that is not reimbursed under the contract; or (2) requires the provider of vision care to use a specific laboratory as the manufacturer of ophthalmic devices or materials provided to covered persons. Section 1 requires a provider of vision care to disclose to any covered person an ownership or pecuniary interest of the provider in a supplier of ophthalmic devices or materials before the covered person authorizes the provider to obtain covered eyewear materials from such a supplier.

 


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ê2023 Statutes of Nevada, Page 2074 (CHAPTER 381, SB 134)ê

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. NRS 686A.135 is hereby amended to read as follows:

      686A.135  1.  An insurer shall not enter into a contract with a provider of vision care that [conditions] :

      (a) Authorizes the insurer to set or limit the amount that the provider of vision care may charge for vision care that is not reimbursed under the contract;

      (b) Requires the provider of vision care to use a specific laboratory as the manufacturer of ophthalmic devices or materials provided to covered persons; or

      (c) Conditions any rate of reimbursement for vision care on the provider of vision care prescribing ophthalmic devices or materials in which the insurer has an ownership or other pecuniary interest or increases the rate of reimbursement if the provider of vision care prescribes such ophthalmic devices or materials.

      2.  Before entering into a contract with a provider of vision care to include the provider of vision care in the network of an insurer, the insurer must provide to the provider of vision care a list of the rates of reimbursement for each service covered by the contract.

      3.  An insurer shall disclose in any policy of insurance that covers vision care or any description of benefits covered by such a policy, whether written or electronic, any ownership or other pecuniary interest of the insurer in a supplier of ophthalmic devices or materials or a provider of vision care. The disclosure must appear in a conspicuous and clear manner.

      4.  An insurer that does not provide reimbursement for specific vision care shall not claim in any advertisement or other material that the insurer covers that vision care if such vision care is available at a discount or with a copayment or coinsurance in an amount that is in addition to the copayment or coinsurance that a covered person is typically required to pay for covered services.

      5.  A provider of vision care shall disclose in writing to any covered person under a policy of insurance that covers vision care any ownership or other pecuniary interest of the provider of vision care in a supplier of ophthalmic devices or materials, including, without limitation, a general disclosure of any rebates or rewards programs, before the covered person authorizes the provider of vision care to obtain covered eyewear materials from such a supplier or laboratory that is not contracted with the insurer providing the policy of insurance that covers vision care. The disclosure must appear in a conspicuous and clear manner.

      6.  Nothing in this section shall be construed to prohibit a covered person from using an in-network source or supplier of ophthalmic devices or materials as set forth in the covered person’s policy of insurance that covers vision care.

      7.  As used in this section:

      (a) “Provider of vision care” means a physician who provides vision care or an optometrist.

      (b) “Vision care” means:

 


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ê2023 Statutes of Nevada, Page 2075 (CHAPTER 381, SB 134)ê

 

             (1) Routine ophthalmological evaluation of the eye, including refraction.

             (2) Ophthalmic devices or materials, including, without limitation, lenses, frames, mountings or other specially fabricated ophthalmic devices.

Ê The term “vision care” does not include the initiation of treatment or diagnosis pursuant to a program of medical care.

      Sec. 2.  The amendatory provisions of section 1 of this act do not apply to any contract existing on October 1, 2023, between an insurer and a provider of vision care until the contract is renewed.

________

CHAPTER 382, SB 191

Senate Bill No. 191–Senator Seevers Gansert

 

CHAPTER 382

 

[Approved: June 12, 2023]

 

AN ACT relating to applied behavior analysis; requiring the State Plan for Medicaid to include coverage for certain services related to applied behavior analysis; revising the issuance fee for a license as a behavior analyst or an assistant behavior analyst; making appropriations to and authorizing expenditures by the Division of Health Care Financing and Policy of the Department of Health and Human Services; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law requires the Director of the Department of Health and Human Services to develop and administer a State Plan for Medicaid which includes a list of specific medical services required to be provided to Medicaid recipients. (NRS 422.063, 422.270-422.27497) Existing law requires the State Plan for Medicaid to include: (1) rates of reimbursement for services provided by behavior analysts, assistant behavior analysts and registered behavior technicians that are comparable to rates paid by Medicaid programs in other states for such services; and (2) reasonable limits on the number of hours that such providers are authorized to bill for services provided to a recipient of Medicaid in a 24-hour period. (NRS 422.27497) Section 1 of this bill requires the Director to include in the State Plan coverage for the cost of services provided by behavior analysts, assistant behavior analysts and registered behavior technicians to Medicaid recipients who are less than 27 years of age.

      Existing law authorizes the Board of Applied Behavior Analysis to charge a fee of not more than $25 for the issuance of an initial license as a behavior analyst or assistant behavior analyst. (NRS 641D.380) Section 2 of this bill increases to $450 the maximum fee for an initial license that the Board is authorized to charge.

      Section 2.5 of this bill makes an appropriation to, and authorizes expenditure by, the Division of Health Care Financing and Policy of the Department for the administrative and medical service costs of providing Medicaid coverage for certain services provided by behavior analysts, assistant behavior analysts and registered behavior technicians pursuant to section 1.

 


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ê2023 Statutes of Nevada, Page 2076 (CHAPTER 382, SB 191)ê

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. NRS 422.27497 is hereby amended to read as follows:

      422.27497  1.  The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for services provided by behavior analysts, assistant behavior analysts and registered behavior technicians to recipients of Medicaid who are less than 27 years of age.

      2.  The Director shall:

      (a) Biennially establish and include in the State Plan for Medicaid rates of reimbursement which are provided on a fee-for-service basis for services provided by behavior analysts, assistant behavior analysts and registered behavior technicians that are comparable to rates of reimbursement paid by Medicaid programs in other states for the services of those providers.

      (b) Establish reasonable limits on the number of hours that a behavior analyst, assistant behavior analyst or registered behavior technician is authorized to bill for services provided to a recipient of Medicaid in a 24-hour period.

      [2.] 3.  The Division shall provide training to behavior analysts, assistant behavior analysts and registered behavior technicians who provide services to recipients of Medicaid concerning the limits established pursuant to paragraph (b) of subsection [1.

      3.] 2.

      4.  On or before January 31 of each year, the Division shall:

      (a) Compile a report concerning the provision of services to recipients of Medicaid who have been diagnosed with an autism spectrum disorder. The report must include:

             (1) The number of recipients of Medicaid who were newly diagnosed with an autism spectrum disorder during the immediately preceding year and the number of those recipients for whom assistance with care management was provided;

             (2) The number of recipients of Medicaid diagnosed with an autism spectrum disorder for whom assistance with care management was reimbursed through Medicaid during the immediately preceding year;

             (3) The number of recipients of Medicaid for whom the first claim for reimbursement for the services of a registered behavior technician was submitted during the immediately preceding year;

             (4) The number of assessments or evaluations by a behavior analyst that were reimbursed through Medicaid during the immediately preceding year;

             (5) The total number of claims for applied behavior analysis services provided to recipients of Medicaid made during the immediately preceding year;

 


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ê2023 Statutes of Nevada, Page 2077 (CHAPTER 382, SB 191)ê

 

             (6) For the immediately preceding year, the average times that elapsed between claims for each step of the process that a recipient of Medicaid must undergo to receive treatment from a registered behavior technician, beginning with initial diagnosis with an autism spectrum disorder and including, without limitation, comprehensive diagnosis with an autism spectrum disorder, evaluation and treatment by a behavior analyst and treatment by a registered behavior technician;

             (7) The number of recipients of Medicaid receiving services through Medicaid managed care who were, at the end of the immediately preceding year, on a wait list for applied behavior analysis services;

             (8) An assessment of the adequacy of the network of each health maintenance organization or managed care organization that provides services to recipients of Medicaid under the State Plan for Medicaid for applied behavior analysis services, as compared to the applicable standard for network adequacy set forth in the contract between the health maintenance organization or managed care organization and the Division;

             (9) The number of behavior analysts and registered behavior technicians who are currently providing services to recipients of Medicaid who receive services through each health maintenance organization or managed care organization described in subparagraph (8); and

             (10) The number of behavior analysts and registered behavior technicians who provide services to recipients of Medicaid who do not receive services through managed care.

      (b) Submit the report to the Director of the Legislative Counsel Bureau for transmittal to:

             (1) In odd-numbered years, the next regular session of the Legislature; and

             (2) In even-numbered years, the Joint Interim Standing Committee on Health and Human Services.

      [4.] 5.  As used in this section:

      (a) “Applied behavior analysis services” means the services of a behavior analyst, assistant behavior analyst or registered behavior technician.

      (b) “Assistant behavior analyst” has the meaning ascribed to it in NRS 641D.020.

      (c) “Behavior analyst” has the meaning ascribed to it in NRS 641D.030.

      (d) “Registered behavior technician” has the meaning ascribed to it in NRS 641D.100.

      Sec. 2. NRS 641D.380 is hereby amended to read as follows:

      641D.380  1.  The Board shall prescribe, by regulation, fees for any services provided by the Board pursuant to this chapter and the following fees, which must not exceed:

Application for licensure as a behavior analyst or assistant behavior analyst $100

Issuance of an initial license as a behavior analyst or assistant behavior analyst [25] 450

Biennial renewal or reinstatement of a license as a behavior analyst 550

Biennial renewal or reinstatement of a license as an assistant behavioral analyst     425

Biennial renewal or reinstatement of a registration as a registered behavior technician 100

Placement of a license on inactive status............................................. 100

 


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ê2023 Statutes of Nevada, Page 2078 (CHAPTER 382, SB 191)ê

 

Biennial review of a license on inactive status................................. $100

Restoration to active status of a license as a behavior analyst on inactive status if the restoration occurs during the first year of the biennium in which the license was issued or renewed     300

Restoration to active status of a license as a behavior analyst on inactive status if the restoration occurs during the second year of the biennium in which the license was issued or renewed      100

Restoration to active status of a license as an assistant behavior analyst on inactive status if the restoration occurs during the first year of the biennium in which the license was issued or renewed     175

Restoration to active status of a license as an assistant behavior analyst on inactive status if the restoration occurs during the second year of the biennium in which the license was issued or renewed      40

Reproduction and mailing of material for an application.................... 25

A dishonored check.................................................................................... 35

A change of name on a license or registration...................................... 25

A duplicate license or registration........................................................... 25

Copies of the provisions of NRS relating to the practice of applied behavior analysis and the rules and regulations adopted by the Board.......................................................................... 25

Letter of good standing.............................................................................. 15

Review and approval of a course or program of continuing education 25

      2.  The Board shall ensure, to the extent practicable, that the amount of such fees is sufficient to pay the costs incurred by the Board under the provisions of this chapter, including, without limitation, the compensation of the Board prescribed by NRS 641D.220, and does not exceed the amount necessary to pay those costs.

      Sec. 2.5.  1.  There is hereby appropriated from the State General Fund to the Division of Health Care Financing and Policy of the Department of Health and Human Services for the administrative and medical service costs of providing Medicaid coverage for services provided by behavior analysts, assistant behavior analysts and registered behavior technicians to recipients of Medicaid who are less than 27 years of age the following sums:

For the Fiscal Year 2023-2024.................................................... $118,272

For the Fiscal Year 2024-2025.................................................... $671,531

      2.  Expenditure of the following sums not appropriated from the State General Fund or the State Highway Fund is hereby authorized by the Division of Health Care Financing and Policy of the Department of Health and Human Services for the same purpose as set forth in subsection 1:

For the Fiscal Year 2023-2024.................................................... $351,662

For the Fiscal Year 2024-2025................................................. $1,610,899

      3.  Any balance of the sums appropriated by subsection 1 remaining at the end of the respective fiscal years must not be committed for expenditure after June 30 of the respective fiscal years by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 20, 2024, and September 19, 2025, respectively, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 20, 2024, and September 19, 2025, respectively.

 


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ê2023 Statutes of Nevada, Page 2079 (CHAPTER 382, SB 191)ê

 

September 20, 2024, and September 19, 2025, respectively, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 20, 2024, and September 19, 2025, respectively.

      Sec. 3.  1.  This section becomes effective upon passage and approval.

      2.  Section 2.5 of this act becomes effective on July 1, 2023.

      3.  Sections 1 and 2 of this act become effective:

      (a) Upon passage and approval for the purpose of adopting any regulations and performing any other preparatory administrative tasks that are necessary to carry out the provisions of this act; and

      (b) On January 1, 2024, for all other purposes.

________

CHAPTER 383, SB 241

Senate Bill No. 241–Senators Titus, Goicoechea, Hansen, Donate; Krasner, Lange, Nguyen and Stone

 

Joint Sponsors: Assemblymen Hafen; and Koenig

 

CHAPTER 383

 

[Approved: June 12, 2023]

 

AN ACT relating to Medicaid; requiring the State Plan for Medicaid to provide coverage for certain services provided by a critical access hospital; prescribing the rate of reimbursement for such services under Medicaid; making appropriations to and authorizing certain expenditures by the Division of Health Care Financing and Policy of the Department of Health and Human Services; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law requires the Director of the Department of Health and Human Services to develop and the Department to administer a State Plan for Medicaid, which includes a list of specific medical services required to be provided to Medicaid recipients. (NRS 422.063, 422.270) Section 1 of this bill requires the Director to include in the State Plan for Medicaid, to the extent that federal financial participation is available, a requirement that the State pay the nonfederal share of expenditures for outpatient services and swing-bed services provided at a critical access hospital. Section 1 also requires Medicaid to reimburse a critical access hospital for such services at a rate equal to the actual cost of providing the services or the amount charged by the critical access hospital for the services, whichever is less. Section 2 of this bill makes a conforming change to indicate that the provisions of section 1 will be administered in the same manner as the provisions of existing law governing the State Plan for Medicaid. Section 2.5 of this bill makes appropriations to and authorizes expenditures by the Division of Health Care Financing and Policy of the Department for providing such cost-based reimbursement under Medicaid to critical care hospitals.

 


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ê2023 Statutes of Nevada, Page 2080 (CHAPTER 383, SB 241)ê

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. Chapter 422 of NRS is hereby amended by adding thereto a new section to read as follows:

      1.  The Director shall include in the State Plan for Medicaid, to the extent that federal financial participation is available, a requirement that the State must:

      (a) Pay the nonfederal share of expenditures for outpatient services and swing-bed services provided by a critical access hospital; and

      (b) Reimburse a critical access hospital for the services described in paragraph (a) at a rate equal to the actual cost to the critical access hospital of providing the services or the amount charged by the critical access hospital for the services, whichever is less.

      2.  As used in this section:

      (a) “Critical access hospital” means a public or private hospital which has been certified as a critical access hospital by the United States Secretary of Health and Human Services pursuant to 42 U.S.C. § 1395i-4(e).

      (b) “Swing-bed services” means services as described in 42 C.F.R. § 482.58.

      Sec. 2. NRS 232.320 is hereby amended to read as follows:

      232.320  1.  The Director:

      (a) Shall appoint, with the consent of the Governor, administrators of the divisions of the Department, who are respectively designated as follows:

             (1) The Administrator of the Aging and Disability Services Division;

             (2) The Administrator of the Division of Welfare and Supportive Services;

             (3) The Administrator of the Division of Child and Family Services;

             (4) The Administrator of the Division of Health Care Financing and Policy; and

             (5) The Administrator of the Division of Public and Behavioral Health.

      (b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public and Behavioral Health or the professional line activities of the other divisions.

      (c) Shall administer any state program for persons with developmental disabilities established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C. §§ 15001 et seq.

      (d) Shall, after considering advice from agencies of local governments and nonprofit organizations which provide social services, adopt a master plan for the provision of human services in this State.

 


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ê2023 Statutes of Nevada, Page 2081 (CHAPTER 383, SB 241)ê

 

plan for the provision of human services in this State. The Director shall revise the plan biennially and deliver a copy of the plan to the Governor and the Legislature at the beginning of each regular session. The plan must:

             (1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplication of those services by federal, state and local agencies;

             (2) Set forth priorities for the provision of those services;

             (3) Provide for communication and the coordination of those services among nonprofit organizations, agencies of local government, the State and the Federal Government;

             (4) Identify the sources of funding for services provided by the Department and the allocation of that funding;

             (5) Set forth sufficient information to assist the Department in providing those services and in the planning and budgeting for the future provision of those services; and

             (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department.

      (e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

      (f) Has such other powers and duties as are provided by law.

      2.  Notwithstanding any other provision of law, the Director, or the Director’s designee, is responsible for appointing and removing subordinate officers and employees of the Department.

      Sec. 2.5.  1.  There is hereby appropriated from the State General Fund to the Division of Health Care Financing and Policy of the Department of Health and Human Services for providing cost-based reimbursement under Medicaid to critical access hospitals pursuant to this act the following sums:

For the Fiscal Year 2023-2024.................................................... $280,015

For the Fiscal Year 2024-2025.................................................... $683,550

      2.  Expenditure of the following sums not appropriated from the State General Fund or the State Highway Fund is hereby authorized by the Division of Health Care Financing and Policy of the Department of Health and Human Services for the same purpose as set forth in subsection 1 the following sums:

For the Fiscal Year 2023-2024.................................................... $745,037

For the Fiscal Year 2024-2025................................................. $1,724,067

      3.  Any balance of the sums appropriated by subsection 1 remaining at the end of the respective fiscal years must not be committed for expenditure after June 30 of the respective fiscal years by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 20, 2024, and September 19, 2025, respectively, by either the

 


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ê2023 Statutes of Nevada, Page 2082 (CHAPTER 383, SB 241)ê

 

entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 20, 2024, and September 19, 2025, respectively.

      4.  As used in this section, “critical access hospital” has the meaning ascribed to it in section 1 of this act.

      Sec. 3.  1.  This section becomes effective upon passage and approval.

      2.  Section 2.5 of this act becomes effective on July 1, 2023.

      3.  Sections 1 and 2 of this act become effective:

      (a) Upon passage and approval for the purpose of performing any preparatory administrative tasks that are necessary to carry out the provisions of this act; and

      (b) On January 1, 2024, for all other purposes.

________

CHAPTER 384, SB 263

Senate Bill No. 263–Senators Seevers Gansert; Daly, Hansen and Krasner

 

Joint Sponsors: Assemblymen Anderson, O’Neill, Dickman; La Rue Hatch, Peters and Taylor

 

CHAPTER 384

 

[Approved: June 12, 2023]

 

AN ACT making an appropriation to the Children’s Cabinet for the purchase and renovation of a parcel of land to carry out the Oddie Project; and providing other matters properly relating thereto.

      Whereas, The Children’s Cabinet and the Food Bank of Northern Nevada, nonprofit organizations, are proposing the Oddie Project, which would serve a high poverty sector in Sparks, Nevada, by providing access to childcare, workforce and job training and wraparound services designed to help individuals and families; and

      Whereas, The high poverty sector that the Oddie Project intends to serve includes significantly more single-parent households, households without a vehicle, households receiving assistance under the Supplemental Nutrition Assistance Program, households receiving public assistance, renters spending 30 percent or more of their income on rent, children and families living below the poverty level, people over the age of 25 without a high school diploma and instances of poor mental health; and

      Whereas, The Oddie Project includes the purchase of a parcel of land, which contains a grocery store that will be renovated to construct spaces for child care, workforce development, offices, community education and meetings; and

      Whereas, The goal of the Oddie Project is to harness passion, deploy expertise and leverage resources for the purposes of integrating services and support necessary to effectively and efficiently improve the long-term social and economic well-being of individuals and families; now, therefore,

 


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ê2023 Statutes of Nevada, Page 2083 (CHAPTER 384, SB 263)ê

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1.  1.  There is hereby appropriated from the State General Fund to the Children’s Cabinet the sum of $6,000,000 for the purchase of land and any buildings thereon, and for the renovation by the Children’s Cabinet of the parcel of land and any buildings thereon, located at 2244 Oddie Boulevard, Sparks, Nevada. The parcel of land proposed for acquisition lies in a portion of the NE 1/4 of Section 6, Township 19 North, Range 20 East, Mount Diablo Base and Meridian, County of Washoe, State of Nevada. Said parcel being more particularly described as:

 

       Beginning at the southeast corner of Parcel 1-C, as shown on Parcel Map No. 5431 for Plaza 800 Partners, LLC, a Delaware Limited Liability Company, File No. 4970983, recorded November 7, 2019, Official Records of Washoe County, Nevada, said point being further described as lying on the northerly right-of-way line of Oddie Boulevard, a 100-foot-wide public roadway; thence along said northerly right-of-way line N 89°22¢35² W, a distance of 433.87 feet; thence departing said northerly right-of-way line N 0°39¢29² E, a distance of 270.58 feet; thence N 89°08¢50² W, a distance of 94.94 feet; thence N 23°36¢37² W, a distance of 22.40 feet; thence N 0°38¢46² E, a distance of 181.60 feet; thence S 89°24¢38² E, a distance of 61.59 feet; thence N 0°39¢22² E, a distance of 97.52 feet; thence S 89°20¢12² E, a distance of 32.95 feet; thence N 19°58¢12² E, a distance of 61.46 feet to a point on the southerly right-of-way line of Greenbrae Drive, a 70-foot-wide public roadway; thence along said southerly right-of-way line the following three courses; S 70°01¢48² E, a distance of 231.56 feet; along the arc of a tangent curve to the left, having a radius of 535.00 feet through a central angle of 20°09¢58², a distance of 188.30 feet; N 89°48¢14² E, a distance of 133.49 feet; thence departing said southerly right-of-way line along the arc of a tangent curve to the right, having a radius of 40.00 feet, through a central angle of 92°17¢12², a distance of 64.43 feet to a point on the westerly right-of-way line of Sullivan Lane, a 70-foot-wide public roadway; thence along said westerly right-of-way line S 2°05¢26² W, a distance of 342.70 feet; thence departing westerly right-of-way line N 89°22¢35² W, a distance of 142.24 feet; thence 2°05¢26² W, a distance of 140.00 feet to the point of beginning, containing 7.50 acres of land, more or less.

 

       ASSESSOR’S PARCEL NO. 026-442-11

 


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ê2023 Statutes of Nevada, Page 2084 (CHAPTER 384, SB 263)ê

 

      2.  Upon acceptance of the money appropriated by subsection 1, the Children’s Cabinet agrees to:

      (a) Prepare and transmit a report to the Interim Finance Committee on or before December 20, 2024, that describes each expenditure made from the money appropriated by subsection 1 from the date on which the money was received by the Children’s Cabinet through December 1, 2024;

      (b) Prepare and transmit a final report to the Interim Finance Committee on or before December 18, 2026, that describes each expenditure made from the money appropriated by subsection 1 from the date on which the money was received by the Children’s Cabinet through December 1, 2026;

      (c) Prepare and transmit a final report to the Interim Finance Committee on or before September 17, 2027, that describes each expenditure made from the money appropriated by subsection 1 from the date on which the money was received by the Children’s Cabinet through June 30, 2027; and

      (d) Upon request of the Legislative Commission, make available to the Legislative Auditor any of the books, accounts, claims, reports, vouchers or other records of information, confidential or otherwise, of the Children’s Cabinet, regardless of their form or location, that the Legislative Auditor deems necessary to conduct an audit of the use of the money appropriated pursuant to subsection 1.

      3.  Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after June 30, 2027, by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after September 17, 2027, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 17, 2027.

      Sec. 2.  This act becomes effective upon passage and approval.

________

 


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ê2023 Statutes of Nevada, Page 2085ê

 

CHAPTER 385, SB 161

Senate Bill No. 161–Senators Scheible, D. Harris, Spearman, Cannizzaro, Seevers Gansert; Daly, Donate, Dondero Loop, Flores, Goicoechea, Hansen, Krasner, Neal, Nguyen, Ohrenschall, Pazina and Stone

 

CHAPTER 385

 

[Approved: June 12, 2023]

 

AN ACT relating to personal health; expanding required insurance coverage of contraception; providing for the use of benefits under certain federal programs for persons with low incomes to purchase menstrual products; authorizing the establishment of a program to assist certain recipients of public assistance in the purchase of menstrual products; authorizing certain persons and entities to acquire controlled substances and dangerous drugs directly from an outsourcing facility; revising requirements governing the dispensing of a drug used for contraception; enacting the Interstate Massage Compact; increasing the number of members of the Board of Massage Therapy required to constitute a quorum for the purposes of transacting the business of the Board; clarifying that a pharmacy benefit manager is subject to certain provisions of law governing an insurer for which the pharmacy benefit manager manages prescription drug coverage; and providing other matters properly relating thereto.

Legislative Counsel’s Digest:

      Existing law requires public and private policies of insurance regulated under Nevada law to include coverage for up to a 12-month supply of contraceptive drugs. (NRS 287.010, 287.04335, 422.27172, 689A.0418, 689B.0378, 689C.1676, 695A.1865, 695B.1919, 695C.1696, 695G.1715) Sections 1, 11 and 14-20 of this bill prohibit an insurer from requiring an insured to obtain prior authorization before receiving a contraceptive drug. Sections 1 and 14-20 also require an insurer to: (1) cover certain contraceptive services when provided by a pharmacist to the same extent as if the services were provided by another provider of health care in certain circumstances; and (2) reimburse a pharmacist for providing such services at a rate that is not less than the rate provided to a physician, physician assistant or advanced practice registered nurse. Sections 1 and 14-20 additionally prescribe certain limitations on the imposition of a copayment or coinsurance for a drug for contraception. Section 10 of this bill requires an insurer to: (1) demonstrate the capacity to adequately deliver family planning services provided by pharmacists to covered persons; and (2) make available to covered persons a notice of pharmacists and pharmacies that are available to provide family planning services to covered persons through the network of the insurer. Sections 12 and 13 of this bill make conforming changes to indicate the proper placement of section 10 in the Nevada Revised Statutes.

      Existing law imposes certain duties on a pharmacy benefit manager. (NRS 683A.178) Section 9 of this bill clarifies that a pharmacy benefit manager that manages prescription drug benefits for an insurer is required to comply with the same provisions of the Nevada Insurance Code as are applicable to the insurer.

      Existing law authorizes the Department of Health and Human Services to enter into a contract with a pharmacy benefit manager or a health maintenance organization to manage, direct and coordinate all payments and rebates for prescription drugs and all other services and payments relating to the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program. (NRS 422.4053) Section 2 of this bill requires such a contract to require the pharmacy benefit manager or health maintenance organization to comply with certain provisions of law regarding the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program.

 


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ê2023 Statutes of Nevada, Page 2086 (CHAPTER 385, SB 161)ê

 

      Existing federal law establishes the Supplemental Nutrition Assistance Program, which provides assistance to certain low-income families for the purchase of food. (7 U.S.C. §§ 2011 et seq.) Existing federal law also establishes the Special Supplemental Nutrition Program for Women, Infants and Children, which provides, through eligible local agencies, nutrition education and supplemental foods to pregnant women, mothers, infants and children less than 5 years of age with low household incomes. (42 U.S.C. § 1786) Existing law requires the Department of Health and Human Services to administer these programs within this State. (NRS 422A.338) Section 3 of this bill requires the Department to authorize recipients of benefits provided under those programs to use such benefits to purchase menstrual products: (1) to the extent authorized by federal law; and (2) to the extent that federal funding is available. This bill also authorizes the Department to: (1) establish and administer a program to provide assistance for the purpose of purchasing menstrual products to recipients of benefits provided through programs for which the Division of Welfare and Supportive Services of the Department is responsible; and (2) accept gifts, grants and donations for the purposes of establishing such a program.

      Existing law imposes certain requirements governing the purchase and sale of controlled substances and dangerous drugs. (NRS 639.268) Existing regulations prescribe certain requirements concerning the operation of outsourcing facilities, which are federally registered facilities that engage in the compounding of drugs. (NAC 639.691-639.6916) Those requirements include requirements that an outsourcing facility: (1) be licensed by the State Board of Pharmacy as a manufacturer; and (2) comply with regulatory requirements governing manufacturers. (NAC 639.6915) Section 5 of this bill authorizes a person or entity authorized to dispense controlled substances and dangerous drugs to purchase or otherwise acquire controlled substances and dangerous drugs compounded or repackaged by an outsourcing facility directly from the outsourcing facility. Section 4 of this bill makes a conforming change to update an internal reference changed by section 5.

      Existing law requires a pharmacist to dispense up to a 12-month supply of contraceptives or therapeutic equivalent or any amount which covers the remainder of the plan year, whichever is less, pursuant to a valid prescription or order if: (1) the patient has previously received a 3-month supply of the same drug; (2) the patient has previously received a 9-month supply of the same drug or a supply of the same drug for the balance of the plan year in which the 3-month supply was prescribed or ordered, whichever is less; (3) the patient is insured by the same health insurance plan; and (4) a provider of health care has not specified in the prescription or order that a different supply of the drug is necessary. (NRS 639.28075) If a patient is not currently using a contraceptive or therapeutic equivalent, section 6 of this bill requires a pharmacist to dispense a full 3-month supply or the amount designated by the prescription or order, whichever is less, pursuant to a valid prescription or order unless the patient is unable or unwilling to pay the applicable charge, copayment or coinsurance. If the patient is currently using the contraceptive or therapeutic equivalent, section 6 requires a pharmacist to dispense a full 9-month supply or a full 12-month supply, as applicable, any amount designated by the prescription or order or any amount which covers the remainder of the plan year, whichever is less, pursuant to a valid prescription or order unless the patient is unable or unwilling to pay the applicable charge, copayment or coinsurance.

      Existing law authorizes the Board of Massage Therapy to issue a license to practice massage therapy and sets forth the requirements that an applicant for a license must satisfy in order to become licensed. (NRS 640C.580) Section 7 of this bill adopts the Interstate Massage Compact, creating a multistate license with uniform licensing requirements, including a national licensing examination, for use by licensees in all member states.

 


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ê2023 Statutes of Nevada, Page 2087 (CHAPTER 385, SB 161)ê

 

      The Compact requires that, in order to be eligible to join the Compact and maintain eligibility as a member state, a state must: (1) license and regulate the practice of massage therapy; (2) have a mechanism or entity in place to receive and investigate complaints from the public, regulatory or law enforcement agencies or the Interstate Massage Compact Commission about licensees practicing in that state; (3) accept passage of a national licensing examination as a criterion for massage therapy licensure in that state; (4) require that licensees satisfy educational requirements before being licensed; (5) implement procedures for requiring background checks for a multistate license and other reporting requirements; (6) have continuing competence requirements; (7) participate in the Compact’s data system; (8) notify the Commission and other member states of any disciplinary action taken against a licensee practicing under a multistate license; (9) comply with any rules of the Commission; and (10) accept licensees with valid multistate licenses from other member states. An applicant for a multistate license must: (1) hold a license to practice massage therapy in a member state; (2) complete 625 hours of massage therapy education or the substantial equivalent; (3) pass a national licensing examination or the substantial equivalent; (4) submit to and pass a background check; and (5) pay all required fees.

      The Compact: (1) establishes the Interstate Massage Compact Commission as a joint governmental agency whose membership consists of all member states; and (2) provides for the Commission’s rules and governance. The Compact also establishes a data system, provided for by the Commission, and requires member states to submit uniform data to the data system on all individuals to whom the Compact is applicable.

      The Compact provides additional provisions to carry out the Compact, including providing procedures for the taking of adverse actions against licensees, provisions for active military members or their spouses, provisions for rulemaking by the Commission, provisions for oversight and dispute resolution and procedures for amendments and withdrawals. The Compact takes effect on the date on which the Compact is enacted into law by the seventh member state.

      Existing law provides that four members of the Board of Massage Therapy constitute a quorum for the purposes of transacting the business of the Board. (NRS 640C.180) Section 8 of this bill increases the number of board members needed to constitute a quorum from four to five.

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

      Section 1. NRS 422.27172 is hereby amended to read as follows:

      422.27172  1.  The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for:

      (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration; and

             (3) Dispensed in accordance with NRS 639.28075;

      (b) Any type of device for contraception which is lawfully prescribed or ordered and which has been approved by the Food and Drug Administration;

      (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;

      (d) Insertion or removal of a device for contraception;

      (e) Education and counseling relating to the initiation of the use of contraceptives and any necessary follow-up after initiating such use;

      (f) Management of side effects relating to contraception; and

 


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ê2023 Statutes of Nevada, Page 2088 (CHAPTER 385, SB 161)ê

 

      (g) Voluntary sterilization for women.

      2.  Except as otherwise provided in subsections 4 and 5, to obtain any benefit provided in the Plan pursuant to subsection 1, a person enrolled in Medicaid must not be required to:

      (a) Pay a higher deductible, any copayment or coinsurance; or

      (b) Be subject to a longer waiting period or any other condition.

      3.  The Director shall ensure that the provisions of this section are carried out in a manner which complies with the requirements established by the Drug Use Review Board and set forth in the list of preferred prescription drugs established by the Department pursuant to NRS 422.4025.

      4.  The Plan may require a person enrolled in Medicaid to pay a higher deductible, copayment or coinsurance for a drug for contraception if the person refuses to accept a therapeutic equivalent of the contraceptive drug.

      5.  For each method of contraception which is approved by the Food and Drug Administration, the Plan must include at least one contraceptive drug or device for which no deductible, copayment or coinsurance may be charged to the person enrolled in Medicaid, but the Plan may charge a deductible, copayment or coinsurance for any other contraceptive drug or device that provides the same method of contraception. If the Plan requires a person enrolled in Medicaid to pay a copayment or coinsurance for a drug for contraception, the Plan may only require the person to pay the copayment or coinsurance:

      (a) Once for the entire amount of the drug dispensed for the plan year; or

      (b) Once for each 1-month supply of the drug dispensed.

      6.  The Plan must provide for the reimbursement of a pharmacist for providing services described in subsection 1 that are within the scope of practice of the pharmacist to the same extent as if the services were provided by another provider of health care. The Plan must not limit:

      (a) Coverage for such services provided by a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.

      (b) Reimbursement for such services provided by a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

      7.  The Plan must not require a recipient of Medicaid to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

      8.  As used in this section:

      (a) “Drug Use Review Board” has the meaning ascribed to it in NRS 422.402.

      (b) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      (c) “Therapeutic equivalent” means a drug which:

             (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

             (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and

             (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

      Sec. 2. NRS 422.4053 is hereby amended to read as follows:

      422.4053  1.  Except as otherwise provided in subsection 2, the Department shall directly manage, direct and coordinate all payments and rebates for prescription drugs and all other services and payments relating to the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program.

 


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ê2023 Statutes of Nevada, Page 2089 (CHAPTER 385, SB 161)ê

 

rebates for prescription drugs and all other services and payments relating to the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program.

      2.  The Department may enter into a contract with:

      (a) A pharmacy benefit manager for the provision of any services described in subsection 1.

      (b) A health maintenance organization pursuant to NRS 422.273 for the provision of any of the services described in subsection 1 for recipients of Medicaid or recipients of insurance through the Children’s Health Insurance Program who receive coverage through a Medicaid managed care program.

      (c) One or more public or private entities from this State, the District of Columbia or other states or territories of the United States for the collaborative purchasing of prescription drugs in accordance with subsection 3 of NRS 277.110.

      3.  A contract entered into pursuant to paragraph (a) or (b) of subsection 2 must:

      (a) Include the provisions required by NRS 422.4056; [and]

      (b) Require the pharmacy benefit manager or health maintenance organization, as applicable, to disclose to the Department any information relating to the services covered by the contract, including, without limitation, information concerning dispensing fees, measures for the control of costs, rebates collected and paid and any fees and charges imposed by the pharmacy benefit manager or health maintenance organization pursuant to the contract [.] ; and

      (c) Require the pharmacy benefit manager or health maintenance organization to comply with the provisions of this chapter regarding the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program to the same extent as the Department.

      4.  In addition to meeting the requirements of subsection 3, a contract entered into pursuant to:

      (a) Paragraph (a) of subsection 2 may require the pharmacy benefit manager to provide the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, to the Department.

      (b) Paragraph (b) of subsection 2 must require the health maintenance organization to provide to the Department the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, less an administrative fee in an amount prescribed by the contract. The Department shall adopt policies prescribing the maximum amount of such an administrative fee.

      Sec. 3. Chapter 422A of NRS is hereby amended by adding thereto a new section to read as follows:

      1.  To the extent authorized by federal law and to the extent that federal funding is available, the Department shall authorize recipients of benefits provided under Supplemental Nutrition Assistance or the Special Supplemental Nutrition Program for Women, Infants and Children established by 42 U.S.C. § 1786 to use such benefits to purchase menstrual products.

 


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ê2023 Statutes of Nevada, Page 2090 (CHAPTER 385, SB 161)ê

 

      2.  The Department shall take any action necessary to obtain federal authorization and federal funding to carry out the provisions of subsection 1, including, without limitation, applying for any necessary federal waiver.

      3.  To the extent that money is available for this purpose, the Department, through the Division, may establish and administer a program to provide assistance for the purpose of purchasing menstrual products to recipients of benefits provided through programs for which the Division is responsible. The Department may accept gifts, grants and donations from any source for the purpose of establishing and administering such a program.

      4.  As used in this section, “menstrual products” includes, without limitation, sanitary napkins, tampons or similar products used in connection with the menstrual cycle.

      Sec. 4. NRS 454.221 is hereby amended to read as follows:

      454.221  1.  A person who furnishes any dangerous drug except upon the prescription of a practitioner is guilty of a category D felony and shall be punished as provided in NRS 193.130, unless the dangerous drug was obtained originally by a legal prescription.

      2.  The provisions of this section do not apply to the furnishing of any dangerous drug by:

      (a) A practitioner to his or her patients;

      (b) A physician assistant licensed pursuant to chapter 630 or 633 of NRS if authorized by the Board;

      (c) A registered nurse while participating in a public health program approved by the Board, or an advanced practice registered nurse who holds a certificate from the State Board of Pharmacy permitting him or her to dispense dangerous drugs;

      (d) A manufacturer or wholesaler or pharmacy to each other or to a practitioner or to a laboratory under records of sales and purchases that correctly give the date, the names and addresses of the supplier and the buyer, the drug and its quantity;

      (e) A hospital pharmacy or a pharmacy so designated by a county health officer in a county whose population is 100,000 or more, or by a district health officer in any county within its jurisdiction or, in the absence of either, by the Chief Medical Officer or the Chief Medical Officer’s designated Medical Director of Emergency Medical Services, to a person or agency described in subsection [3] 4 of NRS 639.268 to stock ambulances or other authorized vehicles or replenish the stock; or

      (f) A pharmacy in a correctional institution to a person designated by the Director of the Department of Corrections to administer a lethal injection to a person who has been sentenced to death.

      Sec. 5. NRS 639.268 is hereby amended to read as follows:

      639.268  1.  A practitioner may purchase supplies of controlled substances, poisons, dangerous drugs and devices from a pharmacy by:

      (a) Making an oral order to the pharmacy or transmitting an oral order through his or her agent, except an order for a controlled substance in schedule II; or

      (b) If the order is for a controlled substance, presenting to the pharmacy a written order signed by the practitioner which contains his or her registration number issued by the Drug Enforcement Administration.

      2.  Any person or entity authorized to dispense controlled substances and dangerous drugs, including, without limitation, a pharmacy, institutional pharmacy or practitioner, may:

 


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ê2023 Statutes of Nevada, Page 2091 (CHAPTER 385, SB 161)ê

 

      (a) Purchase or otherwise acquire controlled substances and dangerous drugs compounded or repackaged by an outsourcing facility directly from the outsourcing facility without an order from a practitioner other than, where applicable, the practitioner purchasing or acquiring the controlled substance or dangerous drug; and

      (b) Administer and dispense controlled substances and dangerous drugs purchased or acquired pursuant to paragraph (a) to the same extent as controlled substances and dangerous drugs acquired through other authorized means.

      3.  A hospital pharmacy or a pharmacy designated for this purpose by a county health officer in a county whose population is 100,000 or more, or by a district health officer in any county within its jurisdiction or, in the absence of either, by the Chief Medical Officer or his or her designated medical director of emergency medical services, may sell to a person or agency described in subsection [3] 4 supplies of controlled substances to stock the ambulances or other authorized vehicles of such a person or agency or replenish the stock if:

      (a) The person or agency is registered with the Drug Enforcement Administration pursuant to 21 C.F.R. Part 1301;

      (b) The person in charge of the controlled substances is:

             (1) A paramedic appropriately certified by the health authority;

             (2) A registered nurse licensed by the State Board of Nursing; or

             (3) A person who holds equivalent certification or licensure issued by another state; and

      (c) Except as otherwise provided in this paragraph, the purchase order is countersigned by a physician or initiated by an oral order and may be made by the person or agency or transmitted by an agent of such a person or agency. An order for a controlled substance listed in schedule II must be made pursuant to NRS 453.251.

      [3.]4.  A pharmacy, institutional pharmacy or other person licensed by the Board to furnish controlled substances and dangerous drugs may sell to:

      (a) The holder of a permit issued pursuant to the provisions of NRS 450B.200 or 450B.210;

      (b) The holder of a permit issued by another state which is substantially similar to a permit issued pursuant to the provisions of NRS 450B.200 or 450B.210; and

      (c) An agency of the Federal Government that provides emergency care or transportation and is registered with the Drug Enforcement Administration pursuant to 21 C.F.R. Part 1301.

      [4.]5.  A pharmacy, institutional pharmacy , outsourcing facility or other person licensed by the Board to furnish dangerous drugs who sells supplies pursuant to this section shall maintain a record of each sale which must contain:

      (a) The date of sale;

      (b) The name, address and signature of the purchaser or the person receiving the delivery;

      (c) The name of the dispensing pharmacist [;] , where applicable;

      (d) The name and address of the authorizing practitioner [;] , where applicable; and

      (e) The name, strength and quantity of each drug sold.

      [5.]6.  A pharmacy, institutional pharmacy or other person licensed by the Board to furnish dangerous drugs who supplies the initial stock for an ambulance or other emergency vehicle shall comply with any applicable regulations adopted by the State Board of Health, or a district board of health, pursuant to NRS 450B.120.

 


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ê2023 Statutes of Nevada, Page 2092 (CHAPTER 385, SB 161)ê

 

ambulance or other emergency vehicle shall comply with any applicable regulations adopted by the State Board of Health, or a district board of health, pursuant to NRS 450B.120.

      [6.]7.  The Board shall adopt regulations regarding the records a pharmacist shall keep of any purchase made pursuant to this section.

      8.  As used in this section:

      (a) “Compounding” includes, without limitation, the combining, admixing, mixing, pooling, reconstituting or other altering of a drug or bulk drug substance, as defined in 21 C.F.R. § 207.3, to create a drug.

      (b) “Outsourcing facility” means a manufacturer at one geographic location or address that:

             (1) Is engaged in the compounding of sterile or nonsterile drugs for use by humans; and

             (2) Has registered with the Secretary of Health and Human Services as an outsourcing facility pursuant to 21 U.S.C. § 353b.

      Sec. 6. NRS 639.28075 is hereby amended to read as follows:

      639.28075  1.  Except as otherwise provided in [subsections] subsection 2 , [and 3,] pursuant to a valid prescription or order for a drug to be used for contraception or its therapeutic equivalent which has been approved by the Food and Drug Administration , a pharmacist shall:

      (a) [The first time dispensing the drug or therapeutic equivalent to] If the patient [,] is not currently using the drug or its therapeutic equivalent, dispense up to a 3-month supply of the drug or therapeutic equivalent [.] or any amount designated by the prescription or order, whichever is less.

      (b) [The second time dispensing] If the drug or therapeutic equivalent has only been dispensed to the patient [,] once pursuant to paragraph (a), dispense up to a 9-month supply of the drug or therapeutic equivalent, any amount designated by the prescription or order or any amount which covers the remainder of the plan year if the patient is covered by a health care plan, whichever is less.

      (c) For a refill in a plan year following the initial dispensing of a drug or therapeutic equivalent pursuant to paragraphs (a) and (b), dispense [up to] a 12-month supply of the drug or therapeutic equivalent , any amount designated by the prescription or order or any amount which covers the remainder of the plan year if the patient is covered by a health care plan, whichever is less.

      2.  [The provisions of paragraphs (b) and (c) of subsection 1 only apply if:

      (a) The drug for contraception or the therapeutic equivalent of such drug is the same drug or therapeutic equivalent which was previously prescribed or ordered pursuant to paragraph (a) of subsection 1; and

      (b) The patient is covered by the same health care plan.

      3.  If a prescription or order for a drug for contraception or its therapeutic equivalent limits the dispensing of the drug or therapeutic equivalent to a quantity which is less than the amount otherwise authorized to be dispensed pursuant to subsection 1, the pharmacist must dispense the drug or therapeutic equivalent in accordance with the quantity specified in the prescription or order.

      4.]  A pharmacist is not required to dispense an amount of a drug to be used for contraception or its therapeutic equivalent for which the patient is unable or unwilling to pay any applicable charge, copayment or coinsurance due to the pharmacy.

      3.  As used in this section:

 


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ê2023 Statutes of Nevada, Page 2093 (CHAPTER 385, SB 161)ê

 

      (a) “Health care plan” means a policy, contract, certificate or agreement offered or issued by an insurer, including without limitation, the State Plan for Medicaid, to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.

      (b) “Plan year” means the year designated in the evidence of coverage of a health care plan in which a person is covered by such plan.

      (c) “Therapeutic equivalent” means a drug which:

             (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

             (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and

             (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

      Sec. 7. Chapter 640C of NRS is hereby amended by adding thereto a new section to read as follows:

 

INTERSTATE MASSAGE COMPACT

ARTICLE 1-PURPOSE

 

      The purpose of this Compact is to reduce the burdens on State governments and to facilitate the interstate practice and regulation of Massage Therapy with the goal of improving public access to, and the safety of, Massage Therapy Services. Through this Compact, the Member States seek to establish a regulatory framework which provides for a new multistate licensing program. Through this additional licensing pathway, the Member States seek to provide increased value and mobility to licensed massage therapists in the Member States, while ensuring the provision of safe, competent, and reliable services to the public.

      This Compact is designed to achieve the following objectives, and the Member States hereby ratify the same intentions by subscribing hereto:

      A.  Increase public access to Massage Therapy Services by providing for a multistate licensing pathway;

      B.  Enhance the Member States’ ability to protect the public’s health and safety;

      C.  Enhance the Member States’ ability to prevent human trafficking and licensure fraud;

      D.  Encourage the cooperation of Member States in regulating the multistate Practice of Massage Therapy;

      E.  Support relocating military members and their spouses;

      F.  Facilitate and enhance the exchange of licensure, investigative, and disciplinary information between the Member States;

      G.  Create an Interstate Commission that will exist to implement and administer the Compact;

      H.  Allow a Member State to hold a Licensee accountable, even where that Licensee holds a Multistate License;

      I.  Create a streamlined pathway for Licensees to practice in Member States, thus increasing the mobility of duly licensed massage therapists; and

      J.  Serve the needs of licensed massage therapists and the public receiving their services; however,

      K.  Nothing in this Compact is intended to prevent a State from enforcing its own laws regarding the Practice of Massage Therapy.

 


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ê2023 Statutes of Nevada, Page 2094 (CHAPTER 385, SB 161)ê

 

ARTICLE 2-DEFINITIONS

 

      As used in this Compact, except as otherwise provided and subject to clarification by the Rules of the Commission, the following definitions shall govern the terms herein:

      A.  “Active Military Member” - any person with full-time duty status in the armed forces of the United States, including members of the National Guard and Reserve.

      B.  “Adverse Action” - any administrative, civil, equitable, or criminal action permitted by a Member State’s laws which is imposed by a Licensing Authority or other regulatory body against a Licensee, including actions against an individual’s Authorization to Practice such as revocation, suspension, probation, surrender in lieu of discipline, monitoring of the Licensee, limitation of the Licensee’s practice, or any other Encumbrance on licensure affecting an individual’s ability to practice Massage Therapy, including the issuance of a cease and desist order.

      C.  “Alternative Program” - a non-disciplinary monitoring or prosecutorial diversion program approved by a Member State’s Licensing Authority.

      D.  “Authorization to Practice” - a legal authorization by a Remote State pursuant to a Multistate License permitting the Practice of Massage Therapy in that Remote State, which shall be subject to the enforcement jurisdiction of the Licensing Authority in that Remote State.

      E.  “Background Check” - the submission of an applicant’s criminal history record information, as further defined in 28 C.F.R. § 20.3(d), as amended from the Federal Bureau of Investigation and the agency responsible for retaining State criminal records in the applicant’s Home State.

      F.  “Charter Member States” - Member States who have enacted legislation to adopt this Compact where such legislation predates the effective date of this Compact as defined in Article 12.

      G.  “Commission” - the government agency whose membership consists of all States that have enacted this Compact, which is known as the Interstate Massage Compact Commission, as defined in Article 8, and which shall operate as an instrumentality of the Member States.

      H.  “Continuing Competence” - a requirement, as a condition of license renewal, to provide evidence of participation in, and completion of, educational or professional activities that maintain, improve, or enhance Massage Therapy fitness to practice.

      I.  “Current Significant Investigative Information” - Investigative Information that a Licensing Authority, after an inquiry or investigation that complies with a Member State’s due process requirements, has reason to believe is not groundless and, if proved true, would indicate a violation of that State’s laws regarding the Practice of Massage Therapy.

      J.  “Data System” - a repository of information about Licensees who hold Multistate Licenses, which may include but is not limited to license status, Investigative Information, and Adverse Actions.

      K.  “Disqualifying Event” - any event which shall disqualify an individual from holding a Multistate License under this Compact, which the Commission may by Rule specify.

      L.  “Encumbrance” - a revocation or suspension of, or any limitation or condition on, the full and unrestricted Practice of Massage Therapy by a Licensing Authority.

 


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ê2023 Statutes of Nevada, Page 2095 (CHAPTER 385, SB 161)ê

 

      M.  “Executive Committee” - a group of delegates elected or appointed to act on behalf of, and within the powers granted to them by, the Commission.

      N.  “Home State” - means the Member State which is a Licensee’s primary state of residence where the Licensee holds an active Single-State License.

      O.  “Investigative Information” - information, records, or documents received or generated by a Licensing Authority pursuant to an investigation or other inquiry.

      P.  “Licensing Authority” - a State’s regulatory body responsible for issuing Massage Therapy licenses or otherwise overseeing the Practice of Massage Therapy in that State.

      Q.  “Licensee” - an individual who currently holds a license from a Member State to fully practice Massage Therapy, whose license is not a student, provisional, temporary, inactive, or other similar status.

      R.  “Massage Therapy”, “Massage Therapy Services”, and the “Practice of Massage Therapy” - the care and services provided by a Licensee as set forth in the Member State’s statutes and regulations in the State where the services are being provided.

      S.  “Member State” - any State that has adopted this Compact.

      T.  “Multistate License” - a license that consists of Authorizations to Practice Massage Therapy in all Remote States pursuant to this Compact, which shall be subject to the enforcement jurisdiction of the Licensing Authority in a Licensee’s Home State.

      U.  “National Licensing Examination” - A national examination developed by a national association of Massage Therapy regulatory boards, as defined by Commission Rule, that is derived from a practice analysis and is consistent with generally accepted psychometric principles of fairness, validity and reliability, and is administered under secure and confidential examination protocols.

      V.  “Remote State” - any Member State, other than the Licensee’s Home State.

      W.  “Rule” - any opinion or regulation promulgated by the Commission under this Compact, which shall have the force of law.

      X.  “Single-State License” - a current, valid authorization issued by a Member State’s Licensing Authority allowing an individual to fully practice Massage Therapy, that is not a restricted, student, provisional, temporary, or inactive practice authorization and authorizes practice only within the issuing State.

      Y.  “State” - a state, territory, possession of the United States, or the District of Columbia.

 

ARTICLE 3-MEMBER STATE REQUIREMENTS

 

      A.  To be eligible to join this Compact, and to maintain eligibility as a Member State, a State must:

      1.  License and regulate the Practice of Massage Therapy;

      2.  Have a mechanism or entity in place to receive and investigate complaints from the public, regulatory or law enforcement agencies, or the Commission about Licensees practicing in that State;

      3.  Accept passage of a National Licensing Examination as a criterion for Massage Therapy licensure in that State;

 


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ê2023 Statutes of Nevada, Page 2096 (CHAPTER 385, SB 161)ê

 

      4.  Require that Licensees satisfy educational requirements prior to being licensed to provide Massage Therapy Services to the public in that State;

      5.  Implement procedures for requiring the Background Check of applicants for a Multistate License, and for the reporting of any Disqualifying Events, including but not limited to obtaining and submitting, for each Licensee holding a Multistate License and each applicant for a Multistate License, fingerprint or other biometric-based information to the Federal Bureau of Investigation for Background Checks; receiving the results of the Federal Bureau of Investigation record search on Background Checks and considering the results of such a Background Check in making licensure decisions;

      6.  Have Continuing Competence requirements as a condition for license renewal;

      7.  Participate in the Data System, including through the use of unique identifying numbers as described herein;

      8.  Notify the Commission and other Member States, in compliance with the terms of the Compact and Rules of the Commission, of any disciplinary action taken by the State against a Licensee practicing under a Multistate License in that State, or of the existence of Investigative Information or Current Significant Investigative Information regarding a Licensee practicing in that State pursuant to a Multistate License;

      9.  Comply with the Rules of the Commission;

      10.  Accept Licensees with valid Multistate Licenses from other Member States as established herein;

      B.  Individuals not residing in a Member State shall continue to be able to apply for a Member State’s Single-State License as provided under the laws of each Member State. However, the Single-State License granted to those individuals shall not be recognized as granting a Multistate License for Massage Therapy in any other Member State;

      C.  Nothing in this Compact shall affect the requirements established by a Member State for the issuance of a Single-State License; and

      D.  A Multistate License issued to a Licensee shall be recognized by each Remote State as an Authorization to Practice Massage Therapy in each Remote State.

 

ARTICLE 4-MULTISTATE LICENSE REQUIREMENTS

 

      A.  To qualify for a Multistate License under this Compact, and to maintain eligibility for such a license, an applicant must:

      1.  Hold an active Single-State License to practice Massage Therapy in the applicant’s Home State;

      2.  Have completed at least six hundred and twenty-five (625) clock hours of Massage Therapy education or the substantial equivalent which the Commission may approve by Rule.

      3.  Have passed a National Licensing Examination or the substantial equivalent which the Commission may approve by Rule;

      4.  Submit to a Background Check;

      5.  Have not been convicted or found guilty, or have entered into an agreed disposition, of a felony offense under applicable State or federal criminal law, within five (5) years prior to the date of their application, where such a time period shall not include any time served for the offense, and provided that the applicant has completed any and all requirements arising as a result of any such offense;

 


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ê2023 Statutes of Nevada, Page 2097 (CHAPTER 385, SB 161)ê

 

and provided that the applicant has completed any and all requirements arising as a result of any such offense;

      6.  Have not been convicted or found guilty, or have entered into an agreed disposition, of a misdemeanor offense related to the Practice of Massage Therapy under applicable State or federal criminal law, within two (2) years prior to the date of their application where such a time period shall not include any time served for the offense, and provided that the applicant has completed any and all requirements arising as a result of any such offense;

      7.  Have not been convicted or found guilty, or have entered into an agreed disposition, of any offense, whether a misdemeanor or a felony, under State or federal law, at any time, relating to any of the following:

             a. Kidnapping;

             b. Human trafficking;

             c. Human smuggling;

             d. Sexual battery, sexual assault, or any related offenses; or

             e. Any other category of offense which the Commission may by Rule designate.

      8.  Have not previously held a Massage Therapy license which was revoked by, or surrendered in lieu of discipline to an applicable Licensing Authority;

      9.  Have no history of any Adverse Action on any occupational or professional license within two (2) years prior to the date of their application; and

      10.  Pay all required fees.

      B.  A Multistate License granted pursuant to this Compact may be effective for a definite period of time concurrent with the renewal of the Home State license.

      C.  A Licensee practicing in a Member State is subject to all scope of practice laws governing Massage Therapy Services in that State.

      D.  The Practice of Massage Therapy under a Multistate License granted pursuant to this Compact will subject the Licensee to the jurisdiction of the Licensing Authority, the courts, and the laws of the Member State in which the Massage Therapy Services are provided.

 

ARTICLE 5-AUTHORITY OF INTERSTATE

MASSAGE COMPACT COMMISSION AND

MEMBER STATE LICENSING AUTHORITIES

 

      A.  Nothing in this Compact, nor any Rule of the Commission, shall be construed to limit, restrict, or in any way reduce the ability of a Member State to enact and enforce laws, regulations, or other rules related to the Practice of Massage Therapy in that State, where those laws, regulations, or other rules are not inconsistent with the provisions of this Compact.

      B.  Nothing in this Compact, nor any Rule of the Commission, shall be construed to limit, restrict, or in any way reduce the ability of a Member State to take Adverse Action against a Licensee’s Single-State License to practice Massage Therapy in that State.

      C.  Nothing in this Compact, nor any Rule of the Commission, shall be construed to limit, restrict, or in any way reduce the ability of a Remote State to take Adverse Action against a Licensee’s Authorization to Practice in that State.

 


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ê2023 Statutes of Nevada, Page 2098 (CHAPTER 385, SB 161)ê

 

      D.  Nothing in this Compact, nor any Rule of the Commission, shall be construed to limit, restrict, or in any way reduce the ability of a Licensee’s Home State to take Adverse Action against a Licensee’s Multistate License based upon information provided by a Remote State.

      E.  Insofar as practical, a Member State’s Licensing Authority shall cooperate with the Commission and with each entity exercising independent regulatory authority over the Practice of Massage Therapy according to the provisions of this Compact.

 

ARTICLE 6-ADVERSE ACTIONS

 

      A.  A Licensee’s Home State shall have exclusive power to impose an Adverse Action against a Licensee’s Multistate License issued by the Home State.

      B.  A Home State may take Adverse Action on a Multistate License based on the Investigative Information, Current Significant Investigative Information, or Adverse Action of a Remote State.

      C.  A Home State shall retain authority to complete any pending investigations of a Licensee practicing under a Multistate License who changes their Home State during the course of such an investigation. The Licensing Authority shall also be empowered to report the results of such an investigation to the Commission through the Data System as described herein.

      D.  Any Member State may investigate actual or alleged violations of the scope of practice laws in any other Member State for a massage therapist who holds a Multistate License.

      E.  A Remote State shall have the authority to:

      1.  Take Adverse Actions against a Licensee’s Authorization to Practice.

      2.  Issue cease and desist orders or impose an Encumbrance on a Licensee’s Authorization to Practice in that State.

      3.  Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses, as well as the production of evidence. Subpoenas issued by a Licensing Authority in a Member State for the attendance and testimony of witnesses or the production of evidence from another Member State shall be enforced in the latter State by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings before it. The issuing Licensing Authority shall pay any witness fees, travel expenses, mileage, and other fees required by the service statutes of the State in which the witnesses or evidence are located.

      4.  If otherwise permitted by State law, recover from the affected Licensee the costs of investigations and disposition of cases resulting from any Adverse Action taken against that Licensee.

      5.  Take Adverse Action against the Licensee’s Authorization to Practice in that State based on the factual findings of another Member State.

      F.  If an Adverse Action is taken by the Home State against a Licensee’s Multistate License or Single-State License to practice in the Home State, the Licensee’s Authorization to Practice in all other Member States shall be deactivated until all Encumbrances have been removed from such license. All Home State disciplinary orders that impose an Adverse Action against a Licensee shall include a statement that the Massage Therapist’s Authorization to Practice is deactivated in all Member States during the pendency of the order.

 


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ê2023 Statutes of Nevada, Page 2099 (CHAPTER 385, SB 161)ê

 

the Massage Therapist’s Authorization to Practice is deactivated in all Member States during the pendency of the order.

      G.  If Adverse Action is taken by a Remote State against a Licensee’s Authorization to Practice, that Adverse Action applies to all Authorizations to Practice in all Remote States. A Licensee whose Authorization to Practice in a Remote State is removed for a specified period of time is not eligible to apply for a new Multistate License in any other State until the specific time for removal of the Authorization to Practice has passed and all encumbrance requirements are satisfied.

      H.  Nothing in this Compact shall override a Member State’s authority to accept a Licensee’s participation in an Alternative Program in lieu of Adverse Action. A Licensee’s Multistate License shall be suspended for the duration of the Licensee’s participation in any Alternative Program.

      I.  Joint Investigations

      1.  In addition to the authority granted to a Member State by its respective scope of practice laws or other applicable State law, a Member State may participate with other Member States in joint investigations of Licensees.

      2.  Member States shall share any investigative, litigation, or compliance materials in furtherance of any joint or individual investigation initiated under the Compact.

 

ARTICLE 7-ACTIVE MILITARY MEMBERS AND THEIR SPOUSES

 

      Active Military Members, or their spouses, shall designate a Home State where the individual has a current license to practice Massage Therapy in good standing. The individual may retain their Home State designation during any period of service when that individual or their spouse is on active duty assignment.

 

ARTICLE 8-ESTABLISHMENT AND OPERATION OF

INTERSTATE MASSAGE COMPACT COMMISSION

 

      A.  The Compact Member States hereby create and establish a joint government agency whose membership consists of all Member States that have enacted the Compact known as the Interstate Massage Compact Commission. The Commission is an instrumentality of the Compact States acting jointly and not an instrumentality of any one State. The Commission shall come into existence on or after the effective date of the Compact as set forth in Article 12.

      B.  Membership, Voting, and Meetings

      1.  Each Member State shall have and be limited to one (1) delegate selected by that Member State’s State Licensing Authority.

      2.  The delegate shall be the primary administrative officer of the State Licensing Authority or their designee.

      3.  The Commission shall by Rule or bylaw establish a term of office for delegates and may by Rule or bylaw establish term limits.

      4.  The Commission may recommend removal or suspension of any delegate from office.

      5.  A Member State’s State Licensing Authority shall fill any vacancy of its delegate occurring on the Commission within 60 days of the vacancy.

      6.  Each delegate shall be entitled to one vote on all matters that are voted on by the Commission.

 


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ê2023 Statutes of Nevada, Page 2100 (CHAPTER 385, SB 161)ê

 

      7.  The Commission shall meet at least once during each calendar year. Additional meetings may be held as set forth in the bylaws. The Commission may meet by telecommunication, video conference or other similar electronic means.

      C.  The Commission shall have the following powers:

      1.  Establish the fiscal year of the Commission;

      2.  Establish code of conduct and conflict of interest policies;

      3.  Adopt Rules and bylaws;

      4.  Maintain its financial records in accordance with the bylaws;

      5.  Meet and take such actions as are consistent with the provisions of this Compact, the Commission’s Rules, and the bylaws;

      6.  Initiate and conclude legal proceedings or actions in the name of the Commission, provided that the standing of any State Licensing Authority to sue or be sued under applicable law shall not be affected;

      7.  Maintain and certify records and information provided to a Member State as the authenticated business records of the Commission, and designate an agent to do so on the Commission’s behalf;

      8.  Purchase and maintain insurance and bonds;

      9.  Borrow, accept, or contract for services of personnel, including, but not limited to, employees of a Member State;

      10.  Conduct an annual financial review;

      11.  Hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of the Compact, and establish the Commission’s personnel policies and programs relating to conflicts of interest, qualifications of personnel, and other related personnel matters;

      12.  Assess and collect fees;

      13.  Accept any and all appropriate gifts, donations, grants of money, other sources of revenue, equipment, supplies, materials, and services, and receive, utilize, and dispose of the same; provided that at all times the Commission shall avoid any appearance of impropriety or conflict of interest;

      14.  Lease, purchase, retain, own, hold, improve, or use any property, real, personal, or mixed, or any undivided interest therein;

      15.  Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property real, personal, or mixed;

      16.  Establish a budget and make expenditures;

      17.  Borrow money;

      18.  Appoint committees, including standing committees, composed of members, State regulators, State legislators or their representatives, and consumer representatives, and such other interested persons as may be designated in this Compact and the bylaws;

      19.  Accept and transmit complaints from the public, regulatory or law enforcement agencies, or the Commission, to the relevant Member State(s) regarding potential misconduct of Licensees;

      20.  Elect a Chair, Vice Chair, Secretary and Treasurer and such other officers of the Commission as provided in the Commission’s bylaws;

      21.  Establish and elect an Executive Committee, including a chair and a vice chair;

      22.  Adopt and provide to the Member States an annual report;

      23.  Determine whether a State’s adopted language is materially different from the model Compact language such that the State would not qualify for participation in the Compact; and

 


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ê2023 Statutes of Nevada, Page 2101 (CHAPTER 385, SB 161)ê

 

      24.  Perform such other functions as may be necessary or appropriate to achieve the purposes of this Compact.

      D.  The Executive Committee

      1.  The Executive Committee shall have the power to act on behalf of the Commission according to the terms of this Compact. The powers, duties, and responsibilities of the Executive Committee shall include:

             a. Overseeing the day-to-day activities of the administration of the Compact including compliance with the provisions of the Compact, the Commission’s Rules and bylaws, and other such duties as deemed necessary;

             b. Recommending to the Commission changes to the Rules or bylaws, changes to this Compact legislation, fees charged to Compact Member States, fees charged to Licensees, and other fees;

             c. Ensuring Compact administration services are appropriately provided, including by contract;

             d. Preparing and recommending the budget;

             e. Maintaining financial records on behalf of the Commission;

             f. Monitoring Compact compliance of Member States and providing compliance reports to the Commission;

             g. Establishing additional committees as necessary;

             h. Exercise the powers and duties of the Commission during the interim between Commission meetings, except for adopting or amending Rules, adopting or amending bylaws, and exercising any other powers and duties expressly reserved to the Commission by Rule or bylaw; and

             i. Other duties as provided in the Rules or bylaws of the Commission.

      2.  The Executive Committee shall be composed of seven voting members and up to two ex-officio members as follows:

             a. The chair and vice chair of the Commission and any other members of the Commission who serve on the Executive Committee shall be voting members of the Executive Committee.

             b. Other than the chair, vice-chair, secretary and treasurer, the Commission shall elect three voting members from the current membership of the Commission.

             c. The Commission may elect ex-officio, nonvoting members as necessary as follows:

                   i. One ex-officio member who is a representative of the national association of State Massage Therapy regulatory boards.

                   ii. One ex-officio member as specified in the Commission’s bylaws.

      3.  The Commission may remove any member of the Executive Committee as provided in the Commission’s bylaws.

      4.  The Executive Committee shall meet at least annually.

             a. Executive Committee meetings shall be open to the public, except that the Executive Committee may meet in a closed, non-public session of a public meeting when dealing with any of the matters covered under subsection F.4.

             b. The Executive Committee shall give five business days advance notice of its public meetings, posted on its website and as determined to provide notice to persons with an interest in the public matters the Executive Committee intends to address at those meetings.

      5.  The Executive Committee may hold an emergency meeting when acting for the Commission to:

 


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ê2023 Statutes of Nevada, Page 2102 (CHAPTER 385, SB 161)ê

 

             a. Meet an imminent threat to public health, safety, or welfare;

             b. Prevent a loss of Commission or Participating State funds; or

             c. Protect public health and safety.

      E.  The Commission shall adopt and provide to the Member States an annual report.

      F.  Meetings of the Commission

      1.  All meetings of the Commission that are not closed pursuant to this subsection shall be open to the public. Notice of public meetings shall be posted on the Commission’s website at least thirty (30) days prior to the public meeting.

      2.  Notwithstanding subsection F.1 of this Article, the Commission may convene an emergency public meeting by providing at least twenty-four (24) hours prior notice on the Commission’s website, and any other means as provided in the Commission’s Rules, for any of the reasons it may dispense with notice of proposed rulemaking under Article 10.L. The Commission’s legal counsel shall certify that one of the reasons justifying an emergency public meeting has been met.

      3.  Notice of all Commission meetings shall provide the time, date, and location of the meeting, and if the meeting is to be held or accessible via telecommunication, video conference, or other electronic means, the notice shall include the mechanism for access to the meeting.

      4.  The Commission may convene in a closed, non-public meeting for the Commission to discuss:

             a. Non-compliance of a Member State with its obligations under the Compact;

             b. The employment, compensation, discipline or other matters, practices or procedures related to specific employees or other matters related to the Commission’s internal personnel practices and procedures;

             c. Current or threatened discipline of a Licensee by the Commission or by a Member State’s Licensing Authority;

             d. Current, threatened, or reasonably anticipated litigation;

             e. Negotiation of contracts for the purchase, lease, or sale of goods, services, or real estate;

             f. Accusing any person of a crime or formally censuring any person;

             g. Trade secrets or commercial or financial information that is privileged or confidential;

             h. Information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy;

             i. Investigative records compiled for law enforcement purposes;

             j. Information related to any investigative reports prepared by or on behalf of or for use of the Commission or other committee charged with responsibility of investigation or determination of compliance issues pursuant to the Compact;

             k. Legal advice;

             l. Matters specifically exempted from disclosure to the public by federal or Member State law; or

             m. Other matters as promulgated by the Commission by Rule.

      5.  If a meeting, or portion of a meeting, is closed, the presiding officer shall state that the meeting will be closed and reference each relevant exempting provision, and such reference shall be recorded in the minutes.

      6.  The Commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, and the reasons therefore, including a description of the views expressed.

 


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ê2023 Statutes of Nevada, Page 2103 (CHAPTER 385, SB 161)ê

 

summary of actions taken, and the reasons therefore, including a description of the views expressed. All documents considered in connection with an action shall be identified in such minutes. All minutes and documents of a closed meeting shall remain under seal, subject to release only by a majority vote of the Commission or order of a court of competent jurisdiction.

      G.  Financing of the Commission

      1.  The Commission shall pay, or provide for the payment of, the reasonable expenses of its establishment, organization, and ongoing activities.

      2.  The Commission may accept any and all appropriate sources of revenue, donations, and grants of money, equipment, supplies, materials, and services.

      3.  The Commission may levy on and collect an annual assessment from each Member State and impose fees on Licensees of Member States to whom it grants a Multistate License to cover the cost of the operations and activities of the Commission and its staff, which must be in a total amount sufficient to cover its annual budget as approved each year for which revenue is not provided by other sources. The aggregate annual assessment amount for Member States shall be allocated based upon a formula that the Commission shall promulgate by Rule.

      4.  The Commission shall not incur obligations of any kind prior to securing the funds adequate to meet the same; nor shall the Commission pledge the credit of any Member States, except by and with the authority of the Member State.

      5.  The Commission shall keep accurate accounts of all receipts and disbursements. The receipts and disbursements of the Commission shall be subject to the financial review and accounting procedures established under its bylaws. All receipts and disbursements of funds handled by the Commission shall be subject to an annual financial review by a certified or licensed public accountant, and the report of the financial review shall be included in and become part of the annual report of the Commission.

      H.  Qualified Immunity, Defense, and Indemnification

      1.  The members, officers, executive director, employees and representatives of the Commission shall be immune from suit and liability, both personally and in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of Commission employment, duties or responsibilities; provided that nothing in this paragraph shall be construed to protect any such person from suit or liability for any damage, loss, injury, or liability caused by the intentional or willful or wanton misconduct of that person. The procurement of insurance of any type by the Commission shall not in any way compromise or limit the immunity granted hereunder.

      2.  The Commission shall defend any member, officer, executive director, employee, and representative of the Commission in any civil action seeking to impose liability arising out of any actual or alleged act, error, or omission that occurred within the scope of Commission employment, duties, or responsibilities, or as determined by the Commission that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of Commission employment, duties, or responsibilities; provided that nothing herein shall be construed to prohibit that person from retaining their own counsel at their own expense; and provided further, that the actual or alleged act, error, or omission did not result from that person’s intentional or willful or wanton misconduct.

 


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ê2023 Statutes of Nevada, Page 2104 (CHAPTER 385, SB 161)ê

 

employment, duties, or responsibilities; provided that nothing herein shall be construed to prohibit that person from retaining their own counsel at their own expense; and provided further, that the actual or alleged act, error, or omission did not result from that person’s intentional or willful or wanton misconduct.

      3.  The Commission shall indemnify and hold harmless any member, officer, executive director, employee, and representative of the Commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error, or omission that occurred within the scope of Commission employment, duties, or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of Commission employment, duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result from the intentional or willful or wanton misconduct of that person.

      4.  Nothing herein shall be construed as a limitation on the liability of any Licensee for professional malpractice or misconduct, which shall be governed solely by any other applicable State laws.

      5.  Nothing in this Compact shall be interpreted to waive or otherwise abrogate a Member State’s State action immunity or State action affirmative defense with respect to antitrust claims under the Sherman Act, Clayton Act, or any other State or federal antitrust or anticompetitive law or regulation.

      6.  Nothing in this Compact shall be construed to be a waiver of sovereign immunity by the Member States or by the Commission.

 

ARTICLE 9-DATA SYSTEM

 

      A.  The Commission shall provide for the development, maintenance, operation, and utilization of a coordinated database and reporting system.

      B.  The Commission shall assign each applicant for a Multistate License a unique identifier, as determined by the Rules of the Commission.

      C.  Notwithstanding any other provision of State law to the contrary, a Member State shall submit a uniform data set to the Data System on all individuals to whom this Compact is applicable as required by the Rules of the Commission, including:

      1.  Identifying information;

      2.  Licensure data;

      3.  Adverse Actions against a license and information related thereto;

      4.  Non-confidential information related to Alternative Program participation, the beginning and ending dates of such participation, and other information related to such participation;

      5.  Any denial of application for licensure, and the reason(s) for such denial (excluding the reporting of any criminal history record information where prohibited by law);

      6.  The existence of Investigative Information;

      7.  The existence presence of Current Significant Investigative Information; and

      8.  Other information that may facilitate the administration of this Compact or the protection of the public, as determined by the Rules of the Commission.

      D.  The records and information provided to a Member State pursuant to this Compact or through the Data System, when certified by the Commission or an agent thereof, shall constitute the authenticated business records of the Commission, and shall be entitled to any associated hearsay exception in any relevant judicial, quasi-judicial or administrative proceedings in a Member State.

 


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business records of the Commission, and shall be entitled to any associated hearsay exception in any relevant judicial, quasi-judicial or administrative proceedings in a Member State.

      E.  The existence of Current Significant Investigative Information and the existence of Investigative Information pertaining to a Licensee in any Member State will only be available to other Member States.

      F.  It is the responsibility of the Member States to report any Adverse Action against a Licensee who holds a Multistate License and to monitor the database to determine whether Adverse Action has been taken against such a Licensee or License applicant. Adverse Action information pertaining to a Licensee or License applicant in any Member State will be available to any other Member State.

      G.  Member States contributing information to the Data System may designate information that may not be shared with the public without the express permission of the contributing State.

      H.  Any information submitted to the Data System that is subsequently expunged pursuant to federal law or the laws of the Member State contributing the information shall be removed from the Data System.

 

ARTICLE 10-RULEMAKING

 

      A.  The Commission shall promulgate reasonable Rules in order to effectively and efficiently implement and administer the purposes and provisions of the Compact. A Rule shall be invalid and have no force or effect only if a court of competent jurisdiction holds that the Rule is invalid because the Commission exercised its rulemaking authority in a manner that is beyond the scope and purposes of the Compact, or the powers granted hereunder, or based upon another applicable standard of review.

      B.  The Rules of the Commission shall have the force of law in each Member State, provided however that where the Rules of the Commission conflict with the laws of the Member State that establish the Member State’s scope of practice as held by a court of competent jurisdiction, the Rules of the Commission shall be ineffective in that State to the extent of the conflict.

      C.  The Commission shall exercise its Rulemaking powers pursuant to the criteria set forth in this article and the Rules adopted thereunder. Rules shall become binding as of the date specified by the Commission for each Rule.

      D.  If a majority of the legislatures of the Member States rejects a Rule or portion of a Rule, by enactment of a statute or resolution in the same manner used to adopt the Compact within four (4) years of the date of adoption of the Rule, then such Rule shall have no further force and effect in any Member State or to any State applying to participate in the Compact.

      E.  Rules shall be adopted at a regular or special meeting of the Commission.

      F.  Prior to adoption of a proposed Rule, the Commission shall hold a public hearing and allow persons to provide oral and written comments, data, facts, opinions, and arguments.

      G.  Prior to adoption of a proposed Rule by the Commission, and at least thirty (30) days in advance of the meeting at which the Commission will hold a public hearing on the proposed Rule, the Commission shall provide a Notice of Proposed Rulemaking:

 


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      1.  On the website of the Commission or other publicly accessible platform;

      2.  To persons who have requested notice of the Commission’s notices of proposed rulemaking, and

      3.  In such other way(s) as the Commission may by Rule specify.

      H.  The Notice of Proposed Rulemaking shall include:

      1.  The time, date, and location of the public hearing at which the Commission will hear public comments on the proposed Rule and, if different, the time, date, and location of the meeting where the Commission will consider and vote on the proposed Rule;

      2.  If the hearing is held via telecommunication, video conference, or other electronic means, the Commission shall include the mechanism for access to the hearing in the Notice of Proposed Rulemaking;

      3.  The text of the proposed Rule and the reason therefor;

      4.  A request for comments on the proposed Rule from any interested person; and

      5.  The manner in which interested persons may submit written comments.

      I.  All hearings will be recorded. A copy of the recording and all written comments and documents received by the Commission in response to the proposed Rule shall be available to the public.

      J.  Nothing in this article shall be construed as requiring a separate hearing on each Rule. Rules may be grouped for the convenience of the Commission at hearings required by this article.

      K.  The Commission shall, by majority vote of all Commissioners, take final action on the proposed Rule based on the Rulemaking record.

      1.  The Commission may adopt changes to the proposed Rule provided the changes do not enlarge the original purpose of the proposed Rule.

      2.  The Commission shall provide an explanation of the reasons for substantive changes made to the proposed Rule as well as reasons for substantive changes not made that were recommended by commenters.

      3.  The Commission shall determine a reasonable effective date for the Rule. Except for an emergency as provided in subsection L, the effective date of the Rule shall be no sooner than thirty (30) days after the Commission issuing the notice that it adopted or amended the Rule.

      L.  Upon determination that an emergency exists, the Commission may consider and adopt an emergency Rule with 24 hours’ notice, provided that the usual Rulemaking procedures provided in the Compact and in this article shall be retroactively applied to the Rule as soon as reasonably possible, in no event later than ninety (90) days after the effective date of the Rule. For the purposes of this provision, an emergency Rule is one that must be adopted immediately to:

      1.  Meet an imminent threat to public health, safety, or welfare;

      2.  Prevent a loss of Commission or Member State funds;

      3.  Meet a deadline for the promulgation of a Rule that is established by federal law or rule; or

      4.  Protect public health and safety.

      M.  The Commission or an authorized committee of the Commission may direct revisions to a previously adopted Rule for purposes of correcting typographical errors, errors in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be posted on the website of the Commission. The revision shall be subject to challenge by any person for a period of thirty (30) days after posting. The revision may be challenged only on grounds that the revision results in a material change to a Rule.

 


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be challenged only on grounds that the revision results in a material change to a Rule. A challenge shall be made in writing and delivered to the Commission prior to the end of the notice period. If no challenge is made, the revision will take effect without further action. If the revision is challenged, the revision may not take effect without the approval of the Commission.

      N.  No Member State’s rulemaking requirements shall apply under this Compact.

 

ARTICLE 11-OVERSIGHT, DISPUTE

RESOLUTION, AND ENFORCEMENT

 

      A.  Oversight

      1.  The executive and judicial branches of State government in each Member State shall enforce this Compact and take all actions necessary and appropriate to implement the Compact.

      2.  Venue is proper and judicial proceedings by or against the Commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of the Commission is located. The Commission may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings. Nothing herein shall affect or limit the selection or propriety of venue in any action against a Licensee for professional malpractice, misconduct or any such similar matter.

      3.  The Commission shall be entitled to receive service of process in any proceeding regarding the enforcement or interpretation of the Compact and shall have standing to intervene in such a proceeding for all purposes. Failure to provide the Commission service of process shall render a judgment or order void as to the Commission, this Compact, or promulgated Rules.

      B.  Default, Technical Assistance, and Termination

      1.  If the Commission determines that a Member State has defaulted in the performance of its obligations or responsibilities under this Compact or the promulgated Rules, the Commission shall provide written notice to the defaulting State. The notice of default shall describe the default, the proposed means of curing the default, and any other action that the Commission may take, and shall offer training and specific technical assistance regarding the default.

      2.  The Commission shall provide a copy of the notice of default to the other Member States.

      C.  If a State in default fails to cure the default, the defaulting State may be terminated from the Compact upon an affirmative vote of a majority of the delegates of the Member States, and all rights, privileges and benefits conferred on that State by this Compact may be terminated on the effective date of termination. A cure of the default does not relieve the offending State of obligations or liabilities incurred during the period of default.

      D.  Termination of membership in the Compact shall be imposed only after all other means of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given by the Commission to the governor, the majority and minority leaders of the defaulting State’s legislature, the defaulting State’s State Licensing Authority and each of the Member States’ State Licensing Authority.

 


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      E.  A State that has been terminated is responsible for all assessments, obligations, and liabilities incurred through the effective date of termination, including obligations that extend beyond the effective date of termination.

      F.  Upon the termination of a State’s membership from this Compact, that State shall immediately provide notice to all Licensees who hold a Multistate License within that State of such termination. The terminated State shall continue to recognize all licenses granted pursuant to this Compact for a minimum of one hundred eighty (180) days after the date of said notice of termination.

      G.  The Commission shall not bear any costs related to a State that is found to be in default or that has been terminated from the Compact, unless agreed upon in writing between the Commission and the defaulting State.

      H.  The defaulting State may appeal the action of the Commission by petitioning the U.S. District Court for the District of Columbia or the federal district where the Commission has its principal offices. The prevailing party shall be awarded all costs of such litigation, including reasonable attorney’s fees.

      I.  Dispute Resolution

      1.  Upon request by a Member State, the Commission shall attempt to resolve disputes related to the Compact that arise among Member States and between Member and non-Member States.

      2.  The Commission shall promulgate a Rule providing for both mediation and binding dispute resolution for disputes as appropriate.

      J.  Enforcement

      1.  The Commission, in the reasonable exercise of its discretion, shall enforce the provisions of this Compact and the Commission’s Rules.

      2.  By majority vote as provided by Commission Rule, the Commission may initiate legal action against a Member State in default in the United States District Court for the District of Columbia or the federal district where the Commission has its principal offices to enforce compliance with the provisions of the Compact and its promulgated Rules. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorney’s fees. The remedies herein shall not be the exclusive remedies of the Commission. The Commission may pursue any other remedies available under federal or the defaulting Member State’s law.

      3.  A Member State may initiate legal action against the Commission in the U.S. District Court for the District of Columbia or the federal district where the Commission has its principal offices to enforce compliance with the provisions of the Compact and its promulgated Rules. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorney’s fees.

      4.  No individual or entity other than a Member State may enforce this Compact against the Commission.

 


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ARTICLE 12-EFFECTIVE DATE, WITHDRAWAL,

AND AMENDMENT

 

      A.  The Compact shall come into effect on the date on which the Compact statute is enacted into law in the seventh Member State.

      1.  On or after the effective date of the Compact, the Commission shall convene and review the enactment of each of the Charter Member States to determine if the statute enacted by each such Charter Member State is materially different than the model Compact statute.

             a. A Charter Member State whose enactment is found to be materially different from the model Compact statute shall be entitled to the default process set forth in Article 11.

             b. If any Member State is later found to be in default, or is terminated or withdraws from the Compact, the Commission shall remain in existence and the Compact shall remain in effect even if the number of Member States should be less than seven (7).

      2.  Member States enacting the Compact subsequent to the Charter Member States shall be subject to the process set forth in Article 8.C.23 to determine if their enactments are materially different from the model Compact statute and whether they qualify for participation in the Compact.

      3.  All actions taken for the benefit of the Commission or in furtherance of the purposes of the administration of the Compact prior to the effective date of the Compact or the Commission coming into existence shall be considered to be actions of the Commission unless specifically repudiated by the Commission.

      4.  Any State that joins the Compact shall be subject to the Commission’s Rules and bylaws as they exist on the date on which the Compact becomes law in that State. Any Rule that has been previously adopted by the Commission shall have the full force and effect of law on the day the Compact becomes law in that State.

      B.  Any Member State may withdraw from this Compact by enacting a statute repealing that State’s enactment of the Compact.

      1.  A Member State’s withdrawal shall not take effect until one hundred eighty (180) days after enactment of the repealing statute.

      2.  Withdrawal shall not affect the continuing requirement of the withdrawing State’s Licensing Authority to comply with the investigative and Adverse Action reporting requirements of this Compact prior to the effective date of withdrawal.

      3.  Upon the enactment of a statute withdrawing from this Compact, a State shall immediately provide notice of such withdrawal to all Licensees within that State. Notwithstanding any subsequent statutory enactment to the contrary, such withdrawing State shall continue to recognize all licenses granted pursuant to this Compact for a minimum of 180 days after the date of such notice of withdrawal.

      C.  Nothing contained in this Compact shall be construed to invalidate or prevent any licensure agreement or other cooperative arrangement between a Member State and a non-Member State that does not conflict with the provisions of this Compact.

      D.  This Compact may be amended by the Member States. No amendment to this Compact shall become effective and binding upon any Member State until it is enacted into the laws of all Member States.

 


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ê2023 Statutes of Nevada, Page 2110 (CHAPTER 385, SB 161)ê

 

ARTICLE 13. CONSTRUCTION AND SEVERABILITY

 

      A.  This Compact and the Commission’s rulemaking authority shall be liberally construed so as to effectuate the purposes, and the implementation and administration of the Compact. Provisions of the Compact expressly authorizing or requiring the promulgation of Rules shall not be construed to limit the Commission’s rulemaking authority solely for those purposes.

      B.  The provisions of this Compact shall be severable and if any phrase, clause, sentence or provision of this Compact is held by a court of competent jurisdiction to be contrary to the constitution of any Member State, a State seeking participation in the Compact, or of the United States, or the applicability thereof to any government, agency, person or circumstance is held to be unconstitutional by a court of competent jurisdiction, the validity of the remainder of this Compact and the applicability thereof to any other government, agency, person or circumstance shall not be affected thereby.

      C.  Notwithstanding subsection B of this article, the Commission may deny a State’s participation in the Compact or, in accordance with the requirements of Article 11.B, terminate a Member State’s participation in the Compact, if it determines that a constitutional requirement of a Member State is a material departure from the Compact. Otherwise, if this Compact shall be held to be contrary to the constitution of any Member State, the Compact shall remain in full force and effect as to the remaining Member States and in full force and effect as to the Member State affected as to all severable matters.

 

ARTICLE 14. CONSISTENT EFFECT AND

CONFLICT WITH OTHER STATE LAWS

 

      Nothing herein shall prevent or inhibit the enforcement of any other law of a Member State that is not inconsistent with the Compact.

      Any laws, statutes, regulations, or other legal requirements in a Member State in conflict with the Compact are superseded to the extent of the conflict.

      All permissible agreements between the Commission and the Member States are binding in accordance with their terms.

      Sec. 8. NRS 640C.180 is hereby amended to read as follows:

      640C.180  1.  At the first meeting of each fiscal year, the members of the Board shall elect a Chair, Vice Chair and Secretary-Treasurer from among the members.

      2.  The Board shall meet at least quarterly and may meet at other times at the call of the Chair or upon the written request of a majority of the members of the Board.

      3.  The Board shall alternate the location of its meetings between the southern district of Nevada and the northern district of Nevada. For the purposes of this subsection:

      (a) The southern district of Nevada consists of all that portion of the State lying within the boundaries of the counties of Clark, Esmeralda, Lincoln and Nye.

      (b) The northern district of Nevada consists of all that portion of the State lying within the boundaries of Carson City and the counties of Churchill, Douglas, Elko, Eureka, Humboldt, Lander, Lyon, Mineral, Pershing, Storey, Washoe and White Pine.

 


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      4.  A meeting of the Board may be conducted telephonically or by videoconferencing. A meeting conducted telephonically or by videoconferencing must meet the requirements of chapter 241 of NRS and any other applicable provisions of law.

      5.  [Four] Five members of the Board constitute a quorum for the purposes of transacting the business of the Board, including, without limitation, issuing, renewing, suspending, revoking or reinstating a license issued pursuant to this chapter.

      Sec. 9. NRS 683A.178 is hereby amended to read as follows:

      683A.178  1.  A pharmacy benefit manager has an obligation of good faith and fair dealing toward a third party or pharmacy when performing duties pursuant to a contract to which the pharmacy benefit manager is a party. Any provision of a contract that waives or limits that obligation is against public policy, void and unenforceable.

      2.  A pharmacy benefit manager shall notify a third party with which it has entered into a contract in writing of any activity, policy or practice of the pharmacy benefit manager that presents a conflict of interest that interferes with the obligations imposed by subsection 1.

      3.  A pharmacy benefit manager that manages prescription drug benefits for an insurer licensed pursuant to this title shall comply with the provisions of this title which are applicable to the insurer when managing such benefits for the insurer.

      Sec. 10. Chapter 687B of NRS is hereby amended by adding thereto a new section to read as follows:

      1.  A health carrier which offers or issues a network plan:

      (a) Must demonstrate the capacity to adequately deliver family planning services provided by pharmacists or pharmacies to covered persons in accordance with the regulations adopted pursuant to subsection 2.

      (b) Shall make available to each covered person in this State a notice that meets the requirements prescribed by the regulations adopted pursuant to subsection 2 of each pharmacist or pharmacy that has entered into a provider network contract with the carrier to provide family planning services to covered persons who participate in the relevant network plan.

      2.  The Commissioner shall adopt regulations to carry out the provisions of this section, including, without limitation, regulations prescribing requirements for:

      (a) A health carrier to demonstrate compliance with paragraph (a) of subsection 1. Those regulations must not allow a health carrier to demonstrate the capacity to adequately deliver family planning services to covered persons by demonstrating that the health carrier has entered into a network contract with one or more pharmacies for the sole purpose of dispensing prescription drugs to covered persons.

      (b) The form and contents of the notice required by paragraph (b) of subsection 1.

      Sec. 11. NRS 687B.225 is hereby amended to read as follows:

      687B.225  1.  Except as otherwise provided in NRS 689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.044, 689A.0445, 689B.031, 689B.0313, 689B.0315, 689B.0317, 689B.0374, 689B.0378, 689C.1675, 689C.1676, 695A.1856, 695A.1865, 695B.1912, 695B.1913, 695B.1914, 695B.1919, 695B.1925, 695B.1942, 695C.1696, 695C.1713, 695C.1735, 695C.1737, 695C.1745, 695C.1751, 695G.170, 695G.171, 695G.1714 , 695G.1715 and 695G.177, any contract for group, blanket or individual health insurance or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care which provides for payment of a certain part of medical or dental care may require the insured or member to obtain prior authorization for that care from the insurer or organization.

 


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health insurance or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care which provides for payment of a certain part of medical or dental care may require the insured or member to obtain prior authorization for that care from the insurer or organization. The insurer or organization shall:

      (a) File its procedure for obtaining approval of care pursuant to this section for approval by the Commissioner; and

      (b) Respond to any request for approval by the insured or member pursuant to this section within 20 days after it receives the request.

      2.  The procedure for prior authorization may not discriminate among persons licensed to provide the covered care.

      Sec. 12. NRS 687B.600 is hereby amended to read as follows:

      687B.600  As used in NRS 687B.600 to 687B.850, inclusive, and section 11 of this act, unless the context otherwise requires, the words and terms defined in NRS 687B.602 to 687B.665, inclusive, have the meanings ascribed to them in those sections.

      Sec. 13. NRS 687B.670 is hereby amended to read as follows:

      687B.670  If a health carrier offers or issues a network plan, the health carrier shall, with regard to that network plan:

      1.  Comply with all applicable requirements set forth in NRS 687B.600 to 687B.850, inclusive [;] , and section 11 of this act;

      2.  As applicable, ensure that each contract entered into for the purposes of the network plan between a participating provider of health care and the health carrier complies with the requirements set forth in NRS 687B.600 to 687B.850, inclusive [;] , and section 11 of this act; and

      3.  As applicable, ensure that the network plan complies with the requirements set forth in NRS 687B.600 to 687B.850, inclusive [.] , and section 11 of this act.

      Sec. 14. NRS 689A.0418 is hereby amended to read as follows:

      689A.0418  1.  Except as otherwise provided in subsection [7,] 8, an insurer that offers or issues a policy of health insurance shall include in the policy coverage for:

      (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration;

             (3) Listed in subsection [10;] 11; and

             (4) Dispensed in accordance with NRS 639.28075;

      (b) Any type of device for contraception which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration; and

             (3) Listed in subsection [10;] 11;

      (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;

      (d) Insertion of a device for contraception or removal of such a device if the device was inserted while the insured was covered by the same policy of health insurance;

      (e) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

      (f) Management of side effects relating to contraception; and

      (g) Voluntary sterilization for women.

      2.  An insurer shall provide coverage for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in-network pharmacy and in accordance with the applicable provider network contract.

 


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pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in-network pharmacy and in accordance with the applicable provider network contract. Such coverage must be provided to the same extent as if the services were provided by another provider of health care, as applicable to the services being provided. The terms of the policy must not limit:

      (a) Coverage for services listed in subsection 1 and provided by such a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.

      (b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

      3.  An insurer must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer.

      [3.]4.  If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the insurer.

      [4.]5.  Except as otherwise provided in subsections [8,] 9 , 10 and [11,] 12, an insurer that offers or issues a policy of health insurance shall not:

      (a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage to obtain any benefit included in the policy pursuant to subsection 1;

      (b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy uses or may use any such benefit;

      (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

      (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

      (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured; or

      (f) Impose any other restrictions or delays on the access of an insured any such benefit.

      [5.]6.  Coverage pursuant to this section for the covered dependent of an insured must be the same as for the insured.

      [6.]7.  Except as otherwise provided in subsection [7,] 8, a policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2022,] 2024, has the legal effect of including the coverage required by [subsection 1,] this section, and any provision of the policy or the renewal which is in conflict with this section is void.

      [7.]8.  An insurer that offers or issues a policy of health insurance and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if the insurer objects on religious grounds. Such an insurer shall, before the issuance of a policy of health insurance and before the renewal of such a policy, provide to the prospective insured written notice of the coverage that the insurer refuses to provide pursuant to this subsection.

 


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      [8.]9.  An insurer may require an insured to pay a higher deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of the drug.

      [9.]10.  For each of the 18 methods of contraception listed in subsection [10] 11 that have been approved by the Food and Drug Administration, a policy of health insurance must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the insurer may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception. If the insurer charges a copayment or coinsurance for a drug for contraception, the insurer may only require an insured to pay the copayment or coinsurance:

      (a) Once for the entire amount of the drug dispensed for the plan year; or

      (b) Once for each 1-month supply of the drug dispensed.

      [10.]11.  The following 18 methods of contraception must be covered pursuant to this section:

      (a) Voluntary sterilization for women;

      (b) Surgical sterilization implants for women;

      (c) Implantable rods;

      (d) Copper-based intrauterine devices;

      (e) Progesterone-based intrauterine devices;

      (f) Injections;

      (g) Combined estrogen- and progestin-based drugs;

      (h) Progestin-based drugs;

      (i) Extended- or continuous-regimen drugs;

      (j) Estrogen- and progestin-based patches;

      (k) Vaginal contraceptive rings;

      (l) Diaphragms with spermicide;

      (m) Sponges with spermicide;

      (n) Cervical caps with spermicide;

      (o) Female condoms;

      (p) Spermicide;

      (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception; and

      (r) Ulipristal acetate for emergency contraception.

      [11.]12.  Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

      [12.]13.  An insurer shall not [use] :

      (a) Use medical management techniques to require an insured to use a method of contraception other than the method prescribed or ordered by a provider of health care [.] ; or

      (b) Require an insured to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

      [13.]14.  An insurer must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the insurer to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2115 (CHAPTER 385, SB 161)ê

 

      [14.]15.  As used in this section:

      (a) “In-network pharmacy” means a pharmacy that has entered into a contract with an insurer to provide services to insureds through a network plan offered or issued by the insurer.

      (b) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

      [(b)](c) “Network plan” means a policy of health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.

      [(c)](d) “Provider network contract” means a contract between an insurer and a provider of health care or pharmacy specifying the rights and responsibilities of the insurer and the provider of health care or pharmacy, as applicable, for delivery of health care services pursuant to a network plan.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      [(d)] (f) “Therapeutic equivalent” means a drug which:

             (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

             (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and

             (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

      Sec. 15. NRS 689B.0378 is hereby amended to read as follows:

      689B.0378  1.  Except as otherwise provided in subsection [7,] 8, an insurer that offers or issues a policy of group health insurance shall include in the policy coverage for:

      (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration;

             (3) Listed in subsection [11;] 12; and

             (4) Dispensed in accordance with NRS 639.28075;

      (b) Any type of device for contraception which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration; and

             (3) Listed in subsection [11;] 12;

      (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;

      (d) Insertion of a device for contraception or removal of such a device if the device was inserted while the insured was covered by the same policy of group health insurance;

      (e) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

      (f) Management of side effects relating to contraception; and

      (g) Voluntary sterilization for women.

      2.  An insurer shall provide coverage for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in-network pharmacy and in accordance with the applicable network contract.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2116 (CHAPTER 385, SB 161)ê

 

pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in-network pharmacy and in accordance with the applicable network contract. Such coverage must be provided to the same extent as if the services were provided by another provider of health care, as applicable to the services being provided. The terms of the policy must not limit:

      (a) Coverage for services listed in subsection 1 and provided by such a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.

      (b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

      3.  An insurer must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer.

      [3.]4.  If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the insurer.

      [4.]5.  Except as otherwise provided in subsections [9,] 10 , 11 and [12,] 13, an insurer that offers or issues a policy of group health insurance shall not:

      (a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit included in the policy pursuant to subsection 1;

      (b) Refuse to issue a policy of group health insurance or cancel a policy of group health insurance solely because the person applying for or covered by the policy uses or may use any such benefit;

      (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

      (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement to the provider of health care;

      (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured; or

      (f) Impose any other restrictions or delays on the access of an insured to any such benefit.

      [5.]6.  Coverage pursuant to this section for the covered dependent of an insured must be the same as for the insured.

      [6.]7.  Except as otherwise provided in subsection [7,] 8, a policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2022,] 2024, has the legal effect of including the coverage required by [subsection 1,] this section, and any provision of the policy or the renewal which is in conflict with this section is void.

      [7.]8.  An insurer that offers or issues a policy of group health insurance and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if the insurer objects on religious grounds. Such an insurer shall, before the issuance of a policy of group health insurance and before the renewal of such a policy, provide to the group policyholder or prospective insured, as applicable, written notice of the coverage that the insurer refuses to provide pursuant to this subsection.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2117 (CHAPTER 385, SB 161)ê

 

the group policyholder or prospective insured, as applicable, written notice of the coverage that the insurer refuses to provide pursuant to this subsection.

      [8.]9.  If an insurer refuses, pursuant to subsection [7,] 8, to provide the coverage required by subsection 1, an employer may otherwise provide for the coverage for the employees of the employer.

      [9.]10.  An insurer may require an insured to pay a higher deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of the drug.

      [10.]11.  For each of the 18 methods of contraception listed in subsection [11] 12 that have been approved by the Food and Drug Administration, a policy of group health insurance must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the insurer may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception. If the insurer charges a copayment or coinsurance for a drug for contraception, the insurer may only require an insured to pay the copayment or coinsurance:

      (a) Once for the entire amount of the drug dispensed for the plan year; or

      (b) Once for each 1-month supply of the drug dispensed.

      [11.]12.  The following 18 methods of contraception must be covered pursuant to this section:

      (a) Voluntary sterilization for women;

      (b) Surgical sterilization implants for women;

      (c) Implantable rods;

      (d) Copper-based intrauterine devices;

      (e) Progesterone-based intrauterine devices;

      (f) Injections;

      (g) Combined estrogen- and progestin-based drugs;

      (h) Progestin-based drugs;

      (i) Extended- or continuous-regimen drugs;

      (j) Estrogen- and progestin-based patches;

      (k) Vaginal contraceptive rings;

      (l) Diaphragms with spermicide;

      (m) Sponges with spermicide;

      (n) Cervical caps with spermicide;

      (o) Female condoms;

      (p) Spermicide;

      (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception; and

      (r) Ulipristal acetate for emergency contraception.

      [12.]13.  Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

      [13.]14.  An insurer shall not [use] :

      (a) Use medical management techniques to require an insured to use a method of contraception other than the method prescribed or ordered by a provider of health care [.] ; or

      (b) Require an insured to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2118 (CHAPTER 385, SB 161)ê

 

      [14.]15.  An insurer must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the insurer to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

      [15.]16.  As used in this section:

      (a) “In-network pharmacy” means a pharmacy that has entered into a contract with an insurer to provide services to insureds through a network plan offered or issued by the insurer.

      (b) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

      [(b)] (c) “Network plan” means a policy of group health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.

      [(c)] (d)“Provider network contract” means a contract between an insurer and a provider of health care or pharmacy specifying the rights and responsibilities of the insurer and the provider of health care or pharmacy, as applicable, for delivery of health care services pursuant to a network plan.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      [(d)](f) “Therapeutic equivalent” means a drug which:

             (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

             (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and

             (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

      Sec. 16. NRS 689C.1676 is hereby amended to read as follows:

      689C.1676  1.  Except as otherwise provided in subsection [7,] 8, a carrier that offers or issues a health benefit plan shall include in the plan coverage for:

      (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration;

             (3) Listed in subsection [10;] 11; and

             (4) Dispensed in accordance with NRS 639.28075;

      (b) Any type of device for contraception which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration; and

             (3) Listed in subsection [10;] 11;

      (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;

      (d) Insertion of a device for contraception or removal of such a device if the device was inserted while the insured was covered by the same health benefit plan;

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2119 (CHAPTER 385, SB 161)ê

 

      (e) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

      (f) Management of side effects relating to contraception; and

      (g) Voluntary sterilization for women.

      2.  A carrier shall provide coverage for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in-network pharmacy and in accordance with the applicable provider network contract. Such coverage must be provided to the same extent as if the services were provided by another provider of health care, as applicable to the services being provided. The terms of the policy must not limit:

      (a) Coverage for services listed in subsection 1 and provided by such a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.

      (b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

      3.  A carrier must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the carrier.

      [3.]4.  If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the carrier.

      [4.]5.  Except as otherwise provided in subsections [8,] 9 , 10 and [11,] 12, a carrier that offers or issues a health benefit plan shall not:

      (a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit included in the health benefit plan pursuant to subsection 1;

      (b) Refuse to issue a health benefit plan or cancel a health benefit plan solely because the person applying for or covered by the plan uses or may use any such benefit;

      (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

      (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement to the provider of health care;

      (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured; or

      (f) Impose any other restrictions or delays on the access of an insured to any such benefit.

      [5.]6.  Coverage pursuant to this section for the covered dependent of an insured must be the same as for the insured.

      [6.]7.  Except as otherwise provided in subsection [7,] 8, a health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2022,] 2024, has the legal effect of including the coverage required by [subsection 1,] this section, and any provision of the plan or the renewal which is in conflict with this section is void.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2120 (CHAPTER 385, SB 161)ê

 

      [7.]8.  A carrier that offers or issues a health benefit plan and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if the carrier objects on religious grounds. Such a carrier shall, before the issuance of a health benefit plan and before the renewal of such a plan, provide to the prospective insured written notice of the coverage that the carrier refuses to provide pursuant to this subsection.

      [8.]9.  A carrier may require an insured to pay a higher deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of the drug.

      [9.]10.  For each of the 18 methods of contraception listed in subsection [10] 11 that have been approved by the Food and Drug Administration, a health benefit plan must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the carrier may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception. If the carrier charges a copayment or coinsurance for a drug for contraception, the carrier may only require an insured to pay the copayment or coinsurance:

      (a) Once for the entire amount of the drug dispensed for the plan year; or

      (b) Once for each 1-month supply of the drug dispensed.

      [10.]11.  The following 18 methods of contraception must be covered pursuant to this section:

      (a) Voluntary sterilization for women;

      (b) Surgical sterilization implants for women;

      (c) Implantable rods;

      (d) Copper-based intrauterine devices;

      (e) Progesterone-based intrauterine devices;

      (f) Injections;

      (g) Combined estrogen- and progestin-based drugs;

      (h) Progestin-based drugs;

      (i) Extended- or continuous-regimen drugs;

      (j) Estrogen- and progestin-based patches;

      (k) Vaginal contraceptive rings;

      (l) Diaphragms with spermicide;

      (m) Sponges with spermicide;

      (n) Cervical caps with spermicide;

      (o) Female condoms;

      (p) Spermicide;

      (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception; and

      (r) Ulipristal acetate for emergency contraception.

      [11.]12.  Except as otherwise provided in this section and federal law, a carrier may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

      [12.]13.  A carrier shall not [use] :

      (a) Use medical management techniques to require an insured to use a method of contraception other than the method prescribed or ordered by a provider of health care [.] ; or

      (b) Require an insured to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2121 (CHAPTER 385, SB 161)ê

 

      [13.]14.  A carrier must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the carrier to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

      [14.]15.  As used in this section:

      (a) “In-network pharmacy” means a pharmacy that has entered into a contract with a carrier to provide services to insureds through a network plan offered or issued by the carrier.

      (b) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

      [(b)] (c) “Network plan” means a health benefit plan offered by a carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the carrier. The term does not include an arrangement for the financing of premiums.

      [(c)] (d) “Provider network contract” means a contract between a carrier and a provider of health care or pharmacy specifying the rights and responsibilities of the carrier and the provider of health care or pharmacy, as applicable, for delivery of health care services pursuant to a network plan.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      [(d)] (f) “Therapeutic equivalent” means a drug which:

             (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

             (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and

             (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

      Sec. 17. NRS 695A.1865 is hereby amended to read as follows:

      695A.1865  1.  Except as otherwise provided in subsection [7,] 8, a society that offers or issues a benefit contract which provides coverage for prescription drugs or devices shall include in the contract coverage for:

      (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration;

             (3) Listed in subsection [10;] 11; and

             (4) Dispensed in accordance with NRS 639.28075;

      (b) Any type of device for contraception which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration; and

             (3) Listed in subsection [10;] 11;

      (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;

      (d) Insertion of a device for contraception or removal of such a device if the device was inserted while the insured was covered by the same benefit contract;

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2122 (CHAPTER 385, SB 161)ê

 

      (e) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

      (f) Management of side effects relating to contraception; and

      (g) Voluntary sterilization for women.

      2.  A society shall provide coverage for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in-network pharmacy and in accordance with the applicable provider network contract. Such coverage must be provided to the same extent as if the services were provided by another provider of health care, as applicable to the services being provided. The terms of the policy must not limit:

      (a) Coverage for services listed in subsection 1 and provided by such a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.

      (b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

      3.  A society must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the society.

      [3.]4.  If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the society.

      [4.]5.  Except as otherwise provided in subsections [8,] 9 , 10 and [11,] 12, a society that offers or issues a benefit contract shall not:

      (a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for any benefit included in the benefit contract pursuant to subsection 1;

      (b) Refuse to issue a benefit contract or cancel a benefit contract solely because the person applying for or covered by the contract uses or may use any such benefit;

      (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

      (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement to the provider of health care;

      (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured; or

      (f) Impose any other restrictions or delays on the access of an insured to any such benefit.

      [5.]6.  Coverage pursuant to this section for the covered dependent of an insured must be the same as for the insured.

      [6.]7.  Except as otherwise provided in subsection [7,] 8, a benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2022,] 2024, has the legal effect of including the coverage required by [subsection 1,] this section, and any provision of the contract or the renewal which is in conflict with this section is void.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2123 (CHAPTER 385, SB 161)ê

 

      [7.]8.  A society that offers or issues a benefit contract and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if the society objects on religious grounds. Such a society shall, before the issuance of a benefit contract and before the renewal of such a contract, provide to the prospective insured written notice of the coverage that the society refuses to provide pursuant to this subsection.

      [8.]9.  A society may require an insured to pay a higher deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of the drug.

      [9.]10.  For each of the 18 methods of contraception listed in subsection [10] 11 that have been approved by the Food and Drug Administration, a benefit contract must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the society may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception. If the society charges a copayment or coinsurance for a drug for contraception, the society may only require an insured to pay the copayment or coinsurance:

      (a) Once for the entire amount of the drug dispensed for the plan year; or

      (b) Once for each 1-month supply of the drug dispensed.

      [10.]11.  The following 18 methods of contraception must be covered pursuant to this section:

      (a) Voluntary sterilization for women;

      (b) Surgical sterilization implants for women;

      (c) Implantable rods;

      (d) Copper-based intrauterine devices;

      (e) Progesterone-based intrauterine devices;

      (f) Injections;

      (g) Combined estrogen- and progestin-based drugs;

      (h) Progestin-based drugs;

      (i) Extended- or continuous-regimen drugs;

      (j) Estrogen- and progestin-based patches;

      (k) Vaginal contraceptive rings;

      (l) Diaphragms with spermicide;

      (m) Sponges with spermicide;

      (n) Cervical caps with spermicide;

      (o) Female condoms;

      (p) Spermicide;

      (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception; and

      (r) Ulipristal acetate for emergency contraception.

      [11.]12.  Except as otherwise provided in this section and federal law, a society may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

      [12.]13.  A society shall not [use] :

      (a) Use medical management techniques to require an insured to use a method of contraception other than the method prescribed or ordered by a provider of health care [.] ; or

      (b) Require an insured to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2124 (CHAPTER 385, SB 161)ê

 

      [13.]14.  A society must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the society to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

      [14.]15.  As used in this section:

      (a) “In-network pharmacy” means a pharmacy that has entered into a contract with a society to provide services to insureds through a network plan offered or issued by the society.

      (b) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

      [(b)](c) “Network plan” means a benefit contract offered by a society under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the society. The term does not include an arrangement for the financing of premiums.

      [(c)] (d) “Provider network contract” means a contract between a society and a provider of health care or pharmacy specifying the rights and responsibilities of the society and the provider of health care or pharmacy, as applicable, for delivery of health care services pursuant to a network plan.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      [(d)] (f) “Therapeutic equivalent” means a drug which:

             (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

             (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and

             (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

      Sec. 18. NRS 695B.1919 is hereby amended to read as follows:

      695B.1919  1.  Except as otherwise provided in subsection [7,] 8, an insurer that offers or issues a contract for hospital or medical service shall include in the contract coverage for:

      (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration;

             (3) Listed in subsection [11;] 12; and

             (4) Dispensed in accordance with NRS 639.28075;

      (b) Any type of device for contraception which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration; and

             (3) Listed in subsection [11;] 12;

      (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;

      (d) Insertion of a device for contraception or removal of such a device if the device was inserted while the insured was covered by the same contract for hospital or medical service;

 


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ê2023 Statutes of Nevada, Page 2125 (CHAPTER 385, SB 161)ê

 

      (e) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

      (f) Management of side effects relating to contraception; and

      (g) Voluntary sterilization for women.

      2.  An insurer shall provide coverage for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in-network pharmacy and in accordance with the applicable provider network contract. Such coverage must be provided to the same extent as if the services were provided by another provider of health care, as applicable to the services being provided. The terms of the policy must not limit:

      (a) Coverage for services listed in subsection 1 and provided by such a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.

      (b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

      3.  An insurer that offers or issues a contract for hospital or medical services must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer.

      [3.]4.  If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the insurer.

      [4.]5.  Except as otherwise provided in subsections [9,] 10 , 11 and [12,] 13, an insurer that offers or issues a contract for hospital or medical service shall not:

      (a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit included in the contract for hospital or medical service pursuant to subsection 1;

      (b) Refuse to issue a contract for hospital or medical service or cancel a contract for hospital or medical service solely because the person applying for or covered by the contract uses or may use any such benefit;

      (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

      (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement to the provider of health care;

      (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured; or

      (f) Impose any other restrictions or delays on the access of an insured to any such benefit.

      [5.]6.  Coverage pursuant to this section for the covered dependent of an insured must be the same as for the insured.

      [6.]7.  Except as otherwise provided in subsection [7,] 8, a contract for hospital or medical service subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2022,] 2024, has the legal effect of including the coverage required by [subsection 1,] this section, and any provision of the contract or the renewal which is in conflict with this section is void.

 


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ê2023 Statutes of Nevada, Page 2126 (CHAPTER 385, SB 161)ê

 

has the legal effect of including the coverage required by [subsection 1,] this section, and any provision of the contract or the renewal which is in conflict with this section is void.

      [7.]8.  An insurer that offers or issues a contract for hospital or medical service and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if the insurer objects on religious grounds. Such an insurer shall, before the issuance of a contract for hospital or medical service and before the renewal of such a contract, provide to the prospective insured written notice of the coverage that the insurer refuses to provide pursuant to this subsection.

      [8.]9.  If an insurer refuses, pursuant to subsection [7,] 8, to provide the coverage required by subsection 1, an employer may otherwise provide for the coverage for the employees of the employer.

      [9.]10.  An insurer may require an insured to pay a higher deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of the drug.

      [10.]11.  For each of the 18 methods of contraception listed in subsection [11] 12 that have been approved by the Food and Drug Administration, a contract for hospital or medical service must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the insurer may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception. If the insurer charges a copayment or coinsurance for a drug for contraception, the insurer may only require an insured to pay the copayment or coinsurance:

      (a) Once for the entire amount of the drug dispensed for the plan year; or

      (b) Once for each 1-month supply of the drug dispensed.

      [11.]12.  The following 18 methods of contraception must be covered pursuant to this section:

      (a) Voluntary sterilization for women;

      (b) Surgical sterilization implants for women;

      (c) Implantable rods;

      (d) Copper-based intrauterine devices;

      (e) Progesterone-based intrauterine devices;

      (f) Injections;

      (g) Combined estrogen- and progestin-based drugs;

      (h) Progestin-based drugs;

      (i) Extended- or continuous-regimen drugs;

      (j) Estrogen- and progestin-based patches;

      (k) Vaginal contraceptive rings;

      (l) Diaphragms with spermicide;

      (m) Sponges with spermicide;

      (n) Cervical caps with spermicide;

      (o) Female condoms;

      (p) Spermicide;

      (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception; and

      (r) Ulipristal acetate for emergency contraception.

      [12.]13.  Except as otherwise provided in this section and federal law, an insurer that offers or issues a contract for hospital or medical services may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

 


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ê2023 Statutes of Nevada, Page 2127 (CHAPTER 385, SB 161)ê

 

available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

      [13.]14.  An insurer shall not [use] :

      (a) Use medical management techniques to require an insured to use a method of contraception other than the method prescribed or ordered by a provider of health care [.] ; or

      (b) Require an insured to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

      [14.]15.  An insurer must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the insurer to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

      [15.]16.  As used in this section:

      (a) “In-network pharmacy” means a pharmacy that has entered into a contract with an insurer to provide services to insureds through a network plan offered or issued by the insurer.

      (b) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

      [(b)] (c) “Network plan” means a contract for hospital or medical service offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.

      [(c)] (d) “Provider network contract” means a contract between an insurer and a provider of health care or pharmacy specifying the rights and responsibilities of the insurer and the provider of health care or pharmacy, as applicable, for delivery of health care services pursuant to a network plan.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      [(d)] (f) “Therapeutic equivalent” means a drug which:

             (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

             (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and

             (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

      Sec. 19. NRS 695C.1696 is hereby amended to read as follows:

      695C.1696  1.  Except as otherwise provided in subsection [7,] 8, a health maintenance organization that offers or issues a health care plan shall include in the plan coverage for:

      (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration;

 


…………………………………………………………………………………………………………………

ê2023 Statutes of Nevada, Page 2128 (CHAPTER 385, SB 161)ê

 

             (3) Listed in subsection [11;] 12; and

             (4) Dispensed in accordance with NRS 639.28075;

      (b) Any type of device for contraception which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration; and

             (3) Listed in subsection [11;] 12;

      (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;

      (d) Insertion of a device for contraception or removal of such a device if the device was inserted while the enrollee was covered by the same health care plan;

      (e) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

      (f) Management of side effects relating to contraception; and

      (g) Voluntary sterilization for women.

      2.  A health maintenance organization shall provide coverage for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in-network pharmacy and in accordance with the applicable provider network contract. Such coverage must be provided to the same extent as if the services were provided by another provider of health care, as applicable to the services being provided. The terms of the policy must not limit:

      (a) Coverage for services listed in subsection 1 and provided by such a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.

      (b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

      3.  A health maintenance organization must ensure that the benefits required by subsection 1 are made available to an enrollee through a provider of health care who participates in the network plan of the health maintenance organization.

      [3.]4.  If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the health maintenance organization.

      [4.]5.  Except as otherwise provided in subsections [9,] 10 , 11 and [12,] 13, a health maintenance organization that offers or issues a health care plan shall not:

      (a) Require an enrollee to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit included in the health care plan pursuant to subsection 1;

      (b) Refuse to issue a health care plan or cancel a health care plan solely because the person applying for or covered by the plan uses or may use any such benefit;

      (c) Offer or pay any type of material inducement or financial incentive to an enrollee to discourage the enrollee from obtaining any such benefit;

      (d) Penalize a provider of health care who provides any such benefit to an enrollee, including, without limitation, reducing the reimbursement of the provider of health care;

 


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ê2023 Statutes of Nevada, Page 2129 (CHAPTER 385, SB 161)ê

 

      (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an enrollee; or

      (f) Impose any other restrictions or delays on the access of an enrollee to any such benefit.

      [5.]6.  Coverage pursuant to this section for the covered dependent of an enrollee must be the same as for the enrollee.

      [6.]7.  Except as otherwise provided in subsection [7,] 8, a health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2022,] 2024, has the legal effect of including the coverage required by [subsection 1,] this section, and any provision of the plan or the renewal which is in conflict with this section is void.

      [7.]8.  A health maintenance organization that offers or issues a health care plan and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if the health maintenance organization objects on religious grounds. Such an organization shall, before the issuance of a health care plan and before the renewal of such a plan, provide to the prospective enrollee written notice of the coverage that the health maintenance organization refuses to provide pursuant to this subsection.

      [8.]9.  If a health maintenance organization refuses, pursuant to subsection [7,] 8, to provide the coverage required by subsection 1, an employer may otherwise provide for the coverage for the employees of the employer.

      [9.]10.  A health maintenance organization may require an enrollee to pay a higher deductible, copayment or coinsurance for a drug for contraception if the enrollee refuses to accept a therapeutic equivalent of the drug.

      [10.]11.  For each of the 18 methods of contraception listed in subsection [11] 12 that have been approved by the Food and Drug Administration, a health care plan must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the enrollee, but the health maintenance organization may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception. If the health maintenance organization charges a copayment or coinsurance for a drug for contraception, the health maintenance organization may only require an enrollee to pay the copayment or coinsurance:

      (a) Once for the entire amount of the drug dispensed for the plan year; or

      (b) Once for each 1-month supply of the drug dispensed.

      [11.]12.  The following 18 methods of contraception must be covered pursuant to this section:

      (a) Voluntary sterilization for women;

      (b) Surgical sterilization implants for women;

      (c) Implantable rods;

      (d) Copper-based intrauterine devices;

      (e) Progesterone-based intrauterine devices;

      (f) Injections;

      (g) Combined estrogen- and progestin-based drugs;

 


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ê2023 Statutes of Nevada, Page 2130 (CHAPTER 385, SB 161)ê

 

      (h) Progestin-based drugs;

      (i) Extended- or continuous-regimen drugs;

      (j) Estrogen- and progestin-based patches;

      (k) Vaginal contraceptive rings;

      (l) Diaphragms with spermicide;

      (m) Sponges with spermicide;

      (n) Cervical caps with spermicide;

      (o) Female condoms;

      (p) Spermicide;

      (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception; and

      (r) Ulipristal acetate for emergency contraception.

      [12.]13.  Except as otherwise provided in this section and federal law, a health maintenance organization may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

      [13.]14.  A health maintenance organization shall not [use] :

      (a) Use medical management techniques to require an enrollee to use a method of contraception other than the method prescribed or ordered by a provider of health care [.] ; or

      (b) Require an enrollee to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

      [14.]15.  A health maintenance organization must provide an accessible, transparent and expedited process which is not unduly burdensome by which an enrollee, or the authorized representative of the enrollee, may request an exception relating to any medical management technique used by the health maintenance organization to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

      [15.]16.  As used in this section:

      (a) “In-network pharmacy” means a pharmacy that has entered into a contract with a health maintenance organization to provide services to enrollees through a network plan offered or issued by the health maintenance organization.

      (b) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

      [(b)] (c) “Network plan” means a health care plan offered by a health maintenance organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the health maintenance organization. The term does not include an arrangement for the financing of premiums.

      [(c)] (d) “Provider network contract” means a contract between a health maintenance organization and a provider of health care or pharmacy specifying the rights and responsibilities of the health maintenance organization and the provider of health care or pharmacy, as applicable, for delivery of health care services pursuant to a network plan.

 


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ê2023 Statutes of Nevada, Page 2131 (CHAPTER 385, SB 161)ê

 

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      [(d)] (f) “Therapeutic equivalent” means a drug which:

             (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

             (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and

             (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

      Sec. 20. NRS 695G.1715 is hereby amended to read as follows:

      695G.1715  1.  Except as otherwise provided in subsection [7,] 8, a managed care organization that offers or issues a health care plan shall include in the plan coverage for:

      (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration;

             (3) Listed in subsection [10;] 11; and

             (4) Dispensed in accordance with NRS 639.28075;

      (b) Any type of device for contraception which is:

             (1) Lawfully prescribed or ordered;

             (2) Approved by the Food and Drug Administration; and

             (3) Listed in subsection [10;] 11;

      (c) Self-administered hormonal contraceptives dispenses by a pharmacist pursuant to NRS 639.28078;

      (d) Insertion of a device for contraception or removal of such a device if the device was inserted while the insured was covered by the same health care plan;

      (e) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

      (f) Management of side effects relating to contraception; and

      (g) Voluntary sterilization for women.

      2.  A managed care organization shall provide coverage for any services listed in subsection 1 which are within the authorized scope of practice of a pharmacist when such services are provided by a pharmacist who is employed by or serves as an independent contractor of an in-network pharmacy and in accordance with the applicable provider network contract. Such coverage must be provided to the same extent as if the services were provided by another provider of health care, as applicable to the services being provided. The terms of the policy must not limit:

      (a) Coverage for services listed in subsection 1 and provided by such a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.

      (b) Reimbursement for services listed in subsection 1 and provided by such a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

      3.  A managed care organization must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the managed care organization.

      [3.]4.  If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the managed care organization.

 


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ê2023 Statutes of Nevada, Page 2132 (CHAPTER 385, SB 161)ê

 

to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the managed care organization.

      [4.]5.  Except as otherwise provided in subsections [8,] 9 , 10 and [11,] 12, a managed care organization that offers or issues a health care plan shall not:

      (a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit included in the health care plan pursuant to subsection 1;

      (b) Refuse to issue a health care plan or cancel a health care plan solely because the person applying for or covered by the plan uses or may use any such benefits;

      (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefits;

      (d) Penalize a provider of health care who provides any such benefits to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

      (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefits to an insured; or

      (f) Impose any other restrictions or delays on the access of an insured to any such benefits.

      [5.]6.  Coverage pursuant to this section for the covered dependent of an insured must be the same as for the insured.

      [6.]7.  Except as otherwise provided in subsection [7,] 8, a health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, [2022,] 2024, has the legal effect of including the coverage required by [subsection 1,] this section, and any provision of the plan or the renewal which is in conflict with this section is void.

      [7.]8.  A managed care organization that offers or issues a health care plan and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if the managed care organization objects on religious grounds. Such an organization shall, before the issuance of a health care plan and before the renewal of such a plan, provide to the prospective insured written notice of the coverage that the managed care organization refuses to provide pursuant to this subsection.

      [8.]9.  A managed care organization may require an insured to pay a higher deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of the drug.

      [9.]10.  For each of the 18 methods of contraception listed in subsection [10] 11 that have been approved by the Food and Drug Administration, a health care plan must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the managed care organization may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception. If the managed care organization charges a copayment or coinsurance for a drug for contraception, the managed care organization may only require an enrollee to pay the copayment or coinsurance:

      (a) Once for the entire amount of the drug dispensed for the plan year; or

 


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ê2023 Statutes of Nevada, Page 2133 (CHAPTER 385, SB 161)ê

 

      (b) Once for each 1-month supply of the drug dispensed.

      [10.]11.  The following 18 methods of contraception must be covered pursuant to this section:

      (a) Voluntary sterilization for women;

      (b) Surgical sterilization implants for women;

      (c) Implantable rods;

      (d) Copper-based intrauterine devices;

      (e) Progesterone-based intrauterine devices;

      (f) Injections;

      (g) Combined estrogen- and progestin-based drugs;

      (h) Progestin-based drugs;

      (i) Extended- or continuous-regimen drugs;

      (j) Estrogen- and progestin-based patches;

      (k) Vaginal contraceptive rings;

      (l) Diaphragms with spermicide;

      (m) Sponges with spermicide;

      (n) Cervical caps with spermicide;

      (o) Female condoms;

      (p) Spermicide;

      (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception; and

      (r) Ulipristal acetate for emergency contraception.

      [11.]12.  Except as otherwise provided in this section and federal law, a managed care organization may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

      [12.]13.  A managed care organization shall not [use] :

      (a) Use medical management techniques to require an insured to use a method of contraception other than the method prescribed or ordered by a provider of health care [.] ; or

      (b) Require an insured to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

      [13.]14.  A managed care organization must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the managed care organization to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

      [14.]15.  As used in this section:

      (a) “In-network pharmacy” means a pharmacy that has entered into a contract with a managed care organization to provide services to insureds through a network plan offered or issued by the managed care organization.

      (b) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

      [(b)] (c) “Network plan” means a health care plan offered by a managed care organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the managed care organization.

 


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ê2023 Statutes of Nevada, Page 2134 (CHAPTER 385, SB 161)ê

 

including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the managed care organization. The term does not include an arrangement for the financing of premiums.

      [(c)] (d) “Provider network contract” means a contract between a managed care organization and a provider of health care or pharmacy specifying the rights and responsibilities of the managed care organization and the provider of health care or pharmacy, as applicable, for delivery of health care services pursuant to a network plan.

      (e) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      [(d)] (f) “Therapeutic equivalent” means a drug which:

             (1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

             (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and

             (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

      Sec. 21.  1.  The provisions of NRS 422.4053, as amended by section 2 of this act, do not apply to a contract between the Department of Health and Human Services and a pharmacy benefit manager or a health maintenance organization entered into pursuant to NRS 422.4053 before January 1, 2024, but do apply to any renewal or extension of such a contract.

      2.  As used in this section:

      (a) “Health maintenance organization” has the meaning ascribed to it in NRS 695C.030.

      (b) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.

      Sec. 22.  The provisions of NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.

      Sec. 23.  1.  This section and sections 4 and 5 of this act become effective upon passage and approval.

      2.  Sections 1, 2, 3 and 6 to 22, inclusive, of this act become effective:

      (a) Upon passage and approval for the purpose of performing any preparatory administrative tasks that are necessary to carry out the provisions of this act; and

      (b) On January 1, 2024, for all other purposes.

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