(Reprinted with amendments adopted on June 5, 2023)
THIRD REPRINT S.B. 161
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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
FEBRUARY 15, 2023
____________
Referred to Committee on Health and Human Services
SUMMARY—Makes revisions relating to personal health and
wellness. (BDR 38-811)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§ 15 & NRS 287.010)
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT)
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
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.
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Legislative Counsel’s Digest:
Existing law requires public and private policies of insurance regulated under 1
Nevada law to include coverage for up to a 12-month supply of contraceptive 2
drugs. (NRS 287.010, 287.04335, 422.27172, 689A.0418, 689B.0378, 689C.1676, 3
695A.1865, 695B.1919, 695C.1696, 695G.1715) Sections 1, 11 and 14-20 of this 4
bill prohibit an insurer from requiring an insured to obtain prior authorization 5
before receiving a contraceptive drug. Sections 1 and 14-20 also require an insurer 6
to: (1) cover certain contraceptive services when provided by a pharmacist to the 7
same extent as if the services were provided by another provider of health care in 8
certain circumstances; and (2) reimburse a pharmacist for providing such services 9
at a rate that is not less than the rate provided to a physician, physician assistant or 10
advanced practice registered nurse. Sections 1 and 14-20 additionally prescribe 11
certain limitations on the imposition of a copayment or coinsurance for a drug for 12
contraception. Section 10 of this bill requires an insurer to: (1) demonstrate the 13
capacity to adequately deliver family planning services provided by pharmacists to 14
covered persons; and (2) make available to covered persons a notice of pharmacists 15
and pharmacies that are available to provide family planning services to covered 16
persons through the network of the insurer. Sections 12 and 13 of this bill make 17
conforming changes to indicate the proper placement of section 10 in the Nevada 18
Revised Statutes. 19
Existing law imposes certain duties on a pharmacy benefit manager. (NRS 20
683A.178) Section 9 of this bill clarifies that a pharmacy benefit manager that 21
manages prescription drug benefits for an insurer is required to comply with the 22
same provisions of the Nevada Insurance Code as are applicable to the insurer. 23
Existing law authorizes the Department of Health and Human Services to enter 24
into a contract with a pharmacy benefit manager or a health maintenance 25
organization to manage, direct and coordinate all payments and rebates for 26
prescription drugs and all other services and payments relating to the provision of 27
prescription drugs under the State Plan for Medicaid and the Children’s Health 28
Insurance Program. (NRS 422.4053) Section 2 of this bill requires such a contract 29
to require the pharmacy benefit manager or health maintenance organization to 30
comply with certain provisions of law regarding the provision of prescription drugs 31
under the State Plan for Medicaid and the Children’s Health Insurance Program. 32
Existing federal law establishes the Supplemental Nutrition Assistance 33
Program, which provides assistance to certain low-income families for the purchase 34
of food. (7 U.S.C. §§ 2011 et seq.) Existing federal law also establishes the Special 35
Supplemental Nutrition Program for Women, Infants and Children, which provides, 36
through eligible local agencies, nutrition education and supplemental foods to 37
pregnant women, mothers, infants and children less than 5 years of age with low 38
household incomes. (42 U.S.C. § 1786) Existing law requires the Department of 39
Health and Human Services to administer these programs within this State. (NRS 40
422A.338) Section 3 of this bill requires the Department to authorize recipients of 41
benefits provided under those programs to use such benefits to purchase menstrual 42
products: (1) to the extent authorized by federal law; and (2) to the extent that 43
federal funding is available. This bill also authorizes the Department to: (1) 44
establish and administer a program to provide assistance for the purpose of 45
purchasing menstrual products to recipients of benefits provided through programs 46
for which the Division of Welfare and Supportive Services of the Department is 47
responsible; and (2) accept gifts, grants and donations for the purposes of 48
establishing such a program. 49
Existing law imposes certain requirements governing the purchase and sale of 50
controlled substances and dangerous drugs. (NRS 639.268) Existing regulations 51
prescribe certain requirements concerning the operation of outsourcing facilities, 52
which are federally registered facilities that engage in the compounding of drugs. 53
(NAC 639.691-639.6916) Those requirements include requirements that an 54
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outsourcing facility: (1) be licensed by the State Board of Pharmacy as a 55
manufacturer; and (2) comply with regulatory requirements governing 56
manufacturers. (NAC 639.6915) Section 5 of this bill authorizes a person or entity 57
authorized to dispense controlled substances and dangerous drugs to purchase or 58
otherwise acquire controlled substances and dangerous drugs compounded or 59
repackaged by an outsourcing facility directly from the outsourcing facility. 60
Section 4 of this bill makes a conforming change to update an internal reference 61
changed by section 5. 62
Existing law requires a pharmacist to dispense up to a 12-month supply of 63
contraceptives or therapeutic equivalent or any amount which covers the remainder 64
of the plan year, whichever is less, pursuant to a valid prescription or order if: (1) 65
the patient has previously received a 3-month supply of the same drug; (2) the 66
patient has previously received a 9-month supply of the same drug or a supply of 67
the same drug for the balance of the plan year in which the 3-month supply was 68
prescribed or ordered, whichever is less; (3) the patient is insured by the same 69
health insurance plan; and (4) a provider of health care has not specified in the 70
prescription or order that a different supply of the drug is necessary. (NRS 71
639.28075) If a patient is not currently using a contraceptive or therapeutic 72
equivalent, section 6 of this bill requires a pharmacist to dispense a full 3-month 73
supply or the amount designated by the prescription or order, whichever is less, 74
pursuant to a valid prescription or order unless the patient is unable or unwilling to 75
pay the applicable charge, copayment or coinsurance. If the patient is currently 76
using the contraceptive or therapeutic equivalent, section 6 requires a pharmacist to 77
dispense a full 9-month supply or a full 12-month supply, as applicable, any 78
amount designated by the prescription or order or any amount which covers the 79
remainder of the plan year, whichever is less, pursuant to a valid prescription or 80
order unless the patient is unable or unwilling to pay the applicable charge, 81
copayment or coinsurance. 82
Existing law authorizes the Board of Massage Therapy to issue a license to 83
practice massage therapy and sets forth the requirements that an applicant for a 84
license must satisfy in order to become licensed. (NRS 640C.580) Section 7 of this 85
bill adopts the Interstate Massage Compact, creating a multistate license with 86
uniform licensing requirements, including a national licensing examination, for use 87
by licensees in all member states. 88
The Compact requires that, in order to be eligible to join the Compact and 89
maintain eligibility as a member state, a state must: (1) license and regulate the 90
practice of massage therapy; (2) have a mechanism or entity in place to receive and 91
investigate complaints from the public, regulatory or law enforcement agencies or 92
the Interstate Massage Compact Commission about licensees practicing in that 93
state; (3) accept passage of a national licensing examination as a criterion for 94
massage therapy licensure in that state; (4) require that licensees satisfy educational 95
requirements before being licensed; (5) implement procedures for requiring 96
background checks for a multistate license and other reporting requirements; (6) 97
have continuing competence requirements; (7) participate in the Compact’s data 98
system; (8) notify the Commission and other member states of any disciplinary 99
action taken against a licensee practicing under a multistate license; (9) comply 100
with any rules of the Commission; and (10) accept licensees with valid multistate 101
licenses from other member states. An applicant for a multistate license must: (1) 102
hold a license to practice massage therapy in a member state; (2) complete 625 103
hours of massage therapy education or the substantial equivalent; (3) pass a 104
national licensing examination or the substantial equivalent; (4) submit to and pass 105
a background check; and (5) pay all required fees. 106
The Compact: (1) establishes the Interstate Massage Compact Commission as a 107
joint governmental agency whose membership consists of all member states; and 108
(2) provides for the Commission’s rules and governance. The Compact also 109
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establishes a data system, provided for by the Commission, and requires member 110
states to submit uniform data to the data system on all individuals to whom the 111
Compact is applicable. 112
The Compact provides additional provisions to carry out the Compact, 113
including providing procedures for the taking of adverse actions against licensees, 114
provisions for active military members or their spouses, provisions for rulemaking 115
by the Commission, provisions for oversight and dispute resolution and procedures 116
for amendments and withdrawals. The Compact takes effect on the date on which 117
the Compact is enacted into law by the seventh member state. 118
Existing law provides that four members of the Board of Massage Therapy 119
constitute a quorum for the purposes of transacting the business of the Board. (NRS 120
640C.180) Section 8 of this bill increases the number of board members needed to 121
constitute a quorum from four to five. 122
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 1
follows: 2
422.27172 1. The Director shall include in the State Plan for 3
Medicaid a requirement that the State pay the nonfederal share of 4
expenditures incurred for: 5
(a) Up to a 12-month supply, per prescription, of any type of 6
drug for contraception or its therapeutic equivalent which is: 7
(1) Lawfully prescribed or ordered; 8
(2) Approved by the Food and Drug Administration; and 9
(3) Dispensed in accordance with NRS 639.28075; 10
(b) Any type of device for contraception which is lawfully 11
prescribed or ordered and which has been approved by the Food and 12
Drug Administration; 13
(c) Self-administered hormonal contraceptives dispensed by a 14
pharmacist pursuant to NRS 639.28078; 15
(d) Insertion or removal of a device for contraception; 16
(e) Education and counseling relating to the initiation of the use 17
of contraceptives and any necessary follow-up after initiating such 18
use; 19
(f) Management of side effects relating to contraception; and 20
(g) Voluntary sterilization for women. 21
2. Except as otherwise provided in subsections 4 and 5, to 22
obtain any benefit provided in the Plan pursuant to subsection 1, a 23
person enrolled in Medicaid must not be required to: 24
(a) Pay a higher deductible, any copayment or coinsurance; or 25
(b) Be subject to a longer waiting period or any other condition. 26
3. The Director shall ensure that the provisions of this section 27
are carried out in a manner which complies with the requirements 28
established by the Drug Use Review Board and set forth in the list 29
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of preferred prescription drugs established by the Department 1
pursuant to NRS 422.4025. 2
4. The Plan may require a person enrolled in Medicaid to pay a 3
higher deductible, copayment or coinsurance for a drug for 4
contraception if the person refuses to accept a therapeutic equivalent 5
of the contraceptive drug. 6
5. For each method of contraception which is approved by the 7
Food and Drug Administration, the Plan must include at least one 8
contraceptive drug or device for which no deductible, copayment or 9
coinsurance may be charged to the person enrolled in Medicaid, but 10
the Plan may charge a deductible, copayment or coinsurance for any 11
other contraceptive drug or device that provides the same method of 12
contraception. If the Plan requires a person enrolled in Medicaid 13
to pay a copayment or coinsurance for a drug for contraception, 14
the Plan may only require the person to pay the copayment or 15
coinsurance: 16
(a) Once for the entire amount of the drug dispensed for the 17
plan year; or 18
(b) Once for each 1-month supply of the drug dispensed. 19
6. The Plan must provide for the reimbursement of a 20
pharmacist for providing services described in subsection 1 that 21
are within the scope of practice of the pharmacist to the same 22
extent as if the services were provided by another provider of 23
health care. The Plan must not limit: 24
(a) Coverage for such services provided by a pharmacist to a 25
number of occasions less than the coverage for such services when 26
provided by another provider of health care. 27
(b) Reimbursement for such services provided by a pharmacist 28
to an amount less than the amount reimbursed for similar services 29
provided by a physician, physician assistant or advanced practice 30
registered nurse. 31
7. The Plan must not require a recipient of Medicaid to 32
obtain prior authorization for the benefits described in paragraphs 33
(a) and (c) of subsection 1. 34
8. As used in this section: 35
(a) “Drug Use Review Board” has the meaning ascribed to it in 36
NRS 422.402. 37
(b) “Provider of health care” has the meaning ascribed to it in 38
NRS 629.031. 39
(c) “Therapeutic equivalent” means a drug which: 40
(1) Contains an identical amount of the same active 41
ingredients in the same dosage and method of administration as 42
another drug; 43
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(2) Is expected to have the same clinical effect when 1
administered to a patient pursuant to a prescription or order as 2
another drug; and 3
(3) Meets any other criteria required by the Food and Drug 4
Administration for classification as a therapeutic equivalent. 5
Sec. 2. NRS 422.4053 is hereby amended to read as follows: 6
422.4053 1. Except as otherwise provided in subsection 2, 7
the Department shall directly manage, direct and coordinate all 8
payments and rebates for prescription drugs and all other services 9
and payments relating to the provision of prescription drugs under 10
the State Plan for Medicaid and the Children’s Health Insurance 11
Program. 12
2. The Department may enter into a contract with: 13
(a) A pharmacy benefit manager for the provision of any 14
services described in subsection 1. 15
(b) A health maintenance organization pursuant to NRS 422.273 16
for the provision of any of the services described in subsection 1 for 17
recipients of Medicaid or recipients of insurance through the 18
Children’s Health Insurance Program who receive coverage through 19
a Medicaid managed care program. 20
(c) One or more public or private entities from this State, the 21
District of Columbia or other states or territories of the United States 22
for the collaborative purchasing of prescription drugs in accordance 23
with subsection 3 of NRS 277.110. 24
3. A contract entered into pursuant to paragraph (a) or (b) of 25
subsection 2 must: 26
(a) Include the provisions required by NRS 422.4056; [and] 27
(b) Require the pharmacy benefit manager or health 28
maintenance organization, as applicable, to disclose to the 29
Department any information relating to the services covered by the 30
contract, including, without limitation, information concerning 31
dispensing fees, measures for the control of costs, rebates collected 32
and paid and any fees and charges imposed by the pharmacy benefit 33
manager or health maintenance organization pursuant to the contract 34
[.] ; and 35
(c) Require the pharmacy benefit manager or health 36
maintenance organization to comply with the provisions of this 37
chapter regarding the provision of prescription drugs under the 38
State Plan for Medicaid and the Children’s Health Insurance 39
Program to the same extent as the Department. 40
4. In addition to meeting the requirements of subsection 3, a 41
contract entered into pursuant to: 42
(a) Paragraph (a) of subsection 2 may require the pharmacy 43
benefit manager to provide the entire amount of any rebates 44
received for the purchase of prescription drugs, including, without 45
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limitation, rebates for the purchase of prescription drugs by an entity 1
other than the Department, to the Department. 2
(b) Paragraph (b) of subsection 2 must require the health 3
maintenance organization to provide to the Department the entire 4
amount of any rebates received for the purchase of prescription 5
drugs, including, without limitation, rebates for the purchase of 6
prescription drugs by an entity other than the Department, less an 7
administrative fee in an amount prescribed by the contract. The 8
Department shall adopt policies prescribing the maximum amount 9
of such an administrative fee. 10
Sec. 3. Chapter 422A of NRS is hereby amended by adding 11
thereto a new section to read as follows: 12
1. To the extent authorized by federal law and to the extent 13
that federal funding is available, the Department shall authorize 14
recipients of benefits provided under Supplemental Nutrition 15
Assistance or the Special Supplemental Nutrition Program for 16
Women, Infants and Children established by 42 U.S.C. § 1786 to 17
use such benefits to purchase menstrual products. 18
2. The Department shall take any action necessary to obtain 19
federal authorization and federal funding to carry out the 20
provisions of subsection 1, including, without limitation, applying 21
for any necessary federal waiver. 22
3. To the extent that money is available for this purpose, the 23
Department, through the Division, may establish and administer a 24
program to provide assistance for the purpose of purchasing 25
menstrual products to recipients of benefits provided through 26
programs for which the Division is responsible. The Department 27
may accept gifts, grants and donations from any source for the 28
purpose of establishing and administering such a program. 29
4. As used in this section, “menstrual products” includes, 30
without limitation, sanitary napkins, tampons or similar products 31
used in connection with the menstrual cycle. 32
Sec. 4. NRS 454.221 is hereby amended to read as follows: 33
454.221 1. A person who furnishes any dangerous drug 34
except upon the prescription of a practitioner is guilty of a category 35
D felony and shall be punished as provided in NRS 193.130, unless 36
the dangerous drug was obtained originally by a legal prescription. 37
2. The provisions of this section do not apply to the furnishing 38
of any dangerous drug by: 39
(a) A practitioner to his or her patients; 40
(b) A physician assistant licensed pursuant to chapter 630 or 633 41
of NRS if authorized by the Board; 42
(c) A registered nurse while participating in a public health 43
program approved by the Board, or an advanced practice registered 44
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nurse who holds a certificate from the State Board of Pharmacy 1
permitting him or her to dispense dangerous drugs; 2
(d) A manufacturer or wholesaler or pharmacy to each other or 3
to a practitioner or to a laboratory under records of sales and 4
purchases that correctly give the date, the names and addresses of 5
the supplier and the buyer, the drug and its quantity; 6
(e) A hospital pharmacy or a pharmacy so designated by a 7
county health officer in a county whose population is 100,000 or 8
more, or by a district health officer in any county within its 9
jurisdiction or, in the absence of either, by the Chief Medical Officer 10
or the Chief Medical Officer’s designated Medical Director of 11
Emergency Medical Services, to a person or agency described in 12
subsection [3] 4 of NRS 639.268 to stock ambulances or other 13
authorized vehicles or replenish the stock; or 14
(f) A pharmacy in a correctional institution to a person 15
designated by the Director of the Department of Corrections to 16
administer a lethal injection to a person who has been sentenced to 17
death. 18
Sec. 5. NRS 639.268 is hereby amended to read as follows: 19
639.268 1. A practitioner may purchase supplies of 20
controlled substances, poisons, dangerous drugs and devices from a 21
pharmacy by: 22
(a) Making an oral order to the pharmacy or transmitting an oral 23
order through his or her agent, except an order for a controlled 24
substance in schedule II; or 25
(b) If the order is for a controlled substance, presenting to the 26
pharmacy a written order signed by the practitioner which contains 27
his or her registration number issued by the Drug Enforcement 28
Administration. 29
2. Any person or entity authorized to dispense controlled 30
substances and dangerous drugs, including, without limitation, a 31
pharmacy, institutional pharmacy or practitioner, may: 32
(a) Purchase or otherwise acquire controlled substances and 33
dangerous drugs compounded or repackaged by an outsourcing 34
facility directly from the outsourcing facility without an order 35
from a practitioner other than, where applicable, the practitioner 36
purchasing or acquiring the controlled substance or dangerous 37
drug; and 38
(b) Administer and dispense controlled substances and 39
dangerous drugs purchased or acquired pursuant to paragraph (a) 40
to the same extent as controlled substances and dangerous drugs 41
acquired through other authorized means. 42
3. A hospital pharmacy or a pharmacy designated for this 43
purpose by a county health officer in a county whose population is 44
100,000 or more, or by a district health officer in any county within 45
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its jurisdiction or, in the absence of either, by the Chief Medical 1
Officer or his or her designated medical director of emergency 2
medical services, may sell to a person or agency described in 3
subsection [3] 4 supplies of controlled substances to stock the 4
ambulances or other authorized vehicles of such a person or agency 5
or replenish the stock if: 6
(a) The person or agency is registered with the Drug 7
Enforcement Administration pursuant to 21 C.F.R. Part 1301; 8
(b) The person in charge of the controlled substances is: 9
(1) A paramedic appropriately certified by the health 10
authority; 11
(2) A registered nurse licensed by the State Board of 12
Nursing; or 13
(3) A person who holds equivalent certification or licensure 14
issued by another state; and 15
(c) Except as otherwise provided in this paragraph, the purchase 16
order is countersigned by a physician or initiated by an oral order 17
and may be made by the person or agency or transmitted by an agent 18
of such a person or agency. An order for a controlled substance 19
listed in schedule II must be made pursuant to NRS 453.251. 20
[3.] 4. A pharmacy, institutional pharmacy or other person 21
licensed by the Board to furnish controlled substances and 22
dangerous drugs may sell to: 23
(a) The holder of a permit issued pursuant to the provisions of 24
NRS 450B.200 or 450B.210; 25
(b) The holder of a permit issued by another state which is 26
substantially similar to a permit issued pursuant to the provisions of 27
NRS 450B.200 or 450B.210; and 28
(c) An agency of the Federal Government that provides 29
emergency care or transportation and is registered with the Drug 30
Enforcement Administration pursuant to 21 C.F.R. Part 1301. 31
[4.] 5. A pharmacy, institutional pharmacy , outsourcing 32
facility or other person licensed by the Board to furnish dangerous 33
drugs who sells supplies pursuant to this section shall maintain a 34
record of each sale which must contain: 35
(a) The date of sale; 36
(b) The name, address and signature of the purchaser or the 37
person receiving the delivery; 38
(c) The name of the dispensing pharmacist [;] , where 39
applicable; 40
(d) The name and address of the authorizing practitioner [;] , 41
where applicable; and 42
(e) The name, strength and quantity of each drug sold. 43
[5.] 6. A pharmacy, institutional pharmacy or other person 44
licensed by the Board to furnish dangerous drugs who supplies the 45
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initial stock for an ambulance or other emergency vehicle shall 1
comply with any applicable regulations adopted by the State Board 2
of Health, or a district board of health, pursuant to NRS 450B.120. 3
[6.] 7. The Board shall adopt regulations regarding the records 4
a pharmacist shall keep of any purchase made pursuant to this 5
section. 6
8. As used in this section: 7
(a) “Compounding” includes, without limitation, the 8
combining, admixing, mixing, pooling, reconstituting or other 9
altering of a drug or bulk drug substance, as defined in 21 C.F.R. 10
§ 207.3, to create a drug. 11
(b) “Outsourcing facility” means a manufacturer at one 12
geographic location or address that: 13
(1) Is engaged in the compounding of sterile or nonsterile 14
drugs for use by humans; and 15
(2) Has registered with the Secretary of Health and Human 16
Services as an outsourcing facility pursuant to 21 U.S.C. § 353b. 17
Sec. 6. NRS 639.28075 is hereby amended to read as follows: 18
639.28075 1. Except as otherwise provided in [subsections] 19
subsection 2 , [and 3,] pursuant to a valid prescription or order for a 20
drug to be used for contraception or its therapeutic equivalent which 21
has been approved by the Food and Drug Administration , a 22
pharmacist shall: 23
(a) [The first time dispensing the drug or therapeutic equivalent 24
to] If the patient [,] is not currently using the drug or its 25
therapeutic equivalent, dispense up to a 3-month supply of the drug 26
or therapeutic equivalent [.] or any amount designated by the 27
prescription or order, whichever is less. 28
(b) [The second time dispensing] If the drug or therapeutic 29
equivalent has only been dispensed to the patient [,] once pursuant 30
to paragraph (a), dispense up to a 9-month supply of the drug or 31
therapeutic equivalent, any amount designated by the prescription 32
or order or any amount which covers the remainder of the plan year 33
if the patient is covered by a health care plan, whichever is less. 34
(c) For a refill in a plan year following the initial dispensing of a 35
drug or therapeutic equivalent pursuant to paragraphs (a) and (b), 36
dispense [up to] a 12-month supply of the drug or therapeutic 37
equivalent , any amount designated by the prescription or order or 38
any amount which covers the remainder of the plan year if the 39
patient is covered by a health care plan, whichever is less. 40
2. [The provisions of paragraphs (b) and (c) of subsection 1 41
only apply if: 42
(a) The drug for contraception or the therapeutic equivalent of 43
such drug is the same drug or therapeutic equivalent which was 44
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previously prescribed or ordered pursuant to paragraph (a) of 1
subsection 1; and 2
(b) The patient is covered by the same health care plan. 3
3. If a prescription or order for a drug for contraception or its 4
therapeutic equivalent limits the dispensing of the drug or 5
therapeutic equivalent to a quantity which is less than the amount 6
otherwise authorized to be dispensed pursuant to subsection 1, the 7
pharmacist must dispense the drug or therapeutic equivalent in 8
accordance with the quantity specified in the prescription or order. 9
4.] A pharmacist is not required to dispense an amount of a 10
drug to be used for contraception or its therapeutic equivalent for 11
which the patient is unable or unwilling to pay any applicable 12
charge, copayment or coinsurance due to the pharmacy. 13
3. As used in this section: 14
(a) “Health care plan” means a policy, contract, certificate or 15
agreement offered or issued by an insurer, including without 16
limitation, the State Plan for Medicaid, to provide, deliver, arrange 17
for, pay for or reimburse any of the costs of health care services. 18
(b) “Plan year” means the year designated in the evidence of 19
coverage of a health care plan in which a person is covered by such 20
plan. 21
(c) “Therapeutic equivalent” means a drug which: 22
(1) Contains an identical amount of the same active 23
ingredients in the same dosage and method of administration as 24
another drug; 25
(2) Is expected to have the same clinical effect when 26
administered to a patient pursuant to a prescription or order as 27
another drug; and 28
(3) Meets any other criteria required by the Food and Drug 29
Administration for classification as a therapeutic equivalent. 30
Sec. 7. Chapter 640C of NRS is hereby amended by adding 31
thereto a new section to read as follows: 32
33
INTERSTATE MASSAGE COMPACT 34
ARTICLE 1-PURPOSE 35
36
The purpose of this Compact is to reduce the burdens on State 37
governments and to facilitate the interstate practice and regulation 38
of Massage Therapy with the goal of improving public access to, 39
and the safety of, Massage Therapy Services. Through this 40
Compact, the Member States seek to establish a regulatory 41
framework which provides for a new multistate licensing program. 42
Through this additional licensing pathway, the Member States 43
seek to provide increased value and mobility to licensed massage 44
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therapists in the Member States, while ensuring the provision of 1
safe, competent, and reliable services to the public. 2
This Compact is designed to achieve the following objectives, 3
and the Member States hereby ratify the same intentions by 4
subscribing hereto: 5
A. Increase public access to Massage Therapy Services by 6
providing for a multistate licensing pathway; 7
B. Enhance the Member States’ ability to protect the public’s 8
health and safety; 9
C. Enhance the Member States’ ability to prevent human 10
trafficking and licensure fraud; 11
D. Encourage the cooperation of Member States in 12
regulating the multistate Practice of Massage Therapy; 13
E. Support relocating military members and their spouses; 14
F. Facilitate and enhance the exchange of licensure, 15
investigative, and disciplinary information between the Member 16
States; 17
G. Create an Interstate Commission that will exist to 18
implement and administer the Compact; 19
H. Allow a Member State to hold a Licensee accountable, 20
even where that Licensee holds a Multistate License; 21
I. Create a streamlined pathway for Licensees to practice in 22
Member States, thus increasing the mobility of duly licensed 23
massage therapists; and 24
J. Serve the needs of licensed massage therapists and the 25
public receiving their services; however, 26
K. Nothing in this Compact is intended to prevent a State 27
from enforcing its own laws regarding the Practice of Massage 28
Therapy. 29
30
ARTICLE 2-DEFINITIONS 31
32
As used in this Compact, except as otherwise provided and 33
subject to clarification by the Rules of the Commission, the 34
following definitions shall govern the terms herein: 35
A. “Active Military Member” - any person with full-time duty 36
status in the armed forces of the United States, including members 37
of the National Guard and Reserve. 38
B. “Adverse Action” - any administrative, civil, equitable, or 39
criminal action permitted by a Member State’s laws which is 40
imposed by a Licensing Authority or other regulatory body against 41
a Licensee, including actions against an individual’s 42
Authorization to Practice such as revocation, suspension, 43
probation, surrender in lieu of discipline, monitoring of the 44
Licensee, limitation of the Licensee’s practice, or any other 45
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Encumbrance on licensure affecting an individual’s ability to 1
practice Massage Therapy, including the issuance of a cease and 2
desist order. 3
C. “Alternative Program” - a non-disciplinary monitoring or 4
prosecutorial diversion program approved by a Member State’s 5
Licensing Authority. 6
D. “Authorization to Practice” - a legal authorization by a 7
Remote State pursuant to a Multistate License permitting the 8
Practice of Massage Therapy in that Remote State, which shall be 9
subject to the enforcement jurisdiction of the Licensing Authority 10
in that Remote State. 11
E. “Background Check” - the submission of an applicant’s 12
criminal history record information, as further defined in 28 13
C.F.R. § 20.3(d), as amended from the Federal Bureau of 14
Investigation and the agency responsible for retaining State 15
criminal records in the applicant’s Home State. 16
F. “Charter Member States” - Member States who have 17
enacted legislation to adopt this Compact where such legislation 18
predates the effective date of this Compact as defined in Article 12. 19
G. “Commission” - the government agency whose 20
membership consists of all States that have enacted this Compact, 21
which is known as the Interstate Massage Compact Commission, 22
as defined in Article 8, and which shall operate as an 23
instrumentality of the Member States. 24
H. “Continuing Competence” - a requirement, as a condition 25
of license renewal, to provide evidence of participation in, and 26
completion of, educational or professional activities that maintain, 27
improve, or enhance Massage Therapy fitness to practice. 28
I. “Current Significant Investigative Information” - 29
Investigative Information that a Licensing Authority, after an 30
inquiry or investigation that complies with a Member State’s due 31
process requirements, has reason to believe is not groundless and, 32
if proved true, would indicate a violation of that State’s laws 33
regarding the Practice of Massage Therapy. 34
J. “Data System” - a repository of information about 35
Licensees who hold Multistate Licenses, which may include but is 36
not limited to license status, Investigative Information, and 37
Adverse Actions. 38
K. “Disqualifying Event” - any event which shall disqualify 39
an individual from holding a Multistate License under this 40
Compact, which the Commission may by Rule specify. 41
L. “Encumbrance” - a revocation or suspension of, or any 42
limitation or condition on, the full and unrestricted Practice of 43
Massage Therapy by a Licensing Authority. 44
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M. “Executive Committee” - a group of delegates elected or 1
appointed to act on behalf of, and within the powers granted to 2
them by, the Commission. 3
N. “Home State” - means the Member State which is a 4
Licensee’s primary state of residence where the Licensee holds an 5
active Single-State License. 6
O. “Investigative Information” - information, records, or 7
documents received or generated by a Licensing Authority 8
pursuant to an investigation or other inquiry. 9
P. “Licensing Authority” - a State’s regulatory body 10
responsible for issuing Massage Therapy licenses or otherwise 11
overseeing the Practice of Massage Therapy in that State. 12
Q. “Licensee” - an individual who currently holds a license 13
from a Member State to fully practice Massage Therapy, whose 14
license is not a student, provisional, temporary, inactive, or other 15
similar status. 16
R. “Massage Therapy”, “Massage Therapy Services”, and 17
the “Practice of Massage Therapy” - the care and services 18
provided by a Licensee as set forth in the Member State’s statutes 19
and regulations in the State where the services are being provided. 20
S. “Member State” - any State that has adopted this Compact. 21
T. “Multistate License” - a license that consists of 22
Authorizations to Practice Massage Therapy in all Remote States 23
pursuant to this Compact, which shall be subject to the 24
enforcement jurisdiction of the Licensing Authority in a 25
Licensee’s Home State. 26
U. “National Licensing Examination” - A national 27
examination developed by a national association of Massage 28
Therapy regulatory boards, as defined by Commission Rule, that is 29
derived from a practice analysis and is consistent with generally 30
accepted psychometric principles of fairness, validity and 31
reliability, and is administered under secure and confidential 32
examination protocols. 33
V. “Remote State” - any Member State, other than the 34
Licensee’s Home State. 35
W. “Rule” - any opinion or regulation promulgated by the 36
Commission under this Compact, which shall have the force of 37
law. 38
X. “Single-State License” - a current, valid authorization 39
issued by a Member State’s Licensing Authority allowing an 40
individual to fully practice Massage Therapy, that is not a 41
restricted, student, provisional, temporary, or inactive practice 42
authorization and authorizes practice only within the issuing 43
State. 44
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Y. “State” - a state, territory, possession of the United States, 1
or the District of Columbia. 2
3
ARTICLE 3-MEMBER STATE REQUIREMENTS 4
5
A. To be eligible to join this Compact, and to maintain 6
eligibility as a Member State, a State must: 7
1. License and regulate the Practice of Massage Therapy; 8
2. Have a mechanism or entity in place to receive and 9
investigate complaints from the public, regulatory or law 10
enforcement agencies, or the Commission about Licensees 11
practicing in that State; 12
3. Accept passage of a National Licensing Examination as a 13
criterion for Massage Therapy licensure in that State; 14
4. Require that Licensees satisfy educational requirements 15
prior to being licensed to provide Massage Therapy Services to the 16
public in that State; 17
5. Implement procedures for requiring the Background 18
Check of applicants for a Multistate License, and for the reporting 19
of any Disqualifying Events, including but not limited to obtaining 20
and submitting, for each Licensee holding a Multistate License 21
and each applicant for a Multistate License, fingerprint or other 22
biometric-based information to the Federal Bureau of 23
Investigation for Background Checks; receiving the results of the 24
Federal Bureau of Investigation record search on Background 25
Checks and considering the results of such a Background Check 26
in making licensure decisions; 27
6. Have Continuing Competence requirements as a condition 28
for license renewal; 29
7. Participate in the Data System, including through the use 30
of unique identifying numbers as described herein; 31
8. Notify the Commission and other Member States, in 32
compliance with the terms of the Compact and Rules of the 33
Commission, of any disciplinary action taken by the State against 34
a Licensee practicing under a Multistate License in that State, or 35
of the existence of Investigative Information or Current 36
Significant Investigative Information regarding a Licensee 37
practicing in that State pursuant to a Multistate License; 38
9. Comply with the Rules of the Commission; 39
10. Accept Licensees with valid Multistate Licenses from 40
other Member States as established herein; 41
B. Individuals not residing in a Member State shall continue 42
to be able to apply for a Member State’s Single-State License as 43
provided under the laws of each Member State. However, the 44
Single-State License granted to those individuals shall not be 45
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recognized as granting a Multistate License for Massage Therapy 1
in any other Member State; 2
C. Nothing in this Compact shall affect the requirements 3
established by a Member State for the issuance of a Single-State 4
License; and 5
D. A Multistate License issued to a Licensee shall be 6
recognized by each Remote State as an Authorization to Practice 7
Massage Therapy in each Remote State. 8
9
ARTICLE 4-MULTISTATE LICENSE REQUIREMENTS 10
11
A. To qualify for a Multistate License under this Compact, 12
and to maintain eligibility for such a license, an applicant must: 13
1. Hold an active Single-State License to practice Massage 14
Therapy in the applicant’s Home State; 15
2. Have completed at least six hundred and twenty-five (625) 16
clock hours of Massage Therapy education or the substantial 17
equivalent which the Commission may approve by Rule. 18
3. Have passed a National Licensing Examination or the 19
substantial equivalent which the Commission may approve by 20
Rule; 21
4. Submit to a Background Check; 22
5. Have not been convicted or found guilty, or have entered 23
into an agreed disposition, of a felony offense under applicable 24
State or federal criminal law, within five (5) years prior to the date 25
of their application, where such a time period shall not include 26
any time served for the offense, and provided that the applicant 27
has completed any and all requirements arising as a result of any 28
such offense; 29
6. Have not been convicted or found guilty, or have entered 30
into an agreed disposition, of a misdemeanor offense related to the 31
Practice of Massage Therapy under applicable State or federal 32
criminal law, within two (2) years prior to the date of their 33
application where such a time period shall not include any time 34
served for the offense, and provided that the applicant has 35
completed any and all requirements arising as a result of any such 36
offense; 37
7. Have not been convicted or found guilty, or have entered 38
into an agreed disposition, of any offense, whether a misdemeanor 39
or a felony, under State or federal law, at any time, relating to any 40
of the following: 41
a. Kidnapping; 42
b. Human trafficking; 43
c. Human smuggling; 44
d. Sexual battery, sexual assault, or any related offenses; or 45
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e. Any other category of offense which the Commission 1
may by Rule designate. 2
8. Have not previously held a Massage Therapy license which 3
was revoked by, or surrendered in lieu of discipline to an 4
applicable Licensing Authority; 5
9. Have no history of any Adverse Action on any 6
occupational or professional license within two (2) years prior to 7
the date of their application; and 8
10. Pay all required fees. 9
B. A Multistate License granted pursuant to this Compact 10
may be effective for a definite period of time concurrent with the 11
renewal of the Home State license. 12
C. A Licensee practicing in a Member State is subject to all 13
scope of practice laws governing Massage Therapy Services in 14
that State. 15
D. The Practice of Massage Therapy under a Multistate 16
License granted pursuant to this Compact will subject the 17
Licensee to the jurisdiction of the Licensing Authority, the courts, 18
and the laws of the Member State in which the Massage Therapy 19
Services are provided. 20
21
ARTICLE 5-AUTHORITY OF INTERSTATE 22
MASSAGE COMPACT COMMISSION AND 23
MEMBER STATE LICENSING AUTHORITIES 24
25
A. Nothing in this Compact, nor any Rule of the Commission, 26
shall be construed to limit, restrict, or in any way reduce the ability 27
of a Member State to enact and enforce laws, regulations, or other 28
rules related to the Practice of Massage Therapy in that State, 29
where those laws, regulations, or other rules are not inconsistent 30
with the provisions of this Compact. 31
B. Nothing in this Compact, nor any Rule of the Commission, 32
shall be construed to limit, restrict, or in any way reduce the ability 33
of a Member State to take Adverse Action against a Licensee’s 34
Single-State License to practice Massage Therapy in that State. 35
C. Nothing in this Compact, nor any Rule of the Commission, 36
shall be construed to limit, restrict, or in any way reduce the ability 37
of a Remote State to take Adverse Action against a Licensee’s 38
Authorization to Practice in that State. 39
D. Nothing in this Compact, nor any Rule of the 40
Commission, shall be construed to limit, restrict, or in any way 41
reduce the ability of a Licensee’s Home State to take Adverse 42
Action against a Licensee’s Multistate License based upon 43
information provided by a Remote State. 44
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E. Insofar as practical, a Member State’s Licensing Authority 1
shall cooperate with the Commission and with each entity 2
exercising independent regulatory authority over the Practice of 3
Massage Therapy according to the provisions of this Compact. 4
5
ARTICLE 6-ADVERSE ACTIONS 6
7
A. A Licensee’s Home State shall have exclusive power to 8
impose an Adverse Action against a Licensee’s Multistate License 9
issued by the Home State. 10
B. A Home State may take Adverse Action on a Multistate 11
License based on the Investigative Information, Current 12
Significant Investigative Information, or Adverse Action of a 13
Remote State. 14
C. A Home State shall retain authority to complete any 15
pending investigations of a Licensee practicing under a Multistate 16
License who changes their Home State during the course of such 17
an investigation. The Licensing Authority shall also be empowered 18
to report the results of such an investigation to the Commission 19
through the Data System as described herein. 20
D. Any Member State may investigate actual or alleged 21
violations of the scope of practice laws in any other Member State 22
for a massage therapist who holds a Multistate License. 23
E. A Remote State shall have the authority to: 24
1. Take Adverse Actions against a Licensee’s Authorization 25
to Practice. 26
2. Issue cease and desist orders or impose an Encumbrance 27
on a Licensee’s Authorization to Practice in that State. 28
3. Issue subpoenas for both hearings and investigations that 29
require the attendance and testimony of witnesses, as well as the 30
production of evidence. Subpoenas issued by a Licensing 31
Authority in a Member State for the attendance and testimony of 32
witnesses or the production of evidence from another Member 33
State shall be enforced in the latter State by any court of 34
competent jurisdiction, according to the practice and procedure of 35
that court applicable to subpoenas issued in proceedings before it. 36
The issuing Licensing Authority shall pay any witness fees, travel 37
expenses, mileage, and other fees required by the service statutes 38
of the State in which the witnesses or evidence are located. 39
4. If otherwise permitted by State law, recover from the 40
affected Licensee the costs of investigations and disposition of 41
cases resulting from any Adverse Action taken against that 42
Licensee. 43
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5. Take Adverse Action against the Licensee’s Authorization 1
to Practice in that State based on the factual findings of another 2
Member State. 3
F. If an Adverse Action is taken by the Home State against a 4
Licensee’s Multistate License or Single-State License to practice 5
in the Home State, the Licensee’s Authorization to Practice in all 6
other Member States shall be deactivated until all Encumbrances 7
have been removed from such license. All Home State disciplinary 8
orders that impose an Adverse Action against a Licensee shall 9
include a statement that the Massage Therapist’s Authorization to 10
Practice is deactivated in all Member States during the pendency 11
of the order. 12
G. If Adverse Action is taken by a Remote State against a 13
Licensee’s Authorization to Practice, that Adverse Action applies 14
to all Authorizations to Practice in all Remote States. A Licensee 15
whose Authorization to Practice in a Remote State is removed for 16
a specified period of time is not eligible to apply for a new 17
Multistate License in any other State until the specific time for 18
removal of the Authorization to Practice has passed and all 19
encumbrance requirements are satisfied. 20
H. Nothing in this Compact shall override a Member State’s 21
authority to accept a Licensee’s participation in an Alternative 22
Program in lieu of Adverse Action. A Licensee’s Multistate 23
License shall be suspended for the duration of the Licensee’s 24
participation in any Alternative Program. 25
I. Joint Investigations 26
1. In addition to the authority granted to a Member State by 27
its respective scope of practice laws or other applicable State law, a 28
Member State may participate with other Member States in joint 29
investigations of Licensees. 30
2. Member States shall share any investigative, litigation, or 31
compliance materials in furtherance of any joint or individual 32
investigation initiated under the Compact. 33
34
ARTICLE 7-ACTIVE MILITARY MEMBERS AND THEIR 35
SPOUSES 36
37
Active Military Members, or their spouses, shall designate a 38
Home State where the individual has a current license to practice 39
Massage Therapy in good standing. The individual may retain 40
their Home State designation during any period of service when 41
that individual or their spouse is on active duty assignment. 42
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ARTICLE 8-ESTABLISHMENT AND OPERATION OF 1
INTERSTATE MASSAGE COMPACT COMMISSION 2
3
A. The Compact Member States hereby create and establish a 4
joint government agency whose membership consists of all 5
Member States that have enacted the Compact known as the 6
Interstate Massage Compact Commission. The Commission is an 7
instrumentality of the Compact States acting jointly and not an 8
instrumentality of any one State. The Commission shall come into 9
existence on or after the effective date of the Compact as set forth 10
in Article 12. 11
B. Membership, Voting, and Meetings 12
1. Each Member State shall have and be limited to one (1) 13
delegate selected by that Member State’s State Licensing 14
Authority. 15
2. The delegate shall be the primary administrative officer of 16
the State Licensing Authority or their designee. 17
3. The Commission shall by Rule or bylaw establish a term of 18
office for delegates and may by Rule or bylaw establish term 19
limits. 20
4. The Commission may recommend removal or suspension 21
of any delegate from office. 22
5. A Member State’s State Licensing Authority shall fill any 23
vacancy of its delegate occurring on the Commission within 60 24
days of the vacancy. 25
6. Each delegate shall be entitled to one vote on all matters 26
that are voted on by the Commission. 27
7. The Commission shall meet at least once during each 28
calendar year. Additional meetings may be held as set forth in the 29
bylaws. The Commission may meet by telecommunication, video 30
conference or other similar electronic means. 31
C. The Commission shall have the following powers: 32
1. Establish the fiscal year of the Commission; 33
2. Establish code of conduct and conflict of interest policies; 34
3. Adopt Rules and bylaws; 35
4. Maintain its financial records in accordance with the 36
bylaws; 37
5. Meet and take such actions as are consistent with the 38
provisions of this Compact, the Commission’s Rules, and the 39
bylaws; 40
6. Initiate and conclude legal proceedings or actions in the 41
name of the Commission, provided that the standing of any State 42
Licensing Authority to sue or be sued under applicable law shall 43
not be affected; 44
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7. Maintain and certify records and information provided to a 1
Member State as the authenticated business records of the 2
Commission, and designate an agent to do so on the Commission’s 3
behalf; 4
8. Purchase and maintain insurance and bonds; 5
9. Borrow, accept, or contract for services of personnel, 6
including, but not limited to, employees of a Member State; 7
10. Conduct an annual financial review; 8
11. Hire employees, elect or appoint officers, fix 9
compensation, define duties, grant such individuals appropriate 10
authority to carry out the purposes of the Compact, and establish 11
the Commission’s personnel policies and programs relating to 12
conflicts of interest, qualifications of personnel, and other related 13
personnel matters; 14
12. Assess and collect fees; 15
13. Accept any and all appropriate gifts, donations, grants of 16
money, other sources of revenue, equipment, supplies, materials, 17
and services, and receive, utilize, and dispose of the same; 18
provided that at all times the Commission shall avoid any 19
appearance of impropriety or conflict of interest; 20
14. Lease, purchase, retain, own, hold, improve, or use any 21
property, real, personal, or mixed, or any undivided interest 22
therein; 23
15. Sell, convey, mortgage, pledge, lease, exchange, abandon, 24
or otherwise dispose of any property real, personal, or mixed; 25
16. Establish a budget and make expenditures; 26
17. Borrow money; 27
18. Appoint committees, including standing committees, 28
composed of members, State regulators, State legislators or their 29
representatives, and consumer representatives, and such other 30
interested persons as may be designated in this Compact and the 31
bylaws; 32
19. Accept and transmit complaints from the public, 33
regulatory or law enforcement agencies, or the Commission, to the 34
relevant Member State(s) regarding potential misconduct of 35
Licensees; 36
20. Elect a Chair, Vice Chair, Secretary and Treasurer and 37
such other officers of the Commission as provided in the 38
Commission’s bylaws; 39
21. Establish and elect an Executive Committee, including a 40
chair and a vice chair; 41
22. Adopt and provide to the Member States an annual 42
report; 43
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23. Determine whether a State’s adopted language is 1
materially different from the model Compact language such that 2
the State would not qualify for participation in the Compact; and 3
24. Perform such other functions as may be necessary or 4
appropriate to achieve the purposes of this Compact. 5
D. The Executive Committee 6
1. The Executive Committee shall have the power to act on 7
behalf of the Commission according to the terms of this Compact. 8
The powers, duties, and responsibilities of the Executive 9
Committee shall include: 10
a. Overseeing the day-to-day activities of the administration 11
of the Compact including compliance with the provisions of the 12
Compact, the Commission’s Rules and bylaws, and other such 13
duties as deemed necessary; 14
b. Recommending to the Commission changes to the Rules 15
or bylaws, changes to this Compact legislation, fees charged to 16
Compact Member States, fees charged to Licensees, and other 17
fees; 18
c. Ensuring Compact administration services are 19
appropriately provided, including by contract; 20
d. Preparing and recommending the budget; 21
e. Maintaining financial records on behalf of the 22
Commission; 23
f. Monitoring Compact compliance of Member States and 24
providing compliance reports to the Commission; 25
g. Establishing additional committees as necessary; 26
h. Exercise the powers and duties of the Commission 27
during the interim between Commission meetings, except for 28
adopting or amending Rules, adopting or amending bylaws, and 29
exercising any other powers and duties expressly reserved to the 30
Commission by Rule or bylaw; and 31
i. Other duties as provided in the Rules or bylaws of the 32
Commission. 33
2. The Executive Committee shall be composed of seven 34
voting members and up to two ex-officio members as follows: 35
a. The chair and vice chair of the Commission and any 36
other members of the Commission who serve on the Executive 37
Committee shall be voting members of the Executive Committee. 38
b. Other than the chair, vice-chair, secretary and treasurer, 39
the Commission shall elect three voting members from the current 40
membership of the Commission. 41
c. The Commission may elect ex-officio, nonvoting 42
members as necessary as follows: 43
i. One ex-officio member who is a representative of the 44
national association of State Massage Therapy regulatory boards. 45
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ii. One ex-officio member as specified in the 1
Commission’s bylaws. 2
3. The Commission may remove any member of the Executive 3
Committee as provided in the Commission’s bylaws. 4
4. The Executive Committee shall meet at least annually. 5
a. Executive Committee meetings shall be open to the 6
public, except that the Executive Committee may meet in a closed, 7
non-public session of a public meeting when dealing with any of 8
the matters covered under subsection F.4. 9
b. The Executive Committee shall give five business days 10
advance notice of its public meetings, posted on its website and as 11
determined to provide notice to persons with an interest in the 12
public matters the Executive Committee intends to address at those 13
meetings. 14
5. The Executive Committee may hold an emergency meeting 15
when acting for the Commission to: 16
a. Meet an imminent threat to public health, safety, or 17
welfare; 18
b. Prevent a loss of Commission or Participating State 19
funds; or 20
c. Protect public health and safety. 21
E. The Commission shall adopt and provide to the Member 22
States an annual report. 23
F. Meetings of the Commission 24
1. All meetings of the Commission that are not closed 25
pursuant to this subsection shall be open to the public. Notice of 26
public meetings shall be posted on the Commission’s website at 27
least thirty (30) days prior to the public meeting. 28
2. Notwithstanding subsection F.1 of this Article, the 29
Commission may convene an emergency public meeting by 30
providing at least twenty-four (24) hours prior notice on the 31
Commission’s website, and any other means as provided in the 32
Commission’s Rules, for any of the reasons it may dispense with 33
notice of proposed rulemaking under Article 10.L. The 34
Commission’s legal counsel shall certify that one of the reasons 35
justifying an emergency public meeting has been met. 36
3. Notice of all Commission meetings shall provide the time, 37
date, and location of the meeting, and if the meeting is to be held 38
or accessible via telecommunication, video conference, or other 39
electronic means, the notice shall include the mechanism for 40
access to the meeting. 41
4. The Commission may convene in a closed, non-public 42
meeting for the Commission to discuss: 43
a. Non-compliance of a Member State with its obligations 44
under the Compact; 45
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b. The employment, compensation, discipline or other 1
matters, practices or procedures related to specific employees or 2
other matters related to the Commission’s internal personnel 3
practices and procedures; 4
c. Current or threatened discipline of a Licensee by the 5
Commission or by a Member State’s Licensing Authority; 6
d. Current, threatened, or reasonably anticipated litigation; 7
e. Negotiation of contracts for the purchase, lease, or sale 8
of goods, services, or real estate; 9
f. Accusing any person of a crime or formally censuring 10
any person; 11
g. Trade secrets or commercial or financial information 12
that is privileged or confidential; 13
h. Information of a personal nature where disclosure would 14
constitute a clearly unwarranted invasion of personal privacy; 15
i. Investigative records compiled for law enforcement 16
purposes; 17
j. Information related to any investigative reports prepared 18
by or on behalf of or for use of the Commission or other 19
committee charged with responsibility of investigation or 20
determination of compliance issues pursuant to the Compact; 21
k. Legal advice; 22
l. Matters specifically exempted from disclosure to the 23
public by federal or Member State law; or 24
m. Other matters as promulgated by the Commission by 25
Rule. 26
5. If a meeting, or portion of a meeting, is closed, the 27
presiding officer shall state that the meeting will be closed and 28
reference each relevant exempting provision, and such reference 29
shall be recorded in the minutes. 30
6. The Commission shall keep minutes that fully and clearly 31
describe all matters discussed in a meeting and shall provide a full 32
and accurate summary of actions taken, and the reasons 33
therefore, including a description of the views expressed. All 34
documents considered in connection with an action shall be 35
identified in such minutes. All minutes and documents of a closed 36
meeting shall remain under seal, subject to release only by a 37
majority vote of the Commission or order of a court of competent 38
jurisdiction. 39
G. Financing of the Commission 40
1. The Commission shall pay, or provide for the payment of, 41
the reasonable expenses of its establishment, organization, and 42
ongoing activities. 43
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2. The Commission may accept any and all appropriate 1
sources of revenue, donations, and grants of money, equipment, 2
supplies, materials, and services. 3
3. The Commission may levy on and collect an annual 4
assessment from each Member State and impose fees on Licensees 5
of Member States to whom it grants a Multistate License to cover 6
the cost of the operations and activities of the Commission and its 7
staff, which must be in a total amount sufficient to cover its 8
annual budget as approved each year for which revenue is not 9
provided by other sources. The aggregate annual assessment 10
amount for Member States shall be allocated based upon a 11
formula that the Commission shall promulgate by Rule. 12
4. The Commission shall not incur obligations of any kind 13
prior to securing the funds adequate to meet the same; nor shall 14
the Commission pledge the credit of any Member States, except by 15
and with the authority of the Member State. 16
5. The Commission shall keep accurate accounts of all 17
receipts and disbursements. The receipts and disbursements of the 18
Commission shall be subject to the financial review and 19
accounting procedures established under its bylaws. All receipts 20
and disbursements of funds handled by the Commission shall be 21
subject to an annual financial review by a certified or licensed 22
public accountant, and the report of the financial review shall be 23
included in and become part of the annual report of the 24
Commission. 25
H. Qualified Immunity, Defense, and Indemnification 26
1. The members, officers, executive director, employees and 27
representatives of the Commission shall be immune from suit and 28
liability, both personally and in their official capacity, for any 29
claim for damage to or loss of property or personal injury or other 30
civil liability caused by or arising out of any actual or alleged act, 31
error, or omission that occurred, or that the person against whom 32
the claim is made had a reasonable basis for believing occurred 33
within the scope of Commission employment, duties or 34
responsibilities; provided that nothing in this paragraph shall be 35
construed to protect any such person from suit or liability for any 36
damage, loss, injury, or liability caused by the intentional or 37
willful or wanton misconduct of that person. The procurement of 38
insurance of any type by the Commission shall not in any way 39
compromise or limit the immunity granted hereunder. 40
2. The Commission shall defend any member, officer, 41
executive director, employee, and representative of the 42
Commission in any civil action seeking to impose liability arising 43
out of any actual or alleged act, error, or omission that occurred 44
within the scope of Commission employment, duties, or 45
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responsibilities, or as determined by the Commission that the 1
person against whom the claim is made had a reasonable basis for 2
believing occurred within the scope of Commission employment, 3
duties, or responsibilities; provided that nothing herein shall be 4
construed to prohibit that person from retaining their own counsel 5
at their own expense; and provided further, that the actual or 6
alleged act, error, or omission did not result from that person’s 7
intentional or willful or wanton misconduct. 8
3. The Commission shall indemnify and hold harmless any 9
member, officer, executive director, employee, and representative 10
of the Commission for the amount of any settlement or judgment 11
obtained against that person arising out of any actual or alleged 12
act, error, or omission that occurred within the scope of 13
Commission employment, duties, or responsibilities, or that such 14
person had a reasonable basis for believing occurred within the 15
scope of Commission employment, duties, or responsibilities, 16
provided that the actual or alleged act, error, or omission did not 17
result from the intentional or willful or wanton misconduct of that 18
person. 19
4. Nothing herein shall be construed as a limitation on the 20
liability of any Licensee for professional malpractice or 21
misconduct, which shall be governed solely by any other 22
applicable State laws. 23
5. Nothing in this Compact shall be interpreted to waive or 24
otherwise abrogate a Member State’s State action immunity or 25
State action affirmative defense with respect to antitrust claims 26
under the Sherman Act, Clayton Act, or any other State or federal 27
antitrust or anticompetitive law or regulation. 28
6. Nothing in this Compact shall be construed to be a waiver 29
of sovereign immunity by the Member States or by the 30
Commission. 31
32
ARTICLE 9-DATA SYSTEM 33
34
A. The Commission shall provide for the development, 35
maintenance, operation, and utilization of a coordinated database 36
and reporting system. 37
B. The Commission shall assign each applicant for a 38
Multistate License a unique identifier, as determined by the Rules 39
of the Commission. 40
C. Notwithstanding any other provision of State law to the 41
contrary, a Member State shall submit a uniform data set to the 42
Data System on all individuals to whom this Compact is applicable 43
as required by the Rules of the Commission, including: 44
1. Identifying information; 45
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2. Licensure data; 1
3. Adverse Actions against a license and information related 2
thereto; 3
4. Non-confidential information related to Alternative 4
Program participation, the beginning and ending dates of such 5
participation, and other information related to such participation; 6
5. Any denial of application for licensure, and the reason(s) 7
for such denial (excluding the reporting of any criminal history 8
record information where prohibited by law); 9
6. The existence of Investigative Information; 10
7. The existence presence of Current Significant Investigative 11
Information; and 12
8. Other information that may facilitate the administration of 13
this Compact or the protection of the public, as determined by the 14
Rules of the Commission. 15
D. The records and information provided to a Member State 16
pursuant to this Compact or through the Data System, when 17
certified by the Commission or an agent thereof, shall constitute 18
the authenticated business records of the Commission, and shall 19
be entitled to any associated hearsay exception in any relevant 20
judicial, quasi-judicial or administrative proceedings in a Member 21
State. 22
E. The existence of Current Significant Investigative 23
Information and the existence of Investigative Information 24
pertaining to a Licensee in any Member State will only be 25
available to other Member States. 26
F. It is the responsibility of the Member States to report any 27
Adverse Action against a Licensee who holds a Multistate License 28
and to monitor the database to determine whether Adverse Action 29
has been taken against such a Licensee or License applicant. 30
Adverse Action information pertaining to a Licensee or License 31
applicant in any Member State will be available to any other 32
Member State. 33
G. Member States contributing information to the Data 34
System may designate information that may not be shared with the 35
public without the express permission of the contributing State. 36
H. Any information submitted to the Data System that is 37
subsequently expunged pursuant to federal law or the laws of the 38
Member State contributing the information shall be removed from 39
the Data System. 40
41
ARTICLE 10-RULEMAKING 42
43
A. The Commission shall promulgate reasonable Rules in 44
order to effectively and efficiently implement and administer the 45
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purposes and provisions of the Compact. A Rule shall be invalid 1
and have no force or effect only if a court of competent 2
jurisdiction holds that the Rule is invalid because the Commission 3
exercised its rulemaking authority in a manner that is beyond the 4
scope and purposes of the Compact, or the powers granted 5
hereunder, or based upon another applicable standard of review. 6
B. The Rules of the Commission shall have the force of law 7
in each Member State, provided however that where the Rules of 8
the Commission conflict with the laws of the Member State that 9
establish the Member State’s scope of practice as held by a court 10
of competent jurisdiction, the Rules of the Commission shall be 11
ineffective in that State to the extent of the conflict. 12
C. The Commission shall exercise its Rulemaking powers 13
pursuant to the criteria set forth in this article and the Rules 14
adopted thereunder. Rules shall become binding as of the date 15
specified by the Commission for each Rule. 16
D. If a majority of the legislatures of the Member States 17
rejects a Rule or portion of a Rule, by enactment of a statute or 18
resolution in the same manner used to adopt the Compact within 19
four (4) years of the date of adoption of the Rule, then such Rule 20
shall have no further force and effect in any Member State or to 21
any State applying to participate in the Compact. 22
E. Rules shall be adopted at a regular or special meeting of 23
the Commission. 24
F. Prior to adoption of a proposed Rule, the Commission 25
shall hold a public hearing and allow persons to provide oral and 26
written comments, data, facts, opinions, and arguments. 27
G. Prior to adoption of a proposed Rule by the Commission, 28
and at least thirty (30) days in advance of the meeting at which the 29
Commission will hold a public hearing on the proposed Rule, the 30
Commission shall provide a Notice of Proposed Rulemaking: 31
1. On the website of the Commission or other publicly 32
accessible platform; 33
2. To persons who have requested notice of the Commission’s 34
notices of proposed rulemaking, and 35
3. In such other way(s) as the Commission may by Rule 36
specify. 37
H. The Notice of Proposed Rulemaking shall include: 38
1. The time, date, and location of the public hearing at which 39
the Commission will hear public comments on the proposed Rule 40
and, if different, the time, date, and location of the meeting where 41
the Commission will consider and vote on the proposed Rule; 42
2. If the hearing is held via telecommunication, video 43
conference, or other electronic means, the Commission shall 44
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include the mechanism for access to the hearing in the Notice of 1
Proposed Rulemaking; 2
3. The text of the proposed Rule and the reason therefor; 3
4. A request for comments on the proposed Rule from any 4
interested person; and 5
5. The manner in which interested persons may submit 6
written comments. 7
I. All hearings will be recorded. A copy of the recording and 8
all written comments and documents received by the Commission 9
in response to the proposed Rule shall be available to the public. 10
J. Nothing in this article shall be construed as requiring a 11
separate hearing on each Rule. Rules may be grouped for the 12
convenience of the Commission at hearings required by this 13
article. 14
K. The Commission shall, by majority vote of all 15
Commissioners, take final action on the proposed Rule based on 16
the Rulemaking record. 17
1. The Commission may adopt changes to the proposed Rule 18
provided the changes do not enlarge the original purpose of the 19
proposed Rule. 20
2. The Commission shall provide an explanation of the 21
reasons for substantive changes made to the proposed Rule as well 22
as reasons for substantive changes not made that were 23
recommended by commenters. 24
3. The Commission shall determine a reasonable effective 25
date for the Rule. Except for an emergency as provided in 26
subsection L, the effective date of the Rule shall be no sooner than 27
thirty (30) days after the Commission issuing the notice that it 28
adopted or amended the Rule. 29
L. Upon determination that an emergency exists, the 30
Commission may consider and adopt an emergency Rule with 24 31
hours’ notice, provided that the usual Rulemaking procedures 32
provided in the Compact and in this article shall be retroactively 33
applied to the Rule as soon as reasonably possible, in no event 34
later than ninety (90) days after the effective date of the Rule. For 35
the purposes of this provision, an emergency Rule is one that must 36
be adopted immediately to: 37
1. Meet an imminent threat to public health, safety, or 38
welfare; 39
2. Prevent a loss of Commission or Member State funds; 40
3. Meet a deadline for the promulgation of a Rule that is 41
established by federal law or rule; or 42
4. Protect public health and safety. 43
M. The Commission or an authorized committee of the 44
Commission may direct revisions to a previously adopted Rule for 45
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purposes of correcting typographical errors, errors in format, 1
errors in consistency, or grammatical errors. Public notice of any 2
revisions shall be posted on the website of the Commission. The 3
revision shall be subject to challenge by any person for a period of 4
thirty (30) days after posting. The revision may be challenged only 5
on grounds that the revision results in a material change to a 6
Rule. A challenge shall be made in writing and delivered to the 7
Commission prior to the end of the notice period. If no challenge 8
is made, the revision will take effect without further action. If the 9
revision is challenged, the revision may not take effect without the 10
approval of the Commission. 11
N. No Member State’s rulemaking requirements shall apply 12
under this Compact. 13
14
ARTICLE 11-OVERSIGHT, DISPUTE 15
RESOLUTION, AND ENFORCEMENT 16
17
A. Oversight 18
1. The executive and judicial branches of State government 19
in each Member State shall enforce this Compact and take all 20
actions necessary and appropriate to implement the Compact. 21
2. Venue is proper and judicial proceedings by or against the 22
Commission shall be brought solely and exclusively in a court of 23
competent jurisdiction where the principal office of the 24
Commission is located. The Commission may waive venue and 25
jurisdictional defenses to the extent it adopts or consents to 26
participate in alternative dispute resolution proceedings. Nothing 27
herein shall affect or limit the selection or propriety of venue in 28
any action against a Licensee for professional malpractice, 29
misconduct or any such similar matter. 30
3. The Commission shall be entitled to receive service of 31
process in any proceeding regarding the enforcement or 32
interpretation of the Compact and shall have standing to intervene 33
in such a proceeding for all purposes. Failure to provide the 34
Commission service of process shall render a judgment or order 35
void as to the Commission, this Compact, or promulgated Rules. 36
B. Default, Technical Assistance, and Termination 37
1. If the Commission determines that a Member State has 38
defaulted in the performance of its obligations or responsibilities 39
under this Compact or the promulgated Rules, the Commission 40
shall provide written notice to the defaulting State. The notice of 41
default shall describe the default, the proposed means of curing 42
the default, and any other action that the Commission may take, 43
and shall offer training and specific technical assistance 44
regarding the default. 45
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2. The Commission shall provide a copy of the notice of 1
default to the other Member States. 2
C. If a State in default fails to cure the default, the defaulting 3
State may be terminated from the Compact upon an affirmative 4
vote of a majority of the delegates of the Member States, and all 5
rights, privileges and benefits conferred on that State by this 6
Compact may be terminated on the effective date of termination. A 7
cure of the default does not relieve the offending State of 8
obligations or liabilities incurred during the period of default. 9
D. Termination of membership in the Compact shall be 10
imposed only after all other means of securing compliance have 11
been exhausted. Notice of intent to suspend or terminate shall be 12
given by the Commission to the governor, the majority and 13
minority leaders of the defaulting State’s legislature, the 14
defaulting State’s State Licensing Authority and each of the 15
Member States’ State Licensing Authority. 16
E. A State that has been terminated is responsible for all 17
assessments, obligations, and liabilities incurred through the 18
effective date of termination, including obligations that extend 19
beyond the effective date of termination. 20
F. Upon the termination of a State’s membership from this 21
Compact, that State shall immediately provide notice to all 22
Licensees who hold a Multistate License within that State of such 23
termination. The terminated State shall continue to recognize all 24
licenses granted pursuant to this Compact for a minimum of one 25
hundred eighty (180) days after the date of said notice of 26
termination. 27
G. The Commission shall not bear any costs related to a State 28
that is found to be in default or that has been terminated from the 29
Compact, unless agreed upon in writing between the Commission 30
and the defaulting State. 31
H. The defaulting State may appeal the action of the 32
Commission by petitioning the U.S. District Court for the District 33
of Columbia or the federal district where the Commission has its 34
principal offices. The prevailing party shall be awarded all costs of 35
such litigation, including reasonable attorney’s fees. 36
I. Dispute Resolution 37
1. Upon request by a Member State, the Commission shall 38
attempt to resolve disputes related to the Compact that arise 39
among Member States and between Member and non-Member 40
States. 41
2. The Commission shall promulgate a Rule providing for 42
both mediation and binding dispute resolution for disputes as 43
appropriate. 44
J. Enforcement 45
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1. The Commission, in the reasonable exercise of its 1
discretion, shall enforce the provisions of this Compact and the 2
Commission’s Rules. 3
2. By majority vote as provided by Commission Rule, the 4
Commission may initiate legal action against a Member State in 5
default in the United States District Court for the District of 6
Columbia or the federal district where the Commission has its 7
principal offices to enforce compliance with the provisions of the 8
Compact and its promulgated Rules. The relief sought may 9
include both injunctive relief and damages. In the event judicial 10
enforcement is necessary, the prevailing party shall be awarded all 11
costs of such litigation, including reasonable attorney’s fees. The 12
remedies herein shall not be the exclusive remedies of the 13
Commission. The Commission may pursue any other remedies 14
available under federal or the defaulting Member State’s law. 15
3. A Member State may initiate legal action against the 16
Commission in the U.S. District Court for the District of Columbia 17
or the federal district where the Commission has its principal 18
offices to enforce compliance with the provisions of the Compact 19
and its promulgated Rules. The relief sought may include both 20
injunctive relief and damages. In the event judicial enforcement is 21
necessary, the prevailing party shall be awarded all costs of such 22
litigation, including reasonable attorney’s fees. 23
4. No individual or entity other than a Member State may 24
enforce this Compact against the Commission. 25
26
ARTICLE 12-EFFECTIVE DATE, WITHDRAWAL, 27
AND AMENDMENT 28
29
A. The Compact shall come into effect on the date on which 30
the Compact statute is enacted into law in the seventh Member 31
State. 32
1. On or after the effective date of the Compact, the 33
Commission shall convene and review the enactment of each of 34
the Charter Member States to determine if the statute enacted by 35
each such Charter Member State is materially different than the 36
model Compact statute. 37
a. A Charter Member State whose enactment is found to be 38
materially different from the model Compact statute shall be 39
entitled to the default process set forth in Article 11. 40
b. If any Member State is later found to be in default, or is 41
terminated or withdraws from the Compact, the Commission shall 42
remain in existence and the Compact shall remain in effect even if 43
the number of Member States should be less than seven (7). 44
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2. Member States enacting the Compact subsequent to the 1
Charter Member States shall be subject to the process set forth in 2
Article 8.C.23 to determine if their enactments are materially 3
different from the model Compact statute and whether they qualify 4
for participation in the Compact. 5
3. All actions taken for the benefit of the Commission or in 6
furtherance of the purposes of the administration of the Compact 7
prior to the effective date of the Compact or the Commission 8
coming into existence shall be considered to be actions of the 9
Commission unless specifically repudiated by the Commission. 10
4. Any State that joins the Compact shall be subject to the 11
Commission’s Rules and bylaws as they exist on the date on which 12
the Compact becomes law in that State. Any Rule that has been 13
previously adopted by the Commission shall have the full force 14
and effect of law on the day the Compact becomes law in that 15
State. 16
B. Any Member State may withdraw from this Compact by 17
enacting a statute repealing that State’s enactment of the 18
Compact. 19
1. A Member State’s withdrawal shall not take effect until 20
one hundred eighty (180) days after enactment of the repealing 21
statute. 22
2. Withdrawal shall not affect the continuing requirement of 23
the withdrawing State’s Licensing Authority to comply with the 24
investigative and Adverse Action reporting requirements of this 25
Compact prior to the effective date of withdrawal. 26
3. Upon the enactment of a statute withdrawing from this 27
Compact, a State shall immediately provide notice of such 28
withdrawal to all Licensees within that State. Notwithstanding any 29
subsequent statutory enactment to the contrary, such withdrawing 30
State shall continue to recognize all licenses granted pursuant to 31
this Compact for a minimum of 180 days after the date of such 32
notice of withdrawal. 33
C. Nothing contained in this Compact shall be construed to 34
invalidate or prevent any licensure agreement or other cooperative 35
arrangement between a Member State and a non-Member State 36
that does not conflict with the provisions of this Compact. 37
D. This Compact may be amended by the Member States. No 38
amendment to this Compact shall become effective and binding 39
upon any Member State until it is enacted into the laws of all 40
Member States. 41
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ARTICLE 13. CONSTRUCTION AND SEVERAB ILITY 1
2
A. This Compact and the Commission’s rulemaking authority 3
shall be liberally construed so as to effectuate the purposes, and 4
the implementation and administration of the Compact. Provisions 5
of the Compact expressly authorizing or requiring the 6
promulgation of Rules shall not be construed to limit the 7
Commission’s rulemaking authority solely for those purposes. 8
B. The provisions of this Compact shall be severable and if 9
any phrase, clause, sentence or provision of this Compact is held 10
by a court of competent jurisdiction to be contrary to the 11
constitution of any Member State, a State seeking participation in 12
the Compact, or of the United States, or the applicability thereof to 13
any government, agency, person or circumstance is held to be 14
unconstitutional by a court of competent jurisdiction, the validity 15
of the remainder of this Compact and the applicability thereof to 16
any other government, agency, person or circumstance shall not 17
be affected thereby. 18
C. Notwithstanding subsection B of this article, the 19
Commission may deny a State’s participation in the Compact or, 20
in accordance with the requirements of Article 11.B, terminate a 21
Member State’s participation in the Compact, if it determines that 22
a constitutional requirement of a Member State is a material 23
departure from the Compact. Otherwise, if this Compact shall be 24
held to be contrary to the constitution of any Member State, the 25
Compact shall remain in full force and effect as to the remaining 26
Member States and in full force and effect as to the Member State 27
affected as to all severable matters. 28
29
ARTICLE 14. CONSISTENT EFFECT AND 30
CONFLICT WITH OTHER STATE LAWS 31
32
Nothing herein shall prevent or inhibit the enforcement of any 33
other law of a Member State that is not inconsistent with the 34
Compact. 35
Any laws, statutes, regulations, or other legal requirements in a 36
Member State in conflict with the Compact are superseded to the 37
extent of the conflict. 38
All permissible agreements between the Commission and the 39
Member States are binding in accordance with their terms. 40
Sec. 8. NRS 640C.180 is hereby amended to read as follows: 41
640C.180 1. At the first meeting of each fiscal year, the 42
members of the Board shall elect a Chair, Vice Chair and Secretary-43
Treasurer from among the members. 44
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2. The Board shall meet at least quarterly and may meet at 1
other times at the call of the Chair or upon the written request of a 2
majority of the members of the Board. 3
3. The Board shall alternate the location of its meetings 4
between the southern district of Nevada and the northern district of 5
Nevada. For the purposes of this subsection: 6
(a) The southern district of Nevada consists of all that portion of 7
the State lying within the boundaries of the counties of Clark, 8
Esmeralda, Lincoln and Nye. 9
(b) The northern district of Nevada consists of all that portion of 10
the State lying within the boundaries of Carson City and the 11
counties of Churchill, Douglas, Elko, Eureka, Humboldt, Lander, 12
Lyon, Mineral, Pershing, Storey, Washoe and White Pine. 13
4. A meeting of the Board may be conducted telephonically or 14
by videoconferencing. A meeting conducted telephonically or by 15
videoconferencing must meet the requirements of chapter 241 of 16
NRS and any other applicable provisions of law. 17
5. [Four] Five members of the Board constitute a quorum for 18
the purposes of transacting the business of the Board, including, 19
without limitation, issuing, renewing, suspending, revoking or 20
reinstating a license issued pursuant to this chapter. 21
Sec. 9. NRS 683A.178 is hereby amended to read as follows: 22
683A.178 1. A pharmacy benefit manager has an obligation 23
of good faith and fair dealing toward a third party or pharmacy 24
when performing duties pursuant to a contract to which the 25
pharmacy benefit manager is a party. Any provision of a contract 26
that waives or limits that obligation is against public policy, void 27
and unenforceable. 28
2. A pharmacy benefit manager shall notify a third party with 29
which it has entered into a contract in writing of any activity, policy 30
or practice of the pharmacy benefit manager that presents a conflict 31
of interest that interferes with the obligations imposed by 32
subsection 1. 33
3. A pharmacy benefit manager that manages prescription 34
drug benefits for an insurer licensed pursuant to this title shall 35
comply with the provisions of this title which are applicable to the 36
insurer when managing such benefits for the insurer. 37
Sec. 10. Chapter 687B of NRS is hereby amended by adding 38
thereto a new section to read as follows: 39
1. A health carrier which offers or issues a network plan: 40
(a) Must demonstrate the capacity to adequately deliver family 41
planning services provided by pharmacists or pharmacies to 42
covered persons in accordance with the regulations adopted 43
pursuant to subsection 2. 44
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(b) Shall make available to each covered person in this State a 1
notice that meets the requirements prescribed by the regulations 2
adopted pursuant to subsection 2 of each pharmacist or pharmacy 3
that has entered into a provider network contract with the carrier 4
to provide family planning services to covered persons who 5
participate in the relevant network plan. 6
2. The Commissioner shall adopt regulations to carry out the 7
provisions of this section, including, without limitation, 8
regulations prescribing requirements for: 9
(a) A health carrier to demonstrate compliance with paragraph 10
(a) of subsection 1. Those regulations must not allow a health 11
carrier to demonstrate the capacity to adequately deliver family 12
planning services to covered persons by demonstrating that the 13
health carrier has entered into a network contract with one or 14
more pharmacies for the sole purpose of dispensing prescription 15
drugs to covered persons. 16
(b) The form and contents of the notice required by paragraph 17
(b) of subsection 1. 18
Sec. 11. NRS 687B.225 is hereby amended to read as follows: 19
687B.225 1. Except as otherwise provided in NRS 20
689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.044, 21
689A.0445, 689B.031, 689B.0313, 689B.0315, 689B.0317, 22
689B.0374, 689B.0378, 689C.1675, 689C.1676, 695A.1856, 23
695A.1865, 695B.1912, 695B.1913, 695B.1914, 695B.1919, 24
695B.1925, 695B.1942, 695C.1696, 695C.1713, 695C.1735, 25
695C.1737, 695C.1745, 695C.1751, 695G.170, 695G.171, 26
695G.1714 , 695G.1715 and 695G.177, any contract for group, 27
blanket or individual health insurance or any contract by a nonprofit 28
hospital, medical or dental service corporation or organization for 29
dental care which provides for payment of a certain part of medical 30
or dental care may require the insured or member to obtain prior 31
authorization for that care from the insurer or organization. The 32
insurer or organization shall: 33
(a) File its procedure for obtaining approval of care pursuant to 34
this section for approval by the Commissioner; and 35
(b) Respond to any request for approval by the insured or 36
member pursuant to this section within 20 days after it receives the 37
request. 38
2. The procedure for prior authorization may not discriminate 39
among persons licensed to provide the covered care. 40
Sec. 12. NRS 687B.600 is hereby amended to read as follows: 41
687B.600 As used in NRS 687B.600 to 687B.850, inclusive, 42
and section 11 of this act, unless the context otherwise requires, the 43
words and terms defined in NRS 687B.602 to 687B.665, inclusive, 44
have the meanings ascribed to them in those sections. 45
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Sec. 13. NRS 687B.670 is hereby amended to read as follows: 1
687B.670 If a health carrier offers or issues a network plan, the 2
health carrier shall, with regard to that network plan: 3
1. Comply with all applicable requirements set forth in NRS 4
687B.600 to 687B.850, inclusive [;] , and section 11 of this act; 5
2. As applicable, ensure that each contract entered into for the 6
purposes of the network plan between a participating provider of 7
health care and the health carrier complies with the requirements set 8
forth in NRS 687B.600 to 687B.850, inclusive [;] , and section 11 9
of this act; and 10
3. As applicable, ensure that the network plan complies with 11
the requirements set forth in NRS 687B.600 to 687B.850, inclusive 12
[.] , and section 11 of this act. 13
Sec. 14. NRS 689A.0418 is hereby amended to read as 14
follows: 15
689A.0418 1. Except as otherwise provided in subsection [7,] 16
8, an insurer that offers or issues a policy of health insurance shall 17
include in the policy coverage for: 18
(a) Up to a 12-month supply, per prescription, of any type of 19
drug for contraception or its therapeutic equivalent which is: 20
(1) Lawfully prescribed or ordered; 21
(2) Approved by the Food and Drug Administration; 22
(3) Listed in subsection [10;] 11; and 23
(4) Dispensed in accordance with NRS 639.28075; 24
(b) Any type of device for contraception which is: 25
(1) Lawfully prescribed or ordered; 26
(2) Approved by the Food and Drug Administration; and 27
(3) Listed in subsection [10;] 11; 28
(c) Self-administered hormonal contraceptives dispensed by a 29
pharmacist pursuant to NRS 639.28078; 30
(d) Insertion of a device for contraception or removal of such a 31
device if the device was inserted while the insured was covered by 32
the same policy of health insurance; 33
(e) Education and counseling relating to the initiation of the use 34
of contraception and any necessary follow-up after initiating such 35
use; 36
(f) Management of side effects relating to contraception; and 37
(g) Voluntary sterilization for women. 38
2. An insurer shall provide coverage for any services listed in 39
subsection 1 which are within the authorized scope of practice of a 40
pharmacist when such services are provided by a pharmacist who 41
is employed by or serves as an independent contractor of an in-42
network pharmacy and in accordance with the applicable provider 43
network contract. Such coverage must be provided to the same 44
extent as if the services were provided by another provider of 45
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health care, as applicable to the services being provided. The terms 1
of the policy must not limit: 2
(a) Coverage for services listed in subsection 1 and provided by 3
such a pharmacist to a number of occasions less than the coverage 4
for such services when provided by another provider of health 5
care. 6
(b) Reimbursement for services listed in subsection 1 and 7
provided by such a pharmacist to an amount less than the amount 8
reimbursed for similar services provided by a physician, physician 9
assistant or advanced practice registered nurse. 10
3. An insurer must ensure that the benefits required by 11
subsection 1 are made available to an insured through a provider of 12
health care who participates in the network plan of the insurer. 13
[3.] 4. If a covered therapeutic equivalent listed in subsection 1 14
is not available or a provider of health care deems a covered 15
therapeutic equivalent to be medically inappropriate, an alternate 16
therapeutic equivalent prescribed by a provider of health care must 17
be covered by the insurer. 18
[4.] 5. Except as otherwise provided in subsections [8,] 9 , 10 19
and [11,] 12, an insurer that offers or issues a policy of health 20
insurance shall not: 21
(a) Require an insured to pay a higher deductible, any 22
copayment or coinsurance or require a longer waiting period or 23
other condition for coverage to obtain any benefit included in the 24
policy pursuant to subsection 1; 25
(b) Refuse to issue a policy of health insurance or cancel a 26
policy of health insurance solely because the person applying for or 27
covered by the policy uses or may use any such benefit; 28
(c) Offer or pay any type of material inducement or financial 29
incentive to an insured to discourage the insured from obtaining any 30
such benefit; 31
(d) Penalize a provider of health care who provides any such 32
benefit to an insured, including, without limitation, reducing the 33
reimbursement of the provider of health care; 34
(e) Offer or pay any type of material inducement, bonus or other 35
financial incentive to a provider of health care to deny, reduce, 36
withhold, limit or delay access to any such benefit to an insured; or 37
(f) Impose any other restrictions or delays on the access of an 38
insured any such benefit. 39
[5.] 6. Coverage pursuant to this section for the covered 40
dependent of an insured must be the same as for the insured. 41
[6.] 7. Except as otherwise provided in subsection [7,] 8, a 42
policy subject to the provisions of this chapter that is delivered, 43
issued for delivery or renewed on or after January 1, [2022,] 2024, 44
has the legal effect of including the coverage required by 45
– 39 –
- *SB161 _R3 *
[subsection 1,] this section, and any provision of the policy or the 1
renewal which is in conflict with this section is void. 2
[7.] 8. An insurer that offers or issues a policy of health 3
insurance and which is affiliated with a religious organization is not 4
required to provide the coverage required by subsection 1 if the 5
insurer objects on religious grounds. Such an insurer shall, before 6
the issuance of a policy of health insurance and before the renewal 7
of such a policy, provide to the prospective insured written notice of 8
the coverage that the insurer refuses to provide pursuant to this 9
subsection. 10
[8.] 9. An insurer may require an insured to pay a higher 11
deductible, copayment or coinsurance for a drug for contraception if 12
the insured refuses to accept a therapeutic equivalent of the drug. 13
[9.] 10. For each of the 18 methods of contraception listed in 14
subsection [10] 11 that have been approved by the Food and Drug 15
Administration, a policy of health insurance must include at least 16
one drug or device for contraception within each method for which 17
no deductible, copayment or coinsurance may be charged to the 18
insured, but the insurer may charge a deductible, copayment or 19
coinsurance for any other drug or device that provides the same 20
method of contraception. If the insurer charges a copayment or 21
coinsurance for a drug for contraception, the insurer may only 22
require an insured to pay the copayment or coinsurance: 23
(a) Once for the entire amount of the drug dispensed for the 24
plan year; or 25
(b) Once for each 1-month supply of the drug dispensed. 26
[10.] 11. The following 18 methods of contraception must be 27
covered pursuant to this section: 28
(a) Voluntary sterilization for women; 29
(b) Surgical sterilization implants for women; 30
(c) Implantable rods; 31
(d) Copper-based intrauterine devices; 32
(e) Progesterone-based intrauterine devices; 33
(f) Injections; 34
(g) Combined estrogen- and progestin-based drugs; 35
(h) Progestin-based drugs; 36
(i) Extended- or continuous-regimen drugs; 37
(j) Estrogen- and progestin-based patches; 38
(k) Vaginal contraceptive rings; 39
(l) Diaphragms with spermicide; 40
(m) Sponges with spermicide; 41
(n) Cervical caps with spermicide; 42
(o) Female condoms; 43
(p) Spermicide; 44
– 40 –
- *SB161 _R3 *
(q) Combined estrogen- and progestin-based drugs for 1
emergency contraception or progestin-based drugs for emergency 2
contraception; and 3
(r) Ulipristal acetate for emergency contraception. 4
[11.] 12. Except as otherwise provided in this section and 5
federal law, an insurer may use medical management techniques, 6
including, without limitation, any available clinical evidence, to 7
determine the frequency of or treatment relating to any benefit 8
required by this section or the type of provider of health care to use 9
for such treatment. 10
[12.] 13. An insurer shall not [use] : 11
(a) Use medical management techniques to require an insured to 12
use a method of contraception other than the method prescribed or 13
ordered by a provider of health care [.] ; or 14
(b) Require an insured to obtain prior authorization for the 15
benefits described in paragraphs (a) and (c) of subsection 1. 16
[13.] 14. An insurer must provide an accessible, transparent 17
and expedited process which is not unduly burdensome by which an 18
insured, or the authorized representative of the insured, may request 19
an exception relating to any medical management technique used by 20
the insurer to obtain any benefit required by this section without a 21
higher deductible, copayment or coinsurance. 22
[14.] 15. As used in this section: 23
(a) “In-network pharmacy” means a pharmacy that has 24
entered into a contract with an insurer to provide services to 25
insureds through a network plan offered or issued by the insurer. 26
(b) “Medical management technique” means a practice which is 27
used to control the cost or utilization of health care services or 28
prescription drug use. The term includes, without limitation, the use 29
of step therapy, prior authorization or categorizing drugs and 30
devices based on cost, type or method of administration. 31
[(b)] (c) “Network plan” means a policy of health insurance 32
offered by an insurer under which the financing and delivery of 33
medical care, including items and services paid for as medical care, 34
are provided, in whole or in part, through a defined set of providers 35
under contract with the insurer. The term does not include an 36
arrangement for the financing of premiums. 37
[(c)] (d) “Provider network contract” means a contract 38
between an insurer and a provider of health care or pharmacy 39
specifying the rights and responsibilities of the insurer and the 40
provider of health care or pharmacy, as applicable, for delivery of 41
health care services pursuant to a network plan. 42
(e) “Provider of health care” has the meaning ascribed to it in 43
NRS 629.031. 44
[(d)] (f) “Therapeutic equivalent” means a drug which: 45
– 41 –
- *SB161 _R3 *
(1) Contains an identical amount of the same active 1
ingredients in the same dosage and method of administration as 2
another drug; 3
(2) Is expected to have the same clinical effect when 4
administered to a patient pursuant to a prescription or order as 5
another drug; and 6
(3) Meets any other criteria required by the Food and Drug 7
Administration for classification as a therapeutic equivalent. 8
Sec. 15. NRS 689B.0378 is hereby amended to read as 9
follows: 10
689B.0378 1. Except as otherwise provided in subsection [7,] 11
8, an insurer that offers or issues a policy of group health insurance 12
shall include in the policy coverage for: 13
(a) Up to a 12-month supply, per prescription, of any type of 14
drug for contraception or its therapeutic equivalent which is: 15
(1) Lawfully prescribed or ordered; 16
(2) Approved by the Food and Drug Administration; 17
(3) Listed in subsection [11;] 12; and 18
(4) Dispensed in accordance with NRS 639.28075; 19
(b) Any type of device for contraception which is: 20
(1) Lawfully prescribed or ordered; 21
(2) Approved by the Food and Drug Administration; and 22
(3) Listed in subsection [11;] 12; 23
(c) Self-administered hormonal contraceptives dispensed by a 24
pharmacist pursuant to NRS 639.28078; 25
(d) Insertion of a device for contraception or removal of such a 26
device if the device was inserted while the insured was covered by 27
the same policy of group health insurance; 28
(e) Education and counseling relating to the initiation of the use 29
of contraception and any necessary follow-up after initiating such 30
use; 31
(f) Management of side effects relating to contraception; and 32
(g) Voluntary sterilization for women. 33
2. An insurer shall provide coverage for any services listed in 34
subsection 1 which are within the authorized scope of practice of a 35
pharmacist when such services are provided by a pharmacist who 36
is employed by or serves as an independent contractor of an in-37
network pharmacy and in accordance with the applicable network 38
contract. Such coverage must be provided to the same extent as if 39
the services were provided by another provider of health care, as 40
applicable to the services being provided. The terms of the policy 41
must not limit: 42
(a) Coverage for services listed in subsection 1 and provided by 43
such a pharmacist to a number of occasions less than the coverage 44
– 42 –
- *SB161 _R3 *
for such services when provided by another provider of health 1
care. 2
(b) Reimbursement for services listed in subsection 1 and 3
provided by such a pharmacist to an amount less than the amount 4
reimbursed for similar services provided by a physician, physician 5
assistant or advanced practice registered nurse. 6
3. An insurer must ensure that the benefits required by 7
subsection 1 are made available to an insured through a provider of 8
health care who participates in the network plan of the insurer. 9
[3.] 4. If a covered therapeutic equivalent listed in subsection 1 10
is not available or a provider of health care deems a covered 11
therapeutic equivalent to be medically inappropriate, an alternate 12
therapeutic equivalent prescribed by a provider of health care must 13
be covered by the insurer. 14
[4.] 5. Except as otherwise provided in subsections [9,] 10 , 11 15
and [12,] 13, an insurer that offers or issues a policy of group health 16
insurance shall not: 17
(a) Require an insured to pay a higher deductible, any 18
copayment or coinsurance or require a longer waiting period or 19
other condition to obtain any benefit included in the policy pursuant 20
to subsection 1; 21
(b) Refuse to issue a policy of group health insurance or cancel a 22
policy of group health insurance solely because the person applying 23
for or covered by the policy uses or may use any such benefit; 24
(c) Offer or pay any type of material inducement or financial 25
incentive to an insured to discourage the insured from obtaining any 26
such benefit; 27
(d) Penalize a provider of health care who provides any such 28
benefit to an insured, including, without limitation, reducing the 29
reimbursement to the provider of health care; 30
(e) Offer or pay any type of material inducement, bonus or other 31
financial incentive to a provider of health care to deny, reduce, 32
withhold, limit or delay access to any such benefit to an insured; or 33
(f) Impose any other restrictions or delays on the access of an 34
insured to any such benefit. 35
[5.] 6. Coverage pursuant to this section for the covered 36
dependent of an insured must be the same as for the insured. 37
[6.] 7. Except as otherwise provided in subsection [7,] 8, a 38
policy subject to the provisions of this chapter that is delivered, 39
issued for delivery or renewed on or after January 1, [2022,] 2024, 40
has the legal effect of including the coverage required by 41
[subsection 1,] this section, and any provision of the policy or the 42
renewal which is in conflict with this section is void. 43
[7.] 8. An insurer that offers or issues a policy of group health 44
insurance and which is affiliated with a religious organization is not 45
– 43 –
- *SB161 _R3 *
required to provide the coverage required by subsection 1 if the 1
insurer objects on religious grounds. Such an insurer shall, before 2
the issuance of a policy of group health insurance and before the 3
renewal of such a policy, provide to the group policyholder or 4
prospective insured, as applicable, written notice of the coverage 5
that the insurer refuses to provide pursuant to this subsection. 6
[8.] 9. If an insurer refuses, pursuant to subsection [7,] 8, to 7
provide the coverage required by subsection 1, an employer may 8
otherwise provide for the coverage for the employees of the 9
employer. 10
[9.] 10. An insurer may require an insured to pay a higher 11
deductible, copayment or coinsurance for a drug for contraception if 12
the insured refuses to accept a therapeutic equivalent of the drug. 13
[10.] 11. For each of the 18 methods of contraception listed in 14
subsection [11] 12 that have been approved by the Food and Drug 15
Administration, a policy of group health insurance must include at 16
least one drug or device for contraception within each method for 17
which no deductible, copayment or coinsurance may be charged to 18
the insured, but the insurer may charge a deductible, copayment or 19
coinsurance for any other drug or device that provides the same 20
method of contraception. If the insurer charges a copayment or 21
coinsurance for a drug for contraception, the insurer may only 22
require an insured to pay the copayment or coinsurance: 23
(a) Once for the entire amount of the drug dispensed for the 24
plan year; or 25
(b) Once for each 1-month supply of the drug dispensed. 26
[11.] 12. The following 18 methods of contraception must be 27
covered pursuant to this section: 28
(a) Voluntary sterilization for women; 29
(b) Surgical sterilization implants for women; 30
(c) Implantable rods; 31
(d) Copper-based intrauterine devices; 32
(e) Progesterone-based intrauterine devices; 33
(f) Injections; 34
(g) Combined estrogen- and progestin-based drugs; 35
(h) Progestin-based drugs; 36
(i) Extended- or continuous-regimen drugs; 37
(j) Estrogen- and progestin-based patches; 38
(k) Vaginal contraceptive rings; 39
(l) Diaphragms with spermicide; 40
(m) Sponges with spermicide; 41
(n) Cervical caps with spermicide; 42
(o) Female condoms; 43
(p) Spermicide; 44
– 44 –
- *SB161 _R3 *
(q) Combined estrogen- and progestin-based drugs for 1
emergency contraception or progestin-based drugs for emergency 2
contraception; and 3
(r) Ulipristal acetate for emergency contraception. 4
[12.] 13. Except as otherwise provided in this section and 5
federal law, an insurer may use medical management techniques, 6
including, without limitation, any available clinical evidence, to 7
determine the frequency of or treatment relating to any benefit 8
required by this section or the type of provider of health care to use 9
for such treatment. 10
[13.] 14. An insurer shall not [use] : 11
(a) Use medical management techniques to require an insured to 12
use a method of contraception other than the method prescribed or 13
ordered by a provider of health care [.] ; or 14
(b) Require an insured to obtain prior authorization for the 15
benefits described in paragraphs (a) and (c) of subsection 1. 16
[14.] 15. An insurer must provide an accessible, transparent 17
and expedited process which is not unduly burdensome by which an 18
insured, or the authorized representative of the insured, may request 19
an exception relating to any medical management technique used by 20
the insurer to obtain any benefit required by this section without a 21
higher deductible, copayment or coinsurance. 22
[15.] 16. As used in this section: 23
(a) “In-network pharmacy” means a pharmacy that has 24
entered into a contract with an insurer to provide services to 25
insureds through a network plan offered or issued by the insurer. 26
(b) “Medical management technique” means a practice which is 27
used to control the cost or utilization of health care services or 28
prescription drug use. The term includes, without limitation, the use 29
of step therapy, prior authorization or categorizing drugs and 30
devices based on cost, type or method of administration. 31
[(b)] (c) “Network plan” means a policy of group health 32
insurance offered by an insurer under which the financing and 33
delivery of medical care, including items and services paid for as 34
medical care, are provided, in whole or in part, through a defined set 35
of providers under contract with the insurer. The term does not 36
include an arrangement for the financing of premiums. 37
[(c)] (d) “Provider network contract” means a contract 38
between an insurer and a provider of health care or pharmacy 39
specifying the rights and responsibilities of the insurer and the 40
provider of health care or pharmacy, as applicable, for delivery of 41
health care services pursuant to a network plan. 42
(e) “Provider of health care” has the meaning ascribed to it in 43
NRS 629.031. 44
[(d)] (f) “Therapeutic equivalent” means a drug which: 45
– 45 –
- *SB161 _R3 *
(1) Contains an identical amount of the same active 1
ingredients in the same dosage and method of administration as 2
another drug; 3
(2) Is expected to have the same clinical effect when 4
administered to a patient pursuant to a prescription or order as 5
another drug; and 6
(3) Meets any other criteria required by the Food and Drug 7
Administration for classification as a therapeutic equivalent. 8
Sec. 16. NRS 689C.1676 is hereby amended to read as 9
follows: 10
689C.1676 1. Except as otherwise provided in subsection [7,] 11
8, a carrier that offers or issues a health benefit plan shall include in 12
the plan coverage for: 13
(a) Up to a 12-month supply, per prescription, of any type of 14
drug for contraception or its therapeutic equivalent which is: 15
(1) Lawfully prescribed or ordered; 16
(2) Approved by the Food and Drug Administration; 17
(3) Listed in subsection [10;] 11; and 18
(4) Dispensed in accordance with NRS 639.28075; 19
(b) Any type of device for contraception which is: 20
(1) Lawfully prescribed or ordered; 21
(2) Approved by the Food and Drug Administration; and 22
(3) Listed in subsection [10;] 11; 23
(c) Self-administered hormonal contraceptives dispensed by a 24
pharmacist pursuant to NRS 639.28078; 25
(d) Insertion of a device for contraception or removal of such a 26
device if the device was inserted while the insured was covered by 27
the same health benefit plan; 28
(e) Education and counseling relating to the initiation of the use 29
of contraception and any necessary follow-up after initiating such 30
use; 31
(f) Management of side effects relating to contraception; and 32
(g) Voluntary sterilization for women. 33
2. A carrier shall provide coverage for any services listed in 34
subsection 1 which are within the authorized scope of practice of a 35
pharmacist when such services are provided by a pharmacist who 36
is employed by or serves as an independent contractor of an in-37
network pharmacy and in accordance with the applicable provider 38
network contract. Such coverage must be provided to the same 39
extent as if the services were provided by another provider of 40
health care, as applicable to the services being provided. The terms 41
of the policy must not limit: 42
(a) Coverage for services listed in subsection 1 and provided by 43
such a pharmacist to a number of occasions less than the coverage 44
– 46 –
- *SB161 _R3 *
for such services when provided by another provider of health 1
care. 2
(b) Reimbursement for services listed in subsection 1 and 3
provided by such a pharmacist to an amount less than the amount 4
reimbursed for similar services provided by a physician, physician 5
assistant or advanced practice registered nurse. 6
3. A carrier must ensure that the benefits required by 7
subsection 1 are made available to an insured through a provider of 8
health care who participates in the network plan of the carrier. 9
[3.] 4. If a covered therapeutic equivalent listed in subsection 1 10
is not available or a provider of health care deems a covered 11
therapeutic equivalent to be medically inappropriate, an alternate 12
therapeutic equivalent prescribed by a provider of health care must 13
be covered by the carrier. 14
[4.] 5. Except as otherwise provided in subsections [8,] 9 , 10 15
and [11,] 12, a carrier that offers or issues a health benefit plan shall 16
not: 17
(a) Require an insured to pay a higher deductible, any 18
copayment or coinsurance or require a longer waiting period or 19
other condition to obtain any benefit included in the health benefit 20
plan pursuant to subsection 1; 21
(b) Refuse to issue a health benefit plan or cancel a health 22
benefit plan solely because the person applying for or covered by 23
the plan uses or may use any such benefit; 24
(c) Offer or pay any type of material inducement or financial 25
incentive to an insured to discourage the insured from obtaining any 26
such benefit; 27
(d) Penalize a provider of health care who provides any such 28
benefit to an insured, including, without limitation, reducing the 29
reimbursement to the provider of health care; 30
(e) Offer or pay any type of material inducement, bonus or other 31
financial incentive to a provider of health care to deny, reduce, 32
withhold, limit or delay access to any such benefit to an insured; or 33
(f) Impose any other restrictions or delays on the access of an 34
insured to any such benefit. 35
[5.] 6. Coverage pursuant to this section for the covered 36
dependent of an insured must be the same as for the insured. 37
[6.] 7. Except as otherwise provided in subsection [7,] 8, a 38
health benefit plan subject to the provisions of this chapter that is 39
delivered, issued for delivery or renewed on or after January 1, 40
[2022,] 2024, has the legal effect of including the coverage required 41
by [subsection 1,] this section, and any provision of the plan or the 42
renewal which is in conflict with this section is void. 43
[7.] 8. A carrier that offers or issues a health benefit plan and 44
which is affiliated with a religious organization is not required to 45
– 47 –
- *SB161 _R3 *
provide the coverage required by subsection 1 if the carrier objects 1
on religious grounds. Such a carrier shall, before the issuance of a 2
health benefit plan and before the renewal of such a plan, provide to 3
the prospective insured written notice of the coverage that the 4
carrier refuses to provide pursuant to this subsection. 5
[8.] 9. A carrier may require an insured to pay a higher 6
deductible, copayment or coinsurance for a drug for contraception if 7
the insured refuses to accept a therapeutic equivalent of the drug. 8
[9.] 10. For each of the 18 methods of contraception listed in 9
subsection [10] 11 that have been approved by the Food and Drug 10
Administration, a health benefit plan must include at least one drug 11
or device for contraception within each method for which no 12
deductible, copayment or coinsurance may be charged to the 13
insured, but the carrier may charge a deductible, copayment or 14
coinsurance for any other drug or device that provides the same 15
method of contraception. If the carrier charges a copayment or 16
coinsurance for a drug for contraception, the carrier may only 17
require an insured to pay the copayment or coinsurance: 18
(a) Once for the entire amount of the drug dispensed for the 19
plan year; or 20
(b) Once for each 1-month supply of the drug dispensed. 21
[10.] 11. The following 18 methods of contraception must be 22
covered pursuant to this section: 23
(a) Voluntary sterilization for women; 24
(b) Surgical sterilization implants for women; 25
(c) Implantable rods; 26
(d) Copper-based intrauterine devices; 27
(e) Progesterone-based intrauterine devices; 28
(f) Injections; 29
(g) Combined estrogen- and progestin-based drugs; 30
(h) Progestin-based drugs; 31
(i) Extended- or continuous-regimen drugs; 32
(j) Estrogen- and progestin-based patches; 33
(k) Vaginal contraceptive rings; 34
(l) Diaphragms with spermicide; 35
(m) Sponges with spermicide; 36
(n) Cervical caps with spermicide; 37
(o) Female condoms; 38
(p) Spermicide; 39
(q) Combined estrogen- and progestin-based drugs for 40
emergency contraception or progestin-based drugs for emergency 41
contraception; and 42
(r) Ulipristal acetate for emergency contraception. 43
[11.] 12. Except as otherwise provided in this section and 44
federal law, a carrier may use medical management techniques, 45
– 48 –
- *SB161 _R3 *
including, without limitation, any available clinical evidence, to 1
determine the frequency of or treatment relating to any benefit 2
required by this section or the type of provider of health care to use 3
for such treatment. 4
[12.] 13. A carrier shall not [use] : 5
(a) Use medical management techniques to require an insured to 6
use a method of contraception other than the method prescribed or 7
ordered by a provider of health care [.] ; or 8
(b) Require an insured to obtain prior authorization for the 9
benefits described in paragraphs (a) and (c) of subsection 1. 10
[13.] 14. A carrier must provide an accessible, transparent and 11
expedited process which is not unduly burdensome by which an 12
insured, or the authorized representative of the insured, may request 13
an exception relating to any medical management technique used by 14
the carrier to obtain any benefit required by this section without a 15
higher deductible, copayment or coinsurance. 16
[14.] 15. As used in this section: 17
(a) “In-network pharmacy” means a pharmacy that has 18
entered into a contract with a carrier to provide services to 19
insureds through a network plan offered or issued by the carrier. 20
(b) “Medical management technique” means a practice which is 21
used to control the cost or utilization of health care services or 22
prescription drug use. The term includes, without limitation, the use 23
of step therapy, prior authorization or categorizing drugs and 24
devices based on cost, type or method of administration. 25
[(b)] (c) “Network plan” means a health benefit plan offered by 26
a carrier under which the financing and delivery of medical care, 27
including items and services paid for as medical care, are provided, 28
in whole or in part, through a defined set of providers under contract 29
with the carrier. The term does not include an arrangement for the 30
financing of premiums. 31
[(c)] (d) “Provider network contract” means a contract 32
between a carrier and a provider of health care or pharmacy 33
specifying the rights and responsibilities of the carrier and the 34
provider of health care or pharmacy, as applicable, for delivery of 35
health care services pursuant to a network plan. 36
(e) “Provider of health care” has the meaning ascribed to it in 37
NRS 629.031. 38
[(d)] (f) “Therapeutic equivalent” means a drug which: 39
(1) Contains an identical amount of the same active 40
ingredients in the same dosage and method of administration as 41
another drug; 42
(2) Is expected to have the same clinical effect when 43
administered to a patient pursuant to a prescription or order as 44
another drug; and 45
– 49 –
- *SB161 _R3 *
(3) Meets any other criteria required by the Food and Drug 1
Administration for classification as a therapeutic equivalent. 2
Sec. 17. NRS 695A.1865 is hereby amended to read as 3
follows: 4
695A.1865 1. Except as otherwise provided in subsection [7,] 5
8, a society that offers or issues a benefit contract which provides 6
coverage for prescription drugs or devices shall include in the 7
contract coverage for: 8
(a) Up to a 12-month supply, per prescription, of any type of 9
drug for contraception or its therapeutic equivalent which is: 10
(1) Lawfully prescribed or ordered; 11
(2) Approved by the Food and Drug Administration; 12
(3) Listed in subsection [10;] 11; and 13
(4) Dispensed in accordance with NRS 639.28075; 14
(b) Any type of device for contraception which is: 15
(1) Lawfully prescribed or ordered; 16
(2) Approved by the Food and Drug Administration; and 17
(3) Listed in subsection [10;] 11; 18
(c) Self-administered hormonal contraceptives dispensed by a 19
pharmacist pursuant to NRS 639.28078; 20
(d) Insertion of a device for contraception or removal of such a 21
device if the device was inserted while the insured was covered by 22
the same benefit contract; 23
(e) Education and counseling relating to the initiation of the use 24
of contraception and any necessary follow-up after initiating such 25
use; 26
(f) Management of side effects relating to contraception; and 27
(g) Voluntary sterilization for women. 28
2. A society shall provide coverage for any services listed in 29
subsection 1 which are within the authorized scope of practice of a 30
pharmacist when such services are provided by a pharmacist who 31
is employed by or serves as an independent contractor of an in-32
network pharmacy and in accordance with the applicable provider 33
network contract. Such coverage must be provided to the same 34
extent as if the services were provided by another provider of 35
health care, as applicable to the services being provided. The terms 36
of the policy must not limit: 37
(a) Coverage for services listed in subsection 1 and provided by 38
such a pharmacist to a number of occasions less than the coverage 39
for such services when provided by another provider of health 40
care. 41
(b) Reimbursement for services listed in subsection 1 and 42
provided by such a pharmacist to an amount less than the amount 43
reimbursed for similar services provided by a physician, physician 44
assistant or advanced practice registered nurse. 45
– 50 –
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3. A society must ensure that the benefits required by 1
subsection 1 are made available to an insured through a provider of 2
health care who participates in the network plan of the society. 3
[3.] 4. If a covered therapeutic equivalent listed in subsection 1 4
is not available or a provider of health care deems a covered 5
therapeutic equivalent to be medically inappropriate, an alternate 6
therapeutic equivalent prescribed by a provider of health care must 7
be covered by the society. 8
[4.] 5. Except as otherwise provided in subsections [8,] 9 , 10 9
and [11,] 12, a society that offers or issues a benefit contract shall 10
not: 11
(a) Require an insured to pay a higher deductible, any 12
copayment or coinsurance or require a longer waiting period or 13
other condition for coverage for any benefit included in the benefit 14
contract pursuant to subsection 1; 15
(b) Refuse to issue a benefit contract or cancel a benefit contract 16
solely because the person applying for or covered by the contract 17
uses or may use any such benefit; 18
(c) Offer or pay any type of material inducement or financial 19
incentive to an insured to discourage the insured from obtaining any 20
such benefit; 21
(d) Penalize a provider of health care who provides any such 22
benefit to an insured, including, without limitation, reducing the 23
reimbursement to the provider of health care; 24
(e) Offer or pay any type of material inducement, bonus or other 25
financial incentive to a provider of health care to deny, reduce, 26
withhold, limit or delay access to any such benefit to an insured; or 27
(f) Impose any other restrictions or delays on the access of an 28
insured to any such benefit. 29
[5.] 6. Coverage pursuant to this section for the covered 30
dependent of an insured must be the same as for the insured. 31
[6.] 7. Except as otherwise provided in subsection [7,] 8, a 32
benefit contract subject to the provisions of this chapter that is 33
delivered, issued for delivery or renewed on or after January 1, 34
[2022,] 2024, has the legal effect of including the coverage required 35
by [subsection 1,] this section, and any provision of the contract or 36
the renewal which is in conflict with this section is void. 37
[7.] 8. A society that offers or issues a benefit contract and 38
which is affiliated with a religious organization is not required to 39
provide the coverage required by subsection 1 if the society objects 40
on religious grounds. Such a society shall, before the issuance of a 41
benefit contract and before the renewal of such a contract, provide 42
to the prospective insured written notice of the coverage that the 43
society refuses to provide pursuant to this subsection. 44
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[8.] 9. A society may require an insured to pay a higher 1
deductible, copayment or coinsurance for a drug for contraception if 2
the insured refuses to accept a therapeutic equivalent of the drug. 3
[9.] 10. For each of the 18 methods of contraception listed in 4
subsection [10] 11 that have been approved by the Food and Drug 5
Administration, a benefit contract must include at least one drug or 6
device for contraception within each method for which no 7
deductible, copayment or coinsurance may be charged to the 8
insured, but the society may charge a deductible, copayment or 9
coinsurance for any other drug or device that provides the same 10
method of contraception. If the society charges a copayment or 11
coinsurance for a drug for contraception, the society may only 12
require an insured to pay the copayment or coinsurance: 13
(a) Once for the entire amount of the drug dispensed for the 14
plan year; or 15
(b) Once for each 1-month supply of the drug dispensed. 16
[10.] 11. The following 18 methods of contraception must be 17
covered pursuant to this section: 18
(a) Voluntary sterilization for women; 19
(b) Surgical sterilization implants for women; 20
(c) Implantable rods; 21
(d) Copper-based intrauterine devices; 22
(e) Progesterone-based intrauterine devices; 23
(f) Injections; 24
(g) Combined estrogen- and progestin-based drugs; 25
(h) Progestin-based drugs; 26
(i) Extended- or continuous-regimen drugs; 27
(j) Estrogen- and progestin-based patches; 28
(k) Vaginal contraceptive rings; 29
(l) Diaphragms with spermicide; 30
(m) Sponges with spermicide; 31
(n) Cervical caps with spermicide; 32
(o) Female condoms; 33
(p) Spermicide; 34
(q) Combined estrogen- and progestin-based drugs for 35
emergency contraception or progestin-based drugs for emergency 36
contraception; and 37
(r) Ulipristal acetate for emergency contraception. 38
[11.] 12. Except as otherwise provided in this section and 39
federal law, a society may use medical management techniques, 40
including, without limitation, any available clinical evidence, to 41
determine the frequency of or treatment relating to any benefit 42
required by this section or the type of provider of health care to use 43
for such treatment. 44
[12.] 13. A society shall not [use] : 45
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(a) Use medical management techniques to require an insured to 1
use a method of contraception other than the method prescribed or 2
ordered by a provider of health care [.] ; or 3
(b) Require an insured to obtain prior authorization for the 4
benefits described in paragraphs (a) and (c) of subsection 1. 5
[13.] 14. A society must provide an accessible, transparent and 6
expedited process which is not unduly burdensome by which an 7
insured, or the authorized representative of the insured, may request 8
an exception relating to any medical management technique used by 9
the society to obtain any benefit required by this section without a 10
higher deductible, copayment or coinsurance. 11
[14.] 15. As used in this section: 12
(a) “In-network pharmacy” means a pharmacy that has 13
entered into a contract with a society to provide services to 14
insureds through a network plan offered or issued by the society. 15
(b) “Medical management technique” means a practice which is 16
used to control the cost or utilization of health care services or 17
prescription drug use. The term includes, without limitation, the use 18
of step therapy, prior authorization or categorizing drugs and 19
devices based on cost, type or method of administration. 20
[(b)] (c) “Network plan” means a benefit contract offered by a 21
society under which the financing and delivery of medical care, 22
including items and services paid for as medical care, are provided, 23
in whole or in part, through a defined set of providers under contract 24
with the society. The term does not include an arrangement for the 25
financing of premiums. 26
[(c)] (d) “Provider network contract” means a contract 27
between a society and a provider of health care or pharmacy 28
specifying the rights and responsibilities of the society and the 29
provider of health care or pharmacy, as applicable, for delivery of 30
health care services pursuant to a network plan. 31
(e) “Provider of health care” has the meaning ascribed to it in 32
NRS 629.031. 33
[(d)] (f) “Therapeutic equivalent” means a drug which: 34
(1) Contains an identical amount of the same active 35
ingredients in the same dosage and method of administration as 36
another drug; 37
(2) Is expected to have the same clinical effect when 38
administered to a patient pursuant to a prescription or order as 39
another drug; and 40
(3) Meets any other criteria required by the Food and Drug 41
Administration for classification as a therapeutic equivalent. 42
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Sec. 18. NRS 695B.1919 is hereby amended to read as 1
follows: 2
695B.1919 1. Except as otherwise provided in subsection [7,] 3
8, an insurer that offers or issues a contract for hospital or medical 4
service shall include in the contract coverage for: 5
(a) Up to a 12-month supply, per prescription, of any type of 6
drug for contraception or its therapeutic equivalent which is: 7
(1) Lawfully prescribed or ordered; 8
(2) Approved by the Food and Drug Administration; 9
(3) Listed in subsection [11;] 12; and 10
(4) Dispensed in accordance with NRS 639.28075; 11
(b) Any type of device for contraception which is: 12
(1) Lawfully prescribed or ordered; 13
(2) Approved by the Food and Drug Administration; and 14
(3) Listed in subsection [11;] 12; 15
(c) Self-administered hormonal contraceptives dispensed by a 16
pharmacist pursuant to NRS 639.28078; 17
(d) Insertion of a device for contraception or removal of such a 18
device if the device was inserted while the insured was covered by 19
the same contract for hospital or medical service; 20
(e) Education and counseling relating to the initiation of the use 21
of contraception and any necessary follow-up after initiating such 22
use; 23
(f) Management of side effects relating to contraception; and 24
(g) Voluntary sterilization for women. 25
2. An insurer shall provide coverage for any services listed in 26
subsection 1 which are within the authorized scope of practice of a 27
pharmacist when such services are provided by a pharmacist who 28
is employed by or serves as an independent contractor of an in-29
network pharmacy and in accordance with the applicable provider 30
network contract. Such coverage must be provided to the same 31
extent as if the services were provided by another provider of 32
health care, as applicable to the services being provided. The terms 33
of the policy must not limit: 34
(a) Coverage for services listed in subsection 1 and provided by 35
such a pharmacist to a number of occasions less than the coverage 36
for such services when provided by another provider of health 37
care. 38
(b) Reimbursement for services listed in subsection 1 and 39
provided by such a pharmacist to an amount less than the amount 40
reimbursed for similar services provided by a physician, physician 41
assistant or advanced practice registered nurse. 42
3. An insurer that offers or issues a contract for hospital or 43
medical services must ensure that the benefits required by 44
– 54 –
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subsection 1 are made available to an insured through a provider of 1
health care who participates in the network plan of the insurer. 2
[3.] 4. If a covered therapeutic equivalent listed in subsection 1 3
is not available or a provider of health care deems a covered 4
therapeutic equivalent to be medically inappropriate, an alternate 5
therapeutic equivalent prescribed by a provider of health care must 6
be covered by the insurer. 7
[4.] 5. Except as otherwise provided in subsections [9,] 10 , 11 8
and [12,] 13, an insurer that offers or issues a contract for hospital or 9
medical service shall not: 10
(a) Require an insured to pay a higher deductible, any 11
copayment or coinsurance or require a longer waiting period or 12
other condition to obtain any benefit included in the contract for 13
hospital or medical service pursuant to subsection 1; 14
(b) Refuse to issue a contract for hospital or medical service or 15
cancel a contract for hospital or medical service solely because the 16
person applying for or covered by the contract uses or may use any 17
such benefit; 18
(c) Offer or pay any type of material inducement or financial 19
incentive to an insured to discourage the insured from obtaining any 20
such benefit; 21
(d) Penalize a provider of health care who provides any such 22
benefit to an insured, including, without limitation, reducing the 23
reimbursement to the provider of health care; 24
(e) Offer or pay any type of material inducement, bonus or other 25
financial incentive to a provider of health care to deny, reduce, 26
withhold, limit or delay access to any such benefit to an insured; or 27
(f) Impose any other restrictions or delays on the access of an 28
insured to any such benefit. 29
[5.] 6. Coverage pursuant to this section for the covered 30
dependent of an insured must be the same as for the insured. 31
[6.] 7. Except as otherwise provided in subsection [7,] 8, a 32
contract for hospital or medical service subject to the provisions of 33
this chapter that is delivered, issued for delivery or renewed on or 34
after January 1, [2022,] 2024, has the legal effect of including the 35
coverage required by [subsection 1,] this section, and any provision 36
of the contract or the renewal which is in conflict with this section is 37
void. 38
[7.] 8. An insurer that offers or issues a contract for hospital or 39
medical service and which is affiliated with a religious organization 40
is not required to provide the coverage required by subsection 1 if 41
the insurer objects on religious grounds. Such an insurer shall, 42
before the issuance of a contract for hospital or medical service and 43
before the renewal of such a contract, provide to the prospective 44
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insured written notice of the coverage that the insurer refuses to 1
provide pursuant to this subsection. 2
[8.] 9. If an insurer refuses, pursuant to subsection [7,] 8, to 3
provide the coverage required by subsection 1, an employer may 4
otherwise provide for the coverage for the employees of the 5
employer. 6
[9.] 10. An insurer may require an insured to pay a higher 7
deductible, copayment or coinsurance for a drug for contraception if 8
the insured refuses to accept a therapeutic equivalent of the drug. 9
[10.] 11. For each of the 18 methods of contraception listed in 10
subsection [11] 12 that have been approved by the Food and Drug 11
Administration, a contract for hospital or medical service must 12
include at least one drug or device for contraception within each 13
method for which no deductible, copayment or coinsurance may be 14
charged to the insured, but the insurer may charge a deductible, 15
copayment or coinsurance for any other drug or device that provides 16
the same method of contraception. If the insurer charges a 17
copayment or coinsurance for a drug for contraception, the 18
insurer may only require an insured to pay the copayment or 19
coinsurance: 20
(a) Once for the entire amount of the drug dispensed for the 21
plan year; or 22
(b) Once for each 1-month supply of the drug dispensed. 23
[11.] 12. The following 18 methods of contraception must be 24
covered pursuant to this section: 25
(a) Voluntary sterilization for women; 26
(b) Surgical sterilization implants for women; 27
(c) Implantable rods; 28
(d) Copper-based intrauterine devices; 29
(e) Progesterone-based intrauterine devices; 30
(f) Injections; 31
(g) Combined estrogen- and progestin-based drugs; 32
(h) Progestin-based drugs; 33
(i) Extended- or continuous-regimen drugs; 34
(j) Estrogen- and progestin-based patches; 35
(k) Vaginal contraceptive rings; 36
(l) Diaphragms with spermicide; 37
(m) Sponges with spermicide; 38
(n) Cervical caps with spermicide; 39
(o) Female condoms; 40
(p) Spermicide; 41
(q) Combined estrogen- and progestin-based drugs for 42
emergency contraception or progestin-based drugs for emergency 43
contraception; and 44
(r) Ulipristal acetate for emergency contraception. 45
– 56 –
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[12.] 13. Except as otherwise provided in this section and 1
federal law, an insurer that offers or issues a contract for hospital or 2
medical services may use medical management techniques, 3
including, without limitation, any available clinical evidence, to 4
determine the frequency of or treatment relating to any benefit 5
required by this section or the type of provider of health care to use 6
for such treatment. 7
[13.] 14. An insurer shall not [use] : 8
(a) Use medical management techniques to require an insured to 9
use a method of contraception other than the method prescribed or 10
ordered by a provider of health care [.] ; or 11
(b) Require an insured to obtain prior authorization for the 12
benefits described in paragraphs (a) and (c) of subsection 1. 13
[14.] 15. An insurer must provide an accessible, transparent 14
and expedited process which is not unduly burdensome by which an 15
insured, or the authorized representative of the insured, may request 16
an exception relating to any medical management technique used by 17
the insurer to obtain any benefit required by this section without a 18
higher deductible, copayment or coinsurance. 19
[15.] 16. As used in this section: 20
(a) “In-network pharmacy” means a pharmacy that has 21
entered into a contract with an insurer to provide services to 22
insureds through a network plan offered or issued by the insurer. 23
(b) “Medical management technique” means a practice which is 24
used to control the cost or utilization of health care services or 25
prescription drug use. The term includes, without limitation, the use 26
of step therapy, prior authorization or categorizing drugs and 27
devices based on cost, type or method of administration. 28
[(b)] (c) “Network plan” means a contract for hospital or 29
medical service offered by an insurer under which the financing and 30
delivery of medical care, including items and services paid for as 31
medical care, are provided, in whole or in part, through a defined set 32
of providers under contract with the insurer. The term does not 33
include an arrangement for the financing of premiums. 34
[(c)] (d) “Provider network contract” means a contract 35
between an insurer and a provider of health care or pharmacy 36
specifying the rights and responsibilities of the insurer and the 37
provider of health care or pharmacy, as applicable, for delivery of 38
health care services pursuant to a network plan. 39
(e) “Provider of health care” has the meaning ascribed to it in 40
NRS 629.031. 41
[(d)] (f) “Therapeutic equivalent” means a drug which: 42
(1) Contains an identical amount of the same active 43
ingredients in the same dosage and method of administration as 44
another drug; 45
– 57 –
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(2) Is expected to have the same clinical effect when 1
administered to a patient pursuant to a prescription or order as 2
another drug; and 3
(3) Meets any other criteria required by the Food and Drug 4
Administration for classification as a therapeutic equivalent. 5
Sec. 19. NRS 695C.1696 is hereby amended to read as 6
follows: 7
695C.1696 1. Except as otherwise provided in subsection [7,] 8
8, a health maintenance organization that offers or issues a health 9
care plan shall include in the plan coverage for: 10
(a) Up to a 12-month supply, per prescription, of any type of 11
drug for contraception or its therapeutic equivalent which is: 12
(1) Lawfully prescribed or ordered; 13
(2) Approved by the Food and Drug Administration; 14
(3) Listed in subsection [11;] 12; and 15
(4) Dispensed in accordance with NRS 639.28075; 16
(b) Any type of device for contraception which is: 17
(1) Lawfully prescribed or ordered; 18
(2) Approved by the Food and Drug Administration; and 19
(3) Listed in subsection [11;] 12; 20
(c) Self-administered hormonal contraceptives dispensed by a 21
pharmacist pursuant to NRS 639.28078; 22
(d) Insertion of a device for contraception or removal of such a 23
device if the device was inserted while the enrollee was covered by 24
the same health care plan; 25
(e) Education and counseling relating to the initiation of the use 26
of contraception and any necessary follow-up after initiating such 27
use; 28
(f) Management of side effects relating to contraception; and 29
(g) Voluntary sterilization for women. 30
2. A health maintenance organization shall provide coverage 31
for any services listed in subsection 1 which are within the 32
authorized scope of practice of a pharmacist when such services 33
are provided by a pharmacist who is employed by or serves as an 34
independent contractor of an in-network pharmacy and in 35
accordance with the applicable provider network contract. Such 36
coverage must be provided to the same extent as if the services 37
were provided by another provider of health care, as applicable to 38
the services being provided. The terms of the policy must not limit: 39
(a) Coverage for services listed in subsection 1 and provided by 40
such a pharmacist to a number of occasions less than the coverage 41
for such services when provided by another provider of health 42
care. 43
(b) Reimbursement for services listed in subsection 1 and 44
provided by such a pharmacist to an amount less than the amount 45
– 58 –
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reimbursed for similar services provided by a physician, physician 1
assistant or advanced practice registered nurse. 2
3. A health maintenance organization must ensure that the 3
benefits required by subsection 1 are made available to an enrollee 4
through a provider of health care who participates in the network 5
plan of the health maintenance organization. 6
[3.] 4. If a covered therapeutic equivalent listed in subsection 1 7
is not available or a provider of health care deems a covered 8
therapeutic equivalent to be medically inappropriate, an alternate 9
therapeutic equivalent prescribed by a provider of health care must 10
be covered by the health maintenance organization. 11
[4.] 5. Except as otherwise provided in subsections [9,] 10 , 11 12
and [12,] 13, a health maintenance organization that offers or issues 13
a health care plan shall not: 14
(a) Require an enrollee to pay a higher deductible, any 15
copayment or coinsurance or require a longer waiting period or 16
other condition to obtain any benefit included in the health care plan 17
pursuant to subsection 1; 18
(b) Refuse to issue a health care plan or cancel a health care plan 19
solely because the person applying for or covered by the plan uses 20
or may use any such benefit; 21
(c) Offer or pay any type of material inducement or financial 22
incentive to an enrollee to discourage the enrollee from obtaining 23
any such benefit; 24
(d) Penalize a provider of health care who provides any such 25
benefit to an enrollee, including, without limitation, reducing the 26
reimbursement of the provider of health care; 27
(e) Offer or pay any type of material inducement, bonus or other 28
financial incentive to a provider of health care to deny, reduce, 29
withhold, limit or delay access to any such benefit to an enrollee; or 30
(f) Impose any other restrictions or delays on the access of an 31
enrollee to any such benefit. 32
[5.] 6. Coverage pursuant to this section for the covered 33
dependent of an enrollee must be the same as for the enrollee. 34
[6.] 7. Except as otherwise provided in subsection [7,] 8, a 35
health care plan subject to the provisions of this chapter that is 36
delivered, issued for delivery or renewed on or after January 1, 37
[2022,] 2024, has the legal effect of including the coverage required 38
by [subsection 1,] this section, and any provision of the plan or the 39
renewal which is in conflict with this section is void. 40
[7.] 8. A health maintenance organization that offers or issues 41
a health care plan and which is affiliated with a religious 42
organization is not required to provide the coverage required by 43
subsection 1 if the health maintenance organization objects on 44
religious grounds. Such an organization shall, before the issuance of 45
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- *SB161 _R3 *
a health care plan and before the renewal of such a plan, provide to 1
the prospective enrollee written notice of the coverage that the 2
health maintenance organization refuses to provide pursuant to this 3
subsection. 4
[8.] 9. If a health maintenance organization refuses, pursuant 5
to subsection [7,] 8, to provide the coverage required by subsection 6
1, an employer may otherwise provide for the coverage for the 7
employees of the employer. 8
[9.] 10. A health maintenance organization may require an 9
enrollee to pay a higher deductible, copayment or coinsurance for a 10
drug for contraception if the enrollee refuses to accept a therapeutic 11
equivalent of the drug. 12
[10.] 11. For each of the 18 methods of contraception listed in 13
subsection [11] 12 that have been approved by the Food and Drug 14
Administration, a health care plan must include at least one drug or 15
device for contraception within each method for which no 16
deductible, copayment or coinsurance may be charged to the 17
enrollee, but the health maintenance organization may charge a 18
deductible, copayment or coinsurance for any other drug or device 19
that provides the same method of contraception. If the health 20
maintenance organization charges a copayment or coinsurance 21
for a drug for contraception, the health maintenance organization 22
may only require an enrollee to pay the copayment or 23
coinsurance: 24
(a) Once for the entire amount of the drug dispensed for the 25
plan year; or 26
(b) Once for each 1-month supply of the drug dispensed. 27
[11.] 12. The following 18 methods of contraception must be 28
covered pursuant to this section: 29
(a) Voluntary sterilization for women; 30
(b) Surgical sterilization implants for women; 31
(c) Implantable rods; 32
(d) Copper-based intrauterine devices; 33
(e) Progesterone-based intrauterine devices; 34
(f) Injections; 35
(g) Combined estrogen- and progestin-based drugs; 36
(h) Progestin-based drugs; 37
(i) Extended- or continuous-regimen drugs; 38
(j) Estrogen- and progestin-based patches; 39
(k) Vaginal contraceptive rings; 40
(l) Diaphragms with spermicide; 41
(m) Sponges with spermicide; 42
(n) Cervical caps with spermicide; 43
(o) Female condoms; 44
(p) Spermicide; 45
– 60 –
- *SB161 _R3 *
(q) Combined estrogen- and progestin-based drugs for 1
emergency contraception or progestin-based drugs for emergency 2
contraception; and 3
(r) Ulipristal acetate for emergency contraception. 4
[12.] 13. Except as otherwise provided in this section and 5
federal law, a health maintenance organization may use medical 6
management techniques, including, without limitation, any available 7
clinical evidence, to determine the frequency of or treatment relating 8
to any benefit required by this section or the type of provider of 9
health care to use for such treatment. 10
[13.] 14. A health maintenance organization shall not [use] : 11
(a) Use medical management techniques to require an enrollee 12
to use a method of contraception other than the method prescribed 13
or ordered by a provider of health care [.] ; or 14
(b) Require an enrollee to obtain prior authorization for the 15
benefits described in paragraphs (a) and (c) of subsection 1. 16
[14.] 15. A health maintenance organization must provide an 17
accessible, transparent and expedited process which is not unduly 18
burdensome by which an enrollee, or the authorized representative 19
of the enrollee, may request an exception relating to any medical 20
management technique used by the health maintenance organization 21
to obtain any benefit required by this section without a higher 22
deductible, copayment or coinsurance. 23
[15.] 16. As used in this section: 24
(a) “In-network pharmacy” means a pharmacy that has 25
entered into a contract with a health maintenance organization to 26
provide services to enrollees through a network plan offered or 27
issued by the health maintenance organization. 28
(b) “Medical management technique” means a practice which is 29
used to control the cost or utilization of health care services or 30
prescription drug use. The term includes, without limitation, the use 31
of step therapy, prior authorization or categorizing drugs and 32
devices based on cost, type or method of administration. 33
[(b)] (c) “Network plan” means a health care plan offered by a 34
health maintenance organization under which the financing and 35
delivery of medical care, including items and services paid for as 36
medical care, are provided, in whole or in part, through a defined set 37
of providers under contract with the health maintenance 38
organization. The term does not include an arrangement for the 39
financing of premiums. 40
[(c)] (d) “Provider network contract” means a contract 41
between a health maintenance organization and a provider of 42
health care or pharmacy specifying the rights and responsibilities 43
of the health maintenance organization and the provider of health 44
– 61 –
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care or pharmacy, as applicable, for delivery of health care 1
services pursuant to a network plan. 2
(e) “Provider of health care” has the meaning ascribed to it in 3
NRS 629.031. 4
[(d)] (f) “Therapeutic equivalent” means a drug which: 5
(1) Contains an identical amount of the same active 6
ingredients in the same dosage and method of administration as 7
another drug; 8
(2) Is expected to have the same clinical effect when 9
administered to a patient pursuant to a prescription or order as 10
another drug; and 11
(3) Meets any other criteria required by the Food and Drug 12
Administration for classification as a therapeutic equivalent. 13
Sec. 20. NRS 695G.1715 is hereby amended to read as 14
follows: 15
695G.1715 1. Except as otherwise provided in subsection [7,] 16
8, a managed care organization that offers or issues a health care 17
plan shall include in the plan coverage for: 18
(a) Up to a 12-month supply, per prescription, of any type of 19
drug for contraception or its therapeutic equivalent which is: 20
(1) Lawfully prescribed or ordered; 21
(2) Approved by the Food and Drug Administration; 22
(3) Listed in subsection [10;] 11; and 23
(4) Dispensed in accordance with NRS 639.28075; 24
(b) Any type of device for contraception which is: 25
(1) Lawfully prescribed or ordered; 26
(2) Approved by the Food and Drug Administration; and 27
(3) Listed in subsection [10;] 11; 28
(c) Self-administered hormonal contraceptives dispenses by a 29
pharmacist pursuant to NRS 639.28078; 30
(d) Insertion of a device for contraception or removal of such a 31
device if the device was inserted while the insured was covered by 32
the same health care plan; 33
(e) Education and counseling relating to the initiation of the use 34
of contraception and any necessary follow-up after initiating such 35
use; 36
(f) Management of side effects relating to contraception; and 37
(g) Voluntary sterilization for women. 38
2. A managed care organization shall provide coverage for 39
any services listed in subsection 1 which are within the authorized 40
scope of practice of a pharmacist when such services are provided 41
by a pharmacist who is employed by or serves as an independent 42
contractor of an in-network pharmacy and in accordance with the 43
applicable provider network contract. Such coverage must be 44
provided to the same extent as if the services were provided by 45
– 62 –
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another provider of health care, as applicable to the services being 1
provided. The terms of the policy must not limit: 2
(a) Coverage for services listed in subsection 1 and provided by 3
such a pharmacist to a number of occasions less than the coverage 4
for such services when provided by another provider of health 5
care. 6
(b) Reimbursement for services listed in subsection 1 and 7
provided by such a pharmacist to an amount less than the amount 8
reimbursed for similar services provided by a physician, physician 9
assistant or advanced practice registered nurse. 10
3. A managed care organization must ensure that the benefits 11
required by subsection 1 are made available to an insured through a 12
provider of health care who participates in the network plan of the 13
managed care organization. 14
[3.] 4. If a covered therapeutic equivalent listed in subsection 1 15
is not available or a provider of health care deems a covered 16
therapeutic equivalent to be medically inappropriate, an alternate 17
therapeutic equivalent prescribed by a provider of health care must 18
be covered by the managed care organization. 19
[4.] 5. Except as otherwise provided in subsections [8,] 9 , 10 20
and [11,] 12, a managed care organization that offers or issues a 21
health care plan shall not: 22
(a) Require an insured to pay a higher deductible, any 23
copayment or coinsurance or require a longer waiting period or 24
other condition to obtain any benefit included in the health care plan 25
pursuant to subsection 1; 26
(b) Refuse to issue a health care plan or cancel a health care plan 27
solely because the person applying for or covered by the plan uses 28
or may use any such benefits; 29
(c) Offer or pay any type of material inducement or financial 30
incentive to an insured to discourage the insured from obtaining any 31
such benefits; 32
(d) Penalize a provider of health care who provides any such 33
benefits to an insured, including, without limitation, reducing the 34
reimbursement of the provider of health care; 35
(e) Offer or pay any type of material inducement, bonus or other 36
financial incentive to a provider of health care to deny, reduce, 37
withhold, limit or delay access to any such benefits to an insured; or 38
(f) Impose any other restrictions or delays on the access of an 39
insured to any such benefits. 40
[5.] 6. Coverage pursuant to this section for the covered 41
dependent of an insured must be the same as for the insured. 42
[6.] 7. Except as otherwise provided in subsection [7,] 8, a 43
health care plan subject to the provisions of this chapter that is 44
delivered, issued for delivery or renewed on or after January 1, 45
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[2022,] 2024, has the legal effect of including the coverage required 1
by [subsection 1,] this section, and any provision of the plan or the 2
renewal which is in conflict with this section is void. 3
[7.] 8. A managed care organization that offers or issues a 4
health care plan and which is affiliated with a religious organization 5
is not required to provide the coverage required by subsection 1 if 6
the managed care organization objects on religious grounds. Such an 7
organization shall, before the issuance of a health care plan and 8
before the renewal of such a plan, provide to the prospective insured 9
written notice of the coverage that the managed care organization 10
refuses to provide pursuant to this subsection. 11
[8.] 9. A managed care organization may require an insured to 12
pay a higher deductible, copayment or coinsurance for a drug for 13
contraception if the insured refuses to accept a therapeutic 14
equivalent of the drug. 15
[9.] 10. For each of the 18 methods of contraception listed in 16
subsection [10] 11 that have been approved by the Food and Drug 17
Administration, a health care plan must include at least one drug or 18
device for contraception within each method for which no 19
deductible, copayment or coinsurance may be charged to the 20
insured, but the managed care organization may charge a deductible, 21
copayment or coinsurance for any other drug or device that provides 22
the same method of contraception. If the managed care 23
organization charges a copayment or coinsurance for a drug for 24
contraception, the managed care organization may only require 25
an enrollee to pay the copayment or coinsurance: 26
(a) Once for the entire amount of the drug dispensed for the 27
plan year; or 28
(b) Once for each 1-month supply of the drug dispensed. 29
[10.] 11. The following 18 methods of contraception must be 30
covered pursuant to this section: 31
(a) Voluntary sterilization for women; 32
(b) Surgical sterilization implants for women; 33
(c) Implantable rods; 34
(d) Copper-based intrauterine devices; 35
(e) Progesterone-based intrauterine devices; 36
(f) Injections; 37
(g) Combined estrogen- and progestin-based drugs; 38
(h) Progestin-based drugs; 39
(i) Extended- or continuous-regimen drugs; 40
(j) Estrogen- and progestin-based patches; 41
(k) Vaginal contraceptive rings; 42
(l) Diaphragms with spermicide; 43
(m) Sponges with spermicide; 44
(n) Cervical caps with spermicide; 45
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(o) Female condoms; 1
(p) Spermicide; 2
(q) Combined estrogen- and progestin-based drugs for 3
emergency contraception or progestin-based drugs for emergency 4
contraception; and 5
(r) Ulipristal acetate for emergency contraception. 6
[11.] 12. Except as otherwise provided in this section and 7
federal law, a managed care organization may use medical 8
management techniques, including, without limitation, any available 9
clinical evidence, to determine the frequency of or treatment relating 10
to any benefit required by this section or the type of provider of 11
health care to use for such treatment. 12
[12.] 13. A managed care organization shall not [use] : 13
(a) Use medical management techniques to require an insured to 14
use a method of contraception other than the method prescribed or 15
ordered by a provider of health care [.] ; or 16
(b) Require an insured to obtain prior authorization for the 17
benefits described in paragraphs (a) and (c) of subsection 1. 18
[13.] 14. A managed care organization must provide an 19
accessible, transparent and expedited process which is not unduly 20
burdensome by which an insured, or the authorized representative of 21
the insured, may request an exception relating to any medical 22
management technique used by the managed care organization to 23
obtain any benefit required by this section without a higher 24
deductible, copayment or coinsurance. 25
[14.] 15. As used in this section: 26
(a) “In-network pharmacy” means a pharmacy that has 27
entered into a contract with a managed care organization to 28
provide services to insureds through a network plan offered or 29
issued by the managed care organization. 30
(b) “Medical management technique” means a practice which is 31
used to control the cost or utilization of health care services or 32
prescription drug use. The term includes, without limitation, the use 33
of step therapy, prior authorization or categorizing drugs and 34
devices based on cost, type or method of administration. 35
[(b)] (c) “Network plan” means a health care plan offered by a 36
managed care organization under which the financing and delivery 37
of medical care, including items and services paid for as medical 38
care, are provided, in whole or in part, through a defined set of 39
providers under contract with the managed care organization. The 40
term does not include an arrangement for the financing of 41
premiums. 42
[(c)] (d) “Provider network contract” means a contract 43
between a managed care organization and a provider of health 44
care or pharmacy specifying the rights and responsibilities of the 45
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managed care organization and the provider of health care or 1
pharmacy, as applicable, for delivery of health care services 2
pursuant to a network plan. 3
(e) “Provider of health care” has the meaning ascribed to it in 4
NRS 629.031. 5
[(d)] (f) “Therapeutic equivalent” means a drug which: 6
(1) Contains an identical amount of the same active 7
ingredients in the same dosage and method of administration as 8
another drug; 9
(2) Is expected to have the same clinical effect when 10
administered to a patient pursuant to a prescription or order as 11
another drug; and 12
(3) Meets any other criteria required by the Food and Drug 13
Administration for classification as a therapeutic equivalent. 14
Sec. 21. 1. The provisions of NRS 422.4053, as amended by 15
section 2 of this act, do not apply to a contract between the 16
Department of Health and Human Services and a pharmacy benefit 17
manager or a health maintenance organization entered into pursuant 18
to NRS 422.4053 before January 1, 2024, but do apply to any 19
renewal or extension of such a contract. 20
2. As used in this section: 21
(a) “Health maintenance organization” has the meaning ascribed 22
to it in NRS 695C.030. 23
(b) “Pharmacy benefit manager” has the meaning ascribed to it 24
in NRS 683A.174. 25
Sec. 22. The provisions of NRS 354.599 do not apply to any 26
additional expenses of a local government that are related to the 27
provisions of this act. 28
Sec. 23. 1. This section and sections 4 and 5 of this act 29
become effective upon passage and approval. 30
2. Sections 1, 2, 3 and 6 to 22, inclusive, of this act become 31
effective: 32
(a) Upon passage and approval for the purpose of performing 33
any preparatory administrative tasks that are necessary to carry out 34
the provisions of this act; and 35
(b) On January 1, 2024, for all other purposes. 36
H