Nevada 2023 Regular Session

Nevada Senate Bill SB161 Compare Versions

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Old	New	Differences
1	1
2	2	- 82nd Session (2023)
3	3	Senate Bill No. 161–Senators Scheible, D. Harris, Spearman,
4	4	Cannizzaro, Seevers Gansert; Daly, Donate, Dondero Loop,
5	5	Flores, Goicoechea, Hansen, Krasner, Neal, Nguyen,
6	6	Ohrenschall, Pazina and Stone
7	7
8	8	CHAPTER..........
9	9
10	10	AN ACT relating to personal health; expanding required insurance
11	11	coverage of contraception; providing for the use of benefits
12	12	under certain federal programs for persons with low incomes
13	13	to purchase menstrual products; authorizing the establishment
14	14	of a program to assist certain recipients of public assistance
15	15	in the purchase of menstrual products; authorizing certain
16	16	persons and entities to acquire controlled substances and
17	17	dangerous drugs directly from an outsourcing facility;
18	18	revising requirements governing the dispensing of a drug
19	19	used for contraception; enacting the Interstate Massage
20	20	Compact; increasing the number of members of the Board of
21	21	Massage Therapy required to constitute a quorum for the
22	22	purposes of transacting the business of the Board; clarifying
23	23	that a pharmacy benefit manager is subject to certain
24	24	provisions of law governing an insurer for which the
25	25	pharmacy benefit manager manages prescription drug
26	26	coverage; and providing other matters properly relating
27	27	thereto.
28	28	Legislative Counsel’s Digest:
29	29	Existing law requires public and private policies of insurance regulated under
30	30	Nevada law to include coverage for up to a 12-month supply of contraceptive
31	31	drugs. (NRS 287.010, 287.04335, 422.27172, 689A.0418, 689B.0378, 689C.1676,
32	32	695A.1865, 695B.1919, 695C.1696, 695G.1715) Sections 1, 11 and 14-20 of this
33	33	bill prohibit an insurer from requiring an insured to obtain prior authorization
34	34	before receiving a contraceptive drug. Sections 1 and 14-20 also require an insurer
35	35	to: (1) cover certain contraceptive services when provided by a pharmacist to the
36	36	same extent as if the services were provided by another provider of health care in
37	37	certain circumstances; and (2) reimburse a pharmacist for providing such services
38	38	at a rate that is not less than the rate provided to a physician, physician assistant or
39	39	advanced practice registered nurse. Sections 1 and 14-20 additionally prescribe
40	40	certain limitations on the imposition of a copayment or coinsurance for a drug for
41	41	contraception. Section 10 of this bill requires an insurer to: (1) demonstrate the
42	42	capacity to adequately deliver family planning services provided by pharmacists to
43	43	covered persons; and (2) make available to covered persons a notice of pharmacists
44	44	and pharmacies that are available to provide family planning services to covered
45	45	persons through the network of the insurer. Sections 12 and 13 of this bill make
46	46	conforming changes to indicate the proper placement of section 10 in the Nevada
47	47	Revised Statutes.
48	48	Existing law imposes certain duties on a pharmacy benefit manager. (NRS
49	49	683A.178) Section 9 of this bill clarifies that a pharmacy benefit manager that
50	50	manages prescription drug benefits for an insurer is required to comply with the
51	51	same provisions of the Nevada Insurance Code as are applicable to the insurer.
52	52	– 2 –
53	53
54	54
55	55	- 82nd Session (2023)
56	56	Existing law authorizes the Department of Health and Human Services to enter
57	57	into a contract with a pharmacy benefit manager or a health maintenance
58	58	organization to manage, direct and coordinate all payments and rebates for
59	59	prescription drugs and all other services and payments relating to the provision of
60	60	prescription drugs under the State Plan for Medicaid and the Children’s Health
61	61	Insurance Program. (NRS 422.4053) Section 2 of this bill requires such a contract
62	62	to require the pharmacy benefit manager or health maintenance organization to
63	63	comply with certain provisions of law regarding the provision of prescription drugs
64	64	under the State Plan for Medicaid and the Children’s Health Insurance Program.
65	65	Existing federal law establishes the Supplemental Nutrition Assistance
66	66	Program, which provides assistance to certain low-income families for the purchase
67	67	of food. (7 U.S.C. §§ 2011 et seq.) Existing federal law also establishes the Special
68	68	Supplemental Nutrition Program for Women, Infants and Children, which provides,
69	69	through eligible local agencies, nutrition education and supplemental foods to
70	70	pregnant women, mothers, infants and children less than 5 years of age with low
71	71	household incomes. (42 U.S.C. § 1786) Existing law requires the Department of
72	72	Health and Human Services to administer these programs within this State. (NRS
73	73	422A.338) Section 3 of this bill requires the Department to authorize recipients of
74	74	benefits provided under those programs to use such benefits to purchase menstrual
75	75	products: (1) to the extent authorized by federal law; and (2) to the extent that
76	76	federal funding is available. This bill also authorizes the Department to: (1)
77	77	establish and administer a program to provide assistance for the purpose of
78	78	purchasing menstrual products to recipients of benefits provided through programs
79	79	for which the Division of Welfare and Supportive Services of the Department is
80	80	responsible; and (2) accept gifts, grants and donations for the purposes of
81	81	establishing such a program.
82	82	Existing law imposes certain requirements governing the purchase and sale of
83	83	controlled substances and dangerous drugs. (NRS 639.268) Existing regulations
84	84	prescribe certain requirements concerning the operation of outsourcing facilities,
85	85	which are federally registered facilities that engage in the compounding of drugs.
86	86	(NAC 639.691-639.6916) Those requirements include requirements that an
87	87	outsourcing facility: (1) be licensed by the State Board of Pharmacy as a
88	88	manufacturer; and (2) comply with regulatory requirements governing
89	89	manufacturers. (NAC 639.6915) Section 5 of this bill authorizes a person or entity
90	90	authorized to dispense controlled substances and dangerous drugs to purchase or
91	91	otherwise acquire controlled substances and dangerous drugs compounded or
92	92	repackaged by an outsourcing facility directly from the outsourcing facility.
93	93	Section 4 of this bill makes a conforming change to update an internal reference
94	94	changed by section 5.
95	95	Existing law requires a pharmacist to dispense up to a 12-month supply of
96	96	contraceptives or therapeutic equivalent or any amount which covers the remainder
97	97	of the plan year, whichever is less, pursuant to a valid prescription or order if: (1)
98	98	the patient has previously received a 3-month supply of the same drug; (2) the
99	99	patient has previously received a 9-month supply of the same drug or a supply of
100	100	the same drug for the balance of the plan year in which the 3-month supply was
101	101	prescribed or ordered, whichever is less; (3) the patient is insured by the same
102	102	health insurance plan; and (4) a provider of health care has not specified in the
103	103	prescription or order that a different supply of the drug is necessary. (NRS
104	104	639.28075) If a patient is not currently using a contraceptive or therapeutic
105	105	equivalent, section 6 of this bill requires a pharmacist to dispense a full 3-month
106	106	supply or the amount designated by the prescription or order, whichever is less,
107	107	pursuant to a valid prescription or order unless the patient is unable or unwilling to
108	108	pay the applicable charge, copayment or coinsurance. If the patient is currently
109	109	– 3 –
110	110
111	111
112	112	- 82nd Session (2023)
113	113	using the contraceptive or therapeutic equivalent, section 6 requires a pharmacist to
114	114	dispense a full 9-month supply or a full 12-month supply, as applicable, any
115	115	amount designated by the prescription or order or any amount which covers the
116	116	remainder of the plan year, whichever is less, pursuant to a valid prescription or
117	117	order unless the patient is unable or unwilling to pay the applicable charge,
118	118	copayment or coinsurance.
119	119	Existing law authorizes the Board of Massage Therapy to issue a license to
120	120	practice massage therapy and sets forth the requirements that an applicant for a
121	121	license must satisfy in order to become licensed. (NRS 640C.580) Section 7 of this
122	122	bill adopts the Interstate Massage Compact, creating a multistate license with
123	123	uniform licensing requirements, including a national licensing examination, for use
124	124	by licensees in all member states.
125	125	The Compact requires that, in order to be eligible to join the Compact and
126	126	maintain eligibility as a member state, a state must: (1) license and regulate the
127	127	practice of massage therapy; (2) have a mechanism or entity in place to receive and
128	128	investigate complaints from the public, regulatory or law enforcement agencies or
129	129	the Interstate Massage Compact Commission about licensees practicing in that
130	130	state; (3) accept passage of a national licensing examination as a criterion for
131	131	massage therapy licensure in that state; (4) require that licensees satisfy educational
132	132	requirements before being licensed; (5) implement procedures for requiring
133	133	background checks for a multistate license and other reporting requirements; (6)
134	134	have continuing competence requirements; (7) participate in the Compact’s data
135	135	system; (8) notify the Commission and other member states of any disciplinary
136	136	action taken against a licensee practicing under a multistate license; (9) comply
137	137	with any rules of the Commission; and (10) accept licensees with valid multistate
138	138	licenses from other member states. An applicant for a multistate license must: (1)
139	139	hold a license to practice massage therapy in a member state; (2) complete 625
140	140	hours of massage therapy education or the substantial equivalent; (3) pass a
141	141	national licensing examination or the substantial equivalent; (4) submit to and pass
142	142	a background check; and (5) pay all required fees.
143	143	The Compact: (1) establishes the Interstate Massage Compact Commission as a
144	144	joint governmental agency whose membership consists of all member states; and
145	145	(2) provides for the Commission’s rules and governance. The Compact also
146	146	establishes a data system, provided for by the Commission, and requires member
147	147	states to submit uniform data to the data system on all individuals to whom the
148	148	Compact is applicable.
149	149	The Compact provides additional provisions to carry out the Compact,
150	150	including providing procedures for the taking of adverse actions against licensees,
151	151	provisions for active military members or their spouses, provisions for rulemaking
152	152	by the Commission, provisions for oversight and dispute resolution and procedures
153	153	for amendments and withdrawals. The Compact takes effect on the date on which
154	154	the Compact is enacted into law by the seventh member state.
155	155	Existing law provides that four members of the Board of Massage Therapy
156	156	constitute a quorum for the purposes of transacting the business of the Board. (NRS
157	157	640C.180) Section 8 of this bill increases the number of board members needed to
158	158	constitute a quorum from four to five.
159	159
160	160
161	161
162	162
163	163
164	164
165	165
166	166	– 4 –
167	167
168	168
169	169	- 82nd Session (2023)
170	170	EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
171	171
172	172
173	173	THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
174	174	SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
175	175
176	176	Section 1. NRS 422.27172 is hereby amended to read as
177	177	follows:
178	178	422.27172 1. The Director shall include in the State Plan for
179	179	Medicaid a requirement that the State pay the nonfederal share of
180	180	expenditures incurred for:
181	181	(a) Up to a 12-month supply, per prescription, of any type of
182	182	drug for contraception or its therapeutic equivalent which is:
183	183	(1) Lawfully prescribed or ordered;
184	184	(2) Approved by the Food and Drug Administration; and
185	185	(3) Dispensed in accordance with NRS 639.28075;
186	186	(b) Any type of device for contraception which is lawfully
187	187	prescribed or ordered and which has been approved by the Food and
188	188	Drug Administration;
189	189	(c) Self-administered hormonal contraceptives dispensed by a
190	190	pharmacist pursuant to NRS 639.28078;
191	191	(d) Insertion or removal of a device for contraception;
192	192	(e) Education and counseling relating to the initiation of the use
193	193	of contraceptives and any necessary follow-up after initiating such
194	194	use;
195	195	(f) Management of side effects relating to contraception; and
196	196	(g) Voluntary sterilization for women.
197	197	2. Except as otherwise provided in subsections 4 and 5, to
198	198	obtain any benefit provided in the Plan pursuant to subsection 1, a
199	199	person enrolled in Medicaid must not be required to:
200	200	(a) Pay a higher deductible, any copayment or coinsurance; or
201	201	(b) Be subject to a longer waiting period or any other condition.
202	202	3. The Director shall ensure that the provisions of this section
203	203	are carried out in a manner which complies with the requirements
204	204	established by the Drug Use Review Board and set forth in the list
205	205	of preferred prescription drugs established by the Department
206	206	pursuant to NRS 422.4025.
207	207	4. The Plan may require a person enrolled in Medicaid to pay a
208	208	higher deductible, copayment or coinsurance for a drug for
209	209	contraception if the person refuses to accept a therapeutic equivalent
210	210	of the contraceptive drug.
211	211	5. For each method of contraception which is approved by the
212	212	Food and Drug Administration, the Plan must include at least one
213	213	contraceptive drug or device for which no deductible, copayment or
214	214	– 5 –
215	215
216	216
217	217	- 82nd Session (2023)
218	218	coinsurance may be charged to the person enrolled in Medicaid, but
219	219	the Plan may charge a deductible, copayment or coinsurance for any
220	220	other contraceptive drug or device that provides the same method of
221	221	contraception. If the Plan requires a person enrolled in Medicaid
222	222	to pay a copayment or coinsurance for a drug for contraception,
223	223	the Plan may only require the person to pay the copayment or
224	224	coinsurance:
225	225	(a) Once for the entire amount of the drug dispensed for the
226	226	plan year; or
227	227	(b) Once for each 1-month supply of the drug dispensed.
228	228	6. The Plan must provide for the reimbursement of a
229	229	pharmacist for providing services described in subsection 1 that
230	230	are within the scope of practice of the pharmacist to the same
231	231	extent as if the services were provided by another provider of
232	232	health care. The Plan must not limit:
233	233	(a) Coverage for such services provided by a pharmacist to a
234	234	number of occasions less than the coverage for such services when
235	235	provided by another provider of health care.
236	236	(b) Reimbursement for such services provided by a pharmacist
237	237	to an amount less than the amount reimbursed for similar services
238	238	provided by a physician, physician assistant or advanced practice
239	239	registered nurse.
240	240	7. The Plan must not require a recipient of Medicaid to
241	241	obtain prior authorization for the benefits described in paragraphs
242	242	(a) and (c) of subsection 1.
243	243	8. As used in this section:
244	244	(a) “Drug Use Review Board” has the meaning ascribed to it in
245	245	NRS 422.402.
246	246	(b) “Provider of health care” has the meaning ascribed to it in
247	247	NRS 629.031.
248	248	(c) “Therapeutic equivalent” means a drug which:
249	249	(1) Contains an identical amount of the same active
250	250	ingredients in the same dosage and method of administration as
251	251	another drug;
252	252	(2) Is expected to have the same clinical effect when
253	253	administered to a patient pursuant to a prescription or order as
254	254	another drug; and
255	255	(3) Meets any other criteria required by the Food and Drug
256	256	Administration for classification as a therapeutic equivalent.
257	257	Sec. 2. NRS 422.4053 is hereby amended to read as follows:
258	258	422.4053 1. Except as otherwise provided in subsection 2,
259	259	the Department shall directly manage, direct and coordinate all
260	260	payments and rebates for prescription drugs and all other services
261	261	– 6 –
262	262
263	263
264	264	- 82nd Session (2023)
265	265	and payments relating to the provision of prescription drugs under
266	266	the State Plan for Medicaid and the Children’s Health Insurance
267	267	Program.
268	268	2. The Department may enter into a contract with:
269	269	(a) A pharmacy benefit manager for the provision of any
270	270	services described in subsection 1.
271	271	(b) A health maintenance organization pursuant to NRS 422.273
272	272	for the provision of any of the services described in subsection 1 for
273	273	recipients of Medicaid or recipients of insurance through the
274	274	Children’s Health Insurance Program who receive coverage through
275	275	a Medicaid managed care program.
276	276	(c) One or more public or private entities from this State, the
277	277	District of Columbia or other states or territories of the United States
278	278	for the collaborative purchasing of prescription drugs in accordance
279	279	with subsection 3 of NRS 277.110.
280	280	3. A contract entered into pursuant to paragraph (a) or (b) of
281	281	subsection 2 must:
282	282	(a) Include the provisions required by NRS 422.4056; [and]
283	283	(b) Require the pharmacy benefit manager or health
284	284	maintenance organization, as applicable, to disclose to the
285	285	Department any information relating to the services covered by the
286	286	contract, including, without limitation, information concerning
287	287	dispensing fees, measures for the control of costs, rebates collected
288	288	and paid and any fees and charges imposed by the pharmacy benefit
289	289	manager or health maintenance organization pursuant to the contract
290	290	[.] ; and
291	291	(c) Require the pharmacy benefit manager or health
292	292	maintenance organization to comply with the provisions of this
293	293	chapter regarding the provision of prescription drugs under the
294	294	State Plan for Medicaid and the Children’s Health Insurance
295	295	Program to the same extent as the Department.
296	296	4. In addition to meeting the requirements of subsection 3, a
297	297	contract entered into pursuant to:
298	298	(a) Paragraph (a) of subsection 2 may require the pharmacy
299	299	benefit manager to provide the entire amount of any rebates
300	300	received for the purchase of prescription drugs, including, without
301	301	limitation, rebates for the purchase of prescription drugs by an entity
302	302	other than the Department, to the Department.
303	303	(b) Paragraph (b) of subsection 2 must require the health
304	304	maintenance organization to provide to the Department the entire
305	305	amount of any rebates received for the purchase of prescription
306	306	drugs, including, without limitation, rebates for the purchase of
307	307	prescription drugs by an entity other than the Department, less an
308	308	– 7 –
309	309
310	310
311	311	- 82nd Session (2023)
312	312	administrative fee in an amount prescribed by the contract. The
313	313	Department shall adopt policies prescribing the maximum amount
314	314	of such an administrative fee.
315	315	Sec. 3. Chapter 422A of NRS is hereby amended by adding
316	316	thereto a new section to read as follows:
317	317	1. To the extent authorized by federal law and to the extent
318	318	that federal funding is available, the Department shall authorize
319	319	recipients of benefits provided under Supplemental Nutrition
320	320	Assistance or the Special Supplemental Nutrition Program for
321	321	Women, Infants and Children established by 42 U.S.C. § 1786 to
322	322	use such benefits to purchase menstrual products.
323	323	2. The Department shall take any action necessary to obtain
324	324	federal authorization and federal funding to carry out the
325	325	provisions of subsection 1, including, without limitation, applying
326	326	for any necessary federal waiver.
327	327	3. To the extent that money is available for this purpose, the
328	328	Department, through the Division, may establish and administer a
329	329	program to provide assistance for the purpose of purchasing
330	330	menstrual products to recipients of benefits provided through
331	331	programs for which the Division is responsible. The Department
332	332	may accept gifts, grants and donations from any source for the
333	333	purpose of establishing and administering such a program.
334	334	4. As used in this section, “menstrual products” includes,
335	335	without limitation, sanitary napkins, tampons or similar products
336	336	used in connection with the menstrual cycle.
337	337	Sec. 4. NRS 454.221 is hereby amended to read as follows:
338	338	454.221 1. A person who furnishes any dangerous drug
339	339	except upon the prescription of a practitioner is guilty of a category
340	340	D felony and shall be punished as provided in NRS 193.130, unless
341	341	the dangerous drug was obtained originally by a legal prescription.
342	342	2. The provisions of this section do not apply to the furnishing
343	343	of any dangerous drug by:
344	344	(a) A practitioner to his or her patients;
345	345	(b) A physician assistant licensed pursuant to chapter 630 or 633
346	346	of NRS if authorized by the Board;
347	347	(c) A registered nurse while participating in a public health
348	348	program approved by the Board, or an advanced practice registered
349	349	nurse who holds a certificate from the State Board of Pharmacy
350	350	permitting him or her to dispense dangerous drugs;
351	351	(d) A manufacturer or wholesaler or pharmacy to each other or
352	352	to a practitioner or to a laboratory under records of sales and
353	353	purchases that correctly give the date, the names and addresses of
354	354	the supplier and the buyer, the drug and its quantity;
355	355	– 8 –
356	356
357	357
358	358	- 82nd Session (2023)
359	359	(e) A hospital pharmacy or a pharmacy so designated by a
360	360	county health officer in a county whose population is 100,000 or
361	361	more, or by a district health officer in any county within its
362	362	jurisdiction or, in the absence of either, by the Chief Medical Officer
363	363	or the Chief Medical Officer’s designated Medical Director of
364	364	Emergency Medical Services, to a person or agency described in
365	365	subsection [3] 4 of NRS 639.268 to stock ambulances or other
366	366	authorized vehicles or replenish the stock; or
367	367	(f) A pharmacy in a correctional institution to a person
368	368	designated by the Director of the Department of Corrections to
369	369	administer a lethal injection to a person who has been sentenced to
370	370	death.
371	371	Sec. 5. NRS 639.268 is hereby amended to read as follows:
372	372	639.268 1. A practitioner may purchase supplies of
373	373	controlled substances, poisons, dangerous drugs and devices from a
374	374	pharmacy by:
375	375	(a) Making an oral order to the pharmacy or transmitting an oral
376	376	order through his or her agent, except an order for a controlled
377	377	substance in schedule II; or
378	378	(b) If the order is for a controlled substance, presenting to the
379	379	pharmacy a written order signed by the practitioner which contains
380	380	his or her registration number issued by the Drug Enforcement
381	381	Administration.
382	382	2. Any person or entity authorized to dispense controlled
383	383	substances and dangerous drugs, including, without limitation, a
384	384	pharmacy, institutional pharmacy or practitioner, may:
385	385	(a) Purchase or otherwise acquire controlled substances and
386	386	dangerous drugs compounded or repackaged by an outsourcing
387	387	facility directly from the outsourcing facility without an order
388	388	from a practitioner other than, where applicable, the practitioner
389	389	purchasing or acquiring the controlled substance or dangerous
390	390	drug; and
391	391	(b) Administer and dispense controlled substances and
392	392	dangerous drugs purchased or acquired pursuant to paragraph (a)
393	393	to the same extent as controlled substances and dangerous drugs
394	394	acquired through other authorized means.
395	395	3. A hospital pharmacy or a pharmacy designated for this
396	396	purpose by a county health officer in a county whose population is
397	397	100,000 or more, or by a district health officer in any county within
398	398	its jurisdiction or, in the absence of either, by the Chief Medical
399	399	Officer or his or her designated medical director of emergency
400	400	medical services, may sell to a person or agency described in
401	401	subsection [3] 4 supplies of controlled substances to stock the
402	402	– 9 –
403	403
404	404
405	405	- 82nd Session (2023)
406	406	ambulances or other authorized vehicles of such a person or agency
407	407	or replenish the stock if:
408	408	(a) The person or agency is registered with the Drug
409	409	Enforcement Administration pursuant to 21 C.F.R. Part 1301;
410	410	(b) The person in charge of the controlled substances is:
411	411	(1) A paramedic appropriately certified by the health
412	412	authority;
413	413	(2) A registered nurse licensed by the State Board of
414	414	Nursing; or
415	415	(3) A person who holds equivalent certification or licensure
416	416	issued by another state; and
417	417	(c) Except as otherwise provided in this paragraph, the purchase
418	418	order is countersigned by a physician or initiated by an oral order
419	419	and may be made by the person or agency or transmitted by an agent
420	420	of such a person or agency. An order for a controlled substance
421	421	listed in schedule II must be made pursuant to NRS 453.251.
422	422	[3.] 4. A pharmacy, institutional pharmacy or other person
423	423	licensed by the Board to furnish controlled substances and
424	424	dangerous drugs may sell to:
425	425	(a) The holder of a permit issued pursuant to the provisions of
426	426	NRS 450B.200 or 450B.210;
427	427	(b) The holder of a permit issued by another state which is
428	428	substantially similar to a permit issued pursuant to the provisions of
429	429	NRS 450B.200 or 450B.210; and
430	430	(c) An agency of the Federal Government that provides
431	431	emergency care or transportation and is registered with the Drug
432	432	Enforcement Administration pursuant to 21 C.F.R. Part 1301.
433	433	[4.] 5. A pharmacy, institutional pharmacy , outsourcing
434	434	facility or other person licensed by the Board to furnish dangerous
435	435	drugs who sells supplies pursuant to this section shall maintain a
436	436	record of each sale which must contain:
437	437	(a) The date of sale;
438	438	(b) The name, address and signature of the purchaser or the
439	439	person receiving the delivery;
440	440	(c) The name of the dispensing pharmacist [;] , where
441	441	applicable;
442	442	(d) The name and address of the authorizing practitioner [;] ,
443	443	where applicable; and
444	444	(e) The name, strength and quantity of each drug sold.
445	445	[5.] 6. A pharmacy, institutional pharmacy or other person
446	446	licensed by the Board to furnish dangerous drugs who supplies the
447	447	initial stock for an ambulance or other emergency vehicle shall
448	448	– 10 –
449	449
450	450
451	451	- 82nd Session (2023)
452	452	comply with any applicable regulations adopted by the State Board
453	453	of Health, or a district board of health, pursuant to NRS 450B.120.
454	454	[6.] 7. The Board shall adopt regulations regarding the records
455	455	a pharmacist shall keep of any purchase made pursuant to this
456	456	section.
457	457	8. As used in this section:
458	458	(a) “Compounding” includes, without limitation, the
459	459	combining, admixing, mixing, pooling, reconstituting or other
460	460	altering of a drug or bulk drug substance, as defined in 21 C.F.R.
461	461	§ 207.3, to create a drug.
462	462	(b) “Outsourcing facility” means a manufacturer at one
463	463	geographic location or address that:
464	464	(1) Is engaged in the compounding of sterile or nonsterile
465	465	drugs for use by humans; and
466	466	(2) Has registered with the Secretary of Health and Human
467	467	Services as an outsourcing facility pursuant to 21 U.S.C. § 353b.
468	468	Sec. 6. NRS 639.28075 is hereby amended to read as follows:
469	469	639.28075 1. Except as otherwise provided in [subsections]
470	470	subsection 2 , [and 3,] pursuant to a valid prescription or order for a
471	471	drug to be used for contraception or its therapeutic equivalent which
472	472	has been approved by the Food and Drug Administration , a
473	473	pharmacist shall:
474	474	(a) [The first time dispensing the drug or therapeutic equivalent
475	475	to] If the patient [,] is not currently using the drug or its
476	476	therapeutic equivalent, dispense up to a 3-month supply of the drug
477	477	or therapeutic equivalent [.] or any amount designated by the
478	478	prescription or order, whichever is less.
479	479	(b) [The second time dispensing] If the drug or therapeutic
480	480	equivalent has only been dispensed to the patient [,] once pursuant
481	481	to paragraph (a), dispense up to a 9-month supply of the drug or
482	482	therapeutic equivalent, any amount designated by the prescription
483	483	or order or any amount which covers the remainder of the plan year
484	484	if the patient is covered by a health care plan, whichever is less.
485	485	(c) For a refill in a plan year following the initial dispensing of a
486	486	drug or therapeutic equivalent pursuant to paragraphs (a) and (b),
487	487	dispense [up to] a 12-month supply of the drug or therapeutic
488	488	equivalent , any amount designated by the prescription or order or
489	489	any amount which covers the remainder of the plan year if the
490	490	patient is covered by a health care plan, whichever is less.
491	491	2. [The provisions of paragraphs (b) and (c) of subsection 1
492	492	only apply if:
493	493	(a) The drug for contraception or the therapeutic equivalent of
494	494	such drug is the same drug or therapeutic equivalent which was
495	495	– 11 –
496	496
497	497
498	498	- 82nd Session (2023)
499	499	previously prescribed or ordered pursuant to paragraph (a) of
500	500	subsection 1; and
501	501	(b) The patient is covered by the same health care plan.
502	502	3. If a prescription or order for a drug for contraception or its
503	503	therapeutic equivalent limits the dispensing of the drug or
504	504	therapeutic equivalent to a quantity which is less than the amount
505	505	otherwise authorized to be dispensed pursuant to subsection 1, the
506	506	pharmacist must dispense the drug or therapeutic equivalent in
507	507	accordance with the quantity specified in the prescription or order.
508	508	4.] A pharmacist is not required to dispense an amount of a
509	509	drug to be used for contraception or its therapeutic equivalent for
510	510	which the patient is unable or unwilling to pay any applicable
511	511	charge, copayment or coinsurance due to the pharmacy.
512	512	3. As used in this section:
513	513	(a) “Health care plan” means a policy, contract, certificate or
514	514	agreement offered or issued by an insurer, including without
515	515	limitation, the State Plan for Medicaid, to provide, deliver, arrange
516	516	for, pay for or reimburse any of the costs of health care services.
517	517	(b) “Plan year” means the year designated in the evidence of
518	518	coverage of a health care plan in which a person is covered by such
519	519	plan.
520	520	(c) “Therapeutic equivalent” means a drug which:
521	521	(1) Contains an identical amount of the same active
522	522	ingredients in the same dosage and method of administration as
523	523	another drug;
524	524	(2) Is expected to have the same clinical effect when
525	525	administered to a patient pursuant to a prescription or order as
526	526	another drug; and
527	527	(3) Meets any other criteria required by the Food and Drug
528	528	Administration for classification as a therapeutic equivalent.
529	529	Sec. 7. Chapter 640C of NRS is hereby amended by adding
530	530	thereto a new section to read as follows:
531	531
532	532	INTERSTATE MASSAGE COMPACT
533	533	ARTICLE 1-PURPOSE
534	534
535	535	The purpose of this Compact is to reduce the burdens on State
536	536	governments and to facilitate the interstate practice and regulation
537	537	of Massage Therapy with the goal of improving public access to,
538	538	and the safety of, Massage Therapy Services. Through this
539	539	Compact, the Member States seek to establish a regulatory
540	540	framework which provides for a new multistate licensing program.
541	541	Through this additional licensing pathway, the Member States
542	542	– 12 –
543	543
544	544
545	545	- 82nd Session (2023)
546	546	seek to provide increased value and mobility to licensed massage
547	547	therapists in the Member States, while ensuring the provision of
548	548	safe, competent, and reliable services to the public.
549	549	This Compact is designed to achieve the following objectives,
550	550	and the Member States hereby ratify the same intentions by
551	551	subscribing hereto:
552	552	A. Increase public access to Massage Therapy Services by
553	553	providing for a multistate licensing pathway;
554	554	B. Enhance the Member States’ ability to protect the public’s
555	555	health and safety;
556	556	C. Enhance the Member States’ ability to prevent human
557	557	trafficking and licensure fraud;
558	558	D. Encourage the cooperation of Member States in
559	559	regulating the multistate Practice of Massage Therapy;
560	560	E. Support relocating military members and their spouses;
561	561	F. Facilitate and enhance the exchange of licensure,
562	562	investigative, and disciplinary information between the Member
563	563	States;
564	564	G. Create an Interstate Commission that will exist to
565	565	implement and administer the Compact;
566	566	H. Allow a Member State to hold a Licensee accountable,
567	567	even where that Licensee holds a Multistate License;
568	568	I. Create a streamlined pathway for Licensees to practice in
569	569	Member States, thus increasing the mobility of duly licensed
570	570	massage therapists; and
571	571	J. Serve the needs of licensed massage therapists and the
572	572	public receiving their services; however,
573	573	K. Nothing in this Compact is intended to prevent a State
574	574	from enforcing its own laws regarding the Practice of Massage
575	575	Therapy.
576	576
577	577	ARTICLE 2-DEFINITIONS
578	578
579	579	As used in this Compact, except as otherwise provided and
580	580	subject to clarification by the Rules of the Commission, the
581	581	following definitions shall govern the terms herein:
582	582	A. “Active Military Member” - any person with full-time duty
583	583	status in the armed forces of the United States, including members
584	584	of the National Guard and Reserve.
585	585	B. “Adverse Action” - any administrative, civil, equitable, or
586	586	criminal action permitted by a Member State’s laws which is
587	587	imposed by a Licensing Authority or other regulatory body against
588	588	a Licensee, including actions against an individual’s
589	589	– 13 –
590	590
591	591
592	592	- 82nd Session (2023)
593	593	Authorization to Practice such as revocation, suspension,
594	594	probation, surrender in lieu of discipline, monitoring of the
595	595	Licensee, limitation of the Licensee’s practice, or any other
596	596	Encumbrance on licensure affecting an individual’s ability to
597	597	practice Massage Therapy, including the issuance of a cease and
598	598	desist order.
599	599	C. “Alternative Program” - a non-disciplinary monitoring or
600	600	prosecutorial diversion program approved by a Member State’s
601	601	Licensing Authority.
602	602	D. “Authorization to Practice” - a legal authorization by a
603	603	Remote State pursuant to a Multistate License permitting the
604	604	Practice of Massage Therapy in that Remote State, which shall be
605	605	subject to the enforcement jurisdiction of the Licensing Authority
606	606	in that Remote State.
607	607	E. “Background Check” - the submission of an applicant’s
608	608	criminal history record information, as further defined in 28
609	609	C.F.R. § 20.3(d), as amended from the Federal Bureau of
610	610	Investigation and the agency responsible for retaining State
611	611	criminal records in the applicant’s Home State.
612	612	F. “Charter Member States” - Member States who have
613	613	enacted legislation to adopt this Compact where such legislation
614	614	predates the effective date of this Compact as defined in Article 12.
615	615	G. “Commission” - the government agency whose
616	616	membership consists of all States that have enacted this Compact,
617	617	which is known as the Interstate Massage Compact Commission,
618	618	as defined in Article 8, and which shall operate as an
619	619	instrumentality of the Member States.
620	620	H. “Continuing Competence” - a requirement, as a condition
621	621	of license renewal, to provide evidence of participation in, and
622	622	completion of, educational or professional activities that maintain,
623	623	improve, or enhance Massage Therapy fitness to practice.
624	624	I. “Current Significant Investigative Information” -
625	625	Investigative Information that a Licensing Authority, after an
626	626	inquiry or investigation that complies with a Member State’s due
627	627	process requirements, has reason to believe is not groundless and,
628	628	if proved true, would indicate a violation of that State’s laws
629	629	regarding the Practice of Massage Therapy.
630	630	J. “Data System” - a repository of information about
631	631	Licensees who hold Multistate Licenses, which may include but is
632	632	not limited to license status, Investigative Information, and
633	633	Adverse Actions.
634	634	– 14 –
635	635
636	636
637	637	- 82nd Session (2023)
638	638	K. “Disqualifying Event” - any event which shall disqualify
639	639	an individual from holding a Multistate License under this
640	640	Compact, which the Commission may by Rule specify.
641	641	L. “Encumbrance” - a revocation or suspension of, or any
642	642	limitation or condition on, the full and unrestricted Practice of
643	643	Massage Therapy by a Licensing Authority.
644	644	M. “Executive Committee” - a group of delegates elected or
645	645	appointed to act on behalf of, and within the powers granted to
646	646	them by, the Commission.
647	647	N. “Home State” - means the Member State which is a
648	648	Licensee’s primary state of residence where the Licensee holds an
649	649	active Single-State License.
650	650	O. “Investigative Information” - information, records, or
651	651	documents received or generated by a Licensing Authority
652	652	pursuant to an investigation or other inquiry.
653	653	P. “Licensing Authority” - a State’s regulatory body
654	654	responsible for issuing Massage Therapy licenses or otherwise
655	655	overseeing the Practice of Massage Therapy in that State.
656	656	Q. “Licensee” - an individual who currently holds a license
657	657	from a Member State to fully practice Massage Therapy, whose
658	658	license is not a student, provisional, temporary, inactive, or other
659	659	similar status.
660	660	R. “Massage Therapy”, “Massage Therapy Services”, and
661	661	the “Practice of Massage Therapy” - the care and services
662	662	provided by a Licensee as set forth in the Member State’s statutes
663	663	and regulations in the State where the services are being provided.
664	664	S. “Member State” - any State that has adopted this Compact.
665	665	T. “Multistate License” - a license that consists of
666	666	Authorizations to Practice Massage Therapy in all Remote States
667	667	pursuant to this Compact, which shall be subject to the
668	668	enforcement jurisdiction of the Licensing Authority in a
669	669	Licensee’s Home State.
670	670	U. “National Licensing Examination” - A national
671	671	examination developed by a national association of Massage
672	672	Therapy regulatory boards, as defined by Commission Rule, that is
673	673	derived from a practice analysis and is consistent with generally
674	674	accepted psychometric principles of fairness, validity and
675	675	reliability, and is administered under secure and confidential
676	676	examination protocols.
677	677	V. “Remote State” - any Member State, other than the
678	678	Licensee’s Home State.
679	679	– 15 –
680	680
681	681
682	682	- 82nd Session (2023)
683	683	W. “Rule” - any opinion or regulation promulgated by the
684	684	Commission under this Compact, which shall have the force of
685	685	law.
686	686	X. “Single-State License” - a current, valid authorization
687	687	issued by a Member State’s Licensing Authority allowing an
688	688	individual to fully practice Massage Therapy, that is not a
689	689	restricted, student, provisional, temporary, or inactive practice
690	690	authorization and authorizes practice only within the issuing
691	691	State.
692	692	Y. “State” - a state, territory, possession of the United States,
693	693	or the District of Columbia.
694	694
695	695	ARTICLE 3-MEMBER STATE REQUIREMENTS
696	696
697	697	A. To be eligible to join this Compact, and to maintain
698	698	eligibility as a Member State, a State must:
699	699	1. License and regulate the Practice of Massage Therapy;
700	700	2. Have a mechanism or entity in place to receive and
701	701	investigate complaints from the public, regulatory or law
702	702	enforcement agencies, or the Commission about Licensees
703	703	practicing in that State;
704	704	3. Accept passage of a National Licensing Examination as a
705	705	criterion for Massage Therapy licensure in that State;
706	706	4. Require that Licensees satisfy educational requirements
707	707	prior to being licensed to provide Massage Therapy Services to the
708	708	public in that State;
709	709	5. Implement procedures for requiring the Background
710	710	Check of applicants for a Multistate License, and for the reporting
711	711	of any Disqualifying Events, including but not limited to obtaining
712	712	and submitting, for each Licensee holding a Multistate License
713	713	and each applicant for a Multistate License, fingerprint or other
714	714	biometric-based information to the Federal Bureau of
715	715	Investigation for Background Checks; receiving the results of the
716	716	Federal Bureau of Investigation record search on Background
717	717	Checks and considering the results of such a Background Check
718	718	in making licensure decisions;
719	719	6. Have Continuing Competence requirements as a condition
720	720	for license renewal;
721	721	7. Participate in the Data System, including through the use
722	722	of unique identifying numbers as described herein;
723	723	8. Notify the Commission and other Member States, in
724	724	compliance with the terms of the Compact and Rules of the
725	725	Commission, of any disciplinary action taken by the State against
726	726	– 16 –
727	727
728	728
729	729	- 82nd Session (2023)
730	730	a Licensee practicing under a Multistate License in that State, or
731	731	of the existence of Investigative Information or Current
732	732	Significant Investigative Information regarding a Licensee
733	733	practicing in that State pursuant to a Multistate License;
734	734	9. Comply with the Rules of the Commission;
735	735	10. Accept Licensees with valid Multistate Licenses from
736	736	other Member States as established herein;
737	737	B. Individuals not residing in a Member State shall continue
738	738	to be able to apply for a Member State’s Single-State License as
739	739	provided under the laws of each Member State. However, the
740	740	Single-State License granted to those individuals shall not be
741	741	recognized as granting a Multistate License for Massage Therapy
742	742	in any other Member State;
743	743	C. Nothing in this Compact shall affect the requirements
744	744	established by a Member State for the issuance of a Single-State
745	745	License; and
746	746	D. A Multistate License issued to a Licensee shall be
747	747	recognized by each Remote State as an Authorization to Practice
748	748	Massage Therapy in each Remote State.
749	749
750	750	ARTICLE 4-MULTISTATE LICENSE REQUIREMENTS
751	751
752	752	A. To qualify for a Multistate License under this Compact,
753	753	and to maintain eligibility for such a license, an applicant must:
754	754	1. Hold an active Single-State License to practice Massage
755	755	Therapy in the applicant’s Home State;
756	756	2. Have completed at least six hundred and twenty-five (625)
757	757	clock hours of Massage Therapy education or the substantial
758	758	equivalent which the Commission may approve by Rule.
759	759	3. Have passed a National Licensing Examination or the
760	760	substantial equivalent which the Commission may approve by
761	761	Rule;
762	762	4. Submit to a Background Check;
763	763	5. Have not been convicted or found guilty, or have entered
764	764	into an agreed disposition, of a felony offense under applicable
765	765	State or federal criminal law, within five (5) years prior to the date
766	766	of their application, where such a time period shall not include
767	767	any time served for the offense, and provided that the applicant
768	768	has completed any and all requirements arising as a result of any
769	769	such offense;
770	770	6. Have not been convicted or found guilty, or have entered
771	771	into an agreed disposition, of a misdemeanor offense related to the
772	772	Practice of Massage Therapy under applicable State or federal
773	773	– 17 –
774	774
775	775
776	776	- 82nd Session (2023)
777	777	criminal law, within two (2) years prior to the date of their
778	778	application where such a time period shall not include any time
779	779	served for the offense, and provided that the applicant has
780	780	completed any and all requirements arising as a result of any such
781	781	offense;
782	782	7. Have not been convicted or found guilty, or have entered
783	783	into an agreed disposition, of any offense, whether a misdemeanor
784	784	or a felony, under State or federal law, at any time, relating to any
785	785	of the following:
786	786	a. Kidnapping;
787	787	b. Human trafficking;
788	788	c. Human smuggling;
789	789	d. Sexual battery, sexual assault, or any related offenses; or
790	790	e. Any other category of offense which the Commission
791	791	may by Rule designate.
792	792	8. Have not previously held a Massage Therapy license which
793	793	was revoked by, or surrendered in lieu of discipline to an
794	794	applicable Licensing Authority;
795	795	9. Have no history of any Adverse Action on any
796	796	occupational or professional license within two (2) years prior to
797	797	the date of their application; and
798	798	10. Pay all required fees.
799	799	B. A Multistate License granted pursuant to this Compact
800	800	may be effective for a definite period of time concurrent with the
801	801	renewal of the Home State license.
802	802	C. A Licensee practicing in a Member State is subject to all
803	803	scope of practice laws governing Massage Therapy Services in
804	804	that State.
805	805	D. The Practice of Massage Therapy under a Multistate
806	806	License granted pursuant to this Compact will subject the
807	807	Licensee to the jurisdiction of the Licensing Authority, the courts,
808	808	and the laws of the Member State in which the Massage Therapy
809	809	Services are provided.
810	810
811	811	ARTICLE 5-AUTHORITY OF INTERSTATE
812	812	MASSAGE COMPACT COMMISSION AND
813	813	MEMBER STATE LICENSING AUTHORITIES
814	814
815	815	A. Nothing in this Compact, nor any Rule of the Commission,
816	816	shall be construed to limit, restrict, or in any way reduce the ability
817	817	of a Member State to enact and enforce laws, regulations, or other
818	818	rules related to the Practice of Massage Therapy in that State,
819	819	– 18 –
820	820
821	821
822	822	- 82nd Session (2023)
823	823	where those laws, regulations, or other rules are not inconsistent
824	824	with the provisions of this Compact.
825	825	B. Nothing in this Compact, nor any Rule of the Commission,
826	826	shall be construed to limit, restrict, or in any way reduce the ability
827	827	of a Member State to take Adverse Action against a Licensee’s
828	828	Single-State License to practice Massage Therapy in that State.
829	829	C. Nothing in this Compact, nor any Rule of the Commission,
830	830	shall be construed to limit, restrict, or in any way reduce the ability
831	831	of a Remote State to take Adverse Action against a Licensee’s
832	832	Authorization to Practice in that State.
833	833	D. Nothing in this Compact, nor any Rule of the
834	834	Commission, shall be construed to limit, restrict, or in any way
835	835	reduce the ability of a Licensee’s Home State to take Adverse
836	836	Action against a Licensee’s Multistate License based upon
837	837	information provided by a Remote State.
838	838	E. Insofar as practical, a Member State’s Licensing Authority
839	839	shall cooperate with the Commission and with each entity
840	840	exercising independent regulatory authority over the Practice of
841	841	Massage Therapy according to the provisions of this Compact.
842	842
843	843	ARTICLE 6-ADVERSE ACTIONS
844	844
845	845	A. A Licensee’s Home State shall have exclusive power to
846	846	impose an Adverse Action against a Licensee’s Multistate License
847	847	issued by the Home State.
848	848	B. A Home State may take Adverse Action on a Multistate
849	849	License based on the Investigative Information, Current
850	850	Significant Investigative Information, or Adverse Action of a
851	851	Remote State.
852	852	C. A Home State shall retain authority to complete any
853	853	pending investigations of a Licensee practicing under a Multistate
854	854	License who changes their Home State during the course of such
855	855	an investigation. The Licensing Authority shall also be empowered
856	856	to report the results of such an investigation to the Commission
857	857	through the Data System as described herein.
858	858	D. Any Member State may investigate actual or alleged
859	859	violations of the scope of practice laws in any other Member State
860	860	for a massage therapist who holds a Multistate License.
861	861	E. A Remote State shall have the authority to:
862	862	1. Take Adverse Actions against a Licensee’s Authorization
863	863	to Practice.
864	864	2. Issue cease and desist orders or impose an Encumbrance
865	865	on a Licensee’s Authorization to Practice in that State.
866	866	– 19 –
867	867
868	868
869	869	- 82nd Session (2023)
870	870	3. Issue subpoenas for both hearings and investigations that
871	871	require the attendance and testimony of witnesses, as well as the
872	872	production of evidence. Subpoenas issued by a Licensing
873	873	Authority in a Member State for the attendance and testimony of
874	874	witnesses or the production of evidence from another Member
875	875	State shall be enforced in the latter State by any court of
876	876	competent jurisdiction, according to the practice and procedure of
877	877	that court applicable to subpoenas issued in proceedings before it.
878	878	The issuing Licensing Authority shall pay any witness fees, travel
879	879	expenses, mileage, and other fees required by the service statutes
880	880	of the State in which the witnesses or evidence are located.
881	881	4. If otherwise permitted by State law, recover from the
882	882	affected Licensee the costs of investigations and disposition of
883	883	cases resulting from any Adverse Action taken against that
884	884	Licensee.
885	885	5. Take Adverse Action against the Licensee’s Authorization
886	886	to Practice in that State based on the factual findings of another
887	887	Member State.
888	888	F. If an Adverse Action is taken by the Home State against a
889	889	Licensee’s Multistate License or Single-State License to practice
890	890	in the Home State, the Licensee’s Authorization to Practice in all
891	891	other Member States shall be deactivated until all Encumbrances
892	892	have been removed from such license. All Home State disciplinary
893	893	orders that impose an Adverse Action against a Licensee shall
894	894	include a statement that the Massage Therapist’s Authorization to
895	895	Practice is deactivated in all Member States during the pendency
896	896	of the order.
897	897	G. If Adverse Action is taken by a Remote State against a
898	898	Licensee’s Authorization to Practice, that Adverse Action applies
899	899	to all Authorizations to Practice in all Remote States. A Licensee
900	900	whose Authorization to Practice in a Remote State is removed for
901	901	a specified period of time is not eligible to apply for a new
902	902	Multistate License in any other State until the specific time for
903	903	removal of the Authorization to Practice has passed and all
904	904	encumbrance requirements are satisfied.
905	905	H. Nothing in this Compact shall override a Member State’s
906	906	authority to accept a Licensee’s participation in an Alternative
907	907	Program in lieu of Adverse Action. A Licensee’s Multistate
908	908	License shall be suspended for the duration of the Licensee’s
909	909	participation in any Alternative Program.
910	910	I. Joint Investigations
911	911	1. In addition to the authority granted to a Member State by
912	912	its respective scope of practice laws or other applicable State law, a
913	913	– 20 –
914	914
915	915
916	916	- 82nd Session (2023)
917	917	Member State may participate with other Member States in joint
918	918	investigations of Licensees.
919	919	2. Member States shall share any investigative, litigation, or
920	920	compliance materials in furtherance of any joint or individual
921	921	investigation initiated under the Compact.
922	922
923	923	ARTICLE 7-ACTIVE MILITARY MEMBERS AND THEIR
924	924	SPOUSES
925	925
926	926	Active Military Members, or their spouses, shall designate a
927	927	Home State where the individual has a current license to practice
928	928	Massage Therapy in good standing. The individual may retain
929	929	their Home State designation during any period of service when
930	930	that individual or their spouse is on active duty assignment.
931	931
932	932	ARTICLE 8-ESTABLISHMENT AND OPERATION OF
933	933	INTERSTATE MASSAGE COMPACT COMMISSION
934	934
935	935	A. The Compact Member States hereby create and establish a
936	936	joint government agency whose membership consists of all
937	937	Member States that have enacted the Compact known as the
938	938	Interstate Massage Compact Commission. The Commission is an
939	939	instrumentality of the Compact States acting jointly and not an
940	940	instrumentality of any one State. The Commission shall come into
941	941	existence on or after the effective date of the Compact as set forth
942	942	in Article 12.
943	943	B. Membership, Voting, and Meetings
944	944	1. Each Member State shall have and be limited to one (1)
945	945	delegate selected by that Member State’s State Licensing
946	946	Authority.
947	947	2. The delegate shall be the primary administrative officer of
948	948	the State Licensing Authority or their designee.
949	949	3. The Commission shall by Rule or bylaw establish a term of
950	950	office for delegates and may by Rule or bylaw establish term
951	951	limits.
952	952	4. The Commission may recommend removal or suspension
953	953	of any delegate from office.
954	954	5. A Member State’s State Licensing Authority shall fill any
955	955	vacancy of its delegate occurring on the Commission within 60
956	956	days of the vacancy.
957	957	6. Each delegate shall be entitled to one vote on all matters
958	958	that are voted on by the Commission.
959	959	– 21 –
960	960
961	961
962	962	- 82nd Session (2023)
963	963	7. The Commission shall meet at least once during each
964	964	calendar year. Additional meetings may be held as set forth in the
965	965	bylaws. The Commission may meet by telecommunication, video
966	966	conference or other similar electronic means.
967	967	C. The Commission shall have the following powers:
968	968	1. Establish the fiscal year of the Commission;
969	969	2. Establish code of conduct and conflict of interest policies;
970	970	3. Adopt Rules and bylaws;
971	971	4. Maintain its financial records in accordance with the
972	972	bylaws;
973	973	5. Meet and take such actions as are consistent with the
974	974	provisions of this Compact, the Commission’s Rules, and the
975	975	bylaws;
976	976	6. Initiate and conclude legal proceedings or actions in the
977	977	name of the Commission, provided that the standing of any State
978	978	Licensing Authority to sue or be sued under applicable law shall
979	979	not be affected;
980	980	7. Maintain and certify records and information provided to a
981	981	Member State as the authenticated business records of the
982	982	Commission, and designate an agent to do so on the Commission’s
983	983	behalf;
984	984	8. Purchase and maintain insurance and bonds;
985	985	9. Borrow, accept, or contract for services of personnel,
986	986	including, but not limited to, employees of a Member State;
987	987	10. Conduct an annual financial review;
988	988	11. Hire employees, elect or appoint officers, fix
989	989	compensation, define duties, grant such individuals appropriate
990	990	authority to carry out the purposes of the Compact, and establish
991	991	the Commission’s personnel policies and programs relating to
992	992	conflicts of interest, qualifications of personnel, and other related
993	993	personnel matters;
994	994	12. Assess and collect fees;
995	995	13. Accept any and all appropriate gifts, donations, grants of
996	996	money, other sources of revenue, equipment, supplies, materials,
997	997	and services, and receive, utilize, and dispose of the same;
998	998	provided that at all times the Commission shall avoid any
999	999	appearance of impropriety or conflict of interest;
1000	1000	14. Lease, purchase, retain, own, hold, improve, or use any
1001	1001	property, real, personal, or mixed, or any undivided interest
1002	1002	therein;
1003	1003	15. Sell, convey, mortgage, pledge, lease, exchange, abandon,
1004	1004	or otherwise dispose of any property real, personal, or mixed;
1005	1005	16. Establish a budget and make expenditures;
1006	1006	– 22 –
1007	1007
1008	1008
1009	1009	- 82nd Session (2023)
1010	1010	17. Borrow money;
1011	1011	18. Appoint committees, including standing committees,
1012	1012	composed of members, State regulators, State legislators or their
1013	1013	representatives, and consumer representatives, and such other
1014	1014	interested persons as may be designated in this Compact and the
1015	1015	bylaws;
1016	1016	19. Accept and transmit complaints from the public,
1017	1017	regulatory or law enforcement agencies, or the Commission, to the
1018	1018	relevant Member State(s) regarding potential misconduct of
1019	1019	Licensees;
1020	1020	20. Elect a Chair, Vice Chair, Secretary and Treasurer and
1021	1021	such other officers of the Commission as provided in the
1022	1022	Commission’s bylaws;
1023	1023	21. Establish and elect an Executive Committee, including a
1024	1024	chair and a vice chair;
1025	1025	22. Adopt and provide to the Member States an annual
1026	1026	report;
1027	1027	23. Determine whether a State’s adopted language is
1028	1028	materially different from the model Compact language such that
1029	1029	the State would not qualify for participation in the Compact; and
1030	1030	24. Perform such other functions as may be necessary or
1031	1031	appropriate to achieve the purposes of this Compact.
1032	1032	D. The Executive Committee
1033	1033	1. The Executive Committee shall have the power to act on
1034	1034	behalf of the Commission according to the terms of this Compact.
1035	1035	The powers, duties, and responsibilities of the Executive
1036	1036	Committee shall include:
1037	1037	a. Overseeing the day-to-day activities of the administration
1038	1038	of the Compact including compliance with the provisions of the
1039	1039	Compact, the Commission’s Rules and bylaws, and other such
1040	1040	duties as deemed necessary;
1041	1041	b. Recommending to the Commission changes to the Rules
1042	1042	or bylaws, changes to this Compact legislation, fees charged to
1043	1043	Compact Member States, fees charged to Licensees, and other
1044	1044	fees;
1045	1045	c. Ensuring Compact administration services are
1046	1046	appropriately provided, including by contract;
1047	1047	d. Preparing and recommending the budget;
1048	1048	e. Maintaining financial records on behalf of the
1049	1049	Commission;
1050	1050	f. Monitoring Compact compliance of Member States and
1051	1051	providing compliance reports to the Commission;
1052	1052	g. Establishing additional committees as necessary;
1053	1053	– 23 –
1054	1054
1055	1055
1056	1056	- 82nd Session (2023)
1057	1057	h. Exercise the powers and duties of the Commission
1058	1058	during the interim between Commission meetings, except for
1059	1059	adopting or amending Rules, adopting or amending bylaws, and
1060	1060	exercising any other powers and duties expressly reserved to the
1061	1061	Commission by Rule or bylaw; and
1062	1062	i. Other duties as provided in the Rules or bylaws of the
1063	1063	Commission.
1064	1064	2. The Executive Committee shall be composed of seven
1065	1065	voting members and up to two ex-officio members as follows:
1066	1066	a. The chair and vice chair of the Commission and any
1067	1067	other members of the Commission who serve on the Executive
1068	1068	Committee shall be voting members of the Executive Committee.
1069	1069	b. Other than the chair, vice-chair, secretary and treasurer,
1070	1070	the Commission shall elect three voting members from the current
1071	1071	membership of the Commission.
1072	1072	c. The Commission may elect ex-officio, nonvoting
1073	1073	members as necessary as follows:
1074	1074	i. One ex-officio member who is a representative of the
1075	1075	national association of State Massage Therapy regulatory boards.
1076	1076	ii. One ex-officio member as specified in the
1077	1077	Commission’s bylaws.
1078	1078	3. The Commission may remove any member of the Executive
1079	1079	Committee as provided in the Commission’s bylaws.
1080	1080	4. The Executive Committee shall meet at least annually.
1081	1081	a. Executive Committee meetings shall be open to the
1082	1082	public, except that the Executive Committee may meet in a closed,
1083	1083	non-public session of a public meeting when dealing with any of
1084	1084	the matters covered under subsection F.4.
1085	1085	b. The Executive Committee shall give five business days
1086	1086	advance notice of its public meetings, posted on its website and as
1087	1087	determined to provide notice to persons with an interest in the
1088	1088	public matters the Executive Committee intends to address at those
1089	1089	meetings.
1090	1090	5. The Executive Committee may hold an emergency meeting
1091	1091	when acting for the Commission to:
1092	1092	a. Meet an imminent threat to public health, safety, or
1093	1093	welfare;
1094	1094	b. Prevent a loss of Commission or Participating State
1095	1095	funds; or
1096	1096	c. Protect public health and safety.
1097	1097	E. The Commission shall adopt and provide to the Member
1098	1098	States an annual report.
1099	1099	F. Meetings of the Commission
1100	1100	– 24 –
1101	1101
1102	1102
1103	1103	- 82nd Session (2023)
1104	1104	1. All meetings of the Commission that are not closed
1105	1105	pursuant to this subsection shall be open to the public. Notice of
1106	1106	public meetings shall be posted on the Commission’s website at
1107	1107	least thirty (30) days prior to the public meeting.
1108	1108	2. Notwithstanding subsection F.1 of this Article, the
1109	1109	Commission may convene an emergency public meeting by
1110	1110	providing at least twenty-four (24) hours prior notice on the
1111	1111	Commission’s website, and any other means as provided in the
1112	1112	Commission’s Rules, for any of the reasons it may dispense with
1113	1113	notice of proposed rulemaking under Article 10.L. The
1114	1114	Commission’s legal counsel shall certify that one of the reasons
1115	1115	justifying an emergency public meeting has been met.
1116	1116	3. Notice of all Commission meetings shall provide the time,
1117	1117	date, and location of the meeting, and if the meeting is to be held
1118	1118	or accessible via telecommunication, video conference, or other
1119	1119	electronic means, the notice shall include the mechanism for
1120	1120	access to the meeting.
1121	1121	4. The Commission may convene in a closed, non-public
1122	1122	meeting for the Commission to discuss:
1123	1123	a. Non-compliance of a Member State with its obligations
1124	1124	under the Compact;
1125	1125	b. The employment, compensation, discipline or other
1126	1126	matters, practices or procedures related to specific employees or
1127	1127	other matters related to the Commission’s internal personnel
1128	1128	practices and procedures;
1129	1129	c. Current or threatened discipline of a Licensee by the
1130	1130	Commission or by a Member State’s Licensing Authority;
1131	1131	d. Current, threatened, or reasonably anticipated litigation;
1132	1132	e. Negotiation of contracts for the purchase, lease, or sale
1133	1133	of goods, services, or real estate;
1134	1134	f. Accusing any person of a crime or formally censuring
1135	1135	any person;
1136	1136	g. Trade secrets or commercial or financial information
1137	1137	that is privileged or confidential;
1138	1138	h. Information of a personal nature where disclosure would
1139	1139	constitute a clearly unwarranted invasion of personal privacy;
1140	1140	i. Investigative records compiled for law enforcement
1141	1141	purposes;
1142	1142	j. Information related to any investigative reports prepared
1143	1143	by or on behalf of or for use of the Commission or other
1144	1144	committee charged with responsibility of investigation or
1145	1145	determination of compliance issues pursuant to the Compact;
1146	1146	k. Legal advice;
1147	1147	– 25 –
1148	1148
1149	1149
1150	1150	- 82nd Session (2023)
1151	1151	l. Matters specifically exempted from disclosure to the
1152	1152	public by federal or Member State law; or
1153	1153	m. Other matters as promulgated by the Commission by
1154	1154	Rule.
1155	1155	5. If a meeting, or portion of a meeting, is closed, the
1156	1156	presiding officer shall state that the meeting will be closed and
1157	1157	reference each relevant exempting provision, and such reference
1158	1158	shall be recorded in the minutes.
1159	1159	6. The Commission shall keep minutes that fully and clearly
1160	1160	describe all matters discussed in a meeting and shall provide a full
1161	1161	and accurate summary of actions taken, and the reasons
1162	1162	therefore, including a description of the views expressed. All
1163	1163	documents considered in connection with an action shall be
1164	1164	identified in such minutes. All minutes and documents of a closed
1165	1165	meeting shall remain under seal, subject to release only by a
1166	1166	majority vote of the Commission or order of a court of competent
1167	1167	jurisdiction.
1168	1168	G. Financing of the Commission
1169	1169	1. The Commission shall pay, or provide for the payment of,
1170	1170	the reasonable expenses of its establishment, organization, and
1171	1171	ongoing activities.
1172	1172	2. The Commission may accept any and all appropriate
1173	1173	sources of revenue, donations, and grants of money, equipment,
1174	1174	supplies, materials, and services.
1175	1175	3. The Commission may levy on and collect an annual
1176	1176	assessment from each Member State and impose fees on Licensees
1177	1177	of Member States to whom it grants a Multistate License to cover
1178	1178	the cost of the operations and activities of the Commission and its
1179	1179	staff, which must be in a total amount sufficient to cover its
1180	1180	annual budget as approved each year for which revenue is not
1181	1181	provided by other sources. The aggregate annual assessment
1182	1182	amount for Member States shall be allocated based upon a
1183	1183	formula that the Commission shall promulgate by Rule.
1184	1184	4. The Commission shall not incur obligations of any kind
1185	1185	prior to securing the funds adequate to meet the same; nor shall
1186	1186	the Commission pledge the credit of any Member States, except by
1187	1187	and with the authority of the Member State.
1188	1188	5. The Commission shall keep accurate accounts of all
1189	1189	receipts and disbursements. The receipts and disbursements of the
1190	1190	Commission shall be subject to the financial review and
1191	1191	accounting procedures established under its bylaws. All receipts
1192	1192	and disbursements of funds handled by the Commission shall be
1193	1193	subject to an annual financial review by a certified or licensed
1194	1194	– 26 –
1195	1195
1196	1196
1197	1197	- 82nd Session (2023)
1198	1198	public accountant, and the report of the financial review shall be
1199	1199	included in and become part of the annual report of the
1200	1200	Commission.
1201	1201	H. Qualified Immunity, Defense, and Indemnification
1202	1202	1. The members, officers, executive director, employees and
1203	1203	representatives of the Commission shall be immune from suit and
1204	1204	liability, both personally and in their official capacity, for any
1205	1205	claim for damage to or loss of property or personal injury or other
1206	1206	civil liability caused by or arising out of any actual or alleged act,
1207	1207	error, or omission that occurred, or that the person against whom
1208	1208	the claim is made had a reasonable basis for believing occurred
1209	1209	within the scope of Commission employment, duties or
1210	1210	responsibilities; provided that nothing in this paragraph shall be
1211	1211	construed to protect any such person from suit or liability for any
1212	1212	damage, loss, injury, or liability caused by the intentional or
1213	1213	willful or wanton misconduct of that person. The procurement of
1214	1214	insurance of any type by the Commission shall not in any way
1215	1215	compromise or limit the immunity granted hereunder.
1216	1216	2. The Commission shall defend any member, officer,
1217	1217	executive director, employee, and representative of the
1218	1218	Commission in any civil action seeking to impose liability arising
1219	1219	out of any actual or alleged act, error, or omission that occurred
1220	1220	within the scope of Commission employment, duties, or
1221	1221	responsibilities, or as determined by the Commission that the
1222	1222	person against whom the claim is made had a reasonable basis for
1223	1223	believing occurred within the scope of Commission employment,
1224	1224	duties, or responsibilities; provided that nothing herein shall be
1225	1225	construed to prohibit that person from retaining their own counsel
1226	1226	at their own expense; and provided further, that the actual or
1227	1227	alleged act, error, or omission did not result from that person’s
1228	1228	intentional or willful or wanton misconduct.
1229	1229	3. The Commission shall indemnify and hold harmless any
1230	1230	member, officer, executive director, employee, and representative
1231	1231	of the Commission for the amount of any settlement or judgment
1232	1232	obtained against that person arising out of any actual or alleged
1233	1233	act, error, or omission that occurred within the scope of
1234	1234	Commission employment, duties, or responsibilities, or that such
1235	1235	person had a reasonable basis for believing occurred within the
1236	1236	scope of Commission employment, duties, or responsibilities,
1237	1237	provided that the actual or alleged act, error, or omission did not
1238	1238	result from the intentional or willful or wanton misconduct of that
1239	1239	person.
1240	1240	– 27 –
1241	1241
1242	1242
1243	1243	- 82nd Session (2023)
1244	1244	4. Nothing herein shall be construed as a limitation on the
1245	1245	liability of any Licensee for professional malpractice or
1246	1246	misconduct, which shall be governed solely by any other
1247	1247	applicable State laws.
1248	1248	5. Nothing in this Compact shall be interpreted to waive or
1249	1249	otherwise abrogate a Member State’s State action immunity or
1250	1250	State action affirmative defense with respect to antitrust claims
1251	1251	under the Sherman Act, Clayton Act, or any other State or federal
1252	1252	antitrust or anticompetitive law or regulation.
1253	1253	6. Nothing in this Compact shall be construed to be a waiver
1254	1254	of sovereign immunity by the Member States or by the
1255	1255	Commission.
1256	1256
1257	1257	ARTICLE 9-DATA SYSTEM
1258	1258
1259	1259	A. The Commission shall provide for the development,
1260	1260	maintenance, operation, and utilization of a coordinated database
1261	1261	and reporting system.
1262	1262	B. The Commission shall assign each applicant for a
1263	1263	Multistate License a unique identifier, as determined by the Rules
1264	1264	of the Commission.
1265	1265	C. Notwithstanding any other provision of State law to the
1266	1266	contrary, a Member State shall submit a uniform data set to the
1267	1267	Data System on all individuals to whom this Compact is applicable
1268	1268	as required by the Rules of the Commission, including:
1269	1269	1. Identifying information;
1270	1270	2. Licensure data;
1271	1271	3. Adverse Actions against a license and information related
1272	1272	thereto;
1273	1273	4. Non-confidential information related to Alternative
1274	1274	Program participation, the beginning and ending dates of such
1275	1275	participation, and other information related to such participation;
1276	1276	5. Any denial of application for licensure, and the reason(s)
1277	1277	for such denial (excluding the reporting of any criminal history
1278	1278	record information where prohibited by law);
1279	1279	6. The existence of Investigative Information;
1280	1280	7. The existence presence of Current Significant Investigative
1281	1281	Information; and
1282	1282	8. Other information that may facilitate the administration of
1283	1283	this Compact or the protection of the public, as determined by the
1284	1284	Rules of the Commission.
1285	1285	D. The records and information provided to a Member State
1286	1286	pursuant to this Compact or through the Data System, when
1287	1287	– 28 –
1288	1288
1289	1289
1290	1290	- 82nd Session (2023)
1291	1291	certified by the Commission or an agent thereof, shall constitute
1292	1292	the authenticated business records of the Commission, and shall
1293	1293	be entitled to any associated hearsay exception in any relevant
1294	1294	judicial, quasi-judicial or administrative proceedings in a Member
1295	1295	State.
1296	1296	E. The existence of Current Significant Investigative
1297	1297	Information and the existence of Investigative Information
1298	1298	pertaining to a Licensee in any Member State will only be
1299	1299	available to other Member States.
1300	1300	F. It is the responsibility of the Member States to report any
1301	1301	Adverse Action against a Licensee who holds a Multistate License
1302	1302	and to monitor the database to determine whether Adverse Action
1303	1303	has been taken against such a Licensee or License applicant.
1304	1304	Adverse Action information pertaining to a Licensee or License
1305	1305	applicant in any Member State will be available to any other
1306	1306	Member State.
1307	1307	G. Member States contributing information to the Data
1308	1308	System may designate information that may not be shared with the
1309	1309	public without the express permission of the contributing State.
1310	1310	H. Any information submitted to the Data System that is
1311	1311	subsequently expunged pursuant to federal law or the laws of the
1312	1312	Member State contributing the information shall be removed from
1313	1313	the Data System.
1314	1314
1315	1315	ARTICLE 10-RULEMAKING
1316	1316
1317	1317	A. The Commission shall promulgate reasonable Rules in
1318	1318	order to effectively and efficiently implement and administer the
1319	1319	purposes and provisions of the Compact. A Rule shall be invalid
1320	1320	and have no force or effect only if a court of competent
1321	1321	jurisdiction holds that the Rule is invalid because the Commission
1322	1322	exercised its rulemaking authority in a manner that is beyond the
1323	1323	scope and purposes of the Compact, or the powers granted
1324	1324	hereunder, or based upon another applicable standard of review.
1325	1325	B. The Rules of the Commission shall have the force of law
1326	1326	in each Member State, provided however that where the Rules of
1327	1327	the Commission conflict with the laws of the Member State that
1328	1328	establish the Member State’s scope of practice as held by a court
1329	1329	of competent jurisdiction, the Rules of the Commission shall be
1330	1330	ineffective in that State to the extent of the conflict.
1331	1331	C. The Commission shall exercise its Rulemaking powers
1332	1332	pursuant to the criteria set forth in this article and the Rules
1333	1333	– 29 –
1334	1334
1335	1335
1336	1336	- 82nd Session (2023)
1337	1337	adopted thereunder. Rules shall become binding as of the date
1338	1338	specified by the Commission for each Rule.
1339	1339	D. If a majority of the legislatures of the Member States
1340	1340	rejects a Rule or portion of a Rule, by enactment of a statute or
1341	1341	resolution in the same manner used to adopt the Compact within
1342	1342	four (4) years of the date of adoption of the Rule, then such Rule
1343	1343	shall have no further force and effect in any Member State or to
1344	1344	any State applying to participate in the Compact.
1345	1345	E. Rules shall be adopted at a regular or special meeting of
1346	1346	the Commission.
1347	1347	F. Prior to adoption of a proposed Rule, the Commission
1348	1348	shall hold a public hearing and allow persons to provide oral and
1349	1349	written comments, data, facts, opinions, and arguments.
1350	1350	G. Prior to adoption of a proposed Rule by the Commission,
1351	1351	and at least thirty (30) days in advance of the meeting at which the
1352	1352	Commission will hold a public hearing on the proposed Rule, the
1353	1353	Commission shall provide a Notice of Proposed Rulemaking:
1354	1354	1. On the website of the Commission or other publicly
1355	1355	accessible platform;
1356	1356	2. To persons who have requested notice of the Commission’s
1357	1357	notices of proposed rulemaking, and
1358	1358	3. In such other way(s) as the Commission may by Rule
1359	1359	specify.
1360	1360	H. The Notice of Proposed Rulemaking shall include:
1361	1361	1. The time, date, and location of the public hearing at which
1362	1362	the Commission will hear public comments on the proposed Rule
1363	1363	and, if different, the time, date, and location of the meeting where
1364	1364	the Commission will consider and vote on the proposed Rule;
1365	1365	2. If the hearing is held via telecommunication, video
1366	1366	conference, or other electronic means, the Commission shall
1367	1367	include the mechanism for access to the hearing in the Notice of
1368	1368	Proposed Rulemaking;
1369	1369	3. The text of the proposed Rule and the reason therefor;
1370	1370	4. A request for comments on the proposed Rule from any
1371	1371	interested person; and
1372	1372	5. The manner in which interested persons may submit
1373	1373	written comments.
1374	1374	I. All hearings will be recorded. A copy of the recording and
1375	1375	all written comments and documents received by the Commission
1376	1376	in response to the proposed Rule shall be available to the public.
1377	1377	J. Nothing in this article shall be construed as requiring a
1378	1378	separate hearing on each Rule. Rules may be grouped for the
1379	1379	– 30 –
1380	1380
1381	1381
1382	1382	- 82nd Session (2023)
1383	1383	convenience of the Commission at hearings required by this
1384	1384	article.
1385	1385	K. The Commission shall, by majority vote of all
1386	1386	Commissioners, take final action on the proposed Rule based on
1387	1387	the Rulemaking record.
1388	1388	1. The Commission may adopt changes to the proposed Rule
1389	1389	provided the changes do not enlarge the original purpose of the
1390	1390	proposed Rule.
1391	1391	2. The Commission shall provide an explanation of the
1392	1392	reasons for substantive changes made to the proposed Rule as well
1393	1393	as reasons for substantive changes not made that were
1394	1394	recommended by commenters.
1395	1395	3. The Commission shall determine a reasonable effective
1396	1396	date for the Rule. Except for an emergency as provided in
1397	1397	subsection L, the effective date of the Rule shall be no sooner than
1398	1398	thirty (30) days after the Commission issuing the notice that it
1399	1399	adopted or amended the Rule.
1400	1400	L. Upon determination that an emergency exists, the
1401	1401	Commission may consider and adopt an emergency Rule with 24
1402	1402	hours’ notice, provided that the usual Rulemaking procedures
1403	1403	provided in the Compact and in this article shall be retroactively
1404	1404	applied to the Rule as soon as reasonably possible, in no event
1405	1405	later than ninety (90) days after the effective date of the Rule. For
1406	1406	the purposes of this provision, an emergency Rule is one that must
1407	1407	be adopted immediately to:
1408	1408	1. Meet an imminent threat to public health, safety, or
1409	1409	welfare;
1410	1410	2. Prevent a loss of Commission or Member State funds;
1411	1411	3. Meet a deadline for the promulgation of a Rule that is
1412	1412	established by federal law or rule; or
1413	1413	4. Protect public health and safety.
1414	1414	M. The Commission or an authorized committee of the
1415	1415	Commission may direct revisions to a previously adopted Rule for
1416	1416	purposes of correcting typographical errors, errors in format,
1417	1417	errors in consistency, or grammatical errors. Public notice of any
1418	1418	revisions shall be posted on the website of the Commission. The
1419	1419	revision shall be subject to challenge by any person for a period of
1420	1420	thirty (30) days after posting. The revision may be challenged only
1421	1421	on grounds that the revision results in a material change to a
1422	1422	Rule. A challenge shall be made in writing and delivered to the
1423	1423	Commission prior to the end of the notice period. If no challenge
1424	1424	is made, the revision will take effect without further action. If the
1425	1425	– 31 –
1426	1426
1427	1427
1428	1428	- 82nd Session (2023)
1429	1429	revision is challenged, the revision may not take effect without the
1430	1430	approval of the Commission.
1431	1431	N. No Member State’s rulemaking requirements shall apply
1432	1432	under this Compact.
1433	1433
1434	1434	ARTICLE 11-OVERSIGHT, DISPUTE
1435	1435	RESOLUTION, AND ENFORCEMENT
1436	1436
1437	1437	A. Oversight
1438	1438	1. The executive and judicial branches of State government
1439	1439	in each Member State shall enforce this Compact and take all
1440	1440	actions necessary and appropriate to implement the Compact.
1441	1441	2. Venue is proper and judicial proceedings by or against the
1442	1442	Commission shall be brought solely and exclusively in a court of
1443	1443	competent jurisdiction where the principal office of the
1444	1444	Commission is located. The Commission may waive venue and
1445	1445	jurisdictional defenses to the extent it adopts or consents to
1446	1446	participate in alternative dispute resolution proceedings. Nothing
1447	1447	herein shall affect or limit the selection or propriety of venue in
1448	1448	any action against a Licensee for professional malpractice,
1449	1449	misconduct or any such similar matter.
1450	1450	3. The Commission shall be entitled to receive service of
1451	1451	process in any proceeding regarding the enforcement or
1452	1452	interpretation of the Compact and shall have standing to intervene
1453	1453	in such a proceeding for all purposes. Failure to provide the
1454	1454	Commission service of process shall render a judgment or order
1455	1455	void as to the Commission, this Compact, or promulgated Rules.
1456	1456	B. Default, Technical Assistance, and Termination
1457	1457	1. If the Commission determines that a Member State has
1458	1458	defaulted in the performance of its obligations or responsibilities
1459	1459	under this Compact or the promulgated Rules, the Commission
1460	1460	shall provide written notice to the defaulting State. The notice of
1461	1461	default shall describe the default, the proposed means of curing
1462	1462	the default, and any other action that the Commission may take,
1463	1463	and shall offer training and specific technical assistance
1464	1464	regarding the default.
1465	1465	2. The Commission shall provide a copy of the notice of
1466	1466	default to the other Member States.
1467	1467	C. If a State in default fails to cure the default, the defaulting
1468	1468	State may be terminated from the Compact upon an affirmative
1469	1469	vote of a majority of the delegates of the Member States, and all
1470	1470	rights, privileges and benefits conferred on that State by this
1471	1471	Compact may be terminated on the effective date of termination. A
1472	1472	– 32 –
1473	1473
1474	1474
1475	1475	- 82nd Session (2023)
1476	1476	cure of the default does not relieve the offending State of
1477	1477	obligations or liabilities incurred during the period of default.
1478	1478	D. Termination of membership in the Compact shall be
1479	1479	imposed only after all other means of securing compliance have
1480	1480	been exhausted. Notice of intent to suspend or terminate shall be
1481	1481	given by the Commission to the governor, the majority and
1482	1482	minority leaders of the defaulting State’s legislature, the
1483	1483	defaulting State’s State Licensing Authority and each of the
1484	1484	Member States’ State Licensing Authority.
1485	1485	E. A State that has been terminated is responsible for all
1486	1486	assessments, obligations, and liabilities incurred through the
1487	1487	effective date of termination, including obligations that extend
1488	1488	beyond the effective date of termination.
1489	1489	F. Upon the termination of a State’s membership from this
1490	1490	Compact, that State shall immediately provide notice to all
1491	1491	Licensees who hold a Multistate License within that State of such
1492	1492	termination. The terminated State shall continue to recognize all
1493	1493	licenses granted pursuant to this Compact for a minimum of one
1494	1494	hundred eighty (180) days after the date of said notice of
1495	1495	termination.
1496	1496	G. The Commission shall not bear any costs related to a State
1497	1497	that is found to be in default or that has been terminated from the
1498	1498	Compact, unless agreed upon in writing between the Commission
1499	1499	and the defaulting State.
1500	1500	H. The defaulting State may appeal the action of the
1501	1501	Commission by petitioning the U.S. District Court for the District
1502	1502	of Columbia or the federal district where the Commission has its
1503	1503	principal offices. The prevailing party shall be awarded all costs of
1504	1504	such litigation, including reasonable attorney’s fees.
1505	1505	I. Dispute Resolution
1506	1506	1. Upon request by a Member State, the Commission shall
1507	1507	attempt to resolve disputes related to the Compact that arise
1508	1508	among Member States and between Member and non-Member
1509	1509	States.
1510	1510	2. The Commission shall promulgate a Rule providing for
1511	1511	both mediation and binding dispute resolution for disputes as
1512	1512	appropriate.
1513	1513	J. Enforcement
1514	1514	1. The Commission, in the reasonable exercise of its
1515	1515	discretion, shall enforce the provisions of this Compact and the
1516	1516	Commission’s Rules.
1517	1517	2. By majority vote as provided by Commission Rule, the
1518	1518	Commission may initiate legal action against a Member State in
1519	1519	– 33 –
1520	1520
1521	1521
1522	1522	- 82nd Session (2023)
1523	1523	default in the United States District Court for the District of
1524	1524	Columbia or the federal district where the Commission has its
1525	1525	principal offices to enforce compliance with the provisions of the
1526	1526	Compact and its promulgated Rules. The relief sought may
1527	1527	include both injunctive relief and damages. In the event judicial
1528	1528	enforcement is necessary, the prevailing party shall be awarded all
1529	1529	costs of such litigation, including reasonable attorney’s fees. The
1530	1530	remedies herein shall not be the exclusive remedies of the
1531	1531	Commission. The Commission may pursue any other remedies
1532	1532	available under federal or the defaulting Member State’s law.
1533	1533	3. A Member State may initiate legal action against the
1534	1534	Commission in the U.S. District Court for the District of Columbia
1535	1535	or the federal district where the Commission has its principal
1536	1536	offices to enforce compliance with the provisions of the Compact
1537	1537	and its promulgated Rules. The relief sought may include both
1538	1538	injunctive relief and damages. In the event judicial enforcement is
1539	1539	necessary, the prevailing party shall be awarded all costs of such
1540	1540	litigation, including reasonable attorney’s fees.
1541	1541	4. No individual or entity other than a Member State may
1542	1542	enforce this Compact against the Commission.
1543	1543
1544	1544	ARTICLE 12-EFFECTIVE DATE, WITHDRAWAL,
1545	1545	AND AMENDMENT
1546	1546
1547	1547	A. The Compact shall come into effect on the date on which
1548	1548	the Compact statute is enacted into law in the seventh Member
1549	1549	State.
1550	1550	1. On or after the effective date of the Compact, the
1551	1551	Commission shall convene and review the enactment of each of
1552	1552	the Charter Member States to determine if the statute enacted by
1553	1553	each such Charter Member State is materially different than the
1554	1554	model Compact statute.
1555	1555	a. A Charter Member State whose enactment is found to be
1556	1556	materially different from the model Compact statute shall be
1557	1557	entitled to the default process set forth in Article 11.
1558	1558	b. If any Member State is later found to be in default, or is
1559	1559	terminated or withdraws from the Compact, the Commission shall
1560	1560	remain in existence and the Compact shall remain in effect even if
1561	1561	the number of Member States should be less than seven (7).
1562	1562	2. Member States enacting the Compact subsequent to the
1563	1563	Charter Member States shall be subject to the process set forth in
1564	1564	Article 8.C.23 to determine if their enactments are materially
1565	1565	– 34 –
1566	1566
1567	1567
1568	1568	- 82nd Session (2023)
1569	1569	different from the model Compact statute and whether they qualify
1570	1570	for participation in the Compact.
1571	1571	3. All actions taken for the benefit of the Commission or in
1572	1572	furtherance of the purposes of the administration of the Compact
1573	1573	prior to the effective date of the Compact or the Commission
1574	1574	coming into existence shall be considered to be actions of the
1575	1575	Commission unless specifically repudiated by the Commission.
1576	1576	4. Any State that joins the Compact shall be subject to the
1577	1577	Commission’s Rules and bylaws as they exist on the date on which
1578	1578	the Compact becomes law in that State. Any Rule that has been
1579	1579	previously adopted by the Commission shall have the full force
1580	1580	and effect of law on the day the Compact becomes law in that
1581	1581	State.
1582	1582	B. Any Member State may withdraw from this Compact by
1583	1583	enacting a statute repealing that State’s enactment of the
1584	1584	Compact.
1585	1585	1. A Member State’s withdrawal shall not take effect until
1586	1586	one hundred eighty (180) days after enactment of the repealing
1587	1587	statute.
1588	1588	2. Withdrawal shall not affect the continuing requirement of
1589	1589	the withdrawing State’s Licensing Authority to comply with the
1590	1590	investigative and Adverse Action reporting requirements of this
1591	1591	Compact prior to the effective date of withdrawal.
1592	1592	3. Upon the enactment of a statute withdrawing from this
1593	1593	Compact, a State shall immediately provide notice of such
1594	1594	withdrawal to all Licensees within that State. Notwithstanding any
1595	1595	subsequent statutory enactment to the contrary, such withdrawing
1596	1596	State shall continue to recognize all licenses granted pursuant to
1597	1597	this Compact for a minimum of 180 days after the date of such
1598	1598	notice of withdrawal.
1599	1599	C. Nothing contained in this Compact shall be construed to
1600	1600	invalidate or prevent any licensure agreement or other cooperative
1601	1601	arrangement between a Member State and a non-Member State
1602	1602	that does not conflict with the provisions of this Compact.
1603	1603	D. This Compact may be amended by the Member States. No
1604	1604	amendment to this Compact shall become effective and binding
1605	1605	upon any Member State until it is enacted into the laws of all
1606	1606	Member States.
1607	1607
1608	1608	ARTICLE 13. CONSTRUCTION AND SEVERABILITY
1609	1609
1610	1610	A. This Compact and the Commission’s rulemaking authority
1611	1611	shall be liberally construed so as to effectuate the purposes, and
1612	1612	– 35 –
1613	1613
1614	1614
1615	1615	- 82nd Session (2023)
1616	1616	the implementation and administration of the Compact. Provisions
1617	1617	of the Compact expressly authorizing or requiring the
1618	1618	promulgation of Rules shall not be construed to limit the
1619	1619	Commission’s rulemaking authority solely for those purposes.
1620	1620	B. The provisions of this Compact shall be severable and if
1621	1621	any phrase, clause, sentence or provision of this Compact is held
1622	1622	by a court of competent jurisdiction to be contrary to the
1623	1623	constitution of any Member State, a State seeking participation in
1624	1624	the Compact, or of the United States, or the applicability thereof to
1625	1625	any government, agency, person or circumstance is held to be
1626	1626	unconstitutional by a court of competent jurisdiction, the validity
1627	1627	of the remainder of this Compact and the applicability thereof to
1628	1628	any other government, agency, person or circumstance shall not
1629	1629	be affected thereby.
1630	1630	C. Notwithstanding subsection B of this article, the
1631	1631	Commission may deny a State’s participation in the Compact or,
1632	1632	in accordance with the requirements of Article 11.B, terminate a
1633	1633	Member State’s participation in the Compact, if it determines that
1634	1634	a constitutional requirement of a Member State is a material
1635	1635	departure from the Compact. Otherwise, if this Compact shall be
1636	1636	held to be contrary to the constitution of any Member State, the
1637	1637	Compact shall remain in full force and effect as to the remaining
1638	1638	Member States and in full force and effect as to the Member State
1639	1639	affected as to all severable matters.
1640	1640
1641	1641	ARTICLE 14. CONSISTENT EFFECT AND
1642	1642	CONFLICT WITH OTHER STATE LAWS
1643	1643
1644	1644	Nothing herein shall prevent or inhibit the enforcement of any
1645	1645	other law of a Member State that is not inconsistent with the
1646	1646	Compact.
1647	1647	Any laws, statutes, regulations, or other legal requirements in a
1648	1648	Member State in conflict with the Compact are superseded to the
1649	1649	extent of the conflict.
1650	1650	All permissible agreements between the Commission and the
1651	1651	Member States are binding in accordance with their terms.
1652	1652	Sec. 8. NRS 640C.180 is hereby amended to read as follows:
1653	1653	640C.180 1. At the first meeting of each fiscal year, the
1654	1654	members of the Board shall elect a Chair, Vice Chair and Secretary-
1655	1655	Treasurer from among the members.
1656	1656	2. The Board shall meet at least quarterly and may meet at
1657	1657	other times at the call of the Chair or upon the written request of a
1658	1658	majority of the members of the Board.
1659	1659	– 36 –
1660	1660
1661	1661
1662	1662	- 82nd Session (2023)
1663	1663	3. The Board shall alternate the location of its meetings
1664	1664	between the southern district of Nevada and the northern district of
1665	1665	Nevada. For the purposes of this subsection:
1666	1666	(a) The southern district of Nevada consists of all that portion of
1667	1667	the State lying within the boundaries of the counties of Clark,
1668	1668	Esmeralda, Lincoln and Nye.
1669	1669	(b) The northern district of Nevada consists of all that portion of
1670	1670	the State lying within the boundaries of Carson City and the
1671	1671	counties of Churchill, Douglas, Elko, Eureka, Humboldt, Lander,
1672	1672	Lyon, Mineral, Pershing, Storey, Washoe and White Pine.
1673	1673	4. A meeting of the Board may be conducted telephonically or
1674	1674	by videoconferencing. A meeting conducted telephonically or by
1675	1675	videoconferencing must meet the requirements of chapter 241 of
1676	1676	NRS and any other applicable provisions of law.
1677	1677	5. [Four] Five members of the Board constitute a quorum for
1678	1678	the purposes of transacting the business of the Board, including,
1679	1679	without limitation, issuing, renewing, suspending, revoking or
1680	1680	reinstating a license issued pursuant to this chapter.
1681	1681	Sec. 9. NRS 683A.178 is hereby amended to read as follows:
1682	1682	683A.178 1. A pharmacy benefit manager has an obligation
1683	1683	of good faith and fair dealing toward a third party or pharmacy
1684	1684	when performing duties pursuant to a contract to which the
1685	1685	pharmacy benefit manager is a party. Any provision of a contract
1686	1686	that waives or limits that obligation is against public policy, void
1687	1687	and unenforceable.
1688	1688	2. A pharmacy benefit manager shall notify a third party with
1689	1689	which it has entered into a contract in writing of any activity, policy
1690	1690	or practice of the pharmacy benefit manager that presents a conflict
1691	1691	of interest that interferes with the obligations imposed by
1692	1692	subsection 1.
1693	1693	3. A pharmacy benefit manager that manages prescription
1694	1694	drug benefits for an insurer licensed pursuant to this title shall
1695	1695	comply with the provisions of this title which are applicable to the
1696	1696	insurer when managing such benefits for the insurer.
1697	1697	Sec. 10. Chapter 687B of NRS is hereby amended by adding
1698	1698	thereto a new section to read as follows:
1699	1699	1. A health carrier which offers or issues a network plan:
1700	1700	(a) Must demonstrate the capacity to adequately deliver family
1701	1701	planning services provided by pharmacists or pharmacies to
1702	1702	covered persons in accordance with the regulations adopted
1703	1703	pursuant to subsection 2.
1704	1704	(b) Shall make available to each covered person in this State a
1705	1705	notice that meets the requirements prescribed by the regulations
1706	1706	– 37 –
1707	1707
1708	1708
1709	1709	- 82nd Session (2023)
1710	1710	adopted pursuant to subsection 2 of each pharmacist or pharmacy
1711	1711	that has entered into a provider network contract with the carrier
1712	1712	to provide family planning services to covered persons who
1713	1713	participate in the relevant network plan.
1714	1714	2. The Commissioner shall adopt regulations to carry out the
1715	1715	provisions of this section, including, without limitation,
1716	1716	regulations prescribing requirements for:
1717	1717	(a) A health carrier to demonstrate compliance with paragraph
1718	1718	(a) of subsection 1. Those regulations must not allow a health
1719	1719	carrier to demonstrate the capacity to adequately deliver family
1720	1720	planning services to covered persons by demonstrating that the
1721	1721	health carrier has entered into a network contract with one or
1722	1722	more pharmacies for the sole purpose of dispensing prescription
1723	1723	drugs to covered persons.
1724	1724	(b) The form and contents of the notice required by paragraph
1725	1725	(b) of subsection 1.
1726	1726	Sec. 11. NRS 687B.225 is hereby amended to read as follows:
1727	1727	687B.225 1. Except as otherwise provided in NRS
1728	1728	689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.044,
1729	1729	689A.0445, 689B.031, 689B.0313, 689B.0315, 689B.0317,
1730	1730	689B.0374, 689B.0378, 689C.1675, 689C.1676, 695A.1856,
1731	1731	695A.1865, 695B.1912, 695B.1913, 695B.1914, 695B.1919,
1732	1732	695B.1925, 695B.1942, 695C.1696, 695C.1713, 695C.1735,
1733	1733	695C.1737, 695C.1745, 695C.1751, 695G.170, 695G.171,
1734	1734	695G.1714 , 695G.1715 and 695G.177, any contract for group,
1735	1735	blanket or individual health insurance or any contract by a nonprofit
1736	1736	hospital, medical or dental service corporation or organization for
1737	1737	dental care which provides for payment of a certain part of medical
1738	1738	or dental care may require the insured or member to obtain prior
1739	1739	authorization for that care from the insurer or organization. The
1740	1740	insurer or organization shall:
1741	1741	(a) File its procedure for obtaining approval of care pursuant to
1742	1742	this section for approval by the Commissioner; and
1743	1743	(b) Respond to any request for approval by the insured or
1744	1744	member pursuant to this section within 20 days after it receives the
1745	1745	request.
1746	1746	2. The procedure for prior authorization may not discriminate
1747	1747	among persons licensed to provide the covered care.
1748	1748	Sec. 12. NRS 687B.600 is hereby amended to read as follows:
1749	1749	687B.600 As used in NRS 687B.600 to 687B.850, inclusive,
1750	1750	and section 11 of this act, unless the context otherwise requires, the
1751	1751	words and terms defined in NRS 687B.602 to 687B.665, inclusive,
1752	1752	have the meanings ascribed to them in those sections.
1753	1753	– 38 –
1754	1754
1755	1755
1756	1756	- 82nd Session (2023)
1757	1757	Sec. 13. NRS 687B.670 is hereby amended to read as follows:
1758	1758	687B.670 If a health carrier offers or issues a network plan, the
1759	1759	health carrier shall, with regard to that network plan:
1760	1760	1. Comply with all applicable requirements set forth in NRS
1761	1761	687B.600 to 687B.850, inclusive [;] , and section 11 of this act;
1762	1762	2. As applicable, ensure that each contract entered into for the
1763	1763	purposes of the network plan between a participating provider of
1764	1764	health care and the health carrier complies with the requirements set
1765	1765	forth in NRS 687B.600 to 687B.850, inclusive [;] , and section 11
1766	1766	of this act; and
1767	1767	3. As applicable, ensure that the network plan complies with
1768	1768	the requirements set forth in NRS 687B.600 to 687B.850, inclusive
1769	1769	[.] , and section 11 of this act.
1770	1770	Sec. 14. NRS 689A.0418 is hereby amended to read as
1771	1771	follows:
1772	1772	689A.0418 1. Except as otherwise provided in subsection [7,]
1773	1773	8, an insurer that offers or issues a policy of health insurance shall
1774	1774	include in the policy coverage for:
1775	1775	(a) Up to a 12-month supply, per prescription, of any type of
1776	1776	drug for contraception or its therapeutic equivalent which is:
1777	1777	(1) Lawfully prescribed or ordered;
1778	1778	(2) Approved by the Food and Drug Administration;
1779	1779	(3) Listed in subsection [10;] 11; and
1780	1780	(4) Dispensed in accordance with NRS 639.28075;
1781	1781	(b) Any type of device for contraception which is:
1782	1782	(1) Lawfully prescribed or ordered;
1783	1783	(2) Approved by the Food and Drug Administration; and
1784	1784	(3) Listed in subsection [10;] 11;
1785	1785	(c) Self-administered hormonal contraceptives dispensed by a
1786	1786	pharmacist pursuant to NRS 639.28078;
1787	1787	(d) Insertion of a device for contraception or removal of such a
1788	1788	device if the device was inserted while the insured was covered by
1789	1789	the same policy of health insurance;
1790	1790	(e) Education and counseling relating to the initiation of the use
1791	1791	of contraception and any necessary follow-up after initiating such
1792	1792	use;
1793	1793	(f) Management of side effects relating to contraception; and
1794	1794	(g) Voluntary sterilization for women.
1795	1795	2. An insurer shall provide coverage for any services listed in
1796	1796	subsection 1 which are within the authorized scope of practice of a
1797	1797	pharmacist when such services are provided by a pharmacist who
1798	1798	is employed by or serves as an independent contractor of an in-
1799	1799	network pharmacy and in accordance with the applicable provider
1800	1800	– 39 –
1801	1801
1802	1802
1803	1803	- 82nd Session (2023)
1804	1804	network contract. Such coverage must be provided to the same
1805	1805	extent as if the services were provided by another provider of
1806	1806	health care, as applicable to the services being provided. The terms
1807	1807	of the policy must not limit:
1808	1808	(a) Coverage for services listed in subsection 1 and provided by
1809	1809	such a pharmacist to a number of occasions less than the coverage
1810	1810	for such services when provided by another provider of health
1811	1811	care.
1812	1812	(b) Reimbursement for services listed in subsection 1 and
1813	1813	provided by such a pharmacist to an amount less than the amount
1814	1814	reimbursed for similar services provided by a physician, physician
1815	1815	assistant or advanced practice registered nurse.
1816	1816	3. An insurer must ensure that the benefits required by
1817	1817	subsection 1 are made available to an insured through a provider of
1818	1818	health care who participates in the network plan of the insurer.
1819	1819	[3.] 4. If a covered therapeutic equivalent listed in subsection 1
1820	1820	is not available or a provider of health care deems a covered
1821	1821	therapeutic equivalent to be medically inappropriate, an alternate
1822	1822	therapeutic equivalent prescribed by a provider of health care must
1823	1823	be covered by the insurer.
1824	1824	[4.] 5. Except as otherwise provided in subsections [8,] 9 , 10
1825	1825	and [11,] 12, an insurer that offers or issues a policy of health
1826	1826	insurance shall not:
1827	1827	(a) Require an insured to pay a higher deductible, any
1828	1828	copayment or coinsurance or require a longer waiting period or
1829	1829	other condition for coverage to obtain any benefit included in the
1830	1830	policy pursuant to subsection 1;
1831	1831	(b) Refuse to issue a policy of health insurance or cancel a
1832	1832	policy of health insurance solely because the person applying for or
1833	1833	covered by the policy uses or may use any such benefit;
1834	1834	(c) Offer or pay any type of material inducement or financial
1835	1835	incentive to an insured to discourage the insured from obtaining any
1836	1836	such benefit;
1837	1837	(d) Penalize a provider of health care who provides any such
1838	1838	benefit to an insured, including, without limitation, reducing the
1839	1839	reimbursement of the provider of health care;
1840	1840	(e) Offer or pay any type of material inducement, bonus or other
1841	1841	financial incentive to a provider of health care to deny, reduce,
1842	1842	withhold, limit or delay access to any such benefit to an insured; or
1843	1843	(f) Impose any other restrictions or delays on the access of an
1844	1844	insured any such benefit.
1845	1845	[5.] 6. Coverage pursuant to this section for the covered
1846	1846	dependent of an insured must be the same as for the insured.
1847	1847	– 40 –
1848	1848
1849	1849
1850	1850	- 82nd Session (2023)
1851	1851	[6.] 7. Except as otherwise provided in subsection [7,] 8, a
1852	1852	policy subject to the provisions of this chapter that is delivered,
1853	1853	issued for delivery or renewed on or after January 1, [2022,] 2024,
1854	1854	has the legal effect of including the coverage required by
1855	1855	[subsection 1,] this section, and any provision of the policy or the
1856	1856	renewal which is in conflict with this section is void.
1857	1857	[7.] 8. An insurer that offers or issues a policy of health
1858	1858	insurance and which is affiliated with a religious organization is not
1859	1859	required to provide the coverage required by subsection 1 if the
1860	1860	insurer objects on religious grounds. Such an insurer shall, before
1861	1861	the issuance of a policy of health insurance and before the renewal
1862	1862	of such a policy, provide to the prospective insured written notice of
1863	1863	the coverage that the insurer refuses to provide pursuant to this
1864	1864	subsection.
1865	1865	[8.] 9. An insurer may require an insured to pay a higher
1866	1866	deductible, copayment or coinsurance for a drug for contraception if
1867	1867	the insured refuses to accept a therapeutic equivalent of the drug.
1868	1868	[9.] 10. For each of the 18 methods of contraception listed in
1869	1869	subsection [10] 11 that have been approved by the Food and Drug
1870	1870	Administration, a policy of health insurance must include at least
1871	1871	one drug or device for contraception within each method for which
1872	1872	no deductible, copayment or coinsurance may be charged to the
1873	1873	insured, but the insurer may charge a deductible, copayment or
1874	1874	coinsurance for any other drug or device that provides the same
1875	1875	method of contraception. If the insurer charges a copayment or
1876	1876	coinsurance for a drug for contraception, the insurer may only
1877	1877	require an insured to pay the copayment or coinsurance:
1878	1878	(a) Once for the entire amount of the drug dispensed for the
1879	1879	plan year; or
1880	1880	(b) Once for each 1-month supply of the drug dispensed.
1881	1881	[10.] 11. The following 18 methods of contraception must be
1882	1882	covered pursuant to this section:
1883	1883	(a) Voluntary sterilization for women;
1884	1884	(b) Surgical sterilization implants for women;
1885	1885	(c) Implantable rods;
1886	1886	(d) Copper-based intrauterine devices;
1887	1887	(e) Progesterone-based intrauterine devices;
1888	1888	(f) Injections;
1889	1889	(g) Combined estrogen- and progestin-based drugs;
1890	1890	(h) Progestin-based drugs;
1891	1891	(i) Extended- or continuous-regimen drugs;
1892	1892	(j) Estrogen- and progestin-based patches;
1893	1893	(k) Vaginal contraceptive rings;
1894	1894	– 41 –
1895	1895
1896	1896
1897	1897	- 82nd Session (2023)
1898	1898	(l) Diaphragms with spermicide;
1899	1899	(m) Sponges with spermicide;
1900	1900	(n) Cervical caps with spermicide;
1901	1901	(o) Female condoms;
1902	1902	(p) Spermicide;
1903	1903	(q) Combined estrogen- and progestin-based drugs for
1904	1904	emergency contraception or progestin-based drugs for emergency
1905	1905	contraception; and
1906	1906	(r) Ulipristal acetate for emergency contraception.
1907	1907	[11.] 12. Except as otherwise provided in this section and
1908	1908	federal law, an insurer may use medical management techniques,
1909	1909	including, without limitation, any available clinical evidence, to
1910	1910	determine the frequency of or treatment relating to any benefit
1911	1911	required by this section or the type of provider of health care to use
1912	1912	for such treatment.
1913	1913	[12.] 13. An insurer shall not [use] :
1914	1914	(a) Use medical management techniques to require an insured to
1915	1915	use a method of contraception other than the method prescribed or
1916	1916	ordered by a provider of health care [.] ; or
1917	1917	(b) Require an insured to obtain prior authorization for the
1918	1918	benefits described in paragraphs (a) and (c) of subsection 1.
1919	1919	[13.] 14. An insurer must provide an accessible, transparent
1920	1920	and expedited process which is not unduly burdensome by which an
1921	1921	insured, or the authorized representative of the insured, may request
1922	1922	an exception relating to any medical management technique used by
1923	1923	the insurer to obtain any benefit required by this section without a
1924	1924	higher deductible, copayment or coinsurance.
1925	1925	[14.] 15. As used in this section:
1926	1926	(a) “In-network pharmacy” means a pharmacy that has
1927	1927	entered into a contract with an insurer to provide services to
1928	1928	insureds through a network plan offered or issued by the insurer.
1929	1929	(b) “Medical management technique” means a practice which is
1930	1930	used to control the cost or utilization of health care services or
1931	1931	prescription drug use. The term includes, without limitation, the use
1932	1932	of step therapy, prior authorization or categorizing drugs and
1933	1933	devices based on cost, type or method of administration.
1934	1934	[(b)] (c) “Network plan” means a policy of health insurance
1935	1935	offered by an insurer under which the financing and delivery of
1936	1936	medical care, including items and services paid for as medical care,
1937	1937	are provided, in whole or in part, through a defined set of providers
1938	1938	under contract with the insurer. The term does not include an
1939	1939	arrangement for the financing of premiums.
1940	1940	– 42 –
1941	1941
1942	1942
1943	1943	- 82nd Session (2023)
1944	1944	[(c)] (d) “Provider network contract” means a contract
1945	1945	between an insurer and a provider of health care or pharmacy
1946	1946	specifying the rights and responsibilities of the insurer and the
1947	1947	provider of health care or pharmacy, as applicable, for delivery of
1948	1948	health care services pursuant to a network plan.
1949	1949	(e) “Provider of health care” has the meaning ascribed to it in
1950	1950	NRS 629.031.
1951	1951	[(d)] (f) “Therapeutic equivalent” means a drug which:
1952	1952	(1) Contains an identical amount of the same active
1953	1953	ingredients in the same dosage and method of administration as
1954	1954	another drug;
1955	1955	(2) Is expected to have the same clinical effect when
1956	1956	administered to a patient pursuant to a prescription or order as
1957	1957	another drug; and
1958	1958	(3) Meets any other criteria required by the Food and Drug
1959	1959	Administration for classification as a therapeutic equivalent.
1960	1960	Sec. 15. NRS 689B.0378 is hereby amended to read as
1961	1961	follows:
1962	1962	689B.0378 1. Except as otherwise provided in subsection [7,]
1963	1963	8, an insurer that offers or issues a policy of group health insurance
1964	1964	shall include in the policy coverage for:
1965	1965	(a) Up to a 12-month supply, per prescription, of any type of
1966	1966	drug for contraception or its therapeutic equivalent which is:
1967	1967	(1) Lawfully prescribed or ordered;
1968	1968	(2) Approved by the Food and Drug Administration;
1969	1969	(3) Listed in subsection [11;] 12; and
1970	1970	(4) Dispensed in accordance with NRS 639.28075;
1971	1971	(b) Any type of device for contraception which is:
1972	1972	(1) Lawfully prescribed or ordered;
1973	1973	(2) Approved by the Food and Drug Administration; and
1974	1974	(3) Listed in subsection [11;] 12;
1975	1975	(c) Self-administered hormonal contraceptives dispensed by a
1976	1976	pharmacist pursuant to NRS 639.28078;
1977	1977	(d) Insertion of a device for contraception or removal of such a
1978	1978	device if the device was inserted while the insured was covered by
1979	1979	the same policy of group health insurance;
1980	1980	(e) Education and counseling relating to the initiation of the use
1981	1981	of contraception and any necessary follow-up after initiating such
1982	1982	use;
1983	1983	(f) Management of side effects relating to contraception; and
1984	1984	(g) Voluntary sterilization for women.
1985	1985	2. An insurer shall provide coverage for any services listed in
1986	1986	subsection 1 which are within the authorized scope of practice of a
1987	1987	– 43 –
1988	1988
1989	1989
1990	1990	- 82nd Session (2023)
1991	1991	pharmacist when such services are provided by a pharmacist who
1992	1992	is employed by or serves as an independent contractor of an in-
1993	1993	network pharmacy and in accordance with the applicable network
1994	1994	contract. Such coverage must be provided to the same extent as if
1995	1995	the services were provided by another provider of health care, as
1996	1996	applicable to the services being provided. The terms of the policy
1997	1997	must not limit:
1998	1998	(a) Coverage for services listed in subsection 1 and provided by
1999	1999	such a pharmacist to a number of occasions less than the coverage
2000	2000	for such services when provided by another provider of health
2001	2001	care.
2002	2002	(b) Reimbursement for services listed in subsection 1 and
2003	2003	provided by such a pharmacist to an amount less than the amount
2004	2004	reimbursed for similar services provided by a physician, physician
2005	2005	assistant or advanced practice registered nurse.
2006	2006	3. An insurer must ensure that the benefits required by
2007	2007	subsection 1 are made available to an insured through a provider of
2008	2008	health care who participates in the network plan of the insurer.
2009	2009	[3.] 4. If a covered therapeutic equivalent listed in subsection 1
2010	2010	is not available or a provider of health care deems a covered
2011	2011	therapeutic equivalent to be medically inappropriate, an alternate
2012	2012	therapeutic equivalent prescribed by a provider of health care must
2013	2013	be covered by the insurer.
2014	2014	[4.] 5. Except as otherwise provided in subsections [9,] 10 , 11
2015	2015	and [12,] 13, an insurer that offers or issues a policy of group health
2016	2016	insurance shall not:
2017	2017	(a) Require an insured to pay a higher deductible, any
2018	2018	copayment or coinsurance or require a longer waiting period or
2019	2019	other condition to obtain any benefit included in the policy pursuant
2020	2020	to subsection 1;
2021	2021	(b) Refuse to issue a policy of group health insurance or cancel a
2022	2022	policy of group health insurance solely because the person applying
2023	2023	for or covered by the policy uses or may use any such benefit;
2024	2024	(c) Offer or pay any type of material inducement or financial
2025	2025	incentive to an insured to discourage the insured from obtaining any
2026	2026	such benefit;
2027	2027	(d) Penalize a provider of health care who provides any such
2028	2028	benefit to an insured, including, without limitation, reducing the
2029	2029	reimbursement to the provider of health care;
2030	2030	(e) Offer or pay any type of material inducement, bonus or other
2031	2031	financial incentive to a provider of health care to deny, reduce,
2032	2032	withhold, limit or delay access to any such benefit to an insured; or
2033	2033	– 44 –
2034	2034
2035	2035
2036	2036	- 82nd Session (2023)
2037	2037	(f) Impose any other restrictions or delays on the access of an
2038	2038	insured to any such benefit.
2039	2039	[5.] 6. Coverage pursuant to this section for the covered
2040	2040	dependent of an insured must be the same as for the insured.
2041	2041	[6.] 7. Except as otherwise provided in subsection [7,] 8, a
2042	2042	policy subject to the provisions of this chapter that is delivered,
2043	2043	issued for delivery or renewed on or after January 1, [2022,] 2024,
2044	2044	has the legal effect of including the coverage required by
2045	2045	[subsection 1,] this section, and any provision of the policy or the
2046	2046	renewal which is in conflict with this section is void.
2047	2047	[7.] 8. An insurer that offers or issues a policy of group health
2048	2048	insurance and which is affiliated with a religious organization is not
2049	2049	required to provide the coverage required by subsection 1 if the
2050	2050	insurer objects on religious grounds. Such an insurer shall, before
2051	2051	the issuance of a policy of group health insurance and before the
2052	2052	renewal of such a policy, provide to the group policyholder or
2053	2053	prospective insured, as applicable, written notice of the coverage
2054	2054	that the insurer refuses to provide pursuant to this subsection.
2055	2055	[8.] 9. If an insurer refuses, pursuant to subsection [7,] 8, to
2056	2056	provide the coverage required by subsection 1, an employer may
2057	2057	otherwise provide for the coverage for the employees of the
2058	2058	employer.
2059	2059	[9.] 10. An insurer may require an insured to pay a higher
2060	2060	deductible, copayment or coinsurance for a drug for contraception if
2061	2061	the insured refuses to accept a therapeutic equivalent of the drug.
2062	2062	[10.] 11. For each of the 18 methods of contraception listed in
2063	2063	subsection [11] 12 that have been approved by the Food and Drug
2064	2064	Administration, a policy of group health insurance must include at
2065	2065	least one drug or device for contraception within each method for
2066	2066	which no deductible, copayment or coinsurance may be charged to
2067	2067	the insured, but the insurer may charge a deductible, copayment or
2068	2068	coinsurance for any other drug or device that provides the same
2069	2069	method of contraception. If the insurer charges a copayment or
2070	2070	coinsurance for a drug for contraception, the insurer may only
2071	2071	require an insured to pay the copayment or coinsurance:
2072	2072	(a) Once for the entire amount of the drug dispensed for the
2073	2073	plan year; or
2074	2074	(b) Once for each 1-month supply of the drug dispensed.
2075	2075	[11.] 12. The following 18 methods of contraception must be
2076	2076	covered pursuant to this section:
2077	2077	(a) Voluntary sterilization for women;
2078	2078	(b) Surgical sterilization implants for women;
2079	2079	(c) Implantable rods;
2080	2080	– 45 –
2081	2081
2082	2082
2083	2083	- 82nd Session (2023)
2084	2084	(d) Copper-based intrauterine devices;
2085	2085	(e) Progesterone-based intrauterine devices;
2086	2086	(f) Injections;
2087	2087	(g) Combined estrogen- and progestin-based drugs;
2088	2088	(h) Progestin-based drugs;
2089	2089	(i) Extended- or continuous-regimen drugs;
2090	2090	(j) Estrogen- and progestin-based patches;
2091	2091	(k) Vaginal contraceptive rings;
2092	2092	(l) Diaphragms with spermicide;
2093	2093	(m) Sponges with spermicide;
2094	2094	(n) Cervical caps with spermicide;
2095	2095	(o) Female condoms;
2096	2096	(p) Spermicide;
2097	2097	(q) Combined estrogen- and progestin-based drugs for
2098	2098	emergency contraception or progestin-based drugs for emergency
2099	2099	contraception; and
2100	2100	(r) Ulipristal acetate for emergency contraception.
2101	2101	[12.] 13. Except as otherwise provided in this section and
2102	2102	federal law, an insurer may use medical management techniques,
2103	2103	including, without limitation, any available clinical evidence, to
2104	2104	determine the frequency of or treatment relating to any benefit
2105	2105	required by this section or the type of provider of health care to use
2106	2106	for such treatment.
2107	2107	[13.] 14. An insurer shall not [use] :
2108	2108	(a) Use medical management techniques to require an insured to
2109	2109	use a method of contraception other than the method prescribed or
2110	2110	ordered by a provider of health care [.] ; or
2111	2111	(b) Require an insured to obtain prior authorization for the
2112	2112	benefits described in paragraphs (a) and (c) of subsection 1.
2113	2113	[14.] 15. An insurer must provide an accessible, transparent
2114	2114	and expedited process which is not unduly burdensome by which an
2115	2115	insured, or the authorized representative of the insured, may request
2116	2116	an exception relating to any medical management technique used by
2117	2117	the insurer to obtain any benefit required by this section without a
2118	2118	higher deductible, copayment or coinsurance.
2119	2119	[15.] 16. As used in this section:
2120	2120	(a) “In-network pharmacy” means a pharmacy that has
2121	2121	entered into a contract with an insurer to provide services to
2122	2122	insureds through a network plan offered or issued by the insurer.
2123	2123	(b) “Medical management technique” means a practice which is
2124	2124	used to control the cost or utilization of health care services or
2125	2125	prescription drug use. The term includes, without limitation, the use
2126	2126	– 46 –
2127	2127
2128	2128
2129	2129	- 82nd Session (2023)
2130	2130	of step therapy, prior authorization or categorizing drugs and
2131	2131	devices based on cost, type or method of administration.
2132	2132	[(b)] (c) “Network plan” means a policy of group health
2133	2133	insurance offered by an insurer under which the financing and
2134	2134	delivery of medical care, including items and services paid for as
2135	2135	medical care, are provided, in whole or in part, through a defined set
2136	2136	of providers under contract with the insurer. The term does not
2137	2137	include an arrangement for the financing of premiums.
2138	2138	[(c)] (d) “Provider network contract” means a contract
2139	2139	between an insurer and a provider of health care or pharmacy
2140	2140	specifying the rights and responsibilities of the insurer and the
2141	2141	provider of health care or pharmacy, as applicable, for delivery of
2142	2142	health care services pursuant to a network plan.
2143	2143	(e) “Provider of health care” has the meaning ascribed to it in
2144	2144	NRS 629.031.
2145	2145	[(d)] (f) “Therapeutic equivalent” means a drug which:
2146	2146	(1) Contains an identical amount of the same active
2147	2147	ingredients in the same dosage and method of administration as
2148	2148	another drug;
2149	2149	(2) Is expected to have the same clinical effect when
2150	2150	administered to a patient pursuant to a prescription or order as
2151	2151	another drug; and
2152	2152	(3) Meets any other criteria required by the Food and Drug
2153	2153	Administration for classification as a therapeutic equivalent.
2154	2154	Sec. 16. NRS 689C.1676 is hereby amended to read as
2155	2155	follows:
2156	2156	689C.1676 1. Except as otherwise provided in subsection [7,]
2157	2157	8, a carrier that offers or issues a health benefit plan shall include in
2158	2158	the plan coverage for:
2159	2159	(a) Up to a 12-month supply, per prescription, of any type of
2160	2160	drug for contraception or its therapeutic equivalent which is:
2161	2161	(1) Lawfully prescribed or ordered;
2162	2162	(2) Approved by the Food and Drug Administration;
2163	2163	(3) Listed in subsection [10;] 11; and
2164	2164	(4) Dispensed in accordance with NRS 639.28075;
2165	2165	(b) Any type of device for contraception which is:
2166	2166	(1) Lawfully prescribed or ordered;
2167	2167	(2) Approved by the Food and Drug Administration; and
2168	2168	(3) Listed in subsection [10;] 11;
2169	2169	(c) Self-administered hormonal contraceptives dispensed by a
2170	2170	pharmacist pursuant to NRS 639.28078;
2171	2171	– 47 –
2172	2172
2173	2173
2174	2174	- 82nd Session (2023)
2175	2175	(d) Insertion of a device for contraception or removal of such a
2176	2176	device if the device was inserted while the insured was covered by
2177	2177	the same health benefit plan;
2178	2178	(e) Education and counseling relating to the initiation of the use
2179	2179	of contraception and any necessary follow-up after initiating such
2180	2180	use;
2181	2181	(f) Management of side effects relating to contraception; and
2182	2182	(g) Voluntary sterilization for women.
2183	2183	2. A carrier shall provide coverage for any services listed in
2184	2184	subsection 1 which are within the authorized scope of practice of a
2185	2185	pharmacist when such services are provided by a pharmacist who
2186	2186	is employed by or serves as an independent contractor of an in-
2187	2187	network pharmacy and in accordance with the applicable provider
2188	2188	network contract. Such coverage must be provided to the same
2189	2189	extent as if the services were provided by another provider of
2190	2190	health care, as applicable to the services being provided. The terms
2191	2191	of the policy must not limit:
2192	2192	(a) Coverage for services listed in subsection 1 and provided by
2193	2193	such a pharmacist to a number of occasions less than the coverage
2194	2194	for such services when provided by another provider of health
2195	2195	care.
2196	2196	(b) Reimbursement for services listed in subsection 1 and
2197	2197	provided by such a pharmacist to an amount less than the amount
2198	2198	reimbursed for similar services provided by a physician, physician
2199	2199	assistant or advanced practice registered nurse.
2200	2200	3. A carrier must ensure that the benefits required by
2201	2201	subsection 1 are made available to an insured through a provider of
2202	2202	health care who participates in the network plan of the carrier.
2203	2203	[3.] 4. If a covered therapeutic equivalent listed in subsection 1
2204	2204	is not available or a provider of health care deems a covered
2205	2205	therapeutic equivalent to be medically inappropriate, an alternate
2206	2206	therapeutic equivalent prescribed by a provider of health care must
2207	2207	be covered by the carrier.
2208	2208	[4.] 5. Except as otherwise provided in subsections [8,] 9 , 10
2209	2209	and [11,] 12, a carrier that offers or issues a health benefit plan shall
2210	2210	not:
2211	2211	(a) Require an insured to pay a higher deductible, any
2212	2212	copayment or coinsurance or require a longer waiting period or
2213	2213	other condition to obtain any benefit included in the health benefit
2214	2214	plan pursuant to subsection 1;
2215	2215	(b) Refuse to issue a health benefit plan or cancel a health
2216	2216	benefit plan solely because the person applying for or covered by
2217	2217	the plan uses or may use any such benefit;
2218	2218	– 48 –
2219	2219
2220	2220
2221	2221	- 82nd Session (2023)
2222	2222	(c) Offer or pay any type of material inducement or financial
2223	2223	incentive to an insured to discourage the insured from obtaining any
2224	2224	such benefit;
2225	2225	(d) Penalize a provider of health care who provides any such
2226	2226	benefit to an insured, including, without limitation, reducing the
2227	2227	reimbursement to the provider of health care;
2228	2228	(e) Offer or pay any type of material inducement, bonus or other
2229	2229	financial incentive to a provider of health care to deny, reduce,
2230	2230	withhold, limit or delay access to any such benefit to an insured; or
2231	2231	(f) Impose any other restrictions or delays on the access of an
2232	2232	insured to any such benefit.
2233	2233	[5.] 6. Coverage pursuant to this section for the covered
2234	2234	dependent of an insured must be the same as for the insured.
2235	2235	[6.] 7. Except as otherwise provided in subsection [7,] 8, a
2236	2236	health benefit plan subject to the provisions of this chapter that is
2237	2237	delivered, issued for delivery or renewed on or after January 1,
2238	2238	[2022,] 2024, has the legal effect of including the coverage required
2239	2239	by [subsection 1,] this section, and any provision of the plan or the
2240	2240	renewal which is in conflict with this section is void.
2241	2241	[7.] 8. A carrier that offers or issues a health benefit plan and
2242	2242	which is affiliated with a religious organization is not required to
2243	2243	provide the coverage required by subsection 1 if the carrier objects
2244	2244	on religious grounds. Such a carrier shall, before the issuance of a
2245	2245	health benefit plan and before the renewal of such a plan, provide to
2246	2246	the prospective insured written notice of the coverage that the
2247	2247	carrier refuses to provide pursuant to this subsection.
2248	2248	[8.] 9. A carrier may require an insured to pay a higher
2249	2249	deductible, copayment or coinsurance for a drug for contraception if
2250	2250	the insured refuses to accept a therapeutic equivalent of the drug.
2251	2251	[9.] 10. For each of the 18 methods of contraception listed in
2252	2252	subsection [10] 11 that have been approved by the Food and Drug
2253	2253	Administration, a health benefit plan must include at least one drug
2254	2254	or device for contraception within each method for which no
2255	2255	deductible, copayment or coinsurance may be charged to the
2256	2256	insured, but the carrier may charge a deductible, copayment or
2257	2257	coinsurance for any other drug or device that provides the same
2258	2258	method of contraception. If the carrier charges a copayment or
2259	2259	coinsurance for a drug for contraception, the carrier may only
2260	2260	require an insured to pay the copayment or coinsurance:
2261	2261	(a) Once for the entire amount of the drug dispensed for the
2262	2262	plan year; or
2263	2263	(b) Once for each 1-month supply of the drug dispensed.
2264	2264	– 49 –
2265	2265
2266	2266
2267	2267	- 82nd Session (2023)
2268	2268	[10.] 11. The following 18 methods of contraception must be
2269	2269	covered pursuant to this section:
2270	2270	(a) Voluntary sterilization for women;
2271	2271	(b) Surgical sterilization implants for women;
2272	2272	(c) Implantable rods;
2273	2273	(d) Copper-based intrauterine devices;
2274	2274	(e) Progesterone-based intrauterine devices;
2275	2275	(f) Injections;
2276	2276	(g) Combined estrogen- and progestin-based drugs;
2277	2277	(h) Progestin-based drugs;
2278	2278	(i) Extended- or continuous-regimen drugs;
2279	2279	(j) Estrogen- and progestin-based patches;
2280	2280	(k) Vaginal contraceptive rings;
2281	2281	(l) Diaphragms with spermicide;
2282	2282	(m) Sponges with spermicide;
2283	2283	(n) Cervical caps with spermicide;
2284	2284	(o) Female condoms;
2285	2285	(p) Spermicide;
2286	2286	(q) Combined estrogen- and progestin-based drugs for
2287	2287	emergency contraception or progestin-based drugs for emergency
2288	2288	contraception; and
2289	2289	(r) Ulipristal acetate for emergency contraception.
2290	2290	[11.] 12. Except as otherwise provided in this section and
2291	2291	federal law, a carrier may use medical management techniques,
2292	2292	including, without limitation, any available clinical evidence, to
2293	2293	determine the frequency of or treatment relating to any benefit
2294	2294	required by this section or the type of provider of health care to use
2295	2295	for such treatment.
2296	2296	[12.] 13. A carrier shall not [use] :
2297	2297	(a) Use medical management techniques to require an insured to
2298	2298	use a method of contraception other than the method prescribed or
2299	2299	ordered by a provider of health care [.] ; or
2300	2300	(b) Require an insured to obtain prior authorization for the
2301	2301	benefits described in paragraphs (a) and (c) of subsection 1.
2302	2302	[13.] 14. A carrier must provide an accessible, transparent and
2303	2303	expedited process which is not unduly burdensome by which an
2304	2304	insured, or the authorized representative of the insured, may request
2305	2305	an exception relating to any medical management technique used by
2306	2306	the carrier to obtain any benefit required by this section without a
2307	2307	higher deductible, copayment or coinsurance.
2308	2308	[14.] 15. As used in this section:
2309	2309	– 50 –
2310	2310
2311	2311
2312	2312	- 82nd Session (2023)
2313	2313	(a) “In-network pharmacy” means a pharmacy that has
2314	2314	entered into a contract with a carrier to provide services to
2315	2315	insureds through a network plan offered or issued by the carrier.
2316	2316	(b) “Medical management technique” means a practice which is
2317	2317	used to control the cost or utilization of health care services or
2318	2318	prescription drug use. The term includes, without limitation, the use
2319	2319	of step therapy, prior authorization or categorizing drugs and
2320	2320	devices based on cost, type or method of administration.
2321	2321	[(b)] (c) “Network plan” means a health benefit plan offered by
2322	2322	a carrier under which the financing and delivery of medical care,
2323	2323	including items and services paid for as medical care, are provided,
2324	2324	in whole or in part, through a defined set of providers under contract
2325	2325	with the carrier. The term does not include an arrangement for the
2326	2326	financing of premiums.
2327	2327	[(c)] (d) “Provider network contract” means a contract
2328	2328	between a carrier and a provider of health care or pharmacy
2329	2329	specifying the rights and responsibilities of the carrier and the
2330	2330	provider of health care or pharmacy, as applicable, for delivery of
2331	2331	health care services pursuant to a network plan.
2332	2332	(e) “Provider of health care” has the meaning ascribed to it in
2333	2333	NRS 629.031.
2334	2334	[(d)] (f) “Therapeutic equivalent” means a drug which:
2335	2335	(1) Contains an identical amount of the same active
2336	2336	ingredients in the same dosage and method of administration as
2337	2337	another drug;
2338	2338	(2) Is expected to have the same clinical effect when
2339	2339	administered to a patient pursuant to a prescription or order as
2340	2340	another drug; and
2341	2341	(3) Meets any other criteria required by the Food and Drug
2342	2342	Administration for classification as a therapeutic equivalent.
2343	2343	Sec. 17. NRS 695A.1865 is hereby amended to read as
2344	2344	follows:
2345	2345	695A.1865 1. Except as otherwise provided in subsection [7,]
2346	2346	8, a society that offers or issues a benefit contract which provides
2347	2347	coverage for prescription drugs or devices shall include in the
2348	2348	contract coverage for:
2349	2349	(a) Up to a 12-month supply, per prescription, of any type of
2350	2350	drug for contraception or its therapeutic equivalent which is:
2351	2351	(1) Lawfully prescribed or ordered;
2352	2352	(2) Approved by the Food and Drug Administration;
2353	2353	(3) Listed in subsection [10;] 11; and
2354	2354	(4) Dispensed in accordance with NRS 639.28075;
2355	2355	(b) Any type of device for contraception which is:
2356	2356	– 51 –
2357	2357
2358	2358
2359	2359	- 82nd Session (2023)
2360	2360	(1) Lawfully prescribed or ordered;
2361	2361	(2) Approved by the Food and Drug Administration; and
2362	2362	(3) Listed in subsection [10;] 11;
2363	2363	(c) Self-administered hormonal contraceptives dispensed by a
2364	2364	pharmacist pursuant to NRS 639.28078;
2365	2365	(d) Insertion of a device for contraception or removal of such a
2366	2366	device if the device was inserted while the insured was covered by
2367	2367	the same benefit contract;
2368	2368	(e) Education and counseling relating to the initiation of the use
2369	2369	of contraception and any necessary follow-up after initiating such
2370	2370	use;
2371	2371	(f) Management of side effects relating to contraception; and
2372	2372	(g) Voluntary sterilization for women.
2373	2373	2. A society shall provide coverage for any services listed in
2374	2374	subsection 1 which are within the authorized scope of practice of a
2375	2375	pharmacist when such services are provided by a pharmacist who
2376	2376	is employed by or serves as an independent contractor of an in-
2377	2377	network pharmacy and in accordance with the applicable provider
2378	2378	network contract. Such coverage must be provided to the same
2379	2379	extent as if the services were provided by another provider of
2380	2380	health care, as applicable to the services being provided. The terms
2381	2381	of the policy must not limit:
2382	2382	(a) Coverage for services listed in subsection 1 and provided by
2383	2383	such a pharmacist to a number of occasions less than the coverage
2384	2384	for such services when provided by another provider of health
2385	2385	care.
2386	2386	(b) Reimbursement for services listed in subsection 1 and
2387	2387	provided by such a pharmacist to an amount less than the amount
2388	2388	reimbursed for similar services provided by a physician, physician
2389	2389	assistant or advanced practice registered nurse.
2390	2390	3. A society must ensure that the benefits required by
2391	2391	subsection 1 are made available to an insured through a provider of
2392	2392	health care who participates in the network plan of the society.
2393	2393	[3.] 4. If a covered therapeutic equivalent listed in subsection 1
2394	2394	is not available or a provider of health care deems a covered
2395	2395	therapeutic equivalent to be medically inappropriate, an alternate
2396	2396	therapeutic equivalent prescribed by a provider of health care must
2397	2397	be covered by the society.
2398	2398	[4.] 5. Except as otherwise provided in subsections [8,] 9 , 10
2399	2399	and [11,] 12, a society that offers or issues a benefit contract shall
2400	2400	not:
2401	2401	(a) Require an insured to pay a higher deductible, any
2402	2402	copayment or coinsurance or require a longer waiting period or
2403	2403	– 52 –
2404	2404
2405	2405
2406	2406	- 82nd Session (2023)
2407	2407	other condition for coverage for any benefit included in the benefit
2408	2408	contract pursuant to subsection 1;
2409	2409	(b) Refuse to issue a benefit contract or cancel a benefit contract
2410	2410	solely because the person applying for or covered by the contract
2411	2411	uses or may use any such benefit;
2412	2412	(c) Offer or pay any type of material inducement or financial
2413	2413	incentive to an insured to discourage the insured from obtaining any
2414	2414	such benefit;
2415	2415	(d) Penalize a provider of health care who provides any such
2416	2416	benefit to an insured, including, without limitation, reducing the
2417	2417	reimbursement to the provider of health care;
2418	2418	(e) Offer or pay any type of material inducement, bonus or other
2419	2419	financial incentive to a provider of health care to deny, reduce,
2420	2420	withhold, limit or delay access to any such benefit to an insured; or
2421	2421	(f) Impose any other restrictions or delays on the access of an
2422	2422	insured to any such benefit.
2423	2423	[5.] 6. Coverage pursuant to this section for the covered
2424	2424	dependent of an insured must be the same as for the insured.
2425	2425	[6.] 7. Except as otherwise provided in subsection [7,] 8, a
2426	2426	benefit contract subject to the provisions of this chapter that is
2427	2427	delivered, issued for delivery or renewed on or after January 1,
2428	2428	[2022,] 2024, has the legal effect of including the coverage required
2429	2429	by [subsection 1,] this section, and any provision of the contract or
2430	2430	the renewal which is in conflict with this section is void.
2431	2431	[7.] 8. A society that offers or issues a benefit contract and
2432	2432	which is affiliated with a religious organization is not required to
2433	2433	provide the coverage required by subsection 1 if the society objects
2434	2434	on religious grounds. Such a society shall, before the issuance of a
2435	2435	benefit contract and before the renewal of such a contract, provide
2436	2436	to the prospective insured written notice of the coverage that the
2437	2437	society refuses to provide pursuant to this subsection.
2438	2438	[8.] 9. A society may require an insured to pay a higher
2439	2439	deductible, copayment or coinsurance for a drug for contraception if
2440	2440	the insured refuses to accept a therapeutic equivalent of the drug.
2441	2441	[9.] 10. For each of the 18 methods of contraception listed in
2442	2442	subsection [10] 11 that have been approved by the Food and Drug
2443	2443	Administration, a benefit contract must include at least one drug or
2444	2444	device for contraception within each method for which no
2445	2445	deductible, copayment or coinsurance may be charged to the
2446	2446	insured, but the society may charge a deductible, copayment or
2447	2447	coinsurance for any other drug or device that provides the same
2448	2448	method of contraception. If the society charges a copayment or
2449	2449	– 53 –
2450	2450
2451	2451
2452	2452	- 82nd Session (2023)
2453	2453	coinsurance for a drug for contraception, the society may only
2454	2454	require an insured to pay the copayment or coinsurance:
2455	2455	(a) Once for the entire amount of the drug dispensed for the
2456	2456	plan year; or
2457	2457	(b) Once for each 1-month supply of the drug dispensed.
2458	2458	[10.] 11. The following 18 methods of contraception must be
2459	2459	covered pursuant to this section:
2460	2460	(a) Voluntary sterilization for women;
2461	2461	(b) Surgical sterilization implants for women;
2462	2462	(c) Implantable rods;
2463	2463	(d) Copper-based intrauterine devices;
2464	2464	(e) Progesterone-based intrauterine devices;
2465	2465	(f) Injections;
2466	2466	(g) Combined estrogen- and progestin-based drugs;
2467	2467	(h) Progestin-based drugs;
2468	2468	(i) Extended- or continuous-regimen drugs;
2469	2469	(j) Estrogen- and progestin-based patches;
2470	2470	(k) Vaginal contraceptive rings;
2471	2471	(l) Diaphragms with spermicide;
2472	2472	(m) Sponges with spermicide;
2473	2473	(n) Cervical caps with spermicide;
2474	2474	(o) Female condoms;
2475	2475	(p) Spermicide;
2476	2476	(q) Combined estrogen- and progestin-based drugs for
2477	2477	emergency contraception or progestin-based drugs for emergency
2478	2478	contraception; and
2479	2479	(r) Ulipristal acetate for emergency contraception.
2480	2480	[11.] 12. Except as otherwise provided in this section and
2481	2481	federal law, a society may use medical management techniques,
2482	2482	including, without limitation, any available clinical evidence, to
2483	2483	determine the frequency of or treatment relating to any benefit
2484	2484	required by this section or the type of provider of health care to use
2485	2485	for such treatment.
2486	2486	[12.] 13. A society shall not [use] :
2487	2487	(a) Use medical management techniques to require an insured to
2488	2488	use a method of contraception other than the method prescribed or
2489	2489	ordered by a provider of health care [.] ; or
2490	2490	(b) Require an insured to obtain prior authorization for the
2491	2491	benefits described in paragraphs (a) and (c) of subsection 1.
2492	2492	[13.] 14. A society must provide an accessible, transparent and
2493	2493	expedited process which is not unduly burdensome by which an
2494	2494	insured, or the authorized representative of the insured, may request
2495	2495	an exception relating to any medical management technique used by
2496	2496	– 54 –
2497	2497
2498	2498
2499	2499	- 82nd Session (2023)
2500	2500	the society to obtain any benefit required by this section without a
2501	2501	higher deductible, copayment or coinsurance.
2502	2502	[14.] 15. As used in this section:
2503	2503	(a) “In-network pharmacy” means a pharmacy that has
2504	2504	entered into a contract with a society to provide services to
2505	2505	insureds through a network plan offered or issued by the society.
2506	2506	(b) “Medical management technique” means a practice which is
2507	2507	used to control the cost or utilization of health care services or
2508	2508	prescription drug use. The term includes, without limitation, the use
2509	2509	of step therapy, prior authorization or categorizing drugs and
2510	2510	devices based on cost, type or method of administration.
2511	2511	[(b)] (c) “Network plan” means a benefit contract offered by a
2512	2512	society under which the financing and delivery of medical care,
2513	2513	including items and services paid for as medical care, are provided,
2514	2514	in whole or in part, through a defined set of providers under contract
2515	2515	with the society. The term does not include an arrangement for the
2516	2516	financing of premiums.
2517	2517	[(c)] (d) “Provider network contract” means a contract
2518	2518	between a society and a provider of health care or pharmacy
2519	2519	specifying the rights and responsibilities of the society and the
2520	2520	provider of health care or pharmacy, as applicable, for delivery of
2521	2521	health care services pursuant to a network plan.
2522	2522	(e) “Provider of health care” has the meaning ascribed to it in
2523	2523	NRS 629.031.
2524	2524	[(d)] (f) “Therapeutic equivalent” means a drug which:
2525	2525	(1) Contains an identical amount of the same active
2526	2526	ingredients in the same dosage and method of administration as
2527	2527	another drug;
2528	2528	(2) Is expected to have the same clinical effect when
2529	2529	administered to a patient pursuant to a prescription or order as
2530	2530	another drug; and
2531	2531	(3) Meets any other criteria required by the Food and Drug
2532	2532	Administration for classification as a therapeutic equivalent.
2533	2533	Sec. 18. NRS 695B.1919 is hereby amended to read as
2534	2534	follows:
2535	2535	695B.1919 1. Except as otherwise provided in subsection [7,]
2536	2536	8, an insurer that offers or issues a contract for hospital or medical
2537	2537	service shall include in the contract coverage for:
2538	2538	(a) Up to a 12-month supply, per prescription, of any type of
2539	2539	drug for contraception or its therapeutic equivalent which is:
2540	2540	(1) Lawfully prescribed or ordered;
2541	2541	(2) Approved by the Food and Drug Administration;
2542	2542	(3) Listed in subsection [11;] 12; and
2543	2543	– 55 –
2544	2544
2545	2545
2546	2546	- 82nd Session (2023)
2547	2547	(4) Dispensed in accordance with NRS 639.28075;
2548	2548	(b) Any type of device for contraception which is:
2549	2549	(1) Lawfully prescribed or ordered;
2550	2550	(2) Approved by the Food and Drug Administration; and
2551	2551	(3) Listed in subsection [11;] 12;
2552	2552	(c) Self-administered hormonal contraceptives dispensed by a
2553	2553	pharmacist pursuant to NRS 639.28078;
2554	2554	(d) Insertion of a device for contraception or removal of such a
2555	2555	device if the device was inserted while the insured was covered by
2556	2556	the same contract for hospital or medical service;
2557	2557	(e) Education and counseling relating to the initiation of the use
2558	2558	of contraception and any necessary follow-up after initiating such
2559	2559	use;
2560	2560	(f) Management of side effects relating to contraception; and
2561	2561	(g) Voluntary sterilization for women.
2562	2562	2. An insurer shall provide coverage for any services listed in
2563	2563	subsection 1 which are within the authorized scope of practice of a
2564	2564	pharmacist when such services are provided by a pharmacist who
2565	2565	is employed by or serves as an independent contractor of an in-
2566	2566	network pharmacy and in accordance with the applicable provider
2567	2567	network contract. Such coverage must be provided to the same
2568	2568	extent as if the services were provided by another provider of
2569	2569	health care, as applicable to the services being provided. The terms
2570	2570	of the policy must not limit:
2571	2571	(a) Coverage for services listed in subsection 1 and provided by
2572	2572	such a pharmacist to a number of occasions less than the coverage
2573	2573	for such services when provided by another provider of health
2574	2574	care.
2575	2575	(b) Reimbursement for services listed in subsection 1 and
2576	2576	provided by such a pharmacist to an amount less than the amount
2577	2577	reimbursed for similar services provided by a physician, physician
2578	2578	assistant or advanced practice registered nurse.
2579	2579	3. An insurer that offers or issues a contract for hospital or
2580	2580	medical services must ensure that the benefits required by
2581	2581	subsection 1 are made available to an insured through a provider of
2582	2582	health care who participates in the network plan of the insurer.
2583	2583	[3.] 4. If a covered therapeutic equivalent listed in subsection 1
2584	2584	is not available or a provider of health care deems a covered
2585	2585	therapeutic equivalent to be medically inappropriate, an alternate
2586	2586	therapeutic equivalent prescribed by a provider of health care must
2587	2587	be covered by the insurer.
2588	2588	– 56 –
2589	2589
2590	2590
2591	2591	- 82nd Session (2023)
2592	2592	[4.] 5. Except as otherwise provided in subsections [9,] 10 , 11
2593	2593	and [12,] 13, an insurer that offers or issues a contract for hospital or
2594	2594	medical service shall not:
2595	2595	(a) Require an insured to pay a higher deductible, any
2596	2596	copayment or coinsurance or require a longer waiting period or
2597	2597	other condition to obtain any benefit included in the contract for
2598	2598	hospital or medical service pursuant to subsection 1;
2599	2599	(b) Refuse to issue a contract for hospital or medical service or
2600	2600	cancel a contract for hospital or medical service solely because the
2601	2601	person applying for or covered by the contract uses or may use any
2602	2602	such benefit;
2603	2603	(c) Offer or pay any type of material inducement or financial
2604	2604	incentive to an insured to discourage the insured from obtaining any
2605	2605	such benefit;
2606	2606	(d) Penalize a provider of health care who provides any such
2607	2607	benefit to an insured, including, without limitation, reducing the
2608	2608	reimbursement to the provider of health care;
2609	2609	(e) Offer or pay any type of material inducement, bonus or other
2610	2610	financial incentive to a provider of health care to deny, reduce,
2611	2611	withhold, limit or delay access to any such benefit to an insured; or
2612	2612	(f) Impose any other restrictions or delays on the access of an
2613	2613	insured to any such benefit.
2614	2614	[5.] 6. Coverage pursuant to this section for the covered
2615	2615	dependent of an insured must be the same as for the insured.
2616	2616	[6.] 7. Except as otherwise provided in subsection [7,] 8, a
2617	2617	contract for hospital or medical service subject to the provisions of
2618	2618	this chapter that is delivered, issued for delivery or renewed on or
2619	2619	after January 1, [2022,] 2024, has the legal effect of including the
2620	2620	coverage required by [subsection 1,] this section, and any provision
2621	2621	of the contract or the renewal which is in conflict with this section is
2622	2622	void.
2623	2623	[7.] 8. An insurer that offers or issues a contract for hospital or
2624	2624	medical service and which is affiliated with a religious organization
2625	2625	is not required to provide the coverage required by subsection 1 if
2626	2626	the insurer objects on religious grounds. Such an insurer shall,
2627	2627	before the issuance of a contract for hospital or medical service and
2628	2628	before the renewal of such a contract, provide to the prospective
2629	2629	insured written notice of the coverage that the insurer refuses to
2630	2630	provide pursuant to this subsection.
2631	2631	[8.] 9. If an insurer refuses, pursuant to subsection [7,] 8, to
2632	2632	provide the coverage required by subsection 1, an employer may
2633	2633	otherwise provide for the coverage for the employees of the
2634	2634	employer.
2635	2635	– 57 –
2636	2636
2637	2637
2638	2638	- 82nd Session (2023)
2639	2639	[9.] 10. An insurer may require an insured to pay a higher
2640	2640	deductible, copayment or coinsurance for a drug for contraception if
2641	2641	the insured refuses to accept a therapeutic equivalent of the drug.
2642	2642	[10.] 11. For each of the 18 methods of contraception listed in
2643	2643	subsection [11] 12 that have been approved by the Food and Drug
2644	2644	Administration, a contract for hospital or medical service must
2645	2645	include at least one drug or device for contraception within each
2646	2646	method for which no deductible, copayment or coinsurance may be
2647	2647	charged to the insured, but the insurer may charge a deductible,
2648	2648	copayment or coinsurance for any other drug or device that provides
2649	2649	the same method of contraception. If the insurer charges a
2650	2650	copayment or coinsurance for a drug for contraception, the
2651	2651	insurer may only require an insured to pay the copayment or
2652	2652	coinsurance:
2653	2653	(a) Once for the entire amount of the drug dispensed for the
2654	2654	plan year; or
2655	2655	(b) Once for each 1-month supply of the drug dispensed.
2656	2656	[11.] 12. The following 18 methods of contraception must be
2657	2657	covered pursuant to this section:
2658	2658	(a) Voluntary sterilization for women;
2659	2659	(b) Surgical sterilization implants for women;
2660	2660	(c) Implantable rods;
2661	2661	(d) Copper-based intrauterine devices;
2662	2662	(e) Progesterone-based intrauterine devices;
2663	2663	(f) Injections;
2664	2664	(g) Combined estrogen- and progestin-based drugs;
2665	2665	(h) Progestin-based drugs;
2666	2666	(i) Extended- or continuous-regimen drugs;
2667	2667	(j) Estrogen- and progestin-based patches;
2668	2668	(k) Vaginal contraceptive rings;
2669	2669	(l) Diaphragms with spermicide;
2670	2670	(m) Sponges with spermicide;
2671	2671	(n) Cervical caps with spermicide;
2672	2672	(o) Female condoms;
2673	2673	(p) Spermicide;
2674	2674	(q) Combined estrogen- and progestin-based drugs for
2675	2675	emergency contraception or progestin-based drugs for emergency
2676	2676	contraception; and
2677	2677	(r) Ulipristal acetate for emergency contraception.
2678	2678	[12.] 13. Except as otherwise provided in this section and
2679	2679	federal law, an insurer that offers or issues a contract for hospital or
2680	2680	medical services may use medical management techniques,
2681	2681	including, without limitation, any available clinical evidence, to
2682	2682	– 58 –
2683	2683
2684	2684
2685	2685	- 82nd Session (2023)
2686	2686	determine the frequency of or treatment relating to any benefit
2687	2687	required by this section or the type of provider of health care to use
2688	2688	for such treatment.
2689	2689	[13.] 14. An insurer shall not [use] :
2690	2690	(a) Use medical management techniques to require an insured to
2691	2691	use a method of contraception other than the method prescribed or
2692	2692	ordered by a provider of health care [.] ; or
2693	2693	(b) Require an insured to obtain prior authorization for the
2694	2694	benefits described in paragraphs (a) and (c) of subsection 1.
2695	2695	[14.] 15. An insurer must provide an accessible, transparent
2696	2696	and expedited process which is not unduly burdensome by which an
2697	2697	insured, or the authorized representative of the insured, may request
2698	2698	an exception relating to any medical management technique used by
2699	2699	the insurer to obtain any benefit required by this section without a
2700	2700	higher deductible, copayment or coinsurance.
2701	2701	[15.] 16. As used in this section:
2702	2702	(a) “In-network pharmacy” means a pharmacy that has
2703	2703	entered into a contract with an insurer to provide services to
2704	2704	insureds through a network plan offered or issued by the insurer.
2705	2705	(b) “Medical management technique” means a practice which is
2706	2706	used to control the cost or utilization of health care services or
2707	2707	prescription drug use. The term includes, without limitation, the use
2708	2708	of step therapy, prior authorization or categorizing drugs and
2709	2709	devices based on cost, type or method of administration.
2710	2710	[(b)] (c) “Network plan” means a contract for hospital or
2711	2711	medical service offered by an insurer under which the financing and
2712	2712	delivery of medical care, including items and services paid for as
2713	2713	medical care, are provided, in whole or in part, through a defined set
2714	2714	of providers under contract with the insurer. The term does not
2715	2715	include an arrangement for the financing of premiums.
2716	2716	[(c)] (d) “Provider network contract” means a contract
2717	2717	between an insurer and a provider of health care or pharmacy
2718	2718	specifying the rights and responsibilities of the insurer and the
2719	2719	provider of health care or pharmacy, as applicable, for delivery of
2720	2720	health care services pursuant to a network plan.
2721	2721	(e) “Provider of health care” has the meaning ascribed to it in
2722	2722	NRS 629.031.
2723	2723	[(d)] (f) “Therapeutic equivalent” means a drug which:
2724	2724	(1) Contains an identical amount of the same active
2725	2725	ingredients in the same dosage and method of administration as
2726	2726	another drug;
2727	2727	– 59 –
2728	2728
2729	2729
2730	2730	- 82nd Session (2023)
2731	2731	(2) Is expected to have the same clinical effect when
2732	2732	administered to a patient pursuant to a prescription or order as
2733	2733	another drug; and
2734	2734	(3) Meets any other criteria required by the Food and Drug
2735	2735	Administration for classification as a therapeutic equivalent.
2736	2736	Sec. 19. NRS 695C.1696 is hereby amended to read as
2737	2737	follows:
2738	2738	695C.1696 1. Except as otherwise provided in subsection [7,]
2739	2739	8, a health maintenance organization that offers or issues a health
2740	2740	care plan shall include in the plan coverage for:
2741	2741	(a) Up to a 12-month supply, per prescription, of any type of
2742	2742	drug for contraception or its therapeutic equivalent which is:
2743	2743	(1) Lawfully prescribed or ordered;
2744	2744	(2) Approved by the Food and Drug Administration;
2745	2745	(3) Listed in subsection [11;] 12; and
2746	2746	(4) Dispensed in accordance with NRS 639.28075;
2747	2747	(b) Any type of device for contraception which is:
2748	2748	(1) Lawfully prescribed or ordered;
2749	2749	(2) Approved by the Food and Drug Administration; and
2750	2750	(3) Listed in subsection [11;] 12;
2751	2751	(c) Self-administered hormonal contraceptives dispensed by a
2752	2752	pharmacist pursuant to NRS 639.28078;
2753	2753	(d) Insertion of a device for contraception or removal of such a
2754	2754	device if the device was inserted while the enrollee was covered by
2755	2755	the same health care plan;
2756	2756	(e) Education and counseling relating to the initiation of the use
2757	2757	of contraception and any necessary follow-up after initiating such
2758	2758	use;
2759	2759	(f) Management of side effects relating to contraception; and
2760	2760	(g) Voluntary sterilization for women.
2761	2761	2. A health maintenance organization shall provide coverage
2762	2762	for any services listed in subsection 1 which are within the
2763	2763	authorized scope of practice of a pharmacist when such services
2764	2764	are provided by a pharmacist who is employed by or serves as an
2765	2765	independent contractor of an in-network pharmacy and in
2766	2766	accordance with the applicable provider network contract. Such
2767	2767	coverage must be provided to the same extent as if the services
2768	2768	were provided by another provider of health care, as applicable to
2769	2769	the services being provided. The terms of the policy must not limit:
2770	2770	(a) Coverage for services listed in subsection 1 and provided by
2771	2771	such a pharmacist to a number of occasions less than the coverage
2772	2772	for such services when provided by another provider of health
2773	2773	care.
2774	2774	– 60 –
2775	2775
2776	2776
2777	2777	- 82nd Session (2023)
2778	2778	(b) Reimbursement for services listed in subsection 1 and
2779	2779	provided by such a pharmacist to an amount less than the amount
2780	2780	reimbursed for similar services provided by a physician, physician
2781	2781	assistant or advanced practice registered nurse.
2782	2782	3. A health maintenance organization must ensure that the
2783	2783	benefits required by subsection 1 are made available to an enrollee
2784	2784	through a provider of health care who participates in the network
2785	2785	plan of the health maintenance organization.
2786	2786	[3.] 4. If a covered therapeutic equivalent listed in subsection 1
2787	2787	is not available or a provider of health care deems a covered
2788	2788	therapeutic equivalent to be medically inappropriate, an alternate
2789	2789	therapeutic equivalent prescribed by a provider of health care must
2790	2790	be covered by the health maintenance organization.
2791	2791	[4.] 5. Except as otherwise provided in subsections [9,] 10 , 11
2792	2792	and [12,] 13, a health maintenance organization that offers or issues
2793	2793	a health care plan shall not:
2794	2794	(a) Require an enrollee to pay a higher deductible, any
2795	2795	copayment or coinsurance or require a longer waiting period or
2796	2796	other condition to obtain any benefit included in the health care plan
2797	2797	pursuant to subsection 1;
2798	2798	(b) Refuse to issue a health care plan or cancel a health care plan
2799	2799	solely because the person applying for or covered by the plan uses
2800	2800	or may use any such benefit;
2801	2801	(c) Offer or pay any type of material inducement or financial
2802	2802	incentive to an enrollee to discourage the enrollee from obtaining
2803	2803	any such benefit;
2804	2804	(d) Penalize a provider of health care who provides any such
2805	2805	benefit to an enrollee, including, without limitation, reducing the
2806	2806	reimbursement of the provider of health care;
2807	2807	(e) Offer or pay any type of material inducement, bonus or other
2808	2808	financial incentive to a provider of health care to deny, reduce,
2809	2809	withhold, limit or delay access to any such benefit to an enrollee; or
2810	2810	(f) Impose any other restrictions or delays on the access of an
2811	2811	enrollee to any such benefit.
2812	2812	[5.] 6. Coverage pursuant to this section for the covered
2813	2813	dependent of an enrollee must be the same as for the enrollee.
2814	2814	[6.] 7. Except as otherwise provided in subsection [7,] 8, a
2815	2815	health care plan subject to the provisions of this chapter that is
2816	2816	delivered, issued for delivery or renewed on or after January 1,
2817	2817	[2022,] 2024, has the legal effect of including the coverage required
2818	2818	by [subsection 1,] this section, and any provision of the plan or the
2819	2819	renewal which is in conflict with this section is void.
2820	2820	– 61 –
2821	2821
2822	2822
2823	2823	- 82nd Session (2023)
2824	2824	[7.] 8. A health maintenance organization that offers or issues
2825	2825	a health care plan and which is affiliated with a religious
2826	2826	organization is not required to provide the coverage required by
2827	2827	subsection 1 if the health maintenance organization objects on
2828	2828	religious grounds. Such an organization shall, before the issuance of
2829	2829	a health care plan and before the renewal of such a plan, provide to
2830	2830	the prospective enrollee written notice of the coverage that the
2831	2831	health maintenance organization refuses to provide pursuant to this
2832	2832	subsection.
2833	2833	[8.] 9. If a health maintenance organization refuses, pursuant
2834	2834	to subsection [7,] 8, to provide the coverage required by subsection
2835	2835	1, an employer may otherwise provide for the coverage for the
2836	2836	employees of the employer.
2837	2837	[9.] 10. A health maintenance organization may require an
2838	2838	enrollee to pay a higher deductible, copayment or coinsurance for a
2839	2839	drug for contraception if the enrollee refuses to accept a therapeutic
2840	2840	equivalent of the drug.
2841	2841	[10.] 11. For each of the 18 methods of contraception listed in
2842	2842	subsection [11] 12 that have been approved by the Food and Drug
2843	2843	Administration, a health care plan must include at least one drug or
2844	2844	device for contraception within each method for which no
2845	2845	deductible, copayment or coinsurance may be charged to the
2846	2846	enrollee, but the health maintenance organization may charge a
2847	2847	deductible, copayment or coinsurance for any other drug or device
2848	2848	that provides the same method of contraception. If the health
2849	2849	maintenance organization charges a copayment or coinsurance
2850	2850	for a drug for contraception, the health maintenance organization
2851	2851	may only require an enrollee to pay the copayment or
2852	2852	coinsurance:
2853	2853	(a) Once for the entire amount of the drug dispensed for the
2854	2854	plan year; or
2855	2855	(b) Once for each 1-month supply of the drug dispensed.
2856	2856	[11.] 12. The following 18 methods of contraception must be
2857	2857	covered pursuant to this section:
2858	2858	(a) Voluntary sterilization for women;
2859	2859	(b) Surgical sterilization implants for women;
2860	2860	(c) Implantable rods;
2861	2861	(d) Copper-based intrauterine devices;
2862	2862	(e) Progesterone-based intrauterine devices;
2863	2863	(f) Injections;
2864	2864	(g) Combined estrogen- and progestin-based drugs;
2865	2865	(h) Progestin-based drugs;
2866	2866	(i) Extended- or continuous-regimen drugs;
2867	2867	– 62 –
2868	2868
2869	2869
2870	2870	- 82nd Session (2023)
2871	2871	(j) Estrogen- and progestin-based patches;
2872	2872	(k) Vaginal contraceptive rings;
2873	2873	(l) Diaphragms with spermicide;
2874	2874	(m) Sponges with spermicide;
2875	2875	(n) Cervical caps with spermicide;
2876	2876	(o) Female condoms;
2877	2877	(p) Spermicide;
2878	2878	(q) Combined estrogen- and progestin-based drugs for
2879	2879	emergency contraception or progestin-based drugs for emergency
2880	2880	contraception; and
2881	2881	(r) Ulipristal acetate for emergency contraception.
2882	2882	[12.] 13. Except as otherwise provided in this section and
2883	2883	federal law, a health maintenance organization may use medical
2884	2884	management techniques, including, without limitation, any available
2885	2885	clinical evidence, to determine the frequency of or treatment relating
2886	2886	to any benefit required by this section or the type of provider of
2887	2887	health care to use for such treatment.
2888	2888	[13.] 14. A health maintenance organization shall not [use] :
2889	2889	(a) Use medical management techniques to require an enrollee
2890	2890	to use a method of contraception other than the method prescribed
2891	2891	or ordered by a provider of health care [.] ; or
2892	2892	(b) Require an enrollee to obtain prior authorization for the
2893	2893	benefits described in paragraphs (a) and (c) of subsection 1.
2894	2894	[14.] 15. A health maintenance organization must provide an
2895	2895	accessible, transparent and expedited process which is not unduly
2896	2896	burdensome by which an enrollee, or the authorized representative
2897	2897	of the enrollee, may request an exception relating to any medical
2898	2898	management technique used by the health maintenance organization
2899	2899	to obtain any benefit required by this section without a higher
2900	2900	deductible, copayment or coinsurance.
2901	2901	[15.] 16. As used in this section:
2902	2902	(a) “In-network pharmacy” means a pharmacy that has
2903	2903	entered into a contract with a health maintenance organization to
2904	2904	provide services to enrollees through a network plan offered or
2905	2905	issued by the health maintenance organization.
2906	2906	(b) “Medical management technique” means a practice which is
2907	2907	used to control the cost or utilization of health care services or
2908	2908	prescription drug use. The term includes, without limitation, the use
2909	2909	of step therapy, prior authorization or categorizing drugs and
2910	2910	devices based on cost, type or method of administration.
2911	2911	[(b)] (c) “Network plan” means a health care plan offered by a
2912	2912	health maintenance organization under which the financing and
2913	2913	delivery of medical care, including items and services paid for as
2914	2914	– 63 –
2915	2915
2916	2916
2917	2917	- 82nd Session (2023)
2918	2918	medical care, are provided, in whole or in part, through a defined set
2919	2919	of providers under contract with the health maintenance
2920	2920	organization. The term does not include an arrangement for the
2921	2921	financing of premiums.
2922	2922	[(c)] (d) “Provider network contract” means a contract
2923	2923	between a health maintenance organization and a provider of
2924	2924	health care or pharmacy specifying the rights and responsibilities
2925	2925	of the health maintenance organization and the provider of health
2926	2926	care or pharmacy, as applicable, for delivery of health care
2927	2927	services pursuant to a network plan.
2928	2928	(e) “Provider of health care” has the meaning ascribed to it in
2929	2929	NRS 629.031.
2930	2930	[(d)] (f) “Therapeutic equivalent” means a drug which:
2931	2931	(1) Contains an identical amount of the same active
2932	2932	ingredients in the same dosage and method of administration as
2933	2933	another drug;
2934	2934	(2) Is expected to have the same clinical effect when
2935	2935	administered to a patient pursuant to a prescription or order as
2936	2936	another drug; and
2937	2937	(3) Meets any other criteria required by the Food and Drug
2938	2938	Administration for classification as a therapeutic equivalent.
2939	2939	Sec. 20. NRS 695G.1715 is hereby amended to read as
2940	2940	follows:
2941	2941	695G.1715 1. Except as otherwise provided in subsection [7,]
2942	2942	8, a managed care organization that offers or issues a health care
2943	2943	plan shall include in the plan coverage for:
2944	2944	(a) Up to a 12-month supply, per prescription, of any type of
2945	2945	drug for contraception or its therapeutic equivalent which is:
2946	2946	(1) Lawfully prescribed or ordered;
2947	2947	(2) Approved by the Food and Drug Administration;
2948	2948	(3) Listed in subsection [10;] 11; and
2949	2949	(4) Dispensed in accordance with NRS 639.28075;
2950	2950	(b) Any type of device for contraception which is:
2951	2951	(1) Lawfully prescribed or ordered;
2952	2952	(2) Approved by the Food and Drug Administration; and
2953	2953	(3) Listed in subsection [10;] 11;
2954	2954	(c) Self-administered hormonal contraceptives dispenses by a
2955	2955	pharmacist pursuant to NRS 639.28078;
2956	2956	(d) Insertion of a device for contraception or removal of such a
2957	2957	device if the device was inserted while the insured was covered by
2958	2958	the same health care plan;
2959	2959	– 64 –
2960	2960
2961	2961
2962	2962	- 82nd Session (2023)
2963	2963	(e) Education and counseling relating to the initiation of the use
2964	2964	of contraception and any necessary follow-up after initiating such
2965	2965	use;
2966	2966	(f) Management of side effects relating to contraception; and
2967	2967	(g) Voluntary sterilization for women.
2968	2968	2. A managed care organization shall provide coverage for
2969	2969	any services listed in subsection 1 which are within the authorized
2970	2970	scope of practice of a pharmacist when such services are provided
2971	2971	by a pharmacist who is employed by or serves as an independent
2972	2972	contractor of an in-network pharmacy and in accordance with the
2973	2973	applicable provider network contract. Such coverage must be
2974	2974	provided to the same extent as if the services were provided by
2975	2975	another provider of health care, as applicable to the services being
2976	2976	provided. The terms of the policy must not limit:
2977	2977	(a) Coverage for services listed in subsection 1 and provided by
2978	2978	such a pharmacist to a number of occasions less than the coverage
2979	2979	for such services when provided by another provider of health
2980	2980	care.
2981	2981	(b) Reimbursement for services listed in subsection 1 and
2982	2982	provided by such a pharmacist to an amount less than the amount
2983	2983	reimbursed for similar services provided by a physician, physician
2984	2984	assistant or advanced practice registered nurse.
2985	2985	3. A managed care organization must ensure that the benefits
2986	2986	required by subsection 1 are made available to an insured through a
2987	2987	provider of health care who participates in the network plan of the
2988	2988	managed care organization.
2989	2989	[3.] 4. If a covered therapeutic equivalent listed in subsection 1
2990	2990	is not available or a provider of health care deems a covered
2991	2991	therapeutic equivalent to be medically inappropriate, an alternate
2992	2992	therapeutic equivalent prescribed by a provider of health care must
2993	2993	be covered by the managed care organization.
2994	2994	[4.] 5. Except as otherwise provided in subsections [8,] 9 , 10
2995	2995	and [11,] 12, a managed care organization that offers or issues a
2996	2996	health care plan shall not:
2997	2997	(a) Require an insured to pay a higher deductible, any
2998	2998	copayment or coinsurance or require a longer waiting period or
2999	2999	other condition to obtain any benefit included in the health care plan
3000	3000	pursuant to subsection 1;
3001	3001	(b) Refuse to issue a health care plan or cancel a health care plan
3002	3002	solely because the person applying for or covered by the plan uses
3003	3003	or may use any such benefits;
3004	3004	– 65 –
3005	3005
3006	3006
3007	3007	- 82nd Session (2023)
3008	3008	(c) Offer or pay any type of material inducement or financial
3009	3009	incentive to an insured to discourage the insured from obtaining any
3010	3010	such benefits;
3011	3011	(d) Penalize a provider of health care who provides any such
3012	3012	benefits to an insured, including, without limitation, reducing the
3013	3013	reimbursement of the provider of health care;
3014	3014	(e) Offer or pay any type of material inducement, bonus or other
3015	3015	financial incentive to a provider of health care to deny, reduce,
3016	3016	withhold, limit or delay access to any such benefits to an insured; or
3017	3017	(f) Impose any other restrictions or delays on the access of an
3018	3018	insured to any such benefits.
3019	3019	[5.] 6. Coverage pursuant to this section for the covered
3020	3020	dependent of an insured must be the same as for the insured.
3021	3021	[6.] 7. Except as otherwise provided in subsection [7,] 8, a
3022	3022	health care plan subject to the provisions of this chapter that is
3023	3023	delivered, issued for delivery or renewed on or after January 1,
3024	3024	[2022,] 2024, has the legal effect of including the coverage required
3025	3025	by [subsection 1,] this section, and any provision of the plan or the
3026	3026	renewal which is in conflict with this section is void.
3027	3027	[7.] 8. A managed care organization that offers or issues a
3028	3028	health care plan and which is affiliated with a religious organization
3029	3029	is not required to provide the coverage required by subsection 1 if
3030	3030	the managed care organization objects on religious grounds. Such an
3031	3031	organization shall, before the issuance of a health care plan and
3032	3032	before the renewal of such a plan, provide to the prospective insured
3033	3033	written notice of the coverage that the managed care organization
3034	3034	refuses to provide pursuant to this subsection.
3035	3035	[8.] 9. A managed care organization may require an insured to
3036	3036	pay a higher deductible, copayment or coinsurance for a drug for
3037	3037	contraception if the insured refuses to accept a therapeutic
3038	3038	equivalent of the drug.
3039	3039	[9.] 10. For each of the 18 methods of contraception listed in
3040	3040	subsection [10] 11 that have been approved by the Food and Drug
3041	3041	Administration, a health care plan must include at least one drug or
3042	3042	device for contraception within each method for which no
3043	3043	deductible, copayment or coinsurance may be charged to the
3044	3044	insured, but the managed care organization may charge a deductible,
3045	3045	copayment or coinsurance for any other drug or device that provides
3046	3046	the same method of contraception. If the managed care
3047	3047	organization charges a copayment or coinsurance for a drug for
3048	3048	contraception, the managed care organization may only require
3049	3049	an enrollee to pay the copayment or coinsurance:
3050	3050	– 66 –
3051	3051
3052	3052
3053	3053	- 82nd Session (2023)
3054	3054	(a) Once for the entire amount of the drug dispensed for the
3055	3055	plan year; or
3056	3056	(b) Once for each 1-month supply of the drug dispensed.
3057	3057	[10.] 11. The following 18 methods of contraception must be
3058	3058	covered pursuant to this section:
3059	3059	(a) Voluntary sterilization for women;
3060	3060	(b) Surgical sterilization implants for women;
3061	3061	(c) Implantable rods;
3062	3062	(d) Copper-based intrauterine devices;
3063	3063	(e) Progesterone-based intrauterine devices;
3064	3064	(f) Injections;
3065	3065	(g) Combined estrogen- and progestin-based drugs;
3066	3066	(h) Progestin-based drugs;
3067	3067	(i) Extended- or continuous-regimen drugs;
3068	3068	(j) Estrogen- and progestin-based patches;
3069	3069	(k) Vaginal contraceptive rings;
3070	3070	(l) Diaphragms with spermicide;
3071	3071	(m) Sponges with spermicide;
3072	3072	(n) Cervical caps with spermicide;
3073	3073	(o) Female condoms;
3074	3074	(p) Spermicide;
3075	3075	(q) Combined estrogen- and progestin-based drugs for
3076	3076	emergency contraception or progestin-based drugs for emergency
3077	3077	contraception; and
3078	3078	(r) Ulipristal acetate for emergency contraception.
3079	3079	[11.] 12. Except as otherwise provided in this section and
3080	3080	federal law, a managed care organization may use medical
3081	3081	management techniques, including, without limitation, any available
3082	3082	clinical evidence, to determine the frequency of or treatment relating
3083	3083	to any benefit required by this section or the type of provider of
3084	3084	health care to use for such treatment.
3085	3085	[12.] 13. A managed care organization shall not [use] :
3086	3086	(a) Use medical management techniques to require an insured to
3087	3087	use a method of contraception other than the method prescribed or
3088	3088	ordered by a provider of health care [.] ; or
3089	3089	(b) Require an insured to obtain prior authorization for the
3090	3090	benefits described in paragraphs (a) and (c) of subsection 1.
3091	3091	[13.] 14. A managed care organization must provide an
3092	3092	accessible, transparent and expedited process which is not unduly
3093	3093	burdensome by which an insured, or the authorized representative of
3094	3094	the insured, may request an exception relating to any medical
3095	3095	management technique used by the managed care organization to
3096	3096	– 67 –
3097	3097
3098	3098
3099	3099	- 82nd Session (2023)
3100	3100	obtain any benefit required by this section without a higher
3101	3101	deductible, copayment or coinsurance.
3102	3102	[14.] 15. As used in this section:
3103	3103	(a) “In-network pharmacy” means a pharmacy that has
3104	3104	entered into a contract with a managed care organization to
3105	3105	provide services to insureds through a network plan offered or
3106	3106	issued by the managed care organization.
3107	3107	(b) “Medical management technique” means a practice which is
3108	3108	used to control the cost or utilization of health care services or
3109	3109	prescription drug use. The term includes, without limitation, the use
3110	3110	of step therapy, prior authorization or categorizing drugs and
3111	3111	devices based on cost, type or method of administration.
3112	3112	[(b)] (c) “Network plan” means a health care plan offered by a
3113	3113	managed care organization under which the financing and delivery
3114	3114	of medical care, including items and services paid for as medical
3115	3115	care, are provided, in whole or in part, through a defined set of
3116	3116	providers under contract with the managed care organization. The
3117	3117	term does not include an arrangement for the financing of
3118	3118	premiums.
3119	3119	[(c)] (d) “Provider network contract” means a contract
3120	3120	between a managed care organization and a provider of health
3121	3121	care or pharmacy specifying the rights and responsibilities of the
3122	3122	managed care organization and the provider of health care or
3123	3123	pharmacy, as applicable, for delivery of health care services
3124	3124	pursuant to a network plan.
3125	3125	(e) “Provider of health care” has the meaning ascribed to it in
3126	3126	NRS 629.031.
3127	3127	[(d)] (f) “Therapeutic equivalent” means a drug which:
3128	3128	(1) Contains an identical amount of the same active
3129	3129	ingredients in the same dosage and method of administration as
3130	3130	another drug;
3131	3131	(2) Is expected to have the same clinical effect when
3132	3132	administered to a patient pursuant to a prescription or order as
3133	3133	another drug; and
3134	3134	(3) Meets any other criteria required by the Food and Drug
3135	3135	Administration for classification as a therapeutic equivalent.
3136	3136	Sec. 21. 1. The provisions of NRS 422.4053, as amended by
3137	3137	section 2 of this act, do not apply to a contract between the
3138	3138	Department of Health and Human Services and a pharmacy benefit
3139	3139	manager or a health maintenance organization entered into pursuant
3140	3140	to NRS 422.4053 before January 1, 2024, but do apply to any
3141	3141	renewal or extension of such a contract.
3142	3142	2. As used in this section:
3143	3143	– 68 –
3144	3144
3145	3145
3146	3146	- 82nd Session (2023)
3147	3147	(a) “Health maintenance organization” has the meaning ascribed
3148	3148	to it in NRS 695C.030.
3149	3149	(b) “Pharmacy benefit manager” has the meaning ascribed to it
3150	3150	in NRS 683A.174.
3151	3151	Sec. 22. The provisions of NRS 354.599 do not apply to any
3152	3152	additional expenses of a local government that are related to the
3153	3153	provisions of this act.
3154	3154	Sec. 23. 1. This section and sections 4 and 5 of this act
3155	3155	become effective upon passage and approval.
3156	3156	2. Sections 1, 2, 3 and 6 to 22, inclusive, of this act become
3157	3157	effective:
3158	3158	(a) Upon passage and approval for the purpose of performing
3159	3159	any preparatory administrative tasks that are necessary to carry out
3160	3160	the provisions of this act; and
3161	3161	(b) On January 1, 2024, for all other purposes.
3162	3162
3163	3163	20 ~~~~~ 23