Nevada Senate Bill SB439 Amended / Bill

                     	EXEMPT 
 (Reprinted with amendments adopted on May 31, 2023) 
 	SECOND REPRINT S.B. 439 
 
- *SB439_R2* 
 
SENATE BILL NO. 439–SENATORS D. HARRIS,  
SCHEIBLE AND DONATE 
 
MARCH 27, 2023 
____________ 
 
Referred to Committee on Health and Human Services 
 
SUMMARY—Revises provisions relating to communicable 
diseases. (BDR 40-987) 
 
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. 
 Effect on the State: Yes. 
 
CONTAINS UNFUNDED MANDATE (§ 1) 
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT) 
 
~ 
 
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. 
 
 
AN ACT relating to communicable diseases; requiring certain state 
and local agencies to develop policies to provide 
uninterrupted services during a public health emergency 
to certain persons; requiring a public or private detention 
facility to take certain measures to ensure the access of 
prisoners to treatment for and methods to prevent the 
acquisition of human immunodeficiency virus; revising 
provisions governing certain crimes committed by 
prisoners; requiring certain public and private health 
insurers to provide certain coverage; requiring such an 
insurer to reimburse an advanced practice registered nurse 
or physician assistant at the same rate as a physician for 
certain services; authorizing providers of health care to 
receive credit toward requirements for continuing 
education for certain training relating to the human 
immunodeficiency virus; requiring certain providers of 
health care to complete such training; providing that the 
repeal or revision of certain crimes applies retroactively; 
and providing other matters properly relating thereto. 
Legislative Counsel’s Digest: 
 Existing law requires the Division of Public and Behavioral Health of the 1 
Department of Health and Human Services and district, county and city health 2 
departments to perform certain functions relating to public health in this State, 3   
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including certain duties relating to the control of communicable diseases. (NRS 4 
439.150-439.265, 439.340, 439.350, 439.360, 439.366, 439.367, 439.3675, 5 
439.405, 439.410, 439.460, 439.470) Existing law also requires a district health 6 
officer or the Chief Medical Officer to perform certain duties relating to the control 7 
of communicable diseases. (Chapter 441A of NRS) Existing law prescribes certain 8 
responsibilities of the Division of Health Care Financing and Policy of the 9 
Department concerning the administration of the Medicaid program. (NRS 10 
422.061, 422.063) Section 1 of this bill requires the Department and all district, 11 
county and city boards of health to develop policies to provide uninterrupted 12 
services during a public health emergency to persons who have been diagnosed 13 
with the human immunodeficiency virus or persons who are at a high risk of 14 
acquiring the human immunodeficiency virus. Section 2 of this bill makes a 15 
conforming change to indicate the proper placement of section 1 in the Nevada 16 
Revised Statutes. 17 
 Existing law requires the Director of the Department of Corrections to establish 18 
standards for the medical and dental services of each institution or facility under the 19 
control of the Department. (NRS 209.381) Existing law also requires a sheriff, chief 20 
of police or town marshal to arrange for the administration of medical care required 21 
by prisoners while in his or her custody. (NRS 211.140) Sections 11 and 12 of this 22 
bill impose certain requirements on the operators of public and private prisons, jails 23 
and detention facilities to ensure the access of prisoners to treatment for human 24 
immunodeficiency virus and methods of preventing the acquisition of human 25 
immunodeficiency virus. 26 
 Existing law prohibits a prisoner from using, propelling, discharging, spreading 27 
or concealing human excrement or bodily fluid with intent or under circumstances 28 
where it is reasonably likely that the excrement or fluid will come in contact with 29 
another person. Under most circumstances, a violation is a gross misdemeanor, a 30 
category D felony or a category B felony, depending on the circumstances of the 31 
prisoner’s confinement. However, if the prisoner knew at the time of the offense 32 
that any portion of the excrement or bodily fluid contained a communicable disease 33 
that causes or is reasonably likely to cause substantial bodily harm, the violation is 34 
a category A felony, regardless of whether the communicable disease was 35 
transmitted. (NRS 212.189) Section 13 of this bill instead provides that such a 36 
violation is only a category A felony where: (1) the communicable disease was 37 
likely to be transmitted by his or her conduct; and (2) the communicable disease 38 
was actually transmitted as a result of the conduct. Section 78 of this bill provides 39 
that the provisions of section 13 apply retroactively to violations that occurred 40 
before the effective date of that section, if the person who committed the violation 41 
has not been convicted before that date. 42 
 Existing law requires public and private health plans, including Medicaid and 43 
health plans for state government employees, to cover an examination and testing 44 
of a pregnant woman for Chlamydia trachomatis, gonorrhea, hepatitis B, hepatitis 45 
C and syphilis. (NRS 287.04335, 422.27173, 689A.0412, 689B.0315, 689C.1675, 46 
695A.1856, 695B.1913, 695C.1737, 695G.1714) Sections 16, 22, 34, 42, 47, 52, 47 
55, 60, 65, 67 and 72 of this bill additionally require such insurance plans to cover: 48 
(1) testing for, treatment of and prevention of sexually transmitted diseases; and (2) 49 
condoms for certain covered persons.  50 
 Existing law requires certain public and private health plans, including health 51 
plans for state government employees, to cover drugs that prevent the acquisition of 52 
human immunodeficiency virus and any related laboratory or diagnostic 53 
procedures. (NRS 287.010, 287.04335, 689A.0437, 689B.0312, 689C.1671, 54 
695A.1843, 695B.1924, 695C.1743, 695G.1705) Sections 31, 37, 44, 51, 57, 62, 68 55 
and 74 of this bill require such insurance plans to cover all such drugs approved by 56 
the United States Food and Drug Administration and all drugs approved by the 57 
Food and Drug Administration for treating human immunodeficiency virus or 58   
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hepatitis C without restrictions, other than step therapy. Sections 23, 37, 44, 51, 57, 59 
62, 68 and 74 of this bill require such insurance plans to: (1) cover any service to 60 
test for, prevent or treat those diseases provided by a provider of primary care if the 61 
service is covered when provided by a specialist and certain other requirements are 62 
met; and (2) reimburse an advanced practice registered nurse or a physician 63 
assistant for such services at a rate equal to that provided to a physician. Sections 64 
16, 20, 31, 33, 41, 46, 52, 54, 59, 64, 67 and 71 impose similar requirements 65 
regarding: (1) coverage of certain drugs approved by the Food and Drug 66 
Administration to treat substance use disorder; (2) coverage of services for the 67 
treatment of substance use disorder provided by a provider of primary care; and (3) 68 
reimbursement for such services provided by an advanced practice registered nurse. 69 
Sections 14.5-15.5 of this bill make conforming changes to exempt local 70 
governmental agencies that provide health insurance to employees through a plan 71 
of self-insurance from the amendatory provisions of section 44 while maintaining 72 
existing requirements that apply to such insurance. Sections 36, 38, 49 and 50 of 73 
this bill make conforming changes to indicate that the coverage required by 74 
sections 33 and 46 is in addition to certain coverage of services for the treatment of 75 
substance use disorder that certain insurers are required by existing law to provide. 76 
Sections 14 and 39 of this bill make conforming changes to indicate the proper 77 
placement of sections 20, 22, 33 and 34 in the Nevada Revised Statutes. Section 78 
69 of this bill authorizes the Commissioner of Insurance to suspend or revoke the 79 
certificate of a health maintenance organization that fails to comply with the 80 
requirements of section 64 or 65. The Commissioner would also be authorized to 81 
take such action against any health insurer who fails to comply with the 82 
requirements of sections 33, 34, 37, 41-44, 46, 47, 50, 54-57, 59-62, 67, 68 or 71-83 
74 of this bill. (NRS 680A.200, 695C.330) 84 
 Existing law requires the Department of Health and Human Services to develop 85 
a list of preferred prescription drugs to be used for the Medicaid program. Existing 86 
law requires the Department to: (1) include on that list drugs for the prevention of 87 
human immunodeficiency virus; and (2) include drugs prescribed to treat the 88 
human immunodeficiency virus on a list of drugs that are excluded from the 89 
restrictions imposed on drugs that are on the list of preferred prescription drugs. 90 
(NRS 422.4025) Section 25 of this bill requires the Medicaid program to cover a 91 
prescription drug that is not on the list of preferred prescription drugs if the drug is: 92 
(1) used to treat hepatitis C, used to provide medication-assisted treatment for 93 
opioid use disorder, used to support safe withdrawal from substance use disorder or 94 
is in the same class as a prescription drug on the list of preferred prescription drugs; 95 
and (2) is unsuitable for a recipient of Medicaid for certain reasons. 96 
 Existing law requires physicians, osteopathic physicians, physician assistants 97 
and nurses to complete certain continuing education in order to renew their 98 
licenses. (NRS 630.253, 632.343, 633.471) Sections 28-30 and 75 of this bill 99 
require such a provider of health care who provides or supervises the provision of 100 
emergency medical care or primary care in a hospital to complete before the first 101 
renewal of their license or, for currently practicing providers, the next renewal of 102 
their license, at least 2 hours of training in stigma, discrimination and unrecognized 103 
bias toward persons who have acquired or are at a high risk of acquiring human 104 
immunodeficiency virus. Section 27 of this bill authorizes any provider of health 105 
care to use training in that subject in place of not more than 2 hours of any other 106 
training that the provider is required to complete, other than continuing education 107 
relating to ethics. 108 
 Senate Bill No. 275 of the 2021 Legislative Session repealed certain criminal 109 
offenses for which an element of the offense was having the human 110 
immunodeficiency virus. (Section 24, chapter 491, Statutes of Nevada 2021, at 111 
page 3199) Section 77 of this bill provides that the repeal of those offenses applies 112   
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retroactively to violations that occurred before the effective date of Senate Bill  113 
No. 275. 114 
 
 
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN 
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: 
 
 Section 1.  Chapter 441A of NRS is hereby amended by 1 
adding thereto a new section to read as follows: 2 
 1. The Department of Health and Human Services and all 3 
district, county and city boards of health shall develop policies to 4 
provide uninterrupted services during a public health emergency 5 
to persons who have been diagnosed with the human 6 
immunodeficiency virus or who are at a high risk of acquiring the 7 
human immunodeficiency virus and who are receiving services 8 
from the Department or any division thereof or the district, county 9 
or city health department, as applicable. Such policies may 10 
provide, without limitation, for the delivery of such services during 11 
a public health emergency: 12 
 (a) Over the Internet; 13 
 (b) Using an application for a mobile device; or 14 
 (c) By calling or sending text messages from a telephone 15 
number that is not generally blocked or identified as a source of 16 
unwanted calls or messages. 17 
 2. As used in this section: 18 
 (a) “Mobile device” includes, without limitation, a smartphone 19 
or a tablet computer. 20 
 (b) “Public health emergency” means: 21 
  (1) A public health emergency or other health event 22 
identified by a health authority pursuant to NRS 439.970; or 23 
  (2) A state of emergency or declaration of disaster 24 
proclaimed pursuant to NRS 414.070 that relates to or affects 25 
public health. 26 
 Sec. 2.  NRS 441A.334 is hereby amended to read as follows: 27 
 441A.334 As used in this section and NRS 441A.335 and 28 
441A.336, and section 1 of this act, “provider of health care” means 29 
a physician, nurse or physician assistant licensed in accordance with 30 
state law. 31 
 Sec. 3.  (Deleted by amendment.) 32 
 Sec. 4.  (Deleted by amendment.) 33 
 Sec. 5.  (Deleted by amendment.) 34 
 Sec. 6.  (Deleted by amendment.) 35 
 Sec. 7.  (Deleted by amendment.) 36 
 Sec. 8.  (Deleted by amendment.) 37 
 Sec. 9.  (Deleted by amendment.) 38 
 Sec. 10.  (Deleted by amendment.) 39   
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 Sec. 11.  Chapter 209 of NRS is hereby amended by adding 1 
thereto a new section to read as follows: 2 
 1. The Department or the operator of a private facility or 3 
institution shall not enter into a contract or other agreement with 4 
any person or entity to provide medical services to offenders who 5 
are diagnosed with human immunodeficiency virus unless the 6 
person or entity demonstrates that at least 95 percent of the 7 
patients who are diagnosed with human immunodeficiency virus 8 
to whom the person or entity provides medical services: 9 
 (a) Are offered treatment on the same day as the diagnosis; 10 
and 11 
 (b) Are able to begin such treatment not later than 7 days after 12 
diagnosis. 13 
 2. Except as otherwise provided in subsection 3, an 14 
institution, facility or private facility or institution shall take 15 
reasonable measures to ensure the availability of:  16 
 (a) Any drug prescribed for treating the human 17 
immunodeficiency virus in the form recommended by the 18 
prescribing practitioner to each offender who has been diagnosed 19 
with human immunodeficiency virus to the same extent and under 20 
the same conditions as other medical care for offenders. 21 
 (b) Methods of preventing the acquisition of human 22 
immunodeficiency virus, including, without limitation, drugs 23 
approved by the United States Food and Drug Administration for 24 
that purpose, to all offenders free of charge. 25 
 3. An institution, facility or private facility or institution: 26 
 (a) Is not required to make available a drug described in 27 
subsection 2 for which a prescription is required to an offender for 28 
whom such a prescription has not been issued. 29 
 (b) Shall take reasonable measures to make available to all 30 
offenders a provider of health care who is authorized to issue a 31 
prescription for a drug described in subsection 2. 32 
 (c) Shall not demand, request or suggest that a provider of 33 
health care refrain from issuing a prescription for a drug 34 
described in subsection 2 to an offender or take any other measure 35 
to prevent a provider of health care from issuing such a 36 
prescription. 37 
 4. As used in this section, “provider of health care” has the 38 
meaning ascribed to it in NRS 629.031. 39 
 Sec. 12.  Chapter 211 of NRS is hereby amended by adding 40 
thereto a new section to read as follows: 41 
 1. A sheriff, chief of police or town marshal who is 42 
responsible for a county, city or town jail or detention facility shall 43 
not enter into a contract or other agreement with any person or 44 
entity to provide medical services to prisoners who are diagnosed 45   
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with human immunodeficiency virus unless the person or entity 1 
demonstrates that at least 95 percent of the patients who are 2 
diagnosed with human immunodeficiency virus to whom the 3 
person or entity provides medical services: 4 
 (a) Are offered treatment on the same day as the diagnosis; 5 
and 6 
 (b) Are able to begin such treatment not later than 7 days after 7 
diagnosis. 8 
 2. Except as otherwise provided in subsection 3, a county, city 9 
or town jail or detention facility shall take reasonable measures to 10 
ensure the availability of:  11 
 (a) Any drug prescribed for treating the human 12 
immunodeficiency virus in the form recommended by the 13 
prescribing practitioner to each prisoner who has been diagnosed 14 
with human immunodeficiency virus to the same extent and under 15 
the same conditions as other medical care for prisoners. 16 
 (b) Methods of preventing the acquisition of human 17 
immunodeficiency virus, including, without limitation, drugs 18 
approved by the United States Food and Drug Administration for 19 
that purpose, to all prisoners free of charge. 20 
 3. A county, city or town jail or detention facility: 21 
 (a) Is not required to make available a drug described in 22 
subsection 2 for which a prescription is required to a prisoner for 23 
whom such a prescription has not been issued. 24 
 (b) Shall take reasonable measures to make available to all 25 
prisoners a provider of health care who is authorized to issue a 26 
prescription for a drug described in subsection 2. 27 
 (c) Shall not demand, request or suggest that a provider of 28 
health care refrain from issuing a prescription for a drug 29 
described in subsection 2 to an offender or take any other measure 30 
to prevent a provider of health care from issuing such a 31 
prescription. 32 
 4. As used in this section, “provider of health care” has the 33 
meaning ascribed to it in NRS 629.031. 34 
 Sec. 13.  NRS 212.189 is hereby amended to read as follows: 35 
 212.189 1.  Except as otherwise provided in subsection 10, a 36 
prisoner who is under lawful arrest, in lawful custody or in lawful 37 
confinement shall not knowingly: 38 
 (a) Store or stockpile any human excrement or bodily fluid; 39 
 (b) Sell, supply or provide any human excrement or bodily fluid 40 
to any other person; 41 
 (c) Buy, receive or acquire any human excrement or bodily fluid 42 
from any other person; or 43   
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 (d) Use, propel, discharge, spread or conceal, or cause to be 1 
used, propelled, discharged, spread or concealed, any human 2 
excrement or bodily fluid: 3 
  (1) With the intent to have the excrement or bodily fluid 4 
come into physical contact with any portion of the body of another 5 
person, including, without limitation, an officer or employee of a 6 
prison or law enforcement agency, whether or not such physical 7 
contact actually occurs; or 8 
  (2) Under circumstances in which the excrement or bodily 9 
fluid is reasonably likely to come into physical contact with any 10 
portion of the body of another person, including, without limitation, 11 
an officer or employee of a prison or law enforcement agency, 12 
whether or not such physical contact actually occurs. 13 
 2.  Except as otherwise provided in subsection 4, if a prisoner 14 
who is under lawful arrest or in lawful custody violates any 15 
provision of subsection 1, the prisoner is guilty of: 16 
 (a) For a first offense, a gross misdemeanor. 17 
 (b) For a second offense or any subsequent offense, a category 18 
D felony and shall be punished as provided in NRS 193.130. 19 
 3.  Except as otherwise provided in subsection 4, if a prisoner 20 
who is in lawful confinement, other than residential confinement, 21 
violates any provision of subsection 1, the prisoner is guilty of a 22 
category B felony and shall be punished by imprisonment in the 23 
state prison for a minimum term of not less than 2 years and a 24 
maximum term of not more than 10 years, and may be further 25 
punished by a fine of not more than $10,000. 26 
 4.  If a prisoner who is under lawful arrest, in lawful custody or 27 
in lawful confinement violates any provision of paragraph (d) of 28 
subsection 1 and, at the time of the offense, the prisoner knew that 29 
any portion of the excrement or bodily fluid involved in the offense 30 
contained a communicable disease that causes or is reasonably 31 
likely to cause substantial bodily harm, [whether or not] the 32 
communicable disease is likely to be transmitted as a result of the 33 
offense and the communicable disease was actually transmitted to a 34 
victim as a result of the offense, the prisoner is guilty of a category 35 
A felony and shall be punished by imprisonment in the state prison: 36 
 (a) For life with the possibility of parole, with eligibility for 37 
parole beginning when a minimum of 10 years has been served; or 38 
 (b) For a definite term of 25 years, with eligibility for parole 39 
beginning when a minimum of 10 years has been served, 40 
 and may be further punished by a fine of not more than $50,000. 41 
 5.  A sentence imposed upon a prisoner pursuant to subsection 42 
2, 3 or 4: 43 
 (a) Is not subject to suspension or the granting of probation; and 44   
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 (b) Must run consecutively after the prisoner has served any 1 
sentences imposed upon the prisoner for the offense or offenses for 2 
which the prisoner was under lawful arrest, in lawful custody or in 3 
lawful confinement when the prisoner violated the provisions of 4 
subsection 1. 5 
 6.  In addition to any other penalty, the court shall order a 6 
prisoner who violates any provision of paragraph (d) of subsection 1 7 
to reimburse the appropriate person or governmental body for the 8 
cost of any examinations or testing: 9 
 (a) Conducted pursuant to paragraphs (a) and (b) of subsection 10 
8; or 11 
 (b) Paid for pursuant to subparagraph (2) of paragraph (c) of 12 
subsection 8. 13 
 7.  The warden, sheriff, administrator or other person 14 
responsible for administering a prison shall immediately and fully 15 
investigate any act described in subsection 1 that is reported or 16 
suspected to have been committed in the prison. 17 
 8.  If there is probable cause to believe that an act described in 18 
paragraph (d) of subsection 1 has been committed in a prison: 19 
 (a) Each prisoner believed to have committed the act or to have 20 
been the bodily source of any portion of the excrement or bodily 21 
fluid involved in the act shall submit to any appropriate 22 
examinations and testing to determine whether each such prisoner 23 
has any communicable disease. 24 
 (b) If possible, a sample of the excrement or bodily fluid 25 
involved in the act must be recovered and tested to determine 26 
whether any communicable disease is present in the excrement or 27 
bodily fluid. 28 
 (c) If the excrement or bodily fluid involved in the act came into 29 
physical contact with any portion of the body of an officer or 30 
employee of a prison or law enforcement agency: 31 
  (1) The results of any examinations or testing conducted 32 
pursuant to paragraphs (a) and (b) must be provided to each such 33 
officer, employee or other person; and 34 
  (2) For each such officer or employee: 35 
   (I) Of a prison, the person or governmental body 36 
operating the prison where the act was committed shall pay for any 37 
appropriate examinations and testing requested by the officer or 38 
employee to determine whether a communicable disease was 39 
transmitted to the officer or employee as a result of the act; and 40 
   (II) Of any law enforcement agency, the law enforcement 41 
agency that employs the officer or employee shall pay for any 42 
appropriate examinations and testing requested by the officer or 43 
employee to determine whether a communicable disease was 44 
transmitted to the officer or employee as a result of the act. 45   
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 (d) The results of the investigation conducted pursuant to 1 
subsection 7 and the results of any examinations or testing 2 
conducted pursuant to paragraphs (a) and (b) must be submitted to 3 
the district attorney of the county in which the act was committed or 4 
to the Office of the Attorney General for possible prosecution of 5 
each prisoner who committed the act. 6 
 9.  If a prisoner is charged with committing an act described in 7 
paragraph (d) of subsection 1 and a victim or an intended victim of 8 
the act was an officer or employee of a prison or law enforcement 9 
agency, the prosecuting attorney shall not dismiss the charge in 10 
exchange for a plea of guilty, guilty but mentally ill or nolo 11 
contendere to a lesser charge or for any other reason unless the 12 
prosecuting attorney knows or it is obvious that the charge is not 13 
supported by probable cause or cannot be proved at the time of trial. 14 
 10.  The provisions of this section do not apply to a prisoner 15 
who is in residential confinement or to a prisoner who commits an 16 
act described in subsection 1 if the act: 17 
 (a) Is otherwise lawful and is authorized by the warden, sheriff, 18 
administrator or other person responsible for administering the 19 
prison, or his or her designee, and the prisoner performs the act in 20 
accordance with the directions or instructions given to the prisoner 21 
by that person; 22 
 (b) Involves the discharge of human excrement or bodily fluid 23 
directly from the body of the prisoner and the discharge is the direct 24 
result of a temporary or permanent injury, disease or medical 25 
condition afflicting the prisoner that prevents the prisoner from 26 
having physical control over the discharge of his or her own 27 
excrement or bodily fluid; or 28 
 (c) Constitutes voluntary sexual conduct with another person in 29 
violation of the provisions of NRS 212.187. 30 
 Sec. 14.  NRS 232.320 is hereby amended to read as follows: 31 
 232.320 1.  The Director: 32 
 (a) Shall appoint, with the consent of the Governor, 33 
administrators of the divisions of the Department, who are 34 
respectively designated as follows: 35 
  (1) The Administrator of the Aging and Disability Services 36 
Division; 37 
  (2) The Administrator of the Division of Welfare and 38 
Supportive Services; 39 
  (3) The Administrator of the Division of Child and Family 40 
Services; 41 
  (4) The Administrator of the Division of Health Care 42 
Financing and Policy; and 43 
  (5) The Administrator of the Division of Public and 44 
Behavioral Health. 45   
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 (b) Shall administer, through the divisions of the Department, 1 
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 2 
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 3 
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 4 
section 20 of this act, 422.580, 432.010 to 432.133, inclusive, 5 
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 6 
and 445A.010 to 445A.055, inclusive, and all other provisions of 7 
law relating to the functions of the divisions of the Department, but 8 
is not responsible for the clinical activities of the Division of Public 9 
and Behavioral Health or the professional line activities of the other 10 
divisions. 11 
 (c) Shall administer any state program for persons with 12 
developmental disabilities established pursuant to the 13 
Developmental Disabilities Assistance and Bill of Rights Act of 14 
2000, 42 U.S.C. §§ 15001 et seq. 15 
 (d) Shall, after considering advice from agencies of local 16 
governments and nonprofit organizations which provide social 17 
services, adopt a master plan for the provision of human services in 18 
this State. The Director shall revise the plan biennially and deliver a 19 
copy of the plan to the Governor and the Legislature at the 20 
beginning of each regular session. The plan must: 21 
  (1) Identify and assess the plans and programs of the 22 
Department for the provision of human services, and any 23 
duplication of those services by federal, state and local agencies; 24 
  (2) Set forth priorities for the provision of those services; 25 
  (3) Provide for communication and the coordination of those 26 
services among nonprofit organizations, agencies of local 27 
government, the State and the Federal Government; 28 
  (4) Identify the sources of funding for services provided by 29 
the Department and the allocation of that funding; 30 
  (5) Set forth sufficient information to assist the Department 31 
in providing those services and in the planning and budgeting for the 32 
future provision of those services; and 33 
  (6) Contain any other information necessary for the 34 
Department to communicate effectively with the Federal 35 
Government concerning demographic trends, formulas for the 36 
distribution of federal money and any need for the modification of 37 
programs administered by the Department. 38 
 (e) May, by regulation, require nonprofit organizations and state 39 
and local governmental agencies to provide information regarding 40 
the programs of those organizations and agencies, excluding 41 
detailed information relating to their budgets and payrolls, which the 42 
Director deems necessary for the performance of the duties imposed 43 
upon him or her pursuant to this section. 44 
 (f) Has such other powers and duties as are provided by law. 45   
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 2.  Notwithstanding any other provision of law, the Director, or 1 
the Director’s designee, is responsible for appointing and removing 2 
subordinate officers and employees of the Department. 3 
 Sec. 14.5.  Chapter 287 of NRS is hereby amended by adding 4 
thereto a new section to read as follows: 5 
 1. The governing body of any county, school district, 6 
municipal corporation, political subdivision, public corporation or 7 
other local governmental agency of the State of Nevada that 8 
provides health insurance through a plan of self-insurance shall 9 
provide coverage for:  10 
 (a) Drugs approved by the United States Food and Drug 11 
Administration for preventing the acquisition of human 12 
immunodeficiency virus;  13 
 (b) Laboratory testing that is necessary for therapy that uses 14 
such a drug; and  15 
 (c) The services described in NRS 639.28085, when provided 16 
by a pharmacist who participates in the network plan of the 17 
governing body.  18 
 2. The governing body of any county, school district, 19 
municipal corporation, political subdivision, public corporation or 20 
other local governmental agency of the State of Nevada that 21 
provides health insurance through a plan of self-insurance shall 22 
reimburse a pharmacist who participates in the network plan of 23 
the governing body for the services described in NRS 639.28085 at 24 
a rate equal to the rate of reimbursement provided to a physician, 25 
physician assistant or advanced practice registered nurse for 26 
similar services.  27 
 3. The governing body of any county, school district, 28 
municipal corporation, political subdivision, public corporation or 29 
other local governmental agency of the State of Nevada that 30 
provides health insurance through a plan of self-insurance may 31 
subject the benefits required by subsection 1 to reasonable medical 32 
management techniques. 33 
 4. The governing body of any county, school district, 34 
municipal corporation, political subdivision, public corporation or 35 
other local governmental agency of the State of Nevada that 36 
provides health insurance through a plan of self-insurance shall 37 
ensure that the benefits required by subsection 1 are made 38 
available to an insured through a provider of health care who 39 
participates in the network plan of the governing body. 40 
 5. A plan of self-insurance described in subsection 1 that is 41 
delivered, issued for delivery or renewed on or after January 1, 42 
2024, has the legal effect of including the coverage required by 43 
subsection 1, and any provision of the plan that conflicts with the 44 
provisions of this section is void.  45   
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 6. As used in this section:  1 
 (a) “Medical management technique” means a practice which 2 
is used to control the cost or use of health care services or 3 
prescription drugs. The term includes, without limitation, the use 4 
of step therapy, prior authorization and categorizing drugs and 5 
devices based on cost, type or method of administration. 6 
 (b) “Network plan” means a plan of self-insurance provided 7 
by the governing body of a local governmental agency under 8 
which the financing and delivery of medical care, including items 9 
and services paid for as medical care, are provided, in whole or in 10 
part, through a defined set of providers under contract with the 11 
governing body. The term does not include an arrangement for the 12 
financing of premiums.  13 
 (c) “Provider of health care” has the meaning ascribed to it in 14 
NRS 629.031. 15 
 Sec. 15.  NRS 287.010 is hereby amended to read as follows: 16 
 287.010 1.  The governing body of any county, school 17 
district, municipal corporation, political subdivision, public 18 
corporation or other local governmental agency of the State of 19 
Nevada may: 20 
 (a) Adopt and carry into effect a system of group life, accident 21 
or health insurance, or any combination thereof, for the benefit of its 22 
officers and employees, and the dependents of officers and 23 
employees who elect to accept the insurance and who, where 24 
necessary, have authorized the governing body to make deductions 25 
from their compensation for the payment of premiums on the 26 
insurance. 27 
 (b) Purchase group policies of life, accident or health insurance, 28 
or any combination thereof, for the benefit of such officers and 29 
employees, and the dependents of such officers and employees, as 30 
have authorized the purchase, from insurance companies authorized 31 
to transact the business of such insurance in the State of Nevada, 32 
and, where necessary, deduct from the compensation of officers and 33 
employees the premiums upon insurance and pay the deductions 34 
upon the premiums. 35 
 (c) Provide group life, accident or health coverage through a 36 
self-insurance reserve fund and, where necessary, deduct 37 
contributions to the maintenance of the fund from the compensation 38 
of officers and employees and pay the deductions into the fund. The 39 
money accumulated for this purpose through deductions from the 40 
compensation of officers and employees and contributions of the 41 
governing body must be maintained as an internal service fund as 42 
defined by NRS 354.543. The money must be deposited in a state or 43 
national bank or credit union authorized to transact business in the 44 
State of Nevada. Any independent administrator of a fund created 45   
 	– 13 – 
 
 
- *SB439_R2* 
under this section is subject to the licensing requirements of chapter 1 
683A of NRS, and must be a resident of this State. Any contract 2 
with an independent administrator must be approved by the 3 
Commissioner of Insurance as to the reasonableness of 4 
administrative charges in relation to contributions collected and 5 
benefits provided. The provisions of NRS 686A.135, 687B.352, 6 
687B.408, 687B.723, 687B.725, 689B.030 to 689B.031, inclusive, 7 
689B.0313 to 689B.050, inclusive, 689B.265, 689B.287 and 8 
689B.500 apply to coverage provided pursuant to this paragraph, 9 
except that the provisions of NRS 689B.0378, 689B.03785 and 10 
689B.500 only apply to coverage for active officers and employees 11 
of the governing body, or the dependents of such officers and 12 
employees. 13 
 (d) Defray part or all of the cost of maintenance of a self-14 
insurance fund or of the premiums upon insurance. The money for 15 
contributions must be budgeted for in accordance with the laws 16 
governing the county, school district, municipal corporation, 17 
political subdivision, public corporation or other local governmental 18 
agency of the State of Nevada. 19 
 2.  If a school district offers group insurance to its officers and 20 
employees pursuant to this section, members of the board of trustees 21 
of the school district must not be excluded from participating in the 22 
group insurance. If the amount of the deductions from compensation 23 
required to pay for the group insurance exceeds the compensation to 24 
which a trustee is entitled, the difference must be paid by the trustee. 25 
 3.  In any county in which a legal services organization exists, 26 
the governing body of the county, or of any school district, 27 
municipal corporation, political subdivision, public corporation or 28 
other local governmental agency of the State of Nevada in the 29 
county, may enter into a contract with the legal services 30 
organization pursuant to which the officers and employees of the 31 
legal services organization, and the dependents of those officers and 32 
employees, are eligible for any life, accident or health insurance 33 
provided pursuant to this section to the officers and employees, and 34 
the dependents of the officers and employees, of the county, school 35 
district, municipal corporation, political subdivision, public 36 
corporation or other local governmental agency. 37 
 4.  If a contract is entered into pursuant to subsection 3, the 38 
officers and employees of the legal services organization: 39 
 (a) Shall be deemed, solely for the purposes of this section, to be 40 
officers and employees of the county, school district, municipal 41 
corporation, political subdivision, public corporation or other local 42 
governmental agency with which the legal services organization has 43 
contracted; and 44   
 	– 14 – 
 
 
- *SB439_R2* 
 (b) Must be required by the contract to pay the premiums or 1 
contributions for all insurance which they elect to accept or of which 2 
they authorize the purchase. 3 
 5.  A contract that is entered into pursuant to subsection 3: 4 
 (a) Must be submitted to the Commissioner of Insurance for 5 
approval not less than 30 days before the date on which the contract 6 
is to become effective. 7 
 (b) Does not become effective unless approved by the 8 
Commissioner. 9 
 (c) Shall be deemed to be approved if not disapproved by the 10 
Commissioner within 30 days after its submission. 11 
 6.  As used in this section, “legal services organization” means 12 
an organization that operates a program for legal aid and receives 13 
money pursuant to NRS 19.031. 14 
 Sec. 15.5.  NRS 287.040 is hereby amended to read as follows: 15 
 287.040 The provisions of NRS 287.010 to 287.040, inclusive, 16 
and section 14.5 of this act do not make it compulsory upon any 17 
governing body of any county, school district, municipal 18 
corporation, political subdivision, public corporation or other local 19 
governmental agency of the State of Nevada, except as otherwise 20 
provided in NRS 287.021 or subsection 4 of NRS 287.023 or in an 21 
agreement entered into pursuant to subsection 3 of NRS 287.015, to 22 
pay any premiums, contributions or other costs for group insurance, 23 
a plan of benefits or medical or hospital services established 24 
pursuant to NRS 287.010, 287.015, 287.020 or paragraph (b), (c) or 25 
(d) of subsection 1 of NRS 287.025, for coverage under the Public 26 
Employees’ Benefits Program, or to make any contributions to a 27 
trust fund established pursuant to NRS 287.017, or upon any officer 28 
or employee of any county, school district, municipal corporation, 29 
political subdivision, public corporation or other local governmental 30 
agency of this State to accept any such coverage or to assign his or 31 
her wages or salary in payment of premiums or contributions 32 
therefor. 33 
 Sec. 16.  NRS 287.04335 is hereby amended to read as 34 
follows: 35 
 287.04335 If the Board provides health insurance through a 36 
plan of self-insurance, it shall comply with the provisions of NRS 37 
686A.135, 687B.352, 687B.409, 687B.723, 687B.725, 689B.0353, 38 
689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 39 
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 40 
695G.1675, 695G.170 to 695G.174, inclusive, and sections 71 and 41 
72 of this act, 695G.176, 695G.177, 695G.200 to 695G.230, 42 
inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the 43 
same manner as an insurer that is licensed pursuant to title 57 of 44 
NRS is required to comply with those provisions. 45   
 	– 15 – 
 
 
- *SB439_R2* 
 Sec. 17.  (Deleted by amendment.) 1 
 Sec. 18.  (Deleted by amendment.) 2 
 Sec. 19.  Chapter 422 of NRS is hereby amended by adding 3 
thereto the provisions set forth as sections 20 and 21 of this act. 4 
 Sec. 20.  1. The Director shall include in the State Plan for 5 
Medicaid a requirement that the State pay the nonfederal share of 6 
expenses for any service for the treatment of substance use 7 
disorder provided by a provider of primary care if the service is 8 
included in the State Plan when provided by a specialist and: 9 
 (a) The service is within the scope of practice of the provider of 10 
primary care; or  11 
 (b) The provider of primary care is capable of providing the 12 
service safely and effectively in consultation with a specialist and 13 
the provider engages in such consultation. 14 
 2. As used in this section, “primary care” means the practice 15 
of family medicine, pediatrics, internal medicine, obstetrics and 16 
gynecology and midwifery.  17 
 Sec. 21.  (Deleted by amendment.) 18 
 Sec. 22.  NRS 422.27173 is hereby amended to read as 19 
follows: 20 
 422.27173 The Director shall include in the State Plan for 21 
Medicaid a requirement that the State must pay the nonfederal share 22 
of expenditures incurred for : 23 
 1. Testing for and the treatment and prevention of sexually 24 
transmitted diseases, including, without limitation, Chlamydia 25 
trachomatis, gonorrhea, syphilis, human immunodeficiency virus 26 
and hepatitis B and C, for all recipients of Medicaid, regardless of 27 
age. Services covered pursuant to this section must include, 28 
without limitation, the examination of a pregnant woman for the 29 
discovery of: 30 
 [1.] (a) Chlamydia trachomatis, gonorrhea, hepatitis B and 31 
hepatitis C in accordance with NRS 442.013. 32 
 [2.] (b) Syphilis in accordance with NRS 442.010. 33 
 2. Condoms for recipients of Medicaid.  34 
 Sec. 23.  NRS 422.27235 is hereby amended to read as 35 
follows: 36 
 422.27235 1. The Director shall include in the State Plan for 37 
Medicaid a requirement that the State pay the nonfederal share of 38 
expenditures incurred for:  39 
 [1.] (a) Any laboratory testing that is necessary for therapy that 40 
uses a drug approved by the United States Food and Drug 41 
Administration for preventing the acquisition of human 42 
immunodeficiency virus . [; and]  43 
 [2.] (b) The services of a pharmacist described in NRS 44 
639.28085. The State must provide reimbursement for such services 45   
 	– 16 – 
 
 
- *SB439_R2* 
at a rate equal to the rate of reimbursement provided to a physician, 1 
physician assistant or advanced practice registered nurse for similar 2 
services.  3 
 (c) Any service to test for, prevent or treat human 4 
immunodeficiency virus or hepatitis C provided by a provider of 5 
primary care if the service is covered when provided by a specialist 6 
and: 7 
  (1) The service is within the scope of practice of the 8 
provider of primary care; or  9 
  (2) The provider of primary care is capable of providing the 10 
service safely and effectively in consultation with a specialist and 11 
the provider engages in such consultation. 12 
 2. The Director shall include in the State Plan for Medicaid a 13 
requirement that the State reimburse an advanced practice 14 
registered nurse or a physician assistant for any service to test for, 15 
prevent or treat human immunodeficiency virus or hepatitis C at a 16 
rate equal to the rate of reimbursement provided to a physician for 17 
similar services. 18 
 3. As used in this section, “primary care” means the practice 19 
of family medicine, pediatrics, internal medicine, obstetrics and 20 
gynecology and midwifery.  21 
 Sec. 24.  (Deleted by amendment.) 22 
 Sec. 25.  NRS 422.4025 is hereby amended to read as follows: 23 
 422.4025 1.  The Department shall: 24 
 (a) By regulation, develop a list of preferred prescription drugs 25 
to be used for the Medicaid program and the Children’s Health 26 
Insurance Program, and each public or nonprofit health benefit plan 27 
that elects to use the list of preferred prescription drugs as its 28 
formulary pursuant to NRS 287.012, 287.0433 or 687B.407; and 29 
 (b) Negotiate and enter into agreements to purchase the drugs 30 
included on the list of preferred prescription drugs on behalf of the 31 
health benefit plans described in paragraph (a) or enter into a 32 
contract pursuant to NRS 422.4053 with a pharmacy benefit 33 
manager, health maintenance organization or one or more public or 34 
private entities in this State, the District of Columbia or other states 35 
or territories of the United States, as appropriate, to negotiate such 36 
agreements. 37 
 2.  The Department shall, by regulation, establish a list of 38 
prescription drugs which must be excluded from any restrictions that 39 
are imposed by the Medicaid program on drugs that are on the list of 40 
preferred prescription drugs established pursuant to subsection 1. 41 
The list established pursuant to this subsection must include, 42 
without limitation: 43   
 	– 17 – 
 
 
- *SB439_R2* 
 (a) Prescription drugs that are prescribed for the treatment of the 1 
human immunodeficiency virus, including, without limitation, 2 
antiretroviral medications; 3 
 (b) Antirejection medications for organ transplants; 4 
 (c) Antihemophilic medications; and 5 
 (d) Any prescription drug which the Board identifies as 6 
appropriate for exclusion from any restrictions that are imposed by 7 
the Medicaid program on drugs that are on the list of preferred 8 
prescription drugs. 9 
 3.  The regulations must provide that the Board makes the final 10 
determination of: 11 
 (a) Whether a class of therapeutic prescription drugs is included 12 
on the list of preferred prescription drugs and is excluded from any 13 
restrictions that are imposed by the Medicaid program on drugs that 14 
are on the list of preferred prescription drugs; 15 
 (b) Which therapeutically equivalent prescription drugs will be 16 
reviewed for inclusion on the list of preferred prescription drugs and 17 
for exclusion from any restrictions that are imposed by the Medicaid 18 
program on drugs that are on the list of preferred prescription drugs; 19 
and 20 
 (c) Which prescription drugs should be excluded from any 21 
restrictions that are imposed by the Medicaid program on drugs that 22 
are on the list of preferred prescription drugs based on continuity of 23 
care concerning a specific diagnosis, condition, class of therapeutic 24 
prescription drugs or medical specialty. 25 
 4.  The list of preferred prescription drugs established pursuant 26 
to subsection 1 must include, without limitation: 27 
 (a) Any prescription drug determined by the Board to be 28 
essential for treating sickle cell disease and its variants; and 29 
 (b) Prescription drugs to prevent the acquisition of human 30 
immunodeficiency virus.  31 
 5. The regulations must provide that each new pharmaceutical 32 
product and each existing pharmaceutical product for which there is 33 
new clinical evidence supporting its inclusion on the list of preferred 34 
prescription drugs must be made available pursuant to the Medicaid 35 
program with prior authorization until the Board reviews the product 36 
or the evidence. 37 
 6. The Medicaid program must cover a prescription drug that 38 
is not included on the list of preferred prescription drugs as if the 39 
drug were included on that list if: 40 
 (a) The drug is: 41 
  (1) Used to treat hepatitis C; 42 
  (2) Used to provide medication-assisted treatment for opioid 43 
use disorder; 44   
 	– 18 – 
 
 
- *SB439_R2* 
  (3) Used to support safe withdrawal from substance use 1 
disorder; or 2 
  (4) In the same class as a drug on the list of preferred 3 
prescription drugs; and  4 
 (b) All preferred prescription drugs within the same class as 5 
the drug are unsuitable for a recipient of Medicaid because: 6 
  (1) The recipient is allergic to all preferred prescription 7 
drugs within the same class as the drug; 8 
  (2) All preferred prescription drugs within the same class as 9 
the drug are contraindicated for the recipient or are likely to 10 
interact in a harmful manner with another drug that the recipient 11 
is taking; 12 
  (3) The recipient has a history of adverse reactions to all 13 
preferred prescription drugs within the same class as the drug; or  14 
  (4) The drug has a unique indication that is supported by 15 
peer-reviewed clinical evidence or approved by the United States 16 
Food and Drug Administration. 17 
 7. On or before February 1 of each year, the Department shall: 18 
 (a) Compile a report concerning the agreements negotiated 19 
pursuant to paragraph (b) of subsection 1 and contracts entered into 20 
pursuant to NRS 422.4053 which must include, without limitation, 21 
the financial effects of obtaining prescription drugs through those 22 
agreements and contracts, in total and aggregated separately for 23 
agreements negotiated by the Department, contracts with a 24 
pharmacy benefit manager, contracts with a health maintenance 25 
organization and contracts with public and private entities from this 26 
State, the District of Columbia and other states and territories of the 27 
United States; and 28 
 (b) Post the report on an Internet website maintained by the 29 
Department and submit the report to the Director of the Legislative 30 
Counsel Bureau for transmittal to: 31 
  (1) In odd-numbered years, the Legislature; or 32 
  (2) In even-numbered years, the Legislative Commission. 33 
 Sec. 26.  NRS 608.156 is hereby amended to read as follows: 34 
 608.156 1.  [If] In addition to any benefits required by NRS 35 
608.1555, an employer provides health benefits for his or her 36 
employees, the employer shall provide benefits for the expenses for 37 
the treatment of alcohol and substance use disorders. The annual 38 
benefits provided by the employer must [consist of:] include, 39 
without limitation: 40 
 (a) Treatment for withdrawal from the physiological effects of 41 
alcohol or drugs, with a maximum benefit of $1,500 per calendar 42 
year. 43 
 (b) Treatment for a patient admitted to a facility, with a 44 
maximum benefit of $9,000 per calendar year. 45   
 	– 19 – 
 
 
- *SB439_R2* 
 (c) Counseling for a person, group or family who is not admitted 1 
to a facility, with a maximum benefit of $2,500 per calendar year. 2 
 2.  The maximum amount which may be paid in the lifetime of 3 
the insured for any combination of the treatments listed in 4 
subsection 1 is $39,000. 5 
 3.  Except as otherwise provided in NRS 687B.409, these 6 
benefits must be paid in the same manner as benefits for any other 7 
illness covered by the employer are paid. 8 
 4.  The employee is entitled to these benefits if treatment is 9 
received in any: 10 
 (a) Program for the treatment of alcohol or substance use 11 
disorders which is certified by the Division of Public and Behavioral 12 
Health of the Department of Health and Human Services. 13 
 (b) Hospital or other medical facility or facility for the 14 
dependent which is licensed by the Division of Public and 15 
Behavioral Health of the Department of Health and Human 16 
Services, is accredited by The Joint Commission or CARF 17 
International and provides a program for the treatment of alcohol or 18 
substance use disorders as part of its accredited activities. 19 
 Sec. 27.  NRS 629.093 is hereby amended to read as follows: 20 
 629.093 Unless a specific statute or regulation requires or 21 
authorizes a greater number of hours, a provider of health care may 22 
use credit earned for continuing education relating to Alzheimer’s 23 
disease or the stigma, discrimination and unrecognized bias 24 
toward persons who have acquired or are at a high risk of 25 
acquiring human immunodeficiency virus in place of not more 26 
than 2 hours each year of the continuing education that the provider 27 
of health care is required to complete, other than any continuing 28 
education relating to ethics that the provider of health care is 29 
required to complete. 30 
 Sec. 28.  NRS 630.253 is hereby amended to read as follows: 31 
 630.253 1.  The Board shall, as a prerequisite for the: 32 
 (a) Renewal of a license as a physician assistant; or 33 
 (b) Biennial registration of the holder of a license to practice 34 
medicine, 35 
 require each holder to submit evidence of compliance with the 36 
requirements for continuing education as set forth in regulations 37 
adopted by the Board. 38 
 2.  These requirements: 39 
 (a) May provide for the completion of one or more courses of 40 
instruction relating to risk management in the performance of 41 
medical services. 42 
 (b) Must provide for the completion of a course of instruction, 43 
within 2 years after initial licensure, relating to the medical 44 
consequences of an act of terrorism that involves the use of a 45   
 	– 20 – 
 
 
- *SB439_R2* 
weapon of mass destruction. The course must provide at least 4 1 
hours of instruction that includes instruction in the following 2 
subjects: 3 
  (1) An overview of acts of terrorism and weapons of mass 4 
destruction; 5 
  (2) Personal protective equipment required for acts of 6 
terrorism; 7 
  (3) Common symptoms and methods of treatment associated 8 
with exposure to, or injuries caused by, chemical, biological, 9 
radioactive and nuclear agents; 10 
  (4) Syndromic surveillance and reporting procedures for acts 11 
of terrorism that involve biological agents; and 12 
  (5) An overview of the information available on, and the use 13 
of, the Health Alert Network. 14 
 (c) Must provide for the completion by a holder of a license to 15 
practice medicine of a course of instruction within 2 years after 16 
initial licensure that provides at least 2 hours of instruction on 17 
evidence-based suicide prevention and awareness as described in 18 
subsection 6. 19 
 (d) Must provide for the completion of at least 2 hours of 20 
training in the screening, brief intervention and referral to treatment 21 
approach to substance use disorder within 2 years after initial 22 
licensure. 23 
 (e) Must provide for the biennial completion by each 24 
psychiatrist and each physician assistant practicing under the 25 
supervision of a psychiatrist of one or more courses of instruction 26 
that provide at least 2 hours of instruction relating to cultural 27 
competency and diversity, equity and inclusion. Such instruction:  28 
  (1) May include the training provided pursuant to NRS 29 
449.103, where applicable.  30 
  (2) Must be based upon a range of research from diverse 31 
sources. 32 
  (3) Must address persons of different cultural backgrounds, 33 
including, without limitation:  34 
   (I) Persons from various gender, racial and ethnic 35 
backgrounds;  36 
   (II) Persons from various religious backgrounds;  37 
   (III) Lesbian, gay, bisexual, transgender and questioning 38 
persons;  39 
   (IV) Children and senior citizens;  40 
   (V) Veterans;  41 
   (VI) Persons with a mental illness;  42 
   (VII) Persons with an intellectual disability, 43 
developmental disability or physical disability; and  44   
 	– 21 – 
 
 
- *SB439_R2* 
   (VIII) Persons who are part of any other population that a 1 
psychiatrist or a physician assistant practicing under the supervision 2 
of a psychiatrist may need to better understand, as determined by the 3 
Board. 4 
 (f) Must allow the holder of a license to receive credit toward 5 
the total amount of continuing education required by the Board for 6 
the completion of a course of instruction relating to genetic 7 
counseling and genetic testing. 8 
 (g) Must provide for the completion by a physician or 9 
physician assistant who provides or supervises the provision of 10 
emergency medical services in a hospital or primary care of at 11 
least 2 hours of training in the stigma, discrimination and 12 
unrecognized bias toward persons who have acquired or are at a 13 
high risk of acquiring human immunodeficiency virus within 2 14 
years after beginning to provide or supervise the provision of such 15 
services or care. 16 
 3. The Board may determine whether to include in a program 17 
of continuing education courses of instruction relating to the 18 
medical consequences of an act of terrorism that involves the use of 19 
a weapon of mass destruction in addition to the course of instruction 20 
required by paragraph (b) of subsection 2. 21 
 4.  The Board shall encourage each holder of a license who 22 
treats or cares for persons who are more than 60 years of age to 23 
receive, as a portion of their continuing education, education in 24 
geriatrics and gerontology, including such topics as: 25 
 (a) The skills and knowledge that the licensee needs to address 26 
aging issues; 27 
 (b) Approaches to providing health care to older persons, 28 
including both didactic and clinical approaches; 29 
 (c) The biological, behavioral, social and emotional aspects of 30 
the aging process; and 31 
 (d) The importance of maintenance of function and 32 
independence for older persons. 33 
 5.  The Board shall encourage each holder of a license to 34 
practice medicine to receive, as a portion of his or her continuing 35 
education, training concerning methods for educating patients about 36 
how to effectively manage medications, including, without 37 
limitation, the ability of the patient to request to have the symptom 38 
or purpose for which a drug is prescribed included on the label 39 
attached to the container of the drug. 40 
 6.  The Board shall require each holder of a license to practice 41 
medicine to receive as a portion of his or her continuing education at 42 
least 2 hours of instruction every 4 years on evidence-based suicide 43 
prevention and awareness, which may include, without limitation, 44 
instruction concerning: 45   
 	– 22 – 
 
 
- *SB439_R2* 
 (a) The skills and knowledge that the licensee needs to detect 1 
behaviors that may lead to suicide, including, without limitation, 2 
post-traumatic stress disorder; 3 
 (b) Approaches to engaging other professionals in suicide 4 
intervention; and 5 
 (c) The detection of suicidal thoughts and ideations and the 6 
prevention of suicide. 7 
 7.  The Board shall encourage each holder of a license to 8 
practice medicine or as a physician assistant to receive, as a portion 9 
of his or her continuing education, training and education in the 10 
diagnosis of rare diseases, including, without limitation: 11 
 (a) Recognizing the symptoms of pediatric cancer; and 12 
 (b) Interpreting family history to determine whether such 13 
symptoms indicate a normal childhood illness or a condition that 14 
requires additional examination. 15 
 8.  A holder of a license to practice medicine may not substitute 16 
the continuing education credits relating to suicide prevention and 17 
awareness required by this section for the purposes of satisfying an 18 
equivalent requirement for continuing education in ethics. 19 
 9.  Except as otherwise provided in NRS 630.2535, a holder of 20 
a license to practice medicine may substitute not more than 2 hours 21 
of continuing education credits in pain management, care for 22 
persons with an addictive disorder or the screening, brief 23 
intervention and referral to treatment approach to substance use 24 
disorder for the purposes of satisfying an equivalent requirement for 25 
continuing education in ethics. 26 
 10. As used in this section: 27 
 (a) “Act of terrorism” has the meaning ascribed to it in  28 
NRS 202.4415. 29 
 (b) “Biological agent” has the meaning ascribed to it in  30 
NRS 202.442. 31 
 (c) “Chemical agent” has the meaning ascribed to it in  32 
NRS 202.4425. 33 
 (d) “Primary care” means the practice of family medicine, 34 
pediatrics, internal medicine, obstetrics and gynecology and 35 
midwifery.  36 
 (e) “Radioactive agent” has the meaning ascribed to it in  37 
NRS 202.4437. 38 
 [(e)] (f) “Weapon of mass destruction” has the meaning 39 
ascribed to it in NRS 202.4445. 40 
 Sec. 29.  NRS 632.343 is hereby amended to read as follows: 41 
 632.343 1.  The Board shall not renew any license issued 42 
under this chapter until the licensee has submitted proof satisfactory 43 
to the Board of completion, during the 2-year period before renewal 44 
of the license, of 30 hours in a program of continuing education 45   
 	– 23 – 
 
 
- *SB439_R2* 
approved by the Board in accordance with regulations adopted by 1 
the Board. Except as otherwise provided in subsection 3, the 2 
licensee is exempt from this provision for the first biennial period 3 
after graduation from: 4 
 (a) An accredited school of professional nursing; 5 
 (b) An accredited school of practical nursing; 6 
 (c) An approved school of professional nursing in the process of 7 
obtaining accreditation; or 8 
 (d) An approved school of practical nursing in the process of 9 
obtaining accreditation. 10 
 2.  The Board shall review all courses offered to nurses for the 11 
completion of the requirement set forth in subsection 1. The Board 12 
may approve nursing and other courses which are directly related to 13 
the practice of nursing as well as others which bear a reasonable 14 
relationship to current developments in the field of nursing or any 15 
special area of practice in which a licensee engages. These may 16 
include academic studies, workshops, extension studies, home study 17 
and other courses. 18 
 3.  The program of continuing education required by subsection 19 
1 must include: 20 
 (a) For a person licensed as an advanced practice registered 21 
nurse: 22 
  (1) A course of instruction to be completed within 2 years 23 
after initial licensure that provides at least 2 hours of instruction on 24 
suicide prevention and awareness as described in subsection 6. 25 
  (2) The ability to receive credit toward the total amount of 26 
continuing education required by subsection 1 for the completion of 27 
a course of instruction relating to genetic counseling and genetic 28 
testing. 29 
 (b) For each person licensed pursuant to this chapter, a course of 30 
instruction, to be completed within 2 years after initial licensure, 31 
relating to the medical consequences of an act of terrorism that 32 
involves the use of a weapon of mass destruction. The course must 33 
provide at least 4 hours of instruction that includes instruction in the 34 
following subjects: 35 
  (1) An overview of acts of terrorism and weapons of mass 36 
destruction; 37 
  (2) Personal protective equipment required for acts of 38 
terrorism; 39 
  (3) Common symptoms and methods of treatment associated 40 
with exposure to, or injuries caused by, chemical, biological, 41 
radioactive and nuclear agents; 42 
  (4) Syndromic surveillance and reporting procedures for acts 43 
of terrorism that involve biological agents; and 44   
 	– 24 – 
 
 
- *SB439_R2* 
  (5) An overview of the information available on, and the use 1 
of, the Health Alert Network. 2 
 (c) For each person licensed pursuant to this chapter, one or 3 
more courses of instruction that provide at least 2 hours of 4 
instruction relating to cultural competency and diversity, equity and 5 
inclusion to be completed biennially. Such instruction:  6 
  (1) May include the training provided pursuant to NRS 7 
449.103, where applicable.  8 
  (2) Must be based upon a range of research from diverse 9 
sources. 10 
  (3) Must address persons of different cultural backgrounds, 11 
including, without limitation:  12 
   (I) Persons from various gender, racial and ethnic 13 
backgrounds;  14 
   (II) Persons from various religious backgrounds;  15 
   (III) Lesbian, gay, bisexual, transgender and questioning 16 
persons;  17 
   (IV) Children and senior citizens;  18 
   (V) Veterans;  19 
   (VI) Persons with a mental illness;  20 
   (VII) Persons with an intellectual disability, 21 
developmental disability or physical disability; and  22 
   (VIII) Persons who are part of any other population that a 23 
person licensed pursuant to this chapter may need to better 24 
understand, as determined by the Board. 25 
 (d) For a person licensed as an advanced practice registered 26 
nurse, at least 2 hours of training in the screening, brief intervention 27 
and referral to treatment approach to substance use disorder to be 28 
completed within 2 years after initial licensure. 29 
 (e) For each person licensed pursuant to this chapter who 30 
provides or supervises the provision of emergency medical services 31 
in a hospital or primary care, at least 2 hours of training in the 32 
stigma, discrimination and unrecognized bias toward persons who 33 
have acquired or are at a high risk of acquiring human 34 
immunodeficiency virus to be completed within 2 years after 35 
beginning to provide or supervise the provision of such services or 36 
care. 37 
 4.  The Board may determine whether to include in a program 38 
of continuing education courses of instruction relating to the 39 
medical consequences of an act of terrorism that involves the use of 40 
a weapon of mass destruction in addition to the course of instruction 41 
required by paragraph (b) of subsection 3. 42 
 5.  The Board shall encourage each licensee who treats or cares 43 
for persons who are more than 60 years of age to receive, as a 44   
 	– 25 – 
 
 
- *SB439_R2* 
portion of their continuing education, education in geriatrics and 1 
gerontology, including such topics as: 2 
 (a) The skills and knowledge that the licensee needs to address 3 
aging issues; 4 
 (b) Approaches to providing health care to older persons, 5 
including both didactic and clinical approaches; 6 
 (c) The biological, behavioral, social and emotional aspects of 7 
the aging process; and 8 
 (d) The importance of maintenance of function and 9 
independence for older persons. 10 
 6.  The Board shall require each person licensed as an advanced 11 
practice registered nurse to receive as a portion of his or her 12 
continuing education at least 2 hours of instruction every 4 years on 13 
evidence-based suicide prevention and awareness or another course 14 
of instruction on suicide prevention and awareness that is approved 15 
by the Board which the Board has determined to be effective and 16 
appropriate. 17 
 7.  The Board shall encourage each person licensed as an 18 
advanced practice registered nurse to receive, as a portion of his or 19 
her continuing education, training and education in the diagnosis of 20 
rare diseases, including, without limitation: 21 
 (a) Recognizing the symptoms of pediatric cancer; and  22 
 (b) Interpreting family history to determine whether such 23 
symptoms indicate a normal childhood illness or a condition that 24 
requires additional examination. 25 
 8. As used in this section: 26 
 (a) “Act of terrorism” has the meaning ascribed to it in  27 
NRS 202.4415. 28 
 (b) “Biological agent” has the meaning ascribed to it in  29 
NRS 202.442. 30 
 (c) “Chemical agent” has the meaning ascribed to it in  31 
NRS 202.4425. 32 
 (d) “Primary care” means the practice of family medicine, 33 
pediatrics, internal medicine, obstetrics and gynecology and 34 
midwifery.  35 
 (e) “Radioactive agent” has the meaning ascribed to it in  36 
NRS 202.4437. 37 
 [(e)] (f) “Weapon of mass destruction” has the meaning 38 
ascribed to it in NRS 202.4445. 39 
 Sec. 30.  NRS 633.471 is hereby amended to read as follows: 40 
 633.471 1.  Except as otherwise provided in subsection [14] 41 
15 and NRS 633.491, every holder of a license, except a physician 42 
assistant, issued under this chapter, except a temporary or a special 43 
license, may renew the license on or before January 1 of each 44 
calendar year after its issuance by: 45   
 	– 26 – 
 
 
- *SB439_R2* 
 (a) Applying for renewal on forms provided by the Board; 1 
 (b) Paying the annual license renewal fee specified in this 2 
chapter; 3 
 (c) Submitting a list of all actions filed or claims submitted to 4 
arbitration or mediation for malpractice or negligence against the 5 
holder during the previous year; 6 
 (d) Subject to subsection [13,] 14, submitting evidence to the 7 
Board that in the year preceding the application for renewal the 8 
holder has attended courses or programs of continuing education 9 
approved by the Board in accordance with regulations adopted by 10 
the Board totaling a number of hours established by the Board 11 
which must not be less than 35 hours nor more than that set in the 12 
requirements for continuing medical education of the American 13 
Osteopathic Association; and 14 
 (e) Submitting all information required to complete the renewal. 15 
 2.  The Secretary of the Board shall notify each licensee of the 16 
requirements for renewal not less than 30 days before the date of 17 
renewal. 18 
 3.  The Board shall request submission of verified evidence of 19 
completion of the required number of hours of continuing medical 20 
education annually from no fewer than one-third of the applicants 21 
for renewal of a license to practice osteopathic medicine or a license 22 
to practice as a physician assistant. Subject to subsection [13,] 14, 23 
upon a request from the Board, an applicant for renewal of a license 24 
to practice osteopathic medicine or a license to practice as a 25 
physician assistant shall submit verified evidence satisfactory to the 26 
Board that in the year preceding the application for renewal the 27 
applicant attended courses or programs of continuing medical 28 
education approved by the Board totaling the number of hours 29 
established by the Board. 30 
 4.  The Board shall require each holder of a license to practice 31 
osteopathic medicine to complete a course of instruction within 2 32 
years after initial licensure that provides at least 2 hours of 33 
instruction on evidence-based suicide prevention and awareness as 34 
described in subsection 9. 35 
 5.  The Board shall encourage each holder of a license to 36 
practice osteopathic medicine to receive, as a portion of his or her 37 
continuing education, training concerning methods for educating 38 
patients about how to effectively manage medications, including, 39 
without limitation, the ability of the patient to request to have the 40 
symptom or purpose for which a drug is prescribed included on the 41 
label attached to the container of the drug. 42 
 6. The Board shall encourage each holder of a license to 43 
practice osteopathic medicine or as a physician assistant to receive, 44 
as a portion of his or her continuing education, training and 45   
 	– 27 – 
 
 
- *SB439_R2* 
education in the diagnosis of rare diseases, including, without 1 
limitation: 2 
 (a) Recognizing the symptoms of pediatric cancer; and  3 
 (b) Interpreting family history to determine whether such 4 
symptoms indicate a normal childhood illness or a condition that 5 
requires additional examination. 6 
 7. The Board shall require, as part of the continuing education 7 
requirements approved by the Board, the biennial completion by a 8 
holder of a license to practice osteopathic medicine of at least 2 9 
hours of continuing education credits in ethics, pain management, 10 
care of persons with addictive disorders or the screening, brief 11 
intervention and referral to treatment approach to substance use 12 
disorder. 13 
 8.  The continuing education requirements approved by the 14 
Board must allow the holder of a license as an osteopathic physician 15 
or physician assistant to receive credit toward the total amount of 16 
continuing education required by the Board for the completion of a 17 
course of instruction relating to genetic counseling and genetic 18 
testing. 19 
 9.  The Board shall require each holder of a license to practice 20 
osteopathic medicine to receive as a portion of his or her continuing 21 
education at least 2 hours of instruction every 4 years on evidence-22 
based suicide prevention and awareness which may include, without 23 
limitation, instruction concerning: 24 
 (a) The skills and knowledge that the licensee needs to detect 25 
behaviors that may lead to suicide, including, without limitation, 26 
post-traumatic stress disorder; 27 
 (b) Approaches to engaging other professionals in suicide 28 
intervention; and 29 
 (c) The detection of suicidal thoughts and ideations and the 30 
prevention of suicide. 31 
 10. A holder of a license to practice osteopathic medicine may 32 
not substitute the continuing education credits relating to suicide 33 
prevention and awareness required by this section for the purposes 34 
of satisfying an equivalent requirement for continuing education in 35 
ethics. 36 
 11. The Board shall require each holder of a license to practice 37 
osteopathic medicine to complete at least 2 hours of training in the 38 
screening, brief intervention and referral to treatment approach to 39 
substance use disorder within 2 years after initial licensure. 40 
 12.  The Board shall require each psychiatrist or a physician 41 
assistant practicing under the supervision of a psychiatrist to 42 
biennially complete one or more courses of instruction that provide 43 
at least 2 hours of instruction relating to cultural competency and 44 
diversity, equity and inclusion. Such instruction:  45   
 	– 28 – 
 
 
- *SB439_R2* 
 (a) May include the training provided pursuant to NRS 449.103, 1 
where applicable.  2 
 (b) Must be based upon a range of research from diverse 3 
sources. 4 
 (c) Must address persons of different cultural backgrounds, 5 
including, without limitation:  6 
  (1) Persons from various gender, racial and ethnic 7 
backgrounds;  8 
  (2) Persons from various religious backgrounds;  9 
  (3) Lesbian, gay, bisexual, transgender and questioning 10 
persons;  11 
  (4) Children and senior citizens;  12 
  (5) Veterans;  13 
  (6) Persons with a mental illness;  14 
  (7) Persons with an intellectual disability, developmental 15 
disability or physical disability; and  16 
  (8) Persons who are part of any other population that a 17 
psychiatrist or physician assistant practicing under the supervision 18 
of a psychiatrist may need to better understand, as determined by the 19 
Board. 20 
 13.  The Board shall require each holder of a license to 21 
practice osteopathic medicine or as a physician assistant who 22 
provides or supervises the provision of emergency medical services 23 
in a hospital or primary care to complete at least 2 hours of 24 
training in the stigma, discrimination and unrecognized bias 25 
toward persons who have acquired or are at a high risk of 26 
acquiring human immunodeficiency virus within 2 years after 27 
beginning to provide or supervise the provision of such services or 28 
care. 29 
 14. The Board shall not require a physician assistant to receive 30 
or maintain certification by the National Commission on 31 
Certification of Physician Assistants, or its successor organization, 32 
or by any other nationally recognized organization for the 33 
accreditation of physician assistants to satisfy any continuing 34 
education requirement pursuant to paragraph (d) of subsection 1 and 35 
subsection 3. 36 
 [14.] 15.  Members of the Armed Forces of the United States 37 
and the United States Public Health Service are exempt from 38 
payment of the annual license renewal fee during their active duty 39 
status. 40 
 16. As used in this section, “primary care” means the practice 41 
of family medicine, pediatrics, internal medicine, obstetrics and 42 
gynecology and midwifery.  43   
 	– 29 – 
 
 
- *SB439_R2* 
 Sec. 31.  NRS 687B.225 is hereby amended to read as follows: 1 
 687B.225 1.  Except as otherwise provided in NRS 2 
689A.0405, 689A.0412, 689A.0413, 689A.0437, 689A.044, 3 
689A.0445, 689B.031, 689B.0312, 689B.0313, 689B.0315, 4 
689B.0317, 689B.0374, 689C.1671, 689C.1675, 695A.1843, 5 
695A.1856, 695B.1912, 695B.1913, 695B.1914, 695B.1924, 6 
695B.1925, 695B.1942, 695C.1713, 695C.1735, 695C.1737, 7 
695C.1743, 695C.1745, 695C.1751, 695G.170, 695G.1705, 8 
695G.171, 695G.1714 and 695G.177, and sections 33, 41, 46, 54, 9 
59, 64 and 71 of this act, any contract for group, blanket or 10 
individual health insurance or any contract by a nonprofit hospital, 11 
medical or dental service corporation or organization for dental care 12 
which provides for payment of a certain part of medical or dental 13 
care may require the insured or member to obtain prior authorization 14 
for that care from the insurer or organization. The insurer or 15 
organization shall: 16 
 (a) File its procedure for obtaining approval of care pursuant to 17 
this section for approval by the Commissioner; and 18 
 (b) Respond to any request for approval by the insured or 19 
member pursuant to this section within 20 days after it receives the 20 
request. 21 
 2.  The procedure for prior authorization may not discriminate 22 
among persons licensed to provide the covered care. 23 
 Sec. 32.  Chapter 689A of NRS is hereby amended by adding 24 
thereto the provisions set forth as sections 33, 34 and 35 of this act. 25 
 Sec. 33.  1. An insurer that offers or issues a policy of 26 
health insurance shall include in the policy coverage for: 27 
 (a) All drugs approved by the United States Food and Drug 28 
Administration to: 29 
  (1) Provide medication-assisted treatment for opioid use 30 
disorder, including, without limitation, buprenorphine, methadone 31 
and naltrexone. 32 
  (2) Support safe withdrawal from substance use disorder, 33 
including, without limitation, lofexidine. 34 
 (b) Any service for the treatment of substance use disorder 35 
provided by a provider of primary care if the service is covered 36 
when provided by a specialist and: 37 
  (1) The service is within the scope of practice of the 38 
provider of primary care; or  39 
  (2) The provider of primary care is capable of providing the 40 
service safely and effectively in consultation with a specialist and 41 
the provider engages in such consultation. 42 
 2. An insurer shall provide the coverage required by 43 
paragraph (a) of subsection 1 regardless of whether the drug is 44 
included in the formulary of the insurer. 45   
 	– 30 – 
 
 
- *SB439_R2* 
 3. An insurer shall not: 1 
 (a) Subject the benefits required by paragraph (a) of 2 
subsection 1 to medical management techniques, other than step 3 
therapy;  4 
 (b) Limit the covered amount of a drug described in paragraph 5 
(a) of subsection 1; or 6 
 (c) Refuse to cover a drug described in paragraph (a) of 7 
subsection 1 because the drug is dispensed by a pharmacy through 8 
mail order service. 9 
 4. An insurer shall ensure that the benefits required by 10 
subsection 1 are made available to an insured through a provider 11 
of health care who participates in the network plan of the insurer.  12 
 5.  A policy of health insurance subject to the provisions of 13 
this chapter that is delivered, issued for delivery or renewed on or 14 
after January 1, 2024, has the legal effect of including the 15 
coverage required by subsection 1, and any provision of the policy 16 
that conflicts with the provisions of this section is void.  17 
 6. As used in this section:  18 
 (a) “Medical management technique” means a practice which 19 
is used to control the cost or use of health care services or 20 
prescription drugs. The term includes, without limitation, the use 21 
of step therapy, prior authorization and categorizing drugs and 22 
devices based on cost, type or method of administration. 23 
 (b) “Network plan” means a policy of health insurance offered 24 
by an insurer under which the financing and delivery of medical 25 
care, including items and services paid for as medical care, are 26 
provided, in whole or in part, through a defined set of providers 27 
under contract with the insurer. The term does not include an 28 
arrangement for the financing of premiums.  29 
 (c) “Primary care” means the practice of family medicine, 30 
pediatrics, internal medicine, obstetrics and gynecology and 31 
midwifery.  32 
 (d) “Provider of health care” has the meaning ascribed to it in 33 
NRS 629.031. 34 
 Sec. 34.  1. An insurer that offers or issues a policy of 35 
health insurance shall include in the policy: 36 
 (a) Coverage of testing for and the treatment and prevention of 37 
sexually transmitted diseases, including, without limitation, 38 
Chlamydia trachomatis, gonorrhea, syphilis, human 39 
immunodeficiency virus and hepatitis B and C, for all insureds, 40 
regardless of age. Such coverage must include, without limitation, 41 
the coverage required by NRS 689A.0412 and 689A.0437. 42 
 (b) Unrestricted coverage of condoms for insureds who are 13 43 
years of age or older. 44   
 	– 31 – 
 
 
- *SB439_R2* 
 2. A policy of health insurance subject to the provisions of 1 
this chapter that is delivered, issued for delivery or renewed on or 2 
after January 1, 2024, has the legal effect of including the 3 
coverage required by subsection 1, and any provision of the policy 4 
that conflicts with the provisions of this section is void.  5 
 Sec. 35.  (Deleted by amendment.) 6 
 Sec. 36.  NRS 689A.030 is hereby amended to read as follows: 7 
 689A.030 A policy of health insurance must not be delivered 8 
or issued for delivery to any person in this State unless it otherwise 9 
complies with this Code, and complies with the following: 10 
 1.  The entire money and other considerations for the policy 11 
must be expressed therein. 12 
 2.  The time when the insurance takes effect and terminates 13 
must be expressed therein. 14 
 3.  It must purport to insure only one person, except that a 15 
policy may insure, originally or by subsequent amendment, upon the 16 
application of an adult member of a family, who shall be deemed the 17 
policyholder, any two or more eligible members of that family, 18 
including the husband, wife, domestic partner as defined in NRS 19 
122A.030, dependent children, from the time of birth, adoption or 20 
placement for the purpose of adoption as provided in NRS 21 
689A.043, or any child on or before the last day of the month in 22 
which the child attains 26 years of age, and any other person 23 
dependent upon the policyholder. 24 
 4.  The style, arrangement and overall appearance of the policy 25 
must not give undue prominence to any portion of the text, and 26 
every printed portion of the text of the policy and of any 27 
endorsements or attached papers must be plainly printed in light-28 
faced type of a style in general use, the size of which must be 29 
uniform and not less than 10 points with a lowercase unspaced 30 
alphabet length not less than 120 points. “Text” includes all printed 31 
matter except the name and address of the insurer, the name or the 32 
title of the policy, the brief description, if any, and captions and 33 
subcaptions. 34 
 5.  The exceptions and reductions of indemnity must be set 35 
forth in the policy and, other than those contained in NRS 689A.050 36 
to 689A.290, inclusive, must be printed, at the insurer’s option, with 37 
the benefit provision to which they apply or under an appropriate 38 
caption such as “Exceptions” or “Exceptions and Reductions,” 39 
except that if an exception or reduction specifically applies only to a 40 
particular benefit of the policy, a statement of that exception or 41 
reduction must be included with the benefit provision to which it 42 
applies. 43   
 	– 32 – 
 
 
- *SB439_R2* 
 6.  Each such form, including riders and endorsements, must be 1 
identified by a number in the lower left-hand corner of the first page 2 
thereof. 3 
 7.  The policy must not contain any provision purporting to 4 
make any portion of the charter, rules, constitution or bylaws of the 5 
insurer a part of the policy unless that portion is set forth in full in 6 
the policy, except in the case of the incorporation of or reference to 7 
a statement of rates or classification of risks, or short-rate table filed 8 
with the Commissioner. 9 
 8.  The policy must provide benefits for expense arising from 10 
care at home or health supportive services if that care or service was 11 
prescribed by a physician and would have been covered by the 12 
policy if performed in a medical facility or facility for the dependent 13 
as defined in chapter 449 of NRS. 14 
 9.  [The] Except as otherwise provided in this subsection, the 15 
policy must provide [, at the option of the applicant,] benefits for 16 
expenses incurred for the treatment of alcohol or substance use 17 
disorder . [, unless] Except for the benefits required by section 34 18 
of this act, such benefits must be provided: 19 
 (a) At the option of the applicant; and 20 
 (b) Unless the policy provides coverage only for a specified 21 
disease or provides for the payment of a specific amount of money 22 
if the insured is hospitalized or receiving health care in his or her 23 
home. 24 
 10.  The policy must provide benefits for expense arising from 25 
hospice care. 26 
 Sec. 37.  NRS 689A.0437 is hereby amended to read as 27 
follows: 28 
 689A.0437 1. An insurer that offers or issues a policy of 29 
health insurance shall include in the policy coverage for:  30 
 (a) [Drugs] All drugs approved by the United States Food and 31 
Drug Administration for preventing the acquisition of human 32 
immunodeficiency virus [;] or treating human immunodeficiency 33 
virus or hepatitis C in the form recommended by the prescribing 34 
practitioner, regardless of whether the drug is included in the 35 
formulary of the insurer; 36 
 (b) Laboratory testing that is necessary for therapy that uses 37 
[such] a drug [;] to prevent the acquisition of human 38 
immunodeficiency virus;  39 
 (c) Any service to test for, prevent or treat human 40 
immunodeficiency virus or hepatitis C provided by a provider of 41 
primary care if the service is covered when provided by a specialist 42 
and: 43 
  (1) The service is within the scope of practice of the 44 
provider of primary care; or  45   
 	– 33 – 
 
 
- *SB439_R2* 
  (2) The provider of primary care is capable of providing the 1 
service safely and effectively in consultation with a specialist and 2 
the provider engages in such consultation; and  3 
 [(c)] (d) The services described in NRS 639.28085, when 4 
provided by a pharmacist who participates in the network plan of the 5 
insurer.  6 
 2. An insurer that offers or issues a policy of health insurance 7 
shall reimburse [a] : 8 
 (a) A pharmacist who participates in the network plan of the 9 
insurer for the services described in NRS 639.28085 at a rate equal 10 
to the rate of reimbursement provided to a physician, physician 11 
assistant or advanced practice registered nurse for similar services.  12 
 (b) An advanced practice registered nurse or a physician 13 
assistant who participates in the network plan of the insurer for 14 
any service to test for, prevent or treat human immunodeficiency 15 
virus or hepatitis C at a rate equal to the rate of reimbursement 16 
provided to a physician for similar services. 17 
 3. An insurer [may subject] shall not: 18 
 (a) Subject the benefits required by subsection 1 to [reasonable] 19 
medical management techniques [.] , other than step therapy;  20 
 (b) Limit the covered amount of a drug described in paragraph 21 
(a) of subsection 1; 22 
 (c) Refuse to cover a drug described in paragraph (a) of 23 
subsection 1 because the drug is dispensed by a pharmacy through 24 
mail order service; or 25 
 (d) Prohibit or restrict access to any service or drug to treat 26 
human immunodeficiency virus or hepatitis C on the same day on 27 
which the insured is diagnosed. 28 
 4. An insurer shall ensure that the benefits required by 29 
subsection 1 are made available to an insured through a provider of 30 
health care who participates in the network plan of the insurer.  31 
 5.  A policy of health insurance subject to the provisions of this 32 
chapter that is delivered, issued for delivery or renewed on or after 33 
[October] January 1, [2021,] 2024, has the legal effect of including 34 
the coverage required by subsection 1, and any provision of the 35 
policy that conflicts with the provisions of this section is void.  36 
 6. As used in this section:  37 
 (a) “Medical management technique” means a practice which is 38 
used to control the cost or use of health care services or prescription 39 
drugs. The term includes, without limitation, the use of step therapy, 40 
prior authorization and categorizing drugs and devices based on 41 
cost, type or method of administration. 42 
 (b) “Network plan” means a policy of health insurance offered 43 
by an insurer under which the financing and delivery of medical 44 
care, including items and services paid for as medical care, are 45   
 	– 34 – 
 
 
- *SB439_R2* 
provided, in whole or in part, through a defined set of providers 1 
under contract with the insurer. The term does not include an 2 
arrangement for the financing of premiums.  3 
 (c) “Primary care” means the practice of family medicine, 4 
pediatrics, internal medicine, obstetrics and gynecology and 5 
midwifery.  6 
 (d) “Provider of health care” has the meaning ascribed to it in 7 
NRS 629.031. 8 
 Sec. 38.  NRS 689A.046 is hereby amended to read as follows: 9 
 689A.046 1.  [The] In addition to the benefits required by 10 
section 33 of this act, the benefits provided by a policy for health 11 
insurance for treatment of alcohol or substance use disorder must 12 
[consist of:] include, without limitation: 13 
 (a) Treatment for withdrawal from the physiological effect of 14 
alcohol or drugs, with a minimum benefit of $1,500 per calendar 15 
year. 16 
 (b) Treatment for a patient admitted to a facility, with a 17 
minimum benefit of $9,000 per calendar year. 18 
 (c) Counseling for a person, group or family who is not admitted 19 
to a facility, with a minimum benefit of $2,500 per calendar year. 20 
 2.  Except as otherwise provided in NRS 687B.409, these 21 
benefits must be paid in the same manner as benefits for any other 22 
illness covered by a similar policy are paid. 23 
 3.  The insured person is entitled to these benefits if treatment is 24 
received in any: 25 
 (a) Facility for the treatment of alcohol or substance use disorder 26 
which is certified by the Division of Public and Behavioral Health 27 
of the Department of Health and Human Services. 28 
 (b) Hospital or other medical facility or facility for the 29 
dependent which is licensed by the Division of Public and 30 
Behavioral Health of the Department of Health and Human 31 
Services, accredited by The Joint Commission or CARF 32 
International and provides a program for the treatment of alcohol or 33 
substance use disorder as part of its accredited activities. 34 
 Sec. 39.  NRS 689A.330 is hereby amended to read as follows: 35 
 689A.330 If any policy is issued by a domestic insurer for 36 
delivery to a person residing in another state, and if the insurance 37 
commissioner or corresponding public officer of that other state has 38 
informed the Commissioner that the policy is not subject to approval 39 
or disapproval by that officer, the Commissioner may by ruling 40 
require that the policy meet the standards set forth in NRS 689A.030 41 
to 689A.320, inclusive [.] , and sections 33 and 34 of this act. 42   
 	– 35 – 
 
 
- *SB439_R2* 
 Sec. 40.  Chapter 689B of NRS is hereby amended by adding 1 
thereto the provisions set forth as sections 41, 42 and 43 of this act. 2 
 Sec. 41.  1. An insurer that offers or issues a policy of 3 
group health insurance shall include in the policy coverage for: 4 
 (a) All drugs approved by the United States Food and Drug 5 
Administration to: 6 
  (1) Provide medication-assisted treatment for opioid use 7 
disorder, including, without limitation, buprenorphine, methadone 8 
and naltrexone. 9 
  (2) Support safe withdrawal from substance use disorder, 10 
including, without limitation, lofexidine. 11 
 (b) Any service for the treatment of substance use disorder 12 
provided by a provider of primary care if the service is covered 13 
when provided by a specialist and: 14 
  (1) The service is within the scope of practice of the 15 
provider of primary care; or  16 
  (2) The provider of primary care is capable of providing the 17 
service safely and effectively in consultation with a specialist and 18 
the provider engages in such consultation. 19 
 2. An insurer shall provide the coverage required by 20 
paragraph (a) of subsection 1 regardless of whether the drug is 21 
included in the formulary of the insurer. 22 
 3. An insurer shall not: 23 
 (a) Subject the benefits required by paragraph (a) of 24 
subsection 1 to medical management techniques, other than step 25 
therapy;  26 
 (b) Limit the covered amount of a drug described in paragraph 27 
(a) of subsection 1; or 28 
 (c) Refuse to cover a drug described in paragraph (a) of 29 
subsection 1 because the drug is dispensed by a pharmacy through 30 
mail order service. 31 
 4. An insurer shall ensure that the benefits required by 32 
subsection 1 are made available to an insured through a provider 33 
of health care who participates in the network plan of the insurer.  34 
 5.  A policy of group health insurance subject to the 35 
provisions of this chapter that is delivered, issued for delivery or 36 
renewed on or after January 1, 2024, has the legal effect of 37 
including the coverage required by subsection 1, and any 38 
provision of the policy that conflicts with the provisions of this 39 
section is void.  40 
 6. As used in this section:  41 
 (a) “Medical management technique” means a practice which 42 
is used to control the cost or use of health care services or 43 
prescription drugs. The term includes, without limitation, the use 44   
 	– 36 – 
 
 
- *SB439_R2* 
of step therapy, prior authorization and categorizing drugs and 1 
devices based on cost, type or method of administration. 2 
 (b) “Network plan” means a policy of group health insurance 3 
offered by an insurer under which the financing and delivery of 4 
medical care, including items and services paid for as medical 5 
care, are provided, in whole or in part, through a defined set of 6 
providers under contract with the insurer. The term does not 7 
include an arrangement for the financing of premiums.  8 
 (c) “Primary care” means the practice of family medicine, 9 
pediatrics, internal medicine, obstetrics and gynecology and 10 
midwifery.  11 
 (d) “Provider of health care” has the meaning ascribed to it in 12 
NRS 629.031. 13 
 Sec. 42.  1. An insurer that offers or issues a policy of 14 
group health insurance shall include in the policy: 15 
 (a) Coverage of testing for and the treatment of and prevention 16 
of sexually transmitted diseases, including, without limitation, 17 
Chlamydia trachomatis, gonorrhea, syphilis, human 18 
immunodeficiency virus and hepatitis B and C, for all insureds, 19 
regardless of age. Such coverage must include, without limitation, 20 
the coverage required by NRS 689B.0312 and 689B.0315. 21 
 (b) Unrestricted coverage of condoms for insureds who are 13 22 
years of age or older. 23 
 2. A policy of group health insurance subject to the 24 
provisions of this chapter that is delivered, issued for delivery or 25 
renewed on or after January 1, 2024, has the legal effect of 26 
including the coverage required by subsection 1, and any 27 
provision of the policy that conflicts with the provisions of this 28 
section is void.  29 
 Sec. 43.  (Deleted by amendment.) 30 
 Sec. 44.  NRS 689B.0312 is hereby amended to read as 31 
follows: 32 
 689B.0312 1. An insurer that offers or issues a policy of 33 
group health insurance shall include in the policy coverage for:  34 
 (a) [Drugs] All drugs approved by the United States Food and 35 
Drug Administration for preventing the acquisition of human 36 
immunodeficiency virus [;] or treating human immunodeficiency 37 
virus or hepatitis C in the form recommended by the prescribing 38 
practitioner, regardless of whether the drug is included in the 39 
formulary of the insurer; 40 
 (b) Laboratory testing that is necessary for therapy that uses 41 
[such] a drug [;] to prevent the acquisition of human 42 
immunodeficiency virus;  43 
 (c) Any service to test for, prevent or treat human 44 
immunodeficiency virus or hepatitis C provided by a provider of 45   
 	– 37 – 
 
 
- *SB439_R2* 
primary care if the service is covered when provided by a specialist 1 
and: 2 
  (1) The service is within the scope of practice of the 3 
provider of primary care; or  4 
  (2) The provider of primary care is capable of providing the 5 
service safely and effectively in consultation with a specialist and 6 
the provider engages in such consultation; and  7 
 [(c)] (d) The services described in NRS 639.28085, when 8 
provided by a pharmacist who participates in the network plan of the 9 
insurer.  10 
 2. An insurer that offers or issues a policy of group health 11 
insurance shall reimburse [a] : 12 
 (a) A pharmacist who participates in the network plan of the 13 
insurer for the services described in NRS 639.28085 at a rate equal 14 
to the rate of reimbursement provided to a physician, physician 15 
assistant or advanced practice registered nurse for similar services.  16 
 (b) An advanced practice registered nurse or a physician 17 
assistant who participates in the network plan of the insurer for 18 
any service to test for, prevent or treat human immunodeficiency 19 
virus or hepatitis C at a rate equal to the rate of reimbursement 20 
provided to a physician for similar services. 21 
 3. An insurer [may subject] shall not: 22 
 (a) Subject the benefits required by subsection 1 to [reasonable] 23 
medical management techniques [.] , other than step therapy;  24 
 (b) Limit the covered amount of a drug described in paragraph 25 
(a) of subsection 1; 26 
 (c) Refuse to cover a drug described in paragraph (a) of 27 
subsection 1 because the drug is dispensed by a pharmacy through 28 
mail order service; or 29 
 (d) Prohibit or restrict access to any service or drug to treat 30 
human immunodeficiency virus or hepatitis C on the same day on 31 
which the insured is diagnosed. 32 
 4. An insurer shall ensure that the benefits required by 33 
subsection 1 are made available to an insured through a provider of 34 
health care who participates in the network plan of the insurer.  35 
 5. A policy of group health insurance subject to the provisions 36 
of this chapter that is delivered, issued for delivery or renewed on or 37 
after [October] January 1, [2021,] 2024, has the legal effect of 38 
including the coverage required by subsection 1, and any provision 39 
of the policy that conflicts with the provisions of this section is void.  40 
 6. As used in this section:  41 
 (a) “Medical management technique” means a practice which is 42 
used to control the cost or use of health care services or prescription 43 
drugs. The term includes, without limitation, the use of step therapy, 44   
 	– 38 – 
 
 
- *SB439_R2* 
prior authorization and categorizing drugs and devices based on 1 
cost, type or method of administration. 2 
 (b) “Network plan” means a policy of group health insurance 3 
offered by an insurer under which the financing and delivery of 4 
medical care, including items and services paid for as medical care, 5 
are provided, in whole or in part, through a defined set of providers 6 
under contract with the insurer. The term does not include an 7 
arrangement for the financing of premiums.  8 
 (c) “Primary care” means the practice of family medicine, 9 
pediatrics, internal medicine, obstetrics and gynecology and 10 
midwifery.  11 
 (d) “Provider of health care” has the meaning ascribed to it in 12 
NRS 629.031. 13 
 Sec. 45.  Chapter 689C of NRS is hereby amended by adding 14 
thereto the provisions set forth as sections 46, 47 and 48 of this act. 15 
 Sec. 46.  1. A carrier that offers or issues a health benefit 16 
plan shall include in the plan coverage for: 17 
 (a) All drugs approved by the United States Food and Drug 18 
Administration to: 19 
  (1) Provide medication-assisted treatment for opioid use 20 
disorder, including, without limitation, buprenorphine, methadone 21 
and naltrexone. 22 
  (2) Support safe withdrawal from substance use disorder, 23 
including, without limitation, lofexidine. 24 
 (b) Any service for the treatment of substance use disorder 25 
provided by a provider of primary care if the service is covered 26 
when provided by a specialist and: 27 
  (1) The service is within the scope of practice of the 28 
provider of primary care; or  29 
  (2) The provider of primary care is capable of providing the 30 
service safely and effectively in consultation with a specialist and 31 
the provider engages in such consultation. 32 
 2. A carrier shall provide the coverage required by paragraph 33 
(a) of subsection 1 regardless of whether the drug is included in 34 
the formulary of the carrier. 35 
 3. A carrier shall not: 36 
 (a) Subject the benefits required by paragraph (a) of 37 
subsection 1 to medical management techniques, other than step 38 
therapy;  39 
 (b) Limit the covered amount of a drug described in paragraph 40 
(a) of subsection 1; or 41 
 (c) Refuse to cover a drug described in paragraph (a) of 42 
subsection 1 because the drug is dispensed by a pharmacy through 43 
mail order service. 44   
 	– 39 – 
 
 
- *SB439_R2* 
 4. A carrier shall ensure that the benefits required by 1 
subsection 1 are made available to an insured through a provider 2 
of health care who participates in the network plan of the carrier.  3 
 5.  A health benefit plan subject to the provisions of this 4 
chapter that is delivered, issued for delivery or renewed on or after 5 
January 1, 2024, has the legal effect of including the coverage 6 
required by subsection 1, and any provision of the plan that 7 
conflicts with the provisions of this section is void.  8 
 6. As used in this section:  9 
 (a) “Medical management technique” means a practice which 10 
is used to control the cost or use of health care services or 11 
prescription drugs. The term includes, without limitation, the use 12 
of step therapy, prior authorization and categorizing drugs and 13 
devices based on cost, type or method of administration. 14 
 (b) “Network plan” means a health benefit plan offered by a 15 
carrier under which the financing and delivery of medical care, 16 
including items and services paid for as medical care, are 17 
provided, in whole or in part, through a defined set of providers 18 
under contract with the carrier. The term does not include an 19 
arrangement for the financing of premiums.  20 
 (c) “Primary care” means the practice of family medicine, 21 
pediatrics, internal medicine, obstetrics and gynecology and 22 
midwifery.  23 
 (d) “Provider of health care” has the meaning ascribed to it in 24 
NRS 629.031. 25 
 Sec. 47.  1. A carrier that offers or issues a health benefit 26 
plan shall include in the plan: 27 
 (a) Coverage of testing for and the treatment and prevention of 28 
sexually transmitted diseases, including, without limitation, 29 
Chlamydia trachomatis, gonorrhea, syphilis, human 30 
immunodeficiency virus and hepatitis B and C, for all insureds, 31 
regardless of age. Such coverage must include, without limitation, 32 
the coverage required by NRS 689C.1671 and 689C.1675. 33 
 (b) Unrestricted coverage of condoms for insureds who are 13 34 
years of age or older. 35 
 2. A health benefit plan subject to the provisions of this 36 
chapter that is delivered, issued for delivery or renewed on or after 37 
January 1, 2024, has the legal effect of including the coverage 38 
required by subsection 1, and any provision of the plan that 39 
conflicts with the provisions of this section is void.  40 
 Sec. 48.  (Deleted by amendment.) 41 
 Sec. 49.  NRS 689C.166 is hereby amended to read as follows: 42 
 689C.166 Each group health insurance policy must contain in 43 
substance a provision for benefits payable for expenses incurred for 44   
 	– 40 – 
 
 
- *SB439_R2* 
the treatment of alcohol or substance use disorder, as provided in 1 
NRS 689C.167 [.] and section 46 of this act. 2 
 Sec. 50.  NRS 689C.167 is hereby amended to read as follows: 3 
 689C.167 1.  [The] In addition to the benefits required by 4 
section 46 of this act, the benefits provided by a group policy for 5 
health insurance, as required by NRS 689C.166, for the treatment of 6 
alcohol or substance use disorders must [consist of:] include, 7 
without limitation: 8 
 (a) Treatment for withdrawal from the physiological effects of 9 
alcohol or drugs, with a minimum benefit of $1,500 per calendar 10 
year. 11 
 (b) Treatment for a patient admitted to a facility, with a 12 
minimum benefit of $9,000 per calendar year. 13 
 (c) Counseling for a person, group or family who is not admitted 14 
to a facility, with a minimum benefit of $2,500 per calendar year. 15 
 2.  Except as otherwise provided in NRS 687B.409, these 16 
benefits must be paid in the same manner as benefits for any other 17 
illness covered by a similar policy are paid. 18 
 3.  The insured person is entitled to these benefits if treatment is 19 
received in any: 20 
 (a) Facility for the treatment of alcohol or substance use 21 
disorders which is certified by the Division of Public and Behavioral 22 
Health of the Department of Health and Human Services. 23 
 (b) Hospital or other medical facility or facility for the 24 
dependent which is licensed by the Division of Public and 25 
Behavioral Health of the Department of Health and Human 26 
Services, is accredited by The Joint Commission or CARF 27 
International and provides a program for the treatment of alcohol or 28 
substance use disorders as part of its accredited activities. 29 
 Sec. 51.  NRS 689C.1671 is hereby amended to read as 30 
follows: 31 
 689C.1671 1.  A carrier that offers or issues a health benefit 32 
plan shall include in the plan coverage for:  33 
 (a) [Drugs] All drugs approved by the United States Food and 34 
Drug Administration for preventing the acquisition of human 35 
immunodeficiency virus [;] or treating human immunodeficiency 36 
virus or hepatitis C in the form recommended by the prescribing 37 
practitioner, regardless of whether the drug is included in the 38 
formulary of the carrier; 39 
 (b) Laboratory testing that is necessary for therapy that uses 40 
[such] a drug [;] to prevent the acquisition of human 41 
immunodeficiency virus;  42 
 (c) Any service to test for, prevent or treat human 43 
immunodeficiency virus or hepatitis C provided by a provider of 44   
 	– 41 – 
 
 
- *SB439_R2* 
primary care if the service is covered when provided by a specialist 1 
and: 2 
  (1) The service is within the scope of practice of the 3 
provider of primary care; or  4 
  (2) The provider of primary care is capable of providing the 5 
service safely and effectively in consultation with a specialist and 6 
the provider engages in such consultation; and  7 
 [(c)] (d) The services described in NRS 639.28085, when 8 
provided by a pharmacist who participates in the health benefit plan 9 
of the carrier.  10 
 2.  A carrier that offers or issues a health benefit plan shall 11 
reimburse [a] : 12 
 (a) A pharmacist who participates in the health benefit plan of 13 
the carrier for the services described in NRS 639.28085 at a rate 14 
equal to the rate of reimbursement provided to a physician, 15 
physician assistant or advanced practice registered nurse for similar 16 
services.  17 
 (b) An advanced practice registered nurse or a physician 18 
assistant who participates in the network plan of the carrier for 19 
any service to test for, prevent or treat human immunodeficiency 20 
virus or hepatitis C at a rate equal to the rate of reimbursement 21 
provided to a physician for similar services. 22 
 3.  A carrier [may subject] shall not: 23 
 (a) Subject the benefits required by subsection 1 to [reasonable] 24 
medical management techniques [.] , other than step therapy;  25 
 (b) Limit the covered amount of a drug described in paragraph 26 
(a) of subsection 1; 27 
 (c) Refuse to cover a drug described in paragraph (a) of 28 
subsection 1 because the drug is dispensed by a pharmacy through 29 
mail order service; or 30 
 (d) Prohibit or restrict access to any service or drug to treat 31 
human immunodeficiency virus or hepatitis C on the same day on 32 
which the insured is diagnosed. 33 
 4.  A carrier shall ensure that the benefits required by 34 
subsection 1 are made available to an insured through a provider of 35 
health care who participates in the network plan of the carrier.  36 
 5.  A health benefit plan subject to the provisions of this chapter 37 
that is delivered, issued for delivery or renewed on or after 38 
[October] January 1, [2021,] 2024, has the legal effect of including 39 
the coverage required by subsection 1, and any provision of the plan 40 
that conflicts with the provisions of this section is void.  41 
 6.  As used in this section:  42 
 (a) “Medical management technique” means a practice which is 43 
used to control the cost or use of health care services or prescription 44 
drugs. The term includes, without limitation, the use of step therapy, 45   
 	– 42 – 
 
 
- *SB439_R2* 
prior authorization and categorizing drugs and devices based on 1 
cost, type or method of administration. 2 
 (b) “Network plan” means a health benefit plan offered by a 3 
carrier under which the financing and delivery of medical care, 4 
including items and services paid for as medical care, are provided, 5 
in whole or in part, through a defined set of providers under contract 6 
with the carrier. The term does not include an arrangement for the 7 
financing of premiums.  8 
 (c) “Primary care” means the practice of family medicine, 9 
pediatrics, internal medicine, obstetrics and gynecology and 10 
midwifery.  11 
 (d) “Provider of health care” has the meaning ascribed to it in 12 
NRS 629.031. 13 
 Sec. 52.  NRS 689C.425 is hereby amended to read as follows: 14 
 689C.425 A voluntary purchasing group and any contract 15 
issued to such a group pursuant to NRS 689C.360 to 689C.600, 16 
inclusive, are subject to the provisions of NRS 689C.015 to 17 
689C.355, inclusive, and sections 46 and 47 of this act to the extent 18 
applicable and not in conflict with the express provisions of NRS 19 
687B.408 and 689C.360 to 689C.600, inclusive. 20 
 Sec. 53.  Chapter 695A of NRS is hereby amended by adding 21 
thereto the provisions set forth as sections 54, 55 and 56 of this act. 22 
 Sec. 54.  1. A society that offers or issues a benefit contract 23 
shall include in the contract coverage for: 24 
 (a) All drugs approved by the United States Food and Drug 25 
Administration to: 26 
  (1) Provide medication-assisted treatment for opioid use 27 
disorder, including, without limitation, buprenorphine, methadone 28 
and naltrexone. 29 
  (2) Support safe withdrawal from substance use disorder, 30 
including, without limitation, lofexidine. 31 
 (b) Any service for the treatment of substance use disorder 32 
provided by a provider of primary care if the service is covered 33 
when provided by a specialist and: 34 
  (1) The service is within the scope of practice of the 35 
provider of primary care; or  36 
  (2) The provider of primary care is capable of providing the 37 
service safely and effectively in consultation with a specialist and 38 
the provider engages in such consultation. 39 
 2. A society shall provide the coverage required by paragraph 40 
(a) of subsection 1 regardless of whether the drug is included in 41 
the formulary of the society. 42 
 3. A society shall not: 43   
 	– 43 – 
 
 
- *SB439_R2* 
 (a) Subject the benefits required by paragraph (a) of 1 
subsection 1 to medical management techniques, other than step 2 
therapy;  3 
 (b) Limit the covered amount of a drug described in paragraph 4 
(a) of subsection 1; or 5 
 (c) Refuse to cover a drug described in paragraph (a) of 6 
subsection 1 because the drug is dispensed by a pharmacy through 7 
mail order service. 8 
 4. A society shall ensure that the benefits required by 9 
subsection 1 are made available to an insured through a provider 10 
of health care who participates in the network plan of the society.  11 
 5.  A benefit contract subject to the provisions of this chapter 12 
that is delivered, issued for delivery or renewed on or after 13 
January 1, 2024, has the legal effect of including the coverage 14 
required by subsection 1, and any provision of the contract that 15 
conflicts with the provisions of this section is void.  16 
 6. As used in this section:  17 
 (a) “Medical management technique” means a practice which 18 
is used to control the cost or use of health care services or 19 
prescription drugs. The term includes, without limitation, the use 20 
of step therapy, prior authorization and categorizing drugs and 21 
devices based on cost, type or method of administration. 22 
 (b) “Network plan” means a benefit contract offered by a 23 
society under which the financing and delivery of medical care, 24 
including items and services paid for as medical care, are 25 
provided, in whole or in part, through a defined set of providers 26 
under contract with the society. The term does not include an 27 
arrangement for the financing of premiums.  28 
 (c) “Primary care” means the practice of family medicine, 29 
pediatrics, internal medicine, obstetrics and gynecology and 30 
midwifery.  31 
 (d) “Provider of health care” has the meaning ascribed to it in 32 
NRS 629.031. 33 
 Sec. 55.  1. A society that offers or issues a benefit contract 34 
shall include in the contract: 35 
 (a) Coverage of testing for and the treatment and prevention of 36 
sexually transmitted diseases, including, without limitation, 37 
Chlamydia trachomatis, gonorrhea, syphilis, human 38 
immunodeficiency virus and hepatitis B and C, for all insureds, 39 
regardless of age. Such coverage must include, without limitation, 40 
the coverage required by NRS 695A.1843 and 695A.1856. 41 
 (b) Unrestricted coverage of condoms for insureds who are 13 42 
years of age or older. 43 
 2. A benefit contract subject to the provisions of this chapter 44 
that is delivered, issued for delivery or renewed on or after 45   
 	– 44 – 
 
 
- *SB439_R2* 
January 1, 2024, has the legal effect of including the coverage 1 
required by subsection 1, and any provision of the contract that 2 
conflicts with the provisions of this section is void.  3 
 Sec. 56.  (Deleted by amendment.) 4 
 Sec. 57.  NRS 695A.1843 is hereby amended to read as 5 
follows: 6 
 695A.1843 1. A society that offers or issues a benefit 7 
contract shall include in the benefit coverage for:  8 
 (a) [Drugs] All approved by the United States Food and Drug 9 
Administration for preventing the acquisition of human 10 
immunodeficiency virus [;] or treating human immunodeficiency 11 
virus or hepatitis C in the form recommended by the prescribing 12 
practitioner, regardless of whether the drug is included in the 13 
formulary of the society; 14 
 (b) Laboratory testing that is necessary for therapy that uses 15 
[such] a drug [;] to prevent the acquisition of human 16 
immunodeficiency virus; 17 
 (c) Any service to test for, prevent or treat human 18 
immunodeficiency virus or hepatitis C provided by a provider of 19 
primary care if the service is covered when provided by a specialist 20 
and: 21 
  (1) The service is within the scope of practice of the 22 
provider of primary care; or  23 
  (2) The provider of primary care is capable of providing the 24 
service safely and effectively in consultation with a specialist and 25 
the provider engages in such consultation; and  26 
 [(c)] (d) The services described in NRS 639.28085, when 27 
provided by a pharmacist who participates in the network plan of the 28 
society.  29 
 2. A society that offers or issues a benefit contract shall 30 
reimburse [a] :  31 
 (a) A pharmacist who participates in the network plan of the 32 
society for the services described in NRS 639.28085 at a rate equal 33 
to the rate of reimbursement provided to a physician, physician 34 
assistant or advanced practice registered nurse for similar services.  35 
 (b) An advanced practice registered nurse or a physician 36 
assistant who participates in the network plan of the society for 37 
any service to test for, prevent or treat human immunodeficiency 38 
virus or hepatitis C at a rate equal to the rate of reimbursement 39 
provided to a physician for similar services. 40 
 3. A society [may subject] shall not: 41 
 (a) Subject the benefits required by subsection 1 to [reasonable] 42 
medical management techniques [.] , other than step therapy;  43 
 (b) Limit the covered amount of a drug described in paragraph 44 
(a) of subsection 1; 45   
 	– 45 – 
 
 
- *SB439_R2* 
 (c) Refuse to cover a drug described in paragraph (a) of 1 
subsection 1 because the drug is dispensed by a pharmacy through 2 
mail order service; or 3 
 (d) Prohibit or restrict access to any service or drug to treat 4 
human immunodeficiency virus or hepatitis C on the same day on 5 
which the insured is diagnosed. 6 
 4. A society shall ensure that the benefits required by 7 
subsection 1 are made available to an insured through a provider of 8 
health care who participates in the network plan of the society.  9 
 5. A benefit contract subject to the provisions of this chapter 10 
that is delivered, issued for delivery or renewed on or after 11 
[October] January 1, [2021,] 2024, has the legal effect of including 12 
the coverage required by subsection 1, and any provision of the plan 13 
that conflicts with the provisions of this section is void.  14 
 6. As used in this section:  15 
 (a) “Medical management technique” means a practice which is 16 
used to control the cost or use of health care services or prescription 17 
drugs. The term includes, without limitation, the use of step therapy, 18 
prior authorization and categorizing drugs and devices based on 19 
cost, type or method of administration. 20 
 (b) “Network plan” means a benefit contract offered by a society 21 
under which the financing and delivery of medical care, including 22 
items and services paid for as medical care, are provided, in whole 23 
or in part, through a defined set of providers under contract with the 24 
society. The term does not include an arrangement for the financing 25 
of premiums.  26 
 (c) “Primary care” means the practice of family medicine, 27 
pediatrics, internal medicine, obstetrics and gynecology and 28 
midwifery.  29 
 (d) “Provider of health care” has the meaning ascribed to it in 30 
NRS 629.031. 31 
 Sec. 58.  Chapter 695B of NRS is hereby amended by adding 32 
thereto the provisions set forth as sections 59, 60 and 61 of this act. 33 
 Sec. 59.  1. A hospital or medical services corporation that 34 
offers or issues a policy of health insurance shall include in the 35 
policy coverage for: 36 
 (a) All drugs approved by the United States Food and Drug 37 
Administration to: 38 
  (1) Provide medication-assisted treatment for opioid use 39 
disorder, including, without limitation, buprenorphine, methadone 40 
and naltrexone. 41 
  (2) Support safe withdrawal from substance use disorder, 42 
including, without limitation, lofexidine. 43   
 	– 46 – 
 
 
- *SB439_R2* 
 (b) Any service for the treatment of substance use disorder 1 
provided by a provider of primary care if the service is covered 2 
when provided by a specialist and: 3 
  (1) The service is within the scope of practice of the 4 
provider of primary care; or  5 
  (2) The provider of primary care is capable of providing the 6 
service safely and effectively in consultation with a specialist and 7 
the provider engages in such consultation. 8 
 2. A hospital or medical services corporation shall provide the 9 
coverage required by paragraph (a) of subsection 1 regardless of 10 
whether the drug is included in the formulary of the hospital or 11 
medical services corporation. 12 
 3. A hospital or medical services corporation shall not: 13 
 (a) Subject the benefits required by paragraph (a) of 14 
subsection 1 to medical management techniques, other than step 15 
therapy;  16 
 (b) Limit the covered amount of a drug described in paragraph 17 
(a) of subsection 1; or 18 
 (c) Refuse to cover a drug described in paragraph (a) of 19 
subsection 1 because the drug is dispensed by a pharmacy through 20 
mail order service. 21 
 4. A hospital or medical services corporation shall ensure 22 
that the benefits required by subsection 1 are made available to an 23 
insured through a provider of health care who participates in the 24 
network plan of the hospital or medical services corporation.  25 
 5.  A policy of health insurance subject to the provisions of 26 
this chapter that is delivered, issued for delivery or renewed on or 27 
after January 1, 2024, has the legal effect of including the 28 
coverage required by subsection 1, and any provision of the policy 29 
that conflicts with the provisions of this section is void.  30 
 6. As used in this section:  31 
 (a) “Medical management technique” means a practice which 32 
is used to control the cost or use of health care services or 33 
prescription drugs. The term includes, without limitation, the use 34 
of step therapy, prior authorization and categorizing drugs and 35 
devices based on cost, type or method of administration. 36 
 (b) “Network plan” means a policy of health insurance offered 37 
by a hospital or medical services corporation under which the 38 
financing and delivery of medical care, including items and 39 
services paid for as medical care, are provided, in whole or in part, 40 
through a defined set of providers under contract with the hospital 41 
or medical services corporation. The term does not include an 42 
arrangement for the financing of premiums.  43   
 	– 47 – 
 
 
- *SB439_R2* 
 (c) “Primary care” means the practice of family medicine, 1 
pediatrics, internal medicine, obstetrics and gynecology and 2 
midwifery.  3 
 (d) “Provider of health care” has the meaning ascribed to it in 4 
NRS 629.031. 5 
 Sec. 60.  1. A hospital or medical services corporation that 6 
offers or issues a policy of health insurance shall include in the 7 
policy: 8 
 (a) Coverage of testing for and the treatment and prevention of 9 
sexually transmitted diseases, including, without limitation, 10 
Chlamydia trachomatis, gonorrhea, syphilis, human 11 
immunodeficiency virus and hepatitis B and C, for all insureds, 12 
regardless of age. Such coverage must include, without limitation, 13 
the coverage required by NRS 695B.1913 and 695B.1924. 14 
 (b) Unrestricted coverage of condoms for insureds who are 13 15 
years of age or older. 16 
 2. A policy of health insurance subject to the provisions of 17 
this chapter that is delivered, issued for delivery or renewed on or 18 
after January 1, 2024, has the legal effect of including the 19 
coverage required by subsection 1, and any provision of the policy 20 
that conflicts with the provisions of this section is void.  21 
 Sec. 61.  (Deleted by amendment.) 22 
 Sec. 62.  NRS 695B.1924 is hereby amended to read as 23 
follows: 24 
 695B.1924 1. A hospital or medical services corporation that 25 
offers or issues a policy of health insurance shall include in the 26 
policy coverage for: 27 
 (a) [Drugs] All drugs approved by the United States Food and 28 
Drug Administration for preventing the acquisition of human 29 
immunodeficiency virus [;] or treating human immunodeficiency 30 
virus or hepatitis C in the form recommended by the prescribing 31 
practitioner, regardless of whether the drug is included in the 32 
formulary of the hospital or medical services organization; 33 
 (b) Laboratory testing that is necessary for therapy using [such] 34 
a drug [;] to prevent the acquisition of human immunodeficiency 35 
virus;  36 
 (c) Any service to test for, prevent or treat human 37 
immunodeficiency virus or hepatitis C provided by a provider of 38 
primary care if the service is covered when provided by a specialist 39 
and: 40 
  (1) The service is within the scope of practice of the 41 
provider of primary care; or  42 
  (2) The provider of primary care is capable of providing the 43 
service safely and effectively in consultation with a specialist and 44 
the provider engages in such consultation; and 45   
 	– 48 – 
 
 
- *SB439_R2* 
 [(c)] (d) The services described in NRS 639.28085, when 1 
provided by a pharmacist who participates in the network plan of the 2 
hospital or medical services corporation. 3 
 2. A hospital or medical services corporation that offers or 4 
issues a policy of health insurance shall reimburse [a] : 5 
 (a) A pharmacist who participates in the network plan of the 6 
hospital or medical services corporation for the services described in 7 
NRS 639.28085 at a rate equal to the rate of reimbursement 8 
provided to a physician, physician assistant or advanced practice 9 
registered nurse for similar services. 10 
 (b) An advanced practice registered nurse or a physician 11 
assistant who participates in the network plan of the hospital or 12 
medical services corporation for any service to test for, prevent or 13 
treat human immunodeficiency virus or hepatitis C at a rate equal 14 
to the rate of reimbursement provided to a physician for similar 15 
services. 16 
 3. A hospital or medical services corporation [may subject] 17 
shall not: 18 
 (a) Subject the benefits required by subsection 1 to [reasonable] 19 
medical management techniques [.] , other than step therapy;  20 
 (b) Limit the covered amount of a drug described in paragraph 21 
(a) of subsection 1; 22 
 (c) Refuse to cover a drug described in paragraph (a) of 23 
subsection 1 because the drug is dispensed by a pharmacy through 24 
mail order service; or 25 
 (d) Prohibit or restrict access to any service or drug to treat 26 
human immunodeficiency virus or hepatitis C on the same day on 27 
which the insured is diagnosed. 28 
 4. A hospital or medical services corporation shall ensure that 29 
the benefits required by subsection 1 are made available to an 30 
insured through a provider of health care who participates in the 31 
network plan of the hospital or medical services corporation. 32 
 5. A policy of health insurance subject to the provisions of this 33 
chapter that is delivered, issued for delivery or renewed on or after 34 
[October] January 1, [2021,] 2024, has the legal effect of including 35 
the coverage required by subsection 1, and any provision of the 36 
policy that conflicts with the provisions of this section is void. 37 
 6. As used in this section: 38 
 (a) “Medical management technique” means a practice which is 39 
used to control the cost or use of health care services or prescription 40 
drugs. The term includes, without limitation, the use of step therapy, 41 
prior authorization and categorizing drugs and devices based on 42 
cost, type or method of administration. 43 
 (b) “Network plan” means a policy of health insurance offered 44 
by a hospital or medical services corporation under which the 45   
 	– 49 – 
 
 
- *SB439_R2* 
financing and delivery of medical care, including items and services 1 
paid for as medical care, are provided, in whole or in part, through a 2 
defined set of providers under contract with the hospital or medical 3 
services corporation. The term does not include an arrangement for 4 
the financing of premiums. 5 
 (c) “Primary care” means the practice of family medicine, 6 
pediatrics, internal medicine, obstetrics and gynecology and 7 
midwifery.  8 
 (d) “Provider of health care” has the meaning ascribed to it in 9 
NRS 629.031. 10 
 Sec. 63.  Chapter 695C of NRS is hereby amended by adding 11 
thereto the provisions set forth as sections 64, 65 and 66 of this act. 12 
 Sec. 64.  1. A health maintenance organization that offers 13 
or issues a health care plan shall include in the plan coverage for: 14 
 (a) All drugs approved by the United States Food and Drug 15 
Administration to: 16 
  (1) Provide medication-assisted treatment for opioid use 17 
disorder, including, without limitation, buprenorphine, methadone 18 
and naltrexone. 19 
  (2) Support safe withdrawal from substance use disorder, 20 
including, without limitation, lofexidine. 21 
 (b) Any service for the treatment of substance use disorder 22 
provided by a provider of primary care if the service is covered 23 
when provided by a specialist and: 24 
  (1) The service is within the scope of practice of the 25 
provider of primary care; or  26 
  (2) The provider of primary care is capable of providing the 27 
service safely and effectively in consultation with a specialist and 28 
the provider engages in such consultation. 29 
 2. A health maintenance organization shall provide the 30 
coverage required by paragraph (a) of subsection 1 regardless of 31 
whether the drug is included in the formulary of the health 32 
maintenance organization. 33 
 3. A health maintenance organization shall not: 34 
 (a) Subject the benefits required by paragraph (a) of 35 
subsection 1 to medical management techniques, other than step 36 
therapy;  37 
 (b) Limit the covered amount of a drug described in paragraph 38 
(a) of subsection 1; or 39 
 (c) Refuse to cover a drug described in paragraph (a) of 40 
subsection 1 because the drug is dispensed by a pharmacy through 41 
mail order service. 42 
 4. A health maintenance organization shall ensure that the 43 
benefits required by subsection 1 are made available to an enrollee 44   
 	– 50 – 
 
 
- *SB439_R2* 
through a provider of health care who participates in the network 1 
plan of the health maintenance organization.  2 
 5.  A health care plan subject to the provisions of this chapter 3 
that is delivered, issued for delivery or renewed on or after 4 
January 1, 2024, has the legal effect of including the coverage 5 
required by subsection 1, and any provision of the plan that 6 
conflicts with the provisions of this section is void.  7 
 6. As used in this section:  8 
 (a) “Medical management technique” means a practice which 9 
is used to control the cost or use of health care services or 10 
prescription drugs. The term includes, without limitation, the use 11 
of step therapy, prior authorization and categorizing drugs and 12 
devices based on cost, type or method of administration. 13 
 (b) “Network plan” means a health care plan offered by a 14 
health maintenance organization under which the financing and 15 
delivery of medical care, including items and services paid for as 16 
medical care, are provided, in whole or in part, through a defined 17 
set of providers under contract with the health maintenance 18 
organization. The term does not include an arrangement for the 19 
financing of premiums.  20 
 (c) “Primary care” means the practice of family medicine, 21 
pediatrics, internal medicine, obstetrics and gynecology and 22 
midwifery.  23 
 (d) “Provider of health care” has the meaning ascribed to it in 24 
NRS 629.031. 25 
 Sec. 65.  1. A health maintenance organization that offers 26 
or issues a health care plan shall include in the plan: 27 
 (a) Coverage of testing for and the treatment and prevention of 28 
sexually transmitted diseases, including, without limitation, 29 
Chlamydia trachomatis, gonorrhea, syphilis, human 30 
immunodeficiency virus and hepatitis B and C, for all enrollees, 31 
regardless of age. Such coverage must include, without limitation, 32 
the coverage required by NRS 695C.1737 and 695C.1743. 33 
 (b) Unrestricted coverage of condoms for enrollees who are 13 34 
years of age or older. 35 
 2. A health care plan subject to the provisions of this chapter 36 
that is delivered, issued for delivery or renewed on or after 37 
January 1, 2024, has the legal effect of including the coverage 38 
required by subsection 1, and any provision of the plan that 39 
conflicts with the provisions of this section is void.  40 
 Sec. 66.  (Deleted by amendment.) 41 
 Sec. 67.  NRS 695C.050 is hereby amended to read as follows: 42 
 695C.050 1.  Except as otherwise provided in this chapter or 43 
in specific provisions of this title, the provisions of this title are not 44 
applicable to any health maintenance organization granted a 45   
 	– 51 – 
 
 
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certificate of authority under this chapter. This provision does not 1 
apply to an insurer licensed and regulated pursuant to this title 2 
except with respect to its activities as a health maintenance 3 
organization authorized and regulated pursuant to this chapter. 4 
 2.  Solicitation of enrollees by a health maintenance 5 
organization granted a certificate of authority, or its representatives, 6 
must not be construed to violate any provision of law relating to 7 
solicitation or advertising by practitioners of a healing art. 8 
 3.  Any health maintenance organization authorized under this 9 
chapter shall not be deemed to be practicing medicine and is exempt 10 
from the provisions of chapter 630 of NRS. 11 
 4.  The provisions of NRS 695C.110, 695C.125, 695C.1691, 12 
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 13 
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 14 
695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 15 
inclusive, and 695C.265 do not apply to a health maintenance 16 
organization that provides health care services through managed 17 
care to recipients of Medicaid under the State Plan for Medicaid or 18 
insurance pursuant to the Children’s Health Insurance Program 19 
pursuant to a contract with the Division of Health Care Financing 20 
and Policy of the Department of Health and Human Services. This 21 
subsection does not exempt a health maintenance organization from 22 
any provision of this chapter for services provided pursuant to any 23 
other contract. 24 
 5.  The provisions of NRS 695C.1694 to 695C.1698, inclusive, 25 
695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17333, 26 
695C.17345, 695C.17347, 695C.1735, 695C.1737, 695C.1743, 27 
695C.1745 and 695C.1757 and sections 64 and 65 of this act apply 28 
to a health maintenance organization that provides health care 29 
services through managed care to recipients of Medicaid under the 30 
State Plan for Medicaid. 31 
 Sec. 68.  NRS 695C.1743 is hereby amended to read as 32 
follows: 33 
 695C.1743 1. A health maintenance organization that offers 34 
or issues a health care plan shall include in the plan coverage for:  35 
 (a) [Drugs] All drugs approved by the United States Food and 36 
Drug Administration for preventing the acquisition of human 37 
immunodeficiency virus [;] or treating human immunodeficiency 38 
virus or hepatitis C in the form recommended by the prescribing 39 
practitioner, regardless of whether the drug is included in the 40 
formulary of the health maintenance organization; 41 
 (b) Laboratory testing that is necessary for therapy that uses 42 
[such] a drug [;] to prevent the acquisition of human 43 
immunodeficiency virus;  44   
 	– 52 – 
 
 
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 (c) Any service to test for, prevent or treat human 1 
immunodeficiency virus or hepatitis C provided by a provider of 2 
primary care if the service is covered when provided by a specialist 3 
and: 4 
  (1) The service is within the scope of practice of the 5 
provider of primary care; or  6 
  (2) The provider of primary care is capable of providing the 7 
service safely and effectively in consultation with a specialist and 8 
the provider engages in such consultation; and  9 
 [(c)] (d) The services described in NRS 639.28085, when 10 
provided by a pharmacist who participates in the network plan of the 11 
health maintenance organization.  12 
 2. A health maintenance organization that offers or issues a 13 
health care plan shall reimburse [a] : 14 
 (a) A pharmacist who participates in the network plan of the 15 
health maintenance organization for the services described in NRS 16 
639.28085 at a rate equal to the rate of reimbursement provided to a 17 
physician, physician assistant or advanced practice registered nurse 18 
for similar services.  19 
 (b) An advanced practice registered nurse or a physician 20 
assistant who participates in the network plan of the health 21 
maintenance organization for any service to test for, prevent or 22 
treat human immunodeficiency virus or hepatitis C at a rate equal 23 
to the rate of reimbursement provided to a physician for similar 24 
services. 25 
 3. A health maintenance organization [may subject] shall not: 26 
 (a) Subject the benefits required by subsection 1 to [reasonable] 27 
medical management techniques [.] , other than step therapy;  28 
 (b) Limit the covered amount of a drug described in paragraph 29 
(a) of subsection 1; 30 
 (c) Refuse to cover a drug described in paragraph (a) of 31 
subsection 1 because the drug is dispensed by a pharmacy through 32 
mail order service; or 33 
 (d) Prohibit or restrict access to any service or drug to treat 34 
human immunodeficiency virus or hepatitis C on the same day on 35 
which the enrollee is diagnosed. 36 
 4. A health maintenance organization shall ensure that the 37 
benefits required by subsection 1 are made available to an enrollee 38 
through a provider of health care who participates in the network 39 
plan of the health maintenance organization.  40 
 5. A health care plan subject to the provisions of this chapter 41 
that is delivered, issued for delivery or renewed on or after 42 
[October] January 1, [2021,] 2024, has the legal effect of including 43 
the coverage required by subsection 1, and any provision of the plan 44 
that conflicts with the provisions of this section is void.  45   
 	– 53 – 
 
 
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 6. As used in this section:  1 
 (a) “Medical management technique” means a practice which is 2 
used to control the cost or use of health care services or prescription 3 
drugs. The term includes, without limitation, the use of step therapy, 4 
prior authorization and categorizing drugs and devices based on 5 
cost, type or method of administration. 6 
 (b) “Network plan” means a health care plan offered by a health 7 
maintenance organization under which the financing and delivery of 8 
medical care, including items and services paid for as medical care, 9 
are provided, in whole or in part, through a defined set of providers 10 
under contract with the health maintenance organization. The term 11 
does not include an arrangement for the financing of premiums.  12 
 (c) “Primary care” means the practice of family medicine, 13 
pediatrics, internal medicine, obstetrics and gynecology and 14 
midwifery. 15 
 (d) “Provider of health care” has the meaning ascribed to it in 16 
NRS 629.031. 17 
 Sec. 69.  NRS 695C.330 is hereby amended to read as follows: 18 
 695C.330 1.  The Commissioner may suspend or revoke any 19 
certificate of authority issued to a health maintenance organization 20 
pursuant to the provisions of this chapter if the Commissioner finds 21 
that any of the following conditions exist: 22 
 (a) The health maintenance organization is operating 23 
significantly in contravention of its basic organizational document, 24 
its health care plan or in a manner contrary to that described in and 25 
reasonably inferred from any other information submitted pursuant 26 
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 27 
to those submissions have been filed with and approved by the 28 
Commissioner; 29 
 (b) The health maintenance organization issues evidence of 30 
coverage or uses a schedule of charges for health care services 31 
which do not comply with the requirements of NRS 695C.1691 to 32 
695C.200, inclusive, and sections 64 and 65 of this act or 33 
695C.207; 34 
 (c) The health care plan does not furnish comprehensive health 35 
care services as provided for in NRS 695C.060; 36 
 (d) The Commissioner certifies that the health maintenance 37 
organization: 38 
  (1) Does not meet the requirements of subsection 1 of NRS 39 
695C.080; or 40 
  (2) Is unable to fulfill its obligations to furnish health care 41 
services as required under its health care plan; 42 
 (e) The health maintenance organization is no longer financially 43 
responsible and may reasonably be expected to be unable to meet its 44 
obligations to enrollees or prospective enrollees; 45   
 	– 54 – 
 
 
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 (f) The health maintenance organization has failed to put into 1 
effect a mechanism affording the enrollees an opportunity to 2 
participate in matters relating to the content of programs pursuant to 3 
NRS 695C.110; 4 
 (g) The health maintenance organization has failed to put into 5 
effect the system required by NRS 695C.260 for: 6 
  (1) Resolving complaints in a manner reasonably to dispose 7 
of valid complaints; and 8 
  (2) Conducting external reviews of adverse determinations 9 
that comply with the provisions of NRS 695G.241 to 695G.310, 10 
inclusive; 11 
 (h) The health maintenance organization or any person on its 12 
behalf has advertised or merchandised its services in an untrue, 13 
misrepresentative, misleading, deceptive or unfair manner; 14 
 (i) The continued operation of the health maintenance 15 
organization would be hazardous to its enrollees or creditors or to 16 
the general public; 17 
 (j) The health maintenance organization fails to provide the 18 
coverage required by NRS 695C.1691; or 19 
 (k) The health maintenance organization has otherwise failed to 20 
comply substantially with the provisions of this chapter. 21 
 2.  A certificate of authority must be suspended or revoked only 22 
after compliance with the requirements of NRS 695C.340. 23 
 3.  If the certificate of authority of a health maintenance 24 
organization is suspended, the health maintenance organization shall 25 
not, during the period of that suspension, enroll any additional 26 
groups or new individual contracts, unless those groups or persons 27 
were contracted for before the date of suspension. 28 
 4.  If the certificate of authority of a health maintenance 29 
organization is revoked, the organization shall proceed, immediately 30 
following the effective date of the order of revocation, to wind up its 31 
affairs and shall conduct no further business except as may be 32 
essential to the orderly conclusion of the affairs of the organization. 33 
It shall engage in no further advertising or solicitation of any kind. 34 
The Commissioner may, by written order, permit such further 35 
operation of the organization as the Commissioner may find to be in 36 
the best interest of enrollees to the end that enrollees are afforded 37 
the greatest practical opportunity to obtain continuing coverage for 38 
health care. 39 
 Sec. 70.  Chapter 695G of NRS is hereby amended by adding 40 
thereto the provisions set forth as sections 71, 72 and 73 of this act. 41 
 Sec. 71.  1. A managed care organization that offers or 42 
issues a health care plan shall include in the plan coverage for: 43 
 (a) All drugs approved by the United States Food and Drug 44 
Administration to: 45   
 	– 55 – 
 
 
- *SB439_R2* 
  (1) Provide medication-assisted treatment for opioid use 1 
disorder, including, without limitation, buprenorphine, methadone 2 
and naltrexone. 3 
  (2) Support safe withdrawal from substance use disorder, 4 
including, without limitation, lofexidine. 5 
 (b) Any service for the treatment of substance use disorder 6 
provided by a provider of primary care if the service is covered 7 
when provided by a specialist and: 8 
  (1) The service is within the scope of practice of the 9 
provider of primary care; or  10 
  (2) The provider of primary care is capable of providing the 11 
service safely and effectively in consultation with a specialist and 12 
the provider engages in such consultation. 13 
 2. A managed care organization shall provide the coverage 14 
required by paragraph (a) of subsection 1 regardless of whether 15 
the drug is included in the formulary of the managed care 16 
organization. 17 
 3. A managed care organization shall not: 18 
 (a) Subject the benefits required by paragraph (a) of 19 
subsection 1 to medical management techniques, other than step 20 
therapy;  21 
 (b) Limit the covered amount of a drug described in paragraph 22 
(a) of subsection 1; or 23 
 (c) Refuse to cover a drug described in paragraph (a) of 24 
subsection 1 because the drug is dispensed by a pharmacy through 25 
mail order service. 26 
 4. A managed care organization shall ensure that the benefits 27 
required by subsection 1 are made available to an insured through 28 
a provider of health care who participates in the network plan of 29 
the managed care organization. 30 
 5.  A health care plan subject to the provisions of this chapter 31 
that is delivered, issued for delivery or renewed on or after 32 
January 1, 2024, has the legal effect of including the coverage 33 
required by subsection 1, and any provision of the plan that 34 
conflicts with the provisions of this section is void.  35 
 6. As used in this section:  36 
 (a) “Medical management technique” means a practice which 37 
is used to control the cost or use of health care services or 38 
prescription drugs. The term includes, without limitation, the use 39 
of step therapy, prior authorization and categorizing drugs and 40 
devices based on cost, type or method of administration. 41 
 (b) “Network plan” means a health care plan offered by a 42 
managed care organization under which the financing and 43 
delivery of medical care, including items and services paid for as 44 
medical care, are provided, in whole or in part, through a defined 45   
 	– 56 – 
 
 
- *SB439_R2* 
set of providers under contract with the managed care 1 
organization. The term does not include an arrangement for the 2 
financing of premiums.  3 
 (c) “Primary care” means the practice of family medicine, 4 
pediatrics, internal medicine, obstetrics and gynecology and 5 
midwifery.  6 
 (d) “Provider of health care” has the meaning ascribed to it in 7 
NRS 629.031. 8 
 Sec. 72.  1. A managed care organization that offers or 9 
issues a health care plan shall include in the plan: 10 
 (a) Coverage of testing for, treatment of and prevention of 11 
sexually transmitted diseases, including, without limitation, 12 
Chlamydia trachomatis, gonorrhea, syphilis, human 13 
immunodeficiency virus and hepatitis B and C, for all insureds, 14 
regardless of age. Such coverage must include, without limitation, 15 
the coverage required by NRS 695G.1705 and 695G.1714. 16 
 (b) Unrestricted coverage of condoms for insureds who are 13 17 
years of age or older. 18 
 2. A health care plan subject to the provisions of this chapter 19 
that is delivered, issued for delivery or renewed on or after 20 
January 1, 2024, has the legal effect of including the coverage 21 
required by subsection 1, and any provision of the plan that 22 
conflicts with the provisions of this section is void.  23 
 Sec. 73.  (Deleted by amendment.) 24 
 Sec. 74.  NRS 695G.1705 is hereby amended to read as 25 
follows: 26 
 695G.1705 1. A managed care organization that offers or 27 
issues a health care plan shall include in the plan coverage for:  28 
 (a) [Drugs] All drugs approved by the United States Food and 29 
Drug Administration for preventing the acquisition of human 30 
immunodeficiency virus [;] or treating human immunodeficiency 31 
virus or hepatitis C in the form recommended by the prescribing 32 
practitioner, regardless of whether the drug is included in the 33 
formulary of the managed care organization; 34 
 (b) Laboratory testing that is necessary for therapy that uses 35 
[such] a drug [;] to prevent the acquisition of human 36 
immunodeficiency virus;  37 
 (c) Any service to test for, prevent or treat human 38 
immunodeficiency virus or hepatitis C provided by a provider of 39 
primary care if the service is covered when provided by a specialist 40 
and: 41 
  (1) The service is within the scope of practice of the 42 
provider of primary care; or  43   
 	– 57 – 
 
 
- *SB439_R2* 
  (2) The provider of primary care is capable of providing the 1 
service safely and effectively in consultation with a specialist and 2 
the provider engages in such consultation; and  3 
 [(c)] (d) The services described in NRS 639.28085, when 4 
provided by a pharmacist who participates in the network plan of the 5 
managed care organization.  6 
 2. A managed care organization that offers or issues a health 7 
care plan shall reimburse [a] : 8 
 (a) A pharmacist who participates in the network plan of the 9 
managed care organization for the services described in NRS 10 
639.28085 at a rate equal to the rate of reimbursement provided to a 11 
physician, physician assistant or advanced practice registered nurse 12 
for similar services.  13 
 (b) An advanced practice registered nurse or a physician 14 
assistant who participates in the network plan of the managed care 15 
organization for any service to test for, prevent or treat human 16 
immunodeficiency virus or hepatitis C at a rate equal to the rate of 17 
reimbursement provided to a physician for similar services. 18 
 3. A managed care organization [may subject] shall not: 19 
 (a) Subject the benefits required by subsection 1 to [reasonable] 20 
medical management techniques [.] , other than step therapy;  21 
 (b) Limit the covered amount of a drug described in paragraph 22 
(a) of subsection 1; 23 
 (c) Refuse to cover a drug described in paragraph (a) of 24 
subsection 1 because the drug is dispensed by a pharmacy through 25 
mail order service; or 26 
 (d) Prohibit or restrict access to any service or drug to treat 27 
human immunodeficiency virus or hepatitis C on the same day on 28 
which the insured is diagnosed. 29 
 4. A managed care organization shall ensure that the benefits 30 
required by subsection 1 are made available to an insured through a 31 
provider of health care who participates in the network plan of the 32 
managed care organization.  33 
 5. A health care plan subject to the provisions of this chapter 34 
that is delivered, issued for delivery or renewed on or after 35 
[October] January 1, [2021,] 2024, has the legal effect of including 36 
the coverage required by subsection 1, and any provision of the plan 37 
that conflicts with the provisions of this section is void.  38 
 6. As used in this section:  39 
 (a) “Medical management technique” means a practice which is 40 
used to control the cost or use of health care services or prescription 41 
drugs. The term includes, without limitation, the use of step therapy, 42 
prior authorization and categorizing drugs and devices based on 43 
cost, type or method of administration. 44   
 	– 58 – 
 
 
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 (b) “Network plan” means a health care plan offered by a 1 
managed care organization under which the financing and delivery 2 
of medical care, including items and services paid for as medical 3 
care, are provided, in whole or in part, through a defined set of 4 
providers under contract with the managed care organization. The 5 
term does not include an arrangement for the financing of 6 
premiums.  7 
 (c) “Primary care” means the practice of family medicine, 8 
pediatrics, internal medicine, obstetrics and gynecology and 9 
midwifery.  10 
 (d) “Provider of health care” has the meaning ascribed to it in 11 
NRS 629.031. 12 
 Sec. 75.  1. The first application that a physician, osteopathic 13 
physician or physician assistant licensed pursuant to chapter 630 or 14 
633 of NRS or a nurse who provides or supervises the provision of 15 
emergency medical services in a hospital or primary care and who is 16 
licensed on January 1, 2024, submits to renew his or her license on 17 
or after that date must include, without limitation, proof that the 18 
applicant has completed at least 2 hours of training in the stigma, 19 
discrimination and unrecognized bias toward persons who have 20 
acquired or are at a high risk of acquiring human immunodeficiency 21 
virus, as required by NRS 630.253, 632.343 and 633.471, as 22 
amended by sections 28, 29 and 30 of this act, respectively, as 23 
applicable. 24 
 2. As used in this section, “primary care” means the practice of 25 
family medicine, pediatrics, internal medicine, obstetrics and 26 
gynecology and midwifery.  27 
 Sec. 76.  The Legislature hereby finds and declares that:  28 
 1. In Lapinski v. State, 84 Nev. 611, 613 (1968), the Nevada 29 
Supreme Court held that “the power to define crimes and penalties 30 
lies exclusively in the legislature.”  31 
 2. The Nevada Supreme Court has further held in Tellis v. 32 
State, 84 Nev. 587, 591 (1968), Sparkman v. State, 95 Nev. 76, 82 33 
(1979) and State v. Dist. Ct. (Pullin), 124 Nev. 564, 567-68 (2008), 34 
that the penalty for a crime is determined by the law in effect at the 35 
time the offender committed the crime and not the law in effect at 36 
the time the offender is sentenced unless the Legislature has 37 
expressed its clear intent that a statute ameliorating the penalty 38 
apply retroactively.  39 
 3. NRS 441A.118 states that “[t]he Legislature hereby finds 40 
and declares that the spread of communicable diseases is best 41 
addressed through public health measures rather than 42 
criminalization.” 43   
 	– 59 – 
 
 
- *SB439_R2* 
 4. For those reasons, the Legislature is exercising its exclusive 1 
power to define the acts which subject a person to criminal penalties 2 
by: 3 
 (a) Retroactively applying the provisions of section 24 of 4 
chapter 491, Statutes of Nevada 2021, at page 3199, which repealed 5 
certain criminal offenses that were based on a person having the 6 
human immunodeficiency virus, to apply to conduct that occurred 7 
before those offenses were repealed; and 8 
 (b) Making certain offenses which were punishable as category 9 
A felonies before the effective date of section 13 of this act based on 10 
the potential to spread a communicable disease instead punishable 11 
as category B felonies, category D felonies or gross misdemeanors.  12 
 Sec. 77.  1. The provisions of section 24 of chapter 491, 13 
Statutes of Nevada 2021, at page 3199, apply to any violation of 14 
NRS 201.205 or 201.358, as those sections existed before the 15 
enactment of section 24 of chapter 491, Statutes of Nevada 2021, at 16 
page 3199, if the violation occurred before, on or after June 6, 2021, 17 
and the person was convicted on or after the effective date of this 18 
section. 19 
 2. If, before June 6, 2021, a person committed a violation of a 20 
NRS 201.205 or 201.358, as those sections existed before the 21 
enactment of section 24 of chapter 491, Statutes of Nevada 2021, at 22 
page 3199, and the person was not charged for that violation before 23 
the effective date of this section, the person must not be charged for 24 
that violation. 25 
 3.  Each court in this State shall cancel each outstanding bench 26 
warrant issued by the court for a person who failed to appear in 27 
court in relation to an alleged violation of NRS 201.205 or 201.358, 28 
as those sections existed before the enactment of section 24 of 29 
chapter 491, Statutes of Nevada 2021, at page 3199. 30 
 4.  The Central Repository for Nevada Records of Criminal 31 
History shall remove from each database or compilation of records 32 
of criminal history maintained by the Central Repository all records 33 
of bench warrants issued for a person who failed to appear in court 34 
in relation to an alleged violation of NRS 201.205 or 201.358, as 35 
those sections existed before the enactment of section 24 of chapter 36 
491, Statutes of Nevada 2021, at page 3199. 37 
 Sec. 78.  1. The provisions of NRS 212.189, as amended by 38 
section 13 of this act, apply to any violation of that section, that 39 
occurred before, on or after the effective date of that section, if the 40 
person was not convicted before the effective date of that section. 41 
 2. If a person commits a violation of a NRS 212.189 which is 42 
punishable as a category A felony before the effective date of 43 
section 13 of this act, and the violation is punishable as a category B 44 
felony, a category D felony or a gross misdemeanor pursuant to 45   
 	– 60 – 
 
 
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NRS 212.189, as amended by section 13 of this act, the person must 1 
not be charged with or convicted of a category A felony, if the 2 
violation occurs on or after the effective date of section 13 of this 3 
act, and may only be charged with and convicted of a category B 4 
felony, category D felony or gross misdemeanor, as applicable, on 5 
or after the effective date of section 13 of this act.  6 
 Sec. 79.  The provisions of NRS 354.599 do not apply to any 7 
additional expenses of a local government that are related to the 8 
provisions of this act. 9 
 Sec. 80.  1. This section and sections 3 to 10, inclusive, 13, 10 
76, 77 and 78 of this act become effective upon passage and 11 
approval. 12 
 2. Sections 1, 2, 11, 12, 14 to 75, inclusive, and 79 of this act 13 
become effective: 14 
 (a) Upon passage and approval for the purpose of adopting any 15 
regulations and performing any other preparatory administrative 16 
tasks that are necessary to carry out the provisions of this act; and 17 
 (b) On January 1, 2024, for all other purposes. 18 
 
H