EXEMPT
(Reprinted with amendments adopted on June 3, 2023)
THIRD REPRINT S.B. 439
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SENATE BILL NO. 439–SENATORS D. HARRIS,
SCHEIBLE AND DONATE
MARCH 27, 2023
____________
JOINT SPONSORS: ASSEMBLYWOMEN
GONZÁLEZ, PETERS AND TAYLOR
____________
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.
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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
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
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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
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
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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
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
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Sec. 7. (Deleted by amendment.) 1
Sec. 8. (Deleted by amendment.) 2
Sec. 9. (Deleted by amendment.) 3
Sec. 10. (Deleted by amendment.) 4
Sec. 11. Chapter 209 of NRS is hereby amended by adding 5
thereto a new section to read as follows: 6
1. The Department or the operator of a private facility or 7
institution shall not enter into a contract or other agreement with 8
any person or entity to provide medical services to offenders who 9
are diagnosed with human immunodeficiency virus unless the 10
person or entity demonstrates that at least 95 percent of the 11
patients who are diagnosed with human immunodeficiency virus 12
to whom the person or entity provides medical services: 13
(a) Are offered treatment on the same day as the diagnosis; 14
and 15
(b) Are able to begin such treatment not later than 7 days after 16
diagnosis. 17
2. Except as otherwise provided in subsection 3, an 18
institution, facility or private facility or institution shall take 19
reasonable measures to ensure the availability of: 20
(a) Any drug prescribed for treating the human 21
immunodeficiency virus in the form recommended by the 22
prescribing practitioner to each offender who has been diagnosed 23
with human immunodeficiency virus to the same extent and under 24
the same conditions as other medical care for offenders. 25
(b) Methods of preventing the acquisition of human 26
immunodeficiency virus, including, without limitation, drugs 27
approved by the United States Food and Drug Administration for 28
that purpose, to all offenders free of charge. 29
3. An institution, facility or private facility or institution: 30
(a) Is not required to make available a drug described in 31
subsection 2 for which a prescription is required to an offender for 32
whom such a prescription has not been issued. 33
(b) Shall take reasonable measures to make available to all 34
offenders a provider of health care who is authorized to issue a 35
prescription for a drug described in subsection 2. 36
(c) Shall not demand, request or suggest that a provider of 37
health care refrain from issuing a prescription for a drug 38
described in subsection 2 to an offender or take any other measure 39
to prevent a provider of health care from issuing such a 40
prescription. 41
4. As used in this section, “provider of health care” has the 42
meaning ascribed to it in NRS 629.031. 43
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Sec. 12. Chapter 211 of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. A sheriff, chief of police or town marshal who is 3
responsible for a county, city or town jail or detention facility shall 4
not enter into a contract or other agreement with any person or 5
entity to provide medical services to prisoners who are diagnosed 6
with human immunodeficiency virus unless the person or entity 7
demonstrates that at least 95 percent of the patients who are 8
diagnosed with human immunodeficiency virus to whom the 9
person or entity provides medical services: 10
(a) Are offered treatment on the same day as the diagnosis; 11
and 12
(b) Are able to begin such treatment not later than 7 days after 13
diagnosis. 14
2. Except as otherwise provided in subsection 3, a county, city 15
or town jail or detention facility shall take reasonable measures to 16
ensure the availability of: 17
(a) Any drug prescribed for treating the human 18
immunodeficiency virus in the form recommended by the 19
prescribing practitioner to each prisoner who has been diagnosed 20
with human immunodeficiency virus to the same extent and under 21
the same conditions as other medical care for prisoners. 22
(b) Methods of preventing the acquisition of human 23
immunodeficiency virus, including, without limitation, drugs 24
approved by the United States Food and Drug Administration for 25
that purpose, to all prisoners free of charge. 26
3. A county, city or town jail or detention facility: 27
(a) Is not required to make available a drug described in 28
subsection 2 for which a prescription is required to a prisoner for 29
whom such a prescription has not been issued. 30
(b) Shall take reasonable measures to make available to all 31
prisoners a provider of health care who is authorized to issue a 32
prescription for a drug described in subsection 2. 33
(c) Shall not demand, request or suggest that a provider of 34
health care refrain from issuing a prescription for a drug 35
described in subsection 2 to an offender or take any other measure 36
to prevent a provider of health care from issuing such a 37
prescription. 38
4. As used in this section, “provider of health care” has the 39
meaning ascribed to it in NRS 629.031. 40
Sec. 13. NRS 212.189 is hereby amended to read as follows: 41
212.189 1. Except as otherwise provided in subsection 10, a 42
prisoner who is under lawful arrest, in lawful custody or in lawful 43
confinement shall not knowingly: 44
(a) Store or stockpile any human excrement or bodily fluid; 45
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(b) Sell, supply or provide any human excrement or bodily fluid 1
to any other person; 2
(c) Buy, receive or acquire any human excrement or bodily fluid 3
from any other person; or 4
(d) Use, propel, discharge, spread or conceal, or cause to be 5
used, propelled, discharged, spread or concealed, any human 6
excrement or bodily fluid: 7
(1) With the intent to have the excrement or bodily fluid 8
come into physical contact with any portion of the body of another 9
person, including, without limitation, an officer or employee of a 10
prison or law enforcement agency, whether or not such physical 11
contact actually occurs; or 12
(2) Under circumstances in which the excrement or bodily 13
fluid is reasonably likely to come into physical contact with any 14
portion of the body of another person, including, without limitation, 15
an officer or employee of a prison or law enforcement agency, 16
whether or not such physical contact actually occurs. 17
2. Except as otherwise provided in subsection 4, if a prisoner 18
who is under lawful arrest or in lawful custody violates any 19
provision of subsection 1, the prisoner is guilty of: 20
(a) For a first offense, a gross misdemeanor. 21
(b) For a second offense or any subsequent offense, a category 22
D felony and shall be punished as provided in NRS 193.130. 23
3. Except as otherwise provided in subsection 4, if a prisoner 24
who is in lawful confinement, other than residential confinement, 25
violates any provision of subsection 1, the prisoner is guilty of a 26
category B felony and shall be punished by imprisonment in the 27
state prison for a minimum term of not less than 2 years and a 28
maximum term of not more than 10 years, and may be further 29
punished by a fine of not more than $10,000. 30
4. If a prisoner who is under lawful arrest, in lawful custody or 31
in lawful confinement violates any provision of paragraph (d) of 32
subsection 1 and, at the time of the offense, the prisoner knew that 33
any portion of the excrement or bodily fluid involved in the offense 34
contained a communicable disease that causes or is reasonably 35
likely to cause substantial bodily harm, [whether or not] the 36
communicable disease is likely to be transmitted as a result of the 37
offense and the communicable disease was actually transmitted to a 38
victim as a result of the offense, the prisoner is guilty of a category 39
A felony and shall be punished by imprisonment in the state prison: 40
(a) For life with the possibility of parole, with eligibility for 41
parole beginning when a minimum of 10 years has been served; or 42
(b) For a definite term of 25 years, with eligibility for parole 43
beginning when a minimum of 10 years has been served, 44
and may be further punished by a fine of not more than $50,000. 45
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5. A sentence imposed upon a prisoner pursuant to subsection 1
2, 3 or 4: 2
(a) Is not subject to suspension or the granting of probation; and 3
(b) Must run consecutively after the prisoner has served any 4
sentences imposed upon the prisoner for the offense or offenses for 5
which the prisoner was under lawful arrest, in lawful custody or in 6
lawful confinement when the prisoner violated the provisions of 7
subsection 1. 8
6. In addition to any other penalty, the court shall order a 9
prisoner who violates any provision of paragraph (d) of subsection 1 10
to reimburse the appropriate person or governmental body for the 11
cost of any examinations or testing: 12
(a) Conducted pursuant to paragraphs (a) and (b) of subsection 13
8; or 14
(b) Paid for pursuant to subparagraph (2) of paragraph (c) of 15
subsection 8. 16
7. The warden, sheriff, administrator or other person 17
responsible for administering a prison shall immediately and fully 18
investigate any act described in subsection 1 that is reported or 19
suspected to have been committed in the prison. 20
8. If there is probable cause to believe that an act described in 21
paragraph (d) of subsection 1 has been committed in a prison: 22
(a) Each prisoner believed to have committed the act or to have 23
been the bodily source of any portion of the excrement or bodily 24
fluid involved in the act shall submit to any appropriate 25
examinations and testing to determine whether each such prisoner 26
has any communicable disease. 27
(b) If possible, a sample of the excrement or bodily fluid 28
involved in the act must be recovered and tested to determine 29
whether any communicable disease is present in the excrement or 30
bodily fluid. 31
(c) If the excrement or bodily fluid involved in the act came into 32
physical contact with any portion of the body of an officer or 33
employee of a prison or law enforcement agency: 34
(1) The results of any examinations or testing conducted 35
pursuant to paragraphs (a) and (b) must be provided to each such 36
officer, employee or other person; and 37
(2) For each such officer or employee: 38
(I) Of a prison, the person or governmental body 39
operating the prison where the act was committed shall pay for any 40
appropriate examinations and testing requested by the officer or 41
employee to determine whether a communicable disease was 42
transmitted to the officer or employee as a result of the act; and 43
(II) Of any law enforcement agency, the law enforcement 44
agency that employs the officer or employee shall pay for any 45
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appropriate examinations and testing requested by the officer or 1
employee to determine whether a communicable disease was 2
transmitted to the officer or employee as a result of the act. 3
(d) The results of the investigation conducted pursuant to 4
subsection 7 and the results of any examinations or testing 5
conducted pursuant to paragraphs (a) and (b) must be submitted to 6
the district attorney of the county in which the act was committed or 7
to the Office of the Attorney General for possible prosecution of 8
each prisoner who committed the act. 9
9. If a prisoner is charged with committing an act described in 10
paragraph (d) of subsection 1 and a victim or an intended victim of 11
the act was an officer or employee of a prison or law enforcement 12
agency, the prosecuting attorney shall not dismiss the charge in 13
exchange for a plea of guilty, guilty but mentally ill or nolo 14
contendere to a lesser charge or for any other reason unless the 15
prosecuting attorney knows or it is obvious that the charge is not 16
supported by probable cause or cannot be proved at the time of trial. 17
10. The provisions of this section do not apply to a prisoner 18
who is in residential confinement or to a prisoner who commits an 19
act described in subsection 1 if the act: 20
(a) Is otherwise lawful and is authorized by the warden, sheriff, 21
administrator or other person responsible for administering the 22
prison, or his or her designee, and the prisoner performs the act in 23
accordance with the directions or instructions given to the prisoner 24
by that person; 25
(b) Involves the discharge of human excrement or bodily fluid 26
directly from the body of the prisoner and the discharge is the direct 27
result of a temporary or permanent injury, disease or medical 28
condition afflicting the prisoner that prevents the prisoner from 29
having physical control over the discharge of his or her own 30
excrement or bodily fluid; or 31
(c) Constitutes voluntary sexual conduct with another person in 32
violation of the provisions of NRS 212.187. 33
Sec. 14. NRS 232.320 is hereby amended to read as follows: 34
232.320 1. The Director: 35
(a) Shall appoint, with the consent of the Governor, 36
administrators of the divisions of the Department, who are 37
respectively designated as follows: 38
(1) The Administrator of the Aging and Disability Services 39
Division; 40
(2) The Administrator of the Division of Welfare and 41
Supportive Services; 42
(3) The Administrator of the Division of Child and Family 43
Services; 44
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(4) The Administrator of the Division of Health Care 1
Financing and Policy; and 2
(5) The Administrator of the Division of Public and 3
Behavioral Health. 4
(b) Shall administer, through the divisions of the Department, 5
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 6
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 7
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 8
section 20 of this act, 422.580, 432.010 to 432.133, inclusive, 9
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 10
and 445A.010 to 445A.055, inclusive, and all other provisions of 11
law relating to the functions of the divisions of the Department, but 12
is not responsible for the clinical activities of the Division of Public 13
and Behavioral Health or the professional line activities of the other 14
divisions. 15
(c) Shall administer any state program for persons with 16
developmental disabilities established pursuant to the 17
Developmental Disabilities Assistance and Bill of Rights Act of 18
2000, 42 U.S.C. §§ 15001 et seq. 19
(d) Shall, after considering advice from agencies of local 20
governments and nonprofit organizations which provide social 21
services, adopt a master plan for the provision of human services in 22
this State. The Director shall revise the plan biennially and deliver a 23
copy of the plan to the Governor and the Legislature at the 24
beginning of each regular session. The plan must: 25
(1) Identify and assess the plans and programs of the 26
Department for the provision of human services, and any 27
duplication of those services by federal, state and local agencies; 28
(2) Set forth priorities for the provision of those services; 29
(3) Provide for communication and the coordination of those 30
services among nonprofit organizations, agencies of local 31
government, the State and the Federal Government; 32
(4) Identify the sources of funding for services provided by 33
the Department and the allocation of that funding; 34
(5) Set forth sufficient information to assist the Department 35
in providing those services and in the planning and budgeting for the 36
future provision of those services; and 37
(6) Contain any other information necessary for the 38
Department to communicate effectively with the Federal 39
Government concerning demographic trends, formulas for the 40
distribution of federal money and any need for the modification of 41
programs administered by the Department. 42
(e) May, by regulation, require nonprofit organizations and state 43
and local governmental agencies to provide information regarding 44
the programs of those organizations and agencies, excluding 45
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detailed information relating to their budgets and payrolls, which the 1
Director deems necessary for the performance of the duties imposed 2
upon him or her pursuant to this section. 3
(f) Has such other powers and duties as are provided by law. 4
2. Notwithstanding any other provision of law, the Director, or 5
the Director’s designee, is responsible for appointing and removing 6
subordinate officers and employees of the Department. 7
Sec. 14.5. Chapter 287 of NRS is hereby amended by adding 8
thereto a new section to read as follows: 9
1. The governing body of any county, school district, 10
municipal corporation, political subdivision, public corporation or 11
other local governmental agency of the State of Nevada that 12
provides health insurance through a plan of self-insurance shall 13
provide coverage for: 14
(a) Drugs approved by the United States Food and Drug 15
Administration for preventing the acquisition of human 16
immunodeficiency virus; 17
(b) Laboratory testing that is necessary for therapy that uses 18
such a drug; and 19
(c) The services described in NRS 639.28085, when provided 20
by a pharmacist who participates in the network plan of the 21
governing body. 22
2. The governing body of any county, school district, 23
municipal corporation, political subdivision, public corporation or 24
other local governmental agency of the State of Nevada that 25
provides health insurance through a plan of self-insurance shall 26
reimburse a pharmacist who participates in the network plan of 27
the governing body for the services described in NRS 639.28085 at 28
a rate equal to the rate of reimbursement provided to a physician, 29
physician assistant or advanced practice registered nurse for 30
similar services. 31
3. The governing body of any county, school district, 32
municipal corporation, political subdivision, public corporation or 33
other local governmental agency of the State of Nevada that 34
provides health insurance through a plan of self-insurance may 35
subject the benefits required by subsection 1 to reasonable medical 36
management techniques. 37
4. The governing body of any county, school district, 38
municipal corporation, political subdivision, public corporation or 39
other local governmental agency of the State of Nevada that 40
provides health insurance through a plan of self-insurance shall 41
ensure that the benefits required by subsection 1 are made 42
available to an insured through a provider of health care who 43
participates in the network plan of the governing body. 44
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5. A plan of self-insurance described in subsection 1 that is 1
delivered, issued for delivery or renewed on or after January 1, 2
2024, has the legal effect of including the coverage required by 3
subsection 1, and any provision of the plan that conflicts with the 4
provisions of this section is void. 5
6. As used in this section: 6
(a) “Medical management technique” means a practice which 7
is used to control the cost or use of health care services or 8
prescription drugs. The term includes, without limitation, the use 9
of step therapy, prior authorization and categorizing drugs and 10
devices based on cost, type or method of administration. 11
(b) “Network plan” means a plan of self-insurance provided 12
by the governing body of a local governmental agency under 13
which the financing and delivery of medical care, including items 14
and services paid for as medical care, are provided, in whole or in 15
part, through a defined set of providers under contract with the 16
governing body. The term does not include an arrangement for the 17
financing of premiums. 18
(c) “Provider of health care” has the meaning ascribed to it in 19
NRS 629.031. 20
Sec. 15. NRS 287.010 is hereby amended to read as follows: 21
287.010 1. The governing body of any county, school 22
district, municipal corporation, political subdivision, public 23
corporation or other local governmental agency of the State of 24
Nevada may: 25
(a) Adopt and carry into effect a system of group life, accident 26
or health insurance, or any combination thereof, for the benefit of its 27
officers and employees, and the dependents of officers and 28
employees who elect to accept the insurance and who, where 29
necessary, have authorized the governing body to make deductions 30
from their compensation for the payment of premiums on the 31
insurance. 32
(b) Purchase group policies of life, accident or health insurance, 33
or any combination thereof, for the benefit of such officers and 34
employees, and the dependents of such officers and employees, as 35
have authorized the purchase, from insurance companies authorized 36
to transact the business of such insurance in the State of Nevada, 37
and, where necessary, deduct from the compensation of officers and 38
employees the premiums upon insurance and pay the deductions 39
upon the premiums. 40
(c) Provide group life, accident or health coverage through a 41
self-insurance reserve fund and, where necessary, deduct 42
contributions to the maintenance of the fund from the compensation 43
of officers and employees and pay the deductions into the fund. The 44
money accumulated for this purpose through deductions from the 45
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compensation of officers and employees and contributions of the 1
governing body must be maintained as an internal service fund as 2
defined by NRS 354.543. The money must be deposited in a state or 3
national bank or credit union authorized to transact business in the 4
State of Nevada. Any independent administrator of a fund created 5
under this section is subject to the licensing requirements of chapter 6
683A of NRS, and must be a resident of this State. Any contract 7
with an independent administrator must be approved by the 8
Commissioner of Insurance as to the reasonableness of 9
administrative charges in relation to contributions collected and 10
benefits provided. The provisions of NRS 686A.135, 687B.352, 11
687B.408, 687B.723, 687B.725, 689B.030 to 689B.031, inclusive, 12
689B.0313 to 689B.050, inclusive, 689B.265, 689B.287 and 13
689B.500 apply to coverage provided pursuant to this paragraph, 14
except that the provisions of NRS 689B.0378, 689B.03785 and 15
689B.500 only apply to coverage for active officers and employees 16
of the governing body, or the dependents of such officers and 17
employees. 18
(d) Defray part or all of the cost of maintenance of a self-19
insurance fund or of the premiums upon insurance. The money for 20
contributions must be budgeted for in accordance with the laws 21
governing the county, school district, municipal corporation, 22
political subdivision, public corporation or other local governmental 23
agency of the State of Nevada. 24
2. If a school district offers group insurance to its officers and 25
employees pursuant to this section, members of the board of trustees 26
of the school district must not be excluded from participating in the 27
group insurance. If the amount of the deductions from compensation 28
required to pay for the group insurance exceeds the compensation to 29
which a trustee is entitled, the difference must be paid by the trustee. 30
3. In any county in which a legal services organization exists, 31
the governing body of the county, or of any school district, 32
municipal corporation, political subdivision, public corporation or 33
other local governmental agency of the State of Nevada in the 34
county, may enter into a contract with the legal services 35
organization pursuant to which the officers and employees of the 36
legal services organization, and the dependents of those officers and 37
employees, are eligible for any life, accident or health insurance 38
provided pursuant to this section to the officers and employees, and 39
the dependents of the officers and employees, of the county, school 40
district, municipal corporation, political subdivision, public 41
corporation or other local governmental agency. 42
4. If a contract is entered into pursuant to subsection 3, the 43
officers and employees of the legal services organization: 44
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(a) Shall be deemed, solely for the purposes of this section, to be 1
officers and employees of the county, school district, municipal 2
corporation, political subdivision, public corporation or other local 3
governmental agency with which the legal services organization has 4
contracted; and 5
(b) Must be required by the contract to pay the premiums or 6
contributions for all insurance which they elect to accept or of which 7
they authorize the purchase. 8
5. A contract that is entered into pursuant to subsection 3: 9
(a) Must be submitted to the Commissioner of Insurance for 10
approval not less than 30 days before the date on which the contract 11
is to become effective. 12
(b) Does not become effective unless approved by the 13
Commissioner. 14
(c) Shall be deemed to be approved if not disapproved by the 15
Commissioner within 30 days after its submission. 16
6. As used in this section, “legal services organization” means 17
an organization that operates a program for legal aid and receives 18
money pursuant to NRS 19.031. 19
Sec. 15.5. NRS 287.040 is hereby amended to read as follows: 20
287.040 The provisions of NRS 287.010 to 287.040, inclusive, 21
and section 14.5 of this act do not make it compulsory upon any 22
governing body of any county, school district, municipal 23
corporation, political subdivision, public corporation or other local 24
governmental agency of the State of Nevada, except as otherwise 25
provided in NRS 287.021 or subsection 4 of NRS 287.023 or in an 26
agreement entered into pursuant to subsection 3 of NRS 287.015, to 27
pay any premiums, contributions or other costs for group insurance, 28
a plan of benefits or medical or hospital services established 29
pursuant to NRS 287.010, 287.015, 287.020 or paragraph (b), (c) or 30
(d) of subsection 1 of NRS 287.025, for coverage under the Public 31
Employees’ Benefits Program, or to make any contributions to a 32
trust fund established pursuant to NRS 287.017, or upon any officer 33
or employee of any county, school district, municipal corporation, 34
political subdivision, public corporation or other local governmental 35
agency of this State to accept any such coverage or to assign his or 36
her wages or salary in payment of premiums or contributions 37
therefor. 38
Sec. 16. NRS 287.04335 is hereby amended to read as 39
follows: 40
287.04335 If the Board provides health insurance through a 41
plan of self-insurance, it shall comply with the provisions of NRS 42
686A.135, 687B.352, 687B.409, 687B.723, 687B.725, 689B.0353, 43
689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 44
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 45
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695G.1675, 695G.170 to 695G.174, inclusive, and sections 71 and 1
72 of this act, 695G.176, 695G.177, 695G.200 to 695G.230, 2
inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the 3
same manner as an insurer that is licensed pursuant to title 57 of 4
NRS is required to comply with those provisions. 5
Sec. 17. (Deleted by amendment.) 6
Sec. 18. (Deleted by amendment.) 7
Sec. 19. Chapter 422 of NRS is hereby amended by adding 8
thereto the provisions set forth as sections 20 and 21 of this act. 9
Sec. 20. 1. The Director shall include in the State Plan for 10
Medicaid a requirement that the State pay the nonfederal share of 11
expenses for any service for the treatment of substance use 12
disorder provided by a provider of primary care if the service is 13
included in the State Plan when provided by a specialist and: 14
(a) The service is within the scope of practice of the provider of 15
primary care; or 16
(b) 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. As used in this section, “primary care” means the practice 20
of family medicine, pediatrics, internal medicine, obstetrics and 21
gynecology and midwifery. 22
Sec. 21. (Deleted by amendment.) 23
Sec. 22. NRS 422.27173 is hereby amended to read as 24
follows: 25
422.27173 The Director shall include in the State Plan for 26
Medicaid a requirement that the State must pay the nonfederal share 27
of expenditures incurred for : 28
1. Testing for and the treatment and prevention of sexually 29
transmitted diseases, including, without limitation, Chlamydia 30
trachomatis, gonorrhea, syphilis, human immunodeficiency virus 31
and hepatitis B and C, for all recipients of Medicaid, regardless of 32
age. Services covered pursuant to this section must include, 33
without limitation, the examination of a pregnant woman for the 34
discovery of: 35
[1.] (a) Chlamydia trachomatis, gonorrhea, hepatitis B and 36
hepatitis C in accordance with NRS 442.013. 37
[2.] (b) Syphilis in accordance with NRS 442.010. 38
2. Condoms for recipients of Medicaid. 39
Sec. 23. NRS 422.27235 is hereby amended to read as 40
follows: 41
422.27235 1. The Director shall include in the State Plan for 42
Medicaid a requirement that the State pay the nonfederal share of 43
expenditures incurred for: 44
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[1.] (a) Any laboratory testing that is necessary for therapy that 1
uses a drug approved by the United States Food and Drug 2
Administration for preventing the acquisition of human 3
immunodeficiency virus . [; and] 4
[2.] (b) The services of a pharmacist described in NRS 5
639.28085. The State must provide reimbursement for such services 6
at a rate equal to the rate of reimbursement provided to a physician, 7
physician assistant or advanced practice registered nurse for similar 8
services. 9
(c) Any service to test for, prevent or treat human 10
immunodeficiency virus or hepatitis C provided by a provider of 11
primary care if the service is covered when provided by a specialist 12
and: 13
(1) The service is within the scope of practice of the 14
provider of primary care; or 15
(2) The provider of primary care is capable of providing the 16
service safely and effectively in consultation with a specialist and 17
the provider engages in such consultation. 18
2. The Director shall include in the State Plan for Medicaid a 19
requirement that the State reimburse an advanced practice 20
registered nurse or a physician assistant for any service to test for, 21
prevent or treat human immunodeficiency virus or hepatitis C at a 22
rate equal to the rate of reimbursement provided to a physician for 23
similar services. 24
3. As used in this section, “primary care” means the practice 25
of family medicine, pediatrics, internal medicine, obstetrics and 26
gynecology and midwifery. 27
Sec. 24. (Deleted by amendment.) 28
Sec. 25. NRS 422.4025 is hereby amended to read as follows: 29
422.4025 1. The Department shall: 30
(a) By regulation, develop a list of preferred prescription drugs 31
to be used for the Medicaid program and the Children’s Health 32
Insurance Program, and each public or nonprofit health benefit plan 33
that elects to use the list of preferred prescription drugs as its 34
formulary pursuant to NRS 287.012, 287.0433 or 687B.407; and 35
(b) Negotiate and enter into agreements to purchase the drugs 36
included on the list of preferred prescription drugs on behalf of the 37
health benefit plans described in paragraph (a) or enter into a 38
contract pursuant to NRS 422.4053 with a pharmacy benefit 39
manager, health maintenance organization or one or more public or 40
private entities in this State, the District of Columbia or other states 41
or territories of the United States, as appropriate, to negotiate such 42
agreements. 43
2. The Department shall, by regulation, establish a list of 44
prescription drugs which must be excluded from any restrictions that 45
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- *SB439_R3*
are imposed by the Medicaid program on drugs that are on the list of 1
preferred prescription drugs established pursuant to subsection 1. 2
The list established pursuant to this subsection must include, 3
without limitation: 4
(a) Prescription drugs that are prescribed for the treatment of the 5
human immunodeficiency virus, including, without limitation, 6
antiretroviral medications; 7
(b) Antirejection medications for organ transplants; 8
(c) Antihemophilic medications; and 9
(d) Any prescription drug which the Board identifies as 10
appropriate for exclusion from any restrictions that are imposed by 11
the Medicaid program on drugs that are on the list of preferred 12
prescription drugs. 13
3. The regulations must provide that the Board makes the final 14
determination of: 15
(a) Whether a class of therapeutic prescription drugs is included 16
on the list of preferred prescription drugs and is excluded from any 17
restrictions that are imposed by the Medicaid program on drugs that 18
are on the list of preferred prescription drugs; 19
(b) Which therapeutically equivalent prescription drugs will be 20
reviewed for inclusion on the list of preferred prescription drugs and 21
for exclusion from any restrictions that are imposed by the Medicaid 22
program on drugs that are on the list of preferred prescription drugs; 23
and 24
(c) Which prescription drugs should be excluded from any 25
restrictions that are imposed by the Medicaid program on drugs that 26
are on the list of preferred prescription drugs based on continuity of 27
care concerning a specific diagnosis, condition, class of therapeutic 28
prescription drugs or medical specialty. 29
4. The list of preferred prescription drugs established pursuant 30
to subsection 1 must include, without limitation: 31
(a) Any prescription drug determined by the Board to be 32
essential for treating sickle cell disease and its variants; and 33
(b) Prescription drugs to prevent the acquisition of human 34
immunodeficiency virus. 35
5. The regulations must provide that each new pharmaceutical 36
product and each existing pharmaceutical product for which there is 37
new clinical evidence supporting its inclusion on the list of preferred 38
prescription drugs must be made available pursuant to the Medicaid 39
program with prior authorization until the Board reviews the product 40
or the evidence. 41
6. The Medicaid program must cover a prescription drug that 42
is not included on the list of preferred prescription drugs as if the 43
drug were included on that list if: 44
(a) The drug is: 45
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(1) Used to treat hepatitis C; 1
(2) Used to provide medication-assisted treatment for opioid 2
use disorder; 3
(3) Used to support safe withdrawal from substance use 4
disorder; or 5
(4) In the same class as a drug on the list of preferred 6
prescription drugs; and 7
(b) All preferred prescription drugs within the same class as 8
the drug are unsuitable for a recipient of Medicaid because: 9
(1) The recipient is allergic to all preferred prescription 10
drugs within the same class as the drug; 11
(2) All preferred prescription drugs within the same class as 12
the drug are contraindicated for the recipient or are likely to 13
interact in a harmful manner with another drug that the recipient 14
is taking; 15
(3) The recipient has a history of adverse reactions to all 16
preferred prescription drugs within the same class as the drug; or 17
(4) The drug has a unique indication that is supported by 18
peer-reviewed clinical evidence or approved by the United States 19
Food and Drug Administration. 20
7. On or before February 1 of each year, the Department shall: 21
(a) Compile a report concerning the agreements negotiated 22
pursuant to paragraph (b) of subsection 1 and contracts entered into 23
pursuant to NRS 422.4053 which must include, without limitation, 24
the financial effects of obtaining prescription drugs through those 25
agreements and contracts, in total and aggregated separately for 26
agreements negotiated by the Department, contracts with a 27
pharmacy benefit manager, contracts with a health maintenance 28
organization and contracts with public and private entities from this 29
State, the District of Columbia and other states and territories of the 30
United States; and 31
(b) Post the report on an Internet website maintained by the 32
Department and submit the report to the Director of the Legislative 33
Counsel Bureau for transmittal to: 34
(1) In odd-numbered years, the Legislature; or 35
(2) In even-numbered years, the Legislative Commission. 36
Sec. 26. NRS 608.156 is hereby amended to read as follows: 37
608.156 1. [If] In addition to any benefits required by NRS 38
608.1555, an employer provides health benefits for his or her 39
employees, the employer shall provide benefits for the expenses for 40
the treatment of alcohol and substance use disorders. The annual 41
benefits provided by the employer must [consist of:] include, 42
without limitation: 43
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(a) Treatment for withdrawal from the physiological effects of 1
alcohol or drugs, with a maximum benefit of $1,500 per calendar 2
year. 3
(b) Treatment for a patient admitted to a facility, with a 4
maximum benefit of $9,000 per calendar year. 5
(c) Counseling for a person, group or family who is not admitted 6
to a facility, with a maximum benefit of $2,500 per calendar year. 7
2. The maximum amount which may be paid in the lifetime of 8
the insured for any combination of the treatments listed in 9
subsection 1 is $39,000. 10
3. Except as otherwise provided in NRS 687B.409, these 11
benefits must be paid in the same manner as benefits for any other 12
illness covered by the employer are paid. 13
4. The employee is entitled to these benefits if treatment is 14
received in any: 15
(a) Program for the treatment of alcohol or substance use 16
disorders which is certified by the Division of Public and Behavioral 17
Health of the Department of Health and Human Services. 18
(b) Hospital or other medical facility or facility for the 19
dependent which is licensed by the Division of Public and 20
Behavioral Health of the Department of Health and Human 21
Services, is accredited by The Joint Commission or CARF 22
International and provides a program for the treatment of alcohol or 23
substance use disorders as part of its accredited activities. 24
Sec. 27. NRS 629.093 is hereby amended to read as follows: 25
629.093 Unless a specific statute or regulation requires or 26
authorizes a greater number of hours, a provider of health care may 27
use credit earned for continuing education relating to Alzheimer’s 28
disease or the stigma, discrimination and unrecognized bias 29
toward persons who have acquired or are at a high risk of 30
acquiring human immunodeficiency virus in place of not more 31
than 2 hours each year of the continuing education that the provider 32
of health care is required to complete, other than any continuing 33
education relating to ethics that the provider of health care is 34
required to complete. 35
Sec. 28. NRS 630.253 is hereby amended to read as follows: 36
630.253 1. The Board shall, as a prerequisite for the: 37
(a) Renewal of a license as a physician assistant; or 38
(b) Biennial registration of the holder of a license to practice 39
medicine, 40
require each holder to submit evidence of compliance with the 41
requirements for continuing education as set forth in regulations 42
adopted by the Board. 43
2. These requirements: 44
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(a) May provide for the completion of one or more courses of 1
instruction relating to risk management in the performance of 2
medical services. 3
(b) Must provide for the completion of a course of instruction, 4
within 2 years after initial licensure, relating to the medical 5
consequences of an act of terrorism that involves the use of a 6
weapon of mass destruction. The course must provide at least 4 7
hours of instruction that includes instruction in the following 8
subjects: 9
(1) An overview of acts of terrorism and weapons of mass 10
destruction; 11
(2) Personal protective equipment required for acts of 12
terrorism; 13
(3) Common symptoms and methods of treatment associated 14
with exposure to, or injuries caused by, chemical, biological, 15
radioactive and nuclear agents; 16
(4) Syndromic surveillance and reporting procedures for acts 17
of terrorism that involve biological agents; and 18
(5) An overview of the information available on, and the use 19
of, the Health Alert Network. 20
(c) Must provide for the completion by a holder of a license to 21
practice medicine of a course of instruction within 2 years after 22
initial licensure that provides at least 2 hours of instruction on 23
evidence-based suicide prevention and awareness as described in 24
subsection 6. 25
(d) Must provide for the completion of at least 2 hours of 26
training in the screening, brief intervention and referral to treatment 27
approach to substance use disorder within 2 years after initial 28
licensure. 29
(e) Must provide for the biennial completion by each 30
psychiatrist and each physician assistant practicing under the 31
supervision of a psychiatrist of one or more courses of instruction 32
that provide at least 2 hours of instruction relating to cultural 33
competency and diversity, equity and inclusion. Such instruction: 34
(1) May include the training provided pursuant to NRS 35
449.103, where applicable. 36
(2) Must be based upon a range of research from diverse 37
sources. 38
(3) Must address persons of different cultural backgrounds, 39
including, without limitation: 40
(I) Persons from various gender, racial and ethnic 41
backgrounds; 42
(II) Persons from various religious backgrounds; 43
(III) Lesbian, gay, bisexual, transgender and questioning 44
persons; 45
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(IV) Children and senior citizens; 1
(V) Veterans; 2
(VI) Persons with a mental illness; 3
(VII) Persons with an intellectual disability, 4
developmental disability or physical disability; and 5
(VIII) Persons who are part of any other population that a 6
psychiatrist or a physician assistant practicing under the supervision 7
of a psychiatrist may need to better understand, as determined by the 8
Board. 9
(f) Must allow the holder of a license to receive credit toward 10
the total amount of continuing education required by the Board for 11
the completion of a course of instruction relating to genetic 12
counseling and genetic testing. 13
(g) Must provide for the completion by a physician or 14
physician assistant who provides or supervises the provision of 15
emergency medical services in a hospital or primary care of at 16
least 2 hours of training in the stigma, discrimination and 17
unrecognized bias toward persons who have acquired or are at a 18
high risk of acquiring human immunodeficiency virus within 2 19
years after beginning to provide or supervise the provision of such 20
services or care. 21
3. The Board may determine whether to include in a program 22
of continuing education courses of instruction relating to the 23
medical consequences of an act of terrorism that involves the use of 24
a weapon of mass destruction in addition to the course of instruction 25
required by paragraph (b) of subsection 2. 26
4. The Board shall encourage each holder of a license who 27
treats or cares for persons who are more than 60 years of age to 28
receive, as a portion of their continuing education, education in 29
geriatrics and gerontology, including such topics as: 30
(a) The skills and knowledge that the licensee needs to address 31
aging issues; 32
(b) Approaches to providing health care to older persons, 33
including both didactic and clinical approaches; 34
(c) The biological, behavioral, social and emotional aspects of 35
the aging process; and 36
(d) The importance of maintenance of function and 37
independence for older persons. 38
5. The Board shall encourage each holder of a license to 39
practice medicine to receive, as a portion of his or her continuing 40
education, training concerning methods for educating patients about 41
how to effectively manage medications, including, without 42
limitation, the ability of the patient to request to have the symptom 43
or purpose for which a drug is prescribed included on the label 44
attached to the container of the drug. 45
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6. The Board shall require each holder of a license to practice 1
medicine to receive as a portion of his or her continuing education at 2
least 2 hours of instruction every 4 years on evidence-based suicide 3
prevention and awareness, which may include, without limitation, 4
instruction concerning: 5
(a) The skills and knowledge that the licensee needs to detect 6
behaviors that may lead to suicide, including, without limitation, 7
post-traumatic stress disorder; 8
(b) Approaches to engaging other professionals in suicide 9
intervention; and 10
(c) The detection of suicidal thoughts and ideations and the 11
prevention of suicide. 12
7. The Board shall encourage each holder of a license to 13
practice medicine or as a physician assistant to receive, as a portion 14
of his or her continuing education, training and education in the 15
diagnosis of rare diseases, including, without limitation: 16
(a) Recognizing the symptoms of pediatric cancer; and 17
(b) Interpreting family history to determine whether such 18
symptoms indicate a normal childhood illness or a condition that 19
requires additional examination. 20
8. A holder of a license to practice medicine may not substitute 21
the continuing education credits relating to suicide prevention and 22
awareness required by this section for the purposes of satisfying an 23
equivalent requirement for continuing education in ethics. 24
9. Except as otherwise provided in NRS 630.2535, a holder of 25
a license to practice medicine may substitute not more than 2 hours 26
of continuing education credits in pain management, care for 27
persons with an addictive disorder or the screening, brief 28
intervention and referral to treatment approach to substance use 29
disorder for the purposes of satisfying an equivalent requirement for 30
continuing education in ethics. 31
10. As used in this section: 32
(a) “Act of terrorism” has the meaning ascribed to it in 33
NRS 202.4415. 34
(b) “Biological agent” has the meaning ascribed to it in 35
NRS 202.442. 36
(c) “Chemical agent” has the meaning ascribed to it in 37
NRS 202.4425. 38
(d) “Primary care” means the practice of family medicine, 39
pediatrics, internal medicine, obstetrics and gynecology and 40
midwifery. 41
(e) “Radioactive agent” has the meaning ascribed to it in 42
NRS 202.4437. 43
[(e)] (f) “Weapon of mass destruction” has the meaning 44
ascribed to it in NRS 202.4445. 45
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Sec. 29. NRS 632.343 is hereby amended to read as follows: 1
632.343 1. The Board shall not renew any license issued 2
under this chapter until the licensee has submitted proof satisfactory 3
to the Board of completion, during the 2-year period before renewal 4
of the license, of 30 hours in a program of continuing education 5
approved by the Board in accordance with regulations adopted by 6
the Board. Except as otherwise provided in subsection 3, the 7
licensee is exempt from this provision for the first biennial period 8
after graduation from: 9
(a) An accredited school of professional nursing; 10
(b) An accredited school of practical nursing; 11
(c) An approved school of professional nursing in the process of 12
obtaining accreditation; or 13
(d) An approved school of practical nursing in the process of 14
obtaining accreditation. 15
2. The Board shall review all courses offered to nurses for the 16
completion of the requirement set forth in subsection 1. The Board 17
may approve nursing and other courses which are directly related to 18
the practice of nursing as well as others which bear a reasonable 19
relationship to current developments in the field of nursing or any 20
special area of practice in which a licensee engages. These may 21
include academic studies, workshops, extension studies, home study 22
and other courses. 23
3. The program of continuing education required by subsection 24
1 must include: 25
(a) For a person licensed as an advanced practice registered 26
nurse: 27
(1) A course of instruction to be completed within 2 years 28
after initial licensure that provides at least 2 hours of instruction on 29
suicide prevention and awareness as described in subsection 6. 30
(2) The ability to receive credit toward the total amount of 31
continuing education required by subsection 1 for the completion of 32
a course of instruction relating to genetic counseling and genetic 33
testing. 34
(b) For each person licensed pursuant to this chapter, a course of 35
instruction, to be completed within 2 years after initial licensure, 36
relating to the medical consequences of an act of terrorism that 37
involves the use of a weapon of mass destruction. The course must 38
provide at least 4 hours of instruction that includes instruction in the 39
following subjects: 40
(1) An overview of acts of terrorism and weapons of mass 41
destruction; 42
(2) Personal protective equipment required for acts of 43
terrorism; 44
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(3) Common symptoms and methods of treatment associated 1
with exposure to, or injuries caused by, chemical, biological, 2
radioactive and nuclear agents; 3
(4) Syndromic surveillance and reporting procedures for acts 4
of terrorism that involve biological agents; and 5
(5) An overview of the information available on, and the use 6
of, the Health Alert Network. 7
(c) For each person licensed pursuant to this chapter, one or 8
more courses of instruction that provide at least 2 hours of 9
instruction relating to cultural competency and diversity, equity and 10
inclusion to be completed biennially. Such instruction: 11
(1) May include the training provided pursuant to NRS 12
449.103, where applicable. 13
(2) Must be based upon a range of research from diverse 14
sources. 15
(3) Must address persons of different cultural backgrounds, 16
including, without limitation: 17
(I) Persons from various gender, racial and ethnic 18
backgrounds; 19
(II) Persons from various religious backgrounds; 20
(III) Lesbian, gay, bisexual, transgender and questioning 21
persons; 22
(IV) Children and senior citizens; 23
(V) Veterans; 24
(VI) Persons with a mental illness; 25
(VII) Persons with an intellectual disability, 26
developmental disability or physical disability; and 27
(VIII) Persons who are part of any other population that a 28
person licensed pursuant to this chapter may need to better 29
understand, as determined by the Board. 30
(d) For a person licensed as an advanced practice registered 31
nurse, at least 2 hours of training in the screening, brief intervention 32
and referral to treatment approach to substance use disorder to be 33
completed within 2 years after initial licensure. 34
(e) For each person licensed pursuant to this chapter who 35
provides or supervises the provision of emergency medical services 36
in a hospital or primary care, at least 2 hours of training in the 37
stigma, discrimination and unrecognized bias toward persons who 38
have acquired or are at a high risk of acquiring human 39
immunodeficiency virus to be completed within 2 years after 40
beginning to provide or supervise the provision of such services or 41
care. 42
4. The Board may determine whether to include in a program 43
of continuing education courses of instruction relating to the 44
medical consequences of an act of terrorism that involves the use of 45
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a weapon of mass destruction in addition to the course of instruction 1
required by paragraph (b) of subsection 3. 2
5. The Board shall encourage each licensee who treats or cares 3
for persons who are more than 60 years of age to receive, as a 4
portion of their continuing education, education in geriatrics and 5
gerontology, including such topics as: 6
(a) The skills and knowledge that the licensee needs to address 7
aging issues; 8
(b) Approaches to providing health care to older persons, 9
including both didactic and clinical approaches; 10
(c) The biological, behavioral, social and emotional aspects of 11
the aging process; and 12
(d) The importance of maintenance of function and 13
independence for older persons. 14
6. The Board shall require each person licensed as an advanced 15
practice registered nurse to receive as a portion of his or her 16
continuing education at least 2 hours of instruction every 4 years on 17
evidence-based suicide prevention and awareness or another course 18
of instruction on suicide prevention and awareness that is approved 19
by the Board which the Board has determined to be effective and 20
appropriate. 21
7. The Board shall encourage each person licensed as an 22
advanced practice registered nurse to receive, as a portion of his or 23
her continuing education, training and education in the diagnosis of 24
rare diseases, including, without limitation: 25
(a) Recognizing the symptoms of pediatric cancer; and 26
(b) Interpreting family history to determine whether such 27
symptoms indicate a normal childhood illness or a condition that 28
requires additional examination. 29
8. As used in this section: 30
(a) “Act of terrorism” has the meaning ascribed to it in 31
NRS 202.4415. 32
(b) “Biological agent” has the meaning ascribed to it in 33
NRS 202.442. 34
(c) “Chemical agent” has the meaning ascribed to it in 35
NRS 202.4425. 36
(d) “Primary care” means the practice of family medicine, 37
pediatrics, internal medicine, obstetrics and gynecology and 38
midwifery. 39
(e) “Radioactive agent” has the meaning ascribed to it in 40
NRS 202.4437. 41
[(e)] (f) “Weapon of mass destruction” has the meaning 42
ascribed to it in NRS 202.4445. 43
– 26 –
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Sec. 30. NRS 633.471 is hereby amended to read as follows: 1
633.471 1. Except as otherwise provided in subsection [14] 2
15 and NRS 633.491, every holder of a license, except a physician 3
assistant, issued under this chapter, except a temporary or a special 4
license, may renew the license on or before January 1 of each 5
calendar year after its issuance by: 6
(a) Applying for renewal on forms provided by the Board; 7
(b) Paying the annual license renewal fee specified in this 8
chapter; 9
(c) Submitting a list of all actions filed or claims submitted to 10
arbitration or mediation for malpractice or negligence against the 11
holder during the previous year; 12
(d) Subject to subsection [13,] 14, submitting evidence to the 13
Board that in the year preceding the application for renewal the 14
holder has attended courses or programs of continuing education 15
approved by the Board in accordance with regulations adopted by 16
the Board totaling a number of hours established by the Board 17
which must not be less than 35 hours nor more than that set in the 18
requirements for continuing medical education of the American 19
Osteopathic Association; and 20
(e) Submitting all information required to complete the renewal. 21
2. The Secretary of the Board shall notify each licensee of the 22
requirements for renewal not less than 30 days before the date of 23
renewal. 24
3. The Board shall request submission of verified evidence of 25
completion of the required number of hours of continuing medical 26
education annually from no fewer than one-third of the applicants 27
for renewal of a license to practice osteopathic medicine or a license 28
to practice as a physician assistant. Subject to subsection [13,] 14, 29
upon a request from the Board, an applicant for renewal of a license 30
to practice osteopathic medicine or a license to practice as a 31
physician assistant shall submit verified evidence satisfactory to the 32
Board that in the year preceding the application for renewal the 33
applicant attended courses or programs of continuing medical 34
education approved by the Board totaling the number of hours 35
established by the Board. 36
4. The Board shall require each holder of a license to practice 37
osteopathic medicine to complete a course of instruction within 2 38
years after initial licensure that provides at least 2 hours of 39
instruction on evidence-based suicide prevention and awareness as 40
described in subsection 9. 41
5. The Board shall encourage each holder of a license to 42
practice osteopathic medicine to receive, as a portion of his or her 43
continuing education, training concerning methods for educating 44
patients about how to effectively manage medications, including, 45
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- *SB439_R3*
without limitation, the ability of the patient to request to have the 1
symptom or purpose for which a drug is prescribed included on the 2
label attached to the container of the drug. 3
6. The Board shall encourage each holder of a license to 4
practice osteopathic medicine or as a physician assistant to receive, 5
as a portion of his or her continuing education, training and 6
education in the diagnosis of rare diseases, including, without 7
limitation: 8
(a) Recognizing the symptoms of pediatric cancer; and 9
(b) Interpreting family history to determine whether such 10
symptoms indicate a normal childhood illness or a condition that 11
requires additional examination. 12
7. The Board shall require, as part of the continuing education 13
requirements approved by the Board, the biennial completion by a 14
holder of a license to practice osteopathic medicine of at least 2 15
hours of continuing education credits in ethics, pain management, 16
care of persons with addictive disorders or the screening, brief 17
intervention and referral to treatment approach to substance use 18
disorder. 19
8. The continuing education requirements approved by the 20
Board must allow the holder of a license as an osteopathic physician 21
or physician assistant to receive credit toward the total amount of 22
continuing education required by the Board for the completion of a 23
course of instruction relating to genetic counseling and genetic 24
testing. 25
9. The Board shall require each holder of a license to practice 26
osteopathic medicine to receive as a portion of his or her continuing 27
education at least 2 hours of instruction every 4 years on evidence-28
based suicide prevention and awareness which may include, without 29
limitation, instruction concerning: 30
(a) The skills and knowledge that the licensee needs to detect 31
behaviors that may lead to suicide, including, without limitation, 32
post-traumatic stress disorder; 33
(b) Approaches to engaging other professionals in suicide 34
intervention; and 35
(c) The detection of suicidal thoughts and ideations and the 36
prevention of suicide. 37
10. A holder of a license to practice osteopathic medicine may 38
not substitute the continuing education credits relating to suicide 39
prevention and awareness required by this section for the purposes 40
of satisfying an equivalent requirement for continuing education in 41
ethics. 42
11. The Board shall require each holder of a license to practice 43
osteopathic medicine to complete at least 2 hours of training in the 44
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screening, brief intervention and referral to treatment approach to 1
substance use disorder within 2 years after initial licensure. 2
12. The Board shall require each psychiatrist or a physician 3
assistant practicing under the supervision of a psychiatrist to 4
biennially complete one or more courses of instruction that provide 5
at least 2 hours of instruction relating to cultural competency and 6
diversity, equity and inclusion. Such instruction: 7
(a) May include the training provided pursuant to NRS 449.103, 8
where applicable. 9
(b) Must be based upon a range of research from diverse 10
sources. 11
(c) Must address persons of different cultural backgrounds, 12
including, without limitation: 13
(1) Persons from various gender, racial and ethnic 14
backgrounds; 15
(2) Persons from various religious backgrounds; 16
(3) Lesbian, gay, bisexual, transgender and questioning 17
persons; 18
(4) Children and senior citizens; 19
(5) Veterans; 20
(6) Persons with a mental illness; 21
(7) Persons with an intellectual disability, developmental 22
disability or physical disability; and 23
(8) Persons who are part of any other population that a 24
psychiatrist or physician assistant practicing under the supervision 25
of a psychiatrist may need to better understand, as determined by the 26
Board. 27
13. The Board shall require each holder of a license to 28
practice osteopathic medicine or as a physician assistant who 29
provides or supervises the provision of emergency medical services 30
in a hospital or primary care to complete at least 2 hours of 31
training in the stigma, discrimination and unrecognized bias 32
toward persons who have acquired or are at a high risk of 33
acquiring human immunodeficiency virus within 2 years after 34
beginning to provide or supervise the provision of such services or 35
care. 36
14. The Board shall not require a physician assistant to receive 37
or maintain certification by the National Commission on 38
Certification of Physician Assistants, or its successor organization, 39
or by any other nationally recognized organization for the 40
accreditation of physician assistants to satisfy any continuing 41
education requirement pursuant to paragraph (d) of subsection 1 and 42
subsection 3. 43
[14.] 15. Members of the Armed Forces of the United States 44
and the United States Public Health Service are exempt from 45
– 29 –
- *SB439_R3*
payment of the annual license renewal fee during their active duty 1
status. 2
16. As used in this section, “primary care” means the practice 3
of family medicine, pediatrics, internal medicine, obstetrics and 4
gynecology and midwifery. 5
Sec. 31. NRS 687B.225 is hereby amended to read as follows: 6
687B.225 1. Except as otherwise provided in NRS 7
689A.0405, 689A.0412, 689A.0413, 689A.0437, 689A.044, 8
689A.0445, 689B.031, 689B.0312, 689B.0313, 689B.0315, 9
689B.0317, 689B.0374, 689C.1671, 689C.1675, 695A.1843, 10
695A.1856, 695B.1912, 695B.1913, 695B.1914, 695B.1924, 11
695B.1925, 695B.1942, 695C.1713, 695C.1735, 695C.1737, 12
695C.1743, 695C.1745, 695C.1751, 695G.170, 695G.1705, 13
695G.171, 695G.1714 and 695G.177, and sections 33, 41, 46, 54, 14
59, 64 and 71 of this act, any contract for group, blanket or 15
individual health insurance or any contract by a nonprofit hospital, 16
medical or dental service corporation or organization for dental care 17
which provides for payment of a certain part of medical or dental 18
care may require the insured or member to obtain prior authorization 19
for that care from the insurer or organization. The insurer or 20
organization shall: 21
(a) File its procedure for obtaining approval of care pursuant to 22
this section for approval by the Commissioner; and 23
(b) Respond to any request for approval by the insured or 24
member pursuant to this section within 20 days after it receives the 25
request. 26
2. The procedure for prior authorization may not discriminate 27
among persons licensed to provide the covered care. 28
Sec. 32. Chapter 689A of NRS is hereby amended by adding 29
thereto the provisions set forth as sections 33, 34 and 35 of this act. 30
Sec. 33. 1. An insurer that offers or issues a policy of 31
health insurance shall include in the policy coverage for: 32
(a) All drugs approved by the United States Food and Drug 33
Administration to: 34
(1) Provide medication-assisted treatment for opioid use 35
disorder, including, without limitation, buprenorphine, methadone 36
and naltrexone. 37
(2) Support safe withdrawal from substance use disorder, 38
including, without limitation, lofexidine. 39
(b) Any service for the treatment of substance use disorder 40
provided by a provider of primary care if the service is covered 41
when provided by a specialist and: 42
(1) The service is within the scope of practice of the 43
provider of primary care; or 44
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- *SB439_R3*
(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. 3
2. An insurer shall provide the coverage required by 4
paragraph (a) of subsection 1 regardless of whether the drug is 5
included in the formulary of the insurer. 6
3. An insurer shall not: 7
(a) Subject the benefits required by paragraph (a) of 8
subsection 1 to medical management techniques, other than step 9
therapy; 10
(b) Limit the covered amount of a drug described in paragraph 11
(a) of subsection 1; or 12
(c) Refuse to cover a drug described in paragraph (a) of 13
subsection 1 because the drug is dispensed by a pharmacy through 14
mail order service. 15
4. An insurer shall ensure that the benefits required by 16
subsection 1 are made available to an insured through a provider 17
of health care who participates in the network plan of the insurer. 18
5. A policy of health insurance subject to the provisions of 19
this chapter that is delivered, issued for delivery or renewed on or 20
after January 1, 2024, has the legal effect of including the 21
coverage required by subsection 1, and any provision of the policy 22
that conflicts with the provisions of this section is void. 23
6. As used in this section: 24
(a) “Medical management technique” means a practice which 25
is used to control the cost or use of health care services or 26
prescription drugs. The term includes, without limitation, the use 27
of step therapy, prior authorization and categorizing drugs and 28
devices based on cost, type or method of administration. 29
(b) “Network plan” means a policy of health insurance offered 30
by an insurer under which the financing and delivery of medical 31
care, including items and services paid for as medical care, are 32
provided, in whole or in part, through a defined set of providers 33
under contract with the insurer. The term does not include an 34
arrangement for the financing of premiums. 35
(c) “Primary care” means the practice of family medicine, 36
pediatrics, internal medicine, obstetrics and gynecology and 37
midwifery. 38
(d) “Provider of health care” has the meaning ascribed to it in 39
NRS 629.031. 40
Sec. 34. 1. An insurer that offers or issues a policy of 41
health insurance shall include in the policy: 42
(a) Coverage of testing for and the treatment and prevention of 43
sexually transmitted diseases, including, without limitation, 44
Chlamydia trachomatis, gonorrhea, syphilis, human 45
– 31 –
- *SB439_R3*
immunodeficiency virus and hepatitis B and C, for all insureds, 1
regardless of age. Such coverage must include, without limitation, 2
the coverage required by NRS 689A.0412 and 689A.0437. 3
(b) Unrestricted coverage of condoms for insureds who are 13 4
years of age or older. 5
2. A policy of health insurance subject to the provisions of 6
this chapter that is delivered, issued for delivery or renewed on or 7
after January 1, 2024, has the legal effect of including the 8
coverage required by subsection 1, and any provision of the policy 9
that conflicts with the provisions of this section is void. 10
Sec. 35. (Deleted by amendment.) 11
Sec. 36. NRS 689A.030 is hereby amended to read as follows: 12
689A.030 A policy of health insurance must not be delivered 13
or issued for delivery to any person in this State unless it otherwise 14
complies with this Code, and complies with the following: 15
1. The entire money and other considerations for the policy 16
must be expressed therein. 17
2. The time when the insurance takes effect and terminates 18
must be expressed therein. 19
3. It must purport to insure only one person, except that a 20
policy may insure, originally or by subsequent amendment, upon the 21
application of an adult member of a family, who shall be deemed the 22
policyholder, any two or more eligible members of that family, 23
including the husband, wife, domestic partner as defined in NRS 24
122A.030, dependent children, from the time of birth, adoption or 25
placement for the purpose of adoption as provided in NRS 26
689A.043, or any child on or before the last day of the month in 27
which the child attains 26 years of age, and any other person 28
dependent upon the policyholder. 29
4. The style, arrangement and overall appearance of the policy 30
must not give undue prominence to any portion of the text, and 31
every printed portion of the text of the policy and of any 32
endorsements or attached papers must be plainly printed in light-33
faced type of a style in general use, the size of which must be 34
uniform and not less than 10 points with a lowercase unspaced 35
alphabet length not less than 120 points. “Text” includes all printed 36
matter except the name and address of the insurer, the name or the 37
title of the policy, the brief description, if any, and captions and 38
subcaptions. 39
5. The exceptions and reductions of indemnity must be set 40
forth in the policy and, other than those contained in NRS 689A.050 41
to 689A.290, inclusive, must be printed, at the insurer’s option, with 42
the benefit provision to which they apply or under an appropriate 43
caption such as “Exceptions” or “Exceptions and Reductions,” 44
except that if an exception or reduction specifically applies only to a 45
– 32 –
- *SB439_R3*
particular benefit of the policy, a statement of that exception or 1
reduction must be included with the benefit provision to which it 2
applies. 3
6. Each such form, including riders and endorsements, must be 4
identified by a number in the lower left-hand corner of the first page 5
thereof. 6
7. The policy must not contain any provision purporting to 7
make any portion of the charter, rules, constitution or bylaws of the 8
insurer a part of the policy unless that portion is set forth in full in 9
the policy, except in the case of the incorporation of or reference to 10
a statement of rates or classification of risks, or short-rate table filed 11
with the Commissioner. 12
8. The policy must provide benefits for expense arising from 13
care at home or health supportive services if that care or service was 14
prescribed by a physician and would have been covered by the 15
policy if performed in a medical facility or facility for the dependent 16
as defined in chapter 449 of NRS. 17
9. [The] Except as otherwise provided in this subsection, the 18
policy must provide [, at the option of the applicant,] benefits for 19
expenses incurred for the treatment of alcohol or substance use 20
disorder . [, unless] Except for the benefits required by section 34 21
of this act, such benefits must be provided: 22
(a) At the option of the applicant; and 23
(b) Unless the policy provides coverage only for a specified 24
disease or provides for the payment of a specific amount of money 25
if the insured is hospitalized or receiving health care in his or her 26
home. 27
10. The policy must provide benefits for expense arising from 28
hospice care. 29
Sec. 37. NRS 689A.0437 is hereby amended to read as 30
follows: 31
689A.0437 1. An insurer that offers or issues a policy of 32
health insurance shall include in the policy 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 insurer; 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
– 33 –
- *SB439_R3*
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 health insurance 11
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 health insurance subject to the provisions of this 36
chapter that is delivered, issued for delivery or renewed on or after 37
[October] January 1, [2021,] 2024, has the legal effect of including 38
the coverage required by subsection 1, and any provision of the 39
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
– 34 –
- *SB439_R3*
prior authorization and categorizing drugs and devices based on 1
cost, type or method of administration. 2
(b) “Network plan” means a policy of health insurance offered 3
by an insurer under which the financing and delivery of medical 4
care, including items and services paid for as medical care, are 5
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. 38. NRS 689A.046 is hereby amended to read as follows: 14
689A.046 1. [The] In addition to the benefits required by 15
section 33 of this act, the benefits provided by a policy for health 16
insurance for treatment of alcohol or substance use disorder must 17
[consist of:] include, without limitation: 18
(a) Treatment for withdrawal from the physiological effect of 19
alcohol or drugs, with a minimum benefit of $1,500 per calendar 20
year. 21
(b) Treatment for a patient admitted to a facility, with a 22
minimum benefit of $9,000 per calendar year. 23
(c) Counseling for a person, group or family who is not admitted 24
to a facility, with a minimum benefit of $2,500 per calendar year. 25
2. Except as otherwise provided in NRS 687B.409, these 26
benefits must be paid in the same manner as benefits for any other 27
illness covered by a similar policy are paid. 28
3. The insured person is entitled to these benefits if treatment is 29
received in any: 30
(a) Facility for the treatment of alcohol or substance use disorder 31
which is certified by the Division of Public and Behavioral Health 32
of the Department of Health and Human Services. 33
(b) Hospital or other medical facility or facility for the 34
dependent which is licensed by the Division of Public and 35
Behavioral Health of the Department of Health and Human 36
Services, accredited by The Joint Commission or CARF 37
International and provides a program for the treatment of alcohol or 38
substance use disorder as part of its accredited activities. 39
Sec. 39. NRS 689A.330 is hereby amended to read as follows: 40
689A.330 If any policy is issued by a domestic insurer for 41
delivery to a person residing in another state, and if the insurance 42
commissioner or corresponding public officer of that other state has 43
informed the Commissioner that the policy is not subject to approval 44
or disapproval by that officer, the Commissioner may by ruling 45
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- *SB439_R3*
require that the policy meet the standards set forth in NRS 689A.030 1
to 689A.320, inclusive [.] , and sections 33 and 34 of this act. 2
Sec. 40. Chapter 689B of NRS is hereby amended by adding 3
thereto the provisions set forth as sections 41, 42 and 43 of this act. 4
Sec. 41. 1. An insurer that offers or issues a policy of 5
group health insurance shall include in the policy coverage for: 6
(a) All drugs approved by the United States Food and Drug 7
Administration to: 8
(1) Provide medication-assisted treatment for opioid use 9
disorder, including, without limitation, buprenorphine, methadone 10
and naltrexone. 11
(2) Support safe withdrawal from substance use disorder, 12
including, without limitation, lofexidine. 13
(b) Any service for the treatment of substance use disorder 14
provided by a provider of primary care if the service is covered 15
when provided by a specialist and: 16
(1) The service is within the scope of practice of the 17
provider of primary care; or 18
(2) The provider of primary care is capable of providing the 19
service safely and effectively in consultation with a specialist and 20
the provider engages in such consultation. 21
2. An insurer shall provide the coverage required by 22
paragraph (a) of subsection 1 regardless of whether the drug is 23
included in the formulary of the insurer. 24
3. An insurer shall not: 25
(a) Subject the benefits required by paragraph (a) of 26
subsection 1 to medical management techniques, other than step 27
therapy; 28
(b) Limit the covered amount of a drug described in paragraph 29
(a) of subsection 1; or 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. 33
4. An insurer shall ensure that the benefits required by 34
subsection 1 are made available to an insured through a provider 35
of health care who participates in the network plan of the insurer. 36
5. A policy of group health insurance subject to the 37
provisions of this chapter that is delivered, issued for delivery or 38
renewed on or after January 1, 2024, has the legal effect of 39
including the coverage required by subsection 1, and any 40
provision of the policy that conflicts with the provisions of this 41
section is void. 42
6. As used in this section: 43
(a) “Medical management technique” means a practice which 44
is used to control the cost or use of health care services or 45
– 36 –
- *SB439_R3*
prescription drugs. The term includes, without limitation, the use 1
of step therapy, prior authorization and categorizing drugs and 2
devices based on cost, type or method of administration. 3
(b) “Network plan” means a policy of group health insurance 4
offered by an insurer under which the financing and delivery of 5
medical care, including items and services paid for as medical 6
care, are provided, in whole or in part, through a defined set of 7
providers under contract with the insurer. The term does not 8
include an arrangement for the financing of premiums. 9
(c) “Primary care” means the practice of family medicine, 10
pediatrics, internal medicine, obstetrics and gynecology and 11
midwifery. 12
(d) “Provider of health care” has the meaning ascribed to it in 13
NRS 629.031. 14
Sec. 42. 1. An insurer that offers or issues a policy of 15
group health insurance shall include in the policy: 16
(a) Coverage of testing for and the treatment of and prevention 17
of sexually transmitted diseases, including, without limitation, 18
Chlamydia trachomatis, gonorrhea, syphilis, human 19
immunodeficiency virus and hepatitis B and C, for all insureds, 20
regardless of age. Such coverage must include, without limitation, 21
the coverage required by NRS 689B.0312 and 689B.0315. 22
(b) Unrestricted coverage of condoms for insureds who are 13 23
years of age or older. 24
2. A policy of group health insurance subject to the 25
provisions of this chapter that is delivered, issued for delivery or 26
renewed on or after January 1, 2024, has the legal effect of 27
including the coverage required by subsection 1, and any 28
provision of the policy that conflicts with the provisions of this 29
section is void. 30
Sec. 43. (Deleted by amendment.) 31
Sec. 44. NRS 689B.0312 is hereby amended to read as 32
follows: 33
689B.0312 1. An insurer that offers or issues a policy of 34
group health insurance shall include in the policy 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 insurer; 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
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- *SB439_R3*
(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
insurer. 12
2. An insurer that offers or issues a policy of group health 13
insurance shall reimburse [a] : 14
(a) A pharmacist who participates in the network plan of the 15
insurer for the services described in NRS 639.28085 at a rate equal 16
to the rate of reimbursement provided to a physician, physician 17
assistant or advanced practice registered nurse for similar services. 18
(b) An advanced practice registered nurse or a physician 19
assistant who participates in the network plan of the insurer for 20
any service to test for, prevent or treat human immunodeficiency 21
virus or hepatitis C at a rate equal to the rate of reimbursement 22
provided to a physician for similar services. 23
3. An insurer [may subject] shall not: 24
(a) Subject the benefits required by subsection 1 to [reasonable] 25
medical management techniques [.] , other than step therapy; 26
(b) Limit the covered amount of a drug described in paragraph 27
(a) of subsection 1; 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; or 31
(d) Prohibit or restrict access to any service or drug to treat 32
human immunodeficiency virus or hepatitis C on the same day on 33
which the insured is diagnosed. 34
4. An insurer shall ensure that the benefits required by 35
subsection 1 are made available to an insured through a provider of 36
health care who participates in the network plan of the insurer. 37
5. A policy of group health insurance subject to the provisions 38
of this chapter that is delivered, issued for delivery or renewed on or 39
after [October] January 1, [2021,] 2024, has the legal effect of 40
including the coverage required by subsection 1, and any provision 41
of the policy that conflicts with the provisions of this section is void. 42
6. As used in this section: 43
(a) “Medical management technique” means a practice which is 44
used to control the cost or use of health care services or prescription 45
– 38 –
- *SB439_R3*
drugs. The term includes, without limitation, the use of step therapy, 1
prior authorization and categorizing drugs and devices based on 2
cost, type or method of administration. 3
(b) “Network plan” means a policy of group health insurance 4
offered by an insurer under which the financing and delivery of 5
medical care, including items and services paid for as medical care, 6
are provided, in whole or in part, through a defined set of providers 7
under contract with the insurer. The term does not include an 8
arrangement for the financing of premiums. 9
(c) “Primary care” means the practice of family medicine, 10
pediatrics, internal medicine, obstetrics and gynecology and 11
midwifery. 12
(d) “Provider of health care” has the meaning ascribed to it in 13
NRS 629.031. 14
Sec. 45. Chapter 689C of NRS is hereby amended by adding 15
thereto the provisions set forth as sections 46, 47 and 48 of this act. 16
Sec. 46. 1. A carrier that offers or issues a health benefit 17
plan shall include in the plan coverage for: 18
(a) All drugs approved by the United States Food and Drug 19
Administration to: 20
(1) Provide medication-assisted treatment for opioid use 21
disorder, including, without limitation, buprenorphine, methadone 22
and naltrexone. 23
(2) Support safe withdrawal from substance use disorder, 24
including, without limitation, lofexidine. 25
(b) Any service for the treatment of substance use disorder 26
provided by a provider of primary care if the service is covered 27
when provided by a specialist and: 28
(1) The service is within the scope of practice of the 29
provider of primary care; or 30
(2) The provider of primary care is capable of providing the 31
service safely and effectively in consultation with a specialist and 32
the provider engages in such consultation. 33
2. A carrier shall provide the coverage required by paragraph 34
(a) of subsection 1 regardless of whether the drug is included in 35
the formulary of the carrier. 36
3. A carrier shall not: 37
(a) Subject the benefits required by paragraph (a) of 38
subsection 1 to medical management techniques, other than step 39
therapy; 40
(b) Limit the covered amount of a drug described in paragraph 41
(a) of subsection 1; or 42
(c) Refuse to cover a drug described in paragraph (a) of 43
subsection 1 because the drug is dispensed by a pharmacy through 44
mail order service. 45
– 39 –
- *SB439_R3*
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_R3*
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_R3*
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_R3*
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_R3*
(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_R3*
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_R3*
(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_R3*
(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_R3*
(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_R3*
[(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_R3*
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_R3*
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
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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
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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
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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
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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
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(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
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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
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(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
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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
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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
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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