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