S.B. 234
- *SB234*
SENATE BILL NO. 234–SENATORS DOÑATE,
FLORES, OHRENSCHALL; AND TAYLOR
FEBRUARY 25, 2025
____________
JOINT SPONSORS: ASSEMBLYMEMBERS MOORE, ROTH, TORRES-
FOSSETT, GONZÁLEZ; ANDERSON, D’SILVA AND NGUYEN
____________
Referred to Committee on Health and Human Services
SUMMARY—Makes revisions relating to Medicaid. (BDR 38-40)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Yes.
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to Medicaid; requiring Medicaid to provide
certain limited coverage to certain persons who would
otherwise be ineligible for Medicaid because of their
immigration status; prescribing the scope and limitations
of such coverage; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing federal law requires Medicaid to provide to certain aliens, including 1
aliens who are not lawfully present in the United States, limited coverage for health 2
care services that are necessary to treat an emergency medical condition. (42 U.S.C. 3
§ 1396b(v)(2); 42 C.F.R. § 440.255) Section 1 of this bill prescribes specific 4
requirements governing such coverage under Medicaid in this State. Specifically, 5
section 1 provides that such coverage must consist of coverage for: (1) emergency 6
medical transportation services directly relating to the treatment of the emergency 7
medical condition; (2) care to treat the emergency medical condition provided in an 8
emergency room or similar setting in a hospital or an independent center for 9
emergency medical care; and (3) certain inpatient services relating to the treatment 10
of the emergency medical condition. Additionally, section 1 provides limited 11
coverage for certain care to treat renal disease and cancer in certain circumstances, 12
if the Department of Health and Human Services grants prior approval for such care 13
based on the medical necessity of the care. Section 1 also provides limited 14
coverage in certain circumstances for continuing care relating to an emergency 15
medical condition that is provided in a facility for skilled nursing, or other similar 16
type of facility, if: (1) such care is necessary to prevent the condition of the person 17
– 2 –
- *SB234*
from becoming an emergency medical condition; and (2) the Department grants 18
prior approval for such care based on the medical necessity of the care. 19
Section 2 of this bill makes a conforming change to require the Director of the 20
Department to administer the provisions of section 1 in the same manner as other 21
provisions relating to Medicaid. 22
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 422 of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. To the extent that federal financial participation is 3
available, the Director shall include under Medicaid pursuant to 4
42 U.S.C. § 1396b(v)(2) and 42 C.F.R. § 440.255 coverage for care 5
that is necessary to treat an emergency medical condition of a 6
resident of this State who would otherwise be ineligible for 7
Medicaid solely because of his or her immigration status. The 8
coverage provided pursuant to this section must consist of 9
coverage for: 10
(a) Emergency medical transportation services directly relating 11
to the treatment of the emergency medical condition; 12
(b) Care to treat the emergency medical condition provided in 13
an emergency room or similar setting in a hospital or an 14
independent center for emergency medical care; 15
(c) Inpatient services provided to a person immediately 16
following the admission of the person from an emergency room, 17
independent center for emergency medical care, clinic or other 18
similar setting where the person originally sought care for his or 19
her emergency medical condition, if the inpatient services directly 20
relate to the treatment of the emergency medical condition; 21
(d) If approved by the Department pursuant to subsection 3: 22
(1) Care that is provided in a facility for skilled nursing or 23
other similar facility for treatment in a community setting 24
following the discharge of a person from a hospital where the 25
person was receiving inpatient services, if the care directly relates 26
to the emergency medical condition for which the person received 27
care before the discharge; 28
(2) Dialysis provided in a hospital or a facility for the 29
treatment of irreversible renal disease; 30
(3) Care, including, without limitation, surgery, 31
chemotherapy and radiation therapy, that is necessary to treat 32
cancer which is not in remission; and 33
(4) The transplant of a kidney, if the person: 34
(I) Has been diagnosed with end-stage renal disease; 35
(II) Is receiving dialysis services; and 36
– 3 –
- *SB234*
(III) Is a candidate for a kidney transplant; and 1
(e) Any follow-up services that are included within a payment 2
for a service described in paragraphs (a) to (d), inclusive. 3
2. The Director shall not include under Medicaid coverage 4
pursuant to this section for any care or service not described in 5
subsection 1, including, without limitation: 6
(a) Elective surgery; 7
(b) Prescription drugs, unless dispensed or administered by a 8
provider of health care as part of the care or treatment described 9
in subsection 1; 10
(c) Preventive care; 11
(d) Rehabilitative services; 12
(e) Personal care services; 13
(f) Physical, occupational or speech therapy; 14
(g) Case management services; 15
(h) Prosthetics, orthotics, durable medical equipment or 16
medical supplies; 17
(i) Dental services; 18
(j) Hospice care; 19
(k) Treatment for substance use disorder; 20
(l) Services for routine prenatal care; 21
(m) Except as otherwise provided by subparagraph (4) of 22
paragraph (d) of subsection 1, organ transplants and stem cell 23
transplants; and 24
(n) Except as otherwise provided by subparagraph (1) of 25
paragraph (d) of subsection 1, continuing care, including, without 26
limitation, care and services provided by a facility for the 27
dependent. 28
3. The Department may not provide coverage under Medicaid 29
pursuant to this section for the care described in paragraph (d) of 30
subsection 1 unless the Department determines, before the care 31
being rendered, that such care is medically necessary and 32
appropriate, based on the condition of the person to whom the 33
care may be provided. To provide coverage for the care described 34
in subparagraph (1) of paragraph (d) of subsection 1, the 35
Department must additionally determine that the care is necessary 36
to prevent the condition of the person from rapidly becoming an 37
emergency medical condition. 38
4. The Department shall: 39
(a) Apply for any waiver of federal law or apply for any 40
amendment to the State Plan for Medicaid that is necessary to 41
obtain federal financial participation to pay for the cost of 42
coverage provided under this section. 43
(b) Fully cooperate in good faith with the Federal Government 44
during the application process to satisfy the requirements of the 45
– 4 –
- *SB234*
Federal Government for obtaining a waiver or amendment 1
pursuant to paragraph (a). 2
(c) Establish procedures for granting prior approval of 3
coverage for the care described in paragraph (d) of subsection 1. 4
5. As used in this section: 5
(a) “Emergency medical condition” has the meaning ascribed 6
to it in 42 U.S.C. § 1396b(v)(3). 7
(b) “Emergency medical transportation services” means 8
emergency medical transportation services provided by an 9
ambulance, air ambulance or vehicle of a fire-fighting agency, 10
including, without limitation, services provided by emergency 11
medical technicians, advanced emergency medical technicians 12
and paramedics in prestabilizing patients and preparing patients 13
for transport. 14
(c) “Facility for skilled nursing” has the meaning ascribed to 15
it in NRS 449.0039. 16
(d) “Facility for the dependent” has the meaning ascribed to it 17
in NRS 449.0045. 18
(e) “Facility for the treatment of irreversible renal disease” 19
has the meaning ascribed to it in NRS 449.0046. 20
(f) “Independent center for emergency medical care” has the 21
meaning ascribed to it in NRS 449.013. 22
(g) “Medically necessary” means health care services or 23
products that a prudent physician would provide to a patient to 24
prevent, diagnose or treat an illness, injury or disease or any 25
symptom thereof, that are necessary and which are: 26
(1) Provided in accordance with generally accepted 27
standards of medical practice; 28
(2) Clinically appropriate for the type, frequency, extent, 29
location and duration; 30
(3) Not primarily provided for the convenience of the 31
patient, physician or other provider of health care; 32
(4) Required to improve a specific health condition of the 33
patient or to preserve the existing state of health of the patient; 34
and 35
(5) The most clinically appropriate level of health care that 36
may be safely provided to the patient. 37
(h) “Provider of health care” has the meaning ascribed to it in 38
NRS 629.031. 39
Sec. 2. NRS 232.320 is hereby amended to read as follows: 40
232.320 1. The Director: 41
(a) Shall appoint, with the consent of the Governor, 42
administrators of the divisions of the Department, who are 43
respectively designated as follows: 44
– 5 –
- *SB234*
(1) The Administrator of the Aging and Disability Services 1
Division; 2
(2) The Administrator of the Division of Welfare and 3
Supportive Services; 4
(3) The Administrator of the Division of Child and Family 5
Services; 6
(4) The Administrator of the Division of Health Care 7
Financing and Policy; and 8
(5) The Administrator of the Division of Public and 9
Behavioral Health. 10
(b) Shall administer, through the divisions of the Department, 11
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 12
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 13
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 14
section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 15
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 16
and 445A.010 to 445A.055, inclusive, and all other provisions of 17
law relating to the functions of the divisions of the Department, but 18
is not responsible for the clinical activities of the Division of Public 19
and Behavioral Health or the professional line activities of the other 20
divisions. 21
(c) Shall administer any state program for persons with 22
developmental disabilities established pursuant to the 23
Developmental Disabilities Assistance and Bill of Rights Act of 24
2000, 42 U.S.C. §§ 15001 et seq. 25
(d) Shall, after considering advice from agencies of local 26
governments and nonprofit organizations which provide social 27
services, adopt a master plan for the provision of human services in 28
this State. The Director shall revise the plan biennially and deliver a 29
copy of the plan to the Governor and the Legislature at the 30
beginning of each regular session. The plan must: 31
(1) Identify and assess the plans and programs of the 32
Department for the provision of human services, and any 33
duplication of those services by federal, state and local agencies; 34
(2) Set forth priorities for the provision of those services; 35
(3) Provide for communication and the coordination of those 36
services among nonprofit organizations, agencies of local 37
government, the State and the Federal Government; 38
(4) Identify the sources of funding for services provided by 39
the Department and the allocation of that funding; 40
(5) Set forth sufficient information to assist the Department 41
in providing those services and in the planning and budgeting for the 42
future provision of those services; and 43
(6) Contain any other information necessary for the 44
Department to communicate effectively with the Federal 45
– 6 –
- *SB234*
Government concerning demographic trends, formulas for the 1
distribution of federal money and any need for the modification of 2
programs administered by the Department. 3
(e) May, by regulation, require nonprofit organizations and state 4
and local governmental agencies to provide information regarding 5
the programs of those organizations and agencies, excluding 6
detailed information relating to their budgets and payrolls, which the 7
Director deems necessary for the performance of the duties imposed 8
upon him or her pursuant to this section. 9
(f) Has such other powers and duties as are provided by law. 10
2. Notwithstanding any other provision of law, the Director, or 11
the Director’s designee, is responsible for appointing and removing 12
subordinate officers and employees of the Department. 13
Sec. 3. 1. This section becomes effective upon passage and 14
approval. 15
2. Sections 1 and 2 of this act become effective: 16
(a) Upon passage and approval for the purpose of adopting any 17
regulations and performing any other preparatory administrative 18
tasks that are necessary to carry out the provisions of this act; and 19
(b) On January 1, 2026, for all other purposes. 20
H