S.B. 312
- *SB312*
SENATE BILL NO. 312–COMMITTEE ON
HEALTH AND HUMAN SERVICES
(ON BEHALF OF THE JOINT INTERIM STANDING COMMITTEE
ON HEALTH AND HUMAN SERVICES)
MARCH 10, 2025
____________
Referred to Committee on Health and Human Services
SUMMARY—Enacts provisions relating to the health of American
Indians, Alaska Natives and Native Hawaiians.
(BDR 38-347)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Contains Appropriation not included
in Executive Budget.
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to health care; requiring the Director of the
Department of Health and Human Services to apply for
certain federal authority to authorize tribal health benefit
coordinators to determine eligibility for Medicaid;
creating the Tribal Health Authority Council; prescribing
the procedure governing the operations of the Council;
providing for the appointment of the Coordinator of the
Council; prescribing the duties of the Council; creating
the Account for Tribal Health; making an appropriation to
the Department of Native American Affairs for the
personnel and operating costs of the Council; and
providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law creates the Department of Native American Affairs, which 1
consists of the Executive Director, the Nevada Indian Commission and the Stewart 2
Indian School Cultural Center and Museum. (NRS 233A.1003) Section 5 of this 3
bill creates the Tribal Health Authority Council and establishes the membership of 4
the Council. Section 4 of this bill defines the term “Council” to refer to the Council 5
for the purposes of sections 4-9 of this bill. Section 6 of this bill establishes certain 6
requirements governing the operation of the Council and provides for the election 7
of the officers of the Council. Section 7 requires the Executive Director to appoint 8
– 2 –
- *SB312*
the Coordinator of the Council. Section 7 also requires the Department to provide 9
any additional personnel, facilities, equipment and supplies to the Council. Section 10
8 of this bill prescribes the duties of the Council, which include adopting and 11
periodically updating a plan to increase access to health care and address and 12
eliminate barriers to health care for American Indians, Alaska Natives and Native 13
Hawaiians in this State. Section 9 of this bill creates the Account for Tribal Health 14
to fund the activities of the Council, and section 10 of this bill appropriates money 15
to the Account. Section 11 of this bill requires the Director of the Department of 16
Health and Human Services to collaborate with the Council to develop a proposal 17
to establish a program to reinvest certain federal funds received by this State under 18
the Medicaid program. 19
Existing law requires the Department of Health and Human Services to 20
administer Medicaid. (NRS 422.270) Additionally, existing federal law requires the 21
Secretary of Health and Human Services to encourage enrollment of American 22
Indians in Medicaid. (42 U.S.C. § 1320b-9) Section 1 of this bill requires the 23
Department to apply for any waiver of federal law or apply for any amendment to 24
the State Plan for Medicaid to authorize certain trained persons affiliated with 25
tribes, known as tribal health benefit coordinators, to determine whether a person is 26
eligible to receive benefits under Medicaid. Section 1 additionally requires the 27
Department to collaborate with the Council and tribal health clinics in this State to 28
ensure that tribal health benefit coordinators have the resources necessary to 29
determine if a person is eligible to receive benefits under Medicaid. Section 2 of 30
this bill makes a conforming change to indicate that the provisions of section 1 will 31
be administered in the same manner as the provisions of existing law governing 32
Medicaid. 33
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. The Department shall: 3
(a) Apply to the Secretary of Health and Human Services for 4
any waiver of federal law or apply for any amendment of the State 5
Plan for Medicaid that is necessary to authorize tribal health 6
benefit coordinators to determine whether a person is eligible to 7
receive benefits under Medicaid. 8
(b) Fully cooperate in good faith with the Federal Government 9
during the application process to satisfy the requirements of the 10
Federal Government for obtaining a waiver or amendment 11
pursuant to paragraph (a). 12
2. Upon approval by the Secretary of Health and Human 13
Services of the waiver or amendment described in subsection 1, 14
the Department shall collaborate with the Tribal Health Authority 15
Council created by section 5 of this act and tribal health clinics in 16
this State to ensure that tribal health benefit coordinators have the 17
resources necessary to determine whether a person is eligible for 18
benefits under Medicaid, including, without limitation: 19
– 3 –
- *SB312*
(a) Providing training to tribal health benefit coordinators 1
concerning the determinations described in paragraph (a) of 2
subsection 1; 3
(b) Coordinating information technology upgrades for tribal 4
organizations; 5
(c) Establishing interfaces with software used by the Division 6
and the Division of Welfare and Supportive Services of the 7
Department; and 8
(d) Any other activities necessary to carry out the provisions of 9
this section. 10
3. As used in this section, “tribal health benefit coordinator” 11
means a natural person who: 12
(a) Lives in or otherwise has a connection to the community of 13
American Indians or Alaska Natives in which he or she provides 14
services; and 15
(b) Is trained to provide certain services which do not require 16
the tribal health benefit coordinator to be licensed pursuant to title 17
54 of NRS, including, without limitation, outreach and 18
coordination of health care. 19
Sec. 2. NRS 232.320 is hereby amended to read as follows: 20
232.320 1. The Director: 21
(a) Shall appoint, with the consent of the Governor, 22
administrators of the divisions of the Department, who are 23
respectively designated as follows: 24
(1) The Administrator of the Aging and Disability Services 25
Division; 26
(2) The Administrator of the Division of Welfare and 27
Supportive Services; 28
(3) The Administrator of the Division of Child and Family 29
Services; 30
(4) The Administrator of the Division of Health Care 31
Financing and Policy; and 32
(5) The Administrator of the Division of Public and 33
Behavioral Health. 34
(b) Shall administer, through the divisions of the Department, 35
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 36
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 37
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 38
section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 39
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 40
and 445A.010 to 445A.055, inclusive, and all other provisions of 41
law relating to the functions of the divisions of the Department, but 42
is not responsible for the clinical activities of the Division of Public 43
and Behavioral Health or the professional line activities of the other 44
divisions. 45
– 4 –
- *SB312*
(c) Shall administer any state program for persons with 1
developmental disabilities established pursuant to the 2
Developmental Disabilities Assistance and Bill of Rights Act of 3
2000, 42 U.S.C. §§ 15001 et seq. 4
(d) Shall, after considering advice from agencies of local 5
governments and nonprofit organizations which provide social 6
services, adopt a master plan for the provision of human services in 7
this State. The Director shall revise the plan biennially and deliver a 8
copy of the plan to the Governor and the Legislature at the 9
beginning of each regular session. The plan must: 10
(1) Identify and assess the plans and programs of the 11
Department for the provision of human services, and any 12
duplication of those services by federal, state and local agencies; 13
(2) Set forth priorities for the provision of those services; 14
(3) Provide for communication and the coordination of those 15
services among nonprofit organizations, agencies of local 16
government, the State and the Federal Government; 17
(4) Identify the sources of funding for services provided by 18
the Department and the allocation of that funding; 19
(5) Set forth sufficient information to assist the Department 20
in providing those services and in the planning and budgeting for the 21
future provision of those services; and 22
(6) Contain any other information necessary for the 23
Department to communicate effectively with the Federal 24
Government concerning demographic trends, formulas for the 25
distribution of federal money and any need for the modification of 26
programs administered by the Department. 27
(e) May, by regulation, require nonprofit organizations and state 28
and local governmental agencies to provide information regarding 29
the programs of those organizations and agencies, excluding 30
detailed information relating to their budgets and payrolls, which the 31
Director deems necessary for the performance of the duties imposed 32
upon him or her pursuant to this section. 33
(f) Has such other powers and duties as are provided by law. 34
2. Notwithstanding any other provision of law, the Director, or 35
the Director’s designee, is responsible for appointing and removing 36
subordinate officers and employees of the Department. 37
Sec. 3. Chapter 233A of NRS is hereby amended by adding 38
thereto the provisions set forth as sections 4 to 9, inclusive, of this 39
act. 40
Sec. 4. As used in sections 4 to 9, inclusive, of this act, unless 41
the context otherwise requires, “Council” means the Tribal Health 42
Authority Council. 43
Sec. 5. 1. The Tribal Health Authority Council is hereby 44
created. 45
– 5 –
- *SB312*
2. The Council consists of: 1
(a) The following voting members: 2
(1) The director of each urban Indian organization in this 3
State, or his or her designee. 4
(2) The director of each program for medical care of a 5
tribal organization in this State that elects to participate, or his or 6
her designee. 7
(3) One person appointed by each Indian tribe in this State 8
that elects to participate, appointed by the leadership of that tribe. 9
The person appointed pursuant to this subparagraph must be 10
involved in the provision of health care or public health services to 11
the tribe that he or she is appointed to represent. 12
(4) One person who is appointed jointly by the Las Vegas 13
Hawaiian Civic Club and the Northern Nevada Hawaiian Civic 14
Club, or their successor organizations, or, if those organizations 15
cease to exist, one person appointed by an organization that 16
represents Native Hawaiians in this State selected by the 17
Governor, to represent the community of Native Hawaiians in this 18
State. 19
(5) One representative of the Office of the Governor, 20
appointed by the Governor. 21
(6) Two members of the Senate, one of whom is appointed 22
by the Majority Leader of the Senate and one of whom is 23
appointed by the Minority Leader of the Senate. 24
(7) Two members of the Assembly, one of whom is 25
appointed by the Speaker of the Assembly and one of whom is 26
appointed by the Minority Leader of the Assembly. 27
(b) The following nonvoting members: 28
(1) One representative of the office of the Indian Health 29
Service having jurisdiction over this State. 30
(2) Any person appointed by a state agency pursuant to 31
subsection 3. 32
3. A state agency whose functions relate to health care may 33
appoint a nonvoting member of the Council to serve as a liaison 34
between the Council and the agency. 35
4. Each member of the Council described in subparagraph 36
(3) of paragraph (a) of subsection 2 may appoint an alternate 37
member in writing to serve in the place of the member if he or she 38
is unable to attend a meeting or perform his or her duties. 39
5. After the initial terms, the term of each member of the 40
Council described in subparagraphs (3) to (7), inclusive, of 41
paragraph (a) of subsection 2 is 4 years. Such members may be 42
reappointed for additional terms of 4 years in the same manner as 43
the initial appointment. A vacancy in the membership of the 44
Council must be filled in the same manner as the initial 45
– 6 –
- *SB312*
appointment for the remainder of the unexpired term, if 1
applicable. 2
6. The members of the Council serve without compensation 3
and are not entitled to the per diem and travel expenses provided 4
for state officers and employees generally. 5
7. Each member of the Council who is an officer or employee 6
of this State or a political subdivision of this State must be relieved 7
from his or her duties without loss of regular compensation so that 8
the officer or employee may prepare for and attend meetings of the 9
Council and perform any work necessary to carry out the duties of 10
the Council in the most timely manner practicable. A state agency 11
or political subdivision of this State shall not require an officer or 12
employee who is a member of the Council to make up the time the 13
officer or employee is absent from work to carry out duties as a 14
member of the Council or use annual leave or compensatory time 15
for the absence. 16
8. As used in this section: 17
(a) “Indian tribe” means a federally recognized American 18
Indian tribe pursuant to 25 C.F.R. §§ 83.1 to 83.12, inclusive. 19
(b) “Urban Indian organization” has the meaning ascribed to 20
it in 25 U.S.C. § 1603. 21
Sec. 6. 1. The Council shall meet: 22
(a) At least once each quarter; and 23
(b) At the times and places specified by a call of the Chair or a 24
majority of the voting members of the Council. 25
2. A majority of the voting members of the Council 26
constitutes a quorum for the transaction of business, and a 27
majority of a quorum present at any meeting is sufficient for any 28
official action taken by the Council. 29
3. If an alternate member attends a meeting of the Council in 30
place of the regular member, the alternate member fully assumes 31
the duties, rights and responsibilities of the replaced regular 32
member for the duration of that meeting. 33
4. Except as otherwise provided in this subsection, the 34
Council shall elect from the members described in subparagraph 35
(3) of paragraph (a) of subsection 2 of section 5 of this act a Chair 36
and Vice Chair by a majority vote of the voting members of the 37
Council. If only one Indian tribe in this State elects to participate 38
in the Council, the member appointed pursuant to subparagraph 39
(3) of paragraph (a) of subsection 1 of section 5 of this act is the 40
Chair of the Council and the Council shall elect a Vice Chair from 41
the other voting members of the Council by a majority vote of the 42
voting members of the Council. If no Indian tribe in this State 43
elects to participate in the Council, the Council shall elect a Chair 44
and Vice Chair from the voting members of the Council by a 45
– 7 –
- *SB312*
majority vote of the voting members of the Council. The Chair and 1
Vice Chair serve until July 1 of the year following their election 2
and may be reelected. If the position of Chair or Vice Chair 3
becomes vacant, the position must be filled in the same manner as 4
the original election for the remainder of the unexpired term. 5
Sec. 7. 1. The Executive Director of the Department shall 6
appoint the Coordinator of the Council. The Coordinator: 7
(a) Is in the unclassified service of the State and serves at the 8
pleasure of the Executive Director. 9
(b) Shall perform such duties as are directed by the Executive 10
Director, as advised by the Council. 11
(c) Must not be a member of the Council. 12
2. The Department shall provide any additional personnel, 13
facilities, equipment and supplies required by the Council to carry 14
out the provisions of sections 4 to 9, inclusive, of this act. 15
Sec. 8. The Council shall: 16
1. Serve as the primary body to advise the Department, the 17
Office of the Governor and the Department of Health and Human 18
Services on matters concerning the health of American Indians, 19
Alaska Natives and Native Hawaiians. 20
2. Periodically assess the health of American Indians, Alaska 21
Natives and Native Hawaiians in this State and the quality of and 22
accessibility to health care for those groups. 23
3. Based on the assessments conducted pursuant to 24
subsection 2, adopt and periodically update a plan to increase 25
access to health care and address and eliminate barriers to health 26
care for American Indians, Alaska Natives and Native Hawaiians 27
in this State. The plan may include, without limitation, specific 28
recommendations for programs, projects or activities that support 29
the advancement of health initiatives for American Indians, 30
Alaska Natives and Native Hawaiians. 31
4. Identify issues related to the health of American Indians, 32
Alaska Natives and Native Hawaiians that the State is incapable of 33
resolving and engage interested persons and entities as necessary 34
to resolve those issues. 35
Sec. 9. 1. The Account for Tribal Health is hereby created 36
in the State General Fund. The Department shall administer the 37
Account. 38
2. The Account is a continuing account without reversion. 39
The money in the Account must be invested as the money in other 40
state accounts is invested. The interest and income earned on the 41
money in the Account, after deducting any applicable charges, 42
must be credited to the Account. Claims against the Account must 43
be paid as other claims against the State are paid. 44
– 8 –
- *SB312*
3. The Department may apply for and accept gifts, grants, 1
donations and money from the Federal Government or any other 2
source for deposit in the Account. 3
4. The Department shall use the money in the Account to 4
support the Council in the performance of the duties prescribed in 5
sections 4 to 9, inclusive, of this act. 6
Sec. 10. 1. There is hereby appropriated from the State 7
General Fund to the Department of Native American Affairs for 8
deposit in the Account for Tribal Health created by section 9 of this 9
act the sum of $224,000 for the personnel and operating costs for the 10
Tribal Health Authority Council created by section 5 of this act. 11
2. Any remaining balance of the appropriation made by 12
subsection 1 must not be committed for expenditure after June 30, 13
2027, by the entity to which the appropriation is made or any entity 14
to which money from the appropriation is granted or otherwise 15
transferred in any manner, and any portion of the appropriated 16
money remaining must not be spent for any purpose after 17
September 17, 2027, by either the entity to which the money was 18
appropriated or the entity to which the money was subsequently 19
granted or transferred, and must be reverted to the State General 20
Fund on or before September 17, 2027. 21
Sec. 11. 1. The Director of the Department of Health and 22
Human Services shall collaborate with the Tribal Health Authority 23
Council created by section 5 of this act during the 2025-2026 24
interim to: 25
(a) Develop a proposal to establish a program to reinvest money 26
obtained through the enhanced federal match for the provision of 27
health care and public health services to American Indians, Alaska 28
Natives and Native Hawaiians; and 29
(b) On or before June 30, 2026: 30
(1) Submit a report on the proposal developed pursuant to 31
paragraph (a) and any recommendations for legislation based on the 32
proposal to the Director of the Legislative Counsel Bureau for 33
transmittal to the Joint Interim Standing Committee on Health and 34
Human Services; and 35
(2) Present the report at a meeting of the Joint Interim 36
Standing Committee on Health and Human Services. 37
2. As used in this section: 38
(a) “Enhanced federal match” means the 100 percent federal 39
medical assistance percentage provided pursuant to 42 U.S.C. § 40
1396d(b) for health care services provided under Medicaid through 41
an Indian Health Service facility or an urban Indian organization. 42
(b) “Urban Indian organization” has the meaning ascribed to it 43
in 25 U.S.C. § 1603. 44
– 9 –
- *SB312*
Sec. 12. As soon as practicable after July 1, 2025, the 1
appointing authorities described in subparagraphs (3) to (7), 2
inclusive, of paragraph (a) of subsection 2 of section 5 of this act 3
shall appoint to the Tribal Health Authority Council created by that 4
section the members described in those subparagraphs to initial 5
terms that, insofar as possible, are staggered so that the terms of an 6
equal number of members expire each year. 7
Sec. 13. 1. This section becomes effective upon passage and 8
approval. 9
2. Sections 1 and 2 of this act become effective: 10
(a) Upon passage and approval for the purpose of performing 11
any other preparatory administrative tasks that are necessary to carry 12
out the provisions of this act; and 13
(b) On January 1, 2026, for all other purposes. 14
3. Sections 3 to 12, inclusive, of this act become effective on 15
July 1, 2025. 16
H