Nevada Senate Bill SB337 Latest Draft

                              
  
  	S.B. 337 
 
- 	*SB337* 
 
SENATE BILL NO. 337–SENATOR LANGE 
 
MARCH 12, 2025 
____________ 
 
Referred to Committee on Health and Human Services 
 
SUMMARY—Revises provisions relating to opioids. 
(BDR 40-204) 
 
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. 
 Effect on the State: Yes. 
 
CONTAINS UNFUNDED MANDATE (§§ 1, 16, 26) 
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT) 
 
~ 
 
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. 
 
 
AN ACT relating to health care; requiring certain health care 
facilities and certain providers of health care to provide 
patients with a form for a non-opioid directive and offer 
patients treatments that do not utilize an opioid under 
certain circumstances; requiring the Division of Public 
and Behavioral Health of the Department of Health and 
Human Services to create a form for a non-opioid 
directive; requiring the Administrator of the Division to 
appoint an advisory board to monitor compliance with 
laws and regulations relating to the non-opioid directive; 
requiring certain policies of health insurance to include 
coverage for at least one drug that is an alternative to 
opioids; requiring certain insurers to provide the form for 
a non-opioid directive to new insureds; revising the 
manner by which money in the Fund for a Resilient 
Nevada allocates money to projects and grants; and 
providing other matters properly relating thereto. 
Legislative Counsel’s Digest: 
 Existing law authorizes a patient to execute certain directives and declarations 1 
to record his or her wishes relating to health care and to direct providers of health 2 
care in the provision of health care to the patient. (NRS 449A.400-449A.645) 3 
Section 15 of this bill requires the Division of Public and Behavioral Health of the 4 
Department of Health and Human Services to create a non-opioid directive, which 5 
is a form on which a person may indicate that he or she does not wish to receive 6   
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opioids, and to post the non-opioid directive on an Internet website maintained by 7 
the Division. Section 16 of this bill requires: (1) certain providers of health care to 8 
provide a person with an opportunity to execute a non-opioid directive; (2) third 9 
party insurers that provide health coverage to provide persons who enroll in such 10 
health coverage a non-opioid directive; and (3) certain health care facilities to 11 
ensure that persons providing care at the facility provide a patient with an 12 
opportunity to execute a non-opioid directive. Section 16 also requires such third 13 
party insurers and health facilities to post the non-opioid directive on their Internet 14 
websites. Sections 17 and 18 of this bill set forth the procedure for a patient to 15 
execute and revoke a non-opioid directive.  16 
 Section 19 of this bill prohibits a person who knows or should know that a 17 
person has executed a non-opioid directive from prescribing, administering or 18 
directing or supervising the administration of an opioid to that person except under 19 
certain circumstances. Section 20 of this bill provides immunity to certain persons 20 
relating to the prescribing, administering or directing or supervising the 21 
administration of an opioid to a patient who has executed a non-opioid directive, or 22 
the failure to take those actions with regard to such a patient, if the person: (1) acts 23 
in good faith; and (2) is in compliance with all applicable laws and regulations 24 
relating to his or her actions. Section 21 of this bill requires the State Board of 25 
Health to adopt regulations prescribing procedures relating to the non-opioid 26 
directive.  27 
 Sections 22 and 23 of this bill require the Administrator of the Division to 28 
appoint an advisory board to: (1) review the implementation of and compliance 29 
with provisions relating to the non-opioid directive; and (2) make recommendations 30 
to practitioner licensing boards and certain governmental entities concerning issues 31 
relating to opioid use and alternative treatments that do not utilize opioids. Sections 32 
8-14 of this bill define certain terms used in sections 8-23.  33 
 Sections 1 and 33-40 of this bill require a medical facility, certain other health 34 
care facilities and certain providers of health care who prescribe or administer 35 
opioids to comply with the provisions of law governing non-opioid directives. 36 
Under section 55 of this bill, beginning on January 1, 2027, sections 1, 33, 35-37, 37 
39 and 40 require such facilities and providers of health care to offer and provide 38 
alternative treatments that do not utilize opioids to patients who have requested 39 
such alternatives or executed non-opioid directives, except in certain circumstances. 40 
Sections 1, 33, 35-37, 39 and 40 require the regulatory bodies that license such 41 
facilities and providers of health care to biennially review the compliance of such 42 
facilities and practitioners with those requirements. Sections 34 and 38 make 43 
conforming changes to clarify that sections 33 and 37, respectively, apply to the 44 
prescribing and administering of opioids to treat intractable pain. Sections 2-6 and 45 
41 of this bill provide for the administration and enforcement of section 1 in the 46 
same manner as other requirements imposed by existing law on licensed health 47 
facilities. 48 
 Sections 25 and 54 of this bill authorize the Board of the Public Employees’ 49 
Benefits Program and the Public Option, which is a state-run health insurance 50 
program for private citizens, to reduce the rates paid to a facility or practitioner who 51 
violates any provision of section 33, 35-37, 39 or 40 or prohibit the facility or 52 
practitioner from receiving payments through the Program or the Public Option. 53 
(NRS 695K.200) Section 27 of this bill applies certain definitions to section 25. 54 
Section 29 of this bill requires the Administrator of the Division of Health Care 55 
Financing and Policy of the Department to adopt regulations to: (1) monitor the 56 
compliance of facilities and practitioners who participate in Medicaid with the 57 
provisions of sections 33, 35-37, 39 and 40; and (2) impose sanctions on a facility 58 
or practitioner who fails to comply with such provisions. 59 
 Existing law requires public and private policies of insurance regulated under 60 
Nevada law and employers who provide such insurance for their employees to 61   
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include coverage for drugs to: (1) support safe withdrawal from substance use 62 
disorder; and (2) provide medication-assisted treatment for opioid use disorder. 63 
(NRS 287.010, 287.04335, 422.4025, 608.1555, 689A.0459, 689B.0319, 64 
689C.1665, 689C.425, 695A.1874, 695B.19197, 695C.050, 695C.1699, 65 
695G.1719) Sections 26, 28, 30, 43, 45-51 and 53 of this bill require certain public 66 
and private policies of health insurance to cover drugs that are alternatives to 67 
opioids for purposes for which opioids are commonly used. Sections 42, 43, 45-51 68 
and 53 of this bill prohibit certain insurers from imposing prior authorization and 69 
certain other conditions on covered opioid alternatives that are not imposed on 70 
opioids. Section 44 of this bill authorizes the Commissioner of Insurance to require 71 
certain policies of health insurance issued by a domestic insurer to a person who 72 
resides in another state to include the coverage required by section 43. Section 52 73 
of this bill authorizes the Commissioner to suspend or revoke the certification of a 74 
health maintenance organization that fails to comply with the requirements of 75 
section 50. The Commissioner would also be authorized to take such actions 76 
against other health insurers who fail to comply with the requirements of sections 77 
43, 45-49, 51 and 53. (NRS 680A.200) Section 24 of this bill makes a conforming 78 
change to require the Director of the Department to administer the provisions of 79 
section 29 in the same manner as other provisions relating to Medicaid. 80 
 Existing law creates the Fund for a Resilient Nevada to hold the proceeds of 81 
certain litigation by the State concerning the manufacture, distribution, sale and 82 
marketing of opioids. (NRS 433.732) Existing law requires the Department to 83 
create a statewide plan to allocate the money in the Fund for certain statewide 84 
projects and grants to local governments and private-sector organizations whose 85 
work relates to opioid use disorder and other substance use disorders. (NRS 86 
433.738) Section 31 of this bill requires the statewide plan to allocate at least 20 87 
percent of the money distributed from the Fund to such projects and grants that are 88 
related to the prevention of substance use disorders. Section 32 of this bill makes a 89 
conforming change to update an internal reference changed by section 31. Section 90 
55 authorizes the Department to continue to utilize the current statewide plan and at 91 
the time that the Department revises the statewide plan or develops a new plan, the 92 
new plan must comply with the provisions of section 31. 93 
 
 
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN 
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: 
 
 Section 1.  Chapter 449 of NRS is hereby amended by adding 1 
thereto a new section to read as follows: 2 
 1. A medical facility or facility which is required by the 3 
regulations adopted by the Board pursuant to NRS 449.0303 to be 4 
licensed that administers opioids to patients shall: 5 
 (a) Comply with the requirements of sections 8 to 23, inclusive, 6 
of this act and any regulations adopted pursuant thereto; and 7 
 (b) Offer to a patient an alternative treatment that does not 8 
utilize an opioid before administering an opioid to the patient for 9 
the first time unless: 10 
  (1) In the opinion of the attending provider of health care, 11 
there is no treatment that does not utilize an opioid that is suitable 12 
for treating the patient; or  13   
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  (2) It is not practicable to offer such an alternative 1 
treatment to the patient. 2 
 2. Except as otherwise provided in subsection 1 and section 3 
19 of this act, if a patient or his or her legal guardian has executed 4 
a non-opioid directive or states that the patient wishes to receive 5 
an alternative treatment that does not utilize an opioid, the 6 
medical facility or facility which is required by the regulations 7 
adopted by the Board pursuant to NRS 449.0303 to be licensed 8 
shall provide such a treatment. 9 
 3. During each even-numbered year, the Division shall 10 
review compliance with the requirements of this section by each 11 
medical facility or facility which is required by the regulations 12 
adopted by the Board pursuant to NRS 449.0303 to be licensed 13 
that administers opioids to patients. 14 
 4. As used in this section: 15 
 (a) “Non-opioid directive” has the meaning ascribed to it in 16 
section 9 of this act. 17 
 (b) “Provider of health care” has the meaning ascribed to it in 18 
NRS 629.031. 19 
 Sec. 2.  NRS 449.029 is hereby amended to read as follows: 20 
 449.029 As used in NRS 449.029 to 449.240, inclusive, and 21 
section 1 of this act, unless the context otherwise requires, “medical 22 
facility” has the meaning ascribed to it in NRS 449.0151 and 23 
includes a program of hospice care described in NRS 449.196. 24 
 Sec. 3.  NRS 449.0301 is hereby amended to read as follows: 25 
 449.0301 The provisions of NRS 449.029 to 449.2428, 26 
inclusive, and section 1 of this act do not apply to: 27 
 1.  Any facility conducted by and for the adherents of any 28 
church or religious denomination for the purpose of providing 29 
facilities for the care and treatment of the sick who depend solely 30 
upon spiritual means through prayer for healing in the practice of 31 
the religion of the church or denomination, except that such a 32 
facility shall comply with all regulations relative to sanitation and 33 
safety applicable to other facilities of a similar category. 34 
 2.  Foster homes as defined in NRS 424.014. 35 
 3.  Any medical facility, facility for the dependent or facility 36 
which is otherwise required by the regulations adopted by the Board 37 
pursuant to NRS 449.0303 to be licensed that is operated and 38 
maintained by the United States Government or an agency thereof. 39 
 Sec. 4.  NRS 449.160 is hereby amended to read as follows: 40 
 449.160 1.  The Division may deny an application for a 41 
license or may suspend or revoke any license issued under the 42 
provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of 43 
this act upon any of the following grounds: 44   
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 (a) Violation by the applicant or the licensee of any of the 1 
provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 2 
section 1 of this act or 449A.100 to 449A.124, inclusive, and 3 
449A.270 to 449A.286, inclusive, or of any other law of this State 4 
or of the standards, rules and regulations adopted thereunder. 5 
 (b) Aiding, abetting or permitting the commission of any illegal 6 
act. 7 
 (c) Conduct inimical to the public health, morals, welfare and 8 
safety of the people of the State of Nevada in the maintenance and 9 
operation of the premises for which a license is issued. 10 
 (d) Conduct or practice detrimental to the health or safety of the 11 
occupants or employees of the facility. 12 
 (e) Failure of the applicant to obtain written approval from the 13 
Director of the Department of Health and Human Services as 14 
required by NRS 439A.100 or 439A.102 or as provided in any 15 
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 16 
and section 1 of this act and 449.435 to 449.531, inclusive, and 17 
chapter 449A of NRS if such approval is required, including, 18 
without limitation, the closure or conversion of any hospital in a 19 
county whose population is 100,000 or more that is owned by the 20 
licensee without approval pursuant to NRS 439A.102. 21 
 (f) Failure to comply with the provisions of NRS 441A.315 and 22 
any regulations adopted pursuant thereto or NRS 449.2486. 23 
 (g) Violation of the provisions of NRS 458.112. 24 
 (h) Failure to comply with the provisions of NRS 449A.170 to 25 
449A.192, inclusive, and any regulation adopted pursuant thereto. 26 
 (i) Violation of the provisions of NRS 629.260. 27 
 2.  In addition to the provisions of subsection 1, the Division 28 
may revoke a license to operate a facility for the dependent if, with 29 
respect to that facility, the licensee that operates the facility, or an 30 
agent or employee of the licensee: 31 
 (a) Is convicted of violating any of the provisions of  32 
NRS 202.470; 33 
 (b) Is ordered to but fails to abate a nuisance pursuant to NRS 34 
244.360, 244.3603 or 268.4124; or 35 
 (c) Is ordered by the appropriate governmental agency to correct 36 
a violation of a building, safety or health code or regulation but fails 37 
to correct the violation. 38 
 3.  The Division shall maintain a log of any complaints that it 39 
receives relating to activities for which the Division may revoke the 40 
license to operate a facility for the dependent pursuant to subsection 41 
2. The Division shall provide to a facility for the care of adults 42 
during the day: 43   
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 (a) A summary of a complaint against the facility if the 1 
investigation of the complaint by the Division either substantiates 2 
the complaint or is inconclusive; 3 
 (b) A report of any investigation conducted with respect to the 4 
complaint; and 5 
 (c) A report of any disciplinary action taken against the facility. 6 
 The facility shall make the information available to the public 7 
pursuant to NRS 449.2486. 8 
 4.  On or before February 1 of each odd-numbered year, the 9 
Division shall submit to the Director of the Legislative Counsel 10 
Bureau a written report setting forth, for the previous biennium: 11 
 (a) Any complaints included in the log maintained by the 12 
Division pursuant to subsection 3; and 13 
 (b) Any disciplinary actions taken by the Division pursuant to 14 
subsection 2. 15 
 Sec. 5.  NRS 449.163 is hereby amended to read as follows: 16 
 449.163 1.  In addition to the payment of the amount required 17 
by NRS 449.0308, if a medical facility, facility for the dependent or 18 
facility which is required by the regulations adopted by the Board 19 
pursuant to NRS 449.0303 to be licensed violates any provision 20 
related to its licensure, including any provision of NRS 439B.410 or 21 
449.029 to 449.2428, inclusive, and section 1 of this act or any 22 
condition, standard or regulation adopted by the Board, the 23 
Division, in accordance with the regulations adopted pursuant to 24 
NRS 449.165, may: 25 
 (a) Prohibit the facility from admitting any patient until it 26 
determines that the facility has corrected the violation; 27 
 (b) Limit the occupancy of the facility to the number of beds 28 
occupied when the violation occurred, until it determines that the 29 
facility has corrected the violation; 30 
 (c) If the license of the facility limits the occupancy of the 31 
facility and the facility has exceeded the approved occupancy, 32 
require the facility, at its own expense, to move patients to another 33 
facility that is licensed; 34 
 (d) Except where a greater penalty is authorized by subsection 2, 35 
impose an administrative penalty of not more than $5,000 per day 36 
for each violation, together with interest thereon at a rate not to 37 
exceed 10 percent per annum; and 38 
 (e) Appoint temporary management to oversee the operation of 39 
the facility and to ensure the health and safety of the patients of the 40 
facility, until: 41 
  (1) It determines that the facility has corrected the violation 42 
and has management which is capable of ensuring continued 43 
compliance with the applicable statutes, conditions, standards and 44 
regulations; or 45   
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  (2) Improvements are made to correct the violation. 1 
 2.  If an off-campus location of a hospital fails to obtain a 2 
national provider identifier that is distinct from the national provider 3 
identifier used by the main campus and any other off-campus 4 
location of the hospital in violation of NRS 449.1818, the Division 5 
may impose against the hospital an administrative penalty of not 6 
more than $10,000 for each day of such failure, together with 7 
interest thereon at a rate not to exceed 10 percent per annum, in 8 
addition to any other action authorized by this chapter. 9 
 3. If the facility fails to pay any administrative penalty imposed 10 
pursuant to paragraph (d) of subsection 1 or subsection 2, the 11 
Division may: 12 
 (a) Suspend the license of the facility until the administrative 13 
penalty is paid; and 14 
 (b) Collect court costs, reasonable attorney’s fees and other 15 
costs incurred to collect the administrative penalty. 16 
 4.  The Division may require any facility that violates any 17 
provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and 18 
section 1 of this act, or any condition, standard or regulation 19 
adopted by the Board to make any improvements necessary to 20 
correct the violation. 21 
 5.  Any money collected as administrative penalties pursuant to 22 
paragraph (d) of subsection 1 or subsection 2 must be accounted for 23 
separately and used to administer and carry out the provisions of 24 
NRS 449.001 to 449.430, inclusive, and section 1 of this act, 25 
449.435 to 449.531, inclusive, and chapter 449A of NRS to protect 26 
the health, safety, well-being and property of the patients and 27 
residents of facilities in accordance with applicable state and federal 28 
standards or for any other purpose authorized by the Legislature. 29 
 Sec. 6.  NRS 449.240 is hereby amended to read as follows: 30 
 449.240 The district attorney of the county in which the facility 31 
is located shall, upon application by the Division, institute and 32 
conduct the prosecution of any action for violation of any provisions 33 
of NRS 449.029 to 449.245, inclusive [.] , and section 1 of this act. 34 
 Sec. 7.  Chapter 449A of NRS is hereby amended by adding 35 
thereto the provisions set forth as sections 8 to 23, inclusive, of this 36 
act. 37 
 Sec. 8.  As used in sections 8 to 23, inclusive, of this act, 38 
unless the context otherwise requires, the words and terms defined 39 
in sections 9 to 14, inclusive, of this act have the meanings 40 
ascribed to them in those sections. 41 
 Sec. 9.  “Non-opioid directive” means the form created 42 
pursuant to section 15 of this act. 43   
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 Sec. 10.  “Non-opioid patient” means a person who executes 1 
a non-opioid directive or whose legal guardian has executed a 2 
non-opioid directive on behalf of the person.  3 
 Sec. 11.  “Practitioner” has the meaning ascribed to it in 4 
NRS 639.0125. 5 
 Sec. 12.  “Practitioner licensing board” means a licensing 6 
board created by chapter 630, 631, 632, 633, 635 or 636 of NRS. 7 
 Sec. 13.  “Provider of health care” has the meaning ascribed 8 
to it in NRS 629.031. 9 
 Sec. 14.  “Third party” means any insurer, governmental 10 
entity or other organization providing health coverage or benefits 11 
in accordance with state or federal law. 12 
 Sec. 15.  1. The Division shall create a form for executing a 13 
non-opioid directive. 14 
 2. The form created pursuant to subsection 1 must include, 15 
without limitation: 16 
 (a) A statement of circumstances prescribed by section 19 of 17 
this act under which an opioid may be administered to a non-18 
opioid patient; 19 
 (b) A statement of the legal effect of the non-opioid directive, 20 
as prescribed by section 19 of this act; 21 
 (c) A place for a person to execute the form in accordance with 22 
section 17 of this act; 23 
 (d) A summary of the procedures for revoking a non-opioid 24 
directive pursuant to section 18 of this act; and 25 
 (e) Any additional information the Division considers relevant. 26 
 3. The Division shall post the form for executing a non-27 
opioid directive on an Internet website maintained by the Division. 28 
 Sec. 16.  1. Except in an emergency situation, before 29 
prescribing, administering or directing or supervising the 30 
administration of an opioid to a patient, a practitioner or a 31 
registered nurse shall: 32 
 (a) Check the medical record of the patient to determine 33 
whether the patient is a non-opioid patient;  34 
 (b) If the patient is not a non-opioid patient, explain to the 35 
patient or his or her legal guardian that he or she may execute a 36 
non-opioid directive in accordance with section 17 of this act; and 37 
 (c) If the patient or legal guardian indicates that he or she 38 
would like to execute a non-opioid directive, provide the non-39 
opioid directive to the patient or legal guardian, as applicable, for 40 
execution pursuant to section 17 of this act. 41 
 2. A third party that provides health coverage in this State 42 
shall: 43 
 (a) Post the form for executing a non-opioid directive on an 44 
Internet website maintained by the third party; and  45   
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 (b) Provide the non-opioid directive to each person who enrolls 1 
in health coverage provided by the third party. 2 
 3. A medical facility or facility which is required by the 3 
regulations adopted by the Board pursuant to NRS 449.0303 to be 4 
licensed that administers opioids to patients shall: 5 
 (a) Ensure that persons described in subsection 1 who provide 6 
care at the facility comply with the requirements of that 7 
subsection; and  8 
 (b) Post the non-opioid directive on an Internet website 9 
maintained by the facility, if the facility maintains an Internet 10 
website.  11 
 Sec. 17.  1. A non-opioid directive may be executed by: 12 
 (a) A person for himself or herself; or  13 
 (b) The legal guardian of a person on behalf of the person. 14 
 2. An executed non-opioid directive becomes effective when a 15 
person described in subsection 1 provides the executed non-opioid 16 
directive to: 17 
 (a) A provider of health care, medical facility, facility for the 18 
dependent or facility which is required by the regulations adopted 19 
by the Board pursuant to NRS 449.0303 to be licensed that is 20 
providing care to the non-opioid patient to whom the non-opioid 21 
directive pertains; or  22 
 (b) A third party that provides coverage to the non-opioid 23 
patient to whom the non-opioid directive pertains. 24 
 3. Upon receiving an executed non-opioid directive pursuant 25 
to subsection 2, a provider of health care, a medical facility, 26 
facility for the dependent or facility which is required by the 27 
regulations adopted by the Board pursuant to NRS 449.0303 to be 28 
licensed or third party shall record the non-opioid directive in the 29 
record of the non-opioid patient to whom the non-opioid directive 30 
pertains. 31 
 Sec. 18.  1. A non-opioid patient may revoke his or her non-32 
opioid directive at any time and in any manner that communicates 33 
to a person or entity described in subsection 2 of section 17 of this 34 
act the intent to revoke the directive. 35 
 2. A legal guardian who has executed a non-opioid directive 36 
may revoke the directive at any time by articulating in writing an 37 
intent to revoke the directive and providing such written notice to 38 
a person or entity described in subsection 2 of section 17 of this 39 
act. 40 
 3. The revocation of a non-opioid directive is effective upon 41 
the patient or legal guardian communicating pursuant to 42 
subsection 1 or 2, the desire to revoke the form. The person or 43 
entity to whom the revocation is communicated shall: 44 
 (a) Make the revocation a part of the records of the patient; or  45   
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 (b) Cause the revocation to be made a part of the record of the 1 
patient. 2 
 Sec. 19.  1. Except as otherwise provided in this section, a 3 
person who knows or should know that a person is a non-opioid 4 
patient shall not prescribe, administer or direct or supervise 5 
another in administering an opioid to a non-opioid patient.  6 
 2.  A practitioner may prescribe, administer, or direct or 7 
supervise the administration of an opioid to a non-opioid patient, 8 
and a person listed in NRS 453.375 may administer an opioid to a 9 
non-opioid patient under such direction or supervision, if: 10 
 (a) Prescribing or administering the opioid is medically 11 
necessary, as determined by the practitioner, to treat the patient in 12 
an emergency situation or while the patient is receiving inpatient 13 
care at a medical facility; 14 
 (b) The opioid is prescribed or administered for intraoperative 15 
use; or  16 
 (c) The opioid is prescribed or administered pursuant to the 17 
regulations adopted by the Board pursuant to subsection 5 of 18 
section 21 of this act. 19 
 3. If a non-opioid patient is prescribed or administered an 20 
opioid pursuant to paragraph (a) of subsection 2, the practitioner 21 
who prescribes, administers or directs or supervises the 22 
administration of the opioid shall ensure that the non-opioid 23 
patient or his or her legal guardian receives information on 24 
preventing opioid use disorder, including, without limitation, 25 
relapse into opioid use disorder, when the emergency situation has 26 
ended or the person is being discharged from the medical facility. 27 
 Sec. 20.  1. A practitioner who acts in good faith and in 28 
accordance with the provisions of sections 8 to 23, inclusive, of 29 
this act and any regulations adopted pursuant thereto and other 30 
applicable law is immune from civil and criminal liability and 31 
professional discipline for: 32 
 (a) Failing to prescribe, administer or direct or supervise the 33 
administration of an opioid to a non-opioid patient; or 34 
 (b) Prescribing, administering or directing or supervising the 35 
administration of an opioid in violation of a non-opioid directive. 36 
 2. A person authorized to possess and administer a controlled 37 
substance pursuant to NRS 453.375 and who acts in good faith 38 
and in accordance with the provisions of sections 8 to 23, 39 
inclusive, of this act and any regulations adopted pursuant thereto 40 
and other applicable law is immune from civil and criminal 41 
liability and professional discipline for administering or failing to 42 
administer an opioid to a non-opioid patient.  43   
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 Sec. 21.  The Board shall adopt regulations as necessary to 1 
carry out the provisions of sections 8 to 23, inclusive, of this act, 2 
including, without limitation, regulations prescribing procedures: 3 
 1. For a practitioner to record a non-opioid directive in the 4 
medical record of a non-opioid patient; 5 
 2.  For a non-opioid patient or the legal guardian of a non-6 
opioid patient to revoke a non-opioid directive;  7 
 3.  To ensure that the recording, disclosure and distribution of 8 
a non-opioid directive and data relating to such a directive 9 
complies with applicable state and federal laws and regulations 10 
concerning the confidentiality of health information and informed 11 
consent to health care; 12 
 4.  For complying with the requirements of section 16 of this 13 
act; and 14 
 5.  For prescribing and administering opioids to a non-opioid 15 
patient: 16 
 (a) To treat a substance use disorder; or  17 
 (b) If the non-opioid patient is receiving hospice care. 18 
 Sec. 22.  1. The Administrator of the Division shall appoint 19 
an advisory board to advise the Division concerning the 20 
implementation of sections 8 to 23, inclusive, of this act and 21 
monitoring compliance with those provisions. The advisory board 22 
must consist of persons selected by the Administrator who have 23 
expertise in the safe and effective use of opioids during the 24 
provision of health care and the treatment of substance use 25 
disorder. 26 
 2. The term of office of a member of the advisory board is 3 27 
years and commences on July 1 of the year of appointment. The 28 
terms of office of the members of the advisory board must be 29 
staggered to result in, as nearly as possible, the appointment of an 30 
equal number of members to the advisory board on July 1 of each 31 
year. 32 
 3. The members of the advisory board serve without 33 
compensation and are not entitled to the per diem and travel 34 
expenses provided for state officers and employees generally. 35 
 4. Each member of the advisory board who is an officer or 36 
employee of this State or a political subdivision of this State must 37 
be relieved from his or her duties without loss of regular 38 
compensation so that the officer or employee may prepare for and 39 
attend meetings of the advisory board and perform any work 40 
necessary to carry out the duties of the advisory board in the most 41 
timely manner practicable. A state agency or political subdivision 42 
of this State shall not require an officer or employee who is a 43 
member of the advisory board to make up the time the officer or 44 
employee is absent from work to carry out duties as a member of 45   
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the advisory board or use annual leave or compensatory time for 1 
the absence. 2 
 5. The advisory board shall: 3 
 (a) Elect a Chair from among its members; and  4 
 (b) Meet at the times and places specified by a call of the 5 
Chair. 6 
 Sec. 23.  The advisory board appointed pursuant to section 22 7 
of this act shall: 8 
 1.  Review the implementation of and compliance with the 9 
requirements of sections 8 to 23, inclusive, of this act, including, 10 
without limitation, by: 11 
 (a) Hearing testimony from: 12 
  (1) Practitioners, patients, persons who have recovered or 13 
are in recovery from opioid use disorder and persons involved in 14 
the treatment of opioid use disorder; 15 
  (2) Representatives of the Division, practitioner licensing 16 
boards and other organizations; and  17 
  (3) Other persons and entities with knowledge and 18 
information related to opioids, opioid use disorder or non-opioid 19 
alternatives to opioids or any other relevant knowledge and 20 
information; and 21 
 (b) Reviewing proposed and enacted legislation, regulations 22 
and other changes to state and local policy related to non-opioid 23 
directives and the prescribing and use of opioids; and 24 
 2. Make recommendations to practitioner licensing boards, 25 
the Department, the Legislature and other governmental entities 26 
concerning issues relating to opioid use and alternative treatments 27 
that do not utilize opioids.  28 
 Sec. 24.  NRS 232.320 is hereby amended to read as follows: 29 
 232.320 1.  The Director: 30 
 (a) Shall appoint, with the consent of the Governor, 31 
administrators of the divisions of the Department, who are 32 
respectively designated as follows: 33 
  (1) The Administrator of the Aging and Disability Services 34 
Division; 35 
  (2) The Administrator of the Division of Welfare and 36 
Supportive Services; 37 
  (3) The Administrator of the Division of Child and Family 38 
Services; 39 
  (4) The Administrator of the Division of Health Care 40 
Financing and Policy; and 41 
  (5) The Administrator of the Division of Public and 42 
Behavioral Health. 43 
 (b) Shall administer, through the divisions of the Department, 44 
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 45   
 	– 13 – 
 
 
- 	*SB337* 
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 1 
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 2 
section 29 of this act, 422.580, 432.010 to 432.133, inclusive, 3 
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 4 
and 445A.010 to 445A.055, inclusive, and all other provisions of 5 
law relating to the functions of the divisions of the Department, but 6 
is not responsible for the clinical activities of the Division of Public 7 
and Behavioral Health or the professional line activities of the other 8 
divisions. 9 
 (c) Shall administer any state program for persons with 10 
developmental disabilities established pursuant to the 11 
Developmental Disabilities Assistance and Bill of Rights Act of 12 
2000, 42 U.S.C. §§ 15001 et seq. 13 
 (d) Shall, after considering advice from agencies of local 14 
governments and nonprofit organizations which provide social 15 
services, adopt a master plan for the provision of human services in 16 
this State. The Director shall revise the plan biennially and deliver a 17 
copy of the plan to the Governor and the Legislature at the 18 
beginning of each regular session. The plan must: 19 
  (1) Identify and assess the plans and programs of the 20 
Department for the provision of human services, and any 21 
duplication of those services by federal, state and local agencies; 22 
  (2) Set forth priorities for the provision of those services; 23 
  (3) Provide for communication and the coordination of those 24 
services among nonprofit organizations, agencies of local 25 
government, the State and the Federal Government; 26 
  (4) Identify the sources of funding for services provided by 27 
the Department and the allocation of that funding; 28 
  (5) Set forth sufficient information to assist the Department 29 
in providing those services and in the planning and budgeting for the 30 
future provision of those services; and 31 
  (6) Contain any other information necessary for the 32 
Department to communicate effectively with the Federal 33 
Government concerning demographic trends, formulas for the 34 
distribution of federal money and any need for the modification of 35 
programs administered by the Department. 36 
 (e) May, by regulation, require nonprofit organizations and state 37 
and local governmental agencies to provide information regarding 38 
the programs of those organizations and agencies, excluding 39 
detailed information relating to their budgets and payrolls, which the 40 
Director deems necessary for the performance of the duties imposed 41 
upon him or her pursuant to this section. 42 
 (f) Has such other powers and duties as are provided by law. 43   
 	– 14 – 
 
 
- 	*SB337* 
 2.  Notwithstanding any other provision of law, the Director, or 1 
the Director’s designee, is responsible for appointing and removing 2 
subordinate officers and employees of the Department. 3 
 Sec. 25.  Chapter 287 of NRS is hereby amended by adding 4 
thereto a new section to read as follows: 5 
 1. If the Division of Public and Behavioral Health of the 6 
Department of Health and Human Services finds that a health 7 
facility has failed to comply with section 1 of this act or a 8 
practitioner licensing board finds that a practitioner has failed to 9 
comply with section 33, 35, 36, 37 or 39 of this act or NRS 10 
636.2882, the Board may: 11 
 (a) Reduce the reimbursement rates paid to the health facility 12 
or practitioner, as applicable, by the plan of health insurance 13 
provided by the Board; or 14 
 (b) Prohibit the health facility or practitioner, as applicable, 15 
from receiving payments through the insurance provided through 16 
the Program. 17 
 2. The Board shall include in any contract with a provider of 18 
health care notice of the actions the Board may take pursuant to 19 
subsection 1. 20 
 3. As used in this section: 21 
 (a) “Health facility” means a medical facility, as defined in 22 
NRS 449.0151, or a facility which is required by the regulations 23 
adopted by the State Board of Health pursuant to NRS 449.0303 to 24 
be licensed. 25 
 (b) “Practitioner” has the meaning ascribed to it in  26 
NRS 639.0125. 27 
 (c) “Practitioner licensing board” means a board created 28 
pursuant to chapter 630, 631, 632, 633, 635 or 636 of NRS. 29 
 Sec. 26.  NRS 287.010 is hereby amended to read as follows: 30 
 287.010 1.  The governing body of any county, school 31 
district, municipal corporation, political subdivision, public 32 
corporation or other local governmental agency of the State of 33 
Nevada may: 34 
 (a) Adopt and carry into effect a system of group life, accident 35 
or health insurance, or any combination thereof, for the benefit of its 36 
officers and employees, and the dependents of officers and 37 
employees who elect to accept the insurance and who, where 38 
necessary, have authorized the governing body to make deductions 39 
from their compensation for the payment of premiums on the 40 
insurance. 41 
 (b) Purchase group policies of life, accident or health insurance, 42 
or any combination thereof, for the benefit of such officers and 43 
employees, and the dependents of such officers and employees, as 44 
have authorized the purchase, from insurance companies authorized 45   
 	– 15 – 
 
 
- 	*SB337* 
to transact the business of such insurance in the State of Nevada, 1 
and, where necessary, deduct from the compensation of officers and 2 
employees the premiums upon insurance and pay the deductions 3 
upon the premiums. 4 
 (c) Provide group life, accident or health coverage through a 5 
self-insurance reserve fund and, where necessary, deduct 6 
contributions to the maintenance of the fund from the compensation 7 
of officers and employees and pay the deductions into the fund. The 8 
money accumulated for this purpose through deductions from the 9 
compensation of officers and employees and contributions of the 10 
governing body must be maintained as an internal service fund as 11 
defined by NRS 354.543. The money must be deposited in a state or 12 
national bank or credit union authorized to transact business in the 13 
State of Nevada. Any independent administrator of a fund created 14 
under this section is subject to the licensing requirements of chapter 15 
683A of NRS, and must be a resident of this State. Any contract 16 
with an independent administrator must be approved by the 17 
Commissioner of Insurance as to the reasonableness of 18 
administrative charges in relation to contributions collected and 19 
benefits provided. The provisions of NRS 439.581 to 439.597, 20 
inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 21 
687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, and 22 
section 45 of this act, paragraphs (b) and (c) of subsection 1 of NRS 23 
689B.0319, subsections 2, 4, 6 and 7 of NRS 689B.0319, 689B.033 24 
to 689B.0369, inclusive, 689B.0375 to 689B.050, inclusive, 25 
689B.0675, 689B.265, 689B.287 and 689B.500 apply to coverage 26 
provided pursuant to this paragraph, except that the provisions of 27 
NRS 689B.0378, 689B.03785 and 689B.500 only apply to coverage 28 
for active officers and employees of the governing body, or the 29 
dependents of such officers and employees. 30 
 (d) Defray part or all of the cost of maintenance of a self-31 
insurance fund or of the premiums upon insurance. The money for 32 
contributions must be budgeted for in accordance with the laws 33 
governing the county, school district, municipal corporation, 34 
political subdivision, public corporation or other local governmental 35 
agency of the State of Nevada. 36 
 2.  If a school district offers group insurance to its officers and 37 
employees pursuant to this section, members of the board of trustees 38 
of the school district must not be excluded from participating in the 39 
group insurance. If the amount of the deductions from compensation 40 
required to pay for the group insurance exceeds the compensation to 41 
which a trustee is entitled, the difference must be paid by the trustee. 42 
 3.  In any county in which a legal services organization exists, 43 
the governing body of the county, or of any school district, 44 
municipal corporation, political subdivision, public corporation or 45   
 	– 16 – 
 
 
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other local governmental agency of the State of Nevada in the 1 
county, may enter into a contract with the legal services 2 
organization pursuant to which the officers and employees of the 3 
legal services organization, and the dependents of those officers and 4 
employees, are eligible for any life, accident or health insurance 5 
provided pursuant to this section to the officers and employees, and 6 
the dependents of the officers and employees, of the county, school 7 
district, municipal corporation, political subdivision, public 8 
corporation or other local governmental agency. 9 
 4.  If a contract is entered into pursuant to subsection 3, the 10 
officers and employees of the legal services organization: 11 
 (a) Shall be deemed, solely for the purposes of this section, to be 12 
officers and employees of the county, school district, municipal 13 
corporation, political subdivision, public corporation or other local 14 
governmental agency with which the legal services organization has 15 
contracted; and 16 
 (b) Must be required by the contract to pay the premiums or 17 
contributions for all insurance which they elect to accept or of which 18 
they authorize the purchase. 19 
 5.  A contract that is entered into pursuant to subsection 3: 20 
 (a) Must be submitted to the Commissioner of Insurance for 21 
approval not less than 30 days before the date on which the contract 22 
is to become effective. 23 
 (b) Does not become effective unless approved by the 24 
Commissioner. 25 
 (c) Shall be deemed to be approved if not disapproved by the 26 
Commissioner within 30 days after its submission. 27 
 6.  As used in this section, “legal services organization” means 28 
an organization that operates a program for legal aid and receives 29 
money pursuant to NRS 19.031. 30 
 Sec. 27.  NRS 287.0402 is hereby amended to read as follows: 31 
 287.0402 As used in NRS 287.0402 to 287.049, inclusive, and 32 
section 25 of this act, unless the context otherwise requires, the 33 
words and terms defined in NRS 287.0404 to 287.04064, inclusive, 34 
have the meanings ascribed to them in those sections. 35 
 Sec. 28.  NRS 287.04335 is hereby amended to read as 36 
follows: 37 
 287.04335 If the Board provides health insurance through a 38 
plan of self-insurance, it shall comply with the provisions of NRS 39 
439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409, 40 
687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.255, 41 
695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 42 
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 43 
695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 44 
695G.174, inclusive, and section 53 of this act, 695G.176, 45   
 	– 17 – 
 
 
- 	*SB337* 
695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 1 
695G.310, inclusive, 695G.405 and 695G.415, in the same manner 2 
as an insurer that is licensed pursuant to title 57 of NRS is required 3 
to comply with those provisions. 4 
 Sec. 29.  Chapter 422 of NRS is hereby amended by adding 5 
thereto a new section to read as follows: 6 
 1. If the Division of Public and Behavioral Health of the 7 
Department finds that a health facility which participates in 8 
Medicaid as a provider of services has failed to comply with 9 
section 1 of this act or a practitioner licensing board finds that a 10 
practitioner who participates in Medicaid as a provider of services 11 
has violated the provisions of section 33, 35, 36, 37 or 39 of this 12 
act or NRS 636.2882, or the Department otherwise determines that 13 
such a health facility or practitioner has violated any of those 14 
provisions, the Department may impose sanctions on the health 15 
facility or practitioner, as applicable, for noncompliance in 16 
accordance with the regulations adopted pursuant to subsection 2. 17 
 2. The Administrator shall adopt regulations establishing: 18 
 (a) Procedures for the Department to monitor compliance by 19 
health care facilities and practitioners who participate in Medicaid 20 
as providers of services with the provisions of sections 1, 33, 35, 21 
36, 37 and 39 of this act and NRS 636.2882; and  22 
 (b) Sanctions that may be taken against a health care facility 23 
or practitioner for noncompliance, which must include, without 24 
limitation, reducing the reimbursement rates paid to a health care 25 
facility or practitioner or excluding a health care facility or 26 
practitioner from participation in Medicaid as a provider of 27 
services.  28 
 3. The Department shall comply with the requirements of 29 
subsection 2 of section 16 of this act with respect to Medicaid. 30 
 4. As used in this section: 31 
 (a) “Health care facility” means a medical facility, as defined 32 
in NRS 449.0151, or a facility which is required by the regulations 33 
adopted by the State Board of Health pursuant to NRS 449.0303 to 34 
be licensed. 35 
 (b) “Practitioner” has the meaning ascribed to it in  36 
NRS 639.0125. 37 
 (c) “Practitioner licensing board” means a board created 38 
pursuant to chapter 630, 631, 632, 633, 635 or 636 of NRS. 39 
 Sec. 30.  NRS 422.4025 is hereby amended to read as follows: 40 
 422.4025 1.  The Department shall: 41 
 (a) By regulation, develop a list of preferred prescription drugs 42 
to be used for the Medicaid program and the Children’s Health 43 
Insurance Program, and each public or nonprofit health benefit plan 44   
 	– 18 – 
 
 
- 	*SB337* 
that elects to use the list of preferred prescription drugs as its 1 
formulary pursuant to NRS 287.012, 287.0433 or 687B.407; and 2 
 (b) Negotiate and enter into agreements to purchase the drugs 3 
included on the list of preferred prescription drugs on behalf of the 4 
health benefit plans described in paragraph (a) or enter into a 5 
contract pursuant to NRS 422.4053 with a pharmacy benefit 6 
manager, health maintenance organization or one or more public or 7 
private entities in this State, the District of Columbia or other states 8 
or territories of the United States, as appropriate, to negotiate such 9 
agreements. 10 
 2.  The Department shall, by regulation, establish a list of 11 
prescription drugs which must be excluded from any restrictions that 12 
are imposed by the Medicaid program on drugs that are on the list of 13 
preferred prescription drugs established pursuant to subsection 1. 14 
The list established pursuant to this subsection must include, 15 
without limitation: 16 
 (a) Prescription drugs that are prescribed for the treatment of the 17 
human immunodeficiency virus, including, without limitation, 18 
antiretroviral medications; 19 
 (b) Antirejection medications for organ transplants; 20 
 (c) Antihemophilic medications; and 21 
 (d) Any prescription drug which the Board identifies as 22 
appropriate for exclusion from any restrictions that are imposed by 23 
the Medicaid program on drugs that are on the list of preferred 24 
prescription drugs. 25 
 3.  The regulations must provide that the Board makes the final 26 
determination of: 27 
 (a) Whether a class of therapeutic prescription drugs is included 28 
on the list of preferred prescription drugs and is excluded from any 29 
restrictions that are imposed by the Medicaid program on drugs that 30 
are on the list of preferred prescription drugs; 31 
 (b) Which therapeutically equivalent prescription drugs will be 32 
reviewed for inclusion on the list of preferred prescription drugs and 33 
for exclusion from any restrictions that are imposed by the Medicaid 34 
program on drugs that are on the list of preferred prescription drugs; 35 
and 36 
 (c) Which prescription drugs should be excluded from any 37 
restrictions that are imposed by the Medicaid program on drugs that 38 
are on the list of preferred prescription drugs based on continuity of 39 
care concerning a specific diagnosis, condition, class of therapeutic 40 
prescription drugs or medical specialty. 41 
 4.  The list of preferred prescription drugs established pursuant 42 
to subsection 1 must include, without limitation: 43 
 (a) Any prescription drug determined by the Board to be 44 
essential for treating sickle cell disease and its variants; [and] 45   
 	– 19 – 
 
 
- 	*SB337* 
 (b) Prescription drugs to prevent the acquisition of human 1 
immunodeficiency virus [.] ; and  2 
 (c) Alternatives to opioids for purposes for which opioids 3 
would normally be used. 4 
 5. The regulations must provide that each new pharmaceutical 5 
product and each existing pharmaceutical product for which there is 6 
new clinical evidence supporting its inclusion on the list of preferred 7 
prescription drugs must be made available pursuant to the Medicaid 8 
program with prior authorization until the Board reviews the product 9 
or the evidence. 10 
 6. The Medicaid program must cover a prescription drug that is 11 
not included on the list of preferred prescription drugs as if the drug 12 
were included on that list if: 13 
 (a) The drug is: 14 
  (1) Used to treat hepatitis C; 15 
  (2) Used to provide medication-assisted treatment for opioid 16 
use disorder; 17 
  (3) Used to support safe withdrawal from substance use 18 
disorder; or 19 
  (4) In the same class as a drug on the list of preferred 20 
prescription drugs; and  21 
 (b) All preferred prescription drugs within the same class as the 22 
drug are unsuitable for a recipient of Medicaid because: 23 
  (1) The recipient is allergic to all preferred prescription drugs 24 
within the same class as the drug; 25 
  (2) All preferred prescription drugs within the same class as 26 
the drug are contraindicated for the recipient or are likely to interact 27 
in a harmful manner with another drug that the recipient is taking; 28 
  (3) The recipient has a history of adverse reactions to all 29 
preferred prescription drugs within the same class as the drug; or  30 
  (4) The drug has a unique indication that is supported by 31 
peer-reviewed clinical evidence or approved by the United States 32 
Food and Drug Administration. 33 
 7.  The Medicaid program must automatically cover any typical 34 
or atypical antipsychotic medication or anticonvulsant medication 35 
that is not on the list of preferred prescription drugs upon the 36 
demonstrated therapeutic failure of one drug on that list to 37 
adequately treat the condition of a recipient of Medicaid. 38 
 8.  On or before February 1 of each year, the Department shall: 39 
 (a) Compile a report concerning the agreements negotiated 40 
pursuant to paragraph (b) of subsection 1 and contracts entered into 41 
pursuant to NRS 422.4053 which must include, without limitation, 42 
the financial effects of obtaining prescription drugs through those 43 
agreements and contracts, in total and aggregated separately for 44 
agreements negotiated by the Department, contracts with a 45   
 	– 20 – 
 
 
- 	*SB337* 
pharmacy benefit manager, contracts with a health maintenance 1 
organization and contracts with public and private entities from this 2 
State, the District of Columbia and other states and territories of the 3 
United States; and 4 
 (b) Post the report on an Internet website maintained by the 5 
Department and submit the report to the Director of the Legislative 6 
Counsel Bureau for transmittal to: 7 
  (1) In odd-numbered years, the Legislature; or 8 
  (2) In even-numbered years, the Legislative Commission. 9 
 Sec. 31.  NRS 433.738 is hereby amended to read as follows: 10 
 433.738 1.  The statewide plan to allocate money from the 11 
Fund established by the Department, in consultation with the Office, 12 
pursuant to paragraph (b) of subsection 1 of NRS 433.734 must: 13 
 (a) Establish policies and procedures for the administration and 14 
distribution of money from the Fund; 15 
 (b) Allocate the money in the Fund for the purposes described in 16 
[subsection] subsections 2 [;] and 3; and 17 
 (c) Establish requirements governing the use of money allocated 18 
from the Fund.  19 
 2.  The statewide plan must allocate at least 20 percent of the 20 
money distributed from the Fund for projects and grants related to 21 
the prevention of substance use disorders. Such money may be 22 
used for: 23 
 (a) The projects described in subparagraphs (15) and (16) of 24 
paragraph (a) of subsection 3 and, where applicable, other 25 
projects described in that paragraph; and 26 
 (b) Grants to an agency or organization listed in paragraph (b) 27 
of subsection 3 for work relating to the prevention of substance 28 
use disorders. 29 
 3.  The statewide plan may allocate money to: 30 
 (a) Statewide projects, which may include, without limitation: 31 
  (1) Expanding access to evidence-based prevention of 32 
substance use disorders, early intervention for persons at risk of a 33 
substance use disorder, treatment for substance use disorders and 34 
support for persons in recovery from substance use disorders; 35 
  (2) Programs to reduce the incidence and severity of neonatal 36 
abstinence syndrome; 37 
  (3) Prevention of adverse childhood experiences and early 38 
intervention for children who have undergone adverse childhood 39 
experiences and the families of such children; 40 
  (4) Services to reduce the harm caused by substance use; 41 
  (5) Prevention and treatment of infectious diseases in persons 42 
with substance use disorders; 43 
  (6) Services for children and other persons in a behavioral 44 
health crisis and the families of such persons; 45   
 	– 21 – 
 
 
- 	*SB337* 
  (7) Housing for persons who have or are in recovery from 1 
substance use disorders; 2 
  (8) Campaigns to educate and increase awareness of the 3 
public concerning substance use and substance use disorders; 4 
  (9) Programs for persons involved in the criminal justice or 5 
juvenile justice system and the families of such persons, including, 6 
without limitation, programs that are administered by courts; 7 
  (10) The evaluation of existing programs relating to 8 
substance use and substance use disorders; 9 
  (11) Development of the workforce of providers of services 10 
relating to substance use and substance use disorders; 11 
  (12) The collection and analysis of data relating to substance 12 
use and substance use disorders;  13 
  (13) Capital projects relating to substance use and substance 14 
use disorders, including, without limitation, construction, 15 
purchasing and remodeling; [and] 16 
  (14) Implementing the hotline for persons who are 17 
considering suicide or otherwise in a behavioral health crisis and 18 
providing services to persons who access that hotline in accordance 19 
with the provisions of NRS 433.702 to 433.710, inclusive [.] ;  20 
  (15) Increased rates of reimbursement under Medicaid for 21 
care that utilizes alternatives for purposes for which opioids would 22 
ordinarily be used; and  23 
  (16) Research into alternative treatments that do not utilize 24 
an opioid. 25 
 (b) Grants to regional, county, local and tribal agencies and 26 
private-sector organizations whose work relates to opioid use 27 
disorder and other substance use disorders.  28 
 [3.] 4.  The projects described in paragraph (a) of subsection 29 
[2] 3 may include, without limitation, projects to maximize 30 
expenditures through federal, local and private matching 31 
contributions.  32 
 [4.] 5.  The Department, in consultation with the Office, may 33 
revise the statewide plan to allocate money from the Fund as 34 
necessary without conducting a statewide needs assessment pursuant 35 
to paragraph (a) of subsection 1 of NRS 433.734 so long as a needs 36 
assessment is conducted at the intervals required by that subsection. 37 
 Sec. 32.  NRS 433.740 is hereby amended to read as follows: 38 
 433.740 1.  If the Department awards grants pursuant to 39 
paragraph (b) of subsection [2] 3 of NRS 433.738, the Department, 40 
in consultation with the Office, must: 41 
 (a) Develop, solicit and accept applications for those grants. An 42 
application submitted by a regional, local or tribal governmental 43 
entity must include, without limitation: 44   
 	– 22 – 
 
 
- 	*SB337* 
  (1) The results of a needs assessment that meets the 1 
requirements of NRS 433.742; and 2 
  (2) A plan for the use of the grant that meets the 3 
requirements of NRS 433.744. 4 
 (b) Coordinate with and provide support to regional, local and 5 
tribal governmental entities in conducting needs assessments and 6 
developing plans pursuant to paragraph (a). 7 
 (c) Consider any money recovered or anticipated to be recovered 8 
by county, local or tribal governmental agencies through judgments 9 
received or settlements entered into as a result of litigation 10 
concerning the manufacture, distribution, sale or marketing of 11 
opioids. 12 
 (d) Conduct annual evaluations of programs to which grants 13 
have been awarded. 14 
 2.  To the extent authorized by the terms of any judgment or 15 
settlement described in subsection 1 of NRS 433.732, the recipient 16 
of a grant pursuant to paragraph (b) of subsection [2] 3 of NRS 17 
433.738 may use not more than 8 percent of the grant for 18 
administrative expenses related to the grant or the projects supported 19 
by the grant. 20 
 3.  The recipient of a grant pursuant to paragraph (b) of 21 
subsection [2] 3 of NRS 433.738 shall annually submit to the 22 
Department a report concerning the expenditure of the money that 23 
was received and the outcomes of the projects on which that money 24 
was spent. 25 
 4.  If a regional, local or tribal governmental entity that receives 26 
a grant pursuant to paragraph (b) of subsection [2] 3 of NRS 27 
433.738 later recovers money through a judgment or a settlement 28 
resulting from litigation concerning the manufacture, distribution, 29 
sale or marketing of opioids: 30 
 (a) The regional, local or tribal governmental entity must 31 
immediately notify the Department; and 32 
 (b) The Department may recover from the governmental entity 33 
an amount not to exceed the amount of the grant or the amount of 34 
the recovery, whichever is less. 35 
 5.  A regional, local or tribal governmental entity that receives a 36 
grant pursuant to paragraph (b) of subsection [2] 3 of NRS 433.738 37 
shall conduct a new needs assessment and update its plan for the use 38 
of the grant at intervals prescribed by regulation of the Department, 39 
which must be not less than every 4 years. 40 
 Sec. 33.  Chapter 630 of NRS is hereby amended by adding 41 
thereto a new section to read as follows: 42 
 1. A physician or physician assistant who prescribes or 43 
administers opioids shall: 44   
 	– 23 – 
 
 
- 	*SB337* 
 (a) Comply with the requirements of sections 8 to 23, inclusive, 1 
of this act, and any regulations adopted pursuant thereto; and 2 
 (b) Offer to a patient an alternative treatment that does not 3 
utilize an opioid before prescribing, administering or directing or 4 
supervising the administration of an opioid to the patient for the 5 
first time unless: 6 
  (1) In the opinion of the physician or physician assistant, 7 
there is no treatment that does not utilize an opioid that is suitable 8 
for treating the patient; or 9 
  (2) It is not practicable to offer such an alternative 10 
treatment to the patient.  11 
 2. Except as otherwise provided in subsection 1 and section 12 
19 of this act, if a patient or his or her legal guardian has executed 13 
a non-opioid directive or states that the patient wishes to receive 14 
an alternative treatment that does not utilize an opioid, the 15 
physician or physician assistant shall provide such a treatment. 16 
 3. During each even-numbered year, the Board shall review 17 
compliance with the requirements of this section by each 18 
physician and physician assistant who prescribes or administers 19 
opioids to patients. 20 
 4. As used in this section, “non-opioid directive” has the 21 
meaning ascribed to it in section 9 of this act. 22 
 Sec. 34.  NRS 630.3066 is hereby amended to read as follows: 23 
 630.3066 A physician is not subject to disciplinary action 24 
solely for: 25 
 1.  Prescribing or administering to a patient under his or her 26 
care a controlled substance which is listed in schedule II, III, IV or 27 
V by the State Board of Pharmacy pursuant to NRS 453.146, if the 28 
controlled substance is lawfully prescribed or administered for the 29 
treatment of intractable pain in accordance with the provisions of 30 
section 33 of this act and NRS 639.23507 and 639.2391 to 31 
639.23916, inclusive, any regulations adopted by the State Board of 32 
Pharmacy pursuant thereto and any other regulations adopted by the 33 
Board of Medical Examiners. 34 
 2.  Engaging in any activity in accordance with the provisions 35 
of chapter 678C of NRS. 36 
 Sec. 35.  Chapter 631 of NRS is hereby amended by adding 37 
thereto a new section to read as follows: 38 
 1. A dentist who prescribes or administers opioids shall: 39 
 (a) Comply with the requirements of sections 8 to 23, inclusive, 40 
of this act, and any regulations adopted pursuant thereto; and 41 
 (b) Offer to a patient an alternative treatment that does not 42 
utilize an opioid before prescribing, administering or directing or 43 
supervising the administration of an opioid to the patient for the 44 
first time unless: 45   
 	– 24 – 
 
 
- 	*SB337* 
  (1) In the opinion of the dentist, there is no treatment that 1 
does not utilize an opioid that is suitable for treating the patient; 2 
or 3 
  (2) It is not practicable to offer such an alternative 4 
treatment to the patient.  5 
 2. Except as otherwise provided in subsection 1 and section 6 
19 of this act, if a patient or his or her legal guardian has executed 7 
a non-opioid directive or states that the patient wishes to receive 8 
an alternative treatment that does not utilize an opioid, the dentist 9 
shall provide such a treatment. 10 
 3. During each even-numbered year, the Board shall review 11 
compliance with the requirements of this section by each dentist 12 
who prescribes or administers opioids to patients. 13 
 4. As used in this section, “non-opioid directive” has the 14 
meaning ascribed to it in section 9 of this act. 15 
 Sec. 36.  Chapter 632 of NRS is hereby amended by adding 16 
thereto a new section to read as follows: 17 
 1. An advanced practice registered nurse or certified 18 
registered nurse anesthetist who prescribes or administers opioids 19 
shall: 20 
 (a) Comply with the requirements of sections 8 to 23, inclusive, 21 
of this act, and any regulations adopted pursuant thereto; and 22 
 (b) Offer to a patient an alternative treatment that does not 23 
utilize an opioid before prescribing, administering or directing or 24 
supervising the administration of an opioid to the patient for the 25 
first time unless: 26 
  (1) In the opinion of the advanced practice registered nurse 27 
or certified registered nurse anesthetist, there is no treatment that 28 
does not utilize an opioid that is suitable for treating the patient; 29 
or 30 
  (2) It is not practicable to offer such an alternative 31 
treatment to the patient.  32 
 2. A registered nurse who administers opioids shall: 33 
 (a) Comply with the requirements of sections 8 to 23, inclusive, 34 
of this act and any regulations adopted pursuant thereto; and 35 
 (b) Offer to a patient an alternative treatment that does not 36 
utilize an opioid before administering an opioid to the patient for 37 
the first time unless: 38 
  (1) In the opinion of the physician, physician assistant, 39 
dentist, podiatric physician or advanced practice registered nurse 40 
who is directing the care of the patient, there is no treatment that 41 
does not utilize an opioid that is suitable for treating the patient; 42 
or 43 
  (2) It is not practicable to offer such an alternative 44 
treatment to the patient.  45   
 	– 25 – 
 
 
- 	*SB337* 
 3. Except as otherwise provided in subsection 1 and section 1 
19 of this act, if a patient or his or her legal guardian has executed 2 
a non-opioid directive or states that the patient wishes to receive 3 
an alternative treatment that does not utilize an opioid, the 4 
advanced practice registered nurse, certified registered nurse 5 
anesthetist or registered nurse shall provide such a treatment. 6 
 4. During each even-numbered year, the Board shall review 7 
compliance with the requirements of this section by each advanced 8 
practice registered nurse or certified registered nurse anesthetist 9 
who prescribes or administers opioids to patients and each 10 
registered nurse who administers opioids to patients. 11 
 5. As used in this section, “non-opioid directive” has the 12 
meaning ascribed to it in section 9 of this act.  13 
 Sec. 37.  Chapter 633 of NRS is hereby amended by adding 14 
thereto a new section to read as follows: 15 
 1. An osteopathic physician or physician assistant who 16 
prescribes or administers opioids shall: 17 
 (a) Comply with the requirements of sections 8 to 23, inclusive, 18 
of this act, and any regulations adopted pursuant thereto; and 19 
 (b) Offer to a patient an alternative treatment that does not 20 
utilize an opioid before prescribing, administering or directing or 21 
supervising the administration of an opioid to the patient for the 22 
first time unless: 23 
  (1) In the opinion of the osteopathic physician or physician 24 
assistant, there is no treatment that does not utilize an opioid that 25 
is suitable for treating the patient; or 26 
  (2) It is not practicable to offer such an alternative 27 
treatment to the patient.  28 
 2. Except as otherwise provided in subsection 1 and section 29 
19 of this act, if a patient or his or her legal guardian has executed 30 
a non-opioid directive or states that the patient wishes to receive 31 
an alternative treatment that does not utilize an opioid, the 32 
osteopathic physician or physician assistant shall provide such a 33 
treatment. 34 
 3. During each even-numbered year, the Board shall review 35 
compliance with the requirements of this section by each 36 
osteopathic physician or physician assistant who prescribes or 37 
administers opioids to patients. 38 
 4. As used in this section, “non-opioid directive” has the 39 
meaning ascribed to it in section 9 of this act. 40 
 Sec. 38.  NRS 633.521 is hereby amended to read as follows: 41 
 633.521 An osteopathic physician is not subject to disciplinary 42 
action solely for: 43 
 1.  Prescribing or administering to a patient under his or her 44 
care: 45   
 	– 26 – 
 
 
- 	*SB337* 
 (a) Amygdalin (laetrile), if the patient has consented to the use 1 
of the substance. 2 
 (b) Procaine hydrochloride with preservatives and stabilizers 3 
(Gerovital H3). 4 
 (c) A controlled substance which is listed in schedule II, III, IV 5 
or V by the State Board of Pharmacy pursuant to NRS 453.146, if 6 
the controlled substance is lawfully prescribed or administered for 7 
the treatment of intractable pain in accordance with the provisions 8 
of NRS 639.23507 and 639.2391 to 639.23916, inclusive, and 9 
section 37 of this act and any regulations adopted by the State 10 
Board of Pharmacy pursuant thereto and the accepted standards for 11 
the practice of osteopathic medicine. 12 
 2.  Engaging in any activity in accordance with the provisions 13 
of chapter 678C of NRS. 14 
 Sec. 39.  Chapter 635 of NRS is hereby amended by adding 15 
thereto a new section to read as follows: 16 
 1. A podiatric physician who prescribes or administers 17 
opioids shall: 18 
 (a) Comply with the requirements of sections 8 to 23, inclusive, 19 
of this act, and any regulations adopted pursuant thereto; and 20 
 (b) Offer to a patient an alternative treatment that does not 21 
utilize an opioid before prescribing, administering or directing or 22 
supervising the administration of an opioid to the patient for the 23 
first time unless: 24 
  (1) In the opinion of the podiatric physician, there is no 25 
treatment that does not utilize an opioid that is suitable for 26 
treating the patient; or 27 
  (2) It is not practicable to offer such an alternative 28 
treatment to the patient.  29 
 2. Except as otherwise provided in subsection 1 and section 30 
19 of this act, if a patient or his or her legal guardian has executed 31 
a non-opioid directive or states that the patient wishes to receive 32 
an alternative treatment that does not utilize an opioid, the 33 
podiatric physician shall provide such a treatment. 34 
 3. During each even-numbered year, the Board shall review 35 
compliance with the requirements of this section by each podiatric 36 
physician who prescribes or administers opioids to patients. 37 
 4. As used in this section, “non-opioid directive” has the 38 
meaning ascribed to it in section 9 of this act.  39 
 Sec. 40.  NRS 636.2882 is hereby amended to read as follows: 40 
 636.2882 1. An optometrist who is certified to administer and 41 
prescribe a pharmaceutical agent pursuant to NRS 636.288 shall not 42 
prescribe a controlled substance unless the optometrist: 43 
 [1.] (a) Has completed an optometric examination of the patient 44 
for whom the controlled substance is prescribed; 45   
 	– 27 – 
 
 
- 	*SB337* 
 [2.] (b) Prescribes the controlled substance in an amount that 1 
does not exceed 90 morphine milligram equivalents per day and will 2 
not last more than 72 hours; and 3 
 [3.] (c) Sets forth in the prescription for the controlled 4 
substance that the prescription may not be refilled without a 5 
subsequent examination of the patient by the optometrist. 6 
 2. An optometrist who prescribes or administers opioids shall: 7 
 (a) Comply with the requirements of sections 8 to 23, inclusive, 8 
of this act, and any regulations adopted pursuant thereto; and 9 
 (b) Offer to a patient an alternative treatment that does not 10 
utilize an opioid before prescribing, administering or directing or 11 
supervising the administration of an opioid to the patient for the 12 
first time unless: 13 
  (1) In the opinion of the optometrist, there is no treatment 14 
that does not utilize an opioid that is suitable for treating the 15 
patient; or 16 
  (2) It is not practicable to offer such an alternative 17 
treatment to the patient.  18 
 3. Except as otherwise provided in subsection 2 and section 19 
19 of this act, if a patient or his or her legal guardian has executed 20 
a non-opioid directive or states that the patient wishes to receive 21 
an alternative treatment that does not utilize an opioid, the 22 
optometrist shall provide such a treatment. 23 
 4. During each even-numbered year, the Board shall review 24 
compliance with the requirements of this section by each 25 
optometrist who prescribes or administers opioids to patients. 26 
 5. As used in this section, “non-opioid directive” has the 27 
meaning ascribed to it in section 9 of this act. 28 
 Sec. 41.  NRS 654.190 is hereby amended to read as follows: 29 
 654.190 1.  The Board may, after notice and an opportunity 30 
for a hearing as required by law, impose an administrative fine of 31 
not more than $10,000 for each violation on, recover reasonable 32 
investigative fees and costs incurred from, suspend, revoke, deny 33 
the issuance or renewal of or place conditions on the license of, and 34 
place on probation or impose any combination of the foregoing on 35 
any licensee who: 36 
 (a) Is convicted of a felony relating to the practice of 37 
administering a facility for skilled nursing or facility for 38 
intermediate care or residential facility for groups or of any offense 39 
involving moral turpitude. 40 
 (b) Has obtained his or her license by the use of fraud or deceit. 41 
 (c) Violates any of the provisions of this chapter. 42 
 (d) Aids or abets any person in the violation of any of the 43 
provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of 44 
this act, or 449A.100 to 449A.124, inclusive, and 449A.270 to 45   
 	– 28 – 
 
 
- 	*SB337* 
449A.286, inclusive, as those provisions pertain to a facility for 1 
skilled nursing, facility for intermediate care or residential facility 2 
for groups. 3 
 (e) Violates any regulation of the Board prescribing additional 4 
standards of conduct for licensees, including, without limitation, a 5 
code of ethics. 6 
 (f) Engages in conduct that violates the trust of a patient or 7 
resident or exploits the relationship between the licensee and the 8 
patient or resident for the financial or other gain of the licensee. 9 
 2.  If a licensee requests a hearing pursuant to subsection 1, the 10 
Board shall give the licensee written notice of a hearing pursuant to 11 
NRS 233B.121 and 241.0333. A licensee may waive, in writing, his 12 
or her right to attend the hearing. 13 
 3.  The Board may compel the attendance of witnesses or the 14 
production of documents or objects by subpoena. The Board may 15 
adopt regulations that set forth a procedure pursuant to which the 16 
Chair of the Board may issue subpoenas on behalf of the Board. 17 
Any person who is subpoenaed pursuant to this subsection may 18 
request the Board to modify the terms of the subpoena or grant 19 
additional time for compliance. 20 
 4.  An order that imposes discipline and the findings of fact and 21 
conclusions of law supporting that order are public records. 22 
 5.  The expiration of a license by operation of law or by order 23 
or decision of the Board or a court, or the voluntary surrender of a 24 
license, does not deprive the Board of jurisdiction to proceed with 25 
any investigation of, or action or disciplinary proceeding against, the 26 
licensee or to render a decision suspending or revoking the license. 27 
 Sec. 42.  NRS 687B.225 is hereby amended to read as follows: 28 
 687B.225 1.  Except as otherwise provided in NRS 29 
689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 30 
689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 31 
689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 32 
689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 33 
695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 34 
695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 35 
695B.1925, 695B.1942, 695C.1696, 695C.1699, 695C.1713, 36 
695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 37 
695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 38 
695G.1719 and 695G.177, and sections 43, 45, 46, 48, 49, 50 and 39 
53 of this act, any contract for group, blanket or individual health 40 
insurance or any contract by a nonprofit hospital, medical or dental 41 
service corporation or organization for dental care which provides 42 
for payment of a certain part of medical or dental care may require 43 
the insured or member to obtain prior authorization for that care 44 
from the insurer or organization. The insurer or organization shall: 45   
 	– 29 – 
 
 
- 	*SB337* 
 (a) File its procedure for obtaining approval of care pursuant to 1 
this section for approval by the Commissioner; and 2 
 (b) Unless a shorter time period is prescribed by a specific 3 
statute, including, without limitation, NRS 689A.0446, 689B.0361, 4 
689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703, 5 
respond to any request for approval by the insured or member 6 
pursuant to this section within 20 days after it receives the request. 7 
 2.  The procedure for prior authorization may not discriminate 8 
among persons licensed to provide the covered care. 9 
 Sec. 43.  Chapter 689A of NRS is hereby amended by adding 10 
thereto a new section to read as follows: 11 
 1. An insurer that offers or issues a policy of health 12 
insurance shall: 13 
 (a) Comply with subsection 2 of section 16 of this act; and  14 
 (b) Include in the policy coverage for at least one alternative to 15 
an opioid that is effective for each purpose for which: 16 
  (1) An opioid is commonly used; and  17 
  (2) A non-opioid alternative is available. 18 
 2. An insurer shall not: 19 
 (a) Require prior authorization for the benefits described in 20 
paragraph (b) of subsection 1 if such prior authorization would 21 
not be required for an opioid under the same circumstances; or 22 
 (b) Impose other requirements on the benefits described in 23 
paragraph (b) of subsection 1 that would not be imposed on an 24 
opioid used under the same circumstances. 25 
 3. A policy of health insurance subject to the provisions of 26 
this chapter that is delivered, issued for delivery or renewed on or 27 
after January 1, 2026, has the legal effect of including the 28 
coverage required by this section, and any provision of the policy 29 
that conflicts with the provisions of this section is void. 30 
 4. As used in this section, “non-opioid directive” has the 31 
meaning ascribed to it in section 9 of this act. 32 
 Sec. 44.  NRS 689A.330 is hereby amended to read as follows: 33 
 689A.330 If any policy is issued by a domestic insurer for 34 
delivery to a person residing in another state, and if the insurance 35 
commissioner or corresponding public officer of that other state has 36 
informed the Commissioner that the policy is not subject to approval 37 
or disapproval by that officer, the Commissioner may by ruling 38 
require that the policy meet the standards set forth in NRS 689A.030 39 
to 689A.320, inclusive [.] , and section 43 of this act. 40 
 Sec. 45.  Chapter 689B of NRS is hereby amended by adding 41 
thereto a new section to read as follows: 42 
 1. An insurer that offers or issues a policy of group health 43 
insurance shall: 44 
 (a) Comply with subsection 2 of section 16 of this act; and  45   
 	– 30 – 
 
 
- 	*SB337* 
 (b) Include in the policy coverage for at least one alternative to 1 
an opioid that is effective for each purpose for which: 2 
  (1) An opioid is commonly used; and  3 
  (2) A non-opioid alternative is available. 4 
 2. An insurer shall not: 5 
 (a) Require prior authorization for the benefits described in 6 
paragraph (b) of subsection 1 if such prior authorization would 7 
not be required for an opioid under the same circumstances; or 8 
 (b) Impose other requirements on the benefits described in 9 
paragraph (b) of subsection 1 that would not be imposed on an 10 
opioid used under the same circumstances. 11 
 3. A policy of group health insurance subject to the 12 
provisions of this chapter that is delivered, issued for delivery or 13 
renewed on or after January 1, 2026, has the legal effect of 14 
including the coverage required by this section, and any provision 15 
of the policy that conflicts with the provisions of this section is 16 
void. 17 
 4. As used in this section, “non-opioid directive” has the 18 
meaning ascribed to it in section 9 of this act. 19 
 Sec. 46.  Chapter 689C of NRS is hereby amended by adding 20 
thereto a new section to read as follows: 21 
 1. A carrier that offers or issues a health benefit plan shall: 22 
 (a) Comply with subsection 2 of section 16 of this act; and  23 
 (b) Include in the plan coverage for at least one alternative to 24 
an opioid that is effective for each purpose for which: 25 
  (1) An opioid is commonly used; and  26 
  (2) A non-opioid alternative is available. 27 
 2. A carrier shall not: 28 
 (a) Require prior authorization for the benefits described in 29 
paragraph (b) of subsection 1 if such prior authorization would 30 
not be required for an opioid under the same circumstances; or 31 
 (b) Impose other requirements on the benefits described in 32 
paragraph (b) of subsection 1 that would not be imposed on an 33 
opioid used under the same circumstances. 34 
 3. A health benefit plan subject to the provisions of this 35 
chapter that is delivered, issued for delivery or renewed on or after 36 
January 1, 2026, has the legal effect of including the coverage 37 
required by this section, and any provision of the plan that 38 
conflicts with the provisions of this section is void. 39 
 4. As used in this section, “non-opioid directive” has the 40 
meaning ascribed to it in section 9 of this act. 41 
 Sec. 47.  NRS 689C.425 is hereby amended to read as follows: 42 
 689C.425 A voluntary purchasing group and any contract 43 
issued to such a group pursuant to NRS 689C.360 to 689C.600, 44 
inclusive, are subject to the provisions of NRS 689C.015 to 45   
 	– 31 – 
 
 
- 	*SB337* 
689C.355, inclusive, and section 46 of this act to the extent 1 
applicable and not in conflict with the express provisions of NRS 2 
687B.408 and 689C.360 to 689C.600, inclusive. 3 
 Sec. 48.  Chapter 695A of NRS is hereby amended by adding 4 
thereto a new section to read as follows: 5 
 1. A society that offers or issues a benefit contract shall: 6 
 (a) Comply with subsection 2 of section 16 of this act; and  7 
 (b) Include in the contract coverage for at least one alternative 8 
to an opioid that is effective for each purpose for which: 9 
  (1) An opioid is commonly used; and  10 
  (2) A non-opioid alternative is available. 11 
 2. A society shall not: 12 
 (a) Require prior authorization for the benefits described in 13 
paragraph (b) of subsection 1 if such prior authorization would 14 
not be required for an opioid under the same circumstances; or 15 
 (b) Impose other requirements on the benefits described in 16 
paragraph (b) of subsection 1 that would not be imposed on an 17 
opioid used under the same circumstances. 18 
 3. A benefit contract subject to the provisions of this chapter 19 
that is delivered, issued for delivery or renewed on or after 20 
January 1, 2026, has the legal effect of including the coverage 21 
required by this section, and any provision of the contract that 22 
conflicts with the provisions of this section is void. 23 
 4. As used in this section, “non-opioid directive” has the 24 
meaning ascribed to it in section 9 of this act. 25 
 Sec. 49.  Chapter 695B of NRS is hereby amended by adding 26 
thereto a new section to read as follows: 27 
 1. A hospital or medical services corporation that offers or 28 
issues a policy of health insurance shall: 29 
 (a) Comply with subsection 2 of section 16 of this act; and  30 
 (b) Include in the policy coverage for at least one alternative to 31 
an opioid that is effective for each purpose for which: 32 
  (1) An opioid is commonly used; and  33 
  (2) A non-opioid alternative is available. 34 
 2. A hospital or medical services corporation shall not: 35 
 (a) Require prior authorization for the benefits described in 36 
paragraph (b) of subsection 1 if such prior authorization would 37 
not be required for an opioid under the same circumstances; or 38 
 (b) Impose other requirements on the benefits described in 39 
paragraph (b) of subsection 1 that would not be imposed on an 40 
opioid used under the same circumstances. 41 
 3. A policy of health insurance subject to the provisions of 42 
this chapter that is delivered, issued for delivery or renewed on or 43 
after January 1, 2026, has the legal effect of including the 44   
 	– 32 – 
 
 
- 	*SB337* 
coverage required by this section, and any provision of the policy 1 
that conflicts with the provisions of this section is void. 2 
 4. As used in this section, “non-opioid directive” has the 3 
meaning ascribed to it in section 9 of this act. 4 
 Sec. 50.  Chapter 695C of NRS is hereby amended by adding 5 
thereto a new section to read as follows: 6 
 1. A health maintenance organization that offers or issues a 7 
health care plan shall: 8 
 (a) Comply with subsection 2 of section 16 of this act; and  9 
 (b) Include in the plan coverage for at least one alternative to 10 
an opioid that is effective for each purpose for which: 11 
  (1) An opioid is commonly used; and  12 
  (2) A non-opioid alternative is available. 13 
 2. A health maintenance organization shall not: 14 
 (a) Require prior authorization for the benefits described in 15 
paragraph (b) of subsection 1 if such prior authorization would 16 
not be required for an opioid under the same circumstances; or 17 
 (b) Impose other requirements on the benefits described in 18 
paragraph (b) of subsection 1 that would not be imposed on an 19 
opioid used under the same circumstances. 20 
 3. A health care plan subject to the provisions of this chapter 21 
that is delivered, issued for delivery or renewed on or after 22 
January 1, 2026, has the legal effect of including the coverage 23 
required by this section, and any provision of the plan that 24 
conflicts with the provisions of this section is void. 25 
 4. As used in this section, “non-opioid directive” has the 26 
meaning ascribed to it in section 9 of this act. 27 
 Sec. 51.  NRS 695C.050 is hereby amended to read as follows: 28 
 695C.050 1.  Except as otherwise provided in this chapter or 29 
in specific provisions of this title, the provisions of this title are not 30 
applicable to any health maintenance organization granted a 31 
certificate of authority under this chapter. This provision does not 32 
apply to an insurer licensed and regulated pursuant to this title 33 
except with respect to its activities as a health maintenance 34 
organization authorized and regulated pursuant to this chapter. 35 
 2.  Solicitation of enrollees by a health maintenance 36 
organization granted a certificate of authority, or its representatives, 37 
must not be construed to violate any provision of law relating to 38 
solicitation or advertising by practitioners of a healing art. 39 
 3.  Any health maintenance organization authorized under this 40 
chapter shall not be deemed to be practicing medicine and is exempt 41 
from the provisions of chapter 630 of NRS. 42 
 4.  The provisions of NRS 695C.110, 695C.125, 695C.1691, 43 
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 44 
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 45   
 	– 33 – 
 
 
- 	*SB337* 
695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 1 
inclusive, and 695C.265 do not apply to a health maintenance 2 
organization that provides health care services through managed 3 
care to recipients of Medicaid under the State Plan for Medicaid or 4 
insurance pursuant to the Children’s Health Insurance Program 5 
pursuant to a contract with the Division of Health Care Financing 6 
and Policy of the Department of Health and Human Services. This 7 
subsection does not exempt a health maintenance organization from 8 
any provision of this chapter for services provided pursuant to any 9 
other contract. 10 
 5.  The provisions of NRS 695C.16932 to 695C.1699, 11 
inclusive, and section 50 of this act, 695C.1701, 695C.1708, 12 
695C.1728, 695C.1731, 695C.17333, 695C.17345, 695C.17347, 13 
695C.1736 to 695C.1745, inclusive, 695C.1757 and 695C.204 apply 14 
to a health maintenance organization that provides health care 15 
services through managed care to recipients of Medicaid under the 16 
State Plan for Medicaid. 17 
 6.  The provisions of NRS 695C.17095 do not apply to a health 18 
maintenance organization that provides health care services to 19 
members of the Public Employees’ Benefits Program. This 20 
subsection does not exempt a health maintenance organization from 21 
any provision of this chapter for services provided pursuant to any 22 
other contract. 23 
 7.  The provisions of NRS 695C.1735 do not apply to a health 24 
maintenance organization that provides health care services to: 25 
 (a) The officers and employees, and the dependents of officers 26 
and employees, of the governing body of any county, school district, 27 
municipal corporation, political subdivision, public corporation or 28 
other local governmental agency of this State; or 29 
 (b) Members of the Public Employees’ Benefits Program.  30 
 This subsection does not exempt a health maintenance 31 
organization from any provision of this chapter for services 32 
provided pursuant to any other contract. 33 
 Sec. 52.  NRS 695C.330 is hereby amended to read as follows: 34 
 695C.330 1.  The Commissioner may suspend or revoke any 35 
certificate of authority issued to a health maintenance organization 36 
pursuant to the provisions of this chapter if the Commissioner finds 37 
that any of the following conditions exist: 38 
 (a) The health maintenance organization is operating 39 
significantly in contravention of its basic organizational document, 40 
its health care plan or in a manner contrary to that described in and 41 
reasonably inferred from any other information submitted pursuant 42 
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 43 
to those submissions have been filed with and approved by the 44 
Commissioner; 45   
 	– 34 – 
 
 
- 	*SB337* 
 (b) The health maintenance organization issues evidence of 1 
coverage or uses a schedule of charges for health care services 2 
which do not comply with the requirements of NRS 695C.1691 to 3 
695C.200, inclusive, and section 50 of this act, 695C.204 or 4 
695C.207; 5 
 (c) The health care plan does not furnish comprehensive health 6 
care services as provided for in NRS 695C.060; 7 
 (d) The Commissioner certifies that the health maintenance 8 
organization: 9 
  (1) Does not meet the requirements of subsection 1 of NRS 10 
695C.080; or 11 
  (2) Is unable to fulfill its obligations to furnish health care 12 
services as required under its health care plan; 13 
 (e) The health maintenance organization is no longer financially 14 
responsible and may reasonably be expected to be unable to meet its 15 
obligations to enrollees or prospective enrollees; 16 
 (f) The health maintenance organization has failed to put into 17 
effect a mechanism affording the enrollees an opportunity to 18 
participate in matters relating to the content of programs pursuant to 19 
NRS 695C.110; 20 
 (g) The health maintenance organization has failed to put into 21 
effect the system required by NRS 695C.260 for: 22 
  (1) Resolving complaints in a manner reasonably to dispose 23 
of valid complaints; and 24 
  (2) Conducting external reviews of adverse determinations 25 
that comply with the provisions of NRS 695G.241 to 695G.310, 26 
inclusive; 27 
 (h) The health maintenance organization or any person on its 28 
behalf has advertised or merchandised its services in an untrue, 29 
misrepresentative, misleading, deceptive or unfair manner; 30 
 (i) The continued operation of the health maintenance 31 
organization would be hazardous to its enrollees or creditors or to 32 
the general public; 33 
 (j) The health maintenance organization fails to provide the 34 
coverage required by NRS 695C.1691; or 35 
 (k) The health maintenance organization has otherwise failed to 36 
comply substantially with the provisions of this chapter. 37 
 2.  A certificate of authority must be suspended or revoked only 38 
after compliance with the requirements of NRS 695C.340. 39 
 3.  If the certificate of authority of a health maintenance 40 
organization is suspended, the health maintenance organization shall 41 
not, during the period of that suspension, enroll any additional 42 
groups or new individual contracts, unless those groups or persons 43 
were contracted for before the date of suspension. 44   
 	– 35 – 
 
 
- 	*SB337* 
 4.  If the certificate of authority of a health maintenance 1 
organization is revoked, the organization shall proceed, immediately 2 
following the effective date of the order of revocation, to wind up its 3 
affairs and shall conduct no further business except as may be 4 
essential to the orderly conclusion of the affairs of the organization. 5 
It shall engage in no further advertising or solicitation of any kind. 6 
The Commissioner may, by written order, permit such further 7 
operation of the organization as the Commissioner may find to be in 8 
the best interest of enrollees to the end that enrollees are afforded 9 
the greatest practical opportunity to obtain continuing coverage for 10 
health care. 11 
 Sec. 53.  Chapter 695G of NRS is hereby amended by adding 12 
thereto a new section to read as follows: 13 
 1. A managed care organization that offers or issues a health 14 
care plan shall: 15 
 (a) Comply with subsection 2 of section 16 of this act; and  16 
 (b) Include in the plan coverage for at least one alternative to 17 
an opioid that is effective for each purpose for which: 18 
  (1) An opioid is commonly used; and  19 
  (2) A non-opioid alternative is available. 20 
 2. A managed care organization shall not: 21 
 (a) Require prior authorization for the benefits described in 22 
paragraph (b) of subsection 1 if such prior authorization would 23 
not be required for an opioid under the same circumstances; or 24 
 (b) Impose other requirements on the benefits described in 25 
paragraph (b) of subsection 1 that would not be imposed on an 26 
opioid used under the same circumstances. 27 
 3. A health care plan subject to the provisions of this chapter 28 
that is delivered, issued for delivery or renewed on or after 29 
January 1, 2026, has the legal effect of including the coverage 30 
required by this section, and any provision of the plan that 31 
conflicts with the provisions of this section is void. 32 
 4. As used in this section, “non-opioid directive” has the 33 
meaning ascribed to it in section 9 of this act. 34 
 Sec. 54.  Chapter 695K of NRS is hereby amended by adding 35 
thereto a new section to read as follows: 36 
 1. If the Division of Public and Behavioral Health of the 37 
Department of Health and Human Services finds that a health 38 
care facility has violated section 1 of this act or a practitioner 39 
licensing board finds that a practitioner has violated section 33, 40 
35, 36, 37 or 39 of this act or NRS 636.2882, the Director may: 41 
 (a) Reduce the reimbursement rates received by the health 42 
care facility or practitioner, as applicable, from the Public Option; 43 
or 44   
 	– 36 – 
 
 
- 	*SB337* 
 (b) Prohibit the health care facility or practitioner, as 1 
applicable, from receiving payments through the insurance 2 
provided through the Public Option. 3 
 2. The Director of the Department of Health and Human 4 
Services shall include in any contract with a health care facility or 5 
practitioner notice of the actions the Director may take pursuant 6 
to subsection 1. 7 
 3. As used in this section: 8 
 (a) “Health care facility” means a medical facility, as defined 9 
in NRS 449.0151, or a facility which is required by the regulations 10 
adopted by the State Board of Health pursuant to NRS 449.0303 to 11 
be licensed. 12 
 (b) “Practitioner” has the meaning ascribed to it in  13 
NRS 639.0125. 14 
 (c) “Practitioner licensing board” means a board created 15 
pursuant to chapter 630, 631, 632, 633, 635 or 636 of NRS. 16 
 Sec. 55.  1. The Department of Health and Human Services 17 
may continue to utilize the statewide plan created pursuant to 18 
paragraph (b) of subsection 1 of NRS 433.734 that is in effect on 19 
January 1, 2026. The Department shall comply with the provisions 20 
of NRS 433.738, as amended by section 31 of this act, when 21 
revising the statewide plan. 22 
 2. Notwithstanding the amendatory provisions of sections 1, 23 
16, 33, 35, 36, 37 and 39 of this act and NRS 636.2882, as amended 24 
by section 40 of this act: 25 
 (a) A medical facility or facility which is required by the 26 
regulations adopted by the Board pursuant to NRS 449.0303 to be 27 
licensed that administers opioids to patients is not required to offer 28 
treatments that are alternatives to opioids to patients or require 29 
practitioners who provide care at the facility to take any action 30 
described in paragraph (b) until January 1, 2027; 31 
 (b) A practitioner who prescribes or administers opioids or a 32 
registered nurse who administers opioids is not required to explain 33 
to the patient or his or her legal guardian that the patient or legal 34 
guardian, as applicable, may execute a non-opioid directive, provide 35 
the non-opioid directive to a patient or his or her legal guardian or 36 
offer treatments that are alternatives to opioids until January 1, 37 
2027; 38 
 (c) The Division of Public and Behavioral Health of the 39 
Department of Health and Human Services may not review the 40 
compliance of medical facilities and facilities which are required by 41 
the regulations adopted pursuant to NRS 449.0303 to be licensed 42 
with the requirements of section 1 of this act until July 1, 2028; and  43 
 (d) A practitioner licensing board may not review the 44 
compliance of practitioners and registered nurses with the 45   
 	– 37 – 
 
 
- 	*SB337* 
requirements of sections 33, 35, 36, 37 and 39 of this act and NRS 1 
636.2882, as amended by section 40 of this act until July 1, 2028. 2 
 3. A practitioner or registered nurse who discovers on or before 3 
January 1, 2027, that a patient is a non-opioid patient and is unable 4 
to offer a treatment that is an alternative to an opioid to the patient 5 
shall, where the practitioner or registered nurse would otherwise be 6 
required by section 33, 35, 36, 37 or 39 of this act or NRS 636.2882, 7 
as amended by section 40 of this act to offer such an alternative 8 
treatment, refer the patient to a provider of health care who is able to 9 
offer such a treatment. 10 
 4. As used in this section: 11 
 (a) “Medical facility” has the meaning ascribed to it in  12 
NRS 449.0151. 13 
 (b) “Non-opioid directive” has the meaning ascribed to it in 14 
section 9 of this act. 15 
 (c) “Non-opioid patient” has the meaning ascribed to it in 16 
section 10 of this act. 17 
 (d) “Practitioner” has the meaning ascribed to it in section 11 of 18 
this act. 19 
 (e) “Practitioner licensing board” has the meaning ascribed to it 20 
in section 12 of this act. 21 
 Sec. 56.  The provisions of NRS 354.599 do not apply to any 22 
additional expenses of a local government that are related to the 23 
provisions of this act. 24 
 Sec. 57.  1. This section becomes effective upon passage and 25 
approval. 26 
 2. Sections 1 to 56, inclusive, of this act become effective: 27 
 (a) Upon passage and approval for the purpose of adopting any 28 
regulations and performing any other preparatory administrative 29 
tasks that are necessary to carry out the provisions of this act; and  30 
 (b) On January 1, 2026, for all other purposes. 31 
 
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