EXEMPT
(Reprinted with amendments adopted on June 5, 2023)
THIRD REPRINT S.B. 400
- *SB 400 _R3 *
SENATE BILL NO. 400–SENATORS NEAL, FLORES AND DONATE
MARCH 27, 2023
____________
JOINT SPONSOR: ASSEMBLYMAN D’SILVA
____________
Referred to Committee on Revenue and
Economic Development
SUMMARY—Revises provisions relating to homelessness.
(BDR 38-1027)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: No.
CONTAINS UNFUNDED MANDATE (§ 3.3)
(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 public welfare; revising provisions governing
the duties of a reinvestment advisory committee; revising
provisions governing contracts entered into by the
Department of Health and Human Services for the
operation of a Medicaid managed care program; requiring
the Department to establish the Fiscal Advisory
Committee for a Flexible Continuum of Care Plan;
making appropriations; and providing other matters
properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires the Department of Health and Human Services, to the 1
extent that money is available, to: (1) establish a Medicaid managed care program 2
to provide health care services to recipients of Medicaid in all geographic areas of 3
this State; and (2) conduct a statewide procurement process to select health 4
maintenance organizations to provide the health care services. (NRS 422.273) 5
Sections 2 and 3 of this bill require each contract entered into by the Department 6
with a health maintenance organization to provide such services to include a 7
requirement for the health maintenance organization to reinvest a percentage of the 8
annual profits of the health maintenance organization in programs and initiatives to 9
address homelessness and to provide sustainable medication and prescription 10
services, alcohol or drug intervention or rehabilitation services and emergency and 11
– 2 –
- *SB 400 _R3 *
supportive housing in the local communities in which the health maintenance 12
organization operates. 13
Existing law establishes a reinvestment advisory committee in each county of 14
this State whose population is 700,000 or more (currently only Clark County) and 15
prescribes the duties of a reinvestment advisory committee, which includes 16
reviewing, making recommendations and reporting to the Legislature and Director 17
of the Department concerning the reinvestment of funds by a health maintenance 18
organization that provides health care services through managed care to recipients 19
of Medicaid in the communities served by those organizations. (NRS 422.185, 20
422.205) Section 1 of this bill revises the duties of the reinvestment advisory 21
committee such that the recommendations and reports of the advisory committee 22
are required to concern the reinvestment of funds by managed care organizations to 23
address homelessness and to provide sustainable medication and prescription 24
services, alcohol or drug intervention or rehabilitation services, and emergency and 25
supportive housing, in conformance with the amendatory provisions of sections 2 26
and 3. 27
Existing federal law establishes a Continuum of Care Program to provide 28
funding for efforts by nonprofit providers, states, and local governments to quickly 29
rehouse homeless individuals and families. (42 U.S.C. 11381 et seq.; 24 C.F.R. Part 30
578) Federal law requires representatives from relevant organizations to establish a 31
Continuum of Care for a geographic area to carry out certain responsibilities and to 32
establish a board to act on behalf of the Continuum. (24 C.F.R. 578.5) Section 3.3 33
of this bill: (1) requires the Department to establish the Fiscal Advisory Committee 34
for a Flexible Continuum of Care Plan; (2) authorizes the Department to make 35
grants of money to the Advisory Committee to fund certain services; and (3) 36
requires the Advisory Committee to prepare an annual report. Section 3.3 requires 37
a city whose population is 150,000 or more but less than 500,000 to transmit an 38
amount of money which is not less than $1,000,000 but not more than $2,000,000 39
to the Department each fiscal year for allocation to the Advisory Committee to fund 40
programs to address homelessness in the service area of the Continuum of Care in 41
which the city is located. Section 3.3 requires the Department to assist the Advisory 42
Committee to enter into service agreements with federally-qualified health centers. 43
Sections 7.1-7.9 of this bill make appropriations to the Department for 44
allocation to the Advisory Committee to carry out the provisions of section 3.3. 45
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. NRS 422.205 is hereby amended to read as follows: 1
422.205 1. A reinvestment advisory committee shall: 2
(a) Solicit and review reports from the Division and Medicaid 3
managed care organizations concerning the reinvestment of funds 4
by those Medicaid managed care organizations in the communities 5
served by the Medicaid managed care organizations. 6
(b) Report to the Division and Medicaid managed care 7
organizations concerning initiatives of local governments in the 8
county to address homelessness [,] and to provide sustainable 9
medication and prescription drug services, alcohol or drug 10
intervention or rehabilitation services, and emergency and 11
supportive housing . [issues and social determinants of health.] 12
– 3 –
- *SB 400 _R3 *
(c) Make recommendations based on the reports reviewed 1
pursuant to paragraph (a) to the Division and Medicaid managed 2
care organizations concerning the reinvestment of funds by those 3
Medicaid managed care organizations in the communities served by 4
the Medicaid managed care organizations. Those recommendations 5
must include, without limitation, recommendations for the use of 6
such funds for the purposes of: 7
(1) Developing innovative partnerships with community 8
development organizations and providers of housing services; and 9
(2) Supporting the initiatives of local governments in the 10
county to address homelessness [,] and to provide sustainable 11
medication and prescription drug services, alcohol or drug 12
intervention or rehabilitation services, and emergency and 13
supportive housing . [issues and social determinants of health.] 14
2. On or before December 31 of each year, a reinvestment 15
advisory committee shall: 16
(a) Compile a report concerning: 17
(1) The uses of funds reinvested by Medicaid managed care 18
organizations in the communities served by those Medicaid 19
managed care organizations, including, without limitation, efforts to 20
address homelessness [, disparities in health care and social 21
determinants of health;] and to provide sustainable medication and 22
prescription drug services, alcohol or drug intervention or 23
rehabilitation services, and emergency and supportive housing; 24
and 25
(2) The activities of the reinvestment advisory committee 26
during the calendar year, including, without limitation, the 27
recommendations made by the reinvestment advisory committee 28
pursuant to paragraph (c) of subsection 1. 29
(b) Submit the report to: 30
(1) The Director of the Legislative Counsel Bureau for 31
transmittal to: 32
(I) In odd-numbered years, the Joint Interim Standing 33
Committee on Health and Human Services; and 34
(II) In even-numbered years, the next regular session of 35
the Legislature. 36
(2) The Director of the Department. 37
3. As used in this section, “Medicaid managed care 38
organization” means a managed care organization that provides 39
health care services to recipients of Medicaid who reside in the 40
county for which a reinvestment advisory committee is established. 41
Sec. 2. NRS 422.273 is hereby amended to read as follows: 42
422.273 1. For any Medicaid managed care program 43
established in the State of Nevada, the Department shall contract 44
only with a health maintenance organization that has: 45
– 4 –
- *SB 400 _R3 *
(a) Negotiated in good faith with a federally-qualified health 1
center to provide health care services for the health maintenance 2
organization; 3
(b) Negotiated in good faith with the University Medical Center 4
of Southern Nevada to provide inpatient and ambulatory services to 5
recipients of Medicaid; and 6
(c) Negotiated in good faith with the University of Nevada 7
School of Medicine to provide health care services to recipients of 8
Medicaid. 9
Nothing in this section shall be construed as exempting a 10
federally-qualified health center, the University Medical Center of 11
Southern Nevada or the University of Nevada School of Medicine 12
from the requirements for contracting with the health maintenance 13
organization. 14
2. During the development and implementation of any 15
Medicaid managed care program, the Department shall cooperate 16
with the University of Nevada School of Medicine by assisting in 17
the provision of an adequate and diverse group of patients upon 18
which the school may base its educational programs. 19
3. The University of Nevada School of Medicine may establish 20
a nonprofit organization to assist in any research necessary for the 21
development of a Medicaid managed care program, receive and 22
accept gifts, grants and donations to support such a program and 23
assist in establishing educational services about the program for 24
recipients of Medicaid. 25
4. For the purpose of contracting with a Medicaid managed 26
care program pursuant to this section, a health maintenance 27
organization is exempt from the provisions of NRS 695C.123. 28
5. The provisions of this section apply to any managed care 29
organization, including a health maintenance organization, that 30
provides health care services to recipients of Medicaid under the 31
State Plan for Medicaid or the Children’s Health Insurance Program 32
pursuant to a contract with the Division. Such a managed care 33
organization or health maintenance organization is not required to 34
establish a system for conducting external reviews of adverse 35
determinations in accordance with chapter 695B, 695C or 695G of 36
NRS. This subsection does not exempt such a managed care 37
organization or health maintenance organization for services 38
provided pursuant to any other contract. 39
6. Each contract entered into by the Department with a 40
health maintenance organization to provide health care services to 41
recipients of Medicaid in all geographic areas of this State shall 42
include a requirement for the health maintenance organization to 43
reinvest a percentage of the annual profits of the health 44
maintenance organization in programs and initiatives to address 45
– 5 –
- *SB 400 _R3 *
homelessness and to provide sustainable medication and 1
prescription drug services, alcohol or drug intervention or 2
rehabilitation services, and emergency and supportive housing in 3
the local communities in which the health maintenance 4
organization operates. 5
7. As used in this section, unless the context otherwise 6
requires: 7
(a) “Federally-qualified health center” has the meaning ascribed 8
to it in 42 U.S.C. § 1396d(l)(2)(B). 9
(b) “Health maintenance organization” has the meaning ascribed 10
to it in NRS 695C.030. 11
(c) “Managed care organization” has the meaning ascribed to it 12
in NRS 695G.050. 13
Sec. 3. NRS 422.273 is hereby amended to read as follows: 14
422.273 1. To the extent that money is available, the 15
Department shall: 16
(a) Establish a Medicaid managed care program to provide 17
health care services to recipients of Medicaid in all geographic areas 18
of this State. The program is not required to provide services to 19
recipients of Medicaid who are aged, blind or disabled pursuant to 20
Title XVI of the Social Security Act, 42 U.S.C. §§ 1381 et seq. 21
(b) Conduct a statewide procurement process to select health 22
maintenance organizations to provide the services described in 23
paragraph (a). 24
2. For any Medicaid managed care program established in the 25
State of Nevada, the Department shall contract only with a health 26
maintenance organization that has: 27
(a) Negotiated in good faith with a federally-qualified health 28
center to provide health care services for the health maintenance 29
organization; 30
(b) Negotiated in good faith with the University Medical Center 31
of Southern Nevada to provide inpatient and ambulatory services to 32
recipients of Medicaid; 33
(c) Negotiated in good faith with the University of Nevada 34
School of Medicine to provide health care services to recipients of 35
Medicaid; and 36
(d) Complied with the provisions of subsection 2 of 37
NRS 695K.220. 38
Nothing in this section shall be construed as exempting a 39
federally-qualified health center, the University Medical Center of 40
Southern Nevada or the University of Nevada School of Medicine 41
from the requirements for contracting with the health maintenance 42
organization. 43
3. During the development and implementation of any 44
Medicaid managed care program, the Department shall cooperate 45
– 6 –
- *SB 400 _R3 *
with the University of Nevada School of Medicine by assisting in 1
the provision of an adequate and diverse group of patients upon 2
which the school may base its educational programs. 3
4. The University of Nevada School of Medicine may establish 4
a nonprofit organization to assist in any research necessary for the 5
development of a Medicaid managed care program, receive and 6
accept gifts, grants and donations to support such a program and 7
assist in establishing educational services about the program for 8
recipients of Medicaid. 9
5. For the purpose of contracting with a Medicaid managed 10
care program pursuant to this section, a health maintenance 11
organization is exempt from the provisions of NRS 695C.123. 12
6. To the extent that money is available, a Medicaid managed 13
care program must include, without limitation, a state-directed 14
payment arrangement established in accordance with 42 C.F.R. § 15
438.6(c) to require a Medicaid managed care organization to 16
reimburse a critical access hospital and any federally-qualified 17
health center or rural health clinic affiliated with a critical access 18
hospital for covered services at a rate that is equal to or greater than 19
the rate received by the critical access hospital, federally-qualified 20
health center or rural health clinic, as applicable, for services 21
provided to recipients of Medicaid on a fee-for-service basis. 22
7. The provisions of this section apply to any managed care 23
organization, including a health maintenance organization, that 24
provides health care services to recipients of Medicaid under the 25
State Plan for Medicaid or the Children’s Health Insurance Program 26
pursuant to a contract with the Division. Such a managed care 27
organization or health maintenance organization is not required to 28
establish a system for conducting external reviews of adverse 29
determinations in accordance with chapter 695B, 695C or 695G of 30
NRS. This subsection does not exempt such a managed care 31
organization or health maintenance organization for services 32
provided pursuant to any other contract. 33
8. Each contract entered into by the Department with a 34
health maintenance organization to provide the services described 35
in paragraph (a) of subsection 1 shall include a requirement for 36
the health maintenance organization to reinvest a percentage of 37
the annual profits of the health maintenance organization in 38
programs and initiatives to address homelessness and to provide 39
sustainable medication and prescription drug services, alcohol or 40
drug intervention or rehabilitation services, and emergency and 41
supportive housing in the local communities in which the health 42
maintenance organization operates. 43
9. As used in this section, unless the context otherwise 44
requires: 45
– 7 –
- *SB 400 _R3 *
(a) “Critical access hospital” means a hospital which has been 1
certified as a critical access hospital by the Secretary of Health and 2
Human Services pursuant to 42 U.S.C. § 1395i-4(e). 3
(b) “Federally-qualified health center” has the meaning ascribed 4
to it in 42 U.S.C. § 1396d(l)(2)(B). 5
(c) “Health maintenance organization” has the meaning ascribed 6
to it in NRS 695C.030. 7
(d) “Managed care organization” has the meaning ascribed to it 8
in NRS 695G.050. 9
(e) “Rural health clinic” has the meaning ascribed to it in 42 10
C.F.R. § 405.2401. 11
Sec. 3.3. Chapter 439 of NRS is hereby amended by adding 12
thereto a new section to read as follows: 13
1. The Department shall establish the Fiscal Advisory 14
Committee for a Flexible Continuum of Care Plan which consists 15
of the following members appointed by the Director of the 16
Department: 17
(a) A representative from the largest incorporated city in the 18
service area of each Continuum of Care in this State, who must 19
also reside in the service area of the Continuum of Care in which 20
the city he or she represents is located; 21
(b) A person who represents a county in this State; 22
(c) A person who represents law enforcement; 23
(d) A person selected from a list of nominees provided by the 24
Nevada Resort Association; and 25
(e) A representative of a nonprofit organization that provides 26
services to persons who are homeless. 27
2. To the extent practicable, each member appointed 28
pursuant to paragraphs (a), (b), (c) and (e) of subsection 1 must be 29
selected from a list of nominees provided by a Continuum of Care 30
in this State. Except as otherwise provided in this subsection and 31
subsection 1, each Continuum of Care in this State shall submit a 32
list of nominees to fill any vacancy on the Advisory Committee. 33
Each member appointed pursuant to paragraph (a) of subsection 1 34
must be selected from a list of nominees provided by the 35
Continuum of Care whose service area includes the city which the 36
member represents. 37
3. Each member of the Advisory Committee serves a term of 2 38
years. Members may be reappointed for additional terms of 2 years 39
in the same manner as the original appointments. Any vacancy 40
occurring in the membership of the Advisory Committee must be 41
filled in the same manner as the original appointment. 42
4. The members of the Advisory Committee serve without 43
compensation but are entitled to receive the per diem allowance 44
– 8 –
- *SB 400 _R3 *
and travel expenses provided for state officers and employees 1
generally. 2
5. A majority of the members of the Advisory Committee 3
constitutes a quorum for the transaction of business, and a 4
majority of a quorum present at any meeting is sufficient for any 5
official action taken by the Advisory Committee. 6
6. A member of the Advisory Committee who is an officer or 7
employee of this State or a political subdivision of this State must 8
be relieved from his or her duties without loss of regular 9
compensation to prepare for and attend meetings of the Advisory 10
Committee and perform any work necessary to carry out the duties 11
of the Advisory Committee in the most timely manner practicable. 12
A state agency or political subdivision of this State shall not 13
require an officer or employee who is a member of the Advisory 14
Committee to: 15
(a) Make up the time he or she is absent from work to carry 16
out his or her duties as a member of the Advisory Committee; or 17
(b) Take annual leave or compensatory time for the absence. 18
7. At its first meeting and annually thereafter, the Advisory 19
Committee shall elect a Chair from among its members. 20
8. To the extent that funding is available for that purpose, 21
and upon application by the Advisory Committee in such form as 22
the Department may require, the Department may make grants to 23
the Advisory Committee to fund: 24
(a) Services for persons released from prison or a county, city 25
or town jail or detention facility including, without limitation, 26
sustainable medication and prescription drug services, alcohol or 27
drug intervention or rehabilitation services, and emergency and 28
supportive housing. 29
(b) Services for persons leaving emergency shelters, including, 30
without limitation, sustainable medication and prescription drug 31
services, alcohol or drug intervention or rehabilitation services, 32
and emergency and supportive housing. 33
(c) Services for persons leaving acute care settings, mental 34
health care facilities, drug and alcohol rehabilitation facilities, or 35
transitional housing. 36
(d) Emergency and supportive housing services, including, 37
without limitation, the acquisition and rehabilitation of properties 38
suitable for conversion to supportive housing. 39
9. Each fiscal year, a city in this State whose population is 40
150,000 or more but less than 500,000 shall transmit to the 41
Department an amount of money which is not less than 42
$1,000,000 but not more than $2,000,000 from money available 43
for that purpose for allocation to the Advisory Committee to fund 44
– 9 –
- *SB 400 _R3 *
programs to address homelessness in the service area of the 1
Continuum of Care in which the city is located. 2
10. The Department shall assist the Advisory Committee to 3
enter into an agreement with a federally-qualified health center to 4
provide services described in paragraphs (a), (b) and (c) of 5
subsection 8. 6
11. On or before September 30 of each year, the Advisory 7
Committee shall submit to the governing board of the Continuum 8
of Care, the Department and the Interim Finance Committee a 9
report detailing the use of any grant of money received from the 10
Department pursuant to subsection 8 and the status of any 11
programs or services funded using such money. 12
12. Any grant of money made to the Advisory Committee and 13
any funding allocated by the Advisory Committee to any person 14
must not supplant, replace, offset or otherwise reduce funding for 15
programs to address homelessness. 16
13. As used in this section, “Continuum of Care” has the 17
meaning ascribed to it in 24 C.F.R. § 578.3. 18
Sec. 3.7. (Deleted by amendment.) 19
Sec. 4. (Deleted by amendment.) 20
Sec. 5. (Deleted by amendment.) 21
Sec. 6. (Deleted by amendment.) 22
Sec. 7. (Deleted by amendment.) 23
Sec. 7.1. There is hereby appropriated from the State General 24
Fund to the Department of Health and Human Services the sum of 25
$17,000,000: 26
1. For allocation to Fiscal Advisory Committee for a Flexible 27
Continuum of Care Plan established pursuant to section 3.3 of this 28
act to fund the services described in subsection 8 of section 3.3 of 29
this act; or 30
2. To satisfy matching requirements for federal grants to fund 31
the services described in subsection 8 of section 3.3 of this act. 32
Sec. 7.3. There is hereby appropriated from the State General 33
Fund to the Department of Health and Human Services the sum of 34
$1,000,000 for allocation to the Fiscal Advisory Committee for a 35
Flexible Continuum of Care Plan established pursuant to section 3.3 36
of this act to match an equal amount of money provided by local 37
governments in the service area of the Northern Nevada Continuum 38
of Care to fund the services described in subsection 8 of section 3.3 39
of this act in the service area of the Northern Nevada Continuum of 40
Care. 41
Sec. 7.5. There is hereby appropriated from the State General 42
Fund to the Department of Health and Human Services the sum of 43
$1,000,000 for allocation to the Fiscal Advisory Committee for a 44
Flexible Continuum of Care Plan established pursuant to section 3.3 45
– 10 –
- *SB 400 _R3 *
of this act to match an equal amount of money provided by local 1
governments in the service area of the Rural Nevada Continuum of 2
Care to fund the services described in subsection 8 of section 3.3 of 3
this act in the service area of the Rural Nevada Continuum of Care. 4
Sec. 7.7. Any remaining balance of the appropriations made 5
by sections 7.1, 7.3 and 7.5 of this act must not be committed for 6
expenditure after June 30, 2025, by the entity to which the 7
appropriation is made or any entity to which money from the 8
appropriation is granted or otherwise transferred in any manner, and 9
any portion of the appropriated money remaining must not be spent 10
for any purpose after September 19, 2025, by either the entity to 11
which the money was appropriated or the entity to which the money 12
was subsequently granted or transferred, and must be reverted to the 13
State General Fund on or before September 19, 2025. 14
Sec. 7.9. 1. There is hereby appropriated from the State 15
General Fund to the Department of Health and Human Services for 16
allocation to the Fiscal Advisory Committee for a Flexible 17
Continuum of Care Plan established pursuant to section 3.3 of this 18
act to address homelessness in the city of Las Vegas the following 19
sums: 20
For the Fiscal Year 2023-2024 ............................... $9,000,000 21
For the Fiscal Year 2024-2025 ............................... $1,000,000 22
2. Any balance of the sums appropriated by subsection 1 23
remaining at the end of the respective fiscal years must not be 24
committed for expenditure after June 30 of the respective fiscal 25
years by the entity to which the appropriation is made or any entity 26
to which money from the appropriation is granted or otherwise 27
transferred in any manner, and any portion of the appropriated 28
money remaining must not be spent for any purpose after 29
September 20, 2024, and September 19, 2025, respectively, by 30
either the entity to which the money was appropriated or the entity 31
to which the money was subsequently granted or transferred, and 32
must be reverted to the State General Fund on or before 33
September 20, 2024, and September 19, 2025, respectively. 34
Sec. 8. The amendatory provisions of sections 1, 2 and 3 of 35
this act do not apply during the current term of any agreement 36
entered into between the Department of Health and Human Services 37
and a health maintenance organization pursuant to NRS 422.273 38
before January 1, 2024, but do apply to any extension or renewal of 39
such an agreement and to any agreement entered into between the 40
Department of Health and Human Services and a health 41
maintenance organization pursuant to NRS 422.273 on or after 42
January 1, 2024. 43
Sec. 9. (Deleted by amendment.) 44
– 11 –
- *SB 400 _R3 *
Sec. 10. 1. This section becomes effective upon passage and 1
approval. 2
2. Sections 3.3, 3.7 and 7.1 to 7.9, inclusive, of this act become 3
effective on July 1, 2023. 4
3. Sections 1, 2 and 8 of this act become effective on 5
January 1, 2024. 6
4. Section 3 of this act becomes effective on January 1, 2026. 7
5. Sections 4 to 7, inclusive, and 9 of this act become effective 8
on July 1, 2027. 9
6. The amendatory provisions of section 2 of this act expire by 10
limitation on December 31, 2025. 11
H