S.B. 423
- *SB423*
SENATE BILL NO. 423–COMMITTEE ON
HEALTH AND HUMAN SERVICES
(ON BEHALF OF THE JOINT INTERIM STANDING COMMITTEE
ON HEALTH AND HUMAN SERVICES)
MARCH 24, 2025
____________
Referred to Committee on Health and Human Services
SUMMARY—Revises provisions governing public health.
(BDR 40-349)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§§ 5, 6)
(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 health; creating the Account for Public
Health; authorizing allocations from the Account to
certain entities who have jurisdiction over public health;
requiring the Division of Public and Behavioral Health of
the Department of Health and Human Services and
entities which receive an allocation from the Account to
prepare reports concerning the use of money in the
Account; revising the membership of district boards of
health; requiring certain health authorities to develop and
adopt a framework for the electronic maintenance,
transmittal and exchange of health information; and
providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law creates a health district in any county whose population is 700,000 1
or more (currently Clark County), which has jurisdiction over all public health 2
matters in the health district. (NRS 439.361, 439.362, 439.366) Existing law 3
authorizes the creation of a health district with similar jurisdiction in counties 4
whose population is less than 700,000 (currently all counties other than Clark 5
County), subject to the approval by the State Board of Health, by affirmative vote 6
of: (1) the board of county commissioners of two or more counties; (2) the 7
governing bodies of two or more cities or towns within any county; or (3) the board 8
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of county commissioners and the governing body or bodies of any incorporated city 9
or cities, town or towns, in such a county. (NRS 439.370) Existing law requires 10
each county which is not within a health district to establish a county board of 11
health. (NRS 439.280, 439.362, 439.380) 12
Section 2 of this bill defines the term “health authority” for the purposes of this 13
bill to include county boards of health, health districts and federally recognized 14
Indian tribes which are located in whole or in part in this State. 15
Existing law requires each insurer to pay to the Department of Taxation a tax 16
upon net direct premiums and net direct considerations written at the rate of 3.5 17
percent. (NRS 680B.027) Section 3 of this bill creates the Account for Public 18
Health in the State General Fund and requires the Division of Public and 19
Behavioral Health of the Department of Health and Human Services to administer 20
the Account. Section 7 of this bill requires the State Treasurer to deposit: (1) the 21
first $30,000,000 of revenues collected from the tax on net direct premiums and net 22
direct considerations during each biennium in the Account; and (2) any revenues 23
collected from the tax during the biennium in excess of $30,000,000 in the State 24
General Fund. Section 3 requires the Division to use any money which is deposited 25
in the Account to: (1) protect and promote public health; and (2) make allocations 26
to health authorities in certain specified percentages of the total money deposited in 27
the Account during the biennium. Section 3 requires the Division to submit to the 28
State Board of Health a report regarding the use of money in the Account. 29
Section 4 of this bill requires the Division to publish on its Internet website, on 30
or before December 1 of each odd-numbered year, an estimate of the amount of 31
money in the Account which will be available for allocation to health authorities for 32
the biennium. Section 4 authorizes a health authority, on or before January 1 of 33
each even-numbered year, to submit to the Division a request for an allocation from 34
the Account, which must be accompanied by a proposal for the use of the allocation 35
that includes certain information. Section 4 requires the Division to make 36
allocations from the Account on or before April 1 of each even-numbered year to 37
health authorities whose requests are approved and provides that money which is 38
not expended or committed for expenditure by the health authority before June 30 39
of an odd-numbered year reverts to the Account. Section 4 requires a health 40
authority that receives an allocation from the Account to submit a report to the 41
Division concerning the use of the allocated money. 42
Existing law authorizes a district board of health within a health district to 43
exercise the powers, duties and authority of a county board of health within the 44
health district and establishes the membership of a district board of health. (NRS 45
439.362, 439.366, 439.380, 439.390) Sections 5 and 6 of this bill revise the 46
membership of a district board of health in counties whose population is 700,000 or 47
more (currently Clark County) and counties whose population is less than 700,000 48
(currently all counties other than Clark County) to add a member selected by the 49
Speaker of the Assembly and a member selected by the Majority Leader of the 50
Senate. 51
Existing law requires: (1) the Director of the Department to adopt regulations to 52
prescribe a framework for the electronic maintenance, transmittal and exchange of 53
electronic health records, prescriptions, health-related information and electronic 54
signatures and requirements for electronic equivalents of written entries or written 55
approvals; and (2) the Department and the divisions thereof, other state and local 56
governmental entities, health care providers and certain entities involved in the 57
business of health insurance to maintain, transmit and exchange health information 58
in accordance with that framework and certain other provisions of law governing 59
electronic health records. (NRS 439.539) Section 8 of this bill requires each health 60
authority that receives an allocation of money from the Account in 2026 to: (1) 61
develop a framework to ensure compliance with those requirements and otherwise 62
promote interoperability with networks and technologies used by certain persons 63
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and entities involved in the provision of health care; and (2) submit the framework 64
to the Division and the Legislature. Section 8 requires a health authority to use that 65
allocation of money from the Account to pay the costs associated with developing 66
the framework. 67
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 439 of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 2, 3 and 4 of this act. 2
Sec. 2. As used in sections 3 and 4 of this act, unless the 3
context otherwise requires, “health authority” means: 4
1. A county board of health created pursuant to 5
NRS 439.280; 6
2. A health district created pursuant to NRS 439.362 or 7
439.370; or 8
3. A federally recognized American Indian tribe pursuant to 9
25 C.F.R. §§ 83.1 to 83.12, inclusive, that is located in whole or in 10
part in this State. 11
Sec. 3. 1. The Account for Public Health is hereby created 12
in the State General Fund. 13
2. The Division shall administer the Account. 14
3. The interest and income earned on money in the Account 15
must be credited to the Account. 16
4. Except as otherwise provided in subsection 8 and 17
subsection 4 of section 4 of this act, any money remaining in the 18
Account at the end of each fiscal year does not revert to the State 19
General Fund and must be carried forward to the next fiscal year. 20
5. Except as otherwise provided in subsection 6, money 21
credited to the Account pursuant to NRS 680B.060 during each 22
biennium must be used for the following purposes in the following 23
prescribed percentages of the total money credited to the Account 24
pursuant to NRS 680B.060 during the biennium: 25
(a) Five percent for use by the Division to protect and promote 26
public health. 27
(b) Ten percent to make allocations pursuant to section 4 of 28
this act to health authorities which are Indian tribes. 29
(c) One percent per each county board of health established 30
pursuant to NRS 439.280, to make allocations pursuant to section 31
4 of this act to each county board of health. 32
(d) One percent per each health district created pursuant to 33
NRS 439.362, to make allocations pursuant to section 4 of this act 34
to each such health district. 35
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(e) One percent per each health district created pursuant to 1
subsection 2 or 3 of NRS 439.370, to make allocations pursuant to 2
section 4 of this act to each such health district. 3
(f) One percent per each county within the jurisdiction of a 4
health district created pursuant to subsection 1 of NRS 439.370 5
which is established by two or more counties, to make allocations 6
pursuant to section 4 of this act to each such health district. 7
(g) Not more than 4 percent to establish or supplement an 8
existing reserve within the Account. 9
(h) Any money not dedicated for one of the purposes described 10
in paragraphs (a) to (g), inclusive, to make allocations pursuant to 11
section 4 of this act to the health authorities described in 12
paragraphs (c) to (f), inclusive, in proportion to their populations. 13
6. Except for money which reverts to the Account from a 14
health authority pursuant to subsection 4 of section 4 of this act, 15
money remaining in the Account on April 2 of an even-numbered 16
year and money which is credited to the Account pursuant to NRS 17
680B.060 after April 1 of an even-numbered year and on or before 18
June 30 of an odd-numbered year becomes part of the reserve of 19
the Account. Money in the reserve may be used by the Division to 20
protect and promote public health. 21
7. Any money allocated from the Account to the Division that 22
is not committed for expenditure for the purpose for which it was 23
distributed on or before June 30 of an odd-numbered year reverts 24
to the Account for Public Health becomes part of the reserve of 25
the Account and must be included in the calculation of the reserve 26
on June 30 for the purposes of subsection 8. 27
8. Any reserve of the Account which exceeds 4 percent of the 28
total money credited to the Account pursuant to NRS 680B.060 29
during the then current biennium and has not been committed for 30
expenditure on or before June 30 of an odd-numbered year reverts 31
to the State General Fund. 32
9. On or before November 30 of an odd-numbered year, the 33
Division shall submit to the State Board of Health a report 34
concerning the use of money in the Account. 35
10. As used in this section, “population” means the current 36
population estimate for that city or county as determined and 37
published by the Department of Taxation and the demographer 38
employed pursuant to NRS 360.283. 39
Sec. 4. 1. On or before December 1 of each odd-numbered 40
year, the Division shall publish on the Internet website of the 41
Division an estimate of the amount of money in the Account for 42
Public Health created by section 3 of this act which will be 43
available for allocation pursuant to this section to health 44
authorities that are Indian tribes and to each health district and 45
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county board of health in this State during the then current 1
biennium. 2
2. On or before January 1 of each even-numbered year, a 3
health authority may submit to the Division a request for an 4
allocation from the Account for Public Health. The request must 5
be accompanied by a proposal for the use of the allocation which 6
includes, without limitation: 7
(a) An evaluation and identification of the public health needs 8
of residents of the area under the jurisdiction of the health 9
authority; 10
(b) A determination of the level of priority of the public health 11
needs identified pursuant to paragraph (a); and 12
(c) A plan for spending the money allocated from the Account 13
for Public Health which is in accordance with the levels of priority 14
determined pursuant to paragraph (b) and includes spending for 15
one or more of the following public health services: 16
(1) Control of communicable diseases; 17
(2) Prevention of chronic diseases and injuries; 18
(3) Environmental public health; 19
(4) Maternal, child and family health; 20
(5) Access to and linkage with medical, oral and behavioral 21
health services; 22
(6) Vital records; 23
(7) Assessing the health of populations; 24
(8) Planning for public health emergencies; 25
(9) Communications; 26
(10) Development and support of policy; 27
(11) Development of community partnerships; 28
(12) Business competencies; and 29
(13) Such other public health services as the State Board of 30
Health prescribes by regulation. 31
3. On or before March 1 of each even-numbered year, the 32
Division shall review each request submitted pursuant to 33
subsection 2 and approve those that meet the requirements of this 34
section, within the limits of money available for the health 35
authority making the request. 36
4. On or before April 1 of each even-numbered year, the 37
Division shall allocate money from the Account for Public Health 38
to each health authority whose request has been approved 39
pursuant to subsection 3. Money allocated pursuant to this section 40
is available for use by the health authority during both fiscal years 41
of the biennium. Any money allocated pursuant to this section that 42
is not committed for expenditure for the purpose for which it was 43
distributed on or before June 30 of an odd-numbered year reverts 44
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to the Account for Public Health. Any amount which reverts from 1
a health authority to the Account for Public Health: 2
(a) Must be accounted for separately. 3
(b) May be used by the Division for statewide public health 4
services or public health services in the region served by the health 5
authority from which the money reverted. 6
(c) Reverts from the Account for Public Health to the State 7
General Fund on June 30 of the year immediately following the 8
year during which the money reverted to the Account. 9
5. On or before October 31 of an odd-numbered year, each 10
health authority that received an allocation from the Account for 11
Public Health pursuant to this section in the immediately 12
preceding biennium shall submit to the Division a report which 13
includes, without limitation: 14
(a) A description of the process used by the health authority 15
pursuant to paragraph (a) of subsection 2 to evaluate the public 16
health needs of residents of the area under the jurisdiction of the 17
health authority and the public health needs identified through 18
that process; 19
(b) A description of the process used by the health authority 20
pursuant to paragraph (b) of subsection 2 to determine the level of 21
priority of the public health needs identified pursuant to 22
paragraph (a) of subsection 2 and the levels of priority assigned to 23
those public health needs through that process; 24
(c) A description of each expenditure of the allocated money 25
made by the health authority; 26
(d) The amount of any unexpended balance of the allocated 27
money at the end of the biennium; and 28
(e) Such other information in such form as the Division may 29
require. 30
Sec. 5. NRS 439.362 is hereby amended to read as follows: 31
439.362 1. A health district with a health department 32
consisting of a district health officer, a chief medical officer, a 33
public health advisory board and a district board of health is hereby 34
created. 35
2. The district board of health consists of: 36
(a) Representatives selected by the following entities from 37
among their elected members: 38
(1) Two representatives of the board of county 39
commissioners; 40
(2) Two representatives of the governing body of the largest 41
incorporated city in the county; and 42
(3) One representative of the governing body of each other 43
city in the county; [and] 44
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(b) The following representatives, selected by the elected 1
representatives of the district board of health selected pursuant to 2
paragraph (a), who shall represent the health district at large and 3
who must be selected based on their qualifications without regard to 4
the location within the health district of their residence or their place 5
of employment: 6
(1) One representative who is a physician licensed to practice 7
medicine in this State; 8
(2) One representative of a nongaming business or from an 9
industry that is subject to regulation by the health district; and 10
(3) One representative of the association of gaming 11
establishments whose membership in the county collectively paid 12
the most gross revenue fees to the State pursuant to NRS 463.370 in 13
the preceding year, who must be selected from a list of nominees 14
submitted by the association [. If] , or, if no such association exists, 15
[the] one representative [selected pursuant to this subparagraph 16
must represent] of the gaming industry [.] ; 17
(c) One representative selected by the Speaker of the 18
Assembly; and 19
(d) One representative selected by the Majority Leader of the 20
Senate. 21
3. The public health advisory board consists of: 22
(a) One resident of each city in the county selected by the 23
governing body of each such city; and 24
(b) The following representatives, selected by the district board 25
of health, who shall advise the health district on matters relating to 26
public health and who must be selected based on their qualifications 27
without regard to the location within the health district of their 28
residence or their place of employment: 29
(1) One representative who is a physician licensed to practice 30
medicine in this State, selected on the basis of his or her education, 31
training, experience or demonstrated abilities in the provision of 32
health care services to members of minority groups and other 33
medically underserved populations; 34
(2) One representative who is a nurse licensed to practice 35
nursing in this State; and 36
(3) One representative who has a background or expertise in 37
environmental health or environmental health services. 38
4. Members of the public health advisory board serve as 39
nonvoting members of the district board of health. A member of the 40
district board of health may not designate another person to vote, 41
participate in a discussion or otherwise serve on his or her behalf. 42
5. Members of the district board of health and the public health 43
advisory board serve terms of 2 years. Vacancies must be filled in 44
the same manner as the original selection for the remainder of the 45
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unexpired term. Members serve without additional compensation for 1
their services, but are entitled to reimbursement for necessary 2
expenses for attending meetings or otherwise engaging in the 3
business of their respective board. 4
6. The district board of health shall meet in July of each year to 5
organize and elect one of its voting members selected pursuant to 6
subsection 2 as chair of the board. 7
7. The county treasurer is the treasurer of the district board of 8
health. The treasurer shall: 9
(a) Keep permanent accounts of all money received by, 10
disbursed for and on behalf of the district board of health; and 11
(b) Administer the health district fund created by the board of 12
county commissioners pursuant to NRS 439.363. 13
8. The district board of health shall maintain records of all of 14
its proceedings and minutes of all meetings, which must be open to 15
inspection. 16
9. No county, city or town board of health may be created in 17
the county. Any county, city or town board of health in existence 18
when the district board of health is created must be abolished. 19
Sec. 6. NRS 439.390 is hereby amended to read as follows: 20
439.390 1. A district board of health must consist of [two] : 21
(a) Two members from each county, city or town which 22
participated in establishing the district, to be appointed by the 23
governing body of the county, city or town in which they reside [, 24
together with one additional] ; 25
(b) One member [to be chosen] selected by the members [so] of 26
the district board of health appointed [. 27
2. The additional member must be] pursuant to paragraph (a), 28
who is a physician licensed to practice medicine in this State [.] ; 29
(c) One member selected by the Speaker of the Assembly; and 30
(d) One member selected by the Majority Leader of the Senate. 31
[3.] 2. If the appointive members of the district board of health 32
described in paragraph (a) of subsection 1 fail to choose the 33
additional member pursuant to paragraph (b) of subsection 1 34
within 30 days after the organization of the district health 35
department, the additional member may be appointed by the Chief 36
Medical Officer. 37
Sec. 7. NRS 680B.060 is hereby amended to read as follows: 38
680B.060 1. The taxes imposed under NRS 680B.027 must 39
be collected by the Department of Taxation and promptly deposited 40
with the State Treasurer . The State Treasurer shall deposit: 41
(a) The first $30,000,000 of the money so received by the State 42
Treasurer in each biennium, for credit to the Account for Public 43
Health created by section 3 of this act. 44
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(b) Any additional amount of the money so received by the 1
State Treasurer, for credit to the State General Fund. 2
2. If the tax is not paid by the insurer on or before the date 3
required for payment, the tax then becomes delinquent, and payment 4
thereof may be enforced by court action instituted on behalf of the 5
State by the Attorney General. The Attorney General may employ 6
additional counsel in the city where the home office of the insurer is 7
located, subject to the approval of compensation for such services 8
by the State Board of Examiners. The administrative and substantive 9
enforcement provisions of chapters 360 and 372 of NRS apply to the 10
enforcement of the taxes imposed under NRS 680B.027. 11
3. Upon the tax becoming delinquent, the Executive Director 12
of the Department of Taxation shall notify the Commissioner, who 13
shall suspend or revoke the insurer’s certificate of authority pursuant 14
to NRS 680A.190. 15
4. If a dispute arises between an insurer and the State as to the 16
amount of tax, if any, payable, the insurer is entitled to pay under 17
protest the tax in the amount assessed by the Department of 18
Taxation, without waiving or otherwise affecting any right of the 19
insurer to recover any amount determined, through appropriate legal 20
action taken by the insurer against the Department of Taxation, to 21
have been in excess of the amount of tax lawfully payable. 22
5. Except as otherwise provided in subsection 1 and NRS 23
680C.110, all taxes, fees, licenses, fines and charges collected under 24
this Code, including the general premium tax provided for under 25
NRS 680B.027 and as increased in any instances pursuant to NRS 26
680A.330, must be promptly deposited with the State Treasurer for 27
credit to the State General Fund. 28
Sec. 8. 1. On or before January 1, 2030, a health authority 29
that receives an allocation of money from the Account for Public 30
Health pursuant to subsection 4 of section 4 of this act on or before 31
April 1, 2026, shall: 32
(a) Develop and adopt a framework to: 33
(1) Ensure that the health authority complies with the 34
requirements of subsection 4 of NRS 439.589; and 35
(2) Otherwise promote interoperability with the networks and 36
technologies used by the Federal Government, the Department of 37
Health and Human Services and the divisions thereof, other state 38
and local governmental entities, health care providers, third parties, 39
pharmacy benefit managers and other entities licensed or certified 40
pursuant to title 57 of NRS; and 41
(b) Submit the framework to: 42
(1) The Division of Public and Behavioral Health of the 43
Department of Health and Human Services; and 44
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(2) The Director of the Legislative Counsel Bureau for 1
transmittal to the Joint Interim Standing Committee on Health and 2
Human Services. 3
2. The framework developed and adopted pursuant to 4
subsection 1 must use: 5
(a) Standards for public health reporting established in the 6
Trusted Exchange Framework and Common Agreement adopted by 7
the Assistant Secretary for Technology Policy of the United States 8
Department of Health and Human Services; or 9
(b) Other nationwide standards for the reporting of public health 10
information established by the Centers for Disease Control and 11
Prevention of the United States Department of Health and Human 12
Services, the Office of the National Coordinator for Health 13
Information Technology of the United States Department of Health 14
and Human Services or another agency of the Federal Government. 15
3. Notwithstanding the provisions of section 3 of this act, a 16
health authority: 17
(a) Shall use the money allocated to the health authority 18
pursuant to subsection 4 of section 4 of this act on or before April 1, 19
2026, to pay any costs associated with developing the framework 20
required by subsection 1; 21
(b) Shall include the expenditures described in paragraph (a) in 22
the plan for spending submitted to the Division of Public and 23
Behavioral Health of the Department of Health and Human Services 24
pursuant to paragraph (c) of subsection 2 of section 4 of this act; and 25
(c) May use any money allocated to the health authority 26
pursuant to subsection 4 of section 4 of this act on or before April 1, 27
2026, that is not necessary for the purpose set forth in paragraph (a) 28
for other purposes authorized by section 4 of this act. 29
4. As used in this section: 30
(a) “Health authority” has the meaning ascribed to it in section 2 31
of this act. 32
(b) “Health care provider” has the meaning ascribed to it in 33
NRS 439.583. 34
(c) “Pharmacy benefit manager” has the meaning ascribed to it 35
in NRS 439.589. 36
(d) “Third party” has the meaning ascribed to it in 37
NRS 439.589. 38
Sec. 9. Notwithstanding the provisions of subsection 9 of 39
section 3 of this act, the first report required by that subsection must 40
be submitted by the Division of Public and Behavioral Health of the 41
Department of Health and Human Services on or before October 31, 42
2027. 43
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Sec. 10. 1. As soon as practicable after July 1, 2025, the 1
Speaker of the Assembly and the Majority Leader of the Senate 2
shall appoint to: 3
(a) Each district board of health created by NRS 439.362 the 4
new representatives required by paragraphs (c) and (d) of subsection 5
2 of NRS 439.362, as amended by section 5 of this act; and 6
(b) Each district board of health created pursuant to NRS 7
439.370 the new members required by paragraphs (c) and (d) of 8
NRS 439.390, as amended by section 6 of this act. 9
2. In making the appointment described in subsection 1, the 10
Speaker of the Assembly and the Majority Leader of the Senate 11
shall, insofar as is possible, appoint the new members to initial 12
terms which are of such duration that the terms are consistent with 13
the manner in which the terms of the other members of the district 14
boards of health are staggered. 15
Sec. 11. The provisions of NRS 354.599 do not apply to any 16
additional expenses of a local government that are related to the 17
provisions of this act. 18
Sec. 12. This act becomes effective on July 1, 2025. 19
H