REQUIRES TWO-THIRDS MAJORITY VOTE (§ 6)
S.B. 424
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SENATE BILL NO. 424–COMMITTEE ON
HEALTH AND HUMAN SERVICES
MARCH 24, 2025
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Referred to Committee on Health and Human Services
SUMMARY—Requires an assessment to be imposed on private
emergency medical transport providers.
(BDR 38-561)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to health care; requiring the Division of Health
Care Financing and Policy of the Department of Health
and Human Services to impose an assessment on private
emergency medical transport providers; creating the
Account to Improve Emergency Medical Transportation
Quality and Access; prescribing the authorized uses of the
revenue generated by the assessment; requiring the
Division to adopt regulations establishing administrative
penalties; authorizing the Division to collect an unpaid
assessment or administrative penalty; authorizing certain
health authorities to impose administrative penalties or
take other disciplinary actions in certain circumstances;
and providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law authorizes the Division of Health Care Financing and Policy of the 1
Department of Health and Human Services to impose, in certain circumstances, an 2
assessment on agencies to provide personal care services in the home or medical 3
facilities that are required to obtain a certain type of license. (NRS 422.3794) 4
Existing law requires the Division to expend the revenue generated from the 5
assessment to: (1) provide supplemental payments and enhanced rates of 6
reimbursement to operators of agencies to provide personal care services in the 7
home and operators of medical facilities for services rendered to recipients of 8
Medicaid; (2) fund certain additional supports and services under Medicaid; and (3) 9
pay administrative costs. (NRS 422.37945) Sections 2-9 of this bill require the 10
imposition of a similar assessment on private emergency medical transport 11
providers. Section 6 requires: (1) the percentage of the assessment to be based on a 12
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percentage of net revenue earned by the private emergency medical transport 13
service from providing services in this State; and (2) the Division to set the amount 14
of the percentage of the assessment by regulation, subject to certain requirements. 15
Section 7 creates the Account to Improve Emergency Medical Transportation 16
Quality and Access. Section 7 requires the Division to administer the Account and 17
to deposit the proceeds collected from the assessment into the Account. Section 7 18
provides that money in the Account may only be expended to: (1) provide enhanced 19
rates of reimbursement under Medicaid to private emergency medical transport 20
providers for providing emergency ambulance services to recipients of Medicaid; 21
(2) fund certain data infrastructure improvements and educational and community 22
outreach initiatives undertaken by the Department; and (3) pay administrative costs 23
related to the assessment. If the Legislature authorizes the money in the Account to 24
be used for any other purpose, section 7: (1) requires that the Division cease 25
imposing the assessment; and (2) provides that the regulations adopted to impose 26
the assessment are void. 27
Section 8 requires the Division to adopt regulations establishing administrative 28
penalties against a private emergency medical transport provider that fails to pay an 29
assessment in a timely manner. Section 8 authorizes the Division, after notifying 30
the provider, to: (1) deduct the amount of an unpaid assessment or administrative 31
penalty from future payments owed to the private emergency transport provider 32
under Medicaid; and (2) negotiate a payment plan with a delinquent private 33
emergency medical transport provider before making such deductions. Section 8 34
also requires the Division to notify the health authority that issued a private 35
emergency medical transport provider a permit to own or operate an ambulance or 36
air ambulance in this State if the provider has failed to pay an assessment or 37
administrative penalty in a timely manner. Section 11 of this bill authorizes the 38
applicable health authority to, after receiving such a notification from the Division, 39
take certain disciplinary actions against the private emergency medical transport 40
provider. 41
Section 9 authorizes the Division to modify the amount of the assessment, the 42
enhanced rates of reimbursement or any other requirement established by sections 43
2-9 as necessary to receive federal financial participation to carry out the provisions 44
of sections 2-9. Section 9 also requires the suspension of the assessment and the 45
payment of enhanced rates of reimbursement upon the occurrence of certain events. 46
Section 9 requires the retroactive reimposition of such assessments and payments 47
when the event triggering the suspension is no longer applicable. 48
Sections 3, 4 and 5 define certain terms and section 2 establishes the 49
applicability of those definitions. Section 10 of this bill requires the Director of the 50
Department to administer the provisions of sections 2-9 in the same manner as 51
other provisions relating to Medicaid. 52
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 422 of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 2 to 9, inclusive, of this 2
act. 3
Sec. 2. As used in sections 2 to 9, inclusive, of this act, unless 4
the context otherwise requires, the words and terms defined in 5
sections 3, 4 and 5 of this act have the meanings ascribed to them 6
in those sections. 7
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Sec. 3. “Account” means the Account to Improve Emergency 1
Medical Transportation Quality and Access created by section 7 of 2
this act. 3
Sec. 4. “Emergency ambulance service”: 4
1. Means the transportation by ambulance or air ambulance 5
of a person who is experiencing a medical emergency to a medical 6
facility; 7
2. Includes the rendering of medical care by a paramedic, as 8
defined in NRS 450B.095, emergency medical technician, as 9
defined in NRS 450B.065, or advanced emergency medical 10
technician, as defined in NRS 450B.025, in connection with the 11
transportation of the person; and 12
3. Does not include transportation provided under non-13
emergency circumstances. 14
Sec. 5. “Private emergency medical transport provider” 15
means a person or entity that: 16
1. Provides or renders emergency ambulance services in this 17
State; 18
2. Holds a permit issued pursuant to the provisions of chapter 19
450B of NRS; and 20
3. Is not owned or operated by a federal, state or local 21
governmental entity or a federally recognized tribe. 22
Sec. 6. 1. Except as otherwise provided in subsection 4 and 23
sections 7 and 9 of this act, the Division shall impose by regulation 24
against each private emergency medical transport provider an 25
assessment in an amount equal to a percentage of the net revenue 26
earned by a private emergency medical transport provider from 27
providing emergency ambulance services in this State during a 28
calendar or fiscal year. The Division shall adopt: 29
(a) Regulations prescribing the percentage that must be used 30
to calculate the amount of the assessment, the date on which the 31
assessment is due and the manner in which the assessment must 32
be paid; and 33
(b) Any other regulations necessary or convenient to carry out 34
the provisions of this section. 35
2. The amount of the assessment imposed pursuant to 36
subsection 1: 37
(a) Except as otherwise provided in paragraph (b), must be 38
equal to the maximum percentage authorized under federal law; 39
and 40
(b) Except where necessary pursuant to subsection 1 of section 41
9 of this act, must not exceed 5.5 percent of the net revenue earned 42
by a private emergency medical transport provider from providing 43
emergency ambulance services in this State during a calendar or 44
fiscal year. 45
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3. The revenue from an assessment imposed pursuant to 1
subsection 1 must be deposited into the Account. 2
4. An assessment imposed pursuant to subsection 1 must 3
comply with the provisions of 42 C.F.R. § 433.68. An assessment 4
must not be imposed pursuant to subsection 1 if federal law or 5
regulations prohibit using the revenue generated by the 6
assessment for the purposes described in section 7 of this act. If 7
new federal law or regulations imposing such a prohibition are 8
enacted or adopted, as applicable: 9
(a) An assessment must not be collected after the effective date 10
of the law or regulations; and 11
(b) Any money collected during the calendar or fiscal year, as 12
applicable, in which the federal law or regulations become 13
effective must be returned to the private emergency medical 14
transport providers from whom it was collected. 15
5. A private emergency medical transport provider shall 16
submit to the Division any information requested by the Division 17
at such times as are determined by the Division for the purposes of 18
carrying out the provisions of this section. Such information may 19
include, without limitation: 20
(a) The number of emergency ambulance service trips 21
provided in this State by the private emergency medical transport 22
provider; and 23
(b) The total net revenue earned by the private emergency 24
medical transport provider for the emergency ambulance services 25
described in paragraph (a). 26
6. A private emergency medical transport provider shall keep 27
and maintain accurate records as necessary to support the 28
accuracy of information requested by Division pursuant to this 29
section. 30
7. As used in this section: 31
(a) “Cash basis” means the system of accounting under which 32
revenues are recorded only when received and expenditures or 33
expenses are recorded only when paid. 34
(b) “Net revenue” means net patient revenue collected by a 35
private emergency medical transport provider that is attributable 36
to the rendering of emergency ambulance services, determined on 37
a cash basis of accounting. 38
Sec. 7. 1. The Account to Improve Emergency Medical 39
Transportation Quality and Access is hereby created in the State 40
General Fund. The Division shall administer the Account. The 41
revenue from assessments and penalties imposed on private 42
emergency medical transport providers pursuant to sections 6 and 43
8, respectively, of this act must be accounted for separately in the 44
Account. 45
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2. The interest and income earned on the money in the 1
Account, after deducting any applicable charges, must be credited 2
to the Account. 3
3. The money in the Account must only be expended to: 4
(a) Provide enhanced rates of reimbursement to private 5
emergency medical transport providers that provide emergency 6
ambulance services to recipients of Medicaid; 7
(b) Provide funding to allow the Department to: 8
(1) Modernize processes and infrastructure relating to the 9
collection and maintenance of data that is useful for purposes 10
relating to public health; 11
(2) Provide education to the public relating to emergency 12
medical services; and 13
(3) Conduct community outreach to improve public health; 14
and 15
(c) Carry out the provisions of sections 2 to 9, inclusive, of this 16
act. 17
4. Any enhanced rates of reimbursement established 18
pursuant to paragraph (a) of subsection 3 may be provided 19
through any or all of the following means: 20
(a) Increases to rates of reimbursement paid to private 21
emergency medical transport providers who receive such 22
reimbursement on a fee-for-service basis. 23
(b) The establishment of minimum fees to be paid to private 24
emergency medical transport providers who provide services to 25
recipients of Medicaid under the Medicaid managed care program 26
established pursuant to NRS 422.273. 27
(c) Direct payments to private emergency medical transport 28
providers who provide services to recipients of Medicaid under the 29
Medicaid managed care program established pursuant to 30
NRS 422.273. 31
5. Not more than 10 percent of the total amount of money 32
generated each year by the assessment imposed pursuant to 33
section 6 of this act may be expended for the purposes described in 34
paragraphs (b) and (c) of subsection 3. Money allocated for such 35
expenditures must be used first for the purpose described in 36
paragraph (c) of subsection 3. If money allocated for such 37
expenditures remains after all necessary expenditures are made 38
for that purpose, the Division shall expend the remaining money 39
for the purposes described in paragraph (b) of subsection 3. 40
6. Any money remaining in the Account at the end of a fiscal 41
year does not revert to the State General Fund, and the balance in 42
the Account must be carried forward to the next fiscal year. 43
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7. Money in the Account must not be expended to replace 1
money that would otherwise be used to provide reimbursement 2
under Medicaid to private emergency medical transport providers. 3
8. The Director shall seek any necessary federal authority to 4
capture all available financial federal participation to carry out 5
the purposes described in paragraph (b) of subsection 3. 6
9. If the Legislature authorizes money in the Account to be 7
used for any purpose other than those authorized by subsection 3: 8
(a) The Division shall cease imposing the assessment provided 9
by section 6 of this act; and 10
(b) The regulations adopted to impose the assessment pursuant 11
to section 6 of this act are void. 12
Sec. 8. 1. The Division shall adopt regulations that 13
establish administrative penalties for the failure to timely pay any 14
assessment imposed pursuant to section 6 of this act. Any money 15
collected from administrative penalties imposed pursuant to this 16
subsection must be deposited into the Account. 17
2. If a private emergency medical transport provider fails to 18
remit to the Division any penalty imposed pursuant to subsection 1 19
or any assessment imposed pursuant to section 6 of this act within 20
30 days after the date on which the penalty or assessment is due, 21
as applicable, the Division: 22
(a) May deduct the amount of the penalty or assessment, as 23
applicable, from any future payment owed to the private 24
emergency medical transport provider under Medicaid; and 25
(b) Shall notify each health authority of this State that has 26
issued the private emergency medical transport provider a permit 27
to operate an ambulance or air ambulance, as applicable, that the 28
private emergency medical transport provider has failed to pay a 29
penalty or assessment, as applicable. 30
3. Before taking any action described in subsection 2, the 31
Division: 32
(a) Shall notify the private emergency medical transport 33
provider of the action that the Division intends to take, the specific 34
reason for the action and, where applicable, the amount of the 35
penalty or assessment that will be deducted; and 36
(b) May negotiate a payment plan with the private emergency 37
medical transport provider. 38
4. As used in this section, “health authority” has the meaning 39
ascribed to it in NRS 450B.077. 40
Sec. 9. 1. The Division may modify the percentage of the 41
assessment imposed on private emergency medical transport 42
providers pursuant to section 6 of this act, the amount of any 43
enhanced rate of reimbursement described in paragraph (a) of 44
subsection 3 of section 7 of this act or any other requirement or 45
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formula established pursuant to sections 2 to 9, inclusive, of this 1
act to the extent necessary to obtain federal financial participation 2
for the enhanced rates of reimbursement described in paragraph 3
(a) of subsection 3 of section 7 of this act. Such modifications 4
must not result in the collection of assessments in an amount 5
greater than is required for the purposes prescribed by subsection 6
3 of section 7 of this act. 7
2. The Division shall take the actions described in subsection 8
3 after determining that: 9
(a) The amount of funding available for the reimbursement of 10
private emergency medical transport providers has decreased 11
below the level of funding that was available for that purpose 12
during the fiscal year ending on June 30, 2025; 13
(b) The rate of reimbursement under Medicaid for emergency 14
ambulance services has decreased below the rate of 15
reimbursement established under Medicaid for emergency 16
ambulance services as of June 30, 2022; 17
(c) Federal financial participation is not available for the 18
payment of enhanced rates of reimbursement described in 19
paragraph (a) of subsection 3 of section 7 of this act; or 20
(d) The revenue collected from assessments imposed pursuant 21
to section 6 of this act will be insufficient for the purposes 22
described in paragraphs (a) and (c) of subsection 3 of section 7 of 23
this act. 24
3. If the Division makes a determination described in 25
subsection 2, the Division shall: 26
(a) Immediately cease collecting the assessment otherwise 27
required to be imposed pursuant to section 6 of this act; 28
(b) Immediately cease using the money generated through that 29
assessment for the purposes described in subsection 3 of section 7 30
of this act; and 31
(c) Return any money collected through the assessment 32
imposed pursuant to section 6 of this act that the Division is 33
prohibited by paragraph (b) from using for the purposes described 34
in subsection 3 of section 7 of this act to the private emergency 35
medical transport provider from whom it was collected. 36
4. If the Division, after suspending the collection of 37
assessments and the payment of enhanced rates of reimbursement 38
pursuant to subsection 3, determines that the provisions of 39
subsection 2 no longer apply, the Division shall: 40
(a) Resume collecting assessments pursuant to section 6 of this 41
act; 42
(b) Resume payment of the enhanced rates of reimbursement 43
described in paragraph (a) of subsection 3 of section 7 of this act; 44
and 45
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(c) Establish, for the period of time during which such 1
assessments and payments were suspended pursuant to subsection 2
3, a schedule for the retroactive: 3
(1) Collection of assessments pursuant to section 6 of this 4
act; and 5
(2) Payment of enhanced rates of reimbursement pursuant 6
to paragraph (a) of subsection 3 of section 7 of this act. 7
Sec. 10. NRS 232.320 is hereby amended to read as follows: 8
232.320 1. The Director: 9
(a) Shall appoint, with the consent of the Governor, 10
administrators of the divisions of the Department, who are 11
respectively designated as follows: 12
(1) The Administrator of the Aging and Disability Services 13
Division; 14
(2) The Administrator of the Division of Welfare and 15
Supportive Services; 16
(3) The Administrator of the Division of Child and Family 17
Services; 18
(4) The Administrator of the Division of Health Care 19
Financing and Policy; and 20
(5) The Administrator of the Division of Public and 21
Behavioral Health. 22
(b) Shall administer, through the divisions of the Department, 23
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 24
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 25
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 26
sections 2 to 9, inclusive, of this act, 422.580, 432.010 to 432.133, 27
inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, 28
inclusive, and 445A.010 to 445A.055, inclusive, and all other 29
provisions of law relating to the functions of the divisions of the 30
Department, but is not responsible for the clinical activities of the 31
Division of Public and Behavioral Health or the professional line 32
activities of the other divisions. 33
(c) Shall administer any state program for persons with 34
developmental disabilities established pursuant to the 35
Developmental Disabilities Assistance and Bill of Rights Act of 36
2000, 42 U.S.C. §§ 15001 et seq. 37
(d) Shall, after considering advice from agencies of local 38
governments and nonprofit organizations which provide social 39
services, adopt a master plan for the provision of human services in 40
this State. The Director shall revise the plan biennially and deliver a 41
copy of the plan to the Governor and the Legislature at the 42
beginning of each regular session. The plan must: 43
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(1) Identify and assess the plans and programs of the 1
Department for the provision of human services, and any 2
duplication of those services by federal, state and local agencies; 3
(2) Set forth priorities for the provision of those services; 4
(3) Provide for communication and the coordination of those 5
services among nonprofit organizations, agencies of local 6
government, the State and the Federal Government; 7
(4) Identify the sources of funding for services provided by 8
the Department and the allocation of that funding; 9
(5) Set forth sufficient information to assist the Department 10
in providing those services and in the planning and budgeting for the 11
future provision of those services; and 12
(6) Contain any other information necessary for the 13
Department to communicate effectively with the Federal 14
Government concerning demographic trends, formulas for the 15
distribution of federal money and any need for the modification of 16
programs administered by the Department. 17
(e) May, by regulation, require nonprofit organizations and state 18
and local governmental agencies to provide information regarding 19
the programs of those organizations and agencies, excluding 20
detailed information relating to their budgets and payrolls, which the 21
Director deems necessary for the performance of the duties imposed 22
upon him or her pursuant to this section. 23
(f) Has such other powers and duties as are provided by law. 24
2. Notwithstanding any other provision of law, the Director, or 25
the Director’s designee, is responsible for appointing and removing 26
subordinate officers and employees of the Department. 27
Sec. 11. NRS 450B.215 is hereby amended to read as follows: 28
450B.215 1. If the health authority receives notification from 29
the Department of Health and Human Services pursuant to NRS 30
439.5895 that the holder of a permit to operate an ambulance, air 31
ambulance or vehicle of a fire-fighting agency is not in compliance 32
with the requirements of subsection 4 of NRS 439.589, the health 33
authority may, after notice and the opportunity for a hearing in 34
accordance with the provisions of this chapter, require corrective 35
action or impose an administrative penalty in an amount established 36
by regulation of the board. 37
2. The health authority shall not suspend or revoke a permit for 38
failure to comply with the requirements of subsection 4 of 39
NRS 439.589. 40
3. If the health authority receives a notification from the 41
Division of Health Care Financing and Policy of the Department 42
of Health and Human Services pursuant to section 8 of this act 43
that the holder of a permit to operate an ambulance or air 44
ambulance, as applicable, has failed to pay an assessment imposed 45
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pursuant to section 6 of this act or an administrative penalty 1
imposed pursuant to section 8 of this act, the health authority may, 2
after notice and the opportunity for a hearing in accordance with 3
the provisions of this chapter: 4
(a) Require corrective action; 5
(b) Impose an administrative penalty in an amount established 6
by regulation of the board; or 7
(c) Revoke or suspend the permit of the holder. 8
Sec. 12. The provisions of subsections 3 and 4 of section 9 of 9
this act apply to any period described in subsection 2 of section 9 of 10
this act that occurs on or after July 1, 2025, including, without 11
limitation, a period where federal financial participation is not 12
available for the payment of enhanced rates of reimbursement 13
described in paragraph (a) of subsection 3 of section 7 of this act 14
because the Department of Health and Human Services has not yet 15
obtained approval from the United States Secretary of Health and 16
Human Services to pay such enhanced rates of reimbursement. 17
Sec. 13. 1. This section becomes effective upon passage and 18
approval. 19
2. Sections 1 to 12, inclusive, of this act become effective: 20
(a) Upon passage and approval for the purpose of adopting any 21
regulations and performing any other preparatory administrative 22
tasks that are necessary to carry out the provisions of this act; and 23
(b) On July 1, 2025, for all other purposes. 24
H