Assembly Bill No. 13

Assembly Bill No. 13-Committee on Health and Human Services

CHAPTER

340

AN ACT relating to state welfare administration; requiring the department of human resources to contract only with certain health maintenance organizations to provide Medicaid managed care; requiring the department of human resources to include the University of Nevada School of Medicine in the development and implementation of any Medicaid managed care program; making a technical change replacing the term "assistance to the medically indigent" with "Medicaid" to make the references to Medicaid consistent throughout the Nevada Revised Statutes; and providing other matters properly relating thereto.

[Approved July 8, 1997]

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 thereto the provisions set forth as sections 2 and 3 of this act.
Sec. 2. "Medicaid" has the meaning ascribed to it in NRS 439B.120.
Sec. 3. 1. For any Medicaid managed care program established in the State of Nevada, the department shall contract only with a health maintenance organization that has:
(a) Negotiated in good faith with a federally-qualified health center to provide health care services for the health maintenance organization;
(b) Negotiated in good faith with the University Medical Center of Southern Nevada to provide inpatient and ambulatory services to recipients of Medicaid; and
(c) Negotiated in good faith with the University of Nevada School of Medicine to provide health care services to recipients of Medicaid.
Nothing in this section shall be construed as exempting a federally-qualified health center, the University Medical Center of Southern Nevada or the University of Nevada School of Medicine from the requirements for contracting with the health maintenance organization.
2. During the development and implementation of any Medicaid managed care program, the department shall cooperate with the University of Nevada School of Medicine by assisting in the provision of an adequate and diverse group of patients upon which the school may base its educational programs.
3. The University of Nevada School of Medicine may establish a nonprofit organization to assist in any research necessary for the development of a Medicaid managed care program, receive and accept gifts, grants and donations to support such a program and assist in establishing educational services about the program for recipients of Medicaid.
4. For the purposes of this section:
(a) "Federally-qualified health center" has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).
(b) "Health maintenance organization" has the meaning ascribed to it in NRS 695C.030.
Sec. 4. NRS 422.001 is hereby amended to read as follows:
422.001 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 422.005 to 422.055, inclusive, and section 2 of this act, have the meanings ascribed to them in those sections.
Sec. 5. NRS 422.050 is hereby amended to read as follows:
422.050 "Public assistance" includes:
1. State supplementary assistance;
2. Aid to families with dependent children;
3. [Assistance to the medically indigent;] Medicaid;
4. Food stamp assistance;
5. Low-income home energy assistance;
6. Low-income weatherization assistance; and
7. Benefits provided pursuant to any other public welfare program administered by the welfare division pursuant to such additional federal legislation as is not inconsistent with the purposes of this chapter.
Sec. 6. NRS 422.054 is hereby amended to read as follows:
422.054 "Undivided estate" means all assets included in the estate of a deceased recipient of [assistance to the medically indigent] Medicaid and any other assets in or to which he had an interest or legal title at the time of his death, to the extent of that interest or title. The term includes assets passing by reason of joint tenancy, reserved life estate, survivorship or trust, and any of the decedent's separate property and his interest in community property that was transferred to a community spouse pursuant to NRS 123.259 or pursuant to an order of a district court under any other provision of law.
Sec. 7. NRS 422.153 is hereby amended to read as follows:
422.153 1. The medical care advisory group consists of the state health officer and:
(a) A person who:
(1) Holds a license to practice medicine in this state; and
(2) Is certified by the board of medical examiners in a medical specialty.
(b) A person who holds a license to practice dentistry in this state.
(c) A person who holds a certificate of registration as a pharmacist in this state.
(d) A member of a profession in the field of health care who is familiar with the needs of persons of low income, the resources required for their care and the availability of those resources.
(e) An administrator of a hospital or a clinic for health care.
(f) An administrator of a facility for intermediate care or a facility for skilled nursing.
(g) A member of an organized group that provides assistance, representation or other support to recipients of [assistance to the medically indigent.] Medicaid.
(h) A recipient of [assistance to the medically indigent.] Medicaid.
2. The director shall appoint each member required by paragraphs (a) to (h), inclusive, of subsection 1 to serve for a term of 1 year.
3. Members of the medical care advisory group serve without compensation, except that while engaged in the business of the advisory group, each member is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally.
Sec. 8. NRS 422.215 is hereby amended to read as follows:
422.215 1. The administrator or his designated representative may administer oaths and take testimony thereunder and issue subpoenas requiring the attendance of witnesses before the welfare division at a designated time and place and the production of books, papers and records relative to:
(a) Eligibility or continued eligibility for public assistance; and
(b) Verification of treatment and payments to a provider of medical care, remedial care or other services pursuant to the state plan for [assistance to the medically indigent.] Medicaid.
2. If a witness fails to appear or refuses to give testimony or to produce books, papers and records as required by the subpoena, the district court of the county in which the investigation is being conducted may compel the attendance of witnesses, the giving of testimony and the production of books, papers and records as required by the subpoena.
Sec. 9. NRS 422.2345 is hereby amended to read as follows:
422.2345 1. The administrator shall:
(a) Promptly comply with a request from the unit for access to and free copies of any records or other information in the possession of the welfare division regarding a provider;
(b) Refer to the unit all cases in which he suspects that a provider has committed an offense under NRS 422.540, 422.550, 422.560 or 422.570; and
(c) Suspend or exclude a provider who he determines has committed an offense under NRS 422.540, 422.550, 422.560 or 422.570 from participation as a provider or an employee of a provider, for a minimum of 3 years. A criminal action need not be brought against the provider before suspension or exclusion pursuant to this subsection.
2. As used in this section:
(a) "Provider" means a person who has applied to participate or who participates in the state plan for [assistance to the medically indigent] Medicaid as the provider of goods or services.
(b) "Unit" means the Medicaid fraud control unit established in the office of the attorney general pursuant to NRS 228.410.
Sec. 10. NRS 422.236 is hereby amended to read as follows:
422.236 1. As part of the health and welfare programs of this state, the welfare division may provide prenatal care to pregnant women who are indigent, or may contract for the provision of that care, at public or nonprofit hospitals in this state.
2. The welfare division shall provide to each person licensed to engage in social work pursuant to chapter 641B of NRS, each applicant for [assistance to the medically indigent] Medicaid and any other interested person, information concerning the prenatal care available pursuant to this section.
3. The welfare division shall adopt regulations setting forth criteria of eligibility and rates of payment for prenatal care provided pursuant to the provisions of this section, and such other provisions relating to the development and administration of the program for prenatal care as the administrator and the board deem necessary.
Sec. 11. NRS 422.270 is hereby amended to read as follows:
422.270 The department through the welfare division shall:
1. Except as otherwise provided in NRS 432.010 to 432.085, inclusive, administer all public welfare programs of this state, including:
(a) State supplementary assistance;
(b) Aid to families with dependent children;
(c) [Assistance to the medically indigent;] Medicaid;
(d) Food stamp assistance;
(e) Low-income home energy assistance;
(f) Low-income weatherization assistance;
(g) The program for the enforcement of child support; and
(h) Other welfare activities and services provided for by the laws of this state.
2. Act as the single state agency of the State of Nevada and its political subdivisions in the administration of any federal money granted to the state to aid in the furtherance of any of the services and activities set forth in subsection 1.
3. Cooperate with the Federal Government in adopting state plans, in all matters of mutual concern, including adoption of methods of administration found by the Federal Government to be necessary for the efficient operation of welfare programs, and in increasing the efficiency of welfare programs by prompt and judicious use of new federal grants which will assist the welfare division in carrying out the provisions of NRS 422.070 to 422.410, inclusive.
4. Observe and study the changing nature and extent of welfare needs and develop through tests and demonstrations effective ways of meeting those needs and employ or contract for personnel and services supported by legislative appropriations from the state general fund or money from federal or other sources.
5. Enter into reciprocal agreements with other states relative to public assistance, welfare services and institutional care, when deemed necessary or convenient by the administrator.
6. Make such agreements with the Federal Government as may be necessary to carry out the supplemental security income program.
Sec. 12. NRS 422.285 is hereby amended to read as follows:
422.285 The department , [of human resources,] through the welfare division, may reimburse directly, under the state plan for [assistance to the medically indigent,] Medicaid, any registered nurse who is authorized pursuant to chapter 632 of NRS to perform additional acts in an emergency or under other special conditions as prescribed by the state board of nursing, for such services rendered under the authorized scope of his practice to persons eligible to receive that assistance if another provider of health care would be reimbursed for providing those same services.
Sec. 13. NRS 422.293 is hereby amended to read as follows:
422.293 1. When a recipient of [assistance to the medically indigent] Medicaid incurs an illness or injury for which medical services are payable under the state plan and which is incurred under circumstances creating a legal liability in some person other than the recipient or the welfare division to pay all or part of the costs of such services, the division is subrogated to the right of the recipient to the extent of all such costs and may join or intervene in any action by the recipient or his successors in interest to enforce such legal liability.
2. If a recipient or his successors in interest fail or refuse to commence an action to enforce the legal liability, the welfare division may commence an independent action, after notice to the recipient or his successors in interest, to recover all costs to which it is entitled. In any such action by the division, the recipient or his successors in interest may be joined as third-party defendants.
3. In any case where the welfare division is subrogated to the rights of the recipient or his successors in interest as provided in subsection 1, the division has a lien upon the proceeds of any recovery from the persons liable, whether the proceeds of the recovery are by way of judgment, settlement or otherwise. Such a lien must be satisfied in full, unless reduced pursuant to subsection 5, at such time as:
(a) The proceeds of any recovery or settlement are distributed to or on behalf of the recipient, his successors in interest or his attorney; and
(b) A dismissal by any court of any action brought to enforce the legal liability established by subsection 1.
No such lien is enforceable unless written notice is first given to the person against whom the lien is asserted.
4. The recipient or his successors in interest shall notify the welfare division in writing before entering any settlement agreement or commencing any action to enforce the legal liability referred to in subsection 1. Except if extraordinary circumstances exist, a person who fails to comply with the provisions of this subsection shall be deemed to have waived any consideration by the administrator of a reduction of the amount of the lien pursuant to subsection 5 and shall pay to the division all costs to which it is entitled and its court costs and attorney's fees.
5. If the welfare division receives notice pursuant to subsection 4, the administrator may, in consideration of the legal services provided by an attorney to procure a recovery for the recipient, reduce the lien on the proceeds of any recovery.
6. The attorney of a recipient:
(a) Shall not condition the amount of attorney's fees or impose additional attorney's fees based on whether a reduction of the lien is authorized by the administrator pursuant to subsection 5.
(b) Shall reduce the amount of the fees charged the recipient for services provided by the amount the attorney receives from the reduction of a lien authorized by the administrator pursuant to subsection 5.
Sec. 14. NRS 422.2935 is hereby amended to read as follows:
422.2935 1. Except as otherwise provided in this section, the welfare division shall, to the extent it is not prohibited by federal law and when circumstances allow:
(a) Recover benefits correctly paid for [assistance to the medically indigent] Medicaid from:
(1) The undivided estate of the person who received those benefits; and
(2) Any recipient of money or property from the undivided estate of the person who received those benefits.
(b) Recover from the recipient of [assistance to the medically indigent] Medicaid or the person who signed the application for [assistance to the medically indigent] Medicaid on behalf of the recipient an amount not to exceed the benefits incorrectly paid to the recipient if the person who signed the application:
(1) Failed to report any required information to the welfare division which he knew at the time he signed the application; or
(2) Failed within the period allowed by the welfare division to report any required information to the welfare division which he obtained after he filed the application.
2. The welfare division shall not recover benefits pursuant to paragraph (a) of subsection 1, except from a person who is neither a surviving spouse nor a child, until after the death of the surviving spouse, if any, and only at a time when the person who received the benefits has no surviving child who is under 21 years of age or is blind or permanently and totally disabled.
3. Except as otherwise provided by federal law, if a transfer of real or personal property by a recipient of [assistance to the medically indigent] Medicaid is made for less than fair market value, the welfare division may pursue any remedy available pursuant to chapter 112 of NRS with respect to the transfer.
4. The amount of [assistance to the medically indigent] Medicaid paid to or on behalf of a person is a claim against the estate in any probate proceeding only at a time when there is no surviving spouse or surviving child who is under 21 years of age or is blind or permanently and totally disabled.
5. The administrator may elect not to file a claim against the estate of a recipient of [assistance to the medically indigent] Medicaid or his spouse if he determines that the filing of the claim will cause an undue hardship for the spouse or other survivors of the recipient. The board shall adopt regulations defining the circumstances that constitute an undue hardship.
6. Any recovery of money obtained pursuant to this section must be applied first to the cost of recovering the money. Any remaining money must be divided among the Federal Government, the department and the county in the proportion that the amount of assistance each contributed to the recipient bears to the total amount of the assistance contributed.
7. An action to recover money owed to the department of human resources as a result of the payment of benefits for [assistance to the medically indigent] Medicaid must be commenced within 6 months after the cause of action accrues. A cause of action accrues after all of the following events have occurred:
(a) The death of the recipient of [the assistance to the medically indigent;] Medicaid;
(b) The death of the surviving spouse of the recipient of [the assistance to the medically indigent;] Medicaid;
(c) The death of all children of the recipient of [the assistance to the medically indigent] Medicaid who are blind or permanently and totally disabled as determined in accordance with 42 U.S.C. § 1382c; and
(d) The arrival of all other children of the recipient of [the assistance to the medically indigent] Medicaid at the age of 21 years.
Sec. 15. NRS 422.29355 is hereby amended to read as follows:
422.29355 1. The welfare division may, to the extent not prohibited by federal law, petition for the imposition of a lien pursuant to the provisions of NRS 108.850 against real or personal property of a recipient of [assistance to the medically indigent] Medicaid as follows:
(a) The welfare division may obtain a lien against a recipient's property, both real or personal, before or after his death in the amount of assistance paid or to be paid on his behalf if the court determines that assistance was incorrectly paid for the recipient.
(b) The welfare division may seek a lien against the real property of a recipient at any age before his death in the amount of assistance paid or to be paid for him if he is an inpatient in a nursing facility, intermediate care facility for the mentally retarded or other medical institution and the welfare division determines, after notice and opportunity for a hearing in accordance with its regulations, that he cannot reasonably be expected to be discharged and return home.
2. No lien may be placed on a recipient's home for assistance correctly paid if:
(a) His spouse;
(b) His child who is under 21 years of age or blind or permanently and totally disabled as determined in accordance with 42 U.S.C. § 1382c; or
(c) His brother or sister who is an owner or part owner of the home and who was residing in the home for at least 1 year immediately before the date the recipient was admitted to the medical institution,
is lawfully residing in the home.
3. Upon the death of a recipient the welfare division may seek a lien upon his undivided estate as defined in NRS 422.054.
4. The state welfare administrator shall release a lien pursuant to this section:
(a) Upon notice by the recipient or his representative to the administrator that the recipient has been discharged from the medical institution and has returned home;
(b) If the lien was incorrectly determined; or
(c) Upon satisfaction of the welfare division's claim.
Sec. 16. NRS 422.2936 is hereby amended to read as follows:
422.2936 Each application for [assistance to the medically indigent] Medicaid must include:
1. A statement that any assistance paid to a recipient may be recovered in an action filed against the estate of the recipient or his spouse; and
2. A statement that any person who signs an application for [assistance to the medically indigent] Medicaid and fails to report:
(a) Any required information to the welfare division which he knew at the time he signed the application; or
(b) Within the period allowed by the welfare division, any required information to the welfare division which he obtained after he filed the application,
may be personally liable for any money incorrectly paid to the recipient.
Sec. 17. NRS 422.2993 is hereby amended to read as follows:
422.2993 1. Except as otherwise provided in NRS 228.410 and 422.2345 and subsection 2 of this section, any information obtained by the welfare division in an investigation of a provider of services under the state plan for [assistance to the medically indigent] Medicaid is confidential.
2. The information presented as evidence at a hearing:
(a) To enforce the provisions of NRS 422.450 to 422.580, inclusive; or
(b) To review an action by the welfare division against a provider of services under the state plan for [assistance to the medically indigent,] Medicaid,
is not confidential, except for the identity of any recipient of the assistance.
Sec. 18. NRS 422.2997 is hereby amended to read as follows:
422.2997 1. Upon receipt of a request for a hearing from a provider of services under the state plan for [assistance to the medically indigent,] Medicaid, the welfare division shall appoint a hearing officer to conduct the hearing. Any employee or other representative of the welfare division who investigated or made the initial decision regarding the action taken against a provider of services may not be appointed as the hearing officer or participate in the making of any decision pursuant to the hearing.
2. The welfare division shall adopt regulations prescribing the procedures to be followed at the hearing.
3. The decision of the hearing officer is a final decision. Any party, including the welfare division, who is aggrieved by the decision of the hearing officer may appeal that decision to the district court. The review of the court must be confined to the record. The court shall not substitute its judgment for that of the hearing officer as to the weight of the evidence on questions of fact. The court may affirm the decision of the hearing officer or remand the case for further proceedings. The court may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions or decisions are:
(a) In violation of constitutional or statutory provisions;
(b) In excess of the statutory authority of the welfare division;
(c) Made upon unlawful procedure;
(d) Affected by other error of law;
(e) Clearly erroneous in view of the reliable, probative and substantial evidence on the whole record; or
(f) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.
Sec. 19. NRS 422.364 is hereby amended to read as follows:
422.364 "Plan" means the state plan for [the medically indigent] Medicaid established pursuant to NRS 422.237.
Sec. 20. NRS 422.380 is hereby amended to read as follows:
422.380 As used in NRS 422.380 to 422.390, inclusive, unless the context otherwise requires:
1. "Hospital" has the meaning ascribed to it in NRS 439B.110 and includes public and private hospitals.
2. ["Medicaid" has the meaning ascribed to it in NRS 439B.120.
3.] "Public hospital" means:
(a) A hospital owned by a state or local government, including, without limitation, a hospital district; or
(b) A hospital that is supported in whole or in part by tax revenue, other than tax revenue received for medical care which is provided to Medicaid patients, indigent patients or other low-income patients.
Sec. 21. NRS 422.385 is hereby amended to read as follows:
422.385 1. The allocations and payments required pursuant to NRS 422.387 must be made, to the extent allowed by the state plan for [assistance to the medically indigent,] Medicaid, from the Medicaid budget account.
2. The money in the intergovernmental transfer account must be transferred from that account to the Medicaid budget account to the extent that money is available from the Federal Government for proposed expenditures, including expenditures for administrative costs. If the amount in the account exceeds the amount authorized for expenditure by the department for the purposes specified in NRS 422.387, the department is authorized to expend the additional revenue in accordance with the provisions of the state plan for [assistance to the medically indigent.] Medicaid.
Sec. 22. NRS 422.387 is hereby amended to read as follows:
422.387 1. Before making the payments required or authorized by this section, the department shall allocate money for the administrative costs necessary to carry out the provisions of NRS 422.380 to 422.390, inclusive. The amount allocated for administrative costs must not exceed the amount authorized for expenditure by the legislature for this purpose in a fiscal year. The interim finance committee may adjust the amount allowed for administrative costs.
2. The state plan for [assistance to the medically indigent] Medicaid must provide:
(a) For the payment of the maximum amount allowable under federal law and regulations after making a payment, if any, pursuant to paragraph (b), to public hospitals for treating a disproportionate share of Medicaid patients, indigent patients or other low-income patients, unless such payments are subsequently limited by federal law or regulation.
(b) For a payment in an amount approved by the legislature to the private hospital that provides the largest volume of medical care to Medicaid patients, indigent patients or other low-income patients in a county that does not have a public hospital.
The plan must be consistent with the provisions of NRS 422.380 to 422.390, inclusive, and Title XIX of the Social Security Act (42 U.S.C. §§ 1396, et seq.), and the regulations adopted pursuant to those provisions.
3. The department may amend the state plan for [assistance to the medically indigent] Medicaid to modify the methodology for establishing the rates of payment to public hospitals for inpatient services, except that such amendments must not reduce the total reimbursements to public hospitals for such services.
Sec. 23. NRS 422.480 is hereby amended to read as follows:
422.480 "Plan" means the state plan for [assistance to the medically indigent] Medicaid established pursuant to NRS 422.237.
Sec. 24. NRS 426A.060 is hereby amended to read as follows:
426A.060 1. The advisory committee on traumatic brain injuries, consisting of 11 members, is hereby created.
2. The director shall appoint to the committee:
(a) One member who is an employee of the rehabilitation division of the department.
(b) One member who is an employee of the welfare division of the department of human resources and participates in the administration of the state program providing [assistance to the medically indigent.] Medicaid.
(c) One member who is a licensed insurer in this state.
(d) One member who represents the interests of educators in this state.
(e) One member who is a person professionally qualified in the field of psychiatric mental health.
(f) Two members who are employees of private providers of rehabilitative health care located in this state.
(g) One member who represents persons who operate community-based programs for head injuries in this state.
(h) One member who represents hospitals in this state.
(i) Two members who represent the recipients of health care in this state.
3. After the initial appointments, each member of the committee serves a term of 3 years.
4. The committee shall elect one of its members to serve as chairman.
5. Members of the committee serve without compensation and are not entitled to receive the per diem allowance or travel expenses provided for state officers and employees generally.
6. The committee may:
(a) Make recommendations to the director relating to the establishment and operation of any program for persons with traumatic brain injuries.
(b) Make recommendations to the director concerning proposed legislation relating to traumatic brain injuries.
(c) Collect information relating to traumatic brain injuries.
7. The committee shall prepare a report of its activities and recommendations each year and submit a copy to the:
(a) Director;
(b) Legislative committee on health care; and
(c) Legislative commission.
8. As used in this section:
(a) "Director" means the director of the department.
(b) "Person professionally qualified in the field of psychiatric mental health" has the meaning ascribed to it in NRS 433.209.
(c) "Provider of health care" has the meaning ascribed to it in NRS 629.031.
Sec. 25. NRS 428.030 is hereby amended to read as follows:
428.030 1. When any person meets the uniform standards of eligibility established by the board of county commissioners or by NRS 439B.310, if applicable, and complies with any requirements imposed pursuant to NRS 428.040, he is entitled to receive such relief as is in accordance with the policies and standards established and approved by the board of county commissioners and within the limits of the money which may be lawfully appropriated pursuant to NRS 428.050, 428.285 and 450.425 for this purpose.
2. The board of county commissioners of the county of residence of indigent inpatients shall pay hospitals for the costs of treating those indigent inpatients and any nonresident indigent inpatients who fall sick in the county an amount which is not less than the payment required for providing the same treatment to patients pursuant to the state plan for [assistance to the medically indigent,] Medicaid within the limits of money which may be lawfully appropriated pursuant to NRS 428.050, 428.285 and 450.425 for this purpose.
3. The board of county commissioners may:
(a) Make contracts for the necessary maintenance of indigent persons;
(b) Appoint such agents as the board deems necessary to oversee and provide the necessary maintenance of indigent persons;
(c) Authorize the payment of cash grants directly to indigent persons for their necessary maintenance; or
(d) Provide for the necessary maintenance of indigent persons by the exercise of the combination of one or more of the powers specified in paragraphs (a), (b) and (c).
4. A hospital may contract with the department of human resources to obtain the services of a state employee to be assigned to the hospital to evaluate the eligibility of patients applying for indigent status. Payment for those services must be made by the hospital.
Sec. 26. NRS 428.090 is hereby amended to read as follows:
428.090 1. When a nonresident or any other person who meets the uniform standards of eligibility prescribed by the board of county commissioners or by NRS 439B.310, if applicable, falls sick in the county, not having money or property to pay his board, nursing or medical aid, the board of county commissioners of the proper county shall, on complaint being made, give or order to be given such assistance to the poor person as is in accordance with the policies and standards established and approved by the board of county commissioners and within the limits of money which may be lawfully appropriated for this purpose pursuant to NRS 428.050, 428.285 and 450.425.
2. If the sick person dies, the board of county commissioners shall give or order to be given to the person a decent burial or cremation.
3. Except as otherwise provided in NRS 422.382, the board of county commissioners shall make such allowance for the person's board, nursing, medical aid, burial or cremation as the board deems just and equitable, and order it paid out of the county treasury.
4. The responsibility of the board of county commissioners to provide medical aid or any other type of remedial aid under this section is relieved to the extent provided in NRS 422.382 and to the extent of the amount of money or the value of services provided by:
(a) The welfare division of the department of human resources to or for such persons for medical care or any type of remedial care under the state plan for [assistance to the medically indigent;] Medicaid; and
(b) The fund for hospital care to indigent persons under the provisions of NRS 428.115 to 428.255, inclusive.
Sec. 27. NRS 108.850 is hereby amended to read as follows:
108.850 1. A petition to the district court for the imposition of a lien as described and limited in NRS 422.29355 to recover money owed to the department of human resources as a result of payment of benefits for [assistance to the medically indigent] Medicaid must set forth:
(a) The facts concerning the giving of assistance;
(b) The name and address of the person who is receiving or who received the benefits for [assistance to the medically indigent;] Medicaid;
(c) A description of the property, sufficient for identification, and its estimated value;
(d) The names, ages, residences and relationship of all persons who are claiming an interest in the property or who are listed as having any interest in the property, so far as known to the petitioner; and
(e) An itemized list of the amount owed to the department of human resources as a result of payment of benefits for [assistance to the medically indigent.] Medicaid.
2. No defect of form or in the statement of facts actually existing voids the petition for the lien.
Sec. 28. NRS 108.860 is hereby amended to read as follows:
108.860 1. A petition for the imposition of a lien must be signed by or on behalf of the state welfare administrator or the attorney general and filed with the clerk of the court, who shall set the petition for hearing.
2. Notice of a petition for the imposition of a lien must be given by registered or certified mail, postage prepaid, at least 10 days before the date set for hearing or other action by the court. Each such notice must be addressed to the intended recipient at his last address known to the administrator, receipt for delivery requested. The administrator shall cause the notice to be published, at least once a week for 3 successive weeks, in one newspaper published in the county, and if there is no newspaper published in the county, then in such mode as the court may determine, notifying all persons claiming any interest in the property of the filing of the petition, the object and the location, date and time of the hearing.
3. Notice of a petition for the imposition of a lien must be given to:
(a) Each person who has requested notice;
(b) The person who is receiving or has received benefits for [assistance to the medically indigent;] Medicaid;
(c) The legal guardian or representative of a person who is receiving or has received [benefits for assistance to the medically indigent,] Medicaid, if any;
(d) Each executor, administrator or trustee of the estate of a decedent who received benefits for [assistance to the medically indigent,] Medicaid, if any;
(e) The heirs of such a decedent known to the administrator; and
(f) Each person who is claiming any interest in the property or who is listed as having any interest in the subject property,
and must state the filing of the petition, the object, and the time set for hearing.
4. At the time appointed, or at any other time to which the hearing may be continued, upon proof being made by affidavit or otherwise to the satisfaction of the court that notice has been given as required by this chapter, the court shall proceed to hear the testimony in support of the petition. Each witness who appears and is sworn shall testify orally.
5. The court shall make findings as to the appropriateness of the lien and the amount of the lien.
6. At the time of the filing of the petition for imposition of a lien the administrator shall file a notice of pendency of the action in the manner provided in NRS 14.010.
7. Upon imposition of the lien by the court, the administrator shall serve the notice of lien upon the owner by certified or registered mail and file it with the office of the county recorder of each county where real property subject to the lien is located.
8. The notice of lien must contain:
(a) The amount due;
(b) The name of the owner of record of the property; and
(c) A description of the property sufficient for identification.
9. If the amount due as stated in the notice of lien is reduced by a payment, the administrator shall amend the notice of lien, stating the amount then due, within 20 days after receiving the payment.
Sec. 29. NRS 108.870 is hereby amended to read as follows:
108.870 The state welfare administrator may, to the extent not prohibited by 42 U.S.C. § 1396p(b), foreclose upon a lien for money owed to the department of human resources as a result of the payment of benefits for [assistance to the medically indigent] Medicaid by action in the district court in the same manner as for foreclosure of any other lien.
Sec. 30. NRS 123.259 is hereby amended to read as follows:
123.259 1. Except as otherwise provided in subsection 2, a court of competent jurisdiction may, upon a proper petition filed by a spouse or the guardian of a spouse, enter a decree dividing the income and resources of a husband and wife pursuant to this section if one spouse is an institutionalized spouse and the other spouse is a community spouse.
2. The court shall not enter such a decree if the division is contrary to a premarital agreement between the spouses which is enforceable pursuant to chapter 123A of NRS.
3. Unless modified pursuant to subsection 4 or 5, the court may divide the income and resources:
(a) Equally between the spouses; or
(b) By protecting income for the community spouse through application of the maximum federal minimum monthly maintenance needs allowance set forth in 42 U.S.C. § 1396r-5(d)(3)(C) and by permitting a transfer of resources to the community spouse an amount which does not exceed the amount set forth in 42 U.S.C. § 1396r-5(f)(2)(A)(ii).
4. If either spouse establishes that the community spouse needs income greater than that otherwise provided under paragraph (b) of subsection 3, upon finding exceptional circumstances resulting in significant financial duress and setting forth in writing the reasons for that finding, the court may enter an order for support against the institutionalized spouse for the support of the community spouse in an amount adequate to provide such additional income as is necessary.
5. If either spouse establishes that a transfer of resources to the community spouse pursuant to paragraph (b) of subsection 3, in relation to the amount of income generated by such a transfer, is inadequate to raise the income of the community spouse to the amount allowed under paragraph (b) of subsection 3 or an order for support issued pursuant to subsection 4, the court may substitute an amount of resources adequate to provide income to fund the amount so allowed or to fund the order for support.
6. A copy of a petition for relief under subsection 4 or 5 and any court order issued pursuant to such a petition must be served on the state welfare administrator when any application for medical assistance is made by or on behalf of an institutionalized spouse. He may intervene no later than 45 days after receipt by the welfare division of the department of human resources of an application for medical assistance and a copy of the petition and any order entered pursuant to subsection 4 or 5, and may move to modify the order.
7. A person may enter into a written agreement with his spouse dividing their community income, assets and obligations into equal shares of separate income, assets and obligations of the spouses. Such an agreement is effective only if one spouse is an institutionalized spouse and the other spouse is a community spouse or a division of the income or resources would allow one spouse to qualify for services under NRS 427A.250 to 427A.280, inclusive.
8. An agreement entered into or decree entered pursuant to this section may not be binding on the welfare division of the department of human resources in making determinations under the state plan for [assistance to the medically indigent.] Medicaid.
9. As used in this section, "community spouse" and "institutionalized spouse" have the meanings respectively ascribed to them in 42 U.S.C. § 1396r-5(h).
Sec. 31. NRS 146.070 is hereby amended to read as follows:
146.070 1. When a person dies leaving an estate, the gross value of which after deducting any encumbrances does not exceed $25,000, and there is a surviving spouse or minor child or minor children of the deceased, the estate must not be administered upon, but the whole thereof, after directing such payments as may be deemed just, must be, by an order for that purpose, assigned and set apart for the support of the surviving spouse or minor children, or for the support of the minor child or minor children, if there is no surviving spouse. Even though there is a surviving spouse, the court may, after directing such payments, set aside the whole of the estate to the minor child or minor children, if it is in their best interests.
2. When there is no surviving spouse or minor child of the deceased and the gross value of a decedent's estate, after deducting any encumbrances, does not exceed $25,000, upon good cause shown therefor, the judge may order that the estate must not be administered upon but the whole thereof must be assigned and set apart:
First: To the payment of funeral expenses, expenses of last illness, money owed to the department of human resources as a result of payment of benefits for [assistance to the medically indigent,] Medicaid, and creditors, if there are any; and
Second: Any balance remaining to the claimant or claimants entitled thereto.
3. All proceedings taken under this section, whether or not the decedent left a will, must be originated by a verified petition containing:
(a) A specific description of all of the decedent's property.
(b) A list of all the liens and encumbrances of record at the date of his death.
(c) An estimate of the value of the property.
(d) A statement of the debts of the decedent so far as known to the petitioner.
(e) The names, ages and residences of the decedent's heirs, devisees and legatees.
The petition may include a prayer that if the court finds the gross value of the estate, less encumbrances, does not exceed $25,000, the estate be set aside as provided in this section.
4. The petitioner shall give notice of the petition and hearing in the manner provided in NRS 155.010 to the decedent's heirs, devisees and legatees and to the welfare division of the department of human resources. The notice must include a statement that a prayer for setting aside the estate to the spouse, or minor child or minor children, as the case may be, is included in the petition.
5. No court or clerk's fees may be charged for the filing of any petition in, or order of court thereon, or for any certified copy of the petition or order in an estate not exceeding $2,500 in value.
6. If the court finds that the gross value of the estate, less encumbrances, does not exceed the sum of $25,000, the court may direct that the estate be distributed to the father or mother of any minor heir or legatee, with or without the filing of any bond, or may require that a general guardian be appointed and that the estate be distributed to the guardian, with or without bond as in the discretion of the court seems to be in the best interests of the minor. The court may direct the manner in which the money may be used for the benefit of the minor.
Sec. 32. NRS 146.080 is hereby amended to read as follows:
146.080 1. When a decedent leaves no real property, nor interest therein nor lien thereon, in this state, and the gross value of the decedent's property in this state, over and above any amounts due to the decedent for services in the Armed Forces of the United States, does not exceed $10,000, the surviving spouse, the children, lawful issue of deceased children, the parent, the brother or sister of the decedent, or the guardian of the estate of any minor or insane or incompetent person bearing that relationship to the decedent, if that person has a right to succeed to the property of the decedent or is the sole beneficiary under the last will and testament of the decedent, or the welfare division of the department of human resources, may, 40 days after the death of the decedent, without procuring letters of administration or awaiting the probate of the will, collect any money due the decedent, receive the property of the decedent, and have any evidences of interest, indebtedness or right transferred to him upon furnishing the person, representative, corporation, officer or body owing the money, having custody of the property or acting as registrar or transfer agent of the evidences of interest, indebtedness or right, with an affidavit showing the right of the affiant or affiants to receive the money or property or to have the evidences transferred.
2. An affidavit made pursuant to this section must state:
(a) The affiant's name and address, and that the affiant is entitled by law to succeed to the property claimed;
(b) That the decedent was a resident of Nevada at the time of his death;
(c) That the gross value of the decedent's property in this state, except amounts due to the decedent for services in the Armed Forces of the United States, does not exceed $10,000, and that the property does not include any real property nor interest therein nor lien thereon;
(d) That at least 40 days have elapsed since the death of the decedent;
(e) That no application or petition for the appointment of a personal representative is pending or has been granted in any jurisdiction;
(f) That all debts of the decedent, including funeral and burial expenses and money owed to the department of human resources as a result of the payment of benefits for [assistance to the medically indigent,] Medicaid have been paid or provided for;
(g) A description of the personal property and the portion claimed;
(h) That the affiant has given written notice, by personal service or by certified mail, identifying his claim and describing the property claimed, to every person whose right to succeed to the decedent's property is equal or superior to that of the affiant, and that at least 10 days have elapsed since the notice was served or mailed; and
(i) That the affiant is personally entitled, or the department of human resources is entitled, to full payment or delivery of the property claimed or is entitled to payment or delivery on behalf of and with the written authority of all other successors who have an interest in the property.
3. If the affiant:
(a) Submits an affidavit which does not meet the requirements of subsection 2 or which contains statements which are not entirely true, any money or property he receives is subject to all debts of the decedent.
(b) Fails to give notice to other successors as required by subsection 2, any money or property he receives is held by him in trust for all other successors who have an interest in the property.
4. A person who receives an affidavit containing the information required by subsection 2 is entitled to rely upon such information, and if he relies in good faith, he is immune from civil liability for actions based on that reliance.
5. Upon receiving proof of the death of the decedent and an affidavit containing the information required by this section:
(a) A transfer agent of any security shall change the registered ownership of the security claimed from the decedent to the person claiming to succeed to ownership of that security.
(b) A governmental agency required to issue certificates of ownership or registration to personal property shall issue a new certificate of ownership or registration to the person claiming to succeed to ownership of the property.
6. If any property of the estate not exceeding $10,000 is located in a state which requires an order of a court for the transfer of the property, or if it consists of stocks or bonds which must be transferred by an agent outside this state, any person qualified under the provisions of subsection 1 to have the stocks or bonds or other property transferred to him may do so by obtaining a court order directing the transfer. The person desiring the transfer must file a verified petition in a court of competent jurisdiction containing:
(a) A specific description of all of the property of the decedent.
(b) A list of all the liens and encumbrances of record at the date of the decedent's death.
(c) An estimate of the value of the property of the decedent.
(d) The names, ages and residences of the decedent's heirs and legatees.
(e) A prayer requesting the court to issue an order directing the transfer of the stocks or bonds or other property if the court finds the gross value of the estate does not exceed $10,000.
If the court finds that the gross value of the estate does not exceed $10,000 and the person requesting the transfer is entitled to it, the court may issue an order directing the transfer.
Sec. 33. NRS 150.220 is hereby amended to read as follows:
150.220 The debts and charges of the estate must be paid in the following order:
1. Funeral expenses.
2. The expenses of the last sickness.
3. Family allowance.
4. Debts having preference by laws of the United States.
5. Money owed to the department of human resources as a result of the payment of benefits for [assistance to the medically indigent.] Medicaid.
6. Wages to the extent of $600, of each employee of the decedent, for work done or personal services rendered within 3 months before the death of the employer. If there is not sufficient money with which to pay all such labor claims in full, the money available must be distributed among the claimants in accordance with the amounts of their respective claims.
7. Judgments rendered against the deceased in his lifetime, and mortgages in order of their date. The preference given to a mortgage must only extend to the proceeds of the property mortgaged. If the proceeds of such property are insufficient to pay the mortgage, the part remaining unsatisfied must be classed with other demands against the estate.
8. All other demands against the estate.
Sec. 34. NRS 150.230 is hereby amended to read as follows:
150.230 1. The executor or administrator shall, as soon as he has sufficient funds in his hands, upon receipt of a sworn statement of the amount due and without any formal action upon creditors' claims, pay the funeral expenses, the expenses of the last sickness, the allowance made to the family of the deceased, money owed to the department of human resources as a result of payment of benefits for [assistance to the medically indigent] Medicaid and wage claims to the extent of $600 of each employee of the decedent for work done or personal services rendered within 3 months before the death of the employer; but he may retain in his hands the necessary expenses of administration.
2. He is not obliged to pay any other debt or any legacy until the payment is ordered by the court.
3. He may, before court approval or order, pay any of the decedent's debts amounting to $100 or less if:
(a) Claims for payment thereof are properly filed in the proceedings;
(b) The debts are justly due; and
(c) The estate is solvent.
In settling the account of the estate, the court shall allow any such payment if the conditions of paragraphs (a), (b) and (c) have been met; otherwise, the executor or administrator is personally liable to any person sustaining loss or damage as a result of such payment.
4. Funeral expenses and expenses of a last sickness are debts payable out of the estate of the deceased spouse and must not be charged to the community share of a surviving spouse, whether or not the surviving spouse is financially able to pay such expenses and whether or not the surviving spouse or any other person is also liable therefor.
Sec. 35. NRS 228.410 is hereby amended to read as follows:
228.410 1. The attorney general has primary jurisdiction to investigate and prosecute violations of NRS 422.540 to 422.570, inclusive, and any fraud in the administration of the plan or in the provision of medical assistance. The provisions of this section notwithstanding, the welfare division of the department of human resources shall enforce the plan and any administrative regulations adopted pursuant thereto.
2. For this purpose, he shall establish within his office the Medicaid fraud control unit. The unit must consist of a group of qualified persons, including, without limitation, an attorney, an auditor and an investigator who, to the extent practicable, has expertise in nursing, medicine and the administration of medical facilities.
3. The attorney general, acting through the unit established pursuant to subsection 2:
(a) Is the single state agency responsible for the investigation and prosecution of violations of NRS 422.540 to 422.570, inclusive;
(b) Shall review reports of abuse or criminal neglect of patients in medical facilities which receive payments under the plan and, when appropriate, investigate and prosecute the persons responsible;
(c) May review and investigate reports of misappropriation of money from the personal resources of patients in medical facilities which receive payments under the plan and, when appropriate, prosecute the persons responsible;
(d) Shall cooperate with federal investigators and prosecutors in coordinating state and federal investigations and prosecutions involving fraud in the provision or administration of medical assistance pursuant to the plan, and provide those federal officers with any information in his possession regarding such an investigation or prosecution; and
(e) Shall protect the privacy of patients and establish procedures to prevent the misuse of information obtained in carrying out this section.
4. When acting pursuant to NRS 228.175 or this section, the attorney general may commence his investigation and file a criminal action without leave of court, and he has exclusive charge of the conduct of the prosecution.
5. As used in this section:
(a) "Medical facility" has the meaning ascribed to it in NRS 449.0151.
(b) "Plan" means the state plan for [the medically indigent] Medicaid established pursuant to NRS 422.237.
Sec. 36. NRS 441A.220 is hereby amended to read as follows:
441A.220 All information of a personal nature about any person provided by any other person reporting a case or suspected case of a communicable disease, or by any person who has a communicable disease, or as determined by investigation of the health authority, is confidential medical information and must not be disclosed to any person under any circumstances, including pursuant to any subpoena, search warrant or discovery proceeding, except as follows:
1. For statistical purposes, provided that the identity of the person is not discernible from the information disclosed.
2. In a prosecution for a violation of this chapter.
3. In a proceeding for an injunction brought pursuant to this chapter.
4. In reporting the actual or suspected abuse or neglect of a child or elderly person.
5. To any person who has a medical need to know the information for his own protection or for the well-being of a patient or dependent person, as determined by the health authority in accordance with regulations of the board.
6. If the person who is the subject of the information consents in writing to the disclosure.
7. Pursuant to subsection 2 of NRS 441A.320.
8. If the disclosure is made to the welfare division of the department of human resources and the person about whom the disclosure is made has been diagnosed as having acquired immunodeficiency syndrome or an illness related to the human immunodeficiency virus and is a recipient of or an applicant for [assistance to the medically indigent.] Medicaid.
9. To a fireman, police officer or person providing emergency medical services if the board has determined that the information relates to a communicable disease significantly related to that occupation. The information must be disclosed in the manner prescribed by the board.
10. If the disclosure is authorized or required by specific statute.
Sec. 37. NRS 442.1192 is hereby amended to read as follows:
442.1192 1. A health officer in a county or community that lacks services for prenatal care may submit an application to the University of Nevada School of Medicine for a grant to subsidize a portion of the malpractice insurance of a provider of prenatal care who provides services to pregnant women in the county or community.
2. A county or community lacks services for prenatal care if at least one of the following conditions is present:
(a) A provider of prenatal care does not offer services to pregnant women within the county or the community.
(b) Fifty percent or more of the live births to women who are residents of the county occur outside the county.
(c) The percentage of live births to women in the county or community who received no prenatal care exceeds the percentage of live births to women in the state who received no prenatal care.
(d) The percentage of live births of babies with low birthweight to women in the county or community is higher than the percentage of live births of babies with low birthweight to women in the state.
3. If the applicant is a county or district health officer, he must provide proof of the financial contribution by the county or district for the provision of prenatal services for women who do not qualify for reimbursement pursuant to the state plan for [assistance to the medically indigent.] Medicaid.
Sec. 38. NRS 422.008 is hereby repealed.
Sec. 39. 1. This act becomes effective on July 1, 1997.
2. Section 31 of this act becomes effective at 12:01 a.m. on July 1, 1997.

TEXT OF REPEALED SECTION

422.008 "Assistance to the medically indigent" defined. "Assistance to the medically indigent" means the program established to provide assistance for part or all of the cost of medical or remedial care rendered on behalf of indigent persons pursuant to Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.) and other provisions of that act relating to medical assistance to indigent persons.
________