Assembly Bill No. 410-Committee on Health and Human Services
April 24, 1997
____________
Referred to Concurrent Committees on Health and Human Services
and Ways and Means
SUMMARY--Establishes program of health assurance to provide medical care to certain recipients of Medicaid and other low-income residents of this state. (BDR 38-1486)
FISCAL NOTE: Effect on Local Government: Yes.
Effect on the State or on Industrial Insurance: Contains Appropriation not included in Executive Budget.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to welfare; creating the commission for health assurance within the department of human resources; requiring the commission to establish a program for health assurance to arrange for the provision of health care services to certain persons who are eligible to receive benefits through Medicaid and to other low-income residents of this state; requiring the commission to employ a program manager to conduct the administrative and operational business of the program; making various changes to the welfare division of the department of human resources regarding Medicaid; indemnifying counties from the responsibility of providing certain health care services to indigent persons; making an appropriation; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1 Title 38 of NRS is hereby amended by adding thereto a new chapter to consist of the provisions set forth as sections 2 to 35, inclusive, of this act.
Sec. 2 As used in this chapter, unless the context otherwise requires, the words and terms defined in sections 3 to 12, inclusive, of this act have the meanings ascribed to them in those sections.
Sec. 3 "Commission" means the commission for health assurance of the department.
Sec. 4 "Department" means the department of human resources.
Sec. 5 "Enrollee" means a person who enrolls in the program.
Sec. 6 "Facility for long-term care" means:
1. A facility for intermediate care as defined in NRS 449.0038;
2. A facility for skilled nursing as defined in NRS 449.0039; or
3. A residential facility for groups as defined in NRS 449.017.
Sec. 7 "Health maintenance organization" has the meaning ascribed to it in subsection 7 of NRS 695C.030.
Sec. 8 "Medicaid" 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.).
Sec. 9 "Program" means the program for health assurance established pursuant to section 13 of this act.
Sec. 10 "Provider of health care" means any physician, hospital or other person who is licensed or otherwise authorized in this state to furnish a health care service.
Sec. 11 "Resident" means a person who:
1. Is a citizen of the United States or who is lawfully entitled to reside in the United States; and
2. Actually resides in this state with domiciliary intent.
Sec. 12 1. The commission shall establish the program for health assurance. The program must arrange for the provision of health care services to the persons listed in section 13 of this act.
2. The program must include the provision of such health care services as are set forth in the state plan for Medicaid established pursuant to section 18 of this act.
Sec. 13 1. A resident who is eligible to receive benefits through Medicaid because he:
(a) Qualifies for the aid to families with dependent children program pursuant to part A of Title IV of the Social Security Act (42 U.S.C. §§ 601 et seq.);
(b) Is 65 years of age or older in accordance with 42 U.S.C. § 1382c(a)(1)(A);
(c) Is disabled, as determined in accordance with 42 U.S.C. § 1382c(a)(3);
(d) Qualifies for the child health assurance program pursuant to 42 U.S.C. § 1396a(a)(10)(A)(i)(IV), (VI) or (VII); or
(e) Qualifies for the aid to families with dependent children-unemployed parent program pursuant to 42 U.S.C. § 682(e)(6),
may receive such benefits only by enrolling in the program.
2. In addition to the persons set forth in subsection 1, enrollment in the program must be offered to:
(a) Any resident who has a monthly household income that is at or below 150 percent of the federally designated level signifying poverty, as revised annually; and
(b) Any other resident to whom enrollment is offered pursuant to paragraph (c) of subsection 2 of section 14 of this act.
3. The welfare division of the department shall determine whether a person is eligible to receive benefits through Medicaid and whether any such person must receive such benefits by enrolling in the program.
Sec. 14 1. The commission shall:
(a) Establish written procedures and policies for the management, administration and regulation of the program.
(b) Hold public hearings, conduct studies and issue reports regarding the delivery of health care services to low-income persons and recipients of Medicaid in this state.
(c) Advise and make recommendations to the program manager and the legislature concerning the policies related to public health and welfare in this state.
(d) Establish a procedure for determining eligibility for enrollment in the program.
(e) Determine the manner in which to enroll each eligible person in the program and the length of time for which to enroll each such person in the program. Initial enrollment must be authorized at any time.
(f) Establish criteria for participation in the program and procedures for disenrolling an enrollee.
(g) Establish a period of open enrollment not more than one time per year during which an enrollee must be allowed to choose to enroll in a different participating health care plan that provides health care services within the geographic area of the residence of the enrollee, if there is more than one such plan available within that area.
(h) Establish requirements for any health maintenance organization that contracts to provide health care services for the program, including, without limitation, requirements regarding business practices, financial practices, quality of health care services and accessibility to health care services.
(i) Establish regulations and procedures for collecting money from counties pursuant to NRS 428.050.
2. The commission may:
(a) Require an enrollee to enroll in a health maintenance organization if a health maintenance organization which has contracted to provide health care services for the program is available within the geographic area of the residence of the enrollee;
(b) Establish any enrollment fees, deductibles and copayments to be paid by an enrollee who receives health care services pursuant to subsection 2 of section 13 of this act;
(c) Establish criteria for the enrollment of additional residents in the program when feasible;
(d) Contract with health maintenance organizations to provide health care services to enrollees;
(e) Contract with agencies of state and local government to provide assistance to the program, including, without limitation, boards of county commissioners pursuant to NRS 428.050;
(f) Employ or contract for personnel and services within the limits of legislative appropriations and other money available from federal or other sources; and
(g) Enter into contracts for any necessary assistance for the program.
3. The department shall provide such technical, clerical and operational assistance to the commission as the functions and operations of the commission may require.
Sec. 15 1. The commission shall contract with a private entity that does not provide or arrange for the provision of health care services to enrollees to serve as the program manager.
2. The program manager shall, under the direction of the commission, conduct the administrative and operational business of arranging for the provision of health care services to enrollees.
3. The program manager must:
(a) Have experience in the provision of health care services to low-income persons;
(b) Have experience performing administrative responsibilities, including, without limitation, collecting data, economic forecasting for budgeting purposes, billing for and collecting fees and managing quality assurance programs related to health care; and
(c) Have a demonstrated ability to oversee effectively the enrollment of persons in the program and the provision of health care services to enrollees.
4. The program manager serves at the pleasure of the commission.
5. The program manager may, with the approval of the commission, expend money from the account created pursuant to section 23 of this act. Such expenditures must be paid upon approval by the commission as other claims against the state are paid.
Sec. 16 1. The program manager shall:
(a) Manage the financial responsibilities of the program. Such responsibilities include, without limitation:
(1) Preparing a complete financial plan for the next 2 fiscal years, including, without limitation, all expenditures for the administration, operation and maintenance of the program;
(2) Preparing and presenting the executive biennial budget of the program to the legislature in conjunction with the budget division of the department of administration;
(3) Preparing an annual report and preparing interim reports upon the request of the commission which evaluate the quality and effectiveness of the program and whether the scope of the health care services provided to enrollees is adequate;
(4) Allocating the appropriation of the state for administration of the program, subject to administrative supervision by the commission; and
(5) Administering any money granted to the State of Nevada by the Federal Government to assist in the furtherance of any of the services and activities set forth in this chapter;
(b) With the approval of the commission, seek any federal approvals or waivers necessary for the establishment and implementation of the program pursuant to this chapter;
(c) Carry out any requirements established by the Federal Government in granting a waiver pursuant to paragraph (b);
(d) Maintain a complete and accurate record of all proceedings pertaining to his office and to the commission, record and file all bonds or contracts concerning the program, and assume responsibility for the custody and preservation of all papers and documents pertaining to his office and to the commission;
(e) Develop methods to assure the quality of health care services provided to enrollees and to monitor enrollees;
(f) Provide periodic reports to the commission concerning the quality of health care services, access to health care services and the resolution of complaints; and
(g) Observe, study and develop effective ways to meet the changing health care needs of low-income persons and recipients of Medicaid in this state.
2. The program manager may accept money and contributions made available by any person, the Federal Government or any political subdivision of this state.
Sec. 17 1. The program manager shall prepare, develop and present to the commission for its approval a proposed state plan for Medicaid as set forth in section 18 of this act.
2. The director, the program manager and the commission shall cooperate with the Federal Government in preparing the proposed state plan for Medicaid in all matters of mutual concern, including, without limitation, methods of administration found by the Federal Government to be necessary for the efficient operation of the state plan for Medicaid, and in increasing the efficiency of the state plan for Medicaid by prompt and judicious use of new federal grants which will assist the commission in carrying out the provisions of this chapter.
Sec. 18 1. The commission shall, with the assistance of the program manager, adopt a state plan for Medicaid which meets all applicable requirements of the Federal Government, either directly or as a condition to the receipt of federal money for the administration of the program. The state plan for Medicaid must include, without limitation:
(a) The requirements for eligibility for enrollment in the program;
(b) The nature and amount of any health care services that may be provided to enrollees;
(c) Any conditions imposed upon an enrollee; and
(d) Such other provisions relating to the development and administration of the program as the commission deems necessary.
The state plan for Medicaid becomes effective upon adoption or such other date as the commission specifies in the state plan for Medicaid.
2. The state plan for Medicaid must set forth all health care services that will be provided under the program to enrollees. Such services may include any health care services other than dental care, services provided in a facility for long-term care, services provided by the mental hygiene and mental retardation division of the department and services provided by the division of child and family services of the department.
3. In developing and revising the state plan for Medicaid, the program manager and the commission shall consider, without limitation:
(a) The amount of money available from the Federal Government;
(b) The conditions attached to the acceptance of any such money; and
(c) The limitations of legislative appropriations and authorizations.
4. The state plan for Medicaid must promote quality health care services for all enrollees and emphasize programs of wellness and treatment for enrollees who have special health care concerns, including, without limitation, programs for enrollees who have a disability.
5. The commission and the program manager shall carry out the state plan for Medicaid adopted pursuant to this section.
Sec. 19 The commission shall adopt regulations for the administration of the provisions of this chapter. Such regulations:
1. Must be formulated or conditioned so that they do not require for their operation throughout a fiscal year the expenditure of any money beyond the amounts appropriated or authorized by the legislature for the fiscal year to which the regulations apply.
2. Become effective upon adoption or such other date as the commission specifies in the regulations.
Sec. 20 1. Except as otherwise provided in subsection 2, each health maintenance organization in this state that satisfies the requirements established pursuant to paragraph (h) of subsection 1 of section 14 of this act must be authorized to contract to provide health care services for the program.
2. The commission may limit the number of health maintenance organizations in a certain geographic area of this state that may participate in the program if the commission determines that it is necessary because of the number of enrollees in that area. The commission shall establish a procedure for awarding a contract pursuant to this subsection by competitive selection.
Sec. 21 The program manager shall:
1. Promptly comply with a request from the Medicaid fraud control unit established pursuant to NRS 228.410 for access to and copies of any records or other information in the possession of the program manager regarding a provider of health care who has applied to participate or who participates in the state plan for Medicaid as a provider of goods or services;
2. Refer to the Medicaid fraud control unit all cases in which he suspects that a provider of health care who has applied to participate or who participates in the state plan for Medicaid as a provider of goods or services has committed an offense set forth in NRS 422.540, 422.550, 422.560 or 422.570; and
3. Suspend or exclude a provider of health care, who has applied to participate or who participates in the state plan for Medicaid as a provider of goods or services who he determines has committed an offense set forth in NRS 422.540, 422.550, 422.560 or 422.570, from participation in the program or being an employee of a provider of goods or services for not less than 3 years. A criminal action need not be commenced against the provider before he is suspended or excluded pursuant to this subsection.
Sec. 22 The commission and the director of the department have the power to sign and execute, in the name of the State of Nevada, by "The Program for Health Assurance," any contract or agreement with the Federal Government or its agencies.
Sec. 23 The account for the program for health assurance is hereby created within the state general fund.
Sec. 24 Any federal money allotted to the State of Nevada for the program and such other money as may be received by the State of Nevada for such purposes must be deposited in the account for the program for health assurance.
Sec. 25 The attorney general and his deputies are the legal advisers for the commission.
Sec. 26 The director of the department shall:
1. Upon request of the commission, schedule a meeting of the commission and develop an agenda of business for the meeting;
2. Provide such recommendations to the commission for improving the program as the director deems necessary;
3. Accept any recommendations from the legislature, the governor or the public for improving the program;
4. Respond to requests for information concerning the program; and
5. Facilitate intradepartmental processes, resource availability and planning to accomplish the goals of the program, as directed by the commission.
Sec. 27 1. The program may provide prenatal care to pregnant women who receive Medicaid pursuant to the program, or the program manager may contract for the provision of such care at hospitals in this state.
2. The program manager must provide to each person licensed to engage in social work pursuant to chapter 641B of NRS, each applicant for Medicaid pursuant to section 13 of this act and any other interested person, information concerning any prenatal care that is covered under the program.
Sec. 28 1. The program manager shall, with the approval of the commission, establish and enforce reasonable rules and regulations governing the custody, use and preservation of the records, files and communications filed with the program manager to restrict the use or disclosure of any information concerning applicants for and recipients of health care services pursuant to this chapter for purposes directly connected with the administration of this chapter, and to provide safeguards therefor, under the applicable provisions of the Social Security Act.
2. Wherever, under provisions of law or regulations of the commission, names and addresses of, or information concerning, applicants for and recipients of health care services pursuant to this chapter are furnished to or held by any other agency or department of government, the agency or department of government is bound by the rules and regulations of the department prohibiting the publication of lists and records thereof or their use for purposes not directly connected with the administration of this chapter.
3. Except for purposes directly connected with the administration of this chapter, no person may publish, disclose or use, or permit or cause to be published, disclosed or used, any confidential information pertaining to a recipient of health care services under the provisions of this chapter.
4. The program manager may, with the approval of the commission, classify as confidential certain records and information obtained from entities that contract with or are considering contracting with the program manager for the provision of health care services to enrollees, including, without limitation, a bid, upon the express condition that they remain confidential.
Sec. 29 1. Except as otherwise provided in subsection 2, NRS 228.410 and section 21 of this act, any information obtained by the director of the department, program manager or commission in an investigation of a provider of services under the state plan for 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 commission against a provider of services under the state plan for Medicaid,
is not confidential, except for the identity of any recipient of the assistance.
Sec. 30 1. Upon receipt of a request for a hearing from a provider of health care under the state plan for Medicaid, the program manager, with the approval of the commission, shall appoint a hearing officer to conduct the hearing. Any employee or other representative of the program manager who investigated or made the initial decision regarding the action taken against the provider of health care may not be appointed as the hearing officer or participate in the making of any decision pursuant to the hearing.
2. The commission 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, without limitation, the program manager, 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 commission;
(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. 31 1. When a recipient of Medicaid incurs an illness or injury for which health care services are payable under the state plan for Medicaid developed pursuant to section 18 of this act and which is incurred under circumstances creating a legal liability in some person other than the recipient or the commission to pay all or part of the costs of such services, the commission 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 the legal liability.
2. If a recipient or his successors in interest fail or refuse to commence an action to enforce the legal liability, the commission 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 commission, the recipient or his successors in interest may be joined as third party defendants.
3. In any case where the commission is subrogated to the rights of the recipient or his successors in interest as provided in subsection 1, the commission 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 commission 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 commission of a reduction of the amount of the lien pursuant to subsection 5 and shall pay to the commission all costs to which it is entitled and its court costs and attorney's fees.
5. If the commission receives notice pursuant to subsection 4, it 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 commission 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 commission pursuant to subsection 5.
Sec. 32 1. Except as otherwise provided in this section, the commission shall, to the extent that it is not prohibited by federal law and when circumstances allow:
(a) Recover benefits correctly paid for 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 Medicaid or the person who signed the application for 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 commission that the person knew at the time he signed the application; or
(2) Failed within the period allowed by the commission to report any required information to the commission which the person obtained after he filed the application.
2. The commission 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 Medicaid is made for less than fair market value, the commission may pursue any remedy available pursuant to chapter 112 of NRS with respect to the transfer.
4. The amount of 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 commission may elect not to file a claim against the estate of a recipient of Medicaid or his spouse if it determines that the filing of the claim will cause an undue hardship for the spouse or other survivors of the recipient. The commission shall, with the approval of the commission, 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 and the program 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 commission as a result of the payment of Medicaid must be commenced within 6 months after the cause of action accrues. A cause of action accrues after all the following events have occurred:
(a) The death of the recipient of Medicaid;
(b) The death of the surviving spouse of the recipient of Medicaid;
(c) The death of all children of the recipient of 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 Medicaid at the age of 21 years.
8. For the purposes of this section, "undivided estate" means all assets included in the estate of a deceased recipient of 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, without limitation, assets passing by reason of joint tenancy, reserved life estate, survivorship or trust, and any of the separate property of the decedent 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. 33 All assistance awarded pursuant to the provisions of this chapter is awarded and held subject to the provisions of any amending or repealing act that may be enacted, and no recipient has any claim for assistance or otherwise by reason of his assistance being affected in any way by an amending or repealing act.
Sec. 34 1. Money to carry out the provisions of this chapter must be provided by appropriation by the legislature from the state general fund.
2. Disbursements for the purposes of this chapter must be made upon claims filed, audited and allowed in the same manner as other money in the state treasury is disbursed.
Sec. 35 If any provision of this chapter is in conflict with the requirements of federal law, that provision is inoperative to the extent of the conflict and is only effective to the extent authorized by the Federal Government.
Sec. 36 Chapter 422 of NRS is hereby amended by adding thereto the provisions set forth as sections 37 to 40, inclusive, of this act.
Sec. 37 "Assistance to the medically indigent" means that portion of Medicaid provided pursuant to the state plan established pursuant to NRS 422.237.
Sec. 38 "Commission for health assurance" means the commission for health assurance of the department established pursuant to section 90 of this act.
Sec. 39 "Facility for long-term care" means:
1. A facility for intermediate care as defined in NRS 449.0038;
2. A facility for skilled nursing as defined in NRS 449.0039; or
3. A residential facility for groups as defined in NRS 449.017.
Sec. 40 "Program for health assurance" means the program established pursuant to section 12 of this act.
Sec. 41 NRS 422.001 is hereby amended to read as follows:
422.001As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 422.005 to 422.055, inclusive, and sections 37 to 40, inclusive, of this act, have the meanings ascribed to them in those sections.
Sec. 42 NRS 422.008 is hereby amended to read as follows:
422.008["Assistance to the medically indigent"] "Medicaid" 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.]
Sec. 43 NRS 422.215 is hereby amended to read as follows:
422.2151. 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 [;] or Medicaid; 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 [.] established pursuant to NRS 422.237.
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. 44 NRS 422.2345 is hereby amended to read as follows:
422.23451. 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 established pursuant to NRS 422.237 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. 45 NRS 422.237 is hereby amended to read as follows:
422.2371. The administrator shall adopt each state plan required by the Federal Government, either directly or as a condition to the receipt of federal money, for the administration of any public assistance or other program for which the welfare division is responsible. Such a plan must set forth, regarding the particular program to which the plan applies:
(a) The requirements for eligibility;
(b) The nature and amounts of grants and other assistance which may be provided;
(c) The conditions imposed; and
(d) Such other provisions relating to the development and administration of the program as the administrator deems necessary.
Such a plan becomes effective upon adoption or such other date as the administrator specifies in the plan.
2. In developing and revising such a plan, the administrator shall consider, among other things:
(a) The amount of money available from the Federal Government;
(b) The conditions attached to the acceptance of that money; and
(c) The limitations of legislative appropriations and authorizations,
for the particular program to which the plan applies.
3. The state plan for assistance to the medically indigent must include all health care services provided to persons who are eligible to receive benefits through Medicaid and who are not eligible to receive benefits under the program for health assurance.
4. The welfare division shall comply with each state plan adopted pursuant to this section.
Sec. 46 NRS 422.270 is hereby amended to read as follows:
422.270The department , through the welfare division , shall:
1. Except as otherwise provided in NRS 432.010 to 432.085, inclusive, and except for any program administered pursuant to sections 2 to 35, inclusive, of this act, 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;
(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 [,] established pursuant to NRS 422.237 in all matters of mutual concern, including , without limitation, 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. 47 NRS 422.285 is hereby amended to read as follows:
422.285The department , [of human resources,] through the welfare division, may reimburse directly, under the state plan for assistance to the medically indigent [,] established pursuant to NRS 422.237, 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. 48 NRS 422.2936 is hereby amended to read as follows:
422.2936Each 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. 49 NRS 422.294 is hereby amended to read as follows:
422.2941. Subject to the provisions of subsection 2, if an application for public assistance or Medicaid is not acted upon by the welfare division within a reasonable time after the filing of the application, or is denied in whole or in part, or if any grant of public assistance or Medicaid is modified or canceled, or if an applicant for or recipient of public assistance or Medicaid believes that any other action or failure to act on the part of the welfare division is erroneous with respect to his case, the applicant or recipient may appeal to the welfare division and may be represented in the appeal by counsel or other representative of his choice.
2. Upon the initial decision to deny, modify or cancel public assistance [,] or Medicaid, the welfare division shall notify that applicant or recipient of its decision, the regulations involved and his right to request a hearing within a certain period. If a request for a hearing is received within that period, the welfare division shall notify that person of the time, place and nature of the hearing. The welfare division shall provide an opportunity for a fair hearing of that appeal and shall review his case regarding all matters alleged in that appeal.
Sec. 50 NRS 422.296 is hereby amended to read as follows:
422.2961. At any hearing held pursuant to the provisions of subsection 2 of NRS 422.294, opportunity must be afforded all parties to respond and present evidence and argument on all issues involved.
2. Unless precluded by law, informal disposition may be made of any hearing by stipulation, agreed settlement, consent order or default.
3. The record of a hearing must include:
(a) All pleadings, motions and intermediate rulings.
(b) Evidence received or considered.
(c) Questions and offers of proof and objections, and rulings thereon.
(d) Any decision, opinion or report by the hearing officer presiding at the hearing.
4. Oral proceedings, or any part thereof, must be transcribed on request of any party seeking judicial review of the decision.
5. Findings of fact must be based exclusively on substantial evidence.
6. Any employee or other representative of the welfare division who investigated or made the initial decision to deny, modify or cancel a grant of public assistance or Medicaid shall not participate in the making of any decision made pursuant to the hearing.
Sec. 51 NRS 422.298 is hereby amended to read as follows:
422.2981. A decision or order adverse to an applicant for or recipient of public assistance or Medicaid must be in writing. A final decision must include findings of fact and conclusions of law, separately stated. Findings of fact, if set forth in statutory or regulatory language, must be accompanied by a concise and explicit statement of the underlying facts supporting the findings. A copy of the decision or order must be delivered by certified mail forthwith to each party and to his attorney or other representative.
2. A person aggrieved by the final decision of the welfare division with respect to public assistance or Medicaid may, at any time within 90 days after the date on which the written notice of the decision is mailed, petition the district court of the judicial district in which he resides to review the decision. The district court shall review the decision on the record of the case before the welfare division, a copy of which must be certified as correct by the administrator and filed by the welfare division with the clerk of the court as part of its answer to any such petition for review.
Sec. 52 NRS 422.2997 is hereby amended to read as follows:
422.29971. Upon receipt of a request for a hearing from a provider of services under the plan for assistance to the medically indigent [,] established pursuant to NRS 422.237, 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. 53 NRS 422.363 is hereby amended to read as follows:
422.363"Medicaid card" means any instrument or device evidencing eligibility for receipt of Medicaid benefits that is issued by the welfare division for the use of a cardholder in obtaining the types of medical and remedial care for which assistance may be provided under [the] a plan.
Sec. 54 NRS 422.364 is hereby amended to read as follows:
422.364"Plan" means the state plan for assistance to the medically indigent established pursuant to NRS 422.237 [.] or the state plan for Medicaid established pursuant to section 18 of this act.
Sec. 55 NRS 422.366 is hereby amended to read as follows:
422.3661. A person who:
(a) Steals, takes or removes a Medicaid card from the person, possession, custody or control of another without the [cardholder's consent;] consent of the cardholder; or
(b) With knowledge that a Medicaid card has been so taken, removed or stolen, receives the Medicaid card with the intent to circulate, use or sell it or to transfer it to a person other than the welfare division , the commission for health assurance, the program manager of the program for health assurance or the cardholder,
is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
2. A person who possesses a Medicaid card without the consent of the cardholder and with the intent to circulate, use, sell or transfer the Medicaid card with the intent to defraud is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
3. A person who has in his possession or under his control two or more Medicaid cards issued in the name of another person is presumed to have obtained and to possess the Medicaid cards with the knowledge that they have been stolen and with the intent to circulate, use, sell or transfer them with the intent to defraud. The presumption established by this subsection may be rebutted by clear and convincing evidence. The presumption does not apply to the possession of two or more Medicaid cards if the possession is with the consent of the welfare division [.] or the commission for health assurance.
Sec. 56 NRS 422.367 is hereby amended to read as follows:
422.367A person who:
1. Sells or buys a Medicaid card; or
2. Authorizes another person to use his Medicaid card to obtain the types of medical and remedial care for which assistance may be provided under [the] a plan, if the person to whom authorization is given is not entitled to use that card to obtain care,
is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
Sec. 57 NRS 422.368 is hereby amended to read as follows:
422.368A person who, with the intent to defraud:
1. Uses a Medicaid card to obtain the types of medical and remedial care for which assistance may be provided under [the] a plan with the knowledge that the Medicaid card was obtained or retained in violation of any of the provisions of NRS 422.361 to 422.367, inclusive, or is forged or is the expired or revoked Medicaid card of another; or
2. Obtains the types of medical and remedial care for which assistance may be provided under [the] a plan by representing, without the consent of the cardholder, that he is the authorized holder of a Medicaid card or that he is the holder of a Medicaid card that has not in fact been issued,
is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
Sec. 58 NRS 422.369 is hereby amended to read as follows:
422.369A person authorized by the welfare division or the commission for health assurance to furnish the types of medical and remedial care for which assistance may be provided under [the] a plan, or an agent or employee of the authorized person, who, with the intent to defraud, furnishes such care upon presentation of a Medicaid card which he knows was obtained or retained in violation of any of the provisions of NRS 422.361 to 422.367, inclusive, or is forged, expired or revoked, is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
Sec. 59 NRS 422.380 is hereby amended to read as follows:
422.380As 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. 60 NRS 422.385 is hereby amended to read as follows:
422.3851. 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 [,] established pursuant to NRS 422.237, 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] may expend the additional revenue in accordance with the provisions of the state plan for assistance to the medically indigent [.] established pursuant to NRS 422.237.
Sec. 61 NRS 422.387 is hereby amended to read as follows:
422.3871. 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 established pursuant to NRS 422.237 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 established pursuant to NRS 422.237 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. 62 NRS 422.410 is hereby amended to read as follows:
422.4101. Unless a different penalty is provided pursuant to NRS 422.361 to 422.369, inclusive, or 422.450 to 422.580, inclusive, a person who knowingly and designedly, by any false pretense, false or misleading statement, impersonation or misrepresentation, obtains or attempts to obtain monetary or any other public assistance having a value of $100 or more, whether by one act or a series of acts, with the intent to cheat, defraud or defeat the purposes of this chapter or sections 2 to 35, inclusive, of this act is guilty of a category E felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
2. For the purposes of subsection 1, whenever a recipient of aid to families with dependent children under the provisions of this chapter receives an overpayment of benefits for the third time and the overpayments have resulted from a false statement or representation by the recipient or from the failure of the recipient to notify the welfare division of a change in his circumstances which would affect the amount of assistance he receives, a rebuttable presumption arises that the payment was fraudulently received.
3. For the purposes of subsection 1, "public assistance" includes any money, property, medical or remedial care or any other service provided pursuant to a state plan.
Sec. 63 NRS 422.460 is hereby amended to read as follows:
422.460"Benefit" means a benefit authorized by [the] a plan.
Sec. 64 NRS 422.470 is hereby amended to read as follows:
422.470"Claim" means a communication, whether oral, written, electronic or magnetic, which is used to identify specific goods, items or services as reimbursable pursuant to [the] a plan, or which states income or expense and is or may be used to determine a rate of payment pursuant to [the] a plan.
Sec. 65 NRS 422.480 is hereby amended to read as follows:
422.480"Plan" means the state plan for assistance to the medically indigent established pursuant to NRS 422.237 [.] or the state plan for Medicaid established pursuant to section 18 of this act.
Sec. 66 NRS 422.490 is hereby amended to read as follows:
422.490"Provider" means a person who has applied to participate or who participates in [the] a plan as the provider of goods or services.
Sec. 67 NRS 422.500 is hereby amended to read as follows:
422.500"Recipient" means a natural person who receives benefits pursuant to [the] a plan.
Sec. 68 NRS 422.510 is hereby amended to read as follows:
422.510"Records" means medical, professional or business records relating to the treatment or care of a recipient, or to a good or a service provided to a recipient, or to rates paid for such a good or a service, and records required to be kept by [the] a plan.
Sec. 69 NRS 422.540 is hereby amended to read as follows:
422.540A person commits an offense and shall be punished as provided in NRS 205.380 if with respect to [the] a plan he:
1. Makes a claim or causes it to be made, knowing the claim to be false, in whole or in part, by commission or omission;
2. Makes or causes to be made a statement or representation for use in obtaining or seeking to obtain authorization to provide specific goods or services, knowing the statement or representation to be false, in whole or in part, by commission or omission;
3. Makes or causes to be made a statement or representation for use by another in obtaining goods or services pursuant to [the] a plan, knowing the statement or representation to be false, in whole or in part, by commission or omission; or
4. Makes or causes to be made a statement or representation for use in qualifying as a provider, knowing the statement or representation to be false, in whole or in part, by commission or omission.
Sec. 70 NRS 422.560 is hereby amended to read as follows:
422.5601. Except as otherwise provided in subsection 2, a person shall not:
(a) While acting on behalf of a provider, purchase or lease goods, services, materials or supplies for which payment may be made, in whole or in part, pursuant to [the] a plan, and solicit or accept anything of additional value in return for or in connection with the purchase or lease;
(b) Sell or lease to or for the use of a provider goods, services, materials or supplies for which payment may be made, in whole or in part, pursuant to [the] a plan, and offer, transfer or pay anything of additional value in connection with or in return for the sale or lease; or
(c) Refer a person to a provider for goods or services for which payment may be made, in whole or in part, pursuant to [the] a plan, and solicit or accept anything of value in connection with the referral.
2. Paragraphs (a) and (b) of subsection 1 do not apply if the additional value transferred is:
(a) A refund or discount made in the ordinary course of business;
(b) Reflected by the books and records of the person transferring or receiving it; and
(c) Reflected in the billings submitted to [the] a plan.
3. A person shall not, while acting on behalf of a provider providing goods or services to a recipient pursuant to [the] a plan, charge, solicit, accept or receive anything of additional value in addition to the amount legally payable pursuant to [the] a plan in connection with the provision of the goods or services.
4. A person who violates this section, if the value of the thing or any combination of things unlawfully solicited, accepted, offered, transferred, paid, charged or received:
(a) Is less than $250, is guilty of a gross misdemeanor.
(b) Is $250 or more, is guilty of a category D felony and shall be punished as provided in NRS 193.130.
Sec. 71 NRS 422.570 is hereby amended to read as follows:
422.5701. A person is guilty of a gross misdemeanor if, upon submitting a claim for or upon receiving payment for goods or services pursuant to [the] a plan, he intentionally fails to maintain such records as are necessary to disclose fully the nature of the goods or services for which a claim was submitted or payment was received, or such records as are necessary to disclose fully all income and expenditures upon which rates of payment were based, for at least 5 years after the date on which payment was received.
2. A person who intentionally destroys such records within 5 years after the date payment was received is guilty of a category D felony and shall be punished as provided in NRS 193.130.
Sec. 72 NRS 422.580 is hereby amended to read as follows:
422.5801. A provider who receives payment to which he is not entitled by reason of a violation of NRS 422.540, 422.550, 422.560 or 422.570 is liable for:
(a) An amount equal to three times the amount unlawfully obtained;
(b) Not less than $5,000 for each act of deception;
(c) An amount equal to three times the total of the reasonable expenses incurred by the state in enforcing this section; and
(d) Payment of interest on the amount of the excess payment at the rate fixed pursuant to NRS 99.040 for the period from the date upon which payment was made to the date upon which repayment is made pursuant to [the] a plan.
2. A criminal action need not be brought against the provider before civil liability attaches under this section.
3. A provider who unknowingly accepts a payment in excess of the amount to which he is entitled is liable for the repayment of the excess amount. It is a defense to any action brought pursuant to this subsection that the provider returned or attempted to return the amount which was in excess of that to which he was entitled within a reasonable time after receiving it.
4. The attorney general shall cause appropriate legal action to be taken on behalf of the state to enforce the provisions of this section.
5. Any penalty or repayment of money collected pursuant to this section is hereby appropriated to provide medical aid to the indigent through programs administered by the welfare division.
Sec. 73 NRS 426A.060 is hereby amended to read as follows:
426A.0601. 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 either an employee of the welfare division of the department of human resources [and] who participates in the administration of the state program providing assistance to the medically indigent [.] or an employee of the commission for health assurance of the department of human resources who participates in the administration of the state program providing 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. 74 Chapter 428 of NRS is hereby amended by adding thereto a new section to read as follows:
As used in this chapter, unless the context otherwise requires, "facility for long-term care" means:
1. A facility for intermediate care as defined in NRS 449.0038;
2. A facility for skilled nursing as defined in NRS 449.0039; or
3. A residential facility for groups as defined in NRS 449.017.
Sec. 75 NRS 428.010 is hereby amended to read as follows:
428.0101. Except as otherwise provided in NRS 422.382, to the extent that money may be lawfully appropriated by the board of county commissioners for this purpose , pursuant to NRS [428.050, 428.285 and] 450.425, every county shall provide care, support and relief to the poor, indigent, incompetent and those incapacitated by age, disease or accident, lawfully resident therein, when those persons are not supported or relieved by their relatives or guardians, by their own means, or by state hospitals, or other state, federal or private institutions or agencies.
2. [Except as otherwise provided in NRS 439B.330, the] The boards of county commissioners of the several counties shall establish and approve policies and standards, prescribe a uniform standard of eligibility, appropriate money for this purpose and appoint agents who will develop regulations and administer these programs to provide care, support and relief to the poor, indigent, incompetent and those incapacitated by age, disease or accident.
Sec. 76 NRS 428.015 is hereby amended to read as follows:
428.0151. Each county shall provide payment for care provided in a facility for long-term care to indigent persons to the extent to which such care is not provided by a payment made by the State of Nevada.
2. The board of county commissioners shall adopt an ordinance and any related policies which establish the requirements and standards of eligibility for [medical] care provided in a facility for long-term care and financial assistance to indigent persons. The ordinance and policies must specify the allowable income, assets and other resources or potential resources of persons eligible for assistance, and any other requirements applicable to an applicant for assistance. The board of county commissioners shall file the ordinance and policies with the secretary of state within 30 days after adoption. Any amendment to the ordinance or policies must be filed with the secretary of state within 30 days after adoption.
[2. A county's standards of eligibility for medical assistance must not deny eligibility to a person living in a household which has a total monthly income of less than:
(a) For one person living without another member of a household, $438.
(b) For two persons, $588.
(c) For three or more persons, $588 plus $150 for each person in the family in excess of two.
For the purposes of this subsection, "income" includes the entire income of a household and the amount which a county projects a person or household is able to earn. "Household" is limited to a person and his spouse, parents, children, brothers and sisters residing with him.
3. A county's program of medical assistance to indigent persons must provide payment for:
(a) Emergency medical care; and
(b) All other medically necessary care rendered in a medical facility designated by the county.
4. As used in this section:
(a) "Emergency medical care" means any care for an urgent medical condition which is likely to result in serious and permanent bodily disability or death if the patient is transported to a medical facility designated by the county.
(b) "Medically necessary care" does not include any experimental or investigative medical care which is not covered by Medicaid or Medicare.]
Sec. 77 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, 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. 78 NRS 428.050 is hereby amended to read as follows:
428.0501. The board of county commissioners of each county shall determine:
(a) The amount of money, excluding the money collected pursuant to NRS 428.285 and 450.425, spent on providing medical assistance other than care provided in a facility for long-term care to indigent persons for each of the past 3 years; and
(b) The ad valorem tax rate necessary to produce the amount of money spent in the year in which the highest amount of money was spent during each of the previous 3 years determined pursuant to paragraph (a).
2. The executive director of the department of taxation shall assist each county in making the determinations pursuant to subsection 1.
3. In addition to the tax levied pursuant to NRS 428.185 and 428.285 and any tax levied pursuant to NRS 450.425, the board of county commissioners of a county shall, at the time provided for the adoption of its final budget, levy an ad valorem tax [to provide aid and relief to those persons coming within the purview of this chapter. In a county whose population is 400,000 or more, this levy must not exceed that adopted for the purposes of this chapter for the fiscal year ending June 30, 1971, diminished by 12.3 cents for each $100 of assessed valuation. In a county whose population is less than 400,000 the rate of the tax must be calculated to produce not more than the amount of money allocated pursuant to NRS 428.295.
2. The board of county commissioners of any county in which there was no levy adopted for the purposes of this chapter for the fiscal year ending June 30, 1971, may request that the Nevada tax commission establish a maximum rate for the levy of taxes ad valorem by the county to provide aid and relief pursuant to this chapter.
3. No county may expend or contract to expend for that aid and relief a sum in excess of that provided by the maximum ad valorem levy set forth in subsection 1 of this section and NRS 428.185, 428.285 and 450.425, or established pursuant to subsection 2, together with such outside resources as it may receive from third persons, including, but not limited to, expense reimbursements, grants-in-aid or donations lawfully attributable to the county indigent fund.
4. Except as otherwise provided in this subsection, no interfund transfer, medium-term obligation procedure or contingency transfer may be made by the board of county commissioners to provide resources or appropriations to a county indigent fund in excess of those which may be otherwise lawfully provided pursuant to subsections 1, 2 and 3 of this section and NRS 428.185, 428.285 and 450.425. If the health of indigent persons in the county is placed in jeopardy and there is a lack of money to provide necessary medical care under this chapter, the board of county commissioners may declare an emergency and provide additional money for medical care from whatever sources may be available.] at the rate calculated pursuant to paragraph (b) of subsection 1.
4. The board of county commissioners of each county shall enter into a written agreement with the commission for health assurance of the department of human resources for the transfer of the proceeds of the tax levied pursuant to subsection 3 to the account for the program for health assurance.
5. If any dispute between the commission for health assurance of the department of human resources and a board of county commissioners cannot be resolved by the parties, it must be referred to the Nevada tax commission for a decision that is binding on all parties.
Sec. 79 NRS 428.060 is hereby amended to read as follows:
428.0601. If it appears to the satisfaction of the board of county commissioners that the county of residence of an indigent person applying for relief is another county in this state, the board shall provide temporary relief for the indigent 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 thereby for this purpose pursuant to NRS [428.050, 428.285 and] 450.425, and shall notify immediately the board of county commissioners of the county of residence of the indigent person.
2. The notice must be in writing, attested by the clerk of the board of county commissioners, and deposited in the post office, addressed to the board of county commissioners of the other county.
3. The board of county commissioners receiving the notice may cause the indigent person to be removed immediately to that county [,] and shall pay a reasonable compensation for the temporary relief afforded. If the board of county commissioners chooses not to remove the indigent person, the county affording relief has a legal claim against any money lawfully available in that county for the relief necessarily furnished [,] and may recover it in a suit at law.
Sec. 80 NRS 428.090 is hereby amended to read as follows:
428.0901. 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 for his [board, nursing or medical aid,] care provided in a facility for long-term care, 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 of the person 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] care provided in a facility for long-term care or any other type of remedial aid [under] pursuant to 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 [;] established pursuant to NRS 422.237; and
(b) The [fund for hospital care to indigent persons under the provisions of NRS 428.115 to 428.255, inclusive.] program for health assurance established pursuant to section 12 of this act.
Sec. 81 NRS 428.175 is hereby amended to read as follows:
428.175[1. The fund for hospital care to indigent persons is hereby created as a trust fund for the purposes described in NRS 428.115 to 428.255, inclusive.
2.] All money collected or recovered pursuant to NRS [428.115 to 428.255, inclusive, and the interest earned on the money in the fund] 428.185 must be deposited for credit to the [fund. Claims against the fund must be paid on claims approved by the board.] account for the program for health assurance.
Sec. 82 NRS 428.185 is hereby amended to read as follows:
428.1851. In addition to the taxes levied pursuant to NRS 428.050 and 428.285 and any tax levied pursuant to NRS 450.425, the board of county commissioners of each county shall levy an ad valorem tax at a rate which must be calculated by [:
(a) First] multiplying the tax rate of 1.5 cents on each $100 of assessed valuation by the assessed valuation of all taxable property in this state, including , without limitation, new real property, possessory interests and mobile homes, during the next fiscal year.
[(b) Then subtracting the amount of unencumbered money in the fund on May 1 of the current fiscal year.
(c) Then setting the rate so that the revenue from the tax does not exceed the amount resulting from the calculations made in paragraphs (a) and (b).]
2. The tax so levied and its proceeds, must be excluded in computing the maximum amount of money which the county is permitted to receive from taxes ad valorem and the highest permissible rate of such taxes.
3. The proceeds of this tax must be remitted in the manner provided for in NRS 361.745 to the state treasurer for credit to the [fund.] account for the program for health assurance.
Sec. 83 NRS 428.285 is hereby amended to read as follows:
428.2851. [The board of county commissioners of each county shall establish a tax rate of at least 6 cents on each $100 of assessed valuation for the purposes of the tax imposed pursuant to subsection 2. A board of county commissioners may increase the rate to not more than 10 cents on each $100 of assessed valuation.
2. In addition to the levies provided in NRS 428.050 and 428.185 and any tax levied pursuant to NRS 450.425, the board of county commissioners shall levy a tax ad valorem at a rate necessary to produce revenue in an amount equal to an amount calculated by multiplying the assessed valuation of all taxable property in the county by the tax rate established pursuant to subsection 1, and subtracting from the product the amount of unencumbered money remaining in the fund on May 1 of the current fiscal year.
3.] For each fiscal year beginning on or after July 1, 1989, the board of county commissioners of each county shall remit to the state treasurer [from the money in the fund] an amount of money equivalent to 1 cent on each $100 of assessed valuation of all taxable property in the county for credit to the [supplemental fund.
4.] account for the program for health assurance. A board of county commissioners may increase the rate to not more than 10 cents on each $100 of assessed valuation.
2. The tax so levied and its proceeds must be excluded in computing the maximum amount of money which the county is permitted to receive from taxes ad valorem and the highest permissible rate of such taxes.
Sec. 84 NRS 123.259 is hereby amended to read as follows:
123.2591. 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] pursuant to 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] :
(a) The welfare division of the department of human resources in making determinations [under] pursuant to the state plan for assistance to the medically indigent [.] established pursuant to NRS 422.237; or
(b) The commission for health assurance of the department of human resources in making determinations pursuant to the state plan for Medicaid established pursuant to section 18 of this act.
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. 85 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, money owed to the commission for health assurance of the department of human resources as a result of payment of benefits for Medicaid and creditors, if there are any; and
Second: Any balance remaining to the claimant or claimants entitled thereto.
3. All proceedings taken [under] pursuant to 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, 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 $1,000 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. 86 NRS 146.080 is hereby amended to read as follows:
146.0801. 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 , without limitation, 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 [,] and money owed to the commission for health assurance of the department of human resources as a result of the payment of benefits for 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. 87 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 [.] and money owed to the commission for health assurance of the department of human resources as a result of the payment of benefits for 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. 88 NRS 150.230 is hereby amended to read as follows:
150.2301. 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 , money owed to the commission for health assurance of the department of human resources as a result of payment of benefits for 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,] 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. 89 NRS 228.410 is hereby amended to read as follows:
228.4101. 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] a plan or in the provision of medical assistance. The provisions of this section notwithstanding [, the] :
(a) The welfare division of the department of human resources shall enforce the state plan for assistance to the medically indigent established pursuant to NRS 422.237 and any administrative regulations adopted pursuant thereto [.] ; and
(b) The commission for health assurance of the department of human resources shall enforce the state plan for Medicaid established pursuant to section 18 of this act 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] a 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] a 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] a 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 this section or 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 assistance to the medically indigent established pursuant to NRS 422.237 [.] or the state plan for Medicaid established pursuant to section 18 of this act.
Sec. 90 Chapter 232 of NRS is hereby amended by adding thereto a new section to read as follows:
1. The commission for health assurance is hereby created within the department. The commission must consist of nine voting members appointed as follows:
(a) Five members appointed by the governor;
(b) Two members appointed by the board of directors of the Nevada Association of Counties;
(c) One member appointed by the board of commissioners of Washoe County; and
(d) One member appointed by the board of commissioners of Clark County.
2. The legislature, or the legislative commission if the legislature is not in session, shall appoint two nonvoting members.
3. Each member serves at the pleasure of his appointing authority.
4. Each appointing authority shall designate an alternate to serve when the appointed member temporarily is not available.
5. Each member of the commission must be selected based on his training, experience, ability to perform and interest in the provision of health care services to low-income persons and recipients of Medicaid in this state. His qualifications must include, without limitation:
(a) A comprehensive knowledge of the principles and practices of developing a budget for a public entity;
(b) A working knowledge of statistical methods;
(c) An extensive knowledge of systems for the delivery of health care;
(d) Familiarity with and experience in the general field of public administration;
(e) Knowledge of the societal and health-related issues concerning low-income persons and recipients of Medicaid in this state; and
(f) Knowledge of issues related to health care that affect persons who have particular concerns related to health care, including, without limitation, disabled persons.
6. Each member is entitled to receive a salary of $80 per day for each day he attends a meeting of the commission and the per diem allowance and travel expenses provided for state officers and employees generally while engaged in the business of the commission.
Sec. 91 NRS 232.290 is hereby amended to read as follows:
232.290As used in NRS 232.290 to 232.465, inclusive, and section 90 of this act, unless the context requires otherwise:
1. "Department" means the department of human resources.
2. "Director" means the director of the department.
Sec. 92 NRS 244.1605 is hereby amended to read as follows:
244.1605The boards of county commissioners may:
1. Establish, equip and maintain limited medical facilities in the outlying areas of their respective counties to provide outpatient care and emergency treatment to the residents of and those falling sick or being injured or maimed in those areas.
2. Provide a full-time or part-time staff for the facilities which may include a physician, a certified physician's assistant, a registered nurse or a licensed practical nurse, a certified emergency medical technician and such other personnel as the board deems necessary or appropriate to ensure adequate staffing commensurate with the needs of the area in which the facility is located.
3. Fix the charges for the medical and nursing care and medicine furnished by the facility to those who are able to pay for them . [, and to provide that care and medicine free of charge to those persons who qualify as medical indigents under the county's criteria of eligibility for medical care.]
4. Purchase, equip and maintain, either in connection with a limited medical facility as authorized in this section or independent therefrom, ambulances and ambulance services for the benefit of the residents of and those falling sick or being injured or maimed in the outlying areas.
Sec. 93 NRS 274.270 is hereby amended to read as follows:
274.2701. The governing body shall investigate the proposal made by a business pursuant to NRS 274.260, and if it finds that the business is qualified by financial responsibility and business experience to create and preserve employment opportunities in the specially benefited zone and improve the economic climate of the municipality and finds further that the business did not relocate from a depressed area in this state or reduce employment elsewhere in Nevada in order to expand in the specially benefited zone, the governing body may, on behalf of the municipality, enter into an agreement with the business, for a period of not more than 20 years, under which the business agrees in return for one or more of the benefits authorized in this chapter and NRS 374.643 for qualified businesses, as specified in the agreement, to establish, expand, renovate or occupy a place of business within the specially benefited zone and hire new employees at least 35 percent of whom at the time they are employed are at least one of the following:
(a) Unemployed persons who have resided at least 6 months in the municipality.
(b) Persons eligible for employment or job training under any federal program for employment and training who have resided at least 6 months in the municipality.
(c) Recipients of benefits under any state or county program of public assistance, including , without limitation, aid to families with dependent children, [aid to the medically indigent] Medicaid and unemployment compensation who have resided at least 6 months in the municipality.
(d) Persons with a physical or mental handicap who have resided at least 6 months in the state.
(e) Residents for at least 1 year of the area comprising the specially benefited zone.
2. To determine whether a business is in compliance with an agreement, the governing body:
(a) Shall each year require the business to file proof satisfactory to the governing body of its compliance with the agreement.
(b) May conduct any necessary investigation into the affairs of the business and may inspect at any reasonable hour its place of business within the specially benefited zone.
If the governing body determines that the business is in compliance with the agreement, it shall issue a certificate to that effect to the business. The certificate expires 1 year after the date of its issuance.
3. The governing body shall file with the administrator, the department of taxation and the employment security division of the department of employment, training and rehabilitation a copy of each agreement, the information submitted under paragraph (a) of subsection 2 and the current certificate issued to the business under that subsection. The governing body shall immediately notify the administrator, the department of taxation and the employment security division of the department of employment, training and rehabilitation whenever the business is no longer certified.
Sec. 94 NRS 353.335 is hereby amended to read as follows:
353.3351. Except as otherwise provided in subsections 5 and 6, a state agency may accept any gift or grant of property or services from any source only if it is included in an act of the legislature authorizing expenditures of nonappropriated money or, when it is not so included, if it is approved as provided in subsection 2.
2. If:
(a) Any proposed gift or grant is necessary because of an emergency as defined in NRS 353.263 or for the protection or preservation of life or property, the governor shall take reasonable and proper action to accept it and shall report the action and his reasons for determining that immediate action was necessary to the interim finance committee at its first meeting after the action is taken. Action by the governor pursuant to this paragraph constitutes acceptance of the gift or grant, and other provisions of this chapter requiring approval before acceptance do not apply.
(b) The governor determines that any proposed gift or grant would be forfeited if the state failed to accept it before the expiration of the period prescribed in paragraph (c), he may declare that the proposed acceptance requires expeditious action by the interim finance committee. Whenever the governor so declares, the interim finance committee has 15 days after the proposal is submitted to its secretary within which to approve or deny the acceptance. Any proposed acceptance which is not considered within the 15-day period shall be deemed approved.
(c) The proposed acceptance of any gift or grant does not qualify pursuant to paragraph (a) or (b), it must be submitted to the interim finance committee. The interim finance committee has 45 days after the proposal is submitted to its secretary within which to consider acceptance. Any proposed acceptance which is not considered within the 45-day period shall be deemed approved.
3. The secretary shall place each request submitted to him pursuant to paragraph (b) or (c) of subsection 2 on the agenda of the next meeting of the interim finance committee.
4. In acting upon a proposed gift or grant, the interim finance committee shall consider, among other things:
(a) The need for the facility or service to be provided or improved;
(b) Any present or future commitment required of the state;
(c) The extent of the program proposed; and
(d) The condition of the national economy [,] and any related fiscal or monetary policies.
5. A state agency may accept:
(a) Gifts, including grants from nongovernmental sources, not exceeding $10,000 each in value; and
(b) Governmental grants not exceeding $50,000 each in value,
if the gifts or grants are used for purposes which do not involve the hiring of new employees and if the agency has the specific approval of the governor or, if the governor delegates this power of approval to the chief of the budget division of the department of administration, the specific approval of the chief.
6. This section does not apply to:
(a) The state industrial insurance system;
(b) The University and Community College System of Nevada; [or]
(c) The department of human resources while acting as the state health planning and development agency pursuant to paragraph (d) of subsection 2 of NRS 439A.081 [.] ; or
(d) The commission for health assurance of the department of human resources.
Sec. 95 NRS 433A.165 is hereby amended to read as follows:
433A.1651. Before an allegedly mentally ill person may be transported to a public or private mental health facility pursuant to NRS 433A.160, he must:
(a) First be examined by a licensed physician to determine whether the person has a medical problem, other than a psychiatric problem, which requires immediate treatment; and
(b) If such treatment is required, be admitted to a hospital for the appropriate medical care.
2. The cost of the examination must be paid by the county in which the allegedly mentally ill person resides if services are provided at a county hospital located in that county or a hospital designated by that county, unless the cost is voluntarily paid by the allegedly mentally ill person or on his behalf, by his insurer or by a state or federal program of medical assistance.
3. The county may recover all or any part of the expenses paid by it, in a civil action against:
(a) The person whose expenses were paid;
(b) The estate of that person; or
(c) A responsible relative as prescribed in NRS 433A.610, to the extent that financial ability is found to exist.
[4. The cost of treatment, including hospitalization, for an indigent must be paid pursuant to NRS 428.010 by the county in which the allegedly mentally ill person resides.]
Sec. 96 NRS 433A.680 is hereby amended to read as follows:
433A.680The expense of diagnostic, medical and surgical services furnished to a client admitted to a division facility by a person not on the staff of the facility, whether rendered while the client is in a general hospital, an outpatient of a general hospital or treated outside any hospital, must be paid by the client, the guardian or relatives responsible pursuant to NRS 433A.610 for his care. In the case of an indigent client or a client whose estate is inadequate to pay the expenses, the expenses must be charged to the [county from which the admission to the division facility was made, if the client had, before admission, been a resident of that county. The expense of such diagnostic, medical and surgical services must not in any case be a charge against or paid by the State of Nevada, except when in the opinion of the administrative officer of the division mental health facility to which the client is admitted payment should be made for nonresident indigent clients and money is authorized pursuant to NRS 433.374 or 433B.230 and the money is authorized in approved budgets.] division.
Sec. 97 NRS 439B.300 is hereby amended to read as follows:
439B.300[1.] The legislature finds and declares that:
[(a)] 1. The practice of refusing to treat an indigent patient if another hospital can provide the treatment endangers the health and well-being of such patients.
[(b)] 2. Counties in which more than one hospital is located may lack available resources to compensate for all indigent care provided at their hospitals. Refusal by a hospital to treat indigent patients in such counties results in a burden upon hospitals which treat large numbers of indigent patients.
[(c)] 3. A requirement that hospitals in such counties provide a designated amount of uncompensated care for indigent patients would [:
(1) Equalize] equalize the burden on such hospitals of treating indigent patients . [; and
(2) Aid the counties in meeting their obligation to compensate hospitals for such care.
(d)] 4. Hospitals with 100 or fewer beds have been meeting the needs of their communities with regard to care of indigents, and have a minimal effect on the provision of such care.
[2. Except as otherwise provided in this subsection, the provisions of NRS 439B.300 to 439B.340, inclusive, apply to each hospital in this state which is located in a county in which there are two or more licensed hospitals. The provisions of NRS 439B.300 to 439B.340, inclusive, do not apply to a hospital which has 100 or fewer beds.
3. The provisions of NRS 439B.300 to 439B.340, inclusive, do not prohibit a county from:
(a) Entering into an agreement for medical care or otherwise contracting with any hospital located within that county; or
(b) Using a definition of "indigent" which would include more persons than the definition in NRS 439B.310.]
Sec. 98 NRS 439B.310 is hereby amended to read as follows:
439B.310For the purposes of this section, NRS 439B.300 [to 439B.340, inclusive,] and 439B.320, "indigent" means [those persons:
1. Who are not covered by any policy of health insurance;
2. Who are ineligible for Medicare, Medicaid, the benefits provided pursuant to NRS 428.115 to 428.255, inclusive, or any other federal or state program of public assistance covering the provision of health care;
3. Who meet the limitations imposed by the county upon assets and other resources or potential resources; and
4. Whose income is less than:
(a) For one person living without another member of a household, $438.
(b) For two persons, $588.
(c) For three or more persons, $588 plus $150 for each person in the family in excess of two.
For the purposes of this subsection, "income" includes the entire income of a household and the amount which the county projects a person or household is able to earn. "Household" is limited to a person and his spouse, parents, children, brothers and sisters residing with him.] a person who is enrolled in the program for health assurance established pursuant to section 12 of this act.
Sec. 99 NRS 439B.320 is hereby amended to read as follows:
439B.3201. A hospital shall provide, without charge, in each fiscal year, care for indigent inpatients in an amount which represents 0.6 percent of its net revenue for the hospital's preceding fiscal year.
2. The commission for health assurance of the department shall compute the obligation of each hospital for care of indigent inpatients for each fiscal year based upon the net revenue of the hospital in its preceding fiscal year . [and shall provide this information to the board of county commissioners of the county in which the hospital is located.]
3. The [board of county commissioners] commission for health assurance of the department shall maintain a record of discharge forms submitted by each hospital located within the county, together with the amount accruing to the hospital. [The amount accruing to the hospital for the care, until the hospital has met its obligation pursuant to this section, is the highest amount the county is paying to any hospital in the county for that care. Except as otherwise provided in subsection 2 of NRS 439B.330, no payment for indigent care may be made to the hospital until the total amount so accruing to the hospital exceeds the minimum obligation of the hospital for the fiscal year, and a hospital may only receive payment from the county for indigent care provided in excess of its obligation pursuant to this section. After a hospital has met its obligation pursuant to this section, the county may reimburse the hospital for care of indigent inpatients at any rate otherwise authorized by law.]
4. Except as otherwise provided in this subsection, the provisions of this section apply to each hospital in this state that is located in a county in which there are two or more licensed hospitals. The provisions of this section do not apply to a hospital that has 100 or fewer beds.
5. The provisions of this section do not prohibit a county from:
(a) Entering into an agreement for medical care or otherwise contracting with any hospital located within that county; or
(b) Using a definition of "indigent" that includes more persons than the definition in NRS 439B.310.
Sec. 100 NRS 439B.410 is hereby amended to read as follows:
439B.4101. Except as otherwise provided in subsection 4, each hospital in this state has an obligation to provide emergency services and care, including care provided by physicians and nurses, and to admit a patient where appropriate, regardless of the financial status of the patient.
2. Except as otherwise provided in subsection 4, it is unlawful for a hospital or a physician working in a hospital emergency room [,] to:
(a) Refuse to accept or treat a patient in need of emergency services and care; or
(b) Except when medically necessary in the judgment of the attending physician:
(1) Transfer a patient to another hospital or health facility unless, as documented in the patient's records:
(I) A determination has been made that the patient is medically fit for transfer;
(II) Consent to the transfer has been given by the receiving physician, hospital or health facility;
(III) The patient has been provided with an explanation of the need for the transfer; and
(IV) Consent to the transfer has been given by the patient or his legal representative; or
(2) Provide a patient with orders for testing at another hospital or health facility when the hospital from which the orders are issued is capable of providing that testing.
3. A physician, hospital or other health facility which treats a patient as a result of a violation of subsection 2 by a hospital or a physician working in the hospital is entitled to recover from that hospital an amount equal to three times the charges for the treatment provided that was billed by the physician, hospital or other health facility which provided the treatment, plus reasonable attorney's fees and costs.
4. This section does not prohibit the transfer of a patient from one hospital to another:
(a) When the patient is covered by an insurance policy or other contractual arrangement which provides for payment at the receiving hospital; or
(b) [After the county responsible for payment for the care of an indigent patient has exhausted the money which may be appropriated for that purpose pursuant to NRS 428.050, 428.285 and 450.425; or
(c)] When the hospital cannot provide the services needed by the
patient.
No transfer may be made pursuant to this subsection until the patient's condition has been stabilized to a degree that allows the transfer without an additional risk to the patient.
5. As used in this section:
(a) "Emergency services and care" means medical screening, examination and evaluation by a physician or, to the extent permitted by a specific statute, by a person under the supervision of a physician, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment and surgery by a physician necessary to relieve or eliminate the emergency medical condition or active labor, within the capability of the hospital. As used in this paragraph:
(1) "Active labor" means, in relation to childbirth, labor that occurs when:
(I) There is inadequate time before delivery to transfer the patient safely to another hospital; or
(II) A transfer may pose a threat to the health and safety of the patient or the unborn child.
(2) "Emergency medical condition" means the presence of acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:
(I) Placing the health of the patient in serious jeopardy;
(II) Serious impairment of bodily functions; or
(III) Serious dysfunction of any bodily organ or part.
(b) "Medically fit" means that the condition of the patient has been sufficiently stabilized so that he may be safely transported to another hospital, or is such that, in the determination of the attending physician, the transfer of the patient constitutes an acceptable risk. Such a determination must be based upon the condition of the patient, the expected benefits, if any, to the patient resulting from the transfer and whether the risks to the patient's health are outweighed by the expected benefits, and must be documented in the patient's records before the transfer.
6. If an allegation of a violation of the provisions of subsection 2 is made against a hospital licensed pursuant to the provisions of chapter 449 of NRS, the health division of the department of human resources shall conduct an investigation of the alleged violation. Such a violation, in addition to any criminal penalties that may be imposed, constitutes grounds for the denial, suspension or revocation of such a license, or for the imposition of any sanction prescribed by NRS 449.163.
7. If an allegation of a violation of the provisions of subsection 2 is made against a physician licensed to practice medicine pursuant to the provisions of chapter 630 of NRS, the board of medical examiners shall conduct an investigation of the alleged violation. Such a violation, in addition to any criminal penalties that may be imposed, constitutes grounds for initiating disciplinary action or denying licensure pursuant to the provisions of subsection 3 of NRS 630.3065.
Sec. 101 NRS 441A.220 is hereby amended to read as follows:
441A.220All 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] if 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 [.] or Medicaid.
9. If the disclosure is made to the commission for health assurance 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 health care services pursuant to the program for health assurance established pursuant to section 12 of this act.
10. 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.] 11. If the disclosure is authorized or required by specific statute.
Sec. 102 NRS 442.040 is hereby amended to read as follows:
442.0401. Any physician, midwife, nurse, maternity home or hospital of any nature, parent, relative or person attendant on or assisting in any way whatever any infant, or the mother of any infant, at childbirth, or any time within 2 weeks after childbirth, knowing the condition defined in NRS 442.030 to exist, shall immediately report such a fact in writing to the local health officer of the county, city or other political subdivision within which the infant or the mother of any infant may reside.
2. Midwives shall immediately report conditions to some qualified practitioner of medicine and thereupon withdraw from the case except as they may act under the physician's instructions.
3. On receipt of such report, the health officer, or the physician notified by a midwife, shall immediately give to the parents or persons having charge of such infant a warning of the dangers to the eye or eyes of the infant . [, and shall, for indigent cases, provide the necessary treatment at the expense of the county, city or other political subdivision.]
Sec. 103 NRS 442.1192 is hereby amended to read as follows:
442.11921. 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 [.] established pursuant to NRS 422.237 or the state plan for Medicaid established pursuant to section 18 of this act.
Sec. 104 NRS 442.215 is hereby amended to read as follows:
442.2151. The administrator of the health division may recover costs of corrective treatment for children with special health care needs from the parents of the child who receives the treatment, pursuant to subsections 2 and 3.
2. The administrator shall investigate the financial circumstances of a parent of a child with special health care needs for whom an application is made to determine whether part or all of the expenses for treatment should be paid for by such parent.
3. The administrator may authorize corrective treatment for a child with special health care needs at state expense when it is determined that the parent of the child is unable to pay the cost of this treatment or any part thereof. A determination of ability to pay and eligibility for payment at state expense must be based on the following factors:
(a) Resources of the parent, including hospital and medical insurance;
(b) Other available sources of payment, including , without limitation, state aid for medically indigent families [;] and Medicaid;
(c) Estimated cost of care;
(d) Length of treatment;
(e) Household size in relation to income; and
(f) Debts and obligations.
4. As used in this section, "parent" means a natural parent or an adoptive parent.
Sec. 105 NRS 450.090 is hereby amended to read as follows:
450.0901. In any county whose population is 400,000 or more, the board of county commissioners is, ex officio, the board of hospital trustees, and the county commissioners shall serve as hospital trustees during their terms of office as county commissioners.
2. In any county whose population is less than 400,000, the board of county commissioners may enact an ordinance providing that the board of county commissioners is, ex officio, the board of hospital trustees. If such an ordinance is enacted in a county:
(a) The county commissioners shall serve as hospital trustees during their terms of office as county commissioners; and
(b) If hospital trustees have been elected pursuant to NRS 450.070 and 450.080, the term of office of each hospital trustee who is serving in that capacity on the effective date of the ordinance is terminated as of the effective date of the ordinance.
3. A board of county commissioners shall not enact an ordinance pursuant to subsection 2 unless it determines that [:
(a) The county has fully funded its indigent care account created pursuant to NRS 428.010;
(b) The county has fulfilled its duty to reimburse the hospital for indigent care provided to qualified indigent patients; and
(c) During] during the previous calendar year:
[(1)] (a) At least one of the hospital's accounts payable was more than 90 days in arrears;
[(2)] (b) The hospital failed to fulfill its statutory financial obligations, such as the payment of taxes, premiums for industrial insurance or contributions to the public employees' retirement system;
[(3)] (c) One or more of the conditions relating to financial emergencies set forth in subsection 1 of NRS 354.685 existed at the hospital; or
[(4)] (d) The hospital received notice from the Federal Government or the State of Nevada that the certification or licensure of the hospital was in imminent jeopardy of being revoked because the hospital had not carried out a previously established plan of action to correct previously noted deficiencies found by the regulatory body.
4. Except in counties where the board of county commissioners is the board of hospital trustees, in any county whose population is 100,000 or more but less than 400,000, the board of hospital trustees for the public hospital must be composed of the five regularly elected or appointed members, and, in addition, three county commissioners selected by the chairman of the board of county commissioners shall serve as voting members of the board of hospital trustees during their terms of office as county commissioners.
5. Except in counties where the board of county commissioners is the board of hospital trustees, in any county whose population is less than 100,000, the board of hospital trustees for the public hospital must be composed of the five regularly elected or appointed members, and, in addition, the board of county commissioners may, by resolution, provide that one county commissioner selected by the chairman of the board of county commissioners shall serve as a voting member of the board of hospital trustees during his term of office as county commissioner.
Sec. 106 NRS 450.240 is hereby amended to read as follows:
450.2401. In all counties where a tax for the establishment and maintenance of a public hospital has been authorized by a majority of the voters voting for a bond issue in accordance with law, the supervision, management, government and control of the county hospital vests in and must be exercised by the board of hospital trustees for the county public hospital, and the institution must thereafter be operated by the board of hospital trustees.
2. Annually, upon the request of the board of hospital trustees, the board of county commissioners may levy a tax for the maintenance and operation of the county public hospital, excluding the establishment, maintenance or operation of any facility located outside the county or counties where the county hospital is established.
3. The resolution adopted by the board of county commissioners imposing a tax levy for a county public hospital must state:
(a) The portion of the levy which is necessary to retire hospital bonds and any other outstanding hospital securities, and to pay interest thereon; and
(b) [The portion of the levy which is necessary to pay for the care of indigent patients; and
(c)] The portion of the levy which is necessary to pay for the cost of new equipment, replacement of old equipment and other improvements to the hospital not covered by specific bond issues or other securities . [and not included in the cost of care of indigent patients as provided in paragraph (b). The cost must be prorated to the county in accordance with the number of patient days of care of county patients.]
4. The board of county commissioners may not levy a tax for the care of indigents in the county public hospital as a hospital expense unless the levy and its justification are included in the budget for the hospital fund submitted to the department of taxation as provided by law.
Sec. 107 NRS 450.420 is hereby amended to read as follows:
450.4201. The board of county commissioners of the county in which a public hospital is located may determine whether patients presented to the public hospital for treatment are subjects of charity. [Except as otherwise provided in NRS 439B.330, the] The board of county commissioners shall establish by ordinance criteria and procedures to be used in the determination of eligibility for medical care as [medical indigents or] subjects of charity.
2. The board of hospital trustees shall fix the charges for treatment of those persons able to pay for the charges, as the board deems just and proper. The board of hospital trustees may impose an interest charge of not more than 12 percent per annum on unpaid accounts. The receipts must be paid to the county treasurer and credited by him to the hospital fund. In fixing charges pursuant to this subsection the board of hospital trustees shall not include, or seek to recover from paying patients, any portion of the expense of the hospital which is properly attributable to the care of indigent patients.
[3. Except as provided in subsection 4 of this section and subsection 3 of NRS 439B.320, the county is chargeable with the entire cost of services rendered by the hospital and any salaried staff physician or employee to any person admitted for emergency treatment, including all reasonably necessary recovery, convalescent and follow-up inpatient care required for any such person as determined by the board of trustees of the hospital, but the hospital shall use reasonable diligence to collect the charges from the emergency patient or any other person responsible for his support. Any amount collected must be reimbursed or credited to the county.
4. The county is not chargeable with the cost of services rendered by the hospital or any attending staff physician or surgeon to the extent the hospital is reimbursed for those services pursuant to NRS 428.115 to 428.255, inclusive.]
Sec. 108 NRS 450.425 is hereby amended to read as follows:
450.4251. The board of county commissioners of a county in which a county hospital is established may, upon approval by a majority of the voters voting on the question in an election held throughout the county, levy an ad valorem tax of not more than 2.5 cents on each $100 of assessed valuation upon all taxable property in the county, to pay the cost of services rendered in the county by the hospital . [pursuant to subsection 3 of NRS 450.420.] The approval required by this subsection may be requested at any primary or general election.
2. Any tax imposed pursuant to this section is in addition to the taxes imposed pursuant to NRS 428.050, 428.185 and 428.285. The proceeds of any tax levied pursuant to this section are exempt from the limitations imposed by NRS 354.59811, 428.050 and 428.285 and must be excluded in determining the maximum rate of tax authorized by those sections.
Sec. 109 NRS 450.490 is hereby amended to read as follows:
450.4901. The board of county commissioners of any county for which a public hospital has been established or is administered pursuant to NRS 450.010 to 450.510, inclusive, and whose public hospital is the only hospital in the county, may convey the hospital for an amount not less than its appraised value or lease it for a term of not more than 50 years to any corporation if all of the following conditions are met:
(a) The corporation must provide in its articles of incorporation for an advisory board for the hospital. The advisory board must consist of persons who represent a broad section of the people to be served by the hospital.
(b) The corporation must contract to:
(1) Care for indigent patients at a charge to the county which does not exceed the actual cost of providing that care, or in accordance with NRS [439B.300 to 439B.340, inclusive,] 439B.320, if applicable; and
(2) Receive any person falling sick or maimed within the county.
(c) The corporation must agree to accept all the current assets, including accounts receivable, to assume all the current liabilities, and to take over and maintain the records of the existing public hospital.
(d) The agreement must provide for the transfer of patients, staff and employees, and for the continuing administration of any trusts or bequests pertaining to the existing public hospital.
(e) The agreement must provide for the assumption by the corporation of all indebtedness of the county which is attributable to the hospital, and:
(1) If the hospital is conveyed, for payment to the county of an amount which is not less than the appraised value of the hospital, after deducting any indebtedness so assumed, immediately or by deferred installments over a period of not more than 30 years.
(2) If the hospital is leased, for a rental which will, over the term of the lease, reimburse the county for its actual capital investment in the hospital, after deducting depreciation and any indebtedness so assumed. The lease may provide a credit against the rental so required for the value of any capital improvements made by the corporation.
2. If any hospital which has been conveyed pursuant to this section ceases to be used as a hospital, unless the premises so conveyed are sold and the proceeds used to erect or enlarge another hospital for the county, the hospital so conveyed reverts to the ownership of the county. If any hospital which has been leased pursuant to this section ceases to be used as a hospital, the lease is terminated.
Sec. 110 NRS 450.500 is hereby amended to read as follows:
450.5001. Except as otherwise provided in NRS 450.490, the board of county commissioners of any county for which a public hospital has been established pursuant to NRS 450.010 to 450.510, inclusive, or established otherwise but administered pursuant to NRS 450.010 to 450.510, inclusive, may convey the hospital, or lease it for a term of not more than 50 years, to a nonprofit corporation if all of the following conditions are met:
(a) The governing body of the nonprofit corporation must be composed initially of the incumbent members of the board of hospital trustees, as individuals. The articles of incorporation must provide for:
(1) A membership of the corporation which is broadly representative of the public and includes residents of each incorporated city in the county and of the unincorporated area of the county or a single member which is a nonprofit corporation whose articles of incorporation provide for a membership which is broadly representative of the public and includes residents of each incorporated city in the county and of the unincorporated area of the county;
(2) The selection of the governing body by the membership of the corporation or, if the corporation has a single member, by the single member;
(3) The governing body to select its members only to fill a vacancy for an unexpired term; and
(4) The terms of office of members of the governing body, not to exceed 6 years.
(b) The nonprofit corporation must contract to:
(1) Care for indigent patients at a charge to the county which does not exceed the actual cost of providing such care, or in accordance with NRS [439B.300 to 439B.340, inclusive,] 439B.320, if applicable; and
(2) Receive any person falling sick or maimed within the county.
(c) The nonprofit corporation must agree to accept all the current assets, including accounts receivable, to assume all the current liabilities, and to take over and maintain the records of the existing public hospital.
(d) The agreement must provide for the transfer of patients, staff and employees, and for the continuing administration of any trusts or bequests pertaining to the existing public hospital.
(e) The agreement must provide for the assumption by the corporation of all indebtedness of the county which is attributable to the hospital, and:
(1) If the hospital is conveyed, for payment to the county of its actual capital investment in the hospital, after deducting depreciation and any indebtedness so assumed, immediately or by deferred installments over a period of not more than 30 years.
(2) If the hospital is leased, for a rental which will over the term of the lease reimburse the county for its actual capital investment in the hospital, after deducting depreciation and any indebtedness so assumed. The lease may provide a credit against the rental so required for the value of any capital improvements made by the corporation.
2. Boards of county commissioners which have joint responsibility for a public hospital may jointly exercise the power conferred by subsection 1, and are subject jointly to the related duties.
3. If any hospital which has been conveyed pursuant to this section ceases to be used as a nonprofit hospital, unless the premises so conveyed are sold and the proceeds used to erect or enlarge another nonprofit hospital for the county, the hospital so conveyed reverts to the ownership of the county. If any hospital which has been leased pursuant to this section ceases to be used as a nonprofit hospital, the lease is terminated.
Sec. 111 NRS 450.510 is hereby amended to read as follows:
450.5101. The board of county commissioners of any county whose population is less than 100,000 may contract with any nonprofit corporation to which a public hospital has been conveyed or leased, for the care of indigent patients from the contracting county and the receiving of other persons falling sick or being maimed or injured within the contracting county. The contract must be consistent with the provisions of NRS [439B.300 to 439B.340, inclusive,] 439B.320, if applicable.
2. The contracting county may participate in the enlargement or alteration of the hospital.
Sec. 112 NRS 450.620 is hereby amended to read as follows:
450.6201. Except as otherwise provided in subsection 2, if a hospital district is created pursuant to NRS 450.550 to 450.700, inclusive, the board of county commissioners shall provide by ordinance for:
(a) The number of trustees who shall govern the hospital;
(b) Their term of office, which must not exceed 4 years; and
(c) The times and manner of their election, which must be nonpartisan.
2. The board of county commissioners may enact an ordinance providing that the board of county commissioners is, ex officio, the board of hospital trustees of the district hospital. If such an ordinance is enacted in a county:
(a) The county commissioners shall serve as the hospital trustees of the district hospital during their terms of office as county commissioners; and
(b) If hospital trustees have been elected pursuant to subsection 1, the term of office of each hospital trustee of the district hospital who is serving in that capacity on the effective date of the ordinance is terminated as of the effective date of the ordinance.
3. A board of county commissioners shall not enact an ordinance pursuant to subsection 2 unless it determines that [:
(a) The county has fully funded its indigent care account created pursuant to NRS 428.010;
(b) The county has fulfilled its duty to reimburse the hospital for indigent care provided to qualified indigent patients; and
(c) During] during the previous calendar year:
[(1)] (a) At least one of the hospital's accounts payable was more than 90 days in arrears;
[(2)] (b) The hospital failed to fulfill its statutory financial obligations, such as the payment of taxes, premiums for industrial insurance or contributions to the public employees' retirement system;
[(3)] (c) One or more of the conditions relating to financial emergencies set forth in subsection 1 of NRS 354.685 existed at the hospital; or
[(4)] (d) The hospital received notice from the Federal Government or the State of Nevada that the certification or licensure of the hospital was in imminent jeopardy of being revoked because the hospital had not carried out a previously established plan of action to correct previously noted deficiencies found by the regulatory body.
Sec. 113 NRS 450.700 is hereby amended to read as follows:
450.7001. The board of county commissioners of the county in which a district hospital is located may determine whether patients presented to the district hospital for treatment are subjects of charity. [Except as otherwise provided in NRS 439B.330, the] The board of county commissioners shall establish by ordinance criteria and procedures to be used in the determination of eligibility for medical care as medical indigents or subjects of charity.
2. The board of trustees shall fix the charges for treatment of those persons able to pay for it, as the board deems just and proper. The receipts therefor must be paid to the county treasurer and credited by him to the fund for the district.
Sec. 114 NRS 695C.050 is hereby amended to read as follows:
695C.0501. Except as otherwise provided in this chapter or in specific provisions of this Title, the provisions of this Title are not applicable to any health maintenance organization granted a certificate of authority under this chapter. This provision does not apply to an insurer licensed and regulated pursuant to this Title except with respect to its activities as a health maintenance organization authorized and regulated pursuant to this chapter.
2. Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, must not be construed to violate any provision of law relating to solicitation or advertising by practitioners of a healing art.
3. Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and is exempt from the provisions of chapter 630 of NRS.
4. The provisions of NRS 695C.110, 695C.170 to 695C.200, inclusive, 695C.250, 695C.260 and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid pursuant to a contract with the welfare division of the department of human resources. [This subsection does]
5. The provisions of NRS 695C.171 to 695C.1795, inclusive, do not apply to a health maintenance organization that provides health care services to enrollees in the program for health assurance established pursuant to a contract with the commission for health assurance of the department of human resources.
6. Subsections 4 and 5 do not exempt a health maintenance organization from any provision of this chapter for services provided pursuant to any other contract.
Sec. 115 NRS 428.070, 428.115, 428.125, 428.136, 428.145, 428.155, 428.165, 428.195, 428.205, 428.215, 428.225, 428.235, 428.245, 428.255, 428.265, 428.275, 428.295, 428.305, 428.315, 428.335, 428.345, 439B.330, 439B.340 and 450.400 are hereby repealed.
Sec. 116 1. There is hereby appropriated from the state general fund to the account for the program for health assurance created pursuant to section 23 of this act the sum of $1,200,000 for establishing the commission for health assurance within the department of human resources, hiring a program manager of the program for health assurance, and administration, design and implementation of the program for health assurance.
2. Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after January 1, 1999, and reverts to the state general fund as soon as all payments of money committed have been made.
Sec. 117 1. This section and sections 1 to 12, inclusive, 14 to 17, inclusive, 19, 20 and 22 to 26, inclusive, 28, 29, 34, 35, 90, 91 and 116 of this act become effective on July 1, 1997.
2. Sections 13, 18, 21, 27, 30 to 33, inclusive, 36 to 89, inclusive, and 92 to 115, inclusive, of this act become effective upon:
(a) The state receiving the appropriate waiver from the Federal Government;
(b) The establishment and operation of the commission for health assurance;
(c) The program manager of the state program for health assurance being prepared to assume administrative responsibility of the operation of the state program for health assurance; and
(d) The legislature, if it is in session, or the interim finance committee, approving a request from the governor that the state program for health assurance be vested with its duties and responsibilities.
LEADLINES OF REPEALED SECTIONS
428.070Responsibility of relative and recipient of aid for hospitalization provided by county: Reimbursement of county; determination of financial responsibility; action to enforce collection.
428.115Definitions.
428.125"Board" defined.
428.136"Fund" defined.
428.145"Hospital" defined.
428.155"Hospital care" defined.
428.165"Injury in motor vehicle accident" defined.
428.195Board of trustees of fund: Composition; terms; vacancies.
428.205Board of trustees of the fund: Powers.
428.215Collection of charges for care by hospital; request for determination of indigency.
428.225Certification of indigency.
428.235Form and contents of application for reimbursement for charges; reimbursement for charges for care furnished to transferred patient.
428.245Review of application; payment to hospital from fund; reimbursement of physician by hospital; board subrogated to right of hospital or physician; lien on proceeds of recovery.
428.255Reimbursement of fund by counties.
428.265Definitions.
428.275Fund for medical assistance to indigent persons.
428.295Allocation of money in budget; payment of excess from fund.
428.305Supplemental account for medical assistance to indigent persons.
428.315Administration of supplemental account by board of trustees of fund for hospital care to indigent persons.
428.335Application by county for reimbursement for charges; certification of indigency and amount of expenditure.
428.345Review of application; payment to county from supplemental account; reimbursement of provider of care by county; board of trustees subrogated to right of county; lien on proceeds of recovery.
439B.330Eligibility of indigent for assistance; payment of hospital for serving disproportionately large share of patients; discharge forms; appeal from determination of county regarding indigent status.
439B.340Report on indigent patients treated; verification by director; compensation for treatment provided in excess of obligation; assessment for failure to fulfill minimum obligation.
450.400Extension of privileges and use of hospital to certain nonresidents: Notice; removal of person to resident county; payment for temporary care; action for recovery of charges.