- Senate Bill No. 427-Committee on Finance
CHAPTER
550
- AN ACT relating to public welfare; creating the division of health care financing and policy within the department of human resources and providing its duties; reassigning certain duties of the welfare division of the department to the division of health care financing and policy and to the housing division of the department of business and industry; exempting the division of health care financing and policy from the requirements of the Nevada Administrative Procedure Act; revising certain provisions regarding reports of the abuse, neglect or exploitation of older persons; revising certain provisions that limit the increase in charges that a major hospital may impose; requiring the legislative committee on health care to conduct a study to evaluate expanding access to health care in this state and to make recommendations for establishing a mandatory Medicaid managed care program; making an appropriation; providing for the allocation and transfer of certain funding for the treatment of Medicaid patients, indigent patients and other low-income patients; and providing other matters properly relating thereto.
[Approved July 16, 1997]
- THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. NRS 228.410 is hereby amended to read as follows:
228.410 1. The attorney general has primary jurisdiction to investigate and prosecute violations of NRS 422.540 to 422.570, inclusive, and any fraud in the administration of the plan or in the provision of medical assistance. The provisions of this section notwithstanding, the welfare division and the division of health care financing and policy of the department of human resources shall enforce the plan and any [administrative] regulations adopted pursuant thereto.
2. For this purpose, [he] the attorney general 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] have expertise in nursing, medicine and the administration of medical facilities.
3. The attorney general, acting through the Medicaid fraud control unit : [established pursuant to subsection 2:]
(a) Is the single state agency responsible for the investigation and prosecution of violations of NRS 422.540 to 422.570, inclusive;
(b) Shall review reports of abuse or criminal neglect of patients in medical facilities which receive payments under the plan and, when appropriate, investigate and prosecute the persons responsible;
(c) May review and investigate reports of misappropriation of money from the personal resources of patients in medical facilities [which] that receive payments under the plan and, when appropriate, shall prosecute the persons responsible;
(d) Shall cooperate with federal investigators and prosecutors in coordinating state and federal investigations and prosecutions involving fraud in the provision or administration of medical assistance pursuant to the plan, and provide those federal officers with any information in his possession regarding such an investigation or prosecution; and
(e) Shall protect the privacy of patients and establish procedures to prevent the misuse of information obtained in carrying out the provisions of this section.
4. When acting pursuant to NRS 228.175 or this section, the attorney general may commence his investigation and file a criminal action without leave of court, and he has exclusive charge of the conduct of the prosecution.
5. As used in this section:
(a) "Medical facility" has the meaning ascribed to it in NRS 449.0151.
(b) "Plan" means the state plan for Medicaid established pursuant to NRS 422.237.
Sec. 2. Chapter 232 of NRS is hereby amended by adding thereto the provisions set forth as sections 3 to 8, inclusive, of this act.
Sec. 3. As used in sections 3 to 8, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 4 to 7, inclusive, of this act have the meanings ascribed to them in those sections.
Sec. 4. "Administrator" means the administrator of the division.
Sec. 5. (Deleted by amendment.)
Sec. 6. "Division" means the division of health care financing and policy of the department.
Sec. 7. "Medicaid" has the meaning ascribed to it in NRS 439B.120.
Sec. 8. The purposes of the division are:
1. To ensure that the Medicaid provided by this state is provided in the manner that is most efficient to this state.
2. To evaluate alternative methods of providing Medicaid.
3. To review Medicaid and other health programs of this state to determine the maximum amount of money that is available from the Federal Government for such programs.
4. To promote access to quality health care for all residents of this state.
5. To restrain the growth of the cost of health care in this state.
Sec. 9. NRS 232.290 is hereby amended to read as follows:
232.290 As used in NRS 232.290 to 232.465, inclusive, and sections 3 to 8, inclusive, 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. 10. NRS 232.300 is hereby amended to read as follows:
232.3001. The department of human resources is hereby created.
2. The department consists of a director and the following divisions:
(a) Aging services division.
(b) Health division.
(c) Mental hygiene and mental retardation division.
(d) Welfare division.
(e) Division of child and family services.
(f) Division of health care financing and policy.
3. The department is the sole agency responsible for administering the provisions of law relating to its respective divisions.
Sec. 11. NRS 232.320 is hereby amended to read as follows:
232.320 1. Except as otherwise provided in subsection 2, the director:
(a) Shall appoint, with the consent of the governor, [chiefs] administrators of the divisions of the department, who are respectively designated as follows:
(1) The administrator of the aging services division;
(2) The administrator of the health division;
(3) The state welfare administrator; [and]
(4) The administrator of the division of child and family services [.] ; and
(5) The administrator of the division of health care financing and policy.
(b) Shall administer, through the divisions of the department, the provisions of chapters 210, 423, 424, 425, 427A, 432A to 442, inclusive, 446, 447, 449 and 450 of NRS, NRS 127.220 to 127.310, inclusive, [422.070] 422.001 to 422.410, inclusive, 422.580, 432.010 to 432.139, inclusive, 444.003 to 444.430, inclusive, and 445A.010 to 445A.050, inclusive, and sections 16 to 29, inclusive, of this act, and all other provisions of law relating to the functions of the divisions of the department, but is not responsible for the clinical activities of the health division or the professional line activities of the other divisions.
(c) Shall, after considering advice from agencies of local governments and nonprofit organizations which provide social services, adopt a master plan for the provision of human services in this state. The director shall revise the plan biennially and deliver a copy of the plan to the governor and the legislature at the beginning of each regular session. The plan must:
(1) Identify and assess the plans and programs of the department for the provision of human services, and any duplication of those services by federal, state and local agencies;
(2) Set forth priorities for the provision of those services;
(3) Provide for communication and the coordination of those services among nonprofit organizations, agencies of local government, the state and the Federal Government;
(4) Identify the sources of funding for services provided by the department and the allocation of that funding;
(5) Set forth sufficient information to assist the department in providing those services and in the planning and budgeting for the future provision of those services; and
(6) Contain any other information necessary for the department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the department.
(d) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information to him regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which he deems necessary for his performance of the duties imposed upon him pursuant to this section.
(e) Has such other powers and duties as are provided by law.
2. The governor shall appoint the administrator of the mental hygiene and mental retardation division.
Sec. 12. NRS 232.340 is hereby amended to read as follows:
232.340 The [chief] administrator of each division of the department:
1. Is in the unclassified service of the state unless federal law or regulation requires otherwise.
2. Shall administer the provisions of law relating to his division, subject to the administrative supervision of the director.
3. Except as otherwise provided in NRS 284.143, shall devote his entire time and attention to the business of his office and shall not pursue any other business or occupation or hold any other office of profit.
Sec. 13. NRS 232.350 is hereby amended to read as follows:
232.350 Unless federal law or regulation requires otherwise:
1. The [chiefs] administrators of the divisions of the department, except as otherwise provided in [subsection 2,] subsections 2 and 3, may each appoint a deputy and a chief assistant in the unclassified service of the state.
2. The administrator of the division of child and family services of the department may appoint three deputies in the unclassified service of the state.
3. The administrator of the division of health care financing and policy of the department may appoint two deputies in the unclassified service of the state.
Sec. 14. NRS 233B.039 is hereby amended to read as follows:
233B.039 1. The following agencies are entirely exempted from the requirements of this chapter:
(a) The governor.
(b) The department of prisons.
(c) The University and Community College System of Nevada.
(d) The office of the military.
(e) The state gaming control board.
(f) The Nevada gaming commission.
(g) The state board of parole commissioners.
(h) The welfare division of the department of human resources.
(i) The division of health care financing and policy of the department of human resources.
(j) The state board of examiners acting pursuant to chapter 217 of NRS.
[(j)] (k) Except as otherwise provided in NRS 533.365, the office of the state engineer.
2. Except as otherwise provided in NRS 391.323, the department of education, the committee on benefits and the commission on professional standards in education are subject to the provisions of this chapter for the purpose of adopting regulations but not with respect to any contested case.
3. The special provisions of:
(a) Chapter 612 of NRS for the distribution of regulations by and the judicial review of decisions of the employment security division of the department of employment, training and rehabilitation;
(b) Chapters 616A to 617, inclusive, of NRS for the determination of contested claims;
(c) Chapter 703 of NRS for the judicial review of decisions of the public service commission of Nevada;
(d) Chapter 91 of NRS for the judicial review of decisions of the administrator of the securities division of the office of the secretary of state; and
(e) NRS 90.800 for the use of summary orders in contested cases,
prevail over the general provisions of this chapter.
4. The provisions of NRS 233B.122, 233B.124, 233B.125 and 233B.126 do not apply to the department of human resources in the adjudication of contested cases involving the issuance of letters of approval for health facilities and agencies.
5. The provisions of this chapter do not apply to:
(a) Any order for immediate action, including, but not limited to, quarantine and the treatment or cleansing of infected or infested animals, objects or premises, made under the authority of the state board of agriculture, the state board of health, the state board of sheep commissioners or any other agency of this state in the discharge of a responsibility for the preservation of human or animal health or for insect or pest control; or
(b) An extraordinary regulation of the state board of pharmacy adopted pursuant to NRS 453.2184.
Sec. 14.1. NRS 200.5093 is hereby amended to read as follows:
200.50931. Any person required to make a report pursuant to this section shall make the report immediately, but in no event later than 24 hours after there is reason to believe that an older person has been abused, neglected or exploited. The report must be made to:
(a) The local office of the [welfare or] aging services division or the division of health care financing and policy of the department of human resources;
(b) Any police department or sheriff's office; or
(c) The county's office for protective services, if one exists in the county where the suspected action occurred.
If the report of abuse, neglect or exploitation involves an act or omission of the [welfare division,] aging services division , another division of the department of human resources or a law enforcement agency, the report must be made to an agency other than the one alleged to have committed the act or omission. Each agency, after reducing the report to writing, shall forward a copy of the report to the aging services division of the department of human resources.
2. Reports must be made by the following persons who, in their professional or occupational capacities, know or have reason to believe that an older person is being or has been abused, neglected or exploited:
(a) Every physician, dentist, dental hygienist, chiropractor, optometrist, podiatric physician, medical examiner, resident, intern, professional or practical nurse, physician's assistant, psychiatrist, psychologist, marriage and family therapist, alcohol or drug abuse counselor, driver of an ambulance, advanced emergency medical technician or other person providing medical services licensed or certified to practice in this state, who examines, attends or treats an older person who appears to have been abused, neglected or exploited.
(b) Any personnel of a hospital or similar institution engaged in the admission, examination, care or treatment of persons or an administrator, manager or other person in charge of a hospital or similar institution upon notification of the suspected abuse, neglect or exploitation of an older person by a member of the staff of the hospital.
(c) A coroner.
(d) Every clergyman, practitioner of Christian Science or religious healer, unless he acquired the knowledge of abuse, neglect or exploitation from the offender during a confession.
(e) Every person who maintains or is employed by an agency to provide nursing in the home.
(f) Every attorney, unless he has acquired the knowledge of abuse, neglect or exploitation from a client who has been or may be accused of the abuse, neglect or exploitation.
(g) Any employee of the department of human resources.
(h) Any employee of a law enforcement agency or a county's office for protective services or an adult or juvenile probation officer.
(i) Any person who maintains or is employed by a facility or establishment that provides care for older persons.
(j) Any person who maintains, is employed by or serves as a volunteer for an agency or service which advises persons regarding the abuse, neglect or exploitation of an older person and refers them to persons and agencies where their requests and needs can be met.
(k) Every social worker.
3. A report may be filed by any other person.
4. Any person required to make a report pursuant to this section who has reasonable cause to believe that an older person has died as a result of abuse or neglect shall report this belief to the appropriate medical examiner or coroner, who shall investigate the cause of death of the older person and submit to the appropriate local law enforcement agencies, the appropriate prosecuting attorney and the aging services division of the department of human resources his written findings. The written findings must include the information required pursuant to the provisions of NRS 200.5094, when possible.
5. A division, office or department which receives a report pursuant to this section shall cause the investigation of the report to commence within 3 working days. A copy of the final report of the investigation conducted by a division, office or department, other than the aging services division of the department of human resources, must be forwarded to the aging services division within 90 days after the completion of the report.
6. If the investigation of the report results in the belief that the older person is abused, neglected or exploited, the [welfare division of the] department of human resources or the county's office for protective services may provide protective services to the older person if he is able and willing to accept them.
Sec. 14.2. NRS 200.5093 is hereby amended to read as follows:
200.50931. A person required to make a report pursuant to this section shall make the report immediately, but in no event later than 24 hours after there is reason to believe that an older person has been abused, neglected, exploited or isolated. The report must be made to:
(a) The local office of the aging services division [or the division of health care financing and policy] of the department of human resources;
(b) A police department or sheriff's office;
(c) The county's office for protective services, if one exists in the county where the suspected action occurred; or
(d) A toll-free telephone service designated by the aging services division of the department of human resources.
If the report of abuse, neglect, exploitation or isolation of an older person involves an act or omission of the aging services division, another division of the department of human resources or a law enforcement agency, the report must be made to an agency other than the one alleged to have committed the act or omission. Each agency, after reducing the report to writing, shall forward a copy of the report to the aging services division of the department of human resources.
2. Reports must be made by the following persons who, in their professional or occupational capacities, know or have reason to believe that an older person is being or has been abused, neglected, exploited or isolated:
(a) Every physician, dentist, dental hygienist, chiropractor, optometrist, podiatric physician, medical examiner, resident, intern, professional or practical nurse, physician's assistant, psychiatrist, psychologist, marriage and family therapist, alcohol or drug abuse counselor, driver of an ambulance, advanced emergency medical technician or other person providing medical services licensed or certified to practice in this state, who examines, attends or treats an older person who appears to have been abused, neglected, exploited or isolated.
(b) Any personnel of a hospital or similar institution engaged in the admission, examination, care or treatment of persons or an administrator, manager or other person in charge of a hospital or similar institution upon notification of the suspected abuse, neglect, exploitation or isolation of an older person by a member of the staff of the hospital.
(c) A coroner.
(d) Every clergyman, practitioner of Christian Science or religious healer, unless he acquired the knowledge of abuse, neglect, exploitation or isolation of the older person from the offender during a confession.
(e) Every person who maintains or is employed by an agency to provide nursing in the home.
(f) Every attorney, unless he has acquired the knowledge of abuse, neglect, exploitation or isolation of the older person from a client who has been or may be accused of such abuse, neglect, exploitation or isolation.
(g) Any employee of the department of human resources.
(h) Any employee of a law enforcement agency or a county's office for protective services or an adult or juvenile probation officer.
(i) Any person who maintains or is employed by a facility or establishment that provides care for older persons.
(j) Any person who maintains, is employed by or serves as a volunteer for an agency or service which advises persons regarding the abuse, neglect, exploitation or isolation of an older person and refers them to persons and agencies where their requests and needs can be met.
(k) Every social worker.
(l) Any person who owns or is employed by a funeral home or mortuary.
3. A report may be filed by any other person.
4. A person required to make a report pursuant to this section who has reasonable cause to believe that an older person has died as a result of abuse, neglect or isolation shall report this belief to the appropriate medical examiner or coroner, who shall investigate the cause of death of the older person and submit to the appropriate local law enforcement agencies, the appropriate prosecuting attorney and the aging services division of the department of human resources his written findings. The written findings must include the information required pursuant to the provisions of NRS 200.5094, when possible.
5. A division, office or department which receives a report pursuant to this section shall cause the investigation of the report to commence within 3 working days. A copy of the final report of the investigation conducted by a division, office or department, other than the aging services division of the department of human resources, must be forwarded to the aging services division within 90 days after the completion of the report.
6. If the investigation of the report results in the belief that the older person is abused, neglected, exploited or isolated, the department of human resources or the county's office for protective services may provide protective services to the older person if he is able and willing to accept them.
7. A person who knowingly and willfully violates any of the provisions of this section is guilty of a misdemeanor.
Sec. 14.3. NRS 200.50984 is hereby amended to read as follows:
200.509841. Notwithstanding any other statute to the contrary, [the local office of the welfare division of] the department of human resources and a county's office for protective services, if one exists in the county where a violation is alleged to have occurred, may for the purpose of investigating an alleged violation of NRS 200.5091 to 200.5099, inclusive, inspect all records pertaining to the older person on whose behalf the investigation is being conducted, including, but not limited to, that person's medical and financial records.
2. Except as otherwise provided in this subsection, if a guardian has not been appointed for the older person, the [welfare division] department of human resources or the county's office for protective services shall obtain the consent of the older person before inspecting those records. If the [welfare division] department of human resources or the county's office for protective services determines that the older person is unable to consent to the inspection, the inspection may be conducted without his consent. Except as otherwise provided in this subsection, if a guardian has been appointed for the older person, the [welfare division] department of human resources or the county's office for protective services shall obtain the consent of the guardian before inspecting those records. If the [welfare division] department of human resources or the county's office for protective services has reason to believe that the guardian is abusing, neglecting or exploiting the older person, the inspection may be conducted without the consent of the guardian, except that if the records to be inspected are in the personal possession of the guardian, the inspection must be approved by a court of competent jurisdiction.
Sec. 14.4. NRS 200.50986 is hereby amended to read as follows:
200.50986The [local office of the welfare division] department of human resources or the county's office for protective services may petition a court in accordance with NRS 159.185 or 159.1905 for the removal of the guardian of an older person, or the termination or modification of that guardianship, if, based on its investigation, the [welfare division] department of human resources or the county's office of protective services has reason to believe that the guardian is abusing, neglecting or exploiting the older person in violation of NRS 200.5095 to 200.5099, inclusive.
Sec. 14.5. Chapter 319 of NRS is hereby amended by adding thereto a new section to read as follows:
The division shall administer the program established to increase the efficiency with which energy is used in dwellings owned or occupied by persons of low income pursuant to 42 U.S.C. §§ 6861 et seq.
Sec. 15. Chapter 422 of NRS is hereby amended by adding thereto the provisions set forth as sections 16 to 29, inclusive, of this act.
Sec. 16. "Division of health care financing and policy" means the division of health care financing and policy of the department.
Sec. 17. As used in NRS 422.285, 422.2993, 422.2997, 422.380 to 422.390, inclusive, 422.580, and sections 17 to 29, inclusive, of this act, unless the context otherwise requires, "administrator" means the administrator of the division of health care financing and policy.
Sec. 18. The administrator and the division of health care financing and policy shall administer the provisions of NRS 422.285, 422.2993, 422.2997, 422.380 to 422.390, inclusive, 422.580, and sections 17 to 29, inclusive, of this act, subject to administrative supervision by the director.
Sec. 19. (Deleted by amendment.)
Sec. 20. The administrator must:
1. Be appointed on the basis of his training, education, experience and interest in the financing of programs for public health, including, without limitation, the financing of Medicaid.
2. Be a graduate in public administration, business administration or a similar area of study from an accredited college or university.
3. Have not less than 3 years of demonstrated successful experience in the financing of health care or other public programs, and not less than 1 year of experience relating to Medicaid, or any equivalent combination of training and experience.
4. Possess qualities of leadership in the fields of health care and the financing of health care.
Sec. 21. The administrator:
1. Shall serve as the executive officer of the division of health care financing and policy.
2. Shall establish policies for the administration of the programs of the division, and shall administer all activities and services of the division in accordance with those policies and any regulations of the administrator, subject to administrative supervision by the director.
3. Is responsible for the management of the division.
Sec. 22. The administrator shall make:
1. Such reports, subject to approval by the director, as will comply with the requirements of federal legislation and this chapter.
2. A biennial report to the director on the condition, operation and functioning of the division of health care financing and policy.
Sec. 23. The administrator:
1. Is responsible for and shall supervise the fiscal affairs and responsibilities of the division of health care financing and policy, subject to administrative supervision by the director.
2. Shall present the biennial budget of the division to the legislature in conjunction with the budget division of the department of administration.
3. Shall allocate, in the interest of efficiency and economy, the state's appropriation for the administration of each program for which the division of health care financing and policy is responsible, subject to administrative supervision by the director.
Sec. 24. The administrator:
1. May establish, consolidate and abolish sections within the division of health care financing and policy.
2. Shall organize the division to comply with the requirements of this chapter and with the standards required by federal legislation, subject to approval by the director.
3. Shall appoint the heads of the sections of the division.
4. May employ such assistants and employees as may be necessary to the efficient operation of the division.
5. Shall set standards of service.
Sec. 25. 1. The administrator or his designated representative may administer oaths and take testimony thereunder and issue subpoenas requiring the attendance of witnesses before the division of health care financing and policy at a designated time and place and the production of books, papers and records relative to:
(a) Eligibility or continued eligibility to provide medical care, remedial care or other services pursuant to the state plan for 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 Medicaid.
2. If a witness fails to appear or refuses to give testimony or to produce books, papers and records as required by the subpoena, the district court of the county in which the investigation is being conducted may compel the attendance of the witness, the giving of testimony and the production of books, papers and records as required by the subpoena.
Sec. 26. The administrator shall:
1. Supply the director with material on which to base proposed legislation.
2. Cooperate with the Federal Government and state governments for the more effective attainment of the purposes of this chapter.
3. Coordinate the activities of the division of health care financing and policy with other agencies, both public and private, with related or similar activities.
4. Keep a complete and accurate record of all proceedings, record and file all bonds and contracts, and assume responsibility for the custody and preservation of all papers and documents pertaining to his office.
5. Inform the public in regard to the activities and operation of the division, and provide other information which will acquaint the public with the financing of Medicaid programs.
6. Conduct studies into the causes of the social problems with which the division is concerned.
7. Invoke any legal, equitable or special procedures for the enforcement of his orders or the enforcement of NRS 422.285, 422.2993, 422.2997, 422.380 to 422.390, inclusive, 422.580, and sections 17 to 29, inclusive, of this act.
8. Exercise any other powers that are necessary and proper for the standardization of state work, to expedite business, and to promote the efficiency of the service provided by the division.
Sec. 27. 1. The administrator shall:
(a) Promptly comply with a request from the unit for access to and free copies of any records or other information in the possession of the division of health care financing and policy regarding a provider;
(b) Refer to the unit all cases in which he suspects that a provider has committed an offense pursuant to NRS 422.540 to 422.570, inclusive; and
(c) Suspend or exclude a provider who he determines has committed an offense pursuant to NRS 422.540 to 422.570, inclusive, 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 Medicaid as the provider of goods or services.
(b) "Unit" means the Medicaid fraud control unit established in the office of the attorney general pursuant to NRS 228.410.
Sec. 28. The administrator may adopt such regulations as are necessary for the administration of NRS 422.285, 422.2993, 422.2997, 422.380 to 422.390, inclusive, 422.580, and sections 17 to 29, inclusive, of this act.
Sec. 29. 1. Any gifts or grants of money which the division of health care financing and policy is authorized to accept must be deposited in the state treasury to the credit of the gift and cooperative account of the division of health care financing and policy which is hereby created in the department of human resources' gift fund.
2. Money in the account must be used for health care purposes only and expended in accordance with the terms of the gift or grant.
3. All claims must be approved by the administrator before they are paid.
Sec. 30. 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] 422.007 to 422.055, inclusive, [and] section 2 of [this act,] Assembly Bill No. 13 of this session and section 16 of this act, have the meanings ascribed to them in those sections.
Sec. 30.5. NRS 422.050 is hereby amended to read as follows:
422.050"Public assistance" includes:
1. State supplementary assistance;
2. Aid to families with dependent children;
3. Medicaid;
4. Food stamp assistance;
5. Low-income home energy assistance; and
6. [Low-income weatherization assistance; and
7.] Benefits provided pursuant to any other public welfare program administered by the welfare division pursuant to such additional federal legislation as is not inconsistent with the purposes of this chapter.
Sec. 31. NRS 422.050 is hereby amended to read as follows:
422.050 "Public assistance" includes:
1. State supplementary assistance;
2. Aid to families with dependent children;
3. Medicaid;
4. Food stamp assistance;
5. Low-income home energy assistance; and
6. Benefits provided pursuant to any other public welfare program administered by the welfare division or the division of health care financing and policy pursuant to such additional federal legislation as is not inconsistent with the purposes of this chapter.
Sec. 32. NRS 422.060 is hereby amended to read as follows:
422.060 The state welfare administrator and the welfare division shall administer the provisions of this section and NRS [422.070 to 422.410, inclusive,] 422.160 to 422.2345, inclusive, 422.238, 422.250, 422.2935 to 422.294, inclusive, 422.296 to 422.299, inclusive, and 422.310 to 422.377, inclusive, subject to administrative supervision by the director.
Sec. 33. NRS 422.110 is hereby amended to read as follows:
422.110 1. The members of the board may meet at such times and at such places as the board, the chairman of the board, the state welfare administrator or the director deems necessary and a meeting of the board may be held at least once each year.
2. Four members of the board constitute a quorum, and a quorum may exercise all the power and authority conferred on the board.
3. The board shall keep minutes of the transactions of each board session, regular or special, which are public records and must be filed with the welfare division.
Sec. 34. NRS 422.120 is hereby amended to read as follows:
422.120 1. At the first meeting after the adjournment of any regular session of the legislature, the board shall elect from its members a chairman and vice chairman. The terms of the offices of chairman and vice chairman expire upon the election of a chairman and vice chairman at the first meeting following the adjournment of the next regular session of the legislature.
2. If a vacancy occurs in the office of chairman, the vice chairman shall assume the duties of chairman for the unexpired term. If a vacancy occurs in the office of vice chairman, the board shall, at its next meeting, fill the vacancy for the unexpired term.
3. The state welfare administrator shall act as the nonvoting recording secretary.
Sec. 35. NRS 422.140 is hereby amended to read as follows:
422.140 1. The board has only those powers and duties authorized by law.
2. The board:
(a) Shall adopt regulations for its own management and government.
(b) May adopt regulations for the administration of public assistance and other programs for which the welfare division is responsible.
3. A regulation of the board:
[(1)] (a) Must be so formulated or conditioned that it does not require for its 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 it applies.
[(2)] (b) Must not be inconsistent with any plan, policy or regulation [adopted] :
(1) Adopted by the state welfare administrator:
(I) Pursuant to NRS 422.238, without the approval of the board; or
(II) Pursuant to NRS 422.180, [422.237,] 422.265, 422.373 or 422.377.
[(3) Becomes effective upon adoption or such other date as the board specifies in the regulation.]
(2) Adopted by the director pursuant to NRS 422.237.
(c) Shall advise and make recommendations to the director or the legislature relative to the public welfare policy of the state.
[3.] 4. The state welfare administrator shall execute and enforce the regulations of the board.
Sec. 36. NRS 422.141 is hereby amended to read as follows:
422.1411. Before adopting, amending or repealing any regulation for the administration of a program of public assistance or any other program for which the [welfare division] department is responsible, the board shall give at least 30 days' notice of its intended action.
2. The notice of intent to act upon a regulation must:
(a) Include a statement of the need for and purpose of the proposed regulation, and either the terms or substance of the proposed regulation or a description of the subjects and issues involved, and of the time when, the place where, and the manner in which, interested persons may present their views thereon.
(b) Include a statement identifying the entities that may be financially affected by the proposed regulation and the potential financial impact, if any, upon local government.
(c) State each address at which the text of the proposed regulation may be inspected and copied.
(d) Be mailed to all persons who have requested in writing that they be placed upon a mailing list, which must be kept by the board for that purpose.
3. All interested persons must be afforded a reasonable opportunity to submit data, views or arguments upon a proposed regulation, orally or in writing. The board shall consider fully all oral and written submissions relating to the proposed regulation.
4. The board shall keep, retain and make available for public inspection written minutes of each public hearing held pursuant to this section in the manner provided in subsections 1 and 2 of NRS 241.035.
5. The board may record each public hearing held pursuant to this section and make those recordings available for public inspection in the manner provided in subsection 4 of NRS 241.035.
6. No objection to any regulation on the ground of noncompliance with the procedural requirements of this section may be made more than 2 years after its effective date.
Sec. 37. NRS 422.151 is hereby amended to read as follows:
422.151 1. The medical care advisory group is hereby created within the [welfare] division of [the department.] health care financing and policy.
2. The function of the medical care advisory group is to:
(a) Advise the [welfare] division regarding the provision of services for the health and medical care of welfare recipients.
(b) Participate, and increase the participation of welfare recipients, in the development of policy and the administration of programs by the [welfare] division.
Sec. 38. NRS 422.155 is hereby amended to read as follows:
422.155 1. The director shall appoint a chairman of the medical care advisory group from among its members.
2. The [chief of the medical care section of the welfare division or other person designated by the administrator to perform an equivalent function] administrator of the division of health care financing and policy or his designee shall serve as secretary for the medical care advisory group.
3. The medical care advisory group:
(a) Shall meet at least once each calendar year.
(b) May, upon the recommendation of the chairman, form subcommittees for decisions and recommendations concerning specific problems within the scope of the functions of the medical care advisory group.
Sec. 39. NRS 422.160 is hereby amended to read as follows:
422.160 The state welfare administrator [shall:] must:
1. Be selected on the basis of his training, experience, capacity and interest in public welfare services.
2. Be a graduate in public or business administration from an accredited college or university.
3. Have had not less than 3 [years'] years of demonstrated successful experience in public welfare administration, with responsibility for general direction and determination of a policy of a general assistance and social service program, or any equivalent combination of training and experience.
4. Possess qualities of leadership in the field of human welfare and health.
Sec. 40. NRS 422.180 is hereby amended to read as follows:
422.180 The state welfare administrator:
1. Shall serve as the executive officer of the welfare division.
2. Shall establish policies for the administration of the programs of the welfare division, and shall administer all activities and services of the welfare division in accordance with those policies and any regulations of the state welfare administrator or the board, subject to administrative supervision by the director.
3. Is responsible for the management of the welfare division.
Sec. 41. NRS 422.190 is hereby amended to read as follows:
422.190 The state welfare administrator shall [have the following powers and duties:
1. To make such] make:
1. Such reports, subject to approval by the director, as will comply with the requirements of federal legislation and [with the provisions of] this chapter.
2. [To make reports] Reports to the [state welfare] board.
3. [To make a] A biennial report to the director [of] on the condition, operation and functioning of the welfare division.
Sec. 42. NRS 422.200 is hereby amended to read as follows:
422.200 The state welfare administrator:
1. Is responsible for and shall supervise the fiscal affairs and responsibilities of the welfare division, subject to administrative supervision by the director.
2. Shall present the biennial budget of the welfare division to the legislature in conjunction with the budget division of the department of administration.
3. Shall allocate, in the interest of efficiency and economy, the state's appropriation for the administration of [the separate programs] each program for which the welfare division is responsible, subject to administrative supervision by the director.
Sec. 43. NRS 422.210 is hereby amended to read as follows:
422.210 The state welfare administrator:
1. May establish, consolidate and abolish sections within the welfare division.
2. Shall organize the welfare division [so as] to comply with the requirements of this chapter and with the standards required by federal legislation, subject to approval by the director.
3. Shall appoint the heads of the sections of the welfare division.
4. May employ such assistants and employees as may be necessary to the efficient operation of the welfare division.
5. Shall set standards of service.
Sec. 44. NRS 422.215 is hereby amended to read as follows:
422.215 1. The state welfare administrator or his designated representative may administer oaths and take testimony thereunder and issue subpoenas requiring the attendance of witnesses before the welfare division at a designated time and place and the production of books, papers and records relative to:
(a) Eligibility or continued eligibility for public assistance; and
(b) Verification of treatment and payments to a provider of medical care, remedial care or other services pursuant to the state plan for Medicaid.
2. If a witness fails to appear or refuses to give testimony or to produce books, papers and records as required by the subpoena, the district court of the county in which the investigation is being conducted may compel the attendance of [witnesses,] the witness, the giving of testimony and the production of books, papers and records as required by the subpoena.
Sec. 45. NRS 422.230 is hereby amended to read as follows:
422.230 The state welfare administrator [has the following powers and duties:
1. To supply] shall:
1. Supply the director with material on which to base proposed legislation.
2. [To cooperate] Cooperate with the Federal Government and state governments for the more effective attainment of the purposes of this chapter.
3. [To coordinate] Coordinate the activities of the welfare division with other agencies, both public and private, with related or similar activities.
4. [To keep] Keep a complete and accurate record of all proceedings, record and file all bonds [or] and contracts, and assume responsibility for the custody and preservation of all papers and documents pertaining to his office.
5. [To inform] Inform the public in regard to the activities and operation of the welfare division, and [to give] provide other information which will acquaint the public with [welfare problems.
6. To conduct] problems relating to welfare.
6. Conduct studies into the causes of the social problems with which the welfare division is concerned.
7. [To provide] Provide leadership in the community in order that all welfare activities are pointed toward the single goal of improving the public welfare.
8. [To invoke] Invoke any legal, equitable or special procedures for the enforcement of his orders or the enforcement of the provisions of NRS [422.070 to 422.410,] 422.060, 422.160 to 422.2345, inclusive, 422.238, 422.250, 422.2935 to 422.294, inclusive, 422.296 to 422.299, inclusive, and 422.310 to 422.377, inclusive.
9. [To exercise] Exercise any other powers that are necessary and proper for the standardization of state work, to expedite business, to ensure fair consideration of applications for aid, and to promote the efficiency of the service [.] provided by the welfare division.
Sec. 46. NRS 422.2345 is hereby amended to read as follows:
422.2345 1. The state welfare 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; and
(b) Refer to the unit all cases in which he suspects that a provider has committed an offense [under] pursuant to 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.] to 422.570, inclusive.
2. As used in this section:
(a) "Provider" means a person who has applied to participate or who participates in the state plan for Medicaid as the provider of goods or services.
(b) "Unit" means the Medicaid fraud control unit established in the office of the attorney general pursuant to NRS 228.410.
Sec. 47. NRS 422.235 is hereby amended to read as follows:
422.235As a part of the health and welfare programs of this state, the welfare division [is authorized to:] or the division of health care financing and policy may:
1. Conduct a family planning service , or contract for the provision of a family planning service, in any county of the state. Such service may include the dispensing of information and the distribution of literature on birth control and family planning methods.
2. Establish a policy of referral of welfare recipients for birth control.
Sec. 48. NRS 422.236 is hereby amended to read as follows:
422.236 1. As part of the health and welfare programs of this state, the welfare division or the division of health care financing and policy may provide prenatal care to pregnant women who are indigent, or may contract for the provision of that care, at public or nonprofit hospitals in this state.
2. The welfare division or the division of health care financing and policy shall provide to each person licensed to engage in social work pursuant to chapter 641B of NRS, each applicant for Medicaid and any other interested person, information concerning the prenatal care available pursuant to this section.
3. The welfare division or the division of health care financing and policy shall adopt regulations setting forth criteria of eligibility and rates of payment for prenatal care provided pursuant to the provisions of this section, and such other provisions relating to the development and administration of the program for prenatal care as the state welfare administrator or the administrator of the division of health care financing and policy, as applicable, and the board deem necessary.
Sec. 49. NRS 422.237 is hereby amended to read as follows:
422.237 1. The [administrator] director 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 or the division of health care financing and policy 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] director 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] director 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 welfare division and the division of health care financing and policy shall comply with each state plan adopted pursuant to this section.
Sec. 50. NRS 422.238 is hereby amended to read as follows:
422.238 1. The state welfare administrator:
(a) Shall propose regulations for the administration of NRS [422.070 to 422.410, inclusive;] 422.060, 422.160 to 422.2345, inclusive, 422.238, 422.250, 422.2935 to 422.294, inclusive, 422.296 to 422.299, inclusive, and 422.310 to 422.377, inclusive; and
(b) May propose regulations to administer any program of the welfare division.
2. The state welfare administrator may adopt any regulation proposed pursuant to this section which:
(a) Is approved by the board;
(b) Is required by the Federal Government, either directly or as a condition to the receipt of federal money, for the administration of any program of the welfare division; or
(c) The director of the department of administration and the state welfare administrator determine is necessary to avoid the expenditure of any money beyond the amounts appropriated or authorized by the legislature for the fiscal year to which the regulation applies.
[3. A regulation adopted by the administrator becomes effective upon adoption or such other date as the administrator specifies in the regulation.]
Sec. 51. NRS 422.240 is hereby amended to read as follows:
422.240 1. Money to carry out the provisions of NRS [422.070] 422.001 to 422.410, inclusive, 422.580, and sections 16 to 29, inclusive, of this act, must be provided by appropriation by the legislature from the state general fund.
2. Disbursements for the purposes of NRS [422.070] 422.001 to 422.410, inclusive, 422.580, and sections 16 to 29, inclusive, of this act, must be made upon claims duly filed, audited and allowed in the same manner as other money in the state treasury is disbursed.
Sec. 52. NRS 422.245 is hereby amended to read as follows:
422.245 Any federal money allotted to the State of Nevada for public assistance programs and other programs for which the welfare division or the division of health care financing and policy is responsible and such other money as may be received by the state for such purposes must be deposited in the appropriate accounts of the welfare division or the division of health care financing and policy in the state general fund.
Sec. 53. NRS 422.250 is hereby amended to read as follows:
422.250 1. Any gifts or grants of money which the welfare division is authorized to accept must be deposited in the state treasury to the credit of the welfare division's gift and cooperative account in the department of human resources' gift fund.
2. Money in the account must be used for welfare purposes only and expended in accordance with the terms of the gift or grant.
3. All claims must be approved by the state welfare administrator before they are paid.
Sec. 54. NRS 422.265 is hereby amended to read as follows:
422.265 If Congress passes any law increasing the participation of the Federal Government in a Nevada program for public assistance, whether relating to eligibility for assistance or otherwise:
1. The director may accept, with the approval of the governor, the increased benefits of such congressional legislation; and
2. The state welfare administrator or the administrator of the division of health care financing and policy may adopt any regulations required by the Federal Government as a condition of acceptance.
Sec. 54.5. 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, administer all public welfare programs of this state, including:
(a) State supplementary assistance;
(b) Aid to families with dependent children;
(c) Medicaid;
(d) Food stamp assistance;
(e) Low-income home energy assistance;
(f) [Low-income weatherization assistance;
(g)] The program for the enforcement of child support; and
[(h)] (g) Other welfare activities and services provided for by the laws of this state.
2. Act as the single state agency of the State of Nevada and its political subdivisions in the administration of any federal money granted to the state to aid in the furtherance of any of the services and activities set forth in subsection 1.
3. Cooperate with the Federal Government in adopting state plans, in all matters of mutual concern, including adoption of methods of administration found by the Federal Government to be necessary for the efficient operation of welfare programs, and in increasing the efficiency of welfare programs by prompt and judicious use of new federal grants which will assist the welfare division in carrying out the provisions of NRS 422.070 to 422.410, inclusive.
4. Observe and study the changing nature and extent of welfare needs and develop through tests and demonstrations effective ways of meeting those needs and employ or contract for personnel and services supported by legislative appropriations from the state general fund or money from federal or other sources.
5. Enter into reciprocal agreements with other states relative to public assistance, welfare services and institutional care, when deemed necessary or convenient by the administrator.
6. Make such agreements with the Federal Government as may be necessary to carry out the supplemental security income program.
Sec. 55. NRS 422.270 is hereby amended to read as follows:
422.270 The department [through the welfare division shall:
1. Except as otherwise provided in NRS 432.010 to 432.085, inclusive, administer] shall:
1. Administer all public welfare programs of this state, including:
(a) State supplementary assistance;
(b) Aid to families with dependent children;
(c) Medicaid;
(d) Food stamp assistance;
(e) Low-income home energy assistance;
(f) The program for the enforcement of child support; and
(g) Other welfare activities and services provided for by the laws of this state.
2. Act as the single state agency of the State of Nevada and its political subdivisions in the administration of any federal money granted to the state to aid in the furtherance of any of the services and activities set forth in subsection 1.
3. Cooperate with the Federal Government in adopting state plans, in all matters of mutual concern, including adoption of methods of administration found by the Federal Government to be necessary for the efficient operation of welfare programs, and in increasing the efficiency of welfare programs by prompt and judicious use of new federal grants which will assist the [welfare division] department in carrying out the provisions of [NRS 422.070 to 422.410, inclusive.] this chapter.
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.] director.
6. Make such agreements with the Federal Government as may be necessary to carry out the supplemental security income program.
Sec. 56. NRS 422.275 is hereby amended to read as follows:
422.275 The attorney general and his deputies are the legal advisers for the welfare division [.] and the division of health care financing and policy.
Sec. 57. NRS 422.280 is hereby amended to read as follows:
422.280 [In order to secure] To ensure accuracy, uniformity and completeness in statistics and information, the welfare division and the division of health care financing and policy may prescribe forms of reports and records to be kept by all persons, associations or institutions, subject to its supervision or investigation, and each such person, association or institution shall keep such records and render such reports in [conformity to] the form so prescribed.
Sec. 58. NRS 422.285 is hereby amended to read as follows:
422.285 The department through the [welfare division,] division of health care financing and policy, may reimburse directly, under the state plan for Medicaid, any registered nurse who is authorized pursuant to chapter 632 of NRS to perform additional acts in an emergency or under other special conditions as prescribed by the state board of nursing, for such services rendered under the authorized scope of his practice to persons eligible to receive that assistance if another provider of health care would be reimbursed for providing those same services.
Sec. 59. NRS 422.290 is hereby amended to read as follows:
422.290 1. [For the purpose of restricting] To restrict the use or disclosure of any information concerning applicants for and recipients of public assistance to purposes directly connected to the administration of this chapter, and to provide safeguards therefor, under the applicable provisions of the Social Security Act, the welfare division and the division of health care financing and policy shall establish and enforce reasonable [rules and] regulations governing the custody, use and preservation of [the] any records, files and communications filed with the welfare division [.
2. Wherever, under provisions of law or regulations] or the division of health care financing and policy.
2. If, pursuant to a specific statute or a regulation of the welfare division [,] or the division of health care financing and policy, names and addresses of, or information concerning, applicants for and recipients of assistance are furnished to or held by any other agency or department of government, such 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 assistance under the provisions of this chapter.
Sec. 60. NRS 422.293 is hereby amended to read as follows:
422.293 1. When a recipient of Medicaid incurs an illness or injury for which medical services are payable under the state plan and which is incurred under circumstances creating a legal liability in some person other than the recipient or [the welfare] a division of the department to pay all or part of the costs of such services, the [division] department is subrogated to the right of the recipient to the extent of all such costs and may join or intervene in any action by the recipient or his successors in interest to enforce such legal liability.
2. If a recipient or his successors in interest fail or refuse to commence an action to enforce the legal liability, the [welfare division] department may commence an independent action, after notice to the recipient or his successors in interest, to recover all costs to which it is entitled. In any such action by the [division,] department, the recipient or his successors in interest may be joined as third-party defendants.
3. In any case where the [welfare division] department is subrogated to the rights of the recipient or his successors in interest as provided in subsection 1, the [division] department has a lien upon the proceeds of any recovery from the persons liable, whether the proceeds of the recovery are by way of judgment, settlement or otherwise. Such a lien must be satisfied in full, unless reduced pursuant to subsection 5, at such time as:
(a) The proceeds of any recovery or settlement are distributed to or on behalf of the recipient, his successors in interest or his attorney; and
(b) A dismissal by any court of any action brought to enforce the legal liability established by subsection 1.
No such lien is enforceable unless written notice is first given to the person against whom the lien is asserted.
4. The recipient or his successors in interest shall notify the [welfare division] department in writing before entering any settlement agreement or commencing any action to enforce the legal liability referred to in subsection 1. Except if extraordinary circumstances exist, a person who fails to comply with the provisions of this subsection shall be deemed to have waived any consideration by the [administrator] director or his designated representative of a reduction of the amount of the lien pursuant to subsection 5 and shall pay to the [division] department all costs to which it is entitled and its court costs and attorney's fees.
5. If the [welfare division] department receives notice pursuant to subsection 4, the [administrator] director or his designated representative may, in consideration of the legal services provided by an attorney to procure a recovery for the recipient, reduce the lien on the proceeds of any recovery.
6. The attorney of a recipient:
(a) Shall not condition the amount of attorney's fees or impose additional attorney's fees based on whether a reduction of the lien is authorized by the [administrator] director or his designated representative pursuant to subsection 5.
(b) Shall reduce the amount of the fees charged the recipient for services provided by the amount the attorney receives from the reduction of a lien authorized by the [administrator] director or his designated representative pursuant to subsection 5.
Sec. 61. NRS 422.2935 is hereby amended to read as follows:
422.2935 1. Except as otherwise provided in this section, the welfare division shall, to the extent it is not prohibited by federal law and when circumstances allow:
(a) Recover benefits correctly paid for 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 welfare division which he knew at the time he signed the application; or
(2) Failed within the period allowed by the welfare division to report any required information to the welfare division which he obtained after he filed the application.
2. The welfare division shall not recover benefits pursuant to paragraph (a) of subsection 1, except from a person who is neither a surviving spouse nor a child, until after the death of the surviving spouse, if any, and only at a time when the person who received the benefits has no surviving child who is under 21 years of age or is blind or permanently and totally disabled.
3. Except as otherwise provided by federal law, if a transfer of real or personal property by a recipient of Medicaid is made for less than fair market value, the welfare division may pursue any remedy available pursuant to chapter 112 of NRS with respect to the transfer.
4. The amount of 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 state welfare administrator may elect not to file a claim against the estate of a recipient of Medicaid or his spouse if he determines that the filing of the claim will cause an undue hardship for the spouse or other survivors of the recipient. The board shall adopt regulations defining the circumstances that constitute an undue hardship.
6. Any recovery of money obtained pursuant to this section must be applied first to the cost of recovering the money. Any remaining money must be divided among the Federal Government, the department and the county in the proportion that the amount of assistance each contributed to the recipient bears to the total amount of the assistance contributed.
7. An action to recover money owed to the department [of human resources] as a result of the payment of benefits for Medicaid must be commenced within 6 months after the cause of action accrues. A cause of action accrues after all of the following events have occurred:
(a) The death of the recipient of 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.
Sec. 62. NRS 422.29355 is hereby amended to read as follows:
422.29355 1. The welfare division may, to the extent not prohibited by federal law, petition for the imposition of a lien pursuant to the provisions of NRS 108.850 against real or personal property of a recipient of Medicaid as follows:
(a) The welfare division may obtain a lien against a recipient's property, both real or personal, before or after his death in the amount of assistance paid or to be paid on his behalf if the court determines that assistance was incorrectly paid for the recipient.
(b) The welfare division may seek a lien against the real property of a recipient at any age before his death in the amount of assistance paid or to be paid for him if he is an inpatient in a nursing facility, intermediate care facility for the mentally retarded or other medical institution and the welfare division determines, after notice and opportunity for a hearing in accordance with its regulations, that he cannot reasonably be expected to be discharged and return home.
2. No lien may be placed on a recipient's home for assistance correctly paid if:
(a) His spouse;
(b) His child who is under 21 years of age or blind or permanently and totally disabled as determined in accordance with 42 U.S.C. § 1382c; or
(c) His brother or sister who is an owner or part owner of the home and who was residing in the home for at least 1 year immediately before the date the recipient was admitted to the medical institution,
is lawfully residing in the home.
3. Upon the death of a recipient the welfare division may seek a lien upon his undivided estate as defined in NRS 422.054.
4. The state welfare administrator shall release a lien pursuant to this section:
(a) Upon notice by the recipient or his representative to the administrator that the recipient has been discharged from the medical institution and has returned home;
(b) If the lien was incorrectly determined; or
(c) Upon satisfaction of the [welfare division's claim.] claim of the welfare division.
Sec. 63. NRS 422.295 is hereby amended to read as follows:
422.295 Any person who is [the] :
1. The subject of a hearing conducted under the authority of the welfare division or the division of health care financing and policy; or [who is a]
2. A witness at that hearing,
and who is a handicapped person as defined in NRS 50.050, is entitled to the services of an interpreter at public expense, subject to the provisions of NRS 50.052 and 50.053. The interpreter must be appointed by the person who presides at the hearing.
Sec. 64. NRS 422.298 is hereby amended to read as follows:
422.298 1. A decision or order adverse to an applicant for or recipient of public assistance 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 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 state welfare 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. 65. NRS 422.2993 is hereby amended to read as follows:
422.2993 1. Except as otherwise provided in NRS 228.410 and [422.2345] section 27 of this act and subsection 2 of this section, any information obtained by the [welfare] division of health care financing and policy 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 [welfare] division of health care financing and policy 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. 66. NRS 422.2997 is hereby amended to read as follows:
422.2997 1. Upon receipt of a request for a hearing from a provider of services under the plan for Medicaid, the [welfare] division of health care financing and policy shall appoint a hearing officer to conduct the hearing. Any employee or other representative of the [welfare] division of health care financing and policy 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 of health care financing and policy 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,] division of health care financing and policy, 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;] division of health care financing and policy;
(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. 67. NRS 422.373 is hereby amended to read as follows:
422.373 The state welfare administrator shall, pursuant to the appropriate provisions of 42 U.S.C. §§ 601 to 645, inclusive, establish by regulation a plan to provide for the education and training of recipients of aid to families with dependent children as a condition of being eligible for that aid.
Sec. 68. NRS 422.375 is hereby amended to read as follows:
422.375 The plan must include provisions for:
1. Assisting the recipient to plan for a career, including:
(a) Testing of the [recipient's skills;] skills of the recipient;
(b) Evaluation of the [recipient's] abilities and goals [;] of the recipient;
(c) Guidance for the recipient in establishing a specific plan for training; and
(d) A contract between the welfare division and the recipient which specifies the responsibilities of each party, including the:
(1) [Recipient's commitment] Commitment of the recipient to specific actions to prepare for and seek employment that will make the recipient self-sufficient.
(2) [Welfare division's commitment] Commitment of the welfare division to provide assistance and services to the recipient while he is seeking employment.
2. Training of a recipient by an employer, including:
(a) Subsidization of the [employer's] costs incurred by the employer in training the recipient; and
(b) An emphasis on training the recipient in increasingly difficult duties under close supervision until the recipient is capable of performing the work on his own.
3. Operation of a program to assist recipients who have limited or no skills to obtain the necessary training and experience for unsubsidized employment.
4. Education and training of a recipient, including:
(a) Courses of training in skills desirable for employment in Nevada;
(b) Payment, for qualified recipients, of the costs of tuition, books and fees for college courses which are directly applicable to the recipient's goals for his career; and
(c) Basic education in reading, writing, mathematics, the sciences and English as a second language, and education leading to the equivalent of a high school diploma.
5. Direct placement in a job, including assisting the recipient to search for a job.
6. Supportive services, including:
(a) If the recipient is employed by an employer who does not provide health insurance, providing health insurance for a limited time after the recipient is employed;
(b) Subsidizing the costs of child care while the recipient is participating in the plan and for a limited time after he is employed; and
(c) Reimbursement of the costs of transportation, up to a limit determined by the state welfare administrator, while the recipient is participating in the plan.
Sec. 69. NRS 422.377 is hereby amended to read as follows:
422.377 The state welfare administrator:
1. Shall adopt regulations for:
(a) The administration of the plan; and
(b) The determination of eligibility of a recipient to participate in any part of the plan;
2. May contract with any state or private agency to provide any of the services of the plan; and
3. May receive a grant of money from the Federal Government or any other source to defray the costs of the plan.
Sec. 70. NRS 422.3805 is hereby amended to read as follows:
422.3805 The [director] administrator shall:
1. Apply for all waivers from federal law or regulation which are necessary to carry out the provisions of NRS 422.380 to 422.390, inclusive; and
2. If a waiver is denied or altered, take all appropriate steps to comply with the directives of the Federal Government.
Sec. 71. NRS 422.382 is hereby amended to read as follows:
422.382 1. In a county within which:
(a) A public hospital is located, the state or local government or other entity responsible for the public hospital shall transfer an amount equal to 75 percent of the amount of the payment made to the public hospital pursuant to NRS 422.387 less $50,000 to the [department.] division of health care financing and policy.
(b) A private hospital which receives a payment pursuant to NRS 422.387 is located, the county shall transfer an amount established by the legislature to the [department.] division of health care financing and policy.
2. A county that transfers the amount required pursuant to paragraph (b) of subsection 1 to the [department] division of health care financing and policy is discharged of the duty and is released from liability for providing medical treatment for indigent inpatients who are treated in the hospital in the county that receives a payment pursuant to paragraph (b) of subsection 2 of NRS 422.387.
3. Any money collected pursuant to subsection 1, including any interest or penalties imposed for a delinquent payment, must be deposited in the state treasury for credit to the intergovernmental transfer account in the state general fund to be administered by the [department.] division of health care financing and policy.
4. The interest and income earned on money in the intergovernmental transfer account, after deducting any applicable charges, must be credited to the account.
Sec. 72. NRS 422.385 is hereby amended to read as follows:
422.385 1. The allocations and payments required pursuant to NRS 422.387 must be made, to the extent allowed by the state plan for Medicaid, from the Medicaid budget account.
2. The money in the intergovernmental transfer account must be transferred from that account to the Medicaid budget account to the extent that money is available from the Federal Government for proposed expenditures, including expenditures for administrative costs. If the amount in the account exceeds the amount authorized for expenditure by the [department] division of health care financing and policy for the purposes specified in NRS 422.387, the [department] division of health care financing and policy is authorized to expend the additional revenue in accordance with the provisions of the state plan for Medicaid.
Sec. 73. NRS 422.387 is hereby amended to read as follows:
422.387 1. Before making the payments required or authorized by this section, the [department] division of health care financing and policy 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 Medicaid must provide:
(a) For the payment of the maximum amount allowable under federal law and regulations after making a payment, if any, pursuant to paragraph (b), to public hospitals for treating a disproportionate share of Medicaid patients, indigent patients or other low-income patients, unless such payments are subsequently limited by federal law or regulation.
(b) For a payment in an amount approved by the legislature to the private hospital that provides the largest volume of medical care to Medicaid patients, indigent patients or other low-income patients in a county that does not have a public hospital.
The plan must be consistent with the provisions of NRS 422.380 to 422.390, inclusive, and Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.), and the regulations adopted pursuant to those provisions.
3. The [department] division of health care financing and policy may , with the approval of the director, amend the state plan for Medicaid to modify the methodology for establishing the rates of payment to public hospitals for inpatient services, except that such amendments must not reduce the total reimbursements to public hospitals for such services.
Sec. 74. NRS 422.390 is hereby amended to read as follows:
422.390 1. The [department, through the welfare division,] division of health care financing and policy shall adopt regulations concerning:
(a) Procedures for the transfer to the [department] division of health care financing and policy of the amount required pursuant to NRS 422.382.
(b) Provisions for the payment of a penalty and interest for a delinquent transfer.
(c) Provisions for the payment of interest by the [department] division of health care financing and policy for late reimbursements to hospitals or other providers of medical care.
2. The [department] division of health care financing and policy shall report to the interim finance committee quarterly concerning the provisions of NRS 422.380 to 422.390, inclusive.
Sec. 75. NRS 439A.082 is hereby amended to read as follows:
439A.082 The director , through the division of health care financing and policy of the department, shall contract with the University and Community College System of Nevada to collect and analyze information from health facilities and purchasers of health care to:
1. Respond to requests for information from the legislature.
2. Provide technical assistance to purchasers of health care.
3. Provide the department with information necessary to carry out the provisions of chapter 439A of NRS.
4. Provide other persons with information relating to the cost of health care.
Sec. 76. NRS 439A.106 is hereby amended to read as follows:
439A.106 1. The department shall prepare annually and release for publication or other dissemination a listing of every hospital in the state and its charges for representative services. The listing must include information regarding each hospital's average and total contractual allowances to categories of payers who pay on the basis of alternative rates rather than billed charges.
2. The department shall not disclose or report the details of contracts entered into by a hospital, or disclose or report information pursuant to this section in a manner that would allow identification of an individual payer or other party to a contract with the hospital, except that the department may disclose to other state agencies the details of contracts between the hospital and a related entity. A state agency shall not disclose or report information disclosed to the agency by the department pursuant to this subsection in a manner that would allow identification of an individual payer or other party to a contract with the hospital.
3. The director may delegate any of the powers or duties of the department pursuant to this section to the division of health care financing and policy of the department.
4. As used in this section, "related entity" means an affiliated person or subsidiary as those terms are defined in NRS 439B.430.
Sec. 77. Chapter 439B of NRS is hereby amended by adding thereto a new section to read as follows:
The director may delegate:
1. Any of his powers or duties pursuant to this chapter to the administrator of the division of health care financing and policy of the department.
2. Any of the department's powers or duties pursuant to this chapter to the division of health care financing and policy.
Sec. 78. Section 21 of chapter 706, Statutes of Nevada 1991, as last amended by chapter 540, Statutes of Nevada 1995, at page 1856, is hereby amended to read as follows:
- Sec. 21. 1. As used in this section:
- (a) "Charge master" means the uniform list of billed charges described in NRS 439B.400, except that the term includes the uniform list of billed charges for units of service or goods provided on an outpatient basis.
- (b) "Department" means the department of human resources.
- (c) "Director" means the director of the department.
- (d) "Hospital" has the meaning ascribed to it in NRS 439B.110.
- (e) "Major hospital" means a hospital which has 200 or more licensed or approved beds, or any hospital in a group of affiliated hospitals in a county which have a combined total of 200 or more licensed or approved beds, that is not operated by a federal, state or local governmental agency.
- (f) "New major hospital" means a hospital that becomes a major hospital, as defined in paragraph (e), on or after July 1, 1991.
- (g) "Revenue neutral" means a change in price made by a hospital that neither increases nor decreases the gross revenue of the hospital.
- 2. On or before July 1, 1991, each major hospital shall submit to the department a complete charge master for the hospital that will be effective on July 1, 1991. The charge master must be submitted on a computer medium in a form acceptable to the director.
- 3. Except as otherwise provided in subsections 4 to [9,] 7, inclusive, during the period from July 1, 1991, through June 30, [1997,] 1999, no major hospital may:
- (a) Raise the unit price of any item in its charge master.
- (b) Modify the unit to which a price applies unless the change is revenue neutral.
- (c) Add a new item to its charge master.
- (d) Charge a patient for an item that is not on its charge master.
- (e) Replace an existing item in the charge master with a different item [or add a new item to its charge master unless the price for the different or new item is approved by the director.
- 4. The director shall by regulation establish a procedure and standards for approving charges for items that:
- (a) Are not stated in the charge master;
- (b) Represent special equipment, supplies or medication ordered by a physician; and
- (c) Are not standard items that the hospital regularly provides,
- and for such other unique or unusual items as the director prescribes by regulation. The director shall allow a hospital to use the rate formula that the hospital has in effect on July 1, 1991, for determining charges for such items.
- 5. A major hospital shall notify the department in writing of any modification pursuant to paragraph (b) of subsection 3 or the replacement or addition of an item pursuant to paragraph (c) of subsection 3 not less than 10 days, excluding Saturdays, Sundays and legal holidays, after the modification, replacement or addition. The hospital shall submit with the notice documentation that:
- (a) The modification is revenue neutral; or
- (b) The different or additional] unless the different item is priced at a level that reflects the same rate of return on the item as the hospital [receives on comparable items or] received on an item being replaced.
- [6. If the director determines that a modification pursuant to paragraph (b) of subsection 3 is not revenue neutral or that a replacement or addition pursuant to paragraph (c) of subsection 3 exceeds the level allowed pursuant to paragraph (b) of subsection 5, he shall disapprove the proposed charge and notify the hospital of the charge he will allow for the items disapproved. The hospital shall charge the amount approved by the director and shall credit the bill of any patient charged the amount disapproved the difference between the approved charge and the actual charge within 20 days, excluding Saturdays, Sundays and legal holidays, after receiving notice of the disapproval. If the director does not give notice of disapproval pursuant to this subsection within 20 days, excluding Saturdays, Sundays and legal holidays, after receiving notice of the modification, replacement or addition, the modification, replacement or addition shall be deemed approved.
- 7.] 4. A major hospital may add an item to its charge master or charge a patient for an item that is not on its charge master, including items that represent special equipment, supplies or medication ordered by a physician or an item that is not a standard item which the hospital regularly provides, if:
- (a) The item is priced at a level that reflects the same rate of return on the item as the hospital receives on comparable items; or
- (b) The hospital uses the rate formula that the hospital had in effect on January 1, 1997,
- and the hospital provides the department with a list of all those items and charges. The director shall by regulation establish a procedure for a major hospital to provide such a list on a periodic basis, which must not be more often than quarterly.
- 5. The director shall, not later than October 1, 1997, adopt regulations establishing a procedure for a major hospital to modify the prices of the items on its charge master. The regulations must:
- (a) Ensure that the net effect of such a modification of prices is revenue neutral.
- (b) Specify a format for a request for such a modification.
- (c) Specify a period for the director to act upon such a request.
- (d) Provide that if the director does not give notice of his disapproval of a request for such a modification within the period specified pursuant to paragraph (c), the request shall be deemed approved.
- 6. If any new state or federal taxes are imposed on hospitals between July 1, 1991, and June 30, 1992, except the tax imposed on hospitals pursuant to section 13 of this act and the tax imposed pursuant to section 16 of this act, a major hospital may increase the prices in its charge master by an amount that will generate net revenue sufficient to recover the amount of the added expense. Prices may be increased pursuant to this subsection only to compensate for new taxes. Prices must not be increased to correspond with increases in existing taxes, or a modification, reconfiguration or replacement of existing taxes which results in an increased tax burden on a hospital. The director shall by regulation establish the mechanism for carrying out the increase allowed by this subsection.
- [8.] 7. At any time during the fiscal years 1992-93, 1993-94, 1994-95, 1995-96 , [and] 1996-97, 1997-98 and 1998-99, a major hospital may increase the price of any item on its charge master by a percentage up to the percentage increase, if any, in the Consumer Price Index (Medical Care Component for All Urban Consumers) as published by the Bureau of Labor Statistics of the United States Department of Labor for the most recent 12-month period for which information is available at the time the notice of the allowable increase is given pursuant to subsection [10. A hospital shall notify the director in writing within 10 days, excluding Saturdays, Sundays and legal holidays, after making an increase allowed by this subsection.] 8. In addition to the increases authorized by this subsection, a hospital may modify the unit to which a price applies, replace an existing item in the charge master with a different item or add a new item to its charge master during the fiscal years 1992-93, 1993-94, 1994-95, 1995-96 , [and] 1996-97 , 1997-98 and 1998-99 in [the manner provided in subsections 5 and 6.
- 9. In addition to the increase allowed pursuant to subsection 8, if the net revenue per admission in a major hospital has decreased by at least 4 percent between the base period of July 1, 1989, to June 30, 1990, and the period from July 1, 1992, to March 31, 1993, the major hospital may increase the price of any item on its charge master by not more than an additional 4 percent at any time during fiscal year 1993-94 and 1994-95. A hospital shall notify the director in writing within 10 working days after making an increase allowed by this subsection.
- 10.] accordance with subsections 3 and 4.
- 8. On or before May 1 of each fiscal year , the director shall notify each major hospital of the permissible percentage increase in each item in its charge master for the succeeding fiscal year.
- [11.] 9. A major hospital shall submit to the department [upon request by the director] on July 1 of each year, and within 30 days after the date the hospital increases its charges pursuant to subsection 7, a detailed listing of charges by the identification code used in the hospital's charge master for any inpatient admission or outpatient visit on a computer medium in a form acceptable to the director.
- [12.] 10. A new major hospital shall submit to the director a complete charge master for the hospital at least 60 days before becoming a major hospital. The charge master must be submitted on a computer medium in a form acceptable to the director. The director shall review, revise as appropriate [,] and approve the prices in the charge master based upon the prevailing charges in the area in which the new major hospital is located. After approval of the charge master, the hospital is subject to the provisions of this section to the same extent as other major hospitals. The director shall adopt regulations governing the approval of a charge master pursuant to this subsection.
- [13.] 11. A major hospital which considers its financial condition so weakened that the quality of care provided by the hospital is seriously jeopardized by any provision of this act, or considers that its financial condition is adversely affected by any other governmental action, may request approval to increase the prices in its charge master by submitting a written request for the increase and supporting documentation to the director. The director shall consider the potential impact on the quality of care provided by the hospital and the probability that failure to grant relief would cause financial instability. The director may approve the request, or revise and approve the request, if he determines that such approval is necessary to ensure the ability of the hospital to provide adequate care to its patients.
- [14.] 12. A hospital that submits its charge master for approval pursuant to subsection [12] 10 or requests an increase in its prices pursuant to subsection [13] 11 shall pay the department a fee for its review of the charge master or the request. The director shall by regulation establish rates or fees for the department's review of the charge master or the request.
- [15. A hospital shall not:
- (a) Raise a unit price in its charge master unless authorized pursuant to this section;
- (b) Charge a patient a higher price for any item than the price stated in the charge master or otherwise authorized pursuant to this section; or
- (c) Except as authorized pursuant to subsection 4, charge a patient for any item not included in its charge master without seeking the approval of the director as required by subsections 5 and 6.
- 16.] 13. The director may compare a major hospital's actual charges with the charges authorized pursuant to this section to determine whether the hospital's charges are in compliance with the provisions of this section. If the director determines that a hospital's charges are not in compliance with this section, the hospital shall adjust any charges it imposes accordingly after it receives notice of that determination, but is not required to adjust any charges previously imposed. If the director determines that a hospital has engaged in a pattern of violations or committed an egregious violation of any provision of this section, he may impose an administrative penalty on the hospital of not more than:
- (a) Two times the difference between the price charged in violation of this section and the allowable price, for each instance in which that item is billed; or
- (b) One thousand dollars,
- whichever is greater.
- [17.] 14. The director may [adopt] :
- (a) Adopt such regulations as he considers necessary to carry out the provisions of this section.
- (b) Delegate to the administrator of the division of health care financing and policy of the department the authority to carry out the provisions of this section.
Sec. 79. Section 22 of chapter 706, Statutes of Nevada 1991, at page 2341, is hereby amended to read as follows:
- Sec. 22. 1. The costs of monitoring compliance with the provisions of section 21 of this act must be met by an annual assessment of the hospitals with 200 or more licensed or approved beds that are not operated by a local government.
- 2. On or before July 15 of each year, the director of the department of human resources shall notify each hospital of its assessment for the fiscal year. Payment of the assessment is due on or before September 15. Late payments bear interest at the rate of 1 percent per month or fraction thereof.
- 3. The director shall estimate the total cost to the department of human resources, within the limits of legislative authorization, for carrying out the provisions of section 21 of this act in the current fiscal year. The total cost must be divided by the total number of patient days of care provided in the previous calendar year by the hospitals subject to the assessment. For each hospital, the assessment must be the result of this calculation multiplied by its number of patient days of care for the preceding calendar year.
- 4. The assessment made pursuant to this section may be combined with the assessments made pursuant to sections 20, 23 and 24 of this act.
- 5. The director may delegate to the administrator of the division of health care financing and policy of the department of human resources the authority to carry out the provisions of this section.
Sec. 80. Section 1 of Assembly Bill No. 9 of this session is hereby amended to read as follows:
- Section 1. NRS 200.5093 is hereby amended to read as follows:
- 200.5093
- 1. Any person required to make a report pursuant to this section shall make the report immediately, but in no event later than 24 hours after there is reason to believe that an older person has been abused, neglected or exploited. The report must be made to:
- (a) The local office of the aging services division or the division of health care financing and policy of the department of human resources;
- (b) Any police department or sheriff's office; [or]
- (c) The county's office for protective services, if one exists in the county where the suspected action occurred [.] ; or
- (d) A toll-free telephone service designated by the aging services division of the department of human resources.
- If the report of abuse, neglect or exploitation involves an act or omission of the aging services division, another division of the department of human resources or a law enforcement agency, the report must be made to an agency other than the one alleged to have committed the act or omission. Each agency, after reducing the report to writing, shall forward a copy of the report to the aging services division of the department of human resources.
- 2. Reports must be made by the following persons who, in their professional or occupational capacities, know or have reason to believe that an older person is being or has been abused, neglected or exploited:
- (a) Every physician, dentist, dental hygienist, chiropractor, optometrist, podiatric physician, medical examiner, resident, intern, professional or practical nurse, physician's assistant, psychiatrist, psychologist, marriage and family therapist, alcohol or drug abuse counselor, driver of an ambulance, advanced emergency medical technician or other person providing medical services licensed or certified to practice in this state, who examines, attends or treats an older person who appears to have been abused, neglected or exploited.
- (b) Any personnel of a hospital or similar institution engaged in the admission, examination, care or treatment of persons or an administrator, manager or other person in charge of a hospital or similar institution upon notification of the suspected abuse, neglect or exploitation of an older person by a member of the staff of the hospital.
- (c) A coroner.
- (d) Every clergyman, practitioner of Christian Science or religious healer, unless he acquired the knowledge of abuse, neglect or exploitation from the offender during a confession.
- (e) Every person who maintains or is employed by an agency to provide nursing in the home.
- (f) Every attorney, unless he has acquired the knowledge of abuse, neglect or exploitation from a client who has been or may be accused of the abuse, neglect or exploitation.
- (g) Any employee of the department of human resources.
- (h) Any employee of a law enforcement agency or a county's office for protective services or an adult or juvenile probation officer.
- (i) Any person who maintains or is employed by a facility or establishment that provides care for older persons.
- (j) Any person who maintains, is employed by or serves as a volunteer for an agency or service which advises persons regarding the abuse, neglect or exploitation of an older person and refers them to persons and agencies where their requests and needs can be met.
- (k) Every social worker.
- (l) Any person who owns or is employed by a funeral home or mortuary.
- 3. A report may be filed by any other person.
- 4. Any person required to make a report pursuant to this section who has reasonable cause to believe that an older person has died as a result of abuse or neglect shall report this belief to the appropriate medical examiner or coroner, who shall investigate the cause of death of the older person and submit to the appropriate local law enforcement agencies, the appropriate prosecuting attorney and the aging services division of the department of human resources his written findings. The written findings must include the information required pursuant to the provisions of NRS 200.5094, when possible.
- 5. A division, office or department which receives a report pursuant to this section shall cause the investigation of the report to commence within 3 working days. A copy of the final report of the investigation conducted by a division, office or department, other than the aging services division of the department of human resources, must be forwarded to the aging services division within 90 days after the completion of the report.
- 6. If the investigation of the report results in the belief that the older person is abused, neglected or exploited, the department of human resources or the county's office for protective services may provide protective services to the older person if he is able and willing to accept them.
Sec. 80.1. Section 7 of Assembly Bill No. 242 of this session is hereby amended to read as follows:
- Sec. 7. NRS 200.5093 is hereby amended to read as follows:
- 200.5093
- 1. [Any] A person required to make a report pursuant to this section shall make the report immediately, but in no event later than 24 hours after there is reason to believe that an older person has been abused, neglected [or exploited.] , exploited or isolated. The report must be made to:
- (a) The local office of the aging services division or the division of health care financing and policy of the department of human resources;
- (b) [Any] A police department or sheriff's office;
- (c) The county's office for protective services, if one exists in the county where the suspected action occurred; or
- (d) A toll-free telephone service designated by the aging services division of the department of human resources.
- If the report of abuse, neglect , [or] exploitation or isolation of an older person involves an act or omission of the aging services division, another division of the department of human resources or a law enforcement agency, the report must be made to an agency other than the one alleged to have committed the act or omission. Each agency, after reducing the report to writing, shall forward a copy of the report to the aging services division of the department of human resources.
- 2. Reports must be made by the following persons who, in their professional or occupational capacities, know or have reason to believe that an older person is being or has been abused, neglected [or exploited:] , exploited or isolated:
- (a) Every physician, dentist, dental hygienist, chiropractor, optometrist, podiatric physician, medical examiner, resident, intern, professional or practical nurse, physician's assistant, psychiatrist, psychologist, marriage and family therapist, alcohol or drug abuse counselor, driver of an ambulance, advanced emergency medical technician or other person providing medical services licensed or certified to practice in this state, who examines, attends or treats an older person who appears to have been abused, neglected [or exploited.] , exploited or isolated.
- (b) Any personnel of a hospital or similar institution engaged in the admission, examination, care or treatment of persons or an administrator, manager or other person in charge of a hospital or similar institution upon notification of the suspected abuse, neglect , [or] exploitation or isolation of an older person by a member of the staff of the hospital.
- (c) A coroner.
- (d) Every clergyman, practitioner of Christian Science or religious healer, unless he acquired the knowledge of abuse, neglect , [or] exploitation or isolation of the older person from the offender during a confession.
- (e) Every person who maintains or is employed by an agency to provide nursing in the home.
- (f) Every attorney, unless he has acquired the knowledge of abuse, neglect , [or] exploitation or isolation of the older person from a client who has been or may be accused of [the] such abuse, neglect [or exploitation.] , exploitation or isolation.
- (g) Any employee of the department of human resources.
- (h) Any employee of a law enforcement agency or a county's office for protective services or an adult or juvenile probation officer.
- (i) Any person who maintains or is employed by a facility or establishment that provides care for older persons.
- (j) Any person who maintains, is employed by or serves as a volunteer for an agency or service which advises persons regarding the abuse, neglect , [or] exploitation or isolation of an older person and refers them to persons and agencies where their requests and needs can be met.
- (k) Every social worker.
- (l) Any person who owns or is employed by a funeral home or mortuary.
- 3. A report may be filed by any other person.
- 4. [Any] A person required to make a report pursuant to this section who has reasonable cause to believe that an older person has died as a result of abuse , [or] neglect or isolation shall report this belief to the appropriate medical examiner or coroner, who shall investigate the cause of death of the older person and submit to the appropriate local law enforcement agencies, the appropriate prosecuting attorney and the aging services division of the department of human resources his written findings. The written findings must include the information required pursuant to the provisions of NRS 200.5094, when possible.
- 5. A division, office or department which receives a report pursuant to this section shall cause the investigation of the report to commence within 3 working days. A copy of the final report of the investigation conducted by a division, office or department, other than the aging services division of the department of human resources, must be forwarded to the aging services division within 90 days after the completion of the report.
- 6. If the investigation of the report results in the belief that the older person is abused, neglected [or exploited,] , exploited or isolated, the department of human resources or the county's office for protective services may provide protective services to the older person if he is able and willing to accept them.
- 7. A person who knowingly and willfully violates any of the provisions of this section is guilty of a misdemeanor.
Sec. 80.2. Section 13 of Assembly Bill No. 242 of this session is hereby amended to read as follows:
- Sec. 13. NRS 200.50984 is hereby amended to read as follows:
- 200.50984
- 1. Notwithstanding any other statute to the contrary, the department of human resources and a county's office for protective services, if one exists in the county where a violation is alleged to have occurred, may for the purpose of investigating an alleged violation of NRS 200.5091 to 200.5099, inclusive, inspect all records pertaining to the older person on whose behalf the investigation is being conducted, including, but not limited to, that person's medical and financial records.
- 2. Except as otherwise provided in this subsection, if a guardian has not been appointed for the older person, the department of human resources or the county's office for protective services shall obtain the consent of the older person before inspecting those records. If the department of human resources or the county's office for protective services determines that the older person is unable to consent to the inspection, the inspection may be conducted without his consent. Except as otherwise provided in this subsection, if a guardian has been appointed for the older person, the department of human resources or the county's office for protective services shall obtain the consent of the guardian before inspecting those records. If the department of human resources or the county's office for protective services has reason to believe that the guardian is abusing, neglecting , [or] exploiting or isolating the older person, the inspection may be conducted without the consent of the guardian, except that if the records to be inspected are in the personal possession of the guardian, the inspection must be approved by a court of competent jurisdiction.
Sec. 80.3. Section 14 of Assembly Bill No. 242 of this session is hereby amended to read as follows:
- Sec. 14. NRS 200.50986 is hereby amended to read as follows:
- 200.50986
- The department of human resources or the county's office for protective services may petition a court in accordance with NRS 159.185 or 159.1905 for the removal of the guardian of an older person, or the termination or modification of that guardianship, if, based on its investigation, the department of human resources or the county's office of protective services has reason to believe that the guardian is abusing, neglecting , [or] exploiting or isolating the older person in violation of NRS 200.5095 to 200.5099, inclusive.
Sec. 81. 1. NRS 422.005 is hereby repealed.
2. NRS 422.0453 is hereby repealed.
Sec. 82. 1. Any regulations adopted by an officer or agency whose responsibilities have been transferred pursuant to the provisions of this act to another officer or agency remain in force until amended by the officer or agency to which the responsibility for the adoption of the regulations is transferred. Such regulations may be enforced by the officer or agency to which the responsibility for the enforcement of the regulation is transferred.
2. Any contracts or other agreements entered into by an officer or agency whose responsibilities have been transferred pursuant to the provisions of this act to another officer or agency are binding upon the officer or agency to which the responsibility for the administration of the provisions of the contract or other agreement is transferred. Such contracts or other agreements may be enforced by the officer or agency to which the responsibility for the enforcement of the contract or other agreement is transferred.
Sec. 83. The director of the department of human resources shall, on or before December 31, 1997, report to the legislative committee on health care and the interim finance committee his recommendations for the allocation of organizational responsibility within the department of human resources for the administration of programs to provide homemaking services and elder protection services, and for any budgetary adjustments necessary to carry out those recommendations.
Sec. 84. 1. The legislative committee on health care and the interim finance committee shall:
(a) Monitor the organizational development of the division of health care financing and policy of the department of human resources.
(b) Provide advice and guidance to the division regarding:
(1) Any organizational changes within the division;
(2) New initiatives to reduce the expenditure of money from the state general fund;
(3) The implementation of Medicaid managed care;
(4) The development and implementation of a study of the re-engineering of business processes relating to the administration of Medicaid; and
(5) Any other issues that may affect the policies of the division.
2. The division of health care financing and policy of the department of human resources shall not:
(a) Revise its Medicaid managed care program or the organizational structure of the division until the legislative committee on health care has approved the revision.
(b) Carry out a study of the re-engineering of business processes relating to the administration of Medicaid until the interim finance committee has approved the scope of the study.
Sec. 85. 1. The legislative committee on health care shall conduct a study to evaluate expanding access to health care in this state. The study must evaluate:
(a) Expanding eligibility for Medicaid to other medically needy persons in this state, including, without limitation, medically needy children, women, persons with disabilities and working adults.
(b) Expanding services provided to recipients of Medicaid.
(c) The long-term and catastrophic health care needs of all persons in this state.
(d) Incentives that may be provided to employers to encourage them to provide health care insurance for their employees.
(e) The responsibility that corporations should accept over the provision of health care services to their employees.
(f) Establishing an independent office to advocate on behalf of consumers of health care.
(g) Identifying all potential sources of funding for the provision of health care services to all persons in this state, including, without limitation, private and public sources of funding.
(h) Establishing a mandatory Medicaid managed care program for all recipients of Medicaid, including, without limitation:
(1) Access to quality health care services;
(2) Coverage of health care services in at least the same amount, scope and duration as are provided to recipients of Medicaid as of July 1, 1997;
(3) Protections for recipients of Medicaid, including, without limitation, adequate procedures for filing complaints and appeals regarding the provision of health care services;
(4) Access to adequate outpatient services and other alternatives to care provided in a hospital;
(5) Contracts with providers of health care who provide services at no charge or for a fee for services based upon a sliding scale that is determined based on the income of a patient, who do not restrict access or services because of the financial limitations of a patient, and who:
(I) Historically have served medically needy or medically indigent patients and have demonstrated a commitment to serve such patients by dedicating a significant portion of their business to such patients; or
(II) Are the only providers of health care in their communities and to the best of their ability have served the medically indigent patients in their communities; and
(6) Agreements by providers of health care who contract to provide services to recipients of Medicaid to presume that certain persons are eligible for Medicaid, including, without limitation, certain pregnant women and persons with physical disabilities.
2. The legislative committee on health care shall establish the:
(a) Manner in which any necessary waivers must be obtained from the Federal Government;
(b) Manner of carrying out the purposes of the Medicaid managed care program;
(c) Procedures for protecting recipients of Medicaid from fraud;
(d) Method of enrolling persons in the Medicaid managed care program;
(e) Procedures for guaranteeing that recipients of Medicaid have adequate due process protections;
(f) Manner for determining the scope of services provided by the Medicaid managed care program; and
(g) Manner of collecting data concerning the Medicaid managed care program.
3. The legislative committee on health care shall:
(a) Report its recommendations to the governor and the department of human resources on or before July 1, 1998; and
(b) Submit quarterly reports to the interim finance committee concerning the progress of its study and its recommendations for establishing a mandatory Medicaid managed care program.
Sec. 86. The department of human resources shall, with the consent of the interim finance committee:
1. Seek all necessary approvals and waivers from the Federal Government to accomplish the goals identified in the recommendations submitted by the legislative committee on health care pursuant to subsection 3 of section 85 of this act; and
2. Submit quarterly reports concerning its progress in obtaining such approvals and waivers to the legislative committee on health care.
Sec. 87. 1. There is hereby appropriated from the state general fund to the legislative committee on health care the sum of $200,000 for hiring a consultant to assist the committee in conducting its study and making recommendations pursuant to section 85 of this act.
2. Any remaining balance of the appropriation made by subsection 1 must not be committed for expenditure after July 1, 1998, and reverts to the state general fund as soon as all payments of money committed have been made.
Sec. 88. 1. Except as otherwise provided in subsection 2:
(a) The state plan for Medicaid must allocate $4,800,000 for the fiscal year 1997-1998 and $4,800,000 for the fiscal year 1998-1999 for distribution to the private hospitals, if any, that qualify for a payment pursuant to NRS 422.387.
(b) If a private hospital receives a payment pursuant to NRS 422.387, the county within which the hospital is located shall transfer $1,550,000 to the department of human resources for the fiscal year 1997-1998 and $1,550,000 for the fiscal year 1998-1999.
2. If federal law changes the amount payable pursuant to paragraph (a) of subsection 2 of NRS 422.387:
(a) The respective amounts required to be allocated and transferred pursuant to subsection 1 must be reduced proportionally in accordance with the limits of federal law.
(b) The administrator of the division of health care financing and policy of the department of human resources shall adopt a regulation specifying the amount of the reductions required by paragraph (a).
Sec. 89. 1. This section and sections 2 to 14.1, inclusive, 14.3 to 29, inclusive, 32 to 43, inclusive, 45, 47, 49 to 54, inclusive, 56, 57, 59, 63, 64, 67 to 71, inclusive, and 74 to 88, inclusive, of this act become effective on July 1, 1997.
2. Sections 1, 30, 30.5, 44, 46, 48, 54.5, 58, 60, 61, 62, 65, 66, 72 and 73 of this act become effective at 12:01 a.m. on July 1, 1997.
3. Sections 31 and 55 of this act become effective at 12:02 a.m. on July 1, 1997.
4. Section 14.2 of this act becomes effective on July 1, 1998.
5. Sections 1 to 14.4, inclusive, 15 to 30, inclusive, 31 to 54, inclusive, 55 to 80.3, inclusive, and 84 of this act, and subsection 1 of section 81 of this act, expires by limitation on June 30, 1999.
________