Senate Bill No. 474-Committee on Human Resources and Facilities
June 23, 1997
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Referred to Committee on Human Resources and Facilities
SUMMARY--Makes various changes regarding administration of pharmaceutical services under Medicaid program. (BDR 38-162)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State or on Industrial Insurance: Yes.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to the administration of Medicaid; prohibiting the state from contracting for the provision of pharmaceutical services through managed care; restricting the authority of the state to limit coverage for drugs; requiring the establishment of an electronic system for the management of pharmaceutical claims; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1 Chapter 422 of NRS is hereby amended by adding thereto a new section to read as follows:
In carrying out its duties regarding the administration of assistance to the medically indigent, the welfare division:
1. Shall not enter into any contracts for the provision of pharmaceutical services through managed care to recipients of that assistance.
2. Except for any limitations on coverage authorized pursuant to 42 U.S.C. § 1396r-8(d)(2), shall provide reimbursement for, without requiring any prior or retroactive approval of, the dispensing of a drug to a recipient of that assistance if the drug:
(a) Has been approved or designated as safe and effective by the Food and Drug Administration; and
(b) Is prescribed by a physician who determines that, in his professional judgment within his lawful scope of practice, the drug is appropriate for the diagnosis or treatment of that recipient.
3. Shall establish an electronic system for the management of pharmaceutical claims. The system must provide for:
(a) The on-line adjudication of pharmaceutical claims;
(b) The utilization review of pharmaceutical services; and
(c) The review of pharmaceutical therapy at the point of sale to identify potential problems in that therapy, including, without limitation, any incorrect dosage, adverse interaction, contraindication, therapeutic duplication, incorrect duration of treatment and clinical abuse or misuse.
Sec. 2 NRS 422.060 is hereby amended to read as follows:
422.060The administrator and the welfare division shall administer the provisions of NRS 422.070 to 422.410, inclusive, and section 1 of this act, subject to administrative supervision by the director.