Assembly Bill No.
504–Committee on
Health and Human Services
CHAPTER..........
AN ACT relating to health care; requiring the Department of Human Resources to apply to the Federal Government to establish a program to extend coverage for prescription drugs and other related services for certain persons; making various changes concerning the allocation of the money in the Fund for a Healthy Nevada; 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 the provisions set forth as sections 2 and 3 of this act.
Sec. 2. 1. The Director shall apply to the Federal
Government for a Medicaid waiver to extend coverage for
prescription drugs and other related services to persons 65 years of
age or older who are not eligible for pharmacy benefits pursuant
to Medicaid and whose incomes are not more than 200 percent of
the federally designated level signifying poverty.
2. The Director shall fully cooperate in good faith with the
Federal Government during the application process to satisfy the
requirements of the Federal Government for obtaining a Medicaid
waiver pursuant to this section, including, without limitation:
(a) Providing any necessary information requested by the
Federal Government in a timely manner;
(b) Responding promptly and thoroughly to any questions or
concerns of the Federal Government concerning the application;
and
(c) Working with the Federal Government to amend any
necessary provisions of the application to satisfy the requirements
for approval of the application.
3. The Director may:
(a) Administer a program established pursuant to this section
through the Division of Health Care Financing and Policy; or
(b) Hire a pharmacy benefits manager by contract to
administer a program established pursuant to this section.
4. Not more than 10 percent of the money received by the
Department to implement a program established pursuant to this
section may be used for administrative expenses or other indirect
costs.
5. The Director shall submit a quarterly report concerning a
program established pursuant to this section to the Interim
Finance Committee and the Legislative Committee on Health
Care.
Sec. 3. 1. Except as otherwise provided in this subsection,
the Director may apply to the Federal Government for a Medicaid
waiver to extend coverage for prescription drugs and other related
services to persons with disabilities who have been determined to
be eligible for disability benefits from the federal social security
system, who are not eligible for pharmacy benefits pursuant to
Medicaid and whose incomes are not more than 200 percent of the
federally designated level signifying poverty. The Director shall
not apply for a waiver pursuant to this subsection unless the
Director and the Interim Finance Committee have determined that
sufficient funds are available in this state to implement the waiver.
2. If the Federal Government approves a Medicaid waiver
which the Director applied for pursuant to subsection 1, the
Director shall adopt regulations to implement the waiver and
establish a program in accordance with the waiver, including,
without limitation, regulations setting forth criteria of eligibility,
the services covered by the program, the amount of any copayment
for which a person who receives services pursuant to the program
is responsible and any limitation on the number of persons who
may receive services pursuant to the program.
3. The Director may:
(a) Administer a program established pursuant to this section
through the Division of Health Care Financing and Policy; or
(b) Hire a pharmacy benefits manager by contract to
administer a program established pursuant to this section.
4. Not more than 10 percent of the money received by the
Department to implement a program established pursuant to this
section may be used for administrative expenses or other indirect
costs.
5. The Director shall submit a quarterly report concerning:
(a) The progress of the Director toward applying for a waiver
pursuant to subsection 1 and establishing a program in
accordance with such a waiver that has been approved by the
Federal Government; and
(b) Any program established pursuant to this section,
to the Interim Finance Committee and the Legislative Committee
on Health Care.
Sec. 4. NRS 422.240 is hereby amended to read as follows:
422.240 1. Money to carry out the provisions of NRS
422.001 to 422.410, inclusive, and sections 2 and 3 of this act, and
422.580, including, without limitation, any federal money allotted to
the State of Nevada pursuant to the program to provide Temporary
Assistance for Needy Families and the Program for Child Care and
Development, must , except as otherwise provided in NRS 439.630,
be provided by appropriation by the Legislature from the State
General Fund.
2. Disbursements for the purposes of NRS 422.001 to 422.410,
inclusive, and sections 2 and 3 of this act, and 422.580 must ,
except as otherwise provided in NRS 439.630, be made upon claims
duly filed, audited and allowed in the same manner as other money
in the State Treasury is disbursed.
Sec. 5. NRS 218.6827 is hereby amended to read as follows:
218.6827 1. Except as otherwise provided in subsections 2
and 3, the Interim Finance Committee may exercise the powers
conferred upon it by law only when the Legislature is not in regular
or special session.
2. During a regular session, the Interim Finance Committee
may also perform the duties imposed on it by subsection 5 of NRS
284.115, subsection 2 of NRS 321.335, NRS 322.007, subsection 2
of NRS 323.020, NRS 323.050, subsection 1 of NRS 323.100, NRS
353.220, 353.224, 353.2705 to 353.2771, inclusive, and 353.335,
paragraph (b) of subsection 4 of NRS 407.0762 and NRS 428.375,
439.620, 439.630, 445B.830 and 538.650 [.] and subsection 1 of
section 3 of this act. In performing those duties, the Senate Standing
Committee on Finance and the Assembly Standing Committee on
Ways and Means may meet separately and transmit the results of
their respective votes to the Chairman of the Interim Finance
Committee to determine the action of the Interim Finance
Committee as a whole.
3. During a regular or special session, the Interim Finance
Committee may exercise the powers and duties conferred upon it
pursuant to the provisions of NRS 353.2705 to 353.2771, inclusive.
4. If the Interim Finance Committee determines that a
fundamental review of the base budget of a state agency is
necessary, it shall, by resolution, notify the Legislative Commission
of that finding for assignment of the review to a legislative
committee for the fundamental review of the base budgets of state
agencies established pursuant to NRS 218.5382.
Sec. 6. NRS 439.620 is hereby amended to read as follows:
439.620 1. The Fund for a Healthy Nevada is hereby created
in the State Treasury. The State Treasurer shall deposit in the Fund:
(a) Fifty percent of all money received by this state pursuant to
any settlement entered into by the State of Nevada and a
manufacturer of tobacco products; and
(b) Fifty percent of all money recovered by this state from a
judgment in a civil action against a manufacturer of tobacco
products.
2. The State Treasurer shall administer the Fund. As
administrator of the Fund, the State Treasurer:
(a) Shall maintain the financial records of the Fund;
(b) Shall invest the money in the Fund as the money in other
state funds is invested;
(c) Shall manage any account associated with the Fund;
(d) Shall maintain any instruments that evidence investments
made with the money in the Fund;
(e) May contract with vendors for any good or service that is
necessary to carry out the provisions of this section; and
(f) May perform any other duties necessary to administer the
Fund.
3. The interest and income earned on the money in the Fund
must, after deducting any applicable charges, be credited to the
Fund. All claims against the Fund must be paid as other claims
against the State are paid.
4. Upon receiving a request from the State Treasurer or the
Department for an allocation for administrative expenses from the
Fund pursuant to this section, the Task Force for the Fund for a
Healthy Nevada shall consider the request within 45 days after
receipt of the request. If the Task Force approves the amount
requested for allocation, the Task Force shall notify the State
Treasurer of the allocation. If the Task Force does not approve the
requested allocation within 45 days after receipt of the request, the
State Treasurer or the Department, as applicable, may submit its
request for allocation to the Interim Finance Committee. Except as
otherwise limited by this subsection, the Interim Finance Committee
may allocate all or part of the money so requested. The annual
allocation for administrative expenses from the Fund, whether
allocated by the Task Force or the Interim Finance Committee must
not exceed:
(a) Not more than 2 percent of the money in the Fund, as
calculated pursuant to this subsection, each year to pay the costs
incurred by the State Treasurer to administer the Fund; and
(b) Not more than 3 percent of the money in the Fund, as
calculated pursuant to this subsection, each year to pay the costs
incurred by the Department, including, without limitation, the Aging
Services Division of the Department, to carry out its duties set forth
in NRS 439.625 to 439.690, inclusive.
For the purposes of this subsection, the amount of money available
for allocation to pay for the administrative costs must be calculated
at the beginning of each fiscal year based on the total amount of
money anticipated by the State Treasurer to be deposited in the Fund
during that fiscal year.
5. The money in the Fund remains in the Fund and does not
revert to the State General Fund at the end of any fiscal year.
6. All money that is deposited or paid into the Fund is hereby
appropriated to the Department and, except as otherwise provided in
paragraphs (c) , [and] (d) and (h) of subsection 1 of NRS 439.630,
may only be expended pursuant to an allocation made by the Task
Force for the Fund for a Healthy Nevada. Money expended from the
Fund for a Healthy Nevada must not be used to supplant existing
methods of funding that are available to public agencies.
Sec. 7. NRS 439.630 is hereby amended to read as follows:
439.630 1. The Task Force for the Fund for a Healthy
Nevada shall:
(a) Conduct public hearings to accept public testimony from a
wide variety of sources and perspectives regarding existing or
proposed programs that:
(1) Promote public health;
(2) Improve health services for children, senior citizens and
persons with disabilities;
(3) Reduce or prevent the use of tobacco;
(4) Reduce or prevent the abuse of and addiction to alcohol
and drugs; and
(5) Offer other general or specific information on health care
in this state.
(b) Establish a process to evaluate the health and health needs of
the residents of this state and a system to rank the health problems
of the residents of this state, including, without limitation, the
specific health problems that are endemic to urban and rural
communities.
(c) Reserve not more than 30 percent of all revenues deposited
in the Fund for a Healthy Nevada each year for direct expenditure
by the Department to pay for prescription drugs and pharmaceutical
services for senior citizens pursuant to NRS 439.635 to 439.690,
inclusive[.] , and to fund in whole or in part any program
established pursuant to section 2 or 3 of this act. From the money
reserved to the Department pursuant to this paragraph, the
Department [shall] may subsidize all of the cost of policies of health
insurance that provide coverage to senior citizens for prescription
drugs and pharmaceutical services pursuant to NRS 439.635 to
439.690, inclusive[.] , and fund in whole or in part any program
established pursuant to section 2 or 3 of this act. The Department
shall consider recommendations from the Task Force for the Fund
for a Healthy Nevada in carrying out the provisions of NRS 439.635
to 439.690, inclusive[.] , and administering any program
established pursuant to section 2 or 3 of this act. The Department
shall submit a quarterly report to the Governor, the Task Force for
the Fund for a Healthy Nevada and the Interim Finance Committee
regarding the general manner in which expenditures have been made
pursuant to this paragraph and the status of the program.
(d) Reserve not more than 30 percent of all revenues deposited
in the Fund for a Healthy Nevada each year for allocation by the
Aging Services Division of the Department in the form of grants for
existing or new programs that assist senior citizens with independent
living, including, without limitation, programs that provide:
(1) Respite care or relief of family caretakers;
(2) Transportation to new or existing services to assist senior
citizens in living independently; and
(3) Care in the home which allows senior citizens to remain
at home instead of in institutional care.
The Aging Services Division of the Department shall consider
recommendations from the Task Force for the Fund for a Healthy
Nevada concerning the independent living needs of senior citizens.
(e) Allocate for expenditure not more than 20 percent of all
revenues deposited in the Fund for a Healthy Nevada each year for
programs that prevent, reduce or treat the use of tobacco and the
consequences of the use of tobacco.
(f) Allocate for expenditure not more than [20] 10 percent of all
revenues deposited in the Fund for a Healthy Nevada each year for
programs that improve health services for children . [and]
(g) Allocate, by contract or grant, for expenditure not more
than 7.5 percent of all revenues deposited in the Fund for a
Healthy Nevada each year for programs that improve the health
and well-being of persons with disabilities.
[(g)] In making allocations pursuant to this paragraph, the
Task Force shall, to the extent practicable, allocate the money
evenly among the following three types of programs:
(1) Programs that provide respite for persons caring for
persons with disabilities;
(2) Programs that provide positive behavioral supports to
persons with disabilities; and
(3) Programs that assist persons with disabilities to live
safely and independently in their communities outside of an
institutional setting.
(h) Reserve not more than 2.5 percent of all revenues
deposited in the Fund for a Healthy Nevada each year for direct
expenditure by the Department to fund in whole or in part any
program established pursuant to section 3 of this act. The
Department shall consider recommendations from the Task Force
for the Fund for a Healthy Nevada in administering any program
established pursuant to section 3 of this act.
(i) Maximize expenditures through local, federal and private
matching contributions.
[(h)] (j) Ensure that any money expended from the Fund for a
Healthy Nevada will not be used to supplant existing methods of
funding that are available to public agencies.
[(i)] (k) Develop policies and procedures for the administration
and distribution of grants and other expenditures to state agencies,
political subdivisions of this state, nonprofit organizations,
universities and community colleges. A condition of any such grant
must be that not more than 8 percent of the grant may be used for
administrative expenses or other indirect costs. The procedures must
require at least one competitive round of requests for proposals per
fiscal year.
[(j)] (l) To make the allocations required by paragraphs (e) , (f)
and [(f):] (g):
(1) Prioritize and quantify the needs for these programs;
(2) Develop, solicit and accept grant applications for
allocations;
(3) Conduct annual evaluations of programs to which
allocations have been awarded; and
(4) Submit annual reports concerning the programs to the
Governor and the Interim Finance Committee.
[(k)] (m) Transmit a report of all findings, recommendations and
expenditures to the Governor and each regular session of the
Legislature.
2. The Task Force may take such other actions as are necessary
to carry out its duties.
3. The Department shall take all actions necessary to ensure
that all allocations for expenditures made by the Task Force are
carried out as directed by the Task Force.
4. To make the allocations required by paragraph (d) of
subsection 1, the Aging Services Division of the Department shall:
(a) Prioritize and quantify the needs of senior citizens for these
programs;
(b) Develop, solicit and accept grant applications for allocations;
(c) As appropriate, expand or augment existing state programs
for senior citizens upon approval of the Interim Finance Committee;
(d) Award grants or other allocations;
(e) Conduct annual evaluations of programs to which grants or
other allocations have been awarded; and
(f) Submit annual reports concerning the grant program to the
Governor and the Interim Finance Committee.
5. The Aging Services Division of the Department shall submit
each proposed grant which would be used to expand or augment an
existing state program to the Interim Finance Committee for
approval before the grant is awarded. The request for approval must
include a description of the proposed use of the money and the
person or entity that would be authorized to expend the money. The
Aging Services Division of the Department shall not expend or
transfer any money allocated to the Aging Services Division
pursuant to this section to subsidize any portion of the cost of
policies of health insurance that provide coverage to senior citizens
for prescription drugs and pharmaceutical services pursuant to NRS
439.635 to 439.690, inclusive[.] , or to pay for any program
established pursuant to section 2 or 3 of this act.
6. The Department, on behalf of the Task Force, shall submit
each allocation proposed pursuant to paragraph (e) [or (f)] , (f) or
(g) of subsection 1 which would be used to expand or augment an
existing state program to the Interim Finance Committee for
approval before the grant is awarded. The request for approval must
include a description of the proposed use of the money and the
person or entity that would be authorized to expend the money.
Sec. 8. NRS 439.665 is hereby amended to read as follows:
439.665 1. The Department [shall] may enter into contracts
with private insurers who transact health insurance in this state to
arrange for the availability, at a reasonable cost, of policies of health
insurance that provide coverage to senior citizens for prescription
drugs and pharmaceutical services.
2. Within the limits of the money available for this purpose in
the Fund for a Healthy Nevada, a senior citizen who is not eligible
for Medicaid and who [purchases] is issued a policy of health
insurance that is made available pursuant to subsection 1 is entitled
to an annual grant from the Trust Fund to subsidize the cost of that
insurance, including premiums and deductibles, if he has been
domiciled in this state for at least 1 year immediately preceding the
date of his application and his household income is not over
$21,500.
3. The subsidy granted pursuant to this section must not exceed
the annual cost of insurance that provides coverage for prescription
drugs and pharmaceutical services, including premiums and
deductibles.
4. A policy of health insurance that is made available pursuant
to subsection 1 must provide for:
(a) A copayment of not more than $10 per prescription drug or
pharmaceutical service that is generic as set forth in the formulary of
the insurer; and
(b) A copayment of not more than $25 per prescription drug or
pharmaceutical service that is preferred as set forth in the formulary
of the insurer.
5. The Department may waive the eligibility requirement set
forth in subsection 2 regarding household income upon written
request of the applicant if the circumstances of the applicant’s
household have changed as a result of:
(a) Illness;
(b) Disability; or
(c) Extreme financial hardship based on a significant reduction
of income, when considering the applicant’s current financial
circumstances.
An applicant who requests such a waiver shall include with that
request all medical and financial documents that support his request.
6. If the Federal Government provides any coverage of
prescription drugs and pharmaceutical services for senior citizens
who are eligible for a subsidy pursuant to subsections 1 to 5,
inclusive, the Department may, upon approval of the Legislature, or
the Interim Finance Committee if the Legislature is not in session,
change any program established pursuant to NRS 439.635 to
439.690, inclusive, and otherwise provide assistance with
prescription drugs and pharmaceutical services for senior citizens
within the limits of the money available for this purpose in the Fund
for a Healthy Nevada.
7. The provisions of subsections 1 to 5, inclusive, do not apply
if the Department provides assistance with prescription drugs and
pharmaceutical services for senior citizens pursuant to subsection 6.
Sec. 9. Any money allocated pursuant to subsection 1 of NRS
439.630 before July 1, 2004, for programs that improve the health
and well-being of persons with disabilities that is unspent and is
returned to the Department of Human Resources may be expended
by the Department to fund any program established pursuant to
section 3 of this act.
Sec. 10. 1. Except as otherwise provided in subsection 2, the
provisions of this act become effective on October 1, 2003.
2. The amendatory provisions of section 7 of this act which
require the Task Force for the Fund for a Healthy Nevada to allocate
for expenditure not more than 10 percent of all revenues deposited
in the Fund for a Healthy Nevada each year for programs that
improve health services for children, to allocate for expenditure not
more than 7.5 percent of all revenues deposited in the Fund each
year for programs that improve the health and well-being of persons
with disabilities, and to reserve not more than 2.5 percent of all
revenues deposited in the Fund each year for direct expenditure by
the Department of Human Resources to fund any program
established pursuant to section 3 of this act become effective on
July 1, 2004.
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