[Rev. 6/29/2024 4:02:17 PM--2023]
TITLE 38 - PUBLIC WELFARE
CHAPTER 422 - HEALTH CARE FINANCING AND POLICY
GENERAL PROVISIONS
NRS 422.001 Definitions.
NRS 422.003 “Administrator” defined.
NRS 422.021 “Children’s Health Insurance Program” defined.
NRS 422.030 “Department” defined.
NRS 422.040 “Director” defined.
NRS 422.041 “Division” defined.
NRS 422.046 “Medicaid” defined.
NRS 422.050 “Public assistance” defined.
NRS 422.054 “Undivided estate” defined.
NRS 422.061 Purposes of Division.
NRS 422.063 State plans for certain programs: Development, adoption and revision by Director; Division required to comply.
NRS 422.064 State plans for certain programs: Priority access to treatment and services for certain parents.
NRS 422.065 Eligibility of persons who are not citizens or nationals of United States for state or local public benefits.
NRS 422.075 Division to submit certain information to Nevada Commission on Autism Spectrum Disorders.
MEDICAL CARE ADVISORY COMMITTEE
NRS 422.151 Creation; function.
NRS 422.153 Composition; terms and compensation of members.
NRS 422.155 Chair; Secretary; meetings; subcommittees.
ADVISORY COMMITTEE ON MEDICAID INNOVATION
NRS 422.162 Creation; appointment of members; terms; Chair; members serve without additional compensation; member who is state employee must be relieved from duties to prepare for and attend meetings.
NRS 422.165 Duties.
REINVESTMENT ADVISORY COMMITTEE
NRS 422.175 “Reinvestment advisory committee” defined.
NRS 422.185 Establishment; membership; members serve without compensation; leave for members who are public employees.
NRS 422.195 Chair; meetings; subcommittees; quorum.
NRS 422.205 Duties; report.
ADMINISTRATOR OF DIVISION OF HEALTH CARE FINANCING AND POLICY
NRS 422.2354 Qualifications.
NRS 422.2356 Executive Officer of Division; administration and management of Division.
NRS 422.2357 Administration of chapter.
NRS 422.2358 Reports.
NRS 422.2362 Fiscal duties.
NRS 422.2364 Organization of Division; appointment of heads of sections; employees; standards of service.
NRS 422.2366 Administration of oaths; testimony of witnesses; subpoenas.
NRS 422.2368 Adoption of regulations.
NRS 422.23685 Regulations required to include provision prohibiting certain actions relating to organ transplants for persons with disabilities.
NRS 422.2369 Procedure for adopting, amending or repealing regulations.
NRS 422.2372 General and miscellaneous powers and duties. [Effective through December 31, 2025.]
NRS 422.2372 General and miscellaneous powers and duties. [Effective January 1, 2026.]
NRS 422.2374 Cooperation with Medicaid Fraud Control Unit; suspension or exclusion of provider of goods or services under State Plan for Medicaid.
STATE DENTAL HEALTH OFFICER
NRS 422.239 Appointment by Division in unclassified service or as contractor; qualifications; duties; restrictions on other employment. [Replaced in revision by NRS 439.272.]
ADMINISTRATION AND PROCEDURE
Financial Administration
NRS 422.240 Legislative appropriations; disbursements.
NRS 422.242 Gifts and grants of money to Division: Deposit in Gift and Cooperative Account of the Division of Health Care Financing and Policy; use; approval of claims by Administrator.
NRS 422.260 Acceptance of Social Security Act and related federal money.
NRS 422.265 Acceptance of increased benefits of future congressional legislation; regulations.
NRS 422.267 Contract or agreement with Federal Government by Director.
State Plan for Medicaid and Children’s Health Insurance Program
NRS 422.270 Duties of Department regarding Medicaid and Children’s Health Insurance Program.
NRS 422.2701 Discrimination by Department on basis of actual or perceived gender identity or expression prohibited.
NRS 422.2703 Department required to establish and maintain system for electronic submission of applications for Medicaid or Children’s Health Insurance Program.
NRS 422.2704 Review of and recommendations concerning rates of reimbursement.
NRS 422.2712 Reporting of certain rates of reimbursement for physicians.
NRS 422.2717 State Plan for Medicaid: Inclusion of requirement that independent foster care adolescents are eligible for Medicaid.
NRS 422.271705 State Plan for Medicaid: Inclusion of requirement concerning monthly personal needs allowance for institutionalized persons who reside in facility for skilled nursing.
NRS 422.27171 State Plan for Medicaid: Inclusion of authorization for pregnant women determined to be presumptively eligible for Medicaid to enroll in Medicaid for prescribed period without submitting application for enrollment which includes additional proof of eligibility; inclusion of authorization for pregnant women with certain household incomes to enroll in Medicaid; prohibition against inclusion of residency period requirement for enrollment in Medicaid by certain pregnant women.
NRS 422.27172 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to family planning; reimbursement of pharmacist for certain family planning services.
NRS 422.27173 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for testing for and treatment and prevention of sexually transmitted diseases and condoms.
NRS 422.27174 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for preventative care.
NRS 422.27175 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for screening, genetic counseling and testing for harmful mutations in the BRCA gene for women.
NRS 422.27176 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for mammogram.
NRS 422.27177 State Plan for Medicaid: Inclusion of coverage for doula services provided by enrolled doula; application for waiver or amendment related to doula services; requirements for enrollment as doula; program to provide incentive payments for enrolled doulas.
NRS 422.271775 State Plan for Medicaid: Inclusion of requirement for payment of costs incurred for postpartum care services.
NRS 422.27178 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for breastfeeding supplies and prenatal screenings and tests.
NRS 422.27179 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for breastfeeding supplies for certain period, prenatal screenings and tests and lactation consultation and support.
NRS 422.2718 State Plan for Medicaid: Inclusion of requirement for payment of certain expenses related to testing for human papillomavirus and administration of human papillomavirus vaccine.
NRS 422.2719 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to fetal alcohol spectrum disorders.
NRS 422.272 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for medical, administrative and transactional costs of certain persons admitted to certain medical facilities for more than 30 days.
NRS 422.27205 State Plan for Medicaid: Inclusion of requirement for payment of costs for certain services provided by critical access hospitals.
NRS 422.2721 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services provided through telehealth; inclusion of prohibition against certain practices related to such services.
NRS 422.2722 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services provided by community health worker.
NRS 422.2723 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to dialysis and emergency care to treat kidney failure.
NRS 422.27234 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to sickle cell disease and its variants.
NRS 422.27235 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to testing for, preventing or treating human immunodeficiency virus or hepatitis C.
NRS 422.27236 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for cognitive assessment and care planning services for persons who experience signs or symptoms of cognitive impairment.
NRS 422.272362 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to gender dysphoria and gender incongruence.
NRS 422.272364 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for biomarker testing.
NRS 422.272366 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for behavioral health services. [Effective July 1, 2024.]
NRS 422.272368 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for treatment of substance use disorder provided by provider of primary care.
NRS 422.27237 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services of pharmacist; rate of reimbursement.
NRS 422.27238 State Plan for Medicaid: Reimbursement for crisis stabilization services.
NRS 422.27239 State Plan for Medicaid: Reimbursement of supervising psychologist for services of psychological assistant, psychological intern or psychological trainee.
NRS 422.2724 State Plan for Medicaid: Reimbursement of registered nurse for certain services provided to persons eligible for Medicaid.
NRS 422.272405 State Plan for Medicaid: Reimbursement for services provided by advanced practice registered nurse to certain recipients.
NRS 422.272407 State Plan for Medicaid: Reimbursement of recipients for personal care services.
NRS 422.27241 State Plan for Medicaid: Reimbursement for services for hospice care provided to persons eligible for Medicaid.
NRS 422.27242 State Plan for Medicaid and Children’s Health Insurance Program: Inclusion of authorization for enrollment of certain children; authority to reduce or eliminate available benefits.
NRS 422.272422 Medicaid: Inclusion of coverage for certain dental care; application for waiver or amendment.
NRS 422.272424 Medicaid: Inclusion of coverage for polycarbonate lenses; application for waiver or amendment.
NRS 422.272428 Medicaid: Inclusion of coverage for limited services for certain persons before scheduled release from incarceration; application for waiver.
NRS 422.27243 Program to provide medical assistance to certain persons who are employed and have disabilities.
NRS 422.27247 Application for federal waiver to provide certain dental care for certain persons.
NRS 422.27248 Application for federal waiver authorizing Department to receive federal funding for coverage for certain treatment for person in institution for mental diseases.
NRS 422.27249 Application for federal waiver to increase rates of reimbursement for rural emergency hospital services.
NRS 422.273 Establishment, development and implementation of Medicaid managed care program. [Effective through December 31, 2025.]
NRS 422.273 Establishment, development and implementation of statewide Medicaid managed care program; statewide procurement process to select health maintenance organizations to provide services. [Effective January 1, 2026.]
NRS 422.2734 Plan to ensure provision of behavioral health services by certain managed care organizations in culturally competent manner: Preparation; contents; implementation; review; additional duties.
NRS 422.2735 Program to provide increased capitation payments to Medicaid managed care plans for ground emergency medical transportation services provided by governmental provider. [Effective on the date that a program to provide increased capitation payments to governmental providers for ground emergency medical transportation services established pursuant to this section is approved by the Centers for Medicare and Medicaid Services.]
NRS 422.2748 Cooperation with Medicaid Fraud Control Unit.
NRS 422.27482 Report concerning provision of health benefits by large employers.
NRS 422.27485 Enrollment of eligible Indian children in Children’s Health Insurance Program: Duty of Department to seek assistance of and cooperate with Indian tribes; immediate action required; certain contracts for provision of services required.
NRS 422.27487 Eligibility for and coverage under Medicaid for persons who are incarcerated and persons released from incarceration; regulations.
NRS 422.2749 Custody, use, preservation and confidentiality of records, files and communications concerning applicants for and recipients of public assistance or assistance pursuant to Children’s Health Insurance Program; regulations.
NRS 422.27495 Contracts for provision of certain transportation services for recipients of Medicaid and recipients of services pursuant to Children’s Health Insurance Program; regulations.
NRS 422.27497 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services provided by behavior analysts, assistant behavior analysts and registered behavior technicians; establishment of certain rates of reimbursement and limitations on hours for provision of such services; reporting of certain information concerning services provided to recipients of Medicaid diagnosed with autism spectrum disorder.
Investigations and Hearings
NRS 422.275 Legal advisers for Division.
NRS 422.276 Appeal to Division by applicant for or recipient of benefits from Medicaid or Children’s Health Insurance Program; notice of initial decision; hearing.
NRS 422.277 Hearing: Rights of parties; informal disposition; record; transcribing of oral proceedings; findings of fact; certain employees or representatives of Division prohibited from participating in decision.
NRS 422.2775 Hearing: Evidence.
NRS 422.278 Hearing: Person with communications disability entitled to services of interpreter.
NRS 422.2785 Contents and delivery of decision or order of hearing officer; petition for judicial review; filing of decision and record with court.
NRS 422.279 Judicial review: Taking of additional evidence; limitations on review; grounds for reversal; appeal to appellate court.
NRS 422.280 Forms of reports and records to be kept by persons subject to supervision or investigation by Division.
Rights and Responsibilities of Recipients
NRS 422.291 Assistance not assignable or subject to process or bankruptcy law.
NRS 422.292 Assistance subject to future amending and repealing acts.
NRS 422.293 Subrogation: Department subrogated to rights of recipient of Medicaid or of insurance provided pursuant to Children’s Health Insurance Program; lien on proceeds of recovery.
NRS 422.293001 Subrogation: Notice to Department of recipient’s claim; statute of limitations tolled until notice received.
NRS 422.293003 Subrogation: Department required to provide notice of amount of lien; enforceability of lien.
NRS 422.293005 Subrogation: Liability for failure to comply with provisions.
Recovery of Medicaid Benefits
NRS 422.29301 Administration of provisions concerning recovery of amounts incorrectly paid for recipient of Medicaid; regulations; enforcement.
NRS 422.29302 Recovery of benefits paid for Medicaid: Powers and duties of Department; claim against estate of recipient; regulations; distribution of money recovered; payment in cash.
NRS 422.29304 Recovery of amounts paid for Medicaid under certain circumstances; powers and duties of Department; duty to reimburse Department; waiver of repayment; regulations.
NRS 422.29306 Imposition and release of lien on property of recipient of Medicaid.
Investigation of Providers
NRS 422.305 Confidentiality of information obtained in investigation of provider of services under State Plan for Medicaid.
NRS 422.306 Hearing to review action taken against provider of services under State Plan for Medicaid; regulations; appeal of final decision.
Health and Welfare Programs
NRS 422.308 Family planning service; birth control.
NRS 422.3085 Development of Sexual Trauma Services Guide; provision of information about Guide to public; regulations.
NRS 422.309 Provision of prenatal care to pregnant women who are indigent; provision of information concerning availability of prenatal care; regulations.
MEDICAID CARDS
NRS 422.361 Definitions.
NRS 422.362 “Cardholder” defined.
NRS 422.363 “Medicaid card” defined.
NRS 422.364 “Plan” defined.
NRS 422.365 “Receives” defined.
NRS 422.366 Unlawful acts: Obtaining or possessing card without consent of holder of card; presumption from possession of card; penalty.
NRS 422.367 Unlawful acts: Sale or purchase of card; authorization by holder of card for use by person not entitled to use card; penalty.
NRS 422.368 Unlawful acts: Use of forged, expired or revoked card to obtain benefits; receipt of benefits by misrepresentation; penalty.
NRS 422.369 Unlawful acts: Fraud by person authorized to provide care to holder of card; penalty.
ASSESSMENT OF FEES ON NURSING FACILITIES TO INCREASE QUALITY OF NURSING CARE
NRS 422.3755 Definitions.
NRS 422.376 “Facility for intermediate care” defined.
NRS 422.3765 “Facility for skilled nursing” defined.
NRS 422.3771 “Nursing facility” defined.
NRS 422.3775 Fee: Payment; amount; due date; allowable cost for Medicaid reimbursement purposes.
NRS 422.378 Report by nursing facility to Division.
NRS 422.3785 Account to Increase the Quality of Nursing Care: Creation; deposit of money; expenditures; consequence of federal law prohibiting certain expenditures from Account.
NRS 422.379 Administrative penalties for late payment of fee; recoupment of fees and administrative penalties; repayment plan.
ASSESSMENT OF FEES ON CERTAIN OPERATORS TO INCREASE COMPENSATION UNDER STATE PLAN
NRS 422.3791 Definitions.
NRS 422.37915 “Account” defined.
NRS 422.3792 “Agency to provide personal care services in the home” defined.
NRS 422.37922 “Hospital” defined.
NRS 422.37925 “Medical facility” defined.
NRS 422.3793 “Operator” defined.
NRS 422.37935 “Operator group” defined.
NRS 422.37938 “Rural hospital” defined.
NRS 422.3794 Imposition of assessment; vote; amount of assessment; regulations; statement of amount of revenue used for certain purposes before polling; deposit of revenue; compliance with federal law; submission of information to Division.
NRS 422.37945 Account to Improve Health Care Quality and Access: Creation; administration; separate accounting; uses and limitations; nonreversion; federal financial participation.
NRS 422.3795 Administrative penalties; deduction from future Medicaid payments; notification; payment plans.
PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENT PATIENTS
NRS 422.380 Definitions.
NRS 422.3805 Federal waivers: Duties of Administrator.
NRS 422.382 Intergovernmental transfers of money from counties to Division; deposit in Intergovernmental Transfer Account in State General Fund; administration by Division.
NRS 422.385 Disproportionate share payments from Medicaid Budget Account; transfer of money from Intergovernmental Transfer Account.
NRS 422.387 Calculation of disproportionate share payments; verification of eligibility for disproportionate share payments; Director authorized to negotiate terms of amendment to State Plan for Medicaid with Centers for Medicare and Medicaid Services of United States Department of Health and Human Services.
NRS 422.390 Regulations; quarterly report.
HOME AND COMMUNITY-BASED SERVICES
NRS 422.396 Establishment and administration of program to provide community-based services; application for federal waiver or amendment to State Plan for Medicaid; contracting for services; adoption of regulations.
NRS 422.3962 Amendment of home and community-based services waiver to include as medical assistance under Medicaid funding of assisted living supportive services for senior citizens who reside in certain assisted living facilities.
NRS 422.3963 Amendment of home and community-based services waiver to include certain services for and compensation of persons with intellectual or developmental disabilities. [Effective January 1, 2025.]
NRS 422.3964 State Plan for Medicaid: Inclusion of certain home and community-based services.
NRS 422.3965 Application for federal waiver authorizing inclusion under Medicaid of structured family caregiving for persons suffering from dementia; regulations. [Effective January 1, 2025.]
NRS 422.3966 Medicaid: Inclusion of coverage for home and community-based services for persons with fetal alcohol spectrum disorder.
NRS 422.3969 Rights of persons receiving home and community-based services.
INDIVIDUAL DEVELOPMENT ACCOUNT PROGRAM
NRS 422.398 Prohibition against considering money deposited in individual development account by recipient of Medicaid to be income for certain purposes.
NRS 422.399 Instruction in financial literacy for certain recipients of Medicaid.
PRESCRIPTION DRUGS
NRS 422.401 Definitions.
NRS 422.4015 “Board” defined.
NRS 422.402 “Drug Use Review Board” defined.
NRS 422.4021 “Health benefit plan” defined.
NRS 422.4022 “Health maintenance organization” defined.
NRS 422.4023 “Pharmacy benefit manager” defined.
NRS 422.4024 “Sickle cell disease and its variants” defined.
NRS 422.4025 List of preferred prescription drugs used for Medicaid program and Children’s Health Insurance Program; list of drugs excluded from restrictions; role of Pharmacy and Therapeutics Committee; availability of new pharmaceutical products and products for which there is new evidence report; coverage of certain drugs not on list of preferred prescription drugs; regulations.
NRS 422.4026 Coverage of certain supplements for treating sickle cell disease and its variants: Adoption of list by regulation; periodic review of list.
NRS 422.403 Establishment and management of use by Medicaid program of step therapy and prior authorization; duties of Drug Use Review Board; exception for certain drugs to treat psychiatric conditions; acceptance of recommendations from Board; regulations.
NRS 422.4032 Exemption from required step therapy for certain drugs: Application process; form; approval; payment of cost of drug for which exemption applies.
NRS 422.4035 Silver State Scripts Board: Creation; membership.
NRS 422.404 Silver State Scripts Board: Chair; terms; vacancies; meetings; quorum.
NRS 422.4045 Silver State Scripts Board: Members serve without compensation; members entitled to per diem; members holding public office or employed by governmental entity.
NRS 422.405 Silver State Scripts Board: Duties and powers.
NRS 422.4052 Department to take certain actions relating to acquisition of prescription drugs for recipient of Medicaid who resides in area for which declared disaster or emergency is in effect.
NRS 422.4053 Department to manage payments and rebates for prescription drugs; contract for provision of certain services.
NRS 422.4056 Audits of certain contracts; posting of audit results on Internet website.
NRS 422.406 Regulations; contracts for services.
UNLAWFUL ACTS; PENALTIES
General Provisions
NRS 422.410 Fraudulent acts; penalties.
State Plan for Medicaid
NRS 422.450 Definitions.
NRS 422.460 “Benefit” defined.
NRS 422.470 “Claim” defined.
NRS 422.480 “Plan” defined.
NRS 422.490 “Provider” defined.
NRS 422.500 “Recipient” defined.
NRS 422.510 “Records” defined.
NRS 422.520 “Sign” defined.
NRS 422.525 “Statement or representation” defined.
NRS 422.530 Responsibility for false claim, statement or representation.
NRS 422.540 Offenses regarding false claims, statements or representations; penalties.
NRS 422.550 Statement regarding truth and accuracy of applications, reports and invoices; perjury; presumption concerning person who signs statement on behalf of provider.
NRS 422.560 Offenses regarding sale, purchase or lease of goods, services, materials or supplies; penalty.
NRS 422.570 Intentional failure to maintain adequate records; intentional destruction of records; penalties.
NRS 422.580 Civil penalties for certain violations; liability of provider for excess amount unknowingly accepted; enforcement; use of money collected as penalty or repayment.
NRS 422.590 Limitation and accrual of actions.
_________
GENERAL PROVISIONS
NRS 422.001 Definitions. As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 422.003 to 422.054, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1993, 2057; A 1995, 2566; 1997, 1237, 2232, 2615; 1999, 581, 1426, 2242; 2001, 161; 2005, 22nd Special Session, 21)
NRS 422.003 “Administrator” defined. “Administrator” means the Administrator of the Division.
(Added to NRS by 2005, 22nd Special Session, 21)
NRS 422.021 “Children’s Health Insurance Program” defined. “Children’s Health Insurance Program” means the program established pursuant to 42 U.S.C. §§ 1397aa to 1397jj, inclusive, to provide health insurance for uninsured children from low-income families in this state.
(Added to NRS by 1999, 1426)
NRS 422.030 “Department” defined. “Department” means the Department of Health and Human Services.
[Part 2:327:1949; 1943 NCL § 5146.02]—(NRS A 1963, 902; 1967, 1153; 1973, 1406; 1993, 2059; 2005, 22nd Special Session, 21)
NRS 422.040 “Director” defined. “Director” means the Director of the Department.
[Part 2:327:1949; 1943 NCL § 5146.02]—(NRS A 1963, 902; 1967, 1153; 1973, 1406; 1993, 2059)
NRS 422.041 “Division” defined. “Division” means the Division of Health Care Financing and Policy of the Department.
(Added to NRS by 1997, 2612; A 1999, 2242; 2005, 22nd Special Session, 21)
NRS 422.046 “Medicaid” defined. “Medicaid” has the meaning ascribed to it in NRS 439B.120.
(Added to NRS by 1997, 1236)
NRS 422.050 “Public assistance” defined. “Public assistance” has the meaning ascribed to it in NRS 422A.065.
[Part 12a:327:1949; added 1951, 296; A 1953, 333]—(NRS A 1959, 518; 1975, 1007; 1981, 1909; 1993, 2059; 1995, 724; 1997, 1237, 2233, 2615; 1999, 581, 1426, 2242; 2001, 161; 2005, 22nd Special Session, 21; 2013, 1303)
NRS 422.054 “Undivided estate” defined. “Undivided estate” means all real and personal property and other assets included in the estate of a deceased recipient of Medicaid and any other real and personal property and other assets in or to which the deceased recipient had an interest or legal title immediately before or at the time of his or her death, to the extent of that interest or title. The term includes, without limitation, assets conveyed to a survivor, heir or assign of the deceased recipient through or as the result of any joint tenancy, tenancy in common, survivorship, life estate, living trust, annuity, declaration of homestead or other arrangement.
(Added to NRS by 1995, 2565; A 1997, 1237; 1999, 877; 2003, 872)
NRS 422.061 Purposes of Division. The purposes of the Division are:
1. To ensure that the Medicaid provided by this State and the insurance provided pursuant to the Children’s Health Insurance Program in this State are provided in the manner that is most efficient to this State.
2. To evaluate alternative methods of providing Medicaid and providing insurance pursuant to the Children’s Health Insurance Program.
3. To review Medicaid, the Children’s Health Insurance Program 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.
(Added to NRS by 2005, 22nd Special Session, 21)
NRS 422.063 State plans for certain programs: Development, adoption and revision by Director; Division required to comply.
1. The 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 Division is responsible. Such a plan must set forth, regarding the particular program to which the plan applies:
(a) The requirements for eligibility;
(b) The nature and amounts of grants and other assistance which may be provided;
(c) The conditions imposed; and
(d) Such other provisions relating to the development and administration of the program as the Director deems necessary.
2. In developing and revising such a plan, the 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,
Ê for the particular program to which the plan applies.
3. The Division shall comply with each state plan adopted pursuant to this section.
(Added to NRS by 1993, 2058; A 1997, 2235, 2621; 1999, 581, 2242; 2005, 22nd Special Session, 26)
NRS 422.064 State plans for certain programs: Priority access to treatment and services for certain parents.
1. The Director shall, to the extent authorized by federal law, include in any state plan adopted pursuant to NRS 422.063 priority for a parent who is referred by an agency which provides child welfare services and who is qualified for public assistance to receive treatment for mental health issues, treatment for substance use disorders and any other treatment or services that may assist with preserving or reunifying the family.
2. As used in this section, “agency which provides child welfare services” has the meaning ascribed to it in NRS 432B.030.
(Added to NRS by 2009, 329)
NRS 422.065 Eligibility of persons who are not citizens or nationals of United States for state or local public benefits.
1. Notwithstanding any other provision of state or local law, a person or governmental entity that provides a state or local public benefit:
(a) Shall comply with the provisions of 8 U.S.C. § 1621 regarding the eligibility of a person who is not a citizen or national of the United States for such a benefit.
(b) Is not required to pay any costs or other expenses relating to the provision of such a benefit after July 1, 1997, to a person who is not a citizen or national of the United States who, pursuant to 8 U.S.C. § 1621, is not eligible for the benefit.
2. Compliance with the provisions of 8 U.S.C. § 1621 must not be construed to constitute any form of discrimination, distinction or restriction made, or any other action taken, on the basis of national origin.
3. As used in this section, “state or local public benefit” has the meaning ascribed to it in 8 U.S.C. § 1621.
(Added to NRS by 1997, 2224; A 2013, 1303)
NRS 422.075 Division to submit certain information to Nevada Commission on Autism Spectrum Disorders. The Division shall submit to the Nevada Commission on Autism Spectrum Disorders created by NRS 427A.8801 upon the request of the Commission a report containing the most current information available concerning:
1. The number of persons receiving services for persons with autism spectrum disorders through the Medicaid program;
2. The outcomes of persons with autism spectrum disorders who receive services through the Medicaid program;
3. The expenditures made on behalf of the Medicaid program related to the provision of services for persons with autism spectrum disorders; and
4. The number of hours billed to the Medicaid program per week for each service provided to persons with autism spectrum disorders through the Medicaid program and the number of hours per week that each such service was actually provided to recipients of Medicaid.
(Added to NRS by 2019, 3055)
MEDICAL CARE ADVISORY COMMITTEE
NRS 422.151 Creation; function.
1. The Medical Care Advisory Committee is hereby created within the Division.
2. The function of the Medical Care Advisory Committee is to:
(a) Advise the 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 Division.
(Added to NRS by 1975, 1093; A 1993, 2060; 1997, 2617; 1999, 2242; 2005, 22nd Special Session, 22; 2015, 2336)
NRS 422.153 Composition; terms and compensation of members.
1. The Medical Care Advisory Committee consists of the Chief Medical Officer and:
(a) A person who:
(1) Holds a license to practice medicine in this state; and
(2) Is certified by the Board of Medical Examiners in a medical specialty.
(b) A person who holds a license to practice dentistry in this state.
(c) A person who holds a certificate of registration as a pharmacist in this state.
(d) A member of a profession in the field of health care who is familiar with the needs of persons of low income, the resources required for their care and the availability of those resources.
(e) An administrator of a hospital or a clinic for health care.
(f) An administrator of a facility for intermediate care or a facility for skilled nursing.
(g) A member of an organized group that provides assistance, representation or other support to recipients of Medicaid.
(h) A recipient of Medicaid.
2. The Director shall appoint each member required by subsection 1 to serve for a term of 2 years.
3. Members of the Medical Care Advisory Committee serve without compensation, except that while engaged in the business of the Advisory Committee, each member is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally.
(Added to NRS by 1975, 1093; A 1985, 421; 1993, 2060; 1997, 1237; 2015, 2337)
NRS 422.155 Chair; Secretary; meetings; subcommittees.
1. The Director shall appoint a Chair of the Medical Care Advisory Committee from among its members.
2. The Administrator or the designee of the Administrator shall serve as Secretary for the Medical Care Advisory Committee.
3. The Medical Care Advisory Committee:
(a) Shall meet at least once each calendar year.
(b) May, upon the recommendation of the Chair, form subcommittees for decisions and recommendations concerning specific problems within the scope of the functions of the Medical Care Advisory Committee.
(Added to NRS by 1975, 1093; A 1993, 2061; 1997, 2617; 1999, 2242; 2005, 22nd Special Session, 22; 2015, 2337)
ADVISORY COMMITTEE ON MEDICAID INNOVATION
NRS 422.162 Creation; appointment of members; terms; Chair; members serve without additional compensation; member who is state employee must be relieved from duties to prepare for and attend meetings.
1. The Advisory Committee on Medicaid Innovation is hereby created in the Division. The Director shall appoint the members to serve on the Advisory Committee.
2. The Director shall appoint officers and employees of the Executive Branch of State Government to serve as voting members of the Advisory Committee and may appoint such other persons as the Director deems necessary or appropriate to serve as nonvoting members.
3. The Director shall appoint each member to serve for a term of 2 years.
4. At its first meeting and annually thereafter, the Advisory Committee shall elect a Chair from among its voting members.
5. Members of the Advisory Committee serve without any additional compensation.
6. A member of the Advisory Committee who is an officer or employee of this State or a political subdivision of this State must be relieved from his or her duties without loss of regular compensation so that he or she may prepare for and attend meetings of the Advisory Committee and perform any work necessary to carry out the duties of the Advisory Committee in the most timely manner practicable. A state agency or political subdivision of this State shall not require an officer or employee who is a member of the Advisory Committee to:
(a) Make up the time the member is absent from work to carry out his or her duties as a member of the Advisory Committee; or
(b) Take annual leave or compensatory time for the absence.
(Added to NRS by 2017, 1301)
1. The Advisory Committee on Medicaid Innovation created by NRS 422.162 shall study:
(a) The manner in which to create or expand public or private prescription purchasing coalitions.
(b) The manner in which to encourage access to employer-based health insurance plans, including, without limitation:
(1) Coordinating coverage provided by the State Plan for Medicaid and private health insurance which may be provided by an employer to a person eligible for Medicaid; and
(2) Providing assistance to a person who is eligible for Medicaid to allow the person to purchase private health insurance.
(c) Opportunities to apply to the Secretary of the United States Department of Health and Human Services for certain waivers pursuant to 42 U.S.C. §§ 1315 and 18052.
2. At least once each year, the Advisory Committee shall make such recommendations to the Director as it deems appropriate relating to opportunities to improve Medicaid or to increase access to health insurance.
(Added to NRS by 2017, 1301)
REINVESTMENT ADVISORY COMMITTEE
NRS 422.175 “Reinvestment advisory committee” defined. As used in NRS 422.175 to 422.205, inclusive, unless the context otherwise requires, “reinvestment advisory committee” means a reinvestment advisory committee established by NRS 422.185.
(Added to NRS by 2021, 1062)
NRS 422.185 Establishment; membership; members serve without compensation; leave for members who are public employees.
1. A reinvestment advisory committee is hereby established in each county whose population is 700,000 or more.
2. A reinvestment advisory committee consists of the following members:
(a) The Administrator, who serves as a voting member;
(b) The following voting members, appointed by the Director:
(1) The director of a social services agency of the county;
(2) A representative of the government of the county;
(3) Two members who represent the government of different cities whose population is 100,000 or more that are located in the county;
(4) Two members who represent nonprofit organizations that work with recipients of Medicaid who reside in the county and receive health care services through managed care; and
(5) One member who represents the Division of Welfare and Supportive Services of the Department; and
(c) Other persons that the Director deems necessary or appropriate to serve as nonvoting members.
3. The members appointed to a reinvestment advisory committee pursuant to paragraphs (b) and (c) of subsection 2 serve at the pleasure of the Director.
4. The members of a reinvestment advisory committee serve without compensation and are not entitled to the per diem allowance and travel expenses provided for state officers and employees generally.
5. Any member of a reinvestment advisory committee who is a public employee must be granted administrative leave from his or her duties to engage in the business of the committee without loss of his or her regular compensation. Such leave does not reduce the amount of the member’s other accrued leave.
(Added to NRS by 2021, 1062)
NRS 422.195 Chair; meetings; subcommittees; quorum.
1. The Director shall appoint the chair of each reinvestment advisory committee from among its voting members.
2. A reinvestment advisory committee:
(a) Shall meet at least twice each calendar year or at the call of the chair.
(b) May, upon the recommendation of the chair, form subcommittees for decisions and recommendations concerning specific issues within the scope of the duties of the committee prescribed by NRS 422.205.
3. A majority of the voting members of a reinvestment advisory committee constitutes a quorum for the transaction of business, and the affirmative vote of a majority of the voting members of the committee is required to take action.
(Added to NRS by 2021, 1063)
1. A reinvestment advisory committee shall:
(a) Solicit and review reports from the Division and Medicaid managed care organizations concerning the reinvestment of funds by those Medicaid managed care organizations in the communities served by the Medicaid managed care organizations.
(b) Report to the Division and Medicaid managed care organizations concerning initiatives of local governments in the county to address homelessness, housing issues and social determinants of health.
(c) Make recommendations based on the reports reviewed pursuant to paragraph (a) to the Division and Medicaid managed care organizations concerning the reinvestment of funds by those Medicaid managed care organizations in the communities served by the Medicaid managed care organizations. Those recommendations must include, without limitation, recommendations for the use of such funds for the purposes of:
(1) Developing innovative partnerships with community development organizations and providers of housing services; and
(2) Supporting the initiatives of local governments in the county to address homelessness, housing issues and social determinants of health.
2. On or before December 31 of each year, a reinvestment advisory committee shall:
(a) Compile a report concerning:
(1) The uses of funds reinvested by Medicaid managed care organizations in the communities served by those Medicaid managed care organizations, including, without limitation, efforts to address homelessness, disparities in health care and social determinants of health; and
(2) The activities of the reinvestment advisory committee during the calendar year, including, without limitation, the recommendations made by the reinvestment advisory committee pursuant to paragraph (c) of subsection 1.
(b) Submit the report to:
(1) The Director of the Legislative Counsel Bureau for transmittal to:
(I) In odd-numbered years, the Joint Interim Standing Committee on Health and Human Services; and
(II) In even-numbered years, the next regular session of the Legislature.
(2) The Director of the Department.
3. As used in this section, “Medicaid managed care organization” means a managed care organization that provides health care services to recipients of Medicaid who reside in the county for which a reinvestment advisory committee is established.
(Added to NRS by 2021, 1063)
ADMINISTRATOR OF DIVISION OF HEALTH CARE FINANCING AND POLICY
NRS 422.2354 Qualifications. The Administrator must:
1. Be appointed on the basis of his or her training, education, experience and interest in the financing of programs for public health, including, without limitation, the financing of Medicaid. In appointing the Administrator, the Director shall, to the extent practicable, give preference to a person who has a degree in a field of public administration, business administration or a related field.
2. 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.
3. Possess qualities of leadership in the fields of health care and the financing of health care.
(Added to NRS by 1997, 2612; A 1999, 2242; 2017, 1404)
NRS 422.2356 Executive Officer of Division; administration and management of Division. The Administrator:
1. Shall serve as the Executive Officer of the Division.
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.
(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd Special Session, 22)
NRS 422.2357 Administration of chapter. The Administrator and the Division shall administer the provisions of this chapter, subject to administrative supervision by the Director.
(Added to NRS by 1997, 2612; A 1999, 2242; 2003, 2748; 2005, 22nd Special Session, 31)
NRS 422.2358 Reports. 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.
(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd Special Session, 22)
NRS 422.2362 Fiscal duties. The Administrator:
1. Is responsible for and shall supervise the fiscal affairs and responsibilities of the Division, 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 Office of Finance.
3. Shall allocate, in the interest of efficiency and economy, the State’s appropriation for the administration of each program for which the Division is responsible, subject to administrative supervision by the Director.
(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd Special Session, 22)
NRS 422.2364 Organization of Division; appointment of heads of sections; employees; standards of service. The Administrator:
1. May establish, consolidate and abolish sections within the Division.
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 for the efficient operation of the Division.
5. Shall set standards of service.
(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd Special Session, 22)
NRS 422.2366 Administration of oaths; testimony of witnesses; subpoenas.
1. The Administrator or a designated representative may administer oaths and take testimony thereunder and issue subpoenas requiring the attendance of witnesses before the Division 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 or the Children’s Health Insurance Program;
(b) Verification of treatment and payments to a provider of medical care, remedial care or other services pursuant to the State Plan for Medicaid or the Children’s Health Insurance Program; and
(c) Recovery of Medicaid benefits paid on behalf of a recipient of medical care, remedial care or other services pursuant to the State Plan for Medicaid or the Children’s Health Insurance Program.
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.
(Added to NRS by 1997, 2613; A 1999, 2227, 2242; 2005, 22nd Special Session, 23; 2011, 2521)
NRS 422.2368 Adoption of regulations. The Administrator may adopt such regulations as are necessary for the administration of this chapter.
(Added to NRS by 1997, 2614; A 1999, 2242; 2003, 2747; 2005, 22nd Special Session, 23)
NRS 422.23685 Regulations required to include provision prohibiting certain actions relating to organ transplants for persons with disabilities.
1. The Administrator shall include in the regulations adopted pursuant to NRS 422.2368 a provision prohibiting the State from:
(a) Denying, limiting or seeking reimbursement from an insured for care related to an organ transplant because the insured is a person with a disability;
(b) Denying a person with a disability eligibility or continued eligibility to enroll or renew coverage to avoid providing coverage in accordance with this section;
(c) Reducing or limiting the reimbursement of or otherwise penalizing a provider of medical or related services because the provider of medical or related services acted in accordance with NRS 460.160; or
(d) Providing monetary or nonmonetary incentives for a provider of medical or related services to induce the provider of medical or related services to provide care to an insured in a manner inconsistent with NRS 460.160.
2. As used in this section:
(a) “Disability” has the meaning ascribed to it in 42 U.S.C. § 12102(1).
(b) “Provider of medical or related services” has the meaning ascribed to it in NRS 460.160.
(Added to NRS by 2021, 1170)
NRS 422.2369 Procedure for adopting, amending or repealing regulations.
1. Before adopting, amending or repealing any regulation for the administration of a program of public assistance or any other program for which the Division is responsible, the Administrator must give at least 30 days’ notice of the 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 Administrator 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 Administrator shall consider fully all oral and written submissions relating to the proposed regulation.
4. The Administrator shall keep, retain and make available for public inspection written minutes and an audio recording or transcript of each public hearing held pursuant to this section in the manner provided in NRS 241.035. A copy of the minutes or audio recordings must be made available to a member of the public upon request at no charge pursuant to NRS 241.035.
5. An objection to any regulation on the ground of noncompliance with the procedural requirements of this section may not be made more than 2 years after its effective date.
(Added to NRS by 1999, 2225; A 2005, 1413; 2005, 22nd Special Session, 23; 2013, 330)
NRS 422.2372 General and miscellaneous powers and duties. [Effective through December 31, 2025.] 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 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 the office of the Administrator.
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 orders issued by the Administrator or the enforcement of the provisions of this chapter.
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.
(Added to NRS by 1997, 2614; A 1999, 2242; 2003, 2747; 2005, 22nd Special Session, 24)
NRS 422.2372 General and miscellaneous powers and duties. [Effective January 1, 2026.] 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 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 the office of the Administrator.
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 orders issued by the Administrator or the enforcement of the provisions of this chapter.
8. Exclude from participation in Medicaid any provider of health care that fails to comply with the requirements of NRS 695K.230.
9. 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.
(Added to NRS by 1997, 2614; A 1999, 2242; 2003, 2747; 2005, 22nd Special Session, 24; 2021, 3637, effective January 1, 2026)
NRS 422.2374 Cooperation with Medicaid Fraud Control Unit; suspension or exclusion of provider of goods or services under State Plan for Medicaid.
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 regarding a provider;
(b) Refer to the Unit all cases in which the Administrator 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 the Administrator 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.
(Added to NRS by 1997, 2614; A 1999, 2242; 2005, 22nd Special Session, 24)
STATE DENTAL HEALTH OFFICER
NRS 422.239 Appointment by Division in unclassified service or as contractor; qualifications; duties; restrictions on other employment. [Replaced in revision by NRS 439.272.]
ADMINISTRATION AND PROCEDURE
Financial Administration
NRS 422.240 Legislative appropriations; disbursements.
1. Money to carry out the provisions of this chapter, including, without limitation, any federal money allotted to the State of Nevada pursuant to the State Plan for Medicaid, the Children’s Health Insurance Program or any other program for which the Division is responsible must, except as otherwise provided in NRS 422.3755 to 422.379, inclusive, and 439.630, be provided by appropriation by the Legislature from the State General Fund.
2. Disbursements for the purposes of this chapter must, except as otherwise provided in NRS 422.3755 to 422.379, inclusive, and 439.630, be made upon claims duly filed and allowed in the same manner as other money in the State Treasury is disbursed.
[14:327:1949; 1943 NCL § 5146.14]—(NRS A 1975, 175; 1991, 1051; 1997, 2236, 2621; 1999, 547, 550, 1427, 2242; 2001, 91, 1519; 2003, 629, 873, 1747; 2005, 736, 923, 1674, 2451; 2005, 22nd Special Session, 25; 2011, 2502; 2013, 1303)
NRS 422.242 Gifts and grants of money to Division: Deposit in Gift and Cooperative Account of the Division of Health Care Financing and Policy; use; approval of claims by Administrator.
1. Any gifts or grants of money which the Division 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 Health and Human Services’ 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.
(Added to NRS by 1997, 2615; A 1999, 2242; 2005, 22nd Special Session, 31)
NRS 422.260 Acceptance of Social Security Act and related federal money.
1. The State of Nevada assents to the purposes of the Act of Congress of the United States entitled the “Social Security Act,” approved August 14, 1935, and assents to such additional federal legislation as is not inconsistent with the purposes of this chapter and NRS 432.010 to 432.085, inclusive.
2. The State of Nevada further accepts, with the approval of the Governor, the appropriations of money by Congress in pursuance of the Social Security Act and authorizes the receipt of such money into the State Treasury for the use of the Department in accordance with this chapter, NRS 432.010 to 432.085, inclusive, and the conditions imposed by the Social Security Act.
3. The State of Nevada may accept, with the approval of the Governor, any additional funds which may become or are made available for extension of programs and services administered by the Department under the provisions of the Social Security Act. Such money must be deposited in the State Treasury for the use of the Department in accordance with this chapter, NRS 432.010 to 432.085, inclusive, and the conditions and purposes under which granted by the Federal Government.
[1:327:1949; 1943 NCL § 5146.01]—(NRS A 1963, 905; 1965, 329; 1993, 2693; 2005, 22nd Special Session, 25)
NRS 422.265 Acceptance of increased benefits of future congressional legislation; regulations. If Congress passes any law increasing the participation of the Federal Government in any program for which the Division is responsible, 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 Administrator may adopt any regulations required by the Federal Government as a condition of acceptance.
(Added to NRS by 1965, 331; A 1993, 2062, 2693; 1995, 674; 1997, 2622; 1999, 2242; 2005, 22nd Special Session, 25; 2013, 1304)
NRS 422.267 Contract or agreement with Federal Government by Director. The Director shall have the power to sign and execute, in the name of the State, by “The Department of Health and Human Services,” any contract or agreement with the Federal Government or its agencies.
[Part 9:327:1949; A 1951, 391; 1953, 333]—(NRS A 1963, 904; 1967, 1153; 1973, 1406; 2005, 22nd Special Session, 26)
State Plan for Medicaid and Children’s Health Insurance Program
NRS 422.270 Duties of Department regarding Medicaid and Children’s Health Insurance Program. The Department shall:
1. Administer Medicaid and the Children’s Health Insurance Program.
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 of Nevada to aid in the furtherance of Medicaid and the Children’s Health Insurance Program.
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 Medicaid and the Children’s Health Insurance Program and in increasing the efficiency of Medicaid and the Children’s Health Insurance Program by prompt and judicious use of new federal grants which will assist the Department in carrying out the provisions of this chapter.
4. Observe and study the changing nature and extent of needs for Medicaid and the Children’s Health Insurance Program 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 Medicaid and institutional care, when deemed necessary or convenient by the Director.
[Part 10:327:1949; A 1951, 546; 1953, 333]—(NRS A 1963, 905; 1965, 330; 1967, 1054; 1971, 374; 1973, 867; 1975, 1007; 1977, 431; 1981, 1910; 1989, 1155; 1991, 1052; 1993, 2063, 2694, 2787; 1995, 723; 1997, 1239, 2236, 2622, 2623; 1999, 581, 1427, 2242; 2001, 161; 2005, 22nd Special Session, 26; 2013, 1304)
NRS 422.2701 Discrimination by Department on basis of actual or perceived gender identity or expression prohibited. The Department shall not discriminate against any person with respect to participation or coverage under Medicaid on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:
1. Denying, cancelling, limiting or refusing to issue a payment or coverage on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;
2. Imposing a payment that is based on the actual or perceived gender identity or expression of a recipient of Medicaid or a family member of the recipient;
3. Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and
4. Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying payment or coverage for health care services that are:
(a) Related to gender transition, provided that there is coverage under Medicaid for the services when the services are not related to gender transition; or
(b) Ordinarily or exclusively available to persons of any sex.
(Added to NRS by 2023, 2053)
NRS 422.2703 Department required to establish and maintain system for electronic submission of applications for Medicaid or Children’s Health Insurance Program.
1. The Department shall establish and maintain a system which allows an applicant for Medicaid or the Children’s Health Insurance Program to submit the application electronically. The system must allow an applicant to submit an application through the Internet or another on-line service designated by the Department.
2. An agency designated by the Director to receive applications or determine eligibility for Medicaid or the Children’s Health Insurance Program shall use the system established pursuant to subsection 1 to forward to the Department all applications received by the agency.
3. An applicant for Medicaid or the Children’s Health Insurance Program must not be required to submit an application electronically. If an applicant submits a written application to an agency designated by the Director, the agency shall create an electronic application on behalf of the applicant and use the system established pursuant to subsection 1 to forward the application to the Department.
(Added to NRS by 2009, 629)
NRS 422.2704 Review of and recommendations concerning rates of reimbursement. On or before January 1, 2018, and every 4 years thereafter, the Division shall:
1. Review the rate of reimbursement for each service or item provided under the State Plan for Medicaid to determine whether the rate of reimbursement accurately reflects the actual cost of providing the service or item; and
2. If the Division determines that the rate of reimbursement for a service or item does not accurately reflect the actual cost of providing the service or item, calculate the rate of reimbursement that accurately reflects the actual cost of providing the service or item and recommend that rate to the Director for possible inclusion in the State Plan for Medicaid.
(Added to NRS by 2017, 185)
NRS 422.2712 Reporting of certain rates of reimbursement for physicians.
1. The Department, with respect to the State Plan for Medicaid and the Children’s Health Insurance Program, shall report every rate of reimbursement for physicians which is provided on a fee-for-service basis and which is lower than the rate provided on the current Medicare fee schedule for care and services provided by physicians.
2. The Director shall post on an Internet website maintained by the Department a schedule of such rates of reimbursement.
3. The Director shall, on or before February 1 of each year, submit a report concerning the schedule of such rates of reimbursement to the Director of the Legislative Counsel Bureau for transmittal to the Legislature in odd-numbered years or to the Joint Interim Standing Committee on Health and Human Services in even-numbered years.
(Added to NRS by 2013, 1302)
NRS 422.2717 State Plan for Medicaid: Inclusion of requirement that independent foster care adolescents are eligible for Medicaid.
1. The Director shall include in the State Plan for Medicaid a requirement that an independent foster care adolescent is eligible for Medicaid.
2. As used in this section, “independent foster care adolescent” means:
(a) A person described in 42 U.S.C. § 1396d(w)(1), as that section existed on July 1, 2005; or
(b) If the Director specifies a different category of adolescents in the manner set forth in 42 U.S.C. § 1396a(a)(10)(A)(ii)(XVII), as that section existed on July 1, 2005, a person who is within such a category.
(Added to NRS by 2005, 2451)
NRS 422.271705 State Plan for Medicaid: Inclusion of requirement concerning monthly personal needs allowance for institutionalized persons who reside in facility for skilled nursing.
1. The Director shall include in the State Plan for Medicaid a requirement that the monthly personal needs allowance described in 42 U.S.C. § 1396a(q) for each institutionalized person who resides in a facility for skilled nursing must be not less than the monthly personal needs allowance provided for residents of residential facilities for groups who, under the State Plan for Medicaid, receive home and community-based services.
2. As used in this section:
(a) “Facility for skilled nursing” has the meaning ascribed to it in NRS 449.0039.
(b) “Institutionalized person” has the meaning ascribed to the term “institutionalized individual or couple” in 42 U.S.C. § 1396a(q)(1)(B).
(c) “Residential facility for groups” has the meaning ascribed to it in NRS 449.017.
(Added to NRS by 2023, 1816)
NRS 422.27171 State Plan for Medicaid: Inclusion of authorization for pregnant women determined to be presumptively eligible for Medicaid to enroll in Medicaid for prescribed period without submitting application for enrollment which includes additional proof of eligibility; inclusion of authorization for pregnant women with certain household incomes to enroll in Medicaid; prohibition against inclusion of residency period requirement for enrollment in Medicaid by certain pregnant women.
1. The Director shall, to the extent authorized by federal law, include in the State Plan for Medicaid authorization for a pregnant woman who is determined by a qualified provider to be presumptively eligible for Medicaid to enroll in Medicaid until the last day of the month immediately following the month of enrollment without submitting an application for enrollment in Medicaid which includes additional proof of eligibility.
2. To the extent that money is available, the Director shall, to the extent authorized by federal law, include in the State Plan for Medicaid authorization for a pregnant woman whose household income is at or below 200 percent of the federally designated level signifying poverty to enroll in Medicaid.
3. Unless otherwise required by federal law, the Director shall not include in the State Plan for Medicaid a requirement that a pregnant woman who resides in this State and who is otherwise eligible for Medicaid must reside in the United States for a prescribed period of time before enrolling in Medicaid.
4. As used in this section, “qualified provider” has the meaning ascribed to it in 42 U.S.C. § 1396r-1(b)(2).
(Added to NRS by 2021, 2565, 3635)
NRS 422.27172 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to family planning; reimbursement of pharmacist for certain family planning services.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for:
(a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:
(1) Lawfully prescribed or ordered;
(2) Approved by the Food and Drug Administration; and
(3) Dispensed in accordance with NRS 639.28075;
(b) Any type of device for contraception which is lawfully prescribed or ordered and which has been approved by the Food and Drug Administration;
(c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;
(d) Insertion or removal of a device for contraception, including, without limitation, the insertion of such a device at a hospital immediately after a person gives birth;
(e) A contraceptive injection, including, without limitation, such an injection immediately after a person gives birth.
(f) Education and counseling relating to the initiation of the use of contraceptives and any necessary follow-up after initiating such use;
(g) Management of side effects relating to contraception; and
(h) Voluntary sterilization for women.
2. Except as otherwise provided in subsections 4 and 5, to obtain any benefit provided in the Plan pursuant to subsection 1, a person enrolled in Medicaid must not be required to:
(a) Pay a higher deductible, any copayment or coinsurance; or
(b) Be subject to a longer waiting period or any other condition.
3. The Director shall ensure that the provisions of this section are carried out in a manner which complies with the requirements established by the Drug Use Review Board and set forth in the list of preferred prescription drugs established by the Department pursuant to NRS 422.4025.
4. The Plan may require a person enrolled in Medicaid to pay a higher deductible, copayment or coinsurance for a drug for contraception if the person refuses to accept a therapeutic equivalent of the contraceptive drug.
5. For each method of contraception which is approved by the Food and Drug Administration, the Plan must include at least one contraceptive drug or device for which no deductible, copayment or coinsurance may be charged to the person enrolled in Medicaid, but the Plan may charge a deductible, copayment or coinsurance for any other contraceptive drug or device that provides the same method of contraception. If the Plan requires a person enrolled in Medicaid to pay a copayment or coinsurance for a drug for contraception, the Plan may only require the person to pay the copayment or coinsurance:
(a) Once for the entire amount of the drug dispensed for the plan year; or
(b) Once for each 1-month supply of the drug dispensed.
6. The Plan must provide for the reimbursement of a pharmacist for providing services described in subsection 1 that are within the scope of practice of the pharmacist to the same extent as if the services were provided by another provider of health care. The Plan must not limit:
(a) Coverage for such services provided by a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.
(b) Reimbursement for such services provided by a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.
7. The Plan must not require a recipient of Medicaid to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.
8. As used in this section:
(a) “Drug Use Review Board” has the meaning ascribed to it in NRS 422.402.
(b) “Provider of health care” has the meaning ascribed to it in NRS 629.031.
(c) “Therapeutic equivalent” means a drug which:
(1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;
(2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug; and
(3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.
(Added to NRS by 2017, 1800, 3927; A 2021, 3272; 2023, 913, 2087)
NRS 422.27173 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for testing for and treatment and prevention of sexually transmitted diseases and condoms. The Director shall include in the State Plan for Medicaid a requirement that the State must pay the nonfederal share of expenditures incurred for:
1. Testing for and the treatment and prevention of sexually transmitted diseases, including, without limitation, Chlamydia trachomatis, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all recipients of Medicaid, regardless of age. Services covered pursuant to this section must include, without limitation, the examination of a pregnant woman for the discovery of:
(a) Chlamydia trachomatis, gonorrhea, hepatitis B and hepatitis C in accordance with NRS 442.013.
(b) Syphilis in accordance with NRS 442.010.
2. Condoms for recipients of Medicaid.
(Added to NRS by 2021, 2577; A 2023, 3498)
NRS 422.27174 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for preventative care.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for:
(a) Counseling and support for breastfeeding;
(b) Screening and counseling for interpersonal and domestic violence;
(c) Counseling for sexually transmitted diseases;
(d) Screening for blood pressure abnormalities and diabetes, including gestational diabetes;
(e) An annual screening for cervical cancer;
(f) Screening for depression;
(g) Screening and counseling for the human immunodeficiency virus;
(h) Smoking cessation programs;
(i) All vaccinations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention of the United States Department of Health and Human Services or its successor organization; and
(j) Such well-woman preventative visits as recommended by the Health Resources and Services Administration.
2. To obtain any benefit provided in the Plan pursuant to subsection 1, a recipient of Medicaid must not be required to:
(a) Pay a higher deductible, any copayment or coinsurance; or
(b) Be subject to a longer waiting period or any other condition.
(Added to NRS by 2017, 1801)
NRS 422.27175 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for screening, genetic counseling and testing for harmful mutations in the BRCA gene for women. The Director shall include in the State Plan for Medicaid a requirement that the State, to the extent authorized by federal law, must pay the nonfederal share of expenditures incurred for screening, genetic counseling and testing for harmful mutations in the BRCA gene for women under circumstances where such screening, genetic counseling or testing, as applicable, is required by NRS 457.301.
(Added to NRS by 2021, 775)
NRS 422.27176 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for mammogram. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for a mammogram.
(Added to NRS by 2017, 1801)
NRS 422.27177 State Plan for Medicaid: Inclusion of coverage for doula services provided by enrolled doula; application for waiver or amendment related to doula services; requirements for enrollment as doula; program to provide incentive payments for enrolled doulas.
1. The Director shall, to the extent authorized by federal law, include under Medicaid coverage for doula services provided by an enrolled doula.
2. The Department shall apply to the Secretary of Health and Human Services for a waiver granted pursuant to 42 U.S.C. § 1315 or apply for an amendment of the State Plan for Medicaid that authorizes the Department to receive federal funding to provide coverage of doula services provided by an enrolled doula. The Department 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 waiver or amendment pursuant to this section.
3. A person who wishes to receive reimbursement through the Medicaid program for doula services provided to a recipient of Medicaid must submit to the Division:
(a) An application for enrollment in the form prescribed by the Division; and
(b) Proof that he or she possesses the required training and qualifications prescribed by the Division pursuant to subsection 4.
4. The Division, in consultation with community-based organizations that provide services to pregnant women in this State, shall prescribe the required training and qualifications for enrollment pursuant to subsection 3 to receive reimbursement through Medicaid for doula services.
5. The Department may establish a program to provide incentive payments for enrolled doulas who provide doula services to recipients of Medicaid in rural areas of this State.
6. As used in this section:
(a) “Doula services” means services to provide education and support relating to childbirth, including, without limitation, emotional and physical support provided during pregnancy, labor, birth and the postpartum period.
(b) “Enrolled doula” means a doula who is enrolled with the Division pursuant to this section to receive reimbursement through Medicaid for doula services.
(Added to NRS by 2021, 2620, 3636; A 2023, 2928)
NRS 422.271775 State Plan for Medicaid: Inclusion of requirement for payment of costs incurred for postpartum care services.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for postpartum care services provided to a recipient of Medicaid for 12 months following the end of pregnancy.
2. As used in this section, “postpartum care services” means medical care that is consistent with current standards of care and provided to a person following the end of pregnancy, including, without limitation:
(a) The development of a plan for postpartum care;
(b) Contact with the person after the end of pregnancy as needed by the person;
(c) A comprehensive postpartum visit, including, without limitation:
(1) Screening concerning the physical, social and psychological well-being of the person; and
(2) If necessary, a referral for a full assessment of the physical, social and psychological well-being of the person and any necessary treatment;
(d) Treatment of complications of pregnancy and childbirth, including, without limitation, pelvic floor disorders and postpartum depression, and any necessary referral for the evaluation and treatment of such complications;
(e) Screening for cardiovascular disease and, if necessary, a referral for a full assessment for cardiovascular disease and any necessary treatment; and
(f) Care related to the loss of a pregnancy.
(Added to NRS by 2023, 1485)
NRS 422.27178 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for breastfeeding supplies and prenatal screenings and tests. The Director may include in the State Plan for Medicaid a requirement that, to the extent money is available, the State pay the nonfederal share of expenditures incurred for:
1. Supplies for breastfeeding; and
2. Such prenatal screenings and tests as recommended by the American College of Obstetricians and Gynecologists or its successor organization.
(Added to NRS by 2017, 1801)
NRS 422.27179 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for breastfeeding supplies for certain period, prenatal screenings and tests and lactation consultation and support.
1. To the extent that money is available, the Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for:
(a) Supplies for breastfeeding a child until the child’s first birthday. Such supplies include, without limitation, electric or hospital-grade breast pumps that:
(1) Have been prescribed or ordered by a qualified provider of health care; and
(2) Are medically necessary for the mother or the child.
(b) Such prenatal screenings and tests as are recommended by the American College of Obstetricians and Gynecologists, or its successor organization.
2. The Director shall include in the State Plan for Medicaid a requirement that, to the extent that money and federal financial participation are available, the State must pay the nonfederal share of expenditures incurred for lactation consultation and support.
3. As used in this section:
(a) “Medically necessary” has the meaning ascribed to it in NRS 695G.055.
(b) “Provider of health care” has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 3637)
NRS 422.2718 State Plan for Medicaid: Inclusion of requirement for payment of certain expenses related to testing for human papillomavirus and administration of human papillomavirus vaccine.
1. The Director shall include in the State Plan for Medicaid a requirement that the State shall pay the nonfederal share of expenses incurred for:
(a) Testing for human papillomavirus; and
(b) Administering the human papillomavirus vaccine at such ages as recommended for vaccination by a competent authority, including, without limitation, the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, the Food and Drug Administration or the manufacturer of the vaccine.
2. For the purposes of this section, “human papillomavirus vaccine” means the Quadrivalent Human Papillomavirus Recombinant Vaccine or its successor which is approved by the Food and Drug Administration to be used for the prevention of human papillomavirus infection and cervical cancer.
(Added to NRS by 2007, 3243; A 2017, 1801)
NRS 422.2719 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to fetal alcohol spectrum disorders.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for screening for and diagnosis of fetal alcohol spectrum disorders and for treatment of fetal alcohol spectrum disorders to persons under the age of 19 years or, if enrolled in high school, until the person reaches the age of 21 years.
2. A managed care organization, including a health maintenance organization, that provides health care services to recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program pursuant to a contract with the Division, which provides coverage for outpatient care shall not require a longer waiting period for coverage for outpatient care related to fetal alcohol spectrum disorders than is required for other outpatient care covered by the plan.
3. A managed care organization shall cover medically necessary treatment of a fetal alcohol spectrum disorder.
4. Treatment of a fetal alcohol spectrum disorder must be identified in a treatment plan and must include medically necessary habilitative or rehabilitative care, prescription care, psychiatric care, psychological care, behavioral therapy or therapeutic care that is:
(a) Prescribed for a person diagnosed with a fetal alcohol spectrum disorder by a licensed physician or licensed psychologist; and
(b) Provided for a person diagnosed with a fetal alcohol spectrum disorder by a licensed physician, licensed psychologist, licensed behavior analyst or other provider that is supervised by the licensed physician, psychologist or behavior analyst.
Ê A managed care organization may request a copy of and review a treatment plan created pursuant to this subsection.
5. Nothing in this section shall be construed as requiring a managed care organization to provide reimbursement to a school for services delivered through school services.
6. As used in this section:
(a) “Applied behavior analysis” means the design, implementation and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvement in human behavior, including, without limitation, the use of direct observation, measurement and functional analysis of the relations between environment and behavior.
(b) “Behavioral therapy” means any interactive therapy derived from evidence-based research, including, without limitation, discrete trial training, early intensive behavioral intervention, intensive intervention programs, pivotal response training and verbal behavior provided by a licensed psychologist, licensed behavior analyst, licensed assistant behavior analyst or registered behavior technician.
(c) “Evidence-based research” means research that applies rigorous, systematic and objective procedures to obtain valid knowledge relevant to fetal alcohol spectrum disorders.
(d) “Fetal alcohol spectrum disorder” has the meaning ascribed to it in NRS 432B.0655.
(e) “Habilitative or rehabilitative care” means counseling, guidance and professional services and treatment programs, including, without limitation, applied behavior analysis, that are necessary to develop, maintain and restore, to the maximum extent practicable, the functioning of a person.
(f) “Health maintenance organization” has the meaning ascribed to it in NRS 695C.030.
(g) “Licensed assistant behavior analyst” has the meaning ascribed to the term “assistant behavior analyst” in NRS 641D.020.
(h) “Licensed behavior analyst” has the meaning ascribed to the term “behavior analyst” in NRS 641D.030.
(i) “Managed care organization” has the meaning ascribed to it in NRS 695G.050.
(j) “Medically necessary” means health care services or products that a prudent physician or psychologist would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and which are:
(1) Provided in accordance with generally accepted standards of medical practice;
(2) Clinically appropriate for the type, frequency, extent, location and duration;
(3) Not primarily provided for the convenience of the patient, physician, psychologist or other provider of health care;
(4) Required to improve a specific health condition of the patient or to preserve the existing state of health of the patient; and
(5) The most clinically appropriate level of health care that may be safely provided to the patient.
(k) “Prescription care” means medications prescribed by a licensed physician and any health-related services deemed medically necessary to determine the need or effectiveness of the medications.
(l) “Psychiatric care” means direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices.
(m) “Psychological care” means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.
(n) “Registered behavior technician” has the meaning ascribed to it in NRS 641D.100.
(o) “Screening for and diagnosis of fetal alcohol spectrum disorders” means medically appropriate assessments, evaluations or tests to screen and diagnose whether a person has a fetal alcohol spectrum disorder.
(p) “Therapeutic care” means services provided by licensed or certified speech-language pathologists, occupational therapists and physical therapists.
(q) “Treatment plan” means a plan to treat a fetal alcohol spectrum disorder that is prescribed by a licensed physician or licensed psychologist and may be developed pursuant to a comprehensive evaluation in coordination with a licensed behavior analyst.
(Added to NRS by 2019, 541; A 2021, 1615)
NRS 422.272 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for medical, administrative and transactional costs of certain persons admitted to certain medical facilities for more than 30 days.
1. The Director shall include in the State Plan for Medicaid a requirement that the State shall pay the nonfederal share of expenditures for the medical, administrative and transactional costs, to the extent not covered by private insurance, of a person:
(a) Who is admitted to a hospital, facility for intermediate care or facility for skilled nursing for not less than 30 consecutive days;
(b) Who is covered by the State Plan for Medicaid; and
(c) Whose net countable income per month is not more than a percentage prescribed annually by the Director of the supplemental security income benefit rate established pursuant to 42 U.S.C. § 1382(b)(1). The Director shall ensure that the percentage prescribed pursuant to this paragraph complies with federal law.
2. As used in this section:
(a) “Facility for intermediate care” has the meaning ascribed to it in NRS 449.0038.
(b) “Facility for skilled nursing” has the meaning ascribed to it in NRS 449.0039.
(c) “Hospital” has the meaning ascribed to it in NRS 449.012.
(Added to NRS by 1997, 2217; A 1997, 2217, 2705; 1999, 581, 590, 2242, 2754; 2001, 158; 2003, 873; 2011, 2684)
NRS 422.27205 State Plan for Medicaid: Inclusion of requirement for payment of costs for certain services provided by critical access hospitals.
1. The Director shall include in the State Plan for Medicaid, to the extent that federal financial participation is available, a requirement that the State must:
(a) Pay the nonfederal share of expenditures for outpatient services and swing-bed services provided by a critical access hospital; and
(b) Reimburse a critical access hospital for the services described in paragraph (a) at a rate equal to the actual cost to the critical access hospital of providing the services or the amount charged by the critical access hospital for the services, whichever is less.
2. As used in this section:
(a) “Critical access hospital” means a public or private hospital which has been certified as a critical access hospital by the United States Secretary of Health and Human Services pursuant to 42 U.S.C. § 1395i-4(e).
(b) “Swing-bed services” means services as described in 42 C.F.R. § 482.58.
(Added to NRS by 2023, 2080)
NRS 422.2721 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services provided through telehealth; inclusion of prohibition against certain practices related to such services.
1. The Director shall include in the State Plan for Medicaid:
(a) A requirement that the State shall pay for the nonfederal share of expenses for services provided to a person through telehealth to the same extent as though provided in person or by other means;
(b) A requirement that the State shall pay the nonfederal share of expenses for services described in paragraph (a) in the same amount as though provided in person or by other means:
(1) If the services:
(I) Are received at an originating site described in 42 U.S.C. § 1395m(m)(4)(C) or furnished by a federally-qualified health center or a rural health clinic; and
(II) Except for services described in subparagraph (2), are not provided through audio-only interaction; or
(2) For counseling or treatment relating to a mental health condition or a substance use disorder, including, without limitation, when such counseling or treatment is provided through audio-only interaction; and
(c) A provision prohibiting the State from:
(1) Requiring a person to obtain prior authorization that would not be required if a service were provided in person or through other means, establish a relationship with a provider of health care or provide any additional consent to or reason for obtaining services through telehealth as a condition to paying for services as described in paragraph (a) or (b). The State Plan for Medicaid may require prior authorization for a service provided through telehealth if such prior authorization would be required if the service were provided in person or through other means.
(2) Requiring a provider of health care to demonstrate that it is necessary to provide services to a person through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to paying for services as described in paragraph (a) or (b).
(3) Refusing to pay for services as described in paragraph (a) or (b) because of:
(I) The distant site from which a provider of health care provides services through telehealth or the originating site at which a person who is covered by the State Plan for Medicaid receives services through telehealth; or
(II) The technology used to provide the services.
(4) Requiring services to be provided through telehealth as a condition to paying for such services.
(5) Categorizing a service provided through telehealth differently for purposes relating to coverage than if the service had been provided in person or through other means.
2. The provisions of this section do not:
(a) Require the Director to include in the State Plan for Medicaid coverage of any service that the Director is not otherwise required by law to include; or
(b) Require the State or any political subdivision thereof to:
(1) Ensure that covered services are available to a recipient of Medicaid through telehealth at a particular originating site; or
(2) Provide coverage for a service that is not included in the State Plan for Medicaid or provided by a provider of health care that does not participate in Medicaid.
3. As used in this section:
(a) “Distant site” has the meaning ascribed to it in NRS 629.515.
(b) “Federally-qualified health center” has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).
(c) “Originating site” has the meaning ascribed to it in NRS 629.515.
(d) “Provider of health care” has the meaning ascribed to it in NRS 439.820.
(e) “Rural health clinic” has the meaning ascribed to it in 42 U.S.C. § 1395x(aa)(2).
(f) “Telehealth” has the meaning ascribed to it in NRS 629.515.
(Added to NRS by 2015, 630; A 2021, 3008, 3009, 3010, 3011; 2023, 235, 237)
NRS 422.2722 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services provided by community health worker.
1. The Director shall include in the State Plan for Medicaid a requirement that the State, to the extent authorized by federal law, pay the nonfederal share of expenditures incurred for the services of a community health worker who provides services under the supervision of a physician, physician assistant or advanced practice registered nurse.
2. The Director may include in the State Plan for Medicaid a requirement that the State, to the extent authorized by federal law, pay the nonfederal share of expenditures incurred for the services of community health workers who provide services under the supervision of specified types of providers of health care, other than those described in subsection 1.
3. As used in this section:
(a) “Community health worker” has the meaning ascribed to it in NRS 449.0027.
(b) “Provider of health care” has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 2568, 3636; A 2023, 223)
NRS 422.2723 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to dialysis and emergency care to treat kidney failure.
1. The Director shall include in the State Plan for Medicaid a requirement that the State shall pay the nonfederal share of expenses incurred in the administration of dialysis that is provided to stabilize a patient with kidney failure and further emergency care necessary for the treatment of such kidney failure.
2. For the purposes of this section, “dialysis” means the method by which a dissolved substance is removed from the body of a patient by diffusion, osmosis and convection from one fluid compartment to another fluid compartment across a semipermeable membrane.
(Added to NRS by 2013, 2265)
NRS 422.27234 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to sickle cell disease and its variants.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for:
(a) Necessary case management services for a participant in Medicaid who has been diagnosed with sickle cell disease and its variants.
(b) Medically necessary care for a participant in Medicaid who has been diagnosed with sickle cell disease and its variants including, without limitation, visits to specialists for evaluation, counseling, treatment for mental illness and education as needed.
(c) Services necessary to transition a recipient of Medicaid who is less than 18 years of age and has been diagnosed with sickle cell disease and its variants from pediatric care to adult care when the recipient reaches 18 years of age.
(d) Unlimited refills of each prescription drug for the treatment of sickle cell disease and its variants included on the list of preferred prescription drugs developed for the Medicaid program pursuant to NRS 422.4025.
(e) Each supplement included in the list of supplements prescribed pursuant to NRS 422.4026, including, without limitation, unlimited amounts of each such supplement.
2. As used in this section:
(a) “Case management services” means medical or other health care management services to assist patients and providers of health care, including, without limitation, identifying and facilitating additional resources and treatments, providing information about treatment options and facilitating communication between providers of services to a patient.
(b) “Sickle cell disease and its variants” has the meaning ascribed to it in NRS 439.4927.
(Added to NRS by 2019, 2166)
NRS 422.27235 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to testing for, preventing or treating human immunodeficiency virus or hepatitis C.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for:
(a) Any laboratory testing that is necessary for therapy that uses a drug approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus.
(b) The services of a pharmacist described in NRS 639.28085. The State must provide reimbursement for such services at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.
(c) Any service to test for, prevent or treat human immunodeficiency virus or hepatitis C provided by a provider of primary care if the service is covered when provided by a specialist and:
(1) The service is within the scope of practice of the provider of primary care; or
(2) The provider of primary care is capable of providing the service safely and effectively in consultation with a specialist and the provider engages in such consultation.
2. The Director shall include in the State Plan for Medicaid a requirement that the State reimburse an advanced practice registered nurse or a physician assistant for any service to test for, prevent or treat human immunodeficiency virus or hepatitis C at a rate equal to the rate of reimbursement provided to a physician for similar services.
3. As used in this section, “primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.
(Added to NRS by 2021, 3204; A 2023, 3498)
NRS 422.27236 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for cognitive assessment and care planning services for persons who experience signs or symptoms of cognitive impairment.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for cognitive assessment and care planning services provided to a person who experiences signs or symptoms of cognitive impairment.
2. As used in this section “cognitive impairment” means a deficiency in:
(a) Short-term or long-term memory;
(b) Orientation as to person, place and time; or
(c) Deductive or abstract reasoning.
Ê The term does not include any condition with temporary or reversible effects.
(Added to NRS by 2021, 2588)
NRS 422.272362 State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to gender dysphoria and gender incongruence.
1. Except as otherwise provided in this section, the Director shall include in the State Plan for Medicaid a requirement that the State, to the extent authorized by federal law, must pay the nonfederal share of expenditures incurred for the medically necessary treatment of conditions relating to gender dysphoria and gender incongruence. Such treatment includes medically necessary psychosocial and surgical intervention and any other medically necessary treatment for such disorders provided by:
(a) Endocrinologists;
(b) Pediatric endocrinologists;
(c) Social workers;
(d) Psychiatrists;
(e) Psychologists;
(f) Gynecologists;
(g) Speech-language pathologists;
(h) Primary care physicians;
(i) Advanced practice registered nurses;
(j) Physician assistants; and
(k) Any other providers of medically necessary services for the treatment of gender dysphoria or gender incongruence.
2. This section does not require the Director to include in the State Plan for Medicaid coverage for cosmetic surgery performed by a plastic surgeon or reconstructive surgeon that is not medically necessary.
3. The Department shall not categorically refuse to cover any medically necessary gender-affirming treatments or procedures or revisions to prior treatments if the State Plan for Medicaid provides coverage for any such services, procedures or revisions for purposes other than gender transition or affirmation.
4. When determining whether treatment is medically necessary for the purposes of this section, the Department must consider the most recent Standards of Care published by the World Professional Association for Transgender Health, or its successor organization.
5. If a person appeals the denial of a payment or coverage under this section on the grounds that the treatment requested by the person is not medically necessary, the Division must consult with a provider of health care who has experience in prescribing or delivering gender-affirming treatment concerning the medical necessity of the treatment requested by the person when considering the appeal.
6. As used in this section:
(a) “Cosmetic surgery”:
(1) Means a surgical procedure that:
(I) Does not meaningfully promote the proper function of the body;
(II) Does not prevent or treat illness or disease; and
(III) Is primarily directed at improving the appearance of a person.
(2) Includes, without limitation, cosmetic surgery directed at preserving beauty.
(b) “Gender dysphoria” means distress or impairment in social, occupational or other areas of functioning caused by a marked difference between the gender identity or expression of a person and the sex assigned to the person at birth which lasts at least 6 months and is shown by at least two of the following:
(1) A marked difference between gender identity or expression and primary or secondary sex characteristics or anticipated secondary sex characteristics in young adolescents.
(2) A strong desire to be rid of primary or secondary sex characteristics because of a marked difference between such sex characteristics and gender identity or expression or a desire to prevent the development of anticipated secondary sex characteristics in young adolescents.
(3) A strong desire for the primary or secondary sex characteristics of the gender opposite from the sex assigned at birth.
(4) A strong desire to be of the opposite gender or a gender different from the sex assigned at birth.
(5) A strong desire to be treated as the opposite gender or a gender different from the sex assigned at birth.
(6) A strong conviction of experiencing typical feelings and reactions of the opposite gender or a gender different from the sex assigned at birth.
(c) “Medically necessary” means health care services or products that a prudent provider of health care would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:
(1) Provided in accordance with generally accepted standards of medical practice;
(2) Clinically appropriate with regard to type, frequency, extent, location and duration;
(3) Not provided primarily for the convenience of the patient or provider of health care;
(4) Required to improve a specific health condition of a patient or to preserve the existing state of health of the patient; and
(5) The most clinically appropriate level of health care that may be safely provided to the patient.
Ê A provider of health care prescribing, ordering, recommending or approving a health care service or product does not, by itself, make that health care service or product medically necessary.
(d) “Provider of health care” has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2023, 2051)
NRS 422.272364 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for biomarker testing.
1. Subject to the limitations prescribed by subsection 4, the Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of cancer when such biomarker testing is supported by medical and scientific evidence. Such evidence includes, without limitation:
(a) The labeled indications for a biomarker test or medication that has been approved or cleared by the United States Food and Drug Administration;
(b) The indicated tests for a drug that has been approved by the United States Food and Drug Administration or the warnings and precautions included on the label of such a drug;
(c) A national coverage determination or local coverage determination, as those terms are defined in 42 C.F.R. § 400.202; or
(d) Nationally recognized clinical practice guidelines or consensus statements.
2. The Director shall:
(a) Ensure that the coverage required by subsection 1 is provided in a manner that limits disruptions in care and the need for multiple specimens;
(b) Include in the State Plan for Medicaid a clear and readily accessible process for a recipient of Medicaid or provider of health care to:
(1) Request an exception to a policy excluding coverage for biomarker testing for the diagnosis, treatment, management or ongoing monitoring of cancer; or
(2) Appeal a denial of coverage for such biomarker testing; and
(c) Make the process described in paragraph (b) available on an Internet website maintained by the Department.
3. If the State Plan for Medicaid requires a recipient of Medicaid to obtain prior authorization for a biomarker test described in subsection 1, the State Plan must require a response to a request for such prior authorization:
(a) Within 24 hours after receiving an urgent request; or
(b) Within 72 hours after receiving any other request.
4. The provisions of this section do not require the State Plan for Medicaid to include coverage of biomarker testing:
(a) For screening purposes;
(b) Conducted by a provider of health care for whom the biomarker testing is not within his or her scope of practice, training and experience; or
(c) That has not been determined to be medically necessary by a provider of health care for whom such a determination is within his or her scope of practice, training and experience.
5. As used in this section:
(a) “Biomarker” means a characteristic that is objectively measured and evaluated as an indicator of a normal biological process, a pathogenic process or a pharmacological response to a specific therapeutic intervention and includes, without limitation:
(1) An interaction between a gene and a drug that is being used by or considered for use by the patient;
(2) A mutation or characteristic of a gene; and
(3) The expression of a protein.
(b) “Biomarker testing” means the analysis of the tissue, blood or other biospecimen of a patient for the presentation of a biomarker and includes, without limitation, single-analyte tests, multiplex panel tests and whole genome, whole exome and whole transcriptome sequencing.
(c) “Consensus statement” means a statement aimed at a specific clinical circumstance that is:
(1) Made for the purpose of optimizing the outcomes of clinical care;
(2) Made by an independent, multidisciplinary panel of experts that has established a policy to avoid conflicts of interest;
(3) Based on scientific evidence; and
(4) Made using a transparent methodology and reporting procedure.
(d) “Medically necessary” means health care services or products that a prudent provider of health care would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:
(1) Provided in accordance with generally accepted standards of medical practice;
(2) Not primarily provided for the convenience of the patient or provider of health care; and
(3) Significant in guiding and informing the provider of health care in providing the most appropriate course of treatment for the patient in order to prevent, delay or lessen the magnitude of an adverse health outcome.
(e) “Nationally recognized clinical practice guidelines” means evidence-based guidelines establishing standards of care that include, without limitation, recommendations intended to optimize care of patients and are:
(1) Informed by a systemic review of evidence and an assessment of the risks and benefits of alternative options for care; and
(2) Developed using a transparent methodology and reporting procedure by an independent organization or society of medical professionals that has established a policy to avoid conflicts of interest.
(f) “Provider of health care” has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2023, 2209)
NRS 422.272366 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for behavioral health services. [Effective July 1, 2024.]
1. The Director shall include in the State Plan for Medicaid a requirement that the State must pay the nonfederal share of expenditures incurred for behavioral health services, including, without limitation, mental health services and services for the treatment of a substance use disorder, that are delivered through evidence-based, behavioral health integration models, including, without limitation, collaborative care management services.
2. As used in this section:
(a) “Behavioral health integration model” means a model of delivering behavioral health services that integrates such services with primary care. The term includes, without limitation, the delivery of behavioral health services using collaborative care management services.
(b) “Collaborative care management services” means a combination of services and structured care management with regular assessments directed and provided by a team of providers of primary care and providers of behavioral health care.
(Added to NRS by 2023, 2297, effective July 1, 2024)
NRS 422.272368 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for treatment of substance use disorder provided by provider of primary care.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenses for any service for the treatment of substance use disorder provided by a provider of primary care if the service is included in the State Plan when provided by a specialist and:
(a) The service is within the scope of practice of the provider of primary care; or
(b) The provider of primary care is capable of providing the service safely and effectively in consultation with a specialist and the provider engages in such consultation.
2. As used in this section, “primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.
(Added to NRS by 2023, 3497)
NRS 422.27237 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services of pharmacist; rate of reimbursement.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for the services of a pharmacist described in NRS 639.28079.
2. The State must provide reimbursement for the services of a pharmacist described in NRS 639.28079 at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.
(Added to NRS by 2023, 2365)
NRS 422.27238 State Plan for Medicaid: Reimbursement for crisis stabilization services. The Department shall take any action necessary to ensure that crisis stabilization services provided at a hospital with an endorsement as a crisis stabilization center pursuant to NRS 449.0915 are reimbursable under Medicaid to the same extent as if the services were provided in another covered facility.
(Added to NRS by 2019, 1923; A 2021, 240)
NRS 422.27239 State Plan for Medicaid: Reimbursement of supervising psychologist for services of psychological assistant, psychological intern or psychological trainee.
1. The Department, through the Division, may reimburse, under the State Plan for Medicaid and to the extent authorized by the Federal Government, any psychologist licensed pursuant to chapter 641 of NRS who supervises a psychological assistant, psychological intern or psychological trainee for such services rendered under the authorized scope of practice of the psychological assistant, psychological intern or psychological trainee to persons eligible to receive that assistance if another provider of health care would be reimbursed for providing those same services.
2. As used in this section:
(a) “Psychological assistant” has the meaning ascribed to it in NRS 641.0263.
(b) “Psychological intern” has the meaning ascribed to it in NRS 641.0265.
(c) “Psychological trainee” has the meaning ascribed to it in NRS 641.0267.
(Added to NRS by 2017, 2517)
NRS 422.2724 State Plan for Medicaid: Reimbursement of registered nurse for certain services provided to persons eligible for Medicaid. The Department, through the Division, 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 the registered nurse’s practice to persons eligible to receive that assistance if another provider of health care would be reimbursed for providing those same services.
(Added to NRS by 1985, 1655; A 1993, 2064; 1997, 1239, 2624; 1999, 2242; 2005, 22nd Special Session, 31)
NRS 422.272405 State Plan for Medicaid: Reimbursement for services provided by advanced practice registered nurse to certain recipients.
1. To the extent that money is available, the Director shall include in the State Plan for Medicaid a requirement that, except as otherwise provided in subsection 2, the State must provide reimbursement for the services of an advanced practice registered nurse, including, without limitation, a certified nurse-midwife, to the same extent as if the services were provided by a physician.
2. The provisions of subsection 1 do not apply to services provided to a recipient of Medicaid who receives health care services through a Medicaid managed care program.
3. As used in this section, “certified nurse-midwife” means a person who is:
(a) Certified as a nurse-midwife by the American Midwifery Certification Board, or its successor organization; and
(b) Licensed as an advanced practice registered nurse pursuant to NRS 632.237.
(Added to NRS by 2021, 3637)
NRS 422.272407 State Plan for Medicaid: Reimbursement of recipients for personal care services.
1. To the extent authorized by federal law, the Director shall include in the State Plan for Medicaid authorization for a recipient of Medicaid to be deemed a provider of services for the purposes of allowing the recipient to receive reimbursements for personal care services covered by Medicaid and use that money to pay for services provided by a personal care assistant acting pursuant to NRS 629.091 or an agency to provide personal care services in the home using a self-directed model.
2. As used in this section:
(a) “Agency to provide personal care services in the home” has the meaning ascribed to it in NRS 449.0021.
(b) “Personal care services” means the services described in NRS 449.1935.
(Added to NRS by 2021, 1290)
NRS 422.27241 State Plan for Medicaid: Reimbursement for services for hospice care provided to persons eligible for Medicaid.
1. Except as otherwise provided in subsection 2, the Department, through the Division, shall pay, under the State Plan for Medicaid:
(a) A facility for hospice care licensed pursuant to chapter 449 of NRS for the services for hospice care, including room and board, provided by that facility to a person who is eligible to receive Medicaid.
(b) A program for hospice care licensed pursuant to chapter 449 of NRS for the services for hospice care provided by that program to a person who is eligible to receive Medicaid.
2. The Department, through the Division, is required to pay, under the State Plan for Medicaid, for the services for hospice care provided by a facility or program described in subsection 1 only to the extent that the Federal Government provides matching federal money under Medicaid for the services for hospice care.
3. As used in this section:
(a) “Facility for hospice care” has the meaning ascribed to it in NRS 449.0033.
(b) “Hospice care” has the meaning ascribed to it in NRS 449.0115.
(Added to NRS by 1997, 1718; A 1999, 247, 469, 470; 2001, 161; 2005, 486; 2005, 22nd Special Session, 31)
NRS 422.27242 State Plan for Medicaid and Children’s Health Insurance Program: Inclusion of authorization for enrollment of certain children; authority to reduce or eliminate available benefits.
1. Except as otherwise provided in subsection 2, the Director shall:
(a) To the extent authorized by federal law, include in the State Plan for Medicaid and in the Children’s Health Insurance Program authorization for a child less than 19 years of age who is described in 42 U.S.C. § 1396b(v)(4)(A)(ii) to enroll in Medicaid and the Children’s Health Insurance Program; and
(b) Take any action necessary to comply with the requirements of the Centers for Medicare and Medicaid Services and any other applicable federal law to carry out the requirements of paragraph (a).
2. The Director may reduce or eliminate any benefits available pursuant to subsection 1 if:
(a) The provision of such benefits is no longer authorized by federal law; or
(b) The federal medical assistance percentage calculated pursuant to 42 U.S.C. § 1396d(b) is significantly reduced below the percentage existing on July 1, 2017.
(Added to NRS by 2017, 4311)
NRS 422.272422 Medicaid: Inclusion of coverage for certain dental care; application for waiver or amendment.
1. To the extent that federal financial participation is available, the Director shall include under Medicaid coverage for:
(a) The filling of cavities;
(b) The fabrication, preparation and placement of temporary and permanent crowns; and
(c) Removable dentures to improve chewing, phonetics and aesthetics.
2. The Department shall:
(a) Apply to the Secretary of Health and Human Services for any waiver of federal law or apply for any amendment of the State Plan for Medicaid that is necessary for the Department to receive federal funding to provide the coverage described in subsection 1.
(b) Fully cooperate in good faith with the Federal Government during the application process to satisfy the requirements of the Federal Government for obtaining a waiver or amendment pursuant to paragraph (a).
(Added to NRS by 2023, 3447)
NRS 422.272424 Medicaid: Inclusion of coverage for polycarbonate lenses; application for waiver or amendment.
1. To the extent that federal financial participation is available, the Director shall include under Medicaid coverage for polycarbonate lenses. Medicaid must not require, as a condition precedent to such coverage:
(a) A provider of health care to provide documentation concerning the reasons for using a polycarbonate lens instead of another type of lens; or
(b) The recipient of Medicaid to try another type of lens.
2. The Department shall:
(a) Apply to the Secretary of Health and Human Services for any waiver of federal law or apply for any amendment of the State Plan for Medicaid that is necessary for the Department to receive federal funding to provide the coverage described in subsection 1.
(b) Fully cooperate in good faith with the Federal Government during the application process to satisfy the requirements of the Federal Government for obtaining a waiver or amendment pursuant to paragraph (a).
(Added to NRS by 2023, 3447)
NRS 422.272428 Medicaid: Inclusion of coverage for limited services for certain persons before scheduled release from incarceration; application for waiver.
1. The Director shall, to the extent that federal financial participation is available, include under Medicaid coverage for limited services for persons described in subsection 2 who are incarcerated, for not more than 90 days before the scheduled release of such persons. Such services must include, without limitation:
(a) Case management;
(b) Consultations with providers of physical and behavioral health care;
(c) Laboratory and radiology services;
(d) Prescription drugs, including, without limitation, medication-assisted treatment; and
(e) The services of a community health worker.
2. A person is eligible for the coverage described in subsection 1 if the person would otherwise be eligible for Medicaid if he or she were not incarcerated and:
(a) Is under 18 years of age;
(b) Has been diagnosed with:
(1) A mental illness;
(2) Substance use disorder;
(3) A chronic disease or other significant disease;
(4) An intellectual disability;
(5) A developmental disability;
(6) A traumatic brain injury; or
(7) Human immunodeficiency virus; or
(c) Is pregnant or not more than 12 weeks postpartum.
3. The Department shall apply to the Secretary of Health and Human Services for a waiver granted pursuant to 42 U.S.C. § 1315 that authorizes the Department to receive federal funding to provide the coverage required by this section. The Department 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 waiver pursuant to this section.
4. If the Secretary of Health and Human Services grants the waiver applied for pursuant to subsection 3, the Department of Corrections shall coordinate with the Department of Health and Human Services on an ongoing basis to ensure persons described in subsection 2 who are incarcerated are screened and identified for eligibility to receive the coverage described in subsection 1.
5. As used in this section:
(a) “Chronic disease” means a health condition or disease which presents for a period of 3 months or more or is persistent, indefinite or incurable.
(b) “Community health worker” has the meaning ascribed to it in NRS 449.0027.
(c) “Developmental disability” has the meaning ascribed to it in NRS 433.069.
(d) “Intellectual disability” has the meaning ascribed to it in NRS 433.099.
(e) “Medication-assisted treatment” means treatment for an opioid use disorder using medication approved by the United States Food and Drug Administration for that purpose.
(f) “Mental illness” means any mental dysfunction leading to the impaired ability of a person to maintain himself or herself and to function effectively in his or her life situation without external support.
(g) “Traumatic brain injury” means a sudden shock or damage to the brain or its coverings which is not of a degenerative nature and produces an altered state of consciousness or temporarily or permanently impairs the mental, cognitive, behavioral or physical functioning of the brain. The term does not include:
(1) A cerebral vascular accident;
(2) An aneurism; or
(3) A congenital defect.
(Added to NRS by 2023, 2992)
NRS 422.27243 Program to provide medical assistance to certain persons who are employed and have disabilities.
1. Upon approval of the Interim Finance Committee, the Director, through the Division, shall establish a program for the provision of medical assistance to certain persons who are employed and have disabilities. The Director shall establish the program by:
(a) Amending the State Plan for Medicaid in the manner set forth in 42 U.S.C. § 1396a(a)(10)(A)(ii)(XIII);
(b) Amending the State Plan for Medicaid in the manner set forth in 42 U.S.C. § 1396a(a)(10)(A)(ii)(XV); or
(c) Obtaining a Medicaid waiver from the Federal Government to carry out the program.
2. The Director may require a person participating in a program established pursuant to subsection 1 to pay a premium or other cost-sharing charges in a manner that is consistent with federal law.
(Added to NRS by 2001, 2371; A 2005, 22nd Special Session, 27)
NRS 422.27247 Application for federal waiver to provide certain dental care for certain persons.
1. The Department shall apply to the Secretary of Health and Human Services for a waiver granted pursuant to 42 U.S.C. § 1315 to authorize the Department to provide the dental care described in this section for persons with diabetes who are at least 21 years of age. To the extent authorized by the waiver and in accordance with any requirements of the waiver, including, without limitation, requirements concerning fiscal neutrality, such dental care must consist of an initial oral evaluation and, if that evaluation determines, in accordance with the criteria for periodontal disease prescribed by the American Academy of Periodontology or its successor organization, that:
(a) The person does not have periodontal disease:
(1) Dental prophylaxis for adults, an oral evaluation, the tracking and monitoring of glycosylated hemoglobin and notification of the person and his or her primary care provider, if any, concerning abnormal results once every 180 days;
(2) A comprehensive periodontal evaluation annually; and
(3) Filling of cavities, as necessary.
(b) The person has periodontal disease:
(1) Up to four quadrants of periodontal scaling and root planing every 36 months or, if periodontal scaling and root planing are determined to be unnecessary in accordance with the guidelines prescribed by the American Dental Association or its successor organization, dental prophylaxis for adults every 180 days;
(2) One periodontal maintenance procedure every 91 days;
(3) Tracking and monitoring of glycosylated hemoglobin and notification of the person and his or her primary care provider, if any, concerning abnormal results every 90 days; and
(4) Filling of cavities, as necessary.
2. The Director shall collaborate with the Division of Public and Behavioral Health of the Department when carrying out the provisions of this section.
3. As used in this section, “dental prophylaxis” means the use of dental tools and polishing procedures to remove plaque, tartar and stains from the portion of the tooth that extends above the gum line
(Added to NRS by 2019, 2417)
NRS 422.27248 Application for federal waiver authorizing Department to receive federal funding for coverage for certain treatment for person in institution for mental diseases.
1. The Department shall apply to the Secretary of Health and Human Services for a waiver granted pursuant to 42 U.S.C. § 1315 that authorizes the Department to receive federal funding to provide coverage under Medicaid for the treatment of the substance use disorder of a person who is in an institution for mental diseases.
2. The Department may apply to the Secretary of Health and Human Services for a waiver granted pursuant to 42 U.S.C. § 1315 that authorizes the Department to receive federal funding to provide coverage under Medicaid for the treatment of an adult with a serious mental illness or a child with a serious emotional disturbance in an institution for mental diseases.
3. The Department shall cooperate with the Federal Government in obtaining:
(a) A waiver pursuant to subsection 1; and
(b) Any waiver for which the Department applies pursuant to subsection 2.
4. As used in this section:
(a) “Adult with a serious mental illness” means a person who is at least 18 years of age and has been diagnosed within the immediately preceding 12 months as having a mental, behavioral or emotional disorder as defined in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, other than an addictive disorder, intellectual or developmental disability, irreversible dementia or a substance use disorder, which interferes with or limits one or more major life activities of the person.
(b) “Child with a serious emotional disturbance” means a person who is less than 18 years of age and has been diagnosed within the immediately preceding 12 months as having a mental, behavioral or emotional disorder as defined in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, other than a disorder designated as a Code V disorder in the Manual, a developmental disability or a substance use disorder, which substantially interferes with or limits the person from developing social, behavioral, cognitive, communicative or adaptive skills or his or her activities relating to family, school or community. The term does not include a person with a disorder which is temporary or is an expected response to a stressful event.
(c) “Developmental disability” has the meaning ascribed to it in NRS 435.007.
(d) “Institution for mental diseases” has the meaning ascribed to it in 42 U.S.C. § 1396d(i).
(e) “Intellectual disability” has the meaning ascribed to it in NRS 435.007.
(Added to NRS by 2021, 2837; A 2023, 2994)
NRS 422.27249 Application for federal waiver to increase rates of reimbursement for rural emergency hospital services.
1. The Department may apply to the Secretary of Health and Human Services for a waiver of federal law or amendment to the State Plan for Medicaid that authorizes the Department to receive federal funding to provide increased rates of reimbursement under the State Plan for rural emergency hospital services provided by a rural emergency hospital. The Department 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 waiver or amendment pursuant to this section.
2. As used in this section:
(a) “Rural emergency hospital” has the meaning ascribed to it in NRS 449.0178.
(b) “Rural emergency hospital services” has the meaning ascribed to it in 42 U.S.C. § 1395x(kkk).
(Added to NRS by 2023, 2938)
NRS 422.273 Establishment, development and implementation of Medicaid managed care program. [Effective through December 31, 2025.]
1. For any Medicaid managed care program established in the State of Nevada, the Department shall contract only with a health maintenance organization that has:
(a) Negotiated in good faith with a federally-qualified health center to provide health care services for the health maintenance organization;
(b) Negotiated in good faith with the University Medical Center of Southern Nevada to provide inpatient and ambulatory services to recipients of Medicaid; and
(c) Negotiated in good faith with the University of Nevada School of Medicine to provide health care services to recipients of Medicaid.
Ê Nothing in this section shall be construed as exempting a federally-qualified health center, the University Medical Center of Southern Nevada or the University of Nevada School of Medicine from the requirements for contracting with the health maintenance organization.
2. During the development and implementation of any Medicaid managed care program, the Department shall cooperate with the University of Nevada School of Medicine by assisting in the provision of an adequate and diverse group of patients upon which the school may base its educational programs.
3. The University of Nevada School of Medicine may establish a nonprofit organization to assist in any research necessary for the development of a Medicaid managed care program, receive and accept gifts, grants and donations to support such a program and assist in establishing educational services about the program for recipients of Medicaid.
4. For the purpose of contracting with a Medicaid managed care program pursuant to this section, a health maintenance organization is exempt from the provisions of NRS 695C.123.
5. The provisions of this section apply to any managed care organization, including a health maintenance organization, that provides health care services to recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program pursuant to a contract with the Division. Such a managed care organization or health maintenance organization is not required to establish a system for conducting external reviews of adverse determinations in accordance with chapter 695B, 695C or 695G of NRS. This subsection does not exempt such a managed care organization or health maintenance organization for services provided pursuant to any other contract.
6. As used in this section, unless the context otherwise requires:
(a) “Federally-qualified health center” has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).
(b) “Health maintenance organization” has the meaning ascribed to it in NRS 695C.030.
(c) “Managed care organization” has the meaning ascribed to it in NRS 695G.050.
(Added to NRS by 1997, 1236; A 2001, 1927; 2003, 785; 2005, 22nd Special Session, 27; 2011, 3419)
NRS 422.273 Establishment, development and implementation of statewide Medicaid managed care program; statewide procurement process to select health maintenance organizations to provide services. [Effective January 1, 2026.]
1. To the extent that money is available, the Department shall:
(a) Establish a Medicaid managed care program to provide health care services to recipients of Medicaid in all geographic areas of this State. The program is not required to provide services to recipients of Medicaid who are aged, blind or disabled pursuant to Title XVI of the Social Security Act, 42 U.S.C. §§ 1381 et seq.
(b) Conduct a statewide procurement process to select health maintenance organizations to provide the services described in paragraph (a).
2. For any Medicaid managed care program established in the State of Nevada, the Department shall contract only with a health maintenance organization that has:
(a) Negotiated in good faith with a federally-qualified health center to provide health care services for the health maintenance organization;
(b) Negotiated in good faith with the University Medical Center of Southern Nevada to provide inpatient and ambulatory services to recipients of Medicaid;
(c) Negotiated in good faith with the University of Nevada School of Medicine to provide health care services to recipients of Medicaid; and
(d) Complied with the provisions of subsection 2 of NRS 695K.220.
Ê Nothing in this section shall be construed as exempting a federally-qualified health center, the University Medical Center of Southern Nevada or the University of Nevada School of Medicine from the requirements for contracting with the health maintenance organization.
3. During the development and implementation of any Medicaid managed care program, the Department shall cooperate with the University of Nevada School of Medicine by assisting in the provision of an adequate and diverse group of patients upon which the school may base its educational programs.
4. The University of Nevada School of Medicine may establish a nonprofit organization to assist in any research necessary for the development of a Medicaid managed care program, receive and accept gifts, grants and donations to support such a program and assist in establishing educational services about the program for recipients of Medicaid.
5. For the purpose of contracting with a Medicaid managed care program pursuant to this section, a health maintenance organization is exempt from the provisions of NRS 695C.123.
6. To the extent that money is available, a Medicaid managed care program must include, without limitation, a state-directed payment arrangement established in accordance with 42 C.F.R. § 438.6(c) to require a Medicaid managed care organization to reimburse a critical access hospital and any federally-qualified health center or rural health clinic affiliated with a critical access hospital for covered services at a rate that is equal to or greater than the rate received by the critical access hospital, federally-qualified health center or rural health clinic, as applicable, for services provided to recipients of Medicaid on a fee-for-service basis.
7. The provisions of this section apply to any managed care organization, including a health maintenance organization, that provides health care services to recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program pursuant to a contract with the Division. Such a managed care organization or health maintenance organization is not required to establish a system for conducting external reviews of adverse determinations in accordance with chapter 695B, 695C or 695G of NRS. This subsection does not exempt such a managed care organization or health maintenance organization for services provided pursuant to any other contract.
8. As used in this section, unless the context otherwise requires:
(a) “Critical access hospital” means a hospital which has been certified as a critical access hospital by the Secretary of Health and Human Services pursuant to 42 U.S.C. § 1395i-4(e).
(b) “Federally-qualified health center” has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).
(c) “Health maintenance organization” has the meaning ascribed to it in NRS 695C.030.
(d) “Managed care organization” has the meaning ascribed to it in NRS 695G.050.
(e) “Rural health clinic” has the meaning ascribed to it in 42 C.F.R. § 405.2401.
(Added to NRS by 1997, 1236; A 2001, 1927; 2003, 785; 2005, 22nd Special Session, 27; 2011, 3419; 2021, 3638, effective January 1, 2026)
NRS 422.2734 Plan to ensure provision of behavioral health services by certain managed care organizations in culturally competent manner: Preparation; contents; implementation; review; additional duties.
1. To the extent practicable, the Division shall require a managed care organization, including, without limitation, a health maintenance organization, that provides behavioral health services to recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program pursuant to a contract with the Division to prepare and implement a plan to ensure that such services are provided in a culturally competent manner.
2. A plan to ensure that behavioral health services are provided in a culturally competent manner must be approved by the Division and must include, without limitation:
(a) Identification of disparities in the incidence of behavioral health problems, in access to or usage of behavioral health services and in behavioral health outcomes based on race, color, ancestry, national origin, disability, familial status, sex, sexual orientation, gender identity or expression, immigration status, primary language and income level, to the extent that data is available to identify such disparities;
(b) Strategies for reducing the disparities identified pursuant to paragraph (a) and the rationale for each strategy;
(c) Mechanisms and goals to measure the effectiveness of the strategies prescribed pursuant to paragraph (b) and, if applicable, the degree to which the managed care organization has achieved goals set forth in previous plans;
(d) Strategies for addressing trauma and providing services in a trauma-informed manner; and
(e) Strategies for soliciting input from persons to whom the managed care organization provides services and other interested persons.
3. If the Division requires a managed care organization to prepare and implement a plan to ensure that behavioral health services are provided in a culturally competent manner, the managed care organization must:
(a) Establish, through an open invitation, a committee of interested persons for the purpose of conducting an ongoing review of the plan. The committee must include, without limitation, state and local government officers and employees, consumers of behavioral health services, advocates for consumers of behavioral health services, experts on reducing disparities in behavioral health and providers of behavioral health services.
(b) Biennially update the plan to reflect changes in the population served by the managed care organization and submit the updated plan to the Division for approval and for technical assistance and feedback concerning the implementation of the plan.
(c) Post the plan and each updated version of the plan on a publicly available Internet website.
(d) Biennially compile, submit to the Division and post publicly on the Internet a report concerning the degree to which the managed care organization has achieved or is progressing toward achieving the goals set forth pursuant to paragraph (c) of subsection 2.
4. A committee established pursuant to paragraph (a) of subsection 3 must meet at least quarterly. Such meetings:
(a) May be conducted remotely or in person; and
(b) Must be open to the public.
5. The Department and the Division shall provide a managed care organization with any demographic information or technical assistance necessary to carry out the requirements imposed pursuant to this section. A managed care organization may solicit any information necessary to carry out the requirements imposed pursuant to this section from persons who receive behavioral health services from the plan.
6. As used in this section, “trauma-informed manner” means a manner that:
(a) Is informed by knowledge of and responsiveness to the effects of trauma;
(b) Emphasizes physical, psychological and emotional safety for persons receiving services; and
(c) Creates opportunities for a person affected by trauma to rebuild a sense of control and empowerment.
(Added to NRS by 2021, 2705)
NRS 422.2735 Program to provide increased capitation payments to Medicaid managed care plans for ground emergency medical transportation services provided by governmental provider. [Effective on the date that a program to provide increased capitation payments to governmental providers for ground emergency medical transportation services established pursuant to this section is approved by the Centers for Medicare and Medicaid Services.]
1. The Director may, in consultation with governmental providers and Medicaid managed care plans, develop a program to include in the managed care organization rate certification for the Medicaid managed care plans increased capitation payments to the Medicaid managed care plans for ground emergency medical transportation services which are provided by a governmental provider pursuant to a contract or other arrangement between the governmental provider and a Medicaid managed care plan. Participation in such a program by a governmental provider is voluntary and, if a governmental provider elects to participate in such a program, the governmental provider must pay the nonfederal share of the expenditures on the program.
2. If a program is established pursuant to this section, a governmental provider or Medicaid managed care plan that wishes to participate in the program must enter into an agreement with the Department to comply with any request by the Department for information or data necessary to claim federal money or obtain federal approval in connection with the program.
3. In addition to complying with subsection 2, a governmental provider that wishes to participate in a program established pursuant to this section must:
(a) Hold a permit to operate an ambulance or a permit to operate a vehicle of a fire-fighting agency at the scene of an emergency issued pursuant to NRS 450B.200; and
(b) Provide ground emergency medical services to recipients of Medicaid pursuant to a contract or other arrangement with a Medicaid managed care plan.
4. If a program is established pursuant to this section, a governmental provider that meets the requirements of subsections 2 and 3 and wishes to receive increased capitation payments must make an intergovernmental transfer of money to the Department in an amount corresponding with the amount that the governmental provider has spent on ground emergency medical transportation services or pay the nonfederal share of expenditures on the program. To the extent that such money is accepted from a governmental provider, the Department shall make increased capitation payments to the applicable Medicaid managed care plan. To the extent permissible under federal law, the increased capitation payments must be in amounts actuarially equivalent to or greater than the supplemental cost based payments available under a program of supplemental reimbursements for governmental providers who provide services on a fee-for-service basis.
5. Except as otherwise provided in subsection 6, all money associated with intergovernmental transfers or the nonfederal share of expenditures made and accepted pursuant to subsection 4 must be used to make additional payments to governmental providers under a program established pursuant to this section. A Medicaid managed care plan shall pay all of any increased capitation payments made pursuant to subsection 4 to a governmental provider for ground emergency medical transportation services pursuant to a contract or other arrangement with the Medicaid managed care plan.
6. The Department may implement the program described in this section only to the extent that the program is approved by the Centers for Medicare and Medicaid Services and federal financial participation is available. To the extent authorized by federal law, the Department may implement the program for ground emergency medical transportation services provided before the effective date of this section.
7. If the Director determines that payments made under the provisions of this section do not comply with federal requirements relating to Medicaid, the Director may:
(a) Return or refuse to accept an intergovernmental transfer; or
(b) Adjust any payment made under the provisions of this section to comply with federal requirements relating to Medicaid.
8. As used in this section:
(a) “Advanced emergency medical technician” has the meaning ascribed to it in NRS 450B.025.
(b) “Ambulance” has the meaning ascribed to it in NRS 450B.040.
(c) “Emergency medical technician” has the meaning ascribed to it in NRS 450B.065.
(d) “Fire-fighting agency” has the meaning ascribed to it in NRS 450B.072.
(e) “Governmental provider” means a provider of ground emergency medical transportation services that is owned or operated by a state or local governmental entity or federally recognized Indian tribe.
(f) “Ground emergency medical transportation services” means emergency medical transportation services provided by an ambulance or a vehicle of a fire-fighting agency, including, without limitation, services provided by emergency medical technicians, advanced emergency medical technicians and paramedics in prestabilizing patients and preparing patients for transport.
(g) “Medicaid managed care plan” means a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.
(h) “Paramedic” has the meaning ascribed to it in NRS 450B.095.
(Added to NRS by 2017, 2194, 2195, effective on the date that a program to provide increased capitation payments to governmental providers for ground emergency medical transportation services established pursuant to this section is approved by the Centers for Medicare and Medicaid Services)
NRS 422.2748 Cooperation with Medicaid Fraud Control Unit.
1. The Director or a representative designated by the Director 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 Department regarding a provider; and
(b) Refer to the Unit all cases in which the Director or designated representative suspects that a provider has committed an offense pursuant to NRS 422.540 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.
(Added to NRS by 1991, 1050; A 1997, 1238, 2620; 1999, 2242; 2003, 659)
NRS 422.27482 Report concerning provision of health benefits by large employers.
1. On or before January 1 of each year, the Director shall prepare, in consultation with the Director of the Department of Business and Industry, a report which includes, without limitation:
(a) The name, street address of the office of the registered agent and the principal place of business of an employer in this State that employs 50 or more employees and whether the employer offers health benefits to its employees;
(b) The total number of persons enrolled in Medicaid who are employed on a full-time basis by such an employer;
(c) The number of persons enrolled in Medicaid who are married to or the dependent of an employee of such an employer; and
(d) The cost of providing coverage through Medicaid to the persons described in paragraphs (b) and (c).
2. The report prepared pursuant to subsection 1 must not contain any individually identifiable health information and must comply with the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as amended.
3. The Director shall submit the report required pursuant to subsection 1 to:
(a) The Governor; and
(b) The Director of the Legislative Counsel Bureau for transmittal to the Legislature.
4. The report required pursuant to this section must not include any personally identifiable information of a person whose information is included in the report.
5. As used in this section, “individually identifiable health information” has the meaning ascribed to it in 45 C.F.R. § 160.103.
(Added to NRS by 2017, 1300)
NRS 422.27485 Enrollment of eligible Indian children in Children’s Health Insurance Program: Duty of Department to seek assistance of and cooperate with Indian tribes; immediate action required; certain contracts for provision of services required. The Department shall:
1. Seek the assistance of and cooperate with Indian tribes, tribal organizations and organizations that collaborate with Indian tribes to identify Indian children who may be eligible to enroll in the Children’s Health Insurance Program and facilitate the enrollment of such children in the Children’s Health Insurance Program;
2. Upon determining that an Indian child is eligible for the Children’s Health Insurance Program, immediately take any necessary action to enroll the child in the Children’s Health Insurance Program; and
3. Contract with the Indian Health Service and tribal clinics that provide health care services to Indians to provide health care services to Indian children who are enrolled in the Children’s Health Insurance Program.
(Added to NRS by 1999, 1426)
NRS 422.27487 Eligibility for and coverage under Medicaid for persons who are incarcerated and persons released from incarceration; regulations.
1. To the extent not prohibited by federal law, the Department shall:
(a) Suspend, rather than terminate, the eligibility for Medicaid of a person who is incarcerated for the amount of time authorized by regulation pursuant to subsection 2;
(b) Authorize a person who is incarcerated and was not eligible for Medicaid before being incarcerated or whose eligibility for Medicaid has been terminated to apply up to 6 months before his or her scheduled release for enrollment in Medicaid immediately upon release, except where such a person is authorized to enroll earlier pursuant to NRS 422.272428; and
(c) Reinstate or institute, as applicable, eligibility for and coverage under Medicaid for a person described in paragraph (a) or (b) as soon as possible upon his or her release from incarceration if the person otherwise meets the requirements to be eligible for Medicaid at that time.
2. The Department may adopt any regulations necessary to carry out the provisions of this section, including, without limitation, regulations that prescribe the amount of time that the eligibility for Medicaid of a person may be suspended pursuant to paragraph (a) of subsection 1 before being terminated.
(Added to NRS by 2021, 2187; A 2023, 2995)
NRS 422.2749 Custody, use, preservation and confidentiality of records, files and communications concerning applicants for and recipients of public assistance or assistance pursuant to Children’s Health Insurance Program; regulations.
1. To restrict the use or disclosure of any information concerning applicants for and recipients of public assistance or assistance pursuant to the Children’s Health Insurance Program 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 Division shall establish and enforce reasonable regulations governing the custody, use and preservation of any records, files and communications filed with the Division.
2. If, pursuant to a specific statute or a regulation of the Division, names and addresses of, or information concerning, applicants for and recipients of assistance, including, without limitation, assistance pursuant to the Children’s Health Insurance Program, are furnished to or held by any other agency or department of government, such agency or department of government is bound by the regulations of the Division 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, including, without limitation, a recipient of assistance pursuant to the Children’s Health Insurance Program, under the provisions of this chapter.
[12:327:1949; 1943 NCL § 5146.12]—(NRS A 1959, 518; 1963, 906; 1991, 1052; 1993, 2694; 1997, 2624; 1999, 2227, 2242; 2005, 22nd Special Session, 30)
NRS 422.27495 Contracts for provision of certain transportation services for recipients of Medicaid and recipients of services pursuant to Children’s Health Insurance Program; regulations.
1. The Department shall, to the extent authorized by federal law, contract with a common motor carrier, a contract motor carrier or a broker for the provision of transportation services to recipients of Medicaid traveling to and returning from providers of services under the State Plan for Medicaid.
2. The Department may, to the extent authorized by federal law, contract with a common motor carrier, a contract motor carrier or a broker for the provision of transportation services to recipients of services pursuant to the Children’s Health Insurance Program traveling to and returning from providers of services under the Children’s Health Insurance Program.
3. The Director may adopt regulations concerning the qualifications of persons who may contract with the Department to provide transportation services pursuant to this section.
4. The Director shall:
(a) Require each motor carrier that has contracted with the Department to provide transportation services pursuant to this section to submit proof to the Department of a liability insurance policy, certificate of insurance or surety which is substantially equivalent in form to and is in the same amount or in a greater amount than the policy, certificate or surety required by the Department of Motor Vehicles pursuant to NRS 706.291 for a similarly situated motor carrier; and
(b) Establish a program, with the assistance of the Nevada Transportation Authority of the Department of Business and Industry, to inspect the vehicles which are used to provide transportation services pursuant to this section to ensure that the vehicles and their operation are safe.
5. As used in this section:
(a) “Broker” has the meaning ascribed to it in NRS 706.021.
(b) “Common motor carrier” has the meaning ascribed to it in NRS 706.036.
(c) “Contract motor carrier” has the meaning ascribed to it in NRS 706.051.
(Added to NRS by 2005, 735; A 2011, 2469; 2013, 1316)
NRS 422.27497 State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services provided by behavior analysts, assistant behavior analysts and registered behavior technicians; establishment of certain rates of reimbursement and limitations on hours for provision of such services; reporting of certain information concerning services provided to recipients of Medicaid diagnosed with autism spectrum disorder.
1. The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for services provided by behavior analysts, assistant behavior analysts and registered behavior technicians to recipients of Medicaid who are less than 27 years of age.
2. The Director shall:
(a) Biennially establish and include in the State Plan for Medicaid rates of reimbursement which are provided on a fee-for-service basis for services provided by behavior analysts, assistant behavior analysts and registered behavior technicians that are comparable to rates of reimbursement paid by Medicaid programs in other states for the services of those providers.
(b) Establish reasonable limits on the number of hours that a behavior analyst, assistant behavior analyst or registered behavior technician is authorized to bill for services provided to a recipient of Medicaid in a 24-hour period.
3. The Division shall provide training to behavior analysts, assistant behavior analysts and registered behavior technicians who provide services to recipients of Medicaid concerning the limits established pursuant to paragraph (b) of subsection 2.
4. On or before January 31 of each year, the Division shall:
(a) Compile a report concerning the provision of services to recipients of Medicaid who have been diagnosed with an autism spectrum disorder. The report must include:
(1) The number of recipients of Medicaid who were newly diagnosed with an autism spectrum disorder during the immediately preceding year and the number of those recipients for whom assistance with care management was provided;
(2) The number of recipients of Medicaid diagnosed with an autism spectrum disorder for whom assistance with care management was reimbursed through Medicaid during the immediately preceding year;
(3) The number of recipients of Medicaid for whom the first claim for reimbursement for the services of a registered behavior technician was submitted during the immediately preceding year;
(4) The number of assessments or evaluations by a behavior analyst that were reimbursed through Medicaid during the immediately preceding year;
(5) The total number of claims for applied behavior analysis services provided to recipients of Medicaid made during the immediately preceding year;
(6) For the immediately preceding year, the average times that elapsed between claims for each step of the process that a recipient of Medicaid must undergo to receive treatment from a registered behavior technician, beginning with initial diagnosis with an autism spectrum disorder and including, without limitation, comprehensive diagnosis with an autism spectrum disorder, evaluation and treatment by a behavior analyst and treatment by a registered behavior technician;
(7) The number of recipients of Medicaid receiving services through Medicaid managed care who were, at the end of the immediately preceding year, on a wait list for applied behavior analysis services;
(8) An assessment of the adequacy of the network of each health maintenance organization or managed care organization that provides services to recipients of Medicaid under the State Plan for Medicaid for applied behavior analysis services, as compared to the applicable standard for network adequacy set forth in the contract between the health maintenance organization or managed care organization and the Division;
(9) The number of behavior analysts and registered behavior technicians who are currently providing services to recipients of Medicaid who receive services through each health maintenance organization or managed care organization described in subparagraph (8); and
(10) The number of behavior analysts and registered behavior technicians who provide services to recipients of Medicaid who do not receive services through managed care.
(b) Submit the report to the Director of the Legislative Counsel Bureau for transmittal to:
(1) In odd-numbered years, the next regular session of the Legislature; and
(2) In even-numbered years, the Joint Interim Standing Committee on Health and Human Services.
5. As used in this section:
(a) “Applied behavior analysis services” means the services of a behavior analyst, assistant behavior analyst or registered behavior technician.
(b) “Assistant behavior analyst” has the meaning ascribed to it in NRS 641D.020.
(c) “Behavior analyst” has the meaning ascribed to it in NRS 641D.030.
(d) “Registered behavior technician” has the meaning ascribed to it in NRS 641D.100.
(Added to NRS by 2021, 2546; A 2023, 2076)
Investigations and Hearings
NRS 422.275 Legal advisers for Division. The Attorney General and the deputies of the Attorney General are the legal advisers for the Division.
(Added to NRS by 1963, 501; A 1967, 1498; 1971, 1437; 1975, 175; 1979, 274; 1981, 1281; 1997, 2624; 1999, 2242; 2005, 22nd Special Session, 29)
NRS 422.276 Appeal to Division by applicant for or recipient of benefits from Medicaid or Children’s Health Insurance Program; notice of initial decision; hearing.
1. Subject to the provisions of subsection 2, if an application for Medicaid or the Children’s Health Insurance Program or a claim for benefits from either program is not acted upon by the Division within a reasonable time after the filing of the application or claim for benefits, or is denied in whole or in part, or if any claim for benefits is reduced, suspended or terminated, the applicant or recipient may appeal to the Division and may be represented in the appeal by counsel or other representative chosen by the applicant or recipient.
2. Upon the initial decision to deny, reduce, suspend or terminate benefits, the Division shall notify that applicant or recipient of its decision, the regulations involved and the right to request a hearing within a certain period. If a request for a hearing is received within that period, the Division shall notify that person of the time, place and nature of the hearing. The Division shall provide an opportunity for a hearing of that appeal and shall review the case regarding all matters alleged in that appeal.
3. The Division is not required to grant a hearing pursuant to this section if the request for the hearing is based solely upon the provisions of a federal law or a law of this State that requires an automatic adjustment to the benefits that may be received by an applicant or recipient.
(Added to NRS by 1981, 1908; A 1985, 857; 1993, 2064; 1997, 2238; 1999, 2229; 2013, 1305)
NRS 422.277 Hearing: Rights of parties; informal disposition; record; transcribing of oral proceedings; findings of fact; certain employees or representatives of Division prohibited from participating in decision.
1. At any hearing held pursuant to the provisions of subsection 2 of NRS 422.276, opportunity must be afforded all parties to respond and present evidence and argument on all issues involved.
2. Unless precluded by law, informal disposition may be made of any hearing by stipulation, agreed settlement, consent order or default.
3. The record of a hearing must include:
(a) All pleadings, motions and intermediate rulings.
(b) Evidence received or considered.
(c) Questions and offers of proof and objections, and rulings thereon.
(d) Any decision, opinion or report by the hearing officer presiding at the hearing.
4. Oral proceedings, or any part thereof, must be transcribed on request of any party seeking judicial review of the decision.
5. Findings of fact must be based exclusively on substantial evidence.
6. Any employee or other representative of the Division who investigated or made the initial decision to deny, modify or cancel benefits provided pursuant to Medicaid or the Children’s Health Insurance Program shall not participate in the making of any decision made pursuant to the hearing.
(Added to NRS by 1985, 855; A 1993, 2064; 1999, 2229; 2001, 158; 2013, 1305)
NRS 422.2775 Hearing: Evidence. In any hearing held pursuant to the provisions of subsection 2 of NRS 422.276:
1. Irrelevant, immaterial or unduly repetitious evidence must be excluded. Unless it is privileged pursuant to chapter 49 of NRS, evidence, including, without limitation, hearsay, may be admitted if it is of a type commonly relied upon by reasonable and prudent persons in the conduct of their affairs. Objections to evidentiary offers may be made. Subject to the requirements of this subsection, if a hearing will be expedited and the interests of the parties will not be prejudiced substantially, any part of the evidence may be received in written form.
2. Documentary evidence may be received in the form of copies or excerpts. Upon request, parties must be given an opportunity to compare the copy with the original.
3. Each party may call and examine witnesses, introduce exhibits, cross-examine opposing witnesses on any matter relevant to the issues whether or not the matter was covered in the direct examination, impeach any witness, regardless of which party first called the witness to testify, and rebut the evidence against the party.
(Added to NRS by 1985, 855; A 1997, 1615)
NRS 422.278 Hearing: Person with communications disability entitled to services of interpreter. Any person who is:
1. The subject of a hearing conducted under the authority of the Division; or
2. A witness at that hearing,
Ê and who is a person with a communications disability as defined in NRS 50.050, is entitled to the services of an interpreter at public expense in accordance with the provisions of NRS 50.050 to 50.053, inclusive. The interpreter must be appointed by the person who presides at the hearing.
(Added to NRS by 1979, 658; A 1997, 2627; 1999, 2242; 2001, 1778; 2005, 22nd Special Session, 29; 2007, 174)
NRS 422.2785 Contents and delivery of decision or order of hearing officer; petition for judicial review; filing of decision and record with court.
1. A decision or order issued by a hearing officer 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 to each party and to the attorney or other representative of each party.
2. The Division or an applicant for or recipient of benefits provided pursuant to Medicaid or the Children’s Health Insurance Program 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 the applicant for or recipient of benefits provided pursuant to Medicaid or the Children’s Health Insurance Program resides to review the decision. The district court shall review the decision on the record of the case before the hearing officer. The decision and record must be certified as correct and filed with the clerk of the court by the Division.
(Added to NRS by 1985, 856; A 1993, 2065; 1997, 2238, 2628; 1999, 581, 2230, 2242; 2013, 1305)
NRS 422.279 Judicial review: Taking of additional evidence; limitations on review; grounds for reversal; appeal to appellate court.
1. Before the date set by the court for hearing, an application may be made to the court by motion, with notice to the opposing party and an opportunity for that party to respond, for leave to present additional evidence. If it is shown to the satisfaction of the court that the additional evidence is material and that there were good reasons for failure to present it in the proceeding before the Department, the court may order that the additional evidence be taken before the Department upon conditions determined by the court. The Department may modify its findings and decision by reason of the additional evidence and shall file that evidence and any modifications, new findings or decisions with the reviewing court.
2. The review must be conducted by the court without a jury and must be confined to the record. In cases of alleged irregularities in procedure before the Department, not shown in the record, proof thereon may be taken in the court. The court, at the request of either party, shall hear oral argument and receive written briefs.
3. The court shall not substitute its judgment for that of the Department as to the weight of the evidence on questions of fact. The court may affirm the decision of the Department or remand the case for further proceedings. The court may reverse the decision and remand the case to the Department for further proceedings if substantial rights of the appellant have been prejudiced because the Department’s findings, inferences, conclusions or decisions are:
(a) In violation of constitutional, regulatory or statutory provisions;
(b) In excess of the statutory authority of the Department;
(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.
4. An aggrieved party may obtain review of any final judgment of the district court by appeal to the appellate court of competent jurisdiction pursuant to the rules fixed by the Supreme Court pursuant to Section 4 of Article 6 of the Nevada Constitution. The appeal must be taken in the manner provided for civil cases.
(Added to NRS by 1985, 856; A 1999, 2230; 2013, 1781)
NRS 422.280 Forms of reports and records to be kept by persons subject to supervision or investigation by Division. To ensure accuracy, uniformity and completeness in statistics and information, the Division 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 the form so prescribed.
[11:327:1949; 1943 NCL § 5146.11]—(NRS A 1963, 906; 1997, 2624; 1999, 2242; 2005, 22nd Special Session, 30)
Rights and Responsibilities of Recipients
NRS 422.291 Assistance not assignable or subject to process or bankruptcy law. Assistance awarded pursuant to the provisions of this chapter is not transferable or assignable at law or in equity and none of the money paid or payable under this chapter is subject to execution, levy, attachment, garnishment or other legal process, or to the operation of any bankruptcy or insolvency law.
(Added to NRS by 1981, 1908)
NRS 422.292 Assistance subject to future amending and repealing acts. All assistance awarded pursuant to the provisions of this chapter is awarded and held subject to the provisions of any amending or repealing act that may be enacted, and no recipient has any claim for assistance or otherwise by reason of such assistance being affected in any way by an amending or repealing act.
(Added to NRS by 1981, 1908)
NRS 422.293 Subrogation: Department subrogated to rights of recipient of Medicaid or of insurance provided pursuant to Children’s Health Insurance Program; lien on proceeds of recovery.
1. When a recipient of Medicaid or a recipient of insurance provided pursuant to the Children’s Health Insurance Program incurs an illness or injury for which medical services are payable by the Department and which is incurred under circumstances creating a legal liability in some person other than the recipient or a division of the Department to pay all or part of the costs of such medical services, the Department is subrogated to the right of the recipient to the extent of all such medical costs and may join or intervene in any action by the recipient or any successors in interest to enforce such legal liability.
2. If a recipient or any successors in interest fail or refuse to commence an action to enforce the legal liability, the Department may commence an independent action, after notice to the recipient or successors in interest, to recover all medical costs to which it is entitled. In any such action by the Department, the recipient or successors in interest may be joined as third-party defendants.
3. In any case where the Department is subrogated to the rights of the recipient or any successors in interest as provided in subsection 1, the 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 4, at such time as:
(a) The proceeds of any recovery or settlement are distributed to or on behalf of the recipient, the successors in interest or the attorney of the recipient; and
(b) A dismissal by any court of any action brought to enforce the legal liability established by subsection 1.
4. If the Department receives notice pursuant to NRS 422.293001, the Director or a representative designated by the Director 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.
5. The attorney of a recipient 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 Director or a designated representative pursuant to subsection 4.
(Added to NRS by 1981, 1909; A 1989, 757; 1993, 923; 1997, 1239, 2624; 1999, 2228, 2242; 2007, 2390)
NRS 422.293001 Subrogation: Notice to Department of recipient’s claim; statute of limitations tolled until notice received.
1. A recipient, upon assertion of a claim against a third party to which the Department is subrogated pursuant to NRS 422.293, or the attorney of the recipient, upon agreeing to represent the recipient, shall provide written notice to the Department in the manner provided in subsection 2.
2. The notice provided pursuant to subsection 1 must include, without limitation:
(a) The name of the recipient;
(b) The social security number of the recipient;
(c) The date of birth of the recipient;
(d) The name of the attorney of the recipient, if applicable;
(e) The name of any person against whom the recipient is making a claim, if known;
(f) The name of any insurer of any person against whom the recipient is making a claim, if known;
(g) The date of the incident giving rise to the claim; and
(h) A short statement identifying the nature of the recipient’s claim or the terms of any settlement, judgment or award.
3. Any statute of limitations applicable to any claim or action by the Department is tolled until such time as the Department receives the notice required by this section.
4. As used in this section, “claim” means a right to payment, whether or not the right is reduced to judgment, liquidated, unliquidated, fixed, contingent, matured, unmatured, disputed, undisputed, legal, equitable, secured or unsecured.
(Added to NRS by 2007, 2390)
NRS 422.293003 Subrogation: Department required to provide notice of amount of lien; enforceability of lien. Upon receiving the notice required pursuant to NRS 422.293001, the Department shall, within 30 days, provide written notice to the recipient or the attorney of the recipient and to the third party. The written notice must include, without limitation, the name of the recipient and the amount of the Department’s lien. No lien created pursuant to NRS 422.293 is enforceable unless written notice is first given to the person against whom the lien is asserted or the attorney of the person against whom the lien is asserted.
(Added to NRS by 2007, 2390)
NRS 422.293005 Subrogation: Liability for failure to comply with provisions.
1. Except as otherwise provided in subsection 2, any person who fails to comply with the provisions of NRS 422.293 and 422.293001 is liable to the Department for:
(a) The total amount of the Department’s lien created pursuant to NRS 422.293; and
(b) Any attorney’s fees and litigation expenses incurred by the Department in enforcing the Department’s rights pursuant to NRS 422.293 and 422.293001.
2. A person other than the recipient is not liable to the Department if the court determines that the failure to provide notice was caused by excusable neglect.
(Added to NRS by 2007, 2390)
Recovery of Medicaid Benefits
NRS 422.29301 Administration of provisions concerning recovery of amounts incorrectly paid for recipient of Medicaid; regulations; enforcement. The Director:
1. Shall administer the provisions of NRS 422.29302, 422.29304 and 422.29306;
2. May adopt such regulations as are necessary for the administration of those provisions; and
3. May invoke any legal, equitable or special procedures for the enforcement of those provisions.
(Added to NRS by 2003, 872; A 2013, 1306)
NRS 422.29302 Recovery of benefits paid for Medicaid: Powers and duties of Department; claim against estate of recipient; regulations; distribution of money recovered; payment in cash.
1. Except as otherwise provided in this section and to the extent it is not prohibited by federal law and when circumstances allow, the Department shall recover benefits correctly paid for Medicaid from:
(a) The undivided estate of the person who received those benefits; and
(b) Any recipient of money or property from the undivided estate of the person who received those benefits.
2. The Department shall not recover benefits pursuant to 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, blind or 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 Department 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, blind or disabled.
5. The Director may elect not to file a claim against the estate of a recipient of Medicaid or the spouse of the recipient if the Director determines that the filing of the claim will cause an undue hardship for the spouse or other survivors of the recipient. The Director 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. Any recovery by the Department from the undivided estate of a recipient pursuant to this section must be paid in cash to the extent of:
(a) The amount of Medicaid paid to or on behalf of the recipient after October 1, 1993; or
(b) The value of the remaining assets in the undivided estate,
Ê whichever is less.
(Added to NRS by 1993, 917; A 1995, 2566; 1997, 1240, 2237, 2626; 1999, 581, 877, 2242; 2001, 158; 2003, 874)
NRS 422.29304 Recovery of amounts paid for Medicaid under certain circumstances; powers and duties of Department; duty to reimburse Department; waiver of repayment; regulations.
1. Except as otherwise provided in this section, the Department shall, to the extent that it is not prohibited by federal law, recover from a recipient of Medicaid the undivided estate of a recipient of Medicaid or a person who signed the application for Medicaid or for admission to a nursing facility on behalf of the recipient an amount not to exceed the amount incorrectly paid on behalf of the recipient, if the person who signed the application:
(a) Failed to report any required information to the Department or the nursing facility that the person knew at the time the person signed the application;
(b) Refused to provide financial information regarding the recipient’s income and assets, including, without limitation, information regarding any transfers or assignments of income or assets;
(c) Concealed information regarding the existence, transfer or disposition of the recipient’s income and assets with the intent of enabling a recipient to meet any eligibility requirement for Medicaid;
(d) Made any false representation regarding the recipient’s income and assets, including, without limitation, any information regarding any transfers or assignments of income or assets; or
(e) Failed to report to the Department or the nursing facility within the period allowed by the Department any required information that the person obtained after the person filed the application.
2. Except as otherwise provided in this section, a recipient of Medicaid, the undivided estate of a recipient of Medicaid or a person who signed the application for Medicaid or for admission to a nursing facility on behalf of the recipient shall reimburse the Department or appropriate state agency for the value of the amount incorrectly paid on behalf of the recipient.
3. The Director or a person designated by the Director may, to the extent that it is not prohibited by federal law, determine the amount of, and settle, adjust, compromise or deny a claim against a recipient of Medicaid, the undivided estate of a recipient of Medicaid or a person who signed the application for Medicaid or for admission to a nursing facility on behalf of the recipient.
4. The Director may, to the extent that it is not prohibited by federal law, waive the repayment of amounts incorrectly paid on behalf of a recipient of Medicaid if the incorrect payment was not the result of an intentional misrepresentation or omission by the recipient and if repayment would cause an undue hardship to the recipient. The Director shall, by regulation, establish the terms and conditions of such a waiver, including, without limitation, the circumstances that constitute undue hardship.
(Added to NRS by 1999, 876; A 2001, 65; 2003, 875; 2007, 2391; 2013, 1306)
NRS 422.29306 Imposition and release of lien on property of recipient of Medicaid.
1. The Department 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 Department may obtain a lien against a recipient’s property, both real or personal, before or after the death of the recipient in the amount of assistance paid or to be paid on behalf of the recipient if the court determines that assistance was incorrectly paid for the recipient.
(b) The Department may seek a lien against the real property of a recipient at any age before the death of the recipient in the amount of assistance paid or to be paid for the recipient if the recipient is an inpatient in a nursing facility, intermediate care facility for persons with intellectual disabilities or other medical institution and the Department determines, after notice and opportunity for a hearing in accordance with applicable regulations, that the recipient cannot reasonably be expected to be discharged and return home.
2. No lien may be placed on a recipient’s home pursuant to paragraph (b) of subsection 1 for assistance correctly paid if:
(a) His or her spouse;
(b) His or her child who is under 21 years of age, blind or disabled as determined in accordance with 42 U.S.C. § 1382c; or
(c) His or her 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,
Ê is lawfully residing in the home.
3. Upon the death of a recipient, the Department may seek a lien upon the recipient’s undivided estate as defined in NRS 422.054.
4. The amount of the lien recovery must be based on the value of the real or personal property at the time of sale of the property.
5. The Director shall release a lien pursuant to this section:
(a) Upon notice by the recipient or the representative of the recipient to the Director 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 claim of the Department.
(Added to NRS by 1995, 2565; A 1997, 650, 1242, 2627; 1999, 878, 2242, 2244; 2003, 875; 2007, 2392; 2013, 695)
Investigation of Providers
NRS 422.305 Confidentiality of information obtained in investigation of provider of services under State Plan for Medicaid.
1. Except as otherwise provided in subsection 2 and NRS 228.410, 239.0115 and 422.2374, any information obtained by the Division 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 422.590, inclusive; or
(b) To review an action by the Division against a provider of services under the State Plan for Medicaid,
Ê is not confidential, except for the identity of any recipient of the assistance.
(Added to NRS by 1987, 1670; A 1991, 1053; 1997, 1243, 2628; 1999, 2242; 2005, 22nd Special Session, 32; 2007, 2103)
NRS 422.306 Hearing to review action taken against provider of services under State Plan for Medicaid; regulations; appeal of final decision.
1. Upon receipt of a request for a hearing from a provider of services under the State Plan for Medicaid, the Division shall appoint a hearing officer to conduct the hearing. Any employee or other representative of the Division who investigated or made the initial decision regarding the action taken against a provider of services may not be appointed as the hearing officer or participate in the making of any decision pursuant to the hearing.
2. The Division shall adopt regulations prescribing the procedures to be followed at the hearing.
3. The decision of the hearing officer is a final decision. Any party, including the Division, who is aggrieved by the decision of the hearing officer may appeal that decision to the District Court in and for Carson City by filing a petition for judicial review within 30 days after receiving the decision of the hearing officer.
4. A petition for judicial review filed pursuant to this section must be served upon every party within 30 days after the filing of the petition for judicial review.
5. Unless otherwise provided by the court:
(a) Within 90 days after the service of the petition for judicial review, the Division shall transmit to the court the original or a certified copy of the entire record of the proceeding under review, including, without limitation, a transcript of the evidence resulting in the final decision of the hearing officer;
(b) The petitioner who is seeking judicial review pursuant to this section shall serve and file an opening brief within 40 days after the Division gives written notice to the parties that the record of the proceeding under review has been filed with the court;
(c) The respondent shall serve and file an answering brief within 30 days after service of the opening brief; and
(d) The petitioner may serve and file a reply brief within 30 days after service of the answering brief.
6. Within 7 days after the expiration of the time within which the petitioner may reply, any party may request a hearing. Unless a request for hearing has been filed, the matter shall be deemed submitted.
7. 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 Division;
(c) Made upon unlawful procedure;
(d) Affected by other error of law;
(e) Clearly erroneous in view of the reliable, probative and substantial evidence on the whole record; or
(f) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.
(Added to NRS by 1987, 1670; A 1997, 1243, 2628; 1999, 581, 2231, 2242; 2005, 22nd Special Session, 32)
Health and Welfare Programs
NRS 422.308 Family planning service; birth control. As a part of the health and welfare programs of this State, the Division 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.
(Added to NRS by 1965, 529; A 1997, 2620; 1999, 2242; 2005, 22nd Special Session, 30)
NRS 422.3085 Development of Sexual Trauma Services Guide; provision of information about Guide to public; regulations.
1. To the extent authorized by federal law, the Department shall develop a Medicaid service package called the Sexual Trauma Services Guide for the purpose of assisting victims of sexual trauma who are eligible for Medicaid.
2. The Department shall post information relating to the Sexual Trauma Services Guide, including, without limitation, information concerning the available services to which victims of sexual trauma are entitled, on the Internet website maintained by the Department and shall make such information available to any person upon request at the office of the Department.
3. The Department may adopt any regulations necessary to carry out the provisions of this section.
(Added to NRS by 2017, 4076)
NRS 422.309 Provision of prenatal care to pregnant women who are indigent; provision of information concerning availability of prenatal care; regulations.
1. As part of the health and welfare programs of this State, the Division or any other division designated by the Director 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 Division or any other division designated by the Director 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 Division or any other division designated by the Department 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 Director or the Administrator, as applicable, deems necessary.
(Added to NRS by 1989, 1455; A 1997, 1238, 2235, 2620; 1999, 581, 2242; 2003, 659; 2005, 22nd Special Session, 30)
MEDICAID CARDS
NRS 422.361 Definitions. As used in NRS 422.361 to 422.369, inclusive, unless the context otherwise requires, the words and terms defined in NRS 422.362 to 422.365, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1993, 141)
NRS 422.362 “Cardholder” defined. “Cardholder” means the person named on the face of a Medicaid card to whom or for whose benefit the Medicaid card is issued by the Department.
(Added to NRS by 1993, 141; A 2003, 660)
NRS 422.363 “Medicaid card” defined. “Medicaid card” means any instrument or device evidencing eligibility for receipt of Medicaid benefits that is issued by the Department for the use of a cardholder in obtaining the types of medical and remedial care for which assistance may be provided under the Plan.
(Added to NRS by 1993, 141; A 2003, 660)
NRS 422.364 “Plan” defined. “Plan” means the State Plan for Medicaid established pursuant to NRS 422.063.
(Added to NRS by 1993, 141; A 1997, 1243)
NRS 422.365 “Receives” defined. “Receives” means to acquire possession or control.
(Added to NRS by 1993, 141)
NRS 422.366 Unlawful acts: Obtaining or possessing card without consent of holder of card; presumption from possession of card; penalty.
1. A person who:
(a) Steals, takes or removes a Medicaid card from the person, possession, custody or control of another without the cardholder’s consent; or
(b) With knowledge that a Medicaid card has been so taken, removed or stolen, receives the Medicaid card with the intent to circulate, use or sell it or to transfer it to a person other than the Department or the cardholder,
Ê is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
2. A person who possesses a Medicaid card without the consent of the cardholder and with the intent to circulate, use, sell or transfer the Medicaid card with the intent to defraud is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
3. A person who has in his or her possession or under his or her control two or more Medicaid cards issued in the name of another person is presumed to have obtained and to possess the Medicaid cards with the knowledge that they have been stolen and with the intent to circulate, use, sell or transfer them with the intent to defraud. The presumption established by this subsection may be rebutted by clear and convincing evidence. The presumption does not apply to the possession of two or more Medicaid cards if the possession is with the consent of the Department.
(Added to NRS by 1993, 141; A 1995, 1272; 2003, 660)
NRS 422.367 Unlawful acts: Sale or purchase of card; authorization by holder of card for use by person not entitled to use card; penalty. A person who:
1. Sells or buys a Medicaid card; or
2. Authorizes another person to use his or her Medicaid card to obtain the types of medical and remedial care for which assistance may be provided under the Plan, if the person to whom authorization is given is not entitled to use that card to obtain care,
Ê is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
(Added to NRS by 1993, 142; A 1995, 1273)
NRS 422.368 Unlawful acts: Use of forged, expired or revoked card to obtain benefits; receipt of benefits by misrepresentation; penalty. A person who, with the intent to defraud:
1. Uses a Medicaid card to obtain the types of medical and remedial care for which assistance may be provided under the Plan with the knowledge that the Medicaid card was obtained or retained in violation of any of the provisions of NRS 422.361 to 422.367, inclusive, or is forged or is the expired or revoked Medicaid card of another; or
2. Obtains the types of medical and remedial care for which assistance may be provided under the Plan by representing, without the consent of the cardholder, that the person is the authorized holder of a Medicaid card or that the person is the holder of a Medicaid card that has not in fact been issued,
Ê is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
(Added to NRS by 1993, 142; A 1995, 1273)
NRS 422.369 Unlawful acts: Fraud by person authorized to provide care to holder of card; penalty. A person authorized by the Division to furnish the types of medical and remedial care for which assistance may be provided under the Plan, or an agent or employee of the authorized person, who, with the intent to defraud, furnishes such care upon presentation of a Medicaid card which the person knows was obtained or retained in violation of any of the provisions of NRS 422.361 to 422.367, inclusive, or is forged, expired or revoked, is guilty of a category D felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
(Added to NRS by 1993, 142; A 1995, 1274; 1999, 2232; 2005, 22nd Special Session, 33)
ASSESSMENT OF FEES ON NURSING FACILITIES TO INCREASE QUALITY OF NURSING CARE
NRS 422.3755 Definitions. As used in NRS 422.3755 to 422.379, inclusive, unless the context otherwise requires, the words and terms defined in NRS 422.376, 422.3765 and 422.3771 have the meanings ascribed to them in those sections.
(Added to NRS by 2003, 2745)
NRS 422.376 “Facility for intermediate care” defined. “Facility for intermediate care” has the meaning ascribed to it in NRS 449.0038, but does not include:
1. A facility which meets the requirements of a general or any other special hospital pursuant to chapter 449 of NRS;
2. A facility for intermediate care which limits its care and treatment to those persons who are intellectually disabled or who have conditions related to intellectual disabilities; or
3. A facility for intermediate care that is owned or operated by the State of Nevada or any political subdivision of the State of Nevada.
(Added to NRS by 2003, 2745; A 2013, 696)
NRS 422.3765 “Facility for skilled nursing” defined. “Facility for skilled nursing” has the meaning ascribed to it in NRS 449.0039, but does not include a facility for skilled nursing that is owned or operated by the State of Nevada or any political subdivision of the State of Nevada.
(Added to NRS by 2003, 2745)
NRS 422.3771 “Nursing facility” defined. “Nursing facility” means a facility for intermediate care or a facility for skilled nursing.
(Added to NRS by 2003, 2745)
NRS 422.3775 Fee: Payment; amount; due date; allowable cost for Medicaid reimbursement purposes.
1. Each nursing facility that is licensed in this State shall pay a fee assessed by the Division to increase the quality of nursing care in this State.
2. To determine the amount of the fee to assess pursuant to this section, the Division shall establish a rate per non-Medicare patient day that is equivalent to a percentage of the total annual accrual basis gross revenue for services provided to patients of all nursing facilities licensed in this State. The percentage used to establish the rate must not exceed that allowed by federal law. For the purposes of this subsection, total annual accrual basis gross revenue does not include charitable contributions received by a nursing facility.
3. The Division shall calculate the fee owed by each nursing facility by multiplying the total number of days of care provided to non-Medicare patients by the nursing facility, as provided to the Division pursuant to NRS 422.378, by the rate established pursuant to subsection 2.
4. A fee assessed pursuant to this section is due 30 days after the end of the month for which the fee was assessed.
5. The payment of a fee to the Division pursuant to NRS 422.3755 to 422.379, inclusive, is an allowable cost for Medicaid reimbursement purposes.
(Added to NRS by 2003, 2746; A 2005, 22nd Special Session, 33; 2007, 2393)
NRS 422.378 Report by nursing facility to Division.
1. Each nursing facility shall file with the Division each month a report setting forth the total number of days of care it provided to non-Medicare patients during the preceding month, the total gross revenue it earned as compensation for services provided to patients during the preceding month and any other information required by the Division.
2. Each nursing facility shall file with the Division any information required and requested by the Division to carry out the provisions of NRS 422.3755 to 422.379, inclusive.
(Added to NRS by 2003, 2746; A 2005, 22nd Special Session, 34)
NRS 422.3785 Account to Increase the Quality of Nursing Care: Creation; deposit of money; expenditures; consequence of federal law prohibiting certain expenditures from Account.
1. There is hereby created in the State General Fund the Account to Increase the Quality of Nursing Care, to be administered by the Division.
2. The interest and income on the money in the Account to Increase the Quality of Nursing Care, after deducting any applicable charges, must be credited to the Account.
3. Any money received by the Division pursuant to NRS 422.3755 to 422.379, inclusive, must be deposited in the Account to Increase the Quality of Nursing Care, and must be expended, to the extent authorized by federal law, to obtain federal financial participation in the Medicaid Program, and in the manner set forth in subsection 4.
4. Expenditures from the Account to Increase the Quality of Nursing Care must be used only:
(a) To increase the rates paid to nursing facilities for providing services pursuant to the Medicaid Program and may not be used to replace existing state expenditures paid to nursing facilities for providing services pursuant to the Medicaid Program; and
(b) To administer the provisions of NRS 422.3755 to 422.379, inclusive. The amount expended pursuant to this paragraph must not exceed 1 percent of the money received from the fees assessed pursuant to NRS 422.3755 to 422.379, inclusive, and must not exceed the amount authorized for expenditure by the Legislature for administrative expenses in a fiscal year.
5. Any money remaining in the Account to Increase the Quality of Nursing Care at the end of a fiscal year does not revert to the State General Fund, and the balance in the Account must be carried forward to the next fiscal year.
6. If federal law or regulation prohibits the money in the Account to Increase the Quality of Nursing Care from being used in the manner set forth in this section, the rates paid to nursing facilities for providing services pursuant to the Medicaid Program must be changed:
(a) Except as otherwise provided in paragraph (b), to the rates paid to such facilities on June 30, 2003; or
(b) If the Legislature or the Division has on or after July 1, 2003, changed the rates paid to such facilities through a manner other than the use of expenditures from the Account, to the rates provided for by the Legislature or the Division.
(Added to NRS by 2003, 2746; A 2005, 22nd Special Session, 34; 2011, 1767; 2013, 2757)
NRS 422.379 Administrative penalties for late payment of fee; recoupment of fees and administrative penalties; repayment plan.
1. The Division shall establish administrative penalties for the late payment by a nursing facility of a fee assessed pursuant to NRS 422.3755 to 422.379, inclusive.
2. The Division may recoup any payments made to nursing facilities providing services pursuant to the Medicaid program up to the amount of the fees owed as determined pursuant to NRS 422.3775 and any administrative penalties owed pursuant to subsection 1 if a nursing facility fails to remit the fees and administrative penalties owed within 30 days after the date they are due. Before recoupment of payments pursuant to this subsection, the Division may allow a nursing facility that fails to remit fees and administrative penalties owed an opportunity to negotiate a repayment plan with the Division. The terms of the repayment plan may be established at the discretion of the Division.
(Added to NRS by 2003, 2747; A 2005, 22nd Special Session, 35; 2007, 2393)
ASSESSMENT OF FEES ON CERTAIN OPERATORS TO INCREASE COMPENSATION UNDER STATE PLAN
NRS 422.3791 Definitions. As used in NRS 422.3791 to 422.3795, inclusive, unless the context otherwise requires, the words and terms defined in NRS 422.37915 to 422.37938, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 2017, 1606; A 2023, 1940)
NRS 422.37915 “Account” defined. “Account” means the Account to Improve Health Care Quality and Access created by NRS 422.37945.
(Added to NRS by 2017, 1606)
NRS 422.3792 “Agency to provide personal care services in the home” defined. “Agency to provide personal care services in the home” has the meaning ascribed to it in NRS 449.0021.
(Added to NRS by 2017, 1606)
NRS 422.37922 “Hospital” defined. “Hospital” has the meaning ascribed to it in NRS 449.012.
(Added to NRS by 2023, 1939)
NRS 422.37925 “Medical facility” defined. “Medical facility” has the meaning ascribed to it in NRS 449.0151.
(Added to NRS by 2017, 1606)
NRS 422.3793 “Operator” defined. “Operator” means the operator of an agency to provide personal care services in the home or the operator of a medical facility.
(Added to NRS by 2017, 1606)
NRS 422.37935 “Operator group” defined. “Operator group” means all operators who are required to obtain a given type of license pursuant to NRS 449.029 to 449.2428, inclusive.
(Added to NRS by 2017, 1606)
NRS 422.37938 “Rural hospital” defined. “Rural hospital” has the meaning ascribed to it in NRS 449.0177.
(Added to NRS by 2023, 1939)
NRS 422.3794 Imposition of assessment; vote; amount of assessment; regulations; statement of amount of revenue used for certain purposes before polling; deposit of revenue; compliance with federal law; submission of information to Division.
1. Except as otherwise provided in this section, after polling the operators in an operator group and receiving an affirmative vote from at least 67 percent of the operators in that operator group, the Division may impose by regulation, against each operator in the operator group, an assessment in an amount equal to a percentage of the net revenue generated by the agency to provide personal care services in the home or medical facility, as applicable, from providing care in this State during a calendar or fiscal year. The Division shall adopt:
(a) Regulations prescribing the percentage that must be used to calculate the amount of the assessment, the date on which the assessment is due and the manner in which the assessment must be paid; and
(b) Any other regulations necessary or convenient to carry out the provisions of this section.
2. Before polling the operator of a hospital or a rural hospital pursuant to subsection 1, the Division shall provide the operator a statement of the amount of the revenue generated by the proposed assessment that will be used for the purposes prescribed by paragraphs (c) and (d) of subsection 3 of NRS 422.37945.
3. The revenue from an assessment imposed pursuant to subsection 1 must be deposited in the Account.
4. An assessment imposed pursuant to subsection 1 must comply with the provisions of 42 C.F.R. § 433.68. The revenue generated by such an assessment must be used only for the purposes authorized by NRS 422.37945. An assessment must not be imposed pursuant to subsection 1 if state or federal law or regulations prohibit or alter the use of the revenue generated by the assessment for the purposes prescribed in NRS 422.37945. If new state or federal law or regulations imposing such a prohibition or making such an alteration are enacted or adopted, as applicable:
(a) An assessment must not be collected after the effective date of the law or regulations; and
(b) Any money collected during the calendar or fiscal year, as applicable, in which the law or regulations become effective must be returned to the operators from whom it was collected.
5. An operator shall submit to the Division any information requested by the Division for the purposes of carrying out the provisions of this section.
(Added to NRS by 2017, 1606; A 2023, 1940)
NRS 422.37945 Account to Improve Health Care Quality and Access: Creation; administration; separate accounting; uses and limitations; nonreversion; federal financial participation.
1. The Account to Improve Health Care Quality and Access is hereby created in the State General Fund. The Division shall administer the Account. The revenue from assessments and penalties imposed on the operators in each operator group must be accounted for separately in the Account.
2. The interest and income on the money in the Account, after deducting any applicable charges, must be credited to the Account.
3. Subject to the provisions of subsections 4 and 5, money in the Account must be expended to:
(a) Provide supplemental payments or enhanced rates of reimbursement to operators pursuant to an upper payment limit program established under the provisions of 42 C.F.R. § 447.272 or 447.321;
(b) Provide supplemental payments to operators who provide care to recipients of Medicaid in addition to the reimbursements those operators would otherwise receive for providing such care;
(c) Administer the provisions of NRS 422.3791 to 422.3795, inclusive; and
(d) For money generated by an assessment imposed against the operators of private hospitals or private rural hospitals, fund additional supports and services under Medicaid, as approved by the Director, to improve access to behavioral health care for recipients of Medicaid with serious behavioral health conditions, including, without limitation, psychiatric disorders, in order to reduce the burden imposed by such recipients on the emergency medical services and inpatient services of the hospitals in this State.
4. Not more than 15 percent of the total amount of money generated each year by assessments against the operators of private hospitals or private rural hospitals may be expended for the purposes described in paragraphs (c) and (d) of subsection 3. Money allocated for such expenditures must be used first for the purpose described in paragraph (c) of subsection 3. If money allocated for such expenditures remains after all necessary expenditures are made for that purpose, the Division shall expend the remaining money for the purpose described in paragraph (d) of subsection 3.
5. Money in the Account that was generated by a specific assessment must not be expended to provide supplemental payments or enhanced rates of reimbursement pursuant to subsection 3 to operators in an operator group that is not subject to the assessment unless such expenditure was identified as a potential use of revenue when the assessment received an affirmative vote of at least 67 percent of the operators in the operator group subject to the assessment pursuant to subsection 1 of NRS 422.3794.
6. Any money remaining in the Account at the end of a fiscal year does not revert to the State General Fund, and the balance of the Account must be carried forward to the next fiscal year.
7. The Director shall seek all necessary federal authority to capture all available federal financial participation to provide additional supports and services as described in paragraph (d) of subsection 3.
(Added to NRS by 2017, 1607; A 2023, 1940)
NRS 422.3795 Administrative penalties; deduction from future Medicaid payments; notification; payment plans.
1. The Division shall adopt regulations that establish administrative penalties for failure to timely pay an assessment imposed pursuant to NRS 422.3794. Any money collected from such a penalty must be deposited in the Account.
2. If an operator fails to remit to the Division any penalty imposed pursuant to this section or any assessment imposed pursuant to NRS 422.3794 within 30 days after the date on which the penalty or assessment is due, the Division may deduct the amount of the assessment or penalty, as applicable, from future payments owed to the operator under the State Plan for Medicaid. Before doing so, the Division:
(a) Shall notify the operator of the intended deduction; and
(b) May negotiate a payment plan with the operator.
(Added to NRS by 2017, 1607)
PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENT PATIENTS
NRS 422.380 Definitions. As used in NRS 422.380 to 422.390, inclusive, unless the context otherwise requires:
1. “Disproportionate share payment” means a payment made pursuant to 42 U.S.C. § 1396r-4.
2. “Hospital” has the meaning ascribed to it in NRS 439B.110 and includes public and private hospitals.
(Added to NRS by 1991, 2334; A 1993, 1967; 1995, 1427, 1430; 1997, 1243; 2003, 2990; 2005, 1450; 2009, 2293)
NRS 422.3805 Federal waivers: Duties of Administrator. The 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.
(Added to NRS by 1993, 1966; A 1995, 1430; 1997, 2630; 1999, 2242)
NRS 422.382 Intergovernmental transfers of money from counties to Division; deposit in Intergovernmental Transfer Account in State General Fund; administration by Division.
1. The money transferred to the Division in accordance with the regulations adopted pursuant to paragraph (a) of subsection 1 of NRS 422.390 must not come from any source of funding that could result in any reduction in revenue to the State pursuant to 42 U.S.C. § 1396b(w).
2. Any money collected in accordance with the regulations adopted pursuant to subsection 1 of NRS 422.390, 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 Division.
3. The interest and income earned on money in the Intergovernmental Transfer Account, after deducting any applicable charges, must be credited to the Account.
(Added to NRS by 1993, 1967; A 1995, 1427, 1430; 1997, 2630; 1999, 2242; 2001, 3114; 2003, 2990; 2005, 22nd Special Session, 35; 2009, 2293)
NRS 422.385 Disproportionate share payments from Medicaid Budget Account; transfer of money from Intergovernmental Transfer Account.
1. The disproportionate share payments made to hospitals 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 Division for the purposes of making disproportionate share payments, the Division is authorized to expend the additional revenue in accordance with the provisions of the State Plan for Medicaid.
3. If enough money is available to support Medicaid and to make the disproportionate share payments, money in the Intergovernmental Transfer Account may be transferred:
(a) To an account established for the provision of health care services to uninsured children pursuant to a federal program in which at least 50 percent of the cost of such services is paid for by the Federal Government, including, without limitation, the Children’s Health Insurance Program; or
(b) To carry out the provisions of NRS 439B.350 and 439B.360.
(Added to NRS by 1991, 2335; A 1993, 1969; 1995, 1428, 1430; 1997, 1244, 1546, 2631; 1999, 581, 2232, 2242; 2001, 3115; 2003, 2991; 2005, 22nd Special Session, 35; 2009, 2294)
NRS 422.387 Calculation of disproportionate share payments; verification of eligibility for disproportionate share payments; Director authorized to negotiate terms of amendment to State Plan for Medicaid with Centers for Medicare and Medicaid Services of United States Department of Health and Human Services.
1. The State Plan for Medicaid must provide the methodology for:
(a) Calculating the initial distribution of the disproportionate share payments in accordance with the regulations adopted pursuant to NRS 422.390;
(b) Adjusting the disproportionate share payment to a hospital if the annual audit of the hospital demonstrates that the disproportionate share payment made to the hospital was greater than the amount of money which the hospital was eligible to receive; and
(c) Redistributing any amount of disproportionate share payments which are returned to the Division as a result of the adjustments made in accordance with paragraph (b).
2. The State Plan for Medicaid or, if the Division deems necessary, the Division may require a hospital to submit any documentation or other information to verify eligibility for a disproportionate share payment or compliance with the requirements of NRS 422.380 to 422.390, inclusive. A disproportionate share payment may not be calculated for or made to a hospital which fails to provide the Division with documentation or other information that is required by the State Plan for Medicaid or the Division.
3. Except as otherwise provided in subsection 4, the State Plan for Medicaid must be consistent with the provisions of NRS 422.380 to 422.390, inclusive, and the regulations adopted pursuant thereto, and Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions.
4. If the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services denies an amendment to the State Plan for Medicaid, the Director may negotiate terms which are acceptable to the Centers for Medicare and Medicaid Services which are inconsistent with the provisions of NRS 422.380 to 422.390, inclusive, and the regulations adopted pursuant thereto if:
(a) Negotiating such terms is necessary to ensure that the State Plan for Medicaid is consistent with the provisions of Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions; and
(b) Before finalizing such an amendment to the State Plan for Medicaid, the Director obtains the approval of the Interim Finance Committee.
(Added to NRS by 1991, 2335; A 1993, 1969; 1995, 1428, 1430; 1997, 1244, 2631; 1999, 2242; 2001, 3116; 2003, 2992; 2005, 22nd Special Session, 36; 2009, 2294)
NRS 422.390 Regulations; quarterly report.
1. The Division shall adopt regulations concerning:
(a) Procedures for the intergovernmental transfers of money from the counties to the Division for the purposes of carrying out the provisions of NRS 422.380 to 422.390, inclusive, and the State Plan for Medicaid.
(b) Provisions for the payment of a penalty and interest for a delinquent intergovernmental transfer.
(c) Provisions for the payment of interest by the Division for late reimbursements to hospitals or other providers of medical care.
(d) Provisions for the calculation of disproportionate share payments for hospitals.
(e) Any required documentation of and reporting by a hospital relating to the calculation of the disproportionate share payment for the hospital and the verification of the disproportionate share payment that has been received by the hospital.
(f) Procedures and requirements for conducting independent and certified audits of hospitals and the disproportionate share payments made to hospitals as required pursuant to Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions.
(g) Procedures for adjusting a disproportionate share payment in accordance with Title XIX of the Social Security Act, 42 U.S.C. §§ 1396, et seq., and the regulations adopted pursuant to those provisions, if the audit of a hospital demonstrates that a disproportionate share payment made to the hospital was greater than the amount of money the hospital was eligible to receive.
(h) Procedures for redistributing any disproportionate share payment returned to the Division by a hospital in accordance with Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions.
2. The Division shall report to the Interim Finance Committee quarterly concerning the provisions of NRS 422.380 to 422.390, inclusive.
3. Notwithstanding the provisions of NRS 233B.039 to the contrary, the regulations adopted pursuant to this section must be adopted in accordance with the provisions of chapter 233B of NRS and must be codified in the Nevada Administrative Code.
(Added to NRS by 1991, 2337; A 1993, 1970; 1995, 1429; 1997, 2631; 1999, 2242; 2003, 2994; 2005, 22nd Special Session, 38; 2009, 2297)
HOME AND COMMUNITY-BASED SERVICES
NRS 422.396 Establishment and administration of program to provide community-based services; application for federal waiver or amendment to State Plan for Medicaid; contracting for services; adoption of regulations.
1. The Department, through a division of the Department designated by the Director, shall establish and administer a program to provide community-based services necessary to enable a person with a physical disability to remain in his or her home or with his or her family and avoid placement in a facility for long-term care. The Department shall coordinate the provision of community-based services pursuant to this section.
2. The Department shall apply to the Secretary of Health and Human Services for a waiver granted pursuant to 42 U.S.C. § 1396n(c) or apply for an amendment to the State Plan for Medicaid that authorizes the Department to include as medical assistance under Medicaid the following services for persons with physical disabilities:
(a) Respite care;
(b) Habilitation;
(c) Residential habilitation;
(d) Environmental modifications;
(e) Supported living;
(f) Supported living habilitation;
(g) Supported personal care; and
(h) Any other community-based services approved by the Secretary of Health and Human Services.
Ê The Department shall cooperate with the Federal Government in obtaining a waiver or amendment pursuant to this subsection.
3. The Department may use personnel of the Department or it may contract with any appropriate public or private agency, organization or institution to provide the community-based services necessary to enable a person with a physical disability to remain in his or her home or with his or her family and avoid placement in a facility for long-term care.
4. A contract entered into with a public or private agency, organization or institution pursuant to subsection 3 must:
(a) Include a description of the type of service to be provided;
(b) Specify the price to be paid for each service and the method of payment; and
(c) Specify the criteria to be used to evaluate the provision of the service.
5. The Department shall adopt regulations necessary to carry out the provisions of this section, including, without limitation, the criteria to be used in determining eligibility for the services provided pursuant to the program. Before adopting regulations pursuant to this section, the Department shall solicit comments from persons with a variety of disabilities and members of the families of those persons.
6. As used in this section, “person with a physical disability” means a person with a severe physical disability that substantially limits his or her ability to participate and contribute independently in the community in which the person lives.
(Added to NRS by 1997, 2659; A 2003, 2622; 2013, 1622; 2023, 2995)
NRS 422.3962 Amendment of home and community-based services waiver to include as medical assistance under Medicaid funding of assisted living supportive services for senior citizens who reside in certain assisted living facilities.
1. The Department shall apply to the Secretary of Health and Human Services to amend its home and community-based services waiver granted pursuant to 42 U.S.C. § 1396n. The waiver must be amended, in addition to providing coverage for any home and community-based services which the waiver covers on June 4, 2005, to authorize the Department to include as medical assistance under Medicaid the funding of assisted living supportive services for senior citizens who reside in assisted living facilities which are certified by the Housing Division of the Department of Business and Industry pursuant to NRS 319.147.
2. The Department shall:
(a) Cooperate with the Federal Government in amending the waiver pursuant to this section;
(b) If the Federal Government approves the amendments to the waiver, adopt regulations necessary to carry out the provisions of this section, including, without limitation, the criteria to be used in determining eligibility for the assisted living supportive services funded pursuant to subsection 1; and
(c) Implement the amendments to the waiver only to the extent that the amendments are approved by the Federal Government.
3. As used in this section:
(a) “Assisted living facility” means a residential facility for groups that:
(1) Satisfies the requirements set forth in subsection 7 of NRS 449.0302; and
(2) Has staff at the facility available 24 hours a day, 7 days a week, to provide scheduled assisted living supportive services and assisted living supportive services that are required in an emergency in a manner that promotes maximum dignity and independence of residents of the facility.
(b) “Assisted living supportive services” means services which are provided at an assisted living facility to residents of the assisted living facility, including, without limitation:
(1) Personal care services;
(2) Homemaker services;
(3) Chore services;
(4) Attendant care;
(5) Companion services;
(6) Medication oversight;
(7) Therapeutic, social and recreational programming; and
(8) Services which ensure that the residents of the facility are safe, secure and adequately supervised.
(Added to NRS by 2005, 922)
NRS 422.3963 Amendment of home and community-based services waiver to include certain services for and compensation of persons with intellectual or developmental disabilities. [Effective January 1, 2025.]
1. The Department shall apply to the Secretary of Health and Human Services to amend its home and community-based services waiver granted pursuant to 42 U.S.C. § 1396n. The waiver must be amended, in addition to providing coverage for any home and community-based service which the waiver covers on January 1, 2025, to authorize:
(a) The Department to include as medical assistance under Medicaid the funding of habilitation services designed to provide persons with intellectual disabilities or persons with developmental disabilities assistance in pursuing competitive integrated employment, including, without limitation:
(1) Benefit counseling to assist a person with an intellectual disability or person with a developmental disability in earning a higher income while retaining any benefits or services that the person may be receiving.
(2) Job coaching and job development. To the extent authorized by the Federal Government, the services described in this subparagraph must not be subject to authorization limits.
(b) The compensation of a recipient of services under the waiver described in subsection 1 who is receiving prevocational services at a rate equal to or greater than the state minimum wage, including, without limitation, by waiving the requirement prescribed by 42 C.F.R. § 440.180(c)(2)(i)(B) that a person receiving prevocational services be compensated at less than 50 percent of the minimum wage.
2. The Department shall:
(a) Cooperate with the Federal Government in amending the waiver pursuant to this section;
(b) If the Federal Government approves the amendments to the waiver, adopt regulations necessary to carry out the provisions of this section, including, without limitation, the criteria to be used in determining eligibility for the habilitation services designed to provide assistance to persons pursuing competitive integrated employment pursuant to subsection 1; and
(c) Implement the amendments to the waiver only to the extent that the amendments are approved by the Federal Government.
3. As used in this section, “competitive integrated employment” has the meaning ascribed to it in 29 U.S.C. § 705(5).
(Added to NRS by 2023, 2956, effective January 1, 2025)
NRS 422.3964 State Plan for Medicaid: Inclusion of certain home and community-based services.
1. The Director shall include in the State Plan for Medicaid an option to provide certain additional home and community-based services in a manner consistent with 42 U.S.C. § 1396n(i). To the extent authorized by federal law, the Division shall provide tenancy support services to assist recipients of Medicaid pursuant to that option.
2. The Division shall adopt any regulations necessary to comply with the requirements of 42 U.S.C. § 1396n(i).
3. As used in this section, “tenancy support services” means services authorized pursuant to federal law that assist a recipient of Medicaid in obtaining and remaining in housing the Division determines to be adequate.
(Added to NRS by 2019, 3106)
NRS 422.3965 Application for federal waiver authorizing inclusion under Medicaid of structured family caregiving for persons suffering from dementia; regulations. [Effective January 1, 2025.]
1. The Department shall apply to the Secretary of Health and Human Services for a home and community-based services waiver granted pursuant to 42 U.S.C. § 1396n(c). The waiver must authorize the Department to include structured family caregiving for persons suffering from dementia as medical assistance under Medicaid.
2. The waiver must:
(a) Authorize an applicant for or a recipient of Medicaid suffering from dementia to choose any:
(1) Person, including, without limitation, a spouse or a person who is legally responsible for the recipient, to serve as his or her caregiver; and
(2) Appropriate residence in which to receive structured family caregiving;
(b) Require a caregiver chosen by a recipient of Medicaid pursuant to paragraph (a), including, without limitation, a caregiver chosen by an applicant whose application is approved, to be or become an employee of an agency to provide personal care services in the home or an intermediary service organization;
(c) Establish a per diem rate to be paid to an agency to provide personal care services in the home or an intermediary service organization that employs a caregiver pursuant to paragraph (b);
(d) Require an agency to provide personal care services in the home or intermediary service organization that employs a caregiver pursuant to paragraph (b) to provide to the caregiver a daily stipend that is at least 65 percent of the per diem rate paid to the agency to provide personal care services in the home or intermediary service organization; and
(e) Require a caregiver chosen by a recipient of Medicaid pursuant to paragraph (a), including, without limitation, a caregiver chosen by an applicant whose application is approved, to complete any training the Aging and Disability Services Division of the Department determines to be necessary for the caregiver to provide adequate care to the recipient.
3. The Department shall:
(a) Cooperate with the Federal Government in obtaining a waiver pursuant to this section;
(b) If the Federal Government approves the waiver, adopt regulations necessary to carry out the provisions of this section, including, without limitation, the criteria to be used in determining eligibility for an applicant for or a recipient of Medicaid suffering from dementia to receive structured family caregiving pursuant to this section; and
(c) Implement the amendments to the waiver only to the extent that the amendments are approved by the Federal Government.
4. As used in this section:
(a) “Agency to provide personal care services in the home” has the meaning ascribed to it in NRS 449.0021.
(b) “Intermediary service organization” has the meaning ascribed to it in NRS 449.4304.
(c) “Structured family caregiving” means the provision of services to a person who resides in the same residence as the caregiver on a full-time basis. The services provided may include, without limitation:
(1) Case management services;
(2) Personal care services;
(3) Personal assistance;
(4) Homemaker services; and
(5) Health-related services, including, without limitation, home health aide services.
(Added to NRS by 2023, 3297, effective January 1, 2025)
NRS 422.3966 Medicaid: Inclusion of coverage for home and community-based services for persons with fetal alcohol spectrum disorder.
1. The Director shall, to the extent that federal financial participation is available, include under Medicaid coverage for supports and services provided to recipients of Medicaid with fetal alcohol spectrum disorders that are aimed at allowing such recipients to remain living in the home of the recipient or in a community-based setting.
2. The Department may apply to the Secretary of Health and Human Services for any waiver granted pursuant to federal law, amendment to the State Plan for Medicaid or other federal authority that authorizes the Department to receive federal funding to provide the coverage described in subsection 1. The Department 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 waiver or amendment pursuant to this section.
3. “Fetal alcohol spectrum disorder” has the meaning ascribed to it in NRS 432B.0655.
(Added to NRS by 2023, 1751)
NRS 422.3969 Rights of persons receiving home and community-based services.
1. This section may be cited as the Bill of Rights for Persons with Intellectual, Developmental or Physical Disabilities or who are Aged.
2. Except as otherwise specifically provided by law, each person with an intellectual disability, developmental disability or physical disability who is receiving services pursuant to a home and community-based services waiver granted pursuant to 42 U.S.C. § 1396n, and each person who is aged and is receiving such services, has, to the extent applicable to the services received by the person and appropriate for the person pursuant to the home and community-based services waiver, the right to:
(a) Participate in decisions that affect the life of the person, including, without limitation, decisions relating to:
(1) The finances and personal property of the person;
(2) The location where the person resides; and
(3) The development and implementation of any plan for delivering services and the frequency with which services are delivered pursuant to the home and community-based services waiver.
(b) Be treated with respect and dignity.
(c) An appropriate, safe and sanitary living environment that complies with all local, state and federal standards and recognizes the needs of the person for privacy and independence.
(d) Food that is adequate to meet the nutritional needs of the person.
(e) Practice the religion of his or her choice or abstain from the practice of any religion.
(f) Receive timely, effective and appropriate health care.
(g) Receive ancillary services, to the extent necessary for the person.
(h) Maintain privacy and confidentiality in personal matters.
(i) Communicate freely with persons of his or her choice and in any reasonable manner he or she chooses.
(j) Own and use personal property.
(k) Have social interactions with persons of any sex or gender identity or expression.
(l) Pursue vocational opportunities to promote and enhance the economic independence of the person.
(m) Be treated as an equal citizen under the law.
(n) Be free from emotional, psychological, physical and financial abuse.
(o) Participate in appropriate programs of education, training, social development, habilitation and reasonable recreation, including, without limitation, a class at or other program administered by a university, college, community college or trade school.
(p) Select a parent, family member, advocate, employee of this State or other person to act on his or her behalf, including, without limitation, by entering into a supported decision-making agreement pursuant to NRS 162C.200.
(q) Manage his or her own personal finances.
(r) Have his or her personal and medical records kept confidential to the extent provided by state and federal law.
(s) Voice grievances and suggest changes in policies, services and providers of services without restraint, interference, coercion, discrimination or reprisal.
(t) Be free from unnecessary chemical, physical or mechanical restraints.
(u) Participate in the political process.
(v) Refuse to participate in any medical, psychological or other research or experiment.
3. The rights set forth in subsection 2 do not abrogate any remedies provided by law.
4. As used in this section:
(a) “Developmental disability” has the meaning ascribed to it in NRS 435.007.
(b) “Intellectual disability” has the meaning ascribed to it in NRS 435.007.
(Added to NRS by 2023, 2009)
INDIVIDUAL DEVELOPMENT ACCOUNT PROGRAM
NRS 422.398 Prohibition against considering money deposited in individual development account by recipient of Medicaid to be income for certain purposes. To the extent authorized by federal law, the Department shall not consider money deposited in an individual development account pursuant to NRS 422A.493 by a recipient of Medicaid to be income for the purpose of determining whether the person who deposited the money is eligible to receive or to continue to receive benefits that are provided by Medicaid.
(Added to NRS by 2021, 1547)
NRS 422.399 Instruction in financial literacy for certain recipients of Medicaid.
1. The Department shall, to the extent that money is provided by the State Treasurer pursuant to NRS 422A.492 for that purpose, ensure that instruction in financial literacy is provided to a recipient of Medicaid who deposits a portion of his or her income in an individual development account pursuant to NRS 422A.493.
2. The Department may contract for the services of an independent contractor to provide the instruction required in subsection 1.
(Added to NRS by 2021, 1547)
PRESCRIPTION DRUGS
NRS 422.401 Definitions. As used in NRS 422.401 to 422.406, inclusive, unless the context otherwise requires, the words and terms defined in NRS 422.4015 to 422.4024, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 2003, 1317; A 2017, 1801, 3928; 2019, 2167, 4028; 2021, 832, 2679)
NRS 422.4015 “Board” defined. “Board” means the Silver State Scripts Board established pursuant to NRS 422.4035.
(Added to NRS by 2003, 1317; A 2019, 4028)
NRS 422.402 “Drug Use Review Board” defined. “Drug Use Review Board” means the Board established pursuant to 42 U.S.C. § 1396r-8(g)(3).
(Added to NRS by 2003, 1317)
NRS 422.4021 “Health benefit plan” defined. “Health benefit plan” means a policy, contract, certificate or agreement offered to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.
(Added to NRS by 2019, 4027)
NRS 422.4022 “Health maintenance organization” defined. “Health maintenance organization” has the meaning ascribed to it in NRS 695C.030.
(Added to NRS by 2019, 4027)
NRS 422.4023 “Pharmacy benefit manager” defined. “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.
(Added to NRS by 2019, 4027)
NRS 422.4024 “Sickle cell disease and its variants” defined. “Sickle cell disease and its variants” has the meaning ascribed to it in NRS 439.4927.
(Added to NRS by 2019, 2167)
NRS 422.4025 List of preferred prescription drugs used for Medicaid program and Children’s Health Insurance Program; list of drugs excluded from restrictions; role of Pharmacy and Therapeutics Committee; availability of new pharmaceutical products and products for which there is new evidence report; coverage of certain drugs not on list of preferred prescription drugs; regulations.
1. The Department shall:
(a) By regulation, develop a list of preferred prescription drugs to be used for the Medicaid program and the Children’s Health Insurance Program, and each public or nonprofit health benefit plan that elects to use the list of preferred prescription drugs as its formulary pursuant to NRS 287.012, 287.0433 or 687B.407; and
(b) Negotiate and enter into agreements to purchase the drugs included on the list of preferred prescription drugs on behalf of the health benefit plans described in paragraph (a) or enter into a contract pursuant to NRS 422.4053 with a pharmacy benefit manager, health maintenance organization or one or more public or private entities in this State, the District of Columbia or other states or territories of the United States, as appropriate, to negotiate such agreements.
2. The Department shall, by regulation, establish a list of prescription drugs which must be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs established pursuant to subsection 1. The list established pursuant to this subsection must include, without limitation:
(a) Prescription drugs that are prescribed for the treatment of the human immunodeficiency virus, including, without limitation, antiretroviral medications;
(b) Antirejection medications for organ transplants;
(c) Antihemophilic medications; and
(d) Any prescription drug which the Board identifies as appropriate for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs.
3. The regulations must provide that the Board makes the final determination of:
(a) Whether a class of therapeutic prescription drugs is included on the list of preferred prescription drugs and is excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs;
(b) Which therapeutically equivalent prescription drugs will be reviewed for inclusion on the list of preferred prescription drugs and for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs; and
(c) Which prescription drugs should be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs based on continuity of care concerning a specific diagnosis, condition, class of therapeutic prescription drugs or medical specialty.
4. The list of preferred prescription drugs established pursuant to subsection 1 must include, without limitation:
(a) Any prescription drug determined by the Board to be essential for treating sickle cell disease and its variants; and
(b) Prescription drugs to prevent the acquisition of human immunodeficiency virus.
5. The regulations must provide that each new pharmaceutical product and each existing pharmaceutical product for which there is new clinical evidence supporting its inclusion on the list of preferred prescription drugs must be made available pursuant to the Medicaid program with prior authorization until the Board reviews the product or the evidence.
6. The Medicaid program must cover a prescription drug that is not included on the list of preferred prescription drugs as if the drug were included on that list if:
(a) The drug is:
(1) Used to treat hepatitis C;
(2) Used to provide medication-assisted treatment for opioid use disorder;
(3) Used to support safe withdrawal from substance use disorder; or
(4) In the same class as a drug on the list of preferred prescription drugs; and
(b) All preferred prescription drugs within the same class as the drug are unsuitable for a recipient of Medicaid because:
(1) The recipient is allergic to all preferred prescription drugs within the same class as the drug;
(2) All preferred prescription drugs within the same class as the drug are contraindicated for the recipient or are likely to interact in a harmful manner with another drug that the recipient is taking;
(3) The recipient has a history of adverse reactions to all preferred prescription drugs within the same class as the drug; or
(4) The drug has a unique indication that is supported by peer-reviewed clinical evidence or approved by the United States Food and Drug Administration.
7. The Medicaid program must automatically cover any typical or atypical antipsychotic medication or anticonvulsant medication that is not on the list of preferred prescription drugs upon the demonstrated therapeutic failure of one drug on that list to adequately treat the condition of a recipient of Medicaid.
8. On or before February 1 of each year, the Department shall:
(a) Compile a report concerning the agreements negotiated pursuant to paragraph (b) of subsection 1 and contracts entered into pursuant to NRS 422.4053 which must include, without limitation, the financial effects of obtaining prescription drugs through those agreements and contracts, in total and aggregated separately for agreements negotiated by the Department, contracts with a pharmacy benefit manager, contracts with a health maintenance organization and contracts with public and private entities from this State, the District of Columbia and other states and territories of the United States; and
(b) Post the report on an Internet website maintained by the Department and submit the report to the Director of the Legislative Counsel Bureau for transmittal to:
(1) In odd-numbered years, the Legislature; or
(2) In even-numbered years, the Legislative Commission.
(Added to NRS by 2003, 1317; A 2010, 26th Special Session, 36; 2011, 985; 2015, 2158; 2017, 2174; 2019, 2167, 4028; 2021, 1751, 3196, 3205; 2023, 522, 3498)
NRS 422.4026 Coverage of certain supplements for treating sickle cell disease and its variants: Adoption of list by regulation; periodic review of list.
1. The Department, upon the recommendation of the Board, shall prescribe by regulation a list of nonprescription supplements essential for treating sickle cell disease and its variants that must be covered by Medicaid for recipients who have sickle cell disease and its variants.
2. The Board shall review the list of supplements prescribed pursuant to subsection 1 at least biennially to determine whether to recommend adding or removing any supplements from the list and report those recommendations to the Department.
(Added to NRS by 2019, 2167)
NRS 422.403 Establishment and management of use by Medicaid program of step therapy and prior authorization; duties of Drug Use Review Board; exception for certain drugs to treat psychiatric conditions; acceptance of recommendations from Board; regulations.
1. The Department shall, by regulation, establish and manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs.
2. The Drug Use Review Board shall:
(a) Advise the Department concerning the use by the Medicaid program of step therapy and prior authorization for prescription drugs;
(b) Develop step therapy protocols and prior authorization policies and procedures for use by the Medicaid program for prescription drugs; and
(c) Review and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols used by the Medicaid program for prescription drugs.
3. The step therapy protocol established pursuant to this section must not apply to a drug approved by the Food and Drug Administration that is prescribed to treat a psychiatric condition of a recipient of Medicaid, if:
(a) The drug has been approved by the Food and Drug Administration with indications for the psychiatric condition of the insured or the use of the drug to treat that psychiatric condition is otherwise supported by medical or scientific evidence;
(b) The drug is prescribed by:
(1) A psychiatrist;
(2) A physician assistant under the supervision of a psychiatrist;
(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120; or
(4) A primary care provider that is providing care to an insured in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in Medicaid is located 60 miles or more from the residence of the recipient; and
(c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the recipient, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.
4. The Department shall not require the Drug Use Review Board to develop, review or approve prior authorization policies or procedures necessary for the operation of the list of preferred prescription drugs developed pursuant to NRS 422.4025.
5. The Department shall accept recommendations from the Drug Use Review Board as the basis for developing or revising step therapy protocols and prior authorization policies and procedures used by the Medicaid program for prescription drugs.
6. As used in this section:
(a) “Medical or scientific evidence” has the meaning ascribed to it in NRS 695G.053.
(b) “Step therapy protocol” means a procedure that requires a recipient of Medicaid to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the recipient before Medicaid provides coverage for the recommended drug.
(Added to NRS by 2003, 1318; A 2019, 4029; 2023, 1792)
NRS 422.4032 Exemption from required step therapy for certain drugs: Application process; form; approval; payment of cost of drug for which exemption applies.
1. The Department or a pharmacy benefit manager or health maintenance organization with which the Department contracts pursuant to NRS 422.4053 to manage prescription drug benefits shall allow a recipient of Medicaid who has been diagnosed with stage 3 or 4 cancer or the attending practitioner of the recipient to apply for an exemption from step therapy that would otherwise be required pursuant to NRS 422.403 to instead use a prescription drug prescribed by the attending practitioner to treat the cancer or any symptom thereof of the recipient of Medicaid. The application process must:
(a) Allow the recipient or attending practitioner, or a designated advocate for the recipient or attending practitioner, to present to the Department, pharmacy benefit manager or health maintenance organization, as applicable, the clinical rationale for the exemption and any relevant medical information.
(b) Clearly prescribe the information and supporting documents that must be submitted with the application, the criteria that will be used to evaluate the request and the conditions under which an expedited determination pursuant to subsection 4 is warranted.
(c) Require the review of each application by at least one physician, registered nurse or pharmacist.
2. The information and supporting documentation required pursuant to paragraph (b) of subsection 1:
(a) May include, without limitation:
(1) The medical history or other health records of the recipient demonstrating that the recipient has:
(I) Tried other drugs included in the pharmacological class of drugs for which the exemption is requested without success; or
(II) Taken the requested drug for a clinically appropriate amount of time to establish stability in relation to the cancer and the guidelines of the prescribing practitioner; and
(2) Any other relevant clinical information.
(b) Must not include any information or supporting documentation that is not necessary to make a determination about the application.
3. Except as otherwise provided in subsection 4, the Department, pharmacy benefit manager or health maintenance organization, as applicable, that receives an application for an exemption pursuant to subsection 1 shall:
(a) Make a determination concerning the application if the application is complete, or request additional information or documentation necessary to complete the application not later than 72 hours after receiving the application; and
(b) If it requests additional information or documentation, make a determination concerning the application not later than 72 hours after receiving the requested information or documentation.
4. If, in the opinion of the attending practitioner, step therapy may seriously jeopardize the life or health of the recipient, the Department, pharmacy benefit manager or health maintenance organization that receives an application for an exemption pursuant to subsection 1, as applicable, must make a determination concerning the application as expeditiously as necessary to avoid serious jeopardy to the life or health of the recipient.
5. The Department, pharmacy benefit manager or health maintenance organization, as applicable, shall disclose to a recipient or attending practitioner who submits an application for an exemption from step therapy pursuant to subsection 1 the qualifications of each person who will review the application.
6. The Department, pharmacy benefit manager or health maintenance organization, as applicable, must grant an exemption from step therapy in response to an application submitted pursuant to subsection 1 if:
(a) Any treatment otherwise required under the step therapy or any drug in the same pharmacological class or having the same mechanism of action as the drug for which the exemption is requested has not been effective at treating the cancer or symptom of the recipient when prescribed in accordance with clinical indications, clinical guidelines or other peer-reviewed evidence;
(b) Delay of effective treatment would have severe or irreversible consequences for the recipient and the treatment otherwise required under the step therapy is not reasonably expected to be effective based on the physical or mental characteristics of the recipient and the known characteristics of the treatment;
(c) Each treatment otherwise required under the step therapy:
(1) Is contraindicated for the recipient or has caused or is likely, based on peer-reviewed clinical evidence, to cause an adverse reaction or other physical harm to the recipient; or
(2) Has prevented or is likely to prevent the recipient from performing the responsibilities of his or her occupation or engaging in activities of daily living, as defined in 42 C.F.R. § 441.505; or
(d) The condition of the recipient is stable while being treated with the prescription drug for which the exemption is requested and the recipient has previously received approval for coverage of that drug.
7. If the Department, pharmacy benefit manager or health maintenance organization, as applicable, approves an application for an exemption from step therapy pursuant to this section, the State must pay the nonfederal share of the cost of the prescription drug to which the exemption applies. The Department, pharmacy benefit manager or health maintenance organization may initially limit the coverage to a 1-week supply of the drug for which the exemption is granted. If the attending practitioner determines after 1 week that the drug is effective at treating the cancer or symptom for which it was prescribed, the State must continue to pay the nonfederal share of the cost of the drug for as long as it is necessary to treat the recipient for the cancer or symptom. The Department, pharmacy benefit manager or health maintenance organization, as applicable, may conduct a review not more frequently than once each quarter to determine, in accordance with available medical evidence, whether the drug remains necessary to treat the recipient for the cancer or symptom. The Department, pharmacy benefit manager or health maintenance organization, as applicable, shall provide a report of the review to the recipient.
8. The Department and any pharmacy benefit manager or health maintenance organization with which the Department contracts pursuant to NRS 422.4053 to manage prescription drug benefits shall post in an easily accessible location on an Internet website maintained by the Department, pharmacy benefit manager or health maintenance organization, as applicable, a form for requesting an exemption pursuant to this section.
9. As used in this section, “attending practitioner” means the practitioner, as defined in NRS 639.0125, who has primary responsibility for the treatment of the cancer or any symptom of such cancer of a recipient.
(Added to NRS by 2021, 2677)
NRS 422.4035 Silver State Scripts Board: Creation; membership.
1. The Director shall create the Silver State Scripts Board within the Department. The Board must consist of such members as are appointed by the Director.
2. The Director shall appoint to the Board health care professionals who have knowledge and expertise in one or more of the following:
(a) The clinically appropriate prescribing of outpatient prescription drugs that are covered by Medicaid;
(b) The clinically appropriate dispensing and monitoring of outpatient prescription drugs that are covered by Medicaid;
(c) The review of, evaluation of and intervention in the use of prescription drugs; and
(d) Medical quality assurance.
3. At least one-third of the members of the Board must be active physicians licensed to practice medicine in this State, at least one of whom must be an active psychiatrist licensed to practice medicine in this State. At least one-third of the members of the Board must be either active pharmacists registered in this State or persons in this State with doctoral degrees in pharmacy.
4. A person must not be appointed to the Board if the person is employed by, compensated by in any manner, has a financial interest in, or is otherwise affiliated with a business or corporation that manufactures prescription drugs.
(Added to NRS by 2003, 1318; A 2015, 304; 2019, 4030)
NRS 422.404 Silver State Scripts Board: Chair; terms; vacancies; meetings; quorum.
1. The Director shall appoint the Chair of the Board from among its members.
2. After the initial terms, the term of each member of the Board is 2 years. A member may be reappointed.
3. A vacancy occurring in the membership of the Board must be filled for the remainder of the unexpired term in the same manner as the original appointment.
4. The Board shall meet at least once every 3 months and at the times and places specified by a call of the Chair of the Board.
5. A majority of the members of the Board constitutes a quorum for the transaction of business, and the affirmative vote of a majority of the members of the Board is required to take action.
(Added to NRS by 2003, 1319; A 2019, 4030)
NRS 422.4045 Silver State Scripts Board: Members serve without compensation; members entitled to per diem; members holding public office or employed by governmental entity.
1. Members of the Board serve without compensation, except that a member of the Board is entitled, while engaged in the business of the Board, to receive the per diem allowance and travel expenses provided for state officers and employees generally.
2. Each member of the Board who is an officer or employee of the State of Nevada or a local government must be relieved from his or her duties without loss of regular compensation so that the person may prepare for and attend meetings of the Board and perform any work necessary to carry out the duties of the Board in the most timely manner practicable. A state agency or local governmental entity shall not require an officer or employee who is a member of the Board to make up the time that the officer or employee is absent from work to carry out any duties as a member of the Board or to use annual vacation or compensatory time for the absence.
(Added to NRS by 2003, 1319; A 2019, 4030)
NRS 422.405 Silver State Scripts Board: Duties and powers.
1. The Department shall, by regulation, set forth the duties of the Board, which must include, without limitation:
(a) Identifying the prescription drugs which should be included on the list of preferred prescription drugs developed by the Department pursuant to NRS 422.4025, which must include, without limitation, any prescription drug required by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to be covered by the Medicaid program and any other prescription drug deemed essential by the Board;
(b) Identifying the prescription drugs which should be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs;
(c) Identifying classes of therapeutic prescription drugs for its review and performing a clinical analysis of each drug included in each class that is identified for review; and
(d) Reviewing at least annually all classes of therapeutic prescription drugs on the list of preferred prescription drugs developed by the Department pursuant to NRS 422.4025.
2. The Department shall, by regulation, require the Board to:
(a) Base its decisions on evidence of clinical efficacy, safety and outcomes for patients and, if the difference between the clinical efficacy, safety and outcomes for two or more drugs is not clinically significant, cost;
(b) Review new pharmaceutical products in as expeditious a manner as possible; and
(c) Consider new clinical evidence supporting the inclusion of an existing pharmaceutical product on the list of preferred prescription drugs developed by the Department and new clinical evidence supporting the exclusion of an existing pharmaceutical product from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs in as expeditious a manner as possible.
3. The Department shall, by regulation, authorize the Board to:
(a) In carrying out its duties, exercise clinical judgment and analyze peer review articles, published studies, and other medical and scientific information; and
(b) Establish subcommittees to analyze specific issues that arise as the Board carries out its duties.
4. The Board may close any portion of a meeting during which it considers the cost of prescription drugs.
(Added to NRS by 2003, 1319; A 2019, 4031)
NRS 422.4052 Department to take certain actions relating to acquisition of prescription drugs for recipient of Medicaid who resides in area for which declared disaster or emergency is in effect.
1. The Department shall ensure that, if the Governor or the Legislature proclaims the existence of a state of emergency or issues a declaration of disaster pursuant to NRS 414.070, a recipient of Medicaid may refill a covered prescription regardless of how many days are remaining on the prescription if the recipient:
(a) Has not exceeded the number of refills authorized by the prescribing practitioner;
(b) Resides in the area for which the emergency or disaster has been declared; and
(c) Requests the refill not later than the end of the state of emergency or disaster or 30 days after the issuance of the proclamation or declaration, whichever is later.
2. The State shall, subject to any applicable copayments, coinsurance or deductibles, pay the nonfederal share of the cost for a supply of a covered prescription drug for up to 30 days for any recipient of Medicaid who requests a refill pursuant to subsection 1.
3. If the Commissioner of Insurance extends the time periods prescribed by NRS 695C.16945 and 695G.1635, the Department must extend the time periods prescribed by this section for the same amount of time.
4. As used in this section, “practitioner” has the meaning ascribed to it in NRS 639.0125.
(Added to NRS by 2021, 832)
NRS 422.4053 Department to manage payments and rebates for prescription drugs; contract for provision of certain services.
1. Except as otherwise provided in subsection 2, the Department shall directly manage, direct and coordinate all payments and rebates for prescription drugs and all other services and payments relating to the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program.
2. The Department may enter into a contract with:
(a) A pharmacy benefit manager for the provision of any services described in subsection 1.
(b) A health maintenance organization pursuant to NRS 422.273 for the provision of any of the services described in subsection 1 for recipients of Medicaid or recipients of insurance through the Children’s Health Insurance Program who receive coverage through a Medicaid managed care program.
(c) One or more public or private entities from this State, the District of Columbia or other states or territories of the United States for the collaborative purchasing of prescription drugs in accordance with subsection 3 of NRS 277.110.
3. A contract entered into pursuant to paragraph (a) or (b) of subsection 2 must:
(a) Include the provisions required by NRS 422.4056;
(b) Require the pharmacy benefit manager or health maintenance organization, as applicable, to disclose to the Department any information relating to the services covered by the contract, including, without limitation, information concerning dispensing fees, measures for the control of costs, rebates collected and paid and any fees and charges imposed by the pharmacy benefit manager or health maintenance organization pursuant to the contract; and
(c) Require the pharmacy benefit manager or health maintenance organization to comply with the provisions of this chapter regarding the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program to the same extent as the Department.
4. In addition to meeting the requirements of subsection 3, a contract entered into pursuant to:
(a) Paragraph (a) of subsection 2 may require the pharmacy benefit manager to provide the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, to the Department.
(b) Paragraph (b) of subsection 2 must require the health maintenance organization to provide to the Department the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, less an administrative fee in an amount prescribed by the contract. The Department shall adopt policies prescribing the maximum amount of such an administrative fee.
(Added to NRS by 2019, 4027; A 2021, 1752; 2023, 2088)
NRS 422.4056 Audits of certain contracts; posting of audit results on Internet website.
1. Any contract between the Department and a pharmacy benefit manager or health maintenance organization entered into pursuant to NRS 422.4053 must require the pharmacy benefit manager or health maintenance organization, as applicable, to:
(a) Submit to and cooperate with an annual audit by the Department to evaluate the compliance of the pharmacy benefit manager or health maintenance organization with the agreement and generally accepted accounting and business practices. The audit must analyze all claims processed by the pharmacy benefit manager or health maintenance organization pursuant to the agreement.
(b) Obtain from an independent accountant, at the expense of the pharmacy benefit manager or health maintenance organization, as applicable, an annual audit of internal controls to ensure the integrity of financial transactions and claims processing.
2. The Department shall post the results of any audit conducted pursuant to paragraph (a) of subsection 1 on an Internet website maintained by the Department.
(Added to NRS by 2019, 4027)
NRS 422.406 Regulations; contracts for services.
1. The Department may, to carry out its duties set forth in NRS 422.27172 to 422.27178, inclusive, and 422.401 to 422.406, inclusive, and to administer the provisions of those sections:
(a) Adopt regulations; and
(b) Enter into contracts for any services.
2. Any regulations adopted by the Department pursuant to NRS 422.27172 to 422.27178, inclusive, and 422.401 to 422.406, inclusive, must be adopted in accordance with the provisions of chapter 241 of NRS.
(Added to NRS by 2003, 1321; A 2017, 1802; 2019, 4032; 2021, 832, 2679)
UNLAWFUL ACTS; PENALTIES
General Provisions
NRS 422.410 Fraudulent acts; penalties.
1. Unless a different penalty is provided pursuant to NRS 422.361 to 422.369, inclusive, or 422.450 to 422.590, inclusive, a person who knowingly and designedly, by any false pretense, false or misleading statement, impersonation, misrepresentation, or concealment, transfer, disposal or assignment of money or property obtains or attempts to obtain monetary or any other public assistance, or money, property, medical or remedial care or any other service provided pursuant to the Children’s Health Insurance Program, having a value of $100 or more, whether by one act or a series of acts, with the intent to cheat, defraud or defeat the purposes of this chapter or to enable a person to meet or appear to meet any requirements of eligibility prescribed by state law or by rule or regulation adopted by the Department for a grant or an increase in a grant of any type of public assistance is guilty of a category E felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
2. For the purposes of subsection 1, whenever a recipient of Temporary Assistance for Needy Families pursuant to the provisions of chapter 422A of NRS receives an overpayment of benefits for the third time and the overpayments have resulted from a false statement or representation by the recipient or from the failure of the recipient to notify the Division of Welfare and Supportive Services of the Department of a change in circumstances which would affect the amount of assistance the recipient receives, a rebuttable presumption arises that the payment was fraudulently received.
3. For the purposes of this section:
(a) “Public assistance” includes any money, property, medical or remedial care or any other service provided pursuant to a state plan.
(b) “Temporary Assistance for Needy Families” has the meaning ascribed to it in NRS 422A.080.
(Added to NRS by 1981, 1909; A 1985, 1405; 1991, 1053; 1993, 142, 2788, 2819; 1995, 1274; 1997, 2239; 1999, 2233; 2005, 22nd Special Session, 38; 2007, 2394; 2013, 1307)
State Plan for Medicaid
NRS 422.450 Definitions. As used in NRS 422.450 to 422.590, inclusive, unless the context otherwise requires, the words and terms defined in NRS 422.460 to 422.525, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1991, 1048; A 1997, 456)
NRS 422.460 “Benefit” defined. “Benefit” means a benefit authorized by the Plan.
(Added to NRS by 1991, 1048)
NRS 422.470 “Claim” defined. “Claim” means a communication, whether oral, written, electronic or magnetic, which is used to identify specific goods, items or services as reimbursable pursuant to the Plan, or which states income or expense and is or may be used to determine a rate of payment pursuant to the Plan.
(Added to NRS by 1991, 1048)
NRS 422.480 “Plan” defined. “Plan” means the State Plan for Medicaid established pursuant to NRS 422.063.
(Added to NRS by 1991, 1048; A 1993, 2067; 1997, 1245)
NRS 422.490 “Provider” defined. “Provider” means a:
1. Person who has applied to participate or who participates in the Plan as the provider of goods or services; or
2. Private insurance carrier, health care cooperative or alliance, health maintenance organization, insurer, organization, entity, association, affiliation or person, who contracts to provide or provides goods or services that are reimbursed by or are a required benefit of the Plan.
(Added to NRS by 1991, 1048; A 1997, 456)
NRS 422.500 “Recipient” defined. “Recipient” means a natural person who receives benefits pursuant to the Plan.
(Added to NRS by 1991, 1048)
NRS 422.510 “Records” defined. “Records” means medical, professional or business records relating to the treatment or care of a recipient, or to a good or a service provided to a recipient, or to rates paid for such a good or a service, and records required to be kept by the Plan.
(Added to NRS by 1991, 1048)
NRS 422.520 “Sign” defined. “Sign” means to affix a signature directly or indirectly by means of handwriting, typewriter, stamp, computer impulse or other means.
(Added to NRS by 1991, 1048)
NRS 422.525 “Statement or representation” defined. “Statement or representation” includes, without limitation, a report, claim, certification, acknowledgment or ratification of:
1. Financial information;
2. An enrollment claim;
3. Demographic statistics;
4. Encounter data;
5. Health services available or rendered;
6. The qualifications of the persons rendering the health care or ancillary services; or
7. Any combination of subsections 1 to 6, inclusive.
(Added to NRS by 1997, 456)
NRS 422.530 Responsibility for false claim, statement or representation. For the purposes of NRS 422.540 and 422.550:
1. A person shall be deemed to have known that a claim, statement or representation was false if the person knew, or by virtue of his or her position, authority or responsibility had reason to know, of the falsity of the claim, statement or representation.
2. A person shall be deemed to have made or caused to be made a claim, statement or representation if the person:
(a) Had the authority or responsibility to:
(1) Make the claim, statement or representation;
(2) Supervise another who made the claim, statement or representation; or
(3) Authorize the making of the claim, statement or representation,
Ê whether by operation of law, business or professional practice, or office procedure; and
(b) Exercised that authority or responsibility or failed to exercise that authority or responsibility and, as a direct or indirect result, the false claim, statement or representation was made.
(Added to NRS by 1991, 1048; A 1997, 456)
NRS 422.540 Offenses regarding false claims, statements or representations; penalties.
1. A person, with the intent to defraud, commits an offense if with respect to the Plan the person:
(a) Makes a claim or causes it to be made, knowing the claim to be false, in whole or in part, by commission or omission;
(b) Makes or causes to be made a statement or representation for use in obtaining or seeking to obtain authorization to provide specific goods or services, knowing the statement or representation to be false, in whole or in part, by commission or omission;
(c) Makes or causes to be made a statement or representation for use by another in obtaining goods or services pursuant to the Plan, knowing the statement or representation to be false, in whole or in part, by commission or omission; or
(d) Makes or causes to be made a statement or representation for use in qualifying as a provider, knowing the statement or representation to be false, in whole or in part, by commission or omission.
2. A person who commits an offense described in subsection 1 shall be punished for a:
(a) Category D felony, as provided in NRS 193.130, if the amount of the claim or the value of the goods or services obtained or sought to be obtained was greater than or equal to $650.
(b) Misdemeanor if the amount of the claim or the value of the goods or services obtained or sought to be obtained was less than $650.
Ê Amounts involved in separate violations of this section committed pursuant to a scheme or continuing course of conduct may be aggregated in determining the punishment.
3. In addition to any other penalty for a violation of the commission of an offense described in subsection 1, the court shall order the person to pay restitution.
(Added to NRS by 1991, 1049; A 1997, 457; 2011, 174)
NRS 422.550 Statement regarding truth and accuracy of applications, reports and invoices; perjury; presumption concerning person who signs statement on behalf of provider.
1. Each application or report submitted to participate as a provider, each report stating income or expense upon which rates of payment are or may be based, and each invoice for payment for goods or services provided to a recipient must contain a statement that all matters stated therein are true and accurate, signed by a natural person who is the provider or is authorized to act for the provider, under the pains and penalties of perjury.
2. A person is guilty of perjury which is a category D felony and shall be punished as provided in NRS 193.130 if the person signs or submits, or causes to be signed or submitted, such a statement, knowing that the application, report or invoice contains information which is false, in whole or in part, by commission or by omission.
3. For the purposes of this section, a person who signs on behalf of a provider is presumed to have the authorization of the provider and to be acting at the direction of the provider.
(Added to NRS by 1991, 1049; A 1995, 1274; 1997, 457)
NRS 422.560 Offenses regarding sale, purchase or lease of goods, services, materials or supplies; penalty.
1. Except as otherwise provided in subsection 2, a person shall not:
(a) While acting on behalf of a provider, purchase or lease goods, services, materials or supplies for which payment may be made, in whole or in part, pursuant to the Plan, and solicit or accept anything of additional value in return for or in connection with the purchase or lease;
(b) Sell or lease to or for the use of a provider goods, services, materials or supplies for which payment may be made, in whole or in part, pursuant to the Plan, and offer, transfer or pay anything of additional value in connection with or in return for the sale or lease; or
(c) Refer a person to a provider for goods or services for which payment may be made, in whole or in part, pursuant to the Plan, and solicit or accept anything of value in connection with the referral.
2. Paragraphs (a) and (b) of subsection 1 do not apply if the additional value transferred is:
(a) A refund or discount made in the ordinary course of business;
(b) Reflected by the books and records of the person transferring or receiving it; and
(c) Reflected in the billings submitted to the Plan.
3. A person shall not, while acting on behalf of a provider providing goods or services to a recipient pursuant to the Plan, charge, solicit, accept or receive anything of additional value in addition to the amount legally payable pursuant to the Plan in connection with the provision of the goods or services.
4. A person who violates this section, if the value of the thing or any combination of things unlawfully solicited, accepted, offered, transferred, paid, charged or received:
(a) Is less than $650, is guilty of a gross misdemeanor.
(b) Is $650 or more, is guilty of a category D felony and shall be punished as provided in NRS 193.130.
(Added to NRS by 1991, 1049; A 1995, 1275; 2011, 175)
NRS 422.570 Intentional failure to maintain adequate records; intentional destruction of records; penalties.
1. A person is guilty of a gross misdemeanor if, upon submitting a claim for or upon receiving payment for goods or services pursuant to the Plan, the person intentionally fails to maintain such records as are necessary to disclose fully the nature of the goods or services for which a claim was submitted or payment was received, or such records as are necessary to disclose fully all income and expenditures upon which rates of payment were based, for at least 5 years after the date on which payment was received.
2. A person who intentionally destroys such records within 5 years after the date payment was received is guilty of a category D felony and shall be punished as provided in NRS 193.130.
(Added to NRS by 1991, 1050; A 1995, 1275)
NRS 422.580 Civil penalties for certain violations; liability of provider for excess amount unknowingly accepted; enforcement; use of money collected as penalty or repayment.
1. A provider who receives payment to which the provider is not entitled by reason of a violation of NRS 422.540, 422.550, 422.560 or 422.570 is liable for:
(a) An amount equal to three times the amount unlawfully obtained;
(b) Not less than $5,000 for each false claim, statement or representation;
(c) An amount equal to three times the total of the reasonable expenses incurred by the State in enforcing this section; and
(d) Payment of interest on the amount of the excess payment at the rate fixed pursuant to NRS 99.040 for the period from the date upon which payment was made to the date upon which repayment is made pursuant to the Plan.
2. A criminal action need not be brought against the provider before civil liability attaches under this section.
3. A provider who unknowingly accepts a payment in excess of the amount to which the provider is entitled is liable for the repayment of the excess amount. It is a defense to any action brought pursuant to this subsection that the provider returned or attempted to return the amount which was in excess of that to which the provider was entitled within a reasonable time after receiving it.
4. The Attorney General shall cause appropriate legal action to be taken on behalf of the State to enforce the provisions of this section.
5. Any penalty or repayment of money collected pursuant to this section is hereby appropriated to provide medical aid to the indigent through programs administered by the Department.
(Added to NRS by 1991, 1050; A 1997, 458; 1999, 2233)
NRS 422.590 Limitation and accrual of actions. An action brought pursuant to NRS 422.540 to 422.580, inclusive, must be commenced within 4 years, but the cause of action in such a case shall be deemed to accrue upon the discovery by the aggrieved party of the facts constituting a violation of NRS 422.540 to 422.580, inclusive.
(Added to NRS by 1997, 456)