3-4 the words and terms defined in NRS 422.010 to 422.055, inclusive, and

3-8 [1.] (a) State supplementary assistance;

3-9 [2.] (b) Temporary assistance for needy families;

3-10 [3.] (c) Medicaid;

3-11 [4.] (d) Food stamp assistance;

3-12 [5.] (e) Low-income home energy assistance;

3-13 [6.] (f) The program for child care and development; and

3-14 [7.] (g) Benefits provided pursuant to any other public welfare program

3-15 administered by the welfare division or the division of health care financing

3-16 and policy pursuant to such additional federal legislation as is not

3-17 inconsistent with the purposes of this chapter.

3-18 2. The term does not include the children’s health insurance

3-22 section 3 of this act, 422.301 to 422.306, inclusive, and 422.380 to

3-23 422.390, inclusive, [and 422.580,] unless the context otherwise requires,

3-24 "administrator" means the administrator of the division of health care

3-28 administer oaths and take testimony thereunder and issue subpoenas

3-29 requiring the attendance of witnesses before the division of health care

3-30 financing and policy at a designated time and place and the production of

3-31 books, papers and records relative to:

3-32 (a) Eligibility or continued eligibility to provide medical care, remedial

3-33 care or other services pursuant to the state plan for Medicaid [;] or the

3-34 children’s health insurance program; and

3-35 (b) Verification of treatment and payments to a provider of medical

3-36 care, remedial care or other services pursuant to the state plan for Medicaid

3-37 [.] or the children’s health insurance program.

3-38 2. If a witness fails to appear or refuses to give testimony or to produce

3-39 books, papers and records as required by the subpoena, the district court of

3-40 the county in which the investigation is being conducted may compel the

3-41 attendance of the witness, the giving of testimony and the production of

4-3 concerning applicants for and recipients of public assistance or assistance

4-4 pursuant to the children’s health insurance program to purposes directly

4-5 connected to the administration of this chapter, and to provide safeguards

4-6 therefor, under the applicable provisions of the Social Security Act, the

4-7 welfare division and the division of health care financing and policy shall

4-8 establish and enforce reasonable regulations governing the custody, use and

4-9 preservation of any records, files and communications filed with the

4-10 welfare division or the division of health care financing and policy.

4-11 2. If, pursuant to a specific statute or a regulation of the welfare

4-12 division or the division of health care financing and policy, names and

4-13 addresses of, or information concerning, applicants for and recipients of

4-14 assistance , including, without limitation, assistance pursuant to the

4-15 children’s health insurance program, are furnished to or held by any other

4-16 agency or department of government, such agency or department of

4-17 government is bound by the regulations of the department prohibiting the

4-18 publication of lists and records thereof or their use for purposes not directly

4-19 connected with the administration of this chapter.

4-20 3. Except for purposes directly connected with the administration of

4-21 this chapter, no person may publish, disclose or use, or permit or cause to

4-22 be published, disclosed or used, any confidential information pertaining to

4-23 a recipient of assistance , including, without limitation, a recipient of

4-24 assistance pursuant to the children’s health insurance program, under

4-28 provided pursuant to the children’s health insurance program incurs an

4-29 illness or injury for which medical services are payable [under the state

4-30 plan] by the department and which is incurred under circumstances

4-31 creating a legal liability in some person other than the recipient or a

4-32 division of the department to pay all or part of the costs of such services,

4-33 the department is subrogated to the right of the recipient to the extent of all

4-34 such costs and may join or intervene in any action by the recipient or his

4-35 successors in interest to enforce such legal liability.

4-36 2. If a recipient or his successors in interest fail or refuse to commence

4-37 an action to enforce the legal liability, the department may commence an

4-38 independent action, after notice to the recipient or his successors in interest,

4-39 to recover all costs to which it is entitled. In any such action by the

4-40 department, the recipient or his successors in interest may be joined as

4-41 third-party defendants.

4-42 3. In any case where the department is subrogated to the rights of the

5-35 pursuant to:

5-36 (a) The program established to provide temporary assistance for needy

5-37 families;

5-38 (b) [The program for assistance to the medically indigent;] Medicaid; or

5-39 (c) Any program for which a grant has been provided to this state

5-40 pursuant to 42 U.S.C. §§ 1397 et seq.,

5-41 to a qualified alien who complies with the requirements established by the

5-42 welfare division pursuant to federal law and this chapter for the receipt of

6-5 for public assistance or claim for services is not acted upon by the [welfare

6-6 division] department within a reasonable time after the filing of the

6-7 application [,] or claim for services, or is denied in whole or in part, or if

6-8 any grant of public assistance or claim for services is reduced, suspended

6-9 or terminated, the applicant for or recipient of public assistance may appeal

6-10 to the [welfare division] department and may be represented in the appeal

6-11 by counsel or other representative of his choice.

6-12 2. Upon the initial decision to deny, reduce, suspend or terminate

6-13 public assistance [, the welfare division] or services, the department shall

6-14 notify that applicant or recipient of its decision, the regulations involved

6-15 and his right to request a hearing within a certain period. If a request for a

6-16 hearing is received within that period, the [welfare division] department

6-17 shall notify that person of the time, place and nature of the hearing. The

6-18 [welfare division] department shall provide an opportunity for a hearing of

6-19 that appeal and shall review his case regarding all matters alleged in that

6-20 appeal.

6-21 3. The [welfare division] department is not required to grant a hearing

6-22 pursuant to this section if the request for the hearing is based solely upon

6-23 the provisions of a federal law or a law of this state that requires an

6-24 automatic adjustment to the amount of public assistance or services that

6-28 subsection 2 of NRS 422.294, opportunity must be afforded all parties to

6-29 respond and present evidence and argument on all issues involved.

6-30 2. Unless precluded by law, informal disposition may be made of any

6-31 hearing by stipulation, agreed settlement, consent order or default.

6-32 3. The record of a hearing must include:

6-33 (a) All pleadings, motions and intermediate rulings.

6-34 (b) Evidence received or considered.

6-35 (c) Questions and offers of proof and objections, and rulings thereon.

6-36 (d) Any decision, opinion or report by the hearing officer presiding at

6-37 the hearing.

6-38 4. Oral proceedings, or any part thereof, must be transcribed on request

6-39 of any party seeking judicial review of the decision.

6-40 5. Findings of fact must be based exclusively on substantial evidence.

7-7 writing. A final decision must include findings of fact and conclusions of

7-8 law, separately stated. Findings of fact, if set forth in statutory or regulatory

7-9 language, must be accompanied by a concise and explicit statement of the

7-10 underlying facts supporting the findings. A copy of the decision or order

7-11 must be delivered by certified mail to each party and to his attorney or

7-12 other representative.

7-13 2. The [welfare division] department or an applicant for or recipient of

7-14 public assistance or services may, at any time within 90 days after the date

7-15 on which the written notice of the decision is mailed, petition the district

7-16 court of the judicial district in which the applicant for or recipient of public

7-17 assistance resides to review the decision. The district court shall review the

7-18 decision on the record of the case before the hearing officer. The decision

7-19 and record must be certified as correct and filed with the clerk of the court

7-23 application may be made to the court by motion, with notice to the

7-24 opposing party and an opportunity for that party to respond, for leave to

7-25 present additional evidence. If it is shown to the satisfaction of the court

7-26 that the additional evidence is material and that there were good reasons for

7-27 failure to present it in the proceeding before the [welfare division,]

7-28 department, the court may order that the additional evidence be taken

7-29 before the [welfare division] department upon conditions determined by

7-30 the court. The [welfare division] department may modify its findings and

7-31 decision by reason of the additional evidence and shall file that evidence

7-32 and any modifications, new findings or decisions with the reviewing court.

7-33 2. The review must be conducted by the court without a jury and must

7-34 be confined to the record. In cases of alleged irregularities in procedure

7-35 before the [welfare division,] department, not shown in the record, proof

7-36 thereon may be taken in the court. The court, at the request of either party,

7-37 shall hear oral argument and receive written briefs.

7-38 3. The court shall not substitute its judgment for that of the [welfare

7-39 division] department as to the weight of the evidence on questions of fact.

7-40 The court may affirm the decision of the [welfare division] department or

7-41 remand the case for further proceedings. The court may reverse the

8-18 services under the state plan for Medicaid, the division of health care

8-19 financing and policy shall appoint a hearing officer to conduct the hearing.

8-20 Any employee or other representative of the division of health care

8-21 financing and policy who investigated or made the initial decision

8-22 regarding the action taken against a provider of services may not be

8-23 appointed as the hearing officer or participate in the making of any decision

8-24 pursuant to the hearing.

8-25 2. The division of health care financing and policy shall adopt

8-26 regulations prescribing the procedures to be followed at the hearing.

8-27 3. The decision of the hearing officer is a final decision. Any party,

8-28 including the division of health care financing and policy, who is aggrieved

8-29 by the decision of the hearing officer may appeal that decision to the

8-30 district court [.] in and for Carson City by filing a petition for judicial

8-31 review within 30 days after receiving the decision of the hearing officer.

8-32 4. A petition for judicial review filed pursuant to this section must be

8-33 served upon every party within 30 days after the filing of the petition for

8-34 judicial review.

8-35 5. Unless otherwise provided by the court:

8-36 (a) Within 90 days after the service of the petition for judicial review,

8-37 the division of health care financing and policy shall transmit to the

8-38 court the original or a certified copy of the entire record of the

8-39 proceeding under review, including, without limitation, a transcript of

8-40 the evidence resulting in the final decision of the hearing officer;

8-41 (b) The petitioner who is seeking judicial review pursuant to this

9-29 financing and policy to furnish the types of medical and remedial care for

9-30 which assistance may be provided under the plan, or an agent or employee

9-31 of the authorized person, who, with the intent to defraud, furnishes such

9-32 care upon presentation of a Medicaid card which he knows was obtained or

9-33 retained in violation of any of the provisions of NRS 422.361 to 422.367,

9-34 inclusive, or is forged, expired or revoked, is guilty of a category D felony

9-35 and shall be punished as provided in NRS 193.130. In addition to any other

9-39 of a household pursuant to NRS 422.3724 includes a provision providing

9-40 for the payment of transitional assistance to the head of the household, the

9-41 welfare division may provide transitional assistance to the head of the

10-11 422.387 must be made, to the extent allowed by the state plan for

10-12 Medicaid, from the Medicaid budget account.

10-13 2. Except as otherwise provided in subsection 3, the money in the

10-14 intergovernmental transfer account must be transferred from that account to

10-15 the Medicaid budget account to the extent that money is available from the

10-16 Federal Government for proposed expenditures, including expenditures for

10-17 administrative costs. If the amount in the account exceeds the amount

10-18 authorized for expenditure by the division of health care financing and

10-19 policy for the purposes specified in NRS 422.387, the division of health

10-20 care financing and policy is authorized to expend the additional revenue in

10-21 accordance with the provisions of the state plan for Medicaid.

10-22 3. If enough money is available to support Medicaid, money in the

10-23 intergovernmental transfer account may be transferred to an account

10-24 established for the provision of health care services to uninsured children

10-25 [who are under the age of 13 years] pursuant to a federal program in which

10-26 at least 50 percent of the cost of such services is paid for by the Federal

10-27 Government, including, without limitation, the children’s health

10-28 insurance program, if enough money is available to continue to satisfy

10-29 existing obligations of the Medicaid program or to carry out the provisions

10-33 422.361 to 422.369, inclusive, or 422.450 to 422.590, inclusive, a person

10-34 who knowingly and designedly, by any false pretense, false or misleading

10-35 statement, impersonation or misrepresentation, obtains or attempts to obtain

10-36 monetary or any other public assistance , or money, property, medical or

10-37 remedial care or any other service provided pursuant to the children’s

10-38 health insurance program, having a value of $100 or more, whether by

10-39 one act or a series of acts, with the intent to cheat, defraud or defeat the

10-40 purposes of this chapter is guilty of a category E felony and shall be

10-41 punished as provided in NRS 193.130. In addition to any other penalty, the

11-14 entitled by reason of a violation of NRS 422.540, 422.550, 422.560 or

11-15 422.570 is liable for:

11-16 (a) An amount equal to three times the amount unlawfully obtained;

11-17 (b) Not less than $5,000 for each false claim, statement or

11-18 representation;

11-19 (c) An amount equal to three times the total of the reasonable expenses

11-20 incurred by the state in enforcing this section; and

11-21 (d) Payment of interest on the amount of the excess payment at the rate

11-22 fixed pursuant to NRS 99.040 for the period from the date upon which

11-23 payment was made to the date upon which repayment is made pursuant to

11-24 the plan.

11-25 2. A criminal action need not be brought against the provider before

11-26 civil liability attaches under this section.

11-27 3. A provider who unknowingly accepts a payment in excess of the

11-28 amount to which he is entitled is liable for the repayment of the excess

11-29 amount. It is a defense to any action brought pursuant to this subsection

11-30 that the provider returned or attempted to return the amount which was in

11-31 excess of that to which he was entitled within a reasonable time after

11-32 receiving it.

11-33 4. The attorney general shall cause appropriate legal action to be taken

11-34 on behalf of the state to enforce the provisions of this section.

11-35 5. Any penalty or repayment of money collected pursuant to this

11-36 section is hereby appropriated to provide medical aid to the indigent

11-40 consisting of 11 members, is hereby created.

11-41 2. The director shall appoint to the committee:

11-42 (a) One member who is an employee of the rehabilitation division of the

12-40 uniform standards of eligibility prescribed by the board of county

12-41 commissioners or by NRS 439B.310, if applicable, falls sick in the county,

12-42 not having money or property to pay his board, nursing or medical aid, the

13-23 investigate and prosecute violations of NRS 422.540 to 422.570, inclusive,

13-24 and any fraud in the administration of the plan or in the provision of

13-25 medical assistance [.] pursuant to the plan. The provisions of this section

13-26 notwithstanding, the welfare division and the division of health care

13-27 financing and policy of the department of human resources shall enforce

13-28 the plan and any regulations adopted pursuant thereto.

13-29 2. For this purpose, the attorney general shall establish within his office

13-30 the Medicaid fraud control unit. The unit must consist of a group of

13-31 qualified persons, including, without limitation, an attorney, an auditor and

13-32 an investigator who, to the extent practicable, have expertise in nursing,

13-33 medicine and the administration of medical facilities.

13-34 3. The attorney general, acting through the Medicaid fraud control unit:

13-35 (a) Is the single state agency responsible for the investigation and

13-36 prosecution of violations of NRS 422.540 to 422.570, inclusive;

13-37 (b) Shall review reports of abuse or criminal neglect of patients in

13-38 medical facilities which receive payments under the plan and, when

13-39 appropriate, investigate and prosecute the persons responsible;

13-40 (c) May review and investigate reports of misappropriation of money

13-41 from the personal resources of patients in medical facilities that receive

13-42 payments under the plan and, when appropriate, shall prosecute the persons

14-23 of this act unless the context otherwise requires, the words and terms

14-24 defined in NRS 232.367, 232.369 and 232.371 and section 25 of this act

14-28 1. To ensure that the Medicaid provided by this state [is] and the

14-29 insurance provided pursuant to the children’s health insurance program

14-30 in this state are provided in the manner that is most efficient to this state.

14-31 2. To evaluate alternative methods of providing Medicaid [.] and

14-32 providing insurance pursuant to the children’s health insurance

14-33 program.

14-34 3. To review Medicaid , the children’s health insurance program and

14-35 other health programs of this state to determine the maximum amount of

14-36 money that is available from the Federal Government for such programs.

14-37 4. To promote access to quality health care for all residents of this

14-38 state.

14-42 by a business pursuant to NRS 274.260, and if it finds that the business is

16-7 requires, the words and terms defined in NRS 439B.030 to 439B.150,

16-8 inclusive, and section 29 of this act have the meanings ascribed to them in

16-12 "indigent" means those persons:

16-13 1. Who are not covered by any policy of health insurance;

16-14 2. Who are ineligible for Medicare, Medicaid, the children’s health

16-15 insurance program, the benefits provided pursuant to NRS 428.115 to

16-16 428.255, inclusive, or any other federal or state program of public

16-17 assistance covering the provision of health care;

16-18 3. Who meet the limitations imposed by the county upon assets and

16-19 other resources or potential resources; and

16-20 4. Whose income is less than:

16-21 (a) For one person living without another member of a household, $438.

16-22 (b) For two persons, $588.

16-23 (c) For three or more persons, $588 plus $150 for each person in the

16-24 family in excess of two.

16-25 For the purposes of this subsection, "income" includes the entire income of

16-26 a household and the amount which the county projects a person or

16-27 household is able to earn. "Household" is limited to a person and his

16-31 provided by any other person reporting a case or suspected case of a

16-32 communicable disease, or by any person who has a communicable disease,

16-33 or as determined by investigation of the health authority, is confidential

16-34 medical information and must not be disclosed to any person under any

16-35 circumstances, including pursuant to any subpoena, search warrant or

16-36 discovery proceeding, except as follows:

16-37 1. For statistical purposes, provided that the identity of the person is

16-38 not discernible from the information disclosed.

16-39 2. In a prosecution for a violation of this chapter.

16-40 3. In a proceeding for an injunction brought pursuant to this chapter.

16-41 4. In reporting the actual or suspected abuse or neglect of a child or

17-20 of 10 members appointed by the board, is hereby created.

17-21 2. The board shall appoint to the advisory committee:

17-22 (a) One representative of facilities for long-term care;

17-23 (b) One representative of medical facilities which provide acute care;

17-24 (c) One representative of agencies to provide nursing in the home;

17-25 (d) One representative of the health division of the department of human

17-26 resources;

17-27 (e) One representative of the [welfare] division of health care financing

17-28 and policy of the department of human resources;

17-29 (f) One representative of the aging services division of the department of

17-30 human resources;

17-31 (g) One representative of the American Association of Retired Persons

17-32 or a similar organization;

17-33 (h) A nursing assistant;

17-34 (i) A registered nurse; and

17-35 (j) A licensed practical nurse.

17-36 3. The advisory committee shall advise the board with regard to

17-40 health benefits or coverage provided pursuant to:

17-41 1. A group health plan;

18-22 provided to a person pursuant to:

18-23 1. A group health plan;

18-24 2. A health benefit plan;

18-25 3. Part A or Part B of Title XVIII of the Social Security Act, also

18-26 known as Medicare;

18-27 4. Title XIX of the Social Security Act, also known as Medicaid, other

18-28 than coverage consisting solely of benefits under section 1928 of that Title;

18-29 5. Chapter 55 of Title 10, United States Code (Civilian Health and

18-30 Medical Program of Uniformed Services (CHAMPUS));

18-31 6. A medical care program of the Indian Health Service or of a tribal

18-32 organization;

18-33 7. A state health benefit risk pool;

18-34 8. A health plan offered pursuant to chapter 89 of Title 5, United States

18-35 Code (Federal Employees Health Benefits Program (FEHBP));

18-36 9. A public health plan as defined in [federal regulations] 45 C.F.R. §

18-37 146.113, authorized by the Public Health Service Act, section

18-38 2701(c)(1)(I), as amended by Public Law 104-191 [; or] , 42 U.S.C. §

18-39 300gg(c)(1)(I);

18-40 10. A health benefit plan under section 5(e) of the Peace Corps Act ,

18-41 [(] 22 U.S.C. § 2504(e) [).] ; or

18-42 11. The children’s health insurance program established pursuant to

19-3 provided to a person pursuant to:

19-4 1. A group health plan;

19-5 2. A health benefit plan;

19-6 3. Part A or Part B of Title XVIII of the Social Security Act, also

19-7 known as Medicare;

19-8 4. Title XIX of the Social Security Act, also known as Medicaid, other

19-9 than coverage consisting solely of benefits under section 1928 of that Title;

19-10 5. Chapter 55 of Title 10, United States Code (Civilian Health and

19-11 Medical Program of Uniformed Services (CHAMPUS));

19-12 6. A medical care program of the Indian Health Service or of a tribal

19-13 organization;

19-14 7. A state health benefit risk pool;

19-15 8. A health plan offered pursuant to chapter 89 of Title 5, United States

19-16 Code (Federal Employees Health Benefits Program (FEHBP));

19-17 9. A public health plan as defined in federal regulations authorized by

19-18 the Public Health Service Act, section 2701(c)(1)(I), as amended by Public

19-19 Law 104-191; [or]

19-20 10. A health benefit plan under section 5(e) of the Peace Corps Act ,

19-21 [(] 22 U.S.C. § 2504(e) [).] ; or

19-22 11. The children’s health insurance program established pursuant to

19-26 specific provisions of this Title, the provisions of this Title are not

19-27 applicable to any health maintenance organization granted a certificate of

19-28 authority under this chapter. This provision does not apply to an insurer

19-29 licensed and regulated pursuant to this Title except with respect to its

19-30 activities as a health maintenance organization authorized and regulated

19-31 pursuant to this chapter.

19-32 2. Solicitation of enrollees by a health maintenance organization

19-33 granted a certificate of authority, or its representatives, must not be

19-34 construed to violate any provision of law relating to solicitation or

19-35 advertising by practitioners of a healing art.

19-36 3. Any health maintenance organization authorized under this chapter

19-37 shall not be deemed to be practicing medicine and is exempt from the

19-38 provisions of chapter 630 of NRS.

19-39 4. The provisions of NRS 695C.110, 695C.170 to 695C.200, inclusive,

19-40 695C.250 and 695C.265 do not apply to a health maintenance organization

19-41 that provides health care services through managed care to recipients of

19-42 Medicaid or insurance pursuant to the children’s health insurance

20-8 14.3 to 29, inclusive, 32 to 43, inclusive, 45, 47, 49 to 54, inclusive,

20-9 56, 57, 59, 63, 64, 67 to 71, inclusive, and 74 to 88, inclusive, of

20-10 this act become effective on July 1, 1997.

20-11 2. Sections 1, 30, 30.5, 44, 46, 48, 54.5, 58, 60, 61, 62, 65, 66,

20-12 72 and 73 of this act become effective at 12:01 a.m. on July 1,

20-13 1997.

20-14 3. Sections 31 and 55 of this act become effective at 12:02 a.m.

20-15 on July 1, 1997.

20-16 4. Section 14.2 of this act becomes effective on July 1, 1998.

20-17 5. Sections [1 to 14.4, inclusive, 15 to 30, inclusive, 31 to 54,

20-18 inclusive, 55 to 80.3, inclusive, and 84 of this act, and subsection 1

20-19 of section 81 of this act, expires] 78 and 79 of this act expire by