Assembly Bill No. 429–Committee on Health
and Human Services

(On Behalf of Division of Health Care
Financing and Policy)

March 10, 1999

____________

Referred to Committee on Health and Human Services

 

SUMMARY—Makes various changes concerning division of health care financing and policy of department of human resources and children’s health insurance program. (BDR 38-635)

FISCAL NOTE: Effect on Local Government: No.

Effect on the State or on Industrial Insurance: Yes.

~

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).

 

AN ACT relating to public welfare; clarifying the duties of and making various changes concerning the division of health care financing and policy of the department of human resources; making various changes concerning the children’s health insurance program; repealing the prospective expiration of the provisions governing the division of health care financing and policy; providing a penalty; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

1-1 Section 1. Chapter 422 of NRS is hereby amended by adding thereto

1-2 the provisions set forth as sections 2, 3 and 4 of this act.

1-3 Sec. 2. "Children’s health insurance program" means the program

1-4 established pursuant to 42 U.S.C. §§ 1397aa to 1397jj, inclusive, to

1-5 provide health insurance for uninsured children from low-income

1-6 families in this state.

1-7 Sec. 3. 1. Before adopting, amending or repealing any regulation

1-8 for the administration of a program of public assistance or any other

1-9 program for which the division of health care financing and policy is

1-10 responsible, the administrator shall give at least 30 days’ notice of his

1-11 intended action.

2-1 2. The notice of intent to act upon a regulation must:

2-2 (a) Include a statement of the need for and purpose of the proposed

2-3 regulation, and either the terms or substance of the proposed regulation

2-4 or a description of the subjects and issues involved, and of the time when,

2-5 the place where, and the manner in which, interested persons may

2-6 present their views thereon.

2-7 (b) Include a statement identifying the entities that may be financially

2-8 affected by the proposed regulation and the potential financial impact, if

2-9 any, upon local government.

2-10 (c) State each address at which the text of the proposed regulation

2-11 may be inspected and copied.

2-12 (d) Be mailed to all persons who have requested in writing that they be

2-13 placed upon a mailing list, which must be kept by the administrator for

2-14 that purpose.

2-15 3. All interested persons must be afforded a reasonable opportunity

2-16 to submit data, views or arguments upon a proposed regulation, orally or

2-17 in writing. The administrator shall consider fully all oral and written

2-18 submissions relating to the proposed regulation.

2-19 4. The administrator shall keep, retain and make available for public

2-20 inspection written minutes of each public hearing held pursuant to this

2-21 section in the manner provided in subsections 1 and 2 of NRS 241.035.

2-22 5. The administrator may record each public hearing held pursuant

2-23 to this section and make those recordings available for public inspection

2-24 in the manner provided in subsection 4 of NRS 241.035.

2-25 6. An objection to any regulation on the ground of noncompliance

2-26 with the procedural requirements of this section may not be made more

2-27 than 2 years after its effective date.

2-28 Sec. 4. 1. If the division of health care financing and policy denies

2-29 an application for the children’s health insurance program, the division

2-30 shall provide written notice of the decision to the applicant. An applicant

2-31 who disagrees with the denial of the application may request a review of

2-32 the case and a hearing before an impartial hearing officer by filing a

2-33 written request within 30 days after the date of the notice of the decision

2-34 at the address specified in the notice.

2-35 2. The division of health care financing and policy shall adopt

2-36 regulations regarding the review and hearing before an impartial

2-37 hearing officer. The decision of the hearing officer must be in writing.

2-38 3. The applicant may at any time within 30 days after the date on

2-39 which the written decision is mailed, petition the district court of the

2-40 judicial district in which the applicant resides to review the decision. The

2-41 district court shall review the decision on the record. The decision and

2-42 record must be certified as correct and filed with the court by the

2-43 administrator of the division for health care financing and policy.

3-1 4. The review by the court must be in accordance with NRS 422.299.

3-2 Sec. 5. NRS 422.001 is hereby amended to read as follows:

3-3 422.001 As used in this chapter, unless the context otherwise requires,

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

3-5 section 2 of this act have the meanings ascribed to them in those sections.

3-6 Sec. 6. NRS 422.050 is hereby amended to read as follows:

3-7 422.050 1. "Public assistance" includes:

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

3-19 program.

3-20 Sec. 7. NRS 422.2352 is hereby amended to read as follows:

3-21 422.2352 As used in NRS 422.2352 to 422.2374, inclusive, and

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

3-23 422.390, inclusive, unless the context otherwise requires, "administrator"

3-24 means the administrator of the division of health care financing and policy.

3-25 Sec. 8. NRS 422.2366 is hereby amended to read as follows:

3-26 422.2366 1. The administrator or his designated representative may

3-27 administer oaths and take testimony thereunder and issue subpoenas

3-28 requiring the attendance of witnesses before the division of health care

3-29 financing and policy at a designated time and place and the production of

3-30 books, papers and records relative to:

3-31 (a) Eligibility or continued eligibility to provide medical care, remedial

3-32 care or other services pursuant to the state plan for Medicaid [;] or the

3-33 children’s health insurance program; and

3-34 (b) Verification of treatment and payments to a provider of medical

3-35 care, remedial care or other services pursuant to the state plan for Medicaid

3-36 [.] or the children’s health insurance program.

3-37 2. If a witness fails to appear or refuses to give testimony or to produce

3-38 books, papers and records as required by the subpoena, the district court of

3-39 the county in which the investigation is being conducted may compel the

3-40 attendance of the witness, the giving of testimony and the production of

3-41 books, papers and records as required by the subpoena.

4-1 Sec. 9. NRS 422.290 is hereby amended to read as follows:

4-2 422.290 1. To restrict the use or disclosure of any information

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

4-25 the provisions of this chapter.

4-26 Sec. 10. NRS 422.293 is hereby amended to read as follows:

4-27 422.293 1. When a recipient of Medicaid or a recipient of insurance

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

4-43 recipient or his successors in interest as provided in subsection 1, the

5-1 department has a lien upon the proceeds of any recovery from the persons

5-2 liable, whether the proceeds of the recovery are by way of judgment,

5-3 settlement or otherwise. Such a lien must be satisfied in full, unless reduced

5-4 pursuant to subsection 5, at such time as:

5-5 (a) The proceeds of any recovery or settlement are distributed to or on

5-6 behalf of the recipient, his successors in interest or his attorney; and

5-7 (b) A dismissal by any court of any action brought to enforce the legal

5-8 liability established by subsection 1.

5-9 No such lien is enforceable unless written notice is first given to the person

5-10 against whom the lien is asserted.

5-11 4. The recipient or his successors in interest shall notify the department

5-12 in writing before entering any settlement agreement or commencing any

5-13 action to enforce the legal liability referred to in subsection 1. Except if

5-14 extraordinary circumstances exist, a person who fails to comply with the

5-15 provisions of this subsection shall be deemed to have waived any

5-16 consideration by the director or his designated representative of a reduction

5-17 of the amount of the lien pursuant to subsection 5 and shall pay to the

5-18 department all costs to which it is entitled and its court costs and attorney’s

5-19 fees.

5-20 5. If the department receives notice pursuant to subsection 4, the

5-21 director or his designated representative may, in consideration of the legal

5-22 services provided by an attorney to procure a recovery for the recipient,

5-23 reduce the lien on the proceeds of any recovery.

5-24 6. The attorney of a recipient:

5-25 (a) Shall not condition the amount of attorney’s fees or impose

5-26 additional attorney’s fees based on whether a reduction of the lien is

5-27 authorized by the director or his designated representative pursuant to

5-28 subsection 5.

5-29 (b) Shall reduce the amount of the fees charged the recipient for services

5-30 provided by the amount the attorney receives from the reduction of a lien

5-31 authorized by the director or his designated representative pursuant to

5-32 subsection 5.

5-33 Sec. 11. NRS 422.29314 is hereby amended to read as follows:

5-34 422.29314 1. The welfare division shall provide public assistance

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

5-43 benefits pursuant to that program.

6-1 2. As used in this section, "qualified alien" has the meaning ascribed to

6-2 it in 8 U.S.C. § 1641.

6-3 Sec. 12. NRS 422.294 is hereby amended to read as follows:

6-4 422.294 1. Subject to the provisions of subsection 2, if an application

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

6-25 may be received by an applicant or recipient.

6-26 Sec. 13. NRS 422.296 is hereby amended to read as follows:

6-27 422.296 1. At any hearing held pursuant to the provisions of

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.

7-1 6. Any employee or other representative of the [welfare division]

7-2 department who investigated or made the initial decision to deny, modify

7-3 or cancel a grant of public assistance shall not participate in the making of

7-4 any decision made pursuant to the hearing.

7-5 Sec. 14. NRS 422.298 is hereby amended to read as follows:

7-6 422.298 1. A decision or order issued by a hearing officer must be in

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

7-20 by the [state welfare administrator.] department.

7-21 Sec. 15. NRS 422.299 is hereby amended to read as follows:

7-22 422.299 1. Before the date set by the court for hearing, an

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

7-42 decision and remand the case to the [division] department for further

8-1 proceedings if substantial rights of the appellant have been prejudiced

8-2 because the [welfare division’s] department’s findings, inferences,

8-3 conclusions or decisions are:

8-4 (a) In violation of constitutional, regulatory or statutory provisions;

8-5 (b) In excess of the statutory authority of the [welfare division;]

8-6 department;

8-7 (c) Made upon unlawful procedure;

8-8 (d) Affected by other error of law;

8-9 (e) Clearly erroneous in view of the reliable, probative and substantial

8-10 evidence on the whole record; or

8-11 (f) Arbitrary or capricious or characterized by abuse of discretion or

8-12 clearly unwarranted exercise of discretion.

8-13 4. An aggrieved party may obtain review of any final judgment of the

8-14 district court by appeal to the supreme court. The appeal must be taken in

8-15 the manner provided for civil cases.

8-16 Sec. 16. NRS 422.306 is hereby amended to read as follows:

8-17 422.306 1. Upon receipt of a request for a hearing from a provider of

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

8-42 section shall serve and file an opening brief within 40 days after the

9-1 division of health care financing and policy gives written notice to the

9-2 parties that the record of the proceeding under review has been filed with

9-3 the court;

9-4 (c) The respondent shall serve and file an answering brief within 30

9-5 days after service of the opening brief; and

9-6 (d) The petitioner may serve and file a reply brief within 30 days after

9-7 service of the answering brief.

9-8 6. Within 7 days after the expiration of the time within which the

9-9 petitioner may reply, any party may request a hearing. Unless a request

9-10 for hearing has been filed, the matter shall be deemed submitted.

9-11 7. The review of the court must be confined to the record. The court

9-12 shall not substitute its judgment for that of the hearing officer as to the

9-13 weight of the evidence on questions of fact. The court may affirm the

9-14 decision of the hearing officer or remand the case for further proceedings.

9-15 The court may reverse or modify the decision if substantial rights of the

9-16 appellant have been prejudiced because the administrative findings,

9-17 inferences, conclusions or decisions are:

9-18 (a) In violation of constitutional or statutory provisions;

9-19 (b) In excess of the statutory authority of the division of health care

9-20 financing and policy;

9-21 (c) Made upon unlawful procedure;

9-22 (d) Affected by other error of law;

9-23 (e) Clearly erroneous in view of the reliable, probative and substantial

9-24 evidence on the whole record; or

9-25 (f) Arbitrary or capricious or characterized by abuse of discretion or

9-26 clearly unwarranted exercise of discretion.

9-27 Sec. 17. NRS 422.369 is hereby amended to read as follows:

9-28 422.369 A person authorized by the [welfare] division of health care

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

9-36 penalty, the court shall order the person to pay restitution.

9-37 Sec. 18. NRS 422.3742 is hereby amended to read as follows:

9-38 422.3742 1. If the plan for personal responsibility signed by the head

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

9-42 household if the household becomes ineligible for benefits for one or more

10-1 of the reasons described in 42 U.S.C. § 608(a)(11). The welfare division

10-2 shall not provide transitional assistance pursuant to this section for more

10-3 than 12 consecutive months.

10-4 2. As used in this section, "transitional assistance" means:

10-5 (a) Assistance provided by the welfare division to low-income families

10-6 to pay for the costs of child care; or

10-7 (b) Medicaid provided pursuant to the plan administered by the [welfare

10-8 division] department pursuant to NRS 422.271.

10-9 Sec. 19. NRS 422.385 is hereby amended to read as follows:

10-10 422.385 1. The allocations and payments required pursuant to NRS

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

10-30 of NRS 439B.350 to 439B.360.

10-31 Sec. 20. NRS 422.410 is hereby amended to read as follows:

10-32 422.410 1. Unless a different penalty is provided pursuant to NRS

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

10-42 court shall order the person to pay restitution.

11-1 2. For the purposes of subsection 1, whenever a recipient of temporary

11-2 assistance for needy families pursuant to the provisions of this chapter

11-3 receives an overpayment of benefits for the third time and the

11-4 overpayments have resulted from a false statement or representation by the

11-5 recipient or from the failure of the recipient to notify the welfare division of

11-6 a change in his circumstances which would affect the amount of assistance

11-7 he receives, a rebuttable presumption arises that the payment was

11-8 fraudulently received.

11-9 3. For the purposes of subsection 1, "public assistance" includes any

11-10 money, property, medical or remedial care or any other service provided

11-11 pursuant to a state plan.

11-12 Sec. 21. NRS 422.580 is hereby amended to read as follows:

11-13 422.580 1. A provider who receives payment to which he is not

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

11-37 through programs administered by the [welfare division.] department.

11-38 Sec. 22. NRS 426A.060 is hereby amended to read as follows:

11-39 426A.060 1. The advisory committee on traumatic brain injuries,

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

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

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

11-43 department.

12-1 (b) One member who is an employee of the [welfare] division of health

12-2 care financing and policy of the department of human resources and

12-3 participates in the administration of the state program providing Medicaid.

12-4 (c) One member who is a licensed insurer in this state.

12-5 (d) One member who represents the interests of educators in this state.

12-6 (e) One member who is a person professionally qualified in the field of

12-7 psychiatric mental health.

12-8 (f) Two members who are employees of private providers of

12-9 rehabilitative health care located in this state.

12-10 (g) One member who represents persons who operate community-based

12-11 programs for head injuries in this state.

12-12 (h) One member who represents hospitals in this state.

12-13 (i) Two members who represent the recipients of health care in this

12-14 state.

12-15 3. After the initial appointments, each member of the committee serves

12-16 a term of 3 years.

12-17 4. The committee shall elect one of its members to serve as chairman.

12-18 5. Members of the committee serve without compensation and are not

12-19 entitled to receive the per diem allowance or travel expenses provided for

12-20 state officers and employees generally [.] , except that members of the

12-21 committee may receive any per diem allowance and travel expenses that

12-22 may be authorized by the committee if the payment of the per diem

12-23 allowance and travel expenses:

12-24 (a) Is made from money received by the committee from a source

12-25 other than the State of Nevada; and

12-26 (b) Is not inconsistent with any condition attached to the acceptance

12-27 of that money.

12-28 6. The committee may:

12-29 (a) Make recommendations to the administrator relating to the

12-30 establishment and operation of any program for persons with traumatic

12-31 brain injuries.

12-32 (b) Make recommendations to the administrator concerning proposed

12-33 legislation relating to traumatic brain injuries.

12-34 (c) Collect information relating to traumatic brain injuries.

12-35 (d) Apply for grants.

12-36 (e) Accept and expend any money made available to the committee by

12-37 gift, grant, donation or bequest.

12-38 7. The committee shall prepare a report of its activities and

12-39 recommendations each year and submit a copy to the:

12-40 (a) Director of the department;

12-41 (b) Administrator;

12-42 (c) Legislative committee on health care; and

12-43 (d) Legislative commission.

13-1 8. As used in this section:

13-2 (a) "Administrator" means the administrator of the rehabilitation

13-3 division of the department.

13-4 (b) "Person professionally qualified in the field of psychiatric mental

13-5 health" has the meaning ascribed to it in NRS 433.209.

13-6 (c) "Provider of health care" has the meaning ascribed to it in NRS

13-7 629.031.

13-8 Sec. 23. NRS 428.090 is hereby amended to read as follows:

13-9 428.090 1. When a nonresident or any other person who meets the

13-10 uniform standards of eligibility prescribed by the board of county

13-11 commissioners or by NRS 439B.310, if applicable, falls sick in the county,

13-12 not having money or property to pay his board, nursing or medical aid, the

13-13 board of county commissioners of the proper county shall, on complaint

13-14 being made, give or order to be given such assistance to the poor person as

13-15 is in accordance with the policies and standards established and approved

13-16 by the board of county commissioners and within the limits of money which

13-17 may be lawfully appropriated for this purpose pursuant to NRS 428.050,

13-18 428.285 and 450.425.

13-19 2. If the sick person dies, the board of county commissioners shall give

13-20 or order to be given to the person a decent burial or cremation.

13-21 3. Except as otherwise provided in NRS 422.382, the board of county

13-22 commissioners shall make such allowance for the person’s board, nursing,

13-23 medical aid, burial or cremation as the board deems just and equitable, and

13-24 order it paid out of the county treasury.

13-25 4. The responsibility of the board of county commissioners to provide

13-26 medical aid or any other type of remedial aid under this section is relieved

13-27 to the extent provided in NRS 422.382 and to the extent of the amount of

13-28 money or the value of services provided by:

13-29 (a) The [welfare division of the] department of human resources to or

13-30 for such persons for medical care or any type of remedial care under the

13-31 state plan for Medicaid; and

13-32 (b) The fund for hospital care to indigent persons under the provisions

13-33 of NRS 428.115 to 428.255, inclusive.

13-34 Sec. 24. NRS 228.410 is hereby amended to read as follows:

13-35 228.410 1. The attorney general has primary jurisdiction to

13-36 investigate and prosecute violations of NRS 422.540 to 422.570, inclusive,

13-37 and any fraud in the administration of the plan or in the provision of

13-38 medical assistance [.] pursuant to the plan. The provisions of this section

13-39 notwithstanding, the welfare division and the division of health care

13-40 financing and policy of the department of human resources shall enforce

13-41 the plan and any regulations adopted pursuant thereto.

13-42 2. For this purpose, the attorney general shall establish within his office

13-43 the Medicaid fraud control unit. The unit must consist of a group of

14-1 qualified persons, including, without limitation, an attorney, an auditor and

14-2 an investigator who, to the extent practicable, have expertise in nursing,

14-3 medicine and the administration of medical facilities.

14-4 3. The attorney general, acting through the Medicaid fraud control unit:

14-5 (a) Is the single state agency responsible for the investigation and

14-6 prosecution of violations of NRS 422.540 to 422.570, inclusive;

14-7 (b) Shall review reports of abuse or criminal neglect of patients in

14-8 medical facilities which receive payments under the plan and, when

14-9 appropriate, investigate and prosecute the persons responsible;

14-10 (c) May review and investigate reports of misappropriation of money

14-11 from the personal resources of patients in medical facilities that receive

14-12 payments under the plan and, when appropriate, shall prosecute the persons

14-13 responsible;

14-14 (d) Shall cooperate with federal investigators and prosecutors in

14-15 coordinating state and federal investigations and prosecutions involving

14-16 fraud in the provision or administration of medical assistance pursuant to

14-17 the plan, and provide those federal officers with any information in his

14-18 possession regarding such an investigation or prosecution; and

14-19 (e) Shall protect the privacy of patients and establish procedures to

14-20 prevent the misuse of information obtained in carrying out the provisions of

14-21 this section.

14-22 4. When acting pursuant to NRS 228.175 or this section, the attorney

14-23 general may commence his investigation and file a criminal action without

14-24 leave of court, and he has exclusive charge of the conduct of the

14-25 prosecution.

14-26 5. As used in this section:

14-27 (a) "Medical facility" has the meaning ascribed to it in NRS 449.0151.

14-28 (b) "Plan" means the state plan for Medicaid established pursuant to

14-29 NRS 422.271.

14-30 Sec. 25. Chapter 232 of NRS is hereby amended by adding thereto a

14-31 new section to read as follows:

14-32 "Children’s health insurance program" has the meaning ascribed to it

14-33 in section 2 of this act.

14-34 Sec. 26. NRS 232.365 is hereby amended to read as follows:

14-35 232.365 As used in NRS 232.365 to 232.373, inclusive, and section 25

14-36 of this act unless the context otherwise requires, the words and terms

14-37 defined in NRS 232.367, 232.369 and 232.371 and section 25 of this act

14-38 have the meanings ascribed to them in those sections.

14-39 Sec. 27. NRS 232.373 is hereby amended to read as follows:

14-40 232.373 The purposes of the division are:

14-41 1. To ensure that the Medicaid provided by this state [is] and the

14-42 insurance provided pursuant to the children’s health insurance program

14-43 in this state are provided in the manner that is most efficient to this state.

15-1 2. To evaluate alternative methods of providing Medicaid [.] and

15-2 providing insurance pursuant to the children’s health insurance

15-3 program.

15-4 3. To review Medicaid , the children’s health insurance program and

15-5 other health programs of this state to determine the maximum amount of

15-6 money that is available from the Federal Government for such programs.

15-7 4. To promote access to quality health care for all residents of this

15-8 state.

15-9 5. To restrain the growth of the cost of health care in this state.

15-10 Sec. 28. NRS 274.270 is hereby amended to read as follows:

15-11 274.270 1. The governing body shall investigate the proposal made

15-12 by a business pursuant to NRS 274.260, and if it finds that the business is

15-13 qualified by financial responsibility and business experience to create and

15-14 preserve employment opportunities in the specially benefited zone and

15-15 improve the economic climate of the municipality and finds further that the

15-16 business did not relocate from a depressed area in this state or reduce

15-17 employment elsewhere in Nevada in order to expand in the specially

15-18 benefited zone, the governing body may, on behalf of the municipality,

15-19 enter into an agreement with the business, for a period of not more than 20

15-20 years, under which the business agrees in return for one or more of the

15-21 benefits authorized in this chapter and NRS 374.643 for qualified

15-22 businesses, as specified in the agreement, to establish, expand, renovate or

15-23 occupy a place of business within the specially benefited zone and hire new

15-24 employees at least 35 percent of whom at the time they are employed are at

15-25 least one of the following:

15-26 (a) Unemployed persons who have resided at least 6 months in the

15-27 municipality.

15-28 (b) Persons eligible for employment or job training under any federal

15-29 program for employment and training who have resided at least 6 months in

15-30 the municipality.

15-31 (c) Recipients of benefits under any state or county program of public

15-32 assistance, including , without limitation, temporary assistance for needy

15-33 families, [aid to the medically indigent] Medicaid and unemployment

15-34 compensation who have resided at least 6 months in the municipality.

15-35 (d) Persons with a physical or mental handicap who have resided at least

15-36 6 months in the state.

15-37 (e) Residents for at least 1 year of the area comprising the specially

15-38 benefited zone.

15-39 2. To determine whether a business is in compliance with an

15-40 agreement, the governing body:

15-41 (a) Shall each year require the business to file proof satisfactory to the

15-42 governing body of its compliance with the agreement.

16-1 (b) May conduct any necessary investigation into the affairs of the

16-2 business and may inspect at any reasonable hour its place of business

16-3 within the specially benefited zone.

16-4 If the governing body determines that the business is in compliance with

16-5 the agreement, it shall issue a certificate to that effect to the business. The

16-6 certificate expires 1 year after the date of its issuance.

16-7 3. The governing body shall file with the administrator, the department

16-8 of taxation and the employment security division of the department of

16-9 employment, training and rehabilitation a copy of each agreement, the

16-10 information submitted under paragraph (a) of subsection 2 and the current

16-11 certificate issued to the business under that subsection. The governing body

16-12 shall immediately notify the administrator, the department of taxation and

16-13 the employment security division of the department of employment,

16-14 training and rehabilitation whenever the business is no longer certified.

16-15 Sec. 29. Chapter 439B of NRS is hereby amended by adding thereto a

16-16 new section to read as follows:

16-17 "Children’s health insurance program" has the meaning ascribed to it

16-18 in section 2 of this act.

16-19 Sec. 30. NRS 439B.010 is hereby amended to read as follows:

16-20 439B.010 As used in this chapter, unless the context otherwise

16-21 requires, the words and terms defined in NRS 439B.030 to 439B.150,

16-22 inclusive, and section 29 of this act have the meanings ascribed to them in

16-23 those sections.

16-24 Sec. 31. NRS 439B.310 is hereby amended to read as follows:

16-25 439B.310 For the purposes of NRS 439B.300 to 439B.340, inclusive,

16-26 "indigent" means those persons:

16-27 1. Who are not covered by any policy of health insurance;

16-28 2. Who are ineligible for Medicare, Medicaid, the children’s health

16-29 insurance program, the benefits provided pursuant to NRS 428.115 to

16-30 428.255, inclusive, or any other federal or state program of public

16-31 assistance covering the provision of health care;

16-32 3. Who meet the limitations imposed by the county upon assets and

16-33 other resources or potential resources; and

16-34 4. Whose income is less than:

16-35 (a) For one person living without another member of a household, $438.

16-36 (b) For two persons, $588.

16-37 (c) For three or more persons, $588 plus $150 for each person in the

16-38 family in excess of two.

16-39 For the purposes of this subsection, "income" includes the entire income of

16-40 a household and the amount which the county projects a person or

16-41 household is able to earn. "Household" is limited to a person and his

16-42 spouse, parents, children, brothers and sisters residing with him.

17-1 Sec. 32. NRS 441A.220 is hereby amended to read as follows:

17-2 441A.220 All information of a personal nature about any person

17-3 provided by any other person reporting a case or suspected case of a

17-4 communicable disease, or by any person who has a communicable disease,

17-5 or as determined by investigation of the health authority, is confidential

17-6 medical information and must not be disclosed to any person under any

17-7 circumstances, including pursuant to any subpoena, search warrant or

17-8 discovery proceeding, except as follows:

17-9 1. For statistical purposes, provided that the identity of the person is

17-10 not discernible from the information disclosed.

17-11 2. In a prosecution for a violation of this chapter.

17-12 3. In a proceeding for an injunction brought pursuant to this chapter.

17-13 4. In reporting the actual or suspected abuse or neglect of a child or

17-14 elderly person.

17-15 5. To any person who has a medical need to know the information for

17-16 his own protection or for the well-being of a patient or dependent person,

17-17 as determined by the health authority in accordance with regulations of the

17-18 board.

17-19 6. If the person who is the subject of the information consents in

17-20 writing to the disclosure.

17-21 7. Pursuant to subsection 2 of NRS 441A.320.

17-22 8. If the disclosure is made to [the welfare division of] the department

17-23 of human resources and the person about whom the disclosure is made has

17-24 been diagnosed as having acquired immunodeficiency syndrome or an

17-25 illness related to the human immunodeficiency virus and is a recipient of or

17-26 an applicant for Medicaid.

17-27 9. To a fireman, police officer or person providing emergency medical

17-28 services if the board has determined that the information relates to a

17-29 communicable disease significantly related to that occupation. The

17-30 information must be disclosed in the manner prescribed by the board.

17-31 10. If the disclosure is authorized or required by specific statute.

17-32 Sec. 33. NRS 632.072 is hereby amended to read as follows:

17-33 632.072 1. The advisory committee on nursing assistants, consisting

17-34 of 10 members appointed by the board, is hereby created.

17-35 2. The board shall appoint to the advisory committee:

17-36 (a) One representative of facilities for long-term care;

17-37 (b) One representative of medical facilities which provide acute care;

17-38 (c) One representative of agencies to provide nursing in the home;

17-39 (d) One representative of the health division of the department of human

17-40 resources;

17-41 (e) One representative of the [welfare] division of health care financing

17-42 and policy of the department of human resources;

18-1 (f) One representative of the aging services division of the department of

18-2 human resources;

18-3 (g) One representative of the American Association of Retired Persons

18-4 or a similar organization;

18-5 (h) A nursing assistant;

18-6 (i) A registered nurse; and

18-7 (j) A licensed practical nurse.

18-8 3. The advisory committee shall advise the board with regard to

18-9 matters relating to nursing assistants.

18-10 Sec. 34. NRS 689A.505 is hereby amended to read as follows:

18-11 689A.505 "Creditable coverage" means, with respect to a person,

18-12 health benefits or coverage provided pursuant to:

18-13 1. A group health plan;

18-14 2. A health benefit plan;

18-15 3. Part A or Part B of Title XVIII of the Social Security Act, also

18-16 known as Medicare;

18-17 4. Title XIX of the Social Security Act, also known as Medicaid, other

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

18-19 5. Chapter 55 of Title 10, United States Code (Civilian Health and

18-20 Medical Program of Uniformed Services (CHAMPUS));

18-21 6. A medical care program of the Indian Health Service or of a tribal

18-22 organization;

18-23 7. A state health benefit risk pool;

18-24 8. A health plan offered pursuant to chapter 89 of Title 5, United States

18-25 Code (Federal Employees Health Benefits Program (FEHBP));

18-26 9. A public health plan as defined in [federal regulations] 45 C.F.R. §

18-27 146.113, authorized by the Public Health Service Act, section

18-28 2701(c)(1)(I), as amended by Public Law 104-191 [; or] , 42 U.S.C. §

18-29 300gg(c)(1)(I);

18-30 10. A health benefit plan under section 5(e) of the Peace Corps Act ,

18-31 [(] 22 U.S.C. § 2504(e) [).] ; or

18-32 11. The children’s health insurance program established pursuant to

18-33 42 U.S.C. §§ 1397aa to 1397jj, inclusive.

18-34 Sec. 35. NRS 689B.380 is hereby amended to read as follows:

18-35 689B.380 "Creditable coverage" means health benefits or coverage

18-36 provided to a person pursuant to:

18-37 1. A group health plan;

18-38 2. A health benefit plan;

18-39 3. Part A or Part B of Title XVIII of the Social Security Act, also

18-40 known as Medicare;

18-41 4. Title XIX of the Social Security Act, also known as Medicaid, other

18-42 than coverage consisting solely of benefits under section 1928 of that Title;

19-1 5. Chapter 55 of Title 10, United States Code (Civilian Health and

19-2 Medical Program of Uniformed Services (CHAMPUS));

19-3 6. A medical care program of the Indian Health Service or of a tribal

19-4 organization;

19-5 7. A state health benefit risk pool;

19-6 8. A health plan offered pursuant to chapter 89 of Title 5, United States

19-7 Code (Federal Employees Health Benefits Program (FEHBP));

19-8 9. A public health plan as defined in [federal regulations] 45 C.F.R. §

19-9 146.113, authorized by the Public Health Service Act, section

19-10 2701(c)(1)(I), as amended by Public Law 104-191 [; or] , 42 U.S.C. §

19-11 300gg(c)(1)(I);

19-12 10. A health benefit plan under section 5(e) of the Peace Corps Act ,

19-13 [(] 22 U.S.C. § 2504(e) [).] ; or

19-14 11. The children’s health insurance program established pursuant to

19-15 42 U.S.C. §§ 1397aa to 1397jj, inclusive.

19-16 Sec. 36. NRS 689C.053 is hereby amended to read as follows:

19-17 689C.053 "Creditable coverage" means health benefits or coverage

19-18 provided to a person pursuant to:

19-19 1. A group health plan;

19-20 2. A health benefit plan;

19-21 3. Part A or Part B of Title XVIII of the Social Security Act, also

19-22 known as Medicare;

19-23 4. Title XIX of the Social Security Act, also known as Medicaid, other

19-24 than coverage consisting solely of benefits under section 1928 of that Title;

19-25 5. Chapter 55 of Title 10, United States Code (Civilian Health and

19-26 Medical Program of Uniformed Services (CHAMPUS));

19-27 6. A medical care program of the Indian Health Service or of a tribal

19-28 organization;

19-29 7. A state health benefit risk pool;

19-30 8. A health plan offered pursuant to chapter 89 of Title 5, United States

19-31 Code (Federal Employees Health Benefits Program (FEHBP));

19-32 9. A public health plan as defined in federal regulations authorized by

19-33 the Public Health Service Act, section 2701(c)(1)(I), as amended by Public

19-34 Law 104-191; [or]

19-35 10. A health benefit plan under section 5(e) of the Peace Corps Act ,

19-36 [(] 22 U.S.C. § 2504(e) [).] ; or

19-37 11. The children’s health insurance program established pursuant to

19-38 42 U.S.C. §§ 1397aa to 1397jj, inclusive.

19-39 Sec. 37. NRS 695C.050 is hereby amended to read as follows:

19-40 695C.050 1. Except as otherwise provided in this chapter or in

19-41 specific provisions of this Title, the provisions of this Title are not

19-42 applicable to any health maintenance organization granted a certificate of

19-43 authority under this chapter. This provision does not apply to an insurer

20-1 licensed and regulated pursuant to this Title except with respect to its

20-2 activities as a health maintenance organization authorized and regulated

20-3 pursuant to this chapter.

20-4 2. Solicitation of enrollees by a health maintenance organization

20-5 granted a certificate of authority, or its representatives, must not be

20-6 construed to violate any provision of law relating to solicitation or

20-7 advertising by practitioners of a healing art.

20-8 3. Any health maintenance organization authorized under this chapter

20-9 shall not be deemed to be practicing medicine and is exempt from the

20-10 provisions of chapter 630 of NRS.

20-11 4. The provisions of NRS 695C.110, 695C.170 to 695C.200, inclusive,

20-12 695C.250 and 695C.265 do not apply to a health maintenance organization

20-13 that provides health care services through managed care to recipients of

20-14 Medicaid or insurance pursuant to the children’s health insurance

20-15 program pursuant to a contract with the [welfare] division of health care

20-16 financing and policy of the department of human resources. This

20-17 subsection does not exempt a health maintenance organization from any

20-18 provision of this chapter for services provided pursuant to any other

20-19 contract.

20-20 Sec. 38. Section 2 of chapter 442, Statutes of Nevada 1997, at page

20-21 1559, is hereby amended to read as follows:

20-22 Sec. 2. 1. On or before October 1, [1999,] 2001, except as

20-23 otherwise provided in subsection 3, in carrying out its duties

20-24 regarding the administration of Medicaid, the welfare division of

20-25 the department of human resources may enter into a contract for the

20-26 provision of pharmaceutical services through managed care to

20-27 recipients of Medicaid if the welfare division and the legislative

20-28 committee on health care determine that such a contract:

20-29 (a) Is cost effective;

20-30 (b) Is the most convenient method of providing pharmaceutical

20-31 services to the recipients of Medicaid; and

20-32 (c) Includes access to pharmacies licensed in this state to the

20-33 maximum extent possible.

20-34 2. If the welfare division enters into a contract pursuant to

20-35 subsection 1, except for any limitations on coverage provided

20-36 pursuant to 42 U.S.C. § 1396r-8(d)(2) or (6), the contract must

20-37 provide for reimbursement for the dispensing of a drug to a

20-38 recipient of Medicaid, without requiring any prior or retroactive

20-39 approval, if the drug:

20-40 (a) Has been approved or designated as safe and effective by the

20-41 Food and Drug Administration; and

21-1 (b) Is prescribed by a physician who determines that the drug is

21-2 appropriate for the diagnosis or treatment of the recipient of

21-3 Medicaid.

21-4 3. The provisions of this section do not apply to a contract that

21-5 provides services only to recipients who are eligible to receive

21-6 benefits pursuant to:

21-7 (a) The program established to provide temporary assistance for

21-8 needy families pursuant to Title IV of the Social Security Act , [(]

21-9 42 U.S.C. §§ 601 et seq [.)] , and other provisions of that act

21-10 relating to temporary assistance for needy families; or

21-11 (b) The child health assurance program established pursuant to

21-12 42 U.S.C. § 1396a(a)(10)(A)(i)(IV), (VI) or (VII).

21-13 Sec. 39. Section 89 of chapter 550, Statutes of Nevada 1997, at page

21-14 2644, is hereby amended to read as follows:

21-15 Sec. 89. 1. This section and sections 2 to 14.1, inclusive,

21-16 14.3 to 29, inclusive, 32 to 43, inclusive, 45, 47, 49 to 54, inclusive,

21-17 56, 57, 59, 63, 64, 67 to 71, inclusive, and 74 to 88, inclusive, of

21-18 this act become effective on July 1, 1997.

21-19 2. Sections 1, 30, 30.5, 44, 46, 48, 54.5, 58, 60, 61, 62, 65, 66,

21-20 72 and 73 of this act become effective at 12:01 a.m. on July 1,

21-21 1997.

21-22 3. Sections 31 and 55 of this act become effective at 12:02 a.m.

21-23 on July 1, 1997.

21-24 4. Section 14.2 of this act becomes effective on July 1, 1998.

21-25 5. Section 14.1 of this act expires by limitation on June 30,

21-26 1998.

21-27 6. Sections [1 to 14.4, inclusive, 15 to 30, inclusive, 31 to 54,

21-28 inclusive, 55 to 80.3, inclusive, and 84 of this act, and subsection 1

21-29 of section 81 of this act, expires] 78 and 79 of this act expire by

21-30 limitation on June 30, 1999.

21-31 Sec. 40. Section 3 of Assembly Bill No. 249 of this session is hereby

21-32 amended to read as follows:

21-33 Sec. 3. NRS 422.2935 is hereby amended to read as follows:

21-34 422.2935 1. Except as otherwise provided in this section [,

21-35 the welfare division shall,] and to the extent it is not prohibited by

21-36 federal law and when circumstances allow [:

21-37 (a) Recover] , the welfare division shall recover benefits

21-38 correctly paid for Medicaid from:

21-39 [(1)] (a) The undivided estate of the person who received

21-40 those benefits; and

21-41 [(2)] (b) Any recipient of money or property from the

21-42 undivided estate of the person who received those benefits.

22-1 [(b) Recover from the recipient of Medicaid or the person who

22-2 signed the application for Medicaid on behalf of the recipient an

22-3 amount not to exceed the benefits incorrectly paid to the recipient if

22-4 the person who signed the application:

22-5 (1) Failed to report any required information to the welfare

22-6 division which he knew at the time he signed the application; or

22-7 (2) Failed within the period allowed by the welfare division to

22-8 report any required information to the welfare division which he

22-9 obtained after he filed the application.]

22-10 2. The welfare division shall not recover benefits pursuant to

22-11 [paragraph (a) of] subsection 1, except from a person who is neither

22-12 a surviving spouse nor a child, until after the death of the surviving

22-13 spouse, if any, and only at a time when the person who received the

22-14 benefits has no surviving child who is under 21 years of age or is

22-15 blind or permanently and totally disabled.

22-16 3. Except as otherwise provided by federal law, if a transfer of

22-17 real or personal property by a recipient of Medicaid is made for less

22-18 than fair market value, the welfare division may pursue any remedy

22-19 available pursuant to chapter 112 of NRS with respect to the

22-20 transfer.

22-21 4. The amount of Medicaid paid to or on behalf of a person is a

22-22 claim against the estate in any probate proceeding only at a time

22-23 when there is no surviving spouse or surviving child who is under

22-24 21 years of age or is blind or permanently and totally disabled.

22-25 5. The state welfare administrator may elect not to file a claim

22-26 against the estate of a recipient of Medicaid or his spouse if he

22-27 determines that the filing of the claim will cause an undue hardship

22-28 for the spouse or other survivors of the recipient. The administrator

22-29 shall adopt regulations defining the circumstances that constitute an

22-30 undue hardship.

22-31 6. Any recovery of money obtained pursuant to this section

22-32 must be applied first to the cost of recovering the money. Any

22-33 remaining money must be divided among the Federal Government,

22-34 the department and the county in the proportion that the amount of

22-35 assistance each contributed to the recipient bears to the total amount

22-36 of the assistance contributed.

22-37 7. [An action to recover money owed to the department as a

22-38 result of the payment of benefits for Medicaid must be commenced

22-39 within 6 months after the cause of action accrues. A cause of action

22-40 accrues after all of the following events have occurred:

22-41 (a) The death of the recipient of Medicaid;

22-42 (b) The death of the surviving spouse of the recipient of

22-43 Medicaid;

23-1 (c) The death of all children of the recipient of Medicaid who

23-2 are blind or permanently and totally disabled as determined in

23-3 accordance with 42 U.S.C. § 1382c; and

23-4 (d) The arrival of all other children of the recipient of Medicaid

23-5 at the age of 21 years.] Any recovery by the welfare division from

23-6 the undivided estate of a recipient pursuant to this section must be

23-7 paid in cash to the extent of:

23-8 (a) The amount of Medicaid paid to or on behalf of the

23-9 recipient after October 1, 1993; or

23-10 (b) The value of the remaining assets in the undivided estate,

23-11 whichever is less.

23-12 Sec. 41. Section 4 of Assembly Bill No. 249 of this session is hereby

23-13 amended to read as follows:

23-14 Sec. 4. NRS 422.29355 is hereby amended to read as follows:

23-15 422.29355 1. The welfare division may, to the extent not

23-16 prohibited by federal law, petition for the imposition of a lien

23-17 pursuant to the provisions of NRS 108.850 against real or personal

23-18 property of a recipient of Medicaid as follows:

23-19 (a) The welfare division may obtain a lien against a recipient’s

23-20 property, both real or personal, before or after his death in the

23-21 amount of assistance paid or to be paid on his behalf if the court

23-22 determines that assistance was incorrectly paid for the recipient.

23-23 (b) The welfare division may seek a lien against the real property

23-24 of a recipient at any age before his death in the amount of assistance

23-25 paid or to be paid for him if he is an inpatient in a nursing facility,

23-26 intermediate care facility for the mentally retarded or other medical

23-27 institution and the welfare division determines, after notice and

23-28 opportunity for a hearing in accordance with its regulations, that he

23-29 cannot reasonably be expected to be discharged and return home.

23-30 2. No lien may be placed on a recipient’s home pursuant to

23-31 paragraph (b) of subsection 1 for assistance correctly paid if:

23-32 (a) His spouse;

23-33 (b) His child who is under 21 years of age or blind or

23-34 permanently and totally disabled as determined in accordance with

23-35 42 U.S.C. § 1382c; or

23-36 (c) His brother or sister who is an owner or part owner of the

23-37 home and who was residing in the home for at least 1 year

23-38 immediately before the date the recipient was admitted to the

23-39 medical institution,

23-40 is lawfully residing in the home.

23-41 3. Upon the death of a recipient the welfare division may seek a

23-42 lien upon his undivided estate as defined in NRS 422.054.

24-1 4. The state welfare administrator shall release a lien pursuant

24-2 to this section:

24-3 (a) Upon notice by the recipient or his representative to the

24-4 administrator that the recipient has been discharged from the

24-5 medical institution and has returned home;

24-6 (b) If the lien was incorrectly determined; or

24-7 (c) Upon satisfaction of the claim of the welfare division.

24-8 Sec. 42. Assembly Bill No. 305 of this session is hereby amended by

24-9 deleting sec. 33 and adding:

24-10 Sec. 33. (Deleted by amendment.)

24-11 Sec. 43. Assembly Bill No. 305 of this session is hereby amended by

24-12 deleting sec. 37 and adding:

24-13 Sec. 37. (Deleted by amendment.)

24-14 Sec. 44. Section 45 of Assembly Bill No. 305 of this session is hereby

24-15 amended to read as follows:

24-16 Sec. 45. [1. This section and sections 1 to 32, inclusive, 34,

24-17 35, 36, 38 to 44, inclusive, and 46 of this act become] This act

24-18 becomes effective upon passage and approval.

24-19 [2. Sections 33 and 37 of this act become effective at 12:01

24-20 a.m. on July 1, 1999.

24-21 3. Sections 32 and 36 of this act expire by limitation on July 1,

24-22 1999.]

24-23 Sec. 45. Section 2 of Assembly Bill No. 483 of this session is hereby

24-24 amended to read as follows:

24-25 Sec. 2. NRS 441A.220 is hereby amended to read as follows:

24-26 441A.220 All information of a personal nature about any

24-27 person provided by any other person reporting a case or suspected

24-28 case of a communicable disease, or by any person who has a

24-29 communicable disease, or as determined by investigation of the

24-30 health authority, is confidential medical information and must not

24-31 be disclosed to any person under any circumstances, including

24-32 pursuant to any subpoena, search warrant or discovery proceeding,

24-33 except as follows:

24-34 1. For statistical purposes, provided that the identity of the

24-35 person is not discernible from the information disclosed.

24-36 2. In a prosecution for a violation of this chapter.

24-37 3. In a proceeding for an injunction brought pursuant to this

24-38 chapter.

24-39 4. In reporting the actual or suspected abuse or neglect of a

24-40 child or elderly person.

24-41 5. To any person who has a medical need to know the

24-42 information for his own protection or for the well-being of a patient

25-1 or dependent person, as determined by the health authority in

25-2 accordance with regulations of the board.

25-3 6. If the person who is the subject of the information consents

25-4 in writing to the disclosure.

25-5 7. Pursuant to subsection 2 of NRS 441A.320 [.] or section 3

25-6 of this act.

25-7 8. If the disclosure is made to the department of human

25-8 resources and the person about whom the disclosure is made has

25-9 been diagnosed as having acquired immunodeficiency syndrome or

25-10 an illness related to the human immunodeficiency virus and is a

25-11 recipient of or an applicant for Medicaid.

25-12 9. To a fireman, police officer or person providing emergency

25-13 medical services if the board has determined that the information

25-14 relates to a communicable disease significantly related to that

25-15 occupation. The information must be disclosed in the manner

25-16 prescribed by the board.

25-17 10. If the disclosure is authorized or required by specific

25-18 statute.

25-19 Sec. 46. Section 1 of Assembly Bill No. 649 of this session is hereby

25-20 amended to read as follows:

25-21 Section 1. NRS 200.5093 is hereby amended to read as

25-22 follows:

25-23 200.5093 1. A person required to make a report pursuant to

25-24 this section shall make the report immediately, but in no event later

25-25 than 24 hours after there is reason to believe that an older person

25-26 has been abused, neglected, exploited or isolated. The report must

25-27 be made to:

25-28 (a) The local office of the aging services division of the

25-29 department of human resources;

25-30 (b) A police department or sheriff’s office;

25-31 (c) The county’s office for protective services, if one exists in

25-32 the county where the suspected action occurred; or

25-33 (d) A toll-free telephone service designated by the aging services

25-34 division of the department of human resources.

25-35 If the report of abuse, neglect, exploitation or isolation of an older

25-36 person involves an act or omission of the aging services division,

25-37 another division of the department of human resources or a law

25-38 enforcement agency, the report must be made to an agency other

25-39 than the one alleged to have committed the act or omission. Each

25-40 agency, after reducing the report to writing, shall forward a copy of

25-41 the report to the aging services division of the department of human

25-42 resources.

26-1 2. Reports must be made by the following persons who, in their

26-2 professional or occupational capacities, know or have reason to

26-3 believe that an older person is being or has been abused, neglected,

26-4 exploited or isolated:

26-5 (a) Every physician, dentist, dental hygienist, chiropractor,

26-6 optometrist, podiatric physician, medical examiner, resident, intern,

26-7 professional or practical nurse, physician’s assistant, psychiatrist,

26-8 psychologist, marriage and family therapist, alcohol or drug abuse

26-9 counselor, driver of an ambulance, advanced emergency medical

26-10 technician or other person providing medical services licensed or

26-11 certified to practice in this state, who examines, attends or treats an

26-12 older person who appears to have been abused, neglected, exploited

26-13 or isolated.

26-14 (b) Any personnel of a hospital or similar institution engaged in

26-15 the admission, examination, care or treatment of persons or an

26-16 administrator, manager or other person in charge of a hospital or

26-17 similar institution upon notification of the suspected abuse, neglect,

26-18 exploitation or isolation of an older person by a member of the staff

26-19 of the hospital.

26-20 (c) A coroner.

26-21 (d) Every clergyman, practitioner of Christian Science or

26-22 religious healer, unless he acquired the knowledge of abuse,

26-23 neglect, exploitation or isolation of the older person from the

26-24 offender during a confession.

26-25 (e) Every person who maintains or is employed by an agency to

26-26 provide nursing in the home.

26-27 (f) Every attorney, unless he has acquired the knowledge of

26-28 abuse, neglect, exploitation or isolation of the older person from a

26-29 client who has been or may be accused of such abuse, neglect,

26-30 exploitation or isolation.

26-31 (g) Any employee of the department of human resources.

26-32 (h) Any employee of a law enforcement agency or a county’s

26-33 office for protective services or an adult or juvenile probation

26-34 officer.

26-35 (i) Any person who maintains or is employed by a facility or

26-36 establishment that provides care for older persons.

26-37 (j) Any person who maintains, is employed by or serves as a

26-38 volunteer for an agency or service which advises persons regarding

26-39 the abuse, neglect, exploitation or isolation of an older person and

26-40 refers them to persons and agencies where their requests and needs

26-41 can be met.

26-42 (k) Every social worker.

27-1 (l) Any person who owns or is employed by a funeral home or

27-2 mortuary.

27-3 3. A report may be filed by any other person.

27-4 4. A person required to make a report pursuant to this section

27-5 who has reasonable cause to believe that an older person has died as

27-6 a result of abuse, neglect or isolation shall report this belief to the

27-7 appropriate medical examiner or coroner, who shall investigate the

27-8 cause of death of the older person and submit to the appropriate

27-9 local law enforcement agencies, the appropriate prosecuting

27-10 attorney and the aging services division of the department of human

27-11 resources his written findings. The written findings must include the

27-12 information required pursuant to the provisions of NRS 200.5094,

27-13 when possible.

27-14 5. A division, office or department which receives a report

27-15 pursuant to this section shall cause the investigation of the report to

27-16 commence within 3 working days. A copy of the final report of the

27-17 investigation conducted by a division, office or department, other

27-18 than the aging services division of the department of human

27-19 resources, must be forwarded to the aging services division within

27-20 90 days after the completion of the report.

27-21 6. If the investigation of the report results in the belief that the

27-22 older person is abused, neglected, exploited or isolated, the aging

27-23 services division of the department of human resources or the

27-24 county’s office for protective services may provide protective

27-25 services to the older person if he is able and willing to accept them.

27-26 7. A person who knowingly and willfully violates any of the

27-27 provisions of this section is guilty of a misdemeanor.

27-28 Sec. 47. Section 2 of Assembly Bill No. 649 of this session is hereby

27-29 amended to read as follows:

27-30 Sec. 2. NRS 200.50984 is hereby amended to read as follows:

27-31 200.50984 1. Notwithstanding any other statute to the

27-32 contrary, the local office of the aging services division of the

27-33 department of human resources and a county’s office for protective

27-34 services, if one exists in the county where a violation is alleged to

27-35 have occurred, may for the purpose of investigating an alleged

27-36 violation of NRS 200.5091 to 200.50995, inclusive, inspect all

27-37 records pertaining to the older person on whose behalf the

27-38 investigation is being conducted, including, but not limited to, that

27-39 person’s medical and financial records.

27-40 2. Except as otherwise provided in this subsection, if a guardian

27-41 has not been appointed for the older person, the [department of

27-42 human resources] aging services division or the county’s office for

27-43 protective services shall obtain the consent of the older person

28-1 before inspecting those records. If the [department of human

28-2 resources] aging services division or the county’s office for

28-3 protective services determines that the older person is unable to

28-4 consent to the inspection, the inspection may be conducted without

28-5 his consent. Except as otherwise provided in this subsection, if a

28-6 guardian has been appointed for the older person, the [department

28-7 of human resources] aging services division or the county’s office

28-8 for protective services shall obtain the consent of the guardian

28-9 before inspecting those records. If the [department of human

28-10 resources] aging services division or the county’s office for

28-11 protective services has reason to believe that the guardian is

28-12 abusing, neglecting, exploiting or isolating the older person, the

28-13 inspection may be conducted without the consent of the guardian,

28-14 except that if the records to be inspected are in the personal

28-15 possession of the guardian, the inspection must be approved by a

28-16 court of competent jurisdiction.

28-17 Sec. 48. Section 3 of Assembly Bill No. 649 of this session is hereby

28-18 amended to read as follows:

28-19 Sec. 3. NRS 200.50986 is hereby amended to read as follows:

28-20 200.50986 The local office of the aging services division of

28-21 the department of human resources or the county’s office for

28-22 protective services may petition a court in accordance with NRS

28-23 159.185 or 159.1905 for the removal of the guardian of an older

28-24 person, or the termination or modification of that guardianship, if,

28-25 based on its investigation, the [department of human resources]

28-26 aging services division or the county’s office of protective services

28-27 has reason to believe that the guardian is abusing, neglecting,

28-28 exploiting or isolating the older person in violation of NRS

28-29 200.5095 to 200.50995, inclusive.

28-30 Sec. 49. Section 4 of Assembly Bill No. 649 of this session is hereby

28-31 amended to read as follows:

28-32 Sec. 4. This act becomes effective on July 1, 1999.

28-33 Sec. 50. Section 1 of Senate Bill No. 398 of this session is hereby

28-34 amended to read as follows:

28-35 Section 1. NRS 422.245 is hereby amended to read as follows:

28-36 422.245 Any federal money allotted to the State of Nevada for

28-37 public assistance programs and other programs for which the

28-38 welfare division or the division of health care financing and policy

28-39 is responsible and such other money as may be received by the state

28-40 for such purposes must , except as otherwise provided in section 2

28-41 of this act, be deposited in the appropriate accounts of the welfare

28-42 division or the division of health care financing and policy in the

28-43 state general fund.

29-1 Sec. 51. Section 4 of Senate Bill No. 398 of this session is

29-2 hereby amended to read as follows:

29-3 Sec. 4. This act becomes effective on July 1, 1999.

29-4 Sec. 52. This act becomes effective upon passage and approval.

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