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).

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

1-3 1. The administrator shall include in the state plan for Medicaid a

1-4 requirement that:

1-5 (a) Any senior citizen who purchases and maintains for at least 3

1-6 years a policy of health insurance for long-term care that is made

1-7 available pursuant to section 19 of this act and whose annual household

1-8 income is less than $100,000 is eligible for Medicaid for long-term care;

1-9 and

1-10 (b) The state shall pay the medical, administrative and transactional

1-11 costs of the senior citizen associated with his long-term care that are not

2-1 otherwise paid under Medicaid, to the extent those costs are not covered

2-2 by the policy of health insurance purchased pursuant to section 19 of this

2-3 act.

2-4 2. As used in this section:

2-5 (a) "Household income" has the meaning ascribed to it in NRS

2-6 361.820.

2-7 (b) "Income" has the meaning ascribed to it in NRS 361.823.

2-8 Sec. 2. NRS 422.272 is hereby amended to read as follows:

2-9 422.272 1. [The] Except as otherwise provided in section 1 of this

2-25 (c) "Hospital" has the meaning ascribed to it in NRS 449.012.

2-26 Sec. 3. Chapter 439 of NRS is hereby amended by adding thereto the

2-27 provisions set forth as sections 4 to 11, inclusive, of this act.

2-28 Sec. 4. 1. The trust fund for health programs is hereby created in

2-29 the state treasury to be administered by the state health officer. Upon

2-30 receipt of any money distributed to the State of Nevada as a result of

2-31 settlement agreements in November 1998 with tobacco companies, the

2-32 state treasurer shall deposit an amount equal to 50 percent of the money

2-33 so received into the trust fund for health programs.

2-34 2. The state treasurer may accept gifts and grants for deposit in the

2-35 trust fund.

2-36 3. The money in the trust fund may be used only for the following

2-37 purposes:

2-38 (a) Ten million dollars may be used annually for the payment of

2-39 subsidies granted pursuant to sections 14 to 28, inclusive, of this act to

2-40 senior citizens for insurance that provides coverage for long-term care.

2-41 (b) Six million dollars may be used annually for the payment of

2-42 subsidies granted pursuant to sections 14 to 28, inclusive, of this act to

3-1 senior citizens for insurance that provides coverage for prescription

3-2 drugs and pharmaceutical services.

3-3 (c) The remaining balance in the trust fund may be used to carry out

3-4 the educational and informational programs designed to prevent and

3-5 reduce the use of cigarettes and other products made from tobacco

3-6 established pursuant to NRS 439.130.

3-7 4. The money in the trust fund must be invested as the money in

3-8 other state funds is invested. The interest and income earned on the

3-9 money in the trust fund must, after deducting any applicable charges, be

3-10 credited to the trust fund. All claims against the trust fund must be paid

3-11 as other claims against the state are paid.

3-12 5. Not more than 2 percent of the money in the trust fund may be

3-13 used to pay the costs of administering the trust fund.

3-14 Sec. 5. 1. The state board of finance may issue special obligations

3-15 to provide money to fund the trust fund for health programs established

3-16 pursuant to section 4 of this act. The obligations may be issued at one

3-17 time or from time to time, and must be issued in accordance with the

3-18 provisions of chapter 349 of NRS.

3-19 2. The face amount of the special obligations issued pursuant to this

3-20 section must not exceed the sum of:

3-21 (a) Fifty percent of the amount of money anticipated to be distributed

3-22 to the State of Nevada as a result of settlement agreements in November

3-23 1998 with tobacco companies; and

3-24 (b) The amount necessary to pay the expenses related to the issuance

3-25 of the obligations which must not exceed 2 percent of the face amount of

3-26 the obligations sold.

3-27 3. The obligations must be secured by a pledge of the money

3-28 distributed to the State of Nevada as a result of settlement agreements in

3-29 November 1998 with tobacco companies in an amount equal to 50

3-30 percent of the money so received, and must mature within not more than

3-31 10 years after their date of issuance.

3-32 4. The proceeds from the sale of the special obligations, after

3-33 deducting the expenses related to the issuance of the obligations, must be

3-34 deposited with the state treasurer and credited to the trust fund for health

3-35 programs.

3-36 5. The special obligations issued pursuant to this section are not an

3-37 indebtedness of the state.

3-38 Sec. 6. As used in sections 6 to 9, inclusive, of this act, "office of

3-39 rural health" means the office of rural health of the University of

3-40 Nevada School of Medicine.

3-41 Sec. 7. 1. The trust fund for rural health care programs is hereby

3-42 created in the state treasury to be administered by the office of rural

3-43 health.

4-1 2. The state treasurer may accept gifts and grants for deposit in the

4-2 trust fund.

4-3 3. The money in the trust fund may be used only for:

4-4 (a) Programs that are designed to improve access to health care

4-5 services for persons in this state who reside in counties whose

4-6 populations are less than 100,000;

4-7 (b) The promotion of public health and programs for the prevention

4-8 of disease or illness in such counties; and

4-9 (c) The payment of grants to counties pursuant to section 8 of this act.

4-10 4. The money in the trust fund must be invested as the money in

4-11 other state funds is invested. The interest and income earned on the

4-12 money in the trust fund must, after deducting any applicable charges, be

4-13 credited to the trust fund. All claims against the trust fund must be paid

4-14 as other claims against the state are paid.

4-15 5. Not more than 2 percent of the money in the trust fund may be

4-16 used to pay the costs of administering the trust fund.

4-17 Sec. 8. 1. A county board of health in a county whose population

4-18 is less than 100,000 may apply to the office of rural health for a grant of

4-19 money from the trust fund for rural health care programs created

4-20 pursuant to section 7 of this act. An application must:

4-21 (a) Be submitted on a form provided by the office; and

4-22 (b) Include a description of the local health care programs for which

4-23 the grant will be used.

4-24 2. If an application is complete, the office shall determine whether

4-25 the applicant is eligible to receive a grant from the fund and submit the

4-26 applications of all eligible applicants to the advisory board for rural

4-27 health care created pursuant to section 9 of this act for its review. Upon

4-28 the receipt of the recommendations of the advisory board, the office shall

4-29 award grants from the trust fund for rural health care programs within

4-30 the limits of money available in the trust fund.

4-31 Sec. 9. 1. The advisory board for rural health care programs is

4-32 hereby created.

4-33 2. The advisory board consists of:

4-34 (a) One member of the board of county commissioners of each county

4-35 in this state, appointed by the board of county commissioners;

4-36 (b) The state health officer; and

4-37 (c) A member of the general public appointed by the governor.

4-38 3. Each member of the advisory board appointed pursuant to

4-39 paragraphs (a) and (c) of subsection 2 serves at the pleasure of the

4-40 appointing authority.

4-41 4. The members of the advisory board serve without compensation,

4-42 except that for each day or portion of a day during which a member of

4-43 the board attends a meeting of the board or is otherwise engaged in the

5-1 business of the board, he is entitled to receive the per diem allowance and

5-2 travel expenses provided for state officers and employees generally.

5-3 5. The advisory board shall:

5-4 (a) Review the applications for grants submitted to the board by the

5-5 office of rural health pursuant to section 8 of this act; and

5-6 (b) Make recommendations to the office of rural health regarding the

5-7 grants to be made from the trust fund for rural health care programs.

5-8 Sec. 10. 1. The advisory board for the prevention and reduction of

5-9 the use of cigarettes and other products made from tobacco is hereby

5-10 created.

5-11 2. The advisory board consists of seven members appointed by the

5-12 governor as follows:

5-13 (a) Two members who represent nonprofit organizations dedicated to

5-14 reducing health care problems related to the use of tobacco;

5-15 (b) One member with expertise in the field of education;

5-16 (c) Two members who represent the general public;

5-17 (d) One member who represents the state board of health; and

5-18 (e) One member with expertise in the field of health care and the

5-19 effects of the use of tobacco.

5-20 3. After their initial terms, the members of the advisory board serve

5-21 terms of 2 years.

5-22 4. If a vacancy occurs in the office of a member of the advisory

5-23 board, the governor shall appoint a person similarly qualified to replace

5-24 that member.

5-25 5. The members of the board serve without compensation, except

5-26 that for each day or portion of a day during which a member of the

5-27 board attends a meeting of the board or is otherwise engaged in the

5-28 business of the board, he is entitled to receive the per diem allowance and

5-29 travel expenses provided for state officers and employees generally.

5-30 6. The advisory board shall meet at least quarterly and at the times

5-31 and places specified by the call of the chairman.

5-32 7. The governor shall appoint a chairman and a vice chairman from

5-33 among the membership of the board.

5-34 Sec. 11. The advisory board created pursuant to section 10 of this

5-35 act shall:

5-36 1. Make recommendations to the state health officer regarding the

5-37 educational and informational programs designed to prevent and reduce

5-38 the use of cigarettes and other products made from tobacco established

5-39 pursuant to NRS 439.130.

5-40 2. Assess the effectiveness of such programs.

5-41 3. Evaluate research and programs conducted in other states that are

5-42 related to the prevention and reduction of the use of cigarettes and other

5-43 products made from tobacco.

6-1 4. Propose strategies for the coordination of proposed programs

6-2 established by the state health officer pursuant to NRS 439.130.

6-3 5. Make recommendations to the state health officer regarding the

6-4 most appropriate criteria for the selection of, standards of operation for

6-5 and types of programs to be established.

6-6 6. Advise and make recommendations to the governor and the

6-7 legislature concerning the policy of this state relating to the prevention

6-8 and reduction of the use of cigarettes and other products made from

6-9 tobacco.

6-10 Sec. 12. NRS 439.130 is hereby amended to read as follows:

6-11 439.130 1. The state health officer shall:

6-29 from time to time, prescribe.

6-30 Sec. 13. Chapter 439B of NRS is hereby amended by adding thereto

6-31 the provisions set forth as sections 14 to 28, inclusive, of this act.

6-32 Sec. 14. As used in sections 14 to 28, inclusive, of this act, the words

6-33 and terms defined in sections 15 to 18, inclusive, of this act have the

6-34 meanings ascribed to them in those sections.

6-35 Sec. 15. "Administrator" means the administrator of the aging

6-36 services division of the department of human resources.

6-37 Sec. 16. "Household income" has the meaning ascribed to it in NRS

6-38 361.820.

6-39 Sec. 17. "Income" has the meaning ascribed to it in NRS 361.823.

6-40 Sec. 18. "Senior citizen" means a person who is domiciled in this

6-41 state and:

7-1 1. For the purpose of receiving a subsidy pursuant to section 19 of

7-2 this act for insurance that provides coverage for prescription drugs and

7-3 pharmaceutical services, is 65 years of age or older.

7-4 2. For the purpose of receiving a subsidy pursuant to section 19 of

7-5 this act for insurance that provides coverage for long-term care, is 59

7-6 years of age or older.

7-7 Sec. 19. 1. The administrator shall enter into contracts with

7-8 private insurers who transact health insurance in this state to arrange for

7-9 the availability at a reasonable cost of policies of health insurance that

7-10 provide coverage to senior citizens for:

7-11 (a) Long-term care, including care received at home or at a facility

7-12 for residential care.

7-13 (b) Prescription drugs and pharmaceutical services.

7-14 2. Within the limits of the money available in the trust fund for

7-15 health programs created pursuant to section 4 of this act, a senior citizen

7-16 who purchases a policy of health insurance that is made available

7-17 pursuant to subsection 1 is entitled to an annual grant from the trust

7-18 fund to subsidize a portion of the cost of that insurance if he has been

7-19 domiciled in this state for at least 1 year immediately preceding the date

7-20 of his application and his household income is within one of the income

7-21 ranges for which grants are provided pursuant to this subsection to the

7-22 extent determined by the percentage shown opposite his household

7-23 income on the following schedule, as that income is adjusted pursuant to

7-24 subsection 4:

7-36 care or $1,200 per year, whichever is less.

7-37 (b) The annual cost of insurance that provides coverage for

7-38 prescription drugs and pharmaceutical services or $480 per year,

7-39 whichever is less.

7-40 4. The monetary amounts shown for each income range in

7-41 subsection 2 must be adjusted for each fiscal year by adding to each

8-1 amount the product of the amount shown multiplied by the percentage

8-2 increase in the Consumer Price Index from December 1998 to the

8-3 December preceding the fiscal year for which the adjustment is

8-4 calculated.

8-5 5. The total amount of subsidies granted each year by the

8-6 administrator pursuant to this section for insurance that provides

8-7 coverage for:

8-8 (a) Long-term care must not exceed $10,000,000.

8-9 (b) Prescription drugs and pharmaceutical services must not exceed

8-10 $6,000,000.

8-11 Sec. 20. A senior citizen who is otherwise qualified may receive a

8-12 subsidy pursuant to section 19 of this act for insurance that provides

8-13 coverage for long-term care while at the same time receiving a subsidy

8-14 for insurance that provides coverage for prescription drugs and

8-15 pharmaceutical services.

8-16 Sec. 21. 1. A senior citizen who wishes to receive a subsidy

8-17 pursuant to section 19 of this act must file a request therefor with the

8-18 administrator.

8-19 2. The request must be made under oath and filed in such form and

8-20 content, and accompanied by such proof, as the administrator may

8-21 prescribe.

8-22 3. The administrator shall, within 45 days after receiving a request

8-23 for a subsidy, examine the request, granting or denying it, and if granted,

8-24 shall determine the amount of the subsidy to which the senior citizen is

8-25 entitled.

8-26 4. The administrator shall certify those senior citizens who are

8-27 eligible to receive a subsidy pursuant to section 19 of this act to the state

8-28 health officer. Any subsidy granted must be paid by the state health

8-29 officer directly to an insurer with whom the administrator has entered

8-30 into a contract pursuant to section 19 of this act.

8-31 Sec. 22. Any subsidy granted pursuant to section 19 of this act to a

8-32 senior citizen who is not qualified for such a subsidy may be revoked by

8-33 the administrator. If a subsidy is so revoked, the senior citizen shall make

8-34 restitution to the administrator for any subsidy he has improperly

8-35 received, and the administrator shall take all proper actions to collect the

8-36 amount of the subsidy as a debt.

8-37 Sec. 23. 1. The administrator shall deny any request for a subsidy

8-38 received pursuant to section 19 of this act to which the senior citizen is

8-39 not entitled or any amount in excess of that to which the senior citizen is

8-40 entitled.

8-41 2. The administrator may deny in total any request which he finds to

8-42 have been filed with fraudulent intent. If any such request has been paid

8-43 and is afterward denied, the amount of the subsidy together with a 10

9-1 percent penalty must be repaid by the senior citizen to the administrator.

9-2 The penalty prescribed by this section is in addition to, and not in lieu of,

9-3 any other penalty prescribed by specific statute.

9-4 3. Any amounts received by the administrator pursuant to this

9-5 section must be deposited with the state treasurer for credit to the trust

9-6 fund for health programs created pursuant to section 4 of this act.

9-7 Sec. 24. Any person who willfully makes a material false statement

9-8 or uses any other fraudulent device to secure for himself or another

9-9 person a subsidy to which he is not entitled is guilty of a misdemeanor.

9-10 Sec. 25. Any person who is aggrieved by a decision of the

9-11 administrator denying a request for a subsidy submitted pursuant to

9-12 section 19 of this act is entitled to judicial review thereof.

9-13 Sec. 26. The administrator is responsible for the administration of

9-14 the provisions of sections 14 to 28, inclusive, of this act and may:

9-15 1. Prescribe the content and form of a request for a subsidy required

9-16 to be submitted pursuant to section 19 of this act.

9-17 2. Designate the proof that must be submitted with such a request.

9-18 3. Adopt regulations to protect the confidentiality of information

9-19 supplied by a senior citizen requesting a subsidy pursuant to section 19 of

9-20 this act.

9-21 4. Adopt such other regulations as may be required to carry out the

9-22 provisions of sections 14 to 28, inclusive, of this act.

9-23 Sec. 27. No person may publish, disclose or use any personal or

9-24 confidential information contained in a request for a subsidy submitted

9-25 pursuant to section 19 of this act except for purposes relating to the

9-26 administration of sections 14 to 28, inclusive, of this act.

9-27 Sec. 28. The administrator shall, in cooperation with the department

9-28 of taxation and the various counties in this state:

9-29 1. Combine all possible administrative procedures required for

9-30 determining those persons who are eligible for assistance pursuant to

9-31 NRS 361.800 to 361.877, inclusive, and sections 14 to 27, inclusive, of

9-32 this act;

9-33 2. Coordinate the collection of information required to carry out

9-34 those provisions in a manner that requires persons requesting assistance

9-35 to furnish information in as few reports as possible; and

9-36 3. Design forms that may be used jointly by the administrator, the

9-37 department of taxation and the various counties in this state to carry out

9-38 the provisions of NRS 361.800 to 361.877, inclusive, and sections 14 to

9-39 27, inclusive, of this act.

9-40 Sec. 29. 1. There is hereby appropriated from the trust fund for

9-41 health programs created pursuant to section 4 of this act to the University

9-42 of Nevada School of Medicine the sum of $5,000,000 for capital

9-43 improvements required to establish a program in Las Vegas that is designed

10-1 to provide health care services to persons for whom health care is not

10-2 readily accessible in this state, including, without limitation, elderly

10-3 persons, persons who reside in the rural areas of the state, persons who are

10-4 culturally disadvantaged and persons who are at risk of contracting certain

10-5 diseases.

10-6 2. The state controller shall not transfer any money from the

10-7 appropriation made by subsection 1 to the University of Nevada School of

10-8 Medicine until $50,000,000 is distributed to the State of Nevada as a result

10-9 of settlement agreements in November 1998 with tobacco companies, 50

10-10 percent of which is deposited in the trust fund for health programs.

10-11 3. Any remaining balance of the appropriation made by subsection 1

10-12 must not be committed for expenditure after completion of the capital

10-13 improvements and reverts to the trust fund for health programs as soon as

10-14 all payments of money committed have been made.

10-15 Sec. 30. 1. There is hereby appropriated from the trust fund for

10-16 health programs created pursuant to section 4 of this act to the state health

10-17 officer the sum of $2,000,000 for the establishment and coordination of

10-18 educational and informational programs designed to prevent and reduce the

10-19 use of cigarettes and other products made from tobacco that are required by

10-20 NRS 439.130, as amended by section 12 of this act.

10-21 2. The state controller shall not transfer any money from the

10-22 appropriation made by subsection 1 to the state health officer until

10-23 $50,000,000 is distributed to the State of Nevada as a result of settlement

10-24 agreements in November 1998 with tobacco companies, 50 percent of

10-25 which is deposited in the trust fund for health programs.

10-26 Sec. 31. 1. There is hereby appropriated from the trust fund for

10-27 health programs created pursuant to section 4 of this act to the trust fund for

10-28 rural health care programs created pursuant to section 7 of this act the sum

10-29 of $2,500,000.

10-30 2. The state controller shall not transfer any money from the

10-31 appropriation made by subsection 1 to the trust fund for rural health care

10-32 programs until $50,000,000 is distributed to the State of Nevada as a result

10-33 of settlement agreements in November 1998 with tobacco companies, 50

10-34 percent of which is deposited in the trust fund for health programs.

10-35 Sec. 32. 1. There is hereby appropriated from the trust fund for

10-36 health programs created pursuant to section 4 of this act to the office of

10-37 rural health of the University of Nevada School of Medicine the sum of

10-38 $1,000,000 for emergency medical services provided in counties whose

10-39 populations are less than 100,000, the improvement of technology used for

10-40 billing by rural hospitals, and the development of systems to provide health

10-41 care services in counties whose populations are less than 100,000 by the

10-42 use of telemedicine and other electronic means.

11-1 2. The state controller shall not transfer any money from the

11-2 appropriation made by subsection 1 to the office of rural health until

11-3 $50,000,000 is distributed to the State of Nevada as a result of settlement

11-4 agreements in November 1998 with tobacco companies, 50 percent of

11-5 which is deposited in the trust fund for health programs.

11-6 Sec. 33. As soon as practicable after July 1, 1999, the governor shall

11-7 appoint to the advisory board for the prevention and reduction of the use of

11-8 cigarettes and other products made from tobacco created pursuant to

11-9 section 10 of this act:

11-10 1. One member who represents a nonprofit organization dedicated to

11-11 reducing health care problems related to the use of tobacco, one member

11-12 who represents the general public and one member with expertise in the

11-13 field of education, whose terms expire on July 1, 2000.

11-14 2. One member who represents a nonprofit organization dedicated to

11-15 reducing health care problems related to the use of tobacco, one member

11-16 who represents the general public, one member who represents the state

11-17 board of health and one member who has expertise in the field of health

11-18 care and the effects of the use of tobacco, whose terms expire on July 1,

11-19 2001.

11-20 Sec. 34. The amendatory provisions of this act do not apply to

11-21 offenses that were committed before July 1, 1999.

11-22 Sec. 35. This act becomes effective on July 1, 1999.