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 receives benefits for at least

1-6 3 years pursuant to a policy of health insurance for long-term care that is

1-7 at least as comprehensive, as determined by the administrator, as the

1-8 policy made available pursuant to section 19 of this act and whose

1-9 annual household income is less than $200,000 is eligible for Medicaid

1-10 for long-term care; and

1-11 (b) The state shall pay the medical, administrative and transactional

1-12 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 (c) "Senior citizen" means a person who is domiciled in this state and

2-9 is 55 years of age or older.

2-10 Sec. 2. NRS 422.272 is hereby amended to read as follows:

2-11 422.272 1. [The] Except as otherwise provided in section 1 of this

2-27 (c) "Hospital" has the meaning ascribed to it in NRS 449.012.

2-28 Sec. 3. Chapter 439 of NRS is hereby amended by adding thereto the

2-29 provisions set forth as sections 4 to 11, inclusive, of this act.

2-30 Sec. 4. 1. The trust fund for health programs is hereby created in

2-31 the state treasury to be administered by the administrator. Upon receipt

2-32 of any money distributed to the State of Nevada as a result of settlement

2-33 agreements in November 1998 with tobacco companies, the state

2-34 treasurer shall deposit an amount equal to 50 percent of the money so

2-35 received into the trust fund for health programs.

2-36 2. The state treasurer may accept gifts and grants for deposit in the

2-37 trust fund.

2-38 3. The money in the trust fund may be used only for the following

2-39 purposes:

2-40 (a) Ten million dollars may be used annually for the payment of

2-41 subsidies granted pursuant to sections 14 to 28, inclusive, of this act to

2-42 senior citizens for insurance that provides coverage for long-term care.

3-1 (b) Six million dollars may be used annually for the payment of

3-2 subsidies granted pursuant to sections 14 to 28, inclusive, of this act to

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

3-4 drugs and pharmaceutical services.

3-5 (c) The remaining balance in the trust fund may be used to carry out

3-6 the educational and informational programs designed to prevent and

3-7 reduce the use of cigarettes and other products made from tobacco

3-8 established pursuant to NRS 439.130.

3-9 4. The money in the trust fund must be invested as the money in

3-10 other state funds is invested. The interest and income earned on the

3-11 money in the trust fund must, after deducting any applicable charges, be

3-12 credited to the trust fund. All claims against the trust fund must be paid

3-13 as other claims against the state are paid.

3-14 5. Not more than 2 percent of the money in the trust fund may be

3-15 used to pay the costs of administering the trust fund.

3-16 Sec. 5. 1. The state board of finance may issue special obligations

3-17 to provide money to fund the trust fund for health programs established

3-18 pursuant to section 4 of this act. The obligations may be issued at one

3-19 time or from time to time, and must be issued in accordance with the

3-20 provisions of chapter 349 of NRS.

3-21 2. The face amount of the special obligations issued pursuant to this

3-22 section must not exceed the sum of:

3-23 (a) Fifty percent of the amount of money anticipated to be distributed

3-24 to the State of Nevada as a result of settlement agreements in November

3-25 1998 with tobacco companies; and

3-26 (b) The amount necessary to pay the expenses related to the issuance

3-27 of the obligations which must not exceed 2 percent of the face amount of

3-28 the obligations sold.

3-29 3. The obligations must be secured by a pledge of the money

3-30 distributed to the State of Nevada as a result of settlement agreements in

3-31 November 1998 with tobacco companies in an amount equal to 50

3-32 percent of the money so received, and must mature within not more than

3-33 10 years after their date of issuance.

3-34 4. The proceeds from the sale of the special obligations, after

3-35 deducting the expenses related to the issuance of the obligations, must be

3-36 deposited with the state treasurer and credited to the trust fund for health

3-37 programs.

3-38 5. The special obligations issued pursuant to this section are not an

3-39 indebtedness of the state.

3-40 Sec. 6. As used in sections 6 to 9, inclusive, of this act, "office of

3-41 rural health" means the office of rural health of the University of

3-42 Nevada School of Medicine.

4-1 Sec. 7. 1. The trust fund for rural health care programs is hereby

4-2 created in the state treasury to be administered by the office of rural

4-3 health.

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

4-5 trust fund.

4-6 3. The money in the trust fund may be used only for:

4-7 (a) Programs that are designed to improve access to health care

4-8 services for persons in this state who reside in counties whose

4-9 populations are less than 100,000;

4-10 (b) The promotion of public health and programs for the prevention

4-11 of disease or illness in such counties; and

4-12 (c) The payment of grants to counties pursuant to section 8 of this act.

4-13 4. The money in the trust fund must be invested as the money in

4-14 other state funds is invested. The interest and income earned on the

4-15 money in the trust fund must, after deducting any applicable charges, be

4-16 credited to the trust fund. All claims against the trust fund must be paid

4-17 as other claims against the state are paid.

4-18 5. Not more than 2 percent of the money in the trust fund may be

4-19 used to pay the costs of administering the trust fund.

4-20 Sec. 8. 1. A county board of health in a county whose population

4-21 is less than 100,000 may apply to the office of rural health for a grant of

4-22 money from the trust fund for rural health care programs created

4-23 pursuant to section 7 of this act. An application must:

4-24 (a) Be submitted on a form provided by the office; and

4-25 (b) Include a description of the local health care programs for which

4-26 the grant will be used.

4-27 2. If an application is complete, the office shall determine whether

4-28 the applicant is eligible to receive a grant from the fund and submit the

4-29 applications of all eligible applicants to the advisory board for rural

4-30 health care created pursuant to section 9 of this act for its review. Upon

4-31 the receipt of the recommendations of the advisory board, the office shall

4-32 award grants from the trust fund for rural health care programs within

4-33 the limits of money available in the trust fund.

4-34 Sec. 9. 1. The advisory board for rural health care programs is

4-35 hereby created.

4-36 2. The advisory board consists of:

4-37 (a) One member of the board of county commissioners of each county

4-38 in this state whose population is less than 100,000 appointed by the board

4-39 of county commissioners;

4-40 (b) The state health officer; and

4-41 (c) A member of the general public appointed by the governor.

5-1 3. Each member of the advisory board appointed pursuant to

5-2 paragraphs (a) and (c) of subsection 2 serves at the pleasure of the

5-3 appointing authority.

5-4 4. The members of the advisory board serve without compensation,

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

5-6 the board attends a meeting of the board or is otherwise engaged in the

5-7 business of the board, he is entitled to receive the per diem allowance and

5-8 travel expenses provided for state officers and employees generally.

5-9 5. The advisory board shall:

5-10 (a) Review the applications for grants submitted to the board by the

5-11 office of rural health pursuant to section 8 of this act;

5-12 (b) Consult with the critical access hospital planning group of the

5-13 University of Nevada School of Medicine and the health division; and

5-14 (c) Make recommendations to the office of rural health regarding the

5-15 grants to be made from the trust fund for rural health care programs.

5-16 Sec. 10. 1. The advisory board for the prevention and reduction of

5-17 the use of cigarettes and other products made from tobacco is hereby

5-18 created.

5-19 2. The advisory board consists of seven members appointed by the

5-20 governor as follows:

5-21 (a) Two members who represent nonprofit organizations dedicated to

5-22 reducing health care problems related to the use of tobacco;

5-23 (b) One member with expertise in the field of education;

5-24 (c) Two members who represent the general public;

5-25 (d) One member who represents the state board of health; and

5-26 (e) One member with expertise in the field of health care and the

5-27 effects of the use of tobacco.

5-28 3. After their initial terms, the members of the advisory board serve

5-29 terms of 4 years.

5-30 4. If a vacancy occurs in the office of a member of the advisory

5-31 board, the governor shall appoint a person similarly qualified to replace

5-32 that member.

5-33 5. The members of the board serve without compensation, except

5-34 that for each day or portion of a day during which a member of the

5-35 board attends a meeting of the board or is otherwise engaged in the

5-36 business of the board, he is entitled to receive the per diem allowance and

5-37 travel expenses provided for state officers and employees generally.

5-38 6. The advisory board shall meet at least quarterly and at the times

5-39 and places specified by the call of the chairman.

5-40 7. The governor shall appoint a chairman and a vice chairman from

5-41 among the membership of the board.

5-42 Sec. 11. 1. The advisory board created pursuant to section 10 of

5-43 this act shall:

6-1 (a) Make recommendations to the administrator regarding the

6-2 educational and informational programs designed to prevent and reduce

6-3 the use of cigarettes and other products made from tobacco established

6-4 pursuant to NRS 439.130.

6-5 (b) Assess the effectiveness of such programs.

6-6 (c) Evaluate research and programs conducted in other states that are

6-7 related to the prevention and reduction of the use of cigarettes and other

6-8 products made from tobacco.

6-9 (d) Propose strategies for the coordination of proposed programs

6-10 established by the administrator pursuant to subsection 2.

6-11 (e) Make recommendations to the administrator regarding the most

6-12 appropriate criteria for the selection of, standards of operation for and

6-13 types of programs to be established.

6-14 (f) Advise and make recommendations to the governor and the

6-15 legislature concerning the policy of this state relating to the prevention

6-16 and reduction of the use of cigarettes and other products made from

6-17 tobacco.

6-18 2. The administrator, in cooperation with the advisory board, shall

6-19 establish and coordinate educational and informational programs

6-20 designed to prevent and reduce the use of cigarettes and other products

6-21 made from tobacco by the residents of this state.

6-22 3. The advisory board may, within the limits of legislative

6-23 appropriations, contract for independent evaluation of the programs

6-24 established pursuant to subsection 2, including a baseline study before

6-25 the establishment of such programs.

6-26 Sec. 12. (Deleted by amendment.)

6-27 Sec. 13. Chapter 439B of NRS is hereby amended by adding thereto

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

6-29 Sec. 14. As used in sections 14 to 28, inclusive, of this act, the words

6-30 and terms defined in sections 15 to 18, inclusive, of this act have the

6-31 meanings ascribed to them in those sections.

6-32 Sec. 15. "Administrator" means the administrator of the aging

6-33 services division of the department of human resources.

6-34 Sec. 16. "Household income" has the meaning ascribed to it in NRS

6-35 361.820.

6-36 Sec. 17. "Income" has the meaning ascribed to it in NRS 361.823.

6-37 Sec. 18. "Senior citizen" means a person who is domiciled in this

6-38 state and:

6-39 1. For the purpose of receiving a subsidy pursuant to section 19 of

6-40 this act for insurance that provides coverage for prescription drugs and

6-41 pharmaceutical services, is 62 years of age or older.

7-1 2. For the purpose of receiving a subsidy pursuant to section 19 of

7-2 this act for insurance that provides coverage for long-term care, is 59

7-3 years of age or older.

7-4 Sec. 19. 1. The administrator shall enter into contracts with

7-5 private insurers who transact health insurance in this state to arrange for

7-6 the availability at a reasonable cost of policies of health insurance that

7-7 provide coverage to senior citizens for:

7-8 (a) Long-term care, including care received at home or at a facility

7-9 for residential care.

7-10 (b) Prescription drugs and pharmaceutical services.

7-11 2. Within the limits of the money available in the trust fund for

7-12 health programs created pursuant to section 4 of this act, a senior citizen

7-13 who is not eligible for Medicaid and who purchases a policy of health

7-14 insurance that is made available pursuant to subsection 1 is entitled to an

7-15 annual grant from the trust fund to subsidize a portion of the cost of that

7-16 insurance if he has been domiciled in this state for at least 1 year

7-17 immediately preceding the date of his application and his household

7-18 income is within one of the income ranges for which grants are provided

7-19 pursuant to this subsection to the extent determined by the percentage

7-20 shown opposite his household income on the following schedule:

7-32 care or $1,200 per year, whichever is less.

7-33 (b) The annual cost of insurance that provides coverage for

7-34 prescription drugs and pharmaceutical services or $480 per year,

7-35 whichever is less.

7-36 4. The total amount of subsidies granted each year by the

7-37 administrator pursuant to this section for insurance that provides

7-38 coverage for:

7-39 (a) Long-term care must not exceed $10,000,000.

7-40 (b) Prescription drugs and pharmaceutical services must not exceed

7-41 $6,000,000.

8-1 Sec. 20. A senior citizen who is otherwise qualified may receive a

8-2 subsidy pursuant to section 19 of this act for insurance that provides

8-3 coverage for long-term care while at the same time receiving a subsidy

8-4 for insurance that provides coverage for prescription drugs and

8-5 pharmaceutical services.

8-6 Sec. 21. 1. A senior citizen who wishes to receive a subsidy

8-7 pursuant to section 19 of this act must file a request therefor with the

8-8 administrator.

8-9 2. The request must be made under oath and filed in such form and

8-10 content, and accompanied by such proof, as the administrator may

8-11 prescribe.

8-12 3. The administrator shall, within 45 days after receiving a request

8-13 for a subsidy, examine the request, granting or denying it, and if granted,

8-14 shall determine the amount of the subsidy to which the senior citizen is

8-15 entitled.

8-16 4. The administrator shall certify those senior citizens who are

8-17 eligible to receive a subsidy pursuant to section 19 of this act to the state

8-18 health officer. Any subsidy granted must be paid by the state health

8-19 officer directly to an insurer with whom the administrator has entered

8-20 into a contract pursuant to section 19 of this act.

8-21 Sec. 22. Any subsidy granted pursuant to section 19 of this act to a

8-22 senior citizen who is not qualified for such a subsidy may be revoked by

8-23 the administrator. If a subsidy is so revoked, the senior citizen shall make

8-24 restitution to the administrator for any subsidy he has improperly

8-25 received, and the administrator shall take all proper actions to collect the

8-26 amount of the subsidy as a debt.

8-27 Sec. 23. 1. The administrator shall deny any request for a subsidy

8-28 received pursuant to section 19 of this act to which the senior citizen is

8-29 not entitled or any amount in excess of that to which the senior citizen is

8-30 entitled.

8-31 2. The administrator may deny in total any request which he finds to

8-32 have been filed with fraudulent intent. If any such request has been paid

8-33 and is afterward denied, the amount of the subsidy together with a 10

8-34 percent penalty must be repaid by the senior citizen to the administrator.

8-35 The penalty prescribed by this section is in addition to, and not in lieu of,

8-36 any other penalty prescribed by specific statute.

8-37 3. Any amounts received by the administrator pursuant to this

8-38 section must be deposited with the state treasurer for credit to the trust

8-39 fund for health programs created pursuant to section 4 of this act.

8-40 Sec. 24. Any person who willfully makes a material false statement

8-41 or uses any other fraudulent device to secure for himself or another

8-42 person a subsidy to which he is not entitled is guilty of a misdemeanor.

9-1 Sec. 25. Any person who is aggrieved by a decision of the

9-2 administrator denying a request for a subsidy submitted pursuant to

9-3 section 19 of this act is entitled to judicial review thereof.

9-4 Sec. 26. The administrator is responsible for the administration of

9-5 the provisions of sections 14 to 28, inclusive, of this act and may:

9-6 1. Prescribe the content and form of a request for a subsidy required

9-7 to be submitted pursuant to section 19 of this act.

9-8 2. Designate the proof that must be submitted with such a request.

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

9-10 supplied by a senior citizen requesting a subsidy pursuant to section 19 of

9-11 this act.

9-12 4. Adopt such other regulations as may be required to carry out the

9-13 provisions of sections 14 to 28, inclusive, of this act.

9-14 Sec. 27. No person may publish, disclose or use any personal or

9-15 confidential information contained in a request for a subsidy submitted

9-16 pursuant to section 19 of this act except for purposes relating to the

9-17 administration of sections 14 to 28, inclusive, of this act.

9-18 Sec. 28. The administrator shall, in cooperation with the department

9-19 of taxation and the various counties in this state:

9-20 1. Combine all possible administrative procedures required for

9-21 determining those persons who are eligible for assistance pursuant to

9-22 NRS 361.800 to 361.877, inclusive, and sections 14 to 27, inclusive, of

9-23 this act;

9-24 2. Coordinate the collection of information required to carry out

9-25 those provisions in a manner that requires persons requesting assistance

9-26 to furnish information in as few reports as possible; and

9-27 3. Design forms that may be used jointly by the administrator, the

9-28 department of taxation and the various counties in this state to carry out

9-29 the provisions of NRS 361.800 to 361.877, inclusive, and sections 14 to

9-30 27, inclusive, of this act.

9-31 Sec. 29. 1. There is hereby appropriated from the trust fund for

9-32 health programs created pursuant to section 4 of this act to the University

9-33 of Nevada School of Medicine the sum of $5,000,000 for capital

9-34 improvements required to establish a program in Las Vegas that is designed

9-35 to provide health care services to persons for whom health care is not

9-36 readily accessible in this state, including, without limitation, elderly

9-37 persons, persons who reside in the rural areas of the state, persons who are

9-38 culturally disadvantaged and persons who are at risk of contracting certain

9-39 diseases.

9-40 2. The state controller shall not transfer any money from the

9-41 appropriation made by subsection 1 to the University of Nevada School of

10-1 Medicine until $50,000,000 is distributed to the State of Nevada as a result

10-2 of settlement agreements in November 1998 with tobacco companies, 50

10-3 percent of which is deposited in the trust fund for health programs.

10-4 3. Any remaining balance of the appropriation made by subsection 1

10-5 must not be committed for expenditure after completion of the capital

10-6 improvements and reverts to the trust fund for health programs as soon as

10-7 all payments of money committed have been made.

10-8 Sec. 30. 1. There is hereby appropriated from the trust fund for

10-9 health programs created pursuant to section 4 of this act to the health

10-10 division of the department of human resources the sum of $2,000,000 for

10-11 the establishment and coordination of educational and informational

10-12 programs designed to prevent and reduce the use of cigarettes and other

10-13 products made from tobacco that are required by section 11 of this act.

10-14 2. The state controller shall not transfer any money from the

10-15 appropriation made by subsection 1 to the health division of the department

10-16 of human resources until $50,000,000 is distributed to the State of Nevada

10-17 as a result of settlement agreements in November 1998 with tobacco

10-18 companies, 50 percent of which is deposited in the trust fund for health

10-19 programs.

10-20 Sec. 31. 1. There is hereby appropriated from the trust fund for

10-21 health programs created pursuant to section 4 of this act to the trust fund for

10-22 rural health care programs created pursuant to section 7 of this act the sum

10-23 of $2,500,000.

10-24 2. The state controller shall not transfer any money from the

10-25 appropriation made by subsection 1 to the trust fund for rural health care

10-26 programs until $50,000,000 is distributed to the State of Nevada as a result

10-27 of settlement agreements in November 1998 with tobacco companies, 50

10-28 percent of which is deposited in the trust fund for health programs.

10-29 Sec. 32. 1. There is hereby appropriated from the trust fund for

10-30 health programs created pursuant to section 4 of this act to the office of

10-31 rural health of the University of Nevada School of Medicine the sum of

10-32 $1,000,000 for emergency medical services provided in counties whose

10-33 populations are less than 100,000, the improvement of technology used for

10-34 billing by rural hospitals, and the development of systems to provide health

10-35 care services in counties whose populations are less than 100,000 by the

10-36 use of telemedicine and other electronic means.

10-37 2. The state controller shall not transfer any money from the

10-38 appropriation made by subsection 1 to the office of rural health until

10-39 $50,000,000 is distributed to the State of Nevada as a result of settlement

10-40 agreements in November 1998 with tobacco companies, 50 percent of

10-41 which is deposited in the trust fund for health programs.

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

11-2 appoint to the advisory board for the prevention and reduction of the use of

11-3 cigarettes and other products made from tobacco created pursuant to

11-4 section 10 of this act:

11-5 1. One member who represents a nonprofit organization dedicated to

11-6 reducing health care problems related to the use of tobacco, one member

11-7 who represents the general public and one member with expertise in the

11-8 field of education, whose terms expire on July 1, 2001.

11-9 2. One member who represents a nonprofit organization dedicated to

11-10 reducing health care problems related to the use of tobacco, one member

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

11-12 board of health and one member who has expertise in the field of health

11-13 care and the effects of the use of tobacco, whose terms expire on July 1,

11-14 2003.

11-15 Sec. 34. The amendatory provisions of this act do not apply to

11-16 offenses that were committed before July 1, 1999.

11-17 Sec. 35. This act becomes effective on July 1, 1999.