Assembly Bill No. 504–Committee on
Health and Human Services

 

March 24, 2003

____________

 

Referred to Committee on Health and Human Services

 

SUMMARY—Makes various changes concerning provision of health care services in this state. (BDR 38‑1207)

 

FISCAL NOTE:  Effect on Local Government: No.

                           Effect on the State: Yes.

 

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to health care; requiring the Department of Human Resources to apply to the Federal Government to establish a program to extend coverage for prescription drugs and other related services for certain persons; making various changes concerning the allocation of the money in the Fund for a Healthy Nevada; 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

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

1-3  Sec. 2.  1.  The Director shall apply to the Federal

1-4  Government for a Medicaid waiver to extend coverage for

1-5  prescription drugs and other related services to persons 65 years of

1-6  age or older who are not eligible for pharmacy benefits pursuant

1-7  to Medicaid and whose incomes are not more than 200 percent of

1-8  the federally designated level signifying poverty.

1-9  2.  The Director shall fully cooperate in good faith with the

1-10  Federal Government during the application process to satisfy the

1-11  requirements of the Federal Government for obtaining a Medicaid

1-12  waiver pursuant to this section, including, without limitation:

1-13      (a) Providing any necessary information requested by the

1-14  Federal Government in a timely manner;

2-1  (b) Responding promptly and thoroughly to any questions or

2-2  concerns of the Federal Government concerning the application;

2-3  and

2-4  (c) Working with the Federal Government to amend any

2-5  necessary provisions of the application to satisfy the requirements

2-6  for approval of the application.

2-7  3.  The Director may:

2-8  (a) Administer a program established pursuant to this section

2-9  through the Division of Health Care Financing and Policy; or

2-10      (b) Hire a pharmacy benefits manager by contract to

2-11  administer a program established pursuant to this section.

2-12      4.  Not more than 10 percent of the money received by the

2-13  Department to implement a program established pursuant to this

2-14  section may be used for administrative expenses or other indirect

2-15  costs.

2-16      5.  The Director shall submit a quarterly report concerning a

2-17  program established pursuant to this section to the Interim

2-18  Finance Committee and the Legislative Committee on Health

2-19  Care.

2-20      Sec. 3.  1.  Except as otherwise provided in this subsection,

2-21  the Director may apply to the Federal Government for a Medicaid

2-22  waiver to extend coverage for prescription drugs and other related

2-23  services to persons with disabilities who have been determined to

2-24  be eligible for disability benefits from the federal social security

2-25  system, who are not eligible for pharmacy benefits pursuant to

2-26  Medicaid and whose incomes are not more than 200 percent of the

2-27  federally designated level signifying poverty. The Director shall

2-28  not apply for a waiver pursuant to this subsection unless the

2-29  Director and the Interim Finance Committee have determined that

2-30  sufficient funds are available in this state to implement the waiver.

2-31      2.  If the Federal Government approves a Medicaid waiver

2-32  which the Director applied for pursuant to subsection 1, the

2-33  Director shall adopt regulations to implement the waiver and

2-34  establish a program in accordance with the waiver, including,

2-35  without limitation, regulations setting forth criteria of eligibility,

2-36  the services covered by the program, the amount of any copayment

2-37  for which a person who receives services pursuant to the program

2-38  is responsible and any limitation on the number of persons who

2-39  may receive services pursuant to the program.

2-40      3.  The Director may:

2-41      (a) Administer a program established pursuant to this section

2-42  through the Division of Health Care Financing and Policy; or

2-43      (b) Hire a pharmacy benefits manager by contract to

2-44  administer a program established pursuant to this section.

3-1  4.  Not more than 10 percent of the money received by the

3-2  Department to implement a program established pursuant to this

3-3  section may be used for administrative expenses or other indirect

3-4  costs.

3-5  5.  The Director shall submit a quarterly report concerning:

3-6  (a) The progress of the Director toward applying for a waiver

3-7  pursuant to subsection 1 and establishing a program in

3-8  accordance with such a waiver that has been approved by the

3-9  Federal Government; and

3-10      (b) Any program established pursuant to this section,

3-11  to the Interim Finance Committee and the Legislative Committee

3-12  on Health Care.

3-13      Sec. 4.  NRS 422.240 is hereby amended to read as follows:

3-14      422.240  1.  Money to carry out the provisions of NRS

3-15  422.001 to 422.410, inclusive, and sections 2 and 3 of this act, and

3-16  422.580, including, without limitation, any federal money allotted to

3-17  the State of Nevada pursuant to the program to provide Temporary

3-18  Assistance for Needy Families and the Program for Child Care and

3-19  Development, must , except as otherwise provided in NRS 439.630,

3-20  be provided by appropriation by the Legislature from the State

3-21  General Fund.

3-22      2.  Disbursements for the purposes of NRS 422.001 to 422.410,

3-23  inclusive, and sections 2 and 3 of this act, and 422.580 must ,

3-24  except as otherwise provided in NRS 439.630, be made upon claims

3-25  duly filed, audited and allowed in the same manner as other money

3-26  in the State Treasury is disbursed.

3-27      Sec. 5.  NRS 218.6827 is hereby amended to read as follows:

3-28      218.6827 1.  Except as otherwise provided in subsections 2

3-29  and 3, the Interim Finance Committee may exercise the powers

3-30  conferred upon it by law only when the Legislature is not in regular

3-31  or special session.

3-32      2.  During a regular session, the Interim Finance Committee

3-33  may also perform the duties imposed on it by subsection 5 of NRS

3-34  284.115, subsection 2 of NRS 321.335, NRS 322.007, subsection 2

3-35  of NRS 323.020, NRS 323.050, subsection 1 of NRS 323.100, NRS

3-36  353.220, 353.224, 353.2705 to 353.2771, inclusive, and 353.335,

3-37  paragraph (b) of subsection 4 of NRS 407.0762 and NRS 428.375,

3-38  439.620, 439.630, 445B.830 and 538.650 [.] and subsection 1 of

3-39  section 3 of this act. In performing those duties, the Senate Standing

3-40  Committee on Finance and the Assembly Standing Committee on

3-41  Ways and Means may meet separately and transmit the results of

3-42  their respective votes to the Chairman of the Interim Finance

3-43  Committee to determine the action of the Interim Finance

3-44  Committee as a whole.

4-1  3.  During a regular or special session, the Interim Finance

4-2  Committee may exercise the powers and duties conferred upon it

4-3  pursuant to the provisions of NRS 353.2705 to 353.2771, inclusive.

4-4  4.  If the Interim Finance Committee determines that a

4-5  fundamental review of the base budget of a state agency is

4-6  necessary, it shall, by resolution, notify the Legislative Commission

4-7  of that finding for assignment of the review to a legislative

4-8  committee for the fundamental review of the base budgets of state

4-9  agencies established pursuant to NRS 218.5382.

4-10      Sec. 6.  NRS 439.620 is hereby amended to read as follows:

4-11      439.620  1.  The Fund for a Healthy Nevada is hereby created

4-12  in the State Treasury. The State Treasurer shall deposit in the Fund:

4-13      (a) Fifty percent of all money received by this state pursuant to

4-14  any settlement entered into by the State of Nevada and a

4-15  manufacturer of tobacco products; and

4-16      (b) Fifty percent of all money recovered by this state from a

4-17  judgment in a civil action against a manufacturer of tobacco

4-18  products.

4-19      2.  The State Treasurer shall administer the Fund. As

4-20  administrator of the Fund, the State Treasurer:

4-21      (a) Shall maintain the financial records of the Fund;

4-22      (b) Shall invest the money in the Fund as the money in other

4-23  state funds is invested;

4-24      (c) Shall manage any account associated with the Fund;

4-25      (d) Shall maintain any instruments that evidence investments

4-26  made with the money in the Fund;

4-27      (e) May contract with vendors for any good or service that is

4-28  necessary to carry out the provisions of this section; and

4-29      (f) May perform any other duties necessary to administer the

4-30  Fund.

4-31      3.  The interest and income earned on the money in the Fund

4-32  must, after deducting any applicable charges, be credited to the

4-33  Fund. All claims against the Fund must be paid as other claims

4-34  against the State are paid.

4-35      4.  Upon receiving a request from the State Treasurer or the

4-36  Department for an allocation for administrative expenses from the

4-37  Fund pursuant to this section, the Task Force for the Fund for a

4-38  Healthy Nevada shall consider the request within 45 days after

4-39  receipt of the request. If the Task Force approves the amount

4-40  requested for allocation, the Task Force shall notify the State

4-41  Treasurer of the allocation. If the Task Force does not approve the

4-42  requested allocation within 45 days after receipt of the request, the

4-43  State Treasurer or the Department, as applicable, may submit its

4-44  request for allocation to the Interim Finance Committee. Except as

4-45  otherwise limited by this subsection, the Interim Finance Committee

5-1  may allocate all or part of the money so requested. The annual

5-2  allocation for administrative expenses from the Fund, whether

5-3  allocated by the Task Force or the Interim Finance Committee must

5-4  not exceed:

5-5  (a) Not more than 2 percent of the money in the Fund, as

5-6  calculated pursuant to this subsection, each year to pay the costs

5-7  incurred by the State Treasurer to administer the Fund; and

5-8  (b) Not more than 3 percent of the money in the Fund, as

5-9  calculated pursuant to this subsection, each year to pay the costs

5-10  incurred by the Department, including, without limitation, the Aging

5-11  Services Division of the Department, to carry out its duties set forth

5-12  in NRS 439.625 to 439.690, inclusive.

5-13  For the purposes of this subsection, the amount of money available

5-14  for allocation to pay for the administrative costs must be calculated

5-15  at the beginning of each fiscal year based on the total amount of

5-16  money anticipated by the State Treasurer to be deposited in the Fund

5-17  during that fiscal year.

5-18      5.  The money in the Fund remains in the Fund and does not

5-19  revert to the State General Fund at the end of any fiscal year.

5-20      6.  All money that is deposited or paid into the Fund is hereby

5-21  appropriated to the Department and, except as otherwise provided in

5-22  paragraphs (c) , [and] (d) and (h) of subsection 1 of NRS 439.630,

5-23  may only be expended pursuant to an allocation made by the Task

5-24  Force for the Fund for a Healthy Nevada. Money expended from the

5-25  Fund for a Healthy Nevada must not be used to supplant existing

5-26  methods of funding that are available to public agencies.

5-27      Sec. 7.  NRS 439.630 is hereby amended to read as follows:

5-28      439.630  1.  The Task Force for the Fund for a Healthy

5-29  Nevada shall:

5-30      (a) Conduct public hearings to accept public testimony from a

5-31  wide variety of sources and perspectives regarding existing or

5-32  proposed programs that:

5-33          (1) Promote public health;

5-34          (2) Improve health services for children, senior citizens and

5-35  persons with disabilities;

5-36          (3) Reduce or prevent the use of tobacco;

5-37          (4) Reduce or prevent the abuse of and addiction to alcohol

5-38  and drugs; and

5-39          (5) Offer other general or specific information on health care

5-40  in this state.

5-41      (b) Establish a process to evaluate the health and health needs of

5-42  the residents of this state and a system to rank the health problems

5-43  of the residents of this state, including, without limitation, the

5-44  specific health problems that are endemic to urban and rural

5-45  communities.

6-1  (c) Reserve not more than 30 percent of all revenues deposited

6-2  in the Fund for a Healthy Nevada each year for direct expenditure

6-3  by the Department to pay for prescription drugs and pharmaceutical

6-4  services for senior citizens pursuant to NRS 439.635 to 439.690,

6-5  inclusive[.] , and to fund in whole or in part any program

6-6  established pursuant to section 2 or 3 of this act. From the money

6-7  reserved to the Department pursuant to this paragraph, the

6-8  Department [shall] may subsidize all of the cost of policies of health

6-9  insurance that provide coverage to senior citizens for prescription

6-10  drugs and pharmaceutical services pursuant to NRS 439.635 to

6-11  439.690, inclusive[.] , and fund in whole or in part any program

6-12  established pursuant to section 2 or 3 of this act. The Department

6-13  shall consider recommendations from the Task Force for the Fund

6-14  for a Healthy Nevada in carrying out the provisions of NRS 439.635

6-15  to 439.690, inclusive[.] , and administering any program

6-16  established pursuant to section 2 or 3 of this act. The Department

6-17  shall submit a quarterly report to the Governor, the Task Force for

6-18  the Fund for a Healthy Nevada and the Interim Finance Committee

6-19  regarding the general manner in which expenditures have been made

6-20  pursuant to this paragraph and the status of the program.

6-21      (d) Reserve not more than 30 percent of all revenues deposited

6-22  in the Fund for a Healthy Nevada each year for allocation by the

6-23  Aging Services Division of the Department in the form of grants for

6-24  existing or new programs that assist senior citizens with independent

6-25  living, including, without limitation, programs that provide:

6-26          (1) Respite care or relief of family caretakers;

6-27          (2) Transportation to new or existing services to assist senior

6-28  citizens in living independently; and

6-29          (3) Care in the home which allows senior citizens to remain

6-30  at home instead of in institutional care.

6-31  The Aging Services Division of the Department shall consider

6-32  recommendations from the Task Force for the Fund for a Healthy

6-33  Nevada concerning the independent living needs of senior citizens.

6-34      (e) Allocate for expenditure not more than 20 percent of all

6-35  revenues deposited in the Fund for a Healthy Nevada each year for

6-36  programs that prevent, reduce or treat the use of tobacco and the

6-37  consequences of the use of tobacco.

6-38      (f) Allocate for expenditure not more than [20] 10 percent of all

6-39  revenues deposited in the Fund for a Healthy Nevada each year for

6-40  programs that improve health services for children . [and]

6-41      (g) Allocate, by contract or grant, for expenditure not more

6-42  than 7.5 percent of all revenues deposited in the Fund for a

6-43  Healthy Nevada each year for programs that improve the health

6-44  and well-being of persons with disabilities.

7-1  [(g)] In making allocations pursuant to this paragraph, the

7-2  Task Force shall, to the extent practicable, allocate the money

7-3  evenly among the following three types of programs:

7-4       (1) Programs that provide respite for persons caring for

7-5  persons with disabilities;

7-6       (2) Programs that provide positive behavioral supports to

7-7  persons with disabilities; and

7-8       (3) Programs that assist persons with disabilities to live

7-9  safely and independently in their communities outside of an

7-10  institutional setting.

7-11      (h) Reserve not more than 2.5 percent of all revenues

7-12  deposited in the Fund for a Healthy Nevada each year for direct

7-13  expenditure by the Department to fund in whole or in part any

7-14  program established pursuant to section 3 of this act. The

7-15  Department shall consider recommendations from the Task Force

7-16  for the Fund for a Healthy Nevada in administering any program

7-17  established pursuant to section 3 of this act.

7-18      (i) Maximize expenditures through local, federal and private

7-19  matching contributions.

7-20      [(h)] (j) Ensure that any money expended from the Fund for a

7-21  Healthy Nevada will not be used to supplant existing methods of

7-22  funding that are available to public agencies.

7-23      [(i)] (k) Develop policies and procedures for the administration

7-24  and distribution of grants and other expenditures to state agencies,

7-25  political subdivisions of this state, nonprofit organizations,

7-26  universities and community colleges. A condition of any such grant

7-27  must be that not more than 8 percent of the grant may be used for

7-28  administrative expenses or other indirect costs. The procedures must

7-29  require at least one competitive round of requests for proposals per

7-30  fiscal year.

7-31      [(j)] (l) To make the allocations required by paragraphs (e) , (f)

7-32  and [(f):] (g):

7-33          (1) Prioritize and quantify the needs for these programs;

7-34          (2) Develop, solicit and accept grant applications for

7-35  allocations;

7-36          (3) Conduct annual evaluations of programs to which

7-37  allocations have been awarded; and

7-38          (4) Submit annual reports concerning the programs to the

7-39  Governor and the Interim Finance Committee.

7-40      [(k)] (m) Transmit a report of all findings, recommendations and

7-41  expenditures to the Governor and each regular session of the

7-42  Legislature.

7-43      2.  The Task Force may take such other actions as are necessary

7-44  to carry out its duties.

8-1  3.  The Department shall take all actions necessary to ensure

8-2  that all allocations for expenditures made by the Task Force are

8-3  carried out as directed by the Task Force.

8-4  4.  To make the allocations required by paragraph (d) of

8-5  subsection 1, the Aging Services Division of the Department shall:

8-6  (a) Prioritize and quantify the needs of senior citizens for these

8-7  programs;

8-8  (b) Develop, solicit and accept grant applications for allocations;

8-9  (c) As appropriate, expand or augment existing state programs

8-10  for senior citizens upon approval of the Interim Finance Committee;

8-11      (d) Award grants or other allocations;

8-12      (e) Conduct annual evaluations of programs to which grants or

8-13  other allocations have been awarded; and

8-14      (f) Submit annual reports concerning the grant program to the

8-15  Governor and the Interim Finance Committee.

8-16      5.  The Aging Services Division of the Department shall submit

8-17  each proposed grant which would be used to expand or augment an

8-18  existing state program to the Interim Finance Committee for

8-19  approval before the grant is awarded. The request for approval must

8-20  include a description of the proposed use of the money and the

8-21  person or entity that would be authorized to expend the money. The

8-22  Aging Services Division of the Department shall not expend or

8-23  transfer any money allocated to the Aging Services Division

8-24  pursuant to this section to subsidize any portion of the cost of

8-25  policies of health insurance that provide coverage to senior citizens

8-26  for prescription drugs and pharmaceutical services pursuant to NRS

8-27  439.635 to 439.690, inclusive[.] , or to pay for any program

8-28  established pursuant to section 2 or 3 of this act.

8-29      6.  The Department, on behalf of the Task Force, shall submit

8-30  each allocation proposed pursuant to paragraph (e) [or (f)] , (f) or

8-31  (g) of subsection 1 which would be used to expand or augment an

8-32  existing state program to the Interim Finance Committee for

8-33  approval before the grant is awarded. The request for approval must

8-34  include a description of the proposed use of the money and the

8-35  person or entity that would be authorized to expend the money.

8-36      Sec. 8.  NRS 439.665 is hereby amended to read as follows:

8-37      439.665  1.  The Department [shall] may enter into contracts

8-38  with private insurers who transact health insurance in this state to

8-39  arrange for the availability, at a reasonable cost, of policies of health

8-40  insurance that provide coverage to senior citizens for prescription

8-41  drugs and pharmaceutical services.

8-42      2.  Within the limits of the money available for this purpose in

8-43  the Fund for a Healthy Nevada, a senior citizen who is not eligible

8-44  for Medicaid and who [purchases] is issued a policy of health

8-45  insurance that is made available pursuant to subsection 1 is entitled

9-1  to an annual grant from the Trust Fund to subsidize the cost of that

9-2  insurance, including premiums and deductibles, if he has been

9-3  domiciled in this state for at least 1 year immediately preceding the

9-4  date of his application and his household income is not over

9-5  $21,500.

9-6  3.  The subsidy granted pursuant to this section must not exceed

9-7  the annual cost of insurance that provides coverage for prescription

9-8  drugs and pharmaceutical services, including premiums and

9-9  deductibles.

9-10      4.  A policy of health insurance that is made available pursuant

9-11  to subsection 1 must provide for:

9-12      (a) A copayment of not more than $10 per prescription drug or

9-13  pharmaceutical service that is generic as set forth in the formulary of

9-14  the insurer; and

9-15      (b) A copayment of not more than $25 per prescription drug or

9-16  pharmaceutical service that is preferred as set forth in the formulary

9-17  of the insurer.

9-18      5.  The Department may waive the eligibility requirement set

9-19  forth in subsection 2 regarding household income upon written

9-20  request of the applicant if the circumstances of the applicant’s

9-21  household have changed as a result of:

9-22      (a) Illness;

9-23      (b) Disability; or

9-24      (c) Extreme financial hardship based on a significant reduction

9-25  of income, when considering the applicant’s current financial

9-26  circumstances.

9-27  An applicant who requests such a waiver shall include with that

9-28  request all medical and financial documents that support his request.

9-29      6.  If the Federal Government provides any coverage of

9-30  prescription drugs and pharmaceutical services for senior citizens

9-31  who are eligible for a subsidy pursuant to subsections 1 to 5,

9-32  inclusive, the Department may, upon approval of the Legislature, or

9-33  the Interim Finance Committee if the Legislature is not in session,

9-34  change any program established pursuant to NRS 439.635 to

9-35  439.690, inclusive, and otherwise provide assistance with

9-36  prescription drugs and pharmaceutical services for senior citizens

9-37  within the limits of the money available for this purpose in the Fund

9-38  for a Healthy Nevada.

9-39      7.  The provisions of subsections 1 to 5, inclusive, do not apply

9-40  if the Department provides assistance with prescription drugs and

9-41  pharmaceutical services for senior citizens pursuant to subsection 6.

9-42      Sec. 9.  Any money allocated pursuant to subsection 1 of NRS

9-43  439.630 before July 1, 2004, for programs that improve the health

9-44  and well-being of persons with disabilities that is unspent and is

9-45  returned to the Department of Human Resources may be expended

10-1  by the Department to fund any program established pursuant to

10-2  section 3 of this act.

10-3      Sec. 10.  1.  Except as otherwise provided in subsection 2, the

10-4  provisions of this act become effective on October 1, 2003.

10-5      2.  The amendatory provisions of section 7 of this act which

10-6  require the Task Force for the Fund for a Healthy Nevada to allocate

10-7  for expenditure not more than 10 percent of all revenues deposited

10-8  in the Fund for a Healthy Nevada each year for programs that

10-9  improve health services for children, to allocate for expenditure not

10-10  more than 7.5 percent of all revenues deposited in the Fund each

10-11  year for programs that improve the health and well-being of persons

10-12  with disabilities, and to reserve not more than 2.5 percent of all

10-13  revenues deposited in the Fund each year for direct expenditure by

10-14  the Department of Human Resources to fund any program

10-15  established pursuant to section 3 of this act become effective on

10-16  July 1, 2004.

 

10-17  H