2005 Nevada Revised Statutes - Chapter 422 — Health Care Financing and Policy

Title 38 - PUBLIC WELFARE

CHAPTER 422 - HEALTH CARE FINANCING ANDPOLICY

GENERAL PROVISIONS

NRS 422.001 Definitions.

NRS 422.003 Administratordefined.

NRS 422.010 Boarddefined. [Repealed.]

NRS 422.021 ChildrensHealth Insurance Program defined.

NRS 422.030 Departmentdefined.

NRS 422.040 Directordefined.

NRS 422.041 Divisiondefined.

NRS 422.042 FoodStamp Assistance defined.

NRS 422.045 Low-IncomeHome Energy Assistance defined.

NRS 422.046 Medicaiddefined.

NRS 422.048 Programfor Child Care and Development defined.

NRS 422.049 Programfor the Enforcement of Child Support defined. [Repealed.]

NRS 422.050 Publicassistance defined.

NRS 422.0525 StateSupplementary Assistance defined.

NRS 422.053 SupplementalSecurity Income Program defined.

NRS 422.0535 TemporaryAssistance for Needy Families defined.

NRS 422.054 Undividedestate defined.

NRS 422.055 WelfareDivision defined. [Repealed.]

NRS 422.061 Purposesof Division.

NRS 422.065 Eligibilityof aliens for state or local public benefits.

STATE WELFARE BOARD

NRS 422.070 Creation;appointment of members. [Repealed.]

NRS 422.080 Qualificationsand removal of members. [Repealed.]

NRS 422.110 Meetings;quorum; notice of meetings; minutes. [Repealed.]

NRS 422.120 Officers.[Repealed.]

NRS 422.130 Compensationof members and employees. [Repealed.]

NRS 422.140 Powersand duties. [Repealed.]

MEDICAL CARE ADVISORY GROUP

NRS 422.151 Creation;function.

NRS 422.153 Composition;terms and compensation of members.

NRS 422.155 Chairman;Secretary; meetings; subcommittees.

STATE WELFARE ADMINISTRATOR

NRS 422.160 Qualifications.[Repealed.]

NRS 422.180 ExecutiveOfficer of Welfare Division; administration and management of Welfare Division.[Repealed.]

NRS 422.190 Reports.[Repealed.]

NRS 422.200 Fiscalduties. [Repealed.]

NRS 422.210 Organizationof Welfare Division; appointment of heads of sections; employees; standards ofservice. [Repealed.]

NRS 422.215 Administrationof oaths by State Welfare Administrator and Director of Department of HumanResources; testimony of witnesses; subpoenas. [Repealed.]

NRS 422.222 Regulations:Authority to adopt. [Repealed.]

NRS 422.224 Regulations:Procedure for adoption, amendment or repeal. [Repealed.]

NRS 422.230 Generaland miscellaneous powers and duties. [Repealed.]

ADMINISTRATOR OF DIVISION OF HEALTH CARE FINANCING AND POLICY

NRS 422.2352 Administratordefined. [Repealed.]

NRS 422.2354 Qualifications.

NRS 422.2356 ExecutiveOfficer of Division; administration and management of Division.

NRS 422.2358 Reports.

NRS 422.2362 Fiscalduties.

NRS 422.2364 Organizationof Division; appointment of heads of sections; employees; standards of service.

NRS 422.2366 Administrationof oaths; testimony of witnesses; subpoenas.

NRS 422.2368 Adoptionof regulations.

NRS 422.2369 Procedurefor adopting, amending or repealing regulations.

NRS 422.2372 Generaland miscellaneous powers and duties.

NRS 422.2374 Cooperationwith Medicaid Fraud Control Unit; suspension or exclusion of provider of goodsor services under State Plan for Medicaid.

ADMINISTRATION AND PROCEDURE

NRS 422.240 Legislativeappropriations; disbursements.

NRS 422.245 Depositof money received for certain programs in appropriate accounts of Division in StateGeneral Fund.

NRS 422.260 Acceptanceof Social Security Act and federal money.

NRS 422.265 Acceptanceof increased benefits of future congressional legislation; regulations.

NRS 422.267 Contractor agreement with Federal Government by Director.

NRS 422.270 Dutiesof Department regarding welfare activities and services.

NRS 422.2705 Contractsfor provision of certain transportation services for recipients of Medicaid andrecipients of services pursuant to Childrens Health Insurance Program.

NRS 422.2708 Amendmentof home and community-based services waiver to include as medical assistanceunder Medicaid funding of assisted living supportive services for seniorcitizens who reside in certain assisted living facilities.

NRS 422.271 Stateplans for certain programs: Development, adoption and revision by Director;Division required to comply.

NRS 422.2715 Establishmentof program to provide medical assistance to certain employed persons havingdisabilities.

NRS 422.2716 Provisionof public assistance to qualified aliens.

NRS 422.2717 StatePlan for Medicaid: Inclusion of requirement that independent foster careadolescents are eligible for Medicaid.

NRS 422.272 StatePlan for Medicaid: Inclusion of requirement for payment of certain costs.

NRS 422.2726 Applicationfor Medicaid waiver pursuant to Health Insurance Flexibility and Accountabilitydemonstration initiative; consideration of recommendations from certainentities.

NRS 422.2727 Requirementsof application for Medicaid waiver pursuant to Health Insurance Flexibility andAccountability demonstration initiative.

NRS 422.2728 Establishmentof program to carry out Medicaid waiver pursuant to Health InsuranceFlexibility and Accountability demonstration initiative; regulations; reports.

NRS 422.2729 Fundingof program to carry out Medicaid waiver pursuant to Health InsuranceFlexibility and Accountability demonstration initiative.

NRS 422.273 Establishment,development and implementation of Medicaid managed care program.

NRS 422.274 Medicaidwaiver to extend coverage for prescription drugs to certain older persons;limitation on administrative expenses; report. [Repealed.]

NRS 422.2745 Medicaidwaiver to extend coverage for prescription drugs to certain persons withdisabilities; limitation on administrative expenses; report. [Repealed.]

NRS 422.2748 Cooperationwith Medicaid Fraud Control Unit.

NRS 422.275 Legaladvisers for Division.

NRS 422.276 Appealto Department by applicant for or recipient of public assistance or services;notice of initial decision; hearing.

NRS 422.277 Hearing:Rights of parties; informal disposition; record; transcribing of oralproceedings; findings of fact; limitation on participation of employee orrepresentative of Department in decision.

NRS 422.2775 Hearing:Evidence.

NRS 422.278 Hearings:Person with disability entitled to services of interpreter.

NRS 422.2785 Contentsand delivery of decision or order of hearing officer; petition for judicialreview; filing of decision and record with court.

NRS 422.279 Judicialreview: Taking of additional evidence; limitations on review; grounds for reversal;appeal to Supreme Court.

NRS 422.280 Formsof reports and records to be kept by persons subject to supervision orinvestigation by Division.

NRS 422.284 Familyplanning service; birth control.

NRS 422.287 Provisionof prenatal care to pregnant women who are indigent; provision of informationconcerning availability of prenatal care; regulations.

NRS 422.288 Enrollmentof eligible Indian children in Childrens Health Insurance Program: Duty ofDepartment to seek assistance of and cooperate with Indian tribes; immediateaction required; certain contracts for provision of services required.

NRS 422.290 Custody,use, preservation and confidentiality of records, files and communicationsconcerning applicants for and recipients of public assistance or assistancepursuant to Childrens Health Insurance Program.

NRS 422.291 Assistancenot assignable or subject to process or bankruptcy law.

NRS 422.292 Assistancesubject to future amending and repealing acts.

NRS 422.293 Departmentsubrogated to rights of recipient of Medicaid or recipient of insuranceprovided pursuant to Childrens Health Insurance Program; lien on proceeds ofrecovery.

NRS 422.29301 Administrationof provisions concerning recovery of assistance paid to recipient of publicassistance.

NRS 422.29302 Recoveryof benefits paid for Medicaid: Powers and duties of Department; claim againstestate of recipient; regulations; distribution of money recovered; payment incash.

NRS 422.29304 Recoveryof benefits paid for public assistance if person failed to report certaininformation: Powers and duties of Department; duty to reimburse Department;waiver of repayment.

NRS 422.29306 Impositionand release of lien on property of recipient of Medicaid.

NRS 422.29308 Applicationfor Medicaid: Statements regarding action for recovery and civil liability ofrecipient.

NRS 422.2931 Administrativeduties. [Repealed.]

NRS 422.29312 Giftsand grants of money: Deposit in Welfare Divisions Gift and CooperativeAccount; use. [Repealed.]

NRS 422.29316 Eligibilityfor certain public assistance of person convicted of felony involvingpossession, use or distribution of controlled substance. [Repealed.]

NRS 422.29318 Identificationand referral of victims of domestic violence; restricted disclosure ofdetermination. [Repealed.]

NRS 422.2932 Recipientsof public assistance: Immunization of dependent children. [Repealed.]

NRS 422.29322 Recipientsof public assistance: Attendance of children at school and assistance withtheir academic performance. [Repealed.]

NRS 422.29324 Prohibitionagainst denial, reduction, discontinuance or termination of public assistancein violation of federal requirements. [Repealed.]

NRS 422.301 Administrativeduties of Administrator and Division.

NRS 422.302 Giftsand grants of money to Division: Deposit in Gift and Cooperative Account of theDivision of Health Care Financing and Policy; use; approval of claims byAdministrator.

NRS 422.303 Reimbursementof registered nurse for certain services provided to person eligible forMedicaid.

NRS 422.304 Reimbursementfor services for hospice care provided to person eligible for Medicaid.

NRS 422.3045 Denialof application for Childrens Health Insurance Program: Notice; review of caseand hearing; regulations; review by court.

NRS 422.305 Confidentialityof information obtained in investigation of provider of services under StatePlan for Medicaid.

NRS 422.306 Hearingto review action taken against provider of services under State Plan forMedicaid; regulations; appeal of final decision.

FINANCIAL RESPONSIBILITY OF RELATIVES

NRS 422.310 Liabilityof spouse for spouse or parent for minor child. [Repealed.]

NRS 422.330 Writtenstatement by responsible relative; perjury. [Repealed.]

NRS 422.340 Enforcementof support by legal action. [Repealed.]

NRS 422.350 Liabilityof relative not grounds for denying or discontinuing public assistance;acceptance of assistance constitutes consent by recipient to suit againstresponsible relative. [Repealed.]

MEDICAID CARDS

NRS 422.361 Definitions.

NRS 422.362 Cardholderdefined.

NRS 422.363 Medicaidcard defined.

NRS 422.364 Plandefined.

NRS 422.365 Receivesdefined.

NRS 422.366 Unlawfulacts: Obtaining or possessing card without consent of holder of card;presumption from possession of card; penalty.

NRS 422.367 Unlawfulacts: Sale or purchase of card; authorization by holder of card for use byperson not entitled to use card; penalty.

NRS 422.368 Unlawfulacts: Use of forged, expired or revoked card to obtain benefits; receipt ofbenefits by misrepresentation; penalty.

NRS 422.369 Unlawfulacts: Fraud by person authorized to provide care to holder of card; penalty.

PROGRAM TO PROVIDE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES

NRS 422.371 Definitions.[Repealed.]

NRS 422.3712 Benefitdefined. [Repealed.]

NRS 422.3714 Headof a household defined. [Repealed.]

NRS 422.3716 Householddefined. [Repealed.]

NRS 422.3718 Programdefined. [Repealed.]

NRS 422.372 Powersand duties of State Welfare Administrator. [Repealed.]

NRS 422.3722 Assessmentof members of applicants household required before provision of benefits;referrals for mental health services. [Repealed.]

NRS 422.3724 Planfor personal responsibility of household: Establishment; contents; execution;expiration; review; amendment. [Repealed.]

NRS 422.3726 Agreementof cooperation: Establishment; execution; contents. [Repealed.]

NRS 422.3728 Periodfor action on application for benefits. [Repealed.]

NRS 422.3732 Performanceof work by head of household: Requirement; failure to comply; regulations.[Repealed.]

NRS 422.3734 Exemptionof head of household from requirement to complete program of job training;exceptions. [Repealed.]

NRS 422.3736 Failureto comply with plan for personal responsibility or agreement of cooperation:Notification of head of household; reduction or termination of benefits;regulations. [Repealed.]

NRS 422.3738 Compliancewith federal prohibitions on receipt of benefits. [Repealed.]

NRS 422.374 Limitationson periods for receipt of benefits; exceptions; denial or suspension ofbenefits to comply with federal limitation. [Repealed.]

NRS 422.3742 Provisionof transitional assistance to head of household. [Repealed.]

NRS 422.3744 Paymentof certain expenses of applicant determined not to be in need of long-termbenefits. [Repealed.]

NRS 422.3746 Programto promote self-sufficiency of certain parents: Establishment; participation.[Repealed.]

NRS 422.3748 Encouragementof employment opportunities. [Repealed.]

NRS 422.3752 Enforcementof court orders for support of children against parents of certain noncustodialparents. [Repealed.]

NRS 422.3754 Waiverof requirements of chapter for certain victims of domestic violence.[Repealed.]

ASSESSMENT OF FEES ON NURSING FACILITIES TO INCREASE QUALITYOF NURSING CARE

NRS 422.3755 Definitions.

NRS 422.376 Facilityfor intermediate care defined.

NRS 422.3765 Facilityfor skilled nursing defined.

NRS 422.3771 Nursingfacility defined.

NRS 422.3775 Paymentof fee; amount of fee; allowable cost for Medicaid reimbursement purposes.

NRS 422.378 Reportby nursing facility to Division.

NRS 422.3785 Creationof Fund to Increase the Quality of Nursing Care; deposit of money for credit toFund; expenditures from Fund; consequence of federal law prohibiting certainexpenditures from Fund.

NRS 422.379 Administrativepenalties for late payment of fee.

PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENTPATIENTS

NRS 422.380 Definitions.

NRS 422.3805 Federalwaivers: Duties of Administrator.

NRS 422.3807 Divisionto determine certain information concerning uncompensated care percentages ofhospitals in larger counties; hospitals to provide information to Division;reports.

NRS 422.382 Transferto Division of percentage of amount of payment to hospital.

NRS 422.385 Allocationsand payments from Medicaid Budget Account; transfer of money fromIntergovernmental Transfer Account.

NRS 422.387 Allocationfor administrative costs; payments to hospitals.

NRS 422.390 Regulations;quarterly report.

PROGRAM TO ASSIST RELATIVES WHO HAVE LEGAL GUARDIANSHIP OFCHILDREN

NRS 422.392 Establishmentand administration of program; qualifications for participation in program;assistance provided by program; adoption of regulations. [Repealed.]

PROGRAM TO PROVIDE COMMUNITY-BASED SERVICES TO PERSONS WITHPHYSICAL DISABILITIES

NRS 422.395 Personwith a physical disability defined.

NRS 422.396 Establishmentand administration of program; application for federal waiver to amend StatePlan for Medicaid; contracting for services; adoption of regulations.

NRS 422.397 Reportsby Director.

PRESCRIPTION DRUGS

NRS 422.401 Definitions.

NRS 422.4015 Committeedefined.

NRS 422.402 DrugUse Review Board defined.

NRS 422.4025 Listof preferred prescription drugs used for Medicaid program; list of drugsexcluded from restrictions; role of Pharmacy and Therapeutics Committee;availability of new pharmaceutical products and products for which there is newevidence.

NRS 422.403 Establishmentand management of use by Medicaid program of step therapy and priorauthorization; duties of Drug Use Review Board; acceptance of recommendationsfrom Board.

NRS 422.4035 Pharmacyand Therapeutics Committee: Creation; membership.

NRS 422.404 Pharmacyand Therapeutics Committee: Chairman; terms; vacancies; meetings; quorum.

NRS 422.4045 Pharmacyand Therapeutics Committee: Members serve without compensation; membersentitled to per diem; members holding public office or employed by governmentalentity.

NRS 422.405 Pharmacyand Therapeutics Committee: Duties and powers.

NRS 422.4055 AdvisoryCommittee to the Pharmacy and Therapeutics Committee and the Drug Use ReviewBoard: Creation; membership; Chairman; terms; vacancies; members serve withoutcompensation; members entitled to per diem; members holding public office oremployed by governmental entity.

NRS 422.406 Regulations;contracts for services.

UNLAWFUL ACTS; PENALTIES

General Provisions

NRS 422.410 Fraudulentacts; penalties.

 

State Plan for Medicaid

NRS 422.450 Definitions.

NRS 422.460 Benefitdefined.

NRS 422.470 Claimdefined.

NRS 422.480 Plandefined.

NRS 422.490 Providerdefined.

NRS 422.500 Recipientdefined.

NRS 422.510 Recordsdefined.

NRS 422.520 Signdefined.

NRS 422.525 Statementor representation defined.

NRS 422.530 Responsibilityfor false claim, statement or representation.

NRS 422.540 Offensesregarding false claims, statements or representations; penalties.

NRS 422.550 Statementregarding truth and accuracy of applications, reports and invoices; perjury;presumption concerning person who signs statement on behalf of provider.

NRS 422.560 Offensesregarding sale, purchase or lease of goods, services, materials or supplies;penalty.

NRS 422.570 Intentionalfailure to maintain adequate records; intentional destruction of records;penalties.

NRS 422.580 Civilpenalties for certain violations; liability of provider for excess amountunknowingly accepted; enforcement; use of money collected as penalty orrepayment.

NRS 422.590 Limitationand accrual of actions.

MISCELLANEOUS PROVISIONS

NRS 422.600 Jobdevelopment coordinators: Employment by Department of Employment, Training andRehabilitation; duties. [Repealed.]

_________

GENERAL PROVISIONS

NRS 422.001 Definitions. As used in this chapter, unless the context otherwiserequires, the words and terms defined in NRS422.003 to 422.054, inclusive, havethe meanings ascribed to them in those sections.

(Added to NRS by 1993, 2057; A 1995, 2566; 1997,1237, 2232, 2615; 1999,581, 1426, 2242; 2001, 161; 2005, 22nd SpecialSession, 21)

NRS 422.003 Administratordefined. Administrator means the Administratorof the Division.

(Added to NRS by 2005, 22nd SpecialSession, 21)

NRS 422.010 Boarddefined. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.010 for similar reenactedprovisions.)

 

NRS 422.021 ChildrensHealth Insurance Program defined. ChildrensHealth Insurance Program means the program established pursuant to 42 U.S.C. 1397aa to 1397jj, inclusive, to provide health insurance for uninsuredchildren from low-income families in this state.

(Added to NRS by 1999, 1426)

NRS 422.030 Departmentdefined. Department means the Department ofHealth and Human Services.

[Part 2:327:1949; 1943 NCL 5146.02](NRS A 1963,902; 1967, 1153; 1973, 1406; 1993, 2059; 2005, 22nd SpecialSession, 21)

NRS 422.040 Directordefined. Director means the Director of theDepartment.

[Part 2:327:1949; 1943 NCL 5146.02](NRS A 1963,902; 1967, 1153; 1973, 1406; 1993, 2059)

NRS 422.041 Divisiondefined. Division means the Division ofHealth Care Financing and Policy of the Department.

(Added to NRS by 1997, 2612; A 1999, 2242; 2005, 22nd SpecialSession, 21)

NRS 422.042 FoodStamp Assistance defined. Food StampAssistance means the program established to provide persons of low income withan opportunity to obtain a more nutritious diet through the issuance of couponspursuant to the Food Stamp Act of 1977, as amended (7 U.S.C. 2011 et seq.).

(Added to NRS by 1993, 2057)

NRS 422.045 Low-IncomeHome Energy Assistance defined. Low-IncomeHome Energy Assistance means the program established to assist persons of lowincome to meet the costs of heating and cooling their homes pursuant to theLow-Income Home Energy Assistance Act of 1981, as amended (42 U.S.C. 8621 etseq.).

(Added to NRS by 1993, 2057)

NRS 422.046 Medicaiddefined. Medicaid has the meaning ascribedto it in NRS 439B.120.

(Added to NRS by 1997, 1236)

NRS 422.048 Program for Child Care and Development defined. Program for Child Care and Development means theprogram established to provide assistance for the care and development ofchildren pursuant to 42 U.S.C. 9858 et seq.

(Added to NRS by 1997, 2224)

NRS 422.049 Programfor the Enforcement of Child Support defined. Repealed.(See chapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.060 for similar reenactedprovisions.)

 

NRS 422.050 Publicassistance defined.

1. Public assistance includes:

(a) State Supplementary Assistance;

(b) Temporary Assistance for Needy Families;

(c) Medicaid;

(d) Food Stamp Assistance;

(e) Low-Income Home Energy Assistance;

(f) The Program for Child Care and Development; and

(g) Benefits provided pursuant to any other publicwelfare program administered by the Division pursuant to such additionalfederal legislation as is not inconsistent with the purposes of this chapter.

2. The term does not include the Childrens HealthInsurance Program.

[Part 12a:327:1949; added 1951, 296; A 1953,333](NRS A 1959, 518; 1975, 1007; 1981, 1909; 1993, 2059; 1995, 724; 1997,1237, 2233, 2615; 1999,581, 1426, 2242; 1999, 581, 1426, 2242; 2001, 161; 2005, 22nd SpecialSession, 21)

NRS 422.0525 StateSupplementary Assistance defined. State SupplementaryAssistance means the program established to provide state assistance to agedor blind persons in connection with the Supplemental Security Income Program.

(Added to NRS by 1981, 1907; A 1993, 2059)

NRS 422.053 SupplementalSecurity Income Program defined. SupplementalSecurity Income Program means the program established for aged, blind ordisabled persons pursuant to Title XVI of the Social Security Act (42 U.S.C. 1381 et seq.), as amended.

(Added to NRS by 1975, 1007; A 1993, 2059)

NRS 422.0535 TemporaryAssistance for Needy Families defined. TemporaryAssistance for Needy Families means the program established to providetemporary assistance for needy families pursuant to Title IV of the Social SecurityAct (42 U.S.C. 601 et seq.) and other provisions of that act relating totemporary assistance for needy families.

(Added to NRS by 1997, 2224)

NRS 422.054 Undividedestate defined. Undivided estate means allreal and personal property and other assets included in the estate of adeceased recipient of Medicaid and any other real and personal property andother assets in or to which he had an interest or legal title immediatelybefore or at the time of his death, to the extent of that interest or title.The term includes, without limitation, assets conveyed to a survivor, heir orassign of the deceased recipient through or as the result of any joint tenancy,tenancy in common, survivorship, life estate, living trust, annuity, declarationof homestead or other arrangement.

(Added to NRS by 1995, 2565; A 1997, 1237; 1999, 877; 2003, 872)

NRS 422.055 WelfareDivision defined. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.030 for similar reenactedprovisions.)

 

NRS 422.061 Purposesof Division. The purposes of the Division are:

1. To ensure that the Medicaid provided by this Stateand the insurance provided pursuant to the Childrens Health Insurance Programin this State are provided in the manner that is most efficient to this State.

2. To evaluate alternative methods of providingMedicaid and providing insurance pursuant to the Childrens Health InsuranceProgram.

3. To review Medicaid, the Childrens Health InsuranceProgram and other health programs of this State to determine the maximum amountof money that is available from the Federal Government for such programs.

4. To promote access to quality health care for allresidents of this State.

5. To restrain the growth of the cost of health carein this State.

(Added to NRS by 2005, 22nd SpecialSession, 21)

NRS 422.065 Eligibilityof aliens for state or local public benefits.

1. Notwithstanding any other provision of state orlocal law, a person or governmental entity that provides a state or localpublic benefit:

(a) Shall comply with the provisions of 8 U.S.C. 1621regarding the eligibility of an alien for such a benefit.

(b) Is not required to pay any costs or other expensesrelating to the provision of such a benefit after July 1, 1997, to an alienwho, pursuant to 8 U.S.C. 1621, is not eligible for the benefit.

2. Compliance with the provisions of 8 U.S.C. 1621must not be construed to constitute any form of discrimination, distinction orrestriction made, or any other action taken, on the basis of national origin.

3. As used in this section, state or local public benefithas the meaning ascribed to it in 8 U.S.C. 1621.

(Added to NRS by 1997, 2224)

STATE WELFARE BOARD

NRS 422.070 Creation;appointment of members. Repealed. (See chapter1, Statutes ofNevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.110 for similar reenactedprovisions.)

 

NRS 422.080 Qualificationsand removal of members. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.115 for similar reenactedprovisions.)

 

NRS 422.110 Meetings;quorum; notice of meetings; minutes. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.120 for similar reenactedprovisions.)

 

NRS 422.120 Officers.Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.125 for similar reenacted provisions.)

 

NRS 422.130 Compensationof members and employees. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.130 for similar reenactedprovisions.)

 

NRS 422.140 Powersand duties. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.135 for similar reenactedprovisions.)

 

MEDICAL CARE ADVISORY GROUP

NRS 422.151 Creation;function.

1. The Medical Care Advisory Group is hereby createdwithin the Division.

2. The function of the Medical Care Advisory Group isto:

(a) Advise the Division regarding the provision ofservices for the health and medical care of welfare recipients.

(b) Participate, and increase the participation ofwelfare recipients, in the development of policy and the administration of programsby the Division.

(Added to NRS by 1975, 1093; A 1993, 2060; 1997,2617; 1999, 2242;2005, 22ndSpecial Session, 22)

NRS 422.153 Composition;terms and compensation of members.

1. The Medical Care Advisory Group consists of thestate health officer and:

(a) A person who:

(1) Holds a license to practice medicine in thisstate; and

(2) Is certified by the Board of MedicalExaminers in a medical specialty.

(b) A person who holds a license to practice dentistryin this state.

(c) A person who holds a certificate of registration asa pharmacist in this state.

(d) A member of a profession in the field of healthcare who is familiar with the needs of persons of low income, the resourcesrequired for their care and the availability of those resources.

(e) An administrator of a hospital or a clinic forhealth care.

(f) An administrator of a facility for intermediatecare or a facility for skilled nursing.

(g) A member of an organized group that providesassistance, representation or other support to recipients of Medicaid.

(h) A recipient of Medicaid.

2. The Director shall appoint each member required byparagraphs (a) to (h), inclusive, of subsection 1 to serve for a term of 1year.

3. Members of the Medical Care Advisory Group servewithout compensation, except that while engaged in the business of the AdvisoryGroup, each member is entitled to receive the per diem allowance and travelexpenses provided for state officers and employees generally.

(Added to NRS by 1975, 1093; A 1985, 421; 1993, 2060;1997, 1237)

NRS 422.155 Chairman;Secretary; meetings; subcommittees.

1. The Director shall appoint a Chairman of theMedical Care Advisory Group from among its members.

2. The Administrator or his designee shall serve asSecretary for the Medical Care Advisory Group.

3. The Medical Care Advisory Group:

(a) Shall meet at least once each calendar year.

(b) May, upon the recommendation of the Chairman, formsubcommittees for decisions and recommendations concerning specific problemswithin the scope of the functions of the Medical Care Advisory Group.

(Added to NRS by 1975, 1093; A 1993, 2061; 1997,2617; 1999, 2242;2005, 22ndSpecial Session, 22)

STATE WELFARE ADMINISTRATOR

NRS 422.160 Qualifications. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.155 for similar reenactedprovisions.)

 

NRS 422.180 ExecutiveOfficer of Welfare Division; administration and management of Welfare Division. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.160 for similar reenactedprovisions.)

 

NRS 422.190 Reports. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.165 for similar reenacted provisions.)

 

NRS 422.200 Fiscalduties. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.170 for similar reenactedprovisions.)

 

NRS 422.210 Organizationof Welfare Division; appointment of heads of sections; employees; standards ofservice. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.175 for similar reenactedprovisions.)

 

NRS 422.215 Administrationof oaths by State Welfare Administrator and Director of Department of HumanResources; testimony of witnesses; subpoenas. Repealed. (See chapter 1,Statutes ofNevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.180 for similar reenactedprovisions.)

 

NRS 422.222 Regulations:Authority to adopt. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.185 for similar reenactedprovisions.)

 

NRS 422.224 Regulations:Procedure for adoption, amendment or repeal. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.190 for similar reenactedprovisions.)

 

NRS 422.230 Generaland miscellaneous powers and duties. Repealed.(See chapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.195 for similar reenactedprovisions.)

 

ADMINISTRATOR OF DIVISION OF HEALTH CARE FINANCING ANDPOLICY

NRS 422.2352 Administratordefined. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.)

 

NRS 422.2354 Qualifications. The Administrator must:

1. Be appointed on the basis of his training,education, experience and interest in the financing of programs for publichealth, including, without limitation, the financing of Medicaid.

2. Be a graduate in public administration, business administrationor a similar area of study from an accredited college or university.

3. Have not less than 3 years of demonstratedsuccessful experience in the financing of health care or other public programs,and not less than 1 year of experience relating to Medicaid, or any equivalentcombination of training and experience.

4. Possess qualities of leadership in the fields ofhealth care and the financing of health care.

(Added to NRS by 1997, 2612; A 1999, 2242)

NRS 422.2356 ExecutiveOfficer of Division; administration and management of Division. The Administrator:

1. Shall serve as the Executive Officer of theDivision.

2. Shall establish policies for the administration ofthe programs of the Division, and shall administer all activities and servicesof the Division in accordance with those policies and any regulations of theAdministrator, subject to administrative supervision by the Director.

3. Is responsible for the management of the Division.

(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd SpecialSession, 22)

NRS 422.2358 Reports. The Administrator shall make:

1. Such reports, subject to approval by the Director,as will comply with the requirements of federal legislation and this chapter.

2. A biennial report to the Director on the condition,operation and functioning of the Division.

(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd SpecialSession, 22)

NRS 422.2362 Fiscalduties. The Administrator:

1. Is responsible for and shall supervise the fiscalaffairs and responsibilities of the Division, subject to administrativesupervision by the Director.

2. Shall present the biennial budget of the Divisionto the Legislature in conjunction with the Budget Division of the Department ofAdministration.

3. Shall allocate, in the interest of efficiency andeconomy, the States appropriation for the administration of each program forwhich the Division is responsible, subject to administrative supervision by theDirector.

(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd SpecialSession, 22)

NRS 422.2364 Organizationof Division; appointment of heads of sections; employees; standards of service. The Administrator:

1. May establish, consolidate and abolish sectionswithin the Division.

2. Shall organize the Division to comply with therequirements of this chapter and with the standards required by federallegislation, subject to approval by the Director.

3. Shall appoint the heads of the sections of theDivision.

4. May employ such assistants and employees as may benecessary for the efficient operation of the Division.

5. Shall set standards of service.

(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd SpecialSession, 22)

NRS 422.2366 Administrationof oaths; testimony of witnesses; subpoenas.

1. The Administrator or his designated representativemay administer oaths and take testimony thereunder and issue subpoenasrequiring the attendance of witnesses before the Division at a designated timeand place and the production of books, papers and records relative to:

(a) Eligibility or continued eligibility to providemedical care, remedial care or other services pursuant to the State Plan forMedicaid or the Childrens Health Insurance Program; and

(b) Verification of treatment and payments to aprovider of medical care, remedial care or other services pursuant to the StatePlan for Medicaid or the Childrens Health Insurance Program.

2. If a witness fails to appear or refuses to givetestimony or to produce books, papers and records as required by the subpoena,the district court of the county in which the investigation is being conductedmay compel the attendance of the witness, the giving of testimony and theproduction of books, papers and records as required by the subpoena.

(Added to NRS by 1997, 2613; A 1999, 2227, 2242; 2005, 22nd SpecialSession, 23)

NRS 422.2368 Adoptionof regulations. The Administrator may adoptsuch regulations as are necessary for the administration of this chapter.

(Added to NRS by 1997, 2614; A 1999, 2242; 2003, 2747; 2005, 22nd SpecialSession, 23)

NRS 422.2369 Procedurefor adopting, amending or repealing regulations.

1. Before adopting, amending or repealing anyregulation for the administration of a program of public assistance or anyother program for which the Division is responsible, the Administrator mustgive at least 30 days notice of his intended action.

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

(a) Include a statement of the need for and purpose ofthe proposed regulation, and either the terms or substance of the proposedregulation or a description of the subjects and issues involved, and of thetime when, the place where and the manner in which interested persons maypresent their views thereon.

(b) Include a statement identifying the entities thatmay be financially affected by the proposed regulation and the potentialfinancial impact, if any, upon local government.

(c) State each address at which the text of theproposed regulation may be inspected and copied.

(d) Be mailed to all persons who have requested inwriting that they be placed upon a mailing list, which must be kept by theAdministrator for that purpose.

3. All interested persons must be afforded areasonable opportunity to submit data, views or arguments upon a proposedregulation, orally or in writing. The Administrator shall consider fully alloral and written submissions relating to the proposed regulation.

4. The Administrator shall keep, retain and makeavailable for public inspection written minutes and an audio recording ortranscript of each public hearing held pursuant to this section in the mannerprovided in NRS 241.035.

5. An objection to any regulation on the ground ofnoncompliance with the procedural requirements of this section may not be mademore than 2 years after its effective date.

(Added to NRS by 1999, 2225; A 2005, 1413; 2005, 22nd SpecialSession, 23)

NRS 422.2372 Generaland miscellaneous powers and duties. The Administratorshall:

1. Supply the Director with material on which to baseproposed legislation.

2. Cooperate with the Federal Government and stategovernments for the more effective attainment of the purposes of this chapter.

3. Coordinate the activities of the Division withother agencies, both public and private, with related or similar activities.

4. Keep a complete and accurate record of allproceedings, record and file all bonds and contracts, and assume responsibilityfor the custody and preservation of all papers and documents pertaining to hisoffice.

5. Inform the public in regard to the activities andoperation of the Division, and provide other information which will acquaint thepublic with the financing of Medicaid programs.

6. Conduct studies into the causes of the socialproblems with which the Division is concerned.

7. Invoke any legal, equitable or special proceduresfor the enforcement of his orders or the enforcement of the provisions of thischapter.

8. Exercise any other powers that are necessary andproper for the standardization of state work, to expedite business and topromote the efficiency of the service provided by the Division.

(Added to NRS by 1997, 2614; A 1999, 2242; 2003, 2747; 2005, 22nd SpecialSession, 24)

NRS 422.2374 Cooperationwith Medicaid Fraud Control Unit; suspension or exclusion of provider of goodsor services under State Plan for Medicaid.

1. The Administrator shall:

(a) Promptly comply with a request from the Unit foraccess to and free copies of any records or other information in the possessionof the Division regarding a provider;

(b) Refer to the Unit all cases in which he suspectsthat a provider has committed an offense pursuant to NRS 422.540 to 422.570, inclusive; and

(c) Suspend or exclude a provider who he determines hascommitted an offense pursuant to NRS 422.540to 422.570, inclusive, fromparticipation as a provider or an employee of a provider, for a minimum of 3years. A criminal action need not be brought against the provider beforesuspension or exclusion pursuant to this subsection.

2. As used in this section:

(a) Provider means a person who has applied toparticipate or who participates in the State Plan for Medicaid as the providerof goods or services.

(b) Unit means the Medicaid Fraud Control Unitestablished in the Office of the Attorney General pursuant to NRS 228.410.

(Added to NRS by 1997, 2614; A 1999, 2242; 2005, 22nd SpecialSession, 24)

ADMINISTRATION AND PROCEDURE

NRS 422.240 Legislativeappropriations; disbursements.

1. Money to carry out the provisions of this chapter,including, without limitation, any federal money allotted to the State ofNevada pursuant to the program to provide Temporary Assistance for Needy Familiesand the Program for Child Care and Development, must, except as otherwiseprovided in NRS 422.2726 to 422.2729, inclusive, 422.3755 to 422.379, inclusive, and 439.630, be provided by appropriation bythe Legislature from the State General Fund.

2. Disbursements for the purposes of this chaptermust, except as otherwise provided in NRS422.2726 to 422.2729, inclusive, 422.3755 to 422.379, inclusive, and 439.630, be made upon claims duly filed andallowed in the same manner as other money in the State Treasury is disbursed.

[14:327:1949; 1943 NCL 5146.14](NRS A 1975, 175;1991, 1051; 1997, 2236, 2621; 1999, 547, 550, 1427, 2242; 2001, 91, 1519; 2003, 629, 873, 1747; 2005, 736, 923, 1674, 2451; 2005, 22nd SpecialSession, 25)

NRS 422.245 Depositof money received for certain programs in appropriate accounts of Division inState General Fund. Any federal money allottedto the State of Nevada for public assistance programs and other programs forwhich the Division is responsible and such other money as may be received bythe State for such purposes must, except as otherwise provided in NRS 425.363, be deposited in theappropriate accounts of the Division in the State General Fund.

(Added to NRS by 1981, 1908; A 1997, 2622; 1999, 823, 2242, 2248; 2005, 22nd SpecialSession, 25)

NRS 422.260 Acceptanceof Social Security Act and federal money.

1. The State of Nevada assents to the purposes of theAct of Congress of the United States entitled the Social Security Act,approved August 14, 1935, and assents to such additional federal legislation asis not inconsistent with the purposes of this chapter and NRS 432.010 to 432.085, inclusive.

2. The State of Nevada further accepts, with theapproval of the Governor, the appropriations of money by Congress in pursuanceof the Social Security Act and authorizes the receipt of such money into theState Treasury for the use of the Department in accordance with this chapter, NRS 432.010 to 432.085, inclusive, and the conditionsimposed by the Social Security Act.

3. The State of Nevada may accept, with the approvalof the Governor, any additional funds which may become or are made availablefor extension of programs and services administered by the Department under theprovisions of the Social Security Act. Such money must be deposited in theState Treasury for the use of the Department in accordance with this chapter, NRS 432.010 to 432.085, inclusive, and the conditions andpurposes under which granted by the Federal Government.

[1:327:1949; 1943 NCL 5146.01](NRS A 1963, 905;1965, 329; 1993, 2693; 2005, 22nd SpecialSession, 25)

NRS 422.265 Acceptanceof increased benefits of future congressional legislation; regulations. If Congress passes any law increasing the participation ofthe Federal Government in a Nevada program for public assistance, whetherrelating to eligibility for assistance or otherwise:

1. The Director may accept, with the approval of theGovernor, the increased benefits of such congressional legislation; and

2. The Administrator may adopt any regulationsrequired by the Federal Government as a condition of acceptance.

(Added to NRS by 1965, 331; A 1993, 2062, 2693; 1995,674; 1997, 2622; 1999,2242; 2005,22nd Special Session, 25)

NRS 422.267 Contractor agreement with Federal Government by Director. TheDirector shall have the power to sign and execute, in the name of the State, byThe Department of Health and Human Services, any contract or agreement withthe Federal Government or its agencies.

[Part 9:327:1949; A 1951, 391; 1953, 333](NRS A1963, 904; 1967, 1153; 1973, 1406; 2005, 22nd SpecialSession, 26)

NRS 422.270 Dutiesof Department regarding welfare activities and services. The Department shall:

1. Administer all public welfare programs of thisState, including:

(a) State Supplementary Assistance;

(b) Temporary Assistance for Needy Families;

(c) Medicaid;

(d) Food Stamp Assistance;

(e) Low-Income Home Energy Assistance;

(f) The Program for Child Care and Development;

(g) The Program for the Enforcement of Child Support;

(h) The Childrens Health Insurance Program; and

(i) Other welfare activities and services provided for bythe laws of this State.

2. Act as the single state agency of the State ofNevada and its political subdivisions in the administration of any federalmoney granted to the State of Nevada to aid in the furtherance of any of theservices and activities set forth in subsection 1.

3. Cooperate with the Federal Government in adoptingstate plans, in all matters of mutual concern, including adoption of methods ofadministration found by the Federal Government to be necessary for theefficient operation of welfare programs, and in increasing the efficiency ofwelfare programs by prompt and judicious use of new federal grants which willassist the Department in carrying out the provisions of this chapter.

4. Observe and study the changing nature and extent ofwelfare needs and develop through tests and demonstrations effective ways ofmeeting those needs and employ or contract for personnel and services supportedby legislative appropriations from the State General Fund or money from federalor other sources.

5. Enter into reciprocal agreements with other statesrelative to public assistance, welfare services and institutional care, whendeemed necessary or convenient by the Director.

6. Make such agreements with the Federal Government asmay be necessary to carry out the Supplemental Security Income Program.

7. As used in this section, Program for theEnforcement of Child Support means the program established to locate absentparents, establish paternity and obtain child support pursuant to Part D ofTitle IV of the Social Security Act, 42 U.S.C. 651 et seq., and any otherprovisions of that act relating to the enforcement of child support.

[Part 10:327:1949; A 1951, 546; 1953, 333](NRS A1963, 905; 1965, 330; 1967, 1054; 1971, 374; 1973, 867; 1975, 1007; 1977, 431;1981, 1910; 1989, 1155; 1991, 1052; 1993, 2063, 2694, 2787; 1995, 723; 1997,1239, 2236, 2622, 2623; 1999,581, 1427, 2242; 2001, 161; 2005, 22nd SpecialSession, 26)

NRS 422.2705 Contractsfor provision of certain transportation services for recipients of Medicaid andrecipients of services pursuant to Childrens Health Insurance Program.

1. The Department shall, to the extent authorized byfederal law, contract with a common motor carrier, a contract motor carrier ora broker for the provision of transportation services to recipients of Medicaidor recipients of services pursuant to the Childrens Health Insurance Programtraveling to and returning from providers of services under the State Plan forMedicaid or the Childrens Health Insurance Program.

2. The Director may adopt regulations concerning thequalifications of persons who may contract with the Department to providetransportation services pursuant to this section.

3. The Director shall:

(a) Require each motor carrier that has contracted withthe Department to provide transportation services pursuant to this section tosubmit proof to the Department of a liability insurance policy, certificate ofinsurance or surety which is substantially equivalent in form to and is in thesame amount or in a greater amount than the policy, certificate or suretyrequired by the Department of Motor Vehicles pursuant to NRS 706.291 for a similarly situated motorcarrier; and

(b) Establish a program, with the assistance of theTransportation Services Authority of the Department of Business and Industry,to inspect the vehicles which are used to provide transportation servicespursuant to this section to ensure that the vehicles and their operation aresafe.

4. As used in this section:

(a) Broker has the meaning ascribed to it in NRS 706.021.

(b) Common motor carrier has the meaning ascribed toit in NRS 706.036.

(c) Contract motor carrier has the meaning ascribedto it in NRS 706.051.

(Added to NRS by 2005, 735)

NRS 422.2708 Amendmentof home and community-based services waiver to include as medical assistanceunder Medicaid funding of assisted living supportive services for seniorcitizens who reside in certain assisted living facilities.

1. The Department shall apply to the Secretary ofHealth and Human Services to amend its home and community-based services waivergranted pursuant to 42 U.S.C. 1396n. The waiver must be amended, in addition toproviding coverage for any home and community-based services which the waivercovers on June 4, 2005, to authorize the Department to include as medicalassistance under Medicaid the funding of assisted living supportive servicesfor senior citizens who reside in assisted living facilities which arecertified by the Housing Division of the Department of Business and Industrypursuant to NRS 319.147.

2. The Department shall:

(a) Cooperate with the Federal Government in amendingthe waiver pursuant to this section;

(b) If the Federal Government approves the amendmentsto the waiver, adopt regulations necessary to carry out the provisions of thissection, including, without limitation, the criteria to be used in determiningeligibility for the assisted living supportive services funded pursuant tosubsection 1; and

(c) Implement the amendments to the waiver only to theextent that the amendments are approved by the Federal Government.

3. As used in this section:

(a) Assisted living facility means a residentialfacility for groups that:

(1) Satisfies the requirements set forth insubsection 7 of NRS 449.037; and

(2) Has staff at the facility available 24 hoursa day, 7 days a week, to provide scheduled assisted living supportive servicesand assisted living supportive services that are required in an emergency in amanner that promotes maximum dignity and independence of residents of thefacility.

(b) Assisted living supportive services meansservices which are provided at an assisted living facility to residents of theassisted living facility, including, without limitation:

(1) Personal care services;

(2) Homemaker services;

(3) Chore services;

(4) Attendant care;

(5) Companion services;

(6) Medication oversight;

(7) Therapeutic, social and recreationalprogramming; and

(8) Services which ensure that the residents ofthe facility are safe, secure and adequately supervised.

(Added to NRS by 2005, 922)

NRS 422.271 Stateplans for certain programs: Development, adoption and revision by Director;Division required to comply.

1. The Director shall adopt each state planrequired by the Federal Government, either directly or as a condition to thereceipt of federal money, for the administration of any public assistance orother program for which the Division is responsible. Such a plan must setforth, regarding the particular program to which the plan applies:

(a) The requirements for eligibility;

(b) The nature and amounts of grants and otherassistance which may be provided;

(c) The conditions imposed; and

(d) Such other provisions relating to the developmentand administration of the program as the Director deems necessary.

2. In developing and revising such a plan, theDirector shall consider, among other things:

(a) The amount of money available from the FederalGovernment;

(b) The conditions attached to the acceptance of thatmoney; and

(c) The limitations of legislative appropriations andauthorizations,

for theparticular program to which the plan applies.

3. The Division shall comply with each state planadopted pursuant to this section.

(Added to NRS by 1993, 2058; A 1997, 2235, 2621; 1999, 581, 2242; 2005, 22nd SpecialSession, 26)

NRS 422.2715 Establishmentof program to provide medical assistance to certain employed persons havingdisabilities.

1. Upon approval of the Interim Finance Committee, theDirector, through the Division, shall establish a program for the provision ofmedical assistance to certain persons who are employed and have disabilities.The Director shall establish the program by:

(a) Amending the State Plan for Medicaid in the mannerset forth in 42 U.S.C. 1396a(a)(10)(A)(ii)(XIII);

(b) Amending the State Plan for Medicaid in the mannerset forth in 42 U.S.C. 1396a(a)(10)(A)(ii)(XV); or

(c) Obtaining a Medicaid waiver from the FederalGovernment to carry out the program.

2. The Director may require a person participating ina program established pursuant to subsection 1 to pay a premium or othercost-sharing charges in a manner that is consistent with federal law.

(Added to NRS by 2001, 2371; A 2005, 22nd SpecialSession, 27)

NRS 422.2716 Provisionof public assistance to qualified aliens.

1. The Department shall provide publicassistance pursuant to:

(a) The program established to provide TemporaryAssistance for Needy Families;

(b) Medicaid; or

(c) Any program for which a grant has been provided tothis state pursuant to 42 U.S.C. 1397 et seq.,

to aqualified alien who complies with the requirements established by the Departmentpursuant to federal law and this chapter for the receipt of benefits pursuantto that program.

2. As used in this section, qualified alien has themeaning ascribed to it in 8 U.S.C. 1641.

(Added to NRS by 1997, 2224; A 1999, 2229; 2003, 659)(Substitutedin revision for NRS 422.29314)

NRS 422.2717 StatePlan for Medicaid: Inclusion of requirement that independent foster careadolescents are eligible for Medicaid.

1. The Director shall include in the State Plan forMedicaid a requirement that an independent foster care adolescent is eligiblefor Medicaid.

2. As used in this section, independent foster careadolescent means:

(a) A person described in 42 U.S.C. 1396d(w)(1), asthat section existed on July 1, 2005; or

(b) If the Director specifies a different category ofadolescents in the manner set forth in 42 U.S.C. 1396a(a)(10)(A)(ii)(XVII),as that section existed on July 1, 2005, a person who is within such acategory.

(Added to NRS by 2005, 2451)

NRS 422.272 StatePlan for Medicaid: Inclusion of requirement for payment of certain costs.

1. The Director shall include in the State Plan forMedicaid a requirement that the State shall pay the nonfederal share ofexpenditures for the medical, administrative and transactional costs, to theextent not covered by private insurance, of a person:

(a) Who is admitted to a hospital, facility for intermediatecare or facility for skilled nursing for not less than 30 consecutive days;

(b) Who is covered by the State Plan for Medicaid; and

(c) Whose net countable income per month is not morethan $775 or 156 percent of the supplemental security income benefit rateestablished pursuant to 42 U.S.C. 1382(b)(1), whichever is greater.

2. As used in this section:

(a) Facility for intermediate care has the meaningascribed to it in NRS 449.0038.

(b) Facility for skilled nursing has the meaningascribed to it in NRS 449.0039.

(c) Hospital has the meaning ascribed to it in NRS 449.012.

(Added to NRS by 1997, 2217; A 1997, 2217, 2705; 1999, 581, 590, 2242, 2754; 2001, 158; 2003, 873)

NRS 422.2726 Applicationfor Medicaid waiver pursuant to Health Insurance Flexibility and Accountabilitydemonstration initiative; consideration of recommendations from certainentities.

1. The Director shall apply to the Federal Governmentfor a Medicaid waiver pursuant to the Health Insurance Flexibility andAccountability demonstration initiative or any succeeding program to providecertain health care benefits through Medicaid and the Childrens HealthInsurance Program to the persons described in NRS 422.2727.

2. The Director shall fully cooperate in good faithwith the Federal Government during the application process to satisfy therequirements of the Federal Government for obtaining a waiver pursuant to thissection, including, without limitation:

(a) Providing any necessary information requested bythe Federal Government in a timely manner;

(b) Responding promptly and thoroughly to any questionsor concerns of the Federal Government concerning the application; and

(c) Working with the Federal Government to amend anynecessary provisions of the application to satisfy the requirements forapproval of the application.

3. In applying for a waiver pursuant to this section,the Director shall consider any recommendations he receives from the Board ofTrustees of the Fund for Hospital Care to Indigent Patients established pursuantto NRS 428.195, any board of countycommissioners and the Board of Directors of the Nevada Association of Counties.

(Added to NRS by 2005, 1672)

NRS 422.2727 Requirementsof application for Medicaid waiver pursuant to Health Insurance Flexibility andAccountability demonstration initiative. TheDirector shall include in the application for the Medicaid waiver pursuant to NRS 422.2726, to the extent authorized byfederal law, that the waiver is to:

1. Provide coverage for medical services to pregnantwomen who have household incomes that are more than 133 percent of thefederally designated level signifying poverty but not more than 185 percent ofthe federally designated level signifying poverty.

2. Provide a monthly subsidy of up to $100 toward apolicy of insurance purchased by an employee or the spouse of an employee:

(a) Who works for an employer that employs at least 2but not more than 50 employees;

(b) Whose household income is less than 200 percent ofthe federally designated level signifying poverty; and

(c) Who is otherwise ineligible for Medicaid.

3. Provide coverage for hospital care to persons whohave low incomes, are otherwise ineligible for Medicaid and who have acatastrophic illness or injury which results in unpaid charges for hospitalcare. As used in this subsection, hospital care has the meaning ascribed toit in NRS 428.155.

(Added to NRS by 2005, 1673)

NRS 422.2728 Establishmentof program to carry out Medicaid waiver pursuant to Health InsuranceFlexibility and Accountability demonstration initiative; regulations; reports.

1. If the Federal Government approves a Medicaidwaiver which the Director applied for pursuant to NRS 422.2726, the Director shall adoptregulations to implement the waiver and establish a program in accordance withthe waiver, which may include, without limitation, regulations setting forth:

(a) Any amount of contribution that a person whoreceives any benefit under the program is required to pay;

(b) Criteria for eligibility;

(c) The services covered by the program;

(d) Any limitation on the number of persons who mayparticipate in the program; and

(e) Any other regulations necessary to carry out theprogram.

2. The Director shall also adopt any necessaryregulations to ensure that an employer that provides health care insurance toan employee does not discontinue or reduce his contribution toward suchinsurance as a result of any subsidy authorized under the program establishedpursuant to this section. Such regulations must include, without limitation, arequirement that a person is not eligible for a subsidy unless his employercontributes at least 50 percent toward the premium for insurance provided bythe employer.

3. The Director shall submit a quarterly reportconcerning benefits provided by the program established pursuant to thissection to the Interim Finance Committee and the Legislative Committee onHealth Care.

(Added to NRS by 2005, 1673)

NRS 422.2729 Fundingof program to carry out Medicaid waiver pursuant to Health InsuranceFlexibility and Accountability demonstration initiative. To fund a program established pursuant to NRS 422.2728, the Director shall use:

1. The money transferred pursuant to subsection 2 of NRS 428.305;

2. Any money provided by appropriation by theLegislature for that purpose; and

3. Any federal money allotted to the State of Nevadafor that purpose.

(Added to NRS by 2005, 1674)

NRS 422.273 Establishment,development and implementation of Medicaid managed care program.

1. For any Medicaid managed care programestablished in the State of Nevada, the Department shall contract only with ahealth maintenance organization that has:

(a) Negotiated in good faith with a federally-qualifiedhealth center to provide health care services for the health maintenanceorganization;

(b) Negotiated in good faith with the UniversityMedical Center of Southern Nevada to provide inpatient and ambulatory servicesto recipients of Medicaid; and

(c) Negotiated in good faith with the University ofNevada School of Medicine to provide health care services to recipients ofMedicaid.

Nothing inthis section shall be construed as exempting a federally-qualified healthcenter, the University Medical Center of Southern Nevada or the University ofNevada School of Medicine from the requirements for contracting with the healthmaintenance organization.

2. During the development and implementation of anyMedicaid managed care program, the Department shall cooperate with theUniversity of Nevada School of Medicine by assisting in the provision of anadequate and diverse group of patients upon which the school may base itseducational programs.

3. The University of Nevada School of Medicine mayestablish a nonprofit organization to assist in any research necessary for thedevelopment of a Medicaid managed care program, receive and accept gifts,grants and donations to support such a program and assist in establishingeducational services about the program for recipients of Medicaid.

4. For the purpose of contracting with a Medicaidmanaged care program pursuant to this section, a health maintenanceorganization is exempt from the provisions of NRS 695C.123.

5. The provisions of this section apply to any managedcare organization, including a health maintenance organization, that provideshealth care services to recipients of Medicaid under the State Plan forMedicaid or the Childrens Health Insurance Program pursuant to a contract withthe Division. Such a managed care organization or health maintenanceorganization is not required to establish a system for conducting externalreviews of final adverse determinations in accordance with chapter 695B, 695Cor 695G of NRS. This subsection does notexempt such a managed care organization or health maintenance organization forservices provided pursuant to any other contract.

6. As used in this section, unless the contextotherwise requires:

(a) Federally-qualified health center has the meaningascribed to it in 42 U.S.C. 1396d(l)(2)(B).

(b) Health maintenance organization has the meaningascribed to it in NRS 695C.030.

(c) Managed care organization has the meaningascribed to it in NRS 695G.050.

(Added to NRS by 1997, 1236; A 2001, 1927; 2003, 785; 2005, 22nd SpecialSession, 27)

NRS 422.274 Medicaidwaiver to extend coverage for prescription drugs to certain older persons;limitation on administrative expenses; report. Repealed. (See chapter353, Statutes ofNevada 2005, at page 1334.)

 

NRS 422.2745 Medicaidwaiver to extend coverage for prescription drugs to certain persons withdisabilities; limitation on administrative expenses; report. Repealed.(See chapter 353, Statutesof Nevada 2005, at page 1334.)

 

NRS 422.2748 Cooperationwith Medicaid Fraud Control Unit.

1. The Director or his designated representativeshall:

(a) Promptly comply with a request from the Unit foraccess to and free copies of any records or other information in the possessionof the Department regarding a provider; and

(b) Refer to the Unit all cases in which he suspectsthat a provider has committed an offense pursuant to NRS 422.540 to 422.570, inclusive.

2. As used in this section:

(a) Provider means a person who has applied toparticipate or who participates in the State Plan for Medicaid as the providerof goods or services.

(b) Unit means the Medicaid Fraud Control Unitestablished in the Office of the Attorney General pursuant to NRS 228.410.

(Added to NRS by 1991, 1050; A 1997, 1238, 2620; 1999, 2242; 2003, 659)(Substitutedin revision for NRS 422.2345)

NRS 422.275 Legaladvisers for Division. The Attorney Generaland his deputies are the legal advisers for the Division.

(Added to NRS by 1963, 501; A 1967, 1498; 1971, 1437;1975, 175; 1979, 274; 1981, 1281; 1997, 2624; 1999, 2242; 2005, 22nd SpecialSession, 29)

NRS 422.276 Appealto Department by applicant for or recipient of public assistance or services;notice of initial decision; hearing.

1. Subject to the provisions of subsection 2,if an application for public assistance or claim for services is not acted uponby the Department within a reasonable time after the filing of the applicationor claim for services, or is denied in whole or in part, or if any grant ofpublic assistance or claim for services is reduced, suspended or terminated,the applicant for or recipient of public assistance or services may appeal tothe Department and may be represented in the appeal by counsel or otherrepresentative of his choice.

2. Upon the initial decision to deny, reduce, suspendor terminate public assistance or services, the Department shall notify thatapplicant or recipient of its decision, the regulations involved and his rightto request a hearing within a certain period. If a request for a hearing isreceived within that period, the Department shall notify that person of thetime, place and nature of the hearing. The Department shall provide anopportunity for a hearing of that appeal and shall review his case regardingall matters alleged in that appeal.

3. The Department is not required to grant a hearingpursuant to this section if the request for the hearing is based solely uponthe provisions of a federal law or a law of this State that requires anautomatic adjustment to the amount of public assistance or services that may bereceived by an applicant or recipient.

(Added to NRS by 1981, 1908; A 1985, 857; 1993, 2064;1997, 2238; 1999,2229)(Substituted in revision for NRS 422.294)

NRS 422.277 Hearing:Rights of parties; informal disposition; record; transcribing of oralproceedings; findings of fact; limitation on participation of employee orrepresentative of Department in decision.

1. At any hearing held pursuant to the provisions ofsubsection 2 of NRS 422.276, opportunitymust be afforded all parties to respond and present evidence and argument onall issues involved.

2. Unless precluded by law, informal disposition maybe made of any hearing by stipulation, agreed settlement, consent order ordefault.

3. The record of a hearing must include:

(a) All pleadings, motions and intermediate rulings.

(b) Evidence received or considered.

(c) Questions and offers of proof and objections, andrulings thereon.

(d) Any decision, opinion or report by the hearingofficer presiding at the hearing.

4. Oral proceedings, or any part thereof, must betranscribed on request of any party seeking judicial review of the decision.

5. Findings of fact must be based exclusively onsubstantial evidence.

6. Any employee or other representative of theDepartment who investigated or made the initial decision to deny, modify orcancel a grant of public assistance or services shall not participate in themaking of any decision made pursuant to the hearing.

(Added to NRS by 1985, 855; A 1993, 2064; 1999, 2229; 2001, 158)

NRS 422.2775 Hearing:Evidence. In any hearing held pursuant to theprovisions of subsection 2 of NRS 422.276:

1. Irrelevant, immaterial or unduly repetitiousevidence must be excluded. Unless it is privileged pursuant to chapter 49 of NRS, evidence, including, withoutlimitation, hearsay, may be admitted if it is of a type commonly relied upon byreasonable and prudent persons in the conduct of their affairs. Objections toevidentiary offers may be made. Subject to the requirements of this subsection,if a hearing will be expedited and the interests of the parties will not beprejudiced substantially, any part of the evidence may be received in writtenform.

2. Documentary evidence may be received in the form ofcopies or excerpts. Upon request, parties must be given an opportunity tocompare the copy with the original.

3. Each party may call and examine witnesses,introduce exhibits, cross-examine opposing witnesses on any matter relevant tothe issues whether or not the matter was covered in the direct examination,impeach any witness, regardless of which party first called him to testify, andrebut the evidence against him.

(Added to NRS by 1985, 855; A 1997,1615)(Substituted in revision for NRS 422.297)

NRS 422.278 Hearings:Person with disability entitled to services of interpreter. Any person who is:

1. The subject of a hearing conducted under theauthority of the Division; or

2. A witness at that hearing,

and who is aperson with a disability as defined in NRS50.050, is entitled to the services of an interpreter at public expense,subject to the provisions of NRS 50.052and 50.053. The interpreter must bequalified to engage in the practice of interpreting in this State pursuant tosubsection 2 of NRS 656A.100 and mustbe appointed by the person who presides at the hearing.

(Added to NRS by 1979, 658; A 1997, 2627; 1999, 2242; 2001, 1778; 2005, 22nd SpecialSession, 29)

NRS 422.2785 Contentsand delivery of decision or order of hearing officer; petition for judicialreview; filing of decision and record with court.

1. A decision or order issued by a hearingofficer must be in writing. A final decision must include findings of fact andconclusions of law, separately stated. Findings of fact, if set forth instatutory or regulatory language, must be accompanied by a concise and explicitstatement of the underlying facts supporting the findings. A copy of thedecision or order must be delivered by certified mail to each party and to hisattorney or other representative.

2. The Department or an applicant for or recipient ofpublic assistance or services may, at any time within 90 days after the date onwhich the written notice of the decision is mailed, petition the district courtof the judicial district in which the applicant for or recipient of publicassistance or services resides to review the decision. The district court shallreview the decision on the record of the case before the hearing officer. Thedecision and record must be certified as correct and filed with the clerk ofthe court by the Department.

(Added to NRS by 1985, 856; A 1993, 2065; 1997, 2238,2628; 1999, 581, 2230, 2242)(Substitutedin revision for NRS 422.298)

NRS 422.279 Judicialreview: Taking of additional evidence; limitations on review; grounds for reversal;appeal to Supreme Court.

1. Before the date set by the court for hearing, anapplication may be made to the court by motion, with notice to the opposingparty and an opportunity for that party to respond, for leave to presentadditional evidence. If it is shown to the satisfaction of the court that theadditional evidence is material and that there were good reasons for failure topresent it in the proceeding before the Department, the court may order thatthe additional evidence be taken before the Department upon conditionsdetermined by the court. The Department may modify its findings and decision byreason of the additional evidence and shall file that evidence and any modifications,new findings or decisions with the reviewing court.

2. The review must be conducted by the court without ajury and must be confined to the record. In cases of alleged irregularities inprocedure before the Department, not shown in the record, proof thereon may betaken in the court. The court, at the request of either party, shall hear oralargument and receive written briefs.

3. The court shall not substitute its judgment forthat of the Department as to the weight of the evidence on questions of fact.The court may affirm the decision of the Department or remand the case forfurther proceedings. The court may reverse the decision and remand the case tothe Department for further proceedings if substantial rights of the appellanthave been prejudiced because the Departments findings, inferences, conclusionsor decisions are:

(a) In violation of constitutional, regulatory orstatutory provisions;

(b) In excess of the statutory authority of theDepartment;

(c) Made upon unlawful procedure;

(d) Affected by other error of law;

(e) Clearly erroneous in view of the reliable, probativeand substantial evidence on the whole record; or

(f) Arbitrary or capricious or characterized by abuseof discretion or clearly unwarranted exercise of discretion.

4. An aggrieved party may obtain review of any finaljudgment of the district court by appeal to the Supreme Court. The appeal mustbe taken in the manner provided for civil cases.

(Added to NRS by 1985, 856; A 1999, 2230)(Substitutedin revision for NRS 422.299)

NRS 422.280 Formsof reports and records to be kept by persons subject to supervision orinvestigation by Division. To ensure accuracy,uniformity and completeness in statistics and information, the Division mayprescribe forms of reports and records to be kept by all persons, associationsor institutions, subject to its supervision or investigation, and each suchperson, association or institution shall keep such records and render suchreports in the form so prescribed.

[11:327:1949; 1943 NCL 5146.11](NRS A 1963, 906;1997, 2624; 1999,2242; 2005,22nd Special Session, 30)

NRS 422.284 Familyplanning service; birth control. As a part ofthe health and welfare programs of this State, the Division may:

1. Conduct a family planning service, or contract forthe provision of a family planning service, in any county of the State. Suchservice may include the dispensing of information and the distribution ofliterature on birth control and family planning methods.

2. Establish a policy of referral of welfarerecipients for birth control.

(Added to NRS by 1965, 529; A 1997, 2620; 1999, 2242; 2005, 22nd SpecialSession, 30)

NRS 422.287 Provisionof prenatal care to pregnant women who are indigent; provision of informationconcerning availability of prenatal care; regulations.

1. As part of the health and welfare programsof this State, the Division or any other division designated by the Directormay provide prenatal care to pregnant women who are indigent, or may contractfor the provision of that care, at public or nonprofit hospitals in this State.

2. The Division or any other division designated bythe Director shall provide to each person licensed to engage in social workpursuant to chapter 641B of NRS, eachapplicant for Medicaid and any other interested person, information concerningthe prenatal care available pursuant to this section.

3. The Division or any other division designated bythe Department shall adopt regulations setting forth criteria of eligibilityand rates of payment for prenatal care provided pursuant to the provisions ofthis section, and such other provisions relating to the development andadministration of the Program for Prenatal Care as the Director or theAdministrator, as applicable, deems necessary.

(Added to NRS by 1989, 1455; A 1997, 1238, 2235,2620; 1999, 581, 2242; 2003, 659; 2005, 22nd SpecialSession, 30)

NRS 422.288 Enrollmentof eligible Indian children in Childrens Health Insurance Program: Duty ofDepartment to seek assistance of and cooperate with Indian tribes; immediateaction required; certain contracts for provision of services required. The Department shall:

1. Seek the assistance of and cooperate with Indiantribes, tribal organizations and organizations that collaborate with Indiantribes to identify Indian children who may be eligible to enroll in theChildrens Health Insurance Program and facilitate the enrollment of suchchildren in the Childrens Health Insurance Program;

2. Upon determining that an Indian child is eligiblefor the Childrens Health Insurance Program, immediately take any necessaryaction to enroll the child in the Childrens Health Insurance Program; and

3. Contract with the Indian Health Service and tribalclinics that provide health care services to Indians to provide health careservices to Indian children who are enrolled in the Childrens Health InsuranceProgram.

(Added to NRS by 1999, 1426)

NRS 422.290 Custody,use, preservation and confidentiality of records, files and communicationsconcerning applicants for and recipients of public assistance or assistancepursuant to Childrens Health Insurance Program.

1. To restrict the use or disclosure of anyinformation concerning applicants for and recipients of public assistance orassistance pursuant to the Childrens Health Insurance Program to purposesdirectly connected to the administration of this chapter, and to providesafeguards therefor, under the applicable provisions of the Social SecurityAct, the Division shall establish and enforce reasonable regulations governingthe custody, use and preservation of any records, files and communicationsfiled with the Division.

2. If, pursuant to a specific statute or a regulationof the Division, names and addresses of, or information concerning, applicantsfor and recipients of assistance, including, without limitation, assistancepursuant to the Childrens Health Insurance Program, are furnished to or heldby any other agency or department of government, such agency or department ofgovernment is bound by the regulations of the Division prohibiting thepublication of lists and records thereof or their use for purposes not directlyconnected with the administration of this chapter.

3. Except for purposes directly connected with theadministration of this chapter, no person may publish, disclose or use, orpermit or cause to be published, disclosed or used, any confidentialinformation pertaining to a recipient of assistance, including, withoutlimitation, a recipient of assistance pursuant to the Childrens HealthInsurance Program, under the provisions of this chapter.

[12:327:1949; 1943 NCL 5146.12](NRS A 1959, 518;1963, 906; 1991, 1052; 1993, 2694; 1997, 2624; 1999, 2227, 2242; 2005, 22nd SpecialSession, 30)

NRS 422.291 Assistancenot assignable or subject to process or bankruptcy law. Assistance awarded pursuant to the provisions of thischapter is not transferable or assignable at law or in equity and none of themoney paid or payable under this chapter is subject to execution, levy,attachment, garnishment or other legal process, or to the operation of anybankruptcy or insolvency law.

(Added to NRS by 1981, 1908)

NRS 422.292 Assistancesubject to future amending and repealing acts. Allassistance awarded pursuant to the provisions of this chapter is awarded andheld subject to the provisions of any amending or repealing act that may beenacted, and no recipient has any claim for assistance or otherwise by reasonof his assistance being affected in any way by an amending or repealing act.

(Added to NRS by 1981, 1908)

NRS 422.293 Departmentsubrogated to rights of recipient of Medicaid or recipient of insuranceprovided pursuant to Childrens Health Insurance Program; lien on proceeds ofrecovery.

1. When a recipient of Medicaid or a recipientof insurance provided pursuant to the Childrens Health Insurance Programincurs an illness or injury for which medical services are payable by theDepartment and which is incurred under circumstances creating a legal liabilityin some person other than the recipient or a division of the Department to payall or part of the costs of such services, the Department is subrogated to theright of the recipient to the extent of all such costs and may join orintervene in any action by the recipient or his successors in interest toenforce such legal liability.

2. If a recipient or his successors in interest failor refuse to commence an action to enforce the legal liability, the Departmentmay commence an independent action, after notice to the recipient or hissuccessors in interest, to recover all costs to which it is entitled. In anysuch action by the Department, the recipient or his successors in interest maybe joined as third-party defendants.

3. In any case where the Department is subrogated tothe rights of the recipient or his successors in interest as provided insubsection 1, the Department has a lien upon the proceeds of any recovery fromthe persons liable, whether the proceeds of the recovery are by way ofjudgment, settlement or otherwise. Such a lien must be satisfied in full,unless reduced pursuant to subsection 5, at such time as:

(a) The proceeds of any recovery or settlement aredistributed to or on behalf of the recipient, his successors in interest or hisattorney; and

(b) A dismissal by any court of any action brought toenforce the legal liability established by subsection 1.

No such lienis enforceable unless written notice is first given to the person against whomthe lien is asserted.

4. The recipient or his successors in interest shallnotify the Department in writing before entering any settlement agreement orcommencing any action to enforce the legal liability referred to in subsection1. Except if extraordinary circumstances exist, a person who fails to complywith the provisions of this subsection shall be deemed to have waived anyconsideration by the Director or his designated representative of a reductionof the amount of the lien pursuant to subsection 5 and shall pay to theDepartment all costs to which it is entitled and its court costs and attorneysfees.

5. If the Department receives notice pursuant tosubsection 4, the Director or his designated representative may, inconsideration of the legal services provided by an attorney to procure arecovery for the recipient, reduce the lien on the proceeds of any recovery.

6. The attorney of a recipient:

(a) Shall not condition the amount of attorneys feesor impose additional attorneys fees based on whether a reduction of the lienis authorized by the Director or his designated representative pursuant to subsection5.

(b) Shall reduce the amount of the fees charged therecipient for services provided by the amount the attorney receives from thereduction of a lien authorized by the Director or his designated representativepursuant to subsection 5.

(Added to NRS by 1981, 1909; A 1989, 757; 1993, 923;1997, 1239, 2624; 1999,2228, 2242)

NRS 422.29301 Administrationof provisions concerning recovery of assistance paid to recipient of publicassistance. The Director:

1. Shall administer the provisions of NRS 422.29302 to 422.29308, inclusive;

2. May adopt such regulations as are necessary for theadministration of those provisions; and

3. May invoke any legal, equitable or specialprocedures for the enforcement of those provisions.

(Added to NRS by 2003, 872)

NRS 422.29302 Recoveryof benefits paid for Medicaid: Powers and duties of Department; claim againstestate of recipient; regulations; distribution of money recovered; payment incash.

1. Except as otherwise provided in this sectionand to the extent it is not prohibited by federal law and when circumstancesallow, the Department shall recover benefits correctly paid for Medicaid from:

(a) The undivided estate of the person who receivedthose benefits; and

(b) Any recipient of money or property from theundivided estate of the person who received those benefits.

2. The Department shall not recover benefits pursuantto subsection 1, except from a person who is neither a surviving spouse nor achild, until after the death of the surviving spouse, if any, and only at atime when the person who received the benefits has no surviving child who isunder 21 years of age, blind or disabled.

3. Except as otherwise provided by federal law, if atransfer of real or personal property by a recipient of Medicaid is made forless than fair market value, the Department may pursue any remedy availablepursuant to chapter 112 of NRS with respect tothe transfer.

4. The amount of Medicaid paid to or on behalf of aperson is a claim against the estate in any probate proceeding only at a timewhen there is no surviving spouse or surviving child who is under 21 years ofage, blind or disabled.

5. The Director may elect not to file a claim againstthe estate of a recipient of Medicaid or his spouse if the Director determinesthat the filing of the claim will cause an undue hardship for the spouse orother survivors of the recipient. The Director shall adopt regulations definingthe circumstances that constitute an undue hardship.

6. Any recovery of money obtained pursuant to thissection must be applied first to the cost of recovering the money. Anyremaining money must be divided among the Federal Government, the Departmentand the county in the proportion that the amount of assistance each contributedto the recipient bears to the total amount of the assistance contributed.

7. Any recovery by the Department from the undividedestate of a recipient pursuant to this section must be paid in cash to theextent of:

(a) The amount of Medicaid paid to or on behalf of therecipient after October 1, 1993; or

(b) The value of the remaining assets in the undividedestate,

whichever isless.

(Added to NRS by 1993, 917; A 1995, 2566; 1997, 1240,2237, 2626; 1999, 581,877, 2242; 2001, 158; 2003, 874)(Substitutedin revision for NRS 422.2935)

NRS 422.29304 Recoveryof benefits paid for public assistance if person failed to report certaininformation: Powers and duties of Department; duty to reimburse Department;waiver of repayment.

1. Except as otherwise provided in this section, theDepartment shall, to the extent that it is not prohibited by federal law,recover from a recipient of public assistance, the estate of the recipient, theundivided estate of a recipient of Medicaid or a person who signed theapplication for public assistance on behalf of the recipient an amount not toexceed the amount of public assistance incorrectly paid to the recipient, ifthe person who signed the application:

(a) Failed to report any required information to theDepartment that the person knew at the time he signed the application; or

(b) Failed to report to the Department within theperiod allowed by the Department any required information that the personobtained after he filed the application.

2. Except as otherwise provided in this section, arecipient of incorrectly paid public assistance, the undivided estate of arecipient of Medicaid or a person who signed the application for publicbenefits on behalf of the recipient shall reimburse the Department orappropriate state agency for the value of the incorrectly paid publicassistance.

3. The Director or his designee may, to the extentthat it is not prohibited by federal law, determine the amount of, and settle,adjust, compromise or deny a claim against a recipient of public assistance,the estate of the recipient, the undivided estate of a recipient of Medicaid ora person who signed the application for public assistance on behalf of therecipient.

4. The Director may, to the extent that it is notprohibited by federal law, waive the repayment of public assistance incorrectlypaid to a recipient if the incorrect payment was not the result of anintentional misrepresentation or omission by the recipient and if repaymentwould cause an undue hardship to the recipient. The Director shall, byregulation, establish the terms and conditions of such a waiver, including,without limitation, the circumstances that constitute undue hardship.

(Added to NRS by 1999, 876; A 2001, 65; 2003, 875)(Substitutedin revision for NRS 422.29353)

NRS 422.29306 Impositionand release of lien on property of recipient of Medicaid.

1. The Department may, to the extent notprohibited by federal law, petition for the imposition of a lien pursuant tothe provisions of NRS 108.850 againstreal or personal property of a recipient of Medicaid as follows:

(a) The Department may obtain a lien against arecipients property, both real or personal, before or after his death in theamount of assistance paid or to be paid on his behalf if the court determinesthat assistance was incorrectly paid for the recipient.

(b) The Department may seek a lien against the realproperty of a recipient at any age before his death in the amount of assistancepaid or to be paid for him if he is an inpatient in a nursing facility,intermediate care facility for the mentally retarded or other medicalinstitution and the Department determines, after notice and opportunity for ahearing in accordance with applicable regulations, that the recipient cannotreasonably be expected to be discharged and return home.

2. No lien may be placed on a recipients homepursuant to paragraph (b) of subsection 1 for assistance correctly paid if:

(a) His spouse;

(b) His child who is under 21 years of age, blind ordisabled as determined in accordance with 42 U.S.C. 1382c; or

(c) His brother or sister who is an owner or part ownerof the home and who was residing in the home for at least 1 year immediatelybefore the date the recipient was admitted to the medical institution,

is lawfullyresiding in the home.

3. Upon the death of a recipient, the Department mayseek a lien upon the recipients undivided estate as defined in NRS 422.054.

4. The Director shall release a lien pursuant to thissection:

(a) Upon notice by the recipient or his representativeto the Director that the recipient has been discharged from the medicalinstitution and has returned home;

(b) If the lien was incorrectly determined; or

(c) Upon satisfaction of the claim of the Department.

(Added to NRS by 1995, 2565; A 1997, 650, 1242, 2627;1999, 878, 2242, 2244; 2003, 875)(Substitutedin revision for NRS 422.29355)

NRS 422.29308 Applicationfor Medicaid: Statements regarding action for recovery and civil liability ofrecipient. Each application for Medicaid mustinclude:

1. A statement that any assistance paid to a recipientmay be recovered in an action filed against the estate of the recipient or hisspouse; and

2. A statement that any person who signs anapplication for Medicaid and fails to report:

(a) Any required information to the Department which heknew at the time he signed the application; or

(b) Within the period allowed by the Department, anyrequired information to the Department which he obtained after he filed theapplication,

may bepersonally liable for any money incorrectly paid to the recipient.

(Added to NRS by 1993, 918; A 1997, 1242; 2003, 876)(Substitutedin revision for NRS 422.2936)

NRS 422.2931 Administrativeduties. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.335 for similar reenactedprovisions.)

 

NRS 422.29312 Giftsand grants of money: Deposit in Welfare Divisions Gift and CooperativeAccount; use. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.340 for similar reenactedprovisions.)

 

NRS 422.29316 Eligibilityfor certain public assistance of person convicted of felony involvingpossession, use or distribution of controlled substance. Repealed. (Seechapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.345 for similar reenactedprovisions.)

 

NRS 422.29318 Identificationand referral of victims of domestic violence; restricted disclosure ofdetermination. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.350 for similar reenactedprovisions.)

 

NRS 422.2932 Recipientsof public assistance: Immunization of dependent children. Repealed.(See chapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.355 for similar reenactedprovisions.)

 

NRS 422.29322 Recipientsof public assistance: Attendance of children at school and assistance withtheir academic performance. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.360 for similar reenactedprovisions.)

 

NRS 422.29324 Prohibitionagainst denial, reduction, discontinuance or termination of public assistancein violation of federal requirements. Repealed.(See chapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.365 for similar reenactedprovisions.)

 

NRS 422.301 Administrativeduties of Administrator and Division. TheAdministrator and the Division shall administer the provisions of this chapter,subject to administrative supervision by the Director.

(Added to NRS by 1997, 2612; A 1999, 2242; 2003, 2748; 2005, 22nd SpecialSession, 31)

NRS 422.302 Giftsand grants of money to Division: Deposit in Gift and Cooperative Account of theDivision of Health Care Financing and Policy; use; approval of claims byAdministrator.

1. Any gifts or grants of money which theDivision is authorized to accept must be deposited in the State Treasury to thecredit of the Gift and Cooperative Account of the Division of Health CareFinancing and Policy which is hereby created in the Department of Health andHuman Services Gift Fund.

2. Money in the Account must be used for health carepurposes only and expended in accordance with the terms of the gift or grant.

3. All claims must be approved by the Administratorbefore they are paid.

(Added to NRS by 1997, 2615; A 1999, 2242; 2005, 22nd SpecialSession, 31)

NRS 422.303 Reimbursementof registered nurse for certain services provided to person eligible forMedicaid. The Department, through theDivision, may reimburse directly, under the State Plan for Medicaid, anyregistered nurse who is authorized pursuant to chapter632 of NRS to perform additional acts in an emergency or under otherspecial conditions as prescribed by the State Board of Nursing, for suchservices rendered under the authorized scope of his practice to persons eligibleto receive that assistance if another provider of health care would be reimbursedfor providing those same services.

(Added to NRS by 1985, 1655; A 1993, 2064; 1997,1239, 2624; 1999,2242; 2005,22nd Special Session, 31)

NRS 422.304 Reimbursementfor services for hospice care provided to person eligible for Medicaid.

1. Except as otherwise provided in subsection 2, theDepartment, through the Division, shall pay, under the State Plan for Medicaid:

(a) A facility for hospice care licensed pursuant to chapter 449 of NRS for the services for hospicecare, including room and board, provided by that facility to a person who iseligible to receive Medicaid.

(b) A program for hospice care licensed pursuant to chapter 449 of NRS for the services for hospicecare provided by that program to a person who is eligible to receive Medicaid.

2. The Department, through the Division, is requiredto pay, under the State Plan for Medicaid, for the services for hospice careprovided by a facility or program described in subsection 1 only to the extentthat the Federal Government provides matching federal money under Medicaid forthe services for hospice care.

3. As used in this section:

(a) Facility for hospice care has the meaningascribed to it in NRS 449.0033.

(b) Hospice care has the meaning ascribed to it in NRS 449.0115.

(Added to NRS by 1997, 1718; A 1999, 247, 469, 470; 2001, 161; 2005, 486; 2005, 22nd SpecialSession, 31)

NRS 422.3045 Denialof application for Childrens Health Insurance Program: Notice; review of caseand hearing; regulations; review by court.

1. If the Division denies an application for theChildrens Health Insurance Program, the Division shall provide written noticeof the decision to the applicant. An applicant who disagrees with the denial ofthe application may request a review of the case and a hearing before animpartial hearing officer by filing a written request within 30 days after thedate of the notice of the decision at the address specified in the notice.

2. The Division shall adopt regulations regarding thereview and hearing before an impartial hearing officer. The decision of thehearing officer must be in writing.

3. The applicant may at any time within 30 days afterthe date on which the written decision is mailed, petition the district courtof the judicial district in which the applicant resides to review the decision.The district court shall review the decision on the record. The decision andrecord must be certified as correct and filed with the court by theAdministrator.

4. The review by the court must be in accordance with NRS 422.279.

(Added to NRS by 1999, 2226; A 2005, 22nd SpecialSession, 31)

NRS 422.305 Confidentialityof information obtained in investigation of provider of services under StatePlan for Medicaid.

1. Except as otherwise provided in subsection 2and in NRS 228.410 and 422.2374, any information obtained by theDivision in an investigation of a provider of services under the State Plan forMedicaid is confidential.

2. The information presented as evidence at a hearing:

(a) To enforce the provisions of NRS 422.450 to 422.590, inclusive; or

(b) To review an action by the Division against aprovider of services under the State Plan for Medicaid,

is notconfidential, except for the identity of any recipient of the assistance.

(Added to NRS by 1987, 1670; A 1991, 1053; 1997,1243, 2628; 1999,2242; 2005,22nd Special Session, 32)

NRS 422.306 Hearingto review action taken against provider of services under State Plan forMedicaid; regulations; appeal of final decision.

1. Upon receipt of a request for a hearing froma provider of services under the State Plan for Medicaid, the Division shallappoint a hearing officer to conduct the hearing. Any employee or otherrepresentative of the Division who investigated or made the initial decisionregarding the action taken against a provider of services may not be appointedas the hearing officer or participate in the making of any decision pursuant tothe hearing.

2. The Division shall adopt regulations prescribingthe procedures to be followed at the hearing.

3. The decision of the hearing officer is a finaldecision. Any party, including the Division, who is aggrieved by the decisionof the hearing officer may appeal that decision to the District Court in andfor Carson City by filing a petition for judicial review within 30 days afterreceiving the decision of the hearing officer.

4. A petition for judicial review filed pursuant tothis section must be served upon every party within 30 days after the filing ofthe petition for judicial review.

5. Unless otherwise provided by the court:

(a) Within 90 days after the service of the petitionfor judicial review, the Division shall transmit to the court the original or acertified copy of the entire record of the proceeding under review, including,without limitation, a transcript of the evidence resulting in the finaldecision of the hearing officer;

(b) The petitioner who is seeking judicial reviewpursuant to this section shall serve and file an opening brief within 40 daysafter the Division gives written notice to the parties that the record of theproceeding under review has been filed with the court;

(c) The respondent shall serve and file an answeringbrief within 30 days after service of the opening brief; and

(d) The petitioner may serve and file a reply briefwithin 30 days after service of the answering brief.

6. Within 7 days after the expiration of the time withinwhich the petitioner may reply, any party may request a hearing. Unless arequest for hearing has been filed, the matter shall be deemed submitted.

7. The review of the court must be confined to therecord. The court shall not substitute its judgment for that of the hearingofficer as to the weight of the evidence on questions of fact. The court mayaffirm the decision of the hearing officer or remand the case for furtherproceedings. The court may reverse or modify the decision if substantial rightsof the appellant have been prejudiced because the administrative findings,inferences, conclusions or decisions are:

(a) In violation of constitutional or statutoryprovisions;

(b) In excess of the statutory authority of theDivision;

(c) Made upon unlawful procedure;

(d) Affected by other error of law;

(e) Clearly erroneous in view of the reliable,probative and substantial evidence on the whole record; or

(f) Arbitrary or capricious or characterized by abuseof discretion or clearly unwarranted exercise of discretion.

(Added to NRS by 1987, 1670; A 1997, 1243, 2628; 1999, 581, 2231, 2242; 2005, 22nd SpecialSession, 32)

FINANCIAL RESPONSIBILITY OF RELATIVES

NRS 422.310 Liabilityof spouse for spouse or parent for minor child. Repealed. (See chapter1, Statutes ofNevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.460 for similar reenactedprovisions.)

 

NRS 422.330 Writtenstatement by responsible relative; perjury. Repealed.(See chapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.465 for similar reenactedprovisions.)

 

NRS 422.340 Enforcementof support by legal action. Repealed. (Seechapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.470 for similar reenactedprovisions.)

 

NRS 422.350 Liabilityof relative not grounds for denying or discontinuing public assistance;acceptance of assistance constitutes consent by recipient to suit againstresponsible relative. Repealed. (See chapter1, Statutes ofNevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.475 for similar reenactedprovisions.)

 

MEDICAID CARDS

NRS 422.361 Definitions. As used in NRS 422.361to 422.369, inclusive, unless the contextotherwise requires, the words and terms defined in NRS 422.362 to 422.365, inclusive, have the meaningsascribed to them in those sections.

(Added to NRS by 1993, 141)

NRS 422.362 Cardholderdefined. Cardholder means the person namedon the face of a Medicaid card to whom or for whose benefit the Medicaid cardis issued by the Department.

(Added to NRS by 1993, 141; A 2003, 660)

NRS 422.363 Medicaidcard defined. Medicaid card means any instrumentor device evidencing eligibility for receipt of Medicaid benefits that is issuedby the Department for the use of a cardholder in obtaining the types of medicaland remedial care for which assistance may be provided under the Plan.

(Added to NRS by 1993, 141; A 2003, 660)

NRS 422.364 Plandefined. Plan means the State Plan forMedicaid established pursuant to NRS 422.271.

(Added to NRS by 1993, 141; A 1997, 1243)

NRS 422.365 Receivesdefined. Receives means to acquirepossession or control.

(Added to NRS by 1993, 141)

NRS 422.366 Unlawfulacts: Obtaining or possessing card without consent of holder of card;presumption from possession of card; penalty.

1. A person who:

(a) Steals, takes or removes a Medicaid card from theperson, possession, custody or control of another without the cardholdersconsent; or

(b) With knowledge that a Medicaid card has been sotaken, removed or stolen, receives the Medicaid card with the intent tocirculate, use or sell it or to transfer it to a person other than theDepartment or the cardholder,

is guilty ofa category D felony and shall be punished as provided in NRS 193.130. In addition to any otherpenalty, the court shall order the person to pay restitution.

2. A person who possesses a Medicaid card without theconsent of the cardholder and with the intent to circulate, use, sell ortransfer the Medicaid card with the intent to defraud is guilty of a category Dfelony and shall be punished as provided in NRS193.130. In addition to any other penalty, the court shall order the personto pay restitution.

3. A person who has in his possession or under hiscontrol two or more Medicaid cards issued in the name of another person ispresumed to have obtained and to possess the Medicaid cards with the knowledgethat they have been stolen and with the intent to circulate, use, sell ortransfer them with the intent to defraud. The presumption established by thissubsection may be rebutted by clear and convincing evidence. The presumptiondoes not apply to the possession of two or more Medicaid cards if the possessionis with the consent of the Department.

(Added to NRS by 1993, 141; A 1995, 1272; 2003, 660)

NRS 422.367 Unlawfulacts: Sale or purchase of card; authorization by holder of card for use byperson not entitled to use card; penalty. Aperson who:

1. Sells or buys a Medicaid card; or

2. Authorizes another person to use his Medicaid cardto obtain the types of medical and remedial care for which assistance may beprovided under the Plan, if the person to whom authorization is given is notentitled to use that card to obtain care,

is guilty ofa category D felony and shall be punished as provided in NRS 193.130. In addition to any otherpenalty, the court shall order the person to pay restitution.

(Added to NRS by 1993, 142; A 1995, 1273)

NRS 422.368 Unlawfulacts: Use of forged, expired or revoked card to obtain benefits; receipt ofbenefits by misrepresentation; penalty. Aperson who, with the intent to defraud:

1. Uses a Medicaid card to obtain the types of medicaland remedial care for which assistance may be provided under the Plan with theknowledge that the Medicaid card was obtained or retained in violation of anyof the provisions of NRS 422.361 to 422.367, inclusive, or is forged or is theexpired or revoked Medicaid card of another; or

2. Obtains the types of medical and remedial care forwhich assistance may be provided under the Plan by representing, without theconsent of the cardholder, that he is the authorized holder of a Medicaid cardor that he is the holder of a Medicaid card that has not in fact been issued,

is guilty ofa category D felony and shall be punished as provided in NRS 193.130. In addition to any otherpenalty, the court shall order the person to pay restitution.

(Added to NRS by 1993, 142; A 1995, 1273)

NRS 422.369 Unlawfulacts: Fraud by person authorized to provide care to holder of card; penalty. A person authorized by the Division to furnish the typesof medical and remedial care for which assistance may be provided under thePlan, or an agent or employee of the authorized person, who, with the intent todefraud, furnishes such care upon presentation of a Medicaid card which heknows was obtained or retained in violation of any of the provisions of NRS 422.361 to 422.367, inclusive, or is forged, expiredor revoked, is guilty of a category D felony and shall be punished as providedin NRS 193.130. In addition to any otherpenalty, the court shall order the person to pay restitution.

(Added to NRS by 1993, 142; A 1995, 1274; 1999, 2232; 2005, 22nd SpecialSession, 33)

PROGRAM TO PROVIDE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES

NRS 422.371 Definitions. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.500 for similar reenactedprovisions.)

 

NRS 422.3712 Benefitdefined. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.505 for similar reenactedprovisions.)

 

NRS 422.3714 Headof a household defined. Repealed. (Seechapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.510 for similar reenactedprovisions.)

 

NRS 422.3716 Householddefined. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.515 for similar reenactedprovisions.)

 

NRS 422.3718 Programdefined. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.520 for similar reenactedprovisions.)

 

NRS 422.372 Powersand duties of State Welfare Administrator. Repealed.(See chapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.525 for similar reenactedprovisions.)

 

NRS 422.3722 Assessmentof members of applicants household required before provision of benefits;referrals for mental health services. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.530 for similar reenactedprovisions.)

 

NRS 422.3724 Planfor personal responsibility of household: Establishment; contents; execution;expiration; review; amendment. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.535 for similar reenactedprovisions.)

 

NRS 422.3726 Agreementof cooperation: Establishment; execution; contents. Repealed. (Seechapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.540 for similar reenactedprovisions.)

 

NRS 422.3728 Periodfor action on application for benefits. Repealed.(See chapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.545 for similar reenactedprovisions.)

 

NRS 422.3732 Performanceof work by head of household: Requirement; failure to comply; regulations.Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.550 for similar reenactedprovisions.)

 

NRS 422.3734 Exemptionof head of household from requirement to complete program of job training;exceptions. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.555 for similar reenactedprovisions.)

 

NRS 422.3736 Failureto comply with plan for personal responsibility or agreement of cooperation:Notification of head of household; reduction or termination of benefits;regulations. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.560 for similar reenactedprovisions.)

 

NRS 422.3738 Compliancewith federal prohibitions on receipt of benefits. Repealed.(See chapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.565 for similar reenactedprovisions.)

 

NRS 422.374 Limitationson periods for receipt of benefits; exceptions; denial or suspension ofbenefits to comply with federal limitation. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.570 for similar reenactedprovisions.)

 

NRS 422.3742 Provisionof transitional assistance to head of household. Repealed. (See chapter1, Statutes ofNevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.575 for similar reenactedprovisions.)

 

NRS 422.3744 Paymentof certain expenses of applicant determined not to be in need of long-termbenefits. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.580 for similar reenactedprovisions.)

 

NRS 422.3746 Programto promote self-sufficiency of certain parents: Establishment; participation.Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.585 for similar reenacted provisions.)

 

NRS 422.3748 Encouragementof employment opportunities. Repealed. (Seechapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.590 for similar reenactedprovisions.)

 

NRS 422.3752 Enforcementof court orders for support of children against parents of certain noncustodialparents. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.595 for similar reenactedprovisions.)

 

NRS 422.3754 Waiverof requirements of chapter for certain victims of domestic violence. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.600 for similar reenactedprovisions.)

 

ASSESSMENT OF FEES ON NURSING FACILITIES TO INCREASEQUALITY OF NURSING CARE

NRS 422.3755 Definitions. As used in NRS422.3755 to 422.379, inclusive,unless the context otherwise requires, the words and terms defined in NRS 422.376, 422.3765 and 422.3771 have the meanings ascribed tothem in those sections.

(Added to NRS by 2003, 2745)

NRS 422.376 Facilityfor intermediate care defined. Facility forintermediate care has the meaning ascribed to it in NRS 449.0038, but does not include:

1. A facility which meets the requirements of ageneral or any other special hospital pursuant to chapter449 of NRS;

2. A facility for intermediate care which limits itscare and treatment to those persons who are mentally retarded or who haveconditions related to mental retardation; or

3. A facility for intermediate care that is owned oroperated by the State of Nevada or any political subdivision of the State ofNevada.

(Added to NRS by 2003, 2745)

NRS 422.3765 Facilityfor skilled nursing defined. Facility for skillednursing has the meaning ascribed to it in NRS449.0039, but does not include a facility for skilled nursing that is ownedor operated by the State of Nevada or any political subdivision of the State ofNevada.

(Added to NRS by 2003, 2745)

NRS 422.3771 Nursingfacility defined. Nursing facility means afacility for intermediate care or a facility for skilled nursing.

(Added to NRS by 2003, 2745)

NRS 422.3775 Paymentof fee; amount of fee; allowable cost for Medicaid reimbursement purposes.

1. Each nursing facility that is licensed in thisState shall pay a fee assessed by the Division to increase the quality ofnursing care in this State.

2. To determine the amount of the fee to assesspursuant to this section, the Division shall establish a uniform rate per non-Medicarepatient day that is equivalent to 6 percent of the total annual accrual basisgross revenue for services provided to patients of all nursing facilitieslicensed in this State. For the purposes of this subsection, total annualaccrual basis gross revenue does not include charitable contributions receivedby a nursing facility.

3. The Division shall calculate the fee owed by eachnursing facility by multiplying the total number of days of care provided tonon-Medicare patients by the nursing facility, as provided to the Divisionpursuant to NRS 422.378, by the uniformrate established pursuant to subsection 2.

4. A fee assessed pursuant to this section is due 30days after the end of the month for which the fee was assessed.

5. The payment of a fee to the Division pursuant to NRS 422.3755 to 422.379, inclusive, is an allowable costfor Medicaid reimbursement purposes.

(Added to NRS by 2003, 2746; A 2005, 22nd SpecialSession, 33)

NRS 422.378 Reportby nursing facility to Division.

1. Each nursing facility shall file with the Divisioneach month a report setting forth the total number of days of care it providedto non-Medicare patients during the preceding month, the total gross revenue itearned as compensation for services provided to patients during the precedingmonth and any other information required by the Division.

2. Each nursing facility shall file with the Divisionany information required and requested by the Division to carry out theprovisions of NRS 422.3755 to 422.379, inclusive.

(Added to NRS by 2003, 2746; A 2005, 22nd SpecialSession, 34)

NRS 422.3785 Creationof Fund to Increase the Quality of Nursing Care; deposit of money for credit toFund; expenditures from Fund; consequence of federal law prohibiting certainexpenditures from Fund.

1. There is hereby created in the State Treasury theFund to Increase the Quality of Nursing Care, to be administered by theDivision.

2. The Fund to Increase the Quality of Nursing Caremust be a separate and continuing fund, and no money in the Fund reverts to theState General Fund at any time. The interest and income on the money in theFund, after deducting any applicable charges, must be credited to the Fund.

3. Any money received by the Division pursuant to NRS 422.3755 to 422.379, inclusive, must be deposited inthe State Treasury for credit to the Fund to Increase the Quality of NursingCare, and must be expended, to the extent authorized by federal law, to obtainfederal financial participation in the Medicaid Program, and in the manner setforth in subsection 4.

4. Expenditures from the Fund to Increase the Qualityof Nursing Care must be used only:

(a) To increase the rates paid to nursing facilitiesfor providing services pursuant to the Medicaid Program and may not be used toreplace existing state expenditures paid to nursing facilities for providingservices pursuant to the Medicaid Program; and

(b) To administer the provisions of NRS 422.3755 to 422.379, inclusive. The amount expendedpursuant to this paragraph must not exceed 1 percent of the money received fromthe fees assessed pursuant to NRS 422.3755to 422.379, inclusive, and must notexceed the amount authorized for expenditure by the Legislature for administrativeexpenses in a fiscal year.

5. If federal law or regulation prohibits the money inthe Fund to Increase the Quality of Nursing Care from being used in the mannerset forth in this section, the rates paid to nursing facilities for providingservices pursuant to the Medicaid Program must be changed:

(a) Except as otherwise provided in paragraph (b), tothe rates paid to such facilities on June 30, 2003; or

(b) If the Legislature or the Division has on or afterJuly 1, 2003, changed the rates paid to such facilities through a manner otherthan the use of expenditures from the Fund to Increase the Quality of NursingCare, to the rates provided for by the Legislature or the Division.

(Added to NRS by 2003, 2746; A 2005, 22nd SpecialSession, 34)

NRS 422.379 Administrativepenalties for late payment of fee. The Divisionshall establish administrative penalties for the late payment by a nursingfacility of a fee assessed pursuant to NRS422.3755 to 422.379, inclusive.

(Added to NRS by 2003, 2747; A 2005, 22nd SpecialSession, 35)

PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENTPATIENTS

NRS 422.380 Definitions. As used in NRS 422.380to 422.390, inclusive, unless thecontext otherwise requires:

1. Disproportionate share payment means a paymentmade pursuant to 42 U.S.C. 1396r-4.

2. Hospital has the meaning ascribed to it in NRS 439B.110 and includes public andprivate hospitals.

3. Public hospital means:

(a) A hospital owned by a state or local government,including, without limitation, a hospital district; or

(b) A hospital that is supported in whole or in part bytax revenue, other than tax revenue received for medical care which is providedto Medicaid patients, indigent patients or other low-income patients.

(Added to NRS by 1991, 2334; A 1993, 1967; 1995,1427, 1430; 1997, 1243; 2003, 2990; 2005, 1450)

NRS 422.3805 Federalwaivers: Duties of Administrator. TheAdministrator shall:

1. Apply for all waivers from federal law orregulation which are necessary to carry out the provisions of NRS 422.380 to 422.390, inclusive; and

2. If a waiver is denied or altered, take allappropriate steps to comply with the directives of the Federal Government.

(Added to NRS by 1993, 1966; A 1995, 1430; 1997,2630; 1999, 2242)

NRS 422.3807 Divisionto determine certain information concerning uncompensated care percentages ofhospitals in larger counties; hospitals to provide information to Division;reports.

1. The Division shall determine for each hospital thatis located in a county whose population is 100,000 or more the uncompensatedcare percentage of the hospital for the preceding fiscal year.

2. Based on the determinations made pursuant tosubsection 1, the Division shall determine for each county whose population is100,000 or more the arithmetic mean of the percentages determined pursuant tosubsection 1 of all hospitals in the county.

3. Each hospital shall provide to the Division anyinformation requested by the Division that the Division determines is necessaryto make a determination pursuant to this section.

4. The Division shall at least once each year prepareand submit a report concerning the determinations it makes pursuant to thissection to:

(a) The Legislative Commission;

(b) The Interim Finance Committee; and

(c) The Legislative Committee on Health Care.

5. As used in this section, uncompensated carepercentage has the meaning ascribed to it in NRS422.387.

(Added to NRS by 2005, 1450)

NRS 422.382 Transferto Division of percentage of amount of payment to hospital.

1. In a county whose population is 100,000 or morewithin which:

(a) A public hospital is located, the state or localgovernment or other entity responsible for the public hospital shall transferan amount equal to:

(1) Seventy percent of the total amount ofdisproportionate share payments distributed to all hospitals pursuant to NRS 422.387 for a fiscal year, less$1,050,000; or

(2) Sixty-eight and fifty-four one hundredthspercent of the total amount of disproportionate share payments distributed toall hospitals pursuant to NRS 422.387for a fiscal year,

whichever isless, to the Division.

(b) A private hospital which receives adisproportionate share payment pursuant to paragraph (c) of subsection 2 of NRS 422.387 is located, the county shalltransfer 1.95 percent of the total amount of disproportionate share paymentsdistributed to all hospitals pursuant to NRS422.387 for a fiscal year, but not more than $1,500,000, to the Division.

2. A county that transfers the amount requiredpursuant to paragraph (b) of subsection 1 to the Division is discharged of theduty and is released from liability for providing medical treatment forindigent inpatients who are treated in the hospital in the county that receivesa payment pursuant to paragraph (c) of subsection 2 of NRS 422.387.

3. The money transferred to the Division pursuant tosubsection 1 must not come from any source of funding that could result in anyreduction in revenue to the State pursuant to 42 U.S.C. 1396b(w).

4. Any money collected pursuant to subsection 1,including any interest or penalties imposed for a delinquent payment, must bedeposited in the State Treasury for credit to the Intergovernmental TransferAccount in the State General Fund to be administered by the Division.

5. The interest and income earned on money in theIntergovernmental Transfer Account, after deducting any applicable charges,must be credited to the Account.

(Added to NRS by 1993, 1967; A 1995, 1427, 1430;1997, 2630; 1999,2242; 2001, 3114;2003, 2990; 2005, 22nd SpecialSession, 35)

NRS 422.385 Allocationsand payments from Medicaid Budget Account; transfer of money fromIntergovernmental Transfer Account.

1. The allocations and payments requiredpursuant to subsections 1 to 5, inclusive, of NRS422.387 must be made, to the extent allowed by the State Plan for Medicaid,from the Medicaid Budget Account.

2. Except as otherwise provided in subsection 3 andsubsection 6 of NRS 422.387, the moneyin the Intergovernmental Transfer Account must be transferred from that Accountto the Medicaid Budget Account to the extent that money is available from theFederal Government for proposed expenditures, including expenditures foradministrative costs. If the amount in the Account exceeds the amountauthorized for expenditure by the Division for the purposes specified in NRS 422.387, the Division is authorized toexpend the additional revenue in accordance with the provisions of the StatePlan for Medicaid.

3. If enough money is available to support Medicaidand to make the payments required by subsection 6 of NRS 422.387, money in the IntergovernmentalTransfer Account may be transferred:

(a) To an account established for the provision ofhealth care services to uninsured children pursuant to a federal program inwhich at least 50 percent of the cost of such services is paid for by theFederal Government, including, without limitation, the Childrens HealthInsurance Program; or

(b) To carry out the provisions of NRS 439B.350 and 439B.360.

(Added to NRS by 1991, 2335; A 1993, 1969; 1995,1428, 1430; 1997, 1244, 1546, 2631; 1999, 581, 2232, 2242; 2001, 3115; 2003, 2991; 2005, 22nd SpecialSession, 35)

NRS 422.387 Allocationfor administrative costs; payments to hospitals.

1. Before making the payments required or authorizedby this section, the Division shall allocate money for the administrative costsnecessary to carry out the provisions of NRS422.380 to 422.390, inclusive. Theamount allocated for administrative costs must not exceed the amount authorizedfor expenditure by the Legislature for this purpose in a fiscal year. TheInterim Finance Committee may adjust the amount allowed for administrativecosts.

2. The State Plan for Medicaid must provide for thepayment of the maximum amount of disproportionate share payments allowableunder federal law and regulations. The State Plan for Medicaid must providethat for:

(a) All public hospitals in counties whose populationis 400,000 or more, the total annual disproportionate share payments are$66,650,000 plus 90 percent of the total amount of disproportionate sharepayments distributed by the State in that fiscal year that exceeds $76,000,000;

(b) All private hospitals in counties whose populationis 400,000 or more, the total annual disproportionate share payments are$1,200,000 plus 2.5 percent of the total amount of disproportionate sharepayments distributed by the State in that fiscal year that exceeds $76,000,000;

(c) All private hospitals in counties whose populationis 100,000 or more but less than 400,000, the total annual disproportionateshare payments are $4,800,000 plus 2.5 percent of the total amount ofdisproportionate share payments distributed by the State in that fiscal yearthat exceeds $76,000,000;

(d) All public hospitals in counties whose populationis less than 100,000, the total annual disproportionate share payments are$900,000 plus 2.5 percent of the total amount of disproportionate share paymentsdistributed by the State in that fiscal year that exceeds $76,000,000; and

(e) All private hospitals in counties whose populationis less than 100,000, the total annual disproportionate share payments are$2,450,000 plus 2.5 percent of the total amount of disproportionate sharepayments distributed by the State in that fiscal year that exceeds $76,000,000.

3. The State Plan for Medicaid must provide for a basepayment in an amount determined pursuant to subsections 4 and 5. Any amount setforth in each paragraph of subsection 2 that remains after all base paymentshave been distributed must be distributed to the hospital within that paragraphwith the highest uncompensated care percentage in an amount equal to either theamount remaining after all base payments have been distributed or the amountnecessary to reduce the uncompensated care percentage of that hospital to theuncompensated care percentage of the hospital in that paragraph with the secondhighest uncompensated care percentage, whichever is less. Any amount set forthin subsection 2 that remains after the uncompensated care percentage of thehospital with the highest uncompensated care percentage in a paragraph has beenreduced to equal the uncompensated care percentage of the hospital in thatparagraph with the second highest uncompensated care percentage must bedistributed equally to the two hospitals with the highest uncompensated care percentagein that paragraph until their uncompensated care percentages are equal to theuncompensated care percentage of the hospital with the third highestuncompensated care percentage in that paragraph. This process must be repeateduntil all available funds set forth in a paragraph of subsection 2 have beendistributed.

4. Except as otherwise provided in subsection 5, thebase payments for the purposes of subsection 3 are:

(a) For the University Medical Center of SouthernNevada, $66,531,729;

(b) For Washoe Medical Center, $4,800,000;

(c) For Carson-Tahoe Hospital, $1,000,000;

(d) For Northeastern Nevada Regional Hospital,$500,000;

(e) For Churchill Community Hospital, $500,000;

(f) For Humboldt General Hospital, $215,109;

(g) For William Bee Ririe Hospital, $204,001;

(h) For Mt. Grant General Hospital, $195,838;

(i) For South Lyon Medical Center, $174,417; and

(j) For Nye Regional Medical Center, $115,000,

or thesuccessors in interest to such hospitals.

5. The Plan must be consistent with the provisions of NRS 422.380 to 422.390, inclusive, and Title XIX of theSocial Security Act, 42 U.S.C. 1396 et seq., and the regulations adoptedpursuant to those provisions. If the total amount available to the State formaking disproportionate share payments is less than $76,000,000, theAdministrator:

(a) Shall adjust the amounts for each group ofhospitals described in a paragraph of subsection 2 proportionally in accordancewith the limits of federal law. If the amount available to hospitals in a groupdescribed in a paragraph of subsection 2 is less than the total amount of basepayments specified in subsection 4, the Administrator shall reduce the basepayments proportionally in accordance with the limits of federal law.

(b) Shall adopt a regulation specifying the amount ofthe reductions required by paragraph (a).

6. To the extent that money is available in theIntergovernmental Transfer Account, the Division shall distribute $50,000 fromthat Account each fiscal year to each public hospital which:

(a) Is located in a county that does not have any otherhospitals; and

(b) Is not eligible for a payment pursuant tosubsections 2, 3 and 4.

7. As used in this section:

(a) Total revenue is the amount of revenue a hospitalreceives for patient care and other services, net of any contractual allowancesor bad debts.

(b) Uncompensated care costs means the total costs ofa hospital incurred in providing care to uninsured patients, including, withoutlimitation, patients covered by Medicaid or another governmental program forindigent patients, less any payments received by the hospital for that care.

(c) Uncompensated care percentage means theuncompensated care costs of a hospital divided by the total revenue for thehospital.

(Added to NRS by 1991, 2335; A 1993, 1969; 1995,1428, 1430; 1997, 1244, 2631; 1999, 2242; 2001, 3116; 2003, 2992; 2005, 22nd SpecialSession, 36)

NRS 422.390 Regulations;quarterly report.

1. The Division shall adopt regulations concerning:

(a) Procedures for the transfer to the Division of theamount required pursuant to NRS 422.382.

(b) Provisions for the payment of a penalty andinterest for a delinquent transfer.

(c) Provisions for the payment of interest by theDivision for late reimbursements to hospitals or other providers of medicalcare.

(d) Provisions for the calculation of the uncompensatedcare percentage for hospitals, including, without limitation, the proceduresand methodology required to be used in calculating the percentage, and anyrequired documentation of and reporting by a hospital relating to thecalculation.

2. The Division shall report to the Interim FinanceCommittee quarterly concerning the provisions of NRS 422.380 to 422.390, inclusive.

(Added to NRS by 1991, 2337; A 1993, 1970; 1995,1429; 1997, 2631; 1999,2242; 2003, 2994;2005, 22ndSpecial Session, 38)

PROGRAM TO ASSIST RELATIVES WHO HAVE LEGAL GUARDIANSHIP OFCHILDREN

NRS 422.392 Establishmentand administration of program; qualifications for participation in program;assistance provided by program; adoption of regulations. Repealed. (Seechapter 1, Statutesof Nevada 2005, 22nd Special Session, at page 63.) (Cf. NRS 422A.650 for similar reenactedprovisions.)

 

PROGRAM TO PROVIDE COMMUNITY-BASED SERVICES TO PERSONS WITHPHYSICAL DISABILITIES

NRS 422.395 Personwith a physical disability defined. As usedin NRS 422.396 and 422.397, unless the context otherwiserequires, person with a physical disability means a person with a severephysical disability that substantially limits his ability to participate andcontribute independently in the community in which he lives.

(Added to NRS by 1997, 2659)

NRS 422.396 Establishmentand administration of program; application for federal waiver to amend StatePlan for Medicaid; contracting for services; adoption of regulations.

1. The Department, through a division of theDepartment designated by the Director, shall establish and administer a programto provide community-based services necessary to enable a person with aphysical disability to remain in his home or with his family and avoidplacement in a facility for long-term care. The Department shall coordinate theprovision of community-based services pursuant to this section.

2. The Department shall apply to the Secretary ofHealth and Human Services for a waiver granted pursuant to 42 U.S.C. 1396n(c)that authorizes the Department to amend the State Plan for Medicaid adopted bythe Department pursuant to NRS 422.271in order to authorize the Department to include as medical assistance under theState Plan the following services for persons with physical disabilities:

(a) Respite care;

(b) Habilitation;

(c) Residential habilitation;

(d) Environmental modifications;

(e) Supported living;

(f) Supported living habilitation;

(g) Supported personal care; and

(h) Any other community-based services approved by theSecretary of Health and Human Services.

TheDepartment shall cooperate with the Federal Government in obtaining a waiverpursuant to this subsection.

3. The Department may use personnel of the Departmentor it may contract with any appropriate public or private agency, organizationor institution to provide the community-based services necessary to enable aperson with a physical disability to remain in his home or with his family andavoid placement in a facility for long-term care.

4. A contract entered into with a public or privateagency, organization or institution pursuant to subsection 3 must:

(a) Include a description of the type of service to beprovided;

(b) Specify the price to be paid for each service andthe method of payment; and

(c) Specify the criteria to be used to evaluate theprovision of the service.

5. The Department shall adopt regulations necessary tocarry out the provisions of this section, including, without limitation, thecriteria to be used in determining eligibility for the services providedpursuant to the program. Before adopting regulations pursuant to this section,the Department shall solicit comments from persons with a variety ofdisabilities and members of the families of those persons.

(Added to NRS by 1997, 2659; A 2003, 2622)

NRS 422.397 Reportsby Director. On or before December 31 of eacheven-numbered year, the Director shall:

1. Prepare a report of the effectiveness of the programadministered pursuant to NRS 422.396during the preceding biennium; and

2. Submit the report to the Governor and to theDirector of the Legislative Counsel Bureau for transmittal to the next regularsession of the Nevada Legislature.

(Added to NRS by 1997, 2660)

PRESCRIPTION DRUGS

NRS 422.401 Definitions. As used in NRS 422.401to 422.406, inclusive, unless thecontext otherwise requires, the words and terms defined in NRS 422.4015 and 422.402 have the meanings ascribed to themin those sections.

(Added to NRS by 2003, 1317)

NRS 422.4015 Committeedefined. Committee means the Pharmacy andTherapeutics Committee established pursuant to NRS 422.4035.

(Added to NRS by 2003, 1317)

NRS 422.402 DrugUse Review Board defined. Drug Use ReviewBoard means the Board established pursuant to 42 U.S.C. 1396r-8(g)(3).

(Added to NRS by 2003, 1317)

NRS 422.4025 Listof preferred prescription drugs used for Medicaid program; list of drugsexcluded from restrictions; role of Pharmacy and Therapeutics Committee;availability of new pharmaceutical products and products for which there is newevidence.

1. The Department shall, by regulation, develop a listof preferred prescription drugs to be used for the Medicaid program.

2. The Department shall, by regulation, establish alist of prescription drugs which must be excluded from any restrictions thatare imposed on drugs that are on the list of preferred prescription drugsestablished pursuant to subsection 1. The list established pursuant to thissubsection must include, without limitation:

(a) Atypical and typical antipsychotic medications thatare prescribed for the treatment of a mental illness of a patient who isreceiving services pursuant to Medicaid;

(b) Prescription drugs that are prescribed for thetreatment of the human immunodeficiency virus or acquired immunodeficiencysyndrome, including, without limitation, protease inhibitors and antiretroviralmedications;

(c) Anticonvulsant medications;

(d) Antirejection medications for organ transplants;

(e) Antidiabetic medications;

(f) Antihemophilic medications; and

(g) Any prescription drug which the Committeeidentifies as appropriate for exclusion from any restrictions that are imposedon drugs that are on the list of preferred prescription drugs.

3. The regulations must provide that the Committeemakes the final determination of:

(a) Whether a class of therapeutic prescription drugsis included on the list of preferred prescription drugs and is excluded fromany restrictions that are imposed on drugs that are on the list of preferredprescription drugs;

(b) Which therapeutically equivalent prescription drugswill be reviewed for inclusion on the list of preferred prescription drugs andfor exclusion from any restrictions that are imposed on drugs that are on thelist of preferred prescription drugs; and

(c) Which prescription drugs should be excluded fromany restrictions that are imposed on drugs that are on the list of preferredprescription drugs based on continuity of care concerning a specific diagnosis,condition, class of therapeutic prescription drugs or medical specialty.

4. The regulations must provide that each newpharmaceutical product and each existing pharmaceutical product for which thereis new clinical evidence supporting its inclusion on the list of preferredprescription drugs must be made available pursuant to the Medicaid program withprior authorization until the Committee reviews the product or the evidence.

(Added to NRS by 2003, 1317)

NRS 422.403 Establishmentand management of use by Medicaid program of step therapy and priorauthorization; duties of Drug Use Review Board; acceptance of recommendationsfrom Board.

1. The Department shall, by regulation, establish andmanage the use by the Medicaid program of step therapy and prior authorizationfor prescription drugs.

2. The Drug Use Review Board shall:

(a) Advise the Department concerning the use by theMedicaid program of step therapy and prior authorization for prescriptiondrugs;

(b) Develop step therapy protocols and priorauthorization policies and procedures for use by the Medicaid program forprescription drugs; and

(c) Review and approve, based on clinical evidence andbest clinical practice guidelines and without consideration of the cost of theprescription drugs being considered, step therapy protocols used by theMedicaid program for prescription drugs.

3. The Department shall not require the Drug UseReview Board to develop, review or approve prior authorization policies orprocedures necessary for the operation of the list of preferred prescriptiondrugs developed for the Medicaid program pursuant to NRS 422.4025.

4. The Department shall accept recommendations fromthe Drug Use Review Board as the basis for developing or revising step therapyprotocols and prior authorization policies and procedures used by the Medicaidprogram for prescription drugs.

(Added to NRS by 2003, 1318)

NRS 422.4035 Pharmacyand Therapeutics Committee: Creation; membership.

1. The Director shall create a Pharmacy andTherapeutics Committee within the Department. The Committee must consist of atleast 9 members and not more than 11 members appointed by the Governor based onrecommendations from the Director.

2. The Governor shall appoint to the Committee healthcare professionals who have knowledge and expertise in one or more of thefollowing:

(a) The clinically appropriate prescribing of outpatientprescription drugs that are covered by Medicaid;

(b) The clinically appropriate dispensing andmonitoring of outpatient prescription drugs that are covered by Medicaid;

(c) The review of, evaluation of and intervention inthe use of prescription drugs; and

(d) Medical quality assurance.

3. At least one-third of the members of the Committeeand not more than 51 percent of the members of the Committee must be activephysicians licensed to practice medicine in this State, at least one of whommust be an active psychiatrist licensed to practice medicine in this State. Atleast one-third of the members of the Committee and not more than 51 percent ofthe members of the Committee must be either active pharmacists registered inthis State or persons in this State with doctoral degrees in pharmacy.

4. A person must not be appointed to the Committee ifhe is employed by, compensated by in any manner, has a financial interest in,or is otherwise affiliated with a business or corporation that manufacturesprescription drugs.

(Added to NRS by 2003, 1318)

NRS 422.404 Pharmacyand Therapeutics Committee: Chairman; terms; vacancies; meetings; quorum.

1. The Governor shall appoint the Chairman of theCommittee from among its members.

2. After the initial terms, the term of each member ofthe Committee is 2 years. A member may be reappointed.

3. A vacancy occurring in the membership of theCommittee must be filled for the remainder of the unexpired term in the samemanner as the original appointment.

4. The Committee shall meet at least once every 3months and at the times and places specified by a call of the Chairman of theCommittee.

5. A majority of the members of the Committeeconstitutes a quorum for the transaction of business, and the affirmative voteof a majority of the members of the Committee is required to take action.

(Added to NRS by 2003, 1319)

NRS 422.4045 Pharmacyand Therapeutics Committee: Members serve without compensation; membersentitled to per diem; members holding public office or employed by governmentalentity.

1. Members of the Committee serve without compensation,except that a member of the Committee is entitled, while engaged in thebusiness of the Committee, to receive the per diem allowance and travelexpenses provided for state officers and employees generally.

2. Each member of the Committee who is an officer oremployee of the State of Nevada or a local government must be relieved from hisduties without loss of his regular compensation so that he may prepare for andattend meetings of the Committee and perform any work necessary to carry outthe duties of the Committee in the most timely manner practicable. A stateagency or local governmental entity shall not require an officer or employeewho is a member of the Committee to make up the time that he is absent fromwork to carry out his duties as a member of the Committee or to use annualvacation or compensatory time for the absence.

(Added to NRS by 2003, 1319)

NRS 422.405 Pharmacyand Therapeutics Committee: Duties and powers.

1. The Department shall, by regulation, set forth theduties of the Committee which must include, without limitation:

(a) Identifying the prescription drugs which should beincluded on the list of preferred prescription drugs developed by the Departmentfor the Medicaid program pursuant to NRS422.4025 and the prescription drugs which should be excluded from anyrestrictions that are imposed on drugs that are on the list of preferredprescription drugs;

(b) Identifying classes of therapeutic prescriptiondrugs for its review and performing a clinical analysis of each drug includedin each class that is identified for review; and

(c) Reviewing at least annually all classes of therapeuticprescription drugs on the list of preferred prescription drugs developed by theDepartment for the Medicaid program pursuant to NRS 422.4025.

2. The Department shall, by regulation, require theCommittee to:

(a) Base its decisions on evidence of clinical efficacyand safety without consideration of the cost of the prescription drugs beingconsidered by the Committee;

(b) Review new pharmaceutical products in asexpeditious a manner as possible; and

(c) Consider new clinical evidence supporting theinclusion of an existing pharmaceutical product on the list of preferredprescription drugs developed by the Department for the Medicaid program and newclinical evidence supporting the exclusion of an existing pharmaceuticalproduct from any restrictions that are imposed on drugs that are on the list ofpreferred prescription drugs in as expeditious a manner as possible.

3. The Department shall, by regulation, authorize theCommittee to:

(a) In carrying out its duties, exercise clinicaljudgment and analyze peer review articles, published studies, and other medicaland scientific information; and

(b) Establish subcommittees to analyze specific issuesthat arise as the Committee carries out its duties.

(Added to NRS by 2003, 1319)

NRS 422.4055 AdvisoryCommittee to the Pharmacy and Therapeutics Committee and the Drug Use ReviewBoard: Creation; membership; Chairman; terms; vacancies; members serve withoutcompensation; members entitled to per diem; members holding public office oremployed by governmental entity.

1. The Advisory Committee to the Pharmacy andTherapeutics Committee and the Drug Use Review Board consisting of threemembers is hereby created in the Department to advise the Committee and theDrug Use Review Board concerning prescription drugs that are used by seniors,persons who are mentally ill or persons with disabilities.

2. The Director of the Department shall appoint to theAdvisory Committee:

(a) One member appointed from a list of personsprovided to the Department by the American Association of Retired Persons orany successor organization;

(b) One member appointed from a list of personsprovided to the Department by the Alliance for the Mentally Ill of Nevada orany successor organization; and

(c) One member appointed from a list of personsprovided to the Department by the Statewide Independent Living Councilestablished in this State pursuant to 29 U.S.C. 796d.

3. The Director shall appoint the Chairman of theAdvisory Committee from among its members.

4. After the initial terms, the term of each member ofthe Advisory Committee is 2 years. A member may be reappointed. A vacancyoccurring in the membership of the Advisory Committee must be filled for theremainder of the unexpired term in the same manner as the original appointment.

5. Members of the Advisory Committee serve withoutcompensation, except that a member of the Advisory Committee is entitled, whileengaged in the business of the Advisory Committee, to receive the per diemallowance and travel expenses provided for state officers and employeesgenerally.

6. Each member of the Advisory Committee who is an officeror employee of the State of Nevada or a local government must be relieved fromhis duties without loss of his regular compensation so that he may prepare forand attend meetings of the Advisory Committee and perform any work necessary tocarry out the duties of the Advisory Committee in the most timely mannerpracticable. A state agency or local governmental entity shall not require anofficer or employee who is a member of the Advisory Committee to make up thetime that he is absent from work to carry out his duties as a member of theAdvisory Committee or to use annual vacation or compensatory time for theabsence.

(Added to NRS by 2003, 1320)

NRS 422.406 Regulations;contracts for services.

1. The Department may, to carry out its duties setforth in NRS 422.401 to 422.406, inclusive, and to administer theprovisions of NRS 422.401 to 422.406, inclusive:

(a) Adopt regulations; and

(b) Enter into contracts for any services.

2. Any regulations adopted by the Department pursuantto NRS 422.401 to 422.406, inclusive, must be adopted inaccordance with the provisions of chapter 241of NRS.

(Added to NRS by 2003, 1321)

UNLAWFUL ACTS; PENALTIES

General Provisions

NRS 422.410 Fraudulentacts; penalties.

1. Unless a different penalty is providedpursuant to NRS 422.361 to 422.369, inclusive, or 422.450 to 422.590, inclusive, a person who knowinglyand designedly, by any false pretense, false or misleading statement,impersonation or misrepresentation, obtains or attempts to obtain monetary orany other public assistance, or money, property, medical or remedial care orany other service provided pursuant to the Childrens Health Insurance Program,having a value of $100 or more, whether by one act or a series of acts, withthe intent to cheat, defraud or defeat the purposes of this chapter is guiltyof a category E felony and shall be punished as provided in NRS 193.130. In addition to any otherpenalty, the court shall order the person to pay restitution.

2. For the purposes of subsection 1, whenever arecipient of Temporary Assistance for Needy Families pursuant to the provisionsof this chapter and chapter 422A of NRSreceives an overpayment of benefits for the third time and the overpaymentshave resulted from a false statement or representation by the recipient or fromthe failure of the recipient to notify the Division of Welfare and SupportiveServices of the Department of a change in his circumstances which would affectthe amount of assistance he receives, a rebuttable presumption arises that thepayment was fraudulently received.

3. For the purposes of subsection 1, publicassistance includes any money, property, medical or remedial care or any otherservice provided pursuant to a state plan.

(Added to NRS by 1981, 1909; A 1985, 1405; 1991,1053; 1993, 142, 2788, 2819; 1995, 1274; 1997, 2239; 1999, 2233; 2005, 22nd SpecialSession, 38)

State Plan for Medicaid

NRS 422.450 Definitions. As used in NRS 422.450to 422.590, inclusive, unless thecontext otherwise requires, the words and terms defined in NRS 422.460 to 422.525, inclusive, have the meaningsascribed to them in those sections.

(Added to NRS by 1991, 1048; A 1997, 456)

NRS 422.460 Benefitdefined. Benefit means a benefit authorizedby the Plan.

(Added to NRS by 1991, 1048)

NRS 422.470 Claimdefined. Claim means a communication,whether oral, written, electronic or magnetic, which is used to identifyspecific goods, items or services as reimbursable pursuant to the Plan, orwhich states income or expense and is or may be used to determine a rate ofpayment pursuant to the Plan.

(Added to NRS by 1991, 1048)

NRS 422.480 Plandefined. Plan means the State Plan forMedicaid established pursuant to NRS 422.271.

(Added to NRS by 1991, 1048; A 1993, 2067; 1997,1245)

NRS 422.490 Providerdefined. Provider means a:

1. Person who has applied to participate or whoparticipates in the Plan as the provider of goods or services; or

2. Private insurance carrier, health care cooperativeor alliance, health maintenance organization, insurer, organization, entity,association, affiliation or person, who contracts to provide or provides goodsor services that are reimbursed by or are a required benefit of the Plan.

(Added to NRS by 1991, 1048; A 1997, 456)

NRS 422.500 Recipientdefined. Recipient means a natural personwho receives benefits pursuant to the Plan.

(Added to NRS by 1991, 1048)

NRS 422.510 Recordsdefined. Records means medical, professionalor business records relating to the treatment or care of a recipient, or to agood or a service provided to a recipient, or to rates paid for such a good ora service, and records required to be kept by the Plan.

(Added to NRS by 1991, 1048)

NRS 422.520 Signdefined. Sign means to affix a signaturedirectly or indirectly by means of handwriting, typewriter, stamp, computerimpulse or other means.

(Added to NRS by 1991, 1048)

NRS 422.525 Statementor representation defined. Statement or representationincludes, without limitation, a report, claim, certification, acknowledgment orratification of:

1. Financial information;

2. An enrollment claim;

3. Demographic statistics;

4. Encounter data;

5. Health services available or rendered;

6. The qualifications of the persons rendering thehealth care or ancillary services; or

7. Any combination of subsections 1 to 6, inclusive.

(Added to NRS by 1997, 456)

NRS 422.530 Responsibilityfor false claim, statement or representation. Forthe purposes of NRS 422.540 and 422.550:

1. A person shall be deemed to have known that aclaim, statement or representation was false if he knew, or by virtue of hisposition, authority or responsibility had reason to know, of the falsity of theclaim, statement or representation.

2. A person shall be deemed to have made or caused tobe made a claim, statement or representation if he:

(a) Had the authority or responsibility to:

(1) Make the claim, statement or representation;

(2) Supervise another who made the claim,statement or representation; or

(3) Authorize the making of the claim, statementor representation,

whether byoperation of law, business or professional practice, or office procedure; and

(b) Exercised that authority or responsibility orfailed to exercise that authority or responsibility and, as a direct orindirect result, the false claim, statement or representation was made.

(Added to NRS by 1991, 1048; A 1997, 456)

NRS 422.540 Offensesregarding false claims, statements or representations; penalties.

1. A person, with the intent to defraud, commits anoffense if with respect to the Plan he:

(a) Makes a claim or causes it to be made, knowing theclaim to be false, in whole or in part, by commission or omission;

(b) Makes or causes to be made a statement orrepresentation for use in obtaining or seeking to obtain authorization toprovide specific goods or services, knowing the statement or representation tobe false, in whole or in part, by commission or omission;

(c) Makes or causes to be made a statement orrepresentation for use by another in obtaining goods or services pursuant tothe Plan, knowing the statement or representation to be false, in whole or inpart, by commission or omission; or

(d) Makes or causes to be made a statement orrepresentation for use in qualifying as a provider, knowing the statement orrepresentation to be false, in whole or in part, by commission or omission.

2. A person who commits an offense described insubsection 1 shall be punished for a:

(a) Category D felony, as provided in NRS 193.130, if the amount of the claim orthe value of the goods or services obtained or sought to be obtained wasgreater than or equal to $250.

(b) Misdemeanor if the amount of the claim or the valueof the goods or services obtained or sought to be obtained was less than $250.

Amountsinvolved in separate violations of this section committed pursuant to a schemeor continuing course of conduct may be aggregated in determining the punishment.

3. In addition to any other penalty for a violation ofthe commission of an offense described in subsection 1, the court shall orderthe person to pay restitution.

(Added to NRS by 1991, 1049; A 1997, 457)

NRS 422.550 Statementregarding truth and accuracy of applications, reports and invoices; perjury;presumption concerning person who signs statement on behalf of provider.

1. Each application or report submitted to participateas a provider, each report stating income or expense upon which rates ofpayment are or may be based, and each invoice for payment for goods or servicesprovided to a recipient must contain a statement that all matters statedtherein are true and accurate, signed by a natural person who is the provideror is authorized to act for the provider, under the pains and penalties ofperjury.

2. A person is guilty of perjury which is a category Dfelony and shall be punished as provided in NRS193.130 if he signs or submits, or causes to be signed or submitted, such astatement, knowing that the application, report or invoice contains informationwhich is false, in whole or in part, by commission or by omission.

3. For the purposes of this section, a person whosigns on behalf of a provider is presumed to have the authorization of theprovider and to be acting at his direction.

(Added to NRS by 1991, 1049; A 1995, 1274; 1997, 457)

NRS 422.560 Offensesregarding sale, purchase or lease of goods, services, materials or supplies;penalty.

1. Except as otherwise provided in subsection 2, aperson shall not:

(a) While acting on behalf of a provider, purchase orlease goods, services, materials or supplies for which payment may be made, inwhole or in part, pursuant to the Plan, and solicit or accept anything ofadditional value in return for or in connection with the purchase or lease;

(b) Sell or lease to or for the use of a providergoods, services, materials or supplies for which payment may be made, in wholeor in part, pursuant to the Plan, and offer, transfer or pay anything ofadditional value in connection with or in return for the sale or lease; or

(c) Refer a person to a provider for goods or servicesfor which payment may be made, in whole or in part, pursuant to the Plan, andsolicit or accept anything of value in connection with the referral.

2. Paragraphs (a) and (b) of subsection 1 do not applyif the additional value transferred is:

(a) A refund or discount made in the ordinary course ofbusiness;

(b) Reflected by the books and records of the persontransferring or receiving it; and

(c) Reflected in the billings submitted to the Plan.

3. A person shall not, while acting on behalf of aprovider providing goods or services to a recipient pursuant to the Plan,charge, solicit, accept or receive anything of additional value in addition tothe amount legally payable pursuant to the Plan in connection with theprovision of the goods or services.

4. A person who violates this section, if the value ofthe thing or any combination of things unlawfully solicited, accepted, offered,transferred, paid, charged or received:

(a) Is less than $250, is guilty of a grossmisdemeanor.

(b) Is $250 or more, is guilty of a category D felonyand shall be punished as provided in NRS193.130.

(Added to NRS by 1991, 1049; A 1995, 1275)

NRS 422.570 Intentionalfailure to maintain adequate records; intentional destruction of records;penalties.

1. A person is guilty of a gross misdemeanor if, uponsubmitting a claim for or upon receiving payment for goods or services pursuantto the Plan, he intentionally fails to maintain such records as are necessaryto disclose fully the nature of the goods or services for which a claim wassubmitted or payment was received, or such records as are necessary to disclosefully all income and expenditures upon which rates of payment were based, forat least 5 years after the date on which payment was received.

2. A person who intentionally destroys such recordswithin 5 years after the date payment was received is guilty of a category Dfelony and shall be punished as provided in NRS193.130.

(Added to NRS by 1991, 1050; A 1995, 1275)

NRS 422.580 Civilpenalties for certain violations; liability of provider for excess amountunknowingly accepted; enforcement; use of money collected as penalty orrepayment.

1. A provider who receives payment to which he is notentitled by reason of a violation of NRS422.540, 422.550, 422.560 or 422.570 is liable for:

(a) An amount equal to three times the amountunlawfully obtained;

(b) Not less than $5,000 for each false claim,statement or representation;

(c) An amount equal to three times the total of thereasonable expenses incurred by the State in enforcing this section; and

(d) Payment of interest on the amount of the excesspayment at the rate fixed pursuant to NRS99.040 for the period from the date upon which payment was made to the dateupon which repayment is made pursuant to the Plan.

2. A criminal action need not be brought against theprovider before civil liability attaches under this section.

3. A provider who unknowingly accepts a payment inexcess of the amount to which he is entitled is liable for the repayment of theexcess amount. It is a defense to any action brought pursuant to thissubsection that the provider returned or attempted to return the amount whichwas in excess of that to which he was entitled within a reasonable time afterreceiving it.

4. The Attorney General shall cause appropriate legalaction to be taken on behalf of the State to enforce the provisions of thissection.

5. Any penalty or repayment of money collectedpursuant to this section is hereby appropriated to provide medical aid to theindigent through programs administered by the Department.

(Added to NRS by 1991, 1050; A 1997, 458; 1999, 2233)

NRS 422.590 Limitationand accrual of actions. An action brought pursuantto NRS 422.540 to 422.580, inclusive, must be commencedwithin 4 years, but the cause of action in such a case shall be deemed toaccrue upon the discovery by the aggrieved party of the facts constituting aviolation of NRS 422.540 to 422.580, inclusive.

(Added to NRS by 1997, 456)

MISCELLANEOUS PROVISIONS

NRS 422.600 Jobdevelopment coordinators: Employment by Department of Employment, Training andRehabilitation; duties. Repealed. (See chapter 1, Statutes of Nevada2005, 22nd Special Session, at page 63.)

 

 

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