[Rev. 2/10/2015 5:24:03
PM--2014R2]
TITLE 38 - PUBLIC WELFARE
CHAPTER 422 - HEALTH CARE FINANCING AND
POLICY
GENERAL PROVISIONS
NRS 422.001 Definitions.
NRS 422.003 “Administrator”
defined.
NRS 422.021 “Children’s
Health Insurance Program” defined.
NRS 422.030 “Department”
defined.
NRS 422.040 “Director”
defined.
NRS 422.041 “Division”
defined.
NRS 422.042 “Food
Stamp Assistance” defined. [Repealed.]
NRS 422.045 “Low-Income
Home Energy Assistance” defined. [Repealed.]
NRS 422.046 “Medicaid”
defined.
NRS 422.048 “Program
for Child Care and Development” defined. [Repealed.]
NRS 422.050 “Public
assistance” defined.
NRS 422.0525 “State
Supplementary Assistance” defined. [Repealed.]
NRS 422.053 “Supplemental
Security Income Program” defined. [Repealed.]
NRS 422.0535 “Temporary
Assistance for Needy Families” defined. [Repealed.]
NRS 422.054 “Undivided
estate” defined.
NRS 422.061 Purposes
of Division.
NRS 422.065 Eligibility
of persons who are not citizens or nationals of United States for state or
local public benefits.
MEDICAL CARE ADVISORY GROUP
NRS 422.151 Creation;
function.
NRS 422.153 Composition;
terms and compensation of members.
NRS 422.155 Chair;
Secretary; meetings; subcommittees.
ADMINISTRATOR OF DIVISION OF HEALTH CARE FINANCING AND POLICY
NRS 422.2354 Qualifications.
NRS 422.2356 Executive
Officer of Division; administration and management of Division.
NRS 422.2358 Reports.
NRS 422.2362 Fiscal
duties.
NRS 422.2364 Organization
of Division; appointment of heads of sections; employees; standards of service.
NRS 422.2366 Administration
of oaths; testimony of witnesses; subpoenas.
NRS 422.2368 Adoption
of regulations.
NRS 422.2369 Procedure
for adopting, amending or repealing regulations.
NRS 422.2372 General
and miscellaneous powers and duties.
NRS 422.2374 Cooperation
with Medicaid Fraud Control Unit; suspension or exclusion of provider of goods
or services under State Plan for Medicaid.
ADMINISTRATION AND PROCEDURE
NRS 422.240 Legislative
appropriations; disbursements.
NRS 422.245 Deposit
of money received for certain programs in appropriate accounts of Division in
State General Fund. [Repealed.]
NRS 422.260 Acceptance
of Social Security Act and federal money.
NRS 422.265 Acceptance
of increased benefits of future congressional legislation; regulations.
NRS 422.267 Contract
or agreement with Federal Government by Director.
NRS 422.270 Duties
of Department regarding Medicaid and Children’s Health Insurance Program.
NRS 422.2703 Department
required to establish and maintain system for electronic submission of
applications for Medicaid or Children’s Health Insurance Program.
NRS 422.2705 Contracts
for provision of certain transportation services for recipients of Medicaid and
recipients of services pursuant to Children’s Health Insurance Program.
NRS 422.2708 Amendment
of home and community-based services waiver to include as medical assistance
under Medicaid funding of assisted living supportive services for senior
citizens who reside in certain assisted living facilities.
NRS 422.271 State
plans for certain programs: Development, adoption and revision by Director;
Division required to comply.
NRS 422.2712 State
plans for certain programs: Reporting of certain rates of reimbursement for
physicians.
NRS 422.2713 State
plans for certain programs: Priority access to treatment and services for certain
parents.
NRS 422.2715 Program
to provide medical assistance to certain persons who are employed and have
disabilities.
NRS 422.2716 Provision
of public assistance to qualified aliens. [Repealed.]
NRS 422.2717 State
Plan for Medicaid: Inclusion of requirement that independent foster care
adolescents are eligible for Medicaid.
NRS 422.2718 State
Plan for Medicaid: Inclusion of requirement for payment of certain expenses
related to administration of human papillomavirus vaccine.
NRS 422.272 State
Plan for Medicaid: Inclusion of requirement for payment of certain costs.
NRS 422.2723 State
Plan for Medicaid: Inclusion of requirement for payment of certain costs
relating to dialysis and emergency care to treat kidney failure.
NRS 422.273 Establishment,
development and implementation of Medicaid managed care program.
NRS 422.2748 Cooperation
with Medicaid Fraud Control Unit.
NRS 422.275 Legal
advisers for Division.
NRS 422.276 Appeal
to Division by applicant for or recipient of benefits from Medicaid or
Children’s Health Insurance Program; notice of initial decision; hearing.
NRS 422.277 Hearing:
Rights of parties; informal disposition; record; transcribing of oral
proceedings; findings of fact; certain employees or representatives of Division
prohibited from participating in decision.
NRS 422.2775 Hearing:
Evidence.
NRS 422.278 Hearing:
Person with communications disability entitled to services of interpreter.
NRS 422.2785 Contents
and delivery of decision or order of hearing officer; petition for judicial
review; filing of decision and record with court.
NRS 422.279 Judicial
review: Taking of additional evidence; limitations on review; grounds for
reversal; appeal to appellate court.
NRS 422.280 Forms
of reports and records to be kept by persons subject to supervision or
investigation by Division.
NRS 422.284 Family
planning service; birth control.
NRS 422.287 Provision
of prenatal care to pregnant women who are indigent; provision of information
concerning availability of prenatal care; regulations.
NRS 422.288 Enrollment
of eligible Indian children in Children’s Health Insurance Program: Duty of
Department to seek assistance of and cooperate with Indian tribes; immediate
action required; certain contracts for provision of services required.
NRS 422.290 Custody,
use, preservation and confidentiality of records, files and communications
concerning applicants for and recipients of public assistance or assistance
pursuant to Children’s Health Insurance Program.
NRS 422.291 Assistance
not assignable or subject to process or bankruptcy law.
NRS 422.292 Assistance
subject to future amending and repealing acts.
NRS 422.293 Subrogation:
Department subrogated to rights of recipient of Medicaid or of insurance
provided pursuant to Children’s Health Insurance Program; lien on proceeds of
recovery.
NRS 422.293001 Subrogation:
Notice to Department of recipient’s claim; statute of limitations tolled until
notice received.
NRS 422.293003 Subrogation:
Department required to provide notice of amount of lien; enforceability of
lien.
NRS 422.293005 Subrogation:
Liability for failure to comply with provisions.
NRS 422.29301 Administration
of provisions concerning recovery of amounts incorrectly paid for recipient of
Medicaid.
NRS 422.29302 Recovery
of benefits paid for Medicaid: Powers and duties of Department; claim against
estate of recipient; regulations; distribution of money recovered; payment in
cash.
NRS 422.29304 Recovery
of amounts paid for Medicaid under certain circumstances; powers and duties of
Department; duty to reimburse Department; waiver of repayment.
NRS 422.29306 Imposition
and release of lien on property of recipient of Medicaid.
NRS 422.29308 Application
for Medicaid: Statements regarding action for recovery and civil liability of
recipient. [Repealed.]
NRS 422.301 Administrative
duties of Administrator and Division.
NRS 422.302 Gifts
and grants of money to Division: Deposit in Gift and Cooperative Account of the
Division of Health Care Financing and Policy; use; approval of claims by
Administrator.
NRS 422.303 Reimbursement
of registered nurse for certain services provided to person eligible for
Medicaid.
NRS 422.304 Reimbursement
for services for hospice care provided to person eligible for Medicaid.
NRS 422.3045 Denial
of application for Children’s Health Insurance Program: Notice; review of case
and hearing; regulations; review by court. [Repealed.]
NRS 422.305 Confidentiality
of information obtained in investigation of provider of services under State
Plan for Medicaid.
NRS 422.306 Hearing
to review action taken against provider of services under State Plan for Medicaid;
regulations; appeal of final decision.
MEDICAID CARDS
NRS 422.361 Definitions.
NRS 422.362 “Cardholder”
defined.
NRS 422.363 “Medicaid
card” defined.
NRS 422.364 “Plan”
defined.
NRS 422.365 “Receives”
defined.
NRS 422.366 Unlawful
acts: Obtaining or possessing card without consent of holder of card;
presumption from possession of card; penalty.
NRS 422.367 Unlawful
acts: Sale or purchase of card; authorization by holder of card for use by
person not entitled to use card; penalty.
NRS 422.368 Unlawful
acts: Use of forged, expired or revoked card to obtain benefits; receipt of
benefits by misrepresentation; penalty.
NRS 422.369 Unlawful
acts: Fraud by person authorized to provide care to holder of card; penalty.
ASSESSMENT OF FEES ON NURSING FACILITIES TO INCREASE QUALITY
OF NURSING CARE
NRS 422.3755 Definitions.
NRS 422.376 “Facility
for intermediate care” defined.
NRS 422.3765 “Facility
for skilled nursing” defined.
NRS 422.3771 “Nursing
facility” defined.
NRS 422.3775 Payment
of fee; amount of fee; allowable cost for Medicaid reimbursement purposes.
NRS 422.378 Report
by nursing facility to Division.
NRS 422.3785 Creation
of Account to Increase the Quality of Nursing Care; deposit of money for credit
to Account; expenditures from Account; consequence of federal law prohibiting
certain expenditures from Account.
NRS 422.379 Administrative
penalties for late payment of fee; recoupment of fees and administrative
penalties.
PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENT
PATIENTS
NRS 422.380 Definitions.
NRS 422.3805 Federal
waivers: Duties of Administrator.
NRS 422.382 Intergovernmental
transfers of money from counties to Division; deposit in Intergovernmental
Transfer Account in State General Fund; administration by Division.
NRS 422.385 Disproportionate
share payments from Medicaid Budget Account; transfer of money from
Intergovernmental Transfer Account.
NRS 422.387 Calculation
of disproportionate share payments; verification of eligibility for
disproportionate share payments; Director authorized to negotiate terms of
amendment to State Plan for Medicaid with Centers for Medicare and Medicaid
Services of United States Department of Health and Human Services.
NRS 422.390 Regulations;
quarterly report.
PROGRAM TO PROVIDE COMMUNITY-BASED SERVICES TO PERSONS WITH PHYSICAL
DISABILITIES
NRS 422.395 “Person
with a physical disability” defined. [Repealed.]
NRS 422.396 Establishment
and administration of program; application for federal waiver to amend State
Plan for Medicaid; contracting for services; adoption of regulations.
NRS 422.397 Reports
by Director. [Repealed.]
PRESCRIPTION DRUGS
NRS 422.401 Definitions.
NRS 422.4015 “Committee”
defined.
NRS 422.402 “Drug
Use Review Board” defined.
NRS 422.4025 List
of preferred prescription drugs used for Medicaid program; list of drugs
excluded from restrictions; role of Pharmacy and Therapeutics Committee;
availability of new pharmaceutical products and products for which there is new
evidence. [Effective through June 30, 2015.]
NRS 422.4025 List
of preferred prescription drugs used for Medicaid program; list of drugs
excluded from restrictions; role of Pharmacy and Therapeutics Committee;
availability of new pharmaceutical products and products for which there is new
evidence. [Effective July 1, 2015.]
NRS 422.403 Establishment
and management of use by Medicaid program of step therapy and prior
authorization; duties of Drug Use Review Board; acceptance of recommendations
from Board.
NRS 422.4035 Pharmacy
and Therapeutics Committee: Creation; membership.
NRS 422.404 Pharmacy
and Therapeutics Committee: Chair; terms; vacancies; meetings; quorum.
NRS 422.4045 Pharmacy
and Therapeutics Committee: Members serve without compensation; members
entitled to per diem; members holding public office or employed by governmental
entity.
NRS 422.405 Pharmacy
and Therapeutics Committee: Duties and powers.
NRS 422.4055 Advisory
Committee to the Pharmacy and Therapeutics Committee and the Drug Use Review
Board: Creation; membership; Chair; terms; vacancies; members serve without
compensation; members entitled to per diem; members holding public office or
employed by governmental entity.
NRS 422.406 Regulations;
contracts for services.
UNLAWFUL ACTS; PENALTIES
General Provisions
NRS 422.410 Fraudulent
acts; penalties.
State Plan for Medicaid
NRS 422.450 Definitions.
NRS 422.460 “Benefit”
defined.
NRS 422.470 “Claim”
defined.
NRS 422.480 “Plan”
defined.
NRS 422.490 “Provider”
defined.
NRS 422.500 “Recipient”
defined.
NRS 422.510 “Records”
defined.
NRS 422.520 “Sign”
defined.
NRS 422.525 “Statement
or representation” defined.
NRS 422.530 Responsibility
for false claim, statement or representation.
NRS 422.540 Offenses
regarding false claims, statements or representations; penalties.
NRS 422.550 Statement
regarding truth and accuracy of applications, reports and invoices; perjury;
presumption concerning person who signs statement on behalf of provider.
NRS 422.560 Offenses
regarding sale, purchase or lease of goods, services, materials or supplies;
penalty.
NRS 422.570 Intentional
failure to maintain adequate records; intentional destruction of records;
penalties.
NRS 422.580 Civil
penalties for certain violations; liability of provider for excess amount
unknowingly accepted; enforcement; use of money collected as penalty or
repayment.
NRS 422.590 Limitation
and accrual of actions.
_________
GENERAL PROVISIONS
NRS 422.001 Definitions. As
used in this chapter, unless the context otherwise requires, the words and
terms defined in NRS 422.003 to 422.054, inclusive, have the 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
Special Session, 21)
NRS 422.003 “Administrator” defined. “Administrator”
means the Administrator of the Division.
(Added to NRS by 2005, 22nd
Special Session, 21)
NRS 422.021 “Children’s Health Insurance Program” defined. “Children’s Health Insurance Program” means
the program established pursuant to 42 U.S.C. §§ 1397aa to 1397jj, inclusive,
to provide health insurance for uninsured children from low-income families in
this state.
(Added to NRS by 1999, 1426)
NRS 422.030 “Department” defined. “Department”
means the Department of Health and Human Services.
[Part 2:327:1949; 1943 NCL § 5146.02]—(NRS A 1963,
902; 1967, 1153; 1973, 1406; 1993, 2059; 2005, 22nd
Special Session, 21)
NRS 422.040 “Director” defined. “Director”
means the Director of the Department.
[Part 2:327:1949; 1943 NCL § 5146.02]—(NRS A 1963,
902; 1967, 1153; 1973, 1406; 1993, 2059)
NRS 422.041 “Division” defined. “Division”
means the Division of Health Care Financing and Policy of the Department.
(Added to NRS by 1997, 2612; A 1999, 2242; 2005, 22nd
Special Session, 21)
NRS 422.042 “Food Stamp Assistance” defined. Repealed.
(See chapter 284, Statutes of Nevada 2013, at page 1316.)
NRS 422.045 “Low-Income Home Energy Assistance” defined. Repealed. (See chapter 284, Statutes of Nevada
2013, at page 1316.)
NRS 422.046 “Medicaid” defined. “Medicaid”
has the meaning ascribed to it in NRS
439B.120.
(Added to NRS by 1997, 1236)
NRS 422.048 “Program for Child Care and Development” defined. Repealed. (See chapter 284, Statutes of Nevada
2013, at page 1316.)
NRS 422.050 “Public assistance” defined. “Public
assistance” has the meaning ascribed to it in NRS 422A.065.
[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; 2001, 161; 2005, 22nd
Special Session, 21; 2013, 1303)
NRS 422.0525 “State Supplementary Assistance” defined. Repealed. (See chapter 284, Statutes of Nevada
2013, at page 1316.)
NRS 422.053 “Supplemental Security Income Program” defined. Repealed. (See chapter 284, Statutes of Nevada
2013, at page 1316.)
NRS 422.0535 “Temporary Assistance for Needy Families” defined. Repealed. (See chapter 284, Statutes of Nevada
2013, at page 1316.)
NRS 422.054 “Undivided estate” defined. “Undivided
estate” means all real and personal property and other assets included in the
estate of a deceased recipient of Medicaid and any other real and personal
property and other assets in or to which the deceased recipient had an interest
or legal title immediately before or at the time of his or her death, to the
extent of that interest or title. The term includes, without limitation, assets
conveyed to a survivor, heir or assign of the deceased recipient through or as
the result of any joint tenancy, tenancy in common, survivorship, life estate,
living trust, annuity, declaration of homestead or other arrangement.
(Added to NRS by 1995, 2565; A 1997, 1237; 1999, 877; 2003, 872)
NRS 422.061 Purposes of Division. The
purposes of the Division are:
1. To ensure that the Medicaid provided by
this State and the insurance provided pursuant to the Children’s Health
Insurance Program in this State are provided in the manner that is most
efficient to this State.
2. To evaluate alternative methods of
providing Medicaid and providing insurance pursuant to the Children’s Health
Insurance Program.
3. To review Medicaid, the Children’s
Health Insurance Program and other health programs of this State to determine
the maximum amount of money that is available from the Federal Government for
such programs.
4. To promote access to quality health
care for all residents of this State.
5. To restrain the growth of the cost of
health care in this State.
(Added to NRS by 2005, 22nd
Special Session, 21)
NRS 422.065 Eligibility of persons who are not citizens or nationals of
United States for state or local public benefits.
1. Notwithstanding any other provision of
state or local law, a person or governmental entity that provides a state or
local public benefit:
(a) Shall comply with the provisions of 8 U.S.C.
§ 1621 regarding the eligibility of a person who is not a citizen or national
of the United States for such a benefit.
(b) Is not required to pay any costs or other
expenses relating to the provision of such a benefit after July 1, 1997, to a
person who is not a citizen or national of the United States who, pursuant to 8
U.S.C. § 1621, is not eligible for the benefit.
2. Compliance with the provisions of 8
U.S.C. § 1621 must not be construed to constitute any form of discrimination,
distinction or restriction made, or any other action taken, on the basis of
national origin.
3. As used in this section, “state or
local public benefit” has the meaning ascribed to it in 8 U.S.C. § 1621.
(Added to NRS by 1997, 2224; A 2013, 1303)
MEDICAL CARE ADVISORY GROUP
NRS 422.151 Creation; function.
1. The Medical Care Advisory Group is
hereby created within the Division.
2. The function of the Medical Care
Advisory Group is to:
(a) Advise the Division regarding the provision
of services for the health and medical care of welfare recipients.
(b) Participate, and increase the participation
of welfare recipients, in the development of policy and the administration of
programs by the Division.
(Added to NRS by 1975, 1093; A 1993, 2060; 1997, 2617; 1999, 2242; 2005, 22nd
Special Session, 22)
NRS 422.153 Composition; terms and compensation of members.
1. The Medical Care Advisory Group
consists of the Chief Medical Officer and:
(a) A person who:
(1) Holds a license to practice medicine
in this state; and
(2) Is certified by the Board of Medical
Examiners in a medical specialty.
(b) A person who holds a license to practice
dentistry in this state.
(c) A person who holds a certificate of
registration as a pharmacist in this state.
(d) A member of a profession in the field of
health care who is familiar with the needs of persons of low income, the
resources required for their care and the availability of those resources.
(e) An administrator of a hospital or a clinic
for health care.
(f) An administrator of a facility for
intermediate care or a facility for skilled nursing.
(g) A member of an organized group that provides
assistance, representation or other support to recipients of Medicaid.
(h) A recipient of Medicaid.
2. The Director shall appoint each member
required by paragraphs (a) to (h), inclusive, of subsection 1 to serve for a
term of 1 year.
3. Members of the Medical Care Advisory
Group serve without compensation, except that while engaged in the business of
the Advisory Group, each member is entitled to receive the per diem allowance
and travel expenses provided for state officers and employees generally.
(Added to NRS by 1975, 1093; A 1985, 421; 1993, 2060; 1997, 1237)
NRS 422.155 Chair; Secretary; meetings; subcommittees.
1. The Director shall appoint a Chair of
the Medical Care Advisory Group from among its members.
2. The Administrator or the designee of
the Administrator shall serve as Secretary 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 Chair,
form subcommittees for decisions and recommendations concerning specific
problems within 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, 22nd
Special Session, 22)
ADMINISTRATOR OF DIVISION OF HEALTH CARE FINANCING AND
POLICY
NRS 422.2354 Qualifications. The
Administrator must:
1. Be appointed on the basis of his or her
training, education, experience and interest in the financing of programs for
public health, including, without limitation, the financing of Medicaid.
2. Be a graduate in public administration,
business administration or a similar area of study from an accredited college
or university.
3. Have not less than 3 years of
demonstrated successful experience in the financing of health care or other
public programs, and not less than 1 year of experience relating to Medicaid,
or any equivalent combination of training and experience.
4. Possess qualities of leadership in the
fields of health care and the financing of health care.
(Added to NRS by 1997, 2612; A 1999, 2242)
NRS 422.2356 Executive Officer of Division; administration and management of
Division. The Administrator:
1. Shall serve as the Executive Officer of
the Division.
2. Shall establish policies for the
administration of the programs of the Division, and shall administer all
activities and services of the Division in accordance with those policies and
any regulations of the Administrator, 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
Special Session, 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
Special Session, 22)
NRS 422.2362 Fiscal duties. The
Administrator:
1. Is responsible for and shall supervise
the fiscal affairs and responsibilities of the Division, subject to
administrative supervision by the Director.
2. Shall present the biennial budget of
the Division to the Legislature in conjunction with the Budget Division of the
Department of Administration.
3. Shall allocate, in the interest of
efficiency and economy, the State’s appropriation for the administration of
each program for which the Division is responsible, subject to administrative
supervision by the Director.
(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd
Special Session, 22)
NRS 422.2364 Organization of Division; appointment of heads of sections;
employees; standards of service. The
Administrator:
1. May establish, consolidate and abolish
sections within the Division.
2. Shall organize the Division to comply
with the requirements of this chapter and with the standards required by
federal legislation, subject to approval by the Director.
3. Shall appoint the heads of the sections
of the Division.
4. May employ such assistants and
employees as may be necessary for the efficient operation of the Division.
5. Shall set standards of service.
(Added to NRS by 1997, 2613; A 1999, 2242; 2005, 22nd
Special Session, 22)
NRS 422.2366 Administration of oaths; testimony of witnesses; subpoenas.
1. The Administrator or a designated
representative may administer oaths and take testimony thereunder and issue
subpoenas requiring the attendance of witnesses before the Division at a
designated time and place and the production of books, papers and records
relative to:
(a) Eligibility or continued eligibility to
provide medical care, remedial care or other services pursuant to the State
Plan for Medicaid or the Children’s Health Insurance Program;
(b) Verification of treatment and payments to a
provider of medical care, remedial care or other services pursuant to the State
Plan for Medicaid or the Children’s Health Insurance Program; and
(c) Recovery of Medicaid benefits paid on behalf
of a recipient of medical care, remedial care or other services pursuant to the
State Plan for Medicaid or the Children’s Health Insurance Program.
2. If a witness fails to appear or refuses
to give testimony or to produce books, papers and records as required by the
subpoena, the district court of the county in which the investigation is being
conducted may compel the attendance of the witness, the giving of testimony and
the production of books, papers and records as required by the subpoena.
(Added to NRS by 1997, 2613; A 1999, 2227, 2242; 2005, 22nd
Special Session, 23; 2011, 2521)
NRS 422.2368 Adoption of regulations. The
Administrator may adopt such regulations as are necessary for the
administration of this chapter.
(Added to NRS by 1997, 2614; A 1999, 2242; 2003, 2747; 2005, 22nd
Special Session, 23)
NRS 422.2369 Procedure for adopting, amending or repealing regulations.
1. Before adopting, amending or repealing
any regulation for the administration of a program of public assistance or any
other program for which the Division is responsible, the Administrator must
give at least 30 days’ notice of the intended action.
2. The notice of intent to act upon a
regulation must:
(a) Include a statement of the need for and
purpose of the proposed regulation, and either the terms or substance of the
proposed regulation or a description of the subjects and issues involved, and
of the time when, the place where and the manner in which interested persons
may present their views thereon.
(b) Include a statement identifying the entities
that may be financially affected by the proposed regulation and the potential
financial impact, if any, upon local government.
(c) State each address at which the text of the
proposed regulation may be inspected and copied.
(d) Be mailed to all persons who have requested
in writing that they be placed upon a mailing list, which must be kept by the
Administrator for that purpose.
3. All interested persons must be afforded
a reasonable opportunity to submit data, views or arguments upon a proposed
regulation, orally or in writing. The Administrator shall consider fully all
oral and written submissions relating to the proposed regulation.
4. The Administrator shall keep, retain
and make available for public inspection written minutes and an audio recording
or transcript of each public hearing held pursuant to this section in the
manner provided in NRS 241.035. A copy
of the minutes or audio recordings must be made available to a member of the
public upon request at no charge pursuant to NRS
241.035.
5. An objection to any regulation on the
ground of noncompliance with the procedural requirements of this section may
not be made more than 2 years after its effective date.
(Added to NRS by 1999, 2225; A 2005, 1413; 2005, 22nd
Special Session, 23; 2013, 330)
NRS 422.2372 General and miscellaneous powers and duties. The Administrator shall:
1. Supply the Director with material on
which to base proposed legislation.
2. Cooperate with the Federal Government
and state governments for the more effective attainment of the purposes of this
chapter.
3. Coordinate the activities of the
Division with other agencies, both public and private, with related or similar
activities.
4. Keep a complete and accurate record of
all proceedings, record and file all bonds and contracts, and assume
responsibility for the custody and preservation of all papers and documents
pertaining to the office of the Administrator.
5. Inform the public in regard to the
activities and operation of the Division, and provide other information which
will acquaint the public with the financing of Medicaid programs.
6. Conduct studies into the causes of the
social problems with which the Division is concerned.
7. Invoke any legal, equitable or special
procedures for the enforcement of orders issued by the Administrator or the
enforcement of the provisions of this chapter.
8. Exercise any other powers that are
necessary and proper for the standardization of state work, to expedite business
and to promote the efficiency of the service provided by the Division.
(Added to NRS by 1997, 2614; A 1999, 2242; 2003, 2747; 2005, 22nd
Special Session, 24)
NRS 422.2374 Cooperation with Medicaid Fraud Control Unit; suspension or
exclusion of provider of goods or services under State Plan for Medicaid.
1. The Administrator shall:
(a) Promptly comply with a request from the Unit
for access to and free copies of any records or other information in the possession
of the Division regarding a provider;
(b) Refer to the Unit all cases in which the
Administrator suspects that a provider has committed an offense pursuant to NRS 422.540 to 422.570,
inclusive; and
(c) Suspend or exclude a provider who the
Administrator determines has committed an offense pursuant to NRS 422.540 to 422.570,
inclusive, from participation as a provider or an employee of a provider, for a
minimum of 3 years. A criminal action need not be brought against the provider
before suspension or exclusion pursuant to this subsection.
2. As used in this section:
(a) “Provider” means a person who has applied to
participate or who participates in the State Plan for Medicaid as the provider
of goods or services.
(b) “Unit” means the Medicaid Fraud Control Unit
established in the Office of the Attorney General pursuant to NRS 228.410.
(Added to NRS by 1997, 2614; A 1999, 2242; 2005, 22nd
Special Session, 24)
ADMINISTRATION AND PROCEDURE
NRS 422.240 Legislative appropriations; disbursements.
1. Money to carry out the provisions of
this chapter, including, without limitation, any federal money allotted to the
State of Nevada pursuant to the State Plan for Medicaid, the Children’s Health
Insurance Program or any other program for which the Division is responsible
must, except as otherwise provided in NRS 422.3755
to 422.379, inclusive, and 439.630, be provided by appropriation by
the Legislature from the State General Fund.
2. Disbursements for the purposes of this
chapter must, except as otherwise provided in NRS
422.3755 to 422.379, inclusive, and 439.630, be made upon claims duly filed
and allowed 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
Special Session, 25; 2011, 2502;
2013, 1303)
NRS 422.245 Deposit of money received for certain programs in appropriate
accounts of Division in State General Fund. Repealed.
(See chapter 284, Statutes of Nevada 2013, at page 1316.)
NRS 422.260 Acceptance of Social Security Act and federal money.
1. The State of Nevada assents to the
purposes of the Act of Congress of the United States entitled the “Social
Security Act,” approved August 14, 1935, and assents to such additional federal
legislation as is not inconsistent with the purposes of this chapter and NRS 432.010 to 432.085, inclusive.
2. The State of Nevada further accepts,
with the approval of the Governor, the appropriations of money by Congress in
pursuance of the Social Security Act and authorizes the receipt of such money
into the State Treasury for the use of the Department in accordance with this
chapter, NRS 432.010 to 432.085, inclusive, and the conditions
imposed by the Social Security Act.
3. The State of Nevada may accept, with
the approval of the Governor, any additional funds which may become or are made
available for extension of programs and services administered by the Department
under the provisions of the Social Security Act. Such money must be deposited
in the State Treasury for the use of the Department in accordance with this
chapter, NRS 432.010 to 432.085, inclusive, and the conditions and
purposes under which granted by the Federal Government.
[1:327:1949; 1943 NCL § 5146.01]—(NRS A 1963, 905;
1965, 329; 1993,
2693; 2005, 22nd
Special Session, 25)
NRS 422.265 Acceptance of increased benefits of future congressional
legislation; regulations. If
Congress passes any law increasing the participation of the Federal Government
in any program for which the Division is responsible, whether relating to
eligibility for assistance or otherwise:
1. The Director may accept, with the
approval of the Governor, the increased benefits of such congressional
legislation; and
2. The Administrator may adopt any
regulations required 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; 2013, 1304)
NRS 422.267 Contract or agreement with Federal Government by Director. The Director shall have the power to sign and
execute, in the name of the State, by “The Department of Health and Human
Services,” any contract or agreement with the Federal Government or its
agencies.
[Part 9:327:1949; A 1951, 391; 1953, 333]—(NRS A
1963, 904; 1967, 1153; 1973, 1406; 2005, 22nd
Special Session, 26)
NRS 422.270 Duties of Department regarding Medicaid and Children’s Health
Insurance Program. The Department
shall:
1. Administer Medicaid and the Children’s
Health Insurance Program.
2. Act as the single state agency of the
State of Nevada and its political subdivisions in the administration of any
federal money granted to the State of Nevada to aid in the furtherance of
Medicaid and the Children’s Health Insurance Program.
3. Cooperate with the Federal Government
in adopting state plans, in all matters of mutual concern, including adoption
of methods of administration found by the Federal Government to be necessary
for the efficient operation of Medicaid and the Children’s Health Insurance
Program and in increasing the efficiency of Medicaid and the Children’s Health
Insurance Program by prompt and judicious use of new federal grants which will
assist the Department in carrying out the provisions of this chapter.
4. Observe and study the changing nature
and extent of needs for Medicaid and the Children’s Health Insurance Program
and develop through tests and demonstrations effective ways of meeting those
needs and employ or contract for personnel and services supported by
legislative appropriations from the State General Fund or money from federal or
other sources.
5. Enter into reciprocal agreements with
other states relative to Medicaid and institutional care, when deemed necessary
or convenient by the Director.
[Part 10:327:1949; A 1951, 546; 1953, 333]—(NRS A
1963, 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
Special Session, 26; 2013, 1304)
NRS 422.2703 Department required to establish and maintain system for
electronic submission of applications for Medicaid or Children’s Health
Insurance Program.
1. The Department shall establish and
maintain a system which allows an applicant for Medicaid or the Children’s
Health Insurance Program to submit the application electronically. The system
must allow an applicant to submit an application through the Internet or
another on-line service designated by the Department.
2. An agency designated by the Director to
receive applications or determine eligibility for Medicaid or the Children’s
Health Insurance Program shall use the system established pursuant to
subsection 1 to forward to the Department all applications received by the
agency.
3. An applicant for Medicaid or the
Children’s Health Insurance Program must not be required to submit an
application electronically. If an applicant submits a written application to an
agency designated by the Director, the agency shall create an electronic
application on behalf of the applicant and use the system established pursuant
to subsection 1 to forward the application to the Department.
(Added to NRS by 2009, 629)
NRS 422.2705 Contracts for provision of certain transportation services for
recipients of Medicaid and recipients of services pursuant to Children’s Health
Insurance Program.
1. The Department shall, to the extent
authorized by federal law, contract with a common motor carrier, a contract
motor carrier or a broker for the provision of transportation services to recipients
of Medicaid traveling to and returning from providers of services under the
State Plan for Medicaid.
2. The Department may, to the extent
authorized by federal law, contract with a common motor carrier, a contract
motor carrier or a broker for the provision of transportation services to
recipients of services pursuant to the Children’s Health Insurance Program
traveling to and returning from providers of services under the Children’s
Health Insurance Program.
3. The Director may adopt regulations
concerning the qualifications of persons who may contract with the Department
to provide transportation services pursuant to this section.
4. The Director shall:
(a) Require each motor carrier that has
contracted with the Department to provide transportation services pursuant to
this section to submit proof to the Department of a liability insurance policy,
certificate of insurance or surety which is substantially equivalent in form to
and is in the same amount or in a greater amount than the policy, certificate
or surety required by the Department of Motor Vehicles pursuant to NRS 706.291 for a similarly situated motor
carrier; and
(b) Establish a program, with the assistance of
the Nevada Transportation Authority of the Department of Business and Industry,
to inspect the vehicles which are used to provide transportation services
pursuant to this section to ensure that the vehicles and their operation are
safe.
5. 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 to it in NRS 706.036.
(c) “Contract motor carrier” has the meaning
ascribed to it in NRS 706.051.
(Added to NRS by 2005, 735; A 2011, 2469;
2013, 1316)
NRS 422.2708 Amendment of home and community-based services waiver to include
as medical assistance under Medicaid funding of assisted living supportive
services for senior citizens who reside in certain assisted living facilities.
1. The Department shall apply to the
Secretary of Health and Human Services to amend its home and community-based
services waiver granted pursuant to 42 U.S.C. § 1396n. The waiver must be
amended, in addition to providing coverage for any home and community-based
services which the waiver covers on June 4, 2005, to authorize the Department
to include as medical assistance under Medicaid the funding of assisted living
supportive services for senior citizens who reside in assisted living
facilities which are certified by the Housing Division of the Department of
Business and Industry pursuant to NRS
319.147.
2. The Department shall:
(a) Cooperate with the Federal Government in
amending the waiver pursuant to this section;
(b) If the Federal Government approves the
amendments to the waiver, adopt regulations necessary to carry out the
provisions of this section, including, without limitation, the criteria to be
used in determining eligibility for the assisted living supportive services
funded pursuant to subsection 1; and
(c) Implement the amendments to the waiver only
to the extent that the amendments are approved by the Federal Government.
3. As used in this section:
(a) “Assisted living facility” means a residential
facility for groups that:
(1) Satisfies the requirements set forth
in subsection 7 of NRS 449.0302; and
(2) Has staff at the facility available 24
hours a day, 7 days a week, to provide scheduled assisted living supportive
services and assisted living supportive services that are required in an
emergency in a manner that promotes maximum dignity and independence of
residents of the facility.
(b) “Assisted living supportive services” means
services which are provided at an assisted living facility to residents of the
assisted 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 recreational
programming; and
(8) Services which ensure that the
residents of the facility are safe, secure and adequately supervised.
(Added to NRS by 2005, 922)
NRS 422.271 State plans for certain programs: Development, adoption and
revision by Director; Division required to comply.
1. The Director shall adopt each state
plan required by the Federal Government, either directly or as a condition to
the receipt of federal money, for the administration of any public assistance
or other program for which the Division is responsible. Such a plan must set
forth, regarding the particular program to which the plan applies:
(a) The requirements for eligibility;
(b) The nature and amounts of grants and other
assistance which may be provided;
(c) The conditions imposed; and
(d) Such other provisions relating to the
development and administration of the program as the Director deems necessary.
2. In developing and revising such a plan,
the Director shall consider, among other things:
(a) The amount of money available from the
Federal Government;
(b) The conditions attached to the acceptance of
that money; and
(c) The limitations of legislative appropriations
and authorizations,
Ê for the
particular program to which the plan applies.
3. The Division shall comply with each
state plan adopted pursuant to this section.
(Added to NRS by 1993, 2058; A 1997, 2235, 2621; 1999, 581, 2242; 2005, 22nd
Special Session, 26)
NRS 422.2712 State plans for certain programs: Reporting of certain rates of
reimbursement for physicians.
1. The Department, with respect to the
State Plan for Medicaid and the Children’s Health Insurance Program, shall
report every rate of reimbursement for physicians which is provided on a
fee-for-service basis and which is lower than the rate provided on the current
Medicare fee schedule for care and services provided by physicians.
2. The Director shall post on an Internet
website maintained by the Department a schedule of such rates of reimbursement.
3. The Director shall, on or before
February 1 of each year, submit a report concerning the schedule of such rates
of reimbursement to the Director of the Legislative Counsel Bureau for
transmittal to the Legislature in odd-numbered years or to the Legislative
Committee on Health Care in even-numbered years.
(Added to NRS by 2013, 1302)
NRS 422.2713 State plans for certain programs: Priority access to treatment
and services for certain parents.
1. The Director shall, to the extent
authorized by federal law, include in any state plan adopted pursuant to NRS 422.271 priority for a parent who is referred by
an agency which provides child welfare services and who is qualified for public
assistance to receive treatment for mental health issues, treatment for
substance abuse and any other treatment or services that may assist with
preserving or reunifying the family.
2. As used in this section, “agency which
provides child welfare services” has the meaning ascribed to it in NRS 432B.030.
(Added to NRS by 2009, 329)
NRS 422.2715 Program to provide medical assistance to certain persons who are
employed and have disabilities.
1. Upon approval of the Interim Finance Committee,
the Director, through the Division, shall establish a program for the provision
of medical 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
manner set forth in 42 U.S.C. § 1396a(a)(10)(A)(ii)(XIII);
(b) Amending the State Plan for Medicaid in the
manner set forth in 42 U.S.C. § 1396a(a)(10)(A)(ii)(XV); or
(c) Obtaining a Medicaid waiver from the Federal
Government to carry out the program.
2. The Director may require a person
participating in a program established pursuant to subsection 1 to pay a
premium or other cost-sharing charges in a manner that is consistent with
federal law.
(Added to NRS by 2001, 2371; A 2005, 22nd
Special Session, 27)
NRS 422.2716 Provision of public assistance to qualified aliens. Repealed.
(See chapter 284, Statutes of Nevada 2013, at page 1316.)
NRS 422.2717 State Plan for Medicaid: Inclusion of requirement that
independent foster care adolescents are eligible for Medicaid.
1. The Director shall include in the State
Plan for Medicaid a requirement that an independent foster care adolescent is
eligible for Medicaid.
2. As used in this section, “independent
foster care adolescent” means:
(a) A person described in 42 U.S.C. §
1396d(w)(1), as that section existed on July 1, 2005; or
(b) If the Director specifies a different
category of adolescents 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 a category.
(Added to NRS by 2005, 2451)
NRS 422.2718 State Plan for Medicaid: Inclusion of requirement for payment of
certain expenses related to administration of human papillomavirus vaccine.
1. The Director shall include in the State
Plan for Medicaid a requirement that the State shall pay the nonfederal share
of expenses incurred for administering the human papillomavirus vaccine to
women and girls at such ages as recommended for vaccination by a competent
authority, including, without limitation, the Centers for Disease Control and
Prevention of the United States Department of Health and Human Services, the
Food and Drug Administration or the manufacturer of the vaccine.
2. For the purposes of this section, “human
papillomavirus vaccine” means the Quadrivalent Human Papillomavirus Recombinant
Vaccine or its successor which is approved by the Food and Drug Administration
to be used for the prevention of human papillomavirus infection and cervical
cancer.
(Added to NRS by 2007, 3243)
NRS 422.272 State Plan for Medicaid: Inclusion of requirement for payment of
certain costs.
1. The Director shall include in the State
Plan for Medicaid a requirement that the State shall pay the nonfederal share
of expenditures for the medical, administrative and transactional costs, to the
extent not covered by private insurance, of a person:
(a) Who is admitted to a hospital, facility for
intermediate care 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
more than a percentage prescribed annually by the Director of the supplemental
security income benefit rate established pursuant to 42 U.S.C. § 1382(b)(1).
The Director shall ensure that the percentage prescribed pursuant to this paragraph
complies with federal law.
2. As used in this section:
(a) “Facility for intermediate care” has the
meaning ascribed to it in NRS 449.0038.
(b) “Facility for skilled nursing” has the
meaning ascribed 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; 2011, 2684)
NRS 422.2723 State Plan for Medicaid: Inclusion of requirement for payment of
certain costs relating to dialysis and emergency care to treat kidney failure.
1. The Director shall include in the State
Plan for Medicaid a requirement that the State shall pay the nonfederal share
of expenses incurred in the administration of dialysis that is provided to
stabilize a patient with kidney failure and further emergency care necessary
for the treatment of such kidney failure.
2. For the purposes of this section,
“dialysis” means the method by which a dissolved substance is removed from the
body of a patient by diffusion, osmosis and convection from one fluid
compartment to another fluid compartment across a semipermeable membrane.
(Added to NRS by 2013, 2265)
NRS 422.273 Establishment, development and implementation of Medicaid
managed care program.
1. For any Medicaid managed care program
established in the State of Nevada, the Department shall contract only with a
health maintenance organization that has:
(a) Negotiated in good faith with a
federally-qualified health center to provide health care services for the
health maintenance organization;
(b) Negotiated in good faith with the University
Medical Center of Southern Nevada to provide inpatient and ambulatory services
to recipients of Medicaid; and
(c) Negotiated in good faith with the University
of Nevada School of Medicine to provide health care services to recipients of
Medicaid.
Ê Nothing in
this section shall be construed as exempting a federally-qualified health
center, the University Medical Center of Southern Nevada or the University of
Nevada School of Medicine from the requirements for contracting with the health
maintenance organization.
2. During the development and
implementation of any Medicaid managed care program, the Department shall
cooperate with the University of Nevada School of Medicine by assisting in the
provision of an adequate and diverse group of patients upon which the school
may base its educational programs.
3. The University of Nevada School of
Medicine may establish a nonprofit organization to assist in any research
necessary for the development of a Medicaid managed care program, receive and
accept gifts, grants and donations to support such a program and assist in establishing
educational services about the program for recipients of Medicaid.
4. For the purpose of contracting with a
Medicaid managed care program pursuant to this section, a health maintenance
organization is exempt from the provisions of NRS 695C.123.
5. The provisions of this section apply to
any managed care organization, including a health maintenance organization,
that provides health care services to recipients of Medicaid under the State
Plan for Medicaid or the Children’s Health Insurance Program pursuant to a
contract with the Division. Such a managed care organization or health
maintenance organization is not required to establish a system for conducting
external reviews of adverse determinations in accordance with chapter 695B, 695C
or 695G of NRS. This subsection does not
exempt such a managed care organization or health maintenance organization for
services provided pursuant to any other contract.
6. As used in this section, unless the
context otherwise requires:
(a) “Federally-qualified health center” has the
meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).
(b) “Health maintenance organization” has the
meaning ascribed to it in NRS 695C.030.
(c) “Managed care organization” has the meaning
ascribed to it in NRS 695G.050.
(Added to NRS by 1997, 1236; A 2001, 1927; 2003, 785; 2005, 22nd
Special Session, 27; 2011, 3419)
NRS 422.2748 Cooperation with Medicaid Fraud Control Unit.
1. The Director or a representative
designated by the Director shall:
(a) Promptly comply with a request from the Unit
for access to and free copies of any records or other information in the
possession of the Department regarding a provider; and
(b) Refer to the Unit all cases in which the
Director or designated representative suspects that 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 to
participate or who participates in the State Plan for Medicaid as the provider
of goods or services.
(b) “Unit” means the Medicaid Fraud Control Unit
established 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)—(Substituted
in revision for NRS 422.2345)
NRS 422.275 Legal advisers for Division. The
Attorney General and the deputies of the Attorney General 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
Special Session, 29)
NRS 422.276 Appeal to Division by applicant for or recipient of benefits
from Medicaid or Children’s Health Insurance Program; notice of initial
decision; hearing.
1. Subject to the provisions of subsection
2, if an application for Medicaid or the Children’s Health Insurance Program or
a claim for benefits from either program is not acted upon by the Division
within a reasonable time after the filing of the application or claim for
benefits, or is denied in whole or in part, or if any claim for benefits is
reduced, suspended or terminated, the applicant or recipient may appeal to the
Division and may be represented in the appeal by counsel or other
representative chosen by the applicant or recipient.
2. Upon the initial decision to deny,
reduce, suspend or terminate benefits, the Division shall notify that applicant
or recipient of its decision, the regulations involved and the right to request
a hearing within a certain period. If a request for a hearing is received
within that period, the Division shall notify that person of the time, place
and nature of the hearing. The Division shall provide an opportunity for a
hearing of that appeal and shall review the case regarding all matters alleged
in that appeal.
3. The Division is not required to grant a
hearing pursuant to this section if the request for the hearing is based solely
upon the provisions of a federal law or a law of this State that requires an
automatic adjustment to the benefits that may be received by an applicant or
recipient.
(Added to NRS by 1981, 1908; A 1985, 857; 1993, 2064; 1997, 2238; 1999, 2229; 2013, 1305)
NRS 422.277 Hearing: Rights of parties; informal disposition; record;
transcribing of oral proceedings; findings of fact; certain employees or
representatives of Division prohibited from participating in decision.
1. At any hearing held pursuant to the provisions
of subsection 2 of NRS 422.276, opportunity must be
afforded all parties to respond and present evidence and argument on all issues
involved.
2. Unless precluded by law, informal disposition
may be made of any hearing by stipulation, agreed settlement, consent order or
default.
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,
and rulings thereon.
(d) Any decision, opinion or report by the
hearing officer presiding at the hearing.
4. Oral proceedings, or any part thereof,
must be transcribed on request of any party seeking judicial review of the decision.
5. Findings of fact must be based
exclusively on substantial evidence.
6. Any employee or other representative of
the Division who investigated or made the initial decision to deny, modify or
cancel benefits provided pursuant to Medicaid or the Children’s Health
Insurance Program shall not participate in the making of any decision made
pursuant to the hearing.
(Added to NRS by 1985, 855; A 1993, 2064; 1999, 2229; 2001, 158; 2013, 1305)
NRS 422.2775 Hearing: Evidence. In
any hearing held pursuant to the provisions of subsection 2 of NRS 422.276:
1. Irrelevant, immaterial or unduly
repetitious evidence must be excluded. Unless it is privileged pursuant to chapter 49 of NRS, evidence, including, without
limitation, hearsay, may be admitted if it is of a type commonly relied upon by
reasonable and prudent persons in the conduct of their affairs. Objections to
evidentiary 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 be
prejudiced substantially, any part of the evidence may be received in written
form.
2. Documentary evidence may be received in
the form of copies or excerpts. Upon request, parties must be given an
opportunity to compare the copy with the original.
3. Each party may call and examine
witnesses, introduce exhibits, cross-examine opposing witnesses on any matter
relevant to the issues whether or not the matter was covered in the direct
examination, impeach any witness, regardless of which party first called the
witness to testify, and rebut the evidence against the party.
(Added to NRS by 1985, 855; A 1997, 1615)—(Substituted
in revision for NRS 422.297)
NRS 422.278 Hearing: Person with communications disability entitled to
services of interpreter. Any
person who is:
1. The subject of a hearing conducted
under the authority of the Division; or
2. A witness at that hearing,
Ê and who is a
person with a communications disability as defined in NRS 50.050, is entitled to the services of
an interpreter at public expense in accordance with the provisions of NRS 50.050 to 50.053, inclusive. The interpreter must be
appointed by the person who presides at the hearing.
(Added to NRS by 1979, 658; A 1997, 2627; 1999, 2242; 2001, 1778; 2005, 22nd
Special Session, 29; 2007, 174)
NRS 422.2785 Contents and delivery of decision or order of hearing officer;
petition for judicial review; filing of decision and record with court.
1. A decision or order issued by a hearing
officer must be in writing. A final decision must include findings of fact and
conclusions of law, separately stated. Findings of fact, if set forth in
statutory or regulatory language, must be accompanied by a concise and explicit
statement of the underlying facts supporting the findings. A copy of the
decision or order must be delivered by certified mail to each party and to the
attorney or other representative of each party.
2. The Division or an applicant for or
recipient of benefits provided pursuant to Medicaid or the Children’s Health
Insurance Program may, at any time within 90 days after the date on which the
written notice of the decision is mailed, petition the district court of the
judicial district in which the applicant for or recipient of benefits provided
pursuant to Medicaid or the Children’s Health Insurance Program resides to
review the decision. The district court shall review the decision on the record
of the case before the hearing officer. The decision and record must be
certified as correct and filed with the clerk of the court by the Division.
(Added to NRS by 1985, 856; A 1993, 2065; 1997, 2238, 2628; 1999, 581, 2230, 2242; 2013, 1305)
NRS 422.279 Judicial review: Taking of additional evidence; limitations on
review; grounds for reversal; appeal to appellate court.
1. Before the date set by the court for
hearing, an application may be made to the court by motion, with notice to the
opposing party and an opportunity for that party to respond, for leave to
present additional evidence. If it is shown to the satisfaction of the court
that the additional evidence is material and that there were good reasons for
failure to present it in the proceeding before the Department, the court may
order that the additional evidence be taken before the Department upon
conditions determined by the court. The Department may modify its findings and
decision by reason 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 a jury and must be confined to the record. In cases of alleged
irregularities in procedure before the Department, not shown in the record,
proof thereon may be taken in the court. The court, at the request of either
party, shall hear oral argument and receive written briefs.
3. The court shall not substitute its
judgment for that 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 for further proceedings. The court may reverse the decision and
remand the case to the Department for further proceedings if substantial rights
of the appellant have been prejudiced because the Department’s findings,
inferences, conclusions or decisions are:
(a) In violation of constitutional, regulatory or
statutory provisions;
(b) In excess of the statutory authority of the
Department;
(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
abuse of discretion or clearly unwarranted exercise of discretion.
4. An aggrieved party may obtain review of
any final judgment of the district court by appeal to the appellate court of
competent jurisdiction pursuant to the rules fixed by the Supreme Court
pursuant to Section 4 of Article 6
of the Nevada Constitution. The appeal must be taken in the manner provided for
civil cases.
(Added to NRS by 1985, 856; A 1999, 2230; 2013, 1781)
NRS 422.280 Forms of reports and records to be kept by persons subject to
supervision or investigation by Division. To
ensure accuracy, uniformity and completeness in statistics and information, the
Division may prescribe forms of reports and records to be kept by all persons,
associations or institutions, subject to its supervision or investigation, and
each such person, association or institution shall keep such records and render
such reports 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 Family planning service; birth control. As
a part of the health and welfare programs of this State, the Division may:
1. Conduct a family planning service, or
contract for the provision of a family planning service, in any county of the
State. Such service may include the dispensing of information and the
distribution of literature on birth control and family planning methods.
2. Establish a policy of referral of
welfare recipients for birth control.
(Added to NRS by 1965, 529; A 1997, 2620; 1999, 2242; 2005, 22nd
Special Session, 30)
NRS 422.287 Provision of prenatal care to pregnant women who are indigent;
provision of information concerning availability of prenatal care; regulations.
1. As part of the health and
welfare programs of this State, the Division or any other division designated
by the Director may provide prenatal care to pregnant women who are indigent,
or may contract for the provision of that care, at public or nonprofit
hospitals in this State.
2. The Division or any other division
designated by the Director shall provide to each person licensed to engage in
social work pursuant to chapter 641B of
NRS, each applicant for Medicaid and any other interested person, information
concerning the prenatal care available pursuant to this section.
3. The Division or any other division
designated by the Department shall adopt regulations setting forth criteria of
eligibility and rates of payment for prenatal care provided pursuant to the
provisions of this section, and such other provisions relating to the
development and administration of the Program for Prenatal Care as the Director
or the Administrator, as applicable, deems necessary.
(Added to NRS by 1989, 1455; A 1997, 1238, 2235, 2620; 1999, 581, 2242; 2003, 659; 2005, 22nd
Special Session, 30)
NRS 422.288 Enrollment of eligible Indian children in Children’s Health
Insurance Program: Duty of Department to seek assistance of and cooperate with
Indian tribes; immediate action required; certain contracts for provision of
services required. The Department
shall:
1. Seek the assistance of and cooperate
with Indian tribes, tribal organizations and organizations that collaborate
with Indian tribes to identify Indian children who may be eligible to enroll in
the Children’s Health Insurance Program and facilitate the enrollment of such
children in the Children’s Health Insurance Program;
2. Upon determining that an Indian child
is eligible for the Children’s Health Insurance Program, immediately take any
necessary action to enroll the child in the Children’s Health Insurance
Program; and
3. Contract with the Indian Health Service
and tribal clinics that provide health care services to Indians to provide
health care services to Indian children who are enrolled in the Children’s
Health Insurance Program.
(Added to NRS by 1999, 1426)
NRS 422.290 Custody, use, preservation and confidentiality of records, files
and communications concerning applicants for and recipients of public
assistance or assistance pursuant to Children’s Health Insurance Program.
1. To restrict the use or
disclosure of any information concerning applicants for and recipients of
public assistance or assistance pursuant to the Children’s Health Insurance
Program to purposes directly connected to the administration of this chapter,
and to provide safeguards therefor, under the applicable provisions of the
Social Security Act, the Division shall establish and enforce reasonable
regulations governing the custody, use and preservation of any records, files
and communications filed with the Division.
2. If, pursuant to a specific statute or a
regulation of the Division, names and addresses of, or information concerning,
applicants for and recipients of assistance, including, without limitation,
assistance pursuant to the Children’s Health Insurance Program, are furnished
to or held by any other agency or department of government, such agency or
department of government is bound by the regulations of the Division
prohibiting the publication of lists and records thereof or their use for
purposes not directly connected with the administration of this chapter.
3. Except for purposes directly connected
with the administration of this chapter, no person may publish, disclose or
use, or permit or cause to be published, disclosed or used, any confidential
information pertaining to a recipient of assistance, including, without
limitation, a recipient of assistance pursuant to the Children’s Health
Insurance 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 Special Session, 30)
NRS 422.291 Assistance not assignable or subject to process or bankruptcy
law. Assistance awarded pursuant
to the provisions of this chapter is not transferable or assignable at law or
in equity and none of the money paid or payable under this chapter is subject
to execution, levy, attachment, garnishment or other legal process, or to the
operation of any bankruptcy or insolvency law.
(Added to NRS by 1981, 1908)
NRS 422.292 Assistance subject to future amending and repealing acts. All assistance awarded pursuant to the
provisions of this chapter is awarded and held subject to the provisions of any
amending or repealing act that may be enacted, and no recipient has any claim
for assistance or otherwise by reason of such assistance being affected in any
way by an amending or repealing act.
(Added to NRS by 1981, 1908)
NRS 422.293 Subrogation: Department subrogated to rights of recipient of
Medicaid or of insurance provided pursuant to Children’s Health Insurance
Program; lien on proceeds of recovery.
1. When a recipient of Medicaid or a
recipient of insurance provided pursuant to the Children’s Health Insurance
Program incurs an illness or injury for which medical services are payable by
the Department and which is incurred under circumstances creating a legal
liability in some person other than the recipient or a division of the
Department to pay all or part of the costs of such medical services, the
Department is subrogated to the right of the recipient to the extent of all
such medical costs and may join or intervene in any action by the recipient or
any successors in interest to enforce such legal liability.
2. If a recipient or any successors in
interest fail or refuse to commence an action to enforce the legal liability,
the Department may commence an independent action, after notice to the
recipient or successors in interest, to recover all medical costs to which it
is entitled. In any such action by the Department, the recipient or successors
in interest may be joined as third-party defendants.
3. In any case where the Department is
subrogated to the rights of the recipient or any successors in interest as
provided in subsection 1, the Department has a lien upon the proceeds of any
recovery from the persons liable, whether the proceeds of the recovery are by
way of judgment, settlement or otherwise. Such a lien must be satisfied in
full, unless reduced pursuant to subsection 4, at such time as:
(a) The proceeds of any recovery or settlement
are distributed to or on behalf of the recipient, the successors in interest or
the attorney of the recipient; and
(b) A dismissal by any court of any action
brought to enforce the legal liability established by subsection 1.
4. If the Department receives notice
pursuant to NRS 422.293001, the Director or a
representative designated by the Director may, in consideration of the legal
services provided by an attorney to procure a recovery for the recipient,
reduce the lien on the proceeds of any recovery.
5. The attorney of a recipient shall not
condition the amount of attorney’s fees or impose additional attorney’s fees
based on whether a reduction of the lien is authorized by the Director or a
designated representative pursuant to subsection 4.
(Added to NRS by 1981, 1909; A 1989, 757; 1993, 923; 1997, 1239, 2624; 1999, 2228, 2242; 2007, 2390)
NRS 422.293001 Subrogation: Notice to Department of recipient’s claim; statute
of limitations tolled until notice received.
1. A recipient, upon assertion of a claim
against a third party to which the Department is subrogated pursuant to NRS 422.293, or the attorney of the recipient, upon
agreeing to represent the recipient, shall provide written notice to the
Department in the manner provided in subsection 2.
2. The notice provided pursuant to
subsection 1 must include, without limitation:
(a) The name of the recipient;
(b) The social security number of the recipient;
(c) The date of birth of the recipient;
(d) The name of the attorney of the recipient, if
applicable;
(e) The name of any person against whom the
recipient is making a claim, if known;
(f) The name of any insurer of any person against
whom the recipient is making a claim, if known;
(g) The date of the incident giving rise to the
claim; and
(h) A short statement identifying the nature of
the recipient’s claim or the terms of any settlement, judgment or award.
3. Any statute of limitations applicable
to any claim or action by the Department is tolled until such time as the
Department receives the notice required by this section.
4. As used in this section, “claim” means
a right to payment, whether or not the right is reduced to judgment,
liquidated, unliquidated, fixed, contingent, matured, unmatured, disputed,
undisputed, legal, equitable, secured or unsecured.
(Added to NRS by 2007, 2390)
NRS 422.293003 Subrogation: Department required to provide notice of amount of
lien; enforceability of lien. Upon
receiving the notice required pursuant to NRS
422.293001, the Department shall, within 30 days, provide written notice to
the recipient or the attorney of the recipient and to the third party. The
written notice must include, without limitation, the name of the recipient and
the amount of the Department’s lien. No lien created pursuant to NRS 422.293 is enforceable unless written notice is
first given to the person against whom the lien is asserted or the attorney of
the person against whom the lien is asserted.
(Added to NRS by 2007, 2390)
NRS 422.293005 Subrogation: Liability for failure to comply with provisions.
1. Except as otherwise provided in
subsection 2, any person who fails to comply with the provisions of NRS 422.293 and 422.293001
is liable to the Department for:
(a) The total amount of the Department’s lien
created pursuant to NRS 422.293; and
(b) Any attorney’s fees and litigation expenses
incurred by the Department in enforcing the Department’s rights pursuant to NRS 422.293 and 422.293001.
2. A person other than the recipient is
not liable to the Department if the court determines that the failure to
provide notice was caused by excusable neglect.
(Added to NRS by 2007, 2390)
NRS 422.29301 Administration of provisions concerning recovery of amounts
incorrectly paid for recipient of Medicaid. The
Director:
1. Shall administer the provisions of NRS 422.29302, 422.29304
and 422.29306;
2. May adopt such regulations as are
necessary for the administration of those provisions; and
3. May invoke any legal, equitable or
special procedures for the enforcement of those provisions.
(Added to NRS by 2003, 872; A 2013, 1306)
NRS 422.29302 Recovery of benefits paid for Medicaid: Powers and duties of
Department; claim against estate of recipient; regulations; distribution of
money recovered; payment in cash.
1. Except as otherwise provided in this
section and to the extent it is not prohibited by federal law and when
circumstances allow, the Department shall recover benefits correctly paid for
Medicaid from:
(a) The undivided estate of the person who
received those benefits; and
(b) Any recipient of money or property from the undivided
estate of the person who received those benefits.
2. The Department shall not recover
benefits pursuant to subsection 1, except from a person who is neither a
surviving spouse nor a child, until after the death of the surviving spouse, if
any, and only at a time when the person who received the benefits has no
surviving child who is under 21 years of age, blind or disabled.
3. Except as otherwise provided by federal
law, if a transfer of real or personal property by a recipient of Medicaid is made
for less than fair market value, the Department may pursue any remedy available
pursuant to chapter 112 of NRS with respect
to the transfer.
4. The amount of Medicaid paid to or on
behalf of a person is a claim against the estate in any probate proceeding only
at a time when there is no surviving spouse or surviving child who is under 21
years of age, blind or disabled.
5. The Director may elect not to file a
claim against the estate of a recipient of Medicaid or the spouse of the
recipient if the Director determines that the filing of the claim will cause an
undue hardship for the spouse or other survivors of the recipient. The Director
shall adopt regulations defining the circumstances that constitute an undue
hardship.
6. Any recovery of money obtained pursuant
to this section must be applied first to the cost of recovering the money. Any
remaining money must be divided among the Federal Government, the Department
and the county in the proportion that the amount of assistance each contributed
to the recipient bears to the total amount of the assistance contributed.
7. Any recovery by the Department from the
undivided estate of a recipient pursuant to this section must be paid in cash
to the extent of:
(a) The amount of Medicaid paid to or on behalf
of the recipient after October 1, 1993; or
(b) The value of the remaining assets in the
undivided estate,
Ê whichever is
less.
(Added to NRS by 1993, 917; A 1995, 2566; 1997, 1240, 2237, 2626; 1999, 581, 877, 2242; 2001, 158; 2003, 874)—(Substituted
in revision for NRS 422.2935)
NRS 422.29304 Recovery of amounts paid for Medicaid under certain
circumstances; powers and duties of Department; duty to reimburse Department;
waiver of repayment.
1. Except as otherwise provided in this
section, the Department shall, to the extent that it is not prohibited by
federal law, recover from a recipient of Medicaid the undivided estate of a
recipient of Medicaid or a person who signed the application for Medicaid or
for admission to a nursing facility on behalf of the recipient an amount not to
exceed the amount incorrectly paid on behalf of the recipient, if the person
who signed the application:
(a) Failed to report any required information to
the Department or the nursing facility that the person knew at the time the
person signed the application;
(b) Refused to provide financial information
regarding the recipient’s income and assets, including, without limitation,
information regarding any transfers or assignments of income or assets;
(c) Concealed information regarding the
existence, transfer or disposition of the recipient’s income and assets with
the intent of enabling a recipient to meet any eligibility requirement for
Medicaid;
(d) Made any false representation regarding the
recipient’s income and assets, including, without limitation, any information
regarding any transfers or assignments of income or assets; or
(e) Failed to report to the Department or the
nursing facility within the period allowed by the Department any required
information that the person obtained after the person filed the application.
2. Except as otherwise provided in this
section, a recipient of Medicaid, the undivided estate of a recipient of
Medicaid or a person who signed the application for Medicaid or for admission
to a nursing facility on behalf of the recipient shall reimburse the Department
or appropriate state agency for the value of the amount incorrectly paid on
behalf of the recipient.
3. The Director or a person designated by
the Director may, to the extent that it is not prohibited by federal law,
determine the amount of, and settle, adjust, compromise or deny a claim against
a recipient of Medicaid, the undivided estate of a recipient of Medicaid or a
person who signed the application for Medicaid or for admission to a nursing
facility on behalf of the recipient.
4. The Director may, to the extent that it
is not prohibited by federal law, waive the repayment of amounts incorrectly
paid on behalf of a recipient of Medicaid if the incorrect payment was not the
result of an intentional misrepresentation or omission by the recipient and if
repayment would cause an undue hardship to the recipient. The Director shall,
by regulation, 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; 2007, 2391; 2013, 1306)
NRS 422.29306 Imposition and release of lien on property of recipient of
Medicaid.
1. The Department may, to the extent not
prohibited by federal law, petition for the imposition of a lien pursuant to
the provisions of NRS 108.850 against
real or personal property of a recipient of Medicaid as follows:
(a) The Department may obtain a lien against a
recipient’s property, both real or personal, before or after the death of the
recipient in the amount of assistance paid or to be paid on behalf of the
recipient if the court determines that assistance was incorrectly paid for the recipient.
(b) The Department may seek a lien against the
real property of a recipient at any age before the death of the recipient in
the amount of assistance paid or to be paid for the recipient if the recipient
is an inpatient in a nursing facility, intermediate care facility for persons
with intellectual disabilities or other medical institution and the Department
determines, after notice and opportunity for a hearing in accordance with
applicable regulations, that the recipient cannot reasonably be expected to be discharged
and return home.
2. No lien may be placed on a recipient’s
home pursuant to paragraph (b) of subsection 1 for assistance correctly paid
if:
(a) His or her spouse;
(b) His or her child who is under 21 years of
age, blind or disabled as determined in accordance with 42 U.S.C. § 1382c; or
(c) His or her brother or sister who is an owner
or part owner of the home and who was residing in the home for at least 1 year
immediately before the date the recipient was admitted to the medical
institution,
Ê is lawfully
residing in the home.
3. Upon the death of a recipient, the
Department may seek a lien upon the recipient’s undivided estate as defined in NRS 422.054.
4. The amount of the lien recovery must be
based on the value of the real or personal property at the time of sale of the
property.
5. The Director shall release a lien
pursuant to this section:
(a) Upon notice by the recipient or the
representative of the recipient to the Director that the recipient has been
discharged from the medical institution 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; 2007, 2392; 2013, 695)
NRS 422.29308 Application for Medicaid: Statements regarding action for
recovery and civil liability of recipient. Repealed.
(See chapter 284, Statutes of Nevada 2013, at page 1316.)
NRS 422.301 Administrative duties of Administrator and Division. The Administrator 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
Special Session, 31)
NRS 422.302 Gifts and grants of money to Division: Deposit in Gift and
Cooperative Account of the Division of Health Care Financing and Policy; use;
approval of claims by Administrator.
1. Any gifts or grants of money
which the Division is authorized to accept must be deposited in the State
Treasury to the credit of the Gift and Cooperative Account of the Division of
Health Care Financing and Policy which is hereby created in the Department of
Health and Human Services’ Gift Fund.
2. Money in the Account must be used for
health care purposes only and expended in accordance with the terms of the gift
or grant.
3. All claims must be approved by the
Administrator before they are paid.
(Added to NRS by 1997, 2615; A 1999, 2242; 2005, 22nd
Special Session, 31)
NRS 422.303 Reimbursement of registered nurse for certain services provided
to person eligible for Medicaid. The
Department, through the Division, may reimburse directly, under the State Plan
for Medicaid, any registered nurse who is authorized pursuant to chapter 632 of NRS to perform additional acts in
an emergency or under other special conditions as prescribed by the State Board
of Nursing, for such services rendered under the authorized scope of the
registered nurse’s practice to persons eligible to receive that assistance if
another provider of health care would be reimbursed for 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 Reimbursement for services for hospice care provided to person
eligible for Medicaid.
1. Except as otherwise provided in
subsection 2, the Department, 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
hospice care, including room and board, provided by that facility to a person
who is eligible to receive Medicaid.
(b) A program for hospice care licensed pursuant
to chapter 449 of NRS for the services for
hospice care provided by that program to a person who is eligible to receive
Medicaid.
2. The Department, through the Division,
is required to pay, under the State Plan for Medicaid, for the services for
hospice care provided by a facility or program described in subsection 1 only
to the extent that the Federal Government provides matching federal money under
Medicaid for the services for hospice care.
3. As used in this section:
(a) “Facility for hospice care” has the meaning
ascribed 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
Special Session, 31)
NRS 422.3045 Denial of application for Children’s Health Insurance Program:
Notice; review of case and hearing; regulations; review by court. Repealed. (See chapter 284, Statutes of Nevada
2013, at page 1316.)
NRS 422.305 Confidentiality of information obtained in investigation of
provider of services under State Plan for Medicaid.
1. Except as otherwise provided in
subsection 2 and NRS 228.410, 239.0115 and 422.2374,
any information obtained by the Division in an investigation of a provider of
services under the State Plan for Medicaid 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 a
provider of services under the State Plan for Medicaid,
Ê is not
confidential, 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; 2007, 2103)
NRS 422.306 Hearing to review action taken against provider of services
under State Plan for Medicaid; regulations; appeal of final decision.
1. Upon receipt of a request for a
hearing from a provider of services under the State Plan for Medicaid, the
Division shall appoint a hearing officer to conduct the hearing. Any employee
or other representative of the Division who investigated or made the initial
decision regarding the action taken against a provider of services may not be
appointed as the hearing officer or participate in the making of any decision
pursuant to the hearing.
2. The Division shall adopt regulations
prescribing the procedures to be followed at the hearing.
3. The decision of the hearing officer is
a final decision. Any party, including the Division, who is aggrieved by the
decision of the hearing officer may appeal that decision to the District Court
in and for Carson City by filing a petition for judicial review within 30 days
after receiving the decision of the hearing officer.
4. A petition for judicial review filed
pursuant to this section must be served upon every party within 30 days after
the filing of the petition for judicial review.
5. Unless otherwise provided by the court:
(a) Within 90 days after the service of the
petition for judicial review, the Division shall transmit to the court the
original or a certified copy of the entire record of the proceeding under
review, including, without limitation, a transcript of the evidence resulting
in the final decision of the hearing officer;
(b) The petitioner who is seeking judicial review
pursuant to this section shall serve and file an opening brief within 40 days
after the Division gives written notice to the parties that the record of the
proceeding under review has been filed with the court;
(c) The respondent shall serve and file an
answering brief within 30 days after service of the opening brief; and
(d) The petitioner may serve and file a reply
brief within 30 days after service of the answering brief.
6. Within 7 days after the expiration of
the time within which the petitioner may reply, any party may request a
hearing. Unless a request for hearing has been filed, the matter shall be
deemed submitted.
7. The review of the court must be
confined to the record. The court shall not substitute its judgment for that of
the hearing officer as to the weight of the evidence on questions of fact. The
court may affirm the decision of the hearing officer or remand the case for
further proceedings. The court may reverse or modify the decision if
substantial rights of the appellant have been prejudiced because the
administrative findings, inferences, conclusions or decisions are:
(a) In violation of constitutional or statutory
provisions;
(b) In excess of the statutory authority of the
Division;
(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
abuse of discretion or clearly unwarranted exercise of discretion.
(Added to NRS by 1987, 1670; A 1997, 1243, 2628; 1999, 581, 2231, 2242; 2005, 22nd
Special Session, 32)
MEDICAID CARDS
NRS 422.361 Definitions. As
used in NRS 422.361 to 422.369,
inclusive, unless the context otherwise requires, the words and terms defined
in NRS 422.362 to 422.365,
inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1993, 141)
NRS 422.362 “Cardholder” defined. “Cardholder”
means the person named on the face of a Medicaid card to whom or for whose
benefit the Medicaid card is issued by the Department.
(Added to NRS by 1993, 141; A 2003, 660)
NRS 422.363 “Medicaid card” defined. “Medicaid
card” means any instrument or device evidencing eligibility for receipt of
Medicaid benefits that is issued by the Department for the use of a cardholder
in obtaining the types of medical and remedial care for which assistance may be
provided under the Plan.
(Added to NRS by 1993, 141; A 2003, 660)
NRS 422.364 “Plan” defined. “Plan”
means the State Plan for Medicaid established pursuant to NRS 422.271.
(Added to NRS by 1993, 141; A 1997, 1243)
NRS 422.365 “Receives” defined. “Receives”
means to acquire possession or control.
(Added to NRS by 1993, 141)
NRS 422.366 Unlawful acts: 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
the person, possession, custody or control of another without the cardholder’s
consent; or
(b) With knowledge that a Medicaid card has been
so taken, removed or stolen, receives the Medicaid card with the intent to
circulate, use or sell it or to transfer it to a person other than the
Department or the cardholder,
Ê is guilty of
a category D felony and shall be punished as provided in NRS 193.130. In addition to any other
penalty, the court shall order the person to pay restitution.
2. A person who possesses a Medicaid card
without the consent of the cardholder and with the intent to circulate, use,
sell or transfer the Medicaid card with the intent to defraud is guilty of a
category D felony and shall be punished as provided in NRS 193.130. In addition to any other
penalty, the court shall order the person to pay restitution.
3. A person who has in his or her
possession or under his or her control two or more Medicaid cards issued in the
name of another person is presumed to have obtained and to possess the Medicaid
cards with the knowledge that they have been stolen and with the intent to
circulate, use, sell or transfer them with the intent to defraud. The
presumption established by this subsection may be rebutted by clear and
convincing evidence. The presumption does not apply to the possession of two or
more Medicaid cards if the possession is with the consent of the Department.
(Added to NRS by 1993, 141; A 1995, 1272; 2003, 660)
NRS 422.367 Unlawful acts: Sale or purchase of card; authorization by holder
of card for use by person not entitled to use card; penalty. A person who:
1. Sells or buys a Medicaid card; or
2. Authorizes another person to use his or
her Medicaid card to obtain the types of medical and remedial care for which
assistance may be provided under the Plan, if the person to whom authorization
is given is not entitled to use that card to obtain care,
Ê is guilty of
a category D felony and shall be punished as provided in NRS 193.130. In addition to any other
penalty, the court shall order the person to pay restitution.
(Added to NRS by 1993, 142; A 1995, 1273)
NRS 422.368 Unlawful acts: Use of forged, expired or revoked card to obtain
benefits; receipt of benefits by misrepresentation; penalty. A person who, with the intent to defraud:
1. Uses a Medicaid card to obtain the
types of medical and remedial care for which assistance may be provided under
the Plan with the knowledge that the Medicaid card was obtained or retained in
violation of any of the provisions of NRS 422.361
to 422.367, inclusive, or is forged or is the
expired or revoked Medicaid card of another; or
2. Obtains the types of medical and
remedial care for which assistance may be provided under the Plan by
representing, without the consent of the cardholder, that the person is the
authorized holder of a Medicaid card or that the person is the holder of a
Medicaid card that has not in fact been issued,
Ê is guilty of
a category D felony and shall be punished as provided in NRS 193.130. In addition to any other
penalty, the court shall order the person to pay restitution.
(Added to NRS by 1993, 142; A 1995, 1273)
NRS 422.369 Unlawful acts: Fraud by person authorized to provide care to
holder of card; penalty. A person
authorized by the Division to furnish the types of medical and remedial care
for which assistance may be provided under the Plan, or an agent or employee of
the authorized person, who, with the intent to defraud, furnishes such care
upon presentation of a Medicaid card which the person knows was obtained or
retained in violation of any of the provisions of NRS
422.361 to 422.367, inclusive, or is forged,
expired or revoked, is guilty of a category D felony and shall be punished as
provided in NRS 193.130. In addition to
any other penalty, the court shall order the person to pay restitution.
(Added to NRS by 1993, 142; A 1995, 1274; 1999, 2232; 2005, 22nd
Special Session, 33)
ASSESSMENT OF FEES ON NURSING FACILITIES TO INCREASE
QUALITY OF NURSING CARE
NRS 422.3755 Definitions. As
used in NRS 422.3755 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 to them in
those sections.
(Added to NRS by 2003, 2745)
NRS 422.376 “Facility for intermediate care” defined. “Facility for intermediate care” has the
meaning ascribed to it in NRS 449.0038,
but does not include:
1. A facility which meets the requirements
of a general or any other special hospital pursuant to chapter 449 of NRS;
2. A facility for intermediate care which
limits its care and treatment to those persons who are intellectually disabled
or who have conditions related to intellectual disabilities; or
3. A facility for intermediate care that
is owned or operated by the State of Nevada or any political subdivision of the
State of Nevada.
(Added to NRS by 2003, 2745; A 2013, 696)
NRS 422.3765 “Facility for skilled nursing” defined. “Facility
for skilled nursing” has the meaning ascribed to it in NRS 449.0039, but does not include a
facility for skilled nursing that is owned or operated by the State of Nevada
or any political subdivision of the State of Nevada.
(Added to NRS by 2003, 2745)
NRS 422.3771 “Nursing facility” defined. “Nursing
facility” means a facility for intermediate care or a facility for skilled
nursing.
(Added to NRS by 2003, 2745)
NRS 422.3775 Payment of fee; amount of fee; allowable cost for Medicaid
reimbursement purposes.
1. Each nursing facility that is licensed
in this State shall pay a fee assessed by the Division to increase the quality
of nursing care in this State.
2. To determine the amount of the fee to
assess pursuant to this section, the Division shall establish a rate per
non-Medicare patient day that is equivalent to a percentage of the total annual
accrual basis gross revenue for services provided to patients of all nursing
facilities licensed in this State. The percentage used to establish the rate
must not exceed that allowed by federal law. For the purposes of this
subsection, total annual accrual basis gross revenue does not include
charitable contributions received by a nursing facility.
3. The Division shall calculate the fee
owed by each nursing facility by multiplying the total number of days of care
provided to non-Medicare patients by the nursing facility, as provided to the
Division pursuant to NRS 422.378, by the rate established
pursuant to subsection 2.
4. A fee assessed pursuant to this section
is due 30 days 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 cost for Medicaid reimbursement purposes.
(Added to NRS by 2003, 2746; A 2005, 22nd
Special Session, 33; 2007, 2393)
NRS 422.378 Report by nursing facility to Division.
1. Each nursing facility shall file with
the Division each month a report setting forth the total number of days of care
it provided to non-Medicare patients during the preceding month, the total
gross revenue it earned as compensation for services provided to patients
during the preceding month and any other information required by the Division.
2. Each nursing facility shall file with
the Division any information required and requested by the Division to carry
out the provisions of NRS 422.3755 to 422.379, inclusive.
(Added to NRS by 2003, 2746; A 2005, 22nd
Special Session, 34)
NRS 422.3785 Creation of Account to Increase the Quality of Nursing Care;
deposit of money for credit to Account; expenditures from Account; consequence
of federal law prohibiting certain expenditures from Account.
1. There is hereby created in the State
General Fund the Account to Increase the Quality of Nursing Care, to be
administered by the Division.
2. The interest and income on the money in
the Account to Increase the Quality of Nursing Care, after deducting any
applicable charges, must be credited to the Account.
3. Any money received by the Division
pursuant to NRS 422.3755 to 422.379,
inclusive, must be deposited in the Account to Increase the Quality of Nursing
Care, and must be expended, to the extent authorized by federal law, to obtain
federal financial participation in the Medicaid Program, and in the manner set
forth in subsection 4.
4. Expenditures from the Account to
Increase the Quality of Nursing Care must be used only:
(a) To increase the rates paid to nursing
facilities for providing services pursuant to the Medicaid Program and may not
be used to replace existing state expenditures paid to nursing facilities for
providing services pursuant to the Medicaid Program; and
(b) To administer the provisions of NRS 422.3755 to 422.379,
inclusive. The amount expended pursuant to this paragraph must not exceed 1
percent of the money received from the fees assessed pursuant to NRS 422.3755 to 422.379,
inclusive, and must not exceed the amount authorized for expenditure by the
Legislature for administrative expenses in a fiscal year.
5. Any money remaining in the Account to
Increase the Quality of Nursing Care at the end of a fiscal year does not
revert to the State General Fund, and the balance in the Account must be
carried forward to the next fiscal year.
6. If federal law or regulation prohibits
the money in the Account to Increase the Quality of Nursing Care from being
used in the manner set forth in this section, the rates paid to nursing
facilities for providing services pursuant to the Medicaid Program must be
changed:
(a) Except as otherwise provided in paragraph
(b), to the rates paid to such facilities on June 30, 2003; or
(b) If the Legislature or the Division has on or
after July 1, 2003, changed the rates paid to such facilities through a manner
other than the use of expenditures from the Account, to the rates provided for
by the Legislature or the Division.
(Added to NRS by 2003, 2746; A 2005, 22nd
Special Session, 34; 2011, 1767;
2013, 2757)
NRS 422.379 Administrative penalties for late payment of fee; recoupment of
fees and administrative penalties.
1. The Division shall establish
administrative penalties for the late payment by a nursing facility of a fee
assessed pursuant to NRS 422.3755 to 422.379, inclusive.
2. The Division may recoup any payments
made to nursing facilities providing services pursuant to the Medicaid program
up to the amount of the fees owed as determined pursuant to NRS 422.3775 and any administrative penalties owed
pursuant to subsection 1 if a nursing facility fails to remit the fees and
administrative penalties owed within 30 days after the date they are due.
Before recoupment of payments pursuant to this subsection, the Division may
allow a nursing facility that fails to remit fees and administrative penalties
owed an opportunity to negotiate a repayment plan with the Division. The terms
of the repayment plan may be established at the discretion of the Division.
(Added to NRS by 2003, 2747; A 2005, 22nd
Special Session, 35; 2007, 2393)
PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENT
PATIENTS
NRS 422.380 Definitions. As
used in NRS 422.380 to 422.390,
inclusive, unless the context otherwise requires:
1. “Disproportionate share payment” means
a payment made pursuant to 42 U.S.C. § 1396r-4.
2. “Hospital” has the meaning ascribed to
it in NRS 439B.110 and includes
public and private hospitals.
(Added to NRS by 1991, 2334; A 1993, 1967; 1995, 1427, 1430; 1997, 1243; 2003, 2990; 2005, 1450; 2009, 2293)
NRS 422.3805 Federal waivers: Duties of Administrator. The Administrator shall:
1. Apply for all waivers from federal law
or regulation 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
all appropriate steps to comply with the directives of the Federal Government.
(Added to NRS by 1993, 1966; A 1995, 1430; 1997, 2630; 1999, 2242)
NRS 422.382 Intergovernmental transfers of money from counties to Division;
deposit in Intergovernmental Transfer Account in State General Fund;
administration by Division.
1. The money transferred to the Division
in accordance with the regulations adopted pursuant to paragraph (a) of
subsection 1 of NRS 422.390 must not come from any
source of funding that could result in any reduction in revenue to the State
pursuant to 42 U.S.C. § 1396b(w).
2. Any money collected in accordance with
the regulations adopted pursuant to subsection 1 of NRS
422.390, including any interest or penalties imposed for a delinquent
payment, must be deposited in the State Treasury for credit to the
Intergovernmental Transfer Account in the State General Fund to be administered
by the Division.
3. The interest and income earned on
money in the Intergovernmental 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
Special Session, 35; 2009, 2293)
NRS 422.385 Disproportionate share payments from Medicaid Budget Account;
transfer of money from Intergovernmental Transfer Account.
1. The disproportionate share payments
made to hospitals must be made, to the extent allowed by the State Plan for
Medicaid, from the Medicaid Budget Account.
2. The money in the Intergovernmental
Transfer Account must be transferred from that Account to the Medicaid Budget
Account to the extent that money is available from the Federal Government for
proposed expenditures, including expenditures for administrative costs. If the amount
in the Account exceeds the amount authorized for expenditure by the Division
for the purposes of making disproportionate share payments, the Division is
authorized to expend the additional revenue in accordance with the provisions
of the State Plan for Medicaid.
3. If enough money is available to support
Medicaid and to make the disproportionate share payments, money in the
Intergovernmental Transfer Account may be transferred:
(a) To an account established for the provision
of health care services to uninsured children pursuant to a federal program in
which at least 50 percent of the cost of such services is paid for by the
Federal Government, including, without limitation, the Children’s Health
Insurance 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
Special Session, 35; 2009, 2294)
NRS 422.387 Calculation of disproportionate share payments; verification of
eligibility for disproportionate share payments; Director authorized to
negotiate terms of amendment to State Plan for Medicaid with Centers for
Medicare and Medicaid Services of United States Department of Health and Human
Services.
1. The State Plan for Medicaid must
provide the methodology for:
(a) Calculating the initial distribution of the
disproportionate share payments in accordance with the regulations adopted
pursuant to NRS 422.390;
(b) Adjusting the disproportionate share payment
to a hospital if the annual audit of the hospital demonstrates that the
disproportionate share payment made to the hospital was greater than the amount
of money which the hospital was eligible to receive; and
(c) Redistributing any amount of disproportionate
share payments which are returned to the Division as a result of the
adjustments made in accordance with paragraph (b).
2. The State Plan for Medicaid or, if the
Division deems necessary, the Division may require a hospital to submit any
documentation or other information to verify eligibility for a disproportionate
share payment or compliance with the requirements of NRS
422.380 to 422.390, inclusive. A
disproportionate share payment may not be calculated for or made to a hospital
which fails to provide the Division with documentation or other information
that is required by the State Plan for Medicaid or the Division.
3. Except as otherwise provided in
subsection 4, the State Plan for Medicaid must be consistent with the
provisions of NRS 422.380 to 422.390,
inclusive, and the regulations adopted pursuant thereto, and Title XIX of the
Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant
to those provisions.
4. If the Centers for Medicare and
Medicaid Services of the United States Department of Health and Human Services
denies an amendment to the State Plan for Medicaid, the Director may negotiate
terms which are acceptable to the Centers for Medicare and Medicaid Services
which are inconsistent with the provisions of NRS
422.380 to 422.390, inclusive, and the
regulations adopted pursuant thereto if:
(a) Negotiating such terms is necessary to ensure
that the State Plan for Medicaid is consistent with the provisions of Title XIX
of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations
adopted pursuant to those provisions; and
(b) Before finalizing such an amendment to the
State Plan for Medicaid, the Director obtains the approval of the Interim
Finance Committee.
(Added to NRS by 1991, 2335; A 1993, 1969; 1995, 1428, 1430; 1997, 1244, 2631; 1999, 2242; 2001, 3116; 2003, 2992; 2005, 22nd
Special Session, 36; 2009, 2294)
NRS 422.390 Regulations; quarterly report.
1. The Division shall adopt regulations
concerning:
(a) Procedures for the intergovernmental
transfers of money from the counties to the Division for the purposes of
carrying out the provisions of NRS 422.380 to 422.390, inclusive, and the State Plan for Medicaid.
(b) Provisions for the payment of a penalty and
interest for a delinquent intergovernmental transfer.
(c) Provisions for the payment of interest by the
Division for late reimbursements to hospitals or other providers of medical
care.
(d) Provisions for the calculation of
disproportionate share payments for hospitals.
(e) Any required documentation of and reporting
by a hospital relating to the calculation of the disproportionate share payment
for the hospital and the verification of the disproportionate share payment
that has been received by the hospital.
(f) Procedures and requirements for conducting
independent and certified audits of hospitals and the disproportionate share
payments made to hospitals as required pursuant to Title XIX of the Social
Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant
to those provisions.
(g) Procedures for adjusting a disproportionate
share payment in accordance with Title XIX of the Social Security Act, 42
U.S.C. §§ 1396, et seq., and the regulations adopted pursuant to those
provisions, if the audit of a hospital demonstrates that a disproportionate
share payment made to the hospital was greater than the amount of money the
hospital was eligible to receive.
(h) Procedures for redistributing any disproportionate
share payment returned to the Division by a hospital in accordance with Title
XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations
adopted pursuant to those provisions.
2. The Division shall report to the
Interim Finance Committee quarterly concerning the provisions of NRS 422.380 to 422.390,
inclusive.
3. Notwithstanding the provisions of NRS 233B.039 to the contrary, the
regulations adopted pursuant to this section must be adopted in accordance with
the provisions of chapter 233B of NRS and
must be codified in the Nevada Administrative Code.
(Added to NRS by 1991, 2337; A 1993, 1970; 1995, 1429; 1997, 2631; 1999, 2242; 2003, 2994; 2005, 22nd
Special Session, 38; 2009, 2297)
PROGRAM TO PROVIDE COMMUNITY-BASED SERVICES TO PERSONS WITH
PHYSICAL DISABILITIES
NRS 422.395 “Person with a physical disability” defined. Repealed. (See chapter 337, Statutes of Nevada
2013, at page 1634.)
NRS 422.396 Establishment and administration of program; application for
federal waiver to amend State Plan for Medicaid; contracting for services;
adoption of regulations.
1. The Department, through a division of
the Department designated by the Director, shall establish and administer a
program to provide community-based services necessary to enable a person with a
physical disability to remain in his or her home or with his or her family and
avoid placement in a facility for long-term care. The Department shall
coordinate the provision of community-based services pursuant to this section.
2. The Department shall apply to the
Secretary of Health 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 by the Department pursuant to NRS
422.271 in order to authorize the Department to include as medical
assistance under the State 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 the Secretary of Health and Human Services.
Ê The
Department shall cooperate with the Federal Government in obtaining a waiver
pursuant to this subsection.
3. The Department may use personnel of the
Department or it may contract with any appropriate public or private agency,
organization or institution to provide the community-based services necessary
to enable a person with a physical disability to remain in his or her home or
with his or her family and avoid placement in a facility for long-term care.
4. A contract entered into with a public
or private agency, organization or institution pursuant to subsection 3 must:
(a) Include a description of the type of service
to be provided;
(b) Specify the price to be paid for each service
and the method of payment; and
(c) Specify the criteria to be used to evaluate
the provision of the service.
5. The Department shall adopt regulations
necessary to carry out the provisions of this section, including, without
limitation, the criteria to be used in determining eligibility for the services
provided pursuant to the program. Before adopting regulations pursuant to this
section, the Department shall solicit comments from persons with a variety of
disabilities and members of the families of those persons.
6. As used in this section, “person with a
physical disability” means a person with a severe physical disability that
substantially limits his or her ability to participate and contribute
independently in the community in which the person lives.
(Added to NRS by 1997, 2659; A 2003, 2622; 2013, 1622)
NRS 422.397 Reports by Director. Repealed.
(See chapter 337, Statutes of Nevada 2013, at page 1634.)
PRESCRIPTION DRUGS
NRS 422.401 Definitions. As
used in NRS 422.401 to 422.406,
inclusive, unless the context otherwise requires, the words and terms defined
in NRS 422.4015 and 422.402
have the meanings ascribed to them in those sections.
(Added to NRS by 2003, 1317)
NRS 422.4015 “Committee” defined. “Committee”
means the Pharmacy and Therapeutics Committee established pursuant to NRS 422.4035.
(Added to NRS by 2003, 1317)
NRS 422.402 “Drug Use Review Board” defined. “Drug
Use Review Board” means the Board established pursuant to 42 U.S.C. §
1396r-8(g)(3).
(Added to NRS by 2003, 1317)
NRS 422.4025 List of preferred prescription drugs used for Medicaid program;
list of drugs excluded from restrictions; role of Pharmacy and Therapeutics
Committee; availability of new pharmaceutical products and products for which
there is new evidence. [Effective through June 30, 2015.]
1. The Department shall, by regulation,
develop a list of preferred prescription drugs to be used for the Medicaid
program.
2. The Department shall, by regulation,
establish a list of prescription drugs which must be excluded from any
restrictions that are imposed on drugs that are on the list of preferred
prescription drugs established pursuant to subsection 1. The list established
pursuant to this subsection must include, without limitation:
(a) Prescription drugs that are prescribed for
the treatment of the human immunodeficiency virus or acquired immunodeficiency
syndrome, including, without limitation, protease inhibitors and antiretroviral
medications;
(b) Antirejection medications for organ
transplants;
(c) Antihemophilic medications; and
(d) Any prescription drug which the Committee
identifies as appropriate for exclusion from any restrictions that are imposed
on drugs that are on the list of preferred prescription drugs.
3. The regulations must provide that the
Committee makes the final determination of:
(a) Whether a class of therapeutic prescription
drugs is included on the list of preferred prescription drugs and is excluded
from any restrictions that are imposed on drugs that are on the list of
preferred prescription drugs;
(b) Which therapeutically equivalent prescription
drugs will be reviewed for inclusion on the list of preferred prescription
drugs and for exclusion from any restrictions that are imposed on drugs that
are on the list of preferred prescription drugs;
(c) Which prescription drugs should be excluded
from any restrictions that are imposed on drugs that are on the list of
preferred prescription drugs based on continuity of care concerning a specific
diagnosis, condition, class of therapeutic prescription drugs or medical
specialty; and
(d) The criteria for prescribing an atypical or
typical antipsychotic medication, anticonvulsant medication or antidiabetic
medication that is not on the list of preferred drugs to a patient who
experiences a therapeutic failure while taking a prescription drug that is on
the list of preferred prescription drugs.
4. Except as otherwise provided in this
subsection, the list of preferred prescription drugs established pursuant to
subsection 1 must include, without limitation, every therapeutic prescription
drug that is classified as an anticonvulsant medication or antidiabetic
medication that was covered by the Medicaid program on June 30, 2010. If a
therapeutic prescription drug that is included on the list of preferred
prescription drugs pursuant to this subsection is prescribed for a clinical
indication other than the indication for which it was approved as of June 30,
2010, the Committee shall review the new clinical indication for that drug
pursuant to the provisions of subsection 5.
5. The regulations adopted pursuant to
this section must provide that each new pharmaceutical product and each
existing pharmaceutical product for which there is new clinical evidence
supporting its inclusion on the list of preferred prescription drugs must be
made available pursuant to the Medicaid program with prior authorization until
the Committee reviews the product or the evidence.
6. The Medicaid program must make
available without prior authorization atypical and typical antipsychotic
medications that are prescribed for the treatment of a mental illness,
anticonvulsant medications and antidiabetic medications for a patient who is
receiving services pursuant to Medicaid if the patient:
(a) Was prescribed the prescription drug on or
before June 30, 2010, and takes the prescription drug continuously, as
prescribed, on and after that date;
(b) Maintains continuous eligibility for
Medicaid; and
(c) Complies with all other requirements of this
section and any regulations adopted pursuant thereto.
(Added to NRS by 2003, 1317; A 2010, 26th
Special Session, 36; 2011, 985)
NRS 422.4025 List of preferred
prescription drugs used for Medicaid program; list of drugs excluded from
restrictions; role of Pharmacy and Therapeutics Committee; availability of new
pharmaceutical products and products for which there is new evidence.
[Effective July 1, 2015.]
1. The Department shall, by regulation,
develop a list of preferred prescription drugs to be used for the Medicaid
program.
2. The Department shall, by regulation,
establish a list of prescription drugs which must be excluded from any
restrictions that are imposed on drugs that are on the list of preferred
prescription drugs established pursuant to subsection 1. The list established
pursuant to this subsection must include, without limitation:
(a) Atypical and typical antipsychotic
medications that are prescribed for the treatment of a mental illness of a
patient who is receiving services pursuant to Medicaid;
(b) Prescription drugs that are prescribed for
the treatment of the human immunodeficiency virus or acquired immunodeficiency
syndrome, including, without limitation, protease inhibitors and antiretroviral
medications;
(c) Anticonvulsant medications;
(d) Antirejection medications for organ
transplants;
(e) Antidiabetic medications;
(f) Antihemophilic medications; and
(g) Any prescription drug which the Committee
identifies as appropriate for exclusion from any restrictions that are imposed
on drugs that are on the list of preferred prescription drugs.
3. The regulations must provide that the
Committee makes the final determination of:
(a) Whether a class of therapeutic prescription
drugs is included on the list of preferred prescription drugs and is excluded
from any restrictions that are imposed on drugs that are on the list of
preferred prescription drugs;
(b) Which therapeutically equivalent prescription
drugs will be reviewed for inclusion on the list of preferred prescription
drugs and for exclusion from any restrictions that are imposed on drugs that
are on the list of preferred prescription drugs; and
(c) Which prescription drugs should be excluded
from any restrictions that are imposed on drugs that are on the list of
preferred prescription 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
new pharmaceutical product and each existing pharmaceutical product for which
there is new clinical evidence supporting its inclusion on the list of
preferred prescription drugs must be made available pursuant to the Medicaid
program with prior authorization until the Committee reviews the product or the
evidence.
(Added to NRS by 2003, 1317; A 2010, 26th
Special Session, 36; 2011, 985,
effective July 1, 2015)
NRS 422.403 Establishment and management of use by Medicaid program of step
therapy and prior authorization; duties of Drug Use Review Board; acceptance of
recommendations from Board.
1. The Department shall, by regulation,
establish and manage the use by the Medicaid program of step therapy and prior
authorization for prescription drugs.
2. The Drug Use Review Board shall:
(a) Advise the Department concerning the use by
the Medicaid program of step therapy and prior authorization for prescription
drugs;
(b) Develop step therapy protocols and prior
authorization policies and procedures for use by the Medicaid program for
prescription drugs; and
(c) Review and approve, based on clinical
evidence and best clinical practice guidelines and without consideration of the
cost of the prescription drugs being considered, step therapy protocols used by
the Medicaid program for prescription drugs.
3. The Department shall not require the
Drug Use Review Board to develop, review or approve prior authorization
policies or procedures necessary for the operation of the list of preferred
prescription drugs developed for the Medicaid program pursuant to NRS 422.4025.
4. The Department shall accept
recommendations from the Drug Use Review Board as the basis for developing or
revising step therapy protocols and prior authorization policies and procedures
used by the Medicaid program for prescription drugs.
(Added to NRS by 2003, 1318)
NRS 422.4035 Pharmacy and Therapeutics Committee: Creation; membership.
1. The Director shall create a Pharmacy
and Therapeutics Committee within the Department. The Committee must consist of
at least 9 members and not more than 11 members appointed by the Governor based
on recommendations from the Director.
2. The Governor shall appoint to the Committee
health care professionals who have knowledge and expertise in one or more of
the following:
(a) The clinically appropriate prescribing of
outpatient prescription drugs that are covered by Medicaid;
(b) The clinically appropriate dispensing and monitoring
of outpatient prescription drugs that are covered by Medicaid;
(c) The review of, evaluation of and intervention
in the use of prescription drugs; and
(d) Medical quality assurance.
3. At least one-third of the members of
the Committee and not more than 51 percent of the members of the Committee must
be active physicians licensed to practice medicine in this State, at least one
of whom must be an active psychiatrist licensed to practice medicine in this
State. At least one-third of the members of the Committee and not more than 51
percent of the members of the Committee must be either active pharmacists
registered in this State or persons in this State with doctoral degrees in
pharmacy.
4. A person must not be appointed to the
Committee if the person is employed by, compensated by in any manner, has a
financial interest in, or is otherwise affiliated with a business or
corporation that manufactures prescription drugs.
(Added to NRS by 2003, 1318)
NRS 422.404 Pharmacy and Therapeutics Committee: Chair; terms; vacancies;
meetings; quorum.
1. The Governor shall appoint the Chair of
the Committee from among its members.
2. After the initial terms, the term of
each member of the Committee is 2 years. A member may be reappointed.
3. A vacancy occurring in the membership
of the Committee must be filled for the remainder of the unexpired term in the
same manner as the original appointment.
4. The Committee shall meet at least once
every 3 months and at the times and places specified by a call of the Chair of
the Committee.
5. A majority of the members of the
Committee constitutes a quorum for the transaction of business, and the
affirmative vote of a majority of the members of the Committee is required to
take action.
(Added to NRS by 2003, 1319)
NRS 422.4045 Pharmacy and Therapeutics Committee: Members serve without
compensation; members entitled to per diem; members holding public office or
employed by governmental entity.
1. Members of the Committee serve without
compensation, except that a member of the Committee is entitled, while engaged
in the business of the Committee, to receive the per diem allowance and travel
expenses provided for state officers and employees generally.
2. Each member of the Committee who is an
officer or employee of the State of Nevada or a local government must be
relieved from his or her duties without loss of regular compensation so that
the person may prepare for and attend meetings of the Committee and perform any
work necessary to carry out the duties of the Committee in the most timely
manner practicable. A state agency or local governmental entity shall not
require an officer or employee who is a member of the Committee to make up the
time that the officer or employee is absent from work to carry out any duties
as a member of the Committee or to use annual vacation or compensatory time for
the absence.
(Added to NRS by 2003, 1319)
NRS 422.405 Pharmacy and Therapeutics Committee: Duties and powers.
1. The Department shall, by regulation,
set forth the duties of the Committee which must include, without limitation:
(a) Identifying the prescription drugs which
should be included on the list of preferred prescription drugs developed by the
Department for the Medicaid program pursuant to NRS
422.4025 and the prescription drugs which should be excluded from any
restrictions that are imposed on drugs that are on the list of preferred
prescription drugs;
(b) Identifying classes of therapeutic
prescription drugs for its review and performing a clinical analysis of each
drug included in each class that is identified for review; and
(c) Reviewing at least annually all classes of
therapeutic prescription drugs on the list of preferred prescription drugs
developed by the Department for the Medicaid program pursuant to NRS 422.4025.
2. The Department shall, by regulation,
require the Committee to:
(a) Base its decisions on evidence of clinical
efficacy and safety without consideration of the cost of the prescription drugs
being considered by the Committee;
(b) Review new pharmaceutical products in as
expeditious a manner as possible; and
(c) Consider new clinical evidence supporting the
inclusion of an existing pharmaceutical product on the list of preferred
prescription drugs developed by the Department for the Medicaid program and new
clinical evidence supporting the exclusion of an existing pharmaceutical
product from any restrictions that are imposed on drugs that are on the list of
preferred prescription drugs in as expeditious a manner as possible.
3. The Department shall, by regulation,
authorize the Committee to:
(a) In carrying out its duties, exercise clinical
judgment and analyze peer review articles, published studies, and other medical
and scientific information; and
(b) Establish subcommittees to analyze specific
issues that arise as the Committee carries out its duties.
(Added to NRS by 2003, 1319)
NRS 422.4055 Advisory Committee to the Pharmacy and Therapeutics Committee
and the Drug Use Review Board: Creation; membership; Chair; terms; vacancies;
members serve without compensation; members entitled to per diem; members holding
public office or employed by governmental entity.
1. The Advisory Committee to the Pharmacy
and Therapeutics Committee and the Drug Use Review Board consisting of three
members is hereby created in the Department to advise the Committee and the
Drug 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 the Advisory Committee:
(a) One member appointed from a list of persons
provided to the Department by the American Association of Retired Persons or
any successor organization;
(b) One member appointed from a list of persons
provided to the Department by the Alliance for the Mentally Ill of Nevada or
any successor organization; and
(c) One member appointed from a list of persons
provided to the Department by the Statewide Independent Living Council
established in this State pursuant to 29 U.S.C. § 796d.
3. The Director shall appoint the Chair of
the Advisory Committee from among its members.
4. After the initial terms, the term of
each member of the Advisory Committee is 2 years. A member may be reappointed.
A vacancy occurring in the membership of the Advisory Committee must be filled
for the remainder of the unexpired term in the same manner as the original
appointment.
5. Members of the Advisory Committee serve
without compensation, except that a member of the Advisory Committee is
entitled, while engaged in the business of the Advisory Committee, to receive
the per diem allowance and travel expenses provided for state officers and
employees generally.
6. Each member of the Advisory Committee
who is an officer or employee of the State of Nevada or a local government must
be relieved from his or her duties without loss of any regular compensation so
that the officer or employee may prepare for and attend meetings of the
Advisory Committee and perform any work necessary to carry out the duties of
the Advisory Committee in the most timely manner practicable. A state agency or
local governmental entity shall not require an officer or employee who is a
member of the Advisory Committee to make up the time that the officer or
employee is absent from work to carry out any duties as a member of the
Advisory Committee or to use annual vacation or compensatory time for the
absence.
(Added to NRS by 2003, 1320)
NRS 422.406 Regulations; contracts for services.
1. The Department may, to carry out its
duties set forth in NRS 422.401 to 422.406, inclusive, and to administer the provisions
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 pursuant to NRS 422.401 to 422.406, inclusive, must be adopted in accordance with
the provisions of chapter 241 of NRS.
(Added to NRS by 2003, 1321)
UNLAWFUL ACTS; PENALTIES
General Provisions
NRS 422.410 Fraudulent acts; penalties.
1. Unless a different penalty is provided
pursuant to NRS 422.361 to 422.369,
inclusive, or 422.450 to 422.590,
inclusive, a person who knowingly and designedly, by any false pretense, false
or misleading statement, impersonation, misrepresentation, or concealment,
transfer, disposal or assignment of money or property obtains or attempts to
obtain monetary or any other public assistance, or money, property, medical or
remedial care or any other service provided pursuant to the Children’s Health
Insurance Program, having a value of $100 or more, whether by one act or a
series of acts, with the intent to cheat, defraud or defeat the purposes of
this chapter or to enable a person to meet or appear to meet any requirements
of eligibility prescribed by state law or by rule or regulation adopted by the
Department for a grant or an increase in a grant of any type of public
assistance is guilty of a category E felony and shall be punished as provided
in NRS 193.130. In addition to any
other penalty, the court shall order the person to pay restitution.
2. For the purposes of subsection 1,
whenever a recipient of Temporary Assistance for Needy Families pursuant to the
provisions of chapter 422A of NRS receives
an overpayment of benefits for the third time and the overpayments have
resulted from a false statement or representation by the recipient or from the
failure of the recipient to notify the Division of Welfare and Supportive
Services of the Department of a change in circumstances which would affect the
amount of assistance the recipient receives, a rebuttable presumption arises
that the payment was fraudulently received.
3. For the purposes of this section:
(a) “Public assistance” includes any money,
property, medical or remedial care or any other service provided pursuant to a
state plan.
(b) “Temporary Assistance for Needy Families” has
the meaning ascribed to it in NRS
422A.080.
(Added to NRS by 1981, 1909; A 1985, 1405; 1991, 1053; 1993, 142, 2788, 2819; 1995, 1274; 1997, 2239; 1999, 2233; 2005, 22nd
Special Session, 38; 2007, 2394; 2013, 1307)
State Plan for Medicaid
NRS 422.450 Definitions. As
used in NRS 422.450 to 422.590,
inclusive, unless the context otherwise requires, the words and terms defined
in NRS 422.460 to 422.525,
inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1991, 1048; A 1997, 456)
NRS 422.460 “Benefit” defined. “Benefit”
means a benefit authorized by the Plan.
(Added to NRS by 1991, 1048)
NRS 422.470 “Claim” defined. “Claim”
means a communication, whether oral, written, electronic or magnetic, which is
used to identify specific goods, items or services as reimbursable pursuant to
the Plan, or which states income or expense and is or may be used to determine
a rate of payment pursuant to the Plan.
(Added to NRS by 1991, 1048)
NRS 422.480 “Plan” defined. “Plan”
means the State Plan for Medicaid established pursuant to NRS 422.271.
(Added to NRS by 1991, 1048; A 1993, 2067; 1997, 1245)
NRS 422.490 “Provider” defined. “Provider”
means a:
1. Person who has applied to participate
or who participates in the Plan as the provider of goods or services; or
2. Private insurance carrier, health care
cooperative or alliance, health maintenance organization, insurer,
organization, entity, association, affiliation or person, who contracts to
provide or provides goods or 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 “Recipient” defined. “Recipient”
means a natural person who receives benefits pursuant to the Plan.
(Added to NRS by 1991, 1048)
NRS 422.510 “Records” defined. “Records”
means medical, professional or business records relating to the treatment or
care of a recipient, or to a good or a service provided to a recipient, or to
rates paid for such a good or a service, and records required to be kept by the
Plan.
(Added to NRS by 1991, 1048)
NRS 422.520 “Sign” defined. “Sign”
means to affix a signature directly or indirectly by means of handwriting,
typewriter, stamp, computer impulse or other means.
(Added to NRS by 1991, 1048)
NRS 422.525 “Statement or representation” defined. “Statement
or representation” includes, without limitation, a report, claim,
certification, acknowledgment or ratification 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 the health care or ancillary services; or
7. Any combination of subsections 1 to 6,
inclusive.
(Added to NRS by 1997, 456)
NRS 422.530 Responsibility for false claim, statement or representation. For the purposes of NRS
422.540 and 422.550:
1. A person shall be deemed to have known
that a claim, statement or representation was false if the person knew, or by
virtue of his or her position, authority or responsibility had reason to know,
of the falsity of the claim, statement or representation.
2. A person shall be deemed to have made
or caused to be made a claim, statement or representation if the person:
(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,
statement or representation,
Ê whether by
operation of law, business or professional practice, or office procedure; and
(b) Exercised that authority or responsibility or
failed to exercise that authority or responsibility and, as a direct or
indirect result, the false claim, statement or representation was made.
(Added to NRS by 1991, 1048; A 1997, 456)
NRS 422.540 Offenses regarding false claims, statements or representations;
penalties.
1. A person, with the intent to defraud,
commits an offense if with respect to the Plan the person:
(a) Makes a claim or causes it to be made,
knowing the claim to be false, in whole or in part, by commission or omission;
(b) Makes or causes to be made a statement or
representation for use in obtaining or seeking to obtain authorization to
provide specific goods or services, knowing the statement or representation to
be false, in whole or in part, by commission or omission;
(c) Makes or causes to be made a statement or
representation for use by another in obtaining goods or services pursuant to
the Plan, knowing the statement or representation to be false, in whole or in
part, by commission or omission; or
(d) Makes or causes to be made a statement or
representation for use in qualifying as a provider, knowing the statement or
representation to be false, in whole or in part, by commission or omission.
2. A person who commits an offense
described in subsection 1 shall be punished for a:
(a) Category D felony, as provided in NRS 193.130, if the amount of the claim or
the value of the goods or services obtained or sought to be obtained was
greater than or equal to $650.
(b) Misdemeanor if the amount of the claim or the
value of the goods or services obtained or sought to be obtained was less than
$650.
Ê Amounts
involved in separate violations of this section committed pursuant to a scheme
or continuing course of conduct may be aggregated in determining the
punishment.
3. In addition to any other penalty for a
violation of the commission of an offense described in subsection 1, the court
shall order the person to pay restitution.
(Added to NRS by 1991, 1049; A 1997, 457; 2011, 174)
NRS 422.550 Statement regarding 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
participate as a provider, each report stating income or expense upon which
rates of payment are or may be based, and each invoice for payment for goods or
services provided to a recipient must contain a statement that all matters
stated therein are true and accurate, signed by a natural person who is the
provider or is authorized to act for the provider, under the pains and penalties
of perjury.
2. A person is guilty of perjury which is
a category D felony and shall be punished as provided in NRS 193.130 if the person signs or
submits, or causes to be signed or submitted, such a statement, knowing that
the application, report or invoice contains information which is false, in
whole or in part, by commission or by omission.
3. For the purposes of this section, a
person who signs on behalf of a provider is presumed to have the authorization
of the provider and to be acting at the direction of the provider.
(Added to NRS by 1991, 1049; A 1995, 1274; 1997, 457)
NRS 422.560 Offenses regarding sale, purchase or lease of goods, services,
materials or supplies; penalty.
1. Except as otherwise provided in
subsection 2, a person shall not:
(a) While acting on behalf of a provider,
purchase or lease goods, services, materials or supplies for which payment may
be made, in whole or in part, pursuant to the Plan, and solicit or accept
anything of additional value in return for or in connection with the purchase
or lease;
(b) Sell or lease to or for the use of a provider
goods, services, materials or supplies for which payment may be made, in whole
or in part, pursuant to the Plan, and offer, transfer or pay anything of
additional value in connection with or in return for the sale or lease; or
(c) Refer a person to a provider for goods or
services for which payment may be made, in whole or in part, pursuant to the
Plan, and solicit or accept anything of value in connection with the referral.
2. Paragraphs (a) and (b) of subsection 1
do not apply if the additional value transferred is:
(a) A refund or discount made in the ordinary
course of business;
(b) Reflected by the books and records of the
person transferring or receiving it; and
(c) Reflected in the billings submitted to the
Plan.
3. A person shall not, while acting on
behalf of a provider providing goods or services to a recipient pursuant to the
Plan, charge, solicit, accept or receive anything of additional value in
addition to the amount legally payable pursuant to the Plan in connection with
the provision of the goods or services.
4. A person who violates this section, if
the value of the thing or any combination of things unlawfully solicited,
accepted, offered, transferred, paid, charged or received:
(a) Is less than $650, is guilty of a gross
misdemeanor.
(b) Is $650 or more, is guilty of a category D
felony and shall be punished as provided in NRS
193.130.
(Added to NRS by 1991, 1049; A 1995, 1275; 2011, 175)
NRS 422.570 Intentional failure to maintain adequate records; intentional
destruction of records; penalties.
1. A person is guilty of a gross
misdemeanor if, upon submitting a claim for or upon receiving payment for goods
or services pursuant to the Plan, the person intentionally fails to maintain
such records as are necessary to disclose fully the nature of the goods or
services for which a claim was submitted or payment was received, or such
records as are necessary to disclose fully all income and expenditures upon
which rates of payment were based, for at least 5 years after the date on which
payment was received.
2. A person who intentionally destroys
such records within 5 years after the date payment was received is guilty of a
category D felony and shall be punished as provided in NRS 193.130.
(Added to NRS by 1991, 1050; A 1995, 1275)
NRS 422.580 Civil penalties for certain violations; liability of provider
for excess amount unknowingly accepted; enforcement; use of money collected as
penalty or repayment.
1. A provider who receives payment to
which the provider is not entitled by reason of a violation of NRS 422.540, 422.550, 422.560 or 422.570 is
liable for:
(a) An amount equal to three times the amount
unlawfully obtained;
(b) Not less than $5,000 for each false claim,
statement or representation;
(c) An amount equal to three times the total of
the reasonable expenses incurred by the State in enforcing this section; and
(d) Payment of interest on the amount of the
excess payment at the rate fixed pursuant to NRS
99.040 for the period from the date upon which payment was made to the date
upon which repayment is made pursuant to the Plan.
2. A criminal action need not be brought
against the provider before civil liability attaches under this section.
3. A provider who unknowingly accepts a
payment in excess of the amount to which the provider is entitled is liable for
the repayment of the excess amount. It is a defense to any action brought
pursuant to this subsection that the provider returned or attempted to return
the amount which was in excess of that to which the provider was entitled
within a reasonable time after receiving it.
4. The Attorney General shall cause appropriate
legal action to be taken on behalf of the State to enforce the provisions of
this section.
5. Any penalty or repayment of money
collected pursuant to this section is hereby appropriated to provide medical
aid to the indigent through programs administered by the Department.
(Added to NRS by 1991, 1050; A 1997, 458; 1999, 2233)
NRS 422.590 Limitation and accrual of actions. An
action brought pursuant to NRS 422.540 to 422.580, inclusive, must be commenced within 4 years,
but the cause of action in such a case shall be deemed to accrue upon the
discovery by the aggrieved party of the facts constituting a violation of NRS 422.540 to 422.580,
inclusive.
(Added to NRS by 1997, 456)
