USA Statutes : nevada
Title : Title 38 - PUBLIC WELFARE
Chapter : CHAPTER 422 - HEALTH CARE FINANCING AND POLICY
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 )
“Administrator” means the
Administrator of the Division.
(Added to NRS by 2005, 22nd Special Session, 21 )
Repealed. (See chapter 1, Statutes
of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.010 for similar reenacted provisions.)
“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 )
“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 )
“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)
“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 )
“Food Stamp
Assistance” means the program established to provide persons of low
income with an opportunity to obtain a more nutritious diet through the
issuance of coupons pursuant to the Food Stamp Act of 1977, as amended (7
U.S.C. §§ 2011 et seq.).
(Added to NRS by 1993, 2057)
“Low-Income Home Energy Assistance” means the program established to
assist persons of low income to meet the costs of heating and cooling
their homes pursuant to the Low-Income Home Energy Assistance Act of
1981, as amended (42 U.S.C. §§ 8621 et seq.).
(Added to NRS by 1993, 2057)
“Medicaid” has the meaning
ascribed to it in NRS 439B.120 .
(Added to NRS by 1997, 1236)
“Program for Child Care and Development” means the program established
to provide assistance for the care and development of children pursuant
to 42 U.S.C. §§ 9858 et seq.
(Added to NRS by 1997, 2224)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special
Session, at page 63 .) (Cf. NRS 422A.060 for similar reenacted provisions.)
1. “Public assistance” includes:
(a) State Supplementary Assistance;
(b) Temporary Assistance for Needy Families;
(c) Medicaid;
(d) Food Stamp Assistance;
(e) Low-Income Home Energy Assistance;
(f) The Program for Child Care and Development; and
(g) Benefits provided pursuant to any other public welfare program
administered by the Division pursuant to such additional federal
legislation as is not inconsistent with the purposes of this chapter.
2. The term does not include the Children’s Health Insurance
Program.
[Part 12a:327:1949; added 1951, 296; A 1953, 333]—(NRS A 1959, 518;
1975, 1007; 1981, 1909; 1993, 2059; 1995, 724; 1997, 1237, 2233, 2615;
1999, 581 , 1426 , 2242 ; 1999, 581 , 1426 , 2242 ; 2001, 161 ; 2005, 22nd Special Session, 21 )
“State
Supplementary Assistance” means the program established to provide state
assistance to aged or blind persons in connection with the Supplemental
Security Income Program.
(Added to NRS by 1981, 1907; A 1993, 2059)
“Supplemental Security Income Program” means the program established for
aged, blind or disabled persons pursuant to Title XVI of the Social
Security Act (42 U.S.C. §§ 1381 et seq.), as amended.
(Added to NRS by 1975, 1007; A 1993, 2059)
“Temporary Assistance for Needy Families” means the program established
to provide temporary assistance for needy families pursuant to Title IV
of the Social Security Act (42 U.S.C. §§ 601 et seq.) and other
provisions of that act relating to temporary assistance for needy
families.
(Added to NRS by 1997, 2224)
“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 he had an interest or legal title
immediately before or at the time of his death, to the extent of that
interest or title. The term includes, without limitation, assets conveyed
to a survivor, heir 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 )
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.030 for similar reenacted provisions.)
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 )
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 an alien 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 an alien 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)
STATE WELFARE BOARD
Repealed. (See
chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.) (Cf. NRS 422A.110 for similar reenacted provisions.)
Repealed. (See
chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.) (Cf. NRS 422A.115 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special Session,
at page 63 .) (Cf. NRS 422A.120 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of
Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.125 for similar reenacted provisions.)
Repealed. (See
chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.) (Cf. NRS 422A.130 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes
of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.135 for similar reenacted provisions.)
MEDICAL CARE ADVISORY GROUP
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 )
1. The Medical Care Advisory Group consists of the state health
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)
1. The Director shall appoint a Chairman of the Medical Care
Advisory Group from among its members.
2. The Administrator or his designee 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 Chairman, 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 )
STATE WELFARE ADMINISTRATOR
Repealed. (See chapter 1, Statutes of
Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.155 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes
of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.160 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada
2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.165 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of
Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.170 for similar reenacted provisions.)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.175 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd
Special Session, at page 63 .) (Cf. NRS 422A.180 for similar reenacted provisions.)
Repealed. (See
chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.) (Cf. NRS 422A.185 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special
Session, at page 63 .) (Cf. NRS 422A.190 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special Session,
at page 63 .) (Cf. NRS 422A.195 for similar reenacted provisions.)
ADMINISTRATOR OF DIVISION OF HEALTH CARE FINANCING AND POLICY
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .)
The Administrator must:
1. Be appointed on the basis of his 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 )
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 )
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 )
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 )
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 )
1. The Administrator or his 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; and
(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.
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 )
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 )
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 his 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 .
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 )
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 his
office.
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 his orders 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 )
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 he 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 he 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
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 program to provide Temporary Assistance for Needy
Families and the Program for Child Care and Development, must, except as
otherwise provided in NRS 422.2726 to
422.2729 , inclusive, 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 422.2726 to
422.2729 , inclusive, 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 )
Any federal
money allotted to the State of Nevada for public assistance programs and
other programs for which the Division is responsible and such other money
as may be received by the State for such purposes must, except as
otherwise provided in NRS 425.363 , be
deposited in the appropriate accounts of the Division in the State
General Fund.
(Added to NRS by 1981, 1908; A 1997, 2622; 1999, 823 , 2242 , 2248 ; 2005, 22nd Special Session, 25 )
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 )
If Congress passes any law
increasing the participation of the Federal Government in a Nevada
program for public assistance, 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 )
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 )
The Department shall:
1. Administer all public welfare programs of this State, including:
(a) State Supplementary Assistance;
(b) Temporary Assistance for Needy Families;
(c) Medicaid;
(d) Food Stamp Assistance;
(e) Low-Income Home Energy Assistance;
(f) The Program for Child Care and Development;
(g) The Program for the Enforcement of Child Support;
(h) The Children’s Health Insurance Program; and
(i) Other welfare activities and services provided for by the laws
of this State.
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 any of the services
and activities set forth in subsection 1.
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 welfare programs, and in increasing the efficiency
of welfare programs 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 welfare
needs 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
public assistance, welfare services and institutional care, when deemed
necessary or convenient by the Director.
6. Make such agreements with the Federal Government as may be
necessary to carry out the Supplemental Security Income Program.
7. As used in this section, “Program for the Enforcement of Child
Support” means the program established to locate absent parents,
establish paternity and obtain child support pursuant to Part D of Title
IV of the Social Security Act, 42 U.S.C. §§ 651 et seq., and any other
provisions of that act relating to the enforcement of child support.
[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 )
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 or recipients of services pursuant to the Children’s Health
Insurance Program traveling to and returning from providers of services
under the State Plan for Medicaid or the Children’s Health Insurance
Program.
2. The Director may adopt regulations concerning the
qualifications of persons who may contract with the Department to provide
transportation services pursuant to this section.
3. 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 Transportation
Services 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.
4. As used in this section:
(a) “Broker” has the meaning ascribed to it in NRS 706.021 .
(b) “Common motor carrier” has the meaning ascribed 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 )
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 449.037 ; 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 )
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 )
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 )
1. The Department shall provide public assistance pursuant to:
(a) The program established to provide Temporary Assistance for
Needy Families;
(b) Medicaid; or
(c) Any program for which a grant has been provided to this state
pursuant to 42 U.S.C. §§ 1397 et seq.,
Ê to a qualified alien who complies with the requirements established by
the Department pursuant to federal law and this chapter for the receipt
of benefits pursuant to that program.
2. As used in this section, “qualified alien” has the meaning
ascribed to it in 8 U.S.C. § 1641.
(Added to NRS by 1997, 2224; A 1999, 2229 ; 2003, 659 )—(Substituted in revision for NRS
422.29314)
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 )
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 $775 or
156 percent of the supplemental security income benefit rate established
pursuant to 42 U.S.C. § 1382(b)(1), whichever is greater.
2. As used in this section:
(a) “Facility for intermediate care” has the 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 )
1. The Director shall apply to the Federal Government for a
Medicaid waiver pursuant to the Health Insurance Flexibility and
Accountability demonstration initiative or any succeeding program to
provide certain health care benefits through Medicaid and the Children’s
Health Insurance Program to the persons described in NRS 422.2727 .
2. The Director shall fully cooperate in good faith with the
Federal Government during the application process to satisfy the
requirements of the Federal Government for obtaining a waiver pursuant to
this section, including, without limitation:
(a) Providing any necessary information requested by the Federal
Government in a timely manner;
(b) Responding promptly and thoroughly to any questions or concerns
of the Federal Government concerning the application; and
(c) Working with the Federal Government to amend any necessary
provisions of the application to satisfy the requirements for approval of
the application.
3. In applying for a waiver pursuant to this section, the Director
shall consider any recommendations he receives from the Board of Trustees
of the Fund for Hospital Care to Indigent Patients established pursuant
to NRS 428.195 , any board of county
commissioners and the Board of Directors of the Nevada Association of
Counties.
(Added to NRS by 2005, 1672 )
The Director shall include in the application for the
Medicaid waiver pursuant to NRS 422.2726 , to the extent authorized by federal law,
that the waiver is to:
1. Provide coverage for medical services to pregnant women who
have household incomes that are more than 133 percent of the federally
designated level signifying poverty but not more than 185 percent of the
federally designated level signifying poverty.
2. Provide a monthly subsidy of up to $100 toward a policy of
insurance purchased by an employee or the spouse of an employee:
(a) Who works for an employer that employs at least 2 but not more
than 50 employees;
(b) Whose household income is less than 200 percent of the
federally designated level signifying poverty; and
(c) Who is otherwise ineligible for Medicaid.
3. Provide coverage for hospital care to persons who have low
incomes, are otherwise ineligible for Medicaid and who have a
catastrophic illness or injury which results in unpaid charges for
hospital care. As used in this subsection, “hospital care” has the
meaning ascribed to it in NRS 428.155 .
(Added to NRS by 2005, 1673 )
1. If the Federal Government approves a Medicaid waiver which the
Director applied for pursuant to NRS 422.2726 , the Director shall adopt regulations to
implement the waiver and establish a program in accordance with the
waiver, which may include, without limitation, regulations setting forth:
(a) Any amount of contribution that a person who receives any
benefit under the program is required to pay;
(b) Criteria for eligibility;
(c) The services covered by the program;
(d) Any limitation on the number of persons who may participate in
the program; and
(e) Any other regulations necessary to carry out the program.
2. The Director shall also adopt any necessary regulations to
ensure that an employer that provides health care insurance to an
employee does not discontinue or reduce his contribution toward such
insurance as a result of any subsidy authorized under the program
established pursuant to this section. Such regulations must include,
without limitation, a requirement that a person is not eligible for a
subsidy unless his employer contributes at least 50 percent toward the
premium for insurance provided by the employer.
3. The Director shall submit a quarterly report concerning
benefits provided by the program established pursuant to this section to
the Interim Finance Committee and the Legislative Committee on Health
Care.
(Added to NRS by 2005, 1673 )
To fund a program established pursuant to NRS 422.2728
, the Director shall use:
1. The money transferred pursuant to subsection 2 of NRS 428.305
;
2. Any money provided by appropriation by the Legislature for that
purpose; and
3. Any federal money allotted to the State of Nevada for that
purpose.
(Added to NRS by 2005, 1674 )
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 final 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 )
Repealed. (See chapter 353, Statutes of Nevada 2005, at page
1334 .)
Repealed. (See chapter 353, Statutes of Nevada 2005,
at page 1334 .)
1. The Director or his designated representative 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 he 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)
The Attorney General and
his deputies are the legal advisers for the Division.
(Added to NRS by 1963, 501; A 1967, 1498; 1971, 1437; 1975, 175;
1979, 274; 1981, 1281; 1997, 2624; 1999, 2242 ; 2005, 22nd Special Session, 29 )
1. Subject to the provisions of subsection 2, if an application
for public assistance or claim for services is not acted upon by the
Department within a reasonable time after the filing of the application
or claim for services, or is denied in whole or in part, or if any grant
of public assistance or claim for services is reduced, suspended or
terminated, the applicant for or recipient of public assistance or
services may appeal to the Department and may be represented in the
appeal by counsel or other representative of his choice.
2. Upon the initial decision to deny, reduce, suspend or terminate
public assistance or services, the Department shall notify that applicant
or recipient of its decision, the regulations involved and his right to
request a hearing within a certain period. If a request for a hearing is
received within that period, the Department shall notify that person of
the time, place and nature of the hearing. The Department shall provide
an opportunity for a hearing of that appeal and shall review his case
regarding all matters alleged in that appeal.
3. The Department 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 amount of public assistance or services that
may be received by an applicant or recipient.
(Added to NRS by 1981, 1908; A 1985, 857; 1993, 2064; 1997, 2238;
1999, 2229 )—(Substituted in revision for NRS 422.294)
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 Department who
investigated or made the initial decision to deny, modify or cancel a
grant of public assistance or services 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 )
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 him to testify, and
rebut the evidence against him.
(Added to NRS by 1985, 855; A 1997, 1615)—(Substituted in revision
for NRS 422.297)
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 disability as defined in NRS 50.050 , is entitled to the services of an interpreter
at public expense, subject to the provisions of NRS 50.052 and 50.053 .
The interpreter must be qualified to engage in the practice of
interpreting in this State pursuant to subsection 2 of NRS 656A.100
and 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 )
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 his attorney or other representative.
2. The Department or an applicant for or recipient of public
assistance or services 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
public assistance or services 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 Department.
(Added to NRS by 1985, 856; A 1993, 2065; 1997, 2238, 2628; 1999,
581 , 2230 , 2242 )—(Substituted in revision for NRS 422.298)
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 Supreme Court. The appeal must be
taken in the manner provided for civil cases.
(Added to NRS by 1985, 856; A 1999, 2230 )—(Substituted in revision for NRS 422.299)
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 )
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 )
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 )
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 )
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 )
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)
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 his assistance being affected in any
way by an amending or repealing act.
(Added to NRS by 1981, 1908)
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 services, the
Department is subrogated to the right of the recipient to the extent of
all such costs and may join or intervene in any action by the recipient
or his successors in interest to enforce such legal liability.
2. If a recipient or his 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 his
successors in interest, to recover all costs to which it is entitled. In
any such action by the Department, the recipient or his 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 his 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 5, at such time as:
(a) The proceeds of any recovery or settlement are distributed to
or on behalf of the recipient, his successors in interest or his
attorney; and
(b) A dismissal by any court of any action brought to enforce the
legal liability established by subsection 1.
Ê No such lien is enforceable unless written notice is first given to the
person against whom the lien is asserted.
4. The recipient or his successors in interest shall notify the
Department in writing before entering any settlement agreement or
commencing any action to enforce the legal liability referred to in
subsection 1. Except if extraordinary circumstances exist, a person who
fails to comply with the provisions of this subsection shall be deemed to
have waived any consideration by the Director or his designated
representative of a reduction of the amount of the lien pursuant to
subsection 5 and shall pay to the Department all costs to which it is
entitled and its court costs and attorney’s fees.
5. If the Department receives notice pursuant to subsection 4, the
Director or his designated representative 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.
6. The attorney of a recipient:
(a) 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 his designated representative pursuant to
subsection 5.
(b) Shall reduce the amount of the fees charged the recipient for
services provided by the amount the attorney receives from the reduction
of a lien authorized by the Director or his designated representative
pursuant to subsection 5.
(Added to NRS by 1981, 1909; A 1989, 757; 1993, 923; 1997, 1239,
2624; 1999, 2228 , 2242 )
The Director:
1. Shall administer the provisions of NRS 422.29302 to 422.29308 , inclusive;
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 )
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 his spouse 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)
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 public assistance, the estate of the recipient, the
undivided estate of a recipient of Medicaid or a person who signed the
application for public assistance on behalf of the recipient an amount
not to exceed the amount of public assistance incorrectly paid to the
recipient, if the person who signed the application:
(a) Failed to report any required information to the Department
that the person knew at the time he signed the application; or
(b) Failed to report to the Department within the period allowed by
the Department any required information that the person obtained after he
filed the application.
2. Except as otherwise provided in this section, a recipient of
incorrectly paid public assistance, the undivided estate of a recipient
of Medicaid or a person who signed the application for public benefits on
behalf of the recipient shall reimburse the Department or appropriate
state agency for the value of the incorrectly paid public assistance.
3. The Director or his designee 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 public assistance, the
estate of the recipient, the undivided estate of a recipient of Medicaid
or a person who signed the application for public assistance on behalf of
the recipient.
4. The Director may, to the extent that it is not prohibited by
federal law, waive the repayment of public assistance incorrectly paid to
a recipient 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 )—(Substituted in revision for NRS
422.29353)
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 his death in the amount
of assistance paid or to be paid on his behalf 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 his death in the amount of assistance paid or
to be paid for him if he is an inpatient in a nursing facility,
intermediate care facility for the mentally retarded 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 spouse;
(b) His child who is under 21 years of age, blind or disabled as
determined in accordance with 42 U.S.C. § 1382c; or
(c) His 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 Director shall release a lien pursuant to this section:
(a) Upon notice by the recipient or his representative 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 )—(Substituted in revision for NRS
422.29355)
Each application
for Medicaid must include:
1. A statement that any assistance paid to a recipient may be
recovered in an action filed against the estate of the recipient or his
spouse; and
2. A statement that any person who signs an application for
Medicaid and fails to report:
(a) Any required information to the Department which he knew at the
time he signed the application; or
(b) Within the period allowed by the Department, any required
information to the Department which he obtained after he filed the
application,
Ê may be personally liable for any money incorrectly paid to the
recipient.
(Added to NRS by 1993, 918; A 1997, 1242; 2003, 876 )—(Substituted in revision for NRS 422.2936)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.335 for similar reenacted provisions.)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.340 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005,
22nd Special Session, at page 63 .) (Cf. NRS 422A.345 for similar reenacted provisions.)
Repealed. (See chapter
1, Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.350 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005,
22nd Special Session, at page 63 .) (Cf. NRS 422A.355 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special Session,
at page 63 .) (Cf. NRS 422A.360 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005,
22nd Special Session, at page 63 .) (Cf. NRS 422A.365 for similar reenacted provisions.)
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 )
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 )
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 his
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 )
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 )
1. If the Division denies an application for the Children’s Health
Insurance Program, the Division shall provide written notice of the
decision to the applicant. An applicant who disagrees with the denial of
the application may request a review of the case and a hearing before an
impartial hearing officer by filing a written request within 30 days
after the date of the notice of the decision at the address specified in
the notice.
2. The Division shall adopt regulations regarding the review and
hearing before an impartial hearing officer. The decision of the hearing
officer must be in writing.
3. The applicant may at any time within 30 days after the date on
which the written decision is mailed, petition the district court of the
judicial district in which the applicant resides to review the decision.
The district court shall review the decision on the record. The decision
and record must be certified as correct and filed with the court by the
Administrator.
4. The review by the court must be in accordance with NRS 422.279
.
(Added to NRS by 1999, 2226 ; A 2005, 22nd Special Session, 31 )
1. Except as otherwise provided in subsection 2 and in NRS 228.410
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 )
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 )
FINANCIAL RESPONSIBILITY OF RELATIVES
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special
Session, at page 63 .) (Cf. NRS 422A.460 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special Session,
at page 63 .) (Cf. NRS 422A.465 for similar reenacted provisions.)
Repealed.
(See chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.) (Cf. NRS 422A.470 for similar reenacted provisions.)
Repealed.
(See chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.) (Cf. NRS 422A.475 for similar reenacted provisions.)
MEDICAID CARDS
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)
“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 )
“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 )
“Plan” means the State Plan for
Medicaid established pursuant to NRS 422.271 .
(Added to NRS by 1993, 141; A 1997, 1243)
“Receives” means to acquire
possession or control.
(Added to NRS by 1993, 141)
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 possession or under his 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 )
A
person who:
1. Sells or buys a Medicaid card; or
2. Authorizes another person to use his 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)
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 he is the authorized holder of a Medicaid
card or that he 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)
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 he 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 )
PROGRAM TO PROVIDE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES
Repealed. (See chapter 1, Statutes of
Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.500 for similar reenacted provisions.)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.505 for similar reenacted provisions.)
Repealed. (See
chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.) (Cf. NRS 422A.510 for similar reenacted provisions.)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.515 for similar reenacted provisions.)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.520 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special Session,
at page 63 .) (Cf. NRS 422A.525 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd
Special Session, at page 63 .) (Cf. NRS 422A.530 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special Session,
at page 63 .) (Cf. NRS 422A.535 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd
Special Session, at page 63 .) (Cf. NRS 422A.540 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd Special Session,
at page 63 .) (Cf. NRS 422A.545 for similar reenacted provisions.)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.550 for similar reenacted provisions.)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.555 for similar reenacted provisions.)
Repealed.
(See chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.) (Cf. NRS 422A.560 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd
Special Session, at page 63 .) (Cf. NRS 422A.565 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd
Special Session, at page 63 .) (Cf. NRS 422A.570 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005, 22nd
Special Session, at page 63 .) (Cf. NRS 422A.575 for similar reenacted provisions.)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.580 for similar reenacted provisions.)
Repealed. (See chapter 1,
Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.585 for similar reenacted provisions.)
Repealed.
(See chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.) (Cf. NRS 422A.590 for similar reenacted provisions.)
Repealed. (See chapter
1, Statutes of Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.595 for similar reenacted provisions.)
Repealed. (See chapter 1, Statutes of Nevada 2005,
22nd Special Session, at page 63 .) (Cf. NRS 422A.600 for similar reenacted provisions.)
ASSESSMENT OF FEES ON NURSING FACILITIES TO INCREASE QUALITY OF NURSING
CARE
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 )
“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 mentally retarded or who have
conditions related to mental retardation; 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 )
“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 )
“Nursing facility” means
a facility for intermediate care or a facility for skilled nursing.
(Added to NRS by 2003, 2745 )
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 uniform rate per non-Medicare
patient day that is equivalent to 6 percent of the total annual accrual
basis gross revenue for services provided to patients of all nursing
facilities licensed in this State. 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 uniform 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 )
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 )
1. There is hereby created in the State Treasury the Fund to
Increase the Quality of Nursing Care, to be administered by the Division.
2. The Fund to Increase the Quality of Nursing Care must be a
separate and continuing fund, and no money in the Fund reverts to the
State General Fund at any time. The interest and income on the money in
the Fund, after deducting any applicable charges, must be credited to the
Fund.
3. Any money received by the Division pursuant to NRS 422.3755
to 422.379 , inclusive, must be deposited in the State
Treasury for credit to the Fund 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 Fund 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. If federal law or regulation prohibits the money in the Fund 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 Fund to Increase the Quality of
Nursing Care, to the rates provided for by the Legislature or the
Division.
(Added to NRS by 2003, 2746 ; A 2005, 22nd Special Session, 34 )
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.
(Added to NRS by 2003, 2747 ; A 2005, 22nd Special Session, 35 )
PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENT PATIENTS
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.
3. “Public hospital” means:
(a) A hospital owned by a state or local government, including,
without limitation, a hospital district; or
(b) A hospital that is supported in whole or in part by tax
revenue, other than tax revenue received for medical care which is
provided to Medicaid patients, indigent patients or other low-income
patients.
(Added to NRS by 1991, 2334; A 1993, 1967; 1995, 1427, 1430; 1997,
1243; 2003, 2990 ; 2005, 1450 )
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
)
1. The Division shall determine for each hospital that is located
in a county whose population is 100,000 or more the uncompensated care
percentage of the hospital for the preceding fiscal year.
2. Based on the determinations made pursuant to subsection 1, the
Division shall determine for each county whose population is 100,000 or
more the arithmetic mean of the percentages determined pursuant to
subsection 1 of all hospitals in the county.
3. Each hospital shall provide to the Division any information
requested by the Division that the Division determines is necessary to
make a determination pursuant to this section.
4. The Division shall at least once each year prepare and submit a
report concerning the determinations it makes pursuant to this section to:
(a) The Legislative Commission;
(b) The Interim Finance Committee; and
(c) The Legislative Committee on Health Care.
5. As used in this section, “uncompensated care percentage” has
the meaning ascribed to it in NRS 422.387 .
(Added to NRS by 2005, 1450 )
1. In a county whose population is 100,000 or more within which:
(a) A public hospital is located, the state or local government or
other entity responsible for the public hospital shall transfer an amount
equal to:
(1) Seventy percent of the total amount of disproportionate
share payments distributed to all hospitals pursuant to NRS 422.387
for a fiscal year, less $1,050,000; or
(2) Sixty-eight and fifty-four one hundredths percent of the
total amount of disproportionate share payments distributed to all
hospitals pursuant to NRS 422.387 for a
fiscal year,
Ê whichever is less, to the Division.
(b) A private hospital which receives a disproportionate share
payment pursuant to paragraph (c) of subsection 2 of NRS 422.387 is located, the county shall transfer 1.95
percent of the total amount of disproportionate share payments
distributed to all hospitals pursuant to NRS 422.387 for a fiscal year, but not more than
$1,500,000, to the Division.
2. A county that transfers the amount required pursuant to
paragraph (b) of subsection 1 to the Division is discharged of the duty
and is released from liability for providing medical treatment for
indigent inpatients who are treated in the hospital in the county that
receives a payment pursuant to paragraph (c) of subsection 2 of NRS
422.387 .
3. The money transferred to the Division pursuant to subsection 1
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).
4. Any money collected pursuant to subsection 1, 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.
5. 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 )
1. The allocations and payments required pursuant to subsections 1
to 5, inclusive, of NRS 422.387 must be
made, to the extent allowed by the State Plan for Medicaid, from the
Medicaid Budget Account.
2. Except as otherwise provided in subsection 3 and subsection 6
of NRS 422.387 , 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 specified in
NRS 422.387 , 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 payments required by subsection 6 of NRS 422.387 , 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 )
1. Before making the payments required or authorized by this
section, the Division shall allocate money for the administrative costs
necessary to carry out the provisions of NRS 422.380 to 422.390 ,
inclusive. The amount allocated for administrative costs must not exceed
the amount authorized for expenditure by the Legislature for this purpose
in a fiscal year. The Interim Finance Committee may adjust the amount
allowed for administrative costs.
2. The State Plan for Medicaid must provide for the payment of the
maximum amount of disproportionate share payments allowable under federal
law and regulations. The State Plan for Medicaid must provide that for:
(a) All public hospitals in counties whose population is 400,000 or
more, the total annual disproportionate share payments are $66,650,000
plus 90 percent of the total amount of disproportionate share payments
distributed by the State in that fiscal year that exceeds $76,000,000;
(b) All private hospitals in counties whose population is 400,000
or more, the total annual disproportionate share payments are $1,200,000
plus 2.5 percent of the total amount of disproportionate share payments
distributed by the State in that fiscal year that exceeds $76,000,000;
(c) All private hospitals in counties whose population is 100,000
or more but less than 400,000, the total annual disproportionate share
payments are $4,800,000 plus 2.5 percent of the total amount of
disproportionate share payments distributed by the State in that fiscal
year that exceeds $76,000,000;
(d) All public hospitals in counties whose population is less than
100,000, the total annual disproportionate share payments are $900,000
plus 2.5 percent of the total amount of disproportionate share payments
distributed by the State in that fiscal year that exceeds $76,000,000; and
(e) All private hospitals in counties whose population is less than
100,000, the total annual disproportionate share payments are $2,450,000
plus 2.5 percent of the total amount of disproportionate share payments
distributed by the State in that fiscal year that exceeds $76,000,000.
3. The State Plan for Medicaid must provide for a base payment in
an amount determined pursuant to subsections 4 and 5. Any amount set
forth in each paragraph of subsection 2 that remains after all base
payments have been distributed must be distributed to the hospital within
that paragraph with the highest uncompensated care percentage in an
amount equal to either the amount remaining after all base payments have
been distributed or the amount necessary to reduce the uncompensated care
percentage of that hospital to the uncompensated care percentage of the
hospital in that paragraph with the second highest uncompensated care
percentage, whichever is less. Any amount set forth in subsection 2 that
remains after the uncompensated care percentage of the hospital with the
highest uncompensated care percentage in a paragraph has been reduced to
equal the uncompensated care percentage of the hospital in that paragraph
with the second highest uncompensated care percentage must be distributed
equally to the two hospitals with the highest uncompensated care
percentage in that paragraph until their uncompensated care percentages
are equal to the uncompensated care percentage of the hospital with the
third highest uncompensated care percentage in that paragraph. This
process must be repeated until all available funds set forth in a
paragraph of subsection 2 have been distributed.
4. Except as otherwise provided in subsection 5, the base payments
for the purposes of subsection 3 are:
(a) For the University Medical Center of Southern Nevada,
$66,531,729;
(b) For Washoe Medical Center, $4,800,000;
(c) For Carson-Tahoe Hospital, $1,000,000;
(d) For Northeastern Nevada Regional Hospital, $500,000;
(e) For Churchill Community Hospital, $500,000;
(f) For Humboldt General Hospital, $215,109;
(g) For William Bee Ririe Hospital, $204,001;
(h) For Mt. Grant General Hospital, $195,838;
(i) For South Lyon Medical Center, $174,417; and
(j) For Nye Regional Medical Center, $115,000,
Ê or the successors in interest to such hospitals.
5. The Plan must be consistent with the provisions of NRS 422.380
to 422.390 , inclusive, and Title XIX of the Social
Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted
pursuant to those provisions. If the total amount available to the State
for making disproportionate share payments is less than $76,000,000, the
Administrator:
(a) Shall adjust the amounts for each group of hospitals described
in a paragraph of subsection 2 proportionally in accordance with the
limits of federal law. If the amount available to hospitals in a group
described in a paragraph of subsection 2 is less than the total amount of
base payments specified in subsection 4, the Administrator shall reduce
the base payments proportionally in accordance with the limits of federal
law.
(b) Shall adopt a regulation specifying the amount of the
reductions required by paragraph (a).
6. To the extent that money is available in the Intergovernmental
Transfer Account, the Division shall distribute $50,000 from that Account
each fiscal year to each public hospital which:
(a) Is located in a county that does not have any other hospitals;
and
(b) Is not eligible for a payment pursuant to subsections 2, 3 and
4.
7. As used in this section:
(a) “Total revenue” is the amount of revenue a hospital receives
for patient care and other services, net of any contractual allowances or
bad debts.
(b) “Uncompensated care costs” means the total costs of a hospital
incurred in providing care to uninsured patients, including, without
limitation, patients covered by Medicaid or another governmental program
for indigent patients, less any payments received by the hospital for
that care.
(c) “Uncompensated care percentage” means the uncompensated care
costs of a hospital divided by the total revenue for the hospital.
(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 )
1. The Division shall adopt regulations concerning:
(a) Procedures for the transfer to the Division of the amount
required pursuant to NRS 422.382 .
(b) Provisions for the payment of a penalty and interest for a
delinquent 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 the uncompensated care
percentage for hospitals, including, without limitation, the procedures
and methodology required to be used in calculating the percentage, and
any required documentation of and reporting by a hospital relating to the
calculation.
2. The Division shall report to the Interim Finance Committee
quarterly concerning the provisions of NRS 422.380 to 422.390 ,
inclusive.
(Added to NRS by 1991, 2337; A 1993, 1970; 1995, 1429; 1997, 2631;
1999, 2242 ; 2003, 2994 ; 2005, 22nd Special Session, 38 )
PROGRAM TO ASSIST RELATIVES WHO HAVE LEGAL GUARDIANSHIP OF CHILDREN
Repealed. (See chapter 1, Statutes of
Nevada 2005, 22nd Special Session, at page 63 .) (Cf. NRS 422A.650 for similar reenacted provisions.)
PROGRAM TO PROVIDE COMMUNITY-BASED SERVICES TO PERSONS WITH PHYSICAL
DISABILITIES
As used
in NRS 422.396 and 422.397 , unless the context otherwise requires,
“person with a physical disability” means a person with a severe physical
disability that substantially limits his ability to participate and
contribute independently in the community in which he lives.
(Added to NRS by 1997, 2659)
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 home or with his 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 home or with his
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.
(Added to NRS by 1997, 2659; A 2003, 2622 )
On or before December 31 of each
even-numbered year, the Director shall:
1. Prepare a report of the effectiveness of the program
administered pursuant to NRS 422.396
during the preceding biennium; and
2. Submit the report to the Governor and to the Director of the
Legislative Counsel Bureau for transmittal to the next regular session of
the Nevada Legislature.
(Added to NRS by 1997, 2660)
PRESCRIPTION DRUGS
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 )
“Committee” means the Pharmacy
and Therapeutics Committee established pursuant to NRS 422.4035 .
(Added to NRS by 2003, 1317 )
“Drug Use Review
Board” means the Board established pursuant to 42 U.S.C. § 1396r-8(g)(3).
(Added to NRS by 2003, 1317 )
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 )
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 )
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 he 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 )
1. The Governor shall appoint the Chairman 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 Chairman 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 )
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
duties without loss of his regular compensation so that he 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 he is absent from work to carry out his duties as a
member of the Committee or to use annual vacation or compensatory time
for the absence.
(Added to NRS by 2003, 1319 )
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 )
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 Chairman 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 duties without loss of his regular compensation so that he 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 he is absent from work to
carry out his 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 )
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
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 or misrepresentation,
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 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
this chapter and 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 his
circumstances which would affect the amount of assistance he receives, a
rebuttable presumption arises that the payment was fraudulently received.
3. For the purposes of subsection 1, “public assistance” includes
any money, property, medical or remedial care or any other service
provided pursuant to a state plan.
(Added to NRS by 1981, 1909; A 1985, 1405; 1991, 1053; 1993, 142,
2788, 2819; 1995, 1274; 1997, 2239; 1999, 2233 ; 2005, 22nd Special Session, 38 )
State Plan for Medicaid
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)
“Benefit” means a benefit
authorized by the Plan.
(Added to NRS by 1991, 1048)
“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)
“Plan” means the State Plan for
Medicaid established pursuant to NRS 422.271 .
(Added to NRS by 1991, 1048; A 1993, 2067; 1997, 1245)
“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)
“Recipient” means a natural
person who receives benefits pursuant to the Plan.
(Added to NRS by 1991, 1048)
“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)
“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)
“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)
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 he knew, or by virtue of his 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 he:
(a) Had the authority or responsibility to:
(1) Make the claim, statement or representation;
(2) Supervise another who made the claim, statement or
representation; or
(3) Authorize the making of the claim, 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)
1. A person, with the intent to defraud, commits an offense if
with respect to the Plan he:
(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 $250.
(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 $250.
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)
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 he 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 his direction.
(Added to NRS by 1991, 1049; A 1995, 1274; 1997, 457)
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 $250, is guilty of a gross misdemeanor.
(b) Is $250 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)
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, he 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)
1. A provider who receives payment to which he 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 he 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 he 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 )
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)
MISCELLANEOUS PROVISIONS
Repealed. (See
chapter 1, Statutes of Nevada 2005, 22nd Special Session, at page 63
.)
