(NRS 422.270- 422.27495) Section 1 of this bill requires the Director to include in the State Plan a requirement that the State pay certain costs for doula services provided to Medicaid recipients.

Finally, section 1 requires a doula who desires to provide doula services for a recipient of Medicaid to [register] enroll with the Division of Health Care Financing and Policy of the Department.

sectionSection 14 among the duties the Director of thethis Departmentbill ismakes requireda toconforming fulfill.nchange Existingby lawincluding requiresthe certainduties personslisted in theirsection professional1 oramong occupationalthe capacityduties to report the suspectedDirector abuse, neglect, exploitation, isolation or abandonment of older or vulnerable persons or the suspectedDepartment abuseis orrequired neglectto offulfill. a child.

(NRSExisting 200.5093,law 432B.220)requires Sectionscertain 2persons andin 3their professional or occupational capacity to report the suspected abuse, neglect, exploitation, isolation or abandonment of thisolder billor expandvulnerable thesepersons reportingor requirementsthe tosuspected anabuse enrolledor doula.neglect of a child.

EXPLANATION(NRS –200.5093, Matter432B.220) inSections bolded2 italicsand is3 new;of this bill expand these reporting requirements to [a registered] an enrolled doula.

matterAssembly betweenAmendment bracketsNo. [omitted material] is material to be omitted.

W208 HEREAS , The process of childbirth poses mortal risk to bothAssembly theBill motherNo. and her child;

and256 WPage HEREAS4 ,W DoulasHEREAS, provideThe physicalprocess andof emotional support, accurate information concerning pregnancy, childbirth andposes themortal carerisk - 81st Session (2021) – 2 – of newborns and unwavering advocacy to womenboth duringthe pregnancy,mother labor, childbirth and theher post-partumchild; period;

and W HEREASHEREAS, ,Doulas Low-incomeprovide womenphysical rarelyand haveemotional accesssupport,accurate toinformation concerning pregnancy, childbirth and the essentialcare servicesof providednewborns byand doulas;unwavering advocacy to women during pregnancy, labor, childbirth and the post- partum period;

and byW theHEREAS, processLow-income ofwomen childbirth,rarely ithave isaccess necessary to expandthe accessessential toservices nonmedicalprovided doulaby services;doulas;

and W HEREAS, To reduce the risk posed to a mother and her child by the process of childbirth, it is necessary to expand access to nonmedical doula services;

The Director shall, to the extent authorized by federal law, include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for doula services provided by [a registered] an enrolled doula.

§ 1315 or apply for an amendment of the State Plan for Medicaid that authorizes the Department to receive federal funding to include in the State Plan for Medicaid coverage of doula services provided by [a registered] an enrolled doula.

The Department 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 or amendment pursuant to this section.

(a) An application for [registration] enrollment in the form prescribed by the Division;

and (b) Proof that he or she possesses the required training and qualifications prescribed by the Division pursuant to subsection 4.4 .

4.[;

Theand Division,(c) inAny consultationfee withfor community-basedregistration organizationsprescribed thatby provide services to pregnant women in this State, shall prescribe the requiredDivision.] training4. and qualifications for enrollment pursuant to subsection 3 to receive reimbursement through Medicaid for doula services.

The Division, in consultation with community-based organizations that provide services to pregnant women in this State, shall [adopt regulations prescribing] prescribe the required training and qualifications for [registration as a] enrollment pursuant to subsection 3 to receive reimbursement through Medicaid for doula [pursuant to this section.] services.

-(b) 81st[“Registered] Session“Enrolled (2021)doula” –means 3a –doula who is [registered] enrolled with the Division [.] pursuant to this section to receive reimbursement the through Medicaid for doula services.

Sec.Assembly Amendment No.

208 to Assembly Bill No.

256 Page 5 Sec.

(a) A person directly responsible or serving as a volunteer for or an employee of a public or private home, institution or facilityorfacility or where the child is receiving child care outside of the home for a portion of the day, the person shall make the report to a law enforcement agency.

Any person who is described in paragraph (a) of subsection 4 who delivers or provides medical services to a newborn infant and who, in his or her professional or occupational capacity, knows or has reasonable cause to believe that the newborn infant has been affected by a fetal alcohol spectrum disorder or prenatal substance use disorder or has withdrawal symptoms resulting from prenatal substance exposure shall, as soon as reasonably practicable but not later than 24 hours after the person knows or has reasonable cause to believe that the newborn infant is so affected or has such symptoms, notify an agency which provides child welfare services of the condition of the infant and refer each person who is responsible for the welfare of the infant to an agency which provides child welfare services for appropriate counseling, training or other services.

A -notification 81stand Sessionreferral (2021)to –an 4agency –which provides child welfare services pursuant to this subsection shall not be construed to require prosecution for any illegal action.

(d) A member of the clergy, practitioner of Christian Science or abusereligious orhealer, neglectunless from the offenderperson duringhas aacquired confession.owledgethe knowledge of the (e)abuse A person employed by a public school or privateneglect schoolfrom andthe anyoffender personduring who serves as a volunteerconfession. at such a school.

(f)(e) AnyA person who maintains or is employed by a facilitypublic orschool establishment that provides care for children, children’s camp or otherprivate publicschool orand privateany facility,person institutionwho orserves agencyas furnishinga carevolunteer toat such a child.school.

Assembly Amendment No.

208 to Assembly Bill No.

256 Page 6 (f) Any person who maintains or is employed by a facility or establishment that provides care for children, children’s camp or other public or private facility, institution or agency furnishing care to a child.

(j) Any person who maintains, is employed by or serves as a volunteer for an agency or service which advises persons regarding abuse or neglect of a child and refers them to persons and agencies whe(k)where Anytheir personrequests whoand isneeds employedcan bybe ormet. serves as a volunteer for a youth shelter.

(k) Any person who is employed by or serves as a volunteer for a youth shelter.

(m) Any person who is [registered] enrolled with the Division of Health Care Financing and Policy of the Department of Health and - 81st Session (2021) – 5 – Human Services to provide doula services to recipients of Medicaid pursuant to section 1 of this act.

If a person who is required to make a report pursuant to subsection 1 knows or has reasonable cause to believe that a child has died as a result of abuse or neglect, the person shall, as soon as reasonably practicable, report this belief to an agency which provides child welfare services or a law enforcement agency.

The agency, board, bureau, commission, department, division or political subdivision of the State responsible for the licensure, certification or endorsement of a person who is described in subsection 4 and who is required in his or her professional or occupational capacity to be licensed, certified or endorsed in this State shall, at the time of initial licensure, certification or end(a)endorsement: Inform the person, in writing or by electronic communication, of his or her duty as a mandatory reporter pursuant to this section;

(a) Inform the person, in writing or by electronic communication, of his or her duty as a mandatory reporter pursuant to this section;

- 81st Session (2021) – 6 – (a) Inform the person, in writing or by electronic communication, of his or her duty as a mandatory reporter pursuant to this section;

(b) Obtain a written acknowledgment or electronic record from the person that he or she has been informed of his or her duty pursuant to this section;

and beenAssembly informedAmendment ofNo. his or her duty (c) Maintain a copy of the written acknowledgment or electronic record for as long as the person is employed by the employer.

208 to Assembly Bill No.

256 Page 7 (c) Maintain a copy of the written acknowledgment or electronic record for as long as the person is employed by the employer.

Any person who is described in subsection 4 and who, in a professional or occupational capacity, knows or has reasonable cause to believe that an older person or vulnerable person has been abused, neglected, exploited, isolated or abandoned shall:

has been abused, neglected, exploited, isolated or abandoned (a) Except as otherwise provided in subsection 2, report the abuse, neglect, exploitation, isolation or abandonment of the older person or vulnerable person to:

-2. 81st Session (2021) – 7 – subsection 1 knows or has reasonable cause to believe that theto abuse, neglect, exploitation, isolation or abandonment of the older person or vulnerable person involves an act or omission of the Aging and Disability Services Division, another division of the Department of Health and Human Services or a law enforcement agency, the person shall make the report to an agency other than the one alleged to have committed the act or omission.

If a person who is required to make a report pursuant to subsection 1 knows or has reasonable cause to believe that the abuse, neglect, exploitation, isolation or abandonment of the older person or vulnerable person involves an act or omission of the Aging and Disability Services Division, another division of the Department of Health and Human Services or a law enforcement agency, the person shall make the report to an agency other than the one alleged to have committed the act or omission.

(a) Every physician, dentist, dental hygienist, chiropractor, optometrist, podiatric physician, medical examiner, resident, intern, professional or practical nurse, physician assistant licensed pursuant to chapter 630 or 633 of NRS, perfusionist, psychiatrist, psychologist, marriage and family therapist, clinical professional counselor, clinical alcohol and drug counselor, alcohol and drug counselor, music therapist, athletic trainer, driver of an ambulance, paramedic, licensed dietitian, holder of a license or a limited license issued under the provisions of chapter 653 of NRS or other person providing medical services licensed or certified to practice in this State, who examines, attends or treats an older person or vulnerable person who appears to have been abused, neglected, exploited, isolated or abandoned.

(b)Assembly AnyAmendment personnelNo. of a hospital or similar institution engaged in the admission, examination, care or treatment of persons or an administrator, manager or other person in charge of a hospital or similar institution upon notification of the suspected abuse, neglect, exploitation, isolation or abandonment of an older person or vulnerable person by a member of the staff of the hospital.

208 to Assembly Bill No.

256 Page 8 (b) Any personnel of a hospital or similar institution engaged in the admission, examination, care or treatment of persons or an administrator, manager or other person in charge of a hospital or similar institution upon notification of the suspected abuse, neglect, exploitation, isolation or abandonment of an older person or vulnerable person by a member of the staff of the hospital.

(c) A coroner.

(g) Any employee of the Department of Health and Human Services, except the State Long-Term Care Ombudsman appointed -pursuant 81stto SessionNRS (2021)427A.125 –and 8any –of his or her advocates or volunteers where prohibited from making such a report pursuant to 45 C.F.R.

recovery(m) organization, as defined in NRS 449.01563.a peer support (n) Every person who operates or is employed by a communitypeer healthsupport workerrecovery pool,organization, as defined in NRS 449.0028,449.01563. or with whom a community health worker pool contracts to provide the services of a community health worker, as defined in NRS 449.0027.

(o)(n) Every person who operates or is enrolledemployed withby thea Divisioncommunity ofhealth Healthworker Carepool, Financingas anddefined Policyin ofNRS the449.0028, Departmentor ofwith Healthwhom anda Humancommunity Serviceshealth worker pool contracts to provide doulathe services to recipients of Medicaida pursuantcommunity tohealth sectionworker, 1as ofdefined thisin act.NRS 449.0027.

(o) Every person who is [registered] enrolled with the Division of Health Care Financing and Policy of the Department of Health and Human Services to provide doula services to recipients of Medicaid pursuant to section 1 of this act.

If a person who is required to make a report pursuant to subsection 1 knows or has reasonable cause to believe that an older person or vulnerable person has died as a result of abuse, neglect, isolation or abandonment, the person shall, as soon as reasonably practicable, report this belief to the appropriate medical examiner or coroner, who shall investigate the cause of death of the older person or vulnerable person and submit to the appropriate local lawerlaw person enforcement agencies, the appropriate prosecuting attorney, the Aging and Disability Services Division of the Department of Health and Human Services and the Unit for the Investigation and Prosecution of Crimes his or her written findings.

A division, office or department which receives a report pursuant to this section shall cause the investigation of the report to - 81st Session (2021) – 9 – commence within 3 working days.

A copy of the final report of the investigation conducted by a division, office or department, other than the Aging and Disability Services Division of the DepartmentAssembly ofAmendment HealthNo. and Human Services, must be forwarded within 30 days aft(a) Aging and Disability Services Division;

208 to Assembly Bill No.

256 Page 9 Department of Health and Human Services, must be forwarded within 30 days after the completion of the report to the:

(a) Aging and Disability Services Division;

(a) Shall appoint, with the consent of the Governor, respectivelyadministrators designatedof asthe follows:thedivisions of the Department, who are (1)respectively Thedesignated Administratoras offollows: the Aging and Disability Services Division;

(1) The Administrator of the Aging and Disability Services Division;

(b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and - 81st Session (2021) – 10 – section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public and Behavioral Health or the professional line activities of the othericother divisions.

(4)Assembly IdentifyAmendment theNo. sources of funding for services provided by the Department and the allocation of that funding;

(5)208 Set forth sufficient information to assistAssembly theBill DepartmentNo. future provision of those services;

andplanning256 andPage budgeting10 for(4) Identify the (6)sources Containof anyfunding otherfor informationservices necessaryprovided forby the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modificationallocation of programsthat administeredfunding; by the Department.

(5) Set forth sufficient information to assist the Department in providing those services and in the planning and budgeting for the future provision of those services;

and (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department.

-2. 81st Session (2021) – 11 – the Director’s designee, is responsible for appointing and removingr subordinate officers and employees of the Department.

Notwithstanding any other provision of law, the Director, or the Director’s designee, is responsible for appointing and removing subordinate officers and employees of the Department.

~~~~~ 21 - 81st Session (2021)