Existing40 lawPage provides4 forrequest thenot collectionmore andthan maintenancetwo ofreports dataeach andyear theconcerning issuancecertain ofissues reportsrelating concerning:to health care from a state or local governmental entity.

Section 1 requires any [data contained in such a report to be presented in a manner that complies with applicable privacy laws.] governmental entity that receives such a request to submit the report to provide the report to the Executive Director of the Commission and a copy of the report to the Attorney General, to the extent that the entity has resources to compile the report and disclosure of the Accountability Act of 1996, Public Law 104-191.lth Insurance Portability and Existing law provides for the collection and maintenance of data and the issuance of reports concerning:

(NRS 439B.600-439B.695, 457.230-457.230-457.280) - 81st Session (2021) – 2 – 457.280) Section 9 of this bill requires,requires to the extent that federal money is available for this purpose, the Department of Health and Human Services to establish an all-all-payer payer claims database of information relating to health insurance claims resulting from medical, dental or pharmacy benefits provided in this State.

Section 9:9 :

(1) requires the Department to adopt regulations to establish an advisory committee to make recommendations concerning the collection, analysis and reporting of data in the database, secure access to such data and the release of such data;

and (2) in authorizes the Department to establish an advisory committee to assist the Department in establishing and maintaining the database.

Section 10 of this bill requires any public or private insurer that provides health benefits and is regulated underauthorizes statecertain law,insurers withthat certainare exceptions,regulated under federal law to submit data to the database.

Section 10 also authorizes certain insurers that are regulated under federal law to submit data to the database.

Section 13 of this bill:bill [prescribes the conditions under which such a request may be granted, which :

(1) differ depending on the sensitivity of the data requested;

and (2 ) include the payment of a fee.] :

and (2) requires the Department to release the information in the database to the Attorney General for purposes relating to unfair or deceptive trade datapractices. to certain governmental entities or an entity that submits information to theed database pursuant to section 10;

Section 13 authorizes the release entity that submits information to the database pursuant to section 10;

Section 13 also prohibits a person or entity to whom data is released from using or disclosing the data in [certain circumstances.] a manner not specified in the request made by the person or entity.

Section 17 of this bill requires the Department to adopt regulations necessary for the establishment and maintenance penalties to be imposed against persons and entities that fail to comply withtive provisions of law or regulations governing the database.

Section 17 requires such regulations to establish administrative penalties to be imposed against [:

(1) an insurer that fails to submit data to the database;

and (2) any person or entity that accesses, maintains, uses or discloses data from the database in an unauthorized manner.] persons and entities that fail to comply with provisions of law or regulations governing the database.

Section 18 of this bill authorizes the use of administrative penalties collected for failure to comply with requirements to provide certain information relating to prescriptionSenate drugsAmendment forNo. similar purposes.

Section175 19.5 of this bill also authorizes the Commissioner of Insurance to refuseSenate toBill continue,No. suspend, limit or revoke an - 81st Session (2021) – 3 – insurer’s certificate of authority for failure to comply with provisions of law or regulations governing the database.

and40 thePage Division5 Commissioner of Insurance ofto therefuse Department of Business and Industry toices develop and submit to thecontinue, Patientsuspend, Protectionlimit Commissionor andrevoke the Legislature a report containing an inventoryinsurer’s ofcertificate certain types of dataauthority reportedfor failure to thecomply Departmentwith provisions of Healthlaw and Human Services or theregulations Divisiongoverning of Insurance of the Departmentdatabase. of Business and Industry.

FinancingSection and20 Policy of this bill requires the Department of Health and Human Services forand theththe CareDivision developmentof Insurance of the all-payerDepartment claimsof databaseBusiness ifand Industry to develop and submit to the databasePatient isProtection establishedCommission pursuantand the Legislature a report containing an inventory of certain types of data reported to sectionthe 9.Department of Health and Human Services or the Division of Insurance of the Department of Business and Industry.

EXPLANATIONTHE –PEOPLE MatterOF inTHE boldedSTATE italicsOF isNEVADA, new;REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

matterSection between1. brackets [omitted material] is material to be omitted.

THE SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:D IN Section 1.

(g) Reviewing the effect of any changes to Medicaid, including, without limitation, the expansion of Medicaid pursuant to the - 81st Session (2021) – 4 – Patient Protection and Affordable Care Act, Public Law 111-148, on the cost and availability of health care and health insurance in this State.

(h) Reviewing proposed and enacted legislation, regulations and State.changesother changes to state and local policy related to health care in this (i)State. Researching possible changes to state or local policy in this State that may improve the quality, accessibility or affordability of health care in this State, including, without limitation:

(i) Researching possible changes to state or local policy in this State that may improve the quality, accessibility or affordability of health care in this State, including, without limitation:

(5)Senate ResolvingAmendment problemsNo. relating to the billing of patients for medical services;

175 to Senate Bill No.

40 Page 6 (5) Resolving problems relating to the billing of patients for medical services;

(j) Monitoring and evaluating proposed and enacted federal legislation and regulations and other proposed and actual changes to onfederal the cost of health care inpolicy thisto State.hedetermine the impact of such changes (k)on Evaluating the degreecost to which the role, structure and duties of the Commission facilitate the oversight of the provision of health care in this State by the Commission and allow the Commission to perform activities necessary to promote the health care needs of residents of this State.

(k) Evaluating the degree to which the role, structure and duties of the Commission facilitate the oversight of the provision of health care in this State by the Commission and allow the Commission to perform activities necessary to promote the health care needs of residents of this State.

The Commission may request that any state or local governmental entity submit [a report] not more than two reports each year containing or analyzing information that is not confidential by law - 81st Session (2021) – 5 – concerning the cost of health care, consolidation among entities that provide or pay for health care or other issues related to access to health care.

[A] To the extent that a governmental entity from which such a report is requested has the resources to compile the report and the disclosure of the information requested is authorized by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, the governmental entity shall provide the report to[. the Executive Director of the Commission and submit a copy of the report to the Attorney General.

Any data contained in such a report must be presented in a manner that complies with relevant state and federal privacy laws, including, without limitation, the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and the regulations adopted pursuant thereto.] to the Executive Director of the Commission and submit a copy of the report to the Attorney General.

As used in sections 3 to 17, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 4 to [8,] 8.5, inclusive, of this act have the meanings ascribed to them in those sections.

“Covered entity” has the meaning ascribed to it in 45 C.F.R.

“Direct patient identifier” means data that directly identifies a patient, including, without limitation, a name, telephone number, social security number, number associated electronicwith maila address.ealthmedical record, health plan beneficiary number [, certificate or Sec.license number, vehicle identification number, serial number, license plate number, Internet address,] or electronic mail address .

[, biometric identifier or photographic image.] Sec.

[“Indirect patient identifier” means data that can be used to identify a patient when combined with other information.] (Deleted by amendment.) Sec.Senate Amendment No.

175 to Senate Bill No.

40 Page 7 Sec.

A specific term of a contract, discount or other agreement between any or all of a provider of health care,care , [or] a health facility,facility [and] , a manufacturer of prescription drugs and an entity described in section 10 of this act;

“Unique identifier” means an identifier that is guaranteed to be unique for a patient and can be used to track - 81st Session (2021) – 6 – information relating to the patient but is not a direct patient identifier.

The Department shall,shall toestablish thean extentall-payer thatclaims federaldatabase moneyof isinformation availablerelating forto thishealth purpose,insurance establish an all-payer claims resulting from medical, dental or pharmacy benefits provided in this State.

IfThe the Department establishes an all-payer claims database pursuant to subsection 1, the Department shall:

3.[(c) Assign an identifier to each patient represented in the database.

IfThe theidentifier Departmentmust establishesallow ana all-payerperson claimswho receives data from the database pursuantthat does not contain direct patient identifiers or indirect patient identifiers to subsectionidentify 1,data concerning the Department:patient without identifying the patient.] 3.

The Department [may establish an] :

(b) May adopt regulations to establish any other advisory committee if necessary to assist the Department in carrying out the pro4.sioTheprovisions membership of anysections advisory3 committee established pursuant to subsection17, 3inclusive, must include, without limitation, representatives of providersthis ofact health. care, health facilities, health authorities, as defined in NRS 439.005, health maintenance organizations, private insurers, nonprofit organizations that represent consumers of health care services and each of the two entities that submit data concerning the largest number of claims to the database.

[, including, without limitation, an advisory committee concerning the maintenance and release of data.] 4.

The membership of any advisory committee established pursuant to [this section] subsection 3 must include, without limitation, representatives of providers of health care, health facilities, health authorities, as defined in NRS 439.005, health maintenance organizations, private insurers, nonprofit organizations that represent consumers of health care services and each of the two entities that submit data concerning the largest number of claims to the database.

If an all-payer claims database is established pursuant to section 9 of this act:

[Each] Except as otherwise provided in this section, each health carrier, governing body of a local governmental agency that provides health insurance through a self-insurance reserve fund pursuant to NRS 287.010 or entity required by the regulations adopted pursuant to section 17 of this act to submit data to the - 81st Session (2021) – 7 – database and the Public Employees’ Benefits Program shall submit to the all-payer claims database the data prescribed by the Department pursuant to section 17 of this act [.] in the format prescribed by the Department pursuant to that section.

The pro(a)provisions An issuer of insurancethis thatsubsection onlydo providesnot limited-scopeapply dentalto: or vision benefits or coverage that is only for a specified disease or illness, with respect to such coverage;

Senate Amendment No.

175 to Senate Bill No.

40 Page 8 (a) An issuer of insurance that only provides limited-scope dental or vision benefits or coverage that is only for a specified disease or illness, with respect to such coverage;

As used in this section:section [, “health] :

(a) “HealthHealth carrier” means an entity subject to the insurance laws and regulations of this State, or subject to the jurisdiction of the Commissioner of Insurance, that contracts or offers tosdictionto of contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services, including, without limitation, a sickness and accident health insurance company, a health maintenance organization, a nonprofit hospital and health service corporation or any other entity providing a plan of health insurance, health benefits or health care services.

Except as otherwise provided in subsection 3 and section 13 of this act, data contained in the all-payer claims database,database if established pursuant to section 9 of this act, is confidential and is not a public record or subject to subpoena.

- 81st Session (2021) – 8 – 2.

The Department shall comply[ensure withthat thedata provisionsis ofsubmitted theto, Healthstored Insurancein Portability and Accountabilityreleased Actfrom ofthe 1996,all-payer Publicclaims Lawdatabase 104-191,in anda anysecure regulationsmanner adoptedthat pursuantcomplies theretowith asall ifapplicable thefederal Departmentand werestate alaws coveredconcerning entitythe maintainingprivacy withof regarddata toincluding, thewithout collectionlimitation,] ofcomply datawith pursuantthe toprovisions sectionof 10the ofHealth thisInsurance act,Portability theand storageAccountability Act of data1996, inPublic theLaw all-payer104-191, claimsand databaseany andregulations theadopted procedurespursuant forthereto releasing[.] dataas fromif the all-payerDepartment claimswere databasea pursuantcovered toentity sectionmaintaining 13protected ofhealth thisinformation, act.as defined in 45 C.F.R.

§ 160.103, with regard to the collection of data pursuant to section 10 of this act, the storage of data in the all-payer claims database and the procedures for releasing data from the all-payer claims database pursuant to section 13 of this act.

To obtain data pursuant to subsection 3 of section of this act from the all-payer claims database,database if[,] established pursuant to subsection 3 of section 913 of this act, a person or entity must submit a request to the Department.

(a)Senate TheAmendment methodologyNo. of any study that will be conducted and any variables that will be used;

and175 (b) The names of any persons or entities to whomSenate theBill applicantNo. plans to disclose data from the all-payer claims database and the rea4.ns The measures that the requester plans to take to ensure the security of the data and prevent unauthorized use of the data in accordance with section 13 of this act and the regulations adopted pursuant to section 17 of this act;

40 Page 9 (a) The methodology of any study that will be conducted and any variables that will be used;

and (b) The names of any persons or entities to whom the applicant plans to disclose data from the all-payer claims database and the reasons for the proposed disclosure;

4.

The measures that the requester plans to take to ensure the security of the data and prevent unauthorized use of the data in accordance with section 13 of this act and the regulations adopted pursuant to section 17 of this act;

If the all-payer claims database is established pursuant to section 9 of this act:

The Department or any Division thereof may [release] access and use data from the all-payer claims database for[that contains direct patient identifiers, indirect patient identifiers, proprietary financial information or any purpose.combination thereof to a person or entity approved by the Department that:

(a) Is conducting research that has been approved by an institutional review board and is designed to:

(1) Assist patients, providers and hospitals to make informed choices concerning care;

(2) Enable providers, hospitals or communities to improve performance by allowing comparison with other providers, hospitals or communities, as applicable;

(3) Enable purchasers of health care services to identify value, build expectations into purchasing strategies and reward improvements over time;

or (4) Promote competition among providers, hospitals or insurers based on quality and cost;

(b) Has executed an agreement with the Department to keep data containing direct patient identifiers absolutely confidential and an agreement with the Department concerning the use of the data that meets the requirements of subsection 6;

and (c) Has submitted a request that meets the requirements of section 12 of this act and the fee prescribed pursuant to section 17 of this act.

In addition to persons and entities who meet the requirements of subsection 1, the Department may release data from the all-payer claims database that contains proprietary financial information, indirect patient identifiers or any combination thereof but does not contain direct patient identifiers to a governmental entity approved by the Department that has:

(a) Executed an agreement with the Department concerning the use of the data that meets the requirements of subsection 6;

and (b) Submitted a request that meets the requirements of section 12 of this act and the fee prescribed pursuant to section 17 of this act.

3.

The Department may release data from the all-payer claims database that contains indirect patient identifiers but does not contain direct patient identifiers or proprietary financial information to any person or entity approved by the Department that has:

(a) Executed an agreement with the Department concerning the use of the data that meets the requirements of subsection 6;

and (b) Submitted a request that meets the requirements of section 12 of this act and the fee prescribed pursuant to section 17 of this act.

4.] for any purpose.

2.

-Senate 81stAmendment SessionNo. (2021) – 9 – 3.

Except175 asto otherwiseSenate providedBill inNo. subsection 4, the Department may release data from the all-payer claims database that does not contain proprietary financial information:

(a)40 InPage de-aggregated10 form3. with unique identifiers upon the of this act to:

requestExcept thatas meetsotherwise provided in subsection 4, the requirementsDepartment ofmay sectionrelease 12data (1)from Athe stateall-payer orclaims federaldatabase governmentalthat entity,does including,not withoutcontain limitation,[direct apatient collegeidentifiers, orindirect universitypatient withinidentifiers theor] Nevadaproprietary Systemfinancial ofinformation Higher[to Education;a] :

(a) In de-aggregated form with unique identifiers upon the submission of a request that meets the requirements of section 12 of this act to:

(1) A state or federal governmental entity, including, without limitation, a college or university within the Nevada System of Higher Education;

(b) In aggregated form to any person or entity approved by the Department that has submitted a request that meets the requirements of section 12 of this act.act .

4.[and the fee prescribed pursuant to section 17 of this act.

The Department shall not release data from the all-payer claims database in any form to any entity that is required or authorized to submit data to the all-payer claims database pursuant to section 10 of this act and fails to submit substantially complete data in accordance with the regulations adopted pursuant to section 17 of this act.

A persongovernmental or entity that receives data fromthat thecontains all-payerproprietary claimsfinancial databaseinformation pursuant to thissubsection section:2 shall not use that data for any purpose related to the purchase or procurement of benefits for employees.

6.

An agreement concerning the use of data from the all-payer claims database executed pursuant to subsection 1, 2 or 3 must include, without limitation:

(a) Required measures for the recipient of the data to protect the security of data containing direct patient identifiers, indirect patient identifiers or proprietary financial information, as applicable;

(b) A prohibition on disclosure of data containing direct patient identifiers, indirect patient identifiers or proprietary financial information, as applicable, by the recipient of the data under circumstances other than those described in subsection 7;

(c) A prohibition on the recipient of the data determining or attempting to determine the identity of any person whom the data concerns or locating or attempting to locate data associated with a specific natural person;

and (d) A requirement that the recipient of the data destroy the data or return the data to the Department at the conclusion of the authorized use of the data.

7.] 4.

The Department shall not release data from the all-payer claims database in any form to any entity that is required or authorized to submit data to the all- payer claims database pursuant to section 10 of this act and fails to submit substantially complete data in accordance with the regulations adopted pursuant to section 17 of this act.

5.

A person or entity that receives data from the all-payer claims database pursuant to this section [shall not:

(a) Disclose direct patient identifiers, indirect patient identifiers or proprietary financial information;

or (b) Disclose] :

data6. is released pursuant to subsection 3 of the percentage ofhom residents of this State who have health coverage for which data was submitted to the all-payer claims database for the time period to which the released data pertains.

AnyThe publishedDepartment documentshall thatnotify containseach person or usesentity datato fromwhom thedata all-payeris claimsreleased database, including, without limitation, the report published by the Department pursuant to sectionsubsection 143 of this act, must state the percentage of residents of this State who have health coverage for which data was submitted to the all-payer claims database for the time period to which the datareleased containeddata in or used by the published document pertains.

Any published document that contains or uses data from the all-payer claims database, including, without limitation, the report published by the Department pursuant to section 14 of this act, must state the percentage of residents of this State who have Senate Amendment No.

175 to Senate Bill No.

40 Page 11 health coverage for which data was submitted to the database for the time period to which the data contained in or used by the published document pertains.

The Department shall, at least annually, publish a report concerning the quality, efficiency and cost of health care in this State based on the data in the all-payer claims database,database. if the all-payer claims database is established pursuant to section 9 - 81st Session (2021) – 10 – of this act.

(b) The Patient Protection Commission created by NRS 439.908;

andatientand Protection Commission created by NRS (c) The Director of the Legislative Counsel Bureau for transmittal to the Legislative Committee on Health Care and the next regular session of the Legislature.

(a) Contain [direct patient identifiers, indirect patient identifiers or] proprietary financial information.

(b) Include in any comparison of the performance of providers of health care information concerning a provider of health care fourwho providers.ractitioneris a solo practitioner or practices in a group of fewer than 5.four providers.

5.

- 81st Session (2021) – 11 – Sec.

If the all-payer claims database is established pursuant to section 9 of this act:

On or before December 31 of each even-numbered year, the Department shall submit to the Director of the Legislative Counsel Bureau for transmittal to the next regular session of the Legislature a report concerning the cost, performance andnand of the effectiveness of the all-payer claims database and any recommendations to improve the all-payer claims database.

and (2)Senate InAmendment allNo. other cases, the Interim Finance Committee.

175 to Senate Bill No.

40 Page 12 (2) In all other cases, the Interim Finance Committee.

No person or entity providing information to the Department, including, without limitation, data submitted to the all-payer claims database,database if established pursuant to section 9 of this act, in accordance with sections 3 to 17, inclusive, of this act, may be held liable in a civil or criminal action for disclosing confidential information unless the person or entity has done so in bad faith or with malicious purpose.

The Department and its members, officers and employees are not liable in any civil or criminal action for any damages resulting from any act, omission, error or technical problem that causes incorrect information from the all-payer claims database to be provided to any person or entity.

If the all-payer claims database is established pursuant to section 9 of this act:

(a) The data that must be [uploaded] submitted to the all-payer claims database pursuant to section 10 of this act,act [and] , the format for submitting such data and the date by which such data must be submitted.

Those[Such regulationsdata must aligninclude, withwithout applicablelimitation: nationally and regionally recognized standards for all-payer claims databases, where applicable and to the extent that those standards do not conflict with each other or the provisions of sections 3 to 17, inclusive, of this act.

(b)(1) TheA privacyreasonable andestimate securityof the aggregate amount of dataall maintainedrebates, inincluding, thewithout all-limitation, payerprice claimsprotection databaserebates, andperformance-based therebates, procedurefees forand releasingadministrative datacosts fromand -any 81stother Sessionnegotiated (2021)price –concessions 12or –payments sectionthat 13reduce ofliability thisfor act,prescription whichdrugs, mustreceived ensuredirectly complianceor withindirectly subsectionfrom 2manufacturers of sectionprescription 11drugs offor pharmacy claims in this act.State during each calendar year by:

(c)(I) TheEach useentity required by section 10 of datathis releasedact fromor the all-payerregulations claimsadopted database,pursuant including,to withoutparagraph limitation,(a) requirementsof concerningsubsection the2 reportingto andupload publicationdata ofto informationthe fromall-payer theclaims database.database;

(d)and Administrative(II) penaltiesEach topharmacy bebenefit assessedmanager againstunder anycontract personwith orsuch entityan whoentity; violates any provision of sections 3 to 17, inclusive, of this act or the regulations adopted pursuant thereto.

Any(2) penaltiesThe foraverage thetotal failureamount tospent complyby witha thepatient requirementscovered ofby each plan offered by an entity required by section 10 of this act or the regulations adopted pursuant to thisparagraph section(a) concerningof thesubsection submission2 ofto upload data to the all-payer claims database muston notpremiums exceedand $5,000cost-sharing, forincluding, eachwithout daylimitation, ofdeductibles, suchcopayments failure.and coinsurance, during each calendar year;

(3) The deductible for each plan offered by an entity required by section 10 of this act or the regulations adopted pursuant to paragraph (a) of subsection 2 to upload data to the all-payer claims database;

(4) The amount of any copayment or coinsurance for items and services prescribed by the Department for each plan offered by an entity required by section 10 of this act or the regulations adopted pursuant to paragraph (a) of subsection 2 to upload data to the all-payer claims database;

and (5) Additional data concerning medical claims, pharmacy claims and dental claims chosen by the Department.

(b) Fees for obtaining data from the database pursuant to section 13 of this act.

Such fees must be calculated to cover the costs incurred by the Department to carry out the provisions of sections 3 to 17, inclusive, of this act.

(c)] Those regulations must align with applicable nationally and regionally recognized standards for all-payer claims databases, where applicable and to the extent that those standards do not conflict with each other or the provisions of sections 3 to 17, inclusive, of this act.

(b) The privacy and security of data maintained in the all-payer claims database and the procedure for releasing data from the all-payer claims database pursuant to subsection 3 of section 13 of this act, which must ensure compliance with subsection 2 of section 11 of this act.

Senate Amendment No.

175 to Senate Bill No.

40 Page 13 (c) The use of data released from the all-payer claims database, including, without limitation, requirements concerning the reporting and publication of information from the database.

(d) Administrative penalties to be assessed against [:

(1) Any person or entity described in subsection 1 of section 10 of this act who fails to submit data to the all-payer claims database as required by that section;

(2) Any person or entity who accesses or discloses data contained in the all-payer claims database in violation of sections 3 to 17, inclusive, of this act;

and (3) Any person or entity to whom data is disclosed pursuant to section 13 of this act who uses, maintains or discloses such data for an unauthorized purpose.] any person or entity who violates any provision of sections 3 to 17, inclusive, of this act or the regulations adopted pursuant thereto.

Any penalties for the failure to comply with the requirements of section 10 of this act or the regulations adopted pursuant to this section concerning the submission of data to the all-payer claims database must not exceed $5,000 for each day of such failure.

(a) Regulations that require entities that provide health coverage in this State, in addition to the entities required by section 10 of this act [,] but not including entities exempt from reporting pursuant to subsection 1 of that section, to upload data to the all-payer claims database;

and that section, to upload data (b) Any other regulations necessary to carry out the provisions of sections 3 to 17, inclusive, of this act.

(1) Obtain certification by the HITRUST Alliance or its successor organization and maintain such certification for the term of the contract;

(2) Comply with the requirements of subsection 2 of section 11 of this act to the same extent as the Department;

-5, 81stAny Sessionmoney (2021)collected –as 13administrative –penalties 5.under the regulations adopted pursuant to this section must be accounted for separately and used by the Department to:

Any(a) moneyCarry collectedout as administrative penalties under the regulationsprovisions adoptedof pursuantNRS 439B.600 to this439B.695, sectioninclusive, mustand besections accounted3 forto separately17, andinclusive, usedof bythis theact; Department to:

(a)and Carry(b) out the provisions of NRS 439B.600 to 439B.695, inc(b) Establish and carry out programs to educate patientsdpatients concerning ways to reduce the cost of health care and prescription drugs.

Sec.[ 5.

As used in this section, “pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.] Senate Amendment No.

175 to Senate Bill No.

40 Page 14 Sec.

If a manufacturer fails to provide to the Department the information required by NRS 439B.635, 439B.640 or 439B.660, a pharmacy benefit manager fails to provide to the Department the information required by NRS 439B.645, a nonprofit organization fails to post or provide to the Department, as applicable, the information required by NRS 439B.665 or a manufacturer, pharmacy benefit manager or nonprofit organization fails to post or provide, as applicable, such information on a timely basis, and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department may impose against the manufacturer, pharmacy benefit manager or nonprofit organization, as applicable, an administrative penalty of not more than $5,000 for each day of such failure.

and - 81st Session (2021) – 14 – (2) Provide education concerning asthma and diabetes and prevent those diseases.

Except as otherwise provided in this section and NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.071, 49.095, 49.293, 62D.420, 62D.440, 62E.516, 62E.620, 62H.025, 62H.030, 62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 80.113, 81.850, 82.183, 86.246, 86.54615, 87.515, 87.5413, 87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A.270, 116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 119A.280, 119A.653, 119A.677, 119B.370, 119B.382, 120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 130.712, 136.050, 159.044, 159A.044, 172.075, 172.245, 176.01249, 176.015, 176.0625, 176.09129, 176.156, 176A.630, 178.39801, 178.4715, 178.5691, 179.495, 179A.070, 179A.165, 179D.160, 200.3771, 200.3772, 200.5095, 200.604, 202.3662, 205.4651, 209.392, 209.3923, 209.3925, 209.419, 209.429, 209.521, 211A.140, 213.010, 213.040, 213.095, 213.131, 217.105, 217.110, 217.464, 217.475, 218A.350, 218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 226.300, 228.270, 228.450, 228.495, 228.570, 231.069, 231.1473, 233.190, 237.300, 239.0105, 239.0113, 239.014, 239B.030, 239B.040, 239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 239C.420, 240.007, 241.020, 241.030, 241.039, 242.105, 244.264, 244.335, 247.540, 247.550, 247.560, 250.087, 250.130, 250.140, 250.150, 268.095, 268.0978, 268.490, 281A.680,268.910, 281A.685,269.174, 281A.750,271A.105, 281A.755,Senate 281A.780,Amendment 284.4068,.350,No. 286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 293.906, 293.908, 293.910, 293B.135, 293D.510, 331.110, 332.061, 332.351, 333.333, 333.335, 338.070, 338.1379, 338.1593, 338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 353A.049, 353A.085, 353A.100, 353C.240, 360.240, 360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 387.631, 388.1455, 388.259, 388.501, 388.503, 388.513, 388.750, 388A.247, 388A.249, 391.033, 391.035, 391.0365, 391.120, 391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 394.1698, 394.447, 394.460, 394.465, 396.3295, 396.405, 396.525, 396.535, 396.9685, - 81st Session (2021) – 15 – 398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 414.280, 416.070, 422.2749, 422.305, 422A.342, 422A.350, 425.400, 427A.1236, 427A.872, 432.028, 432.205, 432B.175, 432B.280, 432B.290, 432B.407, 432B.430, 432B.560, 432B.5902, 439.4941, 439.840, 439.914, 439B.420, 439B.754, 439B.760, 440.170, 441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 442.774, 445A.665, 445B.570, 445B.7773, 447.345, 449.209, 449.245, 449.4315, 449A.112, 450.140, 450B.188, 453.164, 453.720, 453A.610, 453A.700, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 463.790, 467.1005, 480.535, 480.545, 480.935, 480.940, 481.063, 481.091, 481.093, 482.170, 482.5536, 483.340, 483.363, 483.575, 483.659, 483.800, 484A.469, 484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, 571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 612.265, 616B.012, 616B.015, 616B.315, 616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 628B.760, 629.047, 629.069, 630.133, 630.2673, 630.30665, 630.336, 630A.555, 631.368, 632.121, 632.125, 632.3415, 632.405, 633.283, 633.301, 633.4715, 633.524, 634.055, 634.214, 634A.185, 635.158, 636.107, 637.085, 637B.288, 638.087, 638.089, 639.2485, 639.570, 640.075, 640A.220, 640B.730, 640C.580, 640C.600, 640C.620, 640C.745, 640C.760, 640D.190, 640E.340, 641.090, 641.221, 641.325, 641A.191, 641A.262, 641A.289, 641B.170, 641B.282, 641B.460, 645.625, 645A.050, 645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 645D.135, 645G.510, 645H.320, 645H.330, 647.0945, 647.0947, 648.033, 648.197, 649.065, 649.067, 652.228, 653.900, 654.110, 656.105, 657A.510, 661.115, 665.130, 665.133, 669.275, 669.285, 669A.310, 671.170, 673.450, 673.480, 675.380, 676A.340, 676A.370, 677.243, 678A.470, 678C.710, 678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 679B.285, 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 687A.110, 687A.115, 687C.010, 688C.230, 688C.480, 688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 692C.3538, 692C.354, 692C.420, 693A.480, 693A.615, 696B.550, 696C.120, 703.196, 704B.325, 706.1725, 706A.230, 710.159, 711.600, and section 11 of this act, sections 35, 38 and 41 of chapter 478, Statutes of Nevada 2011 and section 2 of chapter 391, Statutes of - 81st Session (2021) – 16 – Nevada 2013 and unless otherwise declared by law to be confidential, all public books and public records of a governmental entity must be open at all times during office hours to inspection by any person, and may be fully copied or an abstract or memorandum such copies, abstracts or memoranda may be used to supply theny general public with copies, abstracts or memoranda of the records or may be used in any other way to the advantage of the governmental entity or of the general public.

175 to Senate Bill No.

40 Page 15 281.195, 281.805, 281A.350, 281A.680, 281A.685, 281A.750, 281A.755, 281A.780, 284.4068, 286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 293.906, 293.908, 293.910, 293B.135, 293D.510, 331.110, 332.061, 332.351, 333.333, 333.335, 338.070, 338.1379, 338.1593, 338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 353A.049, 353A.085, 353A.100, 353C.240, 360.240, 360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 387.631, 388.1455, 388.259, 388.501, 388.503, 388.513, 388.750, 388A.247, 388A.249, 391.033, 391.035, 391.0365, 391.120, 391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 394.1698, 394.447, 394.460, 394.465, 396.3295, 396.405, 396.525, 396.535, 396.9685, 398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 414.280, 416.070, 422.2749, 422.305, 422A.342, 422A.350, 425.400, 427A.1236, 427A.872, 432.028, 432.205, 432B.175, 432B.280, 432B.290, 432B.407, 432B.430, 432B.560, 432B.5902, 432C.140, 432C.150, 433.534, 433A.360, 437.145, 437.207, 439.4941, 439.840, 439.914, 439B.420, 439B.754, 439B.760, 440.170, 441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 442.774, 445A.665, 445B.570, 445B.7773, 447.345, 449.209, 449.245, 449.4315, 449A.112, 450.140, 450B.188, 453.164, 453.720, 453A.610, 453A.700, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 463.790, 467.1005, 480.535, 480.545, 480.935, 480.940, 481.063, 481.091, 481.093, 482.170, 482.5536, 483.340, 483.363, 483.575, 483.659, 483.800, 484A.469, 484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, 571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 612.265, 616B.012, 616B.015, 616B.315, 616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 628B.760, 629.047, 629.069, 630.133, 630.2673, 630.30665, 630.336, 630A.555, 631.368, 632.121, 632.125, 632.3415, 632.405, 633.283, 633.301, 633.4715, 633.524, 634.055, 634.214, 634A.185, 635.158, 636.107, 637.085, 637B.288, 638.087, 638.089, 639.2485, 639.570, 640.075, 640A.220, 640B.730, 640C.580, 640C.600, 640C.620, 640C.745, 640C.760, 640D.190, 640E.340, 641.090, 641.221, 641.325, 641A.191, 641A.262, 641A.289, 641B.170, 641B.282, 641B.460, 641C.760, 641C.800, 642.524, 643.189, 644A.870, 645.180, 645.625, 645A.050, 645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 645D.135, 645G.510, 645H.320, 645H.330, 647.0945, 647.0947, 648.033, 648.197, 649.065, 649.067, 652.228, 653.900, 654.110, 656.105, 657A.510, 661.115, 665.130, 665.133, 669.275, 669.285, 669A.310, 671.170, 673.450, 673.480, 675.380, 676A.340, 676A.370, 677.243, 678A.470, 678C.710, 678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 679B.285, 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 687A.110, 687A.115, 687C.010, 688C.230, 688C.480, 688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 692C.3538, 692C.354, 692C.420, 693A.480, 693A.615, 696B.550, 696C.120, 703.196, 704B.325, 706.1725, 706A.230, 710.159, 711.600, and section 11 of this act, sections 35, 38 and 41 of chapter 478, Statutes of Nevada 2011 and section 2 of chapter 391, Statutes of Nevada 2013 and unless otherwise declared by law to be confidential, all public books and public records of a governmental entity must be open at all times during office hours to inspection by any person, and may be fully copied or an abstract or memorandum may be prepared from those public books and public records.

Any such copies, abstracts or memoranda may be used to supply the general public with Senate Amendment No.

175 to Senate Bill No.

40 Page 16 copies, abstracts or memoranda of the records or may be used in any other way to the advantage of the governmental entity or of the general public.

Nothing in this subsection requires a governmental entity to provide a copy of a public record in an electronic format or by mea(a)means Theof publican record:diumelectronic medium if:

(a) The public record:

-(b) 81stExcept Sessionas (2021)otherwise –provided 17in –NRS 239.030, shall, upon request, prepare the copy of the public record and shall not require the person who has requested the copy to prepare the copy himself or herself.

or (d) Violated any provision of this Code other than one for violation In lieu of suchwhich a suspension or revocation,revocation theis Commissionermandatory. may levy upon the insurer, and the insurer shall pay forthwith, an administrative fine of not more than $2,000 for each act or violation.

 In lieu of such a suspension or revocation, the Commissioner may levy upon the insurer, and the insurer shall pay forthwith, an administrative fine of not more than $2,000 for each act or violation.

(a)Senate IsAmendment inNo. unsound condition, is being fraudulently conducted, or is in such a condition or is using such methods and practices in the conduct of its business as to render its further transaction of insurance in this State currently or prospectively hazardous or injurious to policyholders or to the public.

175 to Senate Bill No.

40 Page 17 (a) Is in unsound condition, is being fraudulently conducted, or is in such a condition or is using such methods and practices in the conduct of its business as to render its further transaction of insurance in this State currently or prospectively hazardous or injurious to policyholders or to the public.

(1) Has without just cause failed to pay, or delayed payment of, claims arising under its policies, whether the claims are in favor of an insured or in favor of a third person with respect to the liability of an insured to the third person;

(c) Refuses to be examined, or its directors, officers, employees or representatives refuse to submit to examination relative to its affairs, or to produce its books, papers, records, contracts, - 81st Session (2021) – 18 – correspondence or other documents for examination by the Commissioner when required, or refuse to perform any legal obligation relative to the examination.

(d) Except as otherwise provided in NRS 681A.110, has rei(e)reinsured Hasall failedits torisks payin anytheir finalentirety judgment rendered against it in thisanother Stateinsurer. upon any policy, bond, recognizance or undertaking as issued or guaranteed by it, within 30 days after the judgment became final or within 30 days after dismissal of an appeal before final determination, whichever date is the later.

(e) Has failed to pay any final judgment rendered against it in this State upon any policy, bond, recognizance or undertaking as issued or guaranteed by it, within 30 days after the judgment became final or within 30 days after dismissal of an appeal before final determination, whichever date is the later.

This limitation does not apply if the Commissioner finds fraudulent or willful evasion of taxes.

the Commissioner finds fraudulent or willful Sec.

19.7.

1.

There is hereby appropriated from the State General Fund to the Division of Health Care Financing and Policy of the Department of Health and Human Services for the development of the all-payer claims database, if the database is established pursuant to section 9 of this act, the following sums:

For the Fiscal Year 2021-2022....................................$24,970 For the Fiscal Year 2022-2023..................................$300,188 2.

Any balance of the sums appropriated by subsection 1 remaining at the end of the respective fiscal years must not be committed for expenditure after June 30 of the respective fiscal years by the entity to which the appropriation is made or any entity to which money from the appropriation is granted or otherwise transferred in any manner, and any portion of the appropriated money remaining must not be spent for any purpose after - 81st Session (2021) – 19 – September 16, 2022, and September 15, 2023, respectively, by either the entity to which the money was appropriated or the entity to which the money was subsequently granted or transferred, and must be reverted to the State General Fund on or before September 16,Sec.

Develop a report containing an inventory of each category of data reported to the Department of Health and Human Services or the Division of Insurance of the Department of Business and Industry that could be used to analyze trends in the cost of health care, consolidation among entities that provide or pay for health care,care , disparities in access to health care or health outcomes related to race, ethnicity or social determinants of health or other issues related to access to health care;

Sec.Senate Amendment No.

175 to Senate Bill No.

40 Page 18 Sec.

On or before December 1, 2021, and December 1, 2022, the Department of Health and Human Services shall,shall: if the all- payer claims database is established pursuant to section 9 of this act:

(a) Develop a report concerning the implementation of sections 3 to 17, inclusive, of this act, including, without limitation, the cost of implementing the all-payerall- payer claims database and the technical progress made toward full implementation of the all-payer claims database;

and (b) Submit the report to the Patient Protection Commission created by NRS 439.908 and the Director of the Legislative Counsel Bureau for transmittal to:

The Department of Health and Human Services shall not release any data pursuant to subsection 3 of section 13 of this act from the all-payer claims database, if the database is established pursuant to subsection 3 of section 913 of this act,act until 6 months after the approval by the Legislative Commission or the Subcommittee to Review Regulations pursuant to NRS 233.067 of regulations adopted pursuant to section 17 of this act relating to the collection, privacy and security of data.

- 81st Session (2021) – 20 – 2.

The provisions of subsection 1 of NRS 218D.380 do not apply to any provision of this act which adds or revises a reqSec.requirement to submit a report to the Legislature.

Sec.

Sections 1, 1818, and20, 19.721 to, 22,21.5 inclusive,and 22 of this act become effective on July 1, 2021.

Sections 2 to 17, inclusive, [and] 19 and 19.5 of this act become effective:

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