AB 156 — Revises provisions relating to substance use disorders. (BDR 40-331)

An advanced practice registered nurse who holds a certificate from the State Board of Pharmacy authorizing him or her to dispense or to prescribe and dispense controlled substances.

3.

A scientific investigator or a pharmacy, hospital or other institution licensed, registered or otherwise authorized in this State to distribute, dispense, conduct research with respect to, to administer, or use in teaching or chemical analysis, a controlled substance in the course of professional practice or research.

4.

A euthanasia technician who is licensed by the Nevada State Board of Veterinary Medical Examiners and registered pursuant to this chapter, while he or she possesses or administers sodium pentobarbital pursuant to his or her license and registration.

5.

A physician assistant who:

(a) Holds a license from the Board of Medical Examiners;

and (b) Is authorized by the Board to possess, administer, prescribe physician as required by chapter 630 of NRS.supervision of a 6.

A physician assistant who:

(a) Holds a license from the State Board of Osteopathic Medicine;

and (b) Is authorized by the Board to possess, administer, prescribe or dispense controlled substances under the supervision of an osteopathic physician as required by chapter 633 of NRS.

7.

An optometrist who is certified by the Nevada State Board of Optometry to prescribe and administer pharmaceutical agents pursuant to NRS 636.288, when the optometrist prescribes or administers pharmaceutical agents within the scope of his or her certification.

- 82nd Session (2023) – 4 – 8.

A pharmacist who is registered pursuant to section 12.3 of this act to prescribe and dispense drugs for medication-assisted treatment.

Sec.

1.05.

NRS 453.128 is hereby amended to read as follows:

(a) An order given individually for the person for whom prescribed, directly from a physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, podiatric physician, optometrist, advanced practice registered nurse , pharmacist registered pursuant to section 12.3 of this act or veterinarian, or his or her agent, to a pharmacist or indirectly by means of an order signed by the practitioner or an electronic transmission from the practitioner to a pharmacist;

or (b) A chart order written for an inpatient specifying drugs which he or she is to take home upon his or her discharge.

2.

The term does not include a chart order written for an inpatient for use while he or she is an inpatient.

Sec.

1.1.

NRS 453.226 is hereby amended to read as follows:

453.226 1.

Every practitioner or other person who dispenses any controlled substance within this State or who proposes to engage in the dispensing of any controlled substance within this State shall obtain biennially a registration issued by the Board in accordance with its regulations.

A person must present proof that he or she is authorized to access the database of the program established pursuant to NRS 453.162 before the Board may issue or renew a registration.

2.

A person registered by the Board in accordance with the conduct research with controlled substances may possess, dispense or conduct research with those substances to the extent authorized by the registration and in conformity with the other provisions of those sections.

3.

The following persons are not required to register and may lawfully possess and distribute controlled substances pursuant to the provisions of NRS 453.011 to 453.552, inclusive:

(a) An agent or employee of a registered dispenser of a controlled substance if he or she is acting in the usual course of his or her business or employment;

(b) A common or contract carrier or warehouseman, or an employee thereof, whose possession of any controlled substance is in the usual course of business or employment;

(c) An ultimate user or a person in possession of any controlled substance pursuant to a lawful order of a physician, physician - 82nd Session (2023) – 5 – advanced practice registered nurse, podiatric physician , pharmacist registered pursuant to section 12.3 of this act or veterinarian or in lawful possession of a schedule V substance;

or (d) A physician who:

(1) Holds a locum tenens license issued by the Board of Medical Examiners or a temporary license issued by the State Board of Osteopathic Medicine;

and (2) Is registered with the Drug Enforcement Administration at a location outside this State.

4.

The Board may waive the requirement for registration of certain dispensers if it finds it consistent with the public health and safety.

5.

A separate registration is required at each principal place of business or professional practice where the applicant dispenses controlled substances.

6.

The Board may inspect the establishment of a registrant or appSec.

1.15.

NRS 453.336 is hereby amended to read as follows:ations.

453.336 1.

Except as otherwise provided in subsection 6, a person shall not knowingly or intentionally possess a controlled substance, unless the substance was obtained directly from, or pursuant to, a prescription or order of a physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, podiatric physician, optometrist, advanced practice registered nurse , pharmacist registered pursuant to section 12.3 of this act or veterinarian while acting in the course of his or her professional practice, or except as otherwise authorized by the provisions of NRS 453.005 to 453.552, inclusive.

2.

Except as otherwise provided in subsections 3, 4 and 5 and in NRS 453.3363, and unless a greater penalty is provided in NRS 212.160, 453.3385 or 453.339, a person who violates this section:

(a) For a first or second offense, if the controlled substance is grams, or if the controlled substance is listed in schedule III, IV or V and the quantity possessed is less than 28 grams, is guilty of possession of a controlled substance and shall be punished for a category E felony as provided in NRS 193.130.

In accordance with NRS 176.211, the court shall defer judgment upon the consent of the person.

(b) For a third or subsequent offense, if the controlled substance is listed in schedule I or II and the quantity possessed is less than 14 grams, or if the controlled substance is listed in schedule III, IV or V - 82nd Session (2023) – 6 – has previously been convicted two or more times in the aggregate ofr any violation of the law of the United States or of any state, territory or district relating to a controlled substance, is guilty of possession of a controlled substance and shall be punished for a category D felony as provided in NRS 193.130, and may be further punished by a fine of not more than $20,000.

(c) If the controlled substance is listed in schedule I or II and the quantity possessed is 14 grams or more, but less than 28 grams, or if the controlled substance is listed in schedule III, IV or V and the quantity possessed is 28 grams or more, but less than 200 grams, is guilty of low-level possession of a controlled substance and shall be punished for a category C felony as provided in NRS 193.130.

(d) If the controlled substance is listed in schedule I or II and the quantity possessed is 28 grams or more, but less than 42 grams, or if the controlled substance is listed in schedule III, IV or V and the quantity possessed is 200 grams or more, is guilty of mid-level category B felony by imprisonment in the state prison for afor a minimum term of not less than 1 year and a maximum term of not more than 10 years and by a fine of not more than $50,000.

(e) If the controlled substance is listed in schedule I or II and the quantity possessed is 42 grams or more, but less than 100 grams, is guilty of high-level possession of a controlled substance and shall be punished for a category B felony by imprisonment in the state prison for a minimum term of not less than 2 years and a maximum term of not more than 15 years and by a fine of not more than $50,000.

3.

Unless a greater penalty is provided in NRS 212.160, 453.337 or 453.3385, a person who is convicted of the possession of flunitrazepam or gamma-hydroxybutyrate, or any substance for which flunitrazepam or gamma-hydroxybutyrate is an immediate precursor, is guilty of a category B felony and shall be punished by imprisonment in the state prison for a minimum term of not less tha4.1 yUnless a greater penalty is provided pursuant to NRS 212.160, a person who is convicted of the possession of 1 ounce or less of marijuana is guilty of a misdemeanor and shall be punished by:

(a) Performing not more than 24 hours of community service;

(b) Attending the live meeting described in paragraph (a) of subsection 2 of NRS 484C.530 and complying with any other requirements set forth in that section;

or - 82nd Session (2023) – 7 – (c) Being required to undergo an evaluation in accordance with subsection 1 of NRS 484C.350,  or any combination thereof.

5.

Unless a greater penalty is provided pursuant to NRS ounce, but less than 50 pounds, of marijuana or more than one-han 1 eighth of an ounce, but less than one pound, of concentrated cannabis is guilty of a category E felony and shall be punished as provided in NRS 193.130.

6.

It is not a violation of this section if a person possesses a trace amount of a controlled substance and that trace amount is in or on a hypodermic device obtained from a sterile hypodermic device program pursuant to NRS 439.985 to 439.994, inclusive.

7.

The court may grant probation to or suspend the sentence of a person convicted of violating this section.

8.

If a person fulfills the terms and conditions imposed for a violation of subsection 4, the court shall, without a hearing, order sealed all documents, papers and exhibits in that person’s record, minute book entries and entries on dockets, and other documents relating to the case in the custody of such other agencies and officers as are named in the court’s order.

The court shall cause a copy of the order to be sent to each agency or officer named in the order.

Each such agency or officer shall notify the court in writing of its compliance with the order.

9.

As used in this section:

(a) “Controlled substance” includes flunitrazepam, gamma- hydroxybutyrate and each substance for which flunitrazepam or gam(b) “Marijuana” does not include concentrated cannabis.

(c) “Sterile hypodermic device program” has the meaning ascribed to it in NRS 439.986.

Sec.

1.2.

NRS 453.381 is hereby amended to read as follows:

453.381 1.

In addition to the limitations imposed by NRS 453.256 and 453.3611 to 453.3648, inclusive, a physician, physician assistant, dentist, advanced practice registered nurse , [or] podiatric physician or pharmacist registered pursuant to section 12.3 of this act may prescribe or administer controlled substances only for a legitimate medical purpose and in the usual course of his or her professional practice, and he or she shall not prescribe, administer or dispense a controlled substance listed in schedule II for himself or herself, his or her spouse or his or her children except in cases of emergency.

- 82nd Session (2023) – 8 – 2.

A veterinarian, in the course of his or her professional practice only, and not for use by a human being, may prescribe, possess and administer controlled substances, and the veterinarian may cause them to be administered by a veterinary technician under the3.ireA euthanasia technician, within the scope of his or her license, and not for use by a human being, may possess and administer sodium pentobarbital.

4.

A pharmacist shall not fill an order which purports to be a prescription if the pharmacist has reason to believe that it was not issued in the usual course of the professional practice of a physician, physician assistant, dentist, advanced practice registered nurse, podiatric physician , pharmacist registered pursuant to section 12.3 of this act or veterinarian.

5.

Any person who has obtained from a physician, physician assistant, dentist, advanced practice registered nurse, podiatric physician , pharmacist registered pursuant to section 12.3 of this act or veterinarian any controlled substance for administration to a patient during the absence of the physician, physician assistant, dentist, advanced practice registered nurse, podiatric physician , pharmacist or veterinarian shall return to him or her any unused portion of the substance when it is no longer required by the patient.

6.

A manufacturer, wholesale supplier or other person legally able to furnish or sell any controlled substance listed in schedule II shall not provide samples of such a controlled substance to registrants.

7.

A salesperson of any manufacturer or wholesaler of controlled substance listed in schedule II.t or furnish any 8.

A person shall not dispense a controlled substance in violation of a regulation adopted by the Board.

Sec.

1.25.

NRS 454.00958 is hereby amended to read as follows:

454.00958 “Practitioner” means:

1.

A physician, dentist, veterinarian or podiatric physician who holds a valid license to practice his or her profession in this State.

2.

A pharmacy, hospital or other institution licensed or registered to distribute, dispense, conduct research with respect to or to administer a dangerous drug in the course of professional practice in this State.

3.

When relating to the prescription of poisons, dangerous drugs and devices:

- 82nd Session (2023) – 9 – (a) An advanced practice registered nurse who holds a certificate from the State Board of Pharmacy permitting him or her so to prescribe;

or (b) A physician assistant who holds a license from the Board of Pharmacy permitting him or her so to prescribe.ate Board of 4.

An optometrist who is certified to prescribe and administer pharmaceutical agents pursuant to NRS 636.288 when the optometrist prescribes or administers dangerous drugs which are within the scope of his or her certification.

5.

A pharmacist who is registered pursuant to section 12.3 of this act to prescribe and dispense drugs for medication-assisted treatment.

Sec.

1.28.

4.must be used only to fund the bulk purchase of opioid antagonists and pay the costs of the Division to distribute those opioid antagonists.

The5. money in the account created pursuant to subsection 1 must be used only to fund the bulk purchase of opioid antagonists and pay the costs of the Division to distribute those opioid antagonists.

- *AB156_R1* – 4 – 5.

[All] Except as otherwise provided in section 11.28 of this act, all gifts or grants of money for a program for alcohol or other substance use disorders which the Division is authorized to accept must be deposited in the State Treasury for credit to the State Grant and Gift Account for Alcohol or Other Substance Use Disorders which is hereby created in the Department of Health and Human Services’ Gift Fund.

- 82nd Session (2023) – 10 – 2.

All claims must be approved by the Administrator before theytheSec. are paid.

Sec.

§ 96.131(a), to receive services for the treatment of alcohol or other substance use disorders fundedfun4.d iAs used in wholethis orsection, in“provider partof byhealth federalcare” orhas statethe money.meaning ascribed to it in NRS 629.031.

4.

As used in this section, “provider of health care” has the meaning ascribed to it in NRS 629.031.

- *AB156_R1* – 5 – (a) Shall appoint, with the consent of the Governor, administrators of the divisions of the Department, who are respectively designated as follows:

- 82nd Session (2023) – 11 – (4) The Administrator of the Division of Health Care Financing and Policy;

(b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442,442,tment, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section 5.5 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 other divisions.

(1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplicationduplica(2) ofSet thoseforth servicespriorities byfor federal,the stateprovision andof localthose agencies;services;

(2) Set forth priorities for the provision of those services;

- *AB156_R1* – 6 – (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;

- 82nd Session (2023) – 12 – (e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Directorupon deemshim necessaryor forher thepursuant performanceto this section.nce of the duties imposed upon(f) himHas orsuch herother pursuantpowers toand thisduties section.as are provided by law.

(f) Has such other powers and duties as are provided by law.

(b) Purchase group policies of life, accident or health insurance, or any combination thereof, for the benefit of such officers and employees, and the dependents of such officers and employees, as have authorized the purchase, from insurance companies authorized to transact the business of such insurance in the State of Nevada, and, where necessary, deduct from the compensation of officers and employees the premiums upon insurance and pay the deductions upon the premiums.

The money accumulated for this purpose through deductions from the compensation of officers and employees and contributions of the - *AB156_R1* – 7 – governing body must be maintained as an internal service fund as defined by NRS 354.543.

Any - 82nd Session (2023) – 13 – contract with an independent administrator must be approved by the Commissioner of Insurance as to the reasonableness of administrative charges in relation to contributions collected and benefits provided.

The provisions of NRS 686A.135, 687B.352, 687B.408, 687B.723, 687B.725, 689B.030 to 689B.050, inclusive, and section 16.3 of this act, 689B.265, 689B.287 and 689B.500689B.500, apply to coverage provided pursuant to this paragraph, except that the provisions of NRS 689B.0378, 689B.03785 and 689B.500 only apply to coverage for active officers and employees of the governing body, or the dependents of such officers and employees.

In any county in which a legal services organization exists, the governing body of the county, or of any school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada in the county, may enter into a contract with the legal services organization pursuant to which the officers and employees of the legal services organization, and the dependents of those officers and employees, are eligible for any life, accident or health insurance provided pursuant to this section to the officers and employees, and the dependents of the officers and employees, of the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency.

(a) Shall be deemed, solely for the purposes of this section, to be officers and employees of the county, school district, municipal corporation, political subdivision, public corporation or other local - *AB156_R1* – 8 – governmental agency with which the legal services organization has contracted;

and - 82nd Session (2023) – 14 – (b) Must be required by the contract to pay the premiums or contributions for all insurance which they elect to accept or of which they authorize the purchase.

(a) Must be submitted to the Commissioner of Insurance for approval not less than 30 days before the date on which the contract is to become effective.

5.

(Deleted by amendment.) Sec.

Sec.Secs.

5.8.5.8 and 6.

NRS 422.4025 is hereby amended to read as follows:

422.4025 1.

The Department shall:

(a) By regulation, develop a list of preferred prescription drugs to be used for the Medicaid program and the Children’s Health - *AB156_R1* – 9 – Insurance Program, and each public or nonprofit health benefit plan that elects to use the list of preferred prescription drugs as its formulary pursuant to NRS 287.012, 287.0433 or 687B.407;

and (b) Negotiate and enter into agreements to purchase the drugs included on the list of preferred prescription drugs on behalf of the health benefit plans described in paragraph (a) or enter into a contract pursuant to NRS 422.4053 with a pharmacy benefit manager, health maintenance organization or one or more public or private entities in this State, the District of Columbia or other states or territories of the United States, as appropriate, to negotiate such agreements.

2.

The Department shall, by regulation, establish a list of prescription drugs which must be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs established pursuant to subsection 1.

The list established pursuant to this subsection must include, without limitation:

(a) Prescription drugs that are prescribed for the treatment of the human immunodeficiency virus, including, without limitation, antiretroviral medications;

(b) Antirejection medications for organ transplants;

(c) Antihemophilic medications;

and (d) Any prescription drug which the Board identifies as appropriate for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs.

3.

The regulations must provide that the Board 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 by the Medicaid program 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 by the Medicaid program 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 by the Medicaid program 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 list of preferred prescription drugs established pursuant to subsection 1 must include, without limitation:

- *AB156_R1* – 10 – (a) Any prescription drug determined by the Board to be essential for treating sickle cell disease and its variants;

[and] (b) Prescription drugs to prevent the acquisition of human immunodeficiency virus [.] ;

and (c) All prescription drugs approved by the United States Food and Drug Administration to provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone.

As used in this paragraph, “medication-assisted treatment” has the meaning ascribed to it in section 12.3 of this act.

5.

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 Board reviews the product or the evidence.

6.

On or before February 1 of each year, the Department shall:

(a) Compile a report concerning the agreements negotiated pursuant to paragraph (b) of subsection 1 and contracts entered into pursuant to NRS 422.4053 which must include, without limitation, the financial effects of obtaining prescription drugs through those agreements and contracts, in total and aggregated separately for agreements negotiated by the Department, contracts with a pharmacy benefit manager, contracts with a health maintenance organization and contracts with public and private entities from this State, the District of Columbia and other states and territories of the United States;

and (b) Post the report on an Internet website maintained by the Department and submit the report to the Director of the Legislative Counsel Bureau for transmittal to:

(1) In odd-numbered years, the Legislature;

or (2) In even-numbered years, the Legislative Commission.

Sec.

6.

[If] In addition to any benefits required by NRS 608.155, if an employer provides health benefits for his or her employees,- the82nd employerSession shall(2023) provide– benefits15 for– the expenses for the treatment of alcohol and substance use disorders.

The annualannualfor benefits provided by the employer must [consist of:] include, without limitation:

- *AB156_R1* – 11 – (c) Counseling for a person, group or family who is not admitted to a facility, with a maximum benefit of $2,500 per calendar year.

4.received in any:ee is entitled to these benefits if treatment is (a) Program for the treatment of alcohol or substance use disorders which is certified by the Division of Public and Behavioral Health of the Department of Health and Human Services.

The employee is entitled to these benefits if treatment is received in any:

(a) Program for the treatment of alcohol or substance use disorders which is certified by the Division of Public and Behavioral Health of the Department of Health and Human Services.

Sec.Secs.

7.7-9.

8.

(Deleted by amendment.) Sec.

9.

(Deleted by amendment.) Sec.

Upon diagnosing a patient as having an opioid use disorder, a physician or physician assistant shall counsel and provide information to the patient concerning evidence-based treatment for opioid use disorders, including, without limitation, medication-assisted treatment.

or (b) If the physician or physician assistant is not authorized under federal and state law to prescribe an appropriate - 82nd Session (2023) – 16 – medication, refer the patient to a physician, osteopathic physician, physician assistant licensed pursuant to this chapter or chapter 633 of NRS, advanced practice registered nurse or pharmacist who is authorized to issue the prescription.

3.has the meaning ascribed to it in section 12.3 of this act.ment” Sec.

As used in this section, “medication-assisted treatment” has the meaning ascribed to it in section 12.3 of this act.

- *AB156_R1* – 12 – Sec.

Chapter 633 of NRS is hereby amended by adding theretothe1.to Upon diagnosing a newpatient sectionas having an opioid use disorder, an osteopathic physician or physician assistant shall counsel and provide information to readthe aspatient follows:concerning evidence-based treatment for opioid use disorders, including, without limitation, medication-assisted treatment.

1.

Upon diagnosing a patient as having an opioid use disorder, an osteopathic physician or physician assistant shall counsel and provide information to the patient concerning evidence-based treatment for opioid use disorders, including, without limitation, medication-assisted treatment.

or (b) If the osteopathic physician or physician assistant is not authorized under federal and state law to prescribe an appropriate medication, refer the patient to a physician, osteopathic physician, physician assistant licensed pursuant to this chapter or chapter 630- 82nd Session (2023) – 17 – of NRS, advanced practice registered nurse or pharmacist who is authorized to issue the prescription.

Sec.thereto a new section to read as follows:eby amended by adding 1.

12.3.To the extent authorized by federal law, a pharmacist who registers with the Board to engage in the activity authorized by this section may, in accordance with the requirements of the protocol prescribed pursuant to subsection 2:

Chapter 639 of NRS is hereby amended by adding thereto a new section to read as follows:

1.

To the extent authorized by federal law, a pharmacist who registers with the Board to engage in the activity authorized by this - *AB156_R1* – 13 – section may, in accordance with the requirements of the protocol prescribed pursuant to subsection 2:

As used in this section, “medication-assisted treatment” means treatment for an opioid use disorder using medication approved by the United States Food and Drug Administration for thatthaSec. purpose.

Sec.

- 82nd Session (2023) – 18 – (f) Maintenance of proper documentation of the source, storage and distribution of a drug.

(h) Development of written guidelines and protocols in collaboration with a practitioner which authorize collaborative drug therapy management.

- *AB156_R1* – 14 – (j) Prescribing, dispensing and administering of drugs for preventing the acquisition of human immunodeficiency virus and ordering and conducting laboratory tests necessary for therapy that uses such drugs pursuant to the protocol prescribed pursuant to NRS 639.28085.

12.8.

NRS 639.0125 is hereby amended to read as follows:

1.9.0A physician, dentist, veterinarian or podiatric physician who holds a license to practice his or her profession in this State;

2.

A hospital, pharmacy or other institution licensed, registered or otherwise permitted to distribute, dispense, conduct research with respect to or administer drugs in the course of professional practice or research in this State;

3.

An advanced practice registered nurse who has been authorized to prescribe controlled substances, poisons, dangerous drugs and devices;

4.

A physician assistant who:

(a) Holds a license issued by the Board of Medical Examiners;

and (b) Is authorized by the Board to possess, administer, prescribe or dispense controlled substances, poisons, dangerous drugs or - 82nd Session (2023) – 19 – devices under the supervision of a physician as required by chapter of NRS;

5.

A physician assistant who:

(a) Holds a license issued by the State Board of Osteopathic Med(b) Is authorized by the Board to possess, administer, prescribe or dispense controlled substances, poisons, dangerous drugs or devices under the supervision of an osteopathic physician as required by chapter 633 of NRS;

or 6.

An optometrist who is certified by the Nevada State Board of Optometry to prescribe and administer pharmaceutical agents pursuant to NRS 636.288, when the optometrist prescribes or administers pharmaceutical agents within the scope of his or her certification.

7.

A pharmacist who is registered pursuant to section 12.3 of this act to prescribe and dispense drugs for medication-assisted treatment.

Sec.

If the patient requests medication-assisted treatment, the psychologist shall refer the patient to a physician, osteopathic physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, advanced practice registered nurse or pharmacist who is authorized under federal and state law to prescribe an appropriate medication.

If the client requests medication-assisted treatment, the marriage and family therapist or clinical professional counselor shall refer the client to a physician, osteopathic physician, physician assistant licensed pursuant to chapter 630 or 633 of - 82nd Session (2023) – 20 – NRS, advanced practice registered nurse or pharmacist who is authorized under federal and state law to prescribe an appropriate medication.

As used in this section, “medication-assisted treatment” hashasSec. the meaning ascribed to it in section 12.3 of this act.

- *AB156_R1* – 15 – Sec.

Upon diagnosing a client as having an opioid use disorder, an alcohol and drug counselor, clinical alcohol and drug counselor or problem gambling counselor shall counsel and provide information to the client concerning evidence-based treatment for opioid use disorders, including, without limitation, med2.atIf the client requests medication-assisted treatment.treatment, the alcohol and drug counselor, clinical alcohol and drug counselor or problem gambling counselor shall refer the client to a physician, osteopathic physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, advanced practice registered nurse or pharmacist who is authorized under federal and state law to prescribe an appropriate medication.

2.

If the client requests medication-assisted treatment, the alcohol and drug counselor, clinical alcohol and drug counselor or problem gambling counselor shall refer the client to a physician, osteopathic physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, advanced practice registered nurse or pharmacist who is authorized under federal and state law to prescribe an appropriate medication.

NRS(Deleted 683A.179by isamendment.) herebySec. amended to read as follows:

683A.179 1.

A pharmacy benefit manager shall not:

(a) Prohibit a pharmacist or pharmacy from providing information to a covered person concerning:

(1) The amount of any copayment or coinsurance for a prescription drug;

or (2) The availability of a less expensive alternative or generic drug including, without limitation, information concerning clinical efficacy of such a drug;

(b) Penalize a pharmacist or pharmacy for providing the information described in paragraph (a) or selling a less expensive alternative or generic drug to a covered person;

- *AB156_R1* – 16 – (c) Prohibit a pharmacy from offering or providing delivery services directly to a covered person as an ancillary service of the pharmacy;

or (d) If the pharmacy benefit manager manages a pharmacy benefits plan that provides coverage through a network plan, charge a copayment or coinsurance for a prescription drug in an amount that is greater than the total amount paid to a pharmacy that is in the network of providers under contract with the third party.

2.

The provisions of this section:

(a) Must not be construed to authorize a pharmacist to dispense a drug that has not been prescribed by a practitioner, as defined in NRS 639.0125, except to the extent authorized by a specific provision of law, including, without limitation, NRS 453C.120, 639.28078 and 639.28085 [.] and section 12.3 of this act.

(b) Do not apply to an institutional pharmacy, as defined in NRS 639.0085, or a pharmacist working in such a pharmacy as an employee or independent contractor.

3.

As used in this section, “network plan” means a health benefit plan offered by a health carrier under which the financing and delivery of medical care is provided, in whole or in part, through a defined set of providers under contract with the carrier.

The term does not include an arrangement for the financing of premiums.

Sec.

(a)- All82nd drugsSession approved(2023) by– the21 United– States Food and Drug Administration to provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone;

and (b) The services described in section 12.3 of this act when provided by a pharmacist whoor pharmacy that participates in the network plan of the insurer.

The Commissioner shall adopt regulations governing the provision of reimbursement for such services.

An insurer that offers or issues a policy of health insurance shall reimburse a pharmacist whoor pharmacy that participates in the network plan of the insurer for the services described in section 12.3 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

AnExcept as otherwise provided in this subsection, an insurer mayshall not subject the benefits required by subsection 1 to medical subject such benefits to other reasonable medical managementmanagementay techniques.techniques when the benefits are provided by a pharmacist in accordance with section 12.3 of this act.

- *AB156_R1* – 17 – 5.

The term includes, without limitation, the use devices based on cost, type or method of stepadministration.ugs therapy,and prior(b) authorization“Network plan” means a policy of health insurance offered by an insurer under which the financing and categorizingdelivery drugsof medical care, including items and devicesservices basedpaid onfor cost,as typemedical care, are provided, in whole or methodin part, through a defined set of administration.providers under contract with the insurer.

(b) “Network plan” means a policy of health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer.

- 82nd Session (2023) – 22 – Sec.

689A.030 A policy of health insurance must not be delivered or issued for delivery to any person in this State unless it otherwise compliescom1. with this Code, and complies with the following:

1.

“Text” includes all printed - *AB156_R1* – 18 – matter except the name and address of the insurer, the name or the title of the policy, the brief description, if any, and captions and subcaptions.

policy, the brief description, if any, and captions and 5.

The policy must not contain any provision purporting to make any portion of the charter, rules, constitution or bylaws of the insurer- a82nd partSession of(2023) the– policy23 unless– that portion is set forth in full in the policy, except in the case of the incorporation of or reference totoin a statement of rates or classification of risks, or short-rate table filed with the Commissioner.

and (b) Unless the policy provides coverage only for a specified disease or provides for the payment of a specific amount of money ifhome.e the insured is hospitalized or receiving health care in his or her home.10.

10.

- *AB156_R1* – 19 – (a) Treatment for withdrawal from the physiological effect of alcohol or drugs, with a minimum benefit of $1,500 per calendar year.

(c) Counseling for a person, group or family who is not admitted to a2.facExcept facility,as withotherwise aprovided minimumin benefitNRS of687B.409, $2,500theser per calendar year.

2.benefits must be paid in the same manner as benefits for any other illness covered by a similar policy are paid.

Except as otherwise provided in NRS 687B.409, these benefits must be paid in the same manner as benefits for any other illness covered by a similar policy are paid.

- 82nd Session (2023) – 24 – (b) Hospital or other medical facility or facility for the dependent which is licensed by the Division of Public and Behavioral Health of the Department of Health and Human Services, accredited by The Joint Commission or CARF International and provides a program for the treatment of alcohol or substance use disorder as part of its accredited activities.activities.cohol or Sec.

Sec.

and (b) The services described in section 12.3 of this act when provided by a pharmacist whoor pharmacy that participates in the network plan of the insurer.

2.The Commissioner shall adopt regulations governing the provision of reimbursement for such ser2.ceAn insurer that offers or issues a policy of group health insurance shall reimburse a pharmacist or pharmacy that participates in the network plan of the insurer for the services described in section 12.3 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

An insurer that offers or issues a policy of group health insurance shall reimburse a pharmacist who participates in the network plan of the insurer for the services described in section 12.3 of this act at a rate equal to the rate of reimbursement - *AB156_R1* – 20 – provided to a physician, physician assistant or advanced practice registered nurse for similar services.

AnExcept as otherwise provided in this subsection, an insurer mayshall not subject the benefits required by subsection 1 to reasonable medical management techniques.techniques, other than step therapy.

An insurer may subject such benefits to other reasonable medical management techniques when the benefits are provided by a pharmacist in accordance with section 12.3 of this act.

- 82nd Session (2023) – 25 – 5.

A policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.

policy that conflicts with the provisions of this 6.

(a) All drugs approved by the United States Food and Drug Administration to provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadonemet(b) andThe naltrexone;services described in section 12.3 of this act when provided by a pharmacist or pharmacy that participates in the network plan of the carrier.

and (b) The servicesCommissioner describedshall inadopt sectionregulations 12.3governing of this act when provided by a pharmacist who participates in the networkprovision plan of thereimbursement carrier.for such services.

A carrier that offers or issues a health benefit plan shall reimburse a pharmacist whoor pharmacy that participates in the network plan of the carrier for the services described in section 12.3 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

- *AB156_R1* – 21 – 3.

AExcept as otherwise provided in this subsection, a carrier mayshall not subject the benefits required by subsection 1 to reasonable medical management techniques.techniques, other than step therapy.

A carrier may subject such benefits to other reasonable medical management - 82nd Session (2023) – 26 – techniques when the benefits are provided by a pharmacist in accordance with section 12.3 of this act.

A carrier shall ensure that the benefits required by subsection 1 are made available to an insured through a provider of health5. care who participates in the network plan of the carrier.

5.A health benefit plan subject to the provisions of thisrrier.

A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.

689C.166 Each group health insurance policy must contain in substance a provision for benefits payable for expenses incurred for the treatment of alcohol or substance use disorder, as provided ininor NRS 689C.167 [.] and section 16.4 of this act.

- 82nd Session (2023) – 27 – (c) Counseling for a person, group or family who is not admitted to a facility, with a minimum benefit of $2,500 per calendar year.

- *AB156_R1* – 22 – 2.

Except as otherwise provided in NRS 687B.409, these benefits must be paid in the same manner as benefits for any other illnessill3. covered by a similar policy are paid.

3.

A society that offers or issues a benefit contract shall includeinc(a) inAll drugs approved by the contractUnited coverageStates for:Food and Drug Administration to provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone;

(a)and All(b) drugsThe approvedservices bydescribed thein Unitedsection States12.3 Foodof andthis Drugact Administrationwhen toprovided provideby medication-assisteda treatmentpharmacist foror opioidpharmacy usethat disorder,participates including,in withoutthe limitation,network buprenorphine,plan methadoneof andthe naltrexone;society.

and (b) The servicesCommissioner describedshall inadopt sectionregulations 12.3governing of this act when provided by a pharmacist who participates in the networkprovision plan of thereimbursement society.for such services.

A society that offers or issues a benefit contract shall reimburse a pharmacist whoor pharmacy that participates in the network plan of the society for the services described in section 12.3 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

3.- 82nd Session (2023) – 28 – shall not subject the benefits required by subsection 1 to medical management techniques, other than step therapy.

A society may subject such benefits to other reasonable medical management techniques when the benefits requiredare provided by subsectiona 1pharmacist toin reasonableaccordance medicalwith managementsection techniques.12.3 of this act.

- *AB156_R1* – 23 – 5.

(a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescriptionof drugs.step therapy, prior authorization and categorizing drugs anduse devices based on cost, type or method of administration.

The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration.

(a) All drugs approved by the United States Food and Drug Administration to provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone;

and (b) The services described in section 12.3 of this act when provided by a pharmacist whoor pharmacy that participates in the network plan of the hospital or medical services corporation.

2.The Commissioner shall adopt regulations governing the provision of reimbursement for such services.

A- hospital82nd orSession medical(2023) services– corporation29 that– offers2. or issues a policy of health insurance shall reimburse a pharmacist who participates in the network plan of the hospital or medical services corporation for the services described in section 12.3 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

A hospital or medical services corporation that offers or issues a policy of health insurance shall reimburse a pharmacist or pharmacy that participates in the network plan of the hospital or medical services corporation for the services described in provided to a physician, physician assistant or advanced practicement registered nurse for similar services.

AExcept as otherwise provided in this subsection, a hospital or medical services corporation mayshall not subject the benefits required by subsection 1 to reasonable medical management techniques.techniques, other than step therapy.

A hospital or medical services corporation may subject such benefits to other reasonable medical management techniques when the benefits are provided by a pharmacist in accordance with section 12.3 of this act.

- *AB156_R1* – 24 – 5.

The term includes, without limitation, the use devices based on cost, type or method of stepadministration.ugs therapy,and prior(b) authorization“Network plan” means a policy of health insurance offered by a hospital or medical services corporation under which the financing and categorizingdelivery drugsof medical care, including items and devicesservices basedpaid onfor cost,as typemedical care, are provided, in whole or methodin part, through a defined set of administration.providers under contract with the hospital or medical services corporation.

(b) “Network plan” means a policy of health insurance offered by a hospital or medical services corporation under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the hospital or medical services corporation.

(a)- All82nd drugsSession approved(2023) by– the30 United– States Food and Drug Administration to provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone;

and (b) The services described in section 12.3 of this act when provided by a pharmacist whoor pharmacy that participates in the network plan of the health maintenance organization.

The Commissioner shall adopt regulations governing the provision of reimbursement for such services.

A health maintenance organization that offers or issues a health care plan shall reimburse a pharmacist whoor pharmacy that participates in the network plan of the health maintenance organization for the services described in section 12.3 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

AExcept healthas maintenanceotherwise organizationprovided mayin subjectthis thesubsection, benefitshealth required by subsection 1 to reasonable medical management techniques.techniques, other thanired step therapy.

A health maintenance organization may subject such benefits to other reasonable medical management techniques when the benefits are provided by a pharmacist in accordance with section 12.3 of this act.

- *AB156_R1* – 25 – 5.

(a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs.

(b) “Network plan” means a health care plan offered by a health maintenance organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the health maintenance - 82nd Session (2023) – 31 – organization.

Sec.follows:16.75.

16.75.NRS 695C.050 is hereby amended to read as 695C.050 1.

NRS 695C.050 is hereby amended to read as follows:

695C.050 1.

The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing - *AB156_R1* – 26 – and Policy of the Department of Health and Human Services.

- 82nd Session (2023) – 32 – Sec.

The Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization pursuantthat toany the provisions of thisthe chapterfollowing ifconditions exist:if the Commissioner finds (a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any ofother theinformation followingsubmitted conditionspursuant exist:to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;

(a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;

(e) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligationsobl(f) The health maintenance organization has failed to put into effect a mechanism affording the enrollees oran prospectiveopportunity enrollees;to participate in matters relating to the content of programs pursuant to NRS 695C.110;

(f) The health maintenance organization has failed to put into effect a mechanism affording the enrollees an opportunity to participate in matters relating to the content of programs pursuant to NRS 695C.110;

- *AB156_R1* – 27 – (1) Resolving complaints in a manner reasonably to dispose of valid complaints;

- 82nd Session (2023) – 33 – (i) The continued operation of the health maintenance organization would be hazardous to its enrollees or creditors or to the general public;

(j) The health maintenance organization fails to provide the coveragecov(k) requiredThe byhealth NRSmaintenance 695C.1691;organization has otherwise failed to comply substantially with the provisions of this chapter.

or (k) The health maintenance organization has otherwise failed to comply substantially with the provisions of this chapter.

1.care plan shall include in the plan coverage for:r issues a health (a) All drugs approved by the United States Food and Drug Administration to provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone;

Aand managed(b) careThe organizationservices thatdescribed offersin orsection issues12.3 of this act when provided by a healthpharmacist careor planpharmacy shallthat includeparticipates in the network plan coverageof for:the managed care organization.

(a)The AllCommissioner drugsshall approvedadopt byregulations governing the Unitedprovision Statesof Foodreimbursement and Drug Administration to provide medication-assisted treatment for opioidsuch useservices. disorder, including, without limitation, buprenorphine, methadone and naltrexone;

and2. (b) The services described in section 12.3 of this act when provided by a pharmacist who participates in the network plan of the managed care organization.

A managed care organization that offers or issues a health care plan shall reimburse a pharmacist or pharmacy that participates in the network plan of the managed care organization for the services described in section 12.3 of this act at a rate equal to the rate of reimbursement provided to a physician, physician - *AB156_R1*82nd Session (2023) – 2834 – 2.services.

A managed care organization that offers or issues a health care plan shall reimburse a pharmacist who participates in the network plan of the managed care organization for the services described in section 12.3 of this act at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.3.

3.Except as otherwise provided in this subsection, managed care organization shall not subject the benefits required by subsection 1 to medical management techniques, other than step therapy.

A managed care organization may subject such benefits to other reasonable medical management techniques when the benefits requiredare provided by subsectiona 1pharmacist toin reasonableaccordance medicalwith managementsection techniques.12.3 of this act.

A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflictscon6. with the provisions of this section is void.

6.As used in this section:of this section is void.

As used in this section:

Sec.NRS 458.103, as amended by section 1.7 of this act, a treatment2 of provider, provider of health care or program for alcohol or substance use disorders is not, unless otherwise required by federal law, required to terminate services to which the provisions of that subsection would otherwise apply to a person who is receiving such services on or before October 1, 2023, from the treatment provider, provider of health care or program in order to provide such services to a person who would otherwise receive priority under that subsection.

17.- 82nd Session (2023) – 35 – by section 1.7 of this act, do not apply to treatment for an alcohol or other substance use disorder provided under any grant, contract or other agreement accepted or entered into on or before October 1, 2023, but do apply to any such treatment provided under such a grant, contract or agreement that is renewed or extended.

1.

Notwithstanding the provisions of subsection 2 of NRS 458.103, as amended by section 1.7 of this act, a treatment provider, provider of health care or program for alcohol or substance use disorders is not, unless otherwise required by federal law, required to terminate services to which the provisions of that subsection would otherwise apply to a person who is receiving such services on or before October 1, 2023 from the treatment provider, provider of health care or program in order to provide such services to a person who would otherwise receive priority under that subsection.

2.

The provisions of subsection 2 of NRS 458.103, as amended by section 1.7 of this act, do not apply to treatment for an alcohol or - *AB156_R1* – 29 – other substance use disorder provided under any grant, contract or other agreement accepted or entered into on or before October 1, 2023, but do apply to any such treatment provided under such a grant, contract or agreement that is renewed or extended.

The study must include,inc(a) withoutBarriers limitation,to anaccessing examinationmedication-assisted of:treatment at institutions and facilities of the Department of Corrections and private facilities and institutions, including, without limitation:

(a) Barriers to accessing medication-assisted treatment at institutions and facilities of the Department of Corrections and private facilities and institutions, including, without limitation:

(c) The feasibility of establishing medication-assisted treatment programs on the grounds of institutions and facilities of the Department of Corrections and private facilities and institutions to provide medication-assisted treatment to offenders with opioid use disorder to the same extent as other health care provided totoid use offenders;

(e)- The82nd feasibilitySession of(2023) forming– partnerships36 with– counties, cities and towns that maintain jails or detention facilities to provideprovideties medication-assisted treatment to prisoners in such jails or detention facilities;

- *AB156_R1* – 30 – (f) The feasibility of storing information concerning offenders who are receiving medication-assisted treatment and sharing such information with providers of treatment, providers of community- based services and other interested persons and entities;

(h) The funding that would be needed to provide medication- assisted treatment to all offenders with opioid use disorder in each institution or facility of the Department of Corrections and eacheachach private facility or institution;

(1) Establishing a program to provide medication-assisted treatment for prisoners with opioid use disorder that meets national standards of care for the provision of medication-assisted treatment in a correctional setting, including, without limitation, with regard to personnel and funding;

- 82nd Session (2023) – 37 – 3.

(a) Conduct the examination described in paragraph (c) of subsectionsub(b) 2;Cooperate with the regional behavioral health policy board created by NRS 433.429 for the behavioral health region established by NRS 433.428 in which the county is located for the purpose of conducting that examination.

and (b) Cooperate with the regional behavioral health policy board created by NRS 433.429 for the behavioral health region established - *AB156_R1* – 31 – by NRS 433.428 in which the county is located for the purpose of conducting that examination.

(d) “Medication-assisted treatment” has the meaning ascribed to it in(e) section“Offender” 12.3has ofthe thismeaning act.ascribed to it in NRS 209.081.

(e) “Offender” has the meaning ascribed to it in NRS 209.081.

Sections 1,1.28, 1.3 and 17.5 of this act becomes effective on July 1, 2023.

- 82nd Session (2023) – 38 – 4.

Sections 1 to 1.25, inclusive, 2 to 16.9, inclusive, and 18 of this act become effective:

H~~~~~ 23 - *AB156_R1*82nd Session (2023)