Struck = removed from the bill ·
added = the amendment's new text.
SenateSession Bill(82nd) A SB167 104 Amendment No.
167–Senators104 DonderoSenate Loop,Amendment Spearman;to Senate Bill No.
Cannizzaro,167 Daly,(BDR D.57-81) Proposed by:
Harris,Senate Krasner,Committee Neal,on Nguyen,Commerce Ohrenschall, Pazina and ScheibleLabor JointAmends: Sponsor:
AssemblywomanSummary: Thomas CHAPTER..........
No Title:
No Preamble:
No Joint Sponsorship:
No Digest:
Yes Adoption of this amendment will MAINTAIN the unfunded mandate not requested by the affected local government to S.B.
167 (§ 13).
ASSEMBLY ACTION Initial and Dat| SENATE ACTION Initial and Date Adopted Lost | Adopted Lost Concurred In Not | Concurred In Not Receded Not | Receded Not EXPLANATION:
Matter in (1) blue bold italics is new language in the original bill;
(2) variations of green bold underlining is language proposed to be added in this amendment;
(3) red strikethrough is deleted language in the original bill;
(4) purple double strikethrough is language proposed to be deleted in this amendment;
(5) orange double underlining is deleted language in the original bill proposed to be retained in this amendment.
DAN/EWR - Date:
4/13/2023 S.B.
No.
167—Prohibits the imposition of step therapy under certain circumstances.
(BDR 57-81) Page 1 of 15 *A_SB167_104* Senate Amendment No.
104 to Senate Bill No.
167 Page 3 SENATE B ILLNO.
167–SENATORS DONDERO L OOP, PEARMAN ;
CANNIZZARO, DALY, D.
HARRIS, K RASNER, NEAL, N GUYEN, O HRENSCHALL , PAZINA AND SCHEIBLE FEBRUARY 16, 2023 _______________ JOINTSPONSOR :
SSEMBLYWOMAN THOMAS _______________ Referred to Committee on Commerce and Labor SUMMARY—Prohibits the imposition of step therapy under certain circumstances.
(BDR 57-81) FISCAL NOTE:
Effect on Local Government:
May have Fiscal Impact.
Effect on the State:
Yes.
CONTAINS UNFUNDED MANDATE (§ 13) (NOTREQUESTED BYAFFECTEDLOCAL GOVERNMENT) ~ EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
Existing law prohibits a policy of health insurance which provides coverage for prescription drugs, including a policy of health insurance provided by a local government or private employer for its employees, from limiting or excluding thecoverage insurer for a medicaldrug conditionif of an insured and the insured’sdrug: provider ofby health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the insured;
(1) had previously been approved for coverage by the insurer for a medical condition of an insured and the insured’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the insured;
(NRS 689A.04045, 689B.0368, 689C.168, 695A.184, 695B.1905, 695C.1734, 695F.156, 695G.166) Existing law also requires the Department of Health and Human Services to establish and manage the use by the Medicaid program of step therapy and prior authorization for prescription drugs.
(NRS 422.403) Sections 1, 3-9 and 11-15 of this bill prohibit private insurers, voluntary purchasing groups, insurance plans for state, local and private employees and Medicaid from imposing a step therapy protocol for a drug that is approved by the United States Food and Drug Administration or that medical or scientific evidence establishesestablishesited may be used to treat a psychiatric condition if:if [the] :
(1) a practitioner who meets certain requirements prescribed the drug;drug ;
and (2) that practitioner reasonably expects each drug that is Sectionrequired 2to ofbe thisdispensed billaccording makesto athe conformingstep changetherapy protocol to indicatebe theineffective. proper placement.
Section 2 of this bill makes a conforming change to indicate the proper placement of section 1 in the Nevada Revised Statutes.
The CommissionerSenate wouldAmendment alsoNo. be authorized to take such action against other health insurers who fail to comply with the requirements of sections 1, 3-8, 11 and 12 of this bill.
(NRS104 680A.200)to -Senate 82ndBill SessionNo. (2023) – 2 – EXPLANATION – Matter in bolded italics is new;
matter167 betweenPage brackets4 [omittedfail material]to iscomply materialwith tothe berequirements omitted.of sections 1, 3-8, 11 and 12 of this bill.
(NRSrs who 680A.200) THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
A policy of health insurance which provides coverage for prescription drugs must not require an insured to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is [appropriately] prescribed to treat a psychiatric condition of the insured, if:if [the] :
(b)(1)(b) AThe psychiatrist;ibeddrug is prescribed by:
(1) A psychiatrist;
and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the insured, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.condition .
[based on the known physical or mental characteristics of the insured and the known characteristics of the drug regimen.] 2.
As used in this section:section [, “practitioner” has the meaning ascribed to it in NRS 639.0125.] :
(a) “Medical or scientific evidence” has the meaning ascribed to (b)it “Network plan” means a policy of health insurance offered by an insurer under which the financing and delivery of medical care is provided, in wholeNRS or695G.053. in part, through a defined set of - 82nd Session (2023) – 3 – include an arrangement for the financing of premiums.oes not (c) “Step therapy protocol” means a procedure that requires an insured to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the insured before his or her policy of health insurance provides coverage for the recommended drug.
Sec.(b) “Network plan” means a policy of health insurance offered by an insurer 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 insurer.
The term does not include an arrangement for the financing of premiums.
(c) “Step therapy protocol” means a procedure that requires an insured to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the insured before his or her policy of health insurance provides coverage for the recommended drug.
Senate Amendment No.
104 to Senate Bill No.
167 Page 5 Sec.
Chapter 689B of NRS is hereby amended by adding the1.tothereto A policy of group health insurance which provides coverage for prescription drugs must not require an insured to submit to a stepnew therapysection protocol before covering a drug approved by the Food and Drug Administration that is prescribed to treatread aas psychiatricfollows: condition of the insured, if:
1.
A policy of group health insurance which provides coverage for prescription drugs must not require an insured to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is [appropriately] prescribed to treat a psychiatric condition of the insured, if [the] :
(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nur(4)Nursing Apursuant primary care provider that is providing care to anNRS insured632.120; in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in the network plan of the insurer is located 60 miles or more from the residence of the insured;
andor (c)(4) TheA practitionerprimary listedcare inprovider paragraphthat (b)is whoproviding prescribedcare theto drugan knows,insured basedin onconsultation thewith medicala historypractitioner oflisted thein insured,subparagraph (1), (2) or reasonably(3), expectsif eachthe alternativeclosest drugpractitioner thatlisted isin requiredsubparagraph to(1), be(2) -or 82nd(3) Sessionwho (2023)participates –in 4the –network treatingplan of the psychiatricinsurer condition.otocolis tolocated be60 ineffectivemiles ator 2.more from the residence of the insured;
and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the insured, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition .
[based on the known physical or mental characteristics of the insured and the known characteristics of the drug regimen.] 2.
As used in this section:section [, “practitioner” has the meaning ascribed to it in NRS 639.0125.] :
(c) “Step therapy protocol” means a procedure that requires an insured to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the insured before his or her policy of group health insurance provides coverage for the or recommended drug.
Sec.Senate Amendment No.
104 to Senate Bill No.
167 Page 6 Sec.
A health benefit plan which provides coverage for prescription drugs must not require an insured to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is [appropriately] prescribed to treat a psychiatric condition of the insured, if:if [the] :
psychiatrist;hysician(2) A physician assistant under the supervision of a (3)psychiatrist; An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120;
or(3) (4)An Aadvanced primarypractice careregistered providernurse thatwho ishas providing care to an insured in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closestpsychiatric practitionertraining listedand inexperience subparagraphprescribed (1),by (2) or (3) who participates in the networkState planBoard of theNursing healthpursuant -to 82ndNRS Session632.120; (2023) – 5 – carrier is located 60 miles or more from the residence of the insured;
andor (c)(4) TheA practitionerprimary listedcare provider that is providing care to an insured in paragraphconsultation (b)with whoa prescribedpractitioner thelisted drugin knows,subparagraph based(1), on(2) or (3), if the medicalclosest historypractitioner oflisted thein insured,subparagraph (1), (2) or used(3) earlierwho participates in the stepnetwork therapyplan protocolof tothe behealth ineffectivecarrier ateis treatinglocated 60 miles or more from the psychiatricresidence condition.of the insured;
2.and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the insured, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition .
[based on the known physical or mental characteristics of the insured and the known characteristics of the drug regimen.] 2.
As used in this section:section [, “practitioner” has the meaning ascribed to it in NRS 639.0125.] :
689C.425 A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to,to 689C.355, inclusive, and section 4 of this act to the extent applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive.
A benefit contract which provides coverage for prescription drugs must not require an insured to submit to a step therapy protocol before covering a drug approvedSenate byAmendment theNo. Food and Drug Administration that is prescribed to treat a psychiatric condition of the insured, if:
104 to Senate Bill No.
167 Page 7 approved by the Food and Drug Administration that is [appropriately] prescribed to treat a psychiatric condition of the insured, if [the] :
-(b) 82ndThe Sessiondrug (2023)is –prescribed 6 – (b)(1) A psychiatrist;ibed by:
(1) A psychiatrist;
and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the insured, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.condition .
provisions[based ofon thisthe chapterknown thatphysical is delivered, issued for delivery or renewedmental oncharacteristics orof afterthe Julyinsured 1,and 2023,the whichknown ischaracteristics inof conflictthe withdrug thisregimen.] section2. is void.
Any provision of a benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, which is in conflict with this section is void.
As used in this section:section [, “practitioner” has the meaning ascribed to it in NRS 639.0125.] :
(c) “Step therapy protocol” means a procedure that requires an insured to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the insured before his or herSec.her benefit contract provides coverage for the recommended drug.
7.tSec. cChapter 695B of NRS is hereby amended by addingrug.
thereto7. a new section to read as follows:
Chapter 695B of NRS is hereby amended by adding thereto a new section to read as follows:
A policy of health insurance offered or issued by a hospital or medical services corporation which provides coverage for prescription drugs must not require an insured to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is [appropriately] prescribed to treat a psychiatric condition of the insured, if:if [the] :
- 82nd Session (2023) – 7 – (a) The drug has been approved by the Food and Drug Administration with indications for the psychiatric condition of the insured or the use of the drug to treat that psychiatric condition is otherwise supported by medical or scientific evidence;
(b)(1)(b) AThe psychiatrist;ibeddrug is prescribed by:
(1) A psychiatrist;
(3)Senate AnAmendment advancedNo. practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120;
104 to Senate Bill No.
167 Page 8 (3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120;
and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the insured, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.condition .
[based on the known physical or mental characteristics of the insured and the known characteristics of the drug regimen.] 2.
As used in this section:section [, “practitioner” has the meaning ascribed to it in NRS 639.0125.] :
to(a) it“Medical inor NRSscientific 695G.053.entific evidence” has the meaning ascribed (b)to “Networkit plan” means a policy of health insurance offered by a hospital or medical services corporation under which the financing and delivery of medical care is provided, in wholeNRS or695G.053. in part, through a defined set of 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 is provided, in whole or in part, through a defined set of providers under contract with the hospital or medical services corporation.
-Sec. 82nd Session (2023) – 8 – thereto a new section to read as follows:y amended by adding 1.
A8. health care plan which provides coverage for prescription drugs must not require an enrollee to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is prescribed to treat a psychiatric condition of the enrollee, if:
Chapter 695C of NRS is hereby amended by adding thereto a new section to read as follows:
1.
A health care plan which provides coverage for prescription drugs must not require an enrollee to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is [appropriately] prescribed to treat a psychiatric condition of the enrollee, if [the] :
(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nur(4)Nursing Apursuant primary care provider that is providing care to anNRS enrollee632.120; in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in the network plan of the health maintenance organization is located 60 miles or more from the residence of the enrollee;
andor (c)(4) TheA practitionerprimary listedcare inprovider paragraphthat (b)is whoproviding prescribedcare theto drugan knows,enrollee basedin onconsultation thewith medicala historypractitioner oflisted thein enrollee,subparagraph (1), (2) or reasonably(3), expectsif eachthe alternativeclosest drugpractitioner thatlisted isin requiredsubparagraph to(1), be(2) usedor earlier(3) who participates in the stepnetwork therapyplan protocolof tothe behealth ineffectivemaintenance atorganization treatingis located 60 miles or more from the psychiatricresidence condition.of the enrollee;
2.and Senate Amendment No.
104 to Senate Bill No.
167 Page 9 (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the enrollee, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition .
[based on the known physical or mental characteristics of the enrollee and the known characteristics of the drug regimen.] 2.
3.
As used in this section [, “practitioner” has the meaning ascribed to it in NRS 639.0125.] :
- 82nd Session (2023) – 9 – (c) “Step therapy protocol” means a procedure that requires an enrollee to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the enrollee before his or herSec.her health care plan provides coverage for the recommended drug.
Sec.
caNRSNRS 695C.050 is hereby amended to read as follows:.follows:
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 and Policy of the Department of Health and Human Services.
Sec.Senate Amendment No.
104 to Senate Bill No.
167 Page 10 Sec.
The Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization - 82nd Session (2023) – 10 – pursuant to the provisions of this chapter if the Commissioner finds that any of the following conditions exist:
(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 and to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;
(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(g) The health maintenance organization has failed to put into effect the system required by NRS 695C.260695C.110; for:
(g) The health maintenance organization has failed to put into effect the system required by NRS 695C.260 for:
or -(k) 82ndThe Sessionhealth (2023)maintenance –organization 11has –otherwise failed to comply substantially with the provisions of this chapter.failedchapter. to 2.
2.
The Commissioner may, by written order, permit such further operation of the organizationSenate asAmendment theNo. Commissioner may find to be in the greatest practical opportunity to obtain continuing coverage ford health care.
104 to Senate Bill No.
167 Page 11 organization as the Commissioner may find to be in the best interest of enrollees to the end that enrollees are afforded the greatest practical opportunity to obtain continuing coverage for health care.
Evidence of coverage which provides coverage for prescription drugs must not require an enrollee to use a step therapy protocol before covering a drug approved by the Food and Drug Administration that is [appropriately] prescribed to treat a psychiatric condition of the enrollee, if:if [the] :
psychiatrist;physician(2) A physician assistant under the supervision of a (3)psychiatrist; An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120;
or(3) (4)An Aadvanced primarypractice careregistered providernurse thatwho ishas providing care to an enrollee in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closestpsychiatric practitionertraining listedand inexperience subparagraphprescribed (1),by (2) or (3) who participates in the networkState planBoard of theNursing prepaidpursuant -to 82ndNRS Session632.120; (2023) – 12 – from the residence of the enrollee;
andlocatedor 60(4) milesA orprimary morecare (c)provider Thethat practitioneris listedproviding incare paragraphto (b)an whoenrollee prescribedin theconsultation drugwith knows,a basedpractitioner onlisted thein medicalsubparagraph history(1), of(2) theor enrollee,(3), orif reasonablythe expectsclosest eachpractitioner alternativelisted drugin thatsubparagraph is(1), required(2) toor be(3) usedwho earlierparticipates in the stepnetwork therapyplan protocolof tothe beprepaid ineffectivelimited athealth treatingservice organization is located 60 miles or more from the psychiatricresidence condition.of the enrollee;
2.and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the enrollee, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition .
[based on the known physical or mental characteristics of the enrollee and the known characteristics of the drug regimen.] 2.
As used in this section:section [, “practitioner” has the meaning ascribed to it in NRS 639.0125.] :
(b) “Network plan” means evidence of coverage offered by a prepaid limited health service organization 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 prepaid limited health service organization.
The term does nothenot include an arrangement for the financing of premiums.
A health care plan which provides coverage for prescription drugs must not require an insured to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is [appropriately] prescribed to treat a psychiatric condition of the insured, if:if [the] :
AdministrationSenate withAmendment indicationsNo. for the psychiatric condition of the insured or the use of the drug to treat that psychiatric condition is otherwise supported by medical or scientific evidence;
104 to Senate Bill No.
167 Page 12 (a) The drug has been approved by the Food and Drug Administration with indications for the psychiatric condition of the insured or the use of the drug to treat that psychiatric condition is otherwise supported by medical or scientific evidence;
-(3) 82ndAn Sessionadvanced (2023)practice –registered 13nurse –who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120;
and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the insured, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.condition .
[based on the known physical or mental characteristics of the insured and the known characteristics of the drug regimen.] 2.
Any provision of a health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, which is in conflict with this sec3.onAssection usedis invoid. this section:
3.
As used in this section [, “practitioner” has the meaning ascribed to it in NRS 639.0125.] :
district,287.010 municipal1. corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada may:
(a)The Adoptgoverning andbody carryof intoany effectcounty, aschool systemdistrict, ofmunicipal groupcorporation, life,political accidentsubdivision, orpublic healthcorporation insurance, or anyother combinationlocal thereof,governmental foragency the benefit of its officers and employees, and the dependentsState of officersNevada andmay: employees who elect to accept the insurance and who, where necessary, have authorized the governing body to make deductions - 82nd Session (2023) – 14 – from their compensation for the payment of premiums on the insurance.
(b)(a) PurchaseAdopt groupand policiescarry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of suchits officers and haveemployees, authorizedand the purchase,dependents fromof insuranceofficers companiesand authorizedemployees who elect to transactaccept the business of such insurance inand thewho, State of Nevada, and, where necessary, deducthave fromauthorized the compensationgoverning ofbody officersto andmake employeesdeductions thefrom premiumstheir uponcompensation insurancefor andthe paypayment theof deductionspremiums uponon the premiums.insurance.
(c)(b) ProvidePurchase group policies of life, accident or health coverageinsurance, throughor aany self-insurancecombination reservethereof, fundfor and,the wherebenefit necessary,of deductsuch contributionsofficers and employees, and the dependents of such officers and employees, as have authorized the purchase, from insurance companies authorized to transact the maintenancebusiness of such insurance in the fundState of Nevada, and, where necessary, deduct from the compensation of officers and employees the premiums upon insurance and pay the deductions intoupon the fund.premiums.
Senate Amendment No.
104 to Senate Bill No.
167 Page 13 (c) Provide group life, accident or health coverage through a self-insurance reserve fund and, where necessary, deduct contributions to the maintenance of the fund from the compensation of officers and employees and pay the deductions into the fund.
The provisions of NRS 686A.135, 687B.352, 687B.408, 687B.723, 687B.725, 689B.030 to 689B.050, inclusive, and section 3 of this act, 689B.265, 689B.287 and 689B.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.
(d) Defray part or all of the cost of maintenance of a self-self-insurance insurance fund or of the premiums upon insurance.
If the amount of the deductions from compensation - 82nd Session (2023) – 15 – required to pay for the group insurance exceeds the compensation to which a trustee is entitled, the difference must be paid by the trustee.
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 theionthe or 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) Must be submitted to the Commissioner of Insurance for approval not less than 30 days before the date on which the contract is (b)to Does not become effectiveeffective. unless approved by the Commissioner.
(b) Does not become effective unless approved by the Commissioner.
6.Senate Amendment No.
104 to Senate Bill No.
167 Page 14 6.
287.04335 If the Board provides health insurance through a plan of self-insurance,self- insurance, it shall comply with the provisions of NRS 686A.135, 687B.352, 687B.409, 687B.723, 687B.725, 689B.0353, 689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.1675, 695G.170 to 695G.174, inclusive, and section 12 of -this 82ndact, Session695G.176, (2023)695G.177, –695G.200 16to –695G.230, inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the sameive,same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.
and (c) Review and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols used by the Medicaid program for prescription drugs.herapydrugs. protocols used 3.
The3. step therapy protocol established pursuant to this section must not apply to a drug approved by the Food and Drug Administration that is prescribed to treat a psychiatric condition of a recipient of Medicaid, if:
The step therapy protocol established pursuant to this section must not apply to a drug approved by the Food and Drug Administration that is [appropriately] prescribed to treat a psychiatric condition of a recipient of Medicaid, if [the] :
(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nur(4)Nursing Apursuant primary care provider that is providing care to anNRS insured632.120; in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in Medicaid is located 60 miles or more from the residence of the recipient;
andor (c)(4) TheA practitionerprimary listedcare inprovider paragraphthat (b)is whoproviding prescribedcare theto drugan knows,insured basedin onconsultation thewith medicala historypractitioner oflisted thein recipient,subparagraph or(1), reasonably(2) expectsor each(3), alternativeif drugthe thatclosest ispractitioner requiredlisted toin besubparagraph -(1), 82nd(2) Sessionor (2023)(3) –who 17participates –in usedMedicaid earlieris inlocated the60 stepmiles therapyor protocolmore tofrom bethe ineffectiveresidence atof treating the psychiatricrecipient; condition.
4.and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the recipient, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition .
The[based Departmenton shall not require the Drugknown Usephysical Review Board to develop, review or approvemental priorcharacteristics authorizationof policiesthe orrecipient prescriptionand drugsthe developedknown pursuantcharacteristics toof NRSthe 422.4025.preferreddrug [4.]regimen.] 5.4.
The Department shall not require the Drug Use Review Board to develop, review or approve prior authorization policies or procedures necessary for the operation of the list of preferred prescription drugs developed pursuant to NRS 422.4025.
Senate Amendment No.
104 to Senate Bill No.
167 Page 15 [4.] 5.
As used in this section:section [, “practitioner” has the meaning ascribed to it in NRS 639.0125.] :
~~~~~ 23 - 82nd Session (2023)