SB 439 — Revises provisions relating to communicable diseases. (BDR 40-987)

(1) used to treat hepatitis C, used to provide medication-assisted treatment for opioid use disorder, used to support safe withdrawal from substance use disorder or is in the same class as a prescription drug on the list of preferred prescription drugs;

and (2) is unsuitable for a recipient of Medicaid for certain reasons.

Section 27 of this bill authorizes any provider of health care to use training in that subject in place of not more than 2 hours of any other - *SB439_R1* – 4 – training that the provider is required to complete, other than continuing education relating to ethics.

offensesSenate forBill whichNo. an element of the offense was having the humanertain criminal immunodeficiency virus.

(Section275 24, chapter 491, Statutes of Nevadathe 2021,2021 atLegislative pageSession 3199)repealed Sectioncertain 77criminal ofoffenses thisfor billwhich providesan thatelement the repeal of thosethe offensesoffense applieswas retroactivelyhaving to violations that occurred before the effectivehuman dateimmunodeficiency ofvirus. Senate Bill No.

(Section 24, chapter 491, Statutes of Nevada 2021, at retroactively to violations that occurred before the effective date of Senate Billies No.

EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

The Department of Health and Human Services and all district, county and city boards of health shall develop policies to provide uninterrupted services during a public health emergency - 82nd Session (2023) – 4 – to persons who have been diagnosed with the human immunodeficiency virus or who are at a high risk of acquiring the human immunodeficiency virus and who are receiving services from the Department or any division thereof or the district, county orprovide, citywithout healthlimitation, department,for asthe applicable.delivery of such services during a public health emergency:

Such policies may provide, without limitation, for the delivery of such services during a public health emergency:

Sec.Secs.

3.3-10.

(Deleted by amendment.) Sec.thereto a new section to read as follows:amended by adding 1.

4.

(Deleted by amendment.) Sec.

5.

(Deleted by amendment.) - *SB439_R1* – 5 – Sec.

6.

(Deleted by amendment.) Sec.

7.

(Deleted by amendment.) Sec.

8.

(Deleted by amendment.) Sec.

9.

(Deleted by amendment.) Sec.

10.

(Deleted by amendment.) Sec.

11.

Chapter 209 of NRS is hereby amended by adding thereto a new section to read as follows:

1.

- 82nd Session (2023) – 5 – (a) Any drug prescribed for treating the human immunodeficiency virus in the form recommended by the prescribing practitioner to each offender who has been diagnosed with human immunodeficiency virus to the same extent and under the(b) Methodstionsofs preventingcalthere acquisitionrs.of human immunodeficiency virus, including, without limitation, drugs approved by the sameUnited conditionsStates asFood otherand medicalDrug careAdministration for offenders.that purpose, to all offenders free of charge.

(b) Methods of preventing the acquisition of human immunodeficiency virus, including, without limitation, drugs approved by the United States Food and Drug Administration for that purpose, to all offenders free of charge.

- *SB439_R1* – 6 – Sec.

A sheriff, chief of police or town marshal who is responsible for a county, city or town jail or detention facility shall not enter into a contract or other agreement with any person or entity to provide medical services to prisoners who are diagnosed with human immunodeficiency virus unless the person or entity demonstrates that at least 95 percent of the patients who are diagnosed with human immunodeficiency virus to whom the person or entity provides medical services:

(a) Any drug prescribed for treating the human immunodeficiency virus in the form recommended by the prescribing practitioner to each prisoner who has been diagnosed - 82nd Session (2023) – 6 – with human immunodeficiency virus to the same extent and under the same conditions as other medical care for prisoners.

(b) Methods of preventing the acquisition of human immunodeficiency virus, including, without limitation, drugs approved by the United States Food and Drug Administration for that purpose, to all prisoners free of charge.charge.ministration for 3.

3.

- *SB439_R1* – 7 – (b) Sell, supply or provide any human excrement or bodily fluid to any other person;

(c) Buy, receive or acquire any human excrement or bodily fluid from any other person;

orquire any human excrement or bodily fluid (d) Use, propel, discharge, spread or conceal, or cause to be used, propelled, discharged, spread or concealed, any human excrement or bodily fluid:

- 82nd Session (2023) – 7 – 2.

(b) For a second offense or any subsequent offense, a category D felony and shall be punished as provided in NRS 193.130.193.130.ategory 3.

3.

or (b) For a definite term of 25 years, with eligibility for parole beginning when a minimum of 10 years has been served,  anda5. may be further punished by a fine of not more than $50,000.

-maA *SB439_R1*sentence –imposed 8upon –a 5.prisoner pursuant to subsection 2, 3 or 4:

A sentence imposed upon a prisoner pursuant to subsection 2, 3 or 4:

or (b)- Paid82nd forSession (2023) – 8 – subsection 8.or pursuant to subparagraph (2) of paragraph (c) of subsection7. 8.

7.

(c) If the excrement or bodily fluid involved in the act came into physical contact with any portion of the body of an officer ororme into employee of a prison or law enforcement agency:

and (II) Of any law enforcement agency, the law enforcement agency that employs the officer or employee shall pay for any - *SB439_R1* – 9 – appropriate examinations and testing requested by the officer or employee to determine whether a communicable disease was transmittedtra(d) toThe theresults officerof orthe employeeinvestigation asconducted apursuant resultto. of the act.

(d) The results of the investigation conducted pursuant to subsection 7 and the results of any examinations or testing conducted pursuant to paragraphs (a) and (b) must be submitted to the district attorney of the county in which the act was committed or to the Office of the Attorney General for possible prosecution of each prisoner who committed the act.

If a prisoner is charged with committing an act described in paragraph (d) of subsection 1 and a victim or an intended victim of the act was an officer or employee of a prison or law enforcement - 82nd Session (2023) – 9 – agency, the prosecuting attorney shall not dismiss the charge in exchange for a plea of guilty, guilty but mentally ill or nolo contendere to a lesser charge or for any other reason unless the prosecuting attorney knows or it is obvious that the charge is not supportedsup10. by probable cause or cannot be proved at the time of trial.

10.The provisions of this section do not apply to a prisonerrial.

The provisions of this section do not apply to a prisoner who is in residential confinement or to a prisoner who commits an act described in subsection 1 if the act:

(1) The Administrator of the Aging and Disability Services Division;Divisi(2) The Administrator of the Division of Welfare and Supportive Services;

(2) The Administrator of the Division of Welfare and Supportive Services;

- *SB439_R1* – 10 – (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, 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 20 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 - 82nd Session (2023) – 10 – 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.

(c)developmentaladminidisabilitieste Shall administer any state program for persons with developmental disabilities established pursuantperpursuanth to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C.

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

(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 - *SB439_R1* – 11 – detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section.

- 82nd Session (2023) – 11 – Sec.

The governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada that provides health insurance through a plan of self-insurance shall provide coverage for:

The governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada that provides health insurance through a plan of self-insurance may subject the benefits required by subsection 1 to reasonable medical management techniques.

- *SB439_R1* – 12 – 5.

- 82nd Session (2023) – 12 – (a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs.

The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devicesdev(b) based“Network onplan” cost,means typea plan of self-insurance provided by the governing body of a local governmental agency under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or methodin part, through a defined set of administration.providers under contract with the governing body.

(b) “Network plan” means a plan of self-insurance provided by the governing body of a local governmental agency 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 governing body.

(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 - *SB439_R1* – 13 – compensation of officers and employees and contributions of the governing body must be maintained as an internal service fund as defined by NRS 354.543.

The money must be deposited in a state or national bank or credit union authorized to transact business in the - 82nd Session (2023) – 13 – State of Nevada.

Any 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 of benefits provided.

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.

- *SB439_R1* – 14 – (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 - 82nd Session (2023) – 14 – governmental agency with which the legal services organization has contracted;

and (b) Must be required by the contract to pay the premiums or contributions for all insurance which they elect to accept or of which theythe5.autA authorizecontract thethat purchase.is entered into pursuant to subsection 3:

5.

A contract that is entered into pursuant to subsection 3:

287.040 The provisions of NRS 287.010 to 287.040, inclusive, and section 14.5 of this act do not make it compulsory upon any governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada, except as otherwise provided in NRS 287.021 or subsection 4 of NRS 287.023 or in an agreement entered into pursuant to subsection 3 of NRS 287.015, to pay any premiums, contributions or other costs for group insurance, a plan of benefits or medical or hospital services established pursuant to NRS 287.010, 287.015, 287.020 or paragraph (b), (c) or (d) of subsection 1 of NRS 287.025, for coverage under the Public Employees’ Benefits Program, or to make any contributions to aalic trust fund established pursuant to NRS 287.017, or upon any officer or employee of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of this State to accept any such coverage or to assign his or her wages or salary in payment of premiums or contributions therefor.

287.04335 If the Board provides health insurance through a plan of 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, - *SB439_R1* – 15 – 695G.1675, 695G.170 to 695G.174, inclusive, and sections 71 and 72- of82nd thisSession act,(2023) 695G.176,– 695G.177,15 695G.200– to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

Sec.Secs.

17.17 and 18.

NRS(Deleted 389.036by isamendment.) herebySec. amended to read as follows:

389.036 1.

The board of trustees of a school district shall [establish] :

(a) Establish a course or unit of a course of [:

(a) Factual] evidence-based, factual instruction [concerning the human immunodeficiency virus;

and (b) Instruction on the human reproductive system, related communicable diseases and sexual responsibility.

2.] in sexuality education.

The course of instruction must comply with the standards of content and performance for a course of study in health established by the Council to Establish Academic Standards for Public Schools pursuant to NRS 389.520 and must be appropriate for the ages of the pupils who receive the instruction.

The course must include, without limitation, instruction concerning:

(1) Reproductive and sexual anatomy and physiology, including, without limitation, biological, psychosocial and emotional changes that accompany maturation;

(2) Puberty, pregnancy, parenting, body image and gender stereotypes;

(3) The human immunodeficiency virus and other sexually transmitted infections and related communicable diseases;

(4) The benefits, potential side effects and proper use of methods approved by the United States Food and Drug Administration for preventing pregnancy and sexually transmitted infections;

(5) The ways in which the use of alcohol and drugs affect responsible decision making;

(6) The impact of media and peers on the thoughts, feelings and behaviors of pupils related to sexuality;

(7) How to identify, prevent and respond to domestic violence, sexual abuse and sexual assault, including, without limitation, medical and legal resources and counseling for survivors of such crimes;

(8) Statutes related to age of consent and statutory rape, including, without limitation, NRS 200.366, 200.727, 201.230, 201.540 and 201.550, and preventing statutory rape;

(9) Statutes related to the transmission and possession of sexually explicit images, including, without limitation, NRS 200.604, 200.727, 200.730 and 200.780, and avoiding participation - *SB439_R1* – 16 – in such acts and exploitation of others through the creation and transmission of such images over the Internet or in any other manner;

and (10) The manner in which to locate and access reproductive health services, including, without limitation, obtaining contraceptives, barrier methods, cancer screenings and testing for and the treatment of sexually transmitted infections;

and (b) Periodically revise the content of the course or unit of a course of instruction established pursuant to paragraph (a) as necessary to ensure that the content is current, appropriate for the ages of the pupils and, as applicable, medically accurate.

2.

The course or unit of a course established pursuant to subsection 1 must:

(a) Use instructional methods and materials that promote the inclusion and acceptance of pupils regardless of race, gender, gender identity or expression, religion, sexual orientation, ethnic or cultural background or disability;

(b) Promote the development of skills, including, without limitation, setting goals that are needed to make responsible decisions about sexuality and sexual behavior throughout life;

(c) Be designed to provide equally meaningful instruction to pupils regardless of their level of sexual experience or whether they are currently engaging in sexual activity;

(d) Emphasize that abstaining from sexual activity is the only way to ensure the avoidance of pregnancy and sexually transmitted infections;

(e) Emphasize the use of interpersonal skills to develop healthy relationships, including, without limitation, friendships, marriage and romantic and familial relationships;

and (f) Involve the parents or guardians of pupils in the instruction provided and encourage pupils to communicate with their families concerning issues relating to sexuality.

3.

Each board of trustees shall appoint an advisory committee consisting of:

(a) Five parents of children who attend schools in the district;

and (b) Four representatives, one from each of four of the following professions or occupations:

(1) Medicine or nursing;

(2) Counseling;

(3) Religion;

(4) Pupils who attend schools in the district;

or (5) Teaching.

[ This] - *SB439_R1* – 17 – 4.

The advisory committee appointed pursuant to subsection 3 shall advise the district concerning the content of and materials to be used in a course or unit of a course of instruction established pursuant to this section, and the recommended ages of the pupils to whom the course or unit is offered.

The final decision on these matters must be that of the board of trustees.

[3.] 5.

The subjects of the [courses] course or unit of a course of instruction may be taught only by a teacher , [or] school nurse [whose qualifications have] , provider of health care or other person who has been [previously] approved by the board of trustees.

The board of trustees may approve a person for the purposes of this subsection if it determines that the person has demonstrated competency in the applicable subject and the use of the required instructional materials.

[4.] 6.

The parent or guardian of each pupil to whom a course or unit of a course of instruction established pursuant to this section is offered must first be furnished written notice that the course or unit of a course will be offered.

The notice must be given in the usual manner used by the local district to transmit written material to parents, and must contain a form for the signature of the parent or guardian of the pupil consenting to the pupil’s attendance.

Upon receipt of the written consent of the parent or guardian, the pupil may attend the course [.] or unit of a course.

If the written consent of the parent or guardian is not received, the pupil must be excused from such attendance without any penalty as to credits or academic standing.

Any course or unit of a course offered pursuant to this section is not a requirement for graduation.

[5.] 7.

All instructional materials to be used in a course or unit of a course of instruction established pursuant to this section must be available for inspection by parents or guardians of pupils at reasonable times and locations before the course is taught, and appropriate written notice of the availability of the material must be furnished to all parents and guardians.

8.

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

Sec.

18.

NRS 389.520 is hereby amended to read as follows:

389.520 1.

The Council shall:

(a) Establish standards of content and performance, including, without limitation, a prescription of the resulting level of achievement, for the grade levels set forth in subsection 5, based upon the content of each course, that is expected of pupils for the following courses of study:

(1) English language arts;

(2) Mathematics;

(3) Science;

- *SB439_R1* – 18 – (4) Social studies, which includes only the subjects of history, geography, economics, civics, financial literacy and multicultural education;

(5) The arts;

(6) Computer education and technology, which includes computer science and computational thinking;

(7) Health;

(8) Physical education;

and (9) A foreign or world language.

(b) Establish a schedule for the periodic review and, if necessary, revision of the standards of content and performance.

The review must include, without limitation, the review required pursuant to NRS 390.115 of the results of pupils on the examinations administered pursuant to NRS 390.105.

(c) Assign priorities to the standards of content and performance relative to importance and degree of emphasis and revise the standards, if necessary, based upon the priorities.

2.

The standards for computer education and technology must include a policy for the ethical, safe and secure use of computers and other electronic devices.

The policy must include, without limitation:

(a) The ethical use of computers and other electronic devices, including, without limitation:

(1) Rules of conduct for the acceptable use of the Internet and other electronic devices;

and (2) Methods to ensure the prevention of:

(I) Cyber-bullying;

(II) Plagiarism;

and (III) The theft of information or data in an electronic form;

(b) The safe use of computers and other electronic devices, including, without limitation, methods to:

(1) Avoid cyber-bullying and other unwanted electronic communication, including, without limitation, communication with on-line predators;

(2) Recognize when an on-line electronic communication is dangerous or potentially dangerous;

and (3) Report a dangerous or potentially dangerous on-line electronic communication to the appropriate school personnel;

(c) The secure use of computers and other electronic devices, including, without limitation:

(1) Methods to maintain the security of personal identifying information and financial information, including, without limitation, identifying unsolicited electronic communication which is sent for - *SB439_R1* – 19 – the purpose of obtaining such personal and financial information for an unlawful purpose;

(2) The necessity for secure passwords or other unique identifiers;

(3) The effects of a computer contaminant;

(4) Methods to identify unsolicited commercial material;

and (5) The dangers associated with social networking Internet sites;

and (d) A designation of the level of detail of instruction as appropriate for the grade level of pupils who receive the instruction.

3.

The standards for social studies must include multicultural education, including, without limitation, information relating to contributions made by men and women from various racial and ethnic backgrounds.

The Council shall consult with members of the community who represent the racial and ethnic diversity of this State in developing such standards.

4.

The standards for health must include [mental] :

(a) Mental health and the relationship between mental health and physical health.

(b) Standards for sexuality education.

The standards for other courses may include topics relating to sexuality education where appropriate.

5.

The Council shall establish standards of content and performance for each grade level in kindergarten and grades 1 to 8, inclusive, for English language arts and mathematics.

The Council shall establish standards of content and performance for the grade levels selected by the Council for the other courses of study prescribed in subsection 1.

6.

The Council shall forward to the State Board the standards of content and performance established by the Council for each course of study.

The State Board shall:

(a) Adopt the standards for each course of study, as submitted by the Council;

or (b) If the State Board objects to the standards for a course of study or a particular grade level for a course of study, return those standards to the Council with a written explanation setting forth the reason for the objection.

7.

If the State Board returns to the Council the standards of content and performance for a course of study or a grade level, the Council shall:

(a) Consider the objection provided by the State Board and determine whether to revise the standards based upon the objection;

and (b) Return the standards or the revised standards, as applicable, to the State Board.

- *SB439_R1* – 20 –  The State Board shall adopt the standards of content and performance or the revised standards, as applicable.

8.

The Council shall work in cooperation with the State Board to prescribe the examinations required by NRS 390.105.

9.

As used in this section:

(a) “Computer contaminant” has the meaning ascribed to it in NRS 205.4737.

(b) “Cyber-bullying” has the meaning ascribed to it in NRS 388.123.

(c) “Electronic communication” has the meaning ascribed to it in NRS 388.124.

Sec.

2.of family medicine, pediatrics, internal medicine, obstetrics ande gynecology and midwifery.

As used in this section, “primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.

[1.]hepatitis (a)C Chlamydiain trachomatis,accordance gonorrhea,with NRS 442.013.a, hepatitis B and hepatitis[2.] C(b) Syphilis in accordance with NRS 442.013.442.010.

[2.] (b) Syphilis in accordance with NRS 442.010.

- *SB439_R1* – 21 – Sec.

- 82nd Session (2023) – 16 – [1.] (a) Any laboratory testing that is necessary for therapy that uses a drug approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus .

and] [2.] (b) The services of a pharmacist described in NRS 639.28085.

24.

(Deleted by amendment.) Sec.

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 - *SB439_R1* – 22 – 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.- 82nd Session (2023) – 17 – 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 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.

[and]and (d) Any prescription drug describedwhich inthe paragraphBoard (b)identifies as appropriate for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of subsectionpreferred 4;prescription drugs.

and (e) 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.

(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;

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

and (b) [Prescription]Prescription All prescription drugs approvedto byprevent the Unitedacquisition Statesof Foodhuman andimmunodeficiency Drugvirus. Administration to [prevent] :

(1) Prevent the acquisition of human immunodeficiency virus [.] or hepatitis C or treat those diseases.

- *SB439_R1* – 23 – (2) Provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone.

(3) Support safe withdrawal from substance use disorder, including, without limitation, lofexidine.

6.- 82nd Session (2023) – 18 – is not included on the list of preferred prescription drugs as if the drug were included on that list if:

(a) The drug is:

(1) Used to treat hepatitis C;

(2) Used to provide medication-assisted treatment for opioid use disorder;

(3) Used to support safe withdrawal from substance use disorder;

or (4) In the same class as a drug on the list of preferred prescription drugs;

and (b) All preferred prescription drugs within the same class as the drug are unsuitable for a recipient of Medicaid because:

(1) The recipient is allergic to all preferred prescription drugs within the same class as the drug;

(2) All preferred prescription drugs within the same class as the drug are contraindicated for the recipient or are likely to is taking;n a harmful manner with another drug that the recipient (3) The recipient has a history of adverse reactions to all preferred prescription drugs within the same class as the drug;

or (4) The drug has a unique indication that is supported by peer-reviewed clinical evidence or approved by the United States Food and Drug Administration.

7.

(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;

andt of Columbia and other states and territories of the (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:

[If] In addition to any benefits required by NRS 608.1555, an employer provides health benefits for his or her employees,- the82nd employerSession shall(2023) provide– benefits19 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:

- *SB439_R1* – 24 – 3.

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.

629.093 Unless a specific statute or regulation requires or authorizes a greater number of hours, a provider of health care may use credit earned for continuing education relating to Alzheimer’s disease or the stigma, discrimination and unrecognized bias toward persons who have acquired or are at a high risk of acquiring human immunodeficiency virus in place of not more than 2 hours each year of the continuing education that the provider of health care is required to complete, other than any continuing education relating to ethics that the provider of health care is required to complete.

or (b)- Biennial82nd Session (2023) – 20 – medicine,ennial registration of the holder of a license to practice medicine,  require each holder to submit evidence of compliance with the requirements for continuing education as set forth in regulations adopted by the Board.

-terrorism;Personal *SB439_R1*protective –equipment 25required –for (2)acts Personalof protective(3) equipmentCommon requiredsymptoms forand actsmethods of terrorism;treatment associated with exposure to, or injuries caused by, chemical, biological, radioactive and nuclear agents;

(3) Common symptoms and methods of treatment associated with exposure to, or injuries caused by, chemical, biological, radioactive and nuclear agents;

(d) Must provide for the completion of at least 2 hours of training in the screening, brief intervention and referral to treatment approachlicensure.o to substance use disorder within 2 years after initial licensure.(e) Must provide for the biennial completion by each psychiatrist and each physician assistant practicing under the supervision of a psychiatrist of one or more courses of instruction that provide at least 2 hours of instruction relating to cultural competency and diversity, equity and inclusion.

(e) Must provide for the biennial completion by each psychiatrist and each physician assistant practicing under the supervision of a psychiatrist of one or more courses of instruction that provide at least 2 hours of instruction relating to cultural competency and diversity, equity and inclusion.

- 82nd Session (2023) – 21 – (2) Must be based upon a range of research from diverse sources.

(I)backgrounds;) Persons from various gender, racial and ethnic (II) Persons from various religious backgrounds;

(II) Persons from various religious backgrounds;

(f) Must allow the holder of a license to receive credit toward the total amount of continuing education required by the Board for - *SB439_R1* – 26 – the completion of a course of instruction relating to genetic counseling and genetic testing.

(g) Must provide for the completion by a physician or physician assistant who provides or supervises the provision of emergency medical services in a hospital or primary care of at least 2 hours of training in the stigma, discrimination and unrecognized bias toward persons who have acquired or are at a high risk of acquiring human immunodeficiency virus within 2 years after beginning to provide or supervise the provision of such services or care.

- 82nd Session (2023) – 22 – (c) The biological, behavioral, social and emotional aspects of the aging process;

5.practice medicine to receive, as a portion of his or her continuing education, training concerning methods for educating patients about how to effectively manage medications, including, without limitation, the ability of the patient to request to have the symptom or purpose for which a drug is prescribed included on the label attached to the container of the drug.

The Board shall encourage each holder of a license to practice medicine to receive, as a portion of his or her continuing education, training concerning methods for educating patients about how to effectively manage medications, including, without limitation, the ability of the patient to request to have the symptom or purpose for which a drug is prescribed included on the label attached to the container of the drug.

and - *SB439_R1* – 27 – (c) The detection of suicidal thoughts and ideations and the prevention of suicide.

(a)(b) RecognizingInterpreting thefamily history to determine whether such symptoms ofindicate pediatrica cancer;normal childhood illness or a condition that requires additional examination.

and (b) Interpreting family history to determine whether such symptoms indicate a normal childhood illness or a condition that requires additional examination.

(a)- “Act82nd ofSession (2023) – 23 – NRS 202.4415.f terrorism” has the meaning ascribed to it in (b) “Biological agent” has the meaning ascribed to it in NRS 202.4415.202.442.

(b) “Biological agent” has the meaning ascribed to it in NRS 202.442.

The Board shall not renew any license issued under this chapter until the licensee has submitted proof satisfactory to the Board of completion, during the 2-year period before renewal of the license, of 30 hours in a program of continuing education approved by the Board in accordance with regulations adopted bybyn the Board.

- *SB439_R1* – 28 – (b) An accredited school of practical nursing;

The Board may approve nursing and other courses which are directly related to the practice of nursing as well as others which bear a reasonable relationship to current developments in the field of nursing or any specialinclude areaacademic ofstudies, practiceworkshops, inextension whichstudies, ahome licenseestudy engages.and other courses.

These may include academic studies, workshops, extension studies, home study and other courses.

The program of continuing education required by subsection 1 must include:

(2)- The82nd abilitySession to(2023) receive– credit24 toward– the total amount of continuing education required by subsection 1 for the completion of a course of instruction relating to genetic counseling and genetic testing.

(4) Syndromic surveillance and reporting procedures for acts of terrorism that involve biological agents;

andandprocedures for acts (5) An overview of the information available on, and the use of, the Health Alert Network.

- *SB439_R1* – 29 – (1) May include the training provided pursuant to NRS 449.103, where applicable.

(II) Persons from various religious backgrounds;

and - 82nd Session (2023) – 25 – (VIII) Persons who are part of any other population that a person licensed pursuant to this chapter may need to better understand, as determined by the Board.

(d) For a person licensed as an advanced practice registered nurse, at least 2 hours of training in the screening, brief intervention and referral to treatment approach to substance use disorder to bebeention completed within 2 years after initial licensure.

(b) Approaches to providing health care to older persons, includinginc(c) bothThe didacticbiological, behavioral, social and clinicalemotional approaches;aspects of the aging process;

- *SB439_R1* – 30 – (c) The biological, behavioral, social and emotional aspects of the aging process;

(a)- Recognizing82nd theSession (2023) – 26 – (b) Interpreting family history to determine whether such symptoms ofindicate pediatrica cancer;normal childhood illness or a condition that requires additional examination.

and (b) Interpreting family history to determine whether such symptoms indicate a normal childhood illness or a condition that requires additional examination.

[(e)] (f) “Weapon of mass destruction” has the meaning ascribedascSec. to it in NRS 202.4445.

Sec.

Except as otherwise provided in subsection [14] 15 and NRS 633.491, every holder of a license, except a physician assistant, issued under this chapter, except a temporary or a special license, may renew the license on or before January 1 of each calendar year after its issuance by:

- *SB439_R1* – 31 – (d) Subject to subsection [13,] 14, submitting evidence to the Board that in the year preceding the application for renewal the holder has attended courses or programs of continuing education approved by the Board in accordance with regulations adopted by the Board totaling a number of hours established by the BoardBoardby which must not be less than 35 hours nor more than that set in the requirements for continuing medical education of the American Osteopathic Association;

3.- 82nd Session (2023) – 27 – completion of the required number of hours of continuing medical education annually from no fewer than one-third of the applicants for renewal of a license to practice osteopathic medicine or a license to practice as a physician assistant.

The Board shall request submission of verified evidence of completion of the required number of hours of continuing medical education annually from no fewer than one-third of the applicants for renewal of a license to practice osteopathic medicine or a license to practice as a physician assistant.

5.practice osteopathic medicine to receive, as a portion of his or her continuing education, training concerning methods for educating patients about how to effectively manage medications, including, without limitation, the ability of the patient to request to have the symptom or purpose for which a drug is prescribed included on the label attached to the container of the drug.

The Board shall encourage each holder of a license to practice osteopathic medicine to receive, as a portion of his or her continuing education, training concerning methods for educating patients about how to effectively manage medications, including, without limitation, the ability of the patient to request to have the symptom or purpose for which a drug is prescribed included on the label attached to the container of the drug.

-requirements *SB439_R1*approved –by 32the –Board, 7.the biennial completion by aon holder of a license to practice osteopathic medicine of at least 2 hours of continuing education credits in ethics, pain management, care of persons with addictive disorders or the screening, brief intervention and referral to treatment approach to substance use disorder.

The Board shall require, as part of the continuing education requirements approved by the Board, the biennial completion by a holder of a license to practice osteopathic medicine of at least 2 hours of continuing education credits in ethics, pain management, care of persons with addictive disorders or the screening, brief intervention and referral to treatment approach to substance use disorder.

The continuing education requirements approved by the Board must allow the holder of a license as an osteopathic physician or physician assistant to receive credit toward the total amount of - 82nd Session (2023) – 28 – continuing education required by the Board for the completion of a course of instruction relating to genetic counseling and genetic testing.

The Board shall require each holder of a license to practice osteopathic medicine to receive as a portion of his or her continuing education at least 2 hours of instruction every 4 years on evidence-evidence-g based suicide prevention and awareness which may include, without limitation, instruction concerning:

The Board shall require each psychiatrist or a physician assistant practicing under the supervision of a psychiatrist to biennially complete one or more courses of instruction that provide at least 2 hours of instruction relating to cultural competency and diversity, equity and inclusion.

Such instruction:instruction:al competency and (a) May include the training provided pursuant to NRS 449.103, where applicable.

(a) May include the training provided pursuant to NRS 449.103, where applicable.

- *SB439_R1* – 33 – (1) Persons from various gender, racial and ethnic backgrounds;

- 82nd Session (2023) – 29 – (7) Persons with an intellectual disability, developmental disability or physical disability;

and (8) Persons who are part of any other population that a psychiatrist or physician assistant practicing under the supervision ofBoard.sychiatrist a psychiatrist may need to better understand, as determined by the Board.13.

13.

As used in this section, “primary care” means the practice ofgynecology familyand medicine,midwifery.trics, pediatrics, internal medicine, obstetrics and gynecologySec. and midwifery.

Sec.

Except as otherwise provided in NRS 689A.0405, 689A.0412, 689A.0413, 689A.0437, 689A.044, 689A.0445, 689B.031, 689B.0312, 689B.0313, 689B.0315, 689B.0317, 689B.0374, 689C.1671, 689C.1675, 695A.1843, 695A.1856, 695B.1912, 695B.1913, 695B.1914, 695B.1924, 695B.1925, 695B.1942, 695C.1713, 695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 695G.170, 695G.1705, - *SB439_R1* – 34 – 695G.171, 695G.1714 and 695G.177, and sections 33, 41, 46, 54, 59, 64 and 71 of this act, any contract for group, blanket or individual health insurance or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care which provides for payment of a certain part of medical or dental care may require the insured or member to obtain prior authorization - 82nd Session (2023) – 30 – for that care from the insurer or organization.

and (b) Respond to any request for approval by the insured or member pursuant to this section within 20 days after it receives the request.

or (2) The provider of primary care is capable of providing the service safely and effectively in consultation with a specialist and the2.rovAn insurer shall provide the providercoverage engagesrequired by paragraph (a) of subsection 1 regardless of whether the drug is included in suchthe consultation.formulary of the insurer.

2.

An insurer shall provide the coverage required by paragraph (a) of subsection 1 regardless of whether the drug is included in the formulary of the insurer.

or - *SB439_R1* – 35 – (c) Refuse to cover a drug described in paragraph (a) of subsection 1 because the drug is dispensed by a pharmacy through mail order service.

- 82nd Session (2023) – 31 – 5.

A policy of 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 thattha6.coAs conflictsused within thethis provisionssection:ons of this section is void.

6.

As used in this section:

(a) Coverage of testing for and the treatment and prevention of sexually transmitted diseases, including, without limitation, Chlamydia trachomatis, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all insureds, regardless of age.

(Deleted by amendment.) - *SB439_R1* – 36 – Sec.

1.- 82nd Session (2023) – 32 – must be expressed therein.

The entire money and other considerations for the policy must2. be expressed therein.

2.

The style, arrangement and overall appearance of the policy must not give undue prominence to any portion of the text, and every printed portion of the text of the policy and of any endorsements or attached papers must be plainly printed in light- faced type of a style in general use, the size of which must bebet- uniform and not less than 10 points with a lowercase unspaced alphabet length not less than 120 points.

6.identified by a number in the lower left-hand corner of the first page thereof.

Each such form, including riders and endorsements, must be identified by a number in the lower left-hand corner of the first page thereof.

The policy must not contain any provision purporting to make any portion of the charter, rules, constitution or bylaws of the insurer a part of the policy unless that portion is set forth in full in the policy, except in the case of the incorporation of or reference to - *SB439_R1* – 37 – a statement of rates or classification of risks, or short-rate table filed with the Commissioner.

8.- 82nd Session (2023) – 33 – care at home or health supportive services if that care or service was prescribed by a physician and would have been covered by the policy if performed in a medical facility or facility for the dependent as defined in chapter 449 of NRS.

The policy must provide benefits for expense arising from care at home or health supportive services if that care or service was prescribed by a physician and would have been covered by the policy if performed in a medical facility or facility for the dependent as defined in chapter 449 of NRS.

Sec.follows:37.

37.NRS 689A.0437 is hereby amended to read as 689A.0437 1.

NRS 689A.0437 is hereby amended to read as follows:

689A.0437 1.

- *SB439_R1*82nd Session (2023) – 3834 – 2.

(a) A pharmacist who participates in the network plan of the insurer for the services described in NRS 639.28085 at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after [October] January 1, [2021,] 2024, has the legal effect of including the coverage required by subsection 1, and any provision of thetheuding policy that conflicts with the provisions of this section is void.

- 82nd Session (2023) – 35 – (c) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.

- *SB439_R1* – 39 – (d) “Provider of health care” has the meaning ascribed to it in NRSNRSSec. 629.031.

Sec.

(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 CARFCARFman International and provides a program for the treatment of alcohol or substance use disorder as part of its accredited activities.

- 82nd Session (2023) – 36 – (a) All drugs approved by the United States Food and Drug Administration to:

(1) Provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone.na(2) Support safe withdrawal from substance use disorder, including, without limitation, lofexidine.

- *SB439_R1* – 40 – (2) Support safe withdrawal from substance use disorder, including, without limitation, lofexidine.

4.subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer.

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

- 82nd Session (2023) – 37 – (b) “Network plan” means a policy of group 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 providersinclude underan contractarrangement withfor the insurer.financing of premiums.oes not (c) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.

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

- *SB439_R1* – 41 – (c) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.

43.

(Deleted by amendment.) Sec.

(c) Any service to test for, prevent or treat human immunodeficiency virus or hepatitis C provided by a provider of - 82nd Session (2023) – 38 – primary care if the service is covered when provided by a specialist and:

or (2) The provider of primary care is capable of providing the service safely and effectively in consultation with a specialist and the provider engages in such consultation;

and - *SB439_R1* – 42 – [(c)] (d) The services described in NRS 639.28085, when provided by a pharmacist who participates in the network plan of the insurer.

(c) Refuse to cover a drug described in paragraph (a) of subsection 1 because the drug is dispensed by a pharmacy through mail order service;

ororhe drug is dispensed by a pharmacy through (d) Prohibit or restrict access to any service or drug to treat human immunodeficiency virus or hepatitis C on the same day on which the insured is diagnosed.

(a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs.- 82nd Session (2023) – 39 – prior authorization and categorizing drugs and devices based onherapy, 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.

- *SB439_R1* – 43 – (c) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.

A carrier that offers or issues a health benefit planpla(a) shallAll includedrugs inapproved by the planUnited coverageStates for:Food and Drug Administration to:

(a) All drugs approved by the United States Food and Drug Administration to:

2.(a) of subsection 1 regardless of whether the drug is included inh the formulary of the carrier.

A carrier shall provide the coverage required by paragraph (a) of subsection 1 regardless of whether the drug is included in the formulary of the carrier.

or - 82nd Session (2023) – 40 – (c) Refuse to cover a drug described in paragraph (a) of subsection 1 because the drug is dispensed by a pharmacy through mail order service.

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

- *SB439_R1* – 44 – (a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs.

(d) “Provider of health care” has the meaning ascribed to it in NRSNRSSec. 629.031.

Sec.

- 82nd Session (2023) – 41 – Sec.

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 in NRS 689C.167 [.] and section 46 of this act.act.sorder, as provided in Sec.

Sec.

- *SB439_R1* – 45 – (a) Treatment for withdrawal from the physiological effects of alcohol or drugs, with a minimum benefit of $1,500 per calendar year.

(b) Hospital or other medical facility or facility for the dependent which is licensed by the Division of Public and the Behavioral Health of the Department of Health and Human Services, is accredited by The Joint Commission or CARF International and provides a program for the treatment of alcohol or substance use disorders as part of its accredited activities.

- 82nd Session (2023) – 42 – (b) Laboratory testing that is necessary for therapy that uses [such] a drug [;] to prevent the acquisition of human immunodeficiency virus;

(c) Any service to test for, prevent or treat human immunodeficiency virus or hepatitis C provided by a provider of primary care if the service is covered when provided by a specialist and:

and - *SB439_R1* – 46 – [(c)] (d) The services described in NRS 639.28085, when provided by a pharmacist who participates in the health benefit plan of the carrier.

3.

A carrier [may subject] shall not:

A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after [October]- January82nd 1,Session [2021,](2023) 2024,– has43 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.

(b) “Network plan” means a health benefit plan offered by a carrier 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 - *SB439_R1* – 47 – with the carrier.

(c) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.mid(d) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(d) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(1) Provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone.

or - 82nd Session (2023) – 44 – (2) The provider of primary care is capable of providing the service safely and effectively in consultation with a specialist and the provider engages in such consultation.

A society shall provide the coverage required by paragraph (a)the formulary of subsectionthe 1society.s regardless of whether the drug is included in the3. formulary of the society.

3.

- *SB439_R1* – 48 – 4.

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 benefit contract offered by a society 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 society.

(b) “Network plan” means a benefit contract offered by a society 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 society.

- 82nd Session (2023) – 45 – (a) Coverage of testing for and the treatment and prevention of sexually transmitted diseases, including, without limitation, Chlamydia trachomatis, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all insureds, regardlessthe coverage required by NRS 695A.1843 and 695A.1856.t limitation, (b) Unrestricted coverage of age.condoms for insureds who are 13 years of age or older.

Such coverage must include, without limitation, the coverage required by NRS 695A.1843 and 695A.1856.

(b) Unrestricted coverage of condoms for insureds who are 13 years of age or older.

- *SB439_R1* – 49 – (a) [Drugs] All approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus [;] or treating human immunodeficiency virus or hepatitis C in the form recommended by the prescribing practitioner, regardless of whether the drug is included in the formulary of the society;

(c) Any service to test for, prevent or treat human immunodeficiency virus or hepatitis C provided by a provider of primary care if the service is covered when provided by a specialist and:

(a) A pharmacist who participates in the network plan of the society for the services described in NRS 639.28085 at a rate equal - 82nd Session (2023) – 46 – to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

(b) An advanced practice registered nurse or a physician assistant who participates in the network plan of the society for any service to test for, prevent or treat human immunodeficiency virus or hepatitis C at a rate equal to the rate of reimbursement provided to a physician for similar services.

- *SB439_R1* – 50 – 4.

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

- 82nd Session (2023) – 47 – Sec.

A hospital or medical services corporation that offers or issues a policy of health insurance shall include in the policypol(a) coverageAll for:drugs approved by the United States Food and Drug Administration to:

(a) All drugs approved by the United States Food and Drug Administration to:

- *SB439_R1* – 51 – 2.

(a) Subject the benefits required by paragraph (a) of subsection 1 to medical management techniques, other than step therapy;the(b) Limit the covered amount of a drug described in paragraph (a) of subsection 1;

(b) Limit the covered amount of a drug described in paragraph (a) of subsection 1;

- 82nd Session (2023) – 48 – (a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs.

The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devicesdev(b) based“Network onplan” cost,means typea policy of health insurance offered by a hospital or methodmedical services corporation under which the financing and delivery of administration.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.

(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) Coverage of testing for and the treatment and prevention of sexually transmitted diseases, including, without limitation, - *SB439_R1* – 52 – Chlamydia trachomatis, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all insureds, regardless of age.

(b) Unrestricted coverage of condoms for insureds who are 13 yearsyea2. of age or older.

2.oA policy of 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.

A policy of 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.

(a) [Drugs] All drugs approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus [;] or treating human immunodeficiency virus or hepatitis C in the form recommended by the prescribing practitioner,- regardless82nd ofSession whether(2023) the– drug49 is– included in the formulary of the hospital or medical services organization;

the (b) Laboratory testing that is necessary for therapy using [such] a drug [;] to prevent the acquisition of human immunodeficiency virus;

2.issues a policy of health insurance shall reimburse [a] :ffers or (a) A pharmacist who participates in the network plan of the hospital or medical services corporation for the services described in NRS 639.28085 at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

A(b) An advanced practice registered nurse or a physician assistant who participates in the network plan of the hospital or medical services corporation thatfor offersany service to test for, prevent or issuestreat human immunodeficiency virus or hepatitis C at a policyrate equal to the rate of healthreimbursement insuranceprovided shallto reimbursea [a]physician :for similar services.

(a) A pharmacist who participates in the network plan of the hospital or medical services corporation for the services described in NRS 639.28085 at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.

- *SB439_R1* – 53 – (b) An advanced practice registered nurse or a physician assistant who participates in the network plan of the hospital or medical services corporation for any service to test for, prevent or treat human immunodeficiency virus or hepatitis C at a rate equal to the rate of reimbursement provided to a physician for similar services.

(a) Subject the benefits required by subsection 1 to [reasonable] medicalmed(b) managementLimit techniquesthe [.]covered ,amount otherof thana stepdrug therapy;described in paragraph (a) of subsection 1;

(b) Limit the covered amount of a drug described in paragraph (a) of subsection 1;

- 82nd Session (2023) – 50 – 4.

5.chapter that is delivered, issued for delivery or renewed on or afters [October] January 1, [2021,] 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.

A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after [October] January 1, [2021,] 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.

-thereto *SB439_R1*the –provisions 54set –forth Sec.as sections 64, 65 and 66 of this act.

63.

Chapter 695C of NRS is hereby amended by adding thereto the provisions set forth as sections 64, 65 and 66 of this act.

or - 82nd Session (2023) – 51 – (2) The provider of primary care is capable of providing the service safely and effectively in consultation with a specialist and the provider engages in such consultation.

A health maintenance organization shall provide the coverage required by paragraph (a) of subsection 1 regardless of whether the drug is included in the formulary of the healthhealthss of maintenance organization.

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

The term includes, without limitation, the use - *SB439_R1* – 55 – of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration.

- 82nd Session (2023) – 52 – Sec.

(a) Coverage of testing for and the treatment and prevention of sexually transmitted diseases, including, without limitation, Chlamydia trachomatis, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all enrollees, regardless of age.

Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, must not be construed to violate any provision of law relating to solicitationsol3.itAny orhealth advertisingmaintenance byorganization practitionersauthorized under this chapter shall not be deemed to be practicing medicine and is exempt from the provisions of achapter healing630 art.of NRS.

3.4.

Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and is exempt from the provisions of chapter 630 of NRS.

- *SB439_R1* – 56 – 4.

This subsection does not exempt a health maintenance organization from any- provision82nd ofSession (2023) – 53 – other contract.f this chapter for services provided pursuant to any other5. contract.

5.

(a) [Drugs] All drugs approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus [;] or treating human immunodeficiency virus or hepatitis C in the form recommended by the prescribing practitioner,formulary regardless of whether the drughealth ismaintenance includedorganization;ncluded in the formulary(b) ofLaboratory testing that is necessary for therapy that uses [such] a drug [;] to prevent the healthacquisition maintenanceof organization;human immunodeficiency virus;

(b) Laboratory testing that is necessary for therapy that uses [such] a drug [;] to prevent the acquisition of human immunodeficiency virus;

and [(c)] (d) The services described in NRS 639.28085, when provided by a pharmacist who participates in the network plan of the hea2.h A health maintenance organization.organization that offers or issues a health care plan shall reimburse [a] :

- *SB439_R1* – 57 – 2.

A health maintenance organization that offers or issues a health care plan shall reimburse [a] :

(b) An advanced practice registered nurse or a physician assistant who participates in the network plan of the health maintenance- organization82nd forSession any(2023) service– to54 test– for, prevent or treat human immunodeficiency virus or hepatitis C at a rate equal to the rate of reimbursement provided to a physician for similar services.

A health maintenance organization shall ensure that the benefits required by subsection 1 are made available to an enrollee throughplan a provider of the health caremaintenance whoorganization.ipates participates in the network plan5. of the health maintenance organization.

5.

(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 organization.

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

- *SB439_R1* – 58 – (c) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.

- 82nd Session (2023) – 55 – Sec.

The Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization pursuant to the provisions of this chapter if the Commissioner finds tha(a) Thef thhealthowimaintenancens exorganization 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;

- *SB439_R1* – 59 – (h) The health maintenance organization or any person on its behalf has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner;

(i)- The82nd continuedSession operation(2023) of– the56 health– maintenance organization would be hazardous to its enrollees or creditors or to the general public;

If the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the organization.

(1) Provide medication-assisted treatment for opioid use disorder, including, without limitation, buprenorphine, methadone and naltrexone.nal(2) Support safe withdrawal from substance use disorder, including, without limitation, lofexidine.

(2) Support safe withdrawal from substance use disorder, including, without limitation, lofexidine.

or - *SB439_R1*82nd Session (2023) – 6057 – (2) The provider of primary care is capable of providing the service safely and effectively in consultation with a specialist and the provider engages in such consultation.

A managed care organization shall provide the coverage required by paragraph (a) of subsection 1 regardless of whether the drug is included in the formulary of the managed carecarehether organization.

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

- 82nd Session (2023) – 58 – Sec.

- *SB439_R1* – 61 – (a) Coverage of testing for, treatment of and prevention of sexually transmitted diseases, including, without limitation, Chlamydia trachomatis, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all insureds,insureds,n regardless of age.

(b) Laboratory testing that is necessary for therapy that uses [such]immunodeficiency avirus;event drugthe [;]acquisition of human (c) Any service to preventtest thefor, acquisitionprevent ofor treat human immunodeficiency virus;virus or hepatitis C provided by a provider of primary care if the service is covered when provided by a specialist and:

(c) Any service to test for, prevent or treat human immunodeficiency virus or hepatitis C provided by a provider of primary care if the service is covered when provided by a specialist and:

- 82nd Session (2023) – 59 – (a) A pharmacist who participates in the network plan of the managed care organization for the services described in NRS 639.28085 at a rate equal to the rate of reimbursement provided to a -physician, *SB439_R1*physician –assistant 62or –advanced physician,practice physicianregistered assistantnurse orfor(b) An advanced practice registered nurse or a physician assistant who participates in the network plan of the managed care organization for any service to test for, prevent or treat human immunodeficiency virus or hepatitis C at a rate equal to the rate of reimbursement provided to a physician for similar services.

(b) An advanced practice registered nurse or a physician assistant who participates in the network plan of the managed care organization for any service to test for, prevent or treat human immunodeficiency virus or hepatitis C at a rate equal to the rate of reimbursement provided to a physician for similar services.

A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after [October] January 1, [2021,] 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.

- 82nd Session (2023) – 60 – (c) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.

(d) “Provider of health care” has the meaning ascribed to it in NRSNRSSec. 629.031.

- *SB439_R1* – 63 – Sec.

The first application that a physician, osteopathic physician or physician assistant licensed pursuant to chapter 630 or 633 of NRS or a nurse who provides or supervises the provision of emergency medical services in a hospital or primary care and who is licensed on January 1, 2024, submits to renew his or her license on or after that date must include, without limitation, proof that the applicant has completed at least 2 hours of training in the stigma, discrimination and unrecognized bias toward persons who have acquired or are at a high risk of acquiring human immunodeficiency virus, as required by NRS 630.253, 632.343 and 633.471, as amended by sections 28, 29 and 30 of this act, respectively, as applicable.

564, 567-68 (2008), that the penalty for a crime is determined by the law in effect at the time the offender committed the crime and not the law in effect at the the time the offender is sentenced unless the Legislature has expressed its clear intent that a statute ameliorating the penalty apply retroactively.