Section 7 createsrequires the AccountDivision to Improveadminister Emergencythe MedicalAccount Transportationand to deposit the proceeds collected from the assessment into the Account.

(2) fund certain data infrastructure improvements and educational andSenate communityAmendment outreachNo. initiatives undertaken by the Department;

and467 (3)to paySenate administrativeBill costsNo. be used for any other purpose, section 7:

(1)424 requiresPage that4 theand Divisioncommunity ceaseuntoutreach toinitiatives imposingundertaken by the assessment;Department;

and (3) pay administrative used for any other purpose, section 7:

(1) requires that the Division cease imposing theto be assessment;

- 83rd Session (2025) – 2 – Section 8 requires the Division to adopt regulations establishing administrative penalties against a private emergency medical transport provider that fails to pay an assessment in a timely manner.

privateSection emergency8 medicalalso transportrequires providerthe aDivision permit to ownnotify orthe operatehealth anssuedauthority athat ambulanceissued ina thisprivate Stateemergency ifmedical thetransport provider hasa failedpermit to payown anor assessmentoperate oran administrativeambulance [or penalty in a timely manner.

Section 9 authorizes the Division to modify the amount of the assessment, the enhanced rates of reimbursement or any other requirement established by sections 2-9 as necessary to receive federal financial participation to carry out the provisions of sections 2-9.

Section 9 also requires the suspension of the assessment and theisionsthe payment of enhanced rates of reimbursement upon the occurrence of certain events.

Section 9 requires the retroactive reimposition of such assessments and payments when the event triggering the suspension is no longerlonSections applicable.[3, 4 and 5] 3-5 define certain terms and section 2 establishes the applicability of those definitions.

SectionsSection 3-510 defineof certainthis termsbill andrequires sectionthe 2Director establishesof the applicabilityDepartment to administer the provisions of thosesections definitions.2-9 in the same manner as other provisions relating to Medicaid.

Section 10 of this bill requires the Director of the Department to administer the provisions of sections 2-9 in the same manner as other provisions relaExisting law authorizes a health authority to operate a training program in emergency first aid, emergency care and other techniques associated with emergency care for the benefit of certain professionals who may respond to emergencies as a part of their job duties, including ambulance attendants and firefighters.

(NRS 450B.850) Section 11.5 of this bill authorizes a health authority to establish a separate training program which is focused on identifying and responding to victims of human trafficking.

EXPLANATION – Matter in bolded italics is new;

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

As used in sections 2 to 9, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections [3, 4 and 5] 3 to 5, inclusive, of this act have the meanings ascribed to them in those sections.

- 83rd Session (2025) – 3 – Sec.

Means the transportation by ambulance [or air ambulance] of a person who is exp2.ieIncludesexperiencing thea rendering of medical careemergency byto a paramedic, as defined in NRS 450B.095, emergency medical technician,facility; as defined in NRS 450B.065, or advanced emergency medical technician, as defined in NRS 450B.025, in connection with the transportation of the person.

Sec.and 2.

Includes the rendering of medical care by a paramedic, as defined in NRS 450B.095, emergency medical technician, as defined in NRS 450B.065, or advanced emergency medical technician, as defined in NRS 450B.025, in connection with the transportation of the person .

[;

and 3.

Does not include transportation provided under non-emergency circumstances.] Sec.

and 3.Senate Amendment No.

467 to Senate Bill No.

424 Page 5 3.

(a) Regulations prescribing the percentage that must be used to calculate the amount of the assessment, the date on which the assessment is due and the manner in which the assessment must be paid;

ands due and the manner in which the assessment must (b) Any other regulations necessary or convenient to carry out the provisions of this section.

and (b) Except where necessary pursuant to subsection 1 of section 9 of this act, must not exceed 5.5 percent of the net revenue earned by a private emergency medical transport provider from providing emergency ambulance services in this State during a calendar or fiscal year.

- 83rd Session (2025) – 4 – 4.

An assessment must not be imposed pursuant to subsection 1 if federal law or regulations prohibit using the revenue generated by the newassessment federalfor lawthe orpurposes regulationsdescribed imposingin suchsection a7 prohibitionof are.this act.

If new federal law or regulations imposing such a prohibition are enacted or adopted, as applicable:

A private emergency medical transport provider shall keep and maintain accurate records as necessary to support the accuracy of information requested by the Division pursuant to this sec7.onAssection. used in this section:

7.

As used in this section:

The Division shallSenate administerAmendment theNo. Account.

467 to Senate Bill No.

424 Page 6 shall administer the Account.

- 83rd Session (2025) – 5 – 2.

(a) Provide enhanced rates of reimbursement to private emergency medical transport providers that provide emergency ambulance services to recipients of Medicaid;

[Any] Except as otherwise provided in section 9 of this act, all money deposited into the Account, except for the money necessary for the purposes described in paragraphs (b) and (c) of subsection 3, and all federal financial participation provided to match the money in the Account must be expended to fund the enhanced rates of reimbursement established pursuant to paragraph (a) of subsection 3.3 .

(a) Increases to rates of reimbursement paid to private emergency medical transport providers who receive such rei(b)reimbursement Theon establishment of a minimumfee-for-service schedulebasis. of fees to be paid to private emergency medical transport providers who provide services to recipients of Medicaid under the Medicaid managed care program established pursuant to NRS 422.273.

(c)(b) DirectedThe paymentsestablishment of a minimum schedule of fees to be paid to private emergency medical transport providers who provide services to recipients of Medicaid under the Medicaid managed care program established pursuant to NRS 422.273,422.273. without respect to whether a provider participates in the network of providers established or used by the Medicaid managed care program.

(c) [Direct] Directed payments to private emergency medical transport providers who provide services to recipients of Medicaid under the Medicaid managed care program established pursuant to NRS 422.273 [.] , without respect to whether a provider participates in the network of providers established or used by the Medicaid managed care program.

Money allocated for such expenditures must be used first for the purpose described in - 83rd Session (2025) – 6 – paragraph (c) of subsection 3.

year6. does not revert to the State General Fund, and the balance in the Account must be carried forward to the next fiscal year.

Any money remaining in the Account at the end of a fiscal year does not revert to the State General Fund, and the balance in the Account must be carried forward to the next fiscal year.

The Director shall seek any necessary federal authority to capture all available financial federal participation to carry out the purposes described in paragraph [(b)] (a) of subsection 3.

(a)Senate TheAmendment DivisionNo. shall cease imposing the assessment provided by section 6 of this act;

467 to Senate Bill No.

424 Page 7 (a) The Division shall cease imposing the assessment provided by section 6 of this act;

If a private emergency medical transport provider fails to remit to the Division any penalty imposed pursuant to subsection 1 or any assessment imposed pursuant to section 6 of this act within as30 applicable,days after the Division:ichdate on which the penalty or assessment is due, (a) May deduct the amount of the penalty or assessment, as applicable, from any future payment owed to the privateDivision: emergency medical transport provider under Medicaid;

and(a) (b)May Shalldeduct notifythe eachamount health authority of thisthe Statepenalty thator hasassessment, issuedas theapplicable, privatefrom emergencyany medicalfuture transportpayment providerowed a permit to operate an ambulance that the private emergency medical transport provider hasunder failedMedicaid; to pay a penalty or assessment, as applicable.

and (b) Shall notify each health authority of this State that has issued the private emergency medical transport provider a permit to operate an ambulance [or air ambulance, as applicable,] that the private emergency medical transport provider has failed to pay a penalty or assessment, as applicable.

and - 83rd Session (2025) – 7 – (b) May negotiate a payment plan with the private emergency medical transport provider.

representativeSec. sample of private emergency medical transport providers, modify the percentage of the assessment imposed on private emergency medical transport providers pursuant to section of this act, the amount of any enhanced rate of reimbursement described in paragraph (a) of subsection 3 of section 7 of this act or any other requirement or formula established pursuant to sections 2 to 9, inclusive, of this act to the extent necessary to obtain federal financial participation for the enhanced rates of reimbursement described in paragraph (a) of subsection 3 of section 7 of this act.

9.

1.

The Division may modify the percentage of the assessment imposed on private emergency medical transport providers pursuant to section 6 of this act, the amount of any enhanced rate of reimbursement described in paragraph (a) of subsection 3 of section 7 of this act or any other requirement or formula established pursuant to sections 2 to 9, inclusive, of this act to the extent necessary to obtain federal financial participation for the enhanced rates of reimbursement described in paragraph (a) of subsection 3 of section 7 of this act.

The Division shall take the actions described in subsection 3 after determining that:

(c) Federal financial participation is not available for the payment of enhanced rates of reimbursement described in for the paragraph (a) of subsection 3 of section 7 of this act;

3.Senate Amendment No.

467 to Senate Bill No.

424 Page 8 3.

(a) Immediately cease imposing and collecting the assessment otherwise required to be imposed pursuant to section 6 of this act;

and (c) Return any money collected through the assessment imposed pursuant to section 6 of this act that the Division is - 83rd Session (2025) – 8 – prohibited by paragraph (b) from using for the purposes described in subsection 3 of section 7 of this act to the private emergency medical transport provider from whom it was collected.

If the Division, after suspending the collection of assessments and the payment of enhanced rates of reimbursement pursuant to subsection 3, determines that the provisions ofentof subsection 2 no longer apply, the Division shall:

5.Sec.

As used in this section, “representative sample of private emergency medical transport providers” means:

(a) A group of private emergency medical transport providers which have collectively provided not less than 67 percent of the emergency ambulance trips provided in this State in the immediately preceding calendar year;

or (b) An association which represents private emergency medical transport providers which have collectively provided not this State in the immediately preceding calendar year.provided in Sec.

and - 83rd Session (2025) – 9 – (5) The Administrator of the Division of Public and Behavioral Health.

(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 sections 2 to 9, inclusive, of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public and Behavioral Health or the professional line activities of the other divisions.

services)Senate amongAmendment nonprofitNo. organizations, agenciesination ofofholocal government, the State and the Federal Government;

467 to Senate Bill No.

424 Page 9 (3) Provide for communication and the coordination of those services among nonprofit organizations, agencies of local government, the State and the Federal Government;

(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 - 83rd Session (2025) – 10 – 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.

the2. Director’s designee, is responsible for appointing and removingr subordinate officers and employees of the Department.

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

If the health authority receives notification from the Department of Health and Human Services pursuant to NRS 439.5895 that the holder of a permit to operate an ambulance, air ambulance or vehicle of a fire-fightingfire- fighting agency is not in compliance with the requirements of subsection 4 of NRS 439.589, the health authority may, after notice and the opportunity for a hearing in accordance with the provisions of this chapter, require corrective action or impose an administrative penalty in an amount established by regulation of the board.

If the health authority receives a notification from the Division of Health Care Financing and Policy of the Department of Health and Human Services pursuant to section 8 of this act that the holder of a permit to operate an ambulance [or air ambulance, as applicable,] has failed to pay an assessment imposed pursuant to section 6 of this act or an administrative penalty imposed pursuant to section 8 of this act, the health authority may, after notice and the opportunity for a hea(a)hearing Requirein correctiveaccordance action;ovisionswith the provisions of this chapter:

(a) Require corrective action;

11.5.

NRS 450B.850 is hereby amended to read as follows:

450B.850 1.

The health authority may operate training programs and may contract with others to operate training programs for ambulance attendants, ambulance service operators, firefighters, law enforcement officers, physicians, nurses and others in emergency first aid, emergency care and any other techniques associated with emergency care, transportation and treatment of the sick and injured and the proper operation of an ambulance service.

2.

The health authority may establish a program of evidence- based training which focuses on the identification of and proper - 83rd Session (2025) – 11 – response to victims of human trafficking, including, without limitation, sex trafficking.

3.

Any program of training established pursuant to subsection 2 must:

education that:oped in coordination with an institution of higher (1) Has met the standards required by an accrediting body recognized by the United States Department of Education;

or (2) Is recognized as accredited by the United States Department of Education;

(b) Utilize curriculum which:

(1) Is consistent with the standards of care for anti- trafficking providers published by the Office for Victims of Crime of the United States Department of Justice and the Office on Trafficking in Persons of the United States Department of Health and Human Services, if such standards have been published;

and (2) Includes instruction on the core components of responding and providing services to victims of human trafficking, including, without limitation:

(I) Outreach to persons affected by human trafficking;

(II) Identifying victims of human trafficking;

(III) Protocols for screening victims of human trafficking;

(IV) Delivering services to victims of human trafficking using trauma-informed methods;

(V) Pathways for referrals;

and (VI) Best practices for ensuring the privacy and con(c) Provide not less than 1 hour of instruction to persons attending the program;

and (d) Be offered by the health authority to:

(1) Any emergency response employee, including, without limitation, a person who currently holds a license or certificate, as applicable, as an ambulance attendant, emergency medical technician, advanced emergency medical technician or paramedic;

or (2) An applicant for a license or certificate described in subparagraph (1), as applicable.

Sec.

The provisions of subsections 3 and 4 of section 9 of this act apply to any period described in subsection 2 of section 9 of this act that occurs on or after July 1, 2025, including, without limitation, a period where federal financial participation is not available for the payment of enhanced rates of reimbursement -described 83rdin Sessionparagraph (2025)(a) –of 12subsection –3 of section 7 of this act because the Department of Health and Human Services has not yet act obtained approval from the United States Secretary of Health and Human Services to pay such enhanced rates of reimbursement.

(a)Senate UponAmendment passageNo. and approval for the purpose of adopting any regulations and performing any other preparatory administrative tasks that are necessary to carry out the provisions of this act;

467 to Senate Bill No.

424 Page 10 (a) Upon passage and approval for the purpose of adopting any regulations and performing any other preparatory administrative tasks that are necessary to carry out the provisions of this act;

~~~~~ 25 - 83rd Session (2025)