SB 337 — Revises provisions relating to opioids. (BDR 40-204)

- *SB337_R1* – 8 – Sec.

- *SB337* – 8 – Sec.

Except in an emergency situation, before prescribing, administering or directing or supervising the administration of an opioid to a patient, a practitioner or a registered nurse shall:

- *SB337_R1* – 9 – (a) Post the form for executing a non-opioid directive on an Internet website maintained by the third party;

and - *SB337* – 9 – (b) Provide the non-opioid directive to each person who enrolls in health coverage provided by the third party.

The revocation of a non-opioid directive is effective upon the patient or legal guardian communicating pursuant to - *SB337_R1* – 10 – subsection 1 or 2, the desire to revoke the form.

or - *SB337* – 10 – (b) Cause the revocation to be made a part of the record of the patient.

1.(Deleted by amendment.) Sec.

A practitioner who acts in good faith and in accordance with the provisions of sections 8 to 23, inclusive, of this act and any regulations adopted pursuant thereto and other applicable law is immune from civil and criminal liability and professional discipline for:

(a) Failing to prescribe, administer or direct or supervise the administration of an opioid to a non-opioid patient;

or (b) Prescribing, administering or directing or supervising the administration of an opioid in violation of a non-opioid directive.

2.

A person authorized to possess and administer a controlled substance pursuant to NRS 453.375 and who acts in good faith and in accordance with the provisions of sections 8 to 23, inclusive, of this act and any regulations adopted pursuant thereto and other applicable law is immune from civil and criminal liability and professional discipline for administering or failing to administer an opioid to a non-opioid patient.

- *SB337* – 11 – Sec.

and - *SB337_R1* – 11 – 5.

A state agency or political subdivision of this State shall not require an officer or employee who is a member of the advisory board to make up the time the officer or employee is absent from work to carry out duties as a member of - *SB337* – 12 – the advisory board or use annual leave or compensatory time for the absence.

- *SB337_R1* – 12 – (1) Practitioners, patients, persons who have recovered or are in recovery from opioid use disorder and persons involved in the treatment of opioid use disorder;

NRS(Deleted 232.320by isamendment.) herebySec. amended to read as follows:

232.320 1.

The Director:

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

(1) The Administrator of the Aging and Disability Services Division;

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

(3) The Administrator of the Division of Child and Family Services;

(4) The Administrator of the Division of Health Care Financing and Policy;

and (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, - *SB337* – 13 – 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 29 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.

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

§§ 15001 et seq.

(d) Shall, after considering advice from agencies of local governments and nonprofit organizations which provide social services, adopt a master plan for the provision of human services in this State.

The Director shall revise the plan biennially and deliver a copy of the plan to the Governor and the Legislature at the beginning of each regular session.

The plan must:

(1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplication of those services by federal, state and local agencies;

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

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

(4) Identify the sources of funding for services provided by the Department and the allocation of that funding;

(5) Set forth sufficient information to assist the Department in providing those services and in the planning and budgeting for the future provision of those services;

and (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the 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 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.

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

- *SB337* – 14 – 2.

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.

Sec.

- *SB337_R1* – 13 – Sec.

(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 - *SB337* – 15 – 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 provisions of NRS 439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, and section 45 of this act, paragraphs (b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, 689B.0375 to 689B.050, inclusive, 689B.0675, 689B.265, 689B.287 and 689B.500 apply to coverage provided pursuant to this paragraph, except that the provisions of NRS 689B.0378, 689B.03785 and 689B.500 only apply to coverage - *SB337_R1* – 14 – for active officers and employees of the governing body, or the dependents of such officers and employees.

In any county in which a legal services organization exists, the governing body of the county, or of any school district, municipal corporation, political subdivision, public corporation or - *SB337* – 16 – 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.

- *SB337_R1* – 15 – 6.

287.04335 If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409, 687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 695G.174, inclusive, and section 53 of this act, 695G.176, - *SB337* – 17 – 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, 695G.405 and 695G.415, in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

Chapter(Deleted 422 of NRS is hereby amended by addingamendment.) theretoSec. a new section to read as follows:

1.

If the Division of Public and Behavioral Health of the Department finds that a health facility which participates in Medicaid as a provider of services has failed to comply with section 1 of this act or a practitioner licensing board finds that a practitioner who participates in Medicaid as a provider of services has violated the provisions of section 33, 35, 36, 37 or 39 of this act or NRS 636.2882, or the Department otherwise determines that such a health facility or practitioner has violated any of those provisions, the Department may impose sanctions on the health facility or practitioner, as applicable, for noncompliance in accordance with the regulations adopted pursuant to subsection 2.

2.

The Administrator shall adopt regulations establishing:

(a) Procedures for the Department to monitor compliance by health care facilities and practitioners who participate in Medicaid as providers of services with the provisions of sections 1, 33, 35, 36, 37 and 39 of this act and NRS 636.2882;

and (b) Sanctions that may be taken against a health care facility or practitioner for noncompliance, which must include, without limitation, reducing the reimbursement rates paid to a health care facility or practitioner or excluding a health care facility or practitioner from participation in Medicaid as a provider of services.

3.

The Department shall comply with the requirements of subsection 2 of section 16 of this act with respect to Medicaid.

4.

As used in this section:

(a) “Health care facility” means a medical facility, as defined in NRS 449.0151, or a facility which is required by the regulations adopted by the State Board of Health pursuant to NRS 449.0303 to be licensed.

(b) “Practitioner” has the meaning ascribed to it in NRS 639.0125.

(c) “Practitioner licensing board” means a board created pursuant to chapter 630, 631, 632, 633, 635 or 636 of NRS.

Sec.

NRS(Deleted 422.4025by isamendment.) herebySec. amended to read as follows:

422.402530.3. 1.

TheNRS Department422.403 shall:is hereby amended to read as follows:

(a)422.403 By1. regulation, develop a list of preferred prescription drugs to be used for the Medicaid program and the Children’s Health Insurance Program, and each public or nonprofit health benefit plan - *SB337* – 18 – that elects to use the list of preferred prescription drugs as its formulary pursuant to NRS 287.012, 287.0433 or 687B.407;

andThe (b)Department Negotiateshall, andby enterregulation, intoestablish agreementsand tomanage purchase the drugsuse includedby on the listMedicaid ofprogram preferred prescription drugs on behalf of thestep healththerapy benefitand plansprior describedauthorization infor paragraphprescription (a)drugs. or enter into a contract pursuant to NRS 422.4053 with a pharmacy benefit manager, health maintenance organization or one or more public or private entities in this State, the District of Columbia or other states or territories of the United States, as appropriate, to negotiate such agreements.

The DepartmentDrug shall,Use byReview regulation,Board establishshall: a list of prescription drugs which must be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs established pursuant to subsection 1.

The(a) listAdvise establishedthe pursuantDepartment toconcerning thisthe subsectionuse mustby include,the withoutMedicaid limitation:program of step therapy and prior authorization for prescription drugs;

(a)(b) PrescriptionDevelop drugsstep thattherapy areprotocols prescribedand forprior theauthorization treatmentpolicies ofand theprocedures humanfor immunodeficiencyuse virus,by including,the withoutMedicaid limitation,program antiretroviralfor medications;prescription drugs;

(b)and Antirejection(c) medicationsReview and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols used by the Medicaid program for organprescription transplants;drugs.

(c) Antihemophilic medications;

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

The regulationsstep therapy protocol established pursuant to this section must providenot thatapply theto Boarda makesdrug approved by the finalFood determinationand of:Drug Administration that is prescribed to treat a psychiatric condition of a recipient of Medicaid, if:

(a) WhetherThe adrug classhas ofbeen therapeuticapproved prescriptionby drugsthe isFood includedand onDrug theAdministration listwith ofindications preferredfor prescriptionthe drugspsychiatric andcondition isof excludedthe from- any*SB337_R1* restrictions– that16 are– imposedinsured byor the Medicaiduse programof onthe drugsdrug to treat that arepsychiatric oncondition theis listotherwise ofsupported preferredby prescriptionmedical drugs;or scientific evidence;

(b) WhichThe therapeuticallydrug equivalentis prescriptionprescribed drugsby: will be reviewed for inclusion on the list of preferred prescription drugs and for exclusion from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs;

and(1) (c)A Whichpsychiatrist; prescription drugs should be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs based on continuity of care concerning a specific diagnosis, condition, class of therapeutic prescription drugs or medical specialty.

(2) A physician assistant under the supervision of a psychiatrist;

(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120;

or (4) A primary care provider that is providing care to an insured in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in Medicaid is located 60 miles or more from the residence of the recipient;

and (c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the recipient, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.

The Department shall not require the Drug Use Review Board to develop, review or approve prior authorization policies or procedures necessary for the operation of the list of preferred prescription drugs establisheddeveloped pursuant to subsectionNRS 1422.4025. must include, without limitation:

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

[and] - *SB337* – 19 – (b) Prescription drugs to prevent the acquisition of human immunodeficiency virus [.] ;

and (c) Alternatives to opioids for purposes for which opioids would normally be used.

The regulationsDepartment mustshall provideaccept thatrecommendations eachfrom newthe pharmaceuticalDrug productUse andReview eachBoard existingas pharmaceuticalthe productbasis for whichdeveloping thereor isrevising newstep clinicaltherapy evidenceprotocols supportingand itsprior inclusionauthorization onpolicies theand listprocedures ofused preferredby prescription drugs must be made available pursuant to the Medicaid program withfor priorprescription authorizationdrugs. until the Board reviews the product or the evidence.

The MedicaidDepartment programshall mustrequire coverthe aDrug prescriptionUse drugReview thatBoard, isfor notthe includedpurpose onof theensuring listsufficient access by recipients of preferredMedicaid prescriptionto drugsalternatives asto ifopioids, to regularly review the drugstep weretherapy includedprotocols onand prior authorization policies and procedures applicable to drugs that listare if:approved by the United States Food and Drug Administration as alternatives to opioids.

(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 interact in a harmful manner with another drug that the recipient is taking;

(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.

TheAs Medicaidused programin mustthis automaticallysection: cover any typical or atypical antipsychotic medication or anticonvulsant medication that is not on the list of preferred prescription drugs upon the demonstrated therapeutic failure of one drug on that list to adequately treat the condition of a recipient of Medicaid.

8.(a) “Medical or scientific evidence” has the meaning ascribed to it in NRS 695G.053.

On(b) “Step therapy protocol” means a procedure that requires a recipient of Medicaid to use a prescription drug or beforesequence Februaryof 1prescription drugs other than a drug that a practitioner recommends for treatment of eacha year,psychiatric condition of the Departmentrecipient shall:before Medicaid provides coverage for the recommended drug.

(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 - *SB337* – 20 – pharmacy benefit manager, contracts with a health maintenance organization and contracts with public and private entities from this State, the District of Columbia and other states and territories of the United States;

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

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

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

30.6.

NRS 422.405 is hereby amended to read as follows:

422.405 1.

The Department shall, by regulation, set forth the duties of the Board, which must include, without limitation:

- *SB337_R1* – 17 – (a) Identifying the prescription drugs which should be included on the list of preferred prescription drugs developed by the Department pursuant to NRS 422.4025, which must include, without limitation, any prescription drug required by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to be covered by the Medicaid program and any other prescription drug deemed essential by the Board;

(b) Identifying the prescription drugs which should be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs;

(c) Identifying classes of therapeutic prescription drugs for its review and performing a clinical analysis of each drug included in each class that is identified for review;

and (d) Reviewing at least annually all classes of therapeutic prescription drugs on the list of preferred prescription drugs developed by the Department pursuant to NRS 422.4025.

2.

The Department shall, by regulation, require the Board to:

(a) Base its decisions on evidence of clinical efficacy, safety and outcomes for patients and, if the difference between the clinical efficacy, safety and outcomes for two or more drugs is not clinically significant, cost;

(b) Review new pharmaceutical products in as expeditious a manner as possible;

[and] (c) Consider new clinical evidence supporting the inclusion of an existing pharmaceutical product on the list of preferred prescription drugs developed by the Department and new clinical evidence supporting the exclusion of an existing pharmaceutical product from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs in as expeditious a manner as possible [.] ;

and (d) Review pursuant to paragraph (c) of subsection 1 each new class of therapeutic prescription drugs that includes a subset of drugs that are approved by the United States Food and Drug Administration as alternatives to opioids for purposes for which opioids would normally be used.

3.

The Department shall, by regulation, authorize the Board to:

(a) In carrying out its duties, exercise clinical judgment and analyze peer review articles, published studies, and other medical and scientific information;

and (b) Establish subcommittees to analyze specific issues that arise as the Board carries out its duties.

4.

The Board may close any portion of a meeting during which it considers the cost of prescription drugs.

- *SB337_R1* – 18 – Sec.

(a) The projects described in subparagraphssubparagraph (15) and (16) of paragraph (a) of subsection 3 and, where applicable, other projects described in that paragraph;

- *SB337* – 21 – (7) Housing for persons who have or are in recovery from substance use disorders;

- *SB337_R1* – 19 – (11) Development of the workforce of providers of services relating to substance use and substance use disorders;

and (15) IncreasedResearch ratesinto ofalternative reimbursementtreatments under Medicaid for care that utilizesdo alternativesnot forutilize purposesan foropioid. which opioids would ordinarily be used;

and (16) Research into alternative treatments that do not utilize an opioid.

- *SB337* – 22 – (1) The results of a needs assessment that meets the requirements of NRS 433.742;

- *SB337_R1* – 20 – (d) Conduct annual evaluations of programs to which grants have been awarded.

- *SB337* – 23 – (a) Comply with the requirements of sections 8 to 23, inclusive, of this act, and any regulations adopted pursuant thereto;

Except as otherwise provided in subsection 1 and section 19 of this act, if a patient or his or her legal guardian has executed - *SB337_R1* – 21 – a non-opioid directive or states that the patient wishes to receive an alternative treatment that does not utilize an opioid, the physician or physician assistant shall provide such a treatment.

- *SB337* – 24 – (1) In the opinion of the dentist, there is no treatment that does not utilize an opioid that is suitable for treating the patient;

- *SB337_R1* – 22 – 4.

AExcept as otherwise provided in subsection 1 and section 19 of this act, if a patient or his or her legal guardian has executed a non-opioid directive or states that the patient wishes to receive an alternative treatment that does not utilize an opioid, the advanced practice registered nurse whoor administerscertified opioidsregistered shall:nurse anesthetist shall provide such a treatment.

(a)3. Comply with the requirements of sections 8 to 23, inclusive, of this act and any regulations adopted pursuant thereto;

andDuring (b)each Offereven-numbered toyear, athe patientBoard anshall alternativereview treatmentcompliance thatwith doesthe notrequirements utilizeof anthis opioidsection beforeby administeringeach anadvanced opioidpractice toregistered thenurse patientor forcertified theregistered firstnurse timeanesthetist unless:who prescribes or administers opioids to patients.

(1) In the opinion of the physician, physician assistant, dentist, podiatric physician or advanced practice registered nurse who is directing the care of the patient, there is no treatment that does not utilize an opioid that is suitable for treating the patient;

or (2) It is not practicable to offer such an alternative treatment to the patient.

- *SB337* – 25 – 3.

Except as otherwise provided in subsection 1 and section 19 of this act, if a patient or his or her legal guardian has executed a non-opioid directive or states that the patient wishes to receive an alternative treatment that does not utilize an opioid, the advanced practice registered nurse, certified registered nurse anesthetist or registered nurse shall provide such a treatment.

During each even-numbered year, the Board shall review compliance with the requirements of this section by each advanced practice registered nurse or certified registered nurse anesthetist who prescribes or administers opioids to patients and each registered nurse who administers opioids to patients.

5.

or - *SB337_R1* – 23 – (2) It is not practicable to offer such an alternative treatment to the patient.

- *SB337* – 26 – (a) Amygdalin (laetrile), if the patient has consented to the use of the substance.

- *SB337_R1* – 24 – (1) In the opinion of the podiatric physician, there is no treatment that does not utilize an opioid that is suitable for treating the patient;

- *SB337* – 27 – [2.] (b) Prescribes the controlled substance in an amount that does not exceed 90 morphine milligram equivalents per day and will not last more than 72 hours;

- *SB337_R1* – 25 – 4.

(d) Aids or abets any person in the violation of any of the provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of this act, or 449A.100 to 449A.124, inclusive, and 449A.270 to - *SB337* – 28 – 449A.286, inclusive, as those provisions pertain to a facility for skilled nursing, facility for intermediate care or residential facility for groups.

- *SB337_R1* – 26 – 5.

- *SB337* – 29 – (a) File its procedure for obtaining approval of care pursuant to this section for approval by the Commissioner;

or - *SB337_R1* – 27 – (b) Impose other requirements on the benefits described in paragraph (b) of subsection 1 that would not be imposed on an opioid used under the same circumstances.

and - *SB337* – 30 – (b) Include in the policy coverage for at least one alternative to an opioid that is effective for each purpose for which:

- *SB337_R1* – 28 – (a) Comply with subsection 2 of section 16 of this act;

689C.425 A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to - *SB337* – 31 – 689C.355, inclusive, and section 46 of this act to the extent applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive.

A benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2026, has the legal effect of including the coverage - *SB337_R1* – 29 – required by this section, and any provision of the contract 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, 2026, has the legal effect of including the - *SB337* – 32 – coverage required by this section, and any provision of the policy that conflicts with the provisions of this section is void.

A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after - *SB337_R1* – 30 – January 1, 2026, has the legal effect of including the coverage required by this section, and any provision of the plan that conflicts with the provisions of this section is void.

The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, - *SB337* – 33 – 695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, inclusive, and 695C.265 and section 50 of this act do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services.

The provisions of NRS 695C.16932 to 695C.1699, inclusive, and section 50 of this act, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745, inclusive, 695C.1757 and 695C.204 apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.

- *SB337_R1* – 31 – 7.

- *SB337* – 34 – (b) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with the requirements of NRS 695C.1691 to 695C.200, inclusive, and section 50 of this act, 695C.204 or 695C.207;

- *SB337_R1* – 32 – (1) Resolving complaints in a manner reasonably to dispose of valid complaints;

- *SB337* – 35 – 4.

- *SB337_R1* – 33 – (a) Require prior authorization for the benefits described in paragraph (b) of subsection 1 if such prior authorization would not be required for an opioid under the same circumstances;

53.5.

NRS 695G.090 is hereby amended to read as follows:

695G.090 1.

Except as otherwise provided in subsection 3, the provisions of this chapter apply to each organization and insurer that operates as a managed care organization and may include, without limitation, an insurer that issues a policy of health insurance, an insurer that issues a policy of individual or group health insurance, a carrier serving small employers, a fraternal benefit society, a hospital or medical service corporation and a health maintenance organization.

2.

In addition to the provisions of this chapter, each managed care organization shall comply with:

(a) The provisions of chapter 686A of NRS, including all obligations and remedies set forth therein;

and (b) Any other applicable provision of this title.

3.

The provisions of NRS 695G.127, 695G.1639, 695G.164, 695G.1645, 695G.167 and section 53 of this act and 695G.200 to 695G.230, inclusive, do not apply to a managed care organization that provides health care services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services.

4.

The provisions of NRS 695C.1735 and 695G.1639 do not apply to a managed care organization that provides health care services to members of the Public Employees’ Benefits Program.

5.

Subsections 3 and 4 do not exempt a managed care organization from any provision of this chapter for services provided pursuant to any other contract.

- *SB337_R1* – 34 – Sec.

or - *SB337* – 36 – (b) Prohibit the health care facility or practitioner, as applicable, from receiving payments through the insurance provided through the Public Option.

(a) A medical facility or facility which is required by the regulations adopted by the State Board of Health pursuant to NRS 449.0303 to be licensed that administers opioids to patients is not required to offer treatments that are alternatives to opioids to patients or require practitioners who provide care at the facility to take any action described in paragraph (b) until JanuaryJuly 1, 2027;2027, or 6 months after the date on which the regulations adopted pursuant to section 21 of this act become effective, whichever occurs later;

(b) A practitioner who prescribes or administers opioids or a registered nurse who administers opioids is not required to explain to the patient or his or her legal guardian that the - *SB337_R1* – 35 – patient or legal guardian, as applicable, may execute a non-opioid directive, provide the non-opioid directive to a patient or his or her legal guardian or offer treatments that are alternatives to opioids until JanuaryJuly 1, 2027;2027, or 6 months after the date on which the regulations adopted pursuant to section 21 of this act become effective, whichever occurs later;

(c) The Division of Public and Behavioral Health of the Department of Health and Human Services may not review the compliance of medical facilities and facilities which are required by the regulations adopted pursuant to NRS 449.0303 to be licensed with the requirements of section 1 of this act until JulyJanuary 1, 2028;2029, or 18 months after the date on which the regulations adopted pursuant to section 21 of this act become effective, whichever occurs later;

and (d) A practitioner licensing board may not review the compliance of practitioners and registered nurses with the - *SB337* – 37 – requirements of sections 33, 35, 36, 37 and 39 of this act and NRS 636.2882, as amended by section 40 of this actact, until JulyJanuary 1, 2028.2029, or 18 months after the date on which the regulations adopted pursuant to section 21 of this act become effective, whichever occurs later.

A practitioner or registered nurse who discovers on or before Januarythe 1,date 2027,set forth in paragraph (b) of subsection 1 that a patient is a non-opioid patient and is unable to offer a treatment that is an alternative to an opioid to the patient shall, where the practitioner or registered nurse would otherwise be required by section 33, 35, 36, 37 or 39 of this act or NRS 636.2882, as amended by section 40 of this actact, to offer such an alternative treatment, refer the patient to a provider of health care who is able to offer such a treatment.

(a)- Upon*SB337_R1* passage– and36 approval– for the purpose of adopting any regulations and performing any other preparatory administrativeadministrativey tasks that are necessary to carry out the provisions of this act;

and (b) On JanuaryJuly 1, 2026, for all other purposes.

H - *SB337**SB337_R1*