Existing law requires all gifts or grants of money for a program for alcohol or other substance use disorders which the Division of Public and Behavioral Health of the Department of Health and Human Services is authorized to accept to be deposited in the State Treasury for credit to the State Grant and Gift Account for Alcohol or Other Substance Use Disorders. (NRS 458.100) Sections 1.28 and 1.3 of this bill authorize the Division to accept and deposit into a separate account gifts, grants, donations, bequests or money from any other source for the purpose of funding the bulk purchase of opioid antagonists. Section 1.28 provides that such money is not subject to provisions of law governing budgeting by agencies of the State Government. Section 1.28 requires the Division to use the money in the account to fund the bulk purchase of opioid antagonists and the distribution of those opioid antagonists. Existing federal regulations require programs funded by certain federal grants for injection drug users to prioritize persons for participation in such programs in the following order: (1) pregnant injecting drug users; (2) pregnant persons with a substance use disorder; (3) other injecting drug users; and (4) all others. (45 C.F.R. § 96.131) Section 1.7 of this bill requires any treatment provider, provider of health care or program for the treatment of alcohol or other substance use disorders to prioritize persons to receive services for the treatment of alcohol or other substance use disorders funded in whole or in part by federal or state money in that order, except that section 1.7 authorizes the State Board of Health to adopt regulations prioritizing additional categories of people for such services. Existing law defines the term “practice of pharmacy” for the purpose of determining which activities require a person to be registered and regulated by the State Board of Pharmacy as a pharmacist. (NRS 639.0124) Section 12.3 of this bill requires the Board to prescribe a protocol to allow a pharmacist who registers with the Board to: (1) assess a patient to determine whether the patient has an opioid use disorder and medication-assisted treatment would be appropriate for the patient; and (2) prescribe and dispense a drug for medication-assisted treatment. Section 12.6 of this bill provides that the practice of pharmacy includes actions authorized by the protocol established in section 12.3. Sections 1-1.25 and 12.8 of this bill make additional changes necessary to authorize a pharmacist who registers with the Board to prescribe a drug for medication-assisted treatment. The Board would be authorized to suspend or revoke the registration of a pharmacist who orders or assesses a patient or prescribes or dispenses drugs under the protocol established pursuant to section 12.3 without complying with the provisions of the protocol. (NRS 639.210) Sections 3.5, 4.5, 16.1, 16.3, 16.4, 16.48-16.75 and 16.9 of this bill require public and private health plans, including Medicaid managed care organizations and health plans for state and local government employees, to: (1) cover drugs approved by the Food and Drug Administration for medication-assisted treatment; and (2) reimburse assessment, prescribing and dispensing by a pharmacist in accordance with section 12.3 at a rate equal to that provided to a physician, physician assistant or advanced practice registered nurse for similar services. Section 5.5 of this bill also requires Medicaid to reimburse those services at such a rate, regardless of whether the services are reimbursed directly or through managed care organizations. Sections 2.5 and 16.2 of this bill make conforming changes to indicate the proper placement of sections 5.5 and 16.1, respectively, of this bill in the Nevada Revised Statutes. Sections 6.5, 16.13, 16.16, 16.43 and 16.45 of this bill make conforming changes to indicate that the coverage required by sections 16.1, 16.3 and 16.4 is in addition to certain coverage for the treatment of substance use disorder that certain insurers are required by existing law to provide. Section 16.8 of this bill authorizes the Commissioner of Insurance to suspend or revoke the certificate of a health maintenance organization that fails to comply with the requirements of section 16.7 of this bill. The Commissioner would also be authorized to take such action against other health insurers who fail to comply with the requirements of sections 16.1, 16.3, 16.48-16.6 or 16.9 of this bill. (NRS 680A.200) Existing law authorizes a physician, physician assistant or advanced practice registered nurse to prescribe controlled substances if he or she is registered with the State Board of Pharmacy. (NRS 453.126, 453.231, 630.271, 632.237, 633.432) Existing federal law requires a physician, physician assistant or advanced practice registered nurse who prescribes or dispenses narcotic drugs for the treatment of opioid use disorder to register with the Drug Enforcement Administration of the United States Department of Justice for the specific purpose of dispensing such drugs. (21 U.S.C. § 822(a)) Sections 10-12 and 13-16 of this bill require a physician, physician assistant, advanced practice registered nurse, osteopathic physician or certain providers of behavioral health care who diagnose a patient with an opioid use disorder to counsel and provide information to the patient concerning evidence-based treatment for opioid use disorder, including medication-assisted treatment. If the patient requests medication-assisted treatment: (1) sections 10-12 require a physician, physician assistant, advanced practice registered nurse or osteopathic physician who is authorized under federal and state law to prescribe such treatment to offer to issue such a prescription; and (2) sections 10-12 and 13-16 require all other physicians, physician assistants, advanced practice registered nurses, osteopathic physicians and certain providers of behavioral health care to refer the patient to a physician, physician assistant, advanced practice registered nurse, osteopathic physician or pharmacist who is authorized to issue such a prescription. Existing law requires the Director of the Department of Corrections to establish one or more programs of treatment for offenders with substance use or co-occurring disorders who have been sentenced to imprisonment in the state prison. (NRS 209.4236, 209.425) Existing law additionally provides that the treatment of a prisoner in a local jail or detention facility who has a substance use disorder may include medication-assisted treatment. (NRS 211.140) Section 17.5 of this bill requires the Department of Corrections, in collaboration with the Department of Health and Human Services, and each county, city or town that maintains a jail or detention facility to study during the 2023-2024 interim certain issues relating to the provision of medication-assisted treatment to incarcerated persons.

Statutes affected:
As Introduced: 458.103, 209.4236, 209.4239, 209.424, 209.425, 209.511, 211.140
Reprint 1: 458.100, 458.103, 232.320, 287.010, 287.04335, 422.4025, 608.156, 639.0124, 683A.179, 689A.030, 689A.046, 689A.330, 689C.166, 689C.167, 689C.425, 695C.050, 695C.330
Reprint 2: 453.126, 453.128, 453.226, 453.336, 453.381, 454.00958, 458.100, 458.103, 232.320, 287.010, 287.04335, 608.156, 639.0124, 639.0125, 689A.030, 689A.046, 689A.330, 689C.166, 689C.167, 689C.425, 695C.050, 695C.330
As Enrolled: 453.126, 453.128, 453.226, 453.336, 453.381, 454.00958, 458.100, 458.103, 232.320, 287.010, 287.04335, 608.156, 639.0124, 639.0125, 689A.030, 689A.046, 689A.330, 689C.166, 689C.167, 689C.425, 695C.050, 695C.330
BDR: 458.103, 209.4236, 209.4239, 209.424, 209.425, 209.511, 211.140