Existing law requires the Director of the Department of Health and Human Services to adopt regulations governing health information exchanges and the transmittal, ownership, management, use and confidentiality of electronic health records. (NRS 439.587, 439.589) Section 6 of this bill requires the Director to prescribe by regulation a framework for the electronic maintenance, transmittal and exchange of electronic health records, prescriptions and health-related information. Section 6 requires that framework to establish standards for networks and technologies to be used to maintain, transmit and exchange health information, including standards that require: (1) the ability for patients to access and forward their records; and (2) the interoperability of such networks and technologies. Section 60 of this bill requires the Director to convene an advisory group to advise the Director in the adoption of those standards. With certain exceptions, sections 6, 28, 29, 45 and 63 of this bill require all governmental entities, health care providers, insurers, pharmacy benefit managers and other insurance administrators to maintain, transmit and exchange health information electronically in accordance with those standards and other provisions governing electronic health records, beginning on: (1) July 1, 2024, for hospitals and large physician group practices; (2) July 1, 2025, for governmental entities, other large health care practices, insurers, pharmacy benefit managers and other insurance administrators; and (3) January 1, 2030, for small physician group practices and other small health care practices. Sections 2 and 6 of this bill provide that a health care provider, insurer, pharmacy benefit manager or other insurance administrator that fails to comply with that requirement is not guilty of a misdemeanor. Instead, section 1 of this bill requires the Department to notify any regulatory body that has issued a license, certificate, registration, permit or similar credential to a health care provider, insurer, pharmacy benefit manager or other insurance administrator if the holder of the credential fails to comply with that requirement. After receiving such notice, sections 9, 17, 45, 47, 50 and 53 of this bill authorize a regulatory body to impose corrective action or an administrative penalty on the health care provider, insurer, pharmacy benefit manager or other insurance administrator. Section 1 requires the Department to notify the relevant regulatory body if a health care provider, insurer, pharmacy benefit manager or other insurance administrator that was previously out of compliance with the requirement to maintain, transmit and exchange health information electronically comes into compliance with that requirement. Section 4 of this bill removes duplicative requirements concerning the adoption of regulations governing electronic health records. Sections 2-5, 10-16, 44, 46, 48, 51, 52, 55 and 56 of this bill make conforming changes to indicate the proper placement of sections 1, 9, 47 and 50 in the Nevada Revised Statutes. Existing law authorizes the Director to contract with not more than one health information exchange to be responsible for compiling statewide master indexes of patients, health care providers and payers. (NRS 439.587) Section 4 authorizes the Director to contract with multiple health information exchanges to perform those functions. Existing law requires that, with certain exceptions, a patient consent before his or her electronic health record is retrieved from a health information exchange. (NRS 439.591) Section 6.5 of this bill requires such consent to be affirmative. Existing law provides that a health care provider who with reasonable care relies upon an apparently genuine electronic health record accessed from a health information exchange to make a decision concerning the provision of health care to a patient is immune from civil or criminal liability for the decision if: (1) the electronic health record is inaccurate; (2) the inaccuracy was not caused by the health care provider; (3) the inaccuracy resulted in an inappropriate health care decision; and (4) the health care decision was appropriate based upon the information contained in the inaccurate electronic health record. (NRS 439.593) Section 7 of this bill expands this immunity from liability to also apply to any health care provider who transmits, accesses, utilizes or discloses an apparently genuine electronic health record or provides such an electronic health record to a patient. Existing law provides that providing information to an electronic health record in accordance with existing law is not an unfair trade practice. (NRS 439.595) Section 8 of this bill additionally provides that transmitting, accessing, utilizing or disclosing an electronic health record in accordance with existing law is not an unfair trade practice. With certain exceptions, existing federal and state law prohibits a person or governmental entity from providing a public benefit to an alien who is not legally present in the United States, except where a state law affirmatively provides for such eligibility. (8 U.S.C. § 1621; NRS 422.065, 422A.085) Section 39 of this bill requires the Director to apply to the Federal Government for authority to provide coverage under the Children's Health Insurance Program for prenatal, labor and delivery care for persons who are not eligible for Medicaid because of their immigration status. Section 57 of this bill makes an appropriation for the purpose of providing such coverage. Section 39 requires the Department to submit a biennial report to the Legislature concerning the implementation and impacts of such coverage. Section 26 of this bill makes a conforming change to indicate the proper placement of section 39 in the Nevada Revised Statutes. Under existing law, the Division of Welfare and Supportive Services of the Department administers provisions concerning applications for Medicaid and the Children's Health Insurance Program. (NRS 422A.3351, 422A.336) Section 41 of this bill creates the Medicaid Outreach Advisory Committee within the Division. Section 42 of this bill requires the Advisory Committee to: (1) advise the Department, the Division of Health Care Financing and Policy of the Department and the Division of Welfare and Supportive Services concerning outreach to, and maximizing enrollment in Medicaid and the Children's Health Insurance Program of, members of marginalized or underserved communities; and (2) post a report of the activities of the Advisory Committee on the Internet on or before July 1 of each even-numbered year. Section 58 of this bill requires the Joint Interim Standing Committee on Health and Human Services to study, during the 2023-2024 interim, the feasibility of including in the State Plan for Medicaid coverage of digital health products and the procedures for and costs of providing such coverage. Section 58.5 of this bill requires the Joint Interim Standing Committee to study, during the 2023-2024 interim: (1) the feasibility of and necessary steps for creating a natural persons index for this State; (2) procedures governing data registries and ways to streamline the collection of data and reduce the burden of reporting requirements applicable to providers of health care; (3) the feasibility of including in the State Plan for Medicaid enhanced rates of reimbursement for providers of health care in medically underserved areas and rural areas; (4) methods for increasing the amount of biotechnological and medical research conducted in this State; and (5) the feasibility of including in the State Plan for Medicaid a program to provide services through managed care to recipients of Medicaid who are aged, blind or disabled.

Statutes affected:
As Introduced: 439.580, 439.581, 439.587, 439.588, 439.589, 439.593, 439.595, 449.029, 449.0301, 449.0302, 449.160, 449.163, 449.170, 449.240, 218D.355, 231.0685, 231A.170, 232.290, 232.320, 239.010, 287.010, 287.04335, 353.207, 360.755, 360.757, 360.7575, 374.357, 422A.372, 603A.100, 629.051, 654.190, 680A.095, 680A.220, 683A.3683, 692A.270, 695C.330, 719.200, 720.140
Reprint 1: 439.580, 439.581, 439.587, 439.588, 439.589, 439.593, 439.595, 449.029, 449.0301, 449.0302, 449.160, 449.163, 449.240, 218D.355, 231.0685, 231A.170, 232.290, 232.320, 239.010, 287.010, 287.04335, 353.207, 360.755, 360.757, 360.7575, 374.357, 422A.372, 603A.100, 629.051, 654.190, 680A.095, 683A.3683, 692A.270, 695I.210, 719.200, 720.140
Reprint 2: 439.580, 439.581, 439.587, 439.588, 439.589, 439.591, 439.593, 439.595, 449.029, 449.0301, 449.0302, 449.160, 449.163, 449.240, 232.320, 287.010, 287.04335, 603A.100, 629.051, 654.190, 680A.095, 683A.3683, 692A.270, 719.200, 720.140
As Enrolled: 439.580, 439.581, 439.587, 439.588, 439.589, 439.591, 439.593, 439.595, 449.029, 449.0301, 449.0302, 449.160, 449.163, 449.240, 232.320, 287.010, 287.04335, 603A.100, 629.051, 654.190, 680A.095, 683A.3683, 692A.270, 719.200, 720.140
BDR: 439.580, 439.581, 439.587, 439.588, 439.589, 439.593, 439.595, 449.029, 449.0301, 449.0302, 449.160, 449.163, 449.170, 449.240, 218D.355, 231.0685, 231A.170, 232.290, 232.320, 239.010, 287.010, 287.04335, 353.207, 360.755, 360.757, 360.7575, 374.357, 422A.372, 603A.100, 629.051, 654.190, 680A.095, 680A.220, 683A.3683, 692A.270, 695C.330, 719.200, 720.140