Existing law authorizes a patient to execute certain directives and declarations to record his or her wishes relating to health care and to direct providers of health care in the provision of health care to the patient. (NRS 449A.400-449A.645) Section 15 of this bill requires the Division of Public and Behavioral Health of the Department of Health and Human Services to create a non-opioid directive, which is a form on which a person may indicate that he or she does not wish to receive opioids, and to post the non-opioid directive on an Internet website maintained by the Division. Section 16 of this bill requires: (1) certain providers of health care to provide a person with an opportunity to execute a non-opioid directive; (2) third party insurers that provide health coverage to provide persons who enroll in such health coverage a non-opioid directive; and (3) certain health care facilities to ensure that persons providing care at the facility provide a patient with an opportunity to execute a non-opioid directive. Section 16 also requires such third party insurers and health facilities to post the non-opioid directive on their Internet websites. Sections 17 and 18 of this bill set forth the procedure for a patient to execute and revoke a non-opioid directive. Section 19 of this bill prohibits a person who knows or should know that a person has executed a non-opioid directive from prescribing, administering or directing or supervising the administration of an opioid to that person except under certain circumstances. Section 20 of this bill provides immunity to certain persons relating to the prescribing, administering or directing or supervising the administration of an opioid to a patient who has executed a non-opioid directive, or the failure to take those actions with regard to such a patient, if the person: (1) acts in good faith; and (2) is in compliance with all applicable laws and regulations relating to his or her actions. Section 21 of this bill requires the State Board of Health to adopt regulations prescribing procedures relating to the non-opioid directive. Sections 22 and 23 of this bill require the Administrator of the Division to appoint an advisory board to: (1) review the implementation of and compliance with provisions relating to the non-opioid directive; and (2) make recommendations to practitioner licensing boards and certain governmental entities concerning issues relating to opioid use and alternative treatments that do not utilize opioids. Sections 8-14 of this bill define certain terms used in sections 8-23. Sections 1 and 33-40 of this bill require a medical facility, certain other health care facilities and certain providers of health care who prescribe or administer opioids to comply with the provisions of law governing non-opioid directives. Under section 55 of this bill, beginning on January 1, 2027, sections 1, 33, 35-37, 39 and 40 require such facilities and providers of health care to offer and provide alternative treatments that do not utilize opioids to patients who have requested such alternatives or executed non-opioid directives, except in certain circumstances. Sections 1, 33, 35-37, 39 and 40 require the regulatory bodies that license such facilities and providers of health care to biennially review the compliance of such facilities and practitioners with those requirements. Sections 34 and 38 make conforming changes to clarify that sections 33 and 37, respectively, apply to the prescribing and administering of opioids to treat intractable pain. Sections 2-6 and 41 of this bill provide for the administration and enforcement of section 1 in the same manner as other requirements imposed by existing law on licensed health facilities. Sections 25 and 54 of this bill authorize the Board of the Public Employees' Benefits Program and the Public Option, which is a state-run health insurance program for private citizens, to reduce the rates paid to a facility or practitioner who violates any provision of section 33, 35-37, 39 or 40 or prohibit the facility or practitioner from receiving payments through the Program or the Public Option. (NRS 695K.200) Section 27 of this bill applies certain definitions to section 25. Section 29 of this bill requires the Administrator of the Division of Health Care Financing and Policy of the Department to adopt regulations to: (1) monitor the compliance of facilities and practitioners who participate in Medicaid with the provisions of sections 33, 35-37, 39 and 40; and (2) impose sanctions on a facility or practitioner who fails to comply with such provisions. Existing law requires public and private policies of insurance regulated under Nevada law and employers who provide such insurance for their employees to include coverage for drugs to: (1) support safe withdrawal from substance use disorder; and (2) provide medication-assisted treatment for opioid use disorder. (NRS 287.010, 287.04335, 422.4025, 608.1555, 689A.0459, 689B.0319, 689C.1665, 689C.425, 695A.1874, 695B.19197, 695C.050, 695C.1699, 695G.1719) Sections 26, 28, 30, 43, 45-51 and 53 of this bill require certain public and private policies of health insurance to cover drugs that are alternatives to opioids for purposes for which opioids are commonly used. Sections 42, 43, 45-51 and 53 of this bill prohibit certain insurers from imposing prior authorization and certain other conditions on covered opioid alternatives that are not imposed on opioids. Section 44 of this bill authorizes the Commissioner of Insurance to require certain policies of health insurance issued by a domestic insurer to a person who resides in another state to include the coverage required by section 43. Section 52 of this bill authorizes the Commissioner to suspend or revoke the certification of a health maintenance organization that fails to comply with the requirements of section 50. The Commissioner would also be authorized to take such actions against other health insurers who fail to comply with the requirements of sections 43, 45-49, 51 and 53. (NRS 680A.200) Section 24 of this bill makes a conforming change to require the Director of the Department to administer the provisions of section 29 in the same manner as other provisions relating to Medicaid. Existing law creates the Fund for a Resilient Nevada to hold the proceeds of certain litigation by the State concerning the manufacture, distribution, sale and marketing of opioids. (NRS 433.732) Existing law requires the Department to create a statewide plan to allocate the money in the Fund for certain statewide projects and grants to local governments and private-sector organizations whose work relates to opioid use disorder and other substance use disorders. (NRS 433.738) Section 31 of this bill requires the statewide plan to allocate at least 20 percent of the money distributed from the Fund to such projects and grants that are related to the prevention of substance use disorders. Section 32 of this bill makes a conforming change to update an internal reference changed by section 31. Section 55 authorizes the Department to continue to utilize the current statewide plan and at the time that the Department revises the statewide plan or develops a new plan, the new plan must comply with the provisions of section 31.

Statutes affected:
As Introduced: 449.029, 449.0301, 449.160, 449.163, 449.240, 232.320, 287.010, 287.0402, 287.04335, 422.4025, 433.738, 433.740, 630.3066, 633.521, 636.2882, 654.190, 687B.225, 689A.330, 689C.425, 695C.050, 695C.330
BDR: 449.029, 449.0301, 449.160, 449.163, 449.240, 232.320, 287.010, 287.0402, 287.04335, 422.4025, 433.738, 433.740, 630.3066, 633.521, 636.2882, 654.190, 687B.225, 689A.330, 689C.425, 695C.050, 695C.330