Existing law requires the Department of Health and Human Services, or the Director of the Department or the divisions thereof, to conduct various programs for the improvement of public health and health care in this State. (NRS 433.702-433.744, 439.4921-439.525, 439.529-439.5297, 439.630, 439A.111-439A.185, 439A.200-439A.290, 442.710-442.745, 457.230-457.280, 458.025, 458A.090, 458A.100, 458A.110) Sections 2-18 of this bill establish the Nevada Health Care Workforce and Access Program, which is a competitive funding program managed by the Department to support projects to address critical shortages of providers of health care in this State. Sections 3-5 define certain terms, and section 2 establishes the applicability of those definitions. Section 6 creates the Nevada Health Care Workforce and Access Account to hold money to fund the Program. Section 119 of this bill appropriates money into the Account. Section 6 authorizes the Director of the Department to transfer money from the Account to another account for the purpose of obtaining additional federal financial participation under Medicaid. Section 7 requires the Director to conduct a biennial assessment of the health care workforce needs of this State, which must identify health care specialties, populations and geographic areas experiencing critical shortages of providers of health care. Section 42 of this bill provides that such an assessment is not a regulation and is therefore not subject to notice-and-comment rulemaking. Section 9 authorizes a person or entity to apply for funding from the Account to support a project to address those critical shortages. Section 8 imposes certain additional requirements for a project to be eligible to receive such funding. Sections 10 and 11 prescribe the process for the Department to review applications and recommend applicants for funding. Section 12 provides for a joint committee consisting of the membership of the Board of Economic Development and the Patient Protection Commission to make the final determination concerning which applicants receive funding. After the joint committee awards funding, section 13 requires the Department to enter into a funding agreement with the recipient of the funding that outlines the terms and conditions of the funding and the responsibilities of the recipient. Section 13 requires a recipient of funding to notify and submit a revised plan to the Department if: (1) the recipient significantly modifies or terminates a funded project; or (2) the amount of money available for a funded project changes. Section 13 authorizes the Department to take certain actions in response to such notice. Section 14 authorizes the Department and the Office of Finance to provide certain oversight of a funded project. Section 15 authorizes the Department to suspend or terminate funding or take certain other actions if it determines that the recipient of the funding has failed to comply with state or federal law or regulations or a funding agreement. Sections 16 and 17 provide for certain reporting concerning the Program, and section 18 requires the Department to adopt regulations governing the Program. Section 67 of this bill: (1) creates the Office of Mental Health within the Department; and (2) requires the Office to perform certain duties to improve access to and the effectiveness of mental health services in this State. Section 67 authorizes the Office to request an allocation of money from the Account to support those duties. Section 89 of this bill requires the Board of Psychological Examiners to: (1) provide continuing education concerning the mental health needs of patients in rural areas; and (2) establish a program to recognize psychologists who provide at least 200 hours of services through telehealth to such patients. Sections 20, 43, 47, 50, 75, 85, 109 and 113 of this bill prescribe requirements to expedite the process of credentialing providers of health care to participate in public and private health insurance plans. Beginning on January 1, 2027, sections 117 and 118 of this bill require insurers that issue such plans, or entities to which such insurers delegate credentialing functions, to process least 95 percent of complete requests for such credentialing not later than 60 days after receiving all of the information necessary to complete such a request. Beginning on January 1, 2027, section 21 of this bill similarly requires a hospital to process at least 95 percent of complete requests from providers of health care for privileges to perform services at the hospital not later than 60 days after receiving all of the information necessary to complete such a request. Existing law authorizes an emergency medical technician, advanced emergency medical technician or paramedic who holds the proper endorsement to provide services, known as community paramedicine services, to patients who do not require emergency medical transportation. (NRS 450B.1993) Sections 29-31 of this bill authorize paramedics to serve as employees or volunteers in a hospital under certain circumstances and with certain limitations. Existing law requires the Director of the Office of Science, Innovation and Technology in the Office of the Governor to implement the Graduate Medical Education Grant Program, which is a program to award grants to institutions in this State seeking to create, expand or retain programs for residency training and postdoctoral fellowships for physicians. (NRS 223.610, 223.637) Sections 36-40 of this bill transfer duties related to the administration of the Program from the Office of Science, Innovation and Technology to the Department. Sections 34 and 35 of this bill make conforming changes to remove the Program from the duties that the Director of the Office of Science, Innovation and Technology is required to perform. Section 39: (1) authorizes the Department to award limited grants for certain purposes relating to the establishment of a program for residency training and postdoctoral fellowships for physicians; and (2) establishes certain priorities for the awarding of grants. Section 33 of this bill prohibits a grantee from eliminating or reducing the size of a program for residency training and postdoctoral fellowships without the approval of the Department. Section 49 of this bill requires the Department to explore ways to use federal financial participation in Medicaid to support such programs. Section 121 of this bill requires the Patient Protection Commission to conduct a study during the 2025-2026 interim concerning academic medical centers in this State, and section 120 of this bill appropriates money for the study. Section 121 authorizes the Patient Protection Commission to request not more than two legislative measures to implement any recommendations resulting from the study. Existing law provides that a noncompetition covenant is void unless the covenant: (1) is supported by valuable consideration; (2) does not impose any restraint that is greater than is required for the protection of the employer; (3) does not impose any undue hardship on the employee; and (4) imposes restrictions that are appropriately related to the consideration for the covenant. (NRS 613.195) Section 71 of this bill provides that, in general, a noncompetition covenant may not restrict a provider of health care from providing care at any location during or after the term of his or her employment or contract. Section 70 of this bill prescribes certain exceptions to that general prohibition. Sections 74 and 84 of this bill require the Board of Medical Examiners and the State Board of Osteopathic Medicine, respectively, to establish by regulation a procedure for prioritizing applications for licensure as a physician or osteopathic physician of applicants who plan to: (1) serve underserved geographic areas or populations in this State; or (2) practice a specialty for which there is a shortage in this State. Sections 76 and 86 of this bill require certain reports submitted by those Boards to the Governor and Legislature to include information relating to the efficiency of the process for licensing physicians or osteopathic physicians, as applicable. Existing law requires an applicant for licensure as a dental hygienist to have graduated from an accredited program of dental hygiene that meets certain requirements. (NRS 631.290) Sections 77 and 79 of this bill require the Board of Dental Examiners of Nevada to establish by regulation an alternative training pathway involving a course of training under the supervision of a licensed dentist that an applicant for such a license may complete instead of graduating from such a program. Section 77 requires an applicant who has completed the alternative training pathway to have also successfully passed: (1) a competency examination conducted by the supervising dentist; (2) a written examination; and (3) a clinical examination approved by the Board. Section 78 of this bill requires such an applicant to submit with his or her application for licensure proof that he or she has passed those examinations. Section 77 provides that a person who completes the alternative training pathway is only eligible for licensure if he or she began the pathway during a biennium during which there was shortage of dental hygienists, as documented by the assessment conducted pursuant to section 7. Section 77 requires the Board to adopt regulations establishing the scope of practice of a dental hygienist who has completed the alternative training pathway, including regulations authorizing such a dental hygienist to: (1) practice at locations in addition to the locations where a dental hygienist is authorized to practice under existing law; and (2) prescribe and dispense preventive agents, in addition to the preventive agents that a dental hygienist is authorized to prescribe and dispense under existing law. (NRS 631.310, 631.3105) Sections 32, 80-82, 87 and 88 of this bill make conforming changes to authorize such a dental hygienist to practice at such locations and prescribe and dispense such protective agents. Existing law requires the Department to administer Medicaid and the Children's Health Insurance Program. (NRS 422.270) Existing federal law authorizes: (1) a hospital to elect to make determinations concerning whether certain persons are presumptively eligible for Medicaid; and (2) a state to allow certain other entities to make such determinations. (42 U.S.C. §§ 1396a(a)(47), 1396r-1, 1396r-1a, 1396r-1b, 1396r-1c) Section 51 of this bill requires the Department to take certain measures to facilitate such presumptive eligibility determinations by the personnel of hospitals and qualified community-based organizations. Section 51 also requires the Department to audit such entities to ensure that the presumptive eligibility determinations made by the personnel of those entities are accurate and comply with applicable law. Existing law authorizes certain health insurers to require prior authorization before an insured may receive coverage for medical and dental care in certain circumstances. If an insurer requires prior authorization, existing law requires the insurer to: (1) file its procedure for obtaining prior authorization with the Commissioner of Insurance for approval; and (2) respond to a request for prior authorization within 20 days after receiving the request. (NRS 687B.225) Beginning on January 1, 2028, sections 44, 47, 53-62, 69, 97-108 and 110 of this bill establish additional requirements relating to the use of prior authorization for medical and dental care by health insurers, including Medicaid, the Children's Health Insurance Program and insurance for public employees, as well as certain entities with which such insurers contract to perform functions relating to prior authorization. Sections 54, 55 and 98-100 define certain terms, and sections 53 and 97 establish the applicability of those definitions. Sections 56 and 110 require an insurer or other entity that performs functions relating to prior authorization to respond to a request for prior authorization within the period of time prescribed by certain nationally recognized operating rules governing prior authorization. If an insurer or other entity that performs functions relating to prior authorization is unable to approve or deny a request for prior authorization within that time period, sections 56 and 110 require the insurer or entity to notify the insured and his or her provider of health care of the delay. Sections 58 and 102 prescribe the required contents of that notice. Sections 59 and 103 require an insurer or other entity that performs functions relating to prior authorization to provide similar notice upon denying a request for prior authorization and establish a process to appeal such a denial. Sections 56 and 110 prohibit insurers and other entities that perform functions relating to prior authorization from requiring prior authorization for covered emergency services. Sections 57 and 101 require insurers and other entities that perform functions relating to prior authorization to implement an electronic system for receiving and processing requests for prior authorization. Sections 22 and 72 of this bill require certain medical facilities and providers of health care to submit requests for prior authorization through those systems. Sections 60 and 104 limit the circumstances under which an insurer or other entity that performs functions relating to prior authorization may: (1) revoke the approval of a request for prior authorization; (2) delay or deny payment for care to which such a request pertains; or (3) assign a lower billing code or otherwise reduce the payment for such care. Section 126 of this bill eliminates certain similar requirements in existing law governing dental insurance that are less stringent than the requirements of section 104. Sections 61 and 105 prescribe certain requirements to ensure the continuity of care for an insured whose benefits are terminated or who switches health insurance plans. Sections 62 and 106 provide for the reporting and publication of certain information relating to prior authorization and the payment of claims. Section 107 establishes the Gold Card Exemption Program to exempt providers of health care whose requests for prior authorization are approved at a rate of at least 95 percent from the requirement to obtain prior authorization for certain services. Section 56 requires the Department, with respect to Medicaid and the Children's Health Insurance Program, or a Medicaid managed care organization to grant Gold Card Exemptions to providers of health care in accordance with section 107 except in certain circumstances. Sections 44 and 63 of this bill require insurance for the employees of local governments, Medicaid and the Children's Health Insurance Program to comply with certain requirements governing the prompt payment of claims that apply under existing law to private insurers and the Public Employees' Benefits Program. (NRS 683A.0879, 689A.410, 689B.255, 689C.355, 689A.188, 695B.2505, 695C.185, 695D.215) Section 63 additionally requires Medicaid to comply with certain federal requirements governing the timely payment of claims under Medicaid. (42 C.F.R. § 447.45(d)(2),(3)) Section 108 requires the Commissioner to adopt regulations prescribing: (1) requirements to ensure that applicants for certain certificates or approval to engage in business related to insurance are equipped to comply with certain requirements governing prior authorization and the payment of health claims; and (2) criteria to ensure that an insurer or other entity that enters into a contract to provide services for certain public insurance programs is in compliance with those requirements. Sections 45, 64, 66, 91, 93-95, 115 and 116 of this bill make various changes to establish the applicability of those regulations. Section 92 of this bill makes a conforming change to indicate the proper placement of section 91 in the Nevada Revised Statutes. Section 108 additionally requires the Commissioner to perform certain other duties relating to the implementation and enforcement of requirements governing prior authorization and the payment of health claims. Section 65 of this bill requires the prior authorization policies and procedures for prescription drugs under Medicaid to comply with sections 53-63. Section 41 of this bill requires the Director of the Department to administer sections 49-63 in the same manner as other provisions governing Medicaid. Sections 44, 47, 52, 69 and 114 of this bill make sections 97-108 and 110 applicable to insurance for public and private employees, Medicaid managed care organizations and nonprofit hospital or medical services corporations. Sections 23-27, 90, 111 and 112 of this bill make conforming changes concerning the applicability and enforcement of sections 20-22 and 109.

Statutes affected:
BDR: 449.029, 449.0301, 449.160, 449.163, 449.240, 450B.250, 454.00958, 223.610, 223.630, 223.631, 223.633, 223.635, 223.637, 223.639, 232.320, 233B.038, 287.010, 287.0433, 287.04335, 422.273, 422.403, 422.4053, 608.1555, 613.195, 630.130, 631.220, 631.290, 631.310, 631.3105, 631.313, 633.286, 639.0125, 639.1374, 654.190, 680A.095, 683A.08524, 683A.3715, 683A.378, 687B.225, 687B.600, 687B.670, 695B.320, 695D.130, 695K.220