Existing law requires the Department of Health and Human Services to administer the Medicaid program, which is a joint program of the state and federal governments to provide health coverage to indigent persons. (NRS 422.270, 439B.120) Existing law also creates the Silver State Health Insurance Exchange to assist natural persons and small businesses in purchasing health coverage. (Chapter 695I of NRS) Section 10 of this bill requires the Director of the Department, in consultation with the Executive Director of the Exchange and the Commissioner of Insurance, to design, establish and operate a public health benefit plan known as the Public Option. Section 2 of this bill sets forth the purposes of the Public Option, and sections 3.5-9 of this bill define terms relevant to the Public Option. Section 10 requires the Public Option to be available through the Exchange and for direct purchase and authorizes the Director to make the Public Option available to small employers in this State or their employees. Section 10 requires the Public Option to meet the requirements established by federal and state law for individual health insurance or health insurance for small employers where applicable. Section 10 also establishes requirements governing the levels of coverage provided by the Public Option and the premiums for the Public Option. Sections 38 and 41 of this bill remove the requirements relating to premiums on January 1, 2030. Section 11 of this bill requires the Director, the Commissioner and the Executive Director of the Exchange to apply for certain waivers to obtain federal financial support for the Public Option. Section 39 of this bill requires the Director, the Commissioner and the Executive Director of the Exchange to contract for the performance of an actuarial study before submitting the initial waiver application. Section 12 of this bill requires the Director to use a statewide competitive bidding process to solicit and enter into contracts with health carriers and other qualified persons to administer the Public Option. Section 12 requires a health carrier that provides health care services to recipients of Medicaid through managed care to participate in the competitive bidding process. Section 12 additionally authorizes the Director to directly administer the Public Option if necessary. Sections 13, 21 and 29 of this bill require providers of health care, including health care facilities, who participate in Medicaid or the Public Employees' Benefits Program or provide care to injured employees under the State's workers' compensation program to enroll in the Public Option as a participating provider of health care. Section 14 of this bill prescribes requirements governing the establishment of networks and the reimbursement of providers under the Public Option. Section 15 of this bill establishes the Public Option Trust Fund to hold certain funds for the purpose of implementing the Public Option. Section 20 of this bill exempts rules and policies governing the Public Option from provisions governing notice-and-comment rulemaking. Sections 16, 19, 22, 32 and 34-37 of this bill make various changes so that the Public Option is treated similarly to comparable forms of public health insurance. Section 16.5 of this bill requires the Executive Director of the Exchange to apply to the federal government for a waiver to authorize certain labor, agricultural and horticultural organizations to offer on the Exchange a policy of insurance to meet the unique needs of tradespersons that can serve as an alternative to the continuation of certain group health benefits. Section 16.5 requires such a policy to be annually certified by the Executive Director in order to be offered on the Exchange. Sections 16.3 and 16.8 of this bill make conforming changes to reflect the fact that a policy of insurance offered pursuant to section 16.5 may not meet all requirements: (1) for individual health insurance prescribed by state law; or (2) to be considered a qualified health plan under federal law. Section 39.5 of this bill requires the Executive Director to apply for the waiver and submit certain recommendations concerning such policies to the Legislature on or before January 1, 2025. Sections 24-28 of this bill expand coverage under Medicaid in various manners. Specifically, section 24 of this bill requires the Director of the Department to expand coverage under the State Plan for Medicaid for pregnant women by: (1) providing coverage for pregnant women whose household income is between 165 percent and 200 percent of the federally designated level signifying poverty if money is available; (2) providing that pregnant women who are determined by certain entities to qualify for Medicaid are presumptively eligible for Medicaid for a prescribed period of time, without submitting an application for enrollment in Medicaid which includes additional proof of eligibility; and (3) prohibiting the imposition of a requirement that a pregnant woman who is otherwise eligible for Medicaid and resides in this State must reside in the United States for a prescribed period of time before enrolling in Medicaid. Section 25 of this bill requires Medicaid to cover the services of a community health worker who provides services under the supervision of a physician, physician assistant or advanced practice registered nurse. Section 26 of this bill requires Medicaid to cover certain costs for doula services provided to Medicaid recipients by a doula who has enrolled with the Division of Health Care Financing and Policy of the Department. Sections 17 and 33 of this bill require a registered doula to report the suspected abuse, neglect, exploitation, isolation or abandonment of older or vulnerable persons or the suspected abuse or neglect of a child. Section 27 of this bill requires Medicaid to reimburse services provided to recipients of Medicaid who do not receive services through managed care by an advanced practice registered nurse to the same extent as if those services were provided by a physician if money is available to reimburse those services at those rates. If money is available, section 28 of this bill requires Medicaid to cover breastfeeding supplies, certain prenatal screenings and tests and lactation consultation and support. Section 18 of this bill makes a conforming change to indicate the proper placement of sections 24-28 in the Nevada Revised Statutes. Existing law establishes certain requirements that apply if a Medicaid managed care program is established in this State. (NRS 422.273) To the extent that money is available, section 30 of this bill requires the Department to: (1) establish such a program to provide health care services to recipients of Medicaid in all geographic areas of this State; and (2) conduct a statewide procurement process to select health maintenance organizations to provide such services. To the extent that money is available, section 30 requires the Medicaid managed care program to include a state-directed payment arrangement to require Medicaid managed care organizations to reimburse critical access hospitals and any affiliated federally-qualified health centers or rural health clinics for covered services at a rate that is equal to or greater than the rate those facilities receive for services provided to recipients of Medicaid on a fee-for-service basis. Existing law requires certain health insurers, including local governments that adopt a system of group health insurance for their employees, to cover enteral formulas under certain conditions. (NRS 287.010, 689A.0423, 689B.0353, 695B.1923, 695C.1723) Sections 16.35-6.47 of this bill specify that enteral formulas include formulas that are ingested orally. Section 20.5 of this bill requires the Public Employees' Benefits Program to cover enteral formulas, including formulas that are ingested orally, under the same conditions as health insurers that are currently required to cover enteral formulas. Section 38.3 of this bill appropriates money to the Division of Welfare and Supportive Services of the Department to pay the costs of making enhancements to its information technology system that are necessary to carry out the provisions of sections 24-28 of this bill. Sections 38.6 and 38.8 of this bill appropriate money to the Public Option Trust Fund and the Silver State Health Insurance Exchange, respectively, to implement the Public Option.

Statutes affected:
As Introduced: 683A.176, 200.5093, 232.320, 232.459, 233B.039, 287.0434, 333.705, 422.2372, 422.273, 422.4053, 427A.605, 432B.220, 439B.260, 439B.665, 439B.736, 449A.162
Reprint 1: 683A.176, 689A.020, 695I.210, 200.5093, 232.320, 232.459, 233B.039, 287.0434, 333.705, 422.2372, 422.273, 422.4053, 427A.605, 432B.220, 439B.260, 439B.665, 439B.736, 449A.162
Reprint 2: 683A.176, 689A.020, 695I.210, 200.5093, 232.320, 232.459, 233B.039, 287.0434, 333.705, 422.2372, 422.273, 427A.605, 432B.220, 439B.260, 439B.665, 439B.736, 449A.162
Reprint 3: 683A.176, 689A.020, 689A.0423, 689B.0353, 695B.1923, 695C.1723, 695I.210, 200.5093, 232.320, 232.459, 233B.039, 287.04335, 287.0434, 333.705, 422.2372, 422.273, 427A.605, 432B.220, 439B.260, 439B.665, 439B.736, 449A.162
As Enrolled: 683A.176, 689A.020, 689A.0423, 689B.0353, 695B.1923, 695C.1723, 695I.210, 200.5093, 232.320, 232.459, 233B.039, 287.04335, 287.0434, 333.705, 422.2372, 422.273, 427A.605, 432B.220, 439B.260, 439B.665, 439B.736, 449A.162