2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.273 - Establishment, development and implementation of Medicaid managed care program. [Effective through December 31, 2025.] Establishment, development and implementation of statewide Medicaid managed care program; statewide procurement process to select health maintenance organizations to provide services. [Effective January 1, 2026.]

1. For any Medicaid managed care program established in the State of Nevada, the Department shall contract only with a health maintenance organization that has:
(a) Negotiated in good faith with a federally-qualified health center to provide health care services for the health maintenance organization;
(b) Negotiated in good faith with the University Medical Center of Southern Nevada to provide inpatient and ambulatory services to recipients of Medicaid; and
(c) Negotiated in good faith with the University of Nevada School of Medicine to provide health care services to recipients of Medicaid.
Nothing in this section shall be construed as exempting a federally-qualified health center, the University Medical Center of Southern Nevada or the University of Nevada School of Medicine from the requirements for contracting with the health maintenance organization.
2. During the development and implementation of any Medicaid managed care program, the Department shall cooperate with the University of Nevada School of Medicine by assisting in the provision of an adequate and diverse group of patients upon which the school may base its educational programs.
3. The University of Nevada School of Medicine may establish a nonprofit organization to assist in any research necessary for the development of a Medicaid managed care program, receive and accept gifts, grants and donations to support such a program and assist in establishing educational services about the program for recipients of Medicaid.
4. For the purpose of contracting with a Medicaid managed care program pursuant to this section, a health maintenance organization is exempt from the provisions of NRS 695C.123.
5. The provisions of this section apply to any managed care organization, including a health maintenance organization, that provides health care services to recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program pursuant to a contract with the Division. Such a managed care organization or health maintenance organization is not required to establish a system for conducting external reviews of adverse determinations in accordance with chapter 695B, 695C or 695G of NRS. This subsection does not exempt such a managed care organization or health maintenance organization for services provided pursuant to any other contract.
6. As used in this section, unless the context otherwise requires:
(a) "Federally-qualified health center" has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).
(b) "Health maintenance organization" has the meaning ascribed to it in NRS 695C.030.
(c) "Managed care organization" has the meaning ascribed to it in NRS 695G.050.
(Added to NRS by 1997, 1236; A 2001, 1927; 2003, 785; 2005, 22nd Special Session, 27; 2011, 3419)
1. To the extent that money is available, the Department shall:
(a) Establish a Medicaid managed care program to provide health care services to recipients of Medicaid in all geographic areas of this State. The program is not required to provide services to recipients of Medicaid who are aged, blind or disabled pursuant to Title XVI of the Social Security Act, 42 U.S.C. §§ 1381 et seq.
(b) Conduct a statewide procurement process to select health maintenance organizations to provide the services described in paragraph (a).
2. For any Medicaid managed care program established in the State of Nevada, the Department shall contract only with a health maintenance organization that has:
(a) Negotiated in good faith with a federally-qualified health center to provide health care services for the health maintenance organization;
(b) Negotiated in good faith with the University Medical Center of Southern Nevada to provide inpatient and ambulatory services to recipients of Medicaid;
(c) Negotiated in good faith with the University of Nevada School of Medicine to provide health care services to recipients of Medicaid; and
(d) Complied with the provisions of subsection 2 of NRS 695K.220.
Nothing in this section shall be construed as exempting a federally-qualified health center, the University Medical Center of Southern Nevada or the University of Nevada School of Medicine from the requirements for contracting with the health maintenance organization.
3. During the development and implementation of any Medicaid managed care program, the Department shall cooperate with the University of Nevada School of Medicine by assisting in the provision of an adequate and diverse group of patients upon which the school may base its educational programs.
4. The University of Nevada School of Medicine may establish a nonprofit organization to assist in any research necessary for the development of a Medicaid managed care program, receive and accept gifts, grants and donations to support such a program and assist in establishing educational services about the program for recipients of Medicaid.
5. For the purpose of contracting with a Medicaid managed care program pursuant to this section, a health maintenance organization is exempt from the provisions of NRS 695C.123.
6. To the extent that money is available, a Medicaid managed care program must include, without limitation, a state-directed payment arrangement established in accordance with 42 C.F.R. § 438.6(c) to require a Medicaid managed care organization to reimburse a critical access hospital and any federally-qualified health center or rural health clinic affiliated with a critical access hospital for covered services at a rate that is equal to or greater than the rate received by the critical access hospital, federally-qualified health center or rural health clinic, as applicable, for services provided to recipients of Medicaid on a fee-for-service basis.
7. The provisions of this section apply to any managed care organization, including a health maintenance organization, that provides health care services to recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program pursuant to a contract with the Division. Such a managed care organization or health maintenance organization is not required to establish a system for conducting external reviews of adverse determinations in accordance with chapter 695B, 695C or 695G of NRS. This subsection does not exempt such a managed care organization or health maintenance organization for services provided pursuant to any other contract.
8. As used in this section, unless the context otherwise requires:
(a) "Critical access hospital" means a hospital which has been certified as a critical access hospital by the Secretary of Health and Human Services pursuant to 42 U.S.C. § 1395i-4(e).
(b) "Federally-qualified health center" has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).
(c) "Health maintenance organization" has the meaning ascribed to it in NRS 695C.030.
(d) "Managed care organization" has the meaning ascribed to it in NRS 695G.050.
(e) "Rural health clinic" has the meaning ascribed to it in 42 C.F.R. § 405.2401.
(Added to NRS by 1997, 1236; A 2001, 1927; 2003, 785; 2005, 22nd Special Session, 27; 2011, 3419; 2021, 3638, effective January 1, 2026)