reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.382 - Intergovernmental transfers of money from counties to Division; deposit in Intergovernmental Transfer Account in State General Fund; administration by Division.

1. The money transferred to the Division in accordance with the regulations adopted pursuant to paragraph (a) of subsection 1 of NRS 422.390 must not come from any source of funding that could result in any reduction in revenue to the State pursuant to 42 U.S.C. § 1396b(w).
2. Any money collected in accordance with the regulations adopted pursuant to subsection 1 of NRS 422.390, including any interest or penalties imposed for a delinquent payment, must be deposited in the State Treasury for credit to the Intergovernmental Transfer Account in the State General Fund to be administered by the Division.
3. The interest and income earned on money in the Intergovernmental Transfer Account, after deducting any applicable charges, must be credited to the Account.
(Added to NRS by 1993, 1967; A 1995, 1427, 1430; 1997, 2630; 1999, 2242; 2001, 3114; 2003, 2990; 2005, 22nd Special Session, 35; 2009, 2293)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.385 - Disproportionate share payments from Medicaid Budget Account; transfer of money from Intergovernmental Transfer Account.

1. The disproportionate share payments made to hospitals must be made, to the extent allowed by the State Plan for Medicaid, from the Medicaid Budget Account.
2. The money in the Intergovernmental Transfer Account must be transferred from that Account to the Medicaid Budget Account to the extent that money is available from the Federal Government for proposed expenditures, including expenditures for administrative costs. If the amount in the Account exceeds the amount authorized for expenditure by the Division for the purposes of making disproportionate share payments, the Division is authorized to expend the additional revenue in accordance with the provisions of the State Plan for Medicaid.
3. If enough money is available to support Medicaid and to make the disproportionate share payments, money in the Intergovernmental Transfer Account may be transferred:
(a) To an account established for the provision of health care services to uninsured children pursuant to a federal program in which at least 50 percent of the cost of such services is paid for by the Federal Government, including, without limitation, the Children’s Health Insurance Program; or
(b) To carry out the provisions of NRS 439B.350 and 439B.360.
(Added to NRS by 1991, 2335; A 1993, 1969; 1995, 1428, 1430; 1997, 1244, 1546, 2631; 1999, 581, 2232, 2242; 2001, 3115; 2003, 2991; 2005, 22nd Special Session, 35; 2009, 2294)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.387 - Calculation of disproportionate share payments; verification of eligibility for disproportionate share payments; Director authorized to negotiate terms of amendment to State Plan for Medicaid with Centers for Medicare and Medicaid Services of United States Department of Health and Human Services.

1. The State Plan for Medicaid must provide the methodology for:
(a) Calculating the initial distribution of the disproportionate share payments in accordance with the regulations adopted pursuant to NRS 422.390;
(b) Adjusting the disproportionate share payment to a hospital if the annual audit of the hospital demonstrates that the disproportionate share payment made to the hospital was greater than the amount of money which the hospital was eligible to receive; and
(c) Redistributing any amount of disproportionate share payments which are returned to the Division as a result of the adjustments made in accordance with paragraph (b).
2. The State Plan for Medicaid or, if the Division deems necessary, the Division may require a hospital to submit any documentation or other information to verify eligibility for a disproportionate share payment or compliance with the requirements of NRS 422.380 to 422.390, inclusive. A disproportionate share payment may not be calculated for or made to a hospital which fails to provide the Division with documentation or other information that is required by the State Plan for Medicaid or the Division.
3. Except as otherwise provided in subsection 4, the State Plan for Medicaid must be consistent with the provisions of NRS 422.380 to 422.390, inclusive, and the regulations adopted pursuant thereto, and Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions.
4. If the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services denies an amendment to the State Plan for Medicaid, the Director may negotiate terms which are acceptable to the Centers for Medicare and Medicaid Services which are inconsistent with the provisions of NRS 422.380 to 422.390, inclusive, and the regulations adopted pursuant thereto if:
(a) Negotiating such terms is necessary to ensure that the State Plan for Medicaid is consistent with the provisions of Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions; and
(b) Before finalizing such an amendment to the State Plan for Medicaid, the Director obtains the approval of the Interim Finance Committee.
(Added to NRS by 1991, 2335; A 1993, 1969; 1995, 1428, 1430; 1997, 1244, 2631; 1999, 2242; 2001, 3116; 2003, 2992; 2005, 22nd Special Session, 36; 2009, 2294)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.390 - Regulations; quarterly report.

1. The Division shall adopt regulations concerning:
(a) Procedures for the intergovernmental transfers of money from the counties to the Division for the purposes of carrying out the provisions of NRS 422.380 to 422.390, inclusive, and the State Plan for Medicaid.
(b) Provisions for the payment of a penalty and interest for a delinquent intergovernmental transfer.
(c) Provisions for the payment of interest by the Division for late reimbursements to hospitals or other providers of medical care.
(d) Provisions for the calculation of disproportionate share payments for hospitals.
(e) Any required documentation of and reporting by a hospital relating to the calculation of the disproportionate share payment for the hospital and the verification of the disproportionate share payment that has been received by the hospital.
(f) Procedures and requirements for conducting independent and certified audits of hospitals and the disproportionate share payments made to hospitals as required pursuant to Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions.
(g) Procedures for adjusting a disproportionate share payment in accordance with Title XIX of the Social Security Act, 42 U.S.C. §§ 1396, et seq., and the regulations adopted pursuant to those provisions, if the audit of a hospital demonstrates that a disproportionate share payment made to the hospital was greater than the amount of money the hospital was eligible to receive.
(h) Procedures for redistributing any disproportionate share payment returned to the Division by a hospital in accordance with Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions.
2. The Division shall report to the Interim Finance Committee quarterly concerning the provisions of NRS 422.380 to 422.390, inclusive.
3. Notwithstanding the provisions of NRS 233B.039 to the contrary, the regulations adopted pursuant to this section must be adopted in accordance with the provisions of chapter 233B of NRS and must be codified in the Nevada Administrative Code.
(Added to NRS by 1991, 2337; A 1993, 1970; 1995, 1429; 1997, 2631; 1999, 2242; 2003, 2994; 2005, 22nd Special Session, 38; 2009, 2297)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.396 - Establishment and administration of program to provide community-based services; application for federal waiver or amendment to State Plan for Medicaid; contracting for services; adoption of regulations.

1. The Department, through a division of the Department designated by the Director, shall establish and administer a program to provide community-based services necessary to enable a person with a physical disability to remain in his or her home or with his or her family and avoid placement in a facility for long-term care. The Department shall coordinate the provision of community-based services pursuant to this section.
2. The Department shall apply to the Secretary of Health and Human Services for a waiver granted pursuant to 42 U.S.C. § 1396n(c) or apply for an amendment to the State Plan for Medicaid that authorizes the Department to include as medical assistance under Medicaid the following services for persons with physical disabilities:
(a) Respite care;
(b) Habilitation;
(c) Residential habilitation;
(d) Environmental modifications;
(e) Supported living;
(f) Supported living habilitation;
(g) Supported personal care; and
(h) Any other community-based services approved by the Secretary of Health and Human Services.
The Department shall cooperate with the Federal Government in obtaining a waiver or amendment pursuant to this subsection.
3. The Department may use personnel of the Department or it may contract with any appropriate public or private agency, organization or institution to provide the community-based services necessary to enable a person with a physical disability to remain in his or her home or with his or her family and avoid placement in a facility for long-term care.
4. A contract entered into with a public or private agency, organization or institution pursuant to subsection 3 must:
(a) Include a description of the type of service to be provided;
(b) Specify the price to be paid for each service and the method of payment; and
(c) Specify the criteria to be used to evaluate the provision of the service.
5. The Department shall adopt regulations necessary to carry out the provisions of this section, including, without limitation, the criteria to be used in determining eligibility for the services provided pursuant to the program. Before adopting regulations pursuant to this section, the Department shall solicit comments from persons with a variety of disabilities and members of the families of those persons.
6. As used in this section, "person with a physical disability" means a person with a severe physical disability that substantially limits his or her ability to participate and contribute independently in the community in which the person lives.
(Added to NRS by 1997, 2659; A 2003, 2622; 2013, 1622; 2023, 2995)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.3962 - Amendment of home and community-based services waiver to include as medical assistance under Medicaid funding of assisted living supportive services for senior citizens who reside in certain assisted living facilities.

1. The Department shall apply to the Secretary of Health and Human Services to amend its home and community-based services waiver granted pursuant to 42 U.S.C. § 1396n. The waiver must be amended, in addition to providing coverage for any home and community-based services which the waiver covers on June 4, 2005, to authorize the Department to include as medical assistance under Medicaid the funding of assisted living supportive services for senior citizens who reside in assisted living facilities which are certified by the Housing Division of the Department of Business and Industry pursuant to NRS 319.147.
2. The Department shall:
(a) Cooperate with the Federal Government in amending the waiver pursuant to this section;
(b) If the Federal Government approves the amendments to the waiver, adopt regulations necessary to carry out the provisions of this section, including, without limitation, the criteria to be used in determining eligibility for the assisted living supportive services funded pursuant to subsection 1; and
(c) Implement the amendments to the waiver only to the extent that the amendments are approved by the Federal Government.
3. As used in this section:
(a) "Assisted living facility" means a residential facility for groups that:
(1) Satisfies the requirements set forth in subsection 7 of NRS 449.0302; and
(2) Has staff at the facility available 24 hours a day, 7 days a week, to provide scheduled assisted living supportive services and assisted living supportive services that are required in an emergency in a manner that promotes maximum dignity and independence of residents of the facility.
(b) "Assisted living supportive services" means services which are provided at an assisted living facility to residents of the assisted living facility, including, without limitation:
(1) Personal care services;
(2) Homemaker services;
(3) Chore services;
(4) Attendant care;
(5) Companion services;
(6) Medication oversight;
(7) Therapeutic, social and recreational programming; and
(8) Services which ensure that the residents of the facility are safe, secure and adequately supervised.
(Added to NRS by 2005, 922)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.3963 - Amendment of home and community-based services waiver to include certain services for and compensation of persons with intellectual or developmental disabilities. [Effective January 1, 2025.]

1. The Department shall apply to the Secretary of Health and Human Services to amend its home and community-based services waiver granted pursuant to 42 U.S.C. § 1396n. The waiver must be amended, in addition to providing coverage for any home and community-based service which the waiver covers on January 1, 2025, to authorize:
(a) The Department to include as medical assistance under Medicaid the funding of habilitation services designed to provide persons with intellectual disabilities or persons with developmental disabilities assistance in pursuing competitive integrated employment, including, without limitation:
(1) Benefit counseling to assist a person with an intellectual disability or person with a developmental disability in earning a higher income while retaining any benefits or services that the person may be receiving.
(2) Job coaching and job development. To the extent authorized by the Federal Government, the services described in this subparagraph must not be subject to authorization limits.
(b) The compensation of a recipient of services under the waiver described in subsection 1 who is receiving prevocational services at a rate equal to or greater than the state minimum wage, including, without limitation, by waiving the requirement prescribed by 42 C.F.R. § 440.180(c)(2)(i)(B) that a person receiving prevocational services be compensated at less than 50 percent of the minimum wage.
2. The Department shall:
(a) Cooperate with the Federal Government in amending the waiver pursuant to this section;
(b) If the Federal Government approves the amendments to the waiver, adopt regulations necessary to carry out the provisions of this section, including, without limitation, the criteria to be used in determining eligibility for the habilitation services designed to provide assistance to persons pursuing competitive integrated employment pursuant to subsection 1; and
(c) Implement the amendments to the waiver only to the extent that the amendments are approved by the Federal Government.
3. As used in this section, "competitive integrated employment" has the meaning ascribed to it in 29 U.S.C. § 705(5).
(Added to NRS by 2023, 2956, effective January 1, 2025)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.3964 - State Plan for Medicaid: Inclusion of certain home and community-based services.

1. The Director shall include in the State Plan for Medicaid an option to provide certain additional home and community-based services in a manner consistent with 42 U.S.C. § 1396n(i). To the extent authorized by federal law, the Division shall provide tenancy support services to assist recipients of Medicaid pursuant to that option.
2. The Division shall adopt any regulations necessary to comply with the requirements of 42 U.S.C. § 1396n(i).
3. As used in this section, "tenancy support services" means services authorized pursuant to federal law that assist a recipient of Medicaid in obtaining and remaining in housing the Division determines to be adequate.
(Added to NRS by 2019, 3106)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.3966 - Medicaid: Inclusion of coverage for home and community-based services for persons with fetal alcohol spectrum disorder.

1. The Director shall, to the extent that federal financial participation is available, include under Medicaid coverage for supports and services provided to recipients of Medicaid with fetal alcohol spectrum disorders that are aimed at allowing such recipients to remain living in the home of the recipient or in a community-based setting.
2. The Department may apply to the Secretary of Health and Human Services for any waiver granted pursuant to federal law, amendment to the State Plan for Medicaid or other federal authority that authorizes the Department to receive federal funding to provide the coverage described in subsection 1. The Department shall fully cooperate in good faith with the Federal Government during the application process to satisfy the requirements of the Federal Government for obtaining a waiver or amendment pursuant to this section.
3. "Fetal alcohol spectrum disorder" has the meaning ascribed to it in NRS 432B.0655.
(Added to NRS by 2023, 1751)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.398 - Prohibition against considering money deposited in individual development account by recipient of Medicaid to be income for certain purposes.

To the extent authorized by federal law, the Department shall not consider money deposited in an individual development account pursuant to NRS 422A.493 by a recipient of Medicaid to be income for the purpose of determining whether the person who deposited the money is eligible to receive or to continue to receive benefits that are provided by Medicaid.
(Added to NRS by 2021, 1547)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.399 - Instruction in financial literacy for certain recipients of Medicaid.

1. The Department shall, to the extent that money is provided by the State Treasurer pursuant to NRS 422A.492 for that purpose, ensure that instruction in financial literacy is provided to a recipient of Medicaid who deposits a portion of his or her income in an individual development account pursuant to NRS 422A.493.
2. The Department may contract for the services of an independent contractor to provide the instruction required in subsection 1.
(Added to NRS by 2021, 1547)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.401 - Definitions.

As used in NRS 422.401 to 422.406, inclusive, unless the context otherwise requires, the words and terms defined in NRS 422.4015 to 422.4024, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 2003, 1317; A 2017, 1801, 3928; 2019, 2167, 4028; 2021, 832, 2679)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.4026 - Coverage of certain supplements for treating sickle cell disease and its variants: Adoption of list by regulation; periodic review of list.

1. The Department, upon the recommendation of the Board, shall prescribe by regulation a list of nonprescription supplements essential for treating sickle cell disease and its variants that must be covered by Medicaid for recipients who have sickle cell disease and its variants.
2. The Board shall review the list of supplements prescribed pursuant to subsection 1 at least biennially to determine whether to recommend adding or removing any supplements from the list and report those recommendations to the Department.
(Added to NRS by 2019, 2167)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.4035 - Silver State Scripts Board: Creation; membership.

1. The Director shall create the Silver State Scripts Board within the Department. The Board must consist of such members as are appointed by the Director.
2. The Director shall appoint to the Board health care professionals who have knowledge and expertise in one or more of the following:
(a) The clinically appropriate prescribing of outpatient prescription drugs that are covered by Medicaid;
(b) The clinically appropriate dispensing and monitoring of outpatient prescription drugs that are covered by Medicaid;
(c) The review of, evaluation of and intervention in the use of prescription drugs; and
(d) Medical quality assurance.
3. At least one-third of the members of the Board must be active physicians licensed to practice medicine in this State, at least one of whom must be an active psychiatrist licensed to practice medicine in this State. At least one-third of the members of the Board must be either active pharmacists registered in this State or persons in this State with doctoral degrees in pharmacy.
4. A person must not be appointed to the Board if the person is employed by, compensated by in any manner, has a financial interest in, or is otherwise affiliated with a business or corporation that manufactures prescription drugs.
(Added to NRS by 2003, 1318; A 2015, 304; 2019, 4030)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.404 - Silver State Scripts Board: Chair; terms; vacancies; meetings; quorum.

1. The Director shall appoint the Chair of the Board from among its members.
2. After the initial terms, the term of each member of the Board is 2 years. A member may be reappointed.
3. A vacancy occurring in the membership of the Board must be filled for the remainder of the unexpired term in the same manner as the original appointment.
4. The Board shall meet at least once every 3 months and at the times and places specified by a call of the Chair of the Board.
5. A majority of the members of the Board constitutes a quorum for the transaction of business, and the affirmative vote of a majority of the members of the Board is required to take action.
(Added to NRS by 2003, 1319; A 2019, 4030)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.4045 - Silver State Scripts Board: Members serve without compensation; members entitled to per diem; members holding public office or employed by governmental entity.

1. Members of the Board serve without compensation, except that a member of the Board is entitled, while engaged in the business of the Board, to receive the per diem allowance and travel expenses provided for state officers and employees generally.
2. Each member of the Board who is an officer or employee of the State of Nevada or a local government must be relieved from his or her duties without loss of regular compensation so that the person may prepare for and attend meetings of the Board and perform any work necessary to carry out the duties of the Board in the most timely manner practicable. A state agency or local governmental entity shall not require an officer or employee who is a member of the Board to make up the time that the officer or employee is absent from work to carry out any duties as a member of the Board or to use annual vacation or compensatory time for the absence.
(Added to NRS by 2003, 1319; A 2019, 4030)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.405 - Silver State Scripts Board: Duties and powers.

1. The Department shall, by regulation, set forth the duties of the Board, which must include, without limitation:
(a) Identifying the prescription drugs which should be included on the list of preferred prescription drugs developed by the Department pursuant to NRS 422.4025, which must include, without limitation, any prescription drug required by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to be covered by the Medicaid program and any other prescription drug deemed essential by the Board;
(b) Identifying the prescription drugs which should be excluded from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs;
(c) Identifying classes of therapeutic prescription drugs for its review and performing a clinical analysis of each drug included in each class that is identified for review; and
(d) Reviewing at least annually all classes of therapeutic prescription drugs on the list of preferred prescription drugs developed by the Department pursuant to NRS 422.4025.
2. The Department shall, by regulation, require the Board to:
(a) Base its decisions on evidence of clinical efficacy, safety and outcomes for patients and, if the difference between the clinical efficacy, safety and outcomes for two or more drugs is not clinically significant, cost;
(b) Review new pharmaceutical products in as expeditious a manner as possible; and
(c) Consider new clinical evidence supporting the inclusion of an existing pharmaceutical product on the list of preferred prescription drugs developed by the Department and new clinical evidence supporting the exclusion of an existing pharmaceutical product from any restrictions that are imposed by the Medicaid program on drugs that are on the list of preferred prescription drugs in as expeditious a manner as possible.
3. The Department shall, by regulation, authorize the Board to:
(a) In carrying out its duties, exercise clinical judgment and analyze peer review articles, published studies, and other medical and scientific information; and
(b) Establish subcommittees to analyze specific issues that arise as the Board carries out its duties.
4. The Board may close any portion of a meeting during which it considers the cost of prescription drugs.
(Added to NRS by 2003, 1319; A 2019, 4031)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.4052 - Department to take certain actions relating to acquisition of prescription drugs for recipient of Medicaid who resides in area for which declared disaster or emergency is in effect.

1. The Department shall ensure that, if the Governor or the Legislature proclaims the existence of a state of emergency or issues a declaration of disaster pursuant to NRS 414.070, a recipient of Medicaid may refill a covered prescription regardless of how many days are remaining on the prescription if the recipient:
(a) Has not exceeded the number of refills authorized by the prescribing practitioner;
(b) Resides in the area for which the emergency or disaster has been declared; and
(c) Requests the refill not later than the end of the state of emergency or disaster or 30 days after the issuance of the proclamation or declaration, whichever is later.
2. The State shall, subject to any applicable copayments, coinsurance or deductibles, pay the nonfederal share of the cost for a supply of a covered prescription drug for up to 30 days for any recipient of Medicaid who requests a refill pursuant to subsection 1.
3. If the Commissioner of Insurance extends the time periods prescribed by NRS 695C.16945 and 695G.1635, the Department must extend the time periods prescribed by this section for the same amount of time.
4. As used in this section, "practitioner" has the meaning ascribed to it in NRS 639.0125.
(Added to NRS by 2021, 832)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.4053 - Department to manage payments and rebates for prescription drugs; contract for provision of certain services.

1. Except as otherwise provided in subsection 2, the Department shall directly manage, direct and coordinate all payments and rebates for prescription drugs and all other services and payments relating to the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program.
2. The Department may enter into a contract with:
(a) A pharmacy benefit manager for the provision of any services described in subsection 1.
(b) A health maintenance organization pursuant to NRS 422.273 for the provision of any of the services described in subsection 1 for recipients of Medicaid or recipients of insurance through the Children’s Health Insurance Program who receive coverage through a Medicaid managed care program.
(c) One or more public or private entities from this State, the District of Columbia or other states or territories of the United States for the collaborative purchasing of prescription drugs in accordance with subsection 3 of NRS 277.110.
3. A contract entered into pursuant to paragraph (a) or (b) of subsection 2 must:
(a) Include the provisions required by NRS 422.4056;
(b) Require the pharmacy benefit manager or health maintenance organization, as applicable, to disclose to the Department any information relating to the services covered by the contract, including, without limitation, information concerning dispensing fees, measures for the control of costs, rebates collected and paid and any fees and charges imposed by the pharmacy benefit manager or health maintenance organization pursuant to the contract; and
(c) Require the pharmacy benefit manager or health maintenance organization to comply with the provisions of this chapter regarding the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program to the same extent as the Department.
4. In addition to meeting the requirements of subsection 3, a contract entered into pursuant to:
(a) Paragraph (a) of subsection 2 may require the pharmacy benefit manager to provide the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, to the Department.
(b) Paragraph (b) of subsection 2 must require the health maintenance organization to provide to the Department the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, less an administrative fee in an amount prescribed by the contract. The Department shall adopt policies prescribing the maximum amount of such an administrative fee.
(Added to NRS by 2019, 4027; A 2021, 1752; 2023, 2088)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.4056 - Audits of certain contracts; posting of audit results on Internet website.

1. Any contract between the Department and a pharmacy benefit manager or health maintenance organization entered into pursuant to NRS 422.4053 must require the pharmacy benefit manager or health maintenance organization, as applicable, to:
(a) Submit to and cooperate with an annual audit by the Department to evaluate the compliance of the pharmacy benefit manager or health maintenance organization with the agreement and generally accepted accounting and business practices. The audit must analyze all claims processed by the pharmacy benefit manager or health maintenance organization pursuant to the agreement.
(b) Obtain from an independent accountant, at the expense of the pharmacy benefit manager or health maintenance organization, as applicable, an annual audit of internal controls to ensure the integrity of financial transactions and claims processing.
2. The Department shall post the results of any audit conducted pursuant to paragraph (a) of subsection 1 on an Internet website maintained by the Department.
(Added to NRS by 2019, 4027)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.406 - Regulations; contracts for services.

1. The Department may, to carry out its duties set forth in NRS 422.27172 to 422.27178, inclusive, and 422.401 to 422.406, inclusive, and to administer the provisions of those sections:
(a) Adopt regulations; and
(b) Enter into contracts for any services.
2. Any regulations adopted by the Department pursuant to NRS 422.27172 to 422.27178, inclusive, and 422.401 to 422.406, inclusive, must be adopted in accordance with the provisions of chapter 241 of NRS.
(Added to NRS by 2003, 1321; A 2017, 1802; 2019, 4032; 2021, 832, 2679)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.410 - Fraudulent acts; penalties.

1. Unless a different penalty is provided pursuant to NRS 422.361 to 422.369, inclusive, or 422.450 to 422.590, inclusive, a person who knowingly and designedly, by any false pretense, false or misleading statement, impersonation, misrepresentation, or concealment, transfer, disposal or assignment of money or property obtains or attempts to obtain monetary or any other public assistance, or money, property, medical or remedial care or any other service provided pursuant to the Children’s Health Insurance Program, having a value of $100 or more, whether by one act or a series of acts, with the intent to cheat, defraud or defeat the purposes of this chapter or to enable a person to meet or appear to meet any requirements of eligibility prescribed by state law or by rule or regulation adopted by the Department for a grant or an increase in a grant of any type of public assistance is guilty of a category E felony and shall be punished as provided in NRS 193.130. In addition to any other penalty, the court shall order the person to pay restitution.
2. For the purposes of subsection 1, whenever a recipient of Temporary Assistance for Needy Families pursuant to the provisions of chapter 422A of NRS receives an overpayment of benefits for the third time and the overpayments have resulted from a false statement or representation by the recipient or from the failure of the recipient to notify the Division of Welfare and Supportive Services of the Department of a change in circumstances which would affect the amount of assistance the recipient receives, a rebuttable presumption arises that the payment was fraudulently received.
3. For the purposes of this section:
(a) "Public assistance" includes any money, property, medical or remedial care or any other service provided pursuant to a state plan.
(b) "Temporary Assistance for Needy Families" has the meaning ascribed to it in NRS 422A.080.
(Added to NRS by 1981, 1909; A 1985, 1405; 1991, 1053; 1993, 142, 2788, 2819; 1995, 1274; 1997, 2239; 1999, 2233; 2005, 22nd Special Session, 38; 2007, 2394; 2013, 1307)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.450 - Definitions.

As used in NRS 422.450 to 422.590, inclusive, unless the context otherwise requires, the words and terms defined in NRS 422.460 to 422.525, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1991, 1048; A 1997, 456)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.470 - "Claim" defined.

"Claim" means a communication, whether oral, written, electronic or magnetic, which is used to identify specific goods, items or services as reimbursable pursuant to the Plan, or which states income or expense and is or may be used to determine a rate of payment pursuant to the Plan.
(Added to NRS by 1991, 1048)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.490 - "Provider" defined.

"Provider" means a:
1. Person who has applied to participate or who participates in the Plan as the provider of goods or services; or
2. Private insurance carrier, health care cooperative or alliance, health maintenance organization, insurer, organization, entity, association, affiliation or person, who contracts to provide or provides goods or services that are reimbursed by or are a required benefit of the Plan.
(Added to NRS by 1991, 1048; A 1997, 456)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.510 - "Records" defined.

"Records" means medical, professional or business records relating to the treatment or care of a recipient, or to a good or a service provided to a recipient, or to rates paid for such a good or a service, and records required to be kept by the Plan.
(Added to NRS by 1991, 1048)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.525 - "Statement or representation" defined.

"Statement or representation" includes, without limitation, a report, claim, certification, acknowledgment or ratification of:
1. Financial information;
2. An enrollment claim;
3. Demographic statistics;
4. Encounter data;
5. Health services available or rendered;
6. The qualifications of the persons rendering the health care or ancillary services; or
7. Any combination of subsections 1 to 6, inclusive.
(Added to NRS by 1997, 456)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.530 - Responsibility for false claim, statement or representation.

For the purposes of NRS 422.540 and 422.550:
1. A person shall be deemed to have known that a claim, statement or representation was false if the person knew, or by virtue of his or her position, authority or responsibility had reason to know, of the falsity of the claim, statement or representation.
2. A person shall be deemed to have made or caused to be made a claim, statement or representation if the person:
(a) Had the authority or responsibility to:
(1) Make the claim, statement or representation;
(2) Supervise another who made the claim, statement or representation; or
(3) Authorize the making of the claim, statement or representation,
whether by operation of law, business or professional practice, or office procedure; and
(b) Exercised that authority or responsibility or failed to exercise that authority or responsibility and, as a direct or indirect result, the false claim, statement or representation was made.
(Added to NRS by 1991, 1048; A 1997, 456)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.540 - Offenses regarding false claims, statements or representations; penalties.

1. A person, with the intent to defraud, commits an offense if with respect to the Plan the person:
(a) Makes a claim or causes it to be made, knowing the claim to be false, in whole or in part, by commission or omission;
(b) Makes or causes to be made a statement or representation for use in obtaining or seeking to obtain authorization to provide specific goods or services, knowing the statement or representation to be false, in whole or in part, by commission or omission;
(c) Makes or causes to be made a statement or representation for use by another in obtaining goods or services pursuant to the Plan, knowing the statement or representation to be false, in whole or in part, by commission or omission; or
(d) Makes or causes to be made a statement or representation for use in qualifying as a provider, knowing the statement or representation to be false, in whole or in part, by commission or omission.
2. A person who commits an offense described in subsection 1 shall be punished for a:
(a) Category D felony, as provided in NRS 193.130, if the amount of the claim or the value of the goods or services obtained or sought to be obtained was greater than or equal to $650.
(b) Misdemeanor if the amount of the claim or the value of the goods or services obtained or sought to be obtained was less than $650.
Amounts involved in separate violations of this section committed pursuant to a scheme or continuing course of conduct may be aggregated in determining the punishment.
3. In addition to any other penalty for a violation of the commission of an offense described in subsection 1, the court shall order the person to pay restitution.
(Added to NRS by 1991, 1049; A 1997, 457; 2011, 174)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.550 - Statement regarding truth and accuracy of applications, reports and invoices; perjury; presumption concerning person who signs statement on behalf of provider.

1. Each application or report submitted to participate as a provider, each report stating income or expense upon which rates of payment are or may be based, and each invoice for payment for goods or services provided to a recipient must contain a statement that all matters stated therein are true and accurate, signed by a natural person who is the provider or is authorized to act for the provider, under the pains and penalties of perjury.
2. A person is guilty of perjury which is a category D felony and shall be punished as provided in NRS 193.130 if the person signs or submits, or causes to be signed or submitted, such a statement, knowing that the application, report or invoice contains information which is false, in whole or in part, by commission or by omission.
3. For the purposes of this section, a person who signs on behalf of a provider is presumed to have the authorization of the provider and to be acting at the direction of the provider.
(Added to NRS by 1991, 1049; A 1995, 1274; 1997, 457)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.560 - Offenses regarding sale, purchase or lease of goods, services, materials or supplies; penalty.

1. Except as otherwise provided in subsection 2, a person shall not:
(a) While acting on behalf of a provider, purchase or lease goods, services, materials or supplies for which payment may be made, in whole or in part, pursuant to the Plan, and solicit or accept anything of additional value in return for or in connection with the purchase or lease;
(b) Sell or lease to or for the use of a provider goods, services, materials or supplies for which payment may be made, in whole or in part, pursuant to the Plan, and offer, transfer or pay anything of additional value in connection with or in return for the sale or lease; or
(c) Refer a person to a provider for goods or services for which payment may be made, in whole or in part, pursuant to the Plan, and solicit or accept anything of value in connection with the referral.
2. Paragraphs (a) and (b) of subsection 1 do not apply if the additional value transferred is:
(a) A refund or discount made in the ordinary course of business;
(b) Reflected by the books and records of the person transferring or receiving it; and
(c) Reflected in the billings submitted to the Plan.
3. A person shall not, while acting on behalf of a provider providing goods or services to a recipient pursuant to the Plan, charge, solicit, accept or receive anything of additional value in addition to the amount legally payable pursuant to the Plan in connection with the provision of the goods or services.
4. A person who violates this section, if the value of the thing or any combination of things unlawfully solicited, accepted, offered, transferred, paid, charged or received:
(a) Is less than $650, is guilty of a gross misdemeanor.
(b) Is $650 or more, is guilty of a category D felony and shall be punished as provided in NRS 193.130.
(Added to NRS by 1991, 1049; A 1995, 1275; 2011, 175)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.570 - Intentional failure to maintain adequate records; intentional destruction of records; penalties.

1. A person is guilty of a gross misdemeanor if, upon submitting a claim for or upon receiving payment for goods or services pursuant to the Plan, the person intentionally fails to maintain such records as are necessary to disclose fully the nature of the goods or services for which a claim was submitted or payment was received, or such records as are necessary to disclose fully all income and expenditures upon which rates of payment were based, for at least 5 years after the date on which payment was received.
2. A person who intentionally destroys such records within 5 years after the date payment was received is guilty of a category D felony and shall be punished as provided in NRS 193.130.
(Added to NRS by 1991, 1050; A 1995, 1275)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.580 - Civil penalties for certain violations; liability of provider for excess amount unknowingly accepted; enforcement; use of money collected as penalty or repayment.

1. A provider who receives payment to which the provider is not entitled by reason of a violation of NRS 422.540, 422.550, 422.560 or 422.570 is liable for:
(a) An amount equal to three times the amount unlawfully obtained;
(b) Not less than $5,000 for each false claim, statement or representation;
(c) An amount equal to three times the total of the reasonable expenses incurred by the State in enforcing this section; and
(d) Payment of interest on the amount of the excess payment at the rate fixed pursuant to NRS 99.040 for the period from the date upon which payment was made to the date upon which repayment is made pursuant to the Plan.
2. A criminal action need not be brought against the provider before civil liability attaches under this section.
3. A provider who unknowingly accepts a payment in excess of the amount to which the provider is entitled is liable for the repayment of the excess amount. It is a defense to any action brought pursuant to this subsection that the provider returned or attempted to return the amount which was in excess of that to which the provider was entitled within a reasonable time after receiving it.
4. The Attorney General shall cause appropriate legal action to be taken on behalf of the State to enforce the provisions of this section.
5. Any penalty or repayment of money collected pursuant to this section is hereby appropriated to provide medical aid to the indigent through programs administered by the Department.
(Added to NRS by 1991, 1050; A 1997, 458; 1999, 2233)
2023 Nevada Revised Statutes › Chapter 422 - Health Care Financing and Policy › NRS 422.590 - Limitation and accrual of actions.

An action brought pursuant to NRS 422.540 to 422.580, inclusive, must be commenced within 4 years, but the cause of action in such a case shall be deemed to accrue upon the discovery by the aggrieved party of the facts constituting a violation of NRS 422.540 to 422.580, inclusive.
(Added to NRS by 1997, 456)
2023 Nevada Revised Statutes › Chapter 422A - Welfare and Supportive Services › NRS 422A.001 - Definitions.

As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 422A.005 to 422A.080, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 2005, 22nd Special Session, 2; A 2013, 1309)
2023 Nevada Revised Statutes › Chapter 422A - Welfare and Supportive Services › NRS 422A.015 - "Children’s Health Insurance Program" defined.

"Children’s Health Insurance Program" means the program established pursuant to 42 U.S.C. §§ 1397aa to 1397jj, inclusive, to provide health insurance for uninsured children from low-income families in this State.
(Added to NRS by 2005, 22nd Special Session, 2)
2023 Nevada Revised Statutes › Chapter 422A - Welfare and Supportive Services › NRS 422A.045 - "Low-Income Home Energy Assistance" defined.

"Low-Income Home Energy Assistance" means the program established to assist persons of low income to meet the costs of heating and cooling their homes pursuant to the Low-Income Home Energy Assistance Act of 1981, 42 U.S.C. §§ 8621 et seq., as amended.
(Added to NRS by 2005, 22nd Special Session, 2)
2023 Nevada Revised Statutes › Chapter 422A - Welfare and Supportive Services › NRS 422A.055 - "Program for Child Care and Development" defined.

"Program for Child Care and Development" means the program established to provide assistance for the care and development of children pursuant to 42 U.S.C. §§ 9858 et seq.
(Added to NRS by 2005, 22nd Special Session, 2)
2023 Nevada Revised Statutes › Chapter 422A - Welfare and Supportive Services › NRS 422A.060 - "Program for the Enforcement of Child Support" defined.

"Program for the Enforcement of Child Support" means the program established to locate absent parents, establish paternity and obtain child support pursuant to Part D of Title IV of the Social Security Act, 42 U.S.C. §§ 651 et seq., and other provisions of that act relating to the enforcement of child support.
(Added to NRS by 2005, 22nd Special Session, 2)