AB349 - Makes revisions relating to health care. (BDR 23-343)

A.B. 349 - *AB349* ASSEMBLY BILL NO. 349–ASSEMBLYMEMBER ORENTLICHER MARCH 3, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Makes revisions relating to health care. (BDR 23-343) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. CONTAINS UNFUNDED MANDATE (§§ 8, 14, 18) (NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT) ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to health care; establishing maximum rates that hospitals, independent centers for emergency medical care and surgical centers for ambulatory patients may charge for certain goods and services provided to patients covered by certain insurance for public employees; requiring hospitals to publish certain information relating to pricing; authorizing the imposition of certain administrative penalties and sanctions; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law creates the Public Employees’ Benefits Program to provide group 1 life, accident or health insurance to certain public employees, state officers and 2 members of the Legislature in this State. (NRS 287.043) Existing law also 3 prescribes a procedure to determine the amount that a third party which provides 4 health coverage to a person, including the Public Employees’ Benefits Program, is 5 required to pay to an out-of-network hospital, independent center for emergency 6 medical care or other provider of health care for medically necessary emergency 7 services rendered to that person. (NRS 439B.700-439B.760) Section 5 of this bill 8 establishes maximum rates that hospitals, independent centers for emergency 9 medical care and surgical centers for ambulatory patients may charge for goods and 10 services when provided to a patient who is covered by the Program or a local 11 government employer that elects to be subject to those maximum rates. Those 12 maximum rates differ depending on whether the facility is an in-network facility or 13 an out-of-network facility. Section 5 authorizes the Division of Health Care 14 Financing and Policy of the Department of Health and Human Services to increase 15 those maximum rates if: (1) the Division determines that health care facilities in 16 – 2 – - *AB349* this State are experiencing financial hardship due to a decrease in the rates of 17 reimbursement provided under Medicaid; and (2) the Interim Finance Committee 18 approves the increase. Section 11 of this bill authorizes the Interim Finance 19 Committee to consider such an increase during a regular or special session of the 20 Legislature. Section 9 of this bill prescribes the manner in which a local 21 government employer may opt in to the provisions of section 5. 22 Section 19 of this bill requires the Board and each participating local 23 government employer to consider the change in rates as a result of implementing 24 section 5 when assessing the cost of premiums of contributions for the Program. 25 Sections 3 and 4 of this bill define necessary terms, and section 2 of this bill 26 establishes the applicability of those definitions. Section 6 of this bill requires the 27 Division to annually submit to the Legislature a report concerning the impacts of 28 the maximum rates established by section 5. 29 Section 7 of this bill requires the Division to adopt certain regulations to 30 implement sections 2-8 of this bill, including regulations prescribing civil penalties 31 to be imposed against a health care facility that charges the Program or a 32 participating local government employer an amount that exceeds the maximum 33 rates prescribed by section 5. Sections 8 and 14 of this bill provide for the 34 imposition of disciplinary action against a health care facility for such a violation. 35 Section 8 also authorizes: (1) the Division or Attorney General to maintain a suit 36 for an injunction against such a violation; and (2) any person or entity injured by 37 such a violation to maintain a suit for damages and attorney’s fees and costs. 38 Section 10 of this bill applies the definitions in existing law relating to the 39 Program to the provisions of sections 2-8. Sections 13 and 16 of this bill make 40 conforming changes to clarify the application of existing provisions concerning the 41 rates that a health care facility, including a county hospital, may charge for certain 42 services. Sections 17 and 18 of this bill make conforming changes to clarify the 43 applicability of certain provisions of existing law relating to the Program. (NRS 44 687B.409, 689B.065) 45 Existing federal regulations require a hospital to publish: (1) a list of standard 46 charges for all items and services provided by the hospital; and (2) a consumer- 47 friendly list of standard charges for a limited set of shoppable services, which are 48 services provided by a hospital that can be scheduled by a consumer in advance. 49 (45 C.F.R. §§ 180.20, 180.40-180.60) Section 12 of this bill requires each hospital 50 in this State to comply with those federal requirements, and sections 12, 14 and 15 51 authorize the imposition of disciplinary action against a hospital that fails to 52 comply with those requirements. 53 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 287 of NRS is hereby amended by adding 1 thereto the provisions set forth as sections 2 to 8, inclusive, of this 2 act. 3 Sec. 2. As used in sections 2 to 8, inclusive, of this act, unless 4 the context otherwise requires, the words and terms defined in 5 sections 3 and 4 of this act have the meanings ascribed to them in 6 those sections. 7 Sec. 3. “Division” means the Division of Health Care 8 Financing and Policy of the Department of Health and Human 9 Services. 10 – 3 – - *AB349* Sec. 4. “Health care facility” means: 1 1. A hospital, as defined in NRS 449.012, other than a 2 hospital which has been certified as a critical access hospital by 3 the United States Secretary of Health and Human Services 4 pursuant to 42 U.S.C. § 1395i-4(e). 5 2. An independent center for emergency medical care, as 6 defined in NRS 449.013. 7 3. A surgical center for ambulatory patients, as defined in 8 NRS 449.019. 9 Sec. 5. 1. Notwithstanding any other provision of law 10 except for subsection 3 to the contrary, any contract for goods and 11 services between the Board or an opt-in local government and a 12 health care facility must establish a rate of reimbursement for 13 inpatient and outpatient services provided by an in-network facility 14 that does not exceed the lesser of: 15 (a) The billed charge for the service; 16 (b) The rate of reimbursement prescribed for the services in a 17 contract between the Board or the opt-in local government, as 18 applicable, and the health care facility for the 2024 plan year; or 19 (c) One hundred and seventy-five percent of the rate of 20 reimbursement provided by Medicare for the same or similar 21 services on the date on which the service is provided. 22 2. Notwithstanding any other provision of law except for 23 subsection 3 to the contrary, an out-of-network facility shall not 24 charge the Program or an opt-in local government an amount for 25 inpatient or outpatient services provided by the health care facility 26 that exceed the lesser of: 27 (a) The billed charge for the service; 28 (b) The rate of reimbursement prescribed for the services in a 29 contract between the Board or the opt-in local government, as 30 applicable, and the health care facility for the 2024 plan year; or 31 (c) One hundred and sixty percent of the rate of 32 reimbursement provided by Medicare for the same or similar 33 services on the date on which the service is provided. 34 3. The Division, with the approval of the Interim Finance 35 Committee, may increase the maximum rates of reimbursement 36 prescribed by subsections 1 and 2 if the Division determines that 37 health care facilities in this State are experiencing financial 38 hardship due to a decrease in the rates of reimbursement provided 39 under Medicaid. 40 4. Nothing in this section prohibits the Board or an opt-in 41 local government from reimbursing a health care facility through 42 a payment model other than fee-for-service as long as: 43 (a) The payments incentivize higher quality or improved health 44 outcomes; and 45 – 4 – - *AB349* (b) The rates of reimbursement paid under the payment model 1 comply with the requirements of this section. 2 5. As used in this section: 3 (a) “In-network facility” means a health care facility that has 4 entered into a contract with the Program or an opt-in local 5 government to provide care to persons covered by the Program or 6 opt-in local government. 7 (b) “Opt-in local government” means a governing body of a 8 county, school district, municipal corporation, political 9 subdivision, public corporation or other local governmental 10 agency of the State of Nevada that provides health coverage 11 pursuant to NRS 287.010 or any issuer of a policy of health 12 insurance purchased pursuant to NRS 287.010 that elects 13 pursuant to NRS 287.012 to pay the rates prescribed by this 14 section to health care facilities. 15 (c) “Out-of-network facility” means a health care facility that 16 has not entered into a contract with the Program or an opt-in local 17 government to provide care to persons covered by the Program or 18 opt-in local government. 19 Sec. 6. On or before July 30 of each even-numbered year, 20 the Division shall: 21 1. Review and study the impacts of the provisions of section 5 22 of this act; 23 2. Compile a report with a summary of such information and 24 any recommendations relating to the provisions of section 5 of this 25 act; and 26 3. Submit the report compiled pursuant to subsection 2 to the 27 Director of the Legislative Counsel Bureau for transmittal to the 28 Joint Interim Standing Committee on Health and Human 29 Services. 30 Sec. 7. The Division shall adopt any regulations necessary to 31 carry out the provisions of sections 2 to 8, inclusive, of this act, 32 including, without limitation, regulations prescribing civil 33 penalties that may be imposed against a health care facility that 34 charges a rate that exceeds the maximum amounts prescribed by 35 section 5 of this act for services to which the provisions of that 36 section apply. 37 Sec. 8. 1. The Division may report any failure by a health 38 care facility to comply with the provisions of sections 2 to 8, 39 inclusive, of this act to the Division of Public and Behavioral 40 Health of the Department of Health and Human Services for the 41 initiation of disciplinary proceedings. 42 2. The Division or the Attorney General may maintain in any 43 court of competent jurisdiction a suit to enjoin any person from 44 charging rates that exceed the maximum amounts prescribed by 45 – 5 – - *AB349* section 5 of this act for services to which the provisions of that 1 section apply. Such an injunction: 2 (a) May be issued without proof of actual damage sustained by 3 any person as a preventive or punitive measure. 4 (b) Does not relieve any person or business entity from any 5 other legal action. 6 3. Any person or entity injured by the failure of a health care 7 facility to charge rates in accordance with the provisions of section 8 5 of this act for services to which that section applies may 9 maintain in any court of competent jurisdiction a suit to recover: 10 (a) Damages resulting from such failure; and 11 (b) Attorney’s fees and costs. 12 Sec. 9. NRS 287.012 is hereby amended to read as follows: 13 287.012 1. A governing body of a county, school district, 14 municipal corporation, political subdivision, public corporation or 15 other local governmental agency of the State of Nevada that 16 provides coverage of prescription drugs pursuant to NRS 287.010 or 17 any issuer of a policy of health insurance purchased pursuant to 18 NRS 287.010 may use the list of preferred prescription drugs 19 developed by the Department of Health and Human Services 20 pursuant to subsection 1 of NRS 422.4025 as its formulary and 21 obtain prescription drugs through the purchasing agreements 22 negotiated by the Department pursuant to that section by notifying 23 the Department in the form prescribed by the Department. 24 2. A governing body of a county, school district, municipal 25 corporation, political subdivision, public corporation or other 26 local governmental agency of the State of Nevada that provides 27 health coverage pursuant to NRS 287.010 or any issuer of a policy 28 of health insurance purchased pursuant to NRS 287.010 may elect 29 to pay rates established by section 5 of this act to health care 30 facilities for goods and services described in that section by 31 notifying the Division of Health Care Financing and Policy of the 32 Department in the form prescribed by the Department. 33 3. As used in this section, “health care facility” has the 34 meaning ascribed to it in section 4 of this act. 35 Sec. 10. NRS 287.0402 is hereby amended to read as follows: 36 287.0402 As used in NRS 287.0402 to 287.049, inclusive, and 37 sections 2 to 8, inclusive, of this act, unless the context otherwise 38 requires, the words and terms defined in NRS 287.0404 to 39 287.04064, inclusive, have the meanings ascribed to them in those 40 sections. 41 Sec. 11. NRS 218E.405 is hereby amended to read as follows: 42 218E.405 1. Except as otherwise provided in subsection 2, 43 the Interim Finance Committee may exercise the powers conferred 44 – 6 – - *AB349* upon it by law only when the Legislature is not in a regular or 1 special session. 2 2. During a regular or special session, the Interim Finance 3 Committee may also perform the duties imposed on it by NRS 4 228.1111, subsection 5 of NRS 284.115, NRS 285.070, subsection 2 5 of NRS 321.335, NRS 322.007, subsection 2 of NRS 323.020, NRS 6 323.050, subsection 1 of NRS 323.100, subsection 3 of 7 NRS 341.126, NRS 341.142, paragraph (f) of subsection 1 of NRS 8 341.145, subsection 3 of NRS 349.073, NRS 353.220, 353.224, 9 353.2705 to 353.2771, inclusive, 353.288, 353.335, 353.3375, 10 353C.224, 353C.226, paragraph (b) of subsection 4 of NRS 11 407.0762, NRS 428.375, [Text truncated for display. Full text available on LegiScan.]