AB383A - Revises provisions relating to health care. (BDR 40-116)

EXEMPT (Reprinted with amendments adopted on June 1, 2023) SECOND REPRINT A.B. 383 - *AB383_R2* ASSEMBLY BILL NO. 383–ASSEMBLYMEN TORRES, PETERS, GORELOW, GONZÁLEZ; ANDERSON, BILBRAY-AXELROD, BROWN-MAY, CONSIDINE, D’SILVA, DURAN, JAUREGUI, C.H. MILLER, NEWBY, SUMMERS-ARMSTRONG, THOMAS AND WATTS MARCH 22, 2023 ____________ JOINT SPONSORS: SENATOR D. HARRIS ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to health care. (BDR 40-116) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to health care; prohibiting a governmental entity from substantially burdening certain activity relating to reproductive health services under certain circumstances; authorizing a person whose engagement in such activity has been so burdened to assert the violation as a claim or defense in a judicial proceeding; authorizing a court to award damages against a governmental entity that substantially burdens such activity in certain circumstances; expanding required coverage of contraception under the State Plan for Medicaid; making appropriations to and authorizing expenditures by the Division of Health Care Financing and Policy of the Department of Health and Human Services; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law prescribes certain rights for a patient of a medical facility or a 1 facility for the dependent. (NRS 449A.100-449A.124) Sections 2-7 of this bill 2 establish the Right to Reproductive Health Care Act. Sections 4-5.5 of this bill 3 define certain terms for purposes of the Act. Section 6 of this bill applies the 4 provisions of the Act to certain state laws and all local laws and ordinances and the 5 – 2 – - *AB383_R2* implementation of those laws and ordinances, regardless of when those laws or 6 ordinances were enacted. Section 7 of this bill generally prohibits a governmental 7 entity from enacting or implementing any limitation or requirement that singles out 8 reproductive health services and substantially burdens: (1) the access of a person to 9 reproductive health services, drugs or devices related to reproductive health 10 services or information related to reproductive health services; or (2) the ability of a 11 provider of health care to provide reproductive health services, drugs or devices 12 related to reproductive health services or information related to reproductive health 13 services within his or her scope of practice, training and experience. Section 7 14 creates an exception to such prohibitions if the governmental entity demonstrates 15 by clear and convincing evidence that the burden, as applied to the person or 16 provider of health care who is subject to the burden: (1) furthers a compelling 17 interest; and (2) is the least restrictive means of furthering that interest. Section 7 18 authorizes a person whose ability to obtain or provide reproductive health services, 19 drugs or devices related to reproductive health services or information related to 20 reproductive health services is burdened to bring or defend an action in court and 21 obtain appropriate relief. Section 7 requires a court to award costs and attorney’s 22 fees to a person who prevails on such a claim. 23 Existing law requires the State Plan for Medicaid to include coverage for 24 certain contraceptive drugs and devices, including: (1) up to a 12-month supply of 25 contraceptive drugs; (2) certain devices for contraception; and (3) voluntary 26 sterilization for women. (NRS 422.27172) Section 8 of this bill additionally 27 requires the State Plan for Medicaid to cover: (1) voluntary sterilization for men; 28 (2) clinical services relating to covered contraceptive drugs, devices and services; 29 and (3) the cost of language translation services provided to facilitate the provision 30 of covered contraceptive drugs, devices and services. Section 8 requires the 31 Division of Health Care Financing and Policy of the Department of Health and 32 Human Services to develop a methodology establishing a rate of compensation for 33 such translation services that is cost effective and comparable to the rate paid for 34 translation services by other governmental entities that arrange for the provision of 35 such services. Section 8 also requires the State Plan to: (1) cover certain 36 contraceptive services when provided by any provider of health care for whom the 37 services are within his or her scope of practice, training and experience; (2) 38 reimburse a provider of health care, other than a physician, physician assistant or 39 advanced practice registered nurse, for providing such services at a rate that is not 40 less than the rate provided to a physician, physician assistant or advanced practice 41 registered nurse; and (3) cover such services regardless of whether the services are 42 provided in an inpatient or outpatient setting. 43 Section 20.5 of this bill makes appropriations to, and authorizes expenditures 44 by, the Division for costs of providing Medicaid coverage for translation services 45 and certain other purposes. 46 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 449A of NRS is hereby amended by 1 adding thereto the provisions set forth as sections 2 to 7, inclusive, 2 of this act. 3 Sec. 2. Sections 2 to 7, inclusive, of this act may be cited as 4 the Right to Reproductive Health Care Act. 5 Sec. 3. As used in sections 2 to 7, inclusive, of this act, unless 6 the context otherwise requires, the words and terms defined in 7 – 3 – - *AB383_R2* sections 4, 5 and 5.5 of this act have the meanings ascribed to 1 them in those sections. 2 Sec. 4. “Governmental entity” means the State of Nevada or 3 any of its agencies or political subdivisions. 4 Sec. 5. “Provider of health care” has the meaning ascribed 5 to it in NRS 629.031. 6 Sec. 5.5. “Reproductive health services” means medical, 7 surgical, counseling or referral services relating to the human 8 reproductive system, including, without limitation, services 9 relating to pregnancy, contraception, miscarriage, in-vitro 10 fertilization or any procedure or care found by a competent 11 medical professional to be appropriate based upon the wishes of a 12 patient and in accordance with the laws of this State. 13 Sec. 6. 1. Except as otherwise provided in this subsection, 14 the provisions of sections 2 to 7, inclusive, of this act apply to all 15 state and local laws and ordinances and the implementation of 16 those laws and ordinances, whether statutory or otherwise, and 17 whether enacted before, on or after January 1, 2024. The 18 provisions of sections 2 to 7, inclusive, of this act do not apply to 19 NRS 442.250 or the implementation of NRS 442.250. 20 2. State laws that are enacted on or after January 1, 2024, are 21 subject to the provisions of sections 2 to 7, inclusive, of this act 22 unless the law explicitly excludes such application by reference to 23 this section. 24 3. The provisions of sections 2 to 7, inclusive, of this act do 25 not: 26 (a) Authorize a governmental entity to burden: 27 (1) The access of any person to reproductive health 28 services, information related to reproductive health services or any 29 drug or device related to reproductive health services; or 30 (2) The ability of a provider of health care to provide 31 reproductive health services or information related to reproductive 32 health services or to provide, administer, dispense or prescribe any 33 drug or device related to reproductive health services within the 34 scope of practice, training and experience of the provider of health 35 care. 36 (b) Authorize or sanction any sterilization procedure without 37 the voluntary and informed consent of the patient. 38 Sec. 7. 1. Except as otherwise provided in this section, a 39 governmental entity shall not enact or implement any limitation or 40 requirement that: 41 (a) Expressly, effectively, implicitly or, as implemented, singles 42 out reproductive health services, drugs or devices related to 43 reproductive health services or information related to reproductive 44 health services or any providers of health care or facilities that 45 – 4 – - *AB383_R2* provide reproductive health services, drugs or devices related to 1 reproductive health services or information related to reproductive 2 health services; and 3 (b) Substantially burdens: 4 (1) The access of a person to reproductive health services, 5 drugs or devices related to reproductive health services or 6 information related to reproductive health services; or 7 (2) The ability of a provider of health care to provide 8 reproductive health services, drugs or devices related to 9 reproductive health services or information related to reproductive 10 health services within the scope of practice, training and 11 experience of the provider of health care. 12 2. A governmental entity may enact a requirement or 13 limitation described in subsection 1 if the governmental entity 14 demonstrates by clear and convincing evidence that the burden 15 imposed by the requirement or limitation on the activity described 16 in paragraph (b) of subsection 1, as applied to the person or 17 provider of health care who is subject to the burden: 18 (a) Furthers a compelling interest; and 19 (b) Is the least restrictive means of furthering that interest. 20 3. Notwithstanding any provision of NRS 41.0305 to 41.039, 21 inclusive, but subject to the limitation on damages set forth in 22 NRS 41.035 when applicable, a person or provider of health care 23 who has been substantially burdened in violation of this section 24 may assert that violation as a claim or defense in a judicial 25 proceeding and obtain appropriate relief. A court shall award 26 costs and attorney’s fees to a person who prevails on such a claim 27 or defense pursuant to this section. 28 4. A court may find that a person is a vexatious litigant if the 29 person makes a claim within the scope of sections 2 to 7, inclusive, 30 of this act which is without merit, fraudulent or otherwise 31 intended to harass or annoy a person. If a court finds that a 32 person is a vexatious litigant pursuant to this subsection, the court 33 may deny standing to that person to bring further claims which 34 allege a violation of this section. 35 Sec. 8. NRS 422.27172 is hereby amended to read as follows: 36 422.27172 1. The Director shall include in the State Plan for 37 Medicaid a requirement that the State pay the nonfederal share of 38 expenditures incurred for: 39 (a) Up to a 12-month supply, per prescription, of any type of 40 drug for contraception or its therapeutic equivalent which is: 41 (1) Lawfully prescribed or ordered; 42 (2) Approved by the Food and Drug Administration; and 43 (3) Dispensed in accordance with NRS 639.28075; 44 – 5 – - *AB383_R2* (b) Any type of device for contraception which is lawfully 1 prescribed or ordered and which has been approved by the Food and 2 Drug Administration; 3 (c) Self-administered hormonal contraceptives dispensed by a 4 pharmacist pursuant to NRS 639.28078; 5 (d) Insertion or removal of a device for contraception; 6 (e) Education and counseling relating to the initiation of the use 7 of contraceptives and any necessary follow-up after initiating such 8 use; 9 (f) Management of side effects relating to contraception; [and] 10 (g) Voluntary sterilization [for women.] ; and 11 (h) Any clinical services relating to the drugs, devices and 12 services described in paragraphs (a) to (g), inclusive. Such clinical 13 services, include, without limitation, services to monitor the use 14 and effectiveness of contraception. 15 2. Except as otherwise provided in subsections 4 and 5, to 16 obtain any benefit provided in the Plan pursuant to subsection 1, a 17 person enrolled in Medicaid must not be required to: 18 (a) Pay a higher deductible, any copayment or coinsurance; or 19 (b) Be subject to a longer waiting period or any other condition. 20 3. The Director shall ensure that the provisions of this section 21 are carried out in a manner which complies with the requirements 22 established by the Drug Use Review Board and set forth in the list 23 of preferred prescription drugs established by the Department 24 pursuant to NRS 422.4025. 25 4. The Plan may require a person enrolled in Medicaid to pay a 26 higher deductible, copayment or coinsurance for a drug for 27 contraception if the person refuses to accept a therapeutic equivalent 28 of the contraceptive drug. 29 5. For each method of contraception which is approved by the 30 Food and Drug Administration, the Plan must include at least one 31 contraceptive drug or device for which no deductible, copayment or 32 coinsurance may be charged to the person enrolled in Medicaid, but 33 the Plan may charge a deductible, copayment or coinsurance for any 34 other contraceptive drug or device that provides the same method of 35 contraception. 36 6. The Plan must: 37 (a) Provide for the reimbursement of a provider of health care 38 for providing services described in subsection 1 if the services are 39 within the scope of practice, training and experience of the 40 provider of health care. 41 (b) Provide coverage for the services described in subsection 1 42 regardless of whether those services are provided in an inpatient 43 or outpatient setting. 44 – 6 – - *AB383_R2* 7. The Director shall include in the State Plan for Medicaid a 1 requirement that the State pay the nonfederal share of 2 expenditures incurred for the costs of any language translation 3 services provided to facilitate the provision of any drug, device or 4 service described in subsection 1. The Division shall develop a 5 methodology establishing a rate of compensation for such 6 translation services that is cost effective and comparable to the 7 rate paid for translation services by other governmental entities 8 that arrange for the provision of such services. 9 8. As used in this section: 10 (a) “Drug Use Review Board” has the meaning ascribed to it in 11 NRS 422.402. 12 (b) “Therapeutic equivalent” means a dru [Text truncated for display. Full text available on LegiScan.]