AB514 - Makes revisions relating to mental health care. (BDR 38-350)

- 83rd Session (2025) Assembly Bill No. 514–Committee on Health and Human Services CHAPTER.......... AN ACT relating to mental health; requiring Medicaid to provide coverage for rehabilitative residential mental health care; requiring the State Long-Term Care Ombudsman to investigate and provide certain assistance to providers of rehabilitative residential mental health care; providing for the licensure and regulation of providers of rehabilitative residential mental health care; making appropriations to and authorizing certain expenditures by the Division of Health Care Financing and Policy of the Department of Health and Human Services; providing a penalty; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires the Department of Health and Human Services to administer Medicaid. (NRS 422.270) Section 1 of this bill requires the Director of the Department to include under Medicaid coverage for rehabilitative residential mental health care provided to certain recipients of Medicaid. Section 5 of this bill defines the term “rehabilitative residential mental health care” to mean community- based, medically monitored care provided in a residential setting that uses established rehabilitative principles to achieve certain goals relating to mental health. Section 6 of this bill applies that definition to provisions of existing law governing medical facilities and other related entities. Section 3 of this bill makes a conforming change to require the Director to administer the provisions of section 1 in the same manner as the provisions of existing law governing the State Plan for Medicaid. Section 17.5 of this bill makes appropriations to and authorizes expenditures by the Division of Health Care Financing and Policy of the Department for costs associated with providing the coverage required by section 1. Existing law provides for the licensure and regulation by the Division of Public and Behavioral Health of the Department of community-based living arrangement services, which are flexible, individualized services that are: (1) provided in the home, for compensation, to persons with mental illness; and (2) designed and coordinated to assist such persons in maximizing their independence. (NRS 449.0026, 449.0045, 449.030, 449.0302) Sections 2 and 4-16 of this bill similarly provide for the licensure and regulation of providers of rehabilitative residential mental health care. Section 8 requires such a provider to obtain a license as a facility for the dependent and comply with other requirements applicable to such facilities. Sections 7, 9 and 10 clarify that such a provider is separate from certain other types of facilities for the dependent. Section 11 requires the State Board of Health to adopt specific regulations governing providers of rehabilitative residential mental health care. Sections 12 and 15 provide for the inspection of buildings operated by such providers. Sections 13 and 14: (1) require periodic background investigations of the personnel of a provider of rehabilitative residential mental health care; and (2) authorize the suspension or revocation of the license of such a provider if the provider or an employee of the provider has been convicted of certain crimes. (NRS 449.174) Section 16 requires a provider of rehabilitative residential mental health care to notify a person receiving such care from the provider, his or her parent or legal guardian or another designated person upon the – 2 – - 83rd Session (2025) discovery by the Division of a deficiency affecting the health and safety of a patient. Section 4 requires such a provider to comply with provisions governing the reporting and investigation of sentinel events and the designation of patient safety officers. (NRS 439.800-439.890) Section 2 adds providers of rehabilitative residential mental health care to the list of facilities that the State Long-Term Care Ombudsman is required to investigate and assist. (NRS 427A.125-427A.165) Section 17 of this bill provides that a person is not required to be a licensed nurse to provide rehabilitative residential mental health care if the person is licensed pursuant to the provisions of this bill. Operating as a provider of rehabilitative residential mental health care without a license would be a misdemeanor. (NRS 449.210) EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 422 of NRS is hereby amended by adding thereto a new section to read as follows: 1. To the extent that federal financial participation is available, the Director shall include under Medicaid coverage for rehabilitative residential mental health care. Such coverage is not required to pay the costs of room and board for a recipient of rehabilitative residential mental health care. 2. The Department shall: (a) Establish a method for providing the coverage described in subsection 1. (b) Apply to the Secretary of Health and Human Services for any waiver of federal law or apply for any amendment of the State Plan for Medicaid that is necessary for the Department to receive federal funding to provide the coverage described in subsection 1. (c) 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 paragraph (b). 3. As used in this section, “rehabilitative residential mental health care” has the meaning ascribed to it in section 5 of this act. Sec. 2. NRS 427A.0292 is hereby amended to read as follows: 427A.0292 “Living arrangement services” means: 1. Community-based living arrangement services, as defined in NRS 449.0026, that include: (a) Intensive services and overnight supervision of recipients who require training concerning behavioral skills, self-care and management of medications; or – 3 – - 83rd Session (2025) (b) Services in the home for recipients with chronic medical conditions and severe mental illness who require habilitation or rehabilitation services, or both; [and] 2. Supported living arrangement services, as defined in NRS 435.3315, that include 24-hour care [.] ; and 3. Rehabilitative residential mental health care, as defined in section 5 of this act. Sec. 3. NRS 232.320 is hereby amended to read as follows: 232.320 1. The Director: (a) Shall appoint, with the consent of the Governor, administrators of the divisions of the Department, who are respectively designated as follows: (1) The Administrator of the Aging and Disability Services Division; (2) The Administrator of the Division of Welfare and Supportive Services; (3) The Administrator of the Division of Child and Family Services; (4) The Administrator of the Division of Health Care Financing and Policy; and (5) The Administrator of the Division of Public and Behavioral Health. (b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public and Behavioral Health or the professional line activities of the other divisions. (c) Shall administer any state program for persons with developmental disabilities established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C. §§ 15001 et seq. (d) Shall, after considering advice from agencies of local governments and nonprofit organizations which provide social services, adopt a master plan for the provision of human services in this State. The Director shall revise the plan biennially and deliver a copy of the plan to the Governor and the Legislature at the beginning of each regular session. The plan must: – 4 – - 83rd Session (2025) (1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplication of those services by federal, state and local agencies; (2) Set forth priorities for the provision of those services; (3) Provide for communication and the coordination of those services among nonprofit organizations, agencies of local government, the State and the Federal Government; (4) Identify the sources of funding for services provided by the Department and the allocation of that funding; (5) Set forth sufficient information to assist the Department in providing those services and in the planning and budgeting for the future provision of those services; and (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department. (e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section. (f) Has such other powers and duties as are provided by law. 2. Notwithstanding any other provision of law, the Director, or the Director’s designee, is responsible for appointing and removing subordinate officers and employees of the Department. Sec. 4. NRS 439.803 is hereby amended to read as follows: 439.803 “Health facility” means: 1. Any facility licensed by the Division pursuant to chapter 449 of NRS; and 2. A home operated by [a] : (a) A provider of community-based living arrangement services, as defined in NRS 449.0026 [.] ; or (b) A provider of rehabilitative residential mental health care, as defined in section 5 of this act. Sec. 5. Chapter 449 of NRS is hereby amended by adding thereto a new section to read as follows: “Rehabilitative residential mental health care” means community-based, medically monitored care provided in a residential setting that uses established rehabilitative principles to: 1. Promote the recovery of the client with a mental illness or other behavioral health condition; and – 5 – - 83rd Session (2025) 2. Assist the client in achieving psychiatric stability, personal and emotional adjustment, self-sufficiency and other skills necessary to transition to a more independent setting. Sec. 6. NRS 449.001 is hereby amended to read as follows: 449.001 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 449.0015 to 449.0195, inclusive, and section 5 of this act have the meanings ascribed to them in those sections. Sec. 7. NRS 449.0026 is hereby amended to read as follows: 449.0026 1. “Community-based living arrangement services” means flexible, individualized services, including, without limitation, training and habilitation services, that are: [1.] (a) Provided in the home, for compensation, to persons with mental illness who are served by the Division or any other entity; and [2.] (b) Designed and coordinated to assist such persons in maximizing their independence. 2. The term does not include rehabilitative residential mental health care. Sec. 8. NRS 449.0045 is hereby amended to read as follows: 449.0045 “Facility for the dependent” includes: 1. A facility for the treatment of alcohol or other substance use disorders; 2. A facility for the care of adults during the day; 3. A residential facility for groups; 4. An agency to provide personal care services in the home; 5. A facility for transitional living for released offenders; 6. A home for individual residential care; 7. A community health worker pool; [and] 8. A provider of community-based living arrangement services [.] ; and 9. A provider of rehabilitative residential mental health care. Sec. 9. NRS 449.0105 is hereby amended to read as follows: 449.0105 “Home for individual residential care” means a home in which a natural person furnishes food, shelter, assistance and limited supervision, for compensation, to not more than two persons with intellectual disabilities or with physical disabilities or who are aged or infirm, unless the persons receiving those services are related within the third degree of consanguinity or affinity to the person providing those services. The term does not include: 1. A recovery house for persons recovering from alcohol or other substance use disorders; [or] – 6 – - 83rd Session (2025) 2. A home in which community-based living arrangement services or supported living arrangement services are provided by a provider of such services during any period in which the provider is engaged in providing the services [.] ; or 3. A location where rehabilitative residential mental health care is provided by a provider of such care. Sec. 10. NRS 449.017 is hereby amended to read as follows: 449.017 1. Except as otherwise provided in subsection 2, “residential facility for groups” means an establishment that furnishes food, shelter, assistance and limited supervision to a person with an intellectual disability or with a physical disability or a person who is aged or infirm. The term includes, without limitation, an assisted living facility. 2. The term does not include: (a) An establishment which provides care only during the day; (b) A natural person who provides care for no more than two persons in his or her own home; (c) A natural person who provides care for one or more persons related to him or her within the third degree of consanguinity or affinity; (d) A recovery house for persons recovering from alcohol or other substance use disorders; [or] (e) A home in which community-based living arrangement services or supported living arrangement services are provided by a provider of such services during any period in which the provider is providing the services [.] ; or (f) A location where rehabilitative residential mental health care is provided by a provider of such care. S [Text truncated for display. Full text available on LegiScan.]