AB516 - Revises provisions relating to Medicaid coverage for certain health services provided to children at schools. (BDR 38-348)

EXEMPT (Reprinted with amendments adopted on April 18, 2025) FIRST REPRINT A.B. 516 - *AB516_R1* ASSEMBLY BILL NO. 516–COMMITTEE ON HEALTH AND HUMAN SERVICES (ON BEHALF OF THE JOINT INTERIM STANDING COMMITTEE ON HEALTH AND HUMAN SERVICES) MARCH 24, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to Medicaid coverage for certain health services provided to children at schools. (BDR 38-348) FISCAL NOTE: Effect on Local Government: No. Effect on the State: Contains Appropriation not included in Executive Budget. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to Medicaid; requiring the Director of the Department of Health and Human Services to take certain measures to facilitate the provision of health services to certain children who are recipients of Medicaid; establishing the School Health Access Resource Center in the Division of Health Care Financing and Policy of the Department for the purpose of providing certain assistance relating to participation in Medicaid as a provider; providing for the increase of certain rates of reimbursement under Medicaid; requiring the Director to apply for any federal authority necessary to simplify and streamline the methodology for reimbursing under Medicaid certain services provided by a school-based health center; making appropriations; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires the Department of Health and Human Services, through 1 the Division of Health Care Financing and Policy of the Department, to administer 2 Medicaid. (NRS 422.2357, 422.270) Section 2 of this bill requires the Director of 3 the Department to: (1) take any action necessary to ensure that local educational 4 agencies and the Department of Education are able to receive reimbursement for 5 – 2 – - *AB516_R1* health services covered by Medicaid when provided on the premises of a school to 6 certain children who are recipients of Medicaid; and (2) establish incentives for 7 certain providers to enter into an agreement with a local educational agency or the 8 Department of Education to provide health services to such children who are 9 enrolled in a public school. Section 3 of this bill establishes the School Health 10 Access Resource Center within the Division for the purpose of assisting providers 11 of services under Medicaid and persons and entities who wish to provide services to 12 recipients of Medicaid on the premises of a school to evaluate and utilize different 13 methods of participating in and billing Medicaid. Section 4 of this bill makes a 14 conforming change to require the Director to administer the provisions of sections 15 2 and 3 in the same manner as the provisions of existing law governing Medicaid. 16 Section 5 of this bill makes appropriations to the Division to cover certain costs of 17 operating the Center. 18 Section 6 of this bill requires the Director to apply for any federal authority that 19 is necessary to increase by at least 5 percent the rates of reimbursement for services 20 covered by Medicaid when provided on the premises of a school by an employee or 21 independent contractor of: (1) a local educational agency; or (2) the Department of 22 Education. Section 6 also requires the Director to apply for any federal authority 23 that is necessary to: (1) simplify and streamline the methodology for reimbursing 24 primary care and preventative services covered by Medicaid when such services are 25 provided by a school-based health center; and (2) increase by at least 10 percent the 26 rates of reimbursement under Medicaid for such services provided by a school- 27 based health center. 28 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 1 thereto the provisions set forth as sections 2 and 3 of this act. 2 Sec. 2. 1. The Director shall: 3 (a) Take any action necessary to ensure that local educational 4 agencies and the Department of Education are able to receive 5 reimbursement for health services covered by Medicaid when such 6 services are provided on the premises of a school to children who 7 are recipients of Medicaid. 8 (b) Establish a program of incentive payments that increase 9 the effective rates of reimbursement provided under Medicaid to a 10 certified community behavioral health clinic or federally-qualified 11 health center that enters into an agreement with a local 12 educational agency or the Department of Education to provide 13 services covered by Medicaid to children who are: 14 (1) Enrolled in a public school; and 15 (2) Recipients of Medicaid. 16 2. The incentives provided pursuant to paragraph (b) of 17 subsection 1 may be provided through increased rates of 18 reimbursement or value-based payment models. 19 3. The Department shall apply to the Secretary of Health and 20 Human Services for any necessary waiver, amendment of the State 21 – 3 – - *AB516_R1* Plan for Medicaid or other federal authority that authorizes the 1 Department to receive federal funding to carry out the provisions 2 of this section. The Department shall fully cooperate in good faith 3 with the Federal Government during the application process to 4 satisfy the requirements of the Federal Government for obtaining 5 a waiver, amendment or other federal authority pursuant to this 6 section. 7 4. As used in this section: 8 (a) “Certified community behavioral health clinic” means a 9 community behavioral health clinic certified in accordance with 10 section 223 of the Protecting Access to Medicare Act of 2014, 11 Public Law No. 113-93. 12 (b) “Federally-qualified health center” has the meaning 13 ascribed to it in 42 U.S.C. § 1396d(l)(2)(B). 14 (c) “Local educational agency” has the meaning ascribed to it 15 in 20 U.S.C. § 7801(30)(A). 16 (d) “Value-based payment model” means a method of payment 17 for health care services that provides incentives based on the 18 quality of care. 19 Sec. 3. 1. The School Health Access Resource Center is 20 hereby established within the Division. 21 2. The School Health Access Resource Center shall assist 22 providers of services under Medicaid and persons and entities that 23 wish to provide services to recipients of Medicaid on the premises 24 of a school to: 25 (a) Evaluate the benefits and drawbacks of various methods of 26 participating in and billing Medicaid that are available to the 27 provider, person or entity, including, without limitation, different 28 provider types under which the provider, person or entity may be 29 authorized to participate in and bill Medicaid; and 30 (b) Meet the requirements and carry out the procedures 31 necessary to participate in and bill Medicaid using the methods 32 chosen by the provider, person or entity, as applicable. 33 3. The Division shall provide the necessary facilities, 34 equipment, staff, supplies and other usual operating expenses 35 necessary to enable the School Health Access Resource Center to 36 carry out its functions. 37 Sec. 4. NRS 232.320 is hereby amended to read as follows: 38 232.320 1. The Director: 39 (a) Shall appoint, with the consent of the Governor, 40 administrators of the divisions of the Department, who are 41 respectively designated as follows: 42 (1) The Administrator of the Aging and Disability Services 43 Division; 44 – 4 – - *AB516_R1* (2) The Administrator of the Division of Welfare and 1 Supportive Services; 2 (3) The Administrator of the Division of Child and Family 3 Services; 4 (4) The Administrator of the Division of Health Care 5 Financing and Policy; and 6 (5) The Administrator of the Division of Public and 7 Behavioral Health. 8 (b) Shall administer, through the divisions of the Department, 9 the provisions of chapters 63, 424, 425, 427A, 432A to 442, 10 inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 11 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 12 sections 2 and 3 of this act, 422.580, 432.010 to 432.133, inclusive, 13 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 14 and 445A.010 to 445A.055, inclusive, and all other provisions of 15 law relating to the functions of the divisions of the Department, but 16 is not responsible for the clinical activities of the Division of Public 17 and Behavioral Health or the professional line activities of the other 18 divisions. 19 (c) Shall administer any state program for persons with 20 developmental disabilities established pursuant to the 21 Developmental Disabilities Assistance and Bill of Rights Act of 22 2000, 42 U.S.C. §§ 15001 et seq. 23 (d) Shall, after considering advice from agencies of local 24 governments and nonprofit organizations which provide social 25 services, adopt a master plan for the provision of human services in 26 this State. The Director shall revise the plan biennially and deliver a 27 copy of the plan to the Governor and the Legislature at the 28 beginning of each regular session. The plan must: 29 (1) Identify and assess the plans and programs of the 30 Department for the provision of human services, and any 31 duplication of those services by federal, state and local agencies; 32 (2) Set forth priorities for the provision of those services; 33 (3) Provide for communication and the coordination of those 34 services among nonprofit organizations, agencies of local 35 government, the State and the Federal Government; 36 (4) Identify the sources of funding for services provided by 37 the Department and the allocation of that funding; 38 (5) Set forth sufficient information to assist the Department 39 in providing those services and in the planning and budgeting for the 40 future provision of those services; and 41 (6) Contain any other information necessary for the 42 Department to communicate effectively with the Federal 43 Government concerning demographic trends, formulas for the 44 – 5 – - *AB516_R1* distribution of federal money and any need for the modification of 1 programs administered by the Department. 2 (e) May, by regulation, require nonprofit organizations and state 3 and local governmental agencies to provide information regarding 4 the programs of those organizations and agencies, excluding 5 detailed information relating to their budgets and payrolls, which the 6 Director deems necessary for the performance of the duties imposed 7 upon him or her pursuant to this section. 8 (f) Has such other powers and duties as are provided by law. 9 2. Notwithstanding any other provision of law, the Director, or 10 the Director’s designee, is responsible for appointing and removing 11 subordinate officers and employees of the Department. 12 Sec. 5. 1. There is hereby appropriated from the State 13 General Fund to the Division of Health Care Financing and Policy 14 of the Department of Health and Human Services: 15 (a) The sum of $600,000 to enter into contracts with such 16 persons or entities as are necessary to conceptualize and establish 17 the School Health Access Resource Center pursuant to section 3 of 18 this act. 19 (b) The sum of $224,000 for the purposes of hiring staff for and 20 covering the costs of operating the School Health Access Resource 21 Center. 22 (c) The sum of $5,000 to acquire such equipment as is necessary 23 to operate the School Health Access Resource Center. 24 2. Any remaining balance of the appropriations made by 25 subsection 1 must not be committed for expenditure after June 30, 26 2027, by the entity to which the appropriation is made or any entity 27 to which money from the appropriation is granted or otherwise 28 transferred in any manner, and any portion of the appropriated 29 money remaining must not be spent for any purpose after 30 September 17, 2027, by either the entity to which the money was 31 appropriated or the entity to which the money was subsequently 32 granted or transferred, and must be reverted to the State General 33 Fund on or before September 17, 2027. 34 Sec. 6. 1. On or before October 1, 2025, the Director of the 35 Department of Health and Human Services shall submit to the 36 United States Secretary of Health and Human Services a request to 37 amend the State Plan for Medicaid or for any other necessary federal 38 authority to: 39 (a) Increase by at least 5 percent the rates of reimbursement for 40 services covered by Medicaid when such services are provided: 41 (1) On the premises of a school; and 42 (2) By an employee or independent contractor of a local 43 educational agency, as defined in 20 U.S.C. § 7801(30)(A), or the 44 Department of Education; 45 – 6 – - *AB516_R1* (b) Simplify and streamline the methodology for reimbursing 1 primary care and preventative services covered by Medicaid when 2 such care and services are provided by a school-based health center; 3 and 4 (c) Increase by at least 10 percent the rates of reimbursement 5 under Medicaid for services described in paragraph (b) when such 6 care and services are provided by a school-based health center. 7 2. As used in this section, “school-based health center” means 8 a health center located on or in school grounds, property, buildings 9 or any other school district facilities for the purpose of rendering 10 care or services to any person. 11 Sec. 7. 1. This section becomes effective upon passage and 12 approval. 13 2. Sections 5 and 6 of this act become effective on July 1, 14 2025. 15 3. Sections 1 to 4, inclusive, of this act become effective: 16 (a) Upon passage and approval for the purpose of adopting any 17 regulations and performing any other preparatory administrative 18 tasks that are necessary to carry out the provisions of this act; and 19 (b) On January 1, 2026, for all other purposes. 20 H