SB29 - Revises provisions relating to Medicaid. (BDR 38-450)

S.B. 29 - *SB29* SENATE BILL NO. 29–COMMITTEE ON HEALTH AND HUMAN SERVICES (ON BEHALF OF THE PATIENT PROTECTION COMMISSION) PREFILED NOVEMBER 13, 2024 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to Medicaid. (BDR 38-450) 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 Medicaid; requiring the development and implementation of a system of reimbursement for services provided under Medicaid through certain accountable care organizations; requiring a survey of providers of health care who participate in Medicaid; providing for certain increases to the rates of reimbursement under Medicaid for services provided by physicians and advanced practice registered nurses; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires the Department of Health and Human Services to 1 administer Medicaid. (NRS 422.270) Section 2 of this bill requires the Department 2 to develop and implement a system of reimbursement for services provided under 3 the Medicaid program through an accountable care organization that focuses on 4 providing high-quality primary care and is improving health outcomes and 5 lowering costs. Section 2 defines “accountable care organization” to mean a group 6 of providers of health care, medical facilities and other persons providing health 7 services who have entered into a partnership to coordinate care and utilize 8 innovative approaches to deliver care to a specified population. 9 Section 3 of this bill requires the Division of Health Care Financing and Policy 10 of the Department to biennially survey providers of health care who participate in 11 Medicaid to solicit recommendations for improving the manner in which providers 12 request and receive reimbursement from Medicaid and the utilization of providers 13 under Medicaid. Section 4 of this bill makes a conforming change to indicate that 14 the provisions of sections 2 and 3 of this bill will be administered in the same 15 manner as the provisions of existing law governing Medicaid. 16 – 2 – - *SB29* Section 5 of this bill requires the Department to request an amendment to the 17 State Plan for Medicaid to increase the rates of reimbursement for physicians and 18 advanced practice registered nurses. 19 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. To the extent that federal financial participation 3 is available, the Department shall develop and implement a system 4 of reimbursement for services provided to recipients of Medicaid 5 through an accountable care organization that focuses on 6 providing high-quality primary care. The system must include, 7 without limitation, incentive payments and other value-based 8 payment arrangements. 9 2. The Department shall: 10 (a) Apply to the Secretary of Health and Human Services for 11 any waiver or apply for any amendment of the State Plan for 12 Medicaid that is necessary for the Department to receive federal 13 funding to develop and implement the system required by this 14 section. 15 (b) Fully cooperate in good faith with the Federal Government 16 during the application process to satisfy the requirements of the 17 Federal Government for obtaining a waiver or amendment 18 pursuant to paragraph (a). 19 3. An accountable care organization that wishes to 20 participate in the system developed and implemented pursuant to 21 subsection 1 must demonstrate to the Department that the 22 accountable care organization is providing services in a manner 23 that improves health outcomes and lowers costs compared to 24 persons who provide the same services through other models of 25 providing health care. 26 4. As used in this section: 27 (a) “Accountable care organization” means a group of 28 providers of health care, medical facilities and other persons 29 providing health services who have entered into a partnership to 30 coordinate care and utilize innovative approaches to deliver care 31 to a specified population. 32 (b) “Medical facility” has the meaning ascribed to it in 33 NRS 449.0151. 34 (c) “Provider of health care” has the meaning ascribed to it in 35 NRS 629.031. 36 – 3 – - *SB29* Sec. 3. 1. Each biennium, the Division shall survey 1 providers of health care who participate in Medicaid to solicit 2 recommendations for improving: 3 (a) The manner in which providers of health care request and 4 receive reimbursement from Medicaid; and 5 (b) The utilization of providers of health care who participate 6 in Medicaid. 7 2. As used in this section, “provider of health care” has the 8 meaning ascribed to it in NRS 629.031. 9 Sec. 4. NRS 232.320 is hereby amended to read as follows: 10 232.320 1. The Director: 11 (a) Shall appoint, with the consent of the Governor, 12 administrators of the divisions of the Department, who are 13 respectively designated as follows: 14 (1) The Administrator of the Aging and Disability Services 15 Division; 16 (2) The Administrator of the Division of Welfare and 17 Supportive Services; 18 (3) The Administrator of the Division of Child and Family 19 Services; 20 (4) The Administrator of the Division of Health Care 21 Financing and Policy; and 22 (5) The Administrator of the Division of Public and 23 Behavioral Health. 24 (b) Shall administer, through the divisions of the Department, 25 the provisions of chapters 63, 424, 425, 427A, 432A to 442, 26 inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 27 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 28 sections 2 and 3 of this act, 422.580, 432.010 to 432.133, inclusive, 29 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 30 and 445A.010 to 445A.055, inclusive, and all other provisions of 31 law relating to the functions of the divisions of the Department, but 32 is not responsible for the clinical activities of the Division of Public 33 and Behavioral Health or the professional line activities of the other 34 divisions. 35 (c) Shall administer any state program for persons with 36 developmental disabilities established pursuant to the 37 Developmental Disabilities Assistance and Bill of Rights Act of 38 2000, 42 U.S.C. §§ 15001 et seq. 39 (d) Shall, after considering advice from agencies of local 40 governments and nonprofit organizations which provide social 41 services, adopt a master plan for the provision of human services in 42 this State. The Director shall revise the plan biennially and deliver a 43 copy of the plan to the Governor and the Legislature at the 44 beginning of each regular session. The plan must: 45 – 4 – - *SB29* (1) Identify and assess the plans and programs of the 1 Department for the provision of human services, and any 2 duplication of those services by federal, state and local agencies; 3 (2) Set forth priorities for the provision of those services; 4 (3) Provide for communication and the coordination of those 5 services among nonprofit organizations, agencies of local 6 government, the State and the Federal Government; 7 (4) Identify the sources of funding for services provided by 8 the Department and the allocation of that funding; 9 (5) Set forth sufficient information to assist the Department 10 in providing those services and in the planning and budgeting for the 11 future provision of those services; and 12 (6) Contain any other information necessary for the 13 Department to communicate effectively with the Federal 14 Government concerning demographic trends, formulas for the 15 distribution of federal money and any need for the modification of 16 programs administered by the Department. 17 (e) May, by regulation, require nonprofit organizations and state 18 and local governmental agencies to provide information regarding 19 the programs of those organizations and agencies, excluding 20 detailed information relating to their budgets and payrolls, which the 21 Director deems necessary for the performance of the duties imposed 22 upon him or her pursuant to this section. 23 (f) Has such other powers and duties as are provided by law. 24 2. Notwithstanding any other provision of law, the Director, or 25 the Director’s designee, is responsible for appointing and removing 26 subordinate officers and employees of the Department. 27 Sec. 5. 1. On or before January 1, 2026, the Department of 28 Health and Human Services shall submit to the United States 29 Secretary of Health and Human Services a request to amend the 30 State Plan for Medicaid to increase the rates of reimbursement 31 which are provided on a fee-for-service basis pursuant to the State 32 Plan for Medicaid for services provided by a physician or advanced 33 practice registered nurse: 34 (a) Except as otherwise provided in paragraph (b), by at least 8 35 percent if the services are provided: 36 (1) In a county whose population is less than 100,000; or 37 (2) In any other county pursuant to a value-based payment 38 arrangement; 39 (b) By at least 11 percent if the services are provided: 40 (1) In a county whose population is less than 100,000; and 41 (2) Pursuant to a value-based payment arrangement; and 42 (c) By at least 5 percent, in all other cases. 43 – 5 – - *SB29* 2. The request submitted pursuant to subsection 1 must be 1 supported using methods for determining rates of reimbursement 2 that are accepted by the Secretary. 3 3. The Department of Health and Human Services shall ensure 4 that a managed care organization that provides health services to 5 recipients of Medicaid under the State Plan for Medicaid pays at 6 least the rates of reimbursement established pursuant to subsection 1 7 for services described in that subsection. 8 4. As used in this section, “managed care organization” has the 9 meaning ascribed to it in NRS 695G.050. 10 Sec. 6. 1. This section and section 5 become effective upon 11 passage and approval. 12 2. Sections 1 to 4, inclusive, of this act become effective: 13 (a) Upon passage and approval for the purpose of adopting any 14 regulations and performing any other preparatory administrative 15 tasks that are necessary to carry out the provisions of this act; and 16 (b) On January 1, 2026, for all other purposes. 17 H