SB118 - Revises requirements relating to coverage under Medicaid for certain services provided by pharmacists. (BDR 38-218)

S.B. 118 - *SB118* SENATE BILL NO. 118–SENATOR STONE PREFILED JANUARY 27, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises requirements relating to coverage under Medicaid for certain services provided by pharmacists. (BDR 38-218) FISCAL NOTE: Effect on Local Government: No. 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 Medicaid to include coverage for certain services provided by a pharmacist; imposing requirements relating to the rate of reimbursement that a pharmacist must receive for services covered under Medicaid; prohibiting Medicaid or a managed care organization that provides health care services to recipients of Medicaid from requiring prior authorization for the services of a pharmacist under certain circumstances; 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 1 of this bill requires the Director of 2 the Department to include under Medicaid: (1) coverage for services provided by a 3 pharmacist within his or her scope of practice if such services are covered when 4 performed by another provider of health care; and (2) reimbursement for such 5 services at an amount equal to or greater than the amount reimbursed to a 6 physician, physician assistant or advanced practice registered nurse for similar 7 services. Sections 1 and 5 of this bill prohibit Medicaid or a managed care 8 organization that provides health care services to recipients of Medicaid from 9 requiring prior authorization for such a service if prior authorization is not required 10 when the service is performed by another provider of health care. Sections 2, 3 and 11 6 of this bill remove requirements related to coverage under Medicaid for specific 12 services provided by pharmacists because section 1 would provide for the coverage 13 of such services. Section 4 of this bill makes a conforming change to indicate that 14 the provisions of section 1 will be administered in the same manner as other 15 provisions of existing law governing Medicaid. 16 – 2 – - *SB118* 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 a new section to read as follows: 2 1. To the extent that federal financial participation is 3 available, the Director shall include under Medicaid coverage for 4 services provided by a pharmacist that are: 5 (a) Within the authorized scope of practice of the pharmacist; 6 and 7 (b) Covered when provided by another provider of health care. 8 2. Medicaid must not limit: 9 (a) Coverage for services provided by a pharmacist to a 10 number of occasions less than for such services when provided by 11 another provider of health care. 12 (b) Reimbursement for services provided by a pharmacist to an 13 amount less than the amount reimbursed for similar services 14 provided by a physician, physician assistant or advanced practice 15 registered nurse. 16 3. Medicaid or a managed care organization, including a 17 health maintenance organization, that provides health care 18 services to recipients of Medicaid shall not require a recipient of 19 Medicaid to obtain prior authorization for any service provided by 20 a pharmacist that is not required for the service when provided by 21 another provider of health care. 22 4. As used in this section: 23 (a) “Health maintenance organization” has the meaning 24 ascribed to it in NRS 695C.030. 25 (b) “Managed care organization” has the meaning ascribed to 26 it in NRS 695G.050. 27 (c) “Provider of health care” has the meaning ascribed to it in 28 NRS 629.031. 29 Sec. 2. NRS 422.27172 is hereby amended to read as follows: 30 422.27172 1. The Director shall include in the State Plan for 31 Medicaid a requirement that the State pay the nonfederal share of 32 expenditures incurred for: 33 (a) Up to a 12-month supply, per prescription, of any type of 34 drug for contraception or its therapeutic equivalent which is: 35 (1) Lawfully prescribed or ordered; 36 (2) Approved by the Food and Drug Administration; and 37 (3) Dispensed in accordance with NRS 639.28075; 38 (b) Any type of device for contraception which is lawfully 39 prescribed or ordered and which has been approved by the Food and 40 Drug Administration; 41 – 3 – - *SB118* (c) Self-administered hormonal contraceptives dispensed by a 1 pharmacist pursuant to NRS 639.28078; 2 (d) Insertion or removal of a device for contraception, including, 3 without limitation, the insertion of such a device at a hospital 4 immediately after a person gives birth; 5 (e) A contraceptive injection, including, without limitation, such 6 an injection immediately after a person gives birth. 7 (f) Education and counseling relating to the initiation of the use 8 of contraceptives and any necessary follow-up after initiating such 9 use; 10 (g) Management of side effects relating to contraception; and 11 (h) Voluntary sterilization for women. 12 2. Except as otherwise provided in subsections 4 and 5, to 13 obtain any benefit provided in the Plan pursuant to subsection 1, a 14 person enrolled in Medicaid must not be required to: 15 (a) Pay a higher deductible, any copayment or coinsurance; or 16 (b) Be subject to a longer waiting period or any other condition. 17 3. The Director shall ensure that the provisions of this section 18 are carried out in a manner which complies with the requirements 19 established by the Drug Use Review Board and set forth in the list 20 of preferred prescription drugs established by the Department 21 pursuant to NRS 422.4025. 22 4. The Plan may require a person enrolled in Medicaid to pay a 23 higher deductible, copayment or coinsurance for a drug for 24 contraception if the person refuses to accept a therapeutic equivalent 25 of the contraceptive drug. 26 5. For each method of contraception which is approved by the 27 Food and Drug Administration, the Plan must include at least one 28 contraceptive drug or device for which no deductible, copayment or 29 coinsurance may be charged to the person enrolled in Medicaid, but 30 the Plan may charge a deductible, copayment or coinsurance for any 31 other contraceptive drug or device that provides the same method of 32 contraception. If the Plan requires a person enrolled in Medicaid to 33 pay a copayment or coinsurance for a drug for contraception, the 34 Plan may only require the person to pay the copayment or 35 coinsurance: 36 (a) Once for the entire amount of the drug dispensed for the plan 37 year; or 38 (b) Once for each 1-month supply of the drug dispensed. 39 6. [The Plan must provide for the reimbursement of a 40 pharmacist for providing services described in subsection 1 that are 41 within the scope of practice of the pharmacist to the same extent as 42 if the services were provided by another provider of health care. The 43 Plan must not limit: 44 – 4 – - *SB118* (a) Coverage for such services provided by a pharmacist to a 1 number of occasions less than the coverage for such services when 2 provided by another provider of health care. 3 (b) Reimbursement for such services provided by a pharmacist 4 to an amount less than the amount reimbursed for similar services 5 provided by a physician, physician assistant or advanced practice 6 registered nurse. 7 7.] The Plan must not require a recipient of Medicaid to obtain 8 prior authorization for the benefits described in paragraphs (a) and 9 (c) of subsection 1. 10 [8.] 7. As used in this section: 11 (a) “Drug Use Review Board” has the meaning ascribed to it in 12 NRS 422.402. 13 (b) “Provider of health care” has the meaning ascribed to it in 14 NRS 629.031. 15 (c) “Therapeutic equivalent” means a drug which: 16 (1) Contains an identical amount of the same active 17 ingredients in the same dosage and method of administration as 18 another drug; 19 (2) Is expected to have the same clinical effect when 20 administered to a patient pursuant to a prescription or order as 21 another drug; and 22 (3) Meets any other criteria required by the Food and Drug 23 Administration for classification as a therapeutic equivalent. 24 Sec. 3. NRS 422.27235 is hereby amended to read as follows: 25 422.27235 1. The Director shall include in the State Plan for 26 Medicaid a requirement that the State pay the nonfederal share of 27 expenditures incurred for: 28 (a) Any laboratory testing that is necessary for therapy that uses 29 a drug approved by the United States Food and Drug Administration 30 for preventing the acquisition of human immunodeficiency virus. 31 (b) [The services of a pharmacist described in NRS 639.28085. 32 The State must provide reimbursement for such services at a rate 33 equal to the rate of reimbursement provided to a physician, 34 physician assistant or advanced practice registered nurse for similar 35 services. 36 (c)] Any service to test for, prevent or treat human 37 immunodeficiency virus or hepatitis C provided by a provider of 38 primary care if the service is covered when provided by a specialist 39 and: 40 (1) The service is within the scope of practice of the provider 41 of primary care; or 42 (2) The provider of primary care is capable of providing the 43 service safely and effectively in consultation with a specialist and 44 the provider engages in such consultation. 45 – 5 – - *SB118* 2. The Director shall include in the State Plan for Medicaid a 1 requirement that the State reimburse an advanced practice registered 2 nurse or a physician assistant for any service to test for, prevent or 3 treat human immunodeficiency virus or hepatitis C at a rate equal to 4 the rate of reimbursement provided to a physician for similar 5 services. 6 3. As used in this section, “primary care” means the practice of 7 family medicine, pediatrics, internal medicine, obstetrics and 8 gynecology and midwifery. 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 section 1 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 – 6 – - *SB118* (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. NRS 687B.225 is hereby amended to read as follows: 28 687B.225 1. Except as otherwise provided in NRS 29 689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 30 689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 31 689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 32 689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 33 695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 34 695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 35 695B.1925, 695B.1942, 695C [Text truncated for display. Full text available on LegiScan.]