SB244 - Requires Medicaid to provide coverage of certain treatments for obesity. (BDR 38-206)

S.B. 244 - *SB244* SENATE BILL NO. 244–SENATORS LANGE, NGUYEN, CRUZ-CRAWFORD; FLORES AND TAYLOR FEBRUARY 26, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Requires Medicaid to provide coverage of certain treatments for obesity. (BDR 38-206) 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 cover certain treatments for obesity and the services of certain programs for the prevention of diabetes; 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 coverage for: (1) intensive health, 3 behavior and lifestyle treatment for obesity; and (2) certain surgical interventions to 4 treat obesity. Section 1 also requires the Director to include under Medicaid the 5 services of certain programs approved under federal regulations for the treatment of 6 diabetes for recipients of Medicaid who: (1) are eligible for such programs; and (2) 7 have not previously participated in a diabetes prevention program while enrolled in 8 Medicaid. Section 4 of this bill requires the Department to notify recipients of 9 Medicaid when such coverage becomes available. Section 3 of this bill makes a 10 conforming change to require the Director to administer the provisions of section 1 11 in the same manner as other provisions governing Medicaid. 12 Existing law requires the Department to develop a list of preferred prescription 13 drugs to be used for the Medicaid program. (NRS 422.4025) Section 2 of this bill 14 requires that list to include prescription drugs approved by the United States Food 15 and Drug Administration with an indication for chronic weight management in 16 patients who have been diagnosed with obesity. Section 2 requires the Medicaid 17 program to cover such drugs to the extent that the drugs are prescribed in 18 accordance with the indications of the United States Food and Drug 19 Administration. 20 – 2 – - *SB244* 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 (a) Treatment for obesity, including, without limitation, 5 coverage of: 6 (1) Intensive health, behavior and lifestyle treatment; and 7 (2) Any surgical intervention included in the most current 8 Guidelines on Indications for Metabolic and Bariatric Surgery 9 published by the American Society for Metabolic and Bariatric 10 Surgery and the International Federation for the Surgery of 11 Obesity and Metabolic Disorders; and 12 (b) The services of a diabetes prevention program for 13 recipients of Medicaid who: 14 (1) Meet the eligibility requirements for the diabetes 15 prevention program; and 16 (2) Have not previously participated in a diabetes 17 prevention program while enrolled in Medicaid. 18 2. The Department shall: 19 (a) Apply to the Secretary of Health and Human Services for 20 any waiver of federal law or apply for any amendment of the State 21 Plan for Medicaid that is necessary for the Department to receive 22 federal funding to provide the coverage described in subsection 1. 23 (b) Fully cooperate in good faith with the Federal Government 24 during the application process to satisfy the requirements of the 25 Federal Government for obtaining a waiver or amendment 26 pursuant to paragraph (a). 27 3. As used in this section: 28 (a) “Diabetes prevention program” means a program that: 29 (1) Consists of structured sessions to create changes in 30 behavioral health for the purpose of preventing or delaying the 31 onset of type II diabetes; 32 (2) Is provided by an entity recognized by the Diabetes 33 Prevention Recognition Program, as defined in 42 C.F.R. § 34 410.79, and is delivered in a manner authorized by that program; 35 and 36 (3) Follows a CDC-approved DPP curriculum, as defined 37 in 42 C.F.R. § 410.79. 38 (b) “Intensive health, behavior and lifestyle treatment” means 39 an evidence-based, intensive, multi-component program to modify 40 the behavior and lifestyle of a participant that: 41 (1) Supports healthy weight management; 42 – 3 – - *SB244* (2) Meets current standards recognized by the Centers for 1 Disease Control and Prevention of the United States Department 2 of Health and Human Services or current clinical standards of 3 care; and 4 (3) Is provided: 5 (I) In person in an office or community-based setting; 6 or 7 (II) Virtually or through telehealth, as defined in 8 NRS 629.515. 9 Sec. 2. NRS 422.4025 is hereby amended to read as follows: 10 422.4025 1. The Department shall: 11 (a) By regulation, develop a list of preferred prescription drugs 12 to be used for the Medicaid program and the Children’s Health 13 Insurance Program, and each public or nonprofit health benefit plan 14 that elects to use the list of preferred prescription drugs as its 15 formulary pursuant to NRS 287.012, 287.0433 or 687B.407; and 16 (b) Negotiate and enter into agreements to purchase the drugs 17 included on the list of preferred prescription drugs on behalf of the 18 health benefit plans described in paragraph (a) or enter into a 19 contract pursuant to NRS 422.4053 with a pharmacy benefit 20 manager, health maintenance organization or one or more public or 21 private entities in this State, the District of Columbia or other states 22 or territories of the United States, as appropriate, to negotiate such 23 agreements. 24 2. The Department shall, by regulation, establish a list of 25 prescription drugs which must be excluded from any restrictions that 26 are imposed by the Medicaid program on drugs that are on the list of 27 preferred prescription drugs established pursuant to subsection 1. 28 The list established pursuant to this subsection must include, 29 without limitation: 30 (a) Prescription drugs that are prescribed for the treatment of the 31 human immunodeficiency virus, including, without limitation, 32 antiretroviral medications; 33 (b) Antirejection medications for organ transplants; 34 (c) Antihemophilic medications; and 35 (d) Any prescription drug which the Board identifies as 36 appropriate for exclusion from any restrictions that are imposed by 37 the Medicaid program on drugs that are on the list of preferred 38 prescription drugs. 39 3. The regulations must provide that the Board makes the final 40 determination of: 41 (a) Whether a class of therapeutic prescription drugs is included 42 on the list of preferred prescription drugs and is excluded from any 43 restrictions that are imposed by the Medicaid program on drugs that 44 are on the list of preferred prescription drugs; 45 – 4 – - *SB244* (b) Which therapeutically equivalent prescription drugs will be 1 reviewed for inclusion on the list of preferred prescription drugs and 2 for exclusion from any restrictions that are imposed by the Medicaid 3 program on drugs that are on the list of preferred prescription drugs; 4 and 5 (c) Which prescription drugs should be excluded from any 6 restrictions that are imposed by the Medicaid program on drugs that 7 are on the list of preferred prescription drugs based on continuity of 8 care concerning a specific diagnosis, condition, class of therapeutic 9 prescription drugs or medical specialty. 10 4. The list of preferred prescription drugs established pursuant 11 to subsection 1 must include, without limitation: 12 (a) Any prescription drug determined by the Board to be 13 essential for treating sickle cell disease and its variants; [and] 14 (b) Prescription drugs to prevent the acquisition of human 15 immunodeficiency virus [.] ; and 16 (c) Prescription drugs approved by the United States Food and 17 Drug Administration with an indication for chronic weight 18 management in patients who have been diagnosed with obesity. 19 5. The regulations must provide that each new pharmaceutical 20 product and each existing pharmaceutical product for which there is 21 new clinical evidence supporting its inclusion on the list of preferred 22 prescription drugs must be made available pursuant to the Medicaid 23 program with prior authorization until the Board reviews the product 24 or the evidence. 25 6. The Medicaid program must cover a prescription drug that is 26 not included on the list of preferred prescription drugs as if the drug 27 were included on that list if: 28 (a) The drug is: 29 (1) Used to treat hepatitis C; 30 (2) Used to provide medication-assisted treatment for opioid 31 use disorder; 32 (3) Used to support safe withdrawal from substance use 33 disorder; or 34 (4) In the same class as a drug on the list of preferred 35 prescription drugs; and 36 (b) All preferred prescription drugs within the same class as the 37 drug are unsuitable for a recipient of Medicaid because: 38 (1) The recipient is allergic to all preferred prescription drugs 39 within the same class as the drug; 40 (2) All preferred prescription drugs within the same class as 41 the drug are contraindicated for the recipient or are likely to interact 42 in a harmful manner with another drug that the recipient is taking; 43 (3) The recipient has a history of adverse reactions to all 44 preferred prescription drugs within the same class as the drug; or 45 – 5 – - *SB244* (4) The drug has a unique indication that is supported by 1 peer-reviewed clinical evidence or approved by the United States 2 Food and Drug Administration. 3 7. The Medicaid program must automatically cover any typical 4 or atypical antipsychotic medication or anticonvulsant medication 5 that is not on the list of preferred prescription drugs upon the 6 demonstrated therapeutic failure of one drug on that list to 7 adequately treat the condition of a recipient of Medicaid. 8 8. The Medicaid program must cover the drugs described in 9 paragraph (c) of subsection 4 to the extent that such drugs are 10 prescribed in accordance with the indications of the United States 11 Food and Drug Administration. 12 9. On or before February 1 of each year, the Department shall: 13 (a) Compile a report concerning the agreements negotiated 14 pursuant to paragraph (b) of subsection 1 and contracts entered into 15 pursuant to NRS 422.4053 which must include, without limitation, 16 the financial effects of obtaining prescription drugs through those 17 agreements and contracts, in total and aggregated separately for 18 agreements negotiated by the Department, contracts with a 19 pharmacy benefit manager, contracts with a health maintenance 20 organization and contracts with public and private entities from this 21 State, the District of Columbia and other states and territories of the 22 United States; and 23 (b) Post the report on an Internet website maintained by the 24 Department and submit the report to the Director of the Legislative 25 Counsel Bureau for transmittal to: 26 (1) In odd-numbered years, the Legislature; or 27 (2) In even-numbered years, the Legislative Commission. 28 Sec. 3. NRS 232.320 is hereby amended to read as follows: 29 232.320 1. The Director: 30 (a) Shall appoint, with the consent of the Governor, 31 administrators of the divisions of the Department, who are 32 respectively designated as follows: 33 (1) The Administrator of the Aging and Disability Services 34 Division; 35 (2) The Administrator of the Division of Welfare and 36 Supportive Services; 37 (3) The Administrator of the Division of Child and Family 38 Services; 39 (4) The Administrator of the Division of Health Care 40 Financing and Policy; and 41 (5) The Administrator of the Division of Public and 42 Behavioral Health. 43 (b) Shall administer, through the divisions of the Department, 44 the provisions of chapters 63, 424, 425, 427A, 432A to 442, 45 – 6 – - *SB244* inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 1 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 2 section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 3 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 4 and 445A.010 to 445A.055, inclusive, and all other provisions of 5 law relating to the functions of the divisions of the Department, but 6 is not responsible for the clinical activities of the Division of Public 7 and Behavioral Health or the professional line activities of the other 8 divisions. 9 (c) Shall administer any state program for persons with 10 developmental disabilities established pursuant to the 11 Developmental Disabilities Assistance and Bill of Rights Act of 12 2000, 42 U.S.C. §§ 15001 et seq. 13 (d) Shall, after considering advice from agencies of local 14 governments and nonprofit organizations which provide social 15 services, adopt a master plan for the provision of human services in 16 this State. The Director shall revise the plan biennially and deliver a 17 copy of the plan to the Governor and the Legislature at the 18 beginning of each regular session. The plan must: 19 (1) Identify and assess the plans and programs of the 20 Department for the provision of human services, and any 21 duplication of those services by federal, state and local agencies; 22 (2) Set forth priorities for the provision of those services; 23 (3) Provide for communication and the coordination of those 24 services among nonprofit organizations, agencies of local 25 government, the State and the Federal Government; 26 (4) Identify the sources of funding for services provided by 27 the Department and the allocation of that funding; 28 (5) Set forth sufficient information to assist the Department 29 in providing those services and in the planning and budgeting for the 30 future provision of those services; and 31 (6) Contain any other information necessary for the 32 Department to communicate effectively with the Federal [Text truncated for display. Full text available on LegiScan.]