SB312 - Enacts provisions relating to the health of American Indians. (BDR 38-347)

- 83rd Session (2025) Senate Bill No. 312–Committee on Health and Human Services CHAPTER.......... AN ACT relating to health care; authorizing Indian tribes to determine if a person is presumptively eligible for Medicaid; creating the Tribal Health Authority Council; prescribing the procedure governing the operations of the Council; authorizing the appointment of the Coordinator of the Council; prescribing the duties of the Council; creating the Account for Tribal Health; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law creates the Department of Native American Affairs, which consists of the Executive Director, the Nevada Indian Commission and the Stewart Indian School Cultural Center and Museum. (NRS 233A.1003) Section 5 of this bill creates the Tribal Health Authority Council and establishes the membership of the Council. Section 4 of this bill defines the term “Council” to refer to the Council for the purposes of sections 4-9 of this bill. Section 6 of this bill: (1) establishes certain requirements governing the operation of the Council; (2) authorizes a member of the Council to participate through a remote technology system; and (3) provides for the election of the officers of the Council. Section 7 authorizes the Executive Director to appoint a Coordinator of the Council. Section 7 also requires the Department to provide any additional personnel, facilities, equipment and supplies to the Council. Section 8 of this bill prescribes the duties of the Council, which include adopting and periodically updating a plan to increase access to health care and address and eliminate barriers to health care for American Indians in this State. Section 1.5 of this bill authorizes the Council to request the drafting of not more than 2 legislative measures which relate to matters within the scope of the Council. Section 1.8 of this bill subjects those requests to certain provisions that apply to requests for the drafting of legislation that are submitted by nonlegislative requesters. Section 9 of this bill creates the Account for Tribal Health to fund the activities of the Council. Section 11 of this bill requires the Director of the Department of Health and Human Services to collaborate with the Council to develop a proposal to establish a program to reinvest certain federal funds received by this State under the Medicaid program. Existing law requires the Department of Health and Human Services to administer Medicaid. (NRS 422.270) Additionally, existing federal law requires the Secretary of Health and Human Services to encourage enrollment of American Indians in Medicaid. (42 U.S.C. § 1320b-9) To the extent authorized by federal law, section 1 of this bill authorizes an Indian tribe to determine whether a person is presumptively eligible to receive benefits under Medicaid. Section 1 requires the Department to apply for any waiver of federal law or apply for any amendment to the State Plan for Medicaid to authorize an Indian tribe to make such determinations. Section 1 additionally requires the Department to provide to each Indian tribe that determines presumptive eligibility the resources, training and technical assistance necessary for the Indian tribe to accurately and effectively determine if a person is presumptively eligible to receive benefits under Medicaid. Section 2 of this bill makes a conforming change to indicate that the provisions of – 2 – - 83rd Session (2025) section 1 will be administered in the same manner as the provisions of existing law governing Medicaid. 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 authorized by federal law, an Indian tribe may determine whether a person is presumptively eligible to receive benefits under Medicaid. 2. The Department shall: (a) 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 to carry out the provisions of subsection 1; and (b) 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 (a). 3. The Department shall provide to each Indian tribe that determines presumptive eligibility pursuant to subsection 1 the resources, training and technical assistance necessary for the Indian tribe to accurately and effectively determine whether a person is presumptively eligible for benefits under Medicaid, including, without limitation, by: (a) Developing and providing training to the representatives of the Indian tribe who are involved in determinations of presumptive eligibility, including, without limitation, through the distribution of training materials and conducting virtual and in- person training; (b) Providing technical assistance and support to ensure that the Indian tribe has the tools necessary to make accurate determinations of presumptive eligibility in compliance with state and federal laws and regulations; and (c) Ensuring that the Indian tribe is able to communicate with the Department and the Tribal Health Authority Council created by section 5 of this act concerning clarification, guidance and updates on changes in the policies or procedures of Medicaid. – 3 – - 83rd Session (2025) 4. As used in this section, “Indian tribe” means a federally recognized American Indian tribe pursuant to 25 C.F.R. §§ 83.1 to 83.12, inclusive. Sec. 1.5. Chapter 218D of NRS is hereby amended by adding thereto a new section to read as follows: 1. The Tribal Health Authority Council created by section 5 of this act may request the drafting of not more than 2 legislative measures which relate to matters within the scope of the Council. The requests must be submitted to the Legislative Counsel on or before September 1 preceding a regular session. 2. Each request made pursuant to this section must be on a form prescribed by the Legislative Counsel. The legislative measures requested pursuant to this section must be prefiled on or before the third Wednesday in November preceding a regular session. A legislative measure that is not prefiled on or before that day shall be deemed withdrawn. Sec. 1.8. NRS 218D.100 is hereby amended to read as follows: 218D.100 1. The provisions of NRS 218D.100 to 218D.220, inclusive, and section 1.5 of this act apply to requests for the drafting of legislative measures for a regular session. 2. Except as otherwise provided by a specific statute, joint rule or concurrent resolution, the Legislative Counsel shall not honor a request for the drafting of a legislative measure if the request: (a) Exceeds the number of requests authorized by NRS 218D.100 to 218D.220, inclusive, and section 1.5 of this act for the requester; or (b) Is submitted by an authorized nonlegislative requester pursuant to NRS 218D.175 to 218D.220, inclusive, and section 1.5 of this act but is not in a subject related to the function of the requester. 3. The Legislative Counsel shall not: (a) Honor a request to change the subject matter of a request for the drafting of a legislative measure after it has been submitted for drafting. (b) Honor a request for the drafting of a legislative measure which has been combined in violation of Section 17 of Article 4 of the Nevada Constitution. Sec. 2. 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: – 4 – - 83rd Session (2025) (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: (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 – 5 – - 83rd Session (2025) (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. 3. Chapter 233A of NRS is hereby amended by adding thereto the provisions set forth as sections 4 to 9, inclusive, of this act. Sec. 4. As used in sections 4 to 9, inclusive, of this act, unless the context otherwise requires, “Council” means the Tribal Health Authority Council. Sec. 5. 1. The Tribal Health Authority Council is hereby created. 2. The Council consists of: (a) The director of each health care facility located in this State which is operated by an Indian tribe that elects to participate, or his or her designee, as voting members. (b) The following nonvoting members: (1) One representative of the office of the Indian Health Service having jurisdiction over this State. (2) Any person appointed by a state agency pursuant to subsection 3. 3. A state agency whose functions relate to health care may appoint a nonvoting member of the Council to serve as a liaison between the Council and the agency. 4. The members of the Council serve without compensation and are not entitled to the per diem and travel expenses provided for state officers and employees generally. 5. Each member of the Council who is an officer or employee of this State or a political subdivision of this State must be relieved from his or her duties without loss of regular compensation so that the officer or employee may prepare for and attend meetings of the Council and perform any work necessary to carry out the duties of – 6 – - 83rd Session (2025) the Council in the most timely manner practicable. A state agency or political subdivision of this State shall not require an officer or employee who is a member of the Council to make up the time the officer or employee is absent from work to carry out duties as a member of the Council or use annual leave or compensatory time for the absence. 6. As used in this section, “Indian tribe” means a federally recognized American Indian tribe pursuant to 25 C.F.R. §§ 83.1 to 83.12, inclusive. Sec. 6. 1. The Council shall meet: (a) At least once each quarter; and (b) At the times and places specified by a call of the Chair or a majority of the voting members of the Council. 2. A member of the Council may participate in the meeting through a remote technology system. A member appearing remotely may participate in the meeting as if the member were appearing in person. 3. A majority of the voting members of the Council constitutes a quorum for the transaction of business, and a majority of a quorum present at any meeting is sufficient for any official action taken by the Council. 4. If an alternate member attends a meeting of the Council in place of the regular member, the alternate member fully assumes the duties, rights and responsibilities of the replaced regular member for the duration of that meeting. 5. Except as otherwise provided in this subsection, the Council shall elect from the voting members a Chair and Vice Chair by a majority vote of the voting members of the Council. The Chair and Vice Chair serve until July 1 of the year following their election and may be reelected. If the position of Chair or Vice Chair becomes vacant, the position must be filled in the same manner as the original election for the remainder of the unexpired term. 6. As used in this section, “remote technology system” has the meaning ascribed to it in NRS 241.015. Sec. 7. 1. The Executive Director of the Departm [Text truncated for display. Full text available on LegiScan.]