SB337 - Revises provisions relating to opioids. (BDR 40-204)

EXEMPT (Reprinted with amendments adopted on April 21, 2025) FIRST REPRINT S.B. 337 - *SB337_R1* SENATE BILL NO. 337–SENATOR LANGE MARCH 12, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to opioids. (BDR 40-204) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. CONTAINS UNFUNDED MANDATE (§§ 1, 16, 26) (NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT) ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to health care; requiring certain health care facilities and certain providers of health care to provide patients with a form for a non-opioid directive and offer patients treatments that do not utilize an opioid under certain circumstances; requiring the Division of Public and Behavioral Health of the Department of Health and Human Services to create a form for a non-opioid directive; requiring the Administrator of the Division to appoint an advisory board to monitor compliance with laws and regulations relating to the non-opioid directive; requiring certain policies of health insurance to include coverage for at least one drug that is an alternative to opioids; requiring certain insurers to provide the form for a non-opioid directive to new insureds; revising the manner by which money in the Fund for a Resilient Nevada allocates money to projects and grants; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law authorizes a patient to execute certain directives and declarations 1 to record his or her wishes relating to health care and to direct providers of health 2 care in the provision of health care to the patient. (NRS 449A.400-449A.645) 3 Section 15 of this bill requires the Division of Public and Behavioral Health of the 4 Department of Health and Human Services to create a non-opioid directive, which 5 is a form on which a person may indicate that he or she does not wish to receive 6 – 2 – - *SB337_R1* opioids, and to post the non-opioid directive on an Internet website maintained by 7 the Division. Section 16 of this bill requires: (1) certain practitioners to provide a 8 person with an opportunity to execute a non-opioid directive; (2) third party 9 insurers that provide health coverage to provide persons who enroll in such health 10 coverage a non-opioid directive; and (3) certain health care facilities to ensure that 11 persons providing care at the facility provide a patient with an opportunity to 12 execute a non-opioid directive. Section 16 also requires such third party insurers 13 and health facilities to post the non-opioid directive on their Internet websites. 14 Sections 17 and 18 of this bill set forth the procedure for a patient to execute and 15 revoke a non-opioid directive. 16 Section 19 of this bill prohibits a person who knows or should know that a 17 person has executed a non-opioid directive from prescribing, administering or 18 directing or supervising the administration of an opioid to that person except under 19 certain circumstances. Section 21 of this bill requires the State Board of Health to 20 adopt regulations prescribing procedures relating to the non-opioid directive. 21 Sections 22 and 23 of this bill require the Administrator of the Division to 22 appoint an advisory board to: (1) review the implementation of and compliance 23 with provisions relating to the non-opioid directive; and (2) make recommendations 24 to practitioner licensing boards and certain governmental entities concerning issues 25 relating to opioid use and alternative treatments that do not utilize opioids. Sections 26 8-14 of this bill define certain terms used in sections 8-23. 27 Sections 1 and 33-40 of this bill require a medical facility, certain other health 28 care facilities and certain practitioners who prescribe or administer opioids to 29 comply with the provisions of law governing non-opioid directives. Under section 30 55 of this bill, beginning on July 1, 2027, or 6 months after the date on which the 31 regulations relating to the non-opioid directives become effective, whichever is 32 later, sections 1, 33, 35-37, 39 and 40 require such facilities and practitioners to 33 offer and provide alternative treatments that do not utilize opioids to patients who 34 have requested such alternatives or executed non-opioid directives, except in 35 certain circumstances. Sections 1, 33, 35-37, 39 and 40 require the regulatory 36 bodies that license such facilities and practitioners to biennially review the 37 compliance of such facilities and practitioners with those requirements. Sections 34 38 and 38 make conforming changes to clarify that sections 33 and 37, respectively, 39 apply to the prescribing and administering of opioids to treat intractable pain. 40 Sections 2-6 and 41 of this bill provide for the administration and enforcement of 41 section 1 in the same manner as other requirements imposed by existing law on 42 licensed health facilities. 43 Sections 25 and 54 of this bill authorize the Board of the Public Employees’ 44 Benefits Program and the Public Option, which is a state-run health insurance 45 program for private citizens, to reduce the rates paid to a facility or practitioner who 46 violates any provision of section 33, 35-37, 39 or 40 or prohibit the facility or 47 practitioner from receiving payments through the Program or the Public Option. 48 (NRS 695K.200) Section 27 of this bill applies certain definitions to section 25. 49 Existing law requires public and private policies of insurance regulated under 50 Nevada law and employers who provide such insurance for their employees to 51 include coverage for drugs to: (1) support safe withdrawal from substance use 52 disorder; and (2) provide medication-assisted treatment for opioid use disorder. 53 (NRS 287.010, 287.04335, 422.4025, 608.1555, 689A.0459, 689B.0319, 54 689C.1665, 689C.425, 695A.1874, 695B.19197, 695C.050, 695C.1699, 55 695G.1719) Sections 26, 28, 43, 45-50 and 53 of this bill require certain public and 56 private policies of health insurance, not including Medicaid, to cover drugs that are 57 alternatives to opioids for purposes for which opioids are commonly used. Sections 58 42, 43, 45-50 and 53 of this bill prohibit certain insurers from imposing prior 59 authorization and certain other conditions on covered opioid alternatives that are 60 not imposed on opioids. Section 44 of this bill authorizes the Commissioner of 61 – 3 – - *SB337_R1* Insurance to require certain policies of health insurance issued by a domestic 62 insurer to a person who resides in another state to include the coverage required by 63 section 43. Sections 51 and 53.5 of this bill exempt certain policies of health 64 insurance that provide health care services to recipients of Medicaid or insurance 65 pursuant to the Children’s Health Insurance Program from requirements to cover 66 drugs that are alternatives to opioids for purposes for which opioids are commonly 67 used. Section 52 of this bill authorizes the Commissioner to suspend or revoke the 68 certification of a health maintenance organization that fails to comply with the 69 requirements of section 50. The Commissioner would also be authorized to take 70 such actions against other health insurers who fail to comply with the requirements 71 of sections 43, 45-49 and 53. (NRS 680A.200) 72 Existing law requires the Director of the Department of Health and Human 73 Services to create the Silver State Scripts Board (NRS 422.4035) Existing law 74 requires the Department to set the duties of the Board by regulation, including 75 identifying the prescription drugs which should be included on the list of preferred 76 prescription drugs for Medicaid. (NRS 422.405) Section 30.6 of this bill 77 additionally requires the Department to require the Board to review new classes of 78 therapeutic prescription drugs that include alternatives to opioids for inclusion on 79 that list. 80 Existing federal law requires a state to establish a Drug Use Review Board to 81 conduct certain reviews related to the use of prescription drugs under Medicaid. (42 82 U.S.C. § 1396r-8(g)(3)) Existing Nevada law requires the Drug Use Review Board 83 to develop step therapy protocols and prior authorization policies and procedures 84 for use by the Medicaid program for prescription drugs. (NRS 422.403) Section 85 30.3 of this bill additionally requires the Drug Use Review Board to regularly 86 review the step therapy protocols and prior authorization policies and procedures 87 applicable to drugs that are alternatives to opioids to ensure sufficient access by 88 recipients of Medicaid to such drugs. 89 Existing law creates the Fund for a Resilient Nevada to hold the proceeds of 90 certain litigation by the State concerning the manufacture, distribution, sale and 91 marketing of opioids. (NRS 433.732) Existing law requires the Department to 92 create a statewide plan to allocate the money in the Fund for certain statewide 93 projects and grants to local governments and private-sector organizations whose 94 work relates to opioid use disorder and other substance use disorders. (NRS 95 433.738) Section 31 of this bill requires the statewide plan to allocate at least 20 96 percent of the money distributed from the Fund to such projects and grants that are 97 related to the prevention of substance use disorders. Section 32 of this bill makes a 98 conforming change to update an internal reference changed by section 31. Section 99 55 authorizes the Department to continue to utilize the current statewide plan and at 100 the time that the Department revises the statewide plan or develops a new plan, the 101 new plan must comply with the provisions of section 31. 102 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 449 of NRS is hereby amended by adding 1 thereto a new section to read as follows: 2 1. A medical facility or facility which is required by the 3 regulations adopted by the Board pursuant to NRS 449.0303 to be 4 licensed that administers opioids to patients shall: 5 (a) Comply with the requirements of sections 8 to 23, inclusive, 6 of this act and any regulations adopted pursuant thereto; and 7 – 4 – - *SB337_R1* (b) Offer to a patient an alternative treatment that does not 1 utilize an opioid before administering an opioid to the patient for 2 the first time unless: 3 (1) In the opinion of the attending provider of health care, 4 there is no treatment that does not utilize an opioid that is suitable 5 for treating the patient; or 6 (2) It is not practicable to offer such an alternative 7 treatment to the patient. 8 2. Except as otherwise provided in subsection 1 and section 9 19 of this act, if a patient or his or her legal guardian has executed 10 a non-opioid directive or states that the patient wishes to receive 11 an alternative treatment that does not utilize an opioid, the 12 medical facility or facility which is required by the regulations 13 adopted by the Board pursuant to NRS 449.0303 to be licensed 14 shall provide such a treatment. 15 3. During each even-numbered year, the Division shall 16 review compliance with the requirements of this section by each 17 medical facility or facility which is required by the regulations 18 adopted by the Board pursuant to NRS 449.0303 to be licensed 19 that administers opioids to patients. 20 4. As used in this section: 21 (a) “Non-opioid directive” has the meaning ascribed to it in 22 section 9 of this act. 23 (b) “Provider of health care” has the meaning ascribed to it in 24 NRS 629.031. 25 Sec. 2. NRS 449.029 is hereby amended to read as follows: 26 449.029 As used in NRS 449.029 to 449.240, inclusive, and 27 section 1 of this act, unless the context otherwise requires, “medical 28 facility” has the meaning ascribed to it in NRS 449.0151 and 29 includes a program of hospice care described in NRS 449.196. 30 Sec. 3. NRS 449.0301 is hereby amended to read as follows: 31 449.0301 The provisions of NRS 449.029 to 449.2428, 32 inclusive, and section 1 of this act do not apply to: 33 1. Any facility conducted by and for the adherents of any 34 church or religious denomination for the purpose of providing 35 facilities for the care and treatment of the sick who depend solely 36 upon spiritual means through prayer for healing in the practice of 37 the religion of the church or denomination, except that such a 38 facility shall comply with all regulations relative to sanitation and 39 safety applicable to other facilities of a similar category. 40 2. Foster homes as defined in NRS 424.014. 41 3. Any medical facility, facility for the dependent or facility 42 which is otherwise required by the regulations adopted by the Board 43 pursuant to NRS 449.0303 to be licensed that is operated and 44 maintained by the United States Government or an agency thereof. 45 – 5 – - *SB337_R1* Sec. 4. NRS 449.160 is hereby amended to read as follows: 1 449.160 1. The Division may deny an application for a 2 license or may suspend or revoke any license issued under the 3 provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of 4 this act upon any of the following grounds: 5 (a) Violation by the applicant or the licensee of any of the 6 provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 7 section 1 of this act or 449A.100 to 449A.124, inclusive, and 8 449A.270 to 449A.286, inclusive, or of any other law of this State 9 or of the standards, rules and regulations adopted thereunder. 10 (b) Aiding, abetting or permitting the commission of any illegal 11 act. 12 (c) Conduct inimical to the public health, morals, welfare and 13 safety of the people of the State of Nevada in the maintenance and 14 operation of the premises for which a license is issued. 15 (d) Conduct or practice detrimental to the health or safety of the 16 occupants or employees of the facility. 17 (e) Failure of the applicant to obtain written approval from the 18 Director of the Department of Health and Human Services as 19 required by NRS 439A.100 or 439A.102 or as provided in any 20 regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 21 and section 1 of this act and 449.435 to 449.531, inclusive, and 22 chapter 449A of NRS if such approval is required, including, [Text truncated for display. 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