SB400A - Revises provisions relating to homelessness. (BDR 38-1027)

EXEMPT (Reprinted with amendments adopted on June 5, 2023) THIRD REPRINT S.B. 400 - *SB400_R3* SENATE BILL NO. 400–SENATORS NEAL, FLORES AND DONATE MARCH 27, 2023 ____________ JOINT SPONSOR: ASSEMBLYMAN D’SILVA ____________ Referred to Committee on Revenue and Economic Development SUMMARY—Revises provisions relating to homelessness. (BDR 38-1027) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: No. CONTAINS UNFUNDED MANDATE (§ 3.3) (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 public welfare; revising provisions governing the duties of a reinvestment advisory committee; revising provisions governing contracts entered into by the Department of Health and Human Services for the operation of a Medicaid managed care program; requiring the Department to establish the Fiscal Advisory Committee for a Flexible Continuum of Care Plan; making appropriations; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires the Department of Health and Human Services, to the 1 extent that money is available, to: (1) establish a Medicaid managed care program 2 to provide health care services to recipients of Medicaid in all geographic areas of 3 this State; and (2) conduct a statewide procurement process to select health 4 maintenance organizations to provide the health care services. (NRS 422.273) 5 Sections 2 and 3 of this bill require each contract entered into by the Department 6 with a health maintenance organization to provide such services to include a 7 requirement for the health maintenance organization to reinvest a percentage of the 8 annual profits of the health maintenance organization in programs and initiatives to 9 address homelessness and to provide sustainable medication and prescription 10 services, alcohol or drug intervention or rehabilitation services and emergency and 11 – 2 – - *SB400_R3* supportive housing in the local communities in which the health maintenance 12 organization operates. 13 Existing law establishes a reinvestment advisory committee in each county of 14 this State whose population is 700,000 or more (currently only Clark County) and 15 prescribes the duties of a reinvestment advisory committee, which includes 16 reviewing, making recommendations and reporting to the Legislature and Director 17 of the Department concerning the reinvestment of funds by a health maintenance 18 organization that provides health care services through managed care to recipients 19 of Medicaid in the communities served by those organizations. (NRS 422.185, 20 422.205) Section 1 of this bill revises the duties of the reinvestment advisory 21 committee such that the recommendations and reports of the advisory committee 22 are required to concern the reinvestment of funds by managed care organizations to 23 address homelessness and to provide sustainable medication and prescription 24 services, alcohol or drug intervention or rehabilitation services, and emergency and 25 supportive housing, in conformance with the amendatory provisions of sections 2 26 and 3. 27 Existing federal law establishes a Continuum of Care Program to provide 28 funding for efforts by nonprofit providers, states, and local governments to quickly 29 rehouse homeless individuals and families. (42 U.S.C. 11381 et seq.; 24 C.F.R. Part 30 578) Federal law requires representatives from relevant organizations to establish a 31 Continuum of Care for a geographic area to carry out certain responsibilities and to 32 establish a board to act on behalf of the Continuum. (24 C.F.R. 578.5) Section 3.3 33 of this bill: (1) requires the Department to establish the Fiscal Advisory Committee 34 for a Flexible Continuum of Care Plan; (2) authorizes the Department to make 35 grants of money to the Advisory Committee to fund certain services; and (3) 36 requires the Advisory Committee to prepare an annual report. Section 3.3 requires 37 a city whose population is 150,000 or more but less than 500,000 to transmit an 38 amount of money which is not less than $1,000,000 but not more than $2,000,000 39 to the Department each fiscal year for allocation to the Advisory Committee to fund 40 programs to address homelessness in the service area of the Continuum of Care in 41 which the city is located. Section 3.3 requires the Department to assist the Advisory 42 Committee to enter into service agreements with federally-qualified health centers. 43 Sections 7.1-7.9 of this bill make appropriations to the Department for 44 allocation to the Advisory Committee to carry out the provisions of section 3.3. 45 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. NRS 422.205 is hereby amended to read as follows: 1 422.205 1. A reinvestment advisory committee shall: 2 (a) Solicit and review reports from the Division and Medicaid 3 managed care organizations concerning the reinvestment of funds 4 by those Medicaid managed care organizations in the communities 5 served by the Medicaid managed care organizations. 6 (b) Report to the Division and Medicaid managed care 7 organizations concerning initiatives of local governments in the 8 county to address homelessness [,] and to provide sustainable 9 medication and prescription drug services, alcohol or drug 10 intervention or rehabilitation services, and emergency and 11 supportive housing . [issues and social determinants of health.] 12 – 3 – - *SB400_R3* (c) Make recommendations based on the reports reviewed 1 pursuant to paragraph (a) to the Division and Medicaid managed 2 care organizations concerning the reinvestment of funds by those 3 Medicaid managed care organizations in the communities served by 4 the Medicaid managed care organizations. Those recommendations 5 must include, without limitation, recommendations for the use of 6 such funds for the purposes of: 7 (1) Developing innovative partnerships with community 8 development organizations and providers of housing services; and 9 (2) Supporting the initiatives of local governments in the 10 county to address homelessness [,] and to provide sustainable 11 medication and prescription drug services, alcohol or drug 12 intervention or rehabilitation services, and emergency and 13 supportive housing . [issues and social determinants of health.] 14 2. On or before December 31 of each year, a reinvestment 15 advisory committee shall: 16 (a) Compile a report concerning: 17 (1) The uses of funds reinvested by Medicaid managed care 18 organizations in the communities served by those Medicaid 19 managed care organizations, including, without limitation, efforts to 20 address homelessness [, disparities in health care and social 21 determinants of health;] and to provide sustainable medication and 22 prescription drug services, alcohol or drug intervention or 23 rehabilitation services, and emergency and supportive housing; 24 and 25 (2) The activities of the reinvestment advisory committee 26 during the calendar year, including, without limitation, the 27 recommendations made by the reinvestment advisory committee 28 pursuant to paragraph (c) of subsection 1. 29 (b) Submit the report to: 30 (1) The Director of the Legislative Counsel Bureau for 31 transmittal to: 32 (I) In odd-numbered years, the Joint Interim Standing 33 Committee on Health and Human Services; and 34 (II) In even-numbered years, the next regular session of 35 the Legislature. 36 (2) The Director of the Department. 37 3. As used in this section, “Medicaid managed care 38 organization” means a managed care organization that provides 39 health care services to recipients of Medicaid who reside in the 40 county for which a reinvestment advisory committee is established. 41 Sec. 2. NRS 422.273 is hereby amended to read as follows: 42 422.273 1. For any Medicaid managed care program 43 established in the State of Nevada, the Department shall contract 44 only with a health maintenance organization that has: 45 – 4 – - *SB400_R3* (a) Negotiated in good faith with a federally-qualified health 1 center to provide health care services for the health maintenance 2 organization; 3 (b) Negotiated in good faith with the University Medical Center 4 of Southern Nevada to provide inpatient and ambulatory services to 5 recipients of Medicaid; and 6 (c) Negotiated in good faith with the University of Nevada 7 School of Medicine to provide health care services to recipients of 8 Medicaid. 9  Nothing in this section shall be construed as exempting a 10 federally-qualified health center, the University Medical Center of 11 Southern Nevada or the University of Nevada School of Medicine 12 from the requirements for contracting with the health maintenance 13 organization. 14 2. During the development and implementation of any 15 Medicaid managed care program, the Department shall cooperate 16 with the University of Nevada School of Medicine by assisting in 17 the provision of an adequate and diverse group of patients upon 18 which the school may base its educational programs. 19 3. The University of Nevada School of Medicine may establish 20 a nonprofit organization to assist in any research necessary for the 21 development of a Medicaid managed care program, receive and 22 accept gifts, grants and donations to support such a program and 23 assist in establishing educational services about the program for 24 recipients of Medicaid. 25 4. For the purpose of contracting with a Medicaid managed 26 care program pursuant to this section, a health maintenance 27 organization is exempt from the provisions of NRS 695C.123. 28 5. The provisions of this section apply to any managed care 29 organization, including a health maintenance organization, that 30 provides health care services to recipients of Medicaid under the 31 State Plan for Medicaid or the Children’s Health Insurance Program 32 pursuant to a contract with the Division. Such a managed care 33 organization or health maintenance organization is not required to 34 establish a system for conducting external reviews of adverse 35 determinations in accordance with chapter 695B, 695C or 695G of 36 NRS. This subsection does not exempt such a managed care 37 organization or health maintenance organization for services 38 provided pursuant to any other contract. 39 6. Each contract entered into by the Department with a 40 health maintenance organization to provide health care services to 41 recipients of Medicaid in all geographic areas of this State shall 42 include a requirement for the health maintenance organization to 43 reinvest a percentage of the annual profits of the health 44 maintenance organization in programs and initiatives to address 45 – 5 – - *SB400_R3* homelessness and to provide sustainable medication and 1 prescription drug services, alcohol or drug intervention or 2 rehabilitation services, and emergency and supportive housing in 3 the local communities in which the health maintenance 4 organization operates. 5 7. As used in this section, unless the context otherwise 6 requires: 7 (a) “Federally-qualified health center” has the meaning ascribed 8 to it in 42 U.S.C. § 1396d(l)(2)(B). 9 (b) “Health maintenance organization” has the meaning ascribed 10 to it in NRS 695C.030. 11 (c) “Managed care organization” has the meaning ascribed to it 12 in NRS 695G.050. 13 Sec. 3. NRS 422.273 is hereby amended to read as follows: 14 422.273 1. To the extent that money is available, the 15 Department shall: 16 (a) Establish a Medicaid managed care program to provide 17 health care services to recipients of Medicaid in all geographic areas 18 of this State. The program is not required to provide services to 19 recipients of Medicaid who are aged, blind or disabled pursuant to 20 Title XVI of the Social Security Act, 42 U.S.C. §§ 1381 et seq. 21 (b) Conduct a statewide procurement process to select health 22 maintenance organizations to provide the services described in 23 paragraph (a). 24 2. For any Medicaid managed care program established in the 25 State of Nevada, the Department shall contract only with a health 26 maintenance organization that has: 27 (a) Negotiated in good faith with a federally-qualified health 28 center to provide health care services for the health maintenance 29 organization; 30 (b) Negotiated in good faith with the University Medical Center 31 of Southern Nevada to provide inpatient and ambulatory services to 32 recipients of Medicaid; 33 (c) Negotiated in good faith with the University of Nevada 34 School of Medicine to provide health care services to recipients of 35 Medicaid; and 36 (d) Complied with the provisions of subsection 2 of 37 NRS 695K.220. 38  Nothing in this section shall be construed as exempting a 39 federally-qualified health center, the University Medical Center of 40 Southern Nevada or the University of Nevada School of Medicine 41 from the requirements for contracting with the health maintenance 42 organization. 43 3. During the development and implementation of any 44 Medicaid managed care program, the Department shall cooperate 45 – 6 – - *SB400_R3* with the University of Nevada School of Medicine by assisting in 1 the provision of an adequate and diverse group of patients upon 2 which the school may base its educational programs. 3 4. The University of Nevada School of Medicine may establish 4 a nonprofit organization to assist in any research necessary for the 5 development of a Medicaid managed care program, receive and 6 accept gifts, grants and donations to support such a program and 7 assist in establishing educational services about the program for 8 recipients of Medicaid. 9 5. For the purpose of contracting with a Medicaid managed 10 care program pursuant to this section, a health maintenance 11 organization is exempt from the provisions of NRS 695C.123. 12 6. To the extent that money is available, a Medicaid managed 13 care program must include, without limitation, a state-directed 14 payment arrangement established in accordance with 42 C.F.R. § 15 438.6(c) to require a Medicaid managed care organization to 16 reimburse a critical access hospital and any federally-qualified 17 healt [Text truncated for display. Full text available on LegiScan.]