SB419A - Makes revisions relating to public health. (BDR 40-748)

EXEMPT (Reprinted with amendments adopted on June 5, 2023) SECOND REPRINT S.B. 419 - *SB419_R2* SENATE BILL NO. 419–COMMITTEE ON HEALTH AND HUMAN SERVICES MARCH 27, 2023 ____________ Referred to Committee on Health and Human Services SUMMARY—Makes revisions relating to public health. (BDR 40-748) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. CONTAINS UNFUNDED MANDATE (§§ 6, 28, 45) (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 health; requiring the adoption of a framework for the electronic transmittal, maintenance and exchange of certain health information; requiring governmental entities, health care providers, insurers and insurance administrators to maintain, transmit and exchange health information electronically; authorizing the imposition of certain discipline against a health care provider, insurer or insurance administrator that fails to comply with that requirement; authorizing the Director of the Department of Health and Human Services to contract with multiple health information exchanges to perform certain functions; clarifying that certain persons are immune from certain criminal and civil liability for transmitting, accessing, utilizing or disclosing electronic health records in accordance with existing law; establishing and prescribing the duties of the Medicaid Outreach Advisory Committee; requiring the provision of certain coverage under the Children’s Health Insurance Program; requiring the Joint Interim Standing Committee on Health and Human Services to conduct certain studies; making an appropriation; and providing other matters properly relating thereto. – 2 – - *SB419_R2* Legislative Counsel’s Digest: Existing law requires the Director of the Department of Health and Human 1 Services to adopt regulations governing health information exchanges and the 2 transmittal, ownership, management, use and confidentiality of electronic health 3 records. (NRS 439.587, 439.589) Section 6 of this bill requires the Director to 4 prescribe by regulation a framework for the electronic maintenance, transmittal and 5 exchange of electronic health records, prescriptions and health-related information. 6 Section 6 requires that framework to establish standards for networks and 7 technologies to be used to maintain, transmit and exchange health information, 8 including standards that require: (1) the ability for patients to access and forward 9 their records; and (2) the interoperability of such networks and technologies. 10 Section 60 of this bill requires the Director to convene an advisory group to advise 11 the Director in the adoption of those standards. With certain exceptions, sections 6, 12 28, 29, 45 and 63 of this bill require all governmental entities, health care 13 providers, insurers, pharmacy benefit managers and other insurance administrators 14 to maintain, transmit and exchange health information electronically in accordance 15 with those standards and other provisions governing electronic health records, 16 beginning on: (1) July 1, 2024, for hospitals and large physician group practices; 17 (2) July 1, 2025, for governmental entities, other large health care practices, 18 insurers, pharmacy benefit managers and other insurance administrators; and (3) 19 January 1, 2030, for small physician group practices and other small health care 20 practices. Sections 2 and 6 of this bill provide that a health care provider, insurer, 21 pharmacy benefit manager or other insurance administrator that fails to comply 22 with that requirement is not guilty of a misdemeanor. Instead, section 1 of this bill 23 requires the Department to notify any regulatory body that has issued a license, 24 certificate, registration, permit or similar credential to a health care provider, 25 insurer, pharmacy benefit manager or other insurance administrator if the holder of 26 the credential fails to comply with that requirement. After receiving such notice, 27 sections 9, 17, 45, 47, 50 and 53 of this bill authorize a regulatory body to impose 28 corrective action or an administrative penalty on the health care provider, insurer, 29 pharmacy benefit manager or other insurance administrator. Section 1 requires the 30 Department to notify the relevant regulatory body if a health care provider, insurer, 31 pharmacy benefit manager or other insurance administrator that was previously out 32 of compliance with the requirement to maintain, transmit and exchange health 33 information electronically comes into compliance with that requirement. Section 4 34 of this bill removes duplicative requirements concerning the adoption of regulations 35 governing electronic health records. Sections 2-5, 10-16, 44, 46, 48, 51, 52, 55 and 36 56 of this bill make conforming changes to indicate the proper placement of 37 sections 1, 9, 47 and 50 in the Nevada Revised Statutes. 38 Existing law authorizes the Director to contract with not more than one health 39 information exchange to be responsible for compiling statewide master indexes of 40 patients, health care providers and payers. (NRS 439.587) Section 4 authorizes the 41 Director to contract with multiple health information exchanges to perform those 42 functions. 43 Existing law requires that, with certain exceptions, a patient consent before his 44 or her electronic health record is retrieved from a health information exchange. 45 (NRS 439.591) Section 6.5 of this bill requires such consent to be affirmative. 46 Existing law provides that a health care provider who with reasonable care 47 relies upon an apparently genuine electronic health record accessed from a health 48 information exchange to make a decision concerning the provision of health care to 49 a patient is immune from civil or criminal liability for the decision if: (1) the 50 electronic health record is inaccurate; (2) the inaccuracy was not caused by the 51 health care provider; (3) the inaccuracy resulted in an inappropriate health care 52 decision; and (4) the health care decision was appropriate based upon the 53 information contained in the inaccurate electronic health record. (NRS 439.593) 54 – 3 – - *SB419_R2* Section 7 of this bill expands this immunity from liability to also apply to any 55 health care provider who transmits, accesses, utilizes or discloses an apparently 56 genuine electronic health record or provides such an electronic health record to a 57 patient. 58 Existing law provides that providing information to an electronic health record 59 in accordance with existing law is not an unfair trade practice. (NRS 439.595) 60 Section 8 of this bill additionally provides that transmitting, accessing, utilizing or 61 disclosing an electronic health record in accordance with existing law is not an 62 unfair trade practice. 63 With certain exceptions, existing federal and state law prohibits a person or 64 governmental entity from providing a public benefit to an alien who is not legally 65 present in the United States, except where a state law affirmatively provides for 66 such eligibility. (8 U.S.C. § 1621; NRS 422.065, 422A.085) Section 39 of this bill 67 requires the Director to apply to the Federal Government for authority to provide 68 coverage under the Children’s Health Insurance Program for prenatal, labor and 69 delivery care for persons who are not eligible for Medicaid because of their 70 immigration status. Section 57 of this bill makes an appropriation for the purpose 71 of providing such coverage. Section 39 requires the Department to submit a 72 biennial report to the Legislature concerning the implementation and impacts of 73 such coverage. Section 26 of this bill makes a conforming change to indicate the 74 proper placement of section 39 in the Nevada Revised Statutes. 75 Under existing law, the Division of Welfare and Supportive Services of the 76 Department administers provisions concerning applications for Medicaid and the 77 Children’s Health Insurance Program. (NRS 422A.3351, 422A.336) Section 41 of 78 this bill creates the Medicaid Outreach Advisory Committee within the Division. 79 Section 42 of this bill requires the Advisory Committee to: (1) advise the 80 Department, the Division of Health Care Financing and Policy of the Department 81 and the Division of Welfare and Supportive Services concerning outreach to, and 82 maximizing enrollment in Medicaid and the Children’s Health Insurance Program 83 of, members of marginalized or underserved communities; and (2) post a report of 84 the activities of the Advisory Committee on the Internet on or before July 1 of each 85 even-numbered year. 86 Section 58 of this bill requires the Joint Interim Standing Committee on Health 87 and Human Services to study, during the 2023-2024 interim, the feasibility of 88 including in the State Plan for Medicaid coverage of digital health products and the 89 procedures for and costs of providing such coverage. Section 58.5 of this bill 90 requires the Joint Interim Standing Committee to study, during the 2023-2024 91 interim: (1) the feasibility of and necessary steps for creating a natural persons 92 index for this State; (2) procedures governing data registries and ways to streamline 93 the collection of data and reduce the burden of reporting requirements applicable to 94 providers of health care; (3) the feasibility of including in the State Plan for 95 Medicaid enhanced rates of reimbursement for providers of health care in medically 96 underserved areas and rural areas; (4) methods for increasing the amount of 97 biotechnological and medical research conducted in this State; and (5) the 98 feasibility of including in the State Plan for Medicaid a program to provide services 99 through managed care to recipients of Medicaid who are aged, blind or disabled. 100 – 4 – - *SB419_R2* THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 439 of NRS is hereby amended by adding 1 thereto a new section to read as follows: 2 1. The Department shall notify each regulatory body of this 3 State that has issued a current, valid license to a licensed provider 4 or insurer if: 5 (a) The Department determines that the licensed provider or 6 insurer is not in compliance with the requirements of subsection 4 7 of NRS 439.589; and 8 (b) The licensed provider or insurer: 9 (1) Is not exempt from those requirements pursuant to 10 subsection 5 of NRS 439.589; and 11 (2) Has not received a waiver of those requirements 12 pursuant to subsection 6 of NRS 439.589. 13 2. If the Department determines that a licensed provider or 14 insurer for which notice was previously provided pursuant to 15 subsection 1 has come into compliance with the requirements of 16 subsection 4 of NRS 439.589, the Department shall immediately 17 notify the regulatory body that issued the license. 18 3. As used in this section: 19 (a) “License” means any license, certificate, registration, 20 permit or similar type of authorization to practice an occupation 21 or profession or engage in a business in this State issued to a 22 licensed provider or insurer. 23 (b) “Licensed provider or insurer” means: 24 (1) A medical facility licensed pursuant to chapter 449 of 25 NRS; 26 (2) The holder of a permit to operate an ambulance, an air 27 ambulance or a vehicle of a fire-fighting agency pursuant to 28 chapter 450B of NRS; 29 (3) A provider of health care, as defined in NRS 629.031, 30 who is licensed pursuant to title 54 of NRS; or 31 (4) Any person licensed pursuant to title 57 of NRS. 32 (c) “Regulatory body” means any governmental entity that 33 issues a license. 34 Sec. 2. NRS 439.580 is hereby amended to read as follows: 35 439.580 1. Any local health officer or a deputy of a local 36 health officer who neglects or fails to enforce the provisions of this 37 chapter in his or her jurisdiction, or neglects or refuses to perform 38 any of the duties imposed upon him or her by this chapter or by the 39 instructions and directions of the Division shall be punished by a 40 fine of not more than $250. 41 – 5 – - *SB419_R2* 2. [Each] Except as otherwise provided in NRS 439.589, each 1 person who violates any of the provisions of this chapter or refuses 2 or neglects to obey any lawful order, rule or regulation of the: 3 (a) State Board of Health or violates any rule or regulation 4 approved by the State Board of Health pursuant to NRS 439.350, 5 439.366, 439.410 and 439.460; or 6 (b) Director adopted pursuant to NRS 439.538 or 439.581 to 7 439.595, inclusive, and section 1 of this act, 8  is guilty of a misdemeanor. 9 Sec. 3. NRS 439.581 is hereby amended to read as follows: 10 439.581 As used in NRS 439.581 to 439.595, inclusive, and 11 section 1 of this act, unless the context otherwise requires, the 12 words and terms defined in NRS 439.582 to 439.585, inclusive, 13 have the meanings ascribed to them in those sections. 14 Sec. 4. NRS 439.587 is hereby amended to read as follows: 15 439.587 1. The Director is the state authority for health 16 information technology. [The Director shall: 17 (a) Ensure that a health information exchange complies with the 18 specifications and protocols for exchanging electronic health 19 records, health-related information and related data prescribed 20 pursuant to the provisions of the Health Information Technology for 21 Economic and Clinical Health Act of 2009, 42 U.S.C. §§ 300jj et 22 seq. and 17901 et seq., and other applicable federal and state law; 23 (b) Encourage the use of a health information exchange by 24 health care providers, payers and patients; 25 (c) Prescribe by regulation standards for the electronic 26 transmittal of electronic health records, prescriptions, health-related 27 information, electronic signatures and requirements for electronic 28 equivalents of written entries or written approvals in accordance 29 with federal law; 30 (d) Prescribe by regulation rules governing the ownership, 31 management and use of electronic health records, health-related 32 information and related data retained or shared by a health 33 information exchange; and 34 (e) Prescribe by regulation, in consultation with the State Board 35 of Pharmacy, standards for the electronic transmission of prior 36 author [Text truncated for display. 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