SB424 - Revises provisions relating to emergency medical services. (BDR 38-561)

- 83rd Session (2025) Senate Bill No. 424–Committee on Health and Human Services CHAPTER.......... AN ACT relating to emergency medical services; requiring the Division of Health Care Financing and Policy of the Department of Health and Human Services to impose an assessment on private emergency medical transport providers; creating the Account to Improve Emergency Medical Transportation Quality and Access; prescribing the authorized uses of the revenue generated by the assessment; requiring the Division to adopt regulations establishing administrative penalties; authorizing the Division to collect an unpaid assessment or administrative penalty; authorizing certain health authorities to impose administrative penalties or take other disciplinary actions in certain circumstances; authorizing a health authority to establish a training program relating to human trafficking; establishing requirements for such a training program; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law authorizes the Division of Health Care Financing and Policy of the Department of Health and Human Services to impose, in certain circumstances, an assessment on agencies to provide personal care services in the home or medical facilities that are required to obtain a certain type of license. (NRS 422.3794) Existing law requires the Division to expend the revenue generated from the assessment to: (1) provide supplemental payments and enhanced rates of reimbursement to operators of agencies to provide personal care services in the home and operators of medical facilities for services rendered to recipients of Medicaid; (2) fund certain additional supports and services under Medicaid; and (3) pay administrative costs. (NRS 422.37945) Sections 2-9 of this bill require the imposition of a similar assessment on private emergency medical transport providers. Section 6 requires: (1) the percentage of the assessment to be based on a percentage of net revenue earned by the private emergency medical transport provider from providing services in this State; and (2) the Division to set the amount of the percentage of the assessment by regulation, subject to certain requirements. Section 7 creates the Account to Improve Emergency Medical Transportation Quality and Access. Section 7 requires the Division to administer the Account and to deposit the proceeds collected from the assessment into the Account. Section 7 provides that money in the Account may only be expended to: (1) provide enhanced rates of reimbursement under Medicaid to private emergency medical transport providers for providing emergency ambulance services to recipients of Medicaid; (2) fund certain data infrastructure improvements and educational and community outreach initiatives undertaken by the Department; and (3) pay administrative costs related to the assessment. If the Legislature authorizes the money in the Account to be used for any other purpose, section 7: (1) requires that the Division cease imposing the assessment; and (2) provides that the regulations adopted to impose the assessment are void. – 2 – - 83rd Session (2025) Section 8 requires the Division to adopt regulations establishing administrative penalties against a private emergency medical transport provider that fails to pay an assessment in a timely manner. Section 8 authorizes the Division, after notifying the provider, to: (1) deduct the amount of an unpaid assessment or administrative penalty from future payments owed to the private emergency medical transport provider under Medicaid; and (2) negotiate a payment plan with a delinquent private emergency medical transport provider before making such deductions. Section 8 also requires the Division to notify the health authority that issued a private emergency medical transport provider a permit to own or operate an ambulance in this State if the provider has failed to pay an assessment or administrative penalty in a timely manner. Section 11 of this bill authorizes the applicable health authority to, after receiving such a notification from the Division, take certain disciplinary actions against the private emergency medical transport provider. Section 9 authorizes the Division to modify the amount of the assessment, the enhanced rates of reimbursement or any other requirement established by sections 2-9 as necessary to receive federal financial participation to carry out the provisions of sections 2-9. Section 9 also requires the suspension of the assessment and the payment of enhanced rates of reimbursement upon the occurrence of certain events. Section 9 requires the retroactive reimposition of such assessments and payments when the event triggering the suspension is no longer applicable. Sections 3-5 define certain terms and section 2 establishes the applicability of those definitions. Section 10 of this bill requires the Director of the Department to administer the provisions of sections 2-9 in the same manner as other provisions relating to Medicaid. Existing law authorizes a health authority to operate a training program in emergency first aid, emergency care and other techniques associated with emergency care for the benefit of certain professionals who may respond to emergencies as a part of their job duties, including ambulance attendants and firefighters. (NRS 450B.850) Section 11.5 of this bill authorizes a health authority to establish a separate training program which is focused on identifying and responding to victims of human trafficking. 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 the provisions set forth as sections 2 to 9, inclusive, of this act. Sec. 2. As used in sections 2 to 9, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 to 5, inclusive, of this act have the meanings ascribed to them in those sections. Sec. 3. “Account” means the Account to Improve Emergency Medical Transportation Quality and Access created by section 7 of this act. – 3 – - 83rd Session (2025) Sec. 3.5. “Ambulance” has the meaning ascribed to it in NRS 450B.040. Sec. 4. “Emergency ambulance service”: 1. Means the transportation by ambulance of a person who is experiencing a medical emergency to a medical facility; and 2. Includes the rendering of medical care by a paramedic, as defined in NRS 450B.095, emergency medical technician, as defined in NRS 450B.065, or advanced emergency medical technician, as defined in NRS 450B.025, in connection with the transportation of the person. Sec. 5. “Private emergency medical transport provider” means a person or entity that: 1. Provides or renders emergency ambulance services in this State; 2. Holds a permit to own or operate an ambulance issued pursuant to the provisions of chapter 450B of NRS; and 3. Is not owned or operated by a federal, state or local governmental entity or a federally recognized tribe. Sec. 6. 1. Except as otherwise provided in subsection 4 and sections 7 and 9 of this act, the Division shall impose by regulation against each private emergency medical transport provider an assessment in an amount equal to a percentage of the net revenue earned by a private emergency medical transport provider from providing emergency ambulance services in this State during a calendar or fiscal year. The Division shall adopt: (a) Regulations prescribing the percentage that must be used to calculate the amount of the assessment, the date on which the assessment is due and the manner in which the assessment must be paid; and (b) Any other regulations necessary or convenient to carry out the provisions of this section. 2. The amount of the assessment imposed pursuant to subsection 1: (a) Except as otherwise provided in paragraph (b), must be equal to the maximum percentage authorized under federal law; and (b) Except where necessary pursuant to subsection 1 of section 9 of this act, must not exceed 5.5 percent of the net revenue earned by a private emergency medical transport provider from providing emergency ambulance services in this State during a calendar or fiscal year. 3. The revenue from an assessment imposed pursuant to subsection 1 must be deposited into the Account. – 4 – - 83rd Session (2025) 4. An assessment imposed pursuant to subsection 1 must comply with the provisions of 42 C.F.R. § 433.68. An assessment must not be imposed pursuant to subsection 1 if federal law or regulations prohibit using the revenue generated by the assessment for the purposes described in section 7 of this act. If new federal law or regulations imposing such a prohibition are enacted or adopted, as applicable: (a) An assessment must not be collected after the effective date of the new federal law or regulations; and (b) Any money collected during the calendar or fiscal year, as applicable, in which the new federal law or regulations become effective must be returned to the private emergency medical transport providers from whom it was collected. 5. A private emergency medical transport provider shall submit to the Division any information requested by the Division at such times as are determined by the Division for the purposes of carrying out the provisions of this section. Such information may include, without limitation: (a) The number of emergency ambulance service trips provided in this State by the private emergency medical transport provider; and (b) The total net revenue earned by the private emergency medical transport provider for the emergency ambulance services described in paragraph (a). 6. A private emergency medical transport provider shall keep and maintain accurate records as necessary to support the accuracy of information requested by the Division pursuant to this section. 7. As used in this section: (a) “Cash basis” means the system of accounting under which revenues are recorded only when received and expenditures or expenses are recorded only when paid. (b) “Net revenue” means net patient revenue collected by a private emergency medical transport provider that is attributable to the rendering of emergency ambulance services, determined on a cash basis of accounting. Sec. 7. 1. The Account to Improve Emergency Medical Transportation Quality and Access is hereby created in the State General Fund. The Division shall administer the Account. The revenue from assessments and penalties imposed on private emergency medical transport providers pursuant to sections 6 and 8, respectively, of this act must be accounted for separately in the Account. – 5 – - 83rd Session (2025) 2. The interest and income earned on the money in the Account, after deducting any applicable charges, must be credited to the Account. 3. The money in the Account must only be expended to: (a) Provide enhanced rates of reimbursement to private emergency medical transport providers that provide emergency ambulance services to recipients of Medicaid; (b) Provide funding to allow the Department to: (1) Modernize processes and infrastructure relating to the collection and maintenance of data that is useful for purposes relating to public health; (2) Provide education to the public relating to emergency medical services; and (3) Conduct community outreach to improve public health; and (c) Carry out the provisions of sections 2 to 9, inclusive, of this act. 4. Except as otherwise provided in section 9 of this act, all money deposited into the Account, except for the money necessary for the purposes described in paragraphs (b) and (c) of subsection 3, and all federal financial participation provided to match the money in the Account must be expended to fund the enhanced rates of reimbursement established pursuant to paragraph (a) of subsection 3. Such enhanced rates of reimbursement may be provided through any or all of the following means: (a) Increases to rates of reimbursement paid to private emergency medical transport providers who receive such reimbursement on a fee-for-service basis. (b) The establishment of a minimum schedule of fees to be paid to private emergency medical transport providers who provide services to recipients of Medicaid under the Medicaid managed care program established pursuant to NRS 422.273. (c) Directed payments to private emergency medical transport providers who provide services to recipients of Medicaid under the Medicaid managed care program established pursuant to NRS 422.273, without respect to whether a provider participates in the network of providers established or used by the Medicaid managed care program. 5. Not more than 10 percent of the total amount of money generated each year by the assessment imposed pursuant to section 6 of this act may be expended for the purposes described in paragraphs (b) and (c) of subsection 3. Money allocated for such expenditures must be used first for the purpose described in – 6 – - 83rd Session (2025) paragraph (c) of subsection 3. If money allocated for such expenditures remains after all necessary expenditures are made for that purpose, the Division shall expend the remaining money for the purposes described in paragraph (b) of subsection 3. 6. Any money remaining in the Account at the end of a fiscal year does not revert to the State General Fund, and the balance in the Account must be carried forward to the next fiscal year. 7. Money in the Account must not be expended to replace money that would otherwise be used to provide reimbursement under Medicaid to private emergency medical transport providers. 8. The Director shall seek any necessary federal authority to capture all available financial federal participation to carry out the purposes described in paragraph (a) of subsection 3. 9. If the Legislature authorizes money in the Account to be used for any purpose other than those authorized by subsection 3: (a) The Division shall cease imposing the assessment provided by section 6 of this act; and (b) The regulations adopted to impose the assessment pursuant to section 6 of this act are void. Sec. 8. 1. The Division shall adopt regulations that establish administrative penalties for the failure to timely pay any assessment imposed pursuant to section 6 of this act. Any money collected from administrative penalties imposed pursuant to this subsection must be deposited into the Account. 2. If [Text truncated for display. Full text available on LegiScan.]