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- 83rd Session (2025)
Senate Bill No. 207–Senators Taylor,
Doñate, Neal; Daly and Stone
CHAPTER..........
AN ACT relating to health care; transferring the authority to
establish and administer a program of all -inclusive care for
the elderly from the Aging and Disability Services Division
of the Department of Health and Human Servi ces to the
Department; requiring the Department to establish such a
program; requiring the Community Advocate within the
Division to provide certain services relating to the program;
making an appropriation; and providing other matters
properly relating thereto.
Legislative Counsel’s Digest:
Existing federal law authorizes a state to establish a program, commonly
known as a program of all -inclusive care for the elderly or PACE program, to
provide services to certain recipients of Medicare and Medicaid who are 55 years of
age or older. (42 U.S.C. §§ 1395eee , 1396u-4) Existing state law authorizes the
Aging and Disability Services Division of the Department of Health and Human
Services to establish and administer a PACE program. (NRS 427A.255, 427A.260)
Sections 2 and 8 of this bill eliminate the authority of the Division to establish
a PACE program, and sections 2-4 of this bill remove references in existing law to
such a PACE program. Instead, section 1 of this bill requires the Department
through any of its divisions to establish and administer a PACE program . Section 6
of this bill makes a conforming change to require the Director of the Department to
administer the provisions of section 1 in the same manner as the provisions of
existing law governing Medicaid and certain other programs administered by the
Department.
Existing law: (1) creates the Office of the Community Advocate within the
Division; and (2) requires the Community Advocate to assist in coordinating
resources and services available to aging persons within their respective
communities, including any PACE program established by the Division. (NRS
427A.300, 427A.310) Section 4 replaces the reference to the PACE program
established by the D ivision with a reference to the PACE program established by
the Department pursuant to section 1, thereby requiring the Community Advocate
to provide assistance related to that PACE program. Sections 5 and 7 of this bill
make conforming changes so that the PACE program created by section 1 is treated
similarly to any PACE program that would have been created under the authority
eliminated by section 8 for purposes relating to: (1) the division of the community
income, assets and obligations of a married cou ple into separate income for the
purpose of qualifying for such a program; and (2) activities of a home care
program, which is a program, including a PACE program, established by a state
agency or a local government which provides in the home personal care services,
personal assistance or temporary respite services to elderly persons or persons with
disabilities. Section 7.5 of this bill appropriates money to and authorize s
expenditures by the Division of Health Care Financing and Policy of the
Department to pay the costs of establishing and administering the PACE program.
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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. The Department shall establish and administer a program
of all-inclusive care for the elderly, commonly known as a PACE
program. The program may be carried out solely by the
Department or any division thereof or in cooperation with another
state agency, the Federal Government or any local government.
2. The program established pursuant to subsection 1 must
comply with the provisions of 42 U.S.C. §§ 1395eee and 1396u -4,
42 C.F.R. Part 460 and any other federal regulations governing
programs of all-inclusive care for the elderly.
3. The Department may use personnel of the Department or it
may contract with any appropriate public or private agency,
organization or institution to provide the services necessary to
administer the program describ ed in this section, including,
without limitation, a federally-qualified health center.
4. A contract entered into with a public or private agency,
organization or institution pursuant to subsection 3 must:
(a) Include a description of the type of service to be provided;
(b) Specify the capitation rate to be paid for all -inclusive care
for the elderly and the method of payment; and
(c) Specify the criteria to be used to evaluate the provisions of
the service.
5. The Department shall:
(a) Apply to th e 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 for the Department to
establish the program required by this section.
(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).
(c) Adopt regulations necessary to carry out the provisions of
this section.
6. The Department may apply for, accept and expend any
federal or private grant of money or any other type of assistance
that becomes available to carry out the provisions of this section.
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Any money received pursuant to this subsection must be
accounted for separately in the State General Fund.
7. As used in this section, “federally -qualified health center”
has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).
Sec. 2. NRS 427A.260 is hereby amended to read as follows:
427A.260 1. The Division may use personnel of the Division
or it may contract with any appropriate public or private agency,
organization or institution [to provide a program of all -inclusive
care for the elderly and ] to provide the community -based services
necessary to enable a frail elderly person to remain in his or her
home.
2. Any such contract must:
(a) Include a description of the type of service to be provided;
(b) [For:
(1) A program of all -inclusive care for the elderly, specify
the capitation rate to be paid for all-inclusive care for the elderly and
the method of payment; and
(2) Any other community -based services, specify ] Specify
the price to be paid for each service and the method of payment; and
(c) Specify the criteria to be used to evaluate the provision of the
service.
Sec. 3. NRS 427A.280 is hereby amended to read as follows:
427A.280 [In addition to the program established pursuant to
NRS 427A.255, the ] The Division may initiate projects to test and
demonstrate various ways of providing the community -based
services and all -inclusive care necessary to enable a frail elderly
person to remain in his or her home.
Sec. 4. NRS 427A.310 is hereby amended to read as follows:
427A.310 1. The Community Advocate shall provide
assistance to persons who are 60 years of age or older and do not
reside in facilities for long-term care. The assistance must include at
least the:
(a) Coordination of resources and services ava ilable to aging
persons within their respective communities, including the services
provided through a program established pursuant to NRS 427A.250
or [427A.255;] section 1 of this act;
(b) Dissemination of information to aging persons on issues of
national and local interest, including information regarding the
services of the Community Advocate and the existence of groups of
aging persons with similar interests and concerns; and
(c) Advocation of issues relating to aging persons.
2. The Administ rator may direct the Community Advocate to
provide assistance to a person who:
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(a) Is less than 60 years of age; and
(b) Does not reside in a facility for long-term care.
Sec. 5. NRS 123.259 is hereby amended to read as follows:
123.259 1. Except as otherwise provided in subsection 2, a
court of competent jurisdiction may, upon a proper petition filed by
a spouse or the guardian of a spouse, enter a decree dividing the
income and resources of a married couple pursuant to this section if
one spouse is an institutionalized spouse and the other spouse is a
community spouse.
2. The court shall not enter such a decree if the division is
contrary to a premarital agreement between the spouses which is
enforceable pursuant to chapter 123A of NRS.
3. Unless modified pursuant to subsection 4 or 5, the court may
divide the income and resources:
(a) Equally between the spouses; or
(b) By protecting income for the community spouse through
application of the maximum federal minimum monthly maintenance
needs allowance set forth in 42 U.S.C. § 1396r -5(d)(3)(C) and by
permitting a transfer of resources to the community spouse an
amount which does not exceed the amount set forth in 42 U.S.C. §
1396r-5(f)(2)(A)(ii).
4. If either spouse establishes that the community spouse needs
income greater than that otherwise provided under paragraph (b) of
subsection 3, upon finding exceptional circumstances resulting in
significant financial duress and setting forth in writing the reasons
for that finding, the court may enter an order for support against the
institutionalized spouse for the support of the community spouse in
an amount adequate to provide such additional income as is
necessary.
5. If either spouse establishes that a transfer of resources to the
community spouse pursuant to paragraph (b) of subsection 3, in
relation to the amount of income generated by such a transfer, is
inadequate to raise the income of the community spouse to the
amount allowed under paragraph (b) of subsectio n 3 or an order for
support issued pursuant to subsection 4, the court may substitute an
amount of resources adequate to provide income to fund the amount
so allowed or to fund the order for support.
6. A copy of a petition for relief under subsection 4 or 5 and
any court order issued pursuant to such a petition must be served on
the Administrator of the Division of Welfare and Supportive
Services of the Department of Health and Human Services when
any application for medical assistance is made by or on b ehalf of an
institutionalized spouse. The Administrator may intervene no later
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than 45 days after receipt by the Division of Welfare and Supportive
Services of the Department of Health and Human Services of an
application for medical assistance and a copy of the petition and any
order entered pursuant to subsection 4 or 5, and may move to
modify the order.
7. A person may enter into a written agreement with his or her
spouse dividing their community income, assets and obligations into
equal shares of sepa rate income, assets and obligations of the
spouses. Such an agreement is effective only if one spouse is an
institutionalized spouse and the other spouse is a community spouse
or a division of the income or resources would allow one spouse to
qualify for services under NRS 427A.250 to 427A.280, inclusive [.]
, or section 1 of this act.
8. An agreement entered into or decree entered pursuant to this
section may not be binding on the Division of Welfare and
Supportive Services of the Department of Health and Human
Services in making determinations under the State Plan for
Medicaid.
9. As used in this section, “community spouse” and
“institutionalized spouse” have the meanings respectively ascribed
to them in 42 U.S.C. § 1396r-5(h).
Sec. 6. 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:
(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, incl usive, 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, inc lusive, and all other provisions of
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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 sourc es 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
(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, t he Director, or
the Director’s designee, is responsible for appointing and removing
subordinate officers and employees of the Department.
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Sec. 7. NRS 608.560 is hereby amended to read as follows:
608.560 1. “Home care pr ogram” means a program
established by a state agency or a local government which provides
in the home personal care services, personal assistance or temporary
respite services to elderly persons or persons with disabilities.
2. The term includes, without limitation:
(a) Any program established under the State Plan for Medicaid
which provides, in the home, the services described in subsection 1.
(b) Any program established pursuant to NRS 427A.250 to
427A.280, inclusive [.] , or section 1 of this act.
(c) The program established pursuant to NRS 422.396.
(d) The program established pursuant to NRS 427A.793.
Sec. 7.5. 1. There is hereby appropriated from the State
General Fund to the Division of Health Care Financing and Policy
of the Department of Health and Human Services for costs to carry
out the provisions of this act the following sums:
For the Fiscal Year 2025-2026 .................................. $293,055
For the Fiscal Year 2026-2027 .................................. $184,057
2. Expenditure of the following sums not appropriated from the
State General Fund or the State Highway Fund is hereby authorized
by the Division of Health Care Financing and Policy of the
Department of Health and Human Services for the same purposes as
set forth in subsection 1:
For the Fiscal Year 2025-2026 .................................. $323,855
For the Fiscal Year 2026-2027 .................................... $91,953
3. Any balance of the sums appropriated by subsection 1
remaining at the end of the respective fiscal years must not be
committed for expenditure after June 30 of the respective fiscal
years by the ent ity to which the appropriation is made or any entity
to which money from the appropriation is granted or otherwise
transferred in any manner, and any portion of the appropriated
money remaining must not be spent for any purpose after
September 18, 2026, a nd September 17, 2027, respectively, by
either the entity to which the money was appropriated or the entity
to which the money was subsequently granted or transferred, and
must be reverted to the State General Fund on or before
September 18, 2026, and September 17, 2027, respectively.
Sec. 8. NRS 427A.255 is hereby repealed.
Sec. 9. 1. This section becomes effective upon passage and
approval.
2. Section 7.5 of this act becomes effective on July 1, 2025.
3. Sections 1 to 7, inclusive, and 8 of this act become effective:
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(a) Upon passage and approval for the purpose of adopting any
regulations and performing any other preparatory administrative
tasks that are necessary to carry out the provisions of this act; and
(b) On January 1, 2026, for all other purposes.
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