Makes revisions relating to Medicaid. (BDR 38-40)

EXEMPT
(Reprinted with amendments adopted on April 18, 2025)
FIRST REPRINT S.B. 234

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SENATE BILL NO. 234–SENATORS DOÑATE,
FLORES, OHRENSCHALL; AND TAYLOR

FEBRUARY 25, 2025
____________

JOINT SPONSORS: ASSEMBLYMEMBERS MOORE, ROTH, TORRES-
FOSSETT, GONZÁLEZ; ANDERSON, D’SILVA AND NGUYEN
____________

Referred to Committee on Health and Human Services

SUMMARY—Makes revisions relating to Medicaid. (BDR 38-40)

FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Yes.

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

AN ACT relating to Medicaid; requiring Medicaid to provide
certain limited coverage to certain persons who would
otherwise be ineligible for Medicaid because of their
immigration status; prescribing the scope and limitations
of such coverage; requiring the Department of Health and
Human Services to seek an increase to rates of
reimbursement under Medicaid for services relating to
certain childhood diseases; and providing other matters
properly relating thereto.
Legislative Counsel’s Digest:
Existing federal law requires Medicaid to provide to certain aliens, including 1
aliens who are not lawfully present in the United States, limited coverage for health 2
care services that are necessary to treat an emergency medical condition. (42 U.S.C. 3
§ 1396b(v)(2); 42 C.F.R. § 440.255) Section 1 of this bill prescribes specific 4
requirements governing such coverage under Medicaid in this State for persons 5
who are less than 21 years of ag e. Specifically, section 1 provides that such 6
coverage must consist of coverage for: (1) emergency medical transportation 7
services directly relating to the treatment of the emergency medical condition; (2) 8
care to treat the emergency medical condition provided in an emergency room or 9
similar setting in a hospital or an independent center for emergency medical care; 10
and (3) certain inpatient services relating to the treatment of the emergency medical 11
condition. Additionally, section 1 provides limited coverage for certain care to treat 12
renal disease and cancer in certain circumstances, if the Department of Health and 13
Human Services grants prior approval for such care based on the medical necessity 14

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of the care. Section 1 also provides limited coverage in certain circumstances for 15
continuing care relating to an emergency medical condition that is provided in a 16
facility for skilled nursing, or other similar type of facility, if: (1) such care is 17
necessary to prevent the condition of the person from becoming an emergency 18
medical condition; and (2) the Department grants prior approval for such care based 19
on the medical necessity of the care. 20
Section 2 of this bill makes a conforming change to require the Director of the 21
Department to administer the provisions of section 1 in the same manner as other 22
provisions relating to Medicaid. 23
Section 2.5 of this bill requires the Director of the Department to: (1) identify 24
the most common services provided by clinics and hospitals in this State to treat 25
pediatric cancer and rare childhood diseases; an d (2) apply to the United States 26
Secretary of Health and Human Services to increase the rate of reimbursement 27
under Medicaid for each service identified. 28

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 1
thereto a new section to read as follows: 2
1. To the extent that federal financial participation is 3
available, the Director shall include under Medicaid pursuant to 4
42 U.S.C. § 1396b(v)(2) and 42 C.F.R. § 440.255 coverage for care 5
that is necessary to treat an emergency medical condition of a 6
resident of this State who is less than 21 years of age and would 7
otherwise be ineligible for Medicaid solely because of his or her 8
immigration status. The coverage provided pursuant to this section 9
must consist of coverage for: 10
(a) Emergency medical transportation services directly relating 11
to the treatment of the emergency medical condition; 12
(b) Care to treat the emergency medical condition provided in 13
an emergency room or similar se tting in a hospital or an 14
independent center for emergency medical care; 15
(c) Inpatient services provided to a person immediately 16
following the admission of the person from an emergency room, 17
independent center for emergency medical care, clinic or other 18
similar setting where the person originally sought care for his or 19
her emergency medical condition, if the inpatient services directly 20
relate to the treatment of the emergency medical condition; 21
(d) If approved by the Department pursuant to subsection 3: 22
(1) Care that is provided in a facility for skilled nursing or 23
other similar facility for treatment in a community setting 24
following the discharge of a person from a hospital where the 25
person was receiving inpatient services, if the care directly relates 26
to the emergency medical condition for which the person received 27
care before the discharge; 28

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(2) Dialysis provided in a hospital or a facility for the 1
treatment of irreversible renal disease; 2
(3) The transplant of bone marrow, if the person: 3
(I) Has been diagnosed with cancer; 4
(II) Is currently receiving treatment for the cancer; and 5
(III) Is a candidate for a bone marrow transplant; 6
(4) Other care that is medically necessary to treat any stage 7
of cancer or to prevent the recurrence of cancer, whether provided 8
on an inpatient or outpatient basis, including, without limitation, 9
surgery, chemotherapy , radiation therapy, targeted therapy and 10
immunotherapy; and 11
(5) The transplant of a kidney, if the person: 12
(I) Has been diagnosed with end-stage renal disease; 13
(II) Is receiving dialysis services; and 14
(III) Is a candidate for a kidney transplant; and 15
(e) Any follow-up services that are included within a payment 16
for a service described in paragraphs (a) to (d), inclusive. 17
2. The Director shall not include under Medicaid coverage 18
pursuant to this section for any care or service not described in 19
subsection 1, including, without limitation: 20
(a) Elective surgery; 21
(b) Prescription drugs, unless dispensed or administered by a 22
provider of healt h care as part of the care or treatment described 23
in subsection 1; 24
(c) Preventive care; 25
(d) Rehabilitative services; 26
(e) Personal care services; 27
(f) Physical, occupational or speech therapy; 28
(g) Case management services; 29
(h) Prosthetics, orthotics, d urable medical equipment or 30
medical supplies; 31
(i) Dental services; 32
(j) Hospice care; 33
(k) Treatment for substance use disorder; 34
(l) Services for routine prenatal care; 35
(m) Except as otherwise provided by subparagraphs (3) and (5) 36
of paragraph (d) of subsection 1, organ transplants and stem cell 37
transplants; and 38
(n) Except as otherwise provided by subparagraph (1) of 39
paragraph (d) of subsection 1, continuing care, including, without 40
limitation, care and services provided by a facility for the 41
dependent. 42
3. The Department may not provide coverage under Medicaid 43
pursuant to this section for the care described in paragraph (d) of 44
subsection 1 unless the Department determines, before the care 45

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being rendered, that such care is medically necessary and 1
appropriate, based on the condition of the person to whom the 2
care may be provided. To provide coverage for the care described 3
in subparagraph (1) of paragraph (d) of subsection 1, the 4
Department must additionally determine that the care is necessary 5
to prevent the condition of the person from rapidly becoming an 6
emergency medical condition. 7
4. The Department shall: 8
(a) Apply for any waiver of federal law or apply for any 9
amendment to the State Plan for Medicaid that is necessary to 10
obtain federal financial participation to pay for the cost of 11
coverage provided under this section. 12
(b) Fully cooperate in good faith with the Federal Government 13
during the application process to satisfy the requirements of the 14
Federal Government for obtaining a waiver or amendme nt 15
pursuant to paragraph (a). 16
(c) Establish procedures for granting prior approval of 17
coverage for the care described in paragraph (d) of subsection 1. 18
5. As used in this section: 19
(a) “Emergency medical condition” has the meaning ascribed 20
to it in 42 U.S.C. § 1396b(v)(3). 21
(b) “Emergency medical transportation services” means 22
emergency medical transportation services provided by an 23
ambulance, air ambulance or vehicle of a fire -fighting agency, 24
including, without limitation, services provided by emergenc y 25
medical technicians, advanced emergency medical technicians 26
and paramedics in prestabilizing patients and preparing patients 27
for transport. 28
(c) “Facility for skilled nursing” has the meaning ascribed to 29
it in NRS 449.0039. 30
(d) “Facility for the dependent” has the meaning ascribed to it 31
in NRS 449.0045. 32
(e) “Facility for the treatment of irreversible renal disease” 33
has the meaning ascribed to it in NRS 449.0046. 34
(f) “Independent center for emergency medical care” has the 35
meaning ascribed to it in NRS 449.013. 36
(g) “Medically necessary” means health care services or 37
products that a prudent physician would provide to a patient to 38
prevent, diagnose or treat an illness, injury or disease or any 39
symptom thereof, that are necessary and which are: 40
(1) Provided in accordance with generally accepted 41
standards of medical practice; 42
(2) Clinically appropriate for the type, frequency, extent, 43
location and duration; 44

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(3) Not primarily provided for the convenience of the 1
patient, physician or other provider of health care; 2
(4) Required to improve a specific health condition of the 3
patient or to preserve the existing state of health of the patient; 4
and 5
(5) The most clinically appropriate level of health care that 6
may be safely provided to the patient. 7
(h) “Provider of health care” has the meaning ascribed to it in 8
NRS 629.031. 9
Sec. 2. NRS 232.320 is hereby amended to read as follows: 10
232.320 1. The Director: 11
(a) Shall appoint, with the consent of the Governor, 12
administrators of the divisions of the Department, who are 13
respectively designated as follows: 14
(1) The Administrator of the Aging and Disability Services 15
Division; 16
(2) The Administrator of the Division of Welfare and 17
Supportive Services; 18
(3) The Administrator of the Division of Child and Family 19
Services; 20
(4) The Administrator of the Division of Health Care 21
Financing and Policy; and 22
(5) The Administrator of the Division of Public and 23
Behavioral Health. 24
(b) Shall administer, through the divisions of the Departm ent, 25
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 26
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 27
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 28
section 1 of this act, 422.580, 432.010 to 432.133, inclusive, 29
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 30
and 445A.010 to 445A.055, inclusive, and all other provisions of 31
law relating to the functions of the divisions of the Department, but 32
is not responsible for the clinical activities of the Divi sion of Public 33
and Behavioral Health or the professional line activities of the other 34
divisions. 35
(c) Shall administer any state program for persons with 36
developmental disabilities established pursuant to the 37
Developmental Disabilities Assistance and Bill of Rights Act of 38
2000, 42 U.S.C. §§ 15001 et seq. 39
(d) Shall, after considering advice from agencies of local 40
governments and nonprofit organizations which provide social 41
services, adopt a master plan for the provision of human services in 42
this State. The Director shall revise the plan biennially and deliver a 43
copy of the plan to the Governor and the Legislature at the 44
beginning of each regular session. The plan must: 45

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(1) Identify and assess the plans and programs of the 1
Department for the provision of hu man services, and any 2
duplication of those services by federal, state and local agencies; 3
(2) Set forth priorities for the provision of those services; 4
(3) Provide for communication and the coordination of those 5
services among nonprofit organizations, agencies of local 6
government, the State and the Federal Government; 7
(4) Identify the sources of funding for services provided by 8
the Department and the allocation of that funding; 9
(5) Set forth sufficient information to assist the Department 10
in providing those services and in the planning and budgeting for the 11
future provision of those services; and 12
(6) Contain any other information necessary for the 13
Department to communicate effectively with the Federal 14
Government concerning demographic trends, formulas for the 15
distribution of federal money and any need for the modification of 16
programs administered by the Department. 17
(e) May, by regulation, require nonprofit organizations and state 18
and local governmental agencies to provide information regarding 19
the programs of those organizations and agencies, excluding 20
detailed information relating to their budgets and payrolls, which the 21
Director deems necessary for the performance of the duties imposed 22
upon him or her pursuant to this section. 23
(f) Has such other powers and duties as are provided by law. 24
2. Notwithstanding any other provision of law, the Director, or 25
the Director’s designee, is responsible for appointing and removing 26
subordinate officers and employees of the Department. 27
Sec. 2.5. 1. On or before January 1, 2026, the Director of 28
Department of Health and Human Services shall: 29
(a) Identify the specific services which are most commonly 30
provided by clinics in this State to recipients of Medicaid for the 31
treatment of pediatric cancer and rare childhood diseases; and 32
(b) Submit to the United States Secretary of Health and Human 33
Services a request to amend the State Plan for Medicaid to increase 34
the rate of reimbursement by not less than 2 percent, or as close to 35
that amount as the Secretary approves, for each service identified 36
pursuant to paragraph (a). 37
2. The request submitted pursuant to subsection 1 must be 38
supported using methods for determining reimbursement rates 39
accepted by the Secretary. 40
Sec. 3. 1. This section and section 2.5 of this act become 41
effective upon passage and approval. 42
2. Sections 1 and 2 of this act become effective: 43

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(a) Upon passage and approval for the purpose of adopting any 1
regulations and performing any other preparatory administrative 2
tasks that are necessary to carry out the provisions of this act; and 3
(b) On January 1, 2026, for all other purposes. 4

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