Read the full stored bill text
- 83rd Session (2025)
Senate Bill No. 312–Committee on
Health and Human Services
CHAPTER..........
AN ACT relating to health care; authorizing Indian tribes to
determine if a person is presumptively eligible for Medicaid;
creating the Tribal Health Authority Council; prescribing the
procedure governing the operations of the Council;
authorizing the appointment of the Coordinator of the
Council; prescribing the duties of the Council; creating the
Account for Tribal Health; and providing o ther matters
properly relating thereto.
Legislative Counsel’s Digest:
Existing law creates the Department of Native American Affairs, which
consists of the Executive Director, the Nevada Indian Commission and the Stewart
Indian School Cultural Center and Museum. (NRS 233A.1003) Section 5 of this
bill creates the Tribal Health Authority Council and establishes the membership of
the Council. Section 4 of this bill defines the term “Council” to refer to the Council
for the purposes of sections 4-9 of this bill. Section 6 of this bill : (1) establishes
certain requirements governing the operation of the Council ; (2) authorizes a
member of the Council to participate through a remote technology system; and (3)
provides for the election of the officers of the Council. Section 7 authorizes the
Executive Director to appoint a Coordinator of the Council. Section 7 also requires
the Department to provide any additional personnel, facilities, equipment and
supplies to the Council. Section 8 of this bill presc ribes the duties of the Council,
which include adopting and periodically updating a plan to increase access to health
care and address and eliminate barriers to health care for American Indians in this
State. Section 1.5 of this bill authorizes the Council to request the drafting of not
more than 2 legislative measures which relate to matters within the scope of the
Council. Section 1.8 of this bill subjects those requests to certain provisions that
apply to requests for the drafting of legislation that are submitted by nonlegislative
requesters. Section 9 of this bill creates the Account for Tribal Health to fund the
activities of the Council . Section 11 of this bill requires the Director of the
Department of Health and Human Services to collaborate with th e Council to
develop a proposal to establish a program to reinvest certain federal funds received
by this State under the Medicaid program.
Existing law requires the Department of Health and Human Services to
administer Medicaid. (NRS 422.270) Additionally, existing federal law requires the
Secretary of Health and Human Services to encourage enrollment of American
Indians in Medicaid. (42 U.S.C. § 1320b -9) To the extent authorized by federal
law, section 1 of this bill authorizes an Indian tribe to determine whether a person
is presumptively eligible to receive benefits under Medicaid. Section 1 requires the
Department to apply for any waiver of federal law or apply for any amendment to
the State Plan for Medicaid to au thorize an Indian tribe to make such
determinations. Section 1 additionally requires the Department to provide to each
Indian tribe that determines presumptive eligibility the resources , training and
technical assistance necessary for the Indian tribe to accurately and effectively
determine if a person is presumptively eligible to receive benefits under Medicaid.
Section 2 of this bill makes a conforming change to indicate that the provisions of
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section 1 will be administered in the same manner as the provi sions of existing law
governing Medicaid.
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. To the extent authorized by federal law, an Indian tribe
may determine whether a person is presumptively eligible to
receive benefits under Medicaid.
2. The Department shall:
(a) Apply to the 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 to carry out the provisions of
subsection 1; and
(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).
3. The Department shall provide to each Indian tribe that
determines presumptive eligibility pursuant to subsection 1 the
resources, training and technical assistance necessary for the
Indian tribe to accurately and effectively determine whether a
person is presumptively eligible for benefits under Medicaid,
including, without limitation, by:
(a) Developing and providing training to the representatives of
the Indian tribe who are involved in determinations of
presumptive eligibility, including, without limitation, through the
distribution of training materials and conducting virtual and in -
person training;
(b) Providing technical assistance and support to ensure that
the Indian tribe has the tools necessary to make accurate
determinations of presumptive eligibility in compliance with state
and federal laws and regulations; and
(c) Ensuring that the Indian tribe is able to communicate with
the Department and the Tribal Health Authority Council created
by section 5 of this act concerning clarification, guidance and
updates on changes in the policies or procedures of Medicaid.
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4. As used in this section, “Indian tribe” means a federally
recognized American Indian tribe pursuant to 25 C.F.R. §§ 83.1 to
83.12, inclusive.
Sec. 1.5. Chapter 218D of NRS is hereby amended by adding
thereto a new section to read as follows:
1. The Tribal Health Authority Council created by section 5
of this act may request the drafting of not more than 2 legislative
measures which relate to matters within the scope of the Council.
The requests must be submitted to the Legislative Counsel on or
before September 1 preceding a regular session.
2. Each request made pursuant to this section must be on a
form prescribed by the Legislative Counsel. The legislative
measures requested pursuant to this section must be prefiled on or
before the third Wednesday in November preceding a regular
session. A legislative measure that is not prefiled on or before that
day shall be deemed withdrawn.
Sec. 1.8. NRS 218D.100 is hereby amended to read as
follows:
218D.100 1. The provisions of NRS 218D.100 to 218D.220,
inclusive, and section 1.5 of this act apply to requests for the
drafting of legislative measures for a regular session.
2. Except as otherwise provided by a specific statute, joint rule
or concurrent resolutio n, the Legislative Counsel shall not honor a
request for the drafting of a legislative measure if the request:
(a) Exceeds the number of requests authorized by NRS
218D.100 to 218D.220, inclusive, and section 1.5 of this act for the
requester; or
(b) Is submitted by an authorized nonlegislative requester
pursuant to NRS 218D.175 to 218D.220, inclusive, and section 1.5
of this act but is not in a subject related to the function of the
requester.
3. The Legislative Counsel shall not:
(a) Honor a request to change the subject matter of a request for
the drafting of a legislative measure after it has been submitted for
drafting.
(b) Honor a request for the drafting of a legislative measure
which has been combined in violation of Section 17 of Article 4 of
the Nevada Constitution.
Sec. 2. 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:
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(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, inclusive, 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 44 4.430, inclusive,
and 445A.010 to 445A.055, inclusive, and all other provisions of
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 p rofessional 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 sources 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
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(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, the Director, or
the Director’s designee, is responsible for appointing and removing
subordinate officers and employees of the Department.
Sec. 3. Chapter 233A of NRS is hereby amended by adding
thereto the provisions set forth as sections 4 to 9, inclusive, of this
act.
Sec. 4. As used in sections 4 to 9, inclusive, of this act, unless
the context otherwise requires, “Council” means the Tribal Health
Authority Council.
Sec. 5. 1. The Tribal Health Authority Council is hereby
created.
2. The Council consists of:
(a) The director of each health care facility located in this
State which is operated by an Indian tribe that elects to participate,
or his or her designee, as voting members.
(b) The following nonvoting members:
(1) One representative of the office of the Indian Health
Service having jurisdiction over this State.
(2) Any person appointed by a state agency pursuant to
subsection 3.
3. A state agency whose functions relate to health care may
appoint a nonvoting member of the Council to serve as a liaison
between the Council and the agency.
4. The members of the Coun cil serve without compensation
and are not entitled to the per diem and travel expenses provided
for state officers and employees generally.
5. Each member of the Council who is an officer or employee
of this State or a political subdivision of this State must be relieved
from his or her duties without loss of regular compensation so that
the officer or employee may prepare for and attend meetings of the
Council and perform any work necessary to carry out the duties of
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the Council in the most timely manne r practicable. A state agency
or political subdivision of this State shall not require an officer or
employee who is a member of the Council to make up the time the
officer or employee is absent from work to carry out duties as a
member of the Council or u se annual leave or compensatory time
for the absence.
6. As used in this section , “Indian tribe” means a federally
recognized American Indian tribe pursuant to 25 C.F.R. §§ 83.1 to
83.12, inclusive.
Sec. 6. 1. The Council shall meet:
(a) At least once each quarter; and
(b) At the times and places specified by a call of the Chair or a
majority of the voting members of the Council.
2. A member of the Council may participate in the meeting
through a remote technology system. A member appearing
remotely may participate in the meeting as if the member were
appearing in person.
3. A majority of the voting members of the Council
constitutes a quorum for the transaction of business, and a
majority of a quorum present at a ny meeting is sufficient for any
official action taken by the Council.
4. If an alternate member attends a meeting of the Council in
place of the regular member, the alternate member fully assumes
the duties, rights and responsibilities of the replaced regular
member for the duration of that meeting.
5. Except as otherwise provided in this subsection, the
Council shall elect from the voting members a Chair and Vice
Chair by a majority vote of the voting members of the Council.
The Chair and Vice Chair serve until July 1 of the year following
their election and may be reelected. If the position of Chair or
Vice Chair becomes vacant, the position must be filled in the same
manner as the original election for the remainder of the unexpired
term.
6. As used in this section, “remote technology system” has the
meaning ascribed to it in NRS 241.015.
Sec. 7. 1. The Executive Director of the Department may
appoint the Coordinator of the Council. If appointed, the
Coordinator:
(a) Is in the unclassified service of the State and serves at the
pleasure of the Executive Director.
(b) Shall perform such duties as are directed by the Executive
Director, as advised by the Council.
(c) Must not be a member of the Council.
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2. The D epartment shall provide any additional personnel,
facilities, equipment and supplies required by the Council to carry
out the provisions of sections 4 to 9, inclusive, of this act.
Sec. 8. The Council shall:
1. Serve as the primary body to advise the Department, the
Office of the Governor and the Department of Health and Human
Services on matters concerning the health of American Indians.
2. Periodically assess the health of American Indians in this
State and the quali ty of and accessibility to health care for those
groups.
3. Based on the assessments conducted pursuant to
subsection 2, adopt and periodically update a plan to increase
access to health care and address and eliminate barriers to health
care for American Indians in this State. The plan may include,
without limitation, specific recommendations for programs,
projects or activities that support the advancement of health
initiatives for American Indians.
4. Identify issues related to the health of American Indians
that the State is incapable of resolving and engage interested
persons and entities as necessary to resolve those issues.
Sec. 9. 1. The Account for Tribal Health is hereby created
in the State General Fund. The D epartment shall administer the
Account.
2. The Account is a continuing account without reversion.
The money in the Account must be invested as the money in other
state accounts is invested. The interest and income earned on the
money in the Account, afte r deducting any applicable charges,
must be credited to the Account. Claims against the Account must
be paid as other claims against the State are paid.
3. The Department may apply for and accept gifts, grants,
donations and money from the Federal Govern ment or any other
source for deposit in the Account.
4. The Department shall use the money in the Account to
support the Council in the performance of the duties prescribed in
sections 4 to 9, inclusive, of this act.
Sec. 10. (Deleted by amendment.)
Sec. 11. 1. The Director of the Department of Health and
Human Services shall collaborate with the Tribal Health Authority
Council created by section 5 of this act during the 2025 -2026
interim to:
(a) Develop a proposal to establish a program to reinvest money
obtained through the enhanced federal match for the provision of
health care and public health services to American Indians; and
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(b) On or before June 30, 2026:
(1) Submit a report on the proposal developed pursuant to
paragraph (a) and any recommendations for legislation based on the
proposal to the Director of the Legislative Counsel Bureau for
transmittal to the Joint Interim Standing Commit tee on Health and
Human Services; and
(2) Present the report at a meeting of the Joint Interim
Standing Committee on Health and Human Services.
2. As used in this section, “enhanced federal match” means the
100 percent federal medical assistance percentage provided pursuant
to 42 U.S.C. § 1396d(b) for health care services provided under
Medicaid through an Indian Health Service facility.
Sec. 12. (Deleted by amendment.)
Sec. 13. 1. This section becomes effective upon passage and
approval.
2. Sections 1 and 2 of this act become effective:
(a) Upon passage and approval for the purpose of performing
any preparatory administrative tasks that are necessary to carry out
the provisions of this act; and
(b) On January 1, 2026, for all other purposes.
3. Sections 1.5, 1.8 and 3 to 12, inclusive, of this act become
effective on July 1, 2025.
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