Revises provisions relating to opioids. (BDR 40-204)

EXEMPT
(Reprinted with amendments adopted on April 21, 2025)
FIRST REPRINT S.B. 337

- *SB337_R1*

SENATE BILL NO. 337–SENATOR LANGE

MARCH 12, 2025
____________

Referred to Committee on Health and Human Services

SUMMARY—Revises provisions relating to opioids.
(BDR 40-204)

FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.

CONTAINS UNFUNDED MANDATE (§§ 1, 16, 26)
(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 health care; requiring certain health care
facilities and certain providers of health care to provide
patients with a form for a non -opioid directive and offer
patients treatments that do not utili ze an opioid under
certain circumstances; requiring the Division of Public
and Behavioral Health of the Department of Health and
Human Services to create a form for a non -opioid
directive; requiring the Administrator of the Division to
appoint an advisory board to monitor compliance with
laws and regulations relating to the non -opioid directive;
requiring certain policies of health insurance to include
coverage for at least one drug that is an alternative to
opioids; requiring certain insurers to provide th e form for
a non -opioid directive to new insureds; revising the
manner by which money in the Fund for a Resilient
Nevada allocates money to projects and grants; and
providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law authorizes a patient to execute certain directives and declarations 1
to record his or her wishes relating to health care and to direct providers of health 2
care in the provision of health care to the patient. (NRS 449A.400 -449A.645) 3
Section 15 of this bill requires the Division of Public and Behavioral Health of the 4
Department of Health and Human Services to create a non -opioid directive, which 5
is a form on which a person may indicate that he or she does not wish to receive 6

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opioids, and to post the non -opioid directive on an Internet website maintained by 7
the Division. Section 16 of this bill requires: (1) certain practitioners to provide a 8
person with an opportunity to execute a non -opioid directive; (2) third party 9
insurers that provide health coverage t o provide persons who enroll in such health 10
coverage a non-opioid directive; and (3) certain health care facilities to ensure that 11
persons providing care at the facility provide a patient with an opportunity to 12
execute a non -opioid directive. Section 16 also requires such third party insurers 13
and health facilities to post the non -opioid directive on their Internet websites. 14
Sections 17 and 18 of this bill set forth the procedure for a patient to execute and 15
revoke a non-opioid directive. 16
Section 19 of this bill prohibits a person who knows or should know that a 17
person has executed a non -opioid directive from prescribing, administering or 18
directing or supervising the administration of an opioid to that person except under 19
certain circumstances. Section 21 of this bill requires the State Board of Health to 20
adopt regulations prescribing procedures relating to the non-opioid directive. 21
Sections 22 and 23 of this bill require the Administrator of the Division to 22
appoint an advisory board to: (1) review the implementation of and compliance 23
with provisions relating to the non-opioid directive; and (2) make recommendations 24
to practitioner licensing boards and certain governmental entities concerning issues 25
relating to opioid use and alternative treatments that do not utilize opioids. Sections 26
8-14 of this bill define certain terms used in sections 8-23. 27
Sections 1 and 33-40 of this bill require a medical facility, certain other health 28
care facilities and certain practitioners who prescribe or administer op ioids to 29
comply with the provisions of law governing non -opioid directives. Under section 30
55 of this bill, beginning on July 1, 2027, or 6 months after the date on which the 31
regulations relating to the non -opioid directives become effective, whichever is 32
later, sections 1, 33, 35-37, 39 and 40 require such facilities and practitioners to 33
offer and provide alternative treatments that do not utilize opioids to patients who 34
have requested such alternatives or executed non -opioid directives, except in 35
certain c ircumstances. Sections 1, 33, 35-37, 39 and 40 require the regulatory 36
bodies that license such facilities and practitioners to biennially review the 37
compliance of such facilities and practitioners with those requirements. Sections 34 38
and 38 make conforming changes to clarify that sections 33 and 37, respectively, 39
apply to the prescribing and administering of opioids to treat intractable pain. 40
Sections 2-6 and 41 of this bill provide for the administration and enforcement of 41
section 1 in the same manner as other requirements imposed by existing law on 42
licensed health facilities. 43
Sections 25 and 54 of this bill authorize the Board of the Public Employees’ 44
Benefits Program and the Public Option, which is a state -run health insurance 45
program for private citizens, to reduce the rates paid to a facility or practitioner who 46
violates any provision of section 33, 35-37, 39 or 40 or prohibit the facility or 47
practitioner from receiving payments through the Program or the Public Option. 48
(NRS 695K.200) Section 27 of this bill applies certain definitions to section 25. 49
Existing law requires public and private policies of insurance regulated under 50
Nevada law and employers who provide such insurance for their employees to 51
include coverage for drugs to: (1) support safe withdrawal from substance use 52
disorder; and (2) provide medication -assisted treatment for opioid use disorder. 53
(NRS 287.010, 287.04335, 422.4025, 608.1555, 689A.0459, 689B.0319, 54
689C.1665, 689C.425, 695A.1874, 695B.19197, 695C.050, 695C.1699, 55
695G.1719) Sections 26, 28, 43, 45-50 and 53 of this bill require certain public and 56
private policies of health insurance, not including Medicaid, to cover drugs that are 57
alternatives to opioids for purposes for which opioids are commonly used. Sections 58
42, 43, 45-50 and 53 of this bill prohibit certain insurers from imposing prior 59
authorization and certain other conditions on covered opioid alternatives that are 60
not imposed on opioids. Section 44 of this bill authorizes the Commissioner of 61

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Insurance to require certain policies of health insurance issued by a domestic 62
insurer to a person who resides in another state to include the coverage required by 63
section 43. Sections 51 and 53.5 of this bill exempt certain policies of health 64
insurance that provide health care services to recipients of Medicaid or insurance 65
pursuant to the Children’s Health Insurance Program from requirements to cover 66
drugs that are alternatives to opioids for purposes for which opioids are commonly 67
used. Section 52 of this bill authorizes the Commissioner to suspend or revoke the 68
certification of a health maintenance organization that fails to comply with the 69
requirements of section 50. The Commissioner would also be authorized to take 70
such actions against other health insurers who fail to comply with the requirements 71
of sections 43, 45-49 and 53. (NRS 680A.200) 72
Existing law requires the Director of the Department of Health and Human 73
Services to create the Silver State Scripts Board (NRS 422.4035) Existing law 74
requires the Department to set the duties of the Board by regulation, including 75
identifying the prescription drugs which should be included on the list of preferred 76
prescription drugs for Medicaid. (NRS 422.405) Section 30 .6 of this bill 77
additionally requires the Department to require the Board to review new classes of 78
therapeutic prescription drugs that include alternatives to opioids for inclusion on 79
that list. 80
Existing federal law requires a state to establish a Drug Us e Review Board to 81
conduct certain reviews related to the use of prescription drugs under Medicaid. (42 82
U.S.C. § 1396r-8(g)(3)) Existing Nevada law requires the Drug Use Review Board 83
to develop step therapy protocols and prior authorization policies and pro cedures 84
for use by the Medicaid program for prescription drugs. (NRS 422.403) Section 85
30.3 of this bill additionally requires the Drug Use Review Board to regularly 86
review the step therapy protocols and prior authorization policies and procedures 87
applicable to drugs that are alternatives to opioids to ensure sufficient access by 88
recipients of Medicaid to such drugs. 89
Existing law creates the Fund for a Resilient Nevada to hold the proceeds of 90
certain litigation by the State concerning the manufacture, distr ibution, sale and 91
marketing of opioids. (NRS 433.732) Existing law requires the Department to 92
create a statewide plan to allocate the money in the Fund for certain statewide 93
projects and grants to local governments and private -sector organizations whose 94
work relates to opioid use disorder and other substance use disorders. (NRS 95
433.738) Section 31 of this bill requires the statewide plan to allocate at least 20 96
percent of the money distributed from the Fund to such projects and grants that are 97
related to the prevention of substance use disorders. Section 32 of this bill makes a 98
conforming change to update an internal reference changed by section 31. Section 99
55 authorizes the Department to continue to utilize the current statewide plan and at 100
the time that the Department revises the statewide plan or develops a new plan, the 101
new plan must comply with the provisions of section 31. 102

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. Chapter 449 of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. A medical facility or facility which is required by the 3
regulations adopted by the Board pursuant to NRS 449.0303 to be 4
licensed that administers opioids to patients shall: 5
(a) Comply with the requirements of sections 8 to 23, inclusive, 6
of this act and any regulations adopted pursuant thereto; and 7

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(b) Offer to a patient an alternative treatment that does not 1
utilize an opioid before administering an opioid to the patient for 2
the first time unless: 3
(1) In the opinion of the attending provider of health care, 4
there is no treatment that does not utilize an opioid that is suitable 5
for treating the patient; or 6
(2) It is not practicable to offer such an alternative 7
treatment to the patient. 8
2. Except as othe rwise provided in subsection 1 and section 9
19 of this act, if a patient or his or her legal guardian has executed 10
a non-opioid directive or states that the patient wishes to receive 11
an alternative treatment that does not utilize an opioid, the 12
medical faci lity or facility which is required by the regulations 13
adopted by the Board pursuant to NRS 449.0303 to be licensed 14
shall provide such a treatment. 15
3. During each even -numbered year, the Division shall 16
review compliance with the requirements of this secti on by each 17
medical facility or facility which is required by the regulations 18
adopted by the Board pursuant to NRS 449.0303 to be licensed 19
that administers opioids to patients. 20
4. As used in this section: 21
(a) “Non-opioid directive” has the meaning ascrib ed to it in 22
section 9 of this act. 23
(b) “Provider of health care” has the meaning ascribed to it in 24
NRS 629.031. 25
Sec. 2. NRS 449.029 is hereby amended to read as follows: 26
449.029 As used in NRS 449.029 to 449.240, inclusi ve, and 27
section 1 of this act, unless the context otherwise requires, “medical 28
facility” has the meaning ascribed to it in NRS 449.0151 and 29
includes a program of hospice care described in NRS 449.196. 30
Sec. 3. NRS 449.0301 is hereby amended to read as follows: 31
449.0301 The provisions of NRS 449.029 to 449.2428, 32
inclusive, and section 1 of this act do not apply to: 33
1. Any facility conducted by and for the adherents of any 34
church or religious denomination for the purpose of providing 35
facilities for the care and treatment of the sick who depend solely 36
upon spiritual means through prayer for healing in the practice of 37
the religion of the church or denomination, except that such a 38
facility shall comply with all regulations rela tive to sanitation and 39
safety applicable to other facilities of a similar category. 40
2. Foster homes as defined in NRS 424.014. 41
3. Any medical facility , facility for the dependent or facility 42
which is otherwise required by the regulations adopted by the Board 43
pursuant to NRS 449.0303 to be licensed that is operated and 44
maintained by the United States Government or an agency thereof. 45

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Sec. 4. NRS 449.160 is hereby amended to read as follows: 1
449.160 1. The Division may d eny an application for a 2
license or may suspend or revoke any license issued under the 3
provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of 4
this act upon any of the following grounds: 5
(a) Violation by the applicant or the licensee of any of the 6
provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 7
section 1 of this act or 449A.100 to 449A.124, inclusive, and 8
449A.270 to 449A.286, inclusive, or of any other law of this State 9
or of the standards, rules and regulations adopted thereunder. 10
(b) Aiding, abetting or permitting the commission of any illegal 11
act. 12
(c) Conduct inimical to the public health, morals, welfare and 13
safety of the people of the State of Nevada in the maintenance and 14
operation of the premises for which a license is issued. 15
(d) Conduct or practice detrimental to the health or safety of the 16
occupants or employees of the facility. 17
(e) Failure of the applicant to obtain written approval from the 18
Director of the Department of Health and Human Services as 19
required by NRS 439A.100 or 439A.102 or as provided in any 20
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 21
and section 1 of this act and 449.435 to 449.531, inclusive, and 22
chapter 449A of NRS if such approval is required, including, 23
without limitation, the closure or conversion of any hospital in a 24
county whose population is 100,000 or more that is owned by the 25
licensee without approval pursuant to NRS 439A.102. 26
(f) Failure to comply with the provisions of NRS 441A.315 and 27
any regulations adopted pursuant thereto or NRS 449.2486. 28
(g) Violation of the provisions of NRS 458.112. 29
(h) Failure to comply with the provisions of NRS 449A.170 to 30
449A.192, inclusive, and any regulation adopted pursuant thereto. 31
(i) Violation of the provisions of NRS 629.260. 32
2. In addition to the provisions of subsection 1, the Division 33
may revoke a license to operate a facility for the dependent if, with 34
respect to that facility, the licensee that operates the facility, or an 35
agent or employee of the licensee: 36
(a) Is convicted of violating any of the provisions of 37
NRS 202.470; 38
(b) Is ordered to but fails to abate a nuisance pursuant to NRS 39
244.360, 244.3603 or 268.4124; or 40
(c) Is ordered by the appropriate governmental agency to correct 41
a violation of a building, safety or health code or regulation but fails 42
to correct the violation. 43
3. The Division shall maintain a log of any complaints that it 44
receives relating to activities for which the Division may revoke the 45

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license to operate a facility for the dependent pursuant to subsection 1
2. The Division shall provide to a facility for the care of adults 2
during the day: 3
(a) A summary of a complaint against t he facility if the 4
investigation of the complaint by the Division either substantiates 5
the complaint or is inconclusive; 6
(b) A report of any investigation conducted with respect to the 7
complaint; and 8
(c) A report of any disciplinary action taken against the facility. 9
 The facility shall make the information available to the public 10
pursuant to NRS 449.2486. 11
4. On or before February 1 of each odd -numbered year, the 12
Division shall submit to the Director of the Legislative Counsel 13
Bureau a written report setting forth, for the previous biennium: 14
(a) Any complaints included in the log maintained by the 15
Division pursuant to subsection 3; and 16
(b) Any disciplinary actions taken by the Division pursuant to 17
subsection 2. 18
Sec. 5. NRS 449.163 is hereby amended to read as follows: 19
449.163 1. In addition to the payment of the amount required 20
by NRS 449.0308, if a medical facility, facility for the dependent or 21
facility which is required by the regulations adopted by the Board 22
pursuant to NRS 449.0303 to be licensed violates any provision 23
related to its licensure, including any provision of NRS 439B.410 or 24
449.029 to 449.2428, inclusive, and section 1 of this act or any 25
condition, standard or regulation adopted by the Board, the 26
Division, in accordance with the regulations adopted pursuant to 27
NRS 449.165, may: 28
(a) Prohibit the facility from admitting any patient until it 29
determines that the facility has corrected the violation; 30
(b) Limit the occupancy of the facility to the number of beds 31
occupied when the violation occurred, until it determines that the 32
facility has corrected the violation; 33
(c) If the license of the facility limits the occupancy of the 34
facility and the facility has exceeded the approved occupancy, 35
require the faci lity, at its own expense, to move patients to another 36
facility that is licensed; 37
(d) Except where a greater penalty is authorized by subsection 2, 38
impose an administrative penalty of not more than $5,000 per day 39
for each violation, together with interest thereon at a rate not to 40
exceed 10 percent per annum; and 41
(e) Appoint temporary management to oversee the operation of 42
the facility and to ensure the health and safety of the patients of the 43
facility, until: 44

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(1) It determines that the facility has corre cted the violation 1
and has management which is capable of ensuring continued 2
compliance with the applicable statutes, conditions, standards and 3
regulations; or 4
(2) Improvements are made to correct the violation. 5
2. If an off -campus location of a hospital fails to obtain a 6
national provider identifier that is distinct from the national provider 7
identifier used by the main campus and any other off -campus 8
location of the hospital in violation of NRS 449.1818, the Division 9
may impose against the hospi tal an administrative penalty of not 10
more than $10,000 for each day of such failure, together with 11
interest thereon at a rate not to exceed 10 percent per annum, in 12
addition to any other action authorized by this chapter. 13
3. If the facility fails to pay any administrative penalty imposed 14
pursuant to paragraph (d) of subsection 1 or subsection 2, the 15
Division may: 16
(a) Suspend the license of the facility until the administrative 17
penalty is paid; and 18
(b) Collect court costs, reasonable attorney’s fees and other 19
costs incurred to collect the administrative penalty. 20
4. The Division may require any facility that violates any 21
provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and 22
section 1 of this act, or any condition, standard or regulation 23
adopted by the Board to make any improvements necessary to 24
correct the violation. 25
5. Any money collected as administrative penalties pursuant to 26
paragraph (d) of subsection 1 or subsection 2 must be accounted for 27
separately and used to administer and carry out the provisions of 28
NRS 449.001 to 449.430, inclusive, and section 1 of this act, 29
449.435 to 449.531, inclusive, and chapter 449A of NRS to protect 30
the health, safety, well -being and property of the patients and 31
residents of facilities in accordance with applicable state and federal 32
standards or for any other purpose authorized by the Legislature. 33
Sec. 6. NRS 449.240 is hereby amended to read as follows: 34
449.240 The district attorney of the county in which the facility 35
is l ocated shall, upon application by the Division, institute and 36
conduct the prosecution of any action for violation of any provisions 37
of NRS 449.029 to 449.245, inclusive [.] , and section 1 of this act. 38
Sec. 7. Chapter 449A of NRS is hereby amended by adding 39
thereto the provisions set forth as sections 8 to 23, inclusive, of this 40
act. 41
Sec. 8. As used in sections 8 to 23, inclusive, of this act, 42
unless the context otherwise requires, the words and terms defined 43
in sections 9 to 14, inclusive, of this act have the meanings 44
ascribed to them in those sections. 45

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Sec. 9. “Non-opioid directive” means the form created 1
pursuant to section 15 of this act. 2
Sec. 10. “Non-opioid patient” means a person who executes 3
a non -opioid directive or whose legal guardian has executed a 4
non-opioid directive on behalf of the person. 5
Sec. 11. “Practitioner” has the meaning ascribed to it in 6
NRS 639.0125. 7
Sec. 12. “Practitioner licensing board” means a licensing 8
board created by chapter 630, 631, 632, 633, 635 or 636 of NRS. 9
Sec. 13. “Provider of health care” has the meaning ascribed 10
to it in NRS 629.031. 11
Sec. 14. “Third party” means any insurer, governmental 12
entity or other organization providing health coverage or benefits 13
in accordance with state or federal law. 14
Sec. 15. 1. The Division shall create a form for executing a 15
non-opioid directive. 16
2. The form created pursuant to subsection 1 must include, 17
without limitation: 18
(a) A statement of circumstances prescribed by section 19 of 19
this act under which an opioid may be administered to a non -20
opioid patient; 21
(b) A statement of the legal effect of the non -opioid directive, 22
as prescribed by section 19 of this act; 23
(c) A place for a person to execute the form in accordance with 24
section 17 of this act; 25
(d) A summary of the procedures for revoking a non -opioid 26
directive pursuant to section 18 of this act; and 27
(e) Any additional information the Division considers relevant. 28
3. The Division shall post the form for executing a non -29
opioid directive on an Internet website maintained by the Division. 30
Sec. 16. 1. Except in an emergency situation, before 31
prescribing, administering or directing or supervising the 32
administration of an opioid to a patient, a practitioner shall: 33
(a) Check the medical record of the patient to determine 34
whether the patient is a non-opioid patient; 35
(b) If the patient is not a non -opioid patient, explain to the 36
patient or his or her legal guardian that he or she may execute a 37
non-opioid directive in accordance with section 17 of this act; and 38
(c) If the patient or legal guardian indicates that he or she 39
would like to execute a non -opioid directive, provide the non -40
opioid directive to the patient or legal guardian, as applicable, for 41
execution pursuant to section 17 of this act. 42
2. A third par ty that provides health coverage in this State 43
shall: 44

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(a) Post the form for executing a non -opioid directive on an 1
Internet website maintained by the third party; and 2
(b) Provide the non-opioid directive to each person who enrolls 3
in health coverage provided by the third party. 4
3. A medical facility or facility which is required by the 5
regulations adopted by the Board pursuant to NRS 449.0303 to be 6
licensed that administers opioids to patients shall: 7
(a) Ensure that persons described in subsection 1 w ho provide 8
care at the facility comply with the requirements of that 9
subsection; and 10
(b) Post the non -opioid directive on an Internet website 11
maintained by the facility, if the facility maintains an Internet 12
website. 13
Sec. 17. 1. A non-opioid directive may be executed by: 14
(a) A person for himself or herself; or 15
(b) The legal guardian of a person on behalf of the person. 16
2. An executed non-opioid directive becomes effective when a 17
person described in subsection 1 prov ides the executed non-opioid 18
directive to: 19
(a) A provider of health care, medical facility, facility for the 20
dependent or facility which is required by the regulations adopted 21
by the Board pursuant to NRS 449.0303 to be licensed that is 22
providing care to the non-opioid patient to whom the non -opioid 23
directive pertains; or 24
(b) A third party that provides coverage to the non -opioid 25
patient to whom the non-opioid directive pertains. 26
3. Upon receiving an executed non -opioid directive pursuant 27
to subsection 2, a provider of health care, a medical facility, 28
facility for the dependent or facility which is required by the 29
regulations adopted by the Board pursuant to NRS 449.0303 to be 30
licensed or third party shall record the non -opioid directive in the 31
record of the non -opioid patient to whom the non -opioid directive 32
pertains. 33
Sec. 18. 1. A non-opioid patient may revoke his or her non-34
opioid directive at any time and in any manner that communicates 35
to a person or entity describe d in subsection 2 of section 17 of this 36
act the intent to revoke the directive. 37
2. A legal guardian who has executed a non -opioid directive 38
may revoke the directive at any time by articulating in writing an 39
intent to revoke the directive and providing su ch written notice to 40
a person or entity described in subsection 2 of section 17 of this 41
act. 42
3. The revocation of a non -opioid directive is effective upon 43
the patient or legal guardian communicating pursuant to 44

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subsection 1 or 2, the desire to revoke the form. The person or 1
entity to whom the revocation is communicated shall: 2
(a) Make the revocation a part of the records of the patient; or 3
(b) Cause the revocation to be made a part of the record of the 4
patient. 5
Sec. 19. 1. Except as otherwise provided in this section, a 6
person who knows or should know that a person is a non -opioid 7
patient shall not prescribe, administer or direct or supervise 8
another in administering an opioid to a non-opioid patient. 9
2. A practition er may prescribe, administer, or direct or 10
supervise the administration of an opioid to a non -opioid patient, 11
and a person listed in NRS 453.375 may administer an opioid to a 12
non-opioid patient under such direction or supervision, if: 13
(a) Prescribing or a dministering the opioid is medically 14
necessary, as determined by the practitioner, to treat the patient in 15
an emergency situation or while the patient is receiving inpatient 16
care at a medical facility; 17
(b) The opioid is prescribed or administered for intr aoperative 18
use; or 19
(c) The opioid is prescribed or administered pursuant to the 20
regulations adopted by the Board pursuant to subsection 5 of 21
section 21 of this act. 22
3. If a non -opioid patient is prescribed or administered an 23
opioid pursuant to paragrap h (a) of subsection 2, the practitioner 24
who prescribes, administers or directs or supervises the 25
administration of the opioid shall ensure that the non -opioid 26
patient or his or her legal guardian receives information on 27
preventing opioid use disorder, incl uding, without limitation, 28
relapse into opioid use disorder, when the emergency situation has 29
ended or the person is being discharged from the medical facility. 30
Sec. 20. (Deleted by amendment.) 31
Sec. 21. The Board shall adopt regulations as necessary to 32
carry out the provisions of sections 8 to 23, inclusive, of this act, 33
including, without limitation, regulations prescribing procedures: 34
1. For a practitioner to record a non -opioid directive in the 35
medical record of a non-opioid patient; 36
2. For a non -opioid patient or the legal guardian of a non -37
opioid patient to revoke a non-opioid directive; 38
3. To ensure that the recording, disclosure and distribution of 39
a non -opioid directive and data relating to such a directive 40
complies with applicable state and federal laws and regulations 41
concerning the confidentiality of health information and informed 42
consent to health care; 43
4. For complying with the requirements of section 16 of this 44
act; and 45

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5. For prescribing and administering opioids to a non -opioid 1
patient: 2
(a) To treat a substance use disorder; or 3
(b) If the non-opioid patient is receiving hospice care. 4
Sec. 22. 1. The Administrator of the Division sh all appoint 5
an advisory board to advise the Division concerning the 6
implementation of sections 8 to 23, inclusive, of this act and 7
monitoring compliance with those provisions. The advisory board 8
must consist of persons selected by the Administrator who hav e 9
expertise in the safe and effective use of opioids during the 10
provision of health care and the treatment of substance use 11
disorder. 12
2. The term of office of a member of the advisory board is 3 13
years and commences on July 1 of the year of appointment. T he 14
terms of office of the members of the advisory board must be 15
staggered to result in, as nearly as possible, the appointment of an 16
equal number of members to the advisory board on July 1 of each 17
year. 18
3. The members of the advisory board serve without 19
compensation and are not entitled to the per diem and travel 20
expenses provided for state officers and employees generally. 21
4. Each member of the advisory board who is an officer or 22
employee of this State or a political subdivision of this State must 23
be r elieved from his or her duties without loss of regular 24
compensation so that the officer or employee may prepare for and 25
attend meetings of the advisory board and perform any work 26
necessary to carry out the duties of the advisory board in the most 27
timely manner practicable. A state agency or political subdivision 28
of this State shall not require an officer or employee who is a 29
member of the advisory board to make up the time the officer or 30
employee is absent from work to carry out duties as a member of 31
the advisory board or use annual leave or compensatory time for 32
the absence. 33
5. The advisory board shall: 34
(a) Elect a Chair from among its members; and 35
(b) Meet at the times and places specified by a call of the 36
Chair. 37
Sec. 23. The advisory board appointed pursuant to section 22 38
of this act shall: 39
1. Review the implementation of and compliance with the 40
requirements of sections 8 to 23, inclusive, of this act, including, 41
without limitation, by: 42
(a) Hearing testimony from: 43

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(1) Practitioners, patients, persons who have recovered or 1
are in recovery from opioid use disorder and persons involved in 2
the treatment of opioid use disorder; 3
(2) Representatives of the Division, practitioner licensing 4
boards and other organizations; and 5
(3) Other persons and entities with knowledge and 6
information related to opioids, opioid use disorder or non -opioid 7
alternatives to opioids or any other relevant knowledge and 8
information; and 9
(b) Reviewing proposed and enacted legislation, regula tions 10
and other changes to state and local policy related to non -opioid 11
directives and the prescribing and use of opioids; and 12
2. Make recommendations to practitioner licensing boards, 13
the Department, the Legislature and other governmental entities 14
concerning issues relating to opioid use and alternative treatments 15
that do not utilize opioids. 16
Sec. 24. (Deleted by amendment.) 17
Sec. 25. Chapter 287 of NRS is hereby amended by adding 18
thereto a new section to read as follows: 19
1. If the Division of Public and Behavioral Health of the 20
Department of Health and Human Services finds that a health 21
facility has failed to comply with section 1 of this act or a 22
practitioner licensing board finds that a practitioner has failed to 23
comply with section 33, 35, 36, 37 or 39 of this act or NRS 24
636.2882, the Board may: 25
(a) Reduce the reimbursement rates paid to the health facility 26
or practitioner, as applicable, by the plan of health insurance 27
provided by the Board; or 28
(b) Prohibit the health facility or practitioner, as applicable, 29
from receiving payments through the insurance provided through 30
the Program. 31
2. The Board shall include in any contract with a provider of 32
health care notice of the actions the Board may take pursuant to 33
subsection 1. 34
3. As used in this section: 35
(a) “Health facility” means a medical facility, as defined in 36
NRS 449.0151, or a facility which is required by the regulations 37
adopted by the State Board of Health pursuant to NRS 449.0303 to 38
be licensed. 39
(b) “Practitioner” has the meaning ascribed to it in 40
NRS 639.0125. 41
(c) “Practitioner licensing board” means a board created 42
pursuant to chapter 630, 631, 632, 633, 635 or 636 of NRS. 43

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Sec. 26. NRS 287.010 is hereby amended to read as follows: 1
287.010 1. The governing body of any county, school 2
district, municipal corporation, political subdivision, public 3
corporation or other local governmental agency of the State of 4
Nevada may: 5
(a) Adopt and carry into effect a system of group life, accident 6
or health insurance, or any combination thereof, for the benefit of its 7
officers and employees, and the dependents of officers and 8
employees who elect to accept the insurance and who, where 9
necessary, have authorized the governing body to make deductions 10
from their compensation for the payment of premiums on the 11
insurance. 12
(b) Purchase group policies of life, accident or health insurance, 13
or any combination thereof, for the benefit of such officers and 14
employees, and the dependents of such officers and employees, as 15
have authorized the purchase, from insurance companies authorized 16
to transact the business of such insurance in the State of Nevada, 17
and, where necessary, deduct from the compensation of offic ers and 18
employees the premiums upon insurance and pay the deductions 19
upon the premiums. 20
(c) Provide group life, accident or health coverage through a 21
self-insurance reserve fund and, where necessary, deduct 22
contributions to the maintenance of the fund fro m the compensation 23
of officers and employees and pay the deductions into the fund. The 24
money accumulated for this purpose through deductions from the 25
compensation of officers and employees and contributions of the 26
governing body must be maintained as an in ternal service fund as 27
defined by NRS 354.543. The money must be deposited in a state or 28
national bank or credit union authorized to transact business in the 29
State of Nevada. Any independent administrator of a fund created 30
under this section is subject to the licensing requirements of chapter 31
683A of NRS, and must be a resident of this State. Any contract 32
with an independent administrator must be approved by the 33
Commissioner of Insurance as to the reasonableness of 34
administrative charges in relation to cont ributions collected and 35
benefits provided. The provisions of NRS 439.581 to 439.597, 36
inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 37
687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, and 38
section 45 of this act, paragraphs (b) and (c) of subsection 1 of NRS 39
689B.0319, subsections 2, 4, 6 and 7 of NRS 689B.0319, 689B.033 40
to 689B.0369, inclusive, 689B.0375 to 689B.050, inclusive, 41
689B.0675, 689B.265, 689B.287 and 689B.500 apply to coverage 42
provided pursuant to this paragraph, except that the p rovisions of 43
NRS 689B.0378, 689B.03785 and 689B.500 only apply to coverage 44

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- *SB337_R1*
for active officers and employees of the governing body, or the 1
dependents of such officers and employees. 2
(d) Defray part or all of the cost of maintenance of a self -3
insurance fund or of the premiums upon insurance. The money for 4
contributions must be budgeted for in accordance with the laws 5
governing the county, school district, municipal corporation, 6
political subdivision, public corporation or other local governmental 7
agency of the State of Nevada. 8
2. If a school district offers group insurance to its officers and 9
employees pursuant to this section, members of the board of trustees 10
of the school district must not be excluded from participating in the 11
group insurance. If the amount of the deductions from compensation 12
required to pay for the group insurance exceeds the compensation to 13
which a trustee is entitled, the difference must be paid by the trustee. 14
3. In any county in which a legal services organization exists, 15
the gover ning body of the county, or of any school district, 16
municipal corporation, political subdivision, public corporation or 17
other local governmental agency of the State of Nevada in the 18
county, may enter into a contract with the legal services 19
organization pur suant to which the officers and employees of the 20
legal services organization, and the dependents of those officers and 21
employees, are eligible for any life, accident or health insurance 22
provided pursuant to this section to the officers and employees, and 23
the dependents of the officers and employees, of the county, school 24
district, municipal corporation, political subdivision, public 25
corporation or other local governmental agency. 26
4. If a contract is entered into pursuant to subsection 3, the 27
officers and employees of the legal services organization: 28
(a) Shall be deemed, solely for the purposes of this section, to be 29
officers and employees of the county, school district, municipal 30
corporation, political subdivision, public corporation or other local 31
governmental agency with which the legal services organization has 32
contracted; and 33
(b) Must be required by the contract to pay the premiums or 34
contributions for all insurance which they elect to accept or of which 35
they authorize the purchase. 36
5. A contract that is entered into pursuant to subsection 3: 37
(a) Must be submitted to the Commissioner of Insurance for 38
approval not less than 30 days before the date on which the contract 39
is to become effective. 40
(b) Does not become effective unless approved by the 41
Commissioner. 42
(c) Shall be deemed to be approved if not disapproved by the 43
Commissioner within 30 days after its submission. 44

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- *SB337_R1*
6. As used in this section, “legal services organization” means 1
an organization that operates a program for legal aid and receives 2
money pursuant to NRS 19.031. 3
Sec. 27. NRS 287.0402 is hereby amended to read as follows: 4
287.0402 As used in NRS 287.0402 to 287.049, inclusive, and 5
section 25 of this act, unless the context otherwise requires, the 6
words and terms defined in NRS 287.0404 to 287.04064, inclusive, 7
have the meanings ascribed to them in those sections. 8
Sec. 28. NRS 287.04335 is hereby amended to read as 9
follows: 10
287.04335 If the Board provides health insura nce through a 11
plan of self -insurance, it shall comply with the provisions of NRS 12
439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409, 13
687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.255, 14
695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 15
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 16
695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 17
695G.174, inclusive, and section 53 of this act, 695G.176, 18
695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 19
695G.310, inclusive, 695G.405 and 695G.415, in the same manner 20
as an insurer that is licensed pursuant to title 57 of NRS is required 21
to comply with those provisions. 22
Sec. 29. (Deleted by amendment.) 23
Sec. 30. (Deleted by amendment.) 24
Sec. 30.3. NRS 422.403 is hereby amended to read as follows: 25
422.403 1. The Department shall, by regulation, establish and 26
manage the use by the Medicaid program of step therapy and prior 27
authorization for prescription drugs. 28
2. The Drug Use Review Board shall: 29
(a) Advise the Department concerning the use by the Medicaid 30
program of step therapy and prior authorization for prescription 31
drugs; 32
(b) Develop step therapy protocols and prior authorization 33
policies and procedures for use by the Medicaid program for 34
prescription drugs; and 35
(c) Review and approve, based on clinical evidence and best 36
clinical practice guidelines and without consideration of the cost of 37
the prescription drugs being considered, step therapy protocols used 38
by the Medicaid program for prescription drugs. 39
3. The step therapy protocol established pursuant to this section 40
must not apply to a drug approved by the Food and Drug 41
Administration that is prescribed to treat a psychiatric condition of a 42
recipient of Medicaid, if: 43
(a) The drug has been approved by the Food and Drug 44
Administration with indications for the psychiatric condition of the 45

– 16 –

- *SB337_R1*
insured or the use of the drug to treat that psychiatric condition is 1
otherwise supported by medical or scientific evidence; 2
(b) The drug is prescribed by: 3
(1) A psychiatrist; 4
(2) A physician assistant under the supervision of a 5
psychiatrist; 6
(3) An advanced practice registered nurse who has the 7
psychiatric training and experience prescribed by the State Board of 8
Nursing pursuant to NRS 632.120; or 9
(4) A primary care provider that is providing care to an 10
insured in consultation with a practitioner listed in subparagraph (1), 11
(2) or (3), if the closest practitioner listed in subparagraph (1), (2) or 12
(3) who participates in Medicaid is located 60 miles or more from 13
the residence of the recipient; and 14
(c) The practitioner listed in paragraph (b) who prescribed the 15
drug knows, based on the medical history of the recipient, or 16
reasonably expects each alternative drug that is required to be used 17
earlier in the step therapy protocol to be ineffective at treating the 18
psychiatric condition. 19
4. The Department shall not require the Drug Use Review 20
Board to develop, review or approve prior authorization policies or 21
procedures necessary for the operation of the list of preferred 22
prescription drugs developed pursuant to NRS 422.4025. 23
5. The Department shall accept recommendations from the 24
Drug Use Review Board as the basis for developing or revising step 25
therapy protocols and prior authorization policies and procedures 26
used by the Medicaid program for prescription drugs. 27
6. The Department shall require the Drug Use Review Board , 28
for the purpose of ensuring sufficient access by recipients of 29
Medicaid to alternatives to opioids, to regularly review the step 30
therapy protocols and prior authorization policies and procedures 31
applicable to drugs that are approved by the United States Food 32
and Drug Administration as alternatives to opioids. 33
7. As used in this section: 34
(a) “Medical or scientific evidence” has the meaning ascribed to 35
it in NRS 695G.053. 36
(b) “Step therapy protocol” means a procedure that requires a 37
recipient of Medicaid to use a prescription drug or sequence of 38
prescription drugs other than a drug that a practitioner recommends 39
for treatment of a psychiatric condition of the recipient before 40
Medicaid provides coverage for the recommended drug. 41
Sec. 30.6. NRS 422.405 is hereby amended to read as follows: 42
422.405 1. The Department shall, by regulation, set forth the 43
duties of the Board, which must include, without limitation: 44

– 17 –

- *SB337_R1*
(a) Identifying the prescription drugs which should be included 1
on the list of preferred prescription drugs developed by the 2
Department pursuant to NRS 422.4025, which must include, 3
without limitation, any prescription drug required by the Centers for 4
Medicare and Medicaid Services of the United States Department of 5
Health and Human Services to be covered by the Medicaid pr ogram 6
and any other prescription drug deemed essential by the Board; 7
(b) Identifying the prescription drugs which should be excluded 8
from any restrictions that are imposed by the Medicaid program on 9
drugs that are on the list of preferred prescription drugs; 10
(c) Identifying classes of therapeutic prescription drugs for its 11
review and performing a clinical analysis of each drug included in 12
each class that is identified for review; and 13
(d) Reviewing at least annually all classes of therapeutic 14
prescription drugs on the list of preferred prescription drugs 15
developed by the Department pursuant to NRS 422.4025. 16
2. The Department shall, by regulation, require the Board to: 17
(a) Base its decisions on evidence of clinical efficacy, safety and 18
outcomes for patie nts and, if the difference between the clinical 19
efficacy, safety and outcomes for two or more drugs is not clinically 20
significant, cost; 21
(b) Review new pharmaceutical products in as expeditious a 22
manner as possible; [and] 23
(c) Consider new clinical eviden ce supporting the inclusion of 24
an existing pharmaceutical product on the list of preferred 25
prescription drugs developed by the Department and new clinical 26
evidence supporting the exclusion of an existing pharmaceutical 27
product from any restrictions that ar e imposed by the Medicaid 28
program on drugs that are on the list of preferred prescription drugs 29
in as expeditious a manner as possible [.] ; and 30
(d) Review pursuant to paragraph (c) of subsection 1 each new 31
class of therapeutic prescription drugs that includes a subset of 32
drugs that are approved by the United States Food and Drug 33
Administration as alternatives to opioid s for purposes for which 34
opioids would normally be used. 35
3. The Department shall, by regulation, authorize the Board to: 36
(a) In carry ing out its duties, exercise clinical judgment and 37
analyze peer review articles, published studies, and other medical 38
and scientific information; and 39
(b) Establish subcommittees to analyze specific issues that arise 40
as the Board carries out its duties. 41
4. The Board may close any portion of a meeting during which 42
it considers the cost of prescription drugs. 43

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- *SB337_R1*
Sec. 31. NRS 433.738 is hereby amended to read as follows: 1
433.738 1. The statewide plan to allocate money from the 2
Fund established by the Department, in consultation with the Office, 3
pursuant to paragraph (b) of subsection 1 of NRS 433.734 must: 4
(a) Establish policies and procedures for the administration and 5
distribution of money from the Fund; 6
(b) Allocate the money in the Fund for the purposes described in 7
[subsection] subsections 2 [;] and 3; and 8
(c) Establish requirements governing the use of money allocated 9
from the Fund. 10
2. The statewide plan must allocate at least 20 percent of the 11
money distributed from the Fund for projects and grants related to 12
the prevention of substance use disorders. Such money may be 13
used for: 14
(a) The projects described in subparagraph (15) of paragraph 15
(a) of subsection 3 and, where applicable, other projects described 16
in that paragraph; and 17
(b) Grants to an agency or organization listed in paragraph (b) 18
of subsection 3 for work relating to the prevention of substance 19
use disorders. 20
3. The statewide plan may allocate money to: 21
(a) Statewide projects, which may include, without limitation: 22
(1) Expanding access to evidence -based prevention of 23
substance use disorders, early intervention for persons at risk of a 24
substance use disorder, treatment for substance use disorders and 25
support for persons in recovery from substance use disorders; 26
(2) Programs to reduce the incidence and severity of neonatal 27
abstinence syndrome; 28
(3) Prevention of adverse childhood experiences and early 29
intervention for children who have undergone adverse childhood 30
experiences and the families of such children; 31
(4) Services to reduce the harm caused by substance use; 32
(5) Prevention and treatment of infectious diseases in persons 33
with substance use disorders; 34
(6) Services for children and other persons in a behavioral 35
health crisis and the families of such persons; 36
(7) Housing for persons who have or are in recovery from 37
substance use disorders; 38
(8) Campaigns to educate and increase awareness of the 39
public concerning substance use and substance use disorders; 40
(9) Programs for persons involved in the criminal justice or 41
juvenile justice system and the families of such persons, including, 42
without limitation, programs that are administered by courts; 43
(10) The evaluation of existing programs relating to 44
substance use and substance use disorders; 45

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- *SB337_R1*
(11) Development of the workforce of providers of services 1
relating to substance use and substance use disorders; 2
(12) The collection and analysis of data relating to substance 3
use and substance use disorders; 4
(13) Capital projects relating to substance use and substance 5
use disorders, including, without limitation, construction, 6
purchasing and remodeling; [and] 7
(14) Implementing the hotline for persons who are 8
considering suicide or otherwise in a behavioral health crisis and 9
providing services to persons who access that hotline in accordance 10
with the provisions of NRS 433.702 to 433.710, inclusive [.] ; and 11
(15) Research into alternative treatments that do not utilize 12
an opioid. 13
(b) Grants to regional, c ounty, local and tribal agencies and 14
private-sector organizations whose work relates to opioid use 15
disorder and other substance use disorders. 16
[3.] 4. The projects described in paragraph (a) of subsection 17
[2] 3 may include, without limitation, projects to maximize 18
expenditures through federal, local and private matching 19
contributions. 20
[4.] 5. The Department, in consultation with the Office, may 21
revise the statewide plan to allocate money from the Fund as 22
necessary without conducting a statewide needs assessment pursuant 23
to paragraph (a) of subsection 1 of NRS 433.734 so long as a needs 24
assessment is conducted at the intervals required by that subsection. 25
Sec. 32. NRS 433.740 is hereby amended to read as follows: 26
433.740 1. If the Department awards grants pursuant to 27
paragraph (b) of subsection [2] 3 of NRS 433.738, the Department, 28
in consultation with the Office, must: 29
(a) Develop, solicit and accept applications for those grants. An 30
application submitted by a regional, local or tribal governmental 31
entity must include, without limitation: 32
(1) The results of a needs assessment that meets the 33
requirements of NRS 433.742; and 34
(2) A plan for the use of the grant that meets the 35
requirements of NRS 433.744. 36
(b) Coordinate with and provide support to regional, local and 37
tribal governmental entities in conducting needs assessments and 38
developing plans pursuant to paragraph (a). 39
(c) Consider any money recovered or anticipated to be recovered 40
by county, local or trib al governmental agencies through judgments 41
received or settlements entered into as a result of litigation 42
concerning the manufacture, distribution, sale or marketing of 43
opioids. 44

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- *SB337_R1*
(d) Conduct annual evaluations of programs to which grants 1
have been awarded. 2
2. To the extent authorized by the terms of any judgment or 3
settlement described in subsection 1 of NRS 433.732, the recipient 4
of a grant pursuant to paragraph (b) of subsection [2] 3 of NRS 5
433.738 may use not more than 8 percent of the grant for 6
administrative expenses related to the grant or the projects supported 7
by the grant. 8
3. The recipient of a grant pursuant to paragraph (b) of 9
subsection [2] 3 of NRS 433.738 shall annually submit to the 10
Department a report concerning the expenditure of the mo ney that 11
was received and the outcomes of the projects on which that money 12
was spent. 13
4. If a regional, local or tribal governmental entity that receives 14
a grant pursuant to paragraph (b) of subsection [2] 3 of NRS 15
433.738 later recovers money through a judgment or a settlement 16
resulting from litigation concerning the manufacture, distribution, 17
sale or marketing of opioids: 18
(a) The regional, local or tribal governmental entity must 19
immediately notify the Department; and 20
(b) The Department may recover fr om the governmental entity 21
an amount not to exceed the amount of the grant or the amount of 22
the recovery, whichever is less. 23
5. A regional, local or tribal governmental entity that receives a 24
grant pursuant to paragraph (b) of subsection [2] 3 of NRS 433.738 25
shall conduct a new needs assessment and update its plan for the use 26
of the grant at intervals prescribed by regulation of the Department, 27
which must be not less than every 4 years. 28
Sec. 33. Chapter 630 of NRS is hereb y amended by adding 29
thereto a new section to read as follows: 30
1. A physician or physician assistant who prescribes or 31
administers opioids shall: 32
(a) Comply with the requirements of sections 8 to 23, inclusive, 33
of this act, and any regulations adopted pursuant thereto; and 34
(b) Offer to a patient an alternative treatment that does not 35
utilize an opioid before prescribing, administering or directing or 36
supervising the administration of an opioid to the patient for the 37
first time unless: 38
(1) In the opinion of the physician or physician assistant, 39
there is no treatment that does not utilize an opioid that is suitable 40
for treating the patient; or 41
(2) It is not practicable to offer such an alternative 42
treatment to the patient. 43
2. Except as otherwis e provided in subsection 1 and section 44
19 of this act, if a patient or his or her legal guardian has executed 45

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- *SB337_R1*
a non-opioid directive or states that the patient wishes to receive 1
an alternative treatment that does not utilize an opioid, the 2
physician or physician assistant shall provide such a treatment. 3
3. During each even -numbered year, the Board shall review 4
compliance with the requirements of this section by each 5
physician and physician assistant who prescribes or administers 6
opioids to patients. 7
4. As used in this section, “non-opioid directive” has the 8
meaning ascribed to it in section 9 of this act. 9
Sec. 34. NRS 630.3066 is hereby amended to read as follows: 10
630.3066 A physician is not subject to disciplinary action 11
solely for: 12
1. Prescribing or administering to a patient under his or her 13
care a controlled substance which is listed in schedule II, III, IV or 14
V by the State Board of Pharmacy pursuant to NRS 453.146, if the 15
controlled substance is lawfully pres cribed or administered for the 16
treatment of intractable pain in accordance with the provisions of 17
section 33 of this act and NRS 639.23507 and 639.2391 to 18
639.23916, inclusive, any regulations adopted by the State Board of 19
Pharmacy pursuant thereto and any other regulations adopted by the 20
Board of Medical Examiners. 21
2. Engaging in any activity in accordance with the provisions 22
of chapter 678C of NRS. 23
Sec. 35. Chapter 631 of NRS is hereby amended by adding 24
thereto a new section to read as follows: 25
1. A dentist who prescribes or administers opioids shall: 26
(a) Comply with the requirements of sections 8 to 23, inclusive, 27
of this act, and any regulations adopted pursuant thereto; and 28
(b) Offer to a patient an alternative treatment that does not 29
utilize an opioid before prescribing, administering or directing or 30
supervising the administration of an opioid to the patient for the 31
first time unless: 32
(1) In the opinion of the dentist, there is no treatment that 33
does not utili ze an opioid that is suitable for treating the patient; 34
or 35
(2) It is not practicable to offer such an alternative 36
treatment to the patient. 37
2. Except as otherwise provided in subsection 1 and section 38
19 of this act, if a patient or his or her legal guardian has executed 39
a non-opioid directive or states that the patient wishes to receive 40
an alternative treatment that does not utilize an opioid, the dentist 41
shall provide such a treatment. 42
3. During each even -numbered year, the Board shall review 43
compliance with the requirements of this section by each dentist 44
who prescribes or administers opioids to patients. 45

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- *SB337_R1*
4. As used in this section, “non-opioid directive” has the 1
meaning ascribed to it in section 9 of this act. 2
Sec. 36. Chapter 632 of NRS is hereby amended by adding 3
thereto a new section to read as follows: 4
1. An advanced practice registered nurse or certified 5
registered nurse anesthetist who prescribes or administers opioids 6
shall: 7
(a) Comply with the requirements of sections 8 to 23, inclusive, 8
of this act, and any regulations adopted pursuant thereto; and 9
(b) Offer to a patient an alternative treatment that does not 10
utilize an opioid before prescribing, administering or directing or 11
supervising the administrat ion of an opioid to the patient for the 12
first time unless: 13
(1) In the opinion of the advanced practice registered nurse 14
or certified registered nurse anesthetist, there is no treatment that 15
does not utilize an opioid that is suitable for treating the pat ient; 16
or 17
(2) It is not practicable to offer such an alternative 18
treatment to the patient. 19
2. Except as otherwise provided in subsection 1 and section 20
19 of this act, if a patient or his or her legal guardian has executed 21
a non-opioid directive or states that the patient wishes to receive 22
an alternative treatment that does not utilize an opioid, the 23
advanced practice registered nurse or certified registere d nurse 24
anesthetist shall provide such a treatment. 25
3. During each even -numbered year, the Board shall review 26
compliance with the requirements of this section by each advanced 27
practice registered nurse or certified registered nurse anesthetist 28
who prescribes or administers opioids to patients. 29
4. As used in this section, “non-opioid directive” has the 30
meaning ascribed to it in section 9 of this act. 31
Sec. 37. Chapter 633 of NRS is hereby amended by adding 32
thereto a new section to read as follows: 33
1. An osteopathic physician or physician assistant who 34
prescribes or administers opioids shall: 35
(a) Comply with the requirements of sections 8 to 23, inclusive, 36
of this act, and any regulations adopted pursuant thereto; and 37
(b) Offer to a patient an alternative treatment that does not 38
utilize an opioid before prescribing, administering or directing or 39
supervising the administration of an opioid to the patient for the 40
first time unless: 41
(1) In the opinion of the osteopathic physician or physician 42
assistant, there is no treatment that does not utilize an opioid that 43
is suitable for treating the patient; or 44

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- *SB337_R1*
(2) It is not practicable to offer such an alternative 1
treatment to the patient. 2
2. Except as otherwise provided in subsection 1 and section 3
19 of this act, if a patient or his or her legal guardian has executed 4
a non-opioid directive or states that the patient wishes to receive 5
an alternative treatment that does not utilize an opioid , the 6
osteopathic physician or physician assistant shall provide such a 7
treatment. 8
3. During each even -numbered year, the Board shall review 9
compliance with the requirements of this section by each 10
osteopathic physician or physician assistant who prescri bes or 11
administers opioids to patients. 12
4. As used in this section, “non-opioid directive” has the 13
meaning ascribed to it in section 9 of this act. 14
Sec. 38. NRS 633.521 is hereby amended to read as follows: 15
633.521 An osteopathic physician is not subject to disciplinary 16
action solely for: 17
1. Prescribing or administering to a patient under his or her 18
care: 19
(a) Amygdalin (laetrile), if the patient has consented to the use 20
of the substance. 21
(b) Procaine hydrochloride wi th preservatives and stabilizers 22
(Gerovital H3). 23
(c) A controlled substance which is listed in schedule II, III, IV 24
or V by the State Board of Pharmacy pursuant to NRS 453.146, if 25
the controlled substance is lawfully prescribed or administered for 26
the treatment of intractable pain in accordance with the provisions 27
of NRS 639.23507 and 639.2391 to 639.23916, inclusive, and 28
section 37 of this act and any regulations adopted by the State 29
Board of Pharmacy pursuant thereto and the accepted standards for 30
the practice of osteopathic medicine. 31
2. Engaging in any activity in accordance with the provisions 32
of chapter 678C of NRS. 33
Sec. 39. Chapter 635 of NRS is hereby amended by adding 34
thereto a new section to read as follows: 35
1. A podiatric physician who prescribes or administers 36
opioids shall: 37
(a) Comply with the requirements of sections 8 to 23, inclusive, 38
of this act, and any regulations adopted pursuant thereto; and 39
(b) Offer to a patient an alternative treatment that does not 40
utilize an opioid before prescribing, administering or directing or 41
supervising the administration of an opioid to the patient for the 42
first time unless: 43

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- *SB337_R1*
(1) In the opinion of the podiatric physician, there is no 1
treatment that does not utilize an o pioid that is suitable for 2
treating the patient; or 3
(2) It is not practicable to offer such an alternative 4
treatment to the patient. 5
2. Except as otherwise provided in subsection 1 and section 6
19 of this act, if a patient or his or her legal guardian has executed 7
a non-opioid directive or states that the patient wishes to receive 8
an alternative treatment that does not utilize an opioid, the 9
podiatric physician shall provide such a treatment. 10
3. During each even -numbered year, the Board shall review 11
compliance with the requirements of this section by each podiatric 12
physician who prescribes or administers opioids to patients. 13
4. As used in this section, “non-opioid directive” has the 14
meaning ascribed to it in section 9 of this act. 15
Sec. 40. NRS 636.2882 is hereby amended to read as follows: 16
636.2882 1. An optometrist who is certified to administer and 17
prescribe a pharmaceutical agent pursuant to NRS 636.288 shall not 18
prescribe a controlled substance unless the optometrist: 19
[1.] (a) Has completed an optometric examination of the patient 20
for whom the controlled substance is prescribed; 21
[2.] (b) Prescribes the controlled substance in an amount that 22
does not exceed 90 morphine milligram equivalents per day and will 23
not last more than 72 hours; and 24
[3.] (c) Sets forth in the prescription for the controlled 25
substance that the prescription may not be refilled without a 26
subsequent examination of the patient by the optometrist. 27
2. An optometrist who prescribes or administers opioids shall: 28
(a) Comply with the requirements of sections 8 to 23, inclusive, 29
of this act, and any regulations adopted pursuant thereto; and 30
(b) Offer to a patient an alternative treatment that does not 31
utilize an opioid before prescribing, administering or directing or 32
supervising the administration of an opioid to the patient for the 33
first time unless: 34
(1) In the opinion of the optometrist, there is no treatment 35
that does not utilize an opioid that is suitable for treating th e 36
patient; or 37
(2) It is not practicable to offer such an alternative 38
treatment to the patient. 39
3. Except as otherwise provided in subsection 2 and section 40
19 of this act, if a patient or his or her legal guardian has executed 41
a non-opioid directive or states that the patient wishes to receive 42
an alternative treatment that does not utilize an opioid, the 43
optometrist shall provide such a treatment. 44

– 25 –

- *SB337_R1*
4. During each even -numbered year, the Board shall review 1
compliance with the requirements of this sectio n by each 2
optometrist who prescribes or administers opioids to patients. 3
5. As used in this section, “non -opioid directive” has the 4
meaning ascribed to it in section 9 of this act. 5
Sec. 41. NRS 654.190 is hereby amended to read as follows: 6
654.190 1. The Board may, after notice and an opportunity 7
for a hearing as required by law, impose an administrative fine of 8
not more than $10,000 for each violation on, recover reasonable 9
investigative fees and costs incurred from, s uspend, revoke, deny 10
the issuance or renewal of or place conditions on the license of, and 11
place on probation or impose any combination of the foregoing on 12
any licensee who: 13
(a) Is convicted of a felony relating to the practice of 14
administering a facility for skilled nursing or facility for 15
intermediate care or residential facility for groups or of any offense 16
involving moral turpitude. 17
(b) Has obtained his or her license by the use of fraud or deceit. 18
(c) Violates any of the provisions of this chapter. 19
(d) Aids or abets any person in the violation of any of the 20
provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of 21
this act, or 449A.100 to 449A.124, inclusive, and 449A.270 to 22
449A.286, inclusive, as those provisions pertain to a facility for 23
skilled nursing, facility for intermediate care or residential facility 24
for groups. 25
(e) Violates any regulation of the Board prescribing additional 26
standards of conduct for licensees, including, without limitation, a 27
code of ethics. 28
(f) Engages in conduct that violates the trust of a patient or 29
resident or exploits the relationship between the licensee and the 30
patient or resident for the financial or other gain of the licensee. 31
2. If a licensee requests a hearing pursuant to subsection 1, the 32
Board shall give the licensee written notice of a hearing pursuant to 33
NRS 233B.121 and 241.0333. A licensee may waive, in writing, his 34
or her right to attend the hearing. 35
3. The Board may compel the attendance of witnesses or the 36
production of documents or o bjects by subpoena. The Board may 37
adopt regulations that set forth a procedure pursuant to which the 38
Chair of the Board may issue subpoenas on behalf of the Board. 39
Any person who is subpoenaed pursuant to this subsection may 40
request the Board to modify the terms of the subpoena or grant 41
additional time for compliance. 42
4. An order that imposes discipline and the findings of fact and 43
conclusions of law supporting that order are public records. 44

– 26 –

- *SB337_R1*
5. The expiration of a license by operation of law or by order 1
or decision of the Board or a court, or the voluntary surrender of a 2
license, does not deprive the Board of jurisdiction to proceed with 3
any investigation of, or action or disciplinary proceeding against, the 4
licensee or to render a decision suspending or revoking the license. 5
Sec. 42. NRS 687B.225 is hereby amended to read as follows: 6
687B.225 1. Except as otherwise provided in NRS 7
689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 8
689A.044, 689A.0445, 689A.0459, 68 9B.031, 689B.0312, 9
689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 10
689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 11
695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 12
695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 13
695B.1925, 695B. 1942, 695C.1696, 695C.1699, 695C.1713, 14
695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 15
695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 16
695G.1719 and 695G.177, and sections 43, 45, 46, 48, 49, 50 and 17
53 of this act, any contract for group, blank et or individual health 18
insurance or any contract by a nonprofit hospital, medical or dental 19
service corporation or organization for dental care which provides 20
for payment of a certain part of medical or dental care may require 21
the insured or member to obt ain prior authorization for that care 22
from the insurer or organization. The insurer or organization shall: 23
(a) File its procedure for obtaining approval of care pursuant to 24
this section for approval by the Commissioner; and 25
(b) Unless a shorter time period is prescribed by a specific 26
statute, including, without limitation, NRS 689A.0446, 689B.0361, 27
689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703, 28
respond to any request for approval by the insured or member 29
pursuant to this section within 20 days after it receives the request. 30
2. The procedure for prior authorization may not discriminate 31
among persons licensed to provide the covered care. 32
Sec. 43. Chapter 689A of NRS is hereby amended by adding 33
thereto a new section to read as follows: 34
1. An insurer that offers or issues a policy of health 35
insurance shall: 36
(a) Comply with subsection 2 of section 16 of this act; and 37
(b) Include in the policy coverage for at least one alternative to 38
an opioid that is effective for each purpose for which: 39
(1) An opioid is commonly used; and 40
(2) A non-opioid alternative is available. 41
2. An insurer shall not: 42
(a) Require prior authorization for the benefits described in 43
paragraph (b) of subsection 1 if such prior authorization would 44
not be required for an opioid under the same circumstances; or 45

– 27 –

- *SB337_R1*
(b) Impose other requirements on the benefits described in 1
paragraph (b) of subsection 1 that would not be imposed on an 2
opioid used under the same circumstances. 3
3. A po licy of health insurance subject to the provisions of 4
this chapter that is delivered, issued for delivery or renewed on or 5
after January 1, 2026, has the legal effect of including the 6
coverage required by this section, and any provision of the policy 7
that conflicts with the provisions of this section is void. 8
4. As used in this section, “non -opioid directive” has the 9
meaning ascribed to it in section 9 of this act. 10
Sec. 44. NRS 689A.330 is hereby amended to read as follows: 11
689A.330 If any policy is issued by a domestic insurer for 12
delivery to a person residing in another state, and if the insurance 13
commissioner or corresponding public officer of that other state has 14
informed the Commissioner that the policy is not subject to approval 15
or disapproval by that officer, the Commissioner may by ruling 16
require that the policy meet the standards set forth in NRS 689A.030 17
to 689A.320, inclusive [.] , and section 43 of this act. 18
Sec. 45. Chapter 689B of NRS is hereby amended by adding 19
thereto a new section to read as follows: 20
1. An insurer that offers or issues a policy of group health 21
insurance shall: 22
(a) Comply with subsection 2 of section 16 of this act; and 23
(b) Include in the policy coverage for at least one alternative to 24
an opioid that is effective for each purpose for which: 25
(1) An opioid is commonly used; and 26
(2) A non-opioid alternative is available. 27
2. An insurer shall not: 28
(a) Require prior authorization for the benefits des cribed in 29
paragraph (b) of subsection 1 if such prior authorization would 30
not be required for an opioid under the same circumstances; or 31
(b) Impose other requirements on the benefits described in 32
paragraph (b) of subsection 1 that would not be imposed on an 33
opioid used under the same circumstances. 34
3. A policy of group health insurance subject to the 35
provisions of this chapter that is delivered, issued for delivery or 36
renewed on or after January 1, 2026, has the legal effect of 37
including the coverage required by this section, and any provision 38
of the policy that conflicts with the provisions of this section is 39
void. 40
4. As used in this section, “non -opioid directive” has the 41
meaning ascribed to it in section 9 of this act. 42
Sec. 46. Chapter 689C of NRS is hereby amended by adding 43
thereto a new section to read as follows: 44
1. A carrier that offers or issues a health benefit plan shall: 45

– 28 –

- *SB337_R1*
(a) Comply with subsection 2 of section 16 of this act; and 1
(b) Include in the plan co verage for at least one alternative to 2
an opioid that is effective for each purpose for which: 3
(1) An opioid is commonly used; and 4
(2) A non-opioid alternative is available. 5
2. A carrier shall not: 6
(a) Require prior authorization for the benefits described in 7
paragraph (b) of subsection 1 if such prior authorization would 8
not be required for an opioid under the same circumstances; or 9
(b) Impose other requirements on the benefits described in 10
paragraph (b) of subsection 1 that would not be imposed on an 11
opioid used under the same circumstances. 12
3. A health benefit plan subject to the provisions of this 13
chapter that is delivered, issued for delivery or renewed on or after 14
January 1, 2026, has the legal effect of including the coverage 15
required by t his section, and any provision of the plan that 16
conflicts with the provisions of this section is void. 17
4. As used in this section, “non -opioid directive” has the 18
meaning ascribed to it in section 9 of this act. 19
Sec. 47. NRS 689C.425 is hereby amended to read as follows: 20
689C.425 A voluntary purchasing group and any contract 21
issued to such a group pursuant to NRS 689C.360 to 689C.600, 22
inclusive, are subject to the provisions of NRS 689C.015 to 23
689C.355, inclusive, and sec tion 46 of this act to the extent 24
applicable and not in conflict with the express provisions of NRS 25
687B.408 and 689C.360 to 689C.600, inclusive. 26
Sec. 48. Chapter 695A of NRS is hereby amended by adding 27
thereto a new section to read as follows: 28
1. A society that offers or issues a benefit contract shall: 29
(a) Comply with subsection 2 of section 16 of this act; and 30
(b) Include in the contract coverage for at least one alternative 31
to an opioid that is effective for each purpose for which: 32
(1) An opioid is commonly used; and 33
(2) A non-opioid alternative is available. 34
2. A society shall not: 35
(a) Require prior authorization for the benefits described in 36
paragraph (b) of subsection 1 if such prior authorization wo uld 37
not be required for an opioid under the same circumstances; or 38
(b) Impose other requirements on the benefits described in 39
paragraph (b) of subsection 1 that would not be imposed on an 40
opioid used under the same circumstances. 41
3. A benefit contract s ubject to the provisions of this chapter 42
that is delivered, issued for delivery or renewed on or after 43
January 1, 2026, has the legal effect of including the coverage 44

– 29 –

- *SB337_R1*
required by this section, and any provision of the contract that 1
conflicts with the provisions of this section is void. 2
4. As used in this section, “non -opioid directive” has the 3
meaning ascribed to it in section 9 of this act. 4
Sec. 49. Chapter 695B of NRS is hereby amended by adding 5
thereto a new section to read as follows: 6
1. A hospital or medical services corporation that offers or 7
issues a policy of health insurance shall: 8
(a) Comply with subsection 2 of section 16 of this act; and 9
(b) Include in the policy coverage for at least one alternative to 10
an opioid that is effective for each purpose for which: 11
(1) An opioid is commonly used; and 12
(2) A non-opioid alternative is available. 13
2. A hospital or medical services corporation shall not: 14
(a) Require prior authorization for the benefits described in 15
paragraph (b) of subsection 1 if such prior authorization would 16
not be required for an opioid under the same circumstances; or 17
(b) Impose other requirements on the benefits described in 18
paragraph (b) of subsection 1 that would not be imposed on an 19
opioid used under the same circumstances. 20
3. A policy of health insurance subject to the provisions of 21
this chapter that is delivered, issued for delivery or renewed on or 22
after January 1, 2026, has the legal effect of including the 23
coverage required by this section, and any provision of the policy 24
that conflicts with the provisions of this section is void. 25
4. As used in this section, “non -opioid directive” has the 26
meaning ascribed to it in section 9 of this act. 27
Sec. 50. Chapter 695C of NRS is hereby amended by adding 28
thereto a new section to read as follows: 29
1. A health maintenance organization that offers or issues a 30
health care plan shall: 31
(a) Comply with subsection 2 of section 16 of this act; and 32
(b) Include in t he plan coverage for at least one alternative to 33
an opioid that is effective for each purpose for which: 34
(1) An opioid is commonly used; and 35
(2) A non-opioid alternative is available. 36
2. A health maintenance organization shall not: 37
(a) Require prio r authorization for the benefits described in 38
paragraph (b) of subsection 1 if such prior authorization would 39
not be required for an opioid under the same circumstances; or 40
(b) Impose other requirements on the benefits described in 41
paragraph (b) of subsec tion 1 that would not be imposed on an 42
opioid used under the same circumstances. 43
3. A health care plan subject to the provisions of this chapter 44
that is delivered, issued for delivery or renewed on or after 45

– 30 –

- *SB337_R1*
January 1, 2026, has the legal effect of includ ing the coverage 1
required by this section, and any provision of the plan that 2
conflicts with the provisions of this section is void. 3
4. As used in this section, “non -opioid directive” has the 4
meaning ascribed to it in section 9 of this act. 5
Sec. 51. NRS 695C.050 is hereby amended to read as follows: 6
695C.050 1. Except as otherwise provided in this chapter or 7
in specific provisions of this title, the provisions of this title are not 8
applicable to any health maintenance organization granted a 9
certificate of authority under this chapter. This provision does not 10
apply to an insurer licensed and regulated pursuant to this title 11
except with respect to its activities as a health maintenance 12
organization authorized and regulated pursuant to this chapter. 13
2. Solicitation of enrollees by a health maintenance 14
organization granted a certificate of authority, or its representatives, 15
must not be construed to violate any provision of law relating to 16
solicitation or advertising by practitioners of a healing art. 17
3. Any health maintenance organization authorized under this 18
chapter shall not be deemed to be practicing medicine and is exempt 19
from the provisions of chapter 630 of NRS. 20
4. The provisions of NRS 695C.110, 695C.125, 695C.1 691, 21
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 22
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 23
695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 24
inclusive, and 695C.265 and section 50 of this act do not apply to a 25
health maintenan ce organization that provides health care services 26
through managed care to recipients of Medicaid under the State Plan 27
for Medicaid or insurance pursuant to the Children’s Health 28
Insurance Program pursuant to a contract with the Division of 29
Health Care Fin ancing and Policy of the Department of Health and 30
Human Services. This subsection does not exempt a health 31
maintenance organization from any provision of this chapter for 32
services provided pursuant to any other contract. 33
5. The provisions of NRS 695C.169 32 to 695C.1699, 34
inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 35
695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745, 36
inclusive, 695C.1757 and 695C.204 apply to a health maintenance 37
organization that provides health care services through mana ged 38
care to recipients of Medicaid under the State Plan for Medicaid. 39
6. The provisions of NRS 695C.17095 do not apply to a health 40
maintenance organization that provides health care services to 41
members of the Public Employees’ Benefits Program. This 42
subsection does not exempt a health maintenance organization from 43
any provision of this chapter for services provided pursuant to any 44
other contract. 45

– 31 –

- *SB337_R1*
7. The provisions of NRS 695C.1735 do not apply to a health 1
maintenance organization that provides health care services to: 2
(a) The officers and employees, and the dependents of officers 3
and employees, of the governing body of any county, school district, 4
municipal corporation, political subdivision, public corporation or 5
other local governmental agency of this State; or 6
(b) Members of the Public Employees’ Benefits Program. 7
 This subsection does not exempt a health maintenance 8
organization from any provision of this chapter for services 9
provided pursuant to any other contract. 10
Sec. 52. NRS 695C.330 is hereby amended to read as follows: 11
695C.330 1. The Commissioner may suspend or revoke any 12
certificate of authority issued to a health maintenance organization 13
pursuant to the provisions of this chapter if the Commissioner find s 14
that any of the following conditions exist: 15
(a) The health maintenance organization is operating 16
significantly in contravention of its basic organizational document, 17
its health care plan or in a manner contrary to that described in and 18
reasonably inferred from any other information submitted pursuant 19
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 20
to those submissions have been filed with and approved by the 21
Commissioner; 22
(b) The health maintenance organization issues evidence of 23
coverage or uses a schedule of charges for health care services 24
which do not comply with the requirements of NRS 695C.1691 to 25
695C.200, inclusive, and section 50 of this act, 695C.204 or 26
695C.207; 27
(c) The health care plan does not furnish comprehensive health 28
care services as provided for in NRS 695C.060; 29
(d) The Commissioner certifies that the health maintenance 30
organization: 31
(1) Does not meet the requirements of subsection 1 of NRS 32
695C.080; or 33
(2) Is unable to fulfill its obligations to furnish health care 34
services as required under its health care plan; 35
(e) The health maintenance organization is no longer financially 36
responsible and may reasonably be expected to be unable to meet its 37
obligations to enrollees or prospective enrollees; 38
(f) The health mainte nance organization has failed to put into 39
effect a mechanism affording the enrollees an opportunity to 40
participate in matters relating to the content of programs pursuant to 41
NRS 695C.110; 42
(g) The health maintenance organization has failed to put into 43
effect the system required by NRS 695C.260 for: 44

– 32 –

- *SB337_R1*
(1) Resolving complaints in a manner reasonably to dispose 1
of valid complaints; and 2
(2) Conducting external reviews of adverse determinations 3
that comply with the provisions of NRS 695G.241 to 695G.310, 4
inclusive; 5
(h) The health maintenance organization or any person on its 6
behalf has advertised or merchandised its services in an untrue, 7
misrepresentative, misleading, deceptive or unfair manner; 8
(i) The continued operation of the health maintenance 9
organization would be hazardous to its enrollees or creditors or to 10
the general public; 11
(j) The health maintenance organization fails to provide the 12
coverage required by NRS 695C.1691; or 13
(k) The health maintenance organization has otherwise failed to 14
comply substantially with the provisions of this chapter. 15
2. A certificate of authority must be suspended or revoked only 16
after compliance with the requirements of NRS 695C.340. 17
3. If the certificate of authority of a health maintenance 18
organization is suspended, the health maintenance organization shall 19
not, during the period of that suspension, enroll any additional 20
groups or new individual contracts, unless those groups or persons 21
were contracted for before the date of suspension. 22
4. If the certificate of aut hority of a health maintenance 23
organization is revoked, the organization shall proceed, immediately 24
following the effective date of the order of revocation, to wind up its 25
affairs and shall conduct no further business except as may be 26
essential to the orderly conclusion of the affairs of the organization. 27
It shall engage in no further advertising or solicitation of any kind. 28
The Commissioner may, by written order, permit such further 29
operation of the organization as the Commissioner may find to be in 30
the be st interest of enrollees to the end that enrollees are afforded 31
the greatest practical opportunity to obtain continuing coverage for 32
health care. 33
Sec. 53. Chapter 695G of NRS is hereby amended by adding 34
thereto a new section to read as follows: 35
1. A managed care organization that offers or issues a health 36
care plan shall: 37
(a) Comply with subsection 2 of section 16 of this act; and 38
(b) Include in the plan coverage for at least one alternative to 39
an opioid that is effective for each purpose for which: 40
(1) An opioid is commonly used; and 41
(2) A non-opioid alternative is available. 42
2. A managed care organization shall not: 43

– 33 –

- *SB337_R1*
(a) Require prior authorization for the benefits described in 1
paragraph (b) of subsection 1 if such prior authorization would 2
not be required for an opioid under the same circumstances; or 3
(b) Impose other requirements on the benefits described in 4
paragraph (b) of subsection 1 that would not be imposed on an 5
opioid used under the same circumstances. 6
3. A health care plan subject to the provisions of this chapter 7
that is delivered, issued for delivery or renewed on or after 8
January 1, 2026, has the legal effect of including the coverage 9
required by this section, and any provision of the plan t hat 10
conflicts with the provisions of this section is void. 11
4. As used in this section, “non -opioid directive” has the 12
meaning ascribed to it in section 9 of this act. 13
Sec. 53.5. NRS 695G.090 is hereby amended to read as 14
follows: 15
695G.090 1. Except as otherwise provided in subsection 3, 16
the provisions of this chapter apply to each organization and insurer 17
that operates as a managed care organization and may include, 18
without limitation, an insurer that issues a policy o f health 19
insurance, an insurer that issues a policy of individual or group 20
health insurance, a carrier serving small employers, a fraternal 21
benefit society, a hospital or medical service corporation and a 22
health maintenance organization. 23
2. In addition t o the provisions of this chapter, each managed 24
care organization shall comply with: 25
(a) The provisions of chapter 686A of NRS, including all 26
obligations and remedies set forth therein; and 27
(b) Any other applicable provision of this title. 28
3. The provisions of NRS 695G.127, 695G.1639, 695G.164, 29
695G.1645, 695G.167 and section 53 of this act and 695G.200 to 30
695G.230, inclusive, do not apply to a managed care organization 31
that provides health care services to recipients of Medicaid under 32
the State Plan for Medicaid or insurance pursuant to the Children’s 33
Health Insurance Program pursuant to a contract with the Division 34
of Health Care Financing and Policy of the Department of Health 35
and Human Services. 36
4. The provisions of NRS 695C.1735 and 695G .1639 do not 37
apply to a managed care organization that provides health care 38
services to members of the Public Employees’ Benefits Program. 39
5. Subsections 3 and 4 do not exempt a managed care 40
organization from any provision of this chapter for services 41
provided pursuant to any other contract. 42

– 34 –

- *SB337_R1*
Sec. 54. Chapter 695K of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. If the Division of Public and Behavioral Health of the 3
Department of Health and Human Services finds that a health 4
care facility has violated section 1 of this act or a practitioner 5
licensing board finds that a practitioner has violated section 33, 6
35, 36, 37 or 39 of this act or NRS 636.2882, the Director may: 7
(a) Reduce the reimbur sement rates received by the health 8
care facility or practitioner, as applicable, from the Public Option; 9
or 10
(b) Prohibit the health care facility or practitioner, as 11
applicable, from receiving payments through the insurance 12
provided through the Public Option. 13
2. The Director of the Department of Health and Human 14
Services shall include in any contract with a health care facility or 15
practitioner notice of the actions the Director may take pursuant 16
to subsection 1. 17
3. As used in this section: 18
(a) “Health care facility” means a medical facility, as defined 19
in NRS 449.0151, or a facility which is required by the regulations 20
adopted by the State Board of Health pursuant to NRS 449.0303 to 21
be licensed. 22
(b) “Practitioner” has the meaning ascribed t o it in 23
NRS 639.0125. 24
(c) “Practitioner licensing board” means a board created 25
pursuant to chapter 630, 631, 632, 633, 635 or 636 of NRS. 26
Sec. 55. 1. The Department of Health and Human Services 27
may continue to utilize th e statewide plan created pursuant to 28
paragraph (b) of subsection 1 of NRS 433.734 that is in effect on 29
January 1, 2026. The Department shall comply with the provisions 30
of NRS 433.738, as amended by section 31 of this act, when 31
revising the statewide plan. 32
2. Notwithstanding the amendatory provisions of sections 1, 33
16, 33, 35, 36, 37 and 39 of this act and NRS 636.2882, as amended 34
by section 40 of this act: 35
(a) A medical facility or facility which is required by the 36
regulations adopted by the State Board of Health pursuant to NRS 37
449.0303 to be licensed that administers opioids to patients is not 38
required to offer treatments that are alternatives to opioids to 39
patients or require practitioners who provide care at the facility to 40
take any action described i n paragraph (b) until July 1, 2027, or 6 41
months after the date on which the regulations adopted pursuant to 42
section 21 of this act become effective, whichever occurs later; 43
(b) A practitioner who prescribes or administers opioids is not 44
required to explain to the patient or his or her legal guardian that the 45

– 35 –

- *SB337_R1*
patient or legal guardian, as applicable, may execute a non -opioid 1
directive, provide the non -opioid directive to a patient or his or her 2
legal guardian or offer treatments that are alternatives to opi oids 3
until July 1, 2027 , or 6 months after the date on which the 4
regulations adopted pursuant to section 21 of this act become 5
effective, whichever occurs later; 6
(c) The Division of Public and Behavioral Health of the 7
Department of Health and Human Services may not review the 8
compliance of medical facilities and facilities which are required by 9
the regulations adopted pursuant to NRS 449.0303 to be licensed 10
with the requirements of section 1 of this act until January 1, 2029, 11
or 18 months after the date on which the regulations adopted 12
pursuant to section 21 of this act become effective , whichever 13
occurs later; and 14
(d) A practitioner licensing board may not review the 15
compliance of practitioners with the requirements of sections 33, 35, 16
36, 37 and 39 of this act and NRS 636.2882, as amended by section 17
40 of this act, until January 1, 2029, or 18 months after the date on 18
which the regulations adopted pursuant to sec tion 21 of this act 19
become effective, whichever occurs later. 20
3. A practitioner who discovers on or before the date set forth 21
in paragraph (b) of subsection 1 that a patient is a non-opioid patient 22
and is unable to offer a treatment that is an alternativ e to an opioid 23
to the patient shall, where the practitioner would otherwise be 24
required by section 33, 35, 36, 37 or 39 of this act or NRS 636.2882, 25
as amended by section 40 of this act , to offer such an alternative 26
treatment, refer the patient to a provider of health care who is able to 27
offer such a treatment. 28
4. As used in this section: 29
(a) “Medical facility” has the meaning ascribed to it in 30
NRS 449.0151. 31
(b) “Non-opioid directive” has the meaning ascribed to it in 32
section 9 of this act. 33
(c) “Non-opioid patient” has the meaning ascribed to it in 34
section 10 of this act. 35
(d) “Practitioner” has the meaning ascribed to it in section 11 of 36
this act. 37
(e) “Practitioner licensing board” has the meaning ascribed to it 38
in section 12 of this act. 39
Sec. 56. The provisions of NRS 354.599 do not apply to any 40
additional expenses of a local government that are related to the 41
provisions of this act. 42
Sec. 57. 1. This section becomes effective upon passage and 43
approval. 44
2. Sections 1 to 56, inclusive, of this act become effective: 45

– 36 –

- *SB337_R1*
(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 July 1, 2026, for all other purposes. 4

H