Revises provisions governing public health. (BDR 40-349)

EXEMPT
(Reprinted with amendments adopted on April 21, 2025)
FIRST REPRINT S.B. 423

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SENATE BILL NO. 423–COMMITTEE ON
HEALTH AND HUMAN SERVICES

(ON BEHALF OF THE JOINT INTERIM STANDING COMMITTEE
ON HEALTH AND HUMAN SERVICES)

MARCH 24, 2025
____________

Referred to Committee on Health and Human Services

SUMMARY—Revises provisions governing public health.
(BDR 40-349)

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

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

AN ACT relating to public health; creating the Account for Public
Health; authorizing allocations from the Account to
certain entities who have jurisdiction over public health ;
requiring the Division of Public and Behavioral Health of
the Department of Health and Human Services and
entities which receive an allocation from the Account to
prepare reports concerning the use of money in the
Account; and providing other matters pro perly relating
thereto.
Legislative Counsel’s Digest:
Existing law creates a health district in any county whose population is 700,000 1
or more (currently Clark County), which has jurisdiction over all public health 2
matters in the health district. (NRS 439 .361, 439.362, 439.366) Existing law 3
authorizes the creation of a health district with similar jurisdiction in counties 4
whose population is less than 700,000 (currently all counties other than Clark 5
County), subject to the approval by the State Board of He alth, by affirmative vote 6
of: (1) the board of county commissioners of two or more counties; (2) the 7
governing bodies of two or more cities or towns within any county; or (3) the board 8
of county commissioners and the governing body or bodies of any incorporated city 9
or cities, town or towns, in such a county. (NRS 439.370) 10
Senate Bill No. 312 of this session proposes to create: (1) the Tribal Health 11
Advisory Council; and (2) the Account for Tribal Health to fund the activities of 12
the Council. Sections 2 and 2.5 of this bill define the term “health authority” for 13
the purposes of this bill to include health districts which are formed by one or more 14

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counties and, if Senate Bill No. 312 of this session is not enacted, federally 15
recognized Indian tribes which are located in whole or in part in this State. 16
Existing law requires each insurer to pay to the Department of Taxation a tax 17
upon net direct premiums and net direct considerations written at the rate of 3.5 18
percent. (NRS 680B.027) Sections 3 and 3.5 of this bill create the Account for 19
Public Health in the State General Fund and require the Division of Public and 20
Behavioral Health of the Department of Health and Human Services to administer 21
the Account. Section 7 of this bill requires the State Treasurer to d eposit: (1) the 22
first $4,925,000 of revenues collected from the tax on net direct premiums and net 23
direct considerations during each biennium in the Account; and (2) any revenues 24
collected from the tax during the biennium in excess of $4,925,000 in the Sta te 25
General Fund. Sections 3 and 3.5 require the Division to use any money which is 26
deposited in the Account to: (1) protect and promote public health; (2) make 27
allocations to health authorities in certain specified amounts from the money 28
deposited in the Account during the biennium; and (3) if Senate Bill No. 312 of this 29
session is enacted, allocate a specified amount of the money deposited in the 30
Account during the biennium to the Account for Tribal Health created by that bill. 31
Sections 3 and 3.5 require the Division to submit to the State Board of Health a 32
report regarding the use of money in the Account. 33
Section 4 of this bill requires the Division to publish on its Internet website, on 34
or before December 1 of each odd -numbered year, an estimate of the a mount of 35
money in the Account which will be available for allocation to health authorities for 36
the biennium. Section 4 authorizes a health authority, on or before January 1 of 37
each even-numbered year, to submit to the Division a request for an allocation from 38
the Account, which must be accompanied by a proposal for the use of the allocation 39
that includes certain information. Section 4 requires the Division to make 40
allocations from the Account on or before April 1 of each even -numbered year to 41
health authori ties whose requests are approved and provides that money which is 42
not expended or committed for expenditure by the health authority before June 30 43
of an odd -numbered year reverts to the Account. Section 4 requires a health 44
authority that receives an alloca tion from the Account to submit a report to the 45
Division concerning the use of the allocated money. 46

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

Section 1. Chapter 439 of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 2 to 4, inclusive, of this 2
act. 3
Sec. 2. As used in sections 3 and 4 of this act, unless the 4
context otherwise requires, “health authority” means: 5
1. A health district created pursuant to NRS 439.362 or 6
subsection 1 of NRS 439.370; or 7
2. A federally recognized American Indian tribe pursuant to 8
25 C.F.R. §§ 83.1 to 83.12, inclusive, that is located in whole or in 9
part in this State. 10
Sec. 2.5. As used in sections 3.5 and 4 of this act, unless the 11
context otherwise requires, “health authority” means a health 12
district created pursuant to N RS 439.362 or subsection 1 of 13
NRS 439.370. 14

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Sec. 3. 1. The Account for Public Health is hereby created 1
in the State General Fund. 2
2. The Division shall administer the Account. 3
3. The interest and income earned on money in the Account 4
must be credited to the Account. 5
4. Except as otherwise provided in subsection 8 and 6
subsection 4 of section 4 of this act, any money remaining in the 7
Account at the end of each fiscal year does not revert to the State 8
General Fund and must be carried forward to the next fiscal year. 9
5. Except as otherwise provided in subsection 6, money 10
credited to the Account pursuant to NRS 680B.060 during each 11
biennium must be used for the following purposes in the following 12
prescribed amounts: 13
(a) Eight hundred thousand dollars for use by the Division to 14
protect and promote public health. 15
(b) Three hundred thousand dollars to make allocations 16
pursuant to section 4 of this act to health authorities which are 17
Indian tribes. 18
(c) Two hundred twenty-five thousand dollars per each county 19
which is not within the jurisdiction of a health district created 20
pursuant to NRS 439.362 or subsection 1 of NRS 439.370, for use 21
by the Division to protect and promote public health in each such 22
county. 23
(d) Two hundred twenty-five thousand dollars per each county 24
within the jurisdiction of a health district created pursuant to NRS 25
439.362 or subsection 1 of NRS 439.370 to make allocations 26
pursuant to section 4 of this act to each such health district. 27
6. Except f or money which reverts to the Account from a 28
health authority pursuant to subsection 4 of section 4 of this act, 29
money remaining in the Account on April 2 of an even -numbered 30
year and money which is credited to the Account pursuant to NRS 31
680B.060 after April 1 of an even-numbered year and on or before 32
June 30 of an odd -numbered year which would otherwise be 33
required to be used for the purpose described in paragraph (b) or 34
(d) of subsection 5 becomes part of the reserve of the Account. 35
Money in the reserve may be used by the Division to protect and 36
promote public health. 37
7. Any money allocated from the Account to the Division 38
pursuant to paragraphs (a) and (c) of subsection 5 that is not 39
committed for expenditure for the purpose for which it was 40
distributed on or before June 30 of an odd -numbered year reverts 41
to the Account , becomes part of the reserve of the Account and 42
must be included in the calculation of the reserve on June 30 for 43
the purposes of subsection 8. 44

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8. Any reserve of the Account which exceeds 4 percent of the 1
total money credited to the Account pursuant to NRS 680B.060 2
during the then current biennium and has not been committed for 3
expenditure on or before June 30 of an odd-numbered year reverts 4
to the State General Fund. 5
9. If the am ount of money credited to the Account pursuant 6
to NRS 680B.060 during the biennium is insufficient to allocate 7
the full amounts prescribed by subsection 5, the money credited to 8
the Account pursuant to NRS 680B.060 during the biennium must 9
be allocated for the purposes prescribed by subsection 5 in the 10
same proportion as the amounts prescribed by subsection 5. 11
10. On or before November 30 of an odd -numbered year, the 12
Division shall submit to the State Board of Health a report 13
concerning the use of money in the Account. 14
Sec. 3.5. 1. The Account for Public Health is hereby 15
created in the State General Fund. 16
2. The Division shall administer the Account. 17
3. The interest and income earned on money in the Account 18
must be credited to the Account. 19
4. Except as otherwise provided in subsection 8 and 20
subsection 4 of section 4 of this act, any money remaining in the 21
Account at the end of each fiscal year does not revert to the State 22
General Fund and must be carried forward to the next fiscal year. 23
5. Except as otherwise provided in subsection 6, money 24
credited to the Account pursuant to NRS 680B.060 during each 25
biennium must be used for the following purposes in the following 26
prescribed amounts: 27
(a) Eight hundred thousand do llars for use by the Division to 28
protect and promote public health. 29
(b) Three hundred thousand dollars for remittance to the 30
Account for Tribal Health created by section 9 of Senate Bill No. 31
312 of this session for use by the Tribal Health Authority Counc il 32
created by section 5 of Senate Bill No. 312 of this session. 33
(c) Two hundred twenty-five thousand dollars per each county 34
which is not within the jurisdiction of a health district created 35
pursuant to NRS 439.362 or subsection 1 of NRS 439.370, for use 36
by the Division to protect and promote public health in each such 37
county. 38
(d) Two hundred twenty-five thousand dollars per each county 39
within the jurisdiction of a health district created pursuant to NRS 40
439.362 or subsection 1 of NRS 439.370 to make allocations 41
pursuant to section 4 of this act to each such health district. 42
6. Except for money which reverts to the Acco unt for Public 43
Health from a health authority pursuant to subsection 4 of section 44
4 of this act, money remaining in the Account on April 2 of an 45

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even-numbered year and money which is credited to the Account 1
pursuant to NRS 680B.060 after April 1 of an even-numbered year 2
and on or before June 30 of an odd -numbered year which would 3
otherwise be required to be used for the purposes described in 4
paragraph (d) of subsection 5 becomes part of the reserve of the 5
Account. Money in the reserve may be used by the Div ision to 6
protect and promote public health. 7
7. Any money allocated from the Account to the Division 8
pursuant to paragraphs (a) and (c) of subsection 5 that is not 9
committed for expenditure for the purpose for which it was 10
distributed on or before June 3 0 of an odd -numbered year reverts 11
to the Account, becomes part of the reserve of the Account and 12
must be included in the calculation of the reserve on June 30 for 13
the purposes of subsection 8. 14
8. Any reserve of the Account which exceeds 4 percent of the 15
total money credited to the Account pursuant to NRS 680B.060 16
during the then current biennium and has not been committed for 17
expenditure on or before June 30 of an odd-numbered year reverts 18
to the State General Fund. 19
9. If the amount of money credited to the Account pursuant 20
to NRS 680B.060 during the biennium is insufficient to allocate 21
the full amounts prescribed by subsection 5, the money credited to 22
the Account pursuant to NRS 680B.060 during the biennium must 23
be allocated for the purposes prescribed by subsection 5 in the 24
same proportion as the amounts prescribed by subsection 5. 25
10. On or before November 30 of an odd -numbered year, the 26
Division shall submit to the State Board of Health a report 27
concerning the use of money in the Account. 28
Sec. 4. 1. On or before December 1 of each odd -numbered 29
year, the Division shall publish on the Internet website of the 30
Division an estimate of the amount of money in the Account for 31
Public Health which will be available for allocation pursuant to 32
this section to health authorities during the then current 33
biennium. 34
2. On or before January 1 of each even -numbered year, a 35
health authority may submit to the Division a request for an 36
allocation from the Account for Public Health . The request must 37
be accompanied by a proposal for the use of the allocation which 38
includes, without limitation: 39
(a) An evaluation and identification of the public health needs 40
of residents of the area under the jurisdiction of the health 41
authority; 42
(b) A determination of the level of priority of the public health 43
needs identified pursuant to paragraph (a); and 44

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(c) A plan for spending the money allocated from the Account 1
for Public Health which is in accordance with the levels of priority 2
determined pursuant to paragraph (b) and includes spending for 3
one or more of the following public health services: 4
(1) Control of communicable diseases; 5
(2) Prevention of chronic diseases and injuries; 6
(3) Environmental public health; 7
(4) Maternal, child and family health; 8
(5) Access to and linkage with medical, oral and behavioral 9
health services; 10
(6) Vital records; 11
(7) Assessing the health of populations; 12
(8) Planning for public health emergencies; 13
(9) Communications; 14
(10) Development and support of policy; 15
(11) Development of community partnerships; 16
(12) Business competencies; and 17
(13) Such other public health services as the State Board of 18
Health prescribes by regulation. 19
3. On or before March 1 of each even -numbered year, the 20
Division sha ll review each request submitted pursuant to 21
subsection 2 and approve those that meet the requirements of this 22
section, within the limits of money available for the health 23
authority making the request. 24
4. On or before April 1 of each even -numbered year, the 25
Division shall allocate money from the Account for Public Health 26
to each health authority whose request has been approved 27
pursuant to subsection 3. Money allocated pursuant to this section 28
is available for use by the health authority during both fiscal years 29
of the biennium. Any money allocated pursuant to this section that 30
is not committed for expenditure for the purpose for which it was 31
distributed on or before June 30 of an odd -numbered year reverts 32
to the Account for Public Health. Any amount which reverts from 33
a health authority to the Account for Public Health: 34
(a) Must be accounted for separately. 35
(b) May be used by the Division for statewide public health 36
services or public health services in the region served by the health 37
authority from which the money reverted. 38
(c) Reverts from the Account for Public Health to the State 39
General Fund on June 30 of the year immediately following the 40
year during which the money reverted to the Account. 41
5. On or before October 31 of an odd -numbered year, each 42
health authority that received an allocation from the Account for 43
Public Health pursuant to this section in the immediately 44

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preceding biennium shall submit to the Division a report which 1
includes, without limitation: 2
(a) A description of the process used by the health authority 3
pursuant to paragraph (a) of subsection 2 to evaluate the public 4
health needs of residents of the area under the jurisdiction of the 5
health authority and the public health ne eds identified through 6
that process; 7
(b) A description of the process used by the health authority 8
pursuant to paragraph (b) of subsection 2 to determine the level of 9
priority of the public health needs identified pursuant to 10
paragraph (a) of subsection 2 and the levels of priority assigned to 11
those public health needs through that process; 12
(c) A description of each expenditure of the allocated money 13
made by the health authority; 14
(d) The amount of any unexpended balance of the allocated 15
money at the end of the biennium; and 16
(e) Such other information in such form as the Division may 17
require. 18
Sec. 5. (Deleted by amendment.) 19
Sec. 6. (Deleted by amendment.) 20
Sec. 7. NRS 680B.060 is hereby amended to read as follows: 21
680B.060 1. The taxes imposed under NRS 680B.027 must 22
be collected by the Department of Taxation and promptly deposited 23
with the State Treasurer . The State Treasurer shall deposit: 24
(a) The first $4,925,000 of the money so received by the State 25
Treasurer in each biennium, for credit to the Account for Public 26
Health created by section 3 of this act. 27
(b) Any additional amount of the money so received by the 28
State Treasurer, for credit to the State General Fund. 29
2. If the tax is not paid by the insurer on or before the date 30
required for payment, the tax then becomes delinquent, and payment 31
thereof may be enforced by court action instituted on behalf of the 32
State by the Attorney General. The Attorne y General may employ 33
additional counsel in the city where the home office of the insurer is 34
located, subject to the approval of compensation for such services 35
by the State Board of Examiners. The administrative and substantive 36
enforcement provisions of chapters 360 and 372 of NRS apply to the 37
enforcement of the taxes imposed under NRS 680B.027. 38
3. Upon the tax becoming delinquent, the Executive Director 39
of the Department of Taxation shall notify the Commissioner, who 40
shall suspend or revoke the insurer’s certificate of authority pursuant 41
to NRS 680A.190. 42
4. If a dispute arises between an insurer and the State as to the 43
amount of tax, if any, payable, the insurer is entitled to pay under 44
protest the tax in the amount assessed by the Department of 45

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Taxation, without waiving or otherwise affecting any right of the 1
insurer to recover any amount determined, through appropriate legal 2
action taken by the insurer against the Department of Taxation, to 3
have been in excess of the amount of tax lawfully payable. 4
5. Except as otherwise provided in subsection 1 and NRS 5
680C.110, all taxes, fees, licenses, fines and charges collected under 6
this Code, including the general premium tax provided for under 7
NRS 680B.027 and as increased in any instances pursuant to NRS 8
680A.330, must be promptly deposited with the State Treasurer for 9
credit to the State General Fund. 10
Sec. 8. (Deleted by amendment.) 11
Sec. 9. Notwithstanding the provisions of subsection 10 of 12
section 3 of this act, the first report required by that subsection must 13
be submitted by the Division of Public and Behavioral Health of the 14
Department of Health and Human Services on or before October 31, 15
2029. 16
Sec. 9.5. Notwithstanding the provisions of subsection 10 of 17
section 3.5 of this act, the first report required by that subsection 18
must be submitted by the Division of Public and Behavioral Health 19
of the Department of Health and Human Services on or before 20
October 31, 2029. 21
Sec. 10. (Deleted by amendment.) 22
Sec. 11. (Deleted by amendment.) 23
Sec. 12. 1. This section and sections 1, 4 to 8, inclusive, 10 24
and 11 of this act become effective on July 1, 2027. 25
2. Sections 2, 3 and 9 of this act become effective on July 1, 26
2027, if and only if Senate Bill No. 312 of this session is not enacted 27
by the Legislature and approved by the Governor. 28
3. Sections 2.5, 3.5 and 9.5 of this act become effective on 29
July 1, 2027, if and only if Senate Bill No. 312 of this session is 30
enacted by the Legislature and approved by the Governor. 31

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