Read the full stored bill text
- 83rd Session (2025)
Senate Bill No. 424–Committee on
Health and Human Services
CHAPTER..........
AN ACT relating to emergency medical services; requiring the
Division of Health Care Financing and Policy of the
Department of Health and Human Services to impose an
assessment on private emergency medical transport
providers; creating the Account to Impr ove Emergency
Medical Transportation Quality and Access; prescribing the
authorized uses of the revenue generated by the assessment;
requiring the Division to adopt regulations establishing
administrative penalties; authorizing the Division to collect
an u npaid assessment or administrative penalty; authorizing
certain health authorities to impose administrative penalties
or take other disciplinary actions in certain circumstances;
authorizing a health authority to establish a training program
relating to hu man trafficking; establishing requirements for
such a training program; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing law authorizes the Division of Health Care Financing and Policy of the
Department of Health and Human Services to impose, in certain circumstances, an
assessment on agencies to provide personal care services in the home or medical
facilities that are required to obtain a certain type of license. (NRS 422.3794)
Existing law requires the Division to expend the revenue generated from the
assessment to: (1) provide supplemental payments and enhanced rates of
reimbursement to operators of agencies to pr ovide personal care services in the
home and operators of medical facilities for services rendered to recipients of
Medicaid; (2) fund certain additional supports and services under Medicaid; and (3)
pay administrative costs. (NRS 422.37945) Sections 2-9 of this bill require the
imposition of a similar assessment on private emergency medical transport
providers. Section 6 requires: (1) the percentage of the assessment to be based on a
percentage of net revenue earned by the private emergency medical transpo rt
provider from providing services in this State; and (2) the Division to set the
amount of the percentage of the assessment by regulation, subject to certain
requirements.
Section 7 creates the Account to Improve Emergency Medical Transportation
Quality and Access. Section 7 requires the Division to administer the Account and
to deposit the proceeds collected from the assessment into the Account. Section 7
provides that money in the Account may only be expended to: (1) provide enhanced
rates of reimburse ment under Medicaid to private emergency medical transport
providers for providing emergency ambulance services to recipients of Medicaid;
(2) fund certain data infrastructure improvements and educational and community
outreach initiatives undertaken by th e Department; and (3) pay administrative costs
related to the assessment. If the Legislature authorizes the money in the Account to
be used for any other purpose, section 7: (1) requires that the Division cease
imposing the assessment; and (2) provides tha t the regulations adopted to impose
the assessment are void.
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Section 8 requires the Division to adopt regulations establishing administrative
penalties against a private emergency medical transport provider that fails to pay an
assessment in a timely mann er. Section 8 authorizes the Division, after notifying
the provider, to: (1) deduct the amount of an unpaid assessment or administrative
penalty from future payments owed to the private emergency medical transport
provider under Medicaid; and (2) negotiate a payment plan with a delinquent
private emergency medical transport provider before making such deductions.
Section 8 also requires the Division to notify the health authority that issued a
private emergency medical transport provider a permit to own or operate an
ambulance in this State if the provider has failed to pay an assessment or
administrative penalty in a timely manner. Section 11 of this bill authorizes the
applicable health authority to, after receiving such a notification from the Division,
take certain disciplinary actions against the private emergency medical transport
provider.
Section 9 authorizes the Division to modify the amount of the assessment, the
enhanced rates of reimbursement or any other requirement established by sections
2-9 as necessary to receive federal financial participation to carry out the provisions
of sections 2-9. Section 9 also requires the suspension of the assessment and the
payment of enhanced rates of reimbursement upon the occurrence of certain events.
Section 9 requires the retroactive reimposition of such assessments and payments
when the event triggering the suspension is no longer applicable.
Sections 3-5 define certain terms and section 2 establishes the applicability of
those definitions. Section 10 of this bill requires the Director of the Department to
administer the provisions of sections 2-9 in the same manner as other provisions
relating to Medicaid.
Existing law authorizes a health authority to operate a training program in
emergency first aid , emergency care and other techniques associated with
emergency care for the benefit of certain professionals who may respond to
emergencies as a part of their job duties, including ambulance attendants and
firefighters. (NRS 450B.850) Section 11.5 of this bill authorizes a health authority
to establish a separate training program which is focused on identifying and
responding to victims of human trafficking.
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 422 of NRS is hereby amended by adding
thereto the provisions set forth as sections 2 to 9, inclusive, of this
act.
Sec. 2. As used in sections 2 to 9, inclusive, of this act, unless
the context otherwise requires, the words and terms defined in
sections 3 to 5, inclusive, of this act have the meanings ascribed to
them in those sections.
Sec. 3. “Account” means the Account to Improve Emergency
Medical Transportation Quality and Access created by section 7 of
this act.
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Sec. 3.5. “Ambulance” has the meaning ascribed to it in
NRS 450B.040.
Sec. 4. “Emergency ambulance service”:
1. Means the transportation by ambulance of a person who is
experiencing a medical emergency to a medical facility; and
2. Includes the rendering of medical care by a paramedic, as
defined in NRS 450B.095, emergency medical technician, as
defined in NRS 450B.065, or advanced emergency medical
technician, as defined in NRS 450B.025, in connection with the
transportation of the person.
Sec. 5. “Private emergency medical transport provider”
means a person or entity that:
1. Provides or renders emergency ambulance services in this
State;
2. Holds a permit to own or operate an ambulance issued
pursuant to the provisions of chapter 450B of NRS; and
3. Is not owned or operated by a federal, state or local
governmental entity or a federally recognized tribe.
Sec. 6. 1. Except as otherwise provided in subsection 4 and
sections 7 and 9 of this act, the Division shall impose by regulation
against each private emergency medical transport provid er an
assessment in an amount equal to a percentage of the net revenue
earned by a private emergency medical transport provider from
providing emergency ambulance services in this State during a
calendar or fiscal year. The Division shall adopt:
(a) Regulations prescribing the percentage that must be used
to calculate the amount of the assessment, the date on which the
assessment is due and the manner in which the assessment must
be paid; and
(b) Any other regulations necessary or convenient to carry out
the provisions of this section.
2. The amount of the assessment imposed pursuant to
subsection 1:
(a) Except as otherwise provided in paragraph (b), must be
equal to the maximum percentage authorized under federal law;
and
(b) Except where necessary pursuant to subsection 1 of section
9 of this act, must not exceed 5.5 percent of the net revenue earned
by a private emergency medical transport provider from providing
emergency ambulance services in this State during a calendar or
fiscal year.
3. The re venue from an assessment imposed pursuant to
subsection 1 must be deposited into the Account.
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4. An assessment imposed pursuant to subsection 1 must
comply with the provisions of 42 C.F.R. § 433.68. An assessment
must not be imposed pursuant to subsectio n 1 if federal law or
regulations prohibit using the revenue generated by the
assessment for the purposes described in section 7 of this act. If
new federal law or regulations imposing such a prohibition are
enacted or adopted, as applicable:
(a) An assessment must not be collected after the effective date
of the new federal law or regulations; and
(b) Any money collected during the calendar or fiscal year, as
applicable, in which the new federal law or regulations become
effective must be returned to the private emergency medical
transport providers from whom it was collected.
5. A private emergency medical transport provider shall
submit to the Division any information requested by the Division
at such times as are determined by the Division for the purposes of
carrying out the provisions of this section. Such information may
include, without limitation:
(a) The number of emergency ambulance service trips
provided in this State by the private emergency medical transport
provider; and
(b) The total net revenue earned by the private emergency
medical transport provider for the emergency ambulance services
described in paragraph (a).
6. A private emergency medical transport provider shall keep
and maintain accurate records as necessary to support the
accuracy of information requested by the Division pursuant to this
section.
7. As used in this section:
(a) “Cash basis” means the system of accounting under which
revenues are recorded only when received and expenditures or
expenses are recorded only when paid.
(b) “Net revenue” means net patient revenue collected by a
private emergency medical transport provider that is attributable
to the rendering of emergency ambulance services, determined on
a cash basis of accounting.
Sec. 7. 1. The Account to Improve Emergency Medical
Transportation Quality and Access is hereby created in the State
General Fund. The Division shall administer the Account. The
revenue from assessments and penalties imposed on private
emergency medical transport providers pursuant to sections 6 and
8, respectively, of this act must be accounted for separately in the
Account.
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2. The interest and income earned on the money in the
Account, after deducting any applicable charges, must be credited
to the Account.
3. The money in the Account must only be expended to:
(a) Provide enhanced rates of reimbursement to private
emergency medical transport providers that provide emergency
ambulance services to recipients of Medicaid;
(b) Provide funding to allow the Department to:
(1) Modernize processes and infrastructure relating to the
collection and maintenance of data that is useful for purposes
relating to public health;
(2) Provide education to the public relating to emergency
medical services; and
(3) Conduct community outreach to improve public health;
and
(c) Carry out the provisions of sections 2 to 9, inclusive, of this
act.
4. Except as otherwise provided in section 9 of this act, all
money deposited into the Account, except for the money necessary
for the purposes described in paragraphs (b) and (c) of subsection
3, and all federal financial participation provided to match the
money in the Account must be expended to fund the enhanced
rates of reimbursement establishe d pursuant to paragraph (a) of
subsection 3 . Such enhanced rates of reimbursement may be
provided through any or all of the following means:
(a) Increases to rates of reimbursement paid to private
emergency medical transport providers who receive such
reimbursement on a fee-for-service basis.
(b) The establishment of a minimum schedule of fees to be
paid to private emergency medical transport providers who provide
services to recipients of Medicaid under the Medicaid managed
care program established pursuant to NRS 422.273.
(c) Directed payments to private emergency medical transport
providers who provide services to recipients of Medicaid under the
Medicaid managed care program established pursuant to NRS
422.273, without respect to whether a provider pa rticipates in the
network of providers established or used by the Medicaid managed
care program.
5. Not more than 10 percent of the total amount of money
generated each year by the assessment imposed pursuant to
section 6 of this act may be expended for the purposes described in
paragraphs (b) and (c) of subsection 3. Money allocated for such
expenditures must be used first for the purpose described in
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paragraph (c) of subsection 3. If money allocated for such
expenditures remains after all necessary expe nditures are made
for that purpose, the Division shall expend the remaining money
for the purposes described in paragraph (b) of subsection 3.
6. Any money remaining in the Account at the end of a fiscal
year does not revert to the State General Fund, an d the balance in
the Account must be carried forward to the next fiscal year.
7. Money in the Account must not be expended to replace
money that would otherwise be used to provide reimbursement
under Medicaid to private emergency medical transport providers.
8. The Director shall seek any necessary federal authority to
capture all available financial federal participation to carry out
the purposes described in paragraph (a) of subsection 3.
9. If the Legislature authorizes money in the Account to be
used for any purpose other than those authorized by subsection 3:
(a) The Division shall cease imposing the assessment provided
by section 6 of this act; and
(b) The regulations adopted to impose the assessment pursuant
to section 6 of this act are void.
Sec. 8. 1. The Division shall adopt regulations that
establish administrative penalties for the failure to timely pay any
assessment imposed pursuant to section 6 of this act. Any money
collected from administrative penalties imposed pursuant to this
subsection must be deposited into the Account.
2. If a private emergency medical transport provider fails to
remit to the Division any penalty imposed pursuant to subsection 1
or any assessment imposed pursuant to section 6 of this act within
30 days after the date on which the penalty or assessment is due,
as applicable, the Division:
(a) May deduct the amount of the penalty or assessment, as
applicable, from any fu ture payment owed to the private
emergency medical transport provider under Medicaid; and
(b) Shall notify each health authority of this State that has
issued the private emergency medical transport provider a permit
to operate an ambulance that the priva te emergency medical
transport provider has failed to pay a penalty or assessment, as
applicable.
3. Before taking any action described in subsection 2, the
Division:
(a) Shall notify the private emergency medical transport
provider of the action that the Division intends to take, the specific
reason for the action and, where applicable, the amount of the
penalty or assessment that will be deducted; and
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(b) May negotiate a payment plan with the private emergency
medical transport provider.
4. As used in this section, “health authority” has the meaning
ascribed to it in NRS 450B.077.
Sec. 9. 1. The Division may , after consulting with a
representative sample of private emergency medical transport
providers, modify the percentage of the assessment imposed on
private emergency medical transport providers pursuant to section
6 of this act, the amount of any enhanced rate of reimbursement
described in paragraph (a) of subsection 3 of section 7 of this act
or any other requirement or formula established pursuant to
sections 2 to 9, inclusive, of this act to the extent necessary to
obtain federal financial participation for the enhanced rates of
reimbursement described in paragraph (a) of subsection 3 of
section 7 of this act. Such modifications must not result in the
collection of assessments in an amount greater than is required
for the purposes prescribed by subsection 3 of section 7 of this act.
2. The Division shall take the actions described in subsection
3 after determining that:
(a) The amount of funding available for the reimbursement of
private emergency medical transport providers has decreased
below the level of funding that was available for that purpose
during the fiscal year ending on June 30, 2025;
(b) The rate of reimbursement under Medicaid for emergency
ambulance services has decreased below the rate of
reimbursement established under Medicaid for emergency
ambulance services as of June 30, 2022;
(c) Federal financial participation is not availa ble for the
payment of enhanced rates of reimbursement described in
paragraph (a) of subsection 3 of section 7 of this act; or
(d) The revenue collected from assessments imposed pursuant
to section 6 of this act will be insufficient for the purposes
described in paragraphs (a) and (c) of subsection 3 of section 7 of
this act.
3. If the Division makes a determination described in
subsection 2, the Division shall:
(a) Immediately cease imposing and collecting the assessment
otherwise required to be imposed pursuant to section 6 of this act;
(b) Immediately cease using the money generated through that
assessment for the purposes described in subsection 3 of section 7
of this act; and
(c) Return any money collected through the assessment
imposed pursuant t o section 6 of this act that the Division is
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prohibited by paragraph (b) from using for the purposes described
in subsection 3 of section 7 of this act to the private emergency
medical transport provider from whom it was collected.
4. If the Division, after suspending the collection of
assessments and the payment of enhanced rates of reimbursement
pursuant to subsection 3, determines that the provisions of
subsection 2 no longer apply, the Division shall:
(a) Resume collecting assessments pursuant to section 6 of this
act;
(b) Resume payment of the enhanced rates of reimbursement
described in paragraph (a) of subsection 3 of section 7 of this act;
and
(c) Establish, for the period of time during which such
assessments and payments were suspended pursu ant to subsection
3, a schedule for the retroactive:
(1) Collection of assessments pursuant to section 6 of this
act; and
(2) Payment of enhanced rates of reimbursement pursuant
to paragraph (a) of subsection 3 of section 7 of this act.
5. As used in this section, “representative sample of private
emergency medical transport providers” means:
(a) A group of private emergency medical transport providers
which have collectively provided not less than 67 percent of the
emergency ambulance trips provided in this State in the
immediately preceding calendar year; or
(b) An association which represents private emergency
medical transport providers which have collectively provided not
less than 67 percent of the emergency ambulance trips provided in
this State in the immediately preceding calendar year.
Sec. 10. NRS 232.320 is hereby amended to read as follows:
232.320 1. The Director:
(a) Shall appoint, with the consent of the Governor,
administrators of the divisions of the Department, who are
respectively designated as follows:
(1) The Administrator of the Aging and Disability Services
Division;
(2) The Administrator of the Division of Welfare and
Supportive Services;
(3) The Administrator of the Division of Child and Family
Services;
(4) The Administrator of the Division of Health Care
Financing and Policy; and
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(5) The Administrator of the Division of Public and
Behavioral Health.
(b) Shall administer, through the divisions of the Department,
the provisions of chapters 63, 424, 425, 427A, 432A to 442,
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and
sections 2 to 9, inclusive, of this act, 422.580, 432.010 to 432.133,
inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430,
inclusive, and 445A.010 to 445A.055, inclusive, and all other
provisions of law relating to the functions of the divisions of the
Department, but is not responsible for the clinical activities of the
Division of Public and Behavioral Health or the professional line
activities of the other divisions.
(c) Shall administer any state program for persons with
developmental disabilities est ablished pursuant to the
Developmental Disabilities Assistance and Bill of Rights Act of
2000, 42 U.S.C. §§ 15001 et seq.
(d) Shall, after considering advice from agencies of local
governments and nonprofit organizations which provide social
services, adopt a master plan for the provision of human services in
this State. The Director shall revise the plan biennially and deliver a
copy of the plan to the Governor and the Legislature at the
beginning of each regular session. The plan must:
(1) Identify and assess the plans and programs of the
Department for the provision of human services, and any
duplication of those services by federal, state and local agencies;
(2) Set forth priorities for the provision of those services;
(3) Provide for communication and the coordination of those
services among nonprofit organizations, agencies of local
government, the State and the Federal Government;
(4) Identify the sources of funding for services provided by
the Department and the allocation of that funding;
(5) Set forth sufficient information to assist the Department
in providing those services and in the planning and budgeting for the
future provision of those services; and
(6) Contain any other information necessary for the
Department to communicate effe ctively with the Federal
Government concerning demographic trends, formulas for the
distribution of federal money and any need for the modification of
programs administered by the Department.
(e) May, by regulation, require nonprofit organizations and sta te
and local governmental agencies to provide information regarding
the programs of those organizations and agencies, excluding
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detailed information relating to their budgets and payrolls, which the
Director deems necessary for the performance of the dutie s imposed
upon him or her pursuant to this section.
(f) Has such other powers and duties as are provided by law.
2. Notwithstanding any other provision of law, the Director, or
the Director’s designee, is responsible for appointing and removing
subordinate officers and employees of the Department.
Sec. 11. NRS 450B.215 is hereby amended to read as follows:
450B.215 1. If the health authority receives notification from
the Department of Health and Human Services pursuant to NRS
439.5895 that the holder of a permit to operate an ambulance, air
ambulance or vehicle of a fire -fighting agency is not in compliance
with the requirements of subsection 4 of NRS 439.589, the health
authority may, after notice and the oppo rtunity for a hearing in
accordance with the provisions of this chapter, require corrective
action or impose an administrative penalty in an amount established
by regulation of the board.
2. The health authority shall not suspend or revoke a permit for
failure to comply with the requirements of subsection 4 of
NRS 439.589.
3. If the health authority receives a notification from the
Division of Health Care Financing and Policy of the Department
of Health and Human Services pursuant to section 8 of this act
that the holder of a permit to operate an ambulance has failed to
pay an assessment imposed pursuant to section 6 of this act or an
administrative penalty imposed pursuant to section 8 of this act,
the health authority may, after notice and the opportu nity for a
hearing in accordance with the provisions of this chapter:
(a) Require corrective action;
(b) Impose an administrative penalty in an amount established
by regulation of the board; or
(c) Revoke or suspend the permit of the holder.
Sec. 11.5. NRS 450B.850 is hereby amended to read as
follows:
450B.850 1. The health authority may operate training
programs and may contract with others to operate training programs
for ambulance attendants, ambulance service operators, firefighters,
law enforcement officers, physicians, nurses and others in
emergency first aid, emergency care and any other techniques
associated with emergency care, transportation and treatment of the
sick and injured and the proper operation of an ambulance service.
2. The health authority may establish a program of evidence-
based training which focuses on the identification of and proper
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response to victims of human trafficking, including, without
limitation, sex trafficking.
3. Any program of training established pursuant to
subsection 2 must:
(a) Be developed in coordination with an institution of higher
education that:
(1) Has met the standards required by an accrediting body
recognized by the United States Department of Education; or
(2) Is recognized as accredited by the United States
Department of Education;
(b) Utilize curriculum which:
(1) Is consistent with the standards of care for anti -
trafficking providers published by the Office for Victims of Crime
of the United States Department of Justice and the Office on
Trafficking in Persons of the United States Department of Health
and Human Services, if such standards have been published; and
(2) Includes instruction on the core components of
responding and providing services to victims of human trafficking,
including, without limitation:
(I) Outreach to persons affected by human trafficking;
(II) Identifying victims of human trafficking;
(III) Protocols for screening victims of human
trafficking;
(IV) Delivering services to victims of human trafficking
using trauma-informed methods;
(V) Pathways for referrals; and
(VI) Best practices for ensuring the privacy and
confidentiality of victims of human trafficking;
(c) Provide not less than 1 hour of instruction to persons
attending the program; and
(d) Be offered by the health authority to:
(1) Any emergency response empl oyee, including, without
limitation, a person who currently holds a license or certificate, as
applicable, as an ambulance attendant, emergency medical
technician, advanced emergency medical technician or
paramedic; or
(2) An applicant for a license or c ertificate described in
subparagraph (1), as applicable.
Sec. 12. The provisions of subsections 3 and 4 of section 9 of
this act apply to any period described in subsection 2 of section 9 of
this act that occurs on or after July 1, 2025, including, without
limitation, a period where federal financial participation is not
available for the payment of enhanced rates of reimbursement
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described in paragraph (a) of subsection 3 of section 7 of this act
because the Department of Health and Human Services has not yet
obtained approval from the United States Secretary of Health and
Human Services to pay such enhanced rates of reimbursement.
Sec. 13. 1. This section becomes effective upon passage and
approval.
2. Sections 1 to 12, inclusive, of this act become effective:
(a) Upon passage and approval for the purpose of adopting any
regulations and performing any other preparatory administrative
tasks that are necessary to carry out the provisions of this act; and
(b) On July 1, 2025, for all other purposes.
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