Text of NV SB 341 (2021)

S.B. 341 - *SB341* SENATE BILL NO. 341–SENATOR SPEARMAN MARCH 23, 2021 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to health care. (BDR 40-62) FISCAL NOTE: Effect on Local Government: No. Effect on the State: Yes. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to health care; requiring the Division of Public and Behavioral Health of the Department of Health and Human Services to apply for grants to reduce disparities in health care and behavioral health; creating and prescribing the duties of the Kidney Disease Prevention and Education Task Force; imposing requirements concerning expenditures relating to certain health matters; creating the Minority Health and Equity Account to hold funding for the Office of Minority Health and Equity within the Department; authorizing the Office to enter into a joint partnership with a public or private entity; requiring a managed care plan that provides behavioral health services to recipients of Medicaid to prepare and implement a plan to ensure the delivery of such services in a culturally competent manner; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law authorizes the Department of Health and Human Services, through 1 the Division of Public and Behavioral Health of the Department, to enter into 2 contracts with various entities to carry out its duties relating to mental health and 3 public health. (NRS 433.354, 439.155) Sections 2 and 17 of this bill require the 4 Division to apply for available grants to address disparities in health care and 5 behavioral health due to race, color, ancestry, national origin, disability, familial 6 status, sex, sexual orientation, gender identity or expression, immigration status, 7 primary language or income level. Sections 2 and 17 authorize the Division to use 8 a competitive process to select and award a grant of money to a community-based 9 nonprofit organization to serve as lead partner in ensuring that services funded by a 10 grant obtained by the Division are funded and allocated in an equitable manner. 11 – 2 – - *SB341* Sections 2 and 17 additionally authorize the Division to establish and consult with 12 an advisory committee to ensure that such services are provided in a culturally 13 competent manner. Sections 2 and 17 require the Department to submit to the 14 Legislature annually two reports concerning efforts to address disparities in health 15 care and behavioral health, respectively, due to race, color, ancestry, national 16 origin, disability, familial status, sex, sexual orientation, gender identity or 17 expression, immigration status, primary language or income level. 18 Section 4 of this bill creates the Kidney Disease Prevention and Education 19 Task Force and section 3 of this bill defines the term “Task Force” to refer to that 20 Task Force. Section 5 of this bill prescribes the duties of the Task Force, which 21 include: (1) collaborating with certain persons and entities to examine, provide 22 education concerning and raise awareness of issues related to kidney disease; (2) 23 developing a sustainable plan to raise awareness concerning early detection of 24 kidney disease, promote transplantation, increase equity in health care and reduce 25 the frequency and severity of kidney disease in this State; and (3) submitting an 26 annual report to the Legislature concerning the activities of the Task Force. Section 27 18 of this bill removes the requirement that the Task Force submit an annual report 28 to the Legislature after 5 years. 29 Existing law creates the Office of Minority Health and Equity within the 30 Department of Health and Human Services to: (1) improve the quality of health 31 care services for members of minority groups; (2) increase access to health care 32 services for members of minority groups; (3) disseminate information to and 33 educate the public on matters concerning health care issues of interest to members 34 of minority groups; and (4) develop recommendations for changes in policy and 35 advocate on behalf of minority groups. (NRS 232.474) Section 8 of this bill creates 36 the Minority Health and Equity Account to hold money provided to the Office 37 through appropriations, gifts, grants and donations. Section 8 provides that such 38 money does not revert to the State General Fund. Section 10 of this bill makes a 39 conforming change to indicate the placement of section 8 in the Nevada Revised 40 Statutes. Section 11 of this bill authorizes the Office to enter into joint partnerships 41 with public and private entities to carry out its purposes. 42 Existing law requires the Chief of the Budget Division of the Office of Finance 43 to biennially prepare a proposed budget for the Executive Department of the State 44 Government for the next 2 fiscal years. (NRS 353.185) Sections 12 and 13 of this 45 bill require that any expenditure proposed by that budget for a health care issue that 46 disproportionately affects Black and Indigenous persons and other persons of color 47 must be proposed to be made in a manner that is in direct proportion to the 48 disproportionate effect of that health care issue on each of those groups. Section 6 49 of this bill requires the Legislature to ensure that any money appropriated or 50 authorized for a health care issue that disproportionately affects those groups is 51 distributed in direct proportion to the disproportionate effect of that health care 52 issue on each of those groups. 53 Existing law requires any department, institution or agency of the Executive 54 Department to submit any request for the revision of the work program of the 55 department, institution or agency for approval by the Chief and, for certain 56 significant expenditures, the Interim Finance Committee. (NRS 353.220) Section 57 14 of this bill requires: (1) any proposed revision to a work program related to 58 money for a health care issue that disproportionately affects Black and Indigenous 59 persons and other persons of color to be proposed to be made in a manner that is in 60 direct proportion to the disproportionate effect of that health care issue on each of 61 those groups; and (2) the Interim Finance Committee to consider, when acting on 62 the proposed revision, whether the revision is proposed to be made in such a 63 manner. 64 Existing law requires certain gifts and grants to a state agency to be approved 65 by the Interim Finance Committee. Section 15 of this bill requires the Interim 66 – 3 – - *SB341* Finance Committee, when acting on a proposed gift or grant, to consider whether a 67 proposed gift or grant for a health care issue that disproportionately affects Black 68 and Indigenous persons and other persons of color is proposed to be expended in a 69 manner that is in direct proportion to the disproportionate effect of that health care 70 issue on each of those groups. Section 7 of this bill requires the Fiscal Analysis 71 Division of the Legislative Counsel Bureau to prepare and post on the Internet 72 annually a report concerning actions taken by the Interim Finance Committee and 73 the Legislature pursuant to sections 6, 14 and 15 to ensure that expenditures on 74 health care issues that disproportionately affect Black and Indigenous persons and 75 other persons of color are made in a manner that is in direct proportion to the 76 disproportionate effect of that health care issue on each of those groups. 77 Existing law requires the Department to administer Medicaid and the 78 Children’s Health Insurance Program. (NRS 422.270) Section 16 of this bill 79 requires the Division of Health Care Financing and Policy of the Department to 80 require a managed care organization that provides behavioral health services to 81 recipients of Medicaid or the Children’s Health Insurance Program to prepare and 82 implement a plan to ensure that such services are provided in a culturally competent 83 manner if such a requirement is practicable. If the Division imposes such a 84 requirement, section 16 requires the managed care organization to establish a 85 committee of interested persons to conduct an ongoing review of the plan. 86 WHEREAS, As stated by James Baldwin, “Not everything that is 1 faced can be changed, but nothing can be changed until it is faced”; 2 and 3 WHEREAS, Systemic racism and structures of racial 4 discrimination create generational poverty and perpetuate 5 debilitating economic, educational and health hardships for persons 6 of color, causing the single most profound economic and social 7 challenge facing Nevada; and 8 WHEREAS, This economic and social challenge has been 9 exacerbated by the COVID-19 pandemic; and 10 WHEREAS, Nearly 49 percent of Nevada’s population is 11 represented by persons of color, including persons who are Black, 12 Indigenous, Hispanic, Asian or Pacific Islander and persons of more 13 than one racial or ethnic background; and 14 WHEREAS, Nevada is a growing and diverse state with 15 continually shifting demographics; and 16 WHEREAS, Racism has deep, harmful impacts and unfairly 17 disadvantages Black and Indigenous persons and other persons of 18 color (BIPOC) and has impeded solutions necessary to achieve 19 racial parity; and 20 WHEREAS, Providers of health care have long noted the 21 existence of racial and ethnic disparities in our health care system, 22 and these inequalities have led to a disproportionate negative impact 23 on BIPOC communities during the COVID-19 pandemic; and 24 WHEREAS, The chronic stress of racism affects the mental and 25 physical health of the members of BIPOC communities and, in 26 particular, affects the mental and physical health of Black 27 – 4 – - *SB341* Americans on a daily basis to a greater degree than other groups; 1 and 2 WHEREAS, During the 32nd Special Session of the Legislature, 3 the Legislature adopted Senate Concurrent Resolution No. 1, which 4 declared that systemic racism and structures of racial discrimination 5 constitute a public health crisis; now, therefore, 6 7 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN 8 SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: 9 10 Section 1. Chapter 439 of NRS is hereby amended by adding 11 thereto the provisions set forth as sections 2 to 5, inclusive, of this 12 act. 13 Sec. 2. 1. The Division shall apply for grants available 14 from any source, including, without limitation, the Federal 15 Government, to support the provision of health care services or 16 other services to promote physical well-being in communities with 17 higher risk of health problems, decreased access to or usage of 18 health care services or worse health outcomes or physical well- 19 being than the general population based on race, color, ancestry, 20 national origin, disability, familial status, sex, sexual orientation, 21 gender identity or expression, immigration status, primary 22 language or income level. 23 2. To the extent authorized by the terms of a grant obtained 24 pursuant to subsection 1, the Division may: 25 (a) Use a competitive process to select and award a grant of 26 money to a nonprofit organization to serve as a lead partner to 27 ensure that health care services supported by a grant obtained 28 pursuant to subsection 1 are funded and allocated in an equitable 29 manner. The lead partner must: 30 (1) Be based in the community to which the health care 31 services are to be provided; and 32 (2) Have demonstrated experience serving that community. 33 (b) Establish and consult with an advisory committee to ensure 34 that health care services supported by a grant obtained pursuant to 35 subsection 1 are provided in a culturally competent manner. The 36 advisory committee must be composed of representatives of 37 nonprofit organizations that have demonstrated experience 38 serving the community to which the health care services are to be 39 provided. 40 3. On or before February 1 of each year, the Department 41 shall: 42 (a) Compile a report that includes, without limitation: 43 (1) The amount of money allocated by the Department 44 during the immediately preceding calendar year to support the 45 – 5 – - *SB341* provision of health care services or other services to promote 1 physical well-being in communities with higher risk of health 2 problems, decreased access to or usage of health care services or 3 worse health outcomes or physical well-being than the general 4 population based on race, color, ancestry, national origin, 5 disability, familial status, sex, sexual orientation, gender identity 6 or expression, immigration status, primary language or income 7 level; 8 (2) A description of the services described in subparagraph 9 (1) that were provided during the immediately preceding calendar 10 year and the efforts made by the Department during the 11 immediately preceding calendar year to locate persons in need of 12 such services and provide such services to those persons; 13 (3) The number of persons who received the services 14 described in subparagraph (1) and, to the extent available, 15 information regarding the income level, age, race and ethnicity of 16 those persons; and 17 (4) Any community-based organizations with which the 18 Department collaborated to provide those services; and 19 (b) Submit the report to the Director of the Legislative Counsel 20 Bureau for transmittal to: 21 (1) In even-numbered years, the Legislative Commission 22 and the Legislative Committee on Health Care; and 23 (2) In odd-numbered years, the next regular session of the 24 Legislature. 25 Sec. 3. As used in this section and sections 4 and 5 of this 26 act, unless the context otherwise requires, “Task Force” means 27 the Kidney Disease Prevention and Education Task Force created 28 by section 4 of this act. 29 Sec. 4. 1. The Kidney Disease Prevention and Education 30 Task Force is hereby created within the Department of Health and 31 Human Services. The Task Force consists of: 32 (a) One member of the Senate who is appointed by the 33 Majority Leader of the Senate; 34 (b) One member of the Assembly who is appointed by the 35 Speaker of the Assembly; 36 (c) One member of the Senate who is appointed by the 37 Minority Leader of the Senate; 38 (d) One member of the Assembly who is appointed by the 39 Minority Leader of the Assembly; 40 (e) One member who is a representative of the Department, 41 appointed by the Governor; 42 (f) One member who is a provider of health care, other than a 43 physician, who provides care to patients with kidney disease, 44 appointed by the Co-Chairs; 45 – 6 – - *SB341* (g) One member who is a representative of a medical facility 1 with a program related to kidney health, appointed by the Co- 2 Chairs; 3 (h) One member who is a physician who provides care to 4 patients with kidney disease, appointed by the Co-Chairs; 5 (i) One member who represents a nonprofit organ 6 procurement organization, appointed by the Co-Chairs; 7 (j) One member who represents the National Kidney 8 Foundation, or its successor organization, and works primarily in 9 this State, appointed by that organization; 10 (k) One member who represents the American Kidney Fund, 11 or its successor organization, and works primarily in this State, 12 appointed by that organization; 13 (l) One member who is a patient who has or has recovered 14 from kidney disease, appointed by the Co-Chairs; and 15 (m) Any additional members appointed by the Co-Chairs to 16 represent public health clinics, community health centers, 17 organizations to provide health care to minority populations and 18 insurers. Members appointed pursuant to this paragraph serve at 19 the pleasure of the Co-Chairs. 20 2. The members appointed to the Task Force pursuant to 21 paragraphs (a) and (b) of subsection 1 shall serve as Co-Chairs. 22 3. After the initial terms, the members of the Task Force 23 described in paragraphs (a) to (l), inclusive, of subsection 1 serve 24 terms of 2 years. A member may be reappointed to the Task Force 25 and any vacancy must be filled in the same manner as the original 26 appointment. 27 4. The members of the Task Force serve without 28 compensation and are not entitled to the per diem and travel 29 expenses provided for state officers and employees generally. 30 5. Each member of the Task Force who is an officer or 31 employee of this State or a political subdivision of this State must 32 be relieved from his or her duties without loss of regular 33 compensation so that the officer or employee may prepare for and 34 attend meetings of the Task Force and perform any work 35 necessary to carry out the duties of the Task Force in the most 36 timely manner practicable. A state agency or political subdivision 37 of this State shall not require an officer or employee who is a 38 member of the Task Force to make up the time the officer or 39 employee is absent from work to carry out duties as a member of 40 the Task Force or use annual leave or compensatory time for the 41 absence. 42 6. The Department shall provide such administrative support 43 to the Task Force as is necessary to carry out the duties of the 44 Task Force. 45 – 7 – - *SB341* 7. As used in this section: 1 (a) “Medical facility” has the meaning ascribed to it in 2 NRS 449.0151. 3 (b) “Organ procurement organization” has the meaning 4 ascribed to it in NRS 451.534. 5 (c) “Provider of health care” has the meaning ascribed to it in 6 NRS 629.031. 7 Sec. 5. 1. The members of the Task Force shall meet at the 8 call of the Co-Chairs. The Task Force shall prescribe regulations 9 for its own management and government. 10 2. A majority of the members of the Task Force constitutes a 11 quorum, and a quorum may exercise all the powers conferred on 12 the Task Force. 13 3. The Task Force shall: 14 (a) Collaborate with interested persons and entities, including, 15 without limitation, governmental entities and educational 16 institutions, to examine, provide education concerning and 17 increase awareness of chronic kidney disease, kidney transplant, 18 donation of kidneys by living and deceased donors and disparities 19 among races in rates of kidney disease. 20 (b) Develop a sustainable plan to raise awareness concerning 21 early detection of kidney disease, promote kidney transplant, 22 increase equity in health care services and reduce the frequency 23 and severity of kidney disease in this State. The plan must include, 24 without limitation, ongoing workshops, seminars, research, 25 preventive screenings, social media campaigns and television and 26 radio advertisements. 27 (c) Make recommendations concerning kidney health and 28 kidney disease to the Division, the Department, the Legislature 29 and other interested persons and entities. 30 (d) On or before December 31 of each year, compile a report 31 concerning the activities of the Task Force and submit the report 32 to the Director of the Legislative Counsel Bureau for transmittal 33 to: 34 (1) In odd-numbered years, the Legislative Committee on 35 Health Care; and 36 (2) In even-numbered years, the next regular session of the 37 Legislature. 38 Sec. 6. Chapter 218D of NRS is hereby amended by adding 39 thereto a new section to read as follows: 40 In enacting any bill that appropriates or authorizes money for 41 a health care issue that disproportionately affects Black and 42 Indigenous persons and other persons of color, the Legislature 43 shall ensure that the money is distributed in direct proportion to 44 – 8 – - *SB341* the disproportionate effect of that health care issue on each of 1 those groups. 2 Sec. 7. NRS 218F.600 is hereby amended to read as follows: 3 218F.600 1. The Fiscal Analysis Division consists of the 4 Senate Fiscal Analyst, the Assembly Fiscal Analyst and such 5 additional staff as the performance of their duties may require. 6 2. The Fiscal Analysis Division shall: 7 (a) Thoroughly examine all agencies of the State with special 8 regard to their activities and the duplication of efforts between them. 9 (b) Recommend to the Legislature any suggested changes 10 looking toward economy and the elimination of inefficiency in 11 government. 12 (c) Ascertain facts and make recommendations to the 13 Legislature concerning the budget of the State and the estimates of 14 the expenditure requirements of the agencies of the State. 15 (d) Make projections of future public revenues for the use of the 16 Legislature. 17 (e) Analyze the history and probable future trend of the State’s 18 financial position in order that a sound fiscal policy may be 19 developed and maintained for the State of Nevada. 20 (f) Analyze appropriation bills, revenue bills and bills having a 21 fiscal impact upon the operation of the government of the State of 22 Nevada or its political subdivisions. 23 (g) Advise the Legislature and its members and committees 24 regarding matters of a fiscal nature. 25 (h) Prepare and cause to be posted on the Internet website of 26 the Legislature annually a report concerning: 27 (1) In an even-numbered year, actions taken by the Interim 28 Finance Committee in accordance with paragraph (c) of 29 subsection 7 of NRS 353.220 and paragraph (e) of subsection 4 of 30 NRS 353.335; and 31 (2) In an odd-numbered year, actions taken by the 32 Legislature in accordance with section 6 of this act. 33 (i) Perform such other functions as may be assigned to the Fiscal 34 Analysis Division by the Legislature, the Legislative Commission or 35 the Director. 36 Sec. 8. Chapter 232 of NRS is hereby amended by adding 37 thereto a new section to read as follows: 38 1. The Minority Health and Equity Account is hereby created 39 in the State General Fund. The Account must be administered by 40 the Manager. The Manager shall deposit in the Account: 41 (a) Any legislative appropriations made to the Office; and 42 (b) Any other money received by the Office pursuant to 43 NRS 232.476. 44 2. The interest and income earned on: 45 – 9 – - *SB341* (a) The money in the Account, after deducting any applicable 1 charges; and 2 (b) Unexpended appropriations made to the Account from the 3 State General Fund, 4  must be credited to the Account. 5 3. Any money in the Account and any unexpended 6 appropriations made to the Account from the State General Fund 7 remaining at the end of a fiscal year do not revert to the State 8 General Fund, and the balance in the Account must be carried 9 forward to the next fiscal year. 10 4. The money in the Account must be expended to carry out 11 the purposes of this section and NRS 232.467 to 232.484, 12 inclusive. 13 Sec. 9. NRS 232.320 is hereby amended to read as follows: 14 232.320 1. The Director: 15 (a) Shall appoint, with the consent of the Governor, 16 administrators of the divisions of the Department, who are 17 respectively designated as follows: 18 (1) The Administrator of the Aging and Disability Services 19 Division; 20 (2) The Administrator of the Division of Welfare and 21 Supportive Services; 22 (3) The Administrator of the Division of Child and Family 23 Services; 24 (4) The Administrator of the Division of Health Care 25 Financing and Policy; and 26 (5) The Administrator of the Division of Public and 27 Behavioral Health. 28 (b) Shall administer, through the divisions of the Department, 29 the provisions of chapters 63, 424, 425, 427A, 432A to 442, 30 inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 31 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 32 section 16 of this act, 422.580, 432.010 to 432.133, inclusive, 33 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 34 and 445A.010 to 445A.055, inclusive, and all other provisions of 35 law relating to the functions of the divisions of the Department, but 36 is not responsible for the clinical activities of the Division of Public 37 and Behavioral Health or the professional line activities of the other 38 divisions. 39 (c) Shall administer any state program for persons with 40 developmental disabilities established pursuant to the 41 Developmental Disabilities Assistance and Bill of Rights Act of 42 2000, 42 U.S.C. §§ 15001 et seq. 43 (d) Shall, after considering advice from agencies of local 44 governments and nonprofit organizations which provide social 45 – 10 – - *SB341* services, adopt a master plan for the provision of human services in 1 this State. The Director shall revise the plan biennially and deliver a 2 copy of the plan to the Governor and the Legislature at the 3 beginning of each regular session. The plan must: 4 (1) Identify and assess the plans and programs of the 5 Department for the provision of human services, and any 6 duplication of those services by federal, state and local agencies; 7 (2) Set forth priorities for the provision of those services; 8 (3) Provide for communication and the coordination of those 9 services among nonprofit organizations, agencies of local 10 government, the State and the Federal Government; 11 (4) Identify the sources of funding for services provided by 12 the Department and the allocation of that funding; 13 (5) Set forth sufficient information to assist the Department 14 in providing those services and in the planning and budgeting for the 15 future provision of those services; and 16 (6) Contain any other information necessary for the 17 Department to communicate effectively with the Federal 18 Government concerning demographic trends, formulas for the 19 distribution of federal money and any need for the modification of 20 programs administered by the Department. 21 (e) May, by regulation, require nonprofit organizations and state 22 and local governmental agencies to provide information regarding 23 the programs of those organizations and agencies, excluding 24 detailed information relating to their budgets and payrolls, which the 25 Director deems necessary for the performance of the duties imposed 26 upon him or her pursuant to this section. 27 (f) Has such other powers and duties as are provided by law. 28 2. Notwithstanding any other provision of law, the Director, or 29 the Director’s designee, is responsible for appointing and removing 30 subordinate officers and employees of the Department. 31 Sec. 10. NRS 232.467 is hereby amended to read as follows: 32 232.467 As used in NRS 232.467 to 232.484, inclusive, and 33 section 8 of this act, unless the context otherwise requires, the 34 words and terms defined in NRS 232.468 to 232.473, inclusive, 35 have the meanings ascribed to them in those sections. 36 Sec. 11. NRS 232.476 is hereby amended to read as follows: 37 232.476 The Office may: 38 1. Apply for any available grants and accept any available 39 gifts, grants, appropriations or donations, and use any such gifts, 40 grants, appropriations or donations to carry out its purposes; 41 2. Contract or enter into a partnership with a public or private 42 entity to assist in carrying out its purposes; and 43 – 11 – - *SB341* 3. Adopt such regulations as are necessary to carry out the 1 provisions of NRS 232.467 to 232.484, inclusive [.] , and section 8 2 of this act. 3 Sec. 12. NRS 353.185 is hereby amended to read as follows: 4 353.185 The powers and duties of the Chief are: 5 1. To appraise the quantity and quality of services rendered by 6 each agency in the Executive Department of the State Government, 7 and the needs for such services and for any new services. 8 2. To develop plans for improvements and economies in 9 organization and operation of the Executive Department, and to 10 install such plans as are approved by the respective heads of the 11 various agencies of the Executive Department, or as are directed to 12 be installed by the Governor or the Legislature. 13 3. To cooperate with the State Public Works Division of the 14 Department of Administration in developing comprehensive, long- 15 range plans for capital improvements and the means for financing 16 them. 17 4. To devise and prescribe the forms for reports on the 18 operations of the agencies in the Executive Department to be 19 required periodically from the several agencies in the Executive 20 Department, and to require the several agencies to make such 21 reports. 22 5. To prepare the executive budget report for the Governor’s 23 approval and submission to the Legislature. 24 6. To prepare a proposed budget for the Executive Department 25 of the State Government for the next 2 fiscal years, which must: 26 (a) Present a complete financial plan for the next 2 fiscal years; 27 (b) Set forth all proposed expenditures for the administration, 28 operation and maintenance of the departments, institutions and 29 agencies of the Executive Department of the State Government, 30 including those operating on funds designated for specific purposes 31 by the Constitution or otherwise, which must include a separate 32 statement of: 33 (1) The anticipated expense, including personnel, for the 34 operation and maintenance of each capital improvement to be 35 constructed during the next 2 fiscal years and of each capital 36 improvement constructed on or after July 1, 1999, which is to be 37 used during those fiscal years or a future fiscal year; [and] 38 (2) If the expenditure is for a health care issue that 39 disproportionately affects Black and Indigenous persons and other 40 persons of color, the distribution of the money, which must be in 41 direct proportion to the disproportionate effect of that health care 42 issue on each of those groups; and 43 – 12 – - *SB341* (3) The proposed source of funding for the operation and 1 maintenance of each capital improvement, including personnel, to 2 be constructed during the next 2 fiscal years; 3 (c) Set forth all charges for interest and debt redemption during 4 the next 2 fiscal years; 5 (d) Set forth all expenditures for capital projects to be 6 undertaken and executed during the next 2 fiscal years, and which 7 must, to the extent practicable, provide that each capital project 8 which exceeds a cost of $10,000,000 be scheduled to receive 9 funding for design and planning during one biennium and funding 10 for construction in the subsequent biennium; and 11 (e) Set forth the anticipated revenues of the State Government, 12 and any other additional means of financing the expenditures 13 proposed for the next 2 fiscal years. 14 7. To examine and approve work programs and allotments to 15 the several agencies in the Executive Department, and changes 16 therein. 17 8. To examine and approve statements and reports on the 18 estimated future financial condition and the operations of the 19 agencies in the Executive Department of the State Government and 20 the several budgetary units that have been prepared by those 21 agencies and budgetary units, before the reports are released to the 22 Governor, to the Legislature or for publication. 23 9. To receive and deal with requests for information as to the 24 budgetary status and operations of the executive agencies of the 25 State Government. 26 10. To prepare such statements of unit costs and other statistics 27 relating to cost as may be required from time to time, or requested 28 by the Governor or the Legislature. 29 11. To do and perform such other and further duties relative to 30 the development and submission of an adequate proposed budget for 31 the Executive Department of the State Government of the State of 32 Nevada as the Governor may require. 33 Sec. 13. NRS 353.205 is hereby amended to read as follows: 34 353.205 1. The proposed budget for the Executive 35 Department of the State Government for each fiscal year must be set 36 up in four parts: 37 (a) Part 1 must consist of a budgetary message by the Governor 38 which includes: 39 (1) A general summary of the long-term performance goals 40 of the Executive Department of the State Government for: 41 (I) Core governmental functions, including the education 42 of pupils in kindergarten through grade 12, higher education, human 43 services and public safety and health; and 44 (II) Other governmental services; 45 – 13 – - *SB341* (2) An explanation of the means by which the proposed 1 budget will provide adequate funding for those governmental 2 functions and services such that ratable progress will be made 3 toward achieving those long-term performance goals; 4 (3) An outline of any other important features of the financial 5 plan of the Executive Department of the State Government for the 6 next 2 fiscal years; and 7 (4) A general summary of the proposed budget setting forth 8 the aggregate figures of the proposed budget in such a manner as to 9 show the balanced relations between the total proposed expenditures 10 and the total anticipated revenues, together with the other means of 11 financing the proposed budget for the next 2 fiscal years, contrasted 12 with the corresponding figures for the last completed fiscal year and 13 fiscal year in progress. The general summary of the proposed budget 14 must be supported by explanatory schedules or statements, 15 classifying the expenditures contained therein by organizational 16 units, objects and funds, and the income by organizational units, 17 sources and funds. The organizational units may be subclassified by 18 functions and by agencies, bureaus or commissions, or in any other 19 manner determined by the Chief. 20 (b) Part 2 must embrace the detailed budgetary estimates both of 21 expenditures and revenues as provided in NRS 353.150 to 353.246, 22 inclusive. The information must be presented in a manner which sets 23 forth separately the cost of continuing each program at the same 24 level of service as the current year and the cost, by budgetary issue, 25 of any recommendations to enhance or reduce that level of service. 26 Revenues must be summarized by type, and expenditures must be 27 summarized by program or budgetary account and by category of 28 expense. If any expenditures are for a health care issue that 29 disproportionately affects Black and Indigenous persons and other 30 persons of color, the expenditures must be proposed to be made in 31 a manner that is in direct proportion to the disproportionate effect 32 of that health care issue on each of those groups. Part 2 must 33 include: 34 (1) The identification of each long-term performance goal of 35 the Executive Department of the State Government for: 36 (I) Core governmental functions, including the education 37 of pupils in kindergarten through grade 12, higher education, human 38 services, and public safety and health; and 39 (II) Other governmental services, 40  and of each intermediate objective for the next 2 fiscal years 41 toward achieving those goals. 42 (2) An explanation of the means by which the proposed 43 budget will provide adequate funding for those governmental 44 functions and services such that those intermediate objectives will 45 – 14 – - *SB341* be met and progress will be made toward achieving those long-term 1 performance goals. 2 (3) A mission statement and measurement indicators for each 3 department, institution and other agency of the Executive 4 Department of the State Government, which articulate the 5 intermediate objectives and long-term performance goals each such 6 department, institution and other agency is tasked with achieving 7 and the particular measurement indicators tracked for each such 8 department, institution and other agency to determine whether the 9 department, institution or other agency is successful in achieving its 10 intermediate objectives and long-term performance goals, provided 11 in sufficient detail to assist the Legislature in performing an analysis 12 of the relative costs and benefits of program budgets and in 13 determining priorities for expenditures. If available, information 14 regarding such measurement indicators must be provided for each of 15 the previous 4 fiscal years. If a new measurement indicator is being 16 added, a rationale for that addition must be provided. If a 17 measurement indicator is being modified, information must be 18 provided regarding both the modified indicator and the indicator as 19 it existed before modification. If a measurement indicator is being 20 deleted, a rationale for that deletion and information regarding the 21 deleted indicator must be provided. 22 (4) Statements of the bonded indebtedness of the State 23 Government, showing the requirements for redemption of debt, the 24 debt authorized and unissued, and the condition of the sinking 25 funds. 26 (5) Any statements relative to the financial plan which the 27 Governor may deem desirable, or which may be required by the 28 Legislature. 29 (c) Part 3 must set forth, for the Office of Economic 30 Development and the Office of Energy, the results of the analyses 31 conducted by those offices and reported to the Chief pursuant to 32 NRS 353.207 for the immediately preceding 2 fiscal years. 33 (d) Part 4 must include a recommendation to the Legislature for 34 the drafting of a general appropriation bill authorizing, by 35 departments, institutions and agencies, and by funds, all 36 expenditures of the Executive Department of the State Government 37 for the next 2 fiscal years, and may include recommendations to the 38 Legislature for the drafting of such other bills as may be required to 39 provide the income necessary to finance the proposed budget and to 40 give legal sanction to the financial plan if adopted by the 41 Legislature. 42 2. Except as otherwise provided in NRS 353.211, as soon as 43 each part of the proposed budget is prepared, a copy of the part must 44 – 15 – - *SB341* be transmitted to the Fiscal Analysis Division of the Legislative 1 Counsel Bureau for confidential examination and retention. 2 3. Except for the information provided to the Fiscal Analysis 3 Division of the Legislative Counsel Bureau pursuant to NRS 4 353.211, parts 1 and 2 of the proposed budget are confidential until 5 the Governor transmits the proposed budget to the Legislature 6 pursuant to NRS 353.230, regardless of whether those parts are in 7 the possession of the Executive or Legislative Department of the 8 State Government. Part 4 of the proposed budget is confidential 9 until the bills which result from the proposed budget are introduced 10 in the Legislature. As soon as practicable after the Governor 11 transmits the proposed budget to the Legislature pursuant to NRS 12 353.230, the information required to be included in the proposed 13 budget pursuant to subparagraphs (1), (2) and (3) of paragraph (b) of 14 subsection 1 must be posted on the Internet websites maintained by 15 the Budget Division of the Office of Finance. 16 Sec. 14. NRS 353.220 is hereby amended to read as follows: 17 353.220 1. The head of any department, institution or agency 18 of the Executive Department of the State Government, whenever he 19 or she deems it necessary because of changed conditions, may 20 request the revision of the work program of his or her department, 21 institution or agency at any time during the fiscal year, and submit 22 the revised program to the Governor through the Chief with a 23 request for revision of the allotments for the remainder of that fiscal 24 year. 25 2. Every request for revision must be submitted to the Chief on 26 the form and with supporting information as the Chief prescribes. If 27 the request for revision is related to money for a health care issue 28 that disproportionately affects Black and Indigenous persons and 29 other persons of color, the request must propose a distribution of 30 the money in direct proportion to the disproportionate effect of 31 that health care issue on each of those groups. 32 3. Before encumbering any appropriated or authorized money, 33 every request for revision must be approved or disapproved in 34 writing by the Governor or the Chief, if the Governor has by written 35 instrument delegated this authority to the Chief. 36 4. Except as otherwise provided in subsection 8, whenever a 37 request for the revision of a work program of a department, 38 institution or agency in an amount more than $30,000 would, when 39 considered with all other changes in allotments for that work 40 program made pursuant to subsections 1, 2 and 3 and NRS 353.215, 41 increase or decrease by 10 percent or $75,000, whichever is less, the 42 expenditure level approved by the Legislature for any of the 43 allotments within the work program, the request must be approved 44 – 16 – - *SB341* as provided in subsection 5 before any appropriated or authorized 1 money may be encumbered for the revision. 2 5. If a request for the revision of a work program requires 3 additional approval as provided in subsection 4 and: 4 (a) Is necessary because of an emergency as defined in NRS 5 353.263 or for the protection of life or property, the Governor shall 6 take reasonable and proper action to approve it and shall report the 7 action, and his or her reasons for determining that immediate action 8 was necessary, to the Interim Finance Committee at its first meeting 9 after the action is taken. Action by the Governor pursuant to this 10 paragraph constitutes approval of the revision, and other provisions 11 of this chapter requiring approval before encumbering money for the 12 revision do not apply. 13 (b) The Governor determines that the revision is necessary and 14 requires expeditious action, he or she may certify that the request 15 requires expeditious action by the Interim Finance Committee. 16 Whenever the Governor so certifies, the Interim Finance Committee 17 has 15 days after the request is submitted to its Secretary within 18 which to consider the revision. Any request for revision which is not 19 considered within the 15-day period shall be deemed approved. 20 (c) Does not qualify pursuant to paragraph (a) or (b), it must be 21 submitted to the Interim Finance Committee. The Interim Finance 22 Committee has 45 days after the request is submitted to its Secretary 23 within which to consider the revision. Any request which is not 24 considered within the 45-day period shall be deemed approved. 25 6. The Secretary shall place each request submitted pursuant to 26 paragraph (b) or (c) of subsection 5 on the agenda of the next 27 meeting of the Interim Finance Committee. 28 7. In acting upon a proposed revision of a work program, the 29 Interim Finance Committee shall consider, among other things: 30 (a) The need for the proposed revision; [and] 31 (b) The intent of the Legislature in approving the budget for the 32 present biennium and originally enacting the statutes which the 33 work program is designed to effectuate [.] ; and 34 (c) If the proposed revision relates to a health care issue that 35 disproportionately affects Black and Indigenous persons and other 36 persons of color, whether the revision is proposed in a manner 37 that distributes the money in direct proportion to the 38 disproportionate effect of that health care issue on each of those 39 groups. 40 8. The provisions of subsection 4 do not apply to any request 41 for the revision of a work program which is required: 42 (a) As a result of the acceptance of a gift or grant of property or 43 services pursuant to subsection 5 of NRS 353.335; or 44 – 17 – - *SB341* (b) To carry forward to a fiscal year, without a change in 1 purpose, the unexpended balance of any money authorized for 2 expenditure in the immediately preceding fiscal year. 3 Sec. 15. NRS 353.335 is hereby amended to read as follows: 4 353.335 1. Except as otherwise provided in subsections 5 and 5 6, a state agency may accept any gift or grant of property or services 6 from any source only if it is included in an act of the Legislature 7 authorizing expenditures of nonappropriated money or, when it is 8 not so included, if it is approved as provided in subsection 2. 9 2. If: 10 (a) Any proposed gift or grant is necessary because of an 11 emergency as defined in NRS 353.263 or for the protection or 12 preservation of life or property, the Governor shall take reasonable 13 and proper action to accept it and shall report the action and his or 14 her reasons for determining that immediate action was necessary to 15 the Interim Finance Committee at its first meeting after the action is 16 taken. Action by the Governor pursuant to this paragraph constitutes 17 acceptance of the gift or grant, and other provisions of this chapter 18 requiring approval before acceptance do not apply. 19 (b) The Governor determines that any proposed gift or grant 20 would be forfeited if the State failed to accept it before the 21 expiration of the period prescribed in paragraph (c), the Governor 22 may declare that the proposed acceptance requires expeditious 23 action by the Interim Finance Committee. Whenever the Governor 24 so declares, the Interim Finance Committee has 15 days after the 25 proposal is submitted to its Secretary within which to approve or 26 deny the acceptance. Any proposed acceptance which is not 27 considered within the 15-day period shall be deemed approved. 28 (c) The proposed acceptance of any gift or grant does not qualify 29 pursuant to paragraph (a) or (b), it must be submitted to the Interim 30 Finance Committee. The Interim Finance Committee has 45 days 31 after the proposal is submitted to its Secretary within which to 32 consider acceptance. Any proposed acceptance which is not 33 considered within the 45-day period shall be deemed approved. 34 3. The Secretary shall place each request submitted to the 35 Secretary pursuant to paragraph (b) or (c) of subsection 2 on the 36 agenda of the next meeting of the Interim Finance Committee. 37 4. In acting upon a proposed gift or grant, the Interim Finance 38 Committee shall consider, among other things: 39 (a) The need for the facility or service to be provided or 40 improved; 41 (b) Any present or future commitment required of the State; 42 (c) The extent of the program proposed; [and] 43 (d) The condition of the national economy, and any related fiscal 44 or monetary policies [.] ; and 45 – 18 – - *SB341* (e) If the proposed gift or grant is proposed to be used for a 1 health care issue that disproportionately affects Black and 2 Indigenous persons and other persons of color, whether the gift or 3 grant is proposed to be expended by the state agency in direct 4 proportion to the disproportionate effect of that health care issue 5 on each of those groups. 6 5. A state agency may accept: 7 (a) Gifts, including grants from nongovernmental sources, not 8 exceeding $20,000 each in value; and 9 (b) Governmental grants not exceeding $150,000 each in value, 10  if the gifts or grants are used for purposes which do not involve 11 the hiring of new employees and if the agency has the specific 12 approval of the Governor or, if the Governor delegates this power of 13 approval to the Chief of the Budget Division of the Office of 14 Finance, the specific approval of the Chief. 15 6. This section does not apply to: 16 (a) The Nevada System of Higher Education; 17 (b) The Department of Health and Human Services while acting 18 as the state health planning and development agency pursuant to 19 paragraph (d) of subsection 2 of NRS 439A.081 or for donations, 20 gifts or grants to be disbursed pursuant to NRS 433.395 or 435.490; 21 or 22 (c) Artifacts donated to the Department of Tourism and Cultural 23 Affairs. 24 Sec. 16. Chapter 422 of NRS is hereby amended by adding 25 thereto a new section to read as follows: 26 1. To the extent practicable, the Division shall require a 27 managed care organization, including, without limitation, a health 28 maintenance organization, that provides behavioral health 29 services to recipients of Medicaid under the State Plan for 30 Medicaid or the Children’s Health Insurance Program pursuant 31 to a contract with the Division to prepare and implement a plan to 32 ensure that such services are provided in a culturally competent 33 manner. 34 2. A plan to ensure that behavioral health services are 35 provided in a culturally competent manner must be approved by 36 the Division and must include, without limitation: 37 (a) Identification of disparities in the incidence of behavioral 38 health problems, access to or usage of behavioral health services 39 and in behavioral health outcomes based on race, color, ancestry, 40 national origin, disability, familial status, sex, sexual orientation, 41 gender identity or expression, immigration status, primary 42 language and income level, to the extent that data is available to 43 identify such disparities; 44 – 19 – - *SB341* (b) Strategies for reducing the disparities identified pursuant 1 to paragraph (a) and the rationale for each strategy; 2 (c) Mechanisms and goals to measure the effectiveness of the 3 strategies prescribed pursuant to paragraph (b) and, if applicable, 4 the degree to which the managed care organization has achieved 5 goals set forth in previous plans; 6 (d) Strategies for addressing trauma and providing services in 7 a trauma-informed manner; and 8 (e) Strategies for soliciting input from persons to whom the 9 managed care organization provides services and other interested 10 persons. 11 3. If the Division requires a managed care organization to 12 prepare and implement a plan to ensure that behavioral health 13 services are provided in a culturally competent manner, the 14 managed care organization must: 15 (a) Establish, through an open invitation, a committee of 16 interested persons for the purpose of conducting an ongoing 17 review of the plan. The committee must include, without 18 limitation, state and local government officers and employees, 19 consumers of behavioral health services, advocates for consumers 20 of behavioral health services, experts on reducing disparities in 21 behavioral health and providers of behavioral health services. 22 (b) Annually update the plan to reflect changes in the 23 population served by the managed care organization and submit 24 the updated plan to the Division for approval. 25 (c) Post the plan and each updated version of the plan on a 26 publicly available Internet website. 27 (d) Annually compile, submit to the Division and post publicly 28 on the Internet a report concerning the degree to which the 29 managed care organization has achieved or is progressing toward 30 achieving the goals set forth pursuant to paragraph (c) of 31 subsection 2. 32 (e) Every third year, submit the plan to the Division for 33 technical assistance and feedback concerning the implementation 34 of the plan. 35 4. A committee established pursuant to paragraph (a) of 36 subsection 3 must meet at least monthly. Such meetings: 37 (a) May be conducted remotely or in person; and 38 (b) Must be open to the public. 39 5. The Department and the Division shall provide a managed 40 care organization with any demographic information or technical 41 assistance necessary to carry out the requirements imposed 42 pursuant to this section. A managed care organization may solicit 43 any information necessary to carry out the requirements imposed 44 – 20 – - *SB341* pursuant to this section from persons who receive behavioral 1 health services from the plan. 2 6. As used in this section, “trauma-informed manner” means 3 a manner that: 4 (a) Is informed by knowledge of and responsiveness to the 5 effects of trauma; 6 (b) Emphasizes physical, psychological and emotional safety 7 for persons receiving services; and 8 (c) Creates opportunities for a person affected by trauma to 9 rebuild a sense of control and empowerment. 10 Sec. 17. Chapter 433 of NRS is hereby amended by adding 11 thereto a new section to read as follows: 12 1. The Division shall apply for grants available from any 13 source, including, without limitation, the Federal Government, to 14 support the provision of behavioral health services or other 15 services to promote emotional well-being in communities with 16 higher risk of behavioral health problems, decreased access to or 17 usage of behavioral health care services or worse behavioral 18 health outcomes or emotional well-being than the general 19 population based on race, color, ancestry, national origin, 20 disability, familial status, sex, sexual orientation, gender identity 21 or expression, immigration status, primary language or income 22 level. 23 2. To the extent authorized by the terms of a grant obtained 24 pursuant to subsection 1, the Division may: 25 (a) Use a competitive process to select and award a grant of 26 money to a nonprofit organization to serve as a lead partner to 27 ensure that services supported by a grant obtained pursuant to 28 subsection 1 are funded and allocated in an equitable manner. 29 The lead partner must: 30 (1) Be based in the community to which the services are to 31 be provided; and 32 (2) Have demonstrated experience serving that community. 33 (b) Establish and consult with an advisory committee to ensure 34 that services supported by a grant obtained pursuant to subsection 35 1 are provided in a culturally competent manner. The advisory 36 committee must be composed of representatives of nonprofit 37 organizations that have demonstrated experience serving the 38 community to which the services are to be provided. 39 3. On or before February 1 of each year, the Department 40 shall: 41 (a) Compile a report that includes, without limitation: 42 (1) The amount of money allocated by the Department 43 during the immediately preceding calendar year to support the 44 provision of behavioral health services or other services to 45 – 21 – - *SB341* promote emotional well-being in communities with higher risk of 1 behavioral health problems, decreased access to or usage of 2 behavioral health services or worse behavioral health outcomes or 3 emotional well-being than the general population based on race, 4 color, ancestry, national origin, disability, familial status, sex, 5 sexual orientation, gender identity or expression, immigration 6 status, primary language or income level; 7 (2) A description of the services described in subparagraph 8 (1) that were provided during the immediately preceding calendar 9 year and the efforts made by the Department during the 10 immediately preceding calendar year to locate persons in need of 11 such services and provide such services to those persons; 12 (3) The number of persons who received the services 13 described in subparagraph (1) and, to the extent available, 14 information regarding the income level, age, race and ethnicity of 15 those persons; and 16 (4) Any community-based organizations with which the 17 Department collaborated to provide those services; and 18 (b) Submit the report to the Director of the Legislative Counsel 19 Bureau for transmittal to: 20 (1) In even-numbered years, the Legislative Commission 21 and the Legislative Committee on Health Care; and 22 (2) In odd-numbered years, the next regular session of the 23 Legislature. 24 Sec. 18. Section 5 of this act is hereby amended to read as 25 follows: 26 Sec. 5. 1. The members of the Task Force shall meet 27 at the call of the Co-Chairs. The Task Force shall prescribe 28 regulations for its own management and government. 29 2. A majority of the members of the Task Force 30 constitutes a quorum, and a quorum may exercise all the 31 powers conferred on the Task Force. 32 3. The Task Force shall: 33 (a) Collaborate with interested persons and entities, 34 including, without limitation, governmental entities and 35 educational institutions, to examine, provide education 36 concerning and increase awareness of chronic kidney disease, 37 kidney transplant, donation of kidneys by living and deceased 38 donors and disparities among races in rates of kidney disease. 39 (b) Develop a sustainable plan to raise awareness 40 concerning early detection of kidney disease, promote kidney 41 transplant, increase equity in health care services and reduce 42 the frequency and severity of kidney disease in this State. The 43 plan must include, without limitation, ongoing workshops, 44 – 22 – - *SB341* seminars, research, preventive screenings, social media 1 campaigns and television and radio advertisements. 2 (c) Make recommendations concerning kidney health and 3 kidney disease to the Division, the Department, the 4 Legislature and other interested persons and entities. 5 [(d) On or before December 31 of each year, compile a 6 report concerning the activities of the Task Force and submit 7 the report to the Director of the Legislative Counsel Bureau 8 for transmittal to: 9 (1) In odd-numbered years, the Legislative Committee 10 on Health Care; and 11 (2) In even-numbered years, the next regular session 12 of the Legislature.] 13 Sec. 19. As soon as practicable after July 1, 2021: 14 1. The Majority Leader of the Senate shall appoint to the 15 Kidney Disease Prevention and Education Task Force the member 16 described in paragraph (a) of subsection 1 of section 4 of this act to 17 an initial term of 2 years. 18 2. The Speaker of the Assembly shall appoint to the Kidney 19 Disease Prevention and Education Task Force the member described 20 in paragraph (b) of subsection 1 of section 4 of this act to an initial 21 term of 2 years. 22 3. The Minority Leader of the Senate shall appoint to the 23 Kidney Disease Prevention and Education Task Force the member 24 described in paragraph (c) of subsection 1 of section 4 of this act to 25 an initial term of 2 years. 26 4. The Minority Leader of the Assembly shall appoint to the 27 Kidney Disease Prevention and Education Task Force the member 28 described in paragraph (d) of subsection 1 of section 4 of this act to 29 an initial term of 2 years. 30 5. The Governor shall appoint to the Kidney Disease 31 Prevention and Education Task Force the member described in 32 paragraph (e) of subsection 1 of section 4 of this act to an initial 33 term of 1 year. 34 6. The Co-Chairs of the Kidney Disease Prevention and 35 Education Task Force shall appoint to the Task Force the members 36 described in paragraphs (f) to (i), inclusive, and (l) of subsection 1 37 of section 4 of this act to initial terms of 1 year. 38 7. The National Kidney Foundation shall appoint to the Kidney 39 Disease Prevention and Education Task Force the member described 40 in paragraph (j) of subsection 1 of section 4 of this act to an initial 41 term of 2 years. 42 8. The American Kidney Fund shall appoint to the Kidney 43 Disease Prevention and Education Task Force the member described 44 – 23 – - *SB341* in paragraph (k) of subsection 1 of section 4 of this act to an initial 1 term of 2 years. 2 Sec. 20. The provisions of subsection 1 of NRS 218D.380 do 3 not apply to any provision of this act which adds or revises a 4 requirement to submit a report to the Legislature. 5 Sec. 21. 1. This section and sections 1 to 17, inclusive, 19 6 and 20 of this act become effective on July 1, 2021. 7 2. Section 18 of this act becomes effective on July 1, 2026. 8 H

- 81st Session (2021) Senate Bill No. 341–Senator Spearman CHAPTER.......... AN ACT relating to racial equity; authorizing the Division of Public and Behavioral Health of the Department of Health and Human Services to apply for grants to reduce disparities in health care and behavioral health and certain disparities relating to kidney disease; requiring the Legislative Auditor to include certain information relating to persons employed as a director or chief executive officer in a report of an audit, to the extent money is available; declaring the policy of this State concerning employee diversity for state employers; requiring public employers to provide racial equity training, to the extent money is available; requiring public officers and employees to complete any such training offered; creating the Minority Health and Equity Account to hold funding for the Office of Minority Health and Equity within the Department; authorizing the Office to enter into a joint partnership with a public or private entity; requiring a managed care plan that provides behavioral health services to recipients of Medicaid to prepare and implement a plan to ensure the delivery of such services in a culturally competent manner; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law authorizes the Department of Health and Human Services, through the Division of Public and Behavioral Health of the Department, to enter into contracts with various entities to carry out its duties relating to mental health and public health. (NRS 433.354, 439.155) Sections 2 and 17 of this bill authorize the Division to apply for available grants with the express purpose of addressing disparities in health care health outcomes, behavioral health care and behavioral health outcomes based on race, color, ancestry, national origin, disability, familial status, sex, sexual orientation, gender identity or expression, immigration status, primary language or income level. Sections 2 and 17 authorize the Division to use a competitive process to select and award a grant of money to a community-based nonprofit organization to serve as lead partner in ensuring that services funded by a grant obtained by the Division are funded and allocated in an equitable manner. Sections 2 and 17 additionally authorize the Division to establish and consult with an advisory committee to ensure that such services are provided in a culturally competent manner. Sections 2 and 17 require the Department to submit to the Legislature annually two reports concerning efforts to address disparities in health care and behavioral health, respectively, due to race, color, ancestry, national origin, disability, familial status, sex, sexual orientation, gender identity or expression, immigration status, primary language or income level. Section 2.5 of this bill authorizes the Division to apply for grants available to address disparities relating to kidney disease that are based on race. Section 2.5 authorizes the Division to establish and consult with an advisory committee consisting of certain persons interested in issues relating to kidney disease to establish a sustainable plan to increase education concerning and awareness of – 2 – - 81st Session (2021) kidney disease through which services funded by such a grant may be provided. Section 2.5 also requires the Department to submit to the Legislature an annual report concerning the status of grants applied for during the immediately preceding calendar year. Existing law requires the Legislative Auditor to conduct certain audits of accounts, funds and other records of agencies of the State to determine certain information. (NRS 218G.200) Section 7.2 of this bill requires a report of an audit conducted by the Legislative Auditor to include certain information relating to persons employed as a director or chief executive officer of the audited agency, to the extent money is available to do so. Section 7.6 of this bill: (1) declares the policy of the State that persons employed by the State must, to the extent practicable, reflect the age, gender, sexual, ethnic and geographic diversity of this State; and (2) requires each state agency to post the policy on its Internet website. Section 7.8 of this bill requires a public employer, to the extent that money is available, to provide training concerning diversity and racial equity to each public officer and employee. Section 7.8 also requires a public officer or employee to complete any such training. Existing law creates the Office of Minority Health and Equity within the Department of Health and Human Services to: (1) improve the quality of health care services for members of minority groups; (2) increase access to health care services for members of minority groups; (3) disseminate information to and educate the public on matters concerning health care issues of interest to members of minority groups; and (4) develop recommendations for changes in policy and advocate on behalf of minority groups. (NRS 232.474) Section 8 of this bill creates the Minority Health and Equity Account to hold money provided to the Office through appropriations, gifts, grants and donations. Section 8 provides that such money does not revert to the State General Fund. Section 10 of this bill makes a conforming change to indicate the placement of section 8 in the Nevada Revised Statutes. Section 11 of this bill authorizes the Office to enter into joint partnerships with public and private entities to carry out its purposes. Existing law requires the Department to administer Medicaid and the Children’s Health Insurance Program. (NRS 422.270) Section 16 of this bill requires the Division of Health Care Financing and Policy of the Department to require a managed care organization that provides behavioral health services to recipients of Medicaid or the Children’s Health Insurance Program to prepare and implement a plan to ensure that such services are provided in a culturally competent manner if such a requirement is practicable. If the Division imposes such a requirement, section 16 requires the managed care organization to establish a committee of interested persons to conduct an ongoing review of the plan. EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. WHEREAS, As stated by James Baldwin, “Not everything that is faced can be changed, but nothing can be changed until it is faced”; and WHEREAS, Systemic racism and structures of racial discrimination create generational poverty and perpetuate debilitating economic, educational and health hardships for persons – 3 – - 81st Session (2021) of color, causing the single most profound economic and social challenge facing Nevada; and WHEREAS, This economic and social challenge has been exacerbated by the COVID-19 pandemic; and WHEREAS, Nearly 49 percent of Nevada’s population is represented by persons of color, including persons who are Black, Indigenous, Hispanic, Asian or Pacific Islander and persons of more than one racial or ethnic background; and WHEREAS, Nevada is a growing and diverse state with continually shifting demographics; and WHEREAS, Racism has deep, harmful impacts and unfairly disadvantages Black and Indigenous persons and other persons of color (BIPOC) and has impeded solutions necessary to achieve racial parity; and WHEREAS, Providers of health care have long noted the existence of racial and ethnic disparities in our health care system, and these inequalities have led to a disproportionate negative impact on BIPOC communities during the COVID-19 pandemic; and WHEREAS, The chronic stress of racism affects the mental and physical health of the members of BIPOC communities and, in particular, affects the mental and physical health of Black Americans on a daily basis to a greater degree than other groups; and WHEREAS, During the 32nd Special Session of the Legislature, the Legislature adopted Senate Concurrent Resolution No. 1, which declared that systemic racism and structures of racial discrimination constitute a public health crisis; now, therefore, 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 thereto the provisions set forth as sections 2 to 5, inclusive, of this act. Sec. 2. 1. The Division may apply for grants available from the Federal Government and other sources which have the express purpose of addressing disparities in health care and health outcomes based on race, color, ancestry, national origin, disability, familial status, sex, sexual orientation, gender identity or expression, immigration status, primary language or income level. 2. To the extent authorized by the terms of a grant obtained pursuant to subsection 1, the Division may: – 4 – - 81st Session (2021) (a) Use a competitive process to select and award a grant of money to a nonprofit organization to serve as a lead partner to ensure that health care services supported by a grant obtained pursuant to subsection 1 are funded and allocated in an equitable manner. The lead partner must: (1) Be based in the community to which the health care services are to be provided; and (2) Have demonstrated experience serving that community. (b) Establish and consult with an advisory committee to ensure that health care services supported by a grant obtained pursuant to subsection 1 are provided in a culturally competent manner. The advisory committee must be composed of representatives of nonprofit organizations that have demonstrated experience serving the community to which the health care services are to be provided. 3. On or before February 1 of each year, the Department shall: (a) Compile a report that includes, without limitation: (1) The amount of money allocated by the Department during the immediately preceding calendar year to support the provision of health care services or other services to promote physical well-being in communities with higher risk of health problems, decreased access to or usage of health care services or worse health outcomes or physical well-being than the general population based on race, color, ancestry, national origin, disability, familial status, sex, sexual orientation, gender identity or expression, immigration status, primary language or income level; (2) A description of the services described in subparagraph (1) that were provided during the immediately preceding calendar year and the efforts made by the Department during the immediately preceding calendar year to locate persons in need of such services and provide such services to those persons; (3) The number of persons who received the services described in subparagraph (1) and, to the extent available, information regarding the income level, age, race and ethnicity of those persons; and (4) Any community-based organizations with which the Department collaborated to provide those services; and (b) Submit the report to the Director of the Legislative Counsel Bureau for transmittal to: (1) In even-numbered years, the Legislative Commission and the Legislative Committee on Health Care; and – 5 – - 81st Session (2021) (2) In odd-numbered years, the next regular session of the Legislature. Sec. 2.5. 1. The Division may apply for grants available from the Federal Government and other sources to support the identification, understanding and mitigation of health disparities relating to kidney disease that are based on race. Such disparities include, without limitation, disparities concerning: (a) Early detection, frequency and severity of kidney disease; and (b) Promotion of kidney transplantation. 2. The Division may establish and consult with an advisory committee to establish a sustainable plan to increase education concerning and awareness of kidney disease through which services supported by a grant obtained pursuant to subsection 1 may, to the extent applicable and authorized by the terms of the grant, be delivered. The advisory committee must be composed of representatives of providers of health care and medical facilities who provide care for kidney disease, patients with kidney disease, organ procurement organizations, national kidney organizations and any other members that the Division deems appropriate. 3. On or before February 1 of each year, the Department shall compile a report that includes, without limitation, the status of grants applied for during the immediately preceding calendar year pursuant to subsection 1 and submit the report to the Director of the Legislative Counsel Bureau for transmittal to: (a) In even-numbered years, the Legislative Commission and the Legislative Committee on Health Care; and (b) In odd-numbered years, the next regular session of the Legislature. 4. As used in this section: (a) “Medical facility” has the meaning ascribed to it in NRS 449.0151. (b) “Organ procurement organization” means a person designated by the Secretary of the United States Department of Health and Human Services as an organ procurement organization. (c) “Provider of health care” has the meaning ascribed to it in NRS 629.031. Secs. 3-7. (Deleted by amendment.) Sec. 7.2. Chapter 218G of NRS is hereby amended by adding thereto a new section to read as follows: The Legislative Auditor shall, to the extent money is available for this purpose, include in a report of an audit the number of – 6 – - 81st Session (2021) persons employed as a director or chief executive officer of the audited agency, and, if available, the number of such persons who self-identify as: 1. Women, without regard to designated sex at birth. 2. Black, African-American, Hispanic, Latino, Asian, Pacific Islander, Native American, Native Hawaiian, Native Alaskan, gay, lesbian, bisexual or transgender. Sec. 7.4. Chapter 281 of NRS is hereby amended by adding thereto the provisions set forth as sections 7.6 and 7.8 of this act. Sec. 7.6. 1. It is hereby declared to be the public policy of the State of Nevada that, except as otherwise required by law, persons employed by the State must, to the extent practicable, reflect the diversity of this State, including, without limitation, the age, gender, sexual, ethnic and geographic diversity of this State. 2. Each state agency shall post the policy set forth in subsection 1 on the Internet website maintained by the State agency. Sec. 7.8. 1. To the extent that money is available, a public employer shall provide training concerning diversity and racial equity to each of its officers and employees, which may include, without limitation, training regarding: (a) Implicit and unconscious bias; and (b) Undoing organizational, institutional, structural and systemic racism. 2. A public officer or employee shall complete any training provided pursuant to subsection 1. Sec. 8. Chapter 232 of NRS is hereby amended by adding thereto a new section to read as follows: 1. The Minority Health and Equity Account is hereby created in the State General Fund. The Account must be administered by the Manager. The Manager shall deposit in the Account: (a) Any legislative appropriations made to the Office; and (b) Any other money received by the Office pursuant to NRS 232.476. 2. The interest and income earned on: (a) The money in the Account, after deducting any applicable charges; and (b) Unexpended appropriations made to the Account from the State General Fund,  must be credited to the Account. 3. Any money in the Account and any unexpended appropriations made to the Account from the State General Fund remaining at the end of a fiscal year do not revert to the State – 7 – - 81st Session (2021) General Fund, and the balance in the Account must be carried forward to the next fiscal year. 4. The money in the Account must be expended to carry out the purposes of this section and NRS 232.467 to 232.484, inclusive. Sec. 9. 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 (5) The Administrator of the Division of Public and Behavioral Health. (b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section 16 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 established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C. §§ 15001 et seq. (d) Shall, after considering advice from agencies of local governments and nonprofit organizations which provide social services, adopt a master plan for the provision of human services in this State. The Director shall revise the plan biennially and deliver a copy of the plan to the Governor and the Legislature at the beginning of each regular session. The plan must: – 8 – - 81st Session (2021) (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 effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department. (e) May, by regulation, require nonprofit organizations and state and local governmental agencies to provide information regarding the programs of those organizations and agencies, excluding detailed information relating to their budgets and payrolls, which the Director deems necessary for the performance of the duties imposed upon him or her pursuant to this section. (f) Has such other powers and duties as are provided by law. 2. Notwithstanding any other provision of law, the Director, or the Director’s designee, is responsible for appointing and removing subordinate officers and employees of the Department. Sec. 10. NRS 232.467 is hereby amended to read as follows: 232.467 As used in NRS 232.467 to 232.484, inclusive, and section 8 of this act, unless the context otherwise requires, the words and terms defined in NRS 232.468 to 232.473, inclusive, have the meanings ascribed to them in those sections. Sec. 11. NRS 232.476 is hereby amended to read as follows: 232.476 The Office may: 1. Apply for any available grants and accept any available gifts, grants, appropriations or donations, and use any such gifts, grants, appropriations or donations to carry out its purposes; 2. Contract or enter into a partnership with a public or private entity to assist in carrying out its purposes; and 3. Adopt such regulations as are necessary to carry out the provisions of NRS 232.467 to 232.484, inclusive [.] , and section 8 of this act. Secs. 12-15. (Deleted by amendment.) – 9 – - 81st Session (2021) Sec. 16. Chapter 422 of NRS is hereby amended by adding thereto a new section to read as follows: 1. To the extent practicable, the Division shall require a managed care organization, including, without limitation, a health maintenance organization, that provides behavioral health services to recipients of Medicaid under the State Plan for Medicaid or the Children’s Health Insurance Program pursuant to a contract with the Division to prepare and implement a plan to ensure that such services are provided in a culturally competent manner. 2. A plan to ensure that behavioral health services are provided in a culturally competent manner must be approved by the Division and must include, without limitation: (a) Identification of disparities in the incidence of behavioral health problems, access to or usage of behavioral health services and in behavioral health outcomes based on race, color, ancestry, national origin, disability, familial status, sex, sexual orientation, gender identity or expression, immigration status, primary language and income level, to the extent that data is available to identify such disparities; (b) Strategies for reducing the disparities identified pursuant to paragraph (a) and the rationale for each strategy; (c) Mechanisms and goals to measure the effectiveness of the strategies prescribed pursuant to paragraph (b) and, if applicable, the degree to which the managed care organization has achieved goals set forth in previous plans; (d) Strategies for addressing trauma and providing services in a trauma-informed manner; and (e) Strategies for soliciting input from persons to whom the managed care organization provides services and other interested persons. 3. If the Division requires a managed care organization to prepare and implement a plan to ensure that behavioral health services are provided in a culturally competent manner, the managed care organization must: (a) Establish, through an open invitation, a committee of interested persons for the purpose of conducting an ongoing review of the plan. The committee must include, without limitation, state and local government officers and employees, consumers of behavioral health services, advocates for consumers of behavioral health services, experts on reducing disparities in behavioral health and providers of behavioral health services. – 10 – - 81st Session (2021) (b) Biennially update the plan to reflect changes in the population served by the managed care organization and submit the updated plan to the Division for approval and for technical assistance and feedback concerning the implementation of the plan. (c) Post the plan and each updated version of the plan on a publicly available Internet website. (d) Biennially compile, submit to the Division and post publicly on the Internet a report concerning the degree to which the managed care organization has achieved or is progressing toward achieving the goals set forth pursuant to paragraph (c) of subsection 2. 4. A committee established pursuant to paragraph (a) of subsection 3 must meet at least quarterly. Such meetings: (a) May be conducted remotely or in person; and (b) Must be open to the public. 5. The Department and the Division shall provide a managed care organization with any demographic information or technical assistance necessary to carry out the requirements imposed pursuant to this section. A managed care organization may solicit any information necessary to carry out the requirements imposed pursuant to this section from persons who receive behavioral health services from the plan. 6. As used in this section, “trauma-informed manner” means a manner that: (a) Is informed by knowledge of and responsiveness to the effects of trauma; (b) Emphasizes physical, psychological and emotional safety for persons receiving services; and (c) Creates opportunities for a person affected by trauma to rebuild a sense of control and empowerment. Sec. 17. Chapter 433 of NRS is hereby amended by adding thereto a new section to read as follows: 1. The Division may apply for grants available from the Federal Government and other sources which have the express purpose of addressing disparities in behavioral health care and behavioral health outcomes based on race, color, ancestry, national origin, disability, familial status, sex, sexual orientation, gender identity or expression, immigration status, primary language or income level. 2. To the extent authorized by the terms of a grant obtained pursuant to subsection 1, the Division may: – 11 – - 81st Session (2021) (a) Use a competitive process to select and award a grant of money to a nonprofit organization to serve as a lead partner to ensure that services supported by a grant obtained pursuant to subsection 1 are funded and allocated in an equitable manner. The lead partner must: (1) Be based in the community to which the services are to be provided; and (2) Have demonstrated experience serving that community. (b) Establish and consult with an advisory committee to ensure that services supported by a grant obtained pursuant to subsection 1 are provided in a culturally competent manner. The advisory committee must be composed of representatives of nonprofit organizations that have demonstrated experience serving the community to which the services are to be provided. 3. On or before February 1 of each year, the Department shall: (a) Compile a report that includes, without limitation: (1) The amount of money allocated by the Department during the immediately preceding calendar year to support the provision of behavioral health services or other services to promote emotional well-being in communities with higher risk of behavioral health problems, decreased access to or usage of behavioral health services or worse behavioral health outcomes or emotional well-being than the general population based on race, color, ancestry, national origin, disability, familial status, sex, sexual orientation, gender identity or expression, immigration status, primary language or income level; (2) A description of the services described in subparagraph (1) that were provided during the immediately preceding calendar year and the efforts made by the Department during the immediately preceding calendar year to locate persons in need of such services and provide such services to those persons; (3) The number of persons who received the services described in subparagraph (1) and, to the extent available, information regarding the income level, age, race and ethnicity of those persons; and (4) Any community-based organizations with which the Department collaborated to provide those services; and (b) Submit the report to the Director of the Legislative Counsel Bureau for transmittal to: (1) In even-numbered years, the Legislative Commission and the Legislative Committee on Health Care; and – 12 – - 81st Session (2021) (2) In odd-numbered years, the next regular session of the Legislature. Secs. 18-19. (Deleted by amendment.) Sec. 20. The provisions of subsection 1 of NRS 218D.380 do not apply to any provision of this act which adds or revises a requirement to submit a report to the Legislature. Sec. 21. 1. This section and sections 1 to 17, inclusive, 19 and 20 of this act become effective on July 1, 2021. 2. Section 18 of this act becomes effective on July 1, 2026. 20 ~~~~~ 21