[Rev. 8/24/2006 5:21:35 PM]
CHAPTER 449 - MEDICAL AND OTHER RELATED FACILITIES
GENERAL PROVISIONS
449.002 Definitions.
449.0022 “Administrator” defined.
449.0024 “Affiliated facility” defined.
449.0026 “Agent” defined.
449.0028 “Bureau” defined.
449.0029 “Centers for Medicare and Medicaid Services” defined.
449.003 “Deficiency” defined.
449.0031 “Division of Welfare and Supportive Services” defined.
449.0032 “Emergency” defined.
449.0034 “Facility” defined.
449.0038 “Health Division” defined.
449.0042 “Holiday” defined.
449.0043 “Home for individual residential care” defined.
449.0044 “Immediate and serious threat” and “immediate jeopardy” defined.
449.0046 “Incident” defined.
449.0048 “License” defined.
449.005 “Licensee” defined.
449.0052 “Medicaid” defined.
449.0054 “Medicare” defined.
449.0056 “Party” defined.
449.0058 “Person” defined.
449.006 “Recipient” defined.
449.0061 “Referral agency” defined.
449.0062 “Resident” defined.
449.0064 “Residential facility” defined.
449.0066 “Sanction” defined.
449.0068 “Services” defined.
449.007 “Survey” defined.
449.0072 “Treatment” defined.
449.008 Computation of time.
449.010 Severability.
449.0105 Adoption of certain publications by reference; revision of publication after adoption.
GENERAL REQUIREMENTS FOR LICENSURE
449.011 Application for license.
449.0112 Investigation; prelicensure survey; inspection for fire safety.
449.0114 Display of license; compliance with law; transfer of real property; change in administrator, ownership, location or services.
449.0115 Review of building plans for new construction or remodeling by certain applicants: Required documents; payment of fees and costs.
449.01153 Approval of building plans for construction or remodeling of certain facilities: Period of validity.
449.01156 On-site advisory inspection of facility: Written request; action by Health Division; fee.
449.0116 Renewal of license: Application; validity of existing license pending decision on application; inspection of facility; untimely filing or failure to file application.
449.0118 Denial, suspension or revocation of license: Grounds.
449.0119 Denial, suspension or revocation of license: Appeals.
FEES
449.012 Definitions.
449.0121 “Ambulatory surgical center” defined.
449.01215 “Branch office” defined.
449.01219 “Community triage center” defined.
449.01225 “Facility for hospice care” defined.
449.01227 “Facility for refractive surgery” defined.
449.01228 “Facility for transitional living for released offenders” defined.
449.01229 “Facility for treatment with narcotics” defined.
449.0123 “Home health agency” defined.
449.01235 “Home office” defined.
449.0124 “Hospice care” defined.
449.01245 “Intermediate care facility for the mentally retarded or persons with developmental disabilities” defined.
449.0125 “Medication unit” defined.
449.01252 “Mobile unit” defined.
449.01255 “Nursing pool” defined.
449.0126 “Rural clinic” defined.
449.01265 “Rural hospital” defined.
449.0127 “Subunit agency” defined.
449.013 License and renewal fees to operate ambulatory surgical center, facility for treatment of irreversible renal disease, home office, subunit agency or branch office of home health agency, rural clinic, obstetric center, program of hospice care, independent center for emergency medical care, nursing pool, facility for treatment with narcotics, medication unit, referral agency, halfway house for recovering alcohol and drug abusers, facility for refractive surgery, mobile unit and facility for transitional living for released offenders; expiration of application for license; refund of certain fees.
449.016 License and renewal fees to operate skilled nursing facility, hospital, rural hospital, intermediate care facilities, residential facility for groups, facility for treatment of abuse of alcohol or drugs, facility for hospice care, home for individual residential care, facility for modified medical detoxification and community triage center; expiration of application for license.
449.0164 Fees for renewal of licenses for certain facilities: Payment in two equal installments.
449.0168 Fees for modification of certain licenses.
PROVISION OF HOSPICE CARE
General Provisions
449.017 Definitions.
449.0171 “Bereavement services” defined.
449.0172 “Facility for hospice care” defined.
449.0173 “Governing body” defined.
449.0175 “Hospice care” defined.
449.0176 “Medical director” defined.
449.01765 “Palliative services” defined.
449.0177 “Patient” defined.
449.0178 “Terminally ill” defined.
Licensing
449.0181 Compliance with regulations required for license to operate facility for hospice care.
449.0183 Report of change in ownership, address or staff of program of hospice care.
Administration
449.0184 Governing body required; duties of governing body and administrator.
Medical Services
449.0185 Requirements for program of hospice care.
449.0186 Requirements for plan of care.
449.0187 Requirements for operation of facility for hospice care.
449.0188 Continuity of service to patients required.
FACILITIES FOR TREATMENT OF ABUSE OF ALCOHOL OR DRUGS
General Provisions
449.019 Definitions.
449.022 “Administrator” defined.
449.025 “Alcohol and drug abuse treatment” defined.
449.030 “Case management services” defined.
449.031 “Client” defined.
449.034 “Detoxification” defined.
449.043 “Facility” defined.
449.044 “Facility for modified medical detoxification” defined.
449.046 “Governing body” defined.
449.060 “Medically managed intensive detoxification program” defined.
449.064 “Overall program” defined.
449.068 “Qualified social worker” defined.
449.069 “Residential program” defined.
449.072 “Social model detoxification program” defined.
Licensing
449.079 Denial, revocation or suspension of license if facility not certified by Health Division; appeal.
449.081 New construction or remodeling: Submission and approval of building plans; prerequisites to approval of licensing.
Administration and Personnel
449.085 Governing body; bylaws.
449.088 Policies and procedures.
449.091 Transfer of client to another facility.
449.094 Money of clients.
449.098 Preparations for disasters; reporting of fire or disaster.
449.102 Inventory and return of client’s belongings.
449.105 Insurance.
449.108 General requirements for programs.
449.111 Administrator: Duties.
449.114 Employees: General requirements.
449.117 Employees: Proof of compliance with provisions concerning tuberculosis.
Social Model Detoxification Programs
449.121 Certain facilities authorized to offer program.
449.1214 General requirements.
449.1218 Program of ongoing quality improvement.
Operation of Facility
449.123 General sanitary requirements.
449.126 Laundry requirements.
449.129 Design, construction, equipment and maintenance.
449.132 Accommodations for clients.
449.135 Safety from fire.
449.141 Health services.
449.144 Medication.
449.147 Dietary services.
449.150 Records of clients.
449.153 Discrimination prohibited.
FACILITIES FOR MODIFIED MEDICAL DETOXIFICATION
449.15311 Definitions.
449.15313 “Administrator” defined.
449.15315 “Client” defined.
449.15317 “Facility” defined.
449.15319 “Overall program” defined.
449.15321 “Program” defined.
449.15323 Proof of certification required; revocation of license.
449.15325 Governing body; bylaws and policies.
449.15327 Policies and procedures for services and operation of facility.
449.15329 Transfer of client.
449.15331 Handling of money of client.
449.15333 Inventory of belongings of client.
449.15335 Liability insurance.
449.15337 Program: Requirements; review.
449.15339 Responsibilities and duties of administrator.
449.15341 Policies and procedures concerning employees.
449.15343 Nursing services.
449.15345 Health services.
449.15347 Pharmaceutical services.
449.15349 Medication and biologicals.
449.15351 Dietary services.
449.15353 Records of clients.
449.15355 Safety and sanitation; temperature.
449.15357 Laundry requirements.
449.15359 New construction or remodeling: Submission and approval of building plans; prerequisites to approval of facility for licensure.
449.15361 Design, construction, equipment and maintenance.
449.15363 Accommodations for clients.
449.15365 Safety from fire.
449.15367 Preparations for disasters; reporting of fire or disaster.
449.15369 Discrimination prohibited.
FACILITIES FOR TREATMENT WITH NARCOTICS; MEDICATION UNITS
General Provisions
449.154 Definitions.
449.15415 “DEA” defined.
449.1542 “Facility for treatment with narcotics” defined.
449.1543 “Medical director” defined.
449.15435 “Medication unit” defined.
449.15438 “SAMHSA” defined.
449.1544 Health Division is state authority for certain federal regulations.
Licensing
449.15445 License and federal certification required to operate facility or unit.
449.1545 Filing requirements; recommendation for certification.
449.15455 Investigation and prelicensure survey.
449.1547 Suspension, revocation or cancellation of license; provisional license; denial of application.
Operation
449.1548 General operational requirements.
449.15485 Continuing review of operations; investigation of complaints.
HALFWAY HOUSES FOR RECOVERING ALCOHOL AND DRUG ABUSERS
449.1549 Definitions.
449.154901 “Administrator” defined.
449.154903 “Client” defined.
449.154905 “Facility” defined.
449.15491 Administrator: Qualifications.
449.154911 Administrator: General duties.
449.154913 General operational guidelines.
449.154915 Policies and procedures: Establishment; maintenance of manual.
449.154917 Limitation on admissions.
449.154919 Health and sanitation.
449.154921 Laundry facilities.
449.154923 Kitchens; storage of food.
449.154925 Bedrooms; bedding.
449.154927 Use of certain areas as bedroom prohibited.
449.154929 Bathrooms and toilet facilities; toilet articles.
449.154931 Accommodations for residents with restricted mobility.
449.154933 First aid.
449.154935 Medication.
449.154937 Telephones; telephone number.
449.154939 Notification to Bureau under certain circumstances.
449.154941 Rights of clients.
449.154943 Client files: Maintenance; contents; confidentiality.
449.154945 Safety from fire.
FACILITIES FOR TRANSITIONAL LIVING FOR RELEASED OFFENDERS
General Provisions
449.154951 Definitions.
449.154953 “Administrator” defined.
449.154955 “Facility” defined.
449.154957 “Resident” defined.
449.154959 “Supportive services” defined.
Administration
449.154961 Administrator: Qualifications.
449.154963 Administrator: General duties.
449.154965 Operation of facility.
449.154967 Policies and procedures.
449.154969 Preparations for disasters and other emergencies.
Operation
449.154971 Limitation on number of admissions.
449.154973 Prerequisites to provision of particular services.
449.154975 Sanitation, safety and comfort.
449.154977 Laundry facilities.
449.154979 Kitchens; preparation and storage of food.
449.154981 Bedrooms and bedding.
449.154983 Use of certain areas as bedroom prohibited.
449.154985 Bathrooms and toilet facilities; toiletries.
449.154987 First aid.
449.154989 Medication.
449.154991 Telephones.
449.154993 Notification of occurrence of certain incidents.
449.154995 Rights of residents.
449.154997 Files for residents.
449.154999 Safety from fire.
HOMES FOR INDIVIDUAL RESIDENTIAL CARE
449.15511 Definitions.
449.15513 “Caregiver” defined.
449.15515 “Director” defined.
449.15517 “Home” defined.
449.15519 “Protective supervision” defined.
449.15521 Director: Qualifications.
449.15523 Director: Duties.
449.15525 Requirements for safety and sanitation of facility.
449.15527 Agreement between operator of home and resident concerning rates; maintenance of records of residents.
449.15529 On-site survey of home by Bureau.
RESIDENTIAL FACILITIES FOR GROUPS
General Provisions
449.156 Definitions.
449.1565 “Administer” defined.
449.157 “Administrator” defined.
449.1575 “Board” defined.
449.1585 “Caregiver” defined.
449.1591 “Category 1 resident” defined.
449.1595 “Category 2 resident” defined.
449.1597 “Dietary supplement” defined.
449.1599 “Discharge” defined.
449.160 “Division” defined.
449.161 “Grade” defined.
449.164 “Hospice care” defined.
449.169 “Medical professional” defined.
449.170 “Placard” defined.
449.172 “Residential facility” defined.
449.173 “Residential facility which provides care to persons with Alzheimer’s disease” defined.
449.175 “Severity and scope score” defined.
449.176 “Staff of a facility” defined.
449.178 “Transfer” defined.
Licensing
449.179 Submission and approval of plan for new construction or remodeling; inspection; evidence of compliance.
449.180 Requirements for purchasing licensed facility.
449.190 License: Contents; validity; transferability; issuance of more than one type.
Administration and Personnel
449.194 Responsibilities of administrator.
449.196 Qualifications and training of caregivers.
449.197 Medical services may be provided only by medical professional.
449.199 Staffing requirements; limitation on number of residents; written schedule for each shift; direct supervision of certain employees.
449.200 Personnel files.
449.202 Rights of staff members during investigation of facility; duties of investigator.
General Operational Requirements
449.204 System of financial accounting; insurance.
449.205 Advertising and promotional materials.
449.208 Restrictions on conducting other businesses or providing other services on premises.
449.209 Health and sanitation.
449.211 Automatic sprinkler systems.
449.213 Laundry and linen services.
449.216 Common areas; dining rooms.
449.217 Kitchens; storage of food; adequate supplies of food; permits; inspections.
449.2175 Service of food; seating; menus; special diets; nutritional requirements; dietary consultants.
449.218 Bedrooms: Floor space; windows and doors; privacy; storage space; bedding; personal furnishings; lighting.
449.220 Bedroom doors.
449.221 Use of certain areas in facility as bedroom prohibited.
449.222 Bathrooms and toilet facilities; toilet articles.
449.224 Housing for staff members.
449.226 Safety requirements for residents with restricted mobility or poor eyesight; water hazards; auditory systems for bathrooms and bedrooms; access by vehicles.
449.227 Accommodations for residents with restricted mobility.
449.229 Requirements and precautions regarding safety from fire.
449.231 First aid and cardiopulmonary resuscitation.
449.232 Telephone; list of telephone numbers.
449.241 Limitations on use of volunteers; requirements concerning residents who volunteer to assist staff or perform other duties.
449.258 Written policies for facility; policy on visiting hours; residents’ mail; compliance with policies.
449.259 Supervision and treatment of residents generally.
449.260 Activities for residents.
449.262 Provision of dental, optical and hearing care and social services; report of suspected abuse, neglect, isolation or exploitation; restrictions on use of restraints, confinement or sedatives.
449.267 Money and property of residents.
449.268 Rights of residents; procedure for filing grievance, complaint or report of incident; investigation and response.
449.269 Discrimination prohibited.
Admitting, Transferring and Discharging Residents
449.2702 Written policy on admissions; eligibility for residency.
449.2704 Disclosure of information concerning rates and payment for services.
449.2706 Transfer of resident whose condition deteriorates.
449.2707 Transfer of resident: Effective date.
449.2708 Discharge of resident; notice of discharge; issuance of notice to quit to resident for improper or harmful behavior.
Restrictions on Admitting or Retaining Residents With Certain Medical Needs or Conditions
449.271 Residents requiring gastrostomy care or suffering from staphylococcus infection or other serious infection or medical condition.
449.2712 Residents requiring use of oxygen.
449.2714 Residents requiring use of intermittent positive pressure breathing equipment.
449.2716 Residents having colostomy or ileostomy.
449.2718 Residents requiring manual removal of fecal impactions or use of enemas or suppositories.
449.272 Residents requiring use of indwelling catheter.
449.2722 Residents having unmanageable condition of bowel or bladder incontinence; residents having manageable condition of bowel or bladder incontinence.
449.2724 Residents having contractures.
449.2726 Residents having diabetes.
449.2728 Residents requiring regular intramuscular, subcutaneous or intradermal injections.
449.2732 Residents requiring protective supervision.
449.2734 Residents having tracheostomy or open wound requiring treatment by medical professional; residents having pressure or stasis ulcers.
449.2736 Procedure to exempt certain residents from restrictions.
449.2738 Review of medical condition of resident; relocation or transfer of resident having certain medical needs or conditions.
Medical Services, Medical Records and Other Records Concerning Residents
449.274 Medical care of resident after illness, injury or accident; periodic physical examination of resident; rejection of medical care by resident; written records.
449.2742 Administration of medication: Responsibilities of administrator, caregiver and employee of facility.
449.2744 Administration of medication: Maintenance and contents of logs and records.
449.2746 Administration of medication: Restrictions concerning medication taken as needed by resident; written records.
449.2748 Medication: Storage; duties upon discharge, transfer and return of resident.
449.2749 Maintenance and contents of separate file for each resident; confidentiality of information.
449.275 Residents receiving hospice care: Responsibilities of staff; retention of resident with special medical needs.
449.2751 Provision of assisted living services: Prerequisites and requirements.
Special Types of Facilities
449.2754 Residential facility which provides care to persons with Alzheimer’s disease: General requirements.
449.2756 Residential facility which provides care to persons with Alzheimer’s disease: Standards for safety; personnel required; training for employees.
449.2758 Residential facility for elderly or disabled persons: Training for caregivers.
449.2762 Residential facility for mentally retarded adults: Training for caregivers; program to modify behavior of resident.
449.2764 Residential facility for persons with mental illnesses: Training for employees.
449.2766 Residential facility for persons with chronic illnesses: Training for employees.
449.2768 Residential facility which provides care to persons with dementia: Training for employees.
Deficiencies
449.27702 Determination of severity and scope of deficiency; assignment of grade.
449.27704 Placard: Issuance and display; failure to comply.
449.27706 Resurvey: Application and fee; failure to comply.
BUSINESSES THAT PROVIDE REFERRALS TO RESIDENTIAL FACILITIES FOR GROUPS
449.27811 Definitions.
449.27813 “Client” defined.
449.27817 “Financial assessment” defined.
449.27819 “Needs assessment” defined.
449.27821 “Residential facility for groups” defined.
449.27823 License not required by certain persons to make referrals; application for licensure.
449.27827 Requirements for employees.
449.27829 Responsibilities of referral agency.
449.27831 Contract for services; fees; maintenance of client records.
HOSPITALS
General Provisions
449.279 Definitions.
449.285 “General hospital” defined.
449.286 “Governing body” defined.
449.287 “Hospital” defined.
449.289 “Inpatient” defined.
449.297 “Outpatient” defined.
449.298 “Outpatient department” defined.
449.299 “Patient” defined.
449.300 “Restraint” defined.
Licensing and Administration
449.307 Applicability of license; coverage against certain liabilities.
449.310 Limitation on number of patients; annual on-site inspection not required under certain circumstances.
449.312 Change in ownership, use or construction; correction of deficiencies.
449.313 Responsibilities and duties of governing body; bylaws; appointment and duties of chief executive officer; protocol for organ donations; annual operating budget.
449.314 Quality of care; scope of services.
449.3152 Quality improvement program.
449.3154 Construction, remodeling, maintenance and change of use: General requirements; prerequisites to approval of licensure.
449.3156 Compliance with certain guidelines for design and construction; correction of deficiencies.
Policies and Procedures for Operation of Hospital
449.316 Physical environment: Safety and well-being of patients; plan for emergency preparedness; safety management.
449.317 Risk management.
449.319 Requirements for personal needs of patients.
449.322 Housekeeping and laundry services.
449.325 Prevention, control and investigation of infections and communicable diseases.
449.327 Preparation, sterilization, storage and distribution of sterile supplies and medical and surgical equipment.
449.329 Admission of patients.
449.331 Emergency services and medical care; transfer agreements.
449.332 Discharge planning.
449.337 Dietary services: General requirements.
449.338 Dietary services: Provision for needs of patients; facilities; standards; permits; records.
449.3385 Dietary services: Personnel.
449.339 Dietary services: Nutritional status of patients.
449.3395 Dietary services: Sanitary conditions; supplies.
449.340 Pharmaceutical services.
449.343 Orders for medication and biologicals.
449.344 Administration of medication; security.
449.346 Rehabilitative services.
449.349 Emergency services.
449.352 Social services.
449.355 Discrimination prohibited.
449.358 Medical staff.
449.361 Nursing services.
449.3622 Appropriate care of patients.
449.3624 Assessment of patients.
449.3626 Rights of patients.
449.3628 Protection of patients; use of physical restraints.
449.363 Personnel policies concerning employment, licensing and certification.
449.364 Obstetrical services: Administration; staffing and equipment.
449.3645 Obstetrical services: Labor rooms; delivery rooms; utility rooms; area for cleaning instruments.
449.365 Obstetrical services: Required services.
449.3655 Obstetrical services: Transfer or discharge of patient.
449.367 Obstetrical services: Nurseries.
449.370 Outpatient services.
449.371 Intensive care services.
449.373 Laboratory services; pathology services; blood and blood products.
449.3735 Transfusions of blood.
449.374 Nuclear medicine services.
449.375 Records for nuclear medicine services; authorization.
449.376 Radiological services.
449.377 Radiological therapeutic services.
449.379 Medical records.
449.382 Medical library.
449.385 Surgical services.
449.388 Anesthesia services.
449.389 Respiratory care services.
449.391 Dental services.
449.394 Psychiatric services.
FACILITIES FOR CARE OF ADULTS DURING THE DAY
General Provisions
449.4061 Definitions.
Licensing
449.4063 Design, construction, equipment and maintenance of facility: General requirements; prerequisites to approval for licensure.
449.4065 Consultation with representative of Division; notice of nonconformity.
449.4067 Operation in combination with other medical facility or facility for the dependent.
449.4069 Insurance.
Operation of Facility
449.407 Advertising and promotional materials.
449.4071 Policies and procedures; accounting.
449.4072 Director and employees: Qualifications and duties; physical and mental health.
449.40723 Supervision of clients; volunteers.
449.40725 Orientation and training of employees and volunteers.
449.4073 Files concerning employees.
449.4074 Requirements of facility; health and sanitation; medications; exits.
449.4075 Preparations for fires and other emergencies; reporting of fire or disaster.
449.4076 First aid.
449.4077 Policy for admissions; retention of signed copy.
449.4078 Requirements for admission; designation of physician.
449.4079 Required services.
449.408 Housekeeping and maintenance.
449.4081 Administration of medication; accidents or illnesses.
449.4082 Service of food; dietary consultants.
449.4083 Discrimination prohibited.
449.40833 Summary of client’s care; referrals.
449.40835 Records.
Medical and Ancillary Services
449.4084 Contract for provision by another person.
449.4085 Provision by facility authorized.
449.4086 Evaluation of programs and policies.
449.4087 Written assessments of clients.
449.4088 Plan of care; periodic assessment.
449.4089 Menus.
FACILITIES FOR REFRACTIVE SURGERY
449.450 “Facility” defined.
449.4502 Applicability of provisions.
449.4504 Administrator: Appointment; duties; qualifications.
449.4505 Administrator of facility that performs intraocular lens implants: Duties.
449.4506 Staffing requirements; personnel files.
449.4508 Maintenance of patient records.
449.451 Written policies and procedures.
449.4512 Program of quality improvement.
449.4514 Rights of patients; informed consent.
449.4516 Equipment and supplies.
449.4518 Liability for use of leased equipment.
449.4522 Sanitation and hygiene; space and storage.
449.4524 Medical care of patients.
449.4526 Application for indemnification for certain damages; claims against surety bond or substitute thereof.
FACILITIES FOR TREATMENT OF IRREVERSIBLE RENAL DISEASE
General Provisions
449.501 Definitions.
449.502 “Advanced practitioner of nursing” defined.
449.504 “Charge nurse” defined.
449.5045 “Competency” defined.
449.505 “Dialysis” defined.
449.5053 “Dialysis technician” defined.
449.5055 “Direct supervision” defined.
449.5065 “End-stage renal disease” defined.
449.507 “Facility” defined.
449.508 “Hemodialysis” defined.
449.510 “Immediate supervision” defined.
449.511 “Intermediate level disinfection” defined.
449.513 “Licensed practical nurse” defined.
449.516 “Product water” defined.
449.517 “Supervision” defined.
449.519 “Training” defined.
Construction; Health and Safety
449.520 New construction or remodeling: Notification; increase in number of stations for which facility is licensed.
449.5205 New construction or remodeling: Submission of plans and specifications; minor changes; inspection.
449.522 Construction, space and design; physical environment; restrictions for treatment of patients with hepatitis B.
449.5225 Safety and comfort of patients during construction; imposition of more stringent design and space requirements.
449.523 Safety requirements.
449.5235 Maintenance and repair of equipment.
449.525 Water treatment system: General requirements.
449.5255 Water treatment system: Chemical testing of product water; records.
449.526 Water treatment system: Microbiological testing of product water.
449.5265 Reuse of hemodialyzer; transport of used dialyzer.
449.528 Adoption of more stringent requirements for treatment of water and reuse of hemodialyzers.
449.5285 Sanitation: Precautions regarding blood and bodily fluids.
449.529 Sanitation: Control of infections; nonsmoking policy.
449.5295 Sanitation: Provision of sanitary environment; walls, floors and ceilings; blood spills.
449.531 Sanitation: Disinfection of dialysis machines; culturing dialysate; cleaning of machines and equipment; handling of waste.
449.5315 Hepatitis B: Vaccinations for certain staff members; postvaccination screening; adoption of related provisions.
449.532 Hepatitis B: Vaccinations for certain patients.
449.5325 Hepatitis B surface antigen: Screening of patients; additional serologic screening.
449.534 Hepatitis B surface antigen: Treatment of patients who test positive.
449.5345 Tuberculosis: Screening of staff and patients.
Provision of Services
449.540 Program of quality assurance; recordation of accidents and incidents; reporting of certain events.
449.5405 Rights of patients.
449.541 Interdisciplinary teams; plans for care of patients.
449.5415 Preparations for emergencies and disasters.
449.543 Pharmaceutical services.
449.5435 Nursing services; physicians and other staff.
449.544 Nutrition services.
449.5445 Social services.
449.546 Patient care: Advanced practitioners of nursing and physician assistants; medical emergencies.
449.5465 Patient care: Licensed practical nurses and dialysis technicians.
449.547 Self-dialysis: Provision of training and certain services.
449.5475 Continuous ambulatory peritoneal dialysis.
449.549 Continuous cycling peritoneal dialysis.
449.5495 Patient services by contract; laboratory.
Administration and Personnel
449.550 Governing body.
449.5505 Medical director.
449.552 Physicians.
449.5525 Orientation program for new employees; continuing education.
449.553 Medical staff: Generally.
449.5535 Nurses.
449.555 Dietitians.
449.5555 Social workers.
449.556 Staff responsible for operating water treatment system.
449.5565 Staff that repairs or maintains equipment used to provide care to patients.
Clinical Records
449.558 Preparation and maintenance.
449.5585 Additional requirements.
449.559 Medical history and physical examination.
449.5595 Transient patients.
449.561 Discharge or transfer of patients; removal of records.
449.5615 Cessation of operation of facility.
Dialysis Technicians
449.570 General qualifications; identification to be worn during training; provision of care; requirements to act as preceptor.
449.5705 Qualification of technician determined to be qualified before July 1, 2001.
449.571 Program of training: Curriculum; duties of instructor; written examinations.
449.5715 Program of training: Qualifications of instructors.
449.573 Program of training: Certain persons authorized to provide instruction and serve as preceptor.
449.5735 Program of training: Required hours.
449.574 Committee to review program of training.
449.5745 Written list concerning knowledge and skills.
449.576 Peritoneal dialysis: Additional activities required.
449.5765 Cannulation or administration of normal saline or heparin: Additional activities required.
449.577 Cannulation or administration of normal saline, heparin or lidocaine: Verification and documentation of competency required.
449.5775 Documentation of successful completion of program of training; employment by another facility.
449.579 Patient care: Technicians must demonstrate certain knowledge and competency.
449.5795 Prohibited acts.
PROVISION OF CERTAIN SPECIAL SERVICES
Obstetric Care
449.6113 Definitions.
449.61132 Authorized obstetric care.
449.61134 Eligible maternal patients.
449.61138 Denial of application for or renewal of license; revocation or suspension of license.
449.6114 Design, construction, equipment and maintenance of obstetric center: General requirements; prerequisites to approval for licensure.
449.61142 Required facilities and services.
449.61144 Required emergency electrical power.
449.61146 Requirements for birth room, toilet and bathing facilities, hallways and doors, water supply and office-based facilities.
449.61148 Governing body of obstetric center; duties.
449.6115 Physician operator or advanced practitioner of nursing operator as licensee.
449.61152 Designation and responsibilities of medical director; privileges of members of medical staff; provision of consultation services with specialists.
449.61154 Medical records: Maintenance; access.
449.61156 Medical records: Contents.
449.61158 Program for review of quality of care.
449.6116 Miscellaneous requirements concerning staff, provision of service and equipment.
449.61162 Requirements for transfer or discharge of patient.
449.61164 Written protocol for discharge of patient.
449.61166 Policies and procedures for control of infectious agents and diseases; program to monitor health of employees.
449.61168 Laboratory services; transfer of maternal patient who needs blood or blood products.
449.6117 Possession, distribution, administration and storage of drugs and controlled substances.
449.61172 Anesthesia.
449.61174 Transfer of patient to hospital or medical facility licensed to provide high-risk perinatal care.
449.61176 Death of patient; notification of Health Division; provision of counseling.
449.61178 Required information to be provided or made available to patient; complaints.
Open-Heart Surgery
449.612 Definitions.
449.612011 “Approval” defined.
449.612012 “Approved hospital” defined.
449.612014 “Cardiac surgery” defined.
449.612017 “Open-heart surgery” defined.
449.61202 Prerequisites to initial provision of service.
449.61204 Form and contents of application for approval to provide service.
449.61206 Notification of applicant upon review of application; site inspection required.
449.61208 Composition and duties of site inspection team.
449.6121 Hospital to pay costs of inspection.
449.61212 Approval or denial of application; period of validity of approval; cessation of performance of surgeries.
449.61214 Amount of surgery required following approval.
449.61216 Provision of patient with preoperative instruction.
449.61218 Surgical team: Composition; privileges and qualifications of members; participation of qualified nurses.
449.6122 Qualifications of anesthesiologist.
449.61222 Qualifications of nurse in charge of service.
449.61224 Perfusion team: Use required; qualifications; approval of members by surgeon of record.
449.61226 Operating rooms: General requirements.
449.61228 Operating rooms: Equipment and staff.
449.6123 Intensive care facility: General requirements.
449.61232 Intensive care facility: Staff.
449.61234 Intensive care facility: Equipment and supplies.
449.61236 Orientation and continuing education of personnel.
449.61238 Maintenance of blood bank.
449.6124 Maintenance of cardiac catheterization laboratory.
449.61242 Maintenance of medical laboratory.
449.61244 Maintenance of facilities to perform contrast studies and equipment to review films of operations.
449.61246 Maintenance of registry to record results for each patient.
449.61248 Maintenance of program to follow recovery of patient.
449.6125 Annual review and inspection of hospital.
449.61252 Annual inspection of hospital: Assessment of rate of mortality.
449.61254 Further review or on-site inspection for failure to comply with provisions or for excessive rate of mortality; notice; plan for compliance.
449.61256 Denial, suspension or revocation of approval: Grounds; hearing.
Transplantation of Organs
449.6126 Definitions.
449.61262 Application for approval to provide services.
449.61264 Evaluation of application for approval.
449.61266 Duties of hospital providing services.
449.61268 Revocation of approval.
449.6127 Notice of intent to deny application or revoke approval; hearing.
INDEPENDENT CENTERS FOR EMERGENCY MEDICAL CARE
Licensing
449.61302 Limitations on issuance of license.
449.61306 Denial of application for license or renewal of license.
449.61308 Compliance with regulations; ground for suspension or revocation of license.
Administration and Personnel
449.6132 Requirement of governing body; adoption of written rules.
449.61322 Exception to requirements of governing body.
449.61324 Standards of care; policy for authentication.
449.61326 Program to review quality of care; contents of program.
449.61328 Integration into local emergency medical system.
449.6133 Appointment and responsibilities of administrator.
449.61332 Employment and duties of medical director.
449.61334 Standards and procedures for selection, treatment and retention of medical staff and members of allied health professions.
449.61336 Rules for organization of medical staff.
449.61338 Employment and duties of chief nurse; size of on-duty nursing staff; limitation on scope of practice by person who is not registered nurse; oversight of nursing staff.
Facilities
449.6135 Design, construction, equipment and maintenance: General requirements; prerequisites to approval for licensure.
449.61352 Contents of center: Emergency entrance; reception and waiting areas; treatment and examination rooms; space for storage and maintenance of medical records and supplies.
449.61354 Contents of treatment rooms; accessibility to person in wheelchair.
Medical Services and Medical Records
449.6137 Requirement for minimum level of care in certain situations.
449.61372 Criteria for denial of care, transfer or discharge of patient; compliance with state and federal laws.
449.61374 Laboratory services and reports; procedures for storage and administration of tissue specimens, blood and blood products; agreements with outside blood banks; review of blood transfusions and reactions.
449.61376 Program for control of infection.
449.61378 Radiological services: Availability; interpretation and reporting of films; storage and retention.
449.6138 Distribution and administration of drugs and controlled substances.
449.61382 Medical records: Maintenance; access; authorized release; completion after discharge.
449.61384 Contents of medical records.
INTERMEDIATE CARE FACILITIES
General Provisions
449.614 Definitions.
449.617 “Administrator” defined.
449.620 “Developmentally disabled person” defined.
449.623 “Facility” defined.
449.629 “Intermediate care facility as a distinct part of a health and care facility furnishing more than one level of care” defined.
449.632 “Intermediate care facility for the mentally retarded or persons with developmental disabilities” defined.
449.635 “Licensee” defined.
449.638 “Long-term care facility” defined.
449.641 “Mentally retarded person” defined.
449.644 “Mixed facility” defined.
449.647 “New facility” defined.
449.650 “Nursing home” defined.
449.653 “Patient in an intermediate care facility I” defined.
449.656 “Patient in an intermediate care facility II” defined.
449.659 “Resident” defined.
Licensing
449.668 Provisional licenses.
Administration and Personnel
449.671 Financing; liability insurance.
449.674 Administrator: Qualifications.
449.677 Employees: General requirements.
449.680 Employees: Health; physical examinations.
449.681 Employees of facility which provides care to persons with dementia: Continuing education.
Construction and Operation: Generally
449.685 Design, construction, equipment and maintenance: General requirements; prerequisites to approval of facility for licensure.
449.692 Sanitary requirements.
449.695 Laundry requirements.
449.698 Fire inspections; hazardous conditions; operation of other business.
449.701 Preparations for emergencies; reporting of fire or disaster.
449.704 Written policies and procedures for facility; admission agreements; transfer agreements.
449.707 Money of residents.
449.710 Inventory of residents’ belongings.
449.713 Program requirements.
449.716 Dietary services.
449.719 Health services.
449.722 Pharmaceutical services.
449.725 Records.
449.728 Supervision by physician; volunteers; advertising.
449.731 Discrimination prohibited.
Construction and Operation: Facilities for Mentally Retarded or Persons With Developmental Disabilities
449.732 Definitions.
449.7322 “Facility” defined.
449.7324 “New facility” defined.
449.7326 Standards for construction, remodeling or change in use of facility; fire alarms; emergency radio system; submission and approval of building plans.
449.7328 Elevators
449.733 Electrical systems.
449.7332 Mechanical systems.
449.7334 Doors, windows, ceilings, walls and floors.
449.7336 Entrances and lobbies; miscellaneous space.
449.7338 Dining and storage space.
449.7342 Facilities for employees and volunteers.
449.7344 Areas for engineering and maintenance.
449.7346 Janitors’ closets.
449.7348 Linen service.
449.735 Area for medical records.
449.7352 Nursing units.
449.7354 Service areas.
449.7356 Processing of waste.
449.736 Personnel.
449.737 Plan of care.
449.740 Corporal punishment; restraints.
449.743 Records.
COMMUNITY TRIAGE CENTERS
449.74311 Definitions.
449.74313 “Administrator” defined.
449.74315 “Facility” defined.
449.74317 “Governing body” defined.
449.74319 “Mentally ill person” defined.
449.74321 “Patient” defined.
449.74323 “Program” defined.
449.74325 “Psychologist” defined.
449.74327 Governing body; bylaws and policies.
449.74329 Policies and procedures for services and operation of facility.
449.74331 Transfer of patient.
449.74333 Handling of money of patient.
449.74335 Inventory of belongings of patient.
449.74337 Liability insurance.
449.74339 General requirements for programs and services.
449.74341 Responsibilities and duties of administrator.
449.74343 Policies and procedures concerning employees.
449.74345 Nursing services.
449.74347 Health services.
449.74349 Mental health services.
449.74351 Pharmaceutical services.
449.74353 Medication and biologicals.
449.74355 Records of patients.
449.74357 Laundry requirements.
449.74359 Dietary services.
449.74361 New construction or remodeling: Submission and approval of building plans; prerequisites to approval of facility for licensure.
449.74363 Design, construction, equipment and maintenance of facility.
449.74365 Entrances, lobbies and offices; storage space.
449.74367 Patients’ rooms; toilet and bathing facilities.
449.74369 Service areas; miscellaneous requirements.
449.74371 Safety and sanitation.
449.74373 Preparations for disasters; reporting of fire or disaster.
449.74375 Discrimination prohibited.
FACILITIES FOR SKILLED NURSING
General Provisions
449.744 “Facility for skilled nursing” defined.
Licensing and Administration of Facility
449.74411 Applicability of license; limitation on number of patients; coverage against certain liabilities.
449.74413 Change in ownership, use or construction of facility.
449.74415 Responsibilities of governing body.
449.74417 Administrator of facility.
449.74419 Committee for quality assurance.
449.74421 Procedures for emergency or disaster.
Admission, Transfer and Discharge of Patient
449.74423 Certain conditions for admission prohibited.
449.74425 Admission of patient with mental illness or mental retardation.
449.74427 Agreement with hospital for transfer of patients.
449.74429 Transfer or discharge of patient.
449.74431 Summary of discharge.
Assessment of Patients and Plan of Care
449.74433 Comprehensive assessment of needs of patient.
449.74435 Quarterly assessment of patient.
449.74437 Conduct of assessments.
449.74439 Comprehensive plan of care.
Medical Records
449.74441 Maintenance.
449.74443 Inspection.
Rights of Patients
449.74445 Generally.
449.74447 Communications with other persons; examination of records by advocate.
449.74449 Notice to patients of rights, services and charges.
449.74451 Charges to be consistent with notice of charges.
449.74453 Notice to patients of programs available for assistance in payment of services.
449.74455 Discrimination prohibited.
449.74457 Policies and procedures for advance directives by patient; information to be furnished regarding physicians.
449.74459 Examination by patient of survey of facility and plan of correction.
449.74461 Finances of patient: System for maintenance and accounting.
449.74463 Finances of patient: Authorization to withhold money.
449.74465 Sending and receiving mail.
449.74467 Performance of services for facility by patient.
Quality of Care
449.74469 Standards of care.
449.74471 Administration of drugs.
449.74473 Program for control of infections.
449.74475 Vision and hearing.
449.74477 Pressure sores.
449.74479 Urinary problems.
449.74481 Range of motion.
449.74483 Mental or psychosocial behavior.
449.74485 Nasogastric tubes.
449.74487 Nutritional health; hydration.
449.74489 Physical or chemical restraint of patients.
449.74491 Prohibition of certain practices regarding patients; investigation of certain violations and injuries to patients; unfit employees.
449.74493 Notification of changes or condition of patient.
449.74495 Development of program of activities.
449.74497 Daily activities of patient.
449.74499 Participation in activities.
Staff and Attending Physicians
449.74511 Personnel policies; personnel records.
449.74513 Medical director.
449.74515 Physicians.
449.74517 Nursing staff.
449.74519 Nursing assistants and nursing assistant trainees.
449.74521 Other health care professionals.
449.74522 Employees of facility which provides care to persons with dementia.
Provision of Services
449.74523 Social services.
449.74525 Dietary services.
449.74527 Specialized rehabilitative services.
449.74529 Dental services.
449.74531 Pharmaceutical services.
449.74533 Laboratory services.
449.74535 Radiological and other diagnostic services.
449.74537 Special services.
Physical Environment
449.74539 General requirements.
449.74543 Design, construction, equipment and maintenance: General requirements; prerequisites to approval of facility for licensure.
449.74549 Patients’ rooms.
NURSING POOLS
General Provisions
449.747 Definitions.
Licensing
449.7471 License required.
449.7473 Location to which license applies; persons named in license; restrictions on use of license.
449.7474 Duties of licensee or applicant for license.
Administration and Personnel
449.7475 Administrator: Qualifications and duties.
449.7476 Director of professional services: Qualifications and duties.
449.7477 Personnel policies: Maintenance and availability.
449.7478 Requirements for contracts to provide nursing services.
449.7479 Referral of patients when services not available; provision of services; bonding of staff.
449.748 Duties of registered nurse; provision of nursing care by practical nurse or nursing assistant.
449.7481 Annual evaluation of nursing pool by licensee.
HOME HEALTH AGENCIES
General Provisions
449.749 Definitions.
Licensing and Inspection
449.752 License required.
449.758 Applicability of license; coverage against certain liabilities.
449.761 Periodic inspections.
449.767 Action to enjoin operation without license.
449.768 Applicant or licensee to maintain home office in Nevada.
Administration and Personnel
449.770 Governing body; bylaws.
449.773 Administrator: Qualifications; duties.
449.776 Director of professional services.
449.779 Professional advisory group.
449.782 Personnel policies.
449.785 Contracts for home health services.
449.787 Duty to provide skilled nursing care and home health aide services; inclusion of additional services.
449.788 Services to patients.
449.791 Duties of personnel.
449.793 Evaluation by governing body; periodic review of contracts, operations, policies and procedures.
Medical Services and Medical Records
449.794 Clinical records: General requirements.
449.797 Contents of clinical records.
449.800 Medical orders.
FINANCIAL REPORTING
449.951 Definitions.
449.953 Annual fee for insurers: Amount; notice; administrative fine for failure to pay.
449.957 Hospitals to file certain reports; certification; exception; extension.
449.960 Hospitals to submit quarterly financial and utilization report; certification; extension.
449.962 Facility for intermediate care or facility for skilled nursing to submit quarterly financial and utilization report; certification; extension.
449.9625 Institution to submit quarterly financial and utilization report; certification; extension; exception.
449.963 Information concerning discharged patients: Submission; limitation on disclosure.
449.966 Notice of insufficiency of submitted information.
449.969 Administrative fine for failing to meet deadlines.
MOBILE UNITS
449.970 Definitions.
449.9701 “Independent facility” defined.
449.97012 “Mobile unit” defined.
449.97014 “Parent facility” defined.
449.97016 “Service site” defined.
449.97018 “Staging area” defined.
449.9702 Applicability of provisions.
449.97022 Licensure.
449.97024 Application for licensure.
449.97026 Design, construction, equipment, maintenance and parking.
449.97028 Staging areas; disposal of biohazards and waste.
449.9703 Compliance with certain statutes and regulations.
449.97032 Compliance with regulations relating to evaluation of quality of services.
449.97034 Written policies for operation of unit; agreement with hospital or medical facility for transfer of patients during emergencies.
449.97036 Rights of patients.
449.97038 Maintenance of schedule and records; supplies and equipment; diagnostic radiological services; laboratory services.
449.9704 Occupancy; fire safety; exits; use and maintenance of equipment; telecommunications device.
449.97042 Restrictions on operation; office of independent facility; operation pursuant to contract.
SURGICAL CENTERS FOR AMBULATORY PATIENTS
General Provisions
449.971 Definitions.
449.9715 “Allied health profession” defined.
449.972 “Ambulatory surgical center” defined.
449.9725 “Division” defined.
449.973 “Governing body” defined.
449.9735 “Licensee” defined.
449.974 “Patient” defined.
449.9741 “Physician” defined.
449.9742 “Registered nurse” defined.
449.9743 “Surgery” defined.
Licensing
449.9745 Compliance with requirements by accreditation.
449.9755 Investigation of applicant and inspection of center.
449.978 Effect of expiration of license.
449.9785 Conformance with regulations required.
Administration
449.979 Governing body required.
449.9795 Duties of governing body.
449.980 Responsibilities of governing body.
449.9801 Procedures for granting privileges to members of medical staff.
449.9805 Establishment of policy for authentication.
449.981 Appointment and responsibilities of administrator.
449.9812 Program for quality assurance.
449.9813 Committee for quality assurance.
449.9815 Maintenance.
449.982 Sanitation and housekeeping.
449.983 Protection from fire and other disasters.
449.9835 Exemption from requirements for governing body and administrator.
449.9837 Restrictions on operation of ambulatory surgical center; maintenance of records.
449.9843 Compliance with certain standards, laws, ordinances and codes; submission and approval of building plans; prerequisites to approval of center for licensure.
Personnel
449.9855 Policies and requirements for personnel.
449.9865 Medical staff.
449.988 Nursing staff.
Medical Records, Services and Facilities
449.9885 Medical records: Maintenance.
449.989 Medical records: Contents.
449.9895 Sterilization.
449.990 Medication and treatment.
449.9902 Emergency equipment and supplies required.
449.9905 Pharmacist required; records, storage and administration of drugs.
449.991 Laboratory services.
449.992 Pathological services.
449.9925 Procurement, storage and transfusion of blood.
449.993 Diagnostic radiological services.
449.9935 Operating and recovery rooms; endoscopy suite.
449.9937 Extended recovery units.
449.994 Records required before surgery; report of surgery.
449.9945 Administration and record of anesthesia.
449.9955 Informing patient of rights, services and cost.
449.996 Transfer of patients.
449.9965 Prohibited locations for construction of center.
449.997 Conversion of hazardous building into center prohibited.
RECEIVERS
449.9981 List of interested and qualified persons.
449.99811 Experience.
449.99812 Authority.
449.99813 Compensation and payment of bond.
449.99814 Operation of facility.
ADMINISTRATIVE SANCTIONS
General Provisions
449.9982 Definitions.
449.99821 “Ban on admissions” defined.
449.99822 “Cluster” defined.
449.99823 “Compliance” and “substantially correct the deficiency” defined.
449.99824 “Costs” defined.
449.99825 “De minimis deficiency” defined.
449.998253 “Division of Health Care Financing and Policy” defined.
449.998255 “Facility” defined.
449.99826 “Immediate family” defined.
449.99827 “Initial deficiency” defined.
449.99828 “Major deficiency” defined.
449.99829 “Medicaid facility” defined.
449.9983 “Medicare facility” defined.
449.99832 “Monitor” defined.
449.99833 “New admission” defined.
449.99834 “Particular kinds of care, treatment or services” defined.
449.99835 “Plan of correction” defined.
449.99836 “Provider agreement” defined.
449.99837 “Repeated deficiency” defined.
449.99838 “Resurvey” defined.
449.99839 “Severity and scope score” defined.
449.9984 “Subsequent deficiency” defined.
449.99841 “Temporary management” defined.
449.99843 Purposes of administrative sanctions.
449.99844 Interpretation of provisions in accordance with federal standards.
Imposition: Generally
449.9985 Authority of Health Division and Bureau.
449.99851 Requirement for imposition; optional imposition.
449.99852 Requirement for imposition; multiple sanctions.
449.99853 Imposition of one or more sanctions; criteria for imposition of particular sanction.
449.99854 Imposition in lieu of or in addition to recommendation to terminate provider agreement; duration of sanctions.
449.99855 Imposition in emergencies: Authority; notice.
449.99856 Deficiencies: Basis for imposition of sanctions; reporting; presumption of de minimis deficiency.
449.99857 Classifications of severity and scope of deficiencies: Use.
449.99858 Scope of violations: Evaluation of representative sample of recipients; size of sample.
449.99859 Scope of deficiencies: Use of scope scale; basis for assessment.
449.9986 Scope of deficiencies: Criteria for evaluation.
449.99861 Severity of deficiencies: Use of severity scale; basis for assessment; criteria for evaluation.
449.99862 Presumption when same deficiency found on resurvey; imposition of sanction for subsequent deficiency.
449.99863 Available sanctions.
449.99864 Determination of appropriate sanction: Procedure.
449.99865 Determination of appropriate sanction: Initial assessment.
449.99866 Determination of appropriate sanction: Consideration of secondary factors.
449.99867 Determination of appropriate sanction: Basis for selection; presumption.
Plan of Correction
449.9987 Development and submission of plan; authority of Bureau when plan is not acceptable; effect of failure to submit plan.
Limitation on Occupancy of Residential Facility
449.99875 Purpose and scope of limitation; imposition in addition to partial ban on admissions.
449.99876 Criteria for imposition.
449.99877 Duration and termination of limitation.
449.99878 Notice of limitation: General requirements; effect of noncompliance.
Ban on Admissions
449.9988 Purpose and scope of ban.
449.99881 Criteria for imposition.
449.99882 Duration and termination of ban.
449.99883 Notice of ban: General requirements; effect of noncompliance.
Monitoring of Facility
449.99885 Authority of Bureau.
Monetary Penalties
449.99895 Imposition by Bureau; purpose; applicable criteria.
449.99896 Criteria for imposition; imposition of initial and daily penalties.
449.99897 Imposition of initial penalty pending hearing or appeal; stay of payment of penalties pending appeal.
449.99898 Procedure for imposition; interest on total penalty assessed.
449.99899 Determination of amount of penalties.
449.999 Limitation on principal amount of total daily penalty.
449.99901 Daily penalty: Computation according to number of recipients.
449.99902 Increase in penalty for repeated deficiencies or false compliance.
449.99903 Presumption regarding deficiencies identified on resurvey.
449.99904 Reduction of penalty.
449.99905 Daily penalty: Effective beginning date.
449.99906 Daily penalty: Date and period of computation; notice to facility.
449.99907 Termination of daily penalties; failure of Medicaid facility to remove immediate and serious threat after appointment of temporary management.
449.99908 Time for payment of penalties.
449.99909 Assessment of interest on unpaid balance of penalty.
449.9991 Recovery of costs for collection of penalty.
449.99911 Failure to pay penalty: Suspension of license of facility.
449.99912 Disposition of money collected.
Temporary Management
449.99915 Appointment of temporary manager when there is immediate and serious threat: Notice; effect of failure to accept manager and to remove threat.
449.99916 Appointment of temporary manager when there is no immediate and serious threat: Notice.
449.99917 Temporary manager: Qualifications.
449.99918 Temporary manager: Authority.
449.99919 Effect of failure to agree to appointment of or to relinquish authority to temporary manager.
449.9992 Events requiring termination of management; initiation of judicial proceedings.
449.99921 Payment of costs and expenses.
Closure of Facility and Transfer of Residents
449.99925 Authority of Bureau.
449.99926 Requirements for notification.
449.99927 Appointment of temporary manager.
449.99928 Bureau to supervise or appoint temporary manager to supervise transfer; imposition of other appropriate sanctions.
449.99929 Determination of appropriate placement of residents.
449.9993 Rights of appeal for transferred residents.
Facilities Participating in Medicaid
449.99935 Authorized recommendations in addition to available sanctions.
449.99936 Withholding of monetary penalties from payments owed to facility.
449.99937 Denial of payments for new admissions generally.
449.99938 Denial of payments for new admissions who have certain specified diagnoses or special care needs.
449.99939 Suspension of payments for services furnished to Medicaid recipient on or after date of deficiency.
GENERAL PROVISIONS
NAC 449.002 Definitions. (NRS 449.037, 449.249) As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 449.0022 to 449.0072, inclusive, have the meanings ascribed to them in those sections.
(Added to NAC by Bd. of Health, eff. 8-1-91; A by R131-99 & R132-99, 11-29-99; R051-02, 7-24-2002)
NAC 449.0022 “Administrator” defined. (NRS 449.037) “Administrator” means the person responsible for the day-to-day management of a facility.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0024 “Affiliated facility” defined. (NRS 449.037) “Affiliated facility” means a facility that owns, directly or indirectly, an equity interest of 5 percent or more in the capital, the stock, the profits or the assets of another facility or is, as a subcontractor, agent or otherwise, responsible for the management or control of that facility.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0026 “Agent” defined. (NRS 449.037) “Agent” means a person having actual or apparent authority to act on behalf of a licensee.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0028 “Bureau” defined. (NRS 449.037) “Bureau” means the Bureau of Licensure and Certification of the Health Division.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0029 “Centers for Medicare and Medicaid Services” defined. (NRS 449.037) “Centers for Medicare and Medicaid Services” means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.
(Added to NAC by Bd. of Health by R051-02, eff. 7-24-2002)
NAC 449.003 “Deficiency” defined. (NRS 449.037)
1. “Deficiency” means noncompliance with any federal or state statute or of the rules or regulations of the Health Division or the Centers for Medicare and Medicaid Services or conditions and standards of or requirements for participation in the Medicare or Medicaid program pertaining to a facility.
2. The term includes an incident concerning a facility where there are no extenuating circumstances or where the facility has made an inappropriate response to a complaint, including the failure to:
(a) Prevent an incident from occurring, if the incident could have been avoided;
(b) Identify an incident;
(c) Take action to correct an incident before the identification of the incident by the Bureau; or
(d) Implement a contingency plan if permanent action to correct an incident has not been undertaken.
3. In determining whether an incident is a deficiency, the right of the recipient to refuse treatment, where applicable, shall be deemed an extenuating circumstance.
(Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02, 7-24-2002)
NAC 449.0031 “Division of Welfare and Supportive Services” defined. (NRS 449.037) “Division of Welfare and Supportive Services” means the Division of Welfare and Supportive Services of the Department of Health and Human Services.
(Added to NAC by Bd. of Health, eff. 8-1-91)—(Substituted in revision for NAC 449.0074)
NAC 449.0032 “Emergency” defined. (NRS 449.037) “Emergency” means a major deficiency that places one or more recipients in immediate jeopardy. The term includes, without limitation, any fire, flood, contagious infection, loss of utilities or inappropriate transfer of residents.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0034 “Facility” defined. (NRS 449.037, 449.249) “Facility” means a medical facility, facility for the dependent, home for individual residential care or referral agency.
(Added to NAC by Bd. of Health, eff. 8-1-91; A by R131-99 & R132-99, 11-29-99)
NAC 449.0038 “Health Division” defined. (NRS 449.037) “Health Division” means the Health Division of the Department of Health and Human Services.
(Added to NAC by Bd. of Health, eff. 8-1-91; A by R094-06 & R098-06, 7-14-2006)
NAC 449.0042 “Holiday” defined. (NRS 449.037) “Holiday” means a day on which the offices of State Government are closed.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0043 “Home for individual residential care” defined. (NRS 449.249) “Home for individual residential care” has the meaning ascribed to it in NRS 449.0105.
(Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)
NAC 449.0044 “Immediate and serious threat” and “immediate jeopardy” defined. (NRS 449.037) “Immediate and serious threat” or “immediate jeopardy” means a situation in which corrective action within 48 hours is necessary because the failure by a facility to comply with a requirement for licensure, certification or participation in Medicare or Medicaid has caused, or if uncorrected is likely to cause, serious injury or harm, or even death, to a recipient.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0046 “Incident” defined. (NRS 449.037) “Incident” means an action, practice or situation that appears to be inconsistent with a federal or state statute, rule or regulation of the Health Division or the Centers for Medicare and Medicaid Services or conditions and standards of or requirement for participation in Medicare or Medicaid.
(Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02, 7-24-2002)
NAC 449.0048 “License” defined. (NRS 449.037) “License” means all or part of any permit, certificate, approval, registration, charter or similar grant of permission to operate issued to a facility by the Health Division.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.005 “Licensee” defined. (NRS 449.037) “Licensee” means any person, corporation, partnership, voluntary association or other public or private entity, including any governmental body, licensed to operate a facility.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0052 “Medicaid” defined. (NRS 449.037) “Medicaid” means the program established pursuant to Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., to provide assistance for part or all of the cost of medical care rendered on behalf of indigent persons.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0054 “Medicare” defined. (NRS 449.037) “Medicare” means the program of health insurance for aged and disabled persons established pursuant to Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0056 “Party” defined. (NRS 449.037) “Party” means each person or agency as defined in NRS 233B.035.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0058 “Person” defined. (NRS 449.037) “Person” means a natural person, trust, estate, partnership, corporation, professional association, governmental body or any other entity, public or private.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.006 “Recipient” defined. (NRS 449.037) “Recipient” means a person receiving care, services or treatment from a facility.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0061 “Referral agency” defined. (NRS 449.0305, 449.037) “Referral agency” means a business that provides referrals to residential facilities for groups which is subject to regulation pursuant to NRS 449.0305, including, without limitation, any business entity that engages in the process of referring clients for compensation to residential facilities for groups.
(Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)
NAC 449.0062 “Resident” defined. (NRS 449.037) “Resident” means a person who resides in a residential facility.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0064 “Residential facility” defined. (NRS 449.037) “Residential facility” means a facility operated 24 hours per day in which one or more persons receiving care, treatment or services ordinarily remain for 24 hours a day.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0066 “Sanction” defined. (NRS 449.037) “Sanction” means a corrective measure or penalty that is imposed by the Bureau upon a facility.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.0068 “Services” defined. (NRS 449.037) “Services” means medical or personal care, including necessary preparation of food, laundry and housekeeping in the case of a residential facility and items such as medical diagnosis and treatment, drugs and biologicals, supplies, appliances, equipment, medical-social services and use of a facility.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.007 “Survey” defined. (NRS 449.037)
1. “Survey” means a regularly scheduled inspection of a facility conducted by employees of the Bureau to verify the facility’s compliance with the regulations of the Health Division, the Centers for Medicare and Medicaid Services, eligibility for participation in the Medicare or Medicaid programs and eligibility for licensure.
2. The term includes a follow-up inspection to recertify a facility or evaluate compliance with a plan of correction or an inspection made in response to a complaint.
(Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02, 7-24-2002)
NAC 449.0072 “Treatment” defined. (NRS 449.037) “Treatment” means any medication, drug, test or procedure conducted or administered to diagnose or remedy a physical or mental illness or condition.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.008 Computation of time. (NRS 449.037) For the purposes of any computation of time required by this chapter:
1. Any prescribed period of more than 5 days includes Saturdays, Sundays and holidays.
2. Any prescribed period of 5 days or less does not include Saturdays, Sundays or holidays.
3. If the date on which any action required to be performed falls on a Saturday, Sunday or holiday, the time is extended until the next day that is not a Saturday, Sunday or holiday.
4. The day of any act or event or on which notice is received is not included in the computation.
(Added to NAC by Bd. of Health, eff. 8-1-91)
NAC 449.010 Severability. (NRS 449.037) If any of the provisions of this chapter or any application thereof to any person, thing or circumstance is held invalid, it is intended that such invalidity not affect the remaining provisions, or their application, that can be given effect without the invalid provision or application.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 17, eff. 3-27-76]
NAC 449.0105 Adoption of certain publications by reference; revision of publication after adoption. (NRS 449.037)
1. The State Board of Health hereby adopts by reference:
(a) NFPA 101: Life Safety Code, in the form most recently published by the National Fire Protection Association, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the code may be obtained from the National Fire Protection Association at 11 Tracy Drive, Avon, Massachusetts 02322, at the Internet address http://www.nfpa.org or by telephone at (800) 344-3555, for the price of $55.80 for members or $62 for nonmembers, plus $7.95 for shipping and handling.
(b) NFPA 99: Standard for Health Care Facilities, in the form most recently published by the National Fire Protection Association, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the standard may be obtained from the National Fire Protection Association at 11 Tracy Drive, Avon, Massachusetts 02322, at the Internet address http://www.nfpa.org or by telephone at (800) 344-3555, for the price of $41.63 for members or $46.25 for nonmembers, plus $7.95 for shipping and handling.
(c) Guidelines for Design and Construction of Hospital and Health Care Facilities, in the form most recently published by the American Institute of Architects, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the guidelines may be obtained from the American Institute of Architects at the AIA Store, 1735 New York Avenue, NW, Washington, D.C. 20006-5292, at the Internet address http://www.aia.org or by telephone at (800) 242-3837, for the price of $52.50 for members or $75 for nonmembers, plus $9 for shipping and handling.
2. The State Board of Health will review each revision of the publications adopted by reference pursuant to subsection 1 to ensure its suitability for this State. If the Board determines that a revision is not suitable for this State, the Board will hold a public hearing to review its determination within 6 months after the date of the publication of the revision and give notice of that hearing. If, after the hearing, the Board does not revise its determination, the Board will give notice within 30 days after the hearing that the revision is not suitable for this State. If the Board does not give such notice, the revision becomes part of the publication adopted by reference pursuant to subsection 1.
(Added to NAC by Bd. of Health by R066-04, R067-04, R068-04, R069-04, R073-04, R076-04 & R077-04, eff. 8-4-2004)
GENERAL REQUIREMENTS FOR LICENSURE
NAC 449.011 Application for license. (NRS 449.037, 449.040) An application for a license that is filed with the Health Division pursuant to NRS 449.040:
1. Must be complete and notarized.
2. In accordance with NRS 449.050, must be accompanied by the appropriate application fee specified in this chapter.
3. In establishing that the applicant is of reputable and responsible character as required by NRS 449.040, must include personal references and information concerning the applicant’s financial status and business activities and associations in and out of this State during the immediately preceding 3-year period. If the applicant is a firm, association, organization, partnership, business trust, corporation or company, such references and information must be provided with respect to the members thereof and the person in charge of the facility or program for which application is made.
4. In addition to the information required by NRS 449.040 and any other information specifically required for a particular license, must include:
(a) Full, complete and accurate information regarding the ownership of the facility or program and all changes to that ownership that occur while the application is pending. The information must include the name of:
(1) Each natural person who is an owner of the facility or program;
(2) Each person who has a direct or indirect ownership interest in the facility or program of 10 percent or more and who is the owner, in whole or in part, of any mortgage, deed of trust, note or other obligation secured in whole or in part by the facility or program or any of the property or assets of the facility or program;
(3) If the applicant is a corporation, each officer and director; and
(4) If the applicant is a partnership, each partner.
(b) The address of the applicant’s principal office.
(c) Evidence satisfactory to the Health Division that the facility or program meets all applicable federal, state and local laws and complies with all safety, health, building and fire codes. If there are any differences between the state and local codes, the more restrictive standards apply.
(d) If required by NRS 439A.100, a copy of a letter of approval issued by the Director of the Department of Health and Human Services.
(e) A copy of the certificate of occupancy, a copy of the applicant’s business license and a copy of any special use permits obtained in connection with the operation of the facility or program.
(f) A copy of any property lease or rental agreements concerning the facility or program.
(g) If the applicant is a corporation, a copy of its bylaws and articles of incorporation.
(Added to NAC by Bd. of Health by R044-97, eff. 10-30-97)
NAC 449.0112 Investigation; prelicensure survey; inspection for fire safety. (NRS 449.037)
1. Upon receipt of a properly completed and notarized application and the appropriate fee, the Health Division shall conduct an investigation concerning the premises, facilities, qualifications of personnel, methods of operation and policies of the applicant and perform a prelicensure survey of:
(a) The applicant; and
(b) The facility, program plan and management plan, as appropriate.
2. Before issuing a license, the Health Division must receive a satisfactory report of inspection of the facility from the State Fire Marshal or the local fire department.
(Added to NAC by Bd. of Health by R044-97, eff. 10-30-97)
NAC 449.0114 Display of license; compliance with law; transfer of real property; change in administrator, ownership, location or services. (NRS 449.037, 449.050)
1. Upon receipt of a license, the licensee shall display the license at a conspicuous location within the facility.
2. During the term of the license, the licensee shall continuously maintain the facility in conformance with the provisions of this chapter and chapter 449 of NRS.
3. If there is a transfer of the real property on which the facility is located, but no change in the operator of the facility, the licensee shall, within 10 days, notify the Health Division of the transfer in writing and provide the Health Division with a copy of any lease agreement relating to the transfer.
4. If there is a change in the administrator of the facility, the licensee shall notify the Health Division of the change within 10 days. The notification must provide evidence that the new administrator is currently licensed pursuant to chapter 654 of NRS and the regulations adopted pursuant thereto. If the licensee fails to notify the Health Division and submit an application for a new license within 10 days after the change, the licensee shall pay to the Health Division a fee in an amount equal to 150 percent of the fee required for a new application set forth in subsection 1 of NAC 449.0168.
5. A licensee shall notify the Health Division immediately of any change in the ownership of, the location of, or the services provided at, the facility.
(Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R122-05, 11-17-2005)
NAC 449.0115 Review of building plans for new construction or remodeling by certain applicants: Required documents; payment of fees and costs. (NRS 439.150, 439.200, 449.037)
1. An applicant for a license or the renewal of a license to operate a medical facility or facility for the dependent who wishes or is required to have building plans for new construction or remodeling reviewed by the Health Division must:
(a) Submit to the Health Division or have on file a current application for a license or renewal of a license;
(b) Pay to the Health Division any fees required for the issuance or renewal of a license pursuant to NAC 449.013 or 449.016; and
(c) Submit two complete sets of building plans for new construction or remodeling prepared by a registered architect, registered residential designer or licensed general contractor to the entity designated to review such plans by the Health Division.
2. All costs incurred for the review of building plans and any changes or revisions made to the plans must be borne by the applicant and paid directly to the designee of the Health Division conducting the review of the plans.
3. The costs required to be paid pursuant to subsection 2 are not refundable and are in addition to the fees charged for the issuance or renewal of the license pursuant to NAC 449.013 or 449.016.
(Added to NAC by Bd. of Health, eff. 11-1-95; A by R035-97, 10-30-97; R129-99, 11-29-99, eff. 1-1-2000; R076-01, 10-18-2001; R067-04, R070-04 & R072-04, 8-4-2004; R076-04, 8-5-2004; R122-05, 11-17-2005; R051-06, 7-14-2006)
NAC 449.01153 Approval of building plans for construction or remodeling of certain facilities: Period of validity. (NRS 449.037) If the Health Division approves building plans for the construction or remodeling of a facility for modified medical detoxification, a facility for skilled nursing, a facility for the care of adults during the day, a facility for the treatment of abuse of alcohol or drugs, a hospital, a mobile unit, a residential facility for groups or a surgical center for ambulatory patients, the approval is valid for 42 months after it is issued, unless there has been:
1. A modification of the building plans;
2. A change in the ownership of the facility; or
3. A change in the intended use of the facility.
(Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004)
NAC 449.01156 On-site advisory inspection of facility: Written request; action by Health Division; fee. (NRS 439.150, 439.200, 449.037)
1. A licensee or an applicant for the issuance or renewal of a license whose building plans for the construction of a facility have been reviewed pursuant to NAC 449.0115 may submit a written request to the Health Division for an on-site advisory inspection to be conducted by the Health Division after at least 80 percent of the construction of the facility is completed. The written request must include, without limitation, the anticipated date on which 80 percent of the construction of the facility will be completed.
2. If the Health Division receives a request submitted pursuant to subsection 1, the Health Division shall determine its ability to grant the request and shall issue a notice of that determination to the licensee or applicant who submitted the request.
3. If the Health Division grants a request submitted pursuant to subsection 1, the licensee or applicant who submitted the request shall, before the Health Division conducts the on-site inspection, submit to the Health Division a fee of:
(a) Five hundred dollars, if the project is valued at not more than $500,000;
(b) One thousand dollars, if the project is valued at more than $500,000 but not more than $1,000,000; or
(c) Two thousand dollars, if the project is valued at more than $1,000,000.
(Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004)
NAC 449.0116 Renewal of license: Application; validity of existing license pending decision on application; inspection of facility; untimely filing or failure to file application. (NRS 439.150, 439.200, 449.037, 449.050, 449.060)
1. Except as otherwise provided in subsection 2, a licensee who wishes to renew his license must submit a complete application for renewal to the Health Division on or before November 15 of the calendar year in which the license expires. The existing license shall be deemed valid until the submitted application for renewal is evaluated and a final determination is made by the Health Division concerning whether to renew the license. The Health Division may require an inspection of the facility to ensure that it meets the requirements of this chapter before deciding whether to renew a license.
2. A licensee who, without good cause, files an application for the renewal of his license after the date set forth in subsection 1 but on or before December 31 of the calendar year in which the license expires and who wishes to renew his license must pay:
(a) The fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate; and
(b) An additional charge equal to one-half the amount of the fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate.
3. A licensee who fails to file an application for the renewal of his license before the license expires is not eligible to renew the license and, if he wishes to be licensed, must submit an application for a new license.
(Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R065-04, 8-4-2004)
NAC 449.0118 Denial, suspension or revocation of license: Grounds. (NRS 449.037) In addition to the grounds set forth in NRS 449.160 and any other grounds specifically applicable to a particular license, the Health Division may deny an application for a license or may suspend or revoke a license upon any of the following grounds:
1. The failure or refusal of an applicant or licensee to comply with any of the provisions of chapter 449 of NRS or the regulations adopted by the State Board of Health.
2. The failure or refusal of an applicant or licensee to comply with a reasonable order from the Health Division to remove a resident from a facility or program.
3. Operating a facility or program without a license, if a license is required before operating.
4. Accepting for care, at any given time, more residents than the number specified in the license.
5. The failure or refusal of a licensee to return an adequate plan of correction to the Health Division within 10 days after the receipt by the licensee of a statement of deficiencies.
6. The failure or refusal to cooperate fully with an investigation or inspection by the Bureau.
7. Misappropriation of the property of a resident of a facility.
8. Abuse, neglect or exploitation of an infirm, mentally retarded or disabled person, or of a person who is 60 years of age or older.
(Added to NAC by Bd. of Health by R044-97, eff. 10-30-97)
NAC 449.0119 Denial, suspension or revocation of license: Appeals. (NRS 449.037, 449.170) An applicant or licensee who is aggrieved by an action of the Health Division relating to the denial, suspension or revocation of a license may appeal pursuant to the procedures set forth in NAC 439.300 to 439.395, inclusive.
(Added to NAC by Bd. of Health by R044-97, eff. 10-30-97)
FEES
NAC 449.012 Definitions. (NRS 449.037, 449.038) As used in NAC 449.012 to 449.0168, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.0121 to 449.0127, inclusive, have the meanings ascribed to them in those sections.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97; A by R229-97, 4-15-98; R052-02 & R063-02, 7-24-2002; R065-04, 8-4-2004; R051-06 & R095-06, 7-14-2006)
NAC 449.0121 “Ambulatory surgical center” defined. (NRS 449.037) “Ambulatory surgical center” has the meaning ascribed to it in NAC 449.972.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.01215 “Branch office” defined. (NRS 449.037) “Branch office” has the meaning ascribed to it in NAC 449.749.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.01219 “Community triage center” defined. (NRS 449.037) “Community triage center” has the meaning ascribed to it in NRS 449.0031.
(Added to NAC by Bd. of Health by R051-06, eff. 7-14-2006)
NAC 449.01225 “Facility for hospice care” defined. (NRS 449.037) “Facility for hospice care” has the meaning ascribed to it in NAC 449.0172.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97; A by R123-99, 11-29-99)
NAC 449.01227 “Facility for refractive surgery” defined. (NRS 449.037) “Facility for refractive surgery” has the meaning ascribed to it in NRS 449.00387.
(Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002; A by R042-06, 7-14-2006)
NAC 449.01228 “Facility for transitional living for released offenders” defined. (NRS 449.037) “Facility for transitional living for released offenders” has the meaning ascribed to it in NRS 449.0055.
(Added to NAC by Bd. of Health by R095-06, eff. 7-14-2006)
NAC 449.01229 “Facility for treatment with narcotics” defined. (NRS 449.037, 449.038) “Facility for treatment with narcotics” has the meaning ascribed to it in NAC 449.1542.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)—(Substituted in revision for NAC 449.0122)
NAC 449.0123 “Home health agency” defined. (NRS 449.037) “Home health agency” has the meaning ascribed to it in NAC 449.749.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.01235 “Home office” defined. (NRS 449.037) “Home office” has the meaning ascribed to it in NAC 449.749.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.0124 “Hospice care” defined. (NRS 449.037) “Hospice care” has the meaning ascribed to it in NAC 449.0175.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.01245 “Intermediate care facility for the mentally retarded or persons with developmental disabilities” defined. (NRS 449.037) “Intermediate care facility for the mentally retarded or persons with developmental disabilities” has the meaning ascribed to it in NAC 449.632.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.0125 “Medication unit” defined. (NRS 449.037, 449.038) “Medication unit” has the meaning ascribed to it in NAC 449.15435.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)
NAC 449.01252 “Mobile unit” defined. (NRS 449.037) “Mobile unit” has the meaning ascribed to it in NRS 449.01515.
(Added to NAC by Bd. of Health by R063-02, eff. 7-24-2002)
NAC 449.01255 “Nursing pool” defined. (NRS 449.037) “Nursing pool” has the meaning ascribed to it in NRS 449.0153.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.0126 “Rural clinic” defined. (NRS 449.037) “Rural clinic” has the meaning ascribed to it in NRS 449.0175.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.01265 “Rural hospital” defined. (NRS 449.037) “Rural hospital” has the meaning ascribed to it in NRS 449.0177.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.0127 “Subunit agency” defined. (NRS 449.037) “Subunit agency” has the meaning ascribed to it in NAC 449.749.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)
NAC 449.013 License and renewal fees to operate ambulatory surgical center, facility for treatment of irreversible renal disease, home office, subunit agency or branch office of home health agency, rural clinic, obstetric center, program of hospice care, independent center for emergency medical care, nursing pool, facility for treatment with narcotics, medication unit, referral agency, halfway house for recovering alcohol and drug abusers, facility for refractive surgery, mobile unit and facility for transitional living for released offenders; expiration of application for license; refund of certain fees. (NRS 439.150, 439.200, 449.0305, 449.037, 449.038, 449.050)
1. Except as otherwise provided in subsection 4 and NAC 449.0168, an applicant for a license to operate any of the following facilities, programs of hospice care or agencies must pay to the Health Division the following nonrefundable fees:
|
(a) An ambulatory surgical center........................................................................ |
................ $3,570 |
|
(b) A facility for the treatment of irreversible renal disease.................................... |
................. 2,748 |
|
(c) A home office or subunit agency of a home health agency............................... |
................. 3,034 |
|
(d) A branch office of a home health agency........................................................ |
................. 2,000 |
|
(e) A rural clinic.................................................................................................. |
................. 2,160 |
|
(f) An obstetric center......................................................................................... |
................. 1,564 |
|
(g) A program of hospice care............................................................................. |
................. 2,106 |
|
(h) An independent center for emergency medical care......................................... |
................. 2,950 |
|
(i) A nursing pool................................................................................................ |
................. 4,272 |
|
(j) A facility for treatment with narcotics............................................................... |
................. 2,482 |
|
(k) A medication unit........................................................................................... |
................. 1,200 |
|
(l) A referral agency............................................................................................ |
................. 2,000 |
|
(m) A halfway house for recovering alcohol and drug abusers............................... |
................. 2,020 |
|
(n) A facility for refractive surgery........................................................................ |
................. 7,556 |
|
(o) A mobile unit................................................................................................. |
................. 2,090 |
|
(p) A facility for transitional living for released offenders....................................... |
................. 2,020 |
2. Except as otherwise provided in subsection 4, an applicant for the renewal of such a license must pay to the Health Division the following nonrefundable fees:
|
(a) An ambulatory surgical center......................................................................... |
............... $1,785 |
|
(b) A facility for the treatment of irreversible renal disease..................................... |
................ 1,374 |
|
(c) A home office or subunit agency of a home health agency................................ |
................ 1,517 |
|
(d) A branch office of a home health agency......................................................... |
................ 1,000 |
|
(e) A rural clinic................................................................................................... |
................ 1,080 |
|
(f) An obstetric center.......................................................................................... |
................ 782 |
|
(g) A program of hospice care.............................................................................. |
................ 1,053 |
|
(h) An independent center for emergency medical care.......................................... |
................ 1,475 |
|
(i) A nursing pool................................................................................................. |
................ 2,136 |
|
(j) A facility for treatment with narcotics................................................................ |
................ 1,241 |
|
(k) A medication unit............................................................................................ |
................ 600 |
|
(l) A referral agency............................................................................................. |
................ 1,000 |
|
(m) A halfway house for recovering alcohol and drug abusers................................ |
................ 1,010 |
|
(n) A facility for refractive surgery......................................................................... |
................ 3,912 |
|
(o) A mobile unit.................................................................................................. |
................ 1,045 |
|
(p) A facility for transitional living for released offenders........................................ |
................ 1,010 |
3. An application for a license is valid for 1 year after the date on which the application is submitted. If an applicant does not meet the requirements for licensure imposed by chapter 449 of NRS or the regulations adopted pursuant thereto within 1 year after the date on which he submits his application, he must submit a new application and pay the required fee to be considered for licensure.
4. Pursuant to NRS 449.050, if an application for a license to operate a facility for transitional living for released offenders or the renewal of such a license is denied, any amount of a fee paid pursuant to paragraph (p) of subsection 1 or paragraph (p) of subsection 2 that exceeds the expenses and costs incurred by the Health Division must be refunded to the applicant.
[Bd. of Health, Health Facility Fees Art. 1, eff. 1-20-77]—(NAC A 7-22-87; 1-31-90; 9-1-93; 11-1-95; 10-3-96; R035-97 & R044-97, 10-30-97; R229-97, 4-15-98; R105-98, 9-23-98; R132-99, 11-29-99; R123-01, 12-17-2001, eff. 1-1-2002; R052-02 & R063-02, 7-24-2002; R050-02, 10-22-2002; R074-03, 10-22-2003; R065-04, 8-4-2004; R042-06 & R095-06, 7-14-2006)
NAC 449.016 License and renewal fees to operate skilled nursing facility, hospital, rural hospital, intermediate care facilities, residential facility for groups, facility for treatment of abuse of alcohol or drugs, facility for hospice care, home for individual residential care, facility for modified medical detoxification and community triage center; expiration of application for license. (NRS 439.150, 439.200, 449.037, 449.050, 449.249)
1. Except as otherwise provided in NAC 449.0168, an applicant for a license to operate any of the following facilities must pay to the Health Division the following nonrefundable fees:
|
|
Fee per facility |
Fee per bed in the facility |
|
|
|
|
|
(a) A skilled nursing facility................................................................. |
......... $2,200 |
$60 |
|
(b) A hospital, other than a rural hospital............................................ |
......... 10,000 |
60 |
|
(c) A rural hospital............................................................................. |
.......... 1,500 |
60 |
|
(d) An intermediate care facility for the mentally retarded or persons with developmental disabilities................................................................. |
.......... 1,564 |
184 |
|
(e) An intermediate care facility, other than an intermediate care facility for the mentally retarded or persons with developmental disabilities.......... |
.......... 1,200 |
90 |
|
(f) Except as otherwise provided in subsection 3, a residential facility for groups.............................................................................................. |
.......... 2,400 |
184 |
|
(g) A facility for the treatment of abuse of alcohol or drugs.................. |
.......... 782 |
184 |
|
(h) A facility for hospice care............................................................. |
.......... 1,564 |
184 |
|
(i) A home for individual residential care............................................. |
.......... 1,764 |
184 |
|
(j) A facility for modified medical detoxification................................... |
.......... 782 |
184 |
|
(k) A community triage center............................................................ |
.......... 782 |
184 |
2. An applicant for the renewal of such a license must pay to the Health Division the following nonrefundable fees:
|
|
Fee per facility |
Fee per bed in the facility |
||
|
|
|
|
||
|
(a) A skilled nursing facility................................................................. |
......... $1,100 |
$30 |
|
|
|
(b) A hospital, other than a rural hospital............................................. |
.......... 5,000 |
30 |
|
|
|
(c) A rural hospital............................................................................. |
.......... 750 |
30 |
|
|
|
(d) An intermediate care facility for the mentally retarded or persons with developmental disabilities................................................................. |
.......... 782 |
92 |
|
|
|
(e) An intermediate care facility, other than an intermediate care facility for the mentally retarded or persons with developmental disabilities.......... |
.......... 600 |
40 |
|
|
|
(f) Except as otherwise provided in subsection 4, a residential facility for groups which has 11 beds or more..................................................... |
.......... 1,182 |
92 |
|
|
|
(g) Except as otherwise provided in subsection 5, a residential facility for groups which has less than 11 beds.................................................... |
.......... 1,085 |
92 |
|
|
|
(h) A facility for the treatment of abuse of alcohol or drugs.................. |
.......... 391 |
92 |
|
|
|
(i) A facility for hospice care............................................................... |
.......... 782 |
92 |
|
|
|
(j) A home for individual residential care............................................. |
.......... 500 |
92 |
|
|
|
(k) A facility for modified medical detoxification.................................. |
.......... 391 |
92 |
|
|
|
(1) A community triage center............................................................ |
.......... 391 |
92 |
|
|
3. An applicant for a license for a residential facility for groups shall pay a fee of $100 for each bed in the facility which is paid entirely with money from:
(a) The Supplemental Security Income Program as defined in NRS 422.053;
(b) The home and community-based services program pursuant to 42 U.S.C. § 1396n; or
(c) A program for group care of adults established by a county.
4. An applicant for the renewal of a license for a residential facility for groups shall pay a fee of $35 for each bed in the facility which is paid entirely with money from:
(a) The Supplemental Security Income Program as defined in NRS 422.053;
(b) The home and community-based services program pursuant to 42 U.S.C. § 1396n; or
(c) A program for group care of adults established by a county.
5. An applicant for the renewal of a license for a residential facility for groups which has less than 11 beds who attests that, during the following licensure period, at least 75 percent of those beds will be paid for entirely with money from the sources described in subsection 4 shall pay a fee of $500 plus:
(a) For each bed that will be paid for entirely with money from the sources described in subsection 4, a fee of $35 in accordance with that subsection; and
(b) For each remaining bed, a fee of $92.
6. An application for a license is valid for 1 year after the date on which the application is submitted. If an applicant does not meet the requirements for licensure imposed by chapter 449 of NRS or the regulations adopted pursuant thereto within 1 year after the date on which he submits his application, he must submit a new application and pay the required fee to be considered for licensure.
[Bd. of Health, Health Facility Fees Art. 2, eff. 1-20-77]—(NAC A 7-22-87; 8-31-89; 9-1-93; 11-1-95; R035-97 & R044-97, 10-30-97; R105-98, 9-23-98; R123-99 & R131-99, 11-29-99; R129-99, 11-29-99, eff. 1-1-2000; R110-01, 11-21-2001; R050-02, 10-22-2002; R074-03, 10-22-2003; R065-04, 8-4-2004; R051-06, 7-14-2006)
NAC 449.0164 Fees for renewal of licenses for certain facilities: Payment in two equal installments. (NRS 439.150, 439.200, 449.037, 449.050, 449.249) An applicant for the renewal of a license for a residential facility for groups, a halfway house for recovering alcohol and drug abusers, a home for individual residential care or a facility for transitional living for released offenders may pay the fee required for the renewal of his license in two equal installments if:
1. On or before November 1 of the calendar year in which his license expires, he submits a complete application for the renewal of the license which includes, without limitation:
(a) The first installment payment which is equal to one-half the amount of the fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate;
(b) An additional fee of $100 for the administrative costs of billing and collecting such payments; and
(c) A signed payment agreement and a confession of judgment for the total amount of the second installment payment which may be filed with a court of competent jurisdiction if he fails to make the second installment payment in accordance with the agreement;
2. On or before April 15 of the calendar year for which the license is renewed, he submits the second installment payment for the remainder of the fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate; and
3. He has not failed to make a payment in accordance with any other similar agreement.
(Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004; A by R095-06, 7-14-2006)
NAC 449.0168 Fees for modification of certain licenses. (NRS 449.0305, 449.037, 449.050)
1. Except as otherwise provided in subsection 2, a holder of a license to operate a medical facility, facility for the dependent, program of hospice care or referral agency who wishes or is required pursuant to NAC 449.190, 449.307, 449.7473 or 449.758 to modify his license to reflect:
(a) A change in the name of the facility, program or agency;
(b) A change of the administrator of the facility, program or agency;
(c) A change in the number of beds in the facility;
(d) A change in the type of facility licensed or the addition of another type of facility to be licensed;
(e) A change in the category of residents who may reside at the facility;
(f) A change in the designation of a staging area for a mobile unit or, if the mobile unit is operated by an independent facility, a change in the address of the independent facility; or
(g) A change in any of the services provided by an agency to provide nursing in the home,
Ê must submit an application for a new license to the Health Division and pay to the Health Division a fee of $250.
2. An applicant who applies for a license pursuant to paragraph (c) of subsection 1 because of an increase in the number of beds in the facility must pay to the Health Division:
(a) A fee of $250; and
(b) A fee for each additional bed as follows:
|
(1) If the facility is an intermediate care facility for the mentally retarded or persons with developmental disabilities............................................................................................ |
......... $184 |
|
(2) Except as otherwise provided in subparagraph (3), if the facility is a residential facility for groups............................................................................................................... |
........... 184 |
|
(3) If the facility is a residential facility for groups and the fee for each bed in the facility is paid entirely with money from sources described in subsection 3 of NAC 449.016 |
........... 100 |
|
(4) If the facility is a facility for the treatment of abuse of alcohol or drugs.................. |
........... 184 |
|
(5) If the facility is a facility for hospice care.............................................................. |
........... 184 |
|
(6) If the facility is a home for individual residential care............................................. |
........... 184 |
|
(7) If the facility is a facility for modified medical detoxification.................................. |
........... 184 |
|
(8) If the facility is a hospital..................................................................................... |
............. 80 |
|
(9) If the facility is a rural hospital............................................................................. |
............. 80 |
|
(10) If the facility is a skilled nursing facility............................................................... |
............. 60 |
|
(11) If the facility is an intermediate care facility, other than an intermediate care facility for the mentally retarded or persons with developmental disabilities.......................... |
............. 90 |
3. If the address of the home office of a home health agency has not changed, a holder of a license to operate a subunit agency or branch office of the home health agency who wishes or is required pursuant to NAC 449.758 to modify his license to reflect a change in the address of the subunit agency or branch office of the home health agency must:
(a) Submit an application for a new license to the Health Division; and
(b) Pay to the Health Division a fee of $250.
4. A fee paid pursuant to this section is nonrefundable.
5. As used in this section:
(a) “Administrator” means the person who is responsible for the daily management of a medical facility, facility for the dependent or program of hospice care.
(b) “Independent facility” has the meaning ascribed to it in NAC 449.9701.
(c) “Staging area” has the meaning ascribed to it in NAC 449.97018.
(Added to NAC by Bd. of Health by R035-97, eff. 10-30-97; A by R053-99, 9-27-99; R132-99, 11-29-99; R110-01, 11-21-2001; R063-02, 7-24-2002; R050-02, 10-22-2002; R074-03, 10-22-2003; R123-05, 11-17-2005)
PROVISION OF HOSPICE CARE
General Provisions
NAC 449.017 Definitions. (NRS 449.037) As used in NAC 449.017 to 449.0188, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.0171 to 449.0178, inclusive, have the meanings ascribed to them in those sections.
(Added to NAC by Bd. of Health, eff. 7-20-90; A by R041-06, 7-14-2006)
NAC 449.0171 “Bereavement services” defined. (NRS 449.037) “Bereavement services” means social and emotional support offered to the family of a patient in a program of hospice care for at least 1 year following the death of the patient.
(Added to NAC by Bd. of Health, eff. 7-20-90)
NAC 449.0172 “Facility for hospice care” defined. (NRS 449.037) “Facility for hospice care” has the meaning ascribed to it in NRS 449.0033.
(Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99, 11-29-99)
NAC 449.0173 “Governing body” defined. (NRS 449.037) “Governing body” means the person or group of persons responsible for carrying out and monitoring the administration of a program of hospice care or for the operation of a facility for hospice care.
(Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99, 11-29-99)
NAC 449.0175 “Hospice care” defined. (NRS 449.037) “Hospice care” has the meaning ascribed to it in NRS 449.0115.
(Added to NAC by Bd. of Health, eff. 7-20-90)
NAC 449.0176 “Medical director” defined. (NRS 449.037) “Medical director” means the physician who is responsible for acting as a medical resource to an interdisciplinary team which provides hospice care.
(Added to NAC by Bd. of Health, eff. 7-20-90)
NAC 449.01765 “Palliative services” defined. (NRS 449.037) “Palliative services” has the meaning ascribed to it in NRS 449.0156.
(Added to NAC by Bd. of Health by R041-06, eff. 7-14-2006)
NAC 449.0177 “Patient” defined. (NRS 449.037) “Patient” means a person who is terminally ill and who is receiving hospice care.
(Added to NAC by Bd. of Health, eff. 7-20-90)
NAC 449.0178 “Terminally ill” defined. (NRS 449.037) “Terminally ill” has the meaning ascribed to it in NRS 449.0195.
(Added to NAC by Bd. of Health, eff. 7-20-90; A by R041-06, 7-14-2006)
Licensing
NAC 449.0181 Compliance with regulations required for license to operate facility for hospice care. (NRS 449.037) The Health Division shall not issue a license to operate a facility for hospice care unless the program of hospice care which it provides complies with the requirements of NAC 449.017 to 449.0188, inclusive.
(Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99, 11-29-99)
NAC 449.0183 Report of change in ownership, address or staff of program of hospice care. (NRS 449.037) An applicant for a license to administer a program of hospice care or a person licensed to administer such a program shall immediately advise the Health Division of any change in:
1. The ownership of the program;
2. The address of the principal office of the program; or
3. The membership of the staff which prevents the program from providing adequate hospice care to each patient.
(Added to NAC by Bd. of Health, eff. 7-20-90)
Administration
NAC 449.0184 Governing body required; duties of governing body and administrator. (NRS 449.037) Every facility which provides a program of hospice care must have a governing body which shall:
1. Appoint an administrator of the program of hospice care. The administrator shall be available on a daily basis for consultation with members of the interdisciplinary team of the program of hospice care.
2. Ensure that all services provided by the program of hospice care are consistent with accepted standards of practice for the care of the patients.
(Added to NAC by Bd. of Health, eff. 7-20-90)
Medical Services
NAC 449.0185 Requirements for program of hospice care. (NRS 449.037) A program of hospice care must comply with the following requirements:
1. A qualified person must be available when required to evaluate the dietary patterns of each patient and plan diets to meet the individual nutritional needs of each patient.
2. Each patient must be advised regarding the availability of pastoral care.
3. Bereavement services must be available to each member of a patient’s family after the patient dies to provide appropriate counseling.
4. Nursing care must be provided by a registered nurse or under the supervision of a registered nurse.
5. A social worker must provide social services to each patient in the program under the direction of the interdisciplinary team.
6. The services of:
(a) A physical therapist;
(b) An occupational therapist; and
(c) A speech and language pathologist,
Ê must be provided when such services are prescribed for a patient by his physician.
7. Home health aide and homemaker services must be available to each patient and provided at intervals which meet the needs of each patient. A registered nurse must:
(a) Supervise the persons providing such services; and
(b) Prepare written instructions for the persons providing such services which identify the duties they are to perform.
8. Arrangements must be made to provide any medical supplies and appliances which are required by a patient, including any drug or biological needed for palliative services.
(Added to NAC by Bd. of Health, eff. 7-20-90; A by R041-06, 7-14-2006)
NAC 449.0186 Requirements for plan of care. (NRS 449.037)
1. The medical director of a program of hospice care shall cause a written plan of care to be established for each patient in the program. Any person who furnishes care for the patient shall adhere to the plan.
2. A plan of care must:
(a) Be established by the physician of the patient or by the medical director of the program of hospice care, and the interdisciplinary team which provides the hospice care;
(b) Include an assessment of the needs of the patient and identify the services required by the patient, which must include the management of discomfort and relief of symptoms of the patient;
(c) State the scope and frequency of each service to be provided to the patient and members of his family; and
(d) Be reviewed and updated at intervals that are specified in the plan by the person who established the plan. The review must be documented in writing.
(Added to NAC by Bd. of Health, eff. 7-20-90)
NAC 449.0187 Requirements for operation of facility for hospice care. (NRS 449.037) A facility for hospice care must comply with the following requirements:
1. A program of hospice care must be provided for each inpatient pursuant to a written plan of care established pursuant to NAC 449.0186.
2. Nursing services must be provided 24 hours per day in accordance with the plan of care for each patient.
3. Medication must be dispensed to each patient according to the instructions of the patient’s physician or the medical director.
4. Treatment must be administered to a patient pursuant to the instructions of the physician of the patient or the plan of care for the patient.
5. Each patient must be maintained in a clean and well-groomed manner.
6. Each patient must be protected from accidents, injuries and infections.
7. At least one registered nurse must be on duty for each work shift, providing direct care to patients.
8. A written plan of the procedures to be followed during a local disaster, a widespread disaster or a disaster which occurs within the facility for hospice care must be adopted. The plan must:
(a) Provide procedures designed to protect each patient and to care for any casualty which may arise from such a disaster;
(b) Be reviewed and the procedures set forth therein rehearsed by all members of the staff at least once in each quarter of the year; and
(c) Be approved by the Health Division.
9. A private room with an adjoining bath must be provided for each patient.
10. An anteroom, a room adjoining the room of each patient or a private area must be provided and furnished with a bed and chairs for use by the members of the patient’s family.
(Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99, 11-29-99)
NAC 449.0188 Continuity of service to patients required. (NRS 449.037) A person licensed to administer a program of hospice care or to operate a facility for hospice care shall maintain the continuity of service provided to each patient pursuant to NAC 449.017 to 449.0188, inclusive, during the term of his license.
(Added to NAC by Bd. of Health, eff. 7-20-90; A by R044-97, 10-30-97; R123-99, 11-29-99)
FACILITIES FOR TREATMENT OF ABUSE OF ALCOHOL OR DRUGS
General Provisions
NAC 449.019 Definitions. (NRS 449.037) As used in NAC 449.019 to 449.153, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.022 to 449.072, inclusive, have the meanings ascribed to them in those sections.
(Supplied in codification; A by Bd. of Health by R077-01, 10-18-2001)
NAC 449.022 “Administrator” defined. (NRS 449.037) “Administrator” means the person who is appointed by the governing body of a facility who has primary responsibility for the operations of the overall program of the facility.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.4, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)
NAC 449.025 “Alcohol and drug abuse treatment” defined. (NRS 449.037) “Alcohol and drug abuse treatment” means a program concerned with substance abuse treatment directed towards achieving the mental and physical restoration of alcohol and drug abusers.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.9, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)
NAC 449.030 “Case management services” defined. (NRS 449.037) “Case management services” means a multistep process by which clients may receive assistance in accessing services, including, without limitation, services concerning health, mental health, education, vocation, employment, legal issues, child care, housing and aftercare for recovery from alcohol and drug abuse.
(Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)
NAC 449.031 “Client” defined. (NRS 449.037) “Client” means a resident or patient of a facility.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.8, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)
NAC 449.034 “Detoxification” defined. (NRS 449.037) “Detoxification” means the process of eliminating the toxic effects of alcohol and drugs from the body.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.1.3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)
NAC 449.043 “Facility” defined. (NRS 449.037) “Facility” means a facility for the treatment of abuse of alcohol or drugs as defined in NRS 449.00455.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.1, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)
NAC 449.044 “Facility for modified medical detoxification” defined. (NRS 449.037) “Facility for modified medical detoxification” has the meaning ascribed to it in NRS 449.00385.
(Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)
NAC 449.046 “Governing body” defined. (NRS 449.037) “Governing body” means a body that has the ultimate authority for the administration of the overall program at a facility pursuant to NAC 449.085.
(Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)
NAC 449.060 “Medically managed intensive detoxification program” defined. (NRS 449.037) “Medically managed intensive detoxification program” means a program which provides 24-hour medical monitoring of treatment and detoxification services in a licensed hospital pursuant to NAC 449.279 to 449.394, inclusive, and which has life support systems in place.
(Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)
NAC 449.064 “Overall program” defined. (NRS 449.037) “Overall program” means all aspects of alcohol and drug abuse treatment, including general fiscal management, fund-raising projects and the general long-term goals of a facility which are defined in writing.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.10, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)
NAC 449.068 “Qualified social worker” defined. (NRS 449.037) “Qualified social worker” means a person who is licensed by the Board of Examiners for Social Workers to practice as a social worker.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.11, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)—(Substituted in revision for NAC 449.073)
NAC 449.069 “Residential program” defined. (NRS 449.037) “Residential program” means a treatment program for alcohol and drug abuse which takes place in a 24-hour residential setting and which encompasses organized services staffed by designated addiction treatment personnel who provide a planned regimen of client care.
(Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)
NAC 449.072 “Social model detoxification program” defined. (NRS 449.037) “Social model detoxification program” means a treatment program that concentrates on providing psychosocial services and nonmedical detoxification.
(Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)
Licensing
NAC 449.079 Denial, revocation or suspension of license if facility not certified by Health Division; appeal. (NRS 449.037)
1. If a facility is not certified by the Health Division pursuant to subsection 4 of NRS 458.025, the Health Division shall deny an application for a license or suspend or revoke the license of the facility.
2. An applicant or licensee who wishes to appeal an action of the Health Division relating to the denial, suspension or revocation of a license may appeal the action pursuant to the procedures set forth in NAC 439.300 to 439.395, inclusive.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 2 §§ 2.7-2.12, eff. 3-27-76; A and renumbered as §§ 2.7-2.11, 12-27-77]—(NAC A by R035-97 & R044-97, 10-30-97; R077-01, 10-18-2001)
NAC 449.081 New construction or remodeling: Submission and approval of building plans; prerequisites to approval of licensing. (NRS 449.037)
1. Building plans for new construction or remodeling must be submitted to the entity designated to review such plans by the Health Division pursuant to the provisions of NAC 449.0115. Before the construction or remodeling may begin, the plans for the construction or remodeling must be approved by the Health Division.
2. The Health Division shall not approve the licensing of a facility until all construction has been completed and a survey is conducted at the site.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 16, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R076-01 & R077-01, 10-18-2001; R073-04, 8-4-2004)
Administration and Personnel
NAC 449.085 Governing body; bylaws. (NRS 449.037)
1. Every facility must have a governing body which has the ultimate authority for the administration of the overall program.
2. The governing body shall adopt written bylaws and policies that define the powers and duties of the governing body, its committees, the administrator and any advisory group.
3. The bylaws and policies must:
(a) Identify the overall goals.
(b) Include an organizational chart.
(c) Define the major lines of authority and areas of responsibility within the treatment program.
(d) Define the membership of the governing body, the types of membership, the method of selection or appointment of members, offices or committees and their terms of office.
(e) Define the frequency of meetings of the governing body and attendance requirements.
4. The duties of the governing body include, but are not limited to, the following items:
(a) Appointment of a qualified administrator with authority and responsibilities appropriate to the requirements of the program;
(b) Adoption, review and revision of the governing body’s bylaws and policies;
(c) Adoption of controls designed to achieve and maintain maximum standards of service; and
(d) Review and approval of an annual budget to carry out the objectives of the program.
5. New facilities must show sufficient resources to operate for 120 days.
6. The governing body shall retain the ultimate responsibility for the overall program and its objectives.
7. The governing body shall meet at least semiannually. Minutes must be kept of the meetings, including the date of the meeting, those in attendance, topics discussed, decisions made and actions taken, target dates for the implementation of recommendations and all program reports.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R044-97, 10-30-97; R077-01, 10-18-2001)
NAC 449.088 Policies and procedures. (NRS 449.037)
1. A facility must have written policies and procedures available to members of the staff, clients and the public which govern the operation of the facility and services provided by the facility.
2. The policies must:
(a) Ensure that only those persons are accepted as clients whose needs can be met by the facility directly or in cooperation with community resources or other providers of treatment with which it is affiliated.
(b) Ensure that a client whose physical or mental condition has changed to such an extent that he can no longer be adequately served by the facility will be transferred promptly to an appropriate facility.
(c) Set forth the rights of clients and members of the staff and provide for the registration and disposition of complaints without threat of discharge or reprisal against any employee or client.
(d) Ensure that the admission agreement between the administrator and the client does not permit the administrator or his designee a power of attorney.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)
NAC 449.091 Transfer of client to another facility. (NRS 449.037)
1. Except in the case of an emergency, the transfer of a client to another facility must not be effected until the client, attending physician, if any, and responsible agency are notified in advance.
2. If a client is transferred to another facility, information required for appropriate continuation of care must be released to the receiving facility in compliance with the standards set forth in 42 C.F.R. Part 2, which are hereby adopted by reference. A copy of the standards may be obtained from the Health Division, free of charge, upon request.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)
NAC 449.094 Money of clients. (NRS 449.037)
1. If a facility handles a client’s money, a written ledger account of all deposits, disbursements or other transactions must be maintained. A record must be made available to the client at least quarterly.
2. A client’s money must be given to him within 24 hours of his exit from the facility.
3. Large sums of money must be maintained in a financial institution in the community where the facility is located in a separate trustee account apart from the facility’s operational accounts and must be clearly designated.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)
NAC 449.098 Preparations for disasters; reporting of fire or disaster. (NRS 449.037)
1. Each facility shall develop a written plan for disasters which outlines procedures for members of the staff and clients to follow in case of fire or another emergency and which provides for meeting the needs of clients if the facility must be evacuated or is destroyed.
2. A simple floor plan showing the routes for evacuating must be posted in prominent locations on each floor of each facility.
3. Each facility shall conduct a disaster drill at least annually, and a written record of each drill must be retained in the facility for not less than 12 months after the drill is conducted.
4. The facility shall notify the Bureau of the occurrence of a fire or disaster in the facility within 24 hours after the facility becomes aware of the fire or disaster.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001; R073-04, 8-4-2004)
NAC 449.102 Inventory and return of client’s belongings. (NRS 449.037) If a facility holds or stores a client’s belongings, there must be an inventory of the belongings on admission, made a part of the client’s record, and updated as needed. These belongings must be returned to the client upon his exit.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)
NAC 449.105 Insurance. (NRS 449.037) Liability insurance in a sufficient amount to protect clients, members of the staff, volunteers, and visitors, must be maintained. A certificate of insurance must be furnished to the Health Division. The certificate must include provision for 30 days notice to the Division of cancellation or the nonrenewal of the policies.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]
NAC 449.108 General requirements for programs. (NRS 449.037)
1. A residential program must be certified by the Health Division pursuant to NAC 458.108 and must comply with any applicable regulations adopted pursuant to subsection 4 of NRS 458.025.
2. At the time of admission into a residential program, there must be documentation indicating that the client has been informed of:
(a) The general nature and goal of the program;
(b) The rules governing client conduct and the infractions that can lead to disciplinary action or discharge from the program;
(c) The treatment costs, if any, to be borne by the client;
(d) The client’s rights and responsibilities; and
(e) Confidentiality laws, rules and regulations.
3. The program must be periodically evaluated to ensure compliance with any applicable regulations adopted pursuant to subsection 4 of NRS 458.025.
4. The facility must provide access to medical, dental, psychological and rehabilitative services to meet the needs of all its clients, to the extent possible, with assistance from available community resources.
5. If a facility provides services through outside sources, written arrangements must be made ensuring that the services are supplied directly by, or under the supervision of, qualified persons.
6. The facility must provide case management services as needed by the client either directly or by written agreement with a qualified social worker, a registered nurse or a counselor certified or licensed by the Board of Examiners for Alcohol, Drug and Gambling Counselors.
7. A plan for case management services must be recorded in the client’s record and must be periodically evaluated in conjunction with the client’s treatment plan.
8. Each facility shall review the program at least annually. Areas reviewed must include, but need not be limited to, appropriateness of admissions, lengths of stay, discharge planning, use of services, and utilization of the components of the program and outside services. Written reports of the reviews must be evaluated by the governing body, administrator and such committees as they designate. Documentation of the evaluation process must be maintained at the facility.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 4, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001; R073-04, 8-4-2004; R098-06, 7-14-2006)
NAC 449.111 Administrator: Duties. (NRS 449.037)
1. The administrator is responsible to the governing body for the operation of the facility in accordance with established policy.
2. The administrator shall:
(a) Organize the administrative functions of the program, delegate duties and establish a formal means of accountability on the part of subordinates.
(b) Ensure that a written manual defining program policies and procedures is prepared, regularly revised and updated. The manual must:
(1) Contain all of the required written policies, procedures, definitions, lists and other documentation required by NAC 449.019 to 449.153, inclusive.
(2) Be available to members of the staff at all times at designated and convenient locations.
(c) Appoint a person of majority age to act for him during any absence.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 5, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)
NAC 449.114 Employees: General requirements. (NRS 449.037)
1. A facility must have on duty, all hours of each day, members of the staff sufficient in number and qualifications to carry out policies, responsibilities and program continuity.
2. Each member of the counseling staff must be:
(a) A registered intern;
(b) Certified or licensed by the Board of Examiners for Alcohol, Drug and Gambling Counselors; or
(c) A licensed mental health professional who has experience with alcohol and drug abuse counseling.
3. The administrator or his appointee must be present and responsible for the operations of the facility during normal hours.
4. A facility must have written policies and procedures for the recruitment, selection, promotion and termination of members of the staff.
5. The facility must have written policies and procedures covering wages and salaries, working hours, employee benefits, vacation and sick leave, rules of conduct, and training and the development of the staff.
6. The facility must provide an orientation session to new employees. Documentation of the sessions must be maintained in the employee’s personnel record.
7. There must be written policies and procedures governing disciplinary actions which clearly define the mechanism for suspension or dismissal of members of the staff as well as the procedures for appeal.
8. Written job descriptions must be maintained for all positions. A description must include:
(a) The title of the job;
(b) The tasks and responsibilities of the job;
(c) The skills, education and experience necessary for the job;
(d) The relationship of the job to other jobs within the program; and
(e) The working conditions, location, shift, materials and equipment to be used on the job.
Ê The job description must accurately reflect the actual job situation and must be reviewed annually or whenever a change in the job or qualifications occurs. Job descriptions must be available on request to all members of the staff.
9. A personnel record must be maintained for each employee. The record must contain:
(a) The employment application;
(b) Letters of recommendation;
(c) Reference investigation records;
(d) Verification of training, experience and, if applicable, certification;
(e) Documentation of attendance at the orientation session for new employees;
(f) Job performance evaluations;
(g) Incident reports; and
(h) Disciplinary actions taken.
10. Personnel records must be maintained in a secure manner and must be available only to those persons authorized in written policies and procedures. An employee must have access to his own records upon request.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 6, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001; R098-06, 7-14-2006)
NAC 449.117 Employees: Proof of compliance with provisions concerning tuberculosis. (NRS 449.037) All persons employed in a facility must have documentation showing that they are in compliance with any applicable provisions of chapter 441A of NAC concerning tuberculosis.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 12, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)
Social Model Detoxification Programs
NAC 449.121 Certain facilities authorized to offer program. (NRS 449.037) A social model detoxification program may be offered to clients in:
1. Residential programs that offer detoxification services;
2. A licensed facility for modified medical detoxification pursuant to NAC 449.15311 to 449.15369, inclusive; or
3. A medically managed intensive detoxification program.
(Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)
NAC 449.1214 General requirements. (NRS 449.037)
1. A facility that offers a social model detoxification program:
(a) Must have a physician, nurse practitioner, registered nurse or physician assistant conduct a physical assessment and a review of the general medical and drug history of a client within 24 hours after the client is admitted to the facility to ensure that a social model detoxification program is appropriate for the client.
(b) Must not provide detoxification services for clients who exhibit life-threatening symptoms of withdrawal from alcohol and drug abuse.
(c) Must develop and implement policies and procedures that protect the safety and health of clients. The facility must have these policies and procedures reviewed annually by a licensed physician who is familiar with the symptoms of withdrawal from alcohol and drug abuse.
(d) Must ensure that the observation of a client during his treatment in the social model detoxification program is reflected in the records of the client as deemed necessary by the policies and procedures of that facility.
2. The staff of a facility that offers a social model detoxification program must complete at least 6 hours of additional education in the detoxification of alcohol and drug abusers, as approved by the program of ongoing quality improvement pursuant to NAC 449.1218, every 2 years. Such education must include instruction in:
(a) Acute withdrawal symptoms from alcohol and drug abuse; and
(b) First-aid procedures for clients with seizures.
(Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)
NAC 449.1218 Program of ongoing quality improvement. (NRS 449.037)
1. A social model detoxification program must have a program of ongoing quality improvement designed to:
(a) Monitor and evaluate, objectively and systematically, the quality and appropriateness of client care;
(b) Pursue opportunities to improve client care; and
(c) Resolve identified problems.
2. The program of ongoing quality improvement must:
(a) Establish written policies and procedures to describe and document the monitoring and evaluation activities of the program of ongoing quality improvement.
(b) Include the participation of a medical professional who is not required to be a member of the staff. For the purposes of this paragraph, “medical professional” means a licensed physician, nurse practitioner, physician assistant or registered nurse who is familiar with clients suffering from acute withdrawal symptoms from alcohol and drug abuse.
(c) In addition to the participation of a medical professional pursuant to paragraph (b), include the participation of the administrator and two staff members of the social model detoxification program.
(d) Approve the 6 hours of additional education required pursuant to NAC 449.1214 to ensure that the additional education is appropriate.
3. The findings of the program of ongoing quality improvement, including any conclusions, recommendations, actions taken and the results of the actions taken, must be documented. All documentation must be reported to the governing body and must be reflected in the minutes annually.
(Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)
Operation of Facility
NAC 449.123 General sanitary requirements. (NRS 449.037)
1. Each facility must meet all state and local environmental health standards.
2. A facility which provides dietary services must have food service equipment of appropriate quality and type for the type of food service program used by the facility. The equipment must comply with all applicable provisions in chapter 446 of NAC.
3. All environmental health inspection reports must be on file in the facility. Any deficiencies must be corrected within 90 days and documented in the file.
4. Premises and equipment must be maintained in a sanitary condition:
(a) The facility must have the necessary cleaning and maintenance equipment with sufficient storage areas and appropriate procedures to maintain a clean and orderly establishment.
(b) Janitorial supplies, including aerosols, must be stored in areas separate from clean linen, food and other supplies.
(c) The storage of dirty linen must be separate from the storage of clean linen, food and other supplies.
5. The facility shall establish a policy that prohibits clients from sharing items for personal use, such as combs, toothbrushes, towels or bar soap.
6. Restrooms or lavatories for the staff must be provided with soap dispensers and individual disposable towels.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 11, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)
NAC 449.126 Laundry requirements. (NRS 449.037)
1. A facility must maintain:
(a) A laundry with equipment which is adequate for the sanitary washing and finishing of linen and other washable goods; or
(b) A written agreement with a commercial establishment to provide laundry services for the facility.
2. The laundry must be situated in an area which is separate from any area where food is stored, prepared or served. The laundry must be well-lighted, ventilated, adequate in size to house the equipment and maintained in a sanitary manner. The equipment must be kept in good repair.
3. Soiled linen must be collected and transported to the laundry in washable or disposable covered containers in a sanitary manner.
4. Clean linen to be dried, ironed, folded, transferred or distributed must be handled in a sanitary manner, specified in writing.
5. Closets for storing linen and laundry supplies must be provided and must not be used for any other purpose.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 11, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001)
NAC 449.129 Design, construction, equipment and maintenance. (NRS 449.037)
1. A facility must be designed, constructed, equipped and maintained in a manner that protects the health and safety of the clients and personnel of the facility and members of the general public.
2. Each facility must comply with all currently adopted life safety, fire, Health Division, local building and zoning codes. If there is a difference between state and local codes, the more stringent standards apply.
3. Facilities housing 17 or more clients must meet the requirements of the chapter entitled “New Hotels and Dormitories,” of the edition of NFPA 101: Life Safety Code, adopted by reference pursuant to NAC 449.0105. Those facilities housing not more than 16 clients must meet the requirements of the chapter entitled “Lodging or Rooming Houses,” of the edition of NFPA 101: Life Safety Code, adopted by reference pursuant to NAC 449.0105.
4. A facility is deemed to be in compliance with the provisions of this section if:
(a) The facility is licensed by May 30, 2001, and:
(1) The use of the physical space in the facility is not changed; and
(2) There are no deficiencies in the construction of the facility that are likely to cause serious injury, harm or impairment to the health and welfare of the public; or
(b) Before May 30, 2001, the facility has submitted building plans to the entity designated to review such plans by the Health Division pursuant to the provisions of NAC 449.0115 and:
(1) The Health Division determines that the plans comply with standards for construction in effect before May 30, 2001;
(2) Construction of the facility is begun before February 1, 2002;
(3) The facility is constructed in accordance with those standards; and
(4) There are no deficiencies in the construction of the facility that are likely to cause serious injury, harm or impairment to the health and welfare of the public.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 13, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001; R073-04, 8-4-2004; R098-06, 7-14-2006)
NAC 449.132 Accommodations for clients. (NRS 449.037)
1. No room or space in a facility may be occupied for sleeping, living or dining which is accessible only by a ladder, by folding stairs or through a trapdoor.
2. If a basement is used for living and dining, at least one exit must be provided directly to the outside at ground level. No facility may:
(a) Be situated more than one story below the ground.
(b) Use any basement or space in a basement for sleeping.
3. Each room of a facility used by clients for sleeping must:
(a) Be furnished with a bed, clean linen and blankets; and
(b) Not be less than 50 square feet per bed.
4. Toilet and bathing facilities must be provided to clients in a manner that ensures their privacy during use and in an adequate number to meet the needs of the clients.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 13, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001)
NAC 449.135 Safety from fire. (NRS 449.037)
1. Portable fire extinguishers must be installed throughout each facility at the direction of the fire authority having jurisdiction. Each portable fire extinguisher available at a facility must be inspected, recharged and tagged at least once each year by a person certified by the State Fire Marshal to conduct such inspections.
2. Any facility with a kitchen range with an upper surface of more than 15 square feet must provide the range with an exhaust hood having an automatic fire protection system in accordance with the chapter titled “Standards for Ventilation Control and Fire Protection of Commercial Cooking Operations,” of the edition of NFPA 101: Life Safety Code, adopted by reference pursuant to NAC 449.0105.
3. A portable room-heating device may be used at a facility if the device:
(a) Is located at least 2 feet from any combustible material;
(b) Is plugged directly into a wall socket;
(c) Turns off automatically if it is tipped over; and
(d) Has no exposed heating elements.
4. Receptacles or outlets serviced by extension cords are prohibited.
5. Rooms in which smoking is allowed by direction of the facility or the fire authority must be provided with plainly visible “Smoking Area” signs.
6. A facility must conduct fire drills at least monthly and a written record of each drill conducted must be retained in the facility for not less than 12 months after the drill is conducted.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 13, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001; R073-04, 8-4-2004)
NAC 449.141 Health services. (NRS 449.037)
1. Facilities must provide access to health services which ensure that each client receives treatment, prescribed medication, adequate diets and other health services consistent with the program administered by the facility.
2. Facilities must implement policies and procedures designed to ensure the early detection of complications or conditions considered to be common among drug abusers. These policies and procedures must be developed in conjunction with and approved by a licensed physician.
3. Before a client’s admission to a program or facility, a general medical and drug history must be taken by a designated member of the staff who is certified or licensed by the Board of Examiners for Alcohol, Drug and Gambling Counselors or who is a licensed mental health professional who has experience with alcohol and drug abuse counseling. Current medical information must be provided on a form that has been approved by a physician. The history must include, but is not limited to:
(a) Drugs used in the past;
(b) Drugs used recently;
(c) Drugs of preference;
(d) Frequently used drugs;
(e) Drugs used in combination;
(f) Dosages used;
(g) Date of first usage;
(h) Incidents of overdose, withdrawal or adverse drug reactions; and
(i) Previous history of treatment.
4. A program may accept medical history and physical examination results from referral sources which were conducted not more than 30 days before admission in lieu of personally taking a general medical and drug history as required pursuant to subsection 3.
5. Each facility must be able to provide directly, or through written arrangements, laboratory tests as requested by a physician or federal regulations.
6. Facilities must implement written policies and procedures that are reviewed by a licensed physician defining the appropriate action to be taken when a medical emergency arises.
7. There must be one staff person in the facility who is capable of providing cardiopulmonary resuscitation at all times. Staff members providing cardiopulmonary resuscitation must be qualified by the American Red Cross or another recognized agency.
8. Clients of residential programs must undergo a tuberculin skin test that meets the requirements specified in chapter 441A of NAC.
9. Each facility shall maintain and have readily available first-aid supplies. Staff members shall have evidence that they have received training on the use of first-aid supplies.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 7, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001; R098-06, 7-14-2006)
NAC 449.144 Medication. (NRS 449.037)
1. In programs that permit the self-administration of medication, there must be written policies and procedures governing this activity. The policies must require that:
(a) The decisions to permit self-administration be based on individual needs.
(b) The reasons for the permission be clearly documented in the client’s case record.
(c) All medications that are to be self-administered be packaged in a manner complying with the Poison Prevention Packaging Act of 1970, 15 U.S.C. §§ 1471 et seq., and all current regulations stemming from that act.
(d) The self-administration of prescription medication be observed by a staff member who has been oriented to the program’s policies and procedures on self-administration of prescription medication.
(e) The self-administration of prescription medication be permitted only when the medication is clearly labeled.
(f) There be documentation in the client’s record of the name of the medication, dose, route of administration, time and name of the person observing the self-administration or the licensed staff member who administered the medication.
(g) Clients who receive medication for self-administration be given instructions concerning the safe storage and usage of the drugs and the appropriate emergency procedures to be followed if adverse reactions occur.
2. Any unusual reaction to a medication by a client must be documented in the client’s record and reported to the appropriate physician as outlined in the policies of the facility.
3. Facilities must provide a locked storage area for prescription medication that is to be self-administered by clients. Such medication must be made available to clients at appropriate times and may be dispensed only from a licensed pharmacy in accordance with all applicable provisions of NRS and NAC.
4. Members of the staff may not administer any medication unless licensed to do so.
5. All medication must be maintained in locked storage. Controlled substances must be maintained in a locked box within the locked storage. Medications requiring refrigeration must be kept in a locked box inside the refrigerator separated from food and other items. Disinfectants and medication for external use must be stored separately from medications for internal use and from medications that can be injected. All potent, poisonous or caustic drugs must be plainly labeled, stored and made accessible only to authorized persons. All medication storage must be maintained in accordance with the security requirements of federal, state and local laws.
6. Narcotic treatment facilities may issue methadone “takeouts” to a client in a facility without listing the strength of the drug if the label shows:
(a) The client’s name or other identifying code; and
(b) The 24-hour emergency telephone number for the narcotic treatment facility.
7. Medication prescribed for a client must not be allowed to be in the possession of another client.
8. Any unused prescription medication left behind at a facility by a client must be destroyed by the administrator or his designee in the presence of a witness, and a notation indicating that the medication was destroyed must be made on the client’s record. At the time a client is discharged or leaves the facility, medications that are currently being self-administered must be sent, in the original container, with the client or a responsible agent of the client.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 9, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)
NAC 449.147 Dietary services. (NRS 449.037)
1. Facilities must serve at least three meals or their equivalent daily, at regular times, with not more than 14 hours between a substantial evening meal and breakfast. A second serving must be provided for those clients who desire one.
2. Menus must be planned and followed to meet the nutritional needs of the clients in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences.
3. Therapeutic menus must be planned by a registered dietitian or must be reviewed and approved by the client’s attending or staff physician.
4. Menus must be in writing, planned in advance, dated and posted, and kept on file for 90 days. Any substitution must be noted on the written menus so that the menu on file reflects what was actually served.
5. Adequate facilities and equipment for the preparation, serving, refrigeration and storage of food in a sanitary manner must be provided.
6. A facility with more than 10 clients must:
(a) Comply with all applicable provisions of chapter 446 of NRS and the regulations adopted pursuant thereto;
(b) Obtain the necessary permits from the Bureau of Health Protection Services of the Health Division;
(c) Maintain a report of each inspection concerning the sanitation of the facility for at least 1 year after the date of the inspection; and
(d) Maintain a report of each corrective action taken to address a deficiency noted in a report described in paragraph (c) for at least 1 year after the date of the corrective action.
7. Clients needing special equipment, implements or utensils to assist them while eating must have such items provided.
8. If a facility operates on the cottage plan, provision must be made for food service that assures hot, palatable meals.
9. A qualified person must be used as a consultant on planning meals and serving food. Consultation each month is required. A qualified person may be a person meeting the requirements for registration with the Commission on Dietetic Registration as either a registered dietitian or a registered dietetic technician.
10. All facilities that contract with food management companies must comply with the applicable regulations of the Health Division as provided in chapter 446 of NAC.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 8, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001; R073-04, 8-4-2004)
NAC 449.150 Records of clients. (NRS 449.037)
1. Each facility must maintain an organized system for clients’ records.
2. Clients’ records must be available to members of the staff who have authority to review such records.
3. Clients’ records must be available to representatives of the Health Division.
4. Clients’ records must contain:
(a) Identification information;
(b) Past medical and social history;
(c) Copies of initial and periodic examinations;
(d) Evaluations and progress notes; and
(e) A review and any revisions of each plan of treatment.
5. There must be an overall plan of treatment stated in quantifiable terms which outlines goals to be accomplished through individually designed activities, therapies and treatments.
6. The plan of treatment must state what service or person is responsible for treatment or services to the client.
7. Entries must be made describing treatments and services rendered, medications administered, including those that are self-administered, and any symptoms or other indications of illness or injury, including the date, time and action taken regarding each incident.
8. Records must be adequately safeguarded against destruction, loss or unauthorized use.
9. Records must be retained for at least 5 years following a client’s discharge.
10. A discharge plan, as determined by a case management services assessment of the client, must be documented for each client discharged from the facility. The discharge plan must be formulated upon a client’s admission to the facility.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 10, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)
NAC 449.153 Discrimination prohibited. (NRS 449.037)
1. No facility may deny treatment to a prospective client on the grounds of race, color, age, disability or national origin.
2. No resident may be segregated, given separate treatment, restricted in the employment of any advantage or privilege enjoyed by others under the program or provided with any aid, treatment, services or other benefits which are different or provided in a different manner from that provided to others under the program, on the grounds of race, color, age, disability or national origin.
[Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 15, eff. 3-27-76]—(NAC A 8-1-91; R077-01, 10-18-2001)
FACILITIES FOR MODIFIED MEDICAL DETOXIFICATION
NAC 449.15311 Definitions. (NRS 449.037) As used in NAC 449.15311 to 449.15369, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.15313 to 449.15321, inclusive, have the meanings ascribed to them in those sections.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15313 “Administrator” defined. (NRS 449.037) “Administrator” means the person who is appointed by the governing body of a facility who has primary responsibility for the overall operations of the program of the facility.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15315 “Client” defined. (NRS 449.037) “Client” means a resident or patient of a facility.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15317 “Facility” defined. (NRS 449.037) “Facility” means a facility for modified medical detoxification as defined in NRS 449.00385.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15319 “Overall program” defined. (NRS 449.037) “Overall program” means tasks that are commonly undertaken by a board of directors, including, without limitation, general fiscal management, fund-raising projects and establishing the general long-term goals of a facility.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15321 “Program” defined. (NRS 449.037) “Program” means the program established pursuant to NAC 449.15337.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15323 Proof of certification required; revocation of license. (NRS 449.037)
1. As a condition of the issuance of a license to a facility, the facility shall provide proof that it is certified by the Health Division.
2. If the Health Division revokes or does not renew the certification of a facility, the Health Division shall revoke the license of the facility subject to the appeals procedure set forth in NAC 439.300 to 439.395, inclusive.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15325 Governing body; bylaws and policies. (NRS 449.037)
1. Each facility shall have a governing body that has the ultimate authority for the administration of the overall program of the facility.
2. The governing body shall adopt written bylaws and policies that define the powers and duties of the governing body, its committees, the administrator and any advisory group.
3. The bylaws and policies must:
(a) Identify the overall goals of the facility;
(b) Include, without limitation, an organizational chart of the facility;
(c) Define the major lines of authority and areas of responsibility within the program of treatment provided by the facility;
(d) Define the membership of the governing body, the types of membership, the method of selection or appointment of members, offices or committees and their terms of office; and
(e) Define the frequency of meetings of the governing body and attendance requirements.
4. The governing body shall:
(a) Appoint a qualified administrator of the facility with authority and responsibilities appropriate to the requirements of the program;
(b) Establish policies governing the responsibilities, authority and duties of the administrator that are designed to enable the administrator to perform the administrative and treatment functions of the facility;
(c) Appoint a medical director of the facility who is responsible for the medical services provided at the facility;
(d) Determine, in accordance with state law, which categories of practitioners are eligible to be appointed to the medical staff of the facility;
(e) Appoint members to the medical staff of the facility who are accountable to the governing body for the quality of medical care provided to clients of the facility, taking into consideration any recommendations of the existing members of the medical staff;
(f) Review and revise the bylaws and policies of the governing body;
(g) Adopt controls designed to achieve and maintain maximum standards of service; and
(h) Review and approve an annual budget to carry out the objectives of the program.
5. The governing body shall retain the ultimate responsibility for the overall program and its objectives.
6. The governing body shall meet at least semiannually. Minutes must be kept of the meetings, including, without limitation, the date of each meeting, those in attendance, topics discussed, decisions made and actions taken, and all program reports.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15327 Policies and procedures for services and operation of facility. (NRS 449.037)
1. Each facility shall have written policies and procedures available to members of the staff, clients and the public that govern the operation of the facility and services provided by the facility.
2. The policies must:
(a) Ensure that only those persons are accepted as clients whose needs can be met by the facility directly or in cooperation with community resources or other providers of treatment with which it is affiliated or has contacts.
(b) Ensure that a client whose physical or mental condition has changed to such an extent that he can no longer be adequately served by the facility will be transferred promptly to an appropriate facility. Written transfer agreements or other written provisions with such other facilities must be maintained by the facility.
(c) Set forth the rights of clients and members of the staff and provide for the registration and disposition of complaints without threat of discharge or reprisal against any employee or client.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15329 Transfer of client. (NRS 449.037)
1. Except in the case of an emergency, the transfer of a client must not be effected until the client, attending physician of the client, if any, and responsible agency are consulted in advance.
2. Except as otherwise provided in subsection 3, if a client is transferred to a hospital or other medical facility, a summary of discharge containing a plan for continuation of care must be prepared and forwarded to the receiving facility if the client or his guardian consents to release such information to the receiving facility.
3. If a client is transferred to a hospital or other medical facility as a result of a medical emergency, information required for appropriate continuation of care must be released to the receiving facility in compliance with the standards set forth in 42 C.F.R. Part 2.
4. The admission agreement must not allow the licensee or his designee to be given power of attorney.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15331 Handling of money of client. (NRS 449.037)
1. If a facility handles the money of a client, a written ledger account of all deposits, disbursements or other transactions must be maintained. A record must be made available to the client at least quarterly.
2. The money of a client must be given to him within 24 hours after his exit from the facility.
3. Large sums of money must be maintained in a financial institution in the community where the facility is located in a separate trustee account apart from the operational accounts of the facility and must be clearly designated.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15333 Inventory of belongings of client. (NRS 449.037) If a facility holds or stores the belongings of a client, there must be an inventory of the belongings on admission, made a part of the record of the client and updated as needed. These belongings must be returned to the client upon his exit.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15335 Liability insurance. (NRS 449.037) Liability insurance in a sufficient amount to protect clients, members of the staff, volunteers and visitors, must be maintained by each facility. A certificate of insurance must be furnished to the Health Division. The certificate must include, without limitation, provision for 30 days’ notice to the Health Division of cancellation or the nonrenewal of a policy of insurance.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15337 Program: Requirements; review. (NRS 449.037)
1. Each facility shall have a written program outlining short-term and long-term objectives and goals. These goals must be realistic, attainable, and clearly and operationally defined.
2. Each component of the program must develop objectives that complement the goals of the program.
3. The Health Division shall:
(a) Periodically evaluate the program;
(b) Prepare a report of the evaluation; and
(c) Distribute the report to the persons who manage the program and make the report available to the members of the staff of the facility and the Bureau of Licensure and Certification of the Health Division.
4. The facility shall provide for the medical, dental and psychological services needed to fulfill the goals of the program and meet the needs of all its clients to the extent that is possible, with assistance from available community resources.
5. If a facility provides services through outside sources, formal, written arrangements must be made ensuring that the services are supplied directly by, or under the supervision of, qualified persons.
6. Each facility shall provide case management services as needed by a client through a social worker or a registered nurse or by written agreement with a social worker or a registered nurse.
7. A plan for case management must be recorded in the records of a client and must be periodically evaluated in conjunction with the treatment plan of the client.
8. Each facility shall review its general program at least annually. Areas reviewed must include, without limitation, appropriateness of admissions, lengths of stay, discharge planning, use of services and utilization of the components of the program and outside services. Written reports of the reviews must be evaluated by the governing body, administrator and such committees as they designate. Documentation of the evaluation process must be maintained at the facility.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15339 Responsibilities and duties of administrator. (NRS 449.037)
1. The administrator of a facility is responsible to the governing body of the facility for the operation of the facility in accordance with the policies and procedures of the facility.
2. The administrator shall:
(a) Organize the administrative functions of the program, delegate duties and establish a formal means of accountability on the part of subordinates.
(b) Ensure that a written manual defining the policies and procedures of the program is prepared, regularly revised and updated. The manual must:
(1) Contain all policies and procedures of the facility, including, without limitation, definitions and other documentation required by NAC 449.15311 to 449.15369; and
(2) Be available to members of the staff of the facility at all times at designated and convenient locations.
(c) Appoint a person who has attained the age of majority to act for him during any extended absence.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15341 Policies and procedures concerning employees. (NRS 449.037)
1. Each facility shall have on duty, all hours of each day, members of the staff sufficient in number and qualifications to carry out policies, responsibilities and program continuity.
2. All members of the counseling staff of a facility shall be authorized by state law to provide alcohol and drug counseling.
3. The administrator or his appointee shall be present and responsible for the operations of the facility during normal hours.
4. Each facility shall have written policies and procedures for the recruitment, selection, promotion and termination of members of the staff.
5. Each facility shall have written policies and procedures concerning wages and salaries, working hours, employee benefits, vacation and sick leave, rules of conduct, and training and development of the staff.
6. Each facility shall provide an orientation session to new employees. Documentation of the session must be maintained in the personnel file of the employee.
7. Each facility shall have written policies and procedures governing disciplinary actions that clearly define the mechanism for the suspension or dismissal of members of the staff as well as the procedures for appeal.
8. Each facility shall maintain a written job description for each position at the facility. The job description must accurately reflect the actual job situation and must be reviewed annually or whenever a change in the responsibilities of the job or qualifications occurs. Job descriptions must be available on request to all members of the staff. A job description must include, without limitation:
(a) The title of the job;
(b) The tasks and responsibilities of the job;
(c) The skills, education and experience necessary for the job;
(d) The relationship of the job to other jobs within the program; and
(e) The working conditions, location and shift of the job, and the materials and equipment to be used on the job.
9. Each facility shall maintain a personnel record for each employee of the facility. The record must include, without limitation:
(a) The employment application;
(b) Letters of recommendation;
(c) Records from any investigation of the employee;
(d) Verification of training, experience and certification;
(e) Job performance evaluations;
(f) Incident reports; and
(g) Disciplinary actions taken.
10. Each facility shall maintain personnel records in a secure manner and make them available only to those persons authorized to receive personnel records in the written policies and procedures of the facility. An employee must have access to his own file upon request.
11. Each person employed in a facility shall have a preemployment physical examination or certification of a 3-year health record from a physician, and be tested for tuberculosis as required in chapter 441A of NAC.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15343 Nursing services. (NRS 449.037)
1. Each facility shall have an organized plan for nursing service that provides nursing services 24 hours per day. The nursing services must be provided or supervised by a registered nurse in compliance with state law, including, without limitation, chapter 632 of NRS and chapter 632 of NAC.
2. The nursing service shall have a sufficient number of registered nurses, licensed practical nurses and other personnel to provide nursing care to all clients as needed.
3. The facility shall ensure that the nursing staff develops and keeps current a plan for nursing care for each client.
4. The administrator shall appoint a chief administrative nurse to direct the nursing service. The chief administrative nurse must:
(a) Be a registered nurse;
(b) Be knowledgeable, skilled and competent in clinical practice and the management of nurses;
(c) Be authorized by state law to provide alcohol and drug counseling; and
(d) Comply with the provisions of chapter 632 of NRS and chapter 632 of NAC and follow professional standards established for organized nursing services.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15345 Health services. (NRS 449.037)
1. Each facility shall provide health services which ensure that each client receives treatment, prescribed medication, adequate diets and other health services consistent with the program administered by the facility.
2. There must be policies and procedures designed to ensure the early detection of complications or conditions considered to be common among alcohol and drug abusers. The policies and procedures must be developed with assistance from and approved by the medical director of the facility.
3. Before a client is admitted to a facility, a general medical and drug history of the client must be taken by a physician or designated member of the nursing staff of the facility. The history must include, without limitation:
(a) Drugs used in the past;
(b) Drugs used recently;
(c) Drugs of preference;
(d) Frequently used drugs;
(e) Drugs used in combination;
(f ) Dosages used;
(g) Date of first usage;
(h) Incidents of overdose, withdrawal or adverse drugs reactions; and
(i) Previous history of treatment.
4. Except as otherwise provided in this subsection, a physical examination and review of the medical and drug history of a client must be conducted by a physician, registered nurse or physician assistant within 48 hours after the client is admitted to a facility. If the assessment performed by a physician or a member of the nursing staff before a client is admitted to the facility concludes that a physical examination of the client should be completed within less than 48 hours after the client is admitted to the facility to ensure that the needs of the client are met, the physical examination must be conducted within the time recommended in the assessment.
5. Each facility must be able to provide directly, or through written arrangements, laboratory tests as requested by a physician or federal regulations.
6. Referral to an outside health resource must be made only if the resource is able to accept the client. Any records that accompany the client must be either expurgated of any sensitive material or be available only to persons authorized to receive the information under the direction of the physician or administrator. Except where an emergency that threatens a life exists and except as otherwise provided in NAC 449.15329, no information may be released without the prior consent of the client or his guardian.
7. Each facility shall have written policies and procedures defining the appropriate action to be taken when a medical emergency arises. The policies and procedures must be reviewed and approved by the medical director of the facility.
8. Each member of the staff of a facility must be qualified by the American Red Cross or another similar nationally recognized agency to administer cardiopulmonary resuscitation.
9. Each client of a facility shall, within 5 days after admission, undergo a Mantoux tuberculin skin test. If the client has no documented history of a two-step Mantoux tuberculin skin test and has not had a single Mantoux tuberculin skin test within the 12 months preceding admission to the facility, the client shall undergo a two-step Mantoux tuberculin skin test.
10. First-aid supplies must be maintained and readily available at each facility.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15347 Pharmaceutical services. (NRS 449.037)
1. Each facility shall have a pharmacy directed by a registered pharmacist or a drug room supervised by no less than a currently licensed professional nurse. The pharmacy or drug room must be administered in accordance with all applicable state and federal laws. The facility shall have a full-time, part-time or consulting pharmacist who is responsible for developing, supervising and coordinating all of the activities of the pharmacy service.
2. Each facility shall have and implement policies and procedures that minimize errors in the administration of drugs. The medical director of the facility and the pharmacist who is responsible for the pharmacy service shall approve the policies and procedures.
3. Drugs and biologicals must be controlled and distributed in accordance with applicable standards of practice and state and federal laws.
4. When a pharmacist is not available at the facility, drugs and biologicals may be removed from the pharmacy or drug area only by a member of the staff who is authorized to remove such substances by the policies and procedures of the facility, which must be established in accordance with state and federal laws.
5. Errors in administering a drug, adverse reactions by a client to a drug and incompatibilities between a drug and a client must be immediately reported to the attending physician of the client.
6. Abuses and losses of controlled substances must be reported to the pharmacist who is responsible for the pharmacy service, the administrator and the chief administrative nurse of the facility, in accordance with all applicable state and federal laws.
7. Information relating to drug interactions and information on drug therapy, side effects, toxicology, dosage indications for use and routes of administration must be available to the professional members of the staff of the facility.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15349 Medication and biologicals. (NRS 449.037)
1. Except as otherwise provided in subsection 2, an order for medication or biologicals for a client must be in writing and signed by the practitioner, or other appropriate professional person authorized by state or federal law to order the medication or biological, who is responsible for the care of the patient.
2. When a telephone or verbal order is used to order medications or biologicals, the order must be:
(a) Accepted only by a person who is authorized by the policies and procedures of the facility, which must be consistent with state law, to accept such an order; and
(b) Signed or initialed by the prescribing practitioner in accordance with the policies and procedures of the facility.
3. Each order for a medication or biological must include, without limitation, the name of the medication or biological, and the dosage, time or frequency of administration and route of administration of the medication or biological.
4. Only a member of the staff of the facility who is authorized by state law to administer medication or biologicals may administer medication or biologicals at the facility.
5. Each facility shall have a system to monitor and improve the process of administering medication and biologicals.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15351 Dietary services. (NRS 449.037)
1. Facilities shall serve at least three meals or their equivalent daily, at regular times, with not more than 14 hours between a substantial evening meal and breakfast. A second serving must be provided for those clients who desire one.
2. Menus must be planned and followed to meet the nutritional needs of the clients in accordance with the recommended dietary allowances recommended by the Food and Nutrition Board of the National Research Council, National Academy of Sciences.
3. Therapeutic menus must be planned by a registered dietitian or must be reviewed and approved by the attending physician of the client or a staff physician.
4. Menus must be in writing, planned in advance, dated and posted, and kept on file at the facility for at least 90 days. Any substitution must be noted on the written menu so that the menu on file reflects what was actually served.
5. Adequate facilities and equipment for the preparation, serving, refrigeration and storage of food in a sanitary manner must be provided.
6. A facility with more than 10 clients shall:
(a) Comply with all applicable provisions of chapter 446 of NRS and the regulations adopted pursuant thereto;
(b) Obtain the necessary permits from the Bureau of Health Protection Services of the Health Division;
(c) Maintain a report of each inspection concerning the sanitation of the facility for at least 1 year after the date of the inspection; and
(d) Maintain a report of each corrective action taken to address a deficiency noted in a report described in paragraph (c) for at least 1 year after the date of the corrective action.
7. Clients needing special equipment, implements or utensils to assist them while eating must have such items provided.
8. If a facility operates on the cottage plan, provision must be made for food service that ensures hot, palatable meals.
9. A professional, qualified person must be used as a consultant on planning meals and serving food. At least 4 hours of consultation each month is required. A person is qualified only if he meets the requirements for registration with the Commission on Dietetic Registration as a dietitian or dietetic technician.
10. A facility that contracts with a food management company shall comply with all applicable regulations of the State Board of Health.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004)
NAC 449.15353 Records of clients. (NRS 449.037)
1. Each facility shall maintain an organized system for the records of clients.
2. The records of a client must be available to professional members of the staff of the facility who are directly involved with the client.
3. The records of clients must be available to representatives of the Health Division.
4. The records of clients must include, without limitation:
(a) Identification information;
(b) Past medical and social history;
(c) Copies of initial and periodic examinations;
(d) Evaluations and progress notes; and
(e) Assessments and goals of the plan of treatment of each client.
5. The plan of treatment must state what service or person is responsible for providing treatment or services to the client.
6. Entries must be made describing treatments and services rendered, medications administered, and any symptoms or other indications of illness or injury, including, without limitation, the date, time and action taken regarding each incident.
7. Records must be adequately safeguarded against destruction, loss or unauthorized use.
8. Records must be retained for at least 5 years after the discharge of a client from a facility.
9. A discharge plan, as determined by a case management assessment of the client, must be documented for each client discharged from the facility.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15355 Safety and sanitation; temperature. (NRS 449.037)
1. The premises and equipment of each facility must be maintained in a safe, functional and sanitary condition. Each facility shall have the necessary cleaning and maintenance equipment with sufficient storage areas and appropriate procedures to maintain a clean and orderly establishment. Janitorial supplies, including, without limitation, aerosols, must be stored in areas separate from clean linen, food and other supplies. The storage of dirty linen must be separate from the storage of clean linen, food and other supplies.
2. Items for personal use, including, without limitation, combs, toothbrushes, towels and bar soap, must not be shared by clients.
3. Restrooms or lavatories for the staff of a facility must be provided with soap dispensers and individual, disposable towels.
4. Each facility shall ensure that the environment of the facility is free of hazards that may cause accidents.
5. Each facility shall maintain an effective program to control pests and rodents in order to ensure that the facility is free from pests and rodents.
6. Each facility shall provide safe and comfortable levels of temperature in the facility. The temperature of the facility must be maintained at a level that is not less than 71 degrees Fahrenheit and not more than 81 degrees Fahrenheit.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004)
NAC 449.15357 Laundry requirements. (NRS 449.037)
1. Each facility shall have the proper equipment for the sanitary washing and finishing of linen and other washable goods or shall maintain a written agreement with a commercial establishment to provide laundry services.
2. The laundry area of a facility must be situated in an area of the facility that is separate and apart from any room where food is stored, prepared or served. The laundry area must be well-lighted, ventilated, adequate in size to house equipment, maintained in a sanitary manner and kept in good repair.
3. Soiled linen must be collected and transported to the laundry in washable or disposable containers in a sanitary manner. Soiled linen must not be transported through areas of the facility used for preparing or serving food.
4. Clean linen to be dried, ironed, folded, transferred or distributed must be handled in a sanitary manner in accordance with a written plan maintained by the facility.
5. Closets for storing linen and laundry supplies must be provided and must not be used for any other purpose.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15359 New construction or remodeling: Submission and approval of building plans; prerequisites to approval of facility for licensure. (NRS 449.037)
1. Except as otherwise provided in subsection 4, before any new construction of a facility or any remodeling of an existing facility is begun:
(a) The facility must submit a copy of the building plans for the new construction or remodeling to the entity designated to review such plans by the Health Division pursuant to the provisions of NAC 449.0115. The entity’s review of those plans is advisory only and does not constitute approval for licensure of the facility.
(b) The building plans must be approved by the Health Division.
2. The Bureau shall not approve a facility for licensure until all construction is completed and a survey is conducted at the site of the facility.
3. The Health Division shall not issue a license to operate a facility until the Bureau has approved the construction of the facility.
4. The provisions of subsection 1 do not apply to plans for remodeling a facility if the remodeling is limited to refurbishing an area within the facility, including, without limitation, painting in the area, replacing flooring in the area, repairing windows in the area or replacing window and wall coverings in the area.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R076-01, 10-18-2001; R069-04, 8-4-2004)
NAC 449.15361 Design, construction, equipment and maintenance. (NRS 449.037)
1. Each facility must be designed, constructed, equipped and maintained in a manner that protects the health and safety of the clients and personnel of the facility and members of the general public.
2. Each facility shall comply with all applicable:
(a) Federal and state laws;
(b) Local ordinances, including, without limitation, zoning ordinances; and
(c) Environmental, life safety, fire, health and local building codes,
Ê related to the construction and maintenance of the facility. If there is a difference between state and local requirements, the more stringent requirements apply.
3. Each facility shall comply with the provisions of NFPA 101: Life Safety Code, as adopted by reference pursuant to NAC 449.0105. Facilities housing 17 or more clients shall meet the requirements of the chapter entitled “Hotel and Dormitories,” of the edition of NFPA 101: Life Safety Code adopted by reference pursuant to NAC 449.0105. Those facilities housing not more than 16 clients shall meet the requirements of the chapter entitled “Lodging or Rooming Houses,” of the edition of NFPA 101: Life Safety Code adopted by reference pursuant to NAC 449.0105.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004)
NAC 449.15363 Accommodations for clients. (NRS 449.037)
1. No room or space of a facility may be occupied for sleeping, living or dining that is accessible only by a ladder, by folding stairs or through a trapdoor.
2. If a basement of a facility is used for living and dining, at least one exit must be provided directly to the outside at ground level. No facility may:
(a) Be situated more than one story below the ground; and
(b) Use any basement or space in a basement for sleeping.
3. Each room of a facility used by clients for sleeping must:
(a) Be provided and furnished with a bed, clean linen and blankets;
(b) Not be less than 60 square feet per bed; and
(c) Not be used for sleeping by more than four clients.
4. Toilet facilities and bathing facilities must be provided to clients in a manner that ensures their privacy while bathing and in an adequate number to meet the needs of the clients.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
NAC 449.15365 Safety from fire. (NRS 449.037)
1. Devices for the detection of combustion other than heat detectors must be installed on the ceiling of each story of a facility, in front of doors to stairways in a facility, and at not more than 30 feet apart in the corridors of all floors of a facility, including, without limitation, the center. Smoke detectors must also be installed in the center of any lounge or recreational area of a facility. The smoke detectors may be single station units with an integral alarm.
2. Portable fire extinguishers must be installed throughout each facility at the direction of the fire authority having jurisdiction. Each portable fire extinguisher available at a facility must be inspected, recharged and tagged at least once each year by a person certified by the State Fire Marshal to conduct such inspections.
3. A portable room-heating device may be used if the device:
(a) Is located 2 feet or more from any combustible material;
(b) Is plugged directly into a wall socket;
(c) Turns off automatically if tipped over; and
(d) Has no exposed heating elements.
4. Receptacles or outlets serviced by extension cords are prohibited in facilities.
5. Rooms in which smoking is allowed by direction of the facility or the fire authority must be provided with plainly visible “Smoking Area” signs.
6. Each facility shall conduct fire drills at least monthly, and a written record of each drill conducted must be retained in the facility for not less than 12 months after the drill is conducted.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004)
NAC 449.15367 Preparations for disasters; reporting of fire or disaster. (NRS 449.037)
1. Each facility shall develop a written plan for disasters that outlines procedures for members of the staff and clients to follow in case of fire or another emergency and provides for meeting the needs of clients if the facility must be evacuated or is destroyed.
2. A simple floor plan showing the routes for evacuating must be posted in prominent locations on each floor of the facility.
3. The facility shall notify the Bureau of the occurrence of a fire or disaster in the facility within 24 hours after the facility becomes aware of the fire or disaster.
4. Each facility shall conduct a disaster drill at least annually and retain a written record of the drill in the facility for not less than 12 months after the drill is conducted.
5. Each facility shall adopt procedures to ensure that water is available to the essential areas of the facility if there is an interruption in the facility’s normal supply of water.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004)
NAC 449.15369 Discrimination prohibited. (NRS 449.037)
1. No facility that accepts a person for treatment for whom all or part of the payment for treatment is made from the money of the Division of Welfare and Supportive Services or any other agency funded in whole or in part by federal money may deny treatment to a prospective client on the grounds of race, color, national origin, age, gender or disability.
2. No client may be segregated, given separate treatment, restricted in the employment of any advantage or privilege enjoyed by others under the program or provided with any aid, treatment, services or other benefits which are different or provided in a different manner from that provided to others under the program on the grounds of race, color, national origin, age, gender or disability.
3. Employment practices of a facility, including, without limitation, hiring, firing, the rate of remuneration, assignments or work hours, may not be based on race, color, national origin, age, gender or disability.
(Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)
FACILITIES FOR TREATMENT WITH NARCOTICS; MEDICATION UNITS
General Provisions
NAC 449.154 Definitions. (NRS 449.037, 449.038) As used in NAC 449.154 to 449.15485, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.15415 to 449.15438, inclusive, have the meanings ascribed to them in those sections.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)
NAC 449.15415 “DEA” defined. (NRS 449.037, 449.038) “DEA” means the Drug Enforcement Administration of the United States Department of Justice.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)
NAC 449.1542 “Facility for treatment with narcotics” defined. (NRS 449.037, 449.038) “Facility for treatment with narcotics” means any person or any public or private facility that provides a narcotic treatment program described in 42 C.F.R. Part 8.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)
NAC 449.1543 “Medical director” defined. (NRS 449.037, 449.038) “Medical director” means a physician who is licensed to practice medicine in this State and who is responsible for the administration of all medical services at a facility for treatment with narcotics or a medication unit and for ensuring that the facility or the medication unit complies with all applicable federal, state and local laws and regulations.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)
NAC 449.15435 “Medication unit” defined. (NRS 449.037, 449.038) “Medication unit” means any person or any public or private facility that:
1. Is established as part of or operates in conjunction with a facility for treatment with narcotics but is separated geographically from the facility for treatment with narcotics; and
2. Is limited to:
(a) Administering or dispensing narcotics; and
(b) Collecting specimens in accordance with chapter 652 of NRS for drug testing or analysis relating to treatment with narcotics.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)
NAC 449.15438 “SAMHSA” defined. (NRS 449.037, 449.038) “SAMHSA” means the Substance Abuse and Mental Health Services Administration of the United States Department of Health and Human Services.
(Added to NAC by Bd. of Health by R053-02, eff. 7-24-2002)
NAC 449.1544 Health Division is state authority for certain federal regulations. (NRS 449.037, 449.038) The Health Division is the state authority for the purposes of 42 C.F.R. Part 8.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)
Licensing
NAC 449.15445 License and federal certification required to operate facility or unit. (NRS 449.037, 449.038)
1. A person or a public or private facility shall not operate or provide the services of a facility for treatment with narcotics or represent that it operates or provides the services of a facility for treatment with narcotics, unless the person or the public or private facility is:
(a) Licensed by the Health Division pursuant to NAC 449.154 to 449.15485, inclusive, to operate the facility for treatment with narcotics; and
(b) Certified by the SAMHSA pursuant to 42 C.F.R. Part 8 to operate the facility for treatment with narcotics.
2. A person or a public or private facility shall not operate or provide the services of a medication unit or represent that it operates or provides the services of a medication unit, unless the person or the public or private facility is:
(a) Licensed by the Health Division pursuant to NAC 449.154 to 449.15485, inclusive, to operate the medication unit and the facility for treatment with narcotics that is associated with the medication unit; and
(b) Certified by the SAMHSA pursuant to 42 C.F.R. Part 8 to operate the medication unit and the facility for treatment with narcotics that is associated with the medication unit.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)
NAC 449.1545 Filing requirements; recommendation for certification. (NRS 449.037, 449.038)
1. If a person or a public or private facility wants to operate a facility for treatment with narcotics or a medication unit, the person or the public or private facility must:
(a) File with the SAMHSA an application for certification pursuant to 42 C.F.R. Part 8;
(b) File with the Bureau an application for a license pursuant to NAC 449.011 and include with the application:
(1) If there is an accreditation body that has been approved pursuant to 42 C.F.R. § 8.3, proof that the applicant has applied for accreditation from such accreditation body; and
(2) Any other information requested by the Bureau; and
(c) Demonstrate that the proposed facility for treatment with narcotics or the proposed medication unit is able to comply with the requirements set forth in NAC 449.1548.
2. A person or a public or private facility must file an application for a license for each facility for treatment with narcotics that it wants to operate, whether or not the person or the public or private facility is already licensed to operate one or more other facilities for treatment with narcotics.
3. A person or a public or private facility must file an application for a license for each medication unit that it wants to operate, whether or not the person or the public or private facility is already licensed to operate one or more other medication units.
4. The Health Division may make a recommendation to the SAMHSA that an applicant for certification of a facility for treatment with narcotics or a medication unit be certified, if the applicant has:
(a) Satisfied all the requirements for licensure by the Health Division pursuant to NAC 449.154 to 449.15485, inclusive;
(b) Submitted all items required pursuant to NAC 449.011; and
(c) Provided satisfactory evidence to the Health Division that the facility is in substantial compliance with the requirements of 42 C.F.R. Part 8.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)
NAC 449.15455 Investigation and prelicensure survey. (NRS 449.037, 449.038)
1. If an application for a license is filed pursuant to NAC 449.1545, the Bureau shall conduct pursuant to NAC 449.0112:
(a) An investigation; and
(b) A prelicensure survey.
2. The investigation and any prelicensure survey conducted by the Bureau must include, but are not limited to, an evaluation of whether the proposed facility for treatment with narcotics or the proposed medication unit is able to comply with the requirements set forth in NAC 449.1548.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)
NAC 449.1547 Suspension, revocation or cancellation of license; provisional license; denial of application. (NRS 449.037, 449.038)
1. The Health Division may suspend or revoke a license issued pursuant to NAC 449.154 to 449.15485, inclusive, or cancel such a license and issue a provisional license based upon any grounds for such action set forth in this chapter or chapter 449 of NRS.
2. The Health Division shall deny an application for a license pursuant to NAC 449.1545 if the SAMHSA denies an application for certification pursuant to 42 C.F.R. Part 8.
3. The Health Division shall suspend or revoke a license issued pursuant to NAC 449.154 to 449.15485, inclusive, if the facility for treatment with narcotics or the medication unit operates without certification from the SAMHSA pursuant to 42 C.F.R. Part 8.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)
Operation
NAC 449.1548 General operational requirements. (NRS 449.037, 449.038) In addition to all other requirements set forth in NAC 449.154 to 449.15485, inclusive, each facility for treatment with narcotics and each medication unit shall:
1. Have a medical director who has a valid and current license to practice medicine in this State;
2. Employ, contract with or allow a person to act as an alcohol and drug abuse counselor only if the person is certified by the Board of Examiners for Alcohol, Drug and Gambling Counselors to be such a counselor;
3. Obtain and maintain with the State Board of Pharmacy a valid and current registration relating to the use of narcotics;
4. Be in full compliance with all applicable provisions of 42 C.F.R. Part 8, all other applicable federal laws and regulations and all other requirements of the SAMHSA and the DEA;
5. Be in full compliance with all applicable provisions of chapters 449 and 453 of NRS and in substantial compliance with all applicable provisions of this chapter and chapter 453 of NAC;
6. Maintain records and documentation of treatment pursuant to NRS 453.690;
7. Provide the Health Division and the State Board of Pharmacy with access to all records and documentation relating to the purchase, distribution and use of narcotics;
8. Comply with the rules of confidentiality and privilege set forth in NRS 453.720;
9. Develop and maintain a system to ensure that prospective and existing clients are not receiving narcotics from any other facility for treatment with narcotics or any other medication unit; and
10. Comply with all applicable local laws and regulations, including, but not limited to, zoning laws and regulations.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002; R098-06, 7-14-2006)
NAC 449.15485 Continuing review of operations; investigation of complaints. (NRS 449.037, 449.038)
1. The operation of a facility for treatment with narcotics or a medication unit is subject to continuing review by the Health Division.
2. The Health Division shall investigate all complaints against a facility for treatment with narcotics or a medication unit directly or in conjunction with other federal, state or local governmental agencies, including, but not limited to, the SAMHSA, the DEA, the State Board of Pharmacy or the Health Division.
(Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)
HALFWAY HOUSES FOR RECOVERING ALCOHOL AND DRUG ABUSERS
NAC 449.1549 Definitions. (NRS 449.037) As used in NAC 449.1549 to 449.154945, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.154901, 449.154903 and 449.154905 have the meanings ascribed to them in those sections.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154901 “Administrator” defined. (NRS 449.037) “Administrator” means a person:
1. Whose name appears on a license issued by the Bureau as administrator of record for a facility; and
2. Who is legally responsible for the management of the facility.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154903 “Client” defined. (NRS 449.037) “Client” means a person who is admitted to a facility.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154905 “Facility” defined. (NRS 449.037) “Facility” means a halfway house for recovering alcohol and drug abusers as defined in NRS 449.008.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.15491 Administrator: Qualifications. (NRS 449.037) An administrator must:
1. Be at least 21 years of age;
2. Have the tests and obtain the certifications required by NAC 441A.375 for a person employed in a facility for the dependent; and
3. Maintain evidence that he satisfies the requirements of this section in a file that is maintained on the premises of the facility.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154911 Administrator: General duties. (NRS 449.037) An administrator shall:
1. Post the license issued by the Bureau in a conspicuous place within the facility.
2. Organize and manage the facility.
3. Establish policies, procedures and rules for the operation of the facility, including, without limitation, the policies and procedures required to be established by NAC 449.154915.
4. Ensure that the records of the facility are maintained in accordance with the requirements of the policies, procedures and rules for the operation of the facility established pursuant to subsection 3.
5. Ensure that the facility complies with any applicable state statutes and regulations and local ordinances.
6. Ensure that the clients of the facility are afforded the opportunity to exercise their individual rights in a manner consistent with the rules of the facility.
7. Ensure that the facility is maintained in a safe and clean condition.
8. Review and approve changes in the policies and procedures established pursuant to subsection 3 at least annually. This review must be signed and dated.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154913 General operational guidelines. (NRS 449.037) An administrator shall ensure that:
1. Alcohol or drugs are not allowed on the premises of the facility;
2. The policies, procedures and rules established pursuant to NAC 449.154911 are carried out;
3. Each client complies with those policies, procedures and rules;
4. The facility provides an environment that will facilitate the reintegration of the clients of the facility into the community; and
5. The operation of the facility is not compromised by a client who violates the policies, procedures or rules of the facility.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154915 Policies and procedures: Establishment; maintenance of manual. (NRS 449.037)
1. An administrator shall establish written policies and procedures concerning:
(a) The manner in which records of clients will be maintained and protected against unauthorized use;
(b) The disclosure of confidential information about clients;
(c) The criteria the facility will use to determine whether to:
(1) Admit a client to the facility; and
(2) Discharge a client from the facility;
(d) The discharge of a client for a violation of the rules of the facility;
(e) The discharge of a client for the use of alcohol or drugs;
(f ) The rights and responsibilities of a client; and
(g) The evacuation of clients in case of fire or other emergency as required by NAC 449.154945.
2. The administrator shall maintain a manual of policies, procedures and rules of the facility that includes the policies and procedures established pursuant to subsection 1. The manual must be available on the premises of the facility at all times.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154917 Limitation on admissions. (NRS 449.037) An administrator shall ensure that the facility does not admit more clients to the facility than the number of beds for which it is licensed.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154919 Health and sanitation. (NRS 449.037)
1. An administrator shall ensure that the facility:
(a) Has a safe and sufficient supply of water, adequate drainage and an adequate system for the disposal of sewage; and
(b) Complies with all local ordinances and state and federal laws and regulations relating to zoning, sanitation, safety and accessibility to persons with disabilities.
2. A container used to store garbage outside of a facility must be kept reasonably clean and must be covered in such a manner that rodents are unable to get inside the container. At least once each week, the container must be emptied and the contents of the container must be removed from the premises of the facility.
3. To the extent practicable, the premises of the facility must be kept free from:
(a) Offensive odors;
(b) Hazards, including obstacles that impede the free movement of clients within and outside the facility;
(c) Insects and rodents; and
(d) Accumulations of dirt, garbage and other refuse.
4. The administrator shall ensure that the premises of the facility are clean and that the interior, exterior and landscaping of the facility are well maintained.
5. All windows that are capable of being opened in the facility and all doors that are left open to provide ventilation for the facility must be screened to prevent the entry of insects.
6. The administrator shall ensure that electrical lighting is maintained in the facility as necessary to ensure the comfort and safety of the clients of the facility.
7. The temperature in the facility must be maintained at a level that is not less than 68 degrees Fahrenheit and not more than 82 degrees Fahrenheit.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154921 Laundry facilities. (NRS 449.037)
1. An administrator shall ensure that laundry facilities are provided in the facility commensurate with the number of clients in the facility. At least one washer and at least one dryer must be provided in the facility.
2. The laundry area in a facility must be maintained in a sanitary manner. All the equipment in the laundry area must be maintained in good working condition. All dryers must be ventilated to the outside of the building.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154923 Kitchens; storage of food. (NRS 449.037)
1. The kitchen in a facility and the equipment in the kitchen must be clean and must allow for the sanitary preparation of food. The equipment must be in good working condition.
2. Perishable food must be refrigerated at a temperature of 40 degrees Fahrenheit or less. Frozen food must be kept at a temperature of 0 degrees Fahrenheit or less.
3. Food must not be stored in any area in which cleaning or pest control products are stored.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154925 Bedrooms; bedding. (NRS 449.037)
1. A bedroom in a facility that is used by more than one client must have at least 45 square feet of floor space for each client who resides in the bedroom. A bedroom that is occupied by only one client must have at least 80 square feet of floor space.
2. The arrangement of the beds and other furniture in the bedroom must accommodate the clients occupying the bedroom in comfort and safety.
3. A bed with a comfortable and clean mattress must be provided for each client. The bed must be made with two clean sheets, a blanket, a pillow and a bedspread. Linens must be changed at least once each week and more often if the linens become dirty.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154927 Use of certain areas as bedroom prohibited. (NRS 449.037) A hall, stairway, unfinished attic, garage, storage area or shed or other similar area of a facility must not be used as a bedroom. Any other room must not be used as a bedroom if it is used for any other purpose.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154929 Bathrooms and toilet facilities; toilet articles. (NRS 449.037)
1. All bathrooms and toilet facilities in the facility must be sufficiently lighted.
2. Each client must have his own towels and washcloths. Paper towels may be used for hand towels. The towels and washcloths must be changed as often as is necessary to maintain cleanliness, but in no event less often than once each week. A soap dispenser that provides liquid or granular soap may be used instead of individual bars of soap.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154931 Accommodations for residents with restricted mobility. (NRS 449.037) A facility that has a client who uses a wheelchair or a walker must:
1. Have hallways, doorways and exits wide enough to accommodate a wheelchair or walker; and
2. Have ramps at all primary exits.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154933 First aid. (NRS 449.037)
1. A first-aid kit must be available at the facility. The first-aid kit must include, without limitation:
(a) A germicide safe for use by humans;
(b) Sterile gauze pads;
(c) Adhesive bandages, rolls of gauze and adhesive tape;
(d) Disposable gloves;
(e) A shield or mask to be used by a person who is administering cardiopulmonary resuscitation; and
(f) A thermometer or other device that may be used to determine the bodily temperature of a person.
2. Except for first aid in an emergency, no treatment or medication may be administered to a client.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154935 Medication. (NRS 449.037)
1. Except as otherwise provided in NAC 449.154933, an administrator or another client shall not administer or assist in the administration of medication to a client.
2. Medication for self-administration may be kept at the facility. That medication must:
(a) Be disposed of immediately when it expires or when a physician orders the medication to be discontinued;
(b) Be stored and controlled in a manner that protects the medication from unauthorized use; and
(c) Not be used by more than one of the clients.
3. The provisions of paragraph (a) of subsection 2 do not apply to over-the-counter medication.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154937 Telephones; telephone number. (NRS 449.037) An administrator shall ensure that:
1. The facility has at least one telephone that is in good working condition in the facility; and
2. The telephone number of the facility is listed in the telephone directory.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154939 Notification to Bureau under certain circumstances. (NRS 449.037) An administrator shall notify the Bureau within 24 hours after the occurrence of an incident that:
1. Involved significant harm to a client of the facility if the client of the facility required medical treatment as a result of the incident;
2. May cause imminent danger to the health or safety of a client of the facility; or
3. May jeopardize the integrity of the operation of the facility.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154941 Rights of clients. (NRS 449.037) An administrator shall ensure that:
1. A client of the facility is not abused, neglected or exploited by another client of the facility or any person who is visiting the facility;
2. A client is not prohibited from speaking to any person who advocates for the rights of the clients of the facility;
3. Each client is treated with respect and dignity;
4. The facility provides a safe and comfortable environment;
5. A client is not prohibited from interacting socially in a manner that is consistent with the rules of the facility;
6. To the extent practicable and in a manner that is consistent with the rules of the facility, each client is allowed to make his own decisions; and
7. The telephone number of the local office of the Bureau and the name and telephone number of the administrator is conspicuously posted on the premises of the facility.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154943 Client files: Maintenance; contents; confidentiality. (NRS 449.037)
1. An administrator shall ensure that the facility maintains a separate file for each client of the facility and retains the file for at least 5 years after the client permanently leaves the facility. The file must be kept locked in a location that is protected against unauthorized use. Each file must contain the information obtained by the facility that is related to the client, including, without limitation:
(a) The full name, address, date of birth and social security number of the client;
(b) The address and telephone number of the client’s physician and any next of kin or guardian of the client;
(c) A statement of the allergies of the client, if any, and any special diet or medication he requires;
(d) Evidence of compliance with the provisions of NAC 441A.380;
(e) A list of the rules of the facility that is signed by the client; and
(f) The name and telephone number of the vendors and medical professionals that provide services for the client.
2. Except as otherwise provided in this subsection, the file of the client must be kept confidential. The file of a client must be made available upon request at any time to an employee of the Bureau who is acting in his capacity as an employee of the Bureau.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
NAC 449.154945 Safety from fire. (NRS 449.037)
1. An administrator shall ensure that the facility complies with the regulations adopted by the State Fire Marshal pursuant to chapter 477 of NRS and any local ordinances relating to safety from fire. The facility must be approved for occupancy by the State Fire Marshal.
2. The administrator shall ensure that the facility has a plan for the evacuation of clients in case of fire or other emergency. The plan must be:
(a) Understood by all clients;
(b) Posted in a common area of the facility; and
(c) Discussed with each client at the time of his admission.
3. At least one portable fire extinguisher must be available at the facility. Any portable fire extinguishers available at the facility must be inspected, recharged and tagged at least once each year by a person certified by the State Fire Marshal to conduct such inspections.
4. The administrator shall ensure that a written policy on smoking is developed and carried out by the facility. The policy must be:
(a) Developed with the purpose of preventing a fire caused by smoking in the facility; and
(b) Posted in a common area of the facility.
5. Smoke detectors installed in a facility must be maintained in proper operating condition at all times and must be tested monthly. The results of the tests conducted pursuant to this subsection must be recorded and maintained at the facility.
6. If a fire sprinkler system is installed in a facility, the system must be maintained in proper operating condition at all times and must be inspected in accordance with the provisions of NAC 477.460.
(Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)
FACILITIES FOR TRANSITIONAL LIVING FOR RELEASED OFFENDERS
General Provisions
NAC 449.154951 Definitions. (NRS 449.037) As used in NAC 449.154951 to 449.154999, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.154953 to 449.154959, inclusive, have the meanings ascribed to them in those sections.
(Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)
NAC 449.154953 “Administrator” defined. (NRS 449.037) “Administrator” means a person:
1. Whose name appears on a license issued by the Bureau as administrator of record for a facility; and
2. Who is legally responsible for the management of the facility.
(Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)
NAC 449.154955 “Facility” defined. (NRS 449.037) “Facility” means a facility for transitional living for released offenders as defined in NRS 449.0055.
(Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)
NAC 449.154957 “Resident” defined. (NRS 449.037) “Resident” means a person who:
1. Is a person who has been released from prison as that term is defined in subsection 2 of NRS 449.0055; and
2. Is admitted to a facility.
(Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)
NAC 449.154959 “Supportive services” defined. (NRS 449.037)
1. “Supportive services” mean services provided by a facility, directly or indirectly through arrangements with other providers, which are intended to assist a resident with reintegration into the community.
2. Those services may include, without limitation:
(a) Referrals and the provision of information concerning:
(1) Health care, including mental health care;
(2) Access to housing, benefits or employment;
(3) Resume writing; and
(4) Required counseling for sex offenders.
(b) Training concerning:
(1) Life skills;
(2) Resume writing; and
(3) Any other topic pursuant to the policies of the facility.
(Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)
Administration
NAC 449.154961 Administrator: Qualifications. (NRS 449.037) An administrator must:
1. Be at least 21 years of age;
2. Have the physical examination or certification required by paragraph (a) of subsection 3 of NAC 441A.375 for a person employed in a facility for the dependent; and
3. Maintain evidence that he satisfies the requirements of this section in a file that is maintained on the premises of the facility.
(Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)
NAC 449.154963 Administrator: General duties. (NRS 449.037) An administrator shall:
1. Post the license issued by the Bureau in a conspicuous place within the facility.
2. Organize and manage the facility.
3. Establish policies, procedures and rules for the operation of the facility, including, without limitation, the policies and procedures required to be established by NAC 449.154967.
4. Ensure that the records of the facility are maintained in accordance with the requirements of the policies, procedures and rules for the operation of the facility established pursuant to subsection 3.
5. Ensure that the facility complies with any applicable state statutes and regulations and local ordinances.
6. Ensure that the residents of the facility are afforded the opportunity to exercise their individual rights in a manner consistent with the rules of the facility.
7. Ensure that the facility is maintained in a safe and clean condition.
8. Review and approve changes in the policies and procedures established pursuant to subsection 3 at least annually. This review must be signed and dated.
(Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)
NAC 449.154965 Operation of facility. (NRS 449.037) An administrator shall ensure that:
1. Alcohol or drugs are not allowed on the premises of the facility;
2. The policies, procedures and rules established pursuant to NAC 449.154963 are carried out;
3. Each resident complies with those policies, procedures and rules;
4. The facility provides an environment that will facilitate the reintegration of the residents of the facility into the community; and
5. The operation of the facility is not compromised by a resident who violates the policies, procedures or rules of the facility.
(Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)
NAC 449.154967 Policies and procedures. (NRS 449.037)
1. An administrator shall establish written policies and procedures concerning:
(a) The manner in which records of residents will be maintained and protected against unauthorized use;
(b) The disclosure of confidential information about residents;
(c) The criteria the facility will use to determine whether to:
(1) Admit a resident to the facility; and
(2) Discharge a resident from the facility;
(d) The discharge of a resident for a violation of the rules of the facility;
(e) The discharge of a resident for the use of alcohol or drugs;
(f) The rights and responsibilities of a resident; and
(g) The evacuation of residents in case of fire or other emergency as required by NAC 449.154999.
2. The administrator shall maintain a manual of policies, procedures and rules of the facility that includes, without limitation, the policies and procedures established pursuant to subsection 1. The manual must be available on the premises of the facility at all times.
(Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)
NAC 449.154969 Preparations for disasters and other emergencies. (NRS 449.037)
1. An administrator shall develop a written plan for disasters that outlines procedures for members of the staff of the facility and residents of the facility to follow in case of a disaster or other emergency. The plan must include, without limitation, provisions outlining procedures to be followed with regard to:
(a) Workplace threats and violence, bomb threats, and the possession of firearms or explosives by a resident;