NAC: CHAPTER 433 - ADMINISTRATION OF MENTAL HEALTH AND INTELLECTUAL AND DEVELOPMENTAL DISABILITY PROGRAMS

[Rev. 11/27/2024 11:22:51 AM]

CHAPTER 433 - ADMINISTRATION OF MENTAL HEALTH AND INTELLECTUAL AND DEVELOPMENTAL DISABILITY PROGRAMS

[NAC-433 Revised Date: 11-22]

GENERAL PROVISIONS

433.001 Definitions.

433.003 “Cemetery” defined.

433.004 “Cemetery authority” defined.

433.005 “Director” defined.

433.010 “Division” defined.

433.013 “Removal” defined.

433.040 “Adult with a serious mental illness” and “child with a serious emotional disturbance” defined for counting purposes.

433.050 Adoption of Manual by reference.

EDUCATION AND CERTIFICATION OF MENTAL HEALTH TECHNICIANS

433.060 Requirements for certification.

433.070 Purposes of vocational and educational program.

433.080 Compensation for participation in vocational and educational program; requirements to repeat failed courses.

433.090 Renewal of certification.

433.100 Designation of certification.

433.110 Vocational and educational program requirements for new employees, permanent employees and promotions; allowance for partial attendance and lack of available courses.

BURIAL PARK AT NORTHERN NEVADA ADULT MENTAL HEALTH SERVICES

433.130 Order by cemetery authority to disinter and remove remains.

433.140 Notice of removal.

433.150 Disposition of remains from removal; request for removal by family member or tribe.

REPORTING THE ABUSE AND NEGLECT OF CONSUMERS

433.200 “Abuse” and “neglect” interpreted.

433.210 Requirements.

PROCEDURES FOR INVOLUNTARY ADMINISTRATION OF PSYCHOTROPIC MEDICATION TO PATIENTS AT PUBLIC OR PRIVATE MENTAL HEALTH FACILITIES

433.220 Definitions.

433.225 “Director” defined.

433.235 “Practitioner” defined.

433.238 “Public or private mental health facility” defined.

433.245 “Working hours” defined.

433.250 Applicability.

433.255 Conditions for administration to patient if facility has not established procedures.

433.260 Compliance with procedures before administration to patient.

433.265 Initiation of procedures to administer to patient; request by practitioner to director of facility.

433.270 Request from practitioner to administer to patient: Director of facility required to appoint committee to hold hearing and advisor to assist patient; hearing by committee.

433.275 Duties of advisor appointed to assist patient.

433.280 Procedures for hearing by committee; recommendation of committee to director of facility.

433.285 Review of recommendation of committee by director of facility or designee; limitation on days medication may be administered; procedure to continue administration of medication.

COMMUNITY-BASED LIVING ARRANGEMENT SERVICES

General Provisions

433.300 Definitions. [Replaced in revision by NAC 449.801.]

433.303 “Certificate” defined. [Replaced in revision by NAC 449.802.]

433.306 “Community-based living arrangement services” or “services” defined. [Replaced in revision by NAC 449.804.]

433.309 “Individual support team” defined. [Replaced in revision by NAC 449.807.]

433.312 “Individualized plan” defined. [Replaced in revision by NAC 449.808.]

433.315 “Mental illness” defined. [Replaced in revision by NAC 449.810.]

433.318 “Provider” defined. [Replaced in revision by NAC 449.811.]

433.321 “Provisional certificate” defined. [Replaced in revision by NAC 449.813.]

433.324 “Quality assurance review” defined. [Replaced in revision by NAC 449.814.]

Issuance and Renewal of Provisional Certificates and Certificates

433.327 Provisional certificate or certificate required to provide services; exception. [Replaced in revision by NAC 449.817.]

433.330 Contents of application for provisional certificate. [Replaced in revision by NAC 449.818.]

433.333 Review of application for provisional certificate; actions upon determination that application is incomplete. [Replaced in revision by NAC 449.819.]

433.336 Interview of applicant; training; issuance and validity of provisional certificate. [Replaced in revision by NAC 449.820.]

433.339 Grounds for denial of application for provisional certificate; notice of denial. [Replaced in revision by NAC 449.822.]

433.342 Request for quality assurance review; revocation or extension of provisional certificate; issuance of certificate. [Replaced in revision by NAC 449.823.]

433.345 Renewal of certificate. [Replaced in revision by NAC 449.825.]

Operation of Provider

433.348 Duties of provider. [Replaced in revision by NAC 449.826.]

433.351 Policies and procedures of governmental or organizational provider. [Replaced in revision by NAC 449.828.]

433.354 Arrangements for services from specially trained persons; determination of need for such services. [Replaced in revision by NAC 449.832.]

433.357 Financial plan; financial records; financial report. [Replaced in revision by NAC 449.834.]

433.360 Assessment of need for services; maintenance of findings of assessment; establishment of individualized support team and permanent individual plan; acceptance of person before assessment. [Replaced in revision by NAC 449.835.]

433.363 Contract for provision of services. [Replaced in revision by NAC 449.837.]

433.366 Training concerning administration of medication; persons authorized to administer medication. [Replaced in revision by NAC 449.838.]

433.369 Record regarding recipient of services: Contents and availability for review. [Replaced in revision by NAC 449.840.]

433.372 Record regarding recipient of services: Retention; availability for review by representatives of Department. [Replaced in revision by NAC 449.841.]

433.375 Rights of recipient of services. [Replaced in revision by NAC 449.843.]

Quality Assurance Reviews and Discipline

433.378 Quality assurance review. [Replaced in revision by NAC 449.853.]

433.381 Authorized actions of Division upon determination of deficiencies; grounds for sanctions; authorized sanctions. [Replaced in revision by NAC 449.855.]

433.384 Grounds for revocation of provisional certificate or certificate. [Replaced in revision by NAC 449.856.]

433.387 Notice of intent to revoke provisional certificate or certificate. [Replaced in revision by NAC 449.858.]

433.390 Immediate termination of provision of services. [Replaced in revision by NAC 449.859.]

433.393 Appeal. [Replaced in revision by NAC 449.861.]

PROVIDERS OF NONEMERGENCY SECURE BEHAVIORAL HEALTH TRANSPORT SERVICES

433.400 “Provider” defined.

433.405 Prohibition on unlicensed person or entity from providing services; application for licensure as provider; period of validity of license; application for renewal.

433.410 Provider required to develop and maintain operational policies.

433.415 Training required of certain employees of provider.

433.420 Provider required to obtain criminal background check on employee who serves on vehicle that transports patients; exceptions.

433.425 Employee prohibited from serving on vehicle that transports patients if convicted of certain crimes; opportunity for employee to correct information acquired through criminal background investigation.

433.430 Provider required to maintain certain liability insurance.

433.435 Vehicle used to provide services: Requirements of layout, equipment, maintenance and staffing.

433.440 Vehicle used to provide services: Initial and annual inspection; written report of violations; date and fee for reinspection.

433.445 Authorized transport of persons by provider.

433.450 Maintenance of certain documentation by provider; submission of quarterly report to Division concerning transportation of patients.

433.455 Grounds for denial, suspension or revocation of license of provider.

433.460 Fees.

_________

NOTE: The sections added to chapter 433 by sections 2 to 11, inclusive of R134-18, 12-19-2018, have been codified as NAC 449.801 to 449.861, inclusive.

GENERAL PROVISIONS

NAC 433.001 Definitions. (NRS 451.080) As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 433.003 to 433.013, inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Div. of Men. Health & Dev. Services by R031-09, eff. 10-27-2009)

NAC 433.003 “Cemetery” defined. (NRS 451.080) “Cemetery” means the nonfunctioning burial park located on the grounds of Northern Nevada Adult Mental Health Services at 480 Galletti Way, Sparks, Nevada 89431.

(Added to NAC by Div. of Men. Health & Dev. Services by R031-09, eff. 10-27-2009)

NAC 433.004 “Cemetery authority” defined. (NRS 451.080) “Cemetery authority” means the Administrator of the Division.

(Added to NAC by Div. of Men. Health & Dev. Services by R031-09, eff. 10-27-2009)

NAC 433.005 “Director” defined. (NRS 435.070) “Director” means the director of the service for which a mental health technician performs his or her duties.

(Added to NAC by Men. Hygiene & Men. Retardation Div., eff. 7-5-94; A by Div. of Men. Health & Dev. Services by R031-09, 10-27-2009)

NAC 433.010 “Division” defined. “Division” means the Division of Mental Health and Developmental Services of the Department of Health and Human Services.

(Supplied in codification)

NAC 433.013 “Removal” defined. (NRS 451.080) “Removal” means the disinterment and removal of human remains from a grave in the cemetery.

(Added to NAC by Div. of Men. Health & Dev. Services by R031-09, eff. 10-27-2009)

NAC 433.040 “Adult with a serious mental illness” and “child with a serious emotional disturbance” defined for counting purposes. (NRS 433.324) Each division facility shall use the following definitions to count the number of persons in this State who are adults with a serious mental illness or children with a serious emotional disturbance:

1. “Adult with a serious mental illness” means a person who is at least 18 years old and has been diagnosed within the immediately preceding 12 months as having a mental, behavioral or emotional disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, as adopted by reference in NAC 433.050, other than a substance use disorder, intellectual or developmental disability, irreversible dementia or a disorder caused by an alcohol or other substance use disorder, which interferes with or limits one or more major life activities of the adult.

2. “Child with a serious emotional disturbance” means a person who is less than 18 years old and has been diagnosed within the immediately preceding 12 months as having a mental, behavioral or emotional disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, as adopted by reference in NAC 433.050, other than a mental disorder designated as a Code V disorder in the Manual, a developmental disorder or a disorder caused by an alcohol or other substance use disorder, which substantially interferes with or limits the child from developing social, behavioral, cognitive, communicative or adaptive skills or his or her activities relating to family, school or community. The term does not include a child with a disorder which is temporary or is an expected response to stressful events.

(Added to NAC by Comm’n on Men. Health & Men. Retardation, eff. 8-24-88; A 11-19-90; R128-97, 11-14-97)

NAC 433.050 Adoption of Manual by reference. (NRS 433.324) The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Revised 1994, published by the American Psychiatric Association, Washington, D.C., and commonly referred to as “DSM,” is hereby adopted by reference. This Manual may be obtained from the American Psychiatric Press, Inc., 1400 K Street, N.W., Washington, D.C. 20005, for the price of $45, plus $7.50 for shipping and handling.

(Added to NAC by Comm’n on Men. Health & Men. Retardation, eff. 8-24-88; A by R128-97, 11-14-97)

EDUCATION AND CERTIFICATION OF MENTAL HEALTH TECHNICIANS

NAC 433.060 Requirements for certification. (NRS 433.279)

1. The Division will certify a mental health technician who is initially employed by the Division in that position on or after July 5, 1994, if he or she:

(a) Is at least 18 years of age;

(b) Is a citizen of the United States or is lawfully entitled to remain and work in the United States; and

2. The Division will certify a mental health technician who is initially employed by the Division in that position before July 5, 1994, if he or she has passed the final examination for each course offered in the vocational and educational program established pursuant to NRS 433.279.

(Added to NAC by Men. Hygiene & Men. Retardation Div., eff. 7-5-94)

NAC 433.070 Purposes of vocational and educational program. (NRS 433.279)

1. The vocational and educational program established by the Division pursuant to NRS 433.279 will be designed to provide the training necessary for a mental health technician to:

(a) Obtain certification from the Division;

(b) Attain the status of a permanent employee; and

2. The Division will not approve a course or program for credit toward certification if it determines that the course or program is not appropriate for the purposes stated in subsection 1.

(Added to NAC by Men. Hygiene & Men. Retardation Div., eff. 7-5-94)

NAC 433.080 Compensation for participation in vocational and educational program; requirements to repeat failed courses. (NRS 433.279)

1. Except as otherwise provided in subsection 2, if a mental health technician must participate in a vocational and educational program, the Division will grant him or her a related amount of administrative leave with pay or, when applicable, compensation for overtime in the form of pay or leave.

2. The Division will not permit a mental health technician who fails to complete successfully a course at the appropriate level to take that course again with pay unless he or she:

(a) Demonstrates good cause for the failure to complete the course successfully; and

(b) Obtains the approval of the director.

(Added to NAC by Men. Hygiene & Men. Retardation Div., eff. 7-5-94)

NAC 433.090 Renewal of certification. (NRS 433.279)

1. Unless renewed, a certificate expires 2 years after the date on which it was issued. A mental health technician shall apply for renewal of his or her certificate on or before the date of expiration. The application for renewal must be:

(a) On a form prescribed by the Division; and

(b) Accompanied by evidence that he or she has completed 20 hours of continuing education during the preceding 2 years in one or more courses or programs approved by the Division.

2. A certificate of renewal becomes effective on the date on which the Division approves the application for renewal.

3. If a mental health technician attends only part of a course or program approved by the Division, the Division may determine the number of hours of credit, if any, that the technician may receive for continuing education.

(Added to NAC by Men. Hygiene & Men. Retardation Div., eff. 7-5-94)

NAC 433.100 Designation of certification. (NRS 433.279) A person who is certified by the Division may place the words or appropriate initials for the words “certified mental health technician” or “certified forensic technician” as applicable, after his or her name.

(Added to NAC by Men. Hygiene & Men. Retardation Div., eff. 7-5-94)

NAC 433.110 Vocational and educational program requirements for new employees, permanent employees and promotions; allowance for partial attendance and lack of available courses. (NRS 433.279)

1. For each mental health technician who is initially employed by the Division in that position on or after July 5, 1994, the director shall require the technician to complete the vocational and educational program established pursuant to NRS 433.279.

2. If a mental health technician attends only part of a course or program approved by the Division, the Division may determine the number of hours of credit, if any, that the technician may receive toward certification.

3. Except as otherwise provided in subsection 4, for each mental health technician who is initially employed by the Division in that position on or after July 5, 1994, the director shall, in determining whether to grant the technician the status of a permanent employee, consider whether the technician has completed 5 hours of credit.

4. The provisions of subsection 3 do not apply if the technician is not able to complete the required hours because of the failure of the Division or the Nevada System of Higher Education to offer the courses necessary for the technician to complete the required hours of credit.

5. Except as otherwise provided in subsection 6, for each mental health technician who is initially employed by the Division in that position on or after July 5, 1994, the director shall not consider the technician as eligible for promotion unless the technician has successfully completed at least 5 additional hours of credit at the appropriate level of the vocational and educational program established pursuant to NRS 433.279.

6. The provisions of subsection 5 do not apply if the technician is not able to complete the additional hours of credit because of the failure of the Division or the Nevada System of Higher Education to offer the courses necessary for the technician to complete the additional hours of credit.

7. If a mental health technician has completed the 5 additional hours of credit necessary for promotion and is subsequently demoted, the director shall determine whether it is necessary for the technician to take additional courses before he or she may be considered for any future promotion. If the director determines that the technician must take additional courses, the director shall notify the technician in the same document which notifies the technician of the demotion.

8. For the purposes of this section, “5 hours of credit” means 75 hours of participation in one or more courses or programs approved by the Division for the vocational and educational program pursuant to NAC 433.070.

(Added to NAC by Men. Hygiene & Men. Retardation Div., eff. 7-5-94)

BURIAL PARK AT NORTHERN NEVADA ADULT MENTAL HEALTH SERVICES

NAC 433.130 Order by cemetery authority to disinter and remove remains. (NRS 451.080)

1. The cemetery authority may order the disinterment and removal of human remains interred in all or any part of the cemetery if the cemetery authority determines that the further maintenance of all or part of the cemetery as a burial place for the human dead is not in accordance with the health, safety, comfort or welfare of the public.

2. The cemetery authority will prescribe a reasonable time of not less than 1 year after which the cemetery authority may proceed with a removal.

(Added to NAC by Div. of Men. Health & Dev. Services by R031-09, eff. 10-27-2009)

NAC 433.140 Notice of removal. (NRS 451.080)

1. If the cemetery authority determines that removal is necessary, the cemetery authority will provide notice of the removal in accordance with the provisions of NRS 451.110, 451.130 and 451.140.

2. If the cemetery authority determines that any of the remains subject to removal may belong to a Native American tribe, notice must be sent to the tribal council of that tribe.

(Added to NAC by Div. of Men. Health & Dev. Services by R031-09, eff. 10-27-2009)

NAC 433.150 Disposition of remains from removal; request for removal by family member or tribe. (NRS 451.080)

1. Except as otherwise provided in this section, the human remains from a removal will be subject to cremation and inurnment or reinterment elsewhere at the discretion of the cemetery authority.

2. Upon the written request to the cemetery authority by a family member or the Native American tribe of the person whose remains are interred in the cemetery, the cemetery authority will allow for the removal by the family member or the Native American tribe. All documentation verifying the familial or tribal relationship must be attached to the written request, and the costs related to the removal must be paid by the family member or tribe.

3. Any removal must be conducted in accordance with the laws and ordinances of the constituted authorities of the city, county and State.

4. As used in this section:

(a) “Cremation” means the technical process that reduces human remains to bone fragments by using heat and evaporation.

(b) “Inurnment” means the disposition of cremated human remains by inserting the remains in an urn and placing the urn in a crypt or niche.

(Added to NAC by Div. of Men. Health & Dev. Services by R031-09, eff. 10-27-2009)

REPORTING THE ABUSE AND NEGLECT OF CONSUMERS

NAC 433.200 “Abuse” and “neglect” interpreted. (NRS 433.331)

1. As used in NRS 433.554, the term:

(a) “Abuse” includes, without limitation, physical abuse, sexual abuse, verbal and mental abuse, and financial exploitation.

(b) “Neglect” includes, without limitation:

(1) Failure to provide the degree of care or other service to a consumer that a person is legally required or contractually obligated to provide, which may include, without limitation, the provision of adequate medical care, nutrition, hydration, clothing or assistance with personal hygiene; and

(2) Failure to act to prevent another person from abusing or neglecting a consumer.

2. As used in this section:

(a) “Financial exploitation” means the illegal or improper use of the money, property or other assets of a consumer. The term includes, without limitation:

(1) Using a consumer’s social security number to obtain a benefit or other financial gain for a person other than the consumer; and

(2) Diverting money or property that is intended to be used for the benefit of the consumer, including, without limitation, money provided by the State.

(b) “Physical abuse” includes, without limitation, intentionally causing physical pain to a consumer, whether or not the action results in an observable injury to the consumer, by burning, cutting, hitting, kicking, punching, pushing, scratching, slapping, or pulling the hair of the consumer.

(1) Engaging or attempting to engage in sexual conduct with a consumer, including, without limitation, the intimate touching or fondling of a consumer;

(2) Encouraging a consumer or another person to engage in sexual conduct with a consumer;

(3) Encouraging a consumer to solicit for, or engage in, prostitution;

(4) Exposing a person’s genitals to a consumer or encouraging a consumer to expose his or her genitals to another person;

(5) Encouraging a consumer to view obscene or pornographic materials; and

(6) Using sexually degrading language or gestures toward a consumer.

(d) “Verbal and mental abuse” includes, without limitation:

(1) Cursing, insulting, mocking, ridiculing or taunting a consumer;

(2) Threatening a consumer with any kind of harm or with the deprivation of any right, privilege or benefit;

(3) Making a hostile or offensive gesture toward a consumer; and

(4) Engaging in any action that is intended to humiliate a consumer,

Ê whether or not the consumer understands the meaning of the words, gestures or actions.

(Added to NAC by Div. of Men. Health & Dev. Services by R063-10, eff. 12-16-2010)

NAC 433.210 Requirements. (NRS 433.331)

1. An employee or contractor who knows or reasonably believes that a consumer has been or is being abused or neglected shall report the abuse or neglect of the consumer:

(a) Verbally, not later than 1 hour after the employee or contractor becomes aware of the abuse or neglect; and

(b) In writing, not later than 24 hours after the employee or contractor becomes aware of the abuse or neglect.

2. A report required pursuant to subsection 1 must be made to the person and in the manner prescribed by the Administrator.

3. An employee or contractor may reasonably believe that a consumer has been or is being abused or neglected based solely on the statement of a consumer.

4. As used in this section:

(a) “Contractor” means a person who provides care or other services to a consumer pursuant to a contract with the Division.

(b) “Employee” means an employee of the Division.

(Added to NAC by Div. of Men. Health & Dev. Services by R063-10, eff. 12-16-2010)

PROCEDURES FOR INVOLUNTARY ADMINISTRATION OF PSYCHOTROPIC MEDICATION TO PATIENTS AT PUBLIC OR PRIVATE MENTAL HEALTH FACILITIES

NAC 433.220 Definitions. (NRS 433.324) As used in NAC 433.220 to 433.285, inclusive, unless the context otherwise requires, the words and terms defined in NAC 433.225 to 433.245, inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.225 “Director” defined. (NRS 433.324) “Director” means:

1. The medical director of a division facility; or

2. The person in charge of the provision of care to patients at any other public or private mental health facility.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.235 “Practitioner” defined. (NRS 433.324) “Practitioner” means a physician, physician assistant or advanced practice registered nurse.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.238 “Public or private mental health facility” defined. (NRS 433.324) “Public or private mental health facility” means:

1. A community triage center, as defined in NRS 449.0031;

2. A psychiatric hospital, as defined in NRS 449.0165, including, without limitation, a psychiatric hospital endorsed as a crisis stabilization center pursuant to NRS 449.0915; or

3. Any other facility for the diagnosis, care and treatment of mental illness which provides 24-hour care.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.245 “Working hours” defined. (NRS 433.324) “Working hours” means hours of operation during the week and excludes any hours on Saturday, Sunday or a holiday.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.250 Applicability. (NRS 433.324) The provisions of NAC 433.220 to 433.285, inclusive, do not apply to:

1. The use of a chemical restraint, as defined in NRS 433.5456; or

2. The involuntary administration of psychotropic medication in an emergency, as defined in NRS 433.5466.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.255 Conditions for administration to patient if facility has not established procedures. (NRS 433.324) If a public or private mental health facility has not established the procedures set forth in NAC 433.260 to 433.285, inclusive, psychotropic medication must not be administered to the patient without consent of the patient unless:

1. The patient has been admitted to the facility involuntarily by court order pursuant to NRS 433A.200 to 433A.330, inclusive; and

2. The practitioner who is primarily responsible for treating the patient obtains from the court that ordered the involuntary admission of the patient an order to involuntarily administer the medication to the patient.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.260 Compliance with procedures before administration to patient. (NRS 433.324) Psychotropic medication may only be administered to a patient at a public or private mental health facility that has established the procedures set forth in NAC 433.260 to 433.285, inclusive, without the consent of the patient after the procedures have been completed and a decision has been made to involuntarily administer the medication pursuant to NAC 433.285.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.265 Initiation of procedures to administer to patient; request by practitioner to director of facility. (NRS 433.324) To initiate the procedures set forth in NAC 433.260 to 433.285, inclusive, for the involuntary administration of psychotropic medication to a patient at a public or private mental health facility that has established such procedures, the practitioner who is primarily responsible for treating the patient must submit to the director of the facility a request to involuntarily administer psychotropic medication to the patient. Such a request may be made by the practitioner if:

1. The patient is currently admitted to the public or private mental health facility under an emergency admission pursuant to NRS 433A.150 or an involuntary court-ordered admission pursuant to NRS 433A.200;

2. The practitioner:

(a) Determines that the patient presents a substantial likelihood of serious harm to himself or herself or others, as determined pursuant to NRS 433A.0195, or is unable to care for himself or herself without the administration of the medication; and

(b) Explains to the patient the nature of the condition for which the psychotropic medication is necessary, the basis for the diagnosis of the condition, the benefits and risks of using the medication including, without limitation, possible side effects from use, any alternative treatment and the potential outcome if the condition remains untreated;

3. The patient refuses to provide informed written consent to the administration of the psychotropic medication after receiving the explanation described in paragraph (b) of subsection 2; and

4. The practitioner documents in the medical record of the patient that the provisions of subsections 1, 2 and 3 were satisfied.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.270 Request from practitioner to administer to patient: Director of facility required to appoint committee to hold hearing and advisor to assist patient; hearing by committee. (NRS 433.324)

1. Upon receiving a request from a practitioner pursuant to NAC 433.265 to involuntarily administer psychotropic medication to a patient, the director of a public or private mental health facility or his or her designee shall:

(a) Appoint a committee consisting of three members, at least two of whom are professionally knowledgeable in the field of psychiatric mental health and at least one of whom is a licensed psychiatrist. A person must not be appointed to serve as a member of the committee if the person is:

(1) Involved in the diagnosis or care of the patient;

(2) The director of the facility; or

(3) Designated by the director to review the decision of the committee pursuant to NAC 433.285.

(b) Appoint an advisor to perform the duties prescribed by NAC 433.275. The advisor must be a person who:

(1) Is not currently involved in the care of the patient;

(2) Understands psychiatric issues; and

(3) Has received training on the procedures set forth in NAC 433.260 to 433.285, inclusive, and understands the role of the advisor.

2. A committee appointed pursuant to subsection 1 shall schedule a hearing to review the request from a practitioner pursuant to NAC 433.265 to involuntarily administer psychotropic medication to a patient. The hearing must be held not less than 24 working hours after the receipt of the request. The committee shall notify the patient and his or her advisor not less than 24 hours before the hearing of the date and time of the hearing.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.275 Duties of advisor appointed to assist patient. (NRS 433.324) An advisor appointed pursuant to NAC 433.270:

1. Shall meet with the patient before the hearing held pursuant to NAC 433.270 to assist the patient in preparing for the hearing.

2. Shall assist the patient to present his or her position concerning the administration of medication to the committee at the hearing.

3. Shall not present his or her personal opinion concerning the appropriateness of the proposed treatment.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.280 Procedures for hearing by committee; recommendation of committee to director of facility. (NRS 433.324)

1. A patient who is the subject of a hearing held pursuant to NAC 433.270 must be allowed to be present during the entire hearing. Unless the patient has indicated in writing or through his or her advisor that he or she will not participate in the hearing, the hearing must not begin until the patient is present.

2. At the hearing, the patient must be allowed to:

(a) Cross-examine any person interviewed by the committee; and

(b) Present evidence and witnesses to the committee.

3. The committee conducting the hearing may interview any person or request any document it deems necessary to assist the committee in making its determination.

4. The committee conducting the hearing shall:

(a) Keep a written, audio or audiovisual record of the hearing;

(b) Prepare a written decision upon the conclusion of the hearing;

(d) Place a copy of the minutes and the written decision of the committee in the medical record of the patient; and

(e) Provide a copy of the minutes and its written decision to the patient.

5. Upon conclusion of the hearing, the committee may recommend approving the request to involuntarily administer psychotropic medication to the patient only if the member of the committee who is a psychiatrist and at least one other member determine that the patient presents a substantial likelihood of serious harm to himself or herself or others, as determined pursuant to NRS 433A.0195, or is unable to care for himself or herself without the administration of the medication. In making that recommendation, the committee must consider:

(a) Any stated objections of the patient to the administration of the medication;

(b) If the patient has completed an advance directive for psychiatric care pursuant to NRS 449A.600 to 449A.645, inclusive, any relevant instructions contained in that advance directive;

(d) Whether the condition of the patient is likely to improve if the medication is not administered to the patient and, if so, whether such improvement would be significantly slower than had the medication been administered;

(e) Whether there is a less invasive means to accomplish the same or similar results to those achieved by administration of the medication;

(f) Any prior experience of the patient with taking the medication; and

(g) Any additional factor deemed relevant by the committee. Any such additional factor must be described in the written decision of the committee.

6. The committee shall forward its written recommendation to the director of the public or private mental health facility for review pursuant to NAC 433.285.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

NAC 433.285 Review of recommendation of committee by director of facility or designee; limitation on days medication may be administered; procedure to continue administration of medication. (NRS 433.324)

1. The director of a public or private mental health facility or a psychiatrist designated by the director shall conduct a review of a recommendation to approve or deny a request for the involuntary administration of psychotropic medication made by a committee pursuant to NAC 433.280 not later than 24 working hours after receiving the recommendation. In reviewing the recommendation, the director must consider, without limitation, the medical record of the patient and any other document reviewed by the committee. The director may also:

(a) Interview any person whom the director or his or her designee believes may have relevant information; and

(b) Conduct an examination of the patient.

2. During the review conducted by the director or his or her designee, the director or his or her designee shall consider:

(a) Whether the committee followed the proper procedures;

(b) Whether the proposed psychotropic medication is medically appropriate for the patient based on the diagnosis and medical history of the patient;

(d) Any other factor deemed relevant.

3. After conducting a review pursuant to this section, the director or his or her designee may:

(a) Require the involuntary administration of psychotropic medication to the patient in the manner requested by the practitioner with the primary responsibility for treating the patient;

(b) Require the involuntary administration of psychotropic medication to the patient in the manner determined appropriate by the director or his or her designee; or

4. If the director or his or her designee requires the involuntary administration of psychotropic medication to a patient pursuant to subsection 3, the medication may be administered involuntarily to the patient for not more than 30 days. If the practitioner who is primarily responsible for treating the patient determines that it is necessary to continue administering medication to the patient for more than 30 days, the practitioner must request the consent of the patient. If the patient refuses to provide consent to continued administration of the medication, the practitioner must submit another request to involuntarily administer psychotropic medication pursuant to NAC 433.265.

(Added to NAC by Bd. of Health by R012-20, eff. 8-26-2020)

COMMUNITY-BASED LIVING ARRANGEMENT SERVICES

General Provisions

NAC 433.300 Definitions. [Replaced in revision by NAC 449.801.]

NAC 433.303 “Certificate” defined. [Replaced in revision by NAC 449.802.]

NAC 433.306 “Community-based living arrangement services” or “services” defined. [Replaced in revision by NAC 449.804.]

NAC 433.309 “Individual support team” defined. [Replaced in revision by NAC 449.807.]

NAC 433.312 “Individualized plan” defined. [Replaced in revision by NAC 449.808.]

NAC 433.315 “Mental illness” defined. [Replaced in revision by NAC 449.810.]

NAC 433.318 “Provider” defined. [Replaced in revision by NAC 449.811.]

NAC 433.321 “Provisional certificate” defined. [Replaced in revision by NAC 449.813.]

NAC 433.324 “Quality assurance review” defined. [Replaced in revision by NAC 449.814.]

Issuance and Renewal of Provisional Certificates and Certificates

NAC 433.327 Provisional certificate or certificate required to provide services; exception. [Replaced in revision by NAC 449.817.]

NAC 433.330 Contents of application for provisional certificate. [Replaced in revision by NAC 449.818.]

NAC 433.333 Review of application for provisional certificate; actions upon determination that application is incomplete. [Replaced in revision by NAC 449.819.]

NAC 433.336 Interview of applicant; training; issuance and validity of provisional certificate. [Replaced in revision by NAC 449.820.]

NAC 433.339 Grounds for denial of application for provisional certificate; notice of denial. [Replaced in revision by NAC 449.822.]

NAC 433.342 Request for quality assurance review; revocation or extension of provisional certificate; issuance of certificate. [Replaced in revision by NAC 449.823.]

NAC 433.345 Renewal of certificate. [Replaced in revision by NAC 449.825.]

Operation of Provider

NAC 433.348 Duties of provider. [Replaced in revision by NAC 449.826.]

NAC 433.351 Policies and procedures of governmental or organizational provider. [Replaced in revision by NAC 449.828.]

NAC 433.354 Arrangements for services from specially trained persons; determination of need for such services. [Replaced in revision by NAC 449.832.]

NAC 433.357 Financial plan; financial records; financial report. [Replaced in revision by NAC 449.834.]

NAC 433.360 Assessment of need for services; maintenance of findings of assessment; establishment of individualized support team and permanent individual plan; acceptance of person before assessment. [Replaced in revision by NAC 449.835.]

NAC 433.363 Contract for provision of services. [Replaced in revision by NAC 449.837.]

NAC 433.366 Training concerning administration of medication; persons authorized to administer medication. [Replaced in revision by NAC 449.838.]

NAC 433.369 Record regarding recipient of services: Contents and availability for review. [Replaced in revision by NAC 449.840.]

NAC 433.372 Record regarding recipient of services: Retention; availability for review by representatives of Department. [Replaced in revision by NAC 449.841.]

NAC 433.375 Rights of recipient of services. [Replaced in revision by NAC 449.843.]

Quality Assurance Reviews and Discipline

NAC 433.378 Quality assurance review. [Replaced in revision by NAC 449.853.]

NAC 433.381 Authorized actions of Division upon determination of deficiencies; grounds for sanctions; authorized sanctions. [Replaced in revision by NAC 449.855.]

NAC 433.384 Grounds for revocation of provisional certificate or certificate. [Replaced in revision by NAC 449.856.]

NAC 433.387 Notice of intent to revoke provisional certificate or certificate. [Replaced in revision by NAC 449.858.]

NAC 433.390 Immediate termination of provision of services. [Replaced in revision by NAC 449.859.]

NAC 433.393 Appeal. [Replaced in revision by NAC 449.861.]

PROVIDERS OF NONEMERGENCY SECURE BEHAVIORAL HEALTH TRANSPORT SERVICES

NAC 433.400 “Provider” defined. (NRS 433.324, 433.3317, 439.200) As used in NAC 433.400 to 433.460, inclusive, unless the context otherwise requires, “provider” means a provider of nonemergency secure behavioral health transport services.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.405 Prohibition on unlicensed person or entity from providing services; application for licensure as provider; period of validity of license; application for renewal. (NRS 433.324, 433.3317, 439.200)

1. A person or entity shall not provide nonemergency secure behavioral health transport services unless the person or entity is licensed as a provider by the Division.

2. To obtain a license as a provider, a person or entity must apply to the Division on a form provided by the Division and pay the initial application fee prescribed by NAC 433.460.

3. A license is valid for a term of 2 years from the date on which it is issued and may be renewed. To renew a license, the licensee must submit an application to the Division on a form provided by the Division and, except as otherwise provided in subsection 5, pay the fee for renewal prescribed by NAC 433.460.

4. The application for renewal must include, without limitation, for each vehicle used by the licensee to transport patients, a form provided by the Division and completed by the person who conducted the most recent inspection of the vehicle pursuant to NAC 433.440 attesting that the vehicle complies with the requirements of NAC 433.400 to 433.460, inclusive.

5. The Division may accept an application for renewal that is submitted late if it is submitted not more than 3 years after the date on which the license expired and is accompanied by the fee for late renewal prescribed by NAC 433.460.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.410 Provider required to develop and maintain operational policies. (NRS 433.324, 433.3317, 439.200)

1. A provider shall develop and maintain operational policies that include, without limitation:

(a) A description of the manner in which the provider will communicate and coordinate with hospitals, mental health facilities, independent centers for emergency medical care, providers of emergency medical services and other providers of medical services;

(b) A description of the locations at which the provider will station vehicles, equipment and supplies;

(c) The manner for determining whether to refuse to transport a patient because the patient requires transport by ambulance;

(d) A description of the area served by the provider;

(e) The manner in which to ensure that each employee who serves on a vehicle that transports patients or provides direct supportive services to patients meets the requirements of NAC 433.415 and a description of the training that each such employee must receive;

(f) The manner in which to handle transportation of patients who cannot demonstrate an ability to pay for the transportation;

(g) A protocol for determining when an emergency that arises during transportation requires the employees to seek additional emergency assistance; and

(h) A list of each vehicle that is used by the provider for nonemergency secure behavioral health transport services that includes, without limitation, the vehicle identification number and license plate number of each vehicle.

2. As used in this section, “independent center for emergency medical care” has the meaning ascribed to it in NRS 449.013.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.415 Training required of certain employees of provider. (NRS 433.324, 433.3317, 439.200)

1. Before an employee of a provider may serve on a vehicle that transports patients or provide direct supportive services to patients, the employee must receive at least:

(a) Four hours of evidence-based training concerning de-escalation of conflicts and obtain biennial recertification in de-escalation of conflicts.

(b) Eight hours of evidence-based training concerning behavioral health which includes, without limitation, training concerning:

(1) Suicide prevention and intervention;

(2) The manner in which to respond when a person has overdosed on opioids; and

(3) Awareness of issues relating to mental health and substance use.

2. In addition to the training required by subsection 1, each such employee must be currently certified in the techniques of administering cardiopulmonary resuscitation.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.420 Provider required to obtain criminal background check on employee who serves on vehicle that transports patients; exceptions. (NRS 433.324, 433.3317, 439.200)

1. Except as otherwise provided in subsections 2 and 3, within 10 days after hiring an employee who serves on a vehicle that transports patients, a provider shall:

(a) Obtain a written statement from the employee stating whether he or she has been convicted of any crime listed in NRS 449.174;

(b) Obtain from the employee one set of fingerprints and a written authorization to forward the fingerprints to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report;

(c) Submit to the Central Repository for Nevada Records of Criminal History the fingerprints obtained pursuant to paragraph (b) to obtain information on the background and personal history of the employee to determine whether he or she has been convicted of any crime listed in NRS 449.174; and

(d) If an Internet website has been established pursuant to NRS 439.942:

(1) Screen the employee using the Internet website. Upon request of the Division, proof that the employee was screened pursuant to this subparagraph must be provided to the Division.

(2) Enter on the Internet website information to be maintained on the website concerning the employee.

2. A provider is not required to obtain the information described in subsection 1 from an employee who serves on a vehicle that transports patients if his or her fingerprints have been submitted to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report within the immediately preceding 6 months and the report of the Federal Bureau of Investigation indicated that the employee has not been convicted of a crime set forth in NRS 449.174.

3. A provider is not required to obtain the information described in subsection 1 from an employee who serves on a vehicle that transports patients if:

(a) The employee agrees to allow the provider to receive notice from the Central Repository for Nevada Records of Criminal History regarding any conviction and subsequent conviction of the employee of a crime listed in NRS 449.174;

(b) An agency, board or commission that regulates an occupation or profession pursuant to title 54 of NRS or temporary employment service has, within the immediately preceding 5 years, submitted the fingerprints of the employee to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report; and

(c) The report of the Federal Bureau of Investigation indicated that the employee has not been convicted of any crime set forth in NRS 449.174.

4. A provider shall ensure that the information concerning the background and personal history of each employee who serves on a vehicle that transports patients:

(a) Except as otherwise provided in subsections 2 and 3, is completed as soon as practicable; and

(b) Is completed at least once every 5 years after the date of the initial investigation.

5. The provider shall, when required:

(a) Obtain one set of fingerprints from the employee;

(b) Obtain written authorization from the employee to forward the fingerprints obtained pursuant to paragraph (a) to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report; and

(c) Submit the fingerprints to the Central Repository for Nevada Records of Criminal History or, if the fingerprints were submitted electronically, obtain proof of electronic submission of the fingerprints to the Central Repository for Nevada Records of Criminal History.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.425 Employee prohibited from serving on vehicle that transports patients if convicted of certain crimes; opportunity for employee to correct information acquired through criminal background investigation. (NRS 433.324, 433.3317, 439.200)

1. Upon receiving information from the Central Repository for Nevada Records of Criminal History pursuant to NAC 433.420, or evidence from any other source, that an employee has been convicted of a crime listed in NRS 449.174, a provider shall prohibit the employee from serving on a vehicle that transports patients after allowing the employee time to correct the information as required pursuant to subsection 2.

2. If an employee who serves on a vehicle that transports patients believes that the information provided by the Central Repository is incorrect, the employee may immediately inform the provider. A provider that is so informed shall give the employee a reasonable amount of time of not less than 30 days to correct the information received from the Central Repository before prohibiting the employee from serving on a vehicle that transports patients pursuant to subsection 1.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.430 Provider required to maintain certain liability insurance. (NRS 433.324, 433.3317, 439.200)

1. A provider shall maintain liability insurance to cover any damage resulting from the operation of a vehicle that transports patients in the amount of $1,000,000 for each individual claim and $1,000,000 for any property damage caused by any single event.

2. Liability insurance required by this section may be obtained from an insurer authorized to issue insurance in this State or through a program of self-insurance.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.435 Vehicle used to provide services: Requirements of layout, equipment, maintenance and staffing. (NRS 433.324, 433.3317, 439.200)

1. A vehicle used for nonemergency secure behavioral health transport services must include:

(a) A driver’s compartment that is separated from the passenger compartment in a manner that:

(1) Allows the driver and the passenger to communicate; and

(2) Prohibits the passenger from accessing the driver or any control for operating the vehicle; and

(b) A passenger’s compartment that:

(1) Has two or more traditional vehicle seats with appropriate seat belt restraints;

(2) Is free from exposed sharp edges or projections;

(3) Is equipped with doors that automatically lock and are not capable of opening while the vehicle is in motion;

(4) Has space for a gurney or stretcher that is adequate for the head of the gurney or stretcher to be lifted to the comfort level of a patient; and

(5) Is equipped with windows that:

(I) Are not capable of opening wide enough to provide space for a passenger to escape;

(II) Allow a passenger to see outside the vehicle; and

(III) Prevent a person outside the vehicle from being able to see inside the vehicle.

2. A vehicle used for nonemergency secure behavioral health transport services must be equipped with:

(a) A first aid kit;

(b) A fire extinguisher with a minimum rating of 2A 10BC;

(d) A radio that connects the driver to a dispatch center operated by the provider or a cellular telephone that is capable of calling a number designated for receiving emergency support.

3. All parts of a vehicle used for nonemergency secure behavioral health transport services, including, without limitation, the engine and body of the vehicle, and any equipment inside the vehicle must be maintained in safe operating condition.

4. When a patient is transported by a vehicle used for nonemergency secure behavioral health transport services, the vehicle must be staffed by a driver and an attendant who each hold a valid driver’s license.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.440 Vehicle used to provide services: Initial and annual inspection; written report of violations; date and fee for reinspection. (NRS 433.324, 433.3317, 439.200)

1. The Division shall inspect or have inspected every vehicle to be used for providing nonemergency secure behavioral health transport services before it is placed in service and determine whether the vehicle complies with the requirements of NAC 433.400 to 433.460, inclusive.

2. After a license is issued to a provider, the Division shall, at least one time each year, inspect or cause to be inspected every vehicle used by the provider for providing nonemergency secure behavioral health transport services. After each inspection, the inspector shall prepare a written report describing any violation of any provisions of NAC 433.400 to 433.460, inclusive, with respect to the vehicle inspected and shall schedule a date for reinspection after correction of the violation within 4 weeks after the inspection. The Division shall collect the reinspection fee prescribed by NAC 433.460 for each vehicle reinspected.

3. The inspector shall give a copy of the report to the holder of the permit for the service inspected.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.445 Authorized transport of persons by provider. (NRS 433.324, 433.3317, 439.200)

1. A provider may only transport:

(a) A patient from a mental health facility or medical facility to another mental health facility or medical facility;

(b) A person alleged to be a person in a mental health crisis to a public or private mental health facility or hospital as authorized by NRS 433A.160; or

(c) A person who is seeking voluntary admission pursuant to NRS 433A.140 to a public or private mental health facility or a division facility.

2. As used in this section:

(a) “Medical facility” has the meaning ascribed to it in NRS 449.0151.

(b) “Person in a mental health crisis” has the meaning ascribed to it in NRS 433A.0175.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.450 Maintenance of certain documentation by provider; submission of quarterly report to Division concerning transportation of patients. (NRS 433.324, 433.3317, 439.200)

1. A provider shall maintain and provide to the Division upon request:

(a) A copy of the operational policies developed pursuant to NAC 433.410;

(b) The name of each employee who serves on a vehicle that transports patients and proof that each such employee:

(1) Holds a valid driver’s license;

(2) Has undergone an investigation of his or her background and personal history as required by NAC 433.420 and has not been convicted of a crime listed in NRS 449.174; and

(3) Meets the requirements set forth in NAC 433.415;

(c) The name of each employee who provides direct supportive services to patients and proof that each such employee has received the training required by NAC 433.415; and

(d) Proof of the insurance required by NAC 433.430.

2. A provider shall submit to the Division a quarterly report which includes:

(a) The total number of patients transported during the quarter; and

(b) For each patient transported during the quarter:

(1) The location from which the patient was transported;

(2) The location to which the patient was transported;

(3) The person or entity that requested the transportation;

(4) The time from the request for transportation until the vehicle arrived;

(5) The type of insurance the patient has, if known; and

(6) Any escapes, injuries or other problems that occurred during the transport.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.455 Grounds for denial, suspension or revocation of license of provider. (NRS 433.324, 433.3317, 439.200) The Division may deny, suspend or revoke the license of a provider if the Division determines, after notice and the opportunity for a hearing conducted pursuant to NAC 439.300 to 439.395, inclusive, that the provider has violated any federal or state law or regulation relating to the provision of nonemergency secure behavioral health transport services.

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)

NAC 433.460 Fees. (NRS 433.324, 433.3317, 439.150, 439.200) The Division shall charge and collect the following fees:

1. For an initial application for a license to provide nonemergency secure behavioral health transport services....................................................................................................................... $900

2. For the renewal of a license............................................................................................. 120

3. For the late renewal of a license...................................................................................... 190

4. Inspection of a vehicle used to provide nonemergency secure behavioral health transport services 23

5. For the reinspection of a vehicle........................................................................................ 75

(Added to NAC by Bd. of Health by R013-20, eff. 8-26-2020)