NRS: CHAPTER 449 - MEDICAL FACILITIES AND OTHER RELATED ENTITIES

[Rev. 6/29/2024 4:08:42 PM--2023]

CHAPTER 449 - MEDICAL FACILITIES AND OTHER RELATED ENTITIES

GENERAL PROVISIONS

NRS 449.001 Definitions.

NRS 449.0015 “Agency to provide nursing in the home” defined.

NRS 449.0021 “Agency to provide personal care services in the home” defined.

NRS 449.0025 “Board” defined.

NRS 449.0026 “Community-based living arrangement services” defined.

NRS 449.0027 “Community health worker” defined.

NRS 449.0028 “Community health worker pool” defined.

NRS 449.0031 “Community triage center” defined.

NRS 449.0032 “Division” defined.

NRS 449.00325 “Employment agency” defined.

NRS 449.0033 “Facility for hospice care” defined.

NRS 449.0038 “Facility for intermediate care” defined.

NRS 449.00385 “Facility for modified medical detoxification” defined.

NRS 449.00387 “Facility for refractive surgery” defined.

NRS 449.0039 “Facility for skilled nursing” defined.

NRS 449.004 “Facility for the care of adults during the day” defined.

NRS 449.0045 “Facility for the dependent” defined.

NRS 449.00455 “Facility for the treatment of alcohol or other substance use disorders” defined.

NRS 449.0046 “Facility for the treatment of irreversible renal disease” defined.

NRS 449.0055 “Facility for transitional living for released offenders” defined.

NRS 449.0065 “Freestanding birthing center” defined.

NRS 449.008 “Halfway house for persons recovering from alcohol or other substance use disorders” defined. [Replaced in revision by NRS 449.0166.]

NRS 449.0105 “Home for individual residential care” defined.

NRS 449.0115 “Hospice care” defined.

NRS 449.012 “Hospital” defined.

NRS 449.013 “Independent center for emergency medical care” defined.

NRS 449.0145 “Licensed practical nurse” defined.

NRS 449.0151 “Medical facility” defined.

NRS 449.01513 “Medication aide - certified” defined.

NRS 449.01515 “Mobile unit” defined.

NRS 449.01517 “Nonmedical services related to personal care to elderly persons or persons with disabilities” defined.

NRS 449.0152 “Nursing assistant” defined.

NRS 449.0153 “Nursing pool” defined.

NRS 449.0156 “Palliative services” defined.

NRS 449.0157 “Provider of health care” defined.

NRS 449.0159 “Provider of supported living arrangement services” defined.

NRS 449.0165 “Psychiatric hospital” defined.

NRS 449.0166 “Recovery house for persons recovering from alcohol or other substance use disorders” defined.

NRS 449.0167 “Registered nurse” defined.

NRS 449.017 “Residential facility for groups” defined.

NRS 449.0175 “Rural clinic” defined.

NRS 449.0177 “Rural hospital” defined.

NRS 449.0178 “Rural emergency hospital” defined.

NRS 449.0179 “Senior living community” defined.

NRS 449.0181 “Senior living community referral agency” defined.

NRS 449.0185 “Supported living arrangement services” defined.

NRS 449.019 “Surgical center for ambulatory patients” defined.

NRS 449.0195 “Terminally ill” defined.

LICENSING AND REGULATION

General Provisions

NRS 449.029 “Medical facility” further defined.

NRS 449.030 License required to operate or maintain medical facility or facility for the dependent.

NRS 449.03005 License to operate employment agency that contracts with persons in State to provide certain nonmedical services; standards and regulations; licensed employment agency prohibited from making certain referrals; civil penalty.

NRS 449.03008 Petition to determine if criminal history will disqualify person from obtaining license; fee; posting of requirements for license and list of disqualifying crimes on Internet; report.

NRS 449.0301 Exemptions.

NRS 449.03013 Facility for the dependent or medical facility that employs community health workers not required to obtain additional license.

NRS 449.03017 Person otherwise licensed under this chapter exempt from requirement to obtain license to operate employment agency that contracts with persons to provide certain nonmedical services.

NRS 449.0302 Board to adopt standards, qualifications and other regulations.

NRS 449.0303 Authority of Board to require licensing of other facilities.

NRS 449.0304 Board to adopt regulations authorizing employees of certain facilities and agencies to perform certain tasks.

NRS 449.0305 Businesses that provide referrals to residential facilities for groups and certain other group housing arrangements: License required; standards and regulations; provision of referrals; prohibited acts; civil penalties.

NRS 449.0306 Money received from licensing of facilities to be deposited in State General Fund; expenditure of state or federal money by Division.

NRS 449.0307 Powers of Division.

NRS 449.03075 Duty of Division to compile and post information concerning licensing status and quality of certain facilities for the treatment of alcohol or other substance use disorders.

NRS 449.0308 Authority of Division to collect actual cost of enforcing provisions from unlicensed medical facility, facility for the dependent or certain other facilities; authorized use of money collected; exceptions.

Licensing

NRS 449.040 Application for license: Filing; contents.

NRS 449.050 Fees.

NRS 449.065 Surety bond for initial license and renewal of license to operate facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in home and agency to provide nursing in home; exemption; exception.

NRS 449.067 Substitute for surety bond required for facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in home and agency to provide nursing in home.

NRS 449.068 Surety bond required for initial license and renewal of license to operate facility for refractive surgery.

NRS 449.069 Substitute for surety bond required for facility for refractive surgery.

NRS 449.080 Issuance, validity and nontransferability of license; inspection of building proposed by applicant for community-based living arrangement services.

NRS 449.085 Form and contents of license.

NRS 449.087 Amendment of license required for addition of certain services; requirements for approval of amendment; revocation of approval; standards.

NRS 449.089 Expiration and renewal of license; fees.

NRS 449.091 Provisional license.

NRS 449.0915 Endorsement of hospital as crisis stabilization center: Issuance; application; requirements; renewal.

NRS 449.0925 Regulations prescribing mandatory training for unlicensed caregivers; posting of list of providers of training on Internet website; duties of administrator or person in charge of facility.

NRS 449.093 Training to recognize and prevent abuse of older persons: Persons required to receive; frequency; topics; costs; actions for failure to complete.

NRS 449.094 Continuing education requirements concerning care of persons with dementia for certain employees of facilities for skilled nursing, facilities for intermediate care and residential facilities for groups.

Standards and Policies for Treatment

NRS 449.101 Discrimination prohibited; development of antidiscrimination policy; posting of nondiscrimination statement and certain other information; construction of section.

NRS 449.102 Duties of licensed facility to protect privacy of patient or resident.

NRS 449.103 Regulations requiring training relating specifically to cultural competency for certain agents or employees of facility; maintenance and distribution of list of approved courses and programs; request to provide unapproved course or program; reports.

NRS 449.104 Regulations to ensure patients or residents are identified in accordance with their gender identity or expression.

Community-based Living Arrangement Services

NRS 449.111 Authorized activities of licensee; requirements governing provision of services.

NRS 449.112 Establishment of individualized plan for recipient; reimbursement of Division for overpayment.

NRS 449.113 Grounds for denying renewal of license.

Senior Living Community Referral Agencies

NRS 449.114 Disclosure and consent before referral: Contents; maintenance of record; provision of copy upon request.

NRS 449.1145 Prohibitions; duties; exception; methods of compensation.

Background Investigations

NRS 449.115 Definitions.

NRS 449.119 “Facility, hospital, agency, program or home” defined.

NRS 449.1195 “Psychiatric residential treatment facility” defined.

NRS 449.121 Exemption for facility for the treatment of alcohol or other substance use disorders; exception.

NRS 449.122 Investigation of applicant for license to operate facility, hospital, agency, program or home.

NRS 449.123 Initial and periodic investigations of employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home; penalty.

NRS 449.1235 Temporary employment service prohibited from sending ineligible employee to facility, hospital, agency, program or home; temporary employment service to provide certain information regarding its employees.

NRS 449.124 Maintenance and availability of certain records regarding employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home.

NRS 449.125 Termination of employment or contract of employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home who has been convicted of certain crime; period in which to correct information regarding conviction; liability of facility, hospital, agency, program or home.

Inspections

NRS 449.131 Entry and inspection of building and premises by Division, State Fire Marshal or designee and Chief Medical Officer.

NRS 449.133 Report of results of inspections of medical facilities and facilities for the dependent by Division; disclosure of results of inspections of facilities for skilled nursing, facilities for intermediate care and residential facilities for groups.

Disciplinary Action

NRS 449.160 Grounds for denial, suspension or revocation of license; revocation of license in connection with certain nuisance activity; log of complaints; information concerning complaint, investigation and disciplinary action to be provided to facility for the care of adults during the day; written report of complaints and disciplinary actions.

NRS 449.163 Administrative sanctions: Imposition by Division; disposition of money collected.

NRS 449.165 Administrative sanctions: Regulations of Board.

NRS 449.167 Administrative sanctions: Imposition for failure to comply with requirements concerning electronic health information. [Effective July 1, 2024.]

NRS 449.170 Denial, suspension or revocation of license or imposition of sanctions: Notice; appeal; adoption of regulations.

NRS 449.171 Authority of Division to take control over medical records of medical facility, facility for the dependent or other facility required to be licensed by Division upon suspension of license or cessation of operation; confidentiality; sharing of records with appropriate authorities; regulations.

NRS 449.172 Residential facility for groups: Duties of Division and operator upon suspension or revocation of license for abuse, neglect, exploitation, isolation or abandonment of occupants.

NRS 449.174 Additional grounds for denial, suspension or revocation of license to operate certain facility, hospital, agency, program or home.

Miscellaneous Provisions

NRS 449.181 Medical facility that has custody of child pursuant to court order to adopt policy relating to medical care and medications for child; employees to receive copy of policy.

NRS 449.1815 Medical facility prohibited from allowing person who is not enrolled at accredited medical school to perform or participate in activity for credit toward medical degree.

NRS 449.1818 Off-campus location of hospital to obtain distinct national provider identifier; inclusion of national provider identifier of off-campus location or independent center for emergency medical care on claims for reimbursement.

NRS 449.1821 Hospital to accept payment through Medicare; exceptions.

NRS 449.1822 Hospital to provide for insertion or injection of long-acting reversible contraception immediately after birth upon request; exceptions; religious objection by provider of health care; maximum amounts charged to third party.

NRS 449.1823 Hospital to provide notice to medicaid patients with nontraumatic dental injuries of teledentistry providers in Medicaid managed care networks.

NRS 449.1824 Duties of hospital and licensed entity that provides care for patient upon discharge to ensure dietary needs of patient are met.

NRS 449.1825 Required posting of certain information concerning quality of certain facilities on Internet and in facilities.

NRS 449.183 Facility for intermediate care, facility for skilled nursing and residential facility for groups to adopt written policy concerning readmission after temporary transfer of patient or resident.

NRS 449.184 Operator of residential facility for groups, facility for intermediate care or facility for skilled nursing to post certain information in conspicuous place.

NRS 449.1845 Administrator of residential facility for groups to conduct annual assessment of history of each resident and cause provider of health care to conduct certain examinations and assessments; placement based on assessment.

NRS 449.186 Supervision of residential facility for groups.

NRS 449.1865 Certain residential facilities for groups to be equipped with fire sprinkler system.

NRS 449.187 Supervision of facility for skilled nursing or facility for intermediate care.

NRS 449.1885 Establishment of working group to develop document concerning sexual assault; distribution of document to hospitals, independent centers for emergency medical care and patients who are victims; duties of hospital and independent center for emergency medical care; access to emergency contraception.

NRS 449.189 Physician and nurse required to operate independent center to provide emergency medical care.

NRS 449.191 Medical facility not required to allow abortions.

NRS 449.1915 Provision of special diet to patient for whom special diet has been ordered; documentation; clinical privileges for licensed dietitian.

NRS 449.192 Admission of dentist to membership on medical staff of hospital.

NRS 449.1923 Admission of advanced practice registered nurse to membership on medical staff of hospital.

NRS 449.1925 Staff privileges for telehealth providers.

NRS 449.193 Facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care to provide itemized statement of charges upon request to certain persons.

NRS 449.1935 Agency to provide personal care services in the home authorized to provide certain services to elderly persons and persons with disabilities.

NRS 449.195 Waiver of deductible or copayment; conditions.

NRS 449.196 Requirements for program of hospice care.

NRS 449.197 Provision of care by facility for hospice care.

NRS 449.198 Requirements for freestanding birthing center; prohibition on surgery; qualifications of director.

NRS 449.199 Residential facility for groups and homes for individual residential care prohibited from providing accommodations to persons not meeting requirements for admission; exception.

NRS 449.201 Certification required for programs for alcohol or other substance use disorders operated or provided by facility for transitional living for released offenders.

NRS 449.202 Classification of hospitals.

NRS 449.203 Designation of hospital as comprehensive or primary stroke center; Division to maintain list of hospitals so designated; regulations.

NRS 449.2035 Designation of hospital as STEMI receiving center; Division to maintain list of hospitals so designated; regulations.

NRS 449.204 Misleading name or other designation of facility prohibited.

Prohibited Acts; Penalties

NRS 449.205 Retaliation or discrimination against employees and certain other persons: Prohibition under certain circumstances; medical facility prohibited from restricting right to make report or take certain other actions.

NRS 449.207 Retaliation or discrimination against employees and certain other persons: Violation; civil action for certain acts of retaliation or discrimination; damages; equitable relief; rebuttable presumption; civil penalty; time limit for bringing action.

NRS 449.208 Retaliation or discrimination against employees or certain other persons: Written notice regarding protections and legal remedies for certain acts of retaliation or discrimination; posting of notice; inclusion of notice in employee handbook.

NRS 449.209 Prohibition against medical facility or employee of medical facility making certain referrals to residential facilities for groups; civil penalties; system to track violations.

NRS 449.210 Penalties for unlicensed operation of medical facility, facility for the dependent or other facility required to be licensed by Division; cease and desist order; authority of Division to bring action; penalty for operating without a license; use of money collected.

NRS 449.220 Action to enjoin violations.

NRS 449.240 Institution and conduct of prosecutions.

REQUIREMENTS RELATING TO STAFFING

NRS 449.241 Definitions.

NRS 449.2413 “Certified nursing assistant” defined.

NRS 449.2414 “Health care facility” defined.

NRS 449.2416 “Licensed nurse” defined.

NRS 449.2417 “Practice of surgical technology” defined.

NRS 449.24175 “Surgical technologist” defined.

NRS 449.2418 “Unit” defined.

NRS 449.24185 Conditions under which health care facility may employ or allow person to engage in practice of surgical technology.

NRS 449.2419 Duties of health care facility that employs or allows person to engage in practice of surgical technology.

NRS 449.24195 Applicability of provisions concerning surgical technology.

NRS 449.242 Establishment of staffing committee by certain hospitals in larger counties; membership; duty to develop documented staffing plan; duty to consider certain requests; quarterly meetings; reporting to Legislature.

NRS 449.2421 Certain health care facilities in larger counties required to make available to Division written policy that allows refusal of or objection to work assignments and documented staffing plan; requirements of staffing plan and flexibility for adjustments.

NRS 449.2423 Certain health care facilities in larger counties to adopt written policy to allow nurse or certified nursing assistant to refuse or object to work assignments; requirements of policy; maintenance of records of refusals of and objections to work assignments.

NRS 449.2425 Division to adopt regulations establishing system for rating certain health care facilities on compliance with requirements relating to staffing: Division to post final star rating and report of unresolved violations of law on Internet website; health care facility to post its rating in facility.

NRS 449.2428 Division required to ensure that certain health care facilities comply with provisions; regulations.

MISCELLANEOUS PROVISIONS

NRS 449.243 Itemized list of charges required; use of Uniform Billing and Claims Forms authorized; contracted rates; summary of charges.

NRS 449.245 Release of child from hospital; provision of authorization for release and other information to Division of Child and Family Services; disclosure of information; penalty.

NRS 449.2455 Authority of hospital to enter into agreement with Armed Forces of United States for provision of medical care by certain persons acting under federal authority.

NRS 449.246 Hospital or freestanding birthing center to provide information relating to voluntary acknowledgment or establishment of paternity before discharging unmarried woman who has borne child; regulations.

NRS 449.2465 Persons entitled to results of tests performed at laboratory regarding patient of rural hospital.

NRS 449.247 Powers and duties of Division and State Board of Nursing with respect to nursing assistants and medication aides - certified and training of nursing assistants and medication aides - certified; provision of information to State Board of Nursing.

NRS 449.2475 Unlicensed insurer not allowed to make payment directly to person who received services in certain circumstances; limitation on civil and criminal liability.

NRS 449.2477 Requirements concerning dispute resolution clause in contract relating to provision of care by facility for long-term care.

NRS 449.248 Additional services to be provided by agency to provide nursing in home.

NRS 449.2485 Return to dispensing pharmacy of unused prescription drug dispensed to patient of facility for skilled nursing or facility for intermediate care for purpose of reissuing drug or transferring drug.

NRS 449.2486 Facility for care of adults during the day to maintain and provide certain information; form in which information to be provided.

NRS 449.2487 Notice to be provided by certain facilities which offer independent living.

NRS 449.2488 Department of Health and Human Services to develop brochure and website to assist persons who are 55 years of age or older in determining appropriate level of care and type of housing; information to be included in brochure and website.

FACILITIES FOR REFRACTIVE SURGERY

NRS 449.2489 Definitions.

NRS 449.24891 “Ophthalmologist” defined.

NRS 449.24892 “Postoperative care” defined.

NRS 449.24893 “Preoperative care” defined.

NRS 449.24894 “Surgical treatment for a refractive error of the eye” defined.

NRS 449.24895 Certain persons not required to obtain license to operate and maintain facility; filing of affidavit with Division required.

NRS 449.24896 Surgical treatments at facility must be performed by licensed ophthalmologist; availability of ophthalmologist.

NRS 449.24898 Collaboration between ophthalmologist and optometrist authorized pursuant to NRS 636.374.

NEVADA HEALTH FACILITIES ASSISTANCE ACT

NRS 449.250 Short title.

NRS 449.260 Definitions.

NRS 449.270 State Department to constitute sole agency of State for certain purposes.

NRS 449.280 Duties of State Department.

NRS 449.300 Inventory of existing health facilities; development of program for construction of facilities.

NRS 449.310 Requirements of program for construction of health facilities.

NRS 449.320 Application for federal money; deposit of money.

NRS 449.340 State Department to prescribe minimum standards; standards to supersede local ordinances and regulations; penalty.

NRS 449.345 Restriction on adoption of regulations concerning construction, maintenance, operation or safety of building, structure or other property.

NRS 449.360 Application for construction of health facility: Filing; compliance with federal and state requirements.

NRS 449.370 Application for construction of health facility: Notice and hearing; approval and forwarding.

NRS 449.380 Inspection of construction of health facility; certification by State Department.

NRS 449.390 Authority to receive and distribute federal money; Health Facilities Assistance Fund; deposits, use and controls.

NRS 449.400 State Public Health Facilities Construction Assistance Fund: Creation; administration.

NRS 449.410 State assistance for construction of certain projects; eligibility of project for assistance.

NRS 449.420 Amount of state assistance: Allocations; payments.

NRS 449.430 Money from State Public Health Facilities Construction Assistance Fund to be paid in installments.

INTERMEDIARY SERVICE ORGANIZATIONS

General Provisions

NRS 449.4304 “Intermediary service organization” defined.

NRS 449.4308 Authority to provide services.

NRS 449.4309 Board to adopt regulations authorizing employee of intermediary service organization to perform certain tasks.

Certification

NRS 449.431 Certificate required; exception; penalty.

NRS 449.4311 Application for certificate: Contents.

NRS 449.4312 Application for certificate: Social security number required. [Effective until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 449.4313 Application for certificate: Statement regarding obligation of child support; grounds for denial; duty of Division. [Effective until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 449.4314 Application for certificate: Fee.

NRS 449.4315 Prohibition on denial of application based on immigration or citizenship status; alternative personally identifying number required by applicant with no social security number; confidentiality of social security or alternative personally identifying number.

NRS 449.4316 Petition to determine if criminal history will disqualify person from obtaining certificate; fee; posting of requirements for certificate and list of disqualifying crimes on Internet; report.

NRS 449.4317 Issuance of certificate; nontransferability.

NRS 449.4318 Form and contents of certificate.

NRS 449.4319 Expiration and renewal of certificate.

NRS 449.432 Application for renewal of certificate: Information concerning state business license required; conditions which require denial.

NRS 449.4321 Grounds for denial, suspension or revocation of certificate.

NRS 449.4322 Suspension of certificate for failure to pay child support or comply with certain subpoenas or warrants; reinstatement of certificate. [Effective until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 449.4324 Provisional certificate.

NRS 449.4325 Deposit of money received; expenses of Division to enforce provisions.

NRS 449.4327 Regulations; powers of Division.

Background Investigations

NRS 449.4329 Initial and periodic investigations of employee, employee of temporary employment service or independent contractor; penalty.

NRS 449.43295 Temporary employment service prohibited from sending ineligible employee to organization; temporary employment service to provide certain information regarding its employees.

NRS 449.433 Maintenance and availability of certain records regarding employee, employee of temporary employment service or independent contractor of organization.

NRS 449.4331 Termination of employment or contract of employee, employee of temporary employment service or independent contractor who has been convicted of certain crime; period in which to correct information regarding conviction; liability of organization.

NRS 449.4332 Additional grounds for denial, suspension or revocation of certificate.

Disciplinary Action; Enforcement

NRS 449.4335 Administrative sanctions: Imposition by Division; consequences of failure to pay; use of money collected.

NRS 449.4336 Administrative sanctions: Regulations.

NRS 449.4337 Notice by Division of disciplinary action; exception; appeal.

NRS 449.4338 Action to enjoin violations.

NRS 449.4339 Prosecution by district attorney.

PERMIT FOR SERVICES OF GENERAL ANESTHESIA, CONSCIOUS SEDATION AND DEEP SEDATION; NATIONAL ACCREDITATION; INSPECTIONS OF SURGICAL CENTERS FOR AMBULATORY PATIENTS AND CERTAIN PHYSICIANS’ OFFICES AND FACILITIES

NRS 449.435 Definitions.

NRS 449.436 “Conscious sedation” defined.

NRS 449.437 “Deep sedation” defined.

NRS 449.438 “General anesthesia” defined.

NRS 449.439 “Physician” defined.

NRS 449.441 Exemption from provisions if physician’s office or facility only administers certain type of pain medication.

NRS 449.442 Permit required for certain physicians’ offices and facilities to offer services; national accreditation required; cessation of services for failure to maintain accreditation.

NRS 449.443 Application for permit; fee; inspection by Division; term of permit.

NRS 449.444 Application for renewal of permit; fee.

NRS 449.4445 Legislative findings and declaration concerning oversight of surgical centers for ambulatory patients.

NRS 449.445 National accreditation required of surgical center for ambulatory patients; inspection by Division; cessation of operation for failure to maintain accreditation.

NRS 449.446 Annual inspections of holders of permits and surgical centers for ambulatory patients; correction of deficiencies identified in inspections; reporting of inspections to Legislature.

NRS 449.4465 Report of Division concerning surgical centers for ambulatory patients.

NRS 449.447 Disciplinary action for certain violations or failure to correct deficiency; notification to State Board of Osteopathic Medicine of violations; administrative sanctions.

NRS 449.448 Regulations.

ACCOUNTING; FINANCIAL REPORTS; FEES; ENSURING QUALITY OF CARE

NRS 449.450 Definitions.

NRS 449.460 Powers of Director.

NRS 449.465 Authority of Director to impose fees; maximum amount of fees collected; requirement to impose fee for support of Joint Interim Standing Committee on Health and Human Services.

NRS 449.470 Director may use staff or contract for services.

NRS 449.476 Committee to ensure quality of care: Formation by hospital; general requirements.

NRS 449.485 Hospital required to use discharge form prescribed by Director; electronic monthly reporting; exception to electronic reporting; use of information by Department.

NRS 449.490 Financial statements and reports required to be filed with Department; additional reporting requirements for hospitals with 100 or more beds; availability of complete current charge master.

NRS 449.500 Director to carry out analyses and studies concerning cost of health care.

NRS 449.510 Director to prepare and file summaries, compilations or other reports; public inspection; collection, maintenance, disclosure or publication of contracts or identification of party to contract prohibited.

NRS 449.520 Reports to Governor and legislative committees; development of comprehensive plan by Joint Interim Standing Committee on Health and Human Services.

NRS 449.530 Administrative fine for violation.

PREVENTING PERSONS FROM ENTERING OR EXITING HEALTH FACILITY

NRS 449.531 Unlawful acts; exception; penalty.

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GENERAL PROVISIONS

NRS 449.001 Definitions. As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 449.0015 to 449.0195, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 1973, 1278; A 1975, 366, 897; 1977, 641; 1979, 160, 1113; 1983, 1657; 1985, 1736; 1989, 304, 1034, 1037; 1993, 2556; 1995, 1600; 1999, 248, 970; 2001, 1341, 2518; 2005, 485, 532, 1379, 1517, 2165, 2350; 2011, 1337; 2013, 3055; 2015, 2160, 2172; 2017, 1409, 1570; 2021, 3437; 2023, 566, 2931)

NRS 449.0015 “Agency to provide nursing in the home” defined.

1. “Agency to provide nursing in the home” means any person or governmental organization which provides in the home, through its employees or by contractual arrangement with other persons, skilled nursing and assistance and training in health and housekeeping skills.

2. The term does not include:

(a) A provider of community-based living arrangement services during any period in which the provider of community-based living arrangement services is engaged in providing community-based living arrangement services; or

(b) A provider of supported living arrangement services during any period in which the provider of supported living arrangement services is engaged in providing supported living arrangement services.

(Added to NRS by 1979, 160; A 1985, 1737; 2005, 1379; 2017, 1409)

NRS 449.0021 “Agency to provide personal care services in the home” defined.

1. “Agency to provide personal care services in the home” means any person, other than a natural person, which provides in the home the services authorized pursuant to NRS 449.1935 to elderly persons or persons with disabilities.

2. The term does not include:

(a) An independent contractor who provides nonmedical services specified in NRS 449.1935 without the assistance of employees;

(b) An organized group of persons composed of the family or friends of a person needing personal care services that employs or contracts with persons to provide nonmedical services specified in NRS 449.1935 for the person if:

(1) The organization of the group of persons is set forth in a written document that is made available for review by the Division upon request; and

(2) The personal care services are provided to only one person or one family who resides in the same residence;

(d) A person or agency that contracts with the Aging and Disability Services Division of the Department of Health and Human Services to provide temporary respite services.

3. As used in this section:

(a) “Intermediary service organization” has the meaning ascribed to it in NRS 449.4304.

(b) “Temporary respite services” means services provided through a contract with the Aging and Disability Services Division of the Department of Health and Human Services to a natural person on a periodic basis to provide a respite for a regular provider of services.

(Added to NRS by 2005, 2164; A 2007, 1225; 2009, 2399; 2013, 134; 2017, 1410)

NRS 449.0025 “Board” defined. “Board” means the State Board of Health.

(Added to NRS by 1985, 1735)

NRS 449.0026 “Community-based living arrangement services” defined. “Community-based living arrangement services” means flexible, individualized services, including, without limitation, training and habilitation services, that are:

1. Provided in the home, for compensation, to persons with mental illness who are served by the Division or any other entity; and

2. Designed and coordinated to assist such persons in maximizing their independence.

(Added to NRS by 2017, 1409; A 2019, 247)

NRS 449.0027 “Community health worker” defined. “Community health worker” means a natural person who:

1. Lives in or otherwise has a connection to the community in which he or she provides services.

2. Is trained by a provider of health care to provide certain services which do not require the community health worker to be licensed.

3. Provides services at the direction of a facility for the dependent, medical facility or provider of health care which may include, without limitation, outreach and the coordination of health care.

(Added to NRS by 2015, 2172)

NRS 449.0028 “Community health worker pool” defined. “Community health worker pool” means a person or agency which provides, for compensation and through its employees or by contract with community health workers, the services of community health workers to any natural person, medical facility or facility for the dependent. The term does not include an independent contractor who personally provides the services of a community health worker or a facility for the dependent or any medical facility other than a community health worker pool which provides the services of a community health worker.

(Added to NRS by 2015, 2172)

NRS 449.0031 “Community triage center” defined. “Community triage center” means a facility that provides on a 24-hour basis medical assessments of and short-term monitoring services for persons with mental illness and persons with alcohol or other substance use disorders in a manner which does not require that the assessments and services be provided in a licensed hospital.

(Added to NRS by 2005, 532)

NRS 449.0032 “Division” defined. “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

(Added to NRS by 2013, 3055)

NRS 449.00325 “Employment agency” defined. “Employment agency” has the meaning ascribed to it in NRS 611.020.

(Added to NRS by 2017, 1569)

NRS 449.0033 “Facility for hospice care” defined. “Facility for hospice care” means a facility which is operated to provide hospice care.

(Added to NRS by 1999, 248)

NRS 449.0038 “Facility for intermediate care” defined. “Facility for intermediate care” means an establishment operated and maintained to provide 24-hour personal and medical supervision, for a person who does not have illness, disease, injury or other condition that would require the degree of care and treatment which a hospital or facility for skilled nursing is designed to provide.

(Added to NRS by 1973, 1279; A 1985, 1737; 1991, 1974)

NRS 449.00385 “Facility for modified medical detoxification” defined. “Facility for modified medical detoxification” means a facility that provides 24-hour medical monitoring of treatment and detoxification in a manner which does not require that the service be provided in a licensed hospital.

(Added to NRS by 1999, 969)

NRS 449.00387 “Facility for refractive surgery” defined.

1. “Facility for refractive surgery” means a freestanding facility that provides limited medical services relating to surgical treatments for patients with refractive errors of the eye, including the preoperative care and evaluation of those patients, the surgical treatment of those patients and the postoperative care and evaluation of those patients.

2. As used in this section:

(a) “Postoperative care” has the meaning ascribed to it in NRS 449.24892.

(b) “Preoperative care” has the meaning ascribed to it in NRS 449.24893.

(Added to NRS by 2001, 1339; A 2005, 2693; 2009, 452)

NRS 449.0039 “Facility for skilled nursing” defined.

1. “Facility for skilled nursing” means an establishment which provides continuous skilled nursing and related care as prescribed by a physician to a patient in the facility who is not in an acute episode of illness and whose primary need is the availability of such care on a continuous basis.

2. “Facility for skilled nursing” does not include a facility which meets the requirements of a general or any other special hospital.

(Added to NRS by 1973, 1279; A 1985, 1738)

NRS 449.004 “Facility for the care of adults during the day” defined. “Facility for the care of adults during the day” means an establishment operated and maintained to provide care during the day on a temporary or permanent basis for aged or infirm persons. The term does not include a recovery house for persons recovering from alcohol or other substance use disorders.

(Added to NRS by 1983, 1657; A 1985, 1736; 2001, 2518)

NRS 449.0045 “Facility for the dependent” defined. “Facility for the dependent” includes:

1. A facility for the treatment of alcohol or other substance use disorders;

2. A facility for the care of adults during the day;

3. A residential facility for groups;

4. An agency to provide personal care services in the home;

5. A facility for transitional living for released offenders;

6. A home for individual residential care;

7. A community health worker pool; and

8. A provider of community-based living arrangement services.

(Added to NRS by 1985, 1735; A 2001, 2518; 2005, 2165, 2350; 2011, 356; 2015, 2160, 2172; 2019, 248; 2021, 2824; 2023, 1733)

NRS 449.00455 “Facility for the treatment of alcohol or other substance use disorders” defined. “Facility for the treatment of alcohol or other substance use disorders” means any public or private establishment which provides residential treatment, including mental and physical restoration, of persons with alcohol or other substance use disorders. It does not include a medical facility or services offered by volunteers or voluntary organizations.

(Added to NRS by 1975, 366; A 1985, 1736; 1993, 1624; 1999, 1871; 2001, 417; 2005, 22nd Special Session, 56; 2013, 3055; 2015, 305, 2475)

NRS 449.0046 “Facility for the treatment of irreversible renal disease” defined. “Facility for the treatment of irreversible renal disease” means a facility that is not part of a hospital and which provides peritoneal dialysis or hemodialysis or trains a person with a permanent irreversible renal impairment to perform dialysis for himself or herself.

(Added to NRS by 1985, 1735)

NRS 449.0055 “Facility for transitional living for released offenders” defined.

1. “Facility for transitional living for released offenders” means a residence that provides housing and a living environment for persons who have been released from prison and who require assistance with reintegration into the community, other than such a residence that is operated or maintained by a state or local government or an agency thereof. The term does not include a recovery house for persons recovering from alcohol or other substance use disorders or a facility for the treatment of alcohol or other substance use disorders.

2. As used in this section, “person who has been released from prison” means:

(a) A parolee.

(b) A person who is participating in:

(1) A judicial program pursuant to NRS 209.4886 or 213.625; or

(2) A correctional program pursuant to NRS 209.4888 or 213.632.

(c) A person who is supervised by the Division of Parole and Probation of the Department of Public Safety through residential confinement pursuant to NRS 213.371 to 213.410, inclusive.

(d) A person who has been released from prison by expiration of his or her term of sentence.

(Added to NRS by 2005, 2349)

NRS 449.0065 “Freestanding birthing center” defined. “Freestanding birthing center” means a facility that provides maternity care and birthing services using a family-centered approach in which births are planned to occur in a location similar to a residence that is not the usual place of residence of the person giving birth to a child.

(Added to NRS by 2021, 3436)

NRS 449.008 “Halfway house for persons recovering from alcohol or other substance use disorders” defined. [Replaced in revision by NRS 449.0166.]

NRS 449.0105 “Home for individual residential care” defined. “Home for individual residential care” means a home in which a natural person furnishes food, shelter, assistance and limited supervision, for compensation, to not more than two persons with intellectual disabilities or with physical disabilities or who are aged or infirm, unless the persons receiving those services are related within the third degree of consanguinity or affinity to the person providing those services. The term does not include:

1. A recovery house for persons recovering from alcohol or other substance use disorders; or

2. A home in which community-based living arrangement services or supported living arrangement services are provided by a provider of such services during any period in which the provider is engaged in providing the services.

(Added to NRS by 1993, 2556; A 2001, 2518; 2005, 1380; 2013, 696; 2017, 1410)

NRS 449.0115 “Hospice care” defined.

1. “Hospice care” means a centrally administered program of palliative services and supportive services provided by an interdisciplinary team directed by a physician. The program includes the provision of physical, psychological, custodial and spiritual care for persons who are terminally ill and their families. The care may be provided in the home, at a residential facility or at a medical facility at any time of the day or night. The term includes the supportive care and services provided to the family after the patient dies.

2. As used in this section:

(a) “Family” includes the immediate family, the person who primarily cared for the patient and other persons with significant personal ties to the patient, whether or not related by blood.

(b) “Interdisciplinary team” means a group of persons who work collectively to meet the special needs of terminally ill patients and their families and includes such persons as a physician, registered nurse, social worker, member of the clergy and trained volunteer.

(Added to NRS by 1979, 1112; A 1985, 1737; 1989, 1035; 2005, 485)

NRS 449.012 “Hospital” defined. “Hospital” means an establishment for the diagnosis, care and treatment of human illness, including care available 24 hours each day from persons licensed to practice professional nursing who are under the direction of a physician, services of a medical laboratory and medical, radiological, dietary and pharmaceutical services.

(Added to NRS by 1973, 1279; A 1985, 1737)

NRS 449.013 “Independent center for emergency medical care” defined. “Independent center for emergency medical care” means a facility, structurally separate and distinct from a hospital, which provides limited services for the treatment of a medical emergency.

(Added to NRS by 1985, 1735)

NRS 449.0145 “Licensed practical nurse” defined. “Licensed practical nurse” has the meaning ascribed to it in NRS 632.016.

(Added to NRS by 2005, 1517)

NRS 449.0151 “Medical facility” defined. “Medical facility” includes:

1. A surgical center for ambulatory patients;

2. A freestanding birthing center;

3. An independent center for emergency medical care;

4. An agency to provide nursing in the home;

5. A facility for intermediate care;

6. A facility for skilled nursing;

7. A facility for hospice care;

8. A hospital;

9. A psychiatric hospital;

10. A facility for the treatment of irreversible renal disease;

11. A rural clinic;

12. A nursing pool;

13. A facility for modified medical detoxification;

14. A facility for refractive surgery;

15. A mobile unit;

16. A community triage center; and

17. A rural emergency hospital.

(Added to NRS by 1973, 1279; A 1975, 366; 1979, 161, 887, 1113; 1983, 1657; 1985, 1736; 1989, 304, 1035, 1037; 1999, 248, 970; 2001, 1341; 2005, 532, 2693; 2021, 3437; 2023, 2931)

NRS 449.01513 “Medication aide - certified” defined. “Medication aide - certified” has the meaning ascribed to it in NRS 632.0165.

(Added to NRS by 2011, 1337)

NRS 449.01515 “Mobile unit” defined.

1. Except as otherwise provided in subsection 2, “mobile unit” means a motor vehicle that is specially designed, constructed and equipped to provide any of the medical services provided by a medical facility described in subsections 1 to 13, inclusive, of NRS 449.0151.

2. “Mobile unit” does not include:

(a) A motor vehicle that is operated by a medical facility described in subsections 1 to 13, inclusive, of NRS 449.0151 which is accredited by the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association;

(b) A motor vehicle that is operated by a health center that is funded under section 330 of the Public Health Service Act, 42 U.S.C. § 254b, as amended; or

(Added to NRS by 2001, 1339; A 2003, 421)

NRS 449.01517 “Nonmedical services related to personal care to elderly persons or persons with disabilities” defined. “Nonmedical services related to personal care to elderly persons or persons with disabilities” includes, without limitation:

1. The elimination of wastes from the body;

2. Dressing and undressing;

3. Bathing;

4. Grooming;

5. The preparation and eating of meals;

6. Laundry;

7. Shopping;

8. Cleaning;

9. Transportation; and

10. Any other minor needs related to the maintenance of personal hygiene.

(Added to NRS by 2017, 1569)

NRS 449.0152 “Nursing assistant” defined. “Nursing assistant” has the meaning ascribed to it in NRS 632.0166.

(Added to NRS by 2005, 1517)

NRS 449.0153 “Nursing pool” defined.

1. “Nursing pool” means a person or agency which provides for compensation, through its employees or by contractual arrangement with other persons, nursing services to any natural person, medical facility or facility for the dependent.

2. The term does not include:

(a) An independent contractor who provides such services without the assistance of employees;

(b) A nursing pool based in a medical facility or facility for the dependent;

(c) A provider of community-based living arrangement services during any period in which the provider of community-based living arrangement services is engaged in providing community-based living arrangement services; or

(d) A provider of supported living arrangement services during any period in which the provider of supported living arrangement services is engaged in providing supported living arrangement services.

(Added to NRS by 1989, 303; A 2005, 1380; 2017, 1410)

NRS 449.0156 “Palliative services” defined. “Palliative services” means services and treatments directed toward the control of pain and symptoms which provide the greatest degree of relief for the longest period while minimizing any adverse effects of the services and treatments, including, without limitation, any side effects of any medications given or administered.

(Added to NRS by 2005, 485)

NRS 449.0157 “Provider of health care” defined. “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(Added to NRS by 1995, 1600)

NRS 449.0159 “Provider of supported living arrangement services” defined. “Provider of supported living arrangement services” means a natural person who or a partnership, firm, corporation, association, state or local government or agency thereof that has been issued a certificate pursuant to NRS 435.3305 to 435.339, inclusive, and the regulations adopted pursuant to NRS 435.3305 to 435.339, inclusive.

(Added to NRS by 2005, 1379)

NRS 449.0165 “Psychiatric hospital” defined. “Psychiatric hospital” means a hospital for the diagnosis, care and treatment of mental illness which provides 24-hour care.

(Added to NRS by 1985, 1735; A 2017, 1895)

NRS 449.0166 “Recovery house for persons recovering from alcohol or other substance use disorders” defined. “Recovery house for persons recovering from alcohol or other substance use disorders” has the meaning ascribed to it in NRS 278.02374.

(Added to NRS by 2001, 2518; A 2005, 2350; 2023, 1733)—(Substituted in revision for NRS 449.008)

NRS 449.0167 “Registered nurse” defined. “Registered nurse” has the meaning ascribed to it in NRS 632.019.

(Added to NRS by 2005, 1517)

NRS 449.017 “Residential facility for groups” defined.

1. Except as otherwise provided in subsection 2, “residential facility for groups” means an establishment that furnishes food, shelter, assistance and limited supervision to a person with an intellectual disability or with a physical disability or a person who is aged or infirm. The term includes, without limitation, an assisted living facility.

2. The term does not include:

(a) An establishment which provides care only during the day;

(b) A natural person who provides care for no more than two persons in his or her own home;

(c) A natural person who provides care for one or more persons related to him or her within the third degree of consanguinity or affinity;

(d) A recovery house for persons recovering from alcohol or other substance use disorders; or

(e) A home in which community-based living arrangement services or supported living arrangement services are provided by a provider of such services during any period in which the provider is providing the services.

(Added to NRS by 1973, 1278; A 1979, 212; 1983, 1657; 1985, 930, 1736; 1991, 1974; 1993, 1213; 1999, 114, 125; 2001, 57, 546, 2519, 2522; 2013, 696; 2017, 1411)

NRS 449.0175 “Rural clinic” defined. “Rural clinic” means a facility located in an area that is not designated as an urban area by the Bureau of the Census, where medical services are provided by a physician assistant licensed pursuant to chapter 630 or 633 of NRS or an advanced practice registered nurse licensed pursuant to NRS 632.237 who is under the supervision of a licensed physician.

(Added to NRS by 1985, 1735; A 2001, 782; 2007, 1862; 2013, 2082)

NRS 449.0177 “Rural hospital” defined. “Rural hospital” means a hospital with 85 or fewer beds which is:

1. The sole institutional provider of health care located within a county whose population is less than 100,000;

2. The sole institutional provider of health care located within a city whose population is less than 25,000; or

3. Maintained and governed pursuant to NRS 450.550 to 450.750, inclusive.

(Added to NRS by 1995, 1600; A 2001, 1992)

NRS 449.0178 “Rural emergency hospital” defined. “Rural emergency hospital” means a hospital that is a rural emergency hospital, as defined in 42 U.S.C. § 1395x(kkk).

(Added to NRS by 2023, 2931)

NRS 449.0179 “Senior living community” defined. “Senior living community” means:

1. A home for individual residential care, residential facility for groups, facility for intermediate care, facility for skilled nursing, assisted living facility or retirement home or village that primarily provides services to persons who are aged; or

2. Any other group housing arrangement that provides assistance, food, shelter or limited supervision to persons who are aged.

(Added to NRS by 2023, 564)

NRS 449.0181 “Senior living community referral agency” defined. “Senior living community referral agency” means a person who refers persons who are aged to senior living communities for a fee paid by the senior living community, the person who is aged or the representative of such a person. The term does not include:

1. A senior living community or an employee of a senior living community; or

2. A resident of a senior living community, a family member of such a resident or any other person who receives any service from a senior living community, regardless of whether the person receives any form of compensation for a referral.

(Added to NRS by 2023, 564)

NRS 449.0185 “Supported living arrangement services” defined. “Supported living arrangement services” has the meaning ascribed to it in NRS 435.3315.

(Added to NRS by 2005, 1379)

NRS 449.019 “Surgical center for ambulatory patients” defined. “Surgical center for ambulatory patients” means a facility with limited medical services available for diagnosis or treatment of patients by surgery where the patients’ recovery, in the opinion of the surgeon, will not require care as a patient in the facility for more than 24 hours.

(Added to NRS by 1975, 366; A 1985, 1736; 1993, 207)

NRS 449.0195 “Terminally ill” defined. “Terminally ill” means a medical diagnosis made by a physician that a person has an anticipated life expectancy of not more than 12 months.

(Added to NRS by 2005, 485)

LICENSING AND REGULATION

General Provisions

NRS 449.029 “Medical facility” further defined. As used in NRS 449.029 to 449.240, inclusive, unless the context otherwise requires, “medical facility” has the meaning ascribed to it in NRS 449.0151 and includes a program of hospice care described in NRS 449.196.

(Added to NRS by 2017, 1895; A 2019, 1112, 1335, 1398, 1919, 2149, 2594, 2641, 2917, 4034; 2021, 364; 2023, 566, 907, 1848, 3332, 3440)

NRS 449.030 License required to operate or maintain medical facility or facility for the dependent. Except as otherwise provided in NRS 449.03013 and 449.03017, no person, state or local government or agency thereof may operate or maintain in this State any medical facility or facility for the dependent without first obtaining a license therefor as provided in NRS 449.029 to 449.2428, inclusive.

[Part 1:336:1951]—(NRS A 1971, 934; 1973, 1281; 1985, 1738; 1989, 1035; 1997, 444, 1484; 1999, 249, 3608; 2011, 704; 2015, 2160, 2172; 2017, 1570, 1895, 4165; 2019, 1674; 2021, 2824)

1. Except as otherwise provided in NRS 449.03017, a person must obtain a license from the Board to operate an employment agency that contracts with persons in this State to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home, regardless of whether the agency is located in this State.

2. The Board shall adopt:

(a) Standards for licensing of employment agencies that provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home;

(b) Standards relating to the fees charged by such employment agencies;

(d) Regulations establishing requirements for training the persons who contract with such employment agencies to provide such nonmedical services.

3. An employment agency that is licensed pursuant to this section shall not refer a person to a home to provide nonmedical services related to personal care to elderly persons or persons with disabilities if that person has not met the requirements set forth in NRS 449.115 to 449.125, inclusive.

4. A person who violates the provisions of subsection 3 is liable for a civil penalty to be recovered by the Attorney General in the name of the Board for the first offense of not more than $10,000 and for a second or subsequent offense of not less than $10,000 nor more than $20,000. Unless otherwise required by federal law, the Board shall deposit all civil penalties collected pursuant to this section into a separate account in the State General Fund to be used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, 449.435 to 449.531, inclusive, and chapter 449A of NRS and to protect the health, safety, well-being and property of the persons served by employment agencies.

(Added to NRS by 2017, 1569; A 2019, 248; 2021, 364)

NRS 449.03008 Petition to determine if criminal history will disqualify person from obtaining license; fee; posting of requirements for license and list of disqualifying crimes on Internet; report.

1. The Division shall develop and implement a process by which a person with a criminal history may petition the Division to review the criminal history of the person to determine if the person’s criminal history will disqualify the person from obtaining a license pursuant to NRS 449.029 to 449.2428, inclusive.

2. Not later than 90 days after a petition is submitted to the Division pursuant to subsection 1, the Division shall inform the person of the determination of the Division of whether the person’s criminal history will disqualify the person from obtaining a license. The Division is not bound by its determination of disqualification or qualification and may rescind such a determination at any time.

3. The Division may provide instructions to a person who receives a determination of disqualification to remedy the determination of disqualification. A person may resubmit a petition pursuant to subsection 1 not earlier than 6 months after receiving instructions pursuant to this subsection if the person remedies the determination of disqualification.

4. A person with a criminal history may petition the Division at any time, including, without limitation, before obtaining any education or paying any fee required to obtain a license from the Division.

5. A person may submit a new petition to the Division not earlier than 2 years after the final determination of the initial petition submitted to the Division.

6. The Division may impose a fee of up to $50 upon the person to fund the administrative costs in complying with the provisions of this section. The Division may waive such fees or allow such fees to be covered by funds from a scholarship or grant.

7. The Division may post on its Internet website:

(a) The requirements to obtain a license pursuant to NRS 449.029 to 449.2428, inclusive, from the Division; and

(b) A list of crimes, if any, that would disqualify a person from obtaining a license from the Division.

8. The Division may request the criminal history record of a person who petitions the Division for a determination pursuant to subsection 1. To the extent consistent with federal law, if the Division makes such a request of a person, the Division shall require the person to submit his or her criminal history record which includes a report from:

(a) The Central Repository for Nevada Records of Criminal History; and

(b) The Federal Bureau of Investigation.

9. A person who petitions the Division for a determination pursuant to subsection 1 shall not submit false or misleading information to the Division.

10. The Division shall, on or before the 20th day of January, April, July and October, submit to the Director of the Legislative Counsel Bureau in an electronic format prescribed by the Director, a report that includes:

(a) The number of petitions submitted to the Division pursuant to subsection 1;

(b) The number of determinations of disqualification made by the Division pursuant to subsection 1;

(d) Any other information that is requested by the Director or which the Division determines would be helpful.

11. The Director shall transmit a compilation of the information received pursuant to subsection 10 to the Legislative Commission quarterly, unless otherwise directed by the Commission.

(Added to NRS by 2019, 2916)

NRS 449.0301 Exemptions. The provisions of NRS 449.029 to 449.2428, inclusive, do not apply to:

1. Any facility conducted by and for the adherents of any church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend solely upon spiritual means through prayer for healing in the practice of the religion of the church or denomination, except that such a facility shall comply with all regulations relative to sanitation and safety applicable to other facilities of a similar category.

2. Foster homes as defined in NRS 424.014.

3. Any medical facility, facility for the dependent or facility which is otherwise required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed that is operated and maintained by the United States Government or an agency thereof.

[Part 3:336:1951] + [7:336:1951]—(NRS A 1971, 935; 1973, 1282; 1979, 887; 1985, 1740; 1993, 2724; 2003, 857; 2005, 2169; 2011, 356, 1064, 1358, 2253, 2396; 2013, 2145; 2015, 1530; 2017, 331, 1570, 1896, 2049, 2304, 4165; 2019, 336, 1112, 1335, 1398, 1674, 1919, 2149, 2594, 2641, 2917, 4034; 2021, 365; 2023, 566, 907, 1848, 3333, 3440)

NRS 449.03013 Facility for the dependent or medical facility that employs community health workers not required to obtain additional license. A person who is licensed pursuant to this chapter as a facility for the dependent or medical facility and who employs community health workers is not required to obtain an additional license as a community health worker pool.

(Added to NRS by 2015, 2172)

NRS 449.03017 Person otherwise licensed under this chapter exempt from requirement to obtain license to operate employment agency that contracts with persons to provide certain nonmedical services. A person who is licensed pursuant to a provision of this chapter other than NRS 449.03005 and who contracts with persons to provide nonmedical services related to personal care to elderly persons or persons with disabilities is not required to obtain an additional license pursuant to NRS 449.03005.

(Added to NRS by 2017, 1569)

NRS 449.0302 Board to adopt standards, qualifications and other regulations.

1. The Board shall adopt:

(a) Licensing standards for each class of medical facility or facility for the dependent covered by NRS 449.029 to 449.2428, inclusive, and for programs of hospice care.

(b) Regulations governing the licensing of such facilities and programs.

(c) Regulations governing the procedure and standards for granting an extension of the time for which a natural person may provide certain care in his or her home without being considered a residential facility for groups pursuant to NRS 449.017. The regulations must require that such grants are effective only if made in writing.

(d) Regulations establishing a procedure for the indemnification by the Division, from the amount of any surety bond or other obligation filed or deposited by a facility for refractive surgery pursuant to NRS 449.068 or 449.069, of a patient of the facility who has sustained any damages as a result of the bankruptcy of or any breach of contract by the facility.

(e) Regulations that prescribe the specific types of discrimination prohibited by NRS 449.101.

(f) Regulations requiring a hospital or independent center for emergency medical care to provide training to each employee who provides care to victims of sexual assault or attempted sexual assault concerning appropriate care for such persons, including, without limitation, training concerning the requirements of NRS 449.1885.

(g) Any other regulations as it deems necessary or convenient to carry out the provisions of NRS 449.029 to 449.2428, inclusive.

2. The Board shall adopt separate regulations governing the licensing and operation of:

(a) Facilities for the care of adults during the day; and

(b) Residential facilities for groups,

Ê which provide care to persons with Alzheimer’s disease or other severe dementia, as described in paragraph (a) of subsection 2 of NRS 449.1845.

3. The Board shall adopt separate regulations for:

(a) The licensure of rural hospitals and rural emergency hospitals which take into consideration the unique problems of operating such a facility in a rural area.

(b) The licensure of facilities for refractive surgery which take into consideration the unique factors of operating such a facility.

(c) The licensure of mobile units which take into consideration the unique factors of operating a facility that is not in a fixed location.

4. The Board shall require that the practices and policies of each medical facility or facility for the dependent provide adequately for the protection of the health, safety and physical, moral and mental well-being of each person accommodated in the facility.

5. In addition to the training requirements prescribed pursuant to NRS 449.093, the Board shall establish minimum qualifications for administrators and employees of residential facilities for groups. In establishing the qualifications, the Board shall consider the related standards set by nationally recognized organizations which accredit such facilities.

6. The Board shall adopt separate regulations regarding the assistance which may be given pursuant to NRS 453.375 and 454.213 to an ultimate user of controlled substances or dangerous drugs by employees of residential facilities for groups. The regulations must require at least the following conditions before such assistance may be given:

(a) The ultimate user’s physical and mental condition is stable and is following a predictable course.

(b) The amount of the medication prescribed is at a maintenance level and does not require a daily assessment.

(1) Addresses possession and assistance in the administration of the medication; and

(2) Includes a plan, which has been prepared under the supervision of a registered nurse or licensed pharmacist, for emergency intervention if an adverse condition results.

(d) Except as otherwise authorized by the regulations adopted pursuant to NRS 449.0304, the prescribed medication is not administered by injection or intravenously.

(e) The employee has successfully completed training and examination approved by the Division regarding the authorized manner of assistance.

7. The Board shall adopt separate regulations governing the licensing and operation of residential facilities for groups which provide assisted living services. The Board shall not allow the licensing of a facility as a residential facility for groups which provides assisted living services and a residential facility for groups shall not claim that it provides “assisted living services” unless:

(a) Before authorizing a person to move into the facility, the facility makes a full written disclosure to the person regarding what services of personalized care will be available to the person and the amount that will be charged for those services throughout the resident’s stay at the facility.

(b) The residents of the facility reside in their own living units which:

(1) Except as otherwise provided in subsection 8, contain toilet facilities;

(2) Contain a sleeping area or bedroom; and

(3) Are shared with another occupant only upon consent of both occupants.

(c) The facility provides personalized care to the residents of the facility and the general approach to operating the facility incorporates these core principles:

(1) The facility is designed to create a residential environment that actively supports and promotes each resident’s quality of life and right to privacy;

(2) The facility is committed to offering high-quality supportive services that are developed by the facility in collaboration with the resident to meet the resident’s individual needs;

(3) The facility provides a variety of creative and innovative services that emphasize the particular needs of each individual resident and the resident’s personal choice of lifestyle;

(4) The operation of the facility and its interaction with its residents supports, to the maximum extent possible, each resident’s need for autonomy and the right to make decisions regarding his or her own life;

(5) The operation of the facility is designed to foster a social climate that allows the resident to develop and maintain personal relationships with fellow residents and with persons in the general community;

(6) The facility is designed to minimize and is operated in a manner which minimizes the need for its residents to move out of the facility as their respective physical and mental conditions change over time; and

(7) The facility is operated in such a manner as to foster a culture that provides a high-quality environment for the residents, their families, the staff, any volunteers and the community at large.

8. The Division may grant an exception from the requirement of subparagraph (1) of paragraph (b) of subsection 7 to a facility which is licensed as a residential facility for groups on or before July 1, 2005, and which is authorized to have 10 or fewer beds and was originally constructed as a single-family dwelling if the Division finds that:

(a) Strict application of that requirement would result in economic hardship to the facility requesting the exception; and

(b) The exception, if granted, would not:

(1) Cause substantial detriment to the health or welfare of any resident of the facility;

(2) Result in more than two residents sharing a toilet facility; or

(3) Otherwise impair substantially the purpose of that requirement.

9. The Board shall, if it determines necessary, adopt regulations and requirements to ensure that each residential facility for groups and its staff are prepared to respond to an emergency, including, without limitation:

(a) The adoption of plans to respond to a natural disaster and other types of emergency situations, including, without limitation, an emergency involving fire;

(b) The adoption of plans to provide for the evacuation of a residential facility for groups in an emergency, including, without limitation, plans to ensure that nonambulatory patients may be evacuated;

(c) Educating the residents of residential facilities for groups concerning the plans adopted pursuant to paragraphs (a) and (b); and

(d) Posting the plans or a summary of the plans adopted pursuant to paragraphs (a) and (b) in a conspicuous place in each residential facility for groups.

10. The regulations governing the licensing and operation of facilities for transitional living for released offenders must provide for the licensure of at least three different types of facilities, including, without limitation:

(a) Facilities that only provide a housing and living environment;

(b) Facilities that provide or arrange for the provision of supportive services for residents of the facility to assist the residents with reintegration into the community, in addition to providing a housing and living environment; and

(c) Facilities that provide or arrange for the provision of programs for alcohol and other substance use disorders, in addition to providing a housing and living environment and providing or arranging for the provision of other supportive services.

Ê The regulations must provide that if a facility was originally constructed as a single-family dwelling, the facility must not be authorized for more than eight beds.

11. The Board shall adopt regulations applicable to providers of community-based living arrangement services which:

(a) Except as otherwise provided in paragraph (b), require a natural person responsible for the operation of a provider of community-based living arrangement services and each employee of a provider of community-based living arrangement services who supervises or provides support to recipients of community-based living arrangement services to complete training concerning the provision of community-based living arrangement services to persons with mental illness and continuing education concerning the particular population served by the provider;

(b) Exempt a person licensed or certified pursuant to title 54 of NRS from the requirements prescribed pursuant to paragraph (a) if the Board determines that the person is required to receive training and continuing education substantially equivalent to that prescribed pursuant to that paragraph;

(c) Require a natural person responsible for the operation of a provider of community-based living arrangement services to receive training concerning the provisions of title 53 of NRS applicable to the provision of community-based living arrangement services; and

(d) Require an applicant for a license to provide community-based living arrangement services to post a surety bond in an amount equal to the operating expenses of the applicant for 2 months, place that amount in escrow or take another action prescribed by the Division to ensure that, if the applicant becomes insolvent, recipients of community-based living arrangement services from the applicant may continue to receive community-based living arrangement services for 2 months at the expense of the applicant.

12. The Board shall adopt separate regulations governing the licensing and operation of freestanding birthing centers. Such regulations must:

(a) Align with the standards established by the American Association of Birth Centers, or its successor organization, the accrediting body of the Commission for the Accreditation of Birth Centers, or its successor organization, or another nationally recognized organization for accrediting freestanding birthing centers; and

(b) Allow the provision of supervised training to providers of health care, as appropriate, at a freestanding birthing center.

13. If the regulations adopted pursuant to this section require a physical examination to be performed on a patient or the medical history of a patient to be obtained before or after the patient is admitted to a hospital, those regulations must authorize a certified nurse-midwife to perform such a physical examination or obtain such a medical history before or after a patient is admitted to a hospital for the purpose of giving birth.

14. As used in this section:

(a) “Certified nurse-midwife” means a person who is:

(1) Certified as a Certified Nurse-Midwife by the American Midwifery Certification Board, or its successor organization; and

(2) Licensed as an advanced practice registered nurse pursuant to NRS 632.237.

(b) “Living unit” means an individual private accommodation designated for a resident within the facility.

(Added to NRS by 1969, 946; A 1971, 934; 1973, 1281; 1985, 1738; 1987, 990; 1989, 1036, 2155, 2156; 1991, 1975; 1993, 1214; 1995, 1600; 1999, 3608; 2001, 1341; 2003, 1921; 2005, 2165, 2350, 2693; 2007, 1921; 2009, 1441; 2011, 2250; 2015, 631, 2160, 2173; 2017, 332, 1896, 2304, 4166; 2019, 336, 1112, 1336, 1399, 1674, 2149, 2595, 2917, 4034; 2021, 365, 1066, 3437; 2023, 566, 858, 907, 2931, 3440)

NRS 449.0303 Authority of Board to require licensing of other facilities. The Board may adopt regulations requiring the licensing of a facility other than those required to be licensed pursuant to NRS 449.029 to 449.2428, inclusive, if the:

1. Facility provides any type of medical care or treatment; and

2. Regulation is necessary to protect the health of the general public.

(Added to NRS by 1985, 1735)

NRS 449.0304 Board to adopt regulations authorizing employees of certain facilities and agencies to perform certain tasks.

1. The Board shall adopt regulations authorizing an employee of a residential facility for groups, an agency to provide personal care services in the home or a facility for the care of adults during the day, with the consent of the person receiving services, to:

(a) Check, record and report the temperature, blood pressure, apical or radial pulse, respiration or oxygen saturation of a person receiving services from the facility or agency;

(b) Using an auto-injection device approved by the Food and Drug Administration for use in the home, administer to a person receiving services from the facility or agency insulin furnished by a registered pharmacist as directed by a physician or assist such a person with the self-administration of such insulin; and

(c) Using a device for monitoring blood glucose approved by the Food and Drug Administration for use in the home, conduct a blood glucose test on a person receiving services from the facility or agency or assist such a person to conduct a blood glucose test on himself or herself.

2. The regulations adopted pursuant to this section:

(a) Must require the tasks described in subsection 1 to be performed in conformance with the Clinical Laboratory Improvement Amendments of 1988, Public Law No. 100-578, 42 U.S.C. § 263a, if applicable, and any other applicable federal law or regulation;

(b) Must prohibit the use of a device for monitoring blood glucose on more than one person; and

(Added to NRS by 2017, 2303)

1. Except as otherwise provided in subsection 5, a person must obtain a license from the Board to operate a business that provides referrals to residential facilities for groups or any other group housing arrangement that provides assistance, food, shelter or limited supervision to a person with a mental illness, intellectual disability, developmental disability or physical disability or who is aged or infirm, including, without limitation, a senior living community referral agency.

2. The Board shall adopt:

(a) Standards for the licensing of businesses described in subsection 1;

(b) Standards relating to the fees charged by such businesses;

(d) Regulations establishing requirements for training the employees of such businesses.

3. A licensed nurse, social worker, physician or hospital, or a provider of geriatric care who is licensed as a nurse or social worker, may provide referrals to residential facilities for groups or any other group housing arrangement described in subsection 1 through a business that is licensed pursuant to this section. The Board may, by regulation, authorize a public guardian or any other person it determines appropriate to provide referrals to residential facilities for groups or any other group housing arrangement described in subsection 1 through a business that is licensed pursuant to this section.

4. A business that is licensed pursuant to this section or an employee of such a business shall not:

(a) Refer a person to a residential facility for groups that is not licensed.

(b) Refer a person to a residential facility for groups or any other group housing arrangement described in subsection 1 if the business or its employee knows or reasonably should know that the facility or other group housing arrangement, or the services provided by the facility or other group housing arrangement, are not appropriate for the condition of the person being referred.

(c) Refer a person to a residential facility for groups or any other group housing arrangement described in subsection 1 that is owned by the same person who owns the business.

Ê A person who violates the provisions of this subsection is liable for a civil penalty to be recovered by the Attorney General in the name of the Board for the first offense of not more than $10,000 and for a second or subsequent offense of not less than $10,000 nor more than $20,000. Unless otherwise required by federal law, the Board shall deposit all civil penalties collected pursuant to this section into a separate account in the State General Fund to be used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, 449.435 to 449.531, inclusive, and chapter 449A of NRS and to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards.

5. This section does not apply to a medical facility that is licensed pursuant to NRS 449.029 to 449.2428, inclusive, on October 1, 1999.

6. As used in this section:

(a) “Developmental disability” has the meaning ascribed to it in NRS 435.007.

(b) “Intellectual disability” has the meaning ascribed to it in NRS 435.007.

(Added to NRS by 1999, 3606; A 2011, 705, 1805; 2013,135; 2017, 1570, 1899; 2019, 406; 2021, 368; 2023, 570)

NRS 449.0306 Money received from licensing of facilities to be deposited in State General Fund; expenditure of state or federal money by Division.

1. Money received from licensing medical facilities and facilities for the dependent must be forwarded to the State Treasurer for deposit in the State General Fund to the credit of the Division.

2. The Division shall enforce the provisions of NRS 449.029 to 449.245, inclusive, and may incur any necessary expenses not in excess of money authorized for that purpose by the State or received from the Federal Government.

[11:336:1951] + [13:336:1951]—(NRS A 1963, 960; 1971, 936; 1973, 1283; 1975, 898; 1979, 209; 1985, 1741; 2009, 1444; 2011, 2253, 2396; 2013, 3055; 2015, 634, 1530; 2017, 334, 1900, 2049, 2307, 4168; 2019, 339, 1115; 2021, 369)

NRS 449.0307 Powers of Division. The Division may:

1. Upon receipt of an application for a license, conduct an investigation into the premises, facilities, qualifications of personnel, methods of operation, policies and purposes of any person proposing to engage in the operation of a medical facility, a facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed. The facility is subject to inspection and approval as to standards for safety from fire, on behalf of the Division, by the State Fire Marshal or a designee of the State Fire Marshal, which may include a local fire agency that meets an industry standard accepted by the State Fire Marshal.

2. Upon receipt of a complaint against a medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed, except for a complaint concerning the cost of services, conduct an investigation into the premises, facilities, qualifications of personnel, methods of operation, policies, procedures and records of that facility or any other medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed which may have information pertinent to the complaint.

3. Employ such professional, technical and clerical assistance as it deems necessary to carry out the provisions of NRS 449.029 to 449.245, inclusive.

[Part 6:336:1951]—(NRS A 1963, 960; 1969, 945; 1971, 936; 1973, 1284; 1975, 898; 1977, 642; 1985, 1220; 2013, 3055; 2017, 1900; 2021, 370; 2023, 1730)

NRS 449.03075 Duty of Division to compile and post information concerning licensing status and quality of certain facilities for the treatment of alcohol or other substance use disorders. The Division shall:

1. Compile and post on an Internet website maintained by the Division information concerning the licensing status and quality of:

(a) Facilities for the treatment of alcohol or other substance use disorders;

(b) Medical facilities that provide a program of treatment for alcohol or other substance use disorders; and

(c) To the extent that such information is available, unlicensed programs of treatment for alcohol or other substance use disorders; and

2. Update the information described in subsection 1 at least annually.

(Added to NRS by 2019, 1673; A 2023, 1733)

1. Except as otherwise provided in this section, the Division may charge and collect from a medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed or a person who operates such a facility without a license issued by the Division the actual costs incurred by the Division for the enforcement of the provisions of NRS 449.029 to 449.2428, inclusive, including, without limitation, the actual cost of conducting an inspection or investigation of the facility.

2. The Division shall not charge and collect the actual cost for enforcement pursuant to subsection 1 if the enforcement activity is:

(a) Related to the issuance or renewal of a license for which the Board charges a fee pursuant to NRS 449.050 or 449.089; or

(b) Conducted pursuant to an agreement with the Federal Government which has appropriated money for that purpose.

3. Any money collected pursuant to subsection 1 may be used by the Division to administer and carry out the provisions of NRS 449.029 to 449.2428, inclusive, and the regulations adopted pursuant thereto.

4. The provisions of this section do not apply to any costs incurred by the Division for the enforcement of the provisions of NRS 449.24185, 449.2419 or 449.24195.

(Added to NRS by 2011, 355; A 2013, 3055; 2017, 335, 1900; 2021, 370)

Licensing

NRS 449.040 Application for license: Filing; contents. Any person, state or local government or agency thereof desiring a license under the provisions of NRS 449.029 to 449.2428, inclusive, must file with the Division an application on a form prescribed, prepared and furnished by the Division, containing:

1. The name of the applicant and, if a natural person, whether the applicant has attained the age of 21 years.

2. The type of facility to be operated.

3. The location of the facility.

4. In specific terms, the nature of services and type of care to be offered, as defined in the regulations.

5. The number of beds authorized by the Director of the Department of Health and Human Services or, if such authorization is not required, the number of beds the facility will contain.

6. The name of the person in charge of the facility.

7. Such other information as may be required by the Division for the proper administration and enforcement of NRS 449.029 to 449.2428, inclusive.

8. Evidence satisfactory to the Division that the applicant is of reputable and responsible character. If the applicant is a firm, association, organization, partnership, business trust, corporation or company, similar evidence must be submitted as to the members thereof and the person in charge of the facility for which application is made. If the applicant is a political subdivision of the State or other governmental agency, similar evidence must be submitted as to the person in charge of the institution for which application is made.

9. Evidence satisfactory to the Division of the ability of the applicant to comply with the provisions of NRS 449.029 to 449.2428, inclusive, and the standards and regulations adopted by the Board.

10. Evidence satisfactory to the Division that the facility conforms to the zoning regulations of the local government within which the facility will be operated or that the applicant has applied for an appropriate reclassification, variance, permit for special use or other exception for the facility.

[2:336:1951]—(NRS A 1963, 959; 1971, 934; 1973, 1281; 1975, 367; 1985, 1739; 1987, 776; 1991, 1078; 2007, 1133; 2009, 2025; 2013, 515, 2145, 3056; 2021, 371)

NRS 449.050 Fees.

1. Each application for a license must be accompanied by such fee as may be determined by regulation of the Board. The Board may, by regulation, allow or require payment of a fee for a license in installments and may fix the amount of each payment and the date that the payment is due.

2. The fee imposed by the Board for a facility for transitional living for released offenders must be based on the type of facility that is being licensed and must be calculated to produce the revenue estimated to cover the costs related to the license, but in no case may a fee for a license exceed the actual cost to the Division of issuing or renewing the license.

3. If an application for a license for a facility for transitional living for released offenders is denied, any amount of the fee paid pursuant to this section that exceeds the expenses and costs incurred by the Division must be refunded to the applicant.

[Part 3:336:1951]—(NRS A 1971, 935; 1973, 1282; 1985, 1739; 1995, 501; 2003, 580; 2005, 2352; 2011, 356; 2013, 3056)

1. Except as otherwise provided in subsections 6 and 7 and NRS 449.067, each facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in the home and agency to provide nursing in the home shall, when applying for a license or renewing a license, file with the Administrator of the Division of Public and Behavioral Health a surety bond:

(a) If the facility, agency, organization or home employs less than 7 employees, in the amount of $5,000;

(b) If the facility, agency, organization or home employs at least 7 but not more than 25 employees, in the amount of $25,000; or

2. A bond filed pursuant to this section must be executed by the facility, agency, organization or home as principal and by a surety company as surety. The bond must be payable to the Aging and Disability Services Division of the Department of Health and Human Services and must be conditioned to provide indemnification to an older patient who the Attorney for the Rights of Older Persons and Persons with a Physical Disability, an Intellectual Disability or a Related Condition determines has suffered property damage as a result of any act or failure to act by the facility, agency, organization or home to protect the property of the older patient.

3. Except when a surety is released, the surety bond must cover the period of the initial license to operate or the period of the renewal, as appropriate.

4. A surety on any bond filed pursuant to this section may be released after the surety gives 30 days’ written notice to the Administrator of the Division of Public and Behavioral Health, but the release does not discharge or otherwise affect any claim filed by an older patient for property damaged as a result of any act or failure to act by the facility, agency, organization or home to protect the property of the older patient alleged to have occurred while the bond was in effect.

5. A license is suspended by operation of law when the facility, agency, organization or home is no longer covered by a surety bond as required by this section or by a substitute for the surety bond pursuant to NRS 449.067. The Administrator of the Division of Public and Behavioral Health shall give the facility, agency, organization or home at least 20 days’ written notice before the release of the surety or the substitute for the surety, to the effect that the license will be suspended by operation of law until another surety bond or substitute for the surety bond is filed in the same manner and amount as the bond or substitute being terminated.

6. The Administrator of the Division of Public and Behavioral Health may exempt a residential facility for groups or a home for individual residential care from the requirement of filing a surety bond pursuant to this section if the Administrator determines that the requirement would result in undue hardship to the residential facility for groups or home for individual residential care.

7. The requirement of filing a surety bond set forth in this section does not apply to a facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in the home or agency to provide nursing in the home that is operated and maintained by the State of Nevada or an agency thereof.

8. As used in this section, “older patient” means a patient who is 60 years of age or older.

(Added to NRS by 1997, 1482; A 2003, 524; 2005, 2168; 2009, 502; 2013, 3057; 2015, 2163; 2017, 180; 2021, 2824)

1. As a substitute for the surety bond required pursuant to NRS 449.065, a facility for intermediate care, a facility for skilled nursing, a residential facility for groups, a home for individual residential care, an agency to provide personal care services in the home and an agency to provide nursing in the home may deposit with any bank or trust company authorized to do business in this State, upon approval from the Administrator of the Division of Public and Behavioral Health:

(a) An obligation of a bank, savings and loan association, savings bank, thrift company or credit union licensed to do business in this State;

(b) Bills, bonds, notes, debentures or other obligations of the United States or any agency or instrumentality thereof, or guaranteed by the United States; or

(c) Any obligation of this State or any city, county, town, township, school district or other instrumentality of this State, or guaranteed by this State, in an aggregate amount, based upon principal amount or market value, whichever is lower.

2. The obligations of a bank, savings and loan association, savings bank, thrift company or credit union must be held to secure the same obligation as would the surety bond required by NRS 449.065. With the approval of the Administrator of the Division of Public and Behavioral Health, the depositor may substitute other suitable obligations for those deposited, which must be assigned to the Aging and Disability Services Division of the Department of Health and Human Services and are negotiable only upon approval by the Administrator of the Aging and Disability Services Division.

3. Any interest or dividends earned on the deposit accrue to the account of the depositor.

4. The deposit must be an amount at least equal to the surety bond required by NRS 449.065 and must state that the amount may not be withdrawn except by direct and sole order of the Administrator of the Aging and Disability Services Division.

(Added to NRS by 1997, 1483; A 2003, 525; 2005, 2169; 2009, 503; 2015, 2164; 2021, 2825)

NRS 449.068 Surety bond required for initial license and renewal of license to operate facility for refractive surgery.

1. Except as otherwise provided in NRS 449.069, each facility for refractive surgery shall, when applying for a license or renewing a license, file with the Administrator of the Division a surety bond:

(a) If the facility employs less than 7 employees, in the amount of $10,000;

(b) If the facility employs at least 7 but not more than 25 employees, in the amount of $50,000; or

2. A bond filed pursuant to this section must be executed by the facility as principal and by a surety company as surety. The bond must be payable to the Division and must be conditioned to provide indemnification to a patient of the facility who the Administrator of the Division or the Administrator’s designee determines has sustained any damages as a result of the bankruptcy of or any breach of contract by the facility.

3. Except when a surety is released, the surety bond must cover the period of the initial license to operate or the period of the renewal, as appropriate.

4. A surety on any bond filed pursuant to this section may be released after the surety gives 30 days’ written notice to the Administrator of the Division, but the release does not discharge or otherwise affect any claim filed by a patient for any damages sustained as a result of the bankruptcy of or any breach of contract by the facility while the bond was in effect.

5. The license of a facility for refractive surgery is suspended by operation of law when the facility is no longer covered by a surety bond as required by this section or by a substitute for the surety bond pursuant to NRS 449.069. The Administrator of the Division shall give the facility at least 20 days’ written notice before the release of the surety or the substitute for the surety, to the effect that the license will be suspended by operation of law until another surety bond is filed or substitute for the surety bond is deposited in the same manner and amount as the bond or substitute being terminated.

(Added to NRS by 2001, 1340; A 2005, 2696)

NRS 449.069 Substitute for surety bond required for facility for refractive surgery.

1. As a substitute for the surety bond required pursuant to NRS 449.068, a facility for refractive surgery may deposit with any bank or trust company authorized to do business in this State, upon approval of the Administrator of the Division:

(a) An obligation of a bank, savings and loan association, savings bank, thrift company or credit union licensed to do business in this State;

(b) Bills, bonds, notes, debentures or other obligations of the United States or any agency or instrumentality thereof, or guaranteed by the United States; or

2. The obligations of a bank, savings and loan association, savings bank, thrift company or credit union must be held to secure the same obligation as would the surety bond required by NRS 449.068. With the approval of the Administrator of the Division, the facility may substitute other suitable obligations for those deposited, which must be assigned to the Division and are negotiable only upon approval of the Administrator of the Division.

3. Any interest or dividends earned on the deposit accrue to the account of the facility.

4. The deposit must be an amount at least equal to the surety bond required by NRS 449.068 and must state that the amount may not be withdrawn except by the direct and sole order of the Administrator of the Division.

(Added to NRS by 2001, 1340; A 2005, 2696)

NRS 449.080 Issuance, validity and nontransferability of license; inspection of building proposed by applicant for community-based living arrangement services.

1. If, after investigation, the Division finds that the:

(a) Applicant is in full compliance with the provisions of NRS 449.029 to 449.2428, inclusive;

(b) Applicant is in substantial compliance with the standards and regulations adopted by the Board;

(c) Applicant, if he or she has undertaken a project for which approval is required pursuant to NRS 439A.100 or 439A.102, has obtained the approval of the Director of the Department of Health and Human Services; and

(d) Facility conforms to the applicable zoning regulations,

Ê the Division shall issue the license to the applicant.

2. Any investigation of an applicant for a license to provide community-based living arrangement services conducted pursuant to subsection 1 must include, without limitation, an inspection of any building operated by the applicant in which the applicant proposes to provide community-based living arrangement services.

3. A license applies only to the person to whom it is issued, is valid only for the premises described in the license and is not transferable.

[Part 3:336:1951]—(NRS A 1963, 959; 1971, 935; 1973, 1283; 1985, 1740; 1987, 777; 1991, 1078; 2011, 1064; 2019, 2153, 2920; 2021, 371; 2023, 2019)

NRS 449.085 Form and contents of license. Each license issued by the Division shall be in the form prescribed by the Division and shall contain:

1. The name of the person or persons authorized to operate such licensed facility;

2. The location of such licensed facility; and

3. The number of beds authorized in such licensed facility, the nature of services offered and the service delivery capacity.

(Added to NRS by 1973, 1279; A 1975, 367)

NRS 449.087 Amendment of license required for addition of certain services; requirements for approval of amendment; revocation of approval; standards.

1. A licensee must obtain the approval of the Division to amend his or her license to operate a facility before the addition of any of the following services:

(a) The intensive care of newborn babies.

(b) The treatment of burns.

(d) The performance of open-heart surgery.

(e) A center for the treatment of trauma.

2. The Division shall approve an application to amend a license to allow a facility to provide any of the services described in subsection 1 if:

(a) The applicant satisfies the requirements contained in NRS 449.080;

(b) The Division determines on the basis of the standards adopted by the Board pursuant to subsection 4 that there are an adequate number of cases in the community to be served to support amending the license to add the service; and

(c) The Division determines that the applicant satisfies any other standards adopted by the Board pursuant to subsection 4.

3. The Division may revoke its approval if the licensee fails to maintain substantial compliance with the standards adopted by the Board pursuant to subsection 4 for the provision of such services, or with any conditions included in the written approval of the Director issued pursuant to the provisions of NRS 439A.100 or 439A.102.

4. The Board shall:

(a) Adopt standards which have been adopted by appropriate national organizations to be used by the Division in determining whether there are an adequate number of cases in the community to be served to support amending the license of a licensee to add a service pursuant to this section; and

(b) Adopt such other standards as it deems necessary for determining whether to approve the provision of services pursuant to this section.

(Added to NRS by 1987, 876; A 1989, 1948; 2011, 741; 2023, 2019)

NRS 449.089 Expiration and renewal of license; fees.

1. Each license issued pursuant to NRS 449.029 to 449.2428, inclusive, expires on December 31 following its issuance and is renewable for 1 year upon reapplication and payment of all fees required pursuant to subsection 4 and NRS 449.050, as applicable, unless the Division finds, after an investigation, that the facility has not:

(a) Satisfactorily complied with the provisions of NRS 449.029 to 449.2428, inclusive, or the standards and regulations adopted by the Board;

(b) Obtained the approval of the Director of the Department of Health and Human Services before undertaking a project, if such approval is required by NRS 439A.100 or 439A.102; or

2. Each reapplication for an agency to provide personal care services in the home, an agency to provide nursing in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a provider of community-based living arrangement services, a hospital described in 42 U.S.C. § 1395ww(d)(1)(B)(iv), a psychiatric hospital that provides inpatient services to children, a psychiatric residential treatment facility, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 C.F.R. § 483.5, a hospital that provides swing-bed services as described in 42 C.F.R. § 482.58 or, if residential services are provided to children, a medical facility or facility for the treatment of alcohol or other substance use disorders must include, without limitation, a statement that the facility, hospital, agency, program, pool or home is in compliance with the provisions of NRS 449.115 to 449.125, inclusive, and 449.174.

3. Each reapplication for an agency to provide personal care services in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a facility for the care of adults during the day, a residential facility for groups or a home for individual residential care must include, without limitation, a statement that the holder of the license to operate, and the administrator or other person in charge and employees of, the facility, agency, pool or home are in compliance with the provisions of NRS 449.093.

4. Each reapplication for a surgical center for ambulatory patients, facility for the treatment of irreversible renal disease, facility for hospice care, program of hospice care, hospital, facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home or rural clinic must be accompanied by the fee prescribed by the State Board of Health pursuant to NRS 457.240, in addition to the fees imposed pursuant to NRS 449.050.

[Part 3:336:1951]—(NRS A 1963, 959; 1971, 935; 1973, 1282; 1985, 1739; 1987, 777; 1991, 1078; 1995, 1490; 1997, 445; 2003, 580; 2005, 2167; 2009, 502; 2011, 2252; 2013, 2146, 2889; 2015, 2165, 2175; 2017, 1901; 2019, 248, 1920, 2153, 2642, 2920; 2021, 372, 2254, 2826; 2023, 1848, 2020, 3333)

NRS 449.091 Provisional license.

1. The Division may cancel the license of a medical facility, facility for the dependent or a facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed and issue a provisional license, effective for a period determined by the Division, to such a facility if it:

(a) Is in operation at the time of the adoption of standards and regulations pursuant to the provisions of NRS 449.029 to 449.2428, inclusive, and the Division determines that the facility requires a reasonable time under the particular circumstances within which to comply with the standards and regulations; or

(b) Has failed to comply with the standards or regulations and the Division determines that the facility is in the process of making the necessary changes or has agreed to make the changes within a reasonable time.

2. The provisions of subsection 1 do not require the issuance of a license or prevent the Division from refusing to renew or from revoking or suspending any license where the Division deems such action necessary for the health and safety of the occupants of any facility.

(Added to NRS by 1973, 1279; A 1985, 1740; 2011, 1064; 2017, 1901; 2021, 372)

NRS 449.0915 Endorsement of hospital as crisis stabilization center: Issuance; application; requirements; renewal.

1. The Division may issue an endorsement as a crisis stabilization center to the holder of a license to operate a hospital that meets the requirements of this section.

2. A hospital that wishes to obtain an endorsement as a crisis stabilization center must submit an application in the form prescribed by the Division which must include, without limitation, proof that the applicant meets the requirements of subsection 3.

3. An endorsement as a crisis stabilization center may only be issued if the hospital to which the endorsement will apply:

(a) Operates in accordance with established administrative protocols, evidence-based protocols for providing treatment and evidence-based standards for documenting information concerning services rendered and recipients of such services in accordance with best practices for providing crisis stabilization services;

(b) Delivers crisis stabilization services:

(1) To patients in an area devoted to crisis stabilization or detoxification before releasing the patient into the community, referring the patient to another facility or transferring the patient to a bed within the hospital for short-term treatment, if the hospital has such beds;

(2) In accordance with best practices for the delivery of crisis stabilization services; and

(3) In a manner that promotes concepts that are integral to recovery for persons with behavioral health issues, including, without limitation, hope, personal empowerment, respect, social connections, self-responsibility and self-determination;

(c) Employs peer recovery support specialists, as defined in NRS 433.627, to provide peer recovery support services, as defined in NRS 433.626, when appropriate;

(d) Uses a data management tool to collect and maintain data relating to admissions, discharges, diagnoses and long-term outcomes for recipients of crisis stabilization services;

(e) Accepts all patients, without regard to:

(1) The race, ethnicity, gender, socioeconomic status, sexual orientation or place of residence of the patient;

(2) Any social conditions that affect the patient;

(3) The ability of the patient to pay; or

(4) Whether the patient is admitted voluntarily to the hospital pursuant to NRS 433A.140 or admitted to the hospital under an emergency admission pursuant to NRS 433A.162;

(f) Performs an initial assessment on any patient who presents at the hospital, regardless of the severity of the behavioral health issues that the patient is experiencing;

(g) Has the equipment and personnel necessary to conduct a medical examination of a patient pursuant to NRS 433A.165; and

(h) Considers whether each patient would be better served by another facility and transfer a patient to another facility when appropriate.

4. Crisis stabilization services that may be provided pursuant to paragraph (b) of subsection 3 may include, without limitation:

(a) Case management services, including, without limitation, such services to assist patients to obtain housing, food, primary health care and other basic needs;

(b) Services to intervene effectively when a behavioral health crisis occurs and address underlying issues that lead to repeated behavioral health crises;

(d) Coordination of aftercare for patients, including, without limitation, at least one follow-up contact with a patient not later than 72 hours after the patient is discharged.

5. An endorsement as a crisis stabilization center must be renewed at the same time as the license to which the endorsement applies. An application to renew an endorsement as a crisis stabilization center must include, without limitation:

(a) The information described in subsection 3; and

(b) Proof that the hospital is a rural hospital or rural emergency hospital or is accredited by the Commission on Accreditation of Rehabilitation Facilities, the Center for Improvement in Healthcare Quality, DNV GL Healthcare, the Accreditation Commission for Health Care or the Joint Commission, or their successor organizations.

6. As used in this section, “crisis stabilization services” means behavioral health services designed to:

(a) De-escalate or stabilize a behavioral crisis, including, without limitation, a behavioral health crisis experienced by a person with a co-occurring substance use disorder; and

(b) When appropriate, avoid admission of a patient to another inpatient mental health facility or hospital and connect the patient with providers of ongoing care as appropriate for the unique needs of the patient.

(Added to NRS by 2019, 1918; A 2021, 238, 2826, 3110; 2023, 2935)

NRS 449.092 Applicant for issuance or renewal of license for home for individual residential care to attest to knowledge of and compliance with certain guidelines concerning safe and appropriate injection practices. The Division shall not issue or renew a license for a home for individual residential care unless the applicant for issuance or renewal of the license attests to knowledge of and compliance with the guidelines of the Centers for Disease Control and Prevention concerning the prevention of transmission of infectious agents through safe and appropriate injection practices.

(Added to NRS by 2011, 2053)

1. The Board shall:

(a) Adopt regulations prescribing mandatory training for unlicensed caregivers who provide care at designated medical facilities, facilities for the dependent and facilities licensed pursuant to NRS 449.0303. The regulations must:

(1) Designate the types of facilities to which the requirements for training apply; and

(2) Establish the required topics for the training, which must include, without limitation, control of infectious diseases and minimum standards for training in each required topic.

(b) Review the required topics for training established pursuant to subparagraph (2) of paragraph (a) at least annually and revise those topics when necessary to address new issues that impact health and safety at the designated facilities.

2. The Division shall post on an Internet website maintained by the Division a list of nationally recognized organizations that provide evidence-based training for caregivers which:

(a) Is free of charge or has a minimal cost; and

(b) May be used to satisfy the requirements of the regulations adopted pursuant to subsection 1.

3. The administrator or other person in charge of a facility to which the regulations adopted pursuant to subsection 1 apply shall:

(a) Ensure that each unlicensed caregiver at the facility completes the training required by the regulations adopted pursuant to subsection 1 and document the completion of the training in the personnel file of each unlicensed caregiver;

(b) Ensure the implementation of the best practices taught in the training required by the regulations adopted pursuant to subsection 1 at the facility where appropriate;

(d) Provide a written copy of the plan for the control of infectious diseases to each employee or independent contractor of the facility, any other person who regularly provides services at the facility and each resident of the facility.

(Added to NRS by 2021, 363)

NRS 449.093 Training to recognize and prevent abuse of older persons: Persons required to receive; frequency; topics; costs; actions for failure to complete.

1. An applicant for a license to operate a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care must receive training to recognize and prevent the abuse of older persons before a license to operate such a facility, agency or home is issued to the applicant. If an applicant has completed such training within the year preceding the date of the application for a license and the application includes evidence of the training, the applicant shall be deemed to have complied with the requirements of this subsection.

2. A licensee who holds a license to operate a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care must annually receive training to recognize and prevent the abuse of older persons before the license to operate such a facility, agency or home may be renewed.

3. If an applicant or licensee who is required by this section to obtain training is not a natural person, the person in charge of the facility, agency or home must receive the training required by this section.

4. An administrator or other person in charge of a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care must receive training to recognize and prevent the abuse of older persons before the facility, agency or home provides care to a person and annually thereafter.

5. An employee who will provide care to a person in a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care must receive training to recognize and prevent the abuse of older persons before the employee provides care to a person in the facility, agency or home and annually thereafter.

6. The topics of instruction that must be included in the training required by this section must include, without limitation:

(a) Recognizing the abuse of older persons, including sexual abuse and violations of NRS 200.5091 to 200.50995, inclusive;

(b) Responding to reports of the alleged abuse of older persons, including sexual abuse and violations of NRS 200.5091 to 200.50995, inclusive; and

(1) The abuse of older persons; and

(2) Facilities for intermediate care, facilities for skilled nursing, agencies to provide personal care services in the home, facilities for the care of adults during the day, residential facilities for groups or homes for individual residential care, as applicable for the person receiving the training.

7. The facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care is responsible for the costs related to the training required by this section.

8. The administrator of a facility for intermediate care, facility for skilled nursing or residential facility for groups who is licensed pursuant to chapter 654 of NRS shall ensure that each employee of the facility who provides care to residents has obtained the training required by this section. If an administrator or employee of a facility or home does not obtain the training required by this section, the Division shall notify the Board of Examiners for Long-Term Care Administrators that the administrator is in violation of this section.

9. The holder of a license to operate a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care shall ensure that each person who is required to comply with the requirements for training pursuant to this section complies with such requirements. The Division may, for any violation of this section, take disciplinary action against a facility, agency or home pursuant to NRS 449.160 and 449.163.

(Added to NRS by 2011, 2248)

1. The Board shall establish minimum continuing education requirements concerning the care of persons with any form of dementia, including, without limitation, dementia caused by Alzheimer’s disease, for each person who is:

(a) Employed by a facility for skilled nursing, facility for intermediate care or residential facility for groups which provides care to persons with any form of dementia; and

(b) Licensed or certified by an occupational licensing board.

2. In establishing continuing education requirements pursuant to subsection 1, the Board shall consider any other educational requirements imposed on such employees to ensure that the continuing education requirements established by the Board do not duplicate or conflict with the existing educational requirements imposed on those employees.

3. The administrator of a facility for skilled nursing, facility for intermediate care or residential facility for groups which provides care to persons with any form of dementia, including, without limitation, dementia caused by Alzheimer’s disease, shall ensure that each employee of the facility who is required to comply with the requirements for continuing education established by the Board pursuant to this section complies with such requirements.

(Added to NRS by 2003, 856)

Standards and Policies for Treatment

NRS 449.101 Discrimination prohibited; development of antidiscrimination policy; posting of nondiscrimination statement and certain other information; construction of section.

1. A medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed and any employee or independent contractor of such a facility shall not discriminate in the admission of, or the provision of services to, a patient or resident based wholly or partially on the actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or human immunodeficiency virus status of the patient or resident or any person with whom the patient or resident associates.

2. A medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed shall:

(a) Develop and carry out policies to prevent the specific types of prohibited discrimination described in the regulations adopted by the Board pursuant to NRS 449.0302 and meet any other requirements prescribed by regulations of the Board; and

(b) Post prominently in the facility and include on any Internet website used to market the facility the following statement:

[Name of facility] does not discriminate and does not permit discrimination, including, without limitation, bullying, abuse or harassment, on the basis of actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status, or based on association with another person on account of that person’s actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status.

3. In addition to the statement prescribed by subsection 2, a facility for skilled nursing, facility for intermediate care or residential facility for groups shall post prominently in the facility and include on any Internet website used to market the facility:

(a) Notice that a patient or resident who has experienced prohibited discrimination may file a complaint with the Division; and

(b) The contact information for the Division.

4. The provisions of this section shall not be construed to:

(a) Require a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed or an employee or independent contractor thereof to take or refrain from taking any action in violation of reasonable medical standards; or

(b) Prohibit a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed from adopting a policy that is applied uniformly and in a nondiscriminatory manner, including, without limitation, such a policy that bans or restricts sexual relations.

(Added to NRS by 2019, 1333)

NRS 449.102 Duties of licensed facility to protect privacy of patient or resident. A medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed shall:

1. Maintain the confidentiality of personally identifiable information concerning the sexual orientation of a patient or resident, whether the patient or resident is transgender or has undergone gender-affirming surgery and the human immunodeficiency virus status of the patient or resident and take reasonable actions to prevent the unauthorized disclosure of such information;

2. Prohibit employees or independent contractors of the facility who are not performing a physical examination or directly providing care to a patient or resident from being present during any portion of the physical examination or care, as applicable, during which the patient or resident is fully or partially unclothed without the express permission of the patient or resident or the authorized representative of the patient or resident;

3. Use visual barriers, including, without limitation, doors, curtains and screens, to provide privacy for patients or residents who are fully or partially unclothed; and

4. Allow a patient or resident to refuse to be examined, observed or treated by an employee or independent contractor of the facility for a purpose that is primarily educational rather than therapeutic.

(Added to NRS by 2019, 1335; A 2021, 3441)

1. Except as otherwise provided in subsection 3, to enable an agent or employee of a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed who is described in subsection 2 to more effectively treat patients or care for residents, as applicable, the Board shall, by regulation, require such a facility to conduct training relating specifically to cultural competency for any agent or employee of the facility who is described in subsection 2 so that such an agent or employee may better understand patients or residents who have different cultural backgrounds, including, without limitation, patients or residents who are:

(a) From various racial and ethnic backgrounds;

(b) From various religious backgrounds;

(d) Children and senior citizens;

(e) Persons with a mental or physical disability; and

(f) Part of any other population that such an agent or employee may need to better understand, as determined by the Board.

Ê The Board shall set forth by regulation the frequency with which a medical facility, facility for the dependent or other facility is required to provide such training relating to cultural competency.

2. Except as otherwise provided in subsection 3, the requirements of subsection 1 apply to any agent or employee of a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed who:

(a) Provides clinical, administrative or support services and has direct patient contact at least once each week on average as a part of his or her regular job duties; or

(b) Oversees an agent or employee described in paragraph (a).

3. A medical facility, facility for the dependent or other facility is not required to provide training relating specifically to cultural competency to an agent or employee who is described in subsection 2 and who has successfully completed a course or program in cultural competency as part of the continuing education requirements for the agent or employee to renew his or her professional license, registration or certificate, as applicable.

4. Except as otherwise provided in subsection 6, the training relating specifically to cultural competency conducted by a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed pursuant to subsection 1 must be provided through a course or program that is approved by the Department of Health and Human Services.

5. The Office of Minority Health and Equity of the Department of Health and Human Services shall:

(a) Establish and maintain a list of the courses and programs that are approved for training relating to cultural competency pursuant to subsection 4. The Office shall make the most current list available on the Internet website of the Office.

(b) Ensure that the list established and maintained pursuant to paragraph (a) is distributed to each medical facility, facility for the dependent or other facility which is required to conduct training relating specifically to cultural competency pursuant to subsection 1.

6. A medical facility, facility for the dependent or other facility which is required to conduct training specifically relating to cultural competency may apply to the Department of Health and Human Services to provide a course or program on cultural competency that is not approved by the Department pursuant to subsection 4. Any such request must be approved or denied by the Department not later than 10 business days after the receipt of the application.

7. On or before October 1 of each year, the Department of Health and Human Services shall report the average length of time within which the Department approved a course of program or training relating to cultural competency in the immediately preceding year pursuant to subsection 4 or 6, as applicable, to the Director of the Legislative Counsel Bureau for transmittal to the Joint Interim Standing Committee on Health and Human Services and the Joint Interim Standing Committee on Commerce and Labor.

8. As used in this section:

(a) “Direct patient contact” means direct contact with a patient or resident of a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed which is in person or using telephone, electronic mail, telehealth or other electronic means, except that the term does not include incidental contact.

(b) “Telehealth” has the meaning ascribed to it in NRS 629.515.

(Added to NRS by 2019, 1334, 1681; A 2021, 3441; 2023, 1176)

NRS 449.104 Regulations to ensure patients or residents are identified in accordance with their gender identity or expression. The Board shall adopt regulations that require a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed to:

1. Develop policies to ensure that a patient or resident is addressed by his or her preferred name and pronoun and in accordance with his or her gender identity or expression;

2. Adapt electronic records to reflect the gender identities or expressions of patients or residents with diverse gender identities or expressions, including, without limitation:

(a) If the facility is a medical facility, adapting health records to meet the medical needs of patients or residents with diverse sexual orientations and gender identities or expressions, including, without limitation, integrating information concerning sexual orientation and gender identity or expression into electronic systems for maintaining health records; and

(b) If the facility is a facility for the dependent or other residential facility, adapting electronic records to include:

(1) The preferred name and pronoun and gender identity or expression of a resident; and

(2) Any other information prescribed by regulation of the Board.

(Added to NRS by 2019, 1335)

Community-based Living Arrangement Services

NRS 449.111 Authorized activities of licensee; requirements governing provision of services.

1. The holder of a license to provide community-based living arrangement services may provide such services to any person with a primary diagnosis of a mental illness, including, without limitation, such a person who has a secondary diagnosis other than a mental illness. Such a secondary diagnosis may include, without limitation, a secondary diagnosis of an intellectual disability or developmental disability.

2. Each person employed by a provider of community-based living arrangement services to supervise or provide support to recipients of such services must be able to communicate with the recipients to whom he or she is to provide services.

3. A child under 18 years of age must not reside in a building operated by a provider of community-based living arrangement services in which community-based living arrangement services are provided.

4. A provider of community-based living arrangement services shall:

(a) Provide each recipient of community-based living arrangement services with access to licensed professionals who are qualified to provide supportive and habilitative services that are appropriate for the recipient; and

(b) Post prominently in any building operated by the provider of community-based living arrangement services in which community-based living arrangement services are provided a sign with the telephone number that may be used to make a complaint to the Division concerning the provider.

(Added to NRS by 2019, 2148)

NRS 449.112 Establishment of individualized plan for recipient; reimbursement of Division for overpayment.

1. The Division shall establish, for each recipient of community-based living arrangement services to whom services are provided pursuant to a contract between the provider and the Division, an individualized plan for the provision of community-based living arrangement services. The individualized plan must include, without limitation:

(a) A description of the case management services that must be provided to the recipient and a designation of the entity responsible for providing those services; and

(b) The hours during which the provider of community-based living arrangement services must provide supervision and support to the recipient.

2. A contract between the Division and a provider of community-based living arrangement services for the provision of such services must include a provision requiring the provider to comply with the individualized plan for each recipient established pursuant to subsection 1.

3. If the Division determines that it has paid the holder of a license to provide community-based living arrangement services with which the Division has entered into a contract an amount that exceeds the amount required by the contract, the holder shall reimburse the amount of the overpayment to the Division.

(Added to NRS by 2019, 2148)

NRS 449.113 Grounds for denying renewal of license. The Division shall not renew a license to provide community-based living arrangement services if:

1. The holder of the license has refused or failed to reimburse any overpayment for community-based living arrangement services as required pursuant to subsection 3 of NRS 449.112; or

2. The holder of the license has failed to correct any practice required by the Division to comply with state law or regulations or the requirements of a contract between the holder and the Division.

(Added to NRS by 2019, 2149)

Senior Living Community Referral Agencies

NRS 449.114 Disclosure and consent before referral: Contents; maintenance of record; provision of copy upon request.

1. Before referring a person who is aged or the representative of such a person to a senior living community, a senior living community referral agency shall:

(a) Provide a statement clearly disclosing the information required by this paragraph to the person or representative orally, in writing or electronically. If the disclosure is made orally, the disclosure must be recorded. The statement must include, without limitation:

(1) A description of each service that the senior living community referral agency is able to provide to the person who is aged;

(2) The contact information of the senior living community referral agency, including, without limitation, the telephone number of the senior living community referral agency;

(3) The address of the Internet website maintained pursuant to paragraph (f) of subsection 2 of NRS 449.1145;

(4) An explanation of the provisions of paragraphs (c), (d) and (e) of subsection 2 of NRS 449.1145; and

(5) A statement of whether the person who is aged or the senior living community to which the person who is aged is referred is responsible for paying the applicable referral fee and, if the person who is aged is responsible for paying the fee, the amount of the fee; and

(b) Obtain the written or recorded consent of a person who is aged or his or her representative to provide referrals.

2. A senior living community referral agency shall maintain a record of each statement or consent provided pursuant to subsection 1 for at least 3 years after the date on which the statement or consent, as applicable, is provided.

3. Upon the request of a person who is aged and who has received a referral from a senior living community referral agency, the representative of such a person or the senior living community to which a person has been referred by the senior living community referral agency, the senior living community referral agency shall provide the person, representative or community a written copy of the statement given to the person who is aged or his or her representative pursuant to subsection 1.

(Added to NRS by 2023, 564)

NRS 449.1145 Prohibitions; duties; exception; methods of compensation.

1. A senior living community referral agency shall not:

(a) Except as otherwise provided in subsection 3, refer a person who is aged or the representative of such a person to a senior living community:

(1) In which the senior living community referral agency, an executive thereof or any immediate family member of such an executive has an ownership or financial interest; or

(2) That is managed wholly or partially by the senior living community referral agency, an executive thereof or any immediate family member of such an executive;

(b) Issue a referral to a person who is aged or the representative of such a person if the senior living community referral agency, an employee thereof or an immediate family member of such an employee holds a power of attorney or any property of the person who is aged;

(c) Refer a person who is aged or the representative of such a person to a senior living community that does not hold a license required by law;

(d) Refer a person who is aged or the representative of such a person to a senior living community that is not capable of adequately caring for the person who is aged; or

(e) Accept compensation for a referral from a senior living community with which the senior living community referral agency has not entered into a written contract concerning such a referral.

2. A senior living community referral agency shall:

(a) Use a nationally accredited provider of criminal background investigations to conduct an investigation into the criminal background of each employee of the senior living community referral agency who directly interacts with persons who are aged or representatives of such persons;

(b) Maintain liability insurance in an amount of at least $1,000,000 for each incident and $2,500,000 in total per year for negligent acts or omissions committed by the senior living community referral agency or an employee thereof;

(c) Cease contacting a person who is aged or the representative of such a person as soon as possible and not later than 10 days after the person or representative requests the senior living community referral agency to cease contacting the person;

(d) Cease making referrals to a senior living community for a person who is aged or the representative of such a person as soon as possible and not later than 10 days after the person or representative requests the senior living community referral agency to cease making such referrals;

(e) Refrain from selling the personal information of a person who is aged or the representative of such a person upon the request of the person or representative; and

(f) Establish a policy to protect the privacy of persons who are aged and the representatives of such persons and post the policy on an Internet website maintained by the senior living community referral agency.

3. A senior living community referral agency may refer a person who is aged or the representative of such a person to a senior living community described in paragraph (a) of subsection 1 if the person or representative provides the senior living community referral agency with written permission to make such a referral before the referral is made.

4. A written contract entered into pursuant to paragraph (e) of subsection 1 may provide for the compensation of a senior living community referral agency by a senior living community in:

(a) An amount for all referrals made by the senior living community referral agency to the senior living community in a specified period of time;

(b) An amount for each referral to the senior living community that is based on a percentage of the cost of the first month of rent and care received by the person referred to the senior living community; or

(Added to NRS by 2023, 565)

Background Investigations

NRS 449.115 Definitions. As used in NRS 449.115 to 449.125, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.119 and 449.1195 have the meanings ascribed to them in those sections.

(Added to NRS by 2017, 1895)

NRS 449.119 “Facility, hospital, agency, program or home” defined. “Facility, hospital, agency, program or home” means an agency to provide personal care services in the home, an employment agency that contracts with persons to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home, an agency to provide nursing in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a provider of community-based living arrangement services, a hospital described in 42 U.S.C. § 1395ww(d)(1)(B)(iv), a psychiatric hospital that provides inpatient services to children, a psychiatric residential treatment facility, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 C.F.R. § 483.5, a hospital that provides swing-bed services as described in 42 C.F.R. § 482.58 or, if residential services are provided to children, a medical facility or facility for the treatment of alcohol or other substance use disorders.

(Added to NRS by 2013, 2889; A 2015, 2165, 2176; 2017, 1571, 1902; 2019, 249, 2642; 2021, 2828)

NRS 449.1195 “Psychiatric residential treatment facility” defined. “Psychiatric residential treatment facility” means a facility, other than a hospital, that provides a range of psychiatric services to treat residents under the age of 21 years on an inpatient basis under the direction of a physician.

(Added to NRS by 2017, 1895)

NRS 449.121 Exemption for facility for the treatment of alcohol or other substance use disorders; exception.

1. Except as otherwise provided in subsection 2, the provisions of NRS 449.115 to 449.125, inclusive, and 449.174 do not apply to any facility for the treatment of alcohol or other substance use disorders.

2. A facility for the treatment of alcohol or other substance use disorders must comply with the requirements of NRS 449.115 to 449.125, inclusive, and 449.174 if the facility for the treatment of alcohol or other substance use disorders provides residential services to children.

(Added to NRS by 1997, 442; A 2011, 3556; 2013, 2890)

NRS 449.122 Investigation of applicant for license to operate facility, hospital, agency, program or home.

1. Each applicant for a license to operate a facility, hospital, agency, program or home shall submit to the Central Repository for Nevada Records of Criminal History one complete set of fingerprints for submission to the Federal Bureau of Investigation for its report.

2. The Central Repository for Nevada Records of Criminal History shall determine whether the applicant has been convicted of a crime listed in paragraph (a) of subsection 1 of NRS 449.174 and immediately inform the administrator of the facility, hospital, agency, program or home, if any, and the Division of whether the applicant has been convicted of such a crime.

3. A person who holds a license to operate a facility, hospital, agency, program or home which provides residential services to children, a psychiatric hospital that provides inpatient services to children or a psychiatric residential treatment facility shall submit to the Central Repository for Nevada Records of Criminal History one complete set of fingerprints for a report required by this section at least once every 5 years after the initial investigation.

(Added to NRS by 1997, 442; A 2009, 504; 2011, 3556; 2013, 2890; 2017, 1902)

NRS 449.123 Initial and periodic investigations of employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home; penalty.

1. Except as otherwise provided in subsections 2 and 3, within 10 days after hiring an employee, accepting an employee of a temporary employment service or entering into a contract with an independent contractor, the administrator of, or the person licensed to operate a facility, hospital, agency, program or home shall:

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

(b) Obtain an oral and written confirmation of the information contained in the written statement obtained pursuant to paragraph (a);

(c) Obtain proof that the employee, employee of the temporary employment service or independent contractor holds any required license, permit or certificate;

(d) Obtain from the employee, employee of the temporary employment service or independent contractor 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;

(e) Submit to the Central Repository for Nevada Records of Criminal History the fingerprints obtained pursuant to paragraph (d) to obtain information on the background and personal history of each employee, employee of a temporary employment service or independent contractor to determine whether the person has been convicted of any crime listed in NRS 449.174; and

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

(1) Screen the employee, employee of the temporary employment service or independent contractor using the Internet website. Upon request of the Division, proof that the employee, temporary employee or independent contractor 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, employee of the temporary employment service or independent contractor.

2. The administrator of, or the person licensed to operate, a facility, hospital, agency, program or home is not required to obtain the information described in subsection 1 from an employee, employee of a temporary employment service or independent contractor 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, employee of the temporary employment service or independent contractor has not been convicted of any crime set forth in NRS 449.174.

3. The administrator of, or the person licensed to operate, a facility, hospital, agency, program or home is not required to obtain the information described in subsection 1, other than the information described in paragraph (c) of subsection 1, from an employee, employee of a temporary employment service or independent contractor if:

(a) The employee, employee of the temporary employment service or independent contractor agrees to allow the administrator of, or the person licensed to operate, a facility, hospital, agency, program or home to receive notice from the Central Repository for Nevada Records of Criminal History regarding any conviction and subsequent conviction of the employee, employee of the temporary employment service or independent contractor 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, employee of the temporary employment service or independent contractor 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, employee of the temporary employment service or independent contractor has not been convicted of any crime set forth in NRS 449.174.

4. The administrator of, or the person licensed to operate, a facility, hospital, agency, program or home shall ensure that the information concerning the background and personal history of each employee, employee of a temporary employment service or independent contractor who works at the facility, hospital, agency, program or home:

(a) Except as otherwise provided in subsection 2, is completed as soon as practicable, and if residential services are provided to children or the facility is a psychiatric hospital that provides inpatient services to children or a psychiatric residential treatment facility, before the employee, employee of the temporary employment service or independent contractor provides any care or services to a child in the facility, hospital, agency, program or home without supervision; and

(b) At least once every 5 years after the date of the initial investigation.

5. The administrator or person shall, when required:

(a) Obtain one set of fingerprints from the employee, employee of the temporary employment service or independent contractor;

(b) Obtain written authorization from the employee, employee of the temporary employment service or independent contractor 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.

6. Upon receiving fingerprints submitted pursuant to this section, the Central Repository for Nevada Records of Criminal History shall determine whether the employee, employee of the temporary employment service or independent contractor has been convicted of a crime listed in NRS 449.174 and immediately inform the Division and the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home at which the person works whether the employee, employee of the temporary employment service or independent contractor has been convicted of such a crime.

7. The Central Repository for Nevada Records of Criminal History may impose a fee upon a facility, hospital, agency, program or home that submits fingerprints pursuant to this section for the reasonable cost of the investigation. The facility, hospital, agency, program or home may recover from the employee or independent contractor whose fingerprints are submitted not more than one-half of the fee imposed by the Central Repository. If the facility, hospital, agency, program or home requires the employee or independent contractor to pay for any part of the fee imposed by the Central Repository, it shall allow the employee or independent contractor to pay the amount through periodic payments. The facility, hospital, agency, program or home may require a temporary employment service which employs a temporary employee whose fingerprints are submitted to pay the fee imposed by the Central Repository. A facility, hospital, agency, program or home shall notify a temporary employment service if a person employed by the temporary employment service is determined to be ineligible to provide services at the facility, hospital, agency, program or home based upon the results of an investigation conducted pursuant to this section.

8. Unless a greater penalty is provided by law, a person who willfully provides a false statement or information in connection with an investigation of the background and personal history of the person pursuant to this section that would disqualify the person from employment, including, without limitation, a conviction of a crime listed in NRS 449.174, is guilty of a misdemeanor.

(Added to NRS by 1997, 442; A 1999, 1946; 2005, 2170; 2009, 504; 2011, 3556; 2013, 2890; 2017, 1902)

1. A temporary employment service shall not send an employee to provide services to a facility, hospital, agency, program or home if the temporary employment service has received notice from a facility, hospital, agency, program or home that the employee of the temporary employment service is ineligible to provide such services.

2. A facility, hospital, agency, program or home that enters into an agreement with a temporary employment service to provide services for the facility, hospital, agency, program or home on a temporary basis must require the temporary employment service to:

(a) Provide proof that each employee of the temporary employment service whom it may send to provide services to the facility, hospital, agency, program or home has been continuously employed by the temporary employment service since the last investigation conducted of the employee pursuant to NRS 449.123; and

(b) Notify the facility, hospital, agency, program or home if the investigation conducted of an employee of the temporary employment service pursuant to NRS 449.123 has not been conducted within the immediately preceding 5 years.

(Added to NRS by 2013, 2889)

NRS 449.124 Maintenance and availability of certain records regarding employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home.

1. Each facility, hospital, agency, program or home shall maintain records of the information concerning its employees, employees of a temporary employment service and independent contractors collected pursuant to NRS 449.123, including, without limitation:

(a) A copy of the fingerprints that were submitted to the Central Repository for Nevada Records of Criminal History or proof of electronic fingerprint submission and a copy of the written authorization that was provided by the employee, employee of the temporary employment service or independent contractor;

(b) Proof that the fingerprints of the employee, employee of the temporary employment service or independent contractor were submitted to the Central Repository; and

2. The records maintained pursuant to subsection 1 must be:

(a) Maintained for the period of the employment of the person with the facility, hospital, agency, program or home; and

(b) Made available for inspection by the Division at any reasonable time, and copies thereof must be furnished to the Division upon request.

3. If an Internet website has been established pursuant to NRS 439.942, a facility, hospital, agency, program or home shall maintain a current list of its employees, employees of a temporary employment service and independent contractors on the Internet website.

4. The Central Repository for Nevada Records of Criminal History may maintain an electronic image of fingerprints submitted pursuant to NRS 449.122 and 449.123 to notify a facility, hospital, agency, program or home and the Division of any subsequent conviction of a person who is required to submit to an investigation pursuant to NRS 449.122 or 449.123.

(Added to NRS by 1997, 443; A 1999, 1947; 2005, 2171; 2009, 505; 2011, 3558; 2013, 2893)

1. Upon receiving information from the Central Repository for Nevada Records of Criminal History pursuant to NRS 449.123, or evidence from any other source, that an employee, employee of a temporary employment service or independent contractor of a facility, hospital, agency, program or home:

(a) Has been convicted of a crime listed in paragraph (a) of subsection 1 of NRS 449.174; or

(b) Has had a substantiated report of abuse or neglect made against him or her, if he or she is employed at a facility, hospital, agency, program or home that provides residential services to children, a psychiatric hospital that provides inpatient services to children or a psychiatric residential treatment facility,

Ê the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home shall terminate the employment or contract of that person or notify the temporary employment service that its employee is prohibited from providing services for the facility, hospital, agency, program or home after allowing the person time to correct the information as required pursuant to subsection 2.

2. If an employee, employee of a temporary employment service or independent contractor believes that the information provided by the Central Repository is incorrect, the employee, employee of the temporary employment service or independent contractor may immediately inform the facility, hospital, agency, program or home or temporary employment service. The facility, hospital, agency, program, home or temporary employment service that is so informed shall give the employee, employee of the temporary employment service or independent contractor a reasonable amount of time of not less than 30 days to correct the information received from the Central Repository before terminating the employment or contract of the person pursuant to subsection 1.

3. A facility, hospital, agency, program or home that has complied with NRS 449.123 may not be held civilly or criminally liable based solely upon the ground that the facility, hospital, agency, program or home allowed an employee, employee of a temporary employment service or independent contractor to work:

(a) Before it received the information concerning the employee, employee of the temporary employment service or independent contractor from the Central Repository, except that an employee, employee of the temporary employment service or independent contractor shall not have contact with a child without supervision before such information is received;

(b) During the period required pursuant to subsection 2 to allow the employee, employee of the temporary employment service or independent contractor to correct that information, except that an employee, employee of the temporary employment service or independent contractor shall not have contact with a child without supervision during such period;

(c) Based on the information received from the Central Repository, if the information received from the Central Repository was inaccurate; or

(d) Any combination thereof.

Ê A facility, hospital, agency, program or home may be held liable for any other conduct determined to be negligent or unlawful.

(Added to NRS by 1997, 443; A 1999, 1948; 2005, 2171; 2009, 505; 2011, 3558; 2013, 2894; 2017, 1905)

Inspections

NRS 449.131 Entry and inspection of building and premises by Division, State Fire Marshal or designee and Chief Medical Officer.

1. Any authorized member or employee of the Division may enter and inspect any building or premises at any time to secure compliance with or prevent a violation of any provision of NRS 449.029 to 449.245, inclusive.

2. The State Fire Marshal or a designee of the State Fire Marshal, which may include a local fire agency that meets an industry standard accepted by the State Fire Marshal, shall, upon receiving a request from the Division or a written complaint concerning compliance with the plans and requirements to respond to an emergency adopted pursuant to subsection 9 of NRS 449.0302:

(a) Enter and inspect a residential facility for groups or a building operated by a provider of community-based living arrangement services in which such services are provided; and

(b) Make recommendations regarding the adoption of plans and requirements pursuant to subsection 9 of NRS 449.0302,

Ê to ensure the safety of the residents of the facility or persons receiving care from the provider, as applicable, in an emergency.

3. The Chief Medical Officer or a designee of the Chief Medical Officer shall enter and inspect at least annually each building or the premises of a residential facility for groups and each building operated by a provider of community-based living arrangement services in which such services are provided to ensure compliance with standards for health and sanitation.

4. An authorized member or employee of the Division shall enter and inspect any building or premises operated by a residential facility for groups or provider of community-based living arrangement services within 72 hours after the Division is notified that a residential facility for groups or provider of community-based living arrangement services is operating without a license.

[Part 4:336:1951]—(NRS A 1963, 962; 1971, 937; 1973, 1286; 1975, 898; 1985, 1742; 1999, 3610; 2001, 1343; 2003, 421, 1923; 2005, 2172; 2009, 1446; 2011, 1067, 2255, 2398; 2019, 250, 339; 2021, 373; 2023, 1730)

NRS 449.132 Inspection of medical facility, facility for the dependent or other facility required to be licensed by Division of Public and Behavioral Health and Aging and Disability Services Division. Every medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed may be inspected at any time, with or without notice, as often as is necessary by:

1. The Division of Public and Behavioral Health to ensure compliance with all applicable regulations and standards; and

2. Any person designated by the Aging and Disability Services Division of the Department of Health and Human Services to investigate complaints made against the facility.

(Added to NRS by 1977, 642; A 1985, 1742; 1991, 1975; 2001, 1343; 2003, 422; 2017, 1906)

1. Prepare a report of the results of its inspections of medical facilities and facilities for the dependent regarding compliance with applicable regulations and standards. The report must be provided to the facility and include, without limitation, a recommendation of the Division for correcting any deficiencies and, if a deficiency is discovered as a result of an investigation by a county, district or city board of health or health officer, the recommendations of the board or health officer.

2. Upon request, disclose to any person or governmental entity the results of its inspections of facilities for skilled nursing, facilities for intermediate care and residential facilities for groups regarding their compliance with applicable regulations and standards.

[14:336:1951]—(NRS A 1963, 961; 1971, 936; 1973, 1285; 1987, 1054; 2009, 559)

NRS 449.134 Facility for intermediate care, facility for skilled nursing, residential facility for groups, provider of community-based living arrangement services or home for individual residential care to provide immediate notification of certain deficiencies to certain persons. A facility for intermediate care, facility for skilled nursing, residential facility for groups, provider of community-based living arrangement services or home for individual residential care shall immediately provide notice of a deficiency affecting the health and safety of a patient discovered during the course of an inspection of the facility for intermediate care, facility for skilled nursing, residential facility for groups, provider of community-based living arrangement services or home for individual residential care conducted by the Division to:

1. A person receiving care at the facility or home or from the provider, as applicable;

2. The parent or legal guardian of the person receiving care at the facility or home or from the provider, as applicable; or

3. Any other natural person designated to receive such notice by the person receiving care at the facility or home or from the provider, as applicable, or the parent or guardian of the person.

(Added to NRS by 2011, 2396; A 2019, 250)

Disciplinary Action

1. The Division may deny an application for a license or may suspend or revoke any license issued under the provisions of NRS 449.029 to 449.2428, inclusive, upon any of the following grounds:

(a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410, 449.029 to 449.245, inclusive, or 449A.100 to 449A.124, inclusive, and 449A.270 to 449A.286, inclusive, or of any other law of this State or of the standards, rules and regulations adopted thereunder.

(b) Aiding, abetting or permitting the commission of any illegal act.

(c) Conduct inimical to the public health, morals, welfare and safety of the people of the State of Nevada in the maintenance and operation of the premises for which a license is issued.

(d) Conduct or practice detrimental to the health or safety of the occupants or employees of the facility.

(e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or 439A.102 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required, including, without limitation, the closure or conversion of any hospital in a county whose population is 100,000 or more that is owned by the licensee without approval pursuant to NRS 439A.102.

(f) Failure to comply with the provisions of NRS 441A.315 and any regulations adopted pursuant thereto or NRS 449.2486.

(g) Violation of the provisions of NRS 458.112.

(h) Failure to comply with the provisions of NRS 449A.170 to 449A.192, inclusive, and any regulation adopted pursuant thereto.

(i) Violation of the provisions of NRS 629.260.

2. In addition to the provisions of subsection 1, the Division may revoke a license to operate a facility for the dependent if, with respect to that facility, the licensee that operates the facility, or an agent or employee of the licensee:

(a) Is convicted of violating any of the provisions of NRS 202.470;

(b) Is ordered to but fails to abate a nuisance pursuant to NRS 244.360, 244.3603 or 268.4124; or

(c) Is ordered by the appropriate governmental agency to correct a violation of a building, safety or health code or regulation but fails to correct the violation.

3. The Division shall maintain a log of any complaints that it receives relating to activities for which the Division may revoke the license to operate a facility for the dependent pursuant to subsection 2. The Division shall provide to a facility for the care of adults during the day:

(a) A summary of a complaint against the facility if the investigation of the complaint by the Division either substantiates the complaint or is inconclusive;

(b) A report of any investigation conducted with respect to the complaint; and

Ê The facility shall make the information available to the public pursuant to NRS 449.2486.

4. On or before February 1 of each odd-numbered year, the Division shall submit to the Director of the Legislative Counsel Bureau a written report setting forth, for the previous biennium:

(a) Any complaints included in the log maintained by the Division pursuant to subsection 3; and

(b) Any disciplinary actions taken by the Division pursuant to subsection 2.

[Part 6:336:1951] + [Part 8:336:1951]—(NRS A 1963, 960; 1971, 936; 1973, 1284; 1975, 898; 1977, 257; 1981, 1220; 1987, 1783; 1989, 1662; 1991, 1079; 2001, 1350; 2003, 47, 857; 2007, 271; 2009, 1444; 2011, 357, 1065, 1358, 2253, 2396; 2013, 136, 2147, 3058; 2015, 634, 1530; 2017, 335, 1572, 1906, 2049, 2307, 4169; 2019, 339, 1115, 1339, 1402, 1677, 1920, 2154, 2598, 2643, 2921, 4037; 2021, 373, 3139; 2023, 571, 714, 911, 1371, 1429, 1849, 2020, 3334, 3444)

NRS 449.163 Administrative sanctions: Imposition by Division; disposition of money collected.

1. In addition to the payment of the amount required by NRS 449.0308, if a medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed violates any provision related to its licensure, including any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

(a) Prohibit the facility from admitting any patient until it determines that the facility has corrected the violation;

(b) Limit the occupancy of the facility to the number of beds occupied when the violation occurred, until it determines that the facility has corrected the violation;

(c) If the license of the facility limits the occupancy of the facility and the facility has exceeded the approved occupancy, require the facility, at its own expense, to move patients to another facility that is licensed;

(d) Except where a greater penalty is authorized by subsection 2, impose an administrative penalty of not more than $5,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum; and

(e) Appoint temporary management to oversee the operation of the facility and to ensure the health and safety of the patients of the facility, until:

(1) It determines that the facility has corrected the violation and has management which is capable of ensuring continued compliance with the applicable statutes, conditions, standards and regulations; or

(2) Improvements are made to correct the violation.

2. If an off-campus location of a hospital fails to obtain a national provider identifier that is distinct from the national provider identifier used by the main campus and any other off-campus location of the hospital in violation of NRS 449.1818, the Division may impose against the hospital an administrative penalty of not more than $10,000 for each day of such failure, together with interest thereon at a rate not to exceed 10 percent per annum, in addition to any other action authorized by this chapter.

3. If the facility fails to pay any administrative penalty imposed pursuant to paragraph (d) of subsection 1 or subsection 2, the Division may:

(a) Suspend the license of the facility until the administrative penalty is paid; and

(b) Collect court costs, reasonable attorney’s fees and other costs incurred to collect the administrative penalty.

4. The Division may require any facility that violates any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, or any condition, standard or regulation adopted by the Board to make any improvements necessary to correct the violation.

5. Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 or subsection 2 must be accounted for separately and used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, 449.435 to 449.531, inclusive, and chapter 449A of NRS to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards or for any other purpose authorized by the Legislature.

(Added to NRS by 1989, 863; A 1989, 1663; 2003, 858; 2009, 558, 1445; 2011, 358, 1066, 1359, 1806, 2254, 2397; 2013, 137, 2148, 3059; 2015, 1531, 2207; 2017, 336, 1907, 2050, 2308, 4170; 2019, 1116, 1340, 1403, 1678, 1921, 2155, 2599, 2644, 2922, 4038; 2021, 374; 2023, 573, 912, 1850, 2021, 3335, 3445)

NRS 449.165 Administrative sanctions: Regulations of Board. The Board shall adopt regulations establishing the criteria for the imposition of each sanction prescribed by NRS 449.163. These regulations must:

1. Prescribe the circumstances and manner in which each sanction applies;

2. Minimize the time between identification of a violation and the imposition of a sanction;

3. Provide for the imposition of incrementally more severe sanctions for repeated or uncorrected violations;

4. Provide for less severe sanctions for lesser violations of applicable state statutes, conditions, standards or regulations; and

5. Establish an administrative penalty to be imposed if a violation by a medical facility, facility for the dependent or a facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed causes harm or the risk of harm to more than one person.

(Added to NRS by 1989, 864; A 2017, 1908)

NRS 449.167 Administrative sanctions: Imposition for failure to comply with requirements concerning electronic health information. [Effective July 1, 2024.]

1. If the Division receives notification from the Department of Health and Human Services pursuant to NRS 439.5895 that a medical facility licensed pursuant to this chapter is not in compliance with the requirements of subsection 4 of NRS 439.589, the Division may, after notice and the opportunity for a hearing in accordance with the provisions of this chapter, require corrective action or impose an administrative penalty in the amount prescribed by NRS 449.163.

2. The Division shall not suspend or revoke a license for failure to comply with the requirements of subsection 4 of NRS 439.589.

(Added to NRS by 2023, 1847, effective July 1, 2024)

NRS 449.170 Denial, suspension or revocation of license or imposition of sanctions: Notice; appeal; adoption of regulations.

1. When the Division intends to deny, suspend or revoke a license, or impose any sanction prescribed by NRS 449.163, it shall give reasonable notice to all parties by certified mail. The notice must contain the legal authority, jurisdiction and reasons for the action to be taken. Notice is not required if the Division finds that the public health requires immediate action. In that case, it may order a summary suspension of a license pursuant to this section and NRS 233B.127 or impose any sanction prescribed by NRS 449.163, pending proceedings for revocation or other action.

2. If a person wants to contest the action of the Division, the person must file an appeal pursuant to regulations adopted by the Board.

3. Upon receiving notice of an appeal, the Division shall hold a hearing pursuant to regulations adopted by the Board.

4. The Board shall adopt such regulations as are necessary to carry out the provisions of this section.

[Part 8:336:1951]—(NRS A 1963, 960; 1969, 95; 1973, 1284; 1977, 70; 1985, 1741; 1989, 864; 1995, 1585; 2009, 558)

1. If the Division suspends the license of a medical facility, a facility for the dependent or a facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed pursuant to the provisions of this chapter, or if a facility otherwise ceases to operate, including, without limitation, pursuant to an action or order of a health authority pursuant to chapter 441A of NRS, the Division may, if deemed necessary by the Administrator of the Division, take control of and ensure the safety of the medical records of the facility.

2. Subject to the provisions of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, the Division shall:

(a) Maintain the confidentiality of the medical records obtained pursuant to subsection 1.

(b) Share medical records obtained pursuant to subsection 1 with law enforcement agencies in this State and other governmental entities which have authority to license the facility or to license the owners or employees of the facility.

(c) Release a medical record obtained pursuant to subsection 1 to the patient or legal guardian of the patient who is the subject of the medical record.

3. The Board shall adopt regulations to carry out the provisions of this section, including, without limitation, regulations for contracting with a person to maintain any medical records under the control of the Division pursuant to subsection 1 and for payment by the facility of the cost of maintaining medical records.

(Added to NRS by 2009, 557; A 2017, 1908)

NRS 449.172 Residential facility for groups: Duties of Division and operator upon suspension or revocation of license for abuse, neglect, exploitation, isolation or abandonment of occupants. If the Division suspends or revokes the license of a person who operates a residential facility for groups for abuse, neglect, exploitation, isolation or abandonment of the occupants of the facility, the Division shall suspend or revoke the license of all residential facilities for groups operated by that person. The person who operates the facility shall move all of the persons who are receiving services in the residential facilities for groups to other licensed residential facilities for groups at his or her own expense.

(Added to NRS by 1999, 3607; A 2015, 839)

NRS 449.174 Additional grounds for denial, suspension or revocation of license to operate certain facility, hospital, agency, program or home.

1. In addition to the grounds listed in NRS 449.160, the Division may deny a license to operate a facility, hospital, agency, program or home to an applicant or may suspend or revoke the license of a licensee to operate such a facility, hospital, agency, program or home if:

(a) The applicant or licensee has been convicted of:

(1) Murder, voluntary manslaughter or mayhem;

(2) Assault or battery with intent to kill or to commit sexual assault or mayhem;

(3) Sexual assault, statutory sexual seduction, incest, lewdness or indecent exposure, or any other sexually related crime that is punished as a felony;

(4) Prostitution, solicitation, lewdness or indecent exposure, or any other sexually related crime that is punished as a misdemeanor, within the immediately preceding 7 years;

(5) A crime involving domestic violence that is punished as a felony;

(6) A crime involving domestic violence that is punished as a misdemeanor, within the immediately preceding 7 years;

(7) Abuse or neglect of a child or contributory delinquency;

(8) A violation of any federal or state law regulating the possession, distribution or use of any controlled substance or any dangerous drug as defined in chapter 454 of NRS, within the immediately preceding 7 years;

(9) Abuse, neglect, exploitation, isolation or abandonment of older persons or vulnerable persons, including, without limitation, a violation of any provision of NRS 200.5091 to 200.50995, inclusive, or a law of any other jurisdiction that prohibits the same or similar conduct;

(10) A violation of any provision of law relating to the State Plan for Medicaid or a law of any other jurisdiction that prohibits the same or similar conduct, within the immediately preceding 7 years;

(11) A violation of any provision of NRS 422.450 to 422.590, inclusive;

(12) A criminal offense under the laws governing Medicaid or Medicare, within the immediately preceding 7 years;

(13) Any offense involving fraud, theft, embezzlement, burglary, robbery, fraudulent conversion or misappropriation of property, within the immediately preceding 7 years;

(14) Any other felony involving the use or threatened use of force or violence against the victim or the use of a firearm or other deadly weapon; or

(15) An attempt or conspiracy to commit any of the offenses listed in this paragraph, within the immediately preceding 7 years;

(b) The licensee has, in violation of NRS 449.125, continued to employ a person who has been convicted of a crime listed in paragraph (a); or

(c) The applicant or licensee has had a substantiated report of child abuse or neglect made against him or her and if the facility, hospital, agency, program or home provides residential services to children, is a psychiatric hospital that provides inpatient services to children or is a psychiatric residential treatment facility.

2. In addition to the grounds listed in NRS 449.160, the Division may suspend or revoke the license of a licensee to operate an agency to provide personal care services in the home, an agency to provide nursing in the home or a community health worker pool if the licensee has, in violation of NRS 449.125, continued to employ a person who has been convicted of a crime listed in paragraph (a) of subsection 1.

3. As used in this section:

(a) “Domestic violence” means an act described in NRS 33.018.

(b) “Facility, hospital, agency, program or home” has the meaning ascribed to it in NRS 449.119.

(d) “Medicare” has the meaning ascribed to it in NRS 439B.130.

(Added to NRS by 1997, 444; A 1999, 1948; 2005, 2171; 2007, 652, 2401; 2009, 506; 2013, 2895; 2015, 839, 2166, 2176; 2017, 1909; 2021, 2828)

Miscellaneous Provisions

NRS 449.181 Medical facility that has custody of child pursuant to court order to adopt policy relating to medical care and medications for child; employees to receive copy of policy.

1. Except as otherwise provided in this section, a medical facility that has custody of a child pursuant to the order of a court shall adopt a policy concerning the manner in which to:

(a) Document the orders of the treating physician of a child;

(b) Administer medication to a child;

(d) Document the administration of medication and any errors in the administration of medication;

(e) Minimize errors in the administration of medication; and

(f) Address errors in the administration of medication.

2. Such a medical facility shall ensure that each employee of the medical facility who will administer medication to such a child receives a copy of and understands the policy adopted pursuant to subsection 1.

(Added to NRS by 2011, 1357)

NRS 449.1815 Medical facility prohibited from allowing person who is not enrolled at accredited medical school to perform or participate in activity for credit toward medical degree. A medical facility shall not allow a person to perform or participate in any activity at the facility for the purpose of receiving credit toward a degree of doctor of medicine, osteopathy or osteopathic medicine, including, without limitation, clinical observation and contact with patients, unless the person is enrolled in good standing at:

1. A medical school that is accredited by the Liaison Committee on Medical Education of the American Medical Association and the Association of American Medical Colleges or their successor organizations; or

2. A school of osteopathic medicine, as defined in NRS 633.121.

(Added to NRS by 2015, 1529)

1. Each off-campus location of a hospital shall obtain and use and include on all claims for reimbursement or payment for health care services provided at the location a national provider identifier that is distinct from the national provider identifier used by the main campus and any other off-campus location of the hospital. If the off-campus location includes the national provider identifier on such a claim, the off-campus location may also include on the claim the national provider identifier used by the main campus of the hospital. If the off-campus location includes both the national provider identifier used by the off-campus location and the national provider identifier used by the main campus on a claim, the claim must clearly identify which national provider identifier corresponds to the off-campus location and which national provider identifier corresponds to the main campus.

2. An independent center for emergency medical care shall include on all claims for reimbursement or payment for health care services provided at the independent center for emergency medical care the national provider identifier used by the independent center for emergency medical care.

3. As used in this section:

(a) “National provider identifier” means the standard, unique health identifier for health care providers that is issued by the national provider system in accordance with 45 C.F.R. Part 162.

(b) “Off-campus location” means a facility:

(1) With operations that are directly or indirectly owned or controlled by, in whole or in part, a hospital or which is affiliated with a hospital, regardless of whether it is operated by the same governing body as the hospital;

(2) That is located more than 250 yards from the main campus of the hospital;

(3) That provides services which are organizationally and functionally integrated with the hospital; and

(4) That is an outpatient facility providing ambulatory surgery, urgent care or emergency room services.

(Added to NRS by 2019, 4033; A 2023, 2022)

NRS 449.1821 Hospital to accept payment through Medicare; exceptions. A hospital, other than a psychiatric hospital, critical access hospital or rural hospital, shall enter into an agreement with the United States Secretary of Health and Human Services pursuant to 42 U.S.C. § 1395cc to accept payment through Medicare.

(Added to NRS by 2019, 2641)

1. Except as otherwise provided in subsection 2, if a patient giving birth at a hospital requests the insertion or injection of long-acting reversible contraception, the hospital shall provide for the insertion or injection of the long-acting reversible contraception immediately after the birth unless:

(a) The use of the long-acting reversible contraception is contraindicated for the patient; or

(b) A physician, physician assistant or advanced practice registered nurse determines that inserting or injecting the long-acting reversible contraception would create an unreasonable risk of harm to the patient.

2. A hospital that is affiliated with a religious organization is not required to provide the service described in subsection 1 if the hospital objects on religious grounds. Before scheduling a patient for maternity care or, if such scheduling does not occur, upon admitting a patient to the hospital for maternity care, the hospital shall provide to the patient written notice that the hospital refuses to provide the service required by subsection 1.

3. A hospital shall not require a provider of health care who objects to the service described in subsection 1 on religious grounds to participate in the provision of that service. If such a provider of health care at a hospital, other than a hospital described in subsection 2, receives a request for that service, the provider shall refer the patient to a provider of health care who is willing to provide the service.

4. A hospital or provider of health care may not require a third party to pay more for:

(a) Long-acting reversible contraception inserted or injected pursuant to subsection 1 than the lowest rate prescribed in a contract between the third party and a hospital or a provider of the same type as the provider of health care, as applicable, for the same type of long-acting reversible contraception.

(b) The insertion or injection of long-acting reversible contraception pursuant to subsection 1 than the lowest rate prescribed in a contract between the third party and a hospital or a provider of the same type as the provider of health care, as applicable, for insertion or injection of the same type of long-acting reversible contraception.

(c) Any testing associated with the insertion or injection of long-acting reversible contraception pursuant to subsection 1 than the lowest rate prescribed in a contract between the third party and a hospital or a provider of health care of the same type as the provider of health care, as applicable, for the same test.

5. As used in this section:

(a) “Long-acting reversible contraception” means a method of contraception that requires administration less than once per month, including, without limitation:

(1) An intrauterine device;

(2) A contraceptive implant; and

(3) An injectable contraceptive.

(b) “Third party” means:

(1) An insurer, as that term is defined in NRS 679B.540;

(2) A health benefit plan, as that term is defined in NRS 687B.470, for employees which provides coverage for prescription drugs;

(3) A participating public agency, as that term is defined in NRS 287.04052, and any other local governmental agency of the State of Nevada which provides a system of health insurance for the benefit of its officers and employees, and the dependents of officers and employees, pursuant to chapter 287 of NRS; or

(4) Any other insurer or organization that provides health coverage or benefits in accordance with state or federal law.

(Added to NRS by 2023, 905)

NRS 449.1823 Hospital to provide notice to medicaid patients with nontraumatic dental injuries of teledentistry providers in Medicaid managed care networks. If a recipient of Medicaid presents in the emergency department of a hospital in this State with a nontraumatic dental injury, the hospital must notify the patient of providers of dental services included in the network of each health maintenance organization or managed care organization that provides services through teledentistry to recipients of Medicaid. The hospital shall provide such notice by:

1. Posting signs on the premises of the hospital that include the list of providers who offer services through teledentistry submitted to the hospital pursuant to NRS 695C.1708 or 695G.162, as applicable, or which direct patients to an Internet website on which such lists are available; or

2. Making available to patients a pamphlet or other written document that includes the list of providers who offer services through teledentistry submitted to the hospital pursuant to NRS 695C.1708 or 695G.162, as applicable, or which directs patients to an Internet website on which those lists are available.

(Added to NRS by 2023, 3332)

NRS 449.1824 Duties of hospital and licensed entity that provides care for patient upon discharge to ensure dietary needs of patient are met.

1. If a patient will be released from a hospital to his or her residence or a rehabilitation center and a dietitian is assigned to a team of persons formed by the hospital to care for the patient while the patient rehabilitates, the hospital shall ensure that the patient or the person with primary responsibility for the care of the patient meets or knows how to contact the dietitian.

2. If a patient is released by a hospital to his or her residence to receive care from an agency to provide personal care services in the home or any other entity licensed pursuant to this chapter that provides care to the patient in his or her residence, the agency to provide personal care services in the home or other entity shall consult with a dietitian, as appropriate, to ensure that the patient or the person with primary responsibility for the care of the patient understands the dietary needs of the patient.

(Added to NRS by 2023, 3439)

NRS 449.1825 Required posting of certain information concerning quality of certain facilities on Internet and in facilities.

1. The Division shall post on an Internet website maintained by the Division links to:

(a) The most recent star rating assigned by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to each medical facility or facility for the dependent in this State that receives such a rating; and

(b) The Ambulatory Surgical Center Quality Reporting Program maintained by the Centers for Medicare and Medicaid Services.

2. A medical facility or facility for the dependent that receives a star rating from the Centers for Medicare and Medicaid Services shall post the most recent star rating assigned to the facility in a conspicuous place near each entrance to the facility that is regularly used by the public and, if the facility maintains an Internet website that is accessible to the public, on that Internet website.

3. A surgical center for ambulatory patients shall post the address of the Internet website for the Ambulatory Surgical Center Quality Reporting Program maintained by the Centers for Medicare and Medicaid Services in a conspicuous place near each entrance to the surgical center for ambulatory patients that is regularly used by the public and, if the surgical center for ambulatory patients maintains an Internet website that is accessible to the public, on that Internet website.

(Added to NRS by 2017, 4164)

1. A facility for intermediate care, facility for skilled nursing and residential facility for groups shall adopt a written policy that establishes:

(a) The number of days the facility will hold the bed of a patient or resident for his or her return if the patient or resident is transferred temporarily to a hospital or other facility for medical reasons; and

(b) That a patient or resident who is so transferred for a period that exceeds the period of the hold established pursuant to paragraph (a) will be allowed to resume his or her residency as soon as a bed becomes available, if the facility is suitable for properly caring for the patient upon his or her return.

2. Upon admission of a patient or resident to a facility for intermediate care, facility for skilled nursing or residential facility for groups, the facility shall provide to the patient or resident and, if applicable, to the legal representative of the patient or resident, a copy of the policy established pursuant to subsection 1.

(Added to NRS by 2011, 1063)

NRS 449.184 Operator of residential facility for groups, facility for intermediate care or facility for skilled nursing to post certain information in conspicuous place.

1. A person who operates a residential facility for groups shall:

(a) Post his or her license to operate the residential facility for groups;

(b) Post the rates for services provided by the residential facility for groups; and

(c) Post contact information for the administrator and the designated representative of the owner or operator of the facility,

Ê in a conspicuous place in the residential facility for groups.

2. A person who operates a facility for intermediate care or facility for skilled nursing shall:

(a) Post his or her license to operate the facility;

(b) Post the organizational structure of the management of the facility; and

(c) Post contact information for the administrator and the designated representative of the owner or operator of the facility,

Ê in a conspicuous place in the facility for intermediate care or facility for skilled nursing.

(Added to NRS by 1999, 3606; A 2011, 1064)

1. The administrator of a residential facility for groups shall:

(a) Annually cause a qualified provider of health care to conduct a physical examination of each resident of the facility;

(b) Annually conduct an assessment of the history of each resident of the facility, which must include, without limitation, an assessment of the condition and daily activities of the resident during the immediately preceding year; and

(c) Cause a qualified provider of health care to conduct an assessment of the condition and needs of a resident of the facility to determine whether the resident meets the criteria prescribed in paragraph (a) of subsection 2:

(1) Upon admission of the resident to the facility; and

(2) If a physical examination, assessment of the history of the resident or the observations of the administrator or staff of the facility, the family of the resident or another person who has a relationship with the resident indicate that:

(I) The resident may meet those criteria; or

(II) The condition of the resident has significantly changed.

2. If, as a result of an assessment conducted pursuant to paragraph (c) of subsection 1, the provider of health care determines that the resident:

(a) Suffers from dementia to an extent that the resident may be a danger to himself or herself or others if the resident is not placed in a secure unit or a facility that assigns not less than one staff member for every six residents, any residential facility for groups in which the resident is placed must meet the requirements prescribed by the Board pursuant to subsection 2 of NRS 449.0302 for the licensing and operation of residential facilities for groups which provide care to persons with Alzheimer’s disease or other severe dementia.

(b) Does not suffer from dementia as described in paragraph (a), the resident may be placed in any residential facility for groups.

3. As used in this section, “provider of health care” has the meaning ascribed to it in NRS 629.031.

(Added to NRS by 2019, 2594)

NRS 449.186 Supervision of residential facility for groups. A residential facility for groups must not be operated except under the supervision of an administrator of a residential facility for groups or a health services executive licensed pursuant to the provisions of chapter 654 of NRS.

(Added to NRS by 1993, 2144; A 2017, 603)

NRS 449.1865 Certain residential facilities for groups to be equipped with fire sprinkler system. A residential facility for groups must be equipped with a fire sprinkler system if the facility has three or more residents who would have difficulty perceiving danger or moving to safety in the event of a fire.

(Added to NRS by 2017, 2049)

NRS 449.187 Supervision of facility for skilled nursing or facility for intermediate care.

1. Except as otherwise provided in subsection 2, a facility for skilled nursing or facility for intermediate care licensed pursuant to the provisions of NRS 449.029 to 449.2428, inclusive, may not be operated except under the supervision of a nursing facility administrator or a health services executive who is at the facility and licensed under the provisions of chapter 654 of NRS.

2. The provisions of subsection 1 do not apply to a facility for intermediate care which limits its care and treatment to those persons with intellectual disabilities or conditions related to intellectual disabilities.

(Added to NRS by 1969, 672; A 1971, 934; 1973, 1281; 1977, 1031; 1985, 1738; 1993, 1214; 2013, 697; 2017, 603)

1. The Division shall establish a working group consisting of representatives of hospitals and independent centers for emergency medical care and experts in treating the effects of sexual assault and attempted sexual assault. The working group shall:

(a) Develop a document to be provided to victims of sexual assault and attempted sexual assault pursuant to subsection 3, which must consist of medically and factually accurate written information concerning:

(1) Emergency contraception and prophylactic antibiotics, including, without limitation, possible side effects of using those medications and the locations of facilities or pharmacies where those medications are available;

(2) Contact information for law enforcement agencies in this State; and

(3) Other services available to victims of sexual assault and attempted sexual assault in all regions of this State, including, without limitation, counseling, a list of clinics and other facilities that specialize in serving victims of sexual assault and a list of locations that provide testing for sexually transmitted diseases. Such information must be organized in a manner that allows a victim to easily identify the services available in his or her region of the State.

(b) Update the document as necessary.

2. The Division shall:

(a) Distribute copies of the document developed pursuant to subsection 1 to each hospital and independent center for emergency medical care located in this State; and

(b) Post the document on an Internet website maintained by the Division.

3. Each hospital or independent center for emergency medical care shall ensure that each victim of sexual assault or attempted sexual assault who is treated by the hospital or independent center for emergency medical care is provided with:

(a) A copy of the document developed pursuant to subsection 1; and

(b) An oral explanation of the information contained in the document and an oral and written explanation of the provisions of subsection 4.

4. If a victim of sexual assault or attempted sexual assault who is receiving treatment at a hospital or independent center for emergency medical care requests emergency contraception, the hospital or independent center for emergency medical care shall ensure that the victim is provided all doses of emergency contraception necessary to prevent pregnancy, including, without limitation, any doses that must be self-administered after the patient leaves the hospital or independent center for emergency medical care.

5. As used in this section:

(a) “Emergency contraception” means methods of birth control which, when administered within a specified period after intercourse, may prevent pregnancy from occurring.

(b) “Sexual assault” means a violation of NRS 200.366 or 200.368.

(Added to NRS by 2019, 335; A 2021, 1070)

NRS 449.189 Physician and nurse required to operate independent center to provide emergency medical care. An independent center to provide emergency medical care shall not be operated unless a physician and registered nurse are on the premises.

(Added to NRS by 1985, 1735)

NRS 449.191 Medical facility not required to allow abortions.

1. A hospital or other medical facility licensed under the provisions of this chapter which is not operated by the State or a local government or an agency of either is not required to permit the use of its facilities for the induction or performance of an abortion, except in a medical emergency.

2. Such refusal does not give rise to a cause of action in favor of any person.

(Added to NRS by 1973, 897; A 1985, 1742)

NRS 449.1915 Provision of special diet to patient for whom special diet has been ordered; documentation; clinical privileges for licensed dietitian.

1. A medical facility shall take such actions as necessary to ensure that the facility provides a diet for each patient for whom a special diet has been ordered by a licensed dietitian or prescribed by a physician, physician assistant, dentist, advanced practice registered nurse or podiatric physician that complies with the order or prescription. Such actions may include, without limitation, purchasing any food or beverage necessary to comply.

2. A medical facility shall maintain documentation which demonstrates that the facility is in compliance with the requirements of subsection 1 and make such documentation available to the Division upon request.

3. A hospital may grant clinical privileges to a licensed dietitian for the purposes of:

(a) Ordering special diets for patients;

(b) Ordering laboratory tests to monitor the effectiveness of special diets or other dietary plans; and

(Added to NRS by 2019, 1111)

NRS 449.192 Admission of dentist to membership on medical staff of hospital. No dentist may be:

1. Automatically admitted to membership on the medical staff of a hospital solely because he or she is licensed as a dentist in this state or is authorized pursuant to NRS 631.267 to perform certain functions; or

2. Denied admission to membership on the medical staff of a hospital merely because he or she is licensed as a dentist and not as a physician.

(Added to NRS by 1985, 2097)

NRS 449.1923 Admission of advanced practice registered nurse to membership on medical staff of hospital. A hospital may admit an advanced practice registered nurse to membership on the medical staff of the hospital to perform any act authorized pursuant to NRS 632.237 that is within the scope of practice of the advanced practice registered nurse. A hospital shall not:

1. Automatically admit an advanced practice registered nurse to membership on the medical staff of the hospital solely because he or she is licensed as an advanced practice registered nurse in this State, is authorized pursuant to NRS 632.237 to perform certain functions or certain functions are within his or her scope of practice; or

2. Deny admission to membership on the medical staff of the hospital to an advanced practice registered nurse solely because he or she is licensed as an advanced practice registered nurse and not as a physician.

(Added to NRS by 2019, 1398)

NRS 449.1925 Staff privileges for telehealth providers. A hospital may grant staff privileges to a provider of health care who is at another location for the purpose of providing services through telehealth, as defined in NRS 629.515, to patients at the hospital in the manner prescribed in 42 C.F.R. §§ 482.12, 482.22 and 485.616.

(Added to NRS by 2015, 631)

1. Subject to the provisions of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, a facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care shall, upon request, provide an itemized statement of charges to:

(a) The person who received care in the facility or home;

(b) The parent or guardian of the person who received care in the facility or home; or

2. An itemized statement of charges provided by a facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care pursuant to subsection 1 must, without limitation:

(a) Itemize the charges for services, care, food, medicine and other supplies provided to the person receiving care at the facility or home;

(b) Identify the amount of payment allocated to each charge;

(d) Be provided at no additional cost; and

(e) Be provided in a timely manner.

(Added to NRS by 2011, 2395)

NRS 449.1935 Agency to provide personal care services in the home authorized to provide certain services to elderly persons and persons with disabilities. An agency to provide personal care services in the home that is licensed pursuant to this section and NRS 449.029 to 449.2428, inclusive, may, through its employees or by contractual arrangement with other persons, provide:

1. To persons with disabilities, any medical services authorized pursuant to NRS 629.091; and

2. Nonmedical services related to personal care to elderly persons or persons with disabilities to assist those persons with activities of daily living.

(Added to NRS by 2013, 134; A 2017, 1573)

NRS 449.194 Certain employees of agency to provide personal care services in the home or community health worker pool immune from civil liability resulting from rendering emergency care or assistance. Any person who is employed by an agency to provide personal care services in the home or a community health worker pool who:

1. Has successfully completed a course in cardiopulmonary resuscitation according to the guidelines of the American National Red Cross or American Heart Association;

2. Has successfully completed the training requirements of a course in basic emergency care of a person in cardiac arrest conducted in accordance with the standards of the American Heart Association; or

3. Has successfully completed the training requirements of a course in the use and administration of first aid, including cardiopulmonary resuscitation,

Ê and who in good faith renders emergency care or assistance in accordance with the person’s training, in the course of his or her regular employment or profession, to an elderly person or a person with a disability, is not liable for any civil damages as a result of any act or omission, not amounting to gross negligence, by that person in rendering that care.

(Added to NRS by 2013, 434; A 2015, 2167, 2177; 2021, 2830)

NRS 449.195 Waiver of deductible or copayment; conditions. A medical facility shall not waive a deductible or copayment if:

1. The medical facility is not a preferred provider of health care; and

2. The waiver would reduce the financial effect of a preferred provider’s incentive or disincentive to its insureds.

(Added to NRS by 1987, 1783; A 1995, 1602)

NRS 449.196 Requirements for program of hospice care. No person, state or local government or agency may represent that it provides “hospice care” unless the program of care, either directly or indirectly:

1. Has a medical director whose responsibilities are appropriate to the needs of the program and who:

(a) Is a physician, currently licensed to practice;

(b) On the basis of training, experience and interest, is knowledgeable about the psychosocial and medical aspects of hospice; and

2. Is provided to the patient, as needed, in the patient’s home, at a residential facility and at a medical facility, at any time of the day or night;

3. Includes medical, nursing, psychological and pastoral care and social services at the level required by the patient’s condition;

4. Provides supportive services for the patient’s immediate family and other persons with significant personal ties to the patient, whether or not related by blood, including:

(a) Care for the patient which provides a respite from the stresses and responsibilities that result from the daily care of the patient; and

(b) Emotional support and other care after the patient dies; and

5. Includes the services of trained volunteers.

(Added to NRS by 1989, 1034)

NRS 449.197 Provision of care by facility for hospice care.

1. A licensed facility for hospice care may provide any of the following levels of care for terminally ill patients:

(a) Medical care for a patient who is in an acute episode of illness;

(b) Skilled nursing care;

(d) Custodial care; and

(e) Palliative services.

2. A licensed facility for hospice care may provide direct supportive services to a patient’s family and persons who provide care for the patient, including services which provide care for the patient during the day and other services which provide a respite from the stresses and responsibilities that result from the daily care of the patient.

(Added to NRS by 1989, 1034; A 1999, 249; 2005, 485)

NRS 449.198 Requirements for freestanding birthing center; prohibition on surgery; qualifications of director.

1. A freestanding birthing center must:

(a) Provide sufficient space for members of the family of the pregnant person and other persons chosen by the pregnant person to assist with the birth;

(b) Have obstetrical services available to meet the needs of an acute patient; and

(c) Be located within 30 miles of a hospital that offers obstetric, neonatal and emergency services relating to pregnancy.

2. Surgery, including, without limitation, the use of forceps, vacuum extractions, cesarean sections and tubal ligations, must not be performed at a freestanding birthing center.

3. A freestanding birthing center must have a director who is responsible for the operation of the freestanding birthing center. The director of a freestanding birthing center must be:

(a) A physician;

(b) A person who:

(1) Is certified as a Certified Professional Midwife by the North American Registry of Midwives, or its successor organization; and

(2) Has successfully completed a program of education and training in midwifery that:

(I) Is accredited by the Midwifery Education Accreditation Council, or its successor organization; and

(II) Provides instruction and training in the Essential Competencies for Midwifery Practice prescribed by the International Confederation of Midwives, or its successor organization; or

4. As used in this section, “certified nurse-midwife” means a person who is:

(a) Certified as a Certified Nurse-Midwife by the American Midwifery Certification Board, or its successor organization; and

(b) Licensed as an advanced practice registered nurse pursuant to NRS 632.237.

(Added to NRS by 1985, 1735; A 2021, 3442)

NRS 449.199 Residential facility for groups and homes for individual residential care prohibited from providing accommodations to persons not meeting requirements for admission; exception.

1. Except as otherwise provided in subsection 2, a residential facility for groups which is authorized to have 10 or fewer beds or a home for individual residential care shall not provide accommodations for a person who does not meet the requirements for admission to the facility or home.

2. A residential facility for groups which is authorized to have 10 or fewer beds or a home for individual residential care may provide accommodations for a person who is related within the third degree of consanguinity to a resident of the facility or home regardless of whether the person meets the requirements for admission to the facility or home.

(Added to NRS by 2009, 1441)

NRS 449.201 Certification required for programs for alcohol or other substance use disorders operated or provided by facility for transitional living for released offenders. Each program for alcohol or other substance use disorders operated or provided by a facility for transitional living for released offenders must be certified by the Division in accordance with the requirements set forth in chapter 458 of NRS and any regulations adopted pursuant thereto. As used in this section, “program for alcohol or other substance use disorders” has the meaning ascribed to it in NRS 458.010.

(Added to NRS by 2005, 2350; A 2013, 3060)

NRS 449.202 Classification of hospitals. A hospital which provides only one or two of the following categories of service:

1. Medical;

2. Surgical;

3. Obstetrical; or

4. Psychiatric,

Ê shall be designated a medical hospital, surgical hospital, obstetrical hospital or psychiatric hospital or combined-categories hospital, as the case may be.

(Added to NRS by 1971, 933; A 1973, 1280; 2019, 2644)

NRS 449.203 Designation of hospital as comprehensive or primary stroke center; Division to maintain list of hospitals so designated; regulations.

1. A hospital licensed pursuant to NRS 449.029 to 449.2428, inclusive, may submit to the Division proof that the hospital is certified as a comprehensive or primary stroke center by the Joint Commission, its successor organization or an equivalent organization approved by the Division. Upon receiving proof that a hospital is certified as a comprehensive or primary stroke center, the Division shall include the hospital on the list established pursuant to subsection 2.

2. On or before July 1 of each year, the Division shall post a list of the hospitals designated as comprehensive or primary stroke centers on an Internet website maintained by the Division.

3. If a hospital wishes to be included as a comprehensive or primary stroke center on the list established pursuant to subsection 2, the hospital must annually resubmit the proof required pursuant to this section.

4. The Division may remove a hospital from the list established pursuant to subsection 2 if the certificate recognizing the hospital as a comprehensive or primary stroke center issued by the Joint Commission, its successor organization or an equivalent organization, as applicable, is suspended or revoked.

5. A hospital that is not included on the list established pursuant to subsection 2 as a comprehensive or primary stroke center shall not represent, advertise or imply that the hospital is designated as a comprehensive or primary stroke center.

6. A hospital that is included on the list established pursuant to subsection 2 as a comprehensive or primary stroke center shall report to the Stroke Registry all consensus measures prescribed by the Paul Coverdell National Acute Stroke Registry of the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, the Joint Commission, the American Heart Association and the American Stroke Association.

7. The provisions of this section do not prohibit a hospital that is licensed pursuant to NRS 449.029 to 449.2428, inclusive, from providing care to a victim of stroke if the hospital does not have a designation as a comprehensive or primary stroke center.

8. The Board may adopt regulations to carry out the provisions of this section and to designate hospitals with similar certifications which are recognized by the Joint Commission, its successor organization or an equivalent organization.

9. As used in this section, “Stroke Registry” means the Stroke Registry established pursuant to NRS 439.5295.

(Added to NRS by 2011, 1363; A 2015, 249)

NRS 449.2035 Designation of hospital as STEMI receiving center; Division to maintain list of hospitals so designated; regulations.

1. A hospital licensed pursuant to NRS 449.029 to 449.2428, inclusive, may submit to the Division proof that the hospital is accredited as a STEMI receiving center. Upon receiving proof that a hospital is accredited as a STEMI receiving center, the Division shall include the hospital on the list established pursuant to subsection 2.

2. On or before July 1 of each year, the Division shall post a list of all hospitals designated as STEMI receiving centers on an Internet website maintained by the Division.

3. If a hospital wishes to be included as a STEMI receiving center on the list established pursuant to subsection 2, the hospital must annually resubmit the proof required pursuant to this section.

4. The Division may remove a hospital from the list established pursuant to subsection 2 if the accreditation recognizing the hospital as a STEMI receiving center is suspended or revoked.

5. A hospital that is not included on the list established pursuant to subsection 2 shall not represent, advertise or imply that the hospital is designated as a STEMI receiving center.

6. The provisions of this section do not prohibit a hospital that is licensed pursuant to NRS 449.029 to 449.2428, inclusive, from providing care to a victim of a heart attack if the hospital does not have a designation as a STEMI receiving center.

7. The Board may adopt regulations to carry out the provisions of this section and to designate hospitals with accreditations similar to those required for designation as a STEMI receiving center.

8. As used in this section:

(a) “STEMI” means a myocardial infarction as indicated by an abnormal elevation of the ST segment of an electrocardiogram that is administered to a patient.

(b) “STEMI receiving center” means a hospital that is accredited by the Society of Cardiovascular Patient Care, in conjunction with the initiative developed by the American Heart Association known as the “Mission: Lifeline initiative,” or an equivalent organization approved by the Division, as having met specific standards of performance in the receipt and treatment of a patient with STEMI.

(Added to NRS by 2013, 507)

NRS 449.204 Misleading name or other designation of facility prohibited. The name, sign, listing or other designation of a medical facility or facility for the dependent must not contain any terms misleading to the public with regard to the services offered.

(Added to NRS by 1973, 1279; A 1975, 367; 1985, 1738)

Prohibited Acts; Penalties

1. A medical facility or any agent or employee thereof shall not retaliate or discriminate unfairly against:

(a) An employee of the medical facility or a person acting on behalf of the employee who in good faith:

(1) Reports to the Board of Medical Examiners or the State Board of Osteopathic Medicine, as applicable, information relating to the conduct of a physician which may constitute grounds for initiating disciplinary action against the physician or which otherwise raises a reasonable question regarding the competence of the physician to practice medicine with reasonable skill and safety to patients;

(2) Reports a sentinel event to the Division pursuant to NRS 439.835; or

(3) Cooperates or otherwise participates in an investigation or proceeding conducted by the Board of Medical Examiners, the State Board of Osteopathic Medicine or another governmental entity relating to conduct described in subparagraph (1) or (2);

(b) A registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility and who:

(1) In accordance with the policy, if any, established by the medical facility:

(I) Reports to his or her immediate supervisor, in writing, that he or she does not possess the knowledge, skill or experience to comply with an assignment to provide nursing services to a patient; and

(II) Refuses to provide to a patient nursing services for which, as verified by documentation in the personnel file of the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified concerning his or her competence to provide various nursing services, he or she does not possess the knowledge, skill or experience to comply with the assignment to provide nursing services to the patient, unless the refusal constitutes unprofessional conduct as set forth in chapter 632 of NRS or any regulations adopted pursuant thereto;

(2) In accordance with a policy adopted pursuant to NRS 449.2423, requests to be relieved of, refuses or objects to a work assignment;

(3) In good faith, reports to the medical facility, the Board of Medical Examiners, the State Board of Osteopathic Medicine, the State Board of Nursing, the Legislature or any committee thereof or any other governmental entity:

(I) Any information concerning the willful conduct of another registered nurse, licensed practical nurse, nursing assistant or medication aide - certified which violates any provision of chapter 632 of NRS or which is required to be reported to the State Board of Nursing;

(II) Any concerns regarding patients who may be exposed to a substantial risk of harm as a result of the failure of the medical facility or any agent or employee thereof to comply with minimum professional or accreditation standards or applicable statutory or regulatory requirements; or

(III) Any other concerns regarding the medical facility, the agents and employees thereof or any situation that reasonably could result in harm to patients; or

(4) Refuses to engage in conduct that would violate the duty of the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified to protect patients from actual or potential harm, conduct which would violate any provision of chapter 632 of NRS or conduct which would subject the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified to disciplinary action by the State Board of Nursing; or

2. A medical facility or any agent or employee thereof shall not retaliate or discriminate unfairly against an employee of the medical facility or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility because the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified has taken an action described in subsection 1.

3. A medical facility or any agent or employee thereof shall not prohibit, restrict or attempt to prohibit or restrict by contract, policy, procedure or any other manner the right of an employee of the medical facility or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility to take an action described in subsection 1.

4. As used in this section:

(a) “Good faith” means honesty in fact in the reporting of the information or in the cooperation in the investigation concerned.

(b) “Physician” means a person licensed to practice medicine pursuant to chapter 630 or 633 of NRS.

(1) Includes, without limitation, any of the following actions if taken solely because the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified took an action described in subsection 1:

(I) Frequent or undesirable changes in the location where the person works;

(II) Frequent or undesirable transfers or reassignments;

(III) The issuance of letters of reprimand, letters of admonition or evaluations of poor performance;

(IV) A demotion;

(V) A reduction in pay;

(VI) The denial of a promotion;

(VII) A suspension;

(VIII) A dismissal;

(IX) A transfer; or

(X) Frequent changes in working hours or workdays.

(2) Does not include an action described in sub-subparagraphs (I) to (X), inclusive, of subparagraph (1) if the action is taken in the normal course of employment or as a form of discipline.

(Added to NRS by 2002 Special Session, 16; A 2005, 1517; 2009, 1418; 2011, 1338; 2013, 2148; 2019, 3677)

1. An employee of a medical facility or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility and who believes that he or she has been retaliated or discriminated against in violation of NRS 449.205 may file an action in a court of competent jurisdiction.

2. If a court determines that a violation of NRS 449.205 has occurred, the court may award such damages as it determines to have resulted from the violation, including, without limitation:

(a) Compensatory damages;

(b) Reimbursement of any wages, salary, employment benefits or other compensation denied to or lost by the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified as a result of the violation;

(d) Punitive damages, if the facts warrant.

3. The court shall award interest on the amount of damages at a rate determined pursuant to NRS 17.130.

4. The court may grant any equitable relief it considers appropriate, including, without limitation, reinstatement of the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified and any temporary, preliminary or permanent injunctive relief.

5. If any action to retaliate or discriminate is taken against an employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified within 60 days after the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified takes any action described in subsection 1 of NRS 449.205, there is a rebuttable presumption that the action taken against the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified constitutes retaliation or discrimination in violation of NRS 449.205.

6. A medical facility or any agent or employee thereof that violates the provisions of NRS 449.205 is subject to a civil penalty of not more than $10,000 for each violation. The Attorney General or any district attorney of this State may recover the penalty in a civil action brought in the name of the State of Nevada in any court of competent jurisdiction.

7. Any action under this section must be brought not later than 2 years after the date of the last event constituting the alleged violation for which the action is brought.

8. As used in this section, “retaliate or discriminate” has the meaning ascribed to it in NRS 449.205.

(Added to NRS by 2002 Special Session, 17; A 2005, 1518; 2009, 1420; 2011, 1339)

1. A medical facility shall prepare a written notice for the employees of the medical facility and for the nurses, nursing assistants and medication aides - certified who contract with the medical facility regarding the protections provided for actions taken pursuant to subsection 1 of NRS 449.205 and the legal remedy provided pursuant to NRS 449.207. The notice must include the process by which an employee, nurse, nursing assistant or medication aide - certified may make a report pursuant to subsection 1 of NRS 449.205.

2. A medical facility shall:

(a) Post in one or more conspicuous places at the medical facility the notice prepared pursuant to subsection 1; and

(b) Include the text of the written notice in any manual or handbook that the medical facility provides to employees, nurses, nursing assistants and medication aides - certified who contract with the medical facility concerning employment practices at the medical facility.

(Added to NRS by 2009, 557; A 2011, 1340)

NRS 449.209 Prohibition against medical facility or employee of medical facility making certain referrals to residential facilities for groups; civil penalties; system to track violations.

1. In addition to the requirements and prohibitions set forth in NRS 449.0305, and notwithstanding any exceptions set forth in that section, a licensed medical facility or an employee of such a medical facility shall not:

(a) Refer a person to a residential facility for groups that is not licensed by the Division; or

(b) Refer a person to a residential facility for groups if the licensed medical facility or its employee knows or reasonably should know that the residential facility for groups, or the services provided by the residential facility for groups, are not appropriate for the condition of the person being referred.

2. If a licensed medical facility or an employee of such a medical facility violates the provisions of subsection 1, the licensed medical facility is liable for a civil penalty to be recovered by the Attorney General in the name of the Board for the first offense of not more than $10,000 and for a second or subsequent offense of not less than $10,000 or more than $20,000. Unless otherwise required by federal law, the Board shall deposit all civil penalties collected pursuant to this section into a separate account in the State General Fund to be used for the enforcement of this section and the protection of the health, safety, well-being and property of residents of residential facilities for groups.

3. The Board shall:

(a) Establish and maintain a system to track violations of this section and NRS 449.0305. Except as otherwise provided in this paragraph, records created by or for the system are public records and are available for public inspection. The following information is confidential:

(1) Any personally identifying information relating to a person who is referred to a residential facility for groups.

(2) Information which may not be disclosed under federal law.

(b) Educate the public regarding the requirements and prohibitions set forth in this section and NRS 449.0305.

4. As used in this section, “licensed medical facility” means:

(a) A medical facility that is required to be licensed pursuant to NRS 449.029 to 449.2428, inclusive.

(b) A facility for the dependent that is required to be licensed pursuant to NRS 449.029 to 449.2428, inclusive.

(c) A facility that provides medical care or treatment and is required by regulation of the Board to be licensed pursuant to NRS 449.0303.

(Added to NRS by 2011, 704)

1. In addition to the payment of the amount required by NRS 449.0308 and any civil penalty imposed pursuant to subsection 4, a person who operates a medical facility, facility for the dependent or a facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed without a license issued by the Division is guilty of a misdemeanor.

2. If the Division believes that a person is operating a medical facility, facility for the dependent or a facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed without such a license, the Division may issue an order to cease and desist the operation of the facility. The order must be served upon the person by personal delivery or by certified or registered mail, return receipt requested. The order is effective upon service.

3. If a person does not voluntarily cease operating a medical facility, facility for the dependent or a facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed without a license or apply for licensure within 30 days after the date of service of the order pursuant to subsection 2, the Division may bring an action in a court of competent jurisdiction pursuant to NRS 449.220.

4. Upon a showing by the Division that a person is operating a medical facility, facility for the dependent or a facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed without a license, a court of competent jurisdiction may:

(a) Enjoin the person from operating the facility.

(b) Impose a civil penalty on the operator to be recovered by the Division of not more than $10,000 for the first offense or not less than $10,000 or more than $25,000 for a second or subsequent offense.

5. Unless otherwise required by federal law, the Division shall deposit all civil penalties collected pursuant to paragraph (b) of subsection 4 into a separate account in the State General Fund to be used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards.

[10:336:1951]—(NRS A 1967, 581; 1971, 936; 1973, 1285; 1985, 1742; 1999, 3609; 2009, 452; 2011, 358, 700, 1806; 2013, 137, 3060; 2015, 356; 2017, 1910)

NRS 449.220 Action to enjoin violations.

1. The Division may bring an action in the name of the State to enjoin any person, state or local government unit or agency thereof from operating or maintaining any facility within the meaning of NRS 449.029 to 449.2428, inclusive:

(a) Without first obtaining a license therefor; or

(b) After his or her license has been revoked or suspended by the Division.

2. It is sufficient in such action to allege that the defendant did, on a certain date and in a certain place, operate and maintain such a facility without a license.

[Part 6:336:1951]—(NRS A 1963, 961; 1971, 937; 1973, 1285; 2009, 1446; 2011, 359, 1067, 1360, 2255, 2398; 2015, 635; 2017, 337, 1573, 1911, 2309, 4170; 2019, 340, 1117, 1679, 2645; 2023, 1851, 3336)

NRS 449.240 Institution and conduct of prosecutions. The district attorney of the county in which the facility is located shall, upon application by the Division, institute and conduct the prosecution of any action for violation of any provisions of NRS 449.029 to 449.245, inclusive.

[Part 8:336:1951]—(NRS A 1963, 962; 1971, 937; 1973, 1286; 1975, 899; 2009, 1446; 2011, 359, 1360, 2256, 2399; 2017, 337, 2309; 2019, 341, 1117, 1340, 1403, 1922, 2156, 2599, 2645, 2923, 4039; 2021, 375; 2023, 573, 912, 1851, 3336, 3446)

REQUIREMENTS RELATING TO STAFFING

NRS 449.241 Definitions. As used in NRS 449.241 to 449.2428, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.2413 to 449.2418, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 2009, 2024; A 2013, 2150; 2017, 37, 4171)

NRS 449.2413 “Certified nursing assistant” defined. “Certified nursing assistant” means a person who has been certified by the State Board of Nursing pursuant to NRS 632.2852 to practice as a nursing assistant in this State.

(Added to NRS by 2013, 2143)

NRS 449.2414 “Health care facility” defined. “Health care facility” means:

1. A hospital;

2. An independent center for emergency medical care;

3. A psychiatric hospital; and

4. A surgical center for ambulatory patients.

(Added to NRS by 2009, 2024)

NRS 449.2416 “Licensed nurse” defined. “Licensed nurse” means a person licensed pursuant to chapter 632 of NRS to practice nursing, including, without limitation, a licensed practical nurse. The term does not include a certified nursing assistant or a medication aide - certified.

(Added to NRS by 2009, 2024; A 2011, 1341; 2013, 2150)

NRS 449.2417 “Practice of surgical technology” defined.

1. “Practice of surgical technology” means performing tasks in preparation for surgery and providing care in collaboration with a team of providers of health care and other persons to a patient before, during and after surgery. The term includes, without limitation:

(a) Working with a registered nurse to carry out a plan to care for the patient and prepare the operating room for surgery;

(b) Preparing and gathering sterile supplies, instruments and equipment necessary for a surgical procedure;

(d) In the operating room under the direction of an appropriate provider of health care:

(1) Ensuring that the area in which the surgery is conducted remains sterile;

(2) Anticipating and responding to the needs of the surgeon and other members of the team during surgery;

(3) Passing supplies, instruments and equipment to other members of the team;

(4) Sponging or suctioning the operative site of the patient;

(5) Preparing and cutting materials for sutures;

(6) Transferring and irrigating with fluids;

(7) Transferring drugs to other members of the team;

(8) Handling specimens;

(9) Holding retractors and other instruments and equipment;

(10) Applying electrocautery to clamps on blood vessels cut during surgery;

(11) Connecting drains and catheters to suction or drainage apparatus;

(12) Applying skin staples and dressings to closed wounds;

(13) Counting sponges, needles and other supplies and instruments; and

(14) Removing instruments after the completion of surgery.

2. The term does not include administering a drug to a patient.

(Added to NRS by 2017, 330)

NRS 449.24175 “Surgical technologist” defined. “Surgical technologist” means a person who is engaged in the practice of surgical technology at a health care facility.

(Added to NRS by 2017, 330)

NRS 449.2418 “Unit” defined. “Unit” has the meaning ascribed to it by regulation of the Division.

(Added to NRS by 2009, 2024; A 2019, 3679)

NRS 449.24185 Conditions under which health care facility may employ or allow person to engage in practice of surgical technology. Except as otherwise provided in this section and NRS 449.0301, 449.24195 and 449.2455:

1. A health care facility may not employ or otherwise allow a person to engage in the practice of surgical technology at the health care facility unless the person has:

(a) Successfully completed a program for surgical technologists that is accredited by a national accrediting organization and is certified as a Certified Surgical Technologist by the National Board of Surgical Technology and Surgical Assisting or a successor organization;

(b) Successfully completed a training program for surgical technologists administered by the United States Public Health Service, Army, Navy, Air Force, Marine Corps or Coast Guard; or

2. A health care facility may employ or otherwise allow a person who has successfully completed a program for surgical technologists that is accredited by a national accrediting organization but who is not certified as a Certified Surgical Technologist pursuant to paragraph (a) of subsection 1 to engage in the practice of surgical technology at the health care facility for 180 days after the date on which the person successfully completed the program.

3. A health care facility may employ a person who does not possess the qualifications prescribed by subsection 1 to engage in the practice of surgical technology at the health care facility if, after conducting a thorough and diligent search, the health care facility is unable to employ a sufficient number of surgical technologists who possess such qualifications. A health care facility may continue to employ such a person after the health care facility determines it is able to employ a sufficient number of surgical technologists who possess such qualifications.

(Added to NRS by 2017, 330; A 2023, 420)

NRS 449.2419 Duties of health care facility that employs or allows person to engage in practice of surgical technology. Except as otherwise provided in NRS 449.24195, a health care facility that employs or otherwise allows a person to engage in the practice of surgical technology at the health care facility shall:

1. Ensure that each such person, including, without limitation, a person who does not possess the qualifications prescribed by subsection 1 of NRS 449.24185, successfully completes not less than 15 hours annually of continuing education concerning the practice of surgical technology; and

2. Maintain records showing that the health care facility is in compliance with this section and NRS 449.24185, including, without limitation:

(a) Records of continuing education completed by surgical technologists;

(b) Records demonstrating that a surgical technologist employed by the health care facility possesses the qualifications prescribed by subsection 1 of NRS 449.24185; and

(c) If the health care facility employs a person who does not possess the qualifications prescribed by subsection 1 of NRS 449.24185 pursuant to subsection 3 of that section, records of the efforts of the health care facility to search for a sufficient number of surgical technologists who possess the qualifications prescribed by subsection 1 of that section before employing the person.

(Added to NRS by 2017, 331)

NRS 449.24195 Applicability of provisions concerning surgical technology. NRS 449.24185 and 449.2419 do not apply to a person who is licensed or certified pursuant to title 54 of NRS and performs an activity listed in NRS 449.2417 that is within the scope of such licensure or certification.

(Added to NRS by 2017, 331)

1. Except as otherwise provided in subsection 4, each hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall establish a staffing committee to develop a written policy as required pursuant to NRS 449.2423 and a documented staffing plan as required pursuant to NRS 449.2421. Each staffing committee established pursuant to this subsection must consist of:

(a) Not less than one-half of the total regular members of the staffing committee from the licensed nursing staff and certified nursing assistants who are providing direct patient care at the hospital. The members described in this paragraph must consist of:

(1) One member representing each unit of the hospital who is a licensed nurse who provides direct patient care on that unit, elected by the licensed nursing staff who provide direct patient care on the unit that the member will represent.

(2) One member representing each unit of the hospital who is a certified nursing assistant who provides direct patient care on that unit, elected by the certified nursing assistants who provide direct patient care on the unit that the member will represent.

(b) Not less than one-half of the total regular members of the staffing committee appointed by the administration of the hospital.

(c) One alternate member representing each unit of the hospital who is a licensed nurse or certified nursing assistant who provides direct patient care on that unit, elected by the licensed nursing staff and certified nursing assistants who provide direct patient care on the unit that the member represents.

2. Each time a new staffing committee is formed pursuant to subsection 1, the administration of the hospital shall hold an election to select the members described in paragraphs (a) and (c) of subsection 1. Each licensed nurse and certified staffing assistant who provides direct patient care at the hospital must be allowed at least 3 days to vote for:

(a) The regular member described in paragraph (a) of subsection 1 who will represent his or her unit and profession; and

(b) The alternate member described in paragraph (c) of subsection 1 who will represent his or her unit.

3. If a vacancy occurs in a position on a staffing committee described in paragraph (a) or (c) of subsection 1, a new regular or alternate member, as applicable, must be elected in the same manner as his or her predecessor.

4. If a staffing committee is established for a health care facility described in subsection 1 through collective bargaining with an employee organization representing the licensed nursing staff and certified nursing assistants of the health care facility:

(a) The health care facility is not required to form a staffing committee pursuant to that subsection; and

(b) The staffing committee established pursuant to the collective bargaining agreement shall be deemed to be the staffing committee established for the health care facility pursuant to subsection 1.

5. In developing the written policy and the staffing plan, the staffing committee shall consider, without limitation, the information received pursuant to paragraph (b) of subsection 5 of NRS 449.2423 regarding requests to be relieved of a work assignment, refusals of a work assignment and objections to a work assignment.

6. The staffing committee of a hospital shall meet at least quarterly.

7. Each hospital that is required to establish a staffing committee pursuant to this section shall prepare a written report concerning the establishment of the staffing committee, the activities and progress of the staffing committee and a determination of the efficacy of the staffing committee. The hospital shall submit the report on or before December 31 of each:

(a) Even-numbered year to the Director of the Legislative Counsel Bureau for transmission to the next regular session of the Legislature.

(b) Odd-numbered year to the Joint Interim Standing Committee on Health and Human Services.

(Added to NRS by 2009, 2024; A 2013, 2151; 2017, 4171; 2019, 3679)

1. As a condition of licensing, a health care facility located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall make available to the Division a written policy adopted pursuant to NRS 449.2423, a documented staffing plan and a written certification that the written policy and the documented staffing plan are adequate to meet the needs of the patients of the health care facility. If the health care facility is a hospital, the written policy and the documented staffing plan must:

(a) Be signed by each member of the staffing committee of the hospital established pursuant to NRS 449.242 to indicate that the member has received a copy of the written policy and the staffing plan and, if applicable, actively participated in the development of the written policy and the staffing plan; and

(b) Include a place where a member of the staffing committee may note any objections to the written policy or the staffing plan.

2. The documented staffing plan must include, without limitation:

(a) A detailed written plan setting forth:

(1) The number, skill mix and classification of licensed nurses required in each unit in the health care facility, which must take into account the experience of the clinical and nonclinical support staff with whom the licensed nurses collaborate, supervise or otherwise delegate assignments; and

(2) The number of certified nursing assistants required in each unit in the health care facility;

(b) A description of the types of patients who are treated in each unit, including, without limitation, the type of care required by the patients;

(d) A description of the size and geography of each unit;

(e) A description of any specialized equipment and technology available for each unit;

(f) Any foreseeable changes in the size or function of each unit; and

(g) Protocols for adequately staffing the health care facility:

(1) In the event of an emergency, including, without limitation, mass casualties and a significant change in the acuity or number of patients;

(2) If applicable, in circumstances when a significant number of patients are diverted from another facility; and

(3) If a licensed nurse or certified nursing assistant is absent or refuses a work assignment pursuant to NRS 449.2423.

3. A documented staffing plan must provide sufficient flexibility to allow for adjustments based upon changes in a unit of the health care facility.

4. The health care facility shall ensure that it is staffed in accordance with the documented staffing plan.

(Added to NRS by 2009, 2025; A 2013, 2151; 2017, 4172)

1. As a condition of licensure, a health care facility which is located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds must adopt and disseminate to each licensed nurse and certified nursing assistant employed by the health care facility a written policy that sets forth the circumstances under which a licensed nurse or certified nursing assistant may refuse or object to a work assignment.

2. The written policy concerning work assignments must, at a minimum, allow a licensed nurse or certified nursing assistant to:

(a) Refuse a work assignment for any reason for refusal set forth in paragraph (b) of subsection 1 of NRS 449.205; and

(b) File an objection to a work assignment if the work assignment violates any provision of NRS 449.241 to 449.2428, inclusive.

3. For the purposes of refusing a work assignment pursuant to paragraph (a) of subsection 2, the written policy concerning work assignments must contain:

(a) Reasonable requirements for prior notice to the supervisor of the licensed nurse or certified nursing assistant of the request by the licensed nurse or certified nursing assistant to be relieved of the work assignment, including, without limitation, the reasons supporting the request;

(b) Reasonable requirements which provide, if feasible, an opportunity for the supervisor to review a request by the licensed nurse or certified nursing assistant to be relieved of the work assignment, including any specific conditions supporting the request, and based upon that review:

(1) Relieve the licensed nurse or certified nursing assistant of the work assignment as requested; or

(2) Deny the request; and

(c) A process pursuant to which a licensed nurse or certified nursing assistant may exercise his or her right to refuse a work assignment if the supervisor does not approve the request to be relieved of the work assignment if:

(1) The supervisor failed to approve the request without proposing a remedy or, if a remedy is proposed, the proposed remedy would be inadequate or untimely;

(2) The process for filing a complaint with the Division or any other appropriate regulatory entity, including any investigation that would be required, would be untimely to address the concerns of the licensed nurse or certified nursing assistant in refusing a work assignment; and

(3) The licensed nurse or certified nursing assistant in good faith believes that the work assignment meets the conditions established in the written policy justifying refusal.

4. For the purposes of objecting to a work assignment pursuant to paragraph (b) of subsection 2, the written policy concerning work assignments must contain:

(a) A process for a licensed nurse or certified nursing assistant to file an objection with the health care facility, but still accept the work assignment despite the objection; and

(b) A requirement that the health care facility respond to the objection as soon as practicable, but not later than 45 days after receiving the objection.

5. The health care facility shall:

(a) Maintain records for at least 2 years of each request to be relieved of a work assignment, each refusal of a work assignment and each objection to a work assignment that is filed with the health care facility pursuant to the written policy adopted pursuant to this section;

(b) If the health care facility has established a staffing committee pursuant to NRS 449.242, provide to the staffing committee:

(1) The number of requests to be relieved of a work assignment and refusals of a work assignment made by a licensed nurse or a certified nursing assistant at the health care facility pursuant to this section;

(2) The number of objections to a work assignment filed by a licensed nurse or a certified nursing assistant at the health care facility pursuant to this section; and

(3) An explanation of how the health care facility addressed the requests, refusals and objections; and

(Added to NRS by 2013, 2143)

1. The Division shall adopt regulations establishing:

(a) A system for rating each health care facility located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds on the compliance by the facility with the provisions of this section and NRS 449.241 to 449.2428, inclusive, including, without limitation, the number of resolved and unresolved violations and the severity of those violations. The rating system must provide for the assignment of a star rating of not more than five stars and not less than one star to each such facility after:

(1) Each inspection conducted by the Division pursuant to NRS 449.132; and

(2) Each investigation conducted by the Division pursuant to NRS 449.0307 concerning a complaint that alleges a violation of the provisions of this section and NRS 449.241 to 449.2428, inclusive.

(b) Procedures by which a health care facility located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds may, not later than 30 days after an investigation or inspection, appeal a finding concerning a violation of the provisions of this section and NRS 449.241 to 449.2428, inclusive, or request a follow-up inspection.

2. A star rating assigned pursuant to subsection 1 becomes final:

(a) Thirty days after the investigation or inspection on which the star rating is based; or

(b) After the completion of any follow-up inspection or the final determination of any appeal pursuant to subsection 1,

Ê whichever is later.

3. Not later than 5 days after a star rating becomes final pursuant to subsection 2, the Division shall post on an Internet website maintained by the Division a report which must include:

(a) The final star rating assigned to the facility pursuant to subsection 1; and

(b) A report of each unresolved violation of an applicable statute or regulation and all proposed actions to correct the violation.

4. A health care facility located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall post the final star rating assigned to the facility pursuant to subsection 1 after the most recent investigation or inspection in a conspicuous place near each entrance to the facility that is regularly used by the public and, if the facility maintains an Internet website that is accessible to the public, on that Internet website.

(Added to NRS by 2017, 4164)

NRS 449.2428 Division required to ensure that certain health care facilities comply with provisions; regulations. For each health care facility which is located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds, the Division shall:

1. Ensure the general compliance of the health care facility with the provisions of NRS 449.241 to 449.2428, inclusive, including, without limitation, those provisions relating to documented staffing plans and written policies adopted pursuant to NRS 449.2423; and

2. Adopt such regulations as are necessary or appropriate to carry out the provisions of this section.

(Added to NRS by 2013, 2145; A 2017, 4173)

MISCELLANEOUS PROVISIONS

NRS 449.243 Itemized list of charges required; use of Uniform Billing and Claims Forms authorized; contracted rates; summary of charges. Every hospital licensed pursuant to the provisions of NRS 449.029 to 449.2428, inclusive:

1. May, except as otherwise provided in subsection 2, utilize the Uniform Billing and Claims Forms established by the American Hospital Association.

2. Shall, except as otherwise provided in this section, on its billings to patients, itemize, on a daily basis, all charges for services, and charges for equipment used and the supplies and medicines provided incident to the provision of those services with specificity and in language that is understandable to an ordinary lay person. This itemized list must be timely provided after the patient is discharged at no additional cost.

3. Except as otherwise provided in this subsection, if a patient is charged a rate, pursuant to a contract or other agreement, that is different than the billed charges, shall provide to the patient either:

(a) A copy of the billing prepared pursuant to subsection 2;

(b) A statement specifying the agreed rate for the services; or

Ê In any case, the hospital shall include on the billing or statement any copayment or deductible for which the patient is responsible. The hospital shall answer any questions regarding the bill.

4. If the hospital is paid by the insurer of a patient a rate that is based on the number of persons treated and not on the services actually rendered, shall, upon the discharge of the patient, advise the patient of the status of any copayment or deductible for which the patient is responsible.

5. Shall prepare a summary of charges for common services for patients admitted to the hospital and make it available to the public.

6. Shall provide to any patient upon request a copy of the billing prepared pursuant to subsection 2.

(Added to NRS by 1975, 897; A 1983, 649; 1985, 905; 1993, 2427; 1995, 1856)

NRS 449.245 Release of child from hospital; provision of authorization for release and other information to Division of Child and Family Services; disclosure of information; penalty.

1. No hospital licensed under the provisions of NRS 449.029 to 449.2428, inclusive, may release from the hospital or otherwise surrender physical custody of any child under 6 months of age, whose living parent or guardian is known to the hospital, to any person other than a parent, guardian or relative by blood or marriage of that child, without a written authorization signed by a living parent, who must be the person who gave birth to the child if unwed, or guardian specifying the particular person or agency to whom the child may be released and the permanent address of that person or agency.

2. Upon the release or other surrender of physical custody of the child, the hospital shall require from the person to whom the child is released such reasonable proof of identity as the hospital may deem necessary for compliance with the provisions of this section. The hospital shall furnish a true copy of the written authorization to the Division of Child and Family Services of the Department of Health and Human Services before the release or other surrender by it of physical custody of the child. The copy must be furnished to the Division immediately upon receipt by the hospital.

3. Any person to whom any such child is released who thereafter surrenders physical custody of that child to any other person or agency shall, upon demand by the Division of Child and Family Services, disclose to the Division the name and permanent address of the person or agency to whom physical custody of the child was delivered.

4. Except as otherwise provided in NRS 239.0115, all information received by the Division of Child and Family Services pursuant to the provisions of this section is confidential and must be protected from disclosure in the same manner that information is protected under NRS 432.035.

5. Compliance with the provisions of this section is not a substitute for compliance with NRS 127.220 to 127.310, inclusive, governing placements for adoption and permanent free care.

6. A violation of any provision of this section is a misdemeanor.

(Added to NRS by 1957, 251; A 1961, 739; 1963, 962; 1967, 1172; 1973, 1286, 1406; 1981, 721; 1993, 2724; 2007, 2109; 2021, 3442)

NRS 449.2455 Authority of hospital to enter into agreement with Armed Forces of United States for provision of medical care by certain persons acting under federal authority.

1. A hospital may enter into an agreement with the Armed Forces of the United States to authorize:

(a) A medical officer to provide medical care in the hospital if:

(1) The medical officer holds a valid license in good standing to provide such medical care in the District of Columbia or any state or territory of the United States;

(2) The medical care is provided as part of a training or educational program designed to further the employment of the medical officer; and

(3) The agreement complies with the provisions of 10 U.S.C. § 1094 and any regulations or guidelines adopted pursuant thereto.

(b) An unlicensed federal medical provider to provide care for which a license, certificate or registration is otherwise required pursuant to chapter 630, 631, 632, 633, 635, 639, 640, 652 or 653 of NRS at the hospital:

(1) In his or her official capacity and within the scope of practice authorized by the Federal Government; and

(2) As part of a training or educational program.

(c) A federal surgical technologist who does not meet the requirements of NRS 449.24185 to engage in the practice of surgical technology at the hospital:

(1) In his or her official capacity and within the scope of practice authorized by the Federal Government; and

(2) As part of a training or educational program.

2. As used in this section:

(a) “Federal surgical technologist” means a surgical technologist who engages in the practice of surgical technology pursuant to authority granted by the Federal Government.

(b) “Medical officer” includes any physician, nurse, dentist or other health care professional who is employed by the Armed Forces of the United States or a reserve component thereof.

(d) “Surgical technologist” has the meaning ascribed to it in NRS 449.24175.

(e) “Unlicensed federal medical provider” means a pharmaceutical technician who is not registered pursuant to chapter 639 of NRS and provides care pursuant to authority granted by the Federal Government or a person who does not hold a license or certificate issued pursuant to chapter 630, 631, 632, 633, 635, 640, 652 or 653 of NRS and provides care pursuant to such authority. The term:

(1) Includes, without limitation, a person who does not hold any license or certificate issued by a licensing authority in the District of Columbia or any state or territory of the United States.

(2) Does not include a health-care professional, as defined in 10 U.S.C. § 1094.

(Added to NRS by 2009, 818; A 2023, 421)

1. Before discharging an unmarried woman who has borne a child, a hospital or freestanding birthing center shall provide to the child’s parents:

(a) The opportunity to sign, in the hospital, a declaration for the voluntary acknowledgment of paternity developed pursuant to NRS 440.283;

(b) Written materials about establishing paternity;

(d) A written description of the rights and responsibilities of acknowledging paternity; and

(e) The opportunity to speak by telephone with personnel of the program for enforcement of child support who are trained to clarify information and answer questions about the establishment of paternity.

2. The Administrator of the Division of Welfare and Supportive Services of the Department of Health and Human Services shall adopt the regulations necessary to ensure that the services provided by a hospital or freestanding birthing center pursuant to this section are in compliance with the regulations adopted by the Secretary of Health and Human Services pursuant to 42 U.S.C. § 666(a)(5)(C).

(Added to NRS by 1995, 2426; A 1997, 2341; 2007, 1529; 2017, 793)

NRS 449.2465 Persons entitled to results of tests performed at laboratory regarding patient of rural hospital. The following persons are entitled to access the results of tests performed at a licensed laboratory regarding a patient of a rural hospital:

1. The patient;

2. The physician who ordered the tests; and

3. A provider of health care who is currently treating or providing assistance in the treatment of the patient.

(Added to NRS by 1995, 1600)

1. The Division may review the personnel files of a medical facility or facility for the dependent to determine that each nursing assistant or medication aide - certified employed by the facility has a current certificate.

2. The Division shall review the qualifications of instructors of nursing assistants or medication aides - certified for each program of which the Division is notified pursuant to NRS 632.127.

3. The Division may conduct the review of training programs for nursing assistants or medication aides - certified in facilities for long-term care.

4. The Division and any other state agency which regulates medical facilities and facilities for the dependent shall provide to the State Board of Nursing any information it discovers concerning:

(a) Programs and instructors for training nursing assistants or medication aides - certified which do not comply with the requirements established by the State Board of Nursing.

(b) The failure of a nursing assistant or medication aide - certified to perform consistently at a safe level.

(c) The results of any investigation of a facility if the investigation concerns a nursing assistant, medication aide - certified or instructor or training program for nursing assistants or medication aides - certified.

5. The State Board of Nursing shall investigate any report submitted pursuant to subsection 4 and may revoke approval of a program or instructor if the allegations of the report are true.

(Added to NRS by 1989, 2017; A 2011, 1341)

NRS 449.2475 Unlicensed insurer not allowed to make payment directly to person who received services in certain circumstances; limitation on civil and criminal liability.

1. An insurer that is not licensed in this State pursuant to title 57 of NRS and that is obligated to pay benefits for services provided to a person by a hospital or other provider of health care, or to reimburse a person for the costs of such services, shall not make the payment directly to the person if an itemized statement for the services is submitted to the insurer which clearly indicates that the right of the person to those benefits has been assigned to the hospital or other provider of health care.

2. The provisions of this section do not create grounds for civil or criminal liability.

(Added to NRS by 2007, 734)

NRS 449.2477 Requirements concerning dispute resolution clause in contract relating to provision of care by facility for long-term care.

1. If a facility for long-term care wishes to include as part of any contract relating to the provision of care a clause which specifies or restricts the means by which the parties to the contract are required to resolve any dispute, the clause must be included as an addendum to the contract and:

(a) Be printed in large font on a separate page with a separate signature line;

(b) Fully explain the effect of signing the addendum, including, without limitation, that any dispute must be resolved exclusively through the means authorized by the clause; and

2. As used in this section, “facility for long-term care” means:

(a) A residential facility for groups;

(b) A facility for intermediate care;

(d) A home for individual residential care; and

(e) Any unlicensed establishment that provides food, shelter, assistance and limited supervision to a resident.

(Added to NRS by 2017, 2533, 2838)

NRS 449.248 Additional services to be provided by agency to provide nursing in home. An agency to provide nursing in the home shall, in addition to skilled nursing, provide at least one of the following services:

1. Speech or occupational therapy;

2. Guidance regarding nutrition or vocations;

3. Physical therapy;

4. Pharmaceutical services; or

5. Other social or medical services.

(Added to NRS by 1979, 160; A 1985, 1742)

1. A facility for skilled nursing or a facility for intermediate care may return a prescription drug that is dispensed to a patient of the facility, but will not be used by that patient, to the dispensing pharmacy for the purpose of reissuing the drug to fill other prescriptions for patients in that facility or for the purpose of transferring the drug to a nonprofit pharmacy designated by the State Board of Pharmacy pursuant to NRS 639.2676 if:

(a) The drug is not a controlled substance;

(b) The drug is dispensed in a unit dose, in individually sealed doses or in a bottle sealed by the manufacturer of the drug;

(d) The usefulness of the drug has not expired;

(e) The packaging or bottle contains the expiration date of the usefulness of the drug; and

(f) The name of the patient for whom the drug was originally prescribed, the prescription number and any other identifying marks are obliterated from the packaging or bottle before the return of the drug.

2. A dispensing pharmacy to which a drug is returned pursuant to this section may:

(a) Reissue the drug to fill other prescriptions for patients in the same facility if the registered pharmacist of the pharmacy determines that the drug is suitable for that purpose in accordance with standards adopted by the State Board of Pharmacy pursuant to subsection 5; or

(b) Transfer the drug to a nonprofit pharmacy designated by the State Board of Pharmacy pursuant to NRS 639.2676.

3. No drug that is returned to a dispensing pharmacy pursuant to this section may be used to fill other prescriptions more than one time.

4. A facility for skilled nursing or facility for intermediate care shall adopt written procedures for returning drugs to a dispensing pharmacy pursuant to this section. The procedures must:

(a) Provide appropriate safeguards for ensuring that the drugs are not compromised or illegally diverted during their return.

(b) Require the maintenance and retention of such records relating to the return of drugs to dispensing pharmacies as are required by the State Board of Pharmacy.

5. The State Board of Pharmacy shall adopt such regulations as are necessary to carry out the provisions of this section, including, without limitation, requirements for:

(a) Returning and reissuing such drugs pursuant to the provisions of this section.

(b) Transferring drugs to a nonprofit pharmacy pursuant to the provisions of this section and NRS 639.2676.

(Added to NRS by 2003, 1372; A 2009, 1087)

NRS 449.2486 Facility for care of adults during the day to maintain and provide certain information; form in which information to be provided.

1. A facility for the care of adults during the day shall maintain a copy of:

(a) The license issued to the facility pursuant to NRS 449.029 to 449.2428, inclusive;

(b) Any summaries of complaints provided to the facility pursuant to subsection 3 of NRS 449.160;

(d) The report of any disciplinary action taken against the facility pursuant to NRS 449.160 or 449.163.

2. The information maintained pursuant to subsection 1 must be provided in the form prescribed pursuant to subsection 3:

(a) To each patient or the patient’s legal representative, at or before the time of admission.

(b) To a prospective patient or the prospective patient’s legal representative, upon request, who is considering admission of the patient to the facility.

(c) In the case of disciplinary action taken pursuant to NRS 449.160 or 449.163, to all patients admitted to the facility and their legal representatives. Notice of disciplinary action must be provided to the legal representatives of all patients admitted to the facility within 3 working days after receipt by the facility.

3. The Division shall develop a standard form for reporting the information required to be provided pursuant to subsection 2. The information reported on the form must include all required information for the 12-month period ending on the last day of the month immediately preceding the month in which the information is provided.

4. The Division shall inform persons seeking information concerning facilities for the care of adults during the day of their right to information pursuant to this section.

(Added to NRS by 2007, 270)

NRS 449.2487 Notice to be provided by certain facilities which offer independent living.

1. A facility for the dependent, a medical facility or an entity affiliated with such a facility which offers housing to persons that does not include the provision of care or services which require licensure pursuant to this chapter shall conspicuously post in the facility and shall include in any contracts of sale or agreements for occupancy a notice that includes the following information:

(a) That the specific area of the facility is intended for independent living and does not directly provide or coordinate the oversight of services to meet the scheduled and unscheduled needs of its residents, including, without limitation, the provision of personal care, supportive services and health-related services.

(b) The other levels of care that are available to persons who require personal care, supportive services or health-related services, including, without limitation, residential facilities for groups, facilities for intermediate care and facilities for skilled nursing. The notice must describe the facilities and levels of care in language that is easy to understand.

(c) A statement that encourages residents to reassess on a regular basis the type of housing and care that is most appropriate for them.

2. The Aging and Disability Services Division of the Department of Health and Human Services shall develop the language for the notice required by subsection 1 in consultation with nationally recognized advocacy groups for older persons and housing organizations.

3. For the purposes of this section, an entity is affiliated with a facility described in subsection 1 if:

(a) It is under common or shared ownership;

(b) It is under common or shared management; or

(Added to NRS by 2007, 2466; A 2011, 359)

1. The Department of Health and Human Services shall develop a brochure and website to assist persons who are 55 years of age or older in determining the appropriate level of care and type of housing that they require to meet their individual needs. The brochure and website must include, without limitation:

(a) The various types of housing and levels of care that are available to persons who are 55 years of age or older, including, without limitation, residential facilities for groups, facilities for intermediate care and facilities for skilled nursing, distinguishing the varying degree of services that are offered by the different types of facilities;

(b) Whether individual facilities accept payment through Medicaid or Medicare for the level of care and type of housing that the facilities provide;

(c) The manner in which a person may obtain information concerning whether the facility has ever been found to have violated the provisions of this chapter; and

(d) Such other information as the Department deems to be beneficial to persons who are 55 years of age or older in determining the appropriate level of care and type of housing that they require to meet their individual needs.

2. As used in this section:

(a) “Medicaid” has the meaning ascribed to it in NRS 439B.120.

(b) “Medicare” has the meaning ascribed to it in NRS 439B.130.

(Added to NRS by 2007, 2467)

FACILITIES FOR REFRACTIVE SURGERY

NRS 449.2489 Definitions. As used in NRS 449.2489 to 449.24898, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.24891 to 449.24894, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 2009, 450)

NRS 449.24891 “Ophthalmologist” defined. “Ophthalmologist” means a physician who is qualified to perform laser surgery or intense pulsed light therapy on the globe of the eye pursuant to NRS 630.371 or 633.693.

(Added to NRS by 2009, 450)

NRS 449.24892 “Postoperative care” defined. “Postoperative care” means assessing, monitoring or treating a patient while the patient is recovering or healing from a surgical treatment for a refractive error of the eye.

(Added to NRS by 2009, 451)

NRS 449.24893 “Preoperative care” defined. “Preoperative care” means assessing or treating a patient in preparation for a surgical treatment for a refractive error of the eye.

(Added to NRS by 2009, 451)

NRS 449.24894 “Surgical treatment for a refractive error of the eye” defined. “Surgical treatment for a refractive error of the eye” means the surgical treatment of a patient with a refractive error of the eye by:

1. Photorefractive keratectomy;

2. Laser in situ keratomileusis;

3. Conductive keratoplasty;

4. Implantation of an intraocular lens; or

5. Any other available technology, technique or procedure which surgically treats refractive errors of the eye and which has been approved by the United States Food and Drug Administration.

(Added to NRS by 2009, 451)

NRS 449.24895 Certain persons not required to obtain license to operate and maintain facility; filing of affidavit with Division required. A person is not required to obtain a license to operate and maintain a facility for refractive surgery pursuant to the provisions of this chapter if the person:

1. Is an ophthalmologist;

2. Provides surgical procedures to patients at the facility in addition to preoperative care, postoperative care and surgical treatments for refractive errors of the eye; and

3. Files with the Division an affidavit attesting that the person provides surgical procedures at the facility in addition to preoperative care, postoperative care and surgical treatments for refractive errors of the eye.

(Added to NRS by 2009, 451)

NRS 449.24896 Surgical treatments at facility must be performed by licensed ophthalmologist; availability of ophthalmologist. A facility for refractive surgery shall ensure that:

1. All surgical treatments for refractive errors of the eye performed at the facility are performed only by an ophthalmologist.

2. The ophthalmologist who performs a surgical treatment for refractive errors of the eye at the facility:

(a) Is available in person for postoperative care if the medical needs of a patient necessitate the services of an ophthalmologist; or

(b) Enters into an agreement with another ophthalmologist to be available in person for postoperative care if the medical needs of the patient necessitate the services of an ophthalmologist.

(Added to NRS by 2009, 451)

NRS 449.24898 Collaboration between ophthalmologist and optometrist authorized pursuant to NRS 636.374. The provisions of NRS 449.2489 to 449.24898, inclusive, do not prohibit an ophthalmologist from collaborating with an optometrist to provide care to a patient if the collaboration complies with the requirements of NRS 636.374.

(Added to NRS by 2009, 452)

NEVADA HEALTH FACILITIES ASSISTANCE ACT

NRS 449.250 Short title. NRS 449.250 to 449.430, inclusive, may be cited as the Nevada Health Facilities Assistance Act.

[1:219:1949; 1943 NCL § 5285.01]—(NRS A 1965, 983; 2011, 3575)

NRS 449.260 Definitions. As used in NRS 449.250 to 449.430, inclusive:

1. “Community mental health center” means a facility providing services for the prevention or diagnosis of mental illness, or care and treatment of patients with mental illness, or rehabilitation of such persons, which services are provided principally for persons residing in a particular community in or near which the facility is situated.

2. “Construction” includes the construction of new buildings, modernization, expansion, remodeling and alteration of existing buildings, and initial equipment of such buildings, including medical transportation facilities, and includes architects’ fees, but excludes the cost of off-site improvements and, except with respect to public health centers, the cost of the acquisition of the land.

3. “Facility for persons with intellectual disabilities” means a facility specially designed for the diagnosis, treatment, education, training or custodial care of persons with intellectual disabilities, including facilities for training specialists and sheltered workshops for persons with intellectual disabilities, but only if such workshops are part of facilities which provide or will provide comprehensive services for persons with intellectual disabilities.

4. “Federal Act” means 42 U.S.C. §§ 291 to 291o-l, inclusive, and 300k to 300t, inclusive, and any other federal law providing for or applicable to the provision of assistance for health facilities.

5. “Federal agency” means the federal department, agency or official designated by law, regulation or delegation of authority to administer the Federal Act.

6. “Health facility” includes a public health center, hospital, facility for hospice care, facility for persons with intellectual disabilities, community mental health center, and other facility to provide diagnosis, treatment, care, rehabilitation, training or related services to persons with physical or mental impairments, including diagnostic or diagnostic and treatment centers, rehabilitation facilities and nursing homes, as those terms are defined in the Federal Act, and such other facilities for which federal aid may be authorized under the Federal Act, but, except for facilities for persons with intellectual disabilities, does not include any facility furnishing primarily domiciliary care.

7. “Nonprofit health facility” means any health facility owned and operated by a corporation or association, no part of the net earnings of which inures or may lawfully inure to the benefit of any private shareholder or natural person.

8. “Public health center” means a publicly owned facility for the provision of public health services, including related facilities such as laboratories, clinics and administrative offices operated in connection with public health centers.

9. “State Department” means the Department of Health and Human Services, acting through its appropriate divisions.

[2:219:1949; A 1956, 47]—(NRS A 1963, 962; 1965, 983; 1967, 1173; 1973, 1406; 1975, 909; 1977, 258; 1979, 1113; 1985, 1743; 1989, 1036; 1999, 249; 2011, 3575; 2013, 697)

NRS 449.270 State Department to constitute sole agency of State for certain purposes. The State Department shall constitute the sole agency of the State for the purpose of:

1. Inventorying existing health facilities, surveying the need for construction of health facilities, and developing programs of health facilities construction as provided in NRS 449.250 to 449.430, inclusive.

2. Developing and administering state plans for the construction of public and other nonprofit health facilities as provided in NRS 449.250 to 449.430, inclusive.

3. Developing and administering any other plan or program providing assistance to health facilities for which funds may be available to this state under the Federal Act.

[3:219:1949; 1943 NCL § 5285.03]—(NRS A 1965, 985)

NRS 449.280 Duties of State Department. In carrying out the purposes of NRS 449.250 to 449.430, inclusive, the State Department is authorized and directed:

1. To require such reports, make such inspections and investigations, and prescribe such regulations as it deems necessary.

2. To provide such methods of administration, appoint all necessary officers and other personnel and take such other action as may be necessary to comply with the requirements of NRS 449.250 to 449.430, inclusive, the Federal Act and the regulations thereunder.

3. To procure in its discretion the temporary or intermittent services of experts or consultants, by contract, when such services are to be performed on a part-time or fee-for-service basis and do not involve the performance of administrative duties.

4. To the extent that it considers desirable to effectuate the purposes of NRS 449.250 to 449.430, inclusive, to enter into agreements for the utilization of the facilities and services of other departments, agencies and institutions, public or private.

5. To accept on behalf of the State and to deposit with the State Treasurer in appropriate accounts in the Department of Health and Human Services’ Gift Fund any grant, gift or contribution made to assist in meeting the cost of carrying out the purposes of NRS 449.250 to 449.430, inclusive, and to expend the same for such purposes.

6. To do all other things on behalf of the State necessary or advisable to obtain the maximum benefits available under the Federal Act.

7. All claims must be approved by the Health Officer before they are paid.

[4:219:1949; 1943 NCL § 5285.04]—(NRS A 1965, 985; 1969, 945; 1981, 79)

NRS 449.300 Inventory of existing health facilities; development of program for construction of facilities. The State Department is authorized and directed to inventory existing health facilities, including public, nonprofit, and proprietary health facilities, to survey the need for construction of health facilities, and, on the basis of such inventory and survey, to develop programs for the construction of such public and other nonprofit health facilities as will, in conjunction with existing facilities, afford the necessary physical facilities for furnishing adequate health facility services to all the people of the State.

[7:219:1949; 1943 NCL § 5285.07]—(NRS A 1965, 986)

NRS 449.310 Requirements of program for construction of health facilities. The construction programs must provide, in accordance with NRS 449.250 to 449.430, inclusive, and the regulations thereunder, for adequate health facilities for the people residing in this State, and, insofar as possible, must provide for their distribution throughout the State in such manner as to make the services of all types of health facilities reasonably accessible to all persons in the State.

[9:219:1949; 1943 NCL § 5285.09]—(NRS A 1965, 986; 1981, 1901)

NRS 449.320 Application for federal money; deposit of money.

1. The State Department may apply to the federal agency for federal money to assist in carrying out the surveys, planning and construction activities provided for in NRS 449.250 to 449.430, inclusive.

2. The money must be deposited in the State Treasury and must be available to the State Department for expenditure for carrying out the purposes of NRS 449.250 to 449.430, inclusive.

[8:219:1949; 1943 NCL § 5285.08]—(NRS A 1965, 987; 1981, 1901)

NRS 449.340 State Department to prescribe minimum standards; standards to supersede local ordinances and regulations; penalty.

1. The State Department may, by regulation, establish standards for the maintenance and operation of health facilities, which supersede all local ordinances and regulations inconsistent therewith.

2. A copy of the regulations, giving the date that they take effect, must be issued in pamphlet form.

3. Any health facility that applies for and accepts federal aid for construction under a state plan does so on the condition that the health facility qualify under the minimum standards for maintenance and operation adopted and enforced by the State Department.

4. Any person, partnership, association or corporation establishing, conducting, managing or operating any health facility within the meaning of NRS 449.250 to 449.430, inclusive, who violates any of the provisions of this section or regulations lawfully adopted thereunder is guilty of a misdemeanor.

[11:219:1949; 1943 NCL § 5285.11] + [12:219:1949; 1943 NCL § 5285.12]—(NRS A 1963, 963; 1965, 987; 1971, 937; 1985, 369)

NRS 449.345 Restriction on adoption of regulations concerning construction, maintenance, operation or safety of building, structure or other property. Before the State Department may adopt any regulation concerning the construction, maintenance, operation or safety of a building, structure or other property in this State, the State Department shall consult with the Deputy Administrator of the Public Works - Compliance and Code Enforcement Section for the purposes of subsection 9 of NRS 341.100.

(Added to NRS by 2011, 3574; A 2013, 397)

NRS 449.360 Application for construction of health facility: Filing; compliance with federal and state requirements.

1. Applications for health facility construction projects for which federal funds are required must be submitted to the appropriate health systems agency and the State Department. They may be submitted by the State or any political subdivision thereof or by any public or nonprofit agency authorized to construct and operate a health facility.

2. Each application for a construction project must conform to federal and state requirements and must be submitted in the manner and form prescribed by the State Department.

[14:219:1949; 1943 NCL § 5285.14]—(NRS A 1965, 988; 1979, 969)

NRS 449.370 Application for construction of health facility: Notice and hearing; approval and forwarding.

1. The State Department shall afford to every applicant for assistance for a construction project an opportunity for a fair hearing before the State Department upon 10 days’ written notice to the applicant.

2. If the State Department, after affording reasonable opportunity for development and presentation of applications in the order of relative need, finds that an application is in conformity with the state plan, the State Department shall approve the application and shall recommend and forward it to the federal agency.

3. The State Department shall consider and forward applications in the order of relative need set forth in the state plan.

[15:219:1949; 1943 NCL § 5285.15]—(NRS A 1965, 988; 1981, 856; 1985, 1362)

NRS 449.380 Inspection of construction of health facility; certification by State Department. From time to time, the State Department shall inspect each construction project approved by the federal agency and, if the inspection so warrants, the State Department shall certify to the federal agency that work has been performed upon the project, or that purchases have been made, in accordance with the approved plans and specifications, and that payment of an installment of federal funds is due to the applicant.

[16:219:1949; 1943 NCL § 5285.16]—(NRS A 1965, 988)

NRS 449.390 Authority to receive and distribute federal money; Health Facilities Assistance Fund; deposits, use and controls.

1. The State Department is hereby authorized to receive federal funds in behalf of, and transmit them to, applicants.

2. There is hereby established a nonreverting trust fund designated as the Health Facilities Assistance Fund. Money received from the Federal Government for a construction project approved by the federal agency shall be transmitted to the State Treasurer to be deposited in the State Treasury to the credit of the Health Facilities Assistance Fund, and shall be used solely for payments due applicants for work performed, purchases made or other approved expenditures in carrying out approved projects or plans, except that any moneys in such Fund which become available under the Federal Act and regulations for expenditure in administering an approved state plan may be expended for that purpose.

3. The State Department shall establish and maintain such accounts and fiscal controls of moneys deposited in and disbursed from the Health Facilities Assistance Fund as may be required by the Federal Act and regulations promulgated thereunder.

[17:219:1949; 1943 NCL § 5285.17]—(NRS A 1965, 988; 1975, 259)

NRS 449.400 State Public Health Facilities Construction Assistance Fund: Creation; administration.

1. In order to provide state assistance for construction projects for publicly owned hospitals, hospitals for the chronically ill and impaired, facilities for persons with intellectual disabilities, community mental health facilities, diagnostic or diagnostic and treatment centers, rehabilitation facilities, nursing homes and other facilities financed in part by federal funds in accordance with NRS 449.250 to 449.430, inclusive, and to promote maximum utilization of federal funds available for such projects, there is hereby created in the State Treasury a nonreverting trust fund to be known as the State Public Health Facilities Construction Assistance Fund. Money for the Fund may be provided from time to time by legislative appropriation.

2. The State Public Health Facilities Construction Assistance Fund must be administered by the State Department in accordance with the purposes and provisions of NRS 449.250 to 449.430, inclusive.

[17.1:219:1949; added 1956, 47]—(NRS A 1965, 989; 1985, 1744; 2013, 698; 2019, 2645)

NRS 449.410 State assistance for construction of certain projects; eligibility of project for assistance.

1. Money in the State Public Health Facilities Construction Assistance Fund must be used to supplement money from the Federal Government and money provided by the sponsor of a project for approved projects for the construction of publicly owned hospitals, hospitals for the chronically ill or impaired, facilities for persons with intellectual disabilities, community mental health facilities, diagnostic or diagnostic and treatment centers, rehabilitation facilities, nursing homes and other facilities financed in part by federal funds pursuant to NRS 449.250 to 449.430, inclusive, and for no other purpose or purposes.

2. Applications for state assistance for construction projects must be submitted to the State Department for consideration in the manner prescribed in NRS 449.250 to 449.430, inclusive, for applications for federal assistance.

3. No project is entitled to receive state assistance unless it is entitled to receive federal assistance.

[17.2:219:1949; added 1956, 47]—(NRS A 1965, 989; 1985, 1744; 2013, 698; 2019, 2645)

NRS 449.420 Amount of state assistance: Allocations; payments. Money in the State Public Health Facilities Construction Assistance Fund must be allocated and paid to construction projects on the basis of relative need in accordance with the need identified in the state health plan and in accordance with a ratio between state money and federal money determined by the State Department. In no event may the amount of state assistance made available or paid out for a project exceed the amount supplied by the sponsor of the project.

[17.3:219:1949; added 1956, 47]—(NRS A 1965, 989; 1981, 856, 1901)

NRS 449.430 Money from State Public Health Facilities Construction Assistance Fund to be paid in installments. Moneys in the State Public Health Facilities Construction Assistance Fund allocated to a particular approved project shall be paid out in installments at the same times and in the same manner as installments of federal funds are paid out from the Health Facilities Assistance Fund pursuant to NRS 449.390.

[17.4:219:1949; added 1956, 47]—(NRS A 1965, 990)

INTERMEDIARY SERVICE ORGANIZATIONS

General Provisions

NRS 449.4304 “Intermediary service organization” defined. As used in NRS 449.4304 to 449.4339, inclusive, unless the context otherwise requires, “intermediary service organization” means a nongovernmental entity that provides services authorized pursuant to NRS 449.4308 for a person with a disability or other responsible person.

(Added to NRS by 2013, 126; A 2017, 2309; 2019, 2923, 4346)

NRS 449.4308 Authority to provide services.

1. An intermediary service organization that is certified pursuant to NRS 449.4304 to 449.4339, inclusive, may provide services for a person with a disability or other responsible person relating to personal assistance received by the person with a disability. The services that may be provided by an intermediary service organization include, without limitation:

(a) Obtaining a criminal background check of a personal assistant selected by the person with a disability or other responsible person to provide nonmedical services and any medical services authorized pursuant to NRS 629.091;

(b) Providing payroll services to pay the personal assistant and determine any tax liability;

(d) Providing any other services relating to the employment of a personal assistant and any other financial assistance relating to the personal assistance for the person with a disability.

2. As used in this section:

(a) “Other responsible person” means:

(1) A parent or guardian of, or any other person legally responsible for, a person with a disability who is under the age of 18 years; or

(2) A parent, spouse, guardian or adult child of a person with a disability who suffers from a cognitive impairment.

(b) “Personal assistance” means the provision of any goods or services to help a person with a disability maintain his or her independence, personal hygiene and safety, including, without limitation, the provision of services by a personal assistant.

(c) “Personal assistant” means a person who, for compensation and under the direction of a person with a disability or other responsible person, performs services for a person with a disability to help the person maintain his or her independence, personal hygiene and safety.

(Added to NRS by 2013, 126)

NRS 449.4309 Board to adopt regulations authorizing employee of intermediary service organization to perform certain tasks.

1. The Board shall adopt regulations authorizing an employee of an intermediary service organization, with the consent of the person receiving services, to:

(a) Check, record and report the temperature, blood pressure, apical or radial pulse, respiration or oxygen saturation of a person receiving services from the organization;

(b) Using an auto-injection device approved by the Food and Drug Administration for use in the home, administer to a person receiving services from the organization insulin furnished by a registered pharmacist as directed by a physician or assist such a person with the self-administration of such insulin; and

(c) Using a device for monitoring blood glucose approved by the Food and Drug Administration for use in the home, perform a blood glucose test on a person receiving services from the organization or assist such a person to perform a blood glucose test on himself or herself.

2. The regulations adopted pursuant to this section:

(b) Must prohibit the use of a device for monitoring blood glucose on more than one person; and

(Added to NRS by 2017, 2304)

Certification

NRS 449.431 Certificate required; exception; penalty.

1. Except as otherwise provided in subsection 2, a person shall not operate or maintain in this State an intermediary service organization without first obtaining a certificate to operate an intermediary service organization as provided in NRS 449.4304 to 449.4339, inclusive.

2. A person who is licensed to operate an agency to provide personal care services in the home pursuant to this chapter is not required to obtain a certificate to operate an intermediary service organization as described in this section.

3. A person who violates the provisions of this section is guilty of a misdemeanor.

(Added to NRS by 2013, 126; A 2019, 2923, 4346)

NRS 449.4311 Application for certificate: Contents. Any person wishing to obtain a certificate to operate an intermediary service organization pursuant to the provisions of NRS 449.4304 to 449.4339, inclusive, must file with the Division an application on a form prescribed, prepared and furnished by the Division, containing:

1. The name of the applicant and, if a natural person, whether the applicant has attained the age of 21 years.

2. The location of the intermediary service organization.

3. The name of the person in charge of the intermediary service organization.

4. Such other information as may be required by the Division for the proper administration and enforcement of NRS 449.4304 to 449.4339, inclusive.

5. Evidence satisfactory to the Division that the applicant is of reputable and responsible character. If the applicant is a firm, association, organization, partnership, business trust, corporation or company, similar evidence must be submitted as to the members thereof, and the person in charge of the intermediary service organization for which application is made.

6. Evidence satisfactory to the Division of the ability of the applicant to comply with the provisions of NRS 449.4304 to 449.4339, inclusive, and the standards and regulations adopted by the Board.

(Added to NRS by 2013, 127)

1. An applicant for the issuance or renewal of a certificate to operate an intermediary service organization must submit to the Division the statement prescribed by the Division of Welfare and Supportive Services of the Department pursuant to NRS 425.520. The statement must be completed and signed by the applicant.

2. The Division shall include the statement required pursuant to subsection 1 in:

(a) The application or any other forms that must be submitted for the issuance or renewal of the certificate; or

(b) A separate form prescribed by the Division.

3. A certificate as an intermediary service organization may not be issued or renewed by the Division if the applicant:

(a) Fails to submit the statement required pursuant to subsection 1; or

(b) Indicates on the statement submitted pursuant to subsection 1 that the applicant is subject to a court order for the support of a child and is not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order.

4. If an applicant indicates on the statement submitted pursuant to subsection 1 that the applicant is subject to a court order for the support of a child and is not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order, the Division shall advise the applicant to contact the district attorney or other public agency enforcing the order to determine the actions that the applicant may take to satisfy the arrearage.

(Added to NRS by 2013, 127)

NRS 449.4314 Application for certificate: Fee. Each application for a certificate to operate an intermediary service organization must be accompanied by such fee as may be determined by regulation of the Board. The Board may, by regulation, allow or require payment of a fee for a certificate in installments and may fix the amount of each payment and the date on which the payment is due.

(Added to NRS by 2013, 128)

1. The Division shall not deny the application of a person for a certificate to operate an intermediary service organization pursuant to NRS 449.4311 based solely on his or her immigration status.

2. Notwithstanding the provisions of NRS 449.4312, an applicant for a certificate to operate an intermediary service organization who does not have a social security number must provide an alternative personally identifying number, including, without limitation, his or her individual taxpayer identification number, when completing an application for a certificate to operate an intermediary service organization.

3. The Division shall not disclose to any person who is not employed by the Division the social security number or alternative personally identifying number, including, without limitation, an individual taxpayer identification number, of an applicant for a license for any purpose except:

(a) Tax purposes;

(b) Licensing purposes; and

4. A social security number or alternative personally identifying number, including, without limitation, an individual taxpayer identification number, provided to the Division is confidential and is not a public record for the purposes of chapter 239 of NRS.

(Added to NRS by 2019, 4346)

1. The Division shall develop and implement a process by which a person with a criminal history may petition the Division to review the criminal history of the person to determine if the person’s criminal history will disqualify the person from obtaining a certificate to operate an intermediary service organization pursuant to NRS 449.431.

2. Not later than 90 days after a petition is submitted to the Division pursuant to subsection 1, the Division shall inform the person of the determination of the Division of whether the person’s criminal history will disqualify the person from obtaining a certificate. The Division is not bound by its determination of disqualification or qualification and may rescind such a determination at any time.

4. A person with a criminal history may petition the Division at any time, including, without limitation, before obtaining any education or paying any fee required to obtain a certificate from the Division.

5. A person may submit a new petition to the Division not earlier than 2 years after the final determination of the initial petition submitted to the Division.

7. The Division may post on its Internet website:

(a) The requirements to obtain a certificate from the Division; and

(b) A list of crimes, if any, that would disqualify a person from obtaining a certificate from the Division.

(a) The Central Repository for Nevada Records of Criminal History; and

(b) The Federal Bureau of Investigation.

9. A person who petitions the Division for a determination pursuant to subsection 1 shall not submit false or misleading information to the Division.

(a) The number of petitions submitted to the Division pursuant to subsection 1;

(b) The number of determinations of disqualification made by the Division pursuant to subsection 1;

(d) Any other information that is requested by the Director or which the Division determines would be helpful.

11. The Director shall transmit a compilation of the information received pursuant to subsection 10 to the Legislative Commission quarterly, unless otherwise directed by the Commission.

(Added to NRS by 2019, 2915)

NRS 449.4317 Issuance of certificate; nontransferability.

1. The Division shall issue the certificate to operate an intermediary service organization to the applicant if, after investigation, the Division finds that the:

(a) Applicant is in full compliance with the provisions of NRS 449.4304 to 449.4339, inclusive; and

(b) Applicant is in substantial compliance with the standards and regulations adopted by the Board.

2. A certificate applies only to the person to whom it is issued and is not transferable.

(Added to NRS by 2013, 128)

NRS 449.4318 Form and contents of certificate. Each certificate to operate an intermediary service organization issued by the Division pursuant to NRS 449.4304 to 449.4339, inclusive, must be in the form prescribed by the Division and must contain:

1. The name of the person or persons authorized to operate the intermediary service organization;

2. The location of the intermediary service organization; and

3. The services offered by the intermediary service organization.

(Added to NRS by 2013, 128)

NRS 449.4319 Expiration and renewal of certificate.

1. Each certificate to operate an intermediary service organization issued pursuant to NRS 449.4304 to 449.4339, inclusive, expires on December 31 following its issuance and is renewable for 1 year upon reapplication and payment of all fees required pursuant to NRS 449.4314 unless the Division finds, after an investigation, that the intermediary service organization has not satisfactorily complied with the provisions of NRS 449.4304 to 449.4339, inclusive, or the standards and regulations adopted by the Board.

2. Each reapplication for an intermediary service organization must include, without limitation, a statement that the organization is in compliance with the provisions of NRS 449.4329 to 449.4332, inclusive.

(Added to NRS by 2013, 128)

NRS 449.432 Application for renewal of certificate: Information concerning state business license required; conditions which require denial.

1. In addition to any other requirements set forth in NRS 449.4304 to 449.4339, inclusive, an applicant for the renewal of a certificate as an intermediary service organization must indicate in the application submitted to the Division whether the applicant has a state business license. If the applicant has a state business license, the applicant must include in the application the business identification number assigned by the Secretary of State upon compliance with the provisions of chapter 76 of NRS.

2. A certificate as an intermediary service organization may not be renewed by the Division if:

(a) The applicant fails to submit the information required by subsection 1; or

(b) The State Controller has informed the Division pursuant to subsection 5 of NRS 353C.1965 that the applicant owes a debt to an agency that has been assigned to the State Controller for collection and the applicant has not:

(1) Satisfied the debt;

(2) Entered into an agreement for the payment of the debt pursuant to NRS 353C.130; or

(3) Demonstrated that the debt is not valid.

3. As used in this section:

(a) “Agency” has the meaning ascribed to it in NRS 353C.020.

(b) “Debt” has the meaning ascribed to it in NRS 353C.040.

(Added to NRS by 2013, 2730)

NRS 449.4321 Grounds for denial, suspension or revocation of certificate. The Division may deny an application for a certificate to operate an intermediary service organization or may suspend or revoke any certificate issued under the provisions of NRS 449.4304 to 449.4339, inclusive, upon any of the following grounds:

1. Violation by the applicant or the holder of a certificate of any of the provisions of NRS 449.4304 to 449.4339, inclusive, or of any other law of this State or of the standards, rules and regulations adopted thereunder.

2. Aiding, abetting or permitting the commission of any illegal act.

3. Conduct inimical to the public health, morals, welfare and safety of the people of the State of Nevada in the operation of an intermediary service organization.

4. Conduct or practice detrimental to the health or safety of a person under contract with or employees of the intermediary service organization.

(Added to NRS by 2013, 128; A 2017, 2310; 2019, 2923, 4347)

1. If the Division receives a copy of a court order issued pursuant to NRS 425.540 that provides for the suspension of all professional, occupational and recreational licenses, certificates and permits issued to a person who is the holder of a certificate to operate an intermediary service organization, the Division shall deem the certificate issued to that person to be suspended at the end of the 30th day after the date on which the court order was issued unless the Division receives a letter issued to the holder of the certificate by the district attorney or other public agency pursuant to NRS 425.550 stating that the holder of the certificate has complied with the subpoena or warrant or has satisfied the arrearage pursuant to NRS 425.560.

2. The Division shall reinstate a certificate to operate an intermediary service organization that has been suspended by a district court pursuant to NRS 425.540 if the Division receives a letter issued by the district attorney or other public agency pursuant to NRS 425.550 to the person whose certificate was suspended stating that the person whose certificate was suspended has complied with the subpoena or warrant or has satisfied the arrearage pursuant to NRS 425.560.

(Added to NRS by 2013, 128)

NRS 449.4324 Provisional certificate.

1. The Division may cancel a certificate to operate an intermediary service organization and issue a provisional certificate, effective for a period determined by the Division, to the intermediary service organization if the intermediary service organization:

(a) Is in operation at the time of the adoption of standards and regulations pursuant to the provisions of NRS 449.4304 to 449.4339, inclusive, and the Division determines that the intermediary service organization requires a reasonable time under the particular circumstances within which to comply with the standards and regulations; or

(b) Has failed to comply with the standards or regulations and the Division determines that the intermediary service organization is in the process of making the necessary changes or has agreed to make the changes within a reasonable time.

2. The provisions of subsection 1 do not require the issuance of a certificate or prevent the Division from refusing to renew or from revoking or suspending any certificate if the Division deems such action necessary for the health and safety of a person for whom the intermediary service organization provides services.

(Added to NRS by 2013, 129)

NRS 449.4325 Deposit of money received; expenses of Division to enforce provisions.

1. Money received from the certification of intermediary service organizations:

(a) Must be forwarded to the State Treasurer for deposit in the State Treasury;

(b) Must be accounted for separately in the State General Fund; and

2. The Division shall enforce the provisions of NRS 449.4304 to 449.4339, inclusive, and may incur any necessary expenses not in excess of money appropriated for that purpose by the State or received from the Federal Government.

(Added to NRS by 2013, 129; A 2017, 2310)

NRS 449.4327 Regulations; powers of Division.

1. The Board shall adopt regulations governing the certification of intermediary service organizations and such other regulations as it deems necessary to carry out the provisions of NRS 449.4304 to 449.4339, inclusive.

2. The Division may:

(a) Upon receipt of an application for a certificate to operate an intermediary service organization, conduct an investigation into the qualifications of personnel, methods of operation and policies and purposes of any person proposing to engage in the operation of an intermediary service organization.

(b) Upon receipt of a complaint against an intermediary service organization, except for a complaint concerning the cost of services, conduct an investigation into the qualifications of personnel, methods of operation and policies, procedures and records of that intermediary service organization or any other intermediary service organization which may have information pertinent to the complaint.

(c) Employ such professional, technical and clerical assistance as it deems necessary to carry out the provisions of NRS 449.4304 to 449.4339, inclusive.

(Added to NRS by 2013, 129)

Background Investigations

NRS 449.4329 Initial and periodic investigations of employee, employee of temporary employment service or independent contractor; penalty.

1. Except as otherwise provided in subsections 2 and 3, within 10 days after hiring an employee, accepting an employee of a temporary employment service or entering into a contract with an independent contractor, the holder of a certificate to operate an intermediary service organization shall:

(b) Obtain an oral and written confirmation of the information contained in the written statement obtained pursuant to paragraph (a);

(c) Obtain proof that the employee, employee of the temporary employment service or independent contractor holds any required license, permit or certificate;

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

(2) Enter on the Internet website information to be maintained on the website concerning the employee, employee of the temporary employment service or independent contractor.

2. The holder of a certificate to operate an intermediary service organization is not required to obtain the information described in subsection 1 from an employee, employee of a temporary employment service or independent contractor 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, employee of the temporary employment service or independent contractor has not been convicted of any crime set forth in subsection 1 of NRS 449.4332.

3. The holder of a certificate to operate an intermediary service organization is not required to obtain the information described in subsection 1, other than the information described in paragraph (c) of subsection 1, from an employee, employee of a temporary employment service or independent contractor if:

(a) The employee, employee of the temporary employment service or independent contractor agrees to allow the holder of a certificate to operate an intermediary service organization to receive notice from the Central Repository for Nevada Records of Criminal History regarding any conviction and subsequent conviction of the employee, employee of the temporary employment service or independent contractor of a crime listed in subsection 1 of NRS 449.4332;

4. The holder of a certificate to operate an intermediary service organization shall ensure that the information concerning the background and personal history of each employee, employee of a temporary employment service or independent contractor who works at or for the intermediary service organization is investigated is completed as soon as practicable and at least once every 5 years after the date of the initial investigation. The holder of the certificate shall, when required:

(a) Obtain one set of fingerprints from the employee, employee of the temporary employment service or independent contractor;

5. Upon receiving fingerprints submitted pursuant to this section, the Central Repository for Nevada Records of Criminal History shall determine whether the employee, employee of the temporary employment service or independent contractor has been convicted of a crime listed in subsection 1 of NRS 449.4332 and immediately inform the Division and the holder of the certificate to operate an intermediary service organization for which the person works whether the employee, employee of the temporary employment service or independent contractor has been convicted of such a crime.

6. The Central Repository for Nevada Records of Criminal History may impose a fee upon an intermediary service organization that submits fingerprints pursuant to this section for the reasonable cost of the investigation. The intermediary service organization may recover from the employee or independent contractor whose fingerprints are submitted not more than one-half of the fee imposed by the Central Repository. If the intermediary service organization requires the employee or independent contractor to pay for any part of the fee imposed by the Central Repository, it shall allow the employee or independent contractor to pay the amount through periodic payments. The intermediary service organization may require a temporary employment service which employs a temporary employee whose fingerprints are submitted to pay the fee imposed by the Central Repository. An intermediary service organization shall notify a temporary employment service if a person employed by the temporary employment service is determined to be ineligible to provide services to the intermediary service organization based upon the results of an investigation conducted pursuant to this section.

7. Unless a greater penalty is provided by law, a person who willfully provides a false statement or information in connection with an investigation of the background and personal history of the person pursuant to this section that would disqualify the person from employment, including, without limitation, a conviction of a crime listed in subsection 1 of NRS 449.4332, is guilty of a misdemeanor.

(Added to NRS by 2013, 131; A 2021, 1644)

NRS 449.43295 Temporary employment service prohibited from sending ineligible employee to organization; temporary employment service to provide certain information regarding its employees.

1. A temporary employment service shall not send an employee to provide services to an intermediary service organization if the temporary employment service has received notice from a holder of a certificate to operate an intermediary service organization that the employee of the temporary employment service is ineligible to provide such services.

2. A holder of a certificate to operate an intermediary service organization who enters into an agreement with a temporary employment service to provide services to the intermediary service organization on a temporary basis must require the temporary employment service to:

(a) Provide proof that each employee of the temporary employment service whom it may send to provide services to the intermediary service organization has been continuously employed by the temporary employment service since the last investigation conducted of the employee pursuant to NRS 449.4329; and

(b) Notify the intermediary service organization if the investigation conducted of an employee of the temporary employment service pursuant to NRS 449.4329 has not been conducted within the immediately preceding 5 years.

(Added to NRS by 2013, 2889)

NRS 449.433 Maintenance and availability of certain records regarding employee, employee of temporary employment service or independent contractor of organization.

1. Each intermediary service organization shall maintain accurate records of the information concerning its employees, employees of a temporary employment service and independent contractors collected pursuant to NRS 449.4329, including, without limitation:

(a) A copy of the fingerprints submitted to the Central Repository for Nevada Records of Criminal History or proof of electronic fingerprint submission and a copy of the written authorization that was provided by the employee, employee of the temporary employment service or independent contractor;

(b) Proof that the fingerprints of the employee, employee of the temporary employment service or independent contractor were submitted to the Central Repository; and

2. The records maintained pursuant to subsection 1 must be:

(a) Maintained for the period of the employment of the person with the intermediary service organization; and

(b) Made available for inspection by the Division at any reasonable time, and copies thereof must be furnished to the Division upon request.

3. If an Internet website has been established pursuant to NRS 439.942, an intermediary service organization shall maintain a current list of its employees, employees of a temporary employment service and independent contractors on the Internet website.

4. The Central Repository for Nevada Records of Criminal History may maintain an electronic image of fingerprints submitted pursuant to NRS 449.4329 to notify an intermediary service organization and the Division of any subsequent conviction of a person who is required to submit to an investigation pursuant to NRS 449.4329.

(Added to NRS by 2013, 132)

1. Upon receiving information from the Central Repository for Nevada Records of Criminal History pursuant to NRS 449.4329, or evidence from any other source, that an employee, employee of a temporary employment service or independent contractor of an intermediary service organization has been convicted of a crime listed in subsection 1 of NRS 449.4332, the holder of the certificate to operate the intermediary service organization shall terminate the employment or contract of that person or notify the temporary employment service that its employee is prohibited from providing services for the intermediary service organization after allowing the person time to correct the information as required pursuant to subsection 2.

2. If an employee, employee of a temporary employment service or independent contractor believes that the information provided by the Central Repository is incorrect, the employee, employee of the temporary employment service or independent contractor may immediately inform the intermediary service organization. The intermediary service organization that is so informed shall give the employee, employee of the temporary employment service or independent contractor a reasonable amount of time of not less than 30 days to correct the information received from the Central Repository before terminating the employment or contract of the person pursuant to subsection 1.

3. An intermediary service organization that has complied with NRS 449.4329 may not be held civilly or criminally liable based solely upon the ground that the intermediary service organization allowed an employee, employee of a temporary employment service or independent contractor to work:

(a) Before it received the information concerning the employee, employee of the temporary employment service or independent contractor from the Central Repository;

(b) During the period required pursuant to subsection 2 to allow the employee, employee of the temporary employment service or independent contractor to correct that information;

(c) Based on the information received from the Central Repository, if the information received from the Central Repository was inaccurate; or

(d) Any combination thereof.

Ê An intermediary service organization may be held liable for any other conduct determined to be negligent or unlawful.

(Added to NRS by 2013, 132)

NRS 449.4332 Additional grounds for denial, suspension or revocation of certificate. In addition to the grounds listed in NRS 449.4321, the Division may deny a certificate to operate an intermediary service organization to an applicant or may suspend or revoke a certificate of a holder of a certificate to operate an intermediary service organization if:

1. The applicant for or holder of the certificate has been convicted of:

(a) Murder, voluntary manslaughter or mayhem;

(b) Assault with intent to kill or to commit sexual assault or mayhem;

(c) Sexual assault, statutory sexual seduction, incest, lewdness or indecent exposure, or any other sexually related crime that is punished as a felony;

(d) Prostitution, solicitation, lewdness or indecent exposure, or any other sexually related crime that is punished as a misdemeanor, if the conviction occurred within the immediately preceding 7 years;

(e) Abuse or neglect of a child or contributory delinquency;

(f) A violation of any federal or state law regulating the possession, distribution or use of any controlled substance or any dangerous drug as defined in chapter 454 of NRS, within the past 7 years;

(g) A violation of any provision of NRS 200.5099 or 200.50995;

(h) Any offense involving fraud, theft, embezzlement, burglary, robbery, fraudulent conversion or misappropriation of property, within the immediately preceding 7 years; or

(i) Any other felony involving the use of a firearm or other deadly weapon, within the immediately preceding 7 years; or

2. The holder of a certificate has continued to employ a person who has been convicted of a crime listed in subsection 1.

(Added to NRS by 2013, 133)

Disciplinary Action; Enforcement

NRS 449.4335 Administrative sanctions: Imposition by Division; consequences of failure to pay; use of money collected.

1. If an intermediary service organization violates any provision related to its certification, including, without limitation, any provision of NRS 449.4304 to 449.4339, inclusive, or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.4336, may, as it deems appropriate:

(a) Prohibit the intermediary service organization from providing services pursuant to NRS 449.4308 until it determines that the intermediary service organization has corrected the violation;

(b) Impose an administrative penalty of not more than $1,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum; and

(c) Appoint temporary management to oversee the operation of the intermediary service organization and to ensure the health and safety of the persons for whom the intermediary service organization performs services, until:

(1) It determines that the intermediary service organization has corrected the violation and has management which is capable of ensuring continued compliance with the applicable statutes, conditions, standards and regulations; or

(2) Improvements are made to correct the violation.

2. If the intermediary service organization fails to pay any administrative penalty imposed pursuant to paragraph (b) of subsection 1, the Division may:

(a) Suspend the certificate to operate an intermediary service organization which is held by the intermediary service organization until the administrative penalty is paid; and

(b) Collect court costs, reasonable attorney’s fees and other costs incurred to collect the administrative penalty.

3. The Division may require any intermediary service organization that violates any provision of NRS 449.4304 to 449.4339, inclusive, or any condition, standard or regulation adopted by the Board, to make any improvements necessary to correct the violation.

4. Any money collected as administrative penalties pursuant to this section must be accounted for separately and used to protect the health or property of the persons for whom the intermediary service organization performs services in accordance with applicable federal standards.

(Added to NRS by 2013, 130; A 2017, 2310; 2019, 2923, 4347)

NRS 449.4336 Administrative sanctions: Regulations. The Board shall adopt regulations establishing the criteria for the imposition of each sanction prescribed by NRS 449.4335. These regulations must:

1. Prescribe the circumstances and manner in which each sanction applies;

2. Minimize the time between identification of a violation and the imposition of a sanction;

3. Provide for the imposition of incrementally more severe sanctions for repeated or uncorrected violations; and

4. Provide for less severe sanctions for lesser violations of applicable state statutes, conditions, standards or regulations.

(Added to NRS by 2013, 130)

NRS 449.4337 Notice by Division of disciplinary action; exception; appeal.

1. When the Division intends to deny, suspend or revoke a certificate to operate an intermediary service organization, or to impose any sanction prescribed by NRS 449.4335, the Division shall give reasonable notice to the holder of the certificate by certified mail. The notice must contain the legal authority, jurisdiction and reasons for the action to be taken. Notice is not required if the Division finds that the public health requires immediate action. In that case, the Division may order a summary suspension of a certificate or impose any sanction prescribed by NRS 449.4335, pending proceedings for revocation or other action.

2. If a person wants to contest the action of the Division, the person must file an appeal pursuant to regulations adopted by the Board.

3. Upon receiving notice of an appeal, the Division shall hold a hearing pursuant to regulations adopted by the Board.

4. The Board shall adopt such regulations as are necessary to carry out the provisions of this section.

(Added to NRS by 2013, 131)

NRS 449.4338 Action to enjoin violations.

1. Except as otherwise provided in subsection 2 of NRS 449.431, the Division may bring an action in the name of the State to enjoin any person from operating or maintaining an intermediary service organization within the meaning of NRS 449.4304 to 449.4339, inclusive:

(a) Without first obtaining a certificate to operate an intermediary service organization; or

(b) After the person’s certificate has been revoked or suspended by the Division.

2. It is sufficient in such action to allege that the defendant did, on a certain date and in a certain place, operate and maintain the intermediary service organization without a certificate.

(Added to NRS by 2013, 133; A 2017, 2311; 2019, 2924, 4348)

NRS 449.4339 Prosecution by district attorney. The district attorney of the county in which an intermediary service organization operates shall, upon application by the Division, institute and conduct the prosecution of any action for violation of any provision of NRS 449.4304 to 449.4339, inclusive.

(Added to NRS by 2013, 134; A 2017, 2311)

NRS 449.435 Definitions. As used in NRS 449.435 to 449.448, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.436 to 449.439, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 2009, 528; A 2017, 605)

NRS 449.436 “Conscious sedation” defined. “Conscious sedation” means a minimally depressed level of consciousness, produced by a pharmacologic or nonpharmacologic method, or a combination thereof, in which the patient retains the ability independently and continuously to maintain an airway and to respond appropriately to physical stimulation and verbal commands.

(Added to NRS by 2009, 528)

NRS 449.437 “Deep sedation” defined. “Deep sedation” means a controlled state of depressed consciousness, produced by a pharmacologic or nonpharmacologic method, or a combination thereof, and accompanied by a partial loss of protective reflexes and the inability to respond purposefully to verbal commands.

(Added to NRS by 2009, 528)

NRS 449.438 “General anesthesia” defined. “General anesthesia” means a controlled state of unconsciousness, produced by a pharmacologic or nonpharmacologic method, or a combination thereof, and accompanied by partial or complete loss of protective reflexes and the inability independently to maintain an airway and respond purposefully to physical stimulation or verbal commands.

(Added to NRS by 2009, 528)

NRS 449.439 “Physician” defined. “Physician” means a person who is licensed to practice medicine pursuant to chapter 630 of NRS or osteopathic medicine pursuant to chapter 633 of NRS.

(Added to NRS by 2009, 528)

NRS 449.441 Exemption from provisions if physician’s office or facility only administers certain type of pain medication. The provisions of NRS 449.435 to 449.448, inclusive, do not apply to an office of a physician or a facility that provides health care, other than a medical facility, if the office of a physician or the facility only administers a medication to a patient to relieve the patient’s anxiety or pain and if the medication is not given in a dosage that is sufficient to induce in a patient a controlled state of depressed consciousness or unconsciousness similar to general anesthesia, deep sedation or conscious sedation.

(Added to NRS by 2009, 529; A 2017, 605)

NRS 449.442 Permit required for certain physicians’ offices and facilities to offer services; national accreditation required; cessation of services for failure to maintain accreditation.

1. An office of a physician or a facility that provides health care, other than a medical facility, must obtain a permit pursuant to NRS 449.443 before offering to a patient a service of general anesthesia, conscious sedation or deep sedation. An office of a physician or a facility that provides health care, other than a medical facility, which operates at more than one location must obtain a permit for each location where a service of general anesthesia, conscious sedation or deep sedation is offered.

2. To offer to a patient a service of general anesthesia, conscious sedation or deep sedation in this State, an office of a physician or a facility that provides health care, other than a medical facility, must maintain current accreditation by a nationally recognized organization approved by the Board. Upon receiving an initial permit, the office or facility shall, within 6 months after obtaining the permit, submit proof to the Division of accreditation by such an organization.

3. If an office of a physician or a facility that provides health care, other than a medical facility, fails to maintain current accreditation or if the accreditation is revoked or is otherwise no longer valid, the office or facility shall immediately cease offering to patients a service of general anesthesia, conscious sedation or deep sedation.

(Added to NRS by 2009, 529)

NRS 449.443 Application for permit; fee; inspection by Division; term of permit.

1. An office of a physician or a facility that provides health care, other than a medical facility, desiring a permit pursuant to NRS 449.435 to 449.448, inclusive, must submit to the Division, on a form prescribed by the Division and accompanied by the appropriate fee, an application for a permit.

2. Before issuing a permit, the Division shall conduct an on-site inspection pursuant to NRS 449.446 of each office of a physician or facility that applies for a permit.

3. Upon receipt of an application and the appropriate fee, the Division may, after conducting an inspection pursuant to NRS 449.446, issue a permit.

4. A permit expires 1 year after the date of issuance and is renewable pursuant to NRS 449.444.

(Added to NRS by 2009, 529)

NRS 449.444 Application for renewal of permit; fee.

1. The holder of a permit issued pursuant to NRS 449.443 may annually submit to the Division, on a form prescribed by the Division and accompanied by the appropriate fee, an application for renewal of the permit before the date on which the permit expires. The application must include proof satisfactory to the Division that the office or facility maintains current accreditation by a nationally recognized organization approved by the Board.

2. Upon receipt of an application for renewal and the accompanying fee, the Division may renew a permit.

(Added to NRS by 2009, 529)

NRS 449.4445 Legislative findings and declaration concerning oversight of surgical centers for ambulatory patients. The Legislature finds and declares that:

1. This State has a compelling interest in assuring that residents of this State have access to health care;

2. Surgical centers for ambulatory patients play an important role in providing essential health care services and have become a critical element in the delivery of health care in this State; and

3. A license issued by this State to operate a surgical center for ambulatory patients pursuant to this chapter should be accompanied by oversight by the agency issuing the license.

(Added to NRS by 2017, 604)

NRS 449.445 National accreditation required of surgical center for ambulatory patients; inspection by Division; cessation of operation for failure to maintain accreditation.

1. To operate in this State, a surgical center for ambulatory patients must maintain current accreditation by a nationally recognized organization approved by the Board. Upon initial licensure, a surgical center for ambulatory patients shall, within 6 months after obtaining its license, submit proof to the Division of the accreditation of the surgical center by such an organization.

2. Before issuing a license to a surgical center for ambulatory patients, the Division shall conduct an on-site inspection of the surgical center pursuant to NRS 449.446.

3. If a surgical center for ambulatory patients fails to maintain current accreditation or if the accreditation is revoked or is otherwise no longer valid, the surgical center shall immediately cease to operate.

(Added to NRS by 2009, 529)

NRS 449.446 Annual inspections of holders of permits and surgical centers for ambulatory patients; correction of deficiencies identified in inspections; reporting of inspections to Legislature.

1. The Division shall conduct annual and unannounced on-site inspections of each office of a physician or a facility that provides health care, other than a medical facility, which holds a permit issued pursuant to NRS 449.443 and each surgical center for ambulatory patients which holds a license issued pursuant to this chapter.

2. An inspection conducted pursuant to this section must focus on the infection control practices and policies of the surgical center for ambulatory patients, the office or the facility that is the subject of the inspection. The Division may, as it deems necessary, conduct a more comprehensive inspection of a surgical center, office or facility.

3. Upon completion of an inspection, the Division shall:

(a) Compile a report of the inspection, including each deficiency discovered during the inspection, if any; and

(b) Forward a copy of the report to the surgical center for ambulatory patients, the office of the physician or the facility where the inspection was conducted.

4. If a deficiency is indicated in the report, the surgical center for ambulatory patients, the office of the physician or the facility shall correct each deficiency indicated in the report in the manner prescribed by the Board pursuant to NRS 449.448.

5. The Division shall annually prepare and submit to the Joint Interim Standing Committee on Health and Human Services and the Legislative Commission a report which includes:

(a) The number and frequency of inspections conducted pursuant to this section;

(b) A summary of deficiencies or other significant problems discovered while conducting inspections pursuant to this section and the results of any follow-up inspections; and

(c) Any other information relating to the inspections as deemed necessary by the Joint Interim Standing Committee on Health and Human Services or the Legislative Commission.

(Added to NRS by 2009, 530)

NRS 449.4465 Report of Division concerning surgical centers for ambulatory patients. The Division shall:

1. Compile the information collected from and submitted by surgical centers for ambulatory patients to the Department pursuant to NRS 439A.240, 439A.250 and 439A.260 and any regulations adopted pursuant thereto, and prepare a quarterly report that:

(a) Identifies the discharge location of each patient of a surgical center for ambulatory patients; and

(b) Compares the discharge location of patients of surgical centers for ambulatory patients in different geographical regions of this State; and

2. Submit the quarterly report prepared pursuant to subsection 1 to the Director of the Legislative Counsel Bureau for transmittal to the Legislature.

(Added to NRS by 2017, 604)

NRS 449.447 Disciplinary action for certain violations or failure to correct deficiency; notification to State Board of Osteopathic Medicine of violations; administrative sanctions.

1. If an office of a physician or a facility that provides health care, other than a medical facility, violates the provisions of NRS 449.435 to 449.448, inclusive, or the regulations adopted pursuant thereto, or fails to correct a deficiency indicated in a report pursuant to NRS 449.446, the Division, in accordance with the regulations adopted pursuant to NRS 449.448, may take any of the following actions:

(a) Decline to issue or renew a permit;

(b) Suspend or revoke a permit; or

(c) Impose an administrative penalty of not more than $1,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum.

2. The Division may review a report submitted pursuant to NRS 633.524 to determine whether an office of a physician or a facility is in violation of the provisions of NRS 449.435 to 449.448, inclusive, or the regulations adopted pursuant thereto. If the Division determines that such a violation has occurred, the Division shall immediately notify the State Board of Osteopathic Medicine.

3. If a surgical center for ambulatory patients violates the provisions of NRS 449.435 to 449.448, inclusive, or the regulations adopted pursuant thereto, or fails to correct a deficiency indicated in a report pursuant to NRS 449.446, the Division may impose administrative sanctions pursuant to NRS 449.163.

(Added to NRS by 2009, 530; A 2017, 605, 2859)

NRS 449.448 Regulations.

1. The Board shall adopt regulations to carry out the provisions of NRS 449.435 to 449.448, inclusive, including, without limitation, regulations which:

(a) Prescribe the amount of the fee required for applications for the issuance and renewal of a permit pursuant to NRS 449.443 and 449.444.

(b) Prescribe the procedures and standards for the issuance and renewal of a permit.

(c) Identify the nationally recognized organizations approved by the Board for the purposes of the accreditation required for the issuance of a:

(1) License to operate a surgical center for ambulatory patients.

(2) Permit for an office of a physician or a facility that provides health care, other than a medical facility, to offer to a patient a service of general anesthesia, conscious sedation or deep sedation.

(d) Prescribe the procedures and scope of the inspections conducted by the Division pursuant to NRS 449.446.

(e) Prescribe the procedures and time frame for correcting each deficiency indicated in a report pursuant to NRS 449.446.

(f) Prescribe the criteria for the imposition of each sanction prescribed by NRS 449.447, including, without limitation:

(1) Setting forth the circumstances and manner in which a sanction applies;

(2) Minimizing the time between the identification of a violation and the imposition of a sanction; and

(3) Providing for the imposition of incrementally more severe sanctions for repeated or uncorrected violations.

2. The regulations adopted pursuant to this section must require that the practices and policies of each holder of a permit to offer to a patient a service of general anesthesia, conscious sedation or deep sedation and each holder of a license to operate a surgical center for ambulatory patients provide adequately for the protection of the health, safety and well-being of patients.

(Added to NRS by 2009, 531; A 2017, 606)

ACCOUNTING; FINANCIAL REPORTS; FEES; ENSURING QUALITY OF CARE

NRS 449.450 Definitions. As used in NRS 449.450 to 449.530, inclusive, unless the context otherwise requires:

1. “Admitted health insurer” means an insurer authorized to transact health insurance in this State under a certificate of authority issued by the Commissioner of Insurance.

2. “Department” means the Department of Health and Human Services.

3. “Director” means the Director of the Department.

4. “Institution” means any person, place, building or agency which maintains and operates facilities for the diagnosis, care and treatment of human illness and provides beds for inpatient care. The term includes but is not limited to hospitals, convalescent care facilities, nursing care facilities, detoxification centers and all specialized medical health care facilities.

(Added to NRS by 1975, 702; A 1979, 887; 1983, 1127; 1985, 1362; 1989, 1800; 1991, 2114)

NRS 449.460 Powers of Director. The Director may:

1. Adopt regulations respecting the exercise of the powers conferred by NRS 449.450 to 449.530, inclusive.

2. Hold public hearings, conduct investigations and require the filing of information relating to any matter affecting the cost of services in all institutions subject to the provisions of NRS 449.450 to 449.530, inclusive, and may subpoena witnesses, financial papers, records and documents in connection therewith. An order requiring the filing of information or a subpoena issued pursuant to this subsection must state the purpose for which it is issued. The Director may also administer oaths in any hearing or investigation.

3. Exercise, subject to the limitations and restrictions imposed in NRS 449.450 to 449.530, inclusive, all other powers which are reasonably necessary to carry out the expressed objects of those sections.

4. Delegate to any of the divisions of the Department the authority to carry out the provisions of NRS 449.450 to 449.530, inclusive.

(Added to NRS by 1975, 702; A 1985, 1363; 1991, 2114; 1997, 2527)

NRS 449.465 Authority of Director to impose fees; maximum amount of fees collected; requirement to impose fee for support of Joint Interim Standing Committee on Health and Human Services.

1. The Director may, by regulation, impose fees upon admitted health insurers to cover the costs of carrying out the provisions of NRS 449.450 to 449.530, inclusive. The maximum amount of fees collected must not exceed the amount authorized by the Legislature in each biennial budget.

2. The Director shall impose a fee of $50 each year upon admitted health insurers for the support of the Joint Interim Standing Committee on Health and Human Services. The fee imposed pursuant to this subsection is in addition to any fee imposed pursuant to subsection 1. The fee collected for the support of the Joint Interim Standing Committee on Health and Human Services must be deposited in the Legislative Fund.

(Added to NRS by 1983, 1126; A 1985, 1363; 1987, 877; 2021, 2534)

NRS 449.470 Director may use staff or contract for services. In carrying out the duties prescribed by NRS 449.450 to 449.530, inclusive, the Director may utilize his or her own staff or may contract with any appropriate, independent and qualified organization. Such a contractor shall not release or publish or otherwise use any information made available to it under its contractual responsibility unless permission is specifically granted by the Director.

(Added to NRS by 1975, 703; A 1985, 1363)

NRS 449.476 Committee to ensure quality of care: Formation by hospital; general requirements.

1. Each hospital licensed to operate in this state shall form a committee to ensure the quality of care provided by the hospital. The committee must be composed of, but is not limited to, physicians and nurses.

2. Each committee formed pursuant to subsection 1 must meet the requirements for programs or plans for ensuring the quality of care specified by the Joint Commission on Accreditation of Healthcare Organizations or by the Federal Government pursuant to Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.).

(Added to NRS by 1989, 1799)

NRS 449.485 Hospital required to use discharge form prescribed by Director; electronic monthly reporting; exception to electronic reporting; use of information by Department.

1. Each hospital in this State shall use for all patients discharged a form prescribed by the Director and shall include in the form all information required by the Department. Any form prescribed by the Director must be a form that is commonly used nationwide by hospitals, if applicable, and comply with federal laws and regulations.

2. Each hospital in this State shall, on a monthly basis, report to the Department the information required to be included in the form for each patient. The information reported must be complete, accurate and timely.

3. Each insurance company or other payer shall accept the form as the bill for services provided by hospitals in this State.

4. Except as otherwise provided in subsection 5, each hospital in this State shall provide the information required pursuant to subsection 2 in an electronic form specified by the Department.

5. The Director may exempt a hospital from the requirements of subsection 4 if requiring the hospital to comply with the requirements would cause the hospital financial hardship.

6. The Department shall use the information submitted pursuant to this section for the program established pursuant to NRS 439A.220 to increase public awareness of health care information concerning the hospitals in this State.

(Added to NRS by 1987, 875; A 2005, 1736; 2007, 661, 2355)

1. Every institution which is subject to the provisions of NRS 449.450 to 449.530, inclusive, shall file with the Department the following financial statements or reports in a form and at intervals specified by the Director but at least annually:

(a) A balance sheet detailing the assets, liabilities and net worth of the institution for its fiscal year; and

(b) A statement of income and expenses for the fiscal year.

2. Each hospital with 100 or more beds shall file with the Department, in a form and at intervals specified by the Director but at least annually, a capital improvement report which includes, without limitation, any major service line that the hospital has added or is in the process of adding since the previous report was filed, any major expansion of the existing facilities of the hospital that has been completed or is in the process of being completed since the previous report was filed, and any major piece of equipment that the hospital has acquired or is in the process of acquiring since the previous report was filed.

3. In addition to the information required to be filed pursuant to subsections 1 and 2, each hospital with 100 or more beds shall file with the Department, in a form and at intervals specified by the Director but at least annually:

(a) The expenses that the hospital has incurred for providing community benefits and the in-kind services that the hospital has provided to the community in which it is located. These expenses must be reported as the total amount expended for community benefits and in-kind services and reported as a percentage of the total net revenues of the hospital. For the purposes of this paragraph, “community benefits” includes, without limitation, goods, services and resources provided by a hospital to a community to address the specific needs and concerns of that community, services provided by a hospital to the uninsured and underserved persons in that community, training programs for employees in a community and health care services provided in areas of a community that have a critical shortage of such services, for which the hospital does not receive full reimbursement.

(b) A statement of its policies and procedures for providing discounted services to, or reducing charges for services provided to, persons without health insurance that are in addition to any reduction or discount required to be provided pursuant to NRS 439B.260.

(d) A report of the cost to the hospital of providing services to patients covered by Medicare.

(e) Financial information from the consolidated corporation, if the hospital is owned by such a corporation and if that information is publicly available, including, without limitation, the annual report of the consolidated corporation.

(f) A statement of its policies regarding patients’ account receivables, including, without limitation, the manner in which a hospital collects or makes payment arrangements for patients’ account receivables, the factors that initiate collections and the method by which unpaid account receivables are collected.

4. A complete current charge master must be available at each hospital during normal business hours for review by the Director, any payor that has a contract with the hospital to pay for services provided by the hospital, any payor that has received a bill from the hospital and any state agency that is authorized to review such information. The complete and current charge master must be made available to the Department, at the request of the Director, in an electronic format specified by the Department. The Department may use the electronic copy of the charge master to review and analyze the data contained in the charge master and, except as otherwise provided in NRS 439A.200 to 439A.290, inclusive, shall not release or publish the information contained in the charge master.

5. The Director shall require the certification of specified financial reports by an independent certified public accountant and may require attestations from responsible officers of the institution that the reports are, to the best of their knowledge and belief, accurate and complete to the extent that the certifications and attestations are not required by federal law.

6. The Director shall require:

(a) The filing of all reports by specified dates, and may adopt regulations which assess penalties for failure to file as required; and

(b) The submission of a final annual report not later than 6 months after the close of the fiscal year,

Ê and may grant extensions to institutions which can show that the required information is not available on the required reporting date.

7. All reports, except privileged medical information, filed under any provisions of NRS 449.450 to 449.530, inclusive:

(a) Are open to public inspection;

(b) Must be in a form which is readily understandable by a member of the general public;

(c) Must, as soon as practicable after those reports become available, be posted on the Internet website maintained pursuant to NRS 439A.270; and

(d) Must be available for examination at the office of the Department during regular business hours.

(Added to NRS by 1975, 702; A 1985, 1364; 1987, 877; 2005, 1737; 2007, 2355; 2011, 967)

NRS 449.500 Director to carry out analyses and studies concerning cost of health care. The Director shall engage in or carry out analyses and studies relating to the cost of health care in Nevada and other states, the financial status of any institution subject to the provisions of NRS 449.450 to 449.530, inclusive, and any other appropriate related matters, and the Director may publish and disseminate any information relating to the financial aspects of health care as the Director deems desirable in the public interest and in accordance with the provisions of NRS 449.450 to 449.530, inclusive. The Director shall further require the filing of information concerning the total financial needs of each institution and the resources available or expected to become available to meet such needs, including but not limited to the effect of proposals made by comprehensive areawide and state health planning agencies. The information must be divided into at least the following components of an institution’s expenses:

1. Operating expenses related to patient care.

2. Expenses incurred for rendering services to patients for whom payment is not made in full including, but not limited to, the separate expenses for contractual allowances imposed by federal or state law, charity care and uncollectible accounts.

3. All incurred interest charges on indebtedness for both capital and operating needs.

4. Costs of education, both primary and continuing.

5. Expenses for research related to patient care.

6. Depreciation expenses of both property and equipment.

7. Amortization of incurred capital and operating related indebtedness.

8. Requirements for capital expenditures for replacement, modernization, renovation and expansion of services and facilities.

9. Requirements for necessary working capital, including but not limited to operating cash, patients’ accounts receivable and inventories.

10. Federal, state and local taxes not ordinarily considered operating expenses where applicable.

11. Operating surpluses necessary for a fair return to their owners equal to returns on investments in industries of comparable risk, or for the purpose of assuring continuity of operation and prudent management.

(Added to NRS by 1975, 703; A 1985, 1364)

1. The Director shall prepare and file such summaries, compilations or other supplementary reports based on the information filed with the Director pursuant to NRS 449.450 to 449.530, inclusive, as will advance the purposes of those sections. All such summaries, compilations and reports are open to public inspection, must be made available to requesting agencies and must be prepared within a reasonable time following the end of each institution’s fiscal year or more frequently as specified by the Director.

2. The Director shall not collect, maintain, disclose, report or publish the details of contracts entered into by a hospital, or collect, maintain, disclose, report or publish information pursuant to this section in a manner that would allow identification of an individual payer or other party to a contract with the hospital, except that the Director may disclose to other state agencies the details of contracts between the hospital and a related entity. A state agency shall not collect, maintain, disclose, report or publish information disclosed to the agency by the Director pursuant to this subsection in a manner that would allow identification of an individual payer or other party to a contract with the hospital. The Director may review any such contracts at the hospital or at a location specified by the hospital.

3. As used in this section, “related entity” means an affiliated person or subsidiary as those terms are defined in NRS 439B.430.

(Added to NRS by 1975, 704; A 1985, 1365; 1991, 2333; 1993, 619; 1997, 2527)

NRS 449.520 Reports to Governor and legislative committees; development of comprehensive plan by Joint Interim Standing Committee on Health and Human Services.

1. On or before October 1 of each year, the Director shall prepare and transmit to the Governor, the Joint Interim Standing Committee on Health and Human Services and the Interim Finance Committee a report of the Department’s operations and activities for the preceding fiscal year.

2. The report prepared pursuant to subsection 1 must include:

(a) Copies of all reports, summaries, compilations and supplementary reports required by NRS 449.450 to 449.530, inclusive, together with such facts, suggestions and policy recommendations as the Director deems necessary;

(b) A summary of the trends of the audits of hospitals in this State that the Department required or performed during the previous year;

(d) An analysis of the methodologies used to determine the corporate home office allocation of hospitals in this State;

(e) An examination and analysis of the manner in which hospitals are reporting the information that is required to be filed pursuant to NRS 449.490, including, without limitation, an examination and analysis of whether that information is being reported in a standard and consistent manner, which fairly reflect the operations of each hospital;

(f) A review and comparison of the policies and procedures used by hospitals in this State to provide discounted services to, and to reduce charges for services provided to, persons without health insurance;

(g) A review and comparison of the policies and procedures used by hospitals in this State to collect unpaid charges for services provided by the hospitals; and

(h) A summary of the status of the programs established pursuant to NRS 439A.220 and 439A.240 to increase public awareness of health care information concerning the hospitals and surgical centers for ambulatory patients in this State, including, without limitation, the information that was posted in the preceding fiscal year on the Internet website maintained for those programs pursuant to NRS 439A.270.

3. The Joint Interim Standing Committee on Health and Human Services shall develop a comprehensive plan concerning the provision of health care in this State which includes, without limitation:

(a) A review of the health care needs in this State as identified by state agencies, local governments, providers of health care and the general public; and

(b) A review of the capital improvement reports submitted by hospitals pursuant to subsection 2 of NRS 449.490.

(Added to NRS by 1975, 704; A 1983, 1127; 1985, 1365; 2005, 1738; 2007, 2357; 2011, 969; 2021, 2534)

NRS 449.530 Administrative fine for violation. The Director may impose upon the institutions subject to supervision under NRS 449.450 to 449.530, inclusive, an administrative fine not exceeding $500 per day for each violation of any of the provisions of NRS 449.450 to 449.530, inclusive.

(Added to NRS by 1975, 704; A 1985, 1365)

PREVENTING PERSONS FROM ENTERING OR EXITING HEALTH FACILITY

NRS 449.531 Unlawful acts; exception; penalty.

1. Except as otherwise provided in this section, a person shall not intentionally prevent another person from entering or exiting the office of a physician, a health facility, a nonprofit health facility, a public health center, a medical facility or a facility for the dependent by physically:

(a) Detaining the other person; or

(b) Obstructing, impeding or hindering the other person’s movement.

2. The provisions of subsection 1 are inapplicable to:

(a) An officer, employee or agent of the physician, health facility, nonprofit health facility, public health center, medical facility or facility for the dependent; or

(b) A peace officer as defined in NRS 169.125,

Ê while acting within the course and scope of his or her duties or employment.

3. The provisions of subsection 1 do not prohibit a person from maintaining a picket during a strike or work stoppage in compliance with the provisions of NRS 614.160, or from engaging in any constitutionally protected exercise of free speech.

4. A person who violates the provisions of subsection 1 is guilty of a misdemeanor and shall be punished by a fine of not more than $1,000, or by imprisonment in the county jail for not more than 3 months, or by both fine and imprisonment.

5. As used in this section, the terms “health facility,” “nonprofit health facility” and “public health center” have the meanings ascribed to them in NRS 449.260.

(Added to NRS by 1991, 1687)