NAC: CHAPTER 439A - PLANNING FOR THE PROVISION OF HEALTH CARE

[Rev. 9/23/2024 10:26:31 AM]

[NAC-439A Revised Date: 8-24]

CHAPTER 439A - PLANNING FOR THE PROVISION OF HEALTH CARE

GENERAL PROVISIONS

439A.010 Definitions.

439A.070 “Capital expenditure” defined.

439A.100 “Donation” defined.

439A.130 “Health maintenance organization” defined.

439A.180 “Hospital” defined.

439A.205 “Letter of approval” defined.

439A.215 “Maximum capital expenditure” defined.

439A.226 “New construction” defined.

439A.240 “Person” defined.

439A.255 “Routine services for health” interpreted.

APPROVAL OF PROJECTS

Requirements Regarding Proposed Projects

439A.295 Determining when capital expenditure is incurred by or on behalf of health facility.

439A.305 Letter of intent: General requirements.

439A.315 Letter of intent: Action by Department; termination.

439A.322 Submission of information to Department.

439A.325 Projects for which approval required.

439A.335 Conference with applicant.

Applications

439A.345 Availability and use of forms.

439A.355 Time for submission; limitation on acceptance.

439A.365 Procedure for submission; fee; acknowledgment of receipt.

439A.375 Amendment.

439A.379 Denial for insufficient information; effect of acceptance.

439A.385 Batching applications for comparative review.

Review of Applications for Approval

439A.389 Public notice.

439A.395 Submission of written information by person other than applicant.

439A.405 Period of review; extension.

439A.415 Public hearings.

439A.435 Review of record for application.

439A.445 Decision of Director.

Approval

439A.455 Letter of approval or disapproval; failure to accept letter of approval; public notice; reconsideration.

439A.465 Progress reports; requests for information; access to project site and records.

439A.475 Extension of approved timetable.

439A.485 Transfer of interest before project is completed.

439A.495 Removal or alteration of conditions.

439A.505 Withdrawal of letter of approval.

Procedural Matters

439A.515 Reconsideration of decisions.

439A.525 Judicial review.

439A.545 Provision of notice: Generally.

439A.555 Provision of notice: Hearings.

Criteria for Review of Proposed Projects

439A.595 Burden of proof; applicability.

439A.605 Need for project to be undertaken.

439A.625 Financial feasibility.

439A.635 Effect on cost of health services.

439A.637 Appropriateness for the area to be served.

439A.639 Health maintenance organizations.

Miscellaneous Provisions

439A.645 Prohibited communications.

439A.655 Civil penalties.

439A.665 Applicable regulations.

439A.670 Waiver of procedural provisions.

439A.675 Reports by Department; access to materials.

PHYSICIAN VISA WAIVER PROGRAM

439A.700 “Advisory Council” defined.

439A.710 Advisory Council: Creation; composition; designation of substitute; vacancies; meetings; appointment of subcommittee authorized.

439A.715 Advisory Council: Duties.

439A.720 Application for letter of support: Requirements; request for waiver of portion of application fee; refund of all or portion of fee; where available.

439A.725 Application for letter of support: Submission; review by Advisory Council; responsibilities of Administrator.

439A.728 Application fee.

439A.730 Contract between employer and J-1 visa physician: Requirements; transfer to different employer; liquidated damages.

439A.735 Employer: Duties.

439A.740 J-1 visa physician: Duties and requirements.

439A.745 Complaints: Submission; investigation; determination of Administrator.

439A.750 Violations.

439A.755 Hearing.

PROGRAMS TO INCREASE AWARENESS OF INFORMATION CONCERNING HOSPITALS AND SURGICAL CENTERS FOR AMBULATORY PATIENTS

439A.810 Information concerning surgical centers for ambulatory patients: Requirements for submission of information to Department; confidential information.

439A.815 Information concerning surgical centers for ambulatory patients: Request for extension of time for submission of information.

439A.820 Information concerning surgical centers for ambulatory patients: Notification by Department that information is incomplete; effect of failure to submit complete information.

439A.825 Information concerning surgical centers for ambulatory patients: Department to determine and make publicly available list of 50 medical treatments for outpatients of surgical centers to be included in program.

439A.830 Information concerning hospitals: Department to determine and make publicly available lists of diagnosis-related groups for inpatients of hospitals and 50 medical treatments for outpatients of hospitals to be included in program.

439A.835 Internet website for information concerning hospitals and surgical centers for ambulatory patients: Duties of Department.

439A.840 Request for information.

GENERAL PROVISIONS

REVISER’S NOTE.

Pursuant to the provisions of NRS 0.024, former NAC 439A.080, 439A.090, 439A.120 and 439A.150 contained definitions that were deemed duplicative of those set forth in NRS 439A.012, 439A.0125, 439A.015 and 439A.017, respectively, and were removed from chapter 439A of NAC in accordance with ch. 56, Stats. 2009, which contains the following provision not included in NRS:

“Sec. 2. The Legislative Counsel shall, in preparing supplements to the Nevada Administrative Code, appropriately change, move or remove any words and terms in the Nevada Administrative Code in a manner that the Legislative Counsel determines necessary to ensure consistency with the provisions of section 1 of this act [NRS 0.024].”

NAC 439A.010 Definitions. (NRS 439A.081) As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 439A.070 to 439A.240, inclusive, have the meanings ascribed to them in those sections.

(Supplied in codification; A by Dep’t of Human Resources, 9-4-84; 3-6-86; 11-10-87; 1-2-90; 10-14-97; A by Dep’t of Health & Human Services by R150-15, 6-28-2016)

NAC 439A.070 “Capital expenditure” defined. (NRS 439A.081) “Capital expenditure” means any expenditure, made by or on behalf of a health facility including the cost of predevelopmental activities, the encumbrance of funds, leases, contractual agreements or donations for purposes which, under generally accepted accounting principles, are not properly chargeable as an expense of operation or maintenance, or both.

[Dep’t of Human Resources, Health Facilities Reg. Art. A § 7, eff. 5-13-82]—(NAC A 9-4-84)

NAC 439A.100 “Donation” defined. (NRS 439A.081) “Donation” means a gift or free contribution which, if accepted, increases capital assets by an amount which, under generally accepted accounting principles, would normally require a review as a capital expenditure.

[Dep’t of Human Resources, Health Facilities Reg. Art. A § 10, eff. 5-13-82]

NAC 439A.130 “Health maintenance organization” defined. (NRS 439A.081) “Health maintenance organization” has the meaning ascribed to it in subsection 6 of NRS 695C.030.

[Dep’t of Human Resources, Health Facilities Reg. Art. A § 13, eff. 5-13-82]

NAC 439A.180 “Hospital” defined. (NRS 439A.081) “Hospital” has the meaning ascribed to it in NRS 449.012.

[Dep’t of Human Resources, Health Facilities Reg. Art. A § 18, eff. 5-13-82]

NAC 439A.205 “Letter of approval” defined. (NRS 439A.081) “Letter of approval” means a document, commonly known as a certificate of need, which is issued by the Director pursuant to NAC 439A.455 and which indicates the approval of a proposed project for which approval is required pursuant to NRS 439A.100.

(Added to NAC by Dep’t of Health & Human Services by R150-15, eff. 6-28-2016)

NAC 439A.215 “Maximum capital expenditure” defined. (NRS 439A.081) “Maximum capital expenditure” means that amount specified in a letter of approval.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 11-25-86)

NAC 439A.226 “New construction” defined. (NRS 439A.081, 439A.100) “New construction” means:

1. Construction of a new health facility or construction which increases the square footage in an existing health facility; or

2. The redesign or renovation of an existing building which is not currently being used as a health facility.

(Added to NAC by Dep’t of Human Resources, eff. 10-14-97)

NAC 439A.240 “Person” defined. (NRS 439A.081) “Person” means a natural person, trust, estate, partnership, corporation (including an association, joint stock company and insurance company), state, political subdivision or instrumentality or a legal entity recognized by the State.

[Dep’t of Human Resources, Health Facilities Reg. Art. A § 24, eff. 5-13-82]—(NAC A 9-4-84)

NAC 439A.255 “Routine services for health” interpreted. (NRS 439A.081) As used in NRS 439A.015, the Director will interpret the term “routine services for health” to mean those services that can be rendered to a patient in a practitioner’s office provided that the rendering of such services does not require the:

1. Construction of a new facility; or

2. Expansion, renovation or redesign of the existing office,

Ê at a cost that exceeds, including the cost of equipment acquired for the new facility, expansion, renovation or redesign, $2,000,000.

(Added to NAC by Dep’t of Health & Human Services by R150-15, eff. 6-28-2016)

APPROVAL OF PROJECTS

Requirements Regarding Proposed Projects

NAC 439A.295 Determining when capital expenditure is incurred by or on behalf of health facility. (NRS 439A.081, 439A.100)

1. A capital expenditure is incurred by or on behalf of a health facility:

(a) When a contract, enforceable under state law, is entered into by or on behalf of the health facility for the construction, acquisition, lease or financing of a capital asset;

(b) When the governing board of the health facility takes formal action to commit money for a construction project undertaken by the health facility as its own contractor; or

2. An obligation for a capital expenditure which is contingent upon issuance of a letter of approval is not considered incurred until the letter of approval is issued.

3. A capital expenditure is incurred by or on behalf of a health facility if the capital expenditure:

(a) Is required for providing health services in or through the facility;

(b) Is required for new construction; or

(c) Will provide a direct benefit to the facility substantially related to the health services to be offered in or through the facility.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 10-14-97)

NAC 439A.305 Letter of intent: General requirements. (NRS 439A.081, 439A.100)

1. Any person who intends to initiate a project that may be subject to review pursuant to NRS 439A.100 shall, before incurring a capital expenditure for the project, submit to the Department a letter of intent.

2. A letter of intent must be submitted on and include the information required by the form prescribed for this purpose by the Department or must include:

(a) The identity of the applicant;

(b) The proposed location of the project;

(c) A description of the proposed project which identifies any facility, medical equipment or health service to be included;

(d) The estimated date of completion of the proposed project, including a summary and schedule of anticipated future phases of construction within the proposed project;

(e) The total estimated costs of the project, including:

(1) The total estimated capital expenditures;

(2) All other costs of the project, including, without limitation, the cost for:

(I) The development of the site;

(II) A contingency plan for an amount which must be at least 10 percent of the total cost of the project;

(III) Architecture and engineering;

(IV) Furniture, fixtures and equipment; and

(V) Major medical equipment; and

(3) The portion of estimated capital expenditures which is related to new construction; and

(f) A copy of a written estimate of the cost of construction of the proposed project, by major cost categories, from an architect or contractor.

3. The Department will determine, pursuant to NAC 439A.315, whether a proposed project is subject to review.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

NAC 439A.315 Letter of intent: Action by Department; termination. (NRS 439A.081)

1. The Department will, within 15 days after the receipt of a letter of intent, determine whether the proposed project is subject to review.

2. If the Department determines that the proposed project would violate any condition imposed by a previously issued letter of approval, the Department will notify the applicant that the proposed project will not be considered until the condition is removed pursuant to NAC 439A.495.

3. The Department will notify the applicant by mail of its decision. If the proposed project is subject to review, the notice will include the date by which an application must be submitted.

4. A letter of intent is considered no longer in effect if an application is not submitted to the Department by the date specified in the notice issued pursuant to subsection 3 of this section.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 10-14-97)

NAC 439A.322 Submission of information to Department. (NRS 439A.081, 439A.100)

1. Any person who wishes to undertake a project listed in subsection 1 of NRS 439A.100 shall provide the Department with the information required by paragraphs (a) to (e), inclusive, of subsection 2 of NAC 439A.305.

2. The Department will maintain a file containing the information submitted pursuant to this section.

(Added to NAC by Dep’t of Human Resources, eff. 11-10-87; A 1-2-90; 10-14-97)

NAC 439A.325 Projects for which approval required. (NRS 439A.081, 439A.100)

1. For projects subject to review pursuant to subsection 1 of NRS 439A.100, the amount specified for the capital expenditure, as adopted by the Department, is $2,000,000.

2. Pursuant to subsection 4 of NRS 439A.100, additional approval must be obtained before any change may be made to a previously approved project if the proposed change would result in:

(a) A change in the location of the project; or

(b) A substantial increase in the maximum capital expenditure.

3. An acquisition by donation, lease, transfer or comparable arrangement requires approval if the acquisition would be subject to review pursuant to subsection 1 if made by purchase. An acquisition for less than fair market value requires a letter of approval if the acquisition would be subject to review pursuant to subsection 1 if made at fair market value. The Department will require an appraisal if it appears that the acquisition was or will be for less than fair market value.

4. A person shall not, in order to evade the scope of review pursuant to this section, divide a single project into separate components which are so interdependent or interrelated that they should not be undertaken separately. In determining whether a project is properly separable, the factors to be considered include:

(a) The physical location of the respective components;

(b) The functional independence of each component;

(d) The time required for initiation and completion of each component.

5. Any new construction proposed to be undertaken within 2 years after the completion of any prior new construction, regardless of whether that prior new construction required a letter of intent or letter of approval, must have:

(a) A letter of intent; and

(b) A letter of approval, if the combined capital expenditure for the prior new construction and proposed new construction is more than $2,000,000 and the projects are not found to be properly separated pursuant to subsection 4.

6. As used in this section, “fair market value” includes all costs associated with the acquisition of a facility, whether the facility is acquired by lease, rental agreement, donation, contractual agreement, purchase or any method of financing or encumbrance of money.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-25-86; 11-10-87; 1-2-90; 10-14-97)

NAC 439A.335 Conference with applicant. (NRS 439A.081)

1. If a proposed project is subject to review, the Department will schedule a conference with the applicant, which will be held not later than 15 days after the date on which the letter of determination has been mailed in response to the letter of intent.

2. Before or at the conference, the Department will provide the applicant with the following information and materials:

(a) A copy of the form for application and any applicable regulations and statutes;

(b) Instructions for completing the form; and

(c) Notice of the applicable guidelines and other data which will be used by the Department in the review of the application.

3. At the conference, the Department will discuss with the applicant the information and materials provided the applicant pursuant to this section and the procedure and schedule for the review.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 10-14-97)

Applications

NAC 439A.345 Availability and use of forms. (NRS 439A.081)

1. The Department will keep on file and make available to any person copies of its current forms for applications.

2. All applications must be submitted in the form prescribed by the Department and must adequately address all questions and supply all information applicable to the proposed project and necessary to enable the Director to make a decision regarding the project.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 1-2-90)

NAC 439A.355 Time for submission; limitation on acceptance. (NRS 439A.081)

1. For a project that is subject to the provisions of NRS 439A.100, an application must be received by the Department no later than 60 days after the date on which the letter of determination is mailed in response to the letter of intent.

2. The Director will not accept an application for a letter of approval if it is submitted to fulfill a need beyond the fifth calendar year after the calendar year in which the application is submitted for review.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

NAC 439A.365 Procedure for submission; fee; acknowledgment of receipt. (NRS 439A.081)

1. The original and three copies of an application for a letter of approval must be submitted by mail or delivered by hand to the Department.

2. Each application submitted to the Department must be accompanied by a nonrefundable fee of $9,500. The fee must be paid by check made payable to the order of the Department of Health and Human Services.

3. The Department will acknowledge receipt of an application and accompanying fee within 5 working days after the date of receipt on a form prescribed by the Department.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97; A by Dep’t of Health & Human Services by R150-15, 6-28-2016; A by Div. of Pub. & Behavioral Health by R022-20, 8-26-2020)

NAC 439A.375 Amendment. (NRS 439A.081)

1. An applicant shall not materially amend its application for a letter of approval after the deadline for its submission. A material amendment is a ground for denial of such an application, and includes:

(a) A substantial change in the identity of the applicant;

(b) A substantial change in the proposed location of the project;

(d) A substantial change in the health services to be provided; or

(e) A substantial change in the size or scope of the project.

2. Information furnished by an applicant before the deadline specified in NAC 439A.395 in response to specific questions from the Department does not constitute a material amendment, even if the information is different from that provided in the application, unless the additional information increases the size or scope of the proposed project.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90)

NAC 439A.379 Denial for insufficient information; effect of acceptance. (NRS 439A.081)

1. Upon receipt of an application for a letter of approval, the Department will examine the application. If the application does not contain information sufficient to enable the Director to review the project, the Director will issue a letter of denial within 15 days after the deadline for submission of the application. The letter of denial will list the reasons why the application is insufficient and constitutes the final decision regarding the application.

2. An application for a letter of approval is considered insufficient only if the applicant has substantially failed to include the information required on the form.

3. The acceptance of such an application by the Department does not constitute a determination that the applicant has provided sufficient information to satisfy its burden of proof regarding the applicable criteria for review or that the application complies with all of the provisions of NAC 439A.295 to 439A.675, inclusive, and is not a waiver of those provisions.

(Added to NAC by Dep’t of Human Resources, eff. 3-6-86; A 11-10-87; 1-2-90)

NAC 439A.385 Batching applications for comparative review. (NRS 439A.081)

1. After the deadline for submission as set forth in subsection 1 of NAC 439A.355, the Department will determine whether any applications which are not denied for insufficiency pursuant to NAC 439A.379 will be batched for comparative review pursuant to paragraph (a) of subsection 3 of NRS 439A.100.

2. An application which involves more than one type of project or service may be placed in more than one batch.

3. Notice of the batching of an application will be made pursuant to NAC 439A.389.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

Review of Applications for Approval

NAC 439A.389 Public notice. (NRS 439A.081) For each application for approval which is received before the deadline for submission and which is not denied for insufficiency pursuant to NAC 439A.379, the Department will, within 15 days after the application is submitted, give public notice of:

1. The identity of the applicant;

2. The nature of the proposed project;

3. The batch, if any, in which the application is placed;

4. The date of commencement of the period of review;

5. The date, time and place of the public hearing to be held during the course of the review; and

6. The date by which written information must be submitted pursuant to NAC 439A.395.

(Added to NAC by Dep’t of Human Resources, eff. 3-6-86; A 11-10-87; 10-14-97)

NAC 439A.395 Submission of written information by person other than applicant. (NRS 439A.081) Any person may submit written information regarding an application for a letter of approval to the Department if the information is received by the Department at least 10 days before the date of the public hearing.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

NAC 439A.405 Period of review; extension. (NRS 439A.081)

1. The period of review of an application for a letter of approval commences on the date on which the application is received by the Department.

2. The public hearing will be held no later than 45 days after the commencement of the period of review.

3. The Director will issue a decision regarding the application within 30 days after the close of the public hearing.

4. The Director will extend the period of review for up to 15 days if he or she determines that it is not practicable to render a decision within the scheduled period as a result of:

(a) The availability of and the amount of work for the employees of the Department who are responsible for conducting the review; or

(b) A circumstance or condition beyond the control of the Department.

5. Notice of any extension will be mailed to each affected applicant.

6. An application is not considered approved or denied solely because the Director failed to render a timely decision.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

NAC 439A.415 Public hearings. (NRS 439A.081)

1. The Department will provide a public hearing for each application for a letter of approval.

2. A single public hearing will be held for all applications within a single batch.

3. The Department will keep a taped record of the public hearing, together with all exhibits introduced.

4. The purposes of the public hearing are:

(a) To provide for public comment on the application; and

(b) To receive evidence from the applicant and those persons who have submitted written information pursuant to NAC 439A.395 regarding material issues and to consider questions from the Department.

5. The Department will, at least 5 days before the date of the hearing, notify the applicant and those persons who have submitted written information of the procedures to be followed at the public hearing.

6. The amount of time allocated to each applicant or person for presenting evidence may be limited if that limitation is equally applied to all applicants or persons.

7. Any person at the public hearing is entitled to be represented by counsel.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90)

NAC 439A.435 Review of record for application. (NRS 439A.081) The Director will review the Department’s record for each application for a letter of approval. The record must include:

1. The application, together with any supporting documents;

2. The record of the public hearing; and

3. The official records of the Department pertaining to the application.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90)

NAC 439A.445 Decision of Director. (NRS 439A.081, 439A.100)

1. The decision of the Director relating to an application for a letter of approval will be supported by written findings of fact which must include:

(a) Whether a need for the proposed project exists in the community;

(b) Whether the proposed project is financially feasible;

(d) The appropriateness of the proposed project in the community.

2. If the Director approves a proposed project subject to specified conditions, the conditions must be directly related to the proposed project and to the criteria used for review.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

Approval

NAC 439A.455 Letter of approval or disapproval; failure to accept letter of approval; public notice; reconsideration. (NRS 439A.081, 439A.100)

1. In connection with an application made pursuant to NRS 439A.100, the Director will issue to each applicant a letter of approval or disapproval, together with a copy of the written findings of fact issued pursuant to NAC 439A.445. This letter is the official document permitting or denying the applicant’s project.

2. A letter of disapproval will contain the reasons for denial.

3. A letter of approval will contain:

(a) A timetable for the project, including a specific date by which the proposed facility must be made available for receiving patients or providing services;

(b) The maximum capital expenditure for the project;

(d) The specific health services and the number of beds identified in the application;

(e) Notice of the requirement that, within 30 days after the date of publication of the decision, the applicant must file with the Department its written acceptance of the decision; and

(f) Each condition placed on the approval which is directly related to the proposed project and the criteria for review.

4. The applicant’s failure to accept the letter of approval within 30 days after the date of publication of the decision cancels the letter of approval, and the project may be reinstated only by a new application and review.

5. Public notice of the decision of the Director will be given within 15 days after the date of the decision.

6. The period during which a reconsideration of the decision of the Director must be requested begins on the date on which the notice of the decision is posted in the manner required pursuant to NAC 439A.545.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97; A by Div. of Pub. & Behavioral Health by R022-20, 8-26-2020)

NAC 439A.465 Progress reports; requests for information; access to project site and records. (NRS 439A.081)

1. The holder of a letter of approval shall provide the Department with quarterly progress reports, beginning with the first calendar quarter following the issuance of the letter of approval and due no later than 30 days after the end of the quarter. Each progress report must include all of the following:

(a) The date of commencement of the project;

(b) The extent of progress made in complying with the approved timetable, including:

(1) All deadlines which have passed; and

(2) Whether the required activity met the deadline;

(c) Any financial arrangements which differ from those originally approved, including a detailed description of, and the reason for, each difference;

(d) The actual cost to date for the project;

(e) A revised estimate of the total project cost, including a detailed description and explanation of the differences, if any, between the revised cost and that originally approved;

(f) All the steps taken to ensure compliance with each applicable condition;

(g) The material changes in the project, including a detailed description and explanation of each change; and

(h) The projected date of completion of the project.

2. The Department may, from time to time, request in writing such additional information as is necessary to determine whether the holder of a letter of approval is complying with the letter of approval.

3. The holder of a letter of approval will have 20 working days from his or her receipt of a request for information from the Department to submit the required information in writing. Failure to respond within this period may constitute grounds for the Department to initiate withdrawal proceedings pursuant to NAC 439A.505.

4. The holder of a letter of approval must provide access to the project site and all project records to the Department’s staff for examination and inspection in order to verify compliance with the letter of approval and any information submitted by the holder of the letter of approval.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 11-10-87; 1-2-90; 10-14-97; A by Dep’t of Health & Human Services by R150-15, 6-28-2016)

NAC 439A.475 Extension of approved timetable. (NRS 439A.081)

1. A letter of approval is subject to withdrawal pursuant to NAC 439A.505 if the approved timetable is not met by the holder of the letter of approval, unless an extension is granted by the Department pursuant to this section.

2. An extension will be granted only if the applicant manifests an intention to complete the project and demonstrates that good and sufficient reasons exist for its failure to meet the timetable. Good and sufficient reasons include delays caused by:

(a) Litigation;

(b) The actions of a regulatory agency other than the Department; or

3. Except as otherwise provided in subsection 4, a request for an extension must be submitted to the Department as part of the quarterly progress report required by NAC 439A.465 at least 90 days before the required date of completion of the project. The request must contain information setting forth the reasons for noncompliance with the timetable and the extent of the progress toward completion of the project.

4. A request for an extension of a letter of approval which is submitted less than 90 days before the required date of completion of the project will not be accepted unless the applicant can demonstrate to the satisfaction of the Department that unforeseen occurrences prevented a timely submission.

5. Within 20 working days after receipt of the request, the Director will determine whether or not to grant an extension.

6. If the decision is to grant an extension, the Director will issue a letter of extension to the holder of the letter of approval, which will contain:

(a) The reasons for granting the extension; and

(b) A revised timetable for the project, including a revised date of completion for the project.

7. If an extension is not granted, proceedings to withdraw the letter of approval may be initiated pursuant to NAC 439A.505.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; A by Dep’t of Health & Human Services by R150-15, 6-28-2016)

NAC 439A.485 Transfer of interest before project is completed. (NRS 439A.081)

1. A person shall not sell, purchase, assign, grant or otherwise transfer or convey in any manner any interest in a letter of approval or a proposed project without first obtaining the written approval of the Director.

2. A written request for the approval of any transfer must be submitted to the Director by the holder of the letter of approval and must include:

(a) The identity and, if other than a natural person, the organizational structure of the person who will acquire the interest;

(b) All facts and materials relating to the proposed transaction;

(d) A statement signed by the person who will acquire the interest manifesting an intent to complete the project and agreeing to be bound by each condition of the letter of approval.

3. Upon the request of the Director, any of the parties involved in the proposed transaction shall submit additional information:

(a) Regarding their financial interest in the transaction or the proposed project;

(b) Regarding any changes in the project or the cost of or charges for the proposed services resulting from the proposed transaction; and

4. The Director will determine the effect of the proposed transaction on the project.

5. Approval of a transfer of interest requested pursuant to this section will be denied only if the Director determines:

(a) That approval would have an adverse effect on the project; or

(b) That the proposed transaction would result in a transfer of more than 49 percent, in the aggregate, of the interest in the project.

6. The Director will issue to the holder of the letter of approval a written decision approving or disapproving the transaction and setting forth the reasons for his or her decision.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 1-2-90; 10-14-97)

NAC 439A.495 Removal or alteration of conditions. (NRS 439A.081)

1. A person whose project has been approved subject to conditions may request the Director to remove or alter those conditions. The request must be submitted to the Director in writing and must include:

(a) A statement of each condition which is requested to be removed or altered; and

(b) For each such condition, specific identification and documentation of the current factors which:

(1) Were not in existence at the time of imposition of the condition; and

(2) Might warrant the removal or alteration of the condition.

2. Within 30 days after receipt of such a written request the Department will schedule and give notice of a public hearing.

3. Within 15 days after the close of the public hearing, the Director will make a decision and a letter signed by the Director containing the decision and the reasons therefor will be issued to the person whose project has been approved.

4. The Director will give public notice of the decision.

5. The procedures of this section also apply to the additional approval of a proposed change in the location of or an increase in the maximum capital expenditure for an approved project.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-25-86)

NAC 439A.505 Withdrawal of letter of approval. (NRS 439A.081, 439A.100)

1. Proceedings to withdraw a letter of approval may be initiated if the holder:

(a) Fails to meet the approved timetable set forth in the letter of approval or an extension thereof;

(b) Fails to comply with subsection 4 of NRS 439A.100 when a change requiring additional approval has occurred;

(d) Fails to execute the project as approved in the letter of approval;

(e) Violates the provisions of NAC 439A.485 regarding a transfer of interest;

(f) Violates the provisions of NAC 439A.465 regarding reports on progress, submission of information or access for inspection and examination; or

(g) Substantially, willfully or intentionally fails to comply with any other material provision of NAC 439A.295 to 439A.675, inclusive, related to the letter of approval.

2. If the Director determines that he or she has sufficient cause to initiate a proceeding for the withdrawal of a letter of approval, the Director will notify by certified mail the holder of the letter of approval of his or her intention to initiate proceedings for withdrawal. The notice will state in writing the reasons for the proposed withdrawal.

3. The Department will schedule and give public notice of a public hearing for a withdrawal.

4. The letter of approval is suspended upon the holder’s receipt of the notice of the public hearing for the withdrawal of the letter of approval. The suspension is effective until the proceeding for withdrawal is terminated or completed.

5. The holder of the letter of approval has 30 days from the date of receipt of the notification specified in subsection 2 in which to submit to the Director in writing any relevant documentation negating the reasons for the proposed withdrawal.

6. The Director will, within 15 days after the deadline for providing the information specified in subsection 2, determine whether the information provided by the holder of the letter of approval adequately negates the reasons for the proposed withdrawal.

7. If the Director determines that the holder of the letter has provided sufficient relevant information to negate the reasons for the proposed withdrawal, the Director will terminate the proceeding for withdrawal and inform the holder of the letter of approval of the decision by mail.

8. If the holder of a letter of approval fails to negate adequately the reasons for the proposed withdrawal, the Director will proceed with the public hearing for a withdrawal.

9. The decision of the Director will be made within 15 days after the close of the public hearing. A letter containing the decision and stating the reasons therefor, signed by the Director, will be issued to the holder of the letter of approval together with written findings of fact.

10. The Director will give public notice of the decision.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

Procedural Matters

NAC 439A.515 Reconsideration of decisions. (NRS 439A.081)

1. Any person:

(a) Who is the subject of a letter of disapproval;

(b) Whose project has been determined to be subject to review pursuant to NAC 439A.315; or

Ê may request reconsideration of the decision.

2. A request for reconsideration will be considered by the Director only if:

(a) It is submitted in writing within 30 days after the date on which the notice of the decision for which the reconsideration is being requested is posted in the manner required pursuant to NAC 439A.545; and

(b) It contains sufficient and adequate documentation of good cause for a reconsideration, which is limited to:

(1) The presentation of significant information relevant to a material issue which was not previously considered by the Director and which, with reasonable diligence, could not have been presented to the Director before the conclusion of the public hearing;

(2) A significant change in a factor or circumstance relied upon by the Director in reaching the decision; or

(3) A showing that the Department has materially failed to follow its procedures in reaching the decision.

3. The Director will, within 15 days after receipt of a request for reconsideration, determine whether good cause is shown as required under subsection 2.

4. If the request for reconsideration is denied, the Director will issue a letter to the person requesting the reconsideration stating the reasons for denial.

5. If the request for reconsideration is granted, the affected decision is set aside and the Director will issue a letter to the person requesting the reconsideration and the applicant or holder of the letter of approval stating the reasons for granting the request.

6. If the Director requests additional information in the letter issued pursuant to subsection 5, the person receiving the request has 15 days from the date of receipt to submit the information requested.

7. The Department will, within 15 days after the date on which reconsideration is granted, schedule and give public notice of a public hearing.

8. The public hearing may be waived upon a written request by the applicant or holder of the letter of approval if:

(a) The applicant or holder of the letter of approval is the only person requesting reconsideration; and

(b) The sole ground for the reconsideration is that the Department failed to follow the adopted procedures.

Ê If the public hearing is waived pursuant to this subsection, public notice of the reconsideration will be given.

9. The person requesting reconsideration shall appear at the public hearing personally or by a representative. If that person fails to appear, the hearing will not be held and the decision for which reconsideration was requested will be reinstated.

10. The decision of the Director will be issued to the applicant or holder of a letter of approval in a letter signed by the Director stating the reasons for the decision, together with written findings of fact, within 30 days after:

(a) The close of the public hearing; or

(b) The date of the granting of the request for reconsideration if the public hearing is waived pursuant to subsection 8.

11. The Director will give public notice of the decision upon reconsideration.

12. The decision of the Director upon reconsideration supersedes the original decision.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; A by Div. of Pub. & Behavioral Health by R022-20, 8-26-2020)

NAC 439A.525 Judicial review. (NRS 439A.081) A decision of the Director subject to reconsideration is a final decision for judicial review and a request for reconsideration is not a prerequisite for judicial review.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86)

NAC 439A.545 Provision of notice: Generally. (NRS 439A.081)

1. Unless otherwise required in NAC 439A.295 to 439A.675, inclusive, notice given pursuant to NAC 439A.295 to 439A.675, inclusive, will be made in accordance with this section.

2. Notice will be provided by mail or electronically to:

(a) The applicant or the holder of a letter of approval;

(b) The person requesting the proceeding for which the notice of the proceeding or the resulting decision is being given;

(c) All persons who have requested in writing or electronically that they be placed on a list for the purpose of receiving such notice; and

(d) Any health facility that:

(1) Holds a license, certificate or permit issued pursuant to chapter 449 of NRS;

(2) Is located in the service area of the proposed project; and

(3) Offers health services similar to those offered by the proposed project.

3. The notice will be provided to the public and all other interested persons by publication on the Internet website maintained by the Division of Public and Behavioral Health of the Department and by posting the notice in a public facility that is located in the area in which the project is located or will be located.

4. For decisions relating to a letter of intent or a letter of determination, the Department will provide the notice required by this section not later than 21 days after such a decision is made.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97; A by Div. of Pub. & Behavioral Health by R022-20, 8-26-2020)

NAC 439A.555 Provision of notice: Hearings. (NRS 439A.081) When a notice of a public hearing is made pursuant to NAC 439A.295 to 439A.675, inclusive, the notice will include:

1. The date of the public hearing;

2. The time and place of the hearing;

3. The nature of the hearing;

4. A statement of the legal authority and jurisdiction under which the hearing is to be held;

5. A reference to the particular sections of state statutes and regulations involved; and

6. A short and plain statement of the matters to be asserted.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; A by Div. of Pub. & Behavioral Health by R022-20, 8-26-2020)

Criteria for Review of Proposed Projects

NAC 439A.595 Burden of proof; applicability. (NRS 439A.081)

1. The applicant for a letter of approval has the burden of proof to satisfy all applicable criteria for review contained in NAC 439A.605 to 439A.637, inclusive.

2. A finding that the applicant has failed to meet its burden of proof regarding an applicable criterion will be made if:

(a) The applicant fails to provide sufficient, relevant, demonstrative evidence for a favorable determination; or

(b) The evidence on the record opposing the application outweighs the evidence in support of the application regarding the criterion.

3. The criteria for review are applicable to a proposed project if the project includes the construction, expansion, renovation, redesign or establishment of a facility to provide health services at a cost that is proposed to exceed, including the cost of equipment acquired for the new facility, expansion, renovation or redesign, $2,000,000.

4. If an application is denied on the basis of these criteria, the written findings of fact must clearly state the reason for that denial.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87; 1-2-90; 10-14-97; A by Dep’t of Health & Human Services by R150-15, 6-28-2016)

NAC 439A.605 Need for project to be undertaken. (NRS 439A.081) The applicant shall demonstrate that the population to be served has a need for the project to be undertaken, based upon:

1. The identification of the population to be served;

2. The projected numbers of persons who will have a need for the proposed service; and

3. A showing that the existing providers of the proposed service in the area cannot or will not meet the projected need of the population to be served.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87)

NAC 439A.625 Financial feasibility. (NRS 439A.081)

1. The applicant shall demonstrate that it will be able to operate in a manner which is financially feasible as a result of the proposed project without unnecessarily increasing the cost to the user or payor for health services provided by the applicant, by showing:

(a) That it will become financially self-supporting within 3 years after completion; or

(b) That the applicant’s total facility will be financially self-supporting within this period or that the financial viability of the facility will not be adversely affected by the proposed project.

2. The factors to be considered in determining whether an applicant has met its burden of proof include:

(a) The ability of the applicant to obtain any required financing for the proposed project;

(b) The extent to which the proposed financing may adversely affect the financial viability of the applicant’s facility because of its effect on the long-term and short-term debt of the applicant;

(c) The availability and degree of commitment to the applicant of the financial resources required to operate the proposed project until the project or the applicant’s facility becomes financially self-supporting;

(d) The relationship between the applicant’s estimated costs of operation, proposed charges and estimated revenues;

(e) The level at which the affected health services of the applicant must be used for the applicant to break even financially and the likelihood that those levels will be achieved;

(f) Whether the applicant’s projected costs of operation and charges are reasonable in relationship to each other and to the health services provided by the applicant; and

(g) Whether the projected revenues to be received by the applicant are likely to be achieved, including the availability of anticipated revenues from federal, state or local governmental programs if the applicant will be eligible for reimbursement from those programs.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87)

NAC 439A.635 Effect on cost of health services. (NRS 439A.081)

1. The applicant shall demonstrate that the proposed project will not have an unnecessarily adverse effect on the cost of health services to users or payors by showing that:

(a) The proposed project will result in a significant savings in costs to users or payors without an adverse effect on the quality of care; or

(b) If the proposed project will not result in a significant savings in costs to the user or payor for health services, the costs of the service are justified by:

(1) A clinical or operational need;

(2) A corresponding increase in the quality of care; or

(3) A significant reduction in risks to the health of the patients to be served by the applicant.

2. The factors to be considered in determining whether the applicant has met its burden of proof include:

(a) The added costs to the applicant resulting from any proposed financing for the proposed project;

(b) If the proposed project involves construction, remodeling or renovation, the relationship between the projected costs of that activity and the prevailing cost for similar construction, remodeling or renovation in the area;

(c) The health or other benefits to be received by users compared to the cost to users or payors resulting from the proposed project; and

(d) Whether alternative methods of providing the proposed service exist or are available which provide a greater benefit for the cost without adversely affecting the quality of care.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86; 11-10-87)

NAC 439A.637 Appropriateness for the area to be served. (NRS 439A.081, 439A.100) In determining whether the proposed project is appropriate for the area to be served, the Director will consider:

1. The location of the proposed project, including:

(a) The time for travel and distance to other facilities for required transfers of patients or transfers in the event of an emergency;

(b) The distance and the time for travel required for the population to be served to reach the applicant’s facility and other facilities providing similar services; and

2. The effect of the proposed project on the cost and quality of care provided by the existing system of health care in the area, based upon the extent to which:

(a) The proposed project is likely to stimulate competition which will result in a reduction in costs for the user or payor;

(b) The proposed project is likely to increase costs to the user or payor through reductions in market shares for services if those reductions would increase costs per unit of service; and

(c) The proposed project contains innovations or improvements in the delivery or financing of health services which will significantly reduce the cost of health care to the user or payor or enhance the quality of care.

3. If the proposed project involves the relocation of a health facility or the relocation of an existing service to another health facility, whether the need of the population currently being served will continue to be met.

4. Whether the proposed project is consistent with the existing system of health care, based upon:

(a) The effect of the proposed project on the availability and the cost in the area of the required personnel; and

(b) The extent to which the applicant will have adequate arrangements for referrals to and from other health facilities in the area which provide for:

(1) Avoidance of unnecessary duplication of effort;

(2) Regionalization of highly specialized health services;

(3) Comprehensive and continuous care of patients; and

(4) Communication and cooperation between related facilities or services.

5. The quality of care provided by the applicant for any existing health facility or service owned or operated by the applicant, based upon:

(a) Whether the applicant has had any adverse action taken against it with regard to any license or certificate held by the applicant and the results of that action;

(b) The extent to which the applicant has previously provided similar health services; and

6. The extent to which equal access by all persons in the area to the applicant’s facility or services will be provided, based upon:

(a) Whether any segment of the population in the area to be served will be denied access to health services similar to those proposed by the applicant as a result of the proposed project;

(b) The extent to which the applicant will provide uncompensated care, exclusive of bad debt, and the effect of the proposed project on the cost to local and state governments and other facilities for providing care to indigents; and

(c) The extent to which financial barriers to access by persons of low income, including any financial preconditions to providing service, will prevent those persons from obtaining needed health services.

(Added to NAC by Dep’t of Human Resources, eff. 3-6-86; A 11-10-87; 10-14-97)

NAC 439A.639 Health maintenance organizations. (NRS 439A.081, 439A.100) If the applicant is a health maintenance organization or the applicant proposes to provide a service only to a health maintenance organization, in addition to the criteria established in NAC 439A.595 to 439A.637, inclusive, the applicant must demonstrate that the proposed service is necessary to meet the needs of enrolled members and a reasonable number of anticipated members of the organization, based upon:

1. The identification of the special needs;

2. The number of enrolled members; and

3. The number of new members anticipated within the next year.

(Added to NAC by Dep’t of Human Resources, eff. 3-6-86; A 11-10-87; 10-14-97)

Miscellaneous Provisions

NAC 439A.645 Prohibited communications. (NRS 439A.081)

1. Communication concerning the subject matter of a hearing held pursuant to NAC 439A.295 to 439A.675, inclusive, is prohibited between:

(a) Any person acting on behalf of the applicant or holder of a letter of approval, or any person opposed to the issuance of or in favor of the withdrawal of a letter of approval; and

(b) Any person in the Department who exercises any responsibility concerning the application or its withdrawal, from the date of commencement of the public hearing until the decision on the subject matter of the hearing is rendered.

2. This prohibition includes any oral or written communication not on the public record, with respect to which reasonable prior notice to all parties is not given, not including requests for status reports on reviews being conducted.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84)

NAC 439A.655 Civil penalties. (NRS 439A.081, 439A.310)

1. Any penalty imposed pursuant to paragraph (a) of subsection 1 of NRS 439A.310 must be paid before the issuance of any license. The failure to pay a penalty is a ground for denial of an application for a letter of approval or withdrawal of a letter of approval.

2. If the Director determines that a person is subject to a penalty pursuant to NRS 439A.310, the Director will, before the imposition of the penalty:

(a) Afford the person a hearing to show cause why a penalty should not be imposed; and

(b) Send to the person, at least 20 days before the hearing, notice of the violation and hearing, which includes:

(1) The specific violation for which the Director proposes to impose a penalty, including a specific citation to the provision which is alleged to have been violated;

(2) The specific amount of the proposed penalty for each specified violation;

(3) The date, time and place scheduled for the hearing; and

(4) A statement of the rights of the person pursuant to chapter 233B of NRS.

3. The Director or a designee thereof will serve as the hearing officer and will render a decision no later than 10 working days after the close of the hearing.

4. The decision of the hearing officer will be made in writing and will include written findings of fact upon which the decision was based.

5. Notice of the decision will be provided to the person by mail.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86)

NAC 439A.665 Applicable regulations. (NRS 439A.081) The regulations in effect at the time of the acceptance of the application for review by the Department will be the regulations governing the entire administrative process for the application.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 3-6-86)

NAC 439A.670 Waiver of procedural provisions. (NRS 439A.081) The Department may waive or alter any procedural provision of NAC 439A.295 to 439A.675, inclusive, if the intent of that provision would not be carried out by its strict application.

(Added to NAC by Dep’t of Human Resources, eff. 11-10-87)

NAC 439A.675 Reports by Department; access to materials. (NRS 439A.081)

1. The Department will prepare and publish a report at least annually indicating the status of all applications and the decisions made on applications since the previous report.

2. The public will have access to all applications and other written materials pertaining to NAC 439A.295 to 439A.675, inclusive, except for materials which are required by law to be made confidential.

3. The Department may provide copies of materials requested pursuant to this section upon reimbursement for the costs of providing the copies.

(Added to NAC by Dep’t of Human Resources, eff. 9-4-84; A 1-2-90)—(Substituted in revision for NAC 439A.565.)

PHYSICIAN VISA WAIVER PROGRAM

NAC 439A.700 “Advisory Council” defined. (NRS 439A.170, 439A.175) As used in NAC 439A.700 to 439A.755, inclusive, unless the context otherwise requires, “Advisory Council” means the Primary Care Advisory Council created by NAC 439A.710.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011)

NAC 439A.710 Advisory Council: Creation; composition; designation of substitute; vacancies; meetings; appointment of subcommittee authorized. (NRS 439A.170, 439A.175)

1. The Primary Care Advisory Council is hereby created within the Division of Public and Behavioral Health. The Advisory Council consists of members appointed by the Administrator as follows:

(a) One member who represents the Nevada Primary Care Association, or a successor organization;

(b) One member who represents a federally qualified health center in this State;

(d) One member who is a physician licensed in good standing pursuant to chapter 630 of NRS and who has successfully completed an employment contract under the Program;

(e) One member who represents the Nevada State Medical Association, or its successor organization;

(f) Members who are health care professionals; and

(g) Representatives from the communities being served by the Program.

2. In addition to the members appointed pursuant to subsection 1, the Administrator may appoint nonvoting members from the Division of Public and Behavioral Health or other governmental agencies who have knowledge of and experience in health care and the Program.

3. Each member of the Advisory Council serves for a term of 2 years. A member may be reappointed.

4. Each member of the Advisory Council may designate a person to attend a meeting in place of the member. Such a designation must be made in accordance with NRS 241.025.

5. If a vacancy occurs during the term of a member, the Administrator shall appoint a person similarly qualified to replace that member for the remainder of the unexpired term.

6. The Advisory Council shall meet at least annually and at such other times as specified by a call of the Chair.

7. At the first meeting, and biennially thereafter, the Advisory Council shall select a Chair from among its members.

8. The Chair of the Advisory Council may appoint a subcommittee to review applications, complaints and policies and procedures of the Program and make recommendations to the Advisory Council.

9. As used in this section, “federally qualified health center” has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011; A by R151-15, 6-28-2016)

NAC 439A.715 Advisory Council: Duties. (NRS 439A.170, 439A.175) The Advisory Council shall review and make recommendations to the Administrator concerning:

1. The approval or denial of applications for letters of support filed with the Administrator pursuant to NAC 439A.725.

2. The disposition of complaints submitted to the Program pursuant to NAC 439A.745.

3. The policies and procedures of the Program.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011)

NAC 439A.720 Application for letter of support: Requirements; request for waiver of portion of application fee; refund of all or portion of fee; where available. (NRS 439.200, 439A.170, 439A.175)

1. An application for a letter of support must:

(a) Be complete.

(b) Include the materials required by subsection 1 of NRS 439A.175.

(d) Contain the notarized signatures of the employer and the J-1 visa physician.

(e) Except as otherwise provided in subsection 2, be accompanied by the application fee pursuant to NAC 439A.728. At least one-half of the fee must be paid by the employer.

2. The Administrator may waive any portion of the application fee which must be paid by the J-1 visa physician or require the J-1 visa physician to pay that portion of the application fee pursuant to a payment plan if the J-1 visa physician is experiencing an economic hardship and the J-1 visa physician submits with the application documentation sufficient to demonstrate that the economic hardship exists.

3. The application fee will not be refunded if the Administrator does not issue a letter of support for the applicant. The Administrator may refund all or any portion of the application fee paid by the J-1 visa physician and the employer if:

(a) The application is withdrawn before the Administrator has made a determination whether to issue a letter of support; or

(b) At the time the application is received by the Division, all the available spots for enrollment of J-1 visa physicians in the Program have been filled for that fiscal year.

4. An employer or a J-1 visa physician may obtain an application for a letter of support from the Division of Public and Behavioral Health on the Internet website maintained by the Division or by submitting a written request for an application to the Primary Care Office of the Division at the address posted on the Internet website maintained by the Division.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011; A by R151-15, 6-28-2016; R017-20, 8-26-2020)

NAC 439A.725 Application for letter of support: Submission; review by Advisory Council; responsibilities of Administrator. (NRS 439.200, 439A.170, 439A.175)

1. An application for a letter of support must be filed with the Administrator by personal delivery, commercial carrier or mail.

2. The Advisory Council may review an application submitted pursuant to this section for completeness and compliance with the provisions of NRS 439A.130 to 439A.185, inclusive, and NAC 439A.700 to 439A.755, inclusive.

3. Applications must be reviewed in the order in which they were received.

4. The Administrator is responsible for the review and the approval or denial of all applications. The Administrator shall provide notice of the approval or denial of an application to the applicant. If an application is incomplete, the Administrator shall provide notice to the applicant within 14 days after receipt of the application and provide a written explanation of the missing information or documentation. An application may be resubmitted with the additional required information or documentation.

5. The Administrator shall accept applications pursuant to this section until all available spots for enrollment of J-1 visa physicians in the Program have been filled. The Administrator shall post the status of the number of available spots for enrollment on the Internet website maintained by the Division of Public and Behavioral Health.

6. The Administrator shall not issue a letter of support to:

(a) An employer for which the Administrator has withdrawn the support of the Division of Public and Behavioral Health pursuant to NAC 439A.750.

(b) A J-1 visa physician who was determined by the Administrator to have violated a provision of NRS 439A.130 to 439A.185, inclusive, or NAC 439A.700 to 439A.755, inclusive, or convicted of a violation of a federal statute or regulation relating to immigration within the immediately preceding 2 years.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011; A by R151-15, 6-28-2016; R017-20, 8-26-2020)

NAC 439A.728 Application fee. (NRS 439.150, 439.200, 439A.170, 439A.175) Except as otherwise provided in NAC 439A.720, the application fee for a letter of support from the Division of Public and Behavioral Health is:

1. For a nonprofit organization, $1,000.

2. For all other applicants, $2,000.

(Added to NAC by Bd. of Health by R151-15, eff. 6-28-2016; A by R017-20, 8-26-2020)

NAC 439A.730 Contract between employer and J-1 visa physician: Requirements; transfer to different employer; liquidated damages. (NRS 439.200, 439A.170, 439A.175)

1. In addition to the requirements of subsection 2 of NRS 439A.175, the contract entered into by the employer and the J-1 visa physician must:

(a) Except as otherwise provided in subsection 2, require the J-1 visa physician to begin work within 90 days after receipt of the J-1 visa waiver.

(b) Except as otherwise provided in subsection 2, be for a term of at least 3 years.

(c) Provide that the J-1 visa physician will work a minimum of 40 hours each week at the location identified on the petition submitted by the J-1 visa physician to the Waiver Review Division of the United States Department of State.

(d) Specify the wage that the J-1 visa physician will earn. The wage must not be less than the prevailing wage determined by the Office of Foreign Labor Certification of the United States Department of Labor, which may be found on the Internet website maintained by the Foreign Labor Certification Data Center.

(e) Contain the signatures of the employer and the J-1 visa physician and the date on which the contract was signed by each person.

(f) Identify the conditions for termination of the contract, which must not include a provision authorizing termination without cause.

2. If a J-1 visa physician is transferred to a different employer pursuant to NAC 439A.750, the contract entered into by the employer to which the J-1 visa physician is transferred and the J-1 visa physician must comply with paragraphs (c) to (f), inclusive, of subsection 1 and:

(a) Require the J-1 visa physician to begin work within 90 days after receiving notice that the transfer was granted; and

(b) Be for a term sufficient for the J-1 visa physician to complete the obligation associated with the J-1 visa waiver.

3. A contract entered into by an employer and a J-1 visa physician may contain a clause for liquidated damages. If a contract entered into by an employer and a J-1 visa physician contains a clause for liquidated damages, the employer may not receive liquidated damages if the contract is terminated by the J-1 visa physician before the end of the contract because the employer has violated a provision of the contract, NRS 439A.130 to 439A.185, inclusive, or NAC 439A.700 to 439A.755, inclusive.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011; A by R017-20, 8-26-2020)

NAC 439A.735 Employer: Duties. (NRS 439.200, 439A.170, 439A.175) An employer shall:

1. Offer fees based on a sliding scale to patients whose income is at or below 200 percent of the federally designated level signifying poverty.

2. Ensure that the J-1 visa physician works only in a location approved by the Administrator.

3. Post a sign in the waiting room of each location where the J-1 visa physician works or provide written notice to each patient which states that:

(a) Fees based on a sliding scale are available for certain patients who have demonstrated a financial need for assistance to pay for care and services.

(b) Patients will be provided care and services regardless of the ability of the patient to pay.

4. Provide documentation satisfactory to the Division of Public and Behavioral Health that the employer participates in Medicaid, Medicare and Nevada Check Up.

5. File the schedule of fees with the Administrator for review.

6. Submit an affidavit to the Administrator once every 6 months which attests that the J-1 visa physician worked at least 40 hours each week at a location approved by the Administrator.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011; A by R017-20, 8-26-2020)

NAC 439A.740 J-1 visa physician: Duties and requirements. (NRS 439.200, 439A.170, 439A.175) A J-1 visa physician must be in the final year of residency or a fellowship program or be requesting a transfer from the J-1 visa waiver program of another state and shall:

1. Comply with the requirements of 8 U.S.C. § 1184(k).

2. If the J-1 visa physician will prescribe or dispense controlled substances:

(a) Obtain any certificate or registration required by chapters 453 and 639 of NRS and any regulations adopted pursuant thereto; and

(b) Register with the Drug Enforcement Administration of the United States Department of Justice.

3. Accept patients who are enrolled in Medicaid, Medicare or Nevada Check Up.

4. Provide care and services based on the sliding scale of fees filed with the Administrator pursuant to subsection 5 of NAC 439A.735.

5. Only work in a location approved by the Administrator.

6. Submit an affidavit to the Administrator once every 6 months which attests that the J-1 visa physician worked at least 40 hours each week at a location approved by the Administrator.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011; A by R017-20, 8-26-2020)

NAC 439A.745 Complaints: Submission; investigation; determination of Administrator. (NRS 439.200, 439A.170, 439A.180)

1. A complaint about an employer or a J-1 visa physician may be submitted to the Program on the Internet website maintained by the Division of Public and Behavioral Health or by submitting a written complaint to the Primary Care Office of the Division at the address posted on the Internet website maintained by the Division.

2. The Administrator shall investigate each complaint submitted pursuant to this section. The investigation must commence within 45 days after receipt of the complaint, except that if the complaint alleges that the safety of a patient was threatened, the investigation must commence as soon as practicable.

3. If the Administrator determines that a violation of NRS 439A.130 to 439A.185, inclusive, or NAC 439A.700 to 439A.755, inclusive, has occurred, the Administrator:

(a) Shall, if the violation affected the health and safety of a patient, submit a report to the Board of Medical Examiners or the Bureau of Health Care Quality and Compliance of the Division of Public and Behavioral Health; or

(b) May, if the violation did not affect the health or safety of a patient, submit a report to the Board of Medical Examiners or to the Bureau of Health Care Quality and Compliance of the Division of Public and Behavioral Health.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011; A by R151-15, 6-28-2016; R017-20, 8-26-2020)

NAC 439A.750 Violations. (NRS 439.200, 439A.170, 439A.180)

1. If an employer violates the provisions of NRS 439A.130 to 439A.185, inclusive, or NAC 439A.700 to 439A.755, inclusive, the Administrator may:

(a) For a first offense, impose an administrative fine of $1,000.

(b) For a second or subsequent offense, impose an administrative fine of $10,000.

(c) Withdraw the support of the Division of Public and Behavioral Health for the employer and assist in the transfer of the J-1 visa physician to a different employer pursuant to subsection 2.

2. If an employer is penalized pursuant to paragraph (c) of subsection 1:

(a) The Administrator shall assist in the transfer of the J-1 visa physician to a different employer, including, without limitation, submitting a letter to the J-1 visa physician which documents the reasons for the transfer and providing documentation for designating a new location in which the J-1 visa physician may work. The Administrator may notify the United States Citizenship and Immigration Services of the withdrawal of support and recommend to the United States Citizenship and Immigration Services that the J-1 visa physician be transferred to a different employer in this State.

(b) The employer may apply to the Administrator to request reinstatement of support not sooner than 2 years after the date on which support is withdrawn. The application must include, without limitation:

(1) A detailed description of changes concerning management or policy which the employer has made to protect the interests of any J-1 visa physicians to be employed by the employer; and

(2) An attestation that each person who has responsibility for any part of the operation or management of the employer has reviewed and agreed to comply with all federal and state requirements relating to the Program.

3. If a J-1 visa physician does not comply with the provisions of NRS 439A.130 to 439A.185, inclusive, and NAC 439A.700 to 439A.755, inclusive, the Administrator may report the failure to comply to the United States Citizenship and Immigration Services and recommend that the J-1 visa waiver of the J-1 visa physician be revoked.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011; A by R017-20, 8-26-2020)

NAC 439A.755 Hearing. (NRS 439A.170, 439A.180) A J-1 visa physician or an employer may request a hearing on any action taken by the Administrator pursuant to subsection 3 of NAC 439A.745 or 439A.750. The hearing must be conducted in accordance with the procedures set forth in NAC 439.300 to 439.395, inclusive.

(Added to NAC by Bd. of Health by R138-10, eff. 5-5-2011)

PROGRAMS TO INCREASE AWARENESS OF INFORMATION CONCERNING HOSPITALS AND SURGICAL CENTERS FOR AMBULATORY PATIENTS

REVISER’S NOTE.

Pursuant to the provisions of NRS 0.024, former NAC 439A.800 contained definitions that were deemed duplicative of those set forth in NRS 439A.210 and was removed from chapter 439A of NAC in accordance with ch. 56, Stats. 2009, which contains the following provision not included in NRS:

NAC 439A.810 Information concerning surgical centers for ambulatory patients: Requirements for submission of information to Department; confidential information. (NRS 439A.250)

1. Each surgical center for ambulatory patients shall prepare and submit to the Department, for each outpatient treated by the surgical center during each calendar month, the most recent universal billing form specified by the Centers for Medicare and Medicaid Services in an electronic format specified by the Department. Except as otherwise provided in NAC 439A.815, the surgical center shall submit the required information not later than 45 days after the last day of each calendar month.

2. The Department, and any person with whom the Department enters into a contract for the development and operation of its universal billing data system, shall not disclose any information from the data system which reveals the identity of a specific outpatient of a surgical center.

(Added to NAC by Dep’t of Health & Human Services by R151-08, 12-17-2008, eff. 5-20-2009)

NAC 439A.815 Information concerning surgical centers for ambulatory patients: Request for extension of time for submission of information. (NRS 439A.250)

1. A surgical center for ambulatory patients may submit to the Director a written request to submit the information required pursuant to NAC 439A.810 more than 45 days after the last day of a calendar month. Each request must be submitted in the form and within the time period required by the Department.

2. The Director shall review each request submitted pursuant to subsection 1 and determine whether to grant the request.

3. If the Director determines that an extension of the time for submission is appropriate, the Director shall provide written notice to the surgical center, including the date by which the information required pursuant to NAC 439A.810 must be submitted.

(Added to NAC by Dep’t of Health & Human Services by R151-08, 12-17-2008, eff. 5-20-2009)

NAC 439A.820 Information concerning surgical centers for ambulatory patients: Notification by Department that information is incomplete; effect of failure to submit complete information. (NRS 439A.250)

1. If a surgical center fails to submit the information required pursuant to NAC 439A.810 or if the Department determines that the information is incomplete or inaccurate, the Department will notify the surgical center pursuant to subsection 3 of NRS 439A.250.

2. If a surgical center is notified pursuant to subsection 1, the surgical center shall submit the required information to the Department within 30 days after receipt of the notice. If the surgical center does not submit the required information within 30 days, the Department may send to the Division of Public and Behavioral Health of the Department a written notice of failure to comply and request that the Division take appropriate disciplinary action against the surgical center, including, without limitation, the imposition of an administrative penalty.

(Added to NAC by Dep’t of Health & Human Services by R151-08, 12-17-2008, eff. 5-20-2009)

NAC 439A.825 Information concerning surgical centers for ambulatory patients: Department to determine and make publicly available list of 50 medical treatments for outpatients of surgical centers to be included in program. (NRS 439A.250)

1. For purposes of paragraph (d) of subsection 2 of NRS 439A.240, the Department will:

(a) Determine and make publicly available a list of the 50 medical treatments for outpatients of surgical centers for ambulatory patients that will be included in the program to increase public awareness of health care information concerning surgical centers for ambulatory patients; and

(b) Review the list of 50 medical treatments once every 2 years and update the list as the Department determines necessary.

2. When selecting and updating the list of 50 medical treatments for outpatients of surgical centers pursuant to subsection 1, the Department will consider, without limitation:

(a) Recommendations of the State Board of Health;

(b) Input received from the general public; and

(c) The medical treatments for outpatients of surgical centers that were most frequently performed by the surgical centers in this State during the immediately preceding 2 years, as reported on the universal billing forms submitted pursuant to NAC 439A.810.

(Added to NAC by Dep’t of Health & Human Services by R151-08, eff. 12-17-2008)

NAC 439A.830 Information concerning hospitals: Department to determine and make publicly available lists of diagnosis-related groups for inpatients of hospitals and 50 medical treatments for outpatients of hospitals to be included in program. (NRS 439A.220, 439A.230)

1. For purposes of paragraph (d) of subsection 2 of NRS 439A.220, the Department will:

(a) Determine and make publicly available a list of the diagnosis-related groups for inpatients of hospitals that will be included in the program to increase public awareness of health care information concerning hospitals;

(b) Determine and make publicly available a list of the 50 medical treatments for outpatients of hospitals that will be included in the program to increase public awareness of health care information concerning hospitals; and

2. When selecting and updating the list of the diagnosis-related groups pursuant to paragraph (a) of subsection 1, the Department will use the information reported on the universal billing forms submitted pursuant to NAC 449.963.

3. When selecting and updating the list of the 50 medical treatments for outpatients of hospitals pursuant to paragraph (b) of subsection 1, the Department will consider, without limitation:

(a) Recommendations of the State Board of Health;

(b) Input received from the general public; and

(c) The medical treatments for outpatients of hospitals that were most frequently performed by the hospitals in this State during the immediately preceding 2 years, as reported on the universal billing forms submitted pursuant to NAC 449.963.

4. As used in this section, “diagnosis-related group” has the meaning ascribed to it in NRS 439A.220.

(Added to NAC by Dep’t of Health & Human Services by R151-08, eff. 12-17-2008; A by Div. of Health Care Fin. & Policy by R099-12, 10-4-2013)

NAC 439A.835 Internet website for information concerning hospitals and surgical centers for ambulatory patients: Duties of Department. (NRS 439A.270, 439A.290) The Department will:

1. Update the information contained on the Internet website established and maintained pursuant to NRS 439A.270 at least quarterly.

2. At least once every 2 years, review the information contained on the Internet website established and maintained pursuant to NRS 439A.270 to determine whether the information or the Internet website should be expanded, modified or otherwise altered. In making such determination, the Department will consider, without limitation, whether new measures of quality have been endorsed by the Agency for Healthcare Research and Quality of the United States Department of Health and Human Services, the National Quality Forum, the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, a quality improvement organization of the Centers for Medicare and Medicaid Services or The Joint Commission.

3. Before including any information on the Internet website established and maintained pursuant to NRS 439A.270, use nationally accepted standards to audit the health information to ensure the completeness and accuracy of the information.

4. Provide on the Internet website established and maintained pursuant to NRS 439A.270 a link to the Internet website of the Division of Public and Behavioral Health of the Department which contains information on sentinel events reported pursuant to NRS 439.800 to 439.890, inclusive.

5. Provide on the Internet website established and maintained pursuant to NRS 439A.270 a report of potentially preventable readmissions of patients who received acute care hospital services from a hospital other than a critical access hospital, using the information reported on the universal billing forms submitted pursuant to NAC 449.963. The Department will annually update the report provided pursuant to this subsection.

6. To the extent that money is available for that purpose, provide on the Internet website established and maintained pursuant to NRS 439A.270 the name of each physician who performed a surgical procedure in a hospital or surgical center for ambulatory patients in this State and the total number of surgical procedures performed by the physician, reported by principal diagnosis and, if the information is available, by diagnosis-related group.

7. As used in this section:

(a) “Acute care hospital services” means services ordinarily furnished in a hospital for the care and treatment of an inpatient under the direction of a physician or dentist which are furnished in an institution that:

(1) Is maintained primarily for the care and treatment of patients with disorders other than mental illness;

(2) Is licensed as a hospital by the Division of Public and Behavioral Health of the Department;

(3) Meets the requirements for participation as a provider for Medicare; and

(4) Has in effect a utilization review plan for any patient who is a recipient of Medicaid which complies with 42 C.F.R. § 482.30.

(b) “Critical access hospital” means a hospital which has been certified as a critical access hospital by the Secretary of Health and Human Services pursuant to 42 U.S.C. § 1395i-4(e).

(Added to NAC by Dep’t of Health & Human Services by R151-08, eff. 12-17-2008; A by Div. of Health Care Fin. & Policy by R099-12, 10-4-2013)

NAC 439A.840 Request for information. (NRS 439A.290)

1. A person may submit to the Department a written request for the review and release of information collected and maintained by the Department pursuant to NRS 439A.200 to 439A.290, inclusive, and NAC 439A.800 to 439A.840, inclusive.

2. If the request is for the purpose of research, the Department will grant the review and release of the information.

3. If the request is for purposes other than research, the Department will consider the request and determine whether to grant the review and release of the information.

4. The Department will ensure that information reviewed or released pursuant to this section does not disclose any information which reveals the identity of a specific patient of a hospital or surgical center for ambulatory patients.

(Added to NAC by Dep’t of Health & Human Services by R151-08, eff. 12-17-2008)