NAC: CHAPTER 442 - MATERNAL AND CHILD HEALTH; ABORTION

[Rev. 12/7/2018 12:55:43 PM]

[NAC-442 Revised Date: 12-18]

CHAPTER 442 - MATERNAL AND CHILD HEALTH; ABORTION

GENERAL PROVISIONS

442.005 “Licensed dietitian” defined.

442.010 Severability.

CHILDBIRTHS AT HOME

442.017 Methods of sterilization.

442.018 Sanitary practices.

BLOOD SAMPLES FROM INFANTS

442.020 Definitions.

442.030 Taking of blood sample required; mailing of newborn screening test kit.

442.035 Transfer of infant from hospital or obstetric center: First blood sample.

442.040 Taking of second blood sample required.

442.044 Additional blood samples: Infant receiving extended care; blood transfusions.

442.046 Abnormal or questionable blood test: Additional blood sample and tests required; evaluation of child by physician.

442.050 Duties of nurse in charge or person legally responsible for registering birth of child; completion of newborn screening collection form required when blood sample not taken.

INFORMATION CONCERNING BIRTH DEFECTS AND ADVERSE BIRTH OUTCOMES

442.052 Definitions.

442.054 Review of certain records; identification and contact of patient.

442.056 Notice of inclusion of certain information in system; request for exclusion of name of patient.

442.058 Access to and confidentiality of information in system.

INFORMATION OBTAINED IN ADMINISTRATION OF PROGRAMS

442.060 Confidential records.

442.070 Chief Medical Officer to control information.

442.080 Chief of Bureau of Children’s Services to inform employees of policy.

442.090 Chief Medical Officer to establish procedures for enforcement.

ABORTION

442.100 Definitions.

442.110 “Abortion” defined.

442.120 “Commencement of pregnancy” defined.

442.130 “First trimester” defined.

442.140 “Health” defined.

442.150 “Physician” defined.

442.160 “Second trimester” defined.

442.170 “Third trimester” defined.

442.180 Required training of counselor; verification by attending physician.

442.190 Follow-up physical examinations.

442.200 Reports.

FEES OF DIVISION OF PUBLIC AND BEHAVIORAL HEALTH

442.210 Fees for certain early intervention services provided to infant or toddler with disability.

442.222 Sliding schedule of fees for certain services and supplies concerning family planning.

PROVISION OF NEONATAL CARE BY HOSPITAL

General Provisions

442.250 Definitions.

442.255 “Advanced practice registered nurse” defined.

442.270 “Division” defined.

442.290 “Hospital” defined.

442.306 “Level I basic care facility” defined.

442.308 “Level II specialty care facility” defined.

442.310 “Level III subspecialty care facility” defined.

442.321 “Neonate” defined.

442.330 “Neonatologist” defined.

442.341 “Pediatrician” defined.

442.350 “Program” defined.

442.370 Adoption by reference of certain publications; revision of publications after adoption.

Levels of Care

442.380 Level I basic care facilities: General requirements.

442.390 Level II specialty care facilities: General requirements.

442.401 Level III subspecialty care facilities: General requirements.

442.405 Level II specialty care facilities and level III subspecialty care facilities: Additional requirements.

Designation of Hospital as Neonatal Facility

442.411 Application; fee; requirements for provision of obstetrical services.

442.415 Accompaniment of application with letter of approval.

442.430 Level III subspecialty care facilities: Requirements for designation.

442.440 Level III subspecialty care facilities: System required for education, consultation, referral and continuing care.

442.461 Reporting requirements; provision of access for inspection.

442.471 Periodic examination of sites and review of performance.

442.480 Provision of certain new services: Requirements for approval; period of approval.

442.501 Denial, suspension or revocation of right to provide care: Grounds.

442.511 Denial, suspension or revocation of right to provide care: Notice; appeal.

442.520 Revocation of designation: Grounds.

442.530 Revocation of designation: Procedure.

Miscellaneous Provisions

442.540 Acceptance of neonate without regard to ability of parents or guardian to pay.

442.550 System of cooperation among facilities; records of problems and solutions discussed.

SERVICES UNDER SOCIAL SECURITY ACT

General Provisions

442.600 Definitions.

442.602 “Activities of daily living” defined.

442.603 “Acute care” defined.

442.605 “Administrator” defined.

442.614 “Ambulatory or outpatient services” defined.

442.616 “Annually” defined.

442.617 “Bureau” defined.

442.619 “Chief” defined.

442.620 “Chronic” defined.

442.625 “Client” defined.

442.635 “Diagnostic evaluation” defined.

442.637 “Disabling condition” defined.

442.638 “Division” defined.

442.639 “Eligible condition” defined.

442.640 “Eligible medical condition” defined.

442.660 “High-risk pregnancy” defined.

442.662 “Hospital” defined.

442.663 “Household” defined.

442.665 “Inpatient” defined.

442.670 “Medicaid” defined.

442.676 “Medical facility” defined.

442.680 “Medical review” defined.

442.685 “Medical services” defined.

442.687 “Memorandum of understanding” defined.

442.688 “Nevada Check Up” defined.

442.690 “Physician” defined.

442.694 “Primary care” defined.

442.696 “Prognosis” defined.

442.700 “Program” defined.

442.702 “Program specialist” defined.

442.705 “Provider” defined.

442.707 “Residence” defined.

442.708 “Resident” defined.

442.710 Eligibility of clients under program.

442.711 Report by applicant of receipt of child support; application for assistance in obtaining child support.

442.712 Receipt of donations, judgments or settlements.

442.715 Eligibility of providers under program.

442.718 Prohibition against discrimination.

442.720 Format of forms to be used.

442.725 Date of eligibility for participation; submission of application; annual updates.

442.751 Limitations of program.

442.765 Grounds for terminating eligibility of client.

442.770 Submission and contents of claims.

442.775 Payment or denial of claim for medical services: Notification of denial to provider; procedure for review of denial and appeal of decision of Bureau.

442.780 Denial of medical services: Notification of applicant or client; procedure for review of denial and appeal of decision of Bureau.

Services for Children With Special Health Care Needs

442.782 Eligibility for medical services.

442.784 Eligible medical conditions: Categories; identification.

442.786 Ineligible conditions and services.

442.788 Payment for dietary supplements and medications; additional covered services.

SCREENING OF HEARING OF NEWBORN CHILDREN

442.850 Annual reports to Division of Public and Behavioral Health: Contents.

442.860 Referral of child for certain services: Notification of Division of Public and Behavioral Health.

GENERAL PROVISIONS

NAC 442.005 “Licensed dietitian” defined. (NRS 439.200) As used in this chapter, unless the context otherwise requires, “licensed dietitian” has the meaning ascribed to it in NRS 640E.040.

(Added to NAC by Bd. of Health by R090-12, eff. 12-20-12)

NAC 442.010 Severability. (NRS 439.200) If any of the provisions of this chapter or any application thereof to any person, thing, or circumstance is held invalid, it is intended that such invalidity not affect the remaining provisions, or their application, that can be given effect without the invalid provision or application.

[Bd. of Health, Abortion Reg. § 4.1, eff. 2-24-78]

CHILDBIRTHS AT HOME

NAC 442.017 Methods of sterilization. (NRS 439.200) The instruments used to assist a woman in labor or during the delivery of a baby in a home must be sterilized by:

1. Washing the instruments in a solution of glutaraldehyde;

2. Heating instruments which are not made of glass at 320°F (160°C) for 2 hours;

3. Heating instruments which are made of glass at 400°F (240°C) for 30 minutes; or

4. Heating the instruments in moist heat, for example, in a pressure cooker, at 15 pounds for 30 minutes.

(Added to NAC by Bd. of Health, eff. 12-16-82)

NAC 442.018 Sanitary practices. (NRS 439.200) Any person attending to a childbirth in a home shall:

1. Wash his or her hands with a bacteriocidal solution for at least 5 minutes immediately before attending to the prospective mother;

2. Cover his or her hair adequately;

3. Wear sterile, disposable gloves;

4. Use a sterile underpad for the mother and a sterile blanket for the newborn;

5. Prepare the perineal area with a bacteriocidal solution such as povidone-iodine;

6. Use instruments which are sterilized according to NAC 442.017; and

7. Exclude all observers or attendants who have a history of exposure to or symptoms of a contagious disease.

(Added to NAC by Bd. of Health, eff. 12-16-82)

BLOOD SAMPLES FROM INFANTS

NAC 442.020 Definitions. (NRS 442.008) As used in NAC 442.020 to 442.050, inclusive:

1. “Hospital” means a medical facility as defined in NRS 449.0151.

2. “Obstetric center” has the meaning ascribed to it in NRS 449.0155.

3. “State Public Health Laboratory” means the State Public Health Laboratory maintained by the University of Nevada School of Medicine pursuant to NRS 439.240.

[Bd. of Health, Metabolic Error Screening of Newborns Reg. § 1.1, eff. 12-27-77] — (NAC A 10-23-87; R033-16, 11-2-2016)

NAC 442.030 Taking of blood sample required; mailing of newborn screening test kit. (NRS 442.008)

1. Except as otherwise provided in NAC 442.035, every hospital or obstetric center in which an infant is born must take a heel stick blood sample from the infant before he or she is discharged from the hospital or obstetric center. The sample must be taken not later than the seventh day of the infant’s life regardless of the feeding status of the infant. If an infant is discharged before he or she is 48 hours of age, the hospital or obstetric center must take a heel stick blood sample as close as possible to the time of the infant’s discharge from the hospital or obstetric center.

2. The sample must be placed in a newborn screening test kit obtained from the State Public Health Laboratory and must be mailed to the address indicated on the kit within 24 hours after the sample is taken.

3. If an infant is not born in a hospital or obstetric center, the person who is legally responsible for registering the birth of the child must have a physician, hospital, public health nurse or the State Public Health Laboratory take the first blood sample between the 3rd and 7th day and the second blood sample between the 15th and 56th day of the infant’s life.

4. As used in this section, “heel stick blood sample” means a small amount of blood obtained by means of a small puncture made to the heel of an infant.

[Bd. of Health, Metabolic Error Screening of Newborns Reg. §§ 2.1-2.3, eff. 12-27-77] — (NAC A 10-23-87; 10-10-90; R033-16, 11-2-2016)

NAC 442.035 Transfer of infant from hospital or obstetric center: First blood sample. (NRS 442.008) If an infant is transferred from a hospital or obstetric center to another hospital or obstetric center:

1. During the first 2 days of life, the hospital or obstetric center which receives the infant shall take the first blood sample from the infant.

2. After the first 2 days of life, the hospital or obstetric center which transfers the infant shall take the first blood sample from the infant before transferring the infant.

(Added to NAC by Bd. of Health, eff. 10-23-87)

NAC 442.040 Taking of second blood sample required. (NRS 442.008) If an infant is born in a hospital or obstetric center, a second blood sample must be taken from the infant as follows:

1. For an infant whose first blood sample was taken within 48 hours of birth, between the 5th and 14th day of life.

2. For an infant whose first blood sample was taken between the 3rd and 7th day of life, between the 15th and 56th day of life.

Ê The hospital or obstetric center must require the parent or guardian of the infant to sign a statement that he or she will take the infant to a hospital, physician, public health nurse or the State Public Health Laboratory during the period prescribed in this section to repeat the test.

[Bd. of Health, Metabolic Error Screening of Newborns Reg. §§ 3.1-3.4, eff. 12-27-77] — (NAC A 10-23-87)

NAC 442.044 Additional blood samples: Infant receiving extended care; blood transfusions. (NRS 442.008)

1. Each hospital in which an infant receives care for more than 15 consecutive days shall take a second blood sample from the infant before the infant is discharged from that hospital.

2. A blood sample must be taken from any infant, regardless of age, who requires an additive blood transfusion or a partial or complete exchange blood transfusion before the transfusion is begun. A second blood sample must be taken from the infant between the 3rd and 7th day after the transfusion is completed.

(Added to NAC by Bd. of Health, eff. 10-23-87)

NAC 442.046 Abnormal or questionable blood test: Additional blood sample and tests required; evaluation of child by physician. (NRS 442.008)

1. Upon notification by the State Public Health Laboratory that a test is abnormal or questionable, the child’s physician or the person who is legally responsible for registering the birth of the child shall cause to have taken an additional blood sample and any additional tests which are required to evaluate the possible abnormality and shall report that action to the State Public Health Laboratory.

2. The parent or guardian of an infant with an abnormal or questionable test result shall upon notification promptly take the child to a physician who shall ensure that a quantitative evaluation of the problem indicated by the test result is performed.

3. The person taking the blood sample shall:

(a) Provide all available information including:

(1) The name and gender of the infant and the name and address of the mother;

(2) The feeding history of the infant;

(3) The gestational age of the infant at birth;

(4) The age of the infant at the time of testing;

(5) The use of antibiotics or hyperalimentation; and

(6) Any additional information the State Public Health Laboratory may require.

(b) Obtain a sufficient blood sample to ensure adequate diagnostic testing on the infant.

(Added to NAC by Bd. of Health, eff. 10-23-87; A by R033-16, 11-2-2016)

NAC 442.050 Duties of nurse in charge or person legally responsible for registering birth of child; completion of newborn screening collection form required when blood sample not taken. (NRS 442.008)

1. The nurse in charge or the person legally responsible for registering the birth of the child shall:

(a) Determine that a blood sample has been properly drawn, executed and placed in a newborn screening test kit obtained pursuant to NAC 442.030 before an infant is discharged from the hospital.

(b) Ensure that the blood sample is mailed within 24 hours after it is drawn.

(d) Ensure that the report required by NRS 442.040 is completed and signed by the parent or guardian.

2. A hospital or obstetric center shall complete a newborn screening collection form obtained from the State Public Health Laboratory if a blood sample is not taken from an infant before his or her discharge from the hospital or obstetric center, unless the infant is transferred to a hospital that provides a higher level of neonatal care. The hospital or obstetric center shall send the newborn screening collection form indicating that a blood sample was not taken from an infant to the State Public Health Laboratory within 2 working days after the infant is discharged from the hospital or obstetric center.

[Bd. of Health, Metabolic Error Screening of Newborns Reg. §§ 4.1 & 4.2, eff. 12-27-77] — (NAC A 10-23-87; 10-10-90; R033-16, 11-2-2016)

INFORMATION CONCERNING BIRTH DEFECTS AND ADVERSE BIRTH OUTCOMES

NAC 442.052 Definitions. (NRS 442.320) As used in NAC 442.052 to 442.058, inclusive, unless the context otherwise requires, the words and terms defined in NRS 442.305, 442.310 and 442.315 have the meanings ascribed to them in those sections.

(Added to NAC by Bd. of Health by R176-99, eff. 2-10-2000)

NAC 442.054 Review of certain records; identification and contact of patient. (NRS 442.320) In carrying out the provisions of NRS 442.300 to 442.330, inclusive, the Chief Medical Officer or a representative thereof:

1. May review any:

(a) Records of birth, stillbirth, death or fetal death maintained by the State Registrar of Vital Statistics;

(b) Records of examinations or tests conducted pursuant to NRS 442.008; and

Ê for any information pertinent to birth defects or adverse birth outcomes.

2. Shall, upon identifying a patient who has:

(a) A condition indicating that the patient may have a birth defect; or

(b) Been discharged with an adverse birth outcome,

Ê contact the patient or, if the patient is a minor, a parent or legal guardian of the patient, to determine the extent to which the patient will participate in the activities of the system.

(Added to NAC by Bd. of Health by R176-99, eff. 2-10-2000)

NAC 442.056 Notice of inclusion of certain information in system; request for exclusion of name of patient. (NRS 442.320)

1. Before including any information in the system that would reveal the identity of a patient, the Chief Medical Officer or a representative thereof shall advise the patient or, if the patient is a minor, a parent or legal guardian of the patient, that:

(a) The name of the patient will be used for research and referrals to related services unless the patient or his or her parent or legal guardian requests in writing to exclude the name from the system;

(b) Any information obtained by the system that would reveal the identity of the patient will remain confidential;

(1) Employed by the Division of Public and Behavioral Health of the Department of Health and Human Services or the University of Nevada School of Medicine; and

(2) Authorized and approved by the Chief Medical Officer or the representative; and

(d) The information obtained by the system may be used only as set forth in NRS 442.330.

2. The Chief Medical Officer and the representatives shall:

(a) Exclude from the system the name of a patient if the patient or, if the patient is a minor, a parent or legal guardian of the patient has requested in writing to exclude the name of the patient from the system; and

(b) Cause the request to be maintained with the records for the patient.

(Added to NAC by Bd. of Health by R176-99, eff. 2-10-2000)

NAC 442.058 Access to and confidentiality of information in system. (NRS 442.330) The Chief Medical Officer shall establish appropriate procedures and take any other actions necessary to ensure that:

1. Access to the information contained in the system is limited to persons who are:

(a) Employed by the Division of Public and Behavioral Health of the Department of Health and Human Services or the University of Nevada School of Medicine; and

(b) Authorized and approved by the Chief Medical Officer or the representative;

2. Any information obtained by the system that would reveal the identity of a patient remains confidential; and

3. Except as otherwise provided in subsection 3 of NRS 442.330, the information obtained by the system is used solely for the purposes set forth in subsection 1 of that section.

(Added to NAC by Bd. of Health by R176-99, eff. 2-10-2000)

INFORMATION OBTAINED IN ADMINISTRATION OF PROGRAMS

NAC 442.060 Confidential records. (NRS 442.140, 442.190, 442.330)

1. Except as otherwise provided in subsection 2 or required to carry out NRS 442.300 to 442.330, inclusive, and NAC 442.052 to 442.058, inclusive:

(a) Any information concerning personal facts and circumstances obtained by the State or a local staff administering the program of services for maternal and child health and the care and treatment of children with special health care needs is a privileged communication and must be held confidential.

(b) The information must not be divulged without the consent of the person seeking or receiving services or the consent of his or her parent or guardian if he or she is a minor.

2. The information may be disclosed without consent if it is in a summary, statistical or other form which does not identify the person receiving or seeking services.

[Bd. of Health, Confidentiality of Records Reg. § 1, eff. 6-5-72; A and renumbered as § 1.0, 12-20-79] — (NAC A by R176-99, 2-10-2000)

NAC 442.070 Chief Medical Officer to control information. (NRS 442.140, 442.190, 442.330) The Chief Medical Officer shall control confidential information, designate persons who may utilize and disclose the information, and acquaint those persons with all regulations concerning confidential information.

[Bd. of Health, Confidentiality of Records Reg. § 2, eff. 6-5-72; A and renumbered as § 1.1, 12-20-79]

NAC 442.080 Chief of Bureau of Children’s Services to inform employees of policy. (NRS 442.140, 442.190, 442.330) The Chief of the Bureau of Children’s Services shall inform all employees of the Bureau of regulations relating to confidential materials.

[Bd. of Health, Confidentiality of Records Reg. § 3, eff. 6-5-72; A and renumbered as § 2.0, 12-20-79]

NAC 442.090 Chief Medical Officer to establish procedures for enforcement. (NRS 442.140, 442.190, 442.330) The Chief Medical Officer shall establish appropriate procedures to ensure the enforcement of NAC 442.060, 442.070 and 442.080.

[Bd. of Health, Confidentiality of Records Reg. § 4, eff. 6-5-72; A 12-20-79]

ABORTION

NAC 442.100 Definitions. As used in NAC 442.100 to 442.200, inclusive, unless the context otherwise requires, the words and terms defined in NAC 442.110 to 442.170, inclusive, have the meanings ascribed to them in those sections.

(Supplied in codification)

NAC 442.110 “Abortion” defined. (NRS 439.200) “Abortion” has the meaning ascribed to it in NRS 442.240.

[Bd. of Health, Abortion Reg. § 1, eff. 12-1-72; A and renumbered as § 1.1, 2-24-78]

NAC 442.120 “Commencement of pregnancy” defined. (NRS 439.200) “Commencement of pregnancy” means the time of conception, the time of ovulation or 2 weeks after the first day of the last normal menses.

[Bd. of Health, Abortion Reg. § 2, eff. 12-1-72; A and renumbered as § 1.2, 2-24-78]

NAC 442.130 “First trimester” defined. (NRS 439.200) “First trimester” means the period from the commencement of pregnancy through the 12th week of pregnancy.

[Bd. of Health, Abortion Reg. § 4, eff. 12-1-72; A and renumbered as § 1.3, 2-24-78]

NAC 442.140 “Health” defined. (NRS 439.200) “Health” includes, but is not limited to, physical, emotional, psychological and familial considerations.

[Bd. of Health, Abortion Reg. § 7, eff. 12-1-72; A and renumbered as § 1.4, 2-24-78]

NAC 442.150 “Physician” defined. (NRS 439.200) “Physician” means a physician licensed in this State or employed by the Federal Government.

[Bd. of Health, Abortion Reg. § 3, eff. 12-1-72; A and renumbered as § 1.5, 2-24-78]

NAC 442.160 “Second trimester” defined. (NRS 439.200) “Second trimester” means the period from the 13th week of pregnancy through the 24th week of pregnancy.

[Bd. of Health, Abortion Reg. § 5, eff. 12-1-72; A and renumbered as § 1.6, 2-24-78]

NAC 442.170 “Third trimester” defined. (NRS 439.200) “Third trimester” means the period from the 25th week of pregnancy until the termination of the pregnancy.

[Bd. of Health, Abortion Reg. § 6, eff. 12-1-72; A and renumbered as § 1.7, 2-24-78]

NAC 442.180 Required training of counselor; verification by attending physician. (NRS 442.260)

1. A person who counsels a pregnant woman before an abortion to obtain informed consent pursuant to NRS 442.253, must have completed training in:

(a) Sexual and reproductive health, including development of the fetus;

(b) The psychological and physiological implications of abortion;

(c) Locating sources to which the woman may be referred for an abortion, alternatives to abortion, prenatal care, adoption, further counseling before the abortion, financial aid and counseling after the abortion;

(d) Requirements of informed consent;

(e) Basic skills for communication and counseling; and

(f) The procedure to be used, its consequences and the proper procedures for care of the woman after the abortion.

2. The attending physician must verify to the Division of Public and Behavioral Health of the Department of Health and Human Services, upon its request, that any person designated by him or her to obtain informed consent of a woman seeking an abortion has received the required training.

[Bd. of Health, Abortion Reg. § 5.0, eff. 12-1-72; A and renumbered as § 2.4, 2-24-78] — (NAC A by Health Div., eff. 5-16-86)

NAC 442.190 Follow-up physical examinations. (NRS 439.200) An early interruption of a pregnancy must be followed by a suitable physical examination to determine that an ectopic pregnancy has not been left undisturbed following the abortion.

[Bd. of Health, Abortion Reg. § 6.0, eff. 12-1-72; renumbered as § 2.5, 2-24-78]

NAC 442.200 Reports. (NRS 439.200)

1. A form for reporting an abortion must be completed by the physician or the physician’s staff for each abortion performed. The contents of the form must be substantially the same as the standard recommended by the National Center for Health Statistics of the United States Public Health Services.

2. The form must be completed in duplicate. The original must be sent to the section of Vital Statistics of the Division of Public and Behavioral Health of the Department of Health and Human Services.

3. Only the physician may retain information identifying the patient by name.

[Bd. of Health, Abortion Reg. §§ 10.0-12.0, eff. 12-1-72; A and renumbered as §§ 3.1-3.3, 2-24-78]

FEES OF DIVISION OF PUBLIC AND BEHAVIORAL HEALTH

NAC 442.210 Fees for certain early intervention services provided to infant or toddler with disability. (NRS 439.150, 439.200)

1. The Division of Public and Behavioral Health of the Department of Health and Human Services shall charge and collect fees for early intervention services provided to an infant or toddler with a disability by the Bureau of Early Intervention Services of the Division. The fees must be based upon and not exceed the actual cost to the Division to provide such services.

2. The Division of Public and Behavioral Health shall maintain a copy of the current schedule of fees at each location in which services are provided by the Bureau of Early Intervention Services. A copy of the schedule of fees may be obtained, free of charge, from the Bureau of Early Intervention Services at the Internet address http://health2k.state.nv.us/BEIS/, by mail at 3427 Goni Road, Suite 108, Carson City, Nevada 89706, or by telephone at (775) 684-3460.

3. The Bureau may develop a sliding schedule of fees for families that receive early intervention services to pay a percentage of the full fee based on the size and income of the family as set forth in the federal guidelines of poverty established by the United States Department of Health and Human Services.

4. As used in this section:

(a) “Early intervention services” has the meaning ascribed to it in the Individuals with Disabilities Education Act, 20 U.S.C. § 1432(4); and

(b) “Infant or toddler with a disability” has the meaning ascribed to it in the Individuals with Disabilities Education Act, 20 U.S.C. § 1432(5).

[Bd. of Health, Fee Schedule for Sp. Children’s Clinics, eff. 5-10-82] — (NAC A 12-12-86; 10-23-87; 7-16-92; 11-29-94; R105-05, 12-29-2005)

NAC 442.222 Sliding schedule of fees for certain services and supplies concerning family planning. (NRS 439.150, 439.200)

1. For a client who qualifies pursuant to 42 U.S.C. §§ 300 et seq. for services and supplies concerning family planning, the fee, if any, to be charged and collected by a community health nursing clinic established by the Division of Public and Behavioral Health for such services and supplies provided by a nurse of the Division must be in the amount listed in the sliding schedule of fees established by the Division pursuant to this section.

2. The Division of Public and Behavioral Health shall establish a sliding schedule of fees which is based on:

(a) A cost analysis of the services and supplies provided by the community health nursing clinics; and

(b) A ratio between the annual gross income of a household and the federally designated level signifying poverty for a household of that size as determined by the United States Department of Health and Human Services and published annually in the Federal Register.

3. The Division of Public and Behavioral Health shall renew and, if necessary, revise the sliding schedule of fees established pursuant to this section:

(a) According to generally accepted accounting principles; and

(b) As needed, to account for modifications to:

(1) The community health nursing program;

(2) The federally designated levels signifying poverty; and

(3) The federal family planning program pursuant to 42 U.S.C. §§ 300 et seq.

4. The sliding schedule of fees established pursuant to this section and any revisions to the sliding schedule of fees become effective upon approval of the sliding schedule of fees by the State Board of Health.

5. The Division of Public and Behavioral Health shall make the sliding schedule of fees established pursuant to this section available:

(a) On the Internet website of the Division and in each community health nursing clinic; and

(b) To any person upon request.

6. If the annual gross income of the household of a client described in subsection 1 is less than the federally designated level signifying poverty for a household of that size, a community health nursing clinic shall not charge a fee to the client for services or supplies provided by a nurse of the Division of Public and Behavioral Health for matters related to family planning. A client who is required to pay a fee pursuant to this section may not be denied services or supplies for nonpayment of the fee.

7. For the purposes of this section, a teenager is considered a household of one.

8. As used in this section, “household” means an association of persons who live together as a single economic unit, regardless of whether they are related.

(Added to NAC by Bd. of Health, eff. 10-14-82; A 7-16-85, eff. 8-1-85; 2-18-88; 12-15-88; 1-31-90; 5-19-92; 9-1-93; 10-30-97; R119-03, 12-3-2003; R145-11, 5-30-2012)

PROVISION OF NEONATAL CARE BY HOSPITAL

General Provisions

NAC 442.250 Definitions. (NRS 442.007, 449.0302) As used in NAC 442.250 to 442.550, inclusive, unless the context otherwise requires, the words and terms defined in NAC 442.255 to 442.350, inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; 9-16-92; R064-04, 8-4-2004)

NAC 442.255 “Advanced practice registered nurse” defined. (NRS 442.007, 449.0302) “Advanced practice registered nurse” has the meaning ascribed to it in NRS 632.012.

(Added to NAC by Bd. of Health by R064-04, eff. 8-4-2004)

NAC 442.270 “Division” defined. (NRS 442.007, 449.0302) “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85)

NAC 442.290 “Hospital” defined. (NRS 442.007, 449.0302) “Hospital” has the meaning ascribed to it in NRS 449.012.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85)

NAC 442.306 “Level I basic care facility” defined. (NRS 442.007, 449.0302) “Level I basic care facility” means a hospital licensed by the Division to provide the neonatal services that are specified in NAC 442.380.

(Added to NAC by Bd. of Health, eff. 9-1-89; A 9-16-92; R064-04, 8-4-2004)

NAC 442.308 “Level II specialty care facility” defined. (NRS 442.007, 449.0302) “Level II specialty care facility” means a hospital licensed by the Division to provide the neonatal services that are specified in NAC 442.390.

(Added to NAC by Bd. of Health, eff. 9-1-89; A 9-16-92; R064-04, 8-4-2004)

NAC 442.310 “Level III subspecialty care facility” defined. (NRS 442.007, 449.0302) “Level III subspecialty care facility” means a hospital licensed by the Division to provide neonatal intensive care for infants as specified in NAC 442.401 and 442.430.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; R064-04, 8-4-2004)

NAC 442.321 “Neonate” defined. (NRS 442.007, 449.0302) “Neonate” means an infant who is less than 28 days of age.

(Added to NAC by Bd. of Health, 7-16-85; eff. 8-1-85; A 9-1-89) — (Substituted in revision for NAC 442.340)

NAC 442.330 “Neonatologist” defined. (NRS 442.007, 449.0302) “Neonatologist” means a physician certified by the American Board of Pediatrics and its Subboard of Neonatal-Perinatal Medicine.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89)

NAC 442.341 “Pediatrician” defined. (NRS 442.007, 449.0302) “Pediatrician” means a physician who is certified by the American Board of Pediatrics.

(Added to NAC by Bd. of Health, eff. 9-1-89)

NAC 442.350 “Program” defined. (NRS 442.007, 449.0302) “Program” means the program for services to children with special health care needs.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-16-92)

NAC 442.370 Adoption by reference of certain publications; revision of publications after adoption. (NRS 442.007, 449.0302)

1. The current edition of Guidelines for Perinatal Care, excluding the chapter concerning construction standards, is adopted by reference as a minimum acceptable standard. This publication is available from the American Academy of Pediatrics, Publications Department, 141 Northwest Point Boulevard, Elk Grove Village, Illinois 60007-1098, for the price of $70 for members or $75 for nonmembers.

2. The State Board of Health hereby adopts by reference:

(a) NFPA 101: Life Safety Code, in the form most recently published by the National Fire Protection Association, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 3. A copy of the Code may be obtained from the National Fire Protection Association at the Internet address http://www.nfpa.org, by mail from the NFPA at 11 Tracy Drive, Avon, Massachusetts 02322, or by telephone at (800) 344-3555, for the price of $55.80 for members or $62 for nonmembers, plus $7.95 for shipping and handling.

(b) The Guidelines for Design and Construction of Hospital and Healthcare Facilities, in the form most recently published by the American Institute of Architects, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 3. A copy of the guidelines may be obtained from the American Institute of Architects at the Internet address http://www.aia.org, from the AIA Store at 1735 New York Avenue, N.W., Washington, D.C. 20006-5292, or by telephone at (800) 242-3837, for the price of $52.50 for members or $75 for nonmembers, plus $9 for shipping and handling.

3. The State Board of Health will review each revision of the publications adopted by reference pursuant to subsections 1 and 2 to ensure its suitability for the State. If the Board determines that the revision is not suitable for this State, it will hold a public hearing to review its determination and give notice of that hearing within 6 months after the date of the publication of the revision. If, after the hearing, the Board does not revise its determination, the Board will give notice that the revision is not suitable for this State within 30 days after the hearing. If the Board does not give such notice, the revision becomes part of the publication adopted by reference pursuant to subsection 1 or 2.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; 9-16-92; R064-04, 8-4-2004)

Levels of Care

NAC 442.380 Level I basic care facilities: General requirements. (NRS 442.007, 449.0302)

1. A level I basic care facility must be able to provide:

(a) A newborn nursery for the routine care of apparently normal neonates who have demonstrated successful adaptation to extrauterine life.

(b) Resuscitation and stabilization of all neonates born in the hospital.

(d) Identification, stabilization and preparation of neonates for transport to a level II specialty care facility or level III subspecialty care facility, as appropriate.

(e) A policy that clearly delineates when consultation with a level II specialty care facility or level III subspecialty care facility is required to prevent rapid or further deterioration of a neonate and prevent delay in treatment at a higher level of care.

(f) Visitation between the neonate and the parents and siblings of the neonate.

(g) Collection and retrieval of data as required pursuant to the Guidelines for Perinatal Care adopted by reference pursuant to NAC 442.370.

2. The hospital providing care as a level I basic care facility must have a written agreement with each level III subspecialty care facility to which it refers neonates. The agreement must include provisions for the level III subspecialty care facility to provide:

(a) Education in perinatal care, including neonatal resuscitation, for the staff of the level I basic care facility; and

(b) Technical assistance in the development of a program of quality assurance for the care provided to neonates by the level I basic care facility.

3. A level I basic care facility that is unable to secure the agreements required by subsection 2 shall document the efforts it made to secure the agreements and develop a plan to provide level I basic care services in the absence of such agreements.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; 9-16-92; R064-04, 8-4-2004)

NAC 442.390 Level II specialty care facilities: General requirements. (NRS 442.007, 449.0302)

1. A level II specialty care facility must be able to provide:

(a) The basic care services as described under subsection 1 of NAC 442.380.

(b) Intermediate care for a minimum of six neonates.

(d) Treatment for moderately ill neonates that were carried to term and larger preterm neonates.

(e) Collection and retrieval of data as required pursuant to the Guidelines for Perinatal Care adopted by reference pursuant to NAC 442.370.

(f) Continuing care of neonates who have a low weight at birth and are not ill but require frequent feeding or require more hours of nursing than normal neonates.

(g) Intermediate care of sick neonates who do not require intensive care but require 6 to 12 hours of nursing care each day. Neonates who require complex care, such as assisted ventilation for more than several hours, will be moved to a level III subspecialty care facility.

(h) Cardiopulmonary resuscitative services and continuous monitoring of cardiopulmonary status.

(i) Care in excess of its designated level for a neonate for not more than 24 hours, while identifying, stabilizing and preparing a high-risk or critically ill neonate for transport to a level III subspecialty care facility.

(j) Continuing care for convalescing neonates transported from level III subspecialty care facilities.

(k) Gavage feeding.

(l) Pharmacy services, including parenteral nutritional solutions, 24 hours per day.

(m) Laboratory consultation services 24 hours per day.

(n) Radiological services, such as X-ray, diagnostic imaging procedures and consultation services, 24 hours per day.

(o) Certified or registered respiratory therapists trained in neonatology on staff 24 hours per day.

2. A level II specialty care facility must have a medical director who is:

(a) A neonatologist or a pediatrician who is certified by the American Board of Pediatrics and has special interest, experience or subspecialty certification in neonatal or perinatal medicine;

(b) Not a medical director of more than two level II specialty care facilities;

(c) Responsible for the care of neonates in the level II specialty care facility and consults with level I basic care facilities for possible admissions to the level II specialty care facility and with level III subspecialty care facilities for possible transfers from the level II specialty care facility to a level III subspecialty care facility;

(d) A supervisor of the advanced practice registered nurses in the level II specialty care facility; and

(e) Able to ensure qualified coverage in his or her absence by other neonatologists or pediatricians with special training and interest in neonatology.

3. The level II specialty care facility must be staffed in accordance with the current edition of the Guidelines for Perinatal Care adopted by reference pursuant to NAC 442.370 and must provide nursing staff trained in the care of high-risk neonates. The nursing staff must be supervised by a qualified registered nurse who shall coordinate the care of the neonates in the level II specialty care facility and assist the medical director in the management of the level II specialty care facility.

4. The level II specialty care facility shall have a written agreement with each level III subspecialty care facility to which it refers neonates. The agreement must include provisions for:

(a) The education in perinatal care, including neonatal resuscitation, of the staff of the level II specialty care facility;

(b) Technical assistance in the development of a program of quality assurance for the care provided to neonates by the level II specialty care facility; and

5. A level II specialty care facility that is unable to secure the agreements required in subsection 4 shall document the efforts it made to secure the agreements and develop a plan to provide level II specialty care services in the absence of such agreements.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; 9-16-92; R064-04, 8-4-2004)

NAC 442.401 Level III subspecialty care facilities: General requirements. (NRS 442.007, 449.0302)

1. A level III subspecialty care facility must:

(a) Be able to care for neonates as provided by NAC 442.390;

(b) Provide nine or more beds for the intensive care of neonates;

(c) Provide and adhere to a formal, written plan for in-house coverage of the level III subspecialty care facility by neonatologists, pediatricians, qualified physicians and advanced practice registered nurses, taking into consideration the condition and medical needs of the neonates requiring level III subspecialty care; and

(d) Have formal, written agreements with each level I basic care facility and level II specialty care facility from which it receives neonates. The agreement must include provisions for:

(1) Education in perinatal care, including neonatal resuscitation, for the staff of the level I basic care facilities and level II specialty care facilities, on at least an annual basis; and

(2) Technical assistance in the development of a program of quality assurance for the care provided to neonates by the level I basic care facilities and level II specialty care facilities.

2. A level III subspecialty care facility that refuses to enter into the required agreements with a level I basic care facility or level II specialty care facility shall show sufficient reason for the refusal and notify the level I basic care facility or level II specialty care facility in writing of the reasons for refusal.

3. If, after an investigation by the Division into the circumstances of the refusal of the level III subspecialty care facility to enter into an agreement with a level I basic care facility or level II specialty care facility, there is a finding that the level III subspecialty care facility’s reasons for refusal are not sufficient, the Division may order the level III subspecialty care facility to enter into an acceptable agreement and set a time for compliance.

4. The medical director of a level III subspecialty care facility must:

(a) Be a neonatologist;

(b) Devote his or her full time to the direction of the facility;

(c) Consider transferring a neonate who no longer requires level III subspecialty care to the hospital in which he or she was born; and

(d) Confer with the attending physician at the hospital in which the neonate was born and the parents or guardians of the neonate before transferring a neonate to the hospital in which he or she was born.

5. The medical staff of the facility must:

(a) Include at least one pediatrician or qualified physician with special interest and experience in neonatology for each 10 beds, or fraction thereof, in the facility.

(b) Be comprised of physicians, not less than one-half of whom are neonatologists or are eligible to take the examination of the American Board of Pediatrics in neonatal-perinatal medicine.

(c) Include a pediatric cardiologist who is certified by the American Board of Pediatrics, Subboard of Pediatric Cardiology, or a qualified physician whose specialty is pediatric cardiology. If a pediatric cardiologist or qualified physician is not available, a qualified pediatric cardiologist must be actively recruited and the hospital shall enter into agreements with other neonatal facilities to provide pediatric cardiology.

(d) Include:

(1) A pediatric surgeon who is certified by the American Board of Surgery, with special qualifications in pediatric surgery; or

(2) A qualified physician whose specialty is pediatric surgery,

Ê who is available 24 hours per day. If a pediatric surgeon or a qualified physician is not available, a qualified pediatric surgeon must be actively recruited and the hospital shall enter into agreements with other neonatal facilities to provide pediatric surgery.

6. At least one registered or certified respiratory therapist must be assigned to the facility for every five neonates on an assisted mode of ventilation, including Continuous Positive Airway Pressure.

7. The nurse manager of the facility must:

(a) Be a registered nurse;

(b) Have not less than 3 years of clinical experience in level III subspecialty care; and

8. The nurse manager and medical director of the level III subspecialty care facility shall identify the personnel and determine the educational requirements necessary to meet the needs of:

(a) The staff of the facility, which must:

(1) Comply with the current edition of the Guidelines for Perinatal Care adopted by reference pursuant to NAC 442.370; and

(2) Include a nursing staff that has experience in the care of high-risk neonates; and

(b) Any outreach program.

9. The level III subspecialty care facility shall provide transportation services for critically ill neonates. Personnel used for these services may include physicians, advanced practice registered nurses, registered nurses, respiratory therapists, emergency medical technicians or such other personnel as the medical director deems appropriate.

10. As used in this section, “qualified physician” means a physician licensed to practice in this State who:

(a) Has been issued a credential to practice a specialty or a subspecialty in a hospital by the governing board of the hospital; and

(b) Has, at any time, completed the occupational and educational requirements of a specialty board for the specialty or subspecialty in which he or she is practicing.

(Added to NAC by Bd. of Health, eff. 9-1-89; A 9-16-92; R064-04, 8-4-2004)

NAC 442.405 Level II specialty care facilities and level III subspecialty care facilities: Additional requirements. (NRS 442.007, 449.0302) In addition to the requirements set forth in NAC 442.390 and 442.401, level II specialty care facilities and level III subspecialty care facilities must meet the following requirements:

1. The following support personnel must be available in level II specialty care facilities and level III subspecialty care facilities:

(a) At least one full-time social worker, licensed pursuant to chapter 641B of NRS, for every 30 beds in the facility. The social worker must have experience with the socioeconomic and psychosocial problems of high-risk women and fetuses, as defined in the Guidelines for Perinatal Care adopted by reference pursuant to NAC 442.370, ill neonates and the families of ill neonates.

(b) At least one occupational therapist or physical therapist with experience in the care of neonates.

(c) At least one licensed dietitian who has special training in perinatal nutrition and can plan diets that meet the special needs of high-risk women and neonates.

(d) Personnel in the pharmacy, including, but not limited to, pharmacists and technicians, who will work to review continually their systems and process of administering medication to ensure that policies relating to the care of patients are maintained.

2. Level II specialty care facilities and level III subspecialty care facilities must have a policy for the use of interpreters to address the needs of patients and their families who do not speak English or are hearing impaired.

3. Level II specialty care facilities and level III subspecialty care facilities must:

(a) Demonstrate through quality assurance activities the ability of the facility to report and track data on morbidity and mortality; and

(b) Establish a policy for obstetricians, perinatologists, neonatologists and pediatricians to confer with other physicians, including physicians not located in the facility, to report trends and outcomes related to data on morbidity and mortality and other issues related to perinatology.

(Added to NAC by Bd. of Health by R064-04, eff. 8-4-2004; A by R090-12, 12-20-2012)

Designation of Hospital as Neonatal Facility

NAC 442.411 Application; fee; requirements for provision of obstetrical services. (NRS 442.007, 449.0302)

1. The Division shall provide a uniform application form for hospitals to apply for a designation as a level II specialty care facility or level III subspecialty care facility.

2. The application must include a statement:

(a) Describing the qualifications of the hospital’s personnel to provide level II specialty care or level III subspecialty care for neonates;

(b) Describing the facilities and equipment to be used to provide level II specialty care or level III subspecialty care for neonates;

(c) Describing how the hospital’s facilities and personnel meet or exceed the standards established in NAC 442.250 to 442.550, inclusive, for the level of neonatal care requested;

(d) From the medical director of the proposed neonatal facility that the hospital has adequate facilities, equipment, personnel and policies and procedures to provide neonatal care at the level requested; and

(e) From the chief operating officer of the hospital that the hospital is committed to maintaining sufficient support personnel and equipment to provide neonatal care at the level requested.

3. An application for a designation as a level II specialty care facility or level III subspecialty care facility must be accompanied by an application fee of $7,500, which, pursuant to subsection 6 of NAC 442.480, will be applied to the costs of the required inspection.

4. The Division is not required to grant a separate designation as a level I basic care facility. If a hospital elects to provide obstetrical services, the hospital must have a level I basic care facility in accordance with NAC 442.380 and 449.3645 to 449.367, inclusive.

(Added to NAC by Bd. of Health, eff. 9-1-89; A 9-16-92; R064-04, 8-4-2004)

NAC 442.415 Accompaniment of application with letter of approval. (NRS 442.007, 449.0302) If a hospital is required to obtain the approval of the Director of the Department of Health and Human Services pursuant to NRS 439A.100 in order to provide intensive care for neonates, the hospital’s application for approval to be designated as a level II specialty care facility or level III subspecialty care facility must be accompanied by a letter of approval received from the Director.

(Added to NAC by Bd. of Health, eff. 9-1-89; A by R064-04, 8-4-2004)

NAC 442.430 Level III subspecialty care facilities: Requirements for designation. (NRS 442.007, 449.0302) A hospital seeking designation as a level III subspecialty care facility must:

1. Demonstrate its capability to provide all required services and equipment, which include:

(a) The following services and equipment for the transportation of a neonate:

(1) A portable incubator;

(2) Resuscitation equipment;

(3) Oxygen, a means of application and a means to monitor levels of saturation;

(4) Portable cardiac and temperature monitoring equipment;

(5) A ventilator; and

(6) Continuous intravenous infusion equipment.

(b) Participation in services for each neonate while he or she remains in the hospital and after release from the hospital, coordinating those services and cooperating with the Division in providing the data concerning those services, including referring all neonates with birth defects, as defined in NRS 442.310, to the Bureau of Early Intervention Services of the Division for review of program eligibility.

(c) A program for perinatal education, offered for all physicians, nurses, respiratory therapists, nurses specializing in community health, advanced practice registered nurses, physician assistants, specialists in the development of children, nutritionists and social workers within the area the hospital serves.

(d) The following diagnostic imaging procedures and associated consultation services 24 hours per day:

(1) X-ray;

(2) Ultra-sound;

(3) Fluoroscopy X-ray;

(4) Computerized axial tomography;

(5) Nuclear medicine; and

(6) Echo cardiography.

(e) Pharmaceutical services including parenteral nutritional solutions 7 days per week.

(f) Laboratory and associated consultation services 24 hours per day.

2. Provide medical personnel, equipment and services required for a neonate in need of intensive care, and a system for consultation between medical personnel and for the use of equipment and services.

3. Adopt a written policy which contains:

(a) The description of the system for neonatal intensive care;

(b) The description of the system for transportation and referral for intensive care;

(c) The plan to provide continuing education of personnel providing neonatal services within those hospitals which make referrals to the level III subspecialty care facility; and

(d) A method for evaluating the plan required by paragraph (c).

4. Demonstrate its intent to provide services to any neonate requiring intensive care regardless of race, religion, color, national origin or ability to pay.

5. Demonstrate its capability to conduct continuing analysis of each neonate, as appropriate, and coordinate that care by periodic conferences on mortality and morbidity.

6. Accept maternal transfers if indicated for care of a high-risk pregnancy regardless of the ability of the patient to pay for hospital services.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; 9-16-92; R064-04, 8-4-2004)

NAC 442.440 Level III subspecialty care facilities: System required for education, consultation, referral and continuing care. (NRS 442.007, 449.0302) A hospital seeking designation as a level III subspecialty care facility must comply with the requirements set forth in NAC 442.430, as appropriate, and must develop and maintain a system which includes:

1. The education of personnel providing neonatal services in hospitals which make referrals to that level III subspecialty care facility;

2. A service by telephone, for 24 hours per day, for consultation and referral;

3. The education of personnel at all usual sources of referrals concerning the identification and stabilization of a neonate at a stage which is considered a high risk; and

4. A program for the continuing analysis of and care for each neonate.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; R064-04, 8-4-2004)

NAC 442.461 Reporting requirements; provision of access for inspection. (NRS 442.007, 449.0302) A level II specialty care facility or level III subspecialty care facility shall:

1. Comply with the reporting requirements established by the Division;

2. Provide access to its facilities and records for inspection by the Division; and

3. Annually submit to the Division reports concerning the birth weight, survival, transfer and incidence of certain conditions of neonates in a format approved by the Division.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; 9-16-92; R064-04, 8-4-2004)

NAC 442.471 Periodic examination of sites and review of performance. (NRS 442.007, 449.0302) The Division shall conduct an examination on the site of each facility designated at each level and review its performance at least once every 5 years.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; R064-04, 8-4-2004)

NAC 442.480 Provision of certain new services: Requirements for approval; period of approval. (NRS 442.007, 449.0302)

1. A hospital may request the Division’s approval to provide a new service for the level II specialty care of neonates after the hospital has operated a level I basic care facility for at least 6 months. A hospital may request the Division’s approval to provide a new service for the level III subspecialty care of neonates after the hospital has operated a level II specialty care facility for at least 6 months. The hospital may not provide a new service for the level II specialty care or level III subspecialty care of neonates before it has received written approval for the service from the Division.

2. The Division shall send written notification to the hospital within 45 working days after receiving the application. The notice must state:

(a) Whether the application is complete; and

(b) If the application is not complete, what is needed for completion.

3. The Division shall not approve an application for the provision of a new service for the level II specialty care or level III subspecialty care of neonates before it receives verification of the findings of the site-inspection team that the hospital complies with the provisions of this chapter.

4. If a hospital has applied for a designation as a level II specialty care facility or level III subspecialty care facility, the site-inspection team must include:

(a) A neonatologist;

(b) An obstetrician;

(d) A health facilities surveyor who is employed by the Division.

Ê A hospital that has applied for permission from the Division to provide a new service of level II specialty care or level III subspecialty care for neonates may request the disqualification of any member of the site-inspection team if the member is not qualified to serve on the team or has a conflict of interest. If the hospital proves the grounds for disqualification, that member must be disqualified from serving on the team.

5. The review by the site-inspection team must include an inspection and appraisal of:

(a) The facilities and equipment for neonatal care;

(b) The services to be provided for neonatal care;

(d) The programs of training relating to neonatal medicine for physicians, nurses, respiratory therapists, nurses specializing in community health, advanced practice registered nurses, physician assistants, specialists in the development of children, nutritionists and social workers within the area the hospital serves;

(e) The plan for employment of professional personnel and the organizational structure for providing neonatal care;

(f) The records and procedures for maintaining records used for providing neonatal services;

(g) The system for referrals to or from the program;

(h) The plan to provide continuing education of personnel providing neonatal services in hospitals which make referrals to the level III subspecialty care facility;

(i) The arrangements for transportation to and from the level III subspecialty care facility;

(j) The arrangements for educating all sources of referral in the identification and stabilization of any neonate who needs to be referred; and

(k) Any other documents and materials required by the Division.

6. The costs of the inspection by the site-inspection team for level II specialty care facilities and level III subspecialty care facilities must be paid by the hospital that was inspected. The Division shall apply the application fee collected pursuant to subsection 3 of NAC 442.411 to the satisfaction, in whole or in part, of such costs.

7. The Division shall notify the hospital of its decision concerning the application within 15 working days after the Division receives the findings of the site-inspection team. An approval by the Division is effective for 5 years.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; 9-16-92; R064-04, 8-4-2004)

NAC 442.501 Denial, suspension or revocation of right to provide care: Grounds. (NRS 442.007, 449.0302) The Division may deny, suspend or revoke the right of a hospital to provide level II specialty care or level III subspecialty care for neonates for the failure of the hospital to:

1. Comply with the provisions of NAC 442.250 to 442.550, inclusive; or

2. Pay the costs associated with an inspection made by a site-inspection team.

(Added to NAC by Bd. of Health, eff. 9-1-89; A 9-16-92; 10-30-97; R064-04, 8-4-2004)

NAC 442.511 Denial, suspension or revocation of right to provide care: Notice; appeal. (NRS 442.007, 449.0302)

1. The Division shall give a hospital written notice in the manner prescribed in chapter 439 of NAC before it:

(a) Denies an application of a hospital to provide level II specialty care or level III subspecialty care for neonates;

(b) Revokes its approval of a hospital to provide level II specialty care or level III subspecialty care for neonates; or

2. A hospital may appeal any decision made by the Division pursuant to subsection 1 in the manner prescribed in NAC 439.190 to 439.395, inclusive.

(Added to NAC by Bd. of Health, eff. 9-1-89; A 9-16-92; 10-30-97; R064-04, 8-4-2004)

NAC 442.520 Revocation of designation: Grounds. (NRS 442.007, 449.0302) The Division may revoke a hospital’s designation as a level II specialty care facility or level III subspecialty care facility if the hospital:

1. Uses unlicensed beds in its level II specialty care facility or level III subspecialty care facility;

2. Fails to provide the services required for a level II specialty care facility or level III subspecialty care facility at its designated level or provides care in excess of its designated level;

3. Fails to comply with the criteria and standards for a level II specialty care facility or level III subspecialty care facility at its designated level;

4. Maintains a policy for admission to the level II specialty care facility or level III subspecialty care facility which discriminates on the basis of financial resources, race, color, religion or national origin;

5. Fails to correct the deficiencies specified by the Division within the time set;

6. Fails to provide the required continuing analysis in accordance with the criteria set by the Division;

7. Fails to provide systems for continuing care and consultation with the referral facility, if applicable; or

8. Holds itself out to the public as anything other than as designated by the Division.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; 9-16-92; R064-04, 8-4-2004)

NAC 442.530 Revocation of designation: Procedure. (NRS 442.007, 449.0302)

1. The Division shall give written notice to a hospital of its intention to revoke the hospital’s designation. The notice must contain the reasons for the Division’s action.

2. Within 30 days after the hospital receives such notice, it may respond in writing and submit evidence to the Division opposing the proposed action.

3. The Division shall revoke the hospital’s designation if the hospital fails to:

(a) Respond in writing pursuant to subsection 2;

(b) Submit evidence which is sufficient to refute the Division’s reasons; or

4. The Division shall:

(a) Notify the hospital of its decision to revoke its designation by certified mail, which is effective when the hospital receives the notice; and

(b) Cause notice of its decision to be published in a newspaper of general circulation in the area the hospital serves.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-16-92)

Miscellaneous Provisions

NAC 442.540 Acceptance of neonate without regard to ability of parents or guardian to pay. (NRS 442.007, 449.0302) A level I basic care facility, level II specialty care facility or level III subspecialty care facility shall accept any neonate transported to or back to that facility, as appropriate, without regard to the ability of the parents or guardian of the neonate to pay for the care to be provided to the neonate.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; R064-04, 8-4-2004)

NAC 442.550 System of cooperation among facilities; records of problems and solutions discussed. (NRS 442.007, 449.0302) A system of cooperation to ensure the quality of care provided must be established between a level III subspecialty care facility and facilities that refer neonates to it. Records must be kept by each facility of any problems and solutions discussed among the facilities in order to maintain a minimum standard for the quality of the care provided. The records are part of the quality assurance program records of the hospital.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A 9-1-89; R064-04, 8-4-2004)

SERVICES UNDER SOCIAL SECURITY ACT

General Provisions

NAC 442.600 Definitions. (NRS 442.140, 442.190) As used in NAC 442.600 to 442.788, inclusive, unless the context otherwise requires, the words and terms defined in NAC 442.602 to 442.708, inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; 10-30-97; R212-97, 7-23-98; R095-99, 11-29-99; R024-06, 7-14-2006)

NAC 442.602 “Activities of daily living” defined. (NRS 442.140, 442.190) “Activities of daily living” means activities that a person performs independently to care for his or her personal needs, including, but not limited to, bathing, grooming, using the toilet, eating, brushing his or her teeth, transferring from a bed to a chair or ambulating.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.603 “Acute care” defined. (NRS 442.190) “Acute care” means a level of medical services provided in a hospital.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.605 “Administrator” defined. (NRS 442.140, 442.190) “Administrator” means the Administrator of the Division.

(Added to NAC by Bd. of Health, eff. 11-27-89)

NAC 442.614 “Ambulatory or outpatient services” defined. (NRS 442.190) “Ambulatory or outpatient services” means limited medical services provided for the diagnosis or treatment of a client who does not require care in a medical facility for more than 24 hours.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.616 “Annually” defined. (NRS 442.140, 442.190) “Annually” means for each continuous period of 12 months of participation in the program.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.617 “Bureau” defined. (NRS 442.140, 442.190) “Bureau” means the Bureau of Family Health Services of the Division.

(Added to NAC by Bd. of Health, eff. 10-30-97)

NAC 442.619 “Chief” defined. (NRS 442.140, 442.190) “Chief” means the Chief of the Bureau.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.620 “Chronic” defined. (NRS 442.190) “Chronic” means a medical condition persisting for more than 12 weeks.

(Added to NAC by Bd. of Health, eff. 11-27-89)

NAC 442.625 “Client” defined. (NRS 442.140, 442.190) “Client” means a person who is eligible to participate in the program pursuant to NAC 442.600 to 442.788, inclusive.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98; R095-99, 11-29-99; R024-06, 7-14-2006)

NAC 442.635 “Diagnostic evaluation” defined. (NRS 442.190) “Diagnostic evaluation” means the performance of a medical history, a physical examination, laboratory tests, radiological procedures, sonography, magnetic resonance imaging, or specific, limited surgical procedures necessary for the definition of pathology.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94)

NAC 442.637 “Disabling condition” defined. (NRS 442.140, 442.190) “Disabling condition” means an anatomical, physiological or other physical deficiency which inhibits normal growth or the ability to perform the activities of daily living.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94) — (Substituted in revision for NAC 442.650)

NAC 442.638 “Division” defined. (NRS 442.140, 442.190) “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

(Added to NAC by Bd. of Health, eff. 11-27-89) — (Substituted in revision for NAC 442.655)

NAC 442.639 “Eligible condition” defined. (NRS 442.140, 442.190) “Eligible condition” means an eligible medical condition or another condition for which coverage is provided under the program pursuant to NAC 442.600 to 442.788, inclusive.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98; A by R095-99, 11-29-99; R024-06, 7-14-2006)

NAC 442.640 “Eligible medical condition” defined. (NRS 442.140, 442.190) “Eligible medical condition” means a medical condition of a client described in NAC 442.784.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98)

NAC 442.660 “High-risk pregnancy” defined. (NRS 442.190) “High-risk pregnancy” means a pregnancy which, on the basis of age or genetic, medical, nutritional or environmental factors, can be considered likely to require more than standard, routine obstetric care.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94)

NAC 442.662 “Hospital” defined. (NRS 442.140, 442.190) “Hospital” has the meaning ascribed to it in NRS 449.012.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.663 “Household” defined. (NRS 442.140, 442.190) “Household” means an association of persons who live together as a single economic unit, regardless of whether they are related.

(Added to NAC by Bd. of Health, eff. 1-18-94; A by R212-97, 7-23-98)

NAC 442.665 “Inpatient” defined. (NRS 442.190) “Inpatient” means a client who requires a stay of more than 24 hours in a hospital for treatment or a diagnostic evaluation.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94)

NAC 442.670 “Medicaid” defined. (NRS 442.140, 442.190) “Medicaid” means the program established pursuant to Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., to provide assistance for part or all of the cost of medical care for indigent persons.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98)

NAC 442.676 “Medical facility” defined. (NRS 442.140, 442.190) “Medical facility” means an establishment that provides treatment and services directed toward the habilitation and rehabilitation of a client to a reasonable level of health and ability to perform the activities of daily living.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.680 “Medical review” defined. (NRS 442.190) “Medical review” means the review of a provider’s medical records by, or in consultation with, a medical staff composed of persons who are employed by the Division or have a contract with the Division for the performance of those services.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98)

NAC 442.685 “Medical services” defined. (NRS 442.140, 442.190) “Medical services” means services rendered by a provider and other treatment, services and necessary appliances directed toward the habilitation and rehabilitation of a client to a reasonable level of health and ability to perform the activities of daily living.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94)

NAC 442.687 “Memorandum of understanding” defined. (NRS 442.140, 442.190) “Memorandum of understanding” means an agreement that defines the type of services a provider will provide to clients and the method by which the provider will be reimbursed for those services under the program.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.688 “Nevada Check Up” defined. (NRS 442.140, 442.190) “Nevada Check Up” means the program established pursuant to 42 U.S.C. §§ 1397aa to 1397jj, inclusive, to provide health insurance for uninsured children from low-income families in this State.

(Added to NAC by Bd. of Health by R095-99, eff. 11-29-99)

NAC 442.690 “Physician” defined. (NRS 442.140, 442.190) “Physician” means a provider who:

1. Is licensed by the state where he or she practices;

2. Is certified by or eligible to take an examination for certification from a specialty board that is a member of the American Board of Medical Specialties; and

3. Has a memorandum of understanding with the Division.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; 10-30-97; R212-97, 7-23-98)

NAC 442.694 “Primary care” defined. (NRS 442.190) “Primary care” means a full range of comprehensive, integrated and longitudinal health services that are based in the community of a client, centered on the family of a client and provided on an ambulatory basis, including, but not limited to, services for prevention, diagnosis, treatment, consultation and referral.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.696 “Prognosis” defined. (NRS 442.140, 442.190) “Prognosis” means the prospects of a client reaching a reasonable level of health and an ability to perform the activities of daily living.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.700 “Program” defined. (NRS 442.140, 442.190) “Program” means the program of the Division that provides reimbursement for the specialized medical services required for the maximum alleviation or rehabilitation of the eligible conditions of clients.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98; R095-99, 11-29-99)

NAC 442.702 “Program specialist” defined. (NRS 442.140, 442.190) “Program specialist” means an employee of the Division who is designated by the Administrator to determine:

1. Eligibility for the receipt of services under the program;

2. Whether to authorize the provision of services under the program before those services are rendered; and

3. Whether to approve claims for compensation submitted by providers under the program.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.705 “Provider” defined. (NRS 442.140, 442.190) “Provider” means a person authorized to provide a health care service or product pursuant to NAC 442.600 to 442.788, inclusive, through a signed memorandum of understanding with the Division.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98; R095-99, 11-29-99; R024-06, 7-14-2006)

NAC 442.707 “Residence” defined. (NRS 442.140, 442.190) “Residence” means a place where a person remains when not called elsewhere for labor or other special temporary purposes, and to which the person returns.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.708 “Resident” defined. (NRS 442.140, 442.190) “Resident” means a person who lives in this State and:

1. Intends to make this State his or her home permanently or for an indefinite period; or

2. Is employed or seeking employment in this State.

Ê This term includes a person who does not have a fixed place of residence in this State, is temporarily absent from the State but intends to return to this State when he or she has accomplished the purpose of the absence, or is a dependent of military personnel for the duration of the tour of duty of his or her parent or guardian in this State.

(Added to NAC by Bd. of Health, eff. 1-18-94; A by R212-97, 7-23-98)

NAC 442.710 Eligibility of clients under program. (NRS 442.140, 442.190)

1. To be eligible for participation in the program, a person must:

(a) Have an eligible condition;

(b) Be financially eligible pursuant to this section;

(1) A citizen of the United States;

(2) A qualified alien, as defined in 8 U.S.C. § 1641; or

(3) An alien who is otherwise eligible for participation in the program pursuant to federal regulations regarding the eligibility of aliens for public assistance; and

(d) Not be eligible for medical services pursuant to any other program, including, without limitation, Medicaid and Nevada Check Up. The person must provide proof of denial to the Division.

2. In addition to the requirements set forth in subsection 1, a client who is a child must be evaluated at least once annually by a physician who is certified by the American Board of Pediatrics as a specialist in pediatrics to determine whether the child has an eligible condition.

3. Financial eligibility for participation in the program varies according to the gross annual income of the client’s household in comparison to 250 percent of the level of poverty designated for a household of that size by the United States Department of Health and Human Services. A client is eligible for diagnostic evaluations pursuant to subsection 7 of NAC 442.751 if his or her gross annual income is not more than 300 percent of the level of poverty designated for a household of that size by the United States Department of Health and Human Services. Gross annual income will be calculated by adding the total income and resources of all members of the client’s household.

4. Resources to be considered for financial eligibility to participate in the program include, but are not limited to:

(a) Savings certificates and savings accounts.

(b) Stocks and bonds held by the client or his or her household, including, but not limited to, individual retirement accounts, money market accounts, tax deferred accounts and accounts established pursuant to 26 U.S.C. § 401(k).

(d) Proceeds from the sale of property.

(e) Income tax refunds or rebates.

(f) Cash gifts, prizes and awards.

(g) Trust funds.

5. Income to be considered for financial eligibility to participate in the program includes, but is not limited to:

(a) Wages, salaries and commissions.

(b) Gratuities.

(d) Alimony and child support.

(e) Inheritances.

(f) Pensions and benefits.

(g) Judgments and settlements resulting from litigation above the cost of litigation and any casualty losses or medical expenses for which the litigation was initiated.

(h) Interest, dividends and royalties.

(i) Any direct payments of money considered to be a gain or benefit, including, but not limited to, any donations of money.

(j) Money in a trust.

(k) Rental income.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98; R095-99, 11-29-99)

NAC 442.711 Report by applicant of receipt of child support; application for assistance in obtaining child support. (NRS 442.140, 442.190)

1. An applicant for participation in the program or a client shall report to the Division of Public and Behavioral Health any payments of child support received for his or her support.

2. Except as otherwise provided in this subsection, an applicant or client who is not receiving all payments of child support to which he or she is entitled for his or her support shall file with the Division of Welfare and Supportive Services of the Department of Health and Human Services or the district attorney of the county in which he or she resides an application for assistance in obtaining that support. The Chief may, because of exceptional circumstances, excuse an applicant or client from compliance with the requirements of this subsection.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.712 Receipt of donations, judgments or settlements. (NRS 442.140, 442.190) Any money received by or on behalf of a client from any donations, judgments or settlements relating to an eligible condition for which the client receives services from a provider under the program must be applied to pay for the cost of those services and related costs before money may be expended under the program for that purpose. If money is expended under the program for that purpose before a client receives money from such a source, the client shall reimburse the program for that expenditure. A client shall inform the Division of all actions taken to obtain such a judgment or settlement, including, without limitation, the name of any attorney retained for that purpose and the dates of any court hearings scheduled for that purpose.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.715 Eligibility of providers under program. (NRS 442.140, 442.190)

1. To provide services to clients, physicians and other regular providers of services under the program must have executed a memorandum of understanding with the Division, except that providers who provide services one time or on a sporadic basis are not required to have executed a memorandum of understanding if they agree to accept reimbursement provided under the program as payment in full for those services. The memorandum of understanding must:

(a) Require the physician or other provider to accept the rates of reimbursement set forth in NAC 442.751; and

(b) Provide that households will not be billed by the provider for the remaining balance.

2. Except in cases of emergency, providers must receive authorization before the delivery of a service to a patient, including, but not limited to, a patient for whom a determination of eligibility for Medicaid is pending, to be eligible for reimbursement for that service. Oral authorization for care must be followed by written authorization. Authorizations for services provided during the hours when the offices of the Bureau are closed may be issued retroactively if:

(a) The client meets the eligibility requirements of the program; and

(b) The Division is notified by the physician, hospital, medical facility or other provider of services within 72 hours after the services are provided.

3. A physician must provide medical justification for and a description of the anticipated outcome of the services requested at the time he or she requests prior authorization.

4. Medical treatment authorized for payment must relate to the primary diagnosis or diagnoses for which the applicant was accepted into the program.

5. The following services covered by the primary physician’s authorization do not require separate prior authorization:

(a) Ambulance, if required by the authorized physician.

(b) Anesthesiologists or anesthetists, except that the fees of the program prevail. The anesthesiologist or anesthetist must bill the insurance carrier or other third-party payer and the program directly. The client’s household must not be billed for charges in excess of those allowed under the program.

(c) Assistant surgeon, except that the fees of the program prevail. The assistant surgeon must bill the insurance carrier or other third-party payer and the program directly. The client’s household must not be billed for charges in excess of those allowed under the program.

(d) Laboratory services, except that the fees of the program prevail. The laboratory must bill the insurance carrier or other third-party payer and the program directly. The client’s household must not be billed for charges in excess of those allowed under the program.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; 10-30-97; R212-97, 7-23-98; R095-99, 11-29-99)

NAC 442.718 Prohibition against discrimination. (NRS 442.140, 442.190) No person may exclude from, deny the benefits of or otherwise discriminate against a person who wishes to participate in the program because of that person’s race, creed, color, national origin or sex.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.720 Format of forms to be used. (NRS 442.140, 442.190) Forms used for application, financial eligibility, authorization and payment must be in a format satisfactory to the program.

(Added to NAC by Bd. of Health, eff. 11-27-89)

NAC 442.725 Date of eligibility for participation; submission of application; annual updates. (NRS 442.140, 442.190)

1. Except as otherwise provided in subsection 2, an applicant’s eligibility for participation in the program begins:

(a) On the date on which the applicant contacts a program specialist;

(b) On the date on which a medical facility notifies a program specialist regarding the applicant; or

Ê if, within 30 days after that date, the applicant submits an application to a program specialist.

2. If an applicant submits an application after the 30-day limit, the applicant’s date of eligibility will be the date on which the applicant completed the application.

3. Incomplete applications must be completed within 30 working days after the initial application is submitted to retain the effective date of the initial application.

4. An applicant or a client shall submit an updated application annually.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; 10-30-97; R212-97, 7-23-98)

NAC 442.751 Limitations of program. (NRS 442.140, 442.190) The program will:

1. Not provide for the total care of a client.

2. Provide only services that are related to treating a client’s condition.

3. Cover conditions with a poor or variable prognosis only as funding for the program allows.

4. Pay not more than $10,000 annually for each client unless, subject to budgetary limitations, the Chief Medical Officer or a person designated by the Administrator authorizes the expenditure of an additional amount in an extraordinary situation.

5. Reimburse providers at Medicaid rates for the costs of the services provided to clients. For the costs incurred for orthotic and prosthetic devices provided by medical prescription to enhance a client’s ability to perform the activities of daily living, the program will reimburse:

(a) At Medicaid rates; or

(b) At 80 percent of the usual and customary charge if no Medicaid rate is available.

6. Approve services provided outside this State only when:

(a) The services are not available within this State; and

(b) The provider who refers the client for those services agrees to provide ongoing follow-up care to the client.

7. Pay the costs of any diagnostic evaluations performed to determine whether a client has an eligible medical condition if the gross annual income of the client is not more than 300 percent of the level of poverty designated for a household of that size by the United States Department of Health and Human Services. For the purposes of this subsection, gross annual income will be calculated as provided in NAC 442.710.

(Added to NAC by Bd. of Health, eff. 1-18-94; A by R212-97, 7-23-98; R095-99, 11-29-99)

NAC 442.765 Grounds for terminating eligibility of client. (NRS 442.140, 442.190) A program specialist shall terminate the eligibility of a client for the following reasons:

1. The client reaches the limitation on age set forth in NAC 442.782.

2. The client has achieved maximum alleviation or rehabilitation of his or her eligible condition.

3. The income of the client’s household no longer meets the requirements of the program for financial eligibility.

4. The client’s household chooses not to continue to participate in the program.

5. Failure by the client to cooperate in carrying out recommended treatment or to apply for third-party assistance, including, without limitation, assistance provided through Medicaid or Nevada Check Up.

6. A lack of money for the program for the continuation of the services required by the client.

7. Denial of other third-party coverage based on failure to cooperate.

8. Misrepresentation of material facts in the application.

9. Failure by the client to cooperate in seeking to obtain any applicable payments of child support, unless excused by the Chief because of exceptional circumstances.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; 10-30-97; R212-97, 7-23-98; R095-99, 11-29-99)

NAC 442.770 Submission and contents of claims. (NRS 442.140, 442.190)

1. Except as otherwise provided in subsections 2 and 3, a provider shall submit a claim for the payment of services provided to a client to third-party payers before submitting the claim to the Division under the program.

2. Except as otherwise provided in subsection 3, the provider may submit the claim directly to the Division under the program if:

(a) The client does not have any third-party payers;

(b) The provider has exhausted the resources of all third-party payers; or

3. A provider shall submit the claim of a client eligible for services pursuant to a program administered by the Indian Health Service to the Division before submitting the claim to the Indian Health Service.

4. If a provider submits a claim to the Division under the program, he or she shall submit a single copy of each completed claim on billing forms acceptable to Medicaid within 120 days after the date:

(a) Of service if the client does not have any third-party payers;

(b) On which the provider exhausts the resources of all third-party payers; or

Ê All claims must be accompanied by legible medical reports and have all appropriate identification as required pursuant to this section or the claim will not be processed.

5. A claim must not be a duplicate or reflect a balance from claims that the provider previously submitted.

6. A claim must not be altered.

7. A claim must include:

(a) The full name, date of birth and address of the client.

(b) The name and address of the provider submitting the claim.

(c) The diagnosis, including the code number for the condition designated by the Division and whether the condition is presumptively covered under the program or is a confirmed eligible medical condition.

(d) The date of service.

(e) The type of service, using the code descriptors designated by the Division.

(f) The usual and customary fee for each type of service.

(g) The provider’s taxpayer identification number.

(h) The signature of the provider or an authorized representative thereof.

8. The primary surgeon’s claims and necessary reports must be submitted to the Division before payment can be made to the assistant surgeon, anesthesiologist or anesthetist or for other ancillary services.

9. If the fee is claimed on the basis of time, the report of the examination must indicate the beginning and ending time of the procedure.

10. Claims for tissue pathology must include the name of the ordering physician, the source of the specimen obtained and the date, and must be submitted with a description of the findings of each procedure performed.

11. Claims for radiology must indicate the name of the ordering physician, the date on which each procedure was performed and the site of the procedure, according to current procedural terminology, and must indicate whether the fee was split.

12. Laboratory and X-ray services ordered by the authorized physician and adjunctive to his or her services do not require separate prior authorization. Either the reports of such services or their mention in the physician’s progress notes or report must accompany the billing for such services.

13. Claims for physical or psychological therapy must include the name of the ordering physician, the date of therapy and documentation of the therapy provided.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98; R095-99, 11-29-99)

NAC 442.775 Payment or denial of claim for medical services: Notification of denial to provider; procedure for review of denial and appeal of decision of Bureau. (NRS 442.140, 442.190)

1. A program specialist shall determine whether to pay a claim for services furnished by a provider.

2. If the program specialist determines that the claim will not be paid, he or she shall notify the provider, in writing, of the reason why the claim will not be paid.

3. The provider may request a review of the decision denying payment of the claim.

4. The provider must submit a written request to the Bureau within 30 days after receiving notice that the claim has been denied.

5. If the Bureau receives a request for a review pursuant to subsection 4, it shall issue a written decision and notify the provider, in writing, of its decision.

6. The provider may appeal the decision of the Bureau in the manner prescribed in NAC 439.190 to 439.395, inclusive.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; 10-30-97; R212-97, 7-23-98)

NAC 442.780 Denial of medical services: Notification of applicant or client; procedure for review of denial and appeal of decision of Bureau. (NRS 442.140, 442.190)

1. If a program specialist determines that:

(a) An applicant for services under the program does not meet the requirements for eligibility;

(b) A client receiving services under the program no longer meets those requirements; or

Ê the program specialist shall notify the applicant or client in writing of the reason why the services will not be provided.

2. The applicant or client may request a review of the denial of services under the program by submitting a written request to the Bureau within 30 days after receiving notice of that denial.

3. If the Bureau receives a request for a review pursuant to subsection 2, it shall issue a written decision and notify the applicant or client, in writing, of its decision.

4. The applicant or client may appeal the decision of the Bureau in the manner prescribed in NAC 439.190 to 439.395, inclusive.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 10-30-97; R212-97, 7-23-98)

Services for Children With Special Health Care Needs

NAC 442.782 Eligibility for medical services. (NRS 442.190) To be eligible for medical services for an eligible medical condition under the program, a person must:

1. Be below the age of 19 years;

2. Have a suspected or confirmed eligible medical condition; and

3. Meet the requirements for eligibility specified in NAC 442.710.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98; A by R095-99, 11-29-99)

NAC 442.784 Eligible medical conditions: Categories; identification. (NRS 442.190)

1. A client’s eligible medical condition will be assigned to one of the following categories to determine the extent of medical services that will be provided under the program:

(a) Category 1 includes conditions:

(1) Which require ambulatory or outpatient services only; and

(2) For which an excellent prognosis is anticipated.

(b) Category 2 includes conditions:

(1) Which require ambulatory or outpatient services or limited inpatient care; and

(2) For which a good prognosis and the prevention of disability or deterioration is anticipated if the condition is treated.

(1) Which require prolonged outpatient treatment and frequent hospitalization with high morbidity if not treated; and

(2) For which a fair prognosis is anticipated.

Ê For the purposes of this subsection, the prognosis must be based on an analysis of the client’s functional ability for the activities of daily living.

2. The following conditions are eligible medical conditions:

(a) Blood cell conditions, including, but not limited to:

(1) Sickle-cell disease.

(2) Thalassemia, major.

(b) Cardiovascular conditions, including, but not limited to:

(1) Acquired heart disease.

(2) Arrhythmia.

(3) Congenital malformations of the blood vessels.

(4) Congenital malformations of the heart.

(5) Hypertension.

(6) Vascular occlusion.

(1) Adrenal dysfunction, including pseudohermaphroditism.

(2) Diabetes mellitus, type 1 (insulin dependent).

(3) Diabetes insipidus.

(4) Thyroid dysfunction.

(5) Pituitary dysfunction, including:

(I) Hypogonadism; and

(II) Dwarfism, if the client’s height is less than the third percentile, growth is less than 4 centimeters per year and bone age is more than 2 years behind chronological age.

(d) Craniofacial anomalies, including, but not limited to:

(1) Cleft lip and palate and medically necessary dental restoration required as a result of the cleft lip or palate.

(2) Congenital facial abnormalities associated with chromosomal abnormalities or known syndromes or causing oral or motor dysfunction, or both.

(3) Craniosynostosis.

(e) Ear disorders, including, but not limited to:

(1) Chronic mastoiditis or cholesteatoma.

(2) Congenital malformations of the ear.

(3) Congenital or acquired hearing loss.

(f) Eye conditions, including, but not limited to:

(1) Eye injuries involving poisoning or trauma. Such injuries will be covered from the time of injury if the potential for rehabilitation exists.

(2) Cataracts.

(3) Congenital herpes.

(4) Glaucoma.

(5) Keratoconus.

(6) Ptosis, if it covers the pupil.

(7) Strabismus that cannot be corrected with eyeglasses.

(g) Gastrointestinal disorders, including, but not limited to:

(1) Incarcerated hernia.

(2) Intestinal obstruction or pseudo-obstruction.

(3) Omphalocele and gastroschisis.

(4) Pancreatitis, chronic.

(5) Ulcerative colitis.

(h) Genitourinary disorders, including, but not limited to:

(1) Ambiguous genitalia.

(2) Epispadias.

(3) Hypospadias.

(4) Incarcerated hernia.

(5) Neurogenic bladder.

(6) Obstructive uropathy.

(7) Testicular torsion.

(8) Undescended testicles.

(9) Ureterocele.

(10) Ureteropelvic junction (UPJ) obstruction.

(11) Vesicoureteral reflux.

(i) Metabolic disorders that are treatable inborn errors of metabolism, including, but not limited to:

(1) Aminoaciduria.

(2) Biotinidase deficiency.

(3) Cystic fibrosis.

(4) Galactosemia.

(5) Glycogen storage disease.

(6) Homocystinuria.

(7) Maple syrup urine disease.

(8) Phenylketonuria.

(9) Tyrosinemia.

(j) Neurological disorders, including, but not limited to:

(1) Arachnoid cysts.

(2) Brain injury or disease.

(3) Seizure disorder.

(4) Dermal sinus of the spine or cranium.

(5) Guillain-Barre syndrome.

(6) Hydrocephalus.

(7) Intracranial neoplasms.

(8) Meningocele.

(9) Tethered cord syndrome (tight filum).

(10) Spina bifida.

(11) Spinal cord disease, including a ruptured disc and spinal fracture causing paraplegia.

(k) Orthopedic conditions, including, but not limited to:

(1) Amputated limbs, congenital or acquired.

(2) Arthrosis.

(3) Blount’s disease.

(4) Osteomyelitis.

(5) Complications of fractures, such as chronic infection, nonunion and avascular necrosis.

(6) Congenital deformities of the arm, hand, hip, knee or foot.

(7) Cysts.

(8) Juvenile rheumatoid arthritis.

(9) Osteochondrosis, including Legg-Perthes disease.

(10) Scoliosis.

(11) Tibial torsion that impairs ambulation.

(12) Tumor.

(l) Pulmonary conditions, including, but not limited to:

(1) Asthma that impedes the ability to perform the activities of daily living and requires daily medication to maintain respiratory function.

(2) Broncho-pulmonary dysplasia.

(3) Congenital emphysema.

(4) Lung hypoplasia associated with diaphragmatic hernia.

(5) Respiratory distress syndrome. Coverage under the program is limited to 1 day of acute care for the administration of a pulmonary surfactant treatment to reduce long-term deficits.

(m) Reconstruction, including, but not limited to:

(1) Burn care and reconstruction. Coverage under the program extends to the date of the initial injury.

(2) Hemangioma.

(3) A disfiguring deformity which impedes normal, daily function relative to social or emotional development.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98; R095-99, 11-29-99)

NAC 442.786 Ineligible conditions and services. (NRS 442.190) The program does not cover the following conditions and services:

1. Acute infectious diseases.

2. Learning disabilities, intellectual disabilities and problems related to behavior.

3. Allergies.

4. The alteration of a construction or dwelling.

5. Benign inflammatory conditions.

6. Blood and plasma, except for processing and administrative fees.

7. Chronic sinusitis, except in cases of severe respiratory impairment.

8. Cosmetic surgery as an isolated indication.

9. Custodial care.

10. Diagnostic or therapeutic procedures, techniques, instrumentalities or agents that:

(a) Have not been approved by the Food and Drug Administration; or

(b) Are experimental.

11. Disorders of the immune system.

12. Educational services.

13. Flat feet, tibial torsion and metatarsus adductus.

14. Hypertrophy of the tonsils and adenoids, unless the tonsils and adenoids significantly contribute to, interfere with, or complicate the management of an eligible medical condition.

15. Initial acute care of accidents, poisoning and violence.

16. Ordinary refractive errors.

17. Prematurity alone.

18. Second opinions that have not been requested by a physician of record with documentation of medical necessity.

19. Services for homemakers.

20. Strabismus, where nonsurgical treatment suffices.

21. Transplant surgeries and drugs and supplies directly related to the transplant.

22. The transportation of a client or a member of his or her household, except that transportation by ambulance is covered in unusual circumstances if it is requested in advance and there is documentation of the unusual circumstances that created the need.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98) — (Substituted in revision for NAC 442.755)

NAC 442.788 Payment for dietary supplements and medications; additional covered services. (NRS 442.190)

1. The program does not pay for dietary supplements or medications relating to eligible medical conditions except as otherwise provided in subsection 2 and in the circumstances specified for the following eligible medical conditions:

(a) Cystic fibrosis, medications related to the eligible medical condition or its complications.

(b) Epilepsy, subject to individual case and medical review.

(d) Inborn errors of metabolism, including those detected through the program for screening newborn babies conducted pursuant to NRS 442.008 and NAC 442.020 to 442.050, inclusive, dietary supplements as prescribed.

(e) Asthma that requires daily medication for a client to perform the activities of daily living, subject to individual case and medical review.

(f) Cardiac conditions that require ongoing medication for a client to perform the activities of daily living, subject to individual case and medical review.

(g) Thyroid conditions that require ongoing medication, subject to individual case and medical review.

2. The program will, subject to individual case and medical review, cover dietary supplements and medications required on an ongoing basis for the prevention or amelioration of complications of an eligible medical condition.

3. The program will cover:

(a) Primary care of a client, as recommended by the American Academy of Pediatrics, to the extent that the Division determines such care is necessary to ensure the optimum health of the client;

(b) Services of a licensed dietitian, to the extent that the Division determines those services are necessary to ensure the optimum health of a client;

(c) Physical therapy necessary to return a client to functional ability, except that, unless otherwise authorized by the Division, such coverage is limited to not more than 12 sessions annually and 60 minutes per session; and

(d) Psychological therapy relating to emotional support for an ongoing, chronic eligible medical condition, except that, unless otherwise authorized by the Division, such coverage is limited to:

(1) For individual therapy, not more than 12 sessions annually and 60 minutes per session.

(2) For group therapy, not more than 24 sessions annually.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; R212-97, 7-23-98; R095-99, 11-29-99; R090-12, 12-20-2012)

SCREENING OF HEARING OF NEWBORN CHILDREN

NAC 442.850 Annual reports to Division of Public and Behavioral Health: Contents. (NRS 442.540, 442.550) The annual written report required to be submitted to the Division of Public and Behavioral Health of the Department of Health and Human Services pursuant to NRS 442.550 by licensed hospitals and licensed obstetric centers must include the following information concerning hearing screenings of newborn children conducted at the licensed hospital or licensed obstetric center during the period covered by the report:

1. The name of the licensed hospital or licensed obstetric center.

2. The number of newborn children screened.

3. The number of newborn children who required follow-up services and for each of those newborn children:

(a) The age of the newborn child at the time the hearing screening was conducted;

(b) The gestational age of the newborn child at birth;

(d) The results of the hearing screening;

(e) Any recommendations made for the newborn child as a result of the hearing screening;

(f) Any referrals made for the newborn child as a result of the hearing screening;

(g) The county of residence of the newborn child;

(h) The name and date of birth of the mother of the newborn child; and

(i) The name of the attending physician of the newborn child.

(Added to NAC by Bd. of Health by R191-01, eff. 5-23-2002)

NAC 442.860 Referral of child for certain services: Notification of Division of Public and Behavioral Health. (NRS 442.540) If a licensed hospital or licensed obstetric center makes a referral for a newborn child because the newborn child needs assistance with accessing diagnostic and treatment services, the licensed hospital or licensed obstetric center shall notify the Division of Public and Behavioral Health of the Department of Health and Human Services of the referral at the time the referral is made.

(Added to NAC by Bd. of Health by R191-01, eff. 5-23-2002)