Assembly Bill No. 118-Committee on Government Affairs
February 3, 1997
____________
Referred to Committee on Government Affairs
SUMMARY--Makes various changes relating to operation of facilities for residential care. (BDR 22-22)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State or on Industrial Insurance: No.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to facilities for residential care; expanding the limitation on local control over the location of housing for mentally retarded persons to include certain facilities for other persons with disabilities; requiring the governing body of a city or county to ensure that a disproportionate number of such facilities are not located in one neighborhood; requiring a person who provides care for not more than two persons in his home to obtain a license to operate a residential facility for groups under certain circumstances and changing the name of residential facilities for groups to facilities for residential care as a result of this requirement; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
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Section 1 NRS 278.021 is hereby amended to read as follows:
278.021 1. The purpose of this section is to remove obstacles imposed by zoning ordinances [, declarations of restrictions, deed restrictions, restrictive covenants and equitable servitudes] which prevent persons [who are mentally retarded] with disabilities from living in normal residences [.] throughout the entire community.
2. In any ordinance adopted by a city or county, the definition of "single-family residence" must include a [home] residential facility for adult care in which six or fewer unrelated persons [who are mentally retarded] with disabilities reside with [one] :
(a) One or two additional persons [to] who act as house parents or guardians and who need not be related to each other or any of the [mentally retarded] disabled persons who reside in the house [.
3. This section does] ; and
(b) Any additional persons who are related to the house parents or guardians within the second degree of consanguinity or affinity and who wish to reside in the facility.
3. The provisions of subsection 2 do not prohibit a definition which permits more persons to reside in the house, nor does it prohibit regulation of homes which are operated on a commercial basis. For the purposes of this subsection, a residential facility for adult care shall not be deemed to be a home that is operated on a commercial basis.
4. The governing body of a city or county shall:
(a) Approve a request to locate the first residential facility for adult care within a particular neighborhood;
(b) If permission is requested to locate an additional residential facility for adult care within 1,000 feet of an existing residential facility for adult care, review the application based on applicable zoning ordinances; and
(c) Ensure that a disproportionate number of residential facilities for adult care are not located in a neighborhood.
5. For the purposes of [subsection 1, a residence for mentally retarded persons is not a commercial activity.] this section, "residential facility for adult care" means a facility or establishment which is operated by the state, or any political subdivision thereof, or is licensed or regulated by the state, or any political subdivision thereof, and which furnishes food, shelter, assistance, treatment and limited supervision to persons who are at least 18 years of age and who are aged, infirm, mentally retarded, handicapped or addicted to drugs or alcohol. The term does not include:
(a) A facility or an establishment that provides care only during the day; or
(b) A natural person who provides care for one or more persons related to him within the third degree of consanguinity or affinity.
Sec. 2 NRS 361.815 is hereby amended to read as follows:
361.815 1. "Home" means residential living quarters located in Nevada. The quarters may consist of a single dwelling unit, or a unit which is an integral part of a larger complex such as a multidwelling or a multipurpose building, together with the land upon which the unit is built and any surrounding land, not to exceed 2 acres, as well as outbuildings and facilities reasonably necessary for use of the unit as residential living quarters.
2. The term "home" includes:
(a) A mobile home.
(b) A home, mobile home or dwelling which the claimant possesses under a contract of sale, deed of trust, life estate, joint tenancy or tenancy in common.
(c) A [residential] facility for [groups] residential care required to be licensed by the health division of the department of human resources, pursuant to NRS 449.001 to 449.240, inclusive.
(d) A dwelling within any housing project which has been established pursuant to chapter 315 of NRS and for which the housing authority makes payments in lieu of taxes.
3. If the residential living quarters are part of a multipurpose building, the "home" does not include any part of the building or land which is not used as living quarters by the claimant and spouse and which generates income for the claimant or spouse.
Sec. 3 NRS 427A.028 is hereby amended to read as follows:
427A.028 "Facility for long-term care" means:
1. A [residential] facility for [groups] residential care as defined in [NRS 449.017;] section 4 of this act;
2. A facility for intermediate care as defined in NRS 449.0038;
3. A facility for skilled nursing as defined in NRS 449.0039; and
4. Any unlicensed establishment that provides food, shelter, assistance and limited supervision to a resident.
Sec. 4 Chapter 449 of NRS is hereby amended by adding thereto a new section to read as follows:
1. "Facility for residential care" means an establishment that furnishes food, shelter, assistance and limited supervision to:
(a) Any aged, infirm, mentally retarded or handicapped person; or
(b) Four or more females during pregnancy or after delivery.
2. The term does not include:
(a) An establishment which provides care only during the day;
(b) A natural person who provides care for one or more persons related to him within the third degree of consanguinity or affinity; or
(c) A facility funded by the welfare division or the mental hygiene and mental retardation division of the department of human resources.
Sec. 5 NRS 449.001 is hereby amended to read as follows:
449.001 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 449.0015 to 449.019, inclusive, and section 4 of this act, have the meanings ascribed to them in those sections.
Sec. 6 NRS 449.0045 is hereby amended to read as follows:
449.0045 "Facility for the dependent" includes a facility for the treatment of abuse of alcohol or drugs, facility for the care of adults during the day or [residential] facility for [groups.] residential care.
Sec. 7 NRS 449.0355 is hereby amended to read as follows:
449.0355 A [residential] facility for [groups] residential care must not be operated except under the supervision of an administrator of a [residential] facility for [groups] residential care licensed pursuant to the provisions of chapter 654 of NRS.
Sec. 8 NRS 449.037 is hereby amended to read as follows:
449.037 1. The board shall adopt:
(a) Licensing standards for each class of medical facility or facility for the dependent covered by NRS 449.001 to 449.240, inclusive, and section 4 of this act, and for programs of hospice care.
(b) Regulations governing the licensing of such facilities and programs.
(c) [Regulations governing the procedure and standards for granting an extension of the time for which a natural person may provide certain care in his home without being considered a residential facility for groups pursuant to NRS 449.017. The regulations must require that such grants are effective only if made in writing.
(d)] Any other regulations as it deems necessary or convenient to carry out the provisions of NRS 449.001 to 449.240, inclusive.
2. The board shall adopt separate regulations governing the licensing and operation of:
(a) Facilities for the care of adults during the day; and
(b) [Residential facilities for groups,] Facilities for residential care,
which provide care to persons with Alzheimer's disease.
3. The board shall adopt separate regulations for the licensure of rural hospitals which take into consideration the unique problems of operating such a facility in a rural area.
4. The board shall require that the practices and policies of each medical facility or facility for the dependent provide adequately for the protection of the health, safety and physical, moral and mental well-being of each person accommodated in the facility.
5. The board shall establish minimum qualifications for administrators and employees of [residential] facilities for [groups.] residential care. In establishing the qualifications, the board shall consider the related standards set by nationally recognized organizations which accredit such facilities.
6. The board shall adopt separate regulations regarding the assistance which may be given pursuant to NRS 453.375 and 454.213 to an ultimate user of controlled substances or dangerous drugs by employees of [residential] facilities for [groups.] residential care. The regulations must require at least the following conditions before such assistance may be given:
(a) The ultimate user's physical and mental condition is stable and is following a predictable course.
(b) The amount of the medication prescribed is at a maintenance level and does not require a daily assessment.
(c) A written plan of care by a physician or registered nurse has been established that:
(1) Addresses possession and assistance in the administration of the medication; and
(2) Includes a plan, which has been prepared under the supervision of a registered nurse or licensed pharmacist, for emergency intervention if an adverse condition results.
(d) The prescribed medication is not administered by injection or intravenously.
(e) The employee has successfully completed training and examination approved by the health division regarding the authorized manner of assistance.
Sec. 9 NRS 453.375 is hereby amended to read as follows:
453.375 A controlled substance may be possessed and administered by the following persons:
1. A practitioner.
2. A registered nurse licensed to practice professional nursing or licensed practical nurse, at the direction of a physician, physician's assistant, dentist, podiatric physician or advanced practitioner of nursing, or pursuant to a chart order, for administration to a patient at another location.
3. An advanced emergency medical technician:
(a) As authorized by regulation of:
(1) The state board of health in a county whose population is less than 100,000; or
(2) A county or district board of health in a county whose population is 100,000 or more; and
(b) In accordance with any applicable regulations of:
(1) The state board of health in a county whose population is less than 100,000;
(2) A county board of health in a county whose population is 100,000 or more; or
(3) A district board of health created pursuant to NRS 439.370 in any county.
4. A respiratory therapist, at the direction of a physician or physician's assistant.
5. A medical student, student in training to become a physician's assistant or student nurse in the course of his studies at an approved college of medicine or school of professional or practical nursing, at the direction of a physician or physician's assistant and:
(a) In the presence of a physician, physician's assistant or a registered nurse; or
(b) Under the supervision of a physician, physician's assistant or a registered nurse if the student is authorized by the college or school to administer the substance outside the presence of a physician, physician's assistant or nurse.
A medical student or student nurse may administer a controlled substance in the presence or under the supervision of a registered nurse alone only if the circumstances are such that the registered nurse would be authorized to administer it personally.
6. An ultimate user or any person whom the ultimate user designates pursuant to a written agreement.
7. Any person designated by the head of a correctional institution.
8. A veterinary technician at the direction of his supervising veterinarian.
9. In accordance with applicable regulations of the state board of health, an employee of a [residential] facility for [groups,] residential care, as defined in [NRS 449.017,] section 4 of this act, pursuant to a written agreement entered into by the ultimate user.
Sec. 10 NRS 454.213 is hereby amended to read as follows:
454.213 A drug or medicine referred to in NRS 454.181 to 454.371, inclusive, may be possessed and administered by:
1. A practitioner.
2. A physician's assistant at the direction of his supervising physician or a licensed dental hygienist acting in the office of and under the supervision of a dentist.
3. A registered nurse licensed to practice professional nursing or licensed practical nurse, at the direction of a prescribing physician, dentist, podiatric physician or advanced practitioner of nursing, or pursuant to a chart order, for administration to a patient at another location.
4. An intermediate emergency medical technician or an advanced emergency medical technician, as authorized by regulation of the state board of pharmacy and in accordance with any applicable regulations of:
(a) The state board of health in a county whose population is less than 100,000;
(b) A county board of health in a county whose population is 100,000 or more; or
(c) A district board of health created pursuant to NRS 439.370 in any county.
5. A respiratory therapist employed in a health care facility. The therapist may possess and administer respiratory products only at the direction of a physician.
6. A dialysis technician, under the direction or supervision of a physician or registered nurse only if the drug or medicine is used for the process of renal dialysis.
7. A medical student or student nurse in the course of his studies at an approved college of medicine or school of professional or practical nursing, at the direction of a physician and:
(a) In the presence of a physician or a registered nurse; or
(b) Under the supervision of a physician or a registered nurse if the student is authorized by the college or school to administer the drug or medicine outside the presence of a physician or nurse.
A medical student or student nurse may administer a dangerous drug in the presence or under the supervision of a registered nurse alone only if the circumstances are such that the registered nurse would be authorized to administer it personally.
8. Any person designated by the head of a correctional institution.
9. An ultimate user or any person designated by the ultimate user pursuant to a written agreement.
10. A nuclear medicine technologist, at the direction of a physician and in accordance with any conditions established by regulation of the board.
11. A radiologic technologist, at the direction of a physician and in accordance with any conditions established by regulation of the board.
12. A chiropractic physician, but only if the drug or medicine is a topical drug used for cooling and stretching external tissue during therapeutic treatments.
13. A physical therapist, but only if the drug or medicine is a topical drug which is:
(a) Used for cooling and stretching external tissue during therapeutic treatments; and
(b) Prescribed by a licensed physician for:
(1) Iontophoresis; or
(2) The transmission of drugs through the skin using ultrasound.
14. In accordance with applicable regulations of the state board of health, an employee of a [residential] facility for [groups,] residential care, as defined in [NRS 449.017,] section 4 of this act, pursuant to a written agreement entered into by the ultimate user.
15. A veterinary technician at the direction of his supervising veterinarian.
Sec. 11 Chapter 654 of NRS is hereby amended by adding thereto a new section to read as follows:
"Facility for residential care" has the meaning ascribed to it in section 4 of this act.
Sec. 12 NRS 654.010 is hereby amended to read as follows:
654.010 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 654.015 to [654.031,] 654.028, inclusive, and section 11 of this act, have the meanings ascribed to them in those sections.
Sec. 13 NRS 654.015 is hereby amended to read as follows:
654.015 "Administrator of a [residential] facility for [groups"] residential care" means a person who manages, supervises and is in general administrative charge of a [residential] facility for [groups.] residential care.
Sec. 14 NRS 654.060 is hereby amended to read as follows:
654.060 1. The governor shall appoint:
(a) Two members who are nursing facility administrators.
(b) One member who is an administrator of a [residential] facility for [groups] residential care with less than seven clients.
(c) One member who is an administrator of a [residential] facility for [groups] residential care with seven or more clients.
(d) One member who is a member of the medical or paramedical professions.
(e) One member who is a representative of the general public.
2. The member who is a representative of the general public shall not participate in preparing, conducting or grading any examination required by the board.
Sec. 15 NRS 654.110 is hereby amended to read as follows:
654.110 1. The board shall:
(a) Develop, impose and enforce standards which must be met by persons to receive licenses as nursing facility administrators or administrators of [residential] facilities for [groups.] residential care. The standards must be designed to ensure that nursing facility administrators or persons acting as administrators of [residential] facilities for [groups] residential care will be persons who are of good character and otherwise suitable, and who, by training or experience in their respective fields of administering health care facilities, are qualified to serve as nursing facility administrators or administrators of [residential] facilities for [groups.] residential care.
(b) Develop and apply appropriate techniques, including examinations and investigations, for determining whether a person meets those standards.
(c) Issue licenses to persons determined, after the application of appropriate techniques, to meet those standards.
(d) Revoke or suspend licenses previously issued by the board in any case if the person holding the license is determined substantially to have failed to conform to the requirements of the standards.
(e) Establish and carry out procedures designed to ensure that persons licensed as nursing facility administrators or administrators of [residential] facilities for [groups] residential care will, during any period they serve as such, comply with the requirements of the standards.
(f) Receive, investigate and take appropriate action with respect to any charge or complaint filed with the board to the effect that any person licensed as a nursing facility administrator or an administrator of a [residential] facility for [groups] residential care has failed to comply with the requirements of the standards. The board shall initiate an investigation of any charge or complaint filed with the board within 30 days after receiving the charge or complaint.
(g) Conduct a continuing study of:
(1) Facilities for skilled nursing, facilities for intermediate care and their administrators; and
(2) [Residential facilities for groups] Facilities for residential care and their administrators,
with a view to the improvement of the standards imposed for the licensing of administrators and of procedures and methods for the enforcement of the standards.
(h) Conduct or approve, or both, a program of training and instruction designed to enable all persons to obtain the qualifications necessary to meet the standards set by the board for qualification as a nursing facility administrator or an administrator of a [residential] facility for [groups.] residential care.
2. All the records kept by the board, not otherwise privileged, are public records.
Sec. 16 NRS 654.130 is hereby amended to read as follows:
654.130 The board shall:
1. Maintain a separate register of all applications for licensure as a nursing facility administrator and a separate register of all applications for licensure as an administrator of a [residential] facility for [groups.] residential care. Each register must include:
(a) The name, age and place of residence of the applicant.
(b) If the register is for:
(1) Nursing facility administrators, the name and address of the facility for skilled nursing or facility for intermediate care of which the applicant is to be administrator.
(2) Administrators of [residential] facilities for [groups,] residential care, the name and address of each [residential] facility for [groups] residential care of which the applicant is to be administrator.
(c) The date of the application.
(d) The date the application was reviewed and the action taken on the application.
(e) The serial number of the license, if any, issued to the applicant.
(f) Such other information as the board may deem pertinent.
2. Maintain a separate register of all nursing facility administrators and a separate register of all administrators of [residential] facilities for [groups] residential care licensed pursuant to this chapter showing the status of each license.
Sec. 17 NRS 654.140 is hereby amended to read as follows:
654.140 1. The board shall prescribe and furnish an application form for the use of all persons who desire to be licensed pursuant to this chapter.
2. All applications filed with the board must be accompanied by the required fee fixed by the board in an amount not to exceed:
(a) For an administrator of a [residential] facility for [groups,] residential care, $150.
(b) For a nursing facility administrator, $250.
3. The board may fix and charge an additional fee to cover the cost of administering the examinations if the board determines that there is not sufficient other money to cover such costs.
Sec. 18 NRS 654.155 is hereby amended to read as follows:
654.155 Each applicant for licensure as an administrator of a [residential] facility for [groups] residential care pursuant to this chapter must:
1. Be at least 21 years of age;
2. Be a citizen of the United States or lawfully entitled to remain and work in the United States;
3. Be of good moral character and physically and emotionally capable of administering a [residential] facility for [groups;] residential care;
4. Have satisfactorily completed a course of instruction and training prescribed or approved by the board or be qualified by reason of his education, training or experience to administer, supervise and manage a [residential] facility for [groups;] residential care;
5. Pass an examination conducted and prescribed by the board;
6. Submit with his application:
(a) A complete set of his fingerprints and written permission authorizing the board to forward the fingerprints to the Federal Bureau of Investigation for its report; and
(b) A fee to cover the actual cost of obtaining the report from the Federal Bureau of Investigation; and
7. Comply with such other standards and qualifications as the board prescribes.
Sec. 19 NRS 654.170 is hereby amended to read as follows:
654.170 1. The board shall issue a numbered license, in such form as it may prescribe, to each applicant who meets the requirements of NRS 654.150 or 654.155 and shall affix its official seal to the license.
2. Each license issued by the board pursuant to this chapter expires 2 years after the last day of the calendar month in which it was issued and may be renewed on or before that date biennially.
3. Any licensed nursing facility administrator or administrator of a [residential] facility for [groups] residential care may renew his license by applying for renewal in the manner prescribed by the board and paying the renewal fee fixed by the board.
4. The board shall, as a prerequisite for the renewal of a license, require each holder to comply with the requirements for continuing education adopted by the board.
Sec. 20 NRS 654.180 is hereby amended to read as follows:
654.180 The board may issue a license as a nursing facility administrator or an administrator of a [residential] facility for [groups,] residential care, without examination, to any applicant who holds the same license from another jurisdiction, if the board finds that the standards for licensure in the other jurisdiction are the substantial equivalent of those prevailing in this state and that the applicant is otherwise qualified.
Sec. 21 NRS 654.190 is hereby amended to read as follows:
654.190 1. The board may, after notice and hearing, impose an administrative fine of not more than $2,500 on and suspend or revoke the license of any nursing facility administrator or administrator of a [residential] facility for [groups] residential care who:
(a) Is convicted of a felony, or of any offense involving moral turpitude.
(b) Has obtained his license by the use of fraud or deceit.
(c) Violates any of the provisions of this chapter.
(d) Aids or abets any person in the violation of any of the provisions of NRS 449.001 to 449.240, inclusive, as those provisions pertain to a facility for skilled nursing, facility for intermediate care or [residential] facility for [groups.] residential care.
(e) Violates any regulation of the board prescribing additional standards of conduct for nursing facility administrators or administrators of [residential] facilities for [groups.] residential care.
2. The board shall give a licensee against whom proceedings are brought pursuant to this section written notice of a hearing not less than 10 days before the date of the hearing.
3. If discipline is imposed pursuant to this section, the costs of the proceeding, including investigative costs and attorney's fees, may be recovered by the board.
Sec. 22 NRS 654.195 is hereby amended to read as follows:
654.195 1. The board may reinstate the license of an administrator of a [residential] facility for [groups] residential care that has been suspended by the board if a majority of the members of the board vote in favor of the reinstatement.
2. The board may reinstate the license of an administrator of a [residential] facility for [groups] residential care that has been revoked by the board if all of the members of the board vote in favor of reinstatement.
Sec. 23 NRS 654.200 is hereby amended to read as follows:
654.200 Any person who acts in the capacity of a nursing facility administrator or an administrator of a [residential] facility for [groups] residential care without a license issued pursuant to the provisions of this chapter is guilty of a misdemeanor.
Sec. 24 NRS 449.0105, 449.017, 449.249, 449.2493, 449.2496 and 654.031 are hereby repealed.
LEADLINES OF REPEALED SECTIONS
449.0105 "Home for individual residential care" defined.
449.017 "Residential facility for groups" defined.
449.249 Establishment of procedure for registration; registration by health division.
449.2493 Authority of health division and aging services division of department of human resources.
449.2496 Registration required for operation; penalty.
654.031 "Residential facility for groups" defined.