NRS: CHAPTER 439B - RESTRAINING COSTS OF HEALTH CARE

[Rev. 6/29/2024 4:06:41 PM--2023]

CHAPTER 439B - RESTRAINING COSTS OF HEALTH CARE

GENERAL PROVISIONS

NRS 439B.010 Definitions.

NRS 439B.030 “Billed charge” defined.

NRS 439B.035 “Children’s Health Insurance Program” defined.

NRS 439B.040 “Committee” defined.

NRS 439B.050 “Department” defined.

NRS 439B.060 “Director” defined.

NRS 439B.070 “Discharge form” defined.

NRS 439B.090 “Fiscal year” defined.

NRS 439B.100 “Health facility” defined.

NRS 439B.110 “Hospital” defined.

NRS 439B.115 “Major hospital” defined.

NRS 439B.120 “Medicaid” defined.

NRS 439B.130 “Medicare” defined.

NRS 439B.140 “Net revenue” defined.

NRS 439B.150 “Practitioner” defined.

NRS 439B.160 Purposes of chapter.

JOINT INTERIM STANDING COMMITTEE ON HEALTH AND HUMAN SERVICES

NRS 439B.220 Powers.

NRS 439B.225 Committee to review certain regulations proposed or adopted by licensing boards; recommendations to Legislature.

NRS 439B.227 Committee to review certain new provisions of law; recommendations to Legislature concerning mandated reporters.

MAJOR HOSPITALS

NRS 439B.260 Reduction of billed charges for certain patients and services; notice; resolution of disputes. [Effective through December 31, 2025.]

NRS 439B.260 Reduction of billed charges for certain patients and services; notice; resolution of disputes. [Effective January 1, 2026.]

NRS 439B.270 Foundation for hospital nursing practice: Establishment; governing body.

NRS 439B.275 Program for provision of technical assistance to rural hospitals.

NRS 439B.280 Educational program to promote wellness, physical fitness and prevention of disease, accidents and motor vehicle crashes.

CARE OF INDIGENT PATIENTS

NRS 439B.300 Legislative findings and declarations; applicability.

NRS 439B.310 “Indigent” defined.

NRS 439B.320 Hospital required to provide care for proportionate share of indigent patients; duties of Department and board of county commissioners; reimbursement for care.

NRS 439B.330 Eligibility of indigent for assistance; payment of hospital for serving disproportionately large share of patients; discharge forms; appeal from determination of county regarding indigent status.

NRS 439B.340 Report on indigent patients treated; verification by Director; compensation for treatment provided in excess of obligation; assessment for failure to fulfill minimum obligation.

PROGRAM TO INCREASE AWARENESS OF HEALTH CARE PROGRAMS FOR CHILDREN

NRS 439B.350 Department to establish; purpose.

NRS 439B.360 Evaluation: Recommendations; report to Interim Finance Committee.

NRS 439B.370 Director authorized to contract for certain services.

MISCELLANEOUS PROVISIONS

NRS 439B.400 Hospital must maintain and use uniform list of billed charges; exception.

NRS 439B.410 Hospital required to provide emergency services and care; unlawful acts of hospital or physician working in hospital emergency room; treating hospital may recover penalty from transferring hospital; exceptions; administrative investigations and sanctions.

NRS 439B.420 Prohibited acts of hospitals and related entities; exceptions; submission of contracts to Director; civil penalty.

NRS 439B.425 Prohibited referral of patients; exceptions; penalty.

NRS 439B.430 Prohibited acts of hospitals; examination by Director; administrative fine; injunctive relief.

NRS 439B.440 Director may require hospitals, health facilities and providers of health services to submit information; independent audit; examinations; penalty.

NRS 439B.450 Powers and duties of Director.

NRS 439B.460 Director authorized to delegate powers and duties.

NRS 439B.500 Penalty for violation of provisions.

REPORTING OF CERTAIN INFORMATION RELATING TO PRESCRIPTION DRUGS

NRS 439B.600 Definitions.

NRS 439B.605 “Manufacturer” defined.

NRS 439B.607 “National Drug Code” defined.

NRS 439B.610 “Pharmacy” defined.

NRS 439B.615 “Pharmacy benefit manager” defined.

NRS 439B.616 “Rebate” defined.

NRS 439B.618 “Third party” defined.

NRS 439B.619 “Unit” defined.

NRS 439B.620 “Wholesale acquisition cost” defined.

NRS 439B.622 “Wholesaler” defined.

NRS 439B.625 Organization representing interests of retail merchants to prepare and update list of most commonly prescribed drugs or generic equivalents.

NRS 439B.630 Department to annually compile lists of certain prescription drugs.

NRS 439B.635 Manufacturer of certain prescription drugs to prepare, submit and affirm accuracy of annual report; contents of report.

NRS 439B.640 Manufacturer of drug that has undergone significant price increase to submit report describing reasons for increase; affirmation of accuracy of report; contents of report.

NRS 439B.642 Wholesaler of certain prescription drugs to prepare, submit and affirm accuracy of annual report; contents of report.

NRS 439B.645 Pharmacy benefit manager to submit and affirm accuracy of annual report concerning certain drugs; contents of report.

NRS 439B.650 Department to compile annual report concerning price of certain drugs; contents of report; presentation of report at public hearing.

NRS 439B.655 Pharmacies to provide to Department contact information, electronic mail address and address of Internet website; exceptions.

NRS 439B.660 Manufacturer required to provide list of its pharmaceutical sales representatives; electronic access to list; prohibition against unlisted person marketing prescription drugs; reports.

NRS 439B.665 Report by certain nonprofit organizations that receive items of value from manufacturer. [Effective through December 31, 2025.]

NRS 439B.665 Report by certain nonprofit organizations that receive items of value from manufacturer. [Effective January 1, 2026.]

NRS 439B.670 Department to place on Internet website certain information concerning pharmacies, nonprofit organizations and prescription drugs and certain reports by Department; additional or alternative procedures for obtaining information concerning pharmacies, nonprofit organizations and prescription drugs.

NRS 439B.675 Manner of presentation of information.

NRS 439B.680 Immunity from civil and criminal liability.

NRS 439B.685 Regulations.

NRS 439B.690 Suspension of components of program or duties of Department if sufficient money not available; acceptance of gifts and grants.

NRS 439B.695 Administrative penalty for failure to provide information to Department; use of money collected by Department.

PAYMENT FOR MEDICALLY NECESSARY EMERGENCY SERVICES PROVIDED OUT-OF-NETWORK

NRS 439B.700 Definitions.

NRS 439B.703 “Covered person” defined.

NRS 439B.706 “Independent center for emergency medical care” defined.

NRS 439B.709 “In-network emergency facility” defined.

NRS 439B.712 “In-network provider” defined.

NRS 439B.715 “Medically necessary emergency services” defined.

NRS 439B.718 “Out-of-network emergency facility” defined.

NRS 439B.721 “Out-of-network provider” defined.

NRS 439B.724 “Provider contract” defined.

NRS 439B.727 “Provider of health care” defined.

NRS 439B.730 “Prudent person” defined.

NRS 439B.733 “Screen” defined.

NRS 439B.736 “Third party” defined. [Effective through December 31, 2025.]

NRS 439B.736 “Third party” defined. [Effective January 1, 2026.]

NRS 439B.739 “To stabilize” and “stabilized” defined.

NRS 439B.742 Inapplicability of provisions to certain hospitals, persons and health care services.

NRS 439B.745 Limitation on amount out-of-network provider may collect from covered person; duties of out-of-network emergency facility upon providing services.

NRS 439B.748 Payment to out-of-network emergency facility by third party.

NRS 439B.751 Payment to out-of-network provider, other than emergency facility, by third party.

NRS 439B.754 Determination of amount owed when no recent contract exists between out-of-network provider and third party; arbitration to resolve dispute; no interest pending resolution of dispute; confidentiality of arbitration.

NRS 439B.757 Election by certain entities and organizations not otherwise covered to submit to provisions; regulations.

NRS 439B.760 Reports; confidentiality of information.

ALL-PAYER CLAIMS DATABASE

NRS 439B.800 Definitions.

NRS 439B.805 “All-payer claims database” defined.

NRS 439B.810 “Covered entity” defined.

NRS 439B.815 “Direct patient identifier” defined.

NRS 439B.820 “Proprietary financial information” defined.

NRS 439B.825 “Provider of health care” defined.

NRS 439B.830 “Unique identifier” defined.

NRS 439B.835 Establishment of database; duties of Department; advisory committees.

NRS 439B.840 Entities required and authorized to submit data to database; removal of direct patient identifiers and assignment of unique identifiers.

NRS 439B.845 Confidentiality of data; compliance with certain federal law; use of data in enforcement proceedings.

NRS 439B.850 Data requests.

NRS 439B.855 Access to and use of data; prohibition on release of data to certain entities; duties of recipient of data; requirement to include certain information in report which contains or uses data.

NRS 439B.860 Report concerning quality, efficiency and cost of health care based on data; publication of list of reports Department intends to publish in next calendar year.

NRS 439B.865 Reports concerning cost, performance and effectiveness of database and information concerning grants.

NRS 439B.870 Immunity from certain civil or criminal liability.

NRS 439B.875 Regulations; administrative penalties; contracts and agreements; gifts, grants and donations; accounting and use of administrative penalties by Department.

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GENERAL PROVISIONS

NRS 439B.010 Definitions. As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 439B.030 to 439B.150, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 1987, 862; A 1991, 2111, 2333; 1993, 619, 620; 1999, 2238)

NRS 439B.030 “Billed charge” defined. “Billed charge” means the total amount charged by a hospital for medical care provided, regardless of the anticipated amount of net revenue to be received or the anticipated source of payment.

(Added to NRS by 1987, 862)

NRS 439B.035 “Children’s Health Insurance Program” defined. “Children’s Health Insurance Program” has the meaning ascribed to it in NRS 422.021.

(Added to NRS by 1999, 2238; A 2001, 158)

NRS 439B.040 “Committee” defined. “Committee” means the Joint Interim Standing Committee on Health and Human Services.

(Added to NRS by 1987, 863; A 2021, 2533)

NRS 439B.050 “Department” defined. “Department” means the Department of Health and Human Services.

(Added to NRS by 1987, 863)

NRS 439B.060 “Director” defined. “Director” means the Director of the Department.

(Added to NRS by 1987, 863)

NRS 439B.070 “Discharge form” defined. “Discharge form” means the form hospitals are required to use to report information concerning the discharge of patients.

(Added to NRS by 1987, 863)

NRS 439B.090 “Fiscal year” defined.

1. Except as otherwise provided in subsection 2, “fiscal year” means a period beginning on July 1 and ending on June 30 of the following year.

2. A hospital’s “fiscal year” is the period of 12 months used by a hospital for the purposes of accounting and the preparation of annual budgets and financial statements.

(Added to NRS by 1987, 863)

NRS 439B.100 “Health facility” defined. “Health facility” has the meaning ascribed to it in NRS 439A.015.

(Added to NRS by 1987, 863)

NRS 439B.110 “Hospital” defined. “Hospital” means any facility licensed as a medical, surgical or obstetrical hospital, or as any combination of medical, surgical or obstetrical hospital, by the Division of Public and Behavioral Health of the Department.

(Added to NRS by 1987, 863)

NRS 439B.115 “Major hospital” defined. “Major hospital” means a hospital in this State which has 200 or more licensed or approved beds, or any hospital in a group of affiliated hospitals in a county which have a combined total of 200 or more licensed or approved beds, that is not operated by a federal, state or local governmental agency.

(Added to NRS by 1991, 2332)

NRS 439B.120 “Medicaid” defined. “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 rendered on behalf of indigent persons.

(Added to NRS by 1987, 863)

NRS 439B.130 “Medicare” defined. “Medicare” means the program of health insurance for aged persons and persons with disabilities established pursuant to Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq.

(Added to NRS by 1987, 863)

NRS 439B.140 “Net revenue” defined. “Net revenue” means all revenues earned from inpatient medical care provided to patients by a hospital.

(Added to NRS by 1987, 863)

NRS 439B.150 “Practitioner” defined. “Practitioner” has the meaning ascribed to it in NRS 439A.0195.

(Added to NRS by 1987, 863)

NRS 439B.160 Purposes of chapter. The purposes of NRS 439B.160 to 439B.500, inclusive, are to:

1. Promote equal access to quality medical care at an affordable cost for all residents of this State.

2. Reduce excessive billed charges and revenues generated by some hospitals in this State in order to provide relief from excessively high costs of medical care.

3. Provide the regulatory mechanisms necessary to ensure that the forces of a competitive market will be able to function effectively in the business of providing medical care in this State.

(Added to NRS by 1987, 863)

JOINT INTERIM STANDING COMMITTEE ON HEALTH AND HUMAN SERVICES

NRS 439B.220 Powers. The Committee may:

1. Review and evaluate the quality and effectiveness of programs for the prevention of illness.

2. Review and compare the costs of medical care among communities in Nevada with similar communities in other states.

3. Analyze the overall system of medical care in the State to determine ways to coordinate the providing of services to all members of society, avoid the duplication of services and achieve the most efficient use of all available resources.

4. Examine the business of providing insurance, including the development of cooperation with health maintenance organizations and organizations which restrict the performance of medical services to certain physicians and hospitals, and procedures to contain the costs of these services.

5. Examine hospitals to:

(a) Increase cooperation among hospitals;

(b) Increase the use of regional medical centers; and

(c) Encourage hospitals to use medical procedures which do not require the patient to be admitted to the hospital and to use the resulting extra space in alternative ways.

6. Examine medical malpractice.

7. Examine the system of education to coordinate:

(a) Programs in health education, including those for the prevention of illness and those which teach the best use of available medical services; and

(b) The education of those who provide medical care.

8. Review competitive mechanisms to aid in the reduction of the costs of medical care.

9. Examine the problem of providing and paying for medical care for indigent and medically indigent persons, including medical care provided by physicians.

10. Examine the effectiveness of any legislation enacted to accomplish the purpose of restraining the costs of health care while ensuring the quality of services, and its effect on the subjects listed in subsections 1 to 9, inclusive.

11. Determine whether regulation by the State will be necessary in the future by examining hospitals for evidence of:

(a) Degradation or discontinuation of services previously offered, including without limitation, neonatal care, pulmonary services and pathology services; or

(b) A change in the policy of the hospital concerning contracts,

Ê as a result of any legislation enacted to accomplish the purpose of restraining the costs of health care while ensuring the quality of services.

12. Study the effect of the acuity of the care provided by a hospital upon the revenues of the hospital and upon limitations upon that revenue.

13. Review the actions of the Director in administering the provisions of NRS 439B.160 to 439B.500, inclusive, and adopting regulations pursuant to those provisions. The Director shall report to the Committee concerning any regulations proposed or adopted pursuant to NRS 439B.160 to 439B.500, inclusive.

14. Identify and evaluate, with the assistance of an advisory group, the alternatives to institutionalization for providing long-term care, including, without limitation:

(a) An analysis of the costs of the alternatives to institutionalization and the costs of institutionalization for persons receiving long-term care in this State;

(b) A determination of the effects of the various methods of providing long-term care services on the quality of life of persons receiving those services in this State;

(d) A determination of the methods for funding the long-term care services provided to all persons who are receiving or who are eligible to receive those services in this State.

15. Evaluate, with the assistance of an advisory group, the feasibility of obtaining a waiver from the Federal Government to integrate and coordinate acute care services provided through Medicare and long-term care services provided through Medicaid in this State.

16. Evaluate, with the assistance of an advisory group, the feasibility of obtaining a waiver from the Federal Government to eliminate the requirement that elderly persons in this State impoverish themselves as a condition of receiving assistance for long-term care.

17. If a data dashboard is established pursuant to NRS 439.245, use the data dashboard to review access by different groups and populations in this State to services provided through telehealth, as defined in NRS 629.515, and evaluate policies to make such access more equitable.

18. Conduct investigations and hold hearings in connection with its review and analysis and exercise any of the investigative powers set forth in NRS 218E.105 to 218E.140, inclusive.

19. Apply for any available grants and accept any gifts, grants or donations to aid the Committee in carrying out its duties pursuant to NRS 439B.160 to 439B.500, inclusive.

20. Direct the Legislative Counsel Bureau to assist in its research, investigations, review and analysis.

21. Recommend to the Legislature as a result of its review any appropriate legislation.

(Added to NRS by 1987, 864; A 2001, 2376; 2007, 2382; 2009, 58; 2013, 3757; 2015, 2337; 2021, 3006)

NRS 439B.225 Committee to review certain regulations proposed or adopted by licensing boards; recommendations to Legislature.

1. As used in this section, “licensing board” means any division or board empowered to adopt standards for the issuance or renewal of licenses, permits or certificates of registration pursuant to NRS 435.3305 to 435.339, inclusive, chapter 449, 625A, 630, 630A, 631, 632, 633, 634, 634A, 634B, 635, 636, 637, 637B, 639, 640, 640A, 640D, 641, 641A, 641B, 641C, 641D, 652, 653 or 654 of NRS.

2. The Committee shall review each regulation that a licensing board proposes or adopts that relates to standards for the issuance or renewal of licenses, permits or certificates of registration issued to a person or facility regulated by the board, giving consideration to:

(a) Any oral or written comment made or submitted to it by members of the public or by persons or facilities affected by the regulation;

(b) The effect of the regulation on the cost of health care in this State;

(c) The effect of the regulation on the number of licensed, permitted or registered persons and facilities available to provide services in this State; and

(d) Any other related factor the Committee deems appropriate.

3. After reviewing a proposed regulation, the Committee shall notify the agency of the opinion of the Committee regarding the advisability of adopting or revising the proposed regulation.

4. The Committee shall recommend to the Legislature as a result of its review of regulations pursuant to this section any appropriate legislation.

(Added to NRS by 1991, 940; A 2003, 2008; 2005, 1379; 2009, 528; 2011, 1099; 2015, 2319; 2017, 1409; 2019, 247, 2704; 2021, 1643; 2023, 1706)

NRS 439B.227 Committee to review certain new provisions of law; recommendations to Legislature concerning mandated reporters. The Committee shall:

1. After each regular session of the Legislature, review any chapter added to this title or title 39 or 54 of NRS that authorizes or requires the issuance of a license, permit or certificate to a person who provides any service related to health care to determine if the person should be included as a person required to make a report pursuant to NRS 432B.220; and

2. Before the beginning of the next regular session of the Legislature, prepare a report concerning its findings pursuant to subsection 1 and submit the report to the Director of the Legislative Counsel Bureau for transmittal to the Legislature. The report must include, without limitation, any recommended legislation.

(Added to NRS by 2013, 1085; A 2021, 2533)

MAJOR HOSPITALS

NRS 439B.260 Reduction of billed charges for certain patients and services; notice; resolution of disputes. [Effective through December 31, 2025.]

1. A major hospital shall reduce or discount the total billed charge by at least 30 percent for hospital services provided to an inpatient who:

(a) Has no policy of health insurance or other contractual agreement with a third party that provides health coverage for the charge;

(b) Is not eligible for coverage by a state or federal program of public assistance that would provide for the payment of the charge; and

(c) Makes reasonable arrangements within 30 days after the date that notice was sent pursuant to subsection 2 to pay the hospital bill.

2. A major hospital shall include on or with the first statement of the hospital bill provided to the patient after his or her discharge a notice of the reduction or discount available pursuant to this section, including, without limitation, notice of the criteria a patient must satisfy to qualify for a reduction or discount.

3. A major hospital or patient who disputes the reasonableness of arrangements made pursuant to paragraph (c) of subsection 1 may submit the dispute to the Bureau for Hospital Patients for resolution as provided in NRS 232.462.

4. A major hospital shall reduce or discount the total billed charge of its outpatient pharmacy by at least 30 percent to a patient who is eligible for Medicare.

5. As used in this section, “third party” means:

(a) An insurer, as that term is defined in NRS 679B.540;

(b) A health benefit plan, as that term is defined in NRS 687B.470, for employees which provides coverage for services and care at a hospital;

(c) A participating public agency, as that term is defined in NRS 287.04052, and any other local governmental agency of the State of Nevada which provides a system of health insurance for the benefit of its officers and employees, and the dependents of officers and employees, pursuant to chapter 287 of NRS; or

(d) Any other insurer or organization providing health coverage or benefits in accordance with state or federal law.

Ê The term does not include an insurer that provides coverage under a policy of casualty or property insurance.

(Added to NRS by 1991, 2332; A 1995, 646, 2248; 2001, 2654; 2011, 1523; 2019, 1108)

NRS 439B.260 Reduction of billed charges for certain patients and services; notice; resolution of disputes. [Effective January 1, 2026.]

1. A major hospital shall reduce or discount the total billed charge by at least 30 percent for hospital services provided to an inpatient who:

(a) Has no policy of health insurance or other contractual agreement with a third party that provides health coverage for the charge;

(b) Is not eligible for coverage by a state or federal program of public assistance that would provide for the payment of the charge; and

(c) Makes reasonable arrangements within 30 days after the date that notice was sent pursuant to subsection 2 to pay the hospital bill.

4. A major hospital shall reduce or discount the total billed charge of its outpatient pharmacy by at least 30 percent to a patient who is eligible for Medicare.

5. As used in this section, “third party” means:

(a) An insurer, as that term is defined in NRS 679B.540;

(b) A health benefit plan, as that term is defined in NRS 687B.470, for employees which provides coverage for services and care at a hospital;

(d) The Public Option established pursuant to NRS 695K.200; or

(e) Any other insurer or organization providing health coverage or benefits in accordance with state or federal law.

Ê The term does not include an insurer that provides coverage under a policy of casualty or property insurance.

(Added to NRS by 1991, 2332; A 1995, 646, 2248; 2001, 2654; 2011, 1523; 2019, 1108; 2021, 3642, effective January 1, 2026)

NRS 439B.265 Collection of deductible or copayment from indigent patient covered by Medicare prohibited. [Effective upon confirmation by the Federal Government that the deductibles and copayments which a hospital is prohibited from collecting from a patient pursuant to this section are deemed uncollectible for the purposes of federal law.] A major hospital shall not collect or seek to collect the deductible or copayment from a patient who is covered by Medicare and who demonstrates that he or she is medically indigent, as that term is defined for the purposes of Medicaid coverage for persons in long-term care. The hospital may seek and collect payment for the deductible or copayment from any source other than the patient, including from the supplemental insurance of the patient.

(Added to NRS by 1991, 2332, effective upon confirmation by the Federal Government that the deductibles and copayments which a hospital is prohibited from collecting from a patient pursuant to this section are deemed uncollectible for the purposes of federal law)

NRS 439B.270 Foundation for hospital nursing practice: Establishment; governing body.

1. The major hospitals shall jointly establish a foundation for hospital nursing practice to promote and encourage the practice of nursing in hospitals.

2. The foundation must be created as a nonprofit entity in compliance with 26 U.S.C. § 501. The governing body of the foundation must consist of one representative of each of the member hospitals and one representative appointed by the Governor. The governing body must have authority to establish rules for the administration of the foundation, to establish programs in pursuit of its purpose, and to allocate money for its programs.

3. If the foundation is not formed, or ceases to exist, the Director shall establish a nonprofit entity to carry out the foundation’s purpose.

(Added to NRS by 1991, 2332)

NRS 439B.275 Program for provision of technical assistance to rural hospitals. The major hospitals shall, in cooperation with the Office of the Governor, the University of Nevada School of Medicine and organizations representing rural hospitals, develop a program for the provision of technical assistance to rural hospitals in Nevada. The resources required to carry out this program must be determined and provided by the major hospitals.

(Added to NRS by 1991, 2332)

NRS 439B.280 Educational program to promote wellness, physical fitness and prevention of disease, accidents and motor vehicle crashes. The major hospitals shall sponsor an educational program to promote wellness, physical fitness and the prevention of disease, accidents and motor vehicle crashes. The program must be:

1. Administered and carried out by the participating hospitals; and

2. Approved by the Director.

(Added to NRS by 1991, 2333; A 2015, 1677)

CARE OF INDIGENT PATIENTS

NRS 439B.300 Legislative findings and declarations; applicability.

1. The Legislature finds and declares that:

(a) The practice of refusing to treat an indigent patient if another hospital can provide the treatment endangers the health and well-being of such patients.

(b) Counties in which more than one hospital is located may lack available resources to compensate for all indigent care provided at their hospitals. Refusal by a hospital to treat indigent patients in such counties results in a burden upon hospitals which treat large numbers of indigent patients.

(c) A requirement that hospitals in such counties provide a designated amount of uncompensated care for indigent patients would:

(1) Equalize the burden on such hospitals of treating indigent patients; and

(2) Aid the counties in meeting their obligation to compensate hospitals for such care.

(d) Hospitals with 100 or fewer beds have been meeting the needs of their communities with regard to care of indigents, and have a minimal effect on the provision of such care.

2. Except as otherwise provided in this subsection, the provisions of NRS 439B.300 to 439B.340, inclusive, apply to each hospital in this State which is located in a county in which there are two or more licensed hospitals. The provisions of NRS 439B.300 to 439B.340, inclusive, do not apply to a hospital which has 100 or fewer beds.

3. The provisions of NRS 439B.300 to 439B.340, inclusive, do not prohibit a county from:

(a) Entering into an agreement for medical care or otherwise contracting with any hospital located within that county; or

(b) Using a definition of “indigent” which would include more persons than the definition in NRS 439B.310.

(Added to NRS by 1987, 867)

NRS 439B.310 “Indigent” defined. For the purposes of NRS 439B.300 to 439B.340, inclusive, “indigent” means those persons:

1. Who are not covered by any policy of health insurance;

2. Who are ineligible for Medicare, Medicaid, the Children’s Health Insurance Program, the benefits provided pursuant to NRS 428.115 to 428.255, inclusive, or any other federal or state program of public assistance covering the provision of health care;

3. Who meet the limitations imposed by the county upon assets and other resources or potential resources; and

4. Whose income is less than:

(a) For one person living without another member of a household, $438.

(b) For two persons, $588.

Ê For the purposes of this subsection, “income” includes the entire income of a household and the amount which the county projects a person or household is able to earn. “Household” is limited to a person and the person’s spouse, parents, children, brothers and sisters residing with him or her.

(Added to NRS by 1987, 868; A 1999, 2238)

NRS 439B.320 Hospital required to provide care for proportionate share of indigent patients; duties of Department and board of county commissioners; reimbursement for care.

1. A hospital shall provide, without charge, in each fiscal year, care for indigent inpatients in an amount which represents 0.6 percent of its net revenue for the hospital’s preceding fiscal year.

2. The Department shall compute the obligation of each hospital for care of indigent inpatients for each fiscal year based upon the net revenue of the hospital in its preceding fiscal year and shall provide this information to the board of county commissioners of the county in which the hospital is located.

3. The board of county commissioners shall maintain a record of discharge forms submitted by each hospital located within the county, together with the amount accruing to the hospital. The amount accruing to the hospital for the care, until the hospital has met its obligation pursuant to this section, is the highest amount the county is paying to any hospital in the county for that care. Except as otherwise provided in subsection 2 of NRS 439B.330, no payment for indigent care may be made to the hospital until the total amount so accruing to the hospital exceeds the minimum obligation of the hospital for the fiscal year, and a hospital may only receive payment from the county for indigent care provided in excess of its obligation pursuant to this section. After a hospital has met its obligation pursuant to this section, the county may reimburse the hospital for care of indigent inpatients at any rate otherwise authorized by law.

(Added to NRS by 1987, 868; A 1991, 2111)

1. Except as otherwise provided in this subsection, subsection 2 and NRS 439B.300, each county shall use the definition of “indigent” in NRS 439B.310 to determine a person’s eligibility for medical assistance pursuant to chapter 428 of NRS, other than assistance provided pursuant to NRS 428.115 to 428.255, inclusive.

2. A board of county commissioners may, if it determines that a hospital within the county is serving a disproportionately large share of low-income patients:

(a) Pay a higher rate to the hospital for treatment of indigent inpatients;

(b) Pay the hospital for treatment of indigent inpatients whom the hospital would otherwise be required to treat without receiving compensation from the county; or

3. Each hospital which treats an indigent inpatient shall submit to the board of county commissioners of the county of residence of the patient a discharge form identifying the patient as a possible indigent and containing the information required by the Department and the county to be included in all such forms.

4. The county which receives a discharge form from a hospital for an indigent inpatient shall verify the status of the patient and the amount which the hospital is entitled to receive. A hospital aggrieved by a determination of a county regarding the indigent status of an inpatient may appeal the determination to the Director or a person designated by the Director to hear such an appeal. The decision of the Director or the designee of the Director must be mailed by registered or certified mail to the county and the hospital. The decision of the Director or the designee of the Director may be appealed to a court having general jurisdiction in the county within 15 days after the date of the postmark on the envelope in which the decision was mailed.

5. Except as otherwise provided in subsection 2 of this section and subsection 3 of NRS 439B.320, if the county is the county of residence of the patient and the patient is indigent, the county shall pay to the hospital the amount required, within the limits of money which may lawfully be appropriated for this purpose pursuant to NRS 428.050, 428.285 and 450.425.

6. For the purposes of this section, the county of residence of the patient is the county of residence of that person before he or she was admitted to the hospital.

(Added to NRS by 1987, 869; A 1989, 1801, 1861; 1991, 1744, 1937; 1993, 1973; 2005, 1676)

NRS 439B.340 Report on indigent patients treated; verification by Director; compensation for treatment provided in excess of obligation; assessment for failure to fulfill minimum obligation.

1. Before September 30 of each year, each county in which hospitals subject to the provisions of NRS 439B.300 to 439B.340, inclusive, are located shall provide to the Department a report showing:

(a) The total number of inpatients treated by each such hospital who are claimed by the hospital to be indigent;

(b) The number of such patients for whom no reimbursement was provided by the county because of the limitation imposed by subsection 3 of NRS 439B.320;

(d) The amount the hospital would have received for patients for whom no reimbursement was provided.

2. The Director shall verify the amount of treatment provided to indigent inpatients by each hospital to which no reimbursement was provided by:

(a) Determining the number of indigent inpatients who received treatment. For a hospital that has contracted with the Department pursuant to subsection 4 of NRS 428.030, the Director shall determine the number based upon the evaluations of eligibility made by the employee assigned to the hospital pursuant to the contract. For all other hospitals, the Director shall determine the number based upon the report submitted pursuant to subsection 1.

(b) Multiplying the number of indigent inpatients who received each type of treatment by the highest amount paid by the county for that treatment.

Ê If the total amount of treatment provided to indigent inpatients in the previous fiscal year by the hospital was less than its minimum obligation for the year, the Director shall assess the hospital for the amount of the difference between the minimum obligation and the actual amount of treatment provided by the hospital to indigent inpatients. If a decision of a county regarding the indigent status of one or more inpatients is pending appeal before the Director or upon receiving satisfactory proof from a hospital that the decision is pending appeal before a court having general jurisdiction in the county pursuant to subsection 4 of NRS 439B.330, the Director shall defer assessing the hospital the amount that may be offset by the determination on appeal until a final determination of the matter is made.

3. If the Director determines that a hospital has met its obligation to provide treatment to indigent inpatients, the Director shall certify to the county in which the hospital is located that the hospital has met its obligation. The county is not required to pay the hospital for the costs of treating indigent inpatients until the certification is received from the Director. The county shall pay the hospital for such treatment within 30 days after receipt of the certification to the extent that money was available for payment pursuant to NRS 428.050, 428.285 and 450.425 at the time the treatment was provided.

4. The Director shall determine the amount of the assessment which a hospital must pay pursuant to this section and shall notify the hospital in writing of that amount on or before November 1 of each year. The notice must include, but is not limited to, a written statement for each claim which is denied indicating why the claim was denied. Payment is due 30 days after receipt of the notice, except for assessments deferred pursuant to subsection 2 which, if required, must be paid within 30 days after the court hearing the appeal renders its decision. If a hospital fails to pay the assessment when it is due the hospital shall pay, in addition to the assessment:

(a) Interest at a rate of 1 percent per month for each month after the assessment is due in which it remains unpaid; and

(b) Any court costs and fees required by the Director to obtain payment of the assessment and interest from the hospital.

5. Any money collected pursuant to this section must be paid to the county in which the hospital paying the assessment is located. The money received by a county from assessments made pursuant to this section does not constitute revenue from taxes ad valorem for the purposes of NRS 354.59811, 428.050, 428.285 and 450.425, and must be excluded in determining the maximum rate of tax authorized by those sections.

(Added to NRS by 1987, 869; A 1987, 1630; 1989, 1802, 2085; 1991, 1938, 2112; 1993, 587; 2013, 2884)

PROGRAM TO INCREASE AWARENESS OF HEALTH CARE PROGRAMS FOR CHILDREN

NRS 439B.350 Department to establish; purpose.

1. The Department shall establish a program to increase awareness of health care programs for children and to encourage enrollment in such programs. The program must provide for the dissemination of information to the public relating to health care services that are available in this state to children who are under the age of 13 years, including, without limitation, information concerning:

(a) Federal, state and local governmental programs which provide health care services to such children;

(b) The requirements for eligibility to participate in such programs; and

2. The information disseminated pursuant to subsection 1 must encourage the use of the programs identified pursuant to subsection 1 and must emphasize:

(a) The benefits of preventive health care services to the well-being of children; and

(b) The reasons that preventive health care services are more efficient in treating potential health care needs and are more economical than obtaining emergency health care services which are often required when symptoms of an illness are not promptly and properly treated.

3. The program must be designed to disseminate information using the most effective means available to the extent possible, including, without limitation, using:

(a) Words or graphics, or both, that promote understanding of the information by the intended audience, considering the average level of reading comprehension of and the language understood by the audience.

(b) Printed materials that may be displayed at or distributed to:

(1) Offices of the federal, state and local government that have contact with parents of children who are under the age of 13 years or direct contact with such children, or both, in the normal course of business;

(2) Schools attended by children who are under the age of 13 years;

(3) Public libraries;

(4) Providers of health care who provide services to children who are under the age of 13 years;

(5) Child care facilities that provide services to children who are under the age of 13 years;

(6) Organizations that provide community-based services to parents of children who are under the age of 13 years, or to such children, or both; and

(7) Any other person deemed appropriate.

(Added to NRS by 1997, 1545)

NRS 439B.360 Evaluation: Recommendations; report to Interim Finance Committee.

1. The Director shall evaluate the effectiveness of the program established pursuant to NRS 439B.350 annually. The evaluation must include, without limitation, measuring the effectiveness of the content, form and method of dissemination of information through the program.

2. The Director shall make any necessary recommendations to improve the program based upon the evaluation.

3. On or before December 31 of each year, the Director shall provide a written report to the Interim Finance Committee concerning the results of the evaluation and any recommendations made to improve the program.

(Added to NRS by 1997, 1546; A 2007, 2401)

NRS 439B.370 Director authorized to contract for certain services. The Director may, within the limits of available money, contract for services to assist the Department in carrying out the provisions of NRS 439B.350 and 439B.360.

(Added to NRS by 1997, 1546)

MISCELLANEOUS PROVISIONS

NRS 439B.400 Hospital must maintain and use uniform list of billed charges; exception. Each hospital in this State shall maintain and use a uniform list of billed charges for that hospital for units of service or goods provided to all inpatients. A hospital may not use a billed charge for an inpatient that is different than the billed charge used for another inpatient for the same service or goods provided. This section does not restrict the ability of a hospital or other person to negotiate a discounted rate from the hospital’s billed charges or to contract for a different rate or mechanism for payment of the hospital.

(Added to NRS by 1987, 867)

1. Except as otherwise provided in subsection 4, each hospital in this State has an obligation to provide emergency services and care, including care provided by physicians and nurses, and to admit a patient where appropriate, regardless of the financial status of the patient.

2. Except as otherwise provided in subsection 4, it is unlawful for a hospital or a physician working in a hospital emergency room to:

(a) Refuse to accept or treat a patient in need of emergency services and care; or

(b) Except when medically necessary in the judgment of the attending physician:

(1) Transfer a patient to another hospital or health facility unless, as documented in the patient’s records:

(I) A determination has been made that the patient is medically fit for transfer;

(II) Consent to the transfer has been given by the receiving physician, hospital or health facility;

(III) The patient has been provided with an explanation of the need for the transfer; and

(IV) Consent to the transfer has been given by the patient or the patient’s legal representative; or

(2) Provide a patient with orders for testing at another hospital or health facility when the hospital from which the orders are issued is capable of providing that testing.

3. A physician, hospital or other health facility which treats a patient as a result of a violation of subsection 2 by a hospital or a physician working in the hospital is entitled to recover from that hospital an amount equal to three times the charges for the treatment provided that was billed by the physician, hospital or other health facility which provided the treatment, plus reasonable attorney’s fees and costs.

4. This section does not prohibit the transfer of a patient from one hospital to another:

(a) When the patient is covered by an insurance policy or other contractual arrangement which provides for payment at the receiving hospital;

(b) After the county responsible for payment for the care of an indigent patient has exhausted the money which may be appropriated for that purpose pursuant to NRS 428.050, 428.285 and 450.425; or

Ê No transfer may be made pursuant to this subsection until the patient’s condition has been stabilized to a degree that allows the transfer without an additional risk to the patient.

5. As used in this section:

(a) “Emergency services and care” means medical screening, examination and evaluation by a physician or, to the extent permitted by a specific statute, by a person under the supervision of a physician, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment and surgery by a physician necessary to relieve or eliminate the emergency medical condition or active labor, within the capability of the hospital. As used in this paragraph:

(1) “Active labor” means, in relation to childbirth, labor that occurs when:

(I) There is inadequate time before delivery to transfer the patient safely to another hospital; or

(II) A transfer may pose a threat to the health and safety of the patient or the unborn child.

(2) “Emergency medical condition” means the presence of acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:

(I) Placing the health of the patient in serious jeopardy;

(II) Serious impairment of bodily functions; or

(III) Serious dysfunction of any bodily organ or part.

(b) “Medically fit” means that the condition of the patient has been sufficiently stabilized so that the patient may be safely transported to another hospital, or is such that, in the determination of the attending physician, the transfer of the patient constitutes an acceptable risk. Such a determination must be based upon the condition of the patient, the expected benefits, if any, to the patient resulting from the transfer and whether the risks to the patient’s health are outweighed by the expected benefits, and must be documented in the patient’s records before the transfer.

6. If an allegation of a violation of the provisions of subsection 2 is made against a hospital licensed pursuant to the provisions of chapter 449 of NRS, the Division of Public and Behavioral Health of the Department shall conduct an investigation of the alleged violation. Such a violation, in addition to any criminal penalties that may be imposed, constitutes grounds for the denial, suspension or revocation of such a license, or for the imposition of any sanction prescribed by NRS 449.163.

7. If an allegation of a violation of the provisions of subsection 2 is made against:

(a) A physician licensed to practice medicine pursuant to the provisions of chapter 630 of NRS, the Board of Medical Examiners shall conduct an investigation of the alleged violation. Such a violation, in addition to any criminal penalties that may be imposed, constitutes grounds for initiating disciplinary action or denying licensure pursuant to the provisions of subsection 3 of NRS 630.3065.

(b) An osteopathic physician licensed to practice osteopathic medicine pursuant to the provisions of chapter 633 of NRS, the State Board of Osteopathic Medicine shall conduct an investigation of the alleged violation. Such a violation, in addition to any criminal penalties that may be imposed, constitutes grounds for initiating disciplinary action pursuant to the provisions of subsection 1 of NRS 633.131.

(Added to NRS by 1987, 867; A 1989, 1660; 2003, 1178; 2013, 3045)

NRS 439B.420 Prohibited acts of hospitals and related entities; exceptions; submission of contracts to Director; civil penalty.

1. A hospital or related entity shall not establish a rental agreement with a physician or entity that employs physicians that requires any portion of his or her medical practice to be referred to the hospital or related entity.

2. The rent required of a physician or entity which employs physicians by a hospital or related entity must not be less than 75 percent of the rent for comparable office space leased to another physician or other lessee in the building, or in a comparable building owned by the hospital or entity.

3. A hospital or related entity shall not pay any portion of the rent of a physician or entity which employs physicians within facilities not owned or operated by the hospital or related entity, unless the resulting rent is no lower than the highest rent for which the hospital or related entity rents comparable office space to other physicians.

4. A health facility shall not offer any provider of medical care any financial inducement, excluding rental agreements subject to the provisions of subsection 2 or 3, whether in the form of immediate, delayed, direct or indirect payment to induce the referral of a patient or group of patients to the health facility. This subsection does not prohibit bona fide gifts under $100, or reasonable promotional food or entertainment.

5. The provisions of subsections 1 to 4, inclusive, do not apply to hospitals in a county whose population is less than 55,000.

6. A hospital, if acting as a billing agent for a medical practitioner performing services in the hospital, shall not add any charges to the practitioner’s bill for services other than a charge related to the cost of processing the billing.

7. A hospital or related entity shall not offer any financial inducement to an officer, employee or agent of an insurer, a person acting as an insurer or self-insurer or a related entity. A person shall not accept such offers. This subsection does not prohibit bona fide gifts of under $100 in value, or reasonable promotional food or entertainment.

8. A hospital or related entity shall not sell goods or services to a physician unless the costs for such goods and services are at least equal to the cost for which the hospital or related entity pays for the goods and services.

9. Except as otherwise provided in this subsection, a practitioner or health facility shall not refer a patient to a health facility or service in which the referring party has a financial interest unless the referring party first discloses the interest to the patient. This subsection does not apply to practitioners subject to the provisions of NRS 439B.425.

10. The Director may, at reasonable intervals, require a hospital or related entity or other party to an agreement to submit copies of operative contracts subject to the provisions of this section after notification by registered mail. The contracts must be submitted within 30 days after receipt of the notice. Contracts submitted pursuant to this subsection are confidential, except pursuant to the provisions of NRS 239.0115 and in cases in which an action is brought pursuant to subsection 11.

11. A person who willfully violates any provision of this section is liable to the State of Nevada for:

(a) A civil penalty in an amount of not more than $5,000 per occurrence, or 100 percent of the value of the illegal transaction, whichever is greater.

(b) Any reasonable expenses incurred by the State in enforcing this section.

Ê Any money recovered pursuant to this subsection as a civil penalty must be deposited in a separate account in the State General Fund and used for projects intended to benefit the residents of this State with regard to health care. Money in the account may only be withdrawn by act of the Legislature.

12. As used in this section, “related entity” means an affiliated person or subsidiary as those terms are defined in NRS 439B.430.

(Added to NRS by 1987, 870; A 1989, 1925; 1993, 2595; 2001, 1988; 2007, 2107; 2011, 1257)

NRS 439B.425 Prohibited referral of patients; exceptions; penalty.

1. Except as otherwise provided in this section, a practitioner shall not refer a patient, for a service or for goods related to health care, to a health facility, medical laboratory, diagnostic imaging or radiation oncology center or commercial establishment in which the practitioner has a financial interest.

2. Subsection 1 does not apply if:

(a) The service or goods required by the patient are not otherwise available within a 30-mile radius of the office of the practitioner;

(b) The service or goods are provided pursuant to a referral to a practitioner who is participating in the health care plan of a health maintenance organization that has been issued a certificate of authority pursuant to chapter 695C of NRS;

(d) The referral is made to a surgical center for ambulatory patients, as defined in NRS 449.019, that is licensed pursuant to chapter 449 of NRS;

(e) The referral is made by:

(1) A urologist for lithotripsy services; or

(2) A nephrologist for services and supplies for a renal dialysis;

(f) The financial interest represents an investment in a corporation that has shareholder equity of more than $100,000,000, regardless of whether the securities of the corporation are publicly traded; or

(g) The referral is made by a physician to a surgical hospital in which the physician has an ownership interest and:

(1) The surgical hospital is:

(I) Located in a county whose population is less than 100,000; and

(II) Licensed pursuant to chapter 449 of NRS as a surgical hospital and not as a medical hospital, obstetrical hospital, combined-categories hospital or center for the treatment of trauma;

(2) The physician making the referral:

(I) Is authorized to perform medical services and has staff privileges at the surgical hospital; and

(II) Has disclosed the physician’s ownership interest in the surgical hospital to the patient before making the referral;

(3) The ownership interest of the physician making the referral pertains to the surgical hospital in its entirety and is not limited to a department, subdivision or other portion of the hospital;

(4) Every physician who has an ownership interest in the surgical hospital has agreed to treat patients receiving benefits pursuant to Medicaid and Medicare;

(5) The terms of investment of each physician who has an ownership interest in the surgical hospital are not related to the volume or value of any referrals made by that physician;

(6) The payments received by each investor in the surgical hospital as a return on his or her investment are directly proportional to the relative amount of capital invested or shares owned by the investor in the hospital;

(7) None of the investors in the surgical hospital has received any financial assistance from the hospital or any other investor in the hospital for the purpose of investing in the hospital; and

(8) Either:

(I) The governing body of every other hospital that regularly provides surgical services to residents of the county in which the surgical hospital is located has issued its written general consent to the referral by such physicians of patients to that surgical hospital; or

(II) The board of county commissioners of the county in which the surgical hospital is located has issued a written declaration of its reasonable belief that the referral by such physicians of patients to that surgical hospital will not, during the 5-year period immediately following the commencement of such referrals, have a substantial adverse financial effect on any other hospital that regularly provides surgical services to residents of that county.

3. A person who violates the provisions of this section is guilty of a misdemeanor.

4. The provisions of this section do not prohibit a practitioner from owning and using equipment in his or her office solely to provide to his or her patients services or goods related to health care.

5. As used in this section:

(a) “Group practice” means two or more practitioners who organized as a business entity in accordance with the laws of this state to provide services related to health care, if:

(1) Each member of the group practice provides substantially all of the services related to health care that he or she routinely provides, including, without limitation, medical care, consultations, diagnoses and treatment, through the joint use of shared offices, facilities, equipment and personnel located at any site of the group practice;

(2) Substantially all of the services related to health care that are provided by the members of the group practice are provided through the group practice; and

(3) No member of the group practice receives compensation based directly on the volume of any services or goods related to health care which are referred to the group practice by that member.

(b) “Patient” means a person who consults with or is examined or interviewed by a practitioner or health facility for purposes of diagnosis or treatment.

(c) “Substantial adverse financial effect” includes, without limitation, a projected decline in the revenue of a hospital as a result of the loss of its surgical business, which is sufficient to cause a deficit in any cash balances, fund balances or retained earnings of the hospital.

(Added to NRS by 1993, 2594; A 1995, 1489; 2001, 1072; 2019, 2639)

NRS 439B.430 Prohibited acts of hospitals; examination by Director; administrative fine; injunctive relief.

1. For the purposes of this section:

(a) An “affiliated person” is a person controlled by any combination of the hospital, the parent corporation, a subsidiary or the principal stockholders or officers or directors of any of the foregoing.

(b) A “subsidiary” is a person of which either the hospital and the parent corporation or the hospital or the parent corporation holds practical control.

2. No hospital may engage in any transaction or agreement with its parent corporation, or with any subsidiary or affiliated person which will result or has resulted in:

(a) Substitution contrary to the interest of the hospital and through any method of any asset of the hospital with an asset or assets of inferior quality or lower fair market value;

(b) Deception as to the true operating results of the hospital;

(d) Allocation to the hospital of a proportion of the expense of combined facilities or operations which is unfavorable to the hospital;

(e) Unfair or excessive charges against the hospital for services, facilities or supplies;

(f) Unfair and inadequate charges by the hospital for services, facilities or supplies furnished by the hospital to others; or

(g) Payment by the hospital for services, facilities or supplies not reasonably needed by the hospital.

3. If the Director has reasonable cause to believe that a violation of subsection 2 has occurred, the Director may conduct an examination of any books and records of the hospital, parent corporation, subsidiary or affiliated person which the Director deems pertinent to the examination. The Director has the same authority to examine the parent corporation, subsidiary or affiliated person and recover the cost of the examination as the Director has with regard to the hospital. A parent corporation, subsidiary or affiliated person which refuses to permit the examination of its books and records is subject to the fine provided for in subsection 4 for each day that access to the books or records is restricted.

4. If a hospital, parent corporation, subsidiary or affiliated person is found, after notice and a hearing, to have violated the provisions of this section, the Director may impose an administrative fine of not more than $20,000 for each violation or the actual amount of damage caused by the violation, whichever is greater.

5. Upon a second or subsequent violation of the provisions of this section, the Director may commence a legal action in the district court of any county to secure an injunction against further violations of this section.

(Added to NRS by 1987, 872)

NRS 439B.440 Director may require hospitals, health facilities and providers of health services to submit information; independent audit; examinations; penalty.

1. The Director may by regulation require hospitals, other health facilities and providers of health services to submit such information as is reasonably necessary for the Director to carry out the provisions of NRS 439B.160 to 439B.500, inclusive.

2. Except as otherwise provided in subsection 3, the Director shall by regulation require an examination of a hospital by an independent auditor appointed by the Director to ensure compliance with NRS 439B.160 to 439B.500, inclusive. The audits must be scheduled on a regular basis but not more often than once each year. The hospital shall pay the costs of the audit. A hospital may contract with the auditor to conduct other work for the hospital in connection with the audit.

3. The Director shall not require an audit of a hospital which has less than 100 beds or is subject to the provisions of chapter 450 of NRS. The Director shall by regulation require such a hospital to submit audits of the hospital on a regular basis but not more often than once each year.

4. If a hospital fails to comply with any regulation adopted pursuant to this section or the Director has reason to believe the hospital has violated any provision of NRS 439B.160 to 439B.500, inclusive, the Director may conduct an examination or contract for an independent examination of the hospital to determine whether it is in compliance with those provisions. The hospital which is the subject of such an examination is responsible for payment of the costs of the examination if the Director determines that the hospital did violate a provision of NRS 439B.160 to 439B.500, inclusive.

5. Any person who fails to submit information as required by any regulation adopted pursuant to NRS 439B.160 to 439B.500, inclusive, to the Department or fails to submit to an audit or examination pursuant to this section is subject to an administrative fine of not more than $1,000 per violation per day until the required information is submitted or the person submits to the audit or examination.

(Added to NRS by 1987, 872; A 1991, 2113; 2005, 1736)

NRS 439B.450 Powers and duties of Director. The Director:

1. May adopt such regulations as are necessary to carry out the provisions of NRS 439B.160 to 439B.500, inclusive.

2. Shall ensure that the administration of NRS 439B.160 to 439B.500, inclusive, does not cause the State to fail to comply with the requirements of the Federal Government concerning Medicare and Medicaid.

(Added to NRS by 1987, 873)

NRS 439B.460 Director authorized to delegate powers and duties. The Director may delegate:

1. Any of the Director’s powers or duties pursuant to NRS 439B.160 to 439B.500, inclusive, to the Administrator of the Division of Health Care Financing and Policy of the Department.

2. Any of the Department’s powers or duties pursuant to NRS 439B.160 to 439B.500, inclusive, to the Division of Health Care Financing and Policy.

(Added to NRS by 1997, 2632; A 1999, 2242)

NRS 439B.500 Penalty for violation of provisions. In addition to any civil or administrative penalty specifically provided in NRS 439B.160 to 439B.500, inclusive, any person who violates a provision of NRS 439B.160 to 439B.500, inclusive, shall be punished by a fine of not more than $5,000 for each violation.

(Added to NRS by 1987, 873)

REPORTING OF CERTAIN INFORMATION RELATING TO PRESCRIPTION DRUGS

NRS 439B.600 Definitions. As used in NRS 439B.600 to 439B.695, inclusive, unless the context otherwise requires, the words and terms defined in NRS 439B.605 to 439B.622, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 2007, 3137; A 2017, 4301; 2021, 3723)

NRS 439B.605 “Manufacturer” defined. “Manufacturer” has the meaning ascribed to it in 42 U.S.C. § 1396r-8(k)(5).

(Added to NRS by 2017, 4297; A 2021, 3723)

NRS 439B.607 “National Drug Code” defined. “National Drug Code” means the numerical code assigned to a prescription drug by the United States Food and Drug Administration.

(Added to NRS by 2021, 3722)

NRS 439B.610 “Pharmacy” defined. “Pharmacy” means every store or shop licensed by the State Board of Pharmacy where drugs, controlled substances, poisons, medicines or chemicals are stored or possessed, or dispensed or sold at retail, or displayed for sale at retail, or where prescriptions are compounded or dispensed. The term does not include an institutional pharmacy as defined in NRS 639.0085.

(Added to NRS by 2017, 4297)

NRS 439B.615 “Pharmacy benefit manager” defined. “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.

(Added to NRS by 2017, 4297)

NRS 439B.616 “Rebate” defined.

1. “Rebate” means a discount or concession that affects the price of a prescription drug which is provided by the manufacture of the drug to:

(a) A third party;

(b) A pharmacy benefit manager after the pharmacy benefit manager has processed a claim from a pharmacy, an institutional pharmacy, as defined in NRS 639.0085, or a pharmacist; or

2. The term does not include a bona fide service fee, as defined in 42 C.F.R. § 447.502.

(Added to NRS by 2021, 3722)

NRS 439B.618 “Third party” defined. “Third party” means:

1. An insurer, as that term is defined in NRS 679B.540;

2. A health benefit plan, as that term is defined in NRS 687B.470, for employees which provides coverage for prescription drugs;

3. The Public Employees’ Benefits Program established pursuant to subsection 1 of NRS 287.043;

4. A governing body of a county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency that provides health coverage to employees through a self-insurance reserve fund pursuant to NRS 287.010;

5. The Department, with regard to Medicaid and the Children’s Health Insurance Program; and

6. Any other insurer or organization providing coverage of prescription drugs in accordance with state or federal law.

(Added to NRS by 2021, 3722)

NRS 439B.619 “Unit” defined. “Unit” has the meaning ascribed to it in 42 U.S.C. § 1395w-3a(b)(2)(B).

(Added to NRS by 2021, 3723)

NRS 439B.620 “Wholesale acquisition cost” defined. “Wholesale acquisition cost” means the manufacturer’s published list price for a prescription drug with a unique National Drug Code for sale to a wholesaler or any other person or entity that purchases the prescription drug directly from the manufacturer, not including any rebates or other price concessions.

(Added to NRS by 2017, 4297; A 2021, 3723)

NRS 439B.622 “Wholesaler” defined. “Wholesaler” has the meaning ascribed to it in NRS 639.016.

(Added to NRS by 2021, 3723)

NRS 439B.625 Organization representing interests of retail merchants to prepare and update list of most commonly prescribed drugs or generic equivalents. The organization with the largest membership in this State which represents the interests of retail merchants, as determined by the Department, shall:

1. Prepare a list of not less than the 100 brand name prescription drugs or generic equivalents most commonly prescribed to residents of this State; and

2. At least once each calendar year, update the list prepared pursuant to subsection 1 and transmit the list to the Department.

(Added to NRS by 2007, 3137)

NRS 439B.630 Department to annually compile lists of certain prescription drugs.

1. On or before February 1 of each year, the Department shall compile:

(a) A list of prescription drugs that the Department determines to be essential for treating diabetes in this State and the wholesale acquisition cost of each such drug on the list. The list must include, without limitation, all forms of insulin and biguanides marketed for sale in this State.

(b) A list of prescription drugs described in paragraph (a) that have been subject to an increase in the wholesale acquisition cost of a percentage equal to or greater than:

(1) The percentage increase in the Consumer Price Index, Medical Care Component during the immediately preceding calendar year; or

(2) Twice the percentage increase in the Consumer Price Index, Medical Care Component during the immediately preceding 2 calendar years.

(c) A list of prescription drugs with a wholesale acquisition cost exceeding $40 for a course of therapy that have been subject to an increase in the wholesale acquisition cost of a percentage equal to or greater than:

(1) Ten percent during the immediately preceding calendar year; or

(2) Twenty percent during the immediately preceding 2 calendar years.

2. As used in this section, “course of therapy” means:

(a) Except as otherwise provided in paragraph (b), the recommended daily dosage of a prescription drug, as set forth on the label for the prescription drug approved by the United States Food and Drug Administration, for 30 days.

(b) If the normal course of treatment using a prescription drug is less than 30 days, the recommended daily dosage of a prescription drug, as set forth on the label for the prescription drug approved by the United States Food and Drug Administration, for the duration of the recommended course of treatment.

(Added to NRS by 2017, 4297; A 2019, 1465; 2021, 3723)

NRS 439B.635 Manufacturer of certain prescription drugs to prepare, submit and affirm accuracy of annual report; contents of report.

1. On or before April 1 of each year, the manufacturer of a prescription drug that appears on either or both of the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 shall prepare and submit to the Department, in the form prescribed by the Department:

(a) A report which includes the information prescribed by subsection 2; and

(b) A statement signed by the person responsible for compiling the report under penalty of perjury affirming the accuracy of the information in the report.

2. The report submitted pursuant to paragraph (a) of subsection 1 must include, for each drug described in subsection 1:

(a) The National Drug Code for the drug, reported in numeric form;

(b) The name, strength, dosage form and package size of the drug;

(d) The total administrative expenditures relating to the drug, including marketing and advertising costs;

(e) The profit that the manufacturer has earned from the drug and the percentage of the manufacturer’s total profit for the period during which the manufacturer has marketed the drug for sale that is attributable to the drug;

(f) The total amount of financial assistance that the manufacturer has provided through any patient prescription assistance program;

(g) The cost associated with coupons provided directly to consumers and for programs to assist consumers in paying copayments, and the cost to the manufacturer attributable to the redemption of those coupons and the use of those programs;

(h) The wholesale acquisition cost of the drug;

(i) A history of any increases in the wholesale acquisition cost of the drug over the 5 years immediately preceding the date on which the report is submitted, including the amount of each such increase expressed as a percentage of the total wholesale acquisition cost of the drug, the month and year in which each increase became effective and any explanation for the increase;

(j) The aggregate amount of all rebates that the manufacturer has provided to pharmacy benefit managers for sales of the drug within this State;

(k) If the manufacturer acquired the intellectual property for the drug within the immediately preceding 5 years:

(1) The name of the entity from which that intellectual property was acquired;

(2) The date of the acquisition and the purchase price;

(3) The wholesale acquisition cost at the time of the acquisition;

(4) The wholesale acquisition cost of the drug 1 year before the date of the acquisition; and

(5) The year that the drug was first made available for sale; and

(l) Any additional information prescribed by regulation of the Department for the purpose of analyzing the cost of prescription drugs that appear on either or both of the lists compiled pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630, trends in those costs and rebates available for such drugs.

(Added to NRS by 2017, 4297; A 2021, 3724)

NRS 439B.640 Manufacturer of drug that has undergone significant price increase to submit report describing reasons for increase; affirmation of accuracy of report; contents of report.

1. On or before April 1 of a year in which a drug is included on either or both of the lists compiled pursuant to paragraph (b) or (c) of subsection 1 of NRS 439B.630, the manufacturer of the drug shall submit to the Department:

(a) A report describing the reasons for the increase in the wholesale acquisition cost of the drug described in paragraph (b) or (c), as applicable, of subsection 1 of NRS 439B.630; and

(b) A statement signed by the person responsible for compiling the report under penalty of perjury affirming the accuracy of the information in the report.

2. The report submitted pursuant to paragraph (a) of subsection 1 must include, without limitation:

(a) A list of each factor that has contributed to the increase;

(b) The percentage of the total increase that is attributable to each factor;

(d) Any other information prescribed by regulation by the Department.

(Added to NRS by 2017, 4298; A 2021, 3725)

NRS 439B.642 Wholesaler of certain prescription drugs to prepare, submit and affirm accuracy of annual report; contents of report.

1. On or before April 1 of each year, a wholesaler that sells a prescription drug that appears on either or both of the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 for use in this State shall prepare and submit to the Department, in the form prescribed by the Department:

(a) A report which includes the information prescribed by subsection 2; and

(b) A statement signed by the person responsible for compiling the report affirming, under penalty of perjury, the accuracy of the information in the report.

2. The report submitted pursuant to paragraph (a) of subsection 1 must include, for each drug described in subsection 1:

(a) The current wholesale acquisition cost of the drug and the minimum and maximum wholesale acquisition cost of the drug during the immediately preceding calendar year;

(b) The total volume in units of the drug shipped by the wholesaler into this State during the immediately preceding calendar year;

(c) The aggregate amount of rebates negotiated directly with the manufacturer of the drug for sales of units of the drug shipped by the wholesaler into this State during the immediately preceding calendar year;

(d) The aggregate amount of rebates negotiated with pharmacies, pharmacy benefit managers and other entities for sales of units of the drug shipped by the wholesaler into this State during the immediately preceding calendar year; and

(e) Any other information prescribed by regulation of the Department.

(Added to NRS by 2021, 3723)

NRS 439B.645 Pharmacy benefit manager to submit and affirm accuracy of annual report concerning certain drugs; contents of report.

1. On or before April 1 of each year, a pharmacy benefit manager shall submit to the Department:

(a) A report which includes the information prescribed by subsection 2; and

(b) A statement signed under penalty of perjury affirming the accuracy of the information in the report.

2. The report submitted pursuant to paragraph (a) of subsection 1 must include:

(a) The current wholesale acquisition cost of each drug included on either or both of the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 and the minimum and maximum wholesale acquisition cost of each such drug during the immediately preceding year;

(b) The total number of units of each drug included on either or both of the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 for which the pharmacy benefit manager negotiated directly with the manufacturer for purchases of the drug for use in in this State during the immediately preceding calendar year;

(c) The number of units of each drug included on either or both of the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 for which the pharmacy benefit manager negotiated directly with the manufacturer during the immediately preceding calendar year for purchases of the drug for use in this State by:

(1) Recipients of Medicare;

(2) Recipients of Medicaid;

(3) Persons covered by third parties that are governmental entities which are not described in subparagraph (1) or (2);

(4) Persons covered by commercial insurers; and

(5) Persons covered by third parties other than those described in subparagraphs (1) to (4), inclusive;

(d) The aggregate amount of the rebates that the pharmacy benefit manager negotiated with manufacturers during the immediately preceding calendar year for purchases of prescription drugs included on the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 for use in this State, in total for each of those lists and for each drug included on such a list;

(e) The aggregate amount of the rebates described in paragraph (d) that were retained by the pharmacy benefit manager, in total for each of the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 and for each drug included on such a list;

(f) The aggregate amount of the rebates described in paragraph (d) that were negotiated for purchases of prescription drugs for use by persons in each category listed in paragraph (c), in total for each of the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 and for each drug included on such a list;

(g) The amount of discounts, dispensing fees or other fees that the pharmacy benefit manager negotiated with pharmacies, prescription drug networks or pharmacy services administrative organizations during the immediately preceding calendar year for purchases of prescription drugs included on the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 for use in this State, in total for each list and for each drug included on such a list;

(h) The amount of discounts, dispensing fees or other fees described in paragraph (g) which were negotiated for purchases of prescription drugs for use by persons in each category prescribed by paragraph (c), in total for each of the most current lists compiled by the Department pursuant to paragraphs (a) and (c) of subsection 1 of NRS 439B.630 and for each drug included on such a list; and

(i) Any other information prescribed by regulation of the Department.

(Added to NRS by 2017, 4298; A 2021, 3726)

NRS 439B.650 Department to compile annual report concerning price of certain drugs; contents of report; presentation of report at public hearing. On or before June 1 of each year, the Department shall:

1. Analyze the information submitted pursuant to NRS 439B.635 to 439B.645, inclusive, and compile a report on the price of prescription drugs. The report:

(a) Must include, without limitation, a separate analysis of the information reported by manufacturers, pharmacy benefit managers and wholesalers, the reasons for any increases in the prices of prescription drugs in this State and the effect of those prices on overall spending on prescription drugs, insurance premiums and cost-sharing in this State; and

(b) May include, without limitation, opportunities for persons and entities in this State to lower the cost of prescription drugs while maintaining access to such drugs.

2. Present the findings in the report at a public hearing.

(Added to NRS by 2017, 4299; A 2019, 1465; 2021, 3727)

NRS 439B.655 Pharmacies to provide to Department contact information, electronic mail address and address of Internet website; exceptions.

1. Except as otherwise provided in subsections 2 and 3, each pharmacy shall, in accordance with the regulations adopted pursuant to NRS 439B.685, provide to the Department:

(a) Information that a consumer may use to locate, contact or otherwise do business with the pharmacy, including, without limitation:

(1) The name of the pharmacy;

(2) The physical address of the pharmacy; and

(3) The phone number of the pharmacy;

(b) If the pharmacy maintains an electronic mail address, the electronic mail address of the pharmacy; and

2. If a pharmacy is not located within the State of Nevada, the pharmacy may, but is not required to, provide to the Department the information described in subsection 1.

3. If a pharmacy is part of a larger company or corporation or a chain of pharmacies or retail stores, the parent company or corporation may provide to the Department the information described in subsection 1.

(Added to NRS by 2007, 3137)

NRS 439B.660 Manufacturer required to provide list of its pharmaceutical sales representatives; electronic access to list; prohibition against unlisted person marketing prescription drugs; reports.

1. A manufacturer of a prescription drug shall provide to the Department a list of each pharmaceutical sales representative who markets prescription drugs on behalf of the manufacturer to providers of health care licensed, certified or registered in this State, pharmacies or employees thereof, operators or employees of medical facilities or persons licensed or certified under the provisions of title 57 of NRS and update the list at least annually.

2. The Department shall provide electronic access to the most recent list provided by each manufacturer pursuant to subsection 1 to each provider of health care licensed, certified or registered in this State, operator of a pharmacy, operator of a medical facility or person licensed or certified under the provisions of title 57 of NRS for the purposes of ensuring compliance with the requirements of subsection 3. This subsection must not be construed to impose any duty on a provider of health care, operator of a pharmacy, operator of a medical facility or person licensed or certified under the provisions of title 57 of NRS to ensure such compliance.

3. A person who is not included on a current list submitted pursuant to subsection 1 shall not market prescription drugs on behalf of a manufacturer:

(a) To any provider of health care licensed, certified or registered in this State, pharmacy or employee thereof, operator or employee of a medical facility or person licensed or certified under the provisions of title 57 of NRS; or

(b) For sale to any resident of this State.

4. On or before March 1 of each year, each person who was included on a list of pharmaceutical sales representatives submitted pursuant to subsection 1 at any time during the immediately preceding calendar year shall submit to the Department a report, which must include, for the immediately preceding calendar year:

(a) A list of providers of health care licensed, certified or registered in this State, pharmacies and employees thereof, operators and employees of medical facilities and persons licensed or certified under the provisions of title 57 of NRS to whom the pharmaceutical sales representative provided:

(1) Any type of compensation with a value that exceeds $10; or

(2) Total compensation with a value that exceeds $100 in aggregate; and

(b) The name and manufacturer of each prescription drug for which the pharmaceutical sales representative provided a free sample to a provider of health care licensed, certified or registered in this State, pharmacy or employee thereof, operator or employee of a medical facility or person licensed or certified under the provisions of title 57 of NRS and the name of each such person to whom a free sample was provided.

5. The Department shall analyze annually the information submitted pursuant to subsection 4 and compile a report on the activities of pharmaceutical sales representatives in this State. Any information contained in such a report that is derived from a list provided pursuant to subsection 1 or a report submitted pursuant to subsection 4 must be reported in aggregate and in a manner that does not reveal the identity of any person or entity. On or before June 1 of each year, the Department shall:

(a) Post the report on the Internet website maintained by the Department; and

(b) Submit the report to the Governor and the Director of the Legislative Counsel Bureau for transmittal to the Joint Interim Standing Committee on Health and Human Services and, in even-numbered years, the next regular session of the Legislature.

6. As used in this section:

(a) “Medical facility” has the meaning ascribed to it in NRS 629.026.

(b) “Pharmaceutical sales representative” means a person who markets prescription drugs to providers of health care licensed, certified or registered in this State, pharmacies or employees thereof, operators or employees of medical facilities or persons licensed or certified under the provisions of title 57 of NRS.

(Added to NRS by 2017, 4299)

NRS 439B.665 Report by certain nonprofit organizations that receive items of value from manufacturer. [Effective through December 31, 2025.]

1. On or before February 1 of each year, a nonprofit organization that advocates on behalf of patients or funds medical research in this State and has received a payment, donation, subsidy or anything else of value from a manufacturer, third party or pharmacy benefit manager or a trade or advocacy group for manufacturers, third parties or pharmacy benefit managers during the immediately preceding calendar year shall:

(a) Compile a report which includes:

(1) For each such contribution, the amount of the contribution and the manufacturer, third party or pharmacy benefit manager or group that provided the payment, donation, subsidy or other contribution; and

(2) The percentage of the total gross income of the organization during the immediately preceding calendar year attributable to payments, donations, subsidies or other contributions from each manufacturer, third party, pharmacy benefit manager or group; and

(b) Except as otherwise provided in this paragraph, post the report on an Internet website that is maintained by the nonprofit organization and accessible to the public. If the nonprofit organization does not maintain an Internet website that is accessible to the public, the nonprofit organization shall submit the report compiled pursuant to paragraph (a) to the Department.

2. As used in this section, “third party” means:

(a) An insurer, as that term is defined in NRS 679B.540;

(b) A health benefit plan, as that term is defined in NRS 687B.470, for employees which provides coverage for prescription drugs;

(d) Any other insurer or organization that provides health coverage or benefits in accordance with state or federal law.

Ê The term does not include an insurer that provides coverage under a policy of casualty or property insurance.

(Added to NRS by 2017, 4300; A 2019, 1108)

NRS 439B.665 Report by certain nonprofit organizations that receive items of value from manufacturer. [Effective January 1, 2026.]

(a) Compile a report which includes:

2. As used in this section, “third party” means:

(a) An insurer, as that term is defined in NRS 679B.540;

(b) A health benefit plan, as that term is defined in NRS 687B.470, for employees which provides coverage for prescription drugs;

(d) The Public Option established pursuant to NRS 695K.200; or

(e) Any other insurer or organization that provides health coverage or benefits in accordance with state or federal law.

Ê The term does not include an insurer that provides coverage under a policy of casualty or property insurance.

(Added to NRS by 2017, 4300; A 2019, 1108; 2021, 3643, effective January 1, 2026)

1. Except as otherwise provided in subsection 2, the Department shall:

(a) Place or cause to be placed on the Internet website maintained by the Department:

(1) The information provided by each pharmacy pursuant to NRS 439B.655;

(2) The information compiled by a nonprofit organization pursuant to NRS 439B.665 if such a report is submitted pursuant to paragraph (b) of subsection 1 of that section;

(3) The lists of prescription drugs compiled by the Department pursuant to NRS 439B.630;

(4) The wholesale acquisition cost of each prescription drug, as reported pursuant to NRS 439B.635, 439B.642 and 439B.645; and

(5) The reports compiled by the Department pursuant to NRS 439B.650 and 439B.660.

(b) Ensure that the information placed on the Internet website maintained by the Department pursuant to paragraph (a) is organized so that each individual pharmacy, manufacturer and nonprofit organization has its own separate entry on that website; and

(c) Ensure that the usual and customary price that each pharmacy charges for each prescription drug that is on the list prepared pursuant to NRS 439B.625 and that is stocked by the pharmacy:

(1) Is presented on the Internet website maintained by the Department in a manner which complies with the requirements of NRS 439B.675; and

(2) Is updated not less frequently than once each calendar quarter.

Ê Nothing in this subsection prohibits the Department from determining the usual and customary price that a pharmacy charges for a prescription drug by extracting or otherwise obtaining such information from claims reported by pharmacies to the Medicaid program.

2. If a pharmacy is part of a larger company or corporation or a chain of pharmacies or retail stores, the Department may present the pricing information pertaining to such a pharmacy in such a manner that the pricing information is combined with the pricing information relative to other pharmacies that are part of the same company, corporation or chain, to the extent that the pricing information does not differ among those pharmacies.

3. The Department may establish additional or alternative procedures by which a consumer who is unable to access the Internet or is otherwise unable to receive the information described in subsection 1 in the manner in which it is presented by the Department may obtain that information:

(a) In the form of paper records;

(b) Through the use of a telephonic system; or

(c) Using other methods or technologies designed specifically to assist consumers who are hearing impaired or visually impaired.

4. As used in this section, “usual and customary price” means the usual and customary charges that a pharmacy charges to the general public for a drug, as described in 42 C.F.R. § 447.512.

(Added to NRS by 2007, 3138; A 2017, 4301; 2021, 3727)

NRS 439B.675 Manner of presentation of information.

1. Except as otherwise provided in this section, the Department shall ensure that the list of prescription drugs prepared pursuant to NRS 439B.625 and the information that pharmacies and the Department provide and obtain pursuant to NRS 439B.655 and 439B.670 are combined and presented to consumers in such a manner that a consumer may easily compare the prices for particular prescription drugs, and their generic equivalents, that are currently charged by:

(a) Pharmacies located within the same city, county or zip code in which the consumer resides;

(b) Internet pharmacies; and

Ê The requirements of paragraphs (b) and (c) apply only to the extent that information regarding such pharmacies is made available to the Department.

2. As used in this section, “Internet pharmacy” has the meaning ascribed to it in NRS 639.00865.

(Added to NRS by 2007, 3138)

NRS 439B.680 Immunity from civil and criminal liability. The Department and its members, officers and employees are not liable civilly or criminally for any act, omission, error or technical problem that results in:

1. The failure to provide to consumers information regarding a pharmacy, prescription drug or nonprofit organization, including, without limitation, the information made available on the Department’s Internet website pursuant to NRS 439B.670; or

2. The providing to consumers of incorrect information regarding a pharmacy, prescription drug or nonprofit organization, including, without limitation, the information made available on the Department’s Internet website pursuant to NRS 439B.670.

(Added to NRS by 2007, 3139; A 2017, 4302)

NRS 439B.685 Regulations. The Department shall adopt such regulations as it determines to be necessary or advisable to carry out the provisions of NRS 439B.600 to 439B.695, inclusive. Such regulations must provide for, without limitation:

1. Notice to consumers stating that:

(a) Although the Department will strive to ensure that consumers receive accurate information regarding pharmacies, prescription drugs and nonprofit organizations including, without limitation, the information made available on the Department’s Internet website pursuant to NRS 439B.670, the Department is unable to guarantee the accuracy of such information;

(b) If a consumer follows an Internet link from the Internet website maintained by the Department to an Internet website not maintained by the Department, the Department is unable to guarantee the accuracy of any information made available on that Internet website; and

(c) The Department advises consumers to contact a pharmacy, manufacturer or nonprofit organization directly to verify the accuracy of any information regarding the pharmacy, a prescription drug manufactured by the manufacturer or the nonprofit organization, as applicable, which is made available to consumers pursuant to NRS 439B.600 to 439B.695, inclusive;

2. Procedures adopted to direct consumers who have questions regarding the program described in NRS 439B.600 to 439B.695, inclusive, to contact the Office for Consumer Health Assistance of the Department;

3. Provisions in accordance with which the Department will allow an Internet link to the information made available on the Department’s Internet website pursuant to NRS 439B.670 to be placed on other Internet websites managed or maintained by other persons and entities, including, without limitation, Internet websites managed or maintained by:

(a) Other governmental entities, including, without limitation, the State Board of Pharmacy and the Office of the Governor; and

(b) Nonprofit organizations and advocacy groups;

4. Procedures pursuant to which consumers, pharmacies, manufacturers and nonprofit organizations may report to the Department that information made available to consumers pursuant to NRS 439B.600 to 439B.695, inclusive, is inaccurate;

5. The form and manner in which pharmacies are to provide to the Department the information described in NRS 439B.655;

6. The form and manner in which manufacturers are to provide to the Department the information described in NRS 439B.635, 439B.640 and 439B.660;

7. The form and manner in which pharmacy benefit managers are to provide to the Department the information described in NRS 439B.645;

8. The form and manner in which pharmaceutical sales representatives are to provide to the Department the information described in NRS 439B.660;

9. The form and manner in which nonprofit organizations are to provide to the Department the information described in NRS 439B.665, if required;

10. The form and manner in which wholesalers are to provide the Department with the information described in NRS 439B.642; and

11. Standards and criteria pursuant to which the Department may remove from its Internet website information regarding a pharmacy or an Internet link to the Internet website maintained by a pharmacy, or both, if the Department determines that the pharmacy has:

(a) Ceased to be licensed and in good standing pursuant to chapter 639 of NRS; or

(b) Engaged in a pattern of providing to consumers information that is false or would be misleading to reasonably informed persons.

(Added to NRS by 2007, 3139; A 2011, 977; 2017, 4302; 2021, 3728)

NRS 439B.690 Suspension of components of program or duties of Department if sufficient money not available; acceptance of gifts and grants.

1. On or before July 1 of each odd-numbered year, the Department shall make a determination of whether sufficient money is available and authorized for expenditure to fund one or more components of the programs and other duties of the Department relating to NRS 439B.600 to 439B.695, inclusive.

2. The Department shall temporarily suspend any components of the program or duties of the Department for which it determines pursuant to subsection 1 that sufficient money is not available.

3. The Department may apply for and accept any available grants and may accept any bequests, devises, donations or gifts from any public or private source to carry out the provisions of NRS 439B.600 to 439B.695, inclusive.

(Added to NRS by 2007, 3140; A 2017, 4303)

NRS 439B.695 Administrative penalty for failure to provide information to Department; use of money collected by Department.

1. If a pharmacy that is licensed under the provisions of chapter 639 of NRS and is located within the State of Nevada fails to provide to the Department the information required to be provided pursuant to NRS 439B.655 or fails to provide such information on a timely basis, and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department may impose against the pharmacy an administrative penalty of not more than $500 for each day of such failure.

2. If a manufacturer fails to provide to the Department the information required by NRS 439B.635, 439B.640 or 439B.660, a pharmacy benefit manager fails to provide to the Department the information required by NRS 439B.645, a wholesaler fails to provide to the Department the information required by NRS 439B.642 or a nonprofit organization fails to post or provide to the Department, as applicable, the information required by NRS 439B.665 or a manufacturer, pharmacy benefit manager, wholesaler or nonprofit organization fails to post or provide, as applicable, such information on a timely basis, and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department may impose against the manufacturer, pharmacy benefit manager, wholesaler or nonprofit organization, as applicable, an administrative penalty of not more than $5,000 for each day of such failure.

3. If a pharmaceutical sales representative fails to comply with the requirements of NRS 439B.660, the Department may impose against the pharmaceutical sales representative an administrative penalty of not more than $500 for each day of such failure.

4. Any money collected as administrative penalties pursuant to this section must be accounted for separately and used by the Department:

(a) For purposes relating to improvement of transparency concerning the costs of prescription drugs, including, without limitation, carrying out and administering the provisions of NRS 439B.600 to 439B.695, inclusive, and 439B.800 to 439B.875, inclusive; and

(b) To establish and carry out programs to:

(1) Educate patients concerning ways to reduce the cost of health care and prescription drugs; and

(2) Provide education concerning chronic diseases.

(Added to NRS by 2007, 3140; A 2017, 4304; 2019, 1465; 2021, 3057, 3730)

PAYMENT FOR MEDICALLY NECESSARY EMERGENCY SERVICES PROVIDED OUT-OF-NETWORK

NRS 439B.700 Definitions. As used in NRS 439B.700 to 439B.760, inclusive, unless the context otherwise requires, the words and terms defined in NRS 439B.703 to 439B.739, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 2019, 320)

NRS 439B.703 “Covered person” defined. “Covered person” means a policyholder, subscriber, enrollee or other person covered by a third party.

(Added to NRS by 2019, 320)

NRS 439B.706 “Independent center for emergency medical care” defined. “Independent center for emergency medical care” has the meaning ascribed to it in NRS 449.013.

(Added to NRS by 2019, 320)

NRS 439B.709 “In-network emergency facility” defined. “In-network emergency facility” means a hospital or independent center for emergency medical care that is an in-network provider.

(Added to NRS by 2019, 320)

NRS 439B.712 “In-network provider” defined. “In-network provider” means, for a particular covered person, a provider of health care that has entered into a provider contract with a third party for the provision of health care to the covered person.

(Added to NRS by 2019, 320)

NRS 439B.715 “Medically necessary emergency services” defined. “Medically necessary emergency services” means health care services that are provided by a provider of health care to screen and to stabilize a covered person after the sudden onset of a medical condition that manifests itself by symptoms of such sufficient severity that a prudent person would believe that the absence of immediate medical attention could result in:

1. Serious jeopardy to the health of the covered person;

2. Serious jeopardy to the health of an unborn child of the covered person;

3. Serious impairment of a bodily function of the covered person; or

4. Serious dysfunction of any bodily organ or part of the covered person.

(Added to NRS by 2019, 320)

NRS 439B.718 “Out-of-network emergency facility” defined. “Out-of-network emergency facility” means a hospital or independent center for emergency medical care that is an out-of-network provider.

(Added to NRS by 2019, 320)

NRS 439B.721 “Out-of-network provider” defined. “Out-of-network provider” means, for a particular covered person, a provider of health care that has not entered into a provider contract with a third party for the provision of health care to the covered person.

(Added to NRS by 2019, 320)

NRS 439B.724 “Provider contract” defined. “Provider contract” means a contract between a third party and an in-network provider to provide health care services to a covered person.

(Added to NRS by 2019, 320)

NRS 439B.727 “Provider of health care” defined. “Provider of health care” has the meaning ascribed to it in NRS 695G.070.

(Added to NRS by 2019, 320)

NRS 439B.730 “Prudent person” defined. “Prudent person” means a person who:

1. Is not a provider of health care;

2. Possesses an average knowledge of health and medicine; and

3. Is acting reasonably under the circumstances.

(Added to NRS by 2019, 321)

NRS 439B.733 “Screen” defined. “Screen” means to conduct the medical screening examination required to be provided to a patient in the emergency department of a hospital pursuant to 42 U.S.C. § 1395dd.

(Added to NRS by 2019, 321)

NRS 439B.736 “Third party” defined. [Effective through December 31, 2025.]

1. “Third party” includes, without limitation:

(a) The issuer of a health benefit plan, as defined in NRS 695G.019, which provides coverage for medically necessary emergency services;

(b) The Public Employees’ Benefits Program established pursuant to subsection 1 of NRS 287.043; and

(c) Any other entity or organization that elects pursuant to NRS 439B.757 for the provisions of NRS 439B.700 to 439B.760, inclusive, to apply to the provision of medically necessary emergency services by out-of-network providers to covered persons.

2. The term does not include the State Plan for Medicaid, the Children’s Health Insurance Program or a health maintenance organization, as defined in NRS 695C.030, or managed care organization, as defined in NRS 695G.050, when providing health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department.

(Added to NRS by 2019, 321)

NRS 439B.736 “Third party” defined. [Effective January 1, 2026.]

1. “Third party” includes, without limitation:

(a) The issuer of a health benefit plan, as defined in NRS 695G.019, which provides coverage for medically necessary emergency services;

(b) The Public Employees’ Benefits Program established pursuant to subsection 1 of NRS 287.043;

(d) Any other entity or organization that elects pursuant to NRS 439B.757 for the provisions of NRS 439B.700 to 439B.760, inclusive, to apply to the provision of medically necessary emergency services by out-of-network providers to covered persons.

(Added to NRS by 2019, 321; A 2021, 3644, effective January 1, 2026)

NRS 439B.739 “To stabilize” and “stabilized” defined. “To stabilize” and “stabilized” have the meanings ascribed to them in 42 U.S.C. § 1395dd(e)(3).

(Added to NRS by 2019, 321)

NRS 439B.742 Inapplicability of provisions to certain hospitals, persons and health care services. The provisions of NRS 439B.745 and 439B.748 do not apply to:

1. A hospital which has been certified as a critical access hospital by the Secretary of Health and Human Services pursuant to 42 U.S.C. § 1395i-4(e) or any medically necessary emergency services provided at such a hospital;

2. A person who is covered by a policy of health insurance that was sold outside this State; or

3. Any health care services provided more than 24 hours after notification is provided pursuant to NRS 439B.745 that a person has been stabilized.

(Added to NRS by 2019, 321)

NRS 439B.745 Limitation on amount out-of-network provider may collect from covered person; duties of out-of-network emergency facility upon providing services.

1. An out-of-network provider shall not collect from a covered person for medically necessary emergency services, and a covered person is not responsible for paying, an amount that exceeds the copayment, coinsurance or deductible required for such services provided by an in-network provider by the coverage for that person.

2. An out-of-network emergency facility that provides medically necessary emergency services to a covered person shall:

(a) When possible, notify the third party that provides coverage for the covered person not later than 8 hours after the covered person presents at the out-of-network emergency facility to receive medically necessary emergency services; and

(b) Notify the third party that the condition of the covered person has stabilized to such a degree that the person may be transferred to an in-network emergency facility not later than 24 hours after the person’s emergency medical condition is stabilized. Not later than 24 hours after the third party receives such notice, the third party shall arrange for the transfer of the person to such a facility.

(Added to NRS by 2019, 321)

NRS 439B.748 Payment to out-of-network emergency facility by third party.

1. If an out-of-network emergency facility had a provider contract as an in-network emergency facility within the 24 months immediately preceding the date on which the medically necessary emergency services were rendered to a covered person, the third party that provides coverage for the covered person shall pay to the out-of-network emergency facility for those services, and the out-of-network emergency facility shall accept as payment in full for those services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network emergency facility:

(a) If the out-of-network emergency facility was an in-network emergency facility within the 12 months immediately preceding the provision of medically necessary emergency services, 108 percent of the amount that would have been paid for those services pursuant to the most recent applicable provider contract between the third party and the out-of-network emergency facility, less the amount of the copayment, coinsurance or deductible, if applicable.

(b) If the out-of-network emergency facility was an in-network emergency facility within the 24 months immediately preceding the provision of medically necessary emergency services, but not within the 12 months immediately preceding the provision of those services, 115 percent of the amount that would have been paid for those services pursuant to the most recent applicable provider contract between the third party and the out-of-network emergency facility, less the amount of the copayment, coinsurance or deductible, if applicable.

2. If an out-of-network emergency facility did not have a provider contract as an in-network emergency facility within the 24 months immediately preceding the date on which the medically necessary emergency services were rendered to a covered person, the third party that provides coverage to the covered person shall pay to the out-of-network emergency facility an amount that the third party has determined to be fair and reasonable as payment for the medically necessary emergency services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network emergency facility.

(Added to NRS by 2019, 322)

NRS 439B.751 Payment to out-of-network provider, other than emergency facility, by third party.

1. If an out-of-network provider, other than an out-of-network emergency facility, had a provider contract as an in-network provider within the 12 months immediately preceding the date on which the medically necessary emergency services were rendered to a covered person and:

(a) The out-of-network provider terminated the most recent applicable provider contract between the third party that provides coverage for the covered person and the out-of-network provider without cause before it was scheduled to expire, the third party shall pay to the out-of-network provider for those services, and the out-of-network provider shall accept as payment in full for those services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider, the amount that would have been paid for those services pursuant to that provider contract, less the amount of the copayment, coinsurance or deductible, if applicable.

(b) The out-of-network provider terminated the most recent applicable provider contract between the third party that provides coverage for the covered person and the out-of-network provider for cause before it was scheduled to expire or the third party terminated the contract without cause, the third party shall pay to the out-of-network provider for those services, and the out-of-network provider shall accept as payment in full for those services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider, 108 percent of the amount that would have been paid for those services pursuant to the provider contract, less the amount of the copayment, coinsurance or deductible, if applicable.

(c) The third party that provides coverage for the covered person terminated the most recent applicable provider contract between the third party and the out-of-network provider for cause before it was scheduled to expire, the third party shall pay to the out-of-network provider an amount that the third party has determined to be fair and reasonable as payment for the medically necessary emergency services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider.

(d) The contract was not terminated by either party, the third party that provides coverage for the covered person shall pay to the out-of-network provider for those services, and the out-of-network provider shall accept as payment in full for those services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider, the amount that would have been paid for those services pursuant to the most recent applicable provider contract between the third party and the out-of-network provider plus an amount equal to the percentage of increase in the Consumer Price Index, Medical Care Component, during the immediately preceding calendar year, less the amount of the copayment, coinsurance or deductible, if applicable.

2. If an out-of-network provider, other than an out-of-network emergency facility, did not have a provider contract as an in-network provider within the 12 months immediately preceding the date on which the medically necessary emergency services were rendered to a covered person, the third party that provides coverage to the covered person shall submit to the out-of-network provider an offer of payment in full for the medically necessary emergency services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider.

(Added to NRS by 2019, 322)

1. An out-of-network provider shall accept or reject an amount paid pursuant to subsection 2 of NRS 439B.748 or paragraph (c) of subsection 1 or subsection 2 of NRS 439B.751 as payment in full for the medically necessary emergency services for which the payment was offered within 30 days after receiving the payment. If an out-of-network provider fails to comply with the requirements of this section, the amount paid shall be deemed accepted as payment in full for the medically necessary emergency services for which the payment was offered 30 days after the out-of-network provider received the payment.

2. If an out-of-network provider rejects the amount paid as payment in full, the out-of-network provider must request from the third party an additional amount which, when combined with the amount previously paid, the out-of-network provider is willing to accept as payment in full for the medically necessary emergency services.

3. If the third party refuses to pay the additional amount requested by the out-of-network provider pursuant to subsection 2 or fails to pay that amount within 30 days after receiving the request for the additional amount, the out-of-network provider must request a list of five randomly selected arbitrators from an entity authorized by regulations of the Director of the Department to provide such arbitrators. Such regulations must require:

(a) For claims of less than $5,000, the use of arbitrators who will conduct the arbitration in an economically efficient manner. Such arbitrators may include, without limitation, qualified employees of the State and arbitrators from the voluntary program for the use of binding arbitration established in the judicial district pursuant to NRS 38.255 or, if no such program has been established in the judicial district, from the program established in the nearest judicial district that has established such a program.

(b) For claims of $5,000 or more, the use of arbitrators from nationally recognized providers of arbitration services, which may include, without limitation, the American Arbitration Association, JAMS or their successor organizations.

4. Upon receiving the list of randomly selected arbitrators pursuant to subsection 3, the out-of-network provider and the third party shall each strike two arbitrators from the list. If one arbitrator remains, that arbitrator must arbitrate the dispute concerning the amount to be paid for the medically necessary emergency services. If more than one arbitrator remains, an arbitrator randomly selected from the remaining arbitrators by the entity that provided the list of arbitrators pursuant to subsection 3 must arbitrate that dispute.

5. The out-of-network provider and the third party shall participate in binding arbitration of the dispute concerning the amount to be paid for the medically necessary emergency services conducted by the arbitrator selected pursuant to subsection 4. The out-of-network provider or third party may provide the arbitrator with any relevant information to assist the arbitrator in making a determination.

6. The arbitrator shall require:

(a) The out-of-network provider to accept as payment in full for the provision of the medically necessary emergency services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider, the amount paid by the third party pursuant to subsection 2 of NRS 439B.748 or paragraph (c) of subsection 1 or subsection 2 of NRS 439B.751, as applicable; or

(b) The third party to pay the additional amount requested by the out-of-network provider pursuant to subsection 2.

7. If the arbitrator requires:

(a) The out-of-network provider to accept the amount paid by the third party pursuant to subsection 2 of NRS 439B.748 or paragraph (c) of subsection 1 or subsection 2 of NRS 439B.751, as applicable, as payment in full for the provision of the medically necessary emergency services, except for any copayment, coinsurance or deductible that the coverage requires the covered person to pay for the services when provided by an in-network provider, the out-of-network provider must pay the costs of the arbitrator.

(b) The third party to pay the additional amount requested by the out-of-network provider pursuant to subsection 2, the third party must pay the costs of the arbitrator.

8. If a qualified employee of the State serves as an arbitrator pursuant to paragraph (a) of subsection 3, the state agency that employs the arbitrator may retain money paid by the out-of-network provider or third party pursuant to subsection 7 for the costs of the arbitrator.

9. An out-of-network provider or a third party must pay its own attorney’s fees incurred during the process prescribed by this section.

10. Interest does not accrue on any claim for which an offer of payment is rejected pursuant to subsection 1 for the period beginning on the date of the rejection and ending 30 days after the arbitrator renders a decision.

11. Except as otherwise provided in this subsection and NRS 439B.760, any decision of an arbitrator pursuant to this section and any documents associated with such a decision are confidential and are not admissible as evidence during a legal proceeding, including, without limitation, a legal proceeding between the third party and the out-of-network provider. The decision of an arbitrator and any documents associated with such a decision may be disclosed and are admissible as evidence during a legal proceeding to enforce the decision.

(Added to NRS by 2019, 323; A 2023, 2664)

NRS 439B.757 Election by certain entities and organizations not otherwise covered to submit to provisions; regulations. Any entity or organization, not otherwise subject to the provisions of NRS 439B.700 to 439B.760, inclusive, that provides coverage for emergency medical services, including, without limitation, a participating public agency, as defined in NRS 287.04052, and any other local governmental agency which provides a system of health insurance for the benefit of its officers and employees, and the dependents of such officers and employees, pursuant to chapter 287 of NRS, may elect for the provisions of NRS 439B.700 to 439B.760, inclusive, to apply to the provision of medically necessary emergency services by out-of-network providers to covered persons. The Director of the Department of Health and Human Services shall:

1. Publish on an Internet website maintained by the Department a list of third parties that have made such an election; and

2. Adopt regulations governing such an election, which may include, without limitation, regulations that establish the procedure by which a third party may make such an election.

(Added to NRS by 2019, 325)

NRS 439B.760 Reports; confidentiality of information.

1. On or before December 31 of each year, an arbitrator who arbitrated a matter pursuant to NRS 439B.754 during the immediately preceding 12 months shall report to the Department of Health and Human Services in the form prescribed by the Department:

(a) The number of cases arbitrated by the arbitrator;

(b) The types of providers of health care and third parties involved in those cases;

(d) Information concerning the geographic location of the provider of health care that provided medically necessary emergency services; and

(e) Any other information requested by the Department.

2. A provider of health care or third party:

(a) Shall provide to the Department any information requested by the Department to complete the report required by subsection 3; and

(b) May provide to the Department any other information relevant to that report.

3. On or before January 31 of each year, the Department shall:

(a) Compile a report which consists of:

(1) Aggregated information provided to the Department pursuant to subsections 1 and 2, presented in a manner that does not reveal the identity of any provider of health care, third party or patient;

(2) An analysis of any identifiable trends in the information described in subparagraph (1); and

(3) An analysis of the impact of actions taken pursuant to NRS 439B.700 to 439B.760, inclusive, on provider contracts and the provision of health care in this State;

(b) Post the report on an Internet website maintained by the Department; and

(1) In even-numbered years, the Joint Interim Standing Committee on Health and Human Services; and

(2) In odd-numbered years, the next regular session of the Legislature.

4. Any information disclosed to the Department pursuant to this section is confidential.

(Added to NRS by 2019, 325)

ALL-PAYER CLAIMS DATABASE

NRS 439B.800 Definitions. As used in NRS 439B.800 to 439B.875, inclusive, unless the context otherwise requires, the words and terms defined in NRS 439B.805 to 439B.830, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 2021, 3050)

NRS 439B.805 “All-payer claims database” defined. “All-payer claims database” means the all-payer claims database established pursuant to NRS 439B.835.

(Added to NRS by 2021, 3050)

NRS 439B.810 “Covered entity” defined. “Covered entity” has the meaning ascribed to it in 45 C.F.R. § 160.103.

(Added to NRS by 2021, 3050)

NRS 439B.815 “Direct patient identifier” defined. “Direct patient identifier” means data that directly identifies a patient, including, without limitation, a name, telephone number, social security number, number associated with a medical record, health plan beneficiary number or electronic mail address.

(Added to NRS by 2021, 3051)

NRS 439B.820 “Proprietary financial information” defined. “Proprietary financial information” means data that discloses or allows the determination of:

1. A specific term of a contract, discount or other agreement between any or all of a provider of health care, a health facility, a manufacturer of prescription drugs and an entity described in NRS 439B.840; or

2. An internal fee schedule or other unique pricing mechanism used by a provider of health care, a health facility or an entity described in NRS 439B.840.

(Added to NRS by 2021, 3051)

NRS 439B.825 “Provider of health care” defined. “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(Added to NRS by 2021, 3051)

NRS 439B.830 “Unique identifier” defined. “Unique identifier” means an identifier that is guaranteed to be unique for a patient and can be used to track information relating to the patient but is not a direct patient identifier.

(Added to NRS by 2021, 3051)

NRS 439B.835 Establishment of database; duties of Department; advisory committees.

1. The Department shall, to the extent that federal money is available for this purpose, establish an all-payer claims database of information relating to health insurance claims resulting from medical, dental or pharmacy benefits provided in this State.

2. If the Department establishes an all-payer claims database pursuant to subsection 1, the Department shall:

(a) Establish a secure process for uploading data to the database pursuant to NRS 439B.840. When establishing that process, the Department shall consider the time and cost incurred to upload data to the database.

(b) Establish and carry out a process to review the data submitted to the database to:

(1) Ensure the accuracy of the data and the consistency of records; and

(2) Identify and remove duplicate records.

3. If the Department establishes an all-payer claims database pursuant to subsection 1, the Department:

(a) Shall adopt regulations to establish an advisory committee to make recommendations to the Department concerning the collection, analysis and reporting of data in the all-payer claims database, secure access to such data and the release of such data pursuant to NRS 439B.800 to 439B.875, inclusive.

(b) May adopt regulations to establish any other advisory committee if necessary to assist the Department in carrying out the provisions of NRS 439B.800 to 439B.875, inclusive.

4. The membership of any advisory committee established pursuant to subsection 3 must include, without limitation, representatives of providers of health care, health facilities, health authorities, as defined in NRS 439.005, health maintenance organizations, private insurers, nonprofit organizations that represent consumers of health care services and each of the two entities that submit data concerning the largest number of claims to the database.

(Added to NRS by 2021, 3051)

NRS 439B.840 Entities required and authorized to submit data to database; removal of direct patient identifiers and assignment of unique identifiers. If an all-payer claims database is established pursuant to NRS 439B.835:

1. Except as otherwise provided in this section, each health carrier, governing body of a local governmental agency that provides health insurance through a self-insurance reserve fund pursuant to NRS 287.010 or entity required by the regulations adopted pursuant to NRS 439B.875 to submit data to the database and the Public Employees’ Benefits Program shall submit to the all-payer claims database the data prescribed by the Department pursuant to NRS 439B.875 in the format prescribed by the Department pursuant to that section. The provisions of this subsection do not apply to:

(a) An issuer of insurance that only provides limited-scope dental or vision benefits or coverage that is only for a specified disease or illness, with respect to such coverage;

(b) An issuer of a Medicare supplemental policy, with respect to such a policy; or

(c) Any health carrier or other entity that provides health coverage to a total of less than 1,000 residents of this State.

2. A provider of health coverage for federal employees, a provider of health coverage that is subject to the Employee Retirement Income Security Act of 1974 or the administrator of a Taft-Hartley trust formed pursuant to 29 U.S.C. § 186(c)(5) are not required but may submit to the all-payer claims database the data prescribed by the Department pursuant to NRS 439B.875.

3. Before submitting data to the all-payer claims database pursuant to subsection 1 or 2, an entity described in either of those subsections shall:

(a) Remove all direct patient identifiers from the data; and

(b) Assign a unique identifier to all data concerning a specific patient.

4. As used in this section:

(a) “Health carrier” means an entity subject to the insurance laws and regulations of this State, or subject to the jurisdiction of the Commissioner of Insurance, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services, including, without limitation, a sickness and accident health insurance company, a health maintenance organization, a nonprofit hospital and health service corporation or any other entity providing a plan of health insurance, health benefits or health care services.

(b) “Medicare supplemental policy” has the meaning ascribed to it in 42 C.F.R. § 403.205 and additionally includes policies offered by public entities that otherwise meet the requirements of that section.

(Added to NRS by 2021, 3052)

NRS 439B.845 Confidentiality of data; compliance with certain federal law; use of data in enforcement proceedings.

1. Except as otherwise provided in subsection 3 and NRS 439B.855, data contained in the all-payer claims database, if established pursuant to NRS 439B.835, is confidential and is not a public record or subject to subpoena.

2. The Department shall comply with the provisions of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and any regulations adopted pursuant thereto as if the Department were a covered entity maintaining protected health information, as defined in 45 C.F.R. § 160.103, with regard to the collection of data pursuant to NRS 439B.840, the storage of data in the all-payer claims database and the procedures for releasing data from the all-payer claims database pursuant to NRS 439B.855.

3. To the extent authorized by federal law, the Department may use data contained in the all-payer claims database in any proceeding to enforce the provisions of NRS 439B.800 to 439B.875, inclusive.

(Added to NRS by 2021, 3052)

NRS 439B.850 Data requests. To obtain data pursuant to subsection 3 of NRS 439B.855 from the all-payer claims database, if established pursuant to NRS 439B.835, a person or entity must submit a request to the Department. The request must include, without limitation:

1. A description of the data the person or entity wishes to receive;

2. The purpose for requesting the data;

3. A description of the proposed use of the data, including, without limitation:

(a) The methodology of any study that will be conducted and any variables that will be used; and

(b) The names of any persons or entities to whom the applicant plans to disclose data from the all-payer claims database and the reasons for the proposed disclosure;

4. The measures that the requester plans to take to ensure the security of the data and prevent unauthorized use of the data in accordance with NRS 439B.855 and the regulations adopted pursuant to NRS 439B.875; and

5. The method by which the data will be stored, destroyed or returned to the Department at the completion of the activities for which the data will be used.

(Added to NRS by 2021, 3053)

1. The Department or any Division thereof may access and use data from the all-payer claims database for any purpose.

2. The Department shall release data from the all-payer claims database to the Attorney General upon request for the purpose of enforcing the provisions of chapters 598 and 598A of NRS.

3. Except as otherwise provided in subsection 4, the Department may release data from the all-payer claims database that does not contain proprietary financial information:

(a) In de-aggregated form with unique identifiers upon the submission of a request that meets the requirements of NRS 439B.850 to:

(1) A state or federal governmental entity, including, without limitation, a college or university within the Nevada System of Higher Education; or

(2) Any entity that submits data to the database pursuant to NRS 439B.840.

(b) In aggregated form to any person or entity approved by the Department that has submitted a request that meets the requirements of NRS 439B.850.

4. The Department shall not release data from the all-payer claims database in any form to any entity that is required or authorized to submit data to the all-payer claims database pursuant to NRS 439B.840 and fails to submit substantially complete data in accordance with the regulations adopted pursuant to NRS 439B.875.

5. A person or entity that receives data from the all-payer claims database pursuant to this section:

(a) Shall comply with any regulations of the Department adopted pursuant to NRS 439B.875.

(b) Shall not disclose or use the data in any manner other than as described in the request submitted pursuant to NRS 439B.850.

6. The Department shall notify each person or entity to whom data is released pursuant to subsection 3 of the percentage of residents of this State who have health coverage for which data was submitted to the all-payer claims database for the time period to which the released data pertains. Any published document that contains or uses data from the all-payer claims database, including, without limitation, the report published by the Department pursuant to NRS 439B.860, must state the percentage of residents of this State who have health coverage for which data was submitted to the database for the time period to which the data contained in or used by the published document pertains.

(Added to NRS by 2021, 3053)

NRS 439B.860 Report concerning quality, efficiency and cost of health care based on data; publication of list of reports Department intends to publish in next calendar year.

1. The Department shall, at least annually, publish a report concerning the quality, efficiency and cost of health care in this State based on the data in the all-payer claims database, if the all-payer claims database is established pursuant to NRS 439B.835. Such a report must be peer-reviewed by entities that submit data pursuant to NRS 439B.840 before the report is released. The Department shall submit the report to:

(a) The Governor;

(b) The Patient Protection Commission created by NRS 439.908; and

(c) The Director of the Legislative Counsel Bureau for transmittal to the Joint Interim Standing Committee on Health and Human Services and the next regular session of the Legislature.

2. A report published pursuant to subsection 1 must, where feasible, separate data by demographics, income, health status and the geography of, and the language spoken by, patients to assist in the identification of variations in the efficiency and quality of care.

3. Any comparison of cost among providers of health care or health care systems presented in a report published pursuant to subsection 1 must account for differences in costs attributable to populations served, severity of illness, subsidies for uninsured patients and recipients of Medicaid and Medicare and expenses for educating providers of health care, where applicable.

4. A report published pursuant to subsection 1 must not:

(a) Contain proprietary financial information. Such a report may contain data concerning aggregate costs calculated using proprietary financial information if the manner in which the data is displayed does not disclose proprietary financial information.

(b) Include in any comparison of the performance of providers of health care information concerning a provider of health care who is a solo practitioner or practices in a group of fewer than four providers.

5. A report published pursuant to subsection 1 must not contain information identified as relating to a specific provider of health care, health facility or entity that submits data pursuant to NRS 439B.840 unless the provider of health care, health facility or entity to which the information pertains is allowed to view the report before publication, request corrections of any errors in the information and comment on the reasonableness of the conclusions of the report.

6. On or before October 31 of each year, the Department shall publish on an Internet website maintained by the Department a list of reports the Department intends to publish pursuant to this section during the next calendar year. The Department may solicit public comment concerning that list.

(Added to NRS by 2021, 3054)

NRS 439B.865 Reports concerning cost, performance and effectiveness of database and information concerning grants. If the all-payer claims database is established pursuant to NRS 439B.835:

1. On or before December 31 of each even-numbered year, the Department shall submit to the Director of the Legislative Counsel Bureau for transmittal to the next regular session of the Legislature a report concerning the cost, performance and effectiveness of the all-payer claims database and any recommendations to improve the all-payer claims database.

2. On or before July 1 and December 31 of each year, the Department shall:

(a) Compile a report of any grants received by the Department to carry out the provisions of NRS 439B.800 to 439B.875, inclusive; and

(b) Submit the report to the Director of the Legislative Counsel Bureau for transmittal to:

(1) On December 31 of an even-numbered year, the next regular session of the Legislature; and

(2) In all other cases, the Interim Finance Committee.

(Added to NRS by 2021, 3055)

NRS 439B.870 Immunity from certain civil or criminal liability.

1. No person or entity providing information to the Department, including, without limitation, data submitted to the all-payer claims database, if established pursuant to NRS 439B.835, in accordance with NRS 439B.800 to 439B.875, inclusive, may be held liable in a civil or criminal action for disclosing confidential information unless the person or entity has done so in bad faith or with malicious purpose.

2. The Department and its members, officers and employees are not liable in any civil or criminal action for any damages resulting from any act, omission, error or technical problem that causes incorrect information from the all-payer claims database to be provided to any person or entity.

(Added to NRS by 2021, 3055)

NRS 439B.875 Regulations; administrative penalties; contracts and agreements; gifts, grants and donations; accounting and use of administrative penalties by Department. If the all-payer claims database is established pursuant to NRS 439B.835:

1. The Department shall adopt regulations that prescribe:

(a) The data that must be submitted to the all-payer claims database pursuant to NRS 439B.840, the format for submitting such data and the date by which such data must be submitted. Those regulations must align with applicable nationally and regionally recognized standards for all-payer claims databases, where applicable and to the extent that those standards do not conflict with each other or the provisions of NRS 439B.800 to 439B.875, inclusive.

(b) The privacy and security of data maintained in the all-payer claims database and the procedure for releasing data from the all-payer claims database pursuant to subsection 3 of NRS 439B.855, which must ensure compliance with subsection 2 of NRS 439B.845.

(c) The use of data released from the all-payer claims database, including, without limitation, requirements concerning the reporting and publication of information from the database.

(d) Administrative penalties to be assessed against any person or entity who violates any provision of NRS 439B.800 to 439B.875, inclusive, or the regulations adopted pursuant thereto. Any penalties for the failure to comply with the requirements of NRS 439B.840 or the regulations adopted pursuant to this section concerning the submission of data to the all-payer claims database must not exceed $5,000 for each day of such failure.

2. The Department may adopt:

(a) Regulations that require entities that provide health coverage in this State, in addition to the entities required by NRS 439B.840 but not including entities exempt from reporting pursuant to subsection 1 of that section, to upload data to the all-payer claims database; and

(b) Any other regulations necessary to carry out the provisions of NRS 439B.800 to 439B.875, inclusive.

3. The Department may:

(a) Enter into any contract or agreement necessary to carry out the provisions of NRS 439B.800 to 439B.875, inclusive; and

(b) Accept any gifts, grants and donations for the purpose of carrying out the provisions of NRS 439B.800 to 439B.875, inclusive.

4. Any contract or agreement entered into pursuant to paragraph (a) of subsection 3 must:

(a) Prohibit the contractor from collecting data containing direct patient identifiers or using data for any purpose not specified by the contract; and

(b) Require the contractor to:

(1) Obtain certification by the HITRUST Alliance or its successor organization and maintain such certification for the term of the contract;

(2) Comply with the requirements of subsection 2 of NRS 439B.845 to the same extent as the Department; and

(3) Comply with any applicable standards prescribed by the National Institute of Standards and Technology of the United States Department of Commerce.

5. Any money collected as administrative penalties under the regulations adopted pursuant to this section must be accounted for separately and used by the Department to:

(a) Carry out the provisions of NRS 439B.600 to 439B.695, inclusive, and 439B.800 to 439B.875, inclusive; and

(b) Establish and carry out programs to educate patients concerning ways to reduce the cost of health care and prescription drugs.

(Added to NRS by 2021, 3055)