Nac: Chapter 439A - Planning For The Provision Of Health Care

Link to law: http://www.leg.state.nv.us/nac/NAC-439A.html
Published: 2015

[Rev. 6/11/2014 10:30:27 AM]

[NAC-439A Revised Date: 6-14]

CHAPTER 439A - PLANNING FOR THE PROVISION

OF HEALTH CARE

GENERAL PROVISIONS

439A.010         Definitions.

439A.070         “Capital expenditure” defined.

439A.080         “Department” defined.

439A.090         “Director” defined.

439A.100         “Donation” defined.

439A.120         “Health facility” defined.

439A.130         “Health maintenance organization”

defined.

439A.150         “Health services” defined.

439A.180         “Hospital” defined.

439A.215         “Maximum capital expenditure”

defined.

439A.226         “New construction” defined.

439A.240         “Person” defined.

APPROVAL OF PROJECTS

Requirements Regarding Proposed Projects

439A.295         Determining when capital expenditure

is incurred by or on behalf of health facility.

439A.305         Letter of intent: General

requirements.

439A.315         Letter of intent: Action by

Department; termination.

439A.322         Submission of information to

Department.

439A.325         Projects for which approval

required.

439A.335         Conference with applicant.

439A.338         Capital expenditures for which

approval not required; determination of cost of new construction subject to

letter of approval.

 

Applications

439A.345         Availability and use of forms.

439A.355         Time for submission; limitation on

acceptance.

439A.365         Procedure for submission; fee;

acknowledgment of receipt.

439A.375         Amendment.

439A.379         Denial for insufficient information;

effect of acceptance.

439A.385         Batching applications for

comparative review.

 

Review of Applications for Approval

439A.389         Public notice.

439A.395         Submission of written information by

person other than applicant.

439A.405         Period of review; extension.

439A.415         Public hearings.

439A.435         Review of record for application.

439A.445         Decision of Director.

 

Approval

439A.455         Letter of approval or disapproval;

failure to accept letter of approval; public notice; reconsideration.

439A.465         Progress reports; requests for

information; access to project site and records.

439A.475         Extension of approved timetable.

439A.485         Transfer of interest.

439A.495         Removal or alteration of conditions.

439A.505         Withdrawal of letter of approval.

 

Procedural Matters

439A.515         Reconsideration of decisions.

439A.525         Judicial review.

439A.545         Provision of notice: Generally.

439A.555         Provision of notice: Hearings.

 

Criteria for Review of Proposed Projects

439A.595         Burden of proof; applicability.

439A.605         Need for project to be undertaken.

439A.625         Financial feasibility.

439A.635         Effect on cost of health services.

439A.637         Appropriateness for the area to be

served.

439A.639         Health maintenance organizations.

 

Miscellaneous Provisions

439A.645         Prohibited communications.

439A.655         Civil penalties.

439A.665         Applicable regulations.

439A.670         Waiver of procedural provisions.

439A.675         Reports by Department; access to

materials.

PHYSICIAN VISA WAIVER PROGRAM

439A.700         “Advisory Council” defined.

439A.710         Advisory Council: Creation;

composition; vacancies; meetings; appointment of subcommittee authorized.

439A.715         Advisory Council: Duties.

439A.720         Application for letter of support:

Requirements; request for waiver of portion of fees; where available.

439A.725         Application for letter of support:

Submission; review by Advisory Council; responsibilities of Administrator.

439A.730         Contract between employer and J-1

visa physician: Requirements; transfer to different employer; liquidated

damages.

439A.735         Employer: Duties.

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

requirements.

439A.745         Complaints: Submission;

investigation; determination of Administrator.

439A.750         Violations.

439A.755         Hearing.

PROGRAMS TO INCREASE AWARENESS OF INFORMATION CONCERNING

HOSPITALS AND SURGICAL CENTERS FOR AMBULATORY PATIENTS

439A.800         “Surgical center for ambulatory

patients” defined.

439A.810         Information concerning surgical

centers for ambulatory patients: Requirements for submission of information to

Department; confidential information.

439A.815         Information concerning surgical

centers for ambulatory patients: Request for extension of time for submission

of information.

439A.820         Information concerning surgical

centers for ambulatory patients: Notification by Department that information is

incomplete; effect of failure to submit complete information.

439A.825         Information concerning surgical

centers for ambulatory patients: Department to determine and make publicly

available list of 50 medical treatments for outpatients of surgical centers to

be included in program.

439A.830         Information concerning hospitals:

Department to determine and make publicly available lists of diagnosis-related

groups for inpatients of hospitals and 50 medical treatments for outpatients of

hospitals to be included in program.

439A.835         Internet website for information

concerning hospitals and surgical centers for ambulatory patients: Duties of

Department.

439A.840         Request for information.

 

 

GENERAL PROVISIONS

      NAC 439A.010  Definitions. (NRS 439A.081)  As used

in this chapter, unless the context otherwise requires, the words and terms

defined in NAC 439A.070 to 439A.240,

inclusive, have the meanings ascribed to them in those sections.

     (Supplied in codification; A by Dep’t of Human

Resources, 9-4-84; 3-6-86; 11-10-87; 1-2-90; 10-14-97)

      NAC 439A.070  “Capital expenditure” defined. (NRS 439A.081)  “Capital

expenditure” means any expenditure, made by or on behalf of a health facility

including the cost of predevelopmental activities, the encumbrance of funds,

leases, contractual agreements or donations for purposes which, under generally

accepted accounting principles, are not properly chargeable as an expense of

operation or maintenance, or both.

     [Dep’t of Human Resources, Health Facilities Reg. Art.

A § 7, eff. 5-13-82]—(NAC A 9-4-84)

      NAC 439A.080  “Department” defined. (NRS 439A.081)  “Department”

means the Department of Health and Human Services.

     [Dep’t of Human Resources, Health Facilities Reg. Art.

A § 8, eff. 5-13-82]

      NAC 439A.090  “Director” defined. (NRS 439A.081)  “Director”

means the Director of the Department.

     [Dep’t of Human Resources, Health Facilities Reg. Art.

A § 9, eff. 5-13-82]

      NAC 439A.100  “Donation” defined. (NRS 439A.081)  “Donation”

means a gift or free contribution which, if accepted, increases capital assets

by an amount which, under generally accepted accounting principles, would

normally require a review as a capital expenditure.

     [Dep’t of Human Resources, Health Facilities Reg. Art.

A § 10, eff. 5-13-82]

      NAC 439A.120  “Health facility” defined. (NRS 439A.081)  “Health

facility” has the meaning ascribed to it in NRS 439A.015.

     [Dep’t of Human Resources, Health Facilities Reg. Art.

A § 12, eff. 5-13-82]

      NAC 439A.130  “Health maintenance organization” defined. (NRS 439A.081)  “Health

maintenance organization” has the meaning ascribed to it in subsection 6 of NRS 695C.030.

     [Dep’t of Human Resources, Health Facilities Reg. Art.

A § 13, eff. 5-13-82]

      NAC 439A.150  “Health services” defined. (NRS 439A.081)  “Health

services” has the meaning ascribed to it in NRS 439A.017.

     [Dep’t of Human Resources, Health Facilities Reg. Art.

A § 15, eff. 5-13-82]

      NAC 439A.180  “Hospital” defined. (NRS 439A.081)  “Hospital”

has the meaning ascribed to it in NRS

449.012.

     [Dep’t of Human Resources, Health Facilities Reg. Art.

A § 18, eff. 5-13-82]

      NAC 439A.215  “Maximum capital expenditure” defined. (NRS 439A.081)  “Maximum

capital expenditure” means that amount specified in a letter of approval.

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

A 11-25-86)

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

construction” means:

     1.  Construction of a new health facility or

construction which increases the square footage in an existing health facility;

or

     2.  The redesign or renovation of an existing

building which is not currently being used as a health facility.

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

      NAC 439A.240  “Person” defined. (NRS 439A.081)  “Person”

means a natural person, trust, estate, partnership, corporation (including an

association, joint stock company and insurance company), state, political

subdivision or instrumentality or a legal entity recognized by the State.

     [Dep’t of Human Resources, Health Facilities Reg. Art.

A § 24, eff. 5-13-82]—(NAC A 9-4-84)

APPROVAL OF PROJECTS

Requirements Regarding Proposed Projects

      NAC 439A.295  Determining when capital expenditure is incurred by or on behalf

of health facility. (NRS 439A.081, 439A.100)

     1.  A capital expenditure is incurred by or

on behalf of a health facility:

     (a) When a contract, enforceable under state law,

is entered into by or on behalf of the health facility for the construction,

acquisition, lease or financing of a capital asset;

     (b) When the governing board of the health facility

takes formal action to commit money for a construction project undertaken by

the health facility as its own contractor; or

     (c) In the case of donated property, on the date on

which the gift is completed under applicable state law.

     2.  An obligation for a capital expenditure

which is contingent upon issuance of a letter of approval is not considered

incurred until the letter of approval is issued.

     3.  A capital expenditure is incurred by or

on behalf of a health facility if the capital expenditure:

     (a) Is required for providing health services in or

through the facility;

     (b) Is required for new construction; or

     (c) Will provide a direct benefit to the facility

substantially related to the health services to be offered in or through the

facility.

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

A 3-6-86; 10-14-97)

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

     1.  Any person who intends to initiate a

project that may be subject to review pursuant to NRS 439A.100 shall, before

incurring a capital expenditure for the project, submit to the Department a

letter of intent.

     2.  A letter of intent must be submitted on

and include the information required by the form prescribed for this purpose by

the Department or must include:

     (a) The identity of the applicant;

     (b) The proposed location of the project;

     (c) A description of the proposed project which

identifies any facility, medical equipment or health service to be included;

     (d) The estimated date of completion of the

proposed project, including a summary and schedule of anticipated future phases

of construction within the proposed project;

     (e) The total estimated costs of the project,

including:

          (1) The total estimated capital expenditures;

          (2) All other costs of the project, including,

without limitation, the cost for:

               (I) The development of the site;

               (II) A contingency plan for an amount

which must be at least 10 percent of the total cost of the project;

               (III) Architecture and engineering;

               (IV) Furniture, fixtures and equipment;

and

               (V) Major medical equipment; and

          (3) The portion of estimated capital

expenditures which is related to new construction; and

     (f) A copy of a written estimate of the cost of

construction of the proposed project, by major cost categories, from an

architect or contractor.

     3.  The Department will determine, pursuant

to NAC 439A.315, whether a proposed project is

subject to review.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

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

     1.  The Department will, within 15 days after

the receipt of a letter of intent, determine whether the proposed project is

subject to review.

     2.  If the Department determines that the

proposed project would violate any condition imposed by a previously issued

letter of approval, the Department will notify the applicant that the proposed

project will not be considered until the condition is removed pursuant to NAC 439A.495.

     3.  The Department will notify the applicant

by mail of its decision. If the proposed project is subject to review, the

notice will include the date by which an application must be submitted.

     4.  A letter of intent is considered no

longer in effect if an application is not submitted to the Department by the

date specified in the notice issued pursuant to subsection 3 of this section.

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

A 3-6-86; 11-10-87; 10-14-97)

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

     1.  Any person who wishes to undertake a

project listed in subsection 1 of NRS

439A.100 shall provide the Department with the information required by

paragraphs (a) to (e), inclusive, of subsection 2 of NAC

439A.305.

     2.  The Department will maintain a file

containing the information submitted pursuant to this section.

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

A 1-2-90; 10-14-97)

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

     1.  For projects subject to review pursuant

to subsection 1 of NRS 439A.100,

the amount specified for the capital expenditure, as adopted by the Department,

is $2,000,000.

     2.  Pursuant to subsection 4 of NRS 439A.100, additional approval

must be obtained before any change may be made to a previously approved project

if the proposed change would result in:

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

     (b) A substantial increase in the maximum capital

expenditure.

     3.  An acquisition by donation, lease,

transfer or comparable arrangement requires approval if the acquisition would

be subject to review pursuant to subsection 1 if made by purchase. An

acquisition for less than fair market value requires a letter of approval if

the acquisition would be subject to review pursuant to subsection 1 if made at

fair market value. The Department will require an appraisal if it appears that

the acquisition was or will be for less than fair market value.

     4.  A person shall not, in order to evade the

scope of review pursuant to this section, divide a single project into separate

components which are so interdependent or interrelated that they should not be

undertaken separately. In determining whether a project is properly separable,

the factors to be considered include:

     (a) The physical location of the respective

components;

     (b) The functional independence of each component;

     (c) The separate and distinct capital expenditures

involved; and

     (d) The time required for initiation and completion

of each component.

     5.  Any new construction proposed to be

undertaken within 2 years after the completion of any prior new construction,

regardless of whether that prior new construction required a letter of intent

or letter of approval, must have:

     (a) A letter of intent; and

     (b) A letter of approval, if the combined capital

expenditure for the prior new construction and proposed new construction is

more than $2,000,000 and the projects are not found to be properly separated

pursuant to subsection 4.

     6.  As used in this section, “fair market

value” includes all costs associated with the acquisition of a facility,

whether the facility is acquired by lease, rental agreement, donation,

contractual agreement, purchase or any method of financing or encumbrance of

money.

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

A 3-6-86; 11-25-86; 11-10-87; 1-2-90; 10-14-97)

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

     1.  If a proposed project is subject to

review, the Department will schedule a conference with the applicant, which

will be held not later than 15 days after the date on which the letter of

determination has been mailed in response to the letter of intent.

     2.  Before or at the conference, the

Department will provide the applicant with the following information and

materials:

     (a) A copy of the form for application and any

applicable regulations and statutes;

     (b) Instructions for completing the form; and

     (c) Notice of the applicable guidelines and other

data which will be used by the Department in the review of the application.

     3.  At the conference, the Department will

discuss with the applicant the information and materials provided the applicant

pursuant to this section and the procedure and schedule for the review.

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

A 3-6-86; 11-10-87; 10-14-97)

      NAC 439A.338  Capital expenditures for which approval not required; determination

of cost of new construction subject to letter of approval. (NRS 439A.081, 439A.100)

     1.  The provisions of subsection 1 of NRS 439A.100 are applicable only

to a project which is not dependent on or related to a larger single project.

     2.  The cost for construction in which no new

square footage is added is not subject to a letter of approval. The cost of

construction related to the existing space must be deducted from the total

capital expenditure to determine the cost of the new construction subject to a

letter of approval.

     3.  The cost of construction attributed to

space for a medical office building or an office for a health practitioner to

be used solely to provide routine health services as defined in NRS 439A.017 must be

deducted from the total capital expenditures to determine the cost of new

construction subject to a letter of approval.

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

A 1-2-90; 10-14-97)

Applications

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

     1.  The Department will keep on file and make

available to any person copies of its current forms for applications.

     2.  All applications must be submitted in the

form prescribed by the Department and must adequately address all questions and

supply all information applicable to the proposed project and necessary to

enable the Director to make a decision regarding the project.

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

A 3-6-86; 1-2-90)

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

     1.  For a project that is subject to the

provisions of NRS 439A.100, an

application must be received by the Department no later than 60 days after the

date on which the letter of determination is mailed in response to the letter

of intent.

     2.  The Director will not accept an

application for a letter of approval if it is submitted to fulfill a need

beyond the fifth calendar year after the calendar year in which the application

is submitted for review.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

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

     1.  The original and three copies of an

application for a letter of approval must be submitted by mail or delivered by

hand to the Department.

     2.  Each application submitted to the

Department must be accompanied by a nonrefundable fee of $9,500. The fee must

be paid by cashier’s check made payable to the order of the Department of

Health and Human Services.

     3.  The Department will acknowledge receipt

of an application and accompanying fee:

     (a) For applications delivered by hand, by a

receipt issued to the deliverer at the time of delivery; or

     (b) For applications received through the mail, by

mail within 5 working days after the date of receipt.

Ê Receipt will

be acknowledged on a form of receipt prescribed by the Department.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

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

     1.  An applicant shall not materially amend

its application for a letter of approval after the deadline for its submission.

A material amendment is a ground for denial of such an application, and

includes:

     (a) A substantial change in the identity of the

applicant;

     (b) A substantial change in the proposed location

of the project;

     (c) A change in the number of beds included in the

project;

     (d) A substantial change in the health services to

be provided; or

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

the project.

     2.  Information furnished by an applicant

before the deadline specified in NAC 439A.395 in

response to specific questions from the Department does not constitute a

material amendment, even if the information is different from that provided in

the application, unless the additional information increases the size or scope

of the proposed project.

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

A 3-6-86; 11-10-87; 1-2-90)

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

     1.  Upon receipt of an application for a

letter of approval, the Department will examine the application. If the

application does not contain information sufficient to enable the Director to

review the project, the Director will issue a letter of denial within 15 days

after the deadline for submission of the application. The letter of denial will

list the reasons why the application is insufficient and constitutes the final

decision regarding the application.

     2.  An application for a letter of approval

is considered insufficient only if the applicant has substantially failed to

include the information required on the form.

     3.  The acceptance of such an application by

the Department does not constitute a determination that the applicant has

provided sufficient information to satisfy its burden of proof regarding the

applicable criteria for review or that the application complies with all of the

provisions of NAC 439A.295 to 439A.675, inclusive, and is not a waiver of those

provisions.

     (Added to NAC by Dep’t of Human Resources, eff. 3-6-86;

A 11-10-87; 1-2-90)

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

     1.  After the deadline for submission as set

forth in subsection 1 of NAC 439A.355, the

Department will determine whether any applications which are not denied for

insufficiency pursuant to NAC 439A.379 will be

batched for comparative review pursuant to paragraph (a) of subsection 3 of NRS 439A.100.

     2.  An application which involves more than

one type of project or service may be placed in more than one batch.

     3.  Notice of the batching of an application

will be made pursuant to NAC 439A.389.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

Review of Applications for Approval

      NAC 439A.389  Public notice. (NRS 439A.081)  For each

application for approval which is received before the deadline for submission

and which is not denied for insufficiency pursuant to NAC

439A.379, the Department will, within 15 days after the application is

submitted, give public notice of:

     1.  The identity of the applicant;

     2.  The nature of the proposed project;

     3.  The batch, if any, in which the

application is placed;

     4.  The date of commencement of the period of

review;

     5.  The date, time and place of the public

hearing to be held during the course of the review; and

     6.  The date by which written information

must be submitted pursuant to NAC 439A.395.

     (Added to NAC by Dep’t of Human Resources, eff. 3-6-86;

A 11-10-87; 10-14-97)

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

(NRS

439A.081)  Any

person may submit written information regarding an application for a letter of

approval to the Department if the information is received by the Department at

least 10 days before the date of the public hearing.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

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

     1.  The period of review of an application

for a letter of approval commences on the date on which the application is

received by the Department.

     2.  The public hearing will be held no later

than 45 days after the commencement of the period of review.

     3.  The Director will issue a decision

regarding the application within 30 days after the close of the public hearing.

     4.  The Director will extend the period of

review for up to 15 days if he or she determines that it is not practicable to

render a decision within the scheduled period as a result of:

     (a) The availability of and the amount of work for

the employees of the Department who are responsible for conducting the review;

or

     (b) A circumstance or condition beyond the control

of the Department.

     5.  Notice of any extension will be mailed to

each affected applicant.

     6.  An application is not considered approved

or denied solely because the Director failed to render a timely decision.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

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

     1.  The Department will provide a public

hearing for each application for a letter of approval.

     2.  A single public hearing will be held for

all applications within a single batch.

     3.  The Department will keep a taped record

of the public hearing, together with all exhibits introduced.

     4.  The purposes of the public hearing are:

     (a) To provide for public comment on the

application; and

     (b) To receive evidence from the applicant and

those persons who have submitted written information pursuant to NAC 439A.395 regarding material issues and to

consider questions from the Department.

     5.  The Department will, at least 5 days

before the date of the hearing, notify the applicant and those persons who have

submitted written information of the procedures to be followed at the public

hearing.

     6.  The amount of time allocated to each

applicant or person for presenting evidence may be limited if that limitation

is equally applied to all applicants or persons.

     7.  Any person at the public hearing is

entitled to be represented by counsel.

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

A 3-6-86; 11-10-87; 1-2-90)

      NAC 439A.435  Review of record for application. (NRS 439A.081)  The

Director will review the Department’s record for each application for a letter

of approval. The record must include:

     1.  The application, together with any

supporting documents;

     2.  The record of the public hearing; and

     3.  The official records of the Department

pertaining to the application.

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

A 3-6-86; 11-10-87; 1-2-90)

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

     1.  The decision of the Director relating to

an application for a letter of approval will be supported by written findings

of fact which must include:

     (a) Whether a need for the proposed project exists

in the community;

     (b) Whether the proposed project is financially

feasible;

     (c) The effect of the proposed project on the cost

of health care; and

     (d) The appropriateness of the proposed project in

the community.

     2.  If the Director approves a proposed

project subject to specified conditions, the conditions must be directly

related to the proposed project and to the criteria used for review.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

Approval

      NAC 439A.455  Letter of approval or disapproval; failure to accept letter of

approval; public notice; reconsideration. (NRS 439A.081, 439A.100)

     1.  In connection with an application made

pursuant to NRS 439A.100, the

Director will issue to each applicant a letter of approval or disapproval,

together with a copy of the written findings of fact issued pursuant to NAC 439A.445. This letter is the official document

permitting or denying the applicant’s project.

     2.  A letter of disapproval will contain the

reasons for denial.

     3.  A letter of approval will contain:

     (a) A timetable for the project, including a

specific date by which the proposed facility must be made available for

receiving patients or providing services;

     (b) The maximum capital expenditure for the

project;

     (c) The specific location of the project;

     (d) The specific health services and the number of

beds identified in the application;

     (e) Notice of the requirement that, within 30 days

after the date of publication of the decision, the applicant must file with the

Department its written acceptance of the decision; and

     (f ) Each

condition placed on the approval which is directly related to the proposed

project and the criteria for review.

     4.  The applicant’s failure to accept the

letter of approval within 30 days after the date of publication of the decision

cancels the letter of approval, and the project may be reinstated only by a new

application and review.

     5.  Public notice of the decision of the

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

     6.  The period during which a reconsideration

of the decision of the Director must be requested begins on the date on which

the notice of the decision first appears in a newspaper of general circulation.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

      NAC 439A.465  Progress reports; requests for information; access to project

site and records. (NRS 439A.081)

     1.  The holder of a letter of approval shall

provide the Department with quarterly progress reports, beginning with the

first calendar quarter following the issuance of the letter of approval and due

no later than 30 days after the end of the quarter. Each progress report must

include all of the following:

     (a) The date of commencement of the project;

     (b) The extent of progress made in complying with

the approved timetable, including:

          (1) All deadlines which have passed; and

          (2) Whether the required activity met the

deadline;

     (c) Any financial arrangements which differ from

those originally approved, including a detailed description of, and the reason

for, each difference;

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

     (e) A revised estimate of the total project cost,

including a detailed description and explanation of the differences, if any,

between the revised cost and that originally approved;

     (f ) All

the steps taken to ensure compliance with each applicable condition;

     (g) The material changes in the project, including

a detailed description and explanation of each change; and

     (h) The projected date of completion of the

project.

     2.  The Department may, from time to time,

request in writing such additional information as is necessary to determine

whether the holder of a letter of approval is complying with the letter of

approval.

     3.  The holder of a letter of approval will

have 20 working days from his or her receipt of a request for information from

the Department to submit the required information in writing. Failure to

respond within this period may constitute grounds for the Department to

initiate withdrawal proceedings pursuant to NAC

439A.505.

     4.  The holder of a letter of approval must

provide access to the project site and all project records to the Department’s

staff for examination and inspection in order to verify compliance with the

letter of approval and any information submitted by the holder of the letter of

approval.

     5.  The provision of information through

progress reports required by the Department will not be construed or

interpreted as an application for extension pursuant to NAC

439A.475 or the notification required pursuant to NAC

439A.305.

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

A 11-10-87; 1-2-90; 10-14-97)

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

     1.  A letter of approval is subject to

withdrawal pursuant to NAC 439A.505 if the

approved timetable is not met by the holder of the letter of approval, unless

an extension is granted by the Department pursuant to this section.

     2.  An extension will be granted only if the

applicant manifests an intention to complete the project and demonstrates that

good and sufficient reasons exist for its failure to meet the timetable. Good

and sufficient reasons include delays caused by:

     (a) Litigation;

     (b) The actions of a regulatory agency other than

the Department; or

     (c) An event determined by the Department to be

beyond the control of the holder of the letter of approval.

     3.  Except as otherwise provided in

subsection 4, a request for an extension must be submitted to the Department at

least 90 days before the required date of completion of the project. The

request must contain information setting forth the reasons for noncompliance

with the timetable and the extent of the progress toward completion of the

project.

     4.  A request for an extension of a letter of

approval which is submitted less than 90 days before the required date of

completion of the project will not be accepted unless the applicant can

demonstrate to the satisfaction of the Department that unforeseen occurrences

prevented a timely submission.

     5.  Within 20 working days after receipt of

the request, the Director will determine whether or not to grant an extension.

     6.  If the decision is to grant an extension,

the Director will issue a letter of extension to the holder of the letter of

approval, which will contain:

     (a) The reasons for granting the extension; and

     (b) A revised timetable for the project, including

a revised date of completion for the project.

     7.  If an extension is not granted,

proceedings to withdraw the letter of approval may be initiated pursuant to NAC 439A.505.

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

A 3-6-86)

      NAC 439A.485  Transfer of interest. (NRS 439A.081)

     1.  A person shall not sell, purchase,

assign, grant or otherwise transfer or convey in any manner any interest in a

letter of approval or a proposed project without first obtaining the written

approval of the Director.

     2.  A written request for the approval of any

transfer must be submitted to the Director by the holder of the letter of

approval and must include:

     (a) The identity and, if other than a natural

person, the organizational structure of the person who will acquire the

interest;

     (b) All facts and materials relating to the

proposed transaction;

     (c) Copies of all legal documents required to be

executed by the parties in order to effect the transfer; and

     (d) A statement signed by the person who will

acquire the interest manifesting an intent to complete the project and agreeing

to be bound by each condition of the letter of approval.

     3.  Upon the request of the Director, any of

the parties involved in the proposed transaction shall submit additional

information:

     (a) Regarding their financial interest in the

transaction or the proposed project;

     (b) Regarding any changes in the project or the

cost of or charges for the proposed services resulting from the proposed

transaction; and

     (c) Which the Director determines is relevant to

the transaction or the proposed project.

     4.  The Director will determine the effect of

the proposed transaction on the project.

     5.  Approval of a transfer of interest

requested pursuant to this section will be denied only if the Director determines:

     (a) That approval would have an adverse effect on

the project; or

     (b) That the proposed transaction would result in a

transfer of more than 49 percent, in the aggregate, of the interest in the

project.

     6.  The Director will issue to the holder of the

letter of approval a written decision approving or disapproving the transaction

and setting forth the reasons for his or her decision.

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

A 3-6-86; 1-2-90; 10-14-97)

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

     1.  A person whose project has been approved

subject to conditions may request the Director to remove or alter those

conditions. The request must be submitted to the Director in writing and must

include:

     (a) A statement of each condition which is

requested to be removed or altered; and

     (b) For each such condition, specific

identification and documentation of the current factors which:

          (1) Were not in existence at the time of

imposition of the condition; and

          (2) Might warrant the removal or alteration of

the condition.

     2.  Within 30 days after receipt of such a

written request the Department will schedule and give notice of a public

hearing.

     3.  Within 15 days after the close of the

public hearing, the Director will make a decision and a letter signed by the

Director containing the decision and the reasons therefor will be issued to the

person whose project has been approved.

     4.  The Director will give public notice of

the decision.

     5.  The procedures of this section also apply

to the additional approval of a proposed change in the location of or an

increase in the maximum capital expenditure for an approved project.

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

A 3-6-86; 11-25-86)

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

439A.100)

     1.  Proceedings to withdraw a letter of

approval may be initiated if the holder:

     (a) Fails to meet the approved timetable set forth

in the letter of approval or an extension thereof;

     (b) Fails to comply with subsection 4 of NRS 439A.100 when a change

requiring additional approval has occurred;

     (c) Fails or prospectively fails to meet any

condition imposed by the letter of approval;

     (d) Fails to execute the project as approved in the

letter of approval;

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

     (f ) Violates

the provisions of NAC 439A.465 regarding reports

on progress, submission of information or access for inspection and

examination; or

     (g) Substantially, willfully or intentionally fails

to comply with any other material provision of NAC

439A.295 to 439A.675, inclusive, related to

the letter of approval.

     2.  If the Director determines that he or she

has sufficient cause to initiate a proceeding for the withdrawal of a letter of

approval, the Director will notify by certified mail the holder of the letter

of approval of his or her intention to initiate proceedings for withdrawal. The

notice will state in writing the reasons for the proposed withdrawal.

     3.  The Department will schedule and give

public notice of a public hearing for a withdrawal.

     4.  The letter of approval is suspended upon

the holder’s receipt of the notice of the public hearing for the withdrawal of

the letter of approval. The suspension is effective until the proceeding for

withdrawal is terminated or completed.

     5.  The holder of the letter of approval has

30 days from the date of receipt of the notification specified in subsection 2

in which to submit to the Director in writing any relevant documentation

negating the reasons for the proposed withdrawal.

     6.  The Director will, within 15 days after

the deadline for providing the information specified in subsection 2, determine

whether the information provided by the holder of the letter of approval

adequately negates the reasons for the proposed withdrawal.

     7.  If the Director determines that the

holder of the letter has provided sufficient relevant information to negate the

reasons for the proposed withdrawal, the Director will terminate the proceeding

for withdrawal and inform the holder of the letter of approval of the decision

by mail.

     8.  If the holder of a letter of approval

fails to negate adequately the reasons for the proposed withdrawal, the

Director will proceed with the public hearing for a withdrawal.

     9.  The decision of the Director will be made

within 15 days after the close of the public hearing. A letter containing the

decision and stating the reasons therefor, signed by the Director, will be

issued to the holder of the letter of approval together with written findings

of fact.

     10.  The Director will give public notice of

the decision.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

Procedural Matters

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

     1.  Any person:

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

     (b) Whose project has been determined to be subject

to review pursuant to NAC 439A.315; or

     (c) Whose letter of approval has been withdrawn

pursuant to NAC 439A.505,

Ê may request

reconsideration of the decision.

     2.  A request for reconsideration will be

considered by the Director only if:

     (a) It is submitted in writing within 30 days after

the first date of publication in a newspaper of general circulation the notice

of the decision for which the reconsideration is being requested; and

     (b) It contains sufficient and adequate

documentation of good cause for a reconsideration, which is limited to:

          (1) The presentation of significant

information relevant to a material issue which was not previously considered by

the Director and which, with reasonable diligence, could not have been

presented to the Director before the conclusion of the public hearing;

          (2) A significant change in a factor or

circumstance relied upon by the Director in reaching the decision; or

          (3) A showing that the Department has

materially failed to follow its procedures in reaching the decision.

     3.  The Director will, within 15 days after

receipt of a request for reconsideration, determine whether good cause is shown

as required under subsection 2.

     4.  If the request for reconsideration is

denied, the Director will issue a letter to the person requesting the

reconsideration stating the reasons for denial.

     5.  If the request for reconsideration is

granted, the affected decision is set aside and the Director will issue a

letter to the person requesting the reconsideration and the applicant or holder

of the letter of approval stating the reasons for granting the request.

     6.  If the Director requests additional

information in the letter issued pursuant to subsection 5, the person receiving

the request has 15 days from the date of receipt to submit the information

requested.

     7.  The Department will, within 15 days after

the date on which reconsideration is granted, schedule and give public notice

of a public hearing.

     8.  The public hearing may be waived upon a

written request by the applicant or holder of the letter of approval if:

     (a) The applicant or holder of the letter of

approval is the only person requesting reconsideration; and

     (b) The sole ground for the reconsideration is that

the Department failed to follow the adopted procedures.

Ê If the public

hearing is waived pursuant to this subsection, public notice of the

reconsideration will be given.

     9.  The person requesting reconsideration

shall appear at the public hearing personally or by a representative. If that

person fails to appear, the hearing will not be held and the decision for which

reconsideration was requested will be reinstated.

     10.  The decision of the Director will be

issued to the applicant or holder of a letter of approval in a letter signed by

the Director stating the reasons for the decision, together with written

findings of fact, within 30 days after:

     (a) The close of the public hearing; or

     (b) The date of the granting of the request for

reconsideration if the public hearing is waived pursuant to subsection 8.

     11.  The Director will give public notice of

the decision upon reconsideration.

     12.  The decision of the Director upon

reconsideration supersedes the original decision.

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

A 3-6-86; 11-10-87)

      NAC 439A.525  Judicial review. (NRS 439A.081)  A

decision of the Director subject to reconsideration is a final decision for

judicial review and a request for reconsideration is not a prerequisite for

judicial review.

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

A 3-6-86)

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

     1.  Unless otherwise required in NAC 439A.295 to 439A.675,

inclusive, notice given pursuant to NAC 439A.295

to 439A.675, inclusive, will be made in accordance

with this section.

     2.  Notice will be provided by mail to:

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

approval;

     (b) The person requesting the proceeding for which

the notice of the proceeding or the resulting decision is being given; and

     (c) All persons who have requested in writing that

they be placed on a mailing list for this purpose.

     3.  The notice will be provided to the public

and all other interested persons by publication in a newspaper of general

circulation in the area in which the project is located or will be located.

     4.  For decisions relating to a letter of

intent or a letter of determination, the Department will provide the notice

required by this section not later than 21 days after such a decision is made.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

      NAC 439A.555  Provision of notice: Hearings. (NRS 439A.081)

     1.  When a notice of a public hearing is made

pursuant to NAC 439A.295 to 439A.675, inclusive, the notice will include:

     (a) The date of the public hearing;

     (b) The time and place of the hearing;

     (c) The nature of the hearing;

     (d) A statement of the legal authority and

jurisdiction under which the hearing is to be held;

     (e) A reference to the particular sections of state

statutes and regulations involved; and

     (f) A short and plain statement of the matters to

be asserted.

     2.  In the case of a hearing for

reconsideration of a decision, the notice will be published in two successive

issues of a newspaper of general circulation.

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

A 3-6-86)

Criteria for Review of Proposed Projects

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

     1.  The applicant for a letter of approval

has the burden of proof to satisfy all applicable criteria for review contained

in NAC 439A.605 to 439A.637,

inclusive.

     2.  A finding that the applicant has failed

to meet its burden of proof regarding an applicable criterion will be made if:

     (a) The applicant fails to provide sufficient,

relevant, demonstrative evidence for a favorable determination; or

     (b) The evidence on the record opposing the application

outweighs the evidence in support of the application regarding the criterion.

     3.  The criteria for review are applicable to

a proposed project if the project includes the construction or establishment of

a facility to provide health services, except for a facility which will be used

solely for the offices of practitioners of health care.

     4.  If an application is denied on the basis

of these criteria, the written findings of fact must clearly state the reason

for that denial.

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

A 3-6-86; 11-10-87; 1-2-90; 10-14-97)

      NAC 439A.605  Need for project to be undertaken. (NRS 439A.081)  The

applicant shall demonstrate that the population to be served has a need for the

project to be undertaken, based upon:

     1.  The identification of the population to

be served;

     2.  The projected numbers of persons who will

have a need for the proposed service; and

     3.  A showing that the existing providers of

the proposed service in the area cannot or will not meet the projected need of

the population to be served.

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

A 3-6-86; 11-10-87)

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

     1.  The applicant shall demonstrate that it

will be able to operate in a manner which is financially feasible as a result

of the proposed project without unnecessarily increasing the cost to the user

or payor for health services provided by the applicant, by showing:

     (a) That it will become financially self-supporting

within 3 years after completion; or

     (b) That the applicant’s total facility will be

financially self-supporting within this period or that the financial viability

of the facility will not be adversely affected by the proposed project.

     2.  The factors to be considered in

determining whether an applicant has met its burden of proof include:

     (a) The ability of the applicant to obtain any

required financing for the proposed project;

     (b) The extent to which the proposed financing may

adversely affect the financial viability of the applicant’s facility because of

its effect on the long-term and short-term debt of the applicant;

     (c) The availability and degree of commitment to

the applicant of the financial resources required to operate the proposed

project until the project or the applicant’s facility becomes financially

self-supporting;

     (d) The relationship between the applicant’s estimated

costs of operation, proposed charges and estimated revenues;

     (e) The level at which the affected health services

of the applicant must be used for the applicant to break even financially and

the likelihood that those levels will be achieved;

     (f ) Whether

the applicant’s projected costs of operation and charges are reasonable in

relationship to each other and to the health services provided by the

applicant; and

     (g) Whether the projected revenues to be received

by the applicant are likely to be achieved, including the availability of

anticipated revenues from federal, state or local governmental programs if the

applicant will be eligible for reimbursement from those programs.

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

A 3-6-86; 11-10-87)

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

     1.  The applicant shall demonstrate that the

proposed project will not have an unnecessarily adverse effect on the cost of

health services to users or payors by showing that:

     (a) The proposed project will result in a

significant savings in costs to users or payors without an adverse effect on

the quality of care; or

     (b) If the proposed project will not result in a

significant savings in costs to the user or payor for health services, the

costs of the service are justified by:

          (1) A clinical or operational need;

          (2) A corresponding increase in the quality of

care; or

          (3) A significant reduction in risks to the

health of the patients to be served by the applicant.

     2.  The factors to be considered in

determining whether the applicant has met its burden of proof include:

     (a) The added costs to the applicant resulting from

any proposed financing for the proposed project;

     (b) If the proposed project involves construction,

remodeling or renovation, the relationship between the projected costs of that

activity and the prevailing cost for similar construction, remodeling or

renovation in the area;

     (c) The health or other benefits to be received by

users compared to the cost to users or payors resulting from the proposed

project; and

     (d) Whether alternative methods of providing the

proposed service exist or are available which provide a greater benefit for the

cost without adversely affecting the quality of care.

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

A 3-6-86; 11-10-87)

      NAC 439A.637  Appropriateness for the area to be served. (NRS 439A.081, 439A.100)  In

determining whether the proposed project is appropriate for the area to be

served, the Director will consider:

     1.  The location of the proposed project,

including:

     (a) The time for travel and distance to other

facilities for required transfers of patients or transfers in the event of an

emergency;

     (b) The distance and the time for travel required

for the population to be served to reach the applicant’s facility and other

facilities providing similar services; and

     (c) The nature of and requirements for zoning for

the area surrounding the proposed location of the project.

     2.  The effect of the proposed project on the

cost and quality of care provided by the existing system of health care in the

area, based upon the extent to which:

     (a) The proposed project is likely to stimulate

competition which will result in a reduction in costs for the user or payor;

     (b) The proposed project is likely to increase

costs to the user or payor through reductions in market shares for services if

those reductions would increase costs per unit of service; and

     (c) The proposed project contains innovations or

improvements in the delivery or financing of health services which will

significantly reduce the cost of health care to the user or payor or enhance

the quality of care.

     3.  If the proposed project involves the

relocation of a health facility or the relocation of an existing service to

another health facility, whether the need of the population currently being

served will continue to be met.

     4.  Whether the proposed project is

consistent with the existing system of health care, based upon:

     (a) The effect of the proposed project on the

availability and the cost in the area of the required personnel; and

     (b) The extent to which the applicant will have

adequate arrangements for referrals to and from other health facilities in the

area which provide for:

          (1) Avoidance of unnecessary duplication of

effort;

          (2) Regionalization of highly specialized

health services;

          (3) Comprehensive and continuous care of

patients; and

          (4) Communication and cooperation between

related facilities or services.

     5.  The quality of care provided by the

applicant for any existing health facility or service owned or operated by the

applicant, based upon:

     (a) Whether the applicant has had any adverse

action taken against it with regard to any license or certificate held by the

applicant and the results of that action;

     (b) The extent to which the applicant has

previously provided similar health services; and

     (c) Any additional evidence in the record regarding

the applicant’s quality of care.

     6.  The extent to which equal access by all

persons in the area to the applicant’s facility or services will be provided,

based upon:

     (a) Whether any segment of the population in the

area to be served will be denied access to health services similar to those

proposed by the applicant as a result of the proposed project;

     (b) The extent to which the applicant will provide

uncompensated care, exclusive of bad debt, and the effect of the proposed

project on the cost to local and state governments and other facilities for

providing care to indigents; and

     (c) The extent to which financial barriers to

access by persons of low income, including any financial preconditions to

providing service, will prevent those persons from obtaining needed health

services.

     (Added to NAC by Dep’t of Human Resources, eff. 3-6-86;

A 11-10-87; 10-14-97)

      NAC 439A.639  Health maintenance organizations. (NRS 439A.081, 439A.100)  If the

applicant is a health maintenance organization or the applicant proposes to

provide a service only to a health maintenance organization, in addition to the

criteria established in NAC 439A.595 to 439A.637, inclusive, the applicant must demonstrate

that the proposed service is necessary to meet the needs of enrolled members

and a reasonable number of anticipated members of the organization, based upon:

     1.  The identification of the special needs;

     2.  The number of enrolled members; and

     3.  The number of new members anticipated

within the next year.

     (Added to NAC by Dep’t of Human Resources, eff. 3-6-86;

A 11-10-87; 10-14-97)

Miscellaneous Provisions

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

     1.  Communication concerning the subject

matter of a hearing held pursuant to NAC 439A.295

to 439A.675, inclusive, is prohibited between:

     (a) Any person acting on behalf of the applicant or

holder of a letter of approval, or any person opposed to the issuance of or in

favor of the withdrawal of a letter of approval; and

     (b) Any person in the Department who exercises any

responsibility concerning the application or its withdrawal, from the date of

commencement of the public hearing until the decision on the subject matter of

the hearing is rendered.

     2.  This prohibition includes any oral or

written communication not on the public record, with respect to which

reasonable prior notice to all parties is not given, not including requests for

status reports on reviews being conducted.

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

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

     1.  Any penalty imposed pursuant to paragraph

(a) of subsection 1 of NRS

439A.310 must be paid before the issuance of any license. The failure to

pay a penalty is a ground for denial of an application for a letter of approval

or withdrawal of a letter of approval.

     2.  If the Director determines that a person

is subject to a penalty pursuant to NRS

439A.310, the Director will, before the imposition of the penalty:

     (a) Afford the person a hearing to show cause why a

penalty should not be imposed; and

     (b) Send to the person, at least 20 days before the

hearing, notice of the violation and hearing, which includes:

          (1) The specific violation for which the

Director proposes to impose a penalty, including a specific citation to the

provision which is alleged to have been violated;

          (2) The specific amount of the proposed

penalty for each specified violation;

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

hearing; and

          (4) A statement of the rights of the person

pursuant to chapter 233B of NRS.

     3.  The Director or a designee thereof will

serve as the hearing officer and will render a decision no later than 10

working days after the close of the hearing.

     4.  The decision of the hearing officer will

be made in writing and will include written findings of fact upon which the

decision was based.

     5.  Notice of the decision will be provided

to the person by mail.

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

A 3-6-86)

      NAC 439A.665  Applicable regulations. (NRS 439A.081)  The

regulations in effect at the time of the acceptance of the application for

review by the Department will be the regulations governing the entire

administrative process for the application.

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

A 3-6-86)

      NAC 439A.670  Waiver of procedural provisions. (NRS 439A.081)  The

Department may waive or alter any procedural provision of NAC 439A.295 to 439A.675,

inclusive, if the intent of that provision would not be carried out by its

strict application.

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

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

     1.  The Department will prepare and publish a

report at least annually indicating the status of all applications and the

decisions made on applications since the previous report.

     2.  The public will have access to all

applications and other written materials pertaining to NAC

439A.295 to 439A.675, inclusive, except for

materials which are required by law to be made confidential.

     3.  The Department may provide copies of

materials requested pursuant to this section upon reimbursement for the costs

of providing the copies.

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

A 1-2-90)—(Substituted in revision for NAC 439A.565.)

PHYSICIAN VISA WAIVER PROGRAM

      NAC 439A.700  “Advisory Council” defined. (NRS 439A.170, 439A.175)  As used

in NAC 439A.700 to 439A.755,

inclusive, unless the context otherwise requires, “Advisory Council” means the

Primary Care Advisory Council created by NAC 439A.710.

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

      NAC 439A.710  Advisory Council: Creation; composition; vacancies; meetings;

appointment of subcommittee authorized. (NRS 439A.170, 439A.175)

     1.  The Primary Care Advisory Council is

hereby created within the Division of Public and Behavioral Health. The

Advisory Council consists of members appointed by the Administrator as follows:

     (a) One member who represents the Great Basin

Primary Care Association, or a successor organization;

     (b) One member who represents a federally qualified

health center in this State;

     (c) One member who represents the Nevada Office of

Rural Health within the University of Nevada School of Medicine;

     (d) One member who is a physician licensed in good

standing pursuant to chapter 630 of

NRS and who has successfully completed an employment contract under the

Program;

     (e) One member who represents the Nevada State

Medical Association, or its successor organization;

     (f) Members who are health care professionals; and

     (g) Representatives from the communities being

served by the Program.

     2.  In addition to the members appointed

pursuant to subsection 1, the Administrator may appoint nonvoting members from

the Division of Public and Behavioral Health or other governmental agencies who

have knowledge of and experience in health care and the Program.

     3.  Each member of the Advisory Council

serves for a term of 2 years. A member may be reappointed.

     4.  If a vacancy occurs during the term of a

member, the Administrator shall appoint a person similarly qualified to replace

that member for the remainder of the unexpired term.

     5.  The Advisory Council shall meet at least

once each calendar quarter and at such other times as specified by a call of

the Chair.

     6.  At the first meeting, and annually

thereafter, the Advisory Council shall select a Chair from among its members.

     7.  The Chair of the Advisory Council may

appoint a subcommittee to review applications, complaints and policies and

procedures of the Program and make recommendations to the Advisory Council.

     8.  As used in this section, “federally

qualified health center” has the meaning ascribed to it in 42 U.S.C. §

1396d(l)(2)(B).

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

      NAC 439A.715  Advisory Council: Duties. (NRS 439A.170, 439A.175)  The

Advisory Council shall review and make recommendations to the Administrator

concerning:

     1.  The approval or denial of applications

for letters of support filed with the Administrator pursuant to NAC 439A.725.

     2.  The disposition of complaints submitted

to the Program pursuant to NAC 439A.745.

     3.  The policies and procedures of the

Program.

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

      NAC 439A.720  Application for letter of support: Requirements; request for

waiver of portion of fees; where available. (NRS 439A.170, 439A.175)

     1.  An application for a letter of support

must:

     (a) Be complete.

     (b) Include the materials required by subsection 1

of NRS 439A.175.

     (c) Be on the form prescribed by the Division of

Public and Behavioral Health.

     (d) Contain the notarized signatures of the

employer and the J-1 visa physician.

     (e) Except as otherwise provided in subsection 2,

be accompanied by an application fee of $500 which must be paid in equal

amounts by the employer and the J-1 visa physician.

     2.  The Administrator may waive the portion

of the application fee which must be paid by the J-1 visa physician or require

the J-1 visa physician to pay that portion of the application fee pursuant to a

payment plan if the J-1 visa physician is experiencing an economic hardship and

the J-1 visa physician submits with the application documentation sufficient to

demonstrate that the economic hardship exists.

     3.  An employer or a J-1 visa physician may

obtain an application for a letter of support from the Division of Public and

Behavioral Health on the Internet website maintained by the Division of Public

and Behavioral Health at http://health.nv.gov/PrimaryCare.htm or by

submitting a written request for an application to the Division of Public and

Behavioral Health, Primary Care Office, 4150 Technology Way, Carson City,

Nevada 89706.

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

      NAC 439A.725  Application for letter of support: Submission; review by Advisory

Council; responsibilities of Administrator. (NRS 439A.170, 439A.175)

     1.  An application for a letter of support

must be filed with the Administrator by personal delivery, commercial carrier

or mail.

     2.  The Advisory Council may review an

application submitted pursuant to this section for completeness and compliance

with the provisions of NRS

439A.130 to 439A.185,

inclusive, and NAC 439A.700 to 439A.755, inclusive.

     3.  Applications must be reviewed in the

order in which they were received.

     4.  The Administrator is responsible for the

review and the approval or denial of all applications. The Administrator shall

provide notice of the approval or denial of an application to the applicant. If

an application is incomplete, the Administrator shall provide notice to the

applicant within 14 days after receipt of the application and provide a written

explanation of the missing information or documentation. An application may be

resubmitted with the additional required information or documentation.

     5.  The Administrator shall accept

applications pursuant to this section until all available spots for enrollment

of J-1 visa physicians in the Program have been filled. The Administrator shall

post the status of the number of available spots for enrollment on the Internet

website maintained by the Division of Public and Behavioral Health at http://health.nv.gov/PrimaryCare.htm.

     6.  The Administrator shall not issue a

letter of support to:

     (a) An employer who was penalized for a violation

of NRS 439A.130 to 439A.185, inclusive, or NAC 439A.700 to 439A.755,

inclusive, or convicted of a violation of a federal statute or regulation

relating to immigration within the immediately preceding 2 years.

     (b) A J-1 visa physician who was determined by the

Administrator to have violated a provision of NRS 439A.130 to 439A.185, inclusive, or NAC 439A.700 to 439A.755,

inclusive, or convicted of a violation of a federal statute or regulation

relating to immigration within the immediately preceding 2 years.

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

      NAC 439A.730  Contract between employer and J-1 visa physician: Requirements;

transfer to different employer; liquidated damages. (NRS 439A.170, 439A.175)

     1.  In addition to the requirements of

subsection 2 of NRS 439A.175,

the contract entered into by the employer and the J-1 visa physician must:

     (a) Except as otherwise provided in subsection 2,

require the J-1 visa physician to begin work within 90 days after receipt of

the J-1 visa waiver.

     (b) Except as otherwise provided in subsection 2,

be for a term of at least 3 years.

     (c) Provide that the J-1 visa physician will work a

minimum of 40 hours each week at the location identified on the petition

submitted by the J-1 visa physician to the Waiver Review Division of the United

States Department of State.

     (d) Specify the wage that the J-1 visa physician

will earn. The wage must not be less than the prevailing wage determined by the

Office of Foreign Labor Certification of the United States Department of Labor,

which may be found on the Internet website maintained by the Foreign Labor

Certification Data Center at http://www.flcdatacenter.com.

     (e) Contain the signatures of the employer and the

J-1 visa physician and the date on which the contract was signed by each

person.

     (f) Identify the conditions for termination of the

contract, which must not include a provision authorizing termination without

cause.

     2.  If a J-1 visa physician is transferred to

a different employer pursuant to NAC 439A.750, the

contract entered into by the employer to which the J-1 visa physician is

transferred and the J-1 visa physician must comply with paragraphs (c) to (f), inclusive,

of subsection 1 and:

     (a) Require the J-1 visa physician to begin work

within 90 days after receiving notice that the transfer was granted; and

     (b) Be for a term equal to the time remaining on

the previous contract.

     3.  A contract entered into by an employer

and a J-1 visa physician may contain a clause for liquidated damages. If a

contract entered into by an employer and a J-1 visa physician contains a clause

for liquidated damages, the employer may not receive liquidated damages if the

contract is terminated by the J-1 visa physician before the end of the contract

because the employer has violated a provision of the contract, NRS 439A.130 to 439A.185, inclusive, or NAC 439A.700 to 439A.755,

inclusive.

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

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

employer shall:

     1.  Offer fees based on a sliding scale to

patients whose income is at or below 200 percent of the federally designated

level signifying poverty.

     2.  Ensure that the J-1 visa physician works

only in a location which is identified on the petition submitted by the J-1

visa physician to the Waiver Review Division of the United States Department of

State.

     3.  Post a sign in the waiting room of each

location where the J-1 visa physician works which states that:

     (a) Fees based on a sliding scale are available for

certain patients who have demonstrated a financial need for assistance to pay

for care and services.

     (b) Patients will be provided care and services

regardless of the ability of the patient to pay.

     4.  Provide documentation satisfactory to the

Division of Public and Behavioral Health that the employer participates in

Medicaid, Medicare and Nevada Check Up.

     5.  File the schedule of fees with the

Administrator for review.

     6.  Submit an affidavit to the Administrator

once every 6 months which attests that the J-1 visa physician:

     (a) Worked at least 40 hours each week at a

location which is identified on the petition submitted by the J-1 visa

physician to the Waiver Review Division; and

     (b) Is not employed at any location which is not

identified on the petition.

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

      NAC 439A.740  J-1 visa physician: Duties and requirements. (NRS 439A.170, 439A.175)  A J-1

visa physician must be in the final year of residency or a fellowship program

or be requesting a transfer from the J-1 visa waiver program of another state

and shall:

     1.  Comply with the requirements of 8 U.S.C. §

1184(k).

     2.  If the J-1 visa physician will prescribe

or dispense controlled substances:

     (a) Obtain any certificate or registration required

by chapters 453 and 639 of NRS and any regulations adopted

pursuant thereto; and

     (b) Register with the Drug Enforcement

Administration of the United States Department of Justice.

     3.  Accept patients who are enrolled in

Medicaid, Medicare or Nevada Check Up.

     4.  Provide care and services based on the

sliding scale of fees filed with the Administrator pursuant to subsection 5 of NAC 439A.735.

     5.  Only work in a location which is

identified on the petition submitted by the J-1 visa physician to the Waiver

Review Division of the United States Department of State.

     6.  Submit an affidavit to the Administrator

once every 6 months which attests that the J-1 visa physician:

     (a) Worked at least 40 hours each week at a

location which is identified on the petition submitted by the J-1 visa

physician to the Waiver Review Division; and

     (b) Is not employed at any other location which is

not identified on the petition.

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

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

Administrator. (NRS 439A.170, 439A.180)

     1.  A complaint about an employer or a J-1

visa physician may be submitted to the Program on the Internet website

maintained by the Division of Public and Behavioral Health at http://health.nv.gov/PrimaryCare_J-1.htm

or by submitting a written complaint to the Division of Public and Behavioral

Health, Primary Care Office, 4150 Technology Way, Carson City, Nevada 89706.

     2.  The Administrator shall investigate or

require the Advisory Council to investigate each complaint submitted pursuant

to this section. The investigation must commence within 45 days after receipt

of the complaint, except that if the complaint alleges that the safety of a

patient was threatened, the investigation must commence as soon as practicable.

The Administrator is responsible for the investigation of complaints submitted

pursuant to this section.

     3.  If the Administrator determines that a

violation of NRS 439A.130 to 439A.185, inclusive, or NAC 439A.700 to 439A.755,

inclusive, has occurred, the Administrator:

     (a) Shall, if the violation affected the health and

safety of a patient, submit a report to the Board of Medical Examiners; or

     (b) May, if the violation did not affect the health

or safety of a patient, submit a report to the Board of Medical Examiners or to

the Bureau of Health Care Quality and Compliance of the Division of Public and

Behavioral Health.

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

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

     1.  If an employer violates the provisions of

NRS 439A.130 to 439A.185, inclusive, or NAC 439A.700 to 439A.755,

inclusive, the Administrator shall:

     (a) For a first offense, impose an administrative

fine of $1,000.

     (b) For a second offense, impose an administrative

fine of $10,000.

     (c) For a third offense, withdraw the support of

the Division of Public and Behavioral Health for the employer and assist in the

transfer of the J-1 visa physician to a different employer pursuant to

subsection 2.

     2.  If an employer is penalized for a third

offense pursuant to paragraph (c) of subsection 1, the Administrator shall, in

cooperation with a different employer, the J-1 visa physician and the Waiver

Review Division of the United States Department of State, assist in the

transfer of the J-1 visa physician to a different employer, including, without

limitation, submitting a letter to the J-1 visa physician which documents the

reasons for the transfer and providing documentation for designating a new

location in which the J-1 visa physician may work.

     3.  If a J-1 visa physician does not comply

with the provisions of NRS

439A.130 to 439A.185,

inclusive, and NAC 439A.700 to 439A.755, inclusive, the Administrator may report the

failure to comply to the United States Citizenship and Immigration Services and

the United States Department of State and recommend that the J-1 visa waiver of

the J-1 visa physician be revoked.

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

      NAC 439A.755  Hearing. (NRS 439A.170, 439A.180)  A J-1

visa physician or an employer may request a hearing on any action taken by the

Administrator pursuant to subsection 3 of NAC 439A.745

or 439A.750. The hearing must be conducted in

accordance with the procedures set forth in NAC

439.300 to 439.395, inclusive.

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

PROGRAMS TO INCREASE AWARENESS OF INFORMATION CONCERNING

HOSPITALS AND SURGICAL CENTERS FOR AMBULATORY PATIENTS

      NAC 439A.800  “Surgical center for ambulatory patients” defined. (NRS 439A.250)  As used

in NAC 439A.800 to 439A.840,

inclusive, unless the context otherwise requires, “surgical center for

ambulatory patients” has the meaning ascribed to it in NRS 449.019.

     (Added to NAC by Dep’t of Health & Human Services

by R151-08, eff. 12-17-2008)

      NAC 439A.810  Information concerning surgical centers for ambulatory patients:

Requirements for submission of information to Department; confidential

information. (NRS

439A.250)

     1.  Each surgical center for ambulatory

patients shall prepare and submit to the Department, for each outpatient

treated by the surgical center during each calendar month, the most recent

universal billing form specified by the Centers for Medicare and Medicaid

Services in an electronic format specified by the Department. Except as

otherwise provided in NAC 439A.815, the surgical

center shall submit the required information not later than 45 days after the

last day of each calendar month.

     2.  The Department, and any person with whom

the Department enters into a contract for the development and operation of its

universal billing data system, shall not disclose any information from the data

system which reveals the identity of a specific outpatient of a surgical

center.

     (Added to NAC by Dep’t of Health & Human Services

by R151-08, 12-17-2008, eff. 5-20-2009)

      NAC 439A.815  Information concerning surgical centers for ambulatory patients:

Request for extension of time for submission of information. (NRS 439A.250)

     1.  A surgical center for ambulatory patients

may submit to the Director a written request to submit the information required

pursuant to NAC 439A.810 more than 45 days after

the last day of a calendar month. Each request must be submitted in the form

and within the time period required by the Department.

     2.  The Director shall review each request

submitted pursuant to subsection 1 and determine whether to grant the request.

     3.  If the Director determines that an

extension of the time for submission is appropriate, the Director shall provide

written notice to the surgical center, including the date by which the

information required pursuant to NAC 439A.810 must

be submitted.

     (Added to NAC by Dep’t of Health & Human Services

by R151-08, 12-17-2008, eff. 5-20-2009)

      NAC 439A.820  Information concerning surgical centers for ambulatory patients:

Notification by Department that information is incomplete; effect of failure to

submit complete information. (NRS 439A.250)

     1.  If a surgical center fails to submit the

information required pursuant to NAC 439A.810 or

if the Department determines that the information is incomplete or inaccurate,

the Department will notify the surgical center pursuant to subsection 3 of NRS 439A.250.

     2.  If a surgical center is notified pursuant

to subsection 1, the surgical center shall submit the required information to

the Department within 30 days after receipt of the notice. If the surgical

center does not submit the required information within 30 days, the Department

may send to the Division of Public and Behavioral Health of the Department a

written notice of failure to comply and request that the Division take

appropriate disciplinary action against the surgical center, including, without

limitation, the imposition of an administrative penalty.

     (Added to NAC by Dep’t of Health & Human Services

by R151-08, 12-17-2008, eff. 5-20-2009)

      NAC 439A.825  Information concerning surgical centers for ambulatory patients:

Department to determine and make publicly available list of 50 medical

treatments for outpatients of surgical centers to be included in program. (NRS 439A.250)

     1.  For purposes of paragraph (d) of

subsection 2 of NRS 439A.240,

the Department will:

     (a) Determine and make publicly available a list of

the 50 medical treatments for outpatients of surgical centers for ambulatory

patients that will be included in the program to increase public awareness of

health care information concerning surgical centers for ambulatory patients;

and

     (b) Review the list of 50 medical treatments once

every 2 years and update the list as the Department determines necessary.

     2.  When selecting and updating the list of

50 medical treatments for outpatients of surgical centers pursuant to

subsection 1, the Department will consider, without limitation:

     (a) Recommendations of the State Board of Health;

     (b) Input received from the general public; and

     (c) The medical treatments for outpatients of

surgical centers that were most frequently performed by the surgical centers in

this State during the immediately preceding 2 years, as reported on the

universal billing forms submitted pursuant to NAC

439A.810.

     (Added to NAC by Dep’t of Health & Human Services

by R151-08, eff. 12-17-2008)

      NAC 439A.830  Information concerning hospitals: Department to determine and

make publicly available lists of diagnosis-related groups for inpatients of

hospitals and 50 medical treatments for outpatients of hospitals to be included

in program. (NRS

439A.220, 439A.230)

     1.  For purposes of paragraph (d) of

subsection 2 of NRS 439A.220,

the Department will:

     (a) Determine and make publicly available a list of

the diagnosis-related groups for inpatients of hospitals that will be included

in the program to increase public awareness of health care information

concerning hospitals;

     (b) Determine and make publicly available a list of

the 50 medical treatments for outpatients of hospitals that will be included in

the program to increase public awareness of health care information concerning

hospitals; and

     (c) Review each list once every 2 years and update

the list as the Department determines necessary.

     2.  When selecting and updating the list of

the diagnosis-related groups pursuant to paragraph (a) of subsection 1, the

Department will use the information reported on the universal billing forms

submitted pursuant to NAC 449.963.

     3.  When selecting and updating the list of

the 50 medical treatments for outpatients of hospitals pursuant to paragraph

(b) of subsection 1, the Department will consider, without limitation:

     (a) Recommendations of the State Board of Health;

     (b) Input received from the general public; and

     (c) The medical treatments for outpatients of

hospitals that were most frequently performed by the hospitals in this State

during the immediately preceding 2 years, as reported on the universal billing

forms submitted pursuant to NAC 449.963.

     4.  As used in this section,

“diagnosis-related group” has the meaning ascribed to it in NRS 439A.220.

     (Added to NAC by Dep’t of Health & Human Services

by R151-08, eff. 12-17-2008; A by Div. of Health Care Fin. & Policy by R099-12,

10-4-2013)

      NAC 439A.835  Internet website for information concerning hospitals and

surgical centers for ambulatory patients: Duties of Department. (NRS 439A.270, 439A.290)  The

Department will:

     1.  Update the information contained on the

Internet website established and maintained pursuant to NRS 439A.270 at least quarterly.

     2.  At least once every 2 years, review the

information contained on the Internet website established and maintained

pursuant to NRS 439A.270 to

determine whether the information or the Internet website should be expanded,

modified or otherwise altered. In making such determination, the Department

will consider, without limitation, whether new measures of quality have been

endorsed by the Agency for Healthcare Research and Quality of the United States

Department of Health and Human Services, the National Quality Forum, the

Centers for Medicare and Medicaid Services of the United States Department of

Health and Human Services, a quality improvement organization of the Centers

for Medicare and Medicaid Services or The Joint Commission.

     3.  Before including any information on the

Internet website established and maintained pursuant to NRS 439A.270, use nationally

accepted standards to audit the health information to ensure the completeness

and accuracy of the information.

     4.  Provide on the Internet website

established and maintained pursuant to NRS 439A.270 a link to the

Internet website of the Division of Public and Behavioral Health of the

Department which contains information on sentinel events reported pursuant to NRS 439.800 to 439.890, inclusive.

     5.  Provide on the Internet website

established and maintained pursuant to NRS 439A.270 a report of potentially

preventable readmissions of patients who received acute care hospital services

from a hospital other than a critical access hospital, using the information

reported on the universal billing forms submitted pursuant to NAC 449.963. The Department will annually

update the report provided pursuant to this subsection.

     6.  To the extent that money is available for

that purpose, provide on the Internet website established and maintained pursuant

to NRS 439A.270 the name of

each physician who performed a surgical procedure in a hospital or surgical

center for ambulatory patients in this State and the total number of surgical

procedures performed by the physician, reported by principal diagnosis and, if

the information is available, by diagnosis-related group.

     7.  As used in this section:

     (a) “Acute care hospital services” means services

ordinarily furnished in a hospital for the care and treatment of an inpatient

under the direction of a physician or dentist which are furnished in an

institution that:

          (1) Is maintained primarily for the care and

treatment of patients with disorders other than mental illness;

          (2) Is licensed as a hospital by the Division

of Public and Behavioral Health of the Department;

          (3) Meets the requirements for participation

as a provider for Medicare; and

          (4) Has in effect a utilization review plan

for any patient who is a recipient of Medicaid which complies with 42 C.F.R. §

482.30.

     (b) “Critical access hospital” means a hospital

which has been certified as a critical access hospital by the Secretary of

Health and Human Services pursuant to 42 U.S.C. § 1395i-4(e).

     (c) “Diagnosis-related group” has the meaning

ascribed to it in NRS 439A.220.

     (Added to NAC by Dep’t of Health & Human Services

by R151-08, eff. 12-17-2008; A by Div. of Health Care Fin. & Policy by R099-12,

10-4-2013)

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

     1.  A person may submit to the Department a

written request for the review and release of information collected and

maintained by the Department pursuant to NRS 439A.200 to 439A.290, inclusive, and NAC 439A.800 to 439A.840,

inclusive.

     2.  If the request is for the purpose of

research, the Department will grant the review and release of the information.

     3.  If the request is for purposes other than

research, the Department will consider the request and determine whether to

grant the review and release of the information.

     4.  The Department will ensure that

information reviewed or released pursuant to this section does not disclose any

information which reveals the identity of a specific patient of a hospital or

surgical center for ambulatory patients.

     (Added to NAC by Dep’t of Health & Human Services

by R151-08, eff. 12-17-2008)
Read Entire Law on www.leg.state.nv.us