Nrs: Chapter 449 - Medical Facilities And Other Related Entities

Link to law: https://www.leg.state.nv.us/NRS/NRS-449.html
Published: 2015

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[Rev. 2/10/2015 5:31:40

PM--2014R2]

CHAPTER 449 - MEDICAL FACILITIES AND OTHER

RELATED ENTITIES

GENERAL PROVISIONS

NRS 449.001           Definitions.



NRS 449.0015         “Agency

to provide nursing in the home” defined.

NRS 449.0021         “Agency

to provide personal care services in the home” defined.

NRS 449.0025         “Board”

defined.

NRS 449.0031         “Community

triage center” defined.

NRS 449.0032         “Division”

defined.

NRS 449.0033         “Facility

for hospice care” defined.

NRS 449.0038         “Facility

for intermediate care” defined.

NRS 449.00385       “Facility

for modified medical detoxification” defined.

NRS 449.00387       “Facility

for refractive surgery” defined.

NRS 449.0039         “Facility

for skilled nursing” defined.

NRS 449.004           “Facility

for the care of adults during the day” defined.

NRS 449.0045         “Facility

for the dependent” defined.

NRS 449.00455       “Facility

for the treatment of abuse of alcohol or drugs” defined.

NRS 449.0046         “Facility

for the treatment of irreversible renal disease” defined.

NRS 449.0055         “Facility

for transitional living for released offenders” defined.

NRS 449.008           “Halfway

house for recovering alcohol and drug abusers” defined.

NRS 449.009           “Health

Division” defined. [Repealed.]

NRS 449.0105         “Home

for individual residential care” defined.

NRS 449.0115         “Hospice

care” defined.

NRS 449.012           “Hospital”

defined.

NRS 449.013           “Independent

center for emergency medical care” defined.

NRS 449.0145         “Licensed

practical nurse” defined.

NRS 449.0151         “Medical

facility” defined.

NRS 449.01513       “Medication

aide - certified” defined.

NRS 449.01515       “Mobile

unit” defined.

NRS 449.0152         “Nursing

assistant” defined.

NRS 449.0153         “Nursing

pool” defined.

NRS 449.0155         “Obstetric

center” defined.

NRS 449.0156         “Palliative

services” defined.

NRS 449.0157         “Provider

of health care” defined.

NRS 449.0159         “Provider

of supported living arrangement services” defined.

NRS 449.0165         “Psychiatric

hospital” defined.

NRS 449.0167         “Registered

nurse” defined.

NRS 449.017           “Residential

facility for groups” defined.

NRS 449.0175         “Rural

clinic” defined.

NRS 449.0177         “Rural

hospital” defined.

NRS 449.0185         “Supported

living arrangement services” defined.

NRS 449.019           “Surgical

center for ambulatory patients” defined.

NRS 449.0195         “Terminally

ill” defined.

LICENSING AND REGULATION

General Provisions

NRS 449.030           License

required to operate or maintain medical facility or facility for the dependent

and to operate program of hospice care.

NRS 449.0301         Exemptions.

NRS 449.0302         Board

to adopt standards, qualifications and other regulations.

NRS 449.0303         Authority

of Board to require licensing of other facilities.

NRS 449.0305         Businesses

that provide referrals to residential facilities for groups: License required;

standards and regulations; provision of referrals; prohibited acts; civil

penalties.

NRS 449.0306         Money

received from licensing of facilities to be deposited in State General Fund;

expenditure of state or federal money.

NRS 449.0307         Powers

of Division.

NRS 449.0308         Authority

of Division to collect actual cost of enforcing provisions from unlicensed

medical facility or facility for the dependent; exception.

 

Licensing

NRS 449.040           Application

for license: Filing; contents.

NRS 449.050           Fees.

NRS 449.065           Surety

bond for initial license and renewal of license to operate facility for

intermediate care, facility for skilled nursing, residential facility for

groups, home for individual residential care, agency to provide personal care

services in home and agency to provide nursing in home; exemption; exception.

NRS 449.067           Substitute

for surety required for facility for intermediate care, facility for skilled

nursing, residential facility for groups, home for individual residential care,

agency to provide personal care services in home and agency to provide nursing

in home.

NRS 449.068           Surety

bond required for initial license and renewal of license to operate facility

for refractive surgery.

NRS 449.069           Substitute

for surety bond required for facility for refractive surgery.

NRS 449.080           Issuance,

validity and transferability of license.

NRS 449.085           Form

and contents of license.

NRS 449.087           Amendment

of license required for addition of certain services; requirements for approval

of amendment; revocation of approval; standards.

NRS 449.089           Expiration

and renewal of license.

NRS 449.091           Provisional

license.

NRS 449.092           Applicant

for issuance or renewal of license for home for individual residential care to

attest to knowledge of and compliance with certain guidelines concerning safe

and appropriate injection practices.

NRS 449.093           Training

to recognize and prevent abuse of older persons: Persons required to receive;

frequency; topics; costs; actions for failure to complete.

NRS 449.094           Continuing

education requirements concerning care of persons with dementia for certain

employees of facilities for skilled nursing, facilities for intermediate care

and residential facilities for groups.

 

Background Investigations

NRS 449.119           “Facility,

hospital, agency, program or home” defined.

NRS 449.121           Exemption

for facility for the treatment of abuse of alcohol or drugs; exception.

NRS 449.122           Investigation

of applicant for license to operate facility, hospital, agency, program or

home.

NRS 449.123           Initial

and periodic investigations of employee, employee of temporary employment

service or independent contractor of facility, hospital, agency, program or

home; penalty.

NRS 449.1235         Temporary

employment service prohibited from sending ineligible employee to facility,

hospital, agency, program or home; temporary employment service to provide

certain information regarding its employees.

NRS 449.124           Maintenance

and availability of certain records regarding employee, employee of temporary

employment service or independent contractor of facility, hospital, agency,

program or home.

NRS 449.125           Termination

of employment or contract of employee, employee of temporary employment service

or independent contractor of facility, hospital, agency, program or home who

has been convicted of certain crime; period in which to correct information

regarding conviction; liability of facility, hospital, agency, program or home.

 

Inspections

NRS 449.131           Entry

and inspection of building and premises by Division, State Fire Marshal and

Chief Medical Officer.

NRS 449.132           Inspection

of medical facility and facility for dependent by Division of Public and

Behavioral Health and Aging and Disability Services Division.

NRS 449.133           Report

of results of inspections of medical facilities and facilities for dependent by

Division; disclosure of results of inspections of facilities for skilled

nursing, facilities for intermediate care and residential facilities for

groups.

NRS 449.134           Facility

for intermediate care, facility for skilled nursing, residential facility for

groups or home for individual residential care to provide immediate

notification of certain deficiencies to certain persons.

 

Disciplinary Action

NRS 449.160           Grounds

for denial, suspension or revocation of license; revocation of license in

connection with certain nuisance activity; log of complaints; information

concerning complaint, investigation and disciplinary action to be provided to

facility for the care of adults during the day; written report of complaints

and disciplinary actions.

NRS 449.163           Administrative

sanctions: Imposition by Division; disposition of money collected.

NRS 449.165           Administrative

sanctions: Regulations of Board.

NRS 449.170           Denial,

suspension or revocation of license or imposition of sanctions: Notice; appeal;

adoption of regulations.

NRS 449.171           Authority

of Division to take control over medical records of medical facility or

facility for dependent upon suspension of license or cessation of operation;

confidentiality; sharing of records with appropriate authorities.

NRS 449.172           Residential

facility for groups: Duties of Division and operator upon suspension or

revocation of license for abuse, neglect or isolation of occupants.

NRS 449.174           Additional

grounds for denial, suspension or revocation of license to operate certain

facility, hospital, agency, program or home.

 

Miscellaneous Provisions

NRS 449.181           Medical

facility that has custody of child pursuant to court order to adopt policy

relating to medical care and medications for child; employees to receive copy

of policy.

NRS 449.183           Facility

for intermediate care, facility for skilled nursing and residential facility

for groups to adopt written policy concerning readmission after temporary

transfer of patient or resident.

NRS 449.184           Operator

of residential facility for groups, facility for intermediate care or facility

for skilled nursing to post certain information in conspicuous place.

NRS 449.186           Supervision

of residential facility for groups.

NRS 449.187           Supervision

of facility for skilled nursing or facility for intermediate care.

NRS 449.189           Physician

and nurse required to operate independent center to provide emergency medical

care.

NRS 449.191           Medical

facility not required to allow abortions.

NRS 449.192           Admission

of dentist to membership on medical staff of hospital.

NRS 449.193           Facility

for intermediate care, facility for skilled nursing, residential facility for

groups or home for individual residential care to provide itemized statement of

charges upon request to certain persons.

NRS 449.1935         Agency

to provide personal care services in the home authorized to provide certain

services to certain persons.

NRS 449.194           Certain

employees of agency to provide personal care services in the home immune from

civil liability resulting from rendering emergency care or assistance.

NRS 449.195           Waiver

of deductible or copayment; conditions.

NRS 449.196           Requirements

for program of hospice care.

NRS 449.197           Provision

of care by facility for hospice care.

NRS 449.198           Requirements

for obstetric center.

NRS 449.199           Residential

facility for groups and homes for individual residential care prohibited from

providing accommodations to persons not meeting requirements for admission;

exception.

NRS 449.201           Certification

required for alcohol and drug abuse programs operated or provided by facility

for transitional living for released offenders.

NRS 449.202           Classification

of hospitals.

NRS 449.203           Designation

of hospital as primary stroke center; Division to maintain list of hospitals so

designated; regulations.

NRS 449.2035         Designation

of hospital as STEMI receiving center; Division to maintain list of hospitals

so designated; regulations.

NRS 449.204           Misleading

name or other designation of facility prohibited.

 

Prohibited Acts; Penalties

NRS 449.205           Retaliation

or discrimination against employees and certain other persons: Prohibition

under certain circumstances; medical facility prohibited from restricting right

to make report or take certain other actions.

NRS 449.207           Retaliation

or discrimination against employees and certain other persons: Violation; civil

action for certain acts of retaliation or discrimination; damages; equitable

relief; rebuttable presumption; civil penalty; time limit for bringing action.

NRS 449.208           Retaliation

or discrimination against employees or certain other persons: Written notice

regarding protections and legal remedies for certain acts of retaliation or

discrimination; posting of notice; inclusion of notice in employee handbook.

NRS 449.209           Prohibition

against medical facility or employee of medical facility making certain

referrals to residential facilities for groups; civil penalties; system to

track violations.

NRS 449.210           Penalties

for unlicensed operation: Medical facility or facility for dependent;

residential facility for groups or home for individual residential care.

NRS 449.220           Action

to enjoin violations.

NRS 449.240           Institution

and conduct of prosecutions.

REQUIREMENTS RELATING TO STAFFING

NRS 449.241           Definitions.

NRS 449.2413         “Certified

nursing assistant” defined.

NRS 449.2414         “Health

care facility” defined.

NRS 449.2416         “Licensed

nurse” defined.

NRS 449.2418         “Unit”

defined.

NRS 449.242           Establishment

of staffing committee by certain hospitals in larger counties; membership; duty

to develop documented staffing plan; duty to consider certain requests;

quarterly meetings; reporting to Legislature.

NRS 449.2421         Certain

health care facilities in larger counties required to make available to

Division written policy that allows refusal of or objection to work assignments

and documented staffing plan; requirements of staffing plan and flexibility for

adjustments.

NRS 449.2423         Certain

health care facilities in larger counties to adopt written policy to allow

nurse or certified nursing assistant to refuse or object to work assignments;

requirements of policy; maintenance of records of refusals of and objections to

work assignments.

NRS 449.2428         Division

required to ensure that certain health care facilities comply with provisions;

regulations.

MISCELLANEOUS PROVISIONS

NRS 449.243           Itemized

list of charges required; use of Uniform Billing and Claims Forms authorized;

contracted rates; summary of charges.

NRS 449.244           Certain

costs for examination or treatment of victims of sexual offenses to be charged

to county. [Repealed.]

NRS 449.245           Release

of child from hospital; provision of authorization for release and other

information to Division of Child and Family Services; disclosure of

information; penalty.

NRS 449.2455         Authority

of hospital to enter into agreement with Armed Forces of United States for

provision of medical care by certain medical officers.

NRS 449.246           Hospital

or obstetric center to provide information relating to voluntary acknowledgment

or establishment of paternity before discharging unmarried woman who has borne

child; regulations.

NRS 449.2465         Persons

entitled to results of tests performed at laboratory regarding patient of rural

hospital.

NRS 449.247           Powers

and duties of Division and State Board of Nursing with respect to nursing

assistants and medication aides - certified and training of nursing assistants

and medication aides - certified; provision of information to State Board of

Nursing.

NRS 449.2475         Unlicensed

insurer not allowed to make payment directly to person who received services in

certain circumstances; limitation on civil and criminal liability.

NRS 449.248           Additional

services to be provided by agency to provide nursing in home.

NRS 449.2485         Return

to dispensing pharmacy of unused prescription drug dispensed to patient of

facility for skilled nursing or facility for intermediate care for purpose of

reissuing drug or transferring drug.

NRS 449.2486         Facility

for care of adults during the day to maintain and provide certain information;

form in which information to be provided.

NRS 449.2487         Notice

to be provided by certain facilities which offer independent living.

NRS 449.2488         Department

to develop brochure and website to assist persons who are 55 years of age or

older in determining appropriate level of care and type of housing; information

to be included in brochure and website.

FACILITIES FOR REFRACTIVE SURGERY

NRS 449.2489         Definitions.

NRS 449.24891       “Ophthalmologist”

defined.

NRS 449.24892       “Postoperative

care” defined.

NRS 449.24893       “Preoperative

care” defined.

NRS 449.24894       “Surgical

treatment for a refractive error of the eye” defined.

NRS 449.24895       Certain

persons not required to obtain license to operate and maintain facility; filing

of affidavit with Division required.

NRS 449.24896       Surgical

treatments at facility must be performed by licensed ophthalmologist;

availability of ophthalmologist.

NRS 449.24897       Order

to cease and desist operation for failure to obtain license; injunction;

penalties.

NRS 449.24898       Collaboration

between ophthalmologist and optometrist authorized pursuant to NRS 636.374.

NEVADA HEALTH FACILITIES ASSISTANCE ACT

NRS 449.250           Short

title.

NRS 449.260           Definitions.

NRS 449.270           State

Department to constitute sole agency of State for certain purposes.

NRS 449.280           Duties

of State Department.

NRS 449.300           Inventory

of existing health facilities; development of program for construction of

facilities.

NRS 449.310           Requirements

of program for construction of health facilities.

NRS 449.320           Application

for federal money; deposit of money.

NRS 449.340           State

Department to prescribe minimum standards; standards to supersede local

ordinances and regulations; penalty.

NRS 449.345           Restriction

on adoption of regulations concerning construction, maintenance, operation or

safety of building, structure or other property.

NRS 449.360           Application

for construction of health facility: Filing; compliance with federal and state

requirements.

NRS 449.370           Application

for construction of health facility: Notice and hearing; approval and

forwarding.

NRS 449.380           Inspection

of construction of health facility; certification by State Department.

NRS 449.390           Authority

to receive and distribute federal money; Health Facilities Assistance Fund;

deposits, use and controls.

NRS 449.400           State

Public Health Facilities Construction Assistance Fund: Creation;

administration.

NRS 449.410           State

assistance for construction of certain projects; eligibility of project for

assistance.

NRS 449.420           Amount

of state assistance: Allocations; payments.

NRS 449.430           Money

from State Public Health Facilities Construction Assistance Fund to be paid in

installments.

INTERMEDIARY SERVICE ORGANIZATIONS

General Provisions

NRS 449.4304         “Intermediary

service organization” defined.

NRS 449.4308         Authority

to provide services.

 

Certification

NRS 449.431           Certificate

required; exception; penalty.

NRS 449.4311         Application

for certificate: Contents.

NRS 449.4312         Application

for certificate: Social security number required. [Effective until the date of

the repeal of 42 U.S.C. § 666, the federal law requiring each state to

establish procedures for withholding, suspending and restricting the

professional, occupational and recreational licenses for child support

arrearages and for noncompliance with certain processes relating to paternity

or child support proceedings.]

NRS 449.4313         Application

for certificate: Statement regarding obligation of child support; grounds for

denial; duty of Division. [Effective until the date of the repeal of 42 U.S.C.

§ 666, the federal law requiring each state to establish procedures for

withholding, suspending and restricting the professional, occupational and

recreational licenses for child support arrearages and for noncompliance with

certain processes relating to paternity or child support proceedings.]

NRS 449.4314         Application

for certificate: Fee.

NRS 449.4317         Issuance

of certificate; nontransferability.

NRS 449.4318         Form

and contents of certificate.

NRS 449.4319         Expiration

and renewal of certificate.

NRS 449.432           Application

for renewal of certificate: Information concerning business license required;

conditions which require denial.

NRS 449.4321         Grounds

for denial, suspension or revocation of certificate.

NRS 449.4322         Suspension

of certificate for failure to pay child support or comply with certain

subpoenas or warrants; reinstatement of certificate. [Effective until the date

of the repeal of 42 U.S.C. § 666, the federal law requiring each state to

establish procedures for withholding, suspending and restricting the

professional, occupational and recreational licenses for child support

arrearages and for noncompliance with certain processes relating to paternity

or child support proceedings.]

NRS 449.4324         Provisional

certificate.

NRS 449.4325         Deposit

of money received; expenses of Division to enforce provisions.

NRS 449.4327         Regulations;

powers of Division.

 

Background Investigations

NRS 449.4329         Initial

and periodic investigations of employee, employee of temporary employment

service or independent contractor; penalty.

NRS 449.43295       Temporary

employment service prohibited from sending ineligible employee to organization;

temporary employment service to provide certain information regarding its

employees.

NRS 449.433           Maintenance

and availability of certain records regarding employee, employee of temporary

employment service or independent contractor of organization.

NRS 449.4331         Termination

of employment or contract of employee, employee of temporary employment service

or independent contractor who has been convicted of certain crime; period in

which to correct information regarding conviction; liability of organization.

NRS 449.4332         Additional

grounds for denial, suspension or revocation of certificate.

 

Disciplinary Action; Enforcement

NRS 449.4335         Administrative

sanctions: Imposition by Division; consequences of failure to pay; use of money

collected.

NRS 449.4336         Administrative

sanctions: Regulations.

NRS 449.4337         Notice

by Division of disciplinary action; exception; appeal.

NRS 449.4338         Action

to enjoin violations.

NRS 449.4339         Prosecution

by district attorney.

PERMIT FOR SERVICES OF GENERAL ANESTHESIA, CONSCIOUS SEDATION

AND DEEP SEDATION; NATIONAL ACCREDITATION; INSPECTIONS OF SURGICAL CENTERS FOR

AMBULATORY PATIENTS AND CERTAIN PHYSICIANS’ OFFICES AND FACILITIES

NRS 449.435           Definitions.

NRS 449.436           “Conscious

sedation” defined.

NRS 449.437           “Deep

sedation” defined.

NRS 449.438           “General

anesthesia” defined.

NRS 449.439           “Physician”

defined.

NRS 449.441           Exemption

from provisions if physician’s office or facility only administers certain type

of pain medication.

NRS 449.442           Permit

required for certain physicians’ offices and facilities to offer services;

national accreditation required; cessation of services for failure to maintain

accreditation.

NRS 449.443           Application

for permit; fee; inspection by Division; term of permit.

NRS 449.444           Application

for renewal of permit; fee.

NRS 449.445           National

accreditation required of surgical center for ambulatory patients; inspection

by Division; cessation of operation for failure to maintain accreditation.

NRS 449.446           Annual

inspections of holders of permits and surgical centers for ambulatory patients;

correction of deficiencies identified in inspections; reporting of inspections

to Legislature.

NRS 449.447           Disciplinary

action for certain violations or failure to correct deficiency; notification to

professional licensing board of violations; administrative sanctions.

NRS 449.448           Regulations.

ACCOUNTING; FINANCIAL REPORTS; FEES; ENSURING QUALITY OF CARE

NRS 449.450           Definitions.

NRS 449.460           Powers

of Director.

NRS 449.465           Authority

of Director to impose fees; maximum amount of fees collected; fee for support

of Legislative Committee on Health Care.

NRS 449.470           Director

may use staff or contract for services.

NRS 449.476           Committee

to ensure quality of care: Formation by hospital; general requirements.

NRS 449.485           Hospital

required to use discharge form prescribed by Director; electronic monthly

reporting; exception to electronic reporting; use of information by Department.

NRS 449.490           Financial

statements and reports required to be filed with Department; additional

reporting requirements for hospitals with 100 or more beds; availability of

complete current charge master.

NRS 449.500           Director

to carry out analyses and studies concerning cost of health care.

NRS 449.510           Director

to prepare and file summaries, compilations or other reports; public

inspection; collection, maintenance, disclosure or publication of contracts or

identification of party to contract prohibited.

NRS 449.520           Reports

to Governor and legislative committees; development of comprehensive plan by

Legislative Committee on Health Care.

NRS 449.530           Administrative

fine for violation.

WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT

NRS 449.535           Short

title; uniformity of application and construction.

NRS 449.540           Definitions.

NRS 449.550           “Attending

physician” defined.

NRS 449.560           “Declaration”

defined.

NRS 449.570           “Life-sustaining

treatment” defined.

NRS 449.575           “Person”

defined.

NRS 449.581           “Provider

of health care” defined.

NRS 449.585           “Qualified

patient” defined.

NRS 449.590           “Terminal

condition” defined.

NRS 449.600           Declaration

relating to use of life-sustaining treatment.

NRS 449.610           Form

of declaration directing physician to withhold or withdraw life-sustaining

treatment.

NRS 449.613           Form

of declaration designating another person to decide to withhold or withdraw

life-sustaining treatment.

NRS 449.617           Time

declaration becomes operative; duty of providers of health care.

NRS 449.620           Revocation

of declaration; entry of revocation in medical records of declarant.

NRS 449.622           Recording

determination of terminal condition and declaration.

NRS 449.624           Treatment

of qualified patients; withholding or withdrawal of artificial nutrition and

hydration; treatment of pregnant patient.

NRS 449.626           Written

consent to withhold or withdraw life-sustaining treatment.

NRS 449.628           Transfer

of care of declarant.

NRS 449.630           Immunity

from civil and criminal liability and discipline for unprofessional conduct.

NRS 449.640           Consideration

of declaration and other factors; failure to follow directions of patient.

NRS 449.645           Assumption

of validity of declaration; presumption of intent to use, withhold or withdraw

life-sustaining treatment not created.

NRS 449.650           Death

does not constitute suicide or homicide; effect of declaration on policy of

insurance; prohibiting or requiring execution of declaration prohibited as

condition for insurance or receipt of health care.

NRS 449.660           Penalties.

NRS 449.670           Actions

contrary to reasonable medical standards not required; mercy-killing, assisted

suicide or euthanasia not authorized.

NRS 449.680           Other

right or responsibility regarding use of life-sustaining treatment or

withholding or withdrawal of medical care not limited.

NRS 449.690           Validity

of declaration executed in another state; effect of previously executed

instrument.

PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT

NRS 449.691           Definitions.

NRS 449.6912         “Attending

physician” defined.

NRS 449.6915         “Do-not-resuscitate

identification” defined.

NRS 449.6916         “Do-not-resuscitate

order” defined.

NRS 449.6918         “Emergency

care” defined.

NRS 449.692           “Health

care facility” defined.

NRS 449.6922         “Incompetent”

defined.

NRS 449.6924         “Life-resuscitating

treatment” defined.

NRS 449.6925         “Life-sustaining

treatment” defined.

NRS 449.6928         “Other

types of advance directives” defined.

NRS 449.693           “Physician

Order for Life-Sustaining Treatment form” or “POLST form” defined.

NRS 449.6932         “Provider

of health care” defined.

NRS 449.6934         “Representative

of the patient” defined.

NRS 449.694           Board

required to prescribe standardized POLST form; requirements.

NRS 449.6942         Physician

required to explain POLST form under certain circumstances and to complete

POLST form upon request of patient; validity.

NRS 449.6944         Revocation

of POLST form; entry of revocation in medical records of patient.

NRS 449.6946         Conflict

with other advance directive or do-not-resuscitate identification.

NRS 449.6948         Immunity

from civil and criminal liability and discipline for unprofessional conduct.

NRS 449.695           Provider

of health care required to comply with valid POLST form; modification by

physician; transfer of care of patient; exceptions.

NRS 449.6952         Assumption

of validity of POLST form; presumption of intent of patient not created if

patient has revoked or not executed POLST form.

NRS 449.6954         Death

does not constitute suicide or homicide; effect of POLST form on policy of

insurance; prohibiting or requiring execution of POLST form prohibited as

condition for insurance or receipt of health care.

NRS 449.6956         Unlawful

acts; penalty.

NRS 449.6958         Actions

contrary to reasonable medical standards not required; mercy-killing,

euthanasia or assisted suicide not authorized; rights associated with other

advance directives not impaired; right to make decisions concerning emergency

care or life-sustaining treatment not affected.

NRS 449.696           Validity

of POLST form executed in another state.

NRS 449.697           Regulations.

PATIENT’S RIGHTS

NRS 449.700           Facility

to provide necessary services or arrange for transfer of patient; explanation

of need for transfer and alternatives available.

NRS 449.705           Facility

to forward medical records upon certain transfers of patient.

NRS 449.710           Specific

rights: Information concerning facility; treatment; billing; visitation.

NRS 449.715           Specific

rights: Designation of persons authorized to visit patient in facility.

NRS 449.720           Specific

rights: Care; refusal of treatment and experimentation; privacy; notice of

appointments and need for care; confidentiality of information concerning

patient.

NRS 449.725           Owner

and administrator of certain facility prohibited from receiving money or

property by will of resident or former resident or from life insurance proceeds

of resident or former resident; exception.

NRS 449.730           Patient

to be informed of rights upon admission to facility; required disclosures and

notices.

NRS 449.740           Procedure

to insert implant in breast of patient: Informed consent required; withdrawal

of consent; penalty.

NRS 449.750           Procedure

to insert implant in breast of patient: Contents of explanation form and

consent form; fee for forms.

COLLECTION OF AMOUNT OWED TO HOSPITAL FOR HOSPITAL CARE

NRS 449.751           Definitions.

NRS 449.753           “Hospital

care” defined.

NRS 449.755           “Responsible

party” defined.

NRS 449.757           Limitations

on efforts of hospitals to collect; date for accrual of interest; rate of

interest; limitations on additional fees.

NRS 449.758           Limitations

on efforts of hospital to collect when hospital has contractual agreement with

third party that provides health coverage for care provided; exception.

NRS 449.759           Manner

of collection.

PREVENTING PERSONS FROM ENTERING OR EXITING HEALTH FACILITY

NRS 449.760           Unlawful

acts; exception; penalty.

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON PATIENTS

WITH DISABILITIES

NRS 449.765           Definitions.

NRS 449.766           “Aversive

intervention” defined.

NRS 449.767           “Chemical

restraint” defined.

NRS 449.768           “Corporal

punishment” defined.

NRS 449.769           “Electric

shock” defined.

NRS 449.770           “Emergency”

defined.

NRS 449.771           “Facility”

defined.

NRS 449.772           “Mechanical

restraint” defined.

NRS 449.773           “Person

with a disability” defined.

NRS 449.774           “Physical

restraint” defined.

NRS 449.775           “Verbal

and mental abuse” defined.

NRS 449.776           Aversive

intervention: Prohibition on use.

NRS 449.777           Forms

of restraint: Restrictions on use.

NRS 449.778           Physical

restraint: Permissible use; report of use in emergency.

NRS 449.779           Mechanical

restraint: Permissible use; report of use in emergency.

NRS 449.780           Chemical

restraint: Permissible use; report of use.

NRS 449.781           Use

of forms of restraint by certain facilities.

NRS 449.782           Education

and training of members of staff of facility.

NRS 449.783           Violations:

Criminal penalties; ineligibility for employment; disciplinary action.

NRS 449.784           Violations:

Report required; development and review of and compliance with corrective plan.

NRS 449.785           Prohibition

on retaliation against person for reporting or providing information regarding

violation.

NRS 449.786           Entry

of denial of rights in patient’s record; notice and report of denial; action by

Division.

REGISTRY OF ADVANCE DIRECTIVES

FOR HEALTH CARE

NRS 449.900           Definitions.

NRS 449.905           “Advance

directive” defined.

NRS 449.910           “Registrant”

defined.

NRS 449.915           “Registry”

defined.

NRS 449.920           Establishment

and maintenance; information to be included in Registry.

NRS 449.925           Registration

of advance directive: Requirements; duties of Secretary of State.

NRS 449.930           Access

to advance directive.

NRS 449.935           Removal

of advance directive of deceased registrant.

NRS 449.940           Secretary

of State not required to determine accuracy of contents of advance directive or

validity of advance directive; effect of registration, failure to register and

failure to notify Secretary of State of revocation of advance directive.

NRS 449.945           Provider

of health care not required to inquire whether patient has registered advance

directive or access Registry; immunity of provider of health care from criminal

and civil liability.

NRS 449.950           Immunity

of Secretary of State and deputies, employees and attorneys of Secretary of

State.

NRS 449.955           Suspension

of components of Registry and duties of Secretary of State if sufficient money

not available; fees authorized; acceptance of gifts and grants.

NRS 449.960           Deposit,

accounting and use of money received; interest and income earned on money

received; payment of claims.

NRS 449.965           Regulations.

_________

_________

 

GENERAL PROVISIONS

      NRS 449.001  Definitions.  As

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

terms defined in NRS 449.0015 to 449.0195, inclusive, have the meanings ascribed to

them in those sections.

      (Added to NRS by 1973, 1278; A 1975, 366, 897; 1977, 641; 1979, 160, 1113; 1983, 1657; 1985, 1736; 1989, 304, 1034, 1037; 1993, 2556; 1995, 1600; 1999, 248, 970; 2001, 1341, 2518; 2005, 485, 532, 1379, 1517, 2165, 2350; 2011, 1337;

2013, 3055)

      NRS 449.0015  “Agency to provide nursing in the home” defined.  “Agency to provide nursing in the home” means

any person or governmental organization which provides in the home, through its

employees or by contractual arrangement with other persons, skilled nursing and

assistance and training in health and housekeeping skills. The term does not

include a provider of supported living arrangement services during any period

in which the provider of supported living arrangement services is engaged in

providing supported living arrangement services.

      (Added to NRS by 1979, 160; A 1985, 1737; 2005, 1379)

      NRS 449.0021  “Agency to provide personal care services in the home” defined.

      1.  “Agency to provide personal care

services in the home” means any person, other than a natural person, which

provides in the home the services authorized pursuant to NRS 449.1935 to elderly persons or persons with

disabilities.

      2.  The term does not include:

      (a) An independent contractor who provides

nonmedical services specified in NRS 449.1935

without the assistance of employees;

      (b) An organized group of persons composed of the

family or friends of a person needing personal care services that employs or

contracts with persons to provide nonmedical services specified in NRS 449.1935 for the person if:

             (1) The organization of the group of

persons is set forth in a written document that is made available for review by

the Division upon request; and

             (2) The personal care services are

provided to only one person or one family who resides in the same residence; or

      (c) An intermediary service organization.

      3.  As used in this section, “intermediary

service organization” has the meaning ascribed to it in NRS

449.4304.

      (Added to NRS by 2005, 2164; A 2007, 1225; 2009, 2399;

2013, 134)

      NRS 449.0025  “Board” defined.  “Board”

means the State Board of Health.

      (Added to NRS by 1985, 1735)

      NRS 449.0031  “Community triage center” defined.  “Community

triage center” means a facility that provides on a 24-hour basis medical

assessments of and short-term monitoring services for persons with mental

illness and abusers of alcohol or drugs in a manner which does not require that

the assessments and services be provided in a licensed hospital.

      (Added to NRS by 2005, 532)

      NRS 449.0032  “Division” defined.  “Division”

means the Division of Public and Behavioral Health of the Department of Health

and Human Services.

      (Added to NRS by 2013, 3055)

      NRS 449.0033  “Facility for hospice care” defined.  “Facility

for hospice care” means a facility which is operated to provide hospice care.

      (Added to NRS by 1999, 248)

      NRS 449.0038  “Facility for intermediate care” defined.  “Facility for intermediate care” means an

establishment operated and maintained to provide 24-hour personal and medical

supervision, for a person who does not have illness, disease, injury or other

condition that would require the degree of care and treatment which a hospital

or facility for skilled nursing is designed to provide.

      (Added to NRS by 1973, 1279; A 1985, 1737; 1991, 1974)

      NRS 449.00385  “Facility for modified medical detoxification” defined.  “Facility for modified medical detoxification”

means a facility that provides 24-hour medical monitoring of treatment and

detoxification in a manner which does not require that the service be provided

in a licensed hospital.

      (Added to NRS by 1999, 969)

      NRS 449.00387  “Facility for refractive surgery” defined.

      1.  “Facility for refractive surgery” means

a freestanding facility that provides limited medical services relating to

surgical treatments for patients with refractive errors of the eye, including

the preoperative care and evaluation of those patients, the surgical treatment

of those patients and the postoperative care and evaluation of those patients.

      2.  As used in this section:

      (a) “Postoperative care” has the meaning ascribed

to it in NRS 449.24892.

      (b) “Preoperative care” has the meaning ascribed

to it in NRS 449.24893.

      (Added to NRS by 2001, 1339; A 2005, 2693; 2009, 452)

      NRS 449.0039  “Facility for skilled nursing” defined.

      1.  “Facility for skilled nursing” means an

establishment which provides continuous skilled nursing and related care as

prescribed by a physician to a patient in the facility who is not in an acute

episode of illness and whose primary need is the availability of such care on a

continuous basis.

      2.  “Facility for skilled nursing” does not

include a facility which meets the requirements of a general or any other

special hospital.

      (Added to NRS by 1973, 1279; A 1985, 1738)—(Substituted

in revision for NRS 449.018)

      NRS 449.004  “Facility for the care of adults during the day” defined.  “Facility for the care of adults during the

day” means an establishment operated and maintained to provide care during the

day on a temporary or permanent basis for aged or infirm persons. The term does

not include a halfway house for recovering alcohol and drug abusers.

      (Added to NRS by 1983, 1657; A 1985, 1736; 2001, 2518)

      NRS 449.0045  “Facility for the dependent” defined.  “Facility

for the dependent” includes:

      1.  A facility for the treatment of abuse

of alcohol or drugs;

      2.  A halfway house for recovering alcohol

and drug abusers;

      3.  A facility for the care of adults during

the day;

      4.  A residential facility for groups;

      5.  An agency to provide personal care

services in the home;

      6.  A facility for transitional living for

released offenders; and

      7.  A home for individual residential care.

      (Added to NRS by 1985, 1735; A 2001, 2518; 2005, 2165, 2350; 2011, 356)

      NRS 449.00455  “Facility for the treatment of abuse of alcohol or drugs”

defined.  “Facility for the

treatment of abuse of alcohol or drugs” means any public or private

establishment which provides residential treatment, including mental and

physical restoration, of abusers of alcohol or drugs and which is certified by

the Division pursuant to subsection 4 of NRS

458.025. It does not include a medical facility or services offered by

volunteers or voluntary organizations.

      (Added to NRS by 1975, 366; A 1985, 1736; 1993, 1624; 1999, 1871; 2001, 417; 2005, 22nd

Special Session, 56; 2013, 3055)

      NRS 449.0046  “Facility for the treatment of irreversible renal disease”

defined.  “Facility for the

treatment of irreversible renal disease” means a facility that is not part of a

hospital and which provides peritoneal dialysis or hemodialysis or trains a

person with a permanent irreversible renal impairment to perform dialysis for

himself or herself.

      (Added to NRS by 1985, 1735)

      NRS 449.0055  “Facility for transitional living for released offenders”

defined.

      1.  “Facility for transitional living for

released offenders” means a residence that provides housing and a living

environment for persons who have been released from prison and who require

assistance with reintegration into the community, other than such a residence

that is operated or maintained by a state or local government or an agency

thereof. The term does not include a halfway house for recovering alcohol and

drug abusers or a facility for the treatment of abuse of alcohol or drugs.

      2.  As used in this section, “person who

has been released from prison” means:

      (a) A parolee.

      (b) A person who is participating in:

             (1) A judicial program pursuant to NRS 209.4886 or 213.625; or

             (2) A correctional program pursuant to NRS 209.4888 or 213.632.

      (c) A person who is supervised by the Division of

Parole and Probation of the Department of Public Safety through residential

confinement pursuant to NRS 213.371 to 213.410, inclusive.

      (d) A person who has been released from prison by

expiration of his or her term of sentence.

      (Added to NRS by 2005, 2349)

      NRS 449.008  “Halfway house for recovering alcohol and drug abusers” defined.  “Halfway house for recovering alcohol and drug

abusers” means a residence that provides housing and a living environment for

recovering alcohol and drug abusers and is operated to facilitate their

reintegration into the community, but does not provide any treatment for

alcohol or drug abuse. The term does not include a facility for transitional living

for released offenders.

      (Added to NRS by 2001, 2518; A 2005, 2350)

      NRS 449.009  “Health Division” defined.  Repealed.

(See chapter 489, Statutes of Nevada 2013, at page 3071.)

 

      NRS 449.0105  “Home for individual residential care” defined.  “Home for individual residential care” means a

home in which a natural person furnishes food, shelter, assistance and limited

supervision, for compensation, to not more than two persons with intellectual

disabilities or with physical disabilities or who are aged or infirm, unless

the persons receiving those services are related within the third degree of

consanguinity or affinity to the person providing those services. The term does

not include:

      1.  A halfway house for recovering alcohol

and drug abusers; or

      2.  A home in which supported living

arrangement services are provided by a provider of supported living arrangement

services during any period in which the provider of supported living

arrangement services is engaged in providing supported living arrangement

services.

      (Added to NRS by 1993, 2556; A 2001, 2518; 2005, 1380; 2013, 696)

      NRS 449.0115  “Hospice care” defined.

      1.  “Hospice care” means a centrally

administered program of palliative services and supportive services provided by

an interdisciplinary team directed by a physician. The program includes the

provision of physical, psychological, custodial and spiritual care for persons

who are terminally ill and their families. The care may be provided in the

home, at a residential facility or at a medical facility at any time of the day

or night. The term includes the supportive care and services provided to the

family after the patient dies.

      2.  As used in this section:

      (a) “Family” includes the immediate family, the

person who primarily cared for the patient and other persons with significant

personal ties to the patient, whether or not related by blood.

      (b) “Interdisciplinary team” means a group of

persons who work collectively to meet the special needs of terminally ill

patients and their families and includes such persons as a physician,

registered nurse, social worker, member of the clergy and trained volunteer.

      (Added to NRS by 1979, 1112; A 1985, 1737; 1989, 1035; 2005, 485)

      NRS 449.012  “Hospital” defined.  “Hospital”

means an establishment for the diagnosis, care and treatment of human illness,

including care available 24 hours each day from persons licensed to practice

professional nursing who are under the direction of a physician, services of a

medical laboratory and medical, radiological, dietary and pharmaceutical

services.

      (Added to NRS by 1973, 1279; A 1985, 1737)

      NRS 449.013  “Independent center for emergency medical care” defined.  “Independent center for emergency medical

care” means a facility, structurally separate and distinct from a hospital,

which provides limited services for the treatment of a medical emergency.

      (Added to NRS by 1985, 1735)

      NRS 449.0145  “Licensed practical nurse” defined.  “Licensed

practical nurse” has the meaning ascribed to it in NRS 632.016.

      (Added to NRS by 2005, 1517)

      NRS 449.0151  “Medical facility” defined.  “Medical

facility” includes:

      1.  A surgical center for ambulatory

patients;

      2.  An obstetric center;

      3.  An independent center for emergency

medical care;

      4.  An agency to provide nursing in the

home;

      5.  A facility for intermediate care;

      6.  A facility for skilled nursing;

      7.  A facility for hospice care;

      8.  A hospital;

      9.  A psychiatric hospital;

      10.  A facility for the treatment of

irreversible renal disease;

      11.  A rural clinic;

      12.  A nursing pool;

      13.  A facility for modified medical

detoxification;

      14.  A facility for refractive surgery;

      15.  A mobile unit; and

      16.  A community triage center.

      (Added to NRS by 1973, 1279; A 1975, 366; 1979, 161, 887, 1113; 1983, 1657; 1985, 1736; 1989, 304, 1035, 1037; 1999, 248, 970; 2001, 1341; 2005, 532, 2693)

      NRS 449.01513  “Medication aide - certified” defined.  “Medication

aide - certified” has the meaning ascribed to it in NRS 632.0165.

      (Added to NRS by 2011, 1337)

      NRS 449.01515  “Mobile unit” defined.

      1.  Except as otherwise provided in

subsection 2, “mobile unit” means a motor vehicle that is specially designed,

constructed and equipped to provide any of the medical services provided by a

medical facility described in subsections 1 to 13, inclusive, of NRS 449.0151.

      2.  “Mobile unit” does not include:

      (a) A motor vehicle that is operated by a medical

facility described in subsections 1 to 13, inclusive, of NRS 449.0151 which is accredited by the Joint

Commission on Accreditation of Healthcare Organizations or the American

Osteopathic Association;

      (b) A motor vehicle that is operated by a health

center that is funded under section 330 of the Public Health Service Act, 42

U.S.C. § 254b, as amended; or

      (c) A vehicle operated under the authority of a

permit issued pursuant to chapter 450B of

NRS.

      (Added to NRS by 2001, 1339; A 2003, 421)

      NRS 449.0152  “Nursing assistant” defined.  “Nursing

assistant” has the meaning ascribed to it in NRS 632.0166.

      (Added to NRS by 2005, 1517)

      NRS 449.0153  “Nursing pool” defined.  “Nursing

pool” means a person or agency which provides for compensation, through its

employees or by contractual arrangement with other persons, nursing services to

any natural person, medical facility or facility for the dependent. The term

does not include:

      1.  An independent contractor who provides

such services without the assistance of employees;

      2.  A nursing pool based in a medical

facility or facility for the dependent; or

      3.  A provider of supported living

arrangement services during any period in which the provider of supported

living arrangement services is engaged in providing supported living

arrangement services.

      (Added to NRS by 1989, 303; A 2005, 1380)

      NRS 449.0155  “Obstetric center” defined.  “Obstetric

center” means a facility that is not part of a hospital and provides services

for normal, uncomplicated births.

      (Added to NRS by 1985, 1735)

      NRS 449.0156  “Palliative services” defined.  “Palliative

services” means services and treatments directed toward the control of pain and

symptoms which provide the greatest degree of relief for the longest period

while minimizing any adverse effects of the services and treatments, including,

without limitation, any side effects of any medications given or administered.

      (Added to NRS by 2005, 485)

      NRS 449.0157  “Provider of health care” defined.  “Provider

of health care” has the meaning ascribed to it in NRS 629.031.

      (Added to NRS by 1995, 1600)

      NRS 449.0159  “Provider of supported living arrangement services” defined.  “Provider of supported living arrangement

services” means a natural person who or a partnership, firm, corporation,

association, state or local government or agency thereof that has been issued a

certificate pursuant to NRS 435.3305

to 435.339, inclusive, and the

regulations adopted pursuant to NRS

435.3305 to 435.339, inclusive.

      (Added to NRS by 2005, 1379)

      NRS 449.0165  “Psychiatric hospital” defined.  “Psychiatric

hospital” means a hospital for the diagnosis, care and treatment of mental

illness which provides 24-hour residential care.

      (Added to NRS by 1985, 1735)

      NRS 449.0167  “Registered nurse” defined.  “Registered

nurse” has the meaning ascribed to it in NRS

632.019.

      (Added to NRS by 2005, 1517)

      NRS 449.017  “Residential facility for groups” defined.

      1.  Except as otherwise provided in

subsection 2, “residential facility for groups” means an establishment that

furnishes food, shelter, assistance and limited supervision to a person with an

intellectual disability or with a physical disability or a person who is aged

or infirm. The term includes, without limitation, an assisted living facility.

      2.  The term does not include:

      (a) An establishment which provides care only

during the day;

      (b) A natural person who provides care for no

more than two persons in his or her own home;

      (c) A natural person who provides care for one or

more persons related to him or her within the third degree of consanguinity or

affinity;

      (d) A halfway house for recovering alcohol and

drug abusers; or

      (e) A facility funded by a division or program of

the Department of Health and Human Services.

      (Added to NRS by 1973, 1278; A 1979, 212; 1983, 1657; 1985, 930, 1736; 1991, 1974; 1993, 1213; 1999, 114, 125; 2001, 57, 546, 2519, 2522; 2013, 696)

      NRS 449.0175  “Rural clinic” defined.  “Rural

clinic” means a facility located in an area that is not designated as an urban

area by the Bureau of the Census, where medical services are provided by a

physician assistant licensed pursuant to chapter

630 or 633 of NRS or an advanced practice

registered nurse licensed pursuant to NRS

632.237 who is under the supervision of a licensed physician.

      (Added to NRS by 1985, 1735; A 2001, 782; 2007, 1862; 2013, 2082)

      NRS 449.0177  “Rural hospital” defined.  “Rural

hospital” means a hospital with 85 or fewer beds which is:

      1.  The sole institutional provider of

health care located within a county whose population is less than 100,000;

      2.  The sole institutional provider of

health care located within a city whose population is less than 25,000; or

      3.  Maintained and governed pursuant to NRS 450.550 to 450.750, inclusive.

      (Added to NRS by 1995, 1600; A 2001, 1992)

      NRS 449.0185  “Supported living arrangement services” defined.  “Supported living arrangement services” has

the meaning ascribed to it in NRS 435.3315.

      (Added to NRS by 2005, 1379)

      NRS 449.019  “Surgical center for ambulatory patients” defined.  “Surgical center for ambulatory patients”

means a facility with limited medical services available for diagnosis or

treatment of patients by surgery where the patients’ recovery, in the opinion

of the surgeon, will not require care as a patient in the facility for more

than 24 hours.

      (Added to NRS by 1975, 366; A 1985, 1736; 1993, 207)

      NRS 449.0195  “Terminally ill” defined.  “Terminally

ill” means a medical diagnosis made by a physician that a person has an

anticipated life expectancy of not more than 12 months.

      (Added to NRS by 2005, 485)

LICENSING AND REGULATION

General Provisions

      NRS 449.030  License required to operate or maintain medical facility or

facility for the dependent and to operate program of hospice care.

      1.  No person, state or local government or

agency thereof may operate or maintain in this State any medical facility or

facility for the dependent without first obtaining a license therefor as provided

in NRS 449.030 to 449.2428,

inclusive.

      2.  Unless licensed as a facility for

hospice care, a person, state or local government or agency thereof shall not

operate a program of hospice care without first obtaining a license for the

program from the Board.

      [Part 1:336:1951]—(NRS A 1971, 934; 1973, 1281; 1985, 1738; 1989, 1035; 1997, 444, 1484; 1999, 249, 3608; 2011, 704)

      NRS 449.0301  Exemptions.  The

provisions of NRS 449.030 to 449.2428, inclusive, do not apply to:

      1.  Any facility conducted by and for the

adherents of any church or religious denomination for the purpose of providing

facilities for the care and treatment of the sick who depend solely upon

spiritual means through prayer for healing in the practice of the religion of

the church or denomination, except that such a facility shall comply with all

regulations relative to sanitation and safety applicable to other facilities of

a similar category.

      2.  Foster homes as defined in NRS 424.014.

      3.  Any medical facility or facility for

the dependent operated and maintained by the United States Government or an

agency thereof.

      [Part 3:336:1951] + [7:336:1951]—(NRS A 1971, 935;

1973, 1282; 1979,

887; 1985,

1740; 1993,

2724; 2003,

857; 2005,

2169; 2011,

356, 1064,

1358, 2253, 2396; 2013, 2145)—(Substituted

in revision for NRS 449.070)

      NRS 449.0302  Board to adopt standards, qualifications and other regulations.

      1.  The Board shall adopt:

      (a) Licensing standards for each class of medical

facility or facility for the dependent covered by NRS

449.030 to 449.2428, inclusive, and for

programs of hospice care.

      (b) Regulations governing the licensing of such

facilities and programs.

      (c) Regulations governing the procedure and

standards for granting an extension of the time for which a natural person may

provide certain care in his or her home without being considered a residential

facility for groups pursuant to NRS 449.017. The

regulations must require that such grants are effective only if made in writing.

      (d) Regulations establishing a procedure for the

indemnification by the Division, from the amount of any surety bond or other

obligation filed or deposited by a facility for refractive surgery pursuant to NRS 449.068 or 449.069, of

a patient of the facility who has sustained any damages as a result of the

bankruptcy of or any breach of contract by the facility.

      (e) Any other regulations as it deems necessary

or convenient to carry out the provisions of NRS

449.030 to 449.2428, inclusive.

      2.  The Board shall adopt separate

regulations governing the licensing and operation of:

      (a) Facilities for the care of adults during the

day; and

      (b) Residential facilities for groups,

Ê which

provide care to persons with Alzheimer’s disease.

      3.  The Board shall adopt separate

regulations for:

      (a) The licensure of rural hospitals which take

into consideration the unique problems of operating such a facility in a rural

area.

      (b) The licensure of facilities for refractive

surgery which take into consideration the unique factors of operating such a

facility.

      (c) The licensure of mobile units which take into

consideration the unique factors of operating a facility that is not in a fixed

location.

      4.  The Board shall require that the

practices and policies of each medical facility or facility for the dependent

provide adequately for the protection of the health, safety and physical, moral

and mental well-being of each person accommodated in the facility.

      5.  In addition to the training

requirements prescribed pursuant to NRS 449.093,

the Board shall establish minimum qualifications for administrators and

employees of residential facilities for groups. In establishing the

qualifications, the Board shall consider the related standards set by

nationally recognized organizations which accredit such facilities.

      6.  The Board shall adopt separate

regulations regarding the assistance which may be given pursuant to NRS 453.375 and 454.213 to an ultimate user of controlled

substances or dangerous drugs by employees of residential facilities for

groups. The regulations must require at least the following conditions before

such assistance may be given:

      (a) The ultimate user’s physical and mental

condition is stable and is following a predictable course.

      (b) The amount of the medication prescribed is at

a maintenance level and does not require a daily assessment.

      (c) A written plan of care by a physician or

registered nurse has been established that:

             (1) Addresses possession and assistance in

the administration of the medication; and

             (2) Includes a plan, which has been

prepared under the supervision of a registered nurse or licensed pharmacist,

for emergency intervention if an adverse condition results.

      (d) The prescribed medication is not administered

by injection or intravenously.

      (e) The employee has successfully completed

training and examination approved by the Division regarding the authorized

manner of assistance.

      7.  The Board shall adopt separate

regulations governing the licensing and operation of residential facilities for

groups which provide assisted living services. The Board shall not allow the

licensing of a facility as a residential facility for groups which provides assisted

living services and a residential facility for groups shall not claim that it

provides “assisted living services” unless:

      (a) Before authorizing a person to move into the

facility, the facility makes a full written disclosure to the person regarding

what services of personalized care will be available to the person and the

amount that will be charged for those services throughout the resident’s stay

at the facility.

      (b) The residents of the facility reside in their

own living units which:

             (1) Except as otherwise provided in

subsection 8, contain toilet facilities;

             (2) Contain a sleeping area or bedroom;

and

             (3) Are shared with another occupant only

upon consent of both occupants.

      (c) The facility provides personalized care to

the residents of the facility and the general approach to operating the

facility incorporates these core principles:

             (1) The facility is designed to create a

residential environment that actively supports and promotes each resident’s

quality of life and right to privacy;

             (2) The facility is committed to offering

high-quality supportive services that are developed by the facility in

collaboration with the resident to meet the resident’s individual needs;

             (3) The facility provides a variety of

creative and innovative services that emphasize the particular needs of each

individual resident and the resident’s personal choice of lifestyle;

             (4) The operation of the facility and its

interaction with its residents supports, to the maximum extent possible, each

resident’s need for autonomy and the right to make decisions regarding his or

her own life;

             (5) The operation of the facility is

designed to foster a social climate that allows the resident to develop and

maintain personal relationships with fellow residents and with persons in the

general community;

             (6) The facility is designed to minimize

and is operated in a manner which minimizes the need for its residents to move

out of the facility as their respective physical and mental conditions change

over time; and

             (7) The facility is operated in such a

manner as to foster a culture that provides a high-quality environment for the

residents, their families, the staff, any volunteers and the community at

large.

      8.  The Division may grant an exception

from the requirement of subparagraph (1) of paragraph (b) of subsection 7 to a

facility which is licensed as a residential facility for groups on or before

July 1, 2005, and which is authorized to have 10 or fewer beds and was

originally constructed as a single-family dwelling if the Division finds that:

      (a) Strict application of that requirement would

result in economic hardship to the facility requesting the exception; and

      (b) The exception, if granted, would not:

             (1) Cause substantial detriment to the

health or welfare of any resident of the facility;

             (2) Result in more than two residents

sharing a toilet facility; or

             (3) Otherwise impair substantially the

purpose of that requirement.

      9.  The Board shall, if it determines

necessary, adopt regulations and requirements to ensure that each residential

facility for groups and its staff are prepared to respond to an emergency,

including, without limitation:

      (a) The adoption of plans to respond to a natural

disaster and other types of emergency situations, including, without

limitation, an emergency involving fire;

      (b) The adoption of plans to provide for the

evacuation of a residential facility for groups in an emergency, including,

without limitation, plans to ensure that nonambulatory patients may be

evacuated;

      (c) Educating the residents of residential

facilities for groups concerning the plans adopted pursuant to paragraphs (a)

and (b); and

      (d) Posting the plans or a summary of the plans

adopted pursuant to paragraphs (a) and (b) in a conspicuous place in each

residential facility for groups.

      10.  The regulations governing the

licensing and operation of facilities for transitional living for released

offenders must provide for the licensure of at least three different types of

facilities, including, without limitation:

      (a) Facilities that only provide a housing and

living environment;

      (b) Facilities that provide or arrange for the

provision of supportive services for residents of the facility to assist the

residents with reintegration into the community, in addition to providing a

housing and living environment; and

      (c) Facilities that provide or arrange for the

provision of alcohol and drug abuse programs, in addition to providing a

housing and living environment and providing or arranging for the provision of

other supportive services.

Ê The

regulations must provide that if a facility was originally constructed as a

single-family dwelling, the facility must not be authorized for more than eight

beds.

      11.  As used in this section, “living unit”

means an individual private accommodation designated for a resident within the

facility.

      (Added to NRS by 1969, 946; A 1971, 934; 1973, 1281; 1985, 1738; 1987, 990; 1989, 1036, 2155, 2156; 1991, 1975; 1993, 1214; 1995, 1600; 1999, 3608; 2001, 1341; 2003, 1921; 2005, 2165, 2350, 2693; 2007, 1921; 2009, 1441;

2011, 2250)—(Substituted

in revision for NRS 449.037)

      NRS 449.0303  Authority of Board to require licensing of other facilities.  The Board may adopt regulations requiring the

licensing of a facility other than those required to be licensed pursuant to NRS 449.030 to 449.2428,

inclusive, if the:

      1.  Facility provides any type of medical

care or treatment; and

      2.  Regulation is necessary to protect the

health of the general public.

      (Added to NRS by 1985, 1735)—(Substituted

in revision for NRS 449.038)

      NRS 449.0305  Businesses that provide referrals to residential facilities for

groups: License required; standards and regulations; provision of referrals;

prohibited acts; civil penalties.

      1.  Except as otherwise provided in

subsection 5, a person must obtain a license from the Board to operate a business

that provides referrals to residential facilities for groups.

      2.  The Board shall adopt:

      (a) Standards for the licensing of businesses

that provide referrals to residential facilities for groups;

      (b) Standards relating to the fees charged by

such businesses;

      (c) Regulations governing the licensing of such

businesses; and

      (d) Regulations establishing requirements for

training the employees of such businesses.

      3.  A licensed nurse, social worker,

physician or hospital, or a provider of geriatric care who is licensed as a

nurse or social worker, may provide referrals to residential facilities for

groups through a business that is licensed pursuant to this section. The Board

may, by regulation, authorize a public guardian or any other person it determines

appropriate to provide referrals to residential facilities for groups through a

business that is licensed pursuant to this section.

      4.  A business that is licensed pursuant to

this section or an employee of such a business shall not:

      (a) Refer a person to a residential facility for

groups that is not licensed.

      (b) Refer a person to a residential facility for

groups if the business or its employee knows or reasonably should know that the

facility, or the services provided by the facility, are not appropriate for the

condition of the person being referred.

      (c) Refer a person to a residential facility for

groups that is owned by the same person who owns the business.

Ê A person who

violates the provisions of this subsection is liable for a civil penalty to be

recovered by the Attorney General in the name of the Board for the first

offense of not more than $10,000 and for a second or subsequent offense of not

less than $10,000 nor more than $20,000. Unless otherwise required by federal

law, the Board shall deposit all civil penalties collected pursuant to this

section into a separate account in the State General Fund to be used to

administer and carry out the provisions of NRS 449.001

to 449.430, inclusive, and 449.435

to 449.965, inclusive, and to protect the health,

safety, well-being and property of the patients and residents of facilities in

accordance with applicable state and federal standards.

      5.  This section does not apply to a

medical facility that is licensed pursuant to NRS

449.030 to 449.2428, inclusive, on October 1,

1999.

      (Added to NRS by 1999, 3606; A 2011, 705, 1805;

2013,135)

      NRS 449.0306  Money received from licensing of facilities to be deposited in

State General Fund; expenditure of state or federal money.

      1.  Money received from licensing medical

facilities and facilities for the dependent must be forwarded to the State

Treasurer for deposit in the State General Fund.

      2.  The Division shall enforce the

provisions of NRS 449.030 to 449.245,

inclusive, and may incur any necessary expenses not in excess of money

appropriated for that purpose by the State or received from the Federal

Government.

      [11:336:1951] + [13:336:1951]—(NRS A 1963, 960; 1971,

936; 1973, 1283; 1975, 898; 1979, 209; 1985, 1741; 2009, 1444;

2011, 2253,

2396; 2013, 3055)—(Substituted

in revision for NRS 449.140)

      NRS 449.0307  Powers of Division.  The

Division may:

      1.  Upon receipt of an application for a

license, conduct an investigation into the premises, facilities, qualifications

of personnel, methods of operation, policies and purposes of any person

proposing to engage in the operation of a medical facility or a facility for

the dependent. The facility is subject to inspection and approval as to

standards for safety from fire, on behalf of the Division, by the State Fire

Marshal.

      2.  Upon receipt of a complaint against a

medical facility or facility for the dependent, except for a complaint

concerning the cost of services, conduct an investigation into the premises,

facilities, qualifications of personnel, methods of operation, policies,

procedures and records of that facility or any other medical facility or

facility for the dependent which may have information pertinent to the

complaint.

      3.  Employ such professional, technical and

clerical assistance as it deems necessary to carry out the provisions of NRS 449.030 to 449.245,

inclusive.

      [Part 6:336:1951]—(NRS A 1963, 960; 1969, 945; 1971,

936; 1973, 1284; 1975, 898; 1977, 642; 1985, 1220; 2013, 3055)—(Substituted

in revision for NRS 449.150)

      NRS 449.0308  Authority of Division to collect actual cost of enforcing

provisions from unlicensed medical facility or facility for the dependent;

exception.

      1.  Except as otherwise provided in this

section, the Division may charge and collect from a medical facility or

facility for the dependent or a person who operates such a facility without a

license issued by the Division the actual costs incurred by the Division for

the enforcement of the provisions of NRS 449.030 to

449.2428, inclusive, including, without

limitation, the actual cost of conducting an inspection or investigation of the

facility.

      2.  The Division shall not charge and

collect the actual cost for enforcement pursuant to subsection 1 if the

enforcement activity is:

      (a) Related to the issuance or renewal of a

license for which the Board charges a fee pursuant to NRS

449.050 or 449.089; or

      (b) Conducted pursuant to an agreement with the

Federal Government which has appropriated money for that purpose.

      3.  Any money collected pursuant to

subsection 1 may be used by the Division to administer and carry out the

provisions of NRS 449.030 to 449.2428, inclusive, and the regulations adopted

pursuant thereto.

      (Added to NRS by 2011, 355;

A 2013,

3055)

Licensing

      NRS 449.040  Application for license: Filing; contents.  Any person, state or local government or

agency thereof desiring a license under the provisions of NRS 449.030 to 449.2428,

inclusive, must file with the Division an application on a form prescribed,

prepared and furnished by the Division, containing:

      1.  The name of the applicant and, if a

natural person, whether the applicant has attained the age of 21 years.

      2.  The type of facility to be operated.

      3.  The location of the facility.

      4.  In specific terms, the nature of

services and type of care to be offered, as defined in the regulations.

      5.  The number of beds authorized by the

Director of the Department of Health and Human Services or, if such

authorization is not required, the number of beds the facility will contain.

      6.  The name of the person in charge of the

facility.

      7.  Such other information as may be

required by the Division for the proper administration and enforcement of NRS 449.030 to 449.2428,

inclusive.

      8.  Evidence satisfactory to the Division

that the applicant is of reputable and responsible character. If the applicant

is a firm, association, organization, partnership, business trust, corporation

or company, similar evidence must be submitted as to the members thereof and

the person in charge of the facility for which application is made. If the

applicant is a political subdivision of the State or other governmental agency,

similar evidence must be submitted as to the person in charge of the

institution for which application is made.

      9.  Evidence satisfactory to the Division

of the ability of the applicant to comply with the provisions of NRS 449.030 to 449.2428,

inclusive, and the standards and regulations adopted by the Board.

      10.  Evidence satisfactory to the Division

that the facility conforms to the zoning regulations of the local government

within which the facility will be operated or that the applicant has applied

for an appropriate reclassification, variance, permit for special use or other

exception for the facility.

      [2:336:1951]—(NRS A 1963, 959; 1971, 934; 1973, 1281;

1975, 367; 1985,

1739; 1987,

776; 1991,

1078; 2007,

1133; 2009,

2025; 2013,

515, 2145,

3056)

      NRS 449.050  Fees.

      1.  Each application for a license must be

accompanied by such fee as may be determined by regulation of the Board. The

Board may, by regulation, allow or require payment of a fee for a license in

installments and may fix the amount of each payment and the date that the

payment is due.

      2.  The fee imposed by the Board for a

facility for transitional living for released offenders must be based on the

type of facility that is being licensed and must be calculated to produce the

revenue estimated to cover the costs related to the license, but in no case may

a fee for a license exceed the actual cost to the Division of issuing or

renewing the license.

      3.  If an application for a license for a

facility for transitional living for released offenders is denied, any amount

of the fee paid pursuant to this section that exceeds the expenses and costs

incurred by the Division must be refunded to the applicant.

      [Part 3:336:1951]—(NRS A 1971, 935; 1973, 1282; 1985, 1739; 1995, 501; 2003, 580; 2005, 2352; 2011, 356; 2013, 3056)

      NRS 449.065  Surety bond for initial license and renewal of license to

operate facility for intermediate care, facility for skilled nursing,

residential facility for groups, home for individual residential care, agency

to provide personal care services in home and agency to provide nursing in

home; exemption; exception.

      1.  Except as otherwise provided in

subsections 6 and 7 and NRS 449.067, each facility

for intermediate care, facility for skilled nursing, residential facility for

groups, home for individual residential care, agency to provide personal care

services in the home and agency to provide nursing in the home shall, when

applying for a license or renewing a license, file with the Administrator of

the Division of Public and Behavioral Health a surety bond:

      (a) If the facility, agency or home employs less

than 7 employees, in the amount of $5,000;

      (b) If the facility, agency or home employs at

least 7 but not more than 25 employees, in the amount of $25,000; or

      (c) If the facility, agency or home employs more than

25 employees, in the amount of $50,000.

      2.  A bond filed pursuant to this section

must be executed by the facility, agency or home as principal and by a surety

company as surety. The bond must be payable to the Aging and Disability

Services Division of the Department of Health and Human Services and must be

conditioned to provide indemnification to an older patient who the Specialist

for the Rights of Elderly Persons determines has suffered property damage as a

result of any act or failure to act by the facility, agency or home to protect

the property of the older patient.

      3.  Except when a surety is released, the

surety bond must cover the period of the initial license to operate or the

period of the renewal, as appropriate.

      4.  A surety on any bond filed pursuant to

this section may be released after the surety gives 30 days’ written notice to

the Administrator of the Division of Public and Behavioral Health, but the

release does not discharge or otherwise affect any claim filed by an older

patient for property damaged as a result of any act or failure to act by the

facility, agency or home to protect the property of the older patient alleged

to have occurred while the bond was in effect.

      5.  A license is suspended by operation of

law when the facility, agency or home is no longer covered by a surety bond as

required by this section or by a substitute for the surety bond pursuant to NRS 449.067. The Administrator of the Division of

Public and Behavioral Health shall give the facility, agency or home at least

20 days’ written notice before the release of the surety or the substitute for

the surety, to the effect that the license will be suspended by operation of

law until another surety bond or substitute for the surety bond is filed in the

same manner and amount as the bond or substitute being terminated.

      6.  The Administrator of the Division of

Public and Behavioral Health may exempt a residential facility for groups or a

home for individual residential care from the requirement of filing a surety

bond pursuant to this section if the Administrator determines that the

requirement would result in undue hardship to the residential facility for

groups or home for individual residential care.

      7.  The requirement of filing a surety bond

set forth in this section does not apply to a facility for intermediate care, facility

for skilled nursing, residential facility for groups, home for individual

residential care, agency to provide personal care services in the home or

agency to provide nursing in the home that is operated and maintained by the

State of Nevada or an agency thereof.

      8.  As used in this section, “older

patient” means a patient who is 60 years of age or older.

      (Added to NRS by 1997, 1482; A 2003, 524; 2005, 2168; 2009, 502; 2013, 3057)

      NRS 449.067  Substitute for surety required for facility for intermediate

care, facility for skilled nursing, residential facility for groups, home for

individual residential care, agency to provide personal care services in home

and agency to provide nursing in home.

      1.  As a substitute for the surety bond

required pursuant to NRS 449.065, a facility for

intermediate care, a facility for skilled nursing, a residential facility for

groups, a home for individual residential care, an agency to provide personal

care services in the home and an agency to provide nursing in the home may

deposit with any bank or trust company authorized to do business in this State,

upon approval from the Administrator of the Division of Public and Behavioral

Health:

      (a) An obligation of a bank, savings and loan

association, thrift company or credit union licensed to do business in this

State;

      (b) Bills, bonds, notes, debentures or other

obligations of the United States or any agency or instrumentality thereof, or

guaranteed by the United States; or

      (c) Any obligation of this State or any city,

county, town, township, school district or other instrumentality of this State,

or guaranteed by this State, in an aggregate amount, based upon principal

amount or market value, whichever is lower.

      2.  The obligations of a bank, savings and

loan association, thrift company or credit union must be held to secure the

same obligation as would the surety bond required by NRS

449.065. With the approval of the Administrator of the Division of Public

and Behavioral Health, the depositor may substitute other suitable obligations

for those deposited, which must be assigned to the Aging and Disability

Services Division of the Department of Health and Human Services and are

negotiable only upon approval by the Administrator of the Aging and Disability

Services Division.

      3.  Any interest or dividends earned on the

deposit accrue to the account of the depositor.

      4.  The deposit must be an amount at least

equal to the surety bond required by NRS 449.065

and must state that the amount may not be withdrawn except by direct and sole

order of the Administrator of the Aging and Disability Services Division.

      (Added to NRS by 1997, 1483; A 2003, 525; 2005, 2169; 2009, 503)

      NRS 449.068  Surety bond required for initial license and renewal of license

to operate facility for refractive surgery.

      1.  Except as otherwise provided in NRS 449.069, each facility for refractive surgery

shall, when applying for a license or renewing a license, file with the

Administrator of the Division a surety bond:

      (a) If the facility employs less than 7

employees, in the amount of $10,000;

      (b) If the facility employs at least 7 but not

more than 25 employees, in the amount of $50,000; or

      (c) If the facility employs more than 25

employees, in the amount of $100,000.

      2.  A bond filed pursuant to this section

must be executed by the facility as principal and by a surety company as

surety. The bond must be payable to the Division and must be conditioned to

provide indemnification to a patient of the facility who the Administrator of

the Division or the Administrator’s designee determines has sustained any

damages as a result of the bankruptcy of or any breach of contract by the

facility.

      3.  Except when a surety is released, the

surety bond must cover the period of the initial license to operate or the

period of the renewal, as appropriate.

      4.  A surety on any bond filed pursuant to

this section may be released after the surety gives 30 days’ written notice to

the Administrator of the Division, but the release does not discharge or

otherwise affect any claim filed by a patient for any damages sustained as a

result of the bankruptcy of or any breach of contract by the facility while the

bond was in effect.

      5.  The license of a facility for

refractive surgery is suspended by operation of law when the facility is no

longer covered by a surety bond as required by this section or by a substitute

for the surety bond pursuant to NRS 449.069. The

Administrator of the Division shall give the facility at least 20 days’ written

notice before the release of the surety or the substitute for the surety, to

the effect that the license will be suspended by operation of law until another

surety bond is filed or substitute for the surety bond is deposited in the same

manner and amount as the bond or substitute being terminated.

      (Added to NRS by 2001, 1340; A 2005, 2696)

      NRS 449.069  Substitute for surety bond required for facility for refractive

surgery.

      1.  As a substitute for the surety bond

required pursuant to NRS 449.068, a facility for

refractive surgery may deposit with any bank or trust company authorized to do

business in this State, upon approval of the Administrator of the Division:

      (a) An obligation of a bank, savings and loan

association, thrift company or credit union licensed to do business in this

State;

      (b) Bills, bonds, notes, debentures or other

obligations of the United States or any agency or instrumentality thereof, or

guaranteed by the United States; or

      (c) Any obligation of this State or any city,

county, town, township, school district or other instrumentality of this State,

or guaranteed by this State, in an aggregate amount, based upon principal

amount or market value, whichever is lower.

      2.  The obligations of a bank, savings and

loan association, thrift company or credit union must be held to secure the

same obligation as would the surety bond required by NRS

449.068. With the approval of the Administrator of the Division, the

facility may substitute other suitable obligations for those deposited, which

must be assigned to the Division and are negotiable only upon approval of the

Administrator of the Division.

      3.  Any interest or dividends earned on the

deposit accrue to the account of the facility.

      4.  The deposit must be an amount at least

equal to the surety bond required by NRS 449.068

and must state that the amount may not be withdrawn except by the direct and

sole order of the Administrator of the Division.

      (Added to NRS by 2001, 1340; A 2005, 2696)

      NRS 449.080  Issuance, validity and transferability of license.

      1.  If, after investigation, the Division

finds that the:

      (a) Applicant is in full compliance with the

provisions of NRS 449.030 to 449.2428, inclusive;

      (b) Applicant is in substantial compliance with

the standards and regulations adopted by the Board;

      (c) Applicant, if he or she has undertaken a

project for which approval is required pursuant to NRS 439A.100, has obtained the approval

of the Director of the Department of Health and Human Services; and

      (d) Facility conforms to the applicable zoning

regulations,

Ê the Division

shall issue the license to the applicant.

      2.  A license applies only to the person to

whom it is issued, is valid only for the premises described in the license and

is not transferable.

      [Part 3:336:1951]—(NRS A 1963, 959; 1971, 935; 1973,

1283; 1985,

1740; 1987,

777; 1991,

1078; 2011,

1064)

      NRS 449.085  Form and contents of license.  Each

license issued by the Division shall be in the form prescribed by the Division

and shall contain:

      1.  The name of the person or persons

authorized to operate such licensed facility;

      2.  The location of such licensed facility;

and

      3.  The number of beds authorized in such

licensed facility, the nature of services offered and the service delivery

capacity.

      (Added to NRS by 1973, 1279; A 1975, 367)

      NRS 449.087  Amendment of license required for addition of certain services;

requirements for approval of amendment; revocation of approval; standards.

      1.  A licensee must obtain the approval of

the Division to amend his or her license to operate a facility before the

addition of any of the following services:

      (a) The intensive care of newborn babies.

      (b) The treatment of burns.

      (c) The transplant of organs.

      (d) The performance of open-heart surgery.

      (e) A center for the treatment of trauma.

      2.  The Division shall approve an

application to amend a license to allow a facility to provide any of the

services described in subsection 1 if:

      (a) The applicant satisfies the requirements

contained in NRS 449.080;

      (b) The Division determines on the basis of the

standards adopted by the Board pursuant to subsection 4 that there are an

adequate number of cases in the community to be served to support amending the

license to add the service; and

      (c) The Division determines that the applicant

satisfies any other standards adopted by the Board pursuant to subsection 4.

      3.  The Division may revoke its approval if

the licensee fails to maintain substantial compliance with the standards

adopted by the Board pursuant to subsection 4 for the provision of such

services, or with any conditions included in the written approval of the

Director issued pursuant to the provisions of NRS 439A.100.

      4.  The Board shall:

      (a) Adopt standards which have been adopted by

appropriate national organizations to be used by the Division in determining

whether there are an adequate number of cases in the community to be served to

support amending the license of a licensee to add a service pursuant to this

section; and

      (b) Adopt such other standards as it deems

necessary for determining whether to approve the provision of services pursuant

to this section.

      (Added to NRS by 1987, 876; A 1989, 1948; 2011, 741)

      NRS 449.089  Expiration and renewal of license.

      1.  Each license issued pursuant to NRS 449.030 to 449.2428,

inclusive, expires on December 31 following its issuance and is renewable for 1

year upon reapplication and payment of all fees required pursuant to NRS 449.050 unless the Division finds, after an

investigation, that the facility has not:

      (a) Satisfactorily complied with the provisions

of NRS 449.030 to 449.2428,

inclusive, or the standards and regulations adopted by the Board;

      (b) Obtained the approval of the Director of the

Department of Health and Human Services before undertaking a project, if such

approval is required by NRS 439A.100;

or

      (c) Conformed to all applicable local zoning

regulations.

      2.  Each reapplication for an agency to

provide personal care services in the home, an agency to provide nursing in the

home, a facility for intermediate care, a facility for skilled nursing, a hospital

described in 42 U.S.C. § 1395ww(d)(1)(B)(iv) which accepts payment through

Medicare, a residential facility for groups, a program of hospice care, a home

for individual residential care, a facility for the care of adults during the

day, a facility for hospice care, a nursing pool, the distinct part of a

hospital which meets the requirements of a skilled nursing facility or nursing

facility pursuant to 42 C.F.R. § 483.5(b)(2), a hospital that provides

swing-bed services as described in 42 C.F.R. § 482.66 or, if residential

services are provided to children, a medical facility or facility for the

treatment of abuse of alcohol or drugs must include, without limitation, a

statement that the facility, hospital, agency, program or home is in compliance

with the provisions of NRS 449.119 to 449.125, inclusive, and 449.174.

      3.  Each reapplication for an agency to

provide personal care services in the home, a facility for intermediate care, a

facility for skilled nursing, a facility for the care of adults during the day,

a residential facility for groups or a home for individual residential care

must include, without limitation, a statement that the holder of the license to

operate, and the administrator or other person in charge and employees of, the

facility, agency or home are in compliance with the provisions of NRS 449.093.

      [Part 3:336:1951]—(NRS A 1963, 959; 1971, 935; 1973,

1282; 1985,

1739; 1987,

777; 1991,

1078; 1995,

1490; 1997,

445; 2003,

580; 2005,

2167; 2009,

502; 2011,

2252; 2013,

2146, 2889)—(Substituted

in revision for NRS 449.060)

      NRS 449.091  Provisional license.

      1.  The Division may cancel the license of

a medical facility or facility for the dependent and issue a provisional

license, effective for a period determined by the Division, to such a facility

if it:

      (a) Is in operation at the time of the adoption

of standards and regulations pursuant to the provisions of NRS 449.030 to 449.2428,

inclusive, and the Division determines that the facility requires a reasonable

time under the particular circumstances within which to comply with the

standards and regulations; or

      (b) Has failed to comply with the standards or

regulations and the Division determines that the facility is in the process of

making the necessary changes or has agreed to make the changes within a

reasonable time.

      2.  The provisions of subsection 1 do not require

the issuance of a license or prevent the Division from refusing to renew or

from revoking or suspending any license where the Division deems such action

necessary for the health and safety of the occupants of any facility.

      (Added to NRS by 1973, 1279; A 1985, 1740; 2011, 1064)

      NRS 449.092  Applicant for issuance or renewal of license for home for

individual residential care to attest to knowledge of and compliance with

certain guidelines concerning safe and appropriate injection practices.  The Division shall not issue or renew a

license for a home for individual residential care unless the applicant for

issuance or renewal of the license attests to knowledge of and compliance with

the guidelines of the Centers for Disease Control and Prevention concerning the

prevention of transmission of infectious agents through safe and appropriate

injection practices.

      (Added to NRS by 2011, 2053)

      NRS 449.093  Training to recognize and prevent abuse of older persons:

Persons required to receive; frequency; topics; costs; actions for failure to

complete.

      1.  An applicant for a license to operate a

facility for intermediate care, facility for skilled nursing, agency to provide

personal care services in the home, facility for the care of adults during the

day, residential facility for groups or home for individual residential care

must receive training to recognize and prevent the abuse of older persons

before a license to operate such a facility, agency or home is issued to the

applicant. If an applicant has completed such training within the year

preceding the date of the application for a license and the application

includes evidence of the training, the applicant shall be deemed to have

complied with the requirements of this subsection.

      2.  A licensee who holds a license to

operate a facility for intermediate care, facility for skilled nursing, agency

to provide personal care services in the home, facility for the care of adults

during the day, residential facility for groups or home for individual

residential care must annually receive training to recognize and prevent the

abuse of older persons before the license to operate such a facility, agency or

home may be renewed.

      3.  If an applicant or licensee who is

required by this section to obtain training is not a natural person, the person

in charge of the facility, agency or home must receive the training required by

this section.

      4.  An administrator or other person in

charge of a facility for intermediate care, facility for skilled nursing,

agency to provide personal care services in the home, facility for the care of

adults during the day, residential facility for groups or home for individual

residential care must receive training to recognize and prevent the abuse of

older persons before the facility, agency or home provides care to a person and

annually thereafter.

      5.  An employee who will provide care to a

person in a facility for intermediate care, facility for skilled nursing,

agency to provide personal care services in the home, facility for the care of

adults during the day, residential facility for groups or home for individual

residential care must receive training to recognize and prevent the abuse of

older persons before the employee provides care to a person in the facility,

agency or home and annually thereafter.

      6.  The topics of instruction that must be

included in the training required by this section must include, without

limitation:

      (a) Recognizing the abuse of older persons,

including sexual abuse and violations of NRS

200.5091 to 200.50995, inclusive;

      (b) Responding to reports of the alleged abuse of

older persons, including sexual abuse and violations of NRS 200.5091 to 200.50995, inclusive; and

      (c) Instruction concerning the federal, state and

local laws, and any changes to those laws, relating to:

             (1) The abuse of older persons; and

             (2) Facilities for intermediate care,

facilities for skilled nursing, agencies to provide personal care services in

the home, facilities for the care of adults during the day, residential

facilities for groups or homes for individual residential care, as applicable

for the person receiving the training.

      7.  The facility for intermediate care,

facility for skilled nursing, agency to provide personal care services in the

home, facility for the care of adults during the day, residential facility for

groups or home for individual residential care is responsible for the costs

related to the training required by this section.

      8.  The administrator of a facility for

intermediate care, facility for skilled nursing or residential facility for

groups who is licensed pursuant to chapter 654

of NRS shall ensure that each employee of the facility who provides care to

residents has obtained the training required by this section. If an

administrator or employee of a facility or home does not obtain the training

required by this section, the Division shall notify the Board of Examiners for

Long-Term Care Administrators that the administrator is in violation of this

section.

      9.  The holder of a license to operate a

facility for intermediate care, facility for skilled nursing, agency to provide

personal care services in the home, facility for the care of adults during the

day, residential facility for groups or home for individual residential care

shall ensure that each person who is required to comply with the requirements

for training pursuant to this section complies with such requirements. The

Division may, for any violation of this section, take disciplinary action

against a facility, agency or home pursuant to NRS

449.160 and 449.163.

      (Added to NRS by 2011, 2248)

      NRS 449.094  Continuing education requirements concerning care of persons

with dementia for certain employees of facilities for skilled nursing, facilities

for intermediate care and residential facilities for groups.

      1.  The Board shall establish minimum

continuing education requirements concerning the care of persons with any form

of dementia, including, without limitation, dementia caused by Alzheimer’s

disease, for each person who is:

      (a) Employed by a facility for skilled nursing,

facility for intermediate care or residential facility for groups which

provides care to persons with any form of dementia; and

      (b) Licensed or certified by an occupational

licensing board.

      2.  In establishing continuing education

requirements pursuant to subsection 1, the Board shall consider any other

educational requirements imposed on such employees to ensure that the

continuing education requirements established by the Board do not duplicate or

conflict with the existing educational requirements imposed on those employees.

      3.  The administrator of a facility for

skilled nursing, facility for intermediate care or residential facility for

groups which provides care to persons with any form of dementia, including,

without limitation, dementia caused by Alzheimer’s disease, shall ensure that

each employee of the facility who is required to comply with the requirements

for continuing education established by the Board pursuant to this section

complies with such requirements.

      (Added to NRS by 2003, 856)—(Substituted

in revision for NRS 449.0357)

Background Investigations

      NRS 449.119  “Facility, hospital, agency, program or home” defined.  As used in NRS 449.119

to 449.125, inclusive, “facility, hospital, agency,

program or home” means an agency to provide personal care services in the home,

an agency to provide nursing in the home, a facility for intermediate care, a

facility for skilled nursing, a hospital described in 42 U.S.C. §

1395ww(d)(1)(B)(iv) which accepts payment through Medicare, a residential

facility for groups, a program of hospice care, a home for individual

residential care, a facility for the care of adults during the day, a facility

for hospice care, a nursing pool, the distinct part of a hospital which meets

the requirements of a skilled nursing facility or nursing facility pursuant to

42 C.F.R. § 483.5(b)(2), a hospital that provides swing-bed services as

described in 42 C.F.R. § 482.66 or, if residential services are provided to

children, a medical facility or facility for the treatment of abuse of alcohol

or drugs.

      (Added to NRS by 2013, 2889)

      NRS 449.121  Exemption for facility for the treatment of abuse of alcohol or

drugs; exception.

      1.  Except as otherwise provided in

subsection 2, the provisions of NRS 449.119 to 449.125, inclusive, and 449.174

do not apply to any facility for the treatment of abuse of alcohol or drugs.

      2.  A facility for the treatment of abuse

of alcohol or drugs must comply with the requirements of NRS

449.119 to 449.125, inclusive, and 449.174 if the facility for the treatment of abuse of

alcohol or drugs provides residential services to children.

      (Added to NRS by 1997, 442; A 2011, 3556;

2013, 2890)—(Substituted

in revision for NRS 449.173)

      NRS 449.122  Investigation of applicant for license to operate facility,

hospital, agency, program or home.

      1.  Each applicant for a license to operate

a facility, hospital, agency, program or home shall submit to the Central

Repository for Nevada Records of Criminal History one complete set of

fingerprints for submission to the Federal Bureau of Investigation for its

report.

      2.  The Central Repository for Nevada

Records of Criminal History shall determine whether the applicant has been

convicted of a crime listed in paragraph (a) of subsection 1 of NRS 449.174 and immediately inform the administrator

of the facility, hospital, agency, program or home, if any, and the Division of

whether the applicant has been convicted of such a crime.

      3.  A person who holds a license to operate

a facility, hospital, agency, program or home which provides residential

services to children shall submit to the Central Repository for Nevada Records

of Criminal History one complete set of fingerprints for a report required by

this section at least once every 5 years after the initial investigation.

      (Added to NRS by 1997, 442; A 2009, 504; 2011, 3556;

2013, 2890)—(Substituted

in revision for NRS 449.176)

      NRS 449.123  Initial and periodic investigations of employee, employee of

temporary employment service or independent contractor of facility, hospital,

agency, program or home; penalty.

      1.  Except as otherwise provided in

subsections 2 and 3, within 10 days after hiring an employee, accepting an

employee of a temporary employment service or entering into a contract with an

independent contractor, the administrator of, or the person licensed to operate

a facility, hospital, agency, program or home shall:

      (a) Obtain a written statement from the employee,

employee of the temporary employment service or independent contractor stating

whether he or she has been convicted of any crime listed in NRS 449.174;

      (b) Obtain an oral and written confirmation of

the information contained in the written statement obtained pursuant to

paragraph (a);

      (c) Obtain proof that the employee, employee of

the temporary employment service or independent contractor holds any required

license, permit or certificate;

      (d) Obtain from the employee, employee of the

temporary employment service or independent contractor one set of fingerprints

and a written authorization to forward the fingerprints to the Central

Repository for Nevada Records of Criminal History for submission to the Federal

Bureau of Investigation for its report;

      (e) Submit to the Central Repository for Nevada

Records of Criminal History the fingerprints obtained pursuant to paragraph (d)

to obtain information on the background and personal history of each employee,

employee of a temporary employment service or independent contractor to

determine whether the person has been convicted of any crime listed in NRS 449.174; and

      (f) If an Internet website has been established

pursuant to NRS 439.942:

             (1) Screen the employee, employee of the

temporary employment service or independent contractor using the Internet website.

Upon request of the Division, proof that the employee, temporary employee or

independent contractor was screened pursuant to this subparagraph must be

provided to the Division.

             (2) Enter on the Internet website

information to be maintained on the website concerning the employee, employee

of the temporary employment service or independent contractor.

      2.  The administrator of, or the person

licensed to operate, a facility, hospital, agency, program or home is not

required to obtain the information described in subsection 1 from an employee,

employee of a temporary employment service or independent contractor if his or

her fingerprints have been submitted to the Central Repository for Nevada

Records of Criminal History for submission to the Federal Bureau of

Investigation for its report within the immediately preceding 6 months and the

report of the Federal Bureau of Investigation indicated that the employee,

employee of the temporary employment service or independent contractor has not

been convicted of any crime set forth in NRS 449.174.

      3.  The administrator of, or the person

licensed to operate, a facility, hospital, agency, program or home is not

required to obtain the information described in subsection 1, other than the

information described in paragraph (c) of subsection 1, from an employee,

employee of a temporary employment service or independent contractor if:

      (a) The employee, employee of the temporary

employment service or independent contractor agrees to allow the administrator

of, or the person licensed to operate, a facility, hospital, agency, program or

home to receive notice from the Central Repository for Nevada Records of

Criminal History regarding any conviction and subsequent conviction of the

employee, employee of the temporary employment service or independent

contractor of a crime listed in NRS 449.174;

      (b) An agency, board or commission that regulates

an occupation or profession pursuant to title 54 of NRS or temporary employment

service has, within the immediately preceding 5 years, submitted the

fingerprints of the employee, employee of the temporary employment service or

independent contractor to the Central Repository for Nevada Records of Criminal

History for submission to the Federal Bureau of Investigation for its report;

and

      (c) The report of the Federal Bureau of

Investigation indicated that the employee, employee of the temporary employment

service or independent contractor has not been convicted of any crime set forth

in NRS 449.174.

      4.  The administrator of, or the person

licensed to operate, a facility, hospital, agency, program or home shall ensure

that the information concerning the background and personal history of each

employee, employee of a temporary employment service or independent contractor

who works at the facility, hospital, agency, program or home:

      (a) Except as otherwise provided in subsection 2,

is completed as soon as practicable, and if residential services are provided

to children, before the employee, employee of the temporary employment service

or independent contractor provides any care or services to a child in the facility,

hospital, agency, program or home without supervision; and

      (b) At least once every 5 years after the date of

the initial investigation.

      5.  The administrator or person shall, when

required:

      (a) Obtain one set of fingerprints from the

employee, employee of the temporary employment service or independent

contractor;

      (b) Obtain written authorization from the

employee, employee of the temporary employment service or independent

contractor to forward the fingerprints obtained pursuant to paragraph (a) to

the Central Repository for Nevada Records of Criminal History for submission to

the Federal Bureau of Investigation for its report; and

      (c) Submit the fingerprints to the Central

Repository for Nevada Records of Criminal History or, if the fingerprints were

submitted electronically, obtain proof of electronic submission of the

fingerprints to the Central Repository for Nevada Records of Criminal History.

      6.  Upon receiving fingerprints submitted

pursuant to this section, the Central Repository for Nevada Records of Criminal

History shall determine whether the employee, employee of the temporary

employment service or independent contractor has been convicted of a crime

listed in NRS 449.174 and immediately inform the

Division and the administrator of, or the person licensed to operate, the facility,

hospital, agency, program or home at which the person works whether the

employee, employee of the temporary employment service or independent

contractor has been convicted of such a crime.

      7.  The Central Repository for Nevada

Records of Criminal History may impose a fee upon a facility, hospital, agency,

program or home that submits fingerprints pursuant to this section for the

reasonable cost of the investigation. The facility, hospital, agency, program

or home may recover from the employee or independent contractor whose

fingerprints are submitted not more than one-half of the fee imposed by the

Central Repository. If the facility, hospital, agency, program or home requires

the employee or independent contractor to pay for any part of the fee imposed

by the Central Repository, it shall allow the employee or independent

contractor to pay the amount through periodic payments. The facility, hospital,

agency, program or home may require a temporary employment service which

employs a temporary employee whose fingerprints are submitted to pay the fee

imposed by the Central Repository. A facility, hospital, agency, program or home

shall notify a temporary employment service if a person employed by the

temporary employment service is determined to be ineligible to provide services

at the facility, hospital, agency, program or home based upon the results of an

investigation conducted pursuant to this section.

      8.  Unless a greater penalty is provided by

law, a person who willfully provides a false statement or information in

connection with an investigation of the background and personal history of the

person pursuant to this section that would disqualify the person from

employment, including, without limitation, a conviction of a crime listed in NRS 449.174, is guilty of a misdemeanor.

      (Added to NRS by 1997, 442; A 1999, 1946; 2005, 2170; 2009, 504; 2011, 3556;

2013, 2890)—(Substituted

in revision for NRS 449.179)

      NRS 449.1235  Temporary employment service prohibited from sending ineligible

employee to facility, hospital, agency, program or home; temporary employment

service to provide certain information regarding its employees.

      1.  A temporary employment service shall

not send an employee to provide services to a facility, hospital, agency,

program or home if the temporary employment service has received notice from a

facility, hospital, agency, program or home that the employee of the temporary

employment service is ineligible to provide such services.

      2.  A facility, hospital, agency, program

or home that enters into an agreement with a temporary employment service to

provide services for the facility, hospital, agency, program or home on a

temporary basis must require the temporary employment service to:

      (a) Provide proof that each employee of the

temporary employment service whom it may send to provide services to the

facility, hospital, agency, program or home has been continuously employed by

the temporary employment service since the last investigation conducted of the

employee pursuant to NRS 449.123; and

      (b) Notify the facility, hospital, agency,

program or home if the investigation conducted of an employee of the temporary

employment service pursuant to NRS 449.123 has not

been conducted within the immediately preceding 5 years.

      (Added to NRS by 2013, 2889)

      NRS 449.124  Maintenance and availability of certain records regarding

employee, employee of temporary employment service or independent contractor of

facility, hospital, agency, program or home.

      1.  Each facility, hospital, agency,

program or home shall maintain records of the information concerning its employees,

employees of a temporary employment service and independent contractors

collected pursuant to NRS 449.123, including,

without limitation:

      (a) A copy of the fingerprints that were

submitted to the Central Repository for Nevada Records of Criminal History or

proof of electronic fingerprint submission and a copy of the written

authorization that was provided by the employee, employee of the temporary

employment service or independent contractor;

      (b) Proof that the fingerprints of the employee,

employee of the temporary employment service or independent contractor were

submitted to the Central Repository; and

      (c) Any other documentation of the information

collected pursuant to NRS 449.123.

      2.  The records maintained pursuant to

subsection 1 must be:

      (a) Maintained for the period of the employment

of the person with the facility, hospital, agency, program or home; and

      (b) Made available for inspection by the Division

at any reasonable time, and copies thereof must be furnished to the Division

upon request.

      3.  If an Internet website has been

established pursuant to NRS 439.942, a facility,

hospital, agency, program or home shall maintain a current list of its

employees, employees of a temporary employment service and independent

contractors on the Internet website.

      4.  The Central Repository for Nevada

Records of Criminal History may maintain an electronic image of fingerprints

submitted pursuant to NRS 449.122 and 449.123 to notify a facility, hospital, agency,

program or home and the Division of any subsequent conviction of a person who

is required to submit to an investigation pursuant to NRS

449.122 or 449.123.

      (Added to NRS by 1997, 443; A 1999, 1947; 2005, 2171; 2009, 505; 2011, 3558;

2013, 2893)—(Substituted

in revision for NRS 449.182)

      NRS 449.125  Termination of employment or contract of employee, employee of

temporary employment service or independent contractor of facility, hospital,

agency, program or home who has been convicted of certain crime; period in

which to correct information regarding conviction; liability of facility,

hospital, agency, program or home.

      1.  Upon receiving information from the

Central Repository for Nevada Records of Criminal History pursuant to NRS 449.123, or evidence from any other source, that

an employee, employee of a temporary employment service or independent

contractor of a facility, hospital, agency, program or home:

      (a) Has been convicted of a crime listed in

paragraph (a) of subsection 1 of NRS 449.174; or

      (b) Has had a substantiated report of abuse or

neglect made against him or her, if he or she is employed at a facility,

hospital, agency, program or home that provides residential services to

children,

Ê the

administrator of, or the person licensed to operate, the facility, hospital,

agency, program or home shall terminate the employment or contract of that

person or notify the temporary employment service that its employee is

prohibited from providing services for the facility, hospital, agency, program

or home after allowing the person time to correct the information as required

pursuant to subsection 2.

      2.  If an employee, employee of a temporary

employment service or independent contractor believes that the information

provided by the Central Repository is incorrect, the employee, employee of the

temporary employment service or independent contractor may immediately inform

the facility, hospital, agency, program or home or temporary employment

service. The facility, hospital, agency, program, home or temporary employment

service that is so informed shall give the employee, employee of the temporary

employment service or independent contractor a reasonable amount of time of not

less than 30 days to correct the information received from the Central

Repository before terminating the employment or contract of the person pursuant

to subsection 1.

      3.  A facility, hospital, agency, program

or home that has complied with NRS 449.123 may not

be held civilly or criminally liable based solely upon the ground that the

facility, hospital, agency, program or home allowed an employee, employee of a

temporary employment service or independent contractor to work:

      (a) Before it received the information concerning

the employee, employee of the temporary employment service or independent

contractor from the Central Repository, except that an employee, employee of

the temporary employment service or independent contractor shall not have

contact with a child without supervision before such information is received;

      (b) During the period required pursuant to

subsection 2 to allow the employee, employee of the temporary employment

service or independent contractor to correct that information, except that an

employee, employee of the temporary employment service or independent

contractor shall not have contact with a child without supervision during such

period;

      (c) Based on the information received from the

Central Repository, if the information received from the Central Repository was

inaccurate; or

      (d) Any combination thereof.

Ê A facility,

hospital, agency, program or home may be held liable for any other conduct

determined to be negligent or unlawful.

      (Added to NRS by 1997, 443; A 1999, 1948; 2005, 2171; 2009, 505; 2011, 3558;

2013, 2894)—(Substituted

in revision for NRS 449.185)

Inspections

      NRS 449.131  Entry and inspection of building and premises by Division, State

Fire Marshal and Chief Medical Officer.

      1.  Any authorized member or employee of

the Division may enter and inspect any building or premises at any time to

secure compliance with or prevent a violation of any provision of NRS 449.030 to 449.245,

inclusive.

      2.  The State Fire Marshal or a designee of

the State Fire Marshal shall, upon receiving a request from the Division or a

written complaint concerning compliance with the plans and requirements to

respond to an emergency adopted pursuant to subsection 9 of NRS 449.0302:

      (a) Enter and inspect a residential facility for

groups; and

      (b) Make recommendations regarding the adoption

of plans and requirements pursuant to subsection 9 of NRS

449.0302,

Ê to ensure the

safety of the residents of the facility in an emergency.

      3.  The Chief Medical Officer or a designee

of the Chief Medical Officer shall enter and inspect at least annually each

building or the premises of a residential facility for groups to ensure compliance

with standards for health and sanitation.

      4.  An authorized member or employee of the

Division shall enter and inspect any building or premises operated by a

residential facility for groups within 72 hours after the Division is notified

that a residential facility for groups is operating without a license.

      [Part 4:336:1951]—(NRS A 1963, 962; 1971, 937; 1973,

1286; 1975, 898; 1985,

1742; 1999,

3610; 2001,

1343; 2003,

421, 1923;

2005, 2172;

2009, 1446;

2011, 1067,

2255, 2398)—(Substituted

in revision for NRS 449.230)

      NRS 449.132  Inspection of medical facility and facility for dependent by

Division of Public and Behavioral Health and Aging and Disability Services

Division.  Every medical facility

or facility for the dependent may be inspected at any time, with or without

notice, as often as is necessary by:

      1.  The Division of Public and Behavioral

Health to ensure compliance with all applicable regulations and standards; and

      2.  Any person designated by the Aging and

Disability Services Division of the Department of Health and Human Services to

investigate complaints made against the facility.

      (Added to NRS by 1977, 642; A 1985, 1742; 1991, 1975; 2001, 1343; 2003, 422)—(Substituted

in revision for NRS 449.235)

      NRS 449.133  Report of results of inspections of medical facilities and

facilities for dependent by Division; disclosure of results of inspections of

facilities for skilled nursing, facilities for intermediate care and

residential facilities for groups.  The

Division shall:

      1.  Prepare a report of the results of its

inspections of medical facilities and facilities for the dependent regarding

compliance with applicable regulations and standards. The report must be

provided to the facility and include, without limitation, a recommendation of

the Division for correcting any deficiencies and, if a deficiency is discovered

as a result of an investigation by a county, district or city board of health

or health officer, the recommendations of the board or health officer.

      2.  Upon request, disclose to any person or

governmental entity the results of its inspections of facilities for skilled

nursing, facilities for intermediate care and residential facilities for groups

regarding their compliance with applicable regulations and standards.

      [14:336:1951]—(NRS A 1963, 961; 1971, 936; 1973,

1285; 1987,

1054; 2009,

559)—(Substituted in revision for NRS 449.200)

      NRS 449.134  Facility for intermediate care, facility for skilled nursing,

residential facility for groups or home for individual residential care to

provide immediate notification of certain deficiencies to certain persons.  A facility for intermediate care, facility for

skilled nursing, residential facility for groups or home for individual

residential care shall immediately provide notice of a deficiency affecting the

health and safety of a patient discovered during the course of an inspection of

the facility for intermediate care, facility for skilled nursing, residential

facility for groups or home for individual residential care conducted by the

Division to:

      1.  A person receiving care at the facility

or home;

      2.  The parent or legal guardian of the

person receiving care at the facility or home; or

      3.  Any other natural person designated to

receive such notice by the person receiving care at the facility or home or the

parent or guardian of the person.

      (Added to NRS by 2011, 2396)

Disciplinary Action

      NRS 449.160  Grounds for denial, suspension or revocation of license;

revocation of license in connection with certain nuisance activity; log of

complaints; information concerning complaint, investigation and disciplinary

action to be provided to facility for the care of adults during the day;

written report of complaints and disciplinary actions.

      1.  The Division may deny an application

for a license or may suspend or revoke any license issued under the provisions

of NRS 449.030 to 449.2428,

inclusive, upon any of the following grounds:

      (a) Violation by the applicant or the licensee of

any of the provisions of NRS 439B.410

or 449.030 to 449.245,

inclusive, or of any other law of this State or of the standards, rules and

regulations adopted thereunder.

      (b) Aiding, abetting or permitting the commission

of any illegal act.

      (c) Conduct inimical to the public health,

morals, welfare and safety of the people of the State of Nevada in the

maintenance and operation of the premises for which a license is issued.

      (d) Conduct or practice detrimental to the health

or safety of the occupants or employees of the facility.

      (e) Failure of the applicant to obtain written

approval from the Director of the Department of Health and Human Services as

required by NRS 439A.100 or as

provided in any regulation adopted pursuant to NRS

449.001 to 449.430, inclusive, and 449.435 to 449.965,

inclusive, if such approval is required.

      (f) Failure to comply with the provisions of NRS 449.2486.

      2.  In addition to the provisions of

subsection 1, the Division may revoke a license to operate a facility for the

dependent if, with respect to that facility, the licensee that operates the

facility, or an agent or employee of the licensee:

      (a) Is convicted of violating any of the

provisions of NRS 202.470;

      (b) Is ordered to but fails to abate a nuisance

pursuant to NRS 244.360, 244.3603 or 268.4124; or

      (c) Is ordered by the appropriate governmental

agency to correct a violation of a building, safety or health code or

regulation but fails to correct the violation.

      3.  The Division shall maintain a log of

any complaints that it receives relating to activities for which the Division

may revoke the license to operate a facility for the dependent pursuant to

subsection 2. The Division shall provide to a facility for the care of adults

during the day:

      (a) A summary of a complaint against the facility

if the investigation of the complaint by the Division either substantiates the

complaint or is inconclusive;

      (b) A report of any investigation conducted with

respect to the complaint; and

      (c) A report of any disciplinary action taken

against the facility.

Ê The facility

shall make the information available to the public pursuant to NRS 449.2486.

      4.  On or before February 1 of each

odd-numbered year, the Division shall submit to the Director of the Legislative

Counsel Bureau a written report setting forth, for the previous biennium:

      (a) Any complaints included in the log maintained

by the Division pursuant to subsection 3; and

      (b) Any disciplinary actions taken by the

Division pursuant to subsection 2.

      [Part 6:336:1951] + [Part 8:336:1951]—(NRS A 1963,

960; 1971, 936; 1973, 1284; 1975, 898; 1977, 257; 1981, 1220; 1987, 1783; 1989, 1662; 1991, 1079; 2001, 1350; 2003, 47, 857; 2007, 271; 2009, 1444;

2011, 357,

1065, 1358, 2253, 2396; 2013, 136, 2147, 3058)

      NRS 449.163  Administrative sanctions: Imposition by Division; disposition of

money collected.

      1.  In addition to the payment of the

amount required by NRS 449.0308, if a medical

facility or facility for the dependent violates any provision related to its

licensure, including any provision of NRS

439B.410 or 449.030 to 449.2428,

inclusive, or any condition, standard or regulation adopted by the Board, the

Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

      (a) Prohibit the facility from admitting any

patient until it determines that the facility has corrected the violation;

      (b) Limit the occupancy of the facility to the

number of beds occupied when the violation occurred, until it determines that

the facility has corrected the violation;

      (c) If the license of the facility limits the

occupancy of the facility and the facility has exceeded the approved occupancy,

require the facility, at its own expense, to move patients to another facility

that is licensed;

      (d) Impose an administrative penalty of not more

than $1,000 per day for each violation, together with interest thereon at a

rate not to exceed 10 percent per annum; and

      (e) Appoint temporary management to oversee the

operation of the facility and to ensure the health and safety of the patients

of the facility, until:

             (1) It determines that the facility has

corrected the violation and has management which is capable of ensuring

continued compliance with the applicable statutes, conditions, standards and

regulations; or

             (2) Improvements are made to correct the

violation.

      2.  If a violation by a medical facility or

facility for the dependent relates to the health or safety of a patient, an

administrative penalty imposed pursuant to paragraph (d) of subsection 1 must

be in a total amount of not less than $1,000 and not more than $10,000 for each

patient who was harmed or at risk of harm as a result of the violation.

      3.  If the facility fails to pay any

administrative penalty imposed pursuant to paragraph (d) of subsection 1, the

Division may:

      (a) Suspend the license of the facility until the

administrative penalty is paid; and

      (b) Collect court costs, reasonable attorney’s

fees and other costs incurred to collect the administrative penalty.

      4.  The Division may require any facility

that violates any provision of NRS

439B.410 or 449.030 to 449.2428,

inclusive, or any condition, standard or regulation adopted by the Board to

make any improvements necessary to correct the violation.

      5.  Any money collected as administrative

penalties pursuant to paragraph (d) of subsection 1 must be accounted for

separately and used to administer and carry out the provisions of NRS 449.001 to 449.430,

inclusive, and 449.435 to 449.965,

inclusive, and to protect the health, safety, well-being and property of the

patients and residents of facilities in accordance with applicable state and

federal standards.

      (Added to NRS by 1989, 863; A 1989, 1663; 2003, 858; 2009, 558, 1445; 2011, 358, 1066, 1359, 1806, 2254, 2397; 2013, 137, 2148, 3059)

      NRS 449.165  Administrative sanctions: Regulations of Board.  The Board shall adopt regulations establishing

the criteria for the imposition of each sanction prescribed by NRS 449.163. These regulations must:

      1.  Prescribe the circumstances and manner

in which each sanction applies;

      2.  Minimize the time between

identification of a violation and the imposition of a sanction;

      3.  Provide for the imposition of

incrementally more severe sanctions for repeated or uncorrected violations; and

      4.  Provide for less severe sanctions for

lesser violations of applicable state statutes, conditions, standards or

regulations.

      (Added to NRS by 1989, 864)

      NRS 449.170  Denial, suspension or revocation of license or imposition of

sanctions: Notice; appeal; adoption of regulations.

      1.  When the Division intends to deny,

suspend or revoke a license, or impose any sanction prescribed by NRS 449.163, it shall give reasonable notice to all

parties by certified mail. The notice must contain the legal authority, jurisdiction

and reasons for the action to be taken. Notice is not required if the Division

finds that the public health requires immediate action. In that case, it may

order a summary suspension of a license pursuant to this section and NRS 233B.127 or impose any sanction

prescribed by NRS 449.163, pending proceedings for

revocation or other action.

      2.  If a person wants to contest the action

of the Division, the person must file an appeal pursuant to regulations adopted

by the Board.

      3.  Upon receiving notice of an appeal, the

Division shall hold a hearing pursuant to regulations adopted by the Board.

      4.  The Board shall adopt such regulations

as are necessary to carry out the provisions of this section.

      [Part 8:336:1951]—(NRS A 1963, 960; 1969, 95; 1973,

1284; 1977, 70;

1985, 1741;

1989, 864; 1995, 1585; 2009, 558)

      NRS 449.171  Authority of Division to take control over medical records of

medical facility or facility for dependent upon suspension of license or

cessation of operation; confidentiality; sharing of records with appropriate

authorities.

      1.  If the Division suspends the license of

a medical facility or a facility for the dependent pursuant to the provisions

of this chapter, or if a facility otherwise ceases to operate, including,

without limitation, pursuant to an action or order of a health authority pursuant

to chapter 441A of NRS, the Division may,

if deemed necessary by the Administrator of the Division, take control of and

ensure the safety of the medical records of the facility.

      2.  Subject to the provisions of the Health

Insurance Portability and Accountability Act of 1996, Public Law 104-191, the

Division shall:

      (a) Maintain the confidentiality of the medical

records obtained pursuant to subsection 1.

      (b) Share medical records obtained pursuant to

subsection 1 with law enforcement agencies in this State and other governmental

entities which have authority to license the facility or to license the owners

or employees of the facility.

      (c) Release a medical record obtained pursuant to

subsection 1 to the patient or legal guardian of the patient who is the subject

of the medical record.

      3.  The Board shall adopt regulations to

carry out the provisions of this section, including, without limitation,

regulations for contracting with a person to maintain any medical records under

the control of the Division pursuant to subsection 1 and for payment by the

facility of the cost of maintaining medical records.

      (Added to NRS by 2009, 557)

      NRS 449.172  Residential facility for groups: Duties of Division and operator

upon suspension or revocation of license for abuse, neglect or isolation of

occupants.  If the Division

suspends or revokes the license of a person who operates a residential facility

for groups for abuse, neglect or isolation of the occupants of the facility,

the Division shall suspend or revoke the license of all residential facilities

for groups operated by that person. The person who operates the facility shall

move all of the persons who are receiving services in the residential

facilities for groups to other licensed residential facilities for groups at

his or her own expense.

      (Added to NRS by 1999, 3607)

      NRS 449.174  Additional grounds for denial, suspension or revocation of

license to operate certain facility, hospital, agency, program or home.

      1.  In addition to the grounds listed in NRS 449.160, the Division may deny a license to

operate a facility, hospital, agency, program or home to an applicant or may

suspend or revoke the license of a licensee to operate such a facility, hospital,

agency, program or home if:

      (a) The applicant or licensee has been convicted

of:

             (1) Murder, voluntary manslaughter or

mayhem;

             (2) Assault or battery with intent to kill

or to commit sexual assault or mayhem;

             (3) Sexual assault, statutory sexual

seduction, incest, lewdness or indecent exposure, or any other sexually related

crime that is punished as a felony;

             (4) Prostitution, solicitation, lewdness

or indecent exposure, or any other sexually related crime that is punished as a

misdemeanor, within the immediately preceding 7 years;

             (5) A crime involving domestic violence

that is punished as a felony;

             (6) A crime involving domestic violence

that is punished as a misdemeanor, within the immediately preceding 7 years;

             (7) Abuse or neglect of a child or

contributory delinquency;

             (8) A violation of any federal or state

law regulating the possession, distribution or use of any controlled substance

or any dangerous drug as defined in chapter 454

of NRS, within the immediately preceding 7 years;

             (9) Abuse, neglect, exploitation or

isolation of older persons or vulnerable persons, including, without

limitation, a violation of any provision of NRS

200.5091 to 200.50995, inclusive,

or a law of any other jurisdiction that prohibits the same or similar conduct;

             (10) A violation of any provision of law

relating to the State Plan for Medicaid or a law of any other jurisdiction that

prohibits the same or similar conduct, within the immediately preceding 7

years;

             (11) A violation of any provision of NRS 422.450 to 422.590, inclusive;

             (12) A criminal offense under the laws

governing Medicaid or Medicare, within the immediately preceding 7 years;

             (13) Any offense involving fraud, theft,

embezzlement, burglary, robbery, fraudulent conversion or misappropriation of

property, within the immediately preceding 7 years;

             (14) Any other felony involving the use or

threatened use of force or violence against the victim or the use of a firearm

or other deadly weapon; or

             (15) An attempt or conspiracy to commit

any of the offenses listed in this paragraph, within the immediately preceding

7 years;

      (b) The licensee has, in violation of NRS 449.125, continued to employ a person who has been

convicted of a crime listed in paragraph (a); or

      (c) The applicant or licensee has had a

substantiated report of child abuse or neglect made against him or her and if

the facility, hospital, agency, program or home provides residential services

to children.

      2.  In addition to the grounds listed in NRS 449.160, the Division may suspend or revoke the

license of a licensee to operate an agency to provide personal care services in

the home or an agency to provide nursing in the home if the licensee has, in

violation of NRS 449.125, continued to employ a

person who has been convicted of a crime listed in paragraph (a) of subsection

1.

      3.  As used in this section:

      (a) “Domestic violence” means an act described in

NRS 33.018.

      (b) “Facility, hospital, agency, program or home”

has the meaning ascribed to it in NRS 449.119.

      (c) “Medicaid” has the meaning ascribed to it in NRS 439B.120.

      (d) “Medicare” has the meaning ascribed to it in NRS 439B.130.

      (Added to NRS by 1997, 444; A 1999, 1948; 2005, 2171; 2007, 652, 2401; 2009, 506; 2013, 2895)—(Substituted

in revision for NRS 449.188)

Miscellaneous Provisions

      NRS 449.181  Medical facility that has custody of child pursuant to court

order to adopt policy relating to medical care and medications for child;

employees to receive copy of policy.

      1.  Except as otherwise provided in this

section, a medical facility that has custody of a child pursuant to the order

of a court shall adopt a policy concerning the manner in which to:

      (a) Document the orders of the treating physician

of a child;

      (b) Administer medication to a child;

      (c) Store, handle and dispose of medication;

      (d) Document the administration of medication and

any errors in the administration of medication;

      (e) Minimize errors in the administration of

medication; and

      (f) Address errors in the administration of

medication.

      2.  Such a medical facility shall ensure

that each employee of the medical facility who will administer medication to

such a child receives a copy of and understands the policy adopted pursuant to

subsection 1.

      (Added to NRS by 2011, 1357)

      NRS 449.183  Facility for intermediate care, facility for skilled nursing and

residential facility for groups to adopt written policy concerning readmission

after temporary transfer of patient or resident.

      1.  A facility for intermediate care,

facility for skilled nursing and residential facility for groups shall adopt a

written policy that establishes:

      (a) The number of days the facility will hold the

bed of a patient or resident for his or her return if the patient or resident

is transferred temporarily to a hospital or other facility for medical reasons;

and

      (b) That a patient or resident who is so

transferred for a period that exceeds the period of the hold established

pursuant to paragraph (a) will be allowed to resume his or her residency as

soon as a bed becomes available, if the facility is suitable for properly

caring for the patient upon his or her return.

      2.  Upon admission of a patient or resident

to a facility for intermediate care, facility for skilled nursing or

residential facility for groups, the facility shall provide to the patient or

resident and, if applicable, to the legal representative of the patient or

resident, a copy of the policy established pursuant to subsection 1.

      (Added to NRS by 2011, 1063)

      NRS 449.184  Operator of residential facility for groups, facility for

intermediate care or facility for skilled nursing to post certain information

in conspicuous place.

      1.  A person who operates a residential

facility for groups shall:

      (a) Post his or her license to operate the

residential facility for groups;

      (b) Post the rates for services provided by the

residential facility for groups; and

      (c) Post contact information for the

administrator and the designated representative of the owner or operator of the

facility,

Ê in a

conspicuous place in the residential facility for groups.

      2.  A person who operates a facility for

intermediate care or facility for skilled nursing shall:

      (a) Post his or her license to operate the

facility;

      (b) Post the organizational structure of the

management of the facility; and

      (c) Post contact information for the

administrator and the designated representative of the owner or operator of the

facility,

Ê in a

conspicuous place in the facility for intermediate care or facility for skilled

nursing.

      (Added to NRS by 1999, 3606; A 2011, 1064)—(Substituted

in revision for NRS 449.095)

      NRS 449.186  Supervision of residential facility for groups.  A residential facility for groups must not be

operated except under the supervision of an administrator of a residential

facility for groups licensed pursuant to the provisions of chapter 654 of NRS.

      (Added to NRS by 1993, 2144)—(Substituted

in revision for NRS 449.0355)

      NRS 449.187  Supervision of facility for skilled nursing or facility for

intermediate care.

      1.  Except as otherwise provided in

subsection 2, a facility for skilled nursing or facility for intermediate care

licensed pursuant to the provisions of NRS 449.030

to 449.2428, inclusive, may not be operated except

under the supervision of a nursing facility administrator who is at the facility

and licensed under the provisions of chapter 654

of NRS.

      2.  The provisions of subsection 1 do not

apply to a facility for intermediate care which limits its care and treatment

to those persons with intellectual disabilities or conditions related to

intellectual disabilities.

      (Added to NRS by 1969, 672; A 1971, 934; 1973, 1281; 1977, 1031; 1985, 1738; 1993, 1214; 2013, 697)

      NRS 449.189  Physician and nurse required to operate independent center to

provide emergency medical care.  An

independent center to provide emergency medical care shall not be operated

unless a physician and registered nurse are on the premises.

      (Added to NRS by 1985, 1735)—(Substituted

in revision for NRS 449.034)

      NRS 449.191  Medical facility not required to allow abortions.

      1.  A hospital or other medical facility

licensed under the provisions of this chapter which is not operated by the

State or a local government or an agency of either is not required to permit the

use of its facilities for the induction or performance of an abortion, except

in a medical emergency.

      2.  Such refusal does not give rise to a

cause of action in favor of any person.

      (Added to NRS by 1973, 897; A 1985, 1742)

      NRS 449.192  Admission of dentist to membership on medical staff of hospital.  No dentist may be:

      1.  Automatically admitted to membership on

the medical staff of a hospital solely because he or she is licensed as a

dentist in this state or is authorized pursuant to NRS 631.267 to perform certain functions;

or

      2.  Denied admission to membership on the

medical staff of a hospital merely because he or she is licensed as a dentist

and not as a physician.

      (Added to NRS by 1985, 2097)—(Substituted

in revision for NRS 449.032)

      NRS 449.193  Facility for intermediate care, facility for skilled nursing,

residential facility for groups or home for individual residential care to

provide itemized statement of charges upon request to certain persons.

      1.  Subject to the provisions of the Health

Insurance Portability and Accountability Act of 1996, Public Law 104-191, a

facility for intermediate care, facility for skilled nursing, residential

facility for groups or home for individual residential care shall, upon

request, provide an itemized statement of charges to:

      (a) The person who received care in the facility

or home;

      (b) The parent or guardian of the person who

received care in the facility or home; or

      (c) Any other natural person designated by the

person receiving care at the facility or home.

      2.  An itemized statement of charges

provided by a facility for intermediate care, facility for skilled nursing,

residential facility for groups or home for individual residential care

pursuant to subsection 1 must, without limitation:

      (a) Itemize the charges for services, care, food,

medicine and other supplies provided to the person receiving care at the

facility or home;

      (b) Identify the amount of payment allocated to

each charge;

      (c) Be provided in a manner that is

understandable to an ordinary person;

      (d) Be provided at no additional cost; and

      (e) Be provided in a timely manner.

      (Added to NRS by 2011, 2395)

      NRS 449.1935  Agency to provide personal care services in the home authorized

to provide certain services to certain persons.  An

agency to provide personal care services in the home that is licensed pursuant

to this section and NRS 449.030 to 449.2428, inclusive, may, through its employees or by

contractual arrangement with other persons, provide:

      1.  To persons with disabilities, any

medical services authorized pursuant to NRS

629.091; and

      2.  Nonmedical services related to personal

care to elderly persons or persons with disabilities to assist those persons

with activities of daily living, including, without limitation:

      (a) The elimination of wastes from the body;

      (b) Dressing and undressing;

      (c) Bathing;

      (d) Grooming;

      (e) The preparation and eating of meals;

      (f) Laundry;

      (g) Shopping;

      (h) Cleaning;

      (i) Transportation; and

      (j) Any other minor needs related to the

maintenance of personal hygiene.

      (Added to NRS by 2013, 134)

      NRS 449.194  Certain employees of agency to provide personal care services in

the home immune from civil liability resulting from rendering emergency care or

assistance.  Any person who is

employed by an agency to provide personal care services in the home who:

      1.  Has successfully completed a course in

cardiopulmonary resuscitation according to the guidelines of the American

National Red Cross or American Heart Association;

      2.  Has successfully completed the training

requirements of a course in basic emergency care of a person in cardiac arrest

conducted in accordance with the standards of the American Heart Association;

or

      3.  Has successfully completed the training

requirements of a course in the use and administration of first aid, including

cardiopulmonary resuscitation,

Ê and who in

good faith renders emergency care or assistance in accordance with the person’s

training, in the course of his or her regular employment or profession, to an

elderly person or a person with a disability, is not liable for any civil damages

as a result of any act or omission, not amounting to gross negligence, by that

person in rendering that care.

      (Added to NRS by 2013, 434)

      NRS 449.195  Waiver of deductible or copayment; conditions.  A medical facility shall not waive a

deductible or copayment if:

      1.  The medical facility is not a preferred

provider of health care; and

      2.  The waiver would reduce the financial

effect of a preferred provider’s incentive or disincentive to its insureds.

      (Added to NRS by 1987, 1783; A 1995, 1602)

      NRS 449.196  Requirements for program of hospice care.  No person, state or local government or agency

may represent that it provides “hospice care” unless the program of care,

either directly or indirectly:

      1.  Has a medical director whose

responsibilities are appropriate to the needs of the program and who:

      (a) Is a physician, currently licensed to

practice;

      (b) On the basis of training, experience and

interest, is knowledgeable about the psychosocial and medical aspects of

hospice; and

      (c) Acts as a medical resource to the

interdisciplinary team which provides the hospice care;

      2.  Is provided to the patient, as needed,

in the patient’s home, at a residential facility and at a medical facility, at

any time of the day or night;

      3.  Includes medical, nursing,

psychological and pastoral care and social services at the level required by

the patient’s condition;

      4.  Provides supportive services for the

patient’s immediate family and other persons with significant personal ties to

the patient, whether or not related by blood, including:

      (a) Care for the patient which provides a respite

from the stresses and responsibilities that result from the daily care of the

patient; and

      (b) Emotional support and other care after the

patient dies; and

      5.  Includes the services of trained

volunteers.

      (Added to NRS by 1989, 1034)—(Substituted

in revision for NRS 449.031)

      NRS 449.197  Provision of care by facility for hospice care.

      1.  A licensed facility for hospice care

may provide any of the following levels of care for terminally ill patients:

      (a) Medical care for a patient who is in an acute

episode of illness;

      (b) Skilled nursing care;

      (c) Intermediate care;

      (d) Custodial care; and

      (e) Palliative services.

      2.  A licensed facility for hospice care

may provide direct supportive services to a patient’s family and persons who

provide care for the patient, including services which provide care for the

patient during the day and other services which provide a respite from the

stresses and responsibilities that result from the daily care of the patient.

      (Added to NRS by 1989, 1034; A 1999, 249; 2005, 485)—(Substituted

in revision for NRS 449.0315)

      NRS 449.198  Requirements for obstetric center.  An

obstetric center must:

      1.  Provide sufficient space for members of

the family of the pregnant woman and other persons chosen by the woman to

assist her with the birth; and

      2.  Have obstetrical services available to

meet the needs of an acute patient.

      (Added to NRS by 1985, 1735)—(Substituted

in revision for NRS 449.036)

      NRS 449.199  Residential facility for groups and homes for individual

residential care prohibited from providing accommodations to persons not

meeting requirements for admission; exception.

      1.  Except as otherwise provided in

subsection 2, a residential facility for groups which is authorized to have 10

or fewer beds or a home for individual residential care shall not provide

accommodations for a person who does not meet the requirements for admission to

the facility or home.

      2.  A residential facility for groups which

is authorized to have 10 or fewer beds or a home for individual residential

care may provide accommodations for a person who is related within the third

degree of consanguinity to a resident of the facility or home regardless of

whether the person meets the requirements for admission to the facility or

home.

      (Added to NRS by 2009, 1441)—(Substituted

in revision for NRS 449.03555)

      NRS 449.201  Certification required for alcohol and drug abuse programs

operated or provided by facility for transitional living for released

offenders.  Each alcohol and drug

abuse program operated or provided by a facility for transitional living for released

offenders must be certified by the Division in accordance with the requirements

set forth in chapter 458 of NRS and any

regulations adopted pursuant thereto. As used in this section, “alcohol and

drug abuse program” has the meaning ascribed to it in NRS 458.010.

      (Added to NRS by 2005, 2350; A 2013, 3060)—(Substituted

in revision for NRS 449.0356)

      NRS 449.202  Classification of hospitals.

      1.  A hospital which provides only one or

two of the following categories of service:

      (a) Medical;

      (b) Surgical;

      (c) Obstetrical; or

      (d) Psychiatric,

Ê shall be

designated a medical hospital, surgical hospital, obstetrical hospital or

psychiatric hospital or combined-categories hospital, as the case may be.

      2.  When a hospital offers services in

medical, surgical and obstetrical categories, as a minimum, it shall be

designated a general hospital.

      (Added to NRS by 1971, 933; A 1973,

1280)—(Substituted in revision for NRS 449.021)

      NRS 449.203  Designation of hospital as primary stroke center; Division to

maintain list of hospitals so designated; regulations.

      1.  A hospital licensed pursuant to NRS 449.030 to 449.2428,

inclusive, may submit to the Division proof that the hospital is certified as a

primary stroke center by the Joint Commission, its successor organization or an

equivalent organization approved by the Division. Upon receiving proof that a

hospital is certified as a primary stroke center, the Division shall include

the hospital on the list established pursuant to subsection 2.

      2.  On or before July 1 of each year, the

Division shall post a list of the hospitals designated as primary stroke

centers on an Internet website maintained by the Division.

      3.  If a hospital wishes to be included as

a primary stroke center on the list established pursuant to subsection 2, the

hospital must annually resubmit the proof required pursuant to this section.

      4.  The Division may remove a hospital from

the list established pursuant to subsection 2 if the certificate recognizing

the hospital as a primary stroke center issued by the Joint Commission, its

successor organization or an equivalent organization, as applicable, is

suspended or revoked.

      5.  A hospital that is not included on the

list established pursuant to subsection 2 as a primary stroke center shall not

represent, advertise or imply that the hospital is designated as a primary

stroke center.

      6.  The provisions of this section do not

prohibit a hospital that is licensed pursuant to NRS

449.030 to 449.2428, inclusive, from providing

care to a victim of stroke if the hospital does not have a designation as a

primary stroke center.

      7.  The Board may adopt regulations to

carry out the provisions of this section and to designate hospitals with

similar certifications which are recognized by the Joint Commission, its

successor organization or an equivalent organization.

      (Added to NRS by 2011, 1363)

      NRS 449.2035  Designation of hospital as STEMI receiving center; Division to

maintain list of hospitals so designated; regulations.

      1.  A hospital licensed pursuant to NRS 449.030 to 449.2428,

inclusive, may submit to the Division proof that the hospital is accredited as

a STEMI receiving center. Upon receiving proof that a hospital is accredited as

a STEMI receiving center, the Division shall include the hospital on the list

established pursuant to subsection 2.

      2.  On or before July 1 of each year, the

Division shall post a list of all hospitals designated as STEMI receiving

centers on an Internet website maintained by the Division.

      3.  If a hospital wishes to be included as

a STEMI receiving center on the list established pursuant to subsection 2, the

hospital must annually resubmit the proof required pursuant to this section.

      4.  The Division may remove a hospital from

the list established pursuant to subsection 2 if the accreditation recognizing

the hospital as a STEMI receiving center is suspended or revoked.

      5.  A hospital that is not included on the

list established pursuant to subsection 2 shall not represent, advertise or

imply that the hospital is designated as a STEMI receiving center.

      6.  The provisions of this section do not

prohibit a hospital that is licensed pursuant to NRS

449.030 to 449.2428, inclusive, from providing

care to a victim of a heart attack if the hospital does not have a designation

as a STEMI receiving center.

      7.  The Board may adopt regulations to

carry out the provisions of this section and to designate hospitals with

accreditations similar to those required for designation as a STEMI receiving

center.

      8.  As used in this section:

      (a) “STEMI” means a myocardial infarction as

indicated by an abnormal elevation of the ST segment of an electrocardiogram

that is administered to a patient.

      (b) “STEMI receiving center” means a hospital

that is accredited by the Society of Cardiovascular Patient Care, in

conjunction with the initiative developed by the American Heart Association

known as the “Mission: Lifeline initiative,” or an equivalent organization

approved by the Division, as having met specific standards of performance in

the receipt and treatment of a patient with STEMI.

      (Added to NRS by 2013, 507)

      NRS 449.204  Misleading name or other designation of facility prohibited.  The name, sign, listing or other designation

of a medical facility or facility for the dependent must not contain any terms

misleading to the public with regard to the services offered.

      (Added to NRS by 1973, 1279; A 1975, 367; 1985, 1738)—(Substituted

in revision for NRS 449.026)

Prohibited Acts; Penalties

      NRS 449.205  Retaliation or discrimination against employees and certain

other persons: Prohibition under certain circumstances; medical facility

prohibited from restricting right to make report or take certain other actions.

      1.  A medical facility or any agent or

employee thereof shall not retaliate or discriminate unfairly against:

      (a) An employee of the medical facility or a

person acting on behalf of the employee who in good faith:

             (1) Reports to the Board of Medical

Examiners or the State Board of Osteopathic Medicine, as applicable,

information relating to the conduct of a physician which may constitute grounds

for initiating disciplinary action against the physician or which otherwise

raises a reasonable question regarding the competence of the physician to

practice medicine with reasonable skill and safety to patients;

             (2) Reports a sentinel event to the

Division pursuant to NRS 439.835; or

             (3) Cooperates or otherwise participates

in an investigation or proceeding conducted by the Board of Medical Examiners,

the State Board of Osteopathic Medicine or another governmental entity relating

to conduct described in subparagraph (1) or (2); or

      (b) A registered nurse, licensed practical nurse,

nursing assistant or medication aide - certified who is employed by or contracts

to provide nursing services for the medical facility and who:

             (1) In accordance with the policy, if any,

established by the medical facility:

                   (I) Reports to his or her immediate

supervisor, in writing, that he or she does not possess the knowledge, skill or

experience to comply with an assignment to provide nursing services to a

patient; and

                   (II) Refuses to provide to a patient

nursing services for which, as verified by documentation in the personnel file

of the registered nurse, licensed practical nurse, nursing assistant or

medication aide - certified concerning his or her competence to provide various

nursing services, he or she does not possess the knowledge, skill or experience

to comply with the assignment to provide nursing services to the patient,

unless the refusal constitutes unprofessional conduct as set forth in chapter 632 of NRS or any regulations adopted

pursuant thereto;

             (2) In accordance with a policy adopted

pursuant to NRS 449.2423, requests to be relieved

of, refuses or objects to a work assignment;

             (3) In good faith, reports to the medical

facility, the Board of Medical Examiners, the State Board of Osteopathic

Medicine, the State Board of Nursing, the Legislature or any committee thereof

or any other governmental entity:

                   (I) Any information concerning the

willful conduct of another registered nurse, licensed practical nurse, nursing

assistant or medication aide - certified which violates any provision of chapter 632 of NRS or which is required to be

reported to the State Board of Nursing;

                   (II) Any concerns regarding patients

who may be exposed to a substantial risk of harm as a result of the failure of

the medical facility or any agent or employee thereof to comply with minimum

professional or accreditation standards or applicable statutory or regulatory

requirements; or

                   (III) Any other concerns regarding

the medical facility, the agents and employees thereof or any situation that

reasonably could result in harm to patients; or

             (4) Refuses to engage in conduct that

would violate the duty of the registered nurse, licensed practical nurse,

nursing assistant or medication aide - certified to protect patients from

actual or potential harm, conduct which would violate any provision of chapter 632 of NRS or conduct which would

subject the registered nurse, licensed practical nurse, nursing assistant or

medication aide - certified to disciplinary action by the State Board of

Nursing.

      2.  A medical facility or any agent or

employee thereof shall not retaliate or discriminate unfairly against an

employee of the medical facility or a registered nurse, licensed practical

nurse, nursing assistant or medication aide - certified who is employed by or

contracts to provide nursing services for the medical facility because the

employee, registered nurse, licensed practical nurse, nursing assistant or

medication aide - certified has taken an action described in subsection 1.

      3.  A medical facility or any agent or

employee thereof shall not prohibit, restrict or attempt to prohibit or

restrict by contract, policy, procedure or any other manner the right of an

employee of the medical facility or a registered nurse, licensed practical

nurse, nursing assistant or medication aide - certified who is employed by or

contracts to provide nursing services for the medical facility to take an

action described in subsection 1.

      4.  As used in this section:

      (a) “Good faith” means honesty in fact in the

reporting of the information or in the cooperation in the investigation

concerned.

      (b) “Physician” means a person licensed to

practice medicine pursuant to chapter 630 or 633 of NRS.

      (c) “Retaliate or discriminate”:

             (1) Includes, without limitation, any of

the following actions if taken solely because the employee, registered nurse,

licensed practical nurse, nursing assistant or medication aide - certified took

an action described in subsection 1:

                   (I) Frequent or undesirable changes

in the location where the person works;

                   (II) Frequent or undesirable transfers

or reassignments;

                   (III) The issuance of letters of

reprimand, letters of admonition or evaluations of poor performance;

                   (IV) A demotion;

                   (V) A reduction in pay;

                   (VI) The denial of a promotion;

                   (VII) A suspension;

                   (VIII) A dismissal;

                    (IX) A transfer; or

                   (X) Frequent changes in working

hours or workdays.

             (2) Does not include an action described

in sub-subparagraphs (I) to (X), inclusive, of subparagraph (1) if the action

is taken in the normal course of employment or as a form of discipline.

      (Added to NRS by 2002

Special Session, 16; A 2005, 1517; 2009, 1418;

2011, 1338;

2013, 2148)

      NRS 449.207  Retaliation or discrimination against employees and certain

other persons: Violation; civil action for certain acts of retaliation or

discrimination; damages; equitable relief; rebuttable presumption; civil

penalty; time limit for bringing action.

      1.  An employee of

a medical facility or a registered nurse, licensed practical nurse, nursing

assistant or medication aide - certified who is employed by or contracts to

provide nursing services for the medical facility and who believes that he or she

has been retaliated or discriminated against in violation of NRS 449.205 may file an action in a court of competent

jurisdiction.

      2.  If a court determines that a violation

of NRS 449.205 has occurred, the court may award

such damages as it determines to have resulted from the violation, including,

without limitation:

      (a) Compensatory damages;

      (b) Reimbursement of any wages, salary,

employment benefits or other compensation denied to or lost by the employee,

registered nurse, licensed practical nurse, nursing assistant or medication

aide - certified as a result of the violation;

      (c) Attorney’s fees and costs, including, without

limitation, fees for expert witnesses; and

      (d) Punitive damages, if the facts warrant.

      3.  The court shall award interest on the

amount of damages at a rate determined pursuant to NRS 17.130.

      4.  The court may grant any equitable

relief it considers appropriate, including, without limitation, reinstatement

of the employee, registered nurse, licensed practical nurse, nursing assistant

or medication aide - certified and any temporary, preliminary or permanent

injunctive relief.

      5.  If any action to retaliate or

discriminate is taken against an employee, registered nurse, licensed practical

nurse, nursing assistant or medication aide - certified within 60 days after

the employee, registered nurse, licensed practical nurse, nursing assistant or

medication aide - certified takes any action described in subsection 1 of NRS 449.205, there is a rebuttable presumption that

the action taken against the employee, registered nurse, licensed practical

nurse, nursing assistant or medication aide - certified constitutes retaliation

or discrimination in violation of NRS 449.205.

      6.  A medical facility or any agent or

employee thereof that violates the provisions of NRS

449.205 is subject to a civil penalty of not more than $10,000 for each

violation. The Attorney General or any district attorney of this State may

recover the penalty in a civil action brought in the name of the State of

Nevada in any court of competent jurisdiction.

      7.  Any action under this section must be

brought not later than 2 years after the date of the last event constituting

the alleged violation for which the action is brought.

      8.  As used in this section, “retaliate or

discriminate” has the meaning ascribed to it in NRS

449.205.

      (Added to NRS by 2002

Special Session, 17; A 2005, 1518; 2009, 1420;

2011, 1339)

      NRS 449.208  Retaliation or discrimination against employees or certain other

persons: Written notice regarding protections and legal remedies for certain

acts of retaliation or discrimination; posting of notice; inclusion of notice

in employee handbook.

      1.  A medical facility shall prepare a

written notice for the employees of the medical facility and for the nurses,

nursing assistants and medication aides - certified who contract with the

medical facility regarding the protections provided for actions taken pursuant

to subsection 1 of NRS 449.205 and the legal remedy

provided pursuant to NRS 449.207. The notice must

include the process by which an employee, nurse, nursing assistant or

medication aide - certified may make a report pursuant to subsection 1 of NRS 449.205.

      2.  A medical facility shall:

      (a) Post in one or more conspicuous places at the

medical facility the notice prepared pursuant to subsection 1; and

      (b) Include the text of the written notice in any

manual or handbook that the medical facility provides to employees, nurses,

nursing assistants and medication aides - certified who contract with the

medical facility concerning employment practices at the medical facility.

      (Added to NRS by 2009, 557;

A 2011,

1340)

      NRS 449.209  Prohibition against medical facility or employee of medical

facility making certain referrals to residential facilities for groups; civil

penalties; system to track violations.

      1.  In addition to the requirements and

prohibitions set forth in NRS 449.0305, and

notwithstanding any exceptions set forth in that section, a licensed medical

facility or an employee of such a medical facility shall not:

      (a) Refer a person to a residential facility for

groups that is not licensed by the Division; or

      (b) Refer a person to a residential facility for

groups if the licensed medical facility or its employee knows or reasonably

should know that the residential facility for groups, or the services provided

by the residential facility for groups, are not appropriate for the condition

of the person being referred.

      2.  If a licensed medical facility or an

employee of such a medical facility violates the provisions of subsection 1,

the licensed medical facility is liable for a civil penalty to be recovered by

the Attorney General in the name of the Board for the first offense of not more

than $10,000 and for a second or subsequent offense of not less than $10,000 or

more than $20,000. Unless otherwise required by federal law, the Board shall

deposit all civil penalties collected pursuant to this section into a separate

account in the State General Fund to be used for the enforcement of this

section and the protection of the health, safety, well-being and property of

residents of residential facilities for groups.

      3.  The Board shall:

      (a) Establish and maintain a system to track

violations of this section and NRS 449.0305.

Except as otherwise provided in this paragraph, records created by or for the

system are public records and are available for public inspection. The

following information is confidential:

             (1) Any personally identifying information

relating to a person who is referred to a residential facility for groups.

             (2) Information which may not be disclosed

under federal law.

      (b) Educate the public regarding the requirements

and prohibitions set forth in this section and NRS

449.0305.

      4.  As used in this section, “licensed

medical facility” means:

      (a) A medical facility that is required to be

licensed pursuant to this section and NRS 449.030

to 449.2428, inclusive.

      (b) A facility for the dependent that is required

to be licensed pursuant to this section and NRS 449.030

to 449.2428, inclusive.

      (c) A facility that provides medical care or

treatment and is required by regulation of the Board to be licensed pursuant to

NRS 449.0303.

      (Added to NRS by 2011, 704)

      NRS 449.210  Penalties for unlicensed operation: Medical facility or facility

for dependent; residential facility for groups or home for individual

residential care.

      1.  In addition to the payment of the

amount required by NRS 449.0308, except as

otherwise provided in subsection 2 and NRS 449.24897,

a person who operates a medical facility or facility for the dependent without

a license issued by the Division is guilty of a misdemeanor.

      2.  In addition to the payment of the

amount required by NRS 449.0308, if a person

operates a residential facility for groups or a home for individual residential

care without a license issued by the Division, the Division shall:

      (a) Impose a civil penalty on the operator in the

following amount:

             (1) For a first offense, $10,000.

             (2) For a second offense, $25,000.

             (3) For a third or subsequent offense,

$50,000.

      (b) Order the operator, at the operator’s own

expense, to move all of the persons who are receiving services in the

residential facility for groups or home for individual residential care to a

residential facility for groups or home for individual residential care, as

applicable, that is licensed.

      (c) Prohibit the operator from applying for a

license to operate a residential facility for groups or home for individual

residential care, as applicable. The duration of the period of prohibition must

be:

             (1) For 6 months if the operator is

punished pursuant to subparagraph (1) of paragraph (a).

             (2) For 1 year if the operator is punished

pursuant to subparagraph (2) of paragraph (a).

             (3) Permanent if the operator is punished

pursuant to subparagraph (3) of paragraph (a).

      3.  Before the Division imposes an

administrative sanction pursuant to subsection 2, the Division shall provide

the operator of a residential facility for groups with reasonable notice. The

notice must contain the legal authority, jurisdiction and reasons for the

action to be taken. If the operator of a residential facility for groups wants

to contest the action, the operator may file an appeal pursuant to the

regulations of the State Board of Health adopted pursuant to NRS 449.165 and 449.170.

Upon receiving notice of an appeal, the Division shall hold a hearing in

accordance with those regulations. For the purpose of this subsection, it is no

defense to the violation of operating a residential facility for groups without

a license that the operator thereof subsequently licensed the facility in

accordance with law.

      4.  Unless otherwise required by federal

law, the Division shall deposit all civil penalties collected pursuant to

paragraph (a) of subsection 2 into a separate account in the State General Fund

to be used to administer and carry out the provisions of NRS

449.001 to 449.430, inclusive, and 449.935 to 449.965,

inclusive, and to protect the health, safety, well-being and property of the

patients and residents of facilities and homes for individual residential care

in accordance with applicable state and federal standards.

      [10:336:1951]—(NRS A 1967, 581; 1971, 936; 1973,

1285; 1985,

1742; 1999,

3609; 2009,

452; 2011,

358, 700,

1806; 2013, 137, 3060)

      NRS 449.220  Action to enjoin violations.

      1.  The Division may bring an action in the

name of the State to enjoin any person, state or local government unit or

agency thereof from operating or maintaining any facility within the meaning of

NRS 449.030 to 449.2428,

inclusive:

      (a) Without first obtaining a license therefor;

or

      (b) After his or her license has been revoked or

suspended by the Division.

      2.  It is sufficient in such action to

allege that the defendant did, on a certain date and in a certain place,

operate and maintain such a facility without a license.

      [Part 6:336:1951]—(NRS A 1963, 961; 1971, 937; 1973,

1285; 2009,

1446; 2011,

359, 1067,

1360, 2255, 2398)

      NRS 449.240  Institution and conduct of prosecutions.  The district attorney of the county in which

the facility is located shall, upon application by the Division, institute and

conduct the prosecution of any action for violation of any provisions of NRS 449.030 to 449.245,

inclusive.

      [Part 8:336:1951]—(NRS A 1963, 962; 1971, 937; 1973,

1286; 1975, 899; 2009, 1446;

2011, 359,

1360, 2256, 2399)

REQUIREMENTS RELATING TO STAFFING

      NRS 449.241  Definitions.  As

used in NRS 449.241 to 449.2428,

inclusive, unless the context otherwise requires, the words and terms defined

in NRS 449.2413 to 449.2418,

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

      (Added to NRS by 2009, 2024;

A 2013,

2150)

      NRS 449.2413  “Certified nursing assistant” defined.  “Certified

nursing assistant” means a person who has been certified by the State Board of

Nursing pursuant to NRS 632.2852 to

practice as a nursing assistant in this State.

      (Added to NRS by 2013, 2143)

      NRS 449.2414  “Health care facility” defined.  “Health

care facility” means:

      1.  A hospital;

      2.  An independent center for emergency

medical care;

      3.  A psychiatric hospital; and

      4.  A surgical center for ambulatory

patients.

      (Added to NRS by 2009, 2024)

      NRS 449.2416  “Licensed nurse” defined.  “Licensed

nurse” means a person licensed pursuant to chapter

632 of NRS to practice nursing, including, without limitation, a licensed

practical nurse. The term does not include a certified nursing assistant or a

medication aide - certified.

      (Added to NRS by 2009, 2024;

A 2011,

1341; 2013,

2150)

      NRS 449.2418  “Unit” defined.  “Unit”

means a component within a health care facility for providing patient care.

      (Added to NRS by 2009, 2024)

      NRS 449.242  Establishment of staffing committee by certain hospitals in

larger counties; membership; duty to develop documented staffing plan; duty to

consider certain requests; quarterly meetings; reporting to Legislature.

      1.  Each hospital located in a county whose

population is 100,000 or more and which is licensed to have more than 70 beds

shall establish a staffing committee to develop a written policy as required

pursuant to NRS 449.2423 and a documented staffing

plan as required pursuant to NRS 449.2421. The

staffing committee must consist of:

      (a) Not less than one-half of the total members

of the staffing committee from the licensed nursing staff and certified nursing

assistants who are providing direct patient care at the hospital; and

      (b) Not less than one-half of the total members

of the staffing committee appointed by the administration of the hospital.

      2.  In developing the written policy and

the staffing plan, the staffing committee shall consider, without limitation,

the information received pursuant to paragraph (b) of subsection 5 of NRS 449.2423 regarding requests to be relieved of a

work assignment, refusals of a work assignment and objections to a work

assignment.

      3.  The staffing committee of a hospital

shall meet at least quarterly.

      4.  Each hospital that is required to

establish a staffing committee pursuant to this section shall prepare a written

report concerning the establishment of the staffing committee, the activities

and progress of the staffing committee and a determination of the efficacy of

the staffing committee. The hospital shall submit the report on or before

December 31 of each:

      (a) Even-numbered year to the Director of the

Legislative Counsel Bureau for transmission to the next regular session of the

Legislature.

      (b) Odd-numbered year to the Legislative

Committee on Health Care.

      (Added to NRS by 2009, 2024;

A 2013,

2151)

      NRS 449.2421  Certain health care facilities in larger counties required to

make available to Division written policy that allows refusal of or objection

to work assignments and documented staffing plan; requirements of staffing plan

and flexibility for adjustments.

      1.  As a condition of licensing, a health

care facility located in a county whose population is 100,000 or more and which

is licensed to have more than 70 beds shall make available to the Division a

written policy adopted pursuant to NRS 449.2423, a

documented staffing plan and a written certification that the written policy

and the documented staffing plan are adequate to meet the needs of the patients

of the health care facility. The documented staffing plan must include, without

limitation:

      (a) A detailed written plan setting forth:

             (1) The number, skill mix and

classification of licensed nurses required in each unit in the health care

facility, which must take into account the experience of the clinical and

nonclinical support staff with whom the licensed nurses collaborate, supervise

or otherwise delegate assignments; and

             (2) The number of certified nursing

assistants required in each unit in the health care facility;

      (b) A description of the types of patients who

are treated in each unit, including, without limitation, the type of care

required by the patients;

      (c) A description of the activities in each unit,

including, without limitation, discharges, transfers and admissions;

      (d) A description of the size and geography of

each unit;

      (e) A description of any specialized equipment

and technology available for each unit;

      (f) Any foreseeable changes in the size or

function of each unit; and

      (g) Protocols for adequately staffing the health

care facility:

             (1) In the event of an emergency,

including, without limitation, mass casualties and a significant change in the

acuity or number of patients;

             (2) If applicable, in circumstances when a

significant number of patients are diverted from another facility; and

             (3) If a licensed nurse or certified

nursing assistant is absent or refuses a work assignment pursuant to NRS 449.2423.

      2.  A documented staffing plan must provide

sufficient flexibility to allow for adjustments based upon changes in a unit of

the health care facility.

      3.  The health care facility shall ensure

that it is staffed in accordance with the documented staffing plan.

      (Added to NRS by 2009, 2025;

A 2013,

2151)

      NRS 449.2423  Certain health care facilities in larger counties to adopt

written policy to allow nurse or certified nursing assistant to refuse or

object to work assignments; requirements of policy; maintenance of records of

refusals of and objections to work assignments.

      1.  As a condition of licensure, a health

care facility which is located in a county whose population is 100,000 or more

and which is licensed to have more than 70 beds must adopt and disseminate to

each licensed nurse and certified nursing assistant employed by the health care

facility a written policy that sets forth the circumstances under which a

licensed nurse or certified nursing assistant may refuse or object to a work

assignment.

      2.  The written policy concerning work

assignments must, at a minimum, allow a licensed nurse or certified nursing assistant

to:

      (a) Refuse a work assignment for any reason for

refusal set forth in paragraph (b) of subsection 1 of NRS

449.205; and

      (b) File an objection to a work assignment if the

work assignment violates any provision of NRS 449.241

to 449.2428, inclusive.

      3.  For the purposes of refusing a work

assignment pursuant to paragraph (a) of subsection 2, the written policy

concerning work assignments must contain:

      (a) Reasonable requirements for prior notice to

the supervisor of the licensed nurse or certified nursing assistant of the

request by the licensed nurse or certified nursing assistant to be relieved of

the work assignment, including, without limitation, the reasons supporting the

request;

      (b) Reasonable requirements which provide, if

feasible, an opportunity for the supervisor to review a request by the licensed

nurse or certified nursing assistant to be relieved of the work assignment,

including any specific conditions supporting the request, and based upon that

review:

             (1) Relieve the licensed nurse or

certified nursing assistant of the work assignment as requested; or

             (2) Deny the request; and

      (c) A process pursuant to which a licensed nurse

or certified nursing assistant may exercise his or her right to refuse a work

assignment if the supervisor does not approve the request to be relieved of the

work assignment if:

             (1) The supervisor failed to approve the

request without proposing a remedy or, if a remedy is proposed, the proposed

remedy would be inadequate or untimely;

             (2) The process for filing a complaint

with the Division or any other appropriate regulatory entity, including any

investigation that would be required, would be untimely to address the concerns

of the licensed nurse or certified nursing assistant in refusing a work

assignment; and

             (3) The licensed nurse or certified

nursing assistant in good faith believes that the work assignment meets the

conditions established in the written policy justifying refusal.

      4.  For the purposes of objecting to a work

assignment pursuant to paragraph (b) of subsection 2, the written policy

concerning work assignments must contain:

      (a) A process for a licensed nurse or certified

nursing assistant to file an objection with the health care facility, but still

accept the work assignment despite the objection; and

      (b) A requirement that the health care facility

respond to the objection as soon as practicable, but not later than 45 days

after receiving the objection.

      5.  The health care facility shall:

      (a) Maintain records for at least 2 years of each

request to be relieved of a work assignment, each refusal of a work assignment

and each objection to a work assignment that is filed with the health care

facility pursuant to the written policy adopted pursuant to this section;

      (b) If the health care facility has established a

staffing committee pursuant to NRS 449.242, provide

to the staffing committee:

             (1) The number of requests to be relieved

of a work assignment and refusals of a work assignment made by a licensed nurse

or a certified nursing assistant at the health care facility pursuant to this

section;

             (2) The number of objections to a work

assignment filed by a licensed nurse or a certified nursing assistant at the

health care facility pursuant to this section; and

             (3) An explanation of how the health care

facility addressed the requests, refusals and objections; and

      (c) Ensure that the health care facility complies

with the written policy adopted pursuant to this section.

      (Added to NRS by 2013, 2143)

      NRS 449.2428  Division required to ensure that certain health care facilities

comply with provisions; regulations.  For

each health care facility which is located in a county whose population is

100,000 or more and which is licensed to have more than 70 beds, the Division

shall:

      1.  Ensure the general compliance of the

health care facility with the provisions of NRS 449.241

to 449.2428, inclusive, including, without

limitation, those provisions relating to documented staffing plans and written

policies adopted pursuant to NRS 449.2423; and

      2.  Adopt such regulations as are necessary

or appropriate to carry out the provisions of this section.

      (Added to NRS by 2013, 2145)

MISCELLANEOUS PROVISIONS

      NRS 449.243  Itemized list of charges required; use of Uniform Billing and

Claims Forms authorized; contracted rates; summary of charges.  Every hospital licensed pursuant to the

provisions of NRS 449.030 to 449.2428, inclusive:

      1.  May, except as otherwise provided in

subsection 2, utilize the Uniform Billing and Claims Forms established by the

American Hospital Association.

      2.  Shall, except as otherwise provided in

this section, on its billings to patients, itemize, on a daily basis, all

charges for services, and charges for equipment used and the supplies and

medicines provided incident to the provision of those services with specificity

and in language that is understandable to an ordinary lay person. This itemized

list must be timely provided after the patient is discharged at no additional

cost.

      3.  Except as otherwise provided in this

subsection, if a patient is charged a rate, pursuant to a contract or other

agreement, that is different than the billed charges, shall provide to the

patient either:

      (a) A copy of the billing prepared pursuant to

subsection 2;

      (b) A statement specifying the agreed rate for

the services; or

      (c) If the patient is not obligated to pay any

portion of the bill, a statement of the total charges.

Ê In any case,

the hospital shall include on the billing or statement any copayment or

deductible for which the patient is responsible. The hospital shall answer any

questions regarding the bill.

      4.  If the hospital is paid by the insurer

of a patient a rate that is based on the number of persons treated and not on

the services actually rendered, shall, upon the discharge of the patient,

advise the patient of the status of any copayment or deductible for which the

patient is responsible.

      5.  Shall prepare a summary of charges for

common services for patients admitted to the hospital and make it available to

the public.

      6.  Shall provide to any patient upon

request a copy of the billing prepared pursuant to subsection 2.

      (Added to NRS by 1975, 897; A 1983, 649; 1985, 905; 1993, 2427; 1995, 1856)

      NRS 449.244  Certain costs for examination or treatment of victims of sexual

offenses to be charged to county.  Repealed.

(See chapter 142, Statutes of Nevada 2013, at page 487.)

 

      NRS 449.245  Release of child from hospital; provision of authorization for

release and other information to Division of Child and Family Services;

disclosure of information; penalty.

      1.  No hospital licensed under the

provisions of NRS 449.030 to 449.2428, inclusive, may release from the hospital or

otherwise surrender physical custody of any child under 6 months of age, whose

living parent or guardian is known to the hospital, to any person other than a

parent, guardian or relative by blood or marriage of that child, without a

written authorization signed by a living parent, who must be the mother if

unwed, or guardian specifying the particular person or agency to whom the child

may be released and the permanent address of that person or agency.

      2.  Upon the release or other surrender of

physical custody of the child, the hospital shall require from the person to

whom the child is released such reasonable proof of identity as the hospital

may deem necessary for compliance with the provisions of this section. The

hospital shall furnish a true copy of the written authorization to the Division

of Child and Family Services of the Department of Health and Human Services

before the release or other surrender by it of physical custody of the child.

The copy must be furnished to the Division immediately upon receipt by the

hospital.

      3.  Any person to whom any such child is

released who thereafter surrenders physical custody of that child to any other

person or agency shall, upon demand by the Division of Child and Family

Services, disclose to the Division the name and permanent address of the person

or agency to whom physical custody of the child was delivered.

      4.  Except as otherwise provided in NRS 239.0115, all information received by

the Division of Child and Family Services pursuant to the provisions of this

section is confidential and must be protected from disclosure in the same

manner that information is protected under NRS

432.035.

      5.  Compliance with the provisions of this

section is not a substitute for compliance with NRS 127.220 to 127.310, inclusive, governing placements

for adoption and permanent free care.

      6.  A violation of any provision of this

section is a misdemeanor.

      (Added to NRS by 1957, 251; A 1961, 739; 1963, 962;

1967, 1172; 1973, 1286, 1406; 1981, 721; 1993, 2724; 2007, 2109)

      NRS 449.2455  Authority of hospital to enter into agreement with Armed Forces

of United States for provision of medical care by certain medical officers.

      1.  A hospital may enter into an agreement

with the Armed Forces of the United States to authorize a medical officer to

provide medical care in the hospital if:

      (a) The medical officer holds a valid license in

good standing to provide such medical care in the District of Columbia or any

state or territory of the United States;

      (b) The medical care is provided as part of a

training or educational program designed to further the employment of the

medical officer; and

      (c) The agreement complies with the provisions of

10 U.S.C. § 1094 and any regulations or guidelines adopted pursuant thereto.

      2.  As used in this section, “medical

officer” includes any physician, nurse, dentist or other health care

professional who is employed by the Armed Forces of the United States or a

reserve component thereof.

      (Added to NRS by 2009, 818)

      NRS 449.246  Hospital or obstetric center to provide information relating to

voluntary acknowledgment or establishment of paternity before discharging

unmarried woman who has borne child; regulations.

      1.  Before discharging an unmarried woman

who has borne a child, a hospital or obstetric center shall provide to the

child’s mother and father:

      (a) The opportunity to sign, in the hospital, a

declaration for the voluntary acknowledgment of paternity developed pursuant to

NRS 440.283;

      (b) Written materials about establishing

paternity;

      (c) The forms necessary to acknowledge paternity

voluntarily;

      (d) A written description of the rights and

responsibilities of acknowledging paternity; and

      (e) The opportunity to speak by telephone with

personnel of the program for enforcement of child support who are trained to

clarify information and answer questions about the establishment of paternity.

      2.  The Administrator of the Division of

Welfare and Supportive Services of the Department of Health and Human Services

shall adopt the regulations necessary to ensure that the services provided by a

hospital or obstetric center pursuant to this section are in compliance with

the regulations adopted by the Secretary of Health and Human Services pursuant

to 42 U.S.C. § 666(a)(5)(C).

      (Added to NRS by 1995, 2426; A 1997, 2341; 2007, 1529)

      NRS 449.2465  Persons entitled to results of tests performed at laboratory

regarding patient of rural hospital.  The

following persons are entitled to access the results of tests performed at a

licensed laboratory regarding a patient of a rural hospital:

      1.  The patient;

      2.  The physician who ordered the tests;

and

      3.  A provider of health care who is

currently treating or providing assistance in the treatment of the patient.

      (Added to NRS by 1995, 1600)

      NRS 449.247  Powers and duties of Division and State Board of Nursing with

respect to nursing assistants and medication aides - certified and training of

nursing assistants and medication aides - certified; provision of information

to State Board of Nursing.

      1.  The Division may review the personnel

files of a medical facility or facility for the dependent to determine that

each nursing assistant or medication aide - certified employed by the facility

has a current certificate.

      2.  The Division shall review the

qualifications of instructors of nursing assistants or medication aides -

certified for each program of which the Division is notified pursuant to NRS 632.127.

      3.  The Division may conduct the review of

training programs for nursing assistants or medication aides - certified in

facilities for long-term care.

      4.  The Division and any other state agency

which regulates medical facilities and facilities for the dependent shall

provide to the State Board of Nursing any information it discovers concerning:

      (a) Programs and instructors for training nursing

assistants or medication aides - certified which do not comply with the

requirements established by the State Board of Nursing.

      (b) The failure of a nursing assistant or

medication aide - certified to perform consistently at a safe level.

      (c) The results of any investigation of a

facility if the investigation concerns a nursing assistant, medication aide -

certified or instructor or training program for nursing assistants or

medication aides - certified.

      5.  The State Board of Nursing shall

investigate any report submitted pursuant to subsection 4 and may revoke

approval of a program or instructor if the allegations of the report are true.

      (Added to NRS by 1989, 2017; A 2011, 1341)

      NRS 449.2475  Unlicensed insurer not allowed to make payment directly to

person who received services in certain circumstances; limitation on civil and

criminal liability.

      1.  An insurer that is not licensed in this

State pursuant to title 57 of NRS and that is obligated to pay benefits for

services provided to a person by a hospital or other provider of health care,

or to reimburse a person for the costs of such services, shall not make the

payment directly to the person if an itemized statement for the services is

submitted to the insurer which clearly indicates that the right of the person

to those benefits has been assigned to the hospital or other provider of health

care.

      2.  The provisions of this section do not

create grounds for civil or criminal liability.

      (Added to NRS by 2007, 734)

      NRS 449.248  Additional services to be provided by agency to provide nursing

in home.  An agency to provide

nursing in the home shall, in addition to skilled nursing, provide at least one

of the following services:

      1.  Speech or occupational therapy;

      2.  Guidance regarding nutrition or

vocations;

      3.  Physical therapy;

      4.  Pharmaceutical services; or

      5.  Other social or medical services.

      (Added to NRS by 1979, 160; A 1985, 1742)

      NRS 449.2485  Return to dispensing pharmacy of unused prescription drug

dispensed to patient of facility for skilled nursing or facility for

intermediate care for purpose of reissuing drug or transferring drug.

      1.  A facility for skilled nursing or a

facility for intermediate care may return a prescription drug that is dispensed

to a patient of the facility, but will not be used by that patient, to the

dispensing pharmacy for the purpose of reissuing the drug to fill other

prescriptions for patients in that facility or for the purpose of transferring

the drug to a nonprofit pharmacy designated by the State Board of Pharmacy

pursuant to NRS 639.2676 if:

      (a) The drug is not a controlled substance;

      (b) The drug is dispensed in a unit dose, in

individually sealed doses or in a bottle sealed by the manufacturer of the

drug;

      (c) The drug is returned unopened and sealed in

the original manufacturer’s packaging or bottle;

      (d) The usefulness of the drug has not expired;

      (e) The packaging or bottle contains the

expiration date of the usefulness of the drug; and

      (f) The name of the patient for whom the drug was

originally prescribed, the prescription number and any other identifying marks

are obliterated from the packaging or bottle before the return of the drug.

      2.  A dispensing pharmacy to which a drug

is returned pursuant to this section may:

      (a) Reissue the drug to fill other prescriptions

for patients in the same facility if the registered pharmacist of the pharmacy

determines that the drug is suitable for that purpose in accordance with

standards adopted by the State Board of Pharmacy pursuant to subsection 5; or

      (b) Transfer the drug to a nonprofit pharmacy

designated by the State Board of Pharmacy pursuant to NRS 639.2676.

      3.  No drug that is returned to a

dispensing pharmacy pursuant to this section may be used to fill other

prescriptions more than one time.

      4.  A facility for skilled nursing or

facility for intermediate care shall adopt written procedures for returning

drugs to a dispensing pharmacy pursuant to this section. The procedures must:

      (a) Provide appropriate safeguards for ensuring

that the drugs are not compromised or illegally diverted during their return.

      (b) Require the maintenance and retention of such

records relating to the return of drugs to dispensing pharmacies as are

required by the State Board of Pharmacy.

      (c) Be approved by the State Board of Pharmacy.

      5.  The State Board of Pharmacy shall adopt

such regulations as are necessary to carry out the provisions of this section,

including, without limitation, requirements for:

      (a) Returning and reissuing such drugs pursuant

to the provisions of this section.

      (b) Transferring drugs to a nonprofit pharmacy

pursuant to the provisions of this section and NRS 639.2676.

      (c) Maintaining records relating to the return

and the use of such drugs to fill other prescriptions.

      (Added to NRS by 2003, 1372; A 2009, 1087)

      NRS 449.2486  Facility for care of adults during the day to maintain and

provide certain information; form in which information to be provided.

      1.  A facility for the care of adults

during the day shall maintain a copy of:

      (a) The license issued to the facility pursuant

to NRS 449.030 to 449.2428,

inclusive;

      (b) Any summaries of complaints provided to the

facility pursuant to subsection 3 of NRS 449.160;

      (c) The report of any investigation conducted

with respect to the complaints; and

      (d) The report of any disciplinary action taken

against the facility pursuant to NRS 449.160 or 449.163.

      2.  The information maintained pursuant to

subsection 1 must be provided in the form prescribed pursuant to subsection 3:

      (a) To each patient or the patient’s legal

representative, at or before the time of admission.

      (b) To a prospective patient or the prospective

patient’s legal representative, upon request, who is considering admission of

the patient to the facility.

      (c) In the case of disciplinary action taken

pursuant to NRS 449.160 or 449.163,

to all patients admitted to the facility and their legal representatives.

Notice of disciplinary action must be provided to the legal representatives of

all patients admitted to the facility within 3 working days after receipt by

the facility.

      3.  The Division shall develop a standard

form for reporting the information required to be provided pursuant to

subsection 2. The information reported on the form must include all required

information for the 12-month period ending on the last day of the month

immediately preceding the month in which the information is provided.

      4.  The Division shall inform persons

seeking information concerning facilities for the care of adults during the day

of their right to information pursuant to this section.

      (Added to NRS by 2007, 270)

      NRS 449.2487  Notice to be provided by certain facilities which offer

independent living.

      1.  A facility for the dependent, a medical

facility or an entity affiliated with such a facility which offers housing to

persons that does not include the provision of care or services which require

licensure pursuant to this chapter shall conspicuously post in the facility and

shall include in any contracts of sale or agreements for occupancy a notice

that includes the following information:

      (a) That the specific area of the facility is

intended for independent living and does not directly provide or coordinate the

oversight of services to meet the scheduled and unscheduled needs of its

residents, including, without limitation, the provision of personal care,

supportive services and health-related services.

      (b) The other levels of care that are available

to persons who require personal care, supportive services or health-related

services, including, without limitation, residential facilities for groups,

facilities for intermediate care and facilities for skilled nursing. The notice

must describe the facilities and levels of care in language that is easy to

understand.

      (c) A statement that encourages residents to

reassess on a regular basis the type of housing and care that is most

appropriate for them.

      2.  The Aging and Disability Services

Division of the Department of Health and Human Services shall develop the

language for the notice required by subsection 1 in consultation with

nationally recognized advocacy groups for older persons and housing

organizations.

      3.  For the purposes of this section, an

entity is affiliated with a facility described in subsection 1 if:

      (a) It is under common or shared ownership;

      (b) It is under common or shared management; or

      (c) It receives promotional or marketing support

from the facility.

      (Added to NRS by 2007, 2466; A 2011, 359)

      NRS 449.2488  Department to develop brochure and website to assist persons who

are 55 years of age or older in determining appropriate level of care and type

of housing; information to be included in brochure and website.

      1.  The Department of Health and Human

Services shall develop a brochure and website to assist persons who are 55

years of age or older in determining the appropriate level of care and type of

housing that they require to meet their individual needs. The brochure and

website must include, without limitation:

      (a) The various types of housing and levels of

care that are available to persons who are 55 years of age or older, including,

without limitation, residential facilities for groups, facilities for

intermediate care and facilities for skilled nursing, distinguishing the

varying degree of services that are offered by the different types of facilities;

      (b) Whether individual facilities accept payment

through Medicaid or Medicare for the level of care and type of housing that the

facilities provide;

      (c) The manner in which a person may obtain

information concerning whether the facility has ever been found to have

violated the provisions of this chapter; and

      (d) Such other information as the Department

deems to be beneficial to persons who are 55 years of age or older in

determining the appropriate level of care and type of housing that they require

to meet their individual needs.

      2.  As used in this section:

      (a) “Medicaid” has the meaning ascribed to it in NRS 439B.120.

      (b) “Medicare” has the meaning ascribed to it in NRS 439B.130.

      (Added to NRS by 2007, 2467)

FACILITIES FOR REFRACTIVE SURGERY

      NRS 449.2489  Definitions.  As

used in NRS 449.2489 to 449.24898,

inclusive, unless the context otherwise requires, the words and terms defined

in NRS 449.24891 to 449.24894,

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

      (Added to NRS by 2009, 450)

      NRS 449.24891  “Ophthalmologist” defined.  “Ophthalmologist”

means a physician who is qualified to perform laser surgery or intense pulsed

light therapy on the globe of the eye pursuant to NRS 630.371 or 633.693.

      (Added to NRS by 2009, 450)

      NRS 449.24892  “Postoperative care” defined.  “Postoperative

care” means assessing, monitoring or treating a patient while the patient is

recovering or healing from a surgical treatment for a refractive error of the

eye.

      (Added to NRS by 2009, 451)

      NRS 449.24893  “Preoperative care” defined.  “Preoperative

care” means assessing or treating a patient in preparation for a surgical

treatment for a refractive error of the eye.

      (Added to NRS by 2009, 451)

      NRS 449.24894  “Surgical treatment for a refractive error of the eye” defined.  “Surgical treatment for a refractive error of

the eye” means the surgical treatment of a patient with a refractive error of

the eye by:

      1.  Photorefractive keratectomy;

      2.  Laser in situ keratomileusis;

      3.  Conductive keratoplasty;

      4.  Implantation of an intraocular lens; or

      5.  Any other available technology,

technique or procedure which surgically treats refractive errors of the eye and

which has been approved by the United States Food and Drug Administration.

      (Added to NRS by 2009, 451)

      NRS 449.24895  Certain persons not required to obtain license to operate and

maintain facility; filing of affidavit with Division required.  A person is not required to obtain a license

to operate and maintain a facility for refractive surgery pursuant to the

provisions of this chapter if the person:

      1.  Is an ophthalmologist;

      2.  Provides surgical procedures to

patients at the facility in addition to preoperative care, postoperative care

and surgical treatments for refractive errors of the eye; and

      3.  Files with the Division an affidavit

attesting that the person provides surgical procedures at the facility in

addition to preoperative care, postoperative care and surgical treatments for

refractive errors of the eye.

      (Added to NRS by 2009, 451)

      NRS 449.24896  Surgical treatments at facility must be performed by licensed

ophthalmologist; availability of ophthalmologist.  A

facility for refractive surgery shall ensure that:

      1.  All surgical treatments for refractive

errors of the eye performed at the facility are performed only by an

ophthalmologist.

      2.  The ophthalmologist who performs a

surgical treatment for refractive errors of the eye at the facility:

      (a) Is available in person for postoperative care

if the medical needs of a patient necessitate the services of an

ophthalmologist; or

      (b) Enters into an agreement with another

ophthalmologist to be available in person for postoperative care if the medical

needs of the patient necessitate the services of an ophthalmologist.

      (Added to NRS by 2009, 451)

      NRS 449.24897  Order to cease and desist operation for failure to obtain

license; injunction; penalties.

      1.  If the Division believes that a person

who is required to obtain a license pursuant to this chapter is operating a

facility for refractive surgery without such a license, the Division may issue

an order to cease and desist the operation of the facility. The order must be

served upon the person directly or by certified or registered mail, return

receipt requested. The order becomes effective upon service.

      2.  An order issued pursuant to subsection

1 expires 30 days after the date of service unless the Division institutes an

action in a court of competent jurisdiction seeking an injunction.

      3.  Upon a showing by the Division that a

person is operating a facility for refractive surgery without a license issued

pursuant to this chapter, a court of competent jurisdiction may:

      (a) Enjoin the person from operating the

facility.

      (b) Impose a civil penalty to be recovered by the

Division of not more than $10,000 for the first offense and of not less than

$10,000 or more than $20,000 for a second or subsequent offense.

      4.  A person enjoined or penalized pursuant

to subsection 3 may not apply for a license to operate a facility for

refractive surgery for a period of 6 months after the date on which the court

issues the injunction or penalty.

      (Added to NRS by 2009, 451)

      NRS 449.24898  Collaboration between ophthalmologist and optometrist authorized

pursuant to NRS 636.374.  The provisions of NRS

449.2489 to 449.24898, inclusive, do not

prohibit an ophthalmologist from collaborating with an optometrist to provide

care to a patient if the collaboration complies with the requirements of NRS 636.374.

      (Added to NRS by 2009, 452)

NEVADA HEALTH FACILITIES ASSISTANCE ACT

      NRS 449.250  Short title.  NRS 449.250 to 449.430,

inclusive, may be cited as the Nevada Health Facilities Assistance Act.

      [1:219:1949; 1943 NCL § 5285.01]—(NRS A 1965, 983; 2011, 3575)

      NRS 449.260  Definitions.  As

used in NRS 449.250 to 449.430,

inclusive:

      1.  “Community mental health center” means

a facility providing services for the prevention or diagnosis of mental

illness, or care and treatment of patients with mental illness, or

rehabilitation of such persons, which services are provided principally for

persons residing in a particular community in or near which the facility is

situated.

      2.  “Construction” includes the

construction of new buildings, modernization, expansion, remodeling and

alteration of existing buildings, and initial equipment of such buildings,

including medical transportation facilities, and includes architects’ fees, but

excludes the cost of off-site improvements and, except with respect to public

health centers, the cost of the acquisition of the land.

      3.  “Facility for persons with intellectual

disabilities” means a facility specially designed for the diagnosis, treatment,

education, training or custodial care of persons with intellectual

disabilities, including facilities for training specialists and sheltered

workshops for persons with intellectual disabilities, but only if such

workshops are part of facilities which provide or will provide comprehensive

services for persons with intellectual disabilities.

      4.  “Federal Act” means 42 U.S.C. §§ 291 to

291o-l, inclusive, and 300k to 300t, inclusive, and any other federal law

providing for or applicable to the provision of assistance for health

facilities.

      5.  “Federal agency” means the federal

department, agency or official designated by law, regulation or delegation of

authority to administer the Federal Act.

      6.  “Health facility” includes a public

health center, hospital, facility for hospice care, facility for persons with

intellectual disabilities, community mental health center, and other facility

to provide diagnosis, treatment, care, rehabilitation, training or related

services to persons with physical or mental impairments, including diagnostic

or diagnostic and treatment centers, rehabilitation facilities and nursing

homes, as those terms are defined in the Federal Act, and such other facilities

for which federal aid may be authorized under the Federal Act, but, except for

facilities for persons with intellectual disabilities, does not include any

facility furnishing primarily domiciliary care.

      7.  “Nonprofit health facility” means any

health facility owned and operated by a corporation or association, no part of

the net earnings of which inures or may lawfully inure to the benefit of any

private shareholder or natural person.

      8.  “Public health center” means a publicly

owned facility for the provision of public health services, including related

facilities such as laboratories, clinics and administrative offices operated in

connection with public health centers.

      9.  “State Department” means the Department

of Health and Human Services, acting through its appropriate divisions.

      [2:219:1949; A 1956, 47]—(NRS A 1963, 962; 1965, 983;

1967, 1173; 1973, 1406; 1975, 909; 1977, 258; 1979, 1113; 1985, 1743; 1989, 1036; 1999, 249; 2011, 3575;

2013, 697)

      NRS 449.270  State Department to constitute sole agency of State for certain

purposes.  The State Department

shall constitute the sole agency of the State for the purpose of:

      1.  Inventorying existing health

facilities, surveying the need for construction of health facilities, and

developing programs of health facilities construction as provided in NRS 449.250 to 449.430,

inclusive.

      2.  Developing and administering state

plans for the construction of public and other nonprofit health facilities as

provided in NRS 449.250 to 449.430,

inclusive.

      3.  Developing and administering any other

plan or program providing assistance to health facilities for which funds may

be available to this state under the Federal Act.

      [3:219:1949; 1943 NCL § 5285.03]—(NRS A 1965, 985)

      NRS 449.280  Duties of State Department.  In

carrying out the purposes of NRS 449.250 to 449.430, inclusive, the State Department is authorized

and directed:

      1.  To require such reports, make such

inspections and investigations, and prescribe such regulations as it deems

necessary.

      2.  To provide such methods of

administration, appoint all necessary officers and other personnel and take

such other action as may be necessary to comply with the requirements of NRS 449.250 to 449.430,

inclusive, the Federal Act and the regulations thereunder.

      3.  To procure in its discretion the

temporary or intermittent services of experts or consultants, by contract, when

such services are to be performed on a part-time or fee-for-service basis and

do not involve the performance of administrative duties.

      4.  To the extent that it considers

desirable to effectuate the purposes of NRS 449.250

to 449.430, inclusive, to enter into agreements for

the utilization of the facilities and services of other departments, agencies

and institutions, public or private.

      5.  To accept on behalf of the State and to

deposit with the State Treasurer in appropriate accounts in the Department of

Health and Human Services’ Gift Fund any grant, gift or contribution made to

assist in meeting the cost of carrying out the purposes of NRS 449.250 to 449.430,

inclusive, and to expend the same for such purposes.

      6.  To do all other things on behalf of the

State necessary or advisable to obtain the maximum benefits available under the

Federal Act.

      7.  All claims must be approved by the

Health Officer before they are paid.

      [4:219:1949; 1943 NCL § 5285.04]—(NRS A 1965, 985;

1969, 945; 1981,

79)

      NRS 449.300  Inventory of existing health facilities; development of program

for construction of facilities.  The

State Department is authorized and directed to inventory existing health

facilities, including public, nonprofit, and proprietary health facilities, to

survey the need for construction of health facilities, and, on the basis of

such inventory and survey, to develop programs for the construction of such

public and other nonprofit health facilities as will, in conjunction with

existing facilities, afford the necessary physical facilities for furnishing

adequate health facility services to all the people of the State.

      [7:219:1949; 1943 NCL § 5285.07]—(NRS A 1965, 986)

      NRS 449.310  Requirements of program for construction of health facilities.  The construction programs must provide, in

accordance with NRS 449.250 to 449.430, inclusive, and the regulations thereunder,

for adequate health facilities for the people residing in this State, and,

insofar as possible, must provide for their distribution throughout the State

in such manner as to make the services of all types of health facilities

reasonably accessible to all persons in the State.

      [9:219:1949; 1943 NCL § 5285.09]—(NRS A 1965, 986; 1981, 1901)

      NRS 449.320  Application for federal money; deposit of money.

      1.  The State Department may apply to the

federal agency for federal money to assist in carrying out the surveys,

planning and construction activities provided for in NRS

449.250 to 449.430, inclusive.

      2.  The money must be deposited in the

State Treasury and must be available to the State Department for expenditure

for carrying out the purposes of NRS 449.250 to 449.430, inclusive.

      [8:219:1949; 1943 NCL § 5285.08]—(NRS A 1965, 987; 1981, 1901)

      NRS 449.340  State Department to prescribe minimum standards; standards to

supersede local ordinances and regulations; penalty.

      1.  The State Department may, by

regulation, establish standards for the maintenance and operation of health

facilities, which supersede all local ordinances and regulations inconsistent

therewith.

      2.  A copy of the regulations, giving the

date that they take effect, must be issued in pamphlet form.

      3.  Any health facility that applies for

and accepts federal aid for construction under a state plan does so on the

condition that the health facility qualify under the minimum standards for

maintenance and operation adopted and enforced by the State Department.

      4.  Any person, partnership, association or

corporation establishing, conducting, managing or operating any health facility

within the meaning of NRS 449.250 to 449.430, inclusive, who violates any of the provisions

of this section or regulations lawfully adopted thereunder is guilty of a

misdemeanor.

      [11:219:1949; 1943 NCL § 5285.11] + [12:219:1949;

1943 NCL § 5285.12]—(NRS A 1963, 963; 1965, 987; 1971, 937; 1985, 369)

      NRS 449.345  Restriction on adoption of regulations concerning construction,

maintenance, operation or safety of building, structure or other property.  Before the State Department may adopt any

regulation concerning the construction, maintenance, operation or safety of a

building, structure or other property in this State, the State Department shall

consult with the Deputy Administrator of the Public Works - Compliance and Code

Enforcement Section for the purposes of subsection 9 of NRS 341.100.

      (Added to NRS by 2011, 3574;

A 2013, 397)

      NRS 449.360  Application for construction of health facility: Filing;

compliance with federal and state requirements.

      1.  Applications for health facility

construction projects for which federal funds are required must be submitted to

the appropriate health systems agency and the State Department. They may be

submitted by the State or any political subdivision thereof or by any public or

nonprofit agency authorized to construct and operate a health facility.

      2.  Each application for a construction

project must conform to federal and state requirements and must be submitted in

the manner and form prescribed by the State Department.

      [14:219:1949; 1943 NCL § 5285.14]—(NRS A 1965, 988; 1979, 969)

      NRS 449.370  Application for construction of health facility: Notice and

hearing; approval and forwarding.

      1.  The State Department shall afford to

every applicant for assistance for a construction project an opportunity for a

fair hearing before the State Department upon 10 days’ written notice to the

applicant.

      2.  If the State Department, after

affording reasonable opportunity for development and presentation of

applications in the order of relative need, finds that an application is in

conformity with the state plan, the State Department shall approve the

application and shall recommend and forward it to the federal agency.

      3.  The State Department shall consider and

forward applications in the order of relative need set forth in the state plan.

      [15:219:1949; 1943 NCL § 5285.15]—(NRS A 1965, 988; 1981, 856; 1985, 1362)

      NRS 449.380  Inspection of construction of health facility; certification by

State Department.  From time to

time, the State Department shall inspect each construction project approved by

the federal agency and, if the inspection so warrants, the State Department

shall certify to the federal agency that work has been performed upon the

project, or that purchases have been made, in accordance with the approved

plans and specifications, and that payment of an installment of federal funds

is due to the applicant.

      [16:219:1949; 1943 NCL § 5285.16]—(NRS A 1965, 988)

      NRS 449.390  Authority to receive and distribute federal money; Health Facilities

Assistance Fund; deposits, use and controls.

      1.  The State Department is hereby

authorized to receive federal funds in behalf of, and transmit them to,

applicants.

      2.  There is hereby established a

nonreverting trust fund designated as the Health Facilities Assistance Fund.

Money received from the Federal Government for a construction project approved

by the federal agency shall be transmitted to the State Treasurer to be

deposited in the State Treasury to the credit of the Health Facilities Assistance

Fund, and shall be used solely for payments due applicants for work performed,

purchases made or other approved expenditures in carrying out approved projects

or plans, except that any moneys in such Fund which become available under the

Federal Act and regulations for expenditure in administering an approved state

plan may be expended for that purpose.

      3.  The State Department shall establish

and maintain such accounts and fiscal controls of moneys deposited in and

disbursed from the Health Facilities Assistance Fund as may be required by the

Federal Act and regulations promulgated thereunder.

      [17:219:1949; 1943 NCL § 5285.17]—(NRS A 1965, 988;

1975, 259)

      NRS 449.400  State Public Health Facilities Construction Assistance Fund:

Creation; administration.

      1.  In order to provide state assistance

for construction projects for publicly owned general hospitals, hospitals for

the chronically ill and impaired, facilities for persons with intellectual

disabilities, community mental health facilities, diagnostic or diagnostic and

treatment centers, rehabilitation facilities, nursing homes and other

facilities financed in part by federal funds in accordance with NRS 449.250 to 449.430,

inclusive, and to promote maximum utilization of federal funds available for

such projects, there is hereby created in the State Treasury a nonreverting

trust fund to be known as the State Public Health Facilities Construction

Assistance Fund. Money for the Fund may be provided from time to time by

legislative appropriation.

      2.  The State Public Health Facilities

Construction Assistance Fund must be administered by the State Department in

accordance with the purposes and provisions of NRS

449.250 to 449.430, inclusive.

      [17.1:219:1949; added 1956, 47]—(NRS A 1965, 989; 1985, 1744; 2013, 698)

      NRS 449.410  State assistance for construction of certain projects;

eligibility of project for assistance.

      1.  Money in the State Public Health

Facilities Construction Assistance Fund must be used to supplement money from

the Federal Government and money provided by the sponsor of a project for

approved projects for the construction of publicly owned general hospitals,

hospitals for the chronically ill or impaired, facilities for persons with

intellectual disabilities, community mental health facilities, diagnostic or

diagnostic and treatment centers, rehabilitation facilities, nursing homes and

other facilities financed in part by federal funds pursuant to NRS 449.250 to 449.430,

inclusive, and for no other purpose or purposes.

      2.  Applications for state assistance for

construction projects must be submitted to the State Department for consideration

in the manner prescribed in NRS 449.250 to 449.430, inclusive, for applications for federal

assistance.

      3.  No project is entitled to receive state

assistance unless it is entitled to receive federal assistance.

      [17.2:219:1949; added 1956, 47]—(NRS A 1965, 989; 1985, 1744; 2013, 698)

      NRS 449.420  Amount of state assistance: Allocations; payments.  Money in the State Public Health Facilities

Construction Assistance Fund must be allocated and paid to construction

projects on the basis of relative need in accordance with the need identified

in the state health plan and in accordance with a ratio between state money and

federal money determined by the State Department. In no event may the amount of

state assistance made available or paid out for a project exceed the amount

supplied by the sponsor of the project.

      [17.3:219:1949; added 1956, 47]—(NRS A 1965, 989; 1981, 856, 1901)

      NRS 449.430  Money from State Public Health Facilities Construction

Assistance Fund to be paid in installments.  Moneys

in the State Public Health Facilities Construction Assistance Fund allocated to

a particular approved project shall be paid out in installments at the same

times and in the same manner as installments of federal funds are paid out from

the Health Facilities Assistance Fund pursuant to NRS 449.390.

      [17.4:219:1949; added 1956, 47]—(NRS A 1965, 990)

INTERMEDIARY SERVICE ORGANIZATIONS

General Provisions

      NRS 449.4304  “Intermediary service organization” defined.  As used in NRS 449.4304

to 449.4339, inclusive, unless the context

otherwise requires, “intermediary service organization” means a nongovernmental

entity that provides services authorized pursuant to NRS

449.4308 for a person with a disability or other responsible person.

      (Added to NRS by 2013, 126)

      NRS 449.4308  Authority to provide services.

      1.  An intermediary service organization

that is certified pursuant to NRS 449.4304 to 449.4339, inclusive, may provide services for a

person with a disability or other responsible person relating to personal

assistance received by the person with a disability. The services that may be

provided by an intermediary service organization include, without limitation:

      (a) Obtaining a criminal background check of a

personal assistant selected by the person with a disability or other

responsible person to provide nonmedical services and any medical services

authorized pursuant to NRS 629.091;

      (b) Providing payroll services to pay the

personal assistant and determine any tax liability;

      (c) Providing services relating to financial

management; and

      (d) Providing any other services relating to the

employment of a personal assistant and any other financial assistance relating

to the personal assistance for the person with a disability.

      2.  As used in this section:

      (a) “Other responsible person” means:

             (1) A parent or guardian of, or any other

person legally responsible for, a person with a disability who is under the age

of 18 years; or

             (2) A parent, spouse, guardian or adult

child of a person with a disability who suffers from a cognitive impairment.

      (b) “Personal assistance” means the provision of

any goods or services to help a person with a disability maintain his or her

independence, personal hygiene and safety, including, without limitation, the

provision of services by a personal assistant.

      (c) “Personal assistant” means a person who, for

compensation and under the direction of a person with a disability or other

responsible person, performs services for a person with a disability to help

the person maintain his or her independence, personal hygiene and safety.

      (Added to NRS by 2013, 126)

Certification

      NRS 449.431  Certificate required; exception; penalty.

      1.  Except as otherwise provided in

subsection 2, a person shall not operate or maintain in this State an

intermediary service organization without first obtaining a certificate to

operate an intermediary service organization as provided in NRS 449.4304 to 449.4339,

inclusive.

      2.  A person who is licensed to operate an

agency to provide personal care services in the home pursuant to this chapter

is not required to obtain a certificate to operate an intermediary service

organization as described in this section.

      3.  A person who violates the provisions of

this section is guilty of a misdemeanor.

      (Added to NRS by 2013, 126)

      NRS 449.4311  Application for certificate: Contents.  Any

person wishing to obtain a certificate to operate an intermediary service

organization pursuant to the provisions of NRS

449.4304 to 449.4339, inclusive, must file

with the Division an application on a form prescribed, prepared and furnished

by the Division, containing:

      1.  The name of the applicant and, if a

natural person, whether the applicant has attained the age of 21 years.

      2.  The location of the intermediary

service organization.

      3.  The name of the person in charge of the

intermediary service organization.

      4.  Such other information as may be

required by the Division for the proper administration and enforcement of NRS 449.4304 to 449.4339,

inclusive.

      5.  Evidence satisfactory to the Division

that the applicant is of reputable and responsible character. If the applicant

is a firm, association, organization, partnership, business trust, corporation

or company, similar evidence must be submitted as to the members thereof, and

the person in charge of the intermediary service organization for which

application is made.

      6.  Evidence satisfactory to the Division

of the ability of the applicant to comply with the provisions of NRS 449.4304 to 449.4339,

inclusive, and the standards and regulations adopted by the Board.

      (Added to NRS by 2013, 127)

      NRS 449.4312  Application for certificate: Social security number required.

[Effective until the date of the repeal of 42 U.S.C. § 666, the federal law

requiring each state to establish procedures for withholding, suspending and

restricting the professional, occupational and recreational licenses for child

support arrearages and for noncompliance with certain processes relating to

paternity or child support proceedings.]  An

application for the issuance of a certificate to operate an intermediary

service organization pursuant to NRS 449.4311 must

include the social security number of the applicant.

      (Added to NRS by 2013, 127)

      NRS 449.4313  Application for certificate: Statement regarding obligation of

child support; grounds for denial; duty of Division. [Effective until the date

of the repeal of 42 U.S.C. § 666, the federal law requiring each state to

establish procedures for withholding, suspending and restricting the

professional, occupational and recreational licenses for child support

arrearages and for noncompliance with certain processes relating to paternity

or child support proceedings.]

      1.  An applicant for the issuance or

renewal of a certificate to operate an intermediary service organization must

submit to the Division the statement prescribed by the Division of Welfare and

Supportive Services of the Department pursuant to NRS 425.520. The statement must be

completed and signed by the applicant.

      2.  The Division shall include the

statement required pursuant to subsection 1 in:

      (a) The application or any other forms that must

be submitted for the issuance or renewal of the certificate; or

      (b) A separate form prescribed by the Division.

      3.  A certificate as an intermediary

service organization may not be issued or renewed by the Division if the applicant:

      (a) Fails to submit the statement required

pursuant to subsection 1; or

      (b) Indicates on the statement submitted pursuant

to subsection 1 that the applicant is subject to a court order for the support

of a child and is not in compliance with the order or a plan approved by the

district attorney or other public agency enforcing the order for the repayment

of the amount owed pursuant to the order.

      4.  If an applicant indicates on the

statement submitted pursuant to subsection 1 that the applicant is subject to a

court order for the support of a child and is not in compliance with the order

or a plan approved by the district attorney or other public agency enforcing

the order for the repayment of the amount owed pursuant to the order, the

Division shall advise the applicant to contact the district attorney or other

public agency enforcing the order to determine the actions that the applicant

may take to satisfy the arrearage.

      (Added to NRS by 2013, 127)

      NRS 449.4314  Application for certificate: Fee.  Each

application for a certificate to operate an intermediary service organization

must be accompanied by such fee as may be determined by regulation of the

Board. The Board may, by regulation, allow or require payment of a fee for a

certificate in installments and may fix the amount of each payment and the date

on which the payment is due.

      (Added to NRS by 2013, 128)

      NRS 449.4317  Issuance of certificate; nontransferability.

      1.  The Division shall issue the

certificate to operate an intermediary service organization to the applicant

if, after investigation, the Division finds that the:

      (a) Applicant is in full compliance with the

provisions of NRS 449.4304 to 449.4339, inclusive; and

      (b) Applicant is in substantial compliance with

the standards and regulations adopted by the Board.

      2.  A certificate applies only to the

person to whom it is issued and is not transferable.

      (Added to NRS by 2013, 128)

      NRS 449.4318  Form and contents of certificate.  Each

certificate to operate an intermediary service organization issued by the

Division pursuant to NRS 449.4304 to 449.4339, inclusive, must be in the form prescribed

by the Division and must contain:

      1.  The name of the person or persons

authorized to operate the intermediary service organization;

      2.  The location of the intermediary

service organization; and

      3.  The services offered by the intermediary

service organization.

      (Added to NRS by 2013, 128)

      NRS 449.4319  Expiration and renewal of certificate.

      1.  Each certificate to operate an

intermediary service organization issued pursuant to NRS

449.4304 to 449.4339, inclusive, expires on

December 31 following its issuance and is renewable for 1 year upon

reapplication and payment of all fees required pursuant to NRS 449.4314 unless the Division finds, after an investigation,

that the intermediary service organization has not satisfactorily complied with

the provisions of NRS 449.4304 to 449.4339, inclusive, or the standards and regulations

adopted by the Board.

      2.  Each reapplication for an intermediary

service organization must include, without limitation, a statement that the

organization is in compliance with the provisions of NRS

449.4329 to 449.4332, inclusive.

      (Added to NRS by 2013, 128)

      NRS 449.432  Application for renewal of certificate: Information concerning

business license required; conditions which require denial.

      1.  In addition to any other requirements

set forth in NRS 449.4304 to 449.4339, inclusive, an applicant for the renewal of

a certificate as an intermediary service organization must indicate in the

application submitted to the Division whether the applicant has a state

business license. If the applicant has a state business license, the applicant

must include in the application the state business license number assigned by

the Secretary of State upon compliance with the provisions of chapter 76 of NRS.

      2.  A certificate as an intermediary

service organization may not be renewed by the Division if:

      (a) The applicant fails to submit the information

required by subsection 1; or

      (b) The State Controller has informed the

Division pursuant to subsection 5 of NRS

353C.1965 that the applicant owes a debt to an agency that has been

assigned to the State Controller for collection and the applicant has not:

             (1) Satisfied the debt;

             (2) Entered into an agreement for the

payment of the debt pursuant to NRS

353C.130; or

             (3) Demonstrated that the debt is not

valid.

      3.  As used in this section:

      (a) “Agency” has the meaning ascribed to it in NRS 353C.020.

      (b) “Debt” has the meaning ascribed to it in NRS 353C.040.

      (Added to NRS by 2013, 2730)

      NRS 449.4321  Grounds for denial, suspension or revocation of certificate.  The Division may deny an application for a

certificate to operate an intermediary service organization or may suspend or

revoke any certificate issued under the provisions of NRS

449.4304 to 449.4339, inclusive, upon any of

the following grounds:

      1.  Violation by the applicant or the

holder of a certificate of any of the provisions of NRS

449.4304 to 449.4339, inclusive, or of any

other law of this State or of the standards, rules and regulations adopted

thereunder.

      2.  Aiding, abetting or permitting the

commission of any illegal act.

      3.  Conduct inimical to the public health,

morals, welfare and safety of the people of the State of Nevada in the

operation of an intermediary service organization.

      4.  Conduct or practice detrimental to the

health or safety of a person under contract with or employees of the

intermediary service organization.

      (Added to NRS by 2013, 128)

      NRS 449.4322  Suspension of certificate for failure to pay child support or

comply with certain subpoenas or warrants; reinstatement of certificate.

[Effective until the date of the repeal of 42 U.S.C. § 666, the federal law

requiring each state to establish procedures for withholding, suspending and

restricting the professional, occupational and recreational licenses for child

support arrearages and for noncompliance with certain processes relating to

paternity or child support proceedings.]

      1.  If the Division receives a copy of a

court order issued pursuant to NRS 425.540

that provides for the suspension of all professional, occupational and

recreational licenses, certificates and permits issued to a person who is the

holder of a certificate to operate an intermediary service organization, the

Division shall deem the certificate issued to that person to be suspended at

the end of the 30th day after the date on which the court order was issued

unless the Division receives a letter issued to the holder of the certificate

by the district attorney or other public agency pursuant to NRS 425.550 stating that the holder of the

certificate has complied with the subpoena or warrant or has satisfied the

arrearage pursuant to NRS 425.560.

      2.  The Division shall reinstate a

certificate to operate an intermediary service organization that has been

suspended by a district court pursuant to NRS

425.540 if the Division receives a letter issued by the district attorney

or other public agency pursuant to NRS

425.550 to the person whose certificate was suspended stating that the

person whose certificate was suspended has complied with the subpoena or

warrant or has satisfied the arrearage pursuant to NRS 425.560.

      (Added to NRS by 2013, 128)

      NRS 449.4324  Provisional certificate.

      1.  The Division may cancel a certificate

to operate an intermediary service organization and issue a provisional

certificate, effective for a period determined by the Division, to the

intermediary service organization if the intermediary service organization:

      (a) Is in operation at the time of the adoption

of standards and regulations pursuant to the provisions of NRS 449.4304 to 449.4339,

inclusive, and the Division determines that the intermediary service

organization requires a reasonable time under the particular circumstances

within which to comply with the standards and regulations; or

      (b) Has failed to comply with the standards or

regulations and the Division determines that the intermediary service

organization is in the process of making the necessary changes or has agreed to

make the changes within a reasonable time.

      2.  The provisions of subsection 1 do not

require the issuance of a certificate or prevent the Division from refusing to

renew or from revoking or suspending any certificate if the Division deems such

action necessary for the health and safety of a person for whom the

intermediary service organization provides services.

      (Added to NRS by 2013, 129)

      NRS 449.4325  Deposit of money received; expenses of Division to enforce

provisions.

      1.  Money received from the certification

of intermediary service organizations:

      (a) Must be forwarded to the State Treasurer for

deposit in the State Treasury;

      (b) Must be accounted for separately in the State

General Fund; and

      (c) May only be used to carry out the provisions

of NRS 449.4304 to 449.4339,

inclusive.

      2.  The Division shall enforce the

provisions of NRS 449.4304 to 449.4339, inclusive, and may incur any necessary

expenses not in excess of money appropriated for that purpose by the State or

received from the Federal Government.

      (Added to NRS by 2013, 129)

      NRS 449.4327  Regulations; powers of Division.

      1.  The Board shall adopt regulations

governing the certification of intermediary service organizations and such

other regulations as it deems necessary to carry out the provisions of NRS 449.4304 to 449.4339,

inclusive.

      2.  The Division may:

      (a) Upon receipt of an application for a

certificate to operate an intermediary service organization, conduct an

investigation into the qualifications of personnel, methods of operation and

policies and purposes of any person proposing to engage in the operation of an

intermediary service organization.

      (b) Upon receipt of a complaint against an

intermediary service organization, except for a complaint concerning the cost

of services, conduct an investigation into the qualifications of personnel,

methods of operation and policies, procedures and records of that intermediary

service organization or any other intermediary service organization which may

have information pertinent to the complaint.

      (c) Employ such professional, technical and

clerical assistance as it deems necessary to carry out the provisions of NRS 449.4304 to 449.4339,

inclusive.

      (Added to NRS by 2013, 129)

Background Investigations

      NRS 449.4329  Initial and periodic investigations of employee, employee of

temporary employment service or independent contractor; penalty.

      1.  Except as otherwise provided in

subsections 2 and 3, within 10 days after hiring an employee, accepting an

employee of a temporary employment service or entering into a contract with an

independent contractor, the holder of a certificate to operate an intermediary

service organization shall:

      (a) Obtain a written statement from the employee,

employee of the temporary employment service or independent contractor stating

whether he or she has been convicted of any crime listed in subsection 1 of NRS 449.4332;

      (b) Obtain an oral and written confirmation of

the information contained in the written statement obtained pursuant to

paragraph (a);

      (c) Obtain proof that the employee, employee of

the temporary employment service or independent contractor holds any required

license, permit or certificate;

      (d) Obtain from the employee, employee of the

temporary employment service or independent contractor one set of fingerprints

and a written authorization to forward the fingerprints to the Central

Repository for Nevada Records of Criminal History for submission to the Federal

Bureau of Investigation for its report;

      (e) Submit to the Central Repository for Nevada

Records of Criminal History the fingerprints obtained pursuant to paragraph (d)

to obtain information on the background and personal history of each employee,

employee of a temporary employment service or independent contractor to

determine whether the person has been convicted of any crime listed in

subsection 1 of NRS 449.4332; and

      (f) If an Internet website has been established

pursuant to NRS 439.942:

             (1) Screen the employee, employee of the

temporary employment service or independent contractor using the Internet

website. Upon request of the Division, proof that the employee, temporary

employee or independent contractor was screened pursuant to this subparagraph

must be provided to the Division.

             (2) Enter on the Internet website

information to be maintained on the website concerning the employee, employee

of the temporary employment service or independent contractor.

      2.  The holder of a certificate to operate

an intermediary service organization is not required to obtain the information

described in subsection 1 from an employee, employee of a temporary employment

service or independent contractor if his or her fingerprints have been

submitted to the Central Repository for Nevada Records of Criminal History for

submission to the Federal Bureau of Investigation for its report within the

immediately preceding 6 months and the report of the Federal Bureau of

Investigation indicated that the employee, employee of the temporary employment

service or independent contractor has not been convicted of any crime set forth

in subsection 1 of NRS 449.4332.

      3.  The holder of a certificate to operate

an intermediary service organization is not required to obtain the information

described in subsection 1, other than the information described in paragraph

(c) of subsection 1, from an employee, employee of a temporary employment

service or independent contractor if:

      (a) The employee, employee of the temporary

employment service or independent contractor agrees to allow the holder of a

certificate to operate an intermediary service organization to receive notice

from the Central Repository for Nevada Records of Criminal History regarding

any conviction and subsequent conviction of the employee, employee of the

temporary employment service or independent contractor of a crime listed in

subsection 1 of NRS 449.4332;

      (b) An agency, board or commission that regulates

an occupation or profession pursuant to title 54 of NRS or temporary employment

service has, within the immediately preceding 5 years, submitted the

fingerprints of the employee, employee of the temporary employment service or

independent contractor to the Central Repository for Nevada Records of Criminal

History for submission to the Federal Bureau of Investigation for its report;

and

      (c) The report of the Federal Bureau of

Investigation indicated that the employee, employee of the temporary employment

service or independent contractor has not been convicted of any crime set forth

in subsection 1 of NRS 449.4332.

      4.  The holder of a certificate to operate

an intermediary service organization shall ensure that the information

concerning the background and personal history of each employee, employee of a

temporary employment service or independent contractor who works at or for the

intermediary service organization is investigated is completed as soon as

practicable and at least once every 5 years after the date of the initial

investigation. The holder of the certificate shall, when required:

      (a) Obtain one set of fingerprints from the

employee, employee of the temporary employment service or independent

contractor;

      (b) Obtain written authorization from the

employee, employee of the temporary employment service or independent

contractor to forward the fingerprints obtained pursuant to paragraph (a) to

the Central Repository for Nevada Records of Criminal History for submission to

the Federal Bureau of Investigation for its report; and

      (c) Submit the fingerprints to the Central

Repository for Nevada Records of Criminal History or, if the fingerprints were

submitted electronically, obtain proof of electronic submission of the

fingerprints to the Central Repository for Nevada Records of Criminal History.

      5.  Upon receiving fingerprints submitted

pursuant to this section, the Central Repository for Nevada Records of Criminal

History shall determine whether the employee, employee of the temporary

employment service or independent contractor has been convicted of a crime

listed in subsection 1 of NRS 449.4332 and

immediately inform the Division and the holder of the certificate to operate an

intermediary service organization for which the person works whether the

employee, employee of the temporary employment service or independent

contractor has been convicted of such a crime.

      6.  The Central Repository for Nevada

Records of Criminal History may impose a fee upon an intermediary service

organization that submits fingerprints pursuant to this section for the

reasonable cost of the investigation. The intermediary service organization may

recover from the employee or independent contractor whose fingerprints are

submitted not more than one-half of the fee imposed by the Central Repository.

If the intermediary service organization requires the employee or independent

contractor to pay for any part of the fee imposed by the Central Repository, it

shall allow the employee or independent contractor to pay the amount through

periodic payments. The intermediary service organization may require a

temporary employment service which employs a temporary employee whose

fingerprints are submitted to pay the fee imposed by the Central Repository. An

intermediary service organization shall notify a temporary employment service

if a person employed by the temporary employment service is determined to be

ineligible to provide services to the intermediary service organization based

upon the results of an investigation conducted pursuant to this section.

      7.  Unless a greater penalty is provided by

law, a person who willfully provides a false statement or information in

connection with an investigation of the background and personal history of the

person pursuant to this section that would disqualify the person from

employment, including, without limitation, a conviction of a crime listed in

subsection 1 of NRS 449.4332, is guilty of a misdemeanor.

      (Added to NRS by 2013, 131)

      NRS 449.43295  Temporary employment service prohibited from sending ineligible

employee to organization; temporary employment service to provide certain

information regarding its employees.

      1.  A temporary employment service shall

not send an employee to provide services to an intermediary service

organization if the temporary employment service has received notice from a

holder of a certificate to operate an intermediary service organization that

the employee of the temporary employment service is ineligible to provide such

services.

      2.  A holder of a certificate to operate an

intermediary service organization who enters into an agreement with a temporary

employment service to provide services to the intermediary service organization

on a temporary basis must require the temporary employment service to:

      (a) Provide proof that each employee of the

temporary employment service whom it may send to provide services to the

intermediary service organization has been continuously employed by the

temporary employment service since the last investigation conducted of the

employee pursuant to NRS 449.4329; and

      (b) Notify the intermediary service organization

if the investigation conducted of an employee of the temporary employment

service pursuant to NRS 449.4329 has not been

conducted within the immediately preceding 5 years.

      (Added to NRS by 2013, 2889)

      NRS 449.433  Maintenance and availability of certain records regarding

employee, employee of temporary employment service or independent contractor of

organization.

      1.  Each intermediary service organization

shall maintain accurate records of the information concerning its employees,

employees of a temporary employment service and independent contractors

collected pursuant to NRS 449.4329, including,

without limitation:

      (a) A copy of the fingerprints submitted to the

Central Repository for Nevada Records of Criminal History or proof of

electronic fingerprint submission and a copy of the written authorization that

was provided by the employee, employee of the temporary employment service or

independent contractor;

      (b) Proof that the fingerprints of the employee,

employee of the temporary employment service or independent contractor were

submitted to the Central Repository; and

      (c) Any other documentation of the information

collected pursuant to NRS 449.4329.

      2.  The records maintained pursuant to

subsection 1 must be:

      (a) Maintained for the period of the employment

of the person with the intermediary service organization; and

      (b) Made available for inspection by the Division

at any reasonable time, and copies thereof must be furnished to the Division

upon request.

      3.  If an Internet website has been

established pursuant to NRS 439.942, an

intermediary service organization shall maintain a current list of its

employees, employees of a temporary employment service and independent

contractors on the Internet website.

      4.  The Central Repository for Nevada

Records of Criminal History may maintain an electronic image of fingerprints

submitted pursuant to NRS 449.4329 to notify an

intermediary service organization and the Division of any subsequent conviction

of a person who is required to submit to an investigation pursuant to NRS 449.4329.

      (Added to NRS by 2013, 132)

      NRS 449.4331  Termination of employment or contract of employee, employee of

temporary employment service or independent contractor who has been convicted of

certain crime; period in which to correct information regarding conviction;

liability of organization.

      1.  Upon receiving information from the

Central Repository for Nevada Records of Criminal History pursuant to NRS 449.4329, or evidence from any other source, that

an employee, employee of a temporary employment service or independent

contractor of an intermediary service organization has been convicted of a

crime listed in subsection 1 of NRS 449.4332, the

holder of the certificate to operate the intermediary service organization

shall terminate the employment or contract of that person or notify the

temporary employment service that its employee is prohibited from providing

services for the intermediary service organization after allowing the person

time to correct the information as required pursuant to subsection 2.

      2.  If an employee, employee of a temporary

employment service or independent contractor believes that the information

provided by the Central Repository is incorrect, the employee, employee of the

temporary employment service or independent contractor may immediately inform

the intermediary service organization. The intermediary service organization

that is so informed shall give the employee, employee of the temporary

employment service or independent contractor a reasonable amount of time of not

less than 30 days to correct the information received from the Central

Repository before terminating the employment or contract of the person pursuant

to subsection 1.

      3.  An intermediary service organization

that has complied with NRS 449.4329 may not be

held civilly or criminally liable based solely upon the ground that the

intermediary service organization allowed an employee, employee of a temporary

employment service or independent contractor to work:

      (a) Before it received the information concerning

the employee, employee of the temporary employment service or independent

contractor from the Central Repository;

      (b) During the period required pursuant to

subsection 2 to allow the employee, employee of the temporary employment

service or independent contractor to correct that information;

      (c) Based on the information received from the

Central Repository, if the information received from the Central Repository was

inaccurate; or

      (d) Any combination thereof.

Ê An

intermediary service organization may be held liable for any other conduct

determined to be negligent or unlawful.

      (Added to NRS by 2013, 132)

      NRS 449.4332  Additional grounds for denial, suspension or revocation of

certificate.  In addition to the

grounds listed in NRS 449.4321, the Division may

deny a certificate to operate an intermediary service organization to an

applicant or may suspend or revoke a certificate of a holder of a certificate

to operate an intermediary service organization if:

      1.  The applicant for or holder of the

certificate has been convicted of:

      (a) Murder, voluntary manslaughter or mayhem;

      (b) Assault with intent to kill or to commit

sexual assault or mayhem;

      (c) Sexual assault, statutory sexual seduction,

incest, lewdness or indecent exposure, or any other sexually related crime that

is punished as a felony;

      (d) Prostitution, solicitation, lewdness or

indecent exposure, or any other sexually related crime that is punished as a

misdemeanor, if the conviction occurred within the immediately preceding 7

years;

      (e) Abuse or neglect of a child or contributory

delinquency;

      (f) A violation of any federal or state law

regulating the possession, distribution or use of any controlled substance or

any dangerous drug as defined in chapter 454

of NRS, within the past 7 years;

      (g) A violation of any provision of NRS 200.5099 or 200.50995;

      (h) Any offense involving fraud, theft, embezzlement,

burglary, robbery, fraudulent conversion or misappropriation of property,

within the immediately preceding 7 years; or

      (i) Any other felony involving the use of a

firearm or other deadly weapon, within the immediately preceding 7 years; or

      2.  The holder of a certificate has

continued to employ a person who has been convicted of a crime listed in

subsection 1.

      (Added to NRS by 2013, 133)

Disciplinary Action; Enforcement

      NRS 449.4335  Administrative sanctions: Imposition by Division; consequences

of failure to pay; use of money collected.

      1.  If an intermediary service organization

violates any provision related to its certification, including, without

limitation, any provision of NRS 449.4304 to 449.4339, inclusive, or any condition, standard or

regulation adopted by the Board, the Division, in accordance with the

regulations adopted pursuant to NRS 449.4336, may,

as it deems appropriate:

      (a) Prohibit the intermediary service

organization from providing services pursuant to NRS

449.4308 until it determines that the intermediary service organization has

corrected the violation;

      (b) Impose an administrative penalty of not more

than $1,000 per day for each violation, together with interest thereon at a

rate not to exceed 10 percent per annum; and

      (c) Appoint temporary management to oversee the

operation of the intermediary service organization and to ensure the health and

safety of the persons for whom the intermediary service organization performs

services, until:

             (1) It determines that the intermediary

service organization has corrected the violation and has management which is

capable of ensuring continued compliance with the applicable statutes,

conditions, standards and regulations; or

             (2) Improvements are made to correct the

violation.

      2.  If the intermediary service

organization fails to pay any administrative penalty imposed pursuant to paragraph

(b) of subsection 1, the Division may:

      (a) Suspend the certificate to operate an

intermediary service organization which is held by the intermediary service

organization until the administrative penalty is paid; and

      (b) Collect court costs, reasonable attorney’s

fees and other costs incurred to collect the administrative penalty.

      3.  The Division may require any

intermediary service organization that violates any provision of NRS 449.4304 to 449.4339,

inclusive, or any condition, standard or regulation adopted by the Board, to

make any improvements necessary to correct the violation.

      4.  Any money collected as administrative

penalties pursuant to this section must be accounted for separately and used to

protect the health or property of the persons for whom the intermediary service

organization performs services in accordance with applicable federal standards.

      (Added to NRS by 2013, 130)

      NRS 449.4336  Administrative sanctions: Regulations.  The

Board shall adopt regulations establishing the criteria for the imposition of

each sanction prescribed by NRS 449.4335. These

regulations must:

      1.  Prescribe the circumstances and manner

in which each sanction applies;

      2.  Minimize the time between

identification of a violation and the imposition of a sanction;

      3.  Provide for the imposition of

incrementally more severe sanctions for repeated or uncorrected violations; and

      4.  Provide for less severe sanctions for

lesser violations of applicable state statutes, conditions, standards or

regulations.

      (Added to NRS by 2013, 130)

      NRS 449.4337  Notice by Division of disciplinary action; exception; appeal.

      1.  When the Division intends to deny,

suspend or revoke a certificate to operate an intermediary service

organization, or to impose any sanction prescribed by NRS

449.4335, the Division shall give reasonable notice to the holder of the

certificate by certified mail. The notice must contain the legal authority,

jurisdiction and reasons for the action to be taken. Notice is not required if

the Division finds that the public health requires immediate action. In that

case, the Division may order a summary suspension of a certificate or impose

any sanction prescribed by NRS 449.4335, pending

proceedings for revocation or other action.

      2.  If a person wants to contest the action

of the Division, the person must file an appeal pursuant to regulations adopted

by the Board.

      3.  Upon receiving notice of an appeal, the

Division shall hold a hearing pursuant to regulations adopted by the Board.

      4.  The Board shall adopt such regulations

as are necessary to carry out the provisions of this section.

      (Added to NRS by 2013, 131)

      NRS 449.4338  Action to enjoin violations.

      1.  Except as otherwise provided in

subsection 2 of NRS 449.431, the Division may bring

an action in the name of the State to enjoin any person from operating or

maintaining an intermediary service organization within the meaning of NRS 449.4304 to 449.4339,

inclusive:

      (a) Without first obtaining a certificate to

operate an intermediary service organization; or

      (b) After the person’s certificate has been

revoked or suspended by the Division.

      2.  It is sufficient in such action to

allege that the defendant did, on a certain date and in a certain place,

operate and maintain the intermediary service organization without a

certificate.

      (Added to NRS by 2013, 133)

      NRS 449.4339  Prosecution by district attorney.  The

district attorney of the county in which an intermediary service organization

operates shall, upon application by the Division, institute and conduct the

prosecution of any action for violation of any provision of NRS 449.4304 to 449.4339,

inclusive.

      (Added to NRS by 2013, 134)

PERMIT FOR SERVICES OF GENERAL ANESTHESIA, CONSCIOUS

SEDATION AND DEEP SEDATION; NATIONAL ACCREDITATION; INSPECTIONS OF SURGICAL

CENTERS FOR AMBULATORY PATIENTS AND CERTAIN PHYSICIANS’ OFFICES AND FACILITIES

      NRS 449.435  Definitions.  As used

in NRS 449.435 to 449.448,

inclusive, unless the context otherwise requires, the words and terms defined

in NRS 449.436 to 449.439,

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

      (Added to NRS by 2009, 528)

      NRS 449.436  “Conscious sedation” defined.  “Conscious

sedation” means a minimally depressed level of consciousness, produced by a

pharmacologic or nonpharmacologic method, or a combination thereof, in which

the patient retains the ability independently and continuously to maintain an

airway and to respond appropriately to physical stimulation and verbal

commands.

      (Added to NRS by 2009, 528)

      NRS 449.437  “Deep sedation” defined.  “Deep

sedation” means a controlled state of depressed consciousness, produced by a

pharmacologic or nonpharmacologic method, or a combination thereof, and

accompanied by a partial loss of protective reflexes and the inability to

respond purposefully to verbal commands.

      (Added to NRS by 2009, 528)

      NRS 449.438  “General anesthesia” defined.  “General

anesthesia” means a controlled state of unconsciousness, produced by a

pharmacologic or nonpharmacologic method, or a combination thereof, and

accompanied by partial or complete loss of protective reflexes and the

inability independently to maintain an airway and respond purposefully to

physical stimulation or verbal commands.

      (Added to NRS by 2009, 528)

      NRS 449.439  “Physician” defined.  “Physician”

means a person who is licensed to practice medicine pursuant to chapter 630 of NRS or osteopathic medicine

pursuant to chapter 633 of NRS.

      (Added to NRS by 2009, 528)

      NRS 449.441  Exemption from provisions if physician’s office or facility only

administers certain type of pain medication.  The

provisions of NRS 449.435 to 449.448,

inclusive, do not apply to an office of a physician or a facility that provides

health care, other than a medical facility, if the office of a physician or the

facility only administers a medication to a patient to relieve the patient’s

anxiety or pain and if the medication is not given in a dosage that is

sufficient to induce in a patient a controlled state of depressed consciousness

or unconsciousness similar to general anesthesia, deep sedation or conscious

sedation.

      (Added to NRS by 2009, 529)

      NRS 449.442  Permit required for certain physicians’ offices and facilities

to offer services; national accreditation required; cessation of services for

failure to maintain accreditation.

      1.  An office of a physician or a facility

that provides health care, other than a medical facility, must obtain a permit

pursuant to NRS 449.443 before offering to a

patient a service of general anesthesia, conscious sedation or deep sedation.

An office of a physician or a facility that provides health care, other than a

medical facility, which operates at more than one location must obtain a permit

for each location where a service of general anesthesia, conscious sedation or

deep sedation is offered.

      2.  To offer to a patient a service of

general anesthesia, conscious sedation or deep sedation in this State, an

office of a physician or a facility that provides health care, other than a

medical facility, must maintain current accreditation by a nationally

recognized organization approved by the Board. Upon receiving an initial

permit, the office or facility shall, within 6 months after obtaining the

permit, submit proof to the Division of accreditation by such an organization.

      3.  If an office of a physician or a

facility that provides health care, other than a medical facility, fails to

maintain current accreditation or if the accreditation is revoked or is

otherwise no longer valid, the office or facility shall immediately cease

offering to patients a service of general anesthesia, conscious sedation or

deep sedation.

      (Added to NRS by 2009, 529)

      NRS 449.443  Application for permit; fee; inspection by Division; term of

permit.

      1.  An office of a physician or a facility

that provides health care, other than a medical facility, desiring a permit

pursuant to NRS 449.435 to 449.448,

inclusive, must submit to the Division, on a form prescribed by the Division

and accompanied by the appropriate fee, an application for a permit.

      2.  Before issuing a permit, the Division

shall conduct an on-site inspection pursuant to NRS

449.446 of each office of a physician or facility that applies for a

permit.

      3.  Upon receipt of an application and the

appropriate fee, the Division may, after conducting an inspection pursuant to NRS 449.446, issue a permit.

      4.  A permit expires 1 year after the date

of issuance and is renewable pursuant to NRS 449.444.

      (Added to NRS by 2009, 529)

      NRS 449.444  Application for renewal of permit; fee.

      1.  The holder of a permit issued pursuant

to NRS 449.443 may annually submit to the Division,

on a form prescribed by the Division and accompanied by the appropriate fee, an

application for renewal of the permit before the date on which the permit

expires. The application must include proof satisfactory to the Division that

the office or facility maintains current accreditation by a nationally

recognized organization approved by the Board.

      2.  Upon receipt of an application for

renewal and the accompanying fee, the Division may renew a permit.

      (Added to NRS by 2009, 529)

      NRS 449.445  National accreditation required of surgical center for

ambulatory patients; inspection by Division; cessation of operation for failure

to maintain accreditation.

      1.  To operate in this State, a surgical

center for ambulatory patients must maintain current accreditation by a

nationally recognized organization approved by the Board. Upon initial

licensure, a surgical center for ambulatory patients shall, within 6 months

after obtaining its license, submit proof to the Division of the accreditation

of the surgical center by such an organization.

      2.  Before issuing a license to a surgical

center for ambulatory patients, the Division shall conduct an on-site

inspection of the surgical center pursuant to NRS

449.446.

      3.  If a surgical center for ambulatory

patients fails to maintain current accreditation or if the accreditation is

revoked or is otherwise no longer valid, the surgical center shall immediately

cease to operate.

      (Added to NRS by 2009, 529)

      NRS 449.446  Annual inspections of holders of permits and surgical centers

for ambulatory patients; correction of deficiencies identified in inspections;

reporting of inspections to Legislature.

      1.  The Division shall conduct annual and

unannounced on-site inspections of each office of a physician or a facility

that provides health care, other than a medical facility, which holds a permit

issued pursuant to NRS 449.443 and each surgical

center for ambulatory patients which holds a license issued pursuant to this

chapter.

      2.  An inspection conducted pursuant to

this section must focus on the infection control practices and policies of the

surgical center for ambulatory patients, the office or the facility that is the

subject of the inspection. The Division may, as it deems necessary, conduct a

more comprehensive inspection of a surgical center, office or facility.

      3.  Upon completion of an inspection, the

Division shall:

      (a) Compile a report of the inspection, including

each deficiency discovered during the inspection, if any; and

      (b) Forward a copy of the report to the surgical

center for ambulatory patients, the office of the physician or the facility

where the inspection was conducted.

      4.  If a deficiency is indicated in the

report, the surgical center for ambulatory patients, the office of the

physician or the facility shall correct each deficiency indicated in the report

in the manner prescribed by the Board pursuant to NRS

449.448.

      5.  The Division shall annually prepare and

submit to the Legislative Committee on Health Care and the Legislative

Commission a report which includes:

      (a) The number and frequency of inspections

conducted pursuant to this section;

      (b) A summary of deficiencies or other

significant problems discovered while conducting inspections pursuant to this

section and the results of any follow-up inspections; and

      (c) Any other information relating to the

inspections as deemed necessary by the Legislative Committee on Health Care or

the Legislative Commission.

      (Added to NRS by 2009, 530)

      NRS 449.447  Disciplinary action for certain violations or failure to correct

deficiency; notification to professional licensing board of violations;

administrative sanctions.

      1.  If an office of a physician or a

facility that provides health care, other than a medical facility, violates the

provisions of NRS 449.435 to 449.448,

inclusive, or the regulations adopted pursuant thereto, or fails to correct a

deficiency indicated in a report pursuant to NRS

449.446, the Division, in accordance with the regulations adopted pursuant

to NRS 449.448, may take any of the following

actions:

      (a) Decline to issue or renew a permit;

      (b) Suspend or revoke a permit; or

      (c) Impose an administrative penalty of not more

than $1,000 per day for each violation, together with interest thereon at a

rate not to exceed 10 percent per annum.

      2.  The Division may review a report

submitted pursuant to NRS 630.30665

or 633.524 to determine whether an

office of a physician or a facility is in violation of the provisions of NRS 449.435 to 449.448,

inclusive, or the regulations adopted pursuant thereto. If the Division

determines that such a violation has occurred, the Division shall immediately

notify the appropriate professional licensing board of the physician.

      3.  If a surgical center for ambulatory

patients violates the provisions of NRS 449.435 to 449.448, inclusive, or the regulations adopted

pursuant thereto, or fails to correct a deficiency indicated in a report

pursuant to NRS 449.446, the Division may impose

administrative sanctions pursuant to NRS 449.163.

      (Added to NRS by 2009, 530)

      NRS 449.448  Regulations.

      1.  The Board shall adopt regulations to

carry out the provisions of NRS 449.435 to 449.448, inclusive, including, without limitation,

regulations which:

      (a) Prescribe the amount of the fee required for

applications for the issuance and renewal of a permit pursuant to NRS 449.443 and 449.444.

      (b) Prescribe the procedures and standards for

the issuance and renewal of a permit.

      (c) Identify the nationally recognized

organizations approved by the Board for the purposes of the accreditation

required for the issuance of a:

             (1) License to operate a surgical center

for ambulatory patients.

             (2) Permit for an office of a physician or

a facility that provides health care, other than a medical facility, to offer

to a patient a service of general anesthesia, conscious sedation or deep

sedation.

      (d) Prescribe the procedures and scope of the inspections

conducted by the Division pursuant to NRS 449.446.

      (e) Prescribe the procedures and time frame for

correcting each deficiency indicated in a report pursuant to NRS 449.446.

      (f) Prescribe the criteria for the imposition of

each sanction prescribed by NRS 449.447, including,

without limitation:

             (1) Setting forth the circumstances and

manner in which a sanction applies;

             (2) Minimizing the time between the

identification of a violation and the imposition of a sanction; and

             (3) Providing for the imposition of

incrementally more severe sanctions for repeated or uncorrected violations.

      2.  The regulations adopted pursuant to

this section must require that the practices and policies of each holder of a

permit to offer to a patient a service of general anesthesia, conscious

sedation or deep sedation and each holder of a license to operate a surgical

center for ambulatory patients provide adequately for the protection of the

health, safety and well-being of patients.

      (Added to NRS by 2009, 531)

ACCOUNTING; FINANCIAL REPORTS; FEES; ENSURING QUALITY OF

CARE

      NRS 449.450  Definitions.  As

used in NRS 449.450 to 449.530,

inclusive, unless the context otherwise requires:

      1.  “Admitted health insurer” means an

insurer authorized to transact health insurance in this State under a

certificate of authority issued by the Commissioner of Insurance.

      2.  “Department” means the Department of

Health and Human Services.

      3.  “Director” means the Director of the

Department.

      4.  “Institution” means any person, place,

building or agency which maintains and operates facilities for the diagnosis,

care and treatment of human illness and provides beds for inpatient care. The

term includes but is not limited to hospitals, convalescent care facilities,

nursing care facilities, detoxification centers and all specialized medical

health care facilities.

      (Added to NRS by 1975, 702; A 1979, 887; 1983, 1127; 1985, 1362; 1989, 1800; 1991, 2114)

      NRS 449.460  Powers of Director.  The

Director may:

      1.  Adopt regulations respecting the

exercise of the powers conferred by NRS 449.450 to 449.530, inclusive.

      2.  Hold public hearings, conduct

investigations and require the filing of information relating to any matter

affecting the cost of services in all institutions subject to the provisions of

NRS 449.450 to 449.530,

inclusive, and may subpoena witnesses, financial papers, records and documents

in connection therewith. An order requiring the filing of information or a

subpoena issued pursuant to this subsection must state the purpose for which it

is issued. The Director may also administer oaths in any hearing or

investigation.

      3.  Exercise, subject to the limitations

and restrictions imposed in NRS 449.450 to 449.530, inclusive, all other powers which are

reasonably necessary to carry out the expressed objects of those sections.

      4.  Delegate to any of the divisions of the

Department the authority to carry out the provisions of NRS

449.450 to 449.530, inclusive.

      (Added to NRS by 1975, 702; A 1985, 1363; 1991, 2114; 1997, 2527)

      NRS 449.465  Authority of Director to impose fees; maximum amount of fees

collected; fee for support of Legislative Committee on Health Care.

      1.  The Director may, by regulation, impose

fees upon admitted health insurers to cover the costs of carrying out the

provisions of NRS 449.450 to 449.530,

inclusive. The maximum amount of fees collected must not exceed the amount

authorized by the Legislature in each biennial budget.

      2.  The Director shall impose a fee of $50

each year upon admitted health insurers for the support of the Legislative

Committee on Health Care. The fee imposed pursuant to this subsection is in

addition to any fee imposed pursuant to subsection 1. The fee collected for the

support of the Legislative Committee on Health Care must be deposited in the

Legislative Fund.

      (Added to NRS by 1983, 1126; A 1985, 1363; 1987, 877)

      NRS 449.470  Director may use staff or contract for services.  In carrying out the duties prescribed by NRS 449.450 to 449.530,

inclusive, the Director may utilize his or her own staff or may contract with

any appropriate, independent and qualified organization. Such a contractor

shall not release or publish or otherwise use any information made available to

it under its contractual responsibility unless permission is specifically

granted by the Director.

      (Added to NRS by 1975, 703; A 1985, 1363)

      NRS 449.476  Committee to ensure quality of care: Formation by hospital;

general requirements.

      1.  Each hospital licensed to operate in

this state shall form a committee to ensure the quality of care provided by the

hospital. The committee must be composed of, but is not limited to, physicians

and nurses.

      2.  Each committee formed pursuant to

subsection 1 must meet the requirements for programs or plans for ensuring the

quality of care specified by the Joint Commission on Accreditation of

Healthcare Organizations or by the Federal Government pursuant to Title XIX of

the Social Security Act (42 U.S.C. §§ 1396 et seq.).

      (Added to NRS by 1989, 1799)

      NRS 449.485  Hospital required to use discharge form prescribed by Director;

electronic monthly reporting; exception to electronic reporting; use of

information by Department.

      1.  Each hospital in this State shall use

for all patients discharged a form prescribed by the Director and shall include

in the form all information required by the Department. Any form prescribed by

the Director must be a form that is commonly used nationwide by hospitals, if

applicable, and comply with federal laws and regulations.

      2.  Each hospital in this State shall, on a

monthly basis, report to the Department the information required to be included

in the form for each patient. The information reported must be complete,

accurate and timely.

      3.  Each insurance company or other payer

shall accept the form as the bill for services provided by hospitals in this

State.

      4.  Except as otherwise provided in

subsection 5, each hospital in this State shall provide the information

required pursuant to subsection 2 in an electronic form specified by the

Department.

      5.  The Director may exempt a hospital from

the requirements of subsection 4 if requiring the hospital to comply with the

requirements would cause the hospital financial hardship.

      6.  The Department shall use the

information submitted pursuant to this section for the program established

pursuant to NRS 439A.220 to increase

public awareness of health care information concerning the hospitals in this

State.

      (Added to NRS by 1987, 875; A 2005, 1736; 2007, 661, 2355)

      NRS 449.490  Financial statements and reports required to be filed with

Department; additional reporting requirements for hospitals with 100 or more

beds; availability of complete current charge master.

      1.  Every institution which is subject to

the provisions of NRS 449.450 to 449.530, inclusive, shall file with the Department the

following financial statements or reports in a form and at intervals specified

by the Director but at least annually:

      (a) A balance sheet detailing the assets,

liabilities and net worth of the institution for its fiscal year; and

      (b) A statement of income and expenses for the

fiscal year.

      2.  Each hospital with 100 or more beds

shall file with the Department, in a form and at intervals specified by the

Director but at least annually, a capital improvement report which includes,

without limitation, any major service line that the hospital has added or is in

the process of adding since the previous report was filed, any major expansion

of the existing facilities of the hospital that has been completed or is in the

process of being completed since the previous report was filed, and any major

piece of equipment that the hospital has acquired or is in the process of

acquiring since the previous report was filed.

      3.  In addition to the information required

to be filed pursuant to subsections 1 and 2, each hospital with 100 or more

beds shall file with the Department, in a form and at intervals specified by

the Director but at least annually:

      (a) The expenses that the hospital has incurred

for providing community benefits and the in-kind services that the hospital has

provided to the community in which it is located. These expenses must be

reported as the total amount expended for community benefits and in-kind

services and reported as a percentage of the total net revenues of the

hospital. For the purposes of this paragraph, “community benefits” includes, without

limitation, goods, services and resources provided by a hospital to a community

to address the specific needs and concerns of that community, services provided

by a hospital to the uninsured and underserved persons in that community,

training programs for employees in a community and health care services

provided in areas of a community that have a critical shortage of such

services, for which the hospital does not receive full reimbursement.

      (b) A statement of its policies and procedures

for providing discounted services to, or reducing charges for services provided

to, persons without health insurance that are in addition to any reduction or

discount required to be provided pursuant to NRS 439B.260.

      (c) A list of the services which the hospital

purchased from its corporate home office.

      (d) A report of the cost to the hospital of

providing services to patients covered by Medicare.

      (e) Financial information from the consolidated

corporation, if the hospital is owned by such a corporation and if that

information is publicly available, including, without limitation, the annual

report of the consolidated corporation.

      (f) A statement of its policies regarding

patients’ account receivables, including, without limitation, the manner in

which a hospital collects or makes payment arrangements for patients’ account

receivables, the factors that initiate collections and the method by which

unpaid account receivables are collected.

      4.  A complete current charge master must

be available at each hospital during normal business hours for review by the

Director, any payor that has a contract with the hospital to pay for services

provided by the hospital, any payor that has received a bill from the hospital

and any state agency that is authorized to review such information. The

complete and current charge master must be made available to the Department, at

the request of the Director, in an electronic format specified by the

Department. The Department may use the electronic copy of the charge master to

review and analyze the data contained in the charge master and, except as

otherwise provided in NRS 439A.200 to

439A.290, inclusive, shall not

release or publish the information contained in the charge master.

      5.  The Director shall require the

certification of specified financial reports by an independent certified public

accountant and may require attestations from responsible officers of the

institution that the reports are, to the best of their knowledge and belief,

accurate and complete to the extent that the certifications and attestations

are not required by federal law.

      6.  The Director shall require:

      (a) The filing of all reports by specified dates,

and may adopt regulations which assess penalties for failure to file as

required; and

      (b) The submission of a final annual report not

later than 6 months after the close of the fiscal year,

Ê and may

grant extensions to institutions which can show that the required information

is not available on the required reporting date.

      7.  All reports, except privileged medical

information, filed under any provisions of NRS 449.450

to 449.530, inclusive:

      (a) Are open to public inspection;

      (b) Must be in a form which is readily

understandable by a member of the general public;

      (c) Must, as soon as practicable after those

reports become available, be posted on the Internet website maintained pursuant

to NRS 439A.270; and

      (d) Must be available for examination at the

office of the Department during regular business hours.

      (Added to NRS by 1975, 702; A 1985, 1364; 1987, 877; 2005, 1737; 2007, 2355; 2011, 967)

      NRS 449.500  Director to carry out analyses and studies concerning cost of

health care.  The Director shall

engage in or carry out analyses and studies relating to the cost of health care

in Nevada and other states, the financial status of any institution subject to

the provisions of NRS 449.450 to 449.530, inclusive, and any other appropriate related

matters, and the Director may publish and disseminate any information relating

to the financial aspects of health care as the Director deems desirable in the

public interest and in accordance with the provisions of NRS

449.450 to 449.530, inclusive. The Director

shall further require the filing of information concerning the total financial

needs of each institution and the resources available or expected to become

available to meet such needs, including but not limited to the effect of

proposals made by comprehensive areawide and state health planning agencies. The

information must be divided into at least the following components of an

institution’s expenses:

      1.  Operating expenses related to patient

care.

      2.  Expenses incurred for rendering

services to patients for whom payment is not made in full including, but not

limited to, the separate expenses for contractual allowances imposed by federal

or state law, charity care and uncollectible accounts.

      3.  All incurred interest charges on

indebtedness for both capital and operating needs.

      4.  Costs of education, both primary and

continuing.

      5.  Expenses for research related to

patient care.

      6.  Depreciation expenses of both property

and equipment.

      7.  Amortization of incurred capital and

operating related indebtedness.

      8.  Requirements for capital expenditures

for replacement, modernization, renovation and expansion of services and

facilities.

      9.  Requirements for necessary working

capital, including but not limited to operating cash, patients’ accounts

receivable and inventories.

      10.  Federal, state and local taxes not

ordinarily considered operating expenses where applicable.

      11.  Operating surpluses necessary for a

fair return to their owners equal to returns on investments in industries of

comparable risk, or for the purpose of assuring continuity of operation and

prudent management.

      (Added to NRS by 1975, 703; A 1985, 1364)

      NRS 449.510  Director to prepare and file summaries, compilations or other

reports; public inspection; collection, maintenance, disclosure or publication

of contracts or identification of party to contract prohibited.

      1.  The Director shall prepare and file

such summaries, compilations or other supplementary reports based on the

information filed with the Director pursuant to NRS

449.450 to 449.530, inclusive, as will advance

the purposes of those sections. All such summaries, compilations and reports

are open to public inspection, must be made available to requesting agencies

and must be prepared within a reasonable time following the end of each

institution’s fiscal year or more frequently as specified by the Director.

      2.  The Director shall not collect,

maintain, disclose, report or publish the details of contracts entered into by

a hospital, or collect, maintain, disclose, report or publish information

pursuant to this section in a manner that would allow identification of an

individual payer or other party to a contract with the hospital, except that

the Director may disclose to other state agencies the details of contracts

between the hospital and a related entity. A state agency shall not collect,

maintain, disclose, report or publish information disclosed to the agency by

the Director pursuant to this subsection in a manner that would allow

identification of an individual payer or other party to a contract with the hospital.

The Director may review any such contracts at the hospital or at a location

specified by the hospital.

      3.  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 1975, 704; A 1985, 1365; 1991, 2333; 1993, 619; 1997, 2527)

      NRS 449.520  Reports to Governor and legislative committees; development of

comprehensive plan by Legislative Committee on Health Care.

      1.  On or before October 1 of each year,

the Director shall prepare and transmit to the Governor, the Legislative

Committee on Health Care and the Interim Finance Committee a report of the

Department’s operations and activities for the preceding fiscal year.

      2.  The report prepared pursuant to

subsection 1 must include:

      (a) Copies of all reports, summaries,

compilations and supplementary reports required by NRS

449.450 to 449.530, inclusive, together with

such facts, suggestions and policy recommendations as the Director deems

necessary;

      (b) A summary of the trends of the audits of hospitals

in this State that the Department required or performed during the previous

year;

      (c) An analysis of the trends in the costs,

expenses and profits of hospitals in this State;

      (d) An analysis of the methodologies used to

determine the corporate home office allocation of hospitals in this State;

      (e) An examination and analysis of the manner in

which hospitals are reporting the information that is required to be filed

pursuant to NRS 449.490, including, without

limitation, an examination and analysis of whether that information is being

reported in a standard and consistent manner, which fairly reflect the

operations of each hospital;

      (f) A review and comparison of the policies and

procedures used by hospitals in this State to provide discounted services to,

and to reduce charges for services provided to, persons without health

insurance;

      (g) A review and comparison of the policies and

procedures used by hospitals in this State to collect unpaid charges for

services provided by the hospitals; and

      (h) A summary of the status of the programs

established pursuant to NRS 439A.220

and 439A.240 to increase public

awareness of health care information concerning the hospitals and surgical

centers for ambulatory patients in this State, including, without limitation,

the information that was posted in the preceding fiscal year on the Internet

website maintained for those programs pursuant to NRS 439A.270.

      3.  The Legislative Committee on Health

Care shall develop a comprehensive plan concerning the provision of health care

in this State which includes, without limitation:

      (a) A review of the health care needs in this

State as identified by state agencies, local governments, providers of health

care and the general public; and

      (b) A review of the capital improvement reports

submitted by hospitals pursuant to subsection 2 of NRS

449.490.

      (Added to NRS by 1975, 704; A 1983, 1127; 1985, 1365; 2005, 1738; 2007, 2357; 2011, 969)

      NRS 449.530  Administrative fine for violation.  The

Director may impose upon the institutions subject to supervision under NRS 449.450 to 449.530,

inclusive, an administrative fine not exceeding $500 per day for each violation

of any of the provisions of NRS 449.450 to 449.530, inclusive.

      (Added to NRS by 1975, 704; A 1985, 1365)

WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT

      NRS 449.535  Short title; uniformity of application and construction.

      1.  NRS 449.535

to 449.690, inclusive, may be cited as the Uniform

Act on Rights of the Terminally Ill.

      2.  NRS 449.535

to 449.690, inclusive, must be applied and

construed to effectuate its general purpose to make uniform the law with

respect to the subject of those sections among states enacting the Uniform Act

on Rights of the Terminally Ill.

      (Added to NRS by 1991, 629)

      NRS 449.540  Definitions.  As

used in NRS 449.535 to 449.690,

inclusive, unless the context otherwise requires, the words and terms defined

in NRS 449.550 to 449.590,

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

      (Added to NRS by 1977, 759; A 1991, 632)

      NRS 449.550  “Attending physician” defined.  “Attending

physician” means the physician who has primary responsibility for the treatment

and care of the patient.

      (Added to NRS by 1977, 759; A 1991, 632)

      NRS 449.560  “Declaration” defined.  “Declaration”

means a writing executed in accordance with the requirements of NRS 449.600.

      (Added to NRS by 1977, 759; A 1991, 632)

      NRS 449.570  “Life-sustaining treatment” defined.  “Life-sustaining

treatment” means a medical procedure or intervention that, when administered to

a patient, serves only to prolong the process of dying.

      (Added to NRS by 1977, 759; A 1991, 633)

      NRS 449.575  “Person” defined.  “Person”

includes a government or a governmental subdivision or agency.

      (Added to NRS by 1991, 629)

      NRS 449.581  “Provider of health care” defined.  “Provider

of health care” means a person who is licensed, certified or otherwise

authorized by the law of this state to administer health care in the ordinary

course of business or practice of a profession.

      (Added to NRS by 1991, 629)

      NRS 449.585  “Qualified patient” defined.  “Qualified

patient” means a patient 18 or more years of age who has executed a declaration

and who has been determined by the attending physician to be in a terminal

condition.

      (Added to NRS by 1991, 629)

      NRS 449.590  “Terminal condition” defined.  “Terminal

condition” means an incurable and irreversible condition that, without the

administration of life-sustaining treatment, will, in the opinion of the

attending physician, result in death within a relatively short time.

      (Added to NRS by 1977, 759; A 1991, 633)

      NRS 449.600  Declaration relating to use of life-sustaining treatment.

      1.  A person of sound mind and 18 or more

years of age may execute at any time a declaration governing the withholding or

withdrawal of life-sustaining treatment. The declarant may designate another

natural person of sound mind and 18 or more years of age to make decisions

governing the withholding or withdrawal of life-sustaining treatment. The

declaration must be signed by the declarant, or another at the declarant’s

direction, and attested by two witnesses.

      2.  A physician or other provider of health

care who is furnished a copy of the declaration shall make it a part of the

declarant’s medical record and, if unwilling to comply with the declaration,

promptly so advise the declarant and any person designated to act for the

declarant.

      (Added to NRS by 1977, 759; A 1985, 1747; 1991, 633)

      NRS 449.610  Form of declaration directing physician to withhold or withdraw

life-sustaining treatment.  A

declaration directing a physician to withhold or withdraw life-sustaining

treatment may, but need not, be in the following form:

 

DECLARATION

 

If I should have an incurable and

irreversible condition that, without the administration of life-sustaining

treatment, will, in the opinion of my attending physician, cause my death

within a relatively short time, and I am no longer able to make decisions

regarding my medical treatment, I direct my attending physician, pursuant to NRS 449.535 to 449.690,

inclusive, to withhold or withdraw treatment that only prolongs the process of

dying and is not necessary for my comfort or to alleviate pain.

 

If you wish to include this

statement in this declaration, you must INITIAL the statement in the box

provided:

 

       Withholding or withdrawal of

artificial nutrition and hydration may result in death by starvation or

dehydration. Initial this box if you want to receive or continue receiving

artificial nutrition and hydration by way of the gastrointestinal tract after

all other treatment is withheld pursuant to this declaration.

 

                                                                                           [............................................ ]

 

Signed this ........………...... day of

..…..........., ......

 

                                                               Signature..........................................................

                                                               Address.............................................................

 

The declarant voluntarily signed

this writing in my presence.

 

                                                               Witness.............................................................

                                                               Address.............................................................

 

                                                               Witness.............................................................

                                                               Address.............................................................

 

      (Added to NRS by 1977, 760; A 1991, 633; 1993, 2790)

      NRS 449.613  Form of declaration designating another person to decide to

withhold or withdraw life-sustaining treatment.

      1.  A declaration that designates another

person to make decisions governing the withholding or withdrawal of

life-sustaining treatment may, but need not, be in the following form:

 

DECLARATION

 

If I should have an incurable and

irreversible condition that, without the administration of life-sustaining

treatment, will, in the opinion of my attending physician, cause my death

within a relatively short time, and I am no longer able to make decisions

regarding my medical treatment, I appoint ............................... or,

if he or she is not reasonably available or is unwilling to serve,

.............................., to make decisions on my behalf regarding

withholding or withdrawal of treatment that only prolongs the process of dying

and is not necessary for my comfort or to alleviate pain, pursuant to NRS 449.535 to 449.690,

inclusive. (If the person or persons I have so appointed are not reasonably

available or are unwilling to serve, I direct my attending physician, pursuant

to those sections, to withhold or withdraw treatment that only prolongs the

process of dying and is not necessary for my comfort or to alleviate pain.)

Strike language in parentheses if

you do not desire it.

 

If you wish to include this

statement in this declaration, you must INITIAL the statement in the box

provided:

 

       Withholding or withdrawal of

artificial nutrition and hydration may result in death by starvation or

dehydration. Initial this box if you want to receive or continue receiving

artificial nutrition and hydration by way of the gastrointestinal tract after

all other treatment is withheld pursuant to this declaration.

                                                                                           [............................................ ]

 

Signed this ........………...... day of

..…..........., ......

 

                                                               Signature..........................................................

                                                               Address.............................................................

 

The declarant voluntarily signed this

writing in my presence.

 

                                                               Witness.............................................................

                                                               Address.............................................................

 

                                                               Witness.............................................................

                                                               Address.............................................................

 

Name and address of each designee.

 

                                                               Name................................................................

                                                               Address.............................................................

 

      2.  The designation of an agent pursuant to

chapter 162A of NRS, or the judicial

appointment of a guardian, who is authorized to make decisions regarding the

withholding or withdrawal of life-sustaining treatment, constitutes for the

purpose of NRS 449.535 to 449.690,

inclusive, a declaration designating another person to act for the declarant

pursuant to subsection 1.

      (Added to NRS by 1991, 630; A 1993, 2791; 2009, 209)

      NRS 449.617  Time declaration becomes operative; duty of providers of health

care.  A declaration becomes

operative when it is communicated to the attending physician and the declarant

is determined by the attending physician to be in a terminal condition and no

longer able to make decisions regarding administration of life-sustaining

treatment. When the declaration becomes operative, the attending physician and

other providers of health care shall act in accordance with its provisions and

with the instructions of a person designated pursuant to NRS

449.600 or comply with the requirements of NRS

449.628 to transfer care of the declarant.

      (Added to NRS by 1991, 631)

      NRS 449.620  Revocation of declaration; entry of revocation in medical

records of declarant.

      1.  A declarant may revoke a declaration at

any time and in any manner, without regard to his or her mental or physical

condition. A revocation is effective upon its communication to the attending

physician or other provider of health care by the declarant or a witness to the

revocation.

      2.  The attending physician or other

provider of health care shall make the revocation a part of the declarant’s

medical record.

      (Added to NRS by 1977, 760; A 1987, 1309; 1991, 635)

      NRS 449.622  Recording determination of terminal condition and declaration.  Upon determining that a declarant is in a

terminal condition, the attending physician who knows of a declaration shall

record the determination, and the terms of the declaration if not already a

part of the record, in the declarant’s medical record.

      (Added to NRS by 1991, 631)

      NRS 449.624  Treatment of qualified patients; withholding or withdrawal of

artificial nutrition and hydration; treatment of pregnant patient.

      1.  A qualified patient may make decisions

regarding life-sustaining treatment so long as the patient is able to do so.

      2.  NRS 449.535

to 449.690, inclusive, do not affect the

responsibility of the attending physician or other provider of health care to

provide treatment for a patient’s comfort or alleviation of pain.

      3.  Artificial nutrition and hydration by

way of the gastrointestinal tract shall be deemed a life-sustaining treatment

and must be withheld or withdrawn from a qualified patient unless a different

desire is expressed in writing by the patient. For a patient who has no

effective declaration, artificial nutrition and hydration must not be withheld

unless a different desire is expressed in writing by the patient’s authorized

representative or the family member with the authority to consent or withhold

consent.

      4.  Life-sustaining treatment must not be

withheld or withdrawn pursuant to a declaration from a qualified patient known

to the attending physician to be pregnant so long as it is probable that the

fetus will develop to the point of live birth with continued application of

life-sustaining treatment.

      (Added to NRS by 1991, 631)

      NRS 449.626  Written consent to withhold or withdraw life-sustaining

treatment.

      1.  If written consent to the withholding

or withdrawal of the treatment, attested by two witnesses, is given to the

attending physician, the attending physician may withhold or withdraw

life-sustaining treatment from a patient who:

      (a) Has been determined by the attending

physician to be in a terminal condition and no longer able to make decisions

regarding administration of life-sustaining treatment; and

      (b) Has no effective declaration.

      2.  The authority to consent or to withhold

consent under subsection 1 may be exercised by the following persons, in order

of priority:

      (a) The spouse of the patient;

      (b) An adult child of the patient or, if there is

more than one adult child, a majority of the adult children who are reasonably

available for consultation;

      (c) The parents of the patient;

      (d) An adult sibling of the patient or, if there

is more than one adult sibling, a majority of the adult siblings who are reasonably

available for consultation; or

      (e) The nearest other adult relative of the

patient by blood or adoption who is reasonably available for consultation.

      3.  If a class entitled to decide whether

to consent is not reasonably available for consultation and competent to

decide, or declines to decide, the next class is authorized to decide, but an

equal division in a class does not authorize the next class to decide.

      4.  A decision to grant or withhold consent

must be made in good faith. A consent is not valid if it conflicts with the

expressed intention of the patient.

      5.  A decision of the attending physician

acting in good faith that a consent is valid or invalid is conclusive.

      6.  Life-sustaining treatment must not be

withheld or withdrawn pursuant to this section from a patient known to the

attending physician to be pregnant so long as it is probable that the fetus

will develop to the point of live birth with continued application of

life-sustaining treatment.

      (Added to NRS by 1991, 631)

      NRS 449.628  Transfer of care of declarant.  An

attending physician or other provider of health care who is unwilling to comply

with NRS 449.535 to 449.690,

inclusive, shall take all reasonable steps as promptly as practicable to

transfer care of the declarant to another physician or provider of health care.

      (Added to NRS by 1991, 632)

      NRS 449.630  Immunity from civil and criminal liability and discipline for

unprofessional conduct.

      1.  A physician or other provider of health

care is not subject to civil or criminal liability, or discipline for

unprofessional conduct, for giving effect to a declaration or the direction of

a person designated pursuant to NRS 449.600 in the

absence of knowledge of the revocation of a declaration, or for giving effect

to a written consent under NRS 449.626.

      2.  A physician or other provider of health

care, whose action pursuant to NRS 449.535 to 449.690, inclusive, is in accord with reasonable

medical standards, is not subject to civil or criminal liability, or discipline

for unprofessional conduct, with respect to that action.

      3.  A physician or other provider of health

care, whose decision about the validity of consent under NRS

449.626 is made in good faith, is not subject to civil or criminal

liability, or discipline for unprofessional conduct, with respect to that

decision.

      4.  A person designated pursuant to NRS 449.600 or a person authorized to consent pursuant

to NRS 449.626, whose decision is made or consent

is given in good faith pursuant to NRS 449.535 to 449.690, inclusive, is not subject to civil or

criminal liability, or discipline for unprofessional conduct, with respect to

that decision.

      (Added to NRS by 1977, 760; A 1985, 1747; 1991, 635)

      NRS 449.640  Consideration of declaration and other factors; failure to

follow directions of patient.

      1.  If a patient in a terminal condition

has a declaration in effect and becomes comatose or is otherwise rendered

incapable of communicating with his or her attending physician, the physician

must give weight to the declaration as evidence of the patient’s directions

regarding the application of life-sustaining treatments, but the attending

physician may also consider other factors in determining whether the

circumstances warrant following the directions.

      2.  No hospital or other medical facility,

physician or person working under the direction of a physician is subject to

criminal or civil liability for failure to follow the directions of the patient

to withhold or withdraw life-sustaining treatments.

      (Added to NRS by 1977, 761; A 1985, 1747; 1993, 2792)

      NRS 449.645  Assumption of validity of declaration; presumption of intent to

use, withhold or withdraw life-sustaining treatment not created.

      1.  Unless he or she has knowledge to the

contrary, a physician or other provider of health care may assume that a

declaration complies with NRS 449.535 to 449.690, inclusive, and is valid.

      2.  NRS 449.535

to 449.690, inclusive, create no presumption

concerning the intention of a person who has revoked or has not executed a

declaration with respect to the use, withholding or withdrawal of

life-sustaining treatment in the event of a terminal condition.

      (Added to NRS by 1991, 632)

      NRS 449.650  Death does not constitute suicide or homicide; effect of

declaration on policy of insurance; prohibiting or requiring execution of

declaration prohibited as condition for insurance or receipt of health care.

      1.  Death resulting from the withholding or

withdrawal of life-sustaining treatment in accordance with NRS 449.535 to 449.690,

inclusive, does not constitute, for any purpose, a suicide or homicide.

      2.  The making of a declaration pursuant to

NRS 449.600 does not affect the sale, procurement

or issuance of a policy of life insurance or annuity, nor does it affect,

impair or modify the terms of an existing policy of life insurance or annuity.

A policy of life insurance or annuity is not legally impaired or invalidated by

the withholding or withdrawal of life-sustaining treatment from an insured,

notwithstanding any term to the contrary.

      3.  A person may not prohibit or require

the execution of a declaration as a condition for being insured for, or

receiving, health care.

      (Added to NRS by 1977, 761; A 1991, 636)

      NRS 449.660  Penalties.

      1.  A physician or other provider of health

care who willfully fails to transfer the care of a patient in accordance with NRS 449.628 is guilty of a gross misdemeanor.

      2.  A physician who willfully fails to

record a determination of terminal condition or the terms of a declaration in

accordance with NRS 449.622 is guilty of a misdemeanor.

      3.  A person who willfully conceals,

cancels, defaces or obliterates the declaration of another without the

declarant’s consent or who falsifies or forges a revocation of the declaration

of another is guilty of a misdemeanor.

      4.  A person who falsifies or forges the

declaration of another, or willfully conceals or withholds personal knowledge

of a revocation, with the intent to cause a withholding or withdrawal of

life-sustaining treatment contrary to the wishes of the declarant and thereby

directly causes life-sustaining treatment to be withheld or withdrawn and death

to be hastened is guilty of murder.

      5.  A person who requires or prohibits the

execution of a declaration as a condition of being insured for, or receiving,

health care is guilty of a misdemeanor.

      6.  A person who coerces or fraudulently

induces another to execute a declaration, or who falsifies or forges the

declaration of another except as provided in subsection 4, is guilty of a gross

misdemeanor.

      7.  The penalties provided in this section

do not displace any sanction applicable under other law.

      (Added to NRS by 1977, 761; A 1991, 636)

      NRS 449.670  Actions contrary to reasonable medical standards not required;

mercy-killing, assisted suicide or euthanasia not authorized.

      1.  NRS 449.535

to 449.690, inclusive, do not require a physician

or other provider of health care to take action contrary to reasonable medical

standards.

      2.  NRS 449.535

to 449.690, inclusive, do not condone, authorize or

approve mercy-killing, assisted suicide or euthanasia.

      (Added to NRS by 1977, 761; A 1991, 637; 1995, 1794)

      NRS 449.680  Other right or responsibility regarding use of life-sustaining

treatment or withholding or withdrawal of medical care not limited.  NRS 449.535 to 449.690, inclusive, do not affect the right of a

patient to make decisions regarding use of life-sustaining treatment, so long

as the patient is able to do so, or impair or supersede a right or

responsibility that any person has to effect the withholding or withdrawal of

medical care.

      (Added to NRS by 1977, 761; A 1991, 637)

      NRS 449.690  Validity of declaration executed in another state; effect of

previously executed instrument.

      1.  A declaration executed in another state

in compliance with the law of that state or of this State is valid for purposes

of NRS 449.535 to 449.690,

inclusive.

      2.  An instrument executed anywhere before

July 1, 1977, which clearly expresses the intent of the declarant to direct the

withholding or withdrawal of life-sustaining treatment from the declarant when

the declarant is in a terminal condition and becomes comatose or is otherwise

rendered incapable of communicating with his or her attending physician, if

executed in a manner which attests voluntary execution, or executed anywhere

before October 1, 1991, which substantially complies with NRS 449.600, and has not been subsequently revoked, is

effective under NRS 449.535 to 449.690, inclusive.

      3.  As used in this section, “state”

includes the District of Columbia, the Commonwealth of Puerto Rico, and a

territory or insular possession subject to the jurisdiction of the United

States.

      (Added to NRS by 1977, 761; A 1991, 637)

PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT

      NRS 449.691  Definitions.  As

used in NRS 449.691 to 449.697,

inclusive, unless the context otherwise requires, the words and terms defined

in NRS 449.6912 to 449.6934,

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

      (Added to NRS by 2013, 2284)

      NRS 449.6912  “Attending physician” defined.  “Attending

physician” has the meaning ascribed to it in NRS

449.550.

      (Added to NRS by 2013, 2284)

      NRS 449.6915  “Do-not-resuscitate identification” defined.  “Do-not-resuscitate identification” has the

meaning ascribed to it in NRS 450B.410.

      (Added to NRS by 2013, 2284)

      NRS 449.6916  “Do-not-resuscitate order” defined.  “Do-not-resuscitate

order” has the meaning ascribed to it in NRS

450B.420.

      (Added to NRS by 2013, 2284)

      NRS 449.6918  “Emergency care” defined.  “Emergency

care” means the use of life-resuscitating treatment and other immediate

treatment provided in response to a sudden, acute and unanticipated medical

emergency in order to avoid injury, impairment or death.

      (Added to NRS by 2013, 2284)

      NRS 449.692  “Health care facility” defined.  “Health

care facility” has the meaning ascribed to it in NRS 162A.740.

      (Added to NRS by 2013, 2284)

      NRS 449.6922  “Incompetent” defined.  “Incompetent”

has the meaning ascribed to it in NRS

159.019.

      (Added to NRS by 2013, 2284)

      NRS 449.6924  “Life-resuscitating treatment” defined.  “Life-resuscitating

treatment” has the meaning ascribed to it in NRS 450B.450.

      (Added to NRS by 2013, 2284)

      NRS 449.6925  “Life-sustaining treatment” defined.  “Life-sustaining

treatment” has the meaning ascribed to it in NRS

449.570.

      (Added to NRS by 2013, 2284)

      NRS 449.6928  “Other types of advance directives” defined.  “Other types of advance directives” means an

advance directive as defined in NRS 449.905, but

does not include a POLST form.

      (Added to NRS by 2013, 2284)

      NRS 449.693  “Physician Order for Life-Sustaining Treatment form” or “POLST

form” defined.  “Physician Order

for Life-Sustaining Treatment form” or “POLST form” means the form prescribed

pursuant to NRS 449.694 that:

      1.  Records the wishes of the patient; and

      2.  Directs a provider of health care

regarding the provision of life-resuscitating treatment and life-sustaining

treatment.

      (Added to NRS by 2013, 2284)

      NRS 449.6932  “Provider of health care” defined.  “Provider

of health care” means an individual who is licensed, certified or otherwise

authorized or allowed by law to provide health care in the ordinary course of

business or practice of a profession, and includes a person who:

      1.  Is described in NRS 629.031; or

      2.  Administers emergency medical services

as defined in NRS 450B.460.

      (Added to NRS by 2013, 2284)

      NRS 449.6934  “Representative of the patient” defined.  “Representative of the patient” means a legal

guardian of the patient, a person designated by the patient to make decisions

governing the withholding or withdrawal of life-sustaining treatment pursuant

to NRS 449.600 or a person given power of attorney

to make decisions concerning health care for the patient pursuant to NRS 162A.700 to 162A.860, inclusive.

      (Added to NRS by 2013, 2285)

      NRS 449.694  Board required to prescribe standardized POLST form;

requirements.  The Board shall

prescribe a standardized Physician Order for Life-Sustaining Treatment form,

commonly known as a POLST form, which:

      1.  Is uniquely identifiable and has a

uniform color;

      2.  Provides a means by which to indicate

whether the patient has made an anatomical gift pursuant to NRS 451.500 to 451.598, inclusive;

      3.  Gives direction to a provider of health

care or health care facility regarding the use of emergency care and

life-sustaining treatment;

      4.  Is intended to be honored by any

provider of health care who treats the patient in any health-care setting,

including, without limitation, the patient’s residence, a health care facility

or the scene of a medical emergency; and

      5.  Includes such other features and

information as the Board may deem advisable.

      (Added to NRS by 2013, 2285)

      NRS 449.6942  Physician required to explain POLST form under certain

circumstances and to complete POLST form upon request of patient; validity.

      1.  A physician shall take the actions

described in subsection 2:

      (a) If the physician diagnoses a patient with a

terminal condition;

      (b) If the physician determines, for any reason,

that a patient has a life expectancy of less than 5 years; or

      (c) At the request of a patient.

      2.  Upon the occurrence of any of the

events specified in subsection 1, the physician shall explain to the patient:

      (a) The existence and availability of the Physician

Order for Life-Sustaining Treatment form;

      (b) The features of and procedures offered by way

of the POLST form; and

      (c) The differences between a POLST form and the

other types of advance directives.

      3.  Upon the request of the patient, the

physician shall complete the POLST form based on the preferences and medical

indications of the patient.

      4.  A POLST form is valid upon execution by

a physician and:

      (a) If the patient is 18 years of age or older

and of sound mind, the patient;

      (b) If the patient is 18 years of age or older

and incompetent, the representative of the patient; or

      (c) If the patient is less than 18 years of age,

the patient and a parent or legal guardian of the patient.

      5.  As used in this section, “terminal

condition” has the meaning ascribed to it in NRS

449.590.

      (Added to NRS by 2013, 2285)

      NRS 449.6944  Revocation of POLST form; entry of revocation in medical records

of patient.

      1.  A Physician Order for Life-Sustaining

Treatment form may be revoked at any time and in any manner by:

      (a) The patient who executed it, if competent,

without regard to his or her age or physical condition;

      (b) If the patient is incompetent, the

representative of the patient; or

      (c) If the patient is less than 18 years of age,

a parent or legal guardian of the patient.

      2.  The revocation of a POLST form is

effective upon the communication to a provider of health care, by the patient

or a witness to the revocation, of the desire to revoke the form. The provider

of health care to whom the revocation is communicated shall:

      (a) Make the revocation a part of the medical

record of the patient; or

      (b) Cause the revocation to be made a part of the

medical record of the patient.

      (Added to NRS by 2013, 2285)

      NRS 449.6946  Conflict with other advance directive or do-not-resuscitate

identification.

      1.  If a valid Physician Order for

Life-Sustaining Treatment form sets forth a declaration, direction or order

which conflicts with a declaration, direction or order set forth in one or more

of the other types of advance directives:

      (a) The declaration, direction or order set forth

in the document executed most recently is valid; and

      (b) Any other declarations, directions or orders

that do not conflict with a declaration, direction or order set forth in

another document referenced in this subsection remain valid.

      2.  If a valid POLST form sets forth a

declaration, direction or order to provide life-resuscitating treatment to a

patient who also possesses a do-not-resuscitate identification, a provider of

health care shall not provide life-resuscitating treatment if the

do-not-resuscitate identification is on the person of the patient when the need

for life-resuscitating treatment arises.

      (Added to NRS by 2013, 2286)

      NRS 449.6948  Immunity from civil and criminal liability and discipline for unprofessional

conduct.

      1.  A provider of health care is not guilty

of unprofessional conduct or subject to civil or criminal liability if:

      (a) The provider of health care withholds

emergency care or life-sustaining treatment:

             (1) In compliance with a Physician Order

for Life-Sustaining Treatment form and the provisions of NRS

449.691 to 449.697, inclusive; or

             (2) In violation of a Physician Order for

Life-Sustaining Treatment form if the provider of health care is acting in

accordance with a declaration, direction or order set forth in one or more of

the other types of advance directives and:

                   (I) Complies with the provisions of NRS 449.695; or

                   (II) Reasonably and in good faith,

at the time the emergency care or life-sustaining treatment is withheld, is

unaware of the existence of the POLST form or believes that the POLST form has

been revoked pursuant to NRS 449.6944; or

      (b) The provider of health care provides

emergency care or life-sustaining treatment:

             (1) Pursuant to an oral or written request

made by the patient, the representative of the patient, or a parent or legal

guardian of the patient, who may revoke the POLST form pursuant to NRS 449.6944;

             (2) Pursuant to an observation that the

patient, the representative of the patient or a parent or legal guardian of the

patient has revoked, or otherwise indicated that he or she wishes to revoke,

the POLST form pursuant to NRS 449.6944; or

             (3) In violation of a POLST form, if the

provider of health care reasonably and in good faith, at the time the emergency

care or life-sustaining treatment is provided, is unaware of the existence of

the POLST form or believes that the POLST form has been revoked pursuant to NRS 449.6944.

      2.  A health care facility, ambulance

service, fire-fighting agency or other entity that employs a provider of health

care is not guilty of unprofessional conduct or subject to civil or criminal

liability for the acts or omissions of the employee carried out in accordance

with the provisions of subsection 1.

      (Added to NRS by 2013, 2286)

      NRS 449.695  Provider of health care required to comply with valid POLST

form; modification by physician; transfer of care of patient; exceptions.

      1.  Except as otherwise provided in this

section and NRS 449.6946, a provider of health

care shall comply with a valid Physician Order for Life-Sustaining Treatment

form, regardless of whether the provider of health care is employed by a health

care facility or other entity affiliated with the physician who executed the

POLST form.

      2.  A physician may medically evaluate the

patient and, based upon the evaluation, may recommend new orders consistent

with the most current information available about the patient’s health status

and goals of care. Before making a modification to a valid POLST form, the

physician shall consult the patient or, if the patient is incompetent, shall

make a reasonable attempt to consult the representative of the patient and the

patient’s attending physician.

      3.  Except as otherwise provided in

subsection 4, a provider of health care who is unwilling or unable to comply

with a valid POLST form shall take all reasonable measures to transfer the

patient to a physician or health care facility so that the POLST form will be

followed.

      4.  Life-sustaining treatment must not be

withheld or withdrawn pursuant to a POLST form of a patient known to the

attending physician to be pregnant, so long as it is probable that the fetus

will develop to the point of live birth with the continued application of

life-sustaining treatment.

      5.  Nothing in this section requires a

provider of health care to comply with a valid POLST form if the provider of

health care does not have actual knowledge of the existence of the form.

      (Added to NRS by 2013, 2287)

      NRS 449.6952  Assumption of validity of POLST form; presumption of intent of

patient not created if patient has revoked or not executed POLST form.

      1.  Unless he or she has knowledge to the

contrary, a provider of health care may assume that a Physician Order for

Life-Sustaining Treatment form complies with the provisions of NRS 449.691 to 449.697,

inclusive, and is valid.

      2.  The provisions of NRS 449.691 to 449.697,

inclusive, do not create a presumption concerning the intention of a:

      (a) Patient if the patient, the representative of

the patient or a parent or legal guardian of the patient has revoked the POLST

form pursuant to NRS 449.6944; or

      (b) Person who has not executed a POLST form,

Ê concerning

the use or withholding of emergency care or life-sustaining treatment.

      (Added to NRS by 2013, 2287)

      NRS 449.6954  Death does not constitute suicide or homicide; effect of POLST

form on policy of insurance; prohibiting or requiring execution of POLST form

prohibited as condition for insurance or receipt of health care.

      1.  Death that results when emergency care

or life-sustaining treatment has been withheld pursuant to a Physician Order

for Life-Sustaining Treatment form and in accordance with the provisions of NRS 449.691 to 449.697,

inclusive, does not constitute a suicide or homicide.

      2.  The execution of a POLST form does not

affect the sale, procurement or issuance of a policy of life insurance or an

annuity, nor does it affect, impair or modify the terms of an existing policy

of life insurance or an annuity. A policy of life insurance or an annuity is

not legally impaired or invalidated if emergency care or life-sustaining

treatment has been withheld from an insured who has executed a POLST form,

notwithstanding any term in the policy or annuity to the contrary.

      3.  A person may not prohibit or require

the execution of a POLST form as a condition of being insured for, or

receiving, health care.

      (Added to NRS by 2013, 2287)

      NRS 449.6956  Unlawful acts; penalty.

      1.  It is unlawful for:

      (a) A provider of health care to willfully fail

to transfer the care of a patient in accordance with subsection 3 of NRS 449.695.

      (b) A person to willfully conceal, cancel, deface

or obliterate a Physician Order for Life-Sustaining Treatment form without the

consent of the patient who executed the form.

      (c) A person to falsify or forge the POLST form

of another person, or willfully conceal or withhold personal knowledge of the

revocation of the POLST form of another person, with the intent to cause the

withholding or withdrawal of emergency care or life-sustaining treatment

contrary to the wishes of the patient.

      (d) A person to require or prohibit the execution

of a POLST form as a condition of being insured for, or receiving, health care

in violation of subsection 3 of NRS 449.6954.

      (e) A person to coerce or fraudulently induce

another to execute a POLST form.

      2.  A person who violates any of the

provisions of this section is guilty of a misdemeanor.

      (Added to NRS by 2013, 2288)

      NRS 449.6958  Actions contrary to reasonable medical standards not required;

mercy-killing, euthanasia or assisted suicide not authorized; rights associated

with other advance directives not impaired; right to make decisions concerning

emergency care or life-sustaining treatment not affected.  The provisions of NRS

449.691 to 449.697, inclusive, do not:

      1.  Require a provider of health care to

take any action contrary to reasonable medical standards;

      2.  Affect the responsibility of a provider

of health care to provide treatment for a patient’s comfort or alleviation of

pain;

      3.  Condone, authorize or approve mercy

killing, euthanasia or assisted suicide;

      4.  Except as otherwise provided in NRS 449.6946, affect or impair any right created

pursuant to the provisions of any other types of advance directives; or

      5.  Affect the right of a patient to make

decisions concerning the use of emergency care or life-sustaining treatment, if

he or she is able to do so.

      (Added to NRS by 2013, 2288)

      NRS 449.696  Validity of POLST form executed in another state.

      1.  A Physician Order for Life-Sustaining

Treatment form executed in another state in compliance with the laws of that

state or this State is valid for the purposes of NRS

449.691 to 449.697, inclusive.

      2.  As used in this section, “state”

includes the District of Columbia, the Commonwealth of Puerto Rico and a

territory or insular possession subject to the jurisdiction of the United

States.

      (Added to NRS by 2013, 2288)

      NRS 449.697  Regulations.  The

Board may adopt such regulations as it determines to be necessary or advisable

to carry out the provisions of NRS 449.691 to 449.697, inclusive.

      (Added to NRS by 2013, 2288)

PATIENT’S RIGHTS

      NRS 449.700  Facility to provide necessary services or arrange for transfer

of patient; explanation of need for transfer and alternatives available.

      1.  Every medical facility and facility for

the dependent must provide the services necessary to treat properly a patient

in a particular case or must be able to arrange the transfer of the patient to

another facility which can provide that care.

      2.  A patient may be transferred to another

facility only if the patient has received an explanation of the need to

transfer the patient and the alternatives available, unless the condition of

the patient necessitates an immediate transfer to a facility for a higher level

of care and the patient is unable to understand the explanation.

      (Added to NRS by 1983, 820; A 1985, 1747; 1999, 1051; 2011, 360)

      NRS 449.705  Facility to forward medical records upon certain transfers of

patient.

      1.  If a patient in a medical facility or

facility for the dependent is transferred to another medical facility or

facility for the dependent, a division facility or a physician licensed to

practice medicine, the facility shall forward a copy of the medical records of

the patient, on or before the date the patient is transferred, to the other

medical facility or facility for the dependent, the division facility or the

physician. The facility is not required to obtain the oral or written consent

of the patient to forward a copy of the medical records.

      2.  As used in this section:

      (a) “Division facility” means any unit or subunit

operated by a division of the Department of Health and Human Services pursuant

to title 39 of NRS.

      (b) “Medical records” includes a medical history

of the patient, a summary of the current physical condition of the patient and

a discharge summary which contains the information necessary for the proper

treatment of the patient.

      (Added to NRS by 1991, 2349; A 1993, 2725; 1999, 1051; 2011, 360)

      NRS 449.710  Specific rights: Information concerning facility; treatment;

billing; visitation.  Every patient

of a medical facility or facility for the dependent has the right to:

      1.  Receive information concerning any

other medical or educational facility or facility for the dependent associated

with the facility at which he or she is a patient which relates to the care of

the patient.

      2.  Obtain information concerning the

professional qualifications or associations of the persons who are treating the

patient.

      3.  Receive the name of the person

responsible for coordinating the care of the patient in the facility.

      4.  Be advised if the facility in which he

or she is a patient proposes to perform experiments on patients which affect

the patient’s own care or treatment.

      5.  Receive from his or her physician a

complete and current description of the patient’s diagnosis, plan for treatment

and prognosis in terms which the patient is able to understand. If it is not

medically advisable to give this information to the patient, the physician

shall:

      (a) Provide the information to an appropriate

person responsible for the patient; and

      (b) Inform that person that he or she shall not

disclose the information to the patient.

      6.  Receive from his or her physician the

information necessary for the patient to give his or her informed consent to a

procedure or treatment. Except in an emergency, this information must not be

limited to a specific procedure or treatment and must include:

      (a) A description of the significant medical

risks involved;

      (b) Any information on alternatives to the

treatment or procedure if the patient requests that information;

      (c) The name of the person responsible for the

procedure or treatment; and

      (d) The costs likely to be incurred for the

treatment or procedure and any alternative treatment or procedure.

      7.  Examine the bill for his or her care

and receive an explanation of the bill, whether or not the patient is

personally responsible for payment of the bill.

      8.  Know the regulations of the facility

concerning his or her conduct at the facility.

      9.  Receive, within reasonable restrictions

as to time and place, visitors of the patient’s choosing, including, without

limitation, friends and members of the patient’s family.

      (Added to NRS by 1983, 820; A 1985, 906, 1748; 1999, 1052; 2001, 3047; 2011, 360)

      NRS 449.715  Specific rights: Designation of persons authorized to visit

patient in facility.

      1.  If, as a result of the incapacitation

of a patient or the inability of a patient to communicate, the patient of a

medical facility or facility for the dependent who is 18 years of age or older

is unable to inform the staff of the facility of the persons whom the patient

authorizes to visit the patient at the facility, the facility shall allow

visitation rights to any person designated by the patient in a letter, form or

other document authorizing visitation executed in accordance with subsection 2.

The visitation rights required by this subsection must be:

      (a) Provided in accordance with the visitation

policies of the facility; and

      (b) The same visitation rights that are provided

to a member of the patient’s family who is legally related to the patient.

      2.  A person 18 years of age or older

wishing to designate a person for the purposes of establishing visitation

rights in a medical facility or facility for the dependent may execute a

letter, form or other document authorizing visitation in substantially the

following form:

 

      (Date)..................................

       I,

..............................., (patient who is designating another person as

having visitation rights of the patient) do hereby designate

.................................. (person who is being designated as having

visitation rights of the patient) as having the right to visit me in a medical

facility or facility for the dependent. I hereby instruct all staff of a

medical facility or facility for the dependent in which I am a patient to admit

...................................... (person who is being designated as

having visitation rights of the patient) to my room and afford him or her the

same visitation rights as are provided to members of my family who are legally

related to me during my time as a patient.

........................................................

       (Signed)

 

      (Added to NRS by 2003, 1879; A 2011, 361)

      NRS 449.720  Specific rights: Care; refusal of treatment and experimentation;

privacy; notice of appointments and need for care; confidentiality of

information concerning patient.

      1.  Every patient of a medical facility or

facility for the dependent has the right to:

      (a) Receive considerate and respectful care.

      (b) Refuse treatment to the extent permitted by

law and to be informed of the consequences of that refusal.

      (c) Refuse to participate in any medical

experiments conducted at the facility.

      (d) Retain his or her privacy concerning the

patient’s program of medical care.

      (e) Have any reasonable request for services

reasonably satisfied by the facility considering its ability to do so.

      (f) Receive continuous care from the facility.

The patient must be informed:

             (1) Of the patient’s appointments for

treatment and the names of the persons available at the facility for those

treatments; and

             (2) By his or her physician or an

authorized representative of the physician, of the patient’s need for

continuing care.

      2.  Except as otherwise provided in NRS 108.640, 239.0115, 439.538, 442.300 to 442.330, inclusive, and 449.705 and chapter 629

of NRS, discussions of the care of a patient, consultation with other persons

concerning the patient, examinations or treatments, and all communications and

records concerning the patient are confidential. The patient must consent to

the presence of any person who is not directly involved with the patient’s care

during any examination, consultation or treatment.

      (Added to NRS by 1983, 821; A 1985, 1748; 1989, 2057; 1991, 2350; 1999, 1052, 3512; 2007, 1979, 2110; 2011, 362)

      NRS 449.725  Owner and administrator of certain facility prohibited from

receiving money or property by will of resident or former resident or from life

insurance proceeds of resident or former resident; exception.

      1.  Except as otherwise provided in subsection

3 and notwithstanding any other provision of law, an owner or administrator of

a medical facility or facility for the dependent is not entitled to receive,

and must not receive:

      (a) Any money, personal property or real property

that is devised or bequeathed by will to the owner or administrator by a

resident or former resident of the facility.

      (b) Any proceeds from a life insurance policy

upon the life or body of a resident or former resident of the facility.

      2.  Except as otherwise provided in subsection

3, any money, property, proceeds or interest therein that is described in

subsection 1 passes in accordance with law as if the owner or administrator of

the medical facility or facility for the dependent had predeceased the decedent

resident or former resident.

      3.  The provisions of subsections 1 and 2

do not apply if the owner or administrator of the medical facility or facility

for the dependent is the spouse, legal guardian or next of kin of the resident

or former resident of the facility or home, as applicable.

      (Added to NRS by 2011, 696)

      NRS 449.730  Patient to be informed of rights upon admission to facility;

required disclosures and notices.

      1.  Every medical facility and facility for

the dependent shall inform each patient or the patient’s legal representative,

upon the admission of the patient to the facility, of the patient’s rights as

listed in NRS 449.700, 449.710,

449.715, 449.720 and 449.725.

      2.  In addition to the requirements of

subsection 1, if a person with a disability is a patient at a facility, as that

term is defined in NRS 449.771, the facility shall

inform the patient of his or her rights pursuant to NRS

449.765 to 449.786, inclusive.

      3.  In addition to the requirements of

subsections 1 and 2, every hospital shall, upon the admission of a patient to

the hospital, provide to the patient or the patient’s legal representative a

written disclosure approved by the Director of the Department of Health and

Human Services, which written disclosure must set forth:

      (a) Notice of the existence of the Bureau for

Hospital Patients created pursuant to NRS

223.575;

      (b) The address and telephone number of the

Bureau; and

      (c) An explanation of the services provided by

the Bureau, including, without limitation, the services for dispute resolution

described in subsection 3 of NRS 223.575.

      4.  In addition to the requirements of

subsections 1, 2 and 3, every hospital shall, upon the discharge of a patient

from the hospital, provide to the patient or the patient’s legal representative

a written disclosure approved by the Director, which written disclosure must

set forth:

      (a) If the hospital is a major hospital:

             (1) Notice of the reduction or discount

available pursuant to NRS 439B.260,

including, without limitation, notice of the criteria a patient must satisfy to

qualify for a reduction or discount under that section; and

             (2) Notice of any policies and procedures

the hospital may have adopted to reduce charges for services provided to

persons or to provide discounted services to persons, which policies and

procedures are in addition to any reduction or discount required to be provided

pursuant to NRS 439B.260. The notice

required by this subparagraph must describe the criteria a patient must satisfy

to qualify for the additional reduction or discount, including, without

limitation, any relevant limitations on income and any relevant requirements as

to the period within which the patient must arrange to make payment.

      (b) If the hospital is not a major hospital,

notice of any policies and procedures the hospital may have adopted to reduce

charges for services provided to persons or to provide discounted services to

persons. The notice required by this paragraph must describe the criteria a

patient must satisfy to qualify for the reduction or discount, including,

without limitation, any relevant limitations on income and any relevant

requirements as to the period within which the patient must arrange to make

payment.

Ê As used in

this subsection, “major hospital” has the meaning ascribed to it in NRS 439B.115.

      5.  In addition to the requirements of

subsections 1 to 4, inclusive, every hospital shall post in a conspicuous place

in each public waiting room in the hospital a legible sign or notice in

14-point type or larger, which sign or notice must:

      (a) Provide a brief description of any policies

and procedures the hospital may have adopted to reduce charges for services

provided to persons or to provide discounted services to persons, including,

without limitation:

             (1) Instructions for receiving additional

information regarding such policies and procedures; and

             (2) Instructions for arranging to make

payment;

      (b) Be written in language that is easy to

understand; and

      (c) Be written in English and Spanish.

      (Added to NRS by 1983, 822; A 1985, 1749; 1999, 1053, 3252; 2003, 1880; 2005, 947; 2011, 362, 697)

      NRS 449.740  Procedure to insert implant in breast of patient: Informed

consent required; withdrawal of consent; penalty.

      1.  A physician shall not perform any

procedure to insert an implant in the breast of a patient unless within 5 days

before the procedure is performed the physician has:

      (a) Discussed with the patient and any other

person whose consent is required pursuant to paragraph (b), the advantages,

disadvantages and risks associated with the procedure; and

      (b) Obtained informed consent in writing from the

following persons freely and without coercion:

             (1) The patient if he or she is 18 years

of age or over or legally emancipated and competent to give that consent, and

from the patient’s legal guardian, if any;

             (2) The parent or guardian of a patient

under 18 years of age and not legally emancipated; or

             (3) The legal guardian of a patient of any

age who has been adjudicated mentally incompetent,

Ê and the

required consent was not withdrawn pursuant to subsection 3 before the

procedure began.

      2.  An informed consent requires that the

person whose consent is sought be adequately informed as to:

      (a) The nature and consequences of the procedure;

      (b) The reasonable risks, possible side effects,

benefits and purposes of the procedure; and

      (c) Any alternative procedures available.

      3.  The consent of a patient or other

person whose consent is required pursuant to paragraph (b) of subsection 1 may

be withdrawn in writing at any time before the procedure has begun, with or

without cause.

      4.  A physician satisfies the requirements

of:

      (a) Paragraph (a) of subsection 1 if the

physician provides the patient and any other person whose consent is required

pursuant to paragraph (b) of subsection 1 with a copy of the current

explanation form prepared by the Division pursuant to NRS

449.750 in a language that the person is able to read.

      (b) Paragraph (b) of subsection 1 if the person

or persons whose consent is required sign a copy of the current consent form

prepared by the Division pursuant to NRS 449.750

freely and without coercion and the consent is not withdrawn pursuant to

subsection 3 before the procedure has begun. The consent form must be in a

language that the person who signs the form is able to read.

      5.  Any person who violates the provisions

of this section is guilty of a misdemeanor.

      (Added to NRS by 1991, 1690)

      NRS 449.750  Procedure to insert implant in breast of patient: Contents of

explanation form and consent form; fee for forms.

      1.  The Division shall prepare and provide

to physicians upon request:

      (a) An explanation form for a procedure to insert

an implant in the breast of a person which includes:

             (1) An explanation of the advantages,

disadvantages and risks associated with a procedure to insert an implant in the

breast of a person, including any known side effects; and

             (2) Any other information the Division

determines to be useful to a person contemplating a procedure to insert an

implant in the breast; and

      (b) A consent form for a procedure to insert an

implant in the breast of a person which includes:

             (1) The nature and consequences of the

procedure;

             (2) The reasonable risks, possible side

effects, benefits and purposes of the procedure; and

             (3) Any alternative procedures available.

      2.  The Division shall revise the

explanation form and consent form as necessary to keep the medical information

current.

      3.  The Division shall charge and collect a

fee for all forms distributed pursuant to this section that is adequate to

cover the cost of producing the forms.

      (Added to NRS by 1991, 1690)

COLLECTION OF AMOUNT OWED TO HOSPITAL FOR HOSPITAL CARE

      NRS 449.751  Definitions.  As used

in NRS 449.751 to 449.759,

inclusive, unless the context otherwise requires, the words and terms defined

in NRS 449.753 and 449.755

have the meanings ascribed to them in those sections.

      (Added to NRS by 2007, 1497; A 2011, 1524)

      NRS 449.753  “Hospital care” defined.  “Hospital

care” has the meaning ascribed to it in NRS

428.155.

      (Added to NRS by 2007, 1497)

      NRS 449.755  “Responsible party” defined.  “Responsible

party” means the person who received the hospital care, the parent or guardian

of the person who received the hospital care or another natural person who is

legally responsible or has agreed to be responsible for the payment to the

hospital of any charges incurred in connection with the hospital care.

      (Added to NRS by 2007, 1497)

      NRS 449.757  Limitations on efforts of hospitals to collect; date for accrual

of interest; rate of interest; limitations on additional fees.

      1.  When a person receives hospital care,

the hospital must not proceed with any efforts to collect on any amount owed to

the hospital for the hospital care from the responsible party, other than for

any copayment or deductible, if the responsible party has health insurance or

may be eligible for Medicaid, the Children’s Health Insurance Program or any

other public program which may pay all or part of the bill, until the hospital

has submitted a bill to the health insurance company or public program and the

health insurance company or public program has made a determination concerning

payment of the claim.

      2.  Collection efforts may begin and

interest may begin to accrue on any amount owed to the hospital for hospital

care which remains unpaid by the responsible party not sooner than 30 days

after the responsible party is sent a bill by mail stating the amount that he

or she is responsible to pay which has been established after receiving a

determination concerning payment of the claim by any insurer or public program

and after applying any discounts. Interest must accrue at a rate which does not

exceed the prime rate at the largest bank in Nevada as ascertained by the

Commissioner of Financial Institutions on January 1 or July 1, as the case may

be, immediately preceding the date on which the payment becomes due, plus 2

percent. The rate must be adjusted accordingly on each January 1 and July 1

thereafter until the payment is satisfied.

      3.  Except for the interest authorized

pursuant to subsection 2 and any court costs and attorney’s fees awarded by a

court, no other fees may be charged concerning the amount that remains unpaid,

including, without limitation, collection fees, other attorney’s fees or any

other fees or costs.

      (Added to NRS by 2007, 1497; A 2011, 1525)

      NRS 449.758  Limitations on efforts of hospital to collect when hospital has

contractual agreement with third party that provides health coverage for care

provided; exception.

      1.  Except as otherwise provided in

subsection 2, if a hospital provides hospital care to a person who has a policy

of health insurance issued by a third party that provides health coverage for

care provided at that hospital and the hospital has a contractual agreement

with the third party, the hospital shall proceed with any efforts to collect on

any amount owed to the hospital for the hospital care in accordance with the

provisions of NRS 449.757 and shall not collect or

attempt to collect that amount from:

      (a) Any proceeds or potential proceeds of a civil

action brought by or on behalf of the patient, including, without limitation,

any amount awarded for medical expenses; or

      (b) An insurer other than a health insurer,

including, without limitation, an insurer that provides coverage under a policy

of casualty or property insurance.

      2.  This section does not apply to:

      (a) Amounts owed to the hospital under the policy

of health insurance that are not collectible; or

      (b) Medicaid, the Children’s Health Insurance

Program or any other public program which may pay all or part of the bill.

      3.  This section does not limit any rights

of a patient to contest an attempt to collect an amount owed to a hospital,

including, without limitation, contesting a lien obtained by a hospital.

      4.  As used in this section, “third party”

has the meaning ascribed to it in NRS

439B.260.

      (Added to NRS by 2011, 1524)

      NRS 449.759  Manner of collection.  A

hospital, or any person acting on its behalf who seeks to collect a debt from a

responsible party for any amount owed to the hospital for hospital care must

collect the debt in a professional, fair and lawful manner. When collecting

such a debt, the hospital or other person acting on its behalf must act in

accordance with sections 803 to 812, inclusive, of the federal Fair Debt

Collection Practices Act, as amended, 15 U.S.C. §§ 1692a to 1692j, inclusive,

even if the hospital or person acting on its behalf is not otherwise subject to

the provisions of that Act.

      (Added to NRS by 2007, 1498)

PREVENTING PERSONS FROM ENTERING OR EXITING HEALTH FACILITY

      NRS 449.760  Unlawful acts; exception; penalty.

      1.  Except as otherwise provided in this

section, a person shall not intentionally prevent another person from entering

or exiting the office of a physician, a health facility, a nonprofit health

facility, a public health center, a medical facility or a facility for the

dependent by physically:

      (a) Detaining the other person; or

      (b) Obstructing, impeding or hindering the other

person’s movement.

      2.  The provisions of subsection 1 are

inapplicable to:

      (a) An officer, employee or agent of the

physician, health facility, nonprofit health facility, public health center,

medical facility or facility for the dependent; or

      (b) A peace officer as defined in NRS 169.125,

Ê while acting

within the course and scope of his or her duties or employment.

      3.  The provisions of subsection 1 do not

prohibit a person from maintaining a picket during a strike or work stoppage in

compliance with the provisions of NRS

614.160, or from engaging in any constitutionally protected exercise of

free speech.

      4.  A person who violates the provisions of

subsection 1 is guilty of a misdemeanor and shall be punished by a fine of not

more than $1,000, or by imprisonment in the county jail for not more than 3

months, or by both fine and imprisonment.

      5.  As used in this section, the terms

“health facility,” “nonprofit health facility” and “public health center” have

the meanings ascribed to them in NRS 449.260.

      (Added to NRS by 1991, 1687)

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON

PATIENTS WITH DISABILITIES

      NRS 449.765  Definitions.  As

used in NRS 449.765 to 449.786,

inclusive, unless the context otherwise requires, the words and terms defined

in NRS 449.766 to 449.775,

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

      (Added to NRS by 1999, 3247)

      NRS 449.766  “Aversive intervention” defined.  “Aversive

intervention” means any of the following actions if the action is used to

punish a person with a disability or to eliminate, reduce or discourage

maladaptive behavior of a person with a disability:

      1.  The use of noxious odors and tastes;

      2.  The use of water and other mists or

sprays;

      3.  The use of blasts of air;

      4.  The use of corporal punishment;

      5.  The use of verbal and mental abuse;

      6.  The use of electric shock;

      7.  Requiring a person to perform exercise

under forced conditions if the:

      (a) Person is required to perform the exercise

because the person exhibited a behavior that is related to his or her

disability;

      (b) Exercise is harmful to the health of the

person because of his or her disability; or

      (c) Nature of the person’s disability prevents

the person from engaging in the exercise;

      8.  Any intervention, technique or

procedure that deprives a person of the use of one or more of the person’s

senses, regardless of the length of the deprivation, including, without

limitation, the use of sensory screens; or

      9.  The deprivation of necessities needed

to sustain the health of a person, regardless of the length of the deprivation,

including, without limitation, the denial or unreasonable delay in the

provision of:

      (a) Food or liquid at a time when it is

customarily served; or

      (b) Medication.

Ê The term

does not include the withholding or withdrawal of life-sustaining treatment in

accordance with NRS 449.626 or 449.691 to 449.697,

inclusive.

      (Added to NRS by 1999, 3247; A 2013, 2288)

      NRS 449.767  “Chemical restraint” defined.  “Chemical

restraint” means the administration of drugs for the specific and exclusive

purpose of controlling an acute or episodic aggressive behavior when

alternative intervention techniques have failed to limit or control the

behavior. The term does not include the administration of drugs on a regular

basis, as prescribed by a physician, to treat the symptoms of mental, physical,

emotional or behavioral disorders and for assisting a person in gaining self-control

over his or her impulses.

      (Added to NRS by 1999, 3247)

      NRS 449.768  “Corporal punishment” defined.  “Corporal

punishment” means the intentional infliction of physical pain, including,

without limitation, hitting, pinching or striking.

      (Added to NRS by 1999, 3248)

      NRS 449.769  “Electric shock” defined.  “Electric

shock” means the application of electric current to a person’s skin or body.

The term does not include electroconvulsive therapy.

      (Added to NRS by 1999, 3248)

      NRS 449.770  “Emergency” defined.  “Emergency”

means a situation in which immediate intervention is necessary to protect the

physical safety of a person or others from an immediate threat of physical

injury or to protect against an immediate threat of severe property damage.

      (Added to NRS by 1999, 3248)

      NRS 449.771  “Facility” defined.  “Facility”

means a facility licensed pursuant to this chapter that is a psychiatric

hospital or a unit of a hospital that is specifically designated to provide

care and services to persons with psychiatric or developmental disabilities.

      (Added to NRS by 1999, 3248)

      NRS 449.772  “Mechanical restraint” defined.  “Mechanical

restraint” means the use of devices, including, without limitation, mittens,

straps and restraint chairs to limit a person’s movement or hold a person

immobile.

      (Added to NRS by 1999, 3248)

      NRS 449.773  “Person with a disability” defined.  “Person

with a disability” means a person who:

      1.  Has a physical or mental impairment

that substantially limits one or more of the major life activities of the

person;

      2.  Has a record of such an impairment; or

      3.  Is regarded as having such an

impairment.

      (Added to NRS by 1999, 3248)

      NRS 449.774  “Physical restraint” defined.  “Physical

restraint” means the use of physical contact to limit a person’s movement or

hold a person immobile.

      (Added to NRS by 1999, 3248)

      NRS 449.775  “Verbal and mental abuse” defined.  “Verbal

and mental abuse” means actions or utterances that are intended to cause and

actually cause severe emotional distress to a person.

      (Added to NRS by 1999, 3248)

      NRS 449.776  Aversive intervention: Prohibition on use.  A person employed by a facility licensed

pursuant to this chapter or any other person shall not use any aversive

intervention on a person with a disability who is a patient at the facility.

      (Added to NRS by 1999, 3248)

      NRS 449.777  Forms of restraint: Restrictions on use.  A person employed by a facility licensed

pursuant to this chapter or any other person shall not:

      1.  Except as otherwise provided in NRS 449.778, use physical restraint on a person with a

disability who is a patient at the facility.

      2.  Except as otherwise provided in NRS 449.779, use mechanical restraint on a person with

a disability who is a patient at the facility.

      3.  Except as otherwise provided in NRS 449.780, use chemical restraint on a person with a

disability who is a patient at the facility.

      (Added to NRS by 1999, 3248)

      NRS 449.778  Physical restraint: Permissible use; report of use in emergency.

      1.  Except as otherwise provided in

subsection 2, physical restraint may be used on a person with a disability who

is a patient at a facility only if:

      (a) An emergency exists that necessitates the use

of physical restraint;

      (b) The physical restraint is used only for the

period that is necessary to contain the behavior of the patient so that the

patient is no longer an immediate threat of causing physical injury to himself

or herself or others or causing severe property damage; and

      (c) The use of force in the application of

physical restraint does not exceed the force that is reasonable and necessary

under the circumstances precipitating the use of physical restraint.

      2.  Physical restraint may be used on a

person with a disability who is a patient at a facility and the provisions of

subsection 1 do not apply if the physical restraint is used to:

      (a) Assist the patient in completing a task or

response if the patient does not resist the application of physical restraint

or if the patient’s resistance is minimal in intensity and duration;

      (b) Escort or carry a patient to safety if the

patient is in danger in his or her present location; or

      (c) Conduct medical examinations or treatments on

the patient that are necessary.

      3.  If physical restraint is used on a

person with a disability who is a patient at a facility in an emergency, the

use of the procedure must be reported as a denial of rights pursuant to NRS 449.786, regardless of whether the use of the

procedure is authorized by statute. The report must be made not later than 1

working day after the procedure is used.

      (Added to NRS by 1999, 3249)

      NRS 449.779  Mechanical restraint: Permissible use; report of use in

emergency.

      1.  Except as otherwise provided in

subsection 2, mechanical restraint may be used on a person with a disability

who is a patient at a facility only if:

      (a) An emergency exists that necessitates the use

of mechanical restraint;

      (b) A medical order authorizing the use of

mechanical restraint is obtained from the patient’s treating physician before

the application of the mechanical restraint or not later than 15 minutes after

the application of the mechanical restraint;

      (c) The physician who signed the order required pursuant

to paragraph (b) or the attending physician examines the patient not later than

1 working day immediately after the application of the mechanical restraint;

      (d) The mechanical restraint is applied by a

member of the staff of the facility who is trained and qualified to apply

mechanical restraint;

      (e) The patient is given the opportunity to move

and exercise the parts of his or her body that are restrained at least 10

minutes per every 60 minutes of restraint;

      (f) A member of the staff of the facility lessens

or discontinues the restraint every 15 minutes to determine whether the patient

will stop or control his or her inappropriate behavior without the use of the

restraint;

      (g) The record of the patient contains a notation

that includes the time of day that the restraint was lessened or discontinued

pursuant to paragraph (f), the response of the patient and the response of the

member of the staff of the facility who applied the mechanical restraint;

      (h) A member of the staff of the facility continuously

monitors the patient during the time that mechanical restraint is used on the

patient; and

      (i) The patient is released from the mechanical

restraint as soon as the behavior of the patient no longer presents an

immediate threat to himself or herself or others.

      2.  Mechanical restraint may be used on a

person with a disability who is a patient at a facility and the provisions of

subsection 1 do not apply if the mechanical restraint is used to:

      (a) Treat the medical needs of a patient;

      (b) Protect a patient who is known to be at risk

of injury to himself or herself because the patient lacks coordination or

suffers from frequent loss of consciousness;

      (c) Provide proper body alignment to a patient;

or

      (d) Position a patient who has physical disabilities

in a manner prescribed in the patient’s plan of treatment.

      3.  If mechanical restraint is used on a

person with a disability who is a patient at a facility in an emergency, the

use of the procedure must be reported as a denial of rights pursuant to NRS 449.786, regardless of whether the use of the

procedure is authorized by statute. The report must be made not later than 1

working day after the procedure is used.

      (Added to NRS by 1999, 3249)

      NRS 449.780  Chemical restraint: Permissible use; report of use.

      1.  Chemical restraint may only be used on

a person with a disability who is a patient at a facility if:

      (a) The patient has been diagnosed as a person

with mental illness, as defined in NRS

433A.115, and is receiving mental health services from a facility;

      (b) The chemical restraint is administered to the

patient while he or she is under the care of the facility;

      (c) An emergency exists that necessitates the use

of chemical restraint;

      (d) A medical order authorizing the use of chemical

restraint is obtained from the patient’s attending physician or psychiatrist;

      (e) The physician or psychiatrist who signed the

order required pursuant to paragraph (d) examines the patient not later than 1

working day immediately after the administration of the chemical restraint; and

      (f) The chemical restraint is administered by a

person licensed to administer medication.

      2.  If chemical restraint is used on a

person with a disability who is a patient, the use of the procedure must be

reported as a denial of rights pursuant to NRS 449.786,

regardless of whether the use of the procedure is authorized by statute. The

report must be made not later than 1 working day after the procedure is used.

      (Added to NRS by 1999, 3250)

      NRS 449.781  Use of forms of restraint by certain facilities.  Notwithstanding the provisions of NRS 449.777 to 449.780,

inclusive, to the contrary, a facility may use or authorize the use of physical

restraint, mechanical restraint or chemical restraint on a person with a

disability who is a patient if the facility is:

      1.  Accredited by a nationally recognized

accreditation association or agency; or

      2.  Certified for participation in the

Medicaid or Medicare program,

Ê only to the

extent that the accreditation or certification allows the use of such

restraint.

      (Added to NRS by 1999, 3248)

      NRS 449.782  Education and training of members of staff of facility.

      1.  Each facility shall develop a program

of education for the members of the staff of the facility to provide

instruction in positive behavioral interventions and positive behavioral

supports that:

      (a) Includes positive methods to modify the

environment of patients to promote adaptive behavior and reduce the occurrence

of inappropriate behavior;

      (b) Includes methods to teach skills to patients

so that patients can replace inappropriate behavior with adaptive behavior;

      (c) Includes methods to enhance a patient’s

independence and quality of life;

      (d) Includes the use of the least intrusive

methods to respond to and reinforce the behavior of patients; and

      (e) Offers a process for designing interventions

based upon the patient that are focused on promoting appropriate changes in

behavior as well as enhancing the overall quality of life for the patient.

      2.  Each facility shall provide appropriate

training for the members of the staff of the facility who are authorized to

carry out and monitor physical restraint and mechanical restraint to ensure

that those members of the staff are competent and qualified to carry out the

procedures in accordance with NRS 449.765 to 449.786, inclusive.

      (Added to NRS by 1999, 3250)

      NRS 449.783  Violations: Criminal penalties; ineligibility for employment;

disciplinary action.

      1.  Unless a more severe penalty is

prescribed by specific statute, a person who willfully uses aversive

intervention on a person with a disability who is a patient at a facility or,

except as otherwise provided in NRS 449.781,

violates NRS 449.777:

      (a) For a first violation that does not result in

substantial bodily harm to the person with a disability, is guilty of a gross

misdemeanor.

      (b) For a first violation that results in

substantial bodily harm to the person with a disability, is guilty of a

category B felony.

      (c) For a second or subsequent violation, is

guilty of a category B felony.

Ê A person who

is convicted of a category B felony pursuant to this section shall be punished

by imprisonment in the state prison for a minimum term of not less than 1 year

and a maximum term of not more than 6 years, or by a fine of not more than

$5,000, or by both fine and imprisonment.

      2.  A person who is convicted pursuant to

this section is ineligible for 5 years for employment with a facility.

      3.  A conviction pursuant to this section

is, when applicable, grounds for disciplinary action against the person so

convicted and the facility where the violation occurred. The Division may

recommend to the appropriate agency or board the suspension or revocation of

the professional license, registration, certificate or permit of a person

convicted.

      (Added to NRS by 1999, 3251)

      NRS 449.784  Violations: Report required; development and review of and

compliance with corrective plan.

      1.  A facility where a violation of the

provisions of NRS 449.765 to 449.786,

inclusive, occurs shall report the violation to the Division not later than 24

hours after the violation occurred, or as soon thereafter as the violation is

discovered.

      2.  A facility where a violation occurred

shall develop, in cooperation with the Division, a corrective plan to ensure

that within 30 calendar days after the violation occurred, appropriate action

is taken by the facility to prevent future violations.

      3.  The Division shall forward the plan to

the Board. The Board shall review the plan to ensure that it complies with

applicable federal law and the statutes and regulations of this state. The

Board may require appropriate revision of the plan to ensure compliance.

      4.  If the facility where the violation

occurred does not meet the requirements of the plan to the satisfaction of the

Board, the Board may direct the agency that administers funding for the

facility to withhold state funding for the facility until the facility meets

the requirements of the plan.

      (Added to NRS by 1999, 3251)

      NRS 449.785  Prohibition on retaliation against person for reporting or

providing information regarding violation.  An

officer, administrator or employee of a facility licensed pursuant to this

chapter shall not retaliate against any person for having:

      1.  Reported a violation of NRS 449.765 to 449.786,

inclusive; or

      2.  Provided information regarding a

violation of NRS 449.765 to 449.786,

inclusive,

Ê by a

facility or a member of the staff of the facility.

      (Added to NRS by 1999, 3252)

      NRS 449.786  Entry of denial of rights in patient’s record; notice and report

of denial; action by Division.

      1.  A denial of rights of a person with a

disability who is a patient of a facility pursuant to NRS

449.765 to 449.786, inclusive, must be entered

in the patient’s record. Notice of the denial must be provided to the

administrator of the facility.

      2.  If the administrator of a facility

receives notice of a denial of rights pursuant to subsection 1, the

administrator shall cause a full report to be prepared which must set forth in

detail the factual circumstances surrounding the denial. A copy of the report

must be provided to the Division.

      3.  The Division:

      (a) Shall receive reports made pursuant to

subsection 2;

      (b) May investigate apparent violations of the

rights of persons with disabilities who are patients at facilities; and

      (c) May act to resolve disputes relating to

apparent violations.

      (Added to NRS by 1999, 3252)

REGISTRY OF ADVANCE DIRECTIVES FOR HEALTH CARE

      NRS 449.900  Definitions.  As used

in NRS 449.900 to 449.965,

inclusive, unless the context otherwise requires, the words and terms defined

in NRS 449.905, 449.910

and 449.915 have the meanings ascribed to them in

those sections.

      (Added to NRS by 2007, 2515)

      NRS 449.905  “Advance directive” defined.  “Advance

directive” means an advance directive for health care. The term includes:

      1.  A declaration governing the withholding

or withdrawal of life-sustaining treatment as set forth in NRS 449.535 to 449.690,

inclusive;

      2.  A durable power of attorney for health

care as set forth in NRS 162A.700 to 162A.860, inclusive;

      3.  A do-not-resuscitate order as defined

in NRS 450B.420; and

      4.  A Physician Order for Life-Sustaining

Treatment form as defined in NRS 449.693.

      (Added to NRS by 2007, 2515; A 2009, 210; 2013, 2289)

      NRS 449.910  “Registrant” defined.  “Registrant”

means a person whose advance directive is registered with the Secretary of

State pursuant to NRS 449.925.

      (Added to NRS by 2007, 2515)

      NRS 449.915  “Registry” defined.  “Registry”

means the Registry of Advance Directives for Health Care established by the

Secretary of State pursuant to NRS 449.920.

      (Added to NRS by 2007, 2515)

      NRS 449.920  Establishment and maintenance; information to be included in

Registry.  The Secretary of State

shall establish and maintain the Registry of Advance Directives for Health Care

on the Internet website of the Secretary of State. The Registry must include,

without limitation, in a secure portion of the website, an electronic

reproduction of each advance directive. The electronic reproduction must be

capable of being viewed on the website and downloaded, printed or otherwise

retrieved by a person as set forth in NRS 449.930.

      (Added to NRS by 2007, 2515)

      NRS 449.925  Registration of advance directive: Requirements; duties of

Secretary of State.

      1.  A person who wishes to register an

advance directive must submit to the Secretary of State:

      (a) An application in the form prescribed by the

Secretary of State;

      (b) A copy of the advance directive; and

      (c) The fee, if any, established by the Secretary

of State pursuant to NRS 449.955.

      2.  If the person satisfies the

requirements of subsection 1, the Secretary of State shall:

      (a) Make an electronic reproduction of the

advance directive and post it to the Registry and, if the person consents

pursuant to NRS 439.591, the statewide

health information exchange system established pursuant to NRS 439.581 to 439.595, inclusive;

      (b) Assign a registration number and password to

the registrant; and

      (c) Provide the registrant with a registration

card that includes, without limitation, the name, registration number and

password of the registrant.

      3.  The Secretary of State shall establish

procedures for:

      (a) The registration of an advance directive that

replaces an advance directive that is posted on the Registry;

      (b) The removal from the Registry of an advance

directive that has been revoked following the revocation of the advance

directive or the death of the registrant; and

      (c) The issuance of a duplicate registration card

or the provision of other access to the registrant’s registration number and

password if a registration card issued pursuant to this section is lost,

stolen, destroyed or otherwise unavailable.

      (Added to NRS by 2007, 2515; A 2013, 2289)

      NRS 449.930  Access to advance directive.

      1.  Except as otherwise provided in this

section, the Secretary of State shall not provide access to a registrant’s

advance directive unless:

      (a) The person requesting access provides the

registration number and password of the registrant;

      (b) The Secretary of State determines that

providing access to the advance directive is in the best interest of the

registrant;

      (c) Access to the advance directive is required

pursuant to the lawful order of a court of competent jurisdiction; or

      (d) Access to the advance directive is requested

by the registrant or the registrant’s personal representative.

      2.  A registrant or the personal

representative of a registrant may access the registrant’s advance directive

for any purpose. A provider of health care to the registrant may access the

registrant’s advance directive only in connection with the provision of health

care to the registrant.

      (Added to NRS by 2007, 2516)

      NRS 449.935  Removal of advance directive of deceased registrant.  The Secretary of State shall remove from the

Registry the advance directives of deceased registrants. The State Registrar of

Vital Statistics shall cooperate with the Secretary of State to identify

registrants whose advance directives must be removed from the Registry. The

Secretary of State shall remove from the Registry the advance directives of

deceased registrants at least once every 5 years.

      (Added to NRS by 2007, 2516)

      NRS 449.940  Secretary of State not required to determine accuracy of

contents of advance directive or validity of advance directive; effect of

registration, failure to register and failure to notify Secretary of State of

revocation of advance directive.

      1.  The provisions of NRS 449.900 to 449.965,

inclusive, do not require the Secretary of State to determine whether the

contents of an advance directive submitted for registration are accurate or the

execution or issuance of the advance directive complies with the requirements

necessary to make the advance directive valid.

      2.  The registration of an advance

directive does not establish or create a presumption that the contents of the

advance directive are accurate or the execution or issuance of the advance

directive complies with the requirements necessary to make the advance

directive valid.

      3.  Failure to register an advance

directive does not affect the validity of the advance directive.

      4.  Failure to notify the Secretary of

State of the revocation of a registrant’s advance directive does not affect the

validity of the revocation.

      (Added to NRS by 2007, 2516)

      NRS 449.945  Provider of health care not required to inquire whether patient

has registered advance directive or access Registry; immunity of provider of

health care from criminal and civil liability.

      1.  The provisions of NRS 449.900 to 449.965,

inclusive, do not require a provider of health care to inquire whether a

patient has an advance directive registered on the Registry or to access the

Registry to determine the terms of the advance directive.

      2.  A provider of health care who relies in

good faith on the provisions of an advance directive retrieved from the

Registry is immune from criminal and civil liability as set forth in:

      (a) NRS 449.630, if

the advance directive is a declaration governing the withholding or withdrawal

of life-sustaining treatment executed pursuant to NRS

449.535 to 449.690, inclusive, or a durable

power of attorney for health care executed pursuant to NRS 162A.700 to 162A.860, inclusive;

      (b) NRS 449.691 to 449.697, inclusive, if the advance directive is a

Physician Order for Life-Sustaining Treatment form; or

      (c) NRS

450B.540, if the advance directive is a do-not-resuscitate order as defined

in NRS 450B.420.

      (Added to NRS by 2007, 2516; A 2009, 210; 2013, 2290)

      NRS 449.950  Immunity of Secretary of State and deputies, employees and

attorneys of Secretary of State.  The

Secretary of State and the deputies, employees and attorneys of the Secretary

of State are not liable for any action or omission made in good faith by the

Secretary of State, deputy, employee or attorney in carrying out the provisions

of NRS 449.900 to 449.965,

inclusive.

      (Added to NRS by 2007, 2516)

      NRS 449.955  Suspension of components of Registry and duties of Secretary of

State if sufficient money not available; fees authorized; acceptance of gifts

and grants.

      1.  On or before July 1 of each

odd-numbered year, the Secretary of State 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 Secretary of State

relating to NRS 449.900 to 449.965,

inclusive.

      2.  The Secretary of State shall

temporarily suspend any components of the programs or duties of the Secretary

of State for which he or she determines pursuant to subsection 1 that

sufficient money is not available.

      3.  The Secretary of State may charge and

collect fees and accept gifts, grants, bequests and other contributions from

any source for the purpose of carrying out the provisions of NRS 449.900 to 449.965,

inclusive.

      (Added to NRS by 2007, 2517)

      NRS 449.960  Deposit, accounting and use of money received; interest and

income earned on money received; payment of claims.

      1.  All money received by the Secretary of

State pursuant to NRS 449.900 to 449.965, inclusive, must be:

      (a) Deposited in the State Treasury and accounted

for separately in the State General Fund; and

      (b) Used only for the purpose of carrying out the

provisions of NRS 449.900 to 449.965,

inclusive.

      2.  The Secretary of State shall administer

the account. The interest and income earned on the money in the account, after

deducting any applicable charges, must be credited to the account.

      3.  The money in the account does not lapse

to the State General Fund at the end of any fiscal year.

      4.  Claims against the account must be paid

as other claims against the State are paid.

      (Added to NRS by 2007, 2517)

      NRS 449.965  Regulations.  The

Secretary of State may adopt regulations to carry out the provisions of NRS 449.900 to 449.965,

inclusive.

      (Added to NRS by 2007, 2517)