NAC: CHAPTER 449 - MEDICAL FACILITIES AND OTHER RELATED ENTITIES

[Rev. 1/4/2022 1:32:15 PM]

[NAC-449 Revised Date: 11-21]

CHAPTER 449 - MEDICAL FACILITIES AND OTHER RELATED ENTITIES

GENERAL PROVISIONS

449.002        Definitions.

449.0022      “Administrator” defined.

449.0024      “Affiliated facility” defined.

449.0026      “Agent” defined.

449.0028      “Bureau” defined.

449.0029      “Centers for Medicare and Medicaid Services” defined.

449.00295    “Central Repository” defined.

449.003        “Deficiency” defined.

449.00305    “Division” defined.

449.0031      “Division of Welfare and Supportive Services” defined.

449.0032      “Emergency” defined.

449.0033      “Employment agency to provide nonmedical services” defined.

449.0034      “Facility” defined.

449.0042      “Holiday” defined.

449.0043      “Home for individual residential care” defined.

449.0044      “Immediate and serious threat” and “immediate jeopardy” defined.

449.0046      “Incident” defined.

449.0048      “License” defined.

449.0049      “Licensed dietitian” defined.

449.005        “Licensee” defined.

449.0052      “Medicaid” defined.

449.0054      “Medicare” defined.

449.0056      “Party” defined.

449.0058      “Person” defined.

449.006        “Recipient” defined.

449.0061      “Referral agency” defined.

449.0062      “Resident” defined.

449.0064      “Residential facility” defined.

449.0066      “Sanction” defined.

449.0068      “Services” defined.

449.007        “Survey” defined.

449.0072      “Treatment” defined.

449.008        Computation of time.

449.0085      Licensee prohibited from employing or contracting with unlicensed person to provide certain nutrition services.

449.009        Control by Division over medical records of medical facility or facility for dependent upon suspension of license or cessation of operation: Authorized actions to remove, store and protect records; facilities to pay cost of maintenance of records; notice before destruction of records.

449.010        Severability.

449.0105      Adoption of certain publications by reference; revision of publication after adoption.

449.0107      Posting of star rating by medical facility or facility for the dependent; exception.

GENERAL REQUIREMENTS FOR LICENSURE

449.011        Application for license.

449.0112      Investigation; prelicensure survey; inspection for fire safety.

449.01125    Duties of Division if Central Repository unable to complete investigation of applicant; grounds for denial or revocation of license or delay of action concerning application.

449.0113      Duties of administrator or licensee if Central Repository unable to complete investigation of employee or independent contractor; grounds for termination; actions to ensure patient safety.

449.0114      Display of license; compliance with law; transfer of real property; change in administrator, ownership, location, services or maximum number of clients.

449.0115      Review of building plans for new construction or remodeling by certain applicants: Required documents; payment of fees and costs.

449.01153    Approval of building plans for construction or remodeling of certain facilities: Period of validity.

449.01156    On-site advisory inspection of facility: Written request; action by Division; fee.

449.0116      Renewal of license: Application; validity of existing license pending decision on application; inspection of facility; untimely filing or failure to file application.

449.0118      Denial, suspension or revocation of license: Grounds.

449.0119      Denial, suspension or revocation of license or endorsement: Appeals.

FEES

449.012        Definitions.

449.01205    “Agency to provide personal care services in the home” defined.

449.0121      “Ambulatory surgical center” defined.

449.01215    “Branch office” defined.

449.01219    “Community triage center” defined.

449.01225    “Facility for hospice care” defined.

449.01227    “Facility for refractive surgery” defined.

449.01228    “Facility for transitional living for released offenders” defined.

449.01229    “Facility for treatment with narcotics” defined.

449.0123      “Home health agency” defined.

449.01235    “Home office” defined.

449.0124      “Hospice care” defined.

449.01245    “Intermediate care facility for persons with an intellectual disability or persons with a developmental disability” defined.

449.0125      “Medication unit” defined.

449.01252    “Mobile unit” defined.

449.01255    “Nursing pool” defined.

449.01257    “Psychiatric residential treatment facility” defined.

449.01259    “Recovery center” defined.

449.0126      “Rural clinic” defined.

449.01265    “Rural hospital” defined.

449.0127      “Subunit agency” defined.

449.013        License and renewal fees to operate ambulatory surgical center, home office or subunit agency of home health agency, branch office of home health agency, rural clinic, obstetric center, program of hospice care, independent center for emergency medical care, nursing pool, facility for treatment with narcotics, medication unit, referral agency, facility for refractive surgery, mobile unit, agency to provide personal care services in home, facility for the care of adults during day, peer support recovery organization, community health worker pool and employment agency to provide nonmedical services; expiration of application for license.

449.016        License and renewal fees to operate skilled nursing facility, hospital, rural hospital, intermediate care facility, residential facility for groups, facility for treatment of alcohol or other substance use disorders, facility for hospice care, home for individual residential care, facility for modified medical detoxification, community triage center, facility for treatment of irreversible renal disease, halfway house for persons recovering from alcohol or other substance use disorders, facility for transitional living for released offenders, psychiatric residential treatment facility and recovery center; expiration of application for license; refund of certain fees.

449.0164      Fees for renewal of licenses for certain facilities: Payment in two equal installments.

449.0168      Fees for modification of certain licenses.

449.01685    Division authorized to charge and collect fee from licensee to recover costs of investigating complaint if complaint is substantiated.

449.0169      Department of Corrections to pay fee to Division for certain services.

PROVISION OF HOSPICE CARE

General Provisions

449.017        Definitions.

449.0171      “Bereavement services” defined.

449.0172      “Facility for hospice care” defined.

449.0173      “Governing body” defined.

449.0175      “Hospice care” defined.

449.0176      “Medical director” defined.

449.01765    “Palliative services” defined.

449.0177      “Patient” defined.

449.0178      “Terminally ill” defined.

Licensing

449.0181      Compliance with regulations required for license to operate facility for hospice care.

449.0183      Report of change in ownership, address or staff of program of hospice care.

Administration

449.0184      Governing body required; duties of governing body and administrator.

Medical Services

449.0185      Requirements for program of hospice care.

449.0186      Requirements for plan of care.

449.0187      Requirements for operation of facility for hospice care.

449.0188      Continuity of service to patients required.

FACILITIES FOR THE TREATMENT OF ALCOHOL OR OTHER SUBSTANCE USE DISORDERS

General Provisions

449.019        Definitions.

449.022        “Administrator” defined.

449.025        “Alcohol or other substance use disorder treatment” defined.

449.030        “Case management services” defined.

449.031        “Client” defined.

449.034        “Detoxification” defined.

449.043        “Facility” defined.

449.044        “Facility for modified medical detoxification” defined.

449.046        “Governing body” defined.

449.060        “Medically managed intensive detoxification program” defined.

449.064        “Overall program” defined.

449.068        “Qualified social worker” defined.

449.069        “Residential program” defined.

449.072        “Social model detoxification program” defined.

Licensing

449.079        Denial, revocation or suspension of license if facility not certified by Division; appeal.

449.081        New construction or remodeling: Submission and approval of building plans; prerequisites to approval of licensing.

Administration and Personnel

449.085        Governing body; bylaws.

449.088        Policies and procedures.

449.091        Transfer of client to another facility.

449.094        Money of clients.

449.098        Preparations for disasters; reporting of fire or disaster.

449.102        Inventory and return of client’s belongings.

449.105        Insurance.

449.108        General requirements for programs.

449.111        Administrator: Duties.

449.114        Employees: General requirements.

449.117        Employees: Proof of compliance with provisions concerning tuberculosis.

Social Model Detoxification Programs

449.121        Certain facilities authorized to offer program.

449.1214      General requirements.

449.1218      Program of ongoing quality improvement.

Operation of Facility

449.123        General sanitary requirements.

449.126        Laundry requirements.

449.129        Design, construction, equipment and maintenance.

449.132        Accommodations for clients.

449.135        Safety from fire.

449.141        Health services.

449.144        Medication.

449.147        Dietary services.

449.150        Records of clients.

449.153        Discrimination prohibited.

FACILITIES FOR MODIFIED MEDICAL DETOXIFICATION

449.15311    Definitions.

449.15313    “Administrator” defined.

449.15315    “Client” defined.

449.15317    “Facility” defined.

449.15319    “Overall program” defined.

449.15321    “Program” defined.

449.15323    Proof of certification required; revocation of license.

449.15325    Governing body; bylaws and policies.

449.15327    Policies and procedures for services and operation of facility.

449.15329    Transfer of client.

449.15331    Handling of money of client.

449.15333    Inventory of belongings of client.

449.15335    Liability insurance.

449.15337    Program: Requirements; review.

449.15339    Responsibilities and duties of administrator.

449.15341    Policies and procedures concerning employees.

449.15343    Nursing services.

449.15345    Health services.

449.15347    Pharmaceutical services.

449.15349    Medication and biologicals.

449.15351    Dietary services.

449.15353    Records of clients.

449.15355    Safety and sanitation; temperature.

449.15357    Laundry requirements.

449.15359    New construction or remodeling: Submission and approval of building plans; prerequisites to approval of facility for licensure.

449.15361    Design, construction, equipment and maintenance.

449.15363    Accommodations for clients.

449.15365    Safety from fire.

449.15367    Preparations for disasters; reporting of fire or disaster.

449.15369    Discrimination prohibited.

FACILITIES FOR TREATMENT WITH NARCOTICS; MEDICATION UNITS

General Provisions

449.154        Definitions.

449.15415    “DEA” defined.

449.1542      “Facility for treatment with narcotics” defined.

449.1543      “Medical director” defined.

449.15435    “Medication unit” defined.

449.15438    “SAMHSA” defined.

449.1544      Division is state authority for certain federal regulations.

Licensing

449.15445    License and federal certification required to operate facility or unit.

449.1545      Filing requirements; recommendation for certification.

449.15455    Investigation and prelicensure survey.

449.1547      Suspension, revocation or cancellation of license; provisional license; denial of application.

Operation

449.1548      General operational requirements.

449.15485    Continuing review of operations; investigation of complaints.

PEER SUPPORT RECOVERY ORGANIZATIONS

449.15488    “Client” defined.

449.154882         License issued to specific person for specific location; name of administrator required to appear on license; proof of liability coverage required.

449.154884         Qualifications and duties of administrator; designated employee to have access to records in absence of administrator.

449.154886         Policies and procedures.

449.154888         Qualifications of employee, volunteer or contractor.

449.15489    Personnel file required for employee, volunteer or contractor; required contents.

449.154892         Required knowledge, training and evaluation for employee, volunteer or contractor.

449.154894         Actions of administrator to protect rights of clients; development and contents of written description of rights of clients.

HALFWAY HOUSES FOR PERSONS RECOVERING FROM ALCOHOL OR OTHER SUBSTANCE USE DISORDERS

449.1549      Definitions.

449.154901         “Administrator” defined.

449.154903         “Client” defined.

449.154905         “Facility” defined.

449.15491    Administrator: Qualifications.

449.154911         Administrator: General duties.

449.154913         General operational guidelines.

449.154915         Policies and procedures: Establishment; maintenance of manual.

449.154917         Limitation on admissions.

449.154919         Health and sanitation.

449.154921         Laundry facilities.

449.154923         Kitchens; storage of food.

449.154925         Bedrooms; bedding.

449.154927         Use of certain areas as bedroom prohibited.

449.154929         Bathrooms and toilet facilities; toilet articles.

449.154931         Accommodations for residents with restricted mobility.

449.154933         First aid.

449.154935         Medication.

449.154937         Telephones; listing of facility’s telephone number.

449.154939         Notification to Bureau under certain circumstances.

449.154941         Rights of clients.

449.154943         Client files: Maintenance; contents; confidentiality.

449.154945         Safety from fire.

FACILITIES FOR TRANSITIONAL LIVING FOR RELEASED OFFENDERS

General Provisions

449.154951         Definitions.

449.154953         “Administrator” defined.

449.154955         “Facility” defined.

449.154957         “Resident” defined.

449.154959         “Supportive services” defined.

Administration

449.154961         Administrator: Qualifications.

449.154963         Administrator: General duties.

449.154965         Operation of facility.

449.154967         Policies and procedures.

449.154969         Preparations for disasters and other emergencies.

Operation

449.154971         Limitation on number of admissions.

449.154973         Prerequisites to provision of particular services.

449.154975         Sanitation, safety and comfort.

449.154977         Laundry facilities.

449.154979         Kitchens; preparation and storage of food.

449.154981         Bedrooms and bedding.

449.154983         Use of certain areas as bedroom prohibited.

449.154985         Bathrooms and toilet facilities; toiletries.

449.154987         First aid.

449.154989         Medication.

449.154991         Telephones; listing of facility’s telephone number.

449.154993         Notification of occurrence of certain incidents.

449.154995         Rights of residents.

449.154997         Files for residents.

449.154999         Safety from fire.

HOMES FOR INDIVIDUAL RESIDENTIAL CARE

449.15511    Definitions.

449.15513    “Caregiver” defined.

449.15515    “Director” defined.

449.15517    “Home” defined.

449.15519    “Protective supervision” defined.

449.15521    Director: Qualifications.

449.15523    Director: Duties.

449.15525    Requirements for safety and sanitation of facility.

449.15527    Agreement between operator of home and resident concerning rates; maintenance of records of residents.

449.15529    On-site survey of home by Bureau.

RESIDENTIAL FACILITIES FOR GROUPS

General Provisions

449.156        Definitions.

449.1565      “Administer” defined.

449.157        “Administrator” defined.

449.1575      “Board” defined.

449.1585      “Caregiver” defined.

449.1591      “Category 1 resident” defined.

449.1595      “Category 2 resident” defined.

449.1597      “Dietary supplement” defined.

449.1599      “Discharge” defined.

449.160        “Division” defined.

449.161        “Grade” defined.

449.164        “Hospice care” defined.

449.169        “Medical professional” defined.

449.170        “Placard” defined.

449.172        “Residential facility” defined.

449.173        “Residential facility which provides care to persons with Alzheimer’s disease” defined.

449.175        “Severity and scope score” defined.

449.176        “Staff of a facility” defined.

449.178        “Transfer” defined.

Licensing

449.179        Submission and approval of plan for new construction or remodeling; inspection; evidence of compliance.

449.180        Requirements for purchasing licensed facility.

449.190        License: Contents; validity; transferability; issuance of more than one type.

449.191        Denial, suspension or revocation of endorsement: Grounds.

449.1915      Suspension or revocation of license and endorsement if residential facility has been assigned grade of D on two or more consecutive surveys or resurveys, or both.

Administration and Personnel

449.194        Responsibilities of administrator.

449.196        Qualifications and training of caregivers.

449.197        Medical services may be provided only by medical professional.

449.1985      Performance of certain tasks by caregiver.

449.199        Staffing requirements; limitation on number of residents; written schedule for each shift; direct supervision of certain employees.

449.200        Personnel files.

449.202        Rights of staff members during investigation of facility; duties of investigator.

General Operational Requirements

449.204        System of financial accounting; insurance.

449.205        Advertising and promotional materials.

449.208        Restrictions on conducting other businesses or providing other services on premises.

449.209        Health and sanitation.

449.211        Automatic sprinkler systems.

449.213        Laundry and linen services.

449.216        Common areas; dining rooms.

449.217        Kitchens; storage of food; adequate supplies of food; permits; inspections.

449.2175      Service of food; seating; menus; special diets; nutritional requirements; dietary consultants.

449.218        Bedrooms: Floor space; windows and doors; privacy; storage space; bedding; personal furnishings; lighting.

449.220        Bedroom doors.

449.221        Use of certain areas in facility as bedroom prohibited.

449.222        Bathrooms and toilet facilities; toilet articles.

449.224        Housing for staff members.

449.226        Safety requirements for residents with restricted mobility or poor eyesight; water hazards; auditory systems for bathrooms and bedrooms; access by vehicles.

449.227        Accommodations for residents with restricted mobility.

449.229        Requirements and precautions regarding safety from fire.

449.231        First aid and cardiopulmonary resuscitation.

449.232        Telephones; emergency telephone numbers for each resident; listing of facility’s telephone number.

449.241        Limitations on use of volunteers; requirements concerning residents who volunteer to assist staff or perform other duties.

449.258        Written policies for facility; policy on visiting hours; residents’ mail; compliance with policies.

449.259        Supervision and treatment of residents generally.

449.260        Activities for residents.

449.262        Provision of dental, optical and hearing care and social services; report of suspected abuse, neglect, isolation or exploitation; restrictions on use of restraints, confinement or sedatives.

449.267        Money and property of residents.

449.268        Rights of residents; procedure for filing grievance, complaint or report of incident; investigation and response.

449.269        Discrimination prohibited.

Admitting, Transferring and Discharging Residents

449.2702      Written policy on admissions; eligibility for residency.

449.2704      Disclosure of information concerning rates and payment for services.

449.2706      Transfer of resident whose condition deteriorates.

449.2707      Transfer of resident: Effective date.

449.2708      Discharge of resident; notice of discharge; issuance of notice to quit to resident for improper or harmful behavior.

Restrictions on Admitting or Retaining Residents With Certain Medical Needs or Conditions

449.271        Residents requiring gastrostomy care or suffering from staphylococcus infection or other serious infection or medical condition.

449.2712      Residents requiring use of oxygen.

449.2714      Residents requiring use of intermittent positive pressure breathing equipment.

449.2716      Residents having colostomy or ileostomy.

449.2718      Residents requiring manual removal of fecal impactions or use of enemas or suppositories.

449.272        Residents requiring use of indwelling catheter.

449.2722      Residents having unmanageable condition of bowel or bladder incontinence; residents having manageable condition of bowel or bladder incontinence.

449.2724      Residents having contractures.

449.2726      Residents having diabetes.

449.2728      Residents requiring regular intramuscular, subcutaneous or intradermal injections.

449.2732      Residents requiring protective supervision.

449.2734      Residents having tracheostomy or open wound requiring treatment by medical professional; residents having pressure or stasis ulcers.

449.2736      Procedure to exempt certain residents from restrictions.

449.2738      Review of medical condition of resident; relocation or transfer of resident having certain medical needs or conditions.

Medical Services, Medical Records and Other Records Concerning Residents

449.274        Medical care of resident after illness, injury or accident; periodic physical examination of resident; rejection of medical care by resident; written records.

449.2742      Administration of medication: Responsibilities of administrator, caregivers and employees of facility.

449.2744      Administration of medication: Maintenance and contents of logs and records.

449.2746      Administration of medication: Restrictions concerning medication taken as needed by resident; written records.

449.2748      Medication: Storage; duties upon discharge, transfer and return of resident.

449.2749      Maintenance and contents of separate file for each resident; confidentiality of information.

Special Types of Services and Facilities

449.275        Residential facility which provides residents with hospice care: Responsibilities of staff; retention of resident with special medical needs.

449.2751      Residential facility which provides assisted living services: Application for endorsement; general requirements.

449.2754      Residential facility which provides care to persons with Alzheimer’s disease: Application for endorsement; general requirements.

449.2756      Residential facility which provides care to persons with Alzheimer’s disease: Standards for safety; personnel required; training for employees.

449.2758      Residential facility which provides care for elderly persons or persons with disabilities: Training for caregivers.

449.2762      Residential facility which offers or provides care for adults with intellectual disabilities or adults with related conditions: Application for endorsement; training for caregivers.

449.2764      Residential facility which offers or provides care for persons with mental illnesses: Application for endorsement; training for employees.

449.2766      Residential facility which offers or provides care for persons with chronic illnesses and debilitating diseases: Application for endorsement; training for employees.

449.2768      Residential facility which provides care to persons with dementia: Training for employees.

Deficiencies

449.27702    Determination of severity and scope of deficiency; assignment of grade.

449.27704    Placard: Issuance and display; failure to comply.

449.27706    Resurvey: Application and fee; failure to comply.

BUSINESSES THAT PROVIDE REFERRALS TO RESIDENTIAL FACILITIES FOR GROUPS

449.27811    Definitions.

449.27813    “Client” defined.

449.27817    “Financial assessment” defined.

449.27819    “Needs assessment” defined.

449.27821    “Residential facility for groups” defined.

449.27823    License not required by certain persons to make referrals; application for licensure.

449.27827    Requirements for employees.

449.27829    Responsibilities of referral agency.

449.27831    Contract for services; fees; maintenance of client records.

HOSPITALS

General Provisions

449.279        Definitions.

449.285        “General hospital” defined.

449.286        “Governing body” defined.

449.287        “Hospital” defined.

449.289        “Inpatient” defined.

449.297        “Outpatient” defined.

449.298        “Outpatient department” defined.

449.299        “Patient” defined.

449.300        “Restraint” defined.

Licensing and Administration

449.307        Applicability of license; coverage against certain liabilities.

449.310        Limitation on number of patients; annual on-site inspection not required under certain circumstances.

449.312        Change in ownership, use or construction; correction of deficiencies.

449.313        Responsibilities and duties of governing body; bylaws; appointment and duties of chief executive officer; protocol for organ donations; annual operating budget.

449.314        Quality of care; scope of services.

449.3152      Quality improvement program.

449.3154      Construction, remodeling, maintenance and change of use: General requirements; prerequisites to approval of licensure.

449.3156      Compliance with certain guidelines for design and construction; correction of deficiencies.

Policies and Procedures for Operation of Hospital

449.316        Physical environment: Safety and well-being of patients; plan for emergency preparedness; safety management.

449.317        Risk management.

449.318        Accreditation by national accrediting organization required; exceptions; submission of proof of accreditation to Division; notification to Division if hospital ceases to be accredited.

449.319        Requirements for personal needs of patients.

449.321        Requirement to be primarily engaged in providing certain services; determination of whether requirement is met; exemption for certain hospitals.

449.322        Housekeeping and laundry services.

449.325        Prevention, control and investigation of infections and communicable diseases.

449.327        Preparation, sterilization, storage and distribution of sterile supplies and medical and surgical equipment.

449.329        Admission of patients.

449.331        Provision of emergency services and medical care; transfer agreements with long-term care facilities; attestation of compliance.

449.332        Discharge planning.

449.337        Dietary services: General requirements.

449.338        Dietary services: Provision for needs of patients; facilities; standards; permits; records.

449.3385      Dietary services: Personnel.

449.339        Dietary services: Nutritional status of patients.

449.3395      Dietary services: Sanitary conditions; supplies.

449.340        Pharmaceutical services.

449.343        Orders for medication and biologicals.

449.344        Administration of medication; security.

449.346        Rehabilitative services.

449.349        Emergency services.

449.352        Social services.

449.355        Discrimination prohibited.

449.358        Medical staff.

449.361        Nursing services.

449.3622      Appropriate care of patients.

449.3624      Assessment of patients.

449.3626      Rights of patients.

449.3628      Protection of patients; use of physical restraints.

449.363        Personnel policies concerning employment, licensing and certification.

449.364        Obstetrical services: Administration; staffing and equipment.

449.3645      Obstetrical services: Labor rooms; delivery rooms; utility rooms; area for cleaning instruments.

449.365        Obstetrical services: Required services.

449.3655      Obstetrical services: Transfer or discharge of patient.

449.367        Obstetrical services: Nurseries.

449.370        Outpatient services.

449.371        Intensive care services.

449.373        Laboratory services; pathology services; blood and blood products.

449.3735      Transfusions of blood.

449.374        Nuclear medicine services.

449.375        Records for nuclear medicine services; authorization.

449.376        Radiological services.

449.377        Radiological therapeutic services.

449.379        Medical records.

449.382        Medical library.

449.385        Surgical services.

449.388        Anesthesia services.

449.389        Respiratory care services.

449.391        Dental services.

449.394        Psychiatric services.

INTERMEDIARY SERVICE ORGANIZATIONS

General Provisions

449.395        Definitions.

449.39501    “Certificate” defined.

449.39502    “Client” defined.

449.39503    “Intermediary service organization” defined.

449.39504    “Managing employer” defined.

449.39505    “Other responsible person” defined.

449.39506    “Personal assistance” defined.

449.39507    “Personal assistant” defined.

449.39508    “Guardian” interpreted.

Certification

449.3951      Form of application; written verification for submission of fingerprints.

449.39511    Application for certificate and renewal: Fees.

449.39512    Application for certificate and renewal: Proof of insurance coverage.

449.39513    Applicability of certificate; specification of primary location; records.

449.39514    Issuance of provisional certificate.

Authorized Activities and General Requirements for Operation

449.39515    Operation of intermediary service organization and agency to provide personal care services in the home.

449.39516    Duties and responsibilities.

449.39517    Personal assistants: Qualifications; maintenance and availability of personnel files.

449.39518    Personal assistants: Results of reports on criminal history.

449.395185         Personal assistants: Performance of certain tasks.

449.39519    Client to serve as managing employer and provide training to personal assistant; reporting of training to organization.

449.3952      Additional training to be provided by intermediary service organization.

449.39521    Visits and telephone interviews with clients.

449.39522    Written statement of services provided to clients.

449.39523    Discussion of services provided to clients.

449.39524    Rights of person with a disability receiving services.

Administrative Review and Hearings

449.39525    Request for administrative review of complaint.

449.39526    Scheduling of administrative review.

449.39527    Conduct of administrative review.

449.39528    Issuance of written decision following administrative review.

449.39529    Request for hearing.

449.395295         Hearings: Scheduling; notice.

449.3953      Hearings: Representation; evidence; rights of parties.

449.39531    Resolution of complaint.

449.39532    Final decision of hearing officer; request for judicial review.

449.39533    Record of hearing.

449.39534    Provision of transcript of oral proceedings of hearing.

Administrative Sanctions

449.39535    Definitions.

449.39536    “Ban on enrollment” defined.

449.39537    “Cluster” defined.

449.39538    “Compliance” defined.

449.39539    “De minimis violation” defined.

449.3954      “Major violation” defined.

449.39541    “Plan of correction” defined.

449.39542    “Resurvey” defined.

449.39543    “Severity and scope score” defined.

449.39544    “Subsequent violation” defined.

449.39545    Imposition of sanctions generally.

449.39546    Minimum sanction to be imposed.

449.39547    Available sanctions.

449.39548    Duration of sanctions.

449.39549    Notice of sanction; appointment of temporary manager; ban on enrollment or suspension of certificate authorized in certain circumstances.

449.3955      Imposition of one or more sanctions; reporting of violations; presumption of de minimis violation.

449.39551    Severity and scope of violations to be considered in determining sanctions to be imposed.

449.39552    Scope of violations: Survey of organization; sampling of clients; use of scope relating to one client authorized.

449.39553    Scope of violations: Use of scope; basis for assessment.

449.39554    Scope of violations: Criteria for evaluation.

449.39555    Severity of violations: Use of severity scale; basis for assessment; criteria for evaluation.

449.39556    Subsequent violation on resurvey: Rebuttable presumption; imposition of sanction.

449.39557    Determination of sanctions: Initial assessment.

449.39558    Determination of sanctions: Secondary factors to be considered.

449.39559    Determination of sanctions: Basis for selection; restrictions upon service and monetary penalties presumed to be most effective.

449.3956      Plan of correction: Development by intermediary service organization; authority of Division when plan is not acceptable; effect of failure to submit plan.

449.39561    Monetary penalties: Determination of initial penalty; daily penalties; maximum total penalties.

COMMUNITY HEALTH WORKER POOLS

449.39565    Definitions.

449.39567    “Client” defined.

449.39569    “Continuing education” defined.

449.39571    “Representative of the client” defined.

449.39573    “Service plan” defined.

449.39575    “Services of a community health worker” defined.

449.39577    Location to which license applies; name of administrator to appear on license; liability coverage.

449.39579    Qualifications and duties of administrator; access to records in absence of administrator.

449.39581    Written policies and procedures.

449.39583    Qualifications of community health worker.

449.39585    Personnel files for community health workers.

449.39587    Training and evaluation of community health workers.

449.39589    Rights of clients: Duties of administrator; provision of written description to clients.

449.39591    Initial screening of client.

AGENCIES TO PROVIDE PERSONAL CARE SERVICES IN THE HOME

General Provisions

449.396        Definitions.

449.3961      “Activities of daily living” defined.

449.3962      “Agency” defined.

449.3963      “Attendant” defined.

449.3964      “Client” defined.

449.3965      “Personal care services” defined.

449.3966      “Representative of the client” defined.

449.3967      “Service plan” defined.

449.3968      “Work station” defined.

Licensing

449.3972      Location to which license applies; agency to retain proof of liability coverage and compliance with certain statutory provisions.

Administration and Personnel

449.3973      Qualifications and duties of administrator; appointment of designee to act in administrator’s absence.

449.3974      Maintenance of policies and procedures concerning qualifications, responsibilities and conditions of employment for staff members.

449.3975      Attendants: Qualifications; annual training.

449.3976      Attendants: Maintenance of personnel file; evaluation of competency.

449.3977      Attendants: Required knowledge and training.

449.39775    Attendants: Performance of certain tasks.

449.3978      Attendants: Prohibition on provision of certain types of services to clients.

Provision of Services

449.3979      Provision of written disclosure statement to client upon acceptance for services by agency.

449.398        Rights of clients: Duties of administrator; provision of written description to clients.

449.3981      Initial screening of client and development or acceptance of service plan; requirements before providing personal care to client.

449.3982      Supervisory home visits or telephone calls required to ensure quality of care provided; documentation of evaluation.

FACILITIES FOR CARE OF ADULTS DURING THE DAY

General Provisions

449.4061      Definitions.

Licensing

449.4063      Design, construction, equipment and maintenance of facility: General requirements; prerequisites to approval for licensure.

449.4065      Consultation with representative of Division; notice of nonconformity.

449.4067      Operation in combination with other medical facility or facility for the dependent.

449.4069      Insurance.

Operation of Facility

449.407        Advertising and promotional materials.

449.4071      Policies and procedures; accounting.

449.4072      Director and employees: Qualifications and duties; physical and mental health; personnel files.

449.40723    Supervision of clients; volunteers.

449.40725    Orientation and training of employees and volunteers.

449.4073      Files concerning employees.

449.4074      Requirements of facility; health and sanitation; medications; exits.

449.4075      Preparations for fires and other emergencies; reporting of fire or disaster.

449.4076      First aid.

449.4077      Policy for admissions; retention of signed copy.

449.4078      Requirements for admission; designation of physician.

449.4079      Required services.

449.408        Housekeeping and maintenance.

449.4081      Administration of medication; notification of accidents, injuries or illnesses; treatment with dignity; use of restraints or sedatives.

449.40815    Performance of certain tasks by employee.

449.4082      Service of food; dietary consultants.

449.4083      Discrimination prohibited.

449.40833    Summary of client’s care; referrals.

449.40835    Records.

Medical and Ancillary Services

449.4084      Contract for provision by another person.

449.4085      Provision by facility authorized.

449.4086      Evaluation of programs and policies.

449.4087      Written assessments of clients.

449.4088      Plan of care; periodic assessment.

449.4089      Menus.

PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES

General Provisions

449.410        Definitions.

449.4105      “Administrator” defined.

449.411        “Psychiatric residential treatment facility” defined.

449.4115      “Resident” defined.

449.413        Discrimination prohibited.

Licensing

449.414        License required to operate facility.

449.4145      Application for accreditation required; recognition as accrediting organization by Board; failure of facility to attain or maintain accreditation.

449.416        Prelicensure investigation and site inspection.

449.417        Issuance of license.

449.419        Personnel: Written policies required; evidence of licensure or certification and tuberculosis testing required.

449.420        Compliance with state, federal and local laws, regulations and ordinances; failure to comply is ground for suspension or revocation of license.

449.421        Suspension, revocation or cancellation of license; provisional license.

Administration and Operation

449.423        Written scope of services; policies and procedures; responsibilities and duties of administrator.

449.424        Quality improvement program.

449.426        Construction and maintenance of facility; plan for emergency preparedness; safety from fire and other disasters.

449.427        Limitation on number of residents.

449.428        Access of residents to their belongings; accommodations, equipment and supplies for residents; lighting and temperature levels.

449.429        Housekeeping services; cleaning and laundry requirements.

449.430        Prevention, control and investigation of infections and communicable diseases.

449.432        Administration of medication; security.

449.4325      Orders for medication and biologicals.

449.433        Reporting of problems concerning administration of drug to resident and misuses and losses of controlled substances; information concerning drugs must be available to professional members of staff.

449.435        Dietary services: General requirements.

449.436        Dietary services: Facilities; standards; permits.

449.438        Dietary services: Sanitary conditions required; supplies.

449.439        Dietary services: Therapeutic diets.

449.441        Dietary services: Personnel.

Provision of Services

449.442        Policies and procedures for protection of rights of residents.

449.445        Policies and procedures for admission of residents; provision of certain information to resident or person legally responsible for resident.

449.447        Records of residents.

449.448        Assessment and appropriate care of residents.

449.4495      Discharge planning.

FACILITIES FOR REFRACTIVE SURGERY

449.450        “Facility” defined.

449.4504      Administrator: Appointment; duties; qualifications.

449.4505      Administrator of facility that performs intraocular lens implants: Duties.

449.4506      Staffing requirements; personnel files.

449.4508      Maintenance of patient records.

449.451        Written policies and procedures.

449.4512      Program of quality improvement.

449.4514      Rights of patients; informed consent.

449.4516      Equipment and supplies.

449.4518      Liability for use of leased equipment.

449.4522      Sanitation and hygiene; space and storage.

449.4524      Medical care of patients.

449.4526      Application for indemnification for certain damages; claims against surety bond or substitute thereof.

FACILITIES FOR TREATMENT OF IRREVERSIBLE RENAL DISEASE

General Provisions

449.501        Definitions.

449.502        “Advanced practice registered nurse” defined.

449.504        “Charge nurse” defined.

449.5045      “Competency” defined.

449.505        “Dialysis” defined.

449.5053      “Dialysis technician” defined.

449.5055      “Direct supervision” defined.

449.5065      “End-stage renal disease” defined.

449.507        “Facility” defined.

449.508        “Hemodialysis” defined.

449.510        “Immediate supervision” defined.

449.511        “Intermediate level disinfection” defined.

449.513        “Licensed practical nurse” defined.

449.516        “Product water” defined.

449.517        “Supervision” defined.

449.519        “Training” defined.

Construction; Health and Safety

449.520        New construction or remodeling: Notification; increase in number of stations for which facility is licensed.

449.5205      New construction or remodeling: Submission of plans and specifications; minor changes; inspection.

449.522        Construction, space and design; physical environment; restrictions for treatment of patients with hepatitis B.

449.5225      Safety and comfort of patients during construction; imposition of more stringent design and space requirements.

449.523        Safety requirements.

449.5235      Maintenance and repair of equipment.

449.525        Water treatment system: General requirements.

449.5255      Water treatment system: Chemical testing of product water; records.

449.526        Water treatment system: Microbiological testing of product water.

449.5265      Reuse of hemodialyzer; transport of used dialyzer.

449.528        Adoption of more stringent requirements for treatment of water and reuse of hemodialyzers.

449.5285      Sanitation: Precautions regarding blood and bodily fluids.

449.529        Sanitation: Control of infections; nonsmoking policy.

449.5295      Sanitation: Provision of sanitary environment; walls, floors and ceilings; blood spills.

449.531        Sanitation: Disinfection of dialysis machines; culturing dialysate; cleaning of machines and equipment; handling of waste.

449.5315      Hepatitis B: Vaccinations for certain staff members; postvaccination screening; adoption of related provisions.

449.532        Hepatitis B: Vaccinations for certain patients.

449.5325      Hepatitis B surface antigen: Screening of patients; additional serologic screening.

449.534        Hepatitis B surface antigen: Treatment of patients who test positive.

449.5345      Tuberculosis: Screening of staff and patients.

Provision of Services

449.540        Program of quality assurance; recordation of accidents and incidents; reporting of certain events.

449.5405      Rights of patients.

449.541        Interdisciplinary teams; plans for care of patients.

449.5415      Preparations for emergencies and disasters.

449.543        Pharmaceutical services.

449.5435      Nursing services; physicians and other staff.

449.544        Nutrition services.

449.5445      Social services.

449.546        Patient care: Advanced practice registered nurses and physician assistants; medical emergencies.

449.5465      Patient care: Licensed practical nurses and dialysis technicians.

449.547        Self-dialysis: Provision of training and certain services.

449.5475      Continuous ambulatory peritoneal dialysis.

449.549        Continuous cycling peritoneal dialysis.

449.5495      Patient services by contract; laboratory.

Administration and Personnel

449.550        Governing body.

449.5505      Medical director.

449.552        Physicians.

449.5525      Orientation program for new employees; continuing education.

449.553        Medical staff: Generally.

449.5535      Nurses.

449.555        Dietitians.

449.5555      Social workers.

449.556        Staff responsible for operating water treatment system.

449.5565      Staff that repairs or maintains equipment used to provide care to patients.

Clinical Records

449.558        Preparation and maintenance.

449.5585      Additional requirements.

449.559        Medical history and physical examination.

449.5595      Transient patients.

449.561        Discharge or transfer of patients; removal of records.

449.5615      Cessation of operation of facility.

Dialysis Technicians

449.570        General qualifications; identification to be worn during training; provision of care; requirements to act as preceptor.

449.5705      Qualification of technician determined to be qualified before July 1, 2001.

449.571        Program of training: Curriculum; duties of instructor; written examinations.

449.5715      Program of training: Qualifications of instructors.

449.573        Program of training: Certain persons authorized to provide instruction and serve as preceptor.

449.5735      Program of training: Required hours.

449.574        Committee to review program of training.

449.5745      Written list concerning knowledge and skills.

449.576        Peritoneal dialysis: Additional activities required.

449.5765      Cannulation or administration of normal saline or heparin: Additional activities required.

449.577        Cannulation or administration of normal saline, heparin or lidocaine: Verification and documentation of competency required.

449.5775      Documentation of successful completion of program of training; employment by another facility.

449.579        Patient care: Technicians must demonstrate certain knowledge and competency.

449.5795      Prohibited acts.

PROVISION OF CERTAIN SPECIAL SERVICES

Obstetric Care

449.6113      Definitions.

449.61132    Authorized obstetric care.

449.61134    Eligible maternal patients.

449.61138    Denial of application for or renewal of license; revocation or suspension of license; accreditation.

449.6114      Design, construction, equipment and maintenance of obstetric center: General requirements; prerequisites to approval for licensure.

449.61142    Required facilities and services.

449.61144    Required emergency electrical power.

449.61145    Protection from fire and other disasters: Written plan; fire drills; training of staff.

449.61146    Requirements for birth room, hallways and doors, water supply and office-based facilities.

449.61148    Governing body of obstetric center; duties.

449.6115      Physician operator or advanced practice registered nurse operator as licensee.

449.61152    Designation and responsibilities of director; privileges of members of clinical staff; provision of consultation services with specialists.

449.61154    Medical records: Maintenance; access.

449.61156    Medical records: Contents.

449.61158    Program for review of quality of care.

449.6116      Miscellaneous requirements concerning staff, provision of service and equipment.

449.61161    Policies and procedures for control of infection: Manufacturer’s guidelines; training and evaluation of employees; notification to employees upon adoption.

449.61162    Requirements for transfer or discharge of patient.

449.61164    Written protocol for discharge of patient.

449.61166    Program to monitor health of employees.

449.61168    Laboratory services; transfer of maternal patient who needs blood or blood products.

449.6117      Possession, distribution, administration and storage of drugs and controlled substances.

449.61172    Anesthesia.

449.61174    Transfer of patient to hospital capable of providing higher level of obstetrical and neonatal care; policies and procedures concerning transfer and availability of physician or designee during labor and delivery.

449.61176    Death of patient; notification of Division; provision of counseling.

449.61178    Required information to be provided or made available to patient; complaints.

Open-Heart Surgery

449.612        Definitions.

449.612011         “Approval” defined.

449.612012         “Approved hospital” defined.

449.612014         “Cardiac surgery” defined.

449.612017         “Open-heart surgery” defined.

449.61202    Prerequisites to initial provision of service.

449.61204    Form and contents of application for approval to provide service.

449.61206    Notification of applicant upon review of application; site inspection required.

449.61208    Composition and duties of site inspection team.

449.6121      Hospital to pay costs of inspection.

449.61212    Approval or denial of application; period of validity of approval; cessation of performance of surgeries.

449.61214    Amount of surgery required following approval.

449.61216    Provision of patient with preoperative instruction.

449.61218    Surgical team: Composition; privileges and qualifications of members; participation of qualified nurses.

449.6122      Qualifications of anesthesiologist.

449.61222    Qualifications of nurse in charge of service.

449.61224    Perfusion team: Use required; qualifications; approval of members by surgeon of record.

449.61226    Operating rooms: General requirements.

449.61228    Operating rooms: Equipment and staff.

449.6123      Intensive care facility: General requirements.

449.61232    Intensive care facility: Staff.

449.61234    Intensive care facility: Equipment and supplies.

449.61236    Orientation and continuing education of personnel.

449.61238    Maintenance of blood bank.

449.6124      Maintenance of cardiac catheterization laboratory.

449.61242    Maintenance of medical laboratory.

449.61244    Maintenance of facilities to perform contrast studies and equipment to review films of operations.

449.61246    Maintenance of registry to record results for each patient.

449.61248    Maintenance of program to follow recovery of patient.

449.6125      Annual review and inspection of hospital.

449.61252    Annual inspection of hospital: Assessment of rate of mortality.

449.61254    Further review or on-site inspection for failure to comply with provisions or for excessive rate of mortality; notice; plan for compliance.

449.61256    Denial, suspension or revocation of approval: Grounds; hearing.

Transplantation of Organs

449.6126      Definitions.

449.61262    Application for approval to provide services.

449.61264    Evaluation of application for approval.

449.61266    Duties of hospital providing services.

449.61268    Revocation of approval.

449.6127      Notice of intent to deny application or revoke approval; hearing.

INDEPENDENT CENTERS FOR EMERGENCY MEDICAL CARE

Licensing

449.61302    Limitations on issuance of license.

449.61306    Denial of application for license or renewal of license.

449.61308    Compliance with regulations; ground for suspension or revocation of license.

Administration and Personnel

449.6132      Requirement of governing body; adoption of written rules.

449.61322    Exception to requirements of governing body.

449.61324    Standards of care; policy for authentication.

449.61326    Program to review quality of care; contents of program.

449.61328    Integration into local emergency medical system.

449.6133      Appointment and responsibilities of administrator.

449.61332    Employment and duties of medical director.

449.61334    Standards and procedures for selection, treatment and retention of medical staff and members of allied health professions.

449.61336    Rules for organization of medical staff.

449.61338    Employment and duties of chief nurse; size of on-duty nursing staff; limitation on scope of practice by person who is not registered nurse; oversight of nursing staff.

Facilities

449.6135      Design, construction, equipment and maintenance: General requirements; prerequisites to approval for licensure.

449.61352    Contents of center: Emergency entrance; reception and waiting areas; treatment and examination rooms; space for storage and maintenance of medical records and supplies.

449.61354    Contents of treatment rooms; accessibility to person in wheelchair.

Medical Services and Medical Records

449.6137      Requirement for minimum level of care in certain situations.

449.61372    Criteria for denial of care, transfer or discharge of patient; compliance with state and federal laws.

449.61374    Laboratory services and reports; procedures for storage and administration of tissue specimens, blood and blood products; agreements with outside blood banks; review of blood transfusions and reactions.

449.61376    Program for control of infection.

449.61378    Radiological services: Availability; interpretation and reporting of films; storage and retention.

449.6138      Distribution and administration of drugs and controlled substances.

449.61382    Medical records: Maintenance; access; authorized release; completion after discharge.

449.61384    Contents of medical records.

INTERMEDIATE CARE FACILITIES

General Provisions

449.614        Definitions.

449.617        “Administrator” defined.

449.623        “Facility” defined.

449.629        “Intermediate care facility as a distinct part of a health and care facility furnishing more than one level of care” defined.

449.632        “Intermediate care facility for persons with an intellectual disability or persons with a developmental disability” defined.

449.635        “Licensee” defined.

449.638        “Long-term care facility” defined.

449.644        “Mixed facility” defined.

449.647        “New facility” defined.

449.650        “Nursing home” defined.

449.653        “Patient in an intermediate care facility I” defined.

449.656        “Patient in an intermediate care facility II” defined.

449.657        “Person with a developmental disability” defined.

449.658        “Person with an intellectual disability” defined.

449.659        “Resident” defined.

Licensing

449.668        Provisional licenses.

Administration and Personnel

449.671        Financing; liability insurance.

449.674        Administrator: Qualifications.

449.677        Employees: General requirements.

449.680        Employees: Health; physical examinations.

449.681        Employees of facility which provides care to persons with dementia: Continuing education.

Construction and Operation: Generally

449.685        Design, construction, equipment and maintenance: General requirements; prerequisites to approval of facility for licensure.

449.692        Sanitary requirements.

449.695        Laundry requirements.

449.698        Fire inspections; hazardous conditions; operation of other business.

449.701        Preparations for emergencies; reporting of fire or disaster.

449.704        Written policies and procedures for facility; admission agreements; transfer agreements.

449.707        Money of residents.

449.710        Inventory of residents’ belongings.

449.713        Program requirements.

449.716        Dietary services.

449.719        Health services.

449.722        Pharmaceutical services.

449.725        Records.

449.728        Supervision by physician; volunteers; advertising.

449.731        Discrimination prohibited.

Construction and Operation: Facilities for Persons With an Intellectual Disability or Persons With a Developmental Disability

449.732        Definitions.

449.7322      “Facility” defined.

449.7324      “New facility” defined.

449.7326      Standards for construction, remodeling or change in use of facility; fire alarms; emergency radio system; submission and approval of building plans.

449.7328      Elevators.

449.733        Electrical systems.

449.7332      Mechanical systems.

449.7334      Doors, windows, ceilings, walls and floors.

449.7336      Entrances and lobbies; miscellaneous space.

449.7338      Dining and storage space.

449.7342      Facilities for employees and volunteers.

449.7344      Areas for engineering and maintenance.

449.7346      Janitors’ closets.

449.7348      Linen service.

449.735        Area for medical records.

449.7352      Nursing units.

449.7354      Service areas.

449.7356      Processing of waste.

449.736        Personnel.

449.737        Plan of care.

449.740        Corporal punishment; restraints.

449.743        Records.

COMMUNITY TRIAGE CENTERS

449.74311    Definitions.

449.74313    “Administrator” defined.

449.74315    “Facility” defined.

449.74317    “Governing body” defined.

449.74321    “Patient” defined.

449.74322    “Person with mental illness” defined.

449.74323    “Program” defined.

449.74325    “Psychologist” defined.

449.74327    Governing body; bylaws and policies.

449.74329    Policies and procedures for services and operation of facility.

449.74331    Transfer of patient.

449.74333    Handling of money of patient.

449.74335    Inventory of belongings of patient.

449.74337    Liability insurance.

449.74339    General requirements for programs and services.

449.74341    Responsibilities and duties of administrator.

449.74343    Policies and procedures concerning employees.

449.74345    Nursing services.

449.74347    Health services.

449.74349    Mental health services.

449.74351    Pharmaceutical services.

449.74353    Medication and biologicals.

449.74355    Records of patients.

449.74357    Laundry requirements.

449.74359    Dietary services.

449.74361    New construction or remodeling: Submission and approval of building plans; prerequisites to approval of facility for licensure.

449.74363    Design, construction, equipment and maintenance of facility.

449.74365    Entrances, lobbies and offices; storage space.

449.74367    Patients’ rooms; toilet and bathing facilities.

449.74369    Service areas; miscellaneous requirements.

449.74371    Safety and sanitation.

449.74373    Preparations for disasters; reporting of fire or disaster.

449.74375    Discrimination prohibited.

FACILITIES FOR SKILLED NURSING

General Provisions

449.744        “Facility for skilled nursing” defined.

Licensing and Administration of Facility

449.74411    Applicability of license; limitation on number of patients; coverage against certain liabilities.

449.74413    Change in ownership, use or construction of facility.

449.74415    Responsibilities of governing body.

449.74417    Administrator of facility.

449.74419    Committee for quality assurance.

449.74421    Procedures for emergency or disaster.

Admission, Transfer and Discharge of Patient

449.74423    Certain conditions for admission prohibited.

449.74425    Admission of patient with mental illness or an intellectual disability.

449.74427    Agreement with hospital for transfer of patients.

449.74429    Transfer or discharge of patient.

449.74431    Summary of discharge.

Assessment of Patients and Plan of Care

449.74433    Comprehensive assessment of needs of patient.

449.74435    Quarterly assessment of patient.

449.74437    Conduct of assessments.

449.74439    Comprehensive plan of care.

Medical Records

449.74441    Maintenance.

449.74443    Inspection.

Rights of Patients

449.74445    Generally.

449.74447    Communications with other persons; examination of records by advocate.

449.74449    Notice to patients of rights, services and charges.

449.74451    Charges to be consistent with notice of charges.

449.74453    Notice to patients of programs available for assistance in payment of services.

449.74455    Discrimination prohibited.

449.74457    Policies and procedures for advance directives by patient; information to be furnished regarding physicians.

449.74459    Examination by patient of survey of facility and plan of correction.

449.74461    Finances of patient: System for maintenance and accounting.

449.74463    Finances of patient: Authorization to withhold money.

449.74465    Sending and receiving mail.

449.74467    Performance of services for facility by patient.

Quality of Care

449.74469    Standards of care.

449.74471    Administration of drugs.

449.74473    Program for control of infections.

449.74475    Vision and hearing.

449.74477    Pressure sores.

449.74479    Urinary problems.

449.74481    Range of motion.

449.74483    Mental or psychosocial behavior.

449.74485    Nasogastric tubes.

449.74487    Nutritional health; hydration.

449.74489    Physical or chemical restraint of patients.

449.74491    Prohibition of certain practices regarding patients; investigation of certain violations and injuries to patients; unfit employees.

449.74493    Notification of changes or condition of patient.

449.74495    Development of program of activities.

449.74497    Daily activities of patient.

449.74499    Participation in activities.

Staff and Attending Physicians

449.74511    Personnel policies; personnel records.

449.74513    Medical director.

449.74515    Physicians.

449.74517    Nursing staff.

449.74519    Nursing assistants and nursing assistant trainees.

449.74521    Other health care professionals.

449.74522    Employees of facility which provides care to persons with dementia.

Provision of Services

449.74523    Social services.

449.74525    Dietary services.

449.74527    Specialized rehabilitative services.

449.74529    Dental services.

449.74531    Pharmaceutical services.

449.74533    Laboratory services.

449.74535    Radiological and other diagnostic services.

449.74537    Special services.

Physical Environment

449.74539    General requirements.

449.74543    Design, construction, equipment and maintenance: General requirements; prerequisites to approval of facility for licensure.

449.74549    Patients’ rooms.

NURSING POOLS

General Provisions

449.747        Definitions.

Licensing

449.7471      License required.

449.7473      Location to which license applies; persons named in license; restrictions on use of license.

449.7474      Duties of licensee or applicant for license.

Administration and Personnel

449.7475      Administrator: Qualifications and duties.

449.7476      Director of professional services: Qualifications and duties.

449.7477      Personnel policies: Maintenance and availability.

449.7478      Requirements for contracts to provide nursing services.

449.7479      Referral of patients when services not available; provision of services; bonding of staff.

449.748        Duties of registered nurse; provision of nursing care by practical nurse or nursing assistant.

449.7481      Annual evaluation of nursing pool by licensee.

HOME HEALTH AGENCIES

General Provisions

449.749        Definitions.

Licensing and Inspection

449.752        License required.

449.758        Applicability of license; coverage against certain liabilities.

449.761        Periodic inspections.

449.767        Action to enjoin operation without license.

449.768        Applicant or licensee to maintain home office in Nevada.

Administration and Personnel

449.770        Governing body; bylaws.

449.773        Administrator: Qualifications; duties.

449.776        Director of professional services.

449.779        Professional advisory group.

449.782        Personnel policies.

449.785        Contracts for home health services.

449.787        Duty to provide skilled nursing care and home health aide services; inclusion of additional services.

449.788        Services to patients.

449.791        Duties of personnel.

449.793        Evaluation by governing body; periodic review of contracts, operations, policies and procedures.

Medical Services and Medical Records

449.794        Clinical records: General requirements.

449.797        Contents of clinical records.

449.800        Medical orders.

COMMUNITY-BASED LIVING ARRANGEMENT SERVICES

General Provisions

449.801        Definitions.

449.802        “Certificate” defined.

449.804        “Community-based living arrangement services” or “services” defined.

449.805        “Facility” defined.

449.807        “Individual support team” defined.

449.808        “Individualized plan” defined.

449.810        “Mental illness” defined.

449.811        “Provider” defined.

449.813        “Provisional certificate” defined.

449.814        “Quality assurance review” defined.

449.816        “Resident” defined.

Issuance and Renewal of Provisional Certificates and Certificates

449.817        Provisional certificate or certificate required to provide services; exception.

449.818        Contents of application for provisional certificate; fee.

449.819        Review of application for provisional certificate; actions upon determination that application is incomplete.

449.820        Training required of applicant for provisional certificate; inspection of facility; issuance and validity of provisional certificate.

449.822        Grounds for denial of application for provisional certificate; notice of denial.

449.823        Quality assurance review; extension or revocation of provisional certificate; issuance of certificate.

449.825        Renewal of certificate; fee.

Operation of Provider

449.826        Duties of provider.

449.828        Policies and procedures of governmental or organizational provider.

449.829        Initial and periodic investigations of employee, independent contractor or adult present during provision of services; termination of employment, contract or authority to be present for conviction of certain crimes; period in which to correct information regarding conviction.

449.831        Required certifications and courses for employee or independent contractor who provides services.

449.832        Arrangements for services from specially trained persons; determination of need for such services.

449.834        Financial plan; financial records; financial report.

449.835        Assessment of need for services; maintenance of findings of assessment; establishment of individual support team and permanent individualized plan; acceptance of person before assessment in urgent situation.

449.837        Contract for provision of services.

449.838        Training concerning administration of medication; persons authorized to administer medication.

449.840        Record regarding recipient of services: Contents; maintenance; availability for review by recipient or guardian.

449.841        Record regarding recipient of services: Retention; availability for review by representatives of Department of Health and Human Services.

449.843        Rights of recipient of services.

449.844        Facilities: Ownership or lease by operator; limitation on number of residents; compliance with certain state and local requirements.

449.846        Facilities: Occupancy, size, furnishings and use of bedrooms; use of certain rooms or bedrooms prohibited.

449.847        Facilities: Common areas; dining areas; kitchens; storage of food.

449.849        Facilities: Maintenance of premises.

449.850        Facilities: Fire safety.

449.852        Facilities: Policy concerning visitation; presence of minor child of provider or employee prohibited; visitation by child of resident.

Quality Assurance Reviews and Discipline

449.853        Quality assurance review; report and correction of violation.

449.855        Authorized actions of Division upon determination of deficiencies; plans of correction; grounds for sanctions; authorized sanctions.

449.856        Grounds for revocation of provisional certificate or certificate.

449.858        Notice of intent to revoke provisional certificate or certificate.

449.859        Immediate termination of provision of services.

449.861        Appeal.

EMPLOYMENT AGENCIES TO PROVIDE NONMEDICAL SERVICES

449.870        Definitions.

449.871        “Attendant” defined.

449.873        “Client” defined.

449.874        “Employment agency” defined.

449.876        “Nonmedical services” defined.

449.877        Designation of primary place of business on license; operation of multiple work stations; licensee’s name to appear on face of license; liability coverage required.

449.879        Qualifications and duties of administrator.

449.880        Qualifications of attendant; required training.

449.882        Duties of employment agency.

CARA PLANS OF CARE

449.939        Definitions.

449.941        “CARA Plan of Care” defined.

449.942        “Infant” defined.

449.944        “Medical facility” defined.

449.945        “Provider of health care” defined.

449.947        Establishment and contents of plan; use of form; provision of copy to parent or guardian and Division.

449.948        Duties of Division; confidentiality and protection of plans and related information.

FINANCIAL REPORTING

449.951        Definitions.

449.953        Annual fee for insurers: Amount; notice; administrative fine for failure to pay.

449.957        Hospitals to file certain reports; certification; exception; extension.

449.960        Hospitals to submit quarterly financial and utilization report; certification; extension.

449.962        Facility for intermediate care or facility for skilled nursing to submit quarterly financial and utilization report; certification; extension.

449.9625      Institution to submit quarterly financial and utilization report; certification; extension; exception.

449.963        Information concerning treated patients: Submission; limitation on disclosure.

449.966        Notice of insufficiency of submitted information.

449.969        Administrative fine for failing to meet deadlines.

MOBILE UNITS

449.970        Definitions.

449.9701      “Independent facility” defined.

449.97012    “Mobile unit” defined.

449.97014    “Parent facility” defined.

449.97016    “Service site” defined.

449.97018    “Staging area” defined.

449.9702      Applicability of provisions.

449.97022    Licensure.

449.97024    Application for licensure.

449.97026    Design, construction, equipment, maintenance and parking.

449.97028    Staging areas; disposal of biohazards and waste.

449.9703      Compliance with certain statutes and regulations.

449.97032    Compliance with regulations relating to evaluation of quality of services.

449.97034    Written policies for operation of unit; agreement with hospital or medical facility for transfer of patients during emergencies.

449.97036    Rights of patients.

449.97038    Maintenance of schedule and records; supplies and equipment; diagnostic radiological services; laboratory services.

449.9704      Occupancy; fire safety; exits; use and maintenance of equipment; telecommunications device.

449.97042    Restrictions on operation; office of independent facility; operation pursuant to contract.

SURGICAL CENTERS FOR AMBULATORY PATIENTS

General Provisions

449.971        Definitions.

449.9715      “Allied health profession” defined.

449.972        “Ambulatory surgical center” defined.

449.9721      “Biohazardous waste” defined.

449.9722      “Biologic indicator test” defined.

449.9724      “Cleaning” defined.

449.9725      “Division” defined.

449.973        “Governing body” defined.

449.9731      “High-level disinfection” defined.

449.9732      “Implantable device” defined.

449.9733      “Invasive procedure” defined.

449.9735      “Licensee” defined.

449.9736      “Low-level disinfection” defined.

449.9738      “Multidose vial” defined.

449.974        “Patient” defined.

449.9741      “Physician” defined.

449.9742      “Registered nurse” defined.

449.97422    “Reprocess” defined.

449.97426    “Single-dose vial” defined.

449.97428    “Sterilization” defined.

449.9743      “Surgery” defined.

Licensing

449.9745      Center required to provide proof of national accreditation; submission of reports to Division; application by accrediting organization for recognition by State Board of Health.

449.9755      Investigation of applicant and inspection of facility.

449.978        Effect of expiration of license.

449.9785      Conformance with regulations required.

Administration

449.979        Governing body required.

449.9795      Duties of governing body.

449.980        Responsibilities of governing body.

449.9801      Procedures for granting privileges to members of medical staff.

449.9805      Establishment of policy for authentication.

449.981        Appointment and responsibilities of administrator.

449.9811      Program for review of surgical procedures and patient outcomes.

449.9812      Program for quality assurance.

449.9813      Committee for quality assurance.

449.9815      Maintenance.

449.982        Sanitation and housekeeping.

449.983        Protection from fire and other disasters.

449.9832      Establishment of policies for provision of services and care by persons under contract with or who are otherwise not employed by center.

449.9835      Exemption from requirements for governing body and administrator.

449.9837      Restrictions on operation of ambulatory surgical center; maintenance of records.

449.9843      Compliance with certain standards, laws, ordinances and codes; submission and approval of building plans; prerequisites to approval of center for licensure.

Program for the Prevention and Control of Infections and Communicable Diseases

449.98451    Adoption of guidelines by governing body for establishment of program.

449.98452    General requirements of program.

449.98453    Program required to include policies and procedures for prevention of exposure to blood-borne and other potentially infectious pathogens.

449.98454    Program required to include policies and procedures for single-dose vials and multidose vials.

449.98455    Sterilization and disinfection of surgical instruments, items and equipment; training required for employees and contractors responsible for sterilization or disinfection.

449.98456    Center required to designate employee or enter into contract for overseeing and managing program; qualifications and duties of employee or contractor.

449.98457    Mandatory training and evaluation of employees and other persons.

Personnel

449.9855      Policies and requirements for personnel.

449.9865      Medical staff.

449.988        Nursing staff.

Medical Records, Services and Facilities

449.9885      Medical records: Maintenance.

449.989        Medical records: Contents.

449.990        Medication and treatment.

449.9902      Emergency equipment and supplies.

449.9905      Pharmacist employed by or contracted with center; records, storage and administration of drugs; center required to obtain license to operate pharmacy.

449.991        Laboratory services.

449.992        Pathological services.

449.9925      Blood and derivatives of blood: Procurement, storage, transfusion and administration; policies and procedures; reporting of adverse reaction.

449.993        Diagnostic radiological services.

449.9935      Operating and recovery rooms; endoscopy suite.

449.9937      Extended recovery units.

449.994        Records required before surgery; report of surgery.

449.9945      Administration and record of anesthesia.

449.9947      Register of surgeries performed in operating rooms.

449.9955      Informing patient of rights, services and cost.

449.996        Transfer of patients.

449.9965      Prohibited locations for construction of center.

449.997        Conversion of hazardous building into center prohibited.

RECOVERY CENTERS

General Provisions

449.99702    “Recovery center” defined.

Licensing and Inspection

449.99704    License required to operate.

449.99706    Requirements to operate.

449.99708    Prelicensure investigation and inspection.

449.9971      Issuance and expiration of license.

449.99712    Suspension, revocation or cancellation of license; provisional license.

Administration

449.99714    Governing body; quality improvement and risk management programs; review of programs.

449.99716    Appointment, qualifications and responsibilities of administrator.

Construction and Operation

449.99718    Design, construction, equipment and maintenance.

449.9972      General requirements.

449.99722    Patients’ rooms.

449.99724    Limitation on number of patients; insurance.

449.99726    Preparations for emergencies; reporting of fire or disaster.

449.99728    Administration of prescription medications.

449.9973      Control of infections.

449.99732    Meals; hydration; sanitation.

Admission, Care, Transfer and Discharge of Patients

449.99734    Responsibilities for admission and care of patient.

449.99736    Assessment of needs of patient.

449.99738    Plan of care; compliance with professional standards.

449.9974      Provision of service or treatment.

449.99742    Summary of discharge.

449.99744    Agreement with hospital for transfer of patients.

Records of Patients

449.99746    Contents, maintenance and confidentiality of medical records.

449.99748    Inspection of records relating to patient.

Personnel and Staffing

449.99749    Personnel policies and records.

449.99752    Staffing.

449.99754    Employment of health care professionals.

Medical Services

449.99756    Specialized rehabilitative services.

449.99758    Pharmaceutical services; labeling and storage of drugs and biologicals.

449.9976      Laboratory services.

449.99762    Radiological and other diagnostic services.

RECEIVERS

449.9981      List of interested and qualified persons.

449.99811    Experience.

449.99812    Authority.

449.99813    Compensation and payment of bond.

449.99814    Operation of facility.

ADMINISTRATIVE SANCTIONS

General Provisions

449.9982      Definitions.

449.99821    “Ban on admissions” defined.

449.99822    “Cluster” defined.

449.99823    “Compliance” and “substantially correct the deficiency” defined.

449.99824    “Costs” defined.

449.99825    “De minimis deficiency” defined.

449.998253         “Division of Health Care Financing and Policy” defined.

449.998255         “Facility” defined.

449.99826    “Immediate family” defined.

449.99827    “Initial deficiency” defined.

449.99828    “Major deficiency” defined.

449.99829    “Medicaid facility” defined.

449.9983      “Medicare facility” defined.

449.99832    “Monitor” defined.

449.99833    “New admission” defined.

449.99834    “Particular kinds of care, treatment or services” defined.

449.99835    “Plan of correction” defined.

449.99836    “Provider agreement” defined.

449.99837    “Repeated deficiency” defined.

449.99838    “Resurvey” defined.

449.99839    “Severity and scope score” defined.

449.9984      “Subsequent deficiency” defined.

449.99841    “Temporary management” defined.

449.99843    Purposes of administrative sanctions.

449.99844    Interpretation of provisions in accordance with federal standards.

Imposition: Generally

449.9985      Authority of Division and Bureau.

449.99851    Requirement for imposition; optional imposition.

449.99852    Requirement for imposition; multiple sanctions.

449.99853    Imposition of one or more sanctions; criteria for imposition of particular sanction.

449.99854    Imposition in lieu of or in addition to recommendation to terminate provider agreement; duration of sanctions.

449.99855    Imposition in emergencies: Authority; notice.

449.99856    Deficiencies: Basis for imposition of sanctions; reporting; presumption of de minimis deficiency.

449.99857    Classifications of severity and scope of deficiencies: Use.

449.99858    Scope of violations: Evaluation of representative sample of recipients; size of sample.

449.99859    Scope of deficiencies: Use of scope scale; basis for assessment.

449.9986      Scope of deficiencies: Criteria for evaluation.

449.99861    Severity of deficiencies: Use of severity scale; basis for assessment; criteria for evaluation.

449.99862    Presumption when same deficiency found on resurvey; imposition of sanction for subsequent deficiency.

449.99863    Available sanctions.

449.99864    Determination of appropriate sanction: Procedure.

449.99865    Determination of appropriate sanction: Initial assessment.

449.99866    Determination of appropriate sanction: Consideration of secondary factors.

449.99867    Determination of appropriate sanction: Basis for selection; presumption.

Plan of Correction

449.9987      Development and submission of plan; authority of Bureau when plan is not acceptable; effect of failure to submit plan.

Limitation on Occupancy of Residential Facility

449.99875    Purpose and scope of limitation; imposition in addition to partial ban on admissions.

449.99876    Criteria for imposition.

449.99877    Duration and termination of limitation.

449.99878    Notice of limitation: General requirements; effect of noncompliance.

Ban on Admissions

449.9988      Purpose and scope of ban.

449.99881    Criteria for imposition.

449.99882    Duration and termination of ban.

449.99883    Notice of ban: General requirements; effect of noncompliance.

Monitoring of Facility

449.99885    Authority of Bureau.

Monetary Penalties

449.99895    Imposition by Bureau; purpose; applicable criteria.

449.99896    Criteria for imposition; imposition of initial and daily penalties.

449.99897    Imposition of initial penalty pending hearing or appeal; stay of payment of penalties pending appeal.

449.99898    Procedure for imposition; interest on total penalty assessed.

449.99899    Determination of amount of penalties.

449.998995         Use of initial monetary penalty to correct deficiency.

449.999        Limitation on principal amount of total daily penalty.

449.99901    Daily penalty: Computation according to number of recipients.

449.99902    Increase in penalty for repeated deficiencies or false compliance.

449.99903    Presumption regarding deficiencies identified on resurvey.

449.99904    Reduction of penalty.

449.99905    Daily penalty: Effective beginning date.

449.99906    Daily penalty: Date and period of computation; notice to facility.

449.99907    Termination of daily penalties; failure of Medicaid facility to remove immediate and serious threat after appointment of temporary management.

449.99908    Time for payment of penalties.

449.99909    Assessment of interest on unpaid balance of penalty.

449.9991      Recovery of costs for collection of penalty.

449.99911    Failure to pay penalty: Suspension of license of facility.

449.99912    Disposition of money collected.

Temporary Management

449.99915    Appointment of temporary manager when there is immediate and serious threat: Notice; effect of failure to accept manager and to remove threat.

449.99916    Appointment of temporary manager when there is no immediate and serious threat: Notice.

449.99917    Temporary manager: Qualifications.

449.99918    Temporary manager: Authority.

449.99919    Effect of failure to agree to appointment of or to relinquish authority to temporary manager.

449.9992      Events requiring termination of management; initiation of judicial proceedings.

449.99921    Payment of costs and expenses.

Closure of Facility and Transfer of Residents

449.99925    Authority of Bureau.

449.99926    Requirements for notification.

449.99927    Appointment of temporary manager.

449.99928    Bureau to supervise or appoint temporary manager to supervise transfer; imposition of other appropriate sanctions.

449.99929    Determination of appropriate placement of residents.

449.9993      Rights of appeal for transferred residents.

Facilities Participating in Medicaid

449.99935    Authorized recommendations in addition to available sanctions.

449.99936    Withholding of monetary penalties from payments owed to facility.

449.99937    Denial of payments for new admissions generally.

449.99938    Denial of payments for new admissions who have certain specified diagnoses or special care needs.

449.99939    Suspension of payments for services furnished to Medicaid recipient on or after date of deficiency.

OUTPATIENT FACILITIES: PERMIT FOR SERVICES OF GENERAL ANESTHESIA, CONSCIOUS SEDATION AND DEEP SEDATION

General Provisions

449.9994      Definitions.

449.99941    “Bureau” defined.

449.999413         “Division” defined.

449.999415         “Inspection” defined.

449.999417         “Outpatient facility” defined.

449.999419         “Treatment” defined.

Permitting

449.99942    Application; general requirements; proof of national accreditation; fee; period for validity; application required for each location.

449.999421         Inspection by Division of applicant and outpatient facility; prerequisite of satisfactory fire inspection.

449.999422         Term of permit; circumstances under which permit deemed invalid.

449.999423         Renewal of permit: Application; additional inspection by Division authorized; fees; untimely filing or failure to file application.

449.999424         Outpatient facility required to provide proof of national accreditation; submission of reports to Division; application by accrediting organization for recognition by State Board of Health; maintenance of list by Division of approved accrediting organizations.

449.999425         Display of permit; maintenance of outpatient facility in compliance with law; notification of transfer of real property; notification of change of ownership, location or services provided.

449.999426         Additional grounds for denial, suspension or revocation of permit.

Program for the Prevention and Control of Infections and Communicable Diseases

449.99943    Definitions.

449.999431         “Biologic indicator test” defined.

449.999432         “Cleaning” defined.

449.999433         “High-level disinfection” defined.

449.999434         “Implantable device” defined.

449.999435         “Invasive procedure” defined.

449.999436         “Low-level disinfection” defined.

449.999437         “Multidose vial” defined.

449.999438         “Reprocess” defined.

449.999439         “Single-dose vial” defined.

449.99944    “Sterilization” defined.

449.999441         Adoption of guidelines by holder of permit for establishment of program.

449.999442         General requirements of program.

449.999443         Program required to include policies and procedures for prevention of exposure to blood-borne and other potentially infectious pathogens.

449.999444         Program required to include policies and procedures for single-dose vials and multidose vials.

449.999445         Sterilization and disinfection of surgical instruments, items and equipment; training required for employees and contractors responsible for sterilization or disinfection.

449.999446         Outpatient facility required to designate employee or enter into contract for overseeing and managing program; qualifications and duties of employee or contractor.

449.999447         Mandatory training and evaluation of employees and other persons.

449.999448         Establishment of additional policies and guidelines by holder of permit to ensure health and safety of patients; professional standards of practice; requirement of tuberculosis test for employees and persons under contract with outpatient facility.

Administrative Sanctions

449.99945    Definitions.

449.999451         “Cluster” defined.

449.999452         “De minimis deficiency” defined.

449.999453         “Deficiency” defined.

449.999454         “Immediate and serious threat” and “immediate jeopardy” defined.

449.999455         “Incident” defined.

449.999456         “Initial deficiency” defined.

449.999457         “Severity and scope score” defined.

449.999458         Purpose of sanctions.

449.999459         Grounds for denial, suspension or revocation of permit.

449.99946    Appeal of denial, suspension or revocation of permit or other sanction.

449.999461         Imposition of sanctions: Authority of Division and Bureau.

449.999462         Imposition of sanctions: Requirement for imposition; optional imposition; multiple sanctions; use of severity and scope factors for particular sanction.

449.999463         Imposition of sanctions in emergencies: Notice; authority; exception to notice requirement.

449.999464         Deficiencies: Basis for imposition of sanctions; reporting; presumption of de minimis deficiency.

449.999465         Scope of violations: Evaluation of representative sample of recipients; sample size.

449.999466         Scope of deficiencies: Use of scope scale; basis for assessment.

449.999467         Scope of deficiencies: Criteria for evaluation.

449.999468         Severity of deficiencies: Use of severity scale; basis for assessment; criteria for evaluation.

449.999469         Presumption when same deficiency found on subsequent inspection; imposition of sanction for subsequent deficiency.

449.99947    Available sanctions.

449.999471         Determination of appropriate sanction: Procedure.

449.999472         Determination of appropriate sanction: Initial assessment.

449.999473         Determination of appropriate sanction: Consideration of secondary factors.

449.999474         Determination of appropriate sanction: Basis for selection; presumption for monetary penalties.

449.999475         Plan of correction: Development and submission of plan; authority of Bureau when plan is not acceptable; effect of failure to submit plan.

449.999476         Monetary penalties: Criteria for imposition; imposition of initial and daily penalties; exception for de minimis deficiency.

449.999477         Monetary penalties: Imposition of initial penalty pending hearing or appeal; stay of payment of penalties pending appeal.

449.999478         Monetary penalties: Procedure for imposition; interest on total penalty assessed.

449.999479         Monetary penalties: Determination of amount of penalties.

449.99948    Monetary penalties: Increase in penalty for repeated deficiencies or falsely alleged compliance.

449.999481         Monetary penalties: Presumption regarding deficiencies identified on subsequent inspection.

449.999482         Monetary penalties: Reduction of penalty.

449.999483         Monetary penalties: Effective beginning date.

449.999484         Monetary penalties: Date and period of computation; notice to outpatient facility.

449.999485         Monetary penalties: Termination of daily penalties.

449.999486         Monetary penalties: Time for payment.

449.999487         Recovery of expenses incurred by Bureau or Division for implementing and enforcing administrative penalties, bringing actions for enforcement and collecting monetary penalties.

449.999488         Failure to pay monetary penalty: Suspension of permit.

449.999489         Disposition of money collected.

STAR RATINGS OF CERTAIN HEALTH CARE FACILITIES

449.99984    Definitions.

449.999842         “Deficiency” defined.

449.999844         “Facility” defined.

449.999846         Criteria for assignment of ratings; issuance of placard with rating.

449.999848         Follow-up inspections and appeals.

 

GENERAL PROVISIONS

      NAC 449.002  Definitions. (NRS 439.200, 449.03005, 449.0302)  As used in NAC 449.002 to 449.99939, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.0022 to 449.0072, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R131-99 & R132-99, 11-29-99; R051-02, 7-24-2002; R179-09, 7-22-2010; R090-12, 12-20-2012; R120-16, 9-21-2017; R133-15, 12-19-17; R109-18, 1-30-2019)

      NAC 449.0022  “Administrator” defined. (NRS 449.0302)  “Administrator” means the person responsible for the day-to-day management of a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0024  “Affiliated facility” defined. (NRS 449.0302)  “Affiliated facility” means a facility that owns, directly or indirectly, an equity interest of 5 percent or more in the capital, the stock, the profits or the assets of another facility or is, as a subcontractor, agent or otherwise, responsible for the management or control of that facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0026  “Agent” defined. (NRS 449.0302)  “Agent” means a person having actual or apparent authority to act on behalf of a licensee.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0028  “Bureau” defined. (NRS 449.0302)  “Bureau” means the Bureau of Health Care Quality and Compliance of the Division.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R179-09, 7-22-2010)

      NAC 449.0029  “Centers for Medicare and Medicaid Services” defined. (NRS 449.0302)  “Centers for Medicare and Medicaid Services” means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.

     (Added to NAC by Bd. of Health by R051-02, eff. 7-24-2002)

      NAC 449.00295  “Central Repository” defined. (NRS 449.0302)  “Central Repository” means the Central Repository for Nevada Records of Criminal History.

     (Added to NAC by Bd. of Health by R111-12, eff. 3-28-2014)

      NAC 449.003  “Deficiency” defined. (NRS 449.0302)

     1.  “Deficiency” means noncompliance with any federal or state statute or of the rules or regulations of the Division or the Centers for Medicare and Medicaid Services or conditions and standards of or requirements for participation in the Medicare or Medicaid program pertaining to a facility.

     2.  The term includes an incident concerning a facility where there are no extenuating circumstances or where the facility has made an inappropriate response to a complaint, including the failure to:

     (a) Prevent an incident from occurring, if the incident could have been avoided;

     (b) Identify an incident;

     (c) Take action to correct an incident before the identification of the incident by the Bureau; or

     (d) Implement a contingency plan if permanent action to correct an incident has not been undertaken.

     3.  In determining whether an incident is a deficiency, the right of the recipient to refuse treatment, where applicable, shall be deemed an extenuating circumstance.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02, 7-24-2002)

      NAC 449.00305  “Division” defined. (NRS 449.0302)  “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R094-06 & R098-06, 7-14-2006) — (Substituted in revision for NAC 449.0038)

      NAC 449.0031  “Division of Welfare and Supportive Services” defined. (NRS 449.0302)  “Division of Welfare and Supportive Services” means the Division of Welfare and Supportive Services of the Department of Health and Human Services.

     (Added to NAC by Bd. of Health, eff. 8-1-91) — (Substituted in revision for NAC 449.0074)

      NAC 449.0032  “Emergency” defined. (NRS 449.0302)  “Emergency” means a major deficiency that places one or more recipients in immediate jeopardy. The term includes, without limitation, any fire, flood, contagious infection, loss of utilities or inappropriate transfer of residents.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0033  “Employment agency to provide nonmedical services” defined. (NRS 439.200, 449.03005)

     “Employment agency to provide nonmedical services” means an employment agency that contracts with persons to provide “nonmedical services related to personal care to elderly persons or persons with disabilities,” as that term is defined in NRS 449.01517.

     (Added to NAC by Bd. of Health by R109-18, eff. 1-30-2019)

      NAC 449.0034  “Facility” defined. (NRS 449.0302)  “Facility” means a medical facility, facility for the dependent, home for individual residential care or referral agency.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R131-99 & R132-99, 11-29-99)

      NAC 449.0042  “Holiday” defined. (NRS 449.0302)  “Holiday” means a day on which the offices of State Government are closed.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0043  “Home for individual residential care” defined. (NRS 449.0302)  “Home for individual residential care” has the meaning ascribed to it in NRS 449.0105.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.0044  “Immediate and serious threat” and “immediate jeopardy” defined. (NRS 449.0302)  “Immediate and serious threat” or “immediate jeopardy” means a situation in which corrective action within 48 hours is necessary because the failure by a facility to comply with a requirement for licensure, certification or participation in Medicare or Medicaid has caused, or if uncorrected is likely to cause, serious injury or harm, or even death, to a recipient.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0046  “Incident” defined. (NRS 449.0302)  “Incident” means an action, practice or situation that appears to be inconsistent with a federal or state statute, rule or regulation of the Division or the Centers for Medicare and Medicaid Services or conditions and standards of or requirement for participation in Medicare or Medicaid.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02, 7-24-2002)

      NAC 449.0048  “License” defined. (NRS 449.0302)  “License” means all or part of any permit, certificate, approval, registration, charter or similar grant of permission to operate issued to a facility by the Division.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0049  “Licensed dietitian” defined. (NRS 449.0302)  “Licensed dietitian” has the meaning ascribed to it in NRS 640E.040.

     (Added to NAC by Bd. of Health by R090-12, eff. 12-20-2012)

      NAC 449.005  “Licensee” defined. (NRS 449.0302)  “Licensee” means any person, corporation, partnership, voluntary association or other public or private entity, including any governmental body, licensed to operate a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0052  “Medicaid” defined. (NRS 449.0302)  “Medicaid” means the program established pursuant to Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., to provide assistance for part or all of the cost of medical care rendered on behalf of indigent persons.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0054  “Medicare” defined. (NRS 449.0302)  “Medicare” means the program of health insurance for aged and disabled persons established pursuant to Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0056  “Party” defined. (NRS 449.0302)  “Party” means each person or agency as defined in NRS 233B.035.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0058  “Person” defined. (NRS 449.0302)  “Person” means a natural person, trust, estate, partnership, corporation, professional association, governmental body or any other entity, public or private.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.006  “Recipient” defined. (NRS 449.0302)  “Recipient” means a person receiving care, services or treatment from a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0061  “Referral agency” defined. (NRS 449.0302, 449.0305)  “Referral agency” means a business that provides referrals to residential facilities for groups which is subject to regulation pursuant to NRS 449.0305, including, without limitation, any business entity that engages in the process of referring clients for compensation to residential facilities for groups.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.0062  “Resident” defined. (NRS 449.0302)  “Resident” means a person who resides in a residential facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0064  “Residential facility” defined. (NRS 449.0302)  “Residential facility” means a facility operated 24 hours per day in which one or more persons receiving care, treatment or services ordinarily remain for 24 hours a day.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0066  “Sanction” defined. (NRS 449.0302)  “Sanction” means a corrective measure or penalty that is imposed by the Bureau upon a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0068  “Services” defined. (NRS 449.0302)  “Services” means medical or personal care, including necessary preparation of food, laundry and housekeeping in the case of a residential facility and items such as medical diagnosis and treatment, drugs and biologicals, supplies, appliances, equipment, medical-social services and use of a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.007  “Survey” defined. (NRS 449.0302)

     1.  “Survey” means a regularly scheduled inspection of a facility conducted by employees of the Bureau to verify the facility’s compliance with the regulations of the Division, the Centers for Medicare and Medicaid Services, eligibility for participation in the Medicare or Medicaid programs and eligibility for licensure.

     2.  The term includes a follow-up inspection to recertify a facility or evaluate compliance with a plan of correction or an inspection made in response to a complaint.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02, 7-24-2002)

      NAC 449.0072  “Treatment” defined. (NRS 449.0302)  “Treatment” means any medication, drug, test or procedure conducted or administered to diagnose or remedy a physical or mental illness or condition.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.008  Computation of time. (NRS 449.0302)  For the purposes of any computation of time required by NAC 449.002 to 449.99939, inclusive:

     1.  Any prescribed period of more than 5 days includes Saturdays, Sundays and holidays.

     2.  Any prescribed period of 5 days or less does not include Saturdays, Sundays or holidays.

     3.  If the date on which any action required to be performed falls on a Saturday, Sunday or holiday, the time is extended until the next day that is not a Saturday, Sunday or holiday.

     4.  The day of any act or event or on which notice is received is not included in the computation.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0085  Licensee prohibited from employing or contracting with unlicensed person to provide certain nutrition services. (NRS 449.0302)  A licensee shall not employ or contract with a person to provide medical nutrition therapy or nutrition services unless the person is licensed pursuant to chapter 640E of NRS or exempt from such licensure.

     (Added to NAC by Bd. of Health by R090-12, eff. 12-20-2012)

      NAC 449.009  Control by Division over medical records of medical facility or facility for dependent upon suspension of license or cessation of operation: Authorized actions to remove, store and protect records; facilities to pay cost of maintenance of records; notice before destruction of records. (NRS 449.171)

     1.  If the Division takes control of the medical records of a medical facility or a facility for the dependent pursuant to NRS 449.171, the Division:

     (a) May remove any or all of the medical records and store them in a manner that ensures the safety of the medical records.

     (b) May contract with a person or governmental entity to ensure the safety of the medical records.

     (c) Shall determine the costs for maintaining the medical records and require the medical facility or facility for the dependent, as applicable, to pay those costs. The costs must be assessed beginning on the date on which the Division obtains control of the medical records and ending on the date on which the medical records are destroyed or returned to the facility pursuant to subsection 3. The medical facility or facility for the dependent, as applicable, shall pay the costs within 30 days after receipt of notice of the amount owed.

     2.  If the Division contracts with a person or governmental entity pursuant to paragraph (b) of subsection 1, the Division shall ensure that the person or governmental entity complies with the provisions of subsection 2 of NRS 449.171.

     3.  The Division may:

     (a) Unless a longer period is required by federal law, destroy a medical record upon expiration of the period of retention required by NRS 629.051; or

     (b) Return a medical record to the medical facility or facility for the dependent, as applicable, if the license of the facility is reinstated or the facility restores its operation.

     4.  If the Division determines that a medical record in the control of the Division will be destroyed in accordance with subsection 3, the Division shall, for a period of not less than 30 days, post on an Internet website maintained by the Division and in other locations as determined by the Division a notice informing the patients of the medical facility or facility for the dependent, as applicable, how to obtain a medical record before it is destroyed.

     5.  If a medical facility or facility for the dependent fails to pay the amount owed pursuant to paragraph (c) of subsection 1, the Division may suspend or revoke the license of the medical facility or facility for the dependent pursuant to NAC 449.0118.

     (Added to NAC by Bd. of Health by R114-10, eff. 12-20-2012)

      NAC 449.010  Severability. (NRS 449.0302)  If any of the provisions of NAC 449.002 to 449.99939, inclusive, or any application thereof to any person, thing or circumstance is held invalid, it is intended that such invalidity not affect the remaining provisions, or their application, that can be given effect without the invalid provision or application.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 17, eff. 3-27-76]

      NAC 449.0105  Adoption of certain publications by reference; revision of publication after adoption. (NRS 439.200, 449.0302)

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

     (a) NFPA 101: Life Safety Code, in the form most recently published by the National Fire Protection Association, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the code may be obtained from the National Fire Protection Association at 11 Tracy Drive, Avon, Massachusetts 02322, at the Internet address http://www.nfpa.org or by telephone at (800) 344-3555, for the price of $88.20 for members or $98.00 for nonmembers, plus, for a printed copy, $9.95 for handling.

     (b) NFPA 99: Health Care Facilities Code, in the form most recently published by the National Fire Protection Association, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the standard may be obtained from the National Fire Protection Association at 11 Tracy Drive, Avon, Massachusetts 02322, at the Internet address http://www.nfpa.org or by telephone at (800) 344-3555, for the price of $65.25 for members or $72.50 for nonmembers, plus, for a printed copy, $9.95 for handling.

     (c) Guidelines for Design and Construction of Hospitals and Outpatient Facilities, in the form most recently published by the Facility Guidelines Institute, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the guidelines may be obtained from the Facility Guidelines Institute at AHA Services, Inc., P.O. Box 933283, Atlanta, Georgia 31193-3283, at the Internet address http://www.fgiguidelines.org/ or by telephone at (800) 242-2626, for the price of $200.

     (d) Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, in the form most recently published by the Facility Guidelines Institute, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the guidelines may be obtained from the Facility Guidelines Institute at AHA Services, Inc., P.O. Box 933283, Atlanta, Georgia 31193-3283, at the Internet address http://www.fgiguidelines.org/ or by telephone at (800) 242-2626, for the price of $200.

     2.  The State Board of Health will review each revision of the publications adopted by reference pursuant to subsection 1 to ensure its suitability for this State. If the Board determines that a revision is not suitable for this State, the Board will hold a public hearing to review its determination within 12 months after the date of the publication of the revision and give notice of that hearing. If, after the hearing, the Board does not revise its determination, the Board will give notice within 30 days after the hearing that the revision is not suitable for this State. If the Board does not give such notice, the revision becomes part of the publication adopted by reference pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R066-04, R067-04, R068-04, R069-04, R073-04, R076-04 & R077-04, eff. 8-4-2004; A by R121-16, 9-21-2017; R122-16, 9-21-2017)

      NAC 449.0107  Posting of star rating by medical facility or facility for the dependent; exception. (NRS 439.200, 449.0302, 449.1825)

     1.  Information posted by a medical facility or facility for the dependent to satisfy the requirements of subsection 2 of NRS 449.1825 must, in addition to meeting the requirements of that subsection:

     (a) Be posted on a sign that is not less than 8.5 inches in height and 11 inches in width, with margins not greater than 1 inch on any side;

     (b) Be written using a single typeface in not less than 20-point type; and

     (c) State the name of the facility and identify the star rating assigned by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services as the “Centers for Medicare and Medicaid Services Star Rating.”

     2.  The requirements of subsection 2 of NRS 449.1825 apply to each entrance to a building where activity is conducted for which a license as a medical facility or facility for the dependent is required.

     3.  A medical facility or facility for the dependent is not required to post a star rating assigned by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services pursuant to subsection 2 of NRS 449.1825 if the facility did not receive such a rating, including, without limitation, if the facility received an asterisk instead of a star rating.

     (Added to NAC by Bd. of Health by R109-18, eff. 1-30-2019)

GENERAL REQUIREMENTS FOR LICENSURE

      NAC 449.011  Application for license. (NRS 449.0302, 449.040)  An application for a license that is filed with the Division pursuant to NRS 449.040:

     1.  Must be complete and include proof of the identity of the applicant that is acceptable to the Division.

     2.  In accordance with NRS 449.050, must be accompanied by the appropriate application fee specified in NAC 449.002 to 449.99939, inclusive.

     3.  In establishing that the applicant is of reputable and responsible character as required by NRS 449.040, must include personal references and information concerning the applicant’s financial status and business activities and associations in and out of this State during the immediately preceding 3-year period. If the applicant is a firm, association, organization, partnership, business trust, corporation or company, such references and information must be provided with respect to the members thereof and the person in charge of the facility or program for which application is made.

     4.  In addition to the information required by NRS 449.040 and any other information specifically required for a particular license, must include:

     (a) Full, complete and accurate information regarding the ownership of the facility or program and all changes to that ownership that occur while the application is pending. The information must include the name of:

          (1) Each natural person who is an owner of the facility or program;

          (2) Each person who has a direct or indirect ownership interest in the facility or program of 10 percent or more and who is the owner, in whole or in part, of any mortgage, deed of trust, note or other obligation secured in whole or in part by the facility or program or any of the property or assets of the facility or program;

          (3) If the applicant is a corporation, each officer and director; and

          (4) If the applicant is a partnership, each partner.

     (b) The address of the applicant’s principal office.

     (c) Evidence satisfactory to the Division that the facility or program meets all applicable federal, state and local laws and complies with all safety, health, building and fire codes. If there are any differences between the state and local codes, the more restrictive standards apply.

     (d) If required by NRS 439A.100, a copy of a letter of approval issued by the Director of the Department of Health and Human Services.

     (e) A copy of the certificate of occupancy, a copy of the applicant’s business license and a copy of any special use permits obtained in connection with the operation of the facility or program.

     (f) A copy of any property lease or rental agreements concerning the facility or program.

     (g) If the applicant is a corporation, a copy of its bylaws and articles of incorporation.

     5.  If the application is for a facility for the care of adults during the day, must include the maximum number of clients allowed to occupy the facility at one time.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R078-12, 12-20-2012; R022-14, 6-26-2015)

      NAC 449.0112  Investigation; prelicensure survey; inspection for fire safety. (NRS 449.0302)

     1.  Upon receipt of a properly completed application, proof of the identity of the applicant that is acceptable to the Division and the appropriate fee, the Division shall conduct an investigation concerning the premises, facilities, qualifications of personnel, methods of operation and policies of the applicant and perform a prelicensure survey of:

     (a) The applicant; and

     (b) The facility, program plan and management plan, as appropriate.

     2.  Before issuing a license, the Division must receive a satisfactory report of inspection of the facility from the State Fire Marshal or the local fire department.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R078-12, 12-20-2012)

      NAC 449.01125  Duties of Division if Central Repository unable to complete investigation of applicant; grounds for denial or revocation of license or delay of action concerning application. (NRS 449.0302)

     1.  If the Central Repository notifies the Division that it is unable to complete an investigation pursuant to NRS 449.122 because:

     (a) Additional information is required, the Division shall send a notice to the applicant or licensee directing the applicant or licensee to provide the Division and the Central Repository with the information or proof that the information cannot be obtained within 30 days after the date on which the notice was sent by the Division.

     (b) Criminal charges against the applicant or licensee are pending, the Division shall notify the applicant or licensee that he or she is required to:

          (1) Notify the Division of the date of each court proceeding relating to the charges; and

          (2) Provide the Central Repository with any information relating to the final disposition of the charges as soon as the information is available.

     2.  The Division may deny an application for a license of an applicant or revoke the license of a licensee who fails to comply with the provisions of this section.

     3.  The Division may delay taking any action concerning an application until the Central Repository completes its investigation.

     (Added to NAC by Bd. of Health by R111-12, eff. 3-28-2014)

      NAC 449.0113  Duties of administrator or licensee if Central Repository unable to complete investigation of employee or independent contractor; grounds for termination; actions to ensure patient safety. (NRS 449.0302)

     1.  If the Central Repository notifies the administrator of, or the person licensed to operate, a facility, hospital, agency, program or home that it is unable to complete an investigation pursuant to NRS 449.123 because:

     (a) Additional information is required, the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home shall, within 10 working days after receiving the notice from the Central Repository, send a notice to the employee, employee of a temporary employment service or independent contractor directing the employee, employee of a temporary employment service or independent contractor to provide the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home and the Central Repository with the information or proof that the information cannot be obtained within 30 days after the date on which the notice was sent by the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home.

     (b) Criminal charges against the employee, employee of a temporary employment service or independent contractor are pending, the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home shall notify the employee, employee of a temporary employment service or independent contractor that he or she is required to:

          (1) Notify the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home of the date of each court proceeding relating to the charges; and

          (2) Provide the Central Repository with any information relating to the final disposition of the charges as soon as the information is available.

     2.  The administrator of, or the person licensed to operate, the facility, hospital, agency, program or home shall terminate the employment of an employee or the contract with an independent contractor or notify the temporary employment service that its employee is prohibited from providing services for the facility, hospital, agency, program or home upon determining that the employee, employee of a temporary employment service or independent contractor has willfully failed to comply with the provisions of this section.

     3.  Pending the completion of an investigation of an employee, employee of a temporary employment service or independent contractor of a facility, hospital, agency, program or home for which the Central Repository has provided notice pursuant to subsection 1 that it is unable to complete the investigation for a reason stated in subsection 1, and during any period in which an employee, employee of a temporary employment service or independent contractor has to correct information provided by the Central Repository pursuant to NRS 449.125, the administrator of, or the person licensed to operate, a facility, hospital, agency, program or home shall take actions to ensure the safety of its patients, residents or clients, including:

     (a) Prohibiting the employee, employee of a temporary employment service or independent contractor from working at the facility, hospital, agency, program or home by placing the employee, employee of a temporary employment service or independent contractor on leave;

     (b) Requiring the employee, employee of a temporary employment service or independent contractor to be under the direct supervision and observation of an employee of the facility, hospital, agency, program or home while caring for any patient, client or resident of the facility, hospital, agency, program or home;

     (c) Conducting an investigation into the circumstances of the record of criminal history to determine and carry out any measures that the facility, hospital, agency, program or home identifies as necessary to ensure the safety of its patients, residents or clients if the employee, employee of a temporary employment service or independent contractor cares for patients, residents or clients; or

     (d) Taking any combination of the actions set forth in paragraph (a), (b) or (c).

     4.  As used in this section, “facility, hospital, agency, program or home” has the meaning ascribed to it in NRS 449.119 and includes an intermediary service organization for the purpose of carrying out this section and NAC 449.01125.

     (Added to NAC by Bd. of Health by R111-12, eff. 3-28-2014)

      NAC 449.0114  Display of license; compliance with law; transfer of real property; change in administrator, ownership, location, services or maximum number of clients. (NRS 449.0302, 449.050)

     1.  Upon receipt of a license, the licensee shall display the license at a conspicuous location within the facility.

     2.  During the term of the license, the licensee shall continuously maintain the facility in conformance with the provisions of NAC 449.002 to 449.99939, inclusive, and chapter 449 of NRS.

     3.  If there is a transfer of the real property on which the facility is located, but no change in the operator of the facility, the licensee shall, within 10 days, notify the Division of the transfer in writing and provide the Division with a copy of any lease agreement relating to the transfer.

     4.  If there is a change in the administrator of the facility, the licensee shall notify the Division of the change within 10 days. The notification must provide evidence that the new administrator is currently licensed pursuant to chapter 654 of NRS and the regulations adopted pursuant thereto. If the licensee fails to notify the Division and submit an application for a new license within 10 days after the change, the licensee shall pay to the Division a fee in an amount equal to 150 percent of the fee required for a new application set forth in subsection 1 of NAC 449.0168.

     5.  A licensee shall notify the Division immediately of any change in:

     (a) The ownership of the facility;

     (b) The location of the facility;

     (c) The services provided at the facility; and

     (d) If the facility is a facility for the care of adults during the day, the maximum number of clients allowed to occupy the facility at one time.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R122-05, 11-17-2005; R022-14, 6-26-2015)

      NAC 449.0115  Review of building plans for new construction or remodeling by certain applicants: Required documents; payment of fees and costs. (NRS 439.150, 439.200, 449.0302)

     1.  An applicant for a license or the renewal of a license to operate a medical facility or facility for the dependent who wishes or is required to have building plans for new construction or remodeling reviewed by the Division must:

     (a) Submit to the Division or have on file a current application for a license or renewal of a license;

     (b) Pay to the Division any fees required for the issuance or renewal of a license pursuant to NAC 449.013 or 449.016; and

     (c) Submit two complete sets of building plans for new construction or remodeling prepared by a registered architect, registered residential designer or licensed general contractor to the entity designated to review such plans by the Division.

     2.  All costs incurred for the review of building plans and any changes or revisions made to the plans must be borne by the applicant and paid directly to the designee of the Division conducting the review of the plans.

     3.  The costs required to be paid pursuant to subsection 2 are not refundable and are in addition to the fees charged for the issuance or renewal of the license pursuant to NAC 449.013 or 449.016.

     (Added to NAC by Bd. of Health, eff. 11-1-95; A by R035-97, 10-30-97; R129-99, 11-29-99, eff. 1-1-2000; R076-01, 10-18-2001; R067-04, R070-04 & R072-04, 8-4-2004; R076-04, 8-5-2004; R122-05, 11-17-2005; R051-06, 7-14-2006)

      NAC 449.01153  Approval of building plans for construction or remodeling of certain facilities: Period of validity. (NRS 449.0302)  If the Division approves building plans for the construction or remodeling of a facility for modified medical detoxification, a facility for skilled nursing, a facility for the care of adults during the day, a facility for the treatment of persons with alcohol or other substance use disorders, a hospital, a mobile unit, a residential facility for groups or a surgical center for ambulatory patients, the approval is valid for 42 months after it is issued, unless there has been:

     1.  A modification of the building plans;

     2.  A change in the ownership of the facility; or

     3.  A change in the intended use of the facility.

     (Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004)

      NAC 449.01156  On-site advisory inspection of facility: Written request; action by Division; fee. (NRS 439.150, 439.200, 449.0302)

     1.  A licensee or an applicant for the issuance or renewal of a license whose building plans for the construction of a facility have been reviewed pursuant to NAC 449.0115 may submit a written request to the Division for an on-site advisory inspection to be conducted by the Division after at least 80 percent of the construction of the facility is completed. The written request must include, without limitation, the anticipated date on which 80 percent of the construction of the facility will be completed.

     2.  If the Division receives a request submitted pursuant to subsection 1, the Division shall determine its ability to grant the request and shall issue a notice of that determination to the licensee or applicant who submitted the request.

     3.  If the Division grants a request submitted pursuant to subsection 1, the licensee or applicant who submitted the request shall, before the Division conducts the on-site inspection, submit to the Division a fee of:

     (a) Five hundred dollars, if the project is valued at not more than $500,000;

     (b) One thousand dollars, if the project is valued at more than $500,000 but not more than $1,000,000; or

     (c) Two thousand dollars, if the project is valued at more than $1,000,000.

     (Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004)

      NAC 449.0116  Renewal of license: Application; validity of existing license pending decision on application; inspection of facility; untimely filing or failure to file application. (NRS 439.150, 439.200, 449.0302, 449.050, 449.089)

     1.  Except as otherwise provided in subsection 2, a licensee who wishes to renew his or her license must submit a complete application for renewal to the Division on or before November 15 of the calendar year in which the license expires. The existing license shall be deemed valid until the submitted application for renewal is evaluated and a final determination is made by the Division concerning whether to renew the license. The Division may require an inspection of the facility to ensure that it meets the requirements of NAC 449.002 to 449.99939, inclusive, before deciding whether to renew a license.

     2.  A licensee who, without good cause, files an application for the renewal of his or her license after the date set forth in subsection 1 but on or before December 31 of the calendar year in which the license expires and who wishes to renew the license must pay:

     (a) The fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate; and

     (b) An additional charge equal to one-half the amount of the fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate.

     3.  A licensee who fails to file an application for the renewal of his or her license before the license expires is not eligible to renew the license and, if he or she wishes to be licensed, must submit an application for a new license.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R065-04, 8-4-2004)

      NAC 449.0118  Denial, suspension or revocation of license: Grounds. (NRS 449.0302)  In addition to the grounds set forth in NRS 449.160 and any other grounds specifically applicable to a particular license, the Division may deny an application for a license or may suspend or revoke a license upon any of the following grounds:

     1.  The failure or refusal of an applicant or licensee to comply with any of the provisions of chapter 449 of NRS or the regulations adopted by the State Board of Health.

     2.  The failure or refusal of an applicant or licensee to comply with a reasonable order from the Division to remove a resident from a facility or program.

     3.  Operating a facility or program without a license, if a license is required before operating.

     4.  Accepting for care, at any given time, more residents than the number specified in the license.

     5.  The failure or refusal of a licensee to return an adequate plan of correction to the Division within 10 days after the receipt by the licensee of a statement of deficiencies.

     6.  The failure or refusal to cooperate fully with an investigation or inspection by the Bureau.

     7.  Misappropriation of the property of a resident of a facility.

     8.  Abuse, neglect or exploitation of an infirm person, a person with an intellectual disability or a person with a disability, or of a person who is 60 years of age or older.

     9.  The failure of a medical facility or facility for the dependent to pay the costs for the maintenance of the medical records of the facility required pursuant to paragraph (c) of subsection 1 of NAC 449.009.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R114-10, 12-20-2012)

      NAC 449.0119  Denial, suspension or revocation of license or endorsement: Appeals. (NRS 449.0302, 449.170)  An applicant or licensee who is aggrieved by an action of the Division relating to the denial, suspension or revocation of a license or an endorsement may appeal pursuant to the procedures set forth in NAC 439.300 to 439.395, inclusive.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R119-10, 1-13-2011)

FEES

      NAC 449.012  Definitions. (NRS 439.150, 439.200, 449.0302, 449.0303, 449.050)  As used in NAC 449.012 to 449.0169, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.01205 to 449.0127, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97; A by R229-97, 4-15-98; R052-02 & R063-02, 7-24-2002; R065-04, 8-4-2004; R051-06 & R095-06, 7-14-2006; R182-07, 1-30-2008; R046-14, 10-24-2014; R121-16, 9-21-2017)

      NAC 449.01205  “Agency to provide personal care services in the home” defined. (NRS 449.0302)  “Agency to provide personal care services in the home” has the meaning ascribed to it in NRS 449.0021.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.0121  “Ambulatory surgical center” defined. (NRS 449.0302)  “Ambulatory surgical center” has the meaning ascribed to it in NAC 449.972.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01215  “Branch office” defined. (NRS 449.0302)  “Branch office” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01219  “Community triage center” defined. (NRS 449.0302)  “Community triage center” has the meaning ascribed to it in NRS 449.0031.

     (Added to NAC by Bd. of Health by R051-06, eff. 7-14-2006)

      NAC 449.01225  “Facility for hospice care” defined. (NRS 449.0302)  “Facility for hospice care” has the meaning ascribed to it in NAC 449.0172.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97; A by R123-99, 11-29-99)

      NAC 449.01227  “Facility for refractive surgery” defined. (NRS 449.0302)  “Facility for refractive surgery” has the meaning ascribed to it in NRS 449.00387.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002; A by R042-06, 7-14-2006)

      NAC 449.01228  “Facility for transitional living for released offenders” defined. (NRS 449.0302)  “Facility for transitional living for released offenders” has the meaning ascribed to it in NRS 449.0055.

     (Added to NAC by Bd. of Health by R095-06, eff. 7-14-2006)

      NAC 449.01229  “Facility for treatment with narcotics” defined. (NRS 449.0302, 449.0303)  “Facility for treatment with narcotics” has the meaning ascribed to it in NAC 449.1542.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98) — (Substituted in revision for NAC 449.0122)

      NAC 449.0123  “Home health agency” defined. (NRS 449.0302)  “Home health agency” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01235  “Home office” defined. (NRS 449.0302)  “Home office” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.0124  “Hospice care” defined. (NRS 449.0302)  “Hospice care” has the meaning ascribed to it in NAC 449.0175.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01245  “Intermediate care facility for persons with an intellectual disability or persons with a developmental disability” defined. (NRS 449.0302)  “Intermediate care facility for persons with an intellectual disability or persons with a developmental disability” has the meaning ascribed to it in NAC 449.632.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.0125  “Medication unit” defined. (NRS 449.0302, 449.0303)  “Medication unit” has the meaning ascribed to it in NAC 449.15435.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)

      NAC 449.01252  “Mobile unit” defined. (NRS 449.0302)  “Mobile unit” has the meaning ascribed to it in NRS 449.01515.

     (Added to NAC by Bd. of Health by R063-02, eff. 7-24-2002)

      NAC 449.01255  “Nursing pool” defined. (NRS 449.0302)  “Nursing pool” has the meaning ascribed to it in NRS 449.0153.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01257  “Psychiatric residential treatment facility” defined. (NRS 439.150, 449.0302, 449.050)  “Psychiatric residential treatment facility” has the meaning ascribed to it in NAC 449.411.

     (Added to NAC by Bd. of Health by R046-14, eff. 10-24-2014)

      NAC 449.01259  “Recovery center” defined. (NRS 439.200, 449.0302, 449.0303)  “Recovery center” has the meaning ascribed to it in NAC 449.99702.

     (Added to NAC by Bd. of Health by R121-16, eff. 9-21-2017)

      NAC 449.0126  “Rural clinic” defined. (NRS 449.0302)  “Rural clinic” has the meaning ascribed to it in NRS 449.0175.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01265  “Rural hospital” defined. (NRS 449.0302)  “Rural hospital” has the meaning ascribed to it in NRS 449.0177.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.0127  “Subunit agency” defined. (NRS 449.0302)  “Subunit agency” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.013  License and renewal fees to operate ambulatory surgical center, home office or subunit agency of home health agency, branch office of home health agency, rural clinic, obstetric center, program of hospice care, independent center for emergency medical care, nursing pool, facility for treatment with narcotics, medication unit, referral agency, facility for refractive surgery, mobile unit, agency to provide personal care services in home, facility for the care of adults during day, peer support recovery organization, community health worker pool and employment agency to provide nonmedical services; expiration of application for license. (NRS 439.150, 439.200, 449.03005, 449.0302, 449.0303, 449.0305, 449.050)

     1.  Except as otherwise provided in NAC 449.0168, an applicant for a license to operate any of the following facilities, programs of hospice care or agencies must pay to the Division of Public and Behavioral Health the following nonrefundable fees:

(a) An ambulatory surgical center	$9,784
(b) A home office or subunit agency of a home health agency	5,168
(c) A branch office of a home health agency	5,358
(d) A rural clinic	4,058
(e) An obstetric center	1,564
(f) A program of hospice care	7,054
(g) An independent center for emergency medical care	4,060
(h) A nursing pool	4,602
(i) A facility for treatment with narcotics	5,046
(j) A medication unit	1,200
(k) A referral agency	2,708
(l) A facility for refractive surgery	6,700
(m) A mobile unit	2,090
(n) An agency to provide personal care services in the home	1,374
(o) A facility for the care of adults during the day allowed to be occupied by not more than 50 clients at one time	.                     1,164
(p) A facility for the care of adults during the day allowed to be occupied by more than 50 clients at one time	...                  1,753
(q) A peer support recovery organization	1,000
(r) A community health worker pool	1,000
(s) An employment agency to provide nonmedical services	1,400

     2.  An applicant for the renewal of such a license must pay to the Division of Public and Behavioral Health the following nonrefundable fees:

(a) An ambulatory surgical center	$4,892
(b) A home office or subunit agency of a home health agency	2,584
(c) A branch office of a home health agency	2,679
(d) A rural clinic	2,029
(e) An obstetric center	782
(f) A program of hospice care	3,527
(g) An independent center for emergency medical care	2,030
(h) A nursing pool	2,301
(i) A facility for treatment with narcotics	2,523
(j) A medication unit	600
(k) A referral agency	1,354
(l) A facility for refractive surgery	3,350
(m) A mobile unit	1,045
(n) An agency to provide personal care services in the home	687
(o) A facility for the care of adults during the day allowed to be occupied by not more than 50 clients at one time	814
(p) A facility for the care of adults during the day allowed to be occupied by more than 50 clients at one time	1,227
(q) A peer support recovery organization	500
(r) A community health worker pool	500
(s) An employment agency to provide nonmedical services	700

     3.  An application for a license is valid for 1 year after the date on which the application is submitted. If an applicant does not meet the requirements for licensure imposed by chapter 449 of NRS or the regulations adopted pursuant thereto within 1 year after the date on which the applicant submits his or her application, the applicant must submit a new application and pay the required fee to be considered for licensure.

     [Bd. of Health, Health Facility Fees Art. 1, eff. 1-20-77] — (NAC A 7-22-87; 1-31-90; 9-1-93; 11-1-95; 10-3-96; R035-97 & R044-97, 10-30-97; R229-97, 4-15-98; R105-98, 9-23-98; R132-99, 11-29-99; R123-01, 12-17-2001, eff. 1-1-2002; R052-02 & R063-02, 7-24-2002; R050-02, 10-22-2002; R074-03, 10-22-2003; R065-04, 8-4-2004; R042-06 & R095-06, 7-14-2006; R182-07, 1-30-2008; R060-10, 1-13-2011; R022-14, 6-26-2015; R120-16, 9-21-2017; R133-15, 12-19-17; R109-18, 1-30-2019)

      NAC 449.016  License and renewal fees to operate skilled nursing facility, hospital, rural hospital, intermediate care facility, residential facility for groups, facility for treatment of alcohol or other substance use disorders, facility for hospice care, home for individual residential care, facility for modified medical detoxification, community triage center, facility for treatment of irreversible renal disease, halfway house for persons recovering from alcohol or other substance use disorders, facility for transitional living for released offenders, psychiatric residential treatment facility and recovery center; expiration of application for license; refund of certain fees. (NRS 439.150, 439.200, 449.0302, 449.050)

     1.  Except as otherwise provided in NAC 449.0168, an applicant for a license to operate any of the following facilities must pay to the Division the following nonrefundable fees:

 

	(c) A rural hospital..........................................................................	9,530		62
	(f) Except as otherwise provided in subsection 3, a residential facility for groups.................................................................................	2,386		200
	(i) A home for individual residential care.......................................	1,764		184
	(l) A facility for the treatment of irreversible renal disease...........	4,178		120
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