Existing law requires the Department of Health and Human Services, or the Director of the Department or the divisions thereof, to conduct various programs for the improvement of public health and health care in this State. (NRS 433.702-433.744, 439.4921-439.525, 439.529-439.5297, 439.630, 439A.111-439A.185, 439A.200-439A.290, 442.710-442.745, 457.230-457.280, 458.025, 458A.090, 458A.100, 458A.110)
Section 7 of this bill requires the Director to conduct a biennial assessment of the health care workforce needs of this State, which must identify health care professions and specialties, types of clinical services and expertise and geographic areas experiencing critical shortages of providers of health care or clinical services or expertise. Section 42 of this bill provides that such an assessment is not a regulation and is therefore not subject to notice-and-comment rulemaking.
Existing law requires the Director to prescribe by regulation a framework for the electronic maintenance, transmittal and exchange of electronic health records, prescriptions, health-related information and electronic signatures and requirements for electronic equivalents of written entries or written approvals. With certain exceptions, existing law requires various entities involved in health care, including persons and facilities that provide health care, to maintain, transmit and exchange health information in accordance with those regulations. (NRS 439.589) Section 3.6 of this bill prohibits those regulations from authorizing such a person or entity to comply with that requirement by connecting with a health information exchange or utilizing any other service that charges a fee for providing electronic health records to such a person or entity or a patient upon request. Section 72.8 of this bill: (1) requires a custodian of health care records to furnish electronic health records to a patient or certain other entities upon the request of a patient within 7 business days; and (2) prohibits a custodian of health care records from charging a fee to furnish health care records under such circumstances.
Sections 3.3, 72.3 and 126 of this bill limit the health care providers that must maintain, transmit and exchange health information electronically to medical facilities and high-level providers of health care. Section 1 of this bill defines the term “high-level provider of health care” to mean a physician, physician assistant, dentist, advanced practice registered nurse, chiropractic physician, podiatric physician or physical therapist. Section 3.3 additionally exempts from requirements to maintain, transmit and exchange health information electronically high-level providers of health care whose solo or group practices are under a certain size. However, section 3.3 requires such high-level providers of health care to furnish the medical records of a patient electronically to the patient or another person or entity upon request of the patient. Section 4.5 of this bill makes conforming changes to revise the applicability of a provision requiring the Department to notify the licensing board of a provider who fails to comply with requirements governing the electronic maintenance, transmittal and exchange of health information. Section 1.5 of this bill establishes the applicability of the definition set forth in section 1, and sections 43, 45.5, 67.9, 116.3 and 116.7 of this bill make other conforming changes to indicate the proper placement of section 1 in the Nevada Revised Statutes. Section 72.5 of this bill updates internal references changed by section 72.3.
Existing law prohibits a person or entity from operating an independent center for emergency medical care without a license issued by the Division of Public and Behavioral Health of the Department. (NRS 449.030) Section 22.5 of this bill requires a facility that is structurally separate from the hospital and provides services for the treatment of a medical emergency, including such a facility that is owned or operated by, or otherwise part of, a hospital, to be licensed as an independent center for emergency medical care. (NRS 449.0151, 449.030) Sections 24.3 and 24.5 of this bill prohibit the Division or the State Board of Health from charging a fee for the issuance of such a license. Section 24.8 of this bill prohibits the Division from issuing a license to operate an independent center for emergency medical care that is located within a 5 mile radius of another independent center for emergency medical care or a hospital with an emergency department. However, section 120.6 of this bill requires the Division to issue a license to certain such independent centers for emergency medical care that are currently licensed or had taken certain steps toward operating by January 1, 2025. Section 26.5 of this bill requires an independent center for emergency medical care to provide urgent care services during all operating hours and imposes certain additional requirements related to the provision of such urgent care, except that section 120.3 of this bill exempts from that requirement independent centers for emergency medical care that are licensed on the date on which this bill is enacted.
Existing law establishes programs to increase awareness of information concerning hospitals and surgical centers for ambulatory patients. (NRS 439A.200-439A.290) Section 9.5 of this bill requires the Department to establish a similar program to increase awareness of information concerning independent centers for emergency medical care. Sections 9.5, 10.5, 12.5, 13.5 and 27.3 of this bill provide for the Department to collect certain information on the operations of independent centers for emergency medical care and the outcomes for patients treated by independent centers for emergency medical care. To facilitate such reporting, section 27.3 requires an independent center for emergency medical care to use the same form prescribed by the Director for discharging patients as a hospital is currently required to use. Section 95.5 of this bill makes a conforming change to reflect that independent centers for emergency medical care will be using the same form. Sections 12.5 and 13.5 require the Department to: (1) make certain information concerning independent centers for emergency medical care available upon request; and (2) post certain information concerning independent centers for emergency medical care on an Internet website maintained by the Department. Sections 11.2 and 41.5 of this bill make conforming changes to add references to independent centers for emergency medical care to sections that discuss the program and associated website. Section 8.5 of this bill defines the term “independent center for emergency medical care” for that purpose. Section 11.5 of this bill establishes the applicability of certain definitions. Section 27.7 of this bill requires a report prepared by the Director on the status of the programs to increase public awareness of information concerning hospitals and surgical centers for ambulatory patients to additionally include information on the status of the program to increase awareness of information concerning independent centers for emergency medical care. Section 51.3 of this bill requires the Director of the Department, to the extent that money is available, to include under Medicaid a system of value-based payments for care provided by independent centers for emergency medical care to recipients of Medicaid.
Existing law authorizes a court, upon a petition, to order the sealing of records of certain convictions if the person who was convicted: (1) has not been convicted of any additional offense, except for minor traffic violations, for a specified period of time; and (2) does not have charges pending for any offense, except for minor traffic violations. (NRS 179.245) Existing law also authorizes a court, upon a petition, to order the sealing of records of an arrest where the charges were dismissed, the prosecutor declined to prosecute or the person who was arrested was acquitted. (NRS 179.255) Section 32.5 of this bill authorizes the Department or the Division of Health Care Financing and Policy of the Department to review certain sealed records for the purpose of determining the suitability of the person to whom the records pertain to serve as a provider of services under Medicaid or to own or serve as an officer, managing employee or managing agent of such a provider of services.
Existing law prescribes a procedure for conducting a hearing to review an action taken against a provider of services under Medicaid. (NRS 422.306) Section 51.5 of this bill requires such a provider of services to maintain and provide certain documents to the Department for the purpose of verifying claims. Section 51.5 authorizes the Department to deny a claim or recover money already paid if the Department is unable to verify the claim. Section 51.8 of this bill: (1) prescribes a process for the Department to review claims for appropriateness and propriety; and (2) authorizes the Department to deny or recover any amount paid pursuant to such a claim or take certain actions based on such a review. Section 119.5 of this bill makes an appropriation to the Division of Health Care Financing and Policy of the Department and authorizes the expenditure of certain other money to carry out sections 51.3-51.8.
Section 67 of this bill: (1) creates the Office of Mental Health within the Department; and (2) requires the Director to appoint the Executive Director of the Office. Section 67.2 of this bill requires the Office to perform certain duties to improve access to and the effectiveness of mental health services in this State. Section 67.4 of this bill requires the Office to perform certain additional duties related to the mental and behavioral health of children. Sections 67.6-67.8 of this bill require the subcommittee on the mental health of children of the Commission on Behavioral Health and each mental health consortium to support those duties. Section 67.5 of this bill requires the Office to submit a biennial report to the Legislature. Section 66.6 of this bill defines the term “Office” for the purposes of sections 67-67.5 to refer to the Office of Mental Health. Senate Bill No. 494 of this legislative session proposes to create a new department in the Executive Branch of State Government known as the Nevada Health Authority to perform certain duties related to health care, including behavioral health care, in this State. Section 121.5 of this bill transfers the Office to the Nevada Health Authority if Senate Bill No. 494 is enacted.
Section 89 of this bill requires the Board of Psychological Examiners to: (1) take certain actions to incentivize licensees to receive continuing education concerning the mental health needs of patients in rural areas; and (2) establish a program to recognize psychologists who provide at least 200 hours of services through telehealth to such patients.
Sections 20, 46, 50, 75, 85, 109 and 113 of this bill prescribe requirements to expedite the process of credentialing providers of health care to participate in public and private health insurance plans. Beginning on January 1, 2027, sections 117 and 118 of this bill require insurers that issue such plans, or entities to which such insurers delegate credentialing functions, to process least 95 percent of complete requests for such credentialing not later than 60 days after receiving all of the information necessary to complete such a request. Beginning on January 1, 2027, section 21 of this bill similarly requires a hospital to process at least 95 percent of complete requests from providers of health care for privileges to perform services at the hospital not later than 60 days after receiving all of the information necessary to complete such a request.
Existing law authorizes an emergency medical technician, advanced emergency medical technician or paramedic who holds the proper endorsement to provide services, known as community paramedicine services, to patients who do not require emergency medical transportation. (NRS 450B.1993) Sections 29-31 of this bill authorize paramedics to serve as employees or volunteers in a hospital under certain circumstances and with certain limitations.
Existing law provides that a noncompetition covenant is void unless the covenant: (1) is supported by valuable consideration; (2) does not impose any restraint that is greater than is required for the protection of the employer; (3) does not impose any undue hardship on the employee; and (4) imposes restrictions that are appropriately related to the consideration for the covenant. (NRS 613.195) Section 71 of this bill provides that a noncompetition covenant may not apply to a provider of health care whose primary duties involve providing clinical care to patients and who is not employed or contracted to primarily perform administrative tasks.
Sections 74 and 84 of this bill require the Board of Medical Examiners and the State Board of Osteopathic Medicine, respectively, to establish by regulation a procedure for prioritizing applications for licensure as a physician or osteopathic physician of applicants who plan to: (1) serve underserved geographic areas or populations in this State; or (2) practice a specialty for which there is a shortage in this State. Sections 76 and 86 of this bill require certain reports submitted by those Boards to the Governor and Legislature to include information relating to the efficiency of the process for licensing physicians or osteopathic physicians, as applicable.
Existing law requires the Director to: (1) develop and make available to each professional licensing board that licenses, certifies or registers providers of health care an electronic data request that solicits certain information relating to the demographics and practices of providers of health care; and (2) establish and maintain a database of information collected through the data request. (NRS 439A.116) Under existing law, providers of health care applying to renew a license, certificate or registration may, but are not required to, complete the data request. (NRS 450B.805, 630.2671, 630A.327, 631.332, 632.3423, 633.4716, 634.1303, 634A.169, 635.111, 636.262, 637.145, 637B.192, 639.183, 640.152, 640A.185, 640B.405, 640D.135, 640E.225, 641.2215, 641A.217, 641B.281, 641C.455, 652.126) Sections 76.5, 82.3, 82.6, 86.2-86.8 and 89.2-89.9 of this bill make completion of the data request mandatory to renew a license, certificate or registration issued by: (1) the Board of Medical Examiners; (2) the Board of Dental Examiners of Nevada; (3) the State Board of Nursing; (4) the State Board of Osteopathic Medicine; (5) the State Board of Podiatry; (6) the Nevada State Board of Optometry; (7) the Board of Dispensing Opticians; (8) the Board of Psychological Examiners; (9) the Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors; (10) the Board of Examiners for Social Workers; (11) the Board of Examiners for Alcohol, Drug and Gambling Counselors; and (12) the Board of Applied Behavior Analysis. Section 42.5 of this bill makes a conforming change to ensure the confidentiality of information submitted through such a data request.
Existing law requires an applicant for licensure as a dental hygienist to have graduated from an accredited program of dental hygiene that meets certain requirements. (NRS 631.290) Sections 77 and 79 of this bill authorize the Board of Dental Examiners of Nevada to establish by regulation an alternative training pathway involving a course of training under the supervision of a licensed dentist that an applicant for such a license may complete instead of graduating from such a program. Section 77 requires an applicant who has completed the alternative training pathway to have also successfully passed: (1) a competency examination conducted by the supervising dentist; (2) a written examination; and (3) a clinical examination approved by the Board. Section 78 of this bill requires such an applicant to submit with his or her application for licensure proof that he or she has passed those examinations. Section 77 provides that a person who completes the alternative training pathway is only eligible for licensure if he or she began the pathway during a biennium during which there was shortage of dental hygienists, as documented by the assessment conducted pursuant to section 7. Section 77 requires the Board to adopt regulations establishing the scope of practice of a dental hygienist who has completed the alternative training pathway. Section 81 of this bill prohibits a dental hygienist who has completed the alternative training pathway and has not subsequently graduated from an accredited program of dental hygiene from prescribing and dispensing preventive agents.
Existing law requires the Department to administer Medicaid and the Children's Health Insurance Program. (NRS 422.270) Existing federal law authorizes: (1) a hospital to elect to make determinations concerning whether certain persons are presumptively eligible for Medicaid; and (2) a state to allow certain other entities to make such determinations. (42 U.S.C. §§ 1396a(a)(47), 1396r-1, 1396r-1a, 1396r-1b, 1396r-1c) Section 51 of this bill requires the Department to take certain measures to facilitate such presumptive eligibility determinations by the personnel of hospitals and qualified community-based organizations. Section 51 also requires the Department to audit such entities to ensure that the presumptive eligibility determinations made by the personnel of those entities are accurate and comply with applicable law.
Existing law authorizes certain health insurers to require prior authorization before an insured may receive coverage for medical and dental care in certain circumstances. If an insurer requires prior authorization, existing law requires the insurer to: (1) file its procedure for obtaining prior authorization with the Commissioner of Insurance for approval; and (2) respond to a request for prior authorization within 20 days after receiving the request. (NRS 687B.225) Beginning on January 1, 2028, sections 47, 53-62, 69, 97-108 and 110 of this bill establish additional requirements relating to the use of prior authorization for medical care by health insurers, including Medicaid, the Children's Health Insurance Program and insurance for state employees, as well as certain entities with which such insurers contract to perform functions relating to prior authorization. Sections 53.5, 54, 55 and 98-100 define certain terms, and sections 53 and 97 establish the applicability of those definitions. Section 101.6 of this bill requires certain insurers and other entities that employ or utilize an artificial intelligence system or automated decision tool to process requests for prior authorization to transmit a notice to each insured that: (1) discloses the insurer's use of the system or tool to process requests for prior authorization; and (2) describes certain aspects of the system or tool. Sections 56 and 110 require an insurer or other entity that performs functions relating to prior authorization to respond to a request for prior authorization within a specified period of time. If an insurer or other entity that performs functions relating to prior authorization is unable to approve or deny a request for prior authorization within that time period, sections 56 and 110 require the insurer or entity to notify the insured and his or her provider of health care of the delay. Sections 58 and 102 prescribe the required contents of that notice. Sections 59 and 103 require an insurer or other entity that performs functions relating to prior authorization to provide similar notice upon denying a request for prior authorization and establish a process to appeal such a denial.
Sections 56 and 110 prohibit insurers and other en