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- 83rd Session (2025)
Assembly Bill No. 360–Assemblymember Goulding
CHAPTER..........
AN ACT relating to health care; requiring certain physician
assistants and advanced practice registered nurses to examine
pregnant women for the discovery of syphilis; requiring the
use of a rapid or point-of-care test when testing certain
pregnant women for syphilis in certain circumstances;
requiring certain medical facilities to develop a policy to
ensure compliance with such requirements; exempting certain
medical fa cilities from requirements relating to testing for
syphilis; authorizing the discipline of certain health care
facilities that violate such requirements; requiring Medicaid
to reimburse for rapid or point -of-care testing for syphilis
performed under certai n circumstances separately from
reimbursement for other prenatal care; and providing other
matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires every physician attending a pregnant woman during
gestation to make an examination for the discovery of syphilis. Existing law also
requires any medical facility, other than a hospital, and an emergency department
or labor and delivery unit in a hospital that is evaluating or treating a pregnant
woman to test the pregnant woman for syphilis using a standard serological test,
unless the pregnant woman refuses the test or indicates that she has already had the
prenatal screenings and tests recommended by the American College of
Obstetricians and Gynecologists. Existing law requires such a physician or facility
to treat a patient who tests positive for syphilis or to refer the patient for such
treatment, except where the patient refuses treatment. (NRS 442.010) Section 1 of
this bill additionally requires a physician a ssistant or advanced practice registered
nurse to make an examination for the discovery of syphilis when attending a
pregnant woman during gestation . Section 1 requires certain medical facilities,
other than a hospital, and an emergency department or labor unit of a hospital to
test a pregnant woman who has not received any prenatal screenings and tests for
syphilis, and who does not refuse testing, using a rapid or point-of-care test instead
of a standard serological test unless the results of a serologica l test are likely to be
available before the woman is discharged or otherwise leaves the facility. Section 1
requires such a facility to perform a serological test if a woman indicates she has a
history of syphilis or refer the woman for such a test. Section 1: (1) clarifies that
such a facility must perform a test for syphilis on a pregnant woman, unless the
woman refuses the test, regardless of the reason the woman is seeking treatment at
the facility; and (2) requires any such refusal to be document ed. Section 1 further
requires such a facility to develop a policy to ensure compliance with such testing
requirements and certain recommendations by the American College of
Obstetricians and Gynecologists or its successor organization . Section 1
additionally exempts rural clinics that are owned, operated or administered by
certain governmental entities from certain requirements governing testing for
syphilis.
Additionally, certain public and private policies of health insurance, including
Medicaid, would be required to cover rapid or point -of-care testing for syphilis
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performed under the conditions required by section 1. (NRS 287.010, 287.04335,
422.27173, 689A.0412, 689B.0315, 689C.1675, 698C.425, 695A.1856, 695B.1913,
695C.050, 695C.1737, 695G.1714) Section 3.5 of this bill requires Medicaid, to the
extent federal financial participation is available, to reimburse such testing for
syphilis separately from the other prenatal care the pregnant woman received at the
time of the testing.
Sections 2 and 3 of this bill authorize the Division of Public and Behavioral
Health of the Department of Health and Human Services to discipline a medical
facility for a violation of section 1.
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. NRS 442.010 is hereby amended to read as follows:
442.010 1. Except as otherwise provided in [subsection 6, ]
subsections 7 and 9, every:
(a) Physician , physician assistant or advanced practice
registered nurse attending a pregnant woman during gestation for
conditions relating to her pregnancy shall make an examination,
including a standard serological test, for the discovery of syphilis.
The physician , physician assistant or advanced practice registered
nurse shall take or cause to be taken a sample of blood of the
woman at the times prescribed by subsection 2, if applicable, and
shall submit the sample to a laboratory licensed pursuant to chapter
652 of NRS for a standard serological test for syphilis.
(b) Person permitted by law to attend upon pregnant women, but
not permitted by law to make blood tests in Nevada, shall cause a
sample of the blood of the pregnant woman to be taken at the times
prescribed by subsection 2, if applicable, by a duly licensed
physician , physician assistant or advanced practice registered
nurse and submitted to a laboratory licensed pursuant to chapter 652
of NRS for a standard serological test for syphilis.
(c) Non-hospital medical facility or emergency department or
labor and delivery unit in a hospital that evaluates or treats a woman
of childbearing age for any reason shall ensure that:
(1) The woman is asked if she is pregnant and, if she
responds in the affirmative, whether she has [had the] received any
prenatal care, inc luding, without limitation, any prenatal
screenings and tests ; [recommended by the American College of
Obstetricians and Gynecologists or its successor organization;] and
(2) An examination is made, including [a standard
serological test,] the performance of:
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(I) A test for the discovery of syphilis [,] in accordance
with subsection 3 if the woman indicates that she is pregnant , [and
has not had the prenatal screenings and tests recommended by the
American College of Obstetricians and Gynecologists or its
successor organization. The non -hospital medical facility,
emergency department or labor and delivery unit shall ensure that a
sample of blood of the woman is taken at the times prescribed by
subsection 2, if applicable, and shall ensure the submission of the
sample to a laboratory licensed pursuant to chapter 652 of NRS for a
standard serological test for] has no history of syphilis and has not
been tested for syphilis within the immediately preceding 3
months; or
(II) A serological test or a referral for the performance
of a serological test if the woman indicates that she has a history
of syphilis.
2. An examination for the discovery of syphilis pursuant to
paragraphs (a) and (b) of subsection 1 must be performed:
(a) [During the first trimester of pregnancy at ] At the first visit
to a physician , physician assistant or advanced practice registered
nurse or other person permitted by law to attend upon pregnant
women, a non-hospital medical facility or an emergency department
or labor and delivery unit of a hospital during a pregnancy or as
soon thereafter as practicable;
(b) During the third trimester of pregnancy between the 27th and
36th week of gestation or as soon thereafter as practicable; and
(c) At delivery for a pregnant woman who:
(1) Should be routinely tested for infection with syphilis, as
recommended by the Centers for Disease Control and Prevention of
the United States Department of Health and Human Services;
(2) Lives in an area designated by the Division as having
high syphilis morbidity;
(3) Did not receive prenatal care; or
(4) Delivers a stillborn infant after 20 weeks of gestation.
3. For the purposes of sub-subparagraph (I) of subparagraph
(2) of paragraph (c) of subsection 1, a non -hospital medical
facility or emergency department or labor and delivery unit of a
hospital may use:
(a) A rapid or point-of-care test; or
(b) A serological test only if the facility performing the test
reasonably believes it is able to obtain the results of the serological
test before the woman is discharged from or otherwise leaves the
facility.
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4. A qualified serological , rapid or point-of-care test for
syphilis is one recognized as such by the State Board of Health.
[4.] 5. If the test is made in a state laboratory, it must be made
without charge.
[5.] 6. If a serological , rapid , point-of-care or physical
examination test performed pursuant to subsection 1 shows that a
pregnant woman is infected with syphilis, the physician, physician
assistant, advanced practice registered nurse, other person, non -
hospital medical facility, emergency departmen t or labor and
delivery unit shall:
(a) If the physician, physician assistant, advanced practice
registered nurse, other person, non -hospital medical facility,
emergency department or labor and delivery unit is capable of
providing treatment for syphilis, seek the consent of the pregnant
woman to begin such treatment and, if such consent is obtained,
commence treatment; or
(b) If the physician, physician assistant, advanced practice
registered nurse, other person, non -hospital medical facility,
emergency department or labor and delivery unit is not capable of
providing treatment for syphilis, seek the consent of the pregnant
woman to refer her for such treatment and, if such consent is
obtained, issue the referral.
[6.] 7. If the pregnant woman objects t o the taking of the
sample of blood or the serological , rapid or point -of-care test [,
the] :
(a) The sample must not be taken and the test must not be
performed [.] ; and
(b) The provider of health care attending to the woman shall
ensure that any refusal is documented in her medical records.
8. Except as otherwise provided in subsection 9, a non-
hospital medical facility and a hospital with an emergency
department or labor and delivery unit shall develop a policy to
ensure compliance with this se ction and recommendations of the
American College of Obstetricians and Gynecologists , or its
successor organization, to the extent that those recommendations
do not conflict with this section, concerning best practices for
prenatal screenings and tests. Th e policy must include, without
limitation, procedures:
(a) For documenting refusals to any service or testing offered
by the non -hospital medical facility, emergency department or
labor and delivery unit; and
(b) To ensure compliance with NRS 441A.150.
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9. A rural clinic that is owned, operated or administered by
the Department or any political subdivision of this State,
including, without limitation, a city, county, city board of health,
county board of health or district board of health , is exempt from
the requirements of paragraph (c) of subsection 1 and
subsection 8.
[7.] 10. As used in this section, “non-hospital medical facility”
means:
(a) A freestanding birthing center;
(b) An independent center for emergency medical care, as
defined in NRS 449.013;
(c) A psychiatric hospital, as defined in NRS 449.0165;
(d) A rural clinic, as defined in NRS 449.0175;
(e) A facility for modified medical detoxification, as defined in
NRS 449.00385;
(f) A mobile unit, as defined in NRS 449.01515; and
(g) A community triage center, as defined in NRS 449.0031.
Sec. 2. NRS 449.160 is hereby amended to read as follows:
449.160 1. The Division may deny an application for a
license or may suspend or revoke any license issue d under the
provisions of NRS 449.029 to 449.2428, inclusive, upon any of the
following grounds:
(a) Violation by the applicant or the licensee of any of the
provisions of NRS 439B.410, 442.010, 449.029 to 449.245,
inclusive, or 449A.100 to 449A.124, inclusive, and 449A.270 to
449A.286, inclusive, or of any other law of this State or of the
standards, rules and regulations adopted thereunder.
(b) Aiding, abetting or permitting the commission of any illegal
act.
(c) Conduct inimical to the public heal th, morals, welfare and
safety of the people of the State of Nevada in the maintenance and
operation of the premises for which a license is issued.
(d) Conduct or practice detrimental to the health or safety of the
occupants or employees of the facility.
(e) Failure of the applicant to obtain written approval from the
Director of the Department of Health and Human Services as
required by NRS 439A.100 or 439A.102 or as provided in any
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive,
and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such
approval is required, including, without limitation, the closure or
conversion of any hospital in a county whose population is 100,000
or more that is owned by the licensee without approval pursu ant to
NRS 439A.102.
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(f) Failure to comply with the provisions of NRS 441A.315 and
any regulations adopted pursuant thereto or NRS 449.2486.
(g) Violation of the provisions of NRS 458.112.
(h) Failure to comply with the provisions of NRS 449A.170 to
449A.192, inclusive, and any regulation adopted pursuant thereto.
(i) Violation of the provisions of NRS 629.260.
2. In addition to the provisions of subsection 1, the Division
may revoke a license to operate a facility for the dependent if, with
respect to that facility, the licensee that operates the facility, or an
agent or employee of the licensee:
(a) Is convicted of violating any of the provisions of
NRS 202.470;
(b) Is ordered to but fails to abate a nuisance pursuant to NRS
244.360, 244.3603 or 268.4124; or
(c) Is ordered by the appropriate governmental agency to correct
a violation of a building, safety or health code or regulation but fails
to correct the violation.
3. The Division shall maintain a log of any complaints that it
receives relating to activities for which the Division may revoke the
license to operate a facility for the dependent pursuant to subsection
2. The Division shall provide to a facility for the care of adults
during the day:
(a) A summary of a complaint against the faci lity if the
investigation of the complaint by the Division either substantiates
the complaint or is inconclusive;
(b) A report of any investigation conducted with respect to the
complaint; and
(c) A report of any disciplinary action taken against the facility.
The facility shall make the information available to the public
pursuant to NRS 449.2486.
4. On or before February 1 of each odd -numbered year, the
Division shall submit to the Director of the Legislative Counsel
Bureau a written report setting forth, for the previous biennium:
(a) Any complaints included in the log maintained by the
Division pursuant to subsection 3; and
(b) Any disciplinary actions taken by the Division pursuant to
subsection 2.
Sec. 3. NRS 449.163 is hereby amended to read as follows:
449.163 1. In addition to the payment of the amount required
by NRS 449.0308, if a medical facility, facility for the dependent or
facility which is required by the regulations adopted by the Board
pursuant to NRS 449.0303 to be licensed violates any provision
related to its licensure, including any provision of NRS 439B.410 ,
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442.010 or 449.029 to 449.2428, inclusive, or any condition,
standard or regulation adopted by the Board, the Division, in
accordance with the regulations adopted pursuant to NRS 449.165,
may:
(a) Prohibit the facility from admitting any patient until it
determines that the facility has corrected the violation;
(b) Limit the occupancy of the facility to the number of beds
occupied when the violation occurred, until it determines that the
facility has corrected the violation;
(c) If the license of the facility limits the occupancy of the
facility and the facility has exceeded the approved occupancy,
require the facility, at its ow n expense, to move patients to another
facility that is licensed;
(d) Except where a greater penalty is authorized by subsection 2,
impose an administrative penalty of not more than $5,000 per day
for each violation, together with interest thereon at a ra te not to
exceed 10 percent per annum; and
(e) Appoint temporary management to oversee the operation of
the facility and to ensure the health and safety of the patients of the
facility, until:
(1) It determines that the facility has corrected the violat ion
and has management which is capable of ensuring continued
compliance with the applicable statutes, conditions, standards and
regulations; or
(2) Improvements are made to correct the violation.
2. If an off -campus location of a hospital fails to obtain a
national provider identifier that is distinct from the national provider
identifier used by the main campus and any other off -campus
location of the hospital in violation of NRS 449.1818, the Division
may impose against the hospital an administrat ive penalty of not
more than $10,000 for each day of such failure, together with
interest thereon at a rate not to exceed 10 percent per annum, in
addition to any other action authorized by this chapter.
3. If the facility fails to pay any administrative penalty imposed
pursuant to paragraph (d) of subsection 1 or subsection 2, the
Division may:
(a) Suspend the license of the facility until the administrative
penalty is paid; and
(b) Collect court costs, reasonable attorney’s fees and other
costs incurred to collect the administrative penalty.
4. The Division may require any facility that violates any
provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, or
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any condition, standard or regulation adopted by the Board to make
any improvements necessary to correct the violation.
5. Any money collected as administrative penalties pursuant to
paragraph (d) of subsection 1 or subsection 2 must be accounted for
separately and used to administer and carry out the provisions of
NRS 449.001 to 449.430, in clusive, 449.435 to 449.531, inclusive,
and chapter 449A of NRS to protect the health, safety, well -being
and property of the patients and residents of facilities in accordance
with applicable state and federal standards or for any other purpose
authorized by the Legislature.
Sec. 3.5. NRS 422.27173 is hereby amended to read as
follows:
422.27173 1. The Director shall include in the State Plan for
Medicaid a requirement that the State must pay the nonfederal share
of expenditures incurred for:
[1.] (a) Testing for and the treatment and prevention of sexually
transmitted diseases, including, without limitation, Chlamydia
trachomatis, gonorrhea, syphilis, human immunodeficiency virus
and hepatitis B and C, for all recipients of Medicaid, regardless of
age. Services covered pursuant to this section must include, without
limitation, the examination of a pregnant woman for the discovery
of:
[(a)] (1) Chlamydia trachomatis , gonorrhea, hepatitis B and
hepatitis C in accordance with NRS 442.013.
[(b)] (2) Syphilis in accordance with NRS 442.010.
[2.] (b) Condoms for recipients of Medicaid.
2. To the extent federal financial participatio n is available,
the Director shall provide reimbursement for rapid or point -of-
care testing for syphilis in accordance with NRS 442.010
separately from the rate of reimbursement provided for other
prenatal care provided to the pregnant woman at the time of the
testing.
3. The Department shall:
(a) Apply to the Secretary of Health and Human Services for
any waiver of federal law or apply for any amendment of the State
Plan for Medicaid that is necessary for the Department to receive
federal funding to provide the coverage described in subsections 1
and 2.
(b) Fully cooperate in good faith with the Federal Government
during the application process to satisfy the requirements of the
Federal Government for obtaining a waiver or amendment
pursuant to paragraph (a).
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Sec. 4. The provisions of NRS 354.599 do not apply to any
additional expenses of a local government that are related to the
provisions of this act.
Sec. 5. 1. This section becomes effective upon passage and
approval.
2. Sections 1 to 4, inclusive, of this act become effective:
(a) Upon passage and approval for the purpose of adopting any
regulations and performing any other preparatory administrative
tasks that are necessary to carry out the provisions of this act; and
(b) On January 1, 2026, for all other purposes.
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