Revises provisions governing hospitals. (BDR 40-839)

A.B. 393

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ASSEMBLY BILL NO. 393–ASSEMBLYMEMBER NADEEM

MARCH 11, 2025
____________

Referred to Committee on Health and Human Services

SUMMARY—Revises provisions governing hospitals.
(BDR 40-839)

FISCAL NOTE: Effect on Local Government: No.
Effect on the State: No.

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

AN ACT relating to health care; prohibiting a hospital or psychiatric
hospital from employing a physician under certain
circumstances; providing penalties for a violation of such
prohibition; and providing other matters properly relating
thereto.
Legislative Counsel’s Digest:
Existing law prescribes certain requirements governing the staffing of hospitals, 1
psychiatric hospitals and certain other health care facilities. (NRS 449.241 -2
449.2428) In 2010, the Attorney General issued an opinion explaining that, whi le it 3
is the longstanding practice in Nevada that a physician generally works as a 4
contractor for, rather than an employee of, a hospital, there is no provision of law 5
prohibiting a hospital from employing a physician. (Att’y Gen. Op. 2010 -04 6
(March 5, 2010)) Section 1 of this bill expressly prohibits a hospital or psychiatric 7
hospital from employing a physician for the purpose of practicing medicine, 8
homeopathic medicine or osteopathic medicine except where expressly authorized 9
by law. 10
Existing law authorizes a county hospital or hospital district, a private nonprofit 11
medical school, a nonprofit medical research institution or certain mental health 12
facilities operated by divisions of the Depart ment of Health and Human Services to 13
employ a physician under certain circumstances. (NRS 433.264, 433B.150, 14
450.180, 450.640, 630.365) Section 1 additionally authorizes a hospital or 15
psychiatric hospital to employ a physician: (1) who is participating in certain 16
graduate programs; or (2) if the hospital or psychiatric hospital is owned or 17
operated by the State Government. 18
Existing law exempts a medical facil ity from certain requirements of existing 19
law relating to the licensing and regulation of medical facilities if the facility: (1) is 20
conducted by and for the adherents of any church or religious denomination for the 21
purpose of providing care and treatment in accordance with the practices of 22
the religion of the church or denomination; or (2) is operated and maintained by the 23

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United States Government or an agency thereof. (NRS 449.0301) Section 2 of this 24
bill exempts these facilities from the provisions of section 1. 25
Existing law authorizes certa in penalties to be imposed against certain medical 26
facilities that violate certain laws and regulations governing the operation of such 27
medical facilities. (NRS 449.160, 449.163, 449.220, 449.240) Sections 3 and 4 of 28
this bill apply these same penalties to a hospital or psychiatric hospital that violates 29
section 1. Section 3 authorizes the Division of Public and Behav ioral Health of the 30
Department of Health and Human Services to suspend or revoke the license of a 31
hospital or psychiatric hospital that violates section 1. Section 4 authorizes the 32
Division to impose certain other penalties on a hospital or psychiatric hospital that 33
violates section 1, including an administrative penalty of not more than $5,000 per 34
day for each violation, together with interest at a rate not to exceed 10 percent per 35
year. 36
Sections 5-7 of this bill make conforming changes to: (1) authorize the 37
Division to bring action to enjoin any person from operating or maintaining any 38
hospital or psychiatric hospital that violates section 1; (2) requires the district 39
attorney of the county where the hospital or psychiatric hospital is located to 40
prosecute such an action upon application by the Division; and (3) apply the 41
definitions of certain terms to section 1. 42

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. Chapter 449 of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. Except as otherwise provi ded in subsection 2, NRS 3
433.264, 433B.150, 450.180, 450.640 and 630.365 or any other 4
provision of law, a hospital or psychiatric hospital shall not 5
employ as an employee a physician for the purpose of engaging in 6
the practice of medicine, homeopathic medi cine or osteopathic 7
medicine. 8
2. A hospital or psychiatric hospital may employ as an 9
employee a physician: 10
(a) Who is participating in a graduate program approved by 11
the Accreditation Council for Graduate Medical Education, or its 12
successor organization, for the purpose of engaging in the practice 13
of medicine, homeopathic medicine or osteopathic medicine; or 14
(b) If the hospital or psychiatric hospital is owned or operated 15
by the State Government. 16
3. As used in this section: 17
(a) “Homeopathic medicine” has the meaning ascribed to it in 18
NRS 630A.040. 19
(b) “Osteopathic medicine” has the meaning ascribed to it in 20
NRS 633.081. 21
(c) “Practice of medicine” has the meaning ascribed to it in 22
NRS 630.020. 23

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Sec. 2. NRS 449.0301 is hereby amended to read as follows: 1
449.0301 The provisions of NRS 449.029 to 449.2428, 2
inclusive, and section 1 of this act do not apply to: 3
1. Any facility conducted by and for the adherents of any 4
church or religious denomination for the purpose of p roviding 5
facilities for the care and treatment of the sick who depend solely 6
upon spiritual means through prayer for healing in the practice of 7
the religion of the church or denomination, except that such a 8
facility shall comply with all regulations relati ve to sanitation and 9
safety applicable to other facilities of a similar category. 10
2. Foster homes as defined in NRS 424.014. 11
3. Any medical facility , facility for the dependent or facility 12
which is otherwise required by the regulations adopted by the Board 13
pursuant to NRS 449.0303 to be licensed that is operated and 14
maintained by the United States Government or an agency thereof. 15
Sec. 3. NRS 449.160 is hereby amended to read as follows: 16
449.160 1. The Division may den y an application for a 17
license or may suspend or revoke any license issued under the 18
provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of 19
this act upon any of the following grounds: 20
(a) Violation by the applicant or the licensee of any of th e 21
provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 22
section 1 of this act or 449A.100 to 449A.124, inclusive, and 23
449A.270 to 449A.286, inclusive, or of any other law of this State 24
or of the standards, rules and regulations adopted thereunder. 25
(b) Aiding, abetting or permitting the commission of any illegal 26
act. 27
(c) Conduct inimical to the public health, morals, welfare and 28
safety of the people of the State of Nevada in the maintenance and 29
operation of the premises for which a license is issued. 30
(d) Conduct or practice detrimental to the health or safety of the 31
occupants or employees of the facility. 32
(e) Failure of the applicant to obtain written approval from the 33
Director of the Department of Health and Human Services as 34
required by NRS 439A.100 or 439A.102 or as provided in any 35
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 36
and section 1 of this act and 449.435 to 449.531, inclusive, and 37
chapter 449A of NRS if such approval is required, including, 38
without limitation, the closure or conversion of any hospital in a 39
county whose population is 100,000 or more that is owned by the 40
licensee without approval pursuant to NRS 439A.102. 41
(f) Failure to comply with the provisions of NRS 441A.315 and 42
any regulations adopted pursuant thereto or NRS 449.2486. 43
(g) Violation of the provisions of NRS 458.112. 44

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(h) Failure to comply with the provisions of NRS 449A.170 to 1
449A.192, inclusive, and any regulation adopted pursuant thereto. 2
(i) Violation of the provisions of NRS 629.260. 3
2. In addition to the provisions of subsection 1, the Division 4
may revoke a license to operate a facility for the dependent if, with 5
respect to that facility, the licensee that operates the facility, or an 6
agent or employee of the licensee: 7
(a) Is convict ed of violating any of the provisions of 8
NRS 202.470; 9
(b) Is ordered to but fails to abate a nuisance pursuant to NRS 10
244.360, 244.3603 or 268.4124; or 11
(c) Is ordered by the appropriate governmental agency to correct 12
a violation of a building, safety or health code or regulation but fails 13
to correct the violation. 14
3. The Division shall maintain a log of any complaints that it 15
receives relating to activities for which the Division may revoke the 16
license to operate a facility for the dependent pursuant to subsection 17
2. The Division shall provide to a facility for the care of adults 18
during the day: 19
(a) A summary of a complaint against the facility if the 20
investigation of the complaint by the Division either substantiates 21
the complaint or is inconclusive; 22
(b) A report of any investigation conducted with respect to the 23
complaint; and 24
(c) A report of any disciplinary action taken against the facility. 25
 The facility shall make the information available to the public 26
pursuant to NRS 449.2486. 27
4. On or befor e February 1 of each odd -numbered year, the 28
Division shall submit to the Director of the Legislative Counsel 29
Bureau a written report setting forth, for the previous biennium: 30
(a) Any complaints included in the log maintained by the 31
Division pursuant to subsection 3; and 32
(b) Any disciplinary actions taken by the Division pursuant to 33
subsection 2. 34
Sec. 4. NRS 449.163 is hereby amended to read as follows: 35
449.163 1. In addition to the payment of the amount required 36
by NRS 449.0308, if a medical facility, facility for the dependent or 37
facility which is required by the regulations adopted by the Board 38
pursuant to NRS 449.0303 to be licensed violates any provision 39
related to its licensure, including any provision of NRS 439B.410 or 40
449.029 to 449.2428, inclusive, and section 1 of this act or any 41
condition, standard or regulation adopted by the Board, the 42
Division, in accordance with the regulations adopted pursuant to 43
NRS 449.165, may: 44

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(a) Prohibit the facility from admitting any patient until it 1
determines that the facility has corrected the violation; 2
(b) Limit the occupancy of the facility to the number of beds 3
occupied when the violation occurred, until it determines that the 4
facility has corrected the violation; 5
(c) If the license of the facility limits the occupancy of the 6
facility and the facility has exceeded the approved occupancy, 7
require the facility, at its own expense, to move patients to another 8
facility that is licensed; 9
(d) Except where a greater penalty is authorized by subsection 2, 10
impose an administrative penalty of not more than $5,000 per day 11
for each violation, together with interest thereon at a rate not to 12
exceed 10 percent per annum; and 13
(e) Appoint temporary management to oversee the operation of 14
the facility and to ensure the health and safety of the patients of the 15
facility, until: 16
(1) It determines that the facility has corrected the violation 17
and has management which is capable of ensuring continued 18
compliance with the applicable statutes, conditions, standards and 19
regulations; or 20
(2) Improvements are made to correct the violation. 21
2. If an off -campus location of a hospital fails to obtain a 22
national provider identifier that is distinct from the national provider 23
identifier used by the main campus and any other off -campus 24
location of the hospital in violation of NRS 449.1818, the Division 25
may impose against the hospital an administrative penalty of not 26
more than $10,000 for each day of such failure, together with 27
interest thereon at a rate not to exceed 10 percent per annum, in 28
addition to any other action authorized by this chapter. 29
3. If the facility fails to pay any administrative penalty imposed 30
pursuant to paragraph (d) of subsection 1 or subsection 2, the 31
Division may: 32
(a) Suspend the license of the facility until the administrative 33
penalty is paid; and 34
(b) Collect court costs, reasonable attorney’s fees and other 35
costs incurred to collect the administrative penalty. 36
4. The Division may require any facility that violates any 37
provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and 38
section 1 of this act or any condition, standard or regulation adopted 39
by the Board to make any improvements necessary to correct the 40
violation. 41
5. Any money collected as administrative penalties pursuant to 42
paragraph (d) of subsection 1 or subsection 2 must be accounted for 43
separately and used to administer and carry out the provisions of 44
NRS 449.001 to 449.430, inclusive, and section 1 of this act , 45

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449.435 to 449.531, inclusive, and chapter 449A of NRS to protect 1
the health, safety, well -being and property of the patients and 2
residents of facilities in accordance with applicable state and federal 3
standards or for any other purpose authorized by the Legislature. 4
Sec. 5. NRS 449.220 is hereby amended to read as follows: 5
449.220 1. The Division may bring an action in the name of 6
the State to enjoin any person, state or local government unit or 7
agency thereof from operating or maintaining any facility within the 8
meaning of NRS 449.029 to 449.2428, inclusive [:] , and section 1 9
of this act: 10
(a) Without first obtaining a license therefor; or 11
(b) After his or her license has been revoked or suspended by 12
the Division. 13
2. It is sufficient in such action to allege that the defendant did, 14
on a certain date and in a certain place, operate and maintain such a 15
facility without a license. 16
Sec. 6. NRS 449.240 is hereby amended to read as follows: 17
449.240 The district attorney of the county in which the facility 18
is located shall, upon application by the Division, institute and 19
conduct the prosecution of any action for violation of any provisions 20
of NRS 449.029 to 449.245, inclusive [.] , and section 1 of this act. 21
Sec. 7. NRS 449.241 is hereby amended to read as follows: 22
449.241 As used in NRS 449.241 to 449.2428, inclusive, and 23
section 1 of this act, unless the context otherwise requires, the 24
words and terms defined in NRS 449.2413 to 449.2418, inclusive, 25
have the meanings ascribed to them in those sections. 26
Sec. 8. This act becomes effective upon passage and approval. 27

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