Revises provisions relating to nonemergency medical transportation. (BDR 40-1042)

A.B. 438

- *AB438*

ASSEMBLY BILL NO. 438–ASSEMBLYMEMBERS DICKMAN;
GALLANT, GRAY, GURR AND O’NEILL

MARCH 17, 2025
____________

Referred to Committee on Health and Human Services

SUMMARY—Revises provisions relating to nonemergency
medical transportation. (BDR 40-1042)

FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.

CONTAINS UNFUNDED MANDATE (§§ 8, 9, 12)
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT)

~

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

AN ACT relating to health care; transferring regulation of
nonemergency medical transportation from the Nevada
Transportation Authority to certain health authorities;
exempting certain operators of a vehicle for
nonemergency medical transportation from the
requirement to be permitted; requiring the driver of a
vehicle for nonemergency medical transportation to report
the abuse, neglect, is olation, abandonment or commercial
sexual exploitation of certain persons; providing a
penalty; and providing other matters properly relating
thereto.
Legislative Counsel’s Digest:
Existing law requires the Nevada Transportation Authority to supervise and 1
regulate common motor carriers of passengers and contract motor carriers of 2
passengers, including private providers of nonmedical emergency transportation, 3
while exempting government vehicles from such regulation. (NRS 706.163, 4
706.166) Existing law requi res a private provider of nonemergency medical 5
transportation to obtain from the Authority a certificate of public convenience and 6
necessity to operate as a common motor carrier or a permit to act as a contract 7
motor carrier. (NRS 706.036, 706.051, 706.386, 706.421) 8
Existing law also requires the Division of Public and Behavioral Health of the 9
Department of Health and Human Services, in a county whose population is less 10
than 700,000 (currently all counties other than Clark County), or the district board 11
of health, in a county whose population is 700,000 or more (currently Clark 12
County), to issue permits for the operation of an ambulance, an air ambulance or a 13

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vehicle of a fire -fighting agency. (NRS 450B.100, 450B.200) Existing law also 14
requires the State Bo ard of Health, in a county whose population is less than 15
700,000 (currently all counties other than Clark County), or the district board of 16
health, in a county whose population is 700,000 or more (currently Clark County), 17
to adopt regulations establishing minimum standards for vehicles for ambulances, 18
air ambulances and vehicles of a fire-fighting agency. (NRS 450B.130) 19
This bill transfers regulatory authority over providers of nonemergency medical 20
transportation from the Nevada Transportation Authority to: (1) the district board of 21
health in a county whose population is 700,000 or more (currently Clark County); 22
or (2) the Division in all other counties. Section 24 of this b ill removes the 23
requirement that a private operator of a vehicle for nonemergency medical 24
transportation obtain a certificate or permit from the Nevada Transportation 25
Authority, and section 16 of this bill instead requires a private operator of such a 26
vehicle to obtain a permit from the district board of health or the Division, as 27
applicable. Sections 8 and 12 of this bill accordingly authorize the operator of such 28
a vehicle to obtain such a pe rmit. Section 12 additionally limits the fee for such a 29
permit to not more than $200. Section 13 of this bill clarifies the scope of a 30
provisional permit to own or operate a vehicle for nonemergency medical 31
transportation services. Sections 9 and 10 of this bill authorize: (1) the district 32
board of health to regulate nonemergency medical transportation in a county whose 33
population is 700,000 or more (currently Clark County); and (2) the State Board of 34
Health to regulate nonemergency medical transportation in all other counties. 35
Section 1 of this bill makes a conforming change to clarify that the district health 36
department in a county whose population is less than 700,000 (currently all 37
counties other than Clark County) will not be regulating nonemergency medical 38
transportation. Section 14 of this bill prohibits a private owner of a vehicle for 39
nonemergency medical transportation to permit the operation of the vehicle in 40
violation of the standards prescribed by the applicable board. Section 15 of this bill 41
requires a provider of nonemergency medical transportation to file his or her 42
schedule of rates with the Division or district board of health, as applicable. 43
Sections 12 and 17 of this bill clarify that the issuance of a permit does not exempt 44
a provider of nonemergency medical transportation from local franchising and 45
permitting requirements. Section 5 of this bill defines the term “nonemergency 46
medical transportation,” and section 7 of this bill establishes the applicability of 47
that definition. Section 18 of this bill preserves the existing exemption for 48
governmental entities that provide nonemergency medical tr ansportation from 49
permitting and regulation. Sections 19 and 20 of this bill require the driver of a 50
vehicle for nonemergency medical transportation to repo rt the abuse, neglect, 51
isolation or abandonment of an elderly or vulnerable person or the abuse or neglect 52
of a child. Such a driver would also be required to report the commercial sexual 53
exploitation of a child. (NRS 432C.110) A willful failure to make su ch a report 54
would be a misdemeanor or gross misdemeanor, depending on the circumstances. 55
(NRS 200.5093, 432B.240, 432C.110) 56
Existing law exempts from certification by the Nevada Transportation 57
Authority a common motor carrier that enters into an agreement with certain local 58
governmental entities to provide nonemergency medical transportation to facilitate 59
the participation of certain persons in jobs and day training services under certain 60
conditions. (NRS 706.745) Section 6 of this bill preserves that exemption from 61
permitting under the same conditions. Sections 2, 3, 20 and 21 of this bill make 62
conforming changes to reflect that nonemergency medical transportation will now 63
be regulated by the Division and the State Board of Health or the district board of 64
health rather than the Nevada Transport ation Authority. Sections 11 and 23 of this 65
bill make conforming changes to avoid granting new authority to providers of 66
nonemergency medical transportation. 67

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

Section 1. NRS 439.410 is hereby amended to read as follows: 1
439.410 1. The district board of health has the powers, duties 2
and authority of a county board of health in the health district. 3
2. The district health department has jurisdiction over all public 4
health matters in the health district, except in matters concerning 5
emergency medical serv ices and nonemergency medical 6
transportation services pursuant to the provisions of chapter 450B 7
of NRS. 8
3. In addition to any other powers, duties and authority 9
conferred on a district board of health by this section, the district 10
board of health may by affirmative vote of a majority of all the 11
members of the board adopt regulations consistent with law, which 12
must take effect immediately on their approval by the State Board of 13
Health, to: 14
(a) Prevent and control nuisances; 15
(b) Regulate sanitation and sanitary practices in the interests of 16
the public health; 17
(c) Provide for the sanitary protection of water and food 18
supplies; and 19
(d) Protect and promote the public health generally in the 20
geographical area subject to the jurisdiction of the health district. 21
4. Before the adoption, amendment or repeal of a regulation, 22
the district board of health must give at least 30 days’ notice of its 23
intended action. The notice must: 24
(a) Include a statement of either the terms or substance of the 25
proposal or a description of the subjects and issues involved, and of 26
the time when, the place where and the manner in which interested 27
persons may present their views thereon. 28
(b) State each address at which the text of the proposal may be 29
inspected and copied. 30
(c) Be mailed to all persons who have requested in writing that 31
they be placed on a mailing list, which must be kept by the district 32
board for such purpose. 33
5. All interested persons must be afforded a reasonable 34
opportunity to submit data, views or arguments, orally or in writing, 35
on the intended action to adopt, amend or repeal the regulation. 36
With respect to substantive regulations, the district board shall set a 37
time and place for an oral public hearing, but if no one appears who 38
will be directly affected by the proposal and requests an oral 39
hearing, the district board may proceed immediately to act upon any 40
written submissions. The district board shall consider fully all 41
written and oral submissions respecting the proposal. 42

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6. Each district board of heal th shall file a copy of all of its 1
adopted regulations with the county clerk of each county in which it 2
has jurisdiction. 3
Sec. 2. NRS 441A.560 is hereby amended to read as follows: 4
441A.560 1. An application to a health authority for an order 5
of emergency isolation or quarantine of a person or a group of 6
persons alleged to have been infected with or exposed to a 7
communicable disease may only be made by another health 8
authority, a physician, a physician assistant licensed pursuant to 9
chapter 630 or 633 of NRS, a registered nurse or a medical facility 10
by submitting the certificate required by NRS 441A.570. Within its 11
jurisdiction, upon application or on its own, subject to the provisions 12
of NRS 441A.505 to 441A.720, inclusive, a health authority may: 13
(a) Pursuant to its own order and without a warrant: 14
(1) Take a person or group of persons alleged to and 15
reasonably believed by the health authority to have been infected 16
with or exposed to a co mmunicable disease into custody in any safe 17
location under emergency isolation or quarantine for testing, 18
examination, observation and the provision of or arrangement for 19
the provision of consensual medical treatment; and 20
(2) Transport the person or grou p of persons alleged to and 21
reasonably believed by the health authority to have been infected 22
with or exposed to a communicable disease to a public or private 23
medical facility, a residence or other safe location for that purpose, 24
or arrange for the person or group of persons to be transported for 25
that purpose by: 26
(I) A local law enforcement agency; 27
(II) A [system] vehicle for [the] nonemergency medical 28
transportation [of persons whose operation is authorized by the 29
Nevada Transportation Authority;] operated by a person who holds 30
a permit issued pursuant to the provisions of chapter 450B of 31
NRS; or 32
(III) If medically necessary, an ambulance service that 33
holds a permit issued pursuant to the provisions of chapter 450B of 34
NRS, 35
 only if the health authority acting in good faith has, based upon 36
personal observation, its own epidemiological investigation or an 37
epidemiological investigation by another health authority, a 38
physician, a physician assistant licensed pursuant to chapter 630 or 39
633 of NRS or a registered nurse as stated in a certificate submitted 40
pursuant to NRS 441A.570, if such a certificate was submitted, of 41
the person or group of persons alleged to have been infected with or 42
exposed to a communicable disease, a reasona ble factual and 43
medical basis to believe that the person or group of persons has been 44
infected with or exposed to a communicable disease, and that 45

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- *AB438*
because of the risks of that disease, the person or group of persons is 1
likely to be an immediate threat to t he health of members of the 2
public who have not been infected with or exposed to the 3
communicable disease. 4
(b) Petition a district court for an emergency order requiring: 5
(1) Any health authority or peace officer to take a person or 6
group of persons alleged to have been infected with or exposed to a 7
communicable disease into custody to allow the health authority to 8
investigate, file and prosecute a petition for the involuntary court -9
ordered isolation or quarantine of the person or group of persons 10
alleged to have been infected with or exposed to a communicable 11
disease in the manner set forth in NRS 441A.505 to 441A.720, 12
inclusive; and 13
(2) Any agency, [system] vehicle or service described in 14
subparagraph (2) of paragraph (a) to transport, in accordance w ith 15
such court order, the person or group of persons alleged to have 16
been infected with or exposed to a communicable disease to a public 17
or private medical facility, a residence or other safe location for that 18
purpose. 19
2. The district court may issue an emergency order for isolation 20
or quarantine pursuant to paragraph (b) of subsection 1: 21
(a) Only for the time deemed necessary by the court to allow a 22
health authority to investigate, file and prosecute each petition for 23
involuntary court -ordered isolation or quarantine pursuant to NRS 24
441A.505 to 441A.720, inclusive; and 25
(b) Only if it is satisfied that there is probable cause to believe 26
that the person or group of persons alleged to have been infected 27
with or exposed to a communicable disease has been in fected with 28
or exposed to a communicable disease, and that because of the risks 29
of that disease, the person or group of persons is likely to be an 30
immediate threat to the health of the public. 31
Sec. 3. NRS 441A.720 is hereby amended to read as follows: 32
441A.720 When any involuntary court isolation or quarantine 33
is ordered under the provisions of NRS 441A.505 to 441A.720, 34
inclusive, the involuntarily isolated or quarantined person, together 35
with the court orders, any certificates of the health authorities, 36
physicians, physician assistants licensed pursuant to chapter 630 or 37
633 of NRS or registered nurses, the written summary of the 38
evaluation team and a full and complete transcript of the notes of 39
the official reporter made at the examination of such person befor e 40
the court, must be delivered to the sheriff of the appropriate county 41
who must be ordered to: 42
1. Transport the person; or 43
2. Arrange for the person to be transported by: 44

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(a) A [system] vehicle for [the] nonemergency medical 1
transportation [of person s whose operation is authorized by the 2
Nevada Transportation Authority;] operated by a person who holds 3
a permit issued pursuant to the provisions of chapter 450B of 4
NRS; or 5
(b) If medically necessary, an ambulance service that holds a 6
permit issued pursuant to the provisions of chapter 450B of NRS, 7
 to the appropriate public or private medical facility, residence or 8
other safe location. 9
Sec. 4. Chapter 450B of NRS is hereby amended by adding 10
thereto the provisions set forth as sections 5 and 6 of this act. 11
Sec. 5. “Nonemergency medical transportation” means the 12
use of a motor vehicle to transport a person for the purpose of 13
receiving nonemergency medical care, i ncluding, without 14
limitation, transportation for a medical examination or treatment. 15
Sec. 6. 1. An operator of a vehicle for nonemergency 16
medical transportation that enters into an agreement for the 17
purchase of its service by an incorporated city, county or regional 18
transportation commission to operate a vehicle for nonemergency 19
medical transportation to facilitate the participation of persons in 20
jobs and day training services is not required to obtain a permit 21
pursuant to NRS 450B.200 or 450B.210 if the transportation is 22
available upon request and without regard to regular routes or 23
fixed schedules. 24
2. Except as otherwise provided in this subsection, an 25
incorporated city, county or regional transportation commission 26
that enters into an agreement with an operator of a vehicle for 27
nonemergency medical transportation pursuant to subsection 1 28
shall provide any required safety inspections. If the incorporated 29
city, county or regional transportation commission is unable to do 30
so, the health authority shall provide for any necessary safety 31
inspections. 32
3. As used in this section, “jobs and day training services” 33
has the meaning ascribed to it in NRS 435.176. 34
Sec. 7. NRS 450B.020 is hereby amended to read as follows: 35
450B.020 As used in this chapter, unless the context otherwise 36
requires, the words and terms defined in NRS 450B.025 to 37
450B.110, inclusive, and section 5 of this act have the meanings 38
ascribed to them in those sections. 39
Sec. 8. NRS 450B.100 is hereby amended to read as follows: 40
450B.100 “Permit” means the permit issued by the health 41
authority under the provisions of this chapter to: 42
1. A person, agency of the State or political subdivision to own 43
or operate an ambulance or air ambulance in the State of Nevada; 44
[or] 45

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2. A fire-fighting agency to provide: 1
(a) Medical care by emergency medical technicians, advanced 2
emergency medical technicians or paramedics to sick or injured 3
persons: 4
(1) At the scene of an emergency; or 5
(2) At the scene of an emergency and while transporting 6
those persons to a medical facility; and 7
(b) Community paramedic ine services, but only if the fire -8
fighting agency has obtained an endorsement on the permit to 9
provide such services pursuant to NRS 450B.1993 [.] ; or 10
3. A person to own or operate a vehicle for nonemergency 11
medical transportation in the State of Nevada. 12
Sec. 9. NRS 450B.130 is hereby amended to read as follows: 13
450B.130 1. The board shall adopt regulations establishing 14
reasonable minimum standards for: 15
(a) Sanitation in ambulances , [and] air ambulances [;] and 16
vehicles for nonemergency medical transportation; 17
(b) Medical and nonmedical equipment and supplies to be 18
carried in ambulances and vehicles for nonemergency medical 19
transportation and medical equipment and supplies to be carried in 20
air ambulances and vehicles of a fire-fighting agency; 21
(c) Interior configuration, design and dimensions of ambulances 22
placed in service after July 1, 1979; 23
(d) Permits for operation of ambulances, air ambulances , [and] 24
vehicles of a fire -fighting agency [;] and vehicles for 25
nonemergency medical transportation; 26
(e) Records to be maintained by an operator of an ambulance 27
[or] , an air ambulance or a vehicle for nonemergency medical 28
transportation or by a fire-fighting agency; and 29
(f) Treatment of patients wh o are critically ill or in urgent need 30
of treatment. 31
2. Any regulations adopted by the board pursuant to subsection 32
1 establishing reasonable minimum standards for a permit for the 33
operation of an air ambulance or records to be maintained by an 34
operator of an air ambulance must: 35
(a) Except as otherwise provided in paragraph (b), be based on 36
the medical aspects of the operation of an air ambulance, including, 37
without limitation, aspects related to patient care; and 38
(b) Not be based on economic factors, i ncluding, without 39
limitation, factors related to the prices, routes or nonmedical 40
services of an air ambulance. 41
3. The health officers of this state shall jointly adopt 42
regulations to establish the minimum standards for the certification 43
or licensure of persons who provide emergency medical care. Upon 44
adoption of the regulations, each health authority shall adopt the 45

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regulations for its jurisdiction. After each health authority adopts the 1
regulations, the standards established constitute the minimum 2
standards for certification or licensure of persons who provide 3
emergency medical care in this state. Any changes to the minimum 4
standards must be adopted jointly by the health officers and by each 5
health authority in the manner set forth in this subsection. An y 6
changes in the minimum standards which are not adopted in the 7
manner set forth in this subsection are void. 8
4. A health officer may adopt regulations that impose 9
additional requirements for the certification or licensure of persons 10
who provide emergenc y medical care in the jurisdiction of the 11
health officer, but the health officer must accept the certification or 12
licensure of a person who provides emergency medical care from 13
the jurisdiction of another health officer as proof that the person 14
who provide s emergency medical care has met the minimum 15
requirements for certification or licensure. 16
5. As used in this section, “person who provides emergency 17
medical care” means an emergency medical technician, advanced 18
emergency medical technician, paramedic, at tendant of an 19
ambulance or air ambulance or firefighter employed by or serving 20
with a fire-fighting agency. 21
Sec. 10. NRS 450B.140 is hereby amended to read as follows: 22
450B.140 1. In adopting regulations under NRS 450B.120 23
and 450B.130, the board may use standards and regulations 24
proposed by: 25
(a) The Committee on Trauma of the American College of 26
Surgeons; 27
(b) The United States Department of Transportation; 28
(c) The United States Public Health Service; 29
(d) The Bu reau of Health Insurance of the Social Security 30
Administration; 31
(e) The American Academy of Orthopaedic Surgeons; 32
(f) The National Academy of Sciences —National Research 33
Council; 34
(g) The American Heart Association; and 35
(h) Regional, state and local emer gency medical services 36
committees and councils. 37
2. The board may establish different standards for commercial, 38
volunteer, industrial and other categories of ambulances , [and] fire-39
fighting agencies and vehicles for nonemergency medical 40
transportation to reflect different circumstances and in the public 41
interest. 42

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Sec. 11. NRS 450B.1993 is hereby amended to read as 1
follows: 2
450B.1993 1. The board shall adopt regulations to provide 3
for the issuance of an endorsement on a permit , other than a permit 4
to own or operate a vehicle for nonemergency medical 5
transportation, which allows an emergency medical provider who is 6
employed by or serves as a volunteer for the holder of the permit to 7
provide community paramedicine services . Such regulations must 8
establish, without limitation: 9
(a) The manner in which to apply for an endorsement; 10
(b) The qualifications and requirements of a holder of a permit 11
to obtain an endorsement; 12
(c) The required training and qualifications of an emer gency 13
medical provider who will provide community paramedicine 14
services and the proof necessary to demonstrate such training and 15
qualifications; 16
(d) The scope of the community paramedicine services that may 17
be provided by an emergency medical provider who is employed by 18
or serves as a volunteer for the holder of the permit, which must not 19
include any services that are outside the scope of practice of the 20
emergency medical provider; 21
(e) The continuing education requirements or other evidence of 22
continued competency for renewal of the endorsement; and 23
(f) Such other requirements as the board deems necessary to 24
carry out the provisions of this section and NRS 450B.199 and 25
450B.1996. 26
2. The holder of a permit , other than a permit to own or 27
operate a vehicle for nonemergency medical transportation, may 28
apply for an endorsement to provide community paramedicine 29
services by submitting to the health authority an application upon 30
forms prescribed by the board and in accordance with procedures 31
established by the board. The health authority must not approve an 32
application for an endorsement or a renewal of an endorsement 33
unless the applicant meets the requirements prescribed by the board 34
by regulation pursuant to subsection 1. No additional fee may be 35
charged for an endorsement. 36
3. An endorsement to provide community paramedicine 37
services expires on the same date as the permit and is renewable 38
annually thereafter at least 30 days before the expiration date. 39
4. An emergency medical provider may provide comm unity 40
paramedicine services only as an employee of or volunteer for the 41
holder of a permit who has obtained an endorsement and only if the 42
emergency medical provider possesses the training and 43
qualifications required by the board. Any services provided must not 44
exceed the scope of practice of the emergency medical provider. 45

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Sec. 12. NRS 450B.200 is hereby amended to read as follows: 1
450B.200 1. The health authority may issue a permit for: 2
(a) The operation of an ambulance or an air ambulance; [or] 3
(b) The operation of a vehicle of a fire-fighting agency: 4
(1) At the scene of an emergency; and 5
(2) To provide community paramedicine services, but only if 6
the holder of the permit has obtain ed an endorsement on the permit 7
to provide such services pursuant to NRS 450B.1993 [.] ; or 8
(c) The operation of a vehicle for nonemergency medical 9
transportation. 10
2. Each permit must be evidenced by a card issued to the 11
holder of the permit. 12
3. No p ermit may be issued unless the applicant is qualified 13
pursuant to the regulations of the board. 14
4. An application for a permit must be made upon forms 15
prescribed by the board and in accordance with procedures 16
established by the board, and must contain the following: 17
(a) The name and address of the owner of the ambulance , [or] 18
air ambulance , [or of the ] fire-fighting agency [;] or vehicle for 19
nonemergency medical transportation; 20
(b) The name under which the applicant is doing business or 21
proposes to do business, if applicable; 22
(c) A description of each ambulance, air ambulance , [or] 23
vehicle of a fire -fighting agency [,] or vehicle for nonemergency 24
medical transportation, including the make, year of manufacture 25
and chassis number, and the color schem e, insigne, name, 26
monogram or other distinguishing characteristics to be used to 27
designate the applicant’s ambulance, air ambulance or vehicle; 28
(d) The location and description of the places from which the 29
ambulance, air ambulance , [or] fire-fighting agency or vehicle for 30
nonemergency medical transportation intends to operate; and 31
(e) Such other information as the board deems reasonable and 32
necessary to a fair determination of compliance with the provisions 33
of this chapter. 34
5. The board shall establish a reasonable fee for annual 35
permits. The fee for a permit for the operation of a vehicle for 36
nonemergency medical transportation must not exceed $200. 37
Revenue from such fees collected by the Division must be 38
accounted for separately and does not revert to the State General 39
Fund at the end of any fiscal year. 40
6. All permits expire on July 1 following the date of issue, and 41
are renewable annually thereafter upon payment of the fee required 42
by subsection 5 at least 30 days before the expiration date. 43
7. The health authority shall: 44

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(a) Revoke, suspend or refuse to renew any permit issued 1
pursuant to this section for violation of any provision of this chapter 2
or of any regulation adopted by the board; or 3
(b) Bring an action in any court for violation of this chapter or 4
the regulations adopted pursuant to this chapter, 5
 only after the holder of a permit is afforded an opportunity for a 6
public hearing pursuant to regulations adopted by the board. 7
8. The health authority may suspend a permit if the holder is 8
using an ambulance, air ambulance or vehicle of a fire -fighting 9
agency or for nonemergency medical transportation which does 10
not meet the minimum requirements for equipment as established by 11
the board pursuant to this chapter. 12
9. In determining whether to issue a permit for the operation of 13
an air ambulance pursuant to this section, the health authority: 14
(a) Except as otherwise provided in paragraph (b), may consider 15
the medical aspects of the operation of an air ambulance, including, 16
without limitation, aspects related to patient care; and 17
(b) Shall not consider economic factors, including, without 18
limitation, factors related to the prices, routes or nonmedical 19
services of an air ambulance. 20
10. The issuance of a permit pursuant to this section or NRS 21
450B.210 does not authorize any [person] : 22
(a) Person or governmental entity to provide those services or to 23
operate any ambulance, air ambulance or vehicle of a fire -fighting 24
agency not in conformi ty with any ordinance or regulation enacted 25
by any county, municipality or special purpose district. 26
(b) Person to operate any vehicle for nonemergency medical 27
transportation not in conformity with any ordinance or regulation 28
enacted by any county, municipality or special purpose district. 29
11. A permit issued pursuant to this section is valid throughout 30
the State, whether issued by the Division or a district board of 31
health. An ambulance, air ambulance , [or] vehicle of a fire-fighting 32
agency or vehicle for nonemergency medical transportation which 33
has received a permit from the district board of health in a county 34
whose population is 700,000 or more is not required to obtain a 35
permit from the Division, even if the ambulance, air ambulance , 36
[or] vehicle of a fire -fighting agency or vehicle for nonemergency 37
medical transportation has routine operations outside the county. 38
12. The Division shall maintain a central registry of all permits 39
issued pursuant to this section, whether issued by the Divi sion or a 40
district board of health. 41
13. The board shall adopt such regulations as are necessary to 42
carry out the provisions of this section. 43

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Sec. 13. NRS 450B.210 is hereby amended to read as follows: 1
450B.210 1. The board may issue provisional permits limited 2
as to time, place and purpose, based on the need therefor. No 3
provisional permit may be issued for a period of longer than 6 4
months. The board may establish a reasonable fee for such 5
provisional permits. Revenue f rom such fees collected by the 6
Division must be accounted for separately and does not revert to the 7
State General Fund at the end of any fiscal year. 8
2. Unless otherwise limited in the permit, a provisional permit 9
issued pursuant to this section is valid for providing emergency 10
services or nonemergency medical transportation services, as 11
applicable, throughout the State, whether issued by the Division or a 12
district board of health. 13
3. In determining whether to issue a permit for the operation of 14
an air ambulance pursuant to this section, the health authority: 15
(a) Except as otherwise provided in paragraph (b), may consider 16
the medical aspects of the operation of an air ambulance, including, 17
without limitation, aspects related to patient care; and 18
(b) Shall not consider economic factors, including, without 19
limitation, factors related to the prices, routes or nonmedical 20
services of an air ambulance. 21
Sec. 14. NRS 450B.230 is hereby amended to read as follows: 22
450B.230 1. The public or private owner of an ambulance or 23
air ambulance , [or] the fire -fighting agency who owns a vehicle 24
used in providing emergency medical care or the private owner of a 25
vehicle for nonemergency medical transportation shall not permit 26
its operation and use without the equipment required by regulations 27
and standards of the board. 28
2. The provisions of this section do not apply to the equipment 29
in or of an air ambulance unless the equipment is related to the 30
medical aspects of the operation of the air ambulance. 31
Sec. 15. NRS 450B.235 is hereby amended to read as follows: 32
450B.235 1. Each public and private owner of an ambulance 33
and each private owner of a vehicle for nonemergency medical 34
transportation shall file his or her schedule of rates with the health 35
authority. Any change in a schedule of an ambulance or vehicle for 36
nonemergency medical transportation must be filed before the 37
change becomes effective. 38
2. The health authority shall keep each schedule of rates or 39
changes filed with it for at least 3 years after the schedule has been 40
superseded or otherwise become ineffective. 41
Sec. 16. NRS 450B.240 is hereby amended to read as follows: 42
450B.240 1. A person or governmental entity shall not 43
engage in the operation of any ambulance or air ambulance service 44

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in this state without a currently valid permit for that service issued 1
by the health authority. 2
2. A fire-fighting agency shall not provide the level of medical 3
care prov ided by an advanced emergency medical technician or 4
paramedic to sick or injured persons at the scene of an emergency or 5
while transporting those persons to a medical facility without a 6
currently valid permit for that care issued by the health authority. 7
3. A person or governmental entity shall not provide 8
community paramedicine services or represent, advertise or 9
otherwise imply that it is authorized to provide community 10
paramedicine services without a currently valid permit with an 11
endorsement to provide community paramedicine services issued by 12
the health authority pursuant to NRS 450B.1993. 13
4. A person shall not engage in the operation of a vehicle for 14
nonemergency medical transportation in this state without a 15
currently valid permit for that service issued by the health 16
authority. 17
5. Nothing in this section precludes the operation of an aircraft 18
in this state in a manner other than as an air ambulance. 19
Sec. 17. NRS 450B.820 is hereby amended to read as follows: 20
450B.820 The issuance of a permit does not authorize any 21
person, firm, corporation or association to provide ambulance 22
services or nonemergency medical transportation services or to 23
operate an ambulance or a vehicle for nonemergency medical 24
transportation without a franchise or permit in any county or 25
incorporated city which has enacted an ordinance making it 26
unlawful to do so. 27
Sec. 18. NRS 450B.830 is hereby amended to read as follows: 28
450B.830 The following are exempted from the provisions of 29
this chapter: 30
1. The occasional use of a vehicle or aircraft to transport 31
injured or sick persons, which vehicle or aircraft is not ordinarily 32
used in the business of transporting persons who are sick or injured. 33
2. A vehicle or aircraft rendering services as an ambulance or 34
air ambulance in case of a major catastrophe or emergency if 35
ambulance or air ambulance services with permits are insufficient to 36
render the services required. 37
3. Persons rendering service as attendants in c ase of a major 38
catastrophe or emergency if licensed attendants cannot be secured. 39
4. Ambulances based outside this State. 40
5. Air ambulances based outside this State which: 41
(a) Deliver patients from a location outside this State to a 42
location within this State; and 43
(b) Do not receive any patients within this State. 44

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6. Attendants based outside this State rendering service solely 1
on ambulances which are exempt from the provisions of this 2
chapter. 3
7. Attendants rendering service solely on air ambulances which 4
are exempt from the provisions of this chapter. 5
8. Vehicles owned and operated by search and rescue 6
organizations chartered by the State as corporations not for profit or 7
otherwise existing as nonprofit associations which are not regularly 8
used to transport injured or sick persons except as part of rescue 9
operations. 10
9. Ambulances or air ambulances owned and operated by an 11
agency of the United States Government. 12
10. Vehicles for nonemergency medical transportation owned 13
and operated by a governmental entity. 14
Sec. 19. NRS 200.5093 is hereby amended to read as follows: 15
200.5093 1. Any person who is described in subsection 4 and 16
who, in a professional or occupational capacity, knows or has 17
reasonable cause to believe that an older person or vulnerable 18
person has been abused, neglected, exploited, isolated or abandoned 19
shall: 20
(a) Except as otherwise provided in subsection 2, report the 21
abuse, neglect, exploitation, isolation or abandonment of the older 22
person or vulnerable person to: 23
(1) The local office of the Aging and Disability Services 24
Division of the Department of Health and Human Services; 25
(2) A police department or sheriff’s office; or 26
(3) A toll-free telephone service designated by the Aging and 27
Disability Services Division of the Department of Health and 28
Human Services; and 29
(b) Make such a report as soon as reasonably practicable but not 30
later than 24 hours after the person knows or has reasonable cause to 31
believe that the older person or vulner able person has been abused, 32
neglected, exploited, isolated or abandoned. 33
2. If a person who is required to make a report pursuant to 34
subsection 1 knows or has reasonable cause to believe that the 35
abuse, neglect, exploitation, isolation or abandonment of the older 36
person or vulnerable person involves an act or omission of the 37
Aging and Disability Services Division, another division of the 38
Department of Health and Human Services or a law enforcement 39
agency, the person shall make the report to an agency oth er than the 40
one alleged to have committed the act or omission. 41
3. Each agency, after reducing a report to writing, shall forward 42
a copy of the report to the Aging and Disability Services Division of 43
the Department of Health and Human Services and the Uni t for the 44
Investigation and Prosecution of Crimes. 45

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4. A report must be made pursuant to subsection 1 by the 1
following persons: 2
(a) Every physician, dentist, dental hygienist, expanded function 3
dental assistant, chiropractic physician, naprapath, optomet rist, 4
podiatric physician, medical examiner, resident, intern, professional 5
or practical nurse, physician assistant licensed pursuant to chapter 6
630 or 633 of NRS, anesthesiologist assistant, perfusionist, 7
psychiatrist, psychologist, marriage and family th erapist, clinical 8
professional counselor, clinical alcohol and drug counselor, alcohol 9
and drug counselor, music therapist, athletic trainer, driver of an 10
ambulance, driver of a vehicle for nonemergency medical 11
transportation, paramedic, licensed dietitian, holder of a license or a 12
limited license issued under the provisions of chapter 653 of NRS, 13
behavior analyst, assistant behavior analyst, registered behavior 14
technician, peer recovery support specialist, as defined in NRS 15
433.627, peer recovery support s pecialist supervisor, as defined in 16
NRS 433.629, or other person providing medical services licensed 17
or certified to practice in this State, who examines, attends or treats 18
an older person or vulnerable person who appears to have been 19
abused, neglected, exploited, isolated or abandoned. 20
(b) Any personnel of a hospital or similar institution engaged in 21
the admission, examination, care or treatment of persons or an 22
administrator, manager or other person in charge of a hospital or 23
similar institution upon not ification of the suspected abuse, neglect, 24
exploitation, isolation or abandonment of an older person or 25
vulnerable person by a member of the staff of the hospital. 26
(c) A coroner. 27
(d) Every person who maintains or is employed by an agency to 28
provide personal care services in the home. 29
(e) Every person who maintains or is employed by an agency to 30
provide nursing in the home. 31
(f) Every person who operates, who is employed by or who 32
contracts to provide services for an intermediary service 33
organization as defined in NRS 449.4304. 34
(g) Any employee of the Department of Health and Human 35
Services, except the State Long -Term Care Ombudsman appointed 36
pursuant to NRS 427A.125 and any of his or her advocates or 37
volunteers where prohibited from making such a re port pursuant to 38
45 C.F.R. § 1321.11. 39
(h) Any employee of a law enforcement agency or a county’s 40
office for protective services or an adult or juvenile probation 41
officer. 42
(i) Any person who maintains or is employed by a facility or 43
establishment that pro vides care for older persons or vulnerable 44
persons. 45

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- *AB438*
(j) Any person who maintains, is employed by or serves as a 1
volunteer for an agency or service which advises persons regarding 2
the abuse, neglect, exploitation, isolation or abandonment of an 3
older perso n or vulnerable person and refers them to persons and 4
agencies where their requests and needs can be met. 5
(k) Every social worker. 6
(l) Any person who owns or is employed by a funeral home or 7
mortuary. 8
(m) Every person who operates or is employed by a community 9
health worker pool, as defined in NRS 449.0028, or with whom a 10
community health worker pool contracts to provide the services of a 11
community health worker, as defined in NRS 449.0027. 12
(n) Every person who is enrolled with the Division of Health 13
Care Financing and Policy of the Department of Health and Human 14
Services to provide doula services to recipients of Medicaid 15
pursuant to NRS 422.27177. 16
5. A report may be made by any other person. 17
6. If a person who is required to make a report pursuan t to 18
subsection 1 knows or has reasonable cause to believe that an older 19
person or vulnerable person has died as a result of abuse, neglect, 20
isolation or abandonment, the person shall, as soon as reasonably 21
practicable, report this belief to the appropriate medical examiner or 22
coroner, who shall investigate the cause of death of the older person 23
or vulnerable person and submit to the appropriate local law 24
enforcement agencies, the appropriate prosecuting attorney, the 25
Aging and Disability Services Division of the Department of Health 26
and Human Services and the Unit for the Investigation and 27
Prosecution of Crimes his or her written findings. The written 28
findings must include the information required pursuant to the 29
provisions of NRS 200.5094, when possible. 30
7. A division, office or department which receives a report 31
pursuant to this section shall cause the investigation of the report to 32
commence within 3 working days. A copy of the final report of the 33
investigation conducted by a division, office or departme nt, other 34
than the Aging and Disability Services Division of the Department 35
of Health and Human Services, must be forwarded within 30 days 36
after the completion of the report to the: 37
(a) Aging and Disability Services Division; 38
(b) Repository for Informati on Concerning Crimes Against 39
Older Persons or Vulnerable Persons created by NRS 179A.450; 40
and 41
(c) Unit for the Investigation and Prosecution of Crimes. 42
8. If the investigation of a report results in the belief that an 43
older person or vulnerable person i s abused, neglected, exploited, 44
isolated or abandoned, the Aging and Disability Services Division 45

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- *AB438*
of the Department of Health and Human Services or the county’s 1
office for protective services may provide protective services to the 2
older person or vulnerabl e person if the older person or vulnerable 3
person is able and willing to accept them. 4
9. A person who knowingly and willfully violates any of the 5
provisions of this section is guilty of a misdemeanor. 6
10. As used in this section, “Unit for the Investig ation and 7
Prosecution of Crimes” means the Unit for the Investigation and 8
Prosecution of Crimes Against Older Persons or Vulnerable Persons 9
in the Office of the Attorney General created pursuant to 10
NRS 228.265. 11
Sec. 20. NRS 432B.220 is hereby amended to read as follows: 12
432B.220 1. Any person who is described in subsection 4 13
and who, in his or her professional or occupational capacity, knows 14
or has reasonable cause to believe that a child has been abused or 15
neglected shall: 16
(a) Except as otherwise provided in subsection 2, report the 17
abuse or neglect of the child to an agency which provides child 18
welfare services or to a law enforcement agency; and 19
(b) Make such a report as soon as reasonably practicable but not 20
later than 24 hours after the person knows or has reasonable cause to 21
believe that the child has been abused or neglected. 22
2. If a person who is required to make a report pursuant to 23
subsection 1 knows or has reasonable cause to believe that the abuse 24
or neglect of the child involves an act or omission of: 25
(a) A person directly responsible or serving as a volunteer for or 26
an employee of a public or private home, institution or facility 27
where the child is receiving child care outside of the home for a 28
portion o f the day, the person shall make the report to a law 29
enforcement agency. 30
(b) An agency which provides child welfare services or a law 31
enforcement agency, the person shall make the report to an agency 32
other than the one alleged to have committed the act or omission, 33
and the investigation of the abuse or neglect of the child must be 34
made by an agency other than the one alleged to have committed the 35
act or omission. 36
3. Any person who is described in paragraph (a) of subsection 37
4 who delivers or provides medical services to a newborn infant and 38
who, in his or her professional or occupational capacity, knows or 39
has reasonable cause to believe that the newborn infant has been 40
affected by a fetal alcohol spectrum disorder or prenatal substance 41
use disorder or ha s withdrawal symptoms resulting from prenatal 42
substance exposure shall, as soon as reasonably practicable but not 43
later than 24 hours after the person knows or has reasonable cause to 44
believe that the newborn infant is so affected or has such symptoms, 45

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- *AB438*
notify an agency which provides child welfare services of the 1
condition of the infant and refer each person who is responsible for 2
the welfare of the infant to an agency which provides child welfare 3
services for appropriate counseling, training or other servi ces. A 4
notification and referral to an agency which provides child welfare 5
services pursuant to this subsection shall not be construed to require 6
prosecution for any illegal action. 7
4. A report must be made pursuant to subsection 1 by the 8
following persons: 9
(a) A person providing services licensed or certified in this State 10
pursuant to, without limitation, chapter 450B, 630, 630A, 631, 632, 11
633, 634, 634A, 634B, 635, 636, 637, 637B, 639, 640, 640A, 640B, 12
640C, 640D, 640E, 641, 641A, 641B, 641C, 641D or 653 of NRS or 13
practicing as an emergency medical technician, advanced 14
emergency medical technician or paramedic in this State under the 15
Recognition of Emergency Medical Services Personnel Licensure 16
Interstate Compact ratified by NRS 450B.145. 17
(b) Any personnel of a medical facility licensed pursuant to 18
chapter 449 of NRS who are engaged in the admission, examination, 19
care or treatment of persons or an administrator, manager or other 20
person in charge of such a medical facility upon notification of 21
suspected abuse or neglect of a child by a member of the staff of the 22
medical facility. 23
(c) A coroner. 24
(d) A member of the clergy, practitioner of Christian Science or 25
religious healer, unless the person has acquired the knowledge of the 26
abuse or neglect from the offender during a confession. 27
(e) A person employed by a public school or private school and 28
any person who serves as a volunteer at such a school. 29
(f) Any person who maintains or is employed by a facility or 30
establishment that provides care for chi ldren, children’s camp or 31
other public or private facility, institution or agency furnishing care 32
to a child. 33
(g) Any person licensed pursuant to chapter 424 of NRS to 34
conduct a foster home. 35
(h) Any officer or employee of a law enforcement agency or an 36
adult or juvenile probation officer. 37
(i) Except as otherwise provided in NRS 432B.225, an attorney. 38
(j) Any person who maintains, is employed by or serves as a 39
volunteer for an agency or service which advises persons regarding 40
abuse or neglect of a child and refers them to persons and agencies 41
where their requests and needs can be met. 42
(k) Any person who is employed by or serves as a volunteer for 43
a youth shelter. As used in this paragraph, “youth shelter” has the 44
meaning ascribed to it in NRS 244.427. 45

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- *AB438*
(l) Any adult person who is employed by an entity that provides 1
organized activities for children, including, without limitation, a 2
person who is employed by a school district or public school. 3
(m) Any person who is enrolled with the Division of Health 4
Care Financing and Policy of the Department of Health and Human 5
Services to provide doula services to recipients of Medicaid 6
pursuant to NRS 422.27177. 7
(n) A peer recovery support specialist, as defined in NRS 8
433.627, or peer recovery support specialist supervisor, as defined 9
in NRS 433.629. 10
(o) A driver of a vehicle for nonemergency medical 11
transportation. 12
5. A report may be made by any other person. 13
6. If a person who is required to make a report pursuant to 14
subsection 1 knows or has reasonable cau se to believe that a child 15
has died as a result of abuse or neglect, the person shall, as soon as 16
reasonably practicable, report this belief to an agency which 17
provides child welfare services or a law enforcement agency. If such 18
a report is made to a law e nforcement agency, the law enforcement 19
agency shall notify an agency which provides child welfare services 20
and the appropriate medical examiner or coroner of the report. If 21
such a report is made to an agency which provides child welfare 22
services, the agenc y which provides child welfare services shall 23
notify the appropriate medical examiner or coroner of the report. 24
The medical examiner or coroner who is notified of a report 25
pursuant to this subsection shall investigate the report and submit 26
his or her written findings to the appropriate agency which provides 27
child welfare services, the appropriate district attorney and a law 28
enforcement agency. The written findings must include, if 29
obtainable, the information required pursuant to the provisions of 30
subsection 2 of NRS 432B.230. 31
7. The agency, board, bureau, commission, department, 32
division or political subdivision of the State responsible for the 33
licensure, certification or endorsement of a person who is described 34
in subsection 4 and who is required in his o r her professional or 35
occupational capacity to be licensed, certified or endorsed in this 36
State shall, at the time of initial licensure, certification or 37
endorsement: 38
(a) Inform the person, in writing or by electronic 39
communication, of his or her duty as a mandatory reporter pursuant 40
to this section; 41
(b) Obtain a written acknowledgment or electronic record from 42
the person that he or she has been informed of his or her duty 43
pursuant to this section; and 44

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- *AB438*
(c) Maintain a copy of the written acknowledgment or electronic 1
record for as long as the person is licensed, certified or endorsed in 2
this State. 3
8. The employer of a person who is described in subsection 4 4
and who is not required in his or her professional or occupational 5
capacity to be licensed, certified or endorsed in this State must, upon 6
initial employment of the person: 7
(a) Inform the person, in writing or by electronic 8
communication, of his or her duty as a mandatory reporter pursuant 9
to this section; 10
(b) Obtain a written acknowledgment or elect ronic record from 11
the person that he or she has been informed of his or her duty 12
pursuant to this section; and 13
(c) Maintain a copy of the written acknowledgment or electronic 14
record for as long as the person is employed by the employer. 15
9. Before a person may serve as a volunteer at a public school 16
or private school, the school must: 17
(a) Inform the person, in writing or by electronic 18
communication, of his or her duty as a mandatory reporter pursuant 19
to this section and NRS 392.303; 20
(b) Obtain a written acknowledgment or electronic record from 21
the person that he or she has been informed of his or her duty 22
pursuant to this section and NRS 392.303; and 23
(c) Maintain a copy of the written acknowledgment or electronic 24
record for as long as the person serves as a volunteer at the school. 25
10. The provisions of subsection 8 do not apply to the 26
employer of a person practicing as an emergency medical 27
technician, advanced emergency medical technician or paramedic in 28
this State under the Recognition of Emergency M edical Services 29
Personnel Licensure Interstate Compact ratified by NRS 450B.145. 30
11. As used in this section: 31
(a) “Private school” has the meaning ascribed to it in 32
NRS 394.103. 33
(b) “Public school” has the meaning ascribed to it in 34
NRS 385.007. 35
Sec. 21. NRS 433A.160 is hereby amended to read as follows: 36
433A.160 1. An officer authorized to make arrests in the 37
State of Nevada or a physician, physician assistant, psychologist, 38
marriage and family therapist, clinical professional counselor, social 39
worker or registered nurse who, based on his or her personal 40
observation of a person or the issuance of a court order pursuant to 41
NRS 433A.155, has probable cause to believe that the person is a 42
person in a mental health crisi s, may place the person on a mental 43
health crisis hold by: 44

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- *AB438*
(a) Taking the person into custody without a warrant for 1
assessment, evaluation, intervention and treatment at a public or 2
private mental health facility or hospital; and 3
(b) Completing and provi ding to the public or private mental 4
health facility or hospital the form prescribed pursuant to NRS 5
433A.085 for the placement of a person on a mental health crisis 6
hold. The form must set forth the circumstances under which the 7
person was taken into custody and the reasons therefor. 8
2. A person who places another person on a mental health 9
crisis hold pursuant to subsection 1 may transport that person to a 10
public or private mental health facility or hospital or arrange for the 11
person to be transported by: 12
(a) A local law enforcement agency; 13
(b) A [system] vehicle for [the] nonemergency medical 14
transportation [of persons whose operation is authorized by the 15
Nevada Transportation Authority;] operated by a person who holds 16
a permit issued pursuant to the p rovisions of chapter 450B of 17
NRS; 18
(c) An entity that is exempt pursuant to NRS 706.745 from the 19
provisions of NRS 706.386 or 706.421; 20
(d) An accredited agent of the Division; 21
(e) A provider of nonemergency secure behavioral health 22
transport services licensed under the regulations adopted pursuant to 23
NRS 433.3317; or 24
(f) If medically necessary, an ambulance service that holds a 25
permit issued pursuant to the provisions of chapter 450B of NRS. 26
3. To the extent practicable, a person described in subsec tion 1 27
shall attempt to obtain the consent of the parent or guardian of an 28
unemancipated person who is less than 18 years of age before 29
placing the person on a mental health crisis hold. The person who 30
places an unemancipated person who is less than 18 yea rs of age on 31
a mental health crisis hold or, if the person is acting within the scope 32
of his or her employment, the employer of the person, shall maintain 33
documentation of each such attempt until the person who is placed 34
on a mental health crisis hold reaches at least 23 years of age. 35
4. The State Board of Health shall adopt regulations governing 36
the manner in which: 37
(a) A person may apply to become an accredited agent of the 38
Division; and 39
(b) Accredited agents of the Division will be monitored and 40
disciplined for professional misconduct. 41
5. As used in this section, “an accredited agent of the Division” 42
means any person authorized by the Division to transport to a 43
mental health facility pursuant to paragraph (d) of subsection 2 44
those persons being placed on a mental health crisis hold. 45

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- *AB438*
Sec. 22. NRS 433A.330 is hereby amended to read as follows: 1
433A.330 When an involuntary court admission to a mental 2
health facility is ordered under the provisions of this chapter, the 3
involuntarily admitted person, together with the court orders and 4
certificates of the physicians, certified psychologists, advanced 5
practice registered nurses or evaluation team and a full and complete 6
transcript of the notes of the official reporter made at the 7
examination of such person before the court, must be delivered to 8
the sheriff of the county who shall: 9
1. Transport the person; or 10
2. Arrange for the person to be transported by: 11
(a) A [system] vehicle for [the] nonemergency medical 12
transportation [of persons whose operation is authorized by the 13
Nevada Transportation Authority;] operated by a person who holds 14
a permit issued pursuant to the provisions of chapter 450B of 15
NRS; 16
(b) A provider of nonemergency secure behavioral health 17
transport services licensed under the regulations adopted pursuant to 18
NRS 433.3317; or 19
(c) If medically necessary, an ambulance service that holds a 20
permit issued pursuant to the provisions of chapter 450B of NRS, 21
 to the appropriate public or private mental health facility. 22
Sec. 23. NRS 639.268 is hereby amended to read as follows: 23
639.268 1. A practitioner may purchase supplies of 24
controlled substances, poisons, dangerous drugs and devices from a 25
pharmacy by: 26
(a) Making an oral order to the pharmacy or transmitting an oral 27
order through his or her agent, except an order for a controlled 28
substance in schedule II; or 29
(b) If the order is for a controlled substance, presenting to t he 30
pharmacy a written order signed by the practitioner which contains 31
his or her registration number issued by the Drug Enforcement 32
Administration. 33
2. Any person or entity authorized to dispense controlled 34
substances and dangerous drugs, including, witho ut limitation, a 35
pharmacy, institutional pharmacy or practitioner, may: 36
(a) Purchase or otherwise acquire controlled substances and 37
dangerous drugs compounded or repackaged by an outsourcing 38
facility directly from the outsourcing facility without an order from 39
a practitioner other than, where applicable, the practitioner 40
purchasing or acquiring the controlled substance or dangerous drug; 41
and 42
(b) Administer and dispense controlled substances and 43
dangerous drugs purchased or acquired pursuant to paragraph ( a) to 44

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- *AB438*
the same extent as controlled substances and dangerous drugs 1
acquired through other authorized means. 2
3. A hospital pharmacy or a pharmacy designated for this 3
purpose by a county health officer in a county whose population is 4
100,000 or more, or by a district health officer in any county within 5
its jurisdiction or, in the absence of either, by the Chief Medical 6
Officer or his or her designated medical director of emergency 7
medical services, may sell to a person or agency described in 8
subsection 4 supplies of controlled substances to stock the 9
ambulances or other authorized vehicles of such a person or agency 10
or replenish the stock if: 11
(a) The person or agency is registered with the Drug 12
Enforcement Administration pursuant to 21 C.F.R. Part 1301; 13
(b) The person in charge of the controlled substances is: 14
(1) A paramedic appropriately certified by the health 15
authority; 16
(2) A registered nurse licensed by the State Board of 17
Nursing; or 18
(3) A person who holds equivalent certification or licensure 19
issued by another state; and 20
(c) Except as otherwise provided in this paragraph, the purchase 21
order is countersigned by a physician or initiated by an oral order 22
and may be made by the person or agency or transmitted by an agent 23
of such a person or agency. An order for a controlled substance 24
listed in schedule II must be made pursuant to NRS 453.251. 25
4. A pharmacy, institutional pharmacy or other person licensed 26
by the Board to furnish controlled substances and dangerous drugs 27
may sell to: 28
(a) The holder of a permit issued pursuant to the provisions of 29
NRS 450B.200 or 450B.210 [;] , other than a permit to own or 30
operate a vehicle for nonemergency medical transportation; 31
(b) The holder of a permit issued by another state which is 32
substantially similar to a permit issued pursuant to the provisions of 33
NRS 450B.200 or 450B.210 [;] , other than a permit to own or 34
operate a vehicle for nonemergency medical transportation; and 35
(c) An agency of the Federal Government that provides 36
emergency care or transportation and is registered with the Drug 37
Enforcement Administration pursuant to 21 C.F.R. Part 1301. 38
5. A pharmacy, institutional pharmacy , outsourcing facility or 39
other person licensed by the Board to furnish dangerous drugs who 40
sells supplies pursuant to this section shall maintain a record of each 41
sale which must contain: 42
(a) The date of sale; 43
(b) The name, address and signature of the purchaser or the 44
person receiving the delivery; 45

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- *AB438*
(c) The name of the dispensing pharmacist, where applicable; 1
(d) The name and address of the authorizing practitioner , where 2
applicable; and 3
(e) The name, strength and quantity of each drug sold. 4
6. A pharmacy, institutional pharmacy or other person licensed 5
by the Board to furnish dangerous drugs who supplies the initial 6
stock for an ambulance or other emergency vehicle shall comply 7
with any applicable regulations adopted by the State Board of 8
Health, or a district board of health, pursuant to NRS 450B.120. 9
7. The Board shall adopt regulations regarding the records a 10
pharmacist shall keep of any purchase made pursuant to this section. 11
8. As used in this section: 12
(a) “Compounding” includes, without limitation, the combining, 13
admixing, mixing, pooling, reconstituting or other altering of a drug 14
or bulk drug substance, as defined in 21 C.F.R. § 207.3, to create a 15
drug. 16
(b) “Outsourcing facility” means a manufacturer at one 17
geographic location or address that: 18
(1) Is engaged in the compounding of sterile or nonsterile 19
drugs for use by humans; and 20
(2) Has registered wit h the Secretary of Health and Human 21
Services as an outsourcing facility pursuant to 21 U.S.C. § 353b. 22
Sec. 24. NRS 706.745 is hereby amended to read as follows: 23
706.745 1. The provisions of NRS 706.386 and 706.421 do 24
not apply to: 25
(a) Ambulances [;] and vehicles for nonemergency medical 26
transportation; 27
(b) Hearses; or 28
(c) Common motor carriers or contract motor carriers that are 29
providing transportation services pursuant to a contract with the 30
Department of Health and Human Services entered into pursuant to 31
NRS 422.27495. 32
2. A common motor carrier that enters into an agreement for 33
the purchase of its service by an incorporated city, county or 34
regional transportation commission is not required to obtain a 35
certificate of public convenience and necessity to operate a system 36
of public transit consisting of: 37
(a) Regular routes and fixed schedules; 38
(b) [Nonemergency medical transportation of persons to 39
facilitate their participation in jobs and day training services as 40
defined in NRS 435.176 if the transportation is available upon 41
request and without regard to regular routes or fixed schedules; 42
(c)] Nonmedical transportation of persons with disabilities 43
without regard to regular routes or fixed schedules; or 44

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- *AB438*
[(d)] (c) In a county whose population is less than 100,000 or an 1
incorporated city within such a county, nonmedical transportation of 2
persons if the transportation is available by reservation 1 day in 3
advance of the transportation and without regard to regular routes or 4
fixed schedules. 5
3. Under any agreement for a system of public transit that 6
provides for the transportation of passengers that is described in 7
subsection 2: 8
(a) The public entity shall provide for any required safety 9
inspections; or 10
(b) If the publi c entity is unable to do so, the Authority shall 11
provide for any required safety inspections. 12
4. In addition to the requirements of subsection 3, under an 13
agreement for a system of public transit that provides for the 14
transportation of passengers that is described in: 15
(a) Paragraph (a) of subsection 2, the public entity shall 16
establish the routes and fares. 17
(b) Paragraph (b) or (c) [or (d) ] of subsection 2, the common 18
motor carrier: 19
(1) May provide transportation to any passenger who can 20
board a vehicle with minimal assistance from the operator of the 21
vehicle. 22
(2) Except as otherwise provided in NRS 706.248, shall not 23
offer medical assistance as part of its transportation service. 24
5. In a county whose population: 25
(a) Is less than 700,000, a n onprofit carrier of elderly persons or 26
persons with disabilities is not required to obtain a certificate of 27
public convenience and necessity to operate as a common motor 28
carrier of such passengers only, but such a carrier is not exempt 29
from inspection by t he Authority to determine whether its vehicles 30
and their operation are safe. 31
(b) Is 700,000 or more, a nonprofit carrier of elderly persons or 32
persons with disabilities is not required to obtain a certificate of 33
public convenience and necessity to operate as a common motor 34
carrier of such passengers only, but: 35
(1) Only if the nonprofit carrier: 36
(I) Does not charge for transportation services; 37
(II) Provides transportation services pursuant to a contract 38
with the Department of Health and Human Services entered into 39
pursuant to NRS 422.27495; or 40
(III) Enters into an agreement for the purchase of its 41
service by an incorporated city, county or regional transportation 42
commission; and 43

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(2) Such a carrier is not exempt from inspection by the 1
Authority to determine whether its vehicles and their operation are 2
safe. 3
6. An incorporated city, county or regional transportation 4
commission is not required to obtain a certificate of public 5
convenience and necessity to operate a system of public 6
transportation. 7
7. Before an incorporated city or a county enters into an 8
agreement with a common motor carrier for a system of public 9
transit that provides for the transportation of passengers that is 10
described in paragraph (b) or (c) [or (d)] of subsection 2 in an area 11
of the incorporated city or an area of the county, it must determine 12
that: 13
(a) There are no other common motor carriers of passengers 14
who are authorized to provide such services in that area; or 15
(b) Although there are other common motor carrier s of 16
passengers who are authorized to provide such services in the area, 17
the common motor carriers of passengers do not wish to provide, or 18
are not capable of providing, such services. 19
8. As used in this section, “nonemergency medical 20
transportation” has the meaning ascribed to it in section 5 of this 21
act. 22
Sec. 25. 1. Notwithstanding the amendatory provisions of 23
this act, any disciplinary or administrative action taken against a 24
provider of nonemergency med ical transportation by the Nevada 25
Transportation Authority remains in effect as if taken by the health 26
authority. 27
2. A certificate of public convenience and necessity to operate 28
as a common motor carrier or a permit to act as a contract motor 29
carrier issued by the Nevada Transportation Authority to a provider 30
of nonemergency medical transportation that is valid on January 1, 31
2026: 32
(a) Shall be deemed to be issued by the health authority; and 33
(b) Remains valid un til its expiration, if the holder of the 34
certificate or permit otherwise remains qualified for the issuance or 35
renewal of a permit to own and operate a vehicle for nonemergency 36
medical transportation on or after January 1, 2026. 37
3. As used in this section: 38
(a) “Common motor carrier” has the m eaning ascribed to it in 39
NRS 706.036. 40
(b) “Contract motor carrier” has the meaning ascribed to it in 41
NRS 706.051. 42
(c) “Health authority” has the meaning ascribed to it in 43
NRS 450B.077. 44

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(d) “Nonemergency medical transportation” has the meaning 1
ascribed to it in section 5 of this act. 2
Sec. 26. The provisions of NRS 354.599 do not apply to any 3
additional expenses of a local government that are related to the 4
provisions of this act. 5
Sec. 27. 1. This section becomes effective upon passage and 6
approval. 7
2. Sections 1 to 26, inclusive, of this act become effective: 8
(a) Upon passage and approval for the purpose of adopting any 9
regulations and performing any other preparatory administrative 10
tasks that are necessary to carry out the provisions of this act; and 11
(b) On January 1, 2026, for all other purposes. 12

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