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- 83rd Session (2025)
Assembly Bill No. 514–Committee on
Health and Human Services
CHAPTER..........
AN ACT relating to mental health; requiring Medicaid to provide
coverage for rehabilitative residential mental health care;
requiring the State Long -Term Care Ombudsman to
investigate and provide certain assistance to providers of
rehabilitative residential mental health care; providing for the
licensure and regulation of providers of rehabilitative
residential mental health c are; making appropriations to and
authorizing certain expenditures by the Division of Health
Care Financing and Policy of the Department of Health and
Human Services; providing a penalty; and providing other
matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires the Department of Health and Human Services to
administer Medicaid. (NRS 422.270) Section 1 of this bill requires the Director of
the Department to include under Medicaid coverage for rehabilitative residential
mental health care provided to certain recipients of Medicaid. Section 5 of this bill
defines the term “rehabilitative residential mental health care” to mean community-
based, medically monitored care provided in a residential setting that uses
established rehabilitative principles to achieve certain goals relating to mental
health. Section 6 of this bill appli es that definition to provisions of existing law
governing medical facilities and other related entities. Section 3 of this bill makes a
conforming change to require the Director to administer the provisions of section 1
in the same manner as the provisions of existing law governing the State Plan for
Medicaid. Section 17.5 of this bill makes appropriations to and authorizes
expenditures by the Division of Health Care Financing and Policy of the
Department for costs associated with providing the coverage required by section 1.
Existing law provides for the licensure and regulation by the Division of Public
and Behavioral Health of the Department of community-based living arrangement
services, which are flexible, individualized services that are: (1) provided in the
home, for compensation, to persons with men tal illness; and (2) designed and
coordinated to assist such persons in maximizing their independence. (NRS
449.0026, 449.0045, 449.030, 449.0302) Sections 2 and 4-16 of this bill similarly
provide for the licensure and regulation of providers of rehabilit ative residential
mental health care. Section 8 requires such a provider to obtain a license as a
facility for the dependent and comply with other requirements applicable to such
facilities. Sections 7, 9 and 10 clarify that such a provider is separate from certain
other types of facilities for the dependent. Section 11 requires the State Board of
Health to adopt specific regulations governing providers of rehabilitative residential
mental health care. Sections 12 and 15 provide for the inspection of buildings
operated by such providers. Sections 13 and 14: (1) require periodic background
investigations of the personnel of a provider of rehabilitative residential mental
health care; and (2) authorize the suspensio n or revocation of the license of such a
provider if the provider or an employee of the provider has been convicted of
certain crimes. (NRS 449.174) Section 16 requires a provider of rehabilitative
residential mental health care to notify a person receivin g such care from the
provider, his or her parent or legal guardian or another designated person upon the
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discovery by the Division of a deficiency affecting the health and safety of a
patient. Section 4 requires such a provider to comply with provisions go verning the
reporting and investigation of sentinel events and the designation of patient safety
officers. (NRS 439.800 -439.890) Section 2 adds providers of rehabilitative
residential mental health care to the list of facilities that the State Long -Term Care
Ombudsman is required to investigate and assist. (NRS 427A.125 -427A.165)
Section 17 of this bill provides that a person is not require d to be a licensed nurse
to provide rehabilitative residential mental health care if the person is licensed
pursuant to the provisions of this bill. Operating as a provider of rehabilitative
residential mental health care without a license would be a misdemeanor.
(NRS 449.210)
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. Chapter 422 of NRS is hereby amended by adding
thereto a new section to read as follows:
1. To the extent that federal financial participation is
available, the Director shall include under Medicaid coverage for
rehabilitative residential mental health care. Such coverage is not
required to pay the costs of room and board for a recipient of
rehabilitative residential mental health care.
2. The Department shall:
(a) Establish a method for providing the coverage described in
subsection 1.
(b) Apply to the Secretary of Health and Human Services for
any waiver of federal law or apply for any a mendment of the State
Plan for Medicaid that is necessary for the Department to receive
federal funding to provide the coverage described in subsection 1.
(c) Fully cooperate in good faith with the Federal Government
during the application process to sati sfy the requirements of the
Federal Government for obtaining a waiver or amendment
pursuant to paragraph (b).
3. As used in this section , “rehabilitative residential mental
health care” has the meaning ascribed to it in section 5 of this act.
Sec. 2. NRS 427A.0292 is hereby amended to read as follows:
427A.0292 “Living arrangement services” means:
1. Community-based living arrangement services, as defined in
NRS 449.0026, that include:
(a) Intensive services and overnight supervision of recipients
who require training concerning behavioral skills, self -care and
management of medications; or
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(b) Services in the home for recipients with chronic medical
conditions and severe mental illness who require habilitation o r
rehabilitation services, or both; [and]
2. Supported living arrangement services, as defined in NRS
435.3315, that include 24-hour care [.] ; and
3. Rehabilitative residential mental health care, as defined in
section 5 of this act.
Sec. 3. NRS 232.320 is hereby amended to read as follows:
232.320 1. The Director:
(a) Shall appoint, with the consent of the Governor,
administrators of the divisions of the Department, who are
respectively designated as follows:
(1) The Administrator of the Aging and Disability Services
Division;
(2) The Administrator of the Division of Welfare and
Supportive Services;
(3) The Administrator of the Division of Child and Family
Services;
(4) The Administrator of the Division of Health Care
Financing and Policy; and
(5) The Administrator of the Division of Public and
Behavioral Health.
(b) Shall administer, through the divisions of the Department,
the provisions of chapters 63, 424, 425, 427A, 432A to 442,
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and
section 1 of this act, 422.580, 432.010 to 432.133, inclusive,
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive,
and 445A.0 10 to 445A.055, inclusive, and all other provisions of
law relating to the functions of the divisions of the Department, but
is not responsible for the clinical activities of the Division of Public
and Behavioral Health or the professional line activities of the other
divisions.
(c) Shall administer any state program for persons with
developmental disabilities established pursuant to the
Developmental Disabilities Assistance and Bill of Rights Act of
2000, 42 U.S.C. §§ 15001 et seq.
(d) Shall, after consi dering advice from agencies of local
governments and nonprofit organizations which provide social
services, adopt a master plan for the provision of human services in
this State. The Director shall revise the plan biennially and deliver a
copy of the plan to the Governor and the Legislature at the
beginning of each regular session. The plan must:
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(1) Identify and assess the plans and programs of the
Department for the provision of human services, and any
duplication of those services by federal, state and local agencies;
(2) Set forth priorities for the provision of those services;
(3) Provide for communication and the coordination of those
services among nonprofit organizations, agencies of local
government, the State and the Federal Government;
(4) Identify the sources of funding for services provided by
the Department and the allocation of that funding;
(5) Set forth sufficient information to assist the Department
in providing those services and in the planning and budgeting for the
future provision of those services; and
(6) Contain any other information necessary for the
Department to communicate effectively with the Federal
Government concerning demographic trends, formulas for the
distribution of federal money and any need for the modificati on of
programs administered by the Department.
(e) May, by regulation, require nonprofit organizations and state
and local governmental agencies to provide information regarding
the programs of those organizations and agencies, excluding
detailed information relating to their budgets and payrolls, which the
Director deems necessary for the performance of the duties imposed
upon him or her pursuant to this section.
(f) Has such other powers and duties as are provided by law.
2. Notwithstanding any other provision of law, the Director, or
the Director’s designee, is responsible for appointing and removing
subordinate officers and employees of the Department.
Sec. 4. NRS 439.803 is hereby amended to read as follows:
439.803 “Health facility” means:
1. Any facility licensed by the Division pursuant to chapter 449
of NRS; and
2. A home operated by [a] :
(a) A provider of community-based living arrangement services,
as defined in NRS 449.0026 [.] ; or
(b) A provider of rehabilitative residential mental health care,
as defined in section 5 of this act.
Sec. 5. Chapter 449 of NRS is hereby amended by adding
thereto a new section to read as follows:
“Rehabilitative residen tial mental health care” means
community-based, medically monitored care provided in a
residential setting that uses established rehabilitative principles to:
1. Promote the recovery of the client with a mental illness or
other behavioral health condition; and
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2. Assist the client in achieving psychiatric stability, personal
and emotional adjustment, self -sufficiency and other skills
necessary to transition to a more independent setting.
Sec. 6. NRS 449.001 is hereby amended to read as follows:
449.001 As used in this chapter, unless the context otherwise
requires, the words and terms defined in NRS 449.0015 to
449.0195, inclusive, and section 5 of this act have the meanings
ascribed to them in those sections.
Sec. 7. NRS 449.0026 is hereby amended to read as follows:
449.0026 1. “Community-based living arrangement services”
means flexible, individualized services, including, without
limitation, training and habilitation services, that are:
[1.] (a) Provided in the home, for compensation, to persons
with mental illness who are served by the Division or any other
entity; and
[2.] (b) Designed and coordinated to assist such persons in
maximizing their independence.
2. The term does not include rehabilitative residential mental
health care.
Sec. 8. NRS 449.0045 is hereby amended to read as follows:
449.0045 “Facility for the dependent” includes:
1. A facility for the treatment of alcohol or other substance use
disorders;
2. A facility for the care of adults during the day;
3. A residential facility for groups;
4. An agency to provide personal care services in the home;
5. A facility for transitional living for released offenders;
6. A home for individual residential care;
7. A community health worker pool; [and]
8. A provider of community-based living arrangement services
[.] ; and
9. A provider of rehabilitative residential mental health care.
Sec. 9. NRS 449.0105 is hereby amended to read as follows:
449.0105 “Home for individual residential care” means a home
in which a natural person furnishes food, shelter, assistance and
limited supervision, for compensation, to not more than two persons
with intellectual disabilities or with physical disabilities or who are
aged or infirm, unless the persons receiving those services are
related within the third degree of consanguinity or affinity to the
person providing those services. The term does not include:
1. A recovery house for persons recovering from alcohol or
other substance use disorders; [or]
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2. A home in which community -based living arrangement
services or supported living arrangement services are provided by a
provider of such services during any period in which the provider is
engaged in providing the services [.] ; or
3. A location where rehabilitative residential mental health
care is provided by a provider of such care.
Sec. 10. NRS 449.017 is hereby amended to read as follows:
449.017 1. Except as otherwise provided in subsection 2,
“residential facility for groups” means an establishment that
furnishes food, shelter, assistance and limited supervision to a
person with an intellectual disability or with a physical disability or
a person who is aged or infirm. The term includes, without
limitation, an assisted living facility.
2. The term does not include:
(a) An establishment which provides care only during the day;
(b) A natural person who pr ovides care for no more than two
persons in his or her own home;
(c) A natural person who provides care for one or more persons
related to him or her within the third degree of consanguinity or
affinity;
(d) A recovery house for persons recovering from a lcohol or
other substance use disorders; [or]
(e) A home in which community -based living arrangement
services or supported living arrangement services are provided by a
provider of such services during any period in which the provider is
providing the services [.] ; or
(f) A location where rehabilitative residential mental health
care is provided by a provider of such care.
Sec. 11. NRS 449.0302 is hereby amended to read as follows:
449.0302 1. The Board shall adopt:
(a) Licensing standards for each class of medical facility or
facility for the dependent covered by NRS 449.029 to 449.2428,
inclusive, and for programs of hospice care.
(b) Regulations governing the licensing of such facilities and
programs.
(c) Regulations governing the procedure and standards for
granting an extension of the time for which a natural person may
provide certain care in his or her home without being considered a
residential facility for groups pursuant to NRS 449.017. The
regulations must require that such grants are effective only if made
in writing.
(d) Regulations establishing a procedure for the indemnification
by the Division, from the amount of any surety bond or other
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obligation filed or deposited by a facility for refractive sur gery
pursuant to NRS 449.068 or 449.069, of a patient of the facility who
has sustained any damages as a result of the bankruptcy of or any
breach of contract by the facility.
(e) Regulations that prescribe the specific types of
discrimination prohibited by NRS 449.101.
(f) Regulations requiring a hospital or independent center for
emergency medical care to provide training to each employee who
provides care to victims of sexual assault or attempted sexual assault
concerning appropriate care for such persons, including, without
limitation, training concerning the requirements of NRS 449.1885.
(g) Any other regulations as it deems necessary or convenient to
carry out the provisions of NRS 449.029 to 449.2428, inclusive.
2. The Board shall adopt separate regulations governing the
licensing and operation of:
(a) Facilities for the care of adults during the day; and
(b) Residential facilities for groups,
which provide care to persons with Alzheimer’s disease or other
severe dementia, as describe d in paragraph (a) of subsection 2 of
NRS 449.1845.
3. The Board shall adopt separate regulations for:
(a) The licensure of rural hospitals and rural emergency
hospitals which take into consideration the unique problems of
operating such a facility in a rural area.
(b) The licensure of facilities for refractive surgery which take
into consideration the unique factors of operating such a facility.
(c) The licensure of mobile units which take into consideration
the unique factors of operating a facility that is not in a fixed
location.
4. The Board shall require that the practices and policies of
each medical facility or facility for the dependent provide
adequately for the protection of the health, safety and physical,
moral and mental well -being of ea ch person accommodated in the
facility.
5. In addition to the training requirements prescribed pursuant
to NRS 449.093, the Board shall establish minimum qualifications
for administrators and employees of residential facilities for groups.
In establishin g the qualifications, the Board shall consider the
related standards set by nationally recognized organizations which
accredit such facilities.
6. The Board shall adopt separate regulations regarding the
assistance which may be given pursuant to NRS 453. 375 and
454.213 to an ultimate user of controlled substances or dangerous
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drugs by employees of residential facilities for groups. The
regulations must require at least the following conditions before
such assistance may be given:
(a) The ultimate user’s physical and mental condition is stable
and is following a predictable course.
(b) The amount of the medication prescribed is at a maintenance
level and does not require a daily assessment.
(c) A written plan of care by a physician or registered nurse ha s
been established that:
(1) Addresses possession and assistance in the administration
of the medication; and
(2) Includes a plan, which has been prepared under the
supervision of a registered nurse or licensed pharmacist, for
emergency intervention if an adverse condition results.
(d) Except as otherwise authorized by the regulations adopted
pursuant to NRS 449.0304, the prescribed medication is not
administered by injection or intravenously.
(e) The employee has successfully completed training and
examination approved by the Division regarding the authorized
manner of assistance.
7. The Board shall adopt separate regulations governing the
licensing and operation of residential facilities for groups which
provide assisted living services. The Board shall not allow the
licensing of a facility as a residential facility for groups which
provides assisted living services and a residential facility for groups
shall not claim that it provides “assisted living services” unless:
(a) Before authorizing a per son to move into the facility, the
facility makes a full written disclosure to the person regarding what
services of personalized care will be available to the person and the
amount that will be charged for those services throughout the
resident’s stay at the facility.
(b) The residents of the facility reside in their own living units
which:
(1) Except as otherwise provided in subsection 8, contain
toilet facilities;
(2) Contain a sleeping area or bedroom; and
(3) Are shared with another occupant only upon consent of
both occupants.
(c) The facility provides personalized care to the residents of the
facility and the general approach to operating the facility
incorporates these core principles:
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(1) The facility is designed to create a residential
environment that actively supports and promotes each resident’s
quality of life and right to privacy;
(2) The facility is committed to offering high -quality
supportive services that are developed by the facility in
collaboration with the resident to mee t the resident’s individual
needs;
(3) The facility provides a variety of creative and innovative
services that emphasize the particular needs of each individual
resident and the resident’s personal choice of lifestyle;
(4) The operation of the facility and its interaction with its
residents supports, to the maximum extent possible, each resident’s
need for autonomy and the right to make decisions regarding his or
her own life;
(5) The operation of the facility is designed to foster a social
climate that allows the resident to develop and maintain personal
relationships with fellow residents and with persons in the general
community;
(6) The facility is designed to minimize and is operated in a
manner which minimizes the need for its residents to move out of
the facility as their respective physical and mental conditions change
over time; and
(7) The facility is operated in such a manner as to foster a
culture that provides a high -quality environment for the residents,
their families, the staff, any volunteers and the community at large.
8. The Division may grant an exception from the requirement
of subparagraph (1) of paragraph (b) of subsection 7 to a facility
which is licensed as a residential facility for groups on or before
July 1, 2005, and which is authorized to have 10 or fewer beds and
was originally constructed as a single -family dwelling if the
Division finds that:
(a) Strict application of that requirement would result in
economic hardship to the facility requesting the exception; and
(b) The exception, if granted, would not:
(1) Cause substantial detriment to the health or welfare of
any resident of the facility;
(2) Result in more than two residents sharing a toilet facility;
or
(3) Otherwise impair substantially the purp ose of that
requirement.
9. The Board shall, if it determines necessary, adopt
regulations and requirements to ensure that each residential facility
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for groups and its staff are prepared to respond to an emergency,
including, without limitation:
(a) The adoption of plans to respond to a natural disaster and
other types of emergency situations, including, without limitation,
an emergency involving fire;
(b) The adoption of plans to provide for the evacuation of a
residential facility for groups in an eme rgency, including, without
limitation, plans to ensure that nonambulatory patients may be
evacuated;
(c) Educating the residents of residential facilities for groups
concerning the plans adopted pursuant to paragraphs (a) and (b); and
(d) Posting the plans or a summary of the plans adopted
pursuant to paragraphs (a) and (b) in a conspicuous place in each
residential facility for groups.
10. The regulations governing the licensing and operation of
facilities for transitional living for released offend ers must provide
for the licensure of at least three different types of facilities,
including, without limitation:
(a) Facilities that only provide a housing and living
environment;
(b) Facilities that provide or arrange for the provision of
supportive services for residents of the facility to assist the residents
with reintegration into the community, in addition to providing a
housing and living environment; and
(c) Facilities that provide or arrange for the provision of
programs for alcohol and other substance use disorders, in addition
to providing a housing and living environment and providing or
arranging for the provision of other supportive services.
The regulations must provide that if a facility was originally
constructed as a single -family dw elling, the facility must not be
authorized for more than eight beds.
11. The Board shall adopt regulations applicable to providers
of community-based living arrangement services which:
(a) Except as otherwise provided in paragraph (b), require a
natural person responsible for the operation of a provider of
community-based living arrangement services and each employee of
a provider of community -based living arrangement services who
supervises or provides support to recipients of community -based
living ar rangement services to complete training concerning the
provision of community -based living arrangement services to
persons with mental illness and continuing education concerning the
particular population served by the provider;
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(b) Exempt a person licens ed or certified pursuant to title 54 of
NRS from the requirements prescribed pursuant to paragraph (a) if
the Board determines that the person is required to receive training
and continuing education substantially equivalent to that prescribed
pursuant to that paragraph;
(c) Require a natural person responsible for the operation of a
provider of community-based living arrangement services to receive
training concerning the provisions of title 53 of NRS applicable to
the provision of community-based living arrangement services; and
(d) Require an applicant for a license to provide community -
based living arrangement services to post a surety bond in an
amount equal to the operating expenses of the applicant for 2
months, place that amount in escrow or take a nother action
prescribed by the Division to ensure that, if the applicant becomes
insolvent, recipients of community -based living arrangement
services from the applicant may continue to receive community -
based living arrangement services for 2 months at the expense of the
applicant.
12. The Board shall adopt separate regulations governing the
licensing and operation of freestanding birthing centers. Such
regulations must:
(a) Align with the standards established by the American
Association of Birth Cente rs, or its successor organization, the
accrediting body of the Commission for the Accreditation of Birth
Centers, or its successor organization, or another nationally
recognized organization for accrediting freestanding birthing
centers; and
(b) Allow the provision of supervised training to providers of
health care, as appropriate, at a freestanding birthing center.
13. If the regulations adopted pursuant to this section require a
physical examination to be performed on a patient or the medical
history o f a patient to be obtained before or after the patient is
admitted to a hospital, those regulations must authorize a certified
nurse-midwife to perform such a physical examination or obtain
such a medical history before or after a patient is admitted to a
hospital for the purpose of giving birth.
14. The Board shall adopt regulations governing the
licensing and operation of providers of rehabilitative residential
mental health care, which must include, without limitation,
separate requirements for providers providing such care to minors
and providers providing such care to adults.
15. As used in this section:
(a) “Certified nurse-midwife” means a person who is:
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(1) Certified as a Certified Nurse -Midwife by the American
Midwifery Certification Board, or its successor organization; and
(2) Licensed as an advanced practice registered nurse
pursuant to NRS 632.237.
(b) “Living unit” means an individual private accommodation
designated for a resident within the facility.
Sec. 12. NRS 449.080 is hereby amended to read as follows:
449.080 1. If, after investigation, the Division finds that the:
(a) Applicant is in full compliance with the provisions of NRS
449.029 to 449.2428, inclusive;
(b) Applicant is in substantial compliance with the standards and
regulations adopted by the Board;
(c) Applicant, if he or she has undertaken a project for which
approval is required pursuant to NRS 439A.100 or 439A.102, has
obtained the approval of the Direc tor of the Department of Health
and Human Services; and
(d) Facility conforms to the applicable zoning regulations,
the Division shall issue the license to the applicant.
2. Any investigation of an applicant for a license to provide
community-based li ving arrangement services or rehabilitative
residential mental health care conducted pursuant to subsection 1
must include, without limitation, an inspection of any building
operated by the applicant in which the applicant proposes to provide
community-based living arrangement services [.] or rehabilitative
residential mental health care, as applicable.
3. A license applies only to the person to whom it is issued, is
valid only for the premises described in the license and is not
transferable.
Sec. 13. NRS 449.089 is hereby amended to read as follows:
449.089 1. Each license issued pursuant to NRS 449.029 to
449.2428, inclusive, expires on December 31 following its issuance
and is renewable for 1 year upon reapplica tion and payment of all
fees required pursuant to subsection 4 and NRS 449.050, as
applicable, unless the Division finds, after an investigation, that the
facility has not:
(a) Satisfactorily complied with the provisions of NRS 449.029
to 449.2428, inclus ive, or the standards and regulations adopted by
the Board;
(b) Obtained the approval of the Director of the Department of
Health and Human Services before undertaking a project, if such
approval is required by NRS 439A.100 or 439A.102; or
(c) Conformed to all applicable local zoning regulations.
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2. Each reapplication for an agency to provide personal care
services in the home, an agency to provide nursing in the home, a
community health worker pool, a facility for intermediate care, a
facility for skil led nursing, a provider of community -based living
arrangement services, a provider of rehabilitative residential
mental health care, a hospital described in 42 U.S.C. §
1395ww(d)(1)(B)(iv), a psychiatric hospital that provides inpatient
services to childre n, a psychiatric residential treatment facility, a
residential facility for groups, a program of hospice care, a home for
individual residential care, a facility for the care of adults during the
day, a facility for hospice care, a nursing pool, the distin ct part of a
hospital which meets the requirements of a skilled nursing facility or
nursing facility pursuant to 42 C.F.R. § 483.5, a hospital that
provides swing-bed services as described in 42 C.F.R. § 482.58 or,
if residential services are provided to c hildren, a medical facility or
facility for the treatment of alcohol or other substance use disorders
must include, without limitation, a statement that the facility,
hospital, agency, provider, program, pool or home is in compliance
with the provisions of NRS 449.115 to 449.125, inclusive, and
449.174.
3. Each reapplication for an agency to provide personal care
services in the home, a community health worker pool, a facility for
intermediate care, a facility for skilled nursing, a facility for the care
of adults during the day, a residential facility for groups or a home
for individual residential care must include, without limitation, a
statement that the holder of the license to operate, and the
administrator or other person in charge and employees of, the
facility, agency, pool or home are in compliance with the provisions
of NRS 449.093.
4. Each reapplication for a surgical center for ambulatory
patients, facility for the treatment of irreversible renal disease,
facility for hospice care, program of hospice care, hospital, facility
for intermediate care, facility for skilled nursing, agency to provide
personal care services in the home or rural clinic must be
accompanied by the fee prescribed by the State Board of Health
pursuant to NRS 457.240, in a ddition to the fees imposed pursuant
to NRS 449.050.
Sec. 14. NRS 449.119 is hereby amended to read as follows:
449.119 “Facility, hospital, agency, program or home” means
an agency to provide personal care services in th e home, an
employment agency that contracts with persons to provide
nonmedical services related to personal care to elderly persons or
persons with disabilities in the home, an agency to provide nursing
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in the home, a community health worker pool, a facili ty for
intermediate care, a facility for skilled nursing, a provider of
community-based living arrangement services, a provider of
rehabilitative residential mental health care, a hospital described in
42 U.S.C. § 1395ww(d)(1)(B)(iv), a psychiatric hospita l that
provides inpatient services to children, a psychiatric residential
treatment facility, a residential facility for groups, a program of
hospice care, a home for individual residential care, a facility for the
care of adults during the day, a facility for hospice care, a nursing
pool, the distinct part of a hospital which meets the requirements of
a skilled nursing facility or nursing facility pursuant to 42 C.F.R. §
483.5, a hospital that provides swing-bed services as described in 42
C.F.R. § 482.58 or, if residential services are provided to children, a
medical facility or facility for the treatment of alcohol or other
substance use disorders.
Sec. 15. NRS 449.131 is hereby amended to read as follows:
449.131 1. Any authorized member or employee of the
Division may enter and inspect any building or premises at any time
to secure compliance with or prevent a violation of any provision of
NRS 449.029 to 449.245, inclusive.
2. The State Fire Marshal or a designee o f the State Fire
Marshal, which may include a local fire agency that meets an
industry standard accepted by the State Fire Marshal, shall, upon
receiving a request from the Division or a written complaint
concerning compliance with the plans and requiremen ts to respond
to an emergency adopted pursuant to subsection 9 of
NRS 449.0302:
(a) Enter and inspect a residential facility for groups or a
building operated by a provider of community -based living
arrangement services or a provider of rehabilitative residential
mental health care in which such services [are] or care is provided;
and
(b) Make recommendations regarding the adoption of plans and
requirements pursuant to subsection 9 of NRS 449.0302,
to ensure the safety of the residents of the facility or persons
receiving care from the provider, as applicable, in an emergency.
3. The Chief Medical Officer or a designee of the Chief
Medical Officer shall enter and inspect at least annually each
building or the premises of a residential facility for groups , [and]
each building operated by a provider of community -based living
arrangement services in which such services are provided and each
building operated by a provider of rehabilitative residential mental
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health care in which such care is provided to ensure compliance
with standards for health and sanitation.
4. An authorized member or employee of the Division shall
enter and inspect any building or premises operated by a residential
facility for groups , [or] provider of community -based living
arrangement services or provider of rehabilitative residential
mental health care within 72 hours after the Division is notified
that a residential facility for groups , [or] provider of community -
based living arrangement servi ces or provider of rehabilitative
residential mental health care is operating without a license.
Sec. 16. NRS 449.134 is hereby amended to read as follows:
449.134 A facility for intermediate care, facility for skilled
nursing, residential facility for groups, provider of community-based
living arrangement services , provider of rehabilitative residential
mental health care or home for individual residential care shall
immediately provide notice of a deficiency affecting the health and
safety of a patient discovered during the course of an inspection of
the facility for intermediate care, facility for skilled nursing,
residential facility for groups, provider of community -based living
arrangement services , provider of re habilitative residential mental
health care or home for individual residential care conducted by the
Division to:
1. A person receiving care at the facility or home or from the
provider, as applicable;
2. The parent or legal guardian of the person rece iving care at
the facility or home or from the provider, as applicable; or
3. Any other natural person designated to receive such notice
by the person receiving care at the facility or home or from the
provider, as applicable, or the parent or guardian of the person.
Sec. 17. NRS 632.316 is hereby amended to read as follows:
632.316 The provisions of NRS 632.315 do not prohibit:
1. Gratuitous nursing by friends or by members of the family
of a patient.
2. The incidental care of the sick by domestic servants or
persons primarily employed as housekeepers as long as they do not
practice nursing within the meaning of this chapter.
3. Nursing assistance in the case of an emergency.
4. The practice of nursing by students enrolled in accredited
schools of nursing or by graduates of those schools or courses
pending the results of the first licensing examination scheduled by
the Board following graduation. A student or graduate may not work
as a nursing assistant unl ess the student or graduate is certified to
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practice as a nursing assistant pursuant to the provisions of this
chapter.
5. The practice of nursing in this State by any legally qualified
nurse or nursing assistant of another state whose engagement
requires the nurse or nursing assistant to accompany and care for a
patient temporarily residing in this State during the period of one
such engagement, not to exceed 6 months, if the person does not
represent or hold himself or herself out as a nurse licensed to
practice in this State or as a nursing assistant who holds a certificate
to practice in this State.
6. The practice of nursing by any person who is employed by
the United States Government, or any bureau, division or agency
thereof, while in the dischar ge of his or her official duties in this
State, including, without limitation, providing medical care in a
hospital in accordance with an agreement entered into pursuant to
NRS 449.2455.
7. Nonmedical nursing for the care of the sick, with or without
compensation, if done by the adherents of, or in connection with, the
practice of the religious tenets of any well -recognized church or
religious denomination, if that nursing does not amount to the
practice of practical or professional nursing as defined in NRS
632.017 and 632.018, respectively.
8. A personal assistant from performing services for a person
with a disability pursuant to NRS 629.091.
9. A natural person from providing community -based living
arrangement services if:
(a) That person has been issued a license pursuant to chapter 449
of NRS and the regulations adopted pursuant thereto; or
(b) That person is employed or retained as an independent
contractor by a partnership, firm, corporation or association, state or
local government or agency thereof that has been issued a license
pursuant to chapter 449 of NRS and the regulations adopted
pursuant thereto.
As used in this subsection, “community-based living arrangement
services” has the meaning ascribed to it in NRS 449.0026.
10. A natural person from providing supported living
arrangement services if:
(a) That person has been issued a certificate pursuant to NRS
435.3305 to 435.339, inclusive, and the regulations adopted
pursuant to NRS 435.3305 to 435.339, inclusive; or
(b) That person i s employed or retained as an independent
contractor by a partnership, firm, corporation or association, state or
local government or agency thereof that has been issued a certificate
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pursuant to NRS 435.3305 to 435.339, inclusive, and the regulations
adopted pursuant to NRS 435.3305 to 435.339, inclusive.
As used in this subsection, “supported living arrangement
services” has the meaning ascribed to it in NRS 435.3315.
11. A natural person from providing jobs and day training
services if:
(a) That person has been issued a certificate pursuant to NRS
435.130 to 435.310, inclusive, and the regulations adopted pursuant
to NRS 435.130 to 435.310, inclusive; or
(b) That person is employed or retained as an independent
contractor by a partnership, firm, corporation or association, state or
local government or agency thereof that has been issued a certificate
pursuant to NRS 435.130 to 435.310, inclusive, and the regulations
adopted pursuant to NRS 435.130 to 435.310, inclusive.
As used in this subsection, “jobs and day training services” has
the meaning ascribed to it in NRS 435.176.
12. A natural person from providing rehabilitative residential
mental health care if:
(a) That person has been issued a license pursuant to the
provisions of chapter 449 of NRS and the regulations adopted
pursuant thereto; or
(b) That person is employed or retained as an independent
contractor by a partnership, firm, corporation or association, state
or local government or agency thereof that has been issued a
license pursuant to the provisions of chapter 449 of NRS and the
regulations adopted pursuant thereto.
As used in this subsection, “rehabilitative residential mental
health care” has the meaning ascribed to it in section 5 of this act.
Sec. 17.5. 1. There is hereby appropriated from the State
General Fund to the Division of Health Care Financing and Policy
of the Department of Health and Human Services for the costs of
providing Medicaid coverage for rehabilitative residential mental
health care pursuant to section 1 of this act and computer system
upgrades associated with the requirements of section 1 of this act the
following sums:
For the Fiscal Year 2025-2026 .................................... $30,800
For the Fiscal Year 2026-2027 .................................. $551,899
2. Expenditure of the following sums not appropriated from the
State General Fund or the State Highway Fund is hereby authorized
by the Division of Health Care Financing and Policy of the
Department of Health and Human Services for the same purposes as
set forth in subsection 1:
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For the Fiscal Year 2025-2026 .................................... $92,400
For the Fiscal Year 2026-2027 ............................... $1,639,954
3. Any balance of the sums appropriated by subsection 1
remaining at the end of the respective fiscal years must not be
committed for expenditure after June 30 of the respective fiscal
years by the entity to which the appropriation is made or any entity
to which money from the appropriation is granted or otherwise
transferred in any manner, and any portion of the appropriated
money remaining must not be spent for any purpose after
September 18, 2026, and September 17, 2027, respectively, by
either the entity to which the money was appropriated or the entity
to which the money was subsequently granted or transferred, and
must be reverted to the State General F und on or before
September 18, 2026, and September 17, 2027, respectively.
Sec. 18. 1. Notwithstanding the amendatory provisions of
section 8 of this act, a provider of rehabilitative residential mental
health care that i s operating on July 1, 2026, may continue to
operate without obtaining a license issued by the Division of Public
and Behavioral Health of the Department of Health and Human
Services until January 1, 2027.
2. As used in this section, “rehabilitative resi dential mental
health care” has the meaning ascribed to it in section 5 of this act.
Sec. 19. 1. This section becomes effective upon passage and
approval.
2. Section 17.5 of this act becomes effective on July 1, 2025.
3. Sections 1 to 17, inclusive, and section 18 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 July 1, 2026, for all other purposes.
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