Read the full stored bill text
- 83rd Session (2025)
Senate Bill No. 188–Senator Doñate
CHAPTER..........
AN ACT relating to health care; requiring certain health facilities
and providers of health care to take reasonable steps to
provide a person with limited English proficiency with
language assistance under certain circumstances; prescribing
requirements governing the use of interpreters and translators
to comply with that requirement; authorizing the discipline of
certain health facilities and providers of health care for
certain violations; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing federal regulations require certain health care entities to take
reasonable steps to provide meaningful access to persons with limited English
proficiency who are eligible to be served or likely to be directly affected by a health
program or activity of the entity. (45 C.F.R. § 92.201(a)) The Director of the Office
for Civil Rights of the United States Department of Health and Human Services has
provided additional guidance by defining meaningful access to mean ensuring that
language barriers do not prevent a person from obtaining necessary health services
and care. (Melanie Fontes Rainer, Director, Office for Civil Rights U.S. Dep’t. of
Health and Human Services (Dec. 5, 2024), Dear Colleague Letter Regarding
Language Access Provisions of the Final Rule Implementing Section 1557 of the
Affordable Care Act, retrieved from http://www.hhs.gov/sites/default/files/ocr-dcl-
section-1557-language-access.pdf) Existing federal regulations prescribe various
requirements and procedures governing the use of interpreters and translators to
comply with those requirements. (45 C.F.R. § 92.201)
Sections 5-8 and 16-20 of this bill codify similar provisions into state law,
thereby requiring certain health facilities and providers of health care to take
reasonable steps to ensure that language barriers do not prevent a person with
limited English proficiency from obtaining necessary access to health care.
Sections 5, 16 and 20 prescribe certain factors for determining whether an action is
necessary for a health facility or provider of health care to be in compliance with
that requirement. Sections 5 and 16 require that a service to provide language
assistance be available free of charge, be accurate in translation or interpretation, be
provided in a timely manner and protect the ability of the person with limited
English proficiency to make independent decisions. Sections 5 and 16 require that
a qualified translator review a machine -translated document under certain
circumstances.
Sections 5 and 16 require a health facility or provider of health care to use a
qualified interpreter or translator to provide interpreting or translating services, and
sections 8 and 19 establish the qualifications to serve as an interpreter or translator.
Sections 6 and 17 prohibit the use of an unqualified interpreter, except in certain
circumstances. Sections 6 and 17 also prohibit a health facility or provider of
health care from requiring a person with limited English pro ficiency to provide his
or her own interpreter or pay the cost of an interpreter. Sections 7 and 18 prescribe
requirements governing the use of a remote interpreter. Sections 3, 4 and 15 of this
bill define certain terms, and section 2 of this bill establishes the applicability of the
definitions set forth in sections 3 and 4. Sections 9 and 10 of this bill make
conforming changes to establish the applicability of certain provisions.
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Sections 11-13, 20 and 21 of this bill prescribe various mechanisms for th e
enforcement of sections 5-8 and 16-19, including the imposition of administrative
sanctions against a health facility that fails to comply with those provisions and
professional discipline against a provider of health care who fails to comply with
those provisions.
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 449 of NRS is hereby amended by adding
thereto the provisions set forth as sections 2 to 8, inclusive, of this
act.
Sec. 2. As used in sections 2 to 8, inclusive, of this act, unless
the context otherwise requires, the words and terms defined in
sections 3 and 4 of this act have the definitions ascribed to them in
those sections.
Sec. 3. “Health facility” means a medical facility, a facility
for the dependent that is a provider of services under Medicaid or
a facility which is required by the regulations adopted by the
Board pursuant to NRS 449.0303 to be licensed.
Sec. 4. “Person with limited English proficiency” means a
person who speaks a language other than English and who cannot
readily understand or communicate in the English language.
Sec. 5. 1. A he alth facility shall take reasonable steps to
ensure that language barriers do not prevent a person with limited
English proficiency from obtaining necessary health care.
2. In determining whether a particular action is necessary to
comply with subsection 1, a health facility shall, and in
determining whether a health facility is in compliance with
subsection 1, the Division shall:
(a) Evaluate, and give substantial weight to, the nature and
importance of the services or programs provided by the health
facility and the relevant communications to the person with
limited English proficiency; and
(b) Consider any other relevant factors, including, without
limitation, the effectiveness of any procedure for providing
language access through written documents.
3. A service to provide language assistance to ensure
compliance with subsection 1 must:
(a) Be provided free of charge to the person with limited
English proficiency;
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(b) Be accurate in translation or interpretation and provided in
a timely manner; and
(c) Protect the privacy and ability of the person with limited
English proficiency to make independent decisions.
4. Except as otherwise provided in section 6 of this act, if a
health facility determines pursuant to subsection 2 that
interpretation services or translation services are necessary to
ensure compliance with subsection 1, the health facility shall
utilize an interpreter or translator who is qualified pursuant to
section 8 of this act to provide those services.
5. A health facility shall ensure that a translator who is
qualified pursuant to section 8 of this act reviews a machine -
translated document if the document:
(a) Relates to the rights of a person with limited English
proficiency, the goods or services provided by the health facili ty or
the ability of a person with limited English proficiency to obtain
necessary health care;
(b) Must be accurately translated to ensure compliance with
subsection 1 or protect the health and well -being of a person with
limited English proficiency; or
(c) Is complex, nonliteral or technical.
Sec. 6. 1. A health facility shall not:
(a) Require a person with limited English proficiency to
provide his or her own interpreter or pay the cost of an interpreter;
(b) Utilize an adult who is not qualified as an interpreter
pursuant to section 8 of this act to interpret or facilitate
communication for a person with limited English proficiency
except where authorized pursuant to subsection 2 or 3;
(c) Utilize a child who is less than 18 years of age to interpret
or facilitate communication for a person with limited English
proficiency except where authorized pursuant to subsection 2; or
(d) Utilize an employee, a contractor or a volunteer of the
health facility who is not an interpreter or a translator qualified
pursuant to section 8 of this act to interpret or facilitate
communication for a person with limited English proficiency.
2. A health facility may utilize an adult who is not qualified
as an interpreter pursuant to section 8 of this act or a child who is
less than 18 years of age to interpret or facilitate communication
for a person with limited English proficiency on a temporary,
emergency basis if:
(a) There is an imminent threat to the safety or welfare of any
person or the public;
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(b) An interpreter who is qualified pursuant to section 8 of this
act is not immediately available;
(c) The health facility is attempting to find an interpreter who
is qualified pursuant to section 8 of this act; and
(d) An interpreter who is qualified pursuant to section 8 of this
act later confirms or supplements the initial communications with
the interpreter utilized pursuant to this section.
3. A health facility may utilize an adult who is not qualified
as an interpre ter pursuant to section 8 of this act to interpret or
facilitate communication for a person with limited English
proficiency if the person with limited English proficiency requests
for the adult to interpret or facilitate communication for him or
her. Such a request must be:
(a) Made without the adult present to an interpreter who is
qualified pursuant to section 8 of this act;
(b) Agreed to by the adult;
(c) Documented in the record of the person with limited
English proficiency; and
(d) Deemed appropriate under the circumstances by the person
providing the program or service on behalf of the health facility.
Sec. 7. 1. A health facility may use a remote interpreter to
provide interpreting services necessary to comply with section 5 of
this act if the health facility utilizes audio -visual communication
technology or audio communication technology that includes,
without limitation, synchronous interaction with audio and, if
applicable, video over a high-speed, wide-bandwidth connection or
wireless connection that, to the extent possible:
(a) Does not produce a lag or irregular pauses in
communication or, if applicable, images;
(b) Provides transmission of voice that is clear and audible;
and
(c) If applicable, produces a high -quality video image that is
not blurry or grainy and is large enough to display the face of the
interpreter and person with limited English proficiency, regardless
of body position.
2. A health facility shall provide training to an employee, a
contractor or a volunteer who is involved in using audio -visual
communication technology or audio communication technology to
facilitate the use of a remote interpreter. Such training must be
adequate to ensure that the employee, contract or or volunteer
operates the technology efficiently and effectively.
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Sec. 8. An interpreter or translator is qualified to provide
interpretation or translation services pursuant to sections 2 to 8,
inclusive, of this act if the interpreter or translator:
1. Has demonstrated proficiency in and understanding of
spoken or written, as applicable:
(a) English and at least one other language; or
(b) At least two languages that are not English if he or she is a
relay interpreter or translator; and
2. Has demonstrated proficiency in interpreting or
translating, as applicable, effectively, accurately and impartially,
including, without limitation , using specialized vocabulary or
terms without change, omission or addition.
Sec. 9. NRS 449.029 is hereby amended to read as follows:
449.029 As used in NRS 449.029 to 449.240, inclusive, and
sections 2 to 8, inclusive, of this act, unless the context otherwise
requires, “medical facility” has the meaning ascribed to it in NRS
449.0151 and includes a program of hospice care described in
NRS 449.196.
Sec. 10. NRS 449.0301 is hereby amended to read as follows:
449.0301 The provisions of NRS 449.029 to 449.2428,
inclusive, and sections 2 to 8, inclusive, of this act do not apply to:
1. Any facility conducted by and for the adherents of any
church or religious denomination for the purpose of providing
facilities for the care and treatment of the sick who depend solely
upon spiritual means through prayer for healing in the practice of
the religion of the church or denomination, except that such a
facility shall comply with all regulations relative to san itation and
safety applicable to other facilities of a similar category.
2. Foster homes as defined in NRS 424.014.
3. Any medical facility , facility for the dependent or facility
which is otherwise required by the regulations adopted by the Board
pursuant to NRS 449.0303 to be licensed that is operated and
maintained by the United States Government or an agency thereof.
Sec. 11. NRS 449.160 is hereby amended to read as follows:
449.160 1. The Division may deny an application for a
license or may suspend or revoke any license issued under the
provisions of NRS 449.029 to 449.2428, inclusive, and sections 2 to
8, inclusive, of this act upon any of the following grounds:
(a) Violation by the applicant or the licensee of any of the
provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and
sections 2 to 8, inclusive, of this act, or 449A.100 to 449A.124,
inclusive, and 449A.270 to 449A.286, inclusive, or of any other law
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of this State or of the standards, rules and regulations adopted
thereunder.
(b) Aiding, abetting or permitting the commission of any illegal
act.
(c) Conduct inimical to the public health, morals, welfare and
safety of the people of the State of Nevada in the maintenance and
operation of the premises for which a license is issued.
(d) Conduct or practice detrimental to the health or safety of the
occupants or employees of the facility.
(e) Failure of the applicant to obtain written approval from the
Director of the Department of Health and Human Services as
required by NRS 439A.100 or 439A.102 or as provided in any
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive,
and sections 2 to 8, inclusive, of this act and 449.435 to 449.531,
inclusive, and chapter 449A of NRS if such approval is required,
including, without limitation, the closure or conversion of any
hospital in a county whose population is 100,000 or more that is
owned by the licensee without approval pursuant to NRS 439A.102.
(f) Failure to comply with the provisions of NRS 441A.315 and
any regulations adopted pursuant thereto or NRS 449.2486.
(g) Violation of the provisions of NRS 458.112.
(h) Failure to comply wit h the provisions of NRS 449A.170 to
449A.192, inclusive, and any regulation adopted pursuant thereto.
(i) Violation of the provisions of NRS 629.260.
2. In addition to the provisions of subsection 1, the Division
may revoke a license to operate a facili ty for the dependent if, with
respect to that facility, the licensee that operates the facility, or an
agent or employee of the licensee:
(a) Is convicted of violating any of the provisions of
NRS 202.470;
(b) Is ordered to but fails to abate a nuisance pursuant to NRS
244.360, 244.3603 or 268.4124; or
(c) Is ordered by the appropriate governmental agency to correct
a violation of a building, safety or health code or regulation but fails
to correct the violation.
3. The Division shall maintain a log o f any complaints that it
receives relating to activities for which the Division may revoke the
license to operate a facility for the dependent pursuant to subsection
2. The Division shall provide to a facility for the care of adults
during the day:
(a) A summary of a complaint against the facility if the
investigation of the complaint by the Division either substantiates
the complaint or is inconclusive;
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(b) A report of any investigation conducted with respect to the
complaint; and
(c) A report of any disciplinary action taken against the facility.
The facility shall make the information available to the public
pursuant to NRS 449.2486.
4. On or before February 1 of each odd -numbered year, the
Division shall submit to the Director of the Legislative Counsel
Bureau a written report setting forth, for the previous biennium:
(a) Any complaints included in the log maintained by the
Division pursuant to subsection 3; and
(b) Any disciplinary actions taken by the Division pursuant to
subsection 2.
Sec. 12. NRS 449.163 is hereby amended to read as follows:
449.163 1. In addition to the payment of the amount required
by NRS 449.0308, if a medical facility, facility for the dependent or
facility which is required by the re gulations adopted by the Board
pursuant to NRS 449.0303 to be licensed violates any provision
related to its licensure, including any provision of NRS 439B.410 or
449.029 to 449.2428, inclusive, and sections 2 to 8, inclusive, of
this act or any condition, standard or regulation adopted by the
Board, the Division, in accordance with the regulations adopted
pursuant to NRS 449.165, may:
(a) Prohibit the facility from admitting any patient until it
determines that the facility has corrected the violation;
(b) Limit the occupancy of the facility to the number of beds
occupied when the violation occurred, until it determines that the
facility has corrected the violation;
(c) If the license of the facility limits the occupancy of the
facility and the facility has exceeded the approved occupancy,
require the facility, at its own expense, to move patients to another
facility that is licensed;
(d) Except where a greater penalty is authorized by subsection 2,
impose an administrative penalty of n ot more than $5,000 per day
for each violation, together with interest thereon at a rate not to
exceed 10 percent per annum; and
(e) Appoint temporary management to oversee the operation of
the facility and to ensure the health and safety of the patients of the
facility, until:
(1) It determines that the facility has corrected the violation
and has management which is capable of ensuring continued
compliance with the applicable statutes, conditions, standards and
regulations; or
(2) Improvements are made to correct the violation.
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2. If an off -campus location of a hospital fails to obtain a
national provider identifier that is distinct from the national provider
identifier used by the main campus and any other off -campus
location of the hospital in vio lation of NRS 449.1818, the Division
may impose against the hospital an administrative penalty of not
more than $10,000 for each day of such failure, together with
interest thereon at a rate not to exceed 10 percent per annum, in
addition to any other action authorized by this chapter.
3. If the facility fails to pay any administrative penalty imposed
pursuant to paragraph (d) of subsection 1 or subsection 2, the
Division may:
(a) Suspend the license of the facility until the administrative
penalty is paid; and
(b) Collect court costs, reasonable attorney’s fees and other
costs incurred to collect the administrative penalty.
4. The Division may require any facility that violates any
provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and
sections 2 to 8, inclusive, of this act or any condition, standard or
regulation adopted by the Board to make any improvements
necessary to correct the violation.
5. Any money collected as administrative penalties pursuant to
paragraph (d) of subsection 1 o r subsection 2 must be accounted for
separately and used to administer and carry out the provisions of
NRS 449.001 to 449.430, inclusive, and sections 2 to 8, inclusive,
of this act, 449.435 to 449.531, inclusive, and chapter 449A of NRS
to protect the hea lth, safety, well-being and property of the patients
and residents of facilities in accordance with applicable state and
federal standards or for any other purpose authorized by the
Legislature.
Sec. 13. NRS 449.240 is hereby amended to read as follows:
449.240 The district attorney of the county in which the facility
is located shall, upon application by the Division, institute and
conduct the prosecution of any action for violation of any provisions
of NRS 449.029 to 449.245, inclusive [.] , and sections 2 to 8,
inclusive, of this act.
Sec. 14. Chapter 629 of NRS is hereby amended by adding
thereto the provisions set forth as sections 15 to 20, inclusive, of this
act.
Sec. 15. As used in sections 15 to 20, inclusive, of this act,
unless the context otherwise requires, “person with limited
English proficiency” has the meaning ascribed to it in section 4 of
this act.
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Sec. 16. 1. A provider of health care shall take reasonable
steps to ensure that language barriers do not prevent a person with
limited English proficiency from obtaining necessary health care.
2. In determining whether a particular action is neces sary to
comply with subsection 1, a provider of health care shall:
(a) Evaluate, and give substantial weight to, the nature and
importance of the services or programs provided by the provider of
health care and the relevant communications to the person wi th
limited English proficiency; and
(b) Consider any other relevant factors, including, without
limitation, the effectiveness of any procedure for providing
language access through written documents.
3. A service to provide language assistance to ensur e
compliance with subsection 1 must:
(a) Be provided free of charge to the person with limited
English proficiency;
(b) Be accurate in translation or interpretation and provided in
a timely manner; and
(c) Protect the privacy and ability of the person with limited
English proficiency to make independent decisions.
4. Except as otherwise provided in section 17 of this act, if a
provider of health care determines pursuant to subsection 2 that
interpretation services or translation services are necessary to
ensure compliance with subsection 1, the provider of health care
shall use an interpreter or translator who is qualified pur suant to
section 19 of this act.
5. A provider of health care shall ensure that a machine -
translated document is reviewed by a translator who is qualified
pursuant to section 19 of this act if the document:
(a) Relates to the rights of a person with lim ited English
proficiency, the goods or services provided by the provider of
health care or the ability of a person with limited English
proficiency to obtain necessary health care;
(b) Must be accurately translated to ensure compliance with
subsection 1 or protect the health and well -being of a person with
limited English proficiency; or
(c) Is complex, nonliteral or technical.
Sec. 17. 1. A provider of health care shall not:
(a) Require a person with limited English pro ficiency to
provide his or her own interpreter or pay the cost of an interpreter;
(b) Utilize an adult who is not qualified as an interpreter
pursuant to section 19 of this act to interpret or facilitate
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communication for a person with limited English pro ficiency
except where authorized pursuant to subsection 2 or 3;
(c) Utilize a child who is less than 18 years of age to interpret
or facilitate communication for a person with limited English
proficiency except where authorized pursuant to subsection 2; or
(d) Utilize a person under the supervision of the provider of
health care who is not an interpreter or a translator qualified
pursuant to section 19 of this act to interpret or facilitate
communication for a person with limited English proficiency.
2. A provider of health care may utilize an adult who is not
qualified as an interpreter pursuant to section 19 of this act or a
child who is less than 18 years of age to interpret or facilitate
communication for a person with limited English proficiency on a
temporary, emergency basis if:
(a) There is an imminent threat to the safety or welfare of any
person or the public;
(b) An interpreter who is qualified pursuant to section 19 of
this act is not immediately available;
(c) The provider of health ca re is attempting to find an
interpreter who is qualified pursuant to section 19 of this act; and
(d) An interpreter who is qualified pursuant to section 19 of
this act later confirms or supplements the initial communications
with the interpreter utilized pursuant to this section.
3. A provider of health care may utilize an adult who is not
qualified as an interpreter pursuant to section 19 of this act to
interpret or facilitate communication for a person with limited
English proficiency if the person wit h limited English proficiency
requests for the adult to interpret or facilitate communication for
him or her. Such a request must be:
(a) Made without the adult present to an interpreter who is
qualified pursuant to section 19 of this act;
(b) Agreed to by the adult;
(c) Documented in the record of the person with limited
English proficiency; and
(d) Deemed appropriate under the circumstances by the
provider of health care.
Sec. 18. 1. A provider of health care may use a remote
interpreter to provide interpreting services necessary to comply
with section 16 of this act if the provider of health care utilizes
audio-visual communication technology or audio communication
technology that includes, without limitation, synchronous
interaction with audio and, if applicable, video over a high -speed,
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wide-bandwidth c onnection or wireless connection that , to the
extent possible:
(a) Does not produce a lag or irregular pauses in
communication or, if applicable, images;
(b) Provides transmission of voice that is clear and audible;
and
(c) If applicable, produces a hi gh-quality video image that is
not blurry or grainy and is large enough to display the face of the
interpreter and person with limited English proficiency, regardless
of body position.
2. A provider of health care shall provide training to a person
he or she supervises who is involved in using audio -visual
communication technology or audio communication technology to
facilitate the use of a remote interpreter. Such training must be
adequate to ensure that the person operates the technology
efficiently and effectively.
Sec. 19. An interpreter or translator is qualified to provide
interpretation or translation services pursuant to sections 15 to 20,
inclusive, of this act if the interpreter or translator:
1. Has demonstrate d proficiency in and understanding of
spoken or written, as applicable:
(a) English and at least one other language; or
(b) At least two languages that are not English if he or she is a
relay interpreter or translator;
2. Has demonstrated proficiency in interpreting or
translating, as applicable, effectively, accurately and impartially,
including, without limitation , using specialized vocabulary or
terms without change, omission or addition.
Sec. 20. 1. A provider of health care who violates any
provision of sections 15 to 20, inclusive, of this act may be
disciplined by the board, agency or other entity in this State by
which he or she is licensed, certified or regulated.
2. The board, agency or other entity in this State by which a
provider of health care is licensed, certified or regulated shall
determine if the provider of health care is in compliance with
sections 15 to 20, inclusive, of this act using the factors listed in
subsection 2 of section 16 of this act.
Sec. 21. NRS 654.190 is hereby amended to read as follows:
654.190 1. The Board may, after notice and an opportunity
for a hearing as required by law, impose an administrative fine of
not more than $10,000 for each violation on, recover reasonable
investigative fees and costs incurred from, suspend, revoke, deny
the issuance or renewal of or place conditions on the license of, and
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place on probation or impose any combination of the foregoing on
any licensee who:
(a) Is convicted of a felony relating to the practice of
administering a facility for skilled nursing or facility for
intermediate care or residential facility for groups or of any offense
involving moral turpitude.
(b) Has obtained his or her license by the use of fraud or deceit.
(c) Violates any of the provisions of this chapter.
(d) Aids or abets any person in the violation of any of the
provisions of NRS 449.029 to 449.2428, inclusive, and sections 2 to
8, inclusive, of this act or 449A.100 to 449A.124, inclusive, and
449A.270 to 449A.286, inclusive, as those provisions pertain to a
facility for skilled nursing, facility for intermediate care or
residential facility for groups.
(e) Violates any regulation of the Board prescribing additional
standards of conduct for licensees, including, without limitation, a
code of ethics.
(f) Engages in conduct that violates the trust of a patient or
resident or exploits the relationship between the licensee and the
patient or resident for the financial or other gain of the licensee.
2. If a licensee requests a hearing pursuant to subsection 1, t he
Board shall give the licensee written notice of a hearing pursuant to
NRS 233B.121 and 241.0333. A licensee may waive, in writing, his
or her right to attend the hearing.
3. The Board may compel the attendance of witnesses or the
production of documen ts or objects by subpoena. The Board may
adopt regulations that set forth a procedure pursuant to which the
Chair of the Board may issue subpoenas on behalf of the Board.
Any person who is subpoenaed pursuant to this subsection may
request the Board to mod ify the terms of the subpoena or grant
additional time for compliance.
4. An order that imposes discipline and the findings of fact and
conclusions of law supporting that order are public records.
5. The expiration of a license by operation of law or by order
or decision of the Board or a court, or the voluntary surrender of a
license, does not deprive the Board of jurisdiction to proceed with
any investigation of, or action or disciplinary proceeding against, the
licensee or to render a decision suspending or revoking the license.
Sec. 22. The provisions of NRS 354.599 do not apply to any
additional expenses of a local government that are related to the
provisions of this act.
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