Revises provisions relating to health care. (BDR 40-1037)

(Reprinted with amendments adopted on June 2, 2025)
FIRST REPRINT S.B. 495

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SENATE BILL NO. 495–COMMITTEE ON
HEALTH AND HUMAN SERVICES

(ON BEHALF OF THE OFFICE OF THE GOVERNOR)

MAY 15, 2025
____________

Referred to Committee on Health and Human Services

SUMMARY—Revises provisions relating to health care.
(BDR 40-1037)

FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Contains Appropriation included in
Executive Budget.

CONTAINS UNFUNDED MANDATE (§§ 20-22, 72.8)
(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; revising requirements governing
the electronic maintenance, t ransmittal and exchange of
health information; making revisions relating to
emergency medical care; prescribing certain requirements
to expedite the credentialing and privileging of providers
of health care; authorizing paramedics to serve as
employees or volunteers in hospitals under certain
circumstances; imposing certain requirements governing
prior authorization for medical care and payment of health
insurance claims; making various revisions relating to
Medicaid; creating and prescribing the duties of the
Office of Mental Health in the Department of Health and
Human Services or the Nevada Health Authority , if it is
created; prohibiting noncompetition covenants governing
certain providers of health care ; requiring the
prioritization of certain applicatio ns for licensure as a
physician or osteopathic physician; requiring certain
providers of health care to provide certain data to the
Department; requiring certain reports of the Board of
Medical Examiners and the State Board of Osteopathic

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Medicine to inclu de certain information; authorizing the
establishment of an alternative pathway to licensure as a
dental hygienist; establishing provisions to incentivize the
provision of psychological services to rural patients;
requiring the Patient Protection Commissio n to study
academic medical centers; making appropriations;
providing a penalty; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing law requires the Department of Health and Human Services, or the 1
Director of the Department or the divisions thereof, to conduct various programs 2
for the improvement of public health and health care in this State. (NRS 433.702 -3
433.744, 439.4921 -439.525, 439.529 -439.5297, 439.630, 439A.111 -439A.185, 4
439A.200-439A.290, 442.710 -442.745, 457.230-457.280, 458.025, 458A.090, 5
458A.100, 458A.110) 6
Section 7 of this bill requires the Director to conduct a biennial assessment of 7
the health care workforce needs of this State, which must identify health care 8
professions and specialties, types of clinical services and expertise and geographic 9
areas experiencing critical shortages of providers of health care or clinical services 10
or expertise. Section 42 of this bill provides that such an assessment is not a 11
regulation and is therefore not subject to notice-and-comment rulemaking. 12
Existing law requires the Director to prescribe by regulation a framework for 13
the electronic maintenance, transmittal and exchange of electronic health records, 14
prescriptions, health-related information and electronic signatures and requirements 15
for electronic equivalents of written entries or written approvals. With certain 16
exceptions, existing law requires various entities involved in health care, including 17
persons and facilities that provide health care, to maintain, tra nsmit and exchange 18
health information in accordance with those regulations. (NRS 439.589) Section 19
3.6 of this bill prohibits those regulations from authorizing such a person or entity 20
to comply with that requirement by connecting with a health information exchange 21
or utilizing any other service that charges a fee for providing electronic health 22
records to such a person or entity or a patient upon request. Section 72.8 of this 23
bill: (1) requires a custodian of health care records to furnish electronic health 24
records to a patient or certain other entities upon the request of a patient within 7 25
business days; and (2) prohibits a custodian of health care records from charging a 26
fee to furnish health care records under such circumstances. 27
Sections 3.3, 72.3 and 126 of this bill limit the health care providers that must 28
maintain, transmit and exchange health inf ormation electronically to medical 29
facilities and high -level providers of health care. Section 1 of this bill defines the 30
term “high-level provider of health care” to mean a physician, physician assistant, 31
dentist, advanced practice registered nurse, chiro practic physician, podiatric 32
physician or physical therapist. Section 3.3 additionally exempts from requirements 33
to maintain, transmit and exchange health information electronically high -level 34
providers of health care whose solo or group practices are unde r a certain size. 35
However, section 3.3 requires such high -level providers of health care to furnish 36
the medical records of a patient electronically to the patient or another person or 37
entity upon request of the patient. Section 4.5 of this bill makes confo rming 38
changes to revise the applicability of a provision requiring the Department to notify 39
the licensing board of a provider who fails to comply with requirements governing 40
the electronic maintenance, transmittal and exchange of health information. Section 41
1.5 of this bill establishes the applicability of the definition set forth in section 1, 42
and sections 43, 45.5, 67.9, 116.3 and 116.7 of this bill make other conforming 43

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changes to indicate the proper placement of section 1 in the Nevada Revised 44
Statutes. Section 72.5 of this bill updates internal references changed by 45
section 72.3. 46
Existing law prohibits a person or entity from operating an independent center 47
for emergency medical care without a license issued by the Division of Public and 48
Behavioral He alth of the Department. (NRS 449.030) Section 22.5 of this bill 49
requires a facility that is structurally separate from the hospital and provides 50
services for the treatment of a medical emergency, including such a facility that is 51
owned or operated by, or o therwise part of, a hospital, to be licensed as an 52
independent center for emergency medical care. (NRS 449.0151, 449.030) Sections 53
24.3 and 24.5 of this bill prohibit the Division or the State Board of Health from 54
charging a fee for the issuance of such a license. Section 24.8 of this bill prohibits 55
the Division from issuing a license to operate an independent center for emergency 56
medical care that is located within a 5 mile radius of another independent center for 57
emergency medical care or a hospital with an emergency department. However, 58
section 120.6 of this bill requires the Division to issue a license to certain such 59
independent centers for emergency medical care that are currently licensed or had 60
taken certain steps toward operating by January 1, 2025 . Section 26.5 of this bill 61
requires an independent center for emergency medical care to provide urgent care 62
services during all operating hours and imposes certain additional requirements 63
related to the provision of such urgent care, except that section 120.3 of this bill 64
exempts from that requirement independent centers for emergency medical care 65
that are licensed on the date on which this bill is enacted. 66
Existing law establishes programs to increase awareness of information 67
concerning hospitals and surgical centers for ambulatory patients. (NRS 439A.200 -68
439A.290) Section 9 .5 of this bill requires the Department to establish a similar 69
program to increase awareness of information concerning independent centers for 70
emergency medical care. Sections 9.5, 10.5, 12.5, 13.5 and 27.3 of this bill provide 71
for the Department to collect certain information on the operations of independent 72
centers for emergency medical care and the outcomes for patients treated by 73
independent centers for emergency medical care. To facilitate such reporting, 74
section 27.3 requires an independent center for emergency medical care to use the 75
same form prescribed by the Director for discharging patients as a hospital is 76
currently required to use. Section 95.5 of this bill makes a conform ing change to 77
reflect that independent centers for emergency medical care will be using the same 78
form. Sections 12 .5 and 13 .5 require the Department to: (1) make certain 79
information concerning independent centers for emergency medical care available 80
upon request; and (2) post certain information concerning independent centers for 81
emergency medical care on an Internet website maintained by the Department. 82
Sections 11.2 and 41.5 of this bill make conforming changes to add references to 83
independent centers for emergency medical care to sections that discuss the 84
program and associated website . Section 8.5 of this bill defines the term 85
“independent center for emergency medical care” for that purpose. Section 11.5 of 86
this bill establishes the applicability of cert ain definitions. Section 27.7 of this bill 87
requires a report prepared by the Director on the status of the programs to increase 88
public awareness of information concerning hospitals and surgical centers for 89
ambulatory patients to additionally include information on the status of the program 90
to increase awareness of information concerning independent centers for 91
emergency medical care. Section 51.3 of this bill requires the Director of the 92
Department, to the extent that money is available, to include under Me dicaid a 93
system of value -based payments for care provided by independent centers for 94
emergency medical care to recipients of Medicaid. 95
Existing law authorizes a court, upon a petition, to order the sealing of records 96
of certain convictions if the person w ho was convicted: (1) has not been convicted 97
of any additional offense, except for minor traffic violations, for a specified period 98

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of time; and (2) does not have charges pending for any offense, except for minor 99
traffic violations. (NRS 179.245) Existing law also authorizes a court, upon a 100
petition, to order the sealing of records of an arrest where the charges were 101
dismissed, the prosecutor declined to prosecute or the person who was arrested was 102
acquitted. (NRS 179.255) Section 32.5 of this bill authorizes the Department or the 103
Division of Health Care Financing and Policy of the Department to review certain 104
sealed records for the purpose of determining the suitability of the person to whom 105
the records pertain to serve as a provider of services under Medic aid or to own or 106
serve as an officer, managing employee or managing agent of such a provider of 107
services. 108
Existing law prescribes a procedure for conducting a hearing to review an 109
action taken against a provider of services under Medicaid. (NRS 422.306) Section 110
51.5 of this bill requires such a provider of services to maintain and provide certain 111
documents to the Department for the purpose of verifying claims. Section 51.5 112
authorizes the Department to deny a claim or recover money already paid if the 113
Department is unable to verify the claim. Section 51.8 of this bill: (1) prescribes a 114
process for the Department to review claims for appropriateness and propriety; and 115
(2) authorizes the Department to deny or recover any amount paid pursuant to such 116
a claim or take certain actions based on such a review. Section 119.5 of this bill 117
makes an appropriation to the Division of Health Care Financing and Policy of the 118
Department and authorizes the expenditure of certain other money to carry out 119
sections 51.3-51.8. 120
Section 67 of this bill: (1) creates the Office of Mental Health within the 121
Department; and (2) requires the Director to appoint the Executive Director of the 122
Office. Section 67.2 of this bill requires the Office to perform certain duties to 123
improve access to and the effectiveness of mental health services in this State. 124
Section 67.4 of this bill requires the Office to perform certain additional duties 125
related to the mental and behavioral health of children. Sections 67.6-67.8 of this 126
bill require the subcom mittee on the mental health of children of the Commission 127
on Behavioral Health and each mental health consortium to support those duties. 128
Section 67.5 of this bill requires the Office to submit a biennial report to the 129
Legislature. Section 66.6 of this bil l defines the term “Office” for the purposes of 130
sections 67-67.5 to refer to the Office of Mental Health. Senate Bill No. 494 of this 131
legislative session proposes to create a new department in the Executive Branch of 132
State Government known as the Nevada He alth Authority to perform certain duties 133
related to health care, including behavioral health care, in this State. Section 121.5 134
of this bill transfers the Office to the Nevada Health Authority if Senate Bill No. 135
494 is enacted. 136
Section 89 of this bill req uires the Board of Psychological Examiners to: (1) 137
take certain actions to incentivize licensees to receive continuing education 138
concerning the mental health needs of patients in rural areas; and (2) establish a 139
program to recognize psychologists who provi de at least 200 hours of services 140
through telehealth to such patients. 141
Sections 20, 46, 50, 75, 85, 109 and 113 of this bill prescribe requirements to 142
expedite the process of credentialing providers of health care to participate in 143
public and private health insurance plans. Beginning on January 1, 2027, sections 144
117 and 118 of this bill require insurers that issue such plans, or entities to which 145
such insurers delegate credentialing functions, to process least 95 percent of 146
complete requests for such credentialing not later than 60 days after receiving all of 147
the information necessary to complete such a request. Beg inning on January 1, 148
2027, section 21 of this bill similarly requires a hospital to process at least 95 149
percent of complete requests from providers of health care for privileges to perform 150
services at the hospital not later than 60 days after receiving all of the information 151
necessary to complete such a request. 152

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Existing law authorizes an emergency medical technician, advanced emergency 153
medical technician or paramedic who holds the proper endorsement to provide 154
services, known as community paramedicine services, to patients who do not 155
require emergency medical transportation. (NRS 450B.1993) Sections 29-31 of this 156
bill authorize paramedics to serve as employees or volunteers in a hospital under 157
certain circumstances and with certain limitations. 158
Existing law provides that a noncompetition cov enant is void unless the 159
covenant: (1) is supported by valuable consideration; (2) does not impose any 160
restraint that is greater than is required for the protection of the employer; (3) does 161
not impose any undue hardship on the employee; and (4) imposes re strictions that 162
are appropriately related to the consideration for the covenant. (NRS 613.195) 163
Section 71 of this bill provides that a noncompetition covenant may not apply to a 164
provider of health care whose primary duties involve providing clinical care t o 165
patients and who is not employed or contracted to primarily perform administrative 166
tasks. 167
Sections 74 and 84 of this bill require the Board of Medical Examiners and the 168
State Board of Osteopathic Medicine, respectively, to establish by regulation a 169
procedure for prioritizing applications for licensure as a physician or osteopathic 170
physician of applicants who plan to: (1) serve underserved geographic areas or 171
populations in this State; or (2) practice a specialty for which there is a shortage in 172
this State. Sections 76 and 86 of this bill require certain reports submitted by those 173
Boards to the Governor and Legislature to include information relating to the 174
efficiency of the process for licensing physicians or osteopathic physicians, as 175
applicable. 176
Existing law requires the Director to: (1) develop and make available to each 177
professional licensing board that licenses, certifies or registers providers of health 178
care an electronic data request that solicits certain information relating to the 179
demographics a nd practices of providers of health care; and (2) establish and 180
maintain a database of information collected through the data request. (NRS 181
439A.116) Under existing law, providers of health care applying to renew a license, 182
certificate or registration may, but are not required to, complete the data request. 183
(NRS 450B.805, 630.2671, 630A.327, 631.332, 632.3423, 633.4716, 634.1303, 184
634A.169, 635.111, 636.262, 637.145, 637B.192, 639.183, 640.152, 640A.185, 185
640B.405, 640D.135, 640E.225, 641.2215, 641A.217, 641B .281, 641C.455, 186
652.126) Sections 76.5, 82.3, 82.6, 86. 2-86.8 and 89.2 -89.9 of this bill make 187
completion of the data request mandatory to renew a license, certificate or 188
registration issued by: (1) the Board of Medical Examiners; (2) the Board of Dental 189
Examiners of Nevada; (3) the State Board of Nursing; (4) the State Board of 190
Osteopathic Medicine; (5) the State Board of Podiatry; (6) the Nevada State Board 191
of Optometry; (7) the Board of Dispensing Opticians; (8) the Board of 192
Psychological Examiners; (9) t he Board of Examiners for Marriage and Family 193
Therapists and Clinical Professional Counselors; (10) the Board of Examiners for 194
Social Workers; (11) the Board of Examiners for Alcohol, Drug and Gambling 195
Counselors; and (12) the Board of Applied Behavior Ana lysis. Section 42.5 of this 196
bill makes a conforming change to ensure the confidentiality of information 197
submitted through such a data request. 198
Existing law requires an applicant for licensure as a dental hygienist to have 199
graduated from an accredited prog ram of dental hygiene that meets certain 200
requirements. (NRS 631.290) Sections 77 and 79 of this bill authorize the Board of 201
Dental Examiners of Nevada to establish by regulation an alternative training 202
pathway involving a course of training under the super vision of a licensed dentist 203
that an applicant for such a license may complete instead of graduating from such a 204
program. Section 77 requires an applicant who has completed the alternative 205
training pathway to have also successfully passed: (1) a competency examination 206
conducted by the supervising dentist; (2) a written examination; and (3) a clinical 207

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examination approved by the Board. Section 78 of this bill requires such an 208
applicant to submit with his or her application for licensure proof that he or she has 209
passed those examinations. Section 77 provides that a person who completes the 210
alternative training pathway is only eligible for licensure if he or she began the 211
pathway during a biennium during which there was shortage of dental hygienists, as 212
documented by the assessment conducted pursuant to section 7. Section 77 213
requires the Board to adopt regulations establishing the scope of practice of a dental 214
hygienist who has completed the alternative training pathway . Section 81 of this 215
bill prohibits a dental hygienist who has completed the alternative training pathway 216
and has not subsequently graduated from an accredited program of dental hygiene 217
from prescribing and dispensing preventive agents. 218
Existing law requires the Dep artment to administer Medicaid and the 219
Children’s Health Insurance Program. (NRS 422.270) Existing federal law 220
authorizes: (1) a hospital to elect to make determinations concerning whether 221
certain persons are presumptively eligible for Medicaid; and (2) a state to allow 222
certain other entities to make such determinations. (42 U.S.C. §§ 1396a(a)(47), 223
1396r-1, 1396r -1a, 1396r -1b, 1396r -1c) Section 51 of this bill requires the 224
Department to take certain measures to facilitate such presumptive eligibility 225
determinations by the personnel of hospitals and qualified community -based 226
organizations. Section 51 also requires the Department to audit such entities to 227
ensure that the presumptive eligibility determinations made by the personnel of 228
those entities are accurate and comply with applicable law. 229
Existing law authorizes certain health insurers to require prior authorization 230
before an insured may receive coverage for medical and dental care in certain 231
circumstances. If an insurer requires prior authorization, exist ing law requires the 232
insurer to: (1) file its procedure for obtaining prior authorization with the 233
Commissioner of Insurance for approval; and (2) respond to a request for prior 234
authorization within 20 days after receiving the request. (NRS 687B.225) 235
Beginning on January 1, 2028, sections 47, 53-62, 69, 97-108 and 110 of this bill 236
establish additional requirements relating to the use of prior authorization for 237
medical care by health insurers, including Medicaid, the Children’s Health 238
Insurance Program and i nsurance for state employees, as well as certain entities 239
with which such insurers contract to perform functions relating to prior 240
authorization. Sections 53.5, 54, 55 and 98-100 define certain terms, and sections 241
53 and 97 establish the applicability of t hose definitions. Section 101.6 of this bill 242
requires certain insurers and other entities that employ or utilize an artificial 243
intelligence system or automated decision tool to process requests for prior 244
authorization to transmit a notice to each insured that: (1) discloses the insurer’s use 245
of the system or tool to process requests for prior authorization; and (2) describes 246
certain aspects of the system or tool. Sections 56 and 110 require an insurer or 247
other entity that performs functions relating to prio r authorization to respond to a 248
request for prior authorization within a specified period of time . If an insurer or 249
other entity that performs functions relating to prior authorization is unable to 250
approve or deny a request for prior authorization within t hat time period, sections 251
56 and 110 require the insurer or entity to notify the insured and his or her provider 252
of health care of the delay. Sections 58 and 102 prescribe the required contents of 253
that notice. Sections 59 and 103 require an insurer or other entity that performs 254
functions relating to prior authorization to provide similar notice upon denying a 255
request for prior authorization and establish a process to appeal such a denial. 256
Sections 56 and 110 prohibit insurers and other entities that perform functions 257
relating to prior authorization from requiring prior authorization for covered 258
emergency services. Sections 57 and 101 require insurers and other entities that 259
perform functions relating to prior authorization to impl ement an electronic system 260
for receiving and processing requests for prior authorization. Sections 22 and 72 of 261

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this bill require certain medical facilities and providers of health care to submit 262
requests for prior authorization through those systems. 263
Sections 60 and 104 limit the circumstances under which an insurer or other 264
entity that performs functions relating to prior authorization may: (1) revoke the 265
approval of a request for prior authorization; (2) delay or deny payment for care to 266
which such a re quest pertains; or (3) assign a lower billing code or otherwise 267
reduce the payment for such care. Sections 61 and 105 prescribe certain 268
requirements to ensure the continuity of care for an insured whose benefits are 269
terminated or who switches health insura nce plans. Sections 62 and 106 provide 270
for the reporting and publication of certain information relating to prior 271
authorization and the payment of claims. Section 107 establishes the Gold Card 272
Exemption Program to exempt providers of health care whose requ ests for prior 273
authorization are approved at a rate of at least 95 percent from the requirement to 274
obtain prior authorization for certain services. Section 56 requires the Department, 275
with respect to Medicaid and the Children’s Health Insurance Program, or a 276
Medicaid managed care organization to grant Gold Card Exemptions to providers 277
of health care in accordance with section 107 except in certain circumstances. 278
Section 63 of this bill requires Medicaid and the Children’s Health Insurance 279
Program to comply with certain requirements governing the prompt payment of 280
claims that apply under existing law to private insurers and the Public Employees’ 281
Benefits Program. (NRS 683A.0879, 689A.410, 689B.255, 689C.355, 689A.188, 282
695B.2505, 695C.185, 695D.215) Section 63 additionally requires Medicaid to 283
comply with certain federal requirements governing the timely payment of claims 284
under Medicaid. (42 C.F.R. § 447.45(d)(2),(3)) 285
Section 108 requires the Commissioner to adopt regulations prescribing: (1) 286
requirements to ensure that applicants for certain certificates or approval to engage 287
in business related to insurance are equipped to comply with certain requirements 288
governing prior authorization and the payment of health claims; and (2) criteria to 289
ensure that an insure r or other entity that enters into a contract to provide services 290
for certain public insurance programs is in compliance with those requirements. 291
Sections 45, 91, 93-95 and 116 of this bill make various changes to establish the 292
applicability of those regulations. Section 92 of this bill makes a conforming 293
change to indicate the proper placement of section 91 in the Nevada Revised 294
Statutes. Section 108 additionally requires the C ommissioner to perform certain 295
other duties relating to the implementation and enforcement of requirements 296
governing prior authorization and the payment of health claims. Section 65 of this 297
bill requires the prior authorization policies and procedures for prescription drugs 298
under Medicaid to comply with sections 53-63. Section 41 of this bill requires the 299
Director of the Department to administer sections 50-63 in the same manner as 300
other provisions governing Medicaid. Sections 47, 69 and 114 of this bill ma ke 301
sections 97-108 and 110 applicable to insurance for state and private employees 302
and nonprofit hospital or medical services corporations. Section 101.3 of this bill 303
makes sections 10 1.8-105 and 110 inapplicable to Medicaid managed care 304
organizations, which are instead required to comply with sections 56 and 58 -61. 305
Sections 23, 24, 25, 26, 27, 90, 111 and 112 of this bill make conforming changes 306
concerning the applicability and enforcement of sections 20-22 and 109. 307
Section 121 of this bill requires the Patient Protection Commission to conduct a 308
study during the 2025 -2026 interim concerning academic medical centers in this 309
State, and section 120 of this bill appropriates money for the study. 310

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

Section 1. Chapter 439 of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
“High-level provider of health care” means a physician or 3
physician assistant licensed pursuant to chapter 630 or 633 of 4
NRS, dentist, advanced practice registered nurse, chiropractic 5
physician, podiatric physician or physical therapist. 6
Sec. 1.5. NRS 439.581 is hereby amended to read as follows: 7
439.581 As used in NRS 439.581 to 439.597, inclusive, and 8
section 1 of this act, unless the context otherwise requires, the 9
words and terms defined in NRS 439.582 to 439.585, inclusive, and 10
section 1 of this act have the meanings ascribed to them in those 11
sections. 12
Sec. 2. (Deleted by amendment.) 13
Sec. 2.5. NRS 439.588 is hereby amended to read as follows: 14
439.588 1. A health information exchange shall not operate 15
in this State without first obtaining certification as provided in 16
subsection 2. 17
2. The Director shall by regulation establish the manner in 18
which a health information exchange may apply for certification and 19
the requirements for granting such certification, which must include, 20
without limitation, that the health information exchange demonstrate 21
its financial and operational sustainability, adherence to the privacy, 22
security and patient consent standards adopted pursuant to NRS 23
439.589 and capacity for interoperability with any other health 24
information exchange certified pursuant to this section. 25
3. The Director may deny an application for certification or 26
may suspend or revoke any certification issued pursuant to 27
subsection 2 for failure to comply with the provisions of NRS 28
439.581 to 439.597, inclusive, and section 1 of this act or the 29
regulations adopted pursuant thereto or any applicable federal or 30
state law. 31
4. When the Director intends to deny, suspend or revoke a 32
certification, he or she shall give reasonable notice to all parties by 33
certified mail. The notice must contain the leg al authority, 34
jurisdiction and reasons for the action to be taken. A health 35
information exchange that wishes to contest the action of the 36
Director must file an appeal with the Director. 37
5. The Director shall adopt regulations establishing the manner 38
in which a person may file a complaint with the Director regarding a 39
violation of the provisions of this section. 40
6. The Director may impose an administrative fine against a 41
health information exchange which operates in this State without 42

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holding a certifica tion in an amount established by the Director by 1
regulation. The Director shall afford a health information exchange 2
so fined an opportunity for a hearing pursuant to the provisions of 3
NRS 233B.121. 4
7. The Director may adopt such regulations as he or she 5
determines are necessary to carry out the provisions of this section. 6
Sec. 3. (Deleted by amendment.) 7
Sec. 3.3. NRS 439.589 is hereby amended to read as follows: 8
439.589 1. The Director, in consultation with health care 9
providers, third parties and other interested persons and entities, 10
shall by regulation prescribe a framework for the electronic 11
maintenance, transmittal and exchange of electronic health records, 12
prescriptions, h ealth-related information and electronic signatures 13
and requirements for electronic equivalents of written entries or 14
written approvals in accordance with federal law. The regulations 15
must: 16
(a) Establish standards for networks and technologies to be used 17
to maintain, transmit and exchange health information, including, 18
without limitation, standards: 19
(1) That require: 20
(I) The use of networks and technologies that allow 21
patients to access electronic health records directly from the health 22
care provider of the patient and forward such electronic health 23
records electronically to other persons and entities; and 24
(II) The interoperability of such networks and 25
technologies in accordance with the applicable standards for the 26
interoperability of Qualified He alth Information Networks 27
prescribed by the Office of the National Coordinator for Health 28
Information Technology of the United States Department of Health 29
and Human Services; 30
(2) To ensure that electronic health records retained or shared 31
are secure; 32
(3) To maintain the confidentiality of electronic health 33
records and health -related information, including, without 34
limitation, standards to maintain the confidentiality of electronic 35
health records relating to a child who has received health care 36
services without the consent of a parent or guardian and which 37
ensure that a child’s right to access such health care services is not 38
impaired; 39
(4) To ensure the privacy of individually identifiable health 40
information, including, without limitation, standards to ensure the 41
privacy of information relating to a child who has received health 42
care services without the consent of a parent or guardian; 43
(5) For obtaining consent from a patient before retrieving the 44
patient’s health records from a health information ex change, 45

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including, without limitation, standards for obtaining such consent 1
from a child who has received health care services without the 2
consent of a parent or guardian; 3
(6) For making any necessary corrections to information or 4
records; 5
(7) For noti fying a patient if the confidentiality of 6
information contained in an electronic health record of the patient is 7
breached; 8
(8) Governing the ownership, management and use of 9
electronic health records, health -related information and related 10
data; and 11
(9) For the electronic transmission of prior authorizations for 12
prescription medication; 13
(b) Ensure compliance with the requirements, specifications and 14
protocols for exchanging, securing and disclosing electronic health 15
records, health -related information and related data prescribed 16
pursuant to the provisions of the Health Information Technology for 17
Economic and Clinical Health Act, 42 U.S.C. §§ 300jj et seq. and 18
17901 et seq., the Health Insurance Portability and Accountability 19
Act of 1996, Public Law 104 -191, and other applicable federal and 20
state law; and 21
(c) Be based on nationally recognized best practices for 22
maintaining, transmitting and exchanging health information 23
electronically. 24
2. The standards prescribed pursuant to this section must 25
include, without limitation: 26
(a) Requirements for the creation, maintenance and transmittal 27
of electronic health records; 28
(b) Requirements for protecting confidentiality, including 29
control over, access to and the collection, organization and 30
maintenance of electronic health records, health-related information 31
and individually identifiable health information; 32
(c) Requirements for the manner in which a patient may, 33
through a health care provider who participates in the sharing of 34
health records using a health information exchange, revoke his or 35
her consent for a health care provider to retrieve the patient’s health 36
records from the health information exchange; 37
(d) A secure and traceable electronic audit system for 38
identifying access points and trails to elect ronic health records and 39
health information exchanges; and 40
(e) Any other requirements necessary to comply with all 41
applicable federal laws relating to electronic health records, health -42
related information, health information exchanges and the security 43
and confidentiality of such records and exchanges. 44

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3. The regulations adopted pursuant to this section must not 1
require any person or entity to use a health information exchange. 2
4. Except as otherwise provided in subsections 5, 6 and 7, the 3
Department and the divisions thereof, other state and local 4
governmental entities, medical facilities, high -level providers of 5
health care , [providers,] third parties, pharmacy benefit manage rs 6
and other entities licensed or certified pursuant to title 57 of NRS 7
shall maintain, transmit and exchange health information in 8
accordance with the regulations adopted pursuant to this section, the 9
provisions of NRS 439.581 to 439.597, inclusive, and section 1 of 10
this act and any other regulations adopted pursuant thereto. 11
5. The Federal Government and employees thereof, a provider 12
of health coverage for federal employees, a provider of health 13
coverage that is subject to the Employee Retirement Incom e 14
Security Act of 1974, 29 U.S.C. §§ 1001 et seq., or a Taft -Hartley 15
trust formed pursuant to 29 U.S.C. § 186(c)(5) is not required to but 16
may maintain, transmit and exchange electronic information in 17
accordance with the regulations adopted pursuant to this section. 18
6. A high-level provider of health care [provider] may apply to 19
the Department for a waiver from the provisions of subsection 4 on 20
the basis that the high-level provider of health care [provider] does 21
not have the infrastructure necessary to comply with those 22
provisions, including, without limitation, because the health care 23
provider does not have access to the Internet. The Department shall 24
grant a waiver if it determines that: 25
(a) The high-level provider of health care [provider] does not 26
currently have the infrastructure necessary to comply with the 27
provisions of subsection 4; and 28
(b) Obtaining such infrastructure is not reasonably practicable, 29
including, without limitation, because the cost of such infrastructure 30
would make it difficult f or the high-level provider of health care 31
[provider] to continue to operate. 32
7. The provisions of subsection 4 do not apply to [the] : 33
(a) The Department of Corrections [.] ; 34
(b) A high -level provider of health care whose solo practice 35
provided care to fewer than 500 patients during the immediately 36
preceding year and reasonably expects to provide care to fewer 37
than 500 patients during the current year; or 38
(c) A high -level provider of health care who, in combination 39
with all other members of his or her group practice provided care 40
to fewer than 500 patients during the immediately preceding year 41
and reasonably expects to provide care to fewer than 500 patients 42
during the current year. 43
8. A high -level provider of health care described in 44
paragraphs (b) and (c) of subsection 7 shall furnish the medical 45

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records of a patient electronically to the patient or, upon the 1
request of the patient, another person or entity, in accordance with 2
NRS 629.062. 3
9. A violation of the provisions of this section or any 4
regulations adopted pursuant thereto is not a misdemeanor. 5
[9.] 10. As used in this section: 6
(a) “Medical facility” has the meaning ascribed to it in 7
NRS 449.0151. 8
(b) “Pharmacy benefit manager” has the meaning ascribed to it 9
in NRS 683A.174. 10
[(b)] (c) “Third party” means any insurer, governmental entity 11
or other organization providing health coverage or benefits in 12
accordance with state or federal law. 13
Sec. 3.6. NRS 439.589 is hereby amended to read as follows: 14
439.589 1. The Director, in consultation with health care 15
providers, third parties and other interested persons and entities, 16
shall by regulation prescribe a framework for the electronic 17
maintenance, transmittal and exchange of electronic health records, 18
prescriptions, health -related information and electronic signatures 19
and requirements for electronic equivalents of written entries or 20
written approvals in accordance with federal law. The regulations 21
must: 22
(a) Establish standards for networks and technologies to be used 23
to maintain, transmit and exchange health information, including, 24
without limitation, standards: 25
(1) That require: 26
(I) The use of networks and technologies that allow 27
patients to access electronic health records directly from the health 28
care provider of the patient and forward such electronic health 29
records electronically to other persons and entities; and 30
(II) The interoperability of such networks and 31
technologies in accordance with the applicable standards for the 32
interoperability of Qualified Health Information Networks 33
prescribed by the Office of the National Coordinator for Health 34
Information Technology of the United States Department of Health 35
and Human Services; 36
(2) To ensure that electronic health records retained or shared 37
are secure; 38
(3) To maintain the confidentiality of electronic health 39
records and health -related information, including, without 40
limitation, standards to maintain the confidentiality of electronic 41
health records relating to a child who has received healt h care 42
services without the consent of a parent or guardian and which 43
ensure that a child’s right to access such health care services is not 44
impaired; 45

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(4) To ensure the privacy of individually identifiable health 1
information, including, without limitation, standards to ensure the 2
privacy of information relating to a child who has received health 3
care services without the consent of a parent or guardian; 4
(5) For obtaining consent from a patient before retrieving the 5
patient’s health records from a health information exchange, 6
including, without limitation, standards for obtaining such consent 7
from a child who has received health care services without the 8
consent of a parent or guardian; 9
(6) For making any necessary corrections to information or 10
records; 11
(7) For notifying a patient if the confidentiality of 12
information contained in an electronic health record of the patient is 13
breached; 14
(8) Governing the ownership, management and use of 15
electronic health records, health -related information an d related 16
data; and 17
(9) For the electronic transmission of prior authorizations for 18
prescription medication; 19
(b) Ensure compliance with the requirements, specifications and 20
protocols for exchanging, securing and disclosing electronic health 21
records, hea lth-related information and related data prescribed 22
pursuant to the provisions of the Health Information Technology for 23
Economic and Clinical Health Act, 42 U.S.C. §§ 300jj et seq. and 24
17901 et seq., the Health Insurance Portability and Accountability 25
Act of 1996, Public Law 104 -191, and other applicable federal and 26
state law; and 27
(c) Be based on nationally recognized best practices for 28
maintaining, transmitting and exchanging health information 29
electronically. 30
2. The standards prescribed pursuant to thi s section must 31
include, without limitation: 32
(a) Requirements for the creation, maintenance and transmittal 33
of electronic health records; 34
(b) Requirements for protecting confidentiality, including 35
control over, access to and the collection, organization a nd 36
maintenance of electronic health records, health -related information 37
and individually identifiable health information; 38
(c) Requirements for the manner in which a patient may, 39
through a health care provider who participates in the sharing of 40
health reco rds using a health information exchange, revoke his or 41
her consent for a health care provider to retrieve the patient’s health 42
records from the health information exchange; 43

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(d) A secure and traceable electronic audit system for 1
identifying access points a nd trails to electronic health records and 2
health information exchanges; and 3
(e) Any other requirements necessary to comply with all 4
applicable federal laws relating to electronic health records, health -5
related information, health information exchanges an d the security 6
and confidentiality of such records and exchanges. 7
3. The regulations adopted pursuant to this section must not 8
[require] : 9
(a) Require any person or entity to use a health information 10
exchange [.] ; or 11
(b) Authorize a person or entity d escribed in subsection 4 to 12
comply with the requirements of that subsection by: 13
(1) Connecting with a health information exchange; or 14
(2) Utilizing any other service that charges a fee to such a 15
person or entity or a patient for providing electronic h ealth 16
records to a patient upon request in violation of NRS 629.062. 17
4. Except as otherwise provided in subsections 5, 6 and 7, the 18
Department and the divisions thereof, other state and local 19
governmental entities, medical facilities, high -level provider s of 20
health care, third parties, pharmacy benefit managers and other 21
entities licensed or certified pursuant to title 57 of NRS shall 22
maintain, transmit and exchange health information in accordance 23
with the regulations adopted pursuant to this section, th e provisions 24
of NRS 439.581 to 439.597, inclusive, and section 1 of this act and 25
any other regulations adopted pursuant thereto. 26
5. The Federal Government and employees thereof, a provider 27
of health coverage for federal employees, a provider of health 28
coverage that is subject to the Employee Retirement Income 29
Security Act of 1974, 29 U.S.C. §§ 1001 et seq., or a Taft -Hartley 30
trust formed pursuant to 29 U.S.C. § 186(c)(5) is not required to but 31
may maintain, transmit and exchange electronic information in 32
accordance with the regulations adopted pursuant to this section. 33
6. A high -level provider of health care may apply to the 34
Department for a waiver from the provisions of subsection 4 on 35
the basis that the high -level provider of health care does not hav e 36
the infrastructure necessary to comply with those provisions, 37
including, without limitation, because the health care provider does 38
not have access to the Internet. The Department shall grant a waiver 39
if it determines that: 40
(a) The high -level provider of health care does not currently 41
have the infrastructure necessary to comply with the provisions of 42
subsection 4; and 43
(b) Obtaining such infrastructure is not reasonably practicable, 44
including, without limitation, because the cost of such infrastructure 45

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would make it difficult for the high -level provider of health care to 1
continue to operate. 2
7. The provisions of subsection 4 do not apply to: 3
(a) The Department of Corrections; 4
(b) A high -level provider of health care whose solo practice 5
provided care to fewer than 500 patients during the immediately 6
preceding year and reasonably expects to provide care to fewer than 7
500 patients during the current year; or 8
(c) A high -level pro vider of health care who, in combination 9
with all other members of his or her group practice provided care to 10
fewer than 500 patients during the immediately preceding year and 11
reasonably expects to provide care to fewer than 500 patients during 12
the current year. 13
8. A high-level provider of health care described in paragraphs 14
(b) and (c) of subsection 7 shall furnish the medical records of a 15
patient electronically to the patient or, upon the request of the 16
patient, another person or entity, in accordance with NRS 629.062. 17
9. A violation of the provisions of this section or any 18
regulations adopted pursuant thereto is not a misdemeanor. 19
10. As used in this section: 20
(a) “Medical facility” has the meaning ascribed to it in 21
NRS 449.0151. 22
(b) “Pharmacy benefit manager” has the meaning ascribed to it 23
in NRS 683A.174. 24
(c) “Third party” means any insurer, governmental entity or 25
other organization providing health coverage or benefits in 26
accordance with state or federal law. 27
Sec. 4. (Deleted by amendment.) 28
Sec. 4.5. NRS 439.5895 is hereby amended to read as follows: 29
439.5895 1. The Department shall notify each regulatory 30
body of this State that has issued a current, valid license to a 31
licensed provider or insurer if: 32
(a) The Department determines that the licensed provider or 33
insurer is not in compliance with the requirements of subsection 4 of 34
NRS 439.589 [;] and 35
[(b) The] the licensed provider or insurer: 36
(1) Is not exempt from t hose requirements pursuant to 37
subsection 5 of NRS 439.589; and 38
(2) Has not received a waiver of those requirements pursuant 39
to subsection 6 of NRS 439.589 [.] ; or 40
(b) The licensed provider or insurer is a high -level provider of 41
health care who is exem pt from the requirements of subsection 4 42
of NRS 439.589 pursuant to paragraph (b) or (c) of subsection 7 43
of NRS 439.589 and the Department determines that the high-level 44

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- *SB495_R1*
provider of health care is not in compliance with subsection 8 of 1
NRS 439.589. 2
2. If the Department determines that a licensed provider or 3
insurer for which notice was previously provided pursuant to 4
subsection 1 has come into compliance with the requirements of 5
subsection 4 of NRS 439.589, the Department shall immediately 6
notify the regulatory body that issued the license. 7
3. As used in this section: 8
(a) “License” means any license, certificate, registration, permit 9
or similar type of authorization to practice an occupation or 10
profession or engage in a business in this State issued to a licensed 11
provider or insurer. 12
(b) “Licensed provider or insurer” means: 13
(1) A medical facility licensed pursuant to chapter 449 of 14
NRS; 15
(2) [The holder of a permit to operate an ambulance, an air 16
ambulance or a vehicle of a fire -fighting agency pursuant to chapter 17
450B of NRS; 18
(3)] A provider of health care, as defined in NRS 629.031, 19
who is licensed pursuant to title 54 of NRS; or 20
[(4)] (3) Any person licensed pursuant to title 57 of NRS. 21
(c) “Regulatory body” means any governmental entity that 22
issues a license. 23
Sec. 5. (Deleted by amendment.) 24
Sec. 5.5. Chapter 439A of NRS is hereby amended by adding 25
thereto the provisions set forth as sections 7 to 10.5, inclusive, of 26
this act. 27
Sec. 6. (Deleted by amendment.) 28
Sec. 7. 1. On or before July 1 of each even -numbered year, 29
the Department, in collaboration with the Health Care Workforce 30
Working Group established pursuant to NRS 439A.118, shall: 31
(a) Conduct a comprehensive assessment of needs with regard 32
to the health care workforce in this State; and 33
(b) Compile a report of the results of the assessment and 34
submit the report to the Governor and the Director of the 35
Legislative Counsel Bureau for transmittal to the Joint Interim 36
Standing Committee on Health and Human Services and the next 37
regular session of the Legislature. 38
2. The assessment conducted pursuant to paragraph (a) of 39
subsection 1 must consist of: 40
(a) A quantitative analysis of the health care workforce in this 41
State, including, without limitation: 42
(1) A determination of the total number of providers of 43
health care in this State and the total number of providers of 44

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health care in this State who practi ce different professions and 1
different specialties within those professions; 2
(2) A determination of the total number of providers of 3
health care who practice in different geographic areas of this State 4
and the total number of providers of health care who practice 5
different professions and different specialties within those 6
geographic areas; and 7
(3) A comparison of the numbers of providers of health 8
care identified pursuant to subparagraphs (1) and (2) with 9
benchmarks established by the Health Resources and Services 10
Administration of the United States Department of Health and 11
Human Services or nationally recognized organizations that 12
prescribe such benchmarks; 13
(b) A determination of the most critical shortages in the health 14
care workforce of this State, prioritizing: 15
(1) Essential health care professions and specialties and 16
essential clinical services or expertise currently experiencing 17
shortages; and 18
(2) Geographic areas of this State that are experiencing the 19
most critical shortages of providers of health care or clinical 20
services or expertise; 21
(c) An identification of unmet needs for specific health 22
technology and therapies, including, without limitation, genomic 23
testing, clinical trials, cellular therapies and palliative care; and 24
(d) A determination of any areas where there is an oversupply 25
of providers of health care, including, without limitation, 26
specialists or clinical services. 27
3. The report compiled pursuant to paragraph (b) of 28
subsection 1 must include, without limitation: 29
(a) A summar y of the assessment conducted pursuant to 30
paragraph (a) of subsection 1, including, without limitation: 31
(1) An analysis of shortages of providers of health care, 32
shortages of clinical services or expertise and unmet health needs 33
in this State; and 34
(2) A description of shortages of providers of health care 35
and the shortages of clinical services or expertise by geographic 36
region, including rural and urban areas; and 37
(b) Recommendations for legislation and regulatory changes 38
to improve the recruitment and retention of providers of health 39
care. 40
4. As used in this section: 41
(a) “Palliative care” means a multidisciplinary and patient - 42
and family -centered approach to specialized medical care for a 43
person with a serious illness, which approach focuses on the care 44
of a patient throughout the continuum of an illness and involves 45

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- *SB495_R1*
addressing the physical, emotional, social and spiritual needs of 1
the patient, as well as facilitating patient autonomy, access to 2
information and choice of care. The term includes, with out 3
limitation, discussion of the goals of the patient for treatment and 4
discussion of treatment options appropriate to the patient, 5
including, where appropriate, hospice care and comprehensive 6
management of pain and symptoms. 7
(b) “Provider of health care” has the meaning ascribed to it in 8
NRS 629.031. 9
Sec. 8. (Deleted by amendment.) 10
Sec. 8.5. “Independent center for emergency medical care” 11
has the meaning ascribed to it in NRS 449.013. 12
Sec. 9. (Deleted by amendment.) 13
Sec. 9.5. 1. The Department shall establish and maintain a 14
program to increase public awareness of health care information 15
concerning the independent centers for emergency medical care in 16
this State. The program must be designed to assist consumers with 17
comparing the quality of care provided by the independent centers 18
for emergency medical care in this State and the charges for that 19
care. 20
2. The program mus t include, without limitation, the 21
collection, maintenance and provision of information concerning: 22
(a) Patients of each independent center for emergency medical 23
care in this State as reported in the forms submitted pursuant to 24
NRS 449.485; 25
(b) The quali ty of care provided by each independent center 26
for emergency medical care in this State as determined by 27
applying measures of quality endorsed by the entities described in 28
subparagraph (1) of paragraph (b) of subsection 1 of section 10 .5 29
of this act, expre ssed as a number of events and rate of 30
occurrence, if such measures can be applied to the information 31
reported in the forms submitted pursuant to NRS 449.485; 32
(c) How consistently each independent center for emergency 33
medical care follows recognized pract ices to prevent the infection 34
of patients, to speed the recovery of patients and to avoid medical 35
complications of patients; 36
(d) The total number of patients discharged from the 37
independent center for emergency medical care and the total 38
number of potenti ally preventable readmissions to a hospital or 39
independent center for emergency medical care, which must be 40
expressed as a total number and a rate of occurrence of potentially 41
preventable readmissions, and the average length of stay and the 42
average billed charges for those potentially preventable 43
readmissions; and 44

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(e) Any other information relating to the charges imposed and 1
the quality of the services provided by the independent centers for 2
emergency medical care in this State which the Department 3
determines is: 4
(1) Useful to consumers; 5
(2) Nationally recognized; and 6
(3) Reported in a standard and reliable manner. 7
Sec. 10. (Deleted by amendment.) 8
Sec. 10.5. 1. The Department shall, by regulation: 9
(a) Prescribe the information that each independent center for 10
emergency medical care in this State must submit to the 11
Department for the program established pursuant to section 9 .5 of 12
this act. 13
(b) Prescribe the measures of quality for i ndependent centers 14
for emergency medical care that are required pursuant to 15
paragraph (b) of subsection 2 of section 9.5 of this act. In adopting 16
the regulations, the Department shall: 17
(1) Use the measures of quality endorsed by the Agency for 18
Healthcare Research and Quality, the National Quality Forum, 19
Centers for Medicare and Medicaid Services of the United States 20
Department of Health and Human Services, a quality 21
improvement organization of the Centers for Medicare and 22
Medicaid Services and the Joint Commission; 23
(2) Prescribe a reasonable number of measures of quality 24
which must not be unduly burdensome on the independent centers 25
for emergency medical care; and 26
(3) Take into consideration the financial burden placed on 27
the independent centers for em ergency medical care to comply 28
with the regulations. 29
(c) Prescribe the manner in which an independent center for 30
emergency medical care must determine whether the readmission 31
of a patient must be reported pursuant to section 9 .5 of this act as 32
a potential ly preventable readmission and prescribe the form for 33
submission of such information. 34
(d) Require each independent center for emergency medical 35
care to provide the information prescribed in paragraphs (a), (b) 36
and (c) in the format required by the Department. 37
2. The information required pursuant to this section and 38
section 9 .5 of this act must be submitted to the Department not 39
later than 45 days after the last day of each calendar month. 40
3. If an independent center for emergency medical care fails 41
to submit the information required pursuant to this section or 42
section 9.5 of this act or submits information that is incomplete or 43
inaccurate, the Department shall send a notice of such failure to 44

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the independent center for emergency medical care and to the 1
Division of Public and Behavioral Health of the Department. 2
Sec. 11. (Deleted by amendment.) 3
Sec. 11.2. NRS 439A.020 is hereby amended to read as 4
follows: 5
439A.020 The purposes of this chapter are to: 6
1. Promote equal access to quality health care at a reasonable 7
cost; 8
2. Promote an adequate supply and distribution of health 9
resources; 10
3. Promote uniform, effective methods of delivering health 11
care; 12
4. Promote and encourage the a dequate distribution of health 13
and care facilities and human resources; 14
5. Promote and encourage the effective use of methods for 15
controlling increases in the cost of health care; 16
6. Encourage participation in health planning by members of 17
the several health professions, representatives of institutions and 18
agencies interested in the provision of health care and the reduction 19
of the cost of such care, and the general public; 20
7. Utilize the viewpoint of the general public for making 21
decisions; 22
8. Provide information to the general public concerning the 23
charges imposed and the quality of the services provided by the 24
hospitals , [and] surgical centers for ambulatory patients and 25
independent centers for emergency medical care in this State; 26
9. Encourage public education regarding proper personal health 27
care and methods for the effective use of available health services; 28
and 29
10. Promote a program of technical assistance to purchasers to 30
contain effectively the cost of health care, including: 31
(a) Providing information to purchasers regarding the charges 32
made by practitioners. 33
(b) Training purchasers to negotiate successfully for a policy of 34
health insurance. 35
(c) Conducting studies and providing other information about 36
measures to assist purchasers in containing the cost of health care. 37
Sec. 11.5. NRS 439A.200 is hereby amended to read as 38
follows: 39
439A.200 As used in NRS 439A.200 to 439A.290, inclusive, 40
and sections 8.5, 9.5 and 10.5 of this act unless the context 41
otherwise requires, the words and terms defined in NRS 439A.205, 42
439A.207 and 439A.210 and section 8.5 of this act have the 43
meanings ascribed to them in those sections. 44
Sec. 12. (Deleted by amendment.) 45

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Sec. 12.5. NRS 439A.260 is hereby amended to read as 1
follows: 2
439A.260 1. The Department shall collect and maintain all 3
information that it receives from the hospitals , [and] surgical 4
centers for ambulatory patients and independent centers for 5
emergency medical care in this State pursuant to NRS 439A.220 to 6
439A.250, inclusive [.] and sections 8.5, 9.5 and 10.5 of this act. 7
Upon request, the Department shall make a summary of the 8
information available to: 9
(a) Consumers of health care; 10
(b) Providers of health care; 11
(c) Representatives of the health insurance industry; and 12
(d) The general public. 13
2. The Department shall ensure that the information it provides 14
pursuant to this section is aggregated so as not to rev eal the identity 15
of a specific inpatient or outpatient of a hospital , [or] of a surgical 16
center for ambulatory patients [.] or of an independent center for 17
emergency medical care. 18
Sec. 13. (Deleted by amendment.) 19
Sec. 13.5. NRS 439A.270 is hereby amended to read as 20
follows: 21
439A.270 1. The Department shall establish and maintain an 22
Internet website that includes the information concerning the 23
charges imposed and the quality of the se rvices provided by the 24
hospitals , [and] surgical centers for ambulatory patients and 25
independent centers for emergency medical care in this State as 26
required by the programs established pursuant to NRS 439A.220 27
and 439A.240 [.] and section 9.5 of this act. The information must: 28
(a) Include, for each hospital in this State, the: 29
(1) Total number of patients discharged, the average length 30
of stay and the average billed charges, reported for the diagnosis -31
related groups for inpat ients and the 50 medical treatments for 32
outpatients that the Department determines are most useful for 33
consumers; 34
(2) Total number of potentially preventable readmissions 35
reported pursuant to NRS 439A.220, the rate of occurrence of 36
potentially preventable readmissions, and the average length of stay 37
and average billed charges of those potentially preventable 38
readmissions, reported by the diagnosis -related group for inpatients 39
for which the patient originally received treatment at a hospital; and 40
(3) Name of each physician who performed a surgical 41
procedure in the hospital and the total number of surgical 42
procedures performed by each physician in the hospital, reported for 43
the most frequent surgical procedures that the Department 44

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determines are most usefu l for consumers if the information is 1
available; 2
(b) Include, for each surgical center for ambulatory patients in 3
this State, the: 4
(1) Total number of patients discharged and the average 5
billed charges, reported for 50 medical treatments for outpatients 6
that the Department determines are most useful for consumers; and 7
(2) Name of each physician who performed a surgical 8
procedure in the surgical center for ambulatory patients and the total 9
number of surgical procedures performed by each physician in the 10
surgical center for ambulatory patients, reported for the most 11
frequent surgical procedures that the Department determines are 12
most useful for consumers; 13
(c) Include, for each independent center for emergency 14
medical care in this State, the: 15
(1) Total number of patients discharged and the average 16
billed charges, reported for the 50 medical treatments for patients 17
of independent centers for emergency medical care that the 18
Department determines are most useful for consumers; and 19
(2) Total number of pote ntially preventable readmissions 20
reported pursuant to section 9 .5 of this act, the rate of occurrence 21
of potentially preventable readmissions, and the average length of 22
stay and average billed charges of those potentially preventable 23
readmissions, reported for the diagnosis for which the patient 24
originally received treatment at an independent center for 25
emergency medical care; 26
(d) Be presented in a manner that allows a person to view and 27
compare the information for the hospitals by: 28
(1) Geographic location of each hospital; 29
(2) Type of medical diagnosis; and 30
(3) Type of medical treatment; 31
[(d)] (e) Be presented in a manner that allows a person to view 32
and compare the information for the surgical centers for ambulatory 33
patients by: 34
(1) Geographic location of each surgical center for 35
ambulatory patients; 36
(2) Type of medical diagnosis; and 37
(3) Type of medical treatment; 38
[(e)] (f) Be presented in a manner that allows a person to view 39
and compare the information for the independent centers for 40
emergency medical care by: 41
(1) Geographic location of each independent center for 42
emergency medical care; 43
(2) Type of medical diagnosis; and 44
(3) Type of medical treatment; 45

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(g) Be presented in a manner that allows a person to view and 1
compare the information separately for: 2
(1) The inpatients and outpatients of each hospital; [and] 3
(2) The outpatients of each surgical center for ambulatory 4
patients; and 5
(3) The patients of each independent center for emergency 6
medical care; 7
[(f)] (h) Be readily accessible and understandable by a member 8
of the general public; 9
[(g)] (i) Include the annual summary of reports of sentinel 10
events prepared for each health facility pursuant to paragraph (c) of 11
subsection 1 of NRS 439.840; 12
[(h)] (j) Include the annual summary of reports of sentinel 13
events prepared pursuant to paragraph (d) of subsection 1 of 14
NRS 439.840; 15
[(i)] (k) Include the reports of information prepared for each 16
medical facility pursuant to paragraph (b) of subsection 4 of 17
NRS 439.847; 18
[(j)] (l) Include a link to electronic copies of all reports, 19
summaries, compilations and supplementary reports required by 20
NRS 449.450 to 449.530, inclusive; 21
[(k)] (m) Include, for each hospital with 100 or more beds, a 22
summary of financial information which is readily understandable 23
by a member of the general public and which includes, without 24
limitation, a summary of: 25
(1) The expenses of the hospital which are attributable to 26
providing community benefits and in -kind services as reported 27
pursuant to NRS 449.490; 28
(2) The capital improvement report submitted to the 29
Department pursuant to NRS 449.490; 30
(3) The net income of the hospital; 31
(4) The net income of the consolidated corporation, if the 32
hospital is owned by such a corporation and if that information is 33
publicly available; 34
(5) The operating margin of the hospital; 35
(6) The ratio of the cost of providing care to patients covered 36
by Medicare to the charges for such care; 37
(7) The ratio of the total costs to charges of the hospital; and 38
(8) The average daily occupancy of the hospital; and 39
[(l)] (n) Provide any other information relating to the charges 40
imposed and the quality of the services provided by the hospitals , 41
[and] surgical centers for ambulatory patients and independent 42
centers for emergency medical care in this State which the 43
Department determines is: 44
(1) Useful to consumers; 45

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(2) Nationally recognized; and 1
(3) Reported in a standard and reliable manner. 2
2. The Department shall: 3
(a) Publicize the availability of the Internet website; 4
(b) Update the information contained on the Internet website at 5
least quarterly; 6
(c) Ensure that the information contained on the Internet website 7
is accurate and reliable; 8
(d) Ensure that the information reported by a hospital , [or] 9
surgical center for ambulatory patients or independent center for 10
emergency medical care for inpatients and outpatients which is 11
contained on the Internet website is expressed as a total number and 12
as a rate, and [must be] is reported in a manner so as not to reveal 13
the identity of a specific inpatient or outpatient of a hospital , [or] 14
surgical center for ambulatory patients [;] or independent center for 15
emergency medical care; 16
(e) Post a disclaimer on the Internet website indicating that the 17
information contained on the website is provided to assist with the 18
comparison of hospitals and independent centers for emergency 19
medical care and is not a guarantee by the Department or its 20
employees as to the charges imposed by the hospitals and 21
independent centers for emergency medical care in this State or the 22
quality of the services provided by the hospitals and independent 23
centers for emergency medical care in this State, including, without 24
limitation, an explanation that the actual amount charged to a person 25
by a particular hospital or independent center for emergency 26
medical care may not be the same charge as posted on the website 27
for that hospital [;] or independent center for emergency medical 28
care. 29
(f) Provide on the Internet website established pursuant to this 30
section a link to the Internet website of the Centers for Medicare and 31
Medicaid Services of the United States Department of Health and 32
Human Services; and 33
(g) Upon request, make the information that is contained on the 34
Internet website available in printed form. 35
3. As used in this section, “diagnosis -related group” means 36
groupings of medical diagnostic categories used as a basis for 37
hospital payment schedules by Medicare and other third-party health 38
care plans. 39
Sec. 14. (Deleted by amendment.) 40
Sec. 15. (Deleted by amendment.) 41
Sec. 16. (Deleted by amendment.) 42
Sec. 17. (Deleted by amendment.) 43
Sec. 18. (Deleted by amendment.) 44

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Sec. 19. Chapter 449 of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 20, 21 and 22 of this act. 2
Sec. 20. 1. A medical facility to which a third party 3
delegates credentialing functions shall comply with the provisions 4
of section 50 or 109 of this act, where applicable. 5
2. As used in this section: 6
(a) “Credentialing” means verifying the credentials o f a 7
provider of health care for the purpose of determining whether the 8
provider of health care meets the requirements for participation in 9
the network of a third party or participation in Medicaid or the 10
Children’s Health Insurance Program as a provider of services. 11
(b) “Network” has the meaning ascribed to it in 12
NRS 687B.640. 13
(c) “Provider of health care” has the meaning ascribed to it in 14
NRS 629.031. 15
(d) “Third party”: 16
(1) Except as otherwise provided in subparagraph ( 2), 17
means any insurer or organization providing health coverage or 18
benefits in accordance with state or federal law. 19
(2) Does not include: 20
(I) A plan that is subject to the Employee Retirement 21
Income Security Act of 1974 or any information relating to such 22
coverage; or 23
(II) Health coverage provided by a local government 24
agency through a self -insurance reserve fund pursuant to 25
NRS 287.010. 26
Sec. 21. 1. A hospital shall, for at least 95 percent of the 27
complete requests for privileging submitt ed by providers of health 28
care to the hospital, process the request not later than 60 days 29
after the hospital receives all information necessary to complete 30
the request. 31
2. Not later than 15 days after a hospital receives an 32
incomplete request for privil eging from a provider of health care, 33
the hospital shall notify the provider of health care of the 34
information necessary to complete the request. 35
3. A hospital shall immediately notify the Division of: 36
(a) Any delay in privileging that exceeds the time period 37
specified in subsection 1; 38
(b) Steps taken to ensure that the request that is subject to the 39
delay is processed as quickly as possible; and 40
(c) An anticipated timeline to complete the processing of the 41
request. 42
4. On or before February 1 of eac h year, a hospital shall 43
compile and submit to the Division a report on the privileging of 44
providers of health care which includes, without limitation: 45

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(a) The average time between the submission by a provider of 1
health care of a request for privileging a nd the request being 2
approved or denied; 3
(b) The rates at which the hospital processes requests for 4
privileging within the time period specified in subsection 1; and 5
(c) Any planned improvements to the hospital’s process for 6
privileging providers of hea lth care, including, without limitation, 7
improvements to technology or procedures to increase the 8
efficiency of the process. 9
5. As used in this section , “privileging” means the process of 10
determining whether to authorize a provider of health care to 11
provide specific services at a hospital based on his or her 12
credentials and qualifications. 13
Sec. 22. 1. A hospital or surgical center for ambulatory 14
patients shall submit requests for prior authorization to third 15
parties using the electronic systems implemented pursuant to 16
sections 57 and 101 of this act, where applicable. 17
2. As used in this section, “third party”: 18
(a) Except as otherwise provided in paragraph (b), means any 19
insurer or organization providing health coverage or benefits in 20
accordance with state or federal law. 21
(b) Does not include: 22
(1) A plan that is subject to the Employee Retirement 23
Income Security Act of 1974 or any information relating to such 24
coverage; or 25
(2) Health coverage provided by a local government agency 26
through a self-insurance reserve fund pursuant to NRS 287.010. 27
Sec. 22.5. NRS 449.013 is hereby amended to read as follows: 28
449.013 “Independent center for emergency medical care” 29
means a facility, str ucturally separate [and distinct] from a hospital, 30
which provides [limited] services for the treatment of a medical 31
emergency. The term includes, without limitation, such a facility 32
that is owned or operated by, or otherwise part of, a hospital but is 33
located more than 250 yards from the hospital. 34
Sec. 23. NRS 449.029 is hereby amended to read as follows: 35
449.029 As used in NRS 449.029 to 449.240, inclusive, and 36
sections 20, 21 and 22 of this act, unless the context otherwise 37
requires, “medical facility” has the meaning ascribed to it in NRS 38
449.0151 and includes a program of hospice care described in 39
NRS 449.196. 40
Sec. 24. NRS 449.0301 is hereby amended to read as follows: 41
449.0301 The provisions of NRS 449.029 to 449.2428, 42
inclusive, and sections 20, 21 and 22 of this act do not apply to: 43
1. Any facility conducted by and for the adherents of any 44
church or religious denomination for the purpose of providing 45

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- *SB495_R1*
facilities for the care and treatment of the sick who depend solely 1
upon spiritual means through prayer for healing in the practice of 2
the religion of the church or denomination, except that such a 3
facility shall comply with all regulations relative to san itation and 4
safety applicable to other facilities of a similar category. 5
2. Foster homes as defined in NRS 424.014. 6
3. Any medical facility , facility for the dependent or facility 7
which is otherwise required by the regulations adopted by the Board 8
pursuant to NRS 449.0303 to be licensed that is operated and 9
maintained by the United States Government or an agency thereof. 10
Sec. 24.3. NRS 449.0308 is hereby amended to read as 11
follows: 12
449.0308 1. Except as otherwise provided in this section, the 13
Division may charge and collect from a medical facility, facility for 14
the dependent or facility which is required by the regulations 15
adopted by the Board pursuant to NRS 449.0303 to be licensed or a 16
person who operates such a facility without a license issued by the 17
Division the actual costs incurred by the Division for the 18
enforcement of the provisions of NRS 449.029 to 449.2428, 19
inclusive, and sections 20, 21 and 22 of this act including, without 20
limitation, the actual cost of conducting an inspection or 21
investigation of the facility. 22
2. The Division shall not charge and collect the actual cost for 23
enforcement pursuant to subsection 1 if the enforcement activity is: 24
(a) Related to the issuance or renewal of a license for which the 25
Board charges a fee pursuant to NRS 449.050 or 449.089; [or] 26
(b) Related to the issuance or renewal of a license to an 27
independent center for emergency medical care that is owned or 28
operated by, or otherwise part of, a hospital; or 29
(c) Conducted pursuant to an agreement with the Federal 30
Government which has appropriated money for that purpose. 31
3. Any money collected pursuant to subsection 1 may be used 32
by the Divis ion to administer and carry out the provisions of NRS 33
449.029 to 449.2428, inclusive, and sections 20, 21 and 22 of this 34
act and the regulations adopted pursuant thereto. 35
4. The provisions of this section do not apply to any costs 36
incurred by the Divisio n for the enforcement of the provisions of 37
NRS 449.24185, 449.2419 or 449.24195. 38
Sec. 24.5. NRS 449.050 is hereby amended to read as follows: 39
449.050 1. [Each] Except as otherwise provided in this 40
section, each application for a license must be accompanied by such 41
fee as may be determined by regulation of the Board. The Board 42
may, by regulation, allow or require payment of a fee for a license in 43
installments and may fix the amount of each payment and the date 44
that the payment is due. 45

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- *SB495_R1*
2. The fee imposed by the Board for a facility for transitional 1
living for released offenders must be based on the type of facility 2
that is being licensed and must be calculated to produce the revenue 3
estimated to cover the costs re lated to the license, but in no case 4
may a fee for a license exceed the actual cost to the Division of 5
issuing or renewing the license. 6
3. If an application for a license for a facility for transitional 7
living for released offenders is denied, any amount of the fee paid 8
pursuant to this section that exceeds the expenses and costs incurred 9
by the Division must be refunded to the applicant. 10
4. The Board shall not require a fee for the issuance or 11
renewal of the license of an independent center for emergen cy 12
medical care that is owned or operated by, or otherwise part of, a 13
hospital. 14
Sec. 24.8. NRS 449.080 is hereby amended to read as follows: 15
449.080 1. [If,] Except as otherwise provided in this section, 16
if, after investigation, the Division finds that the: 17
(a) Applicant is in full compliance with the provisions of NRS 18
449.029 to 449.2428, inclusive [;] , and sections 20, 21 and 22 of 19
this act; 20
(b) Applicant is in substantial compliance with the standards and 21
regulations adopted by the Board; 22
(c) Applicant, if he or she has undertaken a project for which 23
approval is required pursuant to NRS 439A.100 or 439A.102, has 24
obtained the approval of the Director of the Department of Health 25
and Human Services; and 26
(d) Facility conforms to the applicable zoning regulations, 27
 the Division shall issue the license to the applicant. 28
2. Any investigation of an applicant for a license to provide 29
community-based living arrangement services conducted pursuant 30
to subsection 1 must include, without limitation, an inspection of 31
any building operated by the applicant in which the applicant 32
proposes to provide community-based living arrangement services. 33
3. The Division may not issue a license to operate an 34
independent center for emergency medical care that is located 35
within a 5 mile radius of: 36
(a) An existing independent center for emergency medical 37
care; or 38
(b) A hospital with an emergency department. 39
4. A license applies only to the person to whom it is issued, is 40
valid onl y for the premises described in the license and is not 41
transferable. 42
Sec. 25. NRS 449.160 is hereby amended to read as follows: 43
449.160 1. The Division may deny an application for a 44
license or may suspend or revoke any license issued under the 45

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- *SB495_R1*
provisions of NRS 449.029 to 449.2428, inclusive, and sections 20, 1
21 and 22 of this act upon any of the following grounds: 2
(a) Violation by the applicant or the licensee of any of the 3
provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 4
sections 20, 21 and 22 of this act or 449A.100 to 449A.124, 5
inclusive, and 449A.270 to 449A.286, inclusive, or of any other law 6
of this State or of the standards, rules and regulations adopted 7
thereunder. 8
(b) Aiding, abetting or permitting the commission of any illegal 9
act. 10
(c) Conduct inimical to the public health, morals, welfare and 11
safety of the people of the State of Nevada in the m aintenance and 12
operation of the premises for which a license is issued. 13
(d) Conduct or practice detrimental to the health or safety of the 14
occupants or employees of the facility. 15
(e) Failure of the applicant to obtain written approval from the 16
Director o f the Department of Health and Human Services as 17
required by NRS 439A.100 or 439A.102 or as provided in any 18
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 19
and sections 20, 21 and 22 of this act and 449.435 to 449.531, 20
inclusive, and chap ter 449A of NRS if such approval is required, 21
including, without limitation, the closure or conversion of any 22
hospital in a county whose population is 100,000 or more that is 23
owned by the licensee without approval pursuant to NRS 439A.102. 24
(f) Failure to comply with the provisions of NRS 441A.315 and 25
any regulations adopted pursuant thereto or NRS 449.2486. 26
(g) Violation of the provisions of NRS 458.112. 27
(h) Failure to comply with the provisions of NRS 449A.170 to 28
449A.192, inclusive, and any regulation adopted pursuant thereto. 29
(i) Violation of the provisions of NRS 629.260. 30
2. In addition to the provisions of subsection 1, the Division 31
may revoke a license to operate a facility for the dependent if, with 32
respect to that facility, the licensee that operates the facility, or an 33
agent or employee of the licensee: 34
(a) Is convicted of violating any of the provisions of 35
NRS 202.470; 36
(b) Is ordered to but fails to abate a nuisance pursuant to NRS 37
244.360, 244.3603 or 268.4124; or 38
(c) Is ordered by the appropriate governmental agency to correct 39
a violation of a building, safety or health code or regulation but fails 40
to correct the violation. 41
3. The Division shall maintain a log of any complaints that it 42
receives relating to activities for which the Div ision may revoke the 43
license to operate a facility for the dependent pursuant to 44

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- *SB495_R1*
subsection 2. The Division shall provide to a facility for the care of 1
adults during the day: 2
(a) A summary of a complaint against the facility if the 3
investigation of the co mplaint by the Division either substantiates 4
the complaint or is inconclusive; 5
(b) A report of any investigation conducted with respect to the 6
complaint; and 7
(c) A report of any disciplinary action taken against the facility. 8
 The facility shall make th e information available to the public 9
pursuant to NRS 449.2486. 10
4. On or before February 1 of each odd -numbered year, the 11
Division shall submit to the Director of the Legislative Counsel 12
Bureau a written report setting forth, for the previous biennium: 13
(a) Any complaints included in the log maintained by the 14
Division pursuant to subsection 3; and 15
(b) Any disciplinary actions taken by the Division pursuant to 16
subsection 2. 17
Sec. 26. NRS 449.163 is hereby amended to read as follows: 18
449.163 1. In addition to the payment of the amount required 19
by NRS 449.0308, if a medical facility, facility for the dependent or 20
facility which is required by the regulations adopted by the Board 21
pursuant to NRS 449.0303 to be licensed viola tes any provision 22
related to its licensure, including any provision of NRS 439B.410 or 23
449.029 to 449.2428, inclusive, and sections 20, 21 and 22 of this 24
act or any condition, standard or regulation adopted by the Board, 25
the Division, in accordance with the regulations adopted pursuant to 26
NRS 449.165, may: 27
(a) Prohibit the facility from admitting any patient until it 28
determines that the facility has corrected the violation; 29
(b) Limit the occupancy of the facility to the number of beds 30
occupied when the vi olation occurred, until it determines that the 31
facility has corrected the violation; 32
(c) If the license of the facility limits the occupancy of the 33
facility and the facility has exceeded the approved occupancy, 34
require the facility, at its own expense, to move patients to another 35
facility that is licensed; 36
(d) Except where a greater penalty is authorized by subsection 2, 37
impose an administrative penalty of not more than $5,000 per day 38
for each violation, together with interest thereon at a rate not to 39
exceed 10 percent per annum; and 40
(e) Appoint temporary management to oversee the operation of 41
the facility and to ensure the health and safety of the patients of the 42
facility, until: 43
(1) It determines that the facility has corrected the violation 44
and has management which is capable of ensuring continued 45

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- *SB495_R1*
compliance with the applicable statutes, conditions, standards and 1
regulations; or 2
(2) Improvements are made to correct the violation. 3
2. If an off -campus location of a hospital fails to obtain a 4
national provider identifier that is distinct from the national provider 5
identifier used by the main campus and any other off -campus 6
location of the hospital in violation of NRS 449.1818, the Division 7
may impose against the hospital an administrative penalty of not 8
more than $10,000 for each day of such failure, together with 9
interest thereon at a rate not to exceed 10 percent per annum, in 10
addition to any other action authorized by this chapter. 11
3. If the facility fails to pay any administrative penalty imposed 12
pursuant to paragraph (d) of subsection 1 or subsection 2, the 13
Division may: 14
(a) Suspend the license of the facility until the administrative 15
penalty is paid; and 16
(b) Collect court costs, reasonable attorney’s fees and other 17
costs incurred to collect the administrative penalty. 18
4. The Division may require any facility that violates any 19
provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and 20
sections 20, 21 and 22 of this act or any condition, standard or 21
regulation adopted by the Board to make any improvements 22
necessary to correct the violation. 23
5. Any money collected as administrative penalties pursuant to 24
paragraph (d) of subsection 1 or subsection 2 must be accounted for 25
separately and used to administer and carry out the provisions of 26
NRS 449.001 to 449.430, inclusive, and sections 20, 21 and 22 of 27
this act, 449.435 to 449.531, inclusive, and chapter 449A of NRS to 28
protect the health, safety, well -being and property of the patients 29
and residents of facilities in accordance with appl icable state and 30
federal standards or for any other purpose authorized by the 31
Legislature. 32
Sec. 26.5. NRS 449.1818 is hereby amended to read as 33
follows: 34
449.1818 1. Each off -campus location of a hospital shall 35
obtain and use and include on all claims for reimbursement or 36
payment for health care services provided at the location a national 37
provider identifier that is distinct from the national provider 38
identifier used by the main campus and any other off -campus 39
location of the hospital. If the off -campus location includes the 40
national provider identifier on such a claim, the off -campus location 41
may also include on the claim the national provider identifier used 42
by the main campus of the hospital. If the off -campus locati on 43
includes both the national provider identifier used by the off-campus 44
location and the national provider identifier used by the main 45

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- *SB495_R1*
campus on a claim, the claim must clearly identify which national 1
provider identifier corresponds to the off -campus loca tion and 2
which national provider identifier corresponds to the main campus. 3
2. An independent center for emergency medical care shall 4
include on all claims for reimbursement or payment for health care 5
services provided at the independent center for emerg ency medical 6
care the national provider identifier used by the independent center 7
for emergency medical care. 8
3. An independent center for emergency medical care: 9
(a) Shall provide urgent care during all operating hours 10
through: 11
(1) A separate urgent care unit within the independent 12
center for emergency medical care; or 13
(2) A system that uses the severity of the patient’s condition 14
to determine whether the patient receives emergency services or 15
urgent care; 16
(b) Shall not charge more for urgent care than the amount 17
customarily charged for urgent care by an urgent care center; 18
(c) If urgent care services are sufficient to treat or manage the 19
condition of a patient, shall inform the patient that he or she may 20
receive urgent care rather than emergency services; and 21
(d) Shall not require a patient to wait longer to receive urgent 22
care services than a patient with the same condition would be 23
required to wait to receive emergency services. 24
4. As used in this section: 25
(a) “National provider identifier” means the standard, unique 26
health identifier for health care providers that is issued by the 27
national provider system in accordance with 45 C.F.R. Part 162. 28
(b) “Off-campus location” means a facility: 29
(1) With operations that are directly or indirectly owned or 30
controlled by, in whole or in part, a hospital or which is affiliated 31
with a hospital, regardless of whether it is operated by the same 32
governing body as the hospital; 33
(2) That is located more than 250 yards from the main 34
campus of the hospital; 35
(3) That provides services which are organizationally and 36
functionally integrated with the hospital; and 37
(4) That is an outpatient facility providing ambulatory 38
surgery, urgent care or emergency room services. 39
(c) “Urgent care” means health care tha t is furnished to a 40
person whose medical condition is sufficiently acute to require 41
treatment unavailable through, or inappropriate to be provided by, 42
a clinic or the office of a provider of health care, but not so acute 43
as to require treatment in an emergency room. 44

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Sec. 27. NRS 449.240 is hereby amended to read as follows: 1
449.240 The district attorney of the county in which the facility 2
is located shall, upon application by the Division, institute and 3
conduct the prosecution of any action for violation of any provisions 4
of NRS 449.029 to 449.245, inclusive [.] , and sections 20, 21 and 5
22 of this act. 6
Sec. 27.3. NRS 449.485 is hereby amended to read as follows: 7
449.485 1. Each hospital and independent center for 8
emergency medical care in this State shall use for all patients 9
discharged a form prescribed by the Director and shall include in the 10
form all information required by the Department. Any form 11
prescribed by the Direc tor must be a form that is commonly used 12
nationwide by hospitals [,] and independent centers for emergency 13
medical care, if applicable, and comply with federal laws and 14
regulations. 15
2. Each hospital and independent center for emergency 16
medical care in th is State shall, on a monthly basis, report to the 17
Department the information required to be included in the form for 18
each patient. The information reported must be complete, accurate 19
and timely. 20
3. Each insurance company or other payer shall accept the form 21
as the bill for services provided by hospitals and independent 22
centers for emergency medical care in this State. 23
4. Except as otherwise provided in subsection 5, each hospital 24
and independent center for emergency medical care in this State 25
shall provide the information required pursuant to subsection 2 in an 26
electronic form specified by the Department. 27
5. The Director may exempt a hospital or independent center 28
for emergency medical care from the requirements of subsection 4 29
if requiring the hospita l or independent center for emergency 30
medical care to comply with the requirements would cause the 31
hospital financial hardship. 32
6. The Department shall use the information submitted 33
pursuant to this section for the [program] programs established 34
pursuant to NRS 439A.220 and section 9.5 of this act to increase 35
public awareness of health care information concerning the hospitals 36
and independent centers for emergency medical care, respectively, 37
in this State. 38
Sec. 27.7. NRS 449.520 is hereby amended to read as follows: 39
449.520 1. On or before October 1 of each year, the Director 40
shall prepare and transmit to the Governor, the Joint Interim 41
Standing Committee on Health and Human Services and the Interim 42
Finance Committe e a report of the Department’s operations and 43
activities for the preceding fiscal year. 44
2. The report prepared pursuant to subsection 1 must include: 45

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(a) Copies of all reports, summaries, compilations and 1
supplementary reports required by NRS 449.450 to 449.530, 2
inclusive, together with such facts, suggestions and policy 3
recommendations as the Director deems necessary; 4
(b) A summary of the trends of the audits of hospitals in this 5
State that the Department required or performed during the previous 6
year; 7
(c) An analysis of the trends in the costs, expenses and profits of 8
hospitals in this State; 9
(d) An analysis of the methodologies used to determine the 10
corporate home office allocation of hospitals in this State; 11
(e) An examination and analysis of the manner in which 12
hospitals are reporting the information that is required to be filed 13
pursuant to NRS 449.490, including, without limitation, an 14
examination and analysis of whether that information is being 15
reported in a standard and consistent manner, which fairly reflect the 16
operations of each hospital; 17
(f) A review and comparison of the policies and procedures used 18
by hospitals in this State to provide discounted services to, and to 19
reduce charges for services provided to, persons without health 20
insurance; 21
(g) A review and comparison of the policies and procedures 22
used by hospitals in this State to collect unpaid charges for services 23
provided by the hospitals; and 24
(h) A summary of the status of the programs established 25
pursuant to NRS 439A.220 and 439A. 240 and section 9.5 of this 26
act to increase public awareness of health care information 27
concerning the hospitals , [and] surgical centers for ambulatory 28
patients and independent centers for emergency medical care in 29
this State, including, without limitation, the information that was 30
posted in the preceding fiscal year on the Internet website 31
maintained for those programs pursuant to NRS 439A.270. 32
3. The Joint Interim Standing Committee on Health and 33
Human Services shall develop a comprehensive pl an concerning the 34
provision of health care in this State which includes, without 35
limitation: 36
(a) A review of the health care needs in this State as identified 37
by state agencies, local governments, providers of health care and 38
the general public; and 39
(b) A review of the capital improvement reports submitted by 40
hospitals pursuant to subsection 2 of NRS 449.490. 41
Sec. 28. Chapter 450B of NRS is hereby amended by adding 42
thereto the provisions set forth as sections 29 and 30 of this act. 43
Sec. 29. 1. The State Board of Health shall adopt 44
regulations authorizing paramedics to be employed by or volunteer 45

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- *SB495_R1*
in hospitals, including, without limitation, emergency 1
departments, intensive care units and oth er areas for acute or 2
specialty care. 3
2. The regulations adopted pursuant to this section must: 4
(a) Ensure that paramedics who are employed by or volunteer 5
in hospitals perform their duties in a manner that enhances the 6
care of patients while maintaining the safety of patients; 7
(b) Prescribe the duties and responsibilities of a paramedic 8
who is employed by or volunteering in a hospital, which must vary 9
depending on the training and experience of the paramedic; 10
(c) Prescribe standards of training for a paramedic who is 11
employed by or volunteering in a hospital, including, without 12
limitation: 13
(1) Any certifications that such a paramedic must hold; and 14
(2) Any additional training required for paramedics who 15
work in specialty areas or provide care to patient with severe 16
conditions or urgent needs; and 17
(d) Establish specific protocols for the oversight and periodic 18
evaluation of paramedics who are employed by or are volunteering 19
in hospitals in a manner that ensures compliance with the 20
regulations adop ted pursuant to this section and the policies 21
developed pursuant to section 30 of this act. 22
Sec. 30. 1. A hospital that employs paramedics or accepts 23
paramedics as volunteers pursuant to section 29 of this act must 24
develop and implement comprehensive written policies that: 25
(a) Define the scope of duties of such paramedics within the 26
hospital in accordance with the regulations adopted pursuant to 27
section 29 of this act; 28
(b) Establish procedures gov erning the supervision of such 29
paramedics within the hospital in accordance with the regulations 30
adopted pursuant to section 29 of this act, including, without 31
limitation, procedures for: 32
(1) The delegation of tasks to such paramedics by 33
physicians, nurs es and other qualified providers of health care; 34
and 35
(2) The review by providers of health care described in 36
subparagraph (1) of tasks performed by such paramedics; 37
(c) Ensure compliance with applicable standards for 38
accreditation and the safety of pat ients and state and federal law 39
and regulations, including, without limitation, procedures for 40
internal reviews and audits of the duties of such paramedics to 41
ensure adherence to such standards, laws and regulations; and 42
(d) Establish protocols to documen t the outcomes of patients 43
who receive services from such paramedics. 44

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- *SB495_R1*
2. On or before February 1 of each year, a hospital that 1
employs paramedics or accepts paramedics as volunteers shall 2
submit to the State Board of Health a report that includes, withou t 3
limitation: 4
(a) A description of the roles performed by such paramedics 5
within the hospital, including, without limitation, data on the types 6
of services provided by such paramedics; 7
(b) Metrics on the outcomes of patients who receive services 8
from such paramedics in acute care settings; 9
(c) Challenges encountered during the integration of such 10
paramedics into the hospital, best practices established concerning 11
the performance of duties by and oversight of such paramedics 12
and areas for improvement related to the performance of duties by 13
and oversight of such paramedics; and 14
(d) A description to any changes made by the hospital to the 15
policies developed pursuant to subsection 1 in response to the 16
information described in paragraph (c). 17
Sec. 31. NRS 450B.250 is hereby amended to read as follows: 18
450B.250 1. Except as otherwise provided in this chapter, a 19
person shall not serve as an attendant on any ambulance or air 20
ambulance and a firefighter shall not provide the lev el of medical 21
care provided by an advanced emergency medical technician or 22
paramedic to sick or injured persons at the scene of an emergency or 23
while transporting those persons to a medical facility unless the 24
person holds a currently valid license issued by the health authority 25
under the provisions of this chapter. 26
2. A person shall not provide community paramedicine 27
services unless the person: 28
(a) Is certified as an emergency medical technician, an advanced 29
emergency medical technician or a paramedic; 30
(b) Is employed by or serves as a volunteer for a person or 31
governmental entity which has a currently valid permit with an 32
endorsement to provide community paramedicine services issued by 33
the health authority pursuant to NRS 450B.1993; and 34
(c) Meets the qualifications and has satisfied any training 35
required by regulations adopted pursuant to NRS 450B.1993. 36
3. A paramedic shall not serve as an employee or volunteer of 37
a hospital unless: 38
(a) The paramedic meets the qualifications and has satisfied 39
any tr aining required by the regulations adopted pursuant to 40
section 29 of this act; and 41
(b) The hospital has developed and implemented the 42
comprehensive policies required by section 30 of this act. 43
4. A paramedic who serves as an employee or volunteer of a 44
hospital shall not work in an area for which additional training is 45

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- *SB495_R1*
required pursuant to section 29 of this act unless the paramedic 1
has received such additional training. 2
Sec. 32. (Deleted by amendment.) 3
Sec. 32.5. NRS 179.301 is hereby amended to read as follows: 4
179.301 1. The Nevada Gaming Control Board and the 5
Nevada Gaming Commission and their employees, agents and 6
representatives may inquire into and inspect any records sealed 7
pursuant to NRS 179.245 or 179.255, if the event or conviction was 8
related to gaming, to determine the suitability or qualifications of 9
any person to hold a state gaming license, manufacturer’s, seller’s or 10
distributor’s license or registration as a gaming employee pursuant 11
to chapter 463 of NRS. Events and convictions, if any, which are the 12
subject of an order sealing records: 13
(a) May form the basis for recommendation, denial or 14
revocation of those licenses. 15
(b) Must not form the basis for denial or rejection of a gaming 16
work permit unless the event or conviction relates to the applicant’s 17
suitability or qualifications to hold the work permit. 18
2. The Division of Insurance of the Department of Business 19
and Industry and its employees may inquire into and inspect any 20
records sealed pursuant to NRS 179.245 or 179.255, if the event or 21
conviction was related to insurance, to determine the suitability 22
or qualifications of any person to hold a licen se, certification or 23
authorization issued in accordance with title 57 of NRS. Events and 24
convictions, if any, which are the subject of an order sealing records 25
may form the basis for recommendation, denial or revocation of 26
those licenses, certifications and authorizations. 27
3. The Department of Health and Human Services, the 28
Division of Health Care Financing and Policy of the Department 29
and their employees, agents and representatives may inquire into 30
and inspect any records sealed pursuant to NRS 179.245 o r 31
179.255, if the event or conviction was related to Medicare or 32
Medicaid or the provision of professional services for which a 33
license or certification is required. Such inquiry or inspection 34
must be for the purpose of determining the suitability of the 35
person to render such professional services as a provider of 36
services under Medicaid or to own or serve as an officer, 37
managing employee or managing agent of a business seeking to 38
enter into a contract with the Department or a health maintenance 39
organization with which the Department has entered into a 40
contract pursuant to NRS 422.273 for the provision of services 41
under Medicaid. Events and convictions, if any, which are the 42
subject of an order sealing records may form the basis of a 43
decision of the Departme nt to refuse to enter into or terminate 44
such a contract. 45

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- *SB495_R1*
4. A prosecuting attorney may inquire into and inspect any 1
records sealed pursuant to NRS 179.245 or 179.255 if: 2
(a) The records relate to a violation or alleged violation of NRS 3
202.485; and 4
(b) The person who is the subject of the records has been 5
arrested or issued a citation for violating NRS 202.485. 6
[4.] 5. The Central Repository for Nevada Records of Criminal 7
History and its employees may inquire into and inspect any records 8
sealed pursua nt to NRS 179.245 or 179.255 that constitute 9
information relating to sexual offenses, and may notify employers of 10
the information in accordance with federal laws and regulations. 11
[5.] 6. Records which have been sealed pursuant to NRS 12
179.245 or 179.255 a nd which are retained in the statewide registry 13
established pursuant to NRS 179B.200 may be inspected pursuant to 14
chapter 179B of NRS by an officer or employee of the Central 15
Repository for Nevada Records of Criminal History or a law 16
enforcement officer in the regular course of his or her duties. 17
[6.] 7. The State Board of Pardons Commissioners and its 18
agents and representatives may inquire into and inspect any records 19
sealed pursuant to NRS 179.245 or 179.255 if the person who is the 20
subject of the records has applied for a pardon from the Board. 21
[7.] 8. As used in this section: 22
(a) “Information relating to sexual offenses” means information 23
contained in or concerning a record relating in any way to a sexual 24
offense. 25
(b) “Sexual offense” has the meani ng ascribed to it in 26
NRS 179A.073. 27
Sec. 33. (Deleted by amendment.) 28
Sec. 34. (Deleted by amendment.) 29
Sec. 35. (Deleted by amendment.) 30
Sec. 36. (Deleted by amendment.) 31
Sec. 37. (Deleted by amendment.) 32
Sec. 38. (Deleted by amendment.) 33
Sec. 39. (Deleted by amendment.) 34
Sec. 40. (Deleted by amendment.) 35
Sec. 41. NRS 232.320 is hereby amended to read as follows: 36
232.320 1. The Director: 37
(a) Shall appoint, with the consent of the Governor, 38
administrators of the divisions of the Department, who are 39
respectively designated as follows: 40
(1) The Administrator of the Aging and Disability Services 41
Division; 42
(2) The Administrator of the Division of Welfare and 43
Supportive Services; 44

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- *SB495_R1*
(3) The Administrator of the Division of Child and Family 1
Services; 2
(4) The Administrator of the Division of Health Care 3
Financing and Policy; and 4
(5) The Administrator of the Division of Public and 5
Behavioral Health. 6
(b) Shall administer, through the divisio ns of the Department, 7
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 8
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 9
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 10
sections 49 to 63, inclusive, of this act, 422.580, 432.010 to 11
432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 12
444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all 13
other provisions of law relating to the functions of the divisions of 14
the Department, but is not responsible fo r the clinical activities of 15
the Division of Public and Behavioral Health or the professional line 16
activities of the other divisions. 17
(c) Shall administer any state program for persons with 18
developmental disabilities established pursuant to the 19
Developmental Disabilities Assistance and Bill of Rights Act of 20
2000, 42 U.S.C. §§ 15001 et seq. 21
(d) Shall, after considering advice from agencies of local 22
governments and nonprofit organizations which provide social 23
services, adopt a master plan for the provision of human services in 24
this State. The Director shall revise the plan biennially and deliver a 25
copy of the plan to the Governor and the Legislature at the 26
beginning of each regular session. The plan must: 27
(1) Identify and assess the plans and programs of t he 28
Department for the provision of human services, and any 29
duplication of those services by federal, state and local agencies; 30
(2) Set forth priorities for the provision of those services; 31
(3) Provide for communication and the coordination of those 32
services among nonprofit organizations, agencies of local 33
government, the State and the Federal Government; 34
(4) Identify the sources of funding for services provided by 35
the Department and the allocation of that funding; 36
(5) Set forth sufficient informatio n to assist the Department 37
in providing those services and in the planning and budgeting for the 38
future provision of those services; and 39
(6) Contain any other information necessary for the 40
Department to communicate effectively with the Federal 41
Government concerning demographic trends, formulas for the 42
distribution of federal money and any need for the modification of 43
programs administered by the Department. 44

– 40 –

- *SB495_R1*
(e) May, by regulation, require nonprofit organizations and state 1
and local governmental agencies to provide information regarding 2
the programs of those organizations and agencies, excluding 3
detailed information relating to their budgets and payrolls, which the 4
Director deems necessary for the performance of the duties imposed 5
upon him or her pursuant to this section. 6
(f) Has such other powers and duties as are provided by law. 7
2. Notwithstanding any other provision of law, the Director, or 8
the Director’s designee, is responsible for appointing and removing 9
subordinate officers and employees of the Department. 10
Sec. 41.5. NRS 232.459 is hereby amended to read as follows: 11
232.459 1. The Advocate shall: 12
(a) Respond to written and telephonic inquiries received from 13
consumers and injured employees regarding concerns and problems 14
related to health care and workers’ compensation; 15
(b) Assist consumers and injured employees in understanding 16
their rights and responsibilities under health care plans, including, 17
without limitation, the Public Employees’ Benefits Program and the 18
Public Option, and policies of industrial insurance; 19
(c) Identify and investigate complaints of consumers and injured 20
employees regarding their health care plans, including, without 21
limitation, the Public Employees’ Benefits Program and the Public 22
Option, and policies of industrial insurance and assist those 23
consumers and injured employees to resolve their complaints, 24
including, without limitation: 25
(1) Referring consumers and injured employees to the 26
appropriate agency, department or other entity that is responsible for 27
addressing the specific complaint of the consumer or injured 28
employee; and 29
(2) Providing counseling and assistance to consumers and 30
injured employees concerning health care plans, including, without 31
limitation, the Public Employees’ Benefits Program and the Public 32
Option, and policies of industrial insurance; 33
(d) Provide information to consumers and injured employees 34
concerning health care plans, including, without limitation, the 35
Public Employees’ Benefits Program and the Public Op tion, and 36
policies of industrial insurance in this State; 37
(e) Establish and maintain a system to collect and maintain 38
information pertaining to the written and telephonic inquiries 39
received by the Office for Consumer Health Assistance; 40
(f) Take such actions as are necessary to ensure public 41
awareness of the existence and purpose of the services provided by 42
the Advocate pursuant to this section; 43

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- *SB495_R1*
(g) In appropriate cases and pursuant to the direction of the 1
Advocate, refer a complaint or the results of an investigation to the 2
Attorney General for further action; 3
(h) Provide information to and applications for prescription drug 4
programs for consumers without insurance coverage for prescription 5
drugs or pharmaceutical services; 6
(i) Establish and maintain an Internet website which includes: 7
(1) Information concerning purchasing prescription drugs 8
from Canadian pharmacies that have been recommended by the 9
State Board of Pharmacy for inclusion on the Internet website 10
pursuant to subsection 4 of NRS 639.2328; 11
(2) Links to websites of Canadian pharmacies which have 12
been recommended by the State Board of Pharmacy for inclusion on 13
the Internet website pursuant to subsection 4 of NRS 639.2328; and 14
(3) A link to the website established and maintained pursuant 15
to NRS 439A.270 which provides information to the general public 16
concerning the charges imposed and the quality of the services 17
provided by the hospitals , [and] surgical centers for ambulatory 18
patients and independent centers for emergency medical care in 19
this State; 20
(j) Assist consumers with accessing a navigator, case manager 21
or facilitator to help the consumer obtain health care services; 22
(k) Assist consumers with scheduling an appointment with a 23
provider of health care who is in the network of providers under 24
contract to provide services to participants in the health care plan 25
under which the consumer is covered; 26
(l) Assist consumers with filing complaints against health care 27
facilities and health care professionals; 28
(m) Assist consumers with filing complaints with the 29
Commissioner of Insurance against issuers of health care plans; and 30
(n) On or before January 31 of each year, compile a report of 31
aggregated information submitted to the Office for Consumer 32
Health Assistance pursuant to NRS 687B.675, aggregated for each 33
type of provider of health care for which such information is 34
provided and submit the report to the Director of the Legislative 35
Counsel Bureau for transmittal to: 36
(1) In even -numbered years, the Joint Interim Standing 37
Committee on Health and Human Services; and 38
(2) In odd -numbered years, the next regular session of the 39
Legislature. 40
2. The Advocate may adopt regulations to carry out the 41
provisions of this section and NRS 232.461 and 232.462. 42
3. As used in this section: 43
(a) “Health care facility” has the meaning ascribed to it in 44
NRS 162A.740. 45

– 42 –

- *SB495_R1*
(b) “Navigator, case manager or facilitator” has the meaning 1
ascribed to it in NRS 687B.675. 2
Sec. 42. NRS 233B.038 is hereby amended to read as follows: 3
233B.038 1. “Regulation” means: 4
(a) An agency rule, standard, directive or statement of general 5
applicability which effectuates or interprets law or policy, or 6
describes the organization, procedure or practice requirements of 7
any agency; 8
(b) A proposed regulation; 9
(c) The amendment or repeal of a prior regulation; and 10
(d) The general application by an agency of a written policy, 11
interpretation, process or procedure to determine whether a person is 12
in compliance with a federal or state statut e or regulation in order to 13
assess a fine, monetary penalty or monetary interest. 14
2. The term does not include: 15
(a) A statement concerning only the internal management of an 16
agency and not affecting private rights or procedures available to the 17
public; 18
(b) A declaratory ruling; 19
(c) An intraagency memorandum; 20
(d) A manual of internal policies and procedures or audit 21
procedures of an agency which is used solely to train or provide 22
guidance to employees of the agency and which is not used as 23
authority in a contested case to determine whether a person is in 24
compliance with a federal or state statute or regulation; 25
(e) An agency decision or finding in a contested case; 26
(f) An advisory opinion issued by an agency that is not of 27
general applicability; 28
(g) A published opinion of the Attorney General; 29
(h) An interpretation of an agency that has statutory authority to 30
issue interpretations; 31
(i) Letters of approval, concurrence or disapproval issued in 32
relation to a permit for a specific project or activity; 33
(j) A contract or agreement into which an agency has entered; 34
(k) The provisions of a federal law, regulation or guideline; 35
(l) An emergency action taken by an agency that is necessary to 36
protect public health and safety; 37
(m) The application by an agen cy of a policy, interpretation, 38
process or procedure to a person who has sufficient prior actual 39
notice of the policy, interpretation, process or procedure to 40
determine whether the person is in compliance with a federal or 41
state statute or regulation in or der to assess a fine, monetary penalty 42
or monetary interest; 43
(n) A regulation concerning the use of public roads or facilities 44
which is indicated to the public by means of signs, signals and other 45

– 43 –

- *SB495_R1*
traffic-control devices that conform with the manual and 1
specifications for a uniform system of official traffic-control devices 2
adopted pursuant to NRS 484A.430; 3
(o) The classification of wildlife or the designation of seasons 4
for hunting, fishing or trapping by regulation of the Board of 5
Wildlife Commissioners pursuant to the provisions of title 45 of 6
NRS; [or] 7
(p) A technical bulletin prepared pursuant to NRS 360.133 [.] ; 8
or 9
(q) The assessment conducted by the Director of the 10
Department of Health and Human Services pursuant to section 7 11
of this act. 12
Sec. 42.5. NRS 239.010 is hereby amended to read as follows: 13
239.010 1. Except as otherwise provided in this section and 14
NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.0397, 41.071, 49.095, 15
49.293, 62D.420, 62D.440, 62E.516, 62E.620, 62H.025, 62H.030, 16
62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 17
80.113, 81.850, 82.183, 86.246, 86.54615, 87.515, 87.54 13, 18
87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 19
88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A.270, 20
116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 21
119A.280, 119A.653, 119A.677, 119B.370, 119B.382, 120A.640, 22
120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 23
127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 24
130.712, 136.050, 159.044, 159A.044, 164.041, 172.075, 172.245, 25
176.01334, 176.01385, 176.015, 176.0625, 176.09129, 176.156, 26
176A.630, 178. 39801, 178.4715, 178.5691, 178.5717, 179.495, 27
179A.070, 179A.165, 179D.160, 180.600, 200.3771, 200.3772, 28
200.5095, 200.604, 202.3662, 205.4651, 209.392, 209.3923, 29
209.3925, 209.419, 209.429, 209.521, 211A.140, 213.010, 213.040, 30
213.095, 213.131, 217.105, 2 17.110, 217.464, 217.475, 218A.350, 31
218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 218G.615, 32
224.240, 226.462, 226.796, 228.270, 228.450, 228.495, 228.570, 33
231.069, 231.1285, 231.1473, 232.1369, 233.190, 237.300, 34
239.0105, 239.0113, 239.014, 239B.026, 2 39B.030, 239B.040, 35
239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 36
239C.420, 240.007, 241.020, 241.030, 241.039, 242.105, 244.264, 37
244.335, 247.540, 247.545, 247.550, 247.560, 250.087, 250.130, 38
250.140, 250.145, 250.150, 268.095, 268.0978, 268. 490, 268.910, 39
269.174, 271A.105, 281.195, 281.805, 281A.350, 281A.680, 40
281A.685, 281A.750, 281A.755, 281A.780, 284.4068, 284.4086, 41
286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 42
293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 43
293.906, 293.908, 293.909, 293.910, 293B.135, 293D.510, 331.110, 44
332.061, 332.351, 333.333, 333.335, 338.070, 338.1379, 338.1593, 45

– 44 –

- *SB495_R1*
338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 1
353A.049, 353A.085, 353A.100, 353C.240, 353D.250, 360.240, 2
360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 3
366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 4
379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 5
387.631, 388.1455, 388.259, 388.501, 388.503, 388.513, 388.750, 6
388A.247, 3 88A.249, 391.033, 391.035, 391.0365, 391.120, 7
391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 8
392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 9
394.1698, 394.447, 394.460, 394.465, 396.1415, 396.1425, 396.143, 10
396.159, 396.329 5, 396.405, 396.525, 396.535, 396.9685, 11
398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 12
414.280, 416.070, 422.2749, 422.305, 422A.342, 422A.350, 13
425.400, 427A.1236, 427A.872, 427A.940, 432.028, 432.205, 14
432B.175, 432B.280, 432B.290, 432B.4018, 4 32B.407, 432B.430, 15
432B.560, 432B.5902, 432C.140, 432C.150, 433.534, 433A.360, 16
439.4941, 439.4988, 439.5282, 439.840, 439.914, 439A.116, 17
439A.124, 439B.420, 439B.754, 439B.760, 439B.845, 440.170, 18
441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 19
442.774, 445A.665, 445B.570, 445B.7773, 449.209, 449.245, 20
449.4315, 449A.112, 450.140, 450B.188, 450B.805, 453.164, 21
453.720, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 22
459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 23
463.790, 467.1005, 4 80.535, 480.545, 480.935, 480.940, 481.063, 24
481.091, 481.093, 482.170, 482.368, 482.5536, 483.340, 483.363, 25
483.575, 483.659, 483.800, 484A.469, 484B.830, 484B.833, 26
484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, 27
571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 28
598A.420, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 29
604D.500, 604D.600, 612.265, 616B.012, 616B.015, 616B.315, 30
616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 31
624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 32
628B.760, 629.043, 629.047, 629.069, 630.133, 630.2671, 33
630.2672, 630.2673, 630.2687, 630.30665, 630.336, 630A.327, 34
630A.555, 631.332, 631.368, 632.121, 632.125, 632.3415, 35
632.3423, 632.405, 633.283, 633.301, 633.427, 633.4715, 633.4716, 36
633.4717, 633.524, 634.055, 634.1303, 634.214, 634A.169, 37
634A.185, 634B.730, 635.111, 635.158, 636.262, 636.342, 637.085, 38
637.145, 637B.192, 637B.288, 638.087, 638.089, 639.183, 39
639.2485, 639.570, 640.075, 640.152, 640A.185, 640A.220, 40
640B.405, 640B.73 0, 640C.580, 640C.600, 640C.620, 640C.745, 41
640C.760, 640D.135, 640D.190, 640E.225, 640E.340, 641.090, 42
641.221, 641.2215, 641A.191, 641A.217, 641A.262, 641B.170, 43
641B.281, 641B.282, 641C.455, 641C.760, 641D.260, 641D.320, 44
642.524, 643.189, 644A.870, 645.180 , 645.625, 645A.050, 45

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- *SB495_R1*
645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 1
645D.135, 645G.510, 645H.320, 645H.330, 647.0945, 647.0947, 2
648.033, 648.197, 649.065, 649.067, 652.126, 652.228, 653.900, 3
654.110, 656.105, 657A.510, 661.115, 665.130, 665.13 3, 669.275, 4
669.285, 669A.310, 670B.680, 671.365, 671.415, 673.450, 673.480, 5
675.380, 676A.340, 676A.370, 677.243, 678A.470, 678C.710, 6
678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 7
679B.285, 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 8
681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 9
687A.060, 687A.115, 687B.404, 687C.010, 688C.230, 688C.480, 10
688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 11
692C.3538, 692C.354, 692C.420, 693A.480, 693A.615, 696B.550, 12
696C.120, 703 .196, 704B.325, 706.1725, 706A.230, 710.159, 13
711.600, and section 89.9 of this act, sections 35, 38 and 41 of 14
chapter 478, Statutes of Nevada 2011 and section 2 of chapter 391, 15
Statutes of Nevada 2013 and unless otherwise declared by law to be 16
confidential, all public books and public records of a governmental 17
entity must be open at all times during office hours to inspection by 18
any person, and may be fully copied or an abstract or memorandum 19
may be prepared from those public books and public records. Any 20
such copies, abstracts or memoranda may be used to supply the 21
general public with copies, abstracts or memoranda of the records or 22
may be used in any other way to the advantage of the governmental 23
entity or of the general public. This section does not super sede or in 24
any manner affect the federal laws governing copyrights or enlarge, 25
diminish or affect in any other manner the rights of a person in any 26
written book or record which is copyrighted pursuant to federal law. 27
2. A governmental entity may not reje ct a book or record 28
which is copyrighted solely because it is copyrighted. 29
3. A governmental entity that has legal custody or control of a 30
public book or record shall not deny a request made pursuant to 31
subsection 1 to inspect or copy or receive a copy of a public book or 32
record on the basis that the requested public book or record contains 33
information that is confidential if the governmental entity can 34
redact, delete, conceal or separate, including, without limitation, 35
electronically, the confidential in formation from the information 36
included in the public book or record that is not otherwise 37
confidential. 38
4. If requested, a governmental entity shall provide a copy of a 39
public record in an electronic format by means of an electronic 40
medium. Nothing in t his subsection requires a governmental entity 41
to provide a copy of a public record in an electronic format or by 42
means of an electronic medium if: 43
(a) The public record: 44
(1) Was not created or prepared in an electronic format; and 45

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(2) Is not available in an electronic format; or 1
(b) Providing the public record in an electronic format or by 2
means of an electronic medium would: 3
(1) Give access to proprietary software; or 4
(2) Require the production of information that is confidential 5
and that cannot be redacted, deleted, concealed or separated from 6
information that is not otherwise confidential. 7
5. An officer, employee or agent of a governmental entity who 8
has legal custody or control of a public record: 9
(a) Shall not refuse to provide a copy of that public record in the 10
medium that is requested because the officer, employee or agent has 11
already prepared or would prefer to provide the copy in a different 12
medium. 13
(b) Except as otherwise provided in NRS 239.030, shall, upon 14
request, prepare the copy of the public record and shall not require 15
the person who has requested the copy to prepare the copy himself 16
or herself. 17
Sec. 43. NRS 287.010 is hereby amended to read as follows: 18
287.010 1. The governing body of any county, school 19
district, municipal corporation, political subdivision, public 20
corporation or other local governmental agency of the State of 21
Nevada may: 22
(a) Adopt and carry into effect a system of group life, accident 23
or health insurance, or any combination thereof, for the benefit of its 24
officers and employees, and the dependents of officers and 25
employees who elect to accept the insurance and who, where 26
necessary, have authorized the governing body to make deductions 27
from their compensation for the paymen t of premiums on the 28
insurance. 29
(b) Purchase group policies of life, accident or health insurance, 30
or any combination thereof, for the benefit of such officers and 31
employees, and the dependents of such officers and employees, as 32
have authorized the purchase, from insurance companies authorized 33
to transact the business of such insurance in the State of Nevada, 34
and, where necessary, deduct from the compensation of officers and 35
employees the premiums upon insurance and pay the deductions 36
upon the premiums. 37
(c) Provide group life, accident or health coverage through a 38
self-insurance reserve fund and, where necessary, deduct 39
contributions to the maintenance of the fund from the compensation 40
of officers and employees and pay the deductions into the fund. The 41
money accumulated for this purpose through deductions from the 42
compensation of officers and employees and contributions of the 43
governing body must be maintained as an internal service fund as 44
defined by NRS 354.543. The money must be deposited in a state or 45

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- *SB495_R1*
national bank or credit union authorized to transact business in the 1
State of Nevada. Any independent administrator of a fund created 2
under this section is subject to the licensing requirements of chapter 3
683A of NRS, and must be a resident of this State. Any contract 4
with an independent administrator must be approved by the 5
Commissioner of Insurance as to the reasonableness of 6
administrative charges in relation to contributions collected and 7
benefits provided. The provisions of NRS 439.581 to 439.597, 8
inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 9
687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, paragraphs 10
(b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 11
and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, 12
689B.0375 to 689B.050, inclusive, 689B.0675, 689B.265, 689B.287 13
and 689B.500 and section 1 of this act apply to coverage provided 14
pursuant to this paragraph, except that the provisions of NRS 15
689B.0378, 689B.03785 and 689B.500 only apply to coverage for 16
active offic ers and employees of the governing body, or the 17
dependents of such officers and employees. 18
(d) Defray part or all of the cost of maintenance of a self -19
insurance fund or of the premiums upon insurance. The money for 20
contributions must be budgeted for in ac cordance with the laws 21
governing the county, school district, municipal corporation, 22
political subdivision, public corporation or other local governmental 23
agency of the State of Nevada. 24
2. If a school district offers group insurance to its officers and 25
employees pursuant to this section, members of the board of trustees 26
of the school district must not be excluded from participating in the 27
group insurance. If the amount of the deductions from compensation 28
required to pay for the group insurance exceeds the compensation to 29
which a trustee is entitled, the difference must be paid by the trustee. 30
3. In any county in which a legal services organization exists, 31
the governing body of the county, or of any school district, 32
municipal corporation, political subdiv ision, public corporation or 33
other local governmental agency of the State of Nevada in the 34
county, may enter into a contract with the legal services 35
organization pursuant to which the officers and employees of the 36
legal services organization, and the dependents of those officers and 37
employees, are eligible for any life, accident or health insurance 38
provided pursuant to this section to the officers and employees, and 39
the dependents of the officers and employees, of the county, school 40
district, municipal corp oration, political subdivision, public 41
corporation or other local governmental agency. 42
4. If a contract is entered into pursuant to subsection 3, the 43
officers and employees of the legal services organization: 44

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(a) Shall be deemed, solely for the purposes of this section, to be 1
officers and employees of the county, school district, municipal 2
corporation, political subdivision, public corporation or other local 3
governmental agency with which the legal services organization has 4
contracted; and 5
(b) Must be r equired by the contract to pay the premiums or 6
contributions for all insurance which they elect to accept or of which 7
they authorize the purchase. 8
5. A contract that is entered into pursuant to subsection 3: 9
(a) Must be submitted to the Commissioner of Insurance for 10
approval not less than 30 days before the date on which the contract 11
is to become effective. 12
(b) Does not become effective unless approved by the 13
Commissioner. 14
(c) Shall be deemed to be approved if not disapproved by the 15
Commissioner within 30 days after its submission. 16
6. As used in this section, “legal services organization” means 17
an organization that operates a program for legal aid and receives 18
money pursuant to NRS 19.031. 19
Sec. 44. (Deleted by amendment.) 20
Sec. 45. NRS 287.0433 is hereby amended to read as follows: 21
287.0433 1. The Board may establish a plan of life, accident 22
or health insurance and provide for the payment of contributions 23
into the Program Fund, a sched ule of benefits and the disbursement 24
of benefits from the Program Fund. The Board may reinsure any 25
risk or any part of such a risk. 26
2. If the Board provides coverage of prescription drugs 27
pursuant to this section, the Board or any entity with which the 28
Board enters into a contract to provide such coverage may use the 29
list of preferred prescription drugs developed by the Department of 30
Health and Human Services pursuant to subsection 1 of NRS 31
422.4025 as its formulary and obtain prescription drugs through t he 32
purchasing agreements negotiated by the Department pursuant to 33
that section by notifying the Department in the form prescribed by 34
the Department. 35
3. The Board may not enter into a contract with a health 36
carrier, as defined in section 98 of this act, t o perform any 37
function with regard to a plan of health insurance established 38
pursuant to subsection 1 unless the health carrier meets the 39
criteria prescribed by the regulations adopted pursuant to 40
subsection 2 of section 108 of this act. 41
Sec. 45.5. NRS 287.04335 is hereby amended to read as 42
follows: 43
287.04335 If the Board provides health insurance through a 44
plan of self -insurance, it shall comply with the provisions of 45

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NRS 439.581 to 439.597, inclusive, and section 1 of this act, 1
686A.135, 687B.352, 687B.409, 687B.692, 687B.723, 687B.725, 2
687B.805, 689B.0353, 689B.255, 695C.1723, 695G.150, 695G.155, 3
695G.160, 695G.162, 695G.1635, 695G.164, 695G.1645, 4
695G.1665, 695G.167, 695G.1675, 695G.170 to 695G.1712, 5
inclusive, 695G.1714 to 695G.174, inclusive, 695G.176, 695G.177, 6
695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, 7
695G.405 and 695G.415, in the same manner as an insurer that is 8
licensed pursuant to title 57 of NRS is required to comply with those 9
provisions. 10
Sec. 46. NRS 287.04335 is hereby amended to read as 11
follows: 12
287.04335 If the Board provides health insurance through a 13
plan of self -insurance, it shall comply with the provisions of NRS 14
439.581 to 439.59 7, inclusive, and section 1 of this act, 686A.135, 15
687B.352, 687B.409, 687B.692, 687B.723, 687B.725, 687B.805, 16
689B.0353, 689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 17
695G.162, 695G.1635, 695G.164, 695G.1645, 695G.1665, 18
695G.167, 695G.1675, 695G.170 to 695G.1712, inclusive, 19
695G.1714 to 695G.174, inclusive, 695G.176, 695G.177, 695G.200 20
to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, 695G.405 21
and 695G.415, and section 109 of this act in the same manner as an 22
insurer that is licensed pursuant t o title 57 of NRS is required to 23
comply with those provisions. 24
Sec. 47. NRS 287.04335 is hereby amended to read as 25
follows: 26
287.04335 If the Board provides health insurance through a 27
plan of self -insurance, it shall comply with the provisions of NRS 28
439.581 to 439.597, inclusive, and section 1 of this act, 686A.135, 29
paragraph (b) of subsection 2 and subsections 1 and 3 to 8, 30
inclusive, of NRS 687B.225, NRS 687B.352, 687B.409, 687B.692, 31
[687B.723,] 687B.725, 687B.805, 689B.0353, 689B.255, 32
695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 33
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 34
695G.1675, 695G.170 to 695G.1712, incl usive, 695G.1714 to 35
695G.174, inclusive, 695G.176, 695G.177, 695G.200 to 695G.230, 36
inclusive, 695G.241 to 695G.310, inclusive, 695G.405 and 37
695G.415, and [section] sections 97 to 109 , inclusive, of this act in 38
the same manner as an insurer that is license d pursuant to title 57 of 39
NRS is required to comply with those provisions. 40
Sec. 48. Chapter 422 of NRS is hereby amended by adding 41
thereto the provisions set forth as sections 49 to 63, inclusive, of this 42
act. 43
Sec. 49. (Deleted by amendment.) 44

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Sec. 50. 1. The Department or any entity to which the 1
Department delegates credentialing functions for Medicaid or the 2
Children’s Health Insurance Program shall: 3
(a) Use the Provider Data Portal, or any successor system, 4
established by the Council for Affordable Quality Healthcare, or 5
its successor organization, to accept submissions by providers of 6
health care for credentialing; and 7
(b) Use an entity that holds the Credentials Verification 8
Organization Certification issued by the National Committee for 9
Quality Assurance, or its successor organization, for the purpose 10
of verifying the credentials of providers of health care seeking to 11
participate in Medicaid or th e Children’s Health Insurance 12
Program. 13
2. On or before February 1 of each year, the Department 14
shall: 15
(a) Compile a report on the credentialing of providers of 16
health care which includes, without limitation: 17
(1) The average time between the submission of a request 18
by a provider of health care for credentialing for Medicaid and the 19
Children’s Health Insurance Program during the immediately 20
preceding year and the request being approved or denied; and 21
(2) Recommendations for improvements to the process for 22
credentialing providers of health care for Medicaid and the 23
Children’s Health Insurance Program, including, without 24
limitation, recommendations concerning improvements to 25
technology or procedures to increase the efficiency of the process; 26
and 27
(b) Submit the report to the Governor and the Director of the 28
Legislative Counsel Bureau for transmittal to: 29
(1) In even -numbered years, the Joint Interim Standing 30
Committee on Health and Human Services; and 31
(2) In odd-numbered years, the next regular session of the 32
Legislature. 33
3. As used in this section: 34
(a) “Credentialing” means verifying the credentials of a 35
provider of health care for the purpose of determining whether the 36
provider of health care meets the requirements for participation in 37
Medicaid or t he Children’s Health Insurance Program as a 38
provider of services. 39
(b) “Provider of health care” has the meaning ascribed to it in 40
NRS 629.031. 41
Sec. 51. 1. The Department shall: 42
(a) Take such measures as are necessary to facilitate the 43
determination required pursuant to 42 U.S.C. § 1396a(a)(47) by 44
personnel of hospitals who are certified by the Department of the 45

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presumptive eligibility of patients to receive benefits under 1
Medicaid. 2
(b) Apply to the United States Secretar y of Health and Human 3
Services for any waiver of federal law or apply for any amendment 4
of the State Plan for Medicaid that is necessary to authorize 5
personnel of qualified community -based organizations who are 6
certified by the Department to determine whet her a person is 7
presumptively eligible to receive benefits under Medicaid. 8
(c) Fully cooperate in good faith with the Federal Government 9
during the application process to satisfy the requirements of the 10
Federal Government for obtaining a waiver or amendme nt 11
pursuant to paragraph (b). 12
2. The Department shall establish a comprehensive program 13
to certify employees, contractors and volunteers of the entities 14
described in subsection 1 in determining whether a person is 15
presumptively eligible to receive benefi ts under Medicaid. The 16
program must include, without limitation, training concerning: 17
(a) Eligibility criteria for different categories of persons who 18
may be presumptively eligible for benefits under Medicaid; 19
(b) Standardized procedures for making preliminary 20
assessments to determine whether a person may be presumptively 21
eligible under Medicaid; 22
(c) Protocols for notifying persons who are determined to be 23
presumptively eligible for Medicaid of the process to apply for full 24
benefits under Medicaid; and 25
(d) Ensuring the accuracy of determinations concerning the 26
presumptive eligibility of persons for Medicaid. 27
3. To the extent authorized by the Federal Government, each 28
certification described in subsection 1 must expire 1 year after the 29
certification is issued. 30
4. The Department shall conduct regular audits of all entities 31
that make determinations concerning the presumptive eligibility of 32
persons for Medicaid pursuant to this section. Such audits must 33
verify: 34
(a) The accuracy of the determination s made by the personnel 35
of those entities concerning the presumptive eligibility of persons 36
for Medicaid; and 37
(b) Compliance with other state and federal requirements 38
governing Medicaid. 39
Sec. 51.3. 1. To the extent authorized by federal law and to 40
the extent that money is available, the Director shall include under 41
Medicaid a system of value -based payments for care provided by 42
independent centers for emergency medical care. That system 43
must be designed to provide higher rates of reimbursement to 44
independent centers for emergency medical care that: 45

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(a) Provide high quality of care to recipients of Medicaid; and 1
(b) Ensure that recipients of Medicaid receive an appropriate 2
level of care for the conditions with which the recipients present at 3
an independent center for emergency medical care. 4
2. To the extent that money is available to implement the 5
system of value -based payments described in subsection 1, the 6
Department shall: 7
(a) Apply to the Secretary of Health and Human Services for 8
any waiver of federal law or apply for any amendment of the State 9
Plan for Medicaid that is necessary for the Department to receive 10
federal authorization to implement the system of value -based 11
payments described in subsection 1. 12
(b) Fully cooperate in good faith with the Federal Government 13
during the application process to satisfy the requirements of the 14
Federal Government for obtaining a waiver or amendment 15
pursuant to paragraph (a). 16
3. As used in this section, “independent center for emergency 17
medical care” has the meaning ascribed to it in NRS 449.013. 18
Sec. 51.5. 1. A provider of services under Medicaid shall: 19
(a) Maintain such documents as are required by regulation of 20
the Administrator for the v erification of claims for the period of 21
time specified in those regulations; and 22
(b) Provide the documents maintained pursuant to paragraph 23
(a) to the Department upon the request of the Department. 24
2. The Department may audit any documents provided 25
pursuant to paragraph (b) of subsection 1. If the Department is 26
unable to verify a claim using the documents maintained pursuant 27
to subsection 1, the Department may deny the claim or, if the 28
Department has already paid the claim, recover the amount of the 29
payment from the provider. 30
Sec. 51.8. 1. If the Department determines that a provider 31
of services under Medicaid may be prescribing or providing 32
services in a manner that exceeds the needs of recipients of 33
Medicaid, is unnec essary or otherwise conflicts with applicable 34
professional standards or the requirements of the Medicaid 35
program, the Department shall perform a review of the relevant 36
claims to evaluate the appropriateness and propriety of the 37
services for which payment i s claimed. If the Department has not 38
paid the claims, the review must occur before the Department pays 39
the claims. 40
2. Upon deciding to conduct a review pursuant to subsection 41
1, the Department shall: 42
(a) Notify the provider of services who submitted the claims 43
subject to the review; and 44

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(b) Require the provider of services to submit to the 1
Department within a period of time specified by the Department 2
any documentation necessary to substantiate the claims. 3
3. If a provider of services fails to submit the documentation 4
required by the Department pursuant to paragraph (b) of 5
subsection 2 within the time specified pursuant to that paragraph, 6
the Department may take the actions described in paragraph (a) of 7
subsection 5 without the opportunity for a hearin g pursuant to 8
NRS 422.306. 9
4. Not later than 60 days after receiving the documentation 10
requested pursuant to paragraph (b) of subsection 2, the 11
Department shall complete a review pursuant to this section and 12
either: 13
(a) Pay the claims that were subject to the review or, if the 14
Department has already paid such a claim, notify the provider of 15
services who made the claim that the claim has been upheld; or 16
(b) Take an action described in paragraph (a) of subsection 5 17
with respect to the claims that were subject to the review. 18
5. If the Department determines after conducting a review 19
pursuant to this section that a provider of services has prescribed 20
or provided services in a manner that exceeds the needs of 21
recipients of Medicaid, is unnecessary or otherwi se conflicts with 22
applicable professional standards or the requirements of the 23
Medicaid program, the Department may, after the opportunity for 24
a hearing pursuant to NRS 422.306: 25
(a) Deny the affected claims or, if the Department has already 26
paid an affect ed claim, recover the amount of the payment from 27
the provider; 28
(b) Require the provider to request and receive authorization 29
for the delivery of services to recipients of Medicaid before 30
delivering the services; or 31
(c) Take any other action authorized by this chapter and the 32
regulations adopted pursuant thereto. 33
Sec. 52. (Deleted by amendment.) 34
Sec. 53. As used in sections 53 to 63, inclusive, of this act, 35
unless the context otherwise requires, the words and terms defined 36
in sections 53.5, 54 and 55 of this act have the meanings ascribed 37
to them in those sections. 38
Sec. 53.5. “Medicaid managed care entity” means: 39
1. A health maintenance organization or other managed care 40
organization that enters into a contract with the Department or the 41
Division pursuant to NRS 422.273 to provide health care to 42
recipients of Medicaid under the State Plan for Medic aid or the 43
Children’s Health Insurance Program; 44

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2. An administrator, as defined in NRS 683A.025, that 1
performs any function related to prior authorization or the 2
payment of claims for the Department or a health maintenance 3
organization or managed care or ganization described in 4
subsection 1 with respect to Medicaid or the Children’s Health 5
Insurance Program, while acting in its capacity as an 6
administrator for the Department or the health maintenance 7
organization or managed care organization; or 8
3. A utilization review organization, as defined in NRS 9
695G.085, that conducts utilization reviews for the Department or 10
a health maintenance organization or managed care organization 11
described in subsection 1 with respect to Medicaid or the 12
Children’s Health Insurance Program, while acting in its capacity 13
as a utilization review organization for the Department or the 14
health maintenance organization or managed care organization. 15
Sec. 54. “Provider of health care” has the meaning ascribed 16
to it in NRS 695G.070. 17
Sec. 55. “Recipient” means a natural person who receives 18
benefits through Medicaid or the Children’s Health Insurance 19
Program, as applicable. 20
Sec. 56. 1. Unless a shorter time period is prescribed by a 21
specific statute, the Department or a Medicaid managed care 22
entity, with respect to Medicaid and the Children’s Health 23
Insurance Program, shall approve or deny a request for prior 24
authorization for medical or d ental care provided to a recipient or 25
provide notice of a delay in accordance with section 58 of this act 26
within: 27
(a) Two business days after receiving the request; or 28
(b) Except as otherwise provided in subsection s 2 and 4, if the 29
Prior Authorization and Referrals Operating Rules prescribed by 30
the Committee on Operating Rules for Information Exchange of 31
the Council for Affordable Quality Healthcare, or its successor 32
organization would allow the Department or Medicaid managed 33
care entity more than 2 business days to respond to a particular 34
request for prior authorization after receiving the request, the 35
period of time prescribed by the Rules. 36
2. Notwithstanding any period of time prescribed by the Rules 37
described in paragraph (b) of subsection 1, th e Department or a 38
Medicaid managed care entity shall respond as required by 39
subsection 1 to a request for prior authorization within 7 calendar 40
days after receiving the request. 41
3. If the Department fails to comply with subsection 1, 2 or 4, 42
as applicabl e, with respect to a particular request for prior 43
authorization, the request shall be deemed approved. 44

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4. The Department, in collaboration with the Commissioner 1
of Insurance, shall review each revision to the Rules described in 2
paragraph (b) of subsection 1 to ensure their suitability for this 3
State. If the Department determines that a revision is not suitable 4
for this State, the Department shall hold a public hearing within 6 5
months after the date the Rules were revised to review the 6
determination. If the Department does not revise its determination, 7
the Department shall give notice within 30 days after the hearing 8
that the revisions are not suitable for this State. If the Department 9
gives such notice, the Department or a Medicaid managed care 10
entity shall respond as required by subsection 1 to any request for 11
prior authorization that is submitted to the Department or 12
Medicaid managed are entity, as applicable, after the date on 13
which such notice is given within 2 business days after receiving 14
the request. 15
5. The Department or a Medicaid managed care entity shall 16
not require prior authorization for emergency services covered by 17
Medicaid or the Children’s Health Insurance Program, including, 18
where applicable, transportation by ambulance to a hospital or 19
other medical facility. 20
6. Except as otherwise provided in this section, the 21
Department or a Medicaid managed care entity shall comply with 22
the provisions of section 107 of this act to the same extent as a 23
health carrier, as defined in section 98 of this act. The provisions 24
of this subsection do not apply to: 25
(a) Any drug that is in a class of drugs that is included on the 26
list of preferred prescription drugs developed pursuant to 27
subsection 1 of NRS 422.4025; 28
(b) Any goods or services for which prior authorization is 29
required by the Federal Government; or 30
(c) Any goods or services for which prior authorization is 31
required by regulation of the Department pursuant to 32
subsection 7. 33
7. The Department may, by regulation, require the holder of 34
a Gold Card Exemption issued pursuant to section 107 of this act 35
to obtain prior authorization for goods or services provided to 36
recipients of Medicaid or benefits under the Children’s Health 37
Insurance Program if the Department determines that not 38
requiring pr ior authorization for such goods or services would 39
create a risk of fraud or abuse or impair the ability of the 40
Department to control the cost of those programs. Any such 41
requirement may only apply to a particular good or service and 42
must not apply to an entire class of goods or services. 43
8. The Department and Medicaid managed care entities are 44
not subject to the regulations adopted by the Commissioner of 45

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Insurance pursuant to subsection 8 of section 107 of this act. The 1
Administrator shall, pursuant to N RS 422.2368, adopt regulations 2
applicable to the Department and Medicaid managed care entities 3
that, to the extent practicable, are similar to the regulations 4
adopted by the Commissioner of Insurance pursuant to subsection 5
8 of section 107 of this act. 6
9. In addition to the regulations adopted pursuant to 7
subsection 8, the Department shall adopt regulations to ensure the 8
quality of care provided by the holders of Gold Card Exemption s 9
issued by the Department and Medicaid managed care entities 10
pursuant to section 107 of this act. Those regulations must utilize 11
appropriate measurements and ratings of quality of health care, 12
which may include, without limitation: 13
(a) The Five -Star Quality Rating System established by the 14
Centers for Medicare and Medicaid Ser vices of the United States 15
Department of Health and Human Services or other standards 16
and metrics adopted by that agency; or 17
(b) Standards and metrics prescribed by the National 18
Committee for Quality Assurance, or its successor organization. 19
10. The Department shall review the status of any holder of a 20
Gold Card Exemption issued by the Department or a Medicaid 21
managed care entity pursuant to section 107 of this act that fails to 22
maintain an average rating for quality in accordance with the 23
applicable sta ndards adopted pursuant to subsection 9. The 24
Department may suspend or revoke the Gold Card Exemption if, 25
after conducting the review, the Department determines that the 26
holder is not taking sufficient measures to improve the quality of 27
the care provided by the holder. 28
11. The Department shall: 29
(a) Collect any data necessary to implement the provisions of 30
subsections 9 and 10. Such data must include, without limitation, 31
data related to the quality of care provided by the holders of Gold 32
Card Exemptions issued by the Department and Medicaid 33
managed care entities pursuant to section 107 of this act by age, 34
race, ethnicity, primary language and disability of the recipient of 35
the care. 36
(b) Annually publish on an Internet website maintained by the 37
Department a summary of the data collected pursuant to 38
paragraph (a). 39
12. As used in this section, “emergency services” means 40
health care services that are provided by a provider of health care 41
to screen and to stabilize a recipient after the sudden onset of a 42
medical condition that manifests itself by symptoms of such 43
sufficient severity that a prudent person would believe that the 44
absence of immediate medical attention could result in: 45

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(a) Serious jeopardy to the health of the recipient; 1
(b) Serious jeopardy to the health of an unborn child of the 2
recipient; 3
(c) Serious impairment of a bodily function of the recipient; or 4
(d) Serious dysfunction of any bodily organ or part of the 5
recipient. 6
Sec. 57. 1. The Department shall imp lement an electronic 7
system for receiving and processing requests for prior 8
authorization for medical or dental care provided to recipients 9
under Medicaid and the Children’s Health Insurance Program. 10
Such a system must: 11
(a) Allow providers of health care to electronically submit, 12
track and receive updates concerning requests for prior 13
authorization; and 14
(b) Comply with: 15
(1) The Connectivity Operating Rules, Eligibility and 16
Benefits Operating Rules and Health Care Claims Operating 17
Rules prescribed by the Committee on Operating Rules for 18
Information Exchange of the Council for Affordable Quality 19
Healthcare, or its successor organization; 20
(2) The provisions of the Prior Authorization and Referrals 21
Operating Rules prescribed by the Committee on Operating R ules 22
for Information Exchange of the Council for Affordable Quality 23
Healthcare, or its successor organization, which relate to prior 24
authorization; and 25
(3) Any federal laws or regulations governing electronic 26
systems for receiving and processing requests for prior 27
authorization applicable to Medicaid or the Children’s Health 28
Insurance Program. 29
2. The Department, in collaboration with the Commissioner 30
of Insurance, shall review each revision to the Rules described in 31
paragraph (b) of subsection 1 to ensu re their suitability for this 32
State. If the Department determines that a revision is not suitable 33
for this State, the Department shall hold a public hearing within 6 34
months after the date the Rules were revised to review the 35
determination. If the Departmen t does not revise his or her 36
determination, the Department shall give notice within 30 days 37
after the hearing that the revisions are not suitable for this State. 38
If the Department does not give such notice, the Department shall 39
comply with the revision not later than 2 years after the date on 40
which the revision was finalized. 41
Sec. 58. Upon determining that it is necessary to delay a 42
response to a request for prior authorization beyond the period 43
prescribed by subsection 1 , 2 or 4, as applicable, of section 56 of 44
this act, the Department or a Medicaid managed care entity shall 45

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transmit a written notice to the recipient to whom the request 1
pertains and an electronic notice to the provider of health care 2
who submitted the request or the person designated by the provider 3
of health care to manage requests for prior authorization. Such 4
notice must contain: 5
1. A specific description of all reasons that the Department or 6
Medicaid managed care entity, as applicable, is delaying the 7
response; 8
2. The steps necessary to resolve the delay; and 9
3. The anticipated timeline for resolving the delay. 10
Sec. 59. 1. Upon denying a request for prior authorization, 11
the Department or a Medicaid managed care enti ty, as applicable, 12
shall transmit to: 13
(a) The recipient to whom the request pertains a written notice 14
that contains: 15
(1) A specific description of all reasons that the Department 16
or Medicaid managed care entity, as applicable, denied the 17
request; 18
(2) A description of any documentation that the 19
Department or Medicaid managed care entity, as applicable, 20
requested from the recipient or a provider of health care of the 21
recipient and did not receive or deemed insufficient, if the failure 22
to receive sufficient documentation contributed to the denial; 23
(3) A statement that the recipient has the right to appeal the 24
denial; 25
(4) Instructions, written in clear language that is 26
understandable to an ordinary layperson, describing how the 27
recipient can appeal the denial through the process established 28
pursuant to subsection 2; and 29
(5) A description of any documentation that may be 30
necessary or pertinent to an appeal. 31
(b) The provider of health care who submitted the request or 32
the person designated by the provid er of health care to manage 33
requests for prior authorization an electronic notice that includes 34
all the information required by the Rules described in subsection 1 35
of section 56 of this act. 36
2. The Department or a Medicaid managed care entity shall 37
establish a process that allows a recipient to appeal the denial of a 38
request for prior authorization. The process must allow for the 39
clear resolution of each appeal within a reasonable time. 40
Sec. 60. 1. The Departm ent or a Medicaid managed care 41
entity, with respect to Medicaid and the Children’s Health 42
Insurance Program, shall not revoke a request for prior 43
authorization that the Department or Medicaid managed care 44
entity, as applicable, has previously approved or d elay or deny 45

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payment for the medical or dental care to which such a request 1
pertains unless the Department or Medicaid managed care entity, 2
as applicable, determines that: 3
(a) A recipient or a provider of health care procured the 4
approval by fraud or material misrepresentation; 5
(b) The approval was affected by a clerical error; or 6
(c) The person to which the medical or dental care was 7
provided was not, on the date on which the care was provided, a 8
recipient. 9
2. After approving a request for prior auth orization, the 10
Department or a Medicaid managed care entity shall not assign a 11
lower level billing code to the medical or dental care to which the 12
request pertains or otherwise reduce the payment for such care 13
below the amount indicated in the request for prior authorization 14
without a clear, documented justification that aligns with 15
applicable standards of care. 16
3. If the Department or a Medicaid managed care entity takes 17
any action described in subsection 1 or 2, the Department or 18
Medicaid managed care entity shall provide written notice of the 19
action using the same remittance process that the Department or 20
Medicaid managed care entity, as applicable, uses to pay claims to 21
the provider of health care that submitted the request for prior 22
authorization. Su ch notice must include, without limitation, a 23
detailed description of the justification for the action and 24
documentation supporting that justification. 25
4. As used in this section, “clerical error” means a 26
typographical or administrative error or an error in calculation. 27
The term does not include any mistake relating to clinical 28
judgment, the medical necessity of care or the appropriateness of a 29
treatment. 30
Sec. 61. 1. The Department or a Medicaid managed care 31
entity, with respect to Medicaid and the Children’s Health 32
Insurance Program, shall comply with the provisions of 42 U.S.C. 33
§ 300gg-113, and any regulations adopted pursuant thereto, to the 34
same extent as a health insurance issuer, as defined in 42 U.S.C. 35
§ 300gg-91. 36
2. Within the first 90 days that a recipient is enrolled in 37
Medicaid or the Children’s Health Insurance Program, as 38
applicable, the Department or a Medicaid managed care entity 39
shall honor a request for prior authorization that has been 40
approved by a health carrier or other entity that previously 41
provided the recipient with coverage for medical or dental care if: 42
(a) The approval was issued within the 12 months immediately 43
preceding the first day of the enrollment of the recipient; and 44

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(b) The specif ic medical or dental care included within the 1
request is not affirmatively excluded under the terms and 2
conditions of Medicaid or the Children’s Health Insurance 3
Program, as applicable. 4
3. The Department or a Medicaid managed care entity may 5
undertake an independent review of the care approved by the 6
previous health carrier of a recipient which is subject to the 7
requirements of subsection 2 for the purpose of granting its own 8
approval of the care. The Department or a Medicaid managed 9
care entity shall not deny approval in violation of subsection 2 as 10
the result of such a review. 11
4. If the Department or a Medicaid managed care entity 12
approves a request for prior authorization, the Department or 13
Medicaid managed care entity, as applicable, shall not revoke , 14
limit, condition or restrict the approval due to a subsequent 15
change in the coverage under Medicaid or the Children’s Health 16
Insurance Program or the criteria under which the approval was 17
initially issued unless the approved services are no longer covere d 18
as a result of the change in coverage. 19
Sec. 62. 1. On or before March 1 of each year, the 20
Department shall: 21
(a) Compile, post on an Internet website maintained by the 22
Department and submit to the Commissioner of Insurance the 23
following information for Medicaid and the Children’s Health 24
Insurance Program: 25
(1) The specific goods and services for which the 26
Department requires prior authorization and, for each good or 27
service: 28
(I) The number of requests for prior authorization 29
received by the Department during the immediately preceding 30
calendar year for the provision of the good or service to recipients; 31
(II) The number and percentage of the requests 32
included pursuant to sub -subparagraph (I) that were approved; 33
and 34
(III) The number and percentage of the requests 35
included pursuant to sub-subparagraph (I) that were denied; 36
(2) The average amounts of time between when the 37
Department received a request for prior authorization during the 38
immediately preceding year and when the Department: 39
(I) Initially responded to the request; 40
(II) Approved or denied the request; and 41
(III) Paid the claim to which the request pertains; 42
(3) The percentage of claims received by the Department 43
during the immediately prece ding year that the Department 44

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retroactively denied and detailed written explanations of the 1
reasons for such denials; and 2
(4) Explanations of corrective actions that the Department 3
is taking or intends to take to: 4
(I) Lower the rates of delays and den ials of requests for 5
prior authorization and payment of claims; and 6
(II) Correct any failure to comply with the provisions of 7
sections 52 to 63, inclusive, of this act; and 8
(b) Submit the report compiled pursuant to paragraph (a) to 9
the Commissioner of Insurance for inclusion on the Internet 10
website maintained by the Commissioner pursuant to section 106 11
of this act. 12
2. The Department shall not include individually identifiable 13
health information in a report published pursuant to this section. 14
3. As used in this section, “individually identifiable health 15
information” means information relating to the provision of 16
medical or dental care to a recipient: 17
(a) That specifically identifies the recipient; or 18
(b) For which there is a reasonable basis to believe that the 19
information can be used to identify the recipient. 20
Sec. 63. 1. The Department shall comply with the 21
requirements of 42 C.F.R. § 447.45(d)(2) and (3). 22
2. If the Department approves a claim under Medi caid or the 23
Children’s Health Insurance Program, the Department shall pay 24
the claim within 30 days after it is approved. Except as otherwise 25
provided in this section, if the approved claim is not paid within 26
that period, the Department shall pay interest o n the claim at a 27
rate of interest equal to the prime rate at the largest bank in 28
Nevada, as ascertained by the Commissioner of Financial 29
Institutions, on January 1 or July 1, as the case may be, 30
immediately preceding the date on which the payment was due, 31
plus 6 percent. The interest must be calculated from 30 days after 32
the date on which the claim is approved until the date on which 33
the claim is paid. 34
3. If the Department requires additional information to 35
determine whether to approve or deny a claim und er Medicaid or 36
the Children’s Health Insurance Program, it shall notify the 37
claimant of its request for the additional information within 20 38
days after it receives the claim. The Department shall notify the 39
provider of health care of all the specific reaso ns for the delay in 40
approving or denying the claim. The Department shall approve or 41
deny the claim within 30 days after receiving the additional 42
information. If the claim is approved, the insurer shall pay the 43
claim within 30 days after it receives the additional information. If 44
the approved claim is not paid within that period, the Department 45

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shall pay interest on the claim in the manner prescribed in 1
subsection 2. 2
4. The Department shall not request a claimant to resubmit 3
information that the claimant h as already provided to the 4
Department, unless the Department provides a legitimate reason 5
for the request and the purpose of the request is not to delay the 6
payment of the claim, harass the claimant or discourage the filing 7
of claims. 8
5. The Department shall not pay only part of a claim that has 9
been approved and is fully payable. 10
6. If the failure to pay an approved claim within the time 11
period specified in subsection 2 or 3 is the fault of an entity with 12
which the Department has contracted to perform functions 13
relating to the payment of claims under Medicaid or the 14
Children’s Health Insurance Program, the Department may 15
collect from that person reimbursement for the cost of the interest 16
required by those subsections. 17
Sec. 64. (Deleted by amendment.) 18
Sec. 65. NRS 422.403 is hereby amended to read as follows: 19
422.403 1. The Department shall, by regulation, establish and 20
manage the use by the Medicaid program of step therapy and prior 21
authorization for prescription drugs. 22
2. The Drug Use Review Board shall: 23
(a) Advise the Department concerning the use by the Medicaid 24
program of step therapy and prior authorization for prescription 25
drugs; 26
(b) Develop step therapy protocols and prior authorization 27
policies and procedures that comply with the provisions of sections 28
53 to 63, inclusive, of this act for use by the Medicaid program for 29
prescription drugs; and 30
(c) Review and approve, based on clinic al evidence and best 31
clinical practice guidelines and without consideration of the cost of 32
the prescription drugs being considered, step therapy protocols used 33
by the Medicaid program for prescription drugs. 34
3. The step therapy protocol established pursuant to this section 35
must not apply to a drug approved by the Food and Drug 36
Administration that is prescribed to treat a psychiatric condition of a 37
recipient of Medicaid, if: 38
(a) The drug has been approved by the Food and Drug 39
Administration with indicatio ns for the psychiatric condition of the 40
insured or the use of the drug to treat that psychiatric condition is 41
otherwise supported by medical or scientific evidence; 42
(b) The drug is prescribed by: 43
(1) A psychiatrist; 44

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(2) A physician assistant under th e supervision of a 1
psychiatrist; 2
(3) An advanced practice registered nurse who has the 3
psychiatric training and experience prescribed by the State Board of 4
Nursing pursuant to NRS 632.120; or 5
(4) A primary care provider that is providing care to an 6
insured in consultation with a practitioner listed in subparagraph (1), 7
(2) or (3), if the closest practitioner listed in subparagraph (1), (2) or 8
(3) who participates in Medicaid is located 60 miles or more from 9
the residence of the recipient; and 10
(c) The practitioner listed in paragraph (b) who prescribed the 11
drug knows, based on the medical history of the recipient, or 12
reasonably expects each alternative drug that is required to be used 13
earlier in the step therapy protocol to be ineffective at treating th e 14
psychiatric condition. 15
4. The Department shall not require the Drug Use Review 16
Board to develop, review or approve prior authorization policies or 17
procedures necessary for the operation of the list of preferred 18
prescription drugs developed pursuant to NRS 422.4025. 19
5. The Department shall accept recommendations from the 20
Drug Use Review Board as the basis for developing or revising step 21
therapy protocols and prior authorization policies and procedures 22
used by the Medicaid program for prescription drugs. 23
6. As used in this section: 24
(a) “Medical or scientific evidence” has the meaning ascribed to 25
it in NRS 695G.053. 26
(b) “Step therapy protocol” means a procedure that requires a 27
recipient of Medicaid to use a prescription drug or sequence of 28
prescription drugs other than a drug that a practitioner recommends 29
for treatment of a psychiatric condition of the recipient before 30
Medicaid provides coverage for the recommended drug. 31
Sec. 66. (Deleted by amendment.) 32
Sec. 66.3. Chapter 433 of NRS is hereby amended by adding 33
thereto the provisions set forth as sections 66.6 to 67.5, inclusive, of 34
this act. 35
Sec. 66.6. As used in sections 6 6.6 to 67.5, inclus ive, of this 36
act, unless the context otherwise requires, “Office” means the 37
Office of Mental Health created by section 67 of this act. 38
Sec. 67. 1. The Office of Mental Health is hereby created 39
within the Department. 40
2. The Governor shall appoint the Executive Director of the 41
Office. The Executive Director: 42
(a) Serves at the pleasure of the Governor; 43
(b) Shall serve as the executive head of the Office; and 44

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(c) Must have relevant professional experience in the field of 1
behavioral health. The Governor shall give preference to 2
candidates who have: 3
(1) Clinical experience in mental health; or 4
(2) Designing and administering systems of care, including, 5
without limitation, community -based care, for persons with 6
behavioral health needs. 7
3. The Executive Director must not have any conflicts of 8
interest in the performance of his or her duties. Such prohibited 9
conflicts of interest include, without limitation: 10
(a) A financial interest or other personal interest in any entity 11
that: 12
(1) Provides behavioral health services; or 13
(2) Owns, operates or controls an entity that provides 14
behavioral health services. 15
(b) Currently receiving payment from any person or entity 16
other than the Department for the provision of b ehavioral health 17
services. 18
4. The Office may apply for and accept gifts, grants and 19
donations from any source for the purpose of carrying out the 20
provisions of sections 66.6 to 67.5, inclusive, of this act. 21
5. As used in this section, “behavioral healt h services” 22
includes, without limitation, treatment or other services for 23
persons with mental illnesses or persons with substance use 24
disorders. 25
Sec. 67.2. The Office shall perform such activities and 26
functions as may be necessary to: 27
1. Expand access to behavioral health care, with a focus on 28
meeting the behavioral health needs of children, addressing 29
shortages in the mental health care workforce, promoting 30
economic efficiency and meeting the needs of rural and 31
underserved areas; 32
2. Identify best practices in policy regarding mental health 33
care, including, without limitation, the funding of mental health 34
care, to reduce the long -term costs of mental health care and 35
social services to the State and political subdivisions thereof; 36
3. Coordinate with the Commission on Behavioral Health, 37
the Division of Health Care Financing and Policy of the 38
Department, the Division of Child and Family Services of the 39
Department and the Division of Public and Behavioral Health of 40
the Dep artment, other state agencies, the regional behavioral 41
health policy boards created by NRS 433.429, the mental health 42
consortia established by NRS 433B.333, local governments, 43
providers of health care, schools, school districts, postsecondary 44
educational institutions, community organizations and such other 45

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persons and entities as necessary to facilitate a unified approach 1
to the delivery of mental health services and the development of 2
the mental health care workforce in this State; 3
4. Regularly assess the effectiveness of mental health services 4
and programs provided by the State Government and the impact of 5
such programs on access to quality mental health care in this 6
State; and 7
5. Coordinate with the Division of Health Care Financing 8
and Policy of the Department to support participation in Medicaid 9
by providers of mental health care by: 10
(a) Providing training and technical assistance concerning 11
billing and the submission of claims under Medicaid; and 12
(b) Making recommendations to the Division of Heal th Care 13
Financing and Policy for: 14
(1) Reducing administrative barriers to reimbursement of 15
providers of mental health care under Medicaid; and 16
(2) Providing sustainable, competitive rates of 17
reimbursement for providers of mental health services under 18
Medicaid within the limits of available money. 19
Sec. 67.4. The Office shall: 20
1. Develop, publish and update as necessary a statewide plan 21
for the provision of mental and behavioral health services to 22
children in this State. 23
2. Provide expertise and serve as a resource for matters 24
relating to mental and behavioral health services for children in 25
this State. 26
3. Disseminate information relating to programs, 27
opportunities and resources to improve mental and behavioral 28
health care for children in this State. 29
4. Review the long -term strategic plan, budget requests and 30
reports submitted to the Executive Director by each mental health 31
consortium pursuant to NRS 433B.335. 32
5. Track, review and analyze the policies, programs, reports 33
or recommendations of the Commission, each regional behavioral 34
health policy board created by NRS 433.429 and any other agency, 35
board or commission that relate to the mental or behavioral health 36
of children. 37
6. Study and make recommendations to local, state and 38
federal governmental entities concerning policies that relate to the 39
mental and behavioral health needs of children in this State with 40
the goal of improving access to and the delivery of mental and 41
behavioral health services and resources for children in this State. 42
7. Develop sustainable partnerships with community -based 43
organizations and other private sector entities that serve children 44
with mental and behavioral health needs in this State. 45

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8. Collaborate with other persons and entiti es in this State as 1
necessary to streamline and integrate mental and behavioral 2
health services for children in this State. 3
Sec. 67.5. On or before February 1 of each year, the Office 4
shall: 5
1. Compile a report that includes, without limitation: 6
(a) An assessment of any progress in expanding mental health 7
services and the capacity of the mental health care workforce in 8
this State; 9
(b) An analysis of the state budget and the economic impacts 10
of mental health programs; 11
(c) Any recommendations for adjustments to policy regarding 12
mental health care or funding for mental health programs; 13
(d) Data on the utilization of mental health services, the 14
outcomes of mental health programs, the distribution of the 15
mental health car e workforce of this State and the allocation of 16
funding for mental health programs; and 17
(e) A report on the progress of the State in implementing the 18
statewide plan for the provision of mental and behavioral health 19
services to children in this State adopt ed pursuant to subsection 1 20
of section 67.4 of this act, which must include, without limitation, 21
any recommendations concerning changes to policy or funding 22
necessary to implement the statewide plan. 23
2. Submit the report to the Governor and the Director of the 24
Legislative Counsel Bureau for transmittal to: 25
(a) In even -numbered years, the Joint Interim Standing 26
Committee on Health and Human Services; and 27
(b) In odd -numbered years, the next regular session of the 28
Legislature. 29
Sec. 67.6. NRS 433.317 is hereby amended to read as follows: 30
433.317 1. The Commission shall appoint a subcommittee on 31
the mental health of children to review the findings and 32
recommendations of each mental health consortium submitted 33
pursuant to NRS 433B.335 and to [create a ] advise the Office of 34
Mental Health in the creation and updating of the statewide plan 35
for the provision of mental and behavioral health services to 36
children [.] pursuant to subsection 1 of section 67.4 of this act. 37
2. The members of the subcommittee appointed pursuant to 38
this section serve at the pleasure of the Commission. The members 39
serve without compensation, except that each member is entitled, 40
while engaged in the business of the subcommittee, to the per diem 41
allowance and travel expenses provided for state officers and 42
employees generally if funding is available for this purpose. 43

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Sec. 67.7. NRS 433B.335 is hereby amended to read as 1
follows: 2
433B.335 1. Each mental health consortiu m established 3
pursuant to NRS 433B.333 shall prepare and submit to the Director 4
of the Department and the Executive Director of the Office of 5
Mental Health a long-term strategic plan for the provision of mental 6
health services to children with emotional di sturbance in the 7
jurisdiction of the consortium. A plan submitted pursuant to this 8
section is valid for 10 years after the date of submission, and each 9
consortium shall submit a new plan upon its expiration. 10
2. In preparing the long -term strategic plan p ursuant to 11
subsection 1, each mental health consortium must be guided by the 12
following principles: 13
(a) The system of mental health services set forth in the plan 14
should be centered on children with emotional disturbance and their 15
families, with the needs and strengths of those children and their 16
families dictating the types and mix of services provided. 17
(b) The families of children with emotional disturbance, 18
including, without limitation, foster parents, should be active 19
participants in all aspects of pl anning, selecting and delivering 20
mental health services at the local level. 21
(c) The system of mental health services should be community -22
based and flexible, with accountability and the focus of the services 23
at the local level. 24
(d) The system of mental health services should provide timely 25
access to a comprehensive array of cost -effective mental health 26
services. 27
(e) Children and their families who are in need of mental health 28
services should be identified as early as possible through screening, 29
assessment processes, treatment and systems of support. 30
(f) Comprehensive mental health services should be made 31
available in the least restrictive but clinically appropriate 32
environment. 33
(g) The family of a child with an emotional disturbance should 34
be eligible to receive mental health services from the system. 35
(h) Mental health services should be provided to children with 36
emotional disturbance in a sensitive manner that is responsive to 37
cultural and gender -based differences and the special needs of the 38
children. 39
3. The long-term strategic plan prepared pursuant to subsection 40
1 must include: 41
(a) An assessment of the need for mental health services in the 42
jurisdiction of the consortium; 43

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(b) The long -term strategies and goals of the consortium for 1
providing men tal health services to children with emotional 2
disturbance within the jurisdiction of the consortium; 3
(c) A description of the types of services to be offered to 4
children with emotional disturbance within the jurisdiction of the 5
consortium; 6
(d) Criteria for eligibility for those services; 7
(e) A description of the manner in which those services may be 8
obtained by eligible children; 9
(f) The manner in which the costs for those services will be 10
allocated; 11
(g) The mechanisms to manage the money provided for those 12
services; 13
(h) Documentation of the number of children with emotional 14
disturbance who are not currently being provided services, the costs 15
to provide services to those children, the obstacles to providing 16
services to those children and recommendatio ns for removing those 17
obstacles; 18
(i) Methods for obtaining additional money and services for 19
children with emotional disturbance from private and public entities; 20
and 21
(j) The manner in which family members of eligible children 22
and other persons may be involved in the treatment of the children. 23
4. On or before January 31 of each even -numbered year, each 24
mental health consortium shall submit to the Director of the 25
Department , the Executive Director of the Office of Mental Health 26
and the Commission: 27
(a) A list of the priorities of services necessary to implement the 28
long-term strategic plan submitted pursuant to subsection 1 and an 29
itemized list of the costs to provide those services; 30
(b) A description of any revisions to the long-term strategic plan 31
adopted by the consortium during the immediately preceding year; 32
and 33
(c) Any request for an allocation for administrative expenses of 34
the consortium. 35
5. In preparing the biennial budget request for the Department, 36
the Director of the Department shall consider the list of priorities 37
and any request for an allocation submitted pursuant to subsection 4 38
by each mental health consortium. On or before September 30 of 39
each even -numbered year, the Director of the Department shall 40
submit to each mental health c onsortium a report which includes a 41
description of: 42
(a) Each item on the list of priorities of the consortium that was 43
included in the biennial budget request for the Department; 44

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(b) Each item on the list of priorities of the consortium that was 1
not included in the biennial budget request for the Department and 2
an explanation for the exclusion; and 3
(c) Any request for an allocation for administrative expenses of 4
the consortium that was included in the biennial budget request for 5
the Department. 6
6. On o r before January 31 of each odd -numbered year, each 7
consortium shall submit to the Director of the Department , the 8
Executive Director of the Office of Mental Health and the 9
Commission: 10
(a) A report regarding the status of the long -term strategic plan 11
submitted pursuant to subsection 1, including, without limitation, 12
the status of the strategies, goals and services included in the plan; 13
(b) A description of any revisions to the long-term strategic plan 14
adopted by the consortium during the immediately prec eding year; 15
and 16
(c) A report of all expenditures made from an account 17
maintained pursuant to NRS 433B.339, if any. 18
Sec. 67.8. NRS 433B.337 is hereby amended to read as 19
follows: 20
433B.337 1. A mental health consortium e stablished by NRS 21
433B.333 may: 22
(a) Participate in activities within the jurisdiction of the 23
consortium to: 24
(1) Implement the provisions of the long -term strategic plan 25
established by the consortium pursuant to NRS 433B.335; and 26
(2) Improve the provision of mental health services to 27
children with emotional disturbance and their families, including, 28
without limitation, advertising the availability of mental health 29
services and carrying out a demonstration project relating to mental 30
health services. 31
(b) Take other action to carry out its duties set forth in this 32
section and NRS 433B.335 and 433B.339. 33
2. To the extent practicable, a mental health consortium shall 34
coordinate with the Department to avoid duplicating or 35
contradicting the efforts of t he Department to provide mental health 36
services to children with emotional disturbance and their families. 37
3. A mental health consortium shall collaborate with the 38
Office of Mental Health as necessary to assist the Office in 39
carrying out the duties set f orth in sections 67. 2 and 67.4 of this 40
act. 41
Sec. 67.9. NRS 603A.100 is hereby amended to read as 42
follows: 43
603A.100 1. The provisions of NRS 603A.010 to 603A.290, 44
inclusive, do not apply to the maintenance or transmittal of 45

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information in accordance with NRS 439.581 to 439.597, inclusive, 1
and section 1 of this act and the regulations adopted pursuant 2
thereto. 3
2. A data collector who is also an operator, as defined in NRS 4
603A.330, shall comply with the provisions of NRS 603A.300 to 5
603A.360, inclusive. 6
3. Any waiver of the provisions of NRS 603A.010 to 7
603A.290, inclusive, is contrary to public policy, void and 8
unenforceable. 9
Sec. 68. NRS 608.1555 is hereby amended to read as follows: 10
608.1555 Any employer who provides benefits for health care 11
to his or her employees shall provide the same benefits and pay 12
providers of health care in the same manner as a policy of insurance 13
pursuant to chapters 689A and 689B of NRS, including, without 14
limitation, as required by NRS 687B.409, 687B.723 and 687B.725 15
[.] and section 109 of this act. 16
Sec. 69. NRS 608.1555 is hereby amended to read as follows: 17
608.1555 Any employer who provides benefits for health care 18
to his or her employees shall provide the same benefits and pay 19
providers of health care in the same manner as a policy of insurance 20
pursuant to chapters 689A and 689B of NRS, including, without 21
limitation, as required by paragraph (b) of subsection 2 and 22
subsections 1 and 3 to 8, inclusive, of NRS 687B.225, NRS 23
687B.409 [, 687B.723] and 687B.725 [.] and [section] sections 97 24
to 109 , inclusive, of this act. 25
Sec. 70. (Deleted by amendment.) 26
Sec. 71. NRS 613.195 is hereby amended to read as follows: 27
613.195 1. A noncompetition covenant is void and 28
unenforceable unless the noncompetition covenant: 29
(a) Is supported by valuable consideration; 30
(b) Does not impose any restraint that is greater than is required 31
for the protection of the employer for whose benefit the restraint is 32
imposed; 33
(c) Does not impose any undue hardship on the employee; and 34
(d) Imposes restrictions that are appropriate in relation to the 35
valuable consideration supporting the noncompetition covenant. 36
2. A noncompetition covenant may not restrict, and an 37
employer may not bring an action to restrict, a former employee of 38
an employer from providing service to a former customer or client 39
if: 40
(a) The former employee did not solicit the former customer or 41
client; 42
(b) The customer or client voluntarily chose to leave and seek 43
services from the former employee; and 44

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(c) The former employee is otherwise complying with the 1
limitations in the covenant as to time, geographical area and scope 2
of activity to be restrained, other than any limitation on providing 3
services to a former customer or client who seeks the services of the 4
former e mployee without any contact instigated by the former 5
employee. 6
 Any provision in a noncompetition covenant which violates the 7
provisions of this subsection is void and unenforceable. 8
3. A noncompetition covenant may not apply to [an] : 9
(a) An employee who is paid solely on an hourly wage basis, 10
exclusive of any tips or gratuities [.] ; or 11
(b) A patient-facing provider of health care. 12
4. An employer in this State who negotiates, executes or 13
attempts to enforce a noncompetition covenant that is void a nd 14
unenforceable under this section does not violate the provisions of 15
NRS 613.200. 16
5. If the termination of the employment of an employee is the 17
result of a reduction of force, reorganization or similar restructuring 18
of the employer, a noncompetition co venant is only enforceable 19
during the period in which the employer is paying the employee’s 20
salary, benefits or equivalent compensation, including, without 21
limitation, severance pay. 22
6. If an employer brings an action to enforce a noncompetition 23
covenant or an employee brings an action to challenge a 24
noncompetition covenant and the court finds the covenant is 25
supported by valuable consideration but contains limitations as to 26
time, geographical area or scope of activity to be restrained that are 27
not reasonable, imposes a greater restraint than is necessary for the 28
protection of the employer for whose benefit the restraint is imposed 29
or imposes undue hardship on the employee, the court shall revise 30
the covenant to the extent necessary and enforce the covenan t as 31
revised. Such revisions must cause the limitations contained in the 32
covenant as to time, geographical area and scope of activity to be 33
restrained to be reasonable, to not impose undue hardship on the 34
employee and to impose a restraint that is not grea ter than is 35
necessary for the protection of the employer for whose benefit the 36
restraint is imposed. 37
7. If an employer brings an action to enforce a noncompetition 38
covenant or an employee or contractor brings an action to challenge 39
a noncompetition coven ant and the court finds that the 40
noncompetition covenant applies to [an employee ] a person 41
described in subsection 3 or that the employer has restricted or 42
attempted to restrict a former employee in the manner described in 43
subsection 2, the court shall awa rd the employee or contractor 44
reasonable attorney’s fees and costs. Nothing in this subsection shall 45

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be construed as prohibiting a court from otherwise awarding 1
attorney’s fees to a prevailing party pursuant to NRS 18.010. 2
8. As used in this section: 3
(a) “Employer” means every person having control or custody of 4
any employment, place of employment or any employee. 5
(b) “Noncompetition covenant” means an agreement between an 6
employer and employee which, upon termination of the employment 7
of the employee, prohibits the employee from pursuing a similar 8
vocation in competition with or becoming employed by a competitor 9
of the employer. 10
(c) “Patient-facing provider of health care” means a provider 11
of health care, as defined in NRS 629.031: 12
(1) Whose primary duties involve providing clinical care to 13
patients; and 14
(2) Who is not employed or contracted to primarily perform 15
administrative tasks. 16
Sec. 72. Chapter 629 of NRS is hereby amended by adding 17
thereto a new section to read as follows: 18
1. A provider of health care who received at least 10 percent 19
of his or her gross revenue during the immediately preceding 20
calendar year from providing services to patients covered by 21
private health insurance shall submit requests for prior 22
authorization to third parties using the electronic systems 23
implemented pursuant to sections 57 and 101 of this act, where 24
applicable. 25
2. A provider of health care who fails to comply with this 26
section is guilty of unprofessional conduct and is subject to 27
disciplinary action by the board, agency or other entity in this 28
State by which he or she is licensed, certified or regulated. 29
3. As used in this section: 30
(a) “Private health insurance” does not include health 31
coverage issued by a health maintenance organization or other 32
managed care organization to recipients of Medicaid or insurance 33
under the Children’s Health Insurance Program pursuant to a 34
contract with the Department of Health and Human Services 35
entered into pursuant to NRS 422.273. 36
(b) “Third party”: 37
(1) Except as otherwise provided in subparagraph (2), 38
means any insurer or organization providing health coverage or 39
benefits in accordance with state or federal law. 40
(2) Does not include: 41
(I) A plan that is subject to the Employee Retirement 42
Income Security Act of 1974 or any information relating to such 43
coverage; or 44

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(II) Health coverage provided by a local government 1
agency through a self -insurance reserve fund pursuant to 2
NRS 287.010. 3
Sec. 72.3. NRS 629.051 is hereby amended to read as follows: 4
629.051 1. Except as otherwise provided in this section and 5
in regulations adopted by the State Board of Health pursuant to NRS 6
652.135 with regard to the record s of a medical laboratory and 7
unless a longer period is provided by federal law, each custodian of 8
health care records shall retain the health care records of patients as 9
part of the regularly maintained records of the custodian for 5 years 10
after their receipt or production. Health care records may be retained 11
in written form, or by microfilm or any other recognized form of 12
size reduction, including, without limitation, microfiche, computer 13
disc, magnetic tape and optical disc, which does not adversely affect 14
their use for the purposes of NRS 629.061. 15
2. Except as otherwise provided in subsection 4 of NRS 16
439.589, a high-level provider of health care shall comply with the 17
requirements of subsection 4 of NRS 439.589 concerning the 18
maintenance, transmittal and exchange of health records. Health 19
care records [: 20
(a) Must, except as otherwise provided in subsections 5 and 6 of 21
NRS 439.589, be created, maintained, transmitted and exchanged 22
electronically as required by subsection 4 of NRS 439.589; and 23
(b) May] may be created, authenticated and stored in a health 24
information exchange which meets the requirements of NRS 25
439.581 to 439.597, inclusive, and section 1 of this act, and the 26
regulations adopted pursuant thereto. 27
[2.] 3. A provider of health care shall post, in a conspicuous 28
place in each location at which the provider of health care performs 29
health care services, a sign which discloses to patients that their 30
health care records may be destroyed after the period set forth in 31
subsection 1. 32
[3.] 4. When a provider of health care performs health care 33
services for a patient for the first time, the provider of health care 34
shall deliver to the patient a written statement which discloses to the 35
patient that the health care records of the patient may be destro yed 36
after the period set forth in subsection 1. 37
[4.] 5. If a provider of health care fails to deliver the written 38
statement to the patient pursuant to subsection [3,] 4, the provider of 39
health care shall deliver to the patient the written statement 40
described in subsection [3] 4 when the provider of health care next 41
performs health care services for the patient. 42
[5.] 6. In addition to delivering a written statement pursuant to 43
subsection [3 or] 4 [,] or 5, a provider of health care may deliver 44
such a written statement to a patient at any other time. 45

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[6.] 7. A written statement delivered to a patient pursuant to 1
this section may be included with other written information 2
delivered to the patient by a provider of health care. 3
[7.] 8. A custodian of h ealth care records shall not destroy the 4
health care records of a person who is less than 23 years of age on 5
the date of the proposed destruction of the records. The health care 6
records of a person who has attained the age of 23 years may be 7
destroyed in a ccordance with this section for those records which 8
have been retained for at least 5 years or for any longer period 9
provided by federal law. 10
[8.] 9. If a health care licensing board receives notification 11
from the Department of Health and Human Services pursuant to 12
NRS 439.5895 that a high-level provider of health care to which the 13
health care licensing board has issued a license is not in compliance 14
with the requirements of subsection 4 or 8, as applicable, of NRS 15
439.589, the health care licensing board may, after notice and the 16
opportunity for a hearing in accordance with the provisions of this 17
title, require corrective action or impose an administrative penalty in 18
an amount not to exceed the maximum penalty that the health care 19
licensing board is autho rized to impose for other violations. The 20
health care licensing board shall not suspend or revoke a license for 21
failure to comply with the requirements of subsection 4 or 8 of 22
NRS 439.589. 23
[9. The provisions of this section, except for the provisions of 24
paragraph (a) of subsection 1 and subsection 8, do not apply to a 25
pharmacist.] 26
10. The State Board of Health shall adopt: 27
(a) Regulations prescribing the form, size, contents and 28
placement of the signs and written statements required pursuant to 29
this section; and 30
(b) Any other regulations necessary to carry out the provisions 31
of this section. 32
11. As used in this section: 33
(a) “Health care licensing board” means: 34
(1) A board created pursuant to chapter 630, 630A, 631, 632, 35
633, 634, 634A, 635, 636, 637, 637B, 639, 640, 640A, 640B, 640C, 36
641, 641A, 641B, 641C or 641D of NRS. 37
(2) The Division of Public and Behavioral Health of the 38
Department of Health and Human Services. 39
(3) The State Board of Health with respect to licenses issued 40
pursuant to chapter 640D or 640E of NRS. 41
(b) “High-level provider of health care” has the meaning 42
ascribed to it in section 1 of this act. 43
(c) “License” has the meaning ascribed to it in NRS 439.5895. 44

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Sec. 72.5. NRS 629.053 is hereby amended to read as follows: 1
629.053 1. The State Board of Health and each board created 2
pursuant to chapter 630, 630A, 631, 632, 633, 634, 634A, 635, 636, 3
637, 637B, 640, 640A, 640B, 640C, 641, 641A, 641B, 641C or 4
641D of NRS shall post on its website o n the Internet, if any, a 5
statement which discloses that: 6
(a) Pursuant to the provisions of subsection [7] 8 of 7
NRS 629.051: 8
(1) The health care records of a person who is less than 23 9
years of age may not be destroyed; and 10
(2) The health care record s of a person who has attained the 11
age of 23 years may be destroyed for those records which have been 12
retained for at least 5 years or for any longer period provided by 13
federal law; and 14
(b) Except as otherwise provided in subsection [7] 8 of NRS 15
629.051 and unless a longer period is provided by federal law, the 16
health care records of a patient who is 23 years of age or older may 17
be destroyed after 5 years pursuant to subsection 1 of NRS 629.051. 18
2. The State Board of Health shall adopt regulations 19
prescribing the contents of the statements required pursuant to this 20
section. 21
Sec. 72.8. NRS 629.062 is hereby amended to read as follows: 22
629.062 1. If a person who is authorized to request a copy of 23
health care records of a patient pursuant to NRS 629.061 requests 24
that a copy of such records be furnished electronically, the custodian 25
of health care records must electronically transmit a copy of the 26
requested records to the person or, if the patient has provided 27
written authorization for records to be furnished to another person or 28
entity, to that person or entity. Such records must be furnished in an 29
electronic format using a method of secure electronic transmission 30
that complies with applicable federal and state law. If a patient 31
requests that a copy of his or her health care records be furnished 32
electronically to the patient or any covered entity, the custodian of 33
health records shall furnish the copy not later than the end of the 34
seventh business day after the request is made. 35
2. Except as otherwise provided in this subsection and 36
subsections 3 and 4, if a custodian of health care records maintains 37
health care records electronically, any fee to furnish those records 38
electronically pursuant to subsection 1 must not excee d $40 or the 39
amount per page prescribed by NRS 629.061, whichever is less. A 40
custodian of health care records shall not charge a fee to furnish 41
health care records to a patient or, if the patient has requested a 42
copy of his or her health care records to be furnished to any 43
covered entity, to that covered entity. 44

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3. If the total amount of the fee chargeable pursuant to 1
subsection 2 for the furnishing of health care records electronically 2
is less than $5, a custodian of health care records, other than a 3
custodian of the health care records of a state or local governmental 4
entity, may charge a fee of $5 for the furnishing of those health care 5
records. 6
4. [A] Except as otherwise provided in subsection 2, a 7
custodian of health care records, other than a cus todian of the health 8
care records of a state or local governmental entity, may charge the 9
following fees to furnish health care records electronically, in 10
addition to the total amount of the fee charged pursuant to 11
subsection 2 or 3: 12
(a) A fee of $5 for w ritten confirmation that no health care 13
records were found. 14
(b) A fee of $5 for furnishing a copy of a certificate of the 15
custodian of health care records. 16
(c) A fee of $20 for a copy of a printed film sheet. 17
(d) A fee of $25 for furnishing a copy of ra diologic images in 18
any form other than a printed film sheet. 19
5. As used in this section: 20
(a) “Covered entity” has the meaning ascribed to it in 45 21
C.F.R. § 160.103. 22
(b) “Custodian of health care records” has the meaning ascribed 23
to it in NRS 629.016 and additionally includes a covered entity or 24
business associate, as those terms are defined in 45 C.F.R. § 25
160.103. 26
[(b)] (c) “Health care records” has the meaning ascribed to it in 27
NRS 629.021 and additionally includes individually identifiable 28
health information, as defined in 45 C.F.R. § 160.103. 29
[(c)] (d) “Secure electronic transmission” means the sending of 30
information from one computer system to another computer system 31
in such a manner as to ensure that: 32
(1) No person other than the intended reci pient receives the 33
information; 34
(2) The identity and signature of the sender of the 35
information can be authenticated; and 36
(3) The information which is received by the intended 37
recipient is identical to the information that was sent. 38
Sec. 73. Chapter 630 of NRS is hereby amended by adding 39
thereto the provisions set forth as sections 74 and 75 of this act. 40
Sec. 74. 1. The Board shall adopt regulations establishing 41
a procedure to prioritiz e the processing of applications for the 42
initial issuance of a license to practice medicine submitted by an 43
applicant who intends to practice: 44

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(a) Serving g eographic areas and populations of this State 1
where the shortage of providers of health care is most critical, as 2
identified by the assessment conducted pursuant to section 7 of 3
this act; or 4
(b) In a specialty for which the need is most critical, as 5
identified by the assessment conducted pursuant to section 7 of 6
this act. 7
2. In establishing procedures to carry out the regulations 8
adopted pursuant to this section, the Board shall: 9
(a) Establish metrics to monitor the processing times of 10
applications described in subsection 1 to ensure compliance with 11
the requirements of that subsection; and 12
(b) In collaboration with the Department of Health and 13
Human Services, annually update the geographic areas, 14
populations and specialties for which applications are pr ioritized 15
in response to each assessment conducted pursuant to section 7 of 16
this act. 17
Sec. 75. 1. The Board shall: 18
(a) Establish an electronic system to allow an entity that 19
verifies the credentials of providers of health care pursuant to 20
paragraph (b) of subsection 1 of section 50 of this act or 21
paragraph (b) of subsection 1 of section 109 of this act or a 22
hospital to access data in the possession of the Board for the 23
purpose of privileging or credentialing a physician, p hysician 24
assistant, anesthesiologist assistant, perfusionist or practitioner of 25
respiratory care who has authorized the Board to share such data 26
pursuant to paragraph (b). 27
(b) Allow an applicant for the issuance of a license to practice 28
medicine, a physic ian applying for biennial registration or an 29
applicant for the issuance or renewal of a license as a physician 30
assistant, anesthesiologist assistant, perfusionist or practitioner of 31
respiratory care to indicate whether he or she wishes to allow 32
electronic access to his or her data pursuant to paragraph (a). 33
2. As used in this section: 34
(a) “Credentialing” means verifying the credentials of a 35
provider of health care for the purpose of determining whether the 36
provider of health care meets the requirements for participation in 37
the network of a third party or participation in Medicaid or the 38
Children’s Health Insurance Program as a provider of services. 39
(b) “Network” has the meaning ascribed to it in 40
NRS 687B.640. 41
(c) “Privileging” means the process of dete rmining whether to 42
authorize a provider of health care to provide specific services at a 43
hospital based on his or her credentials and qualifications. 44

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(d) “Provider of health care” has the meaning ascribed to it in 1
NRS 629.031. 2
(e) “Third party”: 3
(1) Except as otherwise provided in subparagraph (2), 4
means any insurer or organization providing health coverage or 5
benefits in accordance with state or federal law. 6
(2) Does not include: 7
(I) A plan that is subject to the Employee Retirement 8
Income Security Act of 1974 or any information relating to such 9
coverage; or 10
(II) Health coverage provided by a local government 11
agency through a self -insurance reserve fund pursuant to 12
NRS 287.010. 13
Sec. 76. NRS 630.130 is hereby amended to read as follows: 14
630.130 1. In addition to the other powers and duties 15
provided in this chapter, the Board shall, in the interest of the public, 16
judiciously: 17
(a) Enforce the provisions of this chapter; 18
(b) Establish by regulation standards for licensure under this 19
chapter; 20
(c) Conduct examinations for licensure and establish a system of 21
scoring for those examinations; 22
(d) Investigate the character of each applicant for a license and 23
issue licenses to those applicants who meet the qualifica tions set by 24
this chapter and the Board; and 25
(e) Institute a proceeding in any court to enforce its orders or the 26
provisions of this chapter. 27
2. On or before February 15 of each odd -numbered year, the 28
Board shall submit to the Governor and to the Direct or of the 29
Legislative Counsel Bureau for transmittal to the next regular 30
session of the Legislature a written report compiling: 31
(a) Disciplinary action taken by the Board during the previous 32
biennium against any licensee for malpractice or negligence; 33
(b) Information reported to the Board during the previous 34
biennium pursuant to NRS 630.3067, 630.3068, subsections 3 and 6 35
of NRS 630.307 and NRS 690B.250; [and] 36
(c) Information reported to the Board during the previous 37
biennium pursuant to NRS 630.30665, including, without limitation, 38
the number and types of surgeries performed by each holder of a 39
license to practice medicine and the occurrence of sentinel events 40
arising from such surgeries, if any [.] ; and 41
(d) Information relating to the efficiency of the process for 42
licensing physicians, including, without limitation: 43

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(1) The average time during the previous biennium between 1
when a person applied for a license to practice medicine and when 2
the license was issued or the application was denied; 3
(2) The total number of applications for licensure to 4
practice medicine processed by the Board during the immediately 5
preceding biennium; and 6
(3) Recommendations for improvements to the process for 7
licensing physicians. 8
 The report must include only aggregate information for statistical 9
purposes and exclude any identifying information related to a 10
particular person. 11
3. The Board may adopt such regulations as are necessary or 12
desirable to enable it to carry out the provisions of this chapter. 13
Sec. 76.5. NRS 630.2671 is hereby amended to read as 14
follows: 15
630.2671 1. The Board shall [: 16
(a) Make] make the data request developed by the Director of 17
the Department of Health and Human Services pursuant to NRS 18
439A.116 available to applicants for a biennial registration pursuant 19
to NRS 630.267 or the renewal of a license pursuant to this chapter 20
through a link on the electronic application for a biennial 21
registration or the renewal of a license . [; and 22
(b) Request each] 23
2. Each applicant [to] for a biennial registration pursuant to 24
NRS 630.267 or the renewal of a license pursuant to this chapter 25
must, as a condition for such registration or renewal, complete and 26
electronically submit the data request to the Director. 27
[2.] 3. The information provided by an applicant for a biennial 28
registration or the renewal of a license pursuant to subsection [1] 2 29
is confidential and, except as required by subsection [1,] 2, must not 30
be disclosed to any person or entity. 31
[3. An applicant for a biennial registration or the renewal of a 32
license is not required to complete a data request pursuant to 33
subsection 1 and is not subject to disciplinary action, including, 34
without limitation, refusal to issue the biennial registration or renew 35
the license, for failure to do so.] 36
Sec. 77. Chapter 631 of NRS is hereby amended by adding 37
thereto a new section to read as follows: 38
1. The Board may adopt regulations to establish an 39
alternative training pathway that an applicant for a license as a 40
dental hygienist may, subject to the limitations prescribed by 41
subsection 4, complete instead of graduating from a program of 42
dental hygiene described in paragraph (c) of subsection 1 of 43
NRS 631.290. 44

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2. Any regulations adopt ed pursuant to subsection 1 must 1
require a person receiving training through the alternative 2
training pathway to: 3
(a) Complete an educational program comparable to the 4
educational program required by a program of dental hygiene 5
described in paragraph (c) of subsection 1 of NRS 631.290. Such a 6
program must include, without limitation: 7
(1) Two semesters of biology with laboratory components; 8
(2) Two semesters of chemistry with laboratory 9
components; 10
(3) Two semesters of anatomy and physiology; 11
(4) One semester of microbiology; and 12
(5) One semester of college-level mathematics. 13
(b) Complete a program of clinical training under the 14
supervision of a dentist that is comparable to the clinical training 15
provided by a program of dental hygiene descr ibed in paragraph 16
(c) of subsection 1 of NRS 631.290 and includes a similar number 17
of hours of training as such a program; and 18
(c) Successfully pass a competency examination conducted by 19
his or her supervising dentist, the written examination required by 20
subsection 1 of NRS 631.300 and a clinical examination approved 21
by the Board. 22
3. The Board shall adopt regulations establishing: 23
(a) Requirements for the training completed pursuant to 24
paragraphs (a) and (b) of subsection 2. 25
(b) The scope of practice of a dental hygienist who has 26
completed the alternative training pathway established pursuant to 27
this section. Those regulations must establish: 28
(1) Locations where such a dental hygienist may practice 29
dental hygiene , which must be limited to those ident ified in 30
paragraphs (a) to (e), inclusive, of subsection 1 of NRS 631.310 ; 31
and 32
(2) The manner in which such a dental hygienist must 33
represent himself or herself to patients. 34
4. A person who completes the alternative training pathway 35
established pursuant to this section is only eligible for licensure if 36
he or she began the alternative training pathway during a 37
biennium for which the assessment conducted pursuant to section 38
7 of this act designated dental hygienists as a type of provider of 39
health care for which there is a shortage in this State. 40
Sec. 78. NRS 631.220 is hereby amended to read as follows: 41
631.220 1. Every applicant for a license t o practice dental 42
hygiene, dental therapy, dentistry or expanded function dental 43
assistance must: 44
(a) File an application with the Board. 45

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(b) Accompany the application with a recent photograph of the 1
applicant together with the required fee and such othe r 2
documentation as the Board may require by regulation. 3
(c) Submit with the application a complete set of fingerprints 4
and written permission authorizing the Board to forward the 5
fingerprints to the Central Repository for Nevada Records of 6
Criminal Histor y for submission to the Federal Bureau of 7
Investigation for its report. 8
(d) If the applicant is required to take an examination pursuant 9
to NRS 631.240, 631.300, 631.3121, 631.31286 or 631.31287, or 10
section 77 of this act, submit with the application proof satisfactory 11
that the applicant passed the examination. 12
2. In addition to satisfying the requirements of subsection 1, if 13
an applicant for a license to practice dental hygiene, dental therapy 14
or dentistry intends to provide services through teledentistry, the 15
applicant must submit to the Board proof that the applicant has 16
completed: 17
(a) At least 2 hours of continuing education concerning 18
teledentistry; or 19
(b) A course in teledentistry as part of the requirements for 20
graduation from an accredited institution. 21
3. An application must include all information required to 22
complete the application. 23
4. The Secretary-Treasurer may, in accordance with regulations 24
adopted by the Board and if the Secretary -Treasurer determines that 25
an application is: 26
(a) Sufficient, advise the Executive Director of the sufficiency 27
of the application. Upon the advice of the Secretary -Treasurer, the 28
Executive Director may issue a license to the applicant without 29
further review by the Board. 30
(b) Insufficient, reject t he application by sending written notice 31
of the rejection to the applicant. 32
Sec. 79. NRS 631.290 is hereby amended to read as follows: 33
631.290 1. Any person is eligible to apply for a license to 34
practice dental hygiene in this State who: 35
(a) Is of good moral character; 36
(b) Is over 18 years of age; and 37
(c) [Is] Except as otherwise authorized by section 77 of this act, 38
is a graduate of a program of dental hygiene from an institution 39
which is accredited by a regional edu cational accrediting 40
organization that is recognized by the United States Department of 41
Education. The program of dental hygiene must: 42
(1) Be accredited by the Commission on Dental 43
Accreditation of the American Dental Association or its successor 44
specialty accrediting organization; and 45

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(2) Include a curriculum of not less than 2 years of academic 1
instruction in dental hygiene or its academic equivalent. 2
2. To determine whether a person has good moral character, 3
the Board may consider whether his or her license to practice dental 4
hygiene in another state has been suspended or revoked or whether 5
he or she is currently involved in any disciplinary action concerning 6
his or her license in that state. 7
Sec. 80. NRS 631.310 is hereby amended to read as follows: 8
631.310 1. Except as otherwise provided in NRS 631.271 9
and 631.287 [,] and section 77 of this act, the holder of a license or 10
renewal certificate to practice dental hygiene may practice dental 11
hygiene in this State in the following places: 12
(a) In the office of any licensed dentist. 13
(b) In a clinic or in clinics in the public schools of this State as 14
an employee of the Division of Public and Behavioral Health of the 15
Department of Health and Human Services. 16
(c) In a clinic or in clinics in a state institution as an employee of 17
the institution. 18
(d) In a clinic established by a hospital approved by the Board as 19
an employee of the hospital where service is rendered only to 20
patients of the hospital, and upon the authoriz ation of a member of 21
the dental staff. 22
(e) In an accredited school of dental hygiene. 23
(f) In other places if specified in a regulation adopted by the 24
Board. 25
2. A dental hygienist may perform only the services which are 26
authorized by a dentist licensed in the State of Nevada, unless 27
otherwise provided in a regulation adopted by the Board. 28
3. Except as otherwise provided in NRS 631.287 or 29
specifically authorized by a regulation adopted by the Board, a 30
dental hygienist shall not provide services to a pe rson unless that 31
person is a patient of the dentist who authorized the performance of 32
those services. 33
Sec. 81. NRS 631.3105 is hereby amended to read as follows: 34
631.3105 1. A dental hygienist who meets the requirements 35
prescribed by regulation of the Board pursuant to subsection 4 and is 36
issued a certificate by the State Board of Pharmacy pursuant to NRS 37
639.1374 may prescribe and dispense only: 38
(a) Topical or systemic prescription drugs, other than controlled 39
substances, for preventative care; 40
(b) Fluoride preparations for which a prescription is not 41
required; 42
(c) Topical antimicrobial oral rinses; and 43
(d) Medicament trays or mouthguards. 44
2. A dental hygienist shall not prescribe or dispense: 45

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(a) A controlled substance; or 1
(b) Any drug or device not listed in subsection 1 or authorized 2
under the certificate issued pursuant to NRS 639.1374. 3
3. A dental hygienist may only prescribe and dispense a drug 4
or device pursuant to subsection 1: 5
(a) In compliance with any applicable regulations adopted by the 6
Board; and 7
(b) In compliance with any applicable law governing the 8
handling, prescribing and dispensing of the drug or device. 9
4. The Board shall adopt regulations prescribing the: 10
(a) Education and training that a dental hygienist must complete 11
before prescribing and dispensing a drug or device pursuant to 12
subsection 1; and 13
(b) Continuing education that a dental hygienist must complete 14
to be authorized to continue prescribing and dispensing drugs or 15
devices pursuant to subsection 1. 16
5. A dental hygienist who has completed the alternative 17
training pathway established pursuant to section 77 of this act and 18
has not subsequently graduated from a program of dental hygiene 19
described in paragraph (c) of subsection 1 of NRS 631.290 shall 20
not prescribe and dispense preventive agents pursuant to this 21
section. 22
Sec. 82. (Deleted by amendment.) 23
Sec. 82.3. NRS 631.332 is hereby amended to read as follows: 24
631.332 1. The Board shall [: 25
(a) Make] make the data request developed by the Director of 26
the Department of Health and Human Services pursuant to NRS 27
439A.116 available to applicants for the renewal of a license 28
pursuant to this chapter through a link on the electronic application 29
for the renewal of a license . [; and 30
(b) Request each] 31
2. Each applicant [to] for the renewal of a license pursuant to 32
this chapter must, as a condition for such renewal, complete and 33
electronically submit the data request to the Director. 34
[2.] 3. The information provided by an applicant for the 35
renewal of a license pursuant to subsection [1] 2 is confidential and, 36
except as required by subsection [1,] 2, must not be disclosed to any 37
person or entity. 38
[3. An applicant for the renewal of a license is not required to 39
complete a data request pursuant to subsection 1 and is not subject 40
to disciplinary action, including, without limitation, refusal to renew 41
the license, for failure to do so.] 42
Sec. 82.6. NRS 632.3423 is hereby amended to read as 43
follows: 44
632.3423 1. The Board shall [: 45

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(a) Make] make the data request developed by the Director of 1
the Department of Health and Human Services pursuant to NRS 2
439A.116 available to applicants for the renewal of a license or 3
certificate pursuant to this chapter through a link on the electronic 4
application for the renewal of a license or certificate . [; and 5
(b) Request each] 6
2. Each applicant [to] for the renewal of a license or 7
certificate pursuant to this chapter must, as a condition for such 8
renewal, complete and electronically submit the data request to the 9
Director. 10
[2.] 3. The information provided by an applicant for the 11
renewal of a license or cer tificate pursuant to subsection [1] 2 is 12
confidential and, except as required by subsection [1,] 2, must not 13
be disclosed to any person or entity. 14
[3. An applicant for the renewal of a license or certificate is not 15
required to complete a data request pur suant to subsection 1 and is 16
not subject to disciplinary action, including, without limitation, 17
refusal to renew the license or certificate, for failure to do so.] 18
Sec. 83. Chapter 633 of NRS is hereby amended by adding 19
thereto the provisions set forth as sections 84 and 85 of this act. 20
Sec. 84. 1. The Board shall adopt regulations establishing 21
a procedure to prioritize the processing of appl ications for the 22
initial issuance of a license to practice osteopathic medicine 23
submitted by an applicant who intends to practice: 24
(a) Serving g eographic areas and populations of this State 25
where the shortage of providers of health care is most critical, as 26
identified by the assessment conducted pursuant to section 7 of 27
this act; or 28
(b) In a specialty for which the need is most critical, as 29
identified by the assessment conducted pursuant to section 7 of 30
this act. 31
2. In establishing procedures to carry o ut the regulations 32
adopted pursuant to this section, the Board shall: 33
(a) Establish metrics to monitor the processing times of 34
applications described in subsection 1 to ensure compliance with 35
the requirements of that subsection; and 36
(b) In collaboration with the Department of Health and 37
Human Services, annually update the geographic areas, 38
populations and specialties for which applications are prioritized 39
in response to each assessment conducted pursuant to section 7 of 40
this act. 41
Sec. 85. 1. The Board shall: 42
(a) Establish an electronic system to allow an entity that 43
verifies the credentials of providers of health care pursuant to 44
paragraph (b) of subsection 1 of section 50 of this act or 45

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paragraph (b) o f subsection 1 of section 109 of this act, as 1
applicable, or a hospital to access data in the possession of the 2
Board for the purpose of privileging or credentialing an 3
osteopathic physician, physician assistant or anesthesiologist 4
assistant who has author ized the Board to share such data 5
pursuant to paragraph (b). 6
(b) Allow an applicant for the issuance or renewal of a license 7
as an osteopathic physician, physician assistant or anesthesiologist 8
assistant to indicate whether he or she wishes to allow elect ronic 9
access to his or her data pursuant to paragraph (a). 10
2. As used in this section: 11
(a) “Credentialing” means verifying the credentials of a 12
provider of health care for the purpose of determining whether the 13
provider of health care meets the requirements for participation in 14
the network of a third party or participation in Medicaid or the 15
Children’s Health Insurance Program as a provider of services. 16
(b) “Network” has the meaning ascribed to it in 17
NRS 687B.640. 18
(c) “Privileging” means the process of determining whether to 19
authorize a provider of health care to provide specific services at a 20
hospital based on his or her credentials and qualifications. 21
(d) “Provider of health care” has the meaning ascribed to it in 22
NRS 629.031. 23
(e) “Third party”: 24
(1) Except as otherwise provided in subparagraph (2), 25
means any insurer or organization providing health coverage or 26
benefits in accordance with state or federal law. 27
(2) Does not include: 28
(I) A plan that is subject to the Employee Retirement 29
Income Security Act of 1974 or any information relating to such 30
coverage; or 31
(II) Health coverage provided by a local government 32
agency through a self -insurance reserve fund pursuant to 33
NRS 287.010. 34
Sec. 86. NRS 633.286 is hereby amended to read as follows: 35
633.286 1. On or before February 15 of each odd -numbered 36
year, the Board shall submit to the Governor and to the Director of 37
the Legislative Counsel Bureau for transmittal to the next regular 38
session of the Legislature a written report compiling: 39
(a) Disciplinary action taken by the Board during the previous 40
biennium against osteopathic physicians, physician assistants and 41
anesthesiologist assistants for malpractice or negligence; 42
(b) Information reported to the Board dur ing the previous 43
biennium pursuant to NRS 633.526, 633.527, subsections 3 and 6 of 44
NRS 633.533 and NRS 690B.250; [and] 45

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(c) Information reported to the Board during the previous 1
biennium pursuant to NRS 633.524, including, without limitation, 2
the number and types of surgeries performed by each holder of a 3
license to practice osteopathic medicine and the occurrence of 4
sentinel events arising from such surgeries, if any [.] ; and 5
(d) Information relating to the efficiency of the process for 6
licensing osteopathic physicians, including, without limitation: 7
(1) The average time during the previous biennium between 8
when a person applied for a license to practice osteopathic 9
medicine and when the license was issued or the application was 10
denied; 11
(2) The tota l number of applications for licensure to 12
practice osteopathic medicine processed by the Board during the 13
immediately preceding biennium; and 14
(3) Recommendations for improvements to the process for 15
licensing physicians. 16
2. The report must include only aggregate information for 17
statistical purposes and exclude any identifying information related 18
to a particular person. 19
Sec. 86.2. NRS 633.4716 is hereby amended to read as 20
follows: 21
633.4716 1. The Board shall [: 22
(a) Make] make the data request developed by the Director of 23
the Department of Health and Human Services pursuant to NRS 24
439A.116 available to applicants for the renewal of a license 25
pursuant to this chapter through a link on the electronic application 26
for the renewal of a license . [; and 27
(b) Request each] 28
2. Each applicant [to] for the renewal of a license pursuant to 29
this chapter must, as a condition for such renewal, complete and 30
electronically submit the data request to the Director. 31
[2.] 3. The information provided by an applicant for the 32
renewal of a license pursuant to subsection [1] 2 is confidential and, 33
except as required by subsection [1,] 2, must not be disclosed to any 34
person or entity. 35
[3. An applicant for the renewal of a license is not required to 36
complete a data request pursuant to subsection 1 and is not subject 37
to disciplinary action, including, without limitation, refusal to renew 38
the license, for failure to do so.] 39
Sec. 86.4. NRS 635.111 is hereby amended to read as follows: 40
635.111 1. The Board [may: 41
(a) Make] shall make the data request developed by the Director 42
of the Department of Health and Human Services pursuant to NRS 43
439A.116 available to applicants for the renewal of a license 44

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pursuant to this chapter through a link on the electronic application 1
for the renewal of a license . [; and 2
(b) Request each] 3
2. Each applicant [to] for the renewal of a license pursuant to 4
this chapter must, as a condition for such renewal, complete and 5
electronically submit the data request to the Director. 6
[2.] 3. The information provided by an applicant for the 7
renewal of a license pursuant to subsection [1] 2 is confidential and, 8
except as required by subsection [1,] 2, must not be disclosed to any 9
person or entity. 10
[3. An applicant for the renewal of a license is not required to 11
complete a data request pursuant to subsection 1 and is not subject 12
to disciplinary action, including, without limitation, refusal to renew 13
the license, for failure to do so.] 14
Sec. 86.6. NRS 636.262 is hereby amended to read as follows: 15
636.262 1. The Board [may: 16
(a) Make] shall make the data request developed by the Director 17
of the Department of Health and Human Services pursuant to NRS 18
439A.116 available to applicants for the renewal of a license 19
pursuant to this chapter through a link on the electronic application 20
for the renewal of a license . [; and 21
(b) Request each] 22
2. Each applicant [to] for the renewal of a license pursuant to 23
this chapter must, as a condition for such renewal, complete and 24
electronically submit the data request to the Director. 25
[2.] 3. The information provided by an applicant for the 26
renewal of a license pursuant to subsection [1] 2 is confidential and, 27
except as required by subsection [1,] 2, must not be disclosed to any 28
person or entity. 29
[3. An applicant for the renewal of a license is not required to 30
complete a data request pursuant to subsection 1 and is not subject 31
to disciplinary action, including, without limitation, refusal to renew 32
the license, for failure to do so.] 33
Sec. 86.8. NRS 637.145 is hereby amended to read as follows: 34
637.145 1. The Board [may: 35
(a) Make] shall make the data request developed by the Director 36
of the Department of Health and Human Services pursuant to NRS 37
439A.116 available to applicants for the renewal of a license 38
pursuant to this chapter through a link on the electronic application 39
for the renewal of a license . [; and 40
(b) Request each] 41
2. Each applicant [to] for the renewal of a license pursuant to 42
this chapter must, as a condition for such renewal, complete and 43
electronically submit the data request to the Director. 44

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[2.] 3. The in formation provided by an applicant for the 1
renewal of a license pursuant to subsection [1] 2 is confidential and, 2
except as required by subsection [1,] 2, must not be disclosed to any 3
person or entity. 4
[3. An applicant for the renewal of a license is no t required to 5
complete a data request pursuant to subsection 1 and is not subject 6
to disciplinary action, including, without limitation, refusal to renew 7
the license, for failure to do so.] 8
Sec. 87. (Deleted by amendment.) 9
Sec. 88. (Deleted by amendment.) 10
Sec. 89. Chapter 641 of NRS is hereby amended by adding 11
thereto a new section to read as follows: 12
1. The Board shall , to encourage psychologists to receive 13
training in the mental health needs of patients in rural areas: 14
(a) Make available to licensees information concerning 15
continuing education on the mental health needs of such patients 16
provided by the Committee on Rural Health of the American 17
Psychological Association; and 18
(b) Accept any such continuing education completed by a 19
licensee for credit toward the continuing education required by 20
paragraph (b) of subsection 4 of NRS 641.220. 21
2. The Board shall establish a program to recognize 22
psychologists, including, without limitation and to the extent 23
practicable, psychologists who practice or provide services through 24
telehealth in this State pursuant to the Psychology 25
Interjurisdictional Compact enacted in NRS 641.227, who provide 26
at least 200 h ours of services through telehealth to patients in 27
rural areas of this State. The program must provide for a 28
psychologist who meets that requirement to: 29
(a) Receive a certificate of distinction; and 30
(b) With the consent of the psychologist, be recognized on an 31
Internet website maintained by the Board as a “Committed Rural 32
Service Provider.” 33
3. The Board may: 34
(a) Adopt any regulations necessary to carry out the provisions 35
of this section. 36
(b) Collect any information from holders of licenses and 37
certificates issued by the Board necessary to carry out the 38
provisions of this section. 39
4. On or before October 1 of each odd-numbered year, the 40
Board shall: 41
(a) Compile a report concerning the implementation of and 42
outcomes resulting from the provisions of this section, including, 43
without limitation and to the extent that such information is 44
available: 45

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(1) Participation in the continuing education described in 1
subsection 1; and 2
(2) The number of psychologists recognized under the 3
program established purs uant to subsection 2 and the estimated 4
number of hours of services provided through telehealth to 5
patients in rural areas of this State by such psychologists during 6
the immediately preceding calendar year; and 7
(b) Submit the report to the Director of the Legislative Counsel 8
Bureau for transmittal to the Joint Interim Standing Committee 9
on Health and Human Services. 10
5. As used in this section, “telehealth” has the meaning 11
ascribed to it in NRS 629.515. 12
Sec. 89.2. NRS 6 41.2215 is hereby amended to read as 13
follows: 14
641.2215 1. The Board shall [: 15
(a) Make] make the data request developed by the Director of 16
the Department of Health and Human Services pursuant to NRS 17
439A.116 available to applicants for the renewal of a license or 18
registration pursuant to this chapter through a link on the electronic 19
application for the renewal of a license or registration . [; and 20
(b) Request each] 21
2. Each applicant [to] for the renewal of a license or 22
registration pursuant to this chapter must, as a condition for such 23
renewal, complete and electronically submit the data request to the 24
Director. 25
[2.] 3. The information provided by an applicant for the 26
renewal of a licens e or registration pursuant to subsection [1] 2 is 27
confidential and, except as required by subsection [1,] 2, must not 28
be disclosed to any person or entity. 29
[3. An applicant for the renewal of a license or registration is 30
not required to complete a data r equest pursuant to subsection 1 and 31
is not subject to disciplinary action, including, without limitation, 32
refusal to renew the license or registration, for failure to do so.] 33
Sec. 89.4. NRS 641A.217 is hereby amended to r ead as 34
follows: 35
641A.217 1. The Board shall [: 36
(a) Make] make the data request developed by the Director of 37
the Department of Health and Human Services pursuant to NRS 38
439A.116 available to applicants for the renewal of a license 39
pursuant to this chapter through a link on the electronic application 40
for the renewal of a license . [; and 41
(b) Request each] 42
2. Each applicant [to] for the renewal of a license pursuant to 43
this chapter must, as a condition for such renewal, complete and 44
electronically submit the data request to the Director. 45

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[2.] 3. The information provided by an applicant for the 1
renewal of a license pursuant to subsection [1] 2 is confidential and, 2
except as required by subsection [1,] 2, must not be disclosed to any 3
person or entity. 4
[3. An applicant for the renewal of a license is not required to 5
complete a data request pursuant to subsection 1 and is not subject 6
to disciplinary action, including, without limitation, refusal to renew 7
the license, for failure to do so.] 8
Sec. 89.6. NRS 641B.281 is hereby amended to read as 9
follows: 10
641B.281 1. The Board shall [: 11
(a) Make] make the data request developed by the Director of 12
the Department of Health and Human Services pursuant to NRS 13
439A.116 available to applicants for the renewal of a license 14
pursuant to this chapter through a link on the electronic application 15
for the renewal of a license . [; and 16
(b) Request each] 17
2. Each applicant [to] for the renewal of a license pursuant to 18
this chapter must, as a condition for such renewal, complete and 19
electronically submit the data request to the Director. 20
[2.] 3. The information provided by an applicant for the 21
renewal of a license pursuant to subsection [1] 2 is confidential and, 22
except as required by subsection [1,] 2, must not be disclosed to any 23
person or entity. 24
[3. An applicant for the renewal of a license is not required to 25
complete a data request pursuant to subsection 1 and is not subject 26
to disciplinary action, including, without limitation, refusal to renew 27
the license, for failure to do so.] 28
Sec. 89.8. NRS 641C.455 is hereby amended to read as 29
follows: 30
641C.455 1. The Board [may: 31
(a) Make] shall make the data request developed by the Director 32
of the Department of Health and Human Services pursuant to NRS 33
439A.116 available to applicants for the renewal of a license or 34
certificate pursuant to this chapter through a link on the electronic 35
application for the renewal of a license or certificate . [; and 36
(b) Request each] 37
2. Each applicant [to] for the renewal of a license or 38
certificate pursuant to this chapter must, as a condition for such 39
renewal, complete and electronically submit the data request to the 40
Director. 41
[2.] 3. The information provided by an applicant for the 42
renewal of a license or certificate pursuant to subsection [1] 2 is 43
confidential and, except as required by subsection [1,] 2, must not 44
be disclosed to any person or entity. 45

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[3. An applicant for the renewal of a license or certificate is not 1
required to complete a data request pursuant to subsection 1 and is 2
not subject to disciplinary action, including, without limitation, 3
refusal to renew the license or certificate, for failure to do so.] 4
Sec. 89.9. Chapter 641D of NRS is hereby amended by adding 5
thereto a new section to read as follows: 6
1. The Board shall make the data request developed by the 7
Director of the Department of Health and Huma n Services 8
pursuant to NRS 439A.116 available to applicants for the renewal 9
of a license or registration pursuant to this chapter through a link 10
on the electronic application for the renewal of a license or 11
certificate. 12
2. Each applicant for the renewal of a license or registration 13
pursuant to this chapter must, as a condition for such renewal, 14
complete and electronically submit the data request to the 15
Director. 16
3. The information provided by an applicant for the renewal 17
of a license or registration pursuant to subsection 2 is confidential 18
and, except as required by subsection 2, must not be disclosed to 19
any person or entity. 20
Sec. 90. NRS 654.190 is hereby amended to read as follows: 21
654.190 1. The Board may, after notice and an opportunity 22
for a hearing as required by law, impose an administrative fine of 23
not more than $10,000 for each violation on, recover reasonable 24
investigative fees and costs incurred from, suspend, revoke, deny 25
the issuance or renewal of or pla ce conditions on the license of, and 26
place on probation or impose any combination of the foregoing on 27
any licensee who: 28
(a) Is convicted of a felony relating to the practice of 29
administering a facility for skilled nursing or facility for 30
intermediate care or residential facility for groups or of any offense 31
involving moral turpitude. 32
(b) Has obtained his or her license by the use of fraud or deceit. 33
(c) Violates any of the provisions of this chapter. 34
(d) Aids or abets any person in the violation of any of the 35
provisions of NRS 449.029 to 449.2428, inclusive, and sections 20, 36
21 and 22 of this act, or 449A.100 to 449A.124, inclusive, and 37
449A.270 to 449A.286, inclusive, as those provisions pertain to a 38
facility for skilled nursing, facility for intermedia te care or 39
residential facility for groups. 40
(e) Violates any regulation of the Board prescribing additional 41
standards of conduct for licensees, including, without limitation, a 42
code of ethics. 43

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(f) Engages in conduct that violates the trust of a patient o r 1
resident or exploits the relationship between the licensee and the 2
patient or resident for the financial or other gain of the licensee. 3
2. If a licensee requests a hearing pursuant to subsection 1, the 4
Board shall give the licensee written notice of a hearing pursuant to 5
NRS 233B.121 and 241.0333. A licensee may waive, in writing, his 6
or her right to attend the hearing. 7
3. The Board may compel the attendance of witnesses or the 8
production of documents or objects by subpoena. The Board may 9
adopt regula tions that set forth a procedure pursuant to which the 10
Chair of the Board may issue subpoenas on behalf of the Board. 11
Any person who is subpoenaed pursuant to this subsection may 12
request the Board to modify the terms of the subpoena or grant 13
additional time for compliance. 14
4. An order that imposes discipline and the findings of fact and 15
conclusions of law supporting that order are public records. 16
5. The expiration of a license by operation of law or by order 17
or decision of the Board or a court, or the v oluntary surrender of a 18
license, does not deprive the Board of jurisdiction to proceed with 19
any investigation of, or action or disciplinary proceeding against, the 20
licensee or to render a decision suspending or revoking the license. 21
Sec. 91. Chapter 680A of NRS is hereby amended by adding 22
thereto a new section to read as follows: 23
The Commissioner may not issue a certificate of authority to 24
an insurer that will provide health benefits if the insurer does not 25
meet the requirements established by the regulations adopted 26
pursuant to subsection 1 of section 108 of this act. 27
Sec. 92. NRS 680A.095 is hereby amended to read as follows: 28
680A.095 1. Except as otherwise provided in subsection 3, 29
an insurer which is not authorized to transact insurance in this State 30
may not transact reinsurance with a domesti c insurer in this State, 31
by mail or otherwise, unless the insurer holds a certificate of 32
authority as a reinsurer in accordance with the provisions of NRS 33
680A.010 to 680A.150, inclusive, and section 91 of this act, 34
680A.160 to 680A.280, inclusive, 680A.320 and 680A.330. 35
2. To qualify for authority only to transact reinsurance, an 36
insurer must meet the same requirements for capital and surplus as 37
are imposed on an insurer which is authorized to transact insurance 38
in this State. 39
3. This section does not apply to the joint reinsurance of title 40
insurance risks or to reciprocal insurance authorized pursuant to 41
chapter 694B of NRS. 42

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Sec. 93. NRS 683A.08524 is hereby amended to read as 1
follows: 2
683A.08524 1. Except as otherwise provided in subsection 2 3
or 3, the Commissioner shall issue a certificate of registration as an 4
administrator to an applicant who: 5
(a) Submits an application on a form prescribed by the 6
Commissioner; 7
(b) Has complied with the provisions of NRS 683A.08522; and 8
(c) Pays the fee for the issuance of a certificate of registration 9
prescribed in NRS 680B.010 and, in addition to any other fee or 10
charge, all applicable fees required pursuant to NRS 680C.110. 11
2. The Commissioner may refuse to issue a c ertificate of 12
registration as an administrator to an applicant if the Commissioner 13
determines that the applicant or any person who has completed an 14
affidavit pursuant to subsection 6 of NRS 683A.08522: 15
(a) Is not competent to act as an administrator; 16
(b) Is not trustworthy or financially responsible; 17
(c) Does not have a good personal or business reputation; 18
(d) Has had a license or certificate to transact insurance denied 19
for cause, suspended or revoked in this state or any other state; 20
(e) Has failed to comply with any provision of this chapter; 21
(f) Does not meet the requirements of the regulations adopted 22
pursuant to subsection 1 of section 108 of this act; or 23
[(f)] (g) Is financially unsound. 24
3. If an applicant seeks final approval by the Divisi on of 25
Industrial Relations of the Department of Business and Industry in 26
accordance with regulations adopted pursuant to subsection 8 of 27
NRS 616A.400, the Commissioner shall submit to the Division the 28
information supplied by the applicant pursuant to subse ction 1. 29
Unless the Division provides final approval for the applicant to the 30
Commissioner, the Commissioner shall not issue a certificate of 31
registration as an administrator to the applicant. 32
Sec. 94. NRS 683A.3715 is hereby amended to read as 33
follows: 34
683A.3715 1. An independent review organization must be 35
approved by the Commissioner to be eligible to be assigned to 36
conduct external reviews. 37
2. In order to be eligible for approval or reapproval by the 38
Commissioner to conduct external reviews, an independent review 39
organization: 40
(a) Except as otherwise provided in this section, must be 41
accredited by a nationally recognized private accrediting entity 42
which the Commissioner has determined has standards for the 43
accreditation of independent review organizations that are 44

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- *SB495_R1*
equivalent to or exceed the minimum qualifications for independent 1
review organizations established under NRS 683A.372; 2
(b) Must meet the requirements of the regulations adopted 3
pursuant to subsection 1 of section 108 of this act; and 4
[(b)] (c) Must submit an application in accordance with 5
subsection 4. 6
3. The Commissioner shall develop an application form for the 7
initial approval and reapproval of an independent review 8
organization to conduct external reviews. 9
4. An independent review organization wishing to be appro ved 10
or reapproved to conduct external reviews must submit the 11
application form and include with the form all documentation and 12
information necessary for the Commissioner to determine if the 13
independent review organization satisfies the minimum 14
qualifications established under NRS 683A.372 [.] and the 15
regulations adopted pursuant to subsection 1 of section 108 of this 16
act. 17
5. The Commissioner may approve an independent review 18
organization that is not accredited by a nationally recognized private 19
accrediting entity if there are no acceptable nationally recognized 20
private accrediting entities providing accreditation of independent 21
review organizations. 22
6. The Commissioner may charge any applicable fee which an 23
independent review organization must submit to the Commissioner 24
with its application for initial approval or reapproval. 25
7. An approval or reapproval is effective for 2 years unless the 26
Commissioner determines before its expiration that the independent 27
review organization does not satisfy t he minimum qualifications 28
established under NRS 683A.372. 29
8. Whenever the Commissioner determines that an independent 30
review organization has lost its accreditation or no longer satisfies 31
the minimum requirements established under NRS 683A.372, the 32
Commissioner shall terminate the approval of the independent 33
review organization and remove the independent review 34
organization from the list of independent review organizations 35
approved to conduct external reviews that is maintained by the 36
Commissioner pursuant to subsection 9. 37
9. The Commissioner shall maintain and periodically update a 38
list of approved independent review organizations. 39
10. The Commissioner may adopt regulations to carry out the 40
provisions of this section. 41
11. As used in this section, “i ndependent review organization” 42
has the meaning ascribed to it in NRS 695G.026. 43

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Sec. 95. NRS 683A.378 is hereby amended to read as follows: 1
683A.378 1. A person shall not conduct utilization review 2
unless the person is: 3
(a) Registered with the Commissioner as an agent who performs 4
utilization review and has a medical director who is a physician or, 5
in the case of an agent who reviews dental services, a dentist, 6
licensed in any state; or 7
(b) Employed by a registered agen t who performs utilization 8
review. 9
2. A person may apply for registration by filing with the 10
Commissioner the fee specified in NRS 680B.010 and, in addition 11
to any other fee or charge, all applicable fees required pursuant to 12
NRS 680C.110 and the followi ng information on a form provided 13
by the Commissioner: 14
(a) The applicant’s name, address, telephone number, valid 15
electronic mail address and normal business hours; 16
(b) The name and telephone number of a person the 17
Commissioner may contact for informatio n concerning the 18
applicant; 19
(c) The name of the medical director of the applicant and the 20
state in which he or she is licensed to practice medicine or dentistry; 21
[and] 22
(d) A summary of the plan for utilization review, including 23
procedures for appealing determinations made through utilization 24
review [.] ; and 25
(e) Any additional information required by the Commissioner 26
to ensure that the applicant will meet the requirements of the 27
regulations adopted pursuant to subsection 1 of section 108 of this 28
act. 29
3. An agent who performs utilization review shall file with the 30
Commissioner any material changes in the information provided 31
pursuant to subsection 1 within 30 days after the change occurs. 32
4. The Commissioner shall not evaluate the plan submitted 33
pursuant to paragraph (d) of subsection 2. The Commissioner shall 34
make the plan available upon request and shall charge a reasonable 35
fee for providing a copy of the plan. 36
5. The Commissioner may not approve an application for 37
registration as an agent who perf orms utilization review if the 38
applicant does not meet the requirements of the regulations 39
adopted pursuant to subsection 1 of section 108 of this act. 40
6. Registration pursuant to this section must be renewed on or 41
before March 1 of each year by providin g the information specified 42
in subsection 2 and paying the renewal fee specified in NRS 43
680B.010 and, in addition to any other fee or charge, all applicable 44
fees required pursuant to NRS 680C.110. 45

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Sec. 95.5. NRS 686A.315 is hereby amended to read as 1
follows: 2
686A.315 1. If a hospital or independent center for 3
emergency medical care submits to an insurer the form prescribed 4
by the Director of the Department of Health and Human Services 5
pursuant to NRS 449.485, that form must contain or be 6
accompanied by a statement that reads substantially as follows: 7
8
Any person who misrepresents or falsifies essential 9
information requested on this form may, upon conviction, be 10
subject to a fine and imprisonment under state or federal law, 11
or both. 12
13
2. If a person who is licensed to practice one of the health 14
professions regulated by title 54 of NRS submits to an insurer the 15
form commonly referred to as the “HCFA -1500” for a patient who 16
is not covered by any governmental program which offers insurance 17
coverage for health care, the form must be accompanied by a 18
statement that reads substantially as follows: 19
20
Any person who knowingly files a statement of claim 21
containing any misrepresentation or any false, incomplete or 22
misleading infor mation may be guilty of a criminal act 23
punishable under state or federal law, or both, and may be 24
subject to civil penalties. 25
26
3. The failure to provide any of the statements required by this 27
section is not a defense in a prosecution for insurance fraud pursuant 28
to NRS 686A.291. 29
Sec. 96. Chapter 687B of NRS is hereby amended by adding 30
thereto the provisions set forth as sections 97 to 109, inclusive, of 31
this act. 32
Sec. 97. As used in sections 97 to 108, inclusive, of this act, 33
unless the context otherwise requires, the words and terms defined 34
in sections 98, 99 and 100 of this act have the meanings ascribed 35
to them in those sections. 36
Sec. 98. “Health carrier” has the meaning ascribed to it in 37
NRS 695G.024, and includes, without limitation: 38
1. An administrator, as defined in NRS 683A.025, that 39
performs any function related to prior authorization for medical 40
care or the payment of claims unde r a policy or contract of health 41
insurance, except for health coverage provided by a local 42
government agency through a self -insurance reserve fund 43
pursuant to NRS 287.010; and 44

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2. A utilization review organization, as defined in NRS 1
695G.085, except when performing utilization reviews related to 2
health coverage provided by a local government agency through a 3
self-insurance reserve fund pursuant to NRS 287.010. 4
Sec. 99. “Insured” means a policyholder, subscriber, 5
enrollee or other person covered by a health carrier. 6
Sec. 100. “Provider of health care” has the meaning 7
ascribed to it in NRS 695G.070. 8
Sec. 101. 1. Each health carrier in this State shall 9
implement an electronic system for receiving and processing 10
requests for prior authorization. Such a system must: 11
(a) Allow providers of health care to electronically submit, 12
track and receive updates concerning requests for prior 13
authorization; and 14
(b) Comply with: 15
(1) The Connectivity Rules, Eligibility and Benefits 16
Operating Rules and Health Care Claims Operating Rules 17
prescribed by the Committee on Operating Rules for Information 18
Exchange of the Council for Affordable Quality Healthcare, or its 19
successor organization; 20
(2) The provisions of the Prior Authorization and Referrals 21
Operating Rules prescribed by the Committee on Operating Rules 22
for Information Exchange of the Council for Affordable Quality 23
Healthcare, or its successor organization, which relate t o prior 24
authorization; and 25
(3) Where applicable, any federal laws or regulations 26
governing electronic systems for receiving and processing requests 27
for prior authorization applicable to Medicare Advantage plans 28
and health care plans to provide health car e services to recipients 29
of Medicaid or insurance pursuant to the Children’s Health 30
Insurance Program. 31
2. The Commissioner, in collaboration with the Department 32
of Health and Human Services, shall review each revision to the 33
Rules described in subparagra phs (1) and (2) of paragraph (b) of 34
subsection 1 to ensure their suitability for this State. If the 35
Commissioner determines that a revision is not suitable for this 36
State, the Commissioner shall hold a public hearing within 6 37
months after the date the Rule s were revised to review his or her 38
determination. If the Commissioner does not revise his or her 39
determination, the Commissioner shall give notice within 30 days 40
after the hearing that the revisions are not suitable for this State. 41
3. If the Commissione r does not give notice pursuant to 42
subsection 2 that a revision to the Rules described in 43
subparagraphs (1) and (2) of paragraph (b) of subsection 1 are not 44
suitable for this State within the time period prescribed in 45

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subsection 2, each system implemented by a health carrier 1
pursuant to subsection 1 must comply with the revision not later 2
than 2 years after the date on which the revision was finalized. 3
4. The Commissioner shall annually publish a report on an 4
Internet website maintained by the Commissione r concerning the 5
compliance of health carriers in this State with the requirements 6
of this section. 7
5. As used in this section, “Medicare Advantage plan” means 8
a plan of coverage for health benefits under Medicare Part C, as 9
described in 42 U.S.C. § 1395w-28(b)(1), and includes: 10
(a) Coordinated care plans that provide health care services, 11
including, without limitation: 12
(1) Health maintenance organization plans, with or without 13
a point-of-service provider; 14
(2) Plans offered by provider-sponsored organizations; and 15
(3) Preferred provider organization plans; 16
(b) Medical savings account plans that are coupled with a 17
contribution into Medicare Advantage medical savings accounts; 18
and 19
(c) Medicare Advantage private fee-for-service plans. 20
Sec. 101.3. The provisions of NRS 687B.225 and sections 21
101.6 to 105, inclusive, of this act, do not apply to: 22
1. A health maintenance organization or other managed care 23
organization that enters into a contract with the Department of 24
Health and Human Services or the Division of Health Care 25
Financing and Policy of the Department pursuant to NRS 422.273 26
to provide health care services to recipients of Medicaid under the 27
State Plan for Medicaid or insurance under the Children’s Health 28
Insurance Program to the extent that the organization is providing 29
such services. 30
2. An administrator or utilization review organization that 31
performs any function related to prior authorization for an entity 32
described in subsection 1, while the administrator or utilization 33
review organization, as applicable, is performing such functions. 34
Sec. 101.6. 1. If a health carrier utilizes an artificial 35
intelligence system or automated decision tool to process requests 36
for prior authorization, the health carrier shall make available, in 37
a place that is readily accessible and conspicuous to insureds and 38
the public: 39
(a) A statement that the health carrier utilizes an artificial 40
intelligence system or automated decision to ol to process requests 41
for prior authorization; 42
(b) A general description of how the artificial intelligence 43
system or automated decision tool works; and 44

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(c) A description of the specific types of information or data 1
utilized by the artificial intelligen ce system or automated decision 2
tool to generate an outcome. 3
2. As used in this section: 4
(a) “Artificial intelligence system” means a machine -based 5
system that can, for a given set of human -defined objectives, make 6
predictions, recommendations or decisi ons influencing real or 7
virtual environments. 8
(b) “Automated decision tool” means an automated or 9
computerized system that is specifically developed or modified to 10
make, or be a controlling factor in making, consequential 11
decisions. 12
Sec. 102. Upon determining that it is necessary to delay 13
approving or denying a request for prior authorization beyond the 14
period prescribed by paragraph (b) of subsection 2 or subsection 3 15
or 4 , as applicable, of NRS 687B.225, a health carrier shall 16
transmit a written notice to the insured to whom the request 17
pertains and an electronic notice to the provider of health care 18
who submitted the request or the person designated by the provider 19
of health care to manage requests for prior authorization . Such 20
notice must contain: 21
1. A specific description of all reasons that the health carrier 22
is delaying the response; 23
2. The steps necessary to resolve the delay; and 24
3. The anticipated timeline for resolving the delay. 25
Sec. 103. 1. Upon denying a request for prior 26
authorization, a health carrier shall transmit to: 27
(a) The insured to whom the request pertains a written notice 28
that contains: 29
(1) A specific description of all reasons that the health 30
carrier denied the request; 31
(2) A description of any documentation that the health 32
carrier requested from the insured or a provider of health care of 33
the insured and did not receive or deemed insufficient, if the 34
failure to receive sufficient docu mentation contributed to the 35
denial; 36
(3) A statement that the insured has the right to appeal the 37
denial; 38
(4) Instructions, written in clear language that is 39
understandable to an ordinary layperson, describing how the 40
insured can appeal the denial thro ugh the process established 41
pursuant to subsection 2; and 42
(5) A description of any documentation that may be 43
necessary or pertinent to an appeal. 44

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(b) The provider of health care who submitted the request or 1
the person designated by the provider of healt h care to manage 2
requests for prior authorization an electronic notice that includes 3
all the information required by the Rules described in paragraph 4
(b) of subsection 2 of NRS 687B.225. 5
2. A health carrier shall establish a process that allows an 6
insured to appeal the denial of a request for prior authorization. 7
The process must allow for the clear resolution of each appeal 8
within a reasonable time. 9
Sec. 104. 1. A health carrier shall not revoke a request for 10
prior authorization that the health carrier has previously approved 11
or delay or deny payment for the medical care to which such a 12
request pertains unless the health carrier determines that: 13
(a) An insured or a provider of health care procured the 14
approval by fraud or material misrepresentation; 15
(b) The approval was affected by a clerical error; or 16
(c) The person to which the medical care was provided was 17
not, on the date on which the care was provided, an insured of the 18
health carrier. 19
2. After a health carrier approves a request for prior 20
authorization, the health carrier shall not assign a lower level 21
billing code to the medical care to which the request pertains or 22
otherwise reduce the payment for such care below the amount 23
indicated in the request for prior authorization without a clear, 24
documented justification that aligns with applicable standards of 25
care. 26
3. A health carrier that takes any action described in 27
subsection 1 or 2 shall provide written notice of the action using 28
the same remittance p rocess that the health carrier uses to pay 29
claims to the provider of health care that submitted the request for 30
prior authorization. Such notice must include, without limitation, 31
a detailed description of the justification for the action and 32
documentation supporting that justification. 33
4. As used in this section, “clerical error” means a 34
typographical or administrative error or an error in calculation. 35
The term does not include any mistake relating to clinical 36
judgment, the medical necessity of care or the appropriateness of a 37
treatment. 38
Sec. 105. 1. A health carrier shall comply with the 39
provisions of 26 U.S.C. § 9818 and 42 U.S.C. § 300gg -113, and 40
any regulations adopted pursuant thereto. 41
2. Within the first 90 days of the coverage period for an 42
insured, a health carrier shall honor a request for prior 43
authorization that has been approved by a health carrier or other 44
entity that previously provided the insured with coverage for 45

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medical care if the specific medical care included within the 1
request is not affirmatively excluded under the terms and 2
conditions of the contract or policy of insurance issued by the 3
health carrier. 4
3. The health carrier may, within the 90 -day period 5
established by subsection 2, undertake an in dependent review of 6
the medical care that was approved by the health carrier or other 7
entity that previously provided the insured with coverage. The 8
health carrier shall not deny approval in violation of subsection 2 9
as the result of such a review. 10
4. A change in the health carrier’s procedure for obtaining 11
prior authorization or a new exclusion or limitation of coverage 12
adopted by a health carrier may not take effect until the next 13
coverage period with respect to: 14
(a) An insured for whom the health carr ier has, within the 15
current coverage period, approved a request for prior 16
authorization; and 17
(b) The medical care that is identical to the care for which the 18
health carrier had previously approved a request for prior 19
authorization within the current coverage period. 20
5. If an insured for whom a request for prior authorization 21
has been approved by a health carrier obtains coverage under a 22
different policy or contract of health insurance issued by the same 23
health carrier, the health carrier shall honor the approval to the 24
same extent as if the insured were still covered under the policy or 25
contract of health insurance under which the insured was covered 26
when the health carrier approved the request. 27
6. As used in this section, “coverage period” means the 28
current term of a contract or policy of insurance issued by a 29
health carrier. 30
Sec. 106. 1. Each health carrier shall annually compile 31
and transmit to the Commissioner in the form prescribed by the 32
Commissioner pursuant to su bsection 6 a report containing the 33
following information: 34
(a) The specific goods and services for which the health 35
carrier requires prior authorization and, for each good or service: 36
(1) The number of requests for prior authorization received 37
by the hea lth carrier during the immediately preceding calendar 38
year for the provision of the good or service to insureds in this 39
State; 40
(2) The number and percentage of the requests included 41
pursuant to subparagraph (1) that were approved; and 42
(3) The number an d percentage of the requests included 43
pursuant to subparagraph (1) that were denied; 44

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(b) The average amounts of time between when the health 1
carrier received a request for prior authorization during the 2
immediately preceding calendar year and when the health carrier: 3
(1) Initially responded to the request; 4
(2) Approved or denied the request; and 5
(3) Paid the claim to which the request pertains; 6
(c) The percentage of claims received by the health carrier 7
during the immediately preceding calendar y ear that the health 8
carrier retroactively denied and detailed written explanations of 9
the reasons for such denials; 10
(d) Explanations of corrective actions that the health carrier is 11
taking or intends to take to: 12
(1) Lower the rates of delays and denials of requests for 13
prior authorization and payment of claims; and 14
(2) Correct any failure to comply with the provisions of 15
NRS 687B.225 and sections 97 to 108, inclusive, of this act; and 16
(e) Such additional information as the Commissioner may 17
prescribe by regulation. 18
2. A health carrier shall not include individually identifiable 19
health information in a report published pursuant to subsection 1. 20
3. The Commissioner shall aggregate and post on a 21
centralized, publicly accessible Internet website mainta ined by the 22
Commissioner the information submitted to the Commissioner 23
pursuant to subsection 1 and section 62 of this act. The Internet 24
website must allow a user to: 25
(a) View the information submitted pursuant to: 26
(1) Subsection 1 by each health carrie r that does business 27
in this State; and 28
(2) The Department of Health and Human Services 29
pursuant to section 62 of this act. 30
(b) Compare the information described in paragraph (a) to 31
performance benchmarks established by the Commissioner. 32
4. The Commissioner shall annually: 33
(a) Compile a report: 34
(1) Summarizing the information submitted to the 35
Commissioner pursuant to subsection 1 and section 62 of this act; 36
(2) Describing trends and challenges relating to compliance 37
with the provisions of NRS 687B .225 and sections 97 to 108, 38
inclusive, of this act; and 39
(3) Making recommendations to address the challenges 40
described in subparagraph (2) and improve the administration of 41
health insurance in this State; and 42
(b) Submit the report to the Director of the Legislative Counsel 43
Bureau for transmittal to the Joint Interim Standing Committee 44

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on Health and Human Services and the Joint Interim Standing 1
Committee on Commerce and Labor. 2
5. The Commissioner may: 3
(a) Audit the accuracy of reports submitted by hea lth carriers 4
pursuant to this section; and 5
(b) Require independent audits for health carriers that have 6
repeatedly failed to comply with the requirements of this section or 7
submitted reports that the Commissioner has reason to believe are 8
inaccurate. 9
6. The Commissioner shall adopt regulations to carry out the 10
requirements of this section, including, without limitation, 11
regulations establishing: 12
(a) A standardized form for submitting a report pursuant to 13
subsection 1; 14
(b) The dates on which: 15
(1) Health carriers must submit the reports required by 16
subsection 1; and 17
(2) The Commissioner will submit the report required by 18
subsection 4; and 19
(c) Procedures for conducting audits pursuant to subsection 5. 20
7. As used in this section, “individually identi fiable health 21
information” means information relating to the provision of 22
medical care to an insured: 23
(a) That specifically identifies the insured; or 24
(b) For which there is a reasonable basis to believe that the 25
information can be used to identify the insured. 26
Sec. 107. 1. The Gold Card Exemption Program is hereby 27
established to exempt providers of health care who receive Gold 28
Card Exemptions pursuant to subsection 2 from requirements 29
imposed by health carriers to obtai n prior authorization for 30
specific goods and services set forth in the regulations adopted 31
pursuant to subsection 8. 32
2. A health carrier shall issue a Gold Card Exemption to a 33
provider of health care who participates in the network of the 34
health carrier if: 35
(a) Within the immediately preceding 24 months, the health 36
carrier approved 95 percent or more of the requests for prior 37
authorization submitted by the provider of health care for a 38
specific good or service which is eligible for a Gold Card 39
Exemption under the regulations adopted pursuant to subsection 40
8; and 41
(b) The provider of health care meets any other requirements 42
established by the regulations adopted pursuant to subsection 8. 43
3. A health carrier shall: 44

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(a) Annually review the continued eligibility of a provider of 1
health care who has been granted a Gold Card Exemption 2
pursuant to this section for that Gold Card Exemption; and 3
(b) If the health carrier determines through a review 4
conducted pursuant to paragraph (a) that a provider of health care 5
who holds a Gold Card Exemption no longer meets the 6
requirements of subsection 2: 7
(1) Notify the provider of health care that he or she: 8
(I) Does not meet the requirements to continue to hold a 9
Gold Card Exemption; and 10
(II) May appeal the determination of the health carrier 11
in accordance with the regulations adopted pursuant to subsection 12
8; and 13
(2) Unless the determination that the provider no longer 14
meets the requirements of subsection 2 is reversed on appeal, 15
revoke the Gold Card Exemption. 16
4. Except as otherwise provided in subsections 6, 7 and 8 of 17
section 56 of this act, a health carrier shall not require a provider 18
of health care who holds a Gold Card Exemption to obtain prior 19
authorization for any goods and services to which the Gold Card 20
Exemption applies. 21
5. A health carrier shall maintain on an Internet website 22
maintained by the health carrier a list of all providers of health 23
care who hold a Gold Card Exemption. The list must include, for 24
each provider, the specialty of the provider and the goods and 25
services covered by the Gold Card Exemption. 26
6. A health carrier may audit providers of health care who 27
hold Gold Card Exemptions to determine whether those providers 28
of health care meet the requirements of this section and the 29
regulations adopted thereto. If a health carrier determines that 30
such a provider of health care does not meet those requirements, 31
the health carrier may, after notice and the opportunity for an 32
appeal: 33
(a) Suspend or revoke the Gold Card Exemption; or 34
(b) Impose any other penalties authorized by the regulations 35
adopted pursuant to subsection 8. 36
7. The Commissioner shall periodically: 37
(a) Evaluate, including, without limitation, by soliciting input 38
from interested persons and entities, the effectivenes s of the Gold 39
Card Exemption Program in reducing administrative burdens and 40
improving the delivery of health care; and 41
(b) Revise the regulations adopted pursuant to subsection 8 42
and submit such recommendations to the Legislature as are 43
necessary to improve the Gold Card Exemption Program based on 44
the evaluations conducted pursuant to paragraph (a). 45

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8. The Commissioner, in collaboration with the Department 1
of Health and Human Services, shall adopt such regulations as 2
are necessary to carry out the provisions of this section, including, 3
without limitation, regulations establishing: 4
(a) The goods and services which are eligible for a Gold Card 5
Exemption; 6
(b) The procedure to determine the eligibility of a provider of 7
health care for a Gold Card Exemption; 8
(c) Any requirements, in addition to the requirements 9
prescribed in subsection 2, for a provider of health care to be 10
eligible to receive or continue to hold a Gold Card Exemption, 11
which may include, without limitation, requirements governing 12
the quality of care provided by the provider of health care; 13
(d) Procedures for appeals pursuant to subsections 3 and 6; 14
(e) Procedures for conducting audits pursuant to subsection 6; 15
and 16
(f) Penalties that may be imposed pursuant to subsection 6. 17
9. As used in this section: 18
(a) “Network” means a defined set of providers of health care 19
who are under contract with a health carrier to provide health 20
care services pursuant to a network plan offered or issued by the 21
health carrier. 22
(b) “Network plan” means a contra ct or policy of health 23
insurance offered by a health carrier under which the financing 24
and delivery of medical care is provided, in whole or in part, 25
through a defined set of providers under contract with the health 26
carrier. 27
Sec. 108. 1. The Commissioner shall prescribe by 28
regulation such additional requirements for the issuance of a 29
certificate of authority pursuant to NRS 680A.160 to an insurer 30
that will provide health benefits, the issuance of a certificate of 31
registration pursuant to NRS 683A.08524 to an administrator that 32
will perform any function related to prior authorization for 33
medical care or the payment of claims under a policy or contract 34
of health insurance, the approval of an independent review 35
organization pursuant to NRS 683A.3715 or the registration of an 36
agent who performs utilization review pursuant to NRS 683A.378 37
to ensure that the insurer, administrator, organization or agent, as 38
applicable, is equipped to comply with the provisions of NRS 39
687B.225 and sections 97 to 108, inclusive, of this act, and, where 40
applicable, NRS 683A.0879, 689A.410, 689B.255, 689C.335, 41
695A.188, 695B.2505 or 695C.185. 42
2. The Commissioner, in consultation with the Board of the 43
Public Employees’ Benefits Program, shall adopt regulations 44
establishing criteria to ensure that any health carrier with which 45

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the Board contracts is in complianc e with the requirements of 1
NRS 687B.225, sections 97 to 108, inclusive, of this act and, where 2
applicable, NRS 683A.0879, 689A.410, 689B.255, 689C.335, 3
695A.188, 695B.2505 or 695C.185. 4
3. The Commissioner shall: 5
(a) Perform an annual audit of each health carrier that 6
operates in this State to ensure compliance with the requirements 7
of NRS 687B.225, sections 97 to 108, inclusive, of this act, and, 8
where applicable, NRS 683A.0879, 689A.410, 689B.255, 9
689C.335, 695A.188, 695B.2505 or 695C.185; 10
(b) Annually publish on an Internet website maintained by the 11
Commissioner a report concerning compliance by health carriers 12
with the requirements of NRS 687B.225, sections 97 to 108, 13
inclusive, of this act, and, where applica ble, NRS 683A.0879, 14
689A.410, 689B.255, 689C.335, 695A.188, 695B.2505 or 15
695C.185; and 16
(c) Accept and investigate grievances from providers of health 17
care concerning possible violations of NRS 687B.225, sections 97 18
to 108, inclusive, of this act, and, whe re applicable, NRS 19
683A.0879, 689A.410, 689B.255, 689C.335, 695A.188, 695B.2505 20
or 695C.185. 21
4. The Commissioner, in collaboration with the Department 22
of Health and Human Services, shall: 23
(a) Annually hold a public meeting to: 24
(1) Review the implemen tation of NRS 687B.225 and 25
sections 53 to 63, inclusive, and 97 to 108, inclusive, of this act; 26
and 27
(2) Solicit input on the implementation of NRS 687B.225 28
and sections 53 to 63, inclusive, and 97 to 108, inclusive, of this 29
act from health carriers, prov iders of health care, patients and 30
other interested persons and entities; and 31
(b) Based on the input provided pursuant to subparagraph (2) 32
of paragraph (a), adopt such regulations or submit such 33
recommendations to the Legislature as are necessary to impro ve 34
the process for requesting prior authorization in this State. 35
Sec. 109. 1. A health carrier, or any entity to which a 36
health carrier delegates credentialing functions, shall: 37
(a) Use the Provider Data Portal, or any successor system, 38
established by the Council for Affordable Quality Healthcare, or 39
its successor organization, to accept submissions by providers of 40
health care for credentialing; and 41
(b) Use an entity that holds the Credentials Verification 42
Organization Certification issued by the National Committee for 43
Quality Assurance, or its successor organization, for the purpose 44
of verifying the credentials of providers of health care seeking to 45

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participate in the network of the health carrier. A health carrier or 1
entity to which a health carrier delegates credentialing functions 2
may itself perform the functions described in this paragraph if the 3
health carrier or entity, as applicable, holds such certification. 4
2. The Commissioner shall: 5
(a) Perform an annual aud it of each health carrier that 6
operates in this State to ensure compliance with the requirements 7
of this section; 8
(b) Collect from health carriers and entities to which health 9
carriers designate credentialing functions such data as is 10
necessary to compile the report required by paragraph (c); and 11
(c) On or before February 1 of each year: 12
(1) Compile a report on the credentialing of providers of 13
health care which includes, without limitation: 14
(I) The average time between the submission by a 15
provider o f health care of a request to a health carrier for 16
credentialing and the request being approved or denied, for each 17
health carrier in this State and aggregated for all health carriers 18
in this State; and 19
(II) Recommendations for improvements to the proce ss 20
for credentialing providers of health care, including, without 21
limitation, recommendations concerning improvements to 22
technology or procedures to increase the efficiency of the process; 23
and 24
(2) Submit the report to the Governor and the Director of 25
the Legislative Counsel Bureau for transmittal to: 26
(I) In even-numbered years, the Joint Interim Standing 27
Committee on Health and Human Services; and 28
(II) In odd-numbered years, the next regular session of 29
the Legislature. 30
3. As used in this section: 31
(a) “Credentialing” means verifying the credentials of a 32
provider of health care for the purpose of determining whether the 33
provider of health care meets the requirements for participation in 34
the network of a health carrier. 35
(b) “Provider of health care” has the meaning ascribed to it in 36
NRS 629.031. 37
Sec. 110. NRS 687B.225 is hereby amended to read as 38
follows: 39
687B.225 1. Except as otherwise provided in NRS 40
689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 41
689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 42
689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 43
689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 44
695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 45

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695B.1913, 695B.1914, 695B.1919, 695B.19197, 6 95B.1924, 1
695B.1925, 695B.1942, 695C.1696, 695C.1699, 695C.1713, 2
695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 3
695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 4
695G.1719 and 695G.177, any contract [for group, blanket or 5
individual health ] or p olicy of insurance [or any contract by a 6
nonprofit hospital, medical or dental service corporation or 7
organization for dental care ] issued by a health carrier which 8
provides for payment of a certain part of medical [or dental ] care 9
may require the insured [or member] to obtain prior authorization 10
for that care from the insurer . [or organization. The insurer or 11
organization] 12
2. A health carrier shall: 13
(a) File its procedure for obtaining approval of care pursuant to 14
this section for approval by the Commissioner; and 15
(b) Unless a [shorter] different time period is prescribed by a 16
specific statute, including, without limitation, NRS 689A.0446, 17
689B.0361, 689C.1688, 695A.1859, 695B.19087, 695C.16932 and 18
695G.1703 [, respond to ] and except as otherwise provided in 19
subsections 3 and 4, approve or deny any request for approval by 20
the insured [or member] pursuant to this section or provide notice of 21
a delay in accordance with section 102 of this act within [20] : 22
(1) Two business days after it receives the request [. 23
2.] ; or 24
(2) If the Prior Authorization and Referrals Operating 25
Rules prescribed by the Committee on Operating Rules for 26
Information Exchange of the Council for Affordable Quality 27
Healthcare, or its successor organization , would allow the health 28
carrier more than 2 business days to respond to the particular 29
request for prior authorization after receiving the request, the time 30
period prescribed by the Rules. 31
3. Notwithstanding any time period prescribed by the rules 32
described in subparagraph (2) of paragraph (b) of subsection 2, a 33
health carrier shall respond as required by paragraph (b) of 34
subsection 2 to a request for prior authorization within 7 calendar 35
days after receiving the request. 36
4. The Commissioner, in collaboration with the Department 37
of Health and Human Services, shall review each revision to the 38
Rules described in subparagraph (2) of paragraph (b) of 39
subsection 2 to ensure their suitability for this State. If the 40
Commissioner determines that a revision is not suitable for t his 41
State, the Commissioner shall hold a public hearing within 6 42
months after the date the Rules were revised to review his or her 43
determination. If the Commissioner does not revise his or her 44
determination, the Commissioner shall give notice within 30 day s 45

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after the hearing that the revisions are not suitable for this State. 1
If the Commissioner gives such notice, a health carrier shall 2
respond as required by paragraph (b) of subsection 2 to any 3
request for prior authorization that is submitted to the healt h 4
carrier after the date on which such notice is given within 2 5
business days after receiving the request. 6
5. The procedure for prior authorization may not discriminate 7
among persons licensed to provide the covered care. 8
6. If a health carrier fails to comply with paragraph (b) of 9
subsection 2 or subsection 3 or 4, as applicable, with respect to a 10
particular request for prior authorization, the request shall be 11
deemed approved. 12
7. A health carrier shall not require prior au thorization for 13
emergency services covered by the health carrier, including, where 14
applicable, transportation by ambulance to a hospital or other 15
medical facility. 16
8. As used in this section, “emergency services” means health 17
care services that are provi ded by a provider of health care to 18
screen and to stabilize an insured after the sudden onset of a 19
medical condition that manifests itself by symptoms of such 20
sufficient severity that a prudent person would believe that the 21
absence of immediate medical attention could result in: 22
(a) Serious jeopardy to the health of the insured; 23
(b) Serious jeopardy to the health of an unborn child of the 24
insured; 25
(c) Serious impairment of a bodily function of the insured; or 26
(d) Serious dysfunction of any bodily organ or part of the 27
insured. 28
Sec. 111. NRS 687B.600 is hereby amended to read as 29
follows: 30
687B.600 As used in NRS 687B.600 to 687B.850, inclusive, 31
and section 109 of this act, unless the context otherwise requires, 32
the words and terms defined in NRS 687B.602 to 687B.665, 33
inclusive, have the meanings ascribed to them in those sections. 34
Sec. 112. NRS 687B.670 is hereby amended to read as 35
follows: 36
687B.670 If a health carrier offers or issues a network plan, the 37
health carrier shall, with regard to that network plan: 38
1. Comply with all applicable requirements set forth in NRS 39
687B.600 to 687B.850, inclusive [;] and section 109 of this act; 40
2. As applicable, ensure that each contract entered i nto for the 41
purposes of the network plan between a participating provider of 42
health care and the health carrier complies with the requirements set 43
forth in NRS 687B.600 to 687B.850, inclusive [;] , and section 109 44
of this act; and 45

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3. As applicable, ensure that the network plan complies with 1
the requirements set forth in NRS 687B.600 to 687B.850, inclusive 2
[.] , and section 109 of this act. 3
Sec. 113. NRS 695B.320 is hereby amended to read as 4
follows: 5
695B.320 1. Nonprofit hospital and medical or dental service 6
corporations are subject to the provisions of this chapter, and to the 7
provisions of chapters 679A and 679B of NRS, subsections 2, 4, 17, 8
18 and 30 of NRS 680B.010, NRS 680B.025 to 680B.060, 9
inclusive, chapter 681B of NRS, NRS 686A.010 to 686A.315, 10
inclusive, 686B.010 to 686B.175, inclusive, 687B.010 to 11
687B.040, inclusive, 687B.070 to 687B.140, inclusive, 687B.150, 12
687B.160, 687B.180, 687B.200 to 687B.255, inclusive, 687B.270, 13
687B.310 to 687B.380, inclusive, 687B.410, 687B.420, 687B.430, 14
687B.500 and section 109 of this act and chapters 692B, 692C, 15
693A and 696B of NRS, to the extent applicable and not in conflict 16
with the express provisions of this chapter. 17
2. For the purposes of this section and the provis ions set forth 18
in subsection 1, a nonprofit hospital and medical or dental service 19
corporation is included in the meaning of the term “insurer.” 20
Sec. 114. NRS 695B.320 is hereby amended to read as 21
follows: 22
695B.320 1. Nonprofit hospital and medical or dental service 23
corporations are subject to the provisions of this chapter, and to the 24
provisions of chapters 679A and 679B of NRS, subsections 2, 4, 17, 25
18 and 30 of NRS 680B.010, NRS 680B.025 to 680B.060, 26
inclusive, chapter 681B of NRS, NRS 686A.010 to 27
686A.315, inclusive, 686B.010 to 686B.175, inclusive, 687B.010 to 28
687B.040, inclusive, 687B.070 to 687B.140, inclusive, 687B.150, 29
687B.160, 687B.180, 687B.200 to 687B.255, inclusive, and 30
sections 97 to 108, inclusive, of this act, 687B.270, 687B.310 to 31
687B.380, inclusive, 687B.410, 687B.420, 687B.430, 687B.500 and 32
section 109 of this act and chapters 692B, 692C, 693A and 696B of 33
NRS, to the extent applicable and not in conflict with the express 34
provisions of this chapter. 35
2. For the purposes of this section and the provisions set forth 36
in subsection 1, a nonprofit hospital and medical or dental service 37
corporation is included in the meaning of the term “insurer.” 38
Sec. 115. (Deleted by amendment.) 39
Sec. 116. NRS 695K.220 is hereby amended to read as 40
follows: 41
695K.220 1. The Director, in consultation with the 42
Commissioner and the Executive Director of the Exchange, shall 43
use a statewide comp etitive bidding process, including, without 44
limitation, a request for proposals, to solicit and enter into contracts 45

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with health carriers or other qualified persons or entities to 1
administer the Public Option. If a statewide Medicaid managed care 2
program is established pursuant to subsection 1 of NRS 422.273, the 3
competitive bidding process must coincide with the statewide 4
procurement process for that Medicaid managed care program. 5
2. Each health carrier that provides health care services through 6
managed care to recipients of Medicaid under the State Plan for 7
Medicaid or the Children’s Health Insurance Program shall, as a 8
condition of continued participation in any Medicaid managed care 9
program established in this State, submit a good faith proposal in 10
response to a request for proposals issued pursuant to subsection 1. 11
3. Each proposal submitted pursuant to subsection 2 must 12
demonstrate that the applicant is able to meet the requirements of 13
NRS 695K.200 [.] and meets the criteria prescribed by the 14
regulations adopted pursuant to subsection 2 of section 108 of this 15
act. 16
4. When selecting a health carrier or other qualified person or 17
entity to administer the Public Option, the Director shall prioritize 18
applicants whose proposals: 19
(a) Demonstrate alignment of networks of providers between the 20
Public Option and Medicaid managed care, where applicable; 21
(b) Provide for the inclusion of critical access hospitals, rural 22
health clinics, certified community behavio ral health clinics and 23
federally-qualified health centers in the networks of providers for 24
the Public Option and Medicaid managed care, where applicable; 25
(c) Include proposals for strengthening the workforce in this 26
State and particularly in rural areas o f this State for providers of 27
primary care, mental health care and treatment for substance use 28
disorders; 29
(d) Use payment models for providers included in the networks 30
of providers for the Public Option that increase value for persons 31
enrolled in the Public Option and the State; and 32
(e) Include proposals to contract with providers of health care in 33
a manner that decreases disparities among different populations in 34
this State with regard to access to health care and health outcomes 35
and supports culturally competent care. 36
5. Notwithstanding the provisions of subsections 1 to 4, 37
inclusive, the Director may directly administer the Public Option if 38
necessary to carry out the provisions of this chapter. 39
6. Any health carrier or other person or entity with w hich the 40
Director contracts to administer the Public Option pursuant to this 41
section or the Director, if the Director directly administers the 42
Public Option pursuant to subsection 5, shall take any measures 43
necessary to make the Public Option available as described in 44
paragraph (a) of subsection 2 of NRS 695K.200 and, if required by 45

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- *SB495_R1*
the Director, paragraph (b) of that subsection. Such measures 1
include, without limitation: 2
(a) Filing rates and supporting information with the 3
Commissioner of Insurance as req uired by NRS 686B.010 to 4
686B.1799, inclusive; and 5
(b) Obtaining certification as a qualified health plan pursuant to 6
42 U.S.C. § 18031. 7
7. The Director shall deposit into the Trust Fund any money 8
received from: 9
(a) A health carrier or other person or entity with which the 10
Director contracts to administer the Public Option pursuant to 11
subsection 1 which relates to duties performed under the contract; or 12
(b) If the Director directly administers the Public Option 13
pursuant to subsection 5, any money recei ved from any person or 14
entity in the course of administering the Public Option. 15
8. As used in this section: 16
(a) “Critical access hospital” means a hospital which has been 17
certified as a critical access hospital by the Secretary of Health and 18
Human Services pursuant to 42 U.S.C. § 1395i-4(e). 19
(b) “Health carrier” means an entity subject to the insurance 20
laws and regulations of this State, or subject to the jurisdiction of the 21
Commissioner, that contracts or offers to contract to provide, 22
deliver, arrange for, pay for or reimburse any of the costs of health 23
care services, including, without limitation, a sickness and accident 24
health insurance company, a health maintenance organization, a 25
nonprofit hospital and health service corporation or any other entity 26
providing a plan of health insurance, health benefits or health care 27
services. 28
Sec. 116.3. NRS 719.200 is hereby amended to read as 29
follows: 30
719.200 1. Except as otherwise provided in subsection 2, the 31
provisions of this chapter apply to electronic records and electronic 32
signatures relating to a transaction. 33
2. The provisions of this chapter do not apply to a transaction 34
to the extent it is governed by: 35
(a) Except as otherwise specifically provided by law, a law 36
governing the creation and execution of wills, codicils or 37
testamentary trusts; 38
(b) The Uniform Commercial Code other than NRS 104.1306, 39
104.2101 to 104.2725, inclusive, and 104A.2101 to 104A.2532, 40
inclusive; or 41
(c) The provisions of NRS 439.581 to 439.597, inclusive, and 42
section 1 of this act and the regulations adopted pursuant thereto. 43
3. The provisions of this chapter apply to an electronic record 44
or electronic signature otherwise excluded from the application of 45

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- *SB495_R1*
this chapter under subsection 2 to the extent it is governed by a law 1
other than those specified in subsection 2. 2
4. A transaction subject to the provisions of this chapter is also 3
subject to other applicable substantive law. 4
Sec. 116.7. NRS 720.140 is hereby amended to read as 5
follows: 6
720.140 1. Except as otherwise provided in this subsection, 7
the provisions of this chapter apply to any transaction for which a 8
digital signature is used to sign an electronic record. The provisions 9
of this chapter do not apply to a digital signature that is used to sign 10
an electronic health record in accordance with NRS 439.581 to 11
439.597, inclusive, and section 1 of this act and the regulations 12
adopted pursuant thereto. 13
2. As used in this section, “electronic rec ord” has the meaning 14
ascribed to it in NRS 719.090. 15
Sec. 117. Section 50 of this act is hereby amended to read as 16
follows: 17
Sec. 50. 1. The Department or any entity to which the 18
Department delegates credentialing functions for Medicaid or 19
the Children’s Health Insurance Program shall: 20
(a) Use the Provider Data Portal, or any successor system, 21
established by the Council for Affordable Quality Healthcare, 22
or its successor organization, to accept submissions by 23
providers of health care for credentialing; and 24
(b) Use an entity that holds the Credentials Verification 25
Organization Certification issued by the National Committee 26
for Quality Assurance, or its successor organization, for the 27
purpose of verifying the credent ials of providers of health 28
care seeking to participate in Medicaid or the Children’s 29
Health Insurance Program. 30
2. The Department shall ensure that, for at least 95 31
percent of the complete requests for credentialing submitted 32
by providers of health care to the Department or an entity to 33
which the Department delegates credentialing functions, the 34
Department or entity processes the request not later than 60 35
days after the Department or entity, as applicable, receives 36
all information necessary to complete the request. 37
3. For the purposes of subsection 2, a request for 38
credentialing shall be deemed to be complete if: 39
(a) The provider of health care who submitted the 40
request has completed all fields prescribed by the Council 41
for Affordable Quality Healthcare , or its successor 42
organization; 43
(b) The provider of health care receives electronic notice 44
that the credentialing application is complete; and 45

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(c) The completed request is made available through the 1
Portal or successor system described in paragraph (a) of 2
subsection 1 to the Department or the entity to which the 3
Department delegates credentialing functions. 4
4. An entity to which the Department delegates 5
credentialing functions shall immediately notify the 6
Department of: 7
(a) Any delay in credentialing that exceeds the time 8
period specified in subsection 2; 9
(b) Steps taken to ensure that the request that is subject 10
to the delay is processed as quickly as possible; and 11
(c) An anticipated timeline to complete the processing of 12
the request. 13
5. On or before February 1 of each year, the Department 14
shall: 15
(a) Compile a report on the credentialing of providers of 16
health care which includes, without limitation: 17
(1) The average time between the submission of a 18
request by a provider of health care for creden tialing for 19
Medicaid and the Children’s Health Insurance Program 20
during the immediately preceding year and the request being 21
approved or denied; and 22
(2) The rates at which requests for credentialing are 23
processed within the time period specified in subse ction 2, 24
for Medicaid and the Children’s Health Insurance 25
Program; and 26
[(2)] (3) Recommendations for improvements to the 27
process for credentialing providers of health care for 28
Medicaid and the Children’s Health Insurance Program, 29
including, without limitation, recommendations concerning 30
improvements to technology or procedures to increase the 31
efficiency of the process; and 32
(b) Submit the report to the Governor and the Director of 33
the Legislative Counsel Bureau for transmittal to: 34
(1) In even-numbered years, the Joint Interim Standing 35
Committee on Health and Human Services; and 36
(2) In odd-numbered years, the next regular session of 37
the Legislature. 38
[3.] 6. As used in this section: 39
(a) “Credentialing” means verifying the credentials of a 40
provider of health care for the purpose of determining 41
whether the provider of health care meets the requirements 42
for participation in Medicaid or the Children’s Health 43
Insurance Program as a provider of services. 44

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(b) “Provider of health care” has the mea ning ascribed to 1
it in NRS 629.031. 2
Sec. 118. Section 109 of this act is hereby amended to read as 3
follows: 4
Sec. 109. 1. A health carrier, or any entity to which a 5
health carrier delegates credentialing functions, shall: 6
(a) Use the Provider Data Portal, or any successor system, 7
established by the Council for Affordable Quality Healthcare, 8
or its successor organization, to accept submissions by 9
providers of health care for credentialing; and 10
(b) Use an entity that holds the Credentials Verification 11
Organization Certification issued by the National Committee 12
for Quality Assurance, or its successor organization, for the 13
purpose of verifying the credentials of providers of health 14
care seeking to participate in the network of the health carrier. 15
A health carrier or entity to which a health carrier delegates 16
credentialing functions may itself perform the functions 17
described in this paragraph if the health carrier or entity, as 18
applicable, holds such certification. 19
2. A health carrier shall: 20
(a) Ensure that, for at least 95 percent of the complete 21
requests for credentialing submitted by providers of health 22
care to the health carrier or an entity to which the health 23
carrier delegates credentialing functions, the health ca rrier 24
or entity processes the request not later than 60 days after 25
the health carrier or entity, as applicable, receives all 26
information necessary to complete the request; and 27
(b) Immediately notify the Commissioner of: 28
(1) Any delay in credentialing th at exceeds the time 29
period specified in paragraph (a); 30
(2) Steps taken to ensure that the request that is 31
subject to the delay is processed as quickly as possible; and 32
(3) An anticipated timeline to complete the 33
processing of the request. 34
3. For the purposes of subsection 2, a request for 35
credentialing shall be deemed to be complete if: 36
(a) The provider of health care who submitted the 37
request has completed all fields prescribed by the Council 38
for Affordable Quality Healthcare, or its successor 39
organization; 40
(b) The provider of health care receives electronic notice 41
that the credentialing application is complete; and 42
(c) The completed request is made available through the 43
Portal or successor system described in paragraph (a) of 44

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subsection 1 to the h ealth carrier or the entity to which the 1
health carrier delegates credentialing functions. 2
4. An entity to which a health carrier delegates 3
credentialing functions shall immediately notify the health 4
carrier of any delay in credentialing that exceeds the time 5
period specified in paragraph (a) of subsection 2. Such 6
notice must include the information listed in paragraph (b) 7
of subsection 2. 8
5. The Commissioner shall: 9
(a) Perform an annual audit of each health carrier that 10
operates in this State to ensur e compliance with the 11
requirements of this section; 12
(b) Collect from health carriers and entities to which 13
health carriers designate credentialing functions such data as 14
is necessary to compile the report required by paragraph (b); 15
and 16
(c) On or before February 1 of each year: 17
(1) Compile a report on the credentialing of providers 18
of health care which includes, without limitation: 19
(I) The average time between the submission by a 20
provider of health care of a request to a health carrier for 21
credentialing and the request being approved or denied, for 22
each health carrier in this State and aggregated for all health 23
carriers in this State; [and] 24
(II) The rates at which requests for credentialing 25
are processed within the time period specified in paragraph 26
(a) of subsection 2, for each health carrier in this State and 27
aggregated for all health carriers in this State; and 28
(III) Recommendations for improvements to the 29
process for credentialing providers of health care, including, 30
without limitation, recommendations concerning 31
improvements to technology or procedures to increase the 32
efficiency of the process; and 33
(2) Submit the report to the Governor and the Director 34
of the Legislative Counsel Bureau for transmittal to: 35
(I) In even -numbered years, the Joint Interim 36
Standing Committee on Health and Human Services; and 37
(II) In odd -numbered years, the next regular 38
session of the Legislature. 39
[3.] 6. As used in this section: 40
(a) “Credentialing” means verifying the credentials of a 41
provider of hea lth care for the purpose of determining 42
whether the provider of health care meets the requirements 43
for participation in the network of a health carrier. 44

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(b) “Provider of health care” has the meaning ascribed to 1
it in NRS 629.031. 2
Sec. 119. (Deleted by amendment.) 3
Sec. 119.5. 1. There is hereby appropriated from the State 4
General Fund to the Division of Health Care Financing and Policy 5
of the Department of Health and Hum an Services the sum of 6
$291,296 to carry out the provisions of sections 51.3, 51.5 and 51.8 7
of this act. 8
2. Expenditure of $1,149,153 not appropriated from the State 9
General Fund or the State Highway Fund is hereby authorized 10
during Fiscal Year 2026 -2027 by the Division of Health Care 11
Financing and Policy of the Department of Health and Human 12
Services for the same purpose as set forth in subsection 1. 13
3. Any remaining balance of the appropriation made by 14
subsection 1 must not be committed for expenditur e after June 30, 15
2027, by the entity to which the appropriation is made or any entity 16
to which money from the appropriation is granted or otherwise 17
transferred in any manner, and any portion of the appropriated 18
money remaining must not be spent for any pur pose after 19
September 17, 2027, by either the entity to which the money was 20
appropriated or the entity to which the money was subsequently 21
granted or transferred, and must be reverted to the State General 22
Fund on or before September 17, 2027. 23
Sec. 120. 1. There is hereby appropriated from the State 24
General Fund to the Patient Protection Commission created by NRS 25
439.908 the sum of $200,000 to conduct the study required by 26
section 121 of this act. 27
2. Any remaining balance of the appropriation made by 28
subsection 1 must not be committed for expenditure after June 30, 29
2027, by the entity to which the appropriation is made or any entity 30
to which money from the appropriation is granted or otherwise 31
transferred in any manner, and any portion of the appropriated 32
money remaining must not be spent for any purpose after 33
September 17, 2027, by either the entity to which the money was 34
appropriated or the entity to which the money was subsequently 35
granted or tr ansferred, and must be reverted to the State General 36
Fund on or before September 17, 2027. 37
Sec. 120.3. 1. An independent center for emergency medical 38
care that was licensed on the date on which this act was enacted is 39
exempt from the requirements of subsection 3 of NRS 449.1818, as 40
amended by section 26.5 of this act. 41
2. As used in this section, “independent center for emergency 42
medical care” has the meaning ascribed to it in NRS 449.013, as that 43
section existed on January 1, 2025. 44

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Sec. 120.6. 1. Notwithstanding the amendatory provisions of 1
section 22.5 of this act, an independent center for emergency 2
medical care that is owned or operated by, or otherwise part of, a 3
hospital may conti nue to operate without obtaining a license 4
separate from the license of the hospital pursuant to NRS 449.080 5
until July 1, 2026. 6
2. Notwithstanding the amendatory provisions of section 24.8 7
of this act, the Division of Public and Behavioral Health of the 8
Department of Health and Human Services shall issue a license to 9
operate an independent center for emergency medical care that was 10
operating on the date on which this act was enacted and is located 11
within 5 miles of another independent center for emergency medical 12
care or a hospital with an emergency department if the independent 13
center for emergency medical care otherwise qualifies for licensure 14
pursuant to NRS 449.080. 15
3. Notwithstanding the amendatory provisions of section 24.8 16
of this act, the Divis ion of Public and Behavioral Health of the 17
Department of Health and Human Services shall issue a license to 18
operate an independent center for emergency medical care that is 19
located within 5 miles of another independent center for emergency 20
medical care or a hospital with an emergency department and that 21
otherwise qualifies for licensure pursuant to NRS 449.080 at the 22
time of the application for licensure if, on or before January 1, 2025, 23
the owner or operator of the independent center for emergency 24
medical care had: 25
(a) Acquired the land upon which the independent center for 26
emergency medical care is to be constructed; 27
(b) Obtained or was in the process of obtaining all necessary 28
permits, licenses or other required approvals necessary for the 29
construction of the independent center for emergency medical care; 30
and 31
(c) Commenced the process of obtaining approval from the 32
Director of the Department of Health and Human Services pursuant 33
to NRS 439A.100 or 439A.102, if applicable. 34
4. As used in this section, “ independent center for emergency 35
medical care” has the meaning ascribed to it in NRS 449.013, as 36
amended by section 22.5 of this act. 37
Sec. 121. 1. During the 2025 -2026 interim, the Patient 38
Protection Commission shall stud y the adequacy of the academic 39
medical centers in this State. The study must include, without 40
limitation: 41
(a) An assessment of the current and projected health care 42
workforce in this State; 43

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(b) An evaluation of potential locations for the development or 1
enhancement of academic medical centers in this State, which must 2
consider, without limitation: 3
(1) Equity among the geographic areas of this State; and 4
(2) The needs of the population in the diverse geographic 5
areas of this State for the services of an academic medical center; 6
(c) An analysis of models for sustainable funding of academic 7
medical centers that utilize money from the State and Federal 8
Governments and private persons and entities; 9
(d) Recommendations for integrating existing public and private 10
medical institutions into a cohesive statewide academic medical 11
system; 12
(e) Identification of strategies to expand programs for residency 13
training and postdoctoral fellowships for physicians with a focus on 14
specialties for which a high need exists and on underserved 15
geographic areas of this State; 16
(f) Exploration of opportunities for partnerships between the 17
public and private sector to support the operations of academic 18
medical centers and economic development relating to health care; 19
and 20
(g) An evaluation of the ability of various models of governance 21
for academic medical centers to ensure accountability, facilitate the 22
input of interested persons and entities and align the activities of the 23
academic medical center with the long -term goals of th e State 24
Government relating to health care. 25
2. In conducting the study described in subsection 1, the 26
Patient Protection Commission shall consult with: 27
(a) Experts in health care, academic institutions and economics; 28
and 29
(b) Representatives of various communities in this State. 30
3. On or before November 6, 2026, the Patient Protection 31
Commission shall: 32
(a) Compile a comprehensive report of the findings and 33
recommendations resulting from the study conducted pursuant to 34
subsection 1; and 35
(b) Submit the report to: 36
(1) The Governor; and 37
(2) The Director of the Legislative Counsel Bureau for 38
transmittal to the next regular session of the Legislature. 39
4. As used in this section: 40
(a) “Academic medical center” means a medical school and its 41
affiliated teaching hospitals and clinics that: 42
(1) Operate a program for residency training and 43
postdoctoral fellowships for physicians, and 44

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(2) Conduct research that is overseen by the United States 1
Department of Health and Human Services and involves human 2
subjects. 3
(b) “Patient Protection Commission” means the Patient 4
Protection Commission created by NRS 439.908. 5
Sec. 121.5. If Senate Bill No. 494 of this session is enacted 6
and creates the Nevada Health Authority , t he Office of Mental 7
Health created by section 67 of this act is transferred from the 8
Department of Health and Human Services to the Nevada Health 9
Authority. 10
Sec. 122. 1. The amendatory provisions of this act do not 11
apply to a request for prior authorization submitted: 12
(a) Under a contract or policy of health insurance issued before 13
January 1, 2028, but apply to any request for prior authorization 14
submitted under any renewal of such a contract or policy. 15
(b) To the Department of He alth and Human Services before 16
January 1, 2028, for medical or dental care provided to a recipient of 17
Medicaid. 18
2. A health carrier must, in order to continue requiring prior 19
authorization in contracts or policies of health insurance issued or 20
renewed after January 1, 2028: 21
(a) Develop a procedure for obtaining prior authorization that 22
complies with NRS 687B.225, as amended by section 110 of this 23
act, and sections 97 to 108, inclusive, of this act; and 24
(b) Obtain the approval of the Commissioner of Insu rance 25
pursuant to NRS 687B.225, as amended by section 110 of this act, 26
and sections 97 to 108, inclusive, of this act for the procedure 27
developed pursuant to paragraph (a). 28
3. As used in this section, “health carrier” has the meaning 29
ascribed to it in section 98 of this act. 30
Sec. 122.5. The Department of Health and Human Services: 31
1. Is not required to implement the provisions of subsections 9, 32
10 and 11 of section 56 of this act until January 1, 2029; and 33
2. May, between January 1, 2028, and January 1, 2029, collect 34
such data from providers of services under Medicaid as may be 35
necessary to prepare to implement those provisions. 36
Sec. 123. 1. Any administrative regulations adopted by an 37
officer, agency or other entity whose name has been changed or 38
whose responsibilities have been transferred pursuant to the 39
provisions of this act to another officer, agency or other entity 40
remain in force until amended by the officer, agency or other entity 41
to which the responsibility for the adoption of the regulations has 42
been transferred. 43
2. Any contracts or other agreements entered into by an officer 44
or agency whose name has been changed or whose responsibilities 45

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have been transferred pursuant to the provisions of this act to 1
another officer or agency are binding upon the officer or agency to 2
which the responsibility for the administration of the provisions of 3
the contract or other agreement has been transferred. Such contracts 4
and other agreements may be enforced by the officer or agency to 5
which the responsibility for the enforcement of the provisions of the 6
contract or other agreement has been transferred. 7
3. Any action taken by an officer or agency whose name has 8
been changed or whose responsibilities have been transferred 9
pursuant to the provisions of this act to another officer or agen cy 10
remains in effect as if taken by the officer or agency to which the 11
responsibility for the enforcement of such actions has been 12
transferred. 13
Sec. 124. The provisions of subsection 1 of NRS 218D.380 do 14
not apply to any provision of this act which adds or revises a 15
requirement to submit a report to the Legislature. 16
Sec. 125. The provisions of NRS 354.599 do not apply to any 17
additional expenses of a local government that are related to the 18
provisions of this act. 19
Sec. 126. NRS 450B.215 is hereby repealed. 20
Sec. 127. 1. This section and sections 1 to 3.3, inclusive, 4, 21
4.5, 5, 6, 8, 14 to 18, inclusive, 32.5, 43, 45.5, 67. 9, 70, 71, 72.3, 22
72.5, 116.3, 116.7 and 123 to 126, inclusive, of this act become 23
effective upon passage and approval. 24
2. Sections 5.5, 7, 33 to 40, inclusive, 42, 66.3 to 67.8, 25
inclusive, 119, 120, 121 and 121.5 of this act become effective on 26
July 1, 2025. 27
3. Sections 3.6, 8.5 to 13 .5, inclusive, 19, 20, 22.5 to 32, 28
inclusive, 41, 41.5, 42.5, 46, 48 to 51.3, inclusive, 68, 72.8, 73, 74, 29
76 to 84, inclusive, 86 to 90, inclusive, 95.5, 109, 111, 112, 113, 30
120.3 and 120.6 of this act become effective: 31
(a) Upon passage and approval for the purpose of adopting any 32
regulations and performing any other preparatory administrative 33
tasks that are necessary to carry out the provisions of this act; and 34
(b) On January 1, 2026, for all other purposes. 35
4. Sections 75 and 85 of this act become effective: 36
(a) Upon passage and approval for the purpose of adopting any 37
regulations and performing any other preparatory administrative 38
tasks that are necessary to carry out the provisions of this act; and 39
(b) On July 1, 2026, for all other purposes. 40
5. Section 119.5 of this act becomes effective on July 1, 2026. 41
6. Sections 51.5 and 51.8 of this act become effective: 42
(a) Upon passage and approval for the purpose of adopting any 43
regulations and performing any other pr eparatory administrative 44
tasks that are necessary to carry out the provisions of this act; and 45

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(b) On October 1, 2026, for all other purposes. 1
7. Sections 21, 117 and 118 of this act become effective on 2
January 1, 2027. 3
8. Sections 22, 44, 45, 47, 52 to 66, inclusive, 69, 72, 91 to 95, 4
inclusive, and 96 to 108, inclusive, 110, 114, 115, 116, 122 and 5
122.5 of this act become effective: 6
(a) Upon passage and approval for the purpose of adopting any 7
regulations and performing any other preparatory adminis trative 8
tasks that are necessary to carry out the provisions of this act; and 9
(b) On January 1, 2028, for all other purposes. 10

TEXT OF REPEALED SECTION

450B.215 Administrative sanctions for failure to comply
with requirements concerning electronic health information.
1. If the health authority receives notification from the
Department of Health and Human Services pursuant to NRS
439.5895 that the holder of a permit to operate an ambulance, air
ambulance or vehicle of a fire -fighting agency is not in compliance
with the requirements of subsection 4 of NRS 439.589, the health
authority may, after notice and the opportunity for a hearing in
accordance with the provisions of this chapter, require corrective
action or impose an administrative penalty in an amount established
by regulation of the board.
2. The health authority shall not suspend or revoke a permit for
failure to comply with the requirements of subsection 4 of
NRS 439.589.

H