[Rev. 11/21/2013 11:40:22 AM--2013]

CHAPTER 439A - PLANNING FOR THE PROVISION OF HEALTH CARE

GENERAL PROVISIONS

NRS 439A.010        Definitions.

NRS 439A.012        “Department” defined.

NRS 439A.0125      “Director” defined.

NRS 439A.015        “Health facility” defined.

NRS 439A.017        “Health services” defined.

NRS 439A.0195      “Practitioner” defined.

NRS 439A.020        Purposes of chapter.

ADMINISTRATION; APPROVAL OF PROJECTS

NRS 439A.081        Department is state agency for health planning and development; powers of Director; fees.

NRS 439A.082        Director to contract with Nevada System of Higher Education to collect and analyze information from health facilities and purchasers of health care.

NRS 439A.083        Director to establish procedure for review of statutes, regulations and standards governing approval, licensing or certification of health facilities; preparation of report for Governor and Legislature.

NRS 439A.086        Chief Research and Statistical Analyst: Position created.

NRS 439A.100        Approval of Director required for certain projects; criteria for review of application.

NRS 439A.104        Approval of Chief Medical Officer required for operation of certain medical helicopters; criteria for review of application.

PHYSICIAN VISA WAIVER PROGRAM

NRS 439A.130        Definitions.

NRS 439A.135        “Administrator” defined.

NRS 439A.138        “Division” defined.

NRS 439A.140        “Employer” defined.

NRS 439A.145        “Health Division” defined. [Repealed.]

NRS 439A.150        “J-1 visa physician” defined.

NRS 439A.155        “J-1 visa waiver” defined.

NRS 439A.160        “Letter of support” defined.

NRS 439A.165        “Program” defined.

NRS 439A.170        Establishment; regulations; application fees; accounting and use of money; administration of Program.

NRS 439A.175        Application for letter of support; qualifications; conditions for contract between employer and J-1 visa physician.

NRS 439A.180        Violations and penalties.

NRS 439A.185        Civil and criminal immunity for reporting violations.

PROGRAMS TO INCREASE AWARENESS OF INFORMATION CONCERNING HOSPITALS AND SURGICAL CENTERS FOR AMBULATORY PATIENTS

NRS 439A.200        Definitions.

NRS 439A.205        “Hospital” defined.

NRS 439A.207        “Potentially preventable readmission” defined.

NRS 439A.210        “Surgical center for ambulatory patients” defined.

NRS 439A.220        Information concerning hospitals: Establishment of program; information to be collected, maintained and provided through program.

NRS 439A.230        Information concerning hospitals: Regulations; deadline for submission of information; notice of failure to provide information to be sent to Division of Public and Behavioral Health.

NRS 439A.240        Information concerning surgical centers for ambulatory patients: Establishment of program; information to be collected, maintained and provided through program.

NRS 439A.250        Information concerning surgical centers for ambulatory patients: Regulations; deadline for submission of information; notice of failure to provide information to be sent to Division of Public and Behavioral Health.

NRS 439A.260        Department to collect and maintain information and make summary of information available to certain persons; information to be aggregated.

NRS 439A.270        Internet website for information concerning hospitals and surgical centers for ambulatory patients: Establishment; information to be included on website; presentation of information on website; duties of Department.

NRS 439A.280        Suspension of components of program or duties of Department if sufficient money not available; acceptance of gifts and grants.

NRS 439A.290        Duty of Department to consult; Department allowed to contract with certain entities for analysis of information collected and maintained by Department; regulations for review and release of information; annual report concerning requests for release of information.

ENFORCEMENT

NRS 439A.300        Injunctions.

NRS 439A.310        Civil penalties.

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GENERAL PROVISIONS

      NRS 439A.010  Definitions.  As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 439A.012 to 439A.0195, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1971, 566; A 1977, 253; 1979, 967; 1981, 1214; 1985, 1357; 1991, 2110; 1995, 1485)

      NRS 439A.012  “Department” defined.  “Department” means the Department of Health and Human Services.

      (Added to NRS by 1981, 1213)

      NRS 439A.0125  “Director” defined.  “Director” means the Director of the Department.

      (Added to NRS by 1981, 1213)

      NRS 439A.015  “Health facility” defined.  “Health facility” means a facility in or through which health services are provided, except for the office of a practitioner used solely to provide routine services for health to the practitioner’s patients. The term includes any parent, affiliate, subsidiary or partner of such a facility and any other entity which has a primary purpose of providing a benefit to such a facility. For the purposes of this section, “office of a practitioner used solely to provide routine services for health to the practitioner’s patients” does not include a facility which is or will be qualified to receive reimbursement, other than for the services of a practitioner, as a health facility from any public agency.

      (Added to NRS by 1981, 1213; A 1985, 1358, 1749; 1991, 1075; 1995, 1485)

      NRS 439A.017  “Health services” defined.  “Health services” means the care and observation of patients, the diagnosis of human diseases, the treatment and rehabilitation of patients, or related services. The term includes treatment of patients for alcohol or drug abuse, services related to mental health and diagnostic services.

      (Added to NRS by 1981, 1213; A 1983, 1524)

      NRS 439A.0195  “Practitioner” defined.  “Practitioner” means a physician licensed under chapter 630, 630A or 633 of NRS, dentist, licensed nurse, dispensing optician, optometrist, registered physical therapist, podiatric physician, licensed psychologist, chiropractor, doctor of Oriental medicine in any form, medical laboratory director or technician, pharmacist or other person whose principal occupation is the provision of services for health.

      (Added to NRS by 1985, 1357; A 1991, 1133; 1993, 2232)

      NRS 439A.020  Purposes of chapter.  The purposes of this chapter are to:

      1.  Promote equal access to quality health care at a reasonable cost;

      2.  Promote an adequate supply and distribution of health resources;

      3.  Promote uniform, effective methods of delivering health care;

      4.  Promote and encourage the adequate distribution of health and care facilities and human resources;

      5.  Promote and encourage the effective use of methods for controlling increases in the cost of health care;

      6.  Encourage participation in health planning by members of the several health professions, representatives of institutions and agencies interested in the provision of health care and the reduction of the cost of such care, and the general public;

      7.  Utilize the viewpoint of the general public for making decisions;

      8.  Provide information to the general public concerning the charges imposed and the quality of the services provided by the hospitals and surgical centers for ambulatory patients in this State;

      9.  Encourage public education regarding proper personal health care and methods for the effective use of available health services; and

      10.  Promote a program of technical assistance to purchasers to contain effectively the cost of health care, including:

      (a) Providing information to purchasers regarding the charges made by practitioners.

      (b) Training purchasers to negotiate successfully for a policy of health insurance.

      (c) Conducting studies and providing other information about measures to assist purchasers in containing the cost of health care.

      (Added to NRS by 1971, 566; A 1977, 254; 1983, 1524; 1985, 1358; 2007, 2354)

ADMINISTRATION; APPROVAL OF PROJECTS

      NRS 439A.081  Department is state agency for health planning and development; powers of Director; fees.

      1.  The Department is the agency of the State of Nevada for health planning and development, and shall carry out the state administrative program and perform the functions of health planning and development for the State in accordance with the following priorities:

      (a) Providing for the effective use of methods for controlling increases in the cost of health care;

      (b) Providing for the adequate supply and distribution of health resources;

      (c) Providing for equal access to health care of good quality at a reasonable cost; and

      (d) Providing education to the public regarding proper personal health care and methods for the effective use of available health services.

      2.  In order to carry out the provisions of this chapter, the Director may:

      (a) Delegate the duties of the Director and the Department pursuant to this chapter to any of the divisions of the Department;

      (b) Hire employees in the classified service;

      (c) Adopt such regulations as are necessary; and

      (d) Apply for, accept and disburse money granted by the Federal Government for the purposes of health planning and development.

      3.  The Department may, by regulation, fix fees to be collected from applicants seeking approval of proposed health facilities or services. The amounts of such fees must be based upon the Department’s costs of examining and acting upon the applications.

      4.  In developing and revising any state plan for health planning and development, the Department shall consider, among other things, the amount of money available from the Federal Government for health planning and development and the conditions attached to the acceptance of that money, and the limitations of legislative appropriations for health planning and development.

      (Added to NRS by 1977, 257; A 1979, 967; 1981, 1216, 1899; 1983, 1525; 1985, 1359; 1989, 1945; 1991, 2110; 1995, 1485)

      NRS 439A.082  Director to contract with Nevada System of Higher Education to collect and analyze information from health facilities and purchasers of health care.  The Director, through the Division of Health Care Financing and Policy of the Department, shall contract with the Nevada System of Higher Education to collect and analyze information from health facilities and purchasers of health care to:

      1.  Respond to requests for information from the Legislature.

      2.  Provide technical assistance to purchasers of health care.

      3.  Provide the Department with information necessary to carry out the provisions of this chapter.

      4.  Provide other persons with information relating to the cost of health care.

      (Added to NRS by 1985, 1357; A 1993, 403; 1997, 2632; 1999, 2242)

      NRS 439A.083  Director to establish procedure for review of statutes, regulations and standards governing approval, licensing or certification of health facilities; preparation of report for Governor and Legislature.  The Director shall:

      1.  Establish procedures for the review of all statutes, regulations and standards governing the approval, licensing or certification of health facilities. The procedures must provide for participation in the review by providers of health care and the general public.

      2.  Before December 31 of each even-numbered year, prepare a report to the Governor and the Legislature identifying any statutes, regulations and standards which add to the cost of health care without providing a significant benefit and the action which has been taken or is required to eliminate any such statutes, regulations and standards.

      (Added to NRS by 1985, 1357)

      NRS 439A.086  Chief Research and Statistical Analyst: Position created.  The position of Chief Research and Statistical Analyst is hereby created in the Division of Public and Behavioral Health of the Department. This position is in the unclassified service of the State.

      (Added to NRS by 1989, 1399; A 2005, 22nd Special Session, 55)

      NRS 439A.100  Approval of Director required for certain projects; criteria for review of application.

      1.  Except as otherwise provided in this section, in a county whose population is less than 100,000, no person may undertake any proposed expenditure for new construction by or on behalf of a health facility in excess of the greater of $2,000,000 or such an amount as the Department may specify by regulation, which under generally accepted accounting principles consistently applied is a capital expenditure, without first applying for and obtaining the written approval of the Director. The Division of Public and Behavioral Health of the Department shall not issue a new license or alter an existing license for such a project unless the Director has issued such an approval.

      2.  The provisions of subsection 1 do not apply to:

      (a) Any capital expenditure for:

             (1) The acquisition of land;

             (2) The construction of a facility for parking;

             (3) The maintenance of a health facility;

             (4) The renovation of a health facility to comply with standards for safety, licensure, certification or accreditation;

             (5) The installation of a system to conserve energy;

             (6) The installation of a system for data processing or communication; or

             (7) Any other project which, in the opinion of the Director, does not relate directly to the provision of any health service;

      (b) Any project for the development of a health facility that has received legislative approval and authorization; or

      (c) A project for the construction of a hospital in an unincorporated town if:

             (1) The population of the unincorporated town is more than 24,000;

             (2) No other hospital exists in the town;

             (3) No other hospital has been approved for construction or qualified for an exemption from approval for construction in the town pursuant to this section; and

             (4) The unincorporated town is at least a 45-minute drive from the nearest center for the treatment of trauma that is licensed by the Division of Public and Behavioral Health of the Department.

Ê Upon determining that a project satisfies the requirements for an exemption pursuant to this subsection, the Director shall issue a certificate which states that the project is exempt from the requirements of this section.

      3.  In reviewing an application for approval, the Director shall:

      (a) Comparatively assess applications for similar projects affecting the same geographic area; and

      (b) Base his or her decision on criteria established by the Director by regulation. The criteria must include:

             (1) The need for and the appropriateness of the project in the area to be served;

             (2) The financial feasibility of the project;

             (3) The effect of the project on the cost of health care; and

             (4) The extent to which the project is consistent with the purposes set forth in NRS 439A.020 and the priorities set forth in NRS 439A.081.

      4.  The Department may by regulation require additional approval for a proposed change to a project which has previously been approved if the proposal would result in a change in the location of the project or a substantial increase in the cost of the project.

      5.  The decision of the Director is a final decision for the purposes of judicial review.

      6.  As used in this section, “hospital” has the meaning ascribed to it in NRS 449.012.

      (Added to NRS by 1971, 568; A 1977, 256; 1979, 491, 968; 1981, 1216; 1983, 1526; 1985, 1360; 1987, 873, 1627; 1989, 1946, 2111; 1991, 1075; 1995, 1486; 2003, 1324; 2013, 3044)

      NRS 439A.104  Approval of Chief Medical Officer required for operation of certain medical helicopters; criteria for review of application.

      1.  No person may operate or undertake any proposed expenditure for the operation of a new medical helicopter that will provide medical helicopter services in an area located within 150 miles from the base of an existing medical helicopter without first applying for and obtaining the written approval of the Chief Medical Officer or the designee of the Chief Medical Officer.

      2.  Except as otherwise provided in subsection 3, the Chief Medical Officer or the designee of the Chief Medical Officer may approve an application submitted pursuant to subsection 1 only if the applicant demonstrates that:

      (a) Based on the needs of the specific population to be served by the new medical helicopter and on the projected number of persons who have or will have a need for the proposed service, the population to be served has a need for the new medical helicopter;

      (b) The existing medical helicopter services in the area to be served by the new medical helicopter cannot or will not meet the projected needs of the population to be served by the new medical helicopter;

      (c) The applicant has the financial stability to provide medical helicopter services to the population to be served by the new medical helicopter for a significant period of time;

      (d) The new medical helicopter will result in a significant savings in costs for users of and payors for medical helicopter services;

      (e) The new medical helicopter will not have an adverse effect on the quality of care provided to users of medical helicopter services and will not have an unnecessarily negative effect on the cost of medical helicopter services for users of or payors for such services; and

      (f) The approval of the application will not adversely affect an existing provider of medical helicopter services.

      3.  The Chief Medical Officer or the designee of the Chief Medical Officer shall not approve an application submitted pursuant to subsection 1 if:

      (a) The applicant fails to provide sufficient, relevant, demonstrative evidence for the approval of the application; or

      (b) The evidence opposing the application outweighs the evidence supporting the application.

      4.  In determining whether to approve an application submitted pursuant to subsection 1, the Chief Medical Officer or the designee of the Chief Medical Officer shall:

      (a) Contact existing providers of medical helicopter services, ensure that existing providers of medical helicopter services have an opportunity to participate in any public hearing concerning the application, and seek the input of existing providers of medical helicopter services concerning the application; and

      (b) Consider:

             (1) The level of medical care to be provided by the applicant to the population to be served by the new medical helicopter;

             (2) The impact of the new medical helicopter on the rates, quality of service and safety of existing providers of medical helicopter services and on the level of medical care provided by such providers;

             (3) The effect of the new medical helicopter on the cost of health care services; and

             (4) Any other information the Chief Medical Officer or the designee of the Chief Medical Officer deems relevant.

      5.  An applicant whose application is rejected pursuant to this section may appeal the decision of the Chief Medical Officer or the designee of the Chief Medical Officer to the State Board of Health. The decision of the State Board of Health is a final decision for the purposes of judicial review.

      6.  As used in this section, “medical helicopter” means a helicopter especially designed, constructed, modified or equipped to be used for the transportation of injured or sick persons. The term does not include any commercial helicopter carrying passengers on regularly scheduled flights.

      (Added to NRS by 2003, 1323)

PHYSICIAN VISA WAIVER PROGRAM

      NRS 439A.130  Definitions.  As used in NRS 439A.130 to 439A.185, inclusive, the words and terms defined in NRS 439A.135 to 439A.165, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 2009, 772; A 2013, 3045)

      NRS 439A.135  “Administrator” defined.  “Administrator” means the Administrator of the Division.

      (Added to NRS by 2009, 772; A 2013, 3045)

      NRS 439A.138  “Division” defined.  “Division” means the Division of Public and Behavioral Health of the Department.

      (Added to NRS by 2013, 3044)

      NRS 439A.140  “Employer” defined.  “Employer” means a person who sponsors a J-1 visa physician and enters into a contract with the J-1 visa physician.

      (Added to NRS by 2009, 772)

      NRS 439A.145  “Health Division” defined.  Repealed. (See chapter 489, Statutes of Nevada 2013, at page 3071.)

 

      NRS 439A.150  “J-1 visa physician” defined.  “J-1 visa physician” means a foreign medical graduate who:

      1.  Has an offer of full-time employment at a health facility in an area designated by the Federal Government as a health care professional shortage area or at a health facility which serves patients from such a designated area, and agrees to begin employment at that facility within 90 days after receiving a J-1 visa waiver;

      2.  Signs a contract to continue to work at that health facility for a total of 40 hours per week for not less than 3 years;

      3.  Applies for or has been issued a license to practice medicine pursuant to chapter 630 of NRS; and

      4.  Applies for a J-1 visa waiver.

      (Added to NRS by 2009, 772)

      NRS 439A.155  “J-1 visa waiver” defined.  “J-1 visa waiver” means a waiver of the 2-year foreign residence requirement authorized pursuant to 8 U.S.C. § 1182(e) for a physician who holds a J-1 visa.

      (Added to NRS by 2009, 772)

      NRS 439A.160  “Letter of support” defined.  “Letter of support” means a letter issued by the Program to the Waiver Review Division of the United States Department of State stating that a request for a J-1 visa waiver is in the public interest.

      (Added to NRS by 2009, 772)

      NRS 439A.165  “Program” defined.  “Program” means the Physician Visa Waiver Program established by NRS 439A.170.

      (Added to NRS by 2009, 772)

      NRS 439A.170  Establishment; regulations; application fees; accounting and use of money; administration of Program.

      1.  The Physician Visa Waiver Program is hereby established in the Division. The Administrator shall administer the Program consistent with federal law and the provisions of NRS 439A.130 to 439A.185, inclusive, and the regulations adopted pursuant thereto. The Program must:

      (a) Provide for the oversight of employers and J-1 visa physicians in this State;

      (b) Evaluate applications for letters of support submitted pursuant to NRS 439A.175; and

      (c) Issue letters of support.

      2.  The State Board of Health shall adopt regulations:

      (a) Providing for the administration of the Program; and

      (b) Establishing an application fee, not to exceed $500, payable to the Program by an employer or J-1 visa physician who applies for a letter of support pursuant to NRS 439A.175.

      3.  Any application fees collected by the Program are not refundable and must be deposited in the State Treasury and accounted for separately in the State General Fund. Any interest and income earned on the money in the account, after deducting any applicable charges, must be credited to the account. Any money remaining in the account at the end of a fiscal year does not revert to the State General Fund. All claims against the account must be paid as other claims against the State are paid. The money in the account must be used to pay the costs of administering the Program and for training and educating J-1 visa physicians and employers.

      4.  The Division is hereby designated as the agency of this State to cooperate with the Federal Government in the administration of the Program.

      (Added to NRS by 2009, 772)

      NRS 439A.175  Application for letter of support; qualifications; conditions for contract between employer and J-1 visa physician.

      1.  An employer or J-1 visa physician who seeks a letter of support must:

      (a) Apply to the Program for a letter of support in the manner prescribed by the State Board of Health;

      (b) Include with the application proof satisfactory to the Division that the J-1 visa physician is licensed to practice medicine pursuant to chapter 630 of NRS or has submitted an application for a license to practice medicine pursuant to chapter 630 of NRS; and

      (c) Include with the application a copy of the contract entered into by the employer and the J-1 visa physician.

      2.  The contract entered into by the employer and the J-1 visa physician:

      (a) Must comply with:

             (1) All applicable provisions of federal law; and

             (2) The regulations adopted by the State Board of Health pursuant to NRS 439A.130 to 439A.185, inclusive.

      (b) Must not include:

             (1) A noncompete clause or restrictive covenant that prevents or discourages the J-1 visa physician from continuing to practice after the term of the contract expires; or

             (2) Any provision authorizing termination without cause.

      3.  The Program may provide a letter of support to a J-1 visa physician:

      (a) If the Program determines that the waiver is in the public interest;

      (b) If the contract entered into by the employer and the J-1 visa physician complies with the provisions of this section; and

      (c) Upon payment of the prescribed application fee.

      (Added to NRS by 2009, 773)

      NRS 439A.180  Violations and penalties.

      1.  In addition to any other penalty prescribed by law:

      (a) A J-1 visa physician who:

             (1) Does not provide the required minimum hours of health services in an area designated by the Federal Government as a health care professional shortage area;

             (2) Refuses to provide health services to medically underserved persons in this State; or

             (3) Violates any provision of state law governing physicians or the provision of health services; or

      (b) An employer who:

             (1) Employs a J-1 visa physician in a manner other than that specified in the contract entered into by the employer and the J-1 visa physician;

             (2) Violates any provision of NRS 439A.130 to 439A.185, inclusive, or any regulation adopted pursuant thereto; or

             (3) Violates any provision of state law governing physicians or the provision of health services,

Ê is subject to the penalty prescribed by the State Board of Health pursuant to subsection 2.

      2.  The State Board of Health shall adopt regulations establishing:

      (a) The procedure for reporting a violation of this section; and

      (b) The penalty for any violation of this section.

      (Added to NRS by 2009, 773)

      NRS 439A.185  Civil and criminal immunity for reporting violations.  A person who reports or provides any information concerning a violation of NRS 439A.130 to 439A.185, inclusive, or any regulation adopted pursuant thereto, to a governmental entity is immune from any civil or criminal liability for that action.

      (Added to NRS by 2009, 774)

PROGRAMS TO INCREASE AWARENESS OF INFORMATION CONCERNING HOSPITALS AND SURGICAL CENTERS FOR AMBULATORY PATIENTS

      NRS 439A.200  Definitions.  As used in NRS 439A.200 to 439A.290, inclusive, unless the context otherwise requires, the words and terms defined in NRS 439A.205, 439A.207 and 439A.210 have the meanings ascribed to them in those sections.

      (Added to NRS by 2007, 2350; A 2011, 1802)

      NRS 439A.205  “Hospital” defined.  “Hospital” has the meaning ascribed to it in NRS 449.012.

      (Added to NRS by 2007, 2350)

      NRS 439A.207  “Potentially preventable readmission” defined.  “Potentially preventable readmission” means an unplanned readmission of a patient which:

      1.  Occurs not more than 30 days after the patient is discharged;

      2.  Is clinically related to the initial admission; and

      3.  Was preventable.

      (Added to NRS by 2011, 1802)

      NRS 439A.210  “Surgical center for ambulatory patients” defined.  “Surgical center for ambulatory patients” has the meaning ascribed to it in NRS 449.019.

      (Added to NRS by 2007, 2350)

      NRS 439A.220  Information concerning hospitals: Establishment of program; information to be collected, maintained and provided through program.

      1.  The Department shall establish and maintain a program to increase public awareness of health care information concerning the hospitals in this State. The program must be designed to assist consumers with comparing the quality of care provided by the hospitals in this State and the charges for that care.

      2.  The program must include, without limitation, the collection, maintenance and provision of information concerning:

      (a) Inpatients and outpatients of each hospital in this State as reported in the forms submitted pursuant to NRS 449.485;

      (b) The quality of care provided by each hospital in this State as determined by applying measures of quality endorsed by the entities described in subparagraph (1) of paragraph (b) of subsection 1 of NRS 439A.230, expressed as a number of events and rate of occurrence, if such measures can be applied to the information reported in the forms submitted pursuant to NRS 449.485;

      (c) How consistently each hospital follows recognized practices to prevent the infection of patients, to speed the recovery of patients and to avoid medical complications of patients;

      (d) For each hospital, the total number of patients discharged, the average length of stay and the average billed charges, reported by diagnosis-related groups for inpatients and for the 50 medical treatments for outpatients that the Department determines are most useful for consumers;

      (e) The total number of patients discharged from the hospital and the total number of potentially preventable readmissions, which must be expressed as a total number and a rate of occurrence of potentially preventable readmissions, and the average length of stay and the average billed charges for those potentially preventable readmissions;

      (f) To the extent that money is available for that purpose, for each hospital, the name of each physician who performed a surgical procedure in the hospital and the total number of surgical procedures performed by the physician, reported by diagnosis-related group if the information is available and by principal diagnosis, principal surgical procedure and secondary surgical procedure; and

      (g) Any other information relating to the charges imposed and the quality of the services provided by the hospitals in this State which the Department determines is:

            (1) Useful to consumers;

             (2) Nationally recognized; and

             (3) Reported in a standard and reliable manner.

      3.  As used in this section, “diagnosis-related group” means groupings of medical diagnostic categories used as a basis for hospital payment schedules by Medicare and other third-party health care plans.

      (Added to NRS by 2007, 2350; A 2011, 1802, 2126, 2660)

      NRS 439A.230  Information concerning hospitals: Regulations; deadline for submission of information; notice of failure to provide information to be sent to Division of Public and Behavioral Health.

      1.  The Department shall, by regulation:

      (a) Prescribe the information that each hospital in this State must submit to the Department for the program established pursuant to NRS 439A.220.

      (b) Prescribe the measures of quality for hospitals that are required pursuant to paragraph (b) of subsection 2 of NRS 439A.220. In adopting the regulations, the Department shall:

            (1) Use the measures of quality endorsed by the Agency for Healthcare Research and Quality, the National Quality Forum, Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, a quality improvement organization of the Centers for Medicare and Medicaid Services and the Joint Commission;

             (2) Prescribe a reasonable number of measures of quality which must not be unduly burdensome on the hospitals; and

             (3) Take into consideration the financial burden placed on the hospitals to comply with the regulations.

Ê The measures prescribed pursuant to this paragraph must report health outcomes of hospitals, which do not necessarily correlate with the inpatient diagnosis-related groups or the outpatient treatments that are posted on the Internet website pursuant to NRS 439A.270.

      (c) Prescribe the manner in which a hospital must determine whether the readmission of a patient must be reported pursuant to NRS 439A.220 as a potentially preventable readmission and the form for submission of such information.

      (d) Require each hospital to:

             (1) Provide the information prescribed in paragraphs (a), (b) and (c) in the format required by the Department; and

             (2) Report the information separately for inpatients and outpatients.

      2.  The information required pursuant to this section and NRS 439A.220 must be submitted to the Department not later than 45 days after the last day of each calendar month.

      3.  If a hospital fails to submit the information required pursuant to this section or NRS 439A.220 or submits information that is incomplete or inaccurate, the Department shall send a notice of such failure to the hospital and to the Division of Public and Behavioral Health of the Department.

      (Added to NRS by 2007, 2350; A 2011, 1803)

      NRS 439A.240  Information concerning surgical centers for ambulatory patients: Establishment of program; information to be collected, maintained and provided through program.

      1.  The Department shall establish and maintain a program to increase public awareness of health care information concerning the surgical centers for ambulatory patients in this State. The program must be designed to assist consumers with comparing the quality of care provided by the surgical centers for ambulatory patients in this State and the charges for that care.

      2.  The program must include, without limitation, the collection, maintenance and provision of information concerning:

      (a) The charges imposed on outpatients by each surgical center for ambulatory patients in this State as reported in the forms submitted pursuant to NRS 439A.250;

      (b) The quality of care provided by each surgical center for ambulatory patients in this State as determined by applying uniform measures of quality prescribed by the Department pursuant to NRS 439A.250;

      (c) How consistently each surgical center for ambulatory patients follows recognized practices to prevent the infection of patients, to speed the recovery of patients and to avoid medical complications of patients;

      (d) For each surgical center for ambulatory patients, the total number of patients discharged and the average billed charges, reported for 50 medical treatments for outpatients that the Department determines are most useful for consumers;

      (e) To the extent that money is available for that purpose, for each surgical center for ambulatory patients, the name of each physician who performed a surgical procedure in the surgical center for ambulatory patients and the total number of surgical procedures performed by the physician, reported by type of medical treatment, principal diagnosis and, if the information is available, by principal surgical procedure and secondary surgical procedure; and

      (f) Any other information relating to the charges imposed and the quality of the services provided by the surgical centers for ambulatory patients in this State which the Department determines is:

             (1) Useful to consumers;

             (2) Nationally recognized; and

             (3) Reported in a standard and reliable manner.

      (Added to NRS by 2007, 2351; A 2011, 2661)

      NRS 439A.250  Information concerning surgical centers for ambulatory patients: Regulations; deadline for submission of information; notice of failure to provide information to be sent to Division of Public and Behavioral Health.

      1.  The Department shall, by regulation:

      (a) Prescribe the information that each surgical center for ambulatory patients in this State must submit to the Department for the program as set forth in NRS 439A.240 and the form for submission of such information.

      (b) Prescribe the measures of quality for surgical centers for ambulatory patients that are required pursuant to paragraph (b) of subsection 2 of NRS 439A.240. In adopting the regulations, the Department shall:

             (1) Use measures of quality which are substantially similar to those required pursuant to subparagraph (1) of paragraph (b) of subsection 1 of NRS 439A.230;

             (2) Prescribe a reasonable number of measures of quality which must not be unduly burdensome on the surgical centers for ambulatory patients; and

             (3) Take into consideration the financial burden placed on the surgical centers for ambulatory patients to comply with the regulations.

Ê The measures prescribed pursuant to this paragraph must report health outcomes of surgical centers for ambulatory patients, which do not necessarily correlate with the outpatient treatments posted on the Internet website pursuant to NRS 439A.270.

      (c) Require each surgical center for ambulatory patients to provide the information prescribed in paragraphs (a) and (b) in the format required by the Department.

      (d) Prescribe which surgical centers for ambulatory patients in this State must participate in the program established pursuant to NRS 439A.240.

      2.  The information required pursuant to this section and NRS 439A.240 must be submitted to the Department not later than 45 days after the last day of each calendar month.

      3.  If a surgical center for ambulatory patients fails to submit the information required pursuant to this section or NRS 439A.240 or submits information that is incomplete or inaccurate, the Department shall send a notice of such failure to the surgical center for ambulatory patients and to the Division of Public and Behavioral Health of the Department.

      (Added to NRS by 2007, 2352)

      NRS 439A.260  Department to collect and maintain information and make summary of information available to certain persons; information to be aggregated.

      1.  The Department shall collect and maintain all information that it receives from the hospitals and surgical centers for ambulatory patients in this State pursuant to NRS 439A.220 to 439A.250, inclusive. Upon request, the Department shall make a summary of the information available to:

      (a) Consumers of health care;

      (b) Providers of health care;

      (c) Representatives of the health insurance industry; and

      (d) The general public.

      2.  The Department shall ensure that the information it provides pursuant to this section is aggregated so as not to reveal the identity of a specific inpatient or outpatient of a hospital or of a surgical center for ambulatory patients.

      (Added to NRS by 2007, 2352)

      NRS 439A.270  Internet website for information concerning hospitals and surgical centers for ambulatory patients: Establishment; information to be included on website; presentation of information on website; duties of Department.

      1.  The Department shall establish and maintain an Internet website that includes the information concerning the charges imposed and the quality of the services provided by the hospitals and surgical centers for ambulatory patients in this State as required by the programs established pursuant to NRS 439A.220 and 439A.240. The information must:

      (a) Include, for each hospital in this State, the:

             (1) Total number of patients discharged, the average length of stay and the average billed charges, reported for the diagnosis-related groups for inpatients and the 50 medical treatments for outpatients that the Department determines are most useful for consumers;

             (2) Total number of potentially preventable readmissions reported pursuant to NRS 439A.220, the rate of occurrence of potentially preventable readmissions, and the average length of stay and average billed charges of those potentially preventable readmissions, reported by the diagnosis-related group for inpatients for which the patient originally received treatment at a hospital; and

             (3) Name of each physician who performed a surgical procedure in the hospital and the total number of surgical procedures performed by each physician in the hospital, reported for the most frequent surgical procedures that the Department determines are most useful for consumers if the information is available;

      (b) Include, for each surgical center for ambulatory patients in this State, the:

             (1) Total number of patients discharged and the average billed charges, reported for 50 medical treatments for outpatients that the Department determines are most useful for consumers; and

             (2) Name of each physician who performed a surgical procedure in the surgical center for ambulatory patients and the total number of surgical procedures performed by each physician in the surgical center for ambulatory patients, reported for the most frequent surgical procedures that the Department determines are most useful for consumers;

      (c) Be presented in a manner that allows a person to view and compare the information for the hospitals by:

             (1) Geographic location of each hospital;

             (2) Type of medical diagnosis; and

             (3) Type of medical treatment;

      (d) Be presented in a manner that allows a person to view and compare the information for the surgical centers for ambulatory patients by:

             (1) Geographic location of each surgical center for ambulatory patients;

             (2) Type of medical diagnosis; and

             (3) Type of medical treatment;

      (e) Be presented in a manner that allows a person to view and compare the information separately for:

             (1) The inpatients and outpatients of each hospital; and

             (2) The outpatients of each surgical center for ambulatory patients;

      (f) Be readily accessible and understandable by a member of the general public;

      (g) Include the annual summary of reports of sentinel events prepared for each medical facility pursuant to paragraph (c) of subsection 1 of NRS 439.840;

      (h) Include the annual summary of reports of sentinel events prepared pursuant to paragraph (d) of subsection 1 of NRS 439.840;

      (i) Include the reports of information prepared for each medical facility pursuant to paragraph (b) of subsection 4 of NRS 439.847;

      (j) Include a link to electronic copies of all reports, summaries, compilations and supplementary reports required by NRS 449.450 to 449.530, inclusive;

      (k) Include, for each hospital with 100 or more beds, a summary of financial information which is readily understandable by a member of the general public and which includes, without limitation, a summary of:

             (1) The expenses of the hospital which are attributable to providing community benefits and in-kind services as reported pursuant to NRS 449.490;

             (2) The capital improvement report submitted to the Department pursuant to NRS 449.490;

             (3) The net income of the hospital;

             (4) The net income of the consolidated corporation, if the hospital is owned by such a corporation and if that information is publicly available;

             (5) The operating margin of the hospital;

             (6) The ratio of the cost of providing care to patients covered by Medicare to the charges for such care;

             (7) The ratio of the total costs to charges of the hospital; and

             (8) The average daily occupancy of the hospital; and

      (l) Provide any other information relating to the charges imposed and the quality of the services provided by the hospitals and surgical centers for ambulatory patients in this State which the Department determines is:

             (1) Useful to consumers;

             (2) Nationally recognized; and

             (3) Reported in a standard and reliable manner.

      2.  The Department shall:

      (a) Publicize the availability of the Internet website;

      (b) Update the information contained on the Internet website at least quarterly;

      (c) Ensure that the information contained on the Internet website is accurate and reliable;

      (d) Ensure that the information reported by a hospital or surgical center for ambulatory patients for inpatients and outpatients which is contained on the Internet website is expressed as a total number and as a rate, and must be reported in a manner so as not to reveal the identity of a specific inpatient or outpatient of a hospital or surgical center for ambulatory patients;

      (e) Post a disclaimer on the Internet website indicating that the information contained on the website is provided to assist with the comparison of hospitals and is not a guarantee by the Department or its employees as to the charges imposed by the hospitals in this State or the quality of the services provided by the hospitals in this State, including, without limitation, an explanation that the actual amount charged to a person by a particular hospital may not be the same charge as posted on the website for that hospital;

      (f) Provide on the Internet website established pursuant to this section a link to the Internet website of the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services; and

      (g) Upon request, make the information that is contained on the Internet website available in printed form.

      3.  As used in this section, “diagnosis-related group” means groupings of medical diagnostic categories used as a basis for hospital payment schedules by Medicare and other third-party health care plans.

      (Added to NRS by 2007, 2352; A 2009, 3069; 2011, 838, 965, 1803, 2127, 2661)

      NRS 439A.280  Suspension of components of program or duties of Department if sufficient money not available; acceptance of gifts and grants.

      1.  On or before July 1 of each odd-numbered year, the Department shall make a determination of whether sufficient money is available and authorized for expenditure to fund one or more components of the programs and other duties of the Department relating to NRS 439A.200 to 439A.290, inclusive.

      2.  The Department shall temporarily suspend any components of the program or duties of the Department for which it determines pursuant to subsection 1 that sufficient money is not available.

      3.  The Department may accept any gift, donation, bequest, grant or other source of money for the purpose of carrying out the provisions of NRS 439A.200 to 439A.290, inclusive.

      (Added to NRS by 2007, 2354)

      NRS 439A.290  Duty of Department to consult; Department allowed to contract with certain entities for analysis of information collected and maintained by Department; regulations for review and release of information; annual report concerning requests for release of information.

      1.  In carrying out the provisions of NRS 439A.200 to 439A.290, inclusive, the Department:

      (a) Shall work in consultation with a quality improvement organization of the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services; and

      (b) May contract with the Nevada System of Higher Education or any appropriate, independent and qualified person or entity to analyze the information collected and maintained by the Department pursuant to NRS 439A.200 to 439A.290, inclusive. Such a contractor may release or publish or otherwise use information made available to it pursuant to the contract if the Department determines that the information is accurate and the contractor complies with the regulations adopted pursuant to subsection 2.

      2.  The Department shall adopt regulations for the review and release of information collected and maintained by the Department pursuant to NRS 439A.200 to 439A.290, inclusive. The regulations must require, without limitation, the Department to review each request for information if the request is for purposes other than research.

      3.  The Department shall, on or before July 1 of each year, submit to the Legislative Committee on Health Care a report concerning each request that is made pursuant to subsection 2 and the determination of the Department with regard to each request.

      (Added to NRS by 2007, 2354)

ENFORCEMENT

      NRS 439A.300  Injunctions.

      1.  Except as provided in subsection 2, the Department may apply to any court of competent jurisdiction to enjoin any person, state agency or local governmental agency which has engaged in or is about to engage in any act which violates any provision of this chapter or the regulations adopted pursuant thereto. Such injunction may be issued without proof of actual damage sustained by any person.

      2.  The Department shall not seek injunctive relief under this section if it has imposed a civil penalty for the same violation.

      (Added to NRS by 1977, 257; A 1983, 1528)—(Substituted in revision for NRS 439A.110)

      NRS 439A.310  Civil penalties.

      1.  Except as otherwise provided in subsection 2, any person who violates any of the provisions of this chapter is liable to the State for a civil penalty of:

      (a) Where the provision violated governs the licensing of a project which is required to be approved pursuant to NRS 439A.100, not more than 10 percent of the proposed expenditure for the project.

      (b) Where any other provision is violated, not more than $20,000 for each violation.

      2.  The Department shall not impose a penalty under this section if it applies for injunctive relief to prevent the same violation.

      (Added to NRS by 1983, 1523; A 1991, 1077; 1995, 1488)—(Substituted in revision for NRS 439A.120)