[Rev. 1/14/2014 3:45:26 PM--2014R1]

CHAPTER 449 - MEDICAL FACILITIES AND OTHER RELATED ENTITIES

GENERAL PROVISIONS

NRS 449.001           Definitions.

NRS 449.0015         “Agency to provide nursing in the home” defined.

NRS 449.0021         “Agency to provide personal care services in the home” defined.

NRS 449.0025         “Board” defined.

NRS 449.0031         “Community triage center” defined.

NRS 449.0032         “Division” defined.

NRS 449.0033         “Facility for hospice care” defined.

NRS 449.0038         “Facility for intermediate care” defined.

NRS 449.00385       “Facility for modified medical detoxification” defined.

NRS 449.00387       “Facility for refractive surgery” defined.

NRS 449.0039         “Facility for skilled nursing” defined.

NRS 449.004           “Facility for the care of adults during the day” defined.

NRS 449.0045         “Facility for the dependent” defined.

NRS 449.00455       “Facility for the treatment of abuse of alcohol or drugs” defined.

NRS 449.0046         “Facility for the treatment of irreversible renal disease” defined.

NRS 449.0055         “Facility for transitional living for released offenders” defined.

NRS 449.008           “Halfway house for recovering alcohol and drug abusers” defined.

NRS 449.009           “Health Division” defined. [Repealed.]

NRS 449.0105         “Home for individual residential care” defined.

NRS 449.0115         “Hospice care” defined.

NRS 449.012           “Hospital” defined.

NRS 449.013           “Independent center for emergency medical care” defined.

NRS 449.0145         “Licensed practical nurse” defined.

NRS 449.0151         “Medical facility” defined.

NRS 449.01513       “Medication aide - certified” defined.

NRS 449.01515       “Mobile unit” defined.

NRS 449.0152         “Nursing assistant” defined.

NRS 449.0153         “Nursing pool” defined.

NRS 449.0155         “Obstetric center” defined.

NRS 449.0156         “Palliative services” defined.

NRS 449.0157         “Provider of health care” defined.

NRS 449.0159         “Provider of supported living arrangement services” defined.

NRS 449.0165         “Psychiatric hospital” defined.

NRS 449.0167         “Registered nurse” defined.

NRS 449.017           “Residential facility for groups” defined.

NRS 449.0175         “Rural clinic” defined.

NRS 449.0177         “Rural hospital” defined.

NRS 449.0185         “Supported living arrangement services” defined.

NRS 449.019           “Surgical center for ambulatory patients” defined.

NRS 449.0195         “Terminally ill” defined.

LICENSING AND REGULATION

General Provisions

NRS 449.030           License required to operate or maintain medical facility or facility for the dependent and to operate program of hospice care.

NRS 449.0301         Exemptions.

NRS 449.0302         Board to adopt standards, qualifications and other regulations.

NRS 449.0303         Authority of Board to require licensing of other facilities.

NRS 449.0305         Businesses that provide referrals to residential facilities for groups: License required; standards and regulations; provision of referrals; prohibited acts; civil penalties.

NRS 449.0306         Money received from licensing of facilities to be deposited in State General Fund; expenditure of state or federal money.

NRS 449.0307         Powers of Division.

NRS 449.0308         Authority of Division to collect actual cost of enforcing provisions from unlicensed medical facility or facility for the dependent; exception.

 

Licensing

NRS 449.040           Application for license: Filing; contents.

NRS 449.050           Fees.

NRS 449.065           Surety bond for initial license and renewal of license to operate facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in home and agency to provide nursing in home; exemption; exception.

NRS 449.067           Substitute for surety required for facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in home and agency to provide nursing in home.

NRS 449.068           Surety bond required for initial license and renewal of license to operate facility for refractive surgery.

NRS 449.069           Substitute for surety bond required for facility for refractive surgery.

NRS 449.080           Issuance, validity and transferability of license.

NRS 449.085           Form and contents of license.

NRS 449.087           Amendment of license required for addition of certain services; requirements for approval of amendment; revocation of approval; standards.

NRS 449.089           Expiration and renewal of license.

NRS 449.091           Provisional license.

NRS 449.092           Applicant for issuance or renewal of license for home for individual residential care to attest to knowledge of and compliance with certain guidelines concerning safe and appropriate injection practices.

NRS 449.093           Training to recognize and prevent abuse of older persons: Persons required to receive; frequency; topics; costs; actions for failure to complete.

NRS 449.094           Continuing education requirements concerning care of persons with dementia for certain employees of facilities for skilled nursing, facilities for intermediate care and residential facilities for groups.

 

Background Investigations

NRS 449.119           “Facility, hospital, agency, program or home” defined.

NRS 449.121           Exemption for facility for the treatment of abuse of alcohol or drugs; exception.

NRS 449.122           Investigation of applicant for license to operate facility, hospital, agency, program or home.

NRS 449.123           Initial and periodic investigations of employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home; penalty.

NRS 449.1235         Temporary employment service prohibited from sending ineligible employee to facility, hospital, agency, program or home; temporary employment service to provide certain information regarding its employees.

NRS 449.124           Maintenance and availability of certain records regarding employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home.

NRS 449.125           Termination of employment or contract of employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home who has been convicted of certain crime; period in which to correct information regarding conviction; liability of facility, hospital, agency, program or home.

 

Inspections

NRS 449.131           Entry and inspection of building and premises by Division, State Fire Marshal and Chief Medical Officer.

NRS 449.132           Inspection of medical facility and facility for dependent by Division of Public and Behavioral Health and Aging and Disability Services Division.

NRS 449.133           Report of results of inspections of medical facilities and facilities for dependent by Division; disclosure of results of inspections of facilities for skilled nursing, facilities for intermediate care and residential facilities for groups.

NRS 449.134           Facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care to provide immediate notification of certain deficiencies to certain persons.

 

Disciplinary Action

NRS 449.160           Grounds for denial, suspension or revocation of license; revocation of license in connection with certain nuisance activity; log of complaints; information concerning complaint, investigation and disciplinary action to be provided to facility for the care of adults during the day; written report of complaints and disciplinary actions.

NRS 449.163           Administrative sanctions: Imposition by Division; disposition of money collected.

NRS 449.165           Administrative sanctions: Regulations of Board.

NRS 449.170           Denial, suspension or revocation of license or imposition of sanctions: Notice; appeal; adoption of regulations.

NRS 449.171           Authority of Division to take control over medical records of medical facility or facility for dependent upon suspension of license or cessation of operation; confidentiality; sharing of records with appropriate authorities.

NRS 449.172           Residential facility for groups: Duties of Division and operator upon suspension or revocation of license for abuse, neglect or isolation of occupants.

NRS 449.174           Additional grounds for denial, suspension or revocation of license to operate certain facility, hospital, agency, program or home.

 

Miscellaneous Provisions

NRS 449.181           Medical facility that has custody of child pursuant to court order to adopt policy relating to medical care and medications for child; employees to receive copy of policy.

NRS 449.183           Facility for intermediate care, facility for skilled nursing and residential facility for groups to adopt written policy concerning readmission after temporary transfer of patient or resident.

NRS 449.184           Operator of residential facility for groups, facility for intermediate care or facility for skilled nursing to post certain information in conspicuous place.

NRS 449.186           Supervision of residential facility for groups.

NRS 449.187           Supervision of facility for skilled nursing or facility for intermediate care.

NRS 449.189           Physician and nurse required to operate independent center to provide emergency medical care.

NRS 449.191           Medical facility not required to allow abortions.

NRS 449.192           Admission of dentist to membership on medical staff of hospital.

NRS 449.193           Facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care to provide itemized statement of charges upon request to certain persons.

NRS 449.1935         Agency to provide personal care services in the home authorized to provide certain services to certain persons.

NRS 449.194           Certain employees of agency to provide personal care services in the home immune from civil liability resulting from rendering emergency care or assistance.

NRS 449.195           Waiver of deductible or copayment; conditions.

NRS 449.196           Requirements for program of hospice care.

NRS 449.197           Provision of care by facility for hospice care.

NRS 449.198           Requirements for obstetric center.

NRS 449.199           Residential facility for groups and homes for individual residential care prohibited from providing accommodations to persons not meeting requirements for admission; exception.

NRS 449.201           Certification required for alcohol and drug abuse programs operated or provided by facility for transitional living for released offenders.

NRS 449.202           Classification of hospitals.

NRS 449.203           Designation of hospital as primary stroke center; Division to maintain list of hospitals so designated; regulations.

NRS 449.2035         Designation of hospital as STEMI receiving center; Division to maintain list of hospitals so designated; regulations. [Effective January 1, 2014.]

NRS 449.204           Misleading name or other designation of facility prohibited.

 

Prohibited Acts; Penalties

NRS 449.205           Retaliation or discrimination against employees and certain other persons: Prohibition under certain circumstances; medical facility prohibited from restricting right to make report or take certain other actions.

NRS 449.207           Retaliation or discrimination against employees and certain other persons: Violation; civil action for certain acts of retaliation or discrimination; damages; equitable relief; rebuttable presumption; civil penalty; time limit for bringing action.

NRS 449.208           Retaliation or discrimination against employees or certain other persons: Written notice regarding protections and legal remedies for certain acts of retaliation or discrimination; posting of notice; inclusion of notice in employee handbook.

NRS 449.209           Prohibition against medical facility or employee of medical facility making certain referrals to residential facilities for groups; civil penalties; system to track violations.

NRS 449.210           Penalties for unlicensed operation: Medical facility or facility for dependent; residential facility for groups or home for individual residential care.

NRS 449.220           Action to enjoin violations.

NRS 449.240           Institution and conduct of prosecutions.

REQUIREMENTS RELATING TO STAFFING

NRS 449.241           Definitions.

NRS 449.2413         “Certified nursing assistant” defined.

NRS 449.2414         “Health care facility” defined.

NRS 449.2416         “Licensed nurse” defined.

NRS 449.2418         “Unit” defined.

NRS 449.242           Establishment of staffing committee by certain hospitals in larger counties; membership; duty to develop documented staffing plan; duty to consider certain requests; quarterly meetings; reporting to Legislature.

NRS 449.2421         Certain health care facilities in larger counties required to make available to Division written policy that allows refusal of or objection to work assignments and documented staffing plan; requirements of staffing plan and flexibility for adjustments.

NRS 449.2423         Certain health care facilities in larger counties to adopt written policy to allow nurse or certified nursing assistant to refuse or object to work assignments; requirements of policy; maintenance of records of refusals of and objections to work assignments.

NRS 449.2428         Division required to ensure that certain health care facilities comply with provisions; regulations.

MISCELLANEOUS PROVISIONS

NRS 449.243           Itemized list of charges required; use of Uniform Billing and Claims Forms authorized; contracted rates; summary of charges.

NRS 449.244           Certain costs for examination or treatment of victims of sexual offenses to be charged to county. [Repealed.]

NRS 449.245           Release of child from hospital; provision of authorization for release and other information to Division of Child and Family Services; disclosure of information; penalty.

NRS 449.2455         Authority of hospital to enter into agreement with Armed Forces of United States for provision of medical care by certain medical officers.

NRS 449.246           Hospital or obstetric center to provide information relating to voluntary acknowledgment or establishment of paternity before discharging unmarried woman who has borne child; regulations.

NRS 449.2465         Persons entitled to results of tests performed at laboratory regarding patient of rural hospital.

NRS 449.247           Powers and duties of Division and State Board of Nursing with respect to nursing assistants and medication aides - certified and training of nursing assistants and medication aides - certified; provision of information to State Board of Nursing.

NRS 449.2475         Unlicensed insurer not allowed to make payment directly to person who received services in certain circumstances; limitation on civil and criminal liability.

NRS 449.248           Additional services to be provided by agency to provide nursing in home.

NRS 449.2485         Return to dispensing pharmacy of unused prescription drug dispensed to patient of facility for skilled nursing or facility for intermediate care for purpose of reissuing drug or transferring drug.

NRS 449.2486         Facility for care of adults during the day to maintain and provide certain information; form in which information to be provided.

NRS 449.2487         Notice to be provided by certain facilities which offer independent living.

NRS 449.2488         Department to develop brochure and website to assist persons who are 55 years of age or older in determining appropriate level of care and type of housing; information to be included in brochure and website.

FACILITIES FOR REFRACTIVE SURGERY

NRS 449.2489         Definitions.

NRS 449.24891       “Ophthalmologist” defined.

NRS 449.24892       “Postoperative care” defined.

NRS 449.24893       “Preoperative care” defined.

NRS 449.24894       “Surgical treatment for a refractive error of the eye” defined.

NRS 449.24895       Certain persons not required to obtain license to operate and maintain facility; filing of affidavit with Division required.

NRS 449.24896       Surgical treatments at facility must be performed by licensed ophthalmologist; availability of ophthalmologist.

NRS 449.24897       Order to cease and desist operation for failure to obtain license; injunction; penalties.

NRS 449.24898       Collaboration between ophthalmologist and optometrist authorized pursuant to NRS 636.374.

NEVADA HEALTH FACILITIES ASSISTANCE ACT

NRS 449.250           Short title.

NRS 449.260           Definitions.

NRS 449.270           State Department to constitute sole agency of State for certain purposes.

NRS 449.280           Duties of State Department.

NRS 449.300           Inventory of existing health facilities; development of program for construction of facilities.

NRS 449.310           Requirements of program for construction of health facilities.

NRS 449.320           Application for federal money; deposit of money.

NRS 449.340           State Department to prescribe minimum standards; standards to supersede local ordinances and regulations; penalty.

NRS 449.345           Restriction on adoption of regulations concerning construction, maintenance, operation or safety of building, structure or other property.

NRS 449.360           Application for construction of health facility: Filing; compliance with federal and state requirements.

NRS 449.370           Application for construction of health facility: Notice and hearing; approval and forwarding.

NRS 449.380           Inspection of construction of health facility; certification by State Department.

NRS 449.390           Authority to receive and distribute federal money; Health Facilities Assistance Fund; deposits, use and controls.

NRS 449.400           State Public Health Facilities Construction Assistance Fund: Creation; administration.

NRS 449.410           State assistance for construction of certain projects; eligibility of project for assistance.

NRS 449.420           Amount of state assistance: Allocations; payments.

NRS 449.430           Money from State Public Health Facilities Construction Assistance Fund to be paid in installments.

INTERMEDIARY SERVICE ORGANIZATIONS

General Provisions

NRS 449.4304         “Intermediary service organization” defined.

NRS 449.4308         Authority to provide services.

 

Certification

NRS 449.431           Certificate required; exception; penalty.

NRS 449.4311         Application for certificate: Contents.

NRS 449.4312         Application for certificate: Social security number required. [Effective until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 449.4313         Application for certificate: Statement regarding obligation of child support; grounds for denial; duty of Division. [Effective until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 449.4314         Application for certificate: Fee.

NRS 449.4317         Issuance of certificate; nontransferability.

NRS 449.4318         Form and contents of certificate.

NRS 449.4319         Expiration and renewal of certificate.

NRS 449.432           Application for renewal of certificate: Information concerning business license required; conditions which require denial. [Effective January 1, 2014.]

NRS 449.4321         Grounds for denial, suspension or revocation of certificate.

NRS 449.4322         Suspension of certificate for failure to pay child support or comply with certain subpoenas or warrants; reinstatement of certificate. [Effective until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

NRS 449.4324         Provisional certificate.

NRS 449.4325         Deposit of money received; expenses of Division to enforce provisions.

NRS 449.4327         Regulations; powers of Division.

 

Background Investigations

NRS 449.4329         Initial and periodic investigations of employee, employee of temporary employment service or independent contractor; penalty.

NRS 449.43295       Temporary employment service prohibited from sending ineligible employee to organization; temporary employment service to provide certain information regarding its employees.

NRS 449.433           Maintenance and availability of certain records regarding employee, employee of temporary employment service or independent contractor of organization.

NRS 449.4331         Termination of employment or contract of employee, employee of temporary employment service or independent contractor who has been convicted of certain crime; period in which to correct information regarding conviction; liability of organization.

NRS 449.4332         Additional grounds for denial, suspension or revocation of certificate.

 

Disciplinary Action; Enforcement

NRS 449.4335         Administrative sanctions: Imposition by Division; consequences of failure to pay; use of money collected.

NRS 449.4336         Administrative sanctions: Regulations.

NRS 449.4337         Notice by Division of disciplinary action; exception; appeal.

NRS 449.4338         Action to enjoin violations.

NRS 449.4339         Prosecution by district attorney.

PERMIT FOR SERVICES OF GENERAL ANESTHESIA, CONSCIOUS SEDATION AND DEEP SEDATION; NATIONAL ACCREDITATION; INSPECTIONS OF SURGICAL CENTERS FOR AMBULATORY PATIENTS AND CERTAIN PHYSICIANS’ OFFICES AND FACILITIES

NRS 449.435           Definitions.

NRS 449.436           “Conscious sedation” defined.

NRS 449.437           “Deep sedation” defined.

NRS 449.438           “General anesthesia” defined.

NRS 449.439           “Physician” defined.

NRS 449.441           Exemption from provisions if physician’s office or facility only administers certain type of pain medication.

NRS 449.442           Permit required for certain physicians’ offices and facilities to offer services; national accreditation required; cessation of services for failure to maintain accreditation.

NRS 449.443           Application for permit; fee; inspection by Division; term of permit.

NRS 449.444           Application for renewal of permit; fee.

NRS 449.445           National accreditation required of surgical center for ambulatory patients; inspection by Division; cessation of operation for failure to maintain accreditation.

NRS 449.446           Annual inspections of holders of permits and surgical centers for ambulatory patients; correction of deficiencies identified in inspections; reporting of inspections to Legislature.

NRS 449.447           Disciplinary action for certain violations or failure to correct deficiency; notification to professional licensing board of violations; administrative sanctions.

NRS 449.448           Regulations.

ACCOUNTING; FINANCIAL REPORTS; FEES; ENSURING QUALITY OF CARE

NRS 449.450           Definitions.

NRS 449.460           Powers of Director.

NRS 449.465           Authority of Director to impose fees; maximum amount of fees collected; fee for support of Legislative Committee on Health Care.

NRS 449.470           Director may use staff or contract for services.

NRS 449.476           Committee to ensure quality of care: Formation by hospital; general requirements.

NRS 449.485           Hospital required to use discharge form prescribed by Director; electronic monthly reporting; exception to electronic reporting; use of information by Department.

NRS 449.490           Financial statements and reports required to be filed with Department; additional reporting requirements for hospitals with 100 or more beds; availability of complete current charge master.

NRS 449.500           Director to carry out analyses and studies concerning cost of health care.

NRS 449.510           Director to prepare and file summaries, compilations or other reports; public inspection; collection, maintenance, disclosure or publication of contracts or identification of party to contract prohibited.

NRS 449.520           Reports to Governor and legislative committees; development of comprehensive plan by Legislative Committee on Health Care.

NRS 449.530           Administrative fine for violation.

WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT

NRS 449.535           Short title; uniformity of application and construction.

NRS 449.540           Definitions.

NRS 449.550           “Attending physician” defined.

NRS 449.560           “Declaration” defined.

NRS 449.570           “Life-sustaining treatment” defined.

NRS 449.575           “Person” defined.

NRS 449.581           “Provider of health care” defined.

NRS 449.585           “Qualified patient” defined.

NRS 449.590           “Terminal condition” defined.

NRS 449.600           Declaration relating to use of life-sustaining treatment.

NRS 449.610           Form of declaration directing physician to withhold or withdraw life-sustaining treatment.

NRS 449.613           Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment.

NRS 449.617           Time declaration becomes operative; duty of providers of health care.

NRS 449.620           Revocation of declaration; entry of revocation in medical records of declarant.

NRS 449.622           Recording determination of terminal condition and declaration.

NRS 449.624           Treatment of qualified patients; withholding or withdrawal of artificial nutrition and hydration; treatment of pregnant patient.

NRS 449.626           Written consent to withhold or withdraw life-sustaining treatment.

NRS 449.628           Transfer of care of declarant.

NRS 449.630           Immunity from civil and criminal liability and discipline for unprofessional conduct.

NRS 449.640           Consideration of declaration and other factors; failure to follow directions of patient.

NRS 449.645           Assumption of validity of declaration; presumption of intent to use, withhold or withdraw life-sustaining treatment not created.

NRS 449.650           Death does not constitute suicide or homicide; effect of declaration on policy of insurance; prohibiting or requiring execution of declaration prohibited as condition for insurance or receipt of health care.

NRS 449.660           Penalties.

NRS 449.670           Actions contrary to reasonable medical standards not required; mercy-killing, assisted suicide or euthanasia not authorized.

NRS 449.680           Other right or responsibility regarding use of life-sustaining treatment or withholding or withdrawal of medical care not limited.

NRS 449.690           Validity of declaration executed in another state; effect of previously executed instrument.

PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT

NRS 449.691           Definitions.

NRS 449.6912         “Attending physician” defined.

NRS 449.6915         “Do-not-resuscitate identification” defined.

NRS 449.6916         “Do-not-resuscitate order” defined.

NRS 449.6918         “Emergency care” defined.

NRS 449.692           “Health care facility” defined.

NRS 449.6922         “Incompetent” defined.

NRS 449.6924         “Life-resuscitating treatment” defined.

NRS 449.6925         “Life-sustaining treatment” defined.

NRS 449.6928         “Other types of advance directives” defined.

NRS 449.693           “Physician Order for Life-Sustaining Treatment form” or “POLST form” defined.

NRS 449.6932         “Provider of health care” defined.

NRS 449.6934         “Representative of the patient” defined.

NRS 449.694           Board required to prescribe standardized POLST form; requirements.

NRS 449.6942         Physician required to explain POLST form under certain circumstances and to complete POLST form upon request of patient; validity.

NRS 449.6944         Revocation of POLST form; entry of revocation in medical records of patient.

NRS 449.6946         Conflict with other advance directive or do-not-resuscitate identification.

NRS 449.6948         Immunity from civil and criminal liability and discipline for unprofessional conduct.

NRS 449.695           Provider of health care required to comply with valid POLST form; modification by physician; transfer of care of patient; exceptions.

NRS 449.6952         Assumption of validity of POLST form; presumption of intent of patient not created if patient has revoked or not executed POLST form.

NRS 449.6954         Death does not constitute suicide or homicide; effect of POLST form on policy of insurance; prohibiting or requiring execution of POLST form prohibited as condition for insurance or receipt of health care.

NRS 449.6956         Unlawful acts; penalty.

NRS 449.6958         Actions contrary to reasonable medical standards not required; mercy-killing, euthanasia or assisted suicide not authorized; rights associated with other advance directives not impaired; right to make decisions concerning emergency care or life-sustaining treatment not affected.

NRS 449.696           Validity of POLST form executed in another state.

NRS 449.697           Regulations.

PATIENT’S RIGHTS

NRS 449.700           Facility to provide necessary services or arrange for transfer of patient; explanation of need for transfer and alternatives available.

NRS 449.705           Facility to forward medical records upon certain transfers of patient.

NRS 449.710           Specific rights: Information concerning facility; treatment; billing; visitation.

NRS 449.715           Specific rights: Designation of persons authorized to visit patient in facility.

NRS 449.720           Specific rights: Care; refusal of treatment and experimentation; privacy; notice of appointments and need for care; confidentiality of information concerning patient.

NRS 449.725           Owner and administrator of certain facility prohibited from receiving money or property by will of resident or former resident or from life insurance proceeds of resident or former resident; exception.

NRS 449.730           Patient to be informed of rights upon admission to facility; required disclosures and notices.

NRS 449.740           Procedure to insert implant in breast of patient: Informed consent required; withdrawal of consent; penalty.

NRS 449.750           Procedure to insert implant in breast of patient: Contents of explanation form and consent form; fee for forms.

COLLECTION OF AMOUNT OWED TO HOSPITAL FOR HOSPITAL CARE

NRS 449.751           Definitions.

NRS 449.753           “Hospital care” defined.

NRS 449.755           “Responsible party” defined.

NRS 449.757           Limitations on efforts of hospitals to collect; date for accrual of interest; rate of interest; limitations on additional fees.

NRS 449.758           Limitations on efforts of hospital to collect when hospital has contractual agreement with third party that provides health coverage for care provided; exception.

NRS 449.759           Manner of collection.

PREVENTING PERSONS FROM ENTERING OR EXITING HEALTH FACILITY

NRS 449.760           Unlawful acts; exception; penalty.

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON PATIENTS WITH DISABILITIES

NRS 449.765           Definitions.

NRS 449.766           “Aversive intervention” defined.

NRS 449.767           “Chemical restraint” defined.

NRS 449.768           “Corporal punishment” defined.

NRS 449.769           “Electric shock” defined.

NRS 449.770           “Emergency” defined.

NRS 449.771           “Facility” defined.

NRS 449.772           “Mechanical restraint” defined.

NRS 449.773           “Person with a disability” defined.

NRS 449.774           “Physical restraint” defined.

NRS 449.775           “Verbal and mental abuse” defined.

NRS 449.776           Aversive intervention: Prohibition on use.

NRS 449.777           Forms of restraint: Restrictions on use.

NRS 449.778           Physical restraint: Permissible use; report of use in emergency.

NRS 449.779           Mechanical restraint: Permissible use; report of use in emergency.

NRS 449.780           Chemical restraint: Permissible use; report of use.

NRS 449.781           Use of forms of restraint by certain facilities.

NRS 449.782           Education and training of members of staff of facility.

NRS 449.783           Violations: Criminal penalties; ineligibility for employment; disciplinary action.

NRS 449.784           Violations: Report required; development and review of and compliance with corrective plan.

NRS 449.785           Prohibition on retaliation against person for reporting or providing information regarding violation.

NRS 449.786           Entry of denial of rights in patient’s record; notice and report of denial; action by Division.

REGISTRY OF ADVANCE DIRECTIVES FOR HEALTH CARE

NRS 449.900           Definitions.

NRS 449.905           “Advance directive” defined.

NRS 449.910           “Registrant” defined.

NRS 449.915           “Registry” defined.

NRS 449.920           Establishment and maintenance; information to be included in Registry.

NRS 449.925           Registration of advance directive: Requirements; duties of Secretary of State.

NRS 449.930           Access to advance directive.

NRS 449.935           Removal of advance directive of deceased registrant.

NRS 449.940           Secretary of State not required to determine accuracy of contents of advance directive or validity of advance directive; effect of registration, failure to register and failure to notify Secretary of State of revocation of advance directive.

NRS 449.945           Provider of health care not required to inquire whether patient has registered advance directive or access Registry; immunity of provider of health care from criminal and civil liability.

NRS 449.950           Immunity of Secretary of State and deputies, employees and attorneys of Secretary of State.

NRS 449.955           Suspension of components of Registry and duties of Secretary of State if sufficient money not available; fees authorized; acceptance of gifts and grants.

NRS 449.960           Deposit, accounting and use of money received; interest and income earned on money received; payment of claims.

NRS 449.965           Regulations.

_________

_________

 

GENERAL PROVISIONS

      NRS 449.001  Definitions.  As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 449.0015 to 449.0195, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1973, 1278; A 1975, 366, 897; 1977, 641; 1979, 160, 1113; 1983, 1657; 1985, 1736; 1989, 304, 1034, 1037; 1993, 2556; 1995, 1600; 1999, 248, 970; 2001, 1341, 2518; 2005, 485, 532, 1379, 1517, 2165, 2350; 2011, 1337; 2013, 3055)

      NRS 449.0015  “Agency to provide nursing in the home” defined.  “Agency to provide nursing in the home” means any person or governmental organization which provides in the home, through its employees or by contractual arrangement with other persons, skilled nursing and assistance and training in health and housekeeping skills. The term does not include a provider of supported living arrangement services during any period in which the provider of supported living arrangement services is engaged in providing supported living arrangement services.

      (Added to NRS by 1979, 160; A 1985, 1737; 2005, 1379)

      NRS 449.0021  “Agency to provide personal care services in the home” defined.

      1.  “Agency to provide personal care services in the home” means any person, other than a natural person, which provides in the home the services authorized pursuant to NRS 449.1935 to elderly persons or persons with disabilities.

      2.  The term does not include:

      (a) An independent contractor who provides nonmedical services specified in NRS 449.1935 without the assistance of employees;

      (b) An organized group of persons composed of the family or friends of a person needing personal care services that employs or contracts with persons to provide nonmedical services specified in NRS 449.1935 for the person if:

             (1) The organization of the group of persons is set forth in a written document that is made available for review by the Division upon request; and

             (2) The personal care services are provided to only one person or one family who resides in the same residence; or

      (c) An intermediary service organization.

      3.  As used in this section, “intermediary service organization” has the meaning ascribed to it in NRS 449.4304.

      (Added to NRS by 2005, 2164; A 2007, 1225; 2009, 2399; 2013, 134)

      NRS 449.0025  “Board” defined.  “Board” means the State Board of Health.

      (Added to NRS by 1985, 1735)

      NRS 449.0031  “Community triage center” defined.  “Community triage center” means a facility that provides on a 24-hour basis medical assessments of and short-term monitoring services for persons with mental illness and abusers of alcohol or drugs in a manner which does not require that the assessments and services be provided in a licensed hospital.

      (Added to NRS by 2005, 532)

      NRS 449.0032  “Division” defined.  “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

      (Added to NRS by 2013, 3055)

      NRS 449.0033  “Facility for hospice care” defined.  “Facility for hospice care” means a facility which is operated to provide hospice care.

      (Added to NRS by 1999, 248)

      NRS 449.0038  “Facility for intermediate care” defined.  “Facility for intermediate care” means an establishment operated and maintained to provide 24-hour personal and medical supervision, for a person who does not have illness, disease, injury or other condition that would require the degree of care and treatment which a hospital or facility for skilled nursing is designed to provide.

      (Added to NRS by 1973, 1279; A 1985, 1737; 1991, 1974)

      NRS 449.00385  “Facility for modified medical detoxification” defined.  “Facility for modified medical detoxification” means a facility that provides 24-hour medical monitoring of treatment and detoxification in a manner which does not require that the service be provided in a licensed hospital.

      (Added to NRS by 1999, 969)

      NRS 449.00387  “Facility for refractive surgery” defined.

      1.  “Facility for refractive surgery” means a freestanding facility that provides limited medical services relating to surgical treatments for patients with refractive errors of the eye, including the preoperative care and evaluation of those patients, the surgical treatment of those patients and the postoperative care and evaluation of those patients.

      2.  As used in this section:

      (a) “Postoperative care” has the meaning ascribed to it in NRS 449.24892.

      (b) “Preoperative care” has the meaning ascribed to it in NRS 449.24893.

      (Added to NRS by 2001, 1339; A 2005, 2693; 2009, 452)

      NRS 449.0039  “Facility for skilled nursing” defined.

      1.  “Facility for skilled nursing” means an establishment which provides continuous skilled nursing and related care as prescribed by a physician to a patient in the facility who is not in an acute episode of illness and whose primary need is the availability of such care on a continuous basis.

      2.  “Facility for skilled nursing” does not include a facility which meets the requirements of a general or any other special hospital.

      (Added to NRS by 1973, 1279; A 1985, 1738)—(Substituted in revision for NRS 449.018)

      NRS 449.004  “Facility for the care of adults during the day” defined.  “Facility for the care of adults during the day” means an establishment operated and maintained to provide care during the day on a temporary or permanent basis for aged or infirm persons. The term does not include a halfway house for recovering alcohol and drug abusers.

      (Added to NRS by 1983, 1657; A 1985, 1736; 2001, 2518)

      NRS 449.0045  “Facility for the dependent” defined.  “Facility for the dependent” includes:

      1.  A facility for the treatment of abuse of alcohol or drugs;

      2.  A halfway house for recovering alcohol and drug abusers;

      3.  A facility for the care of adults during the day;

      4.  A residential facility for groups;

      5.  An agency to provide personal care services in the home;

      6.  A facility for transitional living for released offenders; and

      7.  A home for individual residential care.

      (Added to NRS by 1985, 1735; A 2001, 2518; 2005, 2165, 2350; 2011, 356)

      NRS 449.00455  “Facility for the treatment of abuse of alcohol or drugs” defined.  “Facility for the treatment of abuse of alcohol or drugs” means any public or private establishment which provides residential treatment, including mental and physical restoration, of abusers of alcohol or drugs and which is certified by the Division pursuant to subsection 4 of NRS 458.025. It does not include a medical facility or services offered by volunteers or voluntary organizations.

      (Added to NRS by 1975, 366; A 1985, 1736; 1993, 1624; 1999, 1871; 2001, 417; 2005, 22nd Special Session, 56; 2013, 3055)

      NRS 449.0046  “Facility for the treatment of irreversible renal disease” defined.  “Facility for the treatment of irreversible renal disease” means a facility that is not part of a hospital and which provides peritoneal dialysis or hemodialysis or trains a person with a permanent irreversible renal impairment to perform dialysis for himself or herself.

      (Added to NRS by 1985, 1735)

      NRS 449.0055  “Facility for transitional living for released offenders” defined.

      1.  “Facility for transitional living for released offenders” means a residence that provides housing and a living environment for persons who have been released from prison and who require assistance with reintegration into the community, other than such a residence that is operated or maintained by a state or local government or an agency thereof. The term does not include a halfway house for recovering alcohol and drug abusers or a facility for the treatment of abuse of alcohol or drugs.

      2.  As used in this section, “person who has been released from prison” means:

      (a) A parolee.

      (b) A person who is participating in:

             (1) A judicial program pursuant to NRS 209.4886 or 213.625; or

             (2) A correctional program pursuant to NRS 209.4888 or 213.632.

      (c) A person who is supervised by the Division of Parole and Probation of the Department of Public Safety through residential confinement pursuant to NRS 213.371 to 213.410, inclusive.

      (d) A person who has been released from prison by expiration of his or her term of sentence.

      (Added to NRS by 2005, 2349)

      NRS 449.008  “Halfway house for recovering alcohol and drug abusers” defined.  “Halfway house for recovering alcohol and drug abusers” means a residence that provides housing and a living environment for recovering alcohol and drug abusers and is operated to facilitate their reintegration into the community, but does not provide any treatment for alcohol or drug abuse. The term does not include a facility for transitional living for released offenders.

      (Added to NRS by 2001, 2518; A 2005, 2350)

      NRS 449.009  “Health Division” defined.  Repealed. (See chapter 489, Statutes of Nevada 2013, at page 3071.)

 

      NRS 449.0105  “Home for individual residential care” defined.  “Home for individual residential care” means a home in which a natural person furnishes food, shelter, assistance and limited supervision, for compensation, to not more than two persons with intellectual disabilities or with physical disabilities or who are aged or infirm, unless the persons receiving those services are related within the third degree of consanguinity or affinity to the person providing those services. The term does not include:

      1.  A halfway house for recovering alcohol and drug abusers; or

      2.  A home in which supported living arrangement services are provided by a provider of supported living arrangement services during any period in which the provider of supported living arrangement services is engaged in providing supported living arrangement services.

      (Added to NRS by 1993, 2556; A 2001, 2518; 2005, 1380; 2013, 696)

      NRS 449.0115  “Hospice care” defined.

      1.  “Hospice care” means a centrally administered program of palliative services and supportive services provided by an interdisciplinary team directed by a physician. The program includes the provision of physical, psychological, custodial and spiritual care for persons who are terminally ill and their families. The care may be provided in the home, at a residential facility or at a medical facility at any time of the day or night. The term includes the supportive care and services provided to the family after the patient dies.

      2.  As used in this section:

      (a) “Family” includes the immediate family, the person who primarily cared for the patient and other persons with significant personal ties to the patient, whether or not related by blood.

      (b) “Interdisciplinary team” means a group of persons who work collectively to meet the special needs of terminally ill patients and their families and includes such persons as a physician, registered nurse, social worker, member of the clergy and trained volunteer.

      (Added to NRS by 1979, 1112; A 1985, 1737; 1989, 1035; 2005, 485)

      NRS 449.012  “Hospital” defined.  “Hospital” means an establishment for the diagnosis, care and treatment of human illness, including care available 24 hours each day from persons licensed to practice professional nursing who are under the direction of a physician, services of a medical laboratory and medical, radiological, dietary and pharmaceutical services.

      (Added to NRS by 1973, 1279; A 1985, 1737)

      NRS 449.013  “Independent center for emergency medical care” defined.  “Independent center for emergency medical care” means a facility, structurally separate and distinct from a hospital, which provides limited services for the treatment of a medical emergency.

      (Added to NRS by 1985, 1735)

      NRS 449.0145  “Licensed practical nurse” defined.  “Licensed practical nurse” has the meaning ascribed to it in NRS 632.016.

      (Added to NRS by 2005, 1517)

      NRS 449.0151  “Medical facility” defined.  “Medical facility” includes:

      1.  A surgical center for ambulatory patients;

      2.  An obstetric center;

      3.  An independent center for emergency medical care;

      4.  An agency to provide nursing in the home;

      5.  A facility for intermediate care;

      6.  A facility for skilled nursing;

      7.  A facility for hospice care;

      8.  A hospital;

      9.  A psychiatric hospital;

      10.  A facility for the treatment of irreversible renal disease;

      11.  A rural clinic;

      12.  A nursing pool;

      13.  A facility for modified medical detoxification;

      14.  A facility for refractive surgery;

      15.  A mobile unit; and

      16.  A community triage center.

      (Added to NRS by 1973, 1279; A 1975, 366; 1979, 161, 887, 1113; 1983, 1657; 1985, 1736; 1989, 304, 1035, 1037; 1999, 248, 970; 2001, 1341; 2005, 532, 2693)

      NRS 449.01513  “Medication aide - certified” defined.  “Medication aide - certified” has the meaning ascribed to it in NRS 632.0165.

      (Added to NRS by 2011, 1337)

      NRS 449.01515  “Mobile unit” defined.

      1.  Except as otherwise provided in subsection 2, “mobile unit” means a motor vehicle that is specially designed, constructed and equipped to provide any of the medical services provided by a medical facility described in subsections 1 to 13, inclusive, of NRS 449.0151.

      2.  “Mobile unit” does not include:

      (a) A motor vehicle that is operated by a medical facility described in subsections 1 to 13, inclusive, of NRS 449.0151 which is accredited by the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association;

      (b) A motor vehicle that is operated by a health center that is funded under section 330 of the Public Health Service Act, 42 U.S.C. § 254b, as amended; or

      (c) A vehicle operated under the authority of a permit issued pursuant to chapter 450B of NRS.

      (Added to NRS by 2001, 1339; A 2003, 421)

      NRS 449.0152  “Nursing assistant” defined.  “Nursing assistant” has the meaning ascribed to it in NRS 632.0166.

      (Added to NRS by 2005, 1517)

      NRS 449.0153  “Nursing pool” defined.  “Nursing pool” means a person or agency which provides for compensation, through its employees or by contractual arrangement with other persons, nursing services to any natural person, medical facility or facility for the dependent. The term does not include:

      1.  An independent contractor who provides such services without the assistance of employees;

      2.  A nursing pool based in a medical facility or facility for the dependent; or

      3.  A provider of supported living arrangement services during any period in which the provider of supported living arrangement services is engaged in providing supported living arrangement services.

      (Added to NRS by 1989, 303; A 2005, 1380)

      NRS 449.0155  “Obstetric center” defined.  “Obstetric center” means a facility that is not part of a hospital and provides services for normal, uncomplicated births.

      (Added to NRS by 1985, 1735)

      NRS 449.0156  “Palliative services” defined.  “Palliative services” means services and treatments directed toward the control of pain and symptoms which provide the greatest degree of relief for the longest period while minimizing any adverse effects of the services and treatments, including, without limitation, any side effects of any medications given or administered.

      (Added to NRS by 2005, 485)

      NRS 449.0157  “Provider of health care” defined.  “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      (Added to NRS by 1995, 1600)

      NRS 449.0159  “Provider of supported living arrangement services” defined.  “Provider of supported living arrangement services” means a natural person who or a partnership, firm, corporation, association, state or local government or agency thereof that has been issued a certificate pursuant to NRS 435.3305 to 435.339, inclusive, and the regulations adopted pursuant to NRS 435.3305 to 435.339, inclusive.

      (Added to NRS by 2005, 1379)

      NRS 449.0165  “Psychiatric hospital” defined.  “Psychiatric hospital” means a hospital for the diagnosis, care and treatment of mental illness which provides 24-hour residential care.

      (Added to NRS by 1985, 1735)

      NRS 449.0167  “Registered nurse” defined.  “Registered nurse” has the meaning ascribed to it in NRS 632.019.

      (Added to NRS by 2005, 1517)

      NRS 449.017  “Residential facility for groups” defined.

      1.  Except as otherwise provided in subsection 2, “residential facility for groups” means an establishment that furnishes food, shelter, assistance and limited supervision to a person with an intellectual disability or with a physical disability or a person who is aged or infirm. The term includes, without limitation, an assisted living facility.

      2.  The term does not include:

      (a) An establishment which provides care only during the day;

      (b) A natural person who provides care for no more than two persons in his or her own home;

      (c) A natural person who provides care for one or more persons related to him or her within the third degree of consanguinity or affinity;

      (d) A halfway house for recovering alcohol and drug abusers; or

      (e) A facility funded by a division or program of the Department of Health and Human Services.

      (Added to NRS by 1973, 1278; A 1979, 212; 1983, 1657; 1985, 930, 1736; 1991, 1974; 1993, 1213; 1999, 114, 125; 2001, 57, 546, 2519, 2522; 2013, 696)

      NRS 449.0175  “Rural clinic” defined.  “Rural clinic” means a facility located in an area that is not designated as an urban area by the Bureau of the Census, where medical services are provided by a physician assistant licensed pursuant to chapter 630 or 633 of NRS or an advanced practice registered nurse licensed pursuant to NRS 632.237 who is under the supervision of a licensed physician.

      (Added to NRS by 1985, 1735; A 2001, 782; 2007, 1862; 2013, 2082)

      NRS 449.0177  “Rural hospital” defined.  “Rural hospital” means a hospital with 85 or fewer beds which is:

      1.  The sole institutional provider of health care located within a county whose population is less than 100,000;

      2.  The sole institutional provider of health care located within a city whose population is less than 25,000; or

      3.  Maintained and governed pursuant to NRS 450.550 to 450.750, inclusive.

      (Added to NRS by 1995, 1600; A 2001, 1992)

      NRS 449.0185  “Supported living arrangement services” defined.  “Supported living arrangement services” has the meaning ascribed to it in NRS 435.3315.

      (Added to NRS by 2005, 1379)

      NRS 449.019  “Surgical center for ambulatory patients” defined.  “Surgical center for ambulatory patients” means a facility with limited medical services available for diagnosis or treatment of patients by surgery where the patients’ recovery, in the opinion of the surgeon, will not require care as a patient in the facility for more than 24 hours.

      (Added to NRS by 1975, 366; A 1985, 1736; 1993, 207)

      NRS 449.0195  “Terminally ill” defined.  “Terminally ill” means a medical diagnosis made by a physician that a person has an anticipated life expectancy of not more than 12 months.

      (Added to NRS by 2005, 485)

LICENSING AND REGULATION

General Provisions

      NRS 449.030  License required to operate or maintain medical facility or facility for the dependent and to operate program of hospice care.

      1.  No person, state or local government or agency thereof may operate or maintain in this State any medical facility or facility for the dependent without first obtaining a license therefor as provided in NRS 449.030 to 449.2428, inclusive.

      2.  Unless licensed as a facility for hospice care, a person, state or local government or agency thereof shall not operate a program of hospice care without first obtaining a license for the program from the Board.

      [Part 1:336:1951]—(NRS A 1971, 934; 1973, 1281; 1985, 1738; 1989, 1035; 1997, 444, 1484; 1999, 249, 3608; 2011, 704)

      NRS 449.0301  Exemptions.  The provisions of NRS 449.030 to 449.2428, inclusive, do not apply to:

      1.  Any facility conducted by and for the adherents of any church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend solely upon spiritual means through prayer for healing in the practice of the religion of the church or denomination, except that such a facility shall comply with all regulations relative to sanitation and safety applicable to other facilities of a similar category.

      2.  Foster homes as defined in NRS 424.014.

      3.  Any medical facility or facility for the dependent operated and maintained by the United States Government or an agency thereof.

      [Part 3:336:1951] + [7:336:1951]—(NRS A 1971, 935; 1973, 1282; 1979, 887; 1985, 1740; 1993, 2724; 2003, 857; 2005, 2169; 2011, 356, 1064, 1358, 2253, 2396; 2013, 2145)—(Substituted in revision for NRS 449.070)

      NRS 449.0302  Board to adopt standards, qualifications and other regulations.

      1.  The Board shall adopt:

      (a) Licensing standards for each class of medical facility or facility for the dependent covered by NRS 449.030 to 449.2428, inclusive, and for programs of hospice care.

      (b) Regulations governing the licensing of such facilities and programs.

      (c) Regulations governing the procedure and standards for granting an extension of the time for which a natural person may provide certain care in his or her home without being considered a residential facility for groups pursuant to NRS 449.017. The regulations must require that such grants are effective only if made in writing.

      (d) Regulations establishing a procedure for the indemnification by the Division, from the amount of any surety bond or other obligation filed or deposited by a facility for refractive surgery pursuant to NRS 449.068 or 449.069, of a patient of the facility who has sustained any damages as a result of the bankruptcy of or any breach of contract by the facility.

      (e) Any other regulations as it deems necessary or convenient to carry out the provisions of NRS 449.030 to 449.2428, inclusive.

      2.  The Board shall adopt separate regulations governing the licensing and operation of:

      (a) Facilities for the care of adults during the day; and

      (b) Residential facilities for groups,

Ê which provide care to persons with Alzheimer’s disease.

      3.  The Board shall adopt separate regulations for:

      (a) The licensure of rural hospitals which take into consideration the unique problems of operating such a facility in a rural area.

      (b) The licensure of facilities for refractive surgery which take into consideration the unique factors of operating such a facility.

      (c) The licensure of mobile units which take into consideration the unique factors of operating a facility that is not in a fixed location.

      4.  The Board shall require that the practices and policies of each medical facility or facility for the dependent provide adequately for the protection of the health, safety and physical, moral and mental well-being of each person accommodated in the facility.

      5.  In addition to the training requirements prescribed pursuant to NRS 449.093, the Board shall establish minimum qualifications for administrators and employees of residential facilities for groups. In establishing the qualifications, the Board shall consider the related standards set by nationally recognized organizations which accredit such facilities.

      6.  The Board shall adopt separate regulations regarding the assistance which may be given pursuant to NRS 453.375 and 454.213 to an ultimate user of controlled substances or dangerous drugs by employees of residential facilities for groups. The regulations must require at least the following conditions before such assistance may be given:

      (a) The ultimate user’s physical and mental condition is stable and is following a predictable course.

      (b) The amount of the medication prescribed is at a maintenance level and does not require a daily assessment.

      (c) A written plan of care by a physician or registered nurse has been established that:

             (1) Addresses possession and assistance in the administration of the medication; and

             (2) Includes a plan, which has been prepared under the supervision of a registered nurse or licensed pharmacist, for emergency intervention if an adverse condition results.

      (d) The prescribed medication is not administered by injection or intravenously.

      (e) The employee has successfully completed training and examination approved by the Division regarding the authorized manner of assistance.

      7.  The Board shall adopt separate regulations governing the licensing and operation of residential facilities for groups which provide assisted living services. The Board shall not allow the licensing of a facility as a residential facility for groups which provides assisted living services and a residential facility for groups shall not claim that it provides “assisted living services” unless:

      (a) Before authorizing a person to move into the facility, the facility makes a full written disclosure to the person regarding what services of personalized care will be available to the person and the amount that will be charged for those services throughout the resident’s stay at the facility.

      (b) The residents of the facility reside in their own living units which:

             (1) Except as otherwise provided in subsection 8, contain toilet facilities;

             (2) Contain a sleeping area or bedroom; and

             (3) Are shared with another occupant only upon consent of both occupants.

      (c) The facility provides personalized care to the residents of the facility and the general approach to operating the facility incorporates these core principles:

             (1) The facility is designed to create a residential environment that actively supports and promotes each resident’s quality of life and right to privacy;

             (2) The facility is committed to offering high-quality supportive services that are developed by the facility in collaboration with the resident to meet the resident’s individual needs;

             (3) The facility provides a variety of creative and innovative services that emphasize the particular needs of each individual resident and the resident’s personal choice of lifestyle;

             (4) The operation of the facility and its interaction with its residents supports, to the maximum extent possible, each resident’s need for autonomy and the right to make decisions regarding his or her own life;

             (5) The operation of the facility is designed to foster a social climate that allows the resident to develop and maintain personal relationships with fellow residents and with persons in the general community;

             (6) The facility is designed to minimize and is operated in a manner which minimizes the need for its residents to move out of the facility as their respective physical and mental conditions change over time; and

             (7) The facility is operated in such a manner as to foster a culture that provides a high-quality environment for the residents, their families, the staff, any volunteers and the community at large.

      8.  The Division may grant an exception from the requirement of subparagraph (1) of paragraph (b) of subsection 7 to a facility which is licensed as a residential facility for groups on or before July 1, 2005, and which is authorized to have 10 or fewer beds and was originally constructed as a single-family dwelling if the Division finds that:

      (a) Strict application of that requirement would result in economic hardship to the facility requesting the exception; and

      (b) The exception, if granted, would not:

             (1) Cause substantial detriment to the health or welfare of any resident of the facility;

             (2) Result in more than two residents sharing a toilet facility; or

             (3) Otherwise impair substantially the purpose of that requirement.

      9.  The Board shall, if it determines necessary, adopt regulations and requirements to ensure that each residential facility for groups and its staff are prepared to respond to an emergency, including, without limitation:

      (a) The adoption of plans to respond to a natural disaster and other types of emergency situations, including, without limitation, an emergency involving fire;

      (b) The adoption of plans to provide for the evacuation of a residential facility for groups in an emergency, including, without limitation, plans to ensure that nonambulatory patients may be evacuated;

      (c) Educating the residents of residential facilities for groups concerning the plans adopted pursuant to paragraphs (a) and (b); and

      (d) Posting the plans or a summary of the plans adopted pursuant to paragraphs (a) and (b) in a conspicuous place in each residential facility for groups.

      10.  The regulations governing the licensing and operation of facilities for transitional living for released offenders must provide for the licensure of at least three different types of facilities, including, without limitation:

      (a) Facilities that only provide a housing and living environment;

      (b) Facilities that provide or arrange for the provision of supportive services for residents of the facility to assist the residents with reintegration into the community, in addition to providing a housing and living environment; and

      (c) Facilities that provide or arrange for the provision of alcohol and drug abuse programs, in addition to providing a housing and living environment and providing or arranging for the provision of other supportive services.

Ê The regulations must provide that if a facility was originally constructed as a single-family dwelling, the facility must not be authorized for more than eight beds.

      11.  As used in this section, “living unit” means an individual private accommodation designated for a resident within the facility.

      (Added to NRS by 1969, 946; A 1971, 934; 1973, 1281; 1985, 1738; 1987, 990; 1989, 1036, 2155, 2156; 1991, 1975; 1993, 1214; 1995, 1600; 1999, 3608; 2001, 1341; 2003, 1921; 2005, 2165, 2350, 2693; 2007, 1921; 2009, 1441; 2011, 2250)—(Substituted in revision for NRS 449.037)

      NRS 449.0303  Authority of Board to require licensing of other facilities.  The Board may adopt regulations requiring the licensing of a facility other than those required to be licensed pursuant to NRS 449.030 to 449.2428, inclusive, if the:

      1.  Facility provides any type of medical care or treatment; and

      2.  Regulation is necessary to protect the health of the general public.

      (Added to NRS by 1985, 1735)—(Substituted in revision for NRS 449.038)

      NRS 449.0305  Businesses that provide referrals to residential facilities for groups: License required; standards and regulations; provision of referrals; prohibited acts; civil penalties.

      1.  Except as otherwise provided in subsection 5, a person must obtain a license from the Board to operate a business that provides referrals to residential facilities for groups.

      2.  The Board shall adopt:

      (a) Standards for the licensing of businesses that provide referrals to residential facilities for groups;

      (b) Standards relating to the fees charged by such businesses;

      (c) Regulations governing the licensing of such businesses; and

      (d) Regulations establishing requirements for training the employees of such businesses.

      3.  A licensed nurse, social worker, physician or hospital, or a provider of geriatric care who is licensed as a nurse or social worker, may provide referrals to residential facilities for groups through a business that is licensed pursuant to this section. The Board may, by regulation, authorize a public guardian or any other person it determines appropriate to provide referrals to residential facilities for groups through a business that is licensed pursuant to this section.

      4.  A business that is licensed pursuant to this section or an employee of such a business shall not:

      (a) Refer a person to a residential facility for groups that is not licensed.

      (b) Refer a person to a residential facility for groups if the business or its employee knows or reasonably should know that the facility, or the services provided by the facility, are not appropriate for the condition of the person being referred.

      (c) Refer a person to a residential facility for groups that is owned by the same person who owns the business.

Ê A person who violates the provisions of this subsection is liable for a civil penalty to be recovered by the Attorney General in the name of the Board for the first offense of not more than $10,000 and for a second or subsequent offense of not less than $10,000 nor more than $20,000. Unless otherwise required by federal law, the Board shall deposit all civil penalties collected pursuant to this section into a separate account in the State General Fund to be used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and 449.435 to 449.965, inclusive, and to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards.

      5.  This section does not apply to a medical facility that is licensed pursuant to NRS 449.030 to 449.2428, inclusive, on October 1, 1999.

      (Added to NRS by 1999, 3606; A 2011, 705, 1805; 2013,135)

      NRS 449.0306  Money received from licensing of facilities to be deposited in State General Fund; expenditure of state or federal money.

      1.  Money received from licensing medical facilities and facilities for the dependent must be forwarded to the State Treasurer for deposit in the State General Fund.

      2.  The Division shall enforce the provisions of NRS 449.030 to 449.245, inclusive, and may incur any necessary expenses not in excess of money appropriated for that purpose by the State or received from the Federal Government.

      [11:336:1951] + [13:336:1951]—(NRS A 1963, 960; 1971, 936; 1973, 1283; 1975, 898; 1979, 209; 1985, 1741; 2009, 1444; 2011, 2253, 2396; 2013, 3055)—(Substituted in revision for NRS 449.140)

      NRS 449.0307  Powers of Division.  The Division may:

      1.  Upon receipt of an application for a license, conduct an investigation into the premises, facilities, qualifications of personnel, methods of operation, policies and purposes of any person proposing to engage in the operation of a medical facility or a facility for the dependent. The facility is subject to inspection and approval as to standards for safety from fire, on behalf of the Division, by the State Fire Marshal.

      2.  Upon receipt of a complaint against a medical facility or facility for the dependent, except for a complaint concerning the cost of services, conduct an investigation into the premises, facilities, qualifications of personnel, methods of operation, policies, procedures and records of that facility or any other medical facility or facility for the dependent which may have information pertinent to the complaint.

      3.  Employ such professional, technical and clerical assistance as it deems necessary to carry out the provisions of NRS 449.030 to 449.245, inclusive.

      [Part 6:336:1951]—(NRS A 1963, 960; 1969, 945; 1971, 936; 1973, 1284; 1975, 898; 1977, 642; 1985, 1220; 2013, 3055)—(Substituted in revision for NRS 449.150)

      NRS 449.0308  Authority of Division to collect actual cost of enforcing provisions from unlicensed medical facility or facility for the dependent; exception.

      1.  Except as otherwise provided in this section, the Division may charge and collect from a medical facility or facility for the dependent or a person who operates such a facility without a license issued by the Division the actual costs incurred by the Division for the enforcement of the provisions of NRS 449.030 to 449.2428, inclusive, including, without limitation, the actual cost of conducting an inspection or investigation of the facility.

      2.  The Division shall not charge and collect the actual cost for enforcement pursuant to subsection 1 if the enforcement activity is:

      (a) Related to the issuance or renewal of a license for which the Board charges a fee pursuant to NRS 449.050 or 449.089; or

      (b) Conducted pursuant to an agreement with the Federal Government which has appropriated money for that purpose.

      3.  Any money collected pursuant to subsection 1 may be used by the Division to administer and carry out the provisions of NRS 449.030 to 449.2428, inclusive, and the regulations adopted pursuant thereto.

      (Added to NRS by 2011, 355; A 2013, 3055)

Licensing

      NRS 449.040  Application for license: Filing; contents.  Any person, state or local government or agency thereof desiring a license under the provisions of NRS 449.030 to 449.2428, inclusive, must file with the Division an application on a form prescribed, prepared and furnished by the Division, containing:

      1.  The name of the applicant and, if a natural person, whether the applicant has attained the age of 21 years.

      2.  The type of facility to be operated.

      3.  The location of the facility.

      4.  In specific terms, the nature of services and type of care to be offered, as defined in the regulations.

      5.  The number of beds authorized by the Director of the Department of Health and Human Services or, if such authorization is not required, the number of beds the facility will contain.

      6.  The name of the person in charge of the facility.

      7.  Such other information as may be required by the Division for the proper administration and enforcement of NRS 449.030 to 449.2428, inclusive.

      8.  Evidence satisfactory to the Division that the applicant is of reputable and responsible character. If the applicant is a firm, association, organization, partnership, business trust, corporation or company, similar evidence must be submitted as to the members thereof and the person in charge of the facility for which application is made. If the applicant is a political subdivision of the State or other governmental agency, similar evidence must be submitted as to the person in charge of the institution for which application is made.

      9.  Evidence satisfactory to the Division of the ability of the applicant to comply with the provisions of NRS 449.030 to 449.2428, inclusive, and the standards and regulations adopted by the Board.

      10.  Evidence satisfactory to the Division that the facility conforms to the zoning regulations of the local government within which the facility will be operated or that the applicant has applied for an appropriate reclassification, variance, permit for special use or other exception for the facility.

      [2:336:1951]—(NRS A 1963, 959; 1971, 934; 1973, 1281; 1975, 367; 1985, 1739; 1987, 776; 1991, 1078; 2007, 1133; 2009, 2025; 2013, 515, 2145, 3056)

      NRS 449.050  Fees.

      1.  Each application for a license must be accompanied by such fee as may be determined by regulation of the Board. The Board may, by regulation, allow or require payment of a fee for a license in installments and may fix the amount of each payment and the date that the payment is due.

      2.  The fee imposed by the Board for a facility for transitional living for released offenders must be based on the type of facility that is being licensed and must be calculated to produce the revenue estimated to cover the costs related to the license, but in no case may a fee for a license exceed the actual cost to the Division of issuing or renewing the license.

      3.  If an application for a license for a facility for transitional living for released offenders is denied, any amount of the fee paid pursuant to this section that exceeds the expenses and costs incurred by the Division must be refunded to the applicant.

      [Part 3:336:1951]—(NRS A 1971, 935; 1973, 1282; 1985, 1739; 1995, 501; 2003, 580; 2005, 2352; 2011, 356; 2013, 3056)

      NRS 449.065  Surety bond for initial license and renewal of license to operate facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in home and agency to provide nursing in home; exemption; exception.

      1.  Except as otherwise provided in subsections 6 and 7 and NRS 449.067, each facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in the home and agency to provide nursing in the home shall, when applying for a license or renewing a license, file with the Administrator of the Division of Public and Behavioral Health a surety bond:

      (a) If the facility, agency or home employs less than 7 employees, in the amount of $5,000;

      (b) If the facility, agency or home employs at least 7 but not more than 25 employees, in the amount of $25,000; or

      (c) If the facility, agency or home employs more than 25 employees, in the amount of $50,000.

      2.  A bond filed pursuant to this section must be executed by the facility, agency or home as principal and by a surety company as surety. The bond must be payable to the Aging and Disability Services Division of the Department of Health and Human Services and must be conditioned to provide indemnification to an older patient who the Specialist for the Rights of Elderly Persons determines has suffered property damage as a result of any act or failure to act by the facility, agency or home to protect the property of the older patient.

      3.  Except when a surety is released, the surety bond must cover the period of the initial license to operate or the period of the renewal, as appropriate.

      4.  A surety on any bond filed pursuant to this section may be released after the surety gives 30 days’ written notice to the Administrator of the Division of Public and Behavioral Health, but the release does not discharge or otherwise affect any claim filed by an older patient for property damaged as a result of any act or failure to act by the facility, agency or home to protect the property of the older patient alleged to have occurred while the bond was in effect.

      5.  A license is suspended by operation of law when the facility, agency or home is no longer covered by a surety bond as required by this section or by a substitute for the surety bond pursuant to NRS 449.067. The Administrator of the Division of Public and Behavioral Health shall give the facility, agency or home at least 20 days’ written notice before the release of the surety or the substitute for the surety, to the effect that the license will be suspended by operation of law until another surety bond or substitute for the surety bond is filed in the same manner and amount as the bond or substitute being terminated.

      6.  The Administrator of the Division of Public and Behavioral Health may exempt a residential facility for groups or a home for individual residential care from the requirement of filing a surety bond pursuant to this section if the Administrator determines that the requirement would result in undue hardship to the residential facility for groups or home for individual residential care.

      7.  The requirement of filing a surety bond set forth in this section does not apply to a facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in the home or agency to provide nursing in the home that is operated and maintained by the State of Nevada or an agency thereof.

      8.  As used in this section, “older patient” means a patient who is 60 years of age or older.

      (Added to NRS by 1997, 1482; A 2003, 524; 2005, 2168; 2009, 502; 2013, 3057)

      NRS 449.067  Substitute for surety required for facility for intermediate care, facility for skilled nursing, residential facility for groups, home for individual residential care, agency to provide personal care services in home and agency to provide nursing in home.

      1.  As a substitute for the surety bond required pursuant to NRS 449.065, a facility for intermediate care, a facility for skilled nursing, a residential facility for groups, a home for individual residential care, an agency to provide personal care services in the home and an agency to provide nursing in the home may deposit with any bank or trust company authorized to do business in this State, upon approval from the Administrator of the Division of Public and Behavioral Health:

      (a) An obligation of a bank, savings and loan association, thrift company or credit union licensed to do business in this State;

      (b) Bills, bonds, notes, debentures or other obligations of the United States or any agency or instrumentality thereof, or guaranteed by the United States; or

      (c) Any obligation of this State or any city, county, town, township, school district or other instrumentality of this State, or guaranteed by this State, in an aggregate amount, based upon principal amount or market value, whichever is lower.

      2.  The obligations of a bank, savings and loan association, thrift company or credit union must be held to secure the same obligation as would the surety bond required by NRS 449.065. With the approval of the Administrator of the Division of Public and Behavioral Health, the depositor may substitute other suitable obligations for those deposited, which must be assigned to the Aging and Disability Services Division of the Department of Health and Human Services and are negotiable only upon approval by the Administrator of the Aging and Disability Services Division.

      3.  Any interest or dividends earned on the deposit accrue to the account of the depositor.

      4.  The deposit must be an amount at least equal to the surety bond required by NRS 449.065 and must state that the amount may not be withdrawn except by direct and sole order of the Administrator of the Aging and Disability Services Division.

      (Added to NRS by 1997, 1483; A 2003, 525; 2005, 2169; 2009, 503)

      NRS 449.068  Surety bond required for initial license and renewal of license to operate facility for refractive surgery.

      1.  Except as otherwise provided in NRS 449.069, each facility for refractive surgery shall, when applying for a license or renewing a license, file with the Administrator of the Division a surety bond:

      (a) If the facility employs less than 7 employees, in the amount of $10,000;

      (b) If the facility employs at least 7 but not more than 25 employees, in the amount of $50,000; or

      (c) If the facility employs more than 25 employees, in the amount of $100,000.

      2.  A bond filed pursuant to this section must be executed by the facility as principal and by a surety company as surety. The bond must be payable to the Division and must be conditioned to provide indemnification to a patient of the facility who the Administrator of the Division or the Administrator’s designee determines has sustained any damages as a result of the bankruptcy of or any breach of contract by the facility.

      3.  Except when a surety is released, the surety bond must cover the period of the initial license to operate or the period of the renewal, as appropriate.

      4.  A surety on any bond filed pursuant to this section may be released after the surety gives 30 days’ written notice to the Administrator of the Division, but the release does not discharge or otherwise affect any claim filed by a patient for any damages sustained as a result of the bankruptcy of or any breach of contract by the facility while the bond was in effect.

      5.  The license of a facility for refractive surgery is suspended by operation of law when the facility is no longer covered by a surety bond as required by this section or by a substitute for the surety bond pursuant to NRS 449.069. The Administrator of the Division shall give the facility at least 20 days’ written notice before the release of the surety or the substitute for the surety, to the effect that the license will be suspended by operation of law until another surety bond is filed or substitute for the surety bond is deposited in the same manner and amount as the bond or substitute being terminated.

      (Added to NRS by 2001, 1340; A 2005, 2696)

      NRS 449.069  Substitute for surety bond required for facility for refractive surgery.

      1.  As a substitute for the surety bond required pursuant to NRS 449.068, a facility for refractive surgery may deposit with any bank or trust company authorized to do business in this State, upon approval of the Administrator of the Division:

      (a) An obligation of a bank, savings and loan association, thrift company or credit union licensed to do business in this State;

      (b) Bills, bonds, notes, debentures or other obligations of the United States or any agency or instrumentality thereof, or guaranteed by the United States; or

      (c) Any obligation of this State or any city, county, town, township, school district or other instrumentality of this State, or guaranteed by this State, in an aggregate amount, based upon principal amount or market value, whichever is lower.

      2.  The obligations of a bank, savings and loan association, thrift company or credit union must be held to secure the same obligation as would the surety bond required by NRS 449.068. With the approval of the Administrator of the Division, the facility may substitute other suitable obligations for those deposited, which must be assigned to the Division and are negotiable only upon approval of the Administrator of the Division.

      3.  Any interest or dividends earned on the deposit accrue to the account of the facility.

      4.  The deposit must be an amount at least equal to the surety bond required by NRS 449.068 and must state that the amount may not be withdrawn except by the direct and sole order of the Administrator of the Division.

      (Added to NRS by 2001, 1340; A 2005, 2696)

      NRS 449.080  Issuance, validity and transferability of license.

      1.  If, after investigation, the Division finds that the:

      (a) Applicant is in full compliance with the provisions of NRS 449.030 to 449.2428, inclusive;

      (b) Applicant is in substantial compliance with the standards and regulations adopted by the Board;

      (c) Applicant, if he or she has undertaken a project for which approval is required pursuant to NRS 439A.100, has obtained the approval of the Director of the Department of Health and Human Services; and

      (d) Facility conforms to the applicable zoning regulations,

Ê the Division shall issue the license to the applicant.

      2.  A license applies only to the person to whom it is issued, is valid only for the premises described in the license and is not transferable.

      [Part 3:336:1951]—(NRS A 1963, 959; 1971, 935; 1973, 1283; 1985, 1740; 1987, 777; 1991, 1078; 2011, 1064)

      NRS 449.085  Form and contents of license.  Each license issued by the Division shall be in the form prescribed by the Division and shall contain:

      1.  The name of the person or persons authorized to operate such licensed facility;

      2.  The location of such licensed facility; and

      3.  The number of beds authorized in such licensed facility, the nature of services offered and the service delivery capacity.

      (Added to NRS by 1973, 1279; A 1975, 367)

      NRS 449.087  Amendment of license required for addition of certain services; requirements for approval of amendment; revocation of approval; standards.

      1.  A licensee must obtain the approval of the Division to amend his or her license to operate a facility before the addition of any of the following services:

      (a) The intensive care of newborn babies.

      (b) The treatment of burns.

      (c) The transplant of organs.

      (d) The performance of open-heart surgery.

      (e) A center for the treatment of trauma.

      2.  The Division shall approve an application to amend a license to allow a facility to provide any of the services described in subsection 1 if:

      (a) The applicant satisfies the requirements contained in NRS 449.080;

      (b) The Division determines on the basis of the standards adopted by the Board pursuant to subsection 4 that there are an adequate number of cases in the community to be served to support amending the license to add the service; and

      (c) The Division determines that the applicant satisfies any other standards adopted by the Board pursuant to subsection 4.

      3.  The Division may revoke its approval if the licensee fails to maintain substantial compliance with the standards adopted by the Board pursuant to subsection 4 for the provision of such services, or with any conditions included in the written approval of the Director issued pursuant to the provisions of NRS 439A.100.

      4.  The Board shall:

      (a) Adopt standards which have been adopted by appropriate national organizations to be used by the Division in determining whether there are an adequate number of cases in the community to be served to support amending the license of a licensee to add a service pursuant to this section; and

      (b) Adopt such other standards as it deems necessary for determining whether to approve the provision of services pursuant to this section.

      (Added to NRS by 1987, 876; A 1989, 1948; 2011, 741)

      NRS 449.089  Expiration and renewal of license.

      1.  Each license issued pursuant to NRS 449.030 to 449.2428, inclusive, expires on December 31 following its issuance and is renewable for 1 year upon reapplication and payment of all fees required pursuant to NRS 449.050 unless the Division finds, after an investigation, that the facility has not:

      (a) Satisfactorily complied with the provisions of NRS 449.030 to 449.2428, inclusive, or the standards and regulations adopted by the Board;

      (b) Obtained the approval of the Director of the Department of Health and Human Services before undertaking a project, if such approval is required by NRS 439A.100; or

      (c) Conformed to all applicable local zoning regulations.

      2.  Each reapplication for an agency to provide personal care services in the home, an agency to provide nursing in the home, a facility for intermediate care, a facility for skilled nursing, a hospital described in 42 U.S.C. § 1395ww(d)(1)(B)(iv) which accepts payment through Medicare, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 C.F.R. § 483.5(b)(2), a hospital that provides swing-bed services as described in 42 C.F.R. § 482.66 or, if residential services are provided to children, a medical facility or facility for the treatment of abuse of alcohol or drugs must include, without limitation, a statement that the facility, hospital, agency, program or home is in compliance with the provisions of NRS 449.119 to 449.125, inclusive, and 449.174.

      3.  Each reapplication for an agency to provide personal care services in the home, a facility for intermediate care, a facility for skilled nursing, a facility for the care of adults during the day, a residential facility for groups or a home for individual residential care must include, without limitation, a statement that the holder of the license to operate, and the administrator or other person in charge and employees of, the facility, agency or home are in compliance with the provisions of NRS 449.093.

      [Part 3:336:1951]—(NRS A 1963, 959; 1971, 935; 1973, 1282; 1985, 1739; 1987, 777; 1991, 1078; 1995, 1490; 1997, 445; 2003, 580; 2005, 2167; 2009, 502; 2011, 2252; 2013, 2146, 2889)—(Substituted in revision for NRS 449.060)

      NRS 449.091  Provisional license.

      1.  The Division may cancel the license of a medical facility or facility for the dependent and issue a provisional license, effective for a period determined by the Division, to such a facility if it:

      (a) Is in operation at the time of the adoption of standards and regulations pursuant to the provisions of NRS 449.030 to 449.2428, inclusive, and the Division determines that the facility requires a reasonable time under the particular circumstances within which to comply with the standards and regulations; or

      (b) Has failed to comply with the standards or regulations and the Division determines that the facility is in the process of making the necessary changes or has agreed to make the changes within a reasonable time.

      2.  The provisions of subsection 1 do not require the issuance of a license or prevent the Division from refusing to renew or from revoking or suspending any license where the Division deems such action necessary for the health and safety of the occupants of any facility.

      (Added to NRS by 1973, 1279; A 1985, 1740; 2011, 1064)

      NRS 449.092  Applicant for issuance or renewal of license for home for individual residential care to attest to knowledge of and compliance with certain guidelines concerning safe and appropriate injection practices.  The Division shall not issue or renew a license for a home for individual residential care unless the applicant for issuance or renewal of the license attests to knowledge of and compliance with the guidelines of the Centers for Disease Control and Prevention concerning the prevention of transmission of infectious agents through safe and appropriate injection practices.

      (Added to NRS by 2011, 2053)

      NRS 449.093  Training to recognize and prevent abuse of older persons: Persons required to receive; frequency; topics; costs; actions for failure to complete.

      1.  An applicant for a license to operate a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care must receive training to recognize and prevent the abuse of older persons before a license to operate such a facility, agency or home is issued to the applicant. If an applicant has completed such training within the year preceding the date of the application for a license and the application includes evidence of the training, the applicant shall be deemed to have complied with the requirements of this subsection.

      2.  A licensee who holds a license to operate a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care must annually receive training to recognize and prevent the abuse of older persons before the license to operate such a facility, agency or home may be renewed.

      3.  If an applicant or licensee who is required by this section to obtain training is not a natural person, the person in charge of the facility, agency or home must receive the training required by this section.

      4.  An administrator or other person in charge of a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care must receive training to recognize and prevent the abuse of older persons before the facility, agency or home provides care to a person and annually thereafter.

      5.  An employee who will provide care to a person in a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care must receive training to recognize and prevent the abuse of older persons before the employee provides care to a person in the facility, agency or home and annually thereafter.

      6.  The topics of instruction that must be included in the training required by this section must include, without limitation:

      (a) Recognizing the abuse of older persons, including sexual abuse and violations of NRS 200.5091 to 200.50995, inclusive;

      (b) Responding to reports of the alleged abuse of older persons, including sexual abuse and violations of NRS 200.5091 to 200.50995, inclusive; and

      (c) Instruction concerning the federal, state and local laws, and any changes to those laws, relating to:

             (1) The abuse of older persons; and

             (2) Facilities for intermediate care, facilities for skilled nursing, agencies to provide personal care services in the home, facilities for the care of adults during the day, residential facilities for groups or homes for individual residential care, as applicable for the person receiving the training.

      7.  The facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care is responsible for the costs related to the training required by this section.

      8.  The administrator of a facility for intermediate care, facility for skilled nursing or residential facility for groups who is licensed pursuant to chapter 654 of NRS shall ensure that each employee of the facility who provides care to residents has obtained the training required by this section. If an administrator or employee of a facility or home does not obtain the training required by this section, the Division shall notify the Board of Examiners for Long-Term Care Administrators that the administrator is in violation of this section.

      9.  The holder of a license to operate a facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home, facility for the care of adults during the day, residential facility for groups or home for individual residential care shall ensure that each person who is required to comply with the requirements for training pursuant to this section complies with such requirements. The Division may, for any violation of this section, take disciplinary action against a facility, agency or home pursuant to NRS 449.160 and 449.163.

      (Added to NRS by 2011, 2248)

      NRS 449.094  Continuing education requirements concerning care of persons with dementia for certain employees of facilities for skilled nursing, facilities for intermediate care and residential facilities for groups.

      1.  The Board shall establish minimum continuing education requirements concerning the care of persons with any form of dementia, including, without limitation, dementia caused by Alzheimer’s disease, for each person who is:

      (a) Employed by a facility for skilled nursing, facility for intermediate care or residential facility for groups which provides care to persons with any form of dementia; and

      (b) Licensed or certified by an occupational licensing board.

      2.  In establishing continuing education requirements pursuant to subsection 1, the Board shall consider any other educational requirements imposed on such employees to ensure that the continuing education requirements established by the Board do not duplicate or conflict with the existing educational requirements imposed on those employees.

      3.  The administrator of a facility for skilled nursing, facility for intermediate care or residential facility for groups which provides care to persons with any form of dementia, including, without limitation, dementia caused by Alzheimer’s disease, shall ensure that each employee of the facility who is required to comply with the requirements for continuing education established by the Board pursuant to this section complies with such requirements.

      (Added to NRS by 2003, 856)—(Substituted in revision for NRS 449.0357)

Background Investigations

      NRS 449.119  “Facility, hospital, agency, program or home” defined.  As used in NRS 449.119 to 449.125, inclusive, “facility, hospital, agency, program or home” means an agency to provide personal care services in the home, an agency to provide nursing in the home, a facility for intermediate care, a facility for skilled nursing, a hospital described in 42 U.S.C. § 1395ww(d)(1)(B)(iv) which accepts payment through Medicare, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 C.F.R. § 483.5(b)(2), a hospital that provides swing-bed services as described in 42 C.F.R. § 482.66 or, if residential services are provided to children, a medical facility or facility for the treatment of abuse of alcohol or drugs.

      (Added to NRS by 2013, 2889)

      NRS 449.121  Exemption for facility for the treatment of abuse of alcohol or drugs; exception.

      1.  Except as otherwise provided in subsection 2, the provisions of NRS 449.119 to 449.125, inclusive, and 449.174 do not apply to any facility for the treatment of abuse of alcohol or drugs.

      2.  A facility for the treatment of abuse of alcohol or drugs must comply with the requirements of NRS 449.119 to 449.125, inclusive, and 449.174 if the facility for the treatment of abuse of alcohol or drugs provides residential services to children.

      (Added to NRS by 1997, 442; A 2011, 3556; 2013, 2890)—(Substituted in revision for NRS 449.173)

      NRS 449.122  Investigation of applicant for license to operate facility, hospital, agency, program or home.

      1.  Each applicant for a license to operate a facility, hospital, agency, program or home shall submit to the Central Repository for Nevada Records of Criminal History one complete set of fingerprints for submission to the Federal Bureau of Investigation for its report.

      2.  The Central Repository for Nevada Records of Criminal History shall determine whether the applicant has been convicted of a crime listed in paragraph (a) of subsection 1 of NRS 449.174 and immediately inform the administrator of the facility, hospital, agency, program or home, if any, and the Division of whether the applicant has been convicted of such a crime.

      3.  A person who holds a license to operate a facility, hospital, agency, program or home which provides residential services to children shall submit to the Central Repository for Nevada Records of Criminal History one complete set of fingerprints for a report required by this section at least once every 5 years after the initial investigation.

      (Added to NRS by 1997, 442; A 2009, 504; 2011, 3556; 2013, 2890)—(Substituted in revision for NRS 449.176)

      NRS 449.123  Initial and periodic investigations of employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home; penalty.

      1.  Except as otherwise provided in subsections 2 and 3, within 10 days after hiring an employee, accepting an employee of a temporary employment service or entering into a contract with an independent contractor, the administrator of, or the person licensed to operate a facility, hospital, agency, program or home shall:

      (a) Obtain a written statement from the employee, employee of the temporary employment service or independent contractor stating whether he or she has been convicted of any crime listed in NRS 449.174;

      (b) Obtain an oral and written confirmation of the information contained in the written statement obtained pursuant to paragraph (a);

      (c) Obtain proof that the employee, employee of the temporary employment service or independent contractor holds any required license, permit or certificate;

      (d) Obtain from the employee, employee of the temporary employment service or independent contractor one set of fingerprints and a written authorization to forward the fingerprints to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report;

      (e) Submit to the Central Repository for Nevada Records of Criminal History the fingerprints obtained pursuant to paragraph (d) to obtain information on the background and personal history of each employee, employee of a temporary employment service or independent contractor to determine whether the person has been convicted of any crime listed in NRS 449.174; and

      (f) If an Internet website has been established pursuant to NRS 439.942:

             (1) Screen the employee, employee of the temporary employment service or independent contractor using the Internet website. Upon request of the Division, proof that the employee, temporary employee or independent contractor was screened pursuant to this subparagraph must be provided to the Division.

             (2) Enter on the Internet website information to be maintained on the website concerning the employee, employee of the temporary employment service or independent contractor.

      2.  The administrator of, or the person licensed to operate, a facility, hospital, agency, program or home is not required to obtain the information described in subsection 1 from an employee, employee of a temporary employment service or independent contractor if his or her fingerprints have been submitted to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report within the immediately preceding 6 months and the report of the Federal Bureau of Investigation indicated that the employee, employee of the temporary employment service or independent contractor has not been convicted of any crime set forth in NRS 449.174.

      3.  The administrator of, or the person licensed to operate, a facility, hospital, agency, program or home is not required to obtain the information described in subsection 1, other than the information described in paragraph (c) of subsection 1, from an employee, employee of a temporary employment service or independent contractor if:

      (a) The employee, employee of the temporary employment service or independent contractor agrees to allow the administrator of, or the person licensed to operate, a facility, hospital, agency, program or home to receive notice from the Central Repository for Nevada Records of Criminal History regarding any conviction and subsequent conviction of the employee, employee of the temporary employment service or independent contractor of a crime listed in NRS 449.174;

      (b) An agency, board or commission that regulates an occupation or profession pursuant to title 54 of NRS or temporary employment service has, within the immediately preceding 5 years, submitted the fingerprints of the employee, employee of the temporary employment service or independent contractor to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report; and

      (c) The report of the Federal Bureau of Investigation indicated that the employee, employee of the temporary employment service or independent contractor has not been convicted of any crime set forth in NRS 449.174.

      4.  The administrator of, or the person licensed to operate, a facility, hospital, agency, program or home shall ensure that the information concerning the background and personal history of each employee, employee of a temporary employment service or independent contractor who works at the facility, hospital, agency, program or home:

      (a) Except as otherwise provided in subsection 2, is completed as soon as practicable, and if residential services are provided to children, before the employee, employee of the temporary employment service or independent contractor provides any care or services to a child in the facility, hospital, agency, program or home without supervision; and

      (b) At least once every 5 years after the date of the initial investigation.

      5.  The administrator or person shall, when required:

      (a) Obtain one set of fingerprints from the employee, employee of the temporary employment service or independent contractor;

      (b) Obtain written authorization from the employee, employee of the temporary employment service or independent contractor to forward the fingerprints obtained pursuant to paragraph (a) to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report; and

      (c) Submit the fingerprints to the Central Repository for Nevada Records of Criminal History or, if the fingerprints were submitted electronically, obtain proof of electronic submission of the fingerprints to the Central Repository for Nevada Records of Criminal History.

      6.  Upon receiving fingerprints submitted pursuant to this section, the Central Repository for Nevada Records of Criminal History shall determine whether the employee, employee of the temporary employment service or independent contractor has been convicted of a crime listed in NRS 449.174 and immediately inform the Division and the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home at which the person works whether the employee, employee of the temporary employment service or independent contractor has been convicted of such a crime.

      7.  The Central Repository for Nevada Records of Criminal History may impose a fee upon a facility, hospital, agency, program or home that submits fingerprints pursuant to this section for the reasonable cost of the investigation. The facility, hospital, agency, program or home may recover from the employee or independent contractor whose fingerprints are submitted not more than one-half of the fee imposed by the Central Repository. If the facility, hospital, agency, program or home requires the employee or independent contractor to pay for any part of the fee imposed by the Central Repository, it shall allow the employee or independent contractor to pay the amount through periodic payments. The facility, hospital, agency, program or home may require a temporary employment service which employs a temporary employee whose fingerprints are submitted to pay the fee imposed by the Central Repository. A facility, hospital, agency, program or home shall notify a temporary employment service if a person employed by the temporary employment service is determined to be ineligible to provide services at the facility, hospital, agency, program or home based upon the results of an investigation conducted pursuant to this section.

      8.  Unless a greater penalty is provided by law, a person who willfully provides a false statement or information in connection with an investigation of the background and personal history of the person pursuant to this section that would disqualify the person from employment, including, without limitation, a conviction of a crime listed in NRS 449.174, is guilty of a misdemeanor.

      (Added to NRS by 1997, 442; A 1999, 1946; 2005, 2170; 2009, 504; 2011, 3556; 2013, 2890)—(Substituted in revision for NRS 449.179)

      NRS 449.1235  Temporary employment service prohibited from sending ineligible employee to facility, hospital, agency, program or home; temporary employment service to provide certain information regarding its employees.

      1.  A temporary employment service shall not send an employee to provide services to a facility, hospital, agency, program or home if the temporary employment service has received notice from a facility, hospital, agency, program or home that the employee of the temporary employment service is ineligible to provide such services.

      2.  A facility, hospital, agency, program or home that enters into an agreement with a temporary employment service to provide services for the facility, hospital, agency, program or home on a temporary basis must require the temporary employment service to:

      (a) Provide proof that each employee of the temporary employment service whom it may send to provide services to the facility, hospital, agency, program or home has been continuously employed by the temporary employment service since the last investigation conducted of the employee pursuant to NRS 449.123; and

      (b) Notify the facility, hospital, agency, program or home if the investigation conducted of an employee of the temporary employment service pursuant to NRS 449.123 has not been conducted within the immediately preceding 5 years.

      (Added to NRS by 2013, 2889)

      NRS 449.124  Maintenance and availability of certain records regarding employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home.

      1.  Each facility, hospital, agency, program or home shall maintain records of the information concerning its employees, employees of a temporary employment service and independent contractors collected pursuant to NRS 449.123, including, without limitation:

      (a) A copy of the fingerprints that were submitted to the Central Repository for Nevada Records of Criminal History or proof of electronic fingerprint submission and a copy of the written authorization that was provided by the employee, employee of the temporary employment service or independent contractor;

      (b) Proof that the fingerprints of the employee, employee of the temporary employment service or independent contractor were submitted to the Central Repository; and

      (c) Any other documentation of the information collected pursuant to NRS 449.123.

      2.  The records maintained pursuant to subsection 1 must be:

      (a) Maintained for the period of the employment of the person with the facility, hospital, agency, program or home; and

      (b) Made available for inspection by the Division at any reasonable time, and copies thereof must be furnished to the Division upon request.

      3.  If an Internet website has been established pursuant to NRS 439.942, a facility, hospital, agency, program or home shall maintain a current list of its employees, employees of a temporary employment service and independent contractors on the Internet website.

      4.  The Central Repository for Nevada Records of Criminal History may maintain an electronic image of fingerprints submitted pursuant to NRS 449.122 and 449.123 to notify a facility, hospital, agency, program or home and the Division of any subsequent conviction of a person who is required to submit to an investigation pursuant to NRS 449.122 or 449.123.

      (Added to NRS by 1997, 443; A 1999, 1947; 2005, 2171; 2009, 505; 2011, 3558; 2013, 2893)—(Substituted in revision for NRS 449.182)

      NRS 449.125  Termination of employment or contract of employee, employee of temporary employment service or independent contractor of facility, hospital, agency, program or home who has been convicted of certain crime; period in which to correct information regarding conviction; liability of facility, hospital, agency, program or home.

      1.  Upon receiving information from the Central Repository for Nevada Records of Criminal History pursuant to NRS 449.123, or evidence from any other source, that an employee, employee of a temporary employment service or independent contractor of a facility, hospital, agency, program or home:

      (a) Has been convicted of a crime listed in paragraph (a) of subsection 1 of NRS 449.174; or

      (b) Has had a substantiated report of abuse or neglect made against him or her, if he or she is employed at a facility, hospital, agency, program or home that provides residential services to children,

Ê the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home shall terminate the employment or contract of that person or notify the temporary employment service that its employee is prohibited from providing services for the facility, hospital, agency, program or home after allowing the person time to correct the information as required pursuant to subsection 2.

      2.  If an employee, employee of a temporary employment service or independent contractor believes that the information provided by the Central Repository is incorrect, the employee, employee of the temporary employment service or independent contractor may immediately inform the facility, hospital, agency, program or home or temporary employment service. The facility, hospital, agency, program, home or temporary employment service that is so informed shall give the employee, employee of the temporary employment service or independent contractor a reasonable amount of time of not less than 30 days to correct the information received from the Central Repository before terminating the employment or contract of the person pursuant to subsection 1.

      3.  A facility, hospital, agency, program or home that has complied with NRS 449.123 may not be held civilly or criminally liable based solely upon the ground that the facility, hospital, agency, program or home allowed an employee, employee of a temporary employment service or independent contractor to work:

      (a) Before it received the information concerning the employee, employee of the temporary employment service or independent contractor from the Central Repository, except that an employee, employee of the temporary employment service or independent contractor shall not have contact with a child without supervision before such information is received;

      (b) During the period required pursuant to subsection 2 to allow the employee, employee of the temporary employment service or independent contractor to correct that information, except that an employee, employee of the temporary employment service or independent contractor shall not have contact with a child without supervision during such period;

      (c) Based on the information received from the Central Repository, if the information received from the Central Repository was inaccurate; or

      (d) Any combination thereof.

Ê A facility, hospital, agency, program or home may be held liable for any other conduct determined to be negligent or unlawful.

      (Added to NRS by 1997, 443; A 1999, 1948; 2005, 2171; 2009, 505; 2011, 3558; 2013, 2894)—(Substituted in revision for NRS 449.185)

Inspections

      NRS 449.131  Entry and inspection of building and premises by Division, State Fire Marshal and Chief Medical Officer.

      1.  Any authorized member or employee of the Division may enter and inspect any building or premises at any time to secure compliance with or prevent a violation of any provision of NRS 449.030 to 449.245, inclusive.

      2.  The State Fire Marshal or a designee of the State Fire Marshal shall, upon receiving a request from the Division or a written complaint concerning compliance with the plans and requirements to respond to an emergency adopted pursuant to subsection 9 of NRS 449.0302:

      (a) Enter and inspect a residential facility for groups; and

      (b) Make recommendations regarding the adoption of plans and requirements pursuant to subsection 9 of NRS 449.0302,

Ê to ensure the safety of the residents of the facility in an emergency.

      3.  The Chief Medical Officer or a designee of the Chief Medical Officer shall enter and inspect at least annually each building or the premises of a residential facility for groups to ensure compliance with standards for health and sanitation.

      4.  An authorized member or employee of the Division shall enter and inspect any building or premises operated by a residential facility for groups within 72 hours after the Division is notified that a residential facility for groups is operating without a license.

      [Part 4:336:1951]—(NRS A 1963, 962; 1971, 937; 1973, 1286; 1975, 898; 1985, 1742; 1999, 3610; 2001, 1343; 2003, 421, 1923; 2005, 2172; 2009, 1446; 2011, 1067, 2255, 2398)—(Substituted in revision for NRS 449.230)

      NRS 449.132  Inspection of medical facility and facility for dependent by Division of Public and Behavioral Health and Aging and Disability Services Division.  Every medical facility or facility for the dependent may be inspected at any time, with or without notice, as often as is necessary by:

      1.  The Division of Public and Behavioral Health to ensure compliance with all applicable regulations and standards; and

      2.  Any person designated by the Aging and Disability Services Division of the Department of Health and Human Services to investigate complaints made against the facility.

      (Added to NRS by 1977, 642; A 1985, 1742; 1991, 1975; 2001, 1343; 2003, 422)—(Substituted in revision for NRS 449.235)

      NRS 449.133  Report of results of inspections of medical facilities and facilities for dependent by Division; disclosure of results of inspections of facilities for skilled nursing, facilities for intermediate care and residential facilities for groups.  The Division shall:

      1.  Prepare a report of the results of its inspections of medical facilities and facilities for the dependent regarding compliance with applicable regulations and standards. The report must be provided to the facility and include, without limitation, a recommendation of the Division for correcting any deficiencies and, if a deficiency is discovered as a result of an investigation by a county, district or city board of health or health officer, the recommendations of the board or health officer.

      2.  Upon request, disclose to any person or governmental entity the results of its inspections of facilities for skilled nursing, facilities for intermediate care and residential facilities for groups regarding their compliance with applicable regulations and standards.

      [14:336:1951]—(NRS A 1963, 961; 1971, 936; 1973, 1285; 1987, 1054; 2009, 559)—(Substituted in revision for NRS 449.200)

      NRS 449.134  Facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care to provide immediate notification of certain deficiencies to certain persons.  A facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care shall immediately provide notice of a deficiency affecting the health and safety of a patient discovered during the course of an inspection of the facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care conducted by the Division to:

      1.  A person receiving care at the facility or home;

      2.  The parent or legal guardian of the person receiving care at the facility or home; or

      3.  Any other natural person designated to receive such notice by the person receiving care at the facility or home or the parent or guardian of the person.

      (Added to NRS by 2011, 2396)

Disciplinary Action

      NRS 449.160  Grounds for denial, suspension or revocation of license; revocation of license in connection with certain nuisance activity; log of complaints; information concerning complaint, investigation and disciplinary action to be provided to facility for the care of adults during the day; written report of complaints and disciplinary actions.

      1.  The Division may deny an application for a license or may suspend or revoke any license issued under the provisions of NRS 449.030 to 449.2428, inclusive, upon any of the following grounds:

      (a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410 or 449.030 to 449.245, inclusive, or of any other law of this State or of the standards, rules and regulations adopted thereunder.

      (b) Aiding, abetting or permitting the commission of any illegal act.

      (c) Conduct inimical to the public health, morals, welfare and safety of the people of the State of Nevada in the maintenance and operation of the premises for which a license is issued.

      (d) Conduct or practice detrimental to the health or safety of the occupants or employees of the facility.

      (e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and 449.435 to 449.965, inclusive, if such approval is required.

      (f) Failure to comply with the provisions of NRS 449.2486.

      2.  In addition to the provisions of subsection 1, the Division may revoke a license to operate a facility for the dependent if, with respect to that facility, the licensee that operates the facility, or an agent or employee of the licensee:

      (a) Is convicted of violating any of the provisions of NRS 202.470;

      (b) Is ordered to but fails to abate a nuisance pursuant to NRS 244.360, 244.3603 or 268.4124; or

      (c) Is ordered by the appropriate governmental agency to correct a violation of a building, safety or health code or regulation but fails to correct the violation.

      3.  The Division shall maintain a log of any complaints that it receives relating to activities for which the Division may revoke the license to operate a facility for the dependent pursuant to subsection 2. The Division shall provide to a facility for the care of adults during the day:

      (a) A summary of a complaint against the facility if the investigation of the complaint by the Division either substantiates the complaint or is inconclusive;

      (b) A report of any investigation conducted with respect to the complaint; and

      (c) A report of any disciplinary action taken against the facility.

Ê The facility shall make the information available to the public pursuant to NRS 449.2486.

      4.  On or before February 1 of each odd-numbered year, the Division shall submit to the Director of the Legislative Counsel Bureau a written report setting forth, for the previous biennium:

      (a) Any complaints included in the log maintained by the Division pursuant to subsection 3; and

      (b) Any disciplinary actions taken by the Division pursuant to subsection 2.

      [Part 6:336:1951] + [Part 8:336:1951]—(NRS A 1963, 960; 1971, 936; 1973, 1284; 1975, 898; 1977, 257; 1981, 1220; 1987, 1783; 1989, 1662; 1991, 1079; 2001, 1350; 2003, 47, 857; 2007, 271; 2009, 1444; 2011, 357, 1065, 1358, 2253, 2396; 2013, 136, 2147, 3058)

      NRS 449.163  Administrative sanctions: Imposition by Division; disposition of money collected.

      1.  In addition to the payment of the amount required by NRS 449.0308, if a medical facility or facility for the dependent violates any provision related to its licensure, including any provision of NRS 439B.410 or 449.030 to 449.2428, inclusive, or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

      (a) Prohibit the facility from admitting any patient until it determines that the facility has corrected the violation;

      (b) Limit the occupancy of the facility to the number of beds occupied when the violation occurred, until it determines that the facility has corrected the violation;

      (c) If the license of the facility limits the occupancy of the facility and the facility has exceeded the approved occupancy, require the facility, at its own expense, to move patients to another facility that is licensed;

      (d) Impose an administrative penalty of not more than $1,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum; and

      (e) Appoint temporary management to oversee the operation of the facility and to ensure the health and safety of the patients of the facility, until:

             (1) It determines that the facility has corrected the violation and has management which is capable of ensuring continued compliance with the applicable statutes, conditions, standards and regulations; or

             (2) Improvements are made to correct the violation.

      2.  If a violation by a medical facility or facility for the dependent relates to the health or safety of a patient, an administrative penalty imposed pursuant to paragraph (d) of subsection 1 must be in a total amount of not less than $1,000 and not more than $10,000 for each patient who was harmed or at risk of harm as a result of the violation.

      3.  If the facility fails to pay any administrative penalty imposed pursuant to paragraph (d) of subsection 1, the Division may:

      (a) Suspend the license of the facility until the administrative penalty is paid; and

      (b) Collect court costs, reasonable attorney’s fees and other costs incurred to collect the administrative penalty.

      4.  The Division may require any facility that violates any provision of NRS 439B.410 or 449.030 to 449.2428, inclusive, or any condition, standard or regulation adopted by the Board to make any improvements necessary to correct the violation.

      5.  Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 must be accounted for separately and used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and 449.435 to 449.965, inclusive, and to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards.

      (Added to NRS by 1989, 863; A 1989, 1663; 2003, 858; 2009, 558, 1445; 2011, 358, 1066, 1359, 1806, 2254, 2397; 2013, 137, 2148, 3059)

      NRS 449.165  Administrative sanctions: Regulations of Board.  The Board shall adopt regulations establishing the criteria for the imposition of each sanction prescribed by NRS 449.163. These regulations must:

      1.  Prescribe the circumstances and manner in which each sanction applies;

      2.  Minimize the time between identification of a violation and the imposition of a sanction;

      3.  Provide for the imposition of incrementally more severe sanctions for repeated or uncorrected violations; and

      4.  Provide for less severe sanctions for lesser violations of applicable state statutes, conditions, standards or regulations.

      (Added to NRS by 1989, 864)

      NRS 449.170  Denial, suspension or revocation of license or imposition of sanctions: Notice; appeal; adoption of regulations.

      1.  When the Division intends to deny, suspend or revoke a license, or impose any sanction prescribed by NRS 449.163, it shall give reasonable notice to all parties by certified mail. The notice must contain the legal authority, jurisdiction and reasons for the action to be taken. Notice is not required if the Division finds that the public health requires immediate action. In that case, it may order a summary suspension of a license pursuant to this section and NRS 233B.127 or impose any sanction prescribed by NRS 449.163, pending proceedings for revocation or other action.

      2.  If a person wants to contest the action of the Division, the person must file an appeal pursuant to regulations adopted by the Board.

      3.  Upon receiving notice of an appeal, the Division shall hold a hearing pursuant to regulations adopted by the Board.

      4.  The Board shall adopt such regulations as are necessary to carry out the provisions of this section.

      [Part 8:336:1951]—(NRS A 1963, 960; 1969, 95; 1973, 1284; 1977, 70; 1985, 1741; 1989, 864; 1995, 1585; 2009, 558)

      NRS 449.171  Authority of Division to take control over medical records of medical facility or facility for dependent upon suspension of license or cessation of operation; confidentiality; sharing of records with appropriate authorities.

      1.  If the Division suspends the license of a medical facility or a facility for the dependent pursuant to the provisions of this chapter, or if a facility otherwise ceases to operate, including, without limitation, pursuant to an action or order of a health authority pursuant to chapter 441A of NRS, the Division may, if deemed necessary by the Administrator of the Division, take control of and ensure the safety of the medical records of the facility.

      2.  Subject to the provisions of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, the Division shall:

      (a) Maintain the confidentiality of the medical records obtained pursuant to subsection 1.

      (b) Share medical records obtained pursuant to subsection 1 with law enforcement agencies in this State and other governmental entities which have authority to license the facility or to license the owners or employees of the facility.

      (c) Release a medical record obtained pursuant to subsection 1 to the patient or legal guardian of the patient who is the subject of the medical record.

      3.  The Board shall adopt regulations to carry out the provisions of this section, including, without limitation, regulations for contracting with a person to maintain any medical records under the control of the Division pursuant to subsection 1 and for payment by the facility of the cost of maintaining medical records.

      (Added to NRS by 2009, 557)

      NRS 449.172  Residential facility for groups: Duties of Division and operator upon suspension or revocation of license for abuse, neglect or isolation of occupants.  If the Division suspends or revokes the license of a person who operates a residential facility for groups for abuse, neglect or isolation of the occupants of the facility, the Division shall suspend or revoke the license of all residential facilities for groups operated by that person. The person who operates the facility shall move all of the persons who are receiving services in the residential facilities for groups to other licensed residential facilities for groups at his or her own expense.

      (Added to NRS by 1999, 3607)

      NRS 449.174  Additional grounds for denial, suspension or revocation of license to operate certain facility, hospital, agency, program or home.

      1.  In addition to the grounds listed in NRS 449.160, the Division may deny a license to operate a facility, hospital, agency, program or home to an applicant or may suspend or revoke the license of a licensee to operate such a facility, hospital, agency, program or home if:

      (a) The applicant or licensee has been convicted of:

             (1) Murder, voluntary manslaughter or mayhem;

             (2) Assault or battery with intent to kill or to commit sexual assault or mayhem;

             (3) Sexual assault, statutory sexual seduction, incest, lewdness or indecent exposure, or any other sexually related crime that is punished as a felony;

             (4) Prostitution, solicitation, lewdness or indecent exposure, or any other sexually related crime that is punished as a misdemeanor, within the immediately preceding 7 years;

             (5) A crime involving domestic violence that is punished as a felony;

             (6) A crime involving domestic violence that is punished as a misdemeanor, within the immediately preceding 7 years;

             (7) Abuse or neglect of a child or contributory delinquency;

             (8) A violation of any federal or state law regulating the possession, distribution or use of any controlled substance or any dangerous drug as defined in chapter 454 of NRS, within the immediately preceding 7 years;

             (9) Abuse, neglect, exploitation or isolation of older persons or vulnerable persons, including, without limitation, a violation of any provision of NRS 200.5091 to 200.50995, inclusive, or a law of any other jurisdiction that prohibits the same or similar conduct;

             (10) A violation of any provision of law relating to the State Plan for Medicaid or a law of any other jurisdiction that prohibits the same or similar conduct, within the immediately preceding 7 years;

             (11) A violation of any provision of NRS 422.450 to 422.590, inclusive;

             (12) A criminal offense under the laws governing Medicaid or Medicare, within the immediately preceding 7 years;

             (13) Any offense involving fraud, theft, embezzlement, burglary, robbery, fraudulent conversion or misappropriation of property, within the immediately preceding 7 years;

             (14) Any other felony involving the use or threatened use of force or violence against the victim or the use of a firearm or other deadly weapon; or

             (15) An attempt or conspiracy to commit any of the offenses listed in this paragraph, within the immediately preceding 7 years;

      (b) The licensee has, in violation of NRS 449.125, continued to employ a person who has been convicted of a crime listed in paragraph (a); or

      (c) The applicant or licensee has had a substantiated report of child abuse or neglect made against him or her and if the facility, hospital, agency, program or home provides residential services to children.

      2.  In addition to the grounds listed in NRS 449.160, the Division may suspend or revoke the license of a licensee to operate an agency to provide personal care services in the home or an agency to provide nursing in the home if the licensee has, in violation of NRS 449.125, continued to employ a person who has been convicted of a crime listed in paragraph (a) of subsection 1.

      3.  As used in this section:

      (a) “Domestic violence” means an act described in NRS 33.018.

      (b) “Facility, hospital, agency, program or home” has the meaning ascribed to it in NRS 449.119.

      (c) “Medicaid” has the meaning ascribed to it in NRS 439B.120.

      (d) “Medicare” has the meaning ascribed to it in NRS 439B.130.

      (Added to NRS by 1997, 444; A 1999, 1948; 2005, 2171; 2007, 652, 2401; 2009, 506; 2013, 2895)—(Substituted in revision for NRS 449.188)

Miscellaneous Provisions

      NRS 449.181  Medical facility that has custody of child pursuant to court order to adopt policy relating to medical care and medications for child; employees to receive copy of policy.

      1.  Except as otherwise provided in this section, a medical facility that has custody of a child pursuant to the order of a court shall adopt a policy concerning the manner in which to:

      (a) Document the orders of the treating physician of a child;

      (b) Administer medication to a child;

      (c) Store, handle and dispose of medication;

      (d) Document the administration of medication and any errors in the administration of medication;

      (e) Minimize errors in the administration of medication; and

      (f) Address errors in the administration of medication.

      2.  Such a medical facility shall ensure that each employee of the medical facility who will administer medication to such a child receives a copy of and understands the policy adopted pursuant to subsection 1.

      (Added to NRS by 2011, 1357)

      NRS 449.183  Facility for intermediate care, facility for skilled nursing and residential facility for groups to adopt written policy concerning readmission after temporary transfer of patient or resident.

      1.  A facility for intermediate care, facility for skilled nursing and residential facility for groups shall adopt a written policy that establishes:

      (a) The number of days the facility will hold the bed of a patient or resident for his or her return if the patient or resident is transferred temporarily to a hospital or other facility for medical reasons; and

      (b) That a patient or resident who is so transferred for a period that exceeds the period of the hold established pursuant to paragraph (a) will be allowed to resume his or her residency as soon as a bed becomes available, if the facility is suitable for properly caring for the patient upon his or her return.

      2.  Upon admission of a patient or resident to a facility for intermediate care, facility for skilled nursing or residential facility for groups, the facility shall provide to the patient or resident and, if applicable, to the legal representative of the patient or resident, a copy of the policy established pursuant to subsection 1.

      (Added to NRS by 2011, 1063)

      NRS 449.184  Operator of residential facility for groups, facility for intermediate care or facility for skilled nursing to post certain information in conspicuous place.

      1.  A person who operates a residential facility for groups shall:

      (a) Post his or her license to operate the residential facility for groups;

      (b) Post the rates for services provided by the residential facility for groups; and

      (c) Post contact information for the administrator and the designated representative of the owner or operator of the facility,

Ê in a conspicuous place in the residential facility for groups.

      2.  A person who operates a facility for intermediate care or facility for skilled nursing shall:

      (a) Post his or her license to operate the facility;

      (b) Post the organizational structure of the management of the facility; and

      (c) Post contact information for the administrator and the designated representative of the owner or operator of the facility,

Ê in a conspicuous place in the facility for intermediate care or facility for skilled nursing.

      (Added to NRS by 1999, 3606; A 2011, 1064)—(Substituted in revision for NRS 449.095)

      NRS 449.186  Supervision of residential facility for groups.  A residential facility for groups must not be operated except under the supervision of an administrator of a residential facility for groups licensed pursuant to the provisions of chapter 654 of NRS.

      (Added to NRS by 1993, 2144)—(Substituted in revision for NRS 449.0355)

      NRS 449.187  Supervision of facility for skilled nursing or facility for intermediate care.

      1.  Except as otherwise provided in subsection 2, a facility for skilled nursing or facility for intermediate care licensed pursuant to the provisions of NRS 449.030 to 449.2428, inclusive, may not be operated except under the supervision of a nursing facility administrator who is at the facility and licensed under the provisions of chapter 654 of NRS.

      2.  The provisions of subsection 1 do not apply to a facility for intermediate care which limits its care and treatment to those persons with intellectual disabilities or conditions related to intellectual disabilities.

      (Added to NRS by 1969, 672; A 1971, 934; 1973, 1281; 1977, 1031; 1985, 1738; 1993, 1214; 2013, 697)

      NRS 449.189  Physician and nurse required to operate independent center to provide emergency medical care.  An independent center to provide emergency medical care shall not be operated unless a physician and registered nurse are on the premises.

      (Added to NRS by 1985, 1735)—(Substituted in revision for NRS 449.034)

      NRS 449.191  Medical facility not required to allow abortions.

      1.  A hospital or other medical facility licensed under the provisions of this chapter which is not operated by the State or a local government or an agency of either is not required to permit the use of its facilities for the induction or performance of an abortion, except in a medical emergency.

      2.  Such refusal does not give rise to a cause of action in favor of any person.

      (Added to NRS by 1973, 897; A 1985, 1742)

      NRS 449.192  Admission of dentist to membership on medical staff of hospital.  No dentist may be:

      1.  Automatically admitted to membership on the medical staff of a hospital solely because he or she is licensed as a dentist in this state or is authorized pursuant to NRS 631.267 to perform certain functions; or

      2.  Denied admission to membership on the medical staff of a hospital merely because he or she is licensed as a dentist and not as a physician.

      (Added to NRS by 1985, 2097)—(Substituted in revision for NRS 449.032)

      NRS 449.193  Facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care to provide itemized statement of charges upon request to certain persons.

      1.  Subject to the provisions of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, a facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care shall, upon request, provide an itemized statement of charges to:

      (a) The person who received care in the facility or home;

      (b) The parent or guardian of the person who received care in the facility or home; or

      (c) Any other natural person designated by the person receiving care at the facility or home.

      2.  An itemized statement of charges provided by a facility for intermediate care, facility for skilled nursing, residential facility for groups or home for individual residential care pursuant to subsection 1 must, without limitation:

      (a) Itemize the charges for services, care, food, medicine and other supplies provided to the person receiving care at the facility or home;

      (b) Identify the amount of payment allocated to each charge;

      (c) Be provided in a manner that is understandable to an ordinary person;

      (d) Be provided at no additional cost; and

      (e) Be provided in a timely manner.

      (Added to NRS by 2011, 2395)

      NRS 449.1935  Agency to provide personal care services in the home authorized to provide certain services to certain persons.  An agency to provide personal care services in the home that is licensed pursuant to this section and NRS 449.030 to 449.2428, inclusive, may, through its employees or by contractual arrangement with other persons, provide:

      1.  To persons with disabilities, any medical services authorized pursuant to NRS 629.091; and

      2.  Nonmedical services related to personal care to elderly persons or persons with disabilities to assist those persons with activities of daily living, including, without limitation:

      (a) The elimination of wastes from the body;

      (b) Dressing and undressing;

      (c) Bathing;

      (d) Grooming;

      (e) The preparation and eating of meals;

      (f) Laundry;

      (g) Shopping;

      (h) Cleaning;

      (i) Transportation; and

      (j) Any other minor needs related to the maintenance of personal hygiene.

      (Added to NRS by 2013, 134)

      NRS 449.194  Certain employees of agency to provide personal care services in the home immune from civil liability resulting from rendering emergency care or assistance.  Any person who is employed by an agency to provide personal care services in the home who:

      1.  Has successfully completed a course in cardiopulmonary resuscitation according to the guidelines of the American National Red Cross or American Heart Association;

      2.  Has successfully completed the training requirements of a course in basic emergency care of a person in cardiac arrest conducted in accordance with the standards of the American Heart Association; or

      3.  Has successfully completed the training requirements of a course in the use and administration of first aid, including cardiopulmonary resuscitation,

Ê and who in good faith renders emergency care or assistance in accordance with the person’s training, in the course of his or her regular employment or profession, to an elderly person or a person with a disability, is not liable for any civil damages as a result of any act or omission, not amounting to gross negligence, by that person in rendering that care.

      (Added to NRS by 2013, 434)

      NRS 449.195  Waiver of deductible or copayment; conditions.  A medical facility shall not waive a deductible or copayment if:

      1.  The medical facility is not a preferred provider of health care; and

      2.  The waiver would reduce the financial effect of a preferred provider’s incentive or disincentive to its insureds.

      (Added to NRS by 1987, 1783; A 1995, 1602)

      NRS 449.196  Requirements for program of hospice care.  No person, state or local government or agency may represent that it provides “hospice care” unless the program of care, either directly or indirectly:

      1.  Has a medical director whose responsibilities are appropriate to the needs of the program and who:

      (a) Is a physician, currently licensed to practice;

      (b) On the basis of training, experience and interest, is knowledgeable about the psychosocial and medical aspects of hospice; and

      (c) Acts as a medical resource to the interdisciplinary team which provides the hospice care;

      2.  Is provided to the patient, as needed, in the patient’s home, at a residential facility and at a medical facility, at any time of the day or night;

      3.  Includes medical, nursing, psychological and pastoral care and social services at the level required by the patient’s condition;

      4.  Provides supportive services for the patient’s immediate family and other persons with significant personal ties to the patient, whether or not related by blood, including:

      (a) Care for the patient which provides a respite from the stresses and responsibilities that result from the daily care of the patient; and

      (b) Emotional support and other care after the patient dies; and

      5.  Includes the services of trained volunteers.

      (Added to NRS by 1989, 1034)—(Substituted in revision for NRS 449.031)

      NRS 449.197  Provision of care by facility for hospice care.

      1.  A licensed facility for hospice care may provide any of the following levels of care for terminally ill patients:

      (a) Medical care for a patient who is in an acute episode of illness;

      (b) Skilled nursing care;

      (c) Intermediate care;

      (d) Custodial care; and

      (e) Palliative services.

      2.  A licensed facility for hospice care may provide direct supportive services to a patient’s family and persons who provide care for the patient, including services which provide care for the patient during the day and other services which provide a respite from the stresses and responsibilities that result from the daily care of the patient.

      (Added to NRS by 1989, 1034; A 1999, 249; 2005, 485)—(Substituted in revision for NRS 449.0315)

      NRS 449.198  Requirements for obstetric center.  An obstetric center must:

      1.  Provide sufficient space for members of the family of the pregnant woman and other persons chosen by the woman to assist her with the birth; and

      2.  Have obstetrical services available to meet the needs of an acute patient.

      (Added to NRS by 1985, 1735)—(Substituted in revision for NRS 449.036)

      NRS 449.199  Residential facility for groups and homes for individual residential care prohibited from providing accommodations to persons not meeting requirements for admission; exception.

      1.  Except as otherwise provided in subsection 2, a residential facility for groups which is authorized to have 10 or fewer beds or a home for individual residential care shall not provide accommodations for a person who does not meet the requirements for admission to the facility or home.

      2.  A residential facility for groups which is authorized to have 10 or fewer beds or a home for individual residential care may provide accommodations for a person who is related within the third degree of consanguinity to a resident of the facility or home regardless of whether the person meets the requirements for admission to the facility or home.

      (Added to NRS by 2009, 1441)—(Substituted in revision for NRS 449.03555)

      NRS 449.201  Certification required for alcohol and drug abuse programs operated or provided by facility for transitional living for released offenders.  Each alcohol and drug abuse program operated or provided by a facility for transitional living for released offenders must be certified by the Division in accordance with the requirements set forth in chapter 458 of NRS and any regulations adopted pursuant thereto. As used in this section, “alcohol and drug abuse program” has the meaning ascribed to it in NRS 458.010.

      (Added to NRS by 2005, 2350; A 2013, 3060)—(Substituted in revision for NRS 449.0356)

      NRS 449.202  Classification of hospitals.

      1.  A hospital which provides only one or two of the following categories of service:

      (a) Medical;

      (b) Surgical;

      (c) Obstetrical; or

      (d) Psychiatric,

Ê shall be designated a medical hospital, surgical hospital, obstetrical hospital or psychiatric hospital or combined-categories hospital, as the case may be.

      2.  When a hospital offers services in medical, surgical and obstetrical categories, as a minimum, it shall be designated a general hospital.

      (Added to NRS by 1971, 933; A 1973, 1280)—(Substituted in revision for NRS 449.021)

      NRS 449.203  Designation of hospital as primary stroke center; Division to maintain list of hospitals so designated; regulations.

      1.  A hospital licensed pursuant to NRS 449.030 to 449.2428, inclusive, may submit to the Division proof that the hospital is certified as a primary stroke center by the Joint Commission, its successor organization or an equivalent organization approved by the Division. Upon receiving proof that a hospital is certified as a primary stroke center, the Division shall include the hospital on the list established pursuant to subsection 2.

      2.  On or before July 1 of each year, the Division shall post a list of the hospitals designated as primary stroke centers on an Internet website maintained by the Division.

      3.  If a hospital wishes to be included as a primary stroke center on the list established pursuant to subsection 2, the hospital must annually resubmit the proof required pursuant to this section.

      4.  The Division may remove a hospital from the list established pursuant to subsection 2 if the certificate recognizing the hospital as a primary stroke center issued by the Joint Commission, its successor organization or an equivalent organization, as applicable, is suspended or revoked.

      5.  A hospital that is not included on the list established pursuant to subsection 2 as a primary stroke center shall not represent, advertise or imply that the hospital is designated as a primary stroke center.

      6.  The provisions of this section do not prohibit a hospital that is licensed pursuant to NRS 449.030 to 449.2428, inclusive, from providing care to a victim of stroke if the hospital does not have a designation as a primary stroke center.

      7.  The Board may adopt regulations to carry out the provisions of this section and to designate hospitals with similar certifications which are recognized by the Joint Commission, its successor organization or an equivalent organization.

      (Added to NRS by 2011, 1363)

      NRS 449.2035  Designation of hospital as STEMI receiving center; Division to maintain list of hospitals so designated; regulations. [Effective January 1, 2014.]

      1.  A hospital licensed pursuant to NRS 449.030 to 449.2428, inclusive, may submit to the Division proof that the hospital is accredited as a STEMI receiving center. Upon receiving proof that a hospital is accredited as a STEMI receiving center, the Division shall include the hospital on the list established pursuant to subsection 2.

      2.  On or before July 1 of each year, the Division shall post a list of all hospitals designated as STEMI receiving centers on an Internet website maintained by the Division.

      3.  If a hospital wishes to be included as a STEMI receiving center on the list established pursuant to subsection 2, the hospital must annually resubmit the proof required pursuant to this section.

      4.  The Division may remove a hospital from the list established pursuant to subsection 2 if the accreditation recognizing the hospital as a STEMI receiving center is suspended or revoked.

      5.  A hospital that is not included on the list established pursuant to subsection 2 shall not represent, advertise or imply that the hospital is designated as a STEMI receiving center.

      6.  The provisions of this section do not prohibit a hospital that is licensed pursuant to NRS 449.030 to 449.2428, inclusive, from providing care to a victim of a heart attack if the hospital does not have a designation as a STEMI receiving center.

      7.  The Board may adopt regulations to carry out the provisions of this section and to designate hospitals with accreditations similar to those required for designation as a STEMI receiving center.

      8.  As used in this section:

      (a) “STEMI” means a myocardial infarction as indicated by an abnormal elevation of the ST segment of an electrocardiogram that is administered to a patient.

      (b) “STEMI receiving center” means a hospital that is accredited by the Society of Cardiovascular Patient Care, in conjunction with the initiative developed by the American Heart Association known as the “Mission: Lifeline initiative,” or an equivalent organization approved by the Division, as having met specific standards of performance in the receipt and treatment of a patient with STEMI.

      (Added to NRS by 2013, 507, effective January 1, 2014)

      NRS 449.204  Misleading name or other designation of facility prohibited.  The name, sign, listing or other designation of a medical facility or facility for the dependent must not contain any terms misleading to the public with regard to the services offered.

      (Added to NRS by 1973, 1279; A 1975, 367; 1985, 1738)—(Substituted in revision for NRS 449.026)

Prohibited Acts; Penalties

      NRS 449.205  Retaliation or discrimination against employees and certain other persons: Prohibition under certain circumstances; medical facility prohibited from restricting right to make report or take certain other actions.

      1.  A medical facility or any agent or employee thereof shall not retaliate or discriminate unfairly against:

      (a) An employee of the medical facility or a person acting on behalf of the employee who in good faith:

             (1) Reports to the Board of Medical Examiners or the State Board of Osteopathic Medicine, as applicable, information relating to the conduct of a physician which may constitute grounds for initiating disciplinary action against the physician or which otherwise raises a reasonable question regarding the competence of the physician to practice medicine with reasonable skill and safety to patients;

             (2) Reports a sentinel event to the Division pursuant to NRS 439.835; or

             (3) Cooperates or otherwise participates in an investigation or proceeding conducted by the Board of Medical Examiners, the State Board of Osteopathic Medicine or another governmental entity relating to conduct described in subparagraph (1) or (2); or

      (b) A registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility and who:

             (1) In accordance with the policy, if any, established by the medical facility:

                   (I) Reports to his or her immediate supervisor, in writing, that he or she does not possess the knowledge, skill or experience to comply with an assignment to provide nursing services to a patient; and

                   (II) Refuses to provide to a patient nursing services for which, as verified by documentation in the personnel file of the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified concerning his or her competence to provide various nursing services, he or she does not possess the knowledge, skill or experience to comply with the assignment to provide nursing services to the patient, unless the refusal constitutes unprofessional conduct as set forth in chapter 632 of NRS or any regulations adopted pursuant thereto;

             (2) In accordance with a policy adopted pursuant to NRS 449.2423, requests to be relieved of, refuses or objects to a work assignment;

             (3) In good faith, reports to the medical facility, the Board of Medical Examiners, the State Board of Osteopathic Medicine, the State Board of Nursing, the Legislature or any committee thereof or any other governmental entity:

                   (I) Any information concerning the willful conduct of another registered nurse, licensed practical nurse, nursing assistant or medication aide - certified which violates any provision of chapter 632 of NRS or which is required to be reported to the State Board of Nursing;

                   (II) Any concerns regarding patients who may be exposed to a substantial risk of harm as a result of the failure of the medical facility or any agent or employee thereof to comply with minimum professional or accreditation standards or applicable statutory or regulatory requirements; or

                   (III) Any other concerns regarding the medical facility, the agents and employees thereof or any situation that reasonably could result in harm to patients; or

             (4) Refuses to engage in conduct that would violate the duty of the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified to protect patients from actual or potential harm, conduct which would violate any provision of chapter 632 of NRS or conduct which would subject the registered nurse, licensed practical nurse, nursing assistant or medication aide - certified to disciplinary action by the State Board of Nursing.

      2.  A medical facility or any agent or employee thereof shall not retaliate or discriminate unfairly against an employee of the medical facility or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility because the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified has taken an action described in subsection 1.

      3.  A medical facility or any agent or employee thereof shall not prohibit, restrict or attempt to prohibit or restrict by contract, policy, procedure or any other manner the right of an employee of the medical facility or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility to take an action described in subsection 1.

      4.  As used in this section:

      (a) “Good faith” means honesty in fact in the reporting of the information or in the cooperation in the investigation concerned.

      (b) “Physician” means a person licensed to practice medicine pursuant to chapter 630 or 633 of NRS.

      (c) “Retaliate or discriminate”:

             (1) Includes, without limitation, any of the following actions if taken solely because the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified took an action described in subsection 1:

                   (I) Frequent or undesirable changes in the location where the person works;

                   (II) Frequent or undesirable transfers or reassignments;

                   (III) The issuance of letters of reprimand, letters of admonition or evaluations of poor performance;

                   (IV) A demotion;

                   (V) A reduction in pay;

                   (VI) The denial of a promotion;

                   (VII) A suspension;

                   (VIII) A dismissal;

                    (IX) A transfer; or

                   (X) Frequent changes in working hours or workdays.

             (2) Does not include an action described in sub-subparagraphs (I) to (X), inclusive, of subparagraph (1) if the action is taken in the normal course of employment or as a form of discipline.

      (Added to NRS by 2002 Special Session, 16; A 2005, 1517; 2009, 1418; 2011, 1338; 2013, 2148)

      NRS 449.207  Retaliation or discrimination against employees and certain other persons: Violation; civil action for certain acts of retaliation or discrimination; damages; equitable relief; rebuttable presumption; civil penalty; time limit for bringing action.

      1.  An employee of a medical facility or a registered nurse, licensed practical nurse, nursing assistant or medication aide - certified who is employed by or contracts to provide nursing services for the medical facility and who believes that he or she has been retaliated or discriminated against in violation of NRS 449.205 may file an action in a court of competent jurisdiction.

      2.  If a court determines that a violation of NRS 449.205 has occurred, the court may award such damages as it determines to have resulted from the violation, including, without limitation:

      (a) Compensatory damages;

      (b) Reimbursement of any wages, salary, employment benefits or other compensation denied to or lost by the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified as a result of the violation;

      (c) Attorney’s fees and costs, including, without limitation, fees for expert witnesses; and

      (d) Punitive damages, if the facts warrant.

      3.  The court shall award interest on the amount of damages at a rate determined pursuant to NRS 17.130.

      4.  The court may grant any equitable relief it considers appropriate, including, without limitation, reinstatement of the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified and any temporary, preliminary or permanent injunctive relief.

      5.  If any action to retaliate or discriminate is taken against an employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified within 60 days after the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified takes any action described in subsection 1 of NRS 449.205, there is a rebuttable presumption that the action taken against the employee, registered nurse, licensed practical nurse, nursing assistant or medication aide - certified constitutes retaliation or discrimination in violation of NRS 449.205.

      6.  A medical facility or any agent or employee thereof that violates the provisions of NRS 449.205 is subject to a civil penalty of not more than $10,000 for each violation. The Attorney General or any district attorney of this State may recover the penalty in a civil action brought in the name of the State of Nevada in any court of competent jurisdiction.

      7.  Any action under this section must be brought not later than 2 years after the date of the last event constituting the alleged violation for which the action is brought.

      8.  As used in this section, “retaliate or discriminate” has the meaning ascribed to it in NRS 449.205.

      (Added to NRS by 2002 Special Session, 17; A 2005, 1518; 2009, 1420; 2011, 1339)

      NRS 449.208  Retaliation or discrimination against employees or certain other persons: Written notice regarding protections and legal remedies for certain acts of retaliation or discrimination; posting of notice; inclusion of notice in employee handbook.

      1.  A medical facility shall prepare a written notice for the employees of the medical facility and for the nurses, nursing assistants and medication aides - certified who contract with the medical facility regarding the protections provided for actions taken pursuant to subsection 1 of NRS 449.205 and the legal remedy provided pursuant to NRS 449.207. The notice must include the process by which an employee, nurse, nursing assistant or medication aide - certified may make a report pursuant to subsection 1 of NRS 449.205.

      2.  A medical facility shall:

      (a) Post in one or more conspicuous places at the medical facility the notice prepared pursuant to subsection 1; and

      (b) Include the text of the written notice in any manual or handbook that the medical facility provides to employees, nurses, nursing assistants and medication aides - certified who contract with the medical facility concerning employment practices at the medical facility.

      (Added to NRS by 2009, 557; A 2011, 1340)

      NRS 449.209  Prohibition against medical facility or employee of medical facility making certain referrals to residential facilities for groups; civil penalties; system to track violations.

      1.  In addition to the requirements and prohibitions set forth in NRS 449.0305, and notwithstanding any exceptions set forth in that section, a licensed medical facility or an employee of such a medical facility shall not:

      (a) Refer a person to a residential facility for groups that is not licensed by the Division; or

      (b) Refer a person to a residential facility for groups if the licensed medical facility or its employee knows or reasonably should know that the residential facility for groups, or the services provided by the residential facility for groups, are not appropriate for the condition of the person being referred.

      2.  If a licensed medical facility or an employee of such a medical facility violates the provisions of subsection 1, the licensed medical facility is liable for a civil penalty to be recovered by the Attorney General in the name of the Board for the first offense of not more than $10,000 and for a second or subsequent offense of not less than $10,000 or more than $20,000. Unless otherwise required by federal law, the Board shall deposit all civil penalties collected pursuant to this section into a separate account in the State General Fund to be used for the enforcement of this section and the protection of the health, safety, well-being and property of residents of residential facilities for groups.

      3.  The Board shall:

      (a) Establish and maintain a system to track violations of this section and NRS 449.0305. Except as otherwise provided in this paragraph, records created by or for the system are public records and are available for public inspection. The following information is confidential:

             (1) Any personally identifying information relating to a person who is referred to a residential facility for groups.

             (2) Information which may not be disclosed under federal law.

      (b) Educate the public regarding the requirements and prohibitions set forth in this section and NRS 449.0305.

      4.  As used in this section, “licensed medical facility” means:

      (a) A medical facility that is required to be licensed pursuant to this section and NRS 449.030 to 449.2428, inclusive.

      (b) A facility for the dependent that is required to be licensed pursuant to this section and NRS 449.030 to 449.2428, inclusive.

      (c) A facility that provides medical care or treatment and is required by regulation of the Board to be licensed pursuant to NRS 449.0303.

      (Added to NRS by 2011, 704)

      NRS 449.210  Penalties for unlicensed operation: Medical facility or facility for dependent; residential facility for groups or home for individual residential care.

      1.  In addition to the payment of the amount required by NRS 449.0308, except as otherwise provided in subsection 2 and NRS 449.24897, a person who operates a medical facility or facility for the dependent without a license issued by the Division is guilty of a misdemeanor.

      2.  In addition to the payment of the amount required by NRS 449.0308, if a person operates a residential facility for groups or a home for individual residential care without a license issued by the Division, the Division shall:

      (a) Impose a civil penalty on the operator in the following amount:

             (1) For a first offense, $10,000.

             (2) For a second offense, $25,000.

             (3) For a third or subsequent offense, $50,000.

      (b) Order the operator, at the operator’s own expense, to move all of the persons who are receiving services in the residential facility for groups or home for individual residential care to a residential facility for groups or home for individual residential care, as applicable, that is licensed.

      (c) Prohibit the operator from applying for a license to operate a residential facility for groups or home for individual residential care, as applicable. The duration of the period of prohibition must be:

             (1) For 6 months if the operator is punished pursuant to subparagraph (1) of paragraph (a).

             (2) For 1 year if the operator is punished pursuant to subparagraph (2) of paragraph (a).

             (3) Permanent if the operator is punished pursuant to subparagraph (3) of paragraph (a).

      3.  Before the Division imposes an administrative sanction pursuant to subsection 2, the Division shall provide the operator of a residential facility for groups with reasonable notice. The notice must contain the legal authority, jurisdiction and reasons for the action to be taken. If the operator of a residential facility for groups wants to contest the action, the operator may file an appeal pursuant to the regulations of the State Board of Health adopted pursuant to NRS 449.165 and 449.170. Upon receiving notice of an appeal, the Division shall hold a hearing in accordance with those regulations. For the purpose of this subsection, it is no defense to the violation of operating a residential facility for groups without a license that the operator thereof subsequently licensed the facility in accordance with law.

      4.  Unless otherwise required by federal law, the Division shall deposit all civil penalties collected pursuant to paragraph (a) of subsection 2 into a separate account in the State General Fund to be used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and 449.935 to 449.965, inclusive, and to protect the health, safety, well-being and property of the patients and residents of facilities and homes for individual residential care in accordance with applicable state and federal standards.

      [10:336:1951]—(NRS A 1967, 581; 1971, 936; 1973, 1285; 1985, 1742; 1999, 3609; 2009, 452; 2011, 358, 700, 1806; 2013, 137, 3060)

      NRS 449.220  Action to enjoin violations.

      1.  The Division may bring an action in the name of the State to enjoin any person, state or local government unit or agency thereof from operating or maintaining any facility within the meaning of NRS 449.030 to 449.2428, inclusive:

      (a) Without first obtaining a license therefor; or

      (b) After his or her license has been revoked or suspended by the Division.

      2.  It is sufficient in such action to allege that the defendant did, on a certain date and in a certain place, operate and maintain such a facility without a license.

      [Part 6:336:1951]—(NRS A 1963, 961; 1971, 937; 1973, 1285; 2009, 1446; 2011, 359, 1067, 1360, 2255, 2398)

      NRS 449.240  Institution and conduct of prosecutions.  The district attorney of the county in which the facility is located shall, upon application by the Division, institute and conduct the prosecution of any action for violation of any provisions of NRS 449.030 to 449.245, inclusive.

      [Part 8:336:1951]—(NRS A 1963, 962; 1971, 937; 1973, 1286; 1975, 899; 2009, 1446; 2011, 359, 1360, 2256, 2399)

REQUIREMENTS RELATING TO STAFFING

      NRS 449.241  Definitions.  As used in NRS 449.241 to 449.2428, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.2413 to 449.2418, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 2009, 2024; A 2013, 2150)

      NRS 449.2413  “Certified nursing assistant” defined.  “Certified nursing assistant” means a person who has been certified by the State Board of Nursing pursuant to NRS 632.2852 to practice as a nursing assistant in this State.

      (Added to NRS by 2013, 2143)

      NRS 449.2414  “Health care facility” defined.  “Health care facility” means:

      1.  A hospital;

      2.  An independent center for emergency medical care;

      3.  A psychiatric hospital; and

      4.  A surgical center for ambulatory patients.

      (Added to NRS by 2009, 2024)

      NRS 449.2416  “Licensed nurse” defined.  “Licensed nurse” means a person licensed pursuant to chapter 632 of NRS to practice nursing, including, without limitation, a licensed practical nurse. The term does not include a certified nursing assistant or a medication aide - certified.

      (Added to NRS by 2009, 2024; A 2011, 1341; 2013, 2150)

      NRS 449.2418  “Unit” defined.  “Unit” means a component within a health care facility for providing patient care.

      (Added to NRS by 2009, 2024)

      NRS 449.242  Establishment of staffing committee by certain hospitals in larger counties; membership; duty to develop documented staffing plan; duty to consider certain requests; quarterly meetings; reporting to Legislature.

      1.  Each hospital located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall establish a staffing committee to develop a written policy as required pursuant to NRS 449.2423 and a documented staffing plan as required pursuant to NRS 449.2421. The staffing committee must consist of:

      (a) Not less than one-half of the total members of the staffing committee from the licensed nursing staff and certified nursing assistants who are providing direct patient care at the hospital; and

      (b) Not less than one-half of the total members of the staffing committee appointed by the administration of the hospital.

      2.  In developing the written policy and the staffing plan, the staffing committee shall consider, without limitation, the information received pursuant to paragraph (b) of subsection 5 of NRS 449.2423 regarding requests to be relieved of a work assignment, refusals of a work assignment and objections to a work assignment.

      3.  The staffing committee of a hospital shall meet at least quarterly.

      4.  Each hospital that is required to establish a staffing committee pursuant to this section shall prepare a written report concerning the establishment of the staffing committee, the activities and progress of the staffing committee and a determination of the efficacy of the staffing committee. The hospital shall submit the report on or before December 31 of each:

      (a) Even-numbered year to the Director of the Legislative Counsel Bureau for transmission to the next regular session of the Legislature.

      (b) Odd-numbered year to the Legislative Committee on Health Care.

      (Added to NRS by 2009, 2024; A 2013, 2151)

      NRS 449.2421  Certain health care facilities in larger counties required to make available to Division written policy that allows refusal of or objection to work assignments and documented staffing plan; requirements of staffing plan and flexibility for adjustments.

      1.  As a condition of licensing, a health care facility located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds shall make available to the Division a written policy adopted pursuant to NRS 449.2423, a documented staffing plan and a written certification that the written policy and the documented staffing plan are adequate to meet the needs of the patients of the health care facility. The documented staffing plan must include, without limitation:

      (a) A detailed written plan setting forth:

             (1) The number, skill mix and classification of licensed nurses required in each unit in the health care facility, which must take into account the experience of the clinical and nonclinical support staff with whom the licensed nurses collaborate, supervise or otherwise delegate assignments; and

             (2) The number of certified nursing assistants required in each unit in the health care facility;

      (b) A description of the types of patients who are treated in each unit, including, without limitation, the type of care required by the patients;

      (c) A description of the activities in each unit, including, without limitation, discharges, transfers and admissions;

      (d) A description of the size and geography of each unit;

      (e) A description of any specialized equipment and technology available for each unit;

      (f) Any foreseeable changes in the size or function of each unit; and

      (g) Protocols for adequately staffing the health care facility:

             (1) In the event of an emergency, including, without limitation, mass casualties and a significant change in the acuity or number of patients;

             (2) If applicable, in circumstances when a significant number of patients are diverted from another facility; and

             (3) If a licensed nurse or certified nursing assistant is absent or refuses a work assignment pursuant to NRS 449.2423.

      2.  A documented staffing plan must provide sufficient flexibility to allow for adjustments based upon changes in a unit of the health care facility.

      3.  The health care facility shall ensure that it is staffed in accordance with the documented staffing plan.

      (Added to NRS by 2009, 2025; A 2013, 2151)

      NRS 449.2423  Certain health care facilities in larger counties to adopt written policy to allow nurse or certified nursing assistant to refuse or object to work assignments; requirements of policy; maintenance of records of refusals of and objections to work assignments.

      1.  As a condition of licensure, a health care facility which is located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds must adopt and disseminate to each licensed nurse and certified nursing assistant employed by the health care facility a written policy that sets forth the circumstances under which a licensed nurse or certified nursing assistant may refuse or object to a work assignment.

      2.  The written policy concerning work assignments must, at a minimum, allow a licensed nurse or certified nursing assistant to:

      (a) Refuse a work assignment for any reason for refusal set forth in paragraph (b) of subsection 1 of NRS 449.205; and

      (b) File an objection to a work assignment if the work assignment violates any provision of NRS 449.241 to 449.2428, inclusive.

      3.  For the purposes of refusing a work assignment pursuant to paragraph (a) of subsection 2, the written policy concerning work assignments must contain:

      (a) Reasonable requirements for prior notice to the supervisor of the licensed nurse or certified nursing assistant of the request by the licensed nurse or certified nursing assistant to be relieved of the work assignment, including, without limitation, the reasons supporting the request;

      (b) Reasonable requirements which provide, if feasible, an opportunity for the supervisor to review a request by the licensed nurse or certified nursing assistant to be relieved of the work assignment, including any specific conditions supporting the request, and based upon that review:

             (1) Relieve the licensed nurse or certified nursing assistant of the work assignment as requested; or

             (2) Deny the request; and

      (c) A process pursuant to which a licensed nurse or certified nursing assistant may exercise his or her right to refuse a work assignment if the supervisor does not approve the request to be relieved of the work assignment if:

             (1) The supervisor failed to approve the request without proposing a remedy or, if a remedy is proposed, the proposed remedy would be inadequate or untimely;

             (2) The process for filing a complaint with the Division or any other appropriate regulatory entity, including any investigation that would be required, would be untimely to address the concerns of the licensed nurse or certified nursing assistant in refusing a work assignment; and

             (3) The licensed nurse or certified nursing assistant in good faith believes that the work assignment meets the conditions established in the written policy justifying refusal.

      4.  For the purposes of objecting to a work assignment pursuant to paragraph (b) of subsection 2, the written policy concerning work assignments must contain:

      (a) A process for a licensed nurse or certified nursing assistant to file an objection with the health care facility, but still accept the work assignment despite the objection; and

      (b) A requirement that the health care facility respond to the objection as soon as practicable, but not later than 45 days after receiving the objection.

      5.  The health care facility shall:

      (a) Maintain records for at least 2 years of each request to be relieved of a work assignment, each refusal of a work assignment and each objection to a work assignment that is filed with the health care facility pursuant to the written policy adopted pursuant to this section;

      (b) If the health care facility has established a staffing committee pursuant to NRS 449.242, provide to the staffing committee:

             (1) The number of requests to be relieved of a work assignment and refusals of a work assignment made by a licensed nurse or a certified nursing assistant at the health care facility pursuant to this section;

             (2) The number of objections to a work assignment filed by a licensed nurse or a certified nursing assistant at the health care facility pursuant to this section; and

             (3) An explanation of how the health care facility addressed the requests, refusals and objections; and

      (c) Ensure that the health care facility complies with the written policy adopted pursuant to this section.

      (Added to NRS by 2013, 2143)

      NRS 449.2428  Division required to ensure that certain health care facilities comply with provisions; regulations.  For each health care facility which is located in a county whose population is 100,000 or more and which is licensed to have more than 70 beds, the Division shall:

      1.  Ensure the general compliance of the health care facility with the provisions of NRS 449.241 to 449.2428, inclusive, including, without limitation, those provisions relating to documented staffing plans and written policies adopted pursuant to NRS 449.2423; and

      2.  Adopt such regulations as are necessary or appropriate to carry out the provisions of this section.

      (Added to NRS by 2013, 2145)

MISCELLANEOUS PROVISIONS

      NRS 449.243  Itemized list of charges required; use of Uniform Billing and Claims Forms authorized; contracted rates; summary of charges.  Every hospital licensed pursuant to the provisions of NRS 449.030 to 449.2428, inclusive:

      1.  May, except as otherwise provided in subsection 2, utilize the Uniform Billing and Claims Forms established by the American Hospital Association.

      2.  Shall, except as otherwise provided in this section, on its billings to patients, itemize, on a daily basis, all charges for services, and charges for equipment used and the supplies and medicines provided incident to the provision of those services with specificity and in language that is understandable to an ordinary lay person. This itemized list must be timely provided after the patient is discharged at no additional cost.

      3.  Except as otherwise provided in this subsection, if a patient is charged a rate, pursuant to a contract or other agreement, that is different than the billed charges, shall provide to the patient either:

      (a) A copy of the billing prepared pursuant to subsection 2;

      (b) A statement specifying the agreed rate for the services; or

      (c) If the patient is not obligated to pay any portion of the bill, a statement of the total charges.

Ê In any case, the hospital shall include on the billing or statement any copayment or deductible for which the patient is responsible. The hospital shall answer any questions regarding the bill.

      4.  If the hospital is paid by the insurer of a patient a rate that is based on the number of persons treated and not on the services actually rendered, shall, upon the discharge of the patient, advise the patient of the status of any copayment or deductible for which the patient is responsible.

      5.  Shall prepare a summary of charges for common services for patients admitted to the hospital and make it available to the public.

      6.  Shall provide to any patient upon request a copy of the billing prepared pursuant to subsection 2.

      (Added to NRS by 1975, 897; A 1983, 649; 1985, 905; 1993, 2427; 1995, 1856)

      NRS 449.244  Certain costs for examination or treatment of victims of sexual offenses to be charged to county.  Repealed. (See chapter 142, Statutes of Nevada 2013, at page 487.)

 

      NRS 449.245  Release of child from hospital; provision of authorization for release and other information to Division of Child and Family Services; disclosure of information; penalty.

      1.  No hospital licensed under the provisions of NRS 449.030 to 449.2428, inclusive, may release from the hospital or otherwise surrender physical custody of any child under 6 months of age, whose living parent or guardian is known to the hospital, to any person other than a parent, guardian or relative by blood or marriage of that child, without a written authorization signed by a living parent, who must be the mother if unwed, or guardian specifying the particular person or agency to whom the child may be released and the permanent address of that person or agency.

      2.  Upon the release or other surrender of physical custody of the child, the hospital shall require from the person to whom the child is released such reasonable proof of identity as the hospital may deem necessary for compliance with the provisions of this section. The hospital shall furnish a true copy of the written authorization to the Division of Child and Family Services of the Department of Health and Human Services before the release or other surrender by it of physical custody of the child. The copy must be furnished to the Division immediately upon receipt by the hospital.

      3.  Any person to whom any such child is released who thereafter surrenders physical custody of that child to any other person or agency shall, upon demand by the Division of Child and Family Services, disclose to the Division the name and permanent address of the person or agency to whom physical custody of the child was delivered.

      4.  Except as otherwise provided in NRS 239.0115, all information received by the Division of Child and Family Services pursuant to the provisions of this section is confidential and must be protected from disclosure in the same manner that information is protected under NRS 432.035.

      5.  Compliance with the provisions of this section is not a substitute for compliance with NRS 127.220 to 127.310, inclusive, governing placements for adoption and permanent free care.

      6.  A violation of any provision of this section is a misdemeanor.

      (Added to NRS by 1957, 251; A 1961, 739; 1963, 962; 1967, 1172; 1973, 1286, 1406; 1981, 721; 1993, 2724; 2007, 2109)

      NRS 449.2455  Authority of hospital to enter into agreement with Armed Forces of United States for provision of medical care by certain medical officers.

      1.  A hospital may enter into an agreement with the Armed Forces of the United States to authorize a medical officer to provide medical care in the hospital if:

      (a) The medical officer holds a valid license in good standing to provide such medical care in the District of Columbia or any state or territory of the United States;

      (b) The medical care is provided as part of a training or educational program designed to further the employment of the medical officer; and

      (c) The agreement complies with the provisions of 10 U.S.C. § 1094 and any regulations or guidelines adopted pursuant thereto.

      2.  As used in this section, “medical officer” includes any physician, nurse, dentist or other health care professional who is employed by the Armed Forces of the United States or a reserve component thereof.

      (Added to NRS by 2009, 818)

      NRS 449.246  Hospital or obstetric center to provide information relating to voluntary acknowledgment or establishment of paternity before discharging unmarried woman who has borne child; regulations.

      1.  Before discharging an unmarried woman who has borne a child, a hospital or obstetric center shall provide to the child’s mother and father:

      (a) The opportunity to sign, in the hospital, a declaration for the voluntary acknowledgment of paternity developed pursuant to NRS 440.283;

      (b) Written materials about establishing paternity;

      (c) The forms necessary to acknowledge paternity voluntarily;

      (d) A written description of the rights and responsibilities of acknowledging paternity; and

      (e) The opportunity to speak by telephone with personnel of the program for enforcement of child support who are trained to clarify information and answer questions about the establishment of paternity.

      2.  The Administrator of the Division of Welfare and Supportive Services of the Department of Health and Human Services shall adopt the regulations necessary to ensure that the services provided by a hospital or obstetric center pursuant to this section are in compliance with the regulations adopted by the Secretary of Health and Human Services pursuant to 42 U.S.C. § 666(a)(5)(C).

      (Added to NRS by 1995, 2426; A 1997, 2341; 2007, 1529)

      NRS 449.2465  Persons entitled to results of tests performed at laboratory regarding patient of rural hospital.  The following persons are entitled to access the results of tests performed at a licensed laboratory regarding a patient of a rural hospital:

      1.  The patient;

      2.  The physician who ordered the tests; and

      3.  A provider of health care who is currently treating or providing assistance in the treatment of the patient.

      (Added to NRS by 1995, 1600)

      NRS 449.247  Powers and duties of Division and State Board of Nursing with respect to nursing assistants and medication aides - certified and training of nursing assistants and medication aides - certified; provision of information to State Board of Nursing.

      1.  The Division may review the personnel files of a medical facility or facility for the dependent to determine that each nursing assistant or medication aide - certified employed by the facility has a current certificate.

      2.  The Division shall review the qualifications of instructors of nursing assistants or medication aides - certified for each program of which the Division is notified pursuant to NRS 632.127.

      3.  The Division may conduct the review of training programs for nursing assistants or medication aides - certified in facilities for long-term care.

      4.  The Division and any other state agency which regulates medical facilities and facilities for the dependent shall provide to the State Board of Nursing any information it discovers concerning:

      (a) Programs and instructors for training nursing assistants or medication aides - certified which do not comply with the requirements established by the State Board of Nursing.

      (b) The failure of a nursing assistant or medication aide - certified to perform consistently at a safe level.

      (c) The results of any investigation of a facility if the investigation concerns a nursing assistant, medication aide - certified or instructor or training program for nursing assistants or medication aides - certified.

      5.  The State Board of Nursing shall investigate any report submitted pursuant to subsection 4 and may revoke approval of a program or instructor if the allegations of the report are true.

      (Added to NRS by 1989, 2017; A 2011, 1341)

      NRS449.2475  Unlicensed insurer not allowed to make payment directly to person who received services in certain circumstances; limitation on civil and criminal liability.

      1.  An insurer that is not licensed in this State pursuant to title 57 of NRS and that is obligated to pay benefits for services provided to a person by a hospital or other provider of health care, or to reimburse a person for the costs of such services, shall not make the payment directly to the person if an itemized statement for the services is submitted to the insurer which clearly indicates that the right of the person to those benefits has been assigned to the hospital or other provider of health care.

      2.  The provisions of this section do not create grounds for civil or criminal liability.

      (Added to NRS by 2007, 734)

      NRS 449.248  Additional services to be provided by agency to provide nursing in home.  An agency to provide nursing in the home shall, in addition to skilled nursing, provide at least one of the following services:

      1.  Speech or occupational therapy;

      2.  Guidance regarding nutrition or vocations;

      3.  Physical therapy;

      4.  Pharmaceutical services; or

      5.  Other social or medical services.

      (Added to NRS by 1979, 160; A 1985, 1742)

      NRS 449.2485  Return to dispensing pharmacy of unused prescription drug dispensed to patient of facility for skilled nursing or facility for intermediate care for purpose of reissuing drug or transferring drug.

      1.  A facility for skilled nursing or a facility for intermediate care may return a prescription drug that is dispensed to a patient of the facility, but will not be used by that patient, to the dispensing pharmacy for the purpose of reissuing the drug to fill other prescriptions for patients in that facility or for the purpose of transferring the drug to a nonprofit pharmacy designated by the State Board of Pharmacy pursuant to NRS 639.2676 if:

      (a) The drug is not a controlled substance;

      (b) The drug is dispensed in a unit dose, in individually sealed doses or in a bottle sealed by the manufacturer of the drug;

      (c) The drug is returned unopened and sealed in the original manufacturer’s packaging or bottle;

      (d) The usefulness of the drug has not expired;

      (e) The packaging or bottle contains the expiration date of the usefulness of the drug; and

      (f) The name of the patient for whom the drug was originally prescribed, the prescription number and any other identifying marks are obliterated from the packaging or bottle before the return of the drug.

      2.  A dispensing pharmacy to which a drug is returned pursuant to this section may:

      (a) Reissue the drug to fill other prescriptions for patients in the same facility if the registered pharmacist of the pharmacy determines that the drug is suitable for that purpose in accordance with standards adopted by the State Board of Pharmacy pursuant to subsection 5; or

      (b) Transfer the drug to a nonprofit pharmacy designated by the State Board of Pharmacy pursuant to NRS 639.2676.

      3.  No drug that is returned to a dispensing pharmacy pursuant to this section may be used to fill other prescriptions more than one time.

      4.  A facility for skilled nursing or facility for intermediate care shall adopt written procedures for returning drugs to a dispensing pharmacy pursuant to this section. The procedures must:

      (a) Provide appropriate safeguards for ensuring that the drugs are not compromised or illegally diverted during their return.

      (b) Require the maintenance and retention of such records relating to the return of drugs to dispensing pharmacies as are required by the State Board of Pharmacy.

      (c) Be approved by the State Board of Pharmacy.

      5.  The State Board of Pharmacy shall adopt such regulations as are necessary to carry out the provisions of this section, including, without limitation, requirements for:

      (a) Returning and reissuing such drugs pursuant to the provisions of this section.

      (b) Transferring drugs to a nonprofit pharmacy pursuant to the provisions of this section and NRS 639.2676.

      (c) Maintaining records relating to the return and the use of such drugs to fill other prescriptions.

      (Added to NRS by 2003, 1372; A 2009, 1087)

      NRS449.2486  Facility for care of adults during the day to maintain and provide certain information; form in which information to be provided.

      1.  A facility for the care of adults during the day shall maintain a copy of:

      (a) The license issued to the facility pursuant to NRS 449.030 to 449.2428, inclusive;

      (b) Any summaries of complaints provided to the facility pursuant to subsection 3 of NRS 449.160;

      (c) The report of any investigation conducted with respect to the complaints; and

      (d) The report of any disciplinary action taken against the facility pursuant to NRS 449.160 or 449.163.

      2.  The information maintained pursuant to subsection 1 must be provided in the form prescribed pursuant to subsection 3:

      (a) To each patient or the patient’s legal representative, at or before the time of admission.

      (b) To a prospective patient or the prospective patient’s legal representative, upon request, who is considering admission of the patient to the facility.

      (c) In the case of disciplinary action taken pursuant to NRS 449.160 or 449.163, to all patients admitted to the facility and their legal representatives. Notice of disciplinary action must be provided to the legal representatives of all patients admitted to the facility within 3 working days after receipt by the facility.

      3.  The Division shall develop a standard form for reporting the information required to be provided pursuant to subsection 2. The information reported on the form must include all required information for the 12-month period ending on the last day of the month immediately preceding the month in which the information is provided.

      4.  The Division shall inform persons seeking information concerning facilities for the care of adults during the day of their right to information pursuant to this section.

      (Added to NRS by 2007, 270)

      NRS449.2487  Notice to be provided by certain facilities which offer independent living.

      1.  A facility for the dependent, a medical facility or an entity affiliated with such a facility which offers housing to persons that does not include the provision of care or services which require licensure pursuant to this chapter shall conspicuously post in the facility and shall include in any contracts of sale or agreements for occupancy a notice that includes the following information:

      (a) That the specific area of the facility is intended for independent living and does not directly provide or coordinate the oversight of services to meet the scheduled and unscheduled needs of its residents, including, without limitation, the provision of personal care, supportive services and health-related services.

      (b) The other levels of care that are available to persons who require personal care, supportive services or health-related services, including, without limitation, residential facilities for groups, facilities for intermediate care and facilities for skilled nursing. The notice must describe the facilities and levels of care in language that is easy to understand.

      (c) A statement that encourages residents to reassess on a regular basis the type of housing and care that is most appropriate for them.

      2.  The Aging and Disability Services Division of the Department of Health and Human Services shall develop the language for the notice required by subsection 1 in consultation with nationally recognized advocacy groups for older persons and housing organizations.

      3.  For the purposes of this section, an entity is affiliated with a facility described in subsection 1 if:

      (a) It is under common or shared ownership;

      (b) It is under common or shared management; or

      (c) It receives promotional or marketing support from the facility.

      (Added to NRS by 2007, 2466; A 2011, 359)

      NRS449.2488  Department to develop brochure and website to assist persons who are 55 years of age or older in determining appropriate level of care and type of housing; information to be included in brochure and website.

      1.  The Department of Health and Human Services shall develop a brochure and website to assist persons who are 55 years of age or older in determining the appropriate level of care and type of housing that they require to meet their individual needs. The brochure and website must include, without limitation:

      (a) The various types of housing and levels of care that are available to persons who are 55 years of age or older, including, without limitation, residential facilities for groups, facilities for intermediate care and facilities for skilled nursing, distinguishing the varying degree of services that are offered by the different types of facilities;

      (b) Whether individual facilities accept payment through Medicaid or Medicare for the level of care and type of housing that the facilities provide;

      (c) The manner in which a person may obtain information concerning whether the facility has ever been found to have violated the provisions of this chapter; and

      (d) Such other information as the Department deems to be beneficial to persons who are 55 years of age or older in determining the appropriate level of care and type of housing that they require to meet their individual needs.

      2.  As used in this section:

      (a) “Medicaid” has the meaning ascribed to it in NRS 439B.120.

      (b) “Medicare” has the meaning ascribed to it in NRS 439B.130.

      (Added to NRS by 2007, 2467)

FACILITIES FOR REFRACTIVE SURGERY

      NRS 449.2489  Definitions.  As used in NRS 449.2489 to 449.24898, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.24891 to 449.24894, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 2009, 450)

      NRS 449.24891  “Ophthalmologist” defined.  “Ophthalmologist” means a physician who is qualified to perform laser surgery or intense pulsed light therapy on the globe of the eye pursuant to NRS 630.371 or 633.693.

      (Added to NRS by 2009, 450)

      NRS 449.24892  “Postoperative care” defined.  “Postoperative care” means assessing, monitoring or treating a patient while the patient is recovering or healing from a surgical treatment for a refractive error of the eye.

      (Added to NRS by 2009, 451)

      NRS 449.24893  “Preoperative care” defined.  “Preoperative care” means assessing or treating a patient in preparation for a surgical treatment for a refractive error of the eye.

      (Added to NRS by 2009, 451)

      NRS 449.24894  “Surgical treatment for a refractive error of the eye” defined.  “Surgical treatment for a refractive error of the eye” means the surgical treatment of a patient with a refractive error of the eye by:

      1.  Photorefractive keratectomy;

      2.  Laser in situ keratomileusis;

      3.  Conductive keratoplasty;

      4.  Implantation of an intraocular lens; or

      5.  Any other available technology, technique or procedure which surgically treats refractive errors of the eye and which has been approved by the United States Food and Drug Administration.

      (Added to NRS by 2009, 451)

      NRS 449.24895  Certain persons not required to obtain license to operate and maintain facility; filing of affidavit with Division required.  A person is not required to obtain a license to operate and maintain a facility for refractive surgery pursuant to the provisions of this chapter if the person:

      1.  Is an ophthalmologist;

      2.  Provides surgical procedures to patients at the facility in addition to preoperative care, postoperative care and surgical treatments for refractive errors of the eye; and

      3.  Files with the Division an affidavit attesting that the person provides surgical procedures at the facility in addition to preoperative care, postoperative care and surgical treatments for refractive errors of the eye.

      (Added to NRS by 2009, 451)

      NRS 449.24896  Surgical treatments at facility must be performed by licensed ophthalmologist; availability of ophthalmologist.  A facility for refractive surgery shall ensure that:

      1.  All surgical treatments for refractive errors of the eye performed at the facility are performed only by an ophthalmologist.

      2.  The ophthalmologist who performs a surgical treatment for refractive errors of the eye at the facility:

      (a) Is available in person for postoperative care if the medical needs of a patient necessitate the services of an ophthalmologist; or

      (b) Enters into an agreement with another ophthalmologist to be available in person for postoperative care if the medical needs of the patient necessitate the services of an ophthalmologist.

      (Added to NRS by 2009, 451)

      NRS 449.24897  Order to cease and desist operation for failure to obtain license; injunction; penalties.

      1.  If the Division believes that a person who is required to obtain a license pursuant to this chapter is operating a facility for refractive surgery without such a license, the Division may issue an order to cease and desist the operation of the facility. The order must be served upon the person directly or by certified or registered mail, return receipt requested. The order becomes effective upon service.

      2.  An order issued pursuant to subsection 1 expires 30 days after the date of service unless the Division institutes an action in a court of competent jurisdiction seeking an injunction.

      3.  Upon a showing by the Division that a person is operating a facility for refractive surgery without a license issued pursuant to this chapter, a court of competent jurisdiction may:

      (a) Enjoin the person from operating the facility.

      (b) Impose a civil penalty to be recovered by the Division of not more than $10,000 for the first offense and of not less than $10,000 or more than $20,000 for a second or subsequent offense.

      4.  A person enjoined or penalized pursuant to subsection 3 may not apply for a license to operate a facility for refractive surgery for a period of 6 months after the date on which the court issues the injunction or penalty.

      (Added to NRS by 2009, 451)

      NRS 449.24898  Collaboration between ophthalmologist and optometrist authorized pursuant to NRS 636.374.  The provisions of NRS 449.2489 to 449.24898, inclusive, do not prohibit an ophthalmologist from collaborating with an optometrist to provide care to a patient if the collaboration complies with the requirements of NRS 636.374.

      (Added to NRS by 2009, 452)

NEVADA HEALTH FACILITIES ASSISTANCE ACT

      NRS 449.250  Short title.  NRS 449.250 to 449.430, inclusive, may be cited as the Nevada Health Facilities Assistance Act.

      [1:219:1949; 1943 NCL § 5285.01]—(NRS A 1965, 983; 2011, 3575)

      NRS 449.260  Definitions.  As used in NRS 449.250 to 449.430, inclusive:

      1.  “Community mental health center” means a facility providing services for the prevention or diagnosis of mental illness, or care and treatment of patients with mental illness, or rehabilitation of such persons, which services are provided principally for persons residing in a particular community in or near which the facility is situated.

      2.  “Construction” includes the construction of new buildings, modernization, expansion, remodeling and alteration of existing buildings, and initial equipment of such buildings, including medical transportation facilities, and includes architects’ fees, but excludes the cost of off-site improvements and, except with respect to public health centers, the cost of the acquisition of the land.

      3.  “Facility for persons with intellectual disabilities” means a facility specially designed for the diagnosis, treatment, education, training or custodial care of persons with intellectual disabilities, including facilities for training specialists and sheltered workshops for persons with intellectual disabilities, but only if such workshops are part of facilities which provide or will provide comprehensive services for persons with intellectual disabilities.

      4.  “Federal Act” means 42 U.S.C. §§ 291 to 291o-l, inclusive, and 300k to 300t, inclusive, and any other federal law providing for or applicable to the provision of assistance for health facilities.

      5.  “Federal agency” means the federal department, agency or official designated by law, regulation or delegation of authority to administer the Federal Act.

      6.  “Health facility” includes a public health center, hospital, facility for hospice care, facility for persons with intellectual disabilities, community mental health center, and other facility to provide diagnosis, treatment, care, rehabilitation, training or related services to persons with physical or mental impairments, including diagnostic or diagnostic and treatment centers, rehabilitation facilities and nursing homes, as those terms are defined in the Federal Act, and such other facilities for which federal aid may be authorized under the Federal Act, but, except for facilities for persons with intellectual disabilities, does not include any facility furnishing primarily domiciliary care.

      7.  “Nonprofit health facility” means any health facility owned and operated by a corporation or association, no part of the net earnings of which inures or may lawfully inure to the benefit of any private shareholder or natural person.

      8.  “Public health center” means a publicly owned facility for the provision of public health services, including related facilities such as laboratories, clinics and administrative offices operated in connection with public health centers.

      9.  “State Department” means the Department of Health and Human Services, acting through its appropriate divisions.

      [2:219:1949; A 1956, 47]—(NRS A 1963, 962; 1965, 983; 1967, 1173; 1973, 1406; 1975, 909; 1977, 258; 1979, 1113; 1985, 1743; 1989, 1036; 1999, 249; 2011, 3575; 2013, 697)

      NRS 449.270  State Department to constitute sole agency of State for certain purposes.  The State Department shall constitute the sole agency of the State for the purpose of:

      1.  Inventorying existing health facilities, surveying the need for construction of health facilities, and developing programs of health facilities construction as provided in NRS 449.250 to 449.430, inclusive.

      2.  Developing and administering state plans for the construction of public and other nonprofit health facilities as provided in NRS 449.250 to 449.430, inclusive.

      3.  Developing and administering any other plan or program providing assistance to health facilities for which funds may be available to this state under the Federal Act.

      [3:219:1949; 1943 NCL § 5285.03]—(NRS A 1965, 985)

      NRS 449.280  Duties of State Department.  In carrying out the purposes of NRS 449.250 to 449.430, inclusive, the State Department is authorized and directed:

      1.  To require such reports, make such inspections and investigations, and prescribe such regulations as it deems necessary.

      2.  To provide such methods of administration, appoint all necessary officers and other personnel and take such other action as may be necessary to comply with the requirements of NRS 449.250 to 449.430, inclusive, the Federal Act and the regulations thereunder.

      3.  To procure in its discretion the temporary or intermittent services of experts or consultants, by contract, when such services are to be performed on a part-time or fee-for-service basis and do not involve the performance of administrative duties.

      4.  To the extent that it considers desirable to effectuate the purposes of NRS 449.250 to 449.430, inclusive, to enter into agreements for the utilization of the facilities and services of other departments, agencies and institutions, public or private.

      5.  To accept on behalf of the State and to deposit with the State Treasurer in appropriate accounts in the Department of Health and Human Services’ Gift Fund any grant, gift or contribution made to assist in meeting the cost of carrying out the purposes of NRS 449.250 to 449.430, inclusive, and to expend the same for such purposes.

      6.  To do all other things on behalf of the State necessary or advisable to obtain the maximum benefits available under the Federal Act.

      7.  All claims must be approved by the Health Officer before they are paid.

      [4:219:1949; 1943 NCL § 5285.04]—(NRS A 1965, 985; 1969, 945; 1981, 79)

      NRS 449.300  Inventory of existing health facilities; development of program for construction of facilities.  The State Department is authorized and directed to inventory existing health facilities, including public, nonprofit, and proprietary health facilities, to survey the need for construction of health facilities, and, on the basis of such inventory and survey, to develop programs for the construction of such public and other nonprofit health facilities as will, in conjunction with existing facilities, afford the necessary physical facilities for furnishing adequate health facility services to all the people of the State.

      [7:219:1949; 1943 NCL § 5285.07]—(NRS A 1965, 986)

      NRS 449.310  Requirements of program for construction of health facilities.  The construction programs must provide, in accordance with NRS 449.250 to 449.430, inclusive, and the regulations thereunder, for adequate health facilities for the people residing in this State, and, insofar as possible, must provide for their distribution throughout the State in such manner as to make the services of all types of health facilities reasonably accessible to all persons in the State.

      [9:219:1949; 1943 NCL § 5285.09]—(NRS A 1965, 986; 1981, 1901)

      NRS 449.320  Application for federal money; deposit of money.

      1.  The State Department may apply to the federal agency for federal money to assist in carrying out the surveys, planning and construction activities provided for in NRS 449.250 to 449.430, inclusive.

      2.  The money must be deposited in the State Treasury and must be available to the State Department for expenditure for carrying out the purposes of NRS 449.250 to 449.430, inclusive.

      [8:219:1949; 1943 NCL § 5285.08]—(NRS A 1965, 987; 1981, 1901)

      NRS 449.340  State Department to prescribe minimum standards; standards to supersede local ordinances and regulations; penalty.

      1.  The State Department may, by regulation, establish standards for the maintenance and operation of health facilities, which supersede all local ordinances and regulations inconsistent therewith.

      2.  A copy of the regulations, giving the date that they take effect, must be issued in pamphlet form.

      3.  Any health facility that applies for and accepts federal aid for construction under a state plan does so on the condition that the health facility qualify under the minimum standards for maintenance and operation adopted and enforced by the State Department.

      4.  Any person, partnership, association or corporation establishing, conducting, managing or operating any health facility within the meaning of NRS 449.250 to 449.430, inclusive, who violates any of the provisions of this section or regulations lawfully adopted thereunder is guilty of a misdemeanor.

      [11:219:1949; 1943 NCL § 5285.11] + [12:219:1949; 1943 NCL § 5285.12]—(NRS A 1963, 963; 1965, 987; 1971, 937; 1985, 369)

      NRS 449.345  Restriction on adoption of regulations concerning construction, maintenance, operation or safety of building, structure or other property.  Before the State Department may adopt any regulation concerning the construction, maintenance, operation or safety of a building, structure or other property in this State, the State Department shall consult with the Deputy Administrator of the Public Works - Compliance and Code Enforcement Section for the purposes of subsection 9 of NRS 341.100.

      (Added to NRS by 2011, 3574; A 2013, 397)

      NRS 449.360  Application for construction of health facility: Filing; compliance with federal and state requirements.

      1.  Applications for health facility construction projects for which federal funds are required must be submitted to the appropriate health systems agency and the State Department. They may be submitted by the State or any political subdivision thereof or by any public or nonprofit agency authorized to construct and operate a health facility.

      2.  Each application for a construction project must conform to federal and state requirements and must be submitted in the manner and form prescribed by the State Department.

      [14:219:1949; 1943 NCL § 5285.14]—(NRS A 1965, 988; 1979, 969)

      NRS 449.370  Application for construction of health facility: Notice and hearing; approval and forwarding.

      1.  The State Department shall afford to every applicant for assistance for a construction project an opportunity for a fair hearing before the State Department upon 10 days’ written notice to the applicant.

      2.  If the State Department, after affording reasonable opportunity for development and presentation of applications in the order of relative need, finds that an application is in conformity with the state plan, the State Department shall approve the application and shall recommend and forward it to the federal agency.

      3.  The State Department shall consider and forward applications in the order of relative need set forth in the state plan.

      [15:219:1949; 1943 NCL § 5285.15]—(NRS A 1965, 988; 1981, 856; 1985, 1362)

      NRS 449.380  Inspection of construction of health facility; certification by State Department.  From time to time, the State Department shall inspect each construction project approved by the federal agency and, if the inspection so warrants, the State Department shall certify to the federal agency that work has been performed upon the project, or that purchases have been made, in accordance with the approved plans and specifications, and that payment of an installment of federal funds is due to the applicant.

      [16:219:1949; 1943 NCL § 5285.16]—(NRS A 1965, 988)

      NRS 449.390  Authority to receive and distribute federal money; Health Facilities Assistance Fund; deposits, use and controls.

      1.  The State Department is hereby authorized to receive federal funds in behalf of, and transmit them to, applicants.

      2.  There is hereby established a nonreverting trust fund designated as the Health Facilities Assistance Fund. Money received from the Federal Government for a construction project approved by the federal agency shall be transmitted to the State Treasurer to be deposited in the State Treasury to the credit of the Health Facilities Assistance Fund, and shall be used solely for payments due applicants for work performed, purchases made or other approved expenditures in carrying out approved projects or plans, except that any moneys in such Fund which become available under the Federal Act and regulations for expenditure in administering an approved state plan may be expended for that purpose.

      3.  The State Department shall establish and maintain such accounts and fiscal controls of moneys deposited in and disbursed from the Health Facilities Assistance Fund as may be required by the Federal Act and regulations promulgated thereunder.

      [17:219:1949; 1943 NCL § 5285.17]—(NRS A 1965, 988; 1975, 259)

      NRS 449.400  State Public Health Facilities Construction Assistance Fund: Creation; administration.

      1.  In order to provide state assistance for construction projects for publicly owned general hospitals, hospitals for the chronically ill and impaired, facilities for persons with intellectual disabilities, community mental health facilities, diagnostic or diagnostic and treatment centers, rehabilitation facilities, nursing homes and other facilities financed in part by federal funds in accordance with NRS 449.250 to 449.430, inclusive, and to promote maximum utilization of federal funds available for such projects, there is hereby created in the State Treasury a nonreverting trust fund to be known as the State Public Health Facilities Construction Assistance Fund. Money for the Fund may be provided from time to time by legislative appropriation.

      2.  The State Public Health Facilities Construction Assistance Fund must be administered by the State Department in accordance with the purposes and provisions of NRS 449.250 to 449.430, inclusive.

      [17.1:219:1949; added 1956, 47]—(NRS A 1965, 989; 1985, 1744; 2013, 698)

      NRS 449.410  State assistance for construction of certain projects; eligibility of project for assistance.

      1.  Money in the State Public Health Facilities Construction Assistance Fund must be used to supplement money from the Federal Government and money provided by the sponsor of a project for approved projects for the construction of publicly owned general hospitals, hospitals for the chronically ill or impaired, facilities for persons with intellectual disabilities, community mental health facilities, diagnostic or diagnostic and treatment centers, rehabilitation facilities, nursing homes and other facilities financed in part by federal funds pursuant to NRS 449.250 to 449.430, inclusive, and for no other purpose or purposes.

      2.  Applications for state assistance for construction projects must be submitted to the State Department for consideration in the manner prescribed in NRS 449.250 to 449.430, inclusive, for applications for federal assistance.

      3.  No project is entitled to receive state assistance unless it is entitled to receive federal assistance.

      [17.2:219:1949; added 1956, 47]—(NRS A 1965, 989; 1985, 1744; 2013, 698)

      NRS 449.420  Amount of state assistance: Allocations; payments.  Money in the State Public Health Facilities Construction Assistance Fund must be allocated and paid to construction projects on the basis of relative need in accordance with the need identified in the state health plan and in accordance with a ratio between state money and federal money determined by the State Department. In no event may the amount of state assistance made available or paid out for a project exceed the amount supplied by the sponsor of the project.

      [17.3:219:1949; added 1956, 47]—(NRS A 1965, 989; 1981, 856, 1901)

      NRS 449.430  Money from State Public Health Facilities Construction Assistance Fund to be paid in installments.  Moneys in the State Public Health Facilities Construction Assistance Fund allocated to a particular approved project shall be paid out in installments at the same times and in the same manner as installments of federal funds are paid out from the Health Facilities Assistance Fund pursuant to NRS 449.390.

      [17.4:219:1949; added 1956, 47]—(NRS A 1965, 990)

INTERMEDIARY SERVICE ORGANIZATIONS

General Provisions

      NRS 449.4304  “Intermediary service organization” defined.  As used in NRS 449.4304 to 449.4339, inclusive, unless the context otherwise requires, “intermediary service organization” means a nongovernmental entity that provides services authorized pursuant to NRS 449.4308 for a person with a disability or other responsible person.

      (Added to NRS by 2013, 126)

      NRS 449.4308  Authority to provide services.

      1.  An intermediary service organization that is certified pursuant to NRS 449.4304 to 449.4339, inclusive, may provide services for a person with a disability or other responsible person relating to personal assistance received by the person with a disability. The services that may be provided by an intermediary service organization include, without limitation:

      (a) Obtaining a criminal background check of a personal assistant selected by the person with a disability or other responsible person to provide nonmedical services and any medical services authorized pursuant to NRS 629.091;

      (b) Providing payroll services to pay the personal assistant and determine any tax liability;

      (c) Providing services relating to financial management; and

      (d) Providing any other services relating to the employment of a personal assistant and any other financial assistance relating to the personal assistance for the person with a disability.

      2.  As used in this section:

      (a) “Other responsible person” means:

             (1) A parent or guardian of, or any other person legally responsible for, a person with a disability who is under the age of 18 years; or

             (2) A parent, spouse, guardian or adult child of a person with a disability who suffers from a cognitive impairment.

      (b) “Personal assistance” means the provision of any goods or services to help a person with a disability maintain his or her independence, personal hygiene and safety, including, without limitation, the provision of services by a personal assistant.

      (c) “Personal assistant” means a person who, for compensation and under the direction of a person with a disability or other responsible person, performs services for a person with a disability to help the person maintain his or her independence, personal hygiene and safety.

      (Added to NRS by 2013, 126)

Certification

      NRS 449.431  Certificate required; exception; penalty.

      1.  Except as otherwise provided in subsection 2, a person shall not operate or maintain in this State an intermediary service organization without first obtaining a certificate to operate an intermediary service organization as provided in NRS 449.4304 to 449.4339, inclusive.

      2.  A person who is licensed to operate an agency to provide personal care services in the home pursuant to this chapter is not required to obtain a certificate to operate an intermediary service organization as described in this section.

      3.  A person who violates the provisions of this section is guilty of a misdemeanor.

      (Added to NRS by 2013, 126)

      NRS 449.4311  Application for certificate: Contents.  Any person wishing to obtain a certificate to operate an intermediary service organization pursuant to the provisions of NRS 449.4304 to 449.4339, inclusive, must file with the Division an application on a form prescribed, prepared and furnished by the Division, containing:

      1.  The name of the applicant and, if a natural person, whether the applicant has attained the age of 21 years.

      2.  The location of the intermediary service organization.

      3.  The name of the person in charge of the intermediary service organization.

      4.  Such other information as may be required by the Division for the proper administration and enforcement of NRS 449.4304 to 449.4339, inclusive.

      5.  Evidence satisfactory to the Division that the applicant is of reputable and responsible character. If the applicant is a firm, association, organization, partnership, business trust, corporation or company, similar evidence must be submitted as to the members thereof, and the person in charge of the intermediary service organization for which application is made.

      6.  Evidence satisfactory to the Division of the ability of the applicant to comply with the provisions of NRS 449.4304 to 449.4339, inclusive, and the standards and regulations adopted by the Board.

      (Added to NRS by 2013, 127)

      NRS 449.4312  Application for certificate: Social security number required. [Effective until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]  An application for the issuance of a certificate to operate an intermediary service organization pursuant to NRS 449.4311 must include the social security number of the applicant.

      (Added to NRS by 2013, 127)

      NRS 449.4313  Application for certificate: Statement regarding obligation of child support; grounds for denial; duty of Division. [Effective until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

      1.  An applicant for the issuance or renewal of a certificate to operate an intermediary service organization must submit to the Division the statement prescribed by the Division of Welfare and Supportive Services of the Department pursuant to NRS 425.520. The statement must be completed and signed by the applicant.

      2.  The Division shall include the statement required pursuant to subsection 1 in:

      (a) The application or any other forms that must be submitted for the issuance or renewal of the certificate; or

      (b) A separate form prescribed by the Division.

      3.  A certificate as an intermediary service organization may not be issued or renewed by the Division if the applicant:

      (a) Fails to submit the statement required pursuant to subsection 1; or

      (b) Indicates on the statement submitted pursuant to subsection 1 that the applicant is subject to a court order for the support of a child and is not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order.

      4.  If an applicant indicates on the statement submitted pursuant to subsection 1 that the applicant is subject to a court order for the support of a child and is not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order, the Division shall advise the applicant to contact the district attorney or other public agency enforcing the order to determine the actions that the applicant may take to satisfy the arrearage.

      (Added to NRS by 2013, 127)

      NRS 449.4314  Application for certificate: Fee.  Each application for a certificate to operate an intermediary service organization must be accompanied by such fee as may be determined by regulation of the Board. The Board may, by regulation, allow or require payment of a fee for a certificate in installments and may fix the amount of each payment and the date on which the payment is due.

      (Added to NRS by 2013, 128)

      NRS 449.4317  Issuance of certificate; nontransferability.

      1.  The Division shall issue the certificate to operate an intermediary service organization to the applicant if, after investigation, the Division finds that the:

      (a) Applicant is in full compliance with the provisions of NRS 449.4304 to 449.4339, inclusive; and

      (b) Applicant is in substantial compliance with the standards and regulations adopted by the Board.

      2.  A certificate applies only to the person to whom it is issued and is not transferable.

      (Added to NRS by 2013, 128)

      NRS 449.4318  Form and contents of certificate.  Each certificate to operate an intermediary service organization issued by the Division pursuant to NRS 449.4304 to 449.4339, inclusive, must be in the form prescribed by the Division and must contain:

      1.  The name of the person or persons authorized to operate the intermediary service organization;

      2.  The location of the intermediary service organization; and

      3.  The services offered by the intermediary service organization.

      (Added to NRS by 2013, 128)

      NRS 449.4319  Expiration and renewal of certificate.

      1.  Each certificate to operate an intermediary service organization issued pursuant to NRS 449.4304 to 449.4339, inclusive, expires on December 31 following its issuance and is renewable for 1 year upon reapplication and payment of all fees required pursuant to NRS 449.4314 unless the Division finds, after an investigation, that the intermediary service organization has not satisfactorily complied with the provisions of NRS 449.4304 to 449.4339, inclusive, or the standards and regulations adopted by the Board.

      2.  Each reapplication for an intermediary service organization must include, without limitation, a statement that the organization is in compliance with the provisions of NRS 449.4329 to 449.4332, inclusive.

      (Added to NRS by 2013, 128)

      NRS 449.432  Application for renewal of certificate: Information concerning business license required; conditions which require denial. [Effective January 1, 2014.]

      1.  In addition to any other requirements set forth in NRS 449.4304 to 449.4339, inclusive, an applicant for the renewal of a certificate as an intermediary service organization must indicate in the application submitted to the Division whether the applicant has a state business license. If the applicant has a state business license, the applicant must include in the application the state business license number assigned by the Secretary of State upon compliance with the provisions of chapter 76 of NRS.

      2.  A certificate as an intermediary service organization may not be renewed by the Division if:

      (a) The applicant fails to submit the information required by subsection 1; or

      (b) The State Controller has informed the Division pursuant to subsection 5 of NRS 353C.1965 that the applicant owes a debt to an agency that has been assigned to the State Controller for collection and the applicant has not:

             (1) Satisfied the debt;

             (2) Entered into an agreement for the payment of the debt pursuant to NRS 353C.130; or

             (3) Demonstrated that the debt is not valid.

      3.  As used in this section:

      (a) “Agency” has the meaning ascribed to it in NRS 353C.020.

      (b) “Debt” has the meaning ascribed to it in NRS 353C.040.

      (Added to NRS by 2013, 2730, effective January 1, 2014)

      NRS 449.4321  Grounds for denial, suspension or revocation of certificate.  The Division may deny an application for a certificate to operate an intermediary service organization or may suspend or revoke any certificate issued under the provisions of NRS 449.4304 to 449.4339, inclusive, upon any of the following grounds:

      1.  Violation by the applicant or the holder of a certificate of any of the provisions of NRS 449.4304 to 449.4339, inclusive, or of any other law of this State or of the standards, rules and regulations adopted thereunder.

      2.  Aiding, abetting or permitting the commission of any illegal act.

      3.  Conduct inimical to the public health, morals, welfare and safety of the people of the State of Nevada in the operation of an intermediary service organization.

      4.  Conduct or practice detrimental to the health or safety of a person under contract with or employees of the intermediary service organization.

      (Added to NRS by 2013, 128)

      NRS 449.4322  Suspension of certificate for failure to pay child support or comply with certain subpoenas or warrants; reinstatement of certificate. [Effective until the date of the repeal of 42 U.S.C. § 666, the federal law requiring each state to establish procedures for withholding, suspending and restricting the professional, occupational and recreational licenses for child support arrearages and for noncompliance with certain processes relating to paternity or child support proceedings.]

      1.  If the Division receives a copy of a court order issued pursuant to NRS 425.540 that provides for the suspension of all professional, occupational and recreational licenses, certificates and permits issued to a person who is the holder of a certificate to operate an intermediary service organization, the Division shall deem the certificate issued to that person to be suspended at the end of the 30th day after the date on which the court order was issued unless the Division receives a letter issued to the holder of the certificate by the district attorney or other public agency pursuant to NRS 425.550 stating that the holder of the certificate has complied with the subpoena or warrant or has satisfied the arrearage pursuant to NRS 425.560.

      2.  The Division shall reinstate a certificate to operate an intermediary service organization that has been suspended by a district court pursuant to NRS 425.540 if the Division receives a letter issued by the district attorney or other public agency pursuant to NRS 425.550 to the person whose certificate was suspended stating that the person whose certificate was suspended has complied with the subpoena or warrant or has satisfied the arrearage pursuant to NRS 425.560.

      (Added to NRS by 2013, 128)

      NRS 449.4324  Provisional certificate.

      1.  The Division may cancel a certificate to operate an intermediary service organization and issue a provisional certificate, effective for a period determined by the Division, to the intermediary service organization if the intermediary service organization:

      (a) Is in operation at the time of the adoption of standards and regulations pursuant to the provisions of NRS 449.4304 to 449.4339, inclusive, and the Division determines that the intermediary service organization requires a reasonable time under the particular circumstances within which to comply with the standards and regulations; or

      (b) Has failed to comply with the standards or regulations and the Division determines that the intermediary service organization is in the process of making the necessary changes or has agreed to make the changes within a reasonable time.

      2.  The provisions of subsection 1 do not require the issuance of a certificate or prevent the Division from refusing to renew or from revoking or suspending any certificate if the Division deems such action necessary for the health and safety of a person for whom the intermediary service organization provides services.

      (Added to NRS by 2013, 129)

      NRS 449.4325  Deposit of money received; expenses of Division to enforce provisions.

      1.  Money received from the certification of intermediary service organizations:

      (a) Must be forwarded to the State Treasurer for deposit in the State Treasury;

      (b) Must be accounted for separately in the State General Fund; and

      (c) May only be used to carry out the provisions of NRS 449.4304 to 449.4339, inclusive.

      2.  The Division shall enforce the provisions of NRS 449.4304 to 449.4339, inclusive, and may incur any necessary expenses not in excess of money appropriated for that purpose by the State or received from the Federal Government.

      (Added to NRS by 2013, 129)

      NRS 449.4327  Regulations; powers of Division.

      1.  The Board shall adopt regulations governing the certification of intermediary service organizations and such other regulations as it deems necessary to carry out the provisions of NRS 449.4304 to 449.4339, inclusive.

      2.  The Division may:

      (a) Upon receipt of an application for a certificate to operate an intermediary service organization, conduct an investigation into the qualifications of personnel, methods of operation and policies and purposes of any person proposing to engage in the operation of an intermediary service organization.

      (b) Upon receipt of a complaint against an intermediary service organization, except for a complaint concerning the cost of services, conduct an investigation into the qualifications of personnel, methods of operation and policies, procedures and records of that intermediary service organization or any other intermediary service organization which may have information pertinent to the complaint.

      (c) Employ such professional, technical and clerical assistance as it deems necessary to carry out the provisions of NRS 449.4304 to 449.4339, inclusive.

      (Added to NRS by 2013, 129)

Background Investigations

      NRS 449.4329  Initial and periodic investigations of employee, employee of temporary employment service or independent contractor; penalty.

      1.  Except as otherwise provided in subsections 2 and 3, within 10 days after hiring an employee, accepting an employee of a temporary employment service or entering into a contract with an independent contractor, the holder of a certificate to operate an intermediary service organization shall:

      (a) Obtain a written statement from the employee, employee of the temporary employment service or independent contractor stating whether he or she has been convicted of any crime listed in subsection 1 of NRS 449.4332;

      (b) Obtain an oral and written confirmation of the information contained in the written statement obtained pursuant to paragraph (a);

      (c) Obtain proof that the employee, employee of the temporary employment service or independent contractor holds any required license, permit or certificate;

      (d) Obtain from the employee, employee of the temporary employment service or independent contractor one set of fingerprints and a written authorization to forward the fingerprints to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report;

      (e) Submit to the Central Repository for Nevada Records of Criminal History the fingerprints obtained pursuant to paragraph (d) to obtain information on the background and personal history of each employee, employee of a temporary employment service or independent contractor to determine whether the person has been convicted of any crime listed in subsection 1 of NRS 449.4332; and

      (f) If an Internet website has been established pursuant to NRS 439.942:

             (1) Screen the employee, employee of the temporary employment service or independent contractor using the Internet website. Upon request of the Division, proof that the employee, temporary employee or independent contractor was screened pursuant to this subparagraph must be provided to the Division.

             (2) Enter on the Internet website information to be maintained on the website concerning the employee, employee of the temporary employment service or independent contractor.

      2.  The holder of a certificate to operate an intermediary service organization is not required to obtain the information described in subsection 1 from an employee, employee of a temporary employment service or independent contractor if his or her fingerprints have been submitted to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report within the immediately preceding 6 months and the report of the Federal Bureau of Investigation indicated that the employee, employee of the temporary employment service or independent contractor has not been convicted of any crime set forth in subsection 1 of NRS 449.4332.

      3.  The holder of a certificate to operate an intermediary service organization is not required to obtain the information described in subsection 1, other than the information described in paragraph (c) of subsection 1, from an employee, employee of a temporary employment service or independent contractor if:

      (a) The employee, employee of the temporary employment service or independent contractor agrees to allow the holder of a certificate to operate an intermediary service organization to receive notice from the Central Repository for Nevada Records of Criminal History regarding any conviction and subsequent conviction of the employee, employee of the temporary employment service or independent contractor of a crime listed in subsection 1 of NRS 449.4332;

      (b) An agency, board or commission that regulates an occupation or profession pursuant to title 54 of NRS or temporary employment service has, within the immediately preceding 5 years, submitted the fingerprints of the employee, employee of the temporary employment service or independent contractor to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report; and

      (c) The report of the Federal Bureau of Investigation indicated that the employee, employee of the temporary employment service or independent contractor has not been convicted of any crime set forth in subsection 1 of NRS 449.4332.

      4.  The holder of a certificate to operate an intermediary service organization shall ensure that the information concerning the background and personal history of each employee, employee of a temporary employment service or independent contractor who works at or for the intermediary service organization is investigated is completed as soon as practicable and at least once every 5 years after the date of the initial investigation. The holder of the certificate shall, when required:

      (a) Obtain one set of fingerprints from the employee, employee of the temporary employment service or independent contractor;

      (b) Obtain written authorization from the employee, employee of the temporary employment service or independent contractor to forward the fingerprints obtained pursuant to paragraph (a) to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report; and

      (c) Submit the fingerprints to the Central Repository for Nevada Records of Criminal History or, if the fingerprints were submitted electronically, obtain proof of electronic submission of the fingerprints to the Central Repository for Nevada Records of Criminal History.

      5.  Upon receiving fingerprints submitted pursuant to this section, the Central Repository for Nevada Records of Criminal History shall determine whether the employee, employee of the temporary employment service or independent contractor has been convicted of a crime listed in subsection 1 of NRS 449.4332 and immediately inform the Division and the holder of the certificate to operate an intermediary service organization for which the person works whether the employee, employee of the temporary employment service or independent contractor has been convicted of such a crime.

      6.  The Central Repository for Nevada Records of Criminal History may impose a fee upon an intermediary service organization that submits fingerprints pursuant to this section for the reasonable cost of the investigation. The intermediary service organization may recover from the employee or independent contractor whose fingerprints are submitted not more than one-half of the fee imposed by the Central Repository. If the intermediary service organization requires the employee or independent contractor to pay for any part of the fee imposed by the Central Repository, it shall allow the employee or independent contractor to pay the amount through periodic payments. The intermediary service organization may require a temporary employment service which employs a temporary employee whose fingerprints are submitted to pay the fee imposed by the Central Repository. An intermediary service organization shall notify a temporary employment service if a person employed by the temporary employment service is determined to be ineligible to provide services to the intermediary service organization based upon the results of an investigation conducted pursuant to this section.

      7.  Unless a greater penalty is provided by law, a person who willfully provides a false statement or information in connection with an investigation of the background and personal history of the person pursuant to this section that would disqualify the person from employment, including, without limitation, a conviction of a crime listed in subsection 1 of NRS 449.4332, is guilty of a misdemeanor.

      (Added to NRS by 2013, 131)

      NRS 449.43295  Temporary employment service prohibited from sending ineligible employee to organization; temporary employment service to provide certain information regarding its employees.

      1.  A temporary employment service shall not send an employee to provide services to an intermediary service organization if the temporary employment service has received notice from a holder of a certificate to operate an intermediary service organization that the employee of the temporary employment service is ineligible to provide such services.

      2.  A holder of a certificate to operate an intermediary service organization who enters into an agreement with a temporary employment service to provide services to the intermediary service organization on a temporary basis must require the temporary employment service to:

      (a) Provide proof that each employee of the temporary employment service whom it may send to provide services to the intermediary service organization has been continuously employed by the temporary employment service since the last investigation conducted of the employee pursuant to NRS 449.4329; and

      (b) Notify the intermediary service organization if the investigation conducted of an employee of the temporary employment service pursuant to NRS 449.4329 has not been conducted within the immediately preceding 5 years.

      (Added to NRS by 2013, 2889)

      NRS 449.433  Maintenance and availability of certain records regarding employee, employee of temporary employment service or independent contractor of organization.

      1.  Each intermediary service organization shall maintain accurate records of the information concerning its employees, employees of a temporary employment service and independent contractors collected pursuant to NRS 449.4329, including, without limitation:

      (a) A copy of the fingerprints submitted to the Central Repository for Nevada Records of Criminal History or proof of electronic fingerprint submission and a copy of the written authorization that was provided by the employee, employee of the temporary employment service or independent contractor;

      (b) Proof that the fingerprints of the employee, employee of the temporary employment service or independent contractor were submitted to the Central Repository; and

      (c) Any other documentation of the information collected pursuant to NRS 449.4329.

      2.  The records maintained pursuant to subsection 1 must be:

      (a) Maintained for the period of the employment of the person with the intermediary service organization; and

      (b) Made available for inspection by the Division at any reasonable time, and copies thereof must be furnished to the Division upon request.

      3.  If an Internet website has been established pursuant to NRS 439.942, an intermediary service organization shall maintain a current list of its employees, employees of a temporary employment service and independent contractors on the Internet website.

      4.  The Central Repository for Nevada Records of Criminal History may maintain an electronic image of fingerprints submitted pursuant to NRS 449.4329 to notify an intermediary service organization and the Division of any subsequent conviction of a person who is required to submit to an investigation pursuant to NRS 449.4329.

      (Added to NRS by 2013, 132)

      NRS 449.4331  Termination of employment or contract of employee, employee of temporary employment service or independent contractor who has been convicted of certain crime; period in which to correct information regarding conviction; liability of organization.

      1.  Upon receiving information from the Central Repository for Nevada Records of Criminal History pursuant to NRS 449.4329, or evidence from any other source, that an employee, employee of a temporary employment service or independent contractor of an intermediary service organization has been convicted of a crime listed in subsection 1 of NRS 449.4332, the holder of the certificate to operate the intermediary service organization shall terminate the employment or contract of that person or notify the temporary employment service that its employee is prohibited from providing services for the intermediary service organization after allowing the person time to correct the information as required pursuant to subsection 2.

      2.  If an employee, employee of a temporary employment service or independent contractor believes that the information provided by the Central Repository is incorrect, the employee, employee of the temporary employment service or independent contractor may immediately inform the intermediary service organization. The intermediary service organization that is so informed shall give the employee, employee of the temporary employment service or independent contractor a reasonable amount of time of not less than 30 days to correct the information received from the Central Repository before terminating the employment or contract of the person pursuant to subsection 1.

      3.  An intermediary service organization that has complied with NRS 449.4329 may not be held civilly or criminally liable based solely upon the ground that the intermediary service organization allowed an employee, employee of a temporary employment service or independent contractor to work:

      (a) Before it received the information concerning the employee, employee of the temporary employment service or independent contractor from the Central Repository;

      (b) During the period required pursuant to subsection 2 to allow the employee, employee of the temporary employment service or independent contractor to correct that information;

      (c) Based on the information received from the Central Repository, if the information received from the Central Repository was inaccurate; or

      (d) Any combination thereof.

Ê An intermediary service organization may be held liable for any other conduct determined to be negligent or unlawful.

      (Added to NRS by 2013, 132)

      NRS 449.4332  Additional grounds for denial, suspension or revocation of certificate.  In addition to the grounds listed in NRS 449.4321, the Division may deny a certificate to operate an intermediary service organization to an applicant or may suspend or revoke a certificate of a holder of a certificate to operate an intermediary service organization if:

      1.  The applicant for or holder of the certificate has been convicted of:

      (a) Murder, voluntary manslaughter or mayhem;

      (b) Assault with intent to kill or to commit sexual assault or mayhem;

      (c) Sexual assault, statutory sexual seduction, incest, lewdness or indecent exposure, or any other sexually related crime that is punished as a felony;

      (d) Prostitution, solicitation, lewdness or indecent exposure, or any other sexually related crime that is punished as a misdemeanor, if the conviction occurred within the immediately preceding 7 years;

      (e) Abuse or neglect of a child or contributory delinquency;

      (f) A violation of any federal or state law regulating the possession, distribution or use of any controlled substance or any dangerous drug as defined in chapter 454 of NRS, within the past 7 years;

      (g) A violation of any provision of NRS 200.5099 or 200.50995;

      (h) Any offense involving fraud, theft, embezzlement, burglary, robbery, fraudulent conversion or misappropriation of property, within the immediately preceding 7 years; or

      (i) Any other felony involving the use of a firearm or other deadly weapon, within the immediately preceding 7 years; or

      2.  The holder of a certificate has continued to employ a person who has been convicted of a crime listed in subsection 1.

      (Added to NRS by 2013, 133)

Disciplinary Action; Enforcement

      NRS 449.4335  Administrative sanctions: Imposition by Division; consequences of failure to pay; use of money collected.

      1.  If an intermediary service organization violates any provision related to its certification, including, without limitation, any provision of NRS 449.4304 to 449.4339, inclusive, or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.4336, may, as it deems appropriate:

      (a) Prohibit the intermediary service organization from providing services pursuant to NRS 449.4308 until it determines that the intermediary service organization has corrected the violation;

      (b) Impose an administrative penalty of not more than $1,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum; and

      (c) Appoint temporary management to oversee the operation of the intermediary service organization and to ensure the health and safety of the persons for whom the intermediary service organization performs services, until:

             (1) It determines that the intermediary service organization has corrected the violation and has management which is capable of ensuring continued compliance with the applicable statutes, conditions, standards and regulations; or

             (2) Improvements are made to correct the violation.

      2.  If the intermediary service organization fails to pay any administrative penalty imposed pursuant to paragraph (b) of subsection 1, the Division may:

      (a) Suspend the certificate to operate an intermediary service organization which is held by the intermediary service organization until the administrative penalty is paid; and

      (b) Collect court costs, reasonable attorney’s fees and other costs incurred to collect the administrative penalty.

      3.  The Division may require any intermediary service organization that violates any provision of NRS 449.4304 to 449.4339, inclusive, or any condition, standard or regulation adopted by the Board, to make any improvements necessary to correct the violation.

      4.  Any money collected as administrative penalties pursuant to this section must be accounted for separately and used to protect the health or property of the persons for whom the intermediary service organization performs services in accordance with applicable federal standards.

      (Added to NRS by 2013, 130)

      NRS 449.4336  Administrative sanctions: Regulations.  The Board shall adopt regulations establishing the criteria for the imposition of each sanction prescribed by NRS 449.4335. These regulations must:

      1.  Prescribe the circumstances and manner in which each sanction applies;

      2.  Minimize the time between identification of a violation and the imposition of a sanction;

      3.  Provide for the imposition of incrementally more severe sanctions for repeated or uncorrected violations; and

      4.  Provide for less severe sanctions for lesser violations of applicable state statutes, conditions, standards or regulations.

      (Added to NRS by 2013, 130)

      NRS 449.4337  Notice by Division of disciplinary action; exception; appeal.

      1.  When the Division intends to deny, suspend or revoke a certificate to operate an intermediary service organization, or to impose any sanction prescribed by NRS 449.4335, the Division shall give reasonable notice to the holder of the certificate by certified mail. The notice must contain the legal authority, jurisdiction and reasons for the action to be taken. Notice is not required if the Division finds that the public health requires immediate action. In that case, the Division may order a summary suspension of a certificate or impose any sanction prescribed by NRS 449.4335, pending proceedings for revocation or other action.

      2.  If a person wants to contest the action of the Division, the person must file an appeal pursuant to regulations adopted by the Board.

      3.  Upon receiving notice of an appeal, the Division shall hold a hearing pursuant to regulations adopted by the Board.

      4.  The Board shall adopt such regulations as are necessary to carry out the provisions of this section.

      (Added to NRS by 2013, 131)

      NRS 449.4338  Action to enjoin violations.

      1.  Except as otherwise provided in subsection 2 of NRS 449.431, the Division may bring an action in the name of the State to enjoin any person from operating or maintaining an intermediary service organization within the meaning of NRS 449.4304 to 449.4339, inclusive:

      (a) Without first obtaining a certificate to operate an intermediary service organization; or

      (b) After the person’s certificate has been revoked or suspended by the Division.

      2.  It is sufficient in such action to allege that the defendant did, on a certain date and in a certain place, operate and maintain the intermediary service organization without a certificate.

      (Added to NRS by 2013, 133)

      NRS 449.4339  Prosecution by district attorney.  The district attorney of the county in which an intermediary service organization operates shall, upon application by the Division, institute and conduct the prosecution of any action for violation of any provision of NRS 449.4304 to 449.4339, inclusive.

      (Added to NRS by 2013, 134)

PERMIT FOR SERVICES OF GENERAL ANESTHESIA, CONSCIOUS SEDATION AND DEEP SEDATION; NATIONAL ACCREDITATION; INSPECTIONS OF SURGICAL CENTERS FOR AMBULATORY PATIENTS AND CERTAIN PHYSICIANS’ OFFICES AND FACILITIES

      NRS 449.435  Definitions.  As used in NRS 449.435 to 449.448, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.436 to 449.439, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 2009, 528)

      NRS 449.436  “Conscious sedation” defined.  “Conscious sedation” means a minimally depressed level of consciousness, produced by a pharmacologic or nonpharmacologic method, or a combination thereof, in which the patient retains the ability independently and continuously to maintain an airway and to respond appropriately to physical stimulation and verbal commands.

      (Added to NRS by 2009, 528)

      NRS 449.437  “Deep sedation” defined.  “Deep sedation” means a controlled state of depressed consciousness, produced by a pharmacologic or nonpharmacologic method, or a combination thereof, and accompanied by a partial loss of protective reflexes and the inability to respond purposefully to verbal commands.

      (Added to NRS by 2009, 528)

      NRS 449.438  “General anesthesia” defined.  “General anesthesia” means a controlled state of unconsciousness, produced by a pharmacologic or nonpharmacologic method, or a combination thereof, and accompanied by partial or complete loss of protective reflexes and the inability independently to maintain an airway and respond purposefully to physical stimulation or verbal commands.

      (Added to NRS by 2009, 528)

      NRS 449.439  “Physician” defined.  “Physician” means a person who is licensed to practice medicine pursuant to chapter 630 of NRS or osteopathic medicine pursuant to chapter 633 of NRS.

      (Added to NRS by 2009, 528)

      NRS 449.441  Exemption from provisions if physician’s office or facility only administers certain type of pain medication.  The provisions of NRS 449.435 to 449.448, inclusive, do not apply to an office of a physician or a facility that provides health care, other than a medical facility, if the office of a physician or the facility only administers a medication to a patient to relieve the patient’s anxiety or pain and if the medication is not given in a dosage that is sufficient to induce in a patient a controlled state of depressed consciousness or unconsciousness similar to general anesthesia, deep sedation or conscious sedation.

      (Added to NRS by 2009, 529)

      NRS 449.442  Permit required for certain physicians’ offices and facilities to offer services; national accreditation required; cessation of services for failure to maintain accreditation.

      1.  An office of a physician or a facility that provides health care, other than a medical facility, must obtain a permit pursuant to NRS 449.443 before offering to a patient a service of general anesthesia, conscious sedation or deep sedation. An office of a physician or a facility that provides health care, other than a medical facility, which operates at more than one location must obtain a permit for each location where a service of general anesthesia, conscious sedation or deep sedation is offered.

      2.  To offer to a patient a service of general anesthesia, conscious sedation or deep sedation in this State, an office of a physician or a facility that provides health care, other than a medical facility, must maintain current accreditation by a nationally recognized organization approved by the Board. Upon receiving an initial permit, the office or facility shall, within 6 months after obtaining the permit, submit proof to the Division of accreditation by such an organization.

      3.  If an office of a physician or a facility that provides health care, other than a medical facility, fails to maintain current accreditation or if the accreditation is revoked or is otherwise no longer valid, the office or facility shall immediately cease offering to patients a service of general anesthesia, conscious sedation or deep sedation.

      (Added to NRS by 2009, 529)

      NRS 449.443  Application for permit; fee; inspection by Division; term of permit.

      1.  An office of a physician or a facility that provides health care, other than a medical facility, desiring a permit pursuant to NRS 449.435 to 449.448, inclusive, must submit to the Division, on a form prescribed by the Division and accompanied by the appropriate fee, an application for a permit.

      2.  Before issuing a permit, the Division shall conduct an on-site inspection pursuant to NRS 449.446 of each office of a physician or facility that applies for a permit.

      3.  Upon receipt of an application and the appropriate fee, the Division may, after conducting an inspection pursuant to NRS 449.446, issue a permit.

      4.  A permit expires 1 year after the date of issuance and is renewable pursuant to NRS 449.444.

      (Added to NRS by 2009, 529)

      NRS 449.444  Application for renewal of permit; fee.

      1.  The holder of a permit issued pursuant to NRS 449.443 may annually submit to the Division, on a form prescribed by the Division and accompanied by the appropriate fee, an application for renewal of the permit before the date on which the permit expires. The application must include proof satisfactory to the Division that the office or facility maintains current accreditation by a nationally recognized organization approved by the Board.

      2.  Upon receipt of an application for renewal and the accompanying fee, the Division may renew a permit.

      (Added to NRS by 2009, 529)

      NRS 449.445  National accreditation required of surgical center for ambulatory patients; inspection by Division; cessation of operation for failure to maintain accreditation.

      1.  To operate in this State, a surgical center for ambulatory patients must maintain current accreditation by a nationally recognized organization approved by the Board. Upon initial licensure, a surgical center for ambulatory patients shall, within 6 months after obtaining its license, submit proof to the Division of the accreditation of the surgical center by such an organization.

      2.  Before issuing a license to a surgical center for ambulatory patients, the Division shall conduct an on-site inspection of the surgical center pursuant to NRS 449.446.

      3.  If a surgical center for ambulatory patients fails to maintain current accreditation or if the accreditation is revoked or is otherwise no longer valid, the surgical center shall immediately cease to operate.

      (Added to NRS by 2009, 529)

      NRS 449.446  Annual inspections of holders of permits and surgical centers for ambulatory patients; correction of deficiencies identified in inspections; reporting of inspections to Legislature.

      1.  The Division shall conduct annual and unannounced on-site inspections of each office of a physician or a facility that provides health care, other than a medical facility, which holds a permit issued pursuant to NRS 449.443 and each surgical center for ambulatory patients which holds a license issued pursuant to this chapter.

      2.  An inspection conducted pursuant to this section must focus on the infection control practices and policies of the surgical center for ambulatory patients, the office or the facility that is the subject of the inspection. The Division may, as it deems necessary, conduct a more comprehensive inspection of a surgical center, office or facility.

      3.  Upon completion of an inspection, the Division shall:

      (a) Compile a report of the inspection, including each deficiency discovered during the inspection, if any; and

      (b) Forward a copy of the report to the surgical center for ambulatory patients, the office of the physician or the facility where the inspection was conducted.

      4.  If a deficiency is indicated in the report, the surgical center for ambulatory patients, the office of the physician or the facility shall correct each deficiency indicated in the report in the manner prescribed by the Board pursuant to NRS 449.448.

      5.  The Division shall annually prepare and submit to the Legislative Committee on Health Care and the Legislative Commission a report which includes:

      (a) The number and frequency of inspections conducted pursuant to this section;

      (b) A summary of deficiencies or other significant problems discovered while conducting inspections pursuant to this section and the results of any follow-up inspections; and

      (c) Any other information relating to the inspections as deemed necessary by the Legislative Committee on Health Care or the Legislative Commission.

      (Added to NRS by 2009, 530)

      NRS 449.447  Disciplinary action for certain violations or failure to correct deficiency; notification to professional licensing board of violations; administrative sanctions.

      1.  If an office of a physician or a facility that provides health care, other than a medical facility, violates the provisions of NRS 449.435 to 449.448, inclusive, or the regulations adopted pursuant thereto, or fails to correct a deficiency indicated in a report pursuant to NRS 449.446, the Division, in accordance with the regulations adopted pursuant to NRS 449.448, may take any of the following actions:

      (a) Decline to issue or renew a permit;

      (b) Suspend or revoke a permit; or

      (c) Impose an administrative penalty of not more than $1,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum.

      2.  The Division may review a report submitted pursuant to NRS 630.30665 or 633.524 to determine whether an office of a physician or a facility is in violation of the provisions of NRS 449.435 to 449.448, inclusive, or the regulations adopted pursuant thereto. If the Division determines that such a violation has occurred, the Division shall immediately notify the appropriate professional licensing board of the physician.

      3.  If a surgical center for ambulatory patients violates the provisions of NRS 449.435 to 449.448, inclusive, or the regulations adopted pursuant thereto, or fails to correct a deficiency indicated in a report pursuant to NRS 449.446, the Division may impose administrative sanctions pursuant to NRS 449.163.

      (Added to NRS by 2009, 530)

      NRS 449.448  Regulations.

      1.  The Board shall adopt regulations to carry out the provisions of NRS 449.435 to 449.448, inclusive, including, without limitation, regulations which:

      (a) Prescribe the amount of the fee required for applications for the issuance and renewal of a permit pursuant to NRS 449.443 and 449.444.

      (b) Prescribe the procedures and standards for the issuance and renewal of a permit.

      (c) Identify the nationally recognized organizations approved by the Board for the purposes of the accreditation required for the issuance of a:

             (1) License to operate a surgical center for ambulatory patients.

             (2) Permit for an office of a physician or a facility that provides health care, other than a medical facility, to offer to a patient a service of general anesthesia, conscious sedation or deep sedation.

      (d) Prescribe the procedures and scope of the inspections conducted by the Division pursuant to NRS 449.446.

      (e) Prescribe the procedures and time frame for correcting each deficiency indicated in a report pursuant to NRS 449.446.

      (f) Prescribe the criteria for the imposition of each sanction prescribed by NRS 449.447, including, without limitation:

             (1) Setting forth the circumstances and manner in which a sanction applies;

             (2) Minimizing the time between the identification of a violation and the imposition of a sanction; and

             (3) Providing for the imposition of incrementally more severe sanctions for repeated or uncorrected violations.

      2.  The regulations adopted pursuant to this section must require that the practices and policies of each holder of a permit to offer to a patient a service of general anesthesia, conscious sedation or deep sedation and each holder of a license to operate a surgical center for ambulatory patients provide adequately for the protection of the health, safety and well-being of patients.

      (Added to NRS by 2009, 531)

ACCOUNTING; FINANCIAL REPORTS; FEES; ENSURING QUALITY OF CARE

      NRS 449.450  Definitions.  As used in NRS 449.450 to 449.530, inclusive, unless the context otherwise requires:

      1.  “Admitted health insurer” means an insurer authorized to transact health insurance in this State under a certificate of authority issued by the Commissioner of Insurance.

      2.  “Department” means the Department of Health and Human Services.

      3.  “Director” means the Director of the Department.

      4.  “Institution” means any person, place, building or agency which maintains and operates facilities for the diagnosis, care and treatment of human illness and provides beds for inpatient care. The term includes but is not limited to hospitals, convalescent care facilities, nursing care facilities, detoxification centers and all specialized medical health care facilities.

      (Added to NRS by 1975, 702; A 1979, 887; 1983, 1127; 1985, 1362; 1989, 1800; 1991, 2114)

      NRS 449.460  Powers of Director.  The Director may:

      1.  Adopt regulations respecting the exercise of the powers conferred by NRS 449.450 to 449.530, inclusive.

      2.  Hold public hearings, conduct investigations and require the filing of information relating to any matter affecting the cost of services in all institutions subject to the provisions of NRS 449.450 to 449.530, inclusive, and may subpoena witnesses, financial papers, records and documents in connection therewith. An order requiring the filing of information or a subpoena issued pursuant to this subsection must state the purpose for which it is issued. The Director may also administer oaths in any hearing or investigation.

      3.  Exercise, subject to the limitations and restrictions imposed in NRS 449.450 to 449.530, inclusive, all other powers which are reasonably necessary to carry out the expressed objects of those sections.

      4.  Delegate to any of the divisions of the Department the authority to carry out the provisions of NRS 449.450 to 449.530, inclusive.

      (Added to NRS by 1975, 702; A 1985, 1363; 1991, 2114; 1997, 2527)

      NRS 449.465  Authority of Director to impose fees; maximum amount of fees collected; fee for support of Legislative Committee on Health Care.

      1.  The Director may, by regulation, impose fees upon admitted health insurers to cover the costs of carrying out the provisions of NRS 449.450 to 449.530, inclusive. The maximum amount of fees collected must not exceed the amount authorized by the Legislature in each biennial budget.

      2.  The Director shall impose a fee of $50 each year upon admitted health insurers for the support of the Legislative Committee on Health Care. The fee imposed pursuant to this subsection is in addition to any fee imposed pursuant to subsection 1. The fee collected for the support of the Legislative Committee on Health Care must be deposited in the Legislative Fund.

      (Added to NRS by 1983, 1126; A 1985, 1363; 1987, 877)

      NRS 449.470  Director may use staff or contract for services.  In carrying out the duties prescribed by NRS 449.450 to 449.530, inclusive, the Director may utilize his or her own staff or may contract with any appropriate, independent and qualified organization. Such a contractor shall not release or publish or otherwise use any information made available to it under its contractual responsibility unless permission is specifically granted by the Director.

      (Added to NRS by 1975, 703; A 1985, 1363)

      NRS 449.476  Committee to ensure quality of care: Formation by hospital; general requirements.

      1.  Each hospital licensed to operate in this state shall form a committee to ensure the quality of care provided by the hospital. The committee must be composed of, but is not limited to, physicians and nurses.

      2.  Each committee formed pursuant to subsection 1 must meet the requirements for programs or plans for ensuring the quality of care specified by the Joint Commission on Accreditation of Healthcare Organizations or by the Federal Government pursuant to Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.).

      (Added to NRS by 1989, 1799)

      NRS 449.485  Hospital required to use discharge form prescribed by Director; electronic monthly reporting; exception to electronic reporting; use of information by Department.

      1.  Each hospital in this State shall use for all patients discharged a form prescribed by the Director and shall include in the form all information required by the Department. Any form prescribed by the Director must be a form that is commonly used nationwide by hospitals, if applicable, and comply with federal laws and regulations.

      2.  Each hospital in this State shall, on a monthly basis, report to the Department the information required to be included in the form for each patient. The information reported must be complete, accurate and timely.

      3.  Each insurance company or other payer shall accept the form as the bill for services provided by hospitals in this State.

      4.  Except as otherwise provided in subsection 5, each hospital in this State shall provide the information required pursuant to subsection 2 in an electronic form specified by the Department.

      5.  The Director may exempt a hospital from the requirements of subsection 4 if requiring the hospital to comply with the requirements would cause the hospital financial hardship.

      6.  The Department shall use the information submitted pursuant to this section for the program established pursuant to NRS 439A.220 to increase public awareness of health care information concerning the hospitals in this State.

      (Added to NRS by 1987, 875; A 2005, 1736; 2007, 661, 2355)

      NRS 449.490  Financial statements and reports required to be filed with Department; additional reporting requirements for hospitals with 100 or more beds; availability of complete current charge master.

      1.  Every institution which is subject to the provisions of NRS 449.450 to 449.530, inclusive, shall file with the Department the following financial statements or reports in a form and at intervals specified by the Director but at least annually:

      (a) A balance sheet detailing the assets, liabilities and net worth of the institution for its fiscal year; and

      (b) A statement of income and expenses for the fiscal year.

      2.  Each hospital with 100 or more beds shall file with the Department, in a form and at intervals specified by the Director but at least annually, a capital improvement report which includes, without limitation, any major service line that the hospital has added or is in the process of adding since the previous report was filed, any major expansion of the existing facilities of the hospital that has been completed or is in the process of being completed since the previous report was filed, and any major piece of equipment that the hospital has acquired or is in the process of acquiring since the previous report was filed.

      3.  In addition to the information required to be filed pursuant to subsections 1 and 2, each hospital with 100 or more beds shall file with the Department, in a form and at intervals specified by the Director but at least annually:

      (a) The expenses that the hospital has incurred for providing community benefits and the in-kind services that the hospital has provided to the community in which it is located. These expenses must be reported as the total amount expended for community benefits and in-kind services and reported as a percentage of the total net revenues of the hospital. For the purposes of this paragraph, “community benefits” includes, without limitation, goods, services and resources provided by a hospital to a community to address the specific needs and concerns of that community, services provided by a hospital to the uninsured and underserved persons in that community, training programs for employees in a community and health care services provided in areas of a community that have a critical shortage of such services, for which the hospital does not receive full reimbursement.

      (b) A statement of its policies and procedures for providing discounted services to, or reducing charges for services provided to, persons without health insurance that are in addition to any reduction or discount required to be provided pursuant to NRS 439B.260.

      (c) A list of the services which the hospital purchased from its corporate home office.

      (d) A report of the cost to the hospital of providing services to patients covered by Medicare.

      (e) Financial information from the consolidated corporation, if the hospital is owned by such a corporation and if that information is publicly available, including, without limitation, the annual report of the consolidated corporation.

      (f) A statement of its policies regarding patients’ account receivables, including, without limitation, the manner in which a hospital collects or makes payment arrangements for patients’ account receivables, the factors that initiate collections and the method by which unpaid account receivables are collected.

      4.  A complete current charge master must be available at each hospital during normal business hours for review by the Director, any payor that has a contract with the hospital to pay for services provided by the hospital, any payor that has received a bill from the hospital and any state agency that is authorized to review such information. The complete and current charge master must be made available to the Department, at the request of the Director, in an electronic format specified by the Department. The Department may use the electronic copy of the charge master to review and analyze the data contained in the charge master and, except as otherwise provided in NRS 439A.200 to 439A.290, inclusive, shall not release or publish the information contained in the charge master.

      5.  The Director shall require the certification of specified financial reports by an independent certified public accountant and may require attestations from responsible officers of the institution that the reports are, to the best of their knowledge and belief, accurate and complete to the extent that the certifications and attestations are not required by federal law.

      6.  The Director shall require:

      (a) The filing of all reports by specified dates, and may adopt regulations which assess penalties for failure to file as required; and

      (b) The submission of a final annual report not later than 6 months after the close of the fiscal year,

Ê and may grant extensions to institutions which can show that the required information is not available on the required reporting date.

      7.  All reports, except privileged medical information, filed under any provisions of NRS 449.450 to 449.530, inclusive:

      (a) Are open to public inspection;

      (b) Must be in a form which is readily understandable by a member of the general public;

      (c) Must, as soon as practicable after those reports become available, be posted on the Internet website maintained pursuant to NRS 439A.270; and

      (d) Must be available for examination at the office of the Department during regular business hours.

      (Added to NRS by 1975, 702; A 1985, 1364; 1987, 877; 2005, 1737; 2007, 2355; 2011, 967)

      NRS 449.500  Director to carry out analyses and studies concerning cost of health care.  The Director shall engage in or carry out analyses and studies relating to the cost of health care in Nevada and other states, the financial status of any institution subject to the provisions of NRS 449.450 to 449.530, inclusive, and any other appropriate related matters, and the Director may publish and disseminate any information relating to the financial aspects of health care as the Director deems desirable in the public interest and in accordance with the provisions of NRS 449.450 to 449.530, inclusive. The Director shall further require the filing of information concerning the total financial needs of each institution and the resources available or expected to become available to meet such needs, including but not limited to the effect of proposals made by comprehensive areawide and state health planning agencies. The information must be divided into at least the following components of an institution’s expenses:

      1.  Operating expenses related to patient care.

      2.  Expenses incurred for rendering services to patients for whom payment is not made in full including, but not limited to, the separate expenses for contractual allowances imposed by federal or state law, charity care and uncollectible accounts.

      3.  All incurred interest charges on indebtedness for both capital and operating needs.

      4.  Costs of education, both primary and continuing.

      5.  Expenses for research related to patient care.

      6.  Depreciation expenses of both property and equipment.

      7.  Amortization of incurred capital and operating related indebtedness.

      8.  Requirements for capital expenditures for replacement, modernization, renovation and expansion of services and facilities.

      9.  Requirements for necessary working capital, including but not limited to operating cash, patients’ accounts receivable and inventories.

      10.  Federal, state and local taxes not ordinarily considered operating expenses where applicable.

      11.  Operating surpluses necessary for a fair return to their owners equal to returns on investments in industries of comparable risk, or for the purpose of assuring continuity of operation and prudent management.

      (Added to NRS by 1975, 703; A 1985, 1364)

      NRS 449.510  Director to prepare and file summaries, compilations or other reports; public inspection; collection, maintenance, disclosure or publication of contracts or identification of party to contract prohibited.

      1.  The Director shall prepare and file such summaries, compilations or other supplementary reports based on the information filed with the Director pursuant to NRS 449.450 to 449.530, inclusive, as will advance the purposes of those sections. All such summaries, compilations and reports are open to public inspection, must be made available to requesting agencies and must be prepared within a reasonable time following the end of each institution’s fiscal year or more frequently as specified by the Director.

      2.  The Director shall not collect, maintain, disclose, report or publish the details of contracts entered into by a hospital, or collect, maintain, disclose, report or publish information pursuant to this section in a manner that would allow identification of an individual payer or other party to a contract with the hospital, except that the Director may disclose to other state agencies the details of contracts between the hospital and a related entity. A state agency shall not collect, maintain, disclose, report or publish information disclosed to the agency by the Director pursuant to this subsection in a manner that would allow identification of an individual payer or other party to a contract with the hospital. The Director may review any such contracts at the hospital or at a location specified by the hospital.

      3.  As used in this section, “related entity” means an affiliated person or subsidiary as those terms are defined in NRS 439B.430.

      (Added to NRS by 1975, 704; A 1985, 1365; 1991, 2333; 1993, 619; 1997, 2527)

      NRS 449.520  Reports to Governor and legislative committees; development of comprehensive plan by Legislative Committee on Health Care.

      1.  On or before October 1 of each year, the Director shall prepare and transmit to the Governor, the Legislative Committee on Health Care and the Interim Finance Committee a report of the Department’s operations and activities for the preceding fiscal year.

      2.  The report prepared pursuant to subsection 1 must include:

      (a) Copies of all reports, summaries, compilations and supplementary reports required by NRS 449.450 to 449.530, inclusive, together with such facts, suggestions and policy recommendations as the Director deems necessary;

      (b) A summary of the trends of the audits of hospitals in this State that the Department required or performed during the previous year;

      (c) An analysis of the trends in the costs, expenses and profits of hospitals in this State;

      (d) An analysis of the methodologies used to determine the corporate home office allocation of hospitals in this State;

      (e) An examination and analysis of the manner in which hospitals are reporting the information that is required to be filed pursuant to NRS 449.490, including, without limitation, an examination and analysis of whether that information is being reported in a standard and consistent manner, which fairly reflect the operations of each hospital;

      (f) A review and comparison of the policies and procedures used by hospitals in this State to provide discounted services to, and to reduce charges for services provided to, persons without health insurance;

      (g) A review and comparison of the policies and procedures used by hospitals in this State to collect unpaid charges for services provided by the hospitals; and

      (h) A summary of the status of the programs established pursuant to NRS 439A.220 and 439A.240 to increase public awareness of health care information concerning the hospitals and surgical centers for ambulatory patients in this State, including, without limitation, the information that was posted in the preceding fiscal year on the Internet website maintained for those programs pursuant to NRS 439A.270.

      3.  The Legislative Committee on Health Care shall develop a comprehensive plan concerning the provision of health care in this State which includes, without limitation:

      (a) A review of the health care needs in this State as identified by state agencies, local governments, providers of health care and the general public; and

      (b) A review of the capital improvement reports submitted by hospitals pursuant to subsection 2 of NRS 449.490.

      (Added to NRS by 1975, 704; A 1983, 1127; 1985, 1365; 2005, 1738; 2007, 2357; 2011, 969)

      NRS 449.530  Administrative fine for violation.  The Director may impose upon the institutions subject to supervision under NRS 449.450 to 449.530, inclusive, an administrative fine not exceeding $500 per day for each violation of any of the provisions of NRS 449.450 to 449.530, inclusive.

      (Added to NRS by 1975, 704; A 1985, 1365)

WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT

      NRS 449.535  Short title; uniformity of application and construction.

      1.  NRS 449.535 to 449.690, inclusive, may be cited as the Uniform Act on Rights of the Terminally Ill.

      2.  NRS 449.535 to 449.690, inclusive, must be applied and construed to effectuate its general purpose to make uniform the law with respect to the subject of those sections among states enacting the Uniform Act on Rights of the Terminally Ill.

      (Added to NRS by 1991, 629)

      NRS 449.540  Definitions.  As used in NRS 449.535 to 449.690, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.550 to 449.590, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1977, 759; A 1991, 632)

      NRS 449.550  “Attending physician” defined.  “Attending physician” means the physician who has primary responsibility for the treatment and care of the patient.

      (Added to NRS by 1977, 759; A 1991, 632)

      NRS 449.560  “Declaration” defined.  “Declaration” means a writing executed in accordance with the requirements of NRS 449.600.

      (Added to NRS by 1977, 759; A 1991, 632)

      NRS 449.570  “Life-sustaining treatment” defined.  “Life-sustaining treatment” means a medical procedure or intervention that, when administered to a patient, serves only to prolong the process of dying.

      (Added to NRS by 1977, 759; A 1991, 633)

      NRS 449.575  “Person” defined.  “Person” includes a government or a governmental subdivision or agency.

      (Added to NRS by 1991, 629)

      NRS 449.581  “Provider of health care” defined.  “Provider of health care” means a person who is licensed, certified or otherwise authorized by the law of this state to administer health care in the ordinary course of business or practice of a profession.

      (Added to NRS by 1991, 629)

      NRS 449.585  “Qualified patient” defined.  “Qualified patient” means a patient 18 or more years of age who has executed a declaration and who has been determined by the attending physician to be in a terminal condition.

      (Added to NRS by 1991, 629)

      NRS 449.590  “Terminal condition” defined.  “Terminal condition” means an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of the attending physician, result in death within a relatively short time.

      (Added to NRS by 1977, 759; A 1991, 633)

      NRS 449.600  Declaration relating to use of life-sustaining treatment.

      1.  A person of sound mind and 18 or more years of age may execute at any time a declaration governing the withholding or withdrawal of life-sustaining treatment. The declarant may designate another natural person of sound mind and 18 or more years of age to make decisions governing the withholding or withdrawal of life-sustaining treatment. The declaration must be signed by the declarant, or another at the declarant’s direction, and attested by two witnesses.

      2.  A physician or other provider of health care who is furnished a copy of the declaration shall make it a part of the declarant’s medical record and, if unwilling to comply with the declaration, promptly so advise the declarant and any person designated to act for the declarant.

      (Added to NRS by 1977, 759; A 1985, 1747; 1991, 633)

      NRS 449.610  Form of declaration directing physician to withhold or withdraw life-sustaining treatment.  A declaration directing a physician to withhold or withdraw life-sustaining treatment may, but need not, be in the following form:

 

DECLARATION

 

If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician, cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I direct my attending physician, pursuant to NRS 449.535 to 449.690, inclusive, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain.

 

If you wish to include this statement in this declaration, you must INITIAL the statement in the box provided:

 

       Withholding or withdrawal of artificial nutrition and hydration may result in death by starvation or dehydration. Initial this box if you want to receive or continue receiving artificial nutrition and hydration by way of the gastrointestinal tract after all other treatment is withheld pursuant to this declaration.

 

                                                                                           [............................................ ]

 

Signed this ........………...... day of ..…..........., ......

 

                                                               Signature..........................................................

                                                               Address.............................................................

 

The declarant voluntarily signed this writing in my presence.

 

                                                               Witness.............................................................

                                                               Address.............................................................

 

                                                               Witness.............................................................

                                                               Address.............................................................

 

      (Added to NRS by 1977, 760; A 1991, 633; 1993, 2790)

      NRS 449.613  Form of declaration designating another person to decide to withhold or withdraw life-sustaining treatment.

      1.  A declaration that designates another person to make decisions governing the withholding or withdrawal of life-sustaining treatment may, but need not, be in the following form:

 

DECLARATION

 

If I should have an incurable and irreversible condition that, without the administration of life-sustaining treatment, will, in the opinion of my attending physician, cause my death within a relatively short time, and I am no longer able to make decisions regarding my medical treatment, I appoint ............................... or, if he or she is not reasonably available or is unwilling to serve, .............................., to make decisions on my behalf regarding withholding or withdrawal of treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain, pursuant to NRS 449.535 to 449.690, inclusive. (If the person or persons I have so appointed are not reasonably available or are unwilling to serve, I direct my attending physician, pursuant to those sections, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain.)

Strike language in parentheses if you do not desire it.

 

If you wish to include this statement in this declaration, you must INITIAL the statement in the box provided:

 

       Withholding or withdrawal of artificial nutrition and hydration may result in death by starvation or dehydration. Initial this box if you want to receive or continue receiving artificial nutrition and hydration by way of the gastrointestinal tract after all other treatment is withheld pursuant to this declaration.

                                                                                           [............................................ ]

 

Signed this ........………...... day of ..…..........., ......

 

                                                               Signature..........................................................

                                                               Address.............................................................

 

The declarant voluntarily signed this writing in my presence.

 

                                                               Witness.............................................................

                                                               Address.............................................................

 

                                                               Witness.............................................................

                                                               Address.............................................................

 

Name and address of each designee.

 

                                                               Name................................................................

                                                               Address.............................................................

 

      2.  The designation of an agent pursuant to chapter 162A of NRS, or the judicial appointment of a guardian, who is authorized to make decisions regarding the withholding or withdrawal of life-sustaining treatment, constitutes for the purpose of NRS 449.535 to 449.690, inclusive, a declaration designating another person to act for the declarant pursuant to subsection 1.

      (Added to NRS by 1991, 630; A 1993, 2791; 2009, 209)

      NRS 449.617  Time declaration becomes operative; duty of providers of health care.  A declaration becomes operative when it is communicated to the attending physician and the declarant is determined by the attending physician to be in a terminal condition and no longer able to make decisions regarding administration of life-sustaining treatment. When the declaration becomes operative, the attending physician and other providers of health care shall act in accordance with its provisions and with the instructions of a person designated pursuant to NRS 449.600 or comply with the requirements of NRS 449.628 to transfer care of the declarant.

      (Added to NRS by 1991, 631)

      NRS 449.620  Revocation of declaration; entry of revocation in medical records of declarant.

      1.  A declarant may revoke a declaration at any time and in any manner, without regard to his or her mental or physical condition. A revocation is effective upon its communication to the attending physician or other provider of health care by the declarant or a witness to the revocation.

      2.  The attending physician or other provider of health care shall make the revocation a part of the declarant’s medical record.

      (Added to NRS by 1977, 760; A 1987, 1309; 1991, 635)

      NRS 449.622  Recording determination of terminal condition and declaration.  Upon determining that a declarant is in a terminal condition, the attending physician who knows of a declaration shall record the determination, and the terms of the declaration if not already a part of the record, in the declarant’s medical record.

      (Added to NRS by 1991, 631)

      NRS 449.624  Treatment of qualified patients; withholding or withdrawal of artificial nutrition and hydration; treatment of pregnant patient.

      1.  A qualified patient may make decisions regarding life-sustaining treatment so long as the patient is able to do so.

      2.  NRS 449.535 to 449.690, inclusive, do not affect the responsibility of the attending physician or other provider of health care to provide treatment for a patient’s comfort or alleviation of pain.

      3.  Artificial nutrition and hydration by way of the gastrointestinal tract shall be deemed a life-sustaining treatment and must be withheld or withdrawn from a qualified patient unless a different desire is expressed in writing by the patient. For a patient who has no effective declaration, artificial nutrition and hydration must not be withheld unless a different desire is expressed in writing by the patient’s authorized representative or the family member with the authority to consent or withhold consent.

      4.  Life-sustaining treatment must not be withheld or withdrawn pursuant to a declaration from a qualified patient known to the attending physician to be pregnant so long as it is probable that the fetus will develop to the point of live birth with continued application of life-sustaining treatment.

      (Added to NRS by 1991, 631)

      NRS 449.626  Written consent to withhold or withdraw life-sustaining treatment.

      1.  If written consent to the withholding or withdrawal of the treatment, attested by two witnesses, is given to the attending physician, the attending physician may withhold or withdraw life-sustaining treatment from a patient who:

      (a) Has been determined by the attending physician to be in a terminal condition and no longer able to make decisions regarding administration of life-sustaining treatment; and

      (b) Has no effective declaration.

      2.  The authority to consent or to withhold consent under subsection 1 may be exercised by the following persons, in order of priority:

      (a) The spouse of the patient;

      (b) An adult child of the patient or, if there is more than one adult child, a majority of the adult children who are reasonably available for consultation;

      (c) The parents of the patient;

      (d) An adult sibling of the patient or, if there is more than one adult sibling, a majority of the adult siblings who are reasonably available for consultation; or

      (e) The nearest other adult relative of the patient by blood or adoption who is reasonably available for consultation.

      3.  If a class entitled to decide whether to consent is not reasonably available for consultation and competent to decide, or declines to decide, the next class is authorized to decide, but an equal division in a class does not authorize the next class to decide.

      4.  A decision to grant or withhold consent must be made in good faith. A consent is not valid if it conflicts with the expressed intention of the patient.

      5.  A decision of the attending physician acting in good faith that a consent is valid or invalid is conclusive.

      6.  Life-sustaining treatment must not be withheld or withdrawn pursuant to this section from a patient known to the attending physician to be pregnant so long as it is probable that the fetus will develop to the point of live birth with continued application of life-sustaining treatment.

      (Added to NRS by 1991, 631)

      NRS 449.628  Transfer of care of declarant.  An attending physician or other provider of health care who is unwilling to comply with NRS 449.535 to 449.690, inclusive, shall take all reasonable steps as promptly as practicable to transfer care of the declarant to another physician or provider of health care.

      (Added to NRS by 1991, 632)

      NRS 449.630  Immunity from civil and criminal liability and discipline for unprofessional conduct.

      1.  A physician or other provider of health care is not subject to civil or criminal liability, or discipline for unprofessional conduct, for giving effect to a declaration or the direction of a person designated pursuant to NRS 449.600 in the absence of knowledge of the revocation of a declaration, or for giving effect to a written consent under NRS 449.626.

      2.  A physician or other provider of health care, whose action pursuant to NRS 449.535 to 449.690, inclusive, is in accord with reasonable medical standards, is not subject to civil or criminal liability, or discipline for unprofessional conduct, with respect to that action.

      3.  A physician or other provider of health care, whose decision about the validity of consent under NRS 449.626 is made in good faith, is not subject to civil or criminal liability, or discipline for unprofessional conduct, with respect to that decision.

      4.  A person designated pursuant to NRS 449.600 or a person authorized to consent pursuant to NRS 449.626, whose decision is made or consent is given in good faith pursuant to NRS 449.535 to 449.690, inclusive, is not subject to civil or criminal liability, or discipline for unprofessional conduct, with respect to that decision.

      (Added to NRS by 1977, 760; A 1985, 1747; 1991, 635)

      NRS 449.640  Consideration of declaration and other factors; failure to follow directions of patient.

      1.  If a patient in a terminal condition has a declaration in effect and becomes comatose or is otherwise rendered incapable of communicating with his or her attending physician, the physician must give weight to the declaration as evidence of the patient’s directions regarding the application of life-sustaining treatments, but the attending physician may also consider other factors in determining whether the circumstances warrant following the directions.

      2.  No hospital or other medical facility, physician or person working under the direction of a physician is subject to criminal or civil liability for failure to follow the directions of the patient to withhold or withdraw life-sustaining treatments.

      (Added to NRS by 1977, 761; A 1985, 1747; 1993, 2792)

      NRS 449.645  Assumption of validity of declaration; presumption of intent to use, withhold or withdraw life-sustaining treatment not created.

      1.  Unless he or she has knowledge to the contrary, a physician or other provider of health care may assume that a declaration complies with NRS 449.535 to 449.690, inclusive, and is valid.

      2.  NRS 449.535 to 449.690, inclusive, create no presumption concerning the intention of a person who has revoked or has not executed a declaration with respect to the use, withholding or withdrawal of life-sustaining treatment in the event of a terminal condition.

      (Added to NRS by 1991, 632)

      NRS 449.650  Death does not constitute suicide or homicide; effect of declaration on policy of insurance; prohibiting or requiring execution of declaration prohibited as condition for insurance or receipt of health care.

      1.  Death resulting from the withholding or withdrawal of life-sustaining treatment in accordance with NRS 449.535 to 449.690, inclusive, does not constitute, for any purpose, a suicide or homicide.

      2.  The making of a declaration pursuant to NRS 449.600 does not affect the sale, procurement or issuance of a policy of life insurance or annuity, nor does it affect, impair or modify the terms of an existing policy of life insurance or annuity. A policy of life insurance or annuity is not legally impaired or invalidated by the withholding or withdrawal of life-sustaining treatment from an insured, notwithstanding any term to the contrary.

      3.  A person may not prohibit or require the execution of a declaration as a condition for being insured for, or receiving, health care.

      (Added to NRS by 1977, 761; A 1991, 636)

      NRS 449.660  Penalties.

      1.  A physician or other provider of health care who willfully fails to transfer the care of a patient in accordance with NRS 449.628 is guilty of a gross misdemeanor.

      2.  A physician who willfully fails to record a determination of terminal condition or the terms of a declaration in accordance with NRS 449.622 is guilty of a misdemeanor.

      3.  A person who willfully conceals, cancels, defaces or obliterates the declaration of another without the declarant’s consent or who falsifies or forges a revocation of the declaration of another is guilty of a misdemeanor.

      4.  A person who falsifies or forges the declaration of another, or willfully conceals or withholds personal knowledge of a revocation, with the intent to cause a withholding or withdrawal of life-sustaining treatment contrary to the wishes of the declarant and thereby directly causes life-sustaining treatment to be withheld or withdrawn and death to be hastened is guilty of murder.

      5.  A person who requires or prohibits the execution of a declaration as a condition of being insured for, or receiving, health care is guilty of a misdemeanor.

      6.  A person who coerces or fraudulently induces another to execute a declaration, or who falsifies or forges the declaration of another except as provided in subsection 4, is guilty of a gross misdemeanor.

      7.  The penalties provided in this section do not displace any sanction applicable under other law.

      (Added to NRS by 1977, 761; A 1991, 636)

      NRS 449.670  Actions contrary to reasonable medical standards not required; mercy-killing, assisted suicide or euthanasia not authorized.

      1.  NRS 449.535 to 449.690, inclusive, do not require a physician or other provider of health care to take action contrary to reasonable medical standards.

      2.  NRS 449.535 to 449.690, inclusive, do not condone, authorize or approve mercy-killing, assisted suicide or euthanasia.

      (Added to NRS by 1977, 761; A 1991, 637; 1995, 1794)

      NRS 449.680  Other right or responsibility regarding use of life-sustaining treatment or withholding or withdrawal of medical care not limited.  NRS 449.535 to 449.690, inclusive, do not affect the right of a patient to make decisions regarding use of life-sustaining treatment, so long as the patient is able to do so, or impair or supersede a right or responsibility that any person has to effect the withholding or withdrawal of medical care.

      (Added to NRS by 1977, 761; A 1991, 637)

      NRS 449.690  Validity of declaration executed in another state; effect of previously executed instrument.

      1.  A declaration executed in another state in compliance with the law of that state or of this State is valid for purposes of NRS 449.535 to 449.690, inclusive.

      2.  An instrument executed anywhere before July 1, 1977, which clearly expresses the intent of the declarant to direct the withholding or withdrawal of life-sustaining treatment from the declarant when the declarant is in a terminal condition and becomes comatose or is otherwise rendered incapable of communicating with his or her attending physician, if executed in a manner which attests voluntary execution, or executed anywhere before October 1, 1991, which substantially complies with NRS 449.600, and has not been subsequently revoked, is effective under NRS 449.535 to 449.690, inclusive.

      3.  As used in this section, “state” includes the District of Columbia, the Commonwealth of Puerto Rico, and a territory or insular possession subject to the jurisdiction of the United States.

      (Added to NRS by 1977, 761; A 1991, 637)

PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT

      NRS 449.691  Definitions.  As used in NRS 449.691 to 449.697, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.6912 to 449.6934, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 2013, 2284)

      NRS 449.6912  “Attending physician” defined.  “Attending physician” has the meaning ascribed to it in NRS 449.550.

      (Added to NRS by 2013, 2284)

      NRS 449.6915  “Do-not-resuscitate identification” defined.  “Do-not-resuscitate identification” has the meaning ascribed to it in NRS 450B.410.

      (Added to NRS by 2013, 2284)

      NRS 449.6916  “Do-not-resuscitate order” defined.  “Do-not-resuscitate order” has the meaning ascribed to it in NRS 450B.420.

      (Added to NRS by 2013, 2284)

      NRS 449.6918  “Emergency care” defined.  “Emergency care” means the use of life-resuscitating treatment and other immediate treatment provided in response to a sudden, acute and unanticipated medical emergency in order to avoid injury, impairment or death.

      (Added to NRS by 2013, 2284)

      NRS 449.692  “Health care facility” defined.  “Health care facility” has the meaning ascribed to it in NRS 162A.740.

      (Added to NRS by 2013, 2284)

      NRS 449.6922  “Incompetent” defined.  “Incompetent” has the meaning ascribed to it in NRS 159.019.

      (Added to NRS by 2013, 2284)

      NRS 449.6924  “Life-resuscitating treatment” defined.  “Life-resuscitating treatment” has the meaning ascribed to it in NRS 450B.450.

      (Added to NRS by 2013, 2284)

      NRS 449.6925  “Life-sustaining treatment” defined.  “Life-sustaining treatment” has the meaning ascribed to it in NRS 449.570.

      (Added to NRS by 2013, 2284)

      NRS 449.6928  “Other types of advance directives” defined.  “Other types of advance directives” means an advance directive as defined in NRS 449.905, but does not include a POLST form.

      (Added to NRS by 2013, 2284)

      NRS 449.693  “Physician Order for Life-Sustaining Treatment form” or “POLST form” defined.  “Physician Order for Life-Sustaining Treatment form” or “POLST form” means the form prescribed pursuant to NRS 449.694 that:

      1.  Records the wishes of the patient; and

      2.  Directs a provider of health care regarding the provision of life-resuscitating treatment and life-sustaining treatment.

      (Added to NRS by 2013, 2284)

      NRS 449.6932  “Provider of health care” defined.  “Provider of health care” means an individual who is licensed, certified or otherwise authorized or allowed by law to provide health care in the ordinary course of business or practice of a profession, and includes a person who:

      1.  Is described in NRS 629.031; or

      2.  Administers emergency medical services as defined in NRS 450B.460.

      (Added to NRS by 2013, 2284)

      NRS 449.6934  “Representative of the patient” defined.  “Representative of the patient” means a legal guardian of the patient, a person designated by the patient to make decisions governing the withholding or withdrawal of life-sustaining treatment pursuant to NRS 449.600 or a person given power of attorney to make decisions concerning health care for the patient pursuant to NRS 162A.700 to 162A.860, inclusive.

      (Added to NRS by 2013, 2285)

      NRS 449.694  Board required to prescribe standardized POLST form; requirements.  The Board shall prescribe a standardized Physician Order for Life-Sustaining Treatment form, commonly known as a POLST form, which:

      1.  Is uniquely identifiable and has a uniform color;

      2.  Provides a means by which to indicate whether the patient has made an anatomical gift pursuant to NRS 451.500 to 451.598, inclusive;

      3.  Gives direction to a provider of health care or health care facility regarding the use of emergency care and life-sustaining treatment;

      4.  Is intended to be honored by any provider of health care who treats the patient in any health-care setting, including, without limitation, the patient’s residence, a health care facility or the scene of a medical emergency; and

      5.  Includes such other features and information as the Board may deem advisable.

      (Added to NRS by 2013, 2285)

      NRS 449.6942  Physician required to explain POLST form under certain circumstances and to complete POLST form upon request of patient; validity.

      1.  A physician shall take the actions described in subsection 2:

      (a) If the physician diagnoses a patient with a terminal condition;

      (b) If the physician determines, for any reason, that a patient has a life expectancy of less than 5 years; or

      (c) At the request of a patient.

      2.  Upon the occurrence of any of the events specified in subsection 1, the physician shall explain to the patient:

      (a) The existence and availability of the Physician Order for Life-Sustaining Treatment form;

      (b) The features of and procedures offered by way of the POLST form; and

      (c) The differences between a POLST form and the other types of advance directives.

      3.  Upon the request of the patient, the physician shall complete the POLST form based on the preferences and medical indications of the patient.

      4.  A POLST form is valid upon execution by a physician and:

      (a) If the patient is 18 years of age or older and of sound mind, the patient;

      (b) If the patient is 18 years of age or older and incompetent, the representative of the patient; or

      (c) If the patient is less than 18 years of age, the patient and a parent or legal guardian of the patient.

      5.  As used in this section, “terminal condition” has the meaning ascribed to it in NRS 449.590.

      (Added to NRS by 2013, 2285)

      NRS 449.6944  Revocation of POLST form; entry of revocation in medical records of patient.

      1.  A Physician Order for Life-Sustaining Treatment form may be revoked at any time and in any manner by:

      (a) The patient who executed it, if competent, without regard to his or her age or physical condition;

      (b) If the patient is incompetent, the representative of the patient; or

      (c) If the patient is less than 18 years of age, a parent or legal guardian of the patient.

      2.  The revocation of a POLST form is effective upon the communication to a provider of health care, by the patient or a witness to the revocation, of the desire to revoke the form. The provider of health care to whom the revocation is communicated shall:

      (a) Make the revocation a part of the medical record of the patient; or

      (b) Cause the revocation to be made a part of the medical record of the patient.

      (Added to NRS by 2013, 2285)

      NRS 449.6946  Conflict with other advance directive or do-not-resuscitate identification.

      1.  If a valid Physician Order for Life-Sustaining Treatment form sets forth a declaration, direction or order which conflicts with a declaration, direction or order set forth in one or more of the other types of advance directives:

      (a) The declaration, direction or order set forth in the document executed most recently is valid; and

      (b) Any other declarations, directions or orders that do not conflict with a declaration, direction or order set forth in another document referenced in this subsection remain valid.

      2.  If a valid POLST form sets forth a declaration, direction or order to provide life-resuscitating treatment to a patient who also possesses a do-not-resuscitate identification, a provider of health care shall not provide life-resuscitating treatment if the do-not-resuscitate identification is on the person of the patient when the need for life-resuscitating treatment arises.

      (Added to NRS by 2013, 2286)

      NRS 449.6948  Immunity from civil and criminal liability and discipline for unprofessional conduct.

      1.  A provider of health care is not guilty of unprofessional conduct or subject to civil or criminal liability if:

      (a) The provider of health care withholds emergency care or life-sustaining treatment:

             (1) In compliance with a Physician Order for Life-Sustaining Treatment form and the provisions of NRS 449.691 to 449.697, inclusive; or

             (2) In violation of a Physician Order for Life-Sustaining Treatment form if the provider of health care is acting in accordance with a declaration, direction or order set forth in one or more of the other types of advance directives and:

                   (I) Complies with the provisions of NRS 449.695; or

                   (II) Reasonably and in good faith, at the time the emergency care or life-sustaining treatment is withheld, is unaware of the existence of the POLST form or believes that the POLST form has been revoked pursuant to NRS 449.6944; or

      (b) The provider of health care provides emergency care or life-sustaining treatment:

             (1) Pursuant to an oral or written request made by the patient, the representative of the patient, or a parent or legal guardian of the patient, who may revoke the POLST form pursuant to NRS 449.6944;

             (2) Pursuant to an observation that the patient, the representative of the patient or a parent or legal guardian of the patient has revoked, or otherwise indicated that he or she wishes to revoke, the POLST form pursuant to NRS 449.6944; or

             (3) In violation of a POLST form, if the provider of health care reasonably and in good faith, at the time the emergency care or life-sustaining treatment is provided, is unaware of the existence of the POLST form or believes that the POLST form has been revoked pursuant to NRS 449.6944.

      2.  A health care facility, ambulance service, fire-fighting agency or other entity that employs a provider of health care is not guilty of unprofessional conduct or subject to civil or criminal liability for the acts or omissions of the employee carried out in accordance with the provisions of subsection 1.

      (Added to NRS by 2013, 2286)

      NRS 449.695  Provider of health care required to comply with valid POLST form; modification by physician; transfer of care of patient; exceptions.

      1.  Except as otherwise provided in this section and NRS 449.6946, a provider of health care shall comply with a valid Physician Order for Life-Sustaining Treatment form, regardless of whether the provider of health care is employed by a health care facility or other entity affiliated with the physician who executed the POLST form.

      2.  A physician may medically evaluate the patient and, based upon the evaluation, may recommend new orders consistent with the most current information available about the patient’s health status and goals of care. Before making a modification to a valid POLST form, the physician shall consult the patient or, if the patient is incompetent, shall make a reasonable attempt to consult the representative of the patient and the patient’s attending physician.

      3.  Except as otherwise provided in subsection 4, a provider of health care who is unwilling or unable to comply with a valid POLST form shall take all reasonable measures to transfer the patient to a physician or health care facility so that the POLST form will be followed.

      4.  Life-sustaining treatment must not be withheld or withdrawn pursuant to a POLST form of a patient known to the attending physician to be pregnant, so long as it is probable that the fetus will develop to the point of live birth with the continued application of life-sustaining treatment.

      5.  Nothing in this section requires a provider of health care to comply with a valid POLST form if the provider of health care does not have actual knowledge of the existence of the form.

      (Added to NRS by 2013, 2287)

      NRS 449.6952  Assumption of validity of POLST form; presumption of intent of patient not created if patient has revoked or not executed POLST form.

      1.  Unless he or she has knowledge to the contrary, a provider of health care may assume that a Physician Order for Life-Sustaining Treatment form complies with the provisions of NRS 449.691 to 449.697, inclusive, and is valid.

      2.  The provisions of NRS 449.691 to 449.697, inclusive, do not create a presumption concerning the intention of a:

      (a) Patient if the patient, the representative of the patient or a parent or legal guardian of the patient has revoked the POLST form pursuant to NRS 449.6944; or

      (b) Person who has not executed a POLST form,

Ê concerning the use or withholding of emergency care or life-sustaining treatment.

      (Added to NRS by 2013, 2287)

      NRS 449.6954  Death does not constitute suicide or homicide; effect of POLST form on policy of insurance; prohibiting or requiring execution of POLST form prohibited as condition for insurance or receipt of health care.

      1.  Death that results when emergency care or life-sustaining treatment has been withheld pursuant to a Physician Order for Life-Sustaining Treatment form and in accordance with the provisions of NRS 449.691 to 449.697, inclusive, does not constitute a suicide or homicide.

      2.  The execution of a POLST form does not affect the sale, procurement or issuance of a policy of life insurance or an annuity, nor does it affect, impair or modify the terms of an existing policy of life insurance or an annuity. A policy of life insurance or an annuity is not legally impaired or invalidated if emergency care or life-sustaining treatment has been withheld from an insured who has executed a POLST form, notwithstanding any term in the policy or annuity to the contrary.

      3.  A person may not prohibit or require the execution of a POLST form as a condition of being insured for, or receiving, health care.

      (Added to NRS by 2013, 2287)

      NRS 449.6956  Unlawful acts; penalty.

      1.  It is unlawful for:

      (a) A provider of health care to willfully fail to transfer the care of a patient in accordance with subsection 3 of NRS 449.695.

      (b) A person to willfully conceal, cancel, deface or obliterate a Physician Order for Life-Sustaining Treatment form without the consent of the patient who executed the form.

      (c) A person to falsify or forge the POLST form of another person, or willfully conceal or withhold personal knowledge of the revocation of the POLST form of another person, with the intent to cause the withholding or withdrawal of emergency care or life-sustaining treatment contrary to the wishes of the patient.

      (d) A person to require or prohibit the execution of a POLST form as a condition of being insured for, or receiving, health care in violation of subsection 3 of NRS 449.6954.

      (e) A person to coerce or fraudulently induce another to execute a POLST form.

      2.  A person who violates any of the provisions of this section is guilty of a misdemeanor.

      (Added to NRS by 2013, 2288)

      NRS 449.6958  Actions contrary to reasonable medical standards not required; mercy-killing, euthanasia or assisted suicide not authorized; rights associated with other advance directives not impaired; right to make decisions concerning emergency care or life-sustaining treatment not affected.  The provisions of NRS 449.691 to 449.697, inclusive, do not:

      1.  Require a provider of health care to take any action contrary to reasonable medical standards;

      2.  Affect the responsibility of a provider of health care to provide treatment for a patient’s comfort or alleviation of pain;

      3.  Condone, authorize or approve mercy killing, euthanasia or assisted suicide;

      4.  Except as otherwise provided in NRS 449.6946, affect or impair any right created pursuant to the provisions of any other types of advance directives; or

      5.  Affect the right of a patient to make decisions concerning the use of emergency care or life-sustaining treatment, if he or she is able to do so.

      (Added to NRS by 2013, 2288)

      NRS 449.696  Validity of POLST form executed in another state.

      1.  A Physician Order for Life-Sustaining Treatment form executed in another state in compliance with the laws of that state or this State is valid for the purposes of NRS 449.691 to 449.697, inclusive.

      2.  As used in this section, “state” includes the District of Columbia, the Commonwealth of Puerto Rico and a territory or insular possession subject to the jurisdiction of the United States.

      (Added to NRS by 2013, 2288)

      NRS 449.697  Regulations.  The Board may adopt such regulations as it determines to be necessary or advisable to carry out the provisions of NRS 449.691 to 449.697, inclusive.

      (Added to NRS by 2013, 2288)

PATIENT’S RIGHTS

      NRS 449.700  Facility to provide necessary services or arrange for transfer of patient; explanation of need for transfer and alternatives available.

      1.  Every medical facility and facility for the dependent must provide the services necessary to treat properly a patient in a particular case or must be able to arrange the transfer of the patient to another facility which can provide that care.

      2.  A patient may be transferred to another facility only if the patient has received an explanation of the need to transfer the patient and the alternatives available, unless the condition of the patient necessitates an immediate transfer to a facility for a higher level of care and the patient is unable to understand the explanation.

      (Added to NRS by 1983, 820; A 1985, 1747; 1999, 1051; 2011, 360)

      NRS 449.705  Facility to forward medical records upon certain transfers of patient.

      1.  If a patient in a medical facility or facility for the dependent is transferred to another medical facility or facility for the dependent, a division facility or a physician licensed to practice medicine, the facility shall forward a copy of the medical records of the patient, on or before the date the patient is transferred, to the other medical facility or facility for the dependent, the division facility or the physician. The facility is not required to obtain the oral or written consent of the patient to forward a copy of the medical records.

      2.  As used in this section:

      (a) “Division facility” means any unit or subunit operated by a division of the Department of Health and Human Services pursuant to title 39 of NRS.

      (b) “Medical records” includes a medical history of the patient, a summary of the current physical condition of the patient and a discharge summary which contains the information necessary for the proper treatment of the patient.

      (Added to NRS by 1991, 2349; A 1993, 2725; 1999, 1051; 2011, 360)

      NRS 449.710  Specific rights: Information concerning facility; treatment; billing; visitation.  Every patient of a medical facility or facility for the dependent has the right to:

      1.  Receive information concerning any other medical or educational facility or facility for the dependent associated with the facility at which he or she is a patient which relates to the care of the patient.

      2.  Obtain information concerning the professional qualifications or associations of the persons who are treating the patient.

      3.  Receive the name of the person responsible for coordinating the care of the patient in the facility.

      4.  Be advised if the facility in which he or she is a patient proposes to perform experiments on patients which affect the patient’s own care or treatment.

      5.  Receive from his or her physician a complete and current description of the patient’s diagnosis, plan for treatment and prognosis in terms which the patient is able to understand. If it is not medically advisable to give this information to the patient, the physician shall:

      (a) Provide the information to an appropriate person responsible for the patient; and

      (b) Inform that person that he or she shall not disclose the information to the patient.

      6.  Receive from his or her physician the information necessary for the patient to give his or her informed consent to a procedure or treatment. Except in an emergency, this information must not be limited to a specific procedure or treatment and must include:

      (a) A description of the significant medical risks involved;

      (b) Any information on alternatives to the treatment or procedure if the patient requests that information;

      (c) The name of the person responsible for the procedure or treatment; and

      (d) The costs likely to be incurred for the treatment or procedure and any alternative treatment or procedure.

      7.  Examine the bill for his or her care and receive an explanation of the bill, whether or not the patient is personally responsible for payment of the bill.

      8.  Know the regulations of the facility concerning his or her conduct at the facility.

      9.  Receive, within reasonable restrictions as to time and place, visitors of the patient’s choosing, including, without limitation, friends and members of the patient’s family.

      (Added to NRS by 1983, 820; A 1985, 906, 1748; 1999, 1052; 2001, 3047; 2011, 360)

      NRS 449.715  Specific rights: Designation of persons authorized to visit patient in facility.

      1.  If, as a result of the incapacitation of a patient or the inability of a patient to communicate, the patient of a medical facility or facility for the dependent who is 18 years of age or older is unable to inform the staff of the facility of the persons whom the patient authorizes to visit the patient at the facility, the facility shall allow visitation rights to any person designated by the patient in a letter, form or other document authorizing visitation executed in accordance with subsection 2. The visitation rights required by this subsection must be:

      (a) Provided in accordance with the visitation policies of the facility; and

      (b) The same visitation rights that are provided to a member of the patient’s family who is legally related to the patient.

      2.  A person 18 years of age or older wishing to designate a person for the purposes of establishing visitation rights in a medical facility or facility for the dependent may execute a letter, form or other document authorizing visitation in substantially the following form:

 

      (Date)..................................

       I, ..............................., (patient who is designating another person as having visitation rights of the patient) do hereby designate .................................. (person who is being designated as having visitation rights of the patient) as having the right to visit me in a medical facility or facility for the dependent. I hereby instruct all staff of a medical facility or facility for the dependent in which I am a patient to admit ...................................... (person who is being designated as having visitation rights of the patient) to my room and afford him or her the same visitation rights as are provided to members of my family who are legally related to me during my time as a patient.

........................................................

       (Signed)

 

      (Added to NRS by 2003, 1879; A 2011, 361)

      NRS 449.720  Specific rights: Care; refusal of treatment and experimentation; privacy; notice of appointments and need for care; confidentiality of information concerning patient.

      1.  Every patient of a medical facility or facility for the dependent has the right to:

      (a) Receive considerate and respectful care.

      (b) Refuse treatment to the extent permitted by law and to be informed of the consequences of that refusal.

      (c) Refuse to participate in any medical experiments conducted at the facility.

      (d) Retain his or her privacy concerning the patient’s program of medical care.

      (e) Have any reasonable request for services reasonably satisfied by the facility considering its ability to do so.

      (f) Receive continuous care from the facility. The patient must be informed:

             (1) Of the patient’s appointments for treatment and the names of the persons available at the facility for those treatments; and

             (2) By his or her physician or an authorized representative of the physician, of the patient’s need for continuing care.

      2.  Except as otherwise provided in NRS 108.640, 239.0115, 439.538, 442.300 to 442.330, inclusive, and 449.705 and chapter 629 of NRS, discussions of the care of a patient, consultation with other persons concerning the patient, examinations or treatments, and all communications and records concerning the patient are confidential. The patient must consent to the presence of any person who is not directly involved with the patient’s care during any examination, consultation or treatment.

      (Added to NRS by 1983, 821; A 1985, 1748; 1989, 2057; 1991, 2350; 1999, 1052, 3512; 2007, 1979, 2110; 2011, 362)

      NRS 449.725  Owner and administrator of certain facility prohibited from receiving money or property by will of resident or former resident or from life insurance proceeds of resident or former resident; exception.

      1.  Except as otherwise provided in subsection 3 and notwithstanding any other provision of law, an owner or administrator of a medical facility or facility for the dependent is not entitled to receive, and must not receive:

      (a) Any money, personal property or real property that is devised or bequeathed by will to the owner or administrator by a resident or former resident of the facility.

      (b) Any proceeds from a life insurance policy upon the life or body of a resident or former resident of the facility.

      2.  Except as otherwise provided in subsection 3, any money, property, proceeds or interest therein that is described in subsection 1 passes in accordance with law as if the owner or administrator of the medical facility or facility for the dependent had predeceased the decedent resident or former resident.

      3.  The provisions of subsections 1 and 2 do not apply if the owner or administrator of the medical facility or facility for the dependent is the spouse, legal guardian or next of kin of the resident or former resident of the facility or home, as applicable.

      (Added to NRS by 2011, 696)

      NRS 449.730  Patient to be informed of rights upon admission to facility; required disclosures and notices.

      1.  Every medical facility and facility for the dependent shall inform each patient or the patient’s legal representative, upon the admission of the patient to the facility, of the patient’s rights as listed in NRS 449.700, 449.710, 449.715, 449.720 and 449.725.

      2.  In addition to the requirements of subsection 1, if a person with a disability is a patient at a facility, as that term is defined in NRS 449.771, the facility shall inform the patient of his or her rights pursuant to NRS 449.765 to 449.786, inclusive.

      3.  In addition to the requirements of subsections 1 and 2, every hospital shall, upon the admission of a patient to the hospital, provide to the patient or the patient’s legal representative a written disclosure approved by the Director of the Department of Health and Human Services, which written disclosure must set forth:

      (a) Notice of the existence of the Bureau for Hospital Patients created pursuant to NRS 223.575;

      (b) The address and telephone number of the Bureau; and

      (c) An explanation of the services provided by the Bureau, including, without limitation, the services for dispute resolution described in subsection 3 of NRS 223.575.

      4.  In addition to the requirements of subsections 1, 2 and 3, every hospital shall, upon the discharge of a patient from the hospital, provide to the patient or the patient’s legal representative a written disclosure approved by the Director, which written disclosure must set forth:

      (a) If the hospital is a major hospital:

             (1) Notice of the reduction or discount available pursuant to NRS 439B.260, including, without limitation, notice of the criteria a patient must satisfy to qualify for a reduction or discount under that section; and

             (2) Notice of any policies and procedures the hospital may have adopted to reduce charges for services provided to persons or to provide discounted services to persons, which policies and procedures are in addition to any reduction or discount required to be provided pursuant to NRS 439B.260. The notice required by this subparagraph must describe the criteria a patient must satisfy to qualify for the additional reduction or discount, including, without limitation, any relevant limitations on income and any relevant requirements as to the period within which the patient must arrange to make payment.

      (b) If the hospital is not a major hospital, notice of any policies and procedures the hospital may have adopted to reduce charges for services provided to persons or to provide discounted services to persons. The notice required by this paragraph must describe the criteria a patient must satisfy to qualify for the reduction or discount, including, without limitation, any relevant limitations on income and any relevant requirements as to the period within which the patient must arrange to make payment.

Ê As used in this subsection, “major hospital” has the meaning ascribed to it in NRS 439B.115.

      5.  In addition to the requirements of subsections 1 to 4, inclusive, every hospital shall post in a conspicuous place in each public waiting room in the hospital a legible sign or notice in 14-point type or larger, which sign or notice must:

      (a) Provide a brief description of any policies and procedures the hospital may have adopted to reduce charges for services provided to persons or to provide discounted services to persons, including, without limitation:

             (1) Instructions for receiving additional information regarding such policies and procedures; and

             (2) Instructions for arranging to make payment;

      (b) Be written in language that is easy to understand; and

      (c) Be written in English and Spanish.

      (Added to NRS by 1983, 822; A 1985, 1749; 1999, 1053, 3252; 2003, 1880; 2005, 947; 2011, 362, 697)

      NRS 449.740  Procedure to insert implant in breast of patient: Informed consent required; withdrawal of consent; penalty.

      1.  A physician shall not perform any procedure to insert an implant in the breast of a patient unless within 5 days before the procedure is performed the physician has:

      (a) Discussed with the patient and any other person whose consent is required pursuant to paragraph (b), the advantages, disadvantages and risks associated with the procedure; and

      (b) Obtained informed consent in writing from the following persons freely and without coercion:

             (1) The patient if he or she is 18 years of age or over or legally emancipated and competent to give that consent, and from the patient’s legal guardian, if any;

             (2) The parent or guardian of a patient under 18 years of age and not legally emancipated; or

             (3) The legal guardian of a patient of any age who has been adjudicated mentally incompetent,

Ê and the required consent was not withdrawn pursuant to subsection 3 before the procedure began.

      2.  An informed consent requires that the person whose consent is sought be adequately informed as to:

      (a) The nature and consequences of the procedure;

      (b) The reasonable risks, possible side effects, benefits and purposes of the procedure; and

      (c) Any alternative procedures available.

      3.  The consent of a patient or other person whose consent is required pursuant to paragraph (b) of subsection 1 may be withdrawn in writing at any time before the procedure has begun, with or without cause.

      4.  A physician satisfies the requirements of:

      (a) Paragraph (a) of subsection 1 if the physician provides the patient and any other person whose consent is required pursuant to paragraph (b) of subsection 1 with a copy of the current explanation form prepared by the Division pursuant to NRS 449.750 in a language that the person is able to read.

      (b) Paragraph (b) of subsection 1 if the person or persons whose consent is required sign a copy of the current consent form prepared by the Division pursuant to NRS 449.750 freely and without coercion and the consent is not withdrawn pursuant to subsection 3 before the procedure has begun. The consent form must be in a language that the person who signs the form is able to read.

      5.  Any person who violates the provisions of this section is guilty of a misdemeanor.

      (Added to NRS by 1991, 1690)

      NRS 449.750  Procedure to insert implant in breast of patient: Contents of explanation form and consent form; fee for forms.

      1.  The Division shall prepare and provide to physicians upon request:

      (a) An explanation form for a procedure to insert an implant in the breast of a person which includes:

             (1) An explanation of the advantages, disadvantages and risks associated with a procedure to insert an implant in the breast of a person, including any known side effects; and

             (2) Any other information the Division determines to be useful to a person contemplating a procedure to insert an implant in the breast; and

      (b) A consent form for a procedure to insert an implant in the breast of a person which includes:

             (1) The nature and consequences of the procedure;

             (2) The reasonable risks, possible side effects, benefits and purposes of the procedure; and

             (3) Any alternative procedures available.

      2.  The Division shall revise the explanation form and consent form as necessary to keep the medical information current.

      3.  The Division shall charge and collect a fee for all forms distributed pursuant to this section that is adequate to cover the cost of producing the forms.

      (Added to NRS by 1991, 1690)

COLLECTION OF AMOUNT OWED TO HOSPITAL FOR HOSPITAL CARE

      NRS449.751  Definitions.  As used in NRS 449.751 to 449.759, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.753 and 449.755 have the meanings ascribed to them in those sections.

      (Added to NRS by 2007, 1497; A 2011, 1524)

      NRS449.753  Hospital care” defined.  “Hospital care” has the meaning ascribed to it in NRS 428.155.

      (Added to NRS by 2007, 1497)

      NRS449.755  Responsible party” defined.  “Responsible party” means the person who received the hospital care, the parent or guardian of the person who received the hospital care or another natural person who is legally responsible or has agreed to be responsible for the payment to the hospital of any charges incurred in connection with the hospital care.

      (Added to NRS by 2007, 1497)

      NRS449.757  Limitations on efforts of hospitals to collect; date for accrual of interest; rate of interest; limitations on additional fees.

      1.  When a person receives hospital care, the hospital must not proceed with any efforts to collect on any amount owed to the hospital for the hospital care from the responsible party, other than for any copayment or deductible, if the responsible party has health insurance or may be eligible for Medicaid, the Children’s Health Insurance Program or any other public program which may pay all or part of the bill, until the hospital has submitted a bill to the health insurance company or public program and the health insurance company or public program has made a determination concerning payment of the claim.

      2.  Collection efforts may begin and interest may begin to accrue on any amount owed to the hospital for hospital care which remains unpaid by the responsible party not sooner than 30 days after the responsible party is sent a bill by mail stating the amount that he or she is responsible to pay which has been established after receiving a determination concerning payment of the claim by any insurer or public program and after applying any discounts. Interest must accrue at a rate which does not exceed the prime rate at the largest bank in Nevada as ascertained by the Commissioner of Financial Institutions on January 1 or July 1, as the case may be, immediately preceding the date on which the payment becomes due, plus 2 percent. The rate must be adjusted accordingly on each January 1 and July 1 thereafter until the payment is satisfied.

      3.  Except for the interest authorized pursuant to subsection 2 and any court costs and attorney’s fees awarded by a court, no other fees may be charged concerning the amount that remains unpaid, including, without limitation, collection fees, other attorney’s fees or any other fees or costs.

      (Added to NRS by 2007, 1497; A 2011, 1525)

      NRS 449.758  Limitations on efforts of hospital to collect when hospital has contractual agreement with third party that provides health coverage for care provided; exception.

      1.  Except as otherwise provided in subsection 2, if a hospital provides hospital care to a person who has a policy of health insurance issued by a third party that provides health coverage for care provided at that hospital and the hospital has a contractual agreement with the third party, the hospital shall proceed with any efforts to collect on any amount owed to the hospital for the hospital care in accordance with the provisions of NRS 449.757 and shall not collect or attempt to collect that amount from:

      (a) Any proceeds or potential proceeds of a civil action brought by or on behalf of the patient, including, without limitation, any amount awarded for medical expenses; or

      (b) An insurer other than a health insurer, including, without limitation, an insurer that provides coverage under a policy of casualty or property insurance.

      2.  This section does not apply to:

      (a) Amounts owed to the hospital under the policy of health insurance that are not collectible; or

      (b) Medicaid, the Children’s Health Insurance Program or any other public program which may pay all or part of the bill.

      3.  This section does not limit any rights of a patient to contest an attempt to collect an amount owed to a hospital, including, without limitation, contesting a lien obtained by a hospital.

      4.  As used in this section, “third party” has the meaning ascribed to it in NRS 439B.260.

      (Added to NRS by 2011, 1524)

      NRS449.759  Manner of collection.  A hospital, or any person acting on its behalf who seeks to collect a debt from a responsible party for any amount owed to the hospital for hospital care must collect the debt in a professional, fair and lawful manner. When collecting such a debt, the hospital or other person acting on its behalf must act in accordance with sections 803 to 812, inclusive, of the federal Fair Debt Collection Practices Act, as amended, 15 U.S.C. §§ 1692a to 1692j, inclusive, even if the hospital or person acting on its behalf is not otherwise subject to the provisions of that Act.

      (Added to NRS by 2007, 1498)

PREVENTING PERSONS FROM ENTERING OR EXITING HEALTH FACILITY

      NRS 449.760  Unlawful acts; exception; penalty.

      1.  Except as otherwise provided in this section, a person shall not intentionally prevent another person from entering or exiting the office of a physician, a health facility, a nonprofit health facility, a public health center, a medical facility or a facility for the dependent by physically:

      (a) Detaining the other person; or

      (b) Obstructing, impeding or hindering the other person’s movement.

      2.  The provisions of subsection 1 are inapplicable to:

      (a) An officer, employee or agent of the physician, health facility, nonprofit health facility, public health center, medical facility or facility for the dependent; or

      (b) A peace officer as defined in NRS 169.125,

Ê while acting within the course and scope of his or her duties or employment.

      3.  The provisions of subsection 1 do not prohibit a person from maintaining a picket during a strike or work stoppage in compliance with the provisions of NRS 614.160, or from engaging in any constitutionally protected exercise of free speech.

      4.  A person who violates the provisions of subsection 1 is guilty of a misdemeanor and shall be punished by a fine of not more than $1,000, or by imprisonment in the county jail for not more than 3 months, or by both fine and imprisonment.

      5.  As used in this section, the terms “health facility,” “nonprofit health facility” and “public health center” have the meanings ascribed to them in NRS 449.260.

      (Added to NRS by 1991, 1687)

USE OF AVERSIVE INTERVENTION OR FORMS OF RESTRAINT ON PATIENTS WITH DISABILITIES

      NRS 449.765  Definitions.  As used in NRS 449.765 to 449.786, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.766 to 449.775, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1999, 3247)

      NRS 449.766  “Aversive intervention” defined.  “Aversive intervention” means any of the following actions if the action is used to punish a person with a disability or to eliminate, reduce or discourage maladaptive behavior of a person with a disability:

      1.  The use of noxious odors and tastes;

      2.  The use of water and other mists or sprays;

      3.  The use of blasts of air;

      4.  The use of corporal punishment;

      5.  The use of verbal and mental abuse;

      6.  The use of electric shock;

      7.  Requiring a person to perform exercise under forced conditions if the:

      (a) Person is required to perform the exercise because the person exhibited a behavior that is related to his or her disability;

      (b) Exercise is harmful to the health of the person because of his or her disability; or

      (c) Nature of the person’s disability prevents the person from engaging in the exercise;

      8.  Any intervention, technique or procedure that deprives a person of the use of one or more of the person’s senses, regardless of the length of the deprivation, including, without limitation, the use of sensory screens; or

      9.  The deprivation of necessities needed to sustain the health of a person, regardless of the length of the deprivation, including, without limitation, the denial or unreasonable delay in the provision of:

      (a) Food or liquid at a time when it is customarily served; or

      (b) Medication.

Ê The term does not include the withholding or withdrawal of life-sustaining treatment in accordance with NRS 449.626 or 449.691 to 449.697, inclusive.

      (Added to NRS by 1999, 3247; A 2013, 2288)

      NRS 449.767  “Chemical restraint” defined.  “Chemical restraint” means the administration of drugs for the specific and exclusive purpose of controlling an acute or episodic aggressive behavior when alternative intervention techniques have failed to limit or control the behavior. The term does not include the administration of drugs on a regular basis, as prescribed by a physician, to treat the symptoms of mental, physical, emotional or behavioral disorders and for assisting a person in gaining self-control over his or her impulses.

      (Added to NRS by 1999, 3247)

      NRS 449.768  “Corporal punishment” defined.  “Corporal punishment” means the intentional infliction of physical pain, including, without limitation, hitting, pinching or striking.

      (Added to NRS by 1999, 3248)

      NRS 449.769  “Electric shock” defined.  “Electric shock” means the application of electric current to a person’s skin or body. The term does not include electroconvulsive therapy.

      (Added to NRS by 1999, 3248)

      NRS 449.770  “Emergency” defined.  “Emergency” means a situation in which immediate intervention is necessary to protect the physical safety of a person or others from an immediate threat of physical injury or to protect against an immediate threat of severe property damage.

      (Added to NRS by 1999, 3248)

      NRS 449.771  “Facility” defined.  “Facility” means a facility licensed pursuant to this chapter that is a psychiatric hospital or a unit of a hospital that is specifically designated to provide care and services to persons with psychiatric or developmental disabilities.

      (Added to NRS by 1999, 3248)

      NRS 449.772  “Mechanical restraint” defined.  “Mechanical restraint” means the use of devices, including, without limitation, mittens, straps and restraint chairs to limit a person’s movement or hold a person immobile.

      (Added to NRS by 1999, 3248)

      NRS 449.773  “Person with a disability” defined.  “Person with a disability” means a person who:

      1.  Has a physical or mental impairment that substantially limits one or more of the major life activities of the person;

      2.  Has a record of such an impairment; or

      3.  Is regarded as having such an impairment.

      (Added to NRS by 1999, 3248)

      NRS 449.774  “Physical restraint” defined.  “Physical restraint” means the use of physical contact to limit a person’s movement or hold a person immobile.

      (Added to NRS by 1999, 3248)

      NRS 449.775  “Verbal and mental abuse” defined.  “Verbal and mental abuse” means actions or utterances that are intended to cause and actually cause severe emotional distress to a person.

      (Added to NRS by 1999, 3248)

      NRS 449.776  Aversive intervention: Prohibition on use.  A person employed by a facility licensed pursuant to this chapter or any other person shall not use any aversive intervention on a person with a disability who is a patient at the facility.

      (Added to NRS by 1999, 3248)

      NRS 449.777  Forms of restraint: Restrictions on use.  A person employed by a facility licensed pursuant to this chapter or any other person shall not:

      1.  Except as otherwise provided in NRS 449.778, use physical restraint on a person with a disability who is a patient at the facility.

      2.  Except as otherwise provided in NRS 449.779, use mechanical restraint on a person with a disability who is a patient at the facility.

      3.  Except as otherwise provided in NRS 449.780, use chemical restraint on a person with a disability who is a patient at the facility.

      (Added to NRS by 1999, 3248)

      NRS 449.778  Physical restraint: Permissible use; report of use in emergency.

      1.  Except as otherwise provided in subsection 2, physical restraint may be used on a person with a disability who is a patient at a facility only if:

      (a) An emergency exists that necessitates the use of physical restraint;

      (b) The physical restraint is used only for the period that is necessary to contain the behavior of the patient so that the patient is no longer an immediate threat of causing physical injury to himself or herself or others or causing severe property damage; and

      (c) The use of force in the application of physical restraint does not exceed the force that is reasonable and necessary under the circumstances precipitating the use of physical restraint.

      2.  Physical restraint may be used on a person with a disability who is a patient at a facility and the provisions of subsection 1 do not apply if the physical restraint is used to:

      (a) Assist the patient in completing a task or response if the patient does not resist the application of physical restraint or if the patient’s resistance is minimal in intensity and duration;

      (b) Escort or carry a patient to safety if the patient is in danger in his or her present location; or

      (c) Conduct medical examinations or treatments on the patient that are necessary.

      3.  If physical restraint is used on a person with a disability who is a patient at a facility in an emergency, the use of the procedure must be reported as a denial of rights pursuant to NRS 449.786, regardless of whether the use of the procedure is authorized by statute. The report must be made not later than 1 working day after the procedure is used.

      (Added to NRS by 1999, 3249)

      NRS 449.779  Mechanical restraint: Permissible use; report of use in emergency.

      1.  Except as otherwise provided in subsection 2, mechanical restraint may be used on a person with a disability who is a patient at a facility only if:

      (a) An emergency exists that necessitates the use of mechanical restraint;

      (b) A medical order authorizing the use of mechanical restraint is obtained from the patient’s treating physician before the application of the mechanical restraint or not later than 15 minutes after the application of the mechanical restraint;

      (c) The physician who signed the order required pursuant to paragraph (b) or the attending physician examines the patient not later than 1 working day immediately after the application of the mechanical restraint;

      (d) The mechanical restraint is applied by a member of the staff of the facility who is trained and qualified to apply mechanical restraint;

      (e) The patient is given the opportunity to move and exercise the parts of his or her body that are restrained at least 10 minutes per every 60 minutes of restraint;

      (f) A member of the staff of the facility lessens or discontinues the restraint every 15 minutes to determine whether the patient will stop or control his or her inappropriate behavior without the use of the restraint;

      (g) The record of the patient contains a notation that includes the time of day that the restraint was lessened or discontinued pursuant to paragraph (f), the response of the patient and the response of the member of the staff of the facility who applied the mechanical restraint;

      (h) A member of the staff of the facility continuously monitors the patient during the time that mechanical restraint is used on the patient; and

      (i) The patient is released from the mechanical restraint as soon as the behavior of the patient no longer presents an immediate threat to himself or herself or others.

      2.  Mechanical restraint may be used on a person with a disability who is a patient at a facility and the provisions of subsection 1 do not apply if the mechanical restraint is used to:

      (a) Treat the medical needs of a patient;

      (b) Protect a patient who is known to be at risk of injury to himself or herself because the patient lacks coordination or suffers from frequent loss of consciousness;

      (c) Provide proper body alignment to a patient; or

      (d) Position a patient who has physical disabilities in a manner prescribed in the patient’s plan of treatment.

      3.  If mechanical restraint is used on a person with a disability who is a patient at a facility in an emergency, the use of the procedure must be reported as a denial of rights pursuant to NRS 449.786, regardless of whether the use of the procedure is authorized by statute. The report must be made not later than 1 working day after the procedure is used.

      (Added to NRS by 1999, 3249)

      NRS 449.780  Chemical restraint: Permissible use; report of use.

      1.  Chemical restraint may only be used on a person with a disability who is a patient at a facility if:

      (a) The patient has been diagnosed as a person with mental illness, as defined in NRS 433A.115, and is receiving mental health services from a facility;

      (b) The chemical restraint is administered to the patient while he or she is under the care of the facility;

      (c) An emergency exists that necessitates the use of chemical restraint;

      (d) A medical order authorizing the use of chemical restraint is obtained from the patient’s attending physician or psychiatrist;

      (e) The physician or psychiatrist who signed the order required pursuant to paragraph (d) examines the patient not later than 1 working day immediately after the administration of the chemical restraint; and

      (f) The chemical restraint is administered by a person licensed to administer medication.

      2.  If chemical restraint is used on a person with a disability who is a patient, the use of the procedure must be reported as a denial of rights pursuant to NRS 449.786, regardless of whether the use of the procedure is authorized by statute. The report must be made not later than 1 working day after the procedure is used.

      (Added to NRS by 1999, 3250)

      NRS 449.781  Use of forms of restraint by certain facilities.  Notwithstanding the provisions of NRS 449.777 to 449.780, inclusive, to the contrary, a facility may use or authorize the use of physical restraint, mechanical restraint or chemical restraint on a person with a disability who is a patient if the facility is:

      1.  Accredited by a nationally recognized accreditation association or agency; or

      2.  Certified for participation in the Medicaid or Medicare program,

Ê only to the extent that the accreditation or certification allows the use of such restraint.

      (Added to NRS by 1999, 3248)

      NRS 449.782  Education and training of members of staff of facility.

      1.  Each facility shall develop a program of education for the members of the staff of the facility to provide instruction in positive behavioral interventions and positive behavioral supports that:

      (a) Includes positive methods to modify the environment of patients to promote adaptive behavior and reduce the occurrence of inappropriate behavior;

      (b) Includes methods to teach skills to patients so that patients can replace inappropriate behavior with adaptive behavior;

      (c) Includes methods to enhance a patient’s independence and quality of life;

      (d) Includes the use of the least intrusive methods to respond to and reinforce the behavior of patients; and

      (e) Offers a process for designing interventions based upon the patient that are focused on promoting appropriate changes in behavior as well as enhancing the overall quality of life for the patient.

      2.  Each facility shall provide appropriate training for the members of the staff of the facility who are authorized to carry out and monitor physical restraint and mechanical restraint to ensure that those members of the staff are competent and qualified to carry out the procedures in accordance with NRS 449.765 to 449.786, inclusive.

      (Added to NRS by 1999, 3250)

      NRS 449.783  Violations: Criminal penalties; ineligibility for employment; disciplinary action.

      1.  Unless a more severe penalty is prescribed by specific statute, a person who willfully uses aversive intervention on a person with a disability who is a patient at a facility or, except as otherwise provided in NRS 449.781, violates NRS 449.777:

      (a) For a first violation that does not result in substantial bodily harm to the person with a disability, is guilty of a gross misdemeanor.

      (b) For a first violation that results in substantial bodily harm to the person with a disability, is guilty of a category B felony.

      (c) For a second or subsequent violation, is guilty of a category B felony.

Ê A person who is convicted of a category B felony pursuant to this section shall be punished by imprisonment in the state prison for a minimum term of not less than 1 year and a maximum term of not more than 6 years, or by a fine of not more than $5,000, or by both fine and imprisonment.

      2.  A person who is convicted pursuant to this section is ineligible for 5 years for employment with a facility.

      3.  A conviction pursuant to this section is, when applicable, grounds for disciplinary action against the person so convicted and the facility where the violation occurred. The Division may recommend to the appropriate agency or board the suspension or revocation of the professional license, registration, certificate or permit of a person convicted.

      (Added to NRS by 1999, 3251)

      NRS 449.784  Violations: Report required; development and review of and compliance with corrective plan.

      1.  A facility where a violation of the provisions of NRS 449.765 to 449.786, inclusive, occurs shall report the violation to the Division not later than 24 hours after the violation occurred, or as soon thereafter as the violation is discovered.

      2.  A facility where a violation occurred shall develop, in cooperation with the Division, a corrective plan to ensure that within 30 calendar days after the violation occurred, appropriate action is taken by the facility to prevent future violations.

      3.  The Division shall forward the plan to the Board. The Board shall review the plan to ensure that it complies with applicable federal law and the statutes and regulations of this state. The Board may require appropriate revision of the plan to ensure compliance.

      4.  If the facility where the violation occurred does not meet the requirements of the plan to the satisfaction of the Board, the Board may direct the agency that administers funding for the facility to withhold state funding for the facility until the facility meets the requirements of the plan.

      (Added to NRS by 1999, 3251)

      NRS 449.785  Prohibition on retaliation against person for reporting or providing information regarding violation.  An officer, administrator or employee of a facility licensed pursuant to this chapter shall not retaliate against any person for having:

      1.  Reported a violation of NRS 449.765 to 449.786, inclusive; or

      2.  Provided information regarding a violation of NRS 449.765 to 449.786, inclusive,

Ê by a facility or a member of the staff of the facility.

      (Added to NRS by 1999, 3252)

      NRS 449.786  Entry of denial of rights in patient’s record; notice and report of denial; action by Division.

      1.  A denial of rights of a person with a disability who is a patient of a facility pursuant to NRS 449.765 to 449.786, inclusive, must be entered in the patient’s record. Notice of the denial must be provided to the administrator of the facility.

      2.  If the administrator of a facility receives notice of a denial of rights pursuant to subsection 1, the administrator shall cause a full report to be prepared which must set forth in detail the factual circumstances surrounding the denial. A copy of the report must be provided to the Division.

      3.  The Division:

      (a) Shall receive reports made pursuant to subsection 2;

      (b) May investigate apparent violations of the rights of persons with disabilities who are patients at facilities; and

      (c) May act to resolve disputes relating to apparent violations.

      (Added to NRS by 1999, 3252)

REGISTRY OF ADVANCE DIRECTIVES FOR HEALTH CARE

      NRS449.900  Definitions.  As used in NRS 449.900 to 449.965, inclusive, unless the context otherwise requires, the words and terms defined in NRS 449.905, 449.910 and 449.915 have the meanings ascribed to them in those sections.

      (Added to NRS by 2007, 2515)

      NRS449.905  “Advance directive” defined.  “Advance directive” means an advance directive for health care. The term includes:

      1.  A declaration governing the withholding or withdrawal of life-sustaining treatment as set forth in NRS 449.535 to 449.690, inclusive;

      2.  A durable power of attorney for health care as set forth in NRS 162A.700 to 162A.860, inclusive;

      3.  A do-not-resuscitate order as defined in NRS 450B.420; and

      4.  A Physician Order for Life-Sustaining Treatment form as defined in NRS 449.693.

      (Added to NRS by 2007, 2515; A 2009, 210; 2013, 2289)

      NRS449.910  “Registrant” defined.  “Registrant” means a person whose advance directive is registered with the Secretary of State pursuant to NRS 449.925.

      (Added to NRS by 2007, 2515)

      NRS449.915  “Registry” defined.  “Registry” means the Registry of Advance Directives for Health Care established by the Secretary of State pursuant to NRS 449.920.

      (Added to NRS by 2007, 2515)

      NRS449.920  Establishment and maintenance; information to be included in Registry.  The Secretary of State shall establish and maintain the Registry of Advance Directives for Health Care on the Internet website of the Secretary of State. The Registry must include, without limitation, in a secure portion of the website, an electronic reproduction of each advance directive. The electronic reproduction must be capable of being viewed on the website and downloaded, printed or otherwise retrieved by a person as set forth in NRS 449.930.

      (Added to NRS by 2007, 2515)

      NRS449.925  Registration of advance directive: Requirements; duties of Secretary of State.

      1.  A person who wishes to register an advance directive must submit to the Secretary of State:

      (a) An application in the form prescribed by the Secretary of State;

      (b) A copy of the advance directive; and

      (c) The fee, if any, established by the Secretary of State pursuant to NRS 449.955.

      2.  If the person satisfies the requirements of subsection 1, the Secretary of State shall:

      (a) Make an electronic reproduction of the advance directive and post it to the Registry and, if the person consents pursuant to NRS 439.591, the statewide health information exchange system established pursuant to NRS 439.581 to 439.595, inclusive;

      (b) Assign a registration number and password to the registrant; and

      (c) Provide the registrant with a registration card that includes, without limitation, the name, registration number and password of the registrant.

      3.  The Secretary of State shall establish procedures for:

      (a) The registration of an advance directive that replaces an advance directive that is posted on the Registry;

      (b) The removal from the Registry of an advance directive that has been revoked following the revocation of the advance directive or the death of the registrant; and

      (c) The issuance of a duplicate registration card or the provision of other access to the registrant’s registration number and password if a registration card issued pursuant to this section is lost, stolen, destroyed or otherwise unavailable.

      (Added to NRS by 2007, 2515; A 2013, 2289)

      NRS449.930  Access to advance directive.

      1.  Except as otherwise provided in this section, the Secretary of State shall not provide access to a registrant’s advance directive unless:

      (a) The person requesting access provides the registration number and password of the registrant;

      (b) The Secretary of State determines that providing access to the advance directive is in the best interest of the registrant;

      (c) Access to the advance directive is required pursuant to the lawful order of a court of competent jurisdiction; or

      (d) Access to the advance directive is requested by the registrant or the registrant’s personal representative.

      2.  A registrant or the personal representative of a registrant may access the registrant’s advance directive for any purpose. A provider of health care to the registrant may access the registrant’s advance directive only in connection with the provision of health care to the registrant.

      (Added to NRS by 2007, 2516)

      NRS449.935  Removal of advance directive of deceased registrant.  The Secretary of State shall remove from the Registry the advance directives of deceased registrants. The State Registrar of Vital Statistics shall cooperate with the Secretary of State to identify registrants whose advance directives must be removed from the Registry. The Secretary of State shall remove from the Registry the advance directives of deceased registrants at least once every 5 years.

      (Added to NRS by 2007, 2516)

      NRS449.940  Secretary of State not required to determine accuracy of contents of advance directive or validity of advance directive; effect of registration, failure to register and failure to notify Secretary of State of revocation of advance directive.

      1.  The provisions of NRS 449.900 to 449.965, inclusive, do not require the Secretary of State to determine whether the contents of an advance directive submitted for registration are accurate or the execution or issuance of the advance directive complies with the requirements necessary to make the advance directive valid.

      2.  The registration of an advance directive does not establish or create a presumption that the contents of the advance directive are accurate or the execution or issuance of the advance directive complies with the requirements necessary to make the advance directive valid.

      3.  Failure to register an advance directive does not affect the validity of the advance directive.

      4.  Failure to notify the Secretary of State of the revocation of a registrant’s advance directive does not affect the validity of the revocation.

      (Added to NRS by 2007, 2516)

      NRS449.945  Provider of health care not required to inquire whether patient has registered advance directive or access Registry; immunity of provider of health care from criminal and civil liability.

      1.  The provisions of NRS 449.900 to 449.965, inclusive, do not require a provider of health care to inquire whether a patient has an advance directive registered on the Registry or to access the Registry to determine the terms of the advance directive.

      2.  A provider of health care who relies in good faith on the provisions of an advance directive retrieved from the Registry is immune from criminal and civil liability as set forth in:

      (a) NRS 449.630, if the advance directive is a declaration governing the withholding or withdrawal of life-sustaining treatment executed pursuant to NRS 449.535 to 449.690, inclusive, or a durable power of attorney for health care executed pursuant to NRS 162A.700 to 162A.860, inclusive;

      (b) NRS 449.691 to 449.697, inclusive, if the advance directive is a Physician Order for Life-Sustaining Treatment form; or

      (c) NRS 450B.540, if the advance directive is a do-not-resuscitate order as defined in NRS 450B.420.

      (Added to NRS by 2007, 2516; A 2009, 210; 2013, 2290)

      NRS449.950  Immunity of Secretary of State and deputies, employees and attorneys of Secretary of State.  The Secretary of State and the deputies, employees and attorneys of the Secretary of State are not liable for any action or omission made in good faith by the Secretary of State, deputy, employee or attorney in carrying out the provisions of NRS 449.900 to 449.965, inclusive.

      (Added to NRS by 2007, 2516)

      NRS449.955  Suspension of components of Registry and duties of Secretary of State if sufficient money not available; fees authorized; acceptance of gifts and grants.

      1.  On or before July 1 of each odd-numbered year, the Secretary of State 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 Secretary of State relating to NRS 449.900 to 449.965, inclusive.

      2.  The Secretary of State shall temporarily suspend any components of the programs or duties of the Secretary of State for which he or she determines pursuant to subsection 1 that sufficient money is not available.

      3.  The Secretary of State may charge and collect fees and accept gifts, grants, bequests and other contributions from any source for the purpose of carrying out the provisions of NRS 449.900 to 449.965, inclusive.

      (Added to NRS by 2007, 2517)

      NRS449.960  Deposit, accounting and use of money received; interest and income earned on money received; payment of claims.

      1.  All money received by the Secretary of State pursuant to NRS 449.900 to 449.965, inclusive, must be:

      (a) Deposited in the State Treasury and accounted for separately in the State General Fund; and

      (b) Used only for the purpose of carrying out the provisions of NRS 449.900 to 449.965, inclusive.

      2.  The Secretary of State shall administer the account. The interest and income earned on the money in the account, after deducting any applicable charges, must be credited to the account.

      3.  The money in the account does not lapse to the State General Fund at the end of any fiscal year.

      4.  Claims against the account must be paid as other claims against the State are paid.

      (Added to NRS by 2007, 2517)

      NRS449.965  Regulations.  The Secretary of State may adopt regulations to carry out the provisions of NRS 449.900 to 449.965, inclusive.

      (Added to NRS by 2007, 2517)