[Rev. 11/21/2013 11:40:37 AM--2013]

CHAPTER 439B - RESTRAINING COSTS OF HEALTH CARE

GENERAL PROVISIONS

NRS 439B.010        Definitions.

NRS 439B.030        “Billed charge” defined.

NRS 439B.035        “Children’s Health Insurance Program” defined.

NRS 439B.040        “Committee” defined.

NRS 439B.050        “Department” defined.

NRS 439B.060        “Director” defined.

NRS 439B.070        “Discharge form” defined.

NRS 439B.090        “Fiscal year” defined.

NRS 439B.100        “Health facility” defined.

NRS 439B.110        “Hospital” defined.

NRS 439B.115        “Major hospital” defined.

NRS 439B.120        “Medicaid” defined.

NRS 439B.130        “Medicare” defined.

NRS 439B.140        “Net revenue” defined.

NRS 439B.150        “Practitioner” defined.

NRS 439B.160        Purposes of chapter.

LEGISLATIVE COMMITTEE ON HEALTH CARE

NRS 439B.200        Creation; appointment of and restrictions on members; officers; terms of members; vacancies; annual reports.

NRS 439B.210        Meetings; quorum; compensation.

NRS 439B.220        Powers.

NRS 439B.225        Committee to review certain regulations proposed or adopted by licensing boards; recommendations to Legislature.

NRS 439B.227        Committee to review certain new provisions of law; recommendations to Legislature concerning mandated reporters.

NRS 439B.230        Investigations and hearings: Depositions; subpoenas. [Repealed.]

NRS 439B.240        Investigations and hearings: Fees and mileage for witnesses. [Repealed.]

NEVADA ACADEMY OF HEALTH

NRS 439B.250        Establishment; members; qualifications of members; election of Chair; compensation of members; members holding public office or employed by governmental entity; vacancies; duties; appointment of advisory committees authorized; acceptance of gifts and grants.

MAJOR HOSPITALS

NRS 439B.260        Reduction of billed charges for certain patients and services; notice; resolution of disputes.

NRS 439B.265        Collection of deductible or copayment from indigent patient covered by Medicare prohibited. [Effective upon confirmation by the Federal Government that the deductibles and copayments which a hospital is prohibited from collecting from a patient pursuant to this section are deemed uncollectible for the purposes of federal law.]

NRS 439B.270        Foundation for hospital nursing practice: Establishment; governing body.

NRS 439B.275        Program for provision of technical assistance to rural hospitals.

NRS 439B.280        Educational program to promote wellness, physical fitness and prevention of disease and accidents.

CARE OF INDIGENT PATIENTS

NRS 439B.300        Legislative findings and declarations; applicability.

NRS 439B.310        “Indigent” defined.

NRS 439B.320        Hospital required to provide care for proportionate share of indigent patients; duties of Department and board of county commissioners; reimbursement for care.

NRS 439B.330        Eligibility of indigent for assistance; payment of hospital for serving disproportionately large share of patients; discharge forms; appeal from determination of county regarding indigent status.

NRS 439B.340        Report on indigent patients treated; verification by Director; compensation for treatment provided in excess of obligation; assessment for failure to fulfill minimum obligation.

PROGRAM TO INCREASE AWARENESS OF HEALTH CARE PROGRAMS FOR CHILDREN

NRS 439B.350        Department to establish; purpose.

NRS 439B.360        Evaluation: Recommendations; report to Interim Finance Committee.

NRS 439B.370        Director authorized to contract for certain services.

MISCELLANEOUS PROVISIONS

NRS 439B.400        Hospital must maintain and use uniform list of billed charges; exception.

NRS 439B.410        Hospital required to provide emergency services and care; unlawful acts of hospital or physician working in hospital emergency room; treating hospital may recover penalty from transferring hospital; exceptions; administrative investigations and sanctions.

NRS 439B.420        Prohibited acts of hospitals and related entities; exceptions; submission of contracts to Director; civil penalty.

NRS 439B.425        Prohibited referral of patients; exceptions; penalty.

NRS 439B.430        Prohibited acts of hospitals; examination by Director; administrative fine; injunctive relief.

NRS 439B.440        Director may require hospitals, health facilities and providers of health services to submit information; independent audit; examinations; penalty.

NRS 439B.450        Powers and duties of Director.

NRS 439B.460        Director authorized to delegate powers and duties.

NRS 439B.500        Penalty for violation of chapter.

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GENERAL PROVISIONS

      NRS 439B.010  Definitions.  As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 439B.030 to 439B.150, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1987, 862; A 1991, 2111, 2333; 1993, 619, 620; 1999, 2238)

      NRS 439B.030  “Billed charge” defined.  “Billed charge” means the total amount charged by a hospital for medical care provided, regardless of the anticipated amount of net revenue to be received or the anticipated source of payment.

      (Added to NRS by 1987, 862)

      NRS 439B.035  “Children’s Health Insurance Program” defined.  “Children’s Health Insurance Program” has the meaning ascribed to it in NRS 422.021.

      (Added to NRS by 1999, 2238; A 2001, 158)

      NRS 439B.040  “Committee” defined.  “Committee” means the Legislative Committee on Health Care.

      (Added to NRS by 1987, 863)

      NRS 439B.050  “Department” defined.  “Department” means the Department of Health and Human Services.

      (Added to NRS by 1987, 863)

      NRS 439B.060  “Director” defined.  “Director” means the Director of the Department.

      (Added to NRS by 1987, 863)

      NRS 439B.070  “Discharge form” defined.  “Discharge form” means the form hospitals are required to use to report information concerning the discharge of patients.

      (Added to NRS by 1987, 863)

      NRS 439B.090  “Fiscal year” defined.

      1.  Except as otherwise provided in subsection 2, “fiscal year” means a period beginning on July 1 and ending on June 30 of the following year.

      2.  A hospital’s “fiscal year” is the period of 12 months used by a hospital for the purposes of accounting and the preparation of annual budgets and financial statements.

      (Added to NRS by 1987, 863)

      NRS 439B.100  “Health facility” defined.  “Health facility” has the meaning ascribed to it in NRS 439A.015.

      (Added to NRS by 1987, 863)

      NRS 439B.110  “Hospital” defined.  “Hospital” means any facility licensed as a medical, surgical or obstetrical hospital, or as any combination of medical, surgical or obstetrical hospital, by the Division of Public and Behavioral Health of the Department.

      (Added to NRS by 1987, 863)

      NRS 439B.115  “Major hospital” defined.  “Major hospital” means a hospital in this State which has 200 or more licensed or approved beds, or any hospital in a group of affiliated hospitals in a county which have a combined total of 200 or more licensed or approved beds, that is not operated by a federal, state or local governmental agency.

      (Added to NRS by 1991, 2332)

      NRS 439B.120  “Medicaid” defined.  “Medicaid” means the program established pursuant to Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., to provide assistance for part or all of the cost of medical care rendered on behalf of indigent persons.

      (Added to NRS by 1987, 863)

      NRS 439B.130  “Medicare” defined.  “Medicare” means the program of health insurance for aged persons and persons with disabilities established pursuant to Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq.

      (Added to NRS by 1987, 863)

      NRS 439B.140  “Net revenue” defined.  “Net revenue” means all revenues earned from inpatient medical care provided to patients by a hospital.

      (Added to NRS by 1987, 863)

      NRS 439B.150  “Practitioner” defined.  “Practitioner” has the meaning ascribed to it in NRS 439A.0195.

      (Added to NRS by 1987, 863)

      NRS 439B.160  Purposes of chapter.  The purposes of this chapter are to:

      1.  Promote equal access to quality medical care at an affordable cost for all residents of this State.

      2.  Reduce excessive billed charges and revenues generated by some hospitals in this State in order to provide relief from excessively high costs of medical care.

      3.  Provide the regulatory mechanisms necessary to ensure that the forces of a competitive market will be able to function effectively in the business of providing medical care in this State.

      (Added to NRS by 1987, 863)

LEGISLATIVE COMMITTEE ON HEALTH CARE

      NRS 439B.200  Creation; appointment of and restrictions on members; officers; terms of members; vacancies; annual reports.

      1.  There is hereby established a Legislative Committee on Health Care consisting of three members of the Senate and three members of the Assembly, appointed by the Legislative Commission. The members must be appointed with appropriate regard for their experience with and knowledge of matters relating to health care.

      2.  No member of the Committee may:

      (a) Have a financial interest in a health facility in this State;

      (b) Be a member of a board of directors or trustees of a health facility in this State;

      (c) Hold a position with a health facility in this State in which the Legislator exercises control over any policies established for the health facility; or

      (d) Receive a salary or other compensation from a health facility in this State.

      3.  The provisions of subsection 2 do not:

      (a) Prohibit a member of the Committee from selling goods which are not unique to the provision of health care to a health facility if the member primarily sells such goods to persons who are not involved in the provision of health care.

      (b) Prohibit a member of the Legislature from serving as a member of the Committee if:

             (1) The financial interest, membership on the board of directors or trustees, position held with the health facility or salary or other compensation received would not materially affect the independence of judgment of a reasonable person; and

             (2) Serving on the Committee would not materially affect any financial interest the member has in a health facility in a manner greater than that accruing to any other person who has a similar interest.

      4.  The Legislative Commission shall review and approve the budget and work program for the Committee and any changes to the budget or work program. The Legislative Commission shall select the Chair and Vice Chair of the Committee from among the members of the Committee. Each such officer shall hold office for a term of 2 years commencing on July 1 of each odd-numbered year. The office of the Chair of the Committee must alternate each biennium between the houses of the Legislature.

      5.  Any member of the Committee who does not become a candidate for reelection or who is defeated for reelection continues to serve after the general election until the next regular or special session of the Legislature convenes.

      6.  Vacancies on the Committee must be filled in the same manner as original appointments.

      7.  The Committee shall report annually to the Legislative Commission concerning its activities and any recommendations.

      (Added to NRS by 1987, 863; A 1989, 1841; 1991, 2333; 1993, 2590; 2009, 1154, 1568)

      NRS 439B.210  Meetings; quorum; compensation.

      1.  Except as otherwise ordered by the Legislative Commission, the members of the Committee shall meet not earlier than November 1 of each odd-numbered year and not later than August 31 of the following even-numbered year at the times and places specified by a call of the Chair or a majority of the Committee. The Director of the Legislative Counsel Bureau or a person designated by the Director shall act as the nonvoting recording Secretary. The Committee shall prescribe regulations for its own management and government. Four members of the Committee constitute a quorum, and a quorum may exercise all the powers conferred on the Committee.

      2.  Except during a regular or special session of the Legislature, members of the Committee are entitled to receive the compensation provided for a majority of the members of the Legislature during the first 60 days of the preceding regular session for each day or portion of a day during which the member attends a meeting of the Committee or is otherwise engaged in the business of the Committee plus the per diem allowance provided for state officers and employees generally and the travel expenses provided pursuant to NRS 218A.655.

      3.  The salaries and expenses of the Committee must be paid from the Legislative Fund.

      (Added to NRS by 1987, 864; A 1987, 1629; 1989, 1221; 2009, 1155)

      NRS 439B.220  Powers.  The Committee may:

      1.  Review and evaluate the quality and effectiveness of programs for the prevention of illness.

      2.  Review and compare the costs of medical care among communities in Nevada with similar communities in other states.

      3.  Analyze the overall system of medical care in the State to determine ways to coordinate the providing of services to all members of society, avoid the duplication of services and achieve the most efficient use of all available resources.

      4.  Examine the business of providing insurance, including the development of cooperation with health maintenance organizations and organizations which restrict the performance of medical services to certain physicians and hospitals, and procedures to contain the costs of these services.

      5.  Examine hospitals to:

      (a) Increase cooperation among hospitals;

      (b) Increase the use of regional medical centers; and

      (c) Encourage hospitals to use medical procedures which do not require the patient to be admitted to the hospital and to use the resulting extra space in alternative ways.

      6.  Examine medical malpractice.

      7.  Examine the system of education to coordinate:

      (a) Programs in health education, including those for the prevention of illness and those which teach the best use of available medical services; and

      (b) The education of those who provide medical care.

      8.  Review competitive mechanisms to aid in the reduction of the costs of medical care.

      9.  Examine the problem of providing and paying for medical care for indigent and medically indigent persons, including medical care provided by physicians.

      10.  Examine the effectiveness of any legislation enacted to accomplish the purpose of restraining the costs of health care while ensuring the quality of services, and its effect on the subjects listed in subsections 1 to 9, inclusive.

      11.  Determine whether regulation by the State will be necessary in the future by examining hospitals for evidence of:

      (a) Degradation or discontinuation of services previously offered, including without limitation, neonatal care, pulmonary services and pathology services; or

      (b) A change in the policy of the hospital concerning contracts,

Ê as a result of any legislation enacted to accomplish the purpose of restraining the costs of health care while ensuring the quality of services.

      12.  Study the effect of the acuity of the care provided by a hospital upon the revenues of the hospital and upon limitations upon that revenue.

      13.  Review the actions of the Director in administering the provisions of this chapter and adopting regulations pursuant to those provisions. The Director shall report to the Committee concerning any regulations proposed or adopted pursuant to this chapter.

      14.  Identify and evaluate, with the assistance of an advisory group, the alternatives to institutionalization for providing long-term care, including, without limitation:

      (a) An analysis of the costs of the alternatives to institutionalization and the costs of institutionalization for persons receiving long-term care in this State;

      (b) A determination of the effects of the various methods of providing long-term care services on the quality of life of persons receiving those services in this State;

      (c) A determination of the personnel required for each method of providing long-term care services in this State; and

      (d) A determination of the methods for funding the long-term care services provided to all persons who are receiving or who are eligible to receive those services in this State.

      15.  Evaluate, with the assistance of an advisory group, the feasibility of obtaining a waiver from the Federal Government to integrate and coordinate acute care services provided through Medicare and long-term care services provided through Medicaid in this State.

      16.  Evaluate, with the assistance of an advisory group, the feasibility of obtaining a waiver from the Federal Government to eliminate the requirement that elderly persons in this State impoverish themselves as a condition of receiving assistance for long-term care.

      17.  Conduct investigations and hold hearings in connection with its review and analysis and exercise any of the investigative powers set forth in NRS 218E.105 to 218E.140, inclusive.

      18.  Apply for any available grants and accept any gifts, grants or donations to aid the Committee in carrying out its duties pursuant to this chapter.

      19.  Direct the Legislative Counsel Bureau to assist in its research, investigations, review and analysis.

      20.  Recommend to the Legislature as a result of its review any appropriate legislation.

      21.  Prescribe duties and make requests, in addition to those set forth in NRS 439B.250, of the Nevada Academy of Health established pursuant to that section.

      (Added to NRS by 1987, 864; A 2001, 2376; 2007, 2382; 2009, 58; 2013, 3757)

      NRS 439B.225  Committee to review certain regulations proposed or adopted by licensing boards; recommendations to Legislature.

      1.  As used in this section, “licensing board” means any division or board empowered to adopt standards for the issuance or renewal of licenses, permits or certificates of registration pursuant to NRS 435.3305 to 435.339, inclusive, chapter 449, 625A, 630, 630A, 631, 632, 633, 634, 634A, 635, 636, 637, 637A, 637B, 639, 640, 640A, 640D, 641, 641A, 641B, 641C, 652 or 654 of NRS.

      2.  The Committee shall review each regulation that a licensing board proposes or adopts that relates to standards for the issuance or renewal of licenses, permits or certificates of registration issued to a person or facility regulated by the board, giving consideration to:

      (a) Any oral or written comment made or submitted to it by members of the public or by persons or facilities affected by the regulation;

      (b) The effect of the regulation on the cost of health care in this State;

      (c) The effect of the regulation on the number of licensed, permitted or registered persons and facilities available to provide services in this State; and

      (d) Any other related factor the Committee deems appropriate.

      3.  After reviewing a proposed regulation, the Committee shall notify the agency of the opinion of the Committee regarding the advisability of adopting or revising the proposed regulation.

      4.  The Committee shall recommend to the Legislature as a result of its review of regulations pursuant to this section any appropriate legislation.

      (Added to NRS by 1991, 940; A 2003, 2008; 2005, 1379; 2009, 528; 2011, 1099)

      NRS 439B.227  Committee to review certain new provisions of law; recommendations to Legislature concerning mandated reporters.  The Legislative Committee on Health Care shall:

      1.  After each regular session of the Legislature, review any chapter added to this title or title 39 or 54 of NRS that authorizes or requires the issuance of a license, permit or certificate to a person who provides any service related to health care to determine if the person should be included as a person required to make a report pursuant to NRS 432B.220; and

      2.  Before the beginning of the next regular session of the Legislature, prepare a report concerning its findings pursuant to subsection 1 and submit the report to the Director of the Legislative Counsel Bureau for transmittal to the Legislature. The report must include, without limitation, any recommended legislation.

      (Added to NRS by 2013, 1085)

      NRS 439B.230  Investigations and hearings: Depositions; subpoenas.  Repealed. (See chapter 550, Statutes of Nevada 2013, at page 3759.)

 

      NRS 439B.240  Investigations and hearings: Fees and mileage for witnesses.  Repealed. (See chapter 550, Statutes of Nevada 2013, at page 3759.)

 

NEVADA ACADEMY OF HEALTH

      NRS 439B.250  Establishment; members; qualifications of members; election of Chair; compensation of members; members holding public office or employed by governmental entity; vacancies; duties; appointment of advisory committees authorized; acceptance of gifts and grants.

      1.  There is hereby established the Nevada Academy of Health consisting of 13 members as follows:

      (a) The Director or a designee of the Director;

      (b) One member who represents the Nevada System of Higher Education appointed by the Board of Regents of the University of Nevada;

      (c) Four members appointed by the Governor;

      (d) Two members appointed by the Majority Leader of the Senate;

      (e) Two members appointed by the Speaker of the Assembly;

      (f) One member appointed by the Minority Leader of the Senate;

      (g) One member appointed by the Minority Leader of the Assembly; and

      (h) The authorized representative for the State of Nevada of a quality improvement organization of the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services which operates in this State or his or her designee.

      2.  The members appointed to the Academy pursuant to subsection 1 must not be Legislators and, to the extent practicable, must:

      (a) Represent agencies and organizations that provide education or training for providers of health care;

      (b) Be advocates for the rights of patients;

      (c) Be recognized academic scholars; or

      (d) Be members of the general public who have specialized knowledge and experience that are beneficial to the Academy.

      3.  The Chair of the Academy must be elected from among the members of the Academy.

      4.  Each member of the Academy who is not an officer or employee of the State serves without compensation and is not entitled to receive a per diem allowance or travel expenses.

      5.  Each member of the Academy who is an officer or employee of the State must be relieved from his or her duties without loss of his or her regular compensation so that the officer or employee may attend meetings of the Committee or the Academy and is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally, which must be paid by the state agency that employs the officer or employee.

      6.  The term of office of a member of the Academy is 2 years. A vacancy occurring in the membership of the Academy must be filled in the same manner as the original appointment. A member of the Academy may be reappointed.

      7.  The Academy shall:

      (a) Perform any duties prescribed by, and comply with all requests from, the Committee;

      (b) Study issues relating to health care in this State, including, without limitation:

             (1) Medical and clinical research;

             (2) The education and training of providers of health care;

             (3) The improvement of accountability within the system of health care in this State;

             (4) The improvement of access to and quality of health care in this State; and

             (5) The improvement of the health of the residents of this State;

      (c) Establish standards and goals concerning the provision of health care which are measurable and regularly evaluated;

      (d) Analyze and evaluate data relating to health care that is created, collected or reviewed by the Committee and the Department;

      (e) Promote cooperation and partnerships between the public and private sectors, including the development and implementation of technology used to provide health care and the establishment of business partnerships that promote economic development in this State;

      (f) Provide to the Committee:

             (1) Such assistance and technical expertise on matters relating to health care as the Committee may request; and

             (2) Advice and recommendations from consumers of health care; and

      (g) Provide to the Department, at the direction of the Committee:

             (1) Technical expertise in matters relating to health care; and

             (2) Advice and recommendations from consumers of health care.

      8.  The Academy may appoint advisory committees if necessary or appropriate to assist the Academy in carrying out the provisions of this section.

      9.  The Academy may accept gifts, grants and donations of money from any source to carry out the provisions of this section.

      (Added to NRS by 2007, 2381; A 2009, 57, 58)

MAJOR HOSPITALS

      NRS 439B.260  Reduction of billed charges for certain patients and services; notice; resolution of disputes.

      1.  A major hospital shall reduce or discount the total billed charge by at least 30 percent for hospital services provided to an inpatient who:

      (a) Has no policy of health insurance or other contractual agreement with a third party that provides health coverage for the charge;

      (b) Is not eligible for coverage by a state or federal program of public assistance that would provide for the payment of the charge; and

      (c) Makes reasonable arrangements within 30 days after the date that notice was sent pursuant to subsection 2 to pay the hospital bill.

      2.  A major hospital shall include on or with the first statement of the hospital bill provided to the patient after his or her discharge a notice of the reduction or discount available pursuant to this section, including, without limitation, notice of the criteria a patient must satisfy to qualify for a reduction or discount.

      3.  A major hospital or patient who disputes the reasonableness of arrangements made pursuant to paragraph (c) of subsection 1 may submit the dispute to the Bureau for Hospital Patients for resolution as provided in NRS 223.575.

      4.  A major hospital shall reduce or discount the total billed charge of its outpatient pharmacy by at least 30 percent to a patient who is eligible for Medicare.

      5.  As used in this section, “third party” means:

      (a) An insurer, as that term is defined in NRS 679B.540;

      (b) A health benefit plan, as that term is defined in NRS 689A.540, for employees which provides coverage for services and care at a hospital;

      (c) A participating public agency, as that term is defined in NRS 287.04052, and any other local governmental agency of the State of Nevada which provides a system of health insurance for the benefit of its officers and employees, and the dependents of officers and employees, pursuant to chapter 287 of NRS; or

      (d) Any other insurer or organization providing health coverage or benefits in accordance with state or federal law.

Ê The term does not include an insurer that provides coverage under a policy of casualty or property insurance.

      (Added to NRS by 1991, 2332; A 1995, 646, 2248; 2001, 2654; 2011, 1523)

      NRS 439B.265  Collection of deductible or copayment from indigent patient covered by Medicare prohibited. [Effective upon confirmation by the Federal Government that the deductibles and copayments which a hospital is prohibited from collecting from a patient pursuant to this section are deemed uncollectible for the purposes of federal law.]  A major hospital shall not collect or seek to collect the deductible or copayment from a patient who is covered by Medicare and who demonstrates that he or she is medically indigent, as that term is defined for the purposes of Medicaid coverage for persons in long-term care. The hospital may seek and collect payment for the deductible or copayment from any source other than the patient, including from the supplemental insurance of the patient.

      (Added to NRS by 1991, 2332, effective upon confirmation by the Federal Government that the deductibles and copayments which a hospital is prohibited from collecting from a patient pursuant to this section are deemed uncollectible for the purposes of federal law)

      NRS 439B.270  Foundation for hospital nursing practice: Establishment; governing body.

      1.  The major hospitals shall jointly establish a foundation for hospital nursing practice to promote and encourage the practice of nursing in hospitals.

      2.  The foundation must be created as a nonprofit entity in compliance with 26 U.S.C. § 501. The governing body of the foundation must consist of one representative of each of the member hospitals and one representative appointed by the Governor. The governing body must have authority to establish rules for the administration of the foundation, to establish programs in pursuit of its purpose, and to allocate money for its programs.

      3.  If the foundation is not formed, or ceases to exist, the Director shall establish a nonprofit entity to carry out the foundation’s purpose.

      (Added to NRS by 1991, 2332)

      NRS 439B.275  Program for provision of technical assistance to rural hospitals.  The major hospitals shall, in cooperation with the Office of the Governor, the University of Nevada School of Medicine and organizations representing rural hospitals, develop a program for the provision of technical assistance to rural hospitals in Nevada. The resources required to carry out this program must be determined and provided by the major hospitals.

      (Added to NRS by 1991, 2332)

      NRS 439B.280  Educational program to promote wellness, physical fitness and prevention of disease and accidents.  The major hospitals shall sponsor an educational program to promote wellness, physical fitness and the prevention of disease and accidents. The program must be:

      1.  Administered and carried out by the participating hospitals; and

      2.  Approved by the Director.

      (Added to NRS by 1991, 2333)

CARE OF INDIGENT PATIENTS

      NRS 439B.300  Legislative findings and declarations; applicability.

      1.  The Legislature finds and declares that:

      (a) The practice of refusing to treat an indigent patient if another hospital can provide the treatment endangers the health and well-being of such patients.

      (b) Counties in which more than one hospital is located may lack available resources to compensate for all indigent care provided at their hospitals. Refusal by a hospital to treat indigent patients in such counties results in a burden upon hospitals which treat large numbers of indigent patients.

      (c) A requirement that hospitals in such counties provide a designated amount of uncompensated care for indigent patients would:

             (1) Equalize the burden on such hospitals of treating indigent patients; and

             (2) Aid the counties in meeting their obligation to compensate hospitals for such care.

      (d) Hospitals with 100 or fewer beds have been meeting the needs of their communities with regard to care of indigents, and have a minimal effect on the provision of such care.

      2.  Except as otherwise provided in this subsection, the provisions of NRS 439B.300 to 439B.340, inclusive, apply to each hospital in this State which is located in a county in which there are two or more licensed hospitals. The provisions of NRS 439B.300 to 439B.340, inclusive, do not apply to a hospital which has 100 or fewer beds.

      3.  The provisions of NRS 439B.300 to 439B.340, inclusive, do not prohibit a county from:

      (a) Entering into an agreement for medical care or otherwise contracting with any hospital located within that county; or

      (b) Using a definition of “indigent” which would include more persons than the definition in NRS 439B.310.

      (Added to NRS by 1987, 867)

      NRS 439B.310  “Indigent” defined.  For the purposes of NRS 439B.300 to 439B.340, inclusive, “indigent” means those persons:

      1.  Who are not covered by any policy of health insurance;

      2.  Who are ineligible for Medicare, Medicaid, the Children’s Health Insurance Program, the benefits provided pursuant to NRS 428.115 to 428.255, inclusive, or any other federal or state program of public assistance covering the provision of health care;

      3.  Who meet the limitations imposed by the county upon assets and other resources or potential resources; and

      4.  Whose income is less than:

      (a) For one person living without another member of a household, $438.

      (b) For two persons, $588.

      (c) For three or more persons, $588 plus $150 for each person in the family in excess of two.

Ê For the purposes of this subsection, “income” includes the entire income of a household and the amount which the county projects a person or household is able to earn. “Household” is limited to a person and the person’s spouse, parents, children, brothers and sisters residing with him or her.

      (Added to NRS by 1987, 868; A 1999, 2238)

      NRS 439B.320  Hospital required to provide care for proportionate share of indigent patients; duties of Department and board of county commissioners; reimbursement for care.

      1.  A hospital shall provide, without charge, in each fiscal year, care for indigent inpatients in an amount which represents 0.6 percent of its net revenue for the hospital’s preceding fiscal year.

      2.  The Department shall compute the obligation of each hospital for care of indigent inpatients for each fiscal year based upon the net revenue of the hospital in its preceding fiscal year and shall provide this information to the board of county commissioners of the county in which the hospital is located.

      3.  The board of county commissioners shall maintain a record of discharge forms submitted by each hospital located within the county, together with the amount accruing to the hospital. The amount accruing to the hospital for the care, until the hospital has met its obligation pursuant to this section, is the highest amount the county is paying to any hospital in the county for that care. Except as otherwise provided in subsection 2 of NRS 439B.330, no payment for indigent care may be made to the hospital until the total amount so accruing to the hospital exceeds the minimum obligation of the hospital for the fiscal year, and a hospital may only receive payment from the county for indigent care provided in excess of its obligation pursuant to this section. After a hospital has met its obligation pursuant to this section, the county may reimburse the hospital for care of indigent inpatients at any rate otherwise authorized by law.

      (Added to NRS by 1987, 868; A 1991, 2111)

      NRS 439B.330  Eligibility of indigent for assistance; payment of hospital for serving disproportionately large share of patients; discharge forms; appeal from determination of county regarding indigent status.

      1.  Except as otherwise provided in this subsection, subsection 2 and NRS 439B.300, each county shall use the definition of “indigent” in NRS 439B.310 to determine a person’s eligibility for medical assistance pursuant to chapter 428 of NRS, other than assistance provided pursuant to NRS 428.115 to 428.255, inclusive.

      2.  A board of county commissioners may, if it determines that a hospital within the county is serving a disproportionately large share of low-income patients:

      (a) Pay a higher rate to the hospital for treatment of indigent inpatients;

      (b) Pay the hospital for treatment of indigent inpatients whom the hospital would otherwise be required to treat without receiving compensation from the county; or

      (c) Both pay at a higher rate and pay for inpatients for whom the hospital would otherwise be uncompensated.

      3.  Each hospital which treats an indigent inpatient shall submit to the board of county commissioners of the county of residence of the patient a discharge form identifying the patient as a possible indigent and containing the information required by the Department and the county to be included in all such forms.

      4.  The county which receives a discharge form from a hospital for an indigent inpatient shall verify the status of the patient and the amount which the hospital is entitled to receive. A hospital aggrieved by a determination of a county regarding the indigent status of an inpatient may appeal the determination to the Director or a person designated by the Director to hear such an appeal. The decision of the Director or the designee of the Director must be mailed by registered or certified mail to the county and the hospital. The decision of the Director or the designee of the Director may be appealed to a court having general jurisdiction in the county within 15 days after the date of the postmark on the envelope in which the decision was mailed.

      5.  Except as otherwise provided in subsection 2 of this section and subsection 3 of NRS 439B.320, if the county is the county of residence of the patient and the patient is indigent, the county shall pay to the hospital the amount required, within the limits of money which may lawfully be appropriated for this purpose pursuant to NRS 428.050, 428.285 and 450.425.

      6.  For the purposes of this section, the county of residence of the patient is the county of residence of that person before he or she was admitted to the hospital.

      (Added to NRS by 1987, 869; A 1989, 1801, 1861; 1991, 1744, 1937; 1993, 1973; 2005, 1676)

      NRS 439B.340  Report on indigent patients treated; verification by Director; compensation for treatment provided in excess of obligation; assessment for failure to fulfill minimum obligation.

      1.  Before September 30 of each year, each county in which hospitals subject to the provisions of NRS 439B.300 to 439B.340, inclusive, are located shall provide to the Department a report showing:

      (a) The total number of inpatients treated by each such hospital who are claimed by the hospital to be indigent;

      (b) The number of such patients for whom no reimbursement was provided by the county because of the limitation imposed by subsection 3 of NRS 439B.320;

      (c) The total amount paid to each such hospital for treatment of such patients; and

      (d) The amount the hospital would have received for patients for whom no reimbursement was provided.

      2.  The Director shall verify the amount of treatment provided to indigent inpatients by each hospital to which no reimbursement was provided by:

      (a) Determining the number of indigent inpatients who received treatment. For a hospital that has contracted with the Department pursuant to subsection 4 of NRS 428.030, the Director shall determine the number based upon the evaluations of eligibility made by the employee assigned to the hospital pursuant to the contract. For all other hospitals, the Director shall determine the number based upon the report submitted pursuant to subsection 1.

      (b) Multiplying the number of indigent inpatients who received each type of treatment by the highest amount paid by the county for that treatment.

      (c) Adding the products of the calculations made pursuant to paragraphs (a) and (b) for all treatment provided.

Ê If the total amount of treatment provided to indigent inpatients in the previous fiscal year by the hospital was less than its minimum obligation for the year, the Director shall assess the hospital for the amount of the difference between the minimum obligation and the actual amount of treatment provided by the hospital to indigent inpatients. If a decision of a county regarding the indigent status of one or more inpatients is pending appeal before the Director or upon receiving satisfactory proof from a hospital that the decision is pending appeal before a court having general jurisdiction in the county pursuant to subsection 4 of NRS 439B.330, the Director shall defer assessing the hospital the amount that may be offset by the determination on appeal until a final determination of the matter is made.

      3.  If the Director determines that a hospital has met its obligation to provide treatment to indigent inpatients, the Director shall certify to the county in which the hospital is located that the hospital has met its obligation. The county is not required to pay the hospital for the costs of treating indigent inpatients until the certification is received from the Director. The county shall pay the hospital for such treatment within 30 days after receipt of the certification to the extent that money was available for payment pursuant to NRS 428.050, 428.285 and 450.425 at the time the treatment was provided.

      4.  The Director shall determine the amount of the assessment which a hospital must pay pursuant to this section and shall notify the hospital in writing of that amount on or before November 1 of each year. The notice must include, but is not limited to, a written statement for each claim which is denied indicating why the claim was denied. Payment is due 30 days after receipt of the notice, except for assessments deferred pursuant to subsection 2 which, if required, must be paid within 30 days after the court hearing the appeal renders its decision. If a hospital fails to pay the assessment when it is due the hospital shall pay, in addition to the assessment:

      (a) Interest at a rate of 1 percent per month for each month after the assessment is due in which it remains unpaid; and

      (b) Any court costs and fees required by the Director to obtain payment of the assessment and interest from the hospital.

      5.  Any money collected pursuant to this section must be paid to the county in which the hospital paying the assessment is located. The money received by a county from assessments made pursuant to this section does not constitute revenue from taxes ad valorem for the purposes of NRS 354.59811, 428.050, 428.285 and 450.425, and must be excluded in determining the maximum rate of tax authorized by those sections.

      (Added to NRS by 1987, 869; A 1987, 1630; 1989, 1802, 2085; 1991, 1938, 2112; 1993, 587; 2013, 2884)

PROGRAM TO INCREASE AWARENESS OF HEALTH CARE PROGRAMS FOR CHILDREN

      NRS 439B.350  Department to establish; purpose.

      1.  The Department shall establish a program to increase awareness of health care programs for children and to encourage enrollment in such programs. The program must provide for the dissemination of information to the public relating to health care services that are available in this state to children who are under the age of 13 years, including, without limitation, information concerning:

      (a) Federal, state and local governmental programs which provide health care services to such children;

      (b) The requirements for eligibility to participate in such programs; and

      (c) The procedures for enrolling children in such programs.

      2.  The information disseminated pursuant to subsection 1 must encourage the use of the programs identified pursuant to subsection 1 and must emphasize:

      (a) The benefits of preventive health care services to the well-being of children; and

      (b) The reasons that preventive health care services are more efficient in treating potential health care needs and are more economical than obtaining emergency health care services which are often required when symptoms of an illness are not promptly and properly treated.

      3.  The program must be designed to disseminate information using the most effective means available to the extent possible, including, without limitation, using:

      (a) Words or graphics, or both, that promote understanding of the information by the intended audience, considering the average level of reading comprehension of and the language understood by the audience.

      (b) Printed materials that may be displayed at or distributed to:

             (1) Offices of the federal, state and local government that have contact with parents of children who are under the age of 13 years or direct contact with such children, or both, in the normal course of business;

             (2) Schools attended by children who are under the age of 13 years;

             (3) Public libraries;

             (4) Providers of health care who provide services to children who are under the age of 13 years;

             (5) Child care facilities that provide services to children who are under the age of 13 years;

             (6) Organizations that provide community-based services to parents of children who are under the age of 13 years, or to such children, or both; and

             (7) Any other person deemed appropriate.

      (c) Radio, television and other electronic means.

      (Added to NRS by 1997, 1545)

      NRS 439B.360  Evaluation: Recommendations; report to Interim Finance Committee.

      1.  The Director shall evaluate the effectiveness of the program established pursuant to NRS 439B.350 annually. The evaluation must include, without limitation, measuring the effectiveness of the content, form and method of dissemination of information through the program.

      2.  The Director shall make any necessary recommendations to improve the program based upon the evaluation.

      3.  On or before December 31 of each year, the Director shall provide a written report to the Interim Finance Committee concerning the results of the evaluation and any recommendations made to improve the program.

      (Added to NRS by 1997, 1546; A 2007, 2401)

      NRS 439B.370  Director authorized to contract for certain services.  The Director may, within the limits of available money, contract for services to assist the Department in carrying out the provisions of NRS 439B.350 and 439B.360.

      (Added to NRS by 1997, 1546)

MISCELLANEOUS PROVISIONS

      NRS 439B.400  Hospital must maintain and use uniform list of billed charges; exception.  Each hospital in this State shall maintain and use a uniform list of billed charges for that hospital for units of service or goods provided to all inpatients. A hospital may not use a billed charge for an inpatient that is different than the billed charge used for another inpatient for the same service or goods provided. This section does not restrict the ability of a hospital or other person to negotiate a discounted rate from the hospital’s billed charges or to contract for a different rate or mechanism for payment of the hospital.

      (Added to NRS by 1987, 867)

      NRS 439B.410  Hospital required to provide emergency services and care; unlawful acts of hospital or physician working in hospital emergency room; treating hospital may recover penalty from transferring hospital; exceptions; administrative investigations and sanctions.

      1.  Except as otherwise provided in subsection 4, each hospital in this State has an obligation to provide emergency services and care, including care provided by physicians and nurses, and to admit a patient where appropriate, regardless of the financial status of the patient.

      2.  Except as otherwise provided in subsection 4, it is unlawful for a hospital or a physician working in a hospital emergency room to:

      (a) Refuse to accept or treat a patient in need of emergency services and care; or

      (b) Except when medically necessary in the judgment of the attending physician:

             (1) Transfer a patient to another hospital or health facility unless, as documented in the patient’s records:

                   (I) A determination has been made that the patient is medically fit for transfer;

                   (II) Consent to the transfer has been given by the receiving physician, hospital or health facility;

                   (III) The patient has been provided with an explanation of the need for the transfer; and

                   (IV) Consent to the transfer has been given by the patient or the patient’s legal representative; or

             (2) Provide a patient with orders for testing at another hospital or health facility when the hospital from which the orders are issued is capable of providing that testing.

      3.  A physician, hospital or other health facility which treats a patient as a result of a violation of subsection 2 by a hospital or a physician working in the hospital is entitled to recover from that hospital an amount equal to three times the charges for the treatment provided that was billed by the physician, hospital or other health facility which provided the treatment, plus reasonable attorney’s fees and costs.

      4.  This section does not prohibit the transfer of a patient from one hospital to another:

      (a) When the patient is covered by an insurance policy or other contractual arrangement which provides for payment at the receiving hospital;

      (b) After the county responsible for payment for the care of an indigent patient has exhausted the money which may be appropriated for that purpose pursuant to NRS 428.050, 428.285 and 450.425; or

      (c) When the hospital cannot provide the services needed by the patient.

Ê No transfer may be made pursuant to this subsection until the patient’s condition has been stabilized to a degree that allows the transfer without an additional risk to the patient.

      5.  As used in this section:

      (a) “Emergency services and care” means medical screening, examination and evaluation by a physician or, to the extent permitted by a specific statute, by a person under the supervision of a physician, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment and surgery by a physician necessary to relieve or eliminate the emergency medical condition or active labor, within the capability of the hospital. As used in this paragraph:

             (1) “Active labor” means, in relation to childbirth, labor that occurs when:

                   (I) There is inadequate time before delivery to transfer the patient safely to another hospital; or

                   (II) A transfer may pose a threat to the health and safety of the patient or the unborn child.

             (2) “Emergency medical condition” means the presence of acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:

                   (I) Placing the health of the patient in serious jeopardy;

                   (II) Serious impairment of bodily functions; or

                   (III) Serious dysfunction of any bodily organ or part.

      (b) “Medically fit” means that the condition of the patient has been sufficiently stabilized so that the patient may be safely transported to another hospital, or is such that, in the determination of the attending physician, the transfer of the patient constitutes an acceptable risk. Such a determination must be based upon the condition of the patient, the expected benefits, if any, to the patient resulting from the transfer and whether the risks to the patient’s health are outweighed by the expected benefits, and must be documented in the patient’s records before the transfer.

      6.  If an allegation of a violation of the provisions of subsection 2 is made against a hospital licensed pursuant to the provisions of chapter 449 of NRS, the Division of Public and Behavioral Health of the Department shall conduct an investigation of the alleged violation. Such a violation, in addition to any criminal penalties that may be imposed, constitutes grounds for the denial, suspension or revocation of such a license, or for the imposition of any sanction prescribed by NRS 449.163.

      7.  If an allegation of a violation of the provisions of subsection 2 is made against:

      (a) A physician licensed to practice medicine pursuant to the provisions of chapter 630 of NRS, the Board of Medical Examiners shall conduct an investigation of the alleged violation. Such a violation, in addition to any criminal penalties that may be imposed, constitutes grounds for initiating disciplinary action or denying licensure pursuant to the provisions of subsection 3 of NRS 630.3065.

      (b) An osteopathic physician licensed to practice osteopathic medicine pursuant to the provisions of chapter 633 of NRS, the State Board of Osteopathic Medicine shall conduct an investigation of the alleged violation. Such a violation, in addition to any criminal penalties that may be imposed, constitutes grounds for initiating disciplinary action pursuant to the provisions of subsection 1 of NRS 633.131.

      (Added to NRS by 1987, 867; A 1989, 1660; 2003, 1178; 2013, 3045)

      NRS 439B.420  Prohibited acts of hospitals and related entities; exceptions; submission of contracts to Director; civil penalty.

      1.  A hospital or related entity shall not establish a rental agreement with a physician or entity that employs physicians that requires any portion of his or her medical practice to be referred to the hospital or related entity.

      2.  The rent required of a physician or entity which employs physicians by a hospital or related entity must not be less than 75 percent of the rent for comparable office space leased to another physician or other lessee in the building, or in a comparable building owned by the hospital or entity.

      3.  A hospital or related entity shall not pay any portion of the rent of a physician or entity which employs physicians within facilities not owned or operated by the hospital or related entity, unless the resulting rent is no lower than the highest rent for which the hospital or related entity rents comparable office space to other physicians.

      4.  A health facility shall not offer any provider of medical care any financial inducement, excluding rental agreements subject to the provisions of subsection 2 or 3, whether in the form of immediate, delayed, direct or indirect payment to induce the referral of a patient or group of patients to the health facility. This subsection does not prohibit bona fide gifts under $100, or reasonable promotional food or entertainment.

      5.  The provisions of subsections 1 to 4, inclusive, do not apply to hospitals in a county whose population is less than 55,000.

      6.  A hospital, if acting as a billing agent for a medical practitioner performing services in the hospital, shall not add any charges to the practitioner’s bill for services other than a charge related to the cost of processing the billing.

      7.  A hospital or related entity shall not offer any financial inducement to an officer, employee or agent of an insurer, a person acting as an insurer or self-insurer or a related entity. A person shall not accept such offers. This subsection does not prohibit bona fide gifts of under $100 in value, or reasonable promotional food or entertainment.

      8.  A hospital or related entity shall not sell goods or services to a physician unless the costs for such goods and services are at least equal to the cost for which the hospital or related entity pays for the goods and services.

      9.  Except as otherwise provided in this subsection, a practitioner or health facility shall not refer a patient to a health facility or service in which the referring party has a financial interest unless the referring party first discloses the interest to the patient. This subsection does not apply to practitioners subject to the provisions of NRS 439B.425.

      10.  The Director may, at reasonable intervals, require a hospital or related entity or other party to an agreement to submit copies of operative contracts subject to the provisions of this section after notification by registered mail. The contracts must be submitted within 30 days after receipt of the notice. Contracts submitted pursuant to this subsection are confidential, except pursuant to the provisions of NRS 239.0115 and in cases in which an action is brought pursuant to subsection 11.

      11.  A person who willfully violates any provision of this section is liable to the State of Nevada for:

      (a) A civil penalty in an amount of not more than $5,000 per occurrence, or 100 percent of the value of the illegal transaction, whichever is greater.

      (b) Any reasonable expenses incurred by the State in enforcing this section.

Ê Any money recovered pursuant to this subsection as a civil penalty must be deposited in a separate account in the State General Fund and used for projects intended to benefit the residents of this State with regard to health care. Money in the account may only be withdrawn by act of the Legislature.

      12.  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 1987, 870; A 1989, 1925; 1993, 2595; 2001, 1988; 2007, 2107; 2011, 1257)

      NRS 439B.425  Prohibited referral of patients; exceptions; penalty.

      1.  Except as otherwise provided in this section, a practitioner shall not refer a patient, for a service or for goods related to health care, to a health facility, medical laboratory, diagnostic imaging or radiation oncology center or commercial establishment in which the practitioner has a financial interest.

      2.  Subsection 1 does not apply if:

      (a) The service or goods required by the patient are not otherwise available within a 30-mile radius of the office of the practitioner;

      (b) The service or goods are provided pursuant to a referral to a practitioner who is participating in the health care plan of a health maintenance organization that has been issued a certificate of authority pursuant to chapter 695C of NRS;

      (c) The practitioner is a member of a group practice and the referral is made to that group practice;

      (d) The referral is made to a surgical center for ambulatory patients, as defined in NRS 449.019, that is licensed pursuant to chapter 449 of NRS;

      (e) The referral is made by:

             (1) A urologist for lithotripsy services; or

             (2) A nephrologist for services and supplies for a renal dialysis;

      (f) The financial interest represents an investment in a corporation that has shareholder equity of more than $100,000,000, regardless of whether the securities of the corporation are publicly traded; or

      (g) The referral is made by a physician to a surgical hospital in which the physician has an ownership interest and:

             (1) The surgical hospital is:

                   (I) Located in a county whose population is less than 100,000; and

                   (II) Licensed pursuant to chapter 449 of NRS as a surgical hospital and not as a medical hospital, obstetrical hospital, combined-categories hospital, general hospital or center for the treatment of trauma;

             (2) The physician making the referral:

                   (I) Is authorized to perform medical services and has staff privileges at the surgical hospital; and

                   (II) Has disclosed the physician’s ownership interest in the surgical hospital to the patient before making the referral;

             (3) The ownership interest of the physician making the referral pertains to the surgical hospital in its entirety and is not limited to a department, subdivision or other portion of the hospital;

             (4) Every physician who has an ownership interest in the surgical hospital has agreed to treat patients receiving benefits pursuant to Medicaid and Medicare;

             (5) The terms of investment of each physician who has an ownership interest in the surgical hospital are not related to the volume or value of any referrals made by that physician;

             (6) The payments received by each investor in the surgical hospital as a return on his or her investment are directly proportional to the relative amount of capital invested or shares owned by the investor in the hospital;

             (7) None of the investors in the surgical hospital has received any financial assistance from the hospital or any other investor in the hospital for the purpose of investing in the hospital; and

             (8) Either:

                   (I) The governing body of every other hospital that regularly provides surgical services to residents of the county in which the surgical hospital is located has issued its written general consent to the referral by such physicians of patients to that surgical hospital; or

                   (II) The board of county commissioners of the county in which the surgical hospital is located has issued a written declaration of its reasonable belief that the referral by such physicians of patients to that surgical hospital will not, during the 5-year period immediately following the commencement of such referrals, have a substantial adverse financial effect on any other hospital that regularly provides surgical services to residents of that county.

      3.  A person who violates the provisions of this section is guilty of a misdemeanor.

      4.  The provisions of this section do not prohibit a practitioner from owning and using equipment in his or her office solely to provide to his or her patients services or goods related to health care.

      5.  As used in this section:

      (a) “Group practice” means two or more practitioners who organized as a business entity in accordance with the laws of this state to provide services related to health care, if:

             (1) Each member of the group practice provides substantially all of the services related to health care that he or she routinely provides, including, without limitation, medical care, consultations, diagnoses and treatment, through the joint use of shared offices, facilities, equipment and personnel located at any site of the group practice;

             (2) Substantially all of the services related to health care that are provided by the members of the group practice are provided through the group practice; and

             (3) No member of the group practice receives compensation based directly on the volume of any services or goods related to health care which are referred to the group practice by that member.

      (b) “Patient” means a person who consults with or is examined or interviewed by a practitioner or health facility for purposes of diagnosis or treatment.

      (c) “Substantial adverse financial effect” includes, without limitation, a projected decline in the revenue of a hospital as a result of the loss of its surgical business, which is sufficient to cause a deficit in any cash balances, fund balances or retained earnings of the hospital.

      (Added to NRS by 1993, 2594; A 1995, 1489; 2001, 1072)

      NRS 439B.430  Prohibited acts of hospitals; examination by Director; administrative fine; injunctive relief.

      1.  For the purposes of this section:

      (a) An “affiliated person” is a person controlled by any combination of the hospital, the parent corporation, a subsidiary or the principal stockholders or officers or directors of any of the foregoing.

      (b) A “subsidiary” is a person of which either the hospital and the parent corporation or the hospital or the parent corporation holds practical control.

      2.  No hospital may engage in any transaction or agreement with its parent corporation, or with any subsidiary or affiliated person which will result or has resulted in:

      (a) Substitution contrary to the interest of the hospital and through any method of any asset of the hospital with an asset or assets of inferior quality or lower fair market value;

      (b) Deception as to the true operating results of the hospital;

      (c) Deception as to the true financial condition of the hospital;

      (d) Allocation to the hospital of a proportion of the expense of combined facilities or operations which is unfavorable to the hospital;

      (e) Unfair or excessive charges against the hospital for services, facilities or supplies;

      (f) Unfair and inadequate charges by the hospital for services, facilities or supplies furnished by the hospital to others; or

      (g) Payment by the hospital for services, facilities or supplies not reasonably needed by the hospital.

      3.  If the Director has reasonable cause to believe that a violation of subsection 2 has occurred, the Director may conduct an examination of any books and records of the hospital, parent corporation, subsidiary or affiliated person which the Director deems pertinent to the examination. The Director has the same authority to examine the parent corporation, subsidiary or affiliated person and recover the cost of the examination as the Director has with regard to the hospital. A parent corporation, subsidiary or affiliated person which refuses to permit the examination of its books and records is subject to the fine provided for in subsection 4 for each day that access to the books or records is restricted.

      4.  If a hospital, parent corporation, subsidiary or affiliated person is found, after notice and a hearing, to have violated the provisions of this section, the Director may impose an administrative fine of not more than $20,000 for each violation or the actual amount of damage caused by the violation, whichever is greater.

      5.  Upon a second or subsequent violation of the provisions of this section, the Director may commence a legal action in the district court of any county to secure an injunction against further violations of this section.

      (Added to NRS by 1987, 872)

      NRS 439B.440  Director may require hospitals, health facilities and providers of health services to submit information; independent audit; examinations; penalty.

      1.  The Director may by regulation require hospitals, other health facilities and providers of health services to submit such information as is reasonably necessary for the Director to carry out the provisions of this chapter.

      2.  Except as otherwise provided in subsection 3, the Director shall by regulation require an examination of a hospital by an independent auditor appointed by the Director to ensure compliance with this chapter. The audits must be scheduled on a regular basis but not more often than once each year. The hospital shall pay the costs of the audit. A hospital may contract with the auditor to conduct other work for the hospital in connection with the audit.

      3.  The Director shall not require an audit of a hospital which has less than 100 beds or is subject to the provisions of chapter 450 of NRS. The Director shall by regulation require such a hospital to submit audits of the hospital on a regular basis but not more often than once each year.

      4.  If a hospital fails to comply with any regulation adopted pursuant to this section or the Director has reason to believe the hospital has violated any provision of this chapter, the Director may conduct an examination or contract for an independent examination of the hospital to determine whether it is in compliance with those provisions. The hospital which is the subject of such an examination is responsible for payment of the costs of the examination if the Director determines that the hospital did violate a provision of this chapter.

      5.  Any person who fails to submit information as required by any regulation adopted pursuant to this chapter to the Department or fails to submit to an audit or examination pursuant to this section is subject to an administrative fine of not more than $1,000 per violation per day until the required information is submitted or the person submits to the audit or examination.

      (Added to NRS by 1987, 872; A 1991, 2113; 2005, 1736)

      NRS 439B.450  Powers and duties of Director.  The Director:

      1.  May adopt such regulations as are necessary to carry out the provisions of this chapter.

      2.  Shall ensure that the administration of this chapter does not cause the State to fail to comply with the requirements of the Federal Government concerning Medicare and Medicaid.

      (Added to NRS by 1987, 873)

      NRS 439B.460  Director authorized to delegate powers and duties.  The Director may delegate:

      1.  Any of the Director’s powers or duties pursuant to this chapter to the Administrator of the Division of Health Care Financing and Policy of the Department.

      2.  Any of the Department’s powers or duties pursuant to this chapter to the Division of Health Care Financing and Policy.

      (Added to NRS by 1997, 2632; A 1999, 2242)

      NRS 439B.500  Penalty for violation of chapter.  In addition to any civil or administrative penalty specifically provided in this chapter, any person who violates a provision of this chapter shall be punished by a fine of not more than $5,000 for each violation.

      (Added to NRS by 1987, 873)—(Substituted in revision for part of NRS 439B.450)