NAC: CHAPTER 422 - HEALTH CARE FINANCING AND POLICY

[Rev. 10/22/2025 4:26:07 PM]

CHAPTER 422 - HEALTH CARE FINANCING AND POLICY

[NAC-422 Revised Date: 9-25]

PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENT PATIENTS

422.015 Definitions.

422.027 “Disproportionate share payment” defined.

422.035 “Division” defined.

422.055 “Pool of hospitals” defined.

422.065 “Public hospital” defined.

422.075 “Uncompensated care costs” defined.

422.085 Certain hospitals required to submit to Division certain information annually.

422.105 Intergovernmental transfers of money from certain counties to Division; discharge of duty to provide medical treatment for indigent inpatients in certain circumstances; money remitted to State Controller to be credited toward transfer to Division.

422.115 Designation of pools of hospitals and distribution of disproportionate share payments to each pool; requirements; limitations; calculation of total computable payments.

422.135 Percentage of initial distribution of disproportionate share payments.

422.145 Audit of hospitals required.

422.155 Recalculation after audit; final distribution; notification; recovery and redistribution of payments.

422.165 Transfer of money to certain public hospitals.

PROGRAMS TO PROVIDE TENANCY SUPPORT SERVICES

General Provisions

422.201 Definitions.

422.205 “Consultant” defined.

422.207 “Division” defined.

422.212 “Program” defined.

422.213 “Tenancy support services” defined.

Certification of Programs

422.215 Eligibility for certain money; requirements for certification; application; fee; renewal; expiration.

422.217 Review of application for certification or renewal; inspection of program; scoring of applicant; period of validity of certificate; plan of correction; nontransferability.

422.220 Change to program which is likely to affect certification: Notice to Division; duty of Division.

422.222 Grounds for denial, suspension or revocation of certification; report of certain violations committed by operator to regulatory agencies.

422.224 Notice of action to deny, suspend or revoke certification; immediate termination of provision of services under certain circumstances.

422.226 Appeal of denial, suspension or revocation of certification; stay of effective date upon request for appeal.

Management and Operation of Programs

422.230 Designation of operator of program required; delegation of responsibilities by operator; program conducted by corporation; program not operated by corporation.

422.234 Operator to designate manager of program; qualifications of manager.

422.236 Qualifications of supervisors; direct supervision of certain staff; training and competence of staff.

422.238 General ethical requirements of operator and staff.

422.240 System for maintaining records of staff members.

422.242 Operator of program: Duty to develop and maintain manual of policies and procedures; compliance; provision of copy of manual.

422.244 Operator of program: Duty to provide notice to Division of certain incidents or death of certain clients.

422.246 Operator of program: Duty to ensure program provides certain services to assist clients.

422.248 Operator of program: Duty to ensure confidentiality and privacy of clients.

422.250 Operator of program: Duty to ensure program maintains proper insurance coverage.

422.252 Operator of program: Duty to establish plan for improving quality of services and ensuring maintenance of integrity of program; availability of plan during inspection.

422.260 Policies and procedures: Requirements concerning management and operation of program.

422.262 Policies and procedures: Requirements concerning provision of tenancy support services.

422.265 Policies and procedures: Requirements to address issues that threaten housing of or negatively impact health and safety of client.

PAYMENTS TO CERTAIN HOSPITALS FOR TREATMENT OF INDIGENT PATIENTS

NAC 422.015 Definitions. (NRS 422.390) As used in NAC 422.015 to 422.165, inclusive, unless the context otherwise requires, the words and terms defined in NAC 422.027 to 422.075, inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.027 “Disproportionate share payment” defined. (NRS 422.390) “Disproportionate share payment” means a payment made pursuant to 42 U.S.C. § 1396r-4.

(Added to NAC by Div. of Health Care Fin. & Policy by R086-13, eff. 12-22-2014)

NAC 422.035 “Division” defined. (NRS 422.390) “Division” means the Division of Health Care Financing and Policy of the Department of Health and Human Services.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)

NAC 422.055 “Pool of hospitals” defined. (NRS 422.390) “Pool of hospitals” means a group of hospitals designated in a particular pool pursuant to subsection 1 of NAC 422.115.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)

NAC 422.065 “Public hospital” defined. (NRS 422.390) “Public hospital” means:

1. A hospital owned or operated by this State or a political subdivision of this State, including, without limitation, a hospital district; or

2. A hospital that is supported in whole or in part by tax revenue collected in this State, other than tax revenue received by a hospital for medical care which is provided to Medicaid patients, indigent patients or other low-income patients.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.075 “Uncompensated care costs” defined. (NRS 422.390) “Uncompensated care costs” means the total annual uncompensated care costs as defined in 42 C.F.R. § 447.299(c)(16).

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)

NAC 422.085 Certain hospitals required to submit to Division certain information annually. (NRS 422.390)

1. On or before the dates prescribed by the Division pursuant to subsection 2:

(a) Each hospital that is not solely a psychiatric hospital or other type of mental health facility shall complete and submit to the Division annually:

(1) A survey prescribed by the Division concerning obstetric services provided by the hospital; and

(2) A form prescribed by the Division concerning the Medicaid inpatient utilization rate of the hospital.

(b) Each hospital that qualifies as a disproportionate share hospital pursuant to 42 U.S.C. § 1396r-4 shall complete and submit to the Division annually:

(1) A form prescribed by the Division concerning the low-income utilization rate of the hospital; and

(2) A report of the uncompensated care costs of the hospital.

2. The Division will notify each hospital of the date on which the hospital must submit the documents required pursuant to subsection 1.

3. As used in this section:

(a) “Low-income utilization rate” has the meaning ascribed to it in 42 U.S.C. § 1396r-4(b)(3).

(b) “Medicaid inpatient utilization rate” has the meaning ascribed to it in 42 U.S.C. § 1396r-4(b)(2).

(Added to NAC by Div. of Health Care Fin. & Policy by R086-13, eff. 12-22-2014)

NAC 422.105 Intergovernmental transfers of money from certain counties to Division; discharge of duty to provide medical treatment for indigent inpatients in certain circumstances; money remitted to State Controller to be credited toward transfer to Division. (NRS 422.390)

1. In a county whose population is 100,000 or more within which a public hospital is located, the State or political subdivision responsible for the public hospital shall transfer to the Division an amount equal to:

(a) Seventy percent of the total amount of disproportionate share payments distributed to all hospitals pursuant to this chapter and NRS 422.380 to 422.390, inclusive, for the current fiscal year, less $1,050,000; or

(b) Sixty-eight and fifty-four one hundredths percent of the total amount of disproportionate share payments distributed to all hospitals pursuant to this chapter and NRS 422.380 to 422.390, inclusive, for the current fiscal year,

Ê whichever is less.

2. In a county whose population is 100,000 or more within which a private hospital which receives a disproportionate share payment pursuant to paragraph (c) of subsection 1 of NAC 422.115 is located, the county shall transfer to the Division 1.95 percent of the total amount of disproportionate share payments distributed to all hospitals pursuant to this chapter and NRS 422.380 to 422.390, inclusive, for the current fiscal year, but not more than $1,500,000.

3. If a county transfers to the Division the amount required pursuant to subsection 2, the county is discharged of the duty and is released from liability for providing medical treatment for indigent inpatients who are treated in the hospital in the county that receives a payment pursuant to paragraph (c) of subsection 1 of NAC 422.115.

4. The amount remitted by the board of county commissioners of a county to the State Controller pursuant to subsection 3 of NRS 428.285 will be credited toward any amount which the State or political subdivision of this State, as applicable, is required to transfer to the Division pursuant to subsection 1 or 2 of this section.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.115 Designation of pools of hospitals and distribution of disproportionate share payments to each pool; requirements; limitations; calculation of total computable payments. (NRS 422.390)

1. Except as otherwise provided in subsection 2, the Division will initially distribute for:

(a) Pool A, which consists of all public hospitals in counties whose population is 700,000 or more, total annual disproportionate share payments in the amount of 87.97 percent of the total computable disproportionate share hospital supplemental payments for the fiscal year;

(b) Pool B, which consists of all private hospitals in counties whose population is 700,000 or more, total annual disproportionate share payments in the amount of 1.69 percent of the total computable disproportionate share hospital supplemental payments for the fiscal year;

(c) Pool C, which consists of all private hospitals in counties whose population is 100,000 or more but less than 700,000, total annual disproportionate share payments in the amount of 5.86 percent of the total computable disproportionate share hospital supplemental payments for the fiscal year;

(d) Pool D, which consists of all public hospitals in counties whose population is less than 100,000, total annual disproportionate share payments in the amount of 1.34 percent of the total computable disproportionate share hospital supplemental payments for the fiscal year; and

(e) Pool E, which consists of all private hospitals in counties whose population is less than 100,000, total annual disproportionate share payments in the amount of 3.14 percent of the total computable disproportionate share supplemental payments for the fiscal year.

2. A hospital may not receive a disproportionate share payment unless the hospital meets all the requirements:

(a) Established by federal and state statutes and regulations; and

(b) As prescribed in the State Plan for Medicaid.

3. A hospital is not entitled to receive a disproportionate share payment that is greater than the amount of its uncompensated care costs.

4. The Division will calculate the total computable disproportionate share supplemental payments by dividing the amount allocated to this State pursuant to 42 U.S.C. § 1396r-4(f) by the federal medical assistance percentage for the current year determined pursuant to 42 U.S.C. § 1396d(b).

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.135 Percentage of initial distribution of disproportionate share payments. (NRS 422.390)

1. The Division will distribute disproportionate share payments as follows:

(a) Fifty percent of the amount allocated to a pool pursuant to NAC 422.115 will be distributed among hospitals in that pool in an amount corresponding to the uncompensated care percentage of the hospital, which is determined by dividing uncompensated care costs of the hospital by the net patient revenues of the hospital. The net patient revenues of a hospital will be determined by subtracting any contracted allowances and discounts reported on the Medicare Cost Report filed by the hospital pursuant to subsection 1 of NAC 439B.230 from the total patient revenues of the hospital.

(b) Fifty percent of the amount allocated to a pool pursuant to NAC 422.115 will be distributed among hospitals in that pool in an amount corresponding to the percentage of total uncompensated care costs of each hospital, which is determined by dividing the uncompensated care costs of a hospital by the aggregate total uncompensated care costs of all hospitals within the pool of hospitals in which the hospital is placed pursuant to NAC 422.115.

2. The Division will make an initial distribution of disproportionate share payments to a hospital in an amount determined in the manner described in subsection 1 and using the data reported on the Medicare Cost Report filed by the hospital pursuant to subsection 1 of NAC 439B.230.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.145 Audit of hospitals required. (NRS 422.390) The Division will audit each hospital for each year in which the hospital received a disproportionate share payment pursuant to this chapter and NRS 422.380 to 422.390, inclusive. The audit must be conducted in accordance with the provisions of Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., and the regulations adopted pursuant to those provisions.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)

NAC 422.155 Recalculation after audit; final distribution; notification; recovery and redistribution of payments. (NRS 422.390)

1. If the Division determines, based on an audit conducted pursuant to NAC 422.145, that a hospital’s initial disproportionate share payment exceeds the amount that the hospital was entitled to receive, the Division will recalculate, based upon the results of the audit, for each hospital in the affected pool, the:

(a) Uncompensated care costs;

(b) Uncompensated care percentages, determined in the manner described in paragraph (a) of subsection 1 of NAC 422.135; and

(c) Final disproportionate share payments using the amounts recalculated pursuant to paragraphs (a) and (b) and determined in the manner described in NAC 422.135.

2. A hospital may receive as a final distribution of disproportionate share payments for a fiscal year an amount equal to:

(a) The uncompensated care costs calculated pursuant to paragraph (a) of subsection 1; or

(b) The final disproportionate share payment for the hospital calculated pursuant to paragraph (c) of subsection 1,

Ê whichever is less.

3. For each pool that includes a hospital for which the Division has determined pursuant to subsection 1 that the initial disproportionate share payment exceeded the amount that the hospital was entitled to receive, the Division will notify each hospital in the pool whether the final distribution payment calculated pursuant to subsection 2 is less than or greater than the amount of the initial distribution of disproportionate share payments received by the hospital pursuant to NAC 422.135. If the amount of the final distribution payment calculated pursuant to subsection 2 is:

(a) Less than the amount of the initial distribution of disproportionate share payments received by the hospital, the hospital shall return to the Division the difference between the amount of the initial distribution and the amount of the final distribution not later than 90 days after the date on which the hospital receives written notification of the overpayment.

(b) Greater than the amount of the initial distribution of disproportionate share payments received by the hospital, the Division will pay to the hospital the difference between the amount of the final distribution payment and the initial distribution.

4. If each hospital within a pool of hospitals has received the maximum amount of disproportionate share payments allowable by federal and state statutes and regulations, the Division will use the money returned pursuant to paragraph (a) of subsection 3 to pay additional disproportionate share payments as follows:

(a) If the money was returned by a hospital that is a member of Pool A, to hospitals in Pool B;

(b) If the money was returned by a hospital that is a member of Pool B, to hospitals in Pool C;

(d) If the money was returned by a hospital that is a member of Pool D, to hospitals in Pool E; or

(e) If the money was returned by a hospital that is a member of Pool E, to hospitals in Pool D.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010; A by R086-13, 12-22-2014)

NAC 422.165 Transfer of money to certain public hospitals. (NRS 422.390) To the extent that money is available from the amount transferred to the Division pursuant to NAC 422.105, the Division will distribute $50,000 from that amount each fiscal year to each public hospital which:

1. Is located in a county that does not have any other hospital; and

2. Is not eligible for a disproportionate share payment pursuant to this chapter.

(Added to NAC by Div. of Health Care Fin. & Policy by R033-10, eff. 6-30-2010)

PROGRAMS TO PROVIDE TENANCY SUPPORT SERVICES

General Provisions

NAC 422.201 Definitions. (NRS 422.3964, 433.324, 439.200) As used in NAC 422.201 to 422.265, inclusive, unless the context otherwise requires, the words and terms defined in NAC 422.205 to 422.213, inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.205 “Consultant” defined. (NRS 422.3964, 433.324, 439.200) “Consultant” means a person who provides expert advice professionally in the area of tenancy support services.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.207 “Division” defined. (NRS 422.3964, 433.324, 439.200) “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.212 “Program” defined. (NRS 422.3964, 433.324, 439.200) “Program” means a program to provide tenancy support services.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.213 “Tenancy support services” defined. (NRS 422.3964, 433.324, 439.200) “Tenancy support services” has the meaning ascribed to it in NRS 422.3964.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

Certification of Programs

NAC 422.215 Eligibility for certain money; requirements for certification; application; fee; renewal; expiration. (NRS 422.3964, 433.324, 439.150, 439.200)

1. A program is not eligible to receive any state or federal money for tenancy support services administered by the Department of Health and Human Services or any division thereof unless the program is certified by the Division.

2. To obtain the certification of a program, the operator of the program must:

(a) Have at least 2 years of experience in providing tenancy support services; and

(b) Apply to the Division in the form prescribed by the Division. The application must be accompanied by a nonrefundable application fee of $100 and must include, without limitation:

(1) Evidence satisfactory to the Division that the program is in compliance with all applicable federal, state and local laws, regulations and ordinances;

(2) A list of each name used by the applicant in the operation of the program or any other business;

(3) A copy of the policies and procedures adopted by the program pursuant to NAC 422.242;

(4) Evidence that the program holds the liability insurance required by NAC 422.250; and

(5) A letter of support from the Continuum of Care established pursuant to 24 C.F.R. § 578.5 in the geographic area in which the program is located.

3. An application to renew the certification of a program must be submitted to the Division not later than 60 days before its expiration as prescribed by NAC 422.217. The application must be in the form prescribed by the Division, must be accompanied by a nonrefundable application fee of $100 and must include, without limitation:

(a) Evidence satisfactory to the Division that the facility or program is in compliance with all applicable federal, state and local laws, regulations and ordinances;

(b) A list of each name used by the applicant in the operation of the program or any other business;

(c) If the policies and procedures adopted by the program pursuant to NAC 422.242 have changed since certification or the most recent renewal of certification of the program, as applicable:

(1) A copy of the amended procedures and policies; and

(2) A written explanation describing the changes and stating the reason for the changes, including, without limitation, whether the changes were:

(I) Made as a result of findings of an agency or organization, other than an agency or organization owned or operated by the operator of the program; or

(II) Initiated by the operator or an agency or organization owned or operated by the operator;

(d) Evidence that the program holds the liability insurance required by NAC 422.250; and

(e) A letter of support from the Continuum of Care established pursuant to 24 C.F.R. § 578.5 in the geographic area in which the program is located.

4. If the certification of a program expires, the operator of the program may reapply for new certification pursuant to subsection 2 at any time.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.217 Review of application for certification or renewal; inspection of program; scoring of applicant; period of validity of certificate; plan of correction; nontransferability. (NRS 422.3964, 433.324, 439.200)

1. Upon receiving a completed application for the certification of a program or to renew the certification of a program, the Division or its designee shall review the application and determine whether the applicant is eligible for certification or renewal of certification. If the applicant is determined to be eligible, the Division must:

(a) Inspect the program;

(b) Ensure that the program is in compliance with the provisions of NAC 422.201 to 422.265, inclusive; and

2. After the inspection of a program pursuant to subsection 1, the Division shall score the applicant in the categories of:

(a) General organizational protocols and operations;

(b) Policy and procedure requirements;

(d) Protocols and operations concerning the provision of tenancy housing services.

3. If the applicant receives a score of at least 80 percent in each category and an overall weighted score of at least 90 percent, the Division must issue to the applicant a certificate that is valid for 2 years or renew the certificate of the applicant for 2 years, as applicable.

4. If the provisions of subsection 3 do not apply and the applicant receives a score of at least 75 percent in each category and an overall weighted score of at least 75 percent, the Division must issue to the applicant a certificate that is valid for 1 year or renew the certificate of the applicant for 1 year, as applicable.

5. If the provisions of subsection 3 or 4 do not apply and the applicant receives a score of at least 65 percent in each category and an overall weighted score of at least 65 percent, the Division must issue to the applicant a certificate that is valid for 6 months or renew the certificate of the applicant for 6 months, as applicable.

6. If the applicant receives a score of less than 65 percent in any category or an overall weighted score of less than 65 percent, the Division must provide the applicant a report of the score. Not later than 15 days after receiving the report, the applicant shall submit to the Division a plan of correction. The Division shall review the plan of correction and issue or renew, as applicable, or deny certification based on the conclusions of the review.

7. A certificate that is issued or renewed pursuant to this section is not transferrable and may not be used by another program.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.220 Change to program which is likely to affect certification: Notice to Division; duty of Division. (NRS 422.3964, 433.324, 439.200)

1. At least 60 days before the change will occur or, if the operator of a program becomes aware of the change less than 60 days before the change will occur, as soon as the operator becomes aware of the change, the operator shall notify the Division of any change to the program which is likely to affect the certification of the program. Such a change may include, without limitation, a change to the ownership, staff or location of the program or the termination of the program.

2. Upon receiving notice of a change pursuant to subsection 1, the Division must notify the operator of any effect to the certification of the program and actions the operator may be required to take to maintain the certification.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.222 Grounds for denial, suspension or revocation of certification; report of certain violations committed by operator to regulatory agencies. (NRS 422.3964, 433.324, 439.200)

1. Each of the following acts or omissions is a ground for the denial, suspension or revocation of the certification of a program:

(a) Any misrepresentation of or failure to disclose any material fact in the application for the issuance or renewal of the certification or in any financial record or other document requested by the Division.

(b) A lack of personnel in sufficient numbers or qualifications to provide proper care and support for clients.

(c) Conviction of the operator of the program or any employee or independent contractor of the operator of a crime relevant to any aspect of the provision of tenancy support services.

(d) Any deficiency of the operator of the program relating to the provision of tenancy support services that poses an imminent or probable risk of harm to the health or welfare of any client.

(e) Any fraudulent activity by the operator or an employee or independent contractor of the program, including, without limitation, any fraudulent billing, falsification of records or misuse or misappropriation of the property of a client.

(f) Any refusal to participate in any aspect of a review or investigation by the Division.

(g) The failure or refusal of the operator of the program to implement any action required by the Division to correct a deficiency identified during a review or investigation by the Division.

(h) Abuse, neglect, exploitation or coercion of a client.

(i) Harassing, coercive, intimidating, insulting, abusive or disruptive language or behavior directed at:

(1) An employee of the Division;

(2) An employee or independent contractor of the program, another program or a person or entity providing services other than tenancy support services; or

(3) A client or a family member or guardian of a client.

(j) Exclusion of the operator of the program, an officer or employee of the operator or an independent contractor of the operator who oversees the provision of tenancy support services from participation in Medicare, Medicaid or any other federal health care program pursuant to federal law.

2. The Division shall report any known violation of any local, state or federal law, regulation or ordinance by the operator of a program to the appropriate regulatory agencies which govern the tenancy support services.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.224 Notice of action to deny, suspend or revoke certification; immediate termination of provision of services under certain circumstances. (NRS 422.3964, 433.324, 439.200)

1. The Division shall give the operator of a program written notice of any intended action to deny, suspend or revoke the certification of the program in the manner required by NAC 439.345.

2. If the denial, suspension or revocation of the certification of a program is pending and the Division determines that the grounds for the denial, suspension or revocation place any person at an imminent or probable risk of harm, the Division may immediately terminate the provision of tenancy support services by the operator of the program pending a final decision.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.226 Appeal of denial, suspension or revocation of certification; stay of effective date upon request for appeal. (NRS 422.3964, 433.324, 439.200)

1. If the operator of a program is aggrieved by any decision concerning the denial, suspension or revocation of certification, the operator may submit a request for an appeal to the Administrator of the Division pursuant to the procedures set forth in NAC 439.300 to 439.395, inclusive.

2. Except in the case of an immediate termination of the provision of tenancy support services pursuant to NAC 422.224, the effective date of a suspension or revocation is stayed upon receipt of a request for an appeal until the hearing officer renders a decision regarding the appeal.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

Management and Operation of Programs

NAC 422.230 Designation of operator of program required; delegation of responsibilities by operator; program conducted by corporation; program not operated by corporation. (NRS 422.3964, 433.324, 439.200)

1. A program must have a designated operator that is responsible for the operation of the program. The operator may designate another person to carry out the responsibilities of the operator but the operator remains responsible for the actions of any such designee.

2. If a program is conducted by a corporation, the governing body of the corporation must serve as the operator of the program. The governing body shall:

(a) Adopt written bylaws or policies that set forth the amount of any compensation provided to the members of the governing body for serving on the governing body and define the powers and duties of the governing body;

(b) Meet at least quarterly and keep written minutes of each meeting that include, without limitation:

(1) The date and time of the meeting;

(2) The name of each person present at the meeting;

(3) Any decision made by the governing body during the meeting;

(4) Any other action taken by the governing body during the meeting; and

(5) The manner in which any budget was reviewed and approved during the meeting; and

(c) Retain the minutes of each meeting for at least 7 years and make those minutes available to the Division upon request.

3. If a program is not operated by a corporation, the operator must be:

(a) The owner of a private entity;

(b) The governing body of a nonprofit organization or a person designated in writing by such a governing body; or

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.234 Operator to designate manager of program; qualifications of manager. (NRS 422.3964, 433.324, 439.200)

1. The operator of a program shall designate a person to be the manager of the program. The manager must:

(a) Have at least 2 years of experience providing tenancy support services and working with persons who are living with chronic health conditions and persons experiencing homelessness;

(b) Have excellent written and verbal communication skills and organizational skills; and

(1) Methods and processes for providing individualized services related to housing and care management in partnership with the person to whom the services are provided;

(2) Knowledge of providers of housing in the area in which the program operates;

(3) Knowledge of processes for applying for and obtaining housing subsidies;

(4) Documenting the provision of services in accordance with the requirements of 42 U.S.C. § 1396n(i) and the regulations adopted pursuant thereto;

(5) Assessing potential risks to the ability to acquire and maintain housing;

(6) Developing plans to prevent crises;

(7) Conducting interviews as necessary to de-escalate conflict and ensure safety;

(8) Responding to emergent needs in a safe and effective manner; and

(9) Providing services in a trauma-informed manner when appropriate.

2. As used in this section, “trauma-informed manner” means a manner that:

(a) Is informed by knowledge of and responsiveness to the effects of trauma;

(b) Emphasizes physical, psychological and emotional safety for staff and clients; and

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.236 Qualifications of supervisors; direct supervision of certain staff; training and competence of staff. (NRS 422.3964, 433.324, 439.200)

1. A member of the staff of a program who is a supervisor must have at least 2 years of experience providing tenancy support services and working with persons who are living with chronic health conditions and persons experiencing homelessness.

2. The operator of a program shall ensure that:

(a) Each member of the staff of a program who does not have the qualifications described in subsection 1 is under direct supervision at all times; and

(b) Each member of the staff of a program attends an orientation concerning the policies and procedures adopted pursuant to NAC 422.242 that govern his or her duties.

3. Each member of the staff of a program must have training and demonstrated competence in:

(a) Evidence-based best practices for teaching skills in a manner that utilizes the strengths of clients;

(b) Knowledge and behavior necessary to maintain housing;

(c) Engaging and using motivational interviewing techniques to connect and form relationships with persons who are mistrustful of providers of tenancy support services;

(d) Cognitive behavioral techniques and techniques for changing behavior;

(e) Documenting the provision of services in accordance with the requirements of 42 U.S.C. § 1396n(i) and the regulations adopted pursuant thereto;

(f) Conducting interviews as necessary to de-escalate conflict and ensure safety;

(g) Responding to emergent needs in a safe and effective manner; and

(h) Providing services in a trauma-informed manner, as defined in NAC 422.234, when appropriate.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.238 General ethical requirements of operator and staff. (NRS 422.3964, 433.324, 439.200)

1. The operator or a member of the staff of a program shall not knowingly provide false information to the Division or a representative of the Division.

2. The operator and the staff of a program shall use information that is generally accepted in the field of providing tenancy housing services when performing duties related to the program.

3. The operator of a program shall supervise the staff of the program to ensure that a member of the staff does not:

(a) Become impaired in his or her ability to perform services; or

(b) Perform any service that he or she is not authorized to perform under his or her licensure or certification.

4. The operator of a program shall not allow a client to grant a power of attorney to the operator or a member of the staff of the program.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.240 System for maintaining records of staff members. (NRS 422.3964, 433.324, 439.200)

1. The operator of a program shall establish a system for maintaining the records of members of the staff of the program. The system must maintain the confidentiality and safekeeping of records and must include, without limitation:

(a) The application or resume of each member of the staff;

(b) Any employment contract signed by a member of the staff;

(d) A copy of any license, certificate, registration or other credential held by a member of the staff who performs duties for which the license, certificate, registration or other credential is required by law or the policies and procedures developed pursuant to NAC 422.242;

(e) A document signed by each member of the staff verifying that he or she attended the orientation required by NAC 422.236; and

(f) For each staff member who is not a citizen of the United States, a copy of Form I-9, Employment Eligibility Verification, of the United States Citizenship and Immigration Services of the Department of Homeland Security, which verifies that the member of the staff is lawfully entitled to remain and work in the United States.

2. Any employment contract or other document containing standards of job performance signed by a member of the staff must clearly specify the nature and amount of the service to be provided by the member of the staff.

3. Except as otherwise provided in this subsection, a record of a member of the staff of a program is confidential. Such a record must be made available upon request to:

(a) The member of the staff to whom the record pertains and any person authorized by that member of the staff;

(b) Any person authorized by the policies and procedures adopted pursuant to NAC 422.242 to access the record; and

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.242 Operator of program: Duty to develop and maintain manual of policies and procedures; compliance; provision of copy of manual. (NRS 422.3964, 433.324, 439.200) The operator of a program shall:

1. Develop and maintain a manual of policies and procedures for the program which includes, without limitation, policies and procedures for:

(a) The management and operation of the program in accordance with NAC 422.260;

(b) The provision of tenancy support services in accordance with NAC 422.262; and

(c) Addressing issues that may threaten the housing of a client or negatively impact the health and safety of a client in accordance with NAC 422.265.

2. Comply with the policies and procedures developed pursuant to subsection 1.

3. Provide a copy of the manual developed pursuant to subsection 1 to any person upon request.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.244 Operator of program: Duty to provide notice to Division of certain incidents or death of certain clients. (NRS 422.3964, 433.324, 439.200) The operator of a program shall notify the Division not later than 24 hours after:

1. Any incident that may pose an imminent or probable risk of harm to the health or welfare of a client, member of the staff of the program or visitor to the program; or

2. The death of a client while a member of the staff of the program is providing services to the client, regardless of the location of the death.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.246 Operator of program: Duty to ensure program provides certain services to assist clients. (NRS 422.3964, 433.324, 439.200) The operator of a program shall ensure that the program provides services to assist clients with:

1. Developing skills for daily living related to maintaining a housing unit;

2. Developing skills necessary to assert the rights of the client as a tenant, meet the terms and conditions of a lease agreement and comply with the responsibilities of a tenant, including, without limitation, the responsibilities of paying rent and utility bills, using appliances safely, maintaining appropriate levels of sound for television and music and ensuring that the behavior of any guests does not jeopardize the lease;

3. Using resources in the community;

4. Developing social skills to establish relationships and develop support networks;

5. Establishing a daily routine, including, without limitation, planning social and recreational activities;

6. Recognizing the need for assistance and seeking assistance when needed;

7. Managing symptoms of physical and behavioral health conditions; and

8. Managing finances.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.248 Operator of program: Duty to ensure confidentiality and privacy of clients. (NRS 422.3964, 433.324, 439.200) The operator of a program shall ensure that:

1. The program complies with all applicable federal and state laws concerning the confidentiality of records and the privacy of clients;

2. Any consent provided by a client to allow the operator or a designee of the operator to release information that identifies the client and whether the client has tested seropositive for the human immunodeficiency virus is provided explicitly and on a separate form;

3. Each consultant who has access to the confidential information of clients has signed a confidentiality agreement that complies with the applicable provisions of 42 C.F.R. Part 2 and 45 C.F.R. Parts 160, 162 and 164; and

4. Each confidentiality agreement described in subsection 3 is maintained in the personnel file of the consultant.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.250 Operator of program: Duty to ensure program maintains proper insurance coverage. (NRS 422.3964, 433.324, 439.200) The operator of a program shall ensure that the program maintains proper insurance that covers:

1. Liability in an amount sufficient to protect the clients and staff of the program and the visitors to the program. The policy of insurance must, at a minimum, provide coverage for professional liability and, if the operator receives state or federal money for the program and is the governing body of a corporation or of a nonprofit organization, the policy of insurance must include liability insurance for directors and officers of the corporation or nonprofit organization, as applicable. The policy of insurance must provide that notice be given to the Division not later than 30 days after cancellation of the policy or after the operator does not renew the policy. Upon request, the operator shall make a copy of the policy of insurance available to the Division for review.

2. Liability arising out of the acts or omissions of a consultant while providing a service for the program. The policy of insurance may be provided by the program or the consultant. If the policy of insurance is provided by the consultant, the operator must obtain a copy of the policy and place the copy in the personnel file of the consultant.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.252 Operator of program: Duty to establish plan for improving quality of services and ensuring maintenance of integrity of program; availability of plan during inspection. (NRS 422.3964, 433.324, 439.200) The operator of a program shall:

1. Establish a plan for improving the quality of the services provided by the program and ensuring that the integrity of the program is maintained. The plan must address, without limitation, operational services, human resources, fiscal services and means to measure the outcomes of services.

2. Make a copy of the plan established pursuant to subsection 1 available to the Division at the time of an inspection by the Division of the premises where the program is providing services.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.260 Policies and procedures: Requirements concerning management and operation of program. (NRS 422.3964, 433.324, 439.200) The policies and procedures developed pursuant to NAC 422.242 concerning the management and operation of a program must include, without limitation, policies and procedures for:

1. Accepting and resolving complaints made by clients and staff members;

2. Allowing a client or staff member to appeal a decision of the operator of the program without reprisal;

3. Staffing, including, without limitation, the title, duties and qualifications for each position on the staff of the program;

4. Claiming funds and billing clients for services;

5. Receiving and recording funds and recording expenditures;

6. Preparing financial reports;

7. Maintaining information to support any money claimed by the program or charges billed;

8. Implementing internal controls to ensure the integrity of financial and accounting information and fiscal audits as necessary;

9. Informing a prospective client of any financial responsibility for a service before providing that service;

10. Maintaining the financial records of a client, including, without limitation, records of fees charged to the client and payments made by the client; and

11. Making the records described in subsection 10 available to the client to whom those records apply upon request.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.262 Policies and procedures: Requirements concerning provision of tenancy support services. (NRS 422.3964, 433.324, 439.200) The policies and procedures developed pursuant to NAC 422.242 concerning the provision of tenancy support services must include, without limitation, policies and procedures for:

1. Identifying and engaging with underserved persons and connecting such persons with necessary or desired services;

2. The referral and intake of clients;

3. Delivering services, including, without limitation, services before, during and after a tenant moves into the housing, in accordance with 42 U.S.C. § 1396n(i) and the regulations adopted pursuant thereto, and assigning responsibilities relating to the delivery of such services;

4. Conducting an assessment of each client that focuses on his or her housing situation and goals;

5. Based on the results of the assessment conducted pursuant to subsection 4, setting goals for each client and planning any intervention that may be necessary;

6. Preventing a crisis and intervening during a crisis;

7. Working with clients who refuse necessary services, as determined based on the assessment conducted pursuant to subsection 4;

8. Building and maintaining a positive relationship with property managers, landlords and developers to advocate for the needs of clients;

9. Requesting reasonable modifications for a client with a disability;

10. Resolving disputes related to housing;

11. Preventing eviction and intervening when eviction is imminent or has occurred;

12. Assisting clients in determining eligibility for benefits, including, without limitation, Medicaid and benefits related to housing; and

13. Linking clients to and coordinating on behalf of clients with providers of services the clients need or desire, including, without limitation, health care, dental and vision services.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)

NAC 422.265 Policies and procedures: Requirements to address issues that threaten housing of or negatively impact health and safety of client. (NRS 422.3964, 433.324, 439.200) The policies and procedures developed pursuant to NAC 422.242 to address issues that threaten the housing of or negatively impact the health and safety of a client must include, without limitation, policies and procedures for:

1. Responding to a medical emergency;

2. Contributing to a summary of the social history of a client that is compiled by an approved outside entity;

3. Conducting an assessment of the strengths and weaknesses of the client relating to choosing, obtaining and maintaining housing;

4. Coordinating the process to search for housing for a client;

5. Coordinating and making arrangements for a client to move into housing, including, without limitation, scheduling a time to sign a lease, ensuring that utilities are connected and operational and arranging for a moving service, if necessary;

6. Negotiating with landlords, as appropriate, to facilitate access to housing for a client and prevent eviction;

7. Maintaining any documents required for a client to apply for and receive housing subsidies and certifications;

8. Supporting a client with regard to negotiating the terms of leases and the execution of leases;

9. Coordinating with existing providers of primary care, behavioral health care, dental care, vision care and emergency and urgent care for a client or assisting a client with establishing relationships with new providers of such care; and

10. Developing an individualized housing goal and a crisis prevention plan in accordance with 42 U.S.C. § 1396n(i), the regulations adopted pursuant thereto and the Medicaid Services Manual established by the Division of Health Care Financing and Policy of the Department of Health and Human Services.

(Added to NAC by Bd. of Health by R030-20, eff. 12-22-2021)