Nevada 2019 Regular Session Status: Enacted 3 D cosponsors

AB 232 — Makes various changes to provisions governing hospitals. (BDR 40-158)

Last action — Approved by the Governor. Chapter 424.

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Assembly
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced March 01, 2019. Enacted.

Prognosis

Likely to advance 62% · moderate confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 6 sponsors

    6 primary, 0 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (3 D).

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Summary

AN ACT relating to hospitals; requiring certain hospitals to participate as a provider in the Medicare program; eliminating the designation of general hospitals; and providing other matters properly relating thereto.

Bill Text

What changed in the latest version

477 added · 512 removed

477 line(s) added, 512 removed.

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(Reprinted with amendments adopted on May 21, 2019) FIRST REPRINT A.B.
Assembly Bill No.
232 A SSEMBLY B ILL N O.
232–Assemblymen Nguyen, Yeager, Monroe- Moreno, Benitez-Thompson;
232–A SSEMBLYMEN N GUYEN , Y EAGER , M ONROE -M ORENO , BENITEZ -THOMPSON ;
Carlton and Frierson CHAPTER..........
CARLTON AND FRIERSON M ARCH 1, 2019 ____________ Referred to Committee on Health and Human Services SUMMARY—Makes various changes to provisions governing hospitals.
(BDR 40-158) FISCAL NOTE:
Effect on Local Government:
May have Fiscal Impact.
Effect on the State:
Yes.
~ EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
§ 1395x(e)(1)) Existing federal regulations also require such a hospital that has an emergency medical department to provide certain emergency medical care, regardless of whether the patient is eligible for Medicare benefits or has the ability a psychiatric, rural or critical access hospital, to participate as a provider forthan Medicare.
§ emergency medical department to provide certain emergency medical care,that has an regardless of whether the patient is eligible for Medicare benefits or has the ability to pay.
(42 C.F.R.
§ 489.24) Section 2 of this bill requires each hospital, other than a psychiatric, rural or critical access hospital, to participate as a provider for Medicare.
Sections 3-8, 10 and 11 of this bill make conforming changes.
Sections 3-8, 10 and 11 of this bill makeExisting law provides for the designation of a hospital that offers services in at least medical, surgical and obstetric categories as a general hospital.
Existing law provides for the designation of a hospital that offers services in at least medical, surgical and obstetric categories as a general hospital.
(NRS 449.202) Section 9 of this bill eliminates this designation.
(NRS 449.202) make conforming changes to remove references to general hospitals.
Sections 1 and 12-20 of this bill make conforming changes to remove references to general hospitals.
By removingis bill that designation, certain provisions will apply to all hospitals.
By removing that designation, certain provisions will apply to all hospitals.
and (3) the provision of inpatient care to persons with a mental - *AB232_R1* – 2 – illness or an intellectual disability and the responsibility to pay for certain care provided to such persons.
and (3) the provision of inpatient care to persons with a mental illness or an intellectual disability and the responsibility to pay for certain care provided to such persons.
EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
(a) The service or goods required by the patient are not otherwise available within a 30-mile radius of the office of the practitioner;
- 80th Session (2019) – 2 – otherwise available within a 30-mile radius of the office of the practitioner;
(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;
(f) The financial interest represents an investment in a regardless of whether the securities of the corporation are publicly traded;
- *AB232_R1* – 3 – (I) Is authorized to perform medical services and has staff privileges at the surgical hospital;
(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;
and (II) Has disclosed the physician’s ownership interest in the sur(3) The ownership interest of the physician making theal;
(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;
referral pertains to the surgical hospital in its entirety and is not limited to a department, subdivision or other portion of the hospital;
(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;
- 80th Session (2019) – 3 – 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;
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.
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- referrals, have a substantial adverse financial effect on any other hospital that regularly provides surgical services to residents of that county.
(1) Each member of the group practice provides substantially all of the services related to health care that he or she routinely - *AB232_R1* – 4 – 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;
(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, facilities, equipment and personnel located at any site of the group practice;
(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.
- 80th Session (2019) – 4 – (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.
(c) “Substantial adverse financial effect” includes, without of the loss of its surgical business, which is sufficient to cause asult deficit in any cash balances, fund balances or retained earnings of the hospital.
Any facility conducted by and for the adherents of any church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend solely upon spiritual means through prayer for healing in the practice of the religion of the church or denomination, except that such a facility shall comply with all regulations relative to sanitation and safety applicable to other facilities of a similar category.
Any facility conducted by and for the adherents of any church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend solely upon spiritual means through prayer for healing in the practice of the religion of the church or denomination, except that such a safety applicable to other facilities of a similar category.ation and 2.
2.
- *AB232_R1* – 5 – Sec.
Sec.
(a) Satisfactorily complied with the provisions of NRS 449.029 to 449.2428, inclusive, and section 2 of this act or the standards and regulations adopted by the Board;
- 80th Session (2019) – 5 – to 449.2428, inclusive, and section 2 of this act or the standards and regulations adopted by the Board;
§ 1395ww(d)(1)(B)(iv) , [which accepts payment through Medicare,] a psychiatric hospital that provides inpatient services to children, a psychiatric residential treatment facility, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, a peer support recovery organization, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 C.F.R.
§ 1395ww(d)(1)(B)(iv) , [which accepts payment through Medicare,] a psychiatric hospital that provides inpatient services to children, a psychiatric residential treatment facility, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, a peer support recovery organization, skilled nursing facility or nursing facility pursuant to 42 C.F.R.
Each reapplication for an agency to provide personal care services in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a facility for the care of adults during the day, a peer support recovery organization, a residential facility for groups or a home for individual residential care must include, without limitation, a statement that the holder of the license to operate, and the administrator or other person in charge and employees of, the facility, agency, pool, organization or home are in compliance with the provisions of NRS 449.093.
Each reapplication for an agency to provide personal care services in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a facility for the care of adults during the day, a peer support recovery organization, a residential facility for groups or a home for individual residential care must include, without limitation, a statement that the holder of the license to operate, and the administrator or other person in home are in compliance with the provisions of NRS 449.093.ization or Sec.
Sec.
449.119 “Facility, hospital, agency, program or home” means an agency to provide personal care services in the home, an - *AB232_R1* – 6 – employment agency that contracts with persons to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home, an agency to provide nursing in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a hospital described in 42 U.S.C.
449.119 “Facility, hospital, agency, program or home” means an agency to provide personal care services in the home, an employment agency that contracts with persons to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home, an agency to provide nursing in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a hospital described - 80th Session (2019) – 6 – through Medicare,] a psychiatric hospital that provides inpatient services to children, a psychiatric residential treatment facility, a peer support recovery organization, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 C.F.R.
§ 1395ww(d)(1)(B)(iv) , [which accepts payment through Medicare,] a psychiatric hospital that provides inpatient services to children, a psychiatric residential treatment facility, a peer support recovery organization, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 C.F.R.
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(a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410 or 449.029 to 449.245, inclusive, and section 2 of this act or of any other law of this State or of the standards, rules and regulations adopted thereunder.
provisions of NRS 439B.410 or 449.029 to 449.245, inclusive, and section 2 of this act or of any other law of this State or of the standards, rules and regulations adopted thereunder.
(e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and section 2 of this act, and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required.
(e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and section 2 of this act, and 449.435 to 449.531, inclusive, and chapter 449A of NRS(f) Failure to comply with the provisions of NRS 449.2486.
(f) Failure to comply with the provisions of NRS 449.2486.
- *AB232_R1* – 7 – (a) Is convicted of violating any of the provisions of NRS 202.470;
(a) Is convicted of violating any of the provisions of NRS 202.470;
or (c) Is ordered by the appropriate governmental agency to correct a violation of a building, safety or health code or regulation but fails to correct the violation.
or - 80th Session (2019) – 7 – a violation of a building, safety or health code or regulation but fails to correct the violation.
On or before February 1 of each odd-numbered year, the Division shall submit to the Director of the Legislative Counsel Bureau a written report setting forth, for the previous biennium:
On or before February 1 of each odd-numbered year, the Bureau a written report setting forth, for the previous biennium:
(a) Prohibit the facility from admitting any patient until it determines that the facility has corrected the violation;
determines that the facility has corrected the violation;ntil it (b) Limit the occupancy of the facility to the number of beds occupied when the violation occurred, until it determines that the facility has corrected the violation;
(b) Limit the occupancy of the facility to the number of beds occupied when the violation occurred, until it determines that the facility has corrected the violation;
(c) If the license of the facility limits the occupancy of the facility and the facility has exceeded the approved occupancy, require the facility, at its own expense, to move patients to another facility that is licensed;
(c) If the license of the facility limits the occupancy of the facility and the facility has exceeded the approved occupancy, - *AB232_R1* – 8 – require the facility, at its own expense, to move patients to another facility that is licensed;
- 80th Session (2019) – 8 – (d) Impose an administrative penalty of not more than $5,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum;
(d) Impose an administrative penalty of not more than $5,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum;
and (e) Appoint temporary management to oversee the operation of facility, until:
and (e) Appoint temporary management to oversee the operation of the facility and to ensure the health and safety of the patients of the facility, until:
to ensure the health and safety of the patients of the (1) It determines that the facility has corrected the violation and has management which is capable of ensuring continued compliance with the applicable statutes, conditions, standards and regulations;
(1) It determines that the facility has corrected the violation and has management which is capable of ensuring continued compliance with the applicable statutes, conditions, standards and regulations;
Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 must be accounted for separately and used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and section 2 of this act, 449.435 to 449.530, inclusive, and 449.760 and chapter 449A of NRS to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards or for any other purpose authorized by the Legislature.
Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 must be accounted for separately and used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and section 2 of this act, 449.435 to 449.530, inclusive, and 449.760 and chapter 449A of NRS to protect the of facilities in accordance with applicable state and federal standards or for any other purpose authorized by the Legislature.
When a hospital offers services in medical, surgical and obstetrical categories, as a minimum, it shall be designated a general hospital.] - *AB232_R1* – 9 – Sec.
When a hospital offers services in medical, surgical and obstetrical categories, as a minimum, it shall be designated a general hospital.] - 80th Session (2019) – 9 – Sec.
The Division may bring an action in the name of the State to enjoin any person, state or local government unit or agency thereof from operating or maintaining any facility within the meaning of NRS 449.029 to 449.2428, inclusive [:] , and section 2 of this act:
The Division may bring an action in the name of the State to enjoin any person, state or local government unit or agency thereof from operating or maintaining any facility within the of this act:RS 449.029 to 449.2428, inclusive [:] , and section 2 (a) Without first obtaining a license therefor;
(a) Without first obtaining a license therefor;
In order to provide state assistance for construction projects for publicly owned [general] hospitals, hospitals for the chronically ill and impaired, facilities for persons with intellectual disabilities, community mental health facilities, diagnostic or diagnostic and treatment centers, rehabilitation facilities, nursing homes and other facilities financed in part by federal funds in accordance with NRS 449.250 to 449.430, inclusive, and to promote maximum utilization of federal funds available for such projects, there is hereby created in the State Treasury a nonreverting trust fund to be known as the State Public Health Facilities Construction Assistance Fund.
In order to provide state assistance for construction projects for publicly owned [general] hospitals, hospitals for the chronically ill and impaired, facilities for persons with intellectual disabilities, community mental health facilities, diagnostic or diagnostic and treatment centers, rehabilitation facilities, nursing homes and other facilities financed in part by federal funds in accordance with NRS 449.250 to 449.430, inclusive, and to promote maximum utilization of federal funds available for such projects, there is hereby created in the State Health Facilities Construction Assistance Fund.
Money in the State Public Health Facilities Construction Assistance Fund must be used to supplement money from the Federal Government and money provided by the sponsor of a project for approved projects for the construction of publicly owned [general] hospitals, hospitals for the chronically ill or impaired, facilities for persons with intellectual disabilities, community mental health facilities, diagnostic or diagnostic and treatment centers, rehabilitation facilities, nursing homes and other facilities financed in part by federal funds pursuant to NRS 449.250 to 449.430, inclusive, and for no other purpose or purposes.
Money in the State Public Health Facilities Construction Assistance Fund must be used to supplement money from the Federal Government and money provided by the sponsor of a project for approved projects for the construction of publicly owned [general] hospitals, hospitals for the chronically ill or impaired, facilities for persons with intellectual disabilities, community mental health facilities, diagnostic or diagnostic and treatment centers, rehabilitation facilities, nursing homes and other - 80th Session (2019) – 10 – facilities financed in part by federal funds pursuant to NRS 449.250 to 449.430, inclusive, and for no other purpose or purposes.
- *AB232_R1* – 10 – 2.
2.
Applications for state assistance for construction projects must be submitted to the State Department for consideration in the manner prescribed in NRS 449.250 to 449.430, inclusive, for applications for federal assistance.
Applications for state assistance for construction projects must be submitted to the State Department for consideration in the applications for federal assistance.449.430, inclusive, for 3.
3.
The expense of such diagnostic, medical and surgical services must not in any case be a charge against or paid by the State of Nevada, except when in the opinion of the administrative officer of the division mental health facility to which the consumer is admitted payment should be made for nonresident indigent consumers and money is authorized pursuant to NRS 433.374 or 433B.230 and the money is authorized in approved budgets.
The expense of such diagnostic, medical and surgical services must not in any case be a charge against or paid by the State of Nevada, except when in the opinion of the administrative officer of the division mental made for nonresident indigent consumers and money is authorizedd be pursuant to NRS 433.374 or 433B.230 and the money is authorized in approved budgets.
435.085 The administrative officer of a division facility may authorize the transfer of a person with an intellectual disability or a person with a developmental disability to a [general] hospital for necessary diagnostic, medical or surgical services not available within the Division.
435.085 The administrative officer of a division facility may authorize the transfer of a person with an intellectual disability or a - 80th Session (2019) – 11 – person with a developmental disability to a [general] hospital for necessary diagnostic, medical or surgical services not available within the Division.
- *AB232_R1* – 11 – 1.
person with a developmental disability who is judicially committed, the expenses must be paid by the person’s parents or guardian to the extent of their reasonable financial ability as determined by the Administrator, and the remainder, if any, is a charge upon the county of the last known residence of the person with an intellectual disability or the person with a developmental disability;
In the case of a person with an intellectual disability or person with a developmental disability who is judicially committed, the expenses must be paid by the person’s parents or guardian to the extent of their reasonable financial ability as determined by the Administrator, and the remainder, if any, is a charge upon the county of the last known residence of the person with an intellectual disability or the person with a developmental disability;
435.455 The Division may, by contract with [general] hospitals or other institutions having adequate facilities in the State of Nevada, provide for inpatient care of persons with intellectual disabilities or persons with developmental disabilities.
435.455 The Division may, by contract with [general] hospitals or other institutions having adequate facilities in the State of Nevada, provide for inpatient care of persons with intellectual disSec.
Sec.
The expense of such diagnostic, medical and surgical services must not in any case be a charge against or paid by the State of Nevada, except when, in the opinion of the administrative officer of the division facility to which the consumer is admitted, payment should be made for nonresident indigent consumers and money is authorized pursuant to NRS 435.475 and the money is authorized in approved budgets.
The expense of such diagnostic, medical and surgical services must not in any case be a charge against or paid by the State of Nevada, except when, in the opinion of the administrative officer of the division facility to - 80th Session (2019) – 12 – which the consumer is admitted, payment should be made for nonresident indigent consumers and money is authorized pursuant to NRS 435.475 and the money is authorized in approved budgets.
- *AB232_R1* – 12 – Sec.
Sec.
Any additional facility operated by such a hospital at another location that commences operation after the effective date of this act must comply with the requirements of section 2 of this act.
Any that commences operation after the effective date of this act mustn comply with the requirements of section 2 of this act.
2.
A hospital described in subsection 1 shall:
H - *AB232_R1*
~~~~~ 19 - 80th Session (2019)
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Amendments

1 amendment

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Action History

  1. Approved by the Governor. Chapter 424.

  2. Enrolled and delivered to Governor.

  3. Senate Amendment No. 742 concurred in. To enrollment.

  4. In Assembly.

  5. From printer. To engrossment. Engrossed. First reprint. Read third time. Passed, as amended. Title approved. (Yeas: 21, Nays: None.) To Assembly.

  6. Read second time. Amended. (Amend. No. 742.) To printer.

  7. From committee: Amend, and do pass as amended.

  8. In Senate. Read first time. Referred to Committee on Health and Human Services. To committee.

  9. Read third time. Passed. Title approved. (Yeas: 34, Nays: 6, Excused: 2.) To Senate.

  10. Read second time.

  11. From committee: Do pass.

  12. From printer. To committee.

  13. Read first time. Referred to Committee on Health and Human Services. To printer.

Sponsors

Sponsorship breakdown

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6 sponsors · 0 co-sponsors · 61 not signed on

Sponsors (6)

Co-sponsors (0)

None.

Not signed on (61)

61 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does AB 232 do?
AN ACT relating to hospitals; requiring certain hospitals to participate as a provider in the Medicare program; eliminating the designation of general hospitals; and providing other matters properly relating thereto.
Who sponsors AB 232?
AB 232 is sponsored by Yeager, Steve (Democratic), Nguyen, Duy (Democratic), Monroe-Moreno, Daniele (Democratic), Jason Frierson, Maggie Carlton, and Teresa Benitez-Thompson.
What is the current status of AB 232?
This bill has been enacted into law. Introduced March 01, 2019. Enacted.
Where can I track AB 232?
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