(1)Section de-1 escalatedefines or“crisis stabilizestabilization aservices” to mean behavioral crisis;health services designed to:

(1) de-escalate or stabilize a behavioral crisis;

Section [1.4] 9 of this bill requires services provided at a crisisSenate stabilizationAmendment centerNo. to be reimbursable under Medicaid.

Existing909 law authorizes certain entities to transportAssembly aBill personNo. who is the subject an involuntary court-ordered admission to a mental health facility.

(NRS66 433A.160,orFirst 433A.330)Reprint SectionPage 104 of[psychiatric thishospital billestablished requiresby the StateDivision Boardto ofprovide] Healthcrisis stabilization [services] cenExisting law authorizes certain entities to adopttransport regulationsa providingperson forwho is the licensuresubject andof regulationan ofapplication providersfor ofemergency nonemergencyadmission secureto behaviorala hospital or mental health transportfacility services.or an involuntary court-ordered admission to a mental health facility.

Section(NRS 10433A.160, defines433A.330) theSection term10 “nonemergencyof securethis behavioralbill healthrequires transport services” to mean the useState Board of aHealth motorto vehicle,adopt otherregulations thanproviding anfor ambulancethe orlicensure emergency response vehicle, that is specifically designed, equipped and staffedregulation to transport persons with a mental authorize the use of suchproviders services to transport a person who is the subject of annonemergency applicationsecure forbehavioral emergency admission to a hospital or mental health facilitytransport orservices. an involuntary court-ordered admission to a mental health facility.

SectionsSection 1310 anddefines 15the ofterm this“nonemergency billsecure requirebehavioral a health maintenancetransport organizationservices” andto managedmean carethe organizationuse thatof providea healthmotor carevehicle, servicesother tothan recipientsan ofambulance Medicaid or enrolleesemergency inresponse thevehicle, Children’sthat Healthis Insurancespecifically Programdesigned, toequipped negotiateand instaffed good faith to includetransport suchpersons with a psychiatricmental hospitalillness inor theother networkbehavioral ofhealth providerscondition. under conforming changes.

ExistingSections law11 authorizesand the12 Stateof Boardthis bill authorize the use of Healthsuch services to imposemaketransport feesa forperson licensinghealth byfacility theor Division.an involuntary court-ordered admission to a mental health facility.

Sections [1.5] 13 and [1.7] 15 of this bill require a health maintenance organization and managed care organization that provide health care services to recipients of Medicaid or enrollees in the Children’s Health Insurance Program to negotiate in good faith to include such a psychiatric hospital in the network of providers under contract to provide services to such persons.

Sections 2-9 and 14 of this bill make conforming changes.

Existing law authorizes the State Board of Health to impose fees for licensing by the Division.

(NRS 439.150) -THE 80thPEOPLE SessionOF (2019)THE –STATE 2OF –NEVADA, EXPLANATIONREPRESENTED –IN MatterSENATE inAND boldedASSEMBLY, italicsDO isENACT new;AS FOLLOWS:

matterSection between1. brackets [omitted material] is material to be omitted.

THEChapter PEOPLE[433] OF449 THEof STATENRS OFis NEVADA,hereby REPRESENTEDamended INby SENATEadding ANDthereto ASSEMBLY,a DOnew ENACTsection ASto FOLLOWS:read as follows:

thereto a new section to read as follows:y amended by adding 1.

The Division may issue[establish anpsychiatric endorsementhospitals asthat ameet crisis stabilization center to the holderrequirements of athis licensesection to operateprovide] aissue psychiatrican hospitalendorsement thatas meetsa thecrisis requirementsstabilization of[services. this section.

Such] center to the holder of a license to operate a psychiatric hospital that meets the requirements of this section.

A psychiatric hospital that wishes to obtain an endorsement as a crisis stabilization center must [:] submit an application in the form prescribed by the Division which must include, without limitation, proof that the applicant meets the requirements of subsection 3.

(a) Does[Not notlater exceedthan a1 capacityyear after commencing the delivery of 16services bedsto patients, be accredited by the Commission on Accreditation of Rehabilitation Facilities, or constituteits ansuccessor institutionorganization, foror mentalthe diseases,Joint asCommission, definedor inits 42successor U.S.C.organization;

(b) Not] Does not exceed a capacity of 16 beds or [be] constitute an institution for mental diseases, as defined in 42 U.S.C.

[ (c) Operate] (b) Operates in accordance with established administrative protocols, evidenced-based protocols for providing treatment and evidence-based standards for documenting information concerning services rendered and recipients of such services in accordance with best practices for providing crisis stabilization services;

[ (d) Deliver] (c) Delivers crisis stabilization services:

(1)Senate ToAmendment patientsNo. for not less than 24 hours in an area devoted to crisis stabilization or detoxification before releasing the patient into the community, referring the patient to another facility or transferring the patient to a bed within the hospital for short-term treatment, if the psychiatric hospital has such beds;

909 to Assembly Bill No.

66 First Reprint Page 5 (1) To patients for not less than 24 hours in an area devoted to crisis stabilization or detoxification before releasing the patient into the community, referring the patient to another facility or transferring the patient to a bed within the hospital for short-term treatment, if the psychiatric hospital has such beds;

and (3) In a manner that promotes concepts that are integral to recovery for persons with mental illness, including, without connections,limitation, self-responsibilityhope, andpersonal self-determination;t,empowerment, respect, social (d)connections, Employsself-responsibilityand qualifiedself- personsdetermination; to provide peer support services, as defined in NRS 449.01566, when appropriate;

[ (e) UsesEmploy] a(d) dataEmploys managementqualified toolpersons to collectprovide andpeer maintainsupport dataservices, relatingas todefined admissions,in discharges,NRS diagnoses449.01566, andwhen long-termappropriate; outcomes for recipients of crisis stabilization services;

-[ 80th(f) SessionUse] (2019)(e) –Uses 3a –data (f)management Acceptstool allto patients,collect withoutand regardmaintain to:data relating to admissions, discharges, diagnoses and long-term outcomes for recipients of crisis stabilization services;

[ (g) Perform] (f) Accepts all patients, without regard to:

(g) Performs an initial assessment on any patient who presents at the psychiatric hospital, regardless of the severity of thentsthe behavioral health issues that the patient is experiencing;

[ (h) Have] (h) Has the equipment and personnel necessary to conduct a medical examination of a patient pursuant to NRS 433A.165;

and (i) [Consider] Considers whether each patient would be better served by another facility and transfer a patient to another facility when appropriate.

[2.] 4.

Crisis stabilization services that may be provided pursuant to paragraph [(d)] (c) of subsection 1 may include, without limitation:

renewed[3.] at5. the same time as the license to which the endorsement applies.

[The Division may enter into a contract with an organization that specializes in the provision of behavioral health services to provide crisis stabilization services.

Before entering into such a contract, the Division must consult with the regional behavioral health policy board created by NRS 433.429 for the region in which the crisis stabilization center is located concerning the scope of the contract.

4.

A psychiatric hospital established pursuant to this section must accept all patients, without regard to:

Senate Amendment No.

909 to Assembly Bill No.

66 First Reprint Page 6 (a) The race, ethnicity, gender, socioeconomic status, sexual orientation or place of residence of the patient;

(b) Any social conditions that affect the recipient;

(c) The ability of the patient to pay;

or (d) Whether the patient is admitted to the psychiatric hospital on a voluntary admission pursuant to NRS 433A.140 or emergency admission pursuant to NRS 433A.150.

5.

The Division may accept gifts, grants and donations from any source for the purpose of carrying out the provisions of this section.

6.] An endorsement as a crisis stabilization center must be renewed at the same time as the license to which the endorsement applies.

As used in this section,section “crisis[: stabilization services” means behavioral health services designed to:

(a) De-escalate“Crisis] or, stabilize“crisis astabilization behavioralservices” crisis,means including, without limitation, a behavioral health crisisservices experienceddesigned byto: a person with a co-occurring substance use disorder;

and[ -(1)] 80th(a) SessionDe-escalate (2019)or –stabilize 4a –behavioral (b)crisis, Whenincluding, appropriate,without avoidlimitation, admission of a patientbehavioral to another inpatient mental health facilitycrisis orexperienced hospitalby anda connectperson the patient with providersa ofco-occurring ongoingsubstance careuse asdisorder; appropriate for the unique needs of the patient.

Sec.and [ (2)] (b) When appropriate, avoid admission of a patient to another inpatient mental health facility or hospital and connect the patient with providers of ongoing care as appropriate for the unique needs of the patient.

[ (b) “Psychiatric hospital” has the meaning ascribed to it in NRS 449.0165.] Sec.

449.0301Sec. The provisions of NRS 449.029 to 449.2428, follows:

inclusive,3. and section 1 of this act do not apply to:

NRS 449.0301 is hereby amended to read as follows:

449.0301 The provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of this act do not apply to:

Each license issued pursuant to NRS 449.029 to 449.2428, inclusive, and section 1 of this act expires on December 31 following its issuance and is renewable for 1 year upon reapplication and payment of all fees required pursuant to NRS facility449.050 hasunless not:ethe Division finds, after an investigation, that the (a)facility Satisfactorilyhas compliednot: with the provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of this act or the standards and regulations adopted by the Board;

Senate Amendment No.

909 to Assembly Bill No.

66 First Reprint Page 7 (a) Satisfactorily complied with the provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of this act or the standards and regulations adopted by the Board;

§ 1395ww(d)(1)(B)(iv) which accepts payment through Medicare, a - 80th Session (2019) – 5 – 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.

§ 482.58 or, if residential services are provided to children, a medical facility or facility for the treatment of abuse of alcohol or drugs must include, without limitation, a statement that the facility, hospital, agency, program, pool, organization or home is in compliance with the provisions of NRS 449.115 to 449.125, inclusive, and 449.174.

(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 1 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 1 of - 80th Session (2019) – 6 – this act and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required.

NRSSenate 244.360,Amendment 244.3603No. or 268.4124;

orte909 a nuisance pursuant to (c)Assembly IsBill orderedNo. by the appropriate governmental agency to correct a violation of a building, safety or health code or regulation but fails to correct the violation.

66 First Reprint Page 8 (b) Is ordered to but fails to abate a nuisance pursuant to NRS 244.360, 244.3603 or 268.4124;

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

On or before February 1 of each odd-numbered year, the Division shall submit to the Director of the Legislative Counsel Bur(a)Bureau Anya complaintswritten includedreport insetting theforth, logfor maintainedthe byprevious thennium:biennium:

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

In addition to the payment of the amount required by NRS 449.0308, if a medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed violates any provision related to its licensure, including any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and section 1 of this act or any condition, standard or regulation adopted by the Board, the - 80th Session (2019) – 7 – Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

(c) If the license of the facility limits the occupancy of the facility and the facility has exceeded the approved occupancy, facilityrequire thatthe isfacility, licensed;tsat its own expense, to move patients to another (d)facility Imposethat anis administrativelicensed; 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;

The Division may require any facility that violates any sectionprovision 1 of thisNRS act439B.410 or any449.029 condition,to standard449.2428, orinclusive, regulationand adoptedsection by1 theof Boardthis toact makeor any improvementsSenate necessaryAmendment toNo. correct the violation.

909 to Assembly Bill No.

66 First Reprint Page 9 condition, standard or regulation adopted by the Board to make any improvements necessary to correct the violation.

- 80th Session (2019) – 8 – Sec.

449.240 The district attorney of the county in which the facility is located shall, upon application by the Division, institute and conduct the prosecution of any action for violation of any provisions of NRS 449.029 to 449.245, inclusive,inclusive [.] , and section 1 of this act.

Sec.[Sec.

1.3.] Sec.

(a) Shall appoint, with the consent of the Governor, administrators of the divisions of the Department, who are respec(1)respectively Thedesignated Administratoras offollows: the Aging and Disability Services Division;

(1) The Administrator of the Aging and Disability Services Division;

(b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section [1.4] 9 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.621 to 432B.626, inclusive, 444.002 to 444.430, inclusive, and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public divisions.oraland Behavioral Health or the professional line activities of the other (c)divisions. Shall administer any state program for persons with developmental disabilities established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C.

(c) Shall administer any state program for persons with developmental disabilities established pursuant to the Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C.

- 80th Session (2019) – 9 – (1) Identify and assess the plans and programs of the Department for the provision of human services, and any duplication of those services by federal, state and local agencies;

(5) Set forth sufficient information to assist the Department in providing those services and in the planning and budgeting for the future provision of those services;

and (6)Senate ContainAmendment anyNo. other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department.

909 to Assembly Bill No.

66 First Reprint Page 10 (6) Contain any other information necessary for the Department to communicate effectively with the Federal Government concerning demographic trends, formulas for the distribution of federal money and any need for the modification of programs administered by the Department.

thereto[Sec. a new section to read as follows:

amended1.4.] bySec. adding The Department shall take any action necessary to ensure that crisis stabilization services provided at a psychiatric hospital established pursuant to section 1 of this act are reimbursable under Medicaid to the same extent as if the services were provided in another covered facility.

9.

Chapter 422 of NRS is hereby amended by adding thereto a new section to read as follows:

The Department shall take any action necessary to ensure that crisis stabilization services provided at a psychiatric hospital established pursuant to section 1 of this act are reimbursable under Medicaid to the same extent as if the services were provided in another covered facility.

- 80th Session (2019) – 10 – 2.

and (b) Prevents the person being transported from escaping from the vehicle or accessing the driver or the means of controlling the vehSec.vehicle.

Sec.

(II) A system for the nonemergency medical transportation of persons whose operation is authorized by theedicalthe Nevada Transportation Authority;

(III)Senate AnAmendment entityNo. that is exempt pursuant to NRS 706.745 from the provisions of NRS 706.386 or 706.421;

909 to Assembly Bill No.

66 First Reprint Page 11 (III) An entity that is exempt pursuant to NRS 706.745 from the provisions of NRS 706.386 or 706.421;

or (V) If medically necessary, an ambulance service that holds a permit issued pursuant to the provisions of chapter 450B of NRS,  only if the agent, officer, physician, physician assistant, psychologist, marriage and family therapist, clinical professional counselor, social worker or registered nurse has, based upon his or - 80th Session (2019) – 11 – her personal observation of the person alleged to be a person with mental illness, probable cause to believe that the person has a mental illness and, because of that illness, is likely to harm himself or herself or others if allowed his or her liberty.

and (2) Any agency, system , provider or service described in subparagraph (2) of paragraph (a) to transport the person alleged to be a person with mental illness to a public or private mental health facility or hospital for that purpose.

Except as otherwise provided in this subsection, each person admitted to a public or private mental health facility or hospital under an emergency admission must be evaluated at the time ofpitalof admission by a psychiatrist or a psychologist.

- 80th Session (2019) – 12 – Sec.

(b)Senate ArrangeAmendment forNo. the person to be transported by:

909 to Assembly Bill No.

66 First Reprint Page 12 (a) Transport the person;

or (b) Arrange for the person to be transported by:

Sec.[Sec.

1.5.] Sec.

A health maintenance organization that provides health care services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of HealthfHealth and Human Services shall negotiate in good faith to enter into a contract with a psychiatric hospital [established] with an endorsement as a crisis stabilization center pursuant to section 1 of this act to include the psychiatric hospital in the network of providers under contract with the health maintenance organization to provide services to recipients of Medicaid or enrollees in the Children’s Health Insurance Program, as applicable.

Sec.[Sec.

1.6.] Sec.

- 80th Session (2019) – 13 – (a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;

(b) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with the requirements of NRS 695C.1691 to 695C.200, inclusive, and section [1.5] 13 of this act, or 695C.207;

(1)Senate ResolvingAmendment complaintsNo. in a manner reasonably to dispose of val(2) Conducting external reviews of adverse determinations that comply with the provisions of NRS 695G.241 to 695G.310, inclusive;

909 to Assembly Bill No.

66 First Reprint Page 13 (1) Resolving complaints in a manner reasonably to dispose of valid complaints;

and (2) Conducting external reviews of adverse determinations that comply with the provisions of NRS 695G.241 to 695G.310, inclusive;

- 80th Session (2019) – 14 – 2.

Sec.[Sec.

1.7.] Sec.

Chapter 695G of NRS is hereby amended by adding theAthereto managed care organization that provides health care services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contractnew with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall negotiate in good faith to enter into a contract with a psychiatric hospital with an endorsement as a crisis stabilization center pursuant to section 1 of this act to includeread the psychiatric hospital in the network of providers under contract with the managed care organization to provide services to recipients of Medicaid or insureds in the Children’s Health Insurance Program, as applicable.follows:

Sec.A managed care organization that provides health care services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall negotiate in good faith to enter into a contract with a psychiatric hospital [established] with an endorsement as a crisis stabilization center pursuant to section 1 of this act to include the psychiatric hospital in the network of providers under contract with the managed care organization to provide services to recipients of Medicaid or insureds in the Children’s Health Insurance Program, as applicable.

[Sec.

2.] Sec.

~~~~~ 19 - 80th Session (2019)