Nevada 2021 Regular Session Status: Enacted

SB 229 — Revises provisions relating to the practice of pharmacy. (BDR 54-823)

Last action — Approved by the Governor. Chapter 290.

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

This bill has been enacted into law. Introduced March 15, 2021. Enacted.

Prognosis

Advancing 50% · moderate confidence

Where this bill stands today.

Odds of enactment

High

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  • Enacted

    Current position in the legislative process.

  • 1 sponsor

    1 primary, 0 co-sponsors signed on.

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Bill Text

What changed in the latest version

462 added · 489 removed

462 line(s) added, 489 removed.

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(Reprinted with amendments adopted on April 20, 2021) FIRST REPRINT S.B.
Senate Bill No.
229 SENATE BILL NO .
229–Senator Ratti CHAPTER..........
229–SENATOR RATTI M ARCH 15, 2021 ____________ Referred to Committee on Commerce and Labor SUMMARY—Revises provisions relating to the practice of pharmacy.
(BDR 54-823) FISCAL NOTE:
Effect on Local Government:
No.
Effect on the State:
Yes.
~ EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
(2) obtains the informed, written consent of a patient that is referred to the pharmacist;
and (2) practices within 100 miles of the primary location where the pharmacist practices in this State.
and (3) practices within 100 639.2623) Section 2 of this bill removes these requirements and instead:
(NRS 639.2623) requirements to ensure that the geographic distance between a practitioner and ain pharmacist who enter into a collaborative practice agreement does not impair effective collaboration;
(1)(NRS imposes certain requirements to ensure that the geographic distance between a practitioner and a pharmacist who enter into a collaborative practice agreement does not impair effective collaboration;
Section 2 additionally removes a prohibition on collaborative practice expressly authorizes a pharmacist to possess and administer a controlled substance pursuant to a collaborative practice agreement.
Section 2 additionally removes a prohibition on collaborative practice agreements for the management of controlled substances.
Sections 2 and 3 of this bill remove a requirement that a pharmacist obtain the consent of a patient before engaging in the collaborative practice of pharmacy or collaborative drug therapy management.
Section 7 of this bill expressly authorizes a pharmacist to possess and administer a controlled substance pursuant to aSection 3 of this bill makes conforming changes to update references to reflect the changes made by section 2.
Sections 1, 4 and 6 of this bill remove provisions limiting collaborative drug therapy management to patients who are in a concerning the contents of written guidelines and protocols for collaborative drugents - *SB229_R1* – 2 – therapy and removes the requirement that such guidelines and protocols must be approved by the Board.
Sections 1, 4 and 6 of this bill remove provisions limiting collaborative drug therapy management to patients who are in a medical facility or affiliated setting.
Sections 6 and 8 of this bill make conforming changes to reflect the removal of the requirement for such approval.
Section 4 additionally prescribes requirements concerning the contents of written guidelines and protocols for collaborative drug therapy and removes the requirement that such guidelines and protocols must be approved by the Board.
services to, a person who has or is suspected of having a communicable disease or of having suffered a drug overdose to report that fact to the appropriate health authority.
Sections 6 and 8 of this bill make conforming changes to reflect the removal of the requExisting law requires a provider of health care who knows of, or provides services to, a person who has or is suspected of having a communicable disease or of having suffered a drug overdose to report that fact to the appropriate health authority.
(1) requires a provider of health care to take certain measures to cooperate with an investigation by the health authority concerning a case or suspected case of an infectious disease or exposure to a take certain actions against a provider of health care who has significantlythority to contributed to a case of an infectious disease or exposure to a biological, radiological or chemical agent.
(1) requires a provider of health care to take certain measures to cooperate with an investigation by the health authority concerning a case or suspected case of an infectious disease or exposure to a biological, radiological or chemical agent;
and (2) authorizes the health authority to contributed to a case of an infectious disease or exposure to a biological,y radiological or chemical agent.
- 81st Session (2021) – 2 – EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
- *SB229_R1* – 3 – The term does not include the changing of a prescription by a pharmacist or practitioner without the consent of the prescribing practitioner, except as otherwise provided in NRS 639.2583.
The term does not include the changing of a prescription by a practitioner, except as otherwise provided in NRS 639.2583.ribing Sec.
Sec.
To enter into a collaborative practice agreement, a practitioner must [:
To enter into a collaborative practice agreement, a practitioner must:
(a) Be] be licensed in good standing to practice his or her profession in this State .
- 81st Session (2021) – 3 – (a) Be licensed in good standing to practice his or her profession in this State;
and (b) [Agree to maintain an ongoing relationship with a patient who is referred by the practitioner to a pharmacist pursuant to a management;ve practice agreement for collaborative drug therapy (c)] Agree to obtain the informed, written consent from a patient who is referred by the practitioner to a pharmacist pursuant to a collaborative practice agreement for collaborative drug therapy management .
(b) Agree to maintain an ongoing relationship with a patient who is referred by the practitioner to a pharmacist pursuant to a collaborative practice agreement for collaborative drug therapy management;
(c) Agree to obtain the informed, written consent from a patient who is referred by the practitioner to a pharmacist pursuant to a collaborative practice agreement for collaborative drug therapy management;
The Board may grant such a request upon a showing of good cause.] 3.
The Board may grant such a request upon a showing of good cause.] The provisions of this paragraph must not be construed to require a patient to obtain a referral from a practitioner before a pharmacist may engage in the collaborative practice of pharmacy or collaborative drug therapy management.
3.
Except as otherwise provided in this subsection, a practitioner shall not enter a collaborative practice agreement that includes diagnosis or initiating treatment unless the practitioner actively practices his or her profession in this State or provides those services using telehealth.
Except as otherwise provided in this subsection, a practitioner shall not enter a collaborative practice agreement that actively practices his or her profession in this State or provides those services using telehealth.
(a) Except as otherwise provided in paragraph (b), document any treatment or care provided to a patient pursuant to a - *SB229_R1* – 4 – collaborative practice agreement after providing such treatment or care in the medical record of the patient, on the chart of the patient or in a separate log book;
(a) Except as otherwise provided in paragraph (b), document any treatment or care provided to a patient pursuant to a collaborative practice agreement after providing such treatment or care in the medical record of the patient, on the chart of the patient or in a separate log book;
(b) Document in the medical record of the patient, on the chart of the patient or in a separate log book any decision or action concerning the management of drug therapy pursuant to a collaborative practice agreement after making such a decision or taking such an action;
- 81st Session (2021) – 4 – (b) Document in the medical record of the patient, on the chart of the patient or in a separate log book any decision or action concerning the management of drug therapy pursuant to a collaborative practice agreement after making such a decision or tak(c) Maintain all records concerning the care or treatment provided to a patient pursuant to a collaborative practice agreement in written or electronic form for at least 7 years;
(c) Maintain all records concerning the care or treatment provided to a patient pursuant to a collaborative practice agreement in written or electronic form for at least 7 years;
[4.
[4.] 7.
(b) Is not a physician, osteopathic physician, advanced practice registered nurse or physician assistant;
and (b) Is not a physician, osteopathic physician, advanced practice registered nurse or physician assistant .
and (c) May not diagnose.
[;
5.
and 5.) MA practitioner may not enter into a collaborative practice agreement with a pharmacist for the management of controlled substances.
A practitioner may not enter into a collaborative practice agreement with a pharmacist for the management of controlled substances.
6.] 8.
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6.] 7.
(a) A description of the types of decisions concerning the management of drug therapy that the pharmacist is authorized to make, which may include a specific description of the diseases and - *SB229_R1* – 5 – drugs for which the pharmacist is authorized to manage drug therapy;
(a) A description of the types of decisions concerning the management of drug therapy that the pharmacist is authorized to make, which may include a specific description of the diseases and - 81st Session (2021) – 5 – therapy;r which the pharmacist is authorized to manage drug (b) A detailed explanation of the procedures that the pharmacist must follow when engaging in the collaborative practice of pharmacy, including, without limitation, the manner in which the pharmacist must document decisions concerning treatment and care in accordance with subsection [3] 6 of NRS 639.2623, report such decisions to the practitioner and receive feedback from the practitioner;
(b) A detailed explanation of the procedures that the pharmacist must follow when engaging in the collaborative practice of pharmacy, including, without limitation, the manner in which the pharmacist must document decisions concerning treatment and care in accordance with subsection [3] 6 of NRS 639.2623, report such decisions to the practitioner and receive feedback from the practitioner;
(e) A description of the means by which the practitioner will monitor clinical outcomes of a patient and intercede when necessary to protect the health of the patient or accomplish the goals of the treatment prescribed for the patient;
(e) A description of the means by which the practitioner will monitor clinical outcomes of a patient and intercede when necessary treatment prescribed for the patient;or accomplish the goals of the (f) Authorization for the practitioner to override the agreement if necessary to protect the health of the patient or accomplish the goals of the treatment prescribed for the patient;
(f) Authorization for the practitioner to override the agreement if necessary to protect the health of the patient or accomplish the goals of the treatment prescribed for the patient;
and (j) The address of the location where the records described in subsection [3] 6 of NRS 639.2623 will be maintained .
[and] (j) The address of the location where the records described in subsection [3] 6 of NRS 639.2623 will be maintained;
[;
and (k) The process by which the pharmacist will obtain the NRS 639.2623.tten consent required by subsection [4] 7 of 2.
and (k) The process by which the pharmacist will obtain the informed, written consent required by subsection 4 of NRS 639.2623.] 2.
Sec.
- 81st Session (2021) – 6 – Sec.
- *SB229_R1* – 6 – (a) May authorize a pharmacist to order and use the findings of laboratory tests and examinations.
laboratory tests and examinations.to order and use the findings of (b) May provide for collaborative drug therapy management for a patient receiving care:
(b) May provide for collaborative drug therapy management for a patient receiving care:
(a) A description of the types of decisions concerning the management of drug therapy that the pharmacist is authorized to make, including, without limitation:
(a) A description of the types of decisions concerning the management of drug therapy that the pharmacist is authorized to make, i(1) A specific description of the diseases, drugs and categories of drugs covered by the guidelines;
(1) A specific description of the diseases, drugs and categories of drugs covered by the guidelines;
2.
- 81st Session (2021) – 7 – 2.
and (b) Set forth the process for obtaining the approval of the Board of such written guidelines and protocols.] - *SB229_R1* – 7 – Sec.
and (b) Set forth the process for obtaining the approval of the Board of Sec.
5.
5.ittNRS 441A.110 is hereby amended to read as follows:
NRS 441A.110 is hereby amended to read as follows:
441A.110 “Provider of health care” means a physician, nurse or veterinarian licensed in accordance with state law , [or] a physician assistant licensed pursuant to chapter 630 or 633 of NRS [.] or a pharmacist registered pursuant to chapter 639 of NRS.
441A.110 “Provider of health care” means a physician, nurse or veterinarian licensed in accordance with state law, [or] a physician assistant licensed pursuant to chapter 630 or 633 of NRS [.] or a pharmacist registered pursuant to chapter 639 of NRS.
(b) A registered nurse licensed to practice professional nursing or licensed practical nurse, at the direction of a physician, physician assistant, dentist, podiatric physician or advanced practice registered nurse, or pursuant to a chart order, for administration to a patient at another location.
or licensed practical nurse, at the direction of a physician, physician assistant, dentist, podiatric physician or advanced practice registered nurse, or pursuant to a chart order, for administration to a patient at another location.
or (III) A district board of health created pursuant to NRS 439.362 or 439.370 in any county.
or - 81st Session (2021) – 8 – (III) A district board of health created pursuant to NRS 439.362 or 439.370 in any county.
(e) A medical student, student in training to become a physician assistant or student nurse in the course of his or her studies at an accredited college of medicine or approved school of professional or - *SB229_R1* – 8 – practical nursing, at the direction of a physician or physician assistant and:
assistant or student nurse in the course of his or her studies at an accredited college of medicine or approved school of professional or practical nursing, at the direction of a physician or physician assistant and:
(i) In accordance with applicable regulations of the State Board of Health, an employee of a residential facility for groups, as defined in NRS 449.017, pursuant to a written agreement entered into by the ultimate user.
(i) In accordance with applicable regulations of the State Board of Health, an employee of a residential facility for groups, as into by the ultimate user.rsuant to a written agreement entered (j) In accordance with applicable regulations of the State Board of Pharmacy, an animal control officer, a wildlife biologist or an employee designated by a federal, state or local governmental agency whose duties include the control of domestic, wild and predatory animals.
(j) In accordance with applicable regulations of the State Board of Pharmacy, an animal control officer, a wildlife biologist or an employee designated by a federal, state or local governmental agency whose duties include the control of domestic, wild and predatory animals.
(l) A registered pharmacist pursuant to written guidelines and protocols developed pursuant to NRS 639.2629 or a collaborative practice agreement, as defined in NRS 639.0052.
- 81st Session (2021) – 9 – (l) A registered pharmacist pursuant to written guidelines and protocols developed pursuant to NRS 639.2629 or a collaborative practice agreement, as defined in NRS 639.0052.
As used in this section, “accredited college of medicine” means:
As used in this section, “accredited college of medicine” mea(a) A medical school that is accredited by the Liaison Committee on Medical Education of the American Medical Association and the Association of American Medical Colleges or their successor organizations;
(a) A medical school that is accredited by the Liaison Committee on Medical Education of the American Medical Association and the Association of American Medical Colleges or their successor organizations;
or (b) A school of osteopathic medicine, as defined in NRS 633.121.
or - *SB229_R1* – 9 – (b) A school of osteopathic medicine, as defined in NRS 633.121.
(d) In accordance with applicable regulations of the Board, a registered nurse licensed to practice professional nursing or licensed practical nurse who is:
(d) In accordance with applicable regulations of the Board, a practical nurse who is:ed to practice professional nursing or licensed (1) Employed by a health care agency or health care facility that is authorized to provide emergency care, or to respond to the immediate needs of a patient, in the residence of the patient;
(1) Employed by a health care agency or health care facility that is authorized to provide emergency care, or to respond to the immediate needs of a patient, in the residence of the patient;
(f) Except as otherwise provided in paragraph (g), an advanced emergency medical technician or a paramedic, as authorized by regulation of the State Board of Pharmacy and in accordance with any applicable regulations of:
(f) Except as otherwise provided in paragraph (g), an advanced emergency medical technician or a paramedic, as authorized by - 81st Session (2021) – 10 – regulation of the State Board of Pharmacy and in accordance with any applicable regulations of:
(2) A county board of health in a county whose population is 100,000 or more;
100,000 or more;
or (3) A district board of health created pursuant to NRS 439.362 or 439.370 in any county.
or board of health in a county whose population is (3) A district board of health created pursuant to NRS 439.362 or 439.370 in any county.
- *SB229_R1* – 10 – (h) A respiratory therapist employed in a health care facility.
(h) A respiratory therapist employed in a health care facility.
A medical student or student nurse may administer a dangerous drug in the presence or under the supervision of a registered nurse alone only if the circumstances are such that the registered nurse would be authorized to administer it personally.
A medical student or student nurse may administer a dangerous drug in the presence or under the supervision of a registered nurse would be authorized to administer it personally.e registered nurse (k) Any person designated by the head of a correctional institution.
(k) Any person designated by the head of a correctional institution.
(1) Used for cooling and stretching external tissue during therapeutic treatments;
- 81st Session (2021) – 11 – (1) Used for cooling and stretching external tissue during therapeutic treatments;
or (II) The transmission of drugs through the skin using ultrasound.
or ultrasound.II) The transmission of drugs through the skin using (p) In accordance with applicable regulations of the State Board of Health, an employee of a residential facility for groups, as defined in NRS 449.017, pursuant to a written agreement entered into by the ultimate user.
(p) In accordance with applicable regulations of the State Board of Health, an employee of a residential facility for groups, as defined in NRS 449.017, pursuant to a written agreement entered into by the ultimate user.
- *SB229_R1* – 11 – (1) Is trained in and certified to carry out standards and practices for immunization programs;
(1) Is trained in and certified to carry out standards and practices for immunization programs;
(t) A person who is enrolled in a training program to become a physician assistant licensed pursuant to chapter 630 or 633 of NRS, dental hygienist, advanced emergency medical technician, paramedic, respiratory therapist, dialysis technician, physical therapist or veterinary technician or to obtain a license to engage in radiation therapy and radiologic imaging pursuant to chapter 653 of NRS if the person possesses and administers the drug or medicine in the same manner and under the same conditions that apply, respectively, to a physician assistant licensed pursuant to chapter 630 or 633 of NRS, dental hygienist, advanced emergency medical technician, paramedic, respiratory therapist, dialysis technician, physical therapist, veterinary technician or person licensed to engage in radiation therapy and radiologic imaging who may possess and administer the drug or medicine, and under the direct supervision of a person licensed or registered to perform the respective medical art or a supervisor of such a person.
(t) A person who is enrolled in a training program to become a physician assistant licensed pursuant to chapter 630 or 633 of NRS, paramedic, respiratory therapist, dialysis technician, physicalcian, therapist or veterinary technician or to obtain a license to engage in radiation therapy and radiologic imaging pursuant to chapter 653 of NRS if the person possesses and administers the drug or medicine in the same manner and under the same conditions that apply, respectively, to a physician assistant licensed pursuant to chapter or 633 of NRS, dental hygienist, advanced emergency medical technician, paramedic, respiratory therapist, dialysis technician, physical therapist, veterinary technician or person licensed to engage in radiation therapy and radiologic imaging who may possess and administer the drug or medicine, and under the direct supervision of a person licensed or registered to perform the respective medical art or a supervisor of such a person.
(1) Board of Medical Examiners, at the direction of the prescribing physician and under the supervision of a physician or physician assistant.
- 81st Session (2021) – 12 – (1) Board of Medical Examiners, at the direction of the prescribing physician and under the supervision of a physician or physician assistant.
(2) State Board of Osteopathic Medicine, at the direction of the prescribing physician and under the supervision of a physician or physician assistant.
(2) State Board of Osteopathic Medicine, at the direction of or physician assistant.an and under the supervision of a physician 2.
2.
and - *SB229_R1* – 12 – (b) October 1, 2021, for all other purposes.
and (b) October 1, 2021, for all other purposes.
H - *SB229_R1*
~~~~~ 21 - 81st Session (2021)
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Amendments

2 amendments

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Action History

  1. Approved by the Governor. Chapter 290.

  2. Enrolled and delivered to Governor.

  3. In Senate. Assembly Amendment No. 567 concurred in. To enrollment.

  4. Read third time. Passed, as amended. Title approved. (Yeas: 33, Nays: 8, Absent: 1.) To Senate.

  5. From printer. To reengrossment. Reengrossed. Second reprint. Taken from General File. Placed on General File for next legislative day.

  6. From committee: Amend, and do pass as amended. Placed on Second Reading File. Read second time. Amended. (Amend. No. 567.) To printer.

  7. In Assembly. Read first time. Referred to Committee on Commerce and Labor. To committee.

  8. From printer. To engrossment. Engrossed. First reprint. To Assembly.

  9. Read third time. Amended. (Amend. No. 403.) Reprinting dispensed with. Read third time. Passed, as amended. Title approved. (Yeas: 17, Nays: 4.) To printer.

  10. From committee: Amend, and do pass as amended. Placed on Second Reading File. Read second time.

  11. From printer. To committee.

  12. Read first time. Referred to Committee on Commerce and Labor. To printer.

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 66 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (66)

66 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.

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Subjects

public-safety healthcare
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Frequently asked questions

Who sponsors SB 229?
SB 229 is sponsored by Julia Ratti.
What is the current status of SB 229?
This bill has been enacted into law. Introduced March 15, 2021. Enacted.
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