AB 217 — Requires training for unlicensed caregivers at certain facilities. (BDR 40-454)

(c) A written plan of care by a physician or registered nurse has been established that:

The Board shall adopt separate regulations governing the licensing and operation of residential facilities for groups which providelicensing of a facility as a residential facility for groups which provides assisted living services.services and a residential facility for groups shall not claim that it provides “assisted living services” unless:

The(a) BoardBefore shallauthorizing nota allowperson theto licensingmove ofinto athe facility, the facility asmakes a residentialfull facilitywritten fordisclosure groupsto whichthe providesperson assistedregarding livingwhat services andof apersonalized residentialcare facilitywill forbe groupsavailable shallto notthe claimperson and the amount that itwill providesbe “assistedcharged livingfor services”those unless:services throughout the resident’s stay at the facility.

- *AB217*81st Session (2021) – 6 – (a)which: Before authorizing a person to move into the facility, the facility makes a full written disclosure to the person regarding what services of personalized care will be available to the person and the amount that will be charged for those services throughout the resident’s stay at the facility.

(b) The residents of the facility reside in their own living units which:(1) Except as otherwise provided in subsection 8, contain toilet facilities;

(1) Except as otherwise provided in subsection 8, contain toilet facilities;

(3) The facility provides a variety of creative and innovative services that emphasize the particular needs of each individualindividualvative resident and the resident’s personal choice of lifestyle;

and (7) The facility is operated in such a manner as to foster a culture that provides a high-quality environment for the residents, their families, the staff, any volunteers and the community at large.

The Division may grant an exception from the requirement of subparagraph (1) of paragraph (b) of subsection 7 to a facility which is licensed as a residential facility for groups on or before July 1, 2005, and which is authorized to have 10 or fewer beds and - *AB217* – 7 – was originally constructed as a single-family dwelling if the Division finds that:

and - 81st Session (2021) – 7 – (b) The exception, if granted, would not:

(a)environment;ities Facilities that only provide a housing and living (b) Facilities that provide or arrange for the provision of supportive services for residents of the facility to assist the residents with reintegration into the community, in addition to providing a housing and living environment;

(b) Facilities that provide or arrange for the provision of supportive services for residents of the facility to assist the residents with reintegration into the community, in addition to providing a housing and living environment;

- *AB217* – 8 – 11.

(a)- Except81st asSession otherwise(2021) provided– in8 paragraph– (b), require a natural person responsible for the operation of a provider of a community-based living arrangement services and each employee of a provider of community-based living arrangement services who supervises or provides support to recipients of community-based living arrangement services to complete training concerning the provision of community-based living arrangement services to persons with mental illness and continuing education concerning the particular population served by the provider;

(c) Require a natural person responsible for the operation of a provider of community-based living arrangement services to receive training concerning the provisions of title 53 of NRS applicable to the(d) Require an applicant for a license to provide community-nd based living arrangement services to post a surety bond in an amount equal to the provisionoperating expenses of the applicant for 2 months, place that amount in escrow or take another action prescribed by the Division to ensure that, if the applicant becomes insolvent, recipients of community-based living arrangement services;services from the applicant may continue to receive community- based living arrangement services for 2 months at the expense of the applicant.

and (d) Require an applicant for a license to provide community- based living arrangement services to post a surety bond in an amount equal to the operating expenses of the applicant for 2 months, place that amount in escrow or take another action prescribed by the Division to ensure that, if the applicant becomes insolvent, recipients of community-based living arrangement services from the applicant may continue to receive community- based living arrangement services for 2 months at the expense of the applicant.

Except as otherwise provided in subsection 5, a person must obtain a license from the Board to operate a business that provides referrals to residential facilities for groups or any other group housing arrangement that provides assistance, food, shelter or limited supervision to a person with a mental illness, intellectualintellectualr disability, developmental disability or physical disability or who is aged or infirm.

and - *AB217*81st Session (2021) – 9 – (d)employees Regulationsof establishingsuch businesses.ng requirements for training the employees3. of such businesses.

3.

(b) Refer a person to a residential facility for groups or any other group housing arrangement described in subsection 1 if the business or its employee knows or reasonably should know that the facility or other group housing arrangement, or the services provided by the facility or other group housing arrangement, are not appropriate for the condition of the person being referred.

Unless otherwise required by federal law, the Board shall deposit all civil penalties collected pursuant to this section into a separate account in the State General Fund to be used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and section 1 of this act, 449.435 to 449.531, inclusive, and chapter 449A of NRS and to protect the health,health,.531, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards.

- 81st Session (2021) – 10 – (b) “Intellectual disability” has the meaning ascribed to it in NRS 435.007.

- *AB217* – 10 – (c) “Mental illness” has the meaning ascribed to it in NRS 433.164.

Sec.

7.

NRS 449.0306 is hereby amended to read as follows:

Upon receipt of a complaint against 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, except for a complaint concerning the cost of services, conduct an investigation into the premises, facilities, qualifications of personnel, methods of operation, policies, procedures and records of that facility or any other 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 which may have information pertinent to the complaint.

Except as otherwise provided in this section, the Division may charge and collect from 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 or a person who operates such a facility without a license issued by the - 81st Session (2021) – 11 – Division the actual costs incurred by the Division for the enforcement of the provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of this act, including, without limitation, - *AB217* – 11 – the actual cost of conducting an inspection or investigation of the facility.fac2.

2.

3.

The location of the facility.

InThIn specific terms, the nature of services and type of care to be offered, as defined in the regulations.

If the applicant is a political subdivision of the State or - 81st Session (2021) – 12 – other governmental agency, similar evidence must be submitted as to the person in charge of the institution for which application is made.

Evidence satisfactory to the Division of the ability of the applicant to comply with the provisions of NRS 449.029 to - *AB217* – 12 – 449.2428, inclusive, and section 1 of this act and the standards and regulations adopted by the Board.

Any investigation of an applicant for a license to provide community-based living arrangement services conducted pursuant to subsection 1 must include, without limitation, an inspection of any building operated by the applicant in which the applicant proposes to provide community-based living arrangement services.

(b)- Obtained81st theSession approval(2021) of– the13 Director– of the Department of Health and Human Services before undertaking a project, if suchsuchof approval is required by NRS 439A.100;

Each reapplication for an agency to provide personal care services 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 provider of community-based living - *AB217* – 13 – arrangement services, a hospital described in 42 U.S.C.

§ 483.5, a hospital that provides swing-bed services as describedprovided to children, a medical facility or facility for the treatment of alcohol or other substance use disorders must include, without limitation, a statement that the facility, hospital, agency, program, pool, organization or home is in 42compliance C.F.R.with the provisions of NRS 449.115 to 449.125, inclusive, and 449.174.

§ 482.58 or, if residential services are provided to children, a medical facility or facility for the treatment of alcohol or other substance use disorders 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.

449.091facility, 1.facility for the dependent or a facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed and issue a provisional license, effective for a period determined by the Division, to such a facility if it:

The(a) DivisionIs mayin canceloperation at the licensetime of a medical facility, facility for the dependentadoption orof astandards facilityand whichregulations ispursuant requiredto by the regulationsprovisions adoptedof byNRS the449.029 Boardto pursuant449.2428, toinclusive, NRSand 449.0303section to1 beof licensedthis act and issuethe aDivision provisionaldetermines license,that effectivethe forfacility requires a periodreasonable determinedtime byunder the Division,particular to- such81st aSession facility(2021) if– it:14 – regulations;

(a)orithin Iswhich into operationcomply atwith the time of the adoption of standards and regulations(b) pursuantHas tofailed the provisions of NRS 449.029 to 449.2428,comply inclusive,with andthe sectionstandards 1or ofregulations this act and the Division determines that the facility requiresis ain reasonablethe timeprocess underof making the particularnecessary circumstanceschanges withinor whichhas agreed to complymake with the standardschanges andwithin regulations;a reasonable time.

or (b) Has failed to comply with the standards or regulations and the Division determines that the facility is in the process of making the necessary changes or has agreed to make the changes within a reasonable time.

- *AB217* – 14 – Sec.

The State Fire Marshal or a designee of the State Fire Marshal shall, upon receiving a request from the Division or a written complaint concerning compliance with the plans andandor a requirements to respond to an emergency adopted pursuant to subsection 9 of NRS 449.0302:

The Chief Medical Officer or a designee of the Chief Medical Officer shall enter and inspect at least annually each building or the premises of a residential facility for groups and each building operated by a provider of community-based living arrangement services in which such services are provided to ensure compliancecom4.iaAn withauthorized standardsmember foror healthemployee of the Division shall enter and sanitation.inspect any building or premises operated by a residential facility for groups or provider of community-based living arrangement services within 72 hours after the Division is notified that a residential facility for groups or provider of community-based living arrangement services is operating without a license.

4.

An authorized member or employee of the Division shall enter and inspect any building or premises operated by a residential facility for groups or provider of community-based living arrangement services within 72 hours after the Division is notified that a residential facility for groups or provider of community-based living arrangement services is operating without a license.

The Division may deny an application for a license or may suspend or revoke any license issued under the - 81st Session (2021) – 15 – this act upon any of the following grounds:usive, and section 1 of (a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410 or 449.029 to 449.2428,449.245, inclusive, and section 1 of this act uponor of any other law of this State or of the followingstandards, grounds:rules and regulations adopted thereunder.

(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.

- *AB217* – 15 – (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 thisNRS actif andsuch 449.435approval tois 449.531,required.inclusive, inclusive, and chapter 449A of NRS(f) ifFailure suchto approvalcomply iswith required.the provisions of NRS 449.2486.

(f) Failure to comply with the provisions of NRS 449.2486.

The Division shall maintain a log of any complaints that it receives relating to activities for which the Division may revoke the license to operate a facility for the dependent pursuant to subsection 2.

- The81st facilitySession shall(2021) make– the16 information– available to the public pursuant to NRS 449.2486.

the information available to the public 4.

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 - *AB217* – 16 – 449.029 to 449.2428, inclusive, and section 1 of this act or any condition, standard or regulation adopted by the Board, the Division,NRS in449.165, accordancemay:rdance with the regulations adopted pursuant to NRS(a) 449.165,Prohibit may:the facility from admitting any patient until it determines that the facility has corrected the violation;

(a) Prohibit the facility from admitting any patient until it determines that the facility has corrected the violation;

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,facilit(1) until: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;

and (b)- Collect81st courtSession costs,(2021) reasonable– attorney’s17 fees– and other costs incurred to collect the administrative penalty.penalty.s and other 3.

3.

- *AB217* – 17 – 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 [.] , and section 1 of this act.

(d) Aids or abets any person in the violation of any of the provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of this act as those provisions pertain to a facility for skilled nursing, facility for intermediate care or residential facility for groups.

- 81st Session (2021) – 18 – 2.

3.production of documents or objects by subpoena.

The Board may compel the attendance of witnesses or the production of documents or objects by subpoena.

The expiration of a license by operation of law or by order or decision of the Board or a court, or the voluntary surrender of a license, does not deprive the Board of jurisdiction to proceed with - *AB217* – 18 – any investigation of, or action or disciplinary proceeding against, the licensee or to render a decision suspending or revoking the license.

(a) Upon passage and approval for the purpose of adopting any regulations and performing any other preparatory administrative tasks that are necessary to carry out the provisions of this act;

H~~~~~ 21 - *AB217*81st Session (2021)