AB 287 — Revises provisions relating to childbirth. (BDR 40-799)

2.

[An obstetric center,] A freestanding birthing center, as that term is defined in [NRS 449.0151 and 449.0155;] section 11 of this act;

3.

A surgical center for ambulatory patients, as that term is defined in NRS 449.0151 and 449.019;

and term is defined in NRS 449.013 and 449.0151.medical care, as that Sec.

1.1.

If a birth occurs in a hospital or the [mother] person giving birth and child are immediately transported to a - *AB287_R1*81st Session (2021) – 3 – hospital, the person in charge of the hospital or his or her designated representative shall obtain the necessary information, prepare a birth certificate, secure the signatures required by the certificate and file it within 10 days with the health officer of the registration district wherethe medical information required by the certificate and certify to the fact of birth occurred.within 72 hours after the birth.

The physician in attendance shall provide the medical information required by the certificate and certify to the fact of birth within 72 hours after the birth.

(a) Married at the time of birth, the name of [her] the spouse of that person must be entered on the certificate as the other parent of the child unless:

- *AB287_R1*81st Session (2021) – 4 – (1) A court has issued an order establishing that a person other than the [mother’s] spouse of the person giving birth at the time of conception is the other parent of the child;

or (2) The [mother] person giving birth and a person other than theconceptionr’s]haveusesignede [mother’s]parsodeclarationrthfor spousetthetimvoluntary of the person giving birth at the time of conception have signed a declaration for the voluntary acknowledgment of paternity developed by the Board pursuant to NRS 440.283 or a declaration for the voluntary acknowledgment of parentage developed by the Board pursuant to NRS 440.285.

An order entered or a declaration executed pursuant to subsection 6 must be submitted to the local health officer, the local health officer’s authorized representative, or the attending physician or midwife before a proper certificate of birth is forwarded to thetheian State Registrar.

(a)- Develop81st aSession declaration(2021) to– be5 signed– under penalty of perjury for the voluntary acknowledgment of paternity in this State thatthatry - *AB287_R1* – 5 – complies with the requirements prescribed by the Secretary of Health and Human Services pursuant to 42 U.S.C.

(1) Each hospital ,or [or][obstetric obstetriccenter] center or freestanding birthing center in this State;

3.paternity to the [mother of] person who gave birth to a child or a person who wishes to acknowledge the paternity of the child, the agencies described in paragraph (b) of subsection 1 shall ensure that the [mother] person who gave birth and the person who wishes to acknowledge paternity are given notice, orally and in writing, of the rights, responsibilities and legal consequences of, and the alternatives to, signing the declaration for the acknowledgment of paternity.

Before providing a declaration for the acknowledgment of paternity to the [mother of] person who gave birth to a child or a person who wishes to acknowledge the paternity of the child, the agencies described in paragraph (b) of subsection 1 shall ensure that the [mother] person who gave birth and the person who wishes to acknowledge paternity are given notice, orally and in writing, of the rights, responsibilities and legal consequences of, and the alternatives to, signing the declaration for the acknowledgment of paternity.

and (b) Distribute the declarations to each hospital ,or [or][obstetric obstetric center or] freestanding birthing center in this State.

Before providing a declaration for the acknowledgment of parentage to the [mother of] person who gave birth to a child or a person who wishes to acknowledge the parentage of a child, thetheor a agencies described in paragraph (b) of subsection 1 shall ensure that the [mother] person who gave birth and the person who wishes to acknowledge parentage are given notice, orally and in writing, of the rights, responsibilities and legal consequences of, and the alternatives to, signing the declaration for the acknowledgment of parentage.

- 81st Session (2021) – 6 – Sec.

If a [mother] person who has given birth or a person who has signed a declaration for the voluntary acknowledgment of paternity developed by the Board pursuant to NRS 440.283 or a declaration for the voluntary acknowledgment of parentage developed by the Board pursuant to NRS 440.285 with -of *AB287_R1* – 6 – the [mother] person who has given birth rescinds the acknowledgment pursuant to subsection 2 of NRS 126.053, the State Registrar shall not issue a new certificate of birth to remove the name of the person who originally acknowledged paternity or parentage, as applicable, unless a court issues an order establishing that the person who acknowledged paternity or parentage, as applicable, is not the father or parent, as applicable, of the child.

or (c) Order of a district court,  the State Registrar, upon the receipt of the declaration or court order, shall prepare a new certificate of birth in the name of thethet child as shown in the declaration or order with no reference to the fact of legitimation.

The State Registrar shall, upon the request of the Division of Welfare and Supportive Services of the Department of Health and Human Services, open a file that has been sealed pursuant to subsection 3 to allow the Division to compare the information contained in the declaration or order upon which the new certificate - 81st Session (2021) – 7 – was made with the information maintained pursuant to 42 U.S.C.

440.610 Each certificate, as provided for in this chapter, filed within 6 months after the time prescribed for their filing, shall be prima facie evidence of the facts therein stated.

Data pertaining to the [father of] parent who did not give birth to a child is such evidence if the alleged [father] parent is, or becomes, the [husband] spouse of the [mother] person who gave birth to the child in a legal - *AB287_R1* – 7 – marriage;

7.NRS 652.040.oratory” has the meaning ascribed to it in [7.

“Laboratory”“Obstetric center” has the meaning ascribed to it in NRS 652.040.449.0155.

[7.] 8.

“Obstetric center” has the meaning ascribed to it in NRS 449.0155.

[8.] 10.

(b)- A81st physicianSession or(2021) a– physician8 assistant– who is licensed pursuant to chapter 630 or 633 of NRS and who practices in the area ofofursuant obstetrics and gynecology, family practice, internal medicine, pediatrics or psychiatry;

- *AB287_R1* – 8 – Sec.

Except as otherwise provided in this subsection, the examinations and tests required pursuant to subsection 1 must include tests and examinations for each disorder recommended to be screened by the Health Resources and Services Administration of the United States Department of Health and Human Services by not later than 4 years after the recommendation is published.

If the State Public Health Laboratory increases the amount charged for performing such an examination or test pursuant to NRS 439.240, the Division shall hold a public hearing during which the State Public Health Laboratory shall provide to the Division a written and verbal fiscal analysis of the reasons for the increased charges.

- 81st Session (2021) – 9 – (a) Each newborn child who is susceptible to sickle cell disease and its variants and sickle cell trait as determined by regulations of the State Board of Health;

and (b) Each biological parent of a child who wishes to undergo suchsuc5.scrAnying.physician, screening.midwife, nurse, [obstetric center] freestanding birthing center or hospital of any nature attending or assisting in any way any infant, or the [mother of] person who gave birth to any infant, at childbirth shall:

5.

Any physician, midwife, nurse, obstetric center , freestanding birthing center or hospital of any nature attending or assisting in any way any infant, or the [mother of] person who gave birth to any infant, at childbirth shall:

- *AB287_R1* – 9 – (b) Collect and send to the State Public Health Laboratory or cause to be collected and sent to the State Public Health Laboratory any specimens needed for the examinations and tests that must be performed by a laboratory and are required by the regulations adopted pursuant to subsection 1.

If the examination and tests reveal the existence of such conditions in an infant, the physician, midwife, nurse, obstetric[obstetric centercenter] , freestanding birthing center or hospital attending or assisting at the birth of the infant shall immediately:

(a) Report the condition to the Chief Medical Officer or the representative of the Chief Medical Officer, the local health officer of the county or city within which the infant or the [mother of] person who gave birth to the infant resides, and the local health officeroff(b) ofDiscuss the countycondition with the parent, parents or cityother inpersons whichresponsible for the childcare isof born;the infant and inform them of the treatment necessary for the amelioration of the condition.

and (b) Discuss the condition with the parent, parents or other persons responsible for the care of the infant and inform them of the treatment necessary for the amelioration of the condition.

Any physician, midwife, nurse, obstetric[obstetric centercenter] , freestanding birthing center or hospital of any nature, parent, relative or person attending or assisting in any way any infant, or the [mother of] person who gave birth to any infant, at childbirth, or any time within 2 weeks after childbirth, knowing the condition defined in NRS 442.030 to exist, shall immediately report such fact - 81st Session (2021) – 10 – in writing to the local health officer of the county, city or other political subdivision within which the infant or the [mother of] person who gave birth to any infant may reside.

Midwives shall immediately report conditions to some qualified practitioner of medicine and thereupon withdraw from the case except as they may act under the physician’s instructions.instructions.the 3.

3.

NRS(Deleted 442.110by isamendment.) herebySec. amended to read as follows:

442.110 Any physician, midwife, nurse, manager or person in charge of an obstetric center , freestanding birthing center or hospital, parent, relative or person attending upon or assisting at the - *AB287_R1* – 10 – birth of an infant who violates any of the provisions of NRS 442.030 to 442.100, inclusive, shall be punished by a fine of not more than $250.

Sec.

442.137 The purpose of the Advisory Board is to advise the Administrator of the Division concerning perinatal care to enhance the survivability and health of infants and [mothers,] persons who are pregnant, are giving birth and have given birth, and concerning programs to improve the health of preschool children, to achieve the following objectives:

- 81st Session (2021) – 11 – 8.

Ensuring that services to follow up the assessments are available, accessible and affordable to children identified as in need of those10. services;

10.

and - *AB287_R1* – 11 – 12.

NRS(Deleted 442.325by isamendment.) herebySec. amended to read as follows:

442.325 1.

Except as otherwise provided in subsection 2, the chief administrative officer of each hospital , [and] obstetric center and freestanding birthing center or a representative of the officer shall:

(a) Prepare and make available to the Chief Medical Officer or a representative of the Officer a list of:

(1) Patients who are under 7 years of age and have been diagnosed with one or more birth defects;

and (2) Patients discharged with adverse birth outcomes;

and (b) Make available to the Chief Medical Officer or a representative of the Officer the records of the hospital , [or] obstetric center or freestanding birthing center regarding:

(1) Patients who are under 7 years of age and have been diagnosed with one or more birth defects;

and (2) Patients discharged with adverse birth outcomes.

2.

The name of a patient must be excluded from the information prepared and made available pursuant to subsection 1 if the patient or, if the patient is a minor, a parent or legal guardian of the patient has requested in writing to exclude the name of the patient from that information in the manner prescribed by the State Board of Health pursuant to NRS 442.320.

The provisions of this subsection do not relieve the chief administrative officer of the duty of preparing and making available the information required by subsection 1.

3.

The Chief Medical Officer or a representative of the Officer shall abstract from the records and lists required to be prepared and made available pursuant to this section such information as is required by the State Board of Health for inclusion in the system.

4.

As used in this section, “hospital” has the meaning ascribed to it in NRS 449.012.

Sec.

and - *AB287_R1* – 12 – 2.

The report must not contain any identifying information andandSec. may be used only for statistical purposes.

Sec.

- 81st Session (2021) – 12 – Sec.

442.410 An agency which provides child welfare services shall inquire, during its initial contact with a natural parent of a child whom a court has determined must be kept in temporary or permanent custody, about consumption of alcohol by or any substance use disorder of the [mother of] person who gave birth to the child during pregnancy.

NRS(Deleted 442.610by isamendment.) herebySec. amended to read as follows:

442.610 “Provider of health care” means:

1.

A provider of health care as defined in NRS 629.031;

2.

A midwife;

and 3.

An obstetric center or freestanding birthing center licensed pursuant to chapter 449 of NRS.

Sec.

- *AB287_R1* – 13 – Sec.

9.

NRS 442.680 is hereby amended to read as follows:

442.680 1.

Except as otherwise provided in subsection 3, any physician, midwife or nurse attending or assisting in any way any infant at childbirth at an obstetric center , a freestanding birthing center or a hospital which regularly offers obstetric services in the normal course of business and not only on an emergency basis shall make or cause to be made an examination of the infant, to determine whether the infant may suffer from critical congenital heart disease, including, without limitation, conducting pulse oximetry screening.

If the physician, midwife or nurse who conducts the examination is not the attending physician of the infant, the physician, midwife or nurse shall submit the results of the examination to the attending physician of the infant.

2.

If the examination reveals that an infant may suffer from critical congenital heart disease, the attending physician of the infant shall conduct an examination to confirm whether the infant does suffer from critical congenital heart disease.

If the attending physician determines that the infant suffers from critical congenital heart disease, the attending physician must:

(a) Report the condition to the Chief Medical Officer or a representative of the Chief Medical Officer;

and (b) Discuss the condition with the parent, parents or other persons responsible for the care of the infant and inform them of the treatment necessary for the amelioration of the condition.

3.

An examination of an infant is not required pursuant to this section if either parent files a written objection with the person responsible for conducting the examination or with the obstetric center , freestanding birthing center or hospital at which the infant is born.

4.

The State Board of Health may adopt such regulations as necessary to carry out the provisions of this section.

9.

(Deleted by amendment.) Sec.

442.761 “Severe maternal morbidity” means an unexpected incident during childbirth that has a serious negative effect on the short-termbirth or long-termhas healthgiven ofbirth theto a child.e [mother.] person who is giving birthSec. or has given birth to a child.

Sec.

- *AB287_R1* – 14 – (c) Any medical or mental health records of the [mother;] person who gave birth to a child;

(d) Any records of social and rehabilitative services or of any other social service agency which has provided services to the [mother] person who gave birth to a child or the [mother’s] family [;][; of the person who gave birth to a child;

andand] (e)of Any other records determined by the Committeeperson towho begave necessarybirth to perform its duties, except for records of a lawchild; enforcement agency not described in paragraph (a).

- 81st Session (2021) – 13 – other neoplasms established pursuant to NRS 457.230;

andncer and (f) Any other records determined by the Committee to be necessary to perform its duties, except for records of a law enforcement agency not described in paragraph (a).

Except as otherwise provided in NRS 239.0115, any books, records or papers received by the Committee pursuant to the subpoena shall be deemed confidential and privileged and not subject to disclosure.

Chapter(Deleted 449 of NRS is hereby amended by addingamendment.) theretoSec. the provisions set forth as sections 11 and 12 of this act.

Sec.

“FreestandingChapter 449 of NRS is hereby amended by adding the“Freestanding birthing center” means a facility that provides maternity care and birthing services using a family-family-centered centered approach in which births are planned to occur in a location similar to a residence that is not the usual place of residence of the person giving birth to a child.

1.(Deleted by amendment.) Sec.

The13. Board shall adopt:

(a)NRS Regulations449.001 providingis forhereby theamended licensureto ofread freestandingas birthingfollows: centers;

449.001 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 449.0015 to - *AB287_R1*81st Session (2021) – 1514 – (b)449.0195, Anyinclusive, otherand regulationssection necessary11 forof this act have the regulationmeanings ofascribed freestandingto birthingthem centers.in those sections.

Sec.

13.5.

NRS 449.0151 is hereby amended to read as follows:

1.9.0A surgical center for ambulatory patients;

Any[An regulationsobstetric adoptedcenter;] pursuantA tofreestanding thisbirthing section:center;

(a) Must align with the standards established by the American Association of Birth Centers, or its successor organization, the accrediting body of the Commission for the Accreditation of Birth Centers, or its successor organization, or another nationally recognized organization for accrediting freestanding birthing centers;

and (b) Must allow the provision of supervised training to providers of health care, as appropriate, at a freestanding birthing center.

AAn freestandingindependent birthing center mustfor be located within 30 miles of a hospital that offers obstetric, neonatal and emergency servicesmedical relatingcare; to pregnancy.

Surgery,An including,agency withoutto limitation,provide thenursing usein ofthe forceps,home; vacuum extractions, Caesarean sections and tubal ligations, must not be performed at a freestanding birthing center.

Sec.5.

A facility for intermediate care;

6.

A facility for skilled nursing;

7.

A facility for hospice care;

8.

A hospital;

9.

A psychiatric hospital;

10.

A facility for the treatment of irreversible renal disease;

11.

A rural clinic;

12.

A nursing pool;

NRSA 449.001facility isfor herebymodified amendedmedical todetoxification; read as follows:

449.001 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 449.0015 to 449.0195, inclusive, and section 11 of this act have the meanings ascribed to them in those sections.

Sec.

NRSA 449.0155facility isfor herebyrefractive amendedsurgery; to read as follows:

449.0155 “Obstetric center” means a facility that is not part of a hospital and provides services for normal, uncomplicated births.

The term does not include a freestanding birthing center.

Sec.

NRSA 449.029mobile isunit; hereby amended to read as follows:

449.029 As used in NRS 449.029 to 449.240, inclusive, and section16. 12 of this act, unless the context otherwise requires, “medical facility” has the meaning ascribed to it in NRS 449.0151 and includes a program of hospice care described in NRS 449.196.

Sec.A community triage center.

16.Secs.

NRS14-16. 449.0301 is hereby amended to read as follows:

449.0301(Deleted Theby provisionsamendment.) ofSec. NRS 449.029 to 449.2428, inclusive, and section 12 of this act do not apply to:

1.16.5.

AnyNRS facility449.0302 conductedis byhereby andamended 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 sanitationread andas safetyfollows: applicable to other facilities of a similar category.

2.449.0302 1.

FosterThe homesBoard asshall definedadopt: in NRS 424.014.

(a) Licensing standards for each class of medical facility or facility for the dependent covered by NRS 449.029 to 449.2428, inc(b) Regulations governing the licensing of such facilities and programs.

(c) Regulations governing the procedure and standards for granting an extension of the time for which a natural person may provide certain care in his or her home without being considered a residential facility for groups pursuant to NRS 449.017.

The regulations must require that such grants are effective only if made in writing.

(d) Regulations establishing a procedure for the indemnification by the Division, from the amount of any surety bond or other obligation filed or deposited by a facility for refractive surgery pursuant to NRS 449.068 or 449.069, of a patient of the facility who has sustained any damages as a result of the bankruptcy of or any breach of contract by the facility.

- 81st Session (2021) – 15 – (e) Regulations that prescribe the specific types of discrimination prohibited by NRS 449.101.

(f) Any other regulations as it deems necessary or convenient to carry out the provisions of NRS 449.029 to 449.2428, inclusive.

licensing and operation of:

separate regulations governing the (a) Facilities for the care of adults during the day;

and (b) Residential facilities for groups,  which provide care to persons with Alzheimer’s disease or other severe dementia, as described in paragraph (a) of subsection 2 of NRS 449.1845.

AnyThe medicalBoard facility,shall facilityadopt forseparate the dependent , [or] facility which is otherwise required by the regulations adoptedfor: by the Board - *AB287_R1* – 16 – pursuant to NRS 449.0303 to be licensed or freestanding birthing center that is operated and maintained by the United States Government or an agency thereof.

Sec.(a) The licensure of rural hospitals which take into consideration the unique problems of operating such a facility in a rural area.

17.(b) The licensure of facilities for refractive surgery which take into consideration the unique factors of operating such a facility.

NRS(c) 449.0307The islicensure herebyof amendedmobile tounits readwhich astake follows:into consideration the unique factors of operating a facility that is not in a fixed location.

449.0307 The Division may:

1.

Upon receipt of an application for a license, conduct an investigation into the premises, facilities, qualifications of personnel, methods of operation, policies and purposes of any person proposing to engage in the operation of a medical facility, a 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 [.] or a freestanding birthing center.

The facility is subject to inspection and approval as to standards for safety from fire, on behalf of the Division, by the State Fire Marshal.

2.

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 [,] or freestanding birthing center, 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 or freestanding birthing center which may have information pertinent to the complaint.

3.

Employ such professional, technical and clerical assistance as it deems necessary to carry out the provisions of NRS 449.029 to 449.245, inclusive [.] , and section 12 of this act.

Sec.

18.

NRS 449.0308 is hereby amended to read as follows:

449.0308 1.

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 freestanding birthing center or a person who operates such a facility without a license issued by the Division the actual costs incurred by the Division for the enforcement of the provisions of NRS 449.029 to 449.2428, inclusive, and section 12 of this act, including, without limitation, the actual cost of conducting an inspection or investigation of the facility.

2.

The Division shall not charge and collect the actual cost for enforcement pursuant to subsection 1 if the enforcement activity is:

(a) Related to the issuance or renewal of a license for which the Board charges a fee pursuant to NRS 449.050 or 449.089;

or (b) Conducted pursuant to an agreement with the Federal Government which has appropriated money for that purpose.

- *AB287_R1* – 17 – 3.

Any money collected pursuant to subsection 1 may be used by the Division to administer and carry out the provisions of NRS 449.029 to 449.2428, inclusive, and section 12 of this act and the regulations adopted pursuant thereto.

The provisionsBoard ofshall thisrequire sectionthat dothe notpractices applyand topolicies anyof costseach incurredmedical byfacility or facility for the Divisiondependent provide adequately for the enforcementprotection of the provisionshealth, safety and physical, moral and mental well-being of NRSeach 449.24185,person 449.2419accommodated orin 449.24195.the facility.

Sec.5.

19.In addition to the training requirements prescribed pursuant to NRS 449.093, the Board shall establish minimum qualifications for administrators and employees of residential facilities for groups.

NRSrelated 449.089standards isset herebyby amendednationally torecognized readorganizations aswhich follows:accredit such facilities.

449.0896. 1.

EachThe licenseBoard issuedshall pursuantadopt toseparate NRSregulations 449.029regarding tothe 449.2428,assistance inclusive,which andmay sectionbe 12given ofpursuant thisto actNRS expires453.375 on December 31 following its issuance and is454.213 renewableto foran 1ultimate yearuser upon reapplication and payment of allcontrolled feessubstances requiredor pursuantdangerous todrugs NRSby 449.050employees unlessof theresidential Divisionfacilities finds,for aftergroups. an investigation, that the facility has not:

(a)The Satisfactorilyregulations compliedmust withrequire theat provisionsleast of NRS 449.029 to 449.2428, inclusive, and section 12 of this act or the standardsfollowing andconditions regulationsbefore adoptedsuch byassistance themay Board;be given:

(b)(a) ObtainedThe theultimate approvaluser’s ofphysical theand Directormental ofcondition theis Departmentstable of Health and Humanis Servicesfollowing before undertaking a project,predictable ifcourse. such approval is required by NRS 439A.100;

or(b) (c)The Conformedamount toof allthe applicablemedication localprescribed zoningis regulations.at a maintenance level and does not require a daily assessment.

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

Each- reapplication81st forSession an(2021) agency– to16 provide– personalof care services in the home,medication; 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 arrangement services, a hospital described in 42 U.S.C.

§andossession 1395ww(d)(1)(B)(iv),and aassistance psychiatricin 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 careadministration of(2) adultsIncludes during the day, a facilityplan, forwhich hospicehas care,been aprepared nursingunder pool, a peer support recovery organization, the distinctsupervision part of a hospitalregistered whichnurse meetsor thelicensed requirementspharmacist, offor aemergency skilledintervention nursingif facilityan oradverse nursingcondition facilityresults. pursuant to 42 C.F.R.

§(d) 483.5,Except aas hospitalotherwise thatauthorized providesby swing-bedthe servicesregulations asadopted describedpursuant into 42NRS C.F.R.449.0304, the prescribed medication is not administered by injection or intravenously.

§(e) 482.58The or,employee ifhas residentialsuccessfully servicescompleted aretraining providedand toexamination children,approved aby medical facility or facility for the treatmentDivision ofregarding alcohol or other substance use disorders must include, without limitation, a statement that the facility,authorized hospital,manner agency, program, pool, organization or home is in compliance with the provisions of NRSassistance. 449.115 to 449.125, inclusive, and 449.174.

3.7.

EachThe reapplicationBoard forshall anadopt agencyseparate toregulations providegoverning personal care services in the home,licensing aand communityoperation 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 facilityfacilities for groups orwhich aprovide homeassisted forliving individualservices. residential - *AB287_R1* – 18 – 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.

Sec.The Board shall not allow the licensing of a facility as a residential facility for groups which provides assisted living services and a residential facility for groups shall not claim that it provides “assisted living services” unless:

20.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.

NRS(b) 449.091The isresidents herebyof amendedthe tofacility readreside asin follows:their own living units which:

449.091(1) 1.Except as otherwise provided in subsection 8, contain toilet facilities;

The(2) DivisionContain may cancel the license of a medicalsleeping facility,area 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 or freestandingbedroom; birthing center and issue a provisional license, effective for a period determined by the Division, to such a facility if it:

(a) Is in operation at the time of the adoption of standards and regulations(3) pursuantAre toshared thewith provisionsanother ofoccupant NRSonly 449.029upon toconsent 449.2428, inclusive, and section 12 of thisboth actoccupants. and the Division determines that the facility requires a reasonable time under the particular circumstances within which to comply with the standards and regulations;

or(c) (b)The Hasfacility failedprovides topersonalized complycare withto the standardsresidents orof regulations and the Division determines that the facility isand in the processgeneral ofapproach making the necessary changes or has agreed to makeoperating the changesfacility withinincorporates athese reasonablecore time.principles:

2.(1) The facility is designed to create a residential quality of life and right to privacy;d promotes each resident’s (2) The facility is committed to offering high-quality supportive services that are developed by the facility in collaboration with the resident to meet the resident’s individual needs;

(3) The provisionsfacility ofprovides subsectiona 1variety do not require the issuance of acreative licenseand orinnovative preventservices thethat Divisionemphasize from refusing to renew or from revoking or suspending any license where the Divisionparticular deemsneeds suchof actioneach necessaryindividual forresident the health and safetythe ofresident’s thepersonal occupantschoice of anylifestyle; facility.

Sec.- 81st Session (2021) – 17 – residents supports, to the maximum extent possible, each resident’sts need for autonomy and the right to make decisions regarding his or her own life;

21.(5) The operation of the facility is designed to foster a social climate that allows the resident to develop and maintain personal relationships with fellow residents and with persons in the general community;

NRS(6) 449.101The facility is herebydesigned amendedto minimize and is operated in a manner which minimizes the need for its residents to readmove out of the facility as follows:their respective physical and mental conditions change over time;

449.101and 1.(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.

A8. medical facility, facility for the dependent , [or] facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed or freestanding birthing center and any employee or independent contractor of such a facility shall not discriminate in the admission of, or the provision of services to, a patient or resident based wholly or partially on the actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or human immunodeficiency virus status of the patient or resident or any person with whom the patient or resident associates.

2.The Division may grant an exception from the requirement of subparagraph (1) of paragraph (b) of subsection 7 to a facility July 1, 2005, and which is authorized to have 10 or fewer beds ande was originally constructed as a single-family dwelling if the Division finds that:

A(a) medicalStrict facility,application facilityof forthat therequirement dependentwould ,result [or]in facilityeconomic whichhardship isto otherwisethe requiredfacility byrequesting regulations adopted by the Boardexception; pursuant to NRS 449.0303 to be licensed or freestanding birthing center shall:

(a) Develop and carry(b) outThe policiesexception, toif preventgranted, thewould specificnot: types of prohibited discrimination described in the regulations adopted by - *AB287_R1* – 19 – the Board pursuant to NRS 449.0302 and meet any other requirements prescribed by regulations of the Board;

and(1) (b)Cause Postsubstantial prominentlydetriment into the facilityhealth andor includewelfare onof any Internetresident websiteof used to market the facilityfacility; the following statement:

6(2) [NameResult ofin facility]more doesthan nottwo discriminateresidents andsharing doesa nottoilet permitfacility; discrimination, including, without limitation, bullying, abuse or harassment, on the basis of actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status, or based on association with another person on account of that person’s actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status.

3.or (3) Otherwise impair substantially the purpose of that requirement.

In9. addition to the statement prescribed by subsection 2, a facility for skilled nursing, facility for intermediate care or residential facility for groups shall post prominently in the facility and include on any Internet website used to market the facility:

(a)The NoticeBoard shall, if it determines necessary, adopt regulations and requirements to ensure that aeach patientresidential orfacility residentfor whogroups hasand experiencedits prohibitedstaff discriminationare mayprepared fileto respond to an emergency, inc(a) The adoption of plans to respond to a complaintnatural withdisaster theand Division;other types of emergency situations, including, without limitation, an emergency involving fire;

and (b) The contactadoption informationof plans to provide for the Division.evacuation of a residential facility for groups in an emergency, including, without limitation, plans to ensure that nonambulatory patients may be evacuated;

4.(c) Educating the residents of residential facilities for groups concerning the plans adopted pursuant to paragraphs (a) and (b);

Theand provisions- 81st Session (2021) – 18 – (d) Posting the plans or a summary of thisthe sectionplans shalladopted notpursuant beto construedparagraphs to:(a) and (b) in a conspicuous place in each residential facility for groups.

(a)10. Require a medical facility, facility for the dependent , [or] facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed or freestanding birthing center or an employee or independent contractor thereof to take or refrain from taking any action in violation of reasonable medical standards;

orThe (b)regulations Prohibitgoverning a medical facility, facility for the dependentlicensing ,and [or]operation facilityof whichfor is otherwise required by regulations adopted by the Boardlicensure pursuantof toat NRSleast 449.0303three todifferent betypes licensedof orfacilities,vide freestanding birthing center from adopting a policy that is applied uniformly and in a nondiscriminatory manner, including, without limitation,limitation: such a policy that bans or restricts sexual relations.

Sec.(a) Facilities that only provide 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;

and (c) Facilities that provide or arrange for the provision of programs for alcohol and other substance use disorders, in addition to providing a housing and living environment and providing or arranging for the provision of other supportive services.

 The regulations must provide that if a facility was originally constructed as a single-family dwelling, the facility must not be authorized for more than eight beds.

11.

The Board shall adopt regulations applicable to providers of community-based living arrangement services which:

(a) Except as otherwise provided in paragraph (b), require a natural person responsible for the operation of a provider of 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 provision of community-based living arrangement services to the persons with mental illness and continuing education concerning the particular population served by the provider;

(b) Exempt a person licensed or certified pursuant to title 54 of NRS from the requirements prescribed pursuant to paragraph (a) if the Board determines that the person is required to receive training and continuing education substantially equivalent to that prescribed pursuant to that paragraph;

(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 provision of community-based living arrangement services;

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 - 81st Session (2021) – 19 – 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- applicant.ng arrangement services for 2 months at the expense of the 12.

The Board shall adopt separate regulations governing the licensing and operation of freestanding birthing centers.

Such regulations must:

(a) Align with the standards established by the American Association of Birth Centers, or its successor organization, the accrediting body of the Commission for the Accreditation of Birth Centers, or its successor organization, or another nationally recognized organization for accrediting freestanding birthing centers;

and (b) Allow the provision of supervised training to providers of health care, as appropriate, at a freestanding birthing center.

13.

As used in this section, “living unit” means an individual private accommodation designated for a resident within the facility.

Secs.

17-21.

(Deleted by amendment.) Sec.

449.102 A medical facility, facility for the dependent ,or [or] facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed or freestanding birthing center shall:

Maintain the confidentiality of personally identifiable information concerning the sexual orientation of a patient or resident, whether the patient or resident is transgender or has - *AB287_R1* – 20 – undergone [a gender transition] gender-affirming surgery and the human immunodeficiency virus status of the patient or resident and take reasonable actions to prevent the unauthorized disclosure of such information;

Allow a patient or resident to refuse to be examined, observed or treated by an employee or independent contractor of the facility- for81st aSession purpose(2021) that– is20 primarily– educational rather than therapeutic.

a purpose that is primarily educational rather than Sec.

To enable an agent or employee of a medical facility, facility for the dependent ,or [or] facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed or freestanding birthing center who provides care to a patient or resident of the facility to more effectively treat patients or care for residents, as applicable, the Board shall, by regulation, require such a facility to conduct training relating specifically to cultural competency for any agent or employee of the facility who provides care to a patient or resident of the facility so that such an agent or employee may better understand patients or residents who have different cultural backgrounds, including, without limitation, patients or residents who are:

(c) [Lesbian, gay, bisexual, transgender and questioning persons;] Persons with various sexual orientations and gender identities or expressions;

The training relating specifically to cultural competency conducted by a medical facility, facility for the dependent ,or [or] facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed or freestanding birthing center pursuant to subsection 1 must be provided through a - *AB287_R1* – 21 – course or program that is approved by the Department of Health and Human Services.

Sec.Secs.

24.24-29.

NRS(Deleted 449.104by isamendment.) herebySec. amended to read as follows:

449.10429.5. The Board shall adopt regulations that require a medical facility, facility for the dependent , [or] facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed or freestanding birthing center to:

1.NRS 449.198 is hereby amended to read as follows:

Develop449.198 policies[An toobstetric] ensure[1.] that(a) aProvide patientsufficient orspace residentfor ismembers addressedof bythe hisfamily orof herthe preferredpregnant name[woman] person and pronounother andpersons inchosen accordanceby withthe his[woman] orpregnant herperson genderto identityassist or[her] expression;with the birth;

2.[and 2.] (b) Have obstetrical services available to meet the needs of an acute patient [.] ;

Adaptand electronic(c) recordsBe tolocated reflectwithin the30 gendermiles identities or expressions of patientsa orhospital residentsthat withoffers diverseobstetric, genderneonatal identitiesand oremergency expressions,services including,relating withoutto limitation:pregnancy.

(a)- If81st theSession facility(2021) is– a21 medical– facility,2. adapting health records to meet the medical needs of patients or residents with diverse sexual orientations and gender identities or expressions, including, without limitation, integrating information concerning sexual orientation and gender identity or expression into electronic systems for maintaining health records;

andSurgery, (b)including, Ifwithout limitation, the facilityuse isof aforceps, facilityvacuum forextractions, thecesarean dependentsections orand othertubal residentialligations, facility,must adaptingnot electronicbe recordsperformed toat include:a freestanding birthing center.

(1) The preferred name and pronoun and gender identity or expression of a resident;

and (2) Any other information prescribed by regulation of the Board.

Sec.

25.

NRS 449.132 is hereby amended to read as follows:

449.132 Every 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 freestanding birthing center may be inspected at any time, with or without notice, as often as is necessary by:

1.

The Division of Public and Behavioral Health to ensure compliance with all applicable regulations and standards;

and 2.

Any person designated by the Aging and Disability Services Division of the Department of Health and Human Services to investigate complaints made against the facility.

Sec.

26.

NRS 449.160 is hereby amended to read as follows:

449.160 1.

The Division may deny an application for a license or may suspend or revoke any license issued under the provisions of NRS 449.029 to 449.2428, inclusive, and section 12 of this act upon any of the following grounds:

(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 12 of this act or of any other law of this State or of the standards, rules and regulations adopted thereunder.

- *AB287_R1* – 22 – (b) Aiding, abetting or permitting the commission of any illegal act.

(c) Conduct inimical to the public health, morals, welfare and safety of the people of the State of Nevada in the maintenance and operation of the premises for which a license is issued.

(d) Conduct or practice detrimental to the health or safety of the occupants or employees of the facility.

(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 12 of this act, and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required.

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

(g) Violation of the provisions of NRS 458.112.

2.

In addition to the provisions of subsection 1, the Division may revoke a license to operate a facility for the dependent if, with respect to that facility, the licensee that operates the facility, or an agent or employee of the licensee:

(a) Is convicted of violating any of the provisions of NRS 202.470;

(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.

TheA Divisionfreestanding shallbirthing maintaincenter amust loghave ofa anydirector complaintswho thatis itThe receivesdirector relatingof to activities for which the Division may revoke the license to operate a facilityfreestanding forbirthing thecenter dependentmust pursuantbe:ing tocenter. subsection 2.

The(a) DivisionA shallphysician; provide to a facility for the care of adults during the day:

(a)(b) A summaryperson ofwho: a complaint against the facility if the investigation of the complaint by the Division either substantiates the complaint or is inconclusive;

(b)(1) AIs reportcertified ofas anya investigationCertified conductedProfessional withMidwife respectby to the complaint;North American Registry of Midwives, or its successor organization;

and (c)(2) AHas reportsuccessfully ofcompleted anya disciplinaryprogram actionof takeneducation againstand thetraining facility.in midwifery that:

(I) TheIs facilityaccredited shallby make the informationMidwifery availableEducation toAccreditation theCouncil, publicor pursuantits tosuccessor NRSorganization; 449.2486.

and (II) Provides instruction and training in the Essential Competencies for Midwifery Practice prescribed by the International Confederation of Midwives, or its successor organization;

or (c) A certified nurse-midwife.

OnAs orused beforein Februarythis 1section, of“certified eachnurse-midwife” odd-numberedmeans year, the Division shall submit to the Director of the Legislative Counsel Bureau a writtenperson reportwho settingis: forth, for the previous biennium:

(a) AnyCertified complaintsas includeda inCertified theNurse-Midwife log maintained by the DivisionAmerican pursuantMidwifery toCertification subsectionBoard, 3;or its successor organization;

and - *AB287_R1* – 23 – (b) AnyLicensed disciplinaryas actionsan takenadvanced bypractice theregistered Divisionnurse pursuant to subsectionNRS 2.632.237.

Sec.Secs.

27.30-33.

NRS(Deleted 449.163by isamendment.) hereby449.245 amended1. to read as follows:

449.163NRNo 1.hospital licensed under the provisions of NRS 449.029 to 449.2428, inclusive, may release from the hospital or otherwise surrender physical custody of any child under 6 months of age, whose living parent or guardian is known to the hospital, to any person other than a parent, guardian or relative by blood or marriage of that child, without a written authorization signed by a living parent, who must be the [mother] person who gave birth to the child if unwed, or guardian specifying the particular person or agency to whom the child may be released and the permanent address of that person or agency.

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 or freestanding birthing center violates any provision related to its licensure, including any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and section 12 of this act, or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

(a) Prohibit the facility from admitting any patient 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;

(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 the facility and to ensure the health and safety of the patients of the facility, until:

(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;

or (2) Improvements are made to correct the violation.

If the facility fails to pay any administrative penalty imposed pursuant to paragraph (d) of subsection 1, the Division may:

(a) Suspend the license of the facility until the administrative penalty is paid;

and (b) Collect court costs, reasonable attorney’s fees and other costs incurred to collect the administrative penalty.

3.

The Division may require any facility that violates any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and section 12 of this act, or any condition, standard or regulation adopted by the Board to make any improvements necessary to correct the violation.

4.

Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 must be accounted for separately and - *AB287_R1* – 24 – used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and section 12 of this act, 449.435 to 449.531, inclusive, 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.

Sec.

28.

NRS 449.165 is hereby amended to read as follows:

449.165 The Board shall adopt regulations establishing the criteria for the imposition of each sanction prescribed by NRS 449.163.

These regulations must:

1.

Prescribe the circumstances and manner in which each sanction applies;

2.

Minimize the time between identification of a violation and the imposition of a sanction;

3.

Provide for the imposition of incrementally more severe sanctions for repeated or uncorrected violations;

4.

Provide for less severe sanctions for lesser violations of applicable state statutes, conditions, standards or regulations;

and 5.

Establish an administrative penalty to be imposed if a violation by a medical facility, a 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 or a freestanding birthing center causes harm or the risk of harm to more than one person.

Sec.

29.

NRS 449.171 is hereby amended to read as follows:

449.171 1.

If the Division suspends the license of a medical facility, a 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 or a freestanding birthing center pursuant to the provisions of this chapter, or if a facility otherwise ceases to operate, including, without limitation, pursuant to an action or order of a health authority pursuant to chapter 441A of NRS, the Division may, if deemed necessary by the Administrator of the Division, take control of and ensure the safety of the medical records of the facility.

2.

Subject to the provisions of the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, the Division shall:

(a) Maintain the confidentiality of the medical records obtained pursuant to subsection 1.

(b) Share medical records obtained pursuant to subsection 1 with law enforcement agencies in this State and other governmental entities which have authority to license the facility or to license the owners or employees of the facility.

- *AB287_R1* – 25 – (c) Release a medical record obtained pursuant to subsection 1 to the patient or legal guardian of the patient who is the subject of the medical record.

3.

The Board shall adopt regulations to carry out the provisions of this section, including, without limitation, regulations for contracting with a person to maintain any medical records under the control of the Division pursuant to subsection 1 and for payment by the facility of the cost of maintaining medical records.

Sec.

30.

NRS 449.209 is hereby amended to read as follows:

449.209 1.

In addition to the requirements and prohibitions set forth in NRS 449.0305, and notwithstanding any exceptions set forth in that section, a licensed medical facility or an employee of such a medical facility shall not:

(a) Refer a person to a residential facility for groups that is not licensed by the Division;

or (b) Refer a person to a residential facility for groups if the licensed medical facility or its employee knows or reasonably should know that the residential facility for groups, or the services provided by the residential facility for groups, are not appropriate for the condition of the person being referred.

2.

If a licensed medical facility or an employee of such a medical facility violates the provisions of subsection 1, the licensed medical facility is liable for a civil penalty to be recovered by the Attorney General in the name of the Board for the first offense of not more than $10,000 and for a second or subsequent offense of not less than $10,000 or more than $20,000.

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 for the enforcement of this section and the protection of the health, safety, well-being and property of residents of residential facilities for groups.

3.

The Board shall:

(a) Establish and maintain a system to track violations of this section and NRS 449.0305.

Except as otherwise provided in this paragraph, records created by or for the system are public records and are available for public inspection.

The following information is confidential:

(1) Any personally identifying information relating to a person who is referred to a residential facility for groups.

(2) Information which may not be disclosed under federal law.

(b) Educate the public regarding the requirements and prohibitions set forth in this section and NRS 449.0305.

4.

As used in this section, “licensed medical facility” means:

- *AB287_R1* – 26 – (a) A medical facility that is required to be licensed pursuant to NRS 449.029 to 449.2428, inclusive [.] , and section 12 of this act.

(b) A facility for the dependent that is required to be licensed pursuant to NRS 449.029 to 449.2428, inclusive [.] , and section 12 of this act.

(c) A facility that provides medical care or treatment and is required by regulation of the Board to be licensed pursuant to NRS 449.0303.

(d) A freestanding birthing center that is required to be licensed pursuant to NRS 449.029 to 449.2428, inclusive, and section 12 of this act.

Sec.

31.

NRS 449.210 is hereby amended to read as follows:

449.210 1.

In addition to the payment of the amount required by NRS 449.0308 and any civil penalty imposed pursuant to subsection 4, a person who operates a medical facility, 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 or freestanding birthing center without a license issued by the Division is guilty of a misdemeanor.

2.

If the Division believes that a person is operating a medical facility, 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 or freestanding birthing center without such a license, the Division may issue an order to cease and desist the operation of the facility.

The order must be served upon the person by personal delivery or by certified or registered mail, return receipt requested.

The order is effective upon service.

3.

If a person does not voluntarily cease operating a medical facility, 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 or freestanding birthing center without a license or apply for licensure within 30 days after the date of service of the order pursuant to subsection 2, the Division may bring an action in a court of competent jurisdiction pursuant to NRS 449.220.

4.

Upon a showing by the Division that a person is operating a medical facility, 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 or freestanding birthing center without a license, a court of competent jurisdiction may:

(a) Enjoin the person from operating the facility.

(b) Impose a civil penalty on the operator to be recovered by the Division of not more than $10,000 for the first offense or not less than $10,000 or more than $25,000 for a second or subsequent offense.

- *AB287_R1* – 27 – 5.

Unless otherwise required by federal law, the Division shall deposit all civil penalties collected pursuant to paragraph (b) of subsection 4 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 sections 11 and 12 of this act and to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards.

Sec.

32.

NRS 449.220 is hereby amended to read as follows:

449.220 1.

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 12 of this act:

(a) Without first obtaining a license therefor;

or (b) After his or her license has been revoked or suspended by the Division.

2.

It is sufficient in such action to allege that the defendant did, on a certain date and in a certain place, operate and maintain such a facility without a license.

Sec.

33.

NRS 449.240 is hereby amended to read as follows:

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 12 of this act.

Sec.

33.5.

NRS 449.245 is hereby amended to read as follows:

449.245 1.

No hospital licensed under the provisions of NRS 449.029 to 449.2428, inclusive, may release from the hospital or otherwise surrender physical custody of any child under 6 months of age, whose living parent or guardian is known to the hospital, to any person other than a parent, guardian or relative by blood or marriage of that child, without a written authorization signed by a living parent, who must be the [mother] person who gave birth to the child if unwed, or guardian specifying the particular person or agency to whom the child may be released and the permanent address of that person or agency.

2.

The hospital shall furnish a true copy of the written - 81st Session (2021) – 22 – authorization to the Division of Child and Family Services of the Department of Health and Human Services before the release or other surrender by it of physical custody of the child.

The copy must - *AB287_R1* – 28 – be furnished to the Division immediately upon receipt by the hospital.hos3.talAny person to whom any such child is released who thereafter surrenders physical custody of that child to any other person or agency shall, upon demand by the Division of Child and Family Services, disclose to the Division the name and permanent address of the person or agency to whom physical custody of the child was delivered.

3.

Any person to whom any such child is released who thereafter surrenders physical custody of that child to any other person or agency shall, upon demand by the Division of Child and Family Services, disclose to the Division the name and permanent address of the person or agency to whom physical custody of the child was delivered.

NRS(Deleted 449.246by isamendment.) herebySec. amended to read as follows:

449.24634.2. 1.

BeforeNRS discharging449A.001 anis unmarriedhereby womanamended who has borne a child, a hospital , [or] obstetric center or freestanding birthing center shall provide to theread child’sas parents:follows:

(a)449A.001 TheAs opportunityused toin sign,this inchapter, unless the hospital,context aotherwise declarationrequires, for the voluntarywords acknowledgmentand ofterms paternitydefined developedin pursuantNRS [449A.003] 449A.007 to NRS449A.081, 440.283;inclusive, have the meanings ascribed to them in those secSec.

(b)34.5. Written materials about establishing paternity;

(c)NRS The449A.050 formsis necessaryhereby amended to acknowledgeread paternityas voluntarily;follows:

(d)449A.050 A“Medical writtenfacility” description[includes: of the rights and responsibilities of acknowledging paternity;

and1. (e) The opportunity to speak by telephone with personnel of the program for enforcement of child support who are trained to clarify information and answer questions about the establishment of paternity.

A surgical center for ambulatory patients;

TheAn Administrator of the Division of Welfare and Supportive Services of the Department of Health and Human Services shall adopt the regulations necessary to ensure that the services provided by a hospital , [or] obstetric centercenter; or freestanding birthing center pursuant to this section are in compliance with the regulations adopted by the Secretary of Health and Human Services pursuant to 42 U.S.C.

§3. 666(a)(5)(C).

An independent center for emergency medical care;

4.

An agency to provide nursing in the home;

5.

A facility for intermediate care;

6.

A facility for skilled nursing;

7.

A facility for hospice care;

8.

A hospital;

9.

A psychiatric hospital;

10.

A facility for the treatment of irreversible renal disease;

11.

A rural clinic;

12.

A nursing pool;

- 81st Session (2021) – 23 – 13.

A facility for modified medical detoxification;

14.

A facility for refractive surgery;

15.

A mobile unit;

and 16.

A community triage center.] has the meaning ascribed to it in Sec.

34.7.51.NRS 449A.114 is hereby amended to read as follows:

449A.114 1.

Except as otherwise provided in subsection 2, before a facility for intermediate care, facility for skilled nursing or residential facility for groups transfers a patient to another medical facility or facility for the dependent or discharges the patient from the facility, the facility shall:

(a) At least 30 calendar days before transferring or discharging the patient, provide the patient and the Ombudsman with written notice of the intent to transfer or discharge the patient;

and (b) Within 10 calendar days after providing written notice to the patient and the Ombudsman pursuant to paragraph (a), allow the patient and any person authorized by the patient the opportunity to meet in person with the administrator of the facility to discuss the proposed transfer or discharge.

2.