Nevada 2023 Regular Session Status: Enacted Bipartisan · 1 D · 1 R cosponsors

SB 336 — Revises provisions relating to the regulation of certain healing arts. (BDR 54-886)

Last action — Chapter 229.

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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 20, 2023. Enacted.

Signed by Governor Joe Lombardo (Republican) on June 07, 2023.

Prognosis

Likely to advance 70% · moderate confidence

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High

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  • Enacted

    Current position in the legislative process.

  • 2 sponsors

    2 primary, 0 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (1 D · 1 R) — cross-party backing.

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Bill Text

What changed in the latest version

542 added · 577 removed

542 line(s) added, 577 removed.

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REQUIRES TWO-THIRDS MAJORITY VOTE (§§ 5.1, 5.5, 5.9 & NRS 453.22AND4639.170) (Reprinted with amendments adopted on April 24, 2023) FIRST REPRINT S.B.
Senate Bill No.
336 SENATE B ILLN O.
336–Senators Ohrenschall and Stone CHAPTER..........
336–S ENATORS O HRENSCHALL AND S TONE M ARCH 20, 2023 ____________ Referred to Committee on Commerce and Labor SUMMARY—Revises provisions relating to the regulation of certain healing arts.
(BDR 54-886) FISCAL NOTE:
Effect on Local Government:
No.
Effect on the State:
No.
~ EXPLANATION – Matter in bolded italics is new;
matter between brackets [omitted material] is material to be omitted.
Legislative Counsel’s Digest:
LegiExisting law authorizes a physician, physician assistant, dentist, advanced practice registered nurse, podiatric physician or optometrist to prescribe and dispense controlled substances and dangerous drugs under certain circumstances.
Existing law authorizes a physician, physician assistant, dentist, advanced dispense controlled substances and dangerous drugs under certain circumstances.
Section 6 also requires those - *SB336_R1* – 2 – boards to terminate any investigation or disciplinary proceedings for conduct that is outside the scope of those boards.
Section 6 also requires those boards to terminate any investigation or disciplinary proceedings for conduct that is outsExisting law:
Existing law:
and (2) authorizes a certified registered nurse anesthetist to administer anesthetic agents to a person under the care of a this bill requires the State Board of Nursing to issue a certificate of registration to practice as a certified registered nurse anesthetist to a registered nurse who meets the requirements prescribed by existing law for such certification and any additional requirements prescribed by the Board.
and (2) authorizes a certified registered nurse anesthetist to administer anesthetic agents to a person under the care of a licensed physician, dentist or podiatric physician.
Section 2.4 also requires the Board to adopt regulations governing certified registered nurse anesthetists.
(NRS 632.014) Section 2.4 of this bill requires the State Board of Nursing to issue a certificate of registration to practice as a certified registered nurse anesthetist to a registered nurse who meets the requirements prescribed by existing law for such certification and any Board to adopt regulations governing certified registered nurse anesthetists.e Existing law authorizes a registered nurse to possess and administer controlled substances and dangerous drugs under certain circumstances.
Existing law authorizes a registered nurse to possess and administer controlled substances and dangerous drugs under certain circumstances.
(NRS 453.375, 454.213) Sections 2.6, 5.1, 5.5 and 5.9 of this bill additionally authorize a certified registered nurse anesthetist working under the supervision of a physician licensed to practice medicine or osteopathic medicine in this State to order, prescribe, possess and administer controlled substances, poisons, dangerous drugs and devices to treat a person under the care of a licensed physician in a critical access hospital bill make additional changes necessary to authorize a certified registered nurse this - 82nd Session (2023) – 2 – anesthetist to order, prescribe, possess and administer controlled substances, nurse anesthetist who unlawfully possesses, prescribes or administers a controlled substance, dangerous drug or poison would be subject to discipline and criminal and civil penalties to the same extent as other practitioners who unlawfully possess, prescribe or administer such drugs.
(NRS 453.375, registered nurse anesthetist to order, prescribe, possess and administer controlledfied substances, poisons, dangerous drugs and devices to treat a person under the care of a licensed physician in a critical access hospital before, during and after surgery or childbirth.
(NRS 453.236, 453.305, 453.326, 453.3363, 453Section 2.8 of this bill makes a conforming change to remove a provision now duplicated in section 2.4.
Sections 5.2-5.4 and 5.6-5.85 of this bill make additional changes necessary to authorize a certified registered nurse anesthetist to order, prescribe, possess and administer controlled substances, poisons, dangerous drugs and devices in such circumstances.
EXPLANATION – Matter in bolded italics is new;
A certified registered nurse anesthetist who unlawfully poison would be subject to discipline and criminal and civil penalties to the same extent as other practitioners who unlawfully possess, prescribe or administer such drugs.
matter between brackets [omitted material] is material to be omitted.
(NRS 453.236, 453.305, 453.326, 453.3363, 453.553, 454.170, 454.356) Section 2.8 of this bill makes a conforming change to remove a provision now duplicated in section 2.4.
[2.] (b) A dentist, dental hygienist or dental therapist of the United States Army, Navy, Air Force, Public Health Service, Coast Guard or Department of Veterans Affairs in the discharge of his or her official duties, including, without limitation, providing medical care in a hospital in accordance with an agreement entered into pursuant to NRS 449.2455.
[2.] (b) A dentist, dental hygienist or dental therapist of the United States Army, Navy, Air Force, Public Health Service, Coast Guard or Department of Veterans Affairs in the discharge of his or her official duties, including, without limitation, providing medical pursuant to NRS 449.2455.ordance with an agreement entered into (c) Any person permitted to practice any other healing art under this title who does so within the scope of that authority.
(c) Any person permitted to practice any other healing art under this title who does so within the scope of that authority.
- *SB336_R1* – 3 – Sec.
Sec.
2.
- 82nd Session (2023) – 3 – 2.
(a) Specifying any additional training, education and experience necessary for certification as a certified registered nurse anesthetist;
(a) Specifying any additional training, education and nurse anesthetist;ry for certification as a certified registered (b) Delineating the authorized scope of practice of a certified registered nurse anesthetist;
(b) Delineating the authorized scope of practice of a certified registered nurse anesthetist;
(a) Order, prescribe, possess and administer controlled substances, poisons, dangerous drugs and devices to treat a patient under the care of a licensed physician in a critical access hospital in preparation for surgery or childbirth, during surgery or childbirth and while a patient recovers from surgery or childbirth.
(a) Under the supervision of a physician licensed pursuant to chapter 630 or 633 of NRS, order, prescribe, possess and administer controlled substances, poisons, dangerous drugs and devices to treat a patient under the care of a licensed physician in a critical access hospital in preparation for surgery or childbirth, during surgery or childbirth and while a patient recovers from surgery or childbirth.
As used in this section, “critical access hospital” means a hospital which has been certified as a critical access hospital by the Secretary of Health and Human Services pursuant to 42 U.S.C.
As used in this section, “critical access hospital” means a hospital which has been certified as a critical access hospital by U.S.C.
1395i-4(e).
1395i-4(e).ealth and Human Services pursuant to 42 Sec.
Sec.
- *SB336_R1* – 4 – 1.
1.
(a) The practice of medicine or perfusion pursuant to chapter 630 of NRS, dentistry, chiropractic, podiatry, optometry, respiratory care, faith or Christian Science healing, nursing, veterinary medicine or fitting hearing aids.
(a) The practice of medicine or perfusion pursuant to chapter of NRS, dentistry, chiropractic, podiatry, optometry, respiratory - 82nd Session (2023) – 4 – care, faith or Christian Science healing, nursing, veterinary medicine or fitting hearing aids.
(b) A medical officer of the Armed Forces or a medical officer of any division or department of the United States in the discharge of his or her official duties, including, without limitation, providing medical care in a hospital in accordance with an agreement entered into pursuant to NRS 449.2455.
(b) A medical officer of the Armed Forces or a medical officer of any division or department of the United States in the discharge medical care in a hospital in accordance with an agreement enterediding into pursuant to NRS 449.2455.
3.
This chapter does not prohibit:
(a) To commissioned surgeons of the United States Army, Navy or Marine Hospital Service in the actual performance of their official duties, including, without limitation, providing medical care - *SB336_R1* – 5 – in a hospital in accordance with an agreement entered into pursuant to NRS 449.2455.
(a) To commissioned surgeons of the United States Army, Navy or Marine Hospital Service in the actual performance of their official duties, including, without limitation, providing medical care in a hospital in accordance with an agreement entered into pursuant to NRS 449.2455.
3.
- 82nd Session (2023) – 5 – 3.
1.
pursuant to this chapter and any other person engaged in the practice of optometry in this State.
Applies to any person who is licensed to practice optometry pursuant to this chapter and any other person engaged in the practice of optometry in this State.
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and (b) Is authorized by the Board to possess, administer, prescribe or dispense controlled substances, poisons, dangerous drugs or devices under the supervision of a physician as required by chapter 630 of NRS;
and(b) Is authorized by the Board to possess, administer, prescribe or dispense controlled substances, poisons, dangerous drugs or devices under the supervision of a physician as required by chapter of NRS;
and (b) Is authorized by the Board to possess, administer, prescribe or dispense controlled substances, poisons, dangerous drugs or - *SB336_R1* – 6 – devices under the supervision of an osteopathic physician as required by chapter 633 of NRS;
and (b) Is authorized by the Board to possess, administer, prescribe or dispense controlled substances, poisons, dangerous drugs or devices under the supervision of an osteopathic physician as required by chapter 633 of NRS;
An optometrist who is certified by the Nevada State Board of Optometry to prescribe and administer pharmaceutical agents pursuant to NRS 636.288, when the optometrist prescribes or administers pharmaceutical agents within the scope of his or her certification.
An optometrist who is certified by the Nevada State Board of Optometry to prescribe and administer pharmaceutical agents pursuant to NRS 636.288, when the optometrist prescribes or - 82nd Session (2023) – 6 – administers pharmaceutical agents within the scope of his or her certification.
A certified registered nurse anesthetist when he or she orders, prescribes, possesses or administers controlled substances, poisons, dangerous drugs or devices under the conditions prescribed by paragraph (a) of subsection 1 of section 2.6 of this act.
A certified registered nurse anesthetist who orders, prescribes, possesses or administers controlled substances, 2.6 of this act.us drugs or devices in accordance with section Sec.
Sec.
Under emergency treatment in a hospital by a physician, advanced practice registered nurse, certified registered nurse anesthetist, dentist or podiatric physician, or on the written or oral order of a physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, advanced practice registered nurse, certified registered nurse anesthetist, dentist or podiatric physician authorizing the administration of a drug to the patient.
Under emergency treatment in a hospital by a physician, advanced practice registered nurse, certified registered nurse anesthetist, dentist or podiatric physician, or on the written or oral order of a physician, physician assistant licensed pursuant to chapter or 633 of NRS, advanced practice registered nurse, certified registered nurse anesthetist, dentist or podiatric physician autSec.
Sec.
“Manufacture” does not include the preparation, compounding, packaging or labeling of a substance by a pharmacist, physician, physician assistant licensed pursuant to chapter 630 or - *SB336_R1* – 7 – 633 of NRS, dentist, podiatric physician, advanced practice registered nurse , certified registered nurse anesthetist or veterinarian:
“Manufacture” does not include the preparation, compounding, packaging or labeling of a substance by a pharmacist, physician, physician assistant licensed pursuant to chapter 630 or of NRS, dentist, podiatric physician, advanced practice registered nurse , certified registered nurse anesthetist or veterinarian:
(a) As an incident to the administering or dispensing of a substance in the course of his or her professional practice;
- 82nd Session (2023) – 7 – (a) As an incident to the administering or dispensing of a substance in the course of his or her professional practice;
or (b) By an authorized agent under his or her supervision, for the purpose of, or as an incident to, research, teaching or chemical analysis and not for sale.
or (b) By an authorized agent under his or her supervision, for the purpose of, or as an incident to, research, teaching or chemical anaSec.
Sec.
6.
A physician assistant who:
A certified registered nurse anesthetist when he or she orders, prescribes, possesses or administers controlled substances under the conditions prescribed by paragraph (a) of subsection 1 of section 2.6 of this act.
A certified registered nurse anesthetist who orders, prescribes, possesses or administers controlled substances in accordance with section 2.6 of this act.
- *SB336_R1* – 8 – Sec.
Sec.
(a) An order given individually for the person for whom prescribed, directly from a physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, podiatric physician, optometrist, advanced practice registered nurse , certified registered nurse anesthetist or veterinarian, or his or her agent, to a pharmacist or indirectly by means of an order signed by the practitioner or an electronic transmission from the practitioner to a pharmacist;
- 82nd Session (2023) – 8 – prescribed, directly from a physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, podiatric physician, optometrist, advanced practice registered nurse , certified registered nurse anesthetist or veterinarian, or his or her agent, to a pharmacist or indirectly by means of an order signed by the practitioner or an electronic transmission from the practitioner to a pharmacist;
A person must present proof that he or she is authorized to access the database of the program established pursuant to NRS 453.162 before the Board may issue or renew a registration.
A person must present proof that he established pursuant to NRS 453.162 before the Board may issue or renew a registration.
The following persons are not required to register and may lawfully possess and distribute controlled substances pursuant to the provisions of NRS 453.011 to 453.552, inclusive [:] and section 5.2 of this act:
The following persons are not required to register and may lawfully possess and distribute controlled substances pursuant to the provisions of NRS 453.011 to 453.552, inclusive [:] , and section 5.2 of this act:
(b) A common or contract carrier or warehouseman, or an employee thereof, whose possession of any controlled substance is in the usual course of business or employment;
employee thereof, whose possession of any controlled substance is in the usual course of business or employment;
- *SB336_R1* – 9 – (1) Holds a locum tenens license issued by the Board of Medical Examiners or a temporary license issued by the State Board of Osteopathic Medicine;
- 82nd Session (2023) – 9 – Medical Examiners or a temporary license issued by the State Board of Osteopathic Medicine;
Except as otherwise provided in subsection 6, a person shall not knowingly or intentionally possess a controlled substance, unless the substance was obtained directly from, or pursuant to, a prescription or order of a physician, physician assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, podiatric physician, optometrist, advanced practice registered nurse , certified registered nurse anesthetist or veterinarian while acting in the course of his or her professional practice, or except as otherwise authorized by the provisions of NRS 453.005 to 453.552, inclusive [.] and section 5.2 of this act.
Except as otherwise provided in subsection 6, a person shall not knowingly or intentionally possess a controlled substance, unless the substance was obtained directly from, or assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, podiatric physician, optometrist, advanced practice registered nurse , certified registered nurse anesthetist or veterinarian while acting in the course of his or her professional practice, or except as otherwise authorized by the provisions of NRS 453.005 to 453.552, inclusive [.] , and section 5.2 of this act.
In accordance with NRS 176.211, the court shall defer judgment upon the consent of the person.
In accordance with person..211, the court shall defer judgment upon the consent of the (b) For a third or subsequent offense, if the controlled substance is listed in schedule I or II and the quantity possessed is less than 14 grams, or if the controlled substance is listed in schedule III, IV or V and the quantity possessed is less than 28 grams, or if the offender has previously been convicted two or more times in the aggregate of any violation of the law of the United States or of any state, territory or district relating to a controlled substance, is guilty of possession of a controlled substance and shall be punished for a category D - 82nd Session (2023) – 10 – a fine of not more than $20,000.0, and may be further punished by (c) If the controlled substance is listed in schedule I or II and the quantity possessed is 14 grams or more, but less than 28 grams, or if the controlled substance is listed in schedule III, IV or V and the quantity possessed is 28 grams or more, but less than 200 grams, is guilty of low-level possession of a controlled substance and shall be punished for a category C felony as provided in NRS 193.130.
(b) For a third or subsequent offense, if the controlled substance is listed in schedule I or II and the quantity possessed is less than 14 grams, or if the controlled substance is listed in schedule III, IV or V and the quantity possessed is less than 28 grams, or if the offender has previously been convicted two or more times in the aggregate of any violation of the law of the United States or of any state, territory or district relating to a controlled substance, is guilty of possession of a controlled substance and shall be punished for a category D felony as provided in NRS 193.130, and may be further punished by a fine of not more than $20,000.
- *SB336_R1* – 10 – (c) If the controlled substance is listed in schedule I or II and the quantity possessed is 14 grams or more, but less than 28 grams, or if the controlled substance is listed in schedule III, IV or V and the quantity possessed is 28 grams or more, but less than 200 grams, is guilty of low-level possession of a controlled substance and shall be punished for a category C felony as provided in NRS 193.130.
(e) If the controlled substance is listed in schedule I or II and the quantity possessed is 42 grams or more, but less than 100 grams, is guilty of high-level possession of a controlled substance and shall be punished for a category B felony by imprisonment in the state prison for a minimum term of not less than 2 years and a maximum term of not more than 15 years and by a fine of not more than $50,000.
(e) If the controlled substance is listed in schedule I or II and the guilty of high-level possession of a controlled substance and shall be punished for a category B felony by imprisonment in the state prison for a minimum term of not less than 2 years and a maximum term of not more than 15 years and by a fine of not more than $50,000.
(a) Performing not more than 24 hours of community service;
Unless a greater penalty is provided pursuant to NRS 212.160, a person who is convicted of the possession of more than 1 ounce, but less than 50 pounds, of marijuana or more than one- eighth of an ounce, but less than one pound, of concentrated cannabis is guilty of a category E felony and shall be punished as provided in NRS 193.130.
Unless a greater penalty is provided pursuant to NRS 212.160, a person who is convicted of the possession of more than 1 ounce, but less than 50 pounds, of marijuana or more than - 82nd Session (2023) – 11 – one-eighth of an ounce, but less than one pound, of concentrated cannabis is guilty of a category E felony and shall be punished as provided in NRS 193.130.
- *SB336_R1* – 11 – 6.
6.
It is not a violation of this section if a person possesses a trace amount of a controlled substance and that trace amount is in or on a hypodermic device obtained from a sterile hypodermic device program pursuant to NRS 439.985 to 439.994, inclusive.
It is not a violation of this section if a person possesses a on a hypodermic device obtained from a sterile hypodermic devicein or program pursuant to NRS 439.985 to 439.994, inclusive.
In addition to the limitations imposed by NRS 453.256 and 453.3611 to 453.3648, inclusive, a physician, physician assistant, dentist, advanced practice registered nurse , certified registered nurse anesthetist or podiatric physician may prescribe or administer controlled substances only for a legitimate medical purpose and in the usual course of his or her professional practice, and he or she shall not prescribe, administer or dispense a controlled substance listed in schedule II for himself or herself, his or her spouse or his or her children except in cases of emergency.
In addition to the limitations imposed by NRS assistant, dentist, advanced practice registered nurse , certifiedn registered nurse anesthetist or podiatric physician may prescribe or administer controlled substances only for a legitimate medical purpose and in the usual course of his or her professional practice, and he or she shall not prescribe, administer or dispense a controlled substance listed in schedule II for himself or herself, his or her spouse or his or her children except in cases of emergency.
4.
- 82nd Session (2023) – 12 – 4.
A pharmacist shall not fill an order which purports to be a prescription if the pharmacist has reason to believe that it was not issued in the usual course of the professional practice of a physician, physician assistant, dentist, advanced practice registered nurse, - *SB336_R1* – 12 – certified registered nurse anesthetist, podiatric physician or veterinarian.
A pharmacist shall not fill an order which purports to be a prescription if the pharmacist has reason to believe that it was not issued in the usual course of the professional practice of a physician, physician assistant, dentist, advanced practice registered nurse, veterinarian.istered nurse anesthetist, podiatric physician or 5.
5.
Unlawfully take, obtain or attempt to take or obtain a controlled substance or a prescription for a controlled substance from a manufacturer, wholesaler, pharmacist, physician, physician assistant, dentist, advanced practice registered nurse, certified registered nurse anesthetist, veterinarian or any other person authorized to administer, dispense or possess controlled substances.
Unlawfully take, obtain or attempt to take or obtain a from a manufacturer, wholesaler, pharmacist, physician, physician assistant, dentist, advanced practice registered nurse, certified registered nurse anesthetist, veterinarian or any other person authorized to administer, dispense or possess controlled substances.
2.
- 82nd Session (2023) – 13 – 2.
3.
drugs and devices:ing to the prescription of poisons, dangerous (a) An advanced practice registered nurse who holds a certificate from the State Board of Pharmacy permitting him or her so to prescribe;
When relating to the prescription of poisons, dangerous drugs and devices:
- *SB336_R1* – 13 – (a) An advanced practice registered nurse who holds a certificate from the State Board of Pharmacy permitting him or her so to prescribe;
A certified registered nurse anesthetist when he or she orders, prescribes, possesses or administers poisons, dangerous drugs or devices under the conditions prescribed by paragraph (a) of subsection 1 of section 2.6 of this act.
A certified registered nurse anesthetist who orders, prescribes, possesses or administers poisons, dangerous drugs or devices in accordance with section 2.6 of this act.
(a) Occurred before, on or after the effective date of this act;
(a) Occurred before, on or after the effective date of this section;
A regulatory body shall terminate any investigation or disciplinary proceedings:
A regulatory body shall terminate any investigation or dis(a) Against a person permitted to practice any healing art under title 54 of NRS for conduct outside the scope of the regulatory body;
(a) Against a person permitted to practice any healing art under title 54 of NRS for conduct outside the scope of the regulatory body;
This section and sections 1, 2, 2.2, 3, 4 and 5 of this act become effective upon passage and approval.
This section and sections 1, 2, 2.2, 3, 4, 5 and 6 of this act become effective upon passage and approval.
2.
- 82nd Session (2023) – 14 – 2.
H - *SB336_R1*
~~~~~ 23 - 82nd Session (2023)
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Amendments

2 amendments

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Action History

  1. Chapter 229.

  2. Approved by the Governor.

  3. Enrolled and delivered to Governor.

  4. Assembly Amendment No. 670 concurred in. To enrollment.

  5. In Senate.

  6. Read third time. Passed, as amended. Title approved. (Yeas: 41, Nays: None, Excused: 1.) To Senate.

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

  8. From committee: Amend, and do pass as amended. Placed on Second Reading File. Read second time. Amended. (Amend. No. 670.) To printer.

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

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

  11. From committee: Amend, and do pass as amended. Placed on Second Reading File. Read second time. Amended. (Amend. No. 404.) To printer.

  12. From printer. To committee.

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

Sponsors

Sponsorship breakdown

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2 sponsors · 0 co-sponsors · 65 not signed on

Sponsors (2)

Co-sponsors (0)

None.

Not signed on (65)

65 members have not signed on to this bill.

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

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

Subjects

healthcare labor
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Frequently asked questions

Who sponsors SB 336?
SB 336 is sponsored by Ohrenschall, James (Democratic) and Stone, Jeff (Republican).
What is the current status of SB 336?
This bill has been enacted into law. Introduced March 20, 2023. Enacted.
Where can I track SB 336?
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