SB 348 — Revises provisions relating to health facilities. (BDR 40-51)

(e) Data regarding the population served by the hospital in the 24 months immediately preceding the application;

The provisions of this section do not apply to any person whowhoSec. ceases to operate hospitals in this State.

Sec.

(Deleted by amendment.) Sec.this State.

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(a)- The82nd physicianSession group(2023) practices– that4 are– parties to the transaction or contract for management or that are owned by those parties represent at least 20 percent of the physicians who practice any specialty in a primary service area;

- *SB348_R1* – 4 – (c) The acquisition of all or substantially all of the capital stock, membership interests or other equity interests of a physician group practice;

(d) The employment of all or substantially all of the physicians in a(e) The acquisition of an insolvent physician group practice;practice.

or (e) The acquisition of an insolvent physician group practice.

(d) The name and address of each business entity that will provide health services after the transaction or contract for management,man(e) asA applicable;description of the health services to be provided at each location of a business entity described in paragraph (d);

(e) A description of the health services to be provided at each location of a business entity described in paragraph (d);

and - 82nd Session (2023) – 5 – (b) Annually prepare a report regarding market transactions and concentration in health care based on the information in the notices and post the report on an Internet website maintained by the Department.

6.Department pursuant to subsection 1 and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department may impose against the hospital an administrative penalty of not more than $5,000 for each day of such failure.

If a hospital, a physician group practice or a person who owns all or substantially all of a physician group practice fails to provide timely notice to the Department pursuant to subsection 1 or 2, as applicable, and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department may impose against the hospital, physician group practice or person who owns all or substantially all of a physician group practice an administrative penalty of not more than $5,000 for each day of such failure.

AnyIf moneya collectedphysician asgroup administrativepractice penaltiesor pursuanta toperson thiswho sectionowns mustall beor accountedsubstantially forall separatelyof anda usedphysician bygroup practice fails to provide timely notice to the Department pursuant to carrysubsection out2 and the provisionsfailure ofwas NRSnot 439A.111caused toby -excusable *SB348_R1*neglect, –technical 5problems –or 439A.126,other inclusive,extenuating orcircumstances, forthe anyDepartment othershall purposenotify authorizedthe byBoard of Medical Examiners or the Legislature.State Board of Osteopathic Medicine, or both, as applicable, of such failure.

Any money collected as administrative penalties pursuant to this section must be accounted for separately and used by the Department to carry out the provisions of NRS 439A.111 to 439A.126, inclusive, or for any other purpose authorized by the Legislature.

9.

(b) “Primary service area” means an area comprising the smallest number of zip codes from which the hospital or physician group practice draws at least 75 percent of patients.patients.or physician Sec.

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(Deleted by amendment.) - 82nd Session (2023) – 6 – Sec.

(b)regulations Applicantadopted isby inthe substantialBoard;l compliance with the standards and regulations(c) adoptedApplicant, byif he or she has undertaken a project for which approval is required pursuant to NRS 439A.100 [,] or section 2 of this act, has obtained the Board;approval of the Director of the Department of Health and Human Services;

(c) Applicant, if he or she has undertaken a project for which approval is required pursuant to NRS 439A.100 [,] or section 2 of this act, has obtained the approval of the Director of the Department of Health and Human Services;

- *SB348_R1* – 6 – Sec.

(d)(e) TheA performancecenter offor open-heartthe surgery.treatment of trauma..

(e) A center for the treatment of trauma.

The Division may revoke its approval if the licensee fails to maintain substantial compliance with the standards adopted by the Board pursuant to subsection 4 for the provision of such services, or with- any82nd conditionsSession included(2023) in– the7 written– approval of the Director issued pursuant to the provisions of NRS 439A.100 [.] or section 22or of this act.

Each license issued pursuant to NRS 449.029 to 449.2428, inclusive, expires on December 31 following its issuance and is renewable for 1 year upon reapplication and payment of all fees required pursuant to subsection 4 and NRS 449.050, as applicable,facility unlesshas not:s the Division finds, after an investigation, that the facility(a) hasSatisfactorily not:complied with the provisions of NRS 449.029 to 449.2428, inclusive, or the standards and regulations adopted by the Board;

(a)(b) SatisfactorilyObtained compliedthe withapproval of the provisionsDirector of NRSthe 449.029Department toof 449.2428,Health inclusive,and orHuman theServices standardsbefore andundertaking regulationsa adoptedproject, if such approval is required by theNRS Board;439A.100 [;] or section 2 of this act;

- *SB348_R1* – 7 – (b) Obtained the approval of the Director of the Department of Health and Human Services before undertaking a project, if such approval is required by NRS 439A.100 [;] or section 2 of this act;

§ 1395ww(d)(1)(B)(iv), a psychiatric hospital that provides inpatient services to children, a psychiatric residential treatment facility, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 C.F.R.

§ 482.58 or, if residential services are provided to children, a medical facility or facility for the treatment of alcohol or other substance use disorders must include, without limitation, a statement that the facility, hospital,- agency,82nd program,Session pool(2023) or– home8 is– in compliance with the provisions of NRS 449.115 to 449.125, inclusive, and 449.174.

the 3.

Each reapplication for a surgical center for ambulatory patients, facility for the treatment of irreversible renal disease, facility for hospice care, program of hospice care, hospital, facility for intermediate care, facility for skilled nursing, agency to provide personal care services in the home or rural clinic must be accompanied by the fee prescribed by the State Board of Health pursuant to NRS 457.240, in addition to the fees imposed pursuant to NRS 449.050.

457.240, in addition to the fees imposed pursuant Sec.

- *SB348_R1* – 8 – (a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410 or 449.029 to 449.245, inclusive, or of any other law of this State or of the standards, rules and regulations adopted thereunder.

(d)occupants Conduct or practiceemployees detrimentalof tothe facility.to the health or safety of the occupants(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 employeessection 2 of this act or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required [.] , including, without limitation, the facility.closure or conversion of any hospital in a county whose - 82nd Session (2023) – 9 – population is 100,000 or more that is owned by the licensee without approval pursuant to section 2 of this act.

(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 section 2 of this act or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required [.] , including, without limitation, the closure or conversion of any hospital in a county whose population is 100,000 or more that is owned by the licensee without approval pursuant to section 2 of this act.

(g)2.) ViolationVIn ofaddition to the provisions of NRSsubsection 458.112.1, 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:

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:

- *SB348_R1* – 9 –  The facility shall make the information available to the public pursuant to NRS 449.2486.

the information available to the public 4.

10.2.

NRS 449.163 is hereby amended to read as follows:

449.163 1.

In addition to the payment of the amount required by NRS 449.0308, if a medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed violates any provision related to its licensure, including any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, or any condition, standard or - 82nd Session (2023) – 10 – the regulations adopted pursuant to NRS 449.165, may:ordance with (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] Except where a greater penalty is authorized by subsection 2, 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 facilit(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.

2.

If an off-campus location of a hospital fails to obtain a national provider identifier that is distinct from the national provider identifier used by the main campus and any other off- campus location of the hospital in violation of NRS 449.1818, the Division may impose against the hospital an administrative penalty of not more than $10,000 for each day of such failure, together with interest thereon at a rate not to exceed 10 percent per annum, in addition to any other action authorized by this chapter.

3.

If the facility fails to pay any administrative penalty imposed Division may:aragraph (d) of subsection 1 [,] or subsection 2, the (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.] 4.

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

- 82nd Session (2023) – 11 – pursuant to paragraph (d) of subsection 1 or subsection 2 must be accounted for separately and used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, 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.

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10.3.

NRS 449.1818 is hereby amended to read as follows:

449.1818 1.

Each off-campus location of a hospital [must] shall obtain and use and include on all claims for reimbursement or payment for health care services provided at the location a national provider identifier that is distinct from the national provider identifier used by the main campus and any other off-campus location of the hospital.

If the off-campus location includes the national provider identifier on such a claim, the off-campus identifier used by the main campus of the hospital.

If the off- campus location includes both the national provider identifier used by the off-campus location and the national provider identifier used by the main campus on a claim, the claim must clearly identify which national provider identifier corresponds to the off-campus location and which national provider identifier corresponds to the main campus.

2.

An independent center for emergency medical care shall include on all claims for reimbursement or payment for health care services provided at the independent center for emergency medical care the national provider identifier used by the independent center for emergency medical care.

3.

As used in this section:

(a) “National provider identifier” means the standard, unique health identifier for health care providers that is issued by the nat(b) “Off-campus location” means a facility:

C.F.R.

Part 162.

(1) With operations that are directly or indirectly owned or controlled by, in whole or in part, a hospital or which is affiliated with a hospital, regardless of whether it is operated by the same governing body as the hospital;

(2) That is located more than 250 yards from the main campus of the hospital;

(3) That provides services which are organizationally and functionally integrated with the hospital;

and - 82nd Session (2023) – 12 – surgery, urgent care or emergency room services.ng ambulatory Sec.

An independentoff-campus centerlocation for emergency medical care shall post conspicuously in each location where patients are admitted and registered a sign, in not less than 24 point boldface type, which states in English and Spanish:

An off-campus location shall provide to each patient of the emergency department of the off-campus location and any adult accompanying such a patient who is less than 18 years of age immediately upon registration a written statement in substantially the following form:

You will be charged for a visit to an emergency room and not for a visit to an urgent care center.

Youresponses have the right to receivesuch promptquestions and reasonablerequests.reasonable responsesYou tohave suchthe questionsright andto requests.reject treatment.

YouThis haveis thenot righta tocomplete rejectstatement treatment.of patient information or rights.

- *SB348_R1* – 10 – However, we encourage you to defer your questions until after we screen you for an emergency medical condition.

4 This is not a complete statement of patient information or rights.

- 82nd Session (2023) – 13 – 3.

AfterTo the completionextent ofpracticable, an appropriate medical screening examination of a patientwritten ofstatement theprovided emergencypursuant departmentto ofsubsection the2 off-must campusbe locationin that does not reveal an emergency medical condition or after stabilizing the emergencylanguage medicalrequested conditionby of such a patient, an off-campus location shall provide the patient and,or if the patient, is less than 18 years of age, any adult accompanying the patient, withas writtenapplicable. notice of:

4.

After the completion of an appropriate medical screening campus location that does not reveal an emergency medicalhe off- condition or after stabilizing the emergency medical condition of such a patient, an off-campus location shall provide the patient and, if the patient, is less than 18 years of age, any adult accompanying the patient, with written notice of:

4.5.

(a) “Independent“Network” centermeans fora emergencydefined medicalset care”of hasproviders theof meaninghealth ascribedcare who are under contract with a third party to itprovide inhealth NRScare 449.013.services to persons covered by the third party.

(b) “Network”“Off-campus location” means a definedfacility: set of providers of health care who are under contract with a third party to provide health care services to persons covered by the third party.

(c)(1) “Off-campusWith location”operations meansthat are directly or indirectly owned or controlled by, in whole or in part, a facility:hospital or which is affiliated with a hospital, regardless of whether it is operated by the same govern(2) That is located more than 250 yards from the main campus of the hospital;

(1) With operations that are directly or indirectly owned or controlled by, in whole or in part, a hospital or which is affiliated with a hospital, regardless of whether it is operated by the same governing body as the hospital;

(2) That is located more than 250 yards from the main campus of the hospital;

(d)(c) “Third party” means any insurer, governmental entity or other organization providing health coverage or benefits in accordance with state or federal law.

- *SB348_R1* – 11 – Sec.

10.7.

Chapter 630 of NRS is hereby amended by adding thereto a new section to read as follows:

1.

Except as otherwise provided in this subsection, if the Board receives notice from the Department of Health and Human Services pursuant to NRS 439A.126 that a physician group practice or a person who owns all or substantially all of a - 82nd Session (2023) – 14 – physician group practice has failed to provide timely notice to the Department of a transaction described in subsection 3 of NRS 439A.126, the Board must proceed as if a complaint had been filed against the physician group practice or person, as applicable.

If physicians licensed pursuant to this chapter and osteopathic of physicians licensed pursuant to chapter 633 of NRS, the Board shall consult with the State Board of Osteopathic Medicine to ensure that either the Board or the State Board of Osteopathic Medicine, but not both, investigates the notice.

2.

If, after conducting an investigation and a hearing in accordance with the provisions of this chapter, the Board determines that a physician group practice or a person who owns all or substantially all of a physician group practice has failed to provide timely notice to the Department of Health and Human Services of a transaction described in subsection 3 of NRS 439A.126, the Board may impose an administrative penalty of not more than $5,000 for each day of such failure.

3.

As used in this section, “physician group practice” has the meaning ascribed to it in NRS 439A.126.

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11.5.

Chapter 633 of NRS is hereby amended by adding thereto a new section to read as follows:

1.

Except as otherwise provided in this subsection, if the Board receives notice from the Department of Health and Human Services pursuant to NRS 439A.126 that a physician group practice or a person who owns all or substantially all of a Department of a transaction described in subsection 3 of NRS to the 439A.126, the Board must proceed as if a complaint had been filed against the physician group practice or person, as applicable.

If the report concerns a physician group practice that consists of osteopathic physicians licensed pursuant to this chapter and physicians licensed pursuant to chapter 630 of NRS, the Board shall consult with the Board of Medical Examiners to ensure that either the Board or the Board of Medical Examiners, but not both, investigates the notice.

2.

If, after conducting an investigation and a hearing in accordance with the provisions of this chapter, the Board determines that a physician group practice or a person who owns all or substantially all of a physician group practice has failed to provide timely notice to the Department of Health and Human Services of a transaction described in subsection 3 of - 82nd Session (2023) – 15 – of not more than $5,000 for each day of such failure.penalty 3.

As used in this section, “physician group practice” has the meaning ascribed to it in NRS 439A.126.

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Sections 1 to 11,11.5, inclusive, of this act become effective:

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

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