If,Section after4 conductingalso anrequires investigationthe andDepartment ato hearing,notify the Board of Medical Examiners or the State Board of Osteopathic Medicine determines that a physician group practice or a person who owns all or substantially all of a physician group practice hasfails failed to provide such timely noticenotice. to the Department of a transaction for which notice is - 82nd Session (2023) – 2 – required, sections 10.7 and 11.5 authorize the respective board to impose an administrative penalty.

ExistingUpon lawreceiving requiresnotice eachof off-campussuch locationfailure offrom athe hospitalDepartment, tosections obtain10.7 and use11.5 onof allthis claimsbill forrequire reimbursementthose orboards paymentto aproceed nationalas providerif identifiera thatcomplaint ishad distinctbeen fromfiled. the national provider identifier used by the main campus and any other off-campus location of the hospital.

(NRSIf, 449.1818)after Sectionconducting 10.3an investigation and a hearing, the Board of thisMedical billExaminers clarifiesor the State Board of Osteopathic Medicine 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 off-campusDepartment location:of a transaction for which notice is required, sections 10.7 and 11.5 authorize the respective board to impose an administrative penalty.

(1)Existing islaw requiredrequires toeach includeoff-campus thelocation nationalof additionallya includehospital to obtain and use on suchall aclaims claimfor thereimbursement or payment a national provider identifier forthat theis maindistinct campusfrom location of the hospital.

(NRS 449.1818) Section 10.3 of this bill clarifies that the off- campus location:

(1) is required to include the national provider identifier on each claim for reimbursement or payment;

and (2) may additionally include on such a claim the national provider identifier for the main campus of the hospital.

Among other sanctions, existing law authorizes the Division of Public and Behavioral Health to impose against a hospital that fails to obtain a national provider identifier for an off-campus location that is distinct from the national provider identifier used by the main campus and any other off-campus location of the hospital an administrative penalty of not more than $5,000 for each day of such failure, together withadministrative interest.penalty that the Division is authorized to impose for such failure.

(NRSExisting 449.163)law Sectionprovides 10.2every patient of thisa billmedical doublesfacility, theincluding amount[an ofindependent center for emergency medical care or] a hospital, with the administrativeright penaltyto thatreceive certain information about the Divisioncondition isand authorizedcare toof imposethe forpatient and the cost of such failure.care.

Existing(NRS law449A.106) provides[Section] everyIf patientan off-campus location of a medicalhospital facility,provides includingemergency amedical hospital,services, withsection the10.5 rightof tothis receivebill certainrequires information[an aboutindependent thecenter conditionfor andemergency caremedical ofcare] the patientoff-campus andlocation theto cost: of such care.

(NRS(1) 449A.106)post Ifconspicuous annotice off-campusthat locationthe of[independent acenter hospitalfor provides emergency medicalcare] services,off-campus sectionlocation 10.5is of this bill requires the an emergency medical facility and will charge patients for an emergency roomtionroom isvisit visit;[.

andIf (2)an provideoff-campus eachlocation patientof witha certainhospital noticeprovides concerningemergency themedical rightsservices, ofsection 10.5 requires the patientoff-campus uponlocation registration.to] ;

Sectionand 10.5(2) also requires such an off-campus location to provide each patient with a[: more detailed notice concerning billing and payment after the patient is found not to have an emergency medical condition or after the emergency medical condition of the patient has been stabilized, as applicable.

EXPLANATION(1)] –certain Matternotice inconcerning boldedthe italicsrights isof new;the patient upon registration .

matter[; between brackets [omitted material] is material to be omitted.

and (2)] Section 10.5 also concerning billing and payment after the patient is found not to have an emergency medical condition or after the emergency medical condition of the patient has been stabilized, as applicable.

The Division of Public and Behavioral Health of the Department shall not issue a new license or alter an existing license for conversion to a differentAssembly typeAmendment ofNo. health facility unless the Director or the designee of the Director has issued such an approval.

-654 82ndto SessionSenate (2023)Bill –No. 3 – 2.

348 First Reprint Page 5 different type of health facility unless the Director or the designee of the Director has issued such an approval.

2.

An applicant must provide any information requested by the Director or the designee of the Director for consideration of an relatedapplication, to:, which must include, without limitation, information (a)related Theto: location of the hospital;

(a) The location of the hospital;

(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 whoSec.who ceases to operate hospitals in this State.

3.

(Deleted by amendment.) this State.

3.

(Deleted by amendment.) Sec.

-(a) 82ndThe Sessionphysician (2023)group –practices 4that –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;

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

or Assembly Amendment No.

654 to Senate Bill No.

348 First Reprint Page 6 (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 man(e)management, Aas descriptionapplicable; 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.

Department6. 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.

[8.] 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.orpatients. physician Sec.

Sec.

(a)Assembly WhereAmendment theNo. provision violated governs the licensing of a project which is required to be approved pursuant to NRS 439A.100 [,] or section 2 of this act, not more than 10 percent of the proposed expenditure for the project.

654 to Senate Bill No.

348 First Reprint Page 7 (a) Where the provision violated governs the licensing of a project which is required to be approved pursuant to NRS 439A.100 [,] or section 2 of this act, not more than 10 percent of the proposed expenditure for the project.

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

regulations(b) adoptedApplicant byis thein Board;lsubstantial compliance with the standards and (c)regulations Applicant,adopted ifby 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 approvalBoard; 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;

(e)(d) AThe centerperformance for the treatment of trauma..open-heart surgery.

(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 82ndany Sessionconditions (2023)included –in 7the –written approval of the Director issued pursuant to the provisions of NRS 439A.100 [.] or section 2or2 of this act.

and (b)Assembly AdoptAmendment suchNo. other standards as it deems necessary for determining whether to approve the provision of services pursuant to this section.

654 to Senate Bill No.

348 First Reprint Page 8 (b) Adopt such other standards as it deems necessary for determining whether to approve the provision of services pursuant to this section.

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 facilityapplicable, hasunless not:s the Division finds, after an investigation, that the (a)facility Satisfactorilyhas compliednot: with the provisions of NRS 449.029 to 449.2428, inclusive, or the standards and regulations adopted by the Board;

(a) Satisfactorily complied with the provisions of NRS 449.029 to 449.2428, inclusive, or the standards and regulations adopted by the Board;

§ 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, 82ndagency, Sessionprogram, (2023)pool –or 8home –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.

occupantsAssembly orAmendment employeesNo. of the facility.to the health or safety of the (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 - 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.

654 to Senate Bill No.

348 First Reprint Page 9 (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 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.

2.)(g) VInViolation additionof to the provisions of subsectionNRS 1,458.112. 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:

 The facility shall make the information available to the public pursuant to NRS 449.2486.

the information available to the public 4.

In addition to the payment of the amount required by NRS 449.0308, if a medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed violates any provision related to its licensure, including any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, or any condition, standard or -regulation 82ndadopted Sessionby (2023)the –Board, 10the –Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:ordancemay: with (a) Prohibit the facility from admitting any patient until it determines that the facility has corrected the violation;

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

(d)Assembly [Impose]Amendment ExceptNo. 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;

and654 (e) Appoint temporary management to overseeSenate theBill operationNo. 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;

348 First Reprint Page 10 (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 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;

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-off-campus 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.

If the facility fails to pay any administrative penalty imposed Divisionpursuant may:aragraphto paragraph (d) of subsection 1 [,] or subsection 2, the (a)Division Suspendmay: the license of the facility until the administrative penalty is paid;

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

-[4.] 82nd5. 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.

Any money collected as administrative penalties 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.

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

If the off-off-campus campus location includes both the national provider identifier used by the off-campusoff- 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.

(a)Assembly “NationalAmendment providerNo. 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.654 to Senate Bill No.

348 First Reprint Page 11 (a) “National provider identifier” means the standard, unique health identifier for health care providers that is issued by the national provider system in accordance with 45 C.F.R.

(b) “Off-campus location” means a facility:

and -(4) 82ndThat Sessionis (2023)an –outpatient 12facility –providing ambulatory surgery, urgent care or emergency room services.ngservices. ambulatory Sec.

10.5.Sec.

Chapter10.5.Chapter 449A of NRS is hereby amended by adding thereto a new section to read as follows:

An [independent center for emergency medical care] off-campus location 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:

responsesYou tohave suchthe questionsright andto requests.reasonablereceive Youprompt haveand thereasonable rightresponses to rejectsuch treatment.questions and requests.

ThisYou ishave notthe aright completeto statementreject oftreatment. patient information or rights.

You[However, willwe receiveencourage ayou moreto comprehensivedefer statementyour afterquestions theuntil completionafter ofwe ascreen medicalyou screeningfor examination that does not reveal an emergency medical conditioncondition.] orThis afteris yournot emergencya medicalcomplete conditionstatement hasof beenpatient stabilized.information or rights.

-You 82ndwill Sessionreceive (2023)a –more 13comprehensive –statement 3.after the completion of a medical Assembly Amendment No.

654 to Senate Bill No.

348 First Reprint Page 12 screening examination that does not reveal an emergency medical condition or after your emergency medical condition has been stabilized.

4 3.

After the completion of an appropriate medical screening campusexamination of a patient of the emergency department of the off-campus location that does not reveal an emergency medicalhemedical 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) “Network”[“Independent meanscenter afor definedemergency setmedical ofcare” providershas ofthe healthmeaning careascribed who are under contract with a third party to provideit healthin careNRS services449.013. to persons covered by the third party.

(b)(b)] “Off-campus“Network” location” means a facility:defined 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.

(1)[(c)] With(b) operations“Off-campus thatlocation” aremeans directly or indirectly owned or controlled by, in whole or in part, a hospitalfacility: 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.

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 the report concerns a physician group practice that consists of 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.Assembly Amendment No.

654 to Senate Bill No.

348 First Reprint Page 13 2.

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 physician group practice has failed to provide timely notice to the 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, 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 82nd439A.126, Sessionthe (2023)Board –may 15impose –an administrative penalty of not more than $5,000 for each day of such failure.penaltyfailure. 3.

3.

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

~~~~~ 23 - 82nd Session (2023)