[or a newly established independent center for emergency medical care;] and (2) certain amendments to such a license.

Sections 5 and 10 of thisfromthis a bill authorize the Department and the Division of Public and Behavioral Health of the Department to impose certain civil penalties and take certain other disciplinary action against a person who closes[: a hospital in a county whose population is 100,000 or more or converts a hospital in such a county to a different type of health facility without written approval in violation of section 2.

Existing(1)] lawcloses requires:a hospital in a county whose population is 100,000 or more or converts a hospital in such a county to a different type of health facility without written approval in violation of section 2 .

[;

or (2) establishes an independent center for emergency medical care within 15 miles of another Senate Amendment No.

513 to Senate Bill No.

348 Page 4 independent center for emergency medical care or a hospital without written approval in violExisting law requires:

and (2) a physician group practice or a person who owns all or substantially all of a physician group practice to notify the Department of certain similar transactions under certain circumstances.

(NRS 439A.126) Section 4 of this bill authorizes the Department to impose an administrative penalty against a hospitalhospital, physician group practice or person who owns all or substantially all of a physician group practice that fails to provide timely notice of the information required by existing law.

SectionExisting 4law also[requires requires the Departmentoperator to notify the Board of Medicala Examinersmedical orfacility, theincluding Statean Boardindependent ofcenter Osteopathicfor Medicine,emergency asmedical appropriate,care, if a physician group practice or a personfacility whofor ownsthe alldependent orto substantiallyobtain all of a physicianlicense groupfrom practicethe failsDivision. to provide such timely notice.

(NRS 449.030) Section 6 of this bill requirerequires thosean boardsindependent tocenter proceedfor asemergency ifpatient of a complaintmedical hadfacility, beenincluding filed.an independent center for emergency medicalvery care or hospital, with the right to receive certain information about the condition and care of the patient and the cost of such care.

If,(NRS after449A.106) conductingSection an10.5 investigation and a hearing, the Board of Medicalthis Examinersbill orrequires thean Stateindependent Boardcenter offor Osteopathicemergency Medicinemedical determinescare that a physician group practice or a person who owns all or substantially all of a physician group practice has failed to providepost timelyconspicuous notice tothat the Departmentindependent ofcenter a transaction for whichemergency noticecare is -an 82ndemergency Sessionmedical (2023)facility – 2 – required, sections 10.7 and 11.5will authorizecharge thepatients respectivefor board to impose an administrativeemergency penalty.room visit.

ExistingIf lawan requires each off-campus location of a hospital toprovides obtainemergency andmedical useservices, onsection all10.5 claimsrequires for reimbursement or payment a national provider identifier that is distinct from the national provider identifier used by the main campus and any other off-campus location ofto theprovide hospital.each patient with:

(NRS(1) 449.1818)certain Sectionnotice 10.3concerning ofthe thisrights billof clarifies that the off-campuspatient location:upon registration;

(1)and is(2) requireda tomore includedetailed thenotice nationalconcerning additionallybilling includeand onpayment suchafter a claim the nationalmedical providercondition identifierof for the mainpatient campushas ofbeen thestabilized, hospital.as applicable.

Sectionthe 10.3 also requires an independent center for emergency medicalTHE carePEOPLE toOF includeTHE itsSTATE nationalOF providerNEVADA, identifierREPRESENTED onIN allSENATE claimsAND forASSEMBLY, reimbursementDO orENACT payment.AS FOLLOWS:

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 failure, together with interest.

(NRS 449.163) Section 10.2 of this bill doubles the amount of the administrative penalty that the Division is authorized to impose for such failure.

Existing law provides every patient of a medical facility, including a hospital, with the right to receive certain information about the condition and care of the patient and the cost of such care.

(NRS 449A.106) If an off-campus location of a hospital provides emergency medical services, section 10.5 of this bill requires the an emergency medical facility and will charge patients for an emergency roomtion is visit;

and (2) provide each patient with certain notice concerning the rights of the patient upon registration.

Section 10.5 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 – Matter in bolded italics is new;

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

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

- 82nd Session (2023) – 3 – 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;

4.Senate Amendment No.

513 to Senate Bill No.

348 Page 5 4.

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.

[1.

No person may establish an independent center for emergency medical care located within 15 miles of another independent center for emergency medical care or within 15 miles of a hospital without first applying for and obtaining the written approval of the Director or the designee of the Director.

The Division of Public and Behavioral Health of the Department shall not issue a new license or alter an existing license for such an independent center for emergency medical care 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 application, including, without limitation, information related to:

(a) The financial stability and ownership structure of the proposed independent center for emergency medical care and any other health facility relevant to the application;

and (b) The potential effect of the proposed independent center for emergency medical care on the costs of health services.

3.

The Director or the designee of the Director may approve an application submitted pursuant to subsection 1 only if the applicant demonstrates that:

(a) Based on the needs of the specific population to be served by the proposed independent center for emergency medical care and on the projected number of persons who need or will need the services offered by the proposed independent center for emergency medical care, there is a demonstrated need for the proposed independent center for emergency medical care;

(b) The existing independent centers for emergency medical care, existing urgent care facilities and existing hospitals in the geographic area to be served by the proposed independent center for emergency medical care are not willing to meet or are not capable of meeting the projected needs of the population to be served by the proposed independent center for emergency medical care;

(c) The applicant has the financial stability to provide emergency medical services to the population to be served by the proposed independent center for emergency medical care for a significant period of time;

(d) The proposed independent center for emergency medical care is likely to result in significantly reduced health care costs for the population to be served by the proposed independent center for emergency medical care and payors who cover that population;

(e) The proposed independent center for emergency medical care is unlikely to have an adverse effect on the quality of care provided to the population served by the proposed independent center for emergency medical care;

and (f) The approval of the application will not adversely affect an existing provider of emergency medical services.

In determining whether to approve an application submitted pursuant to subsection 1, the Director or the designee of the Director shall:

(a) Contact existing providers of emergency medical services and payors who cover the population to be served by the proposed independent center for emergency medical care;

Senate Amendment No.

513 to Senate Bill No.

348 Page 6 (b) Ensure that such providers and payors have the opportunity to participate in any public hearing concerning the application;

and (c) Otherwise seek the input of such providers and payors.

5.

The Department may by regulation require additional approval for a proposed change to a project which has previously been approved if the proposal would result in a change in the location of the project.

6.

The decision of the Director or the designee of the Director pursuant to this section is a final decision for the purposes of judicial review.

7.

As used in this section, “independent center for emergency medical care” has the meaning ascribed to it in NRS 449.013.] (Deleted by amendment.) Sec.

4.

-(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 (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);

5.Senate Amendment No.

513 to Senate Bill No.

348 Page 7 5.

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.

If 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 2 and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department shall notify the Board of Medical Examiners or the State Board of Osteopathic Medicine, or both, as applicable, of such failure.

8.

9.8.

(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) Where the provision violated governs the licensing of a project which is required to be approved pursuant to NRS 439A.100 [,] or section 2 [or 3] of this act, not more than 10 percent of the proposed expenditure for the project.

(Deleted[NRS by449.030 amendment.)is -hereby 82ndamended Sessionto (2023)read –as 6follows: – Sec.

449.030 1.

Except as otherwise provided in NRS 449.03013 and 449.03017, no person, state or local government or agency thereof may operate or maintain in this State any medical facility or facility for the dependent without first obtaining a license therefor as provided in NRS 449.029 to 449.2428, inclusive.

2.

Each independent center for emergency medical care must be licensed separately from any other independent center for emergency medical care, any other medical facility and any facility for the dependent.] (Deleted by amendment.) 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;

and(c) (d)Applicant, Facilityif conformshe or she has undertaken a project for which approval is required pursuant to theNRS applicable439A.100 zoning[,] regulations,or section the2 Division[or shall3] issueof this act, has obtained the licenseapproval toof the applicant.Director of the Department of Health and Human Services;

and Senate Amendment No.

513 to Senate Bill No.

348 Page 8 (d) Facility conforms to the applicable zoning regulations,  the Division shall issue the license to the applicant.

(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 [or 3] 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 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;

(b)(a) ObtainedSatisfactorily thecomplied approvalwith of the Directorprovisions of theNRS Department449.029 ofto Health449.2428, andinclusive, Humanor Servicesthe beforestandards undertakingand aregulations project,adopted if such approval is required by NRSthe 439A.100Board; [;] or section 2 of this act;

(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 [or 3] of this act;

§ 1395ww(d)(1)(B)(iv),Senate aAmendment psychiatricNo. hospital that provides inpatient 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.

513 to Senate Bill No.

348 Page 9 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.

occupants(d) Conduct or employeespractice ofdetrimental theto facility.to the health or safety of the (e)occupants 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 sectionemployees 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 closurefacility. 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 [or 3] 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:

(b)Senate IsAmendment orderedNo. to but fails to abate a nuisance pursuant to NRS 244.360, 244.3603 or 268.4124;

513 to Senate Bill No.

348 Page 10 (b) Is ordered to but fails to abate a nuisance pursuant to NRS 244.360, 244.3603 or 268.4124;

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

the information available to the public 4.

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

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.

Sec.

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.

10.5.

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

An off-campusindependent locationcenter 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.

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.

Senate Amendment No.

513 to Senate Bill No.

348 Page 11 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.

-9 82nd Session (2023) – 13 – 3.

ToAfter the extentcompletion practicable,of an appropriate medical screening examination of a writtenpatient statementof providedthe pursuantemergency todepartment subsectionof 2the mustoff-campus belocation inthat does not reveal an emergency medical condition or after stabilizing the languageemergency requestedmedical bycondition of such a patient, an off-campus location shall provide the patient orand, if the patient, is less than 18 years of age, any adult accompanying the patient, aswith applicable.written 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:

5.4.

(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) “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“Off-campus operationslocation” thatmeans are 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;

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

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.

Sec.

(Deleted[1. by amendment.) Sec.

11.5.Notwithstanding the provisions of section 3 of this act, a person who has commenced a project before January 1, 2024, for the establishment of an independent center for emergency medical care is not required to obtain the written approval of the Director of the Department of Health and Human Services to continue that project.

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.

If,Notwithstanding afterthe conductingamendatory anprovisions investigationof andsection a6 hearing in accordance with the provisions of this chapter,act, thean Boardindependent determinescenter thatfor aemergency physicianmedical groupcare practicewhich oris aowned personby whothe ownssame allowner oras substantiallyanother allmedical offacility aor physicianfacility groupfor practice has failed to provide timely notice to the Departmentdependent of Health and Humanoperating Servicesunder ofthe asame transactionlicense describedas inthat subsectionmedical 3facility ofor -facility 82ndfor Sessionthe (2023)dependent –may 15continue –to ofoperate notwithout morea thanseparate $5,000license foruntil eachJuly day1, of2024. such failure.penalty 3.

AsSuch usedan inindependent thiscenter section,for “physicianemergency groupmedical practice”care hasis not required to obtain the meaningwritten ascribedapproval toof itthe inSenate NRSAmendment 439A.126.No.

Sec.513 to Senate Bill No.

348 Page 12 Director of the Department of Health and Human Services pursuant to section 3 of this act to obtain a separate license.

3.

As used in this section:

(a) “Independent center for emergency medical care” has the meaning ascribed to it in NRS 449.013.

(b) “Medical facility” has the meaning ascribed to it in NRS 449.0151.] (Deleted by amendment.) Sec.

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

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