AB 147 — Revises provisions relating to dentistry. (BDR 54-74)

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

- *AB147_R1* – 4 – (e) A dental hygienist;

[(i)]- (k)82nd AnSession audiologist;(2023) – 4 – [(j)] (l) A practitioner of respiratory care;

[(j)] (l) A practitioner of respiratory care;

[(y)] (aa) An associate in social work, a social worker, a master social worker, an independent social worker or a clinical social worker licensed pursuant to chapter 641B of NRS;

clinical social [(z)] (bb) An alcohol and drug counselor or a problem gambling counselor who is certified pursuant to chapter 641C of NRS;

and (b) A] a person who holds a current license or certificate to practice his or her respective discipline pursuant to the applicable provisions of law of another state or territory of the United States.

- *AB147_R1* – 5 – Sec.

- 82nd Session (2023) – 5 – Sec.

“Teledentistry” means the use of telehealth by a licensee described in subsection 1 of section 7 of this act who is located at a distant site to facilitate the diagnosis, treatment, education, care management and self-management of or consultationThe withterm aincludes, patientwithout wholimitation:ated is located at an originating site.

The term includes, without limitation:

The provisions of this chapter and the regulations adopted thereto, including, without limitation, clinical requirements, ethical standards and requirements concerning the confidentiality of information concerning patients, apply to services provided through teledentistry to the same extent as if such services were provided in person or by other means.

- *AB147_R1* – 6 – (a) Provide treatment for any condition based solely on the results of an online questionnaire;

- 82nd Session (2023) – 6 – 5.

Nothing in sections 7 to 13, inclusive, of this act prohibits an organization for dental care or an administrator of a health benefit plan that provides dental coverage from negotiating rates of reimbursement for services provided through teledentistry with a dentist,d6.tisAs dentalused hygienistin orthis dentalsection:ental therapist.

6.

As used in this section:

As used in this section, “provider of health care” has the meaningmeaSec. ascribed to it in NRS 629.031.

Sec.

1.1.ed toExcept as otherwise provided in this subsection, a licensee must establish a bona fide relationship, as defined by regulation of the Board, with a patient before providing services to the patient through teledentistry.

ExceptA as otherwise provided in this subsection, a licensee mustmay establish asuch bona fide relationship, as defined by regulation of the Board, with a patientrelationship before providing services to the patient through teledentistry.teledentistry only:

A(a) licenseeFor may establish such a relationship through teledentistry only for the purpose of emergent carecare; or in connection with a public health program.

(b) In connection with a public health program;

or (c) To make an initial diagnosis of a malposition of teeth and a determination of the need for an orthodontic appliance.

Such an initial diagnosis and determination must be confirmed through an in-person visit before the patient begins using the orthodontic appliance.

(b)- If82nd theSession patient(2023) is– a7 minor– who is not authorized by law to consent to the services, confirm that the parent or legal guardian of the patient is present;

- *AB147_R1* – 7 – (c) Confirm that the patient is located in a jurisdiction where the licensee is licensed or otherwise authorized to practice and document the location of the patient in the record of the patient;

Before providing services through teledentistry and upon the request of a patient to whom services are provided through teledentistry, a licensee or any partnership, corporation or other entity through which a licensee provides services shall make other available to the patient proof of the identity of the licensee, the telephone number of the licensee, the address at which the licensee practices, the license number of the licensee and any other relevant information concerning the qualifications of the licensee.licensee and any other licensee who will be involved in providing the services through teledentistry.

(c) Precautions that will be taken in the event of a technological failure or an emergency;

andandhe event of a (d) Any other information prescribed by regulation of the Board.

- 82nd Session (2023) – 8 – (b) “Public health program” means a program approved by the Board or any program administered by:

or (3)Sec. A school district.

Sec.

AAchool licenseelicensee. who provides services through teledentistry shall:

-who *AB147_R1*provides –services 8through –teledentistry 1.shall:

1.

If a licensee is not able to competently provide services through teledentistry, including, without limitation, because the licensee is unable to receive adequate information about thee the patient, the licensee must notify the patient of that fact and:

Those - 82nd Session (2023) – 9 – regulations must include, without limitation, requirements concerning:

(b) The maintenance of records concerning patients to whom services are provided through teledentistry and the protection of the privacy of such patients;

teledentistry and the protection of (c) The use of teledentistry for collaboration between:

and - *AB147_R1* – 9 – (d) Interaction between licensees using teledentistry, including, without limitation:

Ensure that any electronic device on which such information is stored or that may be used to access such informationinfSec. is encrypted and requires a password.

Sec.

TheencThe Board shall, upon application by a dentist, dental hygienist or dental therapist licensed pursuant to this chapter who has completed a course of training in the administration of immunizations that is approved by the Board pursuant to subsection 2, issue a special endorsement of the license allowing the dentist, dental hygienist or dental therapist to administer immunizations.

and - 82nd Session (2023) – 10 – (c) Includes instruction consistent with the guidelines prescribed by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services concerning:

(1) Practices for administering immunizations to children, adolescents and adults;

administering immunizations to children, (2) Basic immunology and the mechanism by which immunizations induce protection from disease;

- *AB147_R1* – 10 – (7) Physiology and techniques for administering immunizations;

16.

(Deleted by amendment.) Sec.

1.1.eletA dentist who holds a special endorsement issued pursuant to section 15 of this act and who administers immunizations or under whose authorization a dental hygienist or dental therapist who holds such an endorsement administers immunizations must:

A dentist who holds a special endorsement issued pursuant to section 15 of this act and who administers immunizations or under whose authorization a dental hygienist or dental therapist who holds such an endorsement administers immunizations must:

and (c) Establish a written plan for addressing emergencies and ensure that the dentist, dental hygienist or dental therapist administering immunizations has immediate access to equipment that- may82nd beSession needed(2023) in– an11 emergency,– including, without limitation, equipment for administering oxygen and epinephrine and other equipment necessary to respond to an allergic reaction.

- *AB147_R1* – 11 – (a) The instructions for storing and handling an immunization prescribed by the manufacturer;

and (b) To the extent that such guidelines do not conflict with the instructions of the manufacturer, any applicable guidelines issued by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, including, without limitation, guidelines for storing, handling and administering immunizations, guidelines for documenting the administration of an immunization and contraindications and precautions for immunizations.

(a) Provide to the patient or, if the patient is a minor and is not authorized by law to provide consent, his or her parent or guardian, the most current Vaccine Information Statement prescribed for the immunization by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, require him or her to read the Vaccine Information Statement and answer any questions that he or she has concerning the information in the Vaccine Information she Statement;

and (c) Review the medical history of the patient, including, without limitation, asking the patient or, if the patient is a minor and is not authorized by law to provide consent, the parent or guardian of the patient, to describe any medications or other - 82nd Session (2023) – 12 – treatments that the patient is currently receiving, allergies to drugs, medical conditions that the patient is currently experiencing, surgeries the patient had or plans to have, past pregnancy or plans to become pregnant and any previous adverse reactionsrea2.ioIf a dentist, dental hygienist or dental therapist who holds a special endorsement issued pursuant to immunizations.section 15 of this act requests a physician, physician assistant or advanced practice registered nurse to conduct an examination and evaluation of a patient to determine whether the patient has a medical condition that would make it inadvisable to administer an immunization, the dentist, dental hygienist or dental therapist must rely on and act in conformance with the conclusions of the physician, physician assistant or advanced practice registered nurse.

2.Sec.

If a dentist, dental hygienist or dental therapist who holds a special endorsement issued pursuant to section 15 of this act requests a physician, physician assistant or advanced practice registered nurse to conduct an examination and evaluation of a patient to determine whether the patient has a medical condition that would make it inadvisable to administer an immunization, the dentist, dental hygienist or dental therapist must rely on and act in conformance with the conclusions of the physician, physician assistant or advanced practice registered nurse.

- *AB147_R1* – 12 – Sec.

(e)dental Thetherapist;r name or initials of the dentist, dental hygienist or dental(f) therapist;Except as otherwise provided in subsection 2, the address of the location where the immunization was administered;

(f) Except as otherwise provided in subsection 2, the address of the location where the immunization was administered;

- 82nd Session (2023) – 13 – 2.

3.in accordance with all applicable federal and state laws andned regulations, including, without limitation:

The records described in subsection 1 must be maintained in accordance with all applicable federal and state laws and regulations, including, without limitation:

- *AB147_R1* – 13 – 2.

631.005 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 631.015 to 631.105,631.105,se inclusive, and sections 3 to 6, inclusive, of this act have the meanings ascribed to them in those sections.

(c) Submit with the application a complete set of fingerprints and written permission authorizing the Board to forward the fingerprints to the Central Repository for Nevada Records of Criminal- History82nd Session (2023) – 14 – Investigation for submissionits report.on to the Federal Bureau of Investigation(d) forIf itsthe report.applicant is required to take an examination pursuant to NRS 631.240, 631.300 or 631.3121, submit with the application proof satisfactory that the applicant passed the examination.

(d) If the applicant is required to take an examination pursuant to NRS 631.240, 631.300 or 631.3121, submit with the application proof satisfactory that the applicant passed the examination.

The Secretary-Treasurer may, in accordance with regulationsdetermines adoptedthat byan theapplication Boardis:nd and if the Secretary-Treasurer determines(a) thatSufficient, anadvise applicationthe is:Executive Director of the sufficiency of the application.

- *AB147_R1* – 14 – (a) Sufficient, advise the Executive Director of the sufficiency of the application.

631.260 Except as otherwise provided in subsection [3] 4 of NRS 631.220, as soon as possible after the examination has been given, the Board, under rules and regulations adopted by it, shall determine the qualifications of the applicant and shall issue to each person found by the Board to have the qualifications therefor a license which will entitle the person to practice dental hygiene, dental therapy or dentistry, or any special branch of dentistry, as in suchsucSec. license defined, subject to the provisions of this chapter.

Sec.

(Deleted by amendment.)amendment.)e Sec.provisions of this chapter.

Sec.

- 82nd Session (2023) – 15 – (b) The criteria used to accredit each course [;] , including, without limitation, specific criteria used to accredit a course in teledentistry;

and (c) The requirements for submission of proof of attendance at courses.cou2.es.Except as otherwise provided in subsection 3, as part of continuing education, each licensee must complete a course of instruction, within 2 years after initial licensure, relating to the medical consequences of an act of terrorism that involves the use of a weapon of mass destruction.

2.

Except as otherwise provided in subsection 3, as part of continuing education, each licensee must complete a course of instruction, within 2 years after initial licensure, relating to the medical consequences of an act of terrorism that involves the use of a weapon of mass destruction.

- *AB147_R1* – 15 – 3.

(a) A course in Basic Disaster Life Support or a course in Core Disaster Life Support if the course is offered by a provider of continuing education accredited by the National Disaster Life SupportSup(b) Foundation;Any other course that the Board determines to be the equivalent of a course specified in paragraph (a).

or (b) Any other course that the Board determines to be the equivalent of a course specified in paragraph (a).

- 82nd Session (2023) – 16 – (a) At least 2 hours of continuing education concerning the life cycle of diseases, drugs and the administration of immunizations;

(b) A course offered by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services concerning the epidemiology and prevention of diseases that are preventable by immunization;

or - *AB147_R1* – 16 – (7) Any hospital accredited by The Joint Commission.

(a) “Act of terrorism” has the meaning ascribed to it in NRS(b) “Biological agent” has the meaning ascribed to it in NRS 202.4415.202.442.

(b) “Biological agent” has the meaning ascribed to it in NRS 202.442.

Suspension or revocation of a license to practice dentistry, the imposition of a fine or other disciplinary action by any agency of - 82nd Session (2023) – 17 – another state authorized to regulate the practice of dentistry in that state;

More than one act by the dentist, dental hygienist or dental therapist constituting substandard care in the practice of dentistry, dentalden5.l hygienehAdministering, dispensing or dentalprescribing therapy;any controlled substance or any dangerous drug as defined in chapter 454 of NRS, if it is not required to treat the dentist’s patient;

5.

Administering, dispensing or prescribing any controlled substance or any dangerous drug as defined in chapter 454 of NRS, if it is not required to treat the dentist’s patient;

- *AB147_R1* – 17 – 8.

9.616D.200, 616D.220, 616D.240 or 616D.300 to 616D.440, of NRS inclusive;

Conviction of violating any of the provisions of NRS 616D.200, 616D.220, 616D.240 or 616D.300 to 616D.440, inclusive;

15.- 82nd Session (2023) – 18 – restricts the ability of the patient to submit a complaint to the Board;

Requiring a patient to enter into an agreement that restricts the ability of the patient to submit a complaint to the Board;

or 19.

Failure to review diagnostic digital or conventional radiographs for orthodontia before:

(a) Making an initial diagnosis of or taking any action to correct malpositions of teeth;

or (b) The initial use of an orthodontic appliance;

20.

Failure to comply with the requirements of subsection 3 of 21.

Sec.Secs.

26.26-29.

27.

(Deleted by amendment.) Sec.

28.

(Deleted by amendment.) Sec.

29.

(Deleted by amendment.) Sec.

If a recipient of Medicaid presents in the emergency department of a hospital in this State with a nontraumatic dental - *AB147_R1* – 18 – injury, the hospital must notify the patient of providers of dental services included in the network of each health maintenance organization or managed care organization that provides services throughprovide teledentistrysuch tonotice by:o recipients of Medicaid.

The hospital shall provide1. such notice by:

1.

Making available to patients a pamphlet or other written document that includes the list of providers who offer services through teledentistry submitted to the hospital pursuant to - 82nd Session (2023) – 19 – NRS 695C.1708 or 695G.162, as applicable, or which directs patients to an Internet website on which those lists are available.

449.029 As used in NRS 449.029 to 449.240, inclusive, and section 30 of this act, unless the context otherwise requires, “medical facility” has the meaning ascribed to it in NRS 449.0151 and includes a program of hospice care described in NRS 449.196.

Each license issued pursuant to NRS 449.029 to 449.2428, inclusive, and section 30 of this act expires on December 31 following its issuance and is renewable for 1 year upon reapplication and payment of all fees required pursuant to subsectionfinds, 4after andan NRSinvestigation, 449.050,that asthe applicable,facility unlesshas not:ivision (a) Satisfactorily complied with the Divisionprovisions finds,of afterNRS an449.029 investigation,to that449.2428, inclusive, and section 30 of this act or the facilitystandards hasand not:regulations adopted by the Board;

(a)(b) SatisfactorilyObtained compliedthe withapproval of the provisionsDirector of NRSthe 449.029Department toof 449.2428,Health inclusive, and sectionHuman 30Services ofbefore thisundertaking acta orproject, theif standardssuch andapproval regulationsis adoptedrequired by theNRS Board;439A.100;

- *AB147_R1* – 19 – (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;

§ 1395ww(d)(1)(B)(iv), a psychiatric hospital that provides inpatient services to children, a psychiatric residential treatment facility, a residential- facility82nd forSession groups,(2023) a– program20 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.

Each reapplication for an agency to provide personal care services in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a facility for the care of adults during the day, a residential facility for groups or a home for individual residential care must include, without limitation, a statement that the holder of the license to operate, and the administrator or other person in charge and employees of, the facility, agency, pool or home are in compliance with the provisions of NRS 449.093.

- *AB147_R1* – 20 – (a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410 or 449.029 to 449.245, inclusive, and section 30 of this act or of any other law of this State or of the standards, rules and regulations adopted thereunder.

(d)- Conduct82nd Session (2023) – 21 – occupants or practiceemployees detrimentalof tothe facility.to the health or safety of the occupants(e) orFailure employeesof the applicant to obtain written approval from the Director of the facility.Department of Health and Human Services as required by NRS 439A.100 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and section 30 of this act and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required.

(e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and section 30 of this act and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required.

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

or abate a nuisance pursuant to NRS (c) Is ordered by the appropriate governmental agency to correct a violation of a building, safety or health code or regulation but fails to correct the violation.

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

-the *AB147_R1*information –available 21to –the public 4.

Sec.- 82nd Session (2023) – 22 – 449.163 1.RS 44In 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, and section 30 of this act or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

35.

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, and section 30 of this act or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

(c) If the license of the facility limits the occupancy of the facility and the facility has exceeded the approved occupancy, requirefacility thethat facility,is atlicensed;ts its own expense, to move patients to another facility(d) thatImpose isan licensed;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;

(d) Impose an administrative penalty of not more than $5,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum;

(a) Suspend the license of the facility until the administrative penaltypen(b) isCollect paid;court costs, reasonable attorney’s fees and other costs incurred to collect the administrative penalty.

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

The Division may require any facility that violates any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and - *AB147_R1* – 22 – section 30 of this act or any condition, standard or regulation adopted by the Board to make any improvements necessary to correct the violation.

Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 must be accounted for separately and used- to82nd administerSession and(2023) carry– out23 the– provisions of NRS 449.001 to 449.430, inclusive, and section 30 of this act, 449.435 to 449.531, inclusive, and chapter 449A of NRS to protect the health, safety, well-being and property of the patients and residents of facilities in accordance with applicable state and federal standards or for any other purpose authorized by the Legislature.

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

Sec.

(a) Require an enrollee to establish a relationship in person with a provider of health care or provide any additional consent to or reasonproviding forthe obtainingcoverage described in subsection 1;as a condition to (b) Require a provider of health care to demonstrate that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to providing the coverage described in subsection 1;

(b)(c) RequireRefuse a provider of health care to demonstrate that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to providing the coverage described in subsection 1;1 because of:

- *AB147_R1*82nd Session (2023) – 2324 – (c)provides Refuseservices tothrough providetelehealth or the coverageoriginating describedsite inat subsectionwhich 1an becauseenrollee of:receives services through telehealth;

(1) The distant site from which a provider of health care provides services through telehealth or the originating site at which an enrollee receives services through telehealth;

A health maintenance organization that provides medical services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health for Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall provide referrals to providers of dental services who provide services through teledentistry.

(b) At least quarterly, update the list and submit a copy of the updated list to the emergency department of each hospital located in this State;

andande emergency department of each hospital located (c) Allow such providers of dental services to include on claim forms codes for teledentistry services provided through both real- time interactions and asynchronous transmissions of medical and dental information.

- *AB147_R1*82nd –Session 24(2023) – (b)25 Provide– coverage for a service that is not a covered service or that is not provided by a covered provider of health care;

ororice (c) Enter into a contract with any provider of health care or cover any service if the health maintenance organization is not otherwise required by law to do so.

(d) “Teledentistry” has the meaning ascribed to it in section 5 of this(e) act.“Telehealth” has the meaning ascribed to it in NRS 629.515.

(e) “Telehealth” has the meaning ascribed to it in NRS 629.515.

(b) Require a provider of health care to demonstrate that it is necessary to provide services to an insured through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to providing the coverage des(c) Refuse to provide the coverage described in subsection 1;1 because of:

(c) Refuse to provide the coverage described in subsection 1 because of:

or (e)- Categorize82nd aSession service(2023) provided– through26 telehealth– differently for purposes relating to coverage than if the service had beenbeenently provided in person or through other means.

- *AB147_R1* – 25 – 3.

5.to recipients of Medicaid under the State Plan for Medicaid orces insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall:

A managed care organization that provides dental services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall:

6.organization to:ions of this section do not require a managed care (a) Ensure that covered services are available to an insured through telehealth at a particular originating site;

The provisions of this section do not require a managed care organization to:

(a) Ensure that covered services are available to an insured through telehealth at a particular originating site;

- 82nd Session (2023) – 27 – [5.] 7.

Evidence of coverage that is delivered, issued for delivery or renewed on or after October 1, 2021, has the legal effect of including the coverage required by this section, and any provision of the plan or the renewal which is in conflict with this section is void.voi[6.] 8.

[6.] 8.

- *AB147_R1* – 26 – (a) “Distant site” has the meaning ascribed to it in NRS 629.515.

The provisions of paragraph (b) of subsection 1 of section 7 of this(a) actThe donext notrenewal applyof tothe alicense personof describedthe inperson subsectionto 1practicentil: until:

(a) The next renewal of the license of the person to practice dentistry, dental hygiene or dental therapy on or after January 1, 2024;

40.5.

Not later than January 1, 2024, the Board of Dental Examiners of Nevada shall:

1.

Compile a report concerning the adoption of regulations pursuant to section 13 of this act.

The report must include, without limitation:

(a) A summary of the progress of the Board in adopting those regulations;

and - 82nd Session (2023) – 28 – (b) A copy of any such regulations that have been adopted or proposed to be adopted, the reasons for the content of those regulations and a summary of any comment received by the Board concerning those regulations.

Bureau for transmittal to the Joint Interim Standing Committee onsel Commerce and Labor.

Sec.

Sections 1 to 40,40.5, inclusive, of this act become effective:

H~~~~~ 23 - *AB147_R1*82nd Session (2023)