AB 386 — Revises provisions relating to midwives. (BDR 54-111)

Sectionor 31ge(2) inrepresenting authorizesthat thehe Divisionor toshe orderis aqualified person to ceaseengage andin desistthe frompractice performingof midwiferycertified orprofessional holdingmidwifery himselfwithout orsupervision. herself out as a midwife if:

(1)- his*AB386_R1* or– her4 license– ascomplaints that a licensedperson certifiedhas professionalrepeatedly midwifeviolated hasthe beenprovisions suspendedof section 31,ceived certify the facts to the Attorney General, or revoked;other appropriate law enforcement officer, who may, in his or her discretion, cause appropriate proceedings to be brought.

(2)Section he32 orauthorizes shethe isDivision or the subjectAttorney ofGeneral pendingto disciplinaryseek action;an injunction against any person violating any provision of sections 2-32.

or (3) he or she has voluntarily relinquished his or her license under certain circumstances.

Section 31 additionally authorizes the Division to, when it has reason to believe or has received complaints that a person has repeatedly violated the provisions of section 31, certify the facts to the Attorney General, or other appropriate law enforcement officer, who may, in authorizes the Division or the Attorney General to seek an injunction against any person violating any provision of sections 2-32.

(NRS 629.031) Existing law imposes certain requirements upon providers of health care, including requirements for billing, standards for advertisements and criminal penalties for acquiring certain debts.

(NRS 629.071, 629.076, 629.078) Section 35 of this bill includes licensed certified professional midwives in the definition of “provider of health care,” thereby subjecting licensed certified professional changemidwives to clarifythe thatsame licensedrequirements. certified professional midwives are providers of health care.

Section 76 of this bill makes a conforming change to clarify that licensed certified professional midwives are providers of health care.

Sections 48 and 49 of this bill provide that a licensed certified professional midwife is not liable for civil damages resulting from providing emergency care or gratuitous care to an indigent person under certain circumstances.

Section 70 of this bill requires a licensed certified professional midwife who attends a birth that occurs outside a hospital which is not also attended by a physician or advanced providespractice forregistered thenurse impositionto ofprepare a finebirth uponcertificate. a person who furnishes false information to a licensed certified professional midwife for the purpose of making incorrect certification of births or deaths.

ExistingSection law71 providesof that,this inbill anyprovides civilfor actionthe concerningimposition anyof unwelcomea orfine nonconsensualupon sexual conduct, there is a rebuttableperson presumptionwho thatfurnishes thefalse sexualinformation conductto wasa unwelcomelicensed orcertified nonconsensualprofessional ifmidwife for the allegedpurpose perpetratorof wasmaking aincorrect personcertification in a position of authoritybirths overor thedeaths. alleged victim.

(NRSExisting 41.138)law Section 47 of this bill provides thatthat, ain licensedany certifiedcivil professionalaction midwife,concerning certifiedany professionalunwelcome midwife student midwife or certifiednonconsensual professionalsexual midwifeconduct, birththere assistant is a perSectionsrebuttable 46,presumption 50-54,that 63,the 64,sexual 66-76a andposition 80-102 of thisauthority billover makethe revisionsalleged tovictim. treat licensed certified professional midwives similarly to other providers of health care in certain respects.

(NRS 41.138) Section 6547 of this bill requiresprovides Medicaidthat to cover the services of a licensed certified professional midwifemidwife, andcertified toprofessional providemidwife reimbursementstudent formidwife suchor servicescertified atprofessional ratesmidwife comparablebirth toassistant otheris providersa person of healthauthority carefor whothat providepurpose. - *AB386_R2* – 5 – similar services.

SectionSections 5646, 50-54, 63, 64, 66-76 and 80-102 of this bill makesmake arevisions conformingto changetreat tolicensed indicatecertified theprofessional propermidwives placementsimilarly ofto sectionother 65providers inof thehealth Nevadacare Revisedin Statutes.certain respects.

serveSection as65 of this bill requires Medicaid to cover the directorservices of a freestandinglicensed birthingcertified center.ed professional midwife and to Existingprovide lawreimbursement requiresfor asuch primaryservices at rates comparable to other providers of health care provider,who includingprovide aproper midwife,placement toof takesection certain65 actionsin the Nevada Revised Statutes.hange to facilitateindicate the detectionSection 77 of harmfulthis mutationsbill inauthorizes thea BRCAlicensed genecertified inprofessional patientsmidwife whoto areserve adultas women.the director of a freestanding birthing center.

Existing law requires a primary care provider, including a midwife, to take certain actions to facilitate the detection of harmful mutations in the BRCA gene in patients who are adult women.

- *AB386_R1* – 5 – THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Behavioral Health of the Department of Health and Human Services.

9.

“Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

- *AB386_R2* – 6 – Sec.

11.5.

“Midwifery” means the provision of care to clients before conception, while pregnant and during the postpartum period and to newborn infants.

The term includes, without limitation, the practice of certified professional midwifery.

Sec.

The term includes, - *AB386_R1* – 6 – without limitation, co-management of the care of a client with a qualified provider of health care.

3.

This chapter does not abridge, limit or otherwise affect the right of any person to deliver a baby in the manner and location that the person desires.

- *AB386_R2* – 7 – (b) One voting member who is aan representativeadvanced ofpractice theregistered generalnurse publicor andphysician whocurrently haspracticing receivedin carethe fromarea aof licensedobstetrics certifiedin professionalthis midwife;State;

and (c) One nonvotingvoting member towho serveis asa provider of health care, other than a liaisonprovider withof thehealth Division.care described in paragraph (a) or (b), who is currently providing neonatal or pediatric care in this State;

(d) One voting member who is a representative of the general public and who has received care from a licensed certified professional midwife;

(e) One nonvoting member who is a social worker licensed in this State or community organizer with experience in public health;

and (f) One nonvoting member to serve as a liaison with the Division.

The Board may adopt regulations, in consultation with the Division, to add not more than three members, in addition to the members appointed pursuant to subsection 2, to the Board.

4.

5.4.

- *AB386_R1* – 7 – (a) May solicit nominations for appointment to the Board from interested persons and entities.

(b) Shall give preference when appointing the members of the Board to candidates who have experience collaborating with licensed certified professional midwives or providing or utilizing midwifery services outside of a hospital.

6.5.

7.6.

8.7.

- *AB386_R2* – 8 – Sec.

In adopting regulations, the Board shall consider measures necessary to minimize the likelihood of serious harm to the clients of licensed certified professional midwives and the fetuses and newborn infants of such clients.

If- the*AB386_R1* Division– determines8 that– the(b) feesA collectedrequirement pursuantthat toan thisapplicant chapterfor will not cover the costsrenewal of thea Divisionlicense tomust performhave thecompleted dutiescontinuing prescribededucation byin thecultural provisionshumility ofor this chapter if that period is longer than 1 year, the Divisionelimination shall notify the Board of thatracism determination.or bias.

Upon receiving such notice, the Board shall adopt regulations pursuant to this paragraph to prescribe a period for which a license is valid that does not exceed 1 year.

(b) A requirement that an applicant for the renewal of a license must have completed continuing education in cultural humility or the elimination of racism or bias.

The regulations adopted pursuant to this paragraph must allow an applicant for the renewal of a license to satisfy that requirement by completing any continuing education in cultural humility or the elimination of racism or bias required by the North American Registry of Midwives, or its successor organization, to maintain certification by that organization.

Requirements governing the reinstatement of a license or special endorsement that has been revoked, including, without limitation, the procedure to apply for reinstatement and the minimum amount of time after the revocation that must pass before the person is authorized to apply for reinstatement.

Requirements governing the reinstatement of the authority to perform midwifery of a person who has been ordered to cease and desist from performing midwifery and holding himself or herself out as a midwife pursuant to section 31 of this act, including, without limitation, the procedure to apply for - *AB386_R2* – 9 – reinstatement and the minimum amount of time after the issuance of the order that must pass before the person is authorized to apply for reinstatement.

6.

7.6.

and - *AB386_R1* – 9 – (2) The information that must be included on the form for providing informed refusal to consent to consultation, co- management, referral or transfer pursuant to section 27 of this act and the management of a client who provides such informed refusal to consent.

8.7.

-8. *AB386_R2* – 10 – 9.

10.9.

11.10.

12.11.

19.5.

1.

The Board may establish by regulation an advisory committee to advise the Board concerning the regulations adopted pursuant to subsection 7 of section 19 of this act.

If such an advisory committee is established, the regulations adopted pursuant to this section must establish:

(a) The membership of the advisory committee;

(b) The terms of the members of the advisory committee;

and (c) The duties of the advisory committee.

2.

Any recommendations of an advisory committee established pursuant to this section must be based on current, peer-reviewed scientific evidence and widely accepted best practices.

Such recommendations may include, without limitation, recommendations concerning the transmission of information necessary for the care of a client from a licensed certified professional midwife to a provider of health care to whom the client is referred or a medical facility to which the client is transferred.

3.

Members of the advisory committee serve without compensation and are not entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally.

4.

A member of the advisory committee who is an officer or employee of this State or a political subdivision of this State must be relieved from his or her duties without loss of regular compensation to prepare for and attend meetings of the advisory committee and perform any work necessary to carry out the duties of the advisory committee in the most timely manner practicable.

A state agency or political subdivision of this State shall not require an officer or employee who is a member of the advisory committee to:

- *AB386_R2* – 11 – (a) Make up the time he or she is absent from work to carry out his or her duties as a member of the advisory committee;

or (b) Take annual leave or compensatory time for the absence.

Sec.

The application must be accompanied by a fee in the amount prescribed by regulation of the State Board of Health pursuant to NRS 439.150, which must not exceed $1,000, and:and a complete set of his or her fingerprints and written permission authorizing the Division to forward the fingerprints to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report.

(a) A complete set of his or her fingerprints and written permission authorizing the Division to forward the fingerprints to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report;

or (b) Written verification, on a form prescribed by the Division, stating that the fingerprints of the applicant were taken in this State and directly forwarded electronically or by another means to the Central Repository and that the applicant has given written permission to the law enforcement agency or other authorized entity taking the fingerprints to submit the fingerprints to the Central Repository for submission to the Federal Bureau of Investigation for its report.

2.

3.2.

A license as a licensed certified professional midwife may be renewed upon submission to the Division of a renewal - *AB386_R1* – 10 – application in the form prescribed by the Division.

4.3.

To the extent that the implementation of such provisions will leave the Division with sufficient money to carry out its duties - *AB386_R2* – 12 – under this chapter, the State Board of Health mayshall establish by regulation a procedure through which:

5.4.

A certified professional midwife birth assistant who is a licensed certified professional midwife or a certified nurse-- midwife*AB386_R1* – 11 – nurse-midwife is not required to possess the qualifications set forth in subsection 1.

- *AB386_R2* – 13 – (a) Administering medications, including, without limitation and to the extent applicable, any medication described in subsection 2 of section 25 of this act, intradermally, subcutaneously and intramuscularly and performing skin tests;

- *AB386_R1* – 12 – Sec.

(b) An applicant for the issuance of a license as a licensed certified professional midwife in this State shall submit to the Division of Public and Behavioral Health of the Department of - *AB386_R2* – 14 – Health and Human Services the statement prescribed by the Division of Welfare and Supportive Services of the Department of Health and Human Services pursuant to NRS 425.520.

The - *AB386_R1* – 13 – preceptor is responsible for each client to whom the certified professional midwife student midwife provides midwifery services.

A certified professional midwife student midwife may administer or implant a contraceptive device or possess and administer a drug prescribed by the regulations adopted pursuant to paragraph (b) of subsection 1 of section 26 of this act only under the direct supervision of a preceptor who is a licensed certified professional midwife, holds the appropriate special endorsement issued pursuant to section 26 of this act authorizing - *AB386_R2* – 15 – the preceptor to engage in such activity and is present on the premises and able to intervene if necessary.

- *AB386_R1* – 14 – (a) The type of midwife that the midwife is;

- *AB386_R2* – 16 – The midwife shall retain a copy of the Community Birth Disclosure for 5 years.

and - *AB386_R1* – 15 – (i) Any other information required by regulation of the Board.

(a) Dopplers, syringes, needles, phlebotomy equipment, sutures, urinary catheters, intravenous equipment, amnihooks, airway suction devices, electronic fetal monitors, tocodynamometer monitors, equipment for administering oxygen, glucose monitoring systems and testing strips, neonatal and adult - *AB386_R2* – 17 – oximetry equipment, centrifuges and equipment for conducting screenings of hearing ability;

- *AB386_R1* – 16 – (a) A special endorsement of the license authorizing the licensed certified professional midwife to order, dispense, administer and implant contraceptive devices for a client.

- *AB386_R2* – 18 – 2.

(b) The period for which a special endorsement is valid, which must not exceed the2 lengthyears. of the period for which the license of the holder of the endorsement is valid.

- *AB386_R1* – 17 – 4.

Except as otherwise provided in subsections 4 and 5, a licensed certified professional midwife must recommend and, with the consent of the client, arrange for consultation or co- management with or referral to a qualified provider of health care or transfer to an appropriate medical facility if the licensed - *AB386_R2* – 19 – certified professional midwife determines that any of the following conditions or symptoms exist:

- *AB386_R1* – 18 – (b) The condition or symptom for which the recommendation was made;

and (d) If the client provides consent, the name, profession and specialty of the provider of health care with whom the licensed certified professional midwife consulted or co-managed or to - *AB386_R2* – 20 – whom the client was referred or the medical facility to which the client was transferred.

(a) Subsection 1 exists and making a reasonable effort to arrange for consultation with, co-management of the condition or symptom with or referral of the client to a qualified provider of health care or the transfer of the client to an appropriate medical facility, a licensed certified professional midwife is unable to - *AB386_R1* – 19 – locate a qualified provider of health care who is willing to consult, co-manage or accept the referral or an appropriate medical facility willing to accept the transfer, the licensed certified professional midwife shall be deemed to be in compliance with the requirements of this section and is not liable for any damages resulting from the inability of the licensed certified professional midwife to consult, co-manage, refer or transfer.

If the condition - *AB386_R2* – 21 – or symptom threatens the life or health of the client or the fetus or newborn infant of the client during labor or delivery, the licensed certified professional midwife must call 911 and provide care until relieved by a qualified provider of health care.

With each application for the renewal of his or her license, a licensed certified professional midwife shall submit to the Division a report,report in the form prescribed by the Division, that includes, for the immediately preceding licensure period:

- *AB386_R1* – 20 – (e) A brief description of any complications resulting in maternal or infant morbidity or mortality;

- *AB386_R2* – 22 – Sec.

Except as otherwise provided in this chapter, the record ismust abe publicopen recordto forpublic theinspection purposesat ofall chapterreasonable 239times. of NRS.

- *AB386_R1* – 21 – 4.

- *AB386_R2* – 23 – Sec.

A person who is not licensed as a licensed certified professional midwife or a person whose license as a licensed certified professional midwife has been suspended or revoked by the Division may use or list the words or headings described in paragraph (a) or (b) of subsection 1 if the person is licensed in the District of Columbia or any state or territory of the United StatesStates. and is not subject to an order issued pursuant to subsection 5.

A person who is licensed as a licensed certified professional midwife and who is also licensed to perform midwifery in any capacity in the District of Columbia or any state or territory of the United States shall disclose each additional district, state or territory, as applicable, in which he or she is currently licensed or has ever been licensed in all circumstances described in paragraphs (a) and (b) of subsection 1.

If the license of such a person to perform midwifery has been revoked or suspended in the other district, state or territory, the person shall not perform midwifery or hold himself or herself out as a midwife until his or her license in the other district, state or territory is reinstated to an active and valid status.

or - *AB386_R2**AB386_R1* – 2422 – (b) Use in connection with his or her name the words “licensed certified professional midwife,” “certified professional midwife,” “licensed midwife” or any other letters, words or insignia indicating or implying that he or she is licensed to engage in the practice of certified professional midwifery without supervision, or in any other way, orally, or in writing or print, or by sign, directly or by implication, represent himself or herself as licensed to engage in the practice of certified professional midwifery without supervision in this State.

The Division may order a person to cease and desist from performing midwifery and holding himself or herself out as a midwife if:

(a) The person’s license as a licensed certified professional midwife has been suspended or revoked;

(b) The person has disciplinary action pending against him or her pursuant to this chapter;

or (c) The person has voluntarily relinquished his or her license while a complaint is pending against the person which alleges a violation which:

(1) Has caused serious injury, serious harm or serious impairment of public health;

or (2) Indicates that the person would be likely to cause serious injury, serious harm or serious impairment of public health if the person continues to perform midwifery.

6.

A person shall not perform midwifery or hold himself or herself out as a midwife after receiving an order to cease and desist from those activities pursuant to subsection 5 unless the Division has reinstated his or her license to practice licensed certified professional midwifery or his or her authority to perform midwifery in accordance with the regulations adopted pursuant to section 19 of this act.

7.

- *AB386_R2* – 25 – (b) Does not relieve any person or business entity from any other legal action.

Notwithstanding the provisions of NRS 623.225, 623A.185, 624.268, 625.387, 625A.105, 628.0345, 628B.320, 630.197, 630A.246, 631.225, 632.3446, 633.307, 634.095, 634A.115, 635.056, 636.159, 637.113, 637B.166, 638.103, 639.129, 640.095, 640A.145, 640B.340, 640C.430, 640D.120, 640E.200, 641.175, 641A.215, 641B.206, 641C.280, 641D.330, 642.0195, 643.095, 644A.485, 645.358, 645A.025, 645B.023, 645B.420, 645C.295, 645C.655, 645D.195, 645G.110, 645H.550, 648.085, 649.233, - *AB386_R1* – 23 – 652.075, 653.550, 654.145, 655.075 and 656.155, and section 22 of this act, an applicant for a license who does not have a social security number must provide an alternative personally identifying number, including, without limitation, his or her individual taxpayer identification number, when completing an application for a license.

A regulatory body that regulates a profession pursuant to chapters 630, 630A, 632 to 641D, inclusive, and sections 2 to 32, inclusive, of this act, 644A or 653 of NRS in this State may enter into a reciprocal agreement with the corresponding - *AB386_R2* – 26 – regulatory authority of the District of Columbia or any other state or territory of the United States for the purposes of:

(b) [Has] Except as otherwise provided in this paragraph, has been in practice for at least the 5 years immediately preceding the - *AB386_R1* – 24 – date on which the person submits an application for the issuance of a license pursuant to a reciprocal agreement entered into pursuant to subsection 1.

If the regulatory body enters into a reciprocal agreement pursuant to subsection 1, the regulatory body must prepare an annual report before January 31 of each year outlining the progress of the regulatory body as it relates to the reciprocal agreement and - *AB386_R2* – 27 – submit the report to the Director of the Legislative Counsel Bureau for transmittal to the next session of the Legislature in odd- numbered years or to the Joint Interim Standing Committee on Health and Human Services in even-numbered years.

- *AB386_R1* – 25 – (m) A podiatric physician;

or - *AB386_R2* – 28 – (dd) A medical facility as the employer of any person specified in this subsection.

- *AB386_R1* – 26 – (d) Homeopathic physicians who are called into this State, other than on a regular basis, for consultation or assistance to any physician licensed in this State, and who are legally qualified to practice in the state or country where they reside.

(a) Any physician, dentist, dental hygienist, licensed certified professional midwife, chiropractic physician, optometrist, podiatric physician, medical examiner, resident, intern, professional or practical nurse, nursing assistant, medication aide - certified, perfusionist, physician assistant licensed pursuant to chapter 630 or 633 of NRS, psychiatrist, psychologist, marriage and family - *AB386_R2* – 29 – therapist, clinical professional counselor, alcohol or drug counselor, peer recovery support specialist, peer recovery support specialist supervisor, music therapist, holder of a license or limited license issued pursuant to chapter 653 of NRS, driver of an ambulance, paramedic or other person providing medical services licensed or certified to practice in this State.

- *AB386_R1* – 27 – (h) Any employee of a law enforcement agency or a county’s office for protective services or an adult or juvenile probation officer.

- *AB386_R2* – 30 – 4.

(b) A medical officer of the Armed Forces or a medical officer of any division or department of the United States in the discharge of his or her official duties, including, without limitation, providing - *AB386_R1* – 28 – medical care in a hospital in accordance with an agreement entered into pursuant to NRS 449.2455.

- *AB386_R2* – 31 – Sec.

- *AB386_R1* – 29 – 2.

An optometrist who is certified by the Nevada State Board of Optometry to prescribe and administer pharmaceutical agents - *AB386_R2* – 32 – pursuant to NRS 636.288, when the optometrist prescribes or administers pharmaceutical agents within the scope of his or her certification [.] ;

- *AB386_R1* – 30 – Sec.

- *AB386_R2* – 33 – 2.

- *AB386_R1* – 31 – (a) A person licensed pursuant to chapter 630, 630A, 631, 632, 633, 634, 634A, 635, 640, 640A or 640B of NRS or sections 2 to 32, inclusive, of this act if the massage therapy, reflexology or structural integration is performed in the course of the practice for which the person is licensed.

- *AB386_R2* – 34 – (e) A person who is an employee of an athletic department of any high school, college or university in this State and who, within the scope of that employment, practices massage therapy, reflexology or structural integration on athletes.

The provisions of this chapter do not prohibit a county, city or town from requiring a massage therapist, reflexologist or structural integration practitioner to obtain a license or permit to transact business within the jurisdiction of the county, city or town, - *AB386_R1* – 32 – if the license or permit is required of other persons, regardless of occupation or profession, who transact business within the jurisdiction of the county, city or town.

and - *AB386_R2* – 35 – (d) Fifteen percent of the amount of recovery that exceeds $600,000.

(b) “Provider of health care” means a physician licensed under chapter 630 or 633 of NRS, dentist, registered nurse, licensed certified professional midwife, dispensing optician, optometrist, registered physical therapist, podiatric physician, licensed - *AB386_R1* – 33 – psychologist, chiropractic physician, doctor of Oriental medicine, holder of a license or a limited license issued under the provisions of chapter 653 of NRS, medical laboratory director or technician, licensed dietitian or a licensed hospital and its employees.

- *AB386_R2* – 36 – (b) “Sexual harassment” has the meaning ascribed to it in NRS 176A.280.

and - *AB386_R1* – 34 – (b) Gratuitously and in good faith, renders medical care within the scope of that person’s license to an indigent person,  is not liable for any civil damages as a result of any act or omission by that person, not amounting to gross negligence or reckless, willful or wanton conduct, in rendering that care.

Any person licensed under the provisions of chapter 630, 632 or 633 of NRS or sections 2 to 32, inclusive, of this act and any person who holds an equivalent license issued by another state who renders emergency obstetrical care or assistance - *AB386_R2* – 37 – to a pregnant woman during labor or the delivery of the child is not liable for any civil damages as a result of any act or omission by that person in rendering that care or assistance if:

41A.017 “Provider of health care” means a physician licensed pursuant to chapter 630 or 633 of NRS, physician assistant, dentist, licensed nurse, licensed certified professional midwife, dispensing optician, optometrist, registered physical therapist, podiatric physician, licensed psychologist, chiropractic physician, doctor of Oriental medicine, holder of a license or a limited license issued - *AB386_R1* – 35 – under the provisions of chapter 653 of NRS, medical laboratory director or technician, licensed dietitian or a licensed hospital, clinic, surgery center, physicians’ professional corporation or group practice that employs any such person and its employees.

- *AB386_R2* – 38 – 2.

A judgment ordering the payment of future damages by periodic payments entered pursuant to subsection 3 must specify the recipient or recipients of the payments, the dollar amount of the - *AB386_R1* – 36 – payments, the interval between payments, and the number of payments or the period of time over which payments will be made.

- *AB386_R2* – 39 – 7.

(d) “Provider of health care” means a physician licensed under chapter 630 or 633 of NRS, dentist, licensed nurse, licensed certified professional midwife, dispensing optician, optometrist, registered physical therapist, podiatric physician, licensed psychologist, chiropractic physician, doctor of Oriental medicine, holder of a license or a limited license issued under the provisions of - *AB386_R1* – 37 – chapter 653 of NRS, medical laboratory director or technician, licensed dietitian or a licensed hospital and its employees.

- *AB386_R2* – 40 – (a) Except as otherwise provided in subsection 2, report the abuse, neglect, exploitation, isolation or abandonment of the older person or vulnerable person to:

Each agency, after reducing a report to writing, shall forward a copy of the report to the Aging and Disability Services Division of - *AB386_R1* – 38 – the Department of Health and Human Services and the Unit for the Investigation and Prosecution of Crimes.

- *AB386_R2* – 41 – (b) Any personnel of a hospital or similar institution engaged in the admission, examination, care or treatment of persons or an administrator, manager or other person in charge of a hospital or similar institution upon notification of the suspected abuse, neglect, exploitation, isolation or abandonment of an older person or vulnerable person by a member of the staff of the hospital.

- *AB386_R1* – 39 – (i) Any person who maintains or is employed by a facility or establishment that provides care for older persons or vulnerable persons.

If a person who is required to make a report pursuant to subsection 1 knows or has reasonable cause to believe that an older person or vulnerable person has died as a result of abuse, neglect, - *AB386_R2* – 42 – isolation or abandonment, the person shall, as soon as reasonably practicable, report this belief to the appropriate medical examiner or coroner, who shall investigate the cause of death of the older person or vulnerable person and submit to the appropriate local law enforcement agencies, the appropriate prosecuting attorney, the Aging and Disability Services Division of the Department of Health and Human Services and the Unit for the Investigation and Prosecution of Crimes his or her written findings.

- *AB386_R1* – 40 – 8.

- *AB386_R2* – 43 – (a) Pursuant to a criminal prosecution;

- *AB386_R1* – 41 – (e) A person engaged in bona fide research, but the identity of the subjects of the report must remain confidential;

- *AB386_R2* – 44 – (k) An attorney appointed by a court to represent a protected person in a guardianship proceeding pursuant to NRS 159.0485, if:

If data or information concerning the reports and investigations of the abuse, neglect, exploitation, isolation or abandonment of an older person or a vulnerable person is made - *AB386_R1* – 42 – available pursuant to paragraph (b) or (j) of subsection 3 or subsection 4, the name and any other identifying information of the person who made the report must be redacted before the data or information is made available.

(b) If the revenue of the board from all sources is $200,000 or more for any fiscal year, or if the board is a regulatory body pursuant to NRS 622.060 and has failed to submit to the Director of - *AB386_R2* – 45 – the Legislative Counsel Bureau for each quarter of that fiscal year the information required by NRS 622.100, engage the services of a certified public accountant or public accountant, or firm of either of such accountants, to audit all its fiscal records for that fiscal year and file a report of the audit with the Legislative Auditor and the Chief of the Budget Division of the Office of Finance on or before December 1 following the end of that fiscal year.

- *AB386_R1* – 43 – 4.

The provisions of this subsection do not - *AB386_R2* – 46 – apply to a state officer who may be removed from office only by impeachment pursuant to Article 7 of the Nevada Constitution.

(b) Shall administer, through the divisions of the Department, the provisions of chapters 63, 424, 425, 427A, 432A to 442, inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and section 65 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, - *AB386_R1* – 44 – and 445A.010 to 445A.055, inclusive, and all other provisions of law relating to the functions of the divisions of the Department, but is not responsible for the clinical activities of the Division of Public and Behavioral Health or the professional line activities of the other divisions.

- *AB386_R2* – 47 – (4) Identify the sources of funding for services provided by the Department and the allocation of that funding;

Except as otherwise provided in this section and NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.0397, 41.071, 49.095, - *AB386_R1* – 45 – 49.293, 62D.420, 62D.440, 62E.516, 62E.620, 62H.025, 62H.030, 62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 80.113, 81.850, 82.183, 86.246, 86.54615, 87.515, 87.5413, 87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A.270, 116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 119A.280, 119A.653, 119A.677, 119B.370, 119B.382, 120A.640, 120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 130.712, 136.050, 159.044, 159A.044, 172.075, 172.245, 176.015, 176.0625, 176.09129, 176.156, 176A.630, 178.39801, 178.4715, 178.5691, 179.495, 179A.070, 179A.165, 179D.160, 200.3771, 200.3772, 200.5095, 200.604, 202.3662, 205.4651, 209.392, 209.3923, 209.3925, 209.419, 209.429, 209.521, 211A.140, 213.010, 213.040, 213.095, 213.131, 217.105, 217.110, 217.464, 217.475, 218A.350, 218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 224.240, 226.300, 228.270, 228.450, 228.495, 228.570, 231.069, 231.1473, 232.1369, 233.190, 237.300, 239.0105, 239.0113, 239.014, 239B.026, 239B.030, 239B.040, 239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 239C.420, 240.007, 241.020, 241.030, 241.039, 242.105, 244.264, 244.335, 247.540, 247.550, 247.560, 250.087, 250.130, 250.140, 250.150, - *AB386_R2* – 48 – 268.095, 268.0978, 268.490, 268.910, 269.174, 271A.105, 281.195, 281.805, 281A.350, 281A.680, 281A.685, 281A.750, 281A.755, 281A.780, 284.4068, 284.4086, 286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 293.906, 293.908, 293.910, 293B.135, 293D.510, 331.110, 332.061, 332.351, 333.333, 333.335, 338.070, 338.1379, 338.1593, 338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 353A.049, 353A.085, 353A.100, 353C.240, 360.240, 360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 387.631, 388.1455, 388.259, 388.501, 388.503, 388.513, 388.750, 388A.247, 388A.249, 391.033, 391.035, 391.0365, 391.120, 391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 394.1698, 394.447, 394.460, 394.465, 396.1415, 396.1425, 396.143, 396.159, 396.3295, 396.405, 396.525, 396.535, 396.9685, 398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 414.280, 416.070, 422.2749, 422.305, 422A.342, 422A.350, 425.400, 427A.1236, 427A.872, 432.028, 432.205, 432B.175, 432B.280, 432B.290, 432B.4018, 432B.407, 432B.430, 432B.560, 432B.5902, 432C.140, 432C.150, 433.534, 433A.360, 439.4941, 439.4988, 439.840, 439.914, 439A.116, - *AB386_R1* – 46 – 439A.124, 439B.420, 439B.754, 439B.760, 439B.845, 440.170, 441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 442.774, 445A.665, 445B.570, 445B.7773, 447.345, 449.209, 449.245, 449.4315, 449A.112, 450.140, 450B.188, 450B.805, 453.164, 453.720, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 463.790, 467.1005, 480.535, 480.545, 480.935, 480.940, 481.063, 481.091, 481.093, 482.170, 482.368, 482.5536, 483.340, 483.363, 483.575, 483.659, 483.800, 484A.469, 484B.830, 484B.833, 484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, 571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 598A.420, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 612.265, 616B.012, 616B.015, 616B.315, 616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 628B.760, 629.047, 629.069, 630.133, 630.2671, 630.2672, 630.2673, 630.30665, 630.336, 630A.327, 630A.555, 631.332, 631.368, 632.121, 632.125, 632.3415, 632.3423, 632.405, 633.283, 633.301, 633.4715, 633.4716, 633.4717, 633.524, 634.055, 634.1303, 634.214, 634A.169, 634A.185, 635.111, 635.158, 636.262, 636.342, 637.085, 637.145, 637B.192, 637B.288, 638.087, 638.089, 639.183, 639.2485, 639.570, 640.075, 640.152, 640A.185, - *AB386_R2* – 49 – 640A.220, 640B.405, 640B.730, 640C.580, 640C.600, 640C.620, 640C.745, 640C.760, 640D.135, 640D.190, 640E.225, 640E.340, 641.090, 641.221, 641.2215, 641.325, 641A.191, 641A.217, 641A.262, 641B.170, 641B.281, 641B.282, 641C.455, 641C.760, 641D.260, 641D.320, 642.524, 643.189, 644A.870, 645.180, 645.625, 645A.050, 645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 645D.135, 645G.510, 645H.320, 645H.330, 647.0945, 647.0947, 648.033, 648.197, 649.065, 649.067, 652.126, 652.228, 653.900, 654.110, 656.105, 657A.510, 661.115, 665.130, 665.133, 669.275, 669.285, 669A.310, 671.170, 673.450, 673.480, 675.380, 676A.340, 676A.370, 677.243, 678A.470, 678C.710, 678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 679B.285, 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 687A.060, 687A.115, 687B.404, 687C.010, 688C.230, 688C.480, 688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 692C.3538, 692C.354, 692C.420, 693A.480, 693A.615, 696B.550, 696C.120, 703.196, 704B.325, 706.1725, 706A.230, 710.159, 711.600, and section 30 of this act, sections 35, 38 and 41 of chapter 478, Statutes of Nevada 2011 and section 2 of chapter 391, Statutes of Nevada 2013 and unless otherwise declared by law to be confidential, all public books and public records of a governmental entity must be open at all times during office hours to inspection by - *AB386_R1* – 47 – any person, and may be fully copied or an abstract or memorandum may be prepared from those public books and public records.

If requested, a governmental entity shall provide a copy of a public record in an electronic format by means of an electronic - *AB386_R2* – 50 – medium.

- *AB386_R1* – 48 – Sec.

The provisions of this - *AB386_R2* – 51 – subsection do not govern the Legislative Commission with respect to the personnel of the Legislative Counsel Bureau.

- *AB386_R1* – 49 – Sec.

- *AB386_R2* – 52 – (a) A board created by the provisions of NRS 590.485 and chapters 623 to 625A, inclusive, 628, 630 to 644A, inclusive, and sections 2 to 32, inclusive, of this act, 648, 654 and 656 of NRS.

- *AB386_R1* – 50 – (a) A board created by the provisions of NRS 590.485 and chapters 623 to 625A, inclusive, 628, 630 to 644A, inclusive, and sections 2 to 32, inclusive, of this act, 648, 654 and 656 of NRS.

and - *AB386_R2* – 53 – (c) The identification of each agency that has weaknesses in its system of internal accounting and administrative control, and the extent and types of such weaknesses.

- *AB386_R1* – 51 – 4.

- *AB386_R2* – 54 – 8.

and (c) The purchase of the medical device is made pursuant to a contract between the governmental entity that purchases the medical - *AB386_R1* – 52 – device and the person who sells the medical device to the governmental entity.

In administering the provisions of NRS 374.330, the Department shall apply the exemption to the sale of a medical - *AB386_R2* – 55 – device to a governmental entity that is exempt pursuant to that section without regard to whether the person using the medical device or the governmental entity that purchased the device is deemed to be the holder of title to the device if:

(c) “Provider of health care” means a physician or physician assistant licensed pursuant to chapter 630, 630A or 633 of NRS, - *AB386_R1* – 53 – perfusionist, dentist, licensed nurse, licensed certified professional midwife, dispensing optician, optometrist, practitioner of respiratory care, registered physical therapist, podiatric physician, licensed psychologist, licensed audiologist, licensed speech-language pathologist, licensed hearing aid specialist, licensed marriage and family therapist, licensed clinical professional counselor, chiropractic physician, licensed dietitian or doctor of Oriental medicine in any form.

The Department or a managed care organization, including, without limitation, a health maintenance organization, that provides health care services to recipients of Medicaid under - *AB386_R2* – 56 – the State Plan for Medicaid may charge a copayment or coinsurance or apply a deductible for the services described in subsection 1.

- *AB386_R1* – 54 – (a) A person directly responsible or serving as a volunteer for or an employee of a public or private home, institution or facility where the child is receiving child care outside of the home for a portion of the day, the person shall make the report to a law enforcement agency.

Any person who is described in paragraph (a) of subsection 4 who delivers or provides medical services to a newborn infant and who, in his or her professional or occupational capacity, knows or has reasonable cause to believe that the newborn infant has been affected by a fetal alcohol spectrum disorder or prenatal substance use disorder or has withdrawal symptoms resulting from prenatal substance exposure shall, as soon as reasonably practicable but not later than 24 hours after the person knows or has reasonable cause to believe that the newborn infant is so affected or has such symptoms, notify an agency which provides child welfare services of the condition of the infant and refer each person who is responsible for the welfare of the infant to an agency which provides child welfare - *AB386_R2* – 57 – services for appropriate counseling, training or other services.

- *AB386_R1* – 55 – (e) A person employed by a public school or private school and any person who serves as a volunteer at such a school.

(m) Any person who is enrolled with the Division of Health Care Financing and Policy of the Department of Health and Human - *AB386_R2* – 58 – Services to provide doula services to recipients of Medicaid pursuant to NRS 422.27177.

The written findings must include, if - *AB386_R1* – 56 – obtainable, the information required pursuant to the provisions of subsection 2 of NRS 432B.230.

- *AB386_R2* – 59 – (a) Inform the person, in writing or by electronic communication, of his or her duty as a mandatory reporter pursuant to this section;

- *AB386_R1* – 57 – Sec.

- *AB386_R2* – 60 – (a) Any oral or written comment made or submitted to it by members of the public or by persons or facilities affected by the regulation;

- *AB386_R1* – 58 – Sec.

- *AB386_R2* – 61 – [(c)] (d) The person giving birth or other parent or, if the other parent is absent and the person giving birth is incapacitated, the person in charge of the premises where the birth occurred.

- *AB386_R1* – 59 – (b) Widowed at the time of birth but married at the time of conception, the name of the spouse of the person giving birth at the time of conception must be entered on the certificate as the other parent of the child unless:

or (c) The parents of the child have signed a declaration for the voluntary acknowledgment of paternity developed by the Board pursuant to NRS 440.283 or a declaration for the voluntary acknowledgment of parentage developed by the Board pursuant to - *AB386_R2* – 62 – NRS 440.285.

- *AB386_R1* – 60 – Sec.

and - *AB386_R2* – 63 – (b) If the patient wishes to be tested, conduct any test which is medically indicated for the patient or assist the patient with obtaining any such test, to the extent practicable for the physician, physician assistant, advanced practice registered nurse or midwife.

A physician, physician assistant, advanced practice registered nurse, midwife or hospital is not required to comply with the requirements of subsection 1 or 2 if the physician, physician assistant, advanced practice registered nurse or midwife or a - *AB386_R1* – 61 – provider of health care who provides emergency medical services or primary care to the patient at the hospital, as applicable, reasonably believes that the patient:

- *AB386_R2* – 64 – (b) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.

- *AB386_R1* – 62 – (1) A Certified Professional Midwife by the North American Registry of Midwives, or its successor organization;

or - *AB386_R2* – 65 – (j) The holder of a certificate of registration as a pharmacist.

- *AB386_R1* – 63 – (e) A licensed certified professional midwife.

76.5.

NRS 449.103 is hereby amended to read as follows:

449.103 1.

To enable an agent or employee of a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed who provides care to a patient or resident of the facility to more effectively treat patients or care for residents, as applicable, the Board shall, by regulation, require such a facility to conduct training relating specifically to cultural competency for any agent or employee of the facility who provides care to a patient or resident of the facility so that such an agent or employee may better understand patients or residents who have different cultural backgrounds, including, without limitation, patients or residents who are:

(a) From various racial and ethnic backgrounds;

- *AB386_R2* – 66 – (b) From various religious backgrounds;

(c) Persons with various sexual orientations and gender identities or expressions;

(d) Children and senior citizens;

(e) Persons with a mental or physical disability;

and (f) Part of any other population that such an agent or employee may need to better understand, as determined by the Board.

2.

The training relating specifically to cultural competency conducted by a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed pursuant to subsection 1 must be provided through a course or program that is approved by the Department of Health and Human Services.

3.

The regulations adopted pursuant to this section must authorize a licensed certified professional midwife who is subject to the requirements of subsection 1 to use the training required by the regulations adopted pursuant to paragraph (b) of subsection 1 of section 19 of this act to satisfy the requirements of subsection 1.

Sec.

and (II) Provides instruction and training in the Essential Competencies for Midwifery Practice prescribed by the - *AB386_R2* – 67 – International Confederation of Midwives, or its successor organization;

- *AB386_R1* – 64 – Sec.

and (d) If the licensed certified professional midwife holds an endorsement issued pursuant to paragraph (b) of subsection 1 of section 26 of this act, prescribing and dispensing any drug - *AB386_R2* – 68 – authorized by the regulations adopted by the Board of Licensed Certified Professional Midwives pursuant to section 26 of this act.

(b) A physician assistant licensed pursuant to chapter 630 or 633 of NRS, at the direction of his or her supervising physician or a - *AB386_R1* – 65 – licensed dental hygienist acting in the office of and under the supervision of a dentist.

- *AB386_R2* – 69 – (h) A respiratory therapist employed in a health care facility.

- *AB386_R1* – 66 – (1) In the presence of a physician or a registered nurse;

- *AB386_R2* – 70 – (1) Is trained in and certified to carry out standards and practices for immunization programs;

- *AB386_R1* – 67 – (s) A registered pharmacist pursuant to written guidelines and protocols developed pursuant to NRS 639.2629 or a collaborative practice agreement, as defined in NRS 639.0052.

- *AB386_R2* – 71 – Sec.

(a) Attempt to determine whether each adult woman to whom he or she provides care has a personal or family history of breast, - *AB386_R1* – 68 – ovarian, tubal or peritoneal cancer or an ancestry associated with a harmful mutation in the BRCA gene or meets any other criteria under which the United States Preventive Services Task Force has recommended screening for a risk of such a mutation;

- *AB386_R2* – 72 – 2.

- *AB386_R1* – 69 – (I) Cities and towns;

- *AB386_R2* – 73 – (c) Number of policies issued;

and - *AB386_R1* – 70 – (2) Claims that have arisen but are unpaid;

- *AB386_R2* – 74 – (d) Variable and fixed annuities;

- *AB386_R1* – 71 – (i) Health insurance offered through a group health plan maintained by a large employer;

At any hearing which is held by the Commissioner to determine whether rates comply with the provisions of NRS 686B.010 to 686B.1799, inclusive, and which involves rates for insurance covering the liability of a practitioner licensed pursuant to chapter 630, 631, 632 or 633 of NRS or sections 2 to 32, inclusive, of this act for a breach of the practitioner’s professional duty toward a patient, if a person is not otherwise authorized pursuant to this title to become a party to the hearing by intervention, the person is entitled to provide testimony at the hearing if, not later than 2 days - *AB386_R2* – 75 – before the date set for the hearing, the person files with the Commissioner a written statement which states:

(a) The Commissioner may, if the Commissioner finds it necessary to preserve order, prevent inordinate delay or protect the - *AB386_R1* – 72 – rights of the parties at the hearing, place reasonable limitations on the duration of the testimony and prohibit the person from providing testimony that is not relevant to the issues raised at the hearing.

or - *AB386_R2* – 76 – (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments, including any changes to the fee schedule applicable to the provider’s practice, specified in paragraph (a) within 7 days after receiving the request.

An insurer that issues a policy of group health insurance shall not charge a provider of health care a fee to include - *AB386_R1* – 73 – the name of the provider on a list of providers of health care given by the insurer to its insureds.

- *AB386_R2* – 77 – Sec.

- *AB386_R1* – 74 – 3.

Each insurer which issues a policy of insurance covering the liability of a practitioner licensed pursuant to chapters 630 to 640, inclusive, of NRS or sections 2 to 32, inclusive, of this act or who holds a license or limited license issued pursuant to chapter 653 of - *AB386_R2* – 78 – NRS for a breach of his or her professional duty toward a patient shall report to the board which licensed the practitioner within 45 days each settlement or award made or judgment rendered by reason of a claim, if the settlement, award or judgment is for more than $5,000, giving the name of the claimant and the practitioner and the circumstances of the case.

A practitioner licensed pursuant to chapters 630 to 640, inclusive, of NRS or sections 2 to 32, inclusive, of this act or who holds a license or limited license issued pursuant to chapter 653 of NRS who does not have insurance covering liability for a breach of his or her professional duty toward a patient shall report to the board - *AB386_R1* – 75 – which issued the practitioner’s license within 45 days of each settlement or award made or judgment rendered by reason of a claim, if the settlement, award or judgment is for more than $5,000, giving the practitioner’s name, the name of the claimant and the circumstances of the case.

- *AB386_R2* – 79 – (a) An amount that is not more than twice the amount of the premium for the claims-made policy at the time of the termination of that policy;

Except as otherwise provided in this section, if an insurer issues a policy of professional liability insurance to a practitioner licensed pursuant to chapter 630, 632 or 633 of NRS or sections 2 to 32, inclusive, of this act who delivers one or more babies per year, the insurer shall not set the premium for the policy at a rate that is different from the rate set for such a policy issued by - *AB386_R1* – 76 – the insurer to any other practitioner licensed pursuant to chapter 630, 632 or 633 of NRS or sections 2 to 32, inclusive, of this act who delivers one or more babies per year if the difference in rates is based in whole or in part upon the number of babies delivered per year by the practitioner.

If an agreement settles a claim or action against a practitioner licensed pursuant to chapter 630, 631, 632 or 633 of NRS or sections 2 to 32, inclusive, of this act for a breach of his or - *AB386_R2* – 80 – her professional duty toward a patient, the following terms of the agreement must not be made confidential:

- *AB386_R1* – 77 – Sec.

- *AB386_R2* – 81 – 3.

- *AB386_R1* – 78 – (a) The amount of gross premiums collected with regard to each medical specialty;

If the Commissioner convenes a hearing pursuant to subsection 1 of NRS 690B.350 and determines that the market for professional liability insurance issued to any class, type or specialty - *AB386_R2* – 82 – of practitioner licensed pursuant to chapter 630, 631 or 633 of NRS or sections 2 to 32, inclusive, of this act is not competitive and that such insurance is unavailable or unaffordable for a substantial number of such practitioners, the Commissioner shall prepare and submit a report of the Commissioner’s findings and recommendations to the Director of the Legislative Counsel Bureau for transmittal to members of the Legislature.

- *AB386_R1* – 79 – Sec.

- *AB386_R2* – 83 – Sec.

A corporation specified in subsection 1 shall not contract with a provider of health care to provide health care to an insured unless the corporation uses the form prescribed by the - *AB386_R1* – 80 – Commissioner pursuant to NRS 629.095 to obtain any information related to the credentials of the provider of health care.

A health maintenance organization shall not contract with a provider of health care to provide health care to an insured unless the health maintenance organization uses the form prescribed by the Commissioner pursuant to NRS 629.095 to obtain - *AB386_R2* – 84 – any information related to the credentials of the provider of health care.

(b) Except as otherwise provided in this paragraph, by the health maintenance organization upon giving to the provider 45 days’ written notice of the modification of the health maintenance - *AB386_R1* – 81 – organization’s schedule of payments, including any changes to the fee schedule applicable to the provider’s practice.

(b) Except as otherwise provided in this paragraph, by the managed care organization upon giving to the provider 45 days’ written notice of the modification of the managed care organization’s schedule of payments, including any changes to the - *AB386_R2* – 85 – fee schedule applicable to the provider’s practice.

If a managed care organization contracts with a provider of health care to provide health care services pursuant to chapter 689A, - *AB386_R1* – 82 – 689B, 689C, 695A, 695B or 695C of NRS, the managed care organization shall:

The application must be accompanied by a fee in the amount prescribed by regulation of the State Board of Health pursuant to NRS 439.150, which must not exceed $1,000, and:and a complete set of his or her fingerprints and written permission authorizing the Division to forward the fingerprints to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report.

(a)2. A complete set of his or her fingerprints and written permission authorizing the Division to forward the fingerprints to the Central Repository for Nevada Records of Criminal History for submission to the Federal Bureau of Investigation for its report;

or (b) Written verification, on a form prescribed by the Division, stating that the fingerprints of the applicant were taken in this State and directly forwarded electronically or by another means to the Central Repository and that the applicant has given written permission to the law enforcement agency or other authorized entity taking the fingerprints to submit the fingerprints to the Central Repository for submission to the Federal Bureau of Investigation for its report.

- *AB386_R2* – 86 – 2.

or (b) Holds a Midwifery Bridge Certificate issued by the North American Registry of Midwives, or its successor organization, and has completed the Portfolio Evaluation Process prescribed by that organization.] [2.] 3.

If the Division determines it to be necessary to address shortages in the number of licensed certified professional midwives practicing in rural or underserved areas in this State or barriers for applicants from marginalized identities, the Division may, on a case-by-case - *AB386_R1* – 83 – basis, exempt an applicant from the requirements of paragraph (b) of subsection 2 if the applicant:

[4.][3.] 5.

To the extent that the implementation of such provisions will leave the Division with sufficient money to carry out its duties under this chapter, the State Board of Health mayshall establish by regulation a procedure through which:

(a) An applicant may petition the Division to reduce the fees imposed pursuant to this sectionsection. or section 26 of this act.

An applicant may qualify for such a reduction if the applicant demonstrates, to the satisfaction of the Division, that the fees imposed pursuant to this section or section 26 of this act are an economic hardship on the applicant.

- *AB386_R2* – 87 – (b) The Division allocates a portion of the fees imposed and collected pursuant to this section or section 26 of this act to programs that promote applicants from marginalized identities through increasing the numbers of such applicants and reducing barriers that such applicants face.

[5.][4.] 6.

(a) An applicant for the issuance of a license as a licensed certified professional midwife in this State shall include the - *AB386_R1* – 84 – social security number of the applicant in the application submitted to the Division.

If an applicant indicates on the statement submitted pursuant to subsection 1 that the applicant is subject to a court - *AB386_R2* – 88 – order for the support of a child and is not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to the order, the Division shall advise the applicant to contact the district attorney or other public agency enforcing the order to determine the actions that the applicant may take to satisfy the arrearage.

(DeletedAs soon as practicable on or after the effective date of this section, but not later than 6 months after receiving the recommendations of the Collaboration and Transfer Guidelines Workgroup created by amendment.)section Sec.107 of this act, the Board of Licensed Certified Professional Midwives created by section 17 of this act shall adopt the regulations required by subsection 6 of section 19 of this act.

In adopting the regulations, the Board shall consider the measures necessary to minimize the likelihood of serious harm to the client and the fetus or newborn infant of the client.

- *AB386_R1* – 85 – Sec.

(Deleted1. by amendment.) Sec.

The Collaboration and Transfer Guidelines Workgroup is hereby created.

2.

The Administrator of the Division of Public and Behavioral Health of the Department of Health and Human Services shall appoint to the Workgroup:

(a) One voting member who is a physician who practices in the area of obstetrics or a certified nurse-midwife in Northern Nevada;

(b) One voting member who is a physician who practices in the area of obstetrics or a certified nurse-midwife in Southern Nevada;

(c) One voting member who is a nurse manager of a labor and delivery ward or a registered nurse with similar duties who is responsible for coordinating transfers of pregnant women from a home or freestanding birthing center, as defined in NRS 449.0065, to a hospital and who practices in Northern Nevada;

(d) One voting member who is a nurse manager of a labor and delivery ward or a registered nurse with similar duties who is responsible for coordinating transfers of pregnant women from a home or freestanding birthing center, as defined in NRS 449.0065, to a hospital and who practices in Southern Nevada;

(e) One voting member who represents a provider of emergency medical services in Northern Nevada;

(f) One voting member who represents a provider of emergency medical services in Southern Nevada;

and (g) One nonvoting member to serve as a liaison with the State Board of Health.

3.

The Nevada Chapter of the National Association of Certified Professional Midwives, or its successor organization, in consultation with the Nevada Association of Certified Professional Midwives, or its successor organization, shall appoint to the Workgroup four voting members who are midwives who reside and practice in Nevada.

To the extent practicable, two members must reside and practice in Northern Nevada and two members must practice in Southern Nevada.

4.

The Nevada Hospital Association, or its successor organization, may appoint to the Workgroup one member who is a representative of the Association, or its successor organization.

5.

A vacancy on the Workgroup must be filled in the same manner as the initial appointment.

6.

Members of the Workgroup serve without compensation and are not entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally.

7.

A member of the Workgroup who is an officer or employee of this State or a political subdivision of this State must be relieved from his or her duties without loss of regular compensation to prepare for and attend meetings of the Workgroup and perform any - *AB386_R1* – 86 – work necessary to carry out the duties of the Workgroup in the most timely manner practicable.

A state agency or political subdivision of this State shall not require an officer or employee who is a member of the Workgroup to:

(a) Make up the time he or she is absent from work to carry out his or her duties as a member of the Workgroup;

or (b) Take annual leave or compensatory time for the absence.

8.

The Workgroup may divide into one subcommittee of members from Northern Nevada and one subcommittee of members from Southern Nevada.

9.

A majority of the voting members of the Workgroup or a subcommittee thereof constitutes a quorum for the transaction of business, and a majority of a quorum present at any meeting is sufficient for any official action taken by the Workgroup or a subcommittee thereof.

10.

The Workgroup and each subcommittee thereof shall:

(a) At its first meeting and annually thereafter, elect a Chair from among its members;

and (b) Meet at the call of the Chair.

11.

Not later than July 1, 2024, the Workgroup or, if the Workgroup divides into subcommittees pursuant to subsection 8, each subcommittee of the Workgroup, shall make recommendations to the Board of Licensed Certified Professional Midwives created by section 17 of this act concerning the regulations required by subsection 6 of section 19 of this act governing the transfer of the client of a licensed certified professional midwife to a medical facility.

Those recommendations must, to the extent practicable, be guided upon peer-reviewed scientific evidence and widely accepted best practices and include, without limitation, provisions for the transmission of all information necessary for the care of the client from the licensed certified professional midwife to the medical facility.

The Workgroup ceases to exist upon submission of those recommendations unless the Board requests that the Workgroup continue to meet.

12.

As used in this section:

(a) “Certified nurse-midwife” means an advanced practice registered nurse who is certified as a nurse-midwife by the American Midwifery Certification Board, or its successor organization.

(b) “Licensed certified professional midwife” means a person who is certified as a certified professional midwife by the North American Registry of Midwives.

(c) “Medical facility” has the meaning ascribed to it in NRS 449.0151.

- *AB386_R1* – 87 – (d) “Northern Nevada” means Carson City and the counties of Churchill, Douglas, Elko, Eureka, Humboldt, Lander, Lyon, Pershing, Storey, Washoe and White Pine.

(e) “Southern Nevada” means the counties of Clark, Esmeralda, Lincoln, Mineral and Nye.

Sec.

One member pursuant to paragraph (b)(d) of subsection 2 of section 17 of this act who has not received care from a licensed certified professional midwife licensed pursuant to section 20 of this act but who has received care from a midwife certified by the North American Registry of Midwives, or its successor organization.

That member may serve until the expiration of the term prescribed pursuant to subsection 65 of section 17 of this act.

- *AB386_R2* – 89 – 4.

- *AB386_R1* – 88 – (a) Have failed to comply with a subpoena or warrant relating to a proceeding to determine the paternity of a child or to establish or enforce an obligation for the support of a child;

§ 666 requiring each state to establish procedures under which the state has authority to withhold or suspend, or to restrict the use of professional, occupational and recreational licenses of persons who:

- *AB386_R2* – 90 – (a) A Certified Professional Midwife by the North American Registry of Midwives, or its successor organization;

or (b) A Certified Nurse-Midwife by the American Midwifery Certification Board, or its successor organization;

orferyor 2.- *AB386_R1* – 89 – 2.Any other type of midwife.

AnyH other- type*AB386_R1* of midwife.

H - *AB386_R2*