AB 7 — Revises provisions relating to electronic health records. (BDR 40-381)

(1) allows patients to electronically access their health records directly from the facility or custodian of the records and forward interoperability of health records with the electronic health records and systems of other facilities and providers of health care.

Section 2.5 of this bill makes an appropriation to the Department to award grants to certain small facilities and providers of health care who work in small business settings to assist in compliance with the requirements of sections 1.3 and 2.

Section 1 of this bill requires the Director to prescribe standards for the make conforming changes to indicate the proper placement of and provide for theill enforcement of section 1.3.

Chapter 439 of NRS is hereby amended by adding thereto a new section to read as follows:

1.

The Department shall notify each regulatory body of this State that has issued a current, valid license to a licensed provider or insurer if:

- 82nd Session (2023) – 3 – insurer is not in compliance with the requirements of subsection 4 of NRS 439.589;

and (b) The licensed provider or insurer:

(1) Is not exempt from those requirements pursuant to subsection 5 of NRS 439.589;

and (2) Has not received a waiver of those requirements pursuant to subsection 6 of NRS 439.589.

2.

If the Department determines that a licensed provider or insurer for which notice was previously provided pursuant to subsection 1 has come into compliance with the requirements of subsection 4 of NRS 439.589, the Department shall immediately notify the regulatory body that issued the license.

3.

As used in this section:

(a) “License” means any license, certificate, registration, permit or similar type of authorization to practice an occupation or profession or engage in a business in this State issued to a lic(b) “Licensed provider or insurer” means:

(1) A medical facility licensed pursuant to chapter 449 of NRS;

(2) The holder of a permit to operate an ambulance, an air ambulance or a vehicle of a fire-fighting agency pursuant to chapter 450B of NRS;

(3) A provider of health care, as defined in NRS 629.031, who is licensed pursuant to title 54 of NRS;

or (4) Any person licensed pursuant to title 57 of NRS.

(c) “Regulatory body” means any governmental entity that issues a license.

Sec.

1.02.

NRS 439.580 is hereby amended to read as follows:

439.580 1.

Any local health officer or a deputy of a local health officer who neglects or fails to enforce the provisions of this chapter in his or her jurisdiction, or neglects or refuses to perform instructions and directions of the Division shall be punished by ae fine of not more than $250.

2.

[Each] Except as otherwise provided in NRS 439.589, each person who violates any of the provisions of this chapter or refuses or neglects to obey any lawful order, rule or regulation of the:

(a) State Board of Health or violates any rule or regulation approved by the State Board of Health pursuant to NRS 439.350, 439.366, 439.410 and 439.460;

or - 82nd Session (2023) – 4 – (b) Director adopted pursuant to NRS 439.538 or 439.581 to 439.595, inclusive, and section 1 of this act,  is guilty of a misdemeanor.

Sec.

1.04.

NRS 439.581 is hereby amended to read as follows:

section 1 of this act, unless the context otherwise requires, the words and terms defined in NRS 439.582 to 439.585, inclusive, have the meanings ascribed to them in those sections.

Sec.

1.06.

The[The Director shall:

(b) [EncourageEncourage the use of a health information exchange by health care providers, payers and patients;

(c)](c) Prescribe by regulation standards for the electronic maintenance, transmittal and exchange of electronic health records, prescriptions, health-related information, electronic signatures and - *AB7_R1* – 3 – requirements for electronic equivalents of written entries or written approvals in accordance with federal law;

[(d)](d) (c) Prescribe by regulation rules governing the ownership, management and use of electronic health records, health-related information and related data retained or shared by a health inf(e) Prescribe by regulation, in consultation with the State Board of Pharmacy, standards for the electronic transmission of prior authorizations for prescription medication using a health information exchange;exchange.] 2.

and [(e)] (d) Prescribe by regulation, in consultation with the State Board of Pharmacy, standards for the electronic transmission of prior authorizations for prescription medication using a health information exchange.

2.

The Director may enter into contracts, apply for and accept available gifts, grants and donations, and adopt such regulations as - 82nd Session (2023) – 5 – are necessary to carry out the provisions of NRS 439.581 to 439.595, inclusive.inclusive , and section 1 of this act.

Sec.

1.07.

NRS 439.588 is hereby amended to read as follows:

439.588 1.

A health information exchange shall not operate subsection 2.

without first obtaining certification as provided in 2.

The Director shall by regulation establish the manner in which a health information exchange may apply for certification and the requirements for granting such certification, which must include, without limitation, that the health information exchange demonstrate its financial and operational sustainability, adherence to the privacy, security and patient consent standards adopted pursuant to NRS 439.589 and capacity for interoperability with any other health information exchange certified pursuant to this section.

3.

The Director may deny an application for certification or may suspend or revoke any certification issued pursuant to subsection 2 for failure to comply with the provisions of NRS 439.581 to 439.595, inclusive, and section 1 of this act, or the regulations adopted pursuant thereto or any applicable federal or state law.

TheWhen regulationsthe adoptedDirector pursuantintends to thisdeny, sectionsuspend andor NRSrevoke 439.589a mustcertification, nothe require any person or entity,she othershall thangive thereasonable Department,notice to useall aparties healthby informationcertified exchange.mail.

The notice must contain the legal authority, jurisdiction and reasons for the action to be taken.

A health information exchange that wishes to contest the action of the Director must file an appeal with the Director.

5.

The Director shall adopt regulations establishing the manner violation of the provisions of this section.the Director regarding a 6.

The Director may impose an administrative fine against a health information exchange which operates in this State without holding a certification in an amount established by the Director by regulation.

The Director shall afford a health information exchange so fined an opportunity for a hearing pursuant to the provisions of NRS 233B.121.

7.

The Director may adopt such regulations as he or she determines are necessary to carry out the provisions of this section.

1.08.

NRS 439.589 is hereby amended to read as follows:

439.589 1.

The Director , in consultation with health care providers, third parties and other interested persons and entities, shall by regulation prescribe a framework for the electronic maintenance, transmittal and exchange of electronic health records, prescriptions, health-related information and electronic - 82nd Session (2023) – 6 – signatures and requirements for electronic equivalents of written entries or written approvals in accordance with federal law.

The regulations must:

(a) Establish standards [:

transmit and exchange health information, including, without, limitation, standards:

(1) That require:

(I) The use of networks and technologies that allow patients to access electronic health records directly from the health care provider of the patient and forward such electronic health records electronically to other persons and entities;

and (II) The interoperability of such networks and technologies in accordance with the applicable standards for the interoperability of Qualified Health Information Networks prescribed by the Office of the National Coordinator for Health Information Technology of the United States Department of Health and Human Services;

(2) To ensure that electronic health records retained or shared [by any health information exchange] are secure;

[(b)] (3) To maintain the confidentiality of electronic health records and health-related information, including, without limitation, standards to maintain the confidentiality of electronic health records relating to a child who has received health care services without the consent of a parent or guardian and which ensure that a child’s right to access such health care services is not impaired;

health information, including, without limitation, standards to ensure the privacy of information relating to a child who has received health care services without the consent of a parent or guardian;

[(d)] (5) For obtaining consent from a patient before retrieving the patient’s health records from a health information exchange, including, without limitation, standards for obtaining such consent from a child who has received health care services without the consent of a parent or guardian;

[(e)] (6) For making any necessary corrections to information or records [retained or shared by a health information exchange;

and (f)] ;

(7) For notifying a patient if the confidentiality of information contained in an electronic health record of the patient is breached [.] ;

- 82nd Session (2023) – 7 – electronic health records, health-related information and related data;

and (9) For the electronic transmission of prior authorizations for prescription medication;

(b) Ensure compliance with the requirements, specifications and protocols for exchanging, securing and disclosing electronic health records, health-related information and related data prescribed pursuant to the provisions of the Health Information Technology for Economic and Clinical Health Act, 42 U.S.C.

§§ 300jj et seq.

and 17901 et seq., the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and other applicable federal and state law;

and (c) Be based on nationally recognized best practices for maintaining, transmitting and exchanging health information electronically.

2.

The standards prescribed pursuant to this section must inc(a) Requirements for the creation, maintenance and transmittal of electronic health records;

(b) Requirements for protecting confidentiality, including control over, access to and the collection, organization and maintenance of electronic health records, health-related information and individually identifiable health information;

(c) Requirements for the manner in which a patient may, through a health care provider who participates in the sharing of health records using a health information exchange, revoke his or her consent for a health care provider to retrieve the patient’s health records from the health information exchange;

(d) A secure and traceable electronic audit system for identifying access points and trails to electronic health records and health information exchanges;

and (e) Any other requirements necessary to comply with all related information, health information exchanges and the securitylth- and confidentiality of such records and exchanges.

3.

The regulations adopted pursuant to this section must not require any person or entity to use a health information exchange.

4.

Except as otherwise provided in subsections 5, 6 and 7, the Department and the divisions thereof, other state and local governmental entities, health care providers, third parties, pharmacy benefit managers and other entities licensed or certified pursuant to title 57 of NRS shall maintain, transmit and exchange - 82nd Session (2023) – 8 – health information in accordance with the regulations adopted pursuant to this section, the provisions of NRS 439.581 to 439.595, inclusive, and section 1 of this act, and any other regulations adopted pursuant thereto.

provider of health coverage for federal employees, a provider of health coverage that is subject to the Employee Retirement Income Security Act of 1974, 29 U.S.C.

§§ 1001 et seq., or a Taft-Hartley trust formed pursuant to 29 U.S.C.

§ 186(c)(5) is not required to but may maintain, transmit and exchange electronic information in accordance with the regulations adopted pursuant to this section.

6.

A health care provider may apply to the Department for a waiver from the provisions of subsection 4 on the basis that the health care provider does not have the infrastructure necessary to comply with those provisions, including, without limitation, because the health care provider does not have access to the Internet.

The Department shall grant a waiver if it determines that:

(a) The health care provider does not currently have the infrastructure necessary to comply with the provisions of subsection 4;

and (b) Obtaining such infrastructure is not reasonably practicable, including, without limitation, because the cost of such infrastructure would make it difficult for the health care provider to continue to operate.

7.

The provisions of subsection 4 do not apply to the Dep8.tmA violation of the provisions of this section or any regulations adopted pursuant thereto is not a misdemeanor.

9.

As used in this section:

(a) “Pharmacy benefit manager” has the meaning ascribed to it in NRS 683A.174.

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

Sec.

1.09.

NRS 439.591 is hereby amended to read as follows:

439.591 1.

Except as otherwise provided in subsection 2 of NRS 439.538, a patient must not be required to participate in a health information exchange.

Before a patient’s health care records may be retrieved from a health information exchange, the patient must be fully informed and affirmatively consent, in the manner prescribed by the Director.

It is the public policy of this State that, - 82nd Session (2023) – 9 – except as otherwise provided in NRS 439.538, a patient’s health care records must not be retrieved from a health information exchange unless the patient provides such affirmative consent.

2.

A patient must be notified in the manner prescribed by the records of the patient or a health information exchange.nic health 3.

A patient who consents to the retrieval of his or her electronic health record from a health information exchange may at any time request that a health care provider access and provide the patient with his or her electronic health record in accordance with the provisions of 45 C.F.R.

§ 164.526.

Sec.

439.593 A health care provider who with reasonable care transmits, accesses, utilizes, discloses, relies upon or provides to a patient an apparently genuine electronic health record [accessed from a health information exchange to make a decision concerning the provision of health care to a patient] in accordance with NRS 439.581 to 439.595, inclusive, and the regulations adopted pursuant thereto is immune from civil or criminal liability for [the] any decision concerning the provision of health care to a patient and any civil or criminal liability resulting from the provision of anthe apparently genuine electronic health record to a patient if:

The health care decision was appropriate based upon the informationinfSec. contained in the inaccurate electronic health record.

- *AB7_R1* – 4 – Sec.

NRS 439.595 is hereby amended to read as follows:follows:rd.

Except1. as otherwise provided in NRS 439.538 and 439.591, a medical facility shall maintain, transmit and exchange health records electronically in accordance with paragraph (a) of subsection 1 of NRS 629.051.

Sec.If the Division receives notification from the Department of Health and Human Services pursuant to section 1 of this act that a medical facility licensed pursuant to this chapter is not in compliance with the requirements of subsection 4 of NRS 439.589, the Division may, after notice and the opportunity for a hearing in accordance with the provisions of this chapter, require corrective - 82nd Session (2023) – 10 – action or impose an administrative penalty in the amount prescribed by NRS 449.163.

2.

The Division shall not suspend or revoke a license for failure to comply with the requirements of subsection 4 of NRSSec.

Each license issued pursuant to NRS 449.029 to 449.2428, inclusive, and section 1.3 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 subsection 4 and NRS 449.050, as applicable, unless the Division finds, after an investigation, that the facility has not:

or - *AB7_R1* – 5 – (c) Conformed to all applicable local zoning regulations.

Each reapplication for an agency to provide personal care services in the home, an agency to provide nursing in the home, a community health worker pool, a facility for intermediate care, a facility for skilled nursing, a provider of community-based living arrangement- services,82nd Session (2023) – 11 – 1395ww(d)(1)(B)(iv), a psychiatric hospital describedthat inprovides inpatient services to children, a psychiatric residential treatment facility, a residential facility for groups, a program of hospice care, a home for individual residential care, a facility for the care of adults during the day, a facility for hospice care, a nursing pool, the distinct part of a hospital which meets the requirements of a skilled nursing facility or nursing facility pursuant to 42 U.S.C.C.F.R.

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

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, aame 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.

The Division may deny an application for a license or may suspend or revoke any license issued under the provisions of NRS 449.029 to 449.2428, inclusive, and section 1.3 of this act upon any of the following grounds:

- *AB7_R1* – 6 – (b) Aiding, abetting or permitting the commission of any illegal act.

(c)- Conduct82nd inimicalSession to(2023) the– public12 health,– morals, welfare and safety of the people of the State of Nevada in the maintenance and operation of the premises for which a license is issued.

In addition to the provisions of subsection 1, the Division may revoke a license to operate a facility for the dependent if, with respect to that facility, the licensee that operates the facility, or an agentage(a) orIs employeeconvicted of violating any of the licensee:provisions of NRS 202.470;

(a) Is convicted of violating any of the provisions of NRS 202.470;

(b) A report of any investigation conducted with respect to the complaint;

andandt of any investigation conducted with respect to the (c) A report of any disciplinary action taken against the facility.

and - *AB7_R1*82nd –Session 7(2023) – (b)13 Any– disciplinarysubsection 2.sciplinary actions taken by the Division pursuant to subsectionSec. 2.

Sec.

(c) If the license of the facility limits the occupancy of the facility and the facility has exceeded the approved occupancy,occupancy,the require the facility, at its own expense, to move patients to another facility that is licensed;

If the facility fails to pay any administrative penalty imposed pursuantpur(a) toSuspend paragraphthe (d)license of subsectionthe 1,facility until the Divisionadministrative may:penalty is paid;

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

- 82nd Session (2023) – 14 – 4.

Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 must be accounted for separately and - *AB7_R1* – 8 – used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and section 1.3 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.

1.92.

Chapter 450B of NRS is hereby amended by adding the1.to If the health authority receives notification from the Department of Health and Human Services pursuant to section 1 of this act that the holder of a permit to operate an ambulance, air ambulance or vehicle of a fire-fighting agency is not in compliance with the requirements of subsection 4 of NRS 439.589, the health authority may, after notice and the opportunity for a hearing in accordance with the provisions of this chapter, require corrective action or impose an administrative penalty in an amount established by regulation of the board.

The health authority shall not suspend or revoke a permit for failure to comply with the requirements of subsection 4 of NRS 439.589.

Sec.

1.94.

NRS 287.010 is hereby amended to read as follows:

287.010 1.

The governing body of any county, school district, municipal corporation, political subdivision, public - 82nd Session (2023) – 15 – corporation or other local governmental agency of the State of Nevada may:

(a) Adopt and carry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of its employees who elect to accept the insurance and who, where necessary, have authorized the governing body to make deductions from their compensation for the payment of premiums on the insurance.

(b) Purchase group policies of life, accident or health insurance, or any combination thereof, for the benefit of such officers and employees, and the dependents of such officers and employees, as have authorized the purchase, from insurance companies authorized to transact the business of such insurance in the State of Nevada, and, where necessary, deduct from the compensation of officers and employees the premiums upon insurance and pay the deductions upon the premiums.

(c) Provide group life, accident or health coverage through a self-insurance reserve fund and, where necessary, deduct contributions to the maintenance of the fund from the compensation of officers and employees and pay the deductions into the fund.

The money accumulated for this purpose through deductions from the compensation of officers and employees and contributions of the governing body must be maintained as an internal service fund as defined by NRS 354.543.

The money must be deposited in a state or national bank or credit union authorized to transact business in the State of Nevada.

Any independent administrator of a fund created 683A of NRS, and must be a resident of this State.

Any contractchapter with an independent administrator must be approved by the Commissioner of Insurance as to the reasonableness of administrative charges in relation to contributions collected and benefits provided.

The provisions of NRS 439.581 to 439.595, inclusive, and section 1 of this act, 686A.135, 687B.352, 687B.408, 687B.723, 687B.725, 689B.030 to 689B.050, inclusive, 689B.265, 689B.287 and 689B.500 apply to coverage provided pursuant to this paragraph, except that the provisions of NRS 689B.0378, 689B.03785 and 689B.500 only apply to coverage for active officers and employees of the governing body, or the dependents of such officers and employees.

(d) Defray part or all of the cost of maintenance of a self- insurance fund or of the premiums upon insurance.

The money for contributions must be budgeted for in accordance with the laws - 82nd Session (2023) – 16 – governing the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada.

2.

If a school district offers group insurance to its officers and of the school district must not be excluded from participating in the group insurance.

If the amount of the deductions from compensation required to pay for the group insurance exceeds the compensation to which a trustee is entitled, the difference must be paid by the trustee.

3.

In any county in which a legal services organization exists, the governing body of the county, or of any school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada in the county, may enter into a contract with the legal services organization pursuant to which the officers and employees of the legal services organization, and the dependents of those officers and employees, are eligible for any life, accident or health insurance provided pursuant to this section to the officers and employees, and the dependents of the officers and employees, of the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency.

4.

If a contract is entered into pursuant to subsection 3, the officers and employees of the legal services organization:

(a) Shall be deemed, solely for the purposes of this section, to be officers and employees of the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency with which the legal services organization has con(b) Must be required by the contract to pay the premiums or contributions for all insurance which they elect to accept or of which they authorize the purchase.

5.

A contract that is entered into pursuant to subsection 3:

(a) Must be submitted to the Commissioner of Insurance for approval not less than 30 days before the date on which the contract is to become effective.

(b) Does not become effective unless approved by the Commissioner.

(c) Shall be deemed to be approved if not disapproved by the Commissioner within 30 days after its submission.

6.

As used in this section, “legal services organization” means an organization that operates a program for legal aid and receives money pursuant to NRS 19.031.

- 82nd Session (2023) – 17 – Sec.

1.96.

NRS 287.04335 is hereby amended to read as follows:

287.04335 If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 687B.352, 687B.409, 687B.723, 687B.725, 689B.0353, 689B.255,6A.135, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.1675, 695G.170 to 695G.174, inclusive, 695G.176, 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

Sec.

1.98.

NRS 603A.100 is hereby amended to read as follows:

603A.100 1.

The provisions of NRS 603A.010 to 603A.290, inclusive, do not apply to the maintenance or transmittal of information in accordance with NRS 439.581 to 439.595, inclusive, and section 1 of this act and the regulations adopted pursuant thereto.

2.

A data collector who is also an operator, as defined in NRS 603A.330, shall comply with the provisions of NRS 603A.300 to 603A.360, inclusive.

3.

Any waiver of the provisions of NRS 603A.010 to 603A.290, inclusive, is contrary to public policy, void and unenforceable.

Sec.

2.

629.051in 1.regulations adopted by the State Board of Health pursuant to NRS 652.135 with regard to the records of a medical laboratory and unless a longer period is provided by federal law, each custodian of health care records shall retain the health care records of patients as part of the regularly maintained records of the custodian for 5 years after their receipt or production.

Except as otherwise provided in this section and in regulations adopted by the State Board of Health pursuant to NRS 652.135 with regard to the records of a medical laboratory and unless a longer period is provided by federal law, each custodian of health care records shall retain the health care records of patients as part of the regularly maintained records of the custodian for 5 years after their receipt or production.

[Health]Health Except as otherwise provided in NRS 439.538 and 439.591, health care records [may] :

(a) MustMust, except as otherwise provided in subsections 5 and 6 of NRS 439.589, be created, maintained, transmitted and exchanged electronically inas arequired mannerby that:subsection 4 of NRS 439.589;

(1)and Allows- patients82nd toSession electronically(2023) access– their18 – (b) May be created, authenticated and stored in a [computer system] health recordsinformation directlyexchange fromwhich meets the custodianrequirements of healthNRS care439.581 recordsto and439.595, forwardinclusive, suchand recordssection electronically1 toof otherthis personsact and entities;the regulations adopted pursuant thereto.

-in *AB7_R1*each –location 9at –which (2)the Allowsprovider forof thehealth interoperabilitycare ofperforms health recordscare withservices, thea electronicsign healthwhich recordsdiscloses andto systemspatients ofthat their health care facilitiesrecords andmay otherbe providersdestroyed ofafter healththe care;period set forth in subsection 1.

and (3) Complies with the applicable provisions of NRS 439.581 to 439.595, inclusive, and any regulations adopted pursuant thereto.

(b) May be created, authenticated and stored in a [computer system] health information exchange which meets the requirements of NRS 439.581 to 439.595, inclusive, and the regulations adopted pursuant thereto.

2.

A provider of health care shall post, in a conspicuous place in each location at which the provider of health care performs health care services, a sign which discloses to patients that their health care records may be destroyed after the period set forth in subsection 1.

The health care records of a person who has attained the age of 23 years may be destroyed in accordance with this section for those records which have been retained for at least 5 years or for any longer period provided by federal law.

TheIf provisionsa health care licensing board receives notification from the Department of thisHealth and Human Services pursuant to section ,1 exceptof this act that a provider of health care to which the health care licensing board has issued a license is not in compliance with the requirements of subsection 4 of NRS 439.589, the health care licensing board may, after notice and the opportunity for a hearing in accordance with the provisions of paragraphthis (a)title, ofrequire subsectioncorrective 1,action door impose an administrative penalty in an amount not applyto exceed the maximum penalty that the health care licensing board is authorized to aimpose pharmacist.for other violations.

The health care licensing board shall not suspend or revoke a - 82nd Session (2023) – 19 – of NRS 439.589.lure to comply with the requirements of subsection 4 9.

The provisions of this section , except for the provisions of paragraph (a) of subsection 1 and subsection 8, do not apply to a pharmacist.

[9.] 10.

-11. *AB7_R1* – 10 – Sec.

2.5.As used in this section:

(a) “Health care licensing board” means:

(1) A board created pursuant to chapter 630, 630A, 631, 632, 633, 634, 634A, 635, 636, 637, 637B, 639, 640, 640A, 640B, 640C, 641, 641A, 641B, 641C or 641D of NRS.

(2) The Division of Public and Behavioral Health of the Depart(3) The State Board of Health with respect to licenses issued pursuant to chapter 640D or 640E of NRS.

(b) “License” has the meaning ascribed to it in section 1 of this act.

Sec.

2.05.

NRS 654.190 is hereby amended to read as follows:

654.190 1.

The Board may, after notice and an opportunity for a hearing as required by law, impose an administrative fine of not more than $10,000 for each violation on, recover reasonable investigative fees and costs incurred from, suspend, revoke, deny the issuance or renewal of or place conditions on the license of, and place on probation or impose any combination of the foregoing on any licensee who:

(a) Is convicted of a felony relating to the practice of administering a nursing facility or residential facility or of any offense involving moral turpitude.

(c) Violates any of the provisions of this chapter.raud or deceit.

(d) Aids or abets any person in the violation of any of the provisions of NRS 449.029 to 449.2428, inclusive, and section 1.3 of this act, as those provisions pertain to a facility for skilled nursing, facility for intermediate care or residential facility for groups.

(e) Violates any regulation of the Board prescribing additional standards of conduct for licensees, including, without limitation, a code of ethics.

- 82nd Session (2023) – 20 – (f) Engages in conduct that violates the trust of a patient or resident or exploits the relationship between the licensee and the patient or resident for the financial or other gain of the licensee.

2.

If a licensee requests a hearing pursuant to subsection 1, the NRS 233B.121 and 241.034.

A licensee may waive, in writing, hisant to or her right to attend the hearing.

3.

The Board may compel the attendance of witnesses or the production of documents or objects by subpoena.

The Board may adopt regulations that set forth a procedure pursuant to which the Chair of the Board may issue subpoenas on behalf of the Board.

Any person who is subpoenaed pursuant to this subsection may request the Board to modify the terms of the subpoena or grant additional time for compliance.

4.

An order that imposes discipline and the findings of fact and conclusions of law supporting that order are public records.

5.

The expiration of a license by operation of law or by order or decision of the Board or a court, or the voluntary surrender of a license, does not deprive the Board of jurisdiction to proceed with any investigation of, or action or disciplinary proceeding against, the licensee or to render a decision suspending or revoking the license.

Sec.

2.1.

Chapter 680A of NRS is hereby amended by adding thereto a new section to read as follows:

ThereIf is hereby appropriated from the StateCommissioner Generalreceives Fundnotification tofrom the Department of Health and Human Services thepursuant sumto ofsection $3,000,0001 forof thethis purposeact ofthat awardingan grantsinsurer tois providersnot ofin healthcompliance carewith andthe medicalrequirements facilitiesof forsubsection the4 purposes of complyingNRS with439.589, the requirementsCommissioner ofwith sectionthe 1.3provisions of this acttitle, andrequire paragraphcorrective (a)action ofor subsectionimpose 1an ofadministrative NRSfine 629.051,in asthe amendedamount prescribed by sectionNRS 2680A.200. of this act.

To receive such a grant, a provider of health care or medical facility must have a staff of less than 50 persons or work for an entity that has a staff of less than 50 persons, as applicable.

The Commissioner shall not suspend or revoke the certificate of authority of an insurer for failure to comply with the requirements of subsection 4 of NRS 439.589.

Sec.

2.15.

NRS 680A.095 is hereby amended to read as follows:

680A.095 1.

Except as otherwise provided in subsection 3, an insurer which is not authorized to transact insurance in this State may not transact reinsurance with a domestic insurer in this State, by mail or otherwise, unless the insurer holds a certificate of authority as a reinsurer in accordance with the provisions of NRS 680A.010 to 680A.150, inclusive, and section 2.1 of this act, 680A.160 to 680A.280, inclusive, 680A.320 and 680A.330.

- 82nd Session (2023) – 21 – 2.

To qualify for authority only to transact reinsurance, an insurer must meet the same requirements for capital and surplus as are imposed on an insurer which is authorized to transact insurance in this State.

insurance risks or to reciprocal insurance authorized pursuant tole chapter 694B of NRS.

Sec.

2.2.

Chapter 683A of NRS is hereby amended by adding thereto a new section to read as follows:

1.

If the Commissioner receives notification from the Department of Health and Human Services pursuant to section 1 of this act that an administrator is not in compliance with the requirements of subsection 4 of NRS 439.589, the Commissioner may, after notice and the opportunity for a hearing in accordance with the provisions of this chapter, require corrective action or impose an administrative fine in the amount prescribed by NRS 683A.461.

2.

The Commissioner shall not suspend or revoke the certificate of registration of an administrator for failure to comply with the requirements of subsection 4 of NRS 439.589.

Sec.

2.25.

NRS 683A.3683 is hereby amended to read as follows:

683A.3683 A producer of limited lines travel insurance and each travel retailer, or employee or authorized representative of a travel retailer, who offers or disseminates travel insurance under the license of a producer of limited lines travel insurance shall be subject to the provisions of NRS 683A.451 to 683A.520, inclusive, andSec.

2.3.

NRS 692A.270 is hereby amended to read as follows:

692A.270 The provisions of NRS 683A.321, 683A.331, 683A.341, 683A.400, 683A.451 to 683A.490, inclusive, and section 2.2 of this act and 683A.520 apply to title insurers, title agents and escrow officers.

Sec.

2.35.

Chapter 695C of NRS is hereby amended by adding thereto a new section to read as follows:

1.

If the Commissioner receives notification from the Department of Health and Human Services pursuant to section 1 of this act that a health maintenance organization is not in compliance with the requirements of subsection 4 of NRS 439.589, the Commissioner may, after notice and the opportunity for a hearing in accordance with the provisions of this chapter, require - 82nd Session (2023) – 22 – corrective action or impose an administrative fine in the amount prescribed by NRS 695C.350.

2.

The Commissioner shall not suspend or revoke the certificate of authority of a health maintenance organization for NRS 439.589.omply with the requirements of subsection 4 of Sec.

2.4.

NRS 719.200 is hereby amended to read as follows:

719.200 1.

Except as otherwise provided in subsection 2, the provisions of this chapter apply to electronic records and electronic signatures relating to a transaction.

2.

The provisions of this chapter do not apply to a transaction to the extent it is governed by:

(a) Except as otherwise specifically provided by law, a law governing the creation and execution of wills, codicils or testamentary trusts;

(b) The Uniform Commercial Code other than NRS 104.1306, 104.2101 to 104.2725, inclusive, and 104A.2101 to 104A.2532, inclusive;

or (c) The provisions of NRS 439.581 to 439.595, inclusive, and section 1 of this act and the regulations adopted pursuant thereto.

3.

The provisions of this chapter apply to an electronic record or electronic signature otherwise excluded from the application of this chapter under subsection 2 to the extent it is governed by a law other than those specified in subsection 2.

4.

A transaction subject to the provisions of this chapter is also subject to other applicable substantive law.

Sec.

2.45.

NRS 720.140 is hereby amended to read as follows:

the provisions of this chapter apply to any transaction for which a digital signature is used to sign an electronic record.

The provisions of this chapter do not apply to a digital signature that is used to sign an electronic health record in accordance with NRS 439.581 to 439.595, inclusive, and section 1 of this act and the regulations adopted pursuant thereto.

2.

As used in this section, “electronic record” has the meaning ascribed to it in NRS 719.090.

Sec.

2.5.

1.

There is hereby appropriated from the State General Fund to the Department of Health and Human Services the sum of $3,000,000 for the purpose of awarding grants to providers of health care and medical facilities for the purposes of complying with the requirements of subsection 4 of NRS 439.589, as amended by section 1.08 of this act.

To receive such a grant, a provider of health care or medical facility must have a staff of less than 50 - 82nd Session (2023) – 23 – as applicable.k for an entity that has a staff of less than 50 persons, 2.

Sec.Department shall convene an advisory group to advise the Director of the Department in the adoption of regulations pursuant to NRS 439.589, as amended by section 1.08 of this act.

The advisory group shall consist of:

(a) The following ex officio members:

(1) The Director of the Department;

(2) The Administrator of the Division of Public and Behavioral Health of the Department;

(3) The Administrator of the Division of Health Care Financing and Policy of the Department;

(4) The Administrator of the Division of Welfare and Supportive Services of the Department;

(5) The Commissioner of Insurance;

(6) Each district health officer appointed pursuant to NRS 439.368 or 439.400;

Program;

ande Executive Officer of the Public Employees’ Benefits (8) The Executive Director of the Silver State Health Insurance Exchange;

and (b) The following members appointed by the Director:

(1) Representatives of third parties, as defined in NRS 439.589, as amended by section 1.08 of this act, that provide health coverage in this State;

- 82nd Session (2023) – 24 – (2) Representatives of hospitals, as defined in NRS 449.012, other medical facilities, as defined in NRS 449.0151, and facilities for the dependent, as defined in NRS 449.0045;

(3) Representatives of consumers of health care;

(5) Professionals in the field of information privacy and security;

(6) Professionals in the field of health information technology and the interoperability of health information;

(7) Representatives of community-based organizations whose work relates to health information;

(8) Representatives of county and city health departments;

(9) Representatives of social services agencies;

and (10) Representatives of community-based organizations whose work relates to social services.

2.

Members appointed to the advisory group pursuant to paragraph (b) of subsection 1 serve at the pleasure of the Director of the Department.

If a vacancy occurs, the Director shall appoint a person similarly qualified to replace that member.

TheMembers provisions of NRSthe 354.599advisory dogroup notserve applywithout tocompensation anyor additionalper expensesdiem ofbut aare localentitled governmentto thatreceive arereimbursement relatedfor totravel expenses in the provisionssame ofamount thisprovided act.for state officers and employees generally.

4.

The Director of the Department shall serve as the Chair of the advisory group.

5.

A majority of the voting members of the advisory group constitutes a quorum for the transaction of business, and a majority any official action taken by the advisory group.g is sufficient for 6.

Each member of the advisory group 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 so that the officer or employee may prepare for and attend meetings of the advisory group and perform any work necessary to carry out the duties of the advisory group 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 group to make up the time the officer or employee is absent from work to carry out duties as a member of the advisory group or use annual leave or compensatory time for the absence.

7.

The advisory group may establish subcommittees and working groups consisting of members of the advisory group or - 82nd Session (2023) – 25 – duties.ersons to assist the advisory group in the performance of its 8.

The advisory group shall advise the Director of the Department on the development and implementation of the regulations adopted pursuant to NRS 439.589, as amended by section 1.08 of this act.

9.

The Director of the Department shall:

(a) On or before August 1, 2024, present at a meeting of the Joint Interim Standing Committee on Health and Human Services concerning the progress of the Director in developing and implementing the regulations adopted pursuant to NRS 439.589, as amended by section 1.08 of this act;

and (b) On or before December 31, 2024, submit to the Director of the Legislative Counsel Bureau for transmittal to the 83rd Session of the Legislature a report concerning the progress of the Director in developing and implementing the regulations adopted pursuant to NRS 439.589, as amended by section 1.08 of this act.

Department of Health and Human Services.ent” means the Sec.

2.8.

1.

Hospitals and physician group practices with more than 20 employees shall comply with the provisions of subsection 4 of NRS 439.589, as amended by section 1.08 of this act, on or before July 1, 2024.

2.

Notwithstanding the amendatory provisions of sections 1, 1.08, 1.3, 1.92, 1.94, 1.96, 2, 2.1, 2.2 and 2.35 of this act:

(a) Persons and entities subject to the provisions of subsection 4 of NRS 439.589, as amended by section 1.08 of this act, other than the persons and entities described in paragraph (b) of this subsection and subsection 1 of this section, are not required to comply with those provisions until July 1, 2025.

(b) Physician group practices or other business entities organized for the purpose of practicing a health care profession with or fewer employees, including, without limitation, sole subsection 4 of NRS 439.589, as amended by section 1.08 of this of act, until January 1, 2030.

3.

As used in this section:

(a) “Hospital” has the meaning ascribed to it in NRS 449.012.

(b) “Health care profession” means any profession practiced by providers of health care, as defined in NRS 629.031.

(c) “Physician group practice” means any business entity organized for the purpose of the practice of medicine or osteopathic medicine by more than one physician.

- 82nd Session (2023) – 26 – additional expenses of a local government that are related to the provisions of this act.

This section and sections 1,1.09, 1.1,1.1 1.2 and 2.51.2 of this act become effective onupon Julypassage 1,and 2023.approval.

Sections 1.32.5 to 2, inclusive, and 32.7 of this act become effective on JanuaryJuly 1, 2028.2023.

H3. - *AB7_R1*

Sections 1 to 1.08, inclusive, 1.3 to 2.45, inclusive, 2.8 and 3 of this act become effective:

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

and (b) On July 1, 2024, for all other purposes.

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