SB 204 — Provides for the limited practice of medicine by certain medical school graduates. (BDR 54-49)

(a) Completed at least 3 years of practice as a full-time physician under the limited license;

(b) Fulfilled all other statutory requirements for licensure pursuant to NRS 630.160 except the requirements of paragraph (c) of subsection 2 of NRS 630.160;

and (c) Not been the subject of disciplinary action by a medical board in any jurisdiction.

3.

- *SB204_R1* – 6 – (c) Commits to practicing in a medically underserved area of this State;

- *SB204* – 6 – 2.

For the first 30 days during which an associate physician practices medicine in a medically underserved urban area under the supervision of a new supervising physician, the supervising physician must be physically present on the same premises and available to assist the associate physician.

An associate physician shall not practice medicine in a medically underserved rural area unless the supervising physician or another physician designated by the supervising physician is physically present on the same premises and available to assist the associate physician.

5.

Such an associate physician and his or her supervising physician are not required to comply with the requirements of any regulations adopted pursuant to section 13 of this act governing the supervision of an associate - *SB204_R1* – 7 – physician that are more stringent than the requirements of federal law and regulations.

6.

A person or entity that employs an associate physician shall credential the associate physician and bill for services rendered by the associate physician in the same manner as the person or entity credentials and bills for the services of a physician assistant.

7.

As used in this section:

(a) “Medically underserved rural area” means a medically underserved area in a county whose population is less than 100,000.

(b) “Medically underserved urban area” means a medically underserved area that is located in a county whose population is 100,000 or more.

An associate physician shall clearly identify himself or herself as an associate physician, including, without limitation, by - *SB204* – 7 – wearing an identification badge that clearly identifies the person as an associate physician.

A physician shall not serve as the supervising physician of an associate physician pursuant to paragraph (b) of subsection 1 of section 7 of this act or the designee of a supervising physician pursuant to subsection 4 of section 7 of this act unless the physician:

and - *SB204_R1* – 8 – (c) May not enter into a collaborative practice agreement with more than three associate physicians.

- *SB204* – 8 – (1) The geographic proximity which,which except as otherwise provided in subsection 4, must exist between the supervising physician and the associate physician while the associate physician is practicing medicine;

(g) The procedure by which the supervising physician will review the standard of care the associate physician is providing to patients, including,which withoutmust limitation,comply awith requirement that, at least every 14 days, the associateregulations physicianadopted submitpursuant to thesection supervising13 physician:of this act;

(1) At least 10 percent of the charts for patients whom the associate physician cared for and did not prescribe or dispense a controlled substance;

and (2) At least 20 percent of the charts for patients whom the associate physician cared for and prescribed or dispensed a controlled substance;

- *SB204_R1* – 9 – 2.

4.

If an associate physician is able to communicate at any time with a supervising physician through electronic communication, videoconferencing or other telecommunication, - *SB204* – 9 – the supervising physician may waive any provision of a collaborative practice agreement described in subparagraph (1) of paragraph (e) of subsection 1 for not more than 28 days in a year while the supervising physician is practicing in a rural health clinic, as defined in 42 U.S.C.

§ 1395x(aa)(2), that:

(a) Is operating independently of other health care facilities;

(b) Is operating jointly with a critical access hospital designated pursuant to 42 U.S.C.

§ 1395i-4;

or (c) Is operating jointly with a hospital that is located more than 50 miles from the clinic.

(a) Is registered with the State Board of Pharmacy pursuant to NRS 453.231;639.1373;

AnSubject to the limitations prescribed in NRS 639.1373, an associate physician who meets the requirements of subsection 1 may prescribe or dispense:

or (b) The associate physician has, at any time, completed 120 hours practicing medicine over a period of not more than 4 - *SB204_R1* – 10 – months with his or her supervising physician physically present on the same premises.

The Board may renew a limited license to practice medicine as an associate physician upon application by the - *SB204* – 10 – associate physician.

(1) Any additional requirements for the issuance or renewal of a limited license to practice medicine as an associate physician;physician.

(2) The required fees for the issuance and renewal of such a license;license.

(3) Standards of practice for associate physicians, including, without limitation, limitations on the practice of medicine by an associate physician in addition to those prescribed by sections 6 to 13, inclusive, of this act;act.

(4) AnyRequirements additional requirements governing collaborative practice agreements entered into pursuant to section 7 of this act;act, including, without limitation, requirements governing the review by the supervising physician of the standard of care the associate physician is providing to patients.

andSuch (5)regulations Anymust additionalnot requirementsbe concerningmore thestringent supervisionthan ofany ansimilar associaterequirements physicianthat byapply ato supervisingphysician physician.assistants.

(5) Any additional requirements concerning the supervision of an associate physician by a supervising physician.

- *SB204_R1* – 11 – 4.

- *SB204* – 11 – Sec.

- *SB204_R1* – 12 – (1) Has completed 36 months of progressive postgraduate:

or - *SB204* – 12 – (II) Fellowship training in the United States or Canada approved by the Board or the Accreditation Council for Graduate Medical Education;

- *SB204_R1* – 13 – (c) Declare the license void if the Board or a committee appointed by the Board determines that the information submitted by the applicant was false, fraudulent or intended to deceive the Board;

or - *SB204* – 13 – (e) If the Board temporarily suspends the license, allow the license to return to active status subject to any terms and conditions specified by the Board, including:

and - *SB204_R1* – 14 – (b) The [standard] certificate of the Educational Commission for Foreign Medical Graduates .

If proof of the degree is unavailable - *SB204* – 14 – from the medical school that granted the degree, the Board may accept proof from any other source specified by the Board.

- *SB204_R1* – 15 – (a) Submit a list of all actions filed or claims submitted to arbitration or mediation for malpractice or negligence against him or her during the previous 2 years.

- *SB204* – 15 – (d) Submit all information required to complete the biennial registration.

and - *SB204_R1* – 16 – (e) Has passed all parts of the Federation Licensing Examination .

- *SB204* – 16 – 3.

- *SB204_R1* – 17 – Sec.

or - *SB204* – 17 – 2.

- *SB204_R1* – 18 – Sec.

and - *SB204* – 18 – (2) With whom the associate osteopathic physician has entered into a collaborative practice agreement that meets the requirements of section 27 of this act;

For the first 30 days during which an associate osteopathic physician practices medicine under the supervision of a new supervising osteopathic physician,physician in a medically underserved urban area, the supervising osteopathic physician must be physically present on the same premises and available to assist the associate osteopathic physician.

An associate osteopathic physician shall not practice medicine in a medically underserved rural area unless the supervising osteopathic physician or another osteopathic physician designated by the supervising osteopathic physician is physically present on the same premises and available to assist the associate osteopathic physician.

5.

6.

A person or entity that employs an associate osteopathic physician shall credential the associate osteopathic physician and bill for services rendered by the associate osteopathic physician in the same manner as the person or entity credentials and bills for the services of a physician assistant.

7.

As used in this section:

- *SB204_R1* – 19 – (a) “Medically underserved rural area” means a medically underserved area in a county whose population is less than 100,000.

(b) “Medically underserved urban area” means a medically underserved area that is located in a county whose population is 100,000 or more.

An osteopathic physician shall not serve as the supervising osteopathic physician of an associate osteopathic - *SB204* – 19 – physician pursuant to paragraph (b) of subsection 1 of section 24 of this act or the designee of a supervising osteopathic physician pursuant to subsection 4 of section 24 of this act unless the osteopathic physician:

The Board may not deny, revoke, suspend or take any other disciplinary action against the supervising osteopathic - *SB204_R1* – 20 – physician of an associate osteopathic physician for any act performed by the associate osteopathic physician that:

(1) The geographic proximity which,which except as otherwise provided in subsection 4, must exist between the supervising osteopathic physician and the associate osteopathic physician while the associate osteopathic physician is practicing osteopathic medicine;

and - *SB204* – 20 – (2) A plan for alternative supervision if the supervising osteopathic physician is absent, incapacitated or otherwise unavailable;

(g) The procedure by which the supervising osteopathic physician will review the standard of care the associate osteopathic physician is providing to patients, including,which withoutmust limitation,comply awith requirement that, at least every 14 days, the associateregulations osteopathicadopted physicianpursuant submit to thesection supervising30 osteopathicof physician:this act;

(1) At least 10 percent of the charts for patients whom the associate osteopathic physician cared for and did not prescribe or dispense a controlled substance;

and (2) At least 20 percent of the charts for patients whom the associate osteopathic physician cared for and prescribed or dispensed a controlled substance;

- *SB204_R1* – 21 – 2.

4.

If an associate osteopathic physician is able to communicate at any time with a supervising osteopathic physician through electronic communication, videoconferencing or other - *SB204* – 21 – telecommunication, the supervising osteopathic physician may waive any provision of a collaborative practice agreement described in subparagraph (1) of paragraph (e) of subsection 1 for not more than 28 days in a year while the supervising osteopathic physician is practicing in a rural health clinic, as defined in 42 U.S.C.

§ 1395x(aa)(2), that:

(a) Is operating independently of other health care facilities;

(b) Is operating jointly with a critical access hospital designated pursuant to 42 U.S.C.

§ 1395i-4;

or (c) Is operating jointly with a hospital that is located more than 50 miles from the clinic.

(a) Is registered with the State Board of Pharmacy pursuant to NRS 453.231;639.1373;

AnSubject to the limitations prescribed by NRS 639.1373, an associate osteopathic physician who meets the requirements of subsection 1 may prescribe or dispense:

- *SB204_R1* – 22 – (a) The supervising osteopathic physician of the associate osteopathic physician is physically present on the same premises;

- *SB204* – 22 – Sec.

(1) Any additional requirements for the issuance or renewal of a limited license to practice osteopathic medicine as an associate osteopathic physician;physician.

(2) The required fees for the issuance and renewal of such a license;license.

(3) Standards of practice for associate osteopathic physicians, including, without limitation, limitations on the practice of osteopathic medicine by an associate osteopathic physician in addition to those prescribed by sections 23 to 30, inclusive, of this act;act.

(4) Any additional requirements governing collaborative practice agreements entered into pursuant to section 24 of this act;act.

and (5) AnyRequirements additional requirements concerning the supervision of an associate osteopathic physician by a supervising osteopathic physician.physician, including, without limitation, requirements governing the review by the supervising osteopathic physician of the standard of care the associate osteopathic physician is providing to patients.

Such regulations must not be more stringent than any similar requirements that apply to physician assistants.

The regulations adopted pursuant to this section and NRS 633.471 must not require an associate osteopathic physician to - *SB204_R1* – 23 – complete a greater amount of continuing education than an osteopathic physician licensed pursuant to NRS 633.311.

The Board shall publish on an Internet website maintained by the Board the name of each associate osteopathic physician and - *SB204* – 23 – the osteopathic physician or osteopathic physicians supervising the associate osteopathic physician.

(2) Has completed 3 years, or such other length of time as required by a specific program, of postgraduate medical education as a resident in the United States or Canada in a program approved by the Board, the Bureau of Professional Education of the American - *SB204_R1* – 24 – Osteopathic Association or the Accreditation Council for Graduate Medical Education;

- *SB204* – 24 – (3) All parts of the licensing examination of the Board, a state, territory or possession of the United States, or the District of Columbia, and is certified by a specialty board of the American Osteopathic Association or by the American Board of Medical Specialties;

- *SB204_R1* – 25 – (c) Submitting a list of all actions filed or claims submitted to arbitration or mediation for malpractice or negligence against the holder during the previous year;

and - *SB204* – 25 – (f) Submitting all information required to complete the renewal.

The Board shall encourage each holder of a license to practice osteopathic medicine or as a physician assistant to receive, as a portion of his or her continuing education, training and - *SB204_R1* – 26 – education in the diagnosis of rare diseases, including, without limitation:

- *SB204* – 26 – 8.

- *SB204_R1* – 27 – (a) May include the training provided pursuant to NRS 449.103, where applicable.

- *SB204* – 27 – (6) Persons with a mental illness;

34.5.

NRS 639.1373 is hereby amended to read as follows:

639.1373 1.

A physician assistant or an associate physician licensed pursuant to chapter 630 or 633 of NRS may, if authorized by the Board, possess, administer, prescribe or dispense controlled substances, or possess, administer, prescribe or dispense poisons, dangerous drugs or devices in or out of the presence of his or her supervising physician only to the extent and subject to the limitations specified in the registration certificate issued to the physician assistant or associate physician by the Board pursuant to this section.

2.

Each physician assistant and associate physician licensed pursuant to chapter 630 or 633 of NRS who is authorized by his or her physician assistant’s or associate physician’s license issued by the Board of Medical Examiners or by the State Board of - *SB204_R1* – 28 – Osteopathic Medicine, respectively, to possess, administer, prescribe or dispense controlled substances, or to possess, administer, prescribe or dispense poisons, dangerous drugs or devices must apply for and obtain a registration certificate from the Board, pay a fee to be set by regulations adopted by the Board and pass an examination administered by the Board on the law relating to pharmacy before the physician assistant or associate physician can possess, administer, prescribe or dispense controlled substances, or possess, administer, prescribe or dispense poisons, dangerous drugs or devices.

3.

The Board shall consider each application separately and may, even though the physician assistant’s or associate physician’s license issued by the Board of Medical Examiners or by the State Board of Osteopathic Medicine authorizes the physician assistant or associate physician to possess, administer, prescribe or dispense controlled substances, or to possess, administer, prescribe or dispense poisons, dangerous drugs and devices:

(a) Refuse to issue a registration certificate;

(b) Issue a registration certificate limiting the authority of the physician assistant or associate physician to possess, administer, prescribe or dispense controlled substances, or to possess, administer, prescribe or dispense poisons, dangerous drugs or devices, the area in which the physician assistant or associate physician may possess controlled substances, poisons, dangerous drugs and devices, or the kind and amount of controlled substances, poisons, dangerous drugs and devices;

or (c) Issue a registration certificate imposing other limitations or restrictions which the Board feels are necessary and required to protect the health, safety and welfare of the public.

4.

If the registration of the physician assistant or associate physician licensed pursuant to chapter 630 or 633 of NRS is suspended or revoked, the physician’s controlled substance registration may also be suspended or revoked.

5.

The Board shall adopt regulations controlling the maximum amount to be administered, possessed and dispensed, and the storage, security, recordkeeping and transportation of controlled substances and the maximum amount to be administered, possessed, prescribed and dispensed and the storage, security, recordkeeping and transportation of poisons, dangerous drugs and devices by physician assistants and associate physicians licensed pursuant to chapter 630 or 633 of NRS.

In the adoption of those regulations, the Board shall consider, but is not limited to, the following:

(a) The area in which the physician assistant or associate physician is to operate;

(b) The population of that area;

- *SB204_R1* – 29 – (c) The experience and training of the physician assistant [;] or associate physician;

(d) The distance to the nearest hospital and physician;

and (e) The effect on the health, safety and welfare of the public.

6.

For the purposes of this section, the term “supervising physician” includes a supervising osteopathic physician as defined in chapter 633 of NRS.

Sec.

(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 - *SB204* – 28 – section 39 of this act, 422.580, 432.010 to 432.133, inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 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.

(c) Shall administer any state program for persons with developmental disabilities established pursuant to the - *SB204_R1* – 30 – Developmental Disabilities Assistance and Bill of Rights Act of 2000, 42 U.S.C.

- *SB204* – 29 – Sec.

(a) Adopt and carry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of its officers and employees, and the dependents of officers and employees who elect to accept the insurance and who, where necessary, have authorized the governing body to make deductions - *SB204_R1* – 31 – from their compensation for the payment of premiums on the insurance.

The money for contributions must be budgeted for in accordance with the laws - *SB204* – 30 – governing the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada.

- *SB204_R1* – 32 – 3.

- *SB204* – 31 – Sec.

- *SB204_R1* – 33 – Sec.

- *SB204* – 32 – (a) Coverage for services provided by such an associate physician to a number of occasions less than for services provided by another provider of health care.

A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the - *SB204_R1* – 34 – coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.

A policy of group health insurance must not require an insured to obtain prior authorization for any service provided by - *SB204* – 33 – an associate physician that is not required for the service when provided by a physician assistant.

- *SB204_R1* – 35 – Sec.

689C.425 A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to 689C.355, inclusive, and section 43 of this act to the extent - *SB204* – 34 – applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive.

- *SB204_R1* – 36 – (b) Reimbursement for services provided by such an associate physician to an amount less than the amount reimbursed for similar services provided by a physician assistant.

- *SB204* – 35 – 3.

As used in this section, “associate physician” means an associate physician licensed pursuant to chapter 630 of NRS or an - *SB204_R1* – 37 – associate osteopathic physician licensed pursuant to chapter 633 of NRS.

- *SB204* – 36 – Sec.

- *SB204_R1* – 38 – 3.

(a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, unless any amendments - *SB204* – 37 – to those submissions have been filed with and approved by the Commissioner;

or - *SB204_R1* – 39 – (2) Is unable to fulfill its obligations to furnish health care services as required under its health care plan;

- *SB204* – 38 – 4.

- *SB204_R1* – 40 – Sec.

and - *SB204* – 39 – (b) On January 1, 2024, for all other purposes.

H - *SB204**SB204_R1*