SB 192 — Revises provisions relating to public health. (BDR 40-86)

The Division may require any facility that violates any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and section 1 of this act, or any condition, standard or regulation - *SB192_R1* – 8 – adopted by the Board to make any improvements necessary to correct the violation.

Any money collected as administrative penalties pursuant to paragraph (d) of subsection 1 or subsection 2 must be accounted for separately and used to administer and carry out the provisions of NRS 449.001 to 449.430, inclusive, and section 1 of this act, - *SB192_R2* – 8 – 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.

- *SB192_R1* – 9 – 3.

(Deleted by amendment.) - *SB192_R2* – 9 – Sec.

(Deleted by amendment.) - *SB192_R1* – 10 – Sec.

- *SB192_R2* – 10 – (a) Meets the requirements of subsection 2;

- *SB192_R1* – 11 – (a) The fact that the diagnosis has not changed;

- *SB192_R2* – 11 – Sec.

- *SB192_R1* – 12 – Sec.

- *SB192_R2* – 12 – 2.

- *SB192_R1* – 13 – (c) The scheduled date of the hearings held pursuant to subsection 2;

- *SB192_R2* – 13 – 2.

- *SB192_R1* – 14 – Sec.

- *SB192_R2* – 14 – (a) Price fixing, which consists of raising, depressing, fixing, pegging or stabilizing the price of any commodity or service, and which includes, but is not limited to:

(e) Monopolization of trade or commerce in this State, including, without limitation, attempting to monopolize or otherwise - *SB192_R1* – 15 – combining or conspiring to monopolize trade or commerce in this State.

(f) Except as otherwise provided in subsection 2, consolidation, conversion, merger, acquisition of shares of stock or other equity interest, directly or indirectly, of another person engaged in - *SB192_R2* – 15 – commerce in this State or the acquisition of any assets of another person engaged in commerce in this State that may:

A group practice , health care facility, private provider of emergency medical services or health carrier coming under - *SB192_R1* – 16 – common ownership with another group practice , health care facility, private provider of emergency medical services or health carrier.

- *SB192_R2* – 16 – Sec.

or - *SB192_R1* – 17 – (2) The capital stock, membership interests or other equity interest of a group practice , health care facility, private provider of emergency medical services or health carrier;

- *SB192_R2* – 17 – (c) The employment of all or substantially all of the practitioners in a group practice;

- *SB192_R1* – 18 – (b) Submit a notification to the Commissioner of Insurance pursuant to NRS 692C.363 regarding the transaction, the person may satisfy the requirement for notification pursuant to subsection 1 - *SB192_R2* – 18 – by simultaneously submitting to the Attorney General a copy of the notification submitted to the Commissioner of Insurance.

(DeletedChapter 630 of NRS is hereby amended by amendment.)adding Sec.thereto the provisions set forth as sections 29 and 30 of this act.

Sec.

Chapter 630 of NRS is hereby amended by adding thereto a new section to read as follows:

Those regulations must list specific - *SB192_R1* – 19 – race-based health formulas and race-based care standards that physicians and physician assistants are authorized to use.

That list - *SB192_R2* – 19 – must not include a race-based health formula or a race-based care standard if there is a race-neutral health formula or race-neutral care standard, as applicable, that is scientifically validated as being at least as effective for the same purpose.

(Deleted1. by amendment.) Sec.

Upon diagnosing a patient with arthritis, osteoarthritis or any other condition that is regularly treated using stem cell therapy, a physician or physician assistant shall discuss with the patient the potential use of stem cell therapy to treat the condition.

2.

During the first encounter with a new patient, a provider of primary care shall inform the patient of options that may be available to the patient for donating, banking or storing stem cells for future use by the patient or a donee.

- *SB192_R1* – 20 – 3.

As used in this section:

(a) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(b) “Provider of primary care” means a physician, physician assistant or group of providers of health care that includes a physician or physician assistant which:

(1) Provides initial and primary health care services to a patient;

and (2) Maintains the continuity of care for the patient.

(c) “Stem cell therapy” means a therapy involving the use of human cells, tissues or cellular or tissue-based products.

Sec.

(DeletedChapter 632 of NRS is hereby amended by amendment.)adding Sec.thereto the provisions set forth as sections 32 and 33 of this act.

Sec.

Chapter 632 of NRS is hereby amended by adding thereto a new section to read as follows:

Those regulations must list specific race-based health formulas and race-based care standards that registered nurses and licensed practical nurses are authorized to - *SB192_R2* – 20 – use.

(b) “Race-based health formula” means a formula for determining whether a health-related condition exists or - *SB192_R1* – 21 – calculating health-related data that takes the race of the patient into account.

(Deleted1. by amendment.) Sec.

Upon diagnosing a patient with arthritis, osteoarthritis or any other condition that is regularly treated using stem cell therapy, an advanced practice registered nurse shall discuss with the patient the potential use of stem cell therapy to treat the condition.

2.

During the first encounter with a new patient, a provider of primary care shall inform the patient of options that may be available to the patient for donating, banking or storing stem cells for future use by the patient or a donee.

3.

As used in this section:

(a) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(b) “Provider of primary care” means an advance practice registered nurse or a group of providers of health care that includes an advanced practice registered nurse which:

(1) Provides initial and primary health care services to a patient;

and (2) Maintains the continuity of care for the patient.

(c) “Stem cell therapy” means a therapy involving the use of human cells, tissues or cellular or tissue-based products.

Sec.

- *SB192_R2* – 21 – (3) For prescribing and dispensing controlled substances and dangerous drugs in accordance with applicable statutes.

(4) For the psychiatric training and experience necessary for an advanced practice registered nurse to be authorized to make the diagnoses, evaluations , assessments and examinations described in NRS 432B.6078, 432B.60816, 433A.162, 433A.240, 433A.335, - *SB192_R1* – 22 – 433A.390, 433A.430, 484C.300 and 484C.320 to 484C.350, inclusive, and section 22 of this act the certifications described in NRS 432B.6075, 432B.60814, 433A.170, 433A.195 and 433A.200 and the sworn statements or declarations described in NRS 433A.210 and 433A.335.

The Board may adopt such other regulations, not inconsistent with state or federal law, as may be necessary to carry - *SB192_R2* – 22 – out the provisions of this chapter relating to nursing assistant trainees, nursing assistants and medication aides - certified.

- *SB192_R1* – 23 – Sec.

(DeletedChapter 633 of NRS is hereby amended by amendment.)adding Sec.thereto the provisions set forth as sections 35 and 36 of this act.

Sec.

Chapter 633 of NRS is hereby amended by adding thereto a new section to read as follows:

(c) “Race-neutral care standard” means a standard of care that does not require or authorize an osteopathic physician or physician assistant to take the race of the patient into account - *SB192_R2* – 23 – when making determinations regarding the care that will be provided to a patient.

- *SB192_R1* – 24 – Sec.

(Deleted1. by amendment.) Sec.

Upon diagnosing a patient with arthritis, osteoarthritis or any other condition that is regularly treated using stem cell therapy, an osteopathic physician or physician assistant shall discuss with the patient the potential use of stem cell therapy to treat the condition.

2.

During the first encounter with a new patient, a provider of primary care shall inform the patient of options that may be available to the patient for donating, banking or storing stem cells for future use by the patient or a donee.

3.

As used in this section:

(a) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(b) “Provider of primary care” means an osteopathic physician, physician assistant or group of providers of health care that includes an osteopathic physician or physician assistant which:

(1) Provides initial and primary health care services to a patient;

and (2) Maintains the continuity of care for the patient.

(c) “Stem cell therapy” means a therapy involving the use of human cells, tissues or cellular or tissue-based products.

Sec.

[(b)] (2) Is employed by or has accepted an offer of employment from a school of medicine or school of osteopathic - *SB192_R1* – 25 – medicine in this State to serve in a position where the provider of health care teaches students studying to become providers of health care or resident physicians at least 50 percent of the time the provider of health care is performing his or her duties for the school;

- *SB192_R2* – 24 – (a) The health carrier contracts with a third party for the delivery of services to covered persons;

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, 2026, has the legal effect of including the - *SB192_R1* – 26 – coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.

- *SB192_R2* – 25 – Sec.

A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after [October] January 1, [1999,] 2026, has the legal effect of including the - *SB192_R1* – 27 – coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.

689A.330 If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding public officer of that other state has informed the Commissioner that the policy is not subject to approval or disapproval by that officer, the Commissioner may by ruling - *SB192_R2* – 26 – require that the policy meet the standards set forth in NRS 689A.030 to 689A.320, inclusive [.] , and section 43 of this act.

- *SB192_R1* – 28 – (a) Testosterone replacement therapy for menopausal women;

(b) Refuse to issue a policy of group health insurance or cancel a policy of group health insurance solely because the person applying - *SB192_R2* – 27 – for or covered by the policy uses or may use in the future hormone replacement therapy;

A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2026, has the legal effect of including the coverage - *SB192_R1* – 29 – required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.

- *SB192_R2* – 28 – Sec.

- *SB192_R1* – 30 – (j) Smoking cessation programs for an insured who is 18 years of age or older consisting of not more than two cessation attempts per year and four counseling sessions per year;

- *SB192_R2* – 29 – 3.

- *SB192_R1* – 31 – (a) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use.

- *SB192_R2* – 30 – Sec.

- *SB192_R1* – 32 – Sec.

- *SB192_R2* – 31 – (c) Behavioral counseling concerning sexually transmitted diseases from a provider of health care for sexually active women who are at increased risk for such diseases;

- *SB192_R1* – 33 – 3.

- *SB192_R2* – 32 – (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

- *SB192_R1* – 34 – Sec.

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, 2026, has the legal effect of including the - *SB192_R2* – 33 – coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.

(b) Refuse to issue a contract for hospital or medical service or cancel a contract for hospital or medical service solely because the - *SB192_R1* – 35 – person applying for or covered by the contract uses or may use in the future hormone replacement therapy;

- *SB192_R2* – 34 – 3.

(b) “Network plan” means a health care plan offered by a health maintenance organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the health maintenance - *SB192_R1* – 36 – organization.

- *SB192_R2* – 35 – 2.

- *SB192_R1* – 37 – (a) The officers and employees, and the dependents of officers and employees, of the governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of this State;

(Deleted by amendment.) - *SB192_R2* – 36 – Sec.

- *SB192_R1* – 38 – 4.

The Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization - *SB192_R2* – 37 – pursuant to the provisions of this chapter if the Commissioner finds that any of the following conditions exist:

- *SB192_R1* – 39 – (h) The health maintenance organization or any person on its behalf has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner;

or - *SB192_R2* – 38 – (k) The health maintenance organization has otherwise failed to comply substantially with the provisions of this chapter.

(a) “Doula services” means services to provide education and support relating to childbirth, including, without limitation, - *SB192_R1* – 40 – emotional and physical support provided during pregnancy, labor, birth and the postpartum period.

(b) “Network plan” means a health care plan offered by a managed care organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the managed care - *SB192_R2* – 39 – organization.

- *SB192_R1* – 41 – (j) Smoking cessation programs for an insured who is 18 years of age or older consisting of not more than two cessation attempts per year and four counseling sessions per year;

and - *SB192_R2* – 40 – (l) Such well-woman preventative visits as recommended by the Health Resources and Services Administration, which must include at least one such visit per year beginning at 14 years of age.

- *SB192_R1* – 42 – 6.

- *SB192_R2* – 41 – (b) “Network plan” means a health care plan offered by a managed care organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the managed care organization.

- *SB192_R1* – 43 – (c) Submit the report published pursuant to paragraph (b) to the Director of the Legislative Counsel Bureau for transmittal to the next regular session of the Legislature.

- *SB192_R2* – 42 – (b) “Race-based care standard” means a standard of care that requires or authorizes a provider of health care to take the race of the patient into account when making determinations regarding the care that will be provided to a patient.

and - *SB192_R1* – 44 – (b) Post on an Internet website maintained by the Commissioner a bulletin stating, for each entity that is required to submit a plan pursuant to subsection 1, whether the entity is likely to be in compliance with amendatory provisions of section 44, 47, 49, 52, 54,54,Sec. 58 or 64 of this act, as applicable.

-68. *SB192_R2* – 43 – additional expenses of a local government that are related to the provisions of this act.

The provisions of NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.

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