(1)Finally, notifysection 3 prohibits a patientprogram orof hishospice orcare herfrom patient;transferring the billinghealth privileges of the program under Medicare within 60 months after:

(2)(1) providebeing aauthorized writtento noticeaccept containingpayment thethrough contactMedicare; information for the of the program and the hours during which the program can be contacted;

(3)or notify(2) a patientchange orin his or her representative not less than 7 days before the programownership terminatesof thean careinterest of the50 patientpercent or ceasesgreater operations;in the program.

Sections 4 and (4)11 provideof athis writtenbill noticeprovide tofor the patientenhanced oroversight hisof ora herprogram representativeof uponhospice admissioncare outliningduring the rightfirst of2 theyears patientafter toinitial filelicensure. a complaint against the program with the Division.

EXPLANATIONExisting –law Matterrequires ina boldedprogram italicsof hospice care to have a medical director who is new;a licensed physician.

matter(NRS between449.196) bracketsSections [omitted8 material]and is14 materialof tothis bebill omitted.prescribe additional required qualifications of the medical director, and section 5 of this bill prescribes the duties of the medical director.

Section 14] Existing law requires a program of hospice care to provide certain care, and section 17 of this bill provides that a patient of a program of hospice care has a right to such care.

(NRS 449.196) Sections 17 and 18 of this bill require a program of hospice care to inform a patient of that right.

Section 15 of this bill removes provisions Assembly Amendment No.

184 to Assembly Bill No.

161 Page 4 authorizing a facility for hospice care to provide certain care that the facility is required by employees of a program of hospice care to receive certain training;

and (2)] a program of hospice care to obtain and document the informed, written consent of a patient or his or her representative for all treatment and all decisions regarding the care of the patient.

Section 14 [establishes certain other requirements governing the operation of] additionally requires a program of hospice care [, including a requirement that the program designate an interdisciplinary team to develop, review and revise a plan of care for each patient.

Sections 2, 7 and 8 of this bill make conforming changes so that “interdisciplinary team” is defined consistently for provisions of law regulating hospice care.

Section 11 requires the State Board of Health to adopt regulations:

(1) requiring a program of hospice care to establish an independent review board to assess compliance with conflicts of interest from determining or assisting in the determination of whether a person is eligible to receive hospice care.

Section 6 of this bill requires the Division to publish an annual report concerning the ownership and licensure of each program of hospice care and the results of inspections of such programs.

Sections 9-13 and 16 of this bill make conforming changes to establish the applicability of sections 3-6 and provide for the enforcement of sections 3-6.] to:

(1) notify a patient or his or her representative if the program has initiated filing claims for benefits on behalf of the patient;

(2) provide a written notice containing the contact information for the program and the hours during which the program can be contacted;

(3) notify a patient or his or her representative not less than 7 provide a written notice to the patient or his or her representative upon admissiond (4) outlining the right of the patient to file a complaint against the program with the Division.

SectionsSection 1-11.1.

[Chapter 449 of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 6, inclusive, of this act.] (Deleted by amendment.) Sec.

2.

[“Interdisciplinary team” means a group of persons who work collectively to meet the special needs of terminally ill patients receiving hospice care and their families and includes such persons as a physician, registered nurse, social worker, member of the clergy and trained volunteer.] (Deleted by amendment.) Sec.

3.

[1.

Not later than 12 months after initial licensure, a program of hospice care shall enter into an agreement with the United States Secretary of Health and Human Services pursuant to 42 U.S.C.

§ 1395cc to accept payment through Medicare.

2.

A program of hospice care must be accredited by a national accrediting agency acceptable to the Division.

3.

A program of hospice care:

(a) Shall promptly inform the Division if any person or entity that holds an ownership interest of at least 5 percent in the program is being investigated for a potential violation of any federal, state or local law related to payment for health care.

(b) Shall not accept any new patients while:

(1) An investigation described in paragraph (a) is pending;

or (2) Any person or entity who has been found in a criminal or civil proceeding to have committed a violation of any federal, state or local law related Assembly Amendment No.

184 to Assembly Bill No.

161 Page 5 to payment for health care retains an ownership interest of at least 5 percent in the program.

(c) Shall not transfer the billing privileges of the program under Medicare to any other person or entity within 60 months after:

(1) Initially entering into an agreement described in subsection 1;

or (2) A change in the ownership of an interest of 50 percent or greater in the program.] (Deleted by amendment.) Sec.

4.

[1.

The Division shall inspect a program of hospice care that is issued an initial license on or after January 1, 2026:

(a) For the first time, within 60 days after initial licensure;

(b) For the second time, within 6 months after initial licensure;

(c) For the third time, within 12 months after initial licensure;

(d) For the fourth time, within 24 months after initial licensure;

and (e) At least once every 36 months thereafter.

2.

The Division shall inspect a program of hospice care that was issued an initial license on or after January 1, 2026, at least once every 36 months.

3.

For the first 24 months after the initial licensure of a program of hospice care that is issued an initial license on or after January 1, 2026:

(a) The program shall submit to the Division each month all information required to be reported to the United States Secretary of Health and Human Services pursuant to 42 U.S.C.

§ 1395f(i)(5).

(b) The Division shall conduct enhanced oversight of the program, which must include, without limitation, a review by the Division of a representative portion, as defined by regulation of the Board, of the claims for payment that the program intends to submit before the program submits the claims.] (Deleted by amendment.) Sec.

5.

[1.

The medical director employed by a program of hospice care pursuant to NRS 449.196 shall:

(a) Assist each interdisciplinary team in the development, review and revision of the plan of care required by paragraph (e) of subsection 1 of NRS 449.196;

(b) Act as a medical resource for each interdisciplinary team;

(c) Develop and periodically review the medical policies of the program, including, without limitation, policies for:

(1) The delivery of services to patients by physicians employed or contracted by the program;

(2) The orientation, training and support of physicians employed or contracted by the program;

(3) Ensuring compliance with paragraphs (c) to (k), inclusive, of subsection 1 of NRS 449.196 and subsections 2 and 3 of NRS 449.196;

and (4) Documentation to ensure compliance with the medical policies;

(d) Consult with the attending physicians of patients concerning the control of pain and symptoms and the medical management of patients, as appropriate;

(e) Act as a liaison between the program and physicians in the community;

(f) Ensure continuity and coordination of all medical services provided to patients;

(g) Provide supervision, direction and oversight for all physicians employed or contracted by the program;

and (h) Perform such other duties as are appropriate for the needs of the program.

2.

Any order for the administration of medication to a patient of a program of hospice care must be written and signed by the medical director of the program.] (Deleted by amendment.) Assembly Amendment No.

184 to Assembly Bill No.

161 Page 6 Sec.

6.

[1.

On or before December 31 of each year, the Division shall compile and post on a publicly available Internet website operated by the Division a report which includes, for each program of hospice care licensed in this State:

(a) The date on which the program was incorporated and the name of each incorporator;

(b) The name of each person or entity that owns at least 5 percent of the program;

(c) The name of any person or entity that is wholly or partially responsible for managing the program;

(d) The date on which the program applied for licensure, the date on which initial licensure was granted and the date on which licensure was most recently renewed;

(e) The date on which the program came into compliance with subsection 1 of section 3 of this act;

(f) The name of the entity that conducted the most recent survey of the program pursuant to 42 C.F.R.

§ 488.1110;

(g) The results of each inspection of the program conducted by the Division during the 5 years immediately preceding the date of the report, including, without limitation:

(1) Any deficiencies noted during the inspection;

(2) Requirements imposed by the Division to correct such deficiencies;

and (3) The date on which the Division determined that the deficiencies had been corrected;

and (h) Any other information required by subsection 2.

2.

The Division shall solicit input from persons and entities interested in the provision of hospice care, including, without limitation, patients, families, as defined in NRS 449.0115, advocates for patients, providers of health care and insurers, and include in the report compiled pursuant to subsection 1 information useful to such persons and entities.] (Deleted by amendment.) Sec.

7.

[NRS 449.001 is hereby amended to read as follows:

449.001 As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 449.0015 to 449.0195, inclusive, and section 2 of this act have the meanings ascribed to them in those sections.] (Deleted by amendment.) Sec.

8.

[NRS 449.0115 is hereby amended to read as follows:

449.0115 1.

“Hospice care” means a centrally administered program of palliative services and supportive services provided by an interdisciplinary team directed by a physician [.] licensed pursuant to chapter 630 or 633 of NRS.

The program includes the provision of physical, psychological, custodial and spiritual care for persons who are terminally ill and their families.

The care may be provided in the home, at a residential facility or at a medical facility at any time of the day or night.

The term includes the supportive care and services provided to the family after the patient dies.

2.

As used in this section [:

(a) “Family”] , “family” includes the immediate family, the person who primarily cared for the patient and other persons with significant personal ties to the patient, whether or not related by blood.

[(b) “Interdisciplinary team” means a group of persons who work collectively to meet the special needs of terminally ill patients and their families and includes such persons as a physician, registered nurse, social worker, member of the clergy and trained volunteer.] (Deleted by amendment.) Assembly Amendment No.

184 to Assembly Bill No.

161 Page 7 Sec.

9.

[NRS 449.029 is hereby amended to read as follows:

449.029 As used in NRS 449.029 to 449.240, inclusive, and sections 3 to 6, inclusive, of this act, unless the context otherwise requires, “medical facility” has the meaning ascribed to it in NRS 449.0151 and includes a program of hospice care described in NRS 449.196.] (Deleted by amendment.) Sec.

10.

[NRS 449.0301 is hereby amended to read as follows:

449.0301 The provisions of NRS 449.029 to 449.2428, inclusive, and sections 3 to 6, inclusive, of this act do not apply to:

1.

Any facility conducted by and for the adherents of any church or religious denomination for the purpose of providing facilities for the care and treatment of the sick who depend solely upon spiritual means through prayer for healing in the practice of the religion of the church or denomination, except that such a facility shall comply with all regulations relative to sanitation and safety applicable to other facilities of a similar category.

2.

Foster homes as defined in NRS 424.014.

3.

Any medical facility, facility for the dependent or facility which is otherwise required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed that is operated and maintained by the United States Government or an agency thereof.] (Deleted by amendment.) Sec.

11.

[NRS 449.0302 is hereby amended to read as follows:

449.0302 1.

The Board shall adopt:

(a) Licensing standards for each class of medical facility or facility for the dependent covered by NRS 449.029 to 449.2428, inclusive, and sections 3 to 6, inclusive, of this act, and for programs of hospice care.

(b) Regulations governing the licensing of such facilities and programs.

(c) Regulations governing the procedure and standards for granting an extension of the time for which a natural person may provide certain care in his or her home without being considered a residential facility for groups pursuant to NRS 449.017.

The regulations must require that such grants are effective only if made in writing.

(d) Regulations establishing a procedure for the indemnification by the Division, from the amount of any surety bond or other obligation filed or deposited by a facility for refractive surgery pursuant to NRS 449.068 or 449.069, of a patient of the facility who has sustained any damages as a result of the bankruptcy of or any breach of contract by the facility.

(e) Regulations that prescribe the specific types of discrimination prohibited by NRS 449.101.

(f) Regulations requiring a hospital or independent center for emergency medical care to provide training to each employee who provides care to victims of sexual assault or attempted sexual assault concerning appropriate care for such persons, including, without limitation, training concerning the requirements of NRS 449.1885.

(g) Any other regulations as it deems necessary or convenient to carry out the provisions of NRS 449.029 to 449.2428, inclusive [.] , and sections 3 to 6, inclusive, of this act.

2.

The Board shall adopt separate regulations governing the licensing and operation of:

(a) Facilities for the care of adults during the day;

and (b) Residential facilities for groups,  which provide care to persons with Alzheimer’s disease or other severe dementia, as described in paragraph (a) of subsection 2 of NRS 449.1845.

3.

The Board shall adopt separate regulations for:

Assembly Amendment No.

184 to Assembly Bill No.

161 Page 8 (a) The licensure of rural hospitals and rural emergency hospitals which take into consideration the unique problems of operating such a facility in a rural area.

(b) The licensure of facilities for refractive surgery which take into consideration the unique factors of operating such a facility.

(c) The licensure of mobile units which take into consideration the unique factors of operating a facility that is not in a fixed location.

4.

The Board shall require that the practices and policies of each medical facility or facility for the dependent provide adequately for the protection of the health, safety and physical, moral and mental well-being of each person accommodated in the facility.

5.

In addition to the training requirements prescribed pursuant to NRS 449.093, the Board shall establish minimum qualifications for administrators and employees of residential facilities for groups.

In establishing the qualifications, the Board shall consider the related standards set by nationally recognized organizations which accredit such facilities.

6.

The Board shall adopt separate regulations regarding the assistance which may be given pursuant to NRS 453.375 and 454.213 to an ultimate user of controlled substances or dangerous drugs by employees of residential facilities for groups.

The regulations must require at least the following conditions before such assistance may be given:

(a) The ultimate user’s physical and mental condition is stable and is following a predictable course.

(b) The amount of the medication prescribed is at a maintenance level and does not require a daily assessment.

(c) A written plan of care by a physician or registered nurse has been established that:

(1) Addresses possession and assistance in the administration of the medication;

and (2) Includes a plan, which has been prepared under the supervision of a registered nurse or licensed pharmacist, for emergency intervention if an adverse condition results.

(d) Except as otherwise authorized by the regulations adopted pursuant to NRS 449.0304, the prescribed medication is not administered by injection or intravenously.

(e) The employee has successfully completed training and examination approved by the Division regarding the authorized manner of assistance.

7.

The Board shall adopt separate regulations governing the licensing and operation of residential facilities for groups which provide assisted living services.

The Board shall not allow the licensing of a facility as a residential facility for groups which provides assisted living services and a residential facility for groups shall not claim that it provides “assisted living services” unless:

(a) Before authorizing a person to move into the facility, the facility makes a full written disclosure to the person regarding what services of personalized care will be available to the person and the amount that will be charged for those services throughout the resident’s stay at the facility.

(b) The residents of the facility reside in their own living units which:

(1) Except as otherwise provided in subsection 8, contain toilet facilities;

(2) Contain a sleeping area or bedroom;

and (3) Are shared with another occupant only upon consent of both occupants.

(c) The facility provides personalized care to the residents of the facility and the general approach to operating the facility incorporates these core principles:

(1) The facility is designed to create a residential environment that actively supports and promotes each resident’s quality of life and right to privacy;

Assembly Amendment No.

184 to Assembly Bill No.

161 Page 9 (2) The facility is committed to offering high-quality supportive services that are developed by the facility in collaboration with the resident to meet the resident’s individual needs;

(3) The facility provides a variety of creative and innovative services that emphasize the particular needs of each individual resident and the resident’s personal choice of lifestyle;

(4) The operation of the facility and its interaction with its residents supports, to the maximum extent possible, each resident’s need for autonomy and the right to make decisions regarding his or her own life;

(5) The operation of the facility is designed to foster a social climate that allows the resident to develop and maintain personal relationships with fellow residents and with persons in the general community;

(6) The facility is designed to minimize and is operated in a manner which minimizes the need for its residents to move out of the facility as their respective physical and mental conditions change over time;

and (7) The facility is operated in such a manner as to foster a culture that provides a high-quality environment for the residents, their families, the staff, any volunteers and the community at large.

8.

The Division may grant an exception from the requirement of subparagraph (1) of paragraph (b) of subsection 7 to a facility which is licensed as a residential facility for groups on or before July 1, 2005, and which is authorized to have 10 or fewer beds and was originally constructed as a single-family dwelling if the Division finds that:

(a) Strict application of that requirement would result in economic hardship to the facility requesting the exception;

and (b) The exception, if granted, would not:

(1) Cause substantial detriment to the health or welfare of any resident of the facility;

(2) Result in more than two residents sharing a toilet facility;

or (3) Otherwise impair substantially the purpose of that requirement.

9.

The Board shall, if it determines necessary, adopt regulations and requirements to ensure that each residential facility for groups and its staff are prepared to respond to an emergency, including, without limitation:

(a) The adoption of plans to respond to a natural disaster and other types of emergency situations, including, without limitation, an emergency involving fire;

(b) The adoption of plans to provide for the evacuation of a residential facility for groups in an emergency, including, without limitation, plans to ensure that nonambulatory patients may be evacuated;

(c) Educating the residents of residential facilities for groups concerning the plans adopted pursuant to paragraphs (a) and (b);

and (d) Posting the plans or a summary of the plans adopted pursuant to paragraphs (a) and (b) in a conspicuous place in each residential facility for groups.

10.

The regulations governing the licensing and operation of facilities for transitional living for released offenders must provide for the licensure of at least three different types of facilities, including, without limitation:

(a) Facilities that only provide a housing and living environment;

(b) Facilities that provide or arrange for the provision of supportive services for residents of the facility to assist the residents with reintegration into the community, in addition to providing a housing and living environment;

and (c) Facilities that provide or arrange for the provision of programs for alcohol and other substance use disorders, in addition to providing a housing and living environment and providing or arranging for the provision of other supportive services.

Assembly Amendment No.

184 to Assembly Bill No.

161 Page 10  The regulations must provide that if a facility was originally constructed as a single-family dwelling, the facility must not be authorized for more than eight beds.

11.

The Board shall adopt regulations applicable to providers of community- based living arrangement services which:

(a) Except as otherwise provided in paragraph (b), require a natural person responsible for the operation of a provider of community-based living arrangement services and each employee of a provider of community-based living arrangement services who supervises or provides support to recipients of community-based living arrangement services to complete training concerning the provision of community-based living arrangement services to persons with mental illness and continuing education concerning the particular population served by the provider;

(b) Exempt a person licensed or certified pursuant to title 54 of NRS from the requirements prescribed pursuant to paragraph (a) if the Board determines that the person is required to receive training and continuing education substantially equivalent to that prescribed pursuant to that paragraph;

(c) Require a natural person responsible for the operation of a provider of community-based living arrangement services to receive training concerning the provisions of title 53 of NRS applicable to the provision of community-based living arrangement services;

and (d) Require an applicant for a license to provide community-based living arrangement services to post a surety bond in an amount equal to the operating expenses of the applicant for 2 months, place that amount in escrow or take another action prescribed by the Division to ensure that, if the applicant becomes insolvent, recipients of community-based living arrangement services from the applicant may continue to receive community-based living arrangement services for 2 months at the expense of the applicant.

The Board shall adopt separate regulations governing the licensing and operation of freestanding birthing centers.

Such regulations must:

(a) Align with the standards established by the American Association of Birth Centers, or its successor organization, the accrediting body of the Commission for the Accreditation of Birth Centers, or its successor organization, or another nationally recognized organization for accrediting freestanding birthing centers;

and (b) Allow the provision of supervised training to providers of health care, as appropriate, at a freestanding birthing center.

13.

If the regulations adopted pursuant to this section require a physical examination to be performed on a patient or the medical history of a patient to be obtained before or after the patient is admitted to a hospital, those regulations must authorize a certified nurse-midwife to perform such a physical examination or obtain such a medical history before or after a patient is admitted to a hospital for the purpose of giving birth.

14.

The Board shall adopt regulations to:

(a) Establish an aggregate annual maximum amount of payments that a program for hospice care may claim during each of the first 2 years after initial licensure;

(b) Require a program of hospice care to establish an independent review board to assess compliance with state, federal and local laws and regulations and ethical standards related to hospice care;

and (c) Prohibit persons with financial conflicts of interest from determining or assisting in any manner with a determination of whether a person is eligible to receive hospice care.

15.

As used in this section:

(a) “Certified nurse-midwife” means a person who is:

Assembly Amendment No.

184 to Assembly Bill No.

161 Page 11 (1) Certified as a Certified Nurse-Midwife by the American Midwifery Certification Board, or its successor organization;

and (2) Licensed as an advanced practice registered nurse pursuant to NRS 632.237.

(b) “Living unit” means an individual private accommodation designated for a resident within the facility.] (Deleted by amendment.) Sec.

12.

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 sections 3 to 6, inclusive, of this act] upon any of the following grounds:

(a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410, 449.029 to 449.245, inclusive, [and sections 3 to 6, inclusive, of this act,] or -449A.100 83rdto Session449A.124, (2025)inclusive, –and 2section –17 of this act and 449A.270 to 449A.286, inclusive, or of any other law of this State or of the standards, rules and regulations adopted thereunder.

(e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or 439A.102 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, [and sections 3 to 6, inclusive, of this act] and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required, including, without limitation, the closure or conversion of any hospital in a county whose population is 100,000 NRSor 439A.102.ismore that is owned by the licensee without approval pursuant to (f) Failure to comply with the provisions of NRS 441A.315439A.102. and any regulations adopted pursuant thereto or NRS 449.2486.

(f) Failure to comply with the provisions of NRS 441A.315 and any regulations adopted pursuant thereto or NRS 449.2486.

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

-(a) 83rdA Sessionsummary (2025)of –a 3complaint –against the facility if the investigation of the complaint by the Division either substantiates the complaint or is inconclusive;

Assembly TheAmendment facilityNo. shall make the information available to the public pursuant to NRS 449.2486.

184 to Assembly Bill No.

161 Page 12  The facility shall make the information available to the public pursuant to NRS 449.2486.

(Deleted[NRS by449.163 amendment.)is Sec.hereby amended to read as follows:

449.163 1.

In addition to the payment of the amount required by NRS 449.0308, if a medical facility, facility for the dependent or facility which is required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed violates any provision related to its licensure, including any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and sections 3 to 6, inclusive, of this act or any condition, standard or regulation adopted by the Board, the Division, in accordance with the regulations adopted pursuant to NRS 449.165, may:

(a) Prohibit the facility from admitting any patient until it determines that the facility has corrected the violation;

(b) Limit the occupancy of the facility to the number of beds occupied when the violation occurred, until it determines that the facility has corrected the violation;

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

(d) Except where a greater penalty is authorized by subsection 2, impose an administrative penalty of not more than $5,000 per day for each violation, together with interest thereon at a rate not to exceed 10 percent per annum;

and (e) Appoint temporary management to oversee the operation of the facility and to ensure the health and safety of the patients of the facility, until:

(1) It determines that the facility has corrected the violation and has management which is capable of ensuring continued compliance with the applicable statutes, conditions, standards and regulations;

or (2) Improvements are made to correct the violation.

2.

If an off-campus location of a hospital fails to obtain a national provider identifier that is distinct from the national provider identifier used by the main campus and any other off-campus location of the hospital in violation of NRS 449.1818, the Division may impose against the hospital an administrative penalty of not more than $10,000 for each day of such failure, together with interest thereon at a rate not to exceed 10 percent per annum, in addition to any other action authorized by this chapter.

3.

If the facility fails to pay any administrative penalty imposed pursuant to paragraph (d) of subsection 1 or subsection 2, the Division may:

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

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

4.

The Division may require any facility that violates any provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and sections 3 to 6, inclusive, of this act or any condition, standard or regulation adopted by the Board to make any improvements necessary to correct the violation.

5.

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 Assembly Amendment No.

184 to Assembly Bill No.

161 Page 13 sections 3 to 6, inclusive, 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.] (Deleted by amendment.) Sec.

may449.196 represent1. that it provides “hospice care” unless the program of care, either directly or indirectly:

[1.]No (a)person, Hasstate aor medicallocal directorgovernment whoseor responsibilitiesagency aremay appropriaterepresent tothat theit needsprovides of“hospice care” unless the program andof who:care , either directly or indirectly]:

[(a)][1. (1) Is a physician, currently licensed to practice;

[(b)]:] (2)(a) On[Has thean basisadministrator ofwho training,has experienceat andleast interest,5 isyears knowledgeableof aboutexperience thein psychosocialhospice andor medicalpalliative aspectsmedicine; of hospice;

(b)] Has a medical director whose [who performs the] responsibilities are appropriate to the needs of the program [listed in section 5 of this act] and who:

[(a)] (1) Is a physician , [who:

(I) Is] currently licensed [pursuant to chapter 630 or 633 of NRS] to practice ;

[medicine or osteopathic medicine, as applicable;

(II) Has at least 5 years of independent experience in the clinical practice of medicine or osteopathic medicine;

and (III) Is an employee of the person, state or local government or agency that provides the program of hospice care;

and] [(b)] (2) On the basis of training, experience and interest, is knowledgeable about the psychosocial [, spiritual] and medical aspects of hospice;

[2.][2. (b) Is provided to the patient, as needed, in the patient’s home, at a residential facility and at a medical facility, at any time of the day or night;

[3.](c)] (c)(b) IncludesIs medical,provided nursing,to psychologicalthe andpatient, pastoralas careneeded, andin social services at the level required by the patient’s con[4.]home, (d)at Providesa supportiveresidential servicesfacility for the patient’s immediate family and otherat personsa withmedical significantfacility, personalat tiesany totime of the patient,day whether or notnight; related by blood, including:

[(a)][3. (1) Care for the patient which provides a respite from the stresses and responsibilities that result from the daily care of the patient;

and(d)] [(b)](c) (2)Includes Emotionalmedical, supportnursing, psychological and otherpastoral care afterand social services at the patientlevel dies;required by the patient’s condition ;

and[4. [5.] (e) Includes the services of trained volunteers.

-, 83rdincluding, Sessionwithout (2025)limitation, –the 4following –types 2.of care:

A(1) programRoutine ofcare hospicein carethe shall:home;

(2) General inpatient care for the management of pain and symptoms;

(3) Continuous in-home care for the acute management of symptoms;

and (4) Care for the patient which provides a respite from the stresses and responsibilities that result from the daily care of the patient;

(e) Designates an interdisciplinary team for the patient to develop a plan of care for the patient and review and revise the plan of care at least once every 15 days in accordance with 42 C.F.R.

§ 418.56;

(f) Requires each person who provides care to a patient to adhere to the plan of care developed pursuant to paragraph (e);

(g) Provides for the visitation of the patient by a member of the interdisciplinary team of the patient at least once each week, and more frequently if required by the plan of care;

(h) Has a physician on call 24 hours each day, 7 days each week to respond to the needs of patients;

(i) Has entered into contracts with other facilities and providers of health care as necessary to allow the transfer of a patient if the patient requires care with respect to the management of pain or symptoms that the program is unable to provide;

(j)] (d) Provides supportive services for the patient’s immediate family and other persons with significant personal ties to the patient, whether or not related by blood, including :

Assembly Amendment No.

184 to Assembly Bill No.

161 Page 14 [(a)] (1) Care for the patient which provides a respite from the stresses and responsibilities that result from the daily care of the patient;

and [(b)] (2) Emotional [emotional] support and other care after the patient dies;

and [5.

(k)] (e) Includes the services of trained volunteers.

2.

[Each employee of a program of hospice care must:

(a) Before beginning his or her employment, receive training on compliance with federal laws and regulations relating to hospice care and relevant requirements of the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services;

and (b) Receive at least 40 hours of training annually concerning the elements of hospice care related to the role of the employee which must include, without limitation, training in ethics.

3.] A program of hospice care shall:

[and] (b) Maintain each document upon which written consent is provided pursuant to paragraph (a) for at least 5 years after the patient ceases receiving care from the program;program [.] ;

449.197Sec. [1.] 449.A licensed facility for hospice care may provide any of the following levels of care for terminally ill patients:

15.

NRS 449.197 is hereby amended to read as follows:

449.197 [1.] A licensed facility for hospice care may provide any of the following levels of care for terminally ill patients:

A licensed facility for hospice care may provide direct supportive services to a patient’s family and persons who provide care for the patient, including services which provide care for the patient during the day and other services which provide a respite from the stresses and responsibilities that result from the daily care of the patient.] Sec.Assembly Amendment No.

184 to Assembly Bill No.

161 Page 15 Sec.

(Deleted[NRS by449.240 amendment.)is -hereby 83rdamended Sessionto (2025)read –as 5follows: – Sec.

449.240 The district attorney of the county in which the facility is located shall, upon application by the Division, institute and conduct the prosecution of any action for violation of any provisions of NRS 449.029 to 449.245, inclusive [.] , and sections 3 to 6, inclusive, of this act.] (Deleted by amendment.) Sec.

Every patient of a program of hospice care has the right to receive the care specified in paragraph [(d)] (c) of subsection 1 of NRS2.49.NotNRS later449.196. than 15 days after a patient elects to receive care from a program of hospice care, the program of hospice care shall provide to the patient or the patient’s legal representative an explanation of the services available through the program.

2.

Not later than 15 days after a patient elects to receive care from a program of hospice care, the program of hospice care shall provide to the patient or the patient’s legal representative an explanation of the services available through the program.

(1) Designate a caregiver pursuant to NRS 449A.300 to 449A.330, inclusive;

andregiverand pursuant to NRS 449A.300 to (2) Express complaints and grievances as described in paragraphs (b) to (f), inclusive;

and -(3) 83rdAn Sessionexplanation (2025)of –the 6services –provided by the Bureau, including, without limitation, the services for dispute resolution described in subsection 3 of NRS 232.462;

(a)Assembly IfAmendment theNo. hospital is a major hospital:

184 to Assembly Bill No.

161 Page 16 (a) If the hospital is a major hospital:

and (2) Notice of any policies and procedures the hospital may have adopted to reduce charges for services provided to persons or to provide discounted services to persons, which policies and procedures are in addition to any reduction or discount required to be provided pursuant to NRS 439B.260.

ascribed toAs itused in NRSthis 439B.115.majorsubsection, “major hospital” has the meaning 5.ascribed to it in NRS 439B.115.

In5. addition to the requirements of subsections 1 to 4, inclusive, every hospital shall post in a conspicuous place in each public waiting room in the hospital a legible sign or notice in 14- point type or larger, which sign or notice must:

In addition to the requirements of subsections 1 to 4, inclusive, every hospital shall post in a conspicuous place in each public waiting room in the hospital a legible sign or notice in 14-point type or larger, which sign or notice must:

- 83rd Session (2025) – 7 – (1) Instructions for receiving additional information regarding such policies and procedures;

and Sec.(c) Be written in English and Spanish.

19.

(Deleted by amendment.)anish.

19.

[1.

A program of hospice care operating in this State on January 1, 2026, is exempt from the requirements of subsections 1 and 2 of section 3 of this act until July 1, 2026.

2.

A program of hospice care that holds a valid license to operate in this State on January 1, 2026, is not subject to the requirements of paragraph (a) of subsection 14 of NRS 449.0302, as amended by section 11 of this act, and any regulations adopted pursuant thereto.

3.

As used in this section, “hospice care” has the meaning ascribed to it in NRS 449.0115.] (Deleted by amendment.) Sec.

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