SB 495 — Revises provisions relating to health care. (BDR 40-1037)

Existing law establishes programs to increase awareness of information concerning hospitals and surgical centers for ambulatory patients.

(NRS 439A.200- 439A.290) Section 9.5 of this bill requires the Department to establish a similar program to increase awareness of information concerning independent centers for emergency medical care.

Sections 9.5, 10.5, 12.5, 13.5 and 27.3 of this bill provide for the Department to collect certain information on the operations of independent independent centers for emergency medical care.

To facilitate such reporting, section 27.3 requires an independent center for emergency medical care to use the same form prescribed by the Director for discharging patients as a hospital is currently required to use.

Section 95.5 of this bill makes a conforming change to reflect that independent centers for emergency medical care will be using the same form.

Sections 12.5 and 13.5 require the Department to:

(1) make certain information concerning independent centers for emergency medical care available upon request;

and (2) post certain information concerning independent centers for emergency medical care on an Internet website maintained by the Department.

independent centers for emergency medical care to sections that discuss thees to program and associated website.

Section 8.5 of this bill defines the term “independent center for emergency medical care” for that purpose.

Section 11.5 of this bill establishes the applicability of certain definitions.

Section 27.7 of this bill requires a report prepared by the Director on the status of the programs to increase public awareness of information concerning hospitals and surgical centers for ambulatory patients to additionally include information on the status of the program to increase awareness of information concerning independent centers for emergency medical care.

Section 51.3 of this bill requires the Director of the system of value-based payments for care provided by independent centers ford a emergency medical care to recipients of Medicaid.

Existing law authorizes a court, upon a petition, to order the sealing of records of certain convictions if the person who was convicted:

(1) has not been convicted of any additional offense, except for minor traffic violations, for a specified period - *SB495_R1* – 4 – traffic violations.

(NRS 179.245) Existing law also authorizes a court, upon aor petition, to order the sealing of records of an arrest where the charges were dismissed, the prosecutor declined to prosecute or the person who was arrested was acquitted.

(NRS 179.255) Section 32.5 of this bill authorizes the Department or the Division of Health Care Financing and Policy of the Department to review certain sealed records for the purpose of determining the suitability of the person to whom the records pertain to serve as a provider of services under Medicaid or to own or serve as an officer, managing employee or managing agent of such a provider of serExisting law prescribes a procedure for conducting a hearing to review an action taken against a provider of services under Medicaid.

(NRS 422.306) Section 51.5 of this bill requires such a provider of services to maintain and provide certain documents to the Department for the purpose of verifying claims.

Section 51.5 authorizes the Department to deny a claim or recover money already paid if the Department is unable to verify the claim.

Section 51.8 of this bill:

(1) prescribes a process for the Department to review claims for appropriateness and propriety;

and (2) authorizes the Department to deny or recover any amount paid pursuant to such a claim or take certain actions based on such a review.

Section 119.5 of this bill Department and authorizes the expenditure of certain other money to carry out the sections 51.3-51.8.

Section 67 of this bill:

and (2) requires the OfficeDirector to performappoint certainthe dutiesExecutive toDirector improveof access to and the effectivenessOffice. of mental health services in this State.

Section 6767.2 authorizesof this bill requires the Office to requestperform ancertain allocationduties ofto moneyimprove fromaccess to and the Accounteffectiveness toof supportmental thosehealth duties.services in this State.

Section 67.4 of this bill requires the Office to perform certain additional duties related to the mental and behavioral health of children.

Sections 67.6-67.8 of this bill require the subcommittee on the mental health of children of the Commission Section 67.5 of this bill requires the Office to submit a biennial report to the Legislature.

Section 66.6 of this bill defines the term “Office” for the purposes of sections 67-67.5 to refer to the Office of Mental Health.

Senate Bill No.

494 of this legislative session proposes to create a new department in the Executive Branch of State Government known as the Nevada Health Authority to perform certain duties related to health care, including behavioral health care, in this State.

Section 121.5 of this bill transfers the Office to the Nevada Health Authority if Senate Bill No.

494 is enacted.

(1) provide continuing education concerning the mental health needs of patients in rural areas;

and (2) establish a program to recognize psychologists who provide at Sectionsleast 20,200 43,hours 47, 50, 75, 85, 109 and 113 of thisservices billthrough prescribetelehealth requirements to expeditesuch thepatients. process of credentialing providers of health care to participate in public and private health insurance plans.

BeginningSections on20, January46, 1,50, 2027,75, sections85, 117109 and 118113 of this bill requireprescribe insurersrequirements that issue such plans, or entities to whichexpedite suchthe insurers delegate credentialing functions, to process least 95 percent of complete requests for such credentialing notproviders laterof thanhealth 60care daysto afterparticipate receivingin allpublic ofand theprivate informationhealth necessaryinsurance toplans. complete such a request.

Beginning on January 1, 2027, sectionsections 21117 and 118 of this bill similarlyrequire requiresinsurers athat hospitalissue tosuch processplans, ator leastentities 95to percentwhich ofsuch completeinsurers requestsdelegate fromcredentialing providersfunctions, ofto healthprocess careleast for95 privilegespercent toof performcomplete necessaryrequests tofor complete such acredentialing request.annot later than 60 days after receiving all of the2027, informationsection Existing21 lawof authorizesthis anbill emergencysimilarly medicalrequires technician,a advancedhospital emergencyto medicalprocess technicianat orleast paramedic95 whopercent holdsof thecomplete properrequests endorsementfrom toproviders provideof services,health knowncare asfor communityprivileges paramedicineto services,perform toservices patientsat whothe dohospital not requirelater emergencythan medical60 transportation.days after receiving all of the information necessary to complete such a request.

- *SB495_R1* – 5 – medical technician or paramedic who holds the proper endorsement to providency services, known as community paramedicine services, to patients who do not require emergency medical transportation.

Existing law requiresprovides thethat Directora ofnoncompetition thecovenant Officeis ofvoid Science,unless Innovation and Technology in the Officecovenant: of the Governor to implement the Graduate Medical State seeking to create, expand or retain programs for residency training andn this postdoctoral fellowships for physicians.

(NRS 223.610, 223.637) Sections 36-40 of this bill transfer duties related to the administration of the Program from the Office of Science, Innovation and Technology to the Department.

Sections 34 and 35 of this bill make conforming changes to remove the Program from the duties that the Director of the Office of Science, Innovation and Technology is required to perform.

Section 39:

(1) authorizes the Department to award limited grants for certain purposes relating to the establishment of a program for residency training and postdoctoral fellowships for physicians;

and (2) establishes certain priorities for or reducing the size of a program for residency training and postdoctoraleliminating fellowships without the approval of the Department.

Section 49 of this bill requires the Department to explore ways to use federal financial participation in Medicaid to support such programs.

Section 121 of this bill requires the Patient Protection Commission to conduct a study during the 2025-2026 interim concerning academic medical centers in this State, and section 120 of this bill appropriates money for the study.

Section 121 authorizes the Patient Protection Commission to request not more than two legislative measures to implement any recommendations resulting from the study.

covenant:

(3) does notare imposeappropriately anyrelated undueto hardshipthe onconsideration for the employee;covenant.

and(NRS (4)613.195)at imposesSection restrictions71 of this bill provides that area appropriatelynoncompetition relatedcovenant may not apply to thea considerationprovider forof thehealth covenant.care whose primary duties involve providing clinical care to patients and who is not employed or contracted to primarily perform administrative tasks.

(NRS 613.195) Section 71 of this bill provides that, in general, a noncompetition covenant may not - *SB495* – 4 – the term of his or her employment or contract.

Section 70 of this bill prescribesafter certain exceptions to that general prohibition.

(1) serve underserved geographic areas or populations in this State;State.

orSections (2)76 practiceand a86 specialtyof forthis whichbill thererequire iscertain areports shortagesubmitted inby thisthosen State.Boards to the Governor and Legislature to include information relating to the efficiency of the process for licensing physicians or osteopathic physicians, as applicable.

SectionsExisting 76law andrequires 86 of this bill require certain reports submitted by those efficiency of the processDirector forto: licensing physicians or osteopathic physicians, as applicable.

(1) develop and make available to each professional licensing board that licenses, certifies or registers providers of health care an electronic data request that solicits certain information relating to the demographics and practices of providers of health care;

and (2) establish and maintain a database of information collected through the data request.

(NRS certificate or registration may, but are not required to, complete the data request.

(NRS 450B.805, 630.2671, 630A.327, 631.332, 632.3423, 633.4716, 634.1303, 634A.169, 635.111, 636.262, 637.145, 637B.192, 639.183, 640.152, 640A.185, 640B.405, 640D.135, 640E.225, 641.2215, 641A.217, 641B.281, 641C.455, 652.126) Sections 76.5, 82.3, 82.6, 86.2-86.8 and 89.2-89.9 of this bill make completion of the data request mandatory to renew a license, certificate or registration issued by:

(1) the Board of Medical Examiners;

(2) the Board of Dental Examiners of Nevada;

(3) the State Board of Nursing;

(4) the State Board of Osteopathic Medicine;

(5) the State Board of Podiatry;

(6) the Nevada State Board Psychological Examiners;

(9) the Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors;

(10) the Board of Examiners for Social Workers;

(11) the Board of Examiners for Alcohol, Drug and Gambling Counselors;

and (12) the Board of Applied Behavior Analysis.

Section 42.5 of this bill makes a conforming change to ensure the confidentiality of information submitted through such a data request.

(NRS 631.290) Sections 77 and 79 of this bill requireauthorize the Board of Dental Examiners of Nevada to establish by regulation an alternative training pathway involving a course of training under the supervision of a licensed dentist that an applicant for such a license may complete instead of graduating from such a program.

Section 77 requires an applicant who has completed the alternative conductedtraining bypathway theto supervisinghave dentist;also successfully passed:

(1) a competency examination conducted by the supervising dentist;

and (3) a clinical examination- approved*SB495_R1* by– the6 Board.– applicant to submit with his or her application for licensure proof that he or she has passed those examinations.

Section 78 of this bill requires such an applicant to submit with his or her application for licensure proof that he or she has passed those examinations.

Section 77 requires the Board to adopt regulations establishing the scope of practice of a dental hygienist who has completed the alternative training pathway,pathway. including regulations locations where a dental hygienist is authorized to practice under existing law;

andSection (2)81 prescribeof andthis dispensebill preventiveprohibits agents,a indental additionhygienist towho has completed the alternative training pathway from prescribing and dispensing preventive agentsagents.ted thatprogram aof dental hygienisthygiene isExisting authorizedlaw requires the Department to prescribeadminister Medicaid and dispensethe underChildren’s existingHealth law.Insurance Program.

(NRS 631.310, 631.3105) Sections 32, 80-82, 87 and 88 of this bill make conforming changes to authorize such a dental hygienist to practice at such locations and prescribe and dispense such protective agents.

Existing law requires the Department to administer Medicaid and the Children’s Health Insurance Program.

(1) a hospital to elect to make determinations concerning whether certain otherpersons entitiesare topresumptively makeeligible suchfor determinations.Medicaid;

and (2) a state to allow certain other entities to make such determinations.

§§ 1396a(a)(47),ow1396a(a)(47), 1396r-1, 1396r-1a, 1396r-1b, 1396r-1c) Section 51 of this bill requires the Department to take certain measures to facilitate such presumptive eligibility determinations by the personnel of hospitals and qualified community-based organizations.ensure that the presumptive eligibility determinations made by the personnel ofo those entities are accurate and comply with applicable law.

SectionExisting 51law alsoauthorizes requirescertain thehealth Departmentinsurers to auditrequire suchprior entitiesauthorization tobefore ensurean thatinsured themay presumptivereceive eligibilitycoverage determinationsfor mademedical by the personnel of those entities are accurate and complydental withcare applicablein law.certain circumstances.

ExistingIf lawan authorizesinsurer certainrequires health insurers to require prior authorizationauthorization, beforeexisting anlaw insuredrequires maythe receive coverage for medical and dental care in certain insurer to:

(1) file its procedure for obtaining prior authorization with theres the Commissioner of Insurance for approval;

(NRS 687B.225) Beginning on January 1, 2028, sections 44, 47, 53-62, 69, 97-108 and 110 of this bill establishmedical additionalcare requirementsby relatinghealth toinsurers, theincluding useMedicaid, ofthe priorChildren’s authorizationHealthon for - *SB495* – 5 – Health Insurance Program and insurance for publicstate employees, as well as certain entities with which such insurers contract to perform functions relating to prior authorization.

Sections 53.5, 54, 55 and 98-100 define certain terms, and sections 53 and 97 establish the applicability of those definitions.

SectionsSection 56101.6 andof 110this requirebill anrequires insurercertain orinsurers and other entityentities that performsemploy functionsor relatingutilize toan priorartificial authorizationintelligence tosystem respondor automated decision tool to aprocess requestrequests for prior authorization withinto thetransmit perioda ofnotice timeto prescribedeach byinsured certainthat: nationally recognized operating rules governing prior authorization.

If(1) andiscloses insurerthe orinsurer’s otheruse entityof that performs functions relating to prior authorization is sections 56 and 110 require the insurersystem or entitytool to notifyprocess therequests insuredfor andprior hisauthorization; or her provider of health care of the delay.

and (2) describes other entity that performs functions relating to prior authorization to respond to a request for prior authorization within a specified period of time.

If an insurer or other entity that performs functions relating to prior authorization is unable to approve or deny a request for prior authorization within that time period, sections 56 and 110 require the insurer or entity to notify the insured and his or her provider of health care of the delay.

Sections 56 and 110 prohibit insurers and other entities that perform functions relating to prior authorization from requiring prior authorization for coveredcoveredions emergency services.

Sections 57 and 101 require insurers and other entities that perform functions relating to prior authorization to implement an electronic system for receiving and processing requests for prior authorization.

Sections 22 and 72 of this- bill*SB495_R1* require– certain7 medical– facilitiesrequests andfor providersprior authorization through those systems.ers of health care to submit requestsSections for60 priorand authorization104 throughlimit thosethe systems.circumstances under which an insurer or other entity that performs functions relating to prior authorization may:

Sections 60 and 104 limit the circumstances under which an insurer or other entity that performs functions relating to prior authorization may:

SectionSections 12661 ofand this105 billprescribe eliminates certain similar requirements in existing law governing dental insurance that are less stringent than requirements to ensure the continuity of care for an insured whose benefits are terminated or who switches health insurance plans.

Sections 62 and 106 provide for the reporting and publication of certain information relating to prior authorization and the payment of claims.

Section 56 requires the Department, with respect to Medicaid and the Children’s Health Insurance Program, or a Medicaid managed care organization to grant Gold Card Exemptions to providers Sectionsof 44health andcare 63in ofaccordance thiswith billsection require107 insuranceexcept forin thecertain employeescircumstances. of locals.

governments,Section 63 of this bill requires Medicaid and the Children’s Health Insurance Program to comply with certain requirements governing the prompt payment of claims that apply under existing law to private insurers and the Public Employees’ Benefits Program.

(NRS 683A.0879, 689A.410, 689B.255, 689C.355, 689A.188,689A.188,mployees’ 695B.2505, 695C.185, 695D.215) Section 63 additionally requires Medicaid to comply with certain federal requirements governing the timely payment of claims under Medicaid.

(1) requirements to ensure that applicants for certain certificates or approval to engage in business related to insurance are equipped to comply with certain requirementsgagerequirements governing prior authorization and the payment of health claims;

and (2) criteria to ensure that an insurer or other entity that enters into a contract to provide services forSections certain45, public91, insurance93-95 programsand is116 inof compliancethis withbill make various changes to establish the applicability of those requirements.regulations.

Sections 45, 64, 66, 91, 93-95, 115 and 116 of this bill make various changes to - *SB495* – 6 – establish the applicability of those regulations.

Section 108 additionally requires the Commissioner to perform certain other duties relating to the implementation and enforcement of requirements governing prior authorization and the payment of health claims.

Section 65 of thissthis bill requires the prior authorization policies and procedures for prescription drugs under Medicaid to comply with sections 53-63.

Section 41 of this bill requires the Director of the Department to administer sections 49-6350-63 in the same manner as othersections provisions97-108 governingand Medicaid.110 applicable to insurance for state and private employees and nonprofit hospital or medical services corporations.

SectionsSection 44,101.3 47,of 52,this 69bill andmakes 114sections of101.8-105 thisand bill110 employees,inapplicable to Medicaid managed care organizationsorganizations, andwhich nonprofitare hospitalinstead orrequired medicalto servicescomply corporations.with sections 56 and 58-61.

Sections 23-27,23, 24, 25, 26, 27, 90, 111 and 112 of this bill make conforming changes concerning the applicability and enforcement of sections 20-20-22 22 and 109.

THESection PEOPLE121 OFof THEthis STATEbill OFrequires NEVADA,the REPRESENTEDPatient INProtection SENATECommission ANDto ASSEMBLY,conduct DOa ENACTstudy ASduring FOLLOWS:the 2025-2026 interim concerning academic medical centers in this State, and section 120 of this bill appropriates money for the study.

- *SB495_R1* – 8 – THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Chapter 439A439 of NRS is hereby amended by adding thereto thea provisionsnew setsection forth as sections 2 to 18,read inclusive,as offollows: this act.

“High-level provider of health care” means a physician or physician assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, advanced practice registered nurse, chiropractic physician, podiatric physician or physical therapist.

2.1.5.

AsNRS used439.581 inis sectionshereby 2amended to 18,read inclusive,as offollows: this act, unless the context otherwise requires, the words and terms defined in sections 3, 4 and 5 of this act have the meanings ascribed to them in those sections.

439.581 As used in NRS 439.581 to 439.597, inclusive, and section 1 of this act, unless the context otherwise requires, the words and terms defined in NRS 439.582 to 439.585, inclusive, and section 1 of this act have the meanings ascribed to them in those sections.

2.

(Deleted by amendment.) Sec.

2.5.

NRS 439.588 is hereby amended to read as follows:

439.588 1.

A health information exchange shall not operate in this State without first obtaining certification as provided in subsection 2.

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.

“Account”The meansDirector themay Nevadadeny Healthan Careapplication Workforcefor andcertification Accessor Accountmay createdsuspend byor sectionrevoke 6any certification issued pursuant to subsection 2 for failure to comply with the provisions of thisNRS act.regulations adopted pursuant thereto or any applicable federal or state law.

Sec.

“BoardWhen ofthe EconomicDirector Development”intends meansto thedeny, Boardsuspend ofor Economicrevoke Developmenta createdcertification, he or she shall give reasonable notice to all parties by NRScertified 231.033.mail.

Sec.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.

“ProviderThe ofDirector healthshall care”adopt hasregulations establishing the meaningmanner ascribedin towhich ita inperson NRSmay 629.031.file a complaint with the Director regarding a violation of the provisions of this section.

Sec.

1.The Director may impose an administrative fine against a health information exchange which operates in this State without - *SB495_R1* – 9 – holding a certification in an amount established by the Director by regulation.

ThereThe isDirector herebyshall createdafford ina thehealth Stateinformation Generalexchange Fundso thefined Nevadaan Healthopportunity Carefor Workforcea andhearing Accesspursuant Account.to the provisions of NRS 233B.121.

The7. Account must be administered by the Director of the Department.

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

AnySec. interest earned on money in the Account, after deducting any applicable charges, must be credited to the Account.

Money that remains in the Account at the end of a fiscal year does not revert to the State General Fund, and the balance in the Account must be carried forward to the next fiscal year.

Except(Deleted asby otherwiseamendment.) providedSec. in subsection 4 and section 67 of this act, money in the Account must be used to carry out the provisions of sections 2 to 18, inclusive, of this act.

3.3.

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 signatures and requirements for electronic equivalents of written entries or written approvals in accordance with federal law.

The regulations must:

(a) Establish standards for networks and technologies to be used to maintain, 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 are secure;

(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;

(4) To ensure the privacy of individually identifiable 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;

(5) For obtaining consent from a patient before retrieving the patient’s health records from a health information exchange, - *SB495_R1* – 10 – 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;

(6) For making any necessary corrections to information or records;

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

(8) Governing the ownership, management and use of 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 include, without limitation:

(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 applicable federal laws relating to electronic health records, health- related information, health information exchanges and the security and confidentiality of such records and exchanges.

- *SB495_R1* – 11 – 3.

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

UponExcept approvalas ofotherwise theprovided Interimin Financesubsections Committee,5, the6 Directorand may7, transferthe moneyDepartment fromand the Accountdivisions tothereof, anotherother accountstate underand thelocal controlgovernmental entities, medical facilities, high-level providers of thehealth Directorcare , [providers,] third parties, pharmacy benefit managers and other entities licensed or certified pursuant to title 57 of NRS shall maintain, transmit and exchange health information in accordance with the Departmentregulations foradopted pursuant to this section, the -provisions *SB495*of –NRS 7439.581 –to purpose439.597, inclusive, and section 1 of obtainingthis additionalact federaland financialany participationother underregulations Medicaid.adopted pursuant thereto.

The DirectorFederal mayGovernment acceptand gifts,employees grantsthereof, anda donationsprovider toof carryhealth outcoverage thefor provisionsfederal employees, a provider of sectionshealth 2coverage that is subject to 18,the inclusive,Employee Retirement Income Security Act of this1974, act.29 U.S.C.

Sec.§§ 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 high-level provider of health care [provider] may apply to the Department for a waiver from the provisions of subsection 4 on the basis that the high-level provider of 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 high-level provider of 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 high-level provider of health care [provider] to continue to operate.

1.The provisions of subsection 4 do not apply to [the] :

On(a) orThe beforeDepartment July 1 of eachCorrections even-numbered[.] year,; the Director, in collaboration with the Division of Public and Behavioral Health of the Department, shall:

(a)(b) ConductA ahigh-level comprehensiveprovider assessment of needshealth withcare regardwhose solo practice provided care to fewer than 500 patients during the healthimmediately preceding year and reasonably expects to provide care workforceto infewer thisthan State;500 patients during the current year;

andor (b)(c) SubmitA ahigh-level reportprovider of thehealth assessmentcare towho, thein Governorcombination andwith theall Directorother members of thehis Legislativeor Counselher Bureaugroup forpractice transmittalprovided care to thefewer Jointthan Interim500 Standingpatients Committeeduring onthe Healthimmediately preceding year and Humanreasonably Servicesexpects andto theprovide nextcare regularto sessionfewer ofthan 500 patients during the Legislature.current year.

2.

The assessment conducted pursuant to subsection 1 must consist of:

(a) An identification of the needs of this State with regard to its health care workforce, including, without limitation, identification of:

(1) Shortages of providers of health care by geographic region, including rural and urban areas, and the types of services provided;

(2) Populations in this State that are experiencing difficulties in accessing health care, with consideration of socioeconomic factors, health outcomes and access to all necessary types of health care;

(3) Geographic areas and populations of this State where the shortage of providers of health care is most critical and the types of services needed;

and (4) Specialty providers of health care for which the need in this State, and in the geographic areas and among the populations identified pursuant to subparagraph (3), is most critical;

(b) Suggestions for strategic investments targeted to meet the needs identified pursuant to paragraph (a), including, where possible, suggestions for meeting those needs in a manner that is sustainable over the long term;

and (c) A description of how the projects funded through the investments described in paragraph (b) will integrate with and enhance existing health care infrastructure.

Sec.

1.A high-level provider of health care described in paragraphs (b) and (c) of subsection 7 shall furnish the medical - *SB495_R1* – 12 – records of a patient electronically to the patient or, upon the request of the patient, another person or entity, in accordance with NRS 629.062.

The Department shall, in accordance with sections 2 to 18, inclusive, of this act, establish and administer a Nevada Health Care Workforce and Access Program as a competitive program to award money from the Account to persons and entities in this State seeking to address shortages of providers of health care and difficulties in accessing health care identified in the assessment conducted pursuant to section 7 of this act.

- *SB495* – 8 – Money from the Account may be awarded through grants, loans, reimbursements or investments.

2.

To be eligible to receive money pursuant to sections 2 to 18, inclusive, of this act, a proposed project must:

(a) Directly address shortages of providers of health care or difficulties in accessing health care identified in the assessment conducted pursuant to section 7 of this act.

(b) Include specific, measurable outcomes to demonstrate an increase in the number of providers of health care, improved access to health care and enhanced capacity of the health care workforce in a manner that addresses the shortages of providers of health care or difficulties in accessing health care identified pursuant to paragraph (a).

(c) Secure from the Federal Government or any other source an amount of matching funds that is at least equal to the amount of the award.

Matching funds from the Federal Government only meet the requirements of this paragraph if federal approval has already been granted.

(d) Demonstrate the potential for financial and operational sustainability after the expiration of the award, including, without limitation by:

(1) Planning for continued staffing, budget sustainability and continued allocation of resources;

and (2) Conducting an impact assessment concerning the sustainability of the project after the expiration of the award.

Sec.

A personviolation orof entitythe thatprovisions wishes to receive funding pursuant to sections 2 to 18, inclusive, of this actsection mustor applyany toregulations theadopted Department in the form prescribed by the Department during an open application period established pursuant tothereto sectionis 18not ofa thismisdemeanor. act.

The[9.] application10. must include, without limitation:

1.As used in this section:

A(a) comprehensive“Medical proposalfacility” forhas the projectmeaning ascribed to beit fundedin thatNRS outlines:449.0151.

(a)(b) The“Pharmacy goalsbenefit andmanager” objectiveshas of the proposedmeaning project;ascribed to it in NRS 683A.174.

(b)[(b)] The(c) specific“Third needsparty” inmeans theany healthinsurer, caregovernmental workforceentity identifiedor inother theorganization assessmentproviding conductedhealth pursuantcoverage toor sectionbenefits 7in ofaccordance thiswith actstate thator thefederal proposedlaw. project will address;

andSec. (c) The manner in which the proposed project will recruit, retain or train providers of health care to address the specific needs outlined pursuant to paragraph (b).

3.6.

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 signatures and requirements for electronic equivalents of written entries or written approvals in accordance with federal law.

The regulations must:

(a) Establish standards for networks and technologies to be used to maintain, 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 are secure;

(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;

- *SB495_R1* – 13 – (4) To ensure the privacy of individually identifiable 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;

(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;

(6) For making any necessary corrections to information or records;

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

(8) Governing the ownership, management and use of 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.

AThe detailedstandards budgetprescribed thatpursuant clearlyto setsthis forthsection themust projectedinclude, costswithout oflimitation: and sources of funding for the proposed project.

Such(a) sourcesRequirements offor funding must include, without limitation, the matchingcreation, fundsmaintenance describedand intransmittal paragraph (c) of subsectionelectronic 2health ofrecords; section 8 of this act.

-(b) *SB495*Requirements –for 9protecting –confidentiality, 3.including control over, access to and the collection, organization and maintenance of electronic health records, health-related information and individually identifiable health information;

Evidence(c) ofRequirements approvalfor orthe commitmentmanner fromin thewhich personsa andpatient entitiesmay, thatthrough willa providehealth thecare matchingprovider fundswho describedparticipates in paragraphthe (c)sharing of subsectionhealth 2records ofusing sectiona 8health ofinformation thisexchange, act.revoke his or her consent for a health care provider to retrieve the patient’s health records from the health information exchange;

- *SB495_R1* – 14 – (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 applicable federal laws relating to electronic health records, health- related information, health information exchanges and the security and confidentiality of such records and exchanges.

3.

The regulations adopted pursuant to this section must not [require] :

(a) Require any person or entity to use a health information exchange [.] ;

or (b) Authorize a person or entity described in subsection 4 to comply with the requirements of that subsection by:

(1) Connecting with a health information exchange;

or (2) Utilizing any other service that charges a fee to such a person or entity or a patient for providing electronic health records to a patient upon request in violation of NRS 629.062.

DocumentationExcept ofas otherwise provided in subsections 5, 6 and 7, the qualificationsDepartment and relevantthe experiencedivisions thereof, other state and local governmental entities, medical facilities, high-level providers of health care, third parties, pharmacy benefit managers and other entities licensed or certified pursuant to title 57 of NRS shall maintain, transmit and exchange health information in accordance with the applicant.regulations adopted pursuant to this section, the provisions of NRS 439.581 to 439.597, inclusive, and section 1 of this act and any other regulations adopted pursuant thereto.

EvidenceThe thatFederal theGovernment applicant has the organizational capacity to successfully implement and sustainemployees thethereof, proposed project, including, without limitation, a descriptionprovider of thehealth keycoverage personnelfor whofederal willemployees, bea involvedprovider andof anyhealth relevantcoverage partnershipsthat withis personssubject andto entities engaged in the provisionEmployee ofRetirement healthIncome care,Security educationalAct institutions,of governmental1974, entities29 orU.S.C. other persons and entities.

§§ 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.

A timelinehigh-level provider of health care may apply to the Department for implementinga waiver from the proposedprovisions projectof subsection 4 on the basis that includes,the withouthigh-level limitation,provider definedof milestones,health measurablecare performancedoes indicatorsnot andhave athe planinfrastructure fornecessary reportingto progresscomply andwith evaluatingthose outcomesprovisions, atincluding, regularwithout intervals.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 high-level provider of health care 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 - *SB495_R1* – 15 – would make it difficult for the high-level provider of health care to continue to operate.

AThe detailedprovisions operationalof plansubsection for4 thedo proposednot projectapply that:to:

(a) OutlinesThe staffing,Department facilities,of equipmentCorrections; and other logistical requirements;

and (b) AddressesA potentialhigh-level challengesprovider inof recruitinghealth care whose solo practice provided care to fewer than 500 patients during the immediately preceding year and retainingreasonably providersexpects ofto healthprovide care.care to fewer than 500 patients during the current year;

or (c) A high-level provider of health care who, in combination with all other members of his or her group practice provided care to fewer than 500 patients during the immediately preceding year and reasonably expects to provide care to fewer than 500 patients during the current year.

A planhigh-level forprovider sustainabilityof thathealth addressescare thedescribed manner in whichparagraphs the(b) proposedand project(c) willof continuesubsection to7 provideshall benefitsfurnish after the expirationmedical records of thea fundingpatient including,electronically withoutto limitation,the possiblepatient sourcesor, upon the request of funding,the partnershipspatient, another person or strategiesentity, forin reinvestment.accordance with NRS 629.062.

AnyA additionalviolation informationof requiredthe byprovisions theof this section or any regulations adopted pursuant tothereto sectionis 18not ofa thismisdemeanor. act.

Sec.

1.

The Department shall review applications submitted pursuant to section 9 of this act to determine which applicants to recommend for funding pursuant to section 11 of this act.

2.

In making determinations pursuant to subsection 1 concerning which applicants to recommend for funding pursuant to section 11 of this act, the Department shall prioritize applicants who:

(a) Possess strong qualifications, appropriate experience and high organizational capacity to effectively implement and sustain the proposed project, including, without limitation, a proven ability to manage similar projects, meet projected outcomes and maintain compliance with the requirements of sections 2 to 18, inclusive, of this act and any regulations adopted pursuant thereto;

(b) Demonstrate strong collaboration with entities in the public and private sectors, including secured financial commitments - *SB495* – 10 – from multiple entities where practicable based on the proposed project;

(c) Maximize the amount of funding available for the proposed project from sources other than the public revenue of this State;

(d) Address areas with severe and urgent shortages of providers of health care or severe and urgent issues with access to health care, with the highest priority given to projects that address needs identified pursuant to subparagraph (3) of paragraph (a) of subsection 2 of section 7 of this act;

(e) Demonstrate the potential to create lasting improvement in accessibility to health care and the availability of providers of health care in the community affected by the proposed project, including, without limitation, by meeting specific metrics for improvements to access to health care, health care outcomes and the capacity of the health care workforce over time;

(f) Illustrate a clear and feasible path to sustainability for the proposed project, thereby reducing the likelihood of needing additional state funding in the future;

(g) Include a substantial investment in and establishment of capital infrastructure to address needs identified in the assessment conducted pursuant to section 7 of this act over the long term and support sustainable access to health care, including, without limitation:

(1) The construction of medical facilities;

(2) The expansion of capabilities for delivering services through telehealth;

and (3) The development of facilities for residencies or other training of providers of health care;

and (h) Propose to use technology or innovative models of delivering health care in a manner that may reduce costs, improve outcomes and expand access to underserved populations.

3.

In making determinations pursuant to subsection 1 concerning which applicants to recommend for funding pursuant to section 11 of this act, the Department may consider in-kind contributions to support the project, but such contributions must not be counted toward the matching contributions required by paragraph (c) of subsection 2 of section 8 of this act.

4.

(b) “Telehealth”“Pharmacy benefit manager” has the meaning ascribed to it in NRS 629.515.683A.174.

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

11.4.

1.(Deleted by amendment.) Sec.

After4.5. reviewing applications pursuant to section 10 of this act, the Department shall submit to the Board of - *SB495* – 11 – Economic Development its recommendations for awarding funding pursuant to sections 2 to 18, inclusive, of this act.

NRS 439.5895 is hereby amended to read as follows:

439.5895 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:

(a) The Department determines that the licensed provider or insurer is not in compliance with the requirements of subsection 4 of NRS 439.589 [;] and [(b) The] 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 [.] ;

or (b) The licensed provider or insurer is a high-level provider of health care who is exempt from the requirements of subsection 4 of NRS 439.589 pursuant to paragraph (b) or (c) of subsection 7 of NRS 439.589 and the Department determines that the high-level - *SB495_R1* – 16 – provider of health care is not in compliance with subsection 8 of NRS 439.589.

ExceptIf asthe otherwiseDepartment provideddetermines inthat thisa subsection,licensed theprovider Departmentor shallinsurer ensurefor thatwhich allnotice applicantswas forpreviously fundingprovided pursuant to sectionssubsection 21 tohas 18,come inclusive,into compliance with the requirements of thissubsection act4 meetof NRS 439.589, the requirementsDepartment ofshall sectionsimmediately 8notify andthe 9regulatory ofbody thisthat act.issued the license.

The Director may waive any such requirement to maximize the ability of the Department to utilize matching funds from the Federal Government and other sources.

If the Department makes a recommendation for funding a project to which such a waiver applies, the Department must include in the recommendation a statement of the reason for the waiver.

WhenAs makingused recommendationsin pursuant to this section,section: the Department:

(a) May“License” recommendmeans fundingany onelicense, certificate, registration, permit or moresimilar proposedtype projects,of withinauthorization theto limitspractice ofan moneyoccupation or profession or engage in thea Account;business in this State issued to a licensed provider or insurer.

and (b) May“Licensed notprovider awardor ainsurer” totalmeans: amount of money during any funding period that exceeds the amount available in the Account for that funding period.

(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)] (3) Any person licensed pursuant to title 57 of NRS.

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

12.

1.

A joint committee consisting of the members of the Board of Economic Development and the members of the Patient Protection Commission created by NRS 439.908 shall review each recommendation for awarding funding submitted to the Board of Economic Development pursuant to section 11 of this act.

2.

When reviewing a recommendation pursuant to subsection 1, the joint committee shall consider, without limitation, the degree to which the recommendation addresses the needs identified in the assessment conducted pursuant to section 7 of this act.

3.

After reviewing a recommendation pursuant to subsection 1, the joint committee may, by a majority vote of its members, approve, deny or request revisions to a recommendation.

If the joint committee requests revisions to a recommendation, the Department shall work with the applicant to whom the recommendation applies to make those revisions.

4.

If a member of the joint committee has a conflict of interest or the appearance of a conflict of interest concerning a recommendation under review, the member shall:

(a) Disclose the actual or apparent conflict of interest before any discussion of or vote on the recommendation;

(b) Abstain from voting on the recommendation;

and (c) Recuse himself or herself from participating in discussions where the actual or apparent conflict of interest may compromise the objectivity of the review process.

If(Deleted theby jointamendment.) committeeSec. votes to approve a recommendation pursuant to subsection 3, the Department shall issue a written - *SB495* – 12 – notice of the approval to the applicant to whom the recommendation pertains.

Such5.5. written notice must include, without limitation:

(a)Chapter The439A totalof amountNRS ofis moneyhereby beingamended awarded;by adding thereto the provisions set forth as sections 7 to 10.5, inclusive, of this act.

andSec. (b) The schedule of disbursements and specific conditions that will be included in the funding agreement entered into pursuant to section 13 of this act.

The(Deleted Departmentby shallamendment.) maintainSec. a public record of all proceedings of the joint committee conducted pursuant to this section, including, without limitation, all votes conducted pursuant to subsection 3.

As used in this section, “conflict of interest” includes, without limitation, any conflict of interest based on:

(a) The personal interests of the member of the joint committee described in subsection 1 or a person within the first degree of consanguinity or affinity of such a member;

and (b) The interests of a business or organization that employs or contracts with a person described in paragraph (a) or with which such a person is otherwise affiliated.

Sec.

13.

NotOn lateror thanbefore 60July days1 afterof aeach recommendationeven-numbered isyear, approvedthe pursuantDepartment, toin sectioncollaboration 12with of this act, the DepartmentHealth shallCare enterWorkforce intoWorking aGroup fundingestablished agreementpursuant with the applicant to whomNRS the439A.118, recommendationshall: pertains.

(a) Conduct a comprehensive assessment of needs with regard to the health care workforce in this State;

and (b) Compile a report of the results of the assessment and submit the report to the Governor and the Director of the Legislative Counsel Bureau for transmittal to the Joint Interim Standing Committee on Health and Human Services and the next regular session of the Legislature.

AThe fundingassessment agreementconducted entered into pursuant to paragraph (a) of subsection 1 must:must consist of:

(a) ProvideA forquantitative theanalysis distribution of the funding in installments that are contingent on the achievement of specific goals and indicators of performance mutually agreed upon by the Department and the recipient of funding which demonstrate measurable progress toward increasing the number of providers of health care, improving access to health care orworkforce enhancingin healththis careState, infrastructure,including, aswithout appropriatelimitation: for the specific project;

(b)(1) RequireA determination of the recipienttotal number of fundingproviders toof submithealth documentationcare thatin thethis recipientState hasand achieved the goalstotal andnumber indicatorsof providers of performance- prescribed*SB495_R1* – 17 – health care in thethis agreementState pursuantwho topractice paragraphdifferent (a)professions beforeand moneydifferent mayspecialties bewithin disbursed;those professions;

(c)(2) EstablishA requirementsdetermination governingof matchingthe fundstotal innumber accordanceof withproviders the provisions of paragraphhealth (c)care ofwho subsectionpractice 2in ofdifferent sectiongeographic 8areas of this act,State including,and withoutthe limitation,total requirementsnumber forof theproviders recipient of fundinghealth tocare submitwho topractice thedifferent Departmentprofessions documentedand proofdifferent ofspecialties adherencewithin to those requirementsgeographic beforeareas; money may be disbursed;

(d)and Require(3) A comparison of the recipientnumbers of fundingproviders toof submithealth care identified pursuant to subparagraphs (1) and (2) with benchmarks established by the Health Resources and Services Administration of the United States Department anof annualHealth reportand Human Services or nationally recognized organizations that includes,prescribe withoutsuch limitation:benchmarks;

-(b) *SB495*A –determination 13of –the (1)most Detailedcritical financialshortages statementsin thatthe include,health withoutcare limitation,workforce expenditures, allocations of matchingthis fundsState, andprioritizing: receipts for major purchases;

(2)(1) UpdatesEssential onhealth thecare progressprofessions ofand thespecialties recipient toward achieving the goals and indicatorsessential ofclinical performanceservices specifiedor pursuantexpertise tocurrently paragraphexperiencing (a);shortages;

(3)and Identification(2) ofGeographic anyareas issuesof orthis delaysState inthat achievingare experiencing the goalsmost andcritical indicatorsshortages of performanceproviders specifiedof pursuanthealth tocare paragraphor (a)clinical andservices anyor adjustmentsexpertise; made to address unforeseen challenges in achieving those goals and indicators;

(4)(c) DocumentationAn identification of partnershipsunmet withneeds publicfor andspecific privatehealth entities,technology and therapies, including, without limitation, financialgenomic contributions,testing, collaborationsclinical andtrials, commitmentscellular fortherapies financial contributions and collaborations;palliative care;

and (5)(d) SuchA additionaldetermination informationof asany mayareas bewhere requiredthere byis thean Departmentoversupply toof assessproviders theof progresshealth andcare, impactincluding, ofwithout thelimitation, project;specialists or clinical services.

(e) Require that the recipient of funding comply with any request made by the Department or the Office of Finance as part of an action taken pursuant to section 14 of this act;

and (f) Include any other provisions deemed necessary by the Department to ensure the accountability of the recipient of funding and the achievement of the objectives of the project, which may include, without limitation, caps on disbursements for projects with extensive capital infrastructure.

IfThe areport recipientcompiled of funding pursuant to sectionsparagraph 2(b) to 18, inclusive, of thissubsection act1 significantlymust modifiesinclude, orwithout terminateslimitation: a funded project, or if there are changes in the availability of funding for such a project, the recipient shall immediately notify the Department and, if the recipient is not terminating the project, submit to the Department a revised plan for the project that details all of the modifications.

Upon(a) receivingA suchsummary notification,of the Departmentassessment may,conducted pursuant to ensureparagraph that(a) moneyof fromsubsection the1, Accountincluding, iswithout usedlimitation: efficiently and effectively in a manner that complies with section 8 of this act:

(a)(1) AdjustAn theanalysis termsof shortages of theproviders fundingof agreement,health including,care, withoutshortages limitation,of theclinical termsservices foror disbursementexpertise and theunmet amounthealth ofneeds funding,in orthis terminateState; the funding agreement;

and (b)(2) ReallocateA unspentdescription moneyof toshortages otherof approvedproviders projectsof orhealth depositcare unspentand money in the Accountshortages toof supportclinical allocationsservices foror otherexpertise projectsby fundedgeographic pursuantregion, toincluding sectionsrural 2and tourban 18,areas; inclusive, of this act.

and (b) Recommendations for legislation and regulatory changes to improve the recruitment and retention of providers of health care.

4.

As used in this section:

(a) “Palliative care” means a multidisciplinary and patient- and family-centered approach to specialized medical care for a person with a serious illness, which approach focuses on the care of a patient throughout the continuum of an illness and involves - *SB495_R1* – 18 – addressing the physical, emotional, social and spiritual needs of the patient, as well as facilitating patient autonomy, access to information and choice of care.

The term includes, without limitation, discussion of the goals of the patient for treatment and discussion of treatment options appropriate to the patient, including, where appropriate, hospice care and comprehensive management of pain and symptoms.

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

14.8.

(Deleted by amendment.) Sec.

8.5.

“Independent center for emergency medical care” has the meaning ascribed to it in NRS 449.013.

Sec.

9.

(Deleted by amendment.) Sec.

9.5.

The Department:Department shall establish and maintain a program to increase public awareness of health care information concerning the independent centers for emergency medical care in this State.

(a)The Mayprogram conductmust periodicbe sitedesigned visits, audits or reviews to ensureassist thatconsumers awith projectcomparing fundedthe pursuantquality to sections 2 to 18, inclusive, of thiscare -provided *SB495*by –the 14independent –centers actfor compliesemergency withmedical thecare requirementsin ofthis thoseState sections and the fundingcharges agreementfor enteredthat intocare. pursuant to section 13 of this act.

(b) Shall annually review each project funded pursuant to sections 2 to 18, inclusive, of this act to analyze the performance and benefits of the project.

The Officeprogram ofmust Financeinclude, maywithout auditlimitation, any project funded pursuant to sections 2 to 18, inclusive, of this act to ensure that the recipientcollection, ofmaintenance the funding is using the money awarded pursuant to sections 2 to 18, inclusive, of this act in an effective and efficientprovision manner that accords with state and federal law and the funding agreement entered into pursuant to section 13 of thisinformation act.concerning:

(a) Patients of each independent center for emergency medical care in this State as reported in the forms submitted pursuant to NRS 449.485;

(b) The quality of care provided by each independent center for emergency medical care in this State as determined by applying measures of quality endorsed by the entities described in subparagraph (1) of paragraph (b) of subsection 1 of section 10.5 of this act, expressed as a number of events and rate of occurrence, if such measures can be applied to the information reported in the forms submitted pursuant to NRS 449.485;

(c) How consistently each independent center for emergency medical care follows recognized practices to prevent the infection of patients, to speed the recovery of patients and to avoid medical complications of patients;

(d) The total number of patients discharged from the independent center for emergency medical care and the total number of potentially preventable readmissions to a hospital or independent center for emergency medical care, which must be expressed as a total number and a rate of occurrence of potentially preventable readmissions, and the average length of stay and the average billed charges for those potentially preventable readmissions;

and - *SB495_R1* – 19 – (e) Any other information relating to the charges imposed and the quality of the services provided by the independent centers for emergency medical care in this State which the Department determines is:

(1) Useful to consumers;

(2) Nationally recognized;

and (3) Reported in a standard and reliable manner.

15.10.

If(Deleted theby Departmentamendment.) concludes,Sec. as the result of a site visit, audit or review conducted pursuant to section 14 of this act or for any other reason, that a recipient of funding pursuant to sections 2 to 18, inclusive, of this act has failed to comply with any provision of those sections, any regulation adopted pursuant thereto, any other state or federal law or any funding agreement entered into pursuant to section 13 of this act, the Department may:

10.5.

AdjustThe theDepartment termsshall, ofby theregulation: funding agreement;

(a) Prescribe the information that each independent center for emergency medical care in this State must submit to the Department for the program established pursuant to section 9.5 of this act.

(b) Prescribe the measures of quality for independent centers for emergency medical care that are required pursuant to paragraph (b) of subsection 2 of section 9.5 of this act.

In adopting the regulations, the Department shall:

(1) Use the measures of quality endorsed by the Agency for Healthcare Research and Quality, the National Quality Forum, Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, a quality improvement organization of the Centers for Medicare and Medicaid Services and the Joint Commission;

(2) Prescribe a reasonable number of measures of quality which must not be unduly burdensome on the independent centers for emergency medical care;

and (3) Take into consideration the financial burden placed on the independent centers for emergency medical care to comply with the regulations.

(c) Prescribe the manner in which an independent center for emergency medical care must determine whether the readmission of a patient must be reported pursuant to section 9.5 of this act as a potentially preventable readmission and prescribe the form for submission of such information.

(d) Require each independent center for emergency medical care to provide the information prescribed in paragraphs (a), (b) and (c) in the format required by the Department.

RequireThe theinformation recipientrequired pursuant to takethis correctivesection action;and section 9.5 of this act must be submitted to the Department not later than 45 days after the last day of each calendar month.

WithholdIf futurean disbursementsindependent center for emergency medical care fails to submit the recipient;information required pursuant to this section or section 9.5 of this act or submits information that is incomplete or inaccurate, the Department shall send a notice of such failure to - *SB495_R1* – 20 – the independent center for emergency medical care and to the Division of Public and Behavioral Health of the Department.

4.

Require the recipient to repay money previously disbursed;

5.

Suspend or terminate the funding;

or 6.

Take such other measures as are necessary to ensure compliance with the provisions of sections 2 to 18, inclusive, of this act, the regulations adopted pursuant thereto and the funding agreement entered into pursuant to section 13 of this act.

16.11.

Upon(Deleted completingby aamendment.) projectSec. for which a person or entity received funding pursuant to sections 2 to 18, inclusive, of this act, the recipient of funding shall submit to the Department a report that includes, without limitation:

11.2.

NRS 439A.020 is hereby amended to read as follows:

439A.020 The purposes of this chapter are to:

APromote summaryequal of the achievements of the project relative to the initial goals of the project, focusing on improvements in access to healthquality care and the capacity of the health care workforceat ina thereasonable areacost; affected by the project;

APromote financialan accountingadequate ofsupply all money received for the project pursuant to sections 2 to 18, inclusive, of this act and fromdistribution other sources, including, without limitation, matching funds, and an itemized statement of expenditureshealth ofresources; such money;

APromote narrativeuniform, evolutioneffective ofmethods the impact of thedelivering projecthealth oncare; the community affected by the project, including, without limitation, benefits realized, challenges encountered and lessons learned for future projects;

- *SB495* – 15 – 4.

AnyPromote relevantand dataencourage onthe patientadequate outcomes,distribution measurements of community health or retention and expansion of the health care workforcefacilities attributableand tohuman theresources; project;

and 5.

FeedbackPromote orand testimonialsencourage concerning the projecteffective fromuse beneficiaries,of partnersmethods andfor othercontrolling affectedincreases personsin andthe entities.cost of health care;

6.

Encourage participation in health planning by members of the several health professions, representatives of institutions and agencies interested in the provision of health care and the reduction of the cost of such care, and the general public;

7.

Utilize the viewpoint of the general public for making decisions;

8.

Provide information to the general public concerning the charges imposed and the quality of the services provided by the hospitals , [and] surgical centers for ambulatory patients and independent centers for emergency medical care in this State;

9.

Encourage public education regarding proper personal health care and methods for the effective use of available health services;

and 10.

Promote a program of technical assistance to purchasers to contain effectively the cost of health care, including:

(a) Providing information to purchasers regarding the charges made by practitioners.

(b) Training purchasers to negotiate successfully for a policy of health insurance.

(c) Conducting studies and providing other information about measures to assist purchasers in containing the cost of health care.

17.11.5.

OnNRS or439A.200 beforeis Septemberhereby 1amended ofto eachread even-numberedas year,follows: the Department shall:

1.439A.200 As used in NRS 439A.200 to 439A.290, inclusive, and sections 8.5, 9.5 and 10.5 of this act unless the context otherwise requires, the words and terms defined in NRS 439A.205, 439A.207 and 439A.210 and section 8.5 of this act have the meanings ascribed to them in those sections.

CompileSec. a report concerning the Nevada Health Care Workforce and Access Program established pursuant to section 8 of this act.

The12. report must:

(a)(Deleted Summarizeby theamendment.) outcomes- of*SB495_R1* projects– funded21 through– theSec. Program;

(b)12.5. Describe best practices developed for awarding money pursuant to sections 2 to 18, inclusive, of this act and monitoring projects that receive such money;

andNRS (c)439A.260 Recommendis anyhereby adjustmentsamended to theread Programas necessaryfollows: to ensure that projects funded through the Program meet the requirements of section 8 of this act.

439A.260 1.

The Department shall collect and maintain all information that it receives from the hospitals , [and] surgical centers for ambulatory patients and independent centers for emergency medical care in this State pursuant to NRS 439A.220 to 439A.250, inclusive [.] and sections 8.5, 9.5 and 10.5 of this act.

Upon request, the Department shall make a summary of the information available to:

(a) Consumers of health care;

(b) Providers of health care;

(c) Representatives of the health insurance industry;

and (d) The general public.

SubmitThe Department shall ensure that the reportinformation compiledit provides pursuant to subsectionthis 1section is aggregated so as not to reveal the Governoridentity andof thea Directorspecific inpatient or outpatient of thea Legislativehospital Counsel, Bureau[or] forof transmittala tosurgical thecenter nextfor regularambulatory sessionpatients [.] or of thean Legislature.independent center for emergency medical care.

18.13.

The(Deleted Departmentby shallamendment.) adoptSec. such regulations as are necessary to carry out the provisions of sections 2 to 18, inclusive, of this act.

Those13.5. regulations must include, without limitation, regulations:

1.NRS 439A.270 is hereby amended to read as follows:

Prescribing439A.270 any1. information that must be included in an application submitted for funding pursuant to sections 2 to 18, inclusive, of this act, in addition to the information required by section 9 of this act, or other requirements governing applicants for such funding as are necessary to ensure that proposed projects achieve the objectives set forth in section 8 of this act in a sustainable manner and ensure the allocation of money pursuant to sections 2 to 18, inclusive, of this act to diverse projects which maximize the utility of the money awarded.

SuchThe requirementsDepartment mayshall include,establish withoutand limitation,maintain capsan onInternet investmentwebsite that includes the information concerning the charges imposed and the quality of the services provided by the hospitals , [and] surgical centers for ambulatory patients and independent centers for emergency medical care in capitalthis infrastructure.State as required by the programs established pursuant to NRS 439A.220 and 439A.240 [.] and section 9.5 of this act.

The information must:

(a) Include, for each hospital in this State, the:

(1) Total number of patients discharged, the average length of stay and the average billed charges, reported for the diagnosis- related groups for inpatients and the 50 medical treatments for outpatients that the Department determines are most useful for consumers;

(2) Total number of potentially preventable readmissions reported pursuant to NRS 439A.220, the rate of occurrence of potentially preventable readmissions, and the average length of stay and average billed charges of those potentially preventable readmissions, reported by the diagnosis-related group for inpatients for which the patient originally received treatment at a hospital;

and (3) Name of each physician who performed a surgical procedure in the hospital and the total number of surgical procedures performed by each physician in the hospital, reported for the most frequent surgical procedures that the Department - *SB495_R1* – 22 – determines are most useful for consumers if the information is available;

(b) Include, for each surgical center for ambulatory patients in this State, the:

(1) Total number of patients discharged and the average billed charges, reported for 50 medical treatments for outpatients that the Department determines are most useful for consumers;

and (2) Name of each physician who performed a surgical procedure in the surgical center for ambulatory patients and the total number of surgical procedures performed by each physician in the surgical center for ambulatory patients, reported for the most frequent surgical procedures that the Department determines are most useful for consumers;

(c) Include, for each independent center for emergency medical care in this State, the:

(1) Total number of patients discharged and the average billed charges, reported for the 50 medical treatments for patients of independent centers for emergency medical care that the Department determines are most useful for consumers;

and (2) Total number of potentially preventable readmissions reported pursuant to section 9.5 of this act, the rate of occurrence of potentially preventable readmissions, and the average length of stay and average billed charges of those potentially preventable readmissions, reported for the diagnosis for which the patient originally received treatment at an independent center for emergency medical care;

(d) Be presented in a manner that allows a person to view and compare the information for the hospitals by:

(1) Geographic location of each hospital;

(2) Type of medical diagnosis;

and (3) Type of medical treatment;

[(d)] (e) Be presented in a manner that allows a person to view and compare the information for the surgical centers for ambulatory patients by:

(1) Geographic location of each surgical center for ambulatory patients;

(2) Type of medical diagnosis;

and (3) Type of medical treatment;

[(e)] (f) Be presented in a manner that allows a person to view and compare the information for the independent centers for emergency medical care by:

(1) Geographic location of each independent center for emergency medical care;

(2) Type of medical diagnosis;

and (3) Type of medical treatment;

- *SB495_R1* – 23 – (g) Be presented in a manner that allows a person to view and compare the information separately for:

(1) The inpatients and outpatients of each hospital;

[and] (2) The outpatients of each surgical center for ambulatory patients;