Text of NV SB 419A (2025)

EXEMPT (Reprinted with amendments adopted on June 5, 2023) SECOND REPRINT S.B. 419 - *SB419_R2* SENATE BILL NO. 419–COMMITTEE ON HEALTH AND HUMAN SERVICES MARCH 27, 2023 ____________ Referred to Committee on Health and Human Services SUMMARY—Makes revisions relating to public health. (BDR 40-748) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. CONTAINS UNFUNDED MANDATE (§§ 6, 28, 45) (NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT) ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to public health; requiring the adoption of a framework for the electronic transmittal, maintenance and exchange of certain health information; requiring governmental entities, health care providers, insurers and insurance administrators to maintain, transmit and exchange health information electronically; authorizing the imposition of certain discipline against a health care provider, insurer or insurance administrator that fails to comply with that requirement; authorizing the Director of the Department of Health and Human Services to contract with multiple health information exchanges to perform certain functions; clarifying that certain persons are immune from certain criminal and civil liability for transmitting, accessing, utilizing or disclosing electronic health records in accordance with existing law; establishing and prescribing the duties of the Medicaid Outreach Advisory Committee; requiring the provision of certain coverage under the Children’s Health Insurance Program; requiring the Joint Interim Standing Committee on Health and Human Services to conduct certain studies; making an appropriation; and providing other matters properly relating thereto. – 2 – - *SB419_R2* Legislative Counsel’s Digest: Existing law requires the Director of the Department of Health and Human 1 Services to adopt regulations governing health information exchanges and the 2 transmittal, ownership, management, use and confidentiality of electronic health 3 records. (NRS 439.587, 439.589) Section 6 of this bill requires the Director to 4 prescribe by regulation a framework for the electronic maintenance, transmittal and 5 exchange of electronic health records, prescriptions and health-related information. 6 Section 6 requires that framework to establish standards for networks and 7 technologies to be used to maintain, transmit and exchange health information, 8 including standards that require: (1) the ability for patients to access and forward 9 their records; and (2) the interoperability of such networks and technologies. 10 Section 60 of this bill requires the Director to convene an advisory group to advise 11 the Director in the adoption of those standards. With certain exceptions, sections 6, 12 28, 29, 45 and 63 of this bill require all governmental entities, health care 13 providers, insurers, pharmacy benefit managers and other insurance administrators 14 to maintain, transmit and exchange health information electronically in accordance 15 with those standards and other provisions governing electronic health records, 16 beginning on: (1) July 1, 2024, for hospitals and large physician group practices; 17 (2) July 1, 2025, for governmental entities, other large health care practices, 18 insurers, pharmacy benefit managers and other insurance administrators; and (3) 19 January 1, 2030, for small physician group practices and other small health care 20 practices. Sections 2 and 6 of this bill provide that a health care provider, insurer, 21 pharmacy benefit manager or other insurance administrator that fails to comply 22 with that requirement is not guilty of a misdemeanor. Instead, section 1 of this bill 23 requires the Department to notify any regulatory body that has issued a license, 24 certificate, registration, permit or similar credential to a health care provider, 25 insurer, pharmacy benefit manager or other insurance administrator if the holder of 26 the credential fails to comply with that requirement. After receiving such notice, 27 sections 9, 17, 45, 47, 50 and 53 of this bill authorize a regulatory body to impose 28 corrective action or an administrative penalty on the health care provider, insurer, 29 pharmacy benefit manager or other insurance administrator. Section 1 requires the 30 Department to notify the relevant regulatory body if a health care provider, insurer, 31 pharmacy benefit manager or other insurance administrator that was previously out 32 of compliance with the requirement to maintain, transmit and exchange health 33 information electronically comes into compliance with that requirement. Section 4 34 of this bill removes duplicative requirements concerning the adoption of regulations 35 governing electronic health records. Sections 2-5, 10-16, 44, 46, 48, 51, 52, 55 and 36 56 of this bill make conforming changes to indicate the proper placement of 37 sections 1, 9, 47 and 50 in the Nevada Revised Statutes. 38 Existing law authorizes the Director to contract with not more than one health 39 information exchange to be responsible for compiling statewide master indexes of 40 patients, health care providers and payers. (NRS 439.587) Section 4 authorizes the 41 Director to contract with multiple health information exchanges to perform those 42 functions. 43 Existing law requires that, with certain exceptions, a patient consent before his 44 or her electronic health record is retrieved from a health information exchange. 45 (NRS 439.591) Section 6.5 of this bill requires such consent to be affirmative. 46 Existing law provides that a health care provider who with reasonable care 47 relies upon an apparently genuine electronic health record accessed from a health 48 information exchange to make a decision concerning the provision of health care to 49 a patient is immune from civil or criminal liability for the decision if: (1) the 50 electronic health record is inaccurate; (2) the inaccuracy was not caused by the 51 health care provider; (3) the inaccuracy resulted in an inappropriate health care 52 decision; and (4) the health care decision was appropriate based upon the 53 information contained in the inaccurate electronic health record. (NRS 439.593) 54 – 3 – - *SB419_R2* Section 7 of this bill expands this immunity from liability to also apply to any 55 health care provider who transmits, accesses, utilizes or discloses an apparently 56 genuine electronic health record or provides such an electronic health record to a 57 patient. 58 Existing law provides that providing information to an electronic health record 59 in accordance with existing law is not an unfair trade practice. (NRS 439.595) 60 Section 8 of this bill additionally provides that transmitting, accessing, utilizing or 61 disclosing an electronic health record in accordance with existing law is not an 62 unfair trade practice. 63 With certain exceptions, existing federal and state law prohibits a person or 64 governmental entity from providing a public benefit to an alien who is not legally 65 present in the United States, except where a state law affirmatively provides for 66 such eligibility. (8 U.S.C. § 1621; NRS 422.065, 422A.085) Section 39 of this bill 67 requires the Director to apply to the Federal Government for authority to provide 68 coverage under the Children’s Health Insurance Program for prenatal, labor and 69 delivery care for persons who are not eligible for Medicaid because of their 70 immigration status. Section 57 of this bill makes an appropriation for the purpose 71 of providing such coverage. Section 39 requires the Department to submit a 72 biennial report to the Legislature concerning the implementation and impacts of 73 such coverage. Section 26 of this bill makes a conforming change to indicate the 74 proper placement of section 39 in the Nevada Revised Statutes. 75 Under existing law, the Division of Welfare and Supportive Services of the 76 Department administers provisions concerning applications for Medicaid and the 77 Children’s Health Insurance Program. (NRS 422A.3351, 422A.336) Section 41 of 78 this bill creates the Medicaid Outreach Advisory Committee within the Division. 79 Section 42 of this bill requires the Advisory Committee to: (1) advise the 80 Department, the Division of Health Care Financing and Policy of the Department 81 and the Division of Welfare and Supportive Services concerning outreach to, and 82 maximizing enrollment in Medicaid and the Children’s Health Insurance Program 83 of, members of marginalized or underserved communities; and (2) post a report of 84 the activities of the Advisory Committee on the Internet on or before July 1 of each 85 even-numbered year. 86 Section 58 of this bill requires the Joint Interim Standing Committee on Health 87 and Human Services to study, during the 2023-2024 interim, the feasibility of 88 including in the State Plan for Medicaid coverage of digital health products and the 89 procedures for and costs of providing such coverage. Section 58.5 of this bill 90 requires the Joint Interim Standing Committee to study, during the 2023-2024 91 interim: (1) the feasibility of and necessary steps for creating a natural persons 92 index for this State; (2) procedures governing data registries and ways to streamline 93 the collection of data and reduce the burden of reporting requirements applicable to 94 providers of health care; (3) the feasibility of including in the State Plan for 95 Medicaid enhanced rates of reimbursement for providers of health care in medically 96 underserved areas and rural areas; (4) methods for increasing the amount of 97 biotechnological and medical research conducted in this State; and (5) the 98 feasibility of including in the State Plan for Medicaid a program to provide services 99 through managed care to recipients of Medicaid who are aged, blind or disabled. 100 – 4 – - *SB419_R2* THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 439 of NRS is hereby amended by adding 1 thereto a new section to read as follows: 2 1. The Department shall notify each regulatory body of this 3 State that has issued a current, valid license to a licensed provider 4 or insurer if: 5 (a) The Department determines that the licensed provider or 6 insurer is not in compliance with the requirements of subsection 4 7 of NRS 439.589; and 8 (b) The licensed provider or insurer: 9 (1) Is not exempt from those requirements pursuant to 10 subsection 5 of NRS 439.589; and 11 (2) Has not received a waiver of those requirements 12 pursuant to subsection 6 of NRS 439.589. 13 2. If the Department determines that a licensed provider or 14 insurer for which notice was previously provided pursuant to 15 subsection 1 has come into compliance with the requirements of 16 subsection 4 of NRS 439.589, the Department shall immediately 17 notify the regulatory body that issued the license. 18 3. As used in this section: 19 (a) “License” means any license, certificate, registration, 20 permit or similar type of authorization to practice an occupation 21 or profession or engage in a business in this State issued to a 22 licensed provider or insurer. 23 (b) “Licensed provider or insurer” means: 24 (1) A medical facility licensed pursuant to chapter 449 of 25 NRS; 26 (2) The holder of a permit to operate an ambulance, an air 27 ambulance or a vehicle of a fire-fighting agency pursuant to 28 chapter 450B of NRS; 29 (3) A provider of health care, as defined in NRS 629.031, 30 who is licensed pursuant to title 54 of NRS; or 31 (4) Any person licensed pursuant to title 57 of NRS. 32 (c) “Regulatory body” means any governmental entity that 33 issues a license. 34 Sec. 2. NRS 439.580 is hereby amended to read as follows: 35 439.580 1. Any local health officer or a deputy of a local 36 health officer who neglects or fails to enforce the provisions of this 37 chapter in his or her jurisdiction, or neglects or refuses to perform 38 any of the duties imposed upon him or her by this chapter or by the 39 instructions and directions of the Division shall be punished by a 40 fine of not more than $250. 41 – 5 – - *SB419_R2* 2. [Each] Except as otherwise provided in NRS 439.589, each 1 person who violates any of the provisions of this chapter or refuses 2 or neglects to obey any lawful order, rule or regulation of the: 3 (a) State Board of Health or violates any rule or regulation 4 approved by the State Board of Health pursuant to NRS 439.350, 5 439.366, 439.410 and 439.460; or 6 (b) Director adopted pursuant to NRS 439.538 or 439.581 to 7 439.595, inclusive, and section 1 of this act, 8  is guilty of a misdemeanor. 9 Sec. 3. NRS 439.581 is hereby amended to read as follows: 10 439.581 As used in NRS 439.581 to 439.595, inclusive, and 11 section 1 of this act, unless the context otherwise requires, the 12 words and terms defined in NRS 439.582 to 439.585, inclusive, 13 have the meanings ascribed to them in those sections. 14 Sec. 4. NRS 439.587 is hereby amended to read as follows: 15 439.587 1. The Director is the state authority for health 16 information technology. [The Director shall: 17 (a) Ensure that a health information exchange complies with the 18 specifications and protocols for exchanging electronic health 19 records, health-related information and related data prescribed 20 pursuant to the provisions of the Health Information Technology for 21 Economic and Clinical Health Act of 2009, 42 U.S.C. §§ 300jj et 22 seq. and 17901 et seq., and other applicable federal and state law; 23 (b) Encourage the use of a health information exchange by 24 health care providers, payers and patients; 25 (c) Prescribe by regulation standards for the electronic 26 transmittal of electronic health records, prescriptions, health-related 27 information, electronic signatures and requirements for electronic 28 equivalents of written entries or written approvals in accordance 29 with federal law; 30 (d) Prescribe by regulation rules governing the ownership, 31 management and use of electronic health records, health-related 32 information and related data retained or shared by a health 33 information exchange; and 34 (e) Prescribe by regulation, in consultation with the State Board 35 of Pharmacy, standards for the electronic transmission of prior 36 authorizations for prescription medication using a health 37 information exchange.] 38 2. The Director may establish or contract with [not more than] 39 one or more health information [exchange to serve as the statewide 40 health information exchange] exchanges to be responsible for 41 compiling statewide master indexes of patients, health care 42 providers and payers. The Director may by regulation prescribe the 43 requirements for such a [statewide] health information exchange, 44 including, without limitation, the procedure by which any patient, 45 – 6 – - *SB419_R2* health care provider or payer master index created pursuant to any 1 contract is transferred to the State upon termination of the contract. 2 3. The Director may enter into contracts, apply for and accept 3 available gifts, grants and donations, and adopt such regulations as 4 are necessary to carry out the provisions of NRS 439.581 to 5 439.595, inclusive [.] , and section 1 of this act. 6 Sec. 4.5. (Deleted by amendment.) 7 Sec. 5. NRS 439.588 is hereby amended to read as follows: 8 439.588 1. A health information exchange shall not operate 9 in this State without first obtaining certification as provided in 10 subsection 2. 11 2. The Director shall by regulation establish the manner in 12 which a health information exchange may apply for certification and 13 the requirements for granting such certification, which must include, 14 without limitation, that the health information exchange demonstrate 15 its financial and operational sustainability, adherence to the privacy, 16 security and patient consent standards adopted pursuant to NRS 17 439.589 and capacity for interoperability with any other health 18 information exchange certified pursuant to this section. 19 3. The Director may deny an application for certification or 20 may suspend or revoke any certification issued pursuant to 21 subsection 2 for failure to comply with the provisions of NRS 22 439.581 to 439.595, inclusive, and section 1 of this act or the 23 regulations adopted pursuant thereto or any applicable federal or 24 state law. 25 4. When the Director intends to deny, suspend or revoke a 26 certification, he or she shall give reasonable notice to all parties by 27 certified mail. The notice must contain the legal authority, 28 jurisdiction and reasons for the action to be taken. A health 29 information exchange that wishes to contest the action of the 30 Director must file an appeal with the Director. 31 5. The Director shall adopt regulations establishing the manner 32 in which a person may file a complaint with the Director regarding a 33 violation of the provisions of this section. 34 6. The Director may impose an administrative fine against a 35 health information exchange which operates in this State without 36 holding a certification in an amount established by the Director by 37 regulation. The Director shall afford a health information exchange 38 so fined an opportunity for a hearing pursuant to the provisions of 39 NRS 233B.121. 40 7. The Director may adopt such regulations as he or she 41 determines are necessary to carry out the provisions of this section. 42 Sec. 6. NRS 439.589 is hereby amended to read as follows: 43 439.589 1. The Director , in consultation with health care 44 providers, third parties and other interested persons and entities, 45 – 7 – - *SB419_R2* shall by regulation prescribe a framework for the electronic 1 maintenance, transmittal and exchange of electronic health 2 records, prescriptions, health-related information and electronic 3 signatures and requirements for electronic equivalents of written 4 entries or written approvals in accordance with federal law. The 5 regulations must: 6 (a) Establish standards [: 7 (a)] for networks and technologies to be used to maintain, 8 transmit and exchange health information, including, without 9 limitation, standards: 10 (1) That require: 11 (I) The use of networks and technologies that allow 12 patients to access electronic health records directly from the 13 health care provider of the patient and forward such electronic 14 health records electronically to other persons and entities; and 15 (II) The interoperability of such networks and 16 technologies in accordance with the applicable standards for the 17 interoperability of Qualified Health Information Networks 18 prescribed by the Office of the National Coordinator for Health 19 Information Technology of the United States Department of 20 Health and Human Services; 21 (2) To ensure that electronic health records retained or shared 22 [by any health information exchange] are secure; 23 [(b)] (3) To maintain the confidentiality of electronic health 24 records and health-related information, including, without 25 limitation, standards to maintain the confidentiality of electronic 26 health records relating to a child who has received health care 27 services without the consent of a parent or guardian and which 28 ensure that a child’s right to access such health care services is not 29 impaired; 30 [(c)] (4) To ensure the privacy of individually identifiable 31 health information, including, without limitation, standards to 32 ensure the privacy of information relating to a child who has 33 received health care services without the consent of a parent or 34 guardian; 35 [(d)] (5) For obtaining consent from a patient before retrieving 36 the patient’s health records from a health information exchange, 37 including, without limitation, standards for obtaining such consent 38 from a child who has received health care services without the 39 consent of a parent or guardian; 40 [(e)] (6) For making any necessary corrections to information or 41 records [retained or shared by a health information exchange; and 42 (f)] ; 43 – 8 – - *SB419_R2* (7) For notifying a patient if the confidentiality of 1 information contained in an electronic health record of the patient is 2 breached [.] ; 3 (8) Governing the ownership, management and use of 4 electronic health records, health-related information and related 5 data; and 6 (9) For the electronic transmission of prior authorizations 7 for prescription medication; 8 (b) Ensure compliance with the requirements, specifications 9 and protocols for exchanging, securing and disclosing electronic 10 health records, health-related information and related data 11 prescribed pursuant to the provisions of the Health Information 12 Technology for Economic and Clinical Health Act, 42 U.S.C. §§ 13 300jj et seq. and 17901 et seq., the Health Insurance Portability 14 and Accountability Act of 1996, Public Law 104-191, and other 15 applicable federal and state law; and 16 (c) Be based on nationally recognized best practices for 17 maintaining, transmitting and exchanging health information 18 electronically. 19 2. The standards prescribed pursuant to this section must 20 include, without limitation: 21 (a) Requirements for the creation, maintenance and transmittal 22 of electronic health records; 23 (b) Requirements for protecting confidentiality, including 24 control over, access to and the collection, organization and 25 maintenance of electronic health records, health-related information 26 and individually identifiable health information; 27 (c) Requirements for the manner in which a patient may, 28 through a health care provider who participates in the sharing of 29 health records using a health information exchange, revoke his or 30 her consent for a health care provider to retrieve the patient’s health 31 records from the health information exchange; 32 (d) A secure and traceable electronic audit system for 33 identifying access points and trails to electronic health records and 34 health information exchanges; and 35 (e) Any other requirements necessary to comply with all 36 applicable federal laws relating to electronic health records, health- 37 related information, health information exchanges and the security 38 and confidentiality of such records and exchanges. 39 3. The regulations adopted pursuant to this section must not 40 require any person or entity to use a health information exchange. 41 4. Except as otherwise provided in subsections 5, 6 and 7, the 42 Department and the divisions thereof, other state and local 43 governmental entities, health care providers, third parties, 44 pharmacy benefit managers and other entities licensed or certified 45 – 9 – - *SB419_R2* pursuant to title 57 of NRS shall maintain, transmit and exchange 1 health information in accordance with the regulations adopted 2 pursuant to this section, the provisions of NRS 439.581 to 439.595, 3 inclusive, and section 1 of this act, and any other regulations 4 adopted pursuant thereto. 5 5. The Federal Government and employees thereof, a 6 provider of health coverage for federal employees, a provider of 7 health coverage that is subject to the Employee Retirement Income 8 Security Act of 1974, 29 U.S.C. §§ 1001 et seq., or a Taft-Hartley 9 trust formed pursuant to 29 U.S.C. § 186(c)(5) is not required to 10 but may maintain, transmit and exchange electronic information 11 in accordance with the regulations adopted pursuant to this 12 section. 13 6. A health care provider may apply to the Department for a 14 waiver from the provisions of subsection 4 on the basis that the 15 health care provider does not have the infrastructure necessary to 16 comply with those provisions, including, without limitation, 17 because the health care provider does not have access to the 18 Internet. The Department shall grant a waiver if it determines 19 that: 20 (a) The health care provider does not currently have the 21 infrastructure necessary to comply with the provisions of 22 subsection 4; and 23 (b) Obtaining such infrastructure is not reasonably 24 practicable, including, without limitation, because the cost of such 25 infrastructure would make it difficult for the health care provider 26 to continue to operate. 27 7. The provisions of subsection 4 do not apply to the 28 Department of Corrections. 29 8. A violation of the provisions of this section or any 30 regulations adopted pursuant thereto is not a misdemeanor. 31 9. As used in this section: 32 (a) “Pharmacy benefit manager” has the meaning ascribed to 33 it in NRS 683A.174. 34 (b) “Third party” means any insurer, governmental entity or 35 other organization providing health coverage or benefits in 36 accordance with state or federal law. 37 Sec. 6.5. NRS 439.591 is hereby amended to read as follows: 38 439.591 1. Except as otherwise provided in subsection 2 of 39 NRS 439.538, a patient must not be required to participate in a 40 health information exchange. Before a patient’s health care records 41 may be retrieved from a health information exchange, the patient 42 must be fully informed and affirmatively consent, in the manner 43 prescribed by the Director. It is the public policy of this State that, 44 except as otherwise provided in NRS 439.538, a patient’s health 45 – 10 – - *SB419_R2* care records must not be retrieved from a health information 1 exchange unless the patient provides such affirmative consent. 2 2. A patient must be notified in the manner prescribed by the 3 Director of any breach of the confidentiality of electronic health 4 records of the patient or a health information exchange. 5 3. A patient who consents to the retrieval of his or her 6 electronic health record from a health information exchange may at 7 any time request that a health care provider access and provide the 8 patient with his or her electronic health record in accordance with 9 the provisions of 45 C.F.R. § 164.526. 10 Sec. 7. NRS 439.593 is hereby amended to read as follows: 11 439.593 A health care provider who with reasonable care 12 transmits, accesses, utilizes, discloses, relies upon or provides to a 13 patient an apparently genuine electronic health record accessed 14 [from a health information exchange to make a decision concerning 15 the provision of health care to a patient] in accordance with NRS 16 439.581 to 439.595, inclusive, and the regulations adopted 17 pursuant thereto is immune from civil or criminal liability for [the] 18 any decision concerning the provision of health care to the patient 19 and any civil or criminal liability resulting from the provision of 20 the record to a patient if: 21 1. The electronic health record is inaccurate; 22 2. The inaccuracy was not caused by the health care provider; 23 3. The inaccuracy resulted in an inappropriate health care 24 decision; and 25 4. The health care decision was appropriate based upon the 26 information contained in the inaccurate electronic health record. 27 Sec. 8. NRS 439.595 is hereby amended to read as follows: 28 439.595 Providing information to , transmitting, accessing, 29 utilizing or disclosing an electronic health record or participating in 30 a health information exchange in accordance with NRS 439.581 to 31 439.595, inclusive, does not constitute an unfair trade practice 32 pursuant to chapter 598A or 686A of NRS. 33 Sec. 9. Chapter 449 of NRS is hereby amended by adding 34 thereto a new section to read as follows: 35 1. If the Division receives notification from the Department 36 of Health and Human Services pursuant to section 1 of this act 37 that a medical facility licensed pursuant to this chapter is not in 38 compliance with the requirements of subsection 4 of NRS 439.589, 39 the Division may, after notice and the opportunity for a hearing in 40 accordance with the provisions of this chapter, require corrective 41 action or impose an administrative penalty in the amount 42 prescribed by NRS 449.163. 43 – 11 – - *SB419_R2* 2. The Division shall not suspend or revoke a license for 1 failure to comply with the requirements of subsection 4 of 2 NRS 439.589. 3 Sec. 10. NRS 449.029 is hereby amended to read as follows: 4 449.029 As used in NRS 449.029 to 449.240, inclusive, and 5 section 9 of this act, unless the context otherwise requires, “medical 6 facility” has the meaning ascribed to it in NRS 449.0151 and 7 includes a program of hospice care described in NRS 449.196. 8 Sec. 11. NRS 449.0301 is hereby amended to read as follows: 9 449.0301 The provisions of NRS 449.029 to 449.2428, 10 inclusive, and section 9 of this act do not apply to: 11 1. Any facility conducted by and for the adherents of any 12 church or religious denomination for the purpose of providing 13 facilities for the care and treatment of the sick who depend solely 14 upon spiritual means through prayer for healing in the practice of 15 the religion of the church or denomination, except that such a 16 facility shall comply with all regulations relative to sanitation and 17 safety applicable to other facilities of a similar category. 18 2. Foster homes as defined in NRS 424.014. 19 3. Any medical facility, facility for the dependent or facility 20 which is otherwise required by the regulations adopted by the Board 21 pursuant to NRS 449.0303 to be licensed that is operated and 22 maintained by the United States Government or an agency thereof. 23 Sec. 12. NRS 449.0302 is hereby amended to read as follows: 24 449.0302 1. The Board shall adopt: 25 (a) Licensing standards for each class of medical facility or 26 facility for the dependent covered by NRS 449.029 to 449.2428, 27 inclusive, and section 9 of this act and for programs of hospice 28 care. 29 (b) Regulations governing the licensing of such facilities and 30 programs. 31 (c) Regulations governing the procedure and standards for 32 granting an extension of the time for which a natural person may 33 provide certain care in his or her home without being considered a 34 residential facility for groups pursuant to NRS 449.017. The 35 regulations must require that such grants are effective only if made 36 in writing. 37 (d) Regulations establishing a procedure for the indemnification 38 by the Division, from the amount of any surety bond or other 39 obligation filed or deposited by a facility for refractive surgery 40 pursuant to NRS 449.068 or 449.069, of a patient of the facility who 41 has sustained any damages as a result of the bankruptcy of or any 42 breach of contract by the facility. 43 (e) Regulations that prescribe the specific types of 44 discrimination prohibited by NRS 449.101. 45 – 12 – - *SB419_R2* (f) Regulations requiring a hospital or independent center for 1 emergency medical care to provide training to each employee who 2 provides care to victims of sexual assault or attempted sexual assault 3 concerning appropriate care for such persons, including, without 4 limitation, training concerning the requirements of NRS 449.1885. 5 (g) Any other regulations as it deems necessary or convenient to 6 carry out the provisions of NRS 449.029 to 449.2428, inclusive [.] , 7 and section 9 of this act. 8 2. The Board shall adopt separate regulations governing the 9 licensing and operation of: 10 (a) Facilities for the care of adults during the day; and 11 (b) Residential facilities for groups, 12  which provide care to persons with Alzheimer’s disease or other 13 severe dementia, as described in paragraph (a) of subsection 2 of 14 NRS 449.1845. 15 3. The Board shall adopt separate regulations for: 16 (a) The licensure of rural hospitals which take into consideration 17 the unique problems of operating such a facility in a rural area. 18 (b) The licensure of facilities for refractive surgery which take 19 into consideration the unique factors of operating such a facility. 20 (c) The licensure of mobile units which take into consideration 21 the unique factors of operating a facility that is not in a fixed 22 location. 23 4. The Board shall require that the practices and policies of 24 each medical facility or facility for the dependent provide 25 adequately for the protection of the health, safety and physical, 26 moral and mental well-being of each person accommodated in the 27 facility. 28 5. In addition to the training requirements prescribed pursuant 29 to NRS 449.093, the Board shall establish minimum qualifications 30 for administrators and employees of residential facilities for groups. 31 In establishing the qualifications, the Board shall consider the 32 related standards set by nationally recognized organizations which 33 accredit such facilities. 34 6. The Board shall adopt separate regulations regarding the 35 assistance which may be given pursuant to NRS 453.375 and 36 454.213 to an ultimate user of controlled substances or dangerous 37 drugs by employees of residential facilities for groups. The 38 regulations must require at least the following conditions before 39 such assistance may be given: 40 (a) The ultimate user’s physical and mental condition is stable 41 and is following a predictable course. 42 (b) The amount of the medication prescribed is at a maintenance 43 level and does not require a daily assessment. 44 – 13 – - *SB419_R2* (c) A written plan of care by a physician or registered nurse has 1 been established that: 2 (1) Addresses possession and assistance in the administration 3 of the medication; and 4 (2) Includes a plan, which has been prepared under the 5 supervision of a registered nurse or licensed pharmacist, for 6 emergency intervention if an adverse condition results. 7 (d) Except as otherwise authorized by the regulations adopted 8 pursuant to NRS 449.0304, the prescribed medication is not 9 administered by injection or intravenously. 10 (e) The employee has successfully completed training and 11 examination approved by the Division regarding the authorized 12 manner of assistance. 13 7. The Board shall adopt separate regulations governing the 14 licensing and operation of residential facilities for groups which 15 provide assisted living services. The Board shall not allow the 16 licensing of a facility as a residential facility for groups which 17 provides assisted living services and a residential facility for groups 18 shall not claim that it provides “assisted living services” unless: 19 (a) Before authorizing a person to move into the facility, the 20 facility makes a full written disclosure to the person regarding what 21 services of personalized care will be available to the person and the 22 amount that will be charged for those services throughout the 23 resident’s stay at the facility. 24 (b) The residents of the facility reside in their own living units 25 which: 26 (1) Except as otherwise provided in subsection 8, contain 27 toilet facilities; 28 (2) Contain a sleeping area or bedroom; and 29 (3) Are shared with another occupant only upon consent of 30 both occupants. 31 (c) The facility provides personalized care to the residents of the 32 facility and the general approach to operating the facility 33 incorporates these core principles: 34 (1) The facility is designed to create a residential 35 environment that actively supports and promotes each resident’s 36 quality of life and right to privacy; 37 (2) The facility is committed to offering high-quality 38 supportive services that are developed by the facility in 39 collaboration with the resident to meet the resident’s individual 40 needs; 41 (3) The facility provides a variety of creative and innovative 42 services that emphasize the particular needs of each individual 43 resident and the resident’s personal choice of lifestyle; 44 – 14 – - *SB419_R2* (4) The operation of the facility and its interaction with its 1 residents supports, to the maximum extent possible, each resident’s 2 need for autonomy and the right to make decisions regarding his or 3 her own life; 4 (5) The operation of the facility is designed to foster a social 5 climate that allows the resident to develop and maintain personal 6 relationships with fellow residents and with persons in the general 7 community; 8 (6) The facility is designed to minimize and is operated in a 9 manner which minimizes the need for its residents to move out of 10 the facility as their respective physical and mental conditions change 11 over time; and 12 (7) The facility is operated in such a manner as to foster a 13 culture that provides a high-quality environment for the residents, 14 their families, the staff, any volunteers and the community at large. 15 8. The Division may grant an exception from the requirement 16 of subparagraph (1) of paragraph (b) of subsection 7 to a facility 17 which is licensed as a residential facility for groups on or before 18 July 1, 2005, and which is authorized to have 10 or fewer beds and 19 was originally constructed as a single-family dwelling if the 20 Division finds that: 21 (a) Strict application of that requirement would result in 22 economic hardship to the facility requesting the exception; and 23 (b) The exception, if granted, would not: 24 (1) Cause substantial detriment to the health or welfare of 25 any resident of the facility; 26 (2) Result in more than two residents sharing a toilet facility; 27 or 28 (3) Otherwise impair substantially the purpose of that 29 requirement. 30 9. The Board shall, if it determines necessary, adopt 31 regulations and requirements to ensure that each residential facility 32 for groups and its staff are prepared to respond to an emergency, 33 including, without limitation: 34 (a) The adoption of plans to respond to a natural disaster and 35 other types of emergency situations, including, without limitation, 36 an emergency involving fire; 37 (b) The adoption of plans to provide for the evacuation of a 38 residential facility for groups in an emergency, including, without 39 limitation, plans to ensure that nonambulatory patients may be 40 evacuated; 41 (c) Educating the residents of residential facilities for groups 42 concerning the plans adopted pursuant to paragraphs (a) and (b); and 43 – 15 – - *SB419_R2* (d) Posting the plans or a summary of the plans adopted 1 pursuant to paragraphs (a) and (b) in a conspicuous place in each 2 residential facility for groups. 3 10. The regulations governing the licensing and operation of 4 facilities for transitional living for released offenders must provide 5 for the licensure of at least three different types of facilities, 6 including, without limitation: 7 (a) Facilities that only provide a housing and living 8 environment; 9 (b) Facilities that provide or arrange for the provision of 10 supportive services for residents of the facility to assist the residents 11 with reintegration into the community, in addition to providing a 12 housing and living environment; and 13 (c) Facilities that provide or arrange for the provision of 14 programs for alcohol and other substance use disorders, in addition 15 to providing a housing and living environment and providing or 16 arranging for the provision of other supportive services. 17  The regulations must provide that if a facility was originally 18 constructed as a single-family dwelling, the facility must not be 19 authorized for more than eight beds. 20 11. The Board shall adopt regulations applicable to providers 21 of community-based living arrangement services which: 22 (a) Except as otherwise provided in paragraph (b), require a 23 natural person responsible for the operation of a provider of 24 community-based living arrangement services and each employee of 25 a provider of community-based living arrangement services who 26 supervises or provides support to recipients of community-based 27 living arrangement services to complete training concerning the 28 provision of community-based living arrangement services to 29 persons with mental illness and continuing education concerning the 30 particular population served by the provider; 31 (b) Exempt a person licensed or certified pursuant to title 54 of 32 NRS from the requirements prescribed pursuant to paragraph (a) if 33 the Board determines that the person is required to receive training 34 and continuing education substantially equivalent to that prescribed 35 pursuant to that paragraph; 36 (c) Require a natural person responsible for the operation of a 37 provider of community-based living arrangement services to receive 38 training concerning the provisions of title 53 of NRS applicable to 39 the provision of community-based living arrangement services; and 40 (d) Require an applicant for a license to provide community- 41 based living arrangement services to post a surety bond in an 42 amount equal to the operating expenses of the applicant for 2 43 months, place that amount in escrow or take another action 44 prescribed by the Division to ensure that, if the applicant becomes 45 – 16 – - *SB419_R2* insolvent, recipients of community-based living arrangement 1 services from the applicant may continue to receive community- 2 based living arrangement services for 2 months at the expense of the 3 applicant. 4 12. The Board shall adopt separate regulations governing the 5 licensing and operation of freestanding birthing centers. Such 6 regulations must: 7 (a) Align with the standards established by the American 8 Association of Birth Centers, or its successor organization, the 9 accrediting body of the Commission for the Accreditation of Birth 10 Centers, or its successor organization, or another nationally 11 recognized organization for accrediting freestanding birthing 12 centers; and 13 (b) Allow the provision of supervised training to providers of 14 health care, as appropriate, at a freestanding birthing center. 15 13. As used in this section, “living unit” means an individual 16 private accommodation designated for a resident within the facility. 17 Sec. 13. NRS 449.160 is hereby amended to read as follows: 18 449.160 1. The Division may deny an application for a 19 license or may suspend or revoke any license issued under the 20 provisions of NRS 449.029 to 449.2428, inclusive, and section 9 of 21 this act upon any of the following grounds: 22 (a) Violation by the applicant or the licensee of any of the 23 provisions of NRS 439B.410 or 449.029 to 449.245, inclusive, and 24 section 9 of this act, or of any other law of this State or of the 25 standards, rules and regulations adopted thereunder. 26 (b) Aiding, abetting or permitting the commission of any illegal 27 act. 28 (c) Conduct inimical to the public health, morals, welfare and 29 safety of the people of the State of Nevada in the maintenance and 30 operation of the premises for which a license is issued. 31 (d) Conduct or practice detrimental to the health or safety of the 32 occupants or employees of the facility. 33 (e) Failure of the applicant to obtain written approval from the 34 Director of the Department of Health and Human Services as 35 required by NRS 439A.100 or as provided in any regulation adopted 36 pursuant to NRS 449.001 to 449.430, inclusive, and section 9 of 37 this act, and 449.435 to 449.531, inclusive, and chapter 449A of 38 NRS if such approval is required. 39 (f) Failure to comply with the provisions of NRS 441A.315 and 40 any regulations adopted pursuant thereto or NRS 449.2486. 41 (g) Violation of the provisions of NRS 458.112. 42 2. In addition to the provisions of subsection 1, the Division 43 may revoke a license to operate a facility for the dependent if, with 44 – 17 – - *SB419_R2* respect to that facility, the licensee that operates the facility, or an 1 agent or employee of the licensee: 2 (a) Is convicted of violating any of the provisions of 3 NRS 202.470; 4 (b) Is ordered to but fails to abate a nuisance pursuant to NRS 5 244.360, 244.3603 or 268.4124; or 6 (c) Is ordered by the appropriate governmental agency to correct 7 a violation of a building, safety or health code or regulation but fails 8 to correct the violation. 9 3. The Division shall maintain a log of any complaints that it 10 receives relating to activities for which the Division may revoke the 11 license to operate a facility for the dependent pursuant to subsection 12 2. The Division shall provide to a facility for the care of adults 13 during the day: 14 (a) A summary of a complaint against the facility if the 15 investigation of the complaint by the Division either substantiates 16 the complaint or is inconclusive; 17 (b) A report of any investigation conducted with respect to the 18 complaint; and 19 (c) A report of any disciplinary action taken against the facility. 20  The facility shall make the information available to the public 21 pursuant to NRS 449.2486. 22 4. On or before February 1 of each odd-numbered year, the 23 Division shall submit to the Director of the Legislative Counsel 24 Bureau a written report setting forth, for the previous biennium: 25 (a) Any complaints included in the log maintained by the 26 Division pursuant to subsection 3; and 27 (b) Any disciplinary actions taken by the Division pursuant to 28 subsection 2. 29 Sec. 14. NRS 449.163 is hereby amended to read as follows: 30 449.163 1. In addition to the payment of the amount required 31 by NRS 449.0308, if a medical facility, facility for the dependent or 32 facility which is required by the regulations adopted by the Board 33 pursuant to NRS 449.0303 to be licensed violates any provision 34 related to its licensure, including any provision of NRS 439B.410 or 35 449.029 to 449.2428, inclusive, and section 9 of this act or any 36 condition, standard or regulation adopted by the Board, the 37 Division, in accordance with the regulations adopted pursuant to 38 NRS 449.165, may: 39 (a) Prohibit the facility from admitting any patient until it 40 determines that the facility has corrected the violation; 41 (b) Limit the occupancy of the facility to the number of beds 42 occupied when the violation occurred, until it determines that the 43 facility has corrected the violation; 44 – 18 – - *SB419_R2* (c) If the license of the facility limits the occupancy of the 1 facility and the facility has exceeded the approved occupancy, 2 require the facility, at its own expense, to move patients to another 3 facility that is licensed; 4 (d) Impose an administrative penalty of not more than $5,000 5 per day for each violation, together with interest thereon at a rate not 6 to exceed 10 percent per annum; and 7 (e) Appoint temporary management to oversee the operation of 8 the facility and to ensure the health and safety of the patients of the 9 facility, until: 10 (1) It determines that the facility has corrected the violation 11 and has management which is capable of ensuring continued 12 compliance with the applicable statutes, conditions, standards and 13 regulations; or 14 (2) Improvements are made to correct the violation. 15 2. If the facility fails to pay any administrative penalty imposed 16 pursuant to paragraph (d) of subsection 1, the Division may: 17 (a) Suspend the license of the facility until the administrative 18 penalty is paid; and 19 (b) Collect court costs, reasonable attorney’s fees and other 20 costs incurred to collect the administrative penalty. 21 3. The Division may require any facility that violates any 22 provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and 23 section 9 of this act or any condition, standard or regulation adopted 24 by the Board to make any improvements necessary to correct the 25 violation. 26 4. Any money collected as administrative penalties pursuant to 27 paragraph (d) of subsection 1 must be accounted for separately and 28 used to administer and carry out the provisions of NRS 449.001 to 29 449.430, inclusive, and section 9 of this act, 449.435 to 449.531, 30 inclusive, and chapter 449A of NRS to protect the health, safety, 31 well-being and property of the patients and residents of facilities in 32 accordance with applicable state and federal standards or for any 33 other purpose authorized by the Legislature. 34 Sec. 15. (Deleted by amendment.) 35 Sec. 16. NRS 449.240 is hereby amended to read as follows: 36 449.240 The district attorney of the county in which the facility 37 is located shall, upon application by the Division, institute and 38 conduct the prosecution of any action for violation of any provisions 39 of NRS 449.029 to 449.245, inclusive [.] , and section 9 of this act. 40 Sec. 17. Chapter 450B of NRS is hereby amended by adding 41 thereto a new section to read as follows: 42 1. If the health authority receives notification from the 43 Department of Health and Human Services pursuant to section 1 44 of this act that the holder of a permit to operate an ambulance, air 45 – 19 – - *SB419_R2* ambulance or vehicle of a fire-fighting agency is not in 1 compliance with the requirements of subsection 4 of NRS 439.589, 2 the health authority may, after notice and the opportunity for a 3 hearing in accordance with the provisions of this chapter, require 4 corrective action or impose an administrative penalty in an 5 amount established by regulation of the board. 6 2. The health authority shall not suspend or revoke a permit 7 for failure to comply with the requirements of subsection 4 of 8 NRS 439.589. 9 Sec. 18. (Deleted by amendment.) 10 Sec. 19. (Deleted by amendment.) 11 Sec. 20. (Deleted by amendment.) 12 Sec. 21. (Deleted by amendment.) 13 Sec. 22. (Deleted by amendment.) 14 Sec. 23. (Deleted by amendment.) 15 Sec. 24. (Deleted by amendment.) 16 Sec. 25. (Deleted by amendment.) 17 Sec. 26. NRS 232.320 is hereby amended to read as follows: 18 232.320 1. The Director: 19 (a) Shall appoint, with the consent of the Governor, 20 administrators of the divisions of the Department, who are 21 respectively designated as follows: 22 (1) The Administrator of the Aging and Disability Services 23 Division; 24 (2) The Administrator of the Division of Welfare and 25 Supportive Services; 26 (3) The Administrator of the Division of Child and Family 27 Services; 28 (4) The Administrator of the Division of Health Care 29 Financing and Policy; and 30 (5) The Administrator of the Division of Public and 31 Behavioral Health. 32 (b) Shall administer, through the divisions of the Department, 33 the provisions of chapters 63, 424, 425, 427A, 432A to 442, 34 inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 35 127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 36 section 39 of this act, 422.580, 432.010 to 432.133, inclusive, 37 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 38 and 445A.010 to 445A.055, inclusive, and all other provisions of 39 law relating to the functions of the divisions of the Department, but 40 is not responsible for the clinical activities of the Division of Public 41 and Behavioral Health or the professional line activities of the other 42 divisions. 43 (c) Shall administer any state program for persons with 44 developmental disabilities established pursuant to the 45 – 20 – - *SB419_R2* Developmental Disabilities Assistance and Bill of Rights Act of 1 2000, 42 U.S.C. §§ 15001 et seq. 2 (d) Shall, after considering advice from agencies of local 3 governments and nonprofit organizations which provide social 4 services, adopt a master plan for the provision of human services in 5 this State. The Director shall revise the plan biennially and deliver a 6 copy of the plan to the Governor and the Legislature at the 7 beginning of each regular session. The plan must: 8 (1) Identify and assess the plans and programs of the 9 Department for the provision of human services, and any 10 duplication of those services by federal, state and local agencies; 11 (2) Set forth priorities for the provision of those services; 12 (3) Provide for communication and the coordination of those 13 services among nonprofit organizations, agencies of local 14 government, the State and the Federal Government; 15 (4) Identify the sources of funding for services provided by 16 the Department and the allocation of that funding; 17 (5) Set forth sufficient information to assist the Department 18 in providing those services and in the planning and budgeting for the 19 future provision of those services; and 20 (6) Contain any other information necessary for the 21 Department to communicate effectively with the Federal 22 Government concerning demographic trends, formulas for the 23 distribution of federal money and any need for the modification of 24 programs administered by the Department. 25 (e) May, by regulation, require nonprofit organizations and state 26 and local governmental agencies to provide information regarding 27 the programs of those organizations and agencies, excluding 28 detailed information relating to their budgets and payrolls, which the 29 Director deems necessary for the performance of the duties imposed 30 upon him or her pursuant to this section. 31 (f) Has such other powers and duties as are provided by law. 32 2. Notwithstanding any other provision of law, the Director, or 33 the Director’s designee, is responsible for appointing and removing 34 subordinate officers and employees of the Department. 35 Sec. 27. (Deleted by amendment.) 36 Sec. 28. NRS 287.010 is hereby amended to read as follows: 37 287.010 1. The governing body of any county, school 38 district, municipal corporation, political subdivision, public 39 corporation or other local governmental agency of the State of 40 Nevada may: 41 (a) Adopt and carry into effect a system of group life, accident 42 or health insurance, or any combination thereof, for the benefit of its 43 officers and employees, and the dependents of officers and 44 employees who elect to accept the insurance and who, where 45 – 21 – - *SB419_R2* necessary, have authorized the governing body to make deductions 1 from their compensation for the payment of premiums on the 2 insurance. 3 (b) Purchase group policies of life, accident or health insurance, 4 or any combination thereof, for the benefit of such officers and 5 employees, and the dependents of such officers and employees, as 6 have authorized the purchase, from insurance companies authorized 7 to transact the business of such insurance in the State of Nevada, 8 and, where necessary, deduct from the compensation of officers and 9 employees the premiums upon insurance and pay the deductions 10 upon the premiums. 11 (c) Provide group life, accident or health coverage through a 12 self-insurance reserve fund and, where necessary, deduct 13 contributions to the maintenance of the fund from the compensation 14 of officers and employees and pay the deductions into the fund. The 15 money accumulated for this purpose through deductions from the 16 compensation of officers and employees and contributions of the 17 governing body must be maintained as an internal service fund as 18 defined by NRS 354.543. The money must be deposited in a state or 19 national bank or credit union authorized to transact business in the 20 State of Nevada. Any independent administrator of a fund created 21 under this section is subject to the licensing requirements of chapter 22 683A of NRS, and must be a resident of this State. Any contract 23 with an independent administrator must be approved by the 24 Commissioner of Insurance as to the reasonableness of 25 administrative charges in relation to contributions collected and 26 benefits provided. The provisions of NRS 439.581 to 439.595, 27 inclusive, and section 1 of this act, 686A.135, 687B.352, 687B.408, 28 687B.723, 687B.725, 689B.030 to 689B.050, inclusive, 689B.265, 29 689B.287 and 689B.500 apply to coverage provided pursuant to this 30 paragraph, except that the provisions of NRS 689B.0378, 31 689B.03785 and 689B.500 only apply to coverage for active officers 32 and employees of the governing body, or the dependents of such 33 officers and employees. 34 (d) Defray part or all of the cost of maintenance of a self- 35 insurance fund or of the premiums upon insurance. The money for 36 contributions must be budgeted for in accordance with the laws 37 governing the county, school district, municipal corporation, 38 political subdivision, public corporation or other local governmental 39 agency of the State of Nevada. 40 2. If a school district offers group insurance to its officers and 41 employees pursuant to this section, members of the board of trustees 42 of the school district must not be excluded from participating in the 43 group insurance. If the amount of the deductions from compensation 44 – 22 – - *SB419_R2* required to pay for the group insurance exceeds the compensation to 1 which a trustee is entitled, the difference must be paid by the trustee. 2 3. In any county in which a legal services organization exists, 3 the governing body of the county, or of any school district, 4 municipal corporation, political subdivision, public corporation or 5 other local governmental agency of the State of Nevada in the 6 county, may enter into a contract with the legal services 7 organization pursuant to which the officers and employees of the 8 legal services organization, and the dependents of those officers and 9 employees, are eligible for any life, accident or health insurance 10 provided pursuant to this section to the officers and employees, and 11 the dependents of the officers and employees, of the county, school 12 district, municipal corporation, political subdivision, public 13 corporation or other local governmental agency. 14 4. If a contract is entered into pursuant to subsection 3, the 15 officers and employees of the legal services organization: 16 (a) Shall be deemed, solely for the purposes of this section, to be 17 officers and employees of the county, school district, municipal 18 corporation, political subdivision, public corporation or other local 19 governmental agency with which the legal services organization has 20 contracted; and 21 (b) Must be required by the contract to pay the premiums or 22 contributions for all insurance which they elect to accept or of which 23 they authorize the purchase. 24 5. A contract that is entered into pursuant to subsection 3: 25 (a) Must be submitted to the Commissioner of Insurance for 26 approval not less than 30 days before the date on which the contract 27 is to become effective. 28 (b) Does not become effective unless approved by the 29 Commissioner. 30 (c) Shall be deemed to be approved if not disapproved by the 31 Commissioner within 30 days after its submission. 32 6. As used in this section, “legal services organization” means 33 an organization that operates a program for legal aid and receives 34 money pursuant to NRS 19.031. 35 Sec. 29. NRS 287.04335 is hereby amended to read as 36 follows: 37 287.04335 If the Board provides health insurance through a 38 plan of self-insurance, it shall comply with the provisions of NRS 39 439.581 to 439.595, inclusive, and section 1 of this act, 686A.135, 40 687B.352, 687B.409, 687B.723, 687B.725, 689B.0353, 689B.255, 41 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 42 695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 43 695G.1675, 695G.170 to 695G.174, inclusive, 695G.176, 695G.177, 44 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, 45 – 23 – - *SB419_R2* and 695G.405, in the same manner as an insurer that is licensed 1 pursuant to title 57 of NRS is required to comply with those 2 provisions. 3 Sec. 30. (Deleted by amendment.) 4 Sec. 31. (Deleted by amendment.) 5 Sec. 32. (Deleted by amendment.) 6 Sec. 33. (Deleted by amendment.) 7 Sec. 34. (Deleted by amendment.) 8 Sec. 35. (Deleted by amendment.) 9 Sec. 36. (Deleted by amendment.) 10 Sec. 37. (Deleted by amendment.) 11 Sec. 38. (Deleted by amendment.) 12 Sec. 39. Chapter 422 of NRS is hereby amended by adding 13 thereto a new section to read as follows: 14 1. The Legislature hereby finds and declares that it is the 15 public policy of this State that each resident of this State who 16 otherwise qualifies for enrollment in Medicaid, regardless of his 17 or her immigration or citizenship status, is eligible to receive the 18 benefits provided for by subsection 2. 19 2. The Director shall apply to the Secretary of Health and 20 Human Services for any federal authority necessary to provide 21 coverage under the Children’s Health Insurance Program for the 22 costs of prenatal care and labor and delivery for persons who: 23 (a) Are not eligible for coverage under the State Plan for 24 Medicaid because of their immigration status; and 25 (b) Would otherwise be eligible for Medicaid. 26 3. The Department shall: 27 (a) Cooperate with the Federal Government in obtaining any 28 federal authority pursuant to subsection 2; 29 (b) If the Federal Government provides the authority 30 necessary to provide the coverage described in subsection 2, take 31 any measures necessary to provide such coverage; and 32 (c) Implement the provisions of subsection 2 only to the extent 33 authorized by the Federal Government. 34 4. On or before July 1 of each even-numbered year, the 35 Department shall: 36 (a) Compile a report of the following information for each of 37 the 2 immediately preceding fiscal years: 38 (1) The number of recipients of coverage provided pursuant 39 to subsection 2 by region and county; 40 (2) The demographics of the recipients described in 41 subparagraph (1), including, without limitation, race, ethnicity, 42 primary language, gender identity or expression and age; 43 – 24 – - *SB419_R2* (3) An overview of the categories of services received by the 1 recipients described in subparagraph (1), including, without 2 limitation, primary care and specialty care; 3 (4) An estimate of the costs saved through the provision of 4 coverage pursuant to subsection 2, including, without limitation, 5 costs saved through: 6 (I) Avoiding visits to an emergency room; and 7 (II) Federal financial participation; and 8 (5) Any other data relevant to guide or provide information 9 concerning the implementation of the provisions of this section; 10 (b) Submit the report to the Director of the Legislative Counsel 11 Bureau for transmittal to the Joint Interim Standing Committee 12 on Health and Human Services; and 13 (c) Post the report on an Internet website maintained by the 14 Department. 15 Sec. 40. Chapter 422A of NRS is hereby amended by adding 16 thereto the provisions set forth as sections 41 and 42 of this act. 17 Sec. 41. 1. The Medicaid Outreach Advisory Committee is 18 hereby established within the Division of Welfare and Supportive 19 Services. 20 2. The Advisory Committee consists of such members as are 21 appointed by the Administrator. The members appointed by the 22 Administrator must be persons with experience conducting 23 outreach to persons described in subsection 1 of section 42 of this 24 act. 25 3. Except as otherwise provided in this section, the members 26 of the Advisory Committee must be appointed to terms of 4 years. 27 The terms must be staggered in such a manner that, to the extent 28 possible, the terms of one-half of the members will expire every 2 29 years. The initial members of the Advisory Committee shall, at the 30 first meeting of the board after their appointment, draw lots to 31 determine which members will initially serve terms of 2 years and 32 which will serve terms of 4 years. A member of the Advisory 33 Committee may be reappointed. 34 4. A vacancy in the membership of the Advisory Committee 35 must be filled in the same manner as the initial appointment. 36 5. The members of the Advisory Committee serve without 37 compensation and are not entitled to the per diem and travel 38 expenses provided for state officers and employees generally. 39 6. Each member of the Advisory Committee who is an officer 40 or employee of this State or a political subdivision of this State 41 must be relieved from his or her duties without loss of regular 42 compensation so that the officer or employee may prepare for and 43 attend meetings of the Advisory Committee and perform any work 44 necessary to carry out the duties of the Advisory Committee in the 45 – 25 – - *SB419_R2* most timely manner practicable. A state agency or political 1 subdivision of this State shall not require an officer or employee 2 who is a member of the Advisory Committee to make up the time 3 the officer or employee is absent from work to carry out duties as a 4 member of the Advisory Committee or use annual leave or 5 compensatory time for the absence. 6 7. The Division shall provide such administrative support to 7 the Advisory Committee as is necessary to carry out the duties of 8 the Advisory Committee. 9 8. The Advisory Committee shall: 10 (a) Annually elect a Chair from among its members; and 11 (b) Meet at least once every 3 months at the times and places 12 specified by a call of the Chair and may meet at such further times 13 as deemed necessary by the Chair. 14 9. A majority of the voting members of the Advisory 15 Committee constitutes a quorum for the transaction of business, 16 and the affirmative vote of a majority of the members of the 17 Advisory Committee is required to take action. 18 Sec. 42. 1. The Medicaid Outreach Advisory Committee 19 created by section 41 of this act shall advise the Department, the 20 Division of Health Care Financing and Policy and the Division of 21 Welfare and Supportive Services concerning outreach to, and 22 maximizing enrollment in Medicaid and the Children’s Health 23 Insurance Program of, members of marginalized or underserved 24 communities, including, without limitation: 25 (a) Racial and ethnic minorities; 26 (b) Persons who reside in rural areas; 27 (c) Persons with disabilities; 28 (d) Persons with mental illness; 29 (e) Persons with substance use disorders; 30 (f) Persons experiencing homelessness; and 31 (g) Parents or guardians of children who are persons 32 described in paragraphs (a) to (f), inclusive. 33 2. On or before July 1 of each even-numbered year, the 34 Advisory Committee shall compile a report of its activities during 35 the immediately preceding biennium and post the report on an 36 Internet website maintained by the Division. 37 Sec. 43. (Deleted by amendment.) 38 Sec. 44. NRS 603A.100 is hereby amended to read as follows: 39 603A.100 1. The provisions of NRS 603A.010 to 603A.290, 40 inclusive, do not apply to the maintenance or transmittal of 41 information in accordance with NRS 439.581 to 439.595, inclusive, 42 and section 1 of this act and the regulations adopted pursuant 43 thereto. 44 – 26 – - *SB419_R2* 2. A data collector who is also an operator, as defined in NRS 1 603A.330, shall comply with the provisions of NRS 603A.300 to 2 603A.360, inclusive. 3 3. Any waiver of the provisions of NRS 603A.010 to 4 603A.290, inclusive, is contrary to public policy, void and 5 unenforceable. 6 Sec. 45. NRS 629.051 is hereby amended to read as follows: 7 629.051 1. Except as otherwise provided in this section and 8 in regulations adopted by the State Board of Health pursuant to NRS 9 652.135 with regard to the records of a medical laboratory and 10 unless a longer period is provided by federal law, each custodian of 11 health care records shall retain the health care records of patients as 12 part of the regularly maintained records of the custodian for 5 years 13 after their receipt or production. Health care records may be retained 14 in written form, or by microfilm or any other recognized form of 15 size reduction, including, without limitation, microfiche, computer 16 disc, magnetic tape and optical disc, which does not adversely affect 17 their use for the purposes of NRS 629.061. Health care records 18 [may] : 19 (a) Must, except as otherwise provided in subsections 5 and 6 20 of NRS 439.589, be created, maintained, transmitted and 21 exchanged electronically as required by subsection 4 of NRS 22 439.589; and 23 (b) May be created, authenticated and stored in a [computer 24 system] health information exchange which meets the 25 requirements of NRS 439.581 to 439.595, inclusive, and section 1 26 of this act, and the regulations adopted pursuant thereto. 27 2. A provider of health care shall post, in a conspicuous place 28 in each location at which the provider of health care performs health 29 care services, a sign which discloses to patients that their health care 30 records may be destroyed after the period set forth in subsection 1. 31 3. When a provider of health care performs health care services 32 for a patient for the first time, the provider of health care shall 33 deliver to the patient a written statement which discloses to the 34 patient that the health care records of the patient may be destroyed 35 after the period set forth in subsection 1. 36 4. If a provider of health care fails to deliver the written 37 statement to the patient pursuant to subsection 3, the provider of 38 health care shall deliver to the patient the written statement 39 described in subsection 3 when the provider of health care next 40 performs health care services for the patient. 41 5. In addition to delivering a written statement pursuant to 42 subsection 3 or 4, a provider of health care may deliver such a 43 written statement to a patient at any other time. 44 – 27 – - *SB419_R2* 6. A written statement delivered to a patient pursuant to this 1 section may be included with other written information delivered to 2 the patient by a provider of health care. 3 7. A custodian of health care records shall not destroy the 4 health care records of a person who is less than 23 years of age on 5 the date of the proposed destruction of the records. The health care 6 records of a person who has attained the age of 23 years may be 7 destroyed in accordance with this section for those records which 8 have been retained for at least 5 years or for any longer period 9 provided by federal law. 10 8. If a health care licensing board receives notification from 11 the Department of Health and Human Services pursuant to 12 section 1 of this act that a provider of health care to which the 13 health care licensing board has issued a license is not in 14 compliance with the requirements of subsection 4 of NRS 439.589, 15 the health care licensing board may, after notice and the 16 opportunity for a hearing in accordance with the provisions of this 17 title, require corrective action or impose an administrative penalty 18 in an amount not to exceed the maximum penalty that the health 19 care licensing board is authorized to impose for other violations. 20 The health care licensing board shall not suspend or revoke a 21 license for failure to comply with the requirements of subsection 4 22 of NRS 439.589. 23 9. The provisions of this section , except for the provisions of 24 paragraph (a) of subsection 1 and subsection 8, do not apply to a 25 pharmacist. 26 [9.] 10. The State Board of Health shall adopt: 27 (a) Regulations prescribing the form, size, contents and 28 placement of the signs and written statements required pursuant to 29 this section; and 30 (b) Any other regulations necessary to carry out the provisions 31 of this section. 32 11. As used in this section: 33 (a) “Health care licensing board” means: 34 (1) A board created pursuant to chapter 630, 630A, 631, 35 632, 633, 634, 634A, 635, 636, 637, 637B, 639, 640, 640A, 640B, 36 640C, 641, 641A, 641B, 641C or 641D of NRS. 37 (2) The Division of Public and Behavioral Health of the 38 Department of Health and Human Services. 39 (3) The State Board of Health with respect to licenses 40 issued pursuant to chapter 640D or 640E of NRS. 41 (b) “License” has the meaning ascribed to it in section 1 of 42 this act. 43 – 28 – - *SB419_R2* Sec. 46. NRS 654.190 is hereby amended to read as follows: 1 654.190 1. The Board may, after notice and an opportunity 2 for a hearing as required by law, impose an administrative fine of 3 not more than $10,000 for each violation on, recover reasonable 4 investigative fees and costs incurred from, suspend, revoke, deny 5 the issuance or renewal of or place conditions on the license of, and 6 place on probation or impose any combination of the foregoing on 7 any licensee who: 8 (a) Is convicted of a felony relating to the practice of 9 administering a nursing facility or residential facility or of any 10 offense involving moral turpitude. 11 (b) Has obtained his or her license by the use of fraud or deceit. 12 (c) Violates any of the provisions of this chapter. 13 (d) Aids or abets any person in the violation of any of the 14 provisions of NRS 449.029 to 449.2428, inclusive, and section 9 of 15 this act, as those provisions pertain to a facility for skilled nursing, 16 facility for intermediate care or residential facility for groups. 17 (e) Violates any regulation of the Board prescribing additional 18 standards of conduct for licensees, including, without limitation, a 19 code of ethics. 20 (f) Engages in conduct that violates the trust of a patient or 21 resident or exploits the relationship between the licensee and the 22 patient or resident for the financial or other gain of the licensee. 23 2. If a licensee requests a hearing pursuant to subsection 1, the 24 Board shall give the licensee written notice of a hearing pursuant to 25 NRS 233B.121 and 241.034. A licensee may waive, in writing, his 26 or her right to attend the hearing. 27 3. The Board may compel the attendance of witnesses or the 28 production of documents or objects by subpoena. The Board may 29 adopt regulations that set forth a procedure pursuant to which the 30 Chair of the Board may issue subpoenas on behalf of the Board. 31 Any person who is subpoenaed pursuant to this subsection may 32 request the Board to modify the terms of the subpoena or grant 33 additional time for compliance. 34 4. An order that imposes discipline and the findings of fact and 35 conclusions of law supporting that order are public records. 36 5. The expiration of a license by operation of law or by order 37 or decision of the Board or a court, or the voluntary surrender of a 38 license, does not deprive the Board of jurisdiction to proceed with 39 any investigation of, or action or disciplinary proceeding against, the 40 licensee or to render a decision suspending or revoking the license. 41 Sec. 47. Chapter 680A of NRS is hereby amended by adding 42 thereto a new section to read as follows: 43 1. If the Commissioner receives notification from the 44 Department of Health and Human Services pursuant to section 1 45 – 29 – - *SB419_R2* of this act that an insurer is not in compliance with the 1 requirements of subsection 4 of NRS 439.589, the Commissioner 2 may, after notice and the opportunity for a hearing in accordance 3 with the provisions of this title, require corrective action or impose 4 an administrative fine in the amount prescribed by NRS 680A.200. 5 2. The Commissioner shall not suspend or revoke the 6 certificate of authority of an insurer for failure to comply with the 7 requirements of subsection 4 of NRS 439.589. 8 Sec. 48. NRS 680A.095 is hereby amended to read as follows: 9 680A.095 1. Except as otherwise provided in subsection 3, 10 an insurer which is not authorized to transact insurance in this State 11 may not transact reinsurance with a domestic insurer in this State, 12 by mail or otherwise, unless the insurer holds a certificate of 13 authority as a reinsurer in accordance with the provisions of NRS 14 680A.010 to 680A.150, inclusive, 680A.160 to 680A.280, inclusive, 15 and section 47 of this act, 680A.320 and 680A.330. 16 2. To qualify for authority only to transact reinsurance, an 17 insurer must meet the same requirements for capital and surplus as 18 are imposed on an insurer which is authorized to transact insurance 19 in this State. 20 3. This section does not apply to the joint reinsurance of title 21 insurance risks or to reciprocal insurance authorized pursuant to 22 chapter 694B of NRS. 23 Sec. 49. (Deleted by amendment.) 24 Sec. 50. Chapter 683A of NRS is hereby amended by adding 25 thereto a new section to read as follows: 26 1. If the Commissioner receives notification from the 27 Department of Health and Human Services pursuant to section 1 28 of this act that an administrator is not in compliance with the 29 requirements of subsection 4 of NRS 439.589, the Commissioner 30 may, after notice and the opportunity for a hearing in accordance 31 with the provisions of this chapter, require corrective action or 32 impose an administrative fine in the amount prescribed by 33 NRS 683A.461. 34 2. The Commissioner shall not suspend or revoke the 35 certificate of registration of an administrator for failure to comply 36 with the requirements of subsection 4 of NRS 439.589. 37 Sec. 51. NRS 683A.3683 is hereby amended to read as 38 follows: 39 683A.3683 A producer of limited lines travel insurance and 40 each travel retailer, or employee or authorized representative of a 41 travel retailer, who offers or disseminates travel insurance under the 42 license of a producer of limited lines travel insurance shall be 43 subject to the provisions of NRS 683A.451 to 683A.520, inclusive, 44 and section 50 of this act and chapter 686A of NRS. 45 – 30 – - *SB419_R2* Sec. 52. NRS 692A.270 is hereby amended to read as follows: 1 692A.270 The provisions of NRS 683A.321, 683A.331, 2 683A.341, 683A.400, 683A.451 to 683A.490, inclusive, and section 3 50 of this act and 683A.520 apply to title insurers, title agents and 4 escrow officers. 5 Sec. 53. Chapter 695C of NRS is hereby amended by adding 6 thereto a new section to read as follows: 7 1. If the Commissioner receives notification from the 8 Department of Health and Human Services pursuant to section 1 9 of this act that a health maintenance organization is not in 10 compliance with the requirements of subsection 4 of NRS 439.589, 11 the Commissioner may, after notice and the opportunity for a 12 hearing in accordance with the provisions of this chapter, require 13 corrective action or impose an administrative fine in the amount 14 prescribed by NRS 695C.350. 15 2. The Commissioner shall not suspend or revoke the 16 certificate of authority of a health maintenance organization for 17 failure to comply with the requirements of subsection 4 of 18 NRS 439.589. 19 Sec. 54. (Deleted by amendment.) 20 Sec. 54.3. (Deleted by amendment.) 21 Sec. 54.6. (Deleted by amendment.) 22 Sec. 55. NRS 719.200 is hereby amended to read as follows: 23 719.200 1. Except as otherwise provided in subsection 2, the 24 provisions of this chapter apply to electronic records and electronic 25 signatures relating to a transaction. 26 2. The provisions of this chapter do not apply to a transaction 27 to the extent it is governed by: 28 (a) Except as otherwise specifically provided by law, a law 29 governing the creation and execution of wills, codicils or 30 testamentary trusts; 31 (b) The Uniform Commercial Code other than NRS 104.1306, 32 104.2101 to 104.2725, inclusive, and 104A.2101 to 104A.2532, 33 inclusive; or 34 (c) The provisions of NRS 439.581 to 439.595, inclusive, and 35 section 1 of this act and the regulations adopted pursuant thereto. 36 3. The provisions of this chapter apply to an electronic record 37 or electronic signature otherwise excluded from the application of 38 this chapter under subsection 2 to the extent it is governed by a law 39 other than those specified in subsection 2. 40 4. A transaction subject to the provisions of this chapter is also 41 subject to other applicable substantive law. 42 Sec. 56. NRS 720.140 is hereby amended to read as follows: 43 720.140 1. Except as otherwise provided in this subsection, 44 the provisions of this chapter apply to any transaction for which a 45 – 31 – - *SB419_R2* digital signature is used to sign an electronic record. The provisions 1 of this chapter do not apply to a digital signature that is used to sign 2 an electronic health record in accordance with NRS 439.581 to 3 439.595, inclusive, and section 1 of this act and the regulations 4 adopted pursuant thereto. 5 2. As used in this section, “electronic record” has the meaning 6 ascribed to it in NRS 719.090. 7 Sec. 57. 1. There is hereby appropriated from the State 8 General Fund to the Division of Health Care Financing and Policy 9 of the Department of Health and Human Services for the purposes 10 of providing the coverage under the Children’s Health Insurance 11 Program required by section 39 of this act the following sums: 12 For the Fiscal Year 2023-2024 .................................. $224,927 13 For the Fiscal Year 2024-2025 ............................... $1,485,480 14 2. Any remaining balance of the sums appropriated by 15 subsection 1 remaining at the end of the respective fiscal years must 16 not be committed for expenditure after June 30 of the respective 17 fiscal years by the entity to which the appropriation is made or any 18 entity to which money from the appropriation is granted or 19 otherwise transferred in any manner, and any portion of the 20 appropriated money remaining must not be spent for any purpose 21 after September 20, 2024, and September 19, 2025, respectively, by 22 either the entity to which the money was appropriated or the entity 23 to which the money was subsequently granted or transferred, and 24 must be reverted to the State General Fund on or before 25 September 20, 2024, and September 19, 2025, respectively. 26 Sec. 58. 1. During the 2023-2024 interim, the Joint Interim 27 Standing Committee on Health and Human Services shall study: 28 (a) The feasibility of including in the State Plan for Medicaid 29 coverage of digital health products, including, without limitation: 30 (1) Remote patient monitoring; 31 (2) Health products that use artificial intelligence; 32 (3) Digital therapeutics; and 33 (4) Health information technology; 34 (b) Procedures for providing the coverage described in 35 paragraph (a), including, without limitation, procedures and criteria 36 for determining whether a digital health product is suitable for 37 coverage; 38 (c) Any waivers of federal law necessary to obtain federal 39 financial participation in the provision of the coverage described in 40 paragraph (a); and 41 (d) The estimated potential costs of providing the coverage 42 described in paragraph (a). 43 2. On or before February 1, 2025, the Joint Interim Standing 44 Committee on Health and Human Services shall submit a report of 45 – 32 – - *SB419_R2* its findings and any recommendations for legislation to the Director 1 of the Legislative Counsel Bureau for transmittal to the 83rd Session 2 of the Legislature. 3 3. As used in this section, “digital therapeutic” means a 4 product, device, Internet application or other technology that uses 5 software primarily to prevent, manage or treat a medical condition, 6 disease or disorder. 7 Sec. 58.5. 1. During the 2023-2024 interim, the Joint Interim 8 Standing Committee on Health and Human Services shall study: 9 (a) The feasibility of creating a natural persons index for this 10 State and the steps necessary to create such an index. The study 11 must include, without limitation, an analysis of the capabilities of 12 providers of health care in this State concerning the exchange of 13 health information. 14 (b) Procedures governing data registries and ways to streamline 15 the collection of data and reduce the burden of reporting 16 requirements applicable to providers of health care to improve 17 collaboration between providers of health care and public health 18 agencies in this State. 19 (c) The feasibility of including in the State Plan for Medicaid an 20 enhanced rate of reimbursement for providers of health care who 21 provide services in medically underserved areas and rural areas of 22 this State. The study must include, without limitation, a specific 23 determination of the feasibility of including in the State Plan an 24 enhanced rate of reimbursement for such providers for whom at 25 least half of their patients are enrolled in Medicare and Medicaid. 26 (d) Methods for increasing the amount of biotechnological and 27 medical research conducted in this State and fostering an 28 environment in this State conducive to the development of patents 29 for and the commercialization of medical and biotechnological 30 products. Methods considered by the study must include, without 31 limitation: 32 (1) Tax abatements for small and medium-sized medical and 33 biotechnology companies that start in or relocate to this State; 34 (2) Matching tax credits for investments in new medical and 35 biotechnology companies; 36 (3) The development of a public-private partnership to 37 establish a program to foster the growth of new medical and 38 biotechnology companies; 39 (4) Tax incentives for research, development and capital 40 investment in health care and biotechnology; and 41 (5) Sustainable funding models to support: 42 (I) The continued advancement of the medical sciences; 43 and 44 – 33 – - *SB419_R2* (II) Programs for developing the health care workforce 1 that are aimed at improving outcomes for patients. 2 (e) The feasibility of including in the State Plan for Medicaid a 3 program to provide services through managed care to recipients of 4 Medicaid who are aged, blind or disabled. 5 2. The study described in paragraph (e) of subsection 1 must 6 include, without limitation, the consideration at a public meeting of 7 the Committee of the feasibility of including in the State Plan for 8 Medicaid a program described in that paragraph. 9 3. On or before February 1, 2025, the Joint Interim Standing 10 Committee on Health and Human Services shall submit a report of 11 its findings and any recommendations for legislation to the Director 12 of the Legislative Counsel Bureau for transmittal to the 83rd Session 13 of the Legislature. 14 4. As used in this section: 15 (a) “Data registry” includes, without limitation: 16 (1) The system for the reporting of information on sickle cell 17 disease and its variants established pursuant to NRS 439.4976. 18 (2) The system for the reporting of information on lupus and 19 its variants established pursuant to NRS 439.4929. 20 (3) The system for the reporting of information on cancer 21 and other neoplasms established pursuant to NRS 457.230. 22 (b) “Medically underserved area” means an area designated as: 23 (1) A health professional shortage area for primary care by 24 the United States Secretary of Health and Human Services pursuant 25 to 42 U.S.C. § 254e; or 26 (2) An area with a medically underserved population by the 27 United States Secretary of Health and Human Services pursuant to 28 42 U.S.C. § 254b. 29 (c) “Natural persons index” means a database of health 30 information concerning natural persons who reside in this State to 31 be used by providers of health care and public health agencies in 32 this State to maintain and access accurate health information 33 concerning such natural persons. 34 (d) “Provider of health care” means: 35 (1) A medical facility licensed pursuant to chapter 449 of 36 NRS; 37 (2) The holder of a permit to operate an ambulance, an air 38 ambulance or a vehicle of a fire-fighting agency pursuant to chapter 39 450B of NRS; or 40 (3) A provider of health care, as defined in NRS 629.031, 41 who is licensed pursuant to title 54 of NRS. 42 Sec. 59. (Deleted by amendment.) 43 Sec. 60. 1. On or before July 1, 2023, the Director of the 44 Department shall convene an advisory group to advise the Director 45 – 34 – - *SB419_R2* of the Department in the adoption of regulations pursuant to NRS 1 439.589, as amended by section 6 of this act. The advisory group 2 shall consist of: 3 (a) The following ex officio members: 4 (1) The Director of the Department; 5 (2) The Administrator of the Division of Public and 6 Behavioral Health of the Department; 7 (3) The Administrator of the Division of Health Care 8 Financing and Policy of the Department; 9 (4) The Administrator of the Division of Welfare and 10 Supportive Services of the Department; 11 (5) The Commissioner of Insurance; 12 (6) Each district health officer appointed pursuant to NRS 13 439.368 or 439.400; 14 (7) The Executive Officer of the Public Employees’ Benefits 15 Program; and 16 (8) The Executive Director of the Silver State Health 17 Insurance Exchange; and 18 (b) The following members appointed by the Director: 19 (1) Representatives of third parties, as defined in NRS 20 439.589, as amended by section 6 of this act, that provide health 21 coverage in this State; 22 (2) Representatives of hospitals, as defined in NRS 449.012, 23 other medical facilities, as defined in NRS 449.0151, and facilities 24 for the dependent, as defined in NRS 449.0045; 25 (3) Representatives of consumers of health care; 26 (4) Representatives of labor organizations; 27 (5) Professionals in the field of information privacy and 28 security; 29 (6) Professionals in the field of health information 30 technology and the interoperability of health information; 31 (7) Representatives of community-based organizations 32 whose work relates to health information; 33 (8) Representatives of county and city health departments; 34 (9) Representatives of social services agencies; and 35 (10) Representatives of community-based organizations 36 whose work relates to social services. 37 2. Members appointed to the advisory group pursuant to 38 paragraph (b) of subsection 1 serve at the pleasure of the Director of 39 the Department. If a vacancy occurs, the Director shall appoint a 40 person similarly qualified to replace that member. 41 3. Members of the advisory group serve without compensation 42 or per diem but are entitled to receive reimbursement for travel 43 expenses in the same amount provided for state officers and 44 employees generally. 45 – 35 – - *SB419_R2* 4. The Director of the Department shall serve as the Chair of 1 the advisory group. 2 5. A majority of the voting members of the advisory group 3 constitutes a quorum for the transaction of business, and a majority 4 of the members of a quorum present at any meeting is sufficient for 5 any official action taken by the advisory group. 6 6. Each member of the advisory group who is an officer or 7 employee of this State or a political subdivision of this State must be 8 relieved from his or her duties without loss of regular compensation 9 so that the officer or employee may prepare for and attend meetings 10 of the advisory group and perform any work necessary to carry out 11 the duties of the advisory group in the most timely manner 12 practicable. A state agency or political subdivision of this State shall 13 not require an officer or employee who is a member of the advisory 14 group to make up the time the officer or employee is absent from 15 work to carry out duties as a member of the advisory group or use 16 annual leave or compensatory time for the absence. 17 7. The advisory group may establish subcommittees and 18 working groups consisting of members of the advisory group or 19 other persons to assist the advisory group in the performance of its 20 duties. 21 8. The advisory group shall advise the Department on the 22 development and implementation of the regulations adopted 23 pursuant to NRS 439.589, as amended by section 6 of this act. 24 9. The Department shall: 25 (a) On or before August 1, 2024, present at a meeting of the 26 Joint Interim Standing Committee on Health and Human Services 27 concerning the progress of the Department in developing and 28 implementing the regulations adopted pursuant to NRS 439.589, as 29 amended by section 6 of this act; and 30 (b) On or before December 31, 2024, submit to the Director of 31 the Legislative Counsel Bureau for transmittal to the 83rd Regular 32 Session of the Legislature a report concerning the progress of the 33 Department in developing and implementing the regulations adopted 34 pursuant to NRS 439.589, as amended by section 6 of this act. 35 10. As used in this section, “Department” means the 36 Department of Health and Human Services. 37 Sec. 61. (Deleted by amendment.) 38 Sec. 62. (Deleted by amendment.) 39 Sec. 63. 1. Hospitals and physician group practices with 40 more than 20 employees shall comply with the provisions of 41 subsection 4 of NRS 439.589, as amended by section 6 of this act, 42 on or before July 1, 2024. 43 2. Notwithstanding the amendatory provisions of sections 1, 6, 44 9, 17, 28, 29, 45, 47, 50 and 53 of this act: 45 – 36 – - *SB419_R2* (a) Persons and entities subject to the provisions of subsection 4 1 of NRS 439.589, as amended by section 6 of this act, other than the 2 persons and entities described in paragraph (b) of this subsection 3 and subsection 1 of this section, are not required to comply with 4 those provisions until July 1, 2025. 5 (b) Physician group practices or other business entities 6 organized for the purpose of practicing a health care profession with 7 20 or fewer employees, including, without limitation, sole 8 proprietorships, are not required to comply with the provisions of 9 subsection 4 of NRS 439.589, as amended by section 6 of this act, 10 until January 1, 2030. 11 3. As used in this section: 12 (a) “Health care profession” means any profession practiced by 13 providers of health care, as defined in NRS 629.031. 14 (b) “Hospital” has the meaning ascribed to it in NRS 449.012. 15 (c) “Physician group practice” means any business entity 16 organized for the purpose of the practice of medicine or osteopathic 17 medicine by more than one physician. 18 Sec. 64. The provisions of subsection 1 of NRS 218D.380 do 19 not apply to any provision of this act which adds or revises a 20 requirement to submit a report to the Legislature. 21 Sec. 65. The provisions of NRS 354.599 do not apply to any 22 additional expenses of a local government that are related to the 23 provisions of this act. 24 Sec. 66. (Deleted by amendment.) 25 Sec. 67. 1. This section and sections 6.5, 7 and 8 of this act 26 become effective upon passage and approval. 27 2. Sections 18, 19, 20, 30 to 38, inclusive, 40, 41, 42, 57 to 60, 28 inclusive, 64 and 66 of this act become effective on July 1, 2023. 29 3. Sections 21 to 27, inclusive, 39, 43, 54.3, 54.6 and 61 of this 30 act become effective: 31 (a) Upon passage and approval for the purpose of adopting any 32 regulations and performing any other preparatory administrative 33 tasks that are necessary to carry out the provisions of this act; and 34 (b) On January 1, 2024, for all other purposes. 35 4. Sections 1 to 4, inclusive, 5, 6, 9 to 16, inclusive, 44, 45, 46, 36 55, 56 and 63 of this act become effective: 37 (a) Upon passage and approval for the purpose of adopting any 38 regulations and performing any other preparatory administrative 39 tasks that are necessary to carry out the provisions of this act; and 40 (b) On July 1, 2024, for all other purposes. 41 5. Sections 17, 28, 29, 47 to 54, inclusive, and 65 of this act 42 become effective: 43 – 37 – - *SB419_R2* (a) Upon passage and approval for the purpose of adopting any 1 regulations and performing any other preparatory administrative 2 tasks that are necessary to carry out the provisions of this act; and 3 (b) On July 1, 2025, for all other purposes. 4 6. Sections 4.5 and 62 of this act become effective on July 1, 5 2025. 6 7. Sections 31 to 38, inclusive, of this act expire by limitation 7 on July 1, 2053. 8 8. Section 60 of this act expires by limitation on January 1, 9 2025. 10 H