As used in this chapter, unless the
context otherwise requires, the words and terms defined in NRS 439B.030
to 439B.150 , inclusive, have the meanings ascribed to
them in those sections.
(Added to NRS by 1987, 862; A 1991, 2111, 2333; 1993, 619, 620;
1999, 2238 )
“Billed charge” means the
total amount charged by a hospital for medical care provided, regardless
of the anticipated amount of net revenue to be received or the
anticipated source of payment.
(Added to NRS by 1987, 862)
“Children’s Health Insurance Program” has the meaning ascribed to it in
NRS 422.021 .
(Added to NRS by 1999, 2238 ; A 2001, 158 )
“Committee” means the
Legislative Committee on Health Care.
(Added to NRS by 1987, 863)
“Department” means the
Department of Health and Human Services.
(Added to NRS by 1987, 863)
“Director” means the Director of
the Department.
(Added to NRS by 1987, 863)
“Discharge form” means the
form hospitals are required to use to report information concerning the
discharge of patients.
(Added to NRS by 1987, 863)
1. Except as otherwise provided in subsection 2, “fiscal year”
means a period beginning on July 1 and ending on June 30 of the following
year.
2. A hospital’s “fiscal year” is the period of 12 months used by a
hospital for the purposes of accounting and the preparation of annual
budgets and financial statements.
(Added to NRS by 1987, 863)
“Health facility” has the
meaning ascribed to it in NRS 439A.015 .
(Added to NRS by 1987, 863)
“Hospital” means any facility
licensed as a medical, surgical or obstetrical hospital, or as any
combination of medical, surgical or obstetrical hospital, by the Health
Division of the Department.
(Added to NRS by 1987, 863)
“Major hospital” means a
hospital in this State which has 200 or more licensed or approved beds,
or any hospital in a group of affiliated hospitals in a county which have
a combined total of 200 or more licensed or approved beds, that is not
operated by a federal, state or local governmental agency.
(Added to NRS by 1991, 2332)
“Medicaid” means the program
established pursuant to Title XIX of the Social Security Act (42 U.S.C.
§§ 1396 et seq.) to provide assistance for part or all of the cost of
medical care rendered on behalf of indigent persons.
(Added to NRS by 1987, 863)
“Medicare” means the program of
health insurance for aged and disabled persons established pursuant to
Title XVIII of the Social Security Act (42 U.S.C. §§ 1395 et seq.).
(Added to NRS by 1987, 863)
“Net revenue” means all
revenues earned from inpatient medical care provided to patients by a
hospital.
(Added to NRS by 1987, 863)
“Practitioner” has the
meaning ascribed to it in NRS 439A.0195 .
(Added to NRS by 1987, 863)
The purposes of this chapter
are to:
1. Promote equal access to quality medical care at an affordable
cost for all residents of this State.
2. Reduce excessive billed charges and revenues generated by some
hospitals in this State in order to provide relief from excessively high
costs of medical care.
3. Provide the regulatory mechanisms necessary to ensure that the
forces of a competitive market will be able to function effectively in
the business of providing medical care in this State.
(Added to NRS by 1987, 863)
LEGISLATIVE COMMITTEE ON HEALTH CARE
1. There is hereby established a Legislative Committee on Health
Care consisting of three members of the Senate and three members of the
Assembly, appointed by the Legislative Commission. The members must be
appointed with appropriate regard for their experience with and knowledge
of matters relating to health care.
2. No member of the Committee may:
(a) Have a financial interest in a health facility in this State;
(b) Be a member of a board of directors or trustees of a health
facility in this State;
(c) Hold a position with a health facility in this State in which
the Legislator exercises control over any policies established for the
health facility; or
(d) Receive a salary or other compensation from a health facility
in this State.
3. The provisions of subsection 2 do not:
(a) Prohibit a member of the Committee from selling goods which are
not unique to the provision of health care to a health facility if the
member primarily sells such goods to persons who are not involved in the
provision of health care.
(b) Prohibit a member of the Legislature from serving as a member
of the Committee if:
(1) The financial interest, membership on the board of
directors or trustees, position held with the health facility or salary
or other compensation received would not materially affect the
independence of judgment of a reasonable person; and
(2) Serving on the Committee would not materially affect any
financial interest he has in a health facility in a manner greater than
that accruing to any other person who has a similar interest.
4. The Legislative Commission shall select the Chairman and Vice
Chairman of the Committee from among the members of the Committee. Each
such officer shall hold office for a term of 2 years commencing on July 1
of each odd-numbered year. The chairmanship of the Committee must
alternate each biennium between the houses of the Legislature.
5. Any member of the Committee who does not return to the
Legislature continues to serve until the next session of the Legislature
convenes.
6. Vacancies on the Committee must be filled in the same manner as
original appointments.
7. The Committee shall report annually to the Legislative
Commission concerning its activities and any recommendations.
(Added to NRS by 1987, 863; A 1989, 1841; 1991, 2333; 1993, 2590)
1. The members of the Committee shall meet throughout each year at
the times and places specified by a call of the Chairman or a majority of
the Committee. The Director of the Legislative Counsel Bureau or a person
he has designated shall act as the nonvoting recording Secretary. The
Committee shall prescribe regulations for its own management and
government. Four members of the Committee constitute a quorum, and a
quorum may exercise all the powers conferred on the Committee.
2. Except during a regular or special session of the Legislature,
members of the Committee are entitled to receive the compensation
provided for a majority of the members of the Legislature during the
first 60 days of the preceding regular session for each day or portion of
a day during which he attends a meeting of the Committee or is otherwise
engaged in the business of the Committee plus the per diem allowance
provided for state officers and employees generally and the travel
expenses provided pursuant to NRS 218.2207 .
3. The salaries and expenses of the Committee must be paid from
the Legislative Fund.
(Added to NRS by 1987, 864; A 1987, 1629; 1989, 1221)
The Committee may:
1. Review and evaluate the quality and effectiveness of programs
for the prevention of illness.
2. Review and compare the costs of medical care among communities
in Nevada with similar communities in other states.
3. Analyze the overall system of medical care in the State to
determine ways to coordinate the providing of services to all members of
society, avoid the duplication of services and achieve the most efficient
use of all available resources.
4. Examine the business of providing insurance, including the
development of cooperation with health maintenance organizations and
organizations which restrict the performance of medical services to
certain physicians and hospitals, and procedures to contain the costs of
these services.
5. Examine hospitals to:
(a) Increase cooperation among hospitals;
(b) Increase the use of regional medical centers; and
(c) Encourage hospitals to use medical procedures which do not
require the patient to be admitted to the hospital and to use the
resulting extra space in alternative ways.
6. Examine medical malpractice.
7. Examine the system of education to coordinate:
(a) Programs in health education, including those for the
prevention of illness and those which teach the best use of available
medical services; and
(b) The education of those who provide medical care.
8. Review competitive mechanisms to aid in the reduction of the
costs of medical care.
9. Examine the problem of providing and paying for medical care
for indigent and medically indigent persons, including medical care
provided by physicians.
10. Examine the effectiveness of any legislation enacted to
accomplish the purpose of restraining the costs of health care while
ensuring the quality of services, and its effect on the subjects listed
in subsections 1 to 9, inclusive.
11. Determine whether regulation by the State will be necessary in
the future by examining hospitals for evidence of:
(a) Degradation or discontinuation of services previously offered,
including without limitation, neonatal care, pulmonary services and
pathology services; or
(b) A change in the policy of the hospital concerning contracts,
Ê as a result of any legislation enacted to accomplish the purpose of
restraining the costs of health care while ensuring the quality of
services.
12. Study the effect of the acuity of the care provided by a
hospital upon the revenues of the hospital and upon limitations upon that
revenue.
13. Review the actions of the Director in administering the
provisions of this chapter and adopting regulations pursuant to those
provisions. The Director shall report to the Committee concerning any
regulations proposed or adopted pursuant to this chapter.
14. Identify and evaluate, with the assistance of an advisory
group, the alternatives to institutionalization for providing long-term
care, including, without limitation:
(a) An analysis of the costs of the alternatives to
institutionalization and the costs of institutionalization for persons
receiving long-term care in this state;
(b) A determination of the effects of the various methods of
providing long-term care services on the quality of life of persons
receiving those services in this state;
(c) A determination of the personnel required for each method of
providing long-term care services in this state; and
(d) A determination of the methods for funding the long-term care
services provided to all persons who are receiving or who are eligible to
receive those services in this state.
15. Evaluate, with the assistance of an advisory group, the
feasibility of obtaining a waiver from the Federal Government to
integrate and coordinate acute care services provided through Medicare
and long-term care services provided through Medicaid in this state.
16. Evaluate, with the assistance of an advisory group, the
feasibility of obtaining a waiver from the Federal Government to
eliminate the requirement that elderly persons in this state impoverish
themselves as a condition of receiving assistance for long-term care.
17. Conduct investigations and hold hearings in connection with
its review and analysis.
18. Apply for any available grants and accept any gifts, grants or
donations to aid the Committee in carrying out its duties pursuant to
this chapter.
19. Direct the Legislative Counsel Bureau to assist in its
research, investigations, review and analysis.
20. Recommend to the Legislature as a result of its review any
appropriate legislation.
(Added to NRS by 1987, 864; A 2001, 2376 )
1. As used in this section, “licensing board” means any division
or board empowered to adopt standards for licensing or registration or
for the renewal of licenses or certificates of registration pursuant to
NRS 435.3305 to 435.339 , inclusive, chapter 449 , 625A , 630 , 630A , 631 , 632 , 633 , 634 , 634A , 635 , 636 , 637 , 637A , 637B , 639 , 640 , 640A , 641 , 641A , 641B , 641C , 652 or 654 of NRS.
2. The Committee shall review each regulation that a licensing
board proposes or adopts that relates to standards for licensing or
registration or to the renewal of a license or certificate of
registration issued to a person or facility regulated by the board,
giving consideration to:
(a) Any oral or written comment made or submitted to it by members
of the public or by persons or facilities affected by the regulation;
(b) The effect of the regulation on the cost of health care in this
State;
(c) The effect of the regulation on the number of licensed or
registered persons and facilities available to provide services in this
State; and
(d) Any other related factor the Committee deems appropriate.
3. After reviewing a proposed regulation, the Committee shall
notify the agency of the opinion of the Committee regarding the
advisability of adopting or revising the proposed regulation.
4. The Committee shall recommend to the Legislature as a result of
its review of regulations pursuant to this section any appropriate
legislation.
(Added to NRS by 1991, 940; A 2003, 2008 ; 2005, 1379 )
1. In conducting the investigations and hearings of the Committee:
(a) The Secretary of the Committee, or in his absence any member of
the Committee, may administer oaths.
(b) The Secretary or Chairman of the Committee may cause the
deposition of witnesses, residing either within or outside of the State,
to be taken in the manner prescribed by rule of court for taking
depositions in civil actions in the district courts.
(c) The Chairman of the Committee may issue subpoenas to compel the
attendance of witnesses and the production of books and papers.
2. If any witness refuses to attend or testify or produce any
books and papers as required by the subpoena, the Chairman of the
Committee may report to the district court by petition, setting forth
that:
(a) Due notice has been given of the time and place of attendance
of the witness or the production of the books and papers;
(b) The witness has been subpoenaed by the Committee pursuant to
this section; and
(c) The witness has failed or refused to attend or produce the
books and papers required by the subpoena before the Committee which is
named in the subpoena, or has refused to answer questions propounded to
him,
Ê and asking for an order of the court compelling the witness to attend
and testify or produce the books and papers before the Committee.
3. Upon such petition, the court shall enter an order directing
the witness to appear before the court at a time and place to be fixed by
the court in its order, the time to be not more than 10 days from the
date of the order, and to show cause why he has not attended or testified
or produced the books or papers before the Committee. A certified copy of
the order must be served upon the witness.
4. If it appears to the court that the subpoena was regularly
issued by the Committee, the court shall enter an order that the witness
appear before the Committee at the time and place fixed in the order and
testify or produce the required books or papers. Failure to obey the
order constitutes contempt of court.
(Added to NRS by 1987, 866; A 1987, 1630)
Each witness who appears before the Committee by its order,
except a state officer or employee, is entitled to receive for his
attendance the fees and mileage provided for witnesses in civil cases in
the courts of record of this state. The fees and mileage must be audited
and paid upon the presentation of proper claims sworn to by the witness
and approved by the Secretary and Chairman of the Committee.
(Added to NRS by 1987, 866)
MAJOR HOSPITALS
1. A major hospital shall reduce or discount the total billed
charge by at least 30 percent for hospital services provided to an
inpatient who:
(a) Has no insurance or other contractual provision for the payment
of the charge by a third party;
(b) Is not eligible for coverage by a state or federal program of
public assistance that would provide for the payment of the charge; and
(c) Makes reasonable arrangements within 30 days after discharge to
pay his hospital bill.
2. A major hospital or patient who disputes the reasonableness of
arrangements made pursuant to paragraph (c) of subsection 1 may submit
the dispute to the Bureau for Hospital Patients for resolution as
provided in NRS 223.575 .
3. A major hospital shall reduce or discount the total billed
charge of its outpatient pharmacy by at least 30 percent to a patient who
is eligible for Medicare.
(Added to NRS by 1991, 2332; A 1995, 646, 2248; 2001, 2654 )
[Effective upon confirmation by
the Federal Government that the deductibles and copayments which a
hospital is prohibited from collecting from a patient pursuant to this
section are deemed uncollectible for the purposes of federal law.] A
major hospital shall not collect or seek to collect the deductible or
copayment from a patient who is covered by Medicare and who demonstrates
that he is medically indigent, as that term is defined for the purposes
of Medicaid coverage for persons in long-term care. The hospital may seek
and collect payment for the deductible or copayment from any source other
than the patient, including from the supplemental insurance of the
patient.
(Added to NRS by 1991, 2332, effective upon confirmation by the
Federal Government that the deductibles and copayments which a hospital
is prohibited from collecting from a patient pursuant to this section are
deemed uncollectible for the purposes of federal law)
1. The major hospitals shall jointly establish a foundation for
hospital nursing practice to promote and encourage the practice of
nursing in hospitals.
2. The foundation must be created as a nonprofit entity in
compliance with 26 U.S.C. § 501. The governing body of the foundation
must consist of one representative of each of the member hospitals and
one representative appointed by the Governor. The governing body must
have authority to establish rules for the administration of the
foundation, to establish programs in pursuit of its purpose, and to
allocate money for its programs.
3. If the foundation is not formed, or ceases to exist, the
Director shall establish a nonprofit entity to carry out the foundation’s
purpose.
(Added to NRS by 1991, 2332)
The major hospitals shall, in cooperation with the
Office of the Governor, the University of Nevada School of Medicine and
organizations representing rural hospitals, develop a program for the
provision of technical assistance to rural hospitals in Nevada. The
resources required to carry out this program must be determined and
provided by the major hospitals.
(Added to NRS by 1991, 2332)
The major hospitals
shall sponsor an educational program to promote wellness, physical
fitness and the prevention of disease and accidents. The program must be:
1. Administered and carried out by the participating hospitals; and
2. Approved by the Director.
(Added to NRS by 1991, 2333)
CARE OF INDIGENT PATIENTS
1. The Legislature finds and declares that:
(a) The practice of refusing to treat an indigent patient if
another hospital can provide the treatment endangers the health and
well-being of such patients.
(b) Counties in which more than one hospital is located may lack
available resources to compensate for all indigent care provided at their
hospitals. Refusal by a hospital to treat indigent patients in such
counties results in a burden upon hospitals which treat large numbers of
indigent patients.
(c) A requirement that hospitals in such counties provide a
designated amount of uncompensated care for indigent patients would:
(1) Equalize the burden on such hospitals of treating
indigent patients; and
(2) Aid the counties in meeting their obligation to
compensate hospitals for such care.
(d) Hospitals with 100 or fewer beds have been meeting the needs of
their communities with regard to care of indigents, and have a minimal
effect on the provision of such care.
2. Except as otherwise provided in this subsection, the provisions
of NRS 439B.300 to 439B.340 , inclusive, apply to each hospital in this
State which is located in a county in which there are two or more
licensed hospitals. The provisions of NRS 439B.300 to 439B.340 , inclusive, do not apply to a hospital which
has 100 or fewer beds.
3. The provisions of NRS 439B.300 to 439B.340 , inclusive, do not prohibit a county from:
(a) Entering into an agreement for medical care or otherwise
contracting with any hospital located within that county; or
(b) Using a definition of “indigent” which would include more
persons than the definition in NRS 439B.310 .
(Added to NRS by 1987, 867)
For the purposes of NRS 439B.300
to 439B.340 , inclusive, “indigent” means those persons:
1. Who are not covered by any policy of health insurance;
2. Who are ineligible for Medicare, Medicaid, the Children’s
Health Insurance Program, the benefits provided pursuant to NRS 428.115
to 428.255 , inclusive, or any other federal or state
program of public assistance covering the provision of health care;
3. Who meet the limitations imposed by the county upon assets and
other resources or potential resources; and
4. Whose income is less than:
(a) For one person living without another member of a household,
$438.
(b) For two persons, $588.
(c) For three or more persons, $588 plus $150 for each person in
the family in excess of two.
Ê For the purposes of this subsection, “income” includes the entire
income of a household and the amount which the county projects a person
or household is able to earn. “Household” is limited to a person and his
spouse, parents, children, brothers and sisters residing with him.
(Added to NRS by 1987, 868; A 1999, 2238 )
1. A hospital shall provide, without charge, in each fiscal year,
care for indigent inpatients in an amount which represents 0.6 percent of
its net revenue for the hospital’s preceding fiscal year.
2. The Department shall compute the obligation of each hospital
for care of indigent inpatients for each fiscal year based upon the net
revenue of the hospital in its preceding fiscal year and shall provide
this information to the board of county commissioners of the county in
which the hospital is located.
3. The board of county commissioners shall maintain a record of
discharge forms submitted by each hospital located within the county,
together with the amount accruing to the hospital. The amount accruing to
the hospital for the care, until the hospital has met its obligation
pursuant to this section, is the highest amount the county is paying to
any hospital in the county for that care. Except as otherwise provided in
subsection 2 of NRS 439B.330 , no
payment for indigent care may be made to the hospital until the total
amount so accruing to the hospital exceeds the minimum obligation of the
hospital for the fiscal year, and a hospital may only receive payment
from the county for indigent care provided in excess of its obligation
pursuant to this section. After a hospital has met its obligation
pursuant to this section, the county may reimburse the hospital for care
of indigent inpatients at any rate otherwise authorized by law.
(Added to NRS by 1987, 868; A 1991, 2111)
[Effective through June 30, 2007, and after that date if the
Federal Government approves the waiver applied for pursuant to NRS
422.2726 .]
1. Except as otherwise provided in this subsection, subsection 2
and NRS 439B.300 , each county shall
use the definition of “indigent” in NRS 439B.310 to determine a person’s eligibility for
medical assistance pursuant to chapter 428 of
NRS, other than assistance provided pursuant to NRS 428.115 to 428.255 ,
inclusive.
2. A board of county commissioners may, if it determines that a
hospital within the county is serving a disproportionately large share of
low-income patients:
(a) Pay a higher rate to the hospital for treatment of indigent
inpatients;
(b) Pay the hospital for treatment of indigent inpatients whom the
hospital would otherwise be required to treat without receiving
compensation from the county; or
(c) Both pay at a higher rate and pay for inpatients for whom the
hospital would otherwise be uncompensated.
3. Each hospital which treats an indigent inpatient shall submit
to the board of county commissioners of the county of residence of the
patient a discharge form identifying the patient as a possible indigent
and containing the information required by the Department and the county
to be included in all such forms.
4. The county which receives a discharge form from a hospital for
an indigent inpatient shall verify the status of the patient and the
amount which the hospital is entitled to receive. A hospital aggrieved by
a determination of a county regarding the indigent status of an inpatient
may appeal the determination to the Director or a person designated by
the Director to hear such an appeal. The decision of the Director or the
person he designates must be mailed by registered or certified mail to
the county and the hospital. The decision of the Director or the person
he designates may be appealed to a court having general jurisdiction in
the county within 15 days after the date of the postmark on the envelope
in which the decision was mailed.
5. Except as otherwise provided in subsection 2 of this section
and subsection 3 of NRS 439B.320 , if
the county is the county of residence of the patient and the patient is
indigent, the county shall pay to the hospital the amount required,
within the limits of money which may lawfully be appropriated for this
purpose pursuant to NRS 428.050 ,
428.285 and 450.425 .
6. For the purposes of this section, the county of residence of
the patient is the county of residence of that person before he was
admitted to the hospital.
(Added to NRS by 1987, 869; A 1989, 1801, 1861; 1991, 1744, 1937;
1993, 1973; 2005, 1676 )
[Effective July 1, 2007, if the Federal Government has not
approved the waiver applied for pursuant to NRS 422.2726 .]
1. Except as otherwise provided in NRS 439B.300 and subsection 2 of this section, each
county shall use the definition of “indigent” in NRS 439B.310 to determine a person’s eligibility for
medical assistance pursuant to chapter 428 of
NRS, other than assistance provided pursuant to NRS 428.115 to 428.255 ,
inclusive.
2. A board of county commissioners may, if it determines that a
hospital within the county is serving a disproportionately large share of
low-income patients:
(a) Pay a higher rate to the hospital for treatment of indigent
inpatients;
(b) Pay the hospital for treatment of indigent inpatients whom the
hospital would otherwise be required to treat without receiving
compensation from the county; or
(c) Both pay at a higher rate and pay for inpatients for whom the
hospital would otherwise be uncompensated.
3. Each hospital which treats an indigent inpatient shall submit
to the board of county commissioners of the county of residence of the
patient a discharge form identifying the patient as a possible indigent
and containing the information required by the Department and the county
to be included in all such forms.
4. The county which receives a discharge form from a hospital for
an indigent inpatient shall verify the status of the patient and the
amount which the hospital is entitled to receive. A hospital aggrieved by
a determination of a county regarding the indigent status of an inpatient
may appeal the determination to the Director or a person designated by
the Director to hear such an appeal. The decision of the Director or the
person he designates must be mailed by registered or certified mail to
the county and the hospital. The decision of the Director or the person
he designates may be appealed to a court having general jurisdiction in
the county within 15 days after the date of the postmark on the envelope
in which the decision was mailed.
5. Except as otherwise provided in subsection 2 of this section
and subsection 3 of NRS 439B.320 , if
the county is the county of residence of the patient and the patient is
indigent, the county shall pay to the hospital the amount required,
within the limits of money which may lawfully be appropriated for this
purpose pursuant to NRS 428.050 ,
428.285 and 450.425 .
6. For the purposes of this section, the county of residence of
the patient is the county of residence of that person before he was
admitted to the hospital.
(Added to NRS by 1987, 869; A 1989, 1801, 1861; 1991, 1744, 1937;
1993, 1973; 2005, 1676 , effective July 1, 2007, if the Federal
Government has not approved the waiver applied for pursuant to NRS
422.2726)
1. Before September 30 of each year, each county in which
hospitals subject to the provisions of NRS 439B.300 to 439B.340 , inclusive, are located shall provide to the
Department a report showing:
(a) The total number of inpatients treated by each such hospital
who are claimed by the hospital to be indigent;
(b) The number of such patients for whom no reimbursement was
provided by the county because of the limitation imposed by subsection 3
of NRS 439B.320 ;
(c) The total amount paid to each such hospital for treatment of
such patients; and
(d) The amount the hospital would have received for patients for
whom no reimbursement was provided.
2. The Director shall verify the amount of treatment provided to
indigent inpatients by each hospital to which no reimbursement was
provided by:
(a) Determining the number of indigent inpatients who received
treatment. For a hospital that has contracted with the Department
pursuant to subsection 4 of NRS 428.030 , the Director shall determine the number based
upon the evaluations of eligibility made by the employee assigned to the
hospital pursuant to the contract. For all other hospitals, the Director
shall determine the number based upon the report submitted pursuant to
subsection 1.
(b) Multiplying the number of indigent inpatients who received each
type of treatment by the highest amount paid by the county for that
treatment.
(c) Adding the products of the calculations made pursuant to
paragraphs (a) and (b) for all treatment provided.
Ê If the total amount of treatment provided to indigent inpatients in the
previous fiscal year by the hospital was less than its minimum obligation
for the year, the Director shall assess the hospital for the amount of
the difference between the minimum obligation and the actual amount of
treatment provided by the hospital to indigent inpatients. If a decision
of a county regarding the indigent status of one or more inpatients is
pending appeal before the Director or upon receiving satisfactory proof
from a hospital that the decision is pending appeal before a court having
general jurisdiction in the county pursuant to subsection 4 of NRS
439B.330 , the Director shall defer
assessing the hospital the amount that may be offset by the determination
on appeal until a final determination of the matter is made.
3. If the Director determines that a hospital has met its
obligation to provide treatment to indigent inpatients, he shall certify
to the county in which the hospital is located that the hospital has met
its obligation. The county is not required to pay the hospital for the
costs of treating indigent inpatients until the certification is received
from the Director. The county shall pay the hospital for such treatment
within 30 days after receipt of the certification to the extent that
money was available for payment pursuant to NRS 428.050 , 428.285 and
450.425 at the time the treatment was
provided.
4. The Director shall determine the amount of the assessment which
a hospital must pay pursuant to this section and shall notify the
hospital in writing of that amount on or before November 1 of each year.
The notice must include, but is not limited to, a written statement for
each claim which is denied indicating why the claim was denied. Payment
is due 30 days after receipt of the notice, except for assessments
deferred pursuant to subsection 2 which, if required, must be paid within
30 days after the court hearing the appeal renders its decision. If a
hospital fails to pay the assessment when it is due the hospital shall
pay, in addition to the assessment:
(a) Interest at a rate of 1 percent per month for each month after
the assessment is due in which it remains unpaid; and
(b) Any court costs and fees required by the Director to obtain
payment of the assessment and interest from the hospital.
5. Any money collected pursuant to this section must be paid to
the county in which the hospital paying the assessment is located for use
in paying other hospitals in the county for the treatment of indigent
inpatients by those hospitals. The money received by a county from
assessments made pursuant to this section does not constitute revenue
from taxes ad valorem for the purposes of NRS 354.59811 , 428.050 ,
428.285 and 450.425 , and must be excluded in determining the
maximum rate of tax authorized by those sections.
(Added to NRS by 1987, 869; A 1987, 1630; 1989, 1802, 2085; 1991,
1938, 2112; 1993, 587)
PROGRAM TO INCREASE AWARENESS OF HEALTH CARE PROGRAMS FOR CHILDREN
1. The Department shall establish a program to increase awareness
of health care programs for children and to encourage enrollment in such
programs. The program must provide for the dissemination of information
to the public relating to health care services that are available in this
state to children who are under the age of 13 years, including, without
limitation, information concerning:
(a) Federal, state and local governmental programs which provide
health care services to such children;
(b) The requirements for eligibility to participate in such
programs; and
(c) The procedures for enrolling children in such programs.
2. The information disseminated pursuant to subsection 1 must
encourage the use of the programs identified pursuant to subsection 1 and
must emphasize:
(a) The benefits of preventive health care services to the
well-being of children; and
(b) The reasons that preventive health care services are more
efficient in treating potential health care needs and are more economical
than obtaining emergency health care services which are often required
when symptoms of an illness are not promptly and properly treated.
3. The program must be designed to disseminate information using
the most effective means available to the extent possible, including,
without limitation, using:
(a) Words or graphics, or both, that promote understanding of the
information by the intended audience, considering the average level of
reading comprehension of and the language understood by the audience.
(b) Printed materials that may be displayed at or distributed to:
(1) Offices of the federal, state and local government that
have contact with parents of children who are under the age of 13 years
or direct contact with such children, or both, in the normal course of
business;
(2) Schools attended by children who are under the age of 13
years;
(3) Public libraries;
(4) Providers of health care who provide services to
children who are under the age of 13 years;
(5) Child care facilities that provide services to children
who are under the age of 13 years;
(6) Organizations that provide community-based services to
parents of children who are under the age of 13 years, or to such
children, or both; and
(7) Any other person deemed appropriate.
(c) Radio, television and other electronic means.
(Added to NRS by 1997, 1545)
1. The Director shall evaluate the effectiveness of the program
established pursuant to NRS 439B.350
annually. The evaluation must include, without limitation:
(a) Determining the total number of children under the age of 13
years who reside in this state and the number of such children who have
received health care services through a federal, state or local
governmental program during the previous year; and
(b) Measuring the effectiveness of the content, form and method of
dissemination of information through the program.
2. The Director shall make any necessary recommendations to
improve the program based upon his evaluation.
3. On or before December 31 of each year, the Director shall
provide a written report to the Interim Finance Committee concerning the
results of the evaluation and any recommendations made to improve the
program.
(Added to NRS by 1997, 1546)
The Director may, within the limits of available money, contract for
services to assist the Department in carrying out the provisions of NRS
439B.350 and 439B.360 .
(Added to NRS by 1997, 1546)
MISCELLANEOUS PROVISIONS
Each hospital in this state shall maintain and use a
uniform list of billed charges for that hospital for units of service or
goods provided to all inpatients. A hospital may not use a billed charge
for an inpatient that is different than the billed charge used for
another inpatient for the same service or goods provided. This section
does not restrict the ability of a hospital or other person to negotiate
a discounted rate from the hospital’s billed charges or to contract for a
different rate or mechanism for payment of the hospital.
(Added to NRS by 1987, 867)
1. Except as otherwise provided in subsection 4, each hospital in
this State has an obligation to provide emergency services and care,
including care provided by physicians and nurses, and to admit a patient
where appropriate, regardless of the financial status of the patient.
2. Except as otherwise provided in subsection 4, it is unlawful
for a hospital or a physician working in a hospital emergency room to:
(a) Refuse to accept or treat a patient in need of emergency
services and care; or
(b) Except when medically necessary in the judgment of the
attending physician:
(1) Transfer a patient to another hospital or health
facility unless, as documented in the patient’s records:
(I) A determination has been made that the patient is
medically fit for transfer;
(II) Consent to the transfer has been given by the
receiving physician, hospital or health facility;
(III) The patient has been provided with an
explanation of the need for the transfer; and
(IV) Consent to the transfer has been given by the
patient or his legal representative; or
(2) Provide a patient with orders for testing at another
hospital or health facility when the hospital from which the orders are
issued is capable of providing that testing.
3. A physician, hospital or other health facility which treats a
patient as a result of a violation of subsection 2 by a hospital or a
physician working in the hospital is entitled to recover from that
hospital an amount equal to three times the charges for the treatment
provided that was billed by the physician, hospital or other health
facility which provided the treatment, plus reasonable attorney’s fees
and costs.
4. This section does not prohibit the transfer of a patient from
one hospital to another:
(a) When the patient is covered by an insurance policy or other
contractual arrangement which provides for payment at the receiving
hospital;
(b) After the county responsible for payment for the care of an
indigent patient has exhausted the money which may be appropriated for
that purpose pursuant to NRS 428.050 ,
428.285 and 450.425 ; or
(c) When the hospital cannot provide the services needed by the
patient.
Ê No transfer may be made pursuant to this subsection until the patient’s
condition has been stabilized to a degree that allows the transfer
without an additional risk to the patient.
5. As used in this section:
(a) “Emergency services and care” means medical screening,
examination and evaluation by a physician or, to the extent permitted by
a specific statute, by a person under the supervision of a physician, to
determine if an emergency medical condition or active labor exists and,
if it does, the care, treatment and surgery by a physician necessary to
relieve or eliminate the emergency medical condition or active labor,
within the capability of the hospital. As used in this paragraph:
(1) “Active labor” means, in relation to childbirth, labor
that occurs when:
(I) There is inadequate time before delivery to
transfer the patient safely to another hospital; or
(II) A transfer may pose a threat to the health and
safety of the patient or the unborn child.
(2) “Emergency medical condition” means the presence of
acute symptoms of sufficient severity, including severe pain, such that
the absence of immediate medical attention could reasonably be expected
to result in:
(I) Placing the health of the patient in serious
jeopardy;
(II) Serious impairment of bodily functions; or
(III) Serious dysfunction of any bodily organ or part.
(b) “Medically fit” means that the condition of the patient has
been sufficiently stabilized so that he may be safely transported to
another hospital, or is such that, in the determination of the attending
physician, the transfer of the patient constitutes an acceptable risk.
Such a determination must be based upon the condition of the patient, the
expected benefits, if any, to the patient resulting from the transfer and
whether the risks to the patient’s health are outweighed by the expected
benefits, and must be documented in the patient’s records before the
transfer.
6. If an allegation of a violation of the provisions of subsection
2 is made against a hospital licensed pursuant to the provisions of
chapter 449 of NRS, the Health Division of
the Department shall conduct an investigation of the alleged violation.
Such a violation, in addition to any criminal penalties that may be
imposed, constitutes grounds for the denial, suspension or revocation of
such a license, or for the imposition of any sanction prescribed by NRS
449.163 .
7. If an allegation of a violation of the provisions of subsection
2 is made against:
(a) A physician licensed to practice medicine pursuant to the
provisions of chapter 630 of NRS, the Board
of Medical Examiners shall conduct an investigation of the alleged
violation. Such a violation, in addition to any criminal penalties that
may be imposed, constitutes grounds for initiating disciplinary action or
denying licensure pursuant to the provisions of subsection 3 of NRS
630.3065 .
(b) An osteopathic physician licensed to practice osteopathic
medicine pursuant to the provisions of chapter 633 of NRS, the State Board of Osteopathic Medicine
shall conduct an investigation of the alleged violation. Such a
violation, in addition to any criminal penalties that may be imposed,
constitutes grounds for initiating disciplinary action pursuant to the
provisions of subsection 1 of NRS 633.131 .
(Added to NRS by 1987, 867; A 1989, 1660; 2003, 1178 )
1. A hospital or related entity shall not establish a rental
agreement with a physician or entity that employs physicians that
requires any portion of his medical practice to be referred to the
hospital or related entity.
2. The rent required of a physician or entity which employs
physicians by a hospital or related entity must not be less than 75
percent of the rent for comparable office space leased to another
physician or other lessee in the building, or in a comparable building
owned by the hospital or entity.
3. A hospital or related entity shall not pay any portion of the
rent of a physician or entity which employs physicians within facilities
not owned or operated by the hospital or related entity, unless the
resulting rent is no lower than the highest rent for which the hospital
or related entity rents comparable office space to other physicians.
4. A health facility shall not offer any provider of medical care
any financial inducement, excluding rental agreements subject to the
provisions of subsection 2 or 3, whether in the form of immediate,
delayed, direct or indirect payment to induce the referral of a patient
or group of patients to the health facility. This subsection does not
prohibit bona fide gifts under $100, or reasonable promotional food or
entertainment.
5. The provisions of subsections 1 to 4, inclusive, do not apply
to hospitals in a county whose population is less than 50,000.
6. A hospital, if acting as a billing agent for a medical
practitioner performing services in the hospital, shall not add any
charges to the practitioner’s bill for services other than a charge
related to the cost of processing the billing.
7. A hospital or related entity shall not offer any financial
inducement to an officer, employee or agent of an insurer, a person
acting as an insurer or self-insurer or a related entity. A person shall
not accept such offers. This subsection does not prohibit bona fide gifts
of under $100 in value, or reasonable promotional food or entertainment.
8. A hospital or related entity shall not sell goods or services
to a physician unless the costs for such goods and services are at least
equal to the cost for which the hospital or related entity pays for the
goods and services.
9. Except as otherwise provided in this subsection, a practitioner
or health facility shall not refer a patient to a health facility or
service in which the referring party has a financial interest unless the
referring party first discloses the interest to the patient. This
subsection does not apply to practitioners subject to the provisions of
NRS 439B.425 .
10. The Director may, at reasonable intervals, require a hospital
or related entity or other party to an agreement to submit copies of
operative contracts subject to the provisions of this section after
notification by registered mail. The contracts must be submitted within
30 days after receipt of the notice. Contracts submitted pursuant to this
subsection are confidential, except in cases in which an action is
brought pursuant to subsection 11.
11. A person who willfully violates any provision of this section
is liable to the State of Nevada for:
(a) A civil penalty in an amount of not more than $5,000 per
occurrence, or 100 percent of the value of the illegal transaction,
whichever is greater.
(b) Any reasonable expenses incurred by the State in enforcing this
section.
Ê Any money recovered pursuant to this subsection as a civil penalty must
be deposited in a separate account in the State General Fund and used for
projects intended to benefit the residents of this State with regard to
health care. Money in the account may only be withdrawn by act of the
Legislature.
12. As used in this section, “related entity” means an affiliated
person or subsidiary as those terms are defined in NRS 439B.430 .
(Added to NRS by 1987, 870; A 1989, 1925; 1993, 2595; 2001, 1988
)
1. Except as otherwise provided in this section, a practitioner
shall not refer a patient, for a service or for goods related to health
care, to a health facility, medical laboratory, diagnostic imaging or
radiation oncology center or commercial establishment in which the
practitioner has a financial interest.
2. Subsection 1 does not apply if:
(a) The service or goods required by the patient are not otherwise
available within a 30-mile radius of the office of the practitioner;
(b) The service or goods are provided pursuant to a referral to a
practitioner who is participating in the health care plan of a health
maintenance organization that has been issued a certificate of authority
pursuant to chapter 695C of NRS;
(c) The practitioner is a member of a group practice and the
referral is made to that group practice;
(d) The referral is made to a surgical center for ambulatory
patients, as defined in NRS 449.019 ,
that is licensed pursuant to chapter 449 of
NRS;
(e) The referral is made by:
(1) A urologist for lithotripsy services; or
(2) A nephrologist for services and supplies for a renal
dialysis;
(f) The financial interest represents an investment in a
corporation that has shareholder equity of more than $100,000,000,
regardless of whether the securities of the corporation are publicly
traded; or
(g) The referral is made by a physician to a surgical hospital in
which the physician has an ownership interest and:
(1) The surgical hospital is:
(I) Located in a county whose population is less than
100,000; and
(II) Licensed pursuant to chapter 449 of NRS as a surgical hospital and not as a medical
hospital, obstetrical hospital, combined-categories hospital, general
hospital or center for the treatment of trauma;
(2) The physician making the referral:
(I) Is authorized to perform medical services and has
staff privileges at the surgical hospital; and
(II) Has disclosed his ownership interest in the
surgical hospital to the patient before making the referral;
(3) The ownership interest of the physician making the
referral pertains to the surgical hospital in its entirety and is not
limited to a department, subdivision or other portion of the hospital;
(4) Every physician who has an ownership interest in the
surgical hospital has agreed to treat patients receiving benefits
pursuant to Medicaid and Medicare;
(5) The terms of investment of each physician who has an
ownership interest in the surgical hospital are not related to the volume
or value of any referrals made by that physician;
(6) The payments received by each investor in the surgical
hospital as a return on his investment are directly proportional to the
relative amount of capital invested or shares owned by the investor in
the hospital;
(7) None of the investors in the surgical hospital has
received any financial assistance from the hospital or any other investor
in the hospital for the purpose of investing in the hospital; and
(8) Either:
(I) The governing body of every other hospital that
regularly provides surgical services to residents of the county in which
the surgical hospital is located has issued its written general consent
to the referral by such physicians of patients to that surgical hospital;
or
(II) The board of county commissioners of the county
in which the surgical hospital is located has issued a written
declaration of its reasonable belief that the referral by such physicians
of patients to that surgical hospital will not, during the 5-year period
immediately following the commencement of such referrals, have a
substantial adverse financial effect on any other hospital that regularly
provides surgical services to residents of that county.
3. A person who violates the provisions of this section is guilty
of a misdemeanor.
4. The provisions of this section do not prohibit a practitioner
from owning and using equipment in his office solely to provide to his
patients services or goods related to health care.
5. As used in this section:
(a) “Group practice” means two or more practitioners who organized
as a business entity in accordance with the laws of this state to provide
services related to health care, if:
(1) Each member of the group practice provides substantially
all of the services related to health care that he routinely provides,
including, without limitation, medical care, consultations, diagnoses and
treatment, through the joint use of shared offices, facilities, equipment
and personnel located at any site of the group practice;
(2) Substantially all of the services related to health care
that are provided by the members of the group practice are provided
through the group practice; and
(3) No member of the group practice receives compensation
based directly on the volume of any services or goods related to health
care which are referred to the group practice by that member.
(b) “Patient” means a person who consults with or is examined or
interviewed by a practitioner or health facility for purposes of
diagnosis or treatment.
(c) “Substantial adverse financial effect” includes, without
limitation, a projected decline in the revenue of a hospital as a result
of the loss of its surgical business, which is sufficient to cause a
deficit in any cash balances, fund balances or retained earnings of the
hospital.
(Added to NRS by 1993, 2594; A 1995, 1489; 2001, 1072 )
1. For the purposes of this section:
(a) An “affiliated person” is a person controlled by any
combination of the hospital, the parent corporation, a subsidiary or the
principal stockholders or officers or directors of any of the foregoing.
(b) A “subsidiary” is a person of which either the hospital and the
parent corporation or the hospital or the parent corporation holds
practical control.
2. No hospital may engage in any transaction or agreement with its
parent corporation, or with any subsidiary or affiliated person which
will result or has resulted in:
(a) Substitution contrary to the interest of the hospital and
through any method of any asset of the hospital with an asset or assets
of inferior quality or lower fair market value;
(b) Deception as to the true operating results of the hospital;
(c) Deception as to the true financial condition of the hospital;
(d) Allocation to the hospital of a proportion of the expense of
combined facilities or operations which is unfavorable to the hospital;
(e) Unfair or excessive charges against the hospital for services,
facilities or supplies;
(f) Unfair and inadequate charges by the hospital for services,
facilities or supplies furnished by the hospital to others; or
(g) Payment by the hospital for services, facilities or supplies
not reasonably needed by the hospital.
3. If the Director has reasonable cause to believe that a
violation of subsection 2 has occurred, he may conduct an examination of
any books and records of the hospital, parent corporation, subsidiary or
affiliated person which he deems pertinent to the examination. The
Director has the same authority to examine the parent corporation,
subsidiary or affiliated person and recover the cost of the examination
as he has with regard to the hospital. A parent corporation, subsidiary
or affiliated person which refuses to permit the examination of its books
and records is subject to the fine provided for in subsection 4 for each
day that access to the books or records is restricted.
4. If a hospital, parent corporation, subsidiary or affiliated
person is found, after notice and a hearing, to have violated the
provisions of this section, the Director may impose an administrative
fine of not more than $20,000 for each violation or the actual amount of
damage caused by the violation, whichever is greater.
5. Upon a second or subsequent violation of the provisions of this
section, the Director may commence a legal action in the district court
of any county to secure an injunction against further violations of this
section.
(Added to NRS by 1987, 872)
1. The Director may by regulation require hospitals, other health
facilities and providers of health services to submit such information as
is reasonably necessary for the Director to carry out the provisions of
this chapter.
2. Except as otherwise provided in subsection 3, the Director
shall by regulation require an examination of a hospital by an
independent auditor appointed by the Director to ensure compliance with
this chapter. The audits must be scheduled on a regular basis but not
more often than once each year. The hospital shall pay the costs of the
audit. A hospital may contract with the auditor to conduct other work for
the hospital in connection with the audit.
3. The Director shall not require an audit of a hospital which has
less than 100 beds or is subject to the provisions of chapter 450 of NRS. The Director shall by regulation require
such a hospital to submit audits of the hospital on a regular basis but
not more often than once each year.
4. If a hospital fails to comply with any regulation adopted
pursuant to this section or the Director has reason to believe the
hospital has violated any provision of this chapter, the Director may
conduct an examination or contract for an independent examination of the
hospital to determine whether it is in compliance with those provisions.
The hospital which is the subject of such an examination is responsible
for payment of the costs of the examination if the Director determines
that the hospital did violate a provision of this chapter.
5. Any person who fails to submit information as required by any
regulation adopted pursuant to this chapter to the Department or fails to
submit to an audit or examination pursuant to this section is subject to
an administrative fine of not more than $1,000 per violation per day
until the required information is submitted or the person submits to the
audit or examination.
(Added to NRS by 1987, 872; A 1991, 2113; 2005, 1736 )
The Director:
1. May adopt such regulations as are necessary to carry out the
provisions of this chapter.
2. Shall ensure that the administration of this chapter does not
cause the State to fail to comply with the requirements of the Federal
Government concerning Medicare and Medicaid.
(Added to NRS by 1987, 873)
The Director may delegate:
1. Any of his powers or duties pursuant to this chapter to the
Administrator of the Division of Health Care Financing and Policy of the
Department.
2. Any of the Department’s powers or duties pursuant to this
chapter to the Division of Health Care Financing and Policy.
(Added to NRS by 1997, 2632; A 1999, 2242 )
In addition to any
civil or administrative penalty specifically provided in this chapter,
any person who violates a provision of this chapter shall be punished by
a fine of not more than $5,000 for each violation.
(Added to NRS by 1987, 873)—(Substituted in revision for part of
NRS 439B.450)
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