AB319 - Makes revisions relating to providers of health care. (BDR 54-791)

- 83rd Session (2025) Assembly Bill No. 319–Assemblymember Orentlicher CHAPTER.......... AN ACT relating to health care; making various revisions governing the qualifications and procedure for licensure as a physician, physician assistant, practitioner of respiratory care or perfusionist; requiring screening of youth for certain health conditions when certain physical examinations are conducted; revising the authority of a practitioner of respiratory care to perform certain laboratory tests; requiring certain sharing of information between the Board of Medical Examiners and the State Board of Osteopathic Medicine; authorizing the Board of Medical Examiners to require certain competency demonstrations; eliminating certain special licenses; revising provisions related to fees owed to the Board of Medical Examiners or the State Board of Osteopathic Medicine; eliminating certain fees; revising investigation procedures and grounds for discipline against a licensee of the Board of Medical Examiners; revising requirements governing certain medical procedures; authorizing a medical assistant to perform tasks under the supervision of a registered nurse; authorizing a certified registered nurse anesthetist to perform certain tasks in certain hospitals; authorizing discipline against a registered nurse who fails to adequately supervise a medical assistant; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law provides for the licensure and regulation of physicians, physician assistants, anesthesiologist assistants, practitioners of respiratory care and perfusionists by the Board of Medical Examiners. (Chapter 630 of NRS) Sections 11 and 14 of this bill revise provisions governing examinations that are necessary for licensure as a physician. Section 14 also increases the amount of the fine that the Board may impose on an applicant for a license as a physician who submits false information in connection with the application. Section 21 of this bill requires each licensee of the Board to maintain a permanent electronic mail address for communication with the Board. Existing law prescribes separate qualifications for licensure for: (1) persons who received their medical education in the United States or Canada; and (2) persons who received their medical education in other foreign countries. (NRS 630.160, 630.170, 630.195, 630.263, 630.264, 630.265) Existing law also requires a physician to have completed certain residencies in ophthalmology in the United States or Canada in order to perform laser surgery or intense pulsed light therapy on the globe of the eye. (NRS 630.371) Sections 4, 5, 8, 14, 19, 26-28 and 64 of this bill make various changes so that persons who received their medical education in the United Kingdom, Australia or New Zealand, and other foreign countries whose standards for medical education are determined to be equivalent by the Board, are – 2 – - 83rd Session (2025) treated identically to persons who received their medical education in the United States or Canada for those purposes. Existing law requires: (1) an applicant for a license to practice medicine to hold certain certifications or have completed or be enrolled in certain progressive postgraduate education; and (2) a physician who performs certain procedures on the eye to have completed certain progressive postgraduate education in ophthalmology. (NRS 630.160, 630.371) Section 6 of this bill prescribes the manner in which the Board must determine whether postgraduate education is progressive for those purposes. Section 14 revises the amount of progressive postgraduate education that a resident physician must have completed in order to be eligible for a license. Existing law authorizes a practitioner of respiratory care to perform certain laboratory tests without obtaining certification as an assistant in a medical laboratory. (NRS 652.210) Sections 9 and 82 of this bill authorize a practitioner of respiratory care to perform certain moderate complexity tests without obtaining such certification if: (1) the practitioner of respiratory care has been trained to perform the test; and (2) the test is within the scope of practice of a practitioner of respiratory care. Sections 15, 16 and 84 of this bill revise and simplify provisions governing licensure by endorsement as a physician by: (1) eliminating expedited licensure by endorsement, except for certain persons affiliated with the Armed Forces of the United States; and (2) making certain revisions relating to the qualifications for licensure by endorsement. Sections 17, 18, 20, 23 and 30 of this bill eliminate references to a section repealed by section 84. Existing law authorizes the Board to require a licensee who has not practiced in more than 24 consecutive months to take the same examination to test competency as that given to applicants for a license. (NRS 630.257) Section 22 of this bill revises this provision to apply to inactive licensees and applicants for a license who have not actively practiced in more than 24 consecutive months. Section 22 also authorizes the Board to require such a person to demonstrate his or her competency in a manner other than by taking an examination. Sections 16, 28, 36, 40 and 41 of this bill make conforming changes to add references to those requirements where appropriate. Existing law provides for the issuance of various special licenses to practice medicine. (NRS 630.258-630.266) Section 23 removes the requirement that the Board automatically issue a special volunteer license, which authorizes certain retired physicians to continue practicing on a volunteer basis, to a person who possesses the required qualifications for such a license. Section 24 of this bill eliminates the specific statutory requirements for licensure from which a person applying for licensure as an administrative physician is exempt and instead requires the Board to adopt regulations prescribing the requirements from which such an applicant is exempt. Sections 25 and 30 of this bill eliminate a special license that allows a licensed physician of another state to come into this State to care for a specific patient in association with a physician licensed in this State. Section 25 also eliminates a restricted license for a specified period if the Board determines the applicant needs supervision or restriction. Sections 1, 25 and 30 of this bill revise the name of a special purpose license, which allows an out-of-state physician to provide certain medical services to patients in this State electronically, telephonically or by fiber optics, to instead be called a telemedicine license. Existing law establishes fees for the issuance and renewal of a license as a physician assistant or anesthesiologist assistant who is simultaneously licensed by the Board of Medical Examiners and the State Board of Osteopathic Medicine that are one-half of the amount of the standard fees for the issuance and renewal of such – 3 – - 83rd Session (2025) a license, meaning that such a person is required to pay one-half of the standard licensure fees to each of those boards. (NRS 630.268, 633.501) If a person who pays such a reduced fee to one of those boards fails to also pay the required fee to the other board within 12 months, sections 29, 31-33, 38, 42 and 76-81 of this bill require the person to pay to the board to whom the person has paid a fee the difference between the reduced fee and the standard fee. Sections 12, 13 and 73-75 of this bill require the Board of Medical Examiners and the State Board of Osteopathic Medicine to share information as necessary to enforce that requirement. Section 30 eliminates certain fees charged by the Board of Medical Examiners. Section 10 of this bill exempts certain students who engage in the supervised practice of perfusion from the requirement to be licensed by the Board of Medical Examiners. Sections 34-37 and 84 of this bill remove a requirement that an applicant for a license as a perfusionist pass an examination given by the American Board of Cardiovascular Perfusion, or its successor organization, and instead require such an applicant to be certified by that organization. Section 39 of this bill eliminates a provision prohibiting the Board from requiring a physician assistant to be certified by a nationally recognized organization for the accreditation of physician assistants to satisfy applicable continuing education requirements. Sections 40 and 41 revise the conditions under which the Board may deny an application for licensure by endorsement as a physician assistant. Section 43 of this bill eliminates certain educational qualifications for licensure as a practitioner of respiratory care. Sections 44 and 45 of this bill clarify certain grounds for discipline against a licensee of the Board. Section 45 also authorizes the Board to discipline a licensee who fails to cooperate with an investigation of the Board. Sections 46-49, 52 and 62 of this bill revise certain provisions regarding the provision to the Board of information relating to certain licensees, the examination to determine the fitness of certain licensees and the removal of limitations or suspensions of licenses to be applicable to all licensees of the Board. Section 46 provides that certain reports filed by an insurer relating to malpractice actions are public records. Section 51 of this bill provides that the Board is not required to review a complaint that is not within the jurisdiction of the Board. Existing law refers to the document that the Board files to initiate a formal disciplinary proceeding as a formal complaint. (NRS 630.311) However, existing law regarding the procedure of licensing boards generally refers to such a document as a charging document. (NRS 622A.300) Sections 3, 50, 51, 54, 56, 57 and 59 of this bill standardize terminology so that such a document is referred to as a charging document. Section 50 also requires that a charging document for charges against a physician assistant, anesthesiologist assistant, perfusionist or practitioner of respiratory care be filed by the Board. Section 57 removes a requirement that the Board hold a hearing on a report from the Attorney General that a licensee has violated certain laws prohibiting industrial insurance fraud. Section 49 instead requires the Board to treat such a report like a complaint, meaning that the Board would conduct an initial investigation before deciding whether to proceed with disciplinary proceedings. (NRS 630.311) In certain circumstances that create doubt about the fitness of a physician, physician assistant, practitioner of respiratory care or perfusionist to practice, existing law authorizes the Board to require such a licensee to undergo certain examinations to determine his or her fitness to practice. (NRS 630.318) Section 52: (1) makes this provision additionally applicable to anesthesiologist assistants; and – 4 – - 83rd Session (2025) (2) provides that the failure to submit to such an examination is grounds for the summary suspension of a license pending further disciplinary proceedings. Existing law authorizes the Board to summarily suspend a license pending further disciplinary proceedings if the Board determines that the health, safety or welfare of the public or any patient is at risk of imminent or continued harm. (NRS 630.326) Section 54: (1) additionally authorizes the Board to restrict the practice of a licensee without suspending his or her license under such circumstances; and (2) removes a requirement that the Board hold a hearing on the summary suspension of a license within 60 days after the summary suspension. Sections 55 and 61 of this bill authorize a court to stay an order of the Board suspending a license if the suspension is not a summary suspension. Section 55 also prohibits a court from staying an order of the Board summarily restricting the practice of a licensee. Section 84 eliminates a duplicative provision authorizing the summary suspension of a licensee’s authority to prescribe and dispense controlled substances for certain violations related to such prescribing and dispensing, and section 53 of this bill eliminates a reference to that provision. Section 56: (1) makes revisions relating to collaboration between the Board and other governmental entities investigating a person; and (2) authorizes the Board, with authorization from a licensee, to cooperate with the employer of a licensee or any other person or entity responsible for credentialing a licensee. Section 57 removes certain procedural requirements governing hearings conducted by the Board. Section 58 of this bill revises requirements governing service of process in proceedings before the Board. Section 59 removes a requirement that the Board allow a complainant to participate in disciplinary proceedings. Section 60 of this bill removes the ability for any person other than the respondent or a witness to be held in contempt for certain conduct in a disciplinary proceeding. Section 62 removes authorization for a person whose license has been revoked by the Board to reinstate his or her license without applying for a new license. Existing law prohibits the Board from investigating or disciplining a physician for: (1) disclosing to a governmental entity a violation of any law, rule or regulation by an applicant for a license to practice medicine or a physician; or (2) cooperating with a governmental entity that is conducting an investigation, hearing or inquiry into such a violation. (NRS 630.364) Section 63 of this bill: (1) makes this provision applicable to all licensees of the Board; and (2) requires the disclosure or cooperation to be in good faith for the immunity from investigation or discipline to apply. Existing law prohibits a physician from administering or supervising the administration of general anesthesia, moderate sedation or deep sedation: (1) in an office or facility that does not hold certain permits; or (2) outside of this State. (NRS 630.373) Section 65 of this bill makes this prohibition also applicable to: (1) physician assistants and anesthesiologist assistants; and (2) administering or supervising the administration of tumescent anesthesia, except where authorized by regulation of the Board. Sections 7, 68 and 72 of this bill require a physician, physician assistant, advanced practice registered nurse or osteopathic physician who performs a physical examination of a person who is at least 12 years of age but not more than 18 years of age to screen the person for certain health conditions. Existing law provides for the registration and regulation of certified registered nurse anes [Text truncated for display. Full text available on LegiScan.]