AB360 - Revises provisions relating to testing for sexually transmitted diseases. (BDR 40-745)

- 83rd Session (2025) Assembly Bill No. 360–Assemblymember Goulding CHAPTER.......... AN ACT relating to health care; requiring certain physician assistants and advanced practice registered nurses to examine pregnant women for the discovery of syphilis; requiring the use of a rapid or point-of-care test when testing certain pregnant women for syphilis in certain circumstances; requiring certain medical facilities to develop a policy to ensure compliance with such requirements; exempting certain medical facilities from requirements relating to testing for syphilis; authorizing the discipline of certain health care facilities that violate such requirements; requiring Medicaid to reimburse for rapid or point-of-care testing for syphilis performed under certain circumstances separately from reimbursement for other prenatal care; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires every physician attending a pregnant woman during gestation to make an examination for the discovery of syphilis. Existing law also requires any medical facility, other than a hospital, and an emergency department or labor and delivery unit in a hospital that is evaluating or treating a pregnant woman to test the pregnant woman for syphilis using a standard serological test, unless the pregnant woman refuses the test or indicates that she has already had the prenatal screenings and tests recommended by the American College of Obstetricians and Gynecologists. Existing law requires such a physician or facility to treat a patient who tests positive for syphilis or to refer the patient for such treatment, except where the patient refuses treatment. (NRS 442.010) Section 1 of this bill additionally requires a physician assistant or advanced practice registered nurse to make an examination for the discovery of syphilis when attending a pregnant woman during gestation. Section 1 requires certain medical facilities, other than a hospital, and an emergency department or labor unit of a hospital to test a pregnant woman who has not received any prenatal screenings and tests for syphilis, and who does not refuse testing, using a rapid or point-of-care test instead of a standard serological test unless the results of a serological test are likely to be available before the woman is discharged or otherwise leaves the facility. Section 1 requires such a facility to perform a serological test if a woman indicates she has a history of syphilis or refer the woman for such a test. Section 1: (1) clarifies that such a facility must perform a test for syphilis on a pregnant woman, unless the woman refuses the test, regardless of the reason the woman is seeking treatment at the facility; and (2) requires any such refusal to be documented. Section 1 further requires such a facility to develop a policy to ensure compliance with such testing requirements and certain recommendations by the American College of Obstetricians and Gynecologists or its successor organization. Section 1 additionally exempts rural clinics that are owned, operated or administered by certain governmental entities from certain requirements governing testing for syphilis. Additionally, certain public and private policies of health insurance, including Medicaid, would be required to cover rapid or point-of-care testing for syphilis – 2 – - 83rd Session (2025) performed under the conditions required by section 1. (NRS 287.010, 287.04335, 422.27173, 689A.0412, 689B.0315, 689C.1675, 698C.425, 695A.1856, 695B.1913, 695C.050, 695C.1737, 695G.1714) Section 3.5 of this bill requires Medicaid, to the extent federal financial participation is available, to reimburse such testing for syphilis separately from the other prenatal care the pregnant woman received at the time of the testing. Sections 2 and 3 of this bill authorize the Division of Public and Behavioral Health of the Department of Health and Human Services to discipline a medical facility for a violation of section 1. EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. NRS 442.010 is hereby amended to read as follows: 442.010 1. Except as otherwise provided in [subsection 6,] subsections 7 and 9, every: (a) Physician , physician assistant or advanced practice registered nurse attending a pregnant woman during gestation for conditions relating to her pregnancy shall make an examination, including a standard serological test, for the discovery of syphilis. The physician , physician assistant or advanced practice registered nurse shall take or cause to be taken a sample of blood of the woman at the times prescribed by subsection 2, if applicable, and shall submit the sample to a laboratory licensed pursuant to chapter 652 of NRS for a standard serological test for syphilis. (b) Person permitted by law to attend upon pregnant women, but not permitted by law to make blood tests in Nevada, shall cause a sample of the blood of the pregnant woman to be taken at the times prescribed by subsection 2, if applicable, by a duly licensed physician , physician assistant or advanced practice registered nurse and submitted to a laboratory licensed pursuant to chapter 652 of NRS for a standard serological test for syphilis. (c) Non-hospital medical facility or emergency department or labor and delivery unit in a hospital that evaluates or treats a woman of childbearing age for any reason shall ensure that: (1) The woman is asked if she is pregnant and, if she responds in the affirmative, whether she has [had the] received any prenatal care, including, without limitation, any prenatal screenings and tests ; [recommended by the American College of Obstetricians and Gynecologists or its successor organization;] and (2) An examination is made, including [a standard serological test,] the performance of: – 3 – - 83rd Session (2025) (I) A test for the discovery of syphilis [,] in accordance with subsection 3 if the woman indicates that she is pregnant , [and has not had the prenatal screenings and tests recommended by the American College of Obstetricians and Gynecologists or its successor organization. The non-hospital medical facility, emergency department or labor and delivery unit shall ensure that a sample of blood of the woman is taken at the times prescribed by subsection 2, if applicable, and shall ensure the submission of the sample to a laboratory licensed pursuant to chapter 652 of NRS for a standard serological test for] has no history of syphilis and has not been tested for syphilis within the immediately preceding 3 months; or (II) A serological test or a referral for the performance of a serological test if the woman indicates that she has a history of syphilis. 2. An examination for the discovery of syphilis pursuant to paragraphs (a) and (b) of subsection 1 must be performed: (a) [During the first trimester of pregnancy at] At the first visit to a physician , physician assistant or advanced practice registered nurse or other person permitted by law to attend upon pregnant women, a non-hospital medical facility or an emergency department or labor and delivery unit of a hospital during a pregnancy or as soon thereafter as practicable; (b) During the third trimester of pregnancy between the 27th and 36th week of gestation or as soon thereafter as practicable; and (c) At delivery for a pregnant woman who: (1) Should be routinely tested for infection with syphilis, as recommended by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services; (2) Lives in an area designated by the Division as having high syphilis morbidity; (3) Did not receive prenatal care; or (4) Delivers a stillborn infant after 20 weeks of gestation. 3. For the purposes of sub-subparagraph (I) of subparagraph (2) of paragraph (c) of subsection 1, a non-hospital medical facility or emergency department or labor and delivery unit of a hospital may use: (a) A rapid or point-of-care test; or (b) A serological test only if the facility performing the test reasonably believes it is able to obtain the results of the serological test before the woman is discharged from or otherwise leaves the facility. – 4 – - 83rd Session (2025) 4. A qualified serological , rapid or point-of-care test for syphilis is one recognized as such by the State Board of Health. [4.] 5. If the test is made in a state laboratory, it must be made without charge. [5.] 6. If a serological , rapid, point-of-care or physical examination test performed pursuant to subsection 1 shows that a pregnant woman is infected with syphilis, the physician, physician assistant, advanced practice registered nurse, other person, non- hospital medical facility, emergency department or labor and delivery unit shall: (a) If the physician, physician assistant, advanced practice registered nurse, other person, non-hospital medical facility, emergency department or labor and delivery unit is capable of providing treatment for syphilis, seek the consent of the pregnant woman to begin such treatment and, if such consent is obtained, commence treatment; or (b) If the physician, physician assistant, advanced practice registered nurse, other person, non-hospital medical facility, emergency department or labor and delivery unit is not capable of providing treatment for syphilis, seek the consent of the pregnant woman to refer her for such treatment and, if such consent is obtained, issue the referral. [6.] 7. If the pregnant woman objects to the taking of the sample of blood or the serological , rapid or point-of-care test [, the] : (a) The sample must not be taken and the test must not be performed [.] ; and (b) The provider of health care attending to the woman shall ensure that any refusal is documented in her medical records. 8. Except as otherwise provided in subsection 9, a non- hospital medical facility and a hospital with an emergency department or labor and delivery unit shall develop a policy to ensure compliance with this section and recommendations of the American College of Obstetricians and Gynecologists, or its successor organization, to the extent that those recommendations do not conflict with this section, concerning best practices for prenatal screenings and tests. The policy must include, without limitation, procedures: (a) For documenting refusals to any service or testing offered by the non-hospital medical facility, emergency department or labor and delivery unit; and (b) To ensure compliance with NRS 441A.150. – 5 – - 83rd Session (2025) 9. A rural clinic that is owned, operated or administered by the Department or any political subdivision of this State, including, without limitation, a city, county, city board of health, county board of health or district board of health, is exempt from the requirements of paragraph (c) of subsection 1 and subsection 8. [7.] 10. As used in this section, “non-hospital medical facility” means: (a) A freestanding birthing center; (b) An independent center for emergency medical care, as defined in NRS 449.013; (c) A psychiatric hospital, as defined in NRS 449.0165; (d) A rural clinic, as defined in NRS 449.0175; (e) A facility for modified medical detoxification, as defined in NRS 449.00385; (f) A mobile unit, as defined in NRS 449.01515; and (g) A community triage center, as defined in NRS 449.0031. Sec. 2. NRS 449.160 is hereby amended to read as follows: 449.160 1. The Division may deny an application for a license or may suspend or revoke any license issued under the provisions of NRS 449.029 to 449.2428, inclusive, upon any of the following grounds: (a) Violation by the applicant or the licensee of any of the provisions of NRS 439B.410, 442.010, 449.029 to 449.245, inclusive, or 449A.100 to 449A.124, inclusive, and 449A.270 to 449A.286, inclusive, or of any other law of this State or of the standards, rules and regulations adopted thereunder. (b) Aiding, abetting or permitting the commission of any illegal act. (c) Conduct inimical to the public health, morals, welfare and safety of the people of the State of Nevada in the maintenance and operation of the premises for which a license is issued. (d) Conduct or practice detrimental to the health or safety of the occupants or employees of the facility. (e) Failure of the applicant to obtain written approval from the Director of the Department of Health and Human Services as required by NRS 439A.100 or 439A.102 or as provided in any regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such approval is required, including, without limitation, the closure or conversion of any hospital in a county whose population is 100,000 or more that is owned by the licensee without approval pursuant to NRS 439A.102. – 6 – - 83rd Session (2025) (f) Failure to comply with the provisions of NRS 441A.315 and any regulations adopted pursuant thereto or NRS 449.2486. (g) Violation of the provisions of NRS 458.112. (h) Failure to comply with the provisions of NRS 449A.170 to 449A.192, inclusive, and any regulation adopted pursuant thereto. (i) Violation of the provisions of NRS 629.260. 2. In addition to the provisions of subsection 1, the Division may revoke a license to operate a facility for the dependent if, with respect to that facility, the licensee that operates the facility, or an agent or employee of the licensee: (a) Is convicted of violating any of the provisions of NRS 202.470; (b) Is ordered to but fails to abate a nuisance pursuant to NRS 244.360, 244.3603 or 268.4124; or (c) Is ordered by the appropriate governmental agency to correct a violation of a building, safety or health code or regulation but fails to correct the violation. 3. The Division shall maintain a log of any complaints that it receives relating to activities for which the Division may revoke the license to operate a facility for the dependent pursuant to subsection 2. The Division shall provide to a facility for the care of adults during the day: (a) A summary of a complaint against the facility if the investigation of the complaint by the Division either substantiates the complaint or is inconclusive; (b) A report of any investigation conducted with respect to the complaint; and (c) A report of any disciplinary action taken against the facility.  The facility [Text truncated for display. Full text available on LegiScan.]