AB393 - Revises provisions governing hospitals. (BDR 40-839)

A.B. 393 - *AB393* ASSEMBLY BILL NO. 393–ASSEMBLYMEMBER NADEEM MARCH 11, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions governing hospitals. (BDR 40-839) FISCAL NOTE: Effect on Local Government: No. Effect on the State: No. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to health care; prohibiting a hospital or psychiatric hospital from employing a physician under certain circumstances; providing penalties for a violation of such prohibition; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law prescribes certain requirements governing the staffing of hospitals, 1 psychiatric hospitals and certain other health care facilities. (NRS 449.241- 2 449.2428) In 2010, the Attorney General issued an opinion explaining that, while it 3 is the longstanding practice in Nevada that a physician generally works as a 4 contractor for, rather than an employee of, a hospital, there is no provision of law 5 prohibiting a hospital from employing a physician. (Att’y Gen. Op. 2010-04 6 (March 5, 2010)) Section 1 of this bill expressly prohibits a hospital or psychiatric 7 hospital from employing a physician for the purpose of practicing medicine, 8 homeopathic medicine or osteopathic medicine except where expressly authorized 9 by law. 10 Existing law authorizes a county hospital or hospital district, a private nonprofit 11 medical school, a nonprofit medical research institution or certain mental health 12 facilities operated by divisions of the Department of Health and Human Services to 13 employ a physician under certain circumstances. (NRS 433.264, 433B.150, 14 450.180, 450.640, 630.365) Section 1 additionally authorizes a hospital or 15 psychiatric hospital to employ a physician: (1) who is participating in certain 16 graduate programs; or (2) if the hospital or psychiatric hospital is owned or 17 operated by the State Government. 18 Existing law exempts a medical facility from certain requirements of existing 19 law relating to the licensing and regulation of medical facilities if the facility: (1) is 20 conducted by and for the adherents of any church or religious denomination for the 21 purpose of providing care and treatment in accordance with the practices of 22 the religion of the church or denomination; or (2) is operated and maintained by the 23 – 2 – - *AB393* United States Government or an agency thereof. (NRS 449.0301) Section 2 of this 24 bill exempts these facilities from the provisions of section 1. 25 Existing law authorizes certain penalties to be imposed against certain medical 26 facilities that violate certain laws and regulations governing the operation of such 27 medical facilities. (NRS 449.160, 449.163, 449.220, 449.240) Sections 3 and 4 of 28 this bill apply these same penalties to a hospital or psychiatric hospital that violates 29 section 1. Section 3 authorizes the Division of Public and Behavioral Health of the 30 Department of Health and Human Services to suspend or revoke the license of a 31 hospital or psychiatric hospital that violates section 1. Section 4 authorizes the 32 Division to impose certain other penalties on a hospital or psychiatric hospital that 33 violates section 1, including an administrative penalty of not more than $5,000 per 34 day for each violation, together with interest at a rate not to exceed 10 percent per 35 year. 36 Sections 5-7 of this bill make conforming changes to: (1) authorize the 37 Division to bring action to enjoin any person from operating or maintaining any 38 hospital or psychiatric hospital that violates section 1; (2) requires the district 39 attorney of the county where the hospital or psychiatric hospital is located to 40 prosecute such an action upon application by the Division; and (3) apply the 41 definitions of certain terms to section 1. 42 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 449 of NRS is hereby amended by adding 1 thereto a new section to read as follows: 2 1. Except as otherwise provided in subsection 2, NRS 3 433.264, 433B.150, 450.180, 450.640 and 630.365 or any other 4 provision of law, a hospital or psychiatric hospital shall not 5 employ as an employee a physician for the purpose of engaging in 6 the practice of medicine, homeopathic medicine or osteopathic 7 medicine. 8 2. A hospital or psychiatric hospital may employ as an 9 employee a physician: 10 (a) Who is participating in a graduate program approved by 11 the Accreditation Council for Graduate Medical Education, or its 12 successor organization, for the purpose of engaging in the practice 13 of medicine, homeopathic medicine or osteopathic medicine; or 14 (b) If the hospital or psychiatric hospital is owned or operated 15 by the State Government. 16 3. As used in this section: 17 (a) “Homeopathic medicine” has the meaning ascribed to it in 18 NRS 630A.040. 19 (b) “Osteopathic medicine” has the meaning ascribed to it in 20 NRS 633.081. 21 (c) “Practice of medicine” has the meaning ascribed to it in 22 NRS 630.020. 23 – 3 – - *AB393* Sec. 2. NRS 449.0301 is hereby amended to read as follows: 1 449.0301 The provisions of NRS 449.029 to 449.2428, 2 inclusive, and section 1 of this act do not apply to: 3 1. Any facility conducted by and for the adherents of any 4 church or religious denomination for the purpose of providing 5 facilities for the care and treatment of the sick who depend solely 6 upon spiritual means through prayer for healing in the practice of 7 the religion of the church or denomination, except that such a 8 facility shall comply with all regulations relative to sanitation and 9 safety applicable to other facilities of a similar category. 10 2. Foster homes as defined in NRS 424.014. 11 3. Any medical facility, facility for the dependent or facility 12 which is otherwise required by the regulations adopted by the Board 13 pursuant to NRS 449.0303 to be licensed that is operated and 14 maintained by the United States Government or an agency thereof. 15 Sec. 3. NRS 449.160 is hereby amended to read as follows: 16 449.160 1. The Division may deny an application for a 17 license or may suspend or revoke any license issued under the 18 provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of 19 this act upon any of the following grounds: 20 (a) Violation by the applicant or the licensee of any of the 21 provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 22 section 1 of this act or 449A.100 to 449A.124, inclusive, and 23 449A.270 to 449A.286, inclusive, or of any other law of this State 24 or of the standards, rules and regulations adopted thereunder. 25 (b) Aiding, abetting or permitting the commission of any illegal 26 act. 27 (c) Conduct inimical to the public health, morals, welfare and 28 safety of the people of the State of Nevada in the maintenance and 29 operation of the premises for which a license is issued. 30 (d) Conduct or practice detrimental to the health or safety of the 31 occupants or employees of the facility. 32 (e) Failure of the applicant to obtain written approval from the 33 Director of the Department of Health and Human Services as 34 required by NRS 439A.100 or 439A.102 or as provided in any 35 regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 36 and section 1 of this act and 449.435 to 449.531, inclusive, and 37 chapter 449A of NRS if such approval is required, including, 38 without limitation, the closure or conversion of any hospital in a 39 county whose population is 100,000 or more that is owned by the 40 licensee without approval pursuant to NRS 439A.102. 41 (f) Failure to comply with the provisions of NRS 441A.315 and 42 any regulations adopted pursuant thereto or NRS 449.2486. 43 (g) Violation of the provisions of NRS 458.112. 44 – 4 – - *AB393* (h) Failure to comply with the provisions of NRS 449A.170 to 1 449A.192, inclusive, and any regulation adopted pursuant thereto. 2 (i) Violation of the provisions of NRS 629.260. 3 2. In addition to the provisions of subsection 1, the Division 4 may revoke a license to operate a facility for the dependent if, with 5 respect to that facility, the licensee that operates the facility, or an 6 agent or employee of the licensee: 7 (a) Is convicted of violating any of the provisions of 8 NRS 202.470; 9 (b) Is ordered to but fails to abate a nuisance pursuant to NRS 10 244.360, 244.3603 or 268.4124; or 11 (c) Is ordered by the appropriate governmental agency to correct 12 a violation of a building, safety or health code or regulation but fails 13 to correct the violation. 14 3. The Division shall maintain a log of any complaints that it 15 receives relating to activities for which the Division may revoke the 16 license to operate a facility for the dependent pursuant to subsection 17 2. The Division shall provide to a facility for the care of adults 18 during the day: 19 (a) A summary of a complaint against the facility if the 20 investigation of the complaint by the Division either substantiates 21 the complaint or is inconclusive; 22 (b) A report of any investigation conducted with respect to the 23 complaint; and 24 (c) A report of any disciplinary action taken against the facility. 25  The facility shall make the information available to the public 26 pursuant to NRS 449.2486. 27 4. On or before February 1 of each odd-numbered year, the 28 Division shall submit to the Director of the Legislative Counsel 29 Bureau a written report setting forth, for the previous biennium: 30 (a) Any complaints included in the log maintained by the 31 Division pursuant to subsection 3; and 32 (b) Any disciplinary actions taken by the Division pursuant to 33 subsection 2. 34 Sec. 4. NRS 449.163 is hereby amended to read as follows: 35 449.163 1. In addition to the payment of the amount required 36 by NRS 449.0308, if a medical facility, facility for the dependent or 37 facility which is required by the regulations adopted by the Board 38 pursuant to NRS 449.0303 to be licensed violates any provision 39 related to its licensure, including any provision of NRS 439B.410 or 40 449.029 to 449.2428, inclusive, and section 1 of this act or any 41 condition, standard or regulation adopted by the Board, the 42 Division, in accordance with the regulations adopted pursuant to 43 NRS 449.165, may: 44 – 5 – - *AB393* (a) Prohibit the facility from admitting any patient until it 1 determines that the facility has corrected the violation; 2 (b) Limit the occupancy of the facility to the number of beds 3 occupied when the violation occurred, until it determines that the 4 facility has corrected the violation; 5 (c) If the license of the facility limits the occupancy of the 6 facility and the facility has exceeded the approved occupancy, 7 require the facility, at its own expense, to move patients to another 8 facility that is licensed; 9 (d) Except where a greater penalty is authorized by subsection 2, 10 impose an administrative penalty of not more than $5,000 per day 11 for each violation, together with interest thereon at a rate not to 12 exceed 10 percent per annum; and 13 (e) Appoint temporary management to oversee the operation of 14 the facility and to ensure the health and safety of the patients of the 15 facility, until: 16 (1) It determines that the facility has corrected the violation 17 and has management which is capable of ensuring continued 18 compliance with the applicable statutes, conditions, standards and 19 regulations; or 20 (2) Improvements are made to correct the violation. 21 2. If an off-campus location of a hospital fails to obtain a 22 national provider identifier that is distinct from the national provider 23 identifier used by the main campus and any other off-campus 24 location of the hospital in violation of NRS 449.1818, the Division 25 may impose against the hospital an administrative penalty of not 26 more than $10,000 for each day of such failure, together with 27 interest thereon at a rate not to exceed 10 percent per annum, in 28 addition to any other action authorized by this chapter. 29 3. If the facility fails to pay any administrative penalty imposed 30 pursuant to paragraph (d) of subsection 1 or subsection 2, the 31 Division may: 32 (a) Suspend the license of the facility until the administrative 33 penalty is paid; and 34 (b) Collect court costs, reasonable attorney’s fees and other 35 costs incurred to collect the administrative penalty. 36 4. The Division may require any facility that violates any 37 provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and 38 section 1 of this act or any condition, standard or regulation adopted 39 by the Board to make any improvements necessary to correct the 40 violation. 41 5. Any money collected as administrative penalties pursuant to 42 paragraph (d) of subsection 1 or subsection 2 must be accounted for 43 separately and used to administer and carry out the provisions of 44 NRS 449.001 to 449.430, inclusive, and section 1 of this act, 45 – 6 – - *AB393* 449.435 to 449.531, inclusive, and chapter 449A of NRS to protect 1 the health, safety, well-being and property of the patients and 2 residents of facilities in accordance with applicable state and federal 3 standards or for any other purpose authorized by the Legislature. 4 Sec. 5. NRS 449.220 is hereby amended to read as follows: 5 449.220 1. The Division may bring an action in the name of 6 the State to enjoin any person, state or local government unit or 7 agency thereof from operating or maintaining any facility within the 8 meaning of NRS 449.029 to 449.2428, inclusive [:] , and section 1 9 of this act: 10 (a) Without first obtaining a license therefor; or 11 (b) After his or her license has been revoked or suspended by 12 the Division. 13 2. It is sufficient in such action to allege that the defendant did, 14 on a certain date and in a certain place, operate and maintain such a 15 facility without a license. 16 Sec. 6. NRS 449.240 is hereby amended to read as follows: 17 449.240 The district attorney of the county in which the facility 18 is located shall, upon application by the Division, institute and 19 conduct the [Text truncated for display. Full text available on LegiScan.]