AB438 - Revises provisions relating to nonemergency medical transportation. (BDR 40-1042)

A.B. 438 - *AB438* ASSEMBLY BILL NO. 438–ASSEMBLYMEMBERS DICKMAN; GALLANT, GRAY, GURR AND O’NEILL MARCH 17, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to nonemergency medical transportation. (BDR 40-1042) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. CONTAINS UNFUNDED MANDATE (§§ 8, 9, 12) (NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT) ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to health care; transferring regulation of nonemergency medical transportation from the Nevada Transportation Authority to certain health authorities; exempting certain operators of a vehicle for nonemergency medical transportation from the requirement to be permitted; requiring the driver of a vehicle for nonemergency medical transportation to report the abuse, neglect, isolation, abandonment or commercial sexual exploitation of certain persons; providing a penalty; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires the Nevada Transportation Authority to supervise and 1 regulate common motor carriers of passengers and contract motor carriers of 2 passengers, including private providers of nonmedical emergency transportation, 3 while exempting government vehicles from such regulation. (NRS 706.163, 4 706.166) Existing law requires a private provider of nonemergency medical 5 transportation to obtain from the Authority a certificate of public convenience and 6 necessity to operate as a common motor carrier or a permit to act as a contract 7 motor carrier. (NRS 706.036, 706.051, 706.386, 706.421) 8 Existing law also requires the Division of Public and Behavioral Health of the 9 Department of Health and Human Services, in a county whose population is less 10 than 700,000 (currently all counties other than Clark County), or the district board 11 of health, in a county whose population is 700,000 or more (currently Clark 12 County), to issue permits for the operation of an ambulance, an air ambulance or a 13 – 2 – - *AB438* vehicle of a fire-fighting agency. (NRS 450B.100, 450B.200) Existing law also 14 requires the State Board of Health, in a county whose population is less than 15 700,000 (currently all counties other than Clark County), or the district board of 16 health, in a county whose population is 700,000 or more (currently Clark County), 17 to adopt regulations establishing minimum standards for vehicles for ambulances, 18 air ambulances and vehicles of a fire-fighting agency. (NRS 450B.130) 19 This bill transfers regulatory authority over providers of nonemergency medical 20 transportation from the Nevada Transportation Authority to: (1) the district board of 21 health in a county whose population is 700,000 or more (currently Clark County); 22 or (2) the Division in all other counties. Section 24 of this bill removes the 23 requirement that a private operator of a vehicle for nonemergency medical 24 transportation obtain a certificate or permit from the Nevada Transportation 25 Authority, and section 16 of this bill instead requires a private operator of such a 26 vehicle to obtain a permit from the district board of health or the Division, as 27 applicable. Sections 8 and 12 of this bill accordingly authorize the operator of such 28 a vehicle to obtain such a permit. Section 12 additionally limits the fee for such a 29 permit to not more than $200. Section 13 of this bill clarifies the scope of a 30 provisional permit to own or operate a vehicle for nonemergency medical 31 transportation services. Sections 9 and 10 of this bill authorize: (1) the district 32 board of health to regulate nonemergency medical transportation in a county whose 33 population is 700,000 or more (currently Clark County); and (2) the State Board of 34 Health to regulate nonemergency medical transportation in all other counties. 35 Section 1 of this bill makes a conforming change to clarify that the district health 36 department in a county whose population is less than 700,000 (currently all 37 counties other than Clark County) will not be regulating nonemergency medical 38 transportation. Section 14 of this bill prohibits a private owner of a vehicle for 39 nonemergency medical transportation to permit the operation of the vehicle in 40 violation of the standards prescribed by the applicable board. Section 15 of this bill 41 requires a provider of nonemergency medical transportation to file his or her 42 schedule of rates with the Division or district board of health, as applicable. 43 Sections 12 and 17 of this bill clarify that the issuance of a permit does not exempt 44 a provider of nonemergency medical transportation from local franchising and 45 permitting requirements. Section 5 of this bill defines the term “nonemergency 46 medical transportation,” and section 7 of this bill establishes the applicability of 47 that definition. Section 18 of this bill preserves the existing exemption for 48 governmental entities that provide nonemergency medical transportation from 49 permitting and regulation. Sections 19 and 20 of this bill require the driver of a 50 vehicle for nonemergency medical transportation to report the abuse, neglect, 51 isolation or abandonment of an elderly or vulnerable person or the abuse or neglect 52 of a child. Such a driver would also be required to report the commercial sexual 53 exploitation of a child. (NRS 432C.110) A willful failure to make such a report 54 would be a misdemeanor or gross misdemeanor, depending on the circumstances. 55 (NRS 200.5093, 432B.240, 432C.110) 56 Existing law exempts from certification by the Nevada Transportation 57 Authority a common motor carrier that enters into an agreement with certain local 58 governmental entities to provide nonemergency medical transportation to facilitate 59 the participation of certain persons in jobs and day training services under certain 60 conditions. (NRS 706.745) Section 6 of this bill preserves that exemption from 61 permitting under the same conditions. Sections 2, 3, 20 and 21 of this bill make 62 conforming changes to reflect that nonemergency medical transportation will now 63 be regulated by the Division and the State Board of Health or the district board of 64 health rather than the Nevada Transportation Authority. Sections 11 and 23 of this 65 bill make conforming changes to avoid granting new authority to providers of 66 nonemergency medical transportation. 67 – 3 – - *AB438* THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. NRS 439.410 is hereby amended to read as follows: 1 439.410 1. The district board of health has the powers, duties 2 and authority of a county board of health in the health district. 3 2. The district health department has jurisdiction over all public 4 health matters in the health district, except in matters concerning 5 emergency medical services and nonemergency medical 6 transportation services pursuant to the provisions of chapter 450B 7 of NRS. 8 3. In addition to any other powers, duties and authority 9 conferred on a district board of health by this section, the district 10 board of health may by affirmative vote of a majority of all the 11 members of the board adopt regulations consistent with law, which 12 must take effect immediately on their approval by the State Board of 13 Health, to: 14 (a) Prevent and control nuisances; 15 (b) Regulate sanitation and sanitary practices in the interests of 16 the public health; 17 (c) Provide for the sanitary protection of water and food 18 supplies; and 19 (d) Protect and promote the public health generally in the 20 geographical area subject to the jurisdiction of the health district. 21 4. Before the adoption, amendment or repeal of a regulation, 22 the district board of health must give at least 30 days’ notice of its 23 intended action. The notice must: 24 (a) Include a statement of either the terms or substance of the 25 proposal or a description of the subjects and issues involved, and of 26 the time when, the place where and the manner in which interested 27 persons may present their views thereon. 28 (b) State each address at which the text of the proposal may be 29 inspected and copied. 30 (c) Be mailed to all persons who have requested in writing that 31 they be placed on a mailing list, which must be kept by the district 32 board for such purpose. 33 5. All interested persons must be afforded a reasonable 34 opportunity to submit data, views or arguments, orally or in writing, 35 on the intended action to adopt, amend or repeal the regulation. 36 With respect to substantive regulations, the district board shall set a 37 time and place for an oral public hearing, but if no one appears who 38 will be directly affected by the proposal and requests an oral 39 hearing, the district board may proceed immediately to act upon any 40 written submissions. The district board shall consider fully all 41 written and oral submissions respecting the proposal. 42 – 4 – - *AB438* 6. Each district board of health shall file a copy of all of its 1 adopted regulations with the county clerk of each county in which it 2 has jurisdiction. 3 Sec. 2. NRS 441A.560 is hereby amended to read as follows: 4 441A.560 1. An application to a health authority for an order 5 of emergency isolation or quarantine of a person or a group of 6 persons alleged to have been infected with or exposed to a 7 communicable disease may only be made by another health 8 authority, a physician, a physician assistant licensed pursuant to 9 chapter 630 or 633 of NRS, a registered nurse or a medical facility 10 by submitting the certificate required by NRS 441A.570. Within its 11 jurisdiction, upon application or on its own, subject to the provisions 12 of NRS 441A.505 to 441A.720, inclusive, a health authority may: 13 (a) Pursuant to its own order and without a warrant: 14 (1) Take a person or group of persons alleged to and 15 reasonably believed by the health authority to have been infected 16 with or exposed to a communicable disease into custody in any safe 17 location under emergency isolation or quarantine for testing, 18 examination, observation and the provision of or arrangement for 19 the provision of consensual medical treatment; and 20 (2) Transport the person or group of persons alleged to and 21 reasonably believed by the health authority to have been infected 22 with or exposed to a communicable disease to a public or private 23 medical facility, a residence or other safe location for that purpose, 24 or arrange for the person or group of persons to be transported for 25 that purpose by: 26 (I) A local law enforcement agency; 27 (II) A [system] vehicle for [the] nonemergency medical 28 transportation [of persons whose operation is authorized by the 29 Nevada Transportation Authority;] operated by a person who holds 30 a permit issued pursuant to the provisions of chapter 450B of 31 NRS; or 32 (III) If medically necessary, an ambulance service that 33 holds a permit issued pursuant to the provisions of chapter 450B of 34 NRS, 35  only if the health authority acting in good faith has, based upon 36 personal observation, its own epidemiological investigation or an 37 epidemiological investigation by another health authority, a 38 physician, a physician assistant licensed pursuant to chapter 630 or 39 633 of NRS or a registered nurse as stated in a certificate submitted 40 pursuant to NRS 441A.570, if such a certificate was submitted, of 41 the person or group of persons alleged to have been infected with or 42 exposed to a communicable disease, a reasonable factual and 43 medical basis to believe that the person or group of persons has been 44 infected with or exposed to a communicable disease, and that 45 – 5 – - *AB438* because of the risks of that disease, the person or group of persons is 1 likely to be an immediate threat to the health of members of the 2 public who have not been infected with or exposed to the 3 communicable disease. 4 (b) Petition a district court for an emergency order requiring: 5 (1) Any health authority or peace officer to take a person or 6 group of persons alleged to have been infected with or exposed to a 7 communicable disease into custody to allow the health authority to 8 investigate, file and prosecute a petition for the involuntary court- 9 ordered isolation or quarantine of the person or group of persons 10 alleged to have been infected with or exposed to a communicable 11 disease in the manner set forth in NRS 441A.505 to 441A.720, 12 inclusive; and 13 (2) Any agency, [system] vehicle or service described in 14 subparagraph (2) of paragraph (a) to transport, in accordance with 15 such court order, the person or group of persons alleged to have 16 been infected with or exposed to a communicable disease to a public 17 or private medical facility, a residence or other safe location for that 18 purpose. 19 2. The district court may issue an emergency order for isolation 20 or quarantine pursuant to paragraph (b) of subsection 1: 21 (a) Only for the time deemed necessary by the court to allow a 22 health authority to investigate, file and prosecute each petition for 23 involuntary court-ordered isolation or quarantine pursuant to NRS 24 441A.505 to 441A.720, inclusive; and 25 (b) Only if it is satisfied that there is probable cause to believe 26 that the person or group of persons alleged to have been infected 27 with or exposed to a communicable disease has been infected with 28 or exposed to a communicable disease, and that because of the risks 29 of that disease, the person or group of persons is likely to be an 30 immediate threat to the health of the public. 31 Sec. 3. NRS 441A.720 is hereby amended to read as follows: 32 441A.720 When any involuntary court isolation or quarantine 33 is ordered under the provisions of NRS 441A.505 to 441A.720, 34 inclusive, the involuntarily isolated or quarantined person, together 35 with the court orders, any certificates of the health authorities, 36 physicians, physician assistants licensed pursuant to chapter 630 or 37 633 of NRS or registered nurses, the written summary of the 38 evaluation team and a full and complete transcript of the notes [Text truncated for display. Full text available on LegiScan.]