AB519 - Creates a separate chapter of the Nevada Revised Statutes governing certain agencies and organizations that provide nonmedical services. (BDR 40-805)

- 83rd Session (2025) Assembly Bill No. 519–Committee on Health and Human Services CHAPTER.......... AN ACT relating to health care; establishing separate provisions for the licensing or certification, regulation and discipline of agencies to provide personal care services in the home, employment agencies that contract to provide certain nonmedical services and intermediary service organizations; enacting provisions to facilitate the collecting of certain debts from applicants for certain licenses; imposing certain requirements as an applicant for a certificate to operate an intermediary service organization; revising the training requirements for certain caregivers who receive reimbursement through Medicaid; authorizing a family member to serve as the personal care assistant for a recipient of Medicaid under certain circumstances; providing penalties; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law provides for the licensure and regulation of various types of medical facilities and facilities for the dependent by the Division of Public and Behavioral Health of the Department of Health and Human Services. (Chapter 449 of NRS) Existing law requires an agency to provide personal care services in the home to be licensed by the Division as a facility for the dependent. (NRS 449.0045, 449.030) Existing law requires an employment agency that contracts with persons in this State to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home to obtain a license from the State Board of Health. (NRS 449.03005) Existing law requires an intermediary service organization to obtain a certificate from the Division. (NRS 449.431) Existing law requires the Board to adopt regulations governing agencies to provide personal care services in the home, employment agencies that contract to provide nonmedical services related to personal care to elderly persons and persons with disabilities and intermediary service organizations. (NRS 449.03005, 449.0302, 449.4309) This bill transfers the provisions of law governing agencies to provide personal care services in the home, employment agencies that contract to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home and intermediary service organizations from the chapter of the Nevada Revised Statutes that generally governs medical facilities and facilities for the dependent to a new chapter in the Nevada Revised Statutes without changing the current substantive provisions that govern such agencies and organizations. Sections 2-19, 24-49, 51-60, 69-79 and 81-90 of this bill create a new chapter consisting of provisions for the licensure and regulation of such entities in a manner substantially identical to the manner in which those entities are licensed and regulated under existing law. Sections 94, 96-104 and 150 of this bill eliminate provisions governing those entities from the chapter of the Nevada Revised Statutes that regulates medical facilities and facilities for the dependent. Sections 93, 111, 113, 117, 118, 120-123, 126-133, 138 and 146 of this bill eliminate references to sections repealed by section 150. Sections 91, 92, 95 and 105-146 of this bill make various conforming changes so that the legal status of – 2 – - 83rd Session (2025) agencies to provide personal care services in the home, employment agencies that contract to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home and intermediary service organizations is not changed by this bill. Existing federal law requires each state to adopt procedures to ensure that applicants for certain licenses and certificates comply with child support obligations, including by requiring an applicant for such a license to provide his or her social security number. (42 U.S.C. § 666) Sections 20, 21 and 50 of this bill enact such procedures as applicable to an applicant for the issuance or renewal of a license to operate an agency to provide personal care services in the home or an employment agency that contracts to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home in order to comply with federal law. Section 23 of this bill establishes alternate provisions for such an applicant who does not have a social security number. Section 22 of this bill also requires an applicant for the renewal of such a license to provide certain information for the purpose of identifying persons who owe certain debts to the State. Sections 65, 69, 74 and 76 of this bill establish similar provisions for intermediary service organizations, which were carried over from existing law. (NRS 449.4312, 449.4313, 449.4315, 449.432, 449.4322) Existing law requires: (1) an agency to provide personal care services in the home to file with the Administrator of the Division a surety bond or a substitute for a surety bond; and (2) an applicant for a license to operate an agency to provide personal care services in the home to undergo a criminal background check. (NRS 449.065, 449.067, 449.122) Sections 67, 68 and 80 of this bill impose similar requirements on intermediary service organizations. Existing law requires: (1) the Department to apply for a home and community- based services waiver to include structured family caregiving for certain persons as medical assistance under Medicaid; and (2) a caregiver providing care under that waiver to complete training required by the Aging and Disability Services Division of the Department. (NRS 422.3965) Sections 30 and 122 of this bill instead require such a caregiver to complete the same training that is required for unlicensed caregivers who provide care for an agency to provide personal care services in the home. Existing law requires the Director of the Department to include in the State Plan for Medicaid authorization for a recipient of Medicaid to be deemed a provider of services for the purposes of allowing the recipient to receive reimbursement for personal care services covered by Medicaid and using that money to pay for services provided by a personal care assistant or an agency to provide personal care services in the home. (NRS 422.272407) Section 120 of this bill authorizes a family member of a recipient of Medicaid to serve as a personal care assistant for a recipient of Medicaid if the family member: (1) completes the training required by section 30 for certain other caregivers; and (2) receives authorization from a provider of health care. Section 147 of this bill requires the Legislative Counsel to move regulations specifically relating to such entities to a new chapter of the Nevada Administrative Code that corresponds to the new chapter of the Nevada Revised Statutes created by sections 2-90. Section 147 also: (1) requires the Board to adopt new regulations to replace other regulations relating to those entities that remain in the chapter of the Nevada Administrative Code governing medical facilities and facilities for the dependent; and (2) provides that those existing regulations remain in effect until the Board adopts new regulations to replace them. Section 148 of this bill clarifies that this bill does not affect the validity of: (1) licenses or certificates to operate agencies to provide personal care services in the home, employment agencies that – 3 – - 83rd Session (2025) contract to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home and intermediary service organizations; (2) certain training completed by the operators, employees and contractors of such entities; or (3) disciplinary actions taken against such entities. 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. Title 40 of NRS is hereby amended by adding thereto a new chapter to consist of the provisions set forth as sections 2 to 90, inclusive, of this act. Sec. 2. As used in this chapter, unless the context otherwise requires, the words and terms defined in sections 3 to 7, inclusive, of this act have the meanings ascribed to them in those sections. Sec. 3. 1. “Agency to provide personal care services in the home” means any person, other than a natural person, which provides services authorized pursuant to section 52 of this act to elderly persons or persons with disabilities in the home. 2. The term does not include: (a) An independent contractor who provides nonmedical services specified in section 52 of this act without the assistance of employees; (b) An organized group of persons composed of the family and friends of a person needing nonmedical services related to personal care that employs or contracts with persons to provide such nonmedical services for the person if: (1) The organization of the group of persons is set forth in a written document that is made available for review by the Division upon request; and (2) The services are provided to only one person or one family who resides in the same residence; (c) An intermediary service organization; or (d) A person or agency that contracts with the Aging and Disability Services Division of the Department of Health and Human Services to provide temporary respite services. 3. As used in this section: (a) “Intermediary service organization” has the meaning ascribed to it in section 59 of this act. (b) “Temporary respite services” means services provided through a contract with the Aging and Disability Services Division of the Department of Health and Human Services to a natural – 4 – - 83rd Session (2025) person on a periodic basis to provide a respite for a regular provider of services. Sec. 4. “Board” means the State Board of Health. Sec. 5. “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services. Sec. 6. “Employment agency” has the meaning ascribed to it in NRS 611.020. Sec. 7. “Nonmedical services related to personal care to elderly persons or persons with disabilities” includes, without limitation: 1. The elimination of wastes from the body; 2. Dressing and undressing; 3. Bathing; 4. Grooming; 5. The preparation and eating of meals; 6. Laundry; 7. Shopping; 8. Cleaning; 9. Transportation; and 10. Any other minor needs related to the maintenance of personal hygiene. Sec. 8. Except as otherwise provided in section 12 of this act, no person, state or local government or agency thereof may operate or maintain in this State an agency to provide personal care services in the home without first obtaining a license as provided in sections 8 to 58, inclusive, of this act. Sec. 9. 1. Except as otherwise provided in section 12 of this act, a person must obtain a license from the Board to operate an employment agency that contracts with persons in this State to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home, regardless of whether the employment agency is located in this State. 2. The Board shall adopt: (a) Standards for licensing of employment agencies that contract to provide nonmedical services related to personal care to elderly persons or persons with disabilities in the home; (b) Standards relating to the fees charged by such employment agencies; (c) Regulations governing the licensing of such employment agencies; and – 5 – - 83rd Session (2025) (d) Regulations establishing requirements for training the persons who contract with such employment agencies to provide such nonmedical services. 3. An employment agency that is licensed pursuant to this section shall not refer a person to a home to provide nonmedical services related to personal care to elderly persons or persons with disabilities if that person has not met the requirements set forth in sections 36 to 40, inclusive, of this act. 4. A person who violates the provisions of subsection 3 is liable for a civil penalty to be recovered by the Attorney General in the name of the Board for the first offense of not more than $10,000 and for a second and subsequent offense of not less than $10,000 nor more than $20,000. Unless otherwise required by federal law, the Board shall deposit all civil penalties collected pursuant to this section into a separate account in the State General Fund to be used to administer and carry out the provisions of chapter 449A of NRS and sections 2 to 58, inclusive, of this act and to protect the health, safety, well-being and property of the persons served by the employment agencies. Sec. 10. 1. The Division shall develop and implement a process by which a person with a criminal history may petition the Division to review the criminal history of the person to determine if the person’s criminal history will disqualify the person from obtaining a license pursuant to sections 2 to 58, inclusive, of this act. 2. Not later than 90 days after a petition is submitted to the Division pursuant to subsection 1, the Division shall inform the person of the determination of the Division of whether the person’s criminal history will disqualify the person from obtaining a license. The Division is not bound by its determination of disqualification or qualification and may rescind such a determination at any time. 3. The Division may provide instructions to a person who receives a determination of disqualification to remedy the determination of disqualification. A person may resubmit a petition pursuant to subsection 1 not earlier than 6 months after receiving instructions pursuant to this subsection if the person remedies the determination of disqualification. 4. A person with a criminal history may petition the Division at any time, including, without limitation, before obtaining any education or paying any fee required to obtain a license from the Division. – 6 – - 83rd Session (2025) 5. A person may submit a new petition to the Division not earlier than 2 years after the final determination of the initial petition submitted to the Division. 6. The Division may impose a fee of up to $50 upon the person to fund the administrative costs in complying with the provisions of this section. The Division may waive such fees or allow such fees to be covered by funds from a scholarship or grant. 7. The Division may post on its Internet website: (a) The requir [Text truncated for display. Full text available on LegiScan.]