SB124 - Revises provisions relating to health care. (BDR 54-38)

- 83rd Session (2025) Senate Bill No. 124–Senators Doñate; Flores, Stone and Taylor Joint Sponsor: Assemblymember González CHAPTER.......... AN ACT relating to health care; providing for the limited licensure of certain foreign physicians; prescribing the conditions under which such a limited licensee is authorized to practice medicine; providing for the unrestricted licensure of certain limited licensees; requiring the Board of Medical Examiners to submit certain reports to the Legislature; updating certain references; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law provides for the licensing of physicians by the Board of Medical Examiners. (NRS 630.160-630.1607, 630.258-630.2665) Existing law also authorizes a graduate of a foreign medical school to obtain a restricted license to teach, research or practice medicine at a medical facility, medical research facility or medical school by completing certain requirements that are less stringent than the requirements to obtain an unrestricted license. (NRS 630.2645) If the holder of such a restricted license wishes to obtain an unrestricted license, existing law requires the holder to meet all of the qualifications ordinarily required to obtain an unrestricted license. (NRS 630.160, 630.2645) Section 1.3 of this bill authorizes the Board of Medical Examiners to issue a limited license to practice medicine to a graduate of a qualified foreign medical school who holds or has held a valid and unrestricted license to practice medicine issued by a foreign country other than Canada and: (1) has completed a residency program or other program of postgraduate training or has performed the duties of a physician in that foreign country within a certain amount of time before applying for the license; and (2) possesses certain other qualifications related to the practice of medicine. Section 1.3 authorizes the Board to additionally require an applicant for a limited license to: (1) take an additional examination if the applicant has not performed the duties of physician for a continuous period of 24 months before applying for licensure; or (2) submit to the Board an offer of employment from certain health related entities. Section 1.3 requires that the holder of a limited license only practice medicine: (1) under the supervision of at least one physician who holds an active unrestricted license and possesses certain additional qualifications and with whom the holder of a limited license has entered into a written practice agreement; and (2) in accordance with the written practice agreement. Section 1.3 authorizes the Board of Medical Examiners to issue an unrestricted license to the holder of a limited license who: (1) has completed at least 2 years of practice as a full-time physician under the limited license; (2) remains in good standing; and (3) has received a recommendation from each physician currently supervising him or her. Section 1.3 additionally authorizes the Board to establish other requirements relating to the licensure and practice of limited licensees. Section 1.7 of this bill requires the Board to annually submit to the Legislature a report concerning the licensure of graduates of foreign medical schools under the provisions of section 1.3. – 2 – - 83rd Session (2025) Section 2 of this bill makes a conforming change to clarify that an applicant for a limited license to practice medicine pursuant to section 1.3 is not required to possess the same qualifications as an applicant for a standard license. Sections 3-6 of this bill update references to certification by the Educational Commission for Foreign Medical Graduates in existing law to reflect the current practices of the Commission. 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. Chapter 630 of NRS is hereby amended by adding thereto the provisions set forth as sections 1.3 and 1.7 of this act. Sec. 1.3. 1. Except as otherwise provided in NRS 630.161, the Board may issue a limited license to practice medicine to an applicant who: (a) Holds or has held a valid and unrestricted license to practice medicine issued by a foreign country other than Canada and has completed a residency program or other program of postgraduate training in that foreign country or performed the duties of a physician in that foreign country within the 5 years immediately preceding the date on which the application is submitted or within such other time period as the Board deems acceptable; (b) Meets the requirements prescribed by the Board with respect to proficiency in the English language; (c) Is of good moral character and reputation; (d) Is in good standing with the foreign regulatory body that issued the license described in paragraph (a) or, if the applicant is no longer licensed by the foreign regulatory body, was in good standing with the regulatory body at the time in which the license of the applicant expired or was otherwise deactivated at the request of the applicant; (e) Is a graduate of a foreign medical school whose curriculum is judged to be acceptable by the Board; and (f) Has passed all steps of the United States Medical Licensing Examination. 2. In addition to the requirements established pursuant to subsection 1, the Board may: (a) Require an applicant who has not performed the duties of a physician for a continuous period of 24 months immediately preceding the date on which the applicant submits the application to complete an examination prescribed by the Board similar to the – 3 – - 83rd Session (2025) Step 2 clinical skills exam of the United States Medical Licensing Examination to evaluate the clinical skills of the applicant to practice medicine. (b) Upon licensure of the applicant, require the applicant to provide to the Board notification of an offer for employment as a physician: (1) At a federally-qualified health center; (2) From the State or a political subdivision thereof, which may include, without limitation, a county hospital, a health district created pursuant to NRS 439.362 or 439.370, a medical school within the Nevada System of Higher Education or a facility operated by a division of the Department of Health and Human Services; (3) At a nonprofit facility which provides mental or behavioral health services or primary care services; or (4) From a physician group practice located in a medically underserved area of this State. 3. The holder of a limited license issued pursuant to this section: (a) Shall file with the Board for approval a written practice agreement between the limited licensee and each physician supervising him or her pursuant to paragraph (b). (b) Except if authorized in emergency or life threatening situations by the regulations adopted pursuant to this section, shall not practice medicine except: (1) Under the supervision and control of a physician who holds an active unrestricted license to practice medicine in this State, practices in the same or a substantially similar specialty as the limited licensee and has practiced in that same or similar specialty for at least 2 years. (2) In accordance with the applicable written practice agreement filed with and approved by the Board pursuant to paragraph (a). (c) Shall inform the Board of any change in the employment status of the limited licensee. 4. A physician supervising a holder of a limited license pursuant to subsection 3: (a) Is responsible for any act that constitutes the practice of medicine by the limited licensee; and (b) Shall continuously monitor, periodically evaluate and, if required by the Board, report to the Board information relating to the performance and competence of the limited licensee. – 4 – - 83rd Session (2025) 5. The holder of a limited license granted pursuant to this section may be disciplined by the Board at any time for any of the grounds provided in NRS 630.161 or 630.301 to 630.3065, inclusive. 6. Except as otherwise provided in NRS 630.161, the Board may issue an unrestricted license to practice medicine upon the submission of an application by the holder of a limited license issued pursuant to this section who: (a) Has completed at least 2 years of practice as a full-time physician under the limited license; (b) Is in good standing in this State; and (c) Has received a written recommendation from each physician currently supervising the holder of a limited license pursuant to subsection 3 which states: (1) That the limited licensee has met all requirements established by the Board for the evaluation of limited licensees licensed pursuant to this section, if applicable; and (2) In the opinion of the supervising physician, the limited licensee is qualified to independently practice medicine. 7. The Board may, after providing the holder of a limited license issued pursuant to this section with notice and an opportunity for a hearing in accordance with the provisions of this chapter and chapter 622A of NRS, suspend or revoke the license issued to the limited licensee if the Board determines that the limited licensee is no longer employed as a physician in this State. 8. The Board: (a) Shall adopt regulations necessary to carry out the provisions of this section, including, without limitation, regulations: (1) Establishing the required provisions of a written practice agreement entered into between the holder of a limited license and his or her supervising physician pursuant to subsection 3; (2) Governing the prescribing and dispensing of controlled substances by limited licensees, which must prohibit a limited licensee from prescribing or dispensing any controlled substance that the supervising physician of the limited licensee is not authorized or qualified to prescribe or dispense; and (3) Establishing the specialties within which a limited licensee may practice pursuant to this section, which may include, without limitation, internal medicine, general medicine, geriatric medicine, family medicine, palliative medicine and hospice. – 5 – - 83rd Session (2025) (b) May adopt such additional regulations as it deems appropriate to carry out the provisions of this section, which may include, without limitation: (1) Any additional requirements for the issuance or renewal of a limited license under the provisions of this section; (2) Regulations governing the scope of practice of a limited licensee, including, without limitation, regulations prescribing the authority of a limited licensee to order home health care; (3) Requirements for the identification of limited licensees, which may include, without limitation, a requirement that a limited licensee wear an identification badge which clearly identifies the person as a limited licensee; (4) Criteria for the monitoring and evaluation of a limited licensee by the supervising physician of the limited licensee pursuant to subsection 4; and (5) Regulations concerning the types of procedures or services which a limited licensee may perform outside of the presence of his or her supervising physician, which may exempt a limited licensee from the requirements of paragraph (b) of subsection 3 in emergency or life threatening situations. 9. As used in this section: (a) “Federally-qualified health center” has the meaning ascribed to it in 42 U.S.C. § 1396d(1)(2)(B). (b) “Medically underserved area” means an area designated as: (1) A health professional shortage area for primary care by the United States Secretary of Health and Human Services pursuant to 42 U.S.C. § 254e; or (2) An area with a medically underserved population by the United States Secretary of Health and Human Services pursuant to 42 U.S.C. § 254b. (c) “Physician group practice” means any business entity organized for the purpose of the practice of medicine or osteopathic medicine by more than one physician. Sec. 1.7. On or before January 31 of each calendar year, the Board shall: 1. Compile a report concerning the licenses issued pursuant to section 1.3 of this act which must include, for the immediately preceding calendar year: (a) The number of applications received by the Board for limited licenses pursuant to subsection 1; – 6 – - 83rd Session (2025) (b) The number of applications received by the Board from the holders of limited licenses for an unrestricted license pursuant to subsection 6 of section 1.3 of this act; (c) An evaluative assessment of the quality of the limited licensees licensed pursuant to this section; and (d) Metrics and data concerning, without limitation, the types of practices and facilities that employ limited licensees licensed pursuant to section 1.3 of this act, the specialties practiced by such limited licensees and the geographic distribution of such limited licensees. 2. Submit the report compiled pursuant to subsection 1 to the Director of the Legislative Counsel Bureau for transmittal to: (a) In even-numbered years, the Joint Interim Standing Committee on Health and Human Services; and (b) In odd-numbered years, the next regular session of the Legislature. Sec. 2. NRS 630.160 is hereby amended to read as follows: 630.160 1. Every person desiring to practice medicine must, before beginning to practice, procure from the Board a license authorizing the person to practice. 2. Except as otherwise provided in NRS 630.1605 to 630.161, inclusive, and 630.258 to 630.2665, inclusive, and sections 1.3 and 1.7 of this act, a license may be issued to any person who: (a) Has received the degree of doctor of medicine from a medical school: (1) Approved by the Liaison Committee on Medical Education of the American Medical Association and Association of American Medical Colleges; or (2) Which provides a course of professional instruction equivalent to that provided in medical schools in the United States approved by the Liaison Committee on Medical Education; (b) Is currently certified by a specialty board of the American Board of Medical Specialties and who agrees to maintain the certification for the duration of the licensure, or has passed: (1) All parts of the examination given by the National Board of Medical Examiners; (2) All parts of the Federation Licensing Examination; (3) All parts of the United States Medical Licensing Examination; (4) All parts of a licensing examination given by any state or territory of the United States, [Text truncated for display. 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