SB186 - Imposes requirements concerning the use of artificial intelligence in health care. (BDR 40-780)

S.B. 186 - *SB186* SENATE BILL NO. 186–SENATOR STONE PREFILED FEBRUARY 3, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Imposes requirements concerning the use of artificial intelligence in health care. (BDR 40-780) 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; requiring a medical facility or a provider of health care who uses generative artificial intelligence to generate certain communications to ensure that those communications include certain information; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law provides for the licensure and regulation of medical facilities and 1 providers of health care in this State. (Chapters 449, 450B, 629-637B, 639-640B 2 and 640D-641D of NRS) Sections 1 and 7 of this bill require a medical facility or 3 provider of health care who uses generative artificial intelligence to generate a 4 written or verbal communication with a patient relating to his or her clinical 5 information to ensure that the communication includes: (1) a disclaimer stating that 6 the communication was generated by generative artificial intelligence; and (2) clear 7 instructions describing how the patient may contact certain persons for further 8 assistance. Sections 1 and 7 exempt from this requirement a written 9 communication that is read and reviewed by a provider of health care. Sections 2-6 10 and 8 of this bill make conforming changes to provide for the administration and 11 enforcement of the requirements of section 1 in the same manner as other 12 requirements imposed on medical facilities by existing law. Section 7 authorizes 13 the imposition of disciplinary action against a provider of health care who fails to 14 comply with the requirements of section 7. 15 – 2 – - *SB186* 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 3, a medical 3 facility that uses generative artificial intelligence to generate a 4 written or verbal communication with a patient relating to his or 5 her clinical information shall ensure that the communication 6 includes: 7 (a) A disclaimer stating that the communication was generated 8 by generative artificial intelligence; and 9 (b) Clear instructions describing how the patient may contact a 10 provider of health care, employee of the medical facility or other 11 appropriate person who can provide any assistance the patient 12 may need with respect to the information in the communication. 13 2. The disclaimer provided pursuant to subsection 1: 14 (a) For written communications, including, without limitation, 15 letters, electronic mail and other written messages, must appear 16 prominently at the beginning of each communication. 17 (b) For written communications involving continuous 18 interactions over the Internet, including, without limitation, chat- 19 based telehealth, must be prominently displayed throughout the 20 interaction. 21 (c) For audio communications, must be provided verbally at 22 the beginning and the end of the interaction. 23 (d) For video communications, must be prominently displayed 24 throughout the interaction. 25 3. The requirements of this section do not apply to a written 26 communication that is generated by generative artificial 27 intelligence if the written communication is read and reviewed by 28 a provider of health care before being provided to a patient. 29 4. As used in this section: 30 (a) “Artificial intelligence” means an engineered or machine- 31 based system that varies in its level of autonomy and that can, for 32 explicit or implicit objectives, infer from the input it receives how 33 to generate outputs that can influence physical or virtual 34 environments. 35 (b) “Generative artificial intelligence” means artificial 36 intelligence that can generate derived synthetic content, including 37 images, videos, audio, text and other digital content. 38 (c) “Telehealth” has the meaning ascribed to it in 39 NRS 629.515. 40 – 3 – - *SB186* Sec. 2. NRS 449.029 is hereby amended to read as follows: 1 449.029 As used in NRS 449.029 to 449.240, inclusive, and 2 section 1 of this act, unless the context otherwise requires, “medical 3 facility” has the meaning ascribed to it in NRS 449.0151 and 4 includes a program of hospice care described in NRS 449.196. 5 Sec. 3. NRS 449.0301 is hereby amended to read as follows: 6 449.0301 The provisions of NRS 449.029 to 449.2428, 7 inclusive, and section 1 of this act do not apply to: 8 1. Any facility conducted by and for the adherents of any 9 church or religious denomination for the purpose of providing 10 facilities for the care and treatment of the sick who depend solely 11 upon spiritual means through prayer for healing in the practice of 12 the religion of the church or denomination, except that such a 13 facility shall comply with all regulations relative to sanitation and 14 safety applicable to other facilities of a similar category. 15 2. Foster homes as defined in NRS 424.014. 16 3. Any medical facility, facility for the dependent or facility 17 which is otherwise required by the regulations adopted by the Board 18 pursuant to NRS 449.0303 to be licensed that is operated and 19 maintained by the United States Government or an agency thereof. 20 Sec. 4. NRS 449.160 is hereby amended to read as follows: 21 449.160 1. The Division may deny an application for a 22 license or may suspend or revoke any license issued under the 23 provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of 24 this act upon any of the following grounds: 25 (a) Violation by the applicant or the licensee of any of the 26 provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 27 section 1 of this act or 449A.100 to 449A.124, inclusive, and 28 449A.270 to 449A.286, inclusive, or of any other law of this State 29 or of the standards, rules and regulations adopted thereunder. 30 (b) Aiding, abetting or permitting the commission of any illegal 31 act. 32 (c) Conduct inimical to the public health, morals, welfare and 33 safety of the people of the State of Nevada in the maintenance and 34 operation of the premises for which a license is issued. 35 (d) Conduct or practice detrimental to the health or safety of the 36 occupants or employees of the facility. 37 (e) Failure of the applicant to obtain written approval from the 38 Director of the Department of Health and Human Services as 39 required by NRS 439A.100 or 439A.102 or as provided in any 40 regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 41 and section 1 of this act and 449.435 to 449.531, inclusive, and 42 chapter 449A of NRS if such approval is required, including, 43 without limitation, the closure or conversion of any hospital in a 44 – 4 – - *SB186* county whose population is 100,000 or more that is owned by the 1 licensee without approval pursuant to NRS 439A.102. 2 (f) Failure to comply with the provisions of NRS 441A.315 and 3 any regulations adopted pursuant thereto or NRS 449.2486. 4 (g) Violation of the provisions of NRS 458.112. 5 (h) Failure to comply with the provisions of NRS 449A.170 to 6 449A.192, inclusive, and any regulation adopted pursuant thereto. 7 (i) Violation of the provisions of NRS 629.260. 8 2. In addition to the provisions of subsection 1, the Division 9 may revoke a license to operate a facility for the dependent if, with 10 respect to that facility, the licensee that operates the facility, or an 11 agent or employee of the licensee: 12 (a) Is convicted of violating any of the provisions of 13 NRS 202.470; 14 (b) Is ordered to but fails to abate a nuisance pursuant to NRS 15 244.360, 244.3603 or 268.4124; or 16 (c) Is ordered by the appropriate governmental agency to correct 17 a violation of a building, safety or health code or regulation but fails 18 to correct the violation. 19 3. The Division shall maintain a log of any complaints that it 20 receives relating to activities for which the Division may revoke the 21 license to operate a facility for the dependent pursuant to subsection 22 2. The Division shall provide to a facility for the care of adults 23 during the day: 24 (a) A summary of a complaint against the facility if the 25 investigation of the complaint by the Division either substantiates 26 the complaint or is inconclusive; 27 (b) A report of any investigation conducted with respect to the 28 complaint; and 29 (c) A report of any disciplinary action taken against the facility. 30  The facility shall make the information available to the public 31 pursuant to NRS 449.2486. 32 4. On or before February 1 of each odd-numbered year, the 33 Division shall submit to the Director of the Legislative Counsel 34 Bureau a written report setting forth, for the previous biennium: 35 (a) Any complaints included in the log maintained by the 36 Division pursuant to subsection 3; and 37 (b) Any disciplinary actions taken by the Division pursuant to 38 subsection 2. 39 Sec. 5. NRS 449.163 is hereby amended to read as follows: 40 449.163 1. In addition to the payment of the amount required 41 by NRS 449.0308, if a medical facility, facility for the dependent or 42 facility which is required by the regulations adopted by the Board 43 pursuant to NRS 449.0303 to be licensed violates any provision 44 related to its licensure, including any provision of NRS 439B.410 or 45 – 5 – - *SB186* 449.029 to 449.2428, inclusive, and section 1 of this act or any 1 condition, standard or regulation adopted by the Board, the 2 Division, in accordance with the regulations adopted pursuant to 3 NRS 449.165, may: 4 (a) Prohibit the facility from admitting any patient until it 5 determines that the facility has corrected the violation; 6 (b) Limit the occupancy of the facility to the number of beds 7 occupied when the violation occurred, until it determines that the 8 facility has corrected the violation; 9 (c) If the license of the facility limits the occupancy of the 10 facility and the facility has exceeded the approved occupancy, 11 require the facility, at its own expense, to move patients to another 12 facility that is licensed; 13 (d) Except where a greater penalty is authorized by subsection 2, 14 impose an administrative penalty of not more than $5,000 per day 15 for each violation, together with interest thereon at a rate not to 16 exceed 10 percent per annum; and 17 (e) Appoint temporary management to oversee the operation of 18 the facility and to ensure the health and safety of the patients of the 19 facility, until: 20 (1) It determines that the facility has corrected the violation 21 and has management which is capable of ensuring continued 22 compliance with the applicable statutes, conditions, standards and 23 regulations; or 24 (2) Improvements are made to correct the violation. 25 2. If an off-campus location of a hospital fails to obtain a 26 national provider identifier that is distinct from the national provider 27 identifier used by the main campus and any other off-campus 28 location of the hospital in violation of NRS 449.1818, the Division 29 may impose against the hospital an administrative penalty of not 30 more than $10,000 for each day of such failure, together with 31 interest thereon at a rate not to exceed 10 percent per annum, in 32 addition to any other action authorized by this chapter. 33 3. If the facility fails to pay any administrative penalty imposed 34 pursuant to paragraph (d) of subsection 1 or subsection 2, the 35 Division may: 36 (a) Suspend the license of the facility until the administrative 37 penalty is paid; and 38 (b) Collect court costs, reasonable attorney’s fees and other 39 costs incurred to collect the administrative penalty. 40 4. The Division may require any facility that violates any 41 provision of NRS 439B.410 or 449.029 to 449.2428, inclusive, and 42 section 1 of this act or any condition, standard or regulation adopted 43 by the Board to make any improvements necessary to correct the 44 violation. 45 – 6 – - *SB186* 5. Any money collected as administrative penalties pursuant to 1 paragraph (d) of subsection 1 or subsection 2 must be accounted for 2 separately and used to administer and carry out the provisions of 3 NRS 449.001 to 449.430, inclusive, and section 1 of this act, 4 449.435 to 449.531, inclusive, and chapter 449A of NRS to protect 5 the health, safety, well-being and property of the patients and 6 residents of facilities in accordance with applicable state and federal 7 standards or for any other purpose authorized by the Legislature. 8 Sec. 6. NRS 449.240 is hereby amended to read as follows: 9 449.240 The district attorney of the county in which the facility 10 is located shall, upon application by the Division, institute and 11 conduct the prosecution of any action for violation of any provisions 12 of NRS 449.029 to 449.245, inclusive [.] , and section 1 of this act. 13 Sec. 7. Chapter 629 of NRS is hereby amended by adding 14 thereto a new section to read as follows: 15 1. Except as otherwise provided in subsection 3, a provider of 16 health care who uses generative artificial intelligence to generate 17 a written or verbal communication with a patient relating to his or 18 her clinical information shall ensure that the communication 19 includes: 20 (a) A disclaimer stating that the communication was generated 21 by generative artificial intelligence; and 22 (b) Clear instructions describing how the patient may contact a 23 provider of health care, employee of the provider of health care or 24 other appropriate person who can provide any assistance the 25 patient may need with respect to the information in the 26 communication. 27 2. The disclaimer provided pursuant to subsection 1: 28 (a) For written communications, including, without limitation, 29 letters, electronic mail and other written messages, must appear 30 prominently at the beginning of each communication. 31 (b) For written commun [Text truncated for display. 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