SB192 - Revises provisions relating to public health. (BDR 40-86)

EXEMPT (Reprinted with amendments adopted on June 1, 2025) FOURTH REPRINT S.B. 192 - *SB192_R4* SENATE BILL NO. 192–SENATOR NEAL FEBRUARY 6, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to public health. (BDR 40-86) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. CONTAINS UNFUNDED MANDATE (§§ 1, 22, 47 & NRS 287.010) (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 public health; imposing requirements relating to birth in a hospital or freestanding birthing center; requiring health insurance to include certain coverage; requiring an independent mental health assessment of certain children in the custody of a child welfare agency; prohibiting the use of race-based health formulas and race-based care standards in certain circumstances; prohibiting a health insurer from engaging in certain discrimination against solo practitioners; providing for a study of certain disparities relating to health care; providing a penalty; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing federal regulations require providers of health care and health care 1 facilities that receive funding or certain other assistance from the Federal 2 Government to ensure that communications with persons with disabilities are as 3 effective as communications with persons who do not have disabilities. (45 C.F.R. 4 § 92.202) Those federal regulations: (1) prohibit such providers and facilities from 5 requiring a person with a disability to be accompanied by a person to interpret for 6 him or her; and (2) authorize such providers and facilities to provide qualified 7 interpreters through video remote interpreting services. (28 C.F.R. § 35.160, 45 8 C.F.R. § 92.202) Section 1 of this bill requires a hospital or freestanding birthing 9 center to provide a qualified sign language interpreter to a patient who is at the 10 hospital or freestanding birthing center for the purpose of giving birth, except 11 where providing such an interpreter would be impractical or delay necessary care. 12 Section 1 also requires a hospital or freestanding birthing center to allow a family 13 – 2 – - *SB192_R4* member of the patient and a doula to be present in the room with the patient during 14 the birthing process. Sections 2-6 of this bill make conforming changes relating to 15 the applicability and enforcement of section 1. 16 Existing law requires Medicaid to cover doula services provided by a doula 17 who enrolls with the Division of Health Care Financing and Policy of the 18 Department of Health and Human Services. (NRS 422.27177) Sections 18, 43, 46, 19 48, 50, 51, 53, 55, 56 and 61 of this bill require various other public and private 20 insurers who cover maternity care to: (1) cover doula services; and (2) include 21 doulas in their networks of providers. Section 45 of this bill authorizes the 22 Commissioner of Insurance to require certain policies of health insurance issued by 23 a domestic insurer to a person who resides in another state to include the coverage 24 required by section 43. Section 60 of this bill authorizes the Commissioner to 25 suspend or revoke the certificate of a health maintenance organization that fails to 26 provide the coverage required by section 55. The Commissioner is also authorized 27 to take such action against other health insurers who fail to provide the coverage 28 required by sections 43, 46, 48, 50, 51, 53 and 61. (NRS 680A.200) 29 Existing law requires certain health insurers, including Medicaid managed care 30 organizations and insurance for state and local governmental employees, to cover 31 hormone replacement therapy to varying degrees. (NRS 287.010, 287.04335, 32 689A.0415, 689B.0376, 689C.1678, 695A.1875, 695B.1916, 695C.050, 33 695C.1694, 695G.1717) Sections 44, 47, 49, 52, 54, 58 and 64 of this bill require 34 such coverage to include coverage of testosterone replacement therapy for 35 menopausal women. Section 67.5 of this bill requires: (1) private insurers to submit 36 to the Commissioner a plan for complying with that requirement on or before 37 January 1, 2026; and (2) the Commissioner to evaluate those plans and post a 38 bulletin on or before February 1, 2026, stating whether each such insurer is likely to 39 be in compliance with that requirement. Section 42 of this bill prohibits certain 40 health insurers from denying a request to include a provider of health care in a 41 provider network because the provider of health care is a solo practitioner. 42 Existing law authorizes a court that finds a child to be in need of protection to 43 place the child in the temporary custody of a public or private agency or institution. 44 (NRS 432B.550) If such a child is placed in the custody of an agency which 45 provides child welfare services and has been diagnosed with a mental or behavioral 46 health condition before or after such placement, section 22 of this bill requires the 47 agency which provides child welfare services to provide for an independent 48 assessment of the child before the child leaves the custody of the agency which 49 provides child welfare services. Section 22 provides that this requirement does not 50 apply if a prior assessment conducted after the initial diagnosis has determined that 51 the child no longer has a mental or behavioral health condition. Sections 7 and 23- 52 25 of this bill make conforming changes to make various provisions governing 53 child welfare proceedings generally applicable to any proceeding related to the 54 provisions of section 22. Section 33.5 of this bill makes a conforming change to 55 require the State Board of Nursing to establish qualifications for an advanced 56 practice registered nurse to conduct an assessment pursuant to section 22. 57 Existing law provides for the regulation of the practices of medicine, nursing 58 and osteopathic medicine by the Board of Medical Examiners, the State Board of 59 Nursing and the State Board of Osteopathic Medicine, respectively. (Chapters 630, 60 632 and 633 of NRS) Sections 29, 32 and 35 of this bill: (1) require those boards to 61 adopt regulations prescribing a list of race-based health formulas and race-based 62 care standards that are authorized for use by licensees in this State; (2) prohibit 63 those boards from including on that list any race-based health formula or race- 64 based care standard if there is a race-neutral health formula or race-neutral care 65 standard that has been scientifically validated as being at least as effective for the 66 same purpose; and (3) prohibit a physician, physician assistant, nurse or osteopathic 67 physician from using or authorizing the use of a race-based health formula or 68 – 3 – - *SB192_R4* race-based care standard that is not included on the list. Section 65 of this bill 69 requires the Board of Medical Examiners, the State Board of Osteopathic Medicine, 70 the University of Nevada, Reno, School of Medicine and the University of Nevada, 71 Las Vegas, School of Medicine to study disparities in health care access, the 72 provision of health care and health care outcomes. 73 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. A hospital or freestanding birthing center shall: 3 (a) Notify each patient who is deaf or hard of hearing and is in 4 labor or intends to give birth at the hospital or freestanding 5 birthing center that a qualified sign language interpreter is 6 available while the patient is in the hospital or freestanding 7 birthing center; and 8 (b) Upon the request of such a patient or his or her 9 representative, provide the patient with a qualified sign language 10 interpreter until the patient is discharged from the hospital or 11 freestanding birthing center, unless providing an interpreter 12 would be impractical under the circumstances or delay necessary 13 care for the patient. 14 2. At the request of a patient who is giving birth, a hospital or 15 freestanding birthing center shall allow a family member of the 16 patient and a doula to be present in the room with the patient 17 during the birthing process so long as the family member and 18 doula comply with the policies of the hospital or freestanding 19 birthing center, as applicable. 20 3. As used in this section, “qualified sign language 21 interpreter” means an interpreter, as defined in NRS 656A.030, 22 who: 23 (a) Has demonstrated proficiency in the practice of sign 24 language interpreting, as defined in NRS 656A.060; 25 (b) Is able to interpret effectively, accurately and impartially, 26 both receptively and expressively, using any necessary specialized 27 vocabulary or terms without changes, omissions, or additions and 28 while preserving the tone, sentiment and emotional level of the 29 original statement; and 30 (c) Adheres to generally accepted ethics principles in the field 31 of sign language interpreting, including, without limitation, client 32 confidentiality. 33 Sec. 2. NRS 449.029 is hereby amended to read as follows: 34 449.029 As used in NRS 449.029 to 449.240, inclusive, and 35 section 1 of this act, unless the context otherwise requires, “medical 36 – 4 – - *SB192_R4* facility” has the meaning ascribed to it in NRS 449.0151 and 1 includes a program of hospice care described in NRS 449.196. 2 Sec. 3. NRS 449.0301 is hereby amended to read as follows: 3 449.0301 The provisions of NRS 449.029 to 449.2428, 4 inclusive, and section 1 of this act do not apply to: 5 1. Any facility conducted by and for the adherents of any 6 church or religious denomination for the purpose of providing 7 facilities for the care and treatment of the sick who depend solely 8 upon spiritual means through prayer for healing in the practice of 9 the religion of the church or denomination, except that such a 10 facility shall comply with all regulations relative to sanitation and 11 safety applicable to other facilities of a similar category. 12 2. Foster homes as defined in NRS 424.014. 13 3. Any medical facility, facility for the dependent or facility 14 which is otherwise required by the regulations adopted by the Board 15 pursuant to NRS 449.0303 to be licensed that is operated and 16 maintained by the United States Government or an agency thereof. 17 Sec. 4. NRS 449.160 is hereby amended to read as follows: 18 449.160 1. The Division may deny an application for a 19 license or may suspend or revoke any license issued under the 20 provisions of NRS 449.029 to 449.2428, inclusive, and section 1 of 21 this act upon any of the following grounds: 22 (a) Violation by the applicant or the licensee of any of the 23 provisions of NRS 439B.410, 449.029 to 449.245, inclusive, and 24 section 1 of this act, or 449A.100 to 449A.124, inclusive, and 25 449A.270 to 449A.286, inclusive, or of any other law of this State 26 or of the standards, rules and regulations adopted thereunder. 27 (b) Aiding, abetting or permitting the commission of any illegal 28 act. 29 (c) Conduct inimical to the public health, morals, welfare and 30 safety of the people of the State of Nevada in the maintenance and 31 operation of the premises for which a license is issued. 32 (d) Conduct or practice detrimental to the health or safety of the 33 occupants or employees of the facility. 34 (e) Failure of the applicant to obtain written approval from the 35 Director of the Department of Health and Human Services as 36 required by NRS 439A.100 or 439A.102 or as provided in any 37 regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 38 and section 1 of this act, and 449.435 to 449.531, inclusive, and 39 chapter 449A of NRS if such approval is required, including, 40 without limitation, the closure or conversion of any hospital in a 41 county whose population is 100,000 or more that is owned by the 42 licensee without approval pursuant to NRS 439A.102. 43 (f) Failure to comply with the provisions of NRS 441A.315 and 44 any regulations adopted pursuant thereto or NRS 449.2486. 45 – 5 – - *SB192_R4* (g) Violation of the provisions of NRS 458.112. 1 (h) Failure to comply with the provisions of NRS 449A.170 to 2 449A.192, inclusive, and any regulation adopted pursuant thereto. 3 (i) Violation of the provisions of NRS 629.260. 4 2. In addition to the provisions of subsection 1, the Division 5 may revoke a license to operate a facility for the dependent if, with 6 respect to that facility, the licensee that operates the facility, or an 7 agent or employee of the licensee: 8 (a) Is convicted of violating any of the provisions of 9 NRS 202.470; 10 (b) Is ordered to but fails to abate a nuisance pursuant to NRS 11 244.360, 244.3603 or 268.4124; or 12 (c) Is ordered by the appropriate governmental agency to correct 13 a violation of a building, safety or health code or regulation but fails 14 to correct the violation. 15 3. The Division shall maintain a log of any complaints that it 16 receives relating to activities for which the Division may revoke the 17 license to operate a facility for the dependent pursuant to subsection 18 2. The Division shall provide to a facility for the care of adults 19 during the day: 20 (a) A summary of a complaint against the facility if the 21 investigation of the complaint by the Division either substantiates 22 the complaint or is inconclusive; 23 (b) A report of any investigation conducted with respect to the 24 complaint; and 25 (c) A report of any disciplinary action taken against the facility. 26  The facility shall make the information available to the public 27 pursuant to NRS 449.2486. 28 4. On or before February 1 of each odd-numbered year, the 29 Division shall submit to the Director of the Legislative Counsel 30 Bureau a written report setting forth, for the previous biennium: 31 (a) Any complaints included in the log maintained by the 32 Division pursuant to subsection 3; and 33 (b) Any disciplinary actions taken by the Division pursuant to 34 subsection 2. 35 Sec. 5. NRS 449.163 is hereby amended to read as follows: 36 449.163 1. In addition to the payment of the amount required 37 by NR [Text truncated for display. Full text available on LegiScan.]