SB378 - Makes revisions relating to health care. (BDR 40-705)

- 83rd Session (2025) Senate Bill No. 378–Senators Doñate, Cruz-Crawford, Nguyen, Flores; Cannizzaro, Lange and Ohrenschall Joint Sponsor: Assemblymember Gray CHAPTER.......... AN ACT relating to health care; revising requirements governing the electronic maintenance, transmittal and exchange of health information; establishing a program to increase awareness of information concerning independent centers for emergency medical care; requiring certain facilities that are owned or operated by, or otherwise part of, hospitals to be licensed as independent centers for emergency medical care; requiring certain independent centers for emergency medical care to provide urgent care services under certain conditions; authorizing the review of certain sealed records to determine the suitability of a person to provide services under Medicaid; requiring Medicaid to include a system of value- based payments for independent centers for emergency medical care; requiring a provider of services under Medicaid to maintain certain records; authorizing audits of such records, the review and denial of claims under Medicaid and the recovery of money paid under Medicaid under certain circumstances; prohibiting a noncompetition covenant from applying to a patient-facing provider of health care; requiring a custodian of health records to furnish health records within a specified period of time and without charging a fee under certain circumstances; making an appropriation; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires the Director of the Department of Health and Human Services to prescribe by regulation a framework for the electronic maintenance, transmittal and exchange of electronic health records, prescriptions, health-related information and electronic signatures and requirements for electronic equivalents of written entries or written approvals. With certain exceptions, existing law requires various entities involved in health care, including persons and facilities that provide health care, to maintain, transmit and exchange health information in accordance with those regulations. (NRS 439.589) Section 5 of this bill prohibits those regulations from authorizing such a person or entity to comply with that requirement by connecting with a health information exchange or utilizing any other service that charges a fee for providing electronic health records to such a person or entity or a patient upon request. Section 33 of this bill: (1) requires a custodian of health care records to furnish electronic health records to a patient or a covered entity upon the request of a patient within 7 business days; and (2) prohibits a custodian of health care records from charging a fee to furnish health care records under such circumstances. Section 33 defines “covered entity” to refer to providers of health care who transmit health information in electronic form, – 2 – - 83rd Session (2025) health insurers and certain other entities involved in the processing of health information. (45 C.F.R. § 160.103) Sections 4, 31 and 40 of this bill limit the health care providers that must maintain, transmit and exchange health information electronically to medical facilities and high-level providers of health care. Section 1 of this bill defines the term “high-level provider of health care” to mean a physician, physician assistant, dentist, advanced practice registered nurse, chiropractic physician, podiatric physician or physical therapist. Section 4 additionally exempts from requirements to maintain, transmit and exchange health information electronically high-level providers of health care whose solo or group practices are under a certain size. However, section 4 requires such high-level providers of health care to furnish the medical records of a patient electronically to the patient or another person or entity upon request of the patient. Section 6 of this bill makes conforming changes to revise the applicability of a provision requiring the Department to notify the licensing board of a provider who fails to comply with requirements governing the electronic maintenance, transmittal and exchange of health information. Section 2 of this bill establishes the applicability of the definition set forth in section 1, and sections 24, 25, 29, 35 and 36 of this bill make other conforming changes to indicate the proper placement of section 1 in the Nevada Revised Statutes. Section 32 of this bill updates internal references changed by section 31. Existing law prohibits a person or entity from operating an independent center for emergency medical care without a license issued by the Division of Public and Behavioral Health of the Department. (NRS 449.030) Section 14 of this bill requires a facility that is structurally separate from the hospital and provides services for the treatment of a medical emergency, including such a facility that is owned or operated by, or otherwise part of, a hospital, to be licensed as an independent center for emergency medical care. (NRS 449.0151, 449.030) Sections 15 and 16 of this bill prohibit the Division or the State Board of Health from charging a fee for the issuance of such a license. Section 17 of this bill prohibits the Division from issuing a license to operate an independent center for emergency medical care that is located within a 5 mile radius of another independent center for emergency medical care or a hospital with an emergency department. However, section 37 of this bill requires the Division to issue a license to an independent center for emergency medical care that: (1) is operating on the date on which this bill is enacted; (2) is newly required by section 14 to be licensed; and (3) otherwise meets the requirements for licensure, regardless of where the facility is located. Section 37 additionally requires the Division to issue a license to an independent center for emergency medical care that has not yet been constructed, but whose owner or operator had taken certain steps toward completing construction prior to January 1, 2025, and that otherwise meets the requirements for licensure at the time of the application for licensure, regardless of where the facility is located. Section 18 of this bill requires an independent center for emergency medical care to provide urgent care services during all operating hours and imposes certain additional requirements related to the provision of such urgent care, except that section 36.5 of this bill exempts independent centers for emergency medical care that are licensed on the date on which this bill is enacted from that requirement. Existing law establishes programs to increase awareness of information concerning hospitals and surgical centers for ambulatory patients. (NRS 439A.200- 439A.290) Section 9 of this bill requires the Department to establish a similar program to increase awareness of information concerning independent centers for emergency medical care. Sections 9, 10, 12, 13 and 19 of this bill provide for the Department to collect certain information on the operations of independent centers for emergency medical care and the outcomes for patients treated by independent – 3 – - 83rd Session (2025) centers for emergency medical care. To facilitate such reporting, section 19 requires an independent center for emergency medical care to use the same form prescribed by the Director for discharging patients as a hospital is currently required to use. Section 34 of this bill makes a conforming change to reflect that independent centers for emergency medical care will be using the same form. Sections 12 and 13 require the Department to: (1) make certain information concerning independent centers for emergency medical care available upon request; and (2) post certain information concerning independent centers for emergency medical care on an Internet website maintained by the Department. Section 23 of this bill makes a conforming change to reflect the revised content of that Internet website. Section 8 of this bill defines the term “independent center for emergency medical care” for that purpose. Section 11 of this bill establishes the applicability of certain definitions. Section 20 of this bill requires a report prepared by the Director on the status of the programs to increase public awareness of information concerning hospitals and surgical centers for ambulatory patients to additionally include information on the status of the program to increase awareness of information concerning independent centers for emergency medical care. Section 26.5 of this bill requires the Director of the Department, to the extent that money is available, to include under Medicaid a system of value-based payments for care provided by independent centers for emergency medical care to recipients of Medicaid. Existing law authorizes a court, upon a petition, to order the sealing of records of certain convictions if the person who was convicted: (1) has not been convicted of any additional offense, except for minor traffic violations, for a specified period of time; and (2) does not have charges pending for any offense, except for minor traffic violations. (NRS 179.245) Existing law also authorizes a court, upon a petition, to order the sealing of records of an arrest where the charges were dismissed, the prosecutor declined to prosecute or the person who was arrested was acquitted. (NRS 179.255) Section 21 of this bill authorizes the Department or the Division of Health Care Financing and Policy of the Department to review certain sealed records for the purpose of determining the suitability of the person to whom the records pertain to serve as a provider of services under Medicaid or to own or serve as an officer, managing employee or managing agent of such a provider of services. Existing law prescribes a procedure for conducting a hearing to review an action taken against a provider of services under Medicaid. (NRS 422.306) Section 27 of this bill requires such a provider of services to maintain and provide certain documents to the Department for the purpose of verifying claims. Section 27 authorizes the Department to deny a claim or recover money already paid if the Department is unable to verify the claim. Section 28 of this bill: (1) prescribes a process for the Department to review claims for appropriateness and propriety; and (2) authorizes the Department to deny or recover any amount paid pursuant to such a claim or take certain actions based on such a review. Section 22 of this bill makes a conforming change to require the Director to administer sections 26.5, 27 and 28 in the same manner as other provisions governing Medicaid. Section 36.2 of this bill makes an appropriation to the Division of Health Care Financing and Policy of the Department and authorizes the expenditure of certain other money to carry out sections 26.5, 27 and 28. Existing law provides that a noncompetition covenant is void unless the covenant: (1) is supported by valuable consideration; (2) does not impose any restraint that is greater than is required for the protection of the employer; (3) does not impose any undue hardship on the employee; and (4) imposes restrictions that are appropriately related to the consideration for the covenant. (NRS 613.195) – 4 – - 83rd Session (2025) Section 30 of this bill provides that a noncompetition covenant may not apply to a provider of health care, which section 30 defines as a provider of health care whose primary duties involve clinical care to patients and who is not employed or contracted to primarily perform administrative tasks. 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 439 of NRS is hereby amended by adding thereto a new section to read as follows: “High-level provider of health care” means a physician or physician assistant licensed pursuant to chapter 630 or 633 of NRS, dentist, advanced practice registered nurse, chiropractic physician, podiatric physician or physical therapist. Sec. 2. NRS 439.581 is hereby amended to read as follows: 439.581 As used in NRS 439.581 to 439.597, inclusive, and section 1 of this act, unless the context otherwise requires, the words and terms defined in NRS 439.582 to 439.585, inclusive, and section 1 of this act have the meanings ascribed to them in those sections. Sec. 3. NRS 439.588 is hereby amended to read as follows: 439.588 1. A health information exchange shall not operate in this State without first obtaining certification as provided in subsection 2. 2. The Director shall by regulation establish the manner in which a health information exchange may apply for certification and the requirements for granting such certification, which must include, without limitation, that the health information exchange demonstrate its financial and operational sustainability, adherence to the privacy, security and patient consent standards adopted pursuant to NRS 439.589 and capacity for interoperability with any other health information exchange certified pursuant to this section. 3. The Director may deny an application for certification or may suspend or revoke any certification issued pursuant to subsection 2 for failure to comply with the provisions of NRS 439.581 to 439.597, inclusive, and section 1 of this act or the regulations adopted pursuant thereto or any applicable federal or state law. 4. When the Director intends to deny, suspend or revoke a certification, he or she shall give reasonable notice to all parties by certified mail. The notice must contain the legal authority, jurisdiction and reasons for the action to be taken. A health – 5 – - 83rd Session (2025) information exchange that wishes to contest the action of the Director must file an appeal with the Director. 5. The Director shall adopt regulations establishing the manner in which a person may file a complaint with the Director regarding a violation of the provisions of this section. 6. The Director may impose an administrative fine against a health information exchange which operates in this State without holding a certification in an amount established by the Director by regulation. The Director shall afford a health information exchange so fined an opportunity for a hearing pursuant to the provisions of NRS 233B.121. 7. The Director may adopt such regulations as he or she determines are necessary to carry out the provisions of this section. Sec. 4. NRS 439.589 is hereby amended to read as follows: [Text truncated for display. 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