PLANNING FOR THE PROVISION OF HEALTH CARE

Nev. Rev. Stat. 439A
in effect

Nev. Rev. Stat. § 439A.010 Definitions.

As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 439A.0115 to 439A.0195, inclusive, have the meanings ascribed to them in those sections.

Nev. Rev. Stat. § 439A.015 “Health facility” defined.

“Health facility” means a facility in or through which health services are provided, except for the office of a practitioner used solely to provide routine services for health to the practitioner’s patients. The term includes any parent, affiliate, subsidiary or partner of such a facility and any other entity which has a primary purpose of providing a benefit to such a facility. For the purposes of this section, “office of a practitioner used solely to provide routine services for health to the practitioner’s patients” does not include a facility which is or will be qualified to receive reimbursement, other than for the services of a practitioner, as a health facility from any public agency.

Nev. Rev. Stat. § 439A.017 “Health services” defined.

“Health services” means the care and observation of patients, the diagnosis of human diseases, the treatment and rehabilitation of patients, or related services. The term includes treatment of patients for alcohol or other substance use disorders, services related to mental health and diagnostic services.

Nev. Rev. Stat. § 439A.020 Purposes of chapter.

The purposes of this chapter are to: 1. Promote equal access to quality health care at a reasonable cost; 2. Promote an adequate supply and distribution of health resources; 3. Promote uniform, effective methods of delivering health care; 4. Promote and encourage the adequate distribution of health and care facilities and human resources; 5. Promote and encourage the effective use of methods for controlling increases in the cost of health care; 6. Encourage participation in health planning by members of the several health professions, representatives of institutions and agencies interested in the provision of health care and the reduction of the cost of such care, and the general public; 7. Utilize the viewpoint of the general public for making decisions; 8. Provide information to the general public concerning the charges imposed and the quality of the services provided by the hospitals and surgical centers for ambulatory patients in this State; 9. Encourage public education regarding proper personal health care and methods for the effective use of available health services; and 10. Promote a program of technical assistance to purchasers to contain effectively the cost of health care, including: (a) Providing information to purchasers regarding the charges made by practitioners. (b) Training purchasers to negotiate successfully for a policy of health insurance. (c) Conducting studies and providing other information about measures to assist purchasers in containing the cost of health care.

Nev. Rev. Stat. § 439A.081 Department is state agency for health planning and development; powers of Director; fees.

1. The Department is the agency of the State of Nevada for health planning and development, and shall carry out the state administrative program and perform the functions of health planning and development for the State in accordance with the following priorities: (a) Providing for the effective use of methods for controlling increases in the cost of health care; (b) Providing for the adequate supply and distribution of health resources; (c) Providing for equal access to health care of good quality at a reasonable cost; and (d) Providing education to the public regarding proper personal health care and methods for the effective use of available health services. 2. In order to carry out the provisions of this chapter, the Director may: (a) Delegate the duties of the Director and the Department pursuant to this chapter to any of the divisions of the Department; (b) Hire employees in the classified service; (c) Adopt such regulations as are necessary; and (d) Apply for, accept and disburse money granted by the Federal Government for the purposes of health planning and development. 3. The Department may, by regulation, fix fees to be collected from applicants seeking approval of proposed health facilities or services. The amounts of such fees must be based upon the Department’s costs of examining and acting upon the applications. 4. Any application fees collected pursuant to subsection 3 are not refundable and must be deposited in the State Treasury and accounted for separately in the State General Fund. Any interest and income earned on the money in the account, after deducting any applicable charges, must be credited to the account. Any money remaining in the account at the end of a fiscal year does not revert to the State General Fund and the balance in the account must be carried forward to the next fiscal year. Any money remaining in the account that is not committed for expenditure after 2 fiscal years following the date on which the money is paid as a fee reverts to the State General Fund. All claims against the account must be paid as other claims against the State are paid. The money in the account must be used to pay the costs of administering the state administrative program. 5. In developing and revising any state plan for health planning and development, the Department shall consider, among other things, the amount of money available from the Federal Government for health planning and development and the conditions attached to the acceptance of that money, and the limitations of legislative appropriations for health planning and development.

Nev. Rev. Stat. § 439A.082 Director to contract with Nevada System of Higher Education to collect and analyze information from health facilities and purchasers of health care.

The Director, in collaboration with the Medicaid Division of the Nevada Health Authority, shall contract with the Nevada System of Higher Education to collect and analyze information from health facilities and purchasers of health care to: 1. Respond to requests for information from the Legislature. 2. Provide technical assistance to purchasers of health care. 3. Provide the Department with information necessary to carry out the provisions of this chapter. 4. Provide other persons with information relating to the cost of health care.

Nev. Rev. Stat. § 439A.083 Director to establish procedure for review of statutes, regulations and standards governing approval, licensing or certification of health facilities.

The Director shall establish procedures for the review of all statutes, regulations and standards governing the approval, licensing or certification of health facilities. The procedures must provide for participation in the review by providers of health care and the general public.

Nev. Rev. Stat. § 439A.086 Chief Research and Statistical Analyst: Position created.

The position of Chief Research and Statistical Analyst is hereby created in the Division of Public and Behavioral Health of the Department. This position is in the unclassified service of the State.

Nev. Rev. Stat. § 439A.100 Approval of Director required for certain projects; criteria for review of application.

1. Except as otherwise provided in this section, in a county whose population is less than 100,000, or in an incorporated city or unincorporated town whose population is less than 25,000 that is located in a county whose population is 100,000 or more, no person may undertake any proposed expenditure for new construction by or on behalf of a health facility in excess of the greater of $2,000,000 or such an amount as the Authority may specify by regulation, which under generally accepted accounting principles consistently applied is a capital expenditure, without first applying for and obtaining the written approval of the Director. The Health Care Purchasing and Compliance Division of the Authority shall not issue a new license or alter an existing license for such a project unless the Director has issued such an approval. 2. The provisions of subsection 1 do not apply to: (a) Any capital expenditure for: (1) The acquisition of land; (2) The construction of a facility for parking; (3) The maintenance of a health facility; (4) The renovation of a health facility to comply with standards for safety, licensure, certification or accreditation; (5) The installation of a system to conserve energy; (6) The installation of a system for data processing or communication; or (7) Any other project which, in the opinion of the Director, does not relate directly to the provision of any health service; (b) Any project for the development of a health facility that has received legislative approval and authorization; or (c) A project for the construction of a hospital in an unincorporated town if: (1) The population of the unincorporated town is more than 24,000; (2) No other hospital exists in the town; (3) No other hospital has been approved for construction or qualified for an exemption from approval for construction in the town pursuant to this section; and (4) The unincorporated town is at least a 45-minute drive from the nearest center for the treatment of trauma that is approved by the Administrator of the Division of Public and Behavioral Health of the Department pursuant to NRS 450B.236 . Ê Upon determining that a project satisfies the requirements for an exemption pursuant to this subsection, the Director shall issue a certificate which states that the project is exempt from the requirements of this section. 3. In reviewing an application for approval, the Director shall: (a) Comparatively assess applications for similar projects affecting the same geographic area; and (b) Base his or her decision on criteria established by the Director by regulation. The criteria must include: (1) The need for and the appropriateness of the project in the area to be served; (2) The financial feasibility of the project; (3) The effect of the project on the cost of health care; and (4) The extent to which the project is consistent with the purposes set forth in NRS 439A.020 and the priorities set forth in NRS 439A.081 , including, without limitation: (I) The impact of the project on other health care facilities; (II) The need for any equipment that the project proposes to add, the manner in which such equipment will improve the quality of health care and any protocols provided in the project for avoiding repetitive testing; (III) The impact of the project on disparate health outcomes for different populations in the area that will be served by the project; (IV) The manner in which the project will expand, promote or enhance the capacity to provide primary health care in the area that will be served by the project; (V) Any plan by the applicant to collect and analyze data concerning the effect of the project on health care quality and patient outcomes in the area served by the project; (VI) Any plan by the applicant for controlling the spread of infectious diseases; and (VII) The manner in which the applicant will coordinate with and support existing health facilities and practitioners, including, without limitation, mental health facilities, programs for the treatment and prevention of substance use disorders and providers of nursing services. 4. The Authority may by regulation require additional approval for a proposed change to a project which has previously been approved if the proposal would result in a change in the location of the project or a substantial increase in the cost of the project. 5. The decision of the Director is a final decision for the purposes of judicial review. 6. As used in this section, “hospital” has the meaning ascribed to it in NRS 449.012 .

Nev. Rev. Stat. § 439A.102 Approval of Director or designee required for closure or conversion of hospital in certain counties; regulations; contents of and criteria for review of application; exception.

1. Except as otherwise provided in this section, no person may close a hospital in a county whose population is 100,000 or more or convert a hospital in such a county into a different type of health facility without first applying for and obtaining the written approval of the Director or the designee of the Director. The Health Care Purchasing and Compliance Division of the Authority shall not issue a new license or alter an existing license for conversion to a different type of health facility unless the Director or the designee of the Director has issued such an approval. 2. The Director may adopt regulations which prescribe the process to apply for written approval pursuant to this section. 3. An applicant must provide any information requested by the Director or the designee of the Director for consideration of an application, which must include, without limitation, information related to: (a) The location of the hospital; (b) The ownership structure of the hospital; (c) Whether the closure or conversion is likely to benefit any other health facility in the same geographic area as the hospital in which any person with an ownership interest in the hospital also has an ownership interest; (d) An explanation of the need for the closure or conversion; (e) Data regarding the population served by the hospital in the 24 months immediately preceding the application; and (f) The manner in which and the locations where the population served by the hospital will be able to obtain the health services that were provided by the hospital during the 24 months following the closure or conversion of the hospital. 4. The Director or the designee of the Director shall not approve an application submitted pursuant to subsection 1 without considering the information required to be submitted pursuant to subsection 3. 5. The decision of the Director or the designee of the Director pursuant to this section is a final decision for the purposes of judicial review. 6. The provisions of this section do not apply to any person who ceases to operate hospitals in this State.

Nev. Rev. Stat. § 439A.104 Approval of Chief Medical Officer required for operation of certain medical helicopters; criteria for review of application.

1. No person may operate or undertake any proposed expenditure for the operation of a new medical helicopter that will provide medical helicopter services in an area located within 150 miles from the base of an existing medical helicopter without first applying for and obtaining the written approval of the Chief Medical Officer or the designee of the Chief Medical Officer. 2. Except as otherwise provided in subsection 3, the Chief Medical Officer or the designee of the Chief Medical Officer may approve an application submitted pursuant to subsection 1 only if the applicant demonstrates that: (a) Based on the needs of the specific population to be served by the new medical helicopter and on the projected number of persons who have or will have a need for the proposed service, the population to be served has a need for the new medical helicopter; (b) The existing medical helicopter services in the area to be served by the new medical helicopter cannot or will not meet the projected needs of the population to be served by the new medical helicopter; (c) The applicant has the financial stability to provide medical helicopter services to the population to be served by the new medical helicopter for a significant period of time; (d) The new medical helicopter will result in a significant savings in costs for users of and payors for medical helicopter services; (e) The new medical helicopter will not have an adverse effect on the quality of care provided to users of medical helicopter services and will not have an unnecessarily negative effect on the cost of medical helicopter services for users of or payors for such services; and (f) The approval of the application will not adversely affect an existing provider of medical helicopter services. 3. The Chief Medical Officer or the designee of the Chief Medical Officer shall not approve an application submitted pursuant to subsection 1 if: (a) The applicant fails to provide sufficient, relevant, demonstrative evidence for the approval of the application; or (b) The evidence opposing the application outweighs the evidence supporting the application. 4. In determining whether to approve an application submitted pursuant to subsection 1, the Chief Medical Officer or the designee of the Chief Medical Officer shall: (a) Contact existing providers of medical helicopter services, ensure that existing providers of medical helicopter services have an opportunity to participate in any public hearing concerning the application, and seek the input of existing providers of medical helicopter services concerning the application; and (b) Consider: (1) The level of medical care to be provided by the applicant to the population to be served by the new medical helicopter; (2) The impact of the new medical helicopter on the rates, quality of service and safety of existing providers of medical helicopter services and on the level of medical care provided by such providers; (3) The effect of the new medical helicopter on the cost of health care services; and (4) Any other information the Chief Medical Officer or the designee of the Chief Medical Officer deems relevant. 5. An applicant whose application is rejected pursuant to this section may appeal the decision of the Chief Medical Officer or the designee of the Chief Medical Officer to the State Board of Health. The decision of the State Board of Health is a final decision for the purposes of judicial review. 6. As used in this section, “medical helicopter” means a helicopter especially designed, constructed, modified or equipped to be used for the transportation of injured or sick persons. The term does not include any commercial helicopter carrying passengers on regularly scheduled flights.

Nev. Rev. Stat. § 439A.111 Definitions.

As used in NRS 439A.111 to 439A.122, inclusive, unless the context otherwise requires, the words and terms defined in NRS 439A.112 and 439A.114 have the meanings ascribed to them in those sections.

Nev. Rev. Stat. § 439A.112 “Provider of health care” defined.

“Provider of health care” has the meaning ascribed to it in NRS 629.031.

Nev. Rev. Stat. § 439A.114 “Working Group” defined.

“Working Group” means the Health Care Workforce Working Group established pursuant to NRS 439A.118.

Nev. Rev. Stat. § 439A.116 Establishment of database of certain information relating to renewal of license, certificate or registration; data request provided to certain professional licensing boards; confidentiality of information; duties of Director.

1. The Director shall establish and maintain a database of information collected from applicants for the renewal of a license, certificate or registration as a provider of health care. The information in the database must include, for each applicant from whom such information is collected: (a) The type of license, certificate or registration held by the applicant; (b) The race and ethnicity of the applicant; (c) The sex of the applicant; (d) The primary language spoken by the applicant; (e) The specialty area in which the applicant practices; (f) Any other jurisdiction where the applicant holds the same type of license, certificate or registration that the applicant is currently renewing; (g) The county of this State in which the applicant spends the majority of his or her working hours; (h) The address of each location at which the applicant practices or intends to practice and the percentage of working hours spent by the applicant at each location; (i) The type of practice in which the applicant engages, including, without limitation, individual private practice, group private practice, multispecialty group private practice, government or nonprofit; (j) The settings in which the applicant practices, including, without limitation, hospitals, clinics and academic settings; (k) Whether the applicant utilizes telehealth, as defined in NRS 629.515 , in his or her practice; (l) The education and primary and secondary specialties of the applicant; (m) The average number of hours worked per week by the applicant and the total number of weeks worked by the applicant during the immediately preceding calendar year; (n) The percentages of working hours during which the applicant engages in patient care and other activities, including, without limitation, teaching, research and administration; (o) The types of patients whom the applicant serves, including, without limitation, newborns, children, adolescents, adults, senior citizens, pregnant persons, veterans, incarcerated persons, persons with disabilities, persons who speak a language other than English, persons who are recipients of Medicaid or Medicare and persons who pay on a sliding fee scale; (p) Any planned major changes to the practice of the applicant within the immediately following 5 years, including, without limitation, retirement, relocation or significant changes in working hours; and (q) Any other information prescribed by regulation of the Director. 2. The Director shall develop and make available to each professional licensing board that licenses, certifies or registers providers of health care an electronic data request that solicits the information described in subsection 1 from an applicant for the renewal of such a license, certificate or registration. 3. Except as otherwise provided in this subsection, information included in the database is confidential and not a public record. The Director shall: (a) Take all necessary measures to ensure the confidentiality of the identity of providers of health care to whom information in the database pertains, including, without limitation, measures to ensure that the identity of a provider of health care is not ascertainable due to his or her reported profession or the reported location at which he or she practices. (b) Make data from the database that does not contain any information that could be used to identify an applicant for or the holder of a license, certificate or registration as a provider of health care available to the Working Group. The Working Group may use such data to support the recommendations made pursuant to NRS 439A.121 or include such data in any report published pursuant to that section. (c) Publish an annual report of data from the database that does not contain any information that could be used to identify an applicant for or holder of a license, certificate or registration as a provider of health care. (d) Analyze the data in the database and make periodic reports to the Legislature, the Department and other agencies of the Executive Branch of the State Government concerning ways in which to: (1) Attract more persons, including, without limitation, members of underrepresented groups, to pursue the education necessary to practice as a provider of health care and practice as a provider of health care in this State; and (2) Improve health outcomes and public health in this State.

Nev. Rev. Stat. § 439A.118 Health Care Workforce Working Group: Establishment; membership; Chair; meetings; quorum; service without compensation; members holding public office or employed by governmental entity; administrative support.

1. The Director shall establish the Health Care Workforce Working Group within the Department. The Director shall appoint to the Working Group providers of health care and representatives of: (a) Groups that represent providers of health care and consumers of health care; (b) The Nevada System of Higher Education, universities, state colleges, community colleges and other institutions in this State that train providers of health care; (c) The Department of Human Services; and (d) Professional licensing boards that license, certify or register providers of health care. 2. The Director shall appoint a Chair of the Working Group. The Working Group shall meet at the call of the Chair. A majority of the members of the Working Group constitutes a quorum and is required to transact any business of the Working Group. 3. The members of the Working Group serve without compensation and are not entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally. 4. A member of the Working Group who is an officer or employee of this State or a political subdivision of this State must be relieved from his or her duties without loss of regular compensation to prepare for and attend meetings of the Working Group and perform any work necessary to carry out the duties of the Working Group in the most timely manner practicable. A state agency or political subdivision of this State shall not require an officer or employee who is a member of the Working Group to: (a) Make up the time he or she is absent from work to carry out his or her duties as a member of the Working Group; or (b) Take annual leave or compensatory time for the absence. 5. The Department shall provide such administrative support to the Working Group as is necessary to carry out the duties of the Working Group.

Nev. Rev. Stat. § 439A.121 Health Care Workforce Working Group: Duties; reports.

1. The Working Group shall: (a) Make recommendations to the Director concerning the information included in the database pursuant to NRS 439A.116 ; (b) Analyze the information contained in the database; and (c) Make recommendations to the Department of Human Services, the Department of Education, the Board of Regents of the University of Nevada, the Legislature, professional licensing boards that license, certify or register providers of health care and other relevant persons and entities concerning ways in which to: (1) Attract more persons, including, without limitation, members of underrepresented groups, to pursue the education necessary to practice as a provider of health care and practice as a provider of health care in this State; and (2) Improve health outcomes and public health in this State. 2. The Working Group may publish reports of any of its findings or recommendations.

Nev. Rev. Stat. § 439A.122 Regulations; contracts and agreements; gifts, grants and donations.

1. The Director may: (a) Adopt any regulations necessary to carry out the provisions of NRS 439A.111 to 439A.122 , inclusive; (b) Enter into any contracts or agreements necessary to carry out the provisions of NRS 439A.111 to 439A.122 , inclusive; and (c) Apply for and accept any gifts, grants and donations to carry out the provisions of NRS 439A.111 to 439A.122 , inclusive. 2. If the Director enters into a contract or agreement pursuant to this section for the establishment or maintenance of the database, the analysis of data or the issuance of reports pursuant to NRS 439A.116 , the contract must provide the Director with unrestricted access to any data maintained by the contracting entity and any analysis or reporting performed by the contracting entity.

Nev. Rev. Stat. § 439A.124 Data request to Board of Medical Examiners and State Board of Osteopathic Medicine for certain information concerning physicians; confidentiality of information; posting of report on Internet website.

1. The Department shall develop and make available to the Board of Medical Examiners and the State Board of Osteopathic Medicine an electronic data request to be completed by an applicant for the renewal of a license as a physician or a biennial registration pursuant to NRS 630.267 . The electronic data request must solicit from each such applicant the following information: (a) Whether the applicant is employed by a hospital, a health system or an entity owned by a health system or practices independently from a hospital, a health system or an entity owned by a health system; (b) If the applicant is employed by a hospital, a health system or an entity owned by a health system, the name of the hospital or health system or the entity and the health system that owns the entity, as applicable; (c) If the applicant is employed by an entity other than a hospital, a health system or an entity owned by a health system, the name of the legal entity which owns the practice and any assumed or fictitious name of that entity known to the applicant; and (d) If the applicant practices independently from a hospital, a health system or an entity owned by a health system, the name of the practice of the applicant. 2. The Department shall collect and maintain the information collected pursuant to subsection 1. Such information is confidential and any reporting of the information maintained pursuant to this section by the Department must be in an aggregate form that does not reveal the identity of any physician. 3. The Department shall annually prepare and post on an Internet website maintained by the Department a report based on the data collected pursuant to subsection 1 that analyzes trends in the employment and practices of physicians in this State.

Nev. Rev. Stat. § 439A.126 Notification to Department concerning certain transactions involving hospitals or physician group practices; posting of information and report on Internet website; administrative penalties; notification of licensing board of noncompliance by physician group practice.

1. A hospital shall notify the Department of any merger, acquisition or joint venture with any entity, including, without limitation, a physician group practice, to which the hospital is a party or any contract for the management of the hospital not later than 60 days after the finalization of the transaction or execution of the contract for management, as applicable. 2. A physician group practice or a person who owns all or substantially all of a physician group practice shall notify the Department of a transaction described in subsection 3 to which the physician group practice or person, as applicable, is a party or any contract for the management of the physician group practice not later than 60 days after the finalization of the transaction or execution of the contract for management, as applicable, if: (a) The physician group practices that are parties to the transaction or contract for management or that are owned by those parties represent at least 20 percent of the physicians who practice any specialty in a primary service area; and (b) The physician group practice represents the largest number of physicians of any physician group practice that is a party to or owned by a party to the transaction or contract for management. 3. Notice must be provided pursuant to subsection 2 for any: (a) Merger of, consolidation of or other affiliation between physician group practices, persons who own physician group practices or any combination thereof; (b) The acquisition of all or substantially all of the properties and assets of a physician group practice; (c) The acquisition of all or substantially all of the capital stock, membership interests or other equity interests of a physician group practice; (d) The employment of all or substantially all of the physicians in a physician group practice; or (e) The acquisition of an insolvent physician group practice. 4. Notice pursuant to subsection 1 or 2 must be provided in the form prescribed by the Department and must include, without limitation: (a) The name of each party to the transaction or contract for management, as applicable; (b) A description of the nature of the proposed relationship of the parties to the transaction or contract for management, as applicable; (c) The names and any specialties of each physician who is a party or employed by or affiliated with a physician group practice that is a party to or is owned by a party to the transaction or contract for management, as applicable; (d) The name and address of each business entity that will provide health services after the transaction or contract for management, as applicable; (e) A description of the health services to be provided at each location of a business entity described in paragraph (d); and (f) The primary service area to be served by each location of a business entity described in paragraph (d). 5. The Department shall: (a) Post the information contained in the notices provided pursuant to subsections 1 and 2 on an Internet website maintained by the Department; and (b) Annually prepare a report regarding market transactions and concentration in health care based on the information in the notices and post the report on an Internet website maintained by the Department. 6. If a hospital fails to provide timely notice to the Department pursuant to subsection 1 and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department may impose against the hospital an administrative penalty of not more than $5,000 for each day of such failure. 7. If a physician group practice or a person who owns all or substantially all of a physician group practice fails to provide timely notice to the Department pursuant to subsection 2 and the failure was not caused by excusable neglect, technical problems or other extenuating circumstances, the Department shall notify the Board of Medical Examiners or the State Board of Osteopathic Medicine, or both, as applicable, of such failure. 8. Any money collected as administrative penalties pursuant to this section must be accounted for separately and used by the Department to carry out the provisions of NRS 439A.111 to 439A.126 , inclusive, or for any other purpose authorized by the Legislature. 9. As used in this section: (a) “Physician group practice” means any business entity organized for the purpose of the practice of medicine or osteopathic medicine by more than one physician. (b) “Primary service area” means an area comprising the smallest number of zip codes from which the hospital or physician group practice draws at least 75 percent of patients.

Nev. Rev. Stat. § 439A.130 Definitions.

As used in NRS 439A.130 to 439A.185, inclusive, the words and terms defined in NRS 439A.135 to 439A.165, inclusive, have the meanings ascribed to them in those sections.

Nev. Rev. Stat. § 439A.140 “Employer” defined.

“Employer” means a person who sponsors a J-1 visa physician and enters into a contract with the J-1 visa physician.

Nev. Rev. Stat. § 439A.150 “J-1 visa physician” defined.

“J-1 visa physician” means a foreign medical graduate who: 1. Has an offer of full-time employment at a health facility in an area designated by the Federal Government as a health care professional shortage area or at a health facility which serves patients from such a designated area, and agrees to begin employment at that facility within 90 days after receiving a J-1 visa waiver; 2. Signs a contract to continue to work at that health facility for a total of 40 hours per week for not less than 3 years; 3. Applies for or has been issued a license to practice medicine pursuant to chapter 630 of NRS; and 4. Applies for a J-1 visa waiver.

Nev. Rev. Stat. § 439A.155 “J-1 visa waiver” defined.

“J-1 visa waiver” means a waiver of the 2-year foreign residence requirement authorized pursuant to 8 U.S.C. § 1182(e) for a physician who holds a J-1 visa.

Nev. Rev. Stat. § 439A.160 “Letter of support” defined.

“Letter of support” means a letter issued by the Program to the Waiver Review Division of the United States Department of State stating that a request for a J-1 visa waiver is in the public interest.

Nev. Rev. Stat. § 439A.170 Establishment; regulations; application fees; accounting and use of money; administration of Program.

1. The Physician Visa Waiver Program is hereby established in the Division. The Administrator shall administer the Program consistent with federal law and the provisions of NRS 439A.130 to 439A.185 , inclusive, and the regulations adopted pursuant thereto. The Program must: (a) Provide for the oversight of employers and J-1 visa physicians in this State; (b) Evaluate applications for letters of support submitted pursuant to NRS 439A.175 ; and (c) Issue letters of support. 2. The State Board of Health shall adopt regulations: (a) Providing for the administration of the Program; and (b) Establishing an application fee, not to exceed $2,000, payable to the Program by an employer or J-1 visa physician who applies for a letter of support pursuant to NRS 439A.175 . 3. Any application fees collected by the Program are not refundable and must be deposited in the State Treasury and accounted for separately in the State General Fund. Any interest and income earned on the money in the account, after deducting any applicable charges, must be credited to the account. Any money remaining in the account at the end of a fiscal year does not revert to the State General Fund. All claims against the account must be paid as other claims against the State are paid. The money in the account must be used to pay the costs of administering the Program and for training and educating J-1 visa physicians and employers. 4. The Division is hereby designated as the agency of this State to cooperate with the Federal Government in the administration of the Program.

Nev. Rev. Stat. § 439A.175 Application for letter of support; qualifications; conditions for contract between employer and J-1 visa physician.

1. An employer or J-1 visa physician who seeks a letter of support must: (a) Apply to the Program for a letter of support in the manner prescribed by the State Board of Health; (b) Include with the application proof satisfactory to the Division that the J-1 visa physician is licensed to practice medicine pursuant to chapter 630 of NRS or has submitted an application for a license to practice medicine pursuant to chapter 630 of NRS; and (c) Include with the application a copy of the contract entered into by the employer and the J-1 visa physician. 2. The contract entered into by the employer and the J-1 visa physician: (a) Must comply with: (1) All applicable provisions of federal law; and (2) The regulations adopted by the State Board of Health pursuant to NRS 439A.130 to 439A.185 , inclusive. (b) Must not include: (1) A noncompete clause or restrictive covenant that prevents or discourages the J-1 visa physician from continuing to practice after the term of the contract expires; or (2) Any provision authorizing termination without cause. 3. The Program may provide a letter of support to a J-1 visa physician: (a) If the Program determines that the waiver is in the public interest; (b) If the contract entered into by the employer and the J-1 visa physician complies with the provisions of this section; and (c) Upon payment of the prescribed application fee.

Nev. Rev. Stat. § 439A.180 Violations and penalties.

1. In addition to any other penalty prescribed by law: (a) A J-1 visa physician who: (1) Does not provide the required minimum hours of health services in an area designated by the Federal Government as a health care professional shortage area; (2) Refuses to provide health services to medically underserved persons in this State; or (3) Violates any provision of state law governing physicians or the provision of health services; or (b) An employer who: (1) Employs a J-1 visa physician in a manner other than that specified in the contract entered into by the employer and the J-1 visa physician; (2) Violates any provision of NRS 439A.130 to 439A.185 , inclusive, or any regulation adopted pursuant thereto; or (3) Violates any provision of state law governing physicians or the provision of health services, Ê is subject to the penalty prescribed by the State Board of Health pursuant to subsection 2. 2. The State Board of Health shall adopt regulations establishing: (a) The procedure for reporting a violation of this section; and (b) The penalty for any violation of this section.

Nev. Rev. Stat. § 439A.185 Civil and criminal immunity for reporting violations.

A person who reports or provides any information concerning a violation of NRS 439A.130 to 439A.185, inclusive, or any regulation adopted pursuant thereto, to a governmental entity is immune from any civil or criminal liability for that action.

Nev. Rev. Stat. § 439A.190 Official recognition required; duty of Department to maintain Internet website; certain activities deemed not to be unfair methods of competition or unfair or deceptive trade practices.

1. A primary care practice shall not represent itself as a patient-centered medical home unless the primary care practice is certified, accredited or otherwise officially recognized as a patient-centered medical home by a nationally recognized organization for the accrediting of patient-centered medical homes. 2. The Department shall post on an Internet website maintained by the Department links to nationally recognized organizations for the accrediting of patient-centered medical homes and any other information specified by the Department to allow patients to find a patient-centered medical home that meets the requirements of this section and any regulations adopted pursuant thereto. 3. Any coordination between an insurer and a patient-centered medical home or acceptance of an incentive from an insurer by a patient-centered medical home that is authorized by federal law shall not be deemed to be an unfair method of competition or an unfair or deceptive trade practice or other act or practice prohibited by the provisions of chapter 598 or 686A of NRS. 4. As used in this section: (a) “Patient-centered medical home” means a primary care practice that: (1) Offers patient-centered, continuous, culturally competent, evidence-based, comprehensive health care that is led by a provider of primary care and a team of health care providers, coordinates the health care needs of the patient and uses enhanced communication strategies and health information technology; and (2) Emphasizes enhanced access to practitioners and preventive care to improve the outcomes for and experiences of patients and lower the costs of health services. (b) “Primary care practice” means a federally qualified health center, as defined in 42 U.S.C. § 1396d(l)(2)(B), or a business where health services are provided by one or more advanced practice registered nurses or one or more physicians who are licensed pursuant to chapter 630 or 633 of NRS and who practice in the area of family practice, internal medicine or pediatrics.

Nev. Rev. Stat. § 439A.0195 “Practitioner” defined.

“Practitioner” means a physician licensed under chapter 630, 630A or 633 of NRS, genetic counselor, dentist, licensed nurse, dispensing optician, optometrist, licensed physical therapist, podiatric physician, licensed psychologist, chiropractic physician, naprapath, doctor of Oriental medicine in any form, medical laboratory director or technician, pharmacist or other person whose principal occupation is the provision of services for health.

Nev. Rev. Stat. § 439A.200 Definitions.

As used in NRS 439A.200 to 439A.290, inclusive, unless the context otherwise requires, the words and terms defined in NRS 439A.205, 439A.207 and 439A.210 have the meanings ascribed to them in those sections.

Nev. Rev. Stat. § 439A.207 “Potentially preventable readmission” defined.

“Potentially preventable readmission” means an unplanned readmission of a patient which: 1. Occurs not more than 30 days after the patient is discharged; 2. Is clinically related to the initial admission; and 3. Was preventable.

Nev. Rev. Stat. § 439A.210 Surgical center for ambulatory patients” defined.

“Surgical center for ambulatory patients” has the meaning ascribed to it in NRS 449.019.

Nev. Rev. Stat. § 439A.220 Information concerning hospitals: Establishment of program; information to be collected, maintained and provided through program.

1. The Authority shall establish and maintain a program to increase public awareness of health care information concerning the hospitals in this State. The program must be designed to assist consumers with comparing the quality of care provided by the hospitals in this State and the charges for that care. 2. The program must include, without limitation, the collection, maintenance and provision of information concerning: (a) Inpatients and outpatients of each hospital in this State as reported in the forms submitted pursuant to NRS 449.485 ; (b) The quality of care provided by each hospital in this State as determined by applying measures of quality endorsed by the entities described in subparagraph (1) of paragraph (b) of subsection 1 of NRS 439A.230 , expressed as a number of events and rate of occurrence, if such measures can be applied to the information reported in the forms submitted pursuant to NRS 449.485 ; (c) How consistently each hospital follows recognized practices to prevent the infection of patients, to speed the recovery of patients and to avoid medical complications of patients; (d) For each hospital, the total number of patients discharged, the average length of stay and the average billed charges, reported by diagnosis-related groups for inpatients and for the 50 medical treatments for outpatients that the Authority determines are most useful for consumers; (e) The total number of patients discharged from the hospital and the total number of potentially preventable readmissions, which must be expressed as a total number and a rate of occurrence of potentially preventable readmissions, and the average length of stay and the average billed charges for those potentially preventable readmissions; (f) To the extent that money is available for that purpose, for each hospital, the name of each physician who performed a surgical procedure in the hospital and the total number of surgical procedures performed by the physician, reported by diagnosis-related group if the information is available and by principal diagnosis, principal surgical procedure and secondary surgical procedure; and (g) Any other information relating to the charges imposed and the quality of the services provided by the hospitals in this State which the Authority determines is: (1) Useful to consumers; (2) Nationally recognized; and (3) Reported in a standard and reliable manner. 3. As used in this section, “diagnosis-related group” means groupings of medical diagnostic categories used as a basis for hospital payment schedules by Medicare and other third-party health care plans.

Nev. Rev. Stat. § 439A.230 Information concerning hospitals: Regulations; deadline for submission of information; notice of failure to provide information to be sent to Health Care Purchasing and Compliance Division.

1. The Authority shall, by regulation: (a) Prescribe the information that each hospital in this State must submit to the Authority for the program established pursuant to NRS 439A.220 . (b) Prescribe the measures of quality for hospitals that are required pursuant to paragraph (b) of subsection 2 of NRS 439A.220 . In adopting the regulations, the Authority shall: (1) Use the measures of quality endorsed by the Agency for Healthcare Research and Quality, the National Quality Forum, Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, a quality improvement organization of the Centers for Medicare and Medicaid Services and the Joint Commission; (2) Prescribe a reasonable number of measures of quality which must not be unduly burdensome on the hospitals; and (3) Take into consideration the financial burden placed on the hospitals to comply with the regulations. Ê The measures prescribed pursuant to this paragraph must report health outcomes of hospitals, which do not necessarily correlate with the inpatient diagnosis-related groups or the outpatient treatments that are posted on the Internet website pursuant to NRS 439A.270 . (c) Prescribe the manner in which a hospital must determine whether the readmission of a patient must be reported pursuant to NRS 439A.220 as a potentially preventable readmission and the form for submission of such information. (d) Require each hospital to: (1) Provide the information prescribed in paragraphs (a), (b) and (c) in the format required by the Authority; and (2) Report the information separately for inpatients and outpatients. 2. The information required pursuant to this section and NRS 439A.220 must be submitted to the Authority not later than 45 days after the last day of each calendar month. 3. If a hospital fails to submit the information required pursuant to this section or NRS 439A.220 or submits information that is incomplete or inaccurate, the Authority shall send a notice of such failure to the hospital and to the Health Care Purchasing and Compliance Division of the Authority.

Nev. Rev. Stat. § 439A.240 Information concerning surgical centers for ambulatory patients: Establishment of program; information to be collected, maintained and provided through program.

1. The Authority shall establish and maintain a program to increase public awareness of health care information concerning the surgical centers for ambulatory patients in this State. The program must be designed to assist consumers with comparing the quality of care provided by the surgical centers for ambulatory patients in this State and the charges for that care. 2. The program must include, without limitation, the collection, maintenance and provision of information concerning: (a) The charges imposed on outpatients by each surgical center for ambulatory patients in this State as reported in the forms submitted pursuant to NRS 439A.250 ; (b) The quality of care provided by each surgical center for ambulatory patients in this State as determined by applying uniform measures of quality prescribed by the Authority pursuant to NRS 439A.250 ; (c) How consistently each surgical center for ambulatory patients follows recognized practices to prevent the infection of patients, to speed the recovery of patients and to avoid medical complications of patients; (d) For each surgical center for ambulatory patients, the total number of patients discharged and the average billed charges, reported for 50 medical treatments for outpatients that the Authority determines are most useful for consumers; (e) To the extent that money is available for that purpose, for each surgical center for ambulatory patients, the name of each physician who performed a surgical procedure in the surgical center for ambulatory patients and the total number of surgical procedures performed by the physician, reported by type of medical treatment, principal diagnosis and, if the information is available, by principal surgical procedure and secondary surgical procedure; and (f) Any other information relating to the charges imposed and the quality of the services provided by the surgical centers for ambulatory patients in this State which the Authority determines is: (1) Useful to consumers; (2) Nationally recognized; and (3) Reported in a standard and reliable manner.

Nev. Rev. Stat. § 439A.250 Information concerning surgical centers for ambulatory patients: Regulations; deadline for submission of information; notice of failure to provide information to be sent to Health Care Purchasing and Compliance Division.

1. The Authority shall, by regulation: (a) Prescribe the information that each surgical center for ambulatory patients in this State must submit to the Authority for the program as set forth in NRS 439A.240 and the form for submission of such information. (b) Prescribe the measures of quality for surgical centers for ambulatory patients that are required pursuant to paragraph (b) of subsection 2 of NRS 439A.240 . In adopting the regulations, the Authority shall: (1) Use measures of quality which are substantially similar to those required pursuant to subparagraph (1) of paragraph (b) of subsection 1 of NRS 439A.230 ; (2) Prescribe a reasonable number of measures of quality which must not be unduly burdensome on the surgical centers for ambulatory patients; and (3) Take into consideration the financial burden placed on the surgical centers for ambulatory patients to comply with the regulations. Ê The measures prescribed pursuant to this paragraph must report health outcomes of surgical centers for ambulatory patients, which do not necessarily correlate with the outpatient treatments posted on the Internet website pursuant to NRS 439A.270 . (c) Require each surgical center for ambulatory patients to provide the information prescribed in paragraphs (a) and (b) in the format required by the Authority. (d) Prescribe which surgical centers for ambulatory patients in this State must participate in the program established pursuant to NRS 439A.240 . 2. The information required pursuant to this section and NRS 439A.240 must be submitted to the Authority not later than 45 days after the last day of each calendar month. 3. If a surgical center for ambulatory patients fails to submit the information required pursuant to this section or NRS 439A.240 or submits information that is incomplete or inaccurate, the Authority shall send a notice of such failure to the surgical center for ambulatory patients and to the Health Care Purchasing and Compliance Division of the Authority.

Nev. Rev. Stat. § 439A.260 Authority to collect and maintain information and make summary of information available to certain persons; information to be aggregated.

1. The Authority shall collect and maintain all information that it receives from the hospitals and surgical centers for ambulatory patients in this State pursuant to NRS 439A.220 to 439A.250 , inclusive. Upon request, the Authority shall make a summary of the information available to: (a) Consumers of health care; (b) Providers of health care; (c) Representatives of the health insurance industry; and (d) The general public. 2. The Authority shall ensure that the information it provides pursuant to this section is aggregated so as not to reveal the identity of a specific inpatient or outpatient of a hospital or of a surgical center for ambulatory patients.

Nev. Rev. Stat. § 439A.270 Internet website for information concerning hospitals and surgical centers for ambulatory patients: Establishment; information to be included on website; presentation of information on website; duties of Authority.

1. The Authority shall establish and maintain an Internet website that includes the information concerning the charges imposed and the quality of the services provided by the hospitals and surgical centers for ambulatory patients in this State as required by the programs established pursuant to NRS 439A.220 and 439A.240 . The information must: (a) Include, for each hospital in this State, the: (1) Total number of patients discharged, the average length of stay and the average billed charges, reported for the diagnosis-related groups for inpatients and the 50 medical treatments for outpatients that the Authority determines are most useful for consumers; (2) Total number of potentially preventable readmissions reported pursuant to NRS 439A.220 , the rate of occurrence of potentially preventable readmissions, and the average length of stay and average billed charges of those potentially preventable readmissions, reported by the diagnosis-related group for inpatients for which the patient originally received treatment at a hospital; and (3) Name of each physician who performed a surgical procedure in the hospital and the total number of surgical procedures performed by each physician in the hospital, reported for the most frequent surgical procedures that the Authority determines are most useful for consumers if the information is available; (b) Include, for each surgical center for ambulatory patients in this State, the: (1) Total number of patients discharged and the average billed charges, reported for 50 medical treatments for outpatients that the Authority determines are most useful for consumers; and (2) Name of each physician who performed a surgical procedure in the surgical center for ambulatory patients and the total number of surgical procedures performed by each physician in the surgical center for ambulatory patients, reported for the most frequent surgical procedures that the Authority determines are most useful for consumers; (c) Be presented in a manner that allows a person to view and compare the information for the hospitals by: (1) Geographic location of each hospital; (2) Type of medical diagnosis; and (3) Type of medical treatment; (d) Be presented in a manner that allows a person to view and compare the information for the surgical centers for ambulatory patients by: (1) Geographic location of each surgical center for ambulatory patients; (2) Type of medical diagnosis; and (3) Type of medical treatment; (e) Be presented in a manner that allows a person to view and compare the information separately for: (1) The inpatients and outpatients of each hospital; and (2) The outpatients of each surgical center for ambulatory patients; (f) Be readily accessible and understandable by a member of the general public; (g) Include the annual summary of reports of sentinel events prepared for each health facility pursuant to paragraph (c) of subsection 1 of NRS 439.840 ; (h) Include the annual summary of reports of sentinel events prepared pursuant to paragraph (d) of subsection 1 of NRS 439.840 ; (i) Include the reports of information prepared for each medical facility pursuant to paragraph (b) of subsection 4 of NRS 439.847 ; (j) Include a link to electronic copies of all reports, summaries, compilations and supplementary reports required by NRS 449.450 to 449.530 , inclusive; (k) Include, for each hospital with 100 or more beds, a summary of financial information which is readily understandable by a member of the general public and which includes, without limitation, a summary of: (1) The expenses of the hospital which are attributable to providing community benefits and in-kind services as reported pursuant to NRS 449.490 ; (2) The capital improvement report submitted to the Authority pursuant to NRS 449.490 ; (3) The net income of the hospital; (4) The net income of the consolidated corporation, if the hospital is owned by such a corporation and if that information is publicly available; (5) The operating margin of the hospital; (6) The ratio of the cost of providing care to patients covered by Medicare to the charges for such care; (7) The ratio of the total costs to charges of the hospital; and (8) The average daily occupancy of the hospital; and (l) Provide any other information relating to the charges imposed and the quality of the services provided by the hospitals and surgical centers for ambulatory patients in this State which the Authority determines is: (1) Useful to consumers; (2) Nationally recognized; and (3) Reported in a standard and reliable manner. 2. The Authority shall: (a) Publicize the availability of the Internet website; (b) Update the information contained on the Internet website at least quarterly; (c) Ensure that the information contained on the Internet website is accurate and reliable; (d) Ensure that the information reported by a hospital or surgical center for ambulatory patients for inpatients and outpatients which is contained on the Internet website is expressed as a total number and as a rate, and must be reported in a manner so as not to reveal the identity of a specific inpatient or outpatient of a hospital or surgical center for ambulatory patients; (e) Post a disclaimer on the Internet website indicating that the information contained on the website is provided to assist with the comparison of hospitals and is not a guarantee by the Authority or its employees as to the charges imposed by the hospitals in this State or the quality of the services provided by the hospitals in this State, including, without limitation, an explanation that the actual amount charged to a person by a particular hospital may not be the same charge as posted on the website for that hospital; (f) Provide on the Internet website established pursuant to this section a link to the Internet website of the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services; and (g) Upon request, make the information that is contained on the Internet website available in printed form. 3. As used in this section, “diagnosis-related group” means groupings of medical diagnostic categories used as a basis for hospital payment schedules by Medicare and other third-party health care plans.

Nev. Rev. Stat. § 439A.280 Suspension of certain components of program or duties of Authority if sufficient money not available; acceptance of gifts and grants.

1. On or before July 1 of each odd-numbered year, the Authority shall make a determination of whether sufficient money is available and authorized for expenditure to fund one or more components of the programs and other duties of the Authority relating to NRS 439A.200 to 439A.290 , inclusive. 2. The Authority shall temporarily suspend any components of the program or duties of the Authority, other than those set forth in NRS 439A.240 and 439A.250 , for which it determines pursuant to subsection 1 that sufficient money is not available. 3. The Authority may accept any gift, donation, bequest, grant or other source of money for the purpose of carrying out the provisions of NRS 439A.200 to 439A.290 , inclusive.

Nev. Rev. Stat. § 439A.290 Duty of Authority to consult; Authority allowed to contract with certain entities for analysis of information collected and maintained by Authority; regulations for review and release of information; annual report concerning requests for release of information.

1. In carrying out the provisions of NRS 439A.200 to 439A.290 , inclusive, the Authority: (a) Shall work in consultation with a quality improvement organization of the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services; and (b) May contract with the Nevada System of Higher Education or any appropriate, independent and qualified person or entity to analyze the information collected and maintained by the Authority pursuant to NRS 439A.200 to 439A.290 , inclusive. Such a contractor may release or publish or otherwise use information made available to it pursuant to the contract if the Authority determines that the information is accurate and the contractor complies with the regulations adopted pursuant to subsection 2. 2. The Authority shall adopt regulations for the review and release of information collected and maintained by the Authority pursuant to NRS 439A.200 to 439A.290 , inclusive. The regulations must require, without limitation, the Authority to review each request for information if the request is for purposes other than research. 3. The Authority shall, on or before July 1 of each year, submit to the Joint Interim Standing Committee on Health and Human Services a report concerning each request that is made pursuant to subsection 2 and the determination of the Authority with regard to each request.

Nev. Rev. Stat. § 439A.350 Definitions.

As used in NRS 439A.350 to 439A.398, inclusive, unless the context otherwise requires, the words and terms defined in NRS 439A.353 to 439A.365, inclusive, have the meanings ascribed to them in those sections.

Nev. Rev. Stat. § 439A.353 “Account” defined.

“Account” means the Statewide Health Care Access and Recruitment Program Account created by NRS 439A.368.

Nev. Rev. Stat. § 439A.356 “Certified area of need” defined.

“Certified area of need” means a critical shortage of providers of health care who practice a health care profession or specialty, a critical shortage of providers of health care in a geographic area of this State or a critical shortage of clinical services or expertise in this State or a geographic area of this State, as identified by the assessment conducted pursuant to NRS 439A.371.

Nev. Rev. Stat. § 439A.359 “Funding agreement” defined.

“Funding agreement” means a funding agreement between the Authority and a grantee entered into pursuant to NRS 439A.386.

Nev. Rev. Stat. § 439A.365 “Provider of health care” defined.

“Provider of health care” has the meaning ascribed to it in NRS 629.031.

Nev. Rev. Stat. § 439A.368 Statewide Health Care Access and Recruitment Program Account: Creation; administration; interest; nonreversion; uses; gifts, grants and donations.

1. There is hereby created in the State General Fund the Statewide Health Care Access and Recruitment Program Account. The Authority shall administer the Account. 2. Any interest earned on money in the Account, after deducting any applicable charges, must be credited to the Account. Money that remains in the Account at the end of a fiscal year does not revert to the State General Fund, and the balance in the Account must be carried forward to the next fiscal year. 3. Except as otherwise provided in subsection 4, money in the Account must be used to carry out the provisions of NRS 439A.350 to 439A.398 , inclusive. The Authority may use not more than 3.5 percent of the money in the Account to pay the administrative costs necessary to carry out those provisions. 4. With the approval of the Interim Finance Committee, the Director of the Authority may transfer money from the Account to another account for the purpose of obtaining additional federal financial participation under Medicaid. 5. The Authority may accept gifts, grants and donations to carry out the provisions of NRS 439A.350 to 439A.398 , inclusive. The Director of the Authority shall deposit such gifts, grants and donations into the Account.

Nev. Rev. Stat. § 439A.371 Assessment of health care needs; report to Governor and Legislature.

1. On or before July 1 of each even-numbered year, the Authority shall: (a) Conduct a comprehensive assessment of the health care needs in this State; and (b) Compile a report of the results of the assessment and submit the report to the Governor and the Director of the Legislative Counsel Bureau for transmittal to the Joint Interim Standing Committee on Health and Human Services and the next regular session of the Legislature. 2. The assessment conducted pursuant to paragraph (a) of subsection 1 must consist of: (a) A quantitative analysis of the health care workforce in this State, including, without limitation: (1) A determination of the total number of providers of health care in this State and the total number of providers of health care in this State who practice different professions and different specialties within those professions; (2) A determination of the total number of providers of health care who practice in different geographic areas of this State and the total number of providers of health care who practice different professions and different specialties within those geographic areas; and (3) A comparison of the numbers of providers of health care identified pursuant to subparagraphs (1) and (2) with benchmarks established by the Health Resources and Services Administration of the United States Department of Health and Human Services or nationally recognized organizations that prescribe such benchmarks; (b) A determination of the most critical shortages in the health care workforce of this State, prioritizing: (1) Essential health care professions and specialties and essential clinical services or expertise currently experiencing shortages; and (2) Geographic areas of this State that are experiencing the most critical shortages of providers of health care or clinical services or expertise; and (c) An identification of unmet needs for specific health technology and therapies, including, without limitation, genomic testing, clinical trials, cellular therapies and palliative care. 3. The report compiled pursuant to paragraph (b) of subsection 1 must include, without limitation: (a) A summary of the assessment conducted pursuant to paragraph (a) of subsection 1, including, without limitation: (1) An analysis of shortages of providers of health care, shortages of clinical services or expertise and unmet health needs in this State; and (2) A description of shortages of providers of health care and the shortages of clinical services or expertise by geographic region, including rural and urban areas; (b) A prioritized list of recommendations for allocating funding pursuant to NRS 439A.350 to 439A.398 , inclusive, in a manner that addresses the critical shortages and unmet needs identified in the assessment conducted pursuant to paragraph (a) of subsection 1; (c) Recommendations for legislation and regulatory changes to improve the recruitment and retention of providers of health care; and (d) An analysis of the effects of projects funded pursuant to NRS 439A.350 to 439A.398 , inclusive, on the health care workforce and health needs of this State. 4. As used in this section, “palliative care” means a multidisciplinary and patient- and family-centered approach to specialized medical care for a person with a serious illness, which approach focuses on the care of a patient throughout the continuum of an illness and involves addressing the physical, emotional, social and spiritual needs of the patient, as well as facilitating patient autonomy, access to information and choice of care. The term includes, without limitation, discussion of the goals of the patient for treatment and discussion of treatment options appropriate to the patient, including, where appropriate, hospice care and comprehensive management of pain and symptoms.

Nev. Rev. Stat. § 439A.374 Establishment and administration of Program; eligibility for grant.

1. The Authority shall, in accordance with NRS 439A.350 to 439A.398 , inclusive, establish and administer the Statewide Health Care Access and Recruitment Grant Program as a competitive program to award grants of money from the Account to entities described in subsection 2 seeking to address shortages of providers of health care or clinical services or expertise and difficulties in accessing health care identified in the assessment conducted pursuant to NRS 439A.371 . The Authority may adopt any regulations necessary to carry out the provisions of NRS 439A.350 to 439A.398 , inclusive. 2. The following entities are eligible to apply for a grant from the Account: (a) Entities that provide health care or coordinate or otherwise facilitate the provision of health care, including, without limitation: (1) Medical facilities and community health clinics; (2) Group practices of providers of health care; (3) Federally-qualified health centers, as defined in 42 U.S.C. § 1396d(l)(2)(B); (4) Accredited institutions of higher education that offer programs to train providers of health care, including, without limitation, residency and fellowship programs for providers of health care; (5) Entities that provide behavioral health care; (6) Facilities for the treatment of alcohol or other substance use disorders, as defined in NRS 449.00455 ; (7) Detoxification facilities or programs certified pursuant to NRS 458.025 ; (8) Substance use disorder prevention coalitions certified pursuant to NRS 458.033 ; and (9) Oncology organizations, including, without limitation, oncology organizations that: (I) Offer programs for transplantation and cellular therapy; (II) Provide or facilitate the provision of clinical trials; (III) Host fellowships in oncology and oncology subspecialties; or (IV) Have been designated as a comprehensive cancer center by the National Cancer Institute, or its successor organization; (b) Governmental entities; and (c) Nonprofit organizations that provide direct care to patients, training for providers of health care or services aimed at expanding access to health care. 3. To be eligible for a grant from the Account, a proposed project must: (a) Be designed to increase the number of providers of health care, improve the expertise of providers of health care or improve access to clinical services or innovative treatments. (b) Directly address one or more certified areas of need. (c) Include specific, measurable outcomes to demonstrate an increase in the number of providers of health care, improved access to health care and the enhanced capacity of the health care workforce in a manner that addresses the certified areas of need identified in paragraph (b). (d) Except for projects proposed by entities described in section 71113 of the One Big Beautiful Bill Act of 2025, Public Law No. 119-21, secure from the Federal Government or any other source, or receive from the Federal Government or any other source a commitment to provide, an amount of matching funds and in-kind contributions for which the total value is at least equal to the amount of the grant for which the applicant is applying. Matching funds from the Federal Government meet the requirements of this section only if the applicant demonstrates that the project qualifies for and is likely to receive such federal money. In-kind contributions may consist of, without limitation: (1) Construction or procurement of machinery or infrastructure; (2) Recruitment of providers of health care; (3) The provision of free health care; (4) Charitable contributions after the completion of the project; and (5) Unfunded research. (e) Demonstrate the potential for financial and operational sustainability after the expiration of the grant, including, without limitation, through: (1) Plans for continued staffing, budget sustainability and continued allocation of resources; and (2) An impact assessment concerning the potential long-term effects of the project on survival, quality of life and the experience of patients. (f) Demonstrate that: (1) All patient care funded by the grant will be provided in this State; or (2) After making a good faith effort to determine a manner in which to satisfy the requirement set forth in subparagraph (1), the applicant cannot feasibly satisfy that requirement. 4. Money awarded through a grant from the Account must not be used to supplant money previously budgeted for a proposed project.

Nev. Rev. Stat. § 439A.377 Application for grant.

An entity described in subsection 2 of NRS 439A.374 that wishes to receive a grant from the Account to support a project described in subsection 3 of NRS 439A.374 must apply to the Authority in the form prescribed by the Authority during an open application period established by the Authority. The application must include, without limitation: 1. A comprehensive proposal for the project to be funded by the grant that outlines: (a) The goals and objectives of the proposed project; (b) The specific certified areas of need that the proposed project will address; and (c) Detailed plans to recruit, retain or train providers of health care. 2. A detailed budget that clearly sets forth the projected costs and sources of funding for the proposed project and the manner in which that funding will be used to pay those projected costs. Such sources of funding must include, without limitation, the matching funds and in-kind contributions described in paragraph (d) of subsection 3 of NRS 439A.374 , where applicable. 3. If applicable, evidence of approval or commitment from the persons and entities that will provide the matching funds or in-kind contributions described in paragraph (d) of subsection 3 of NRS 439A.374 or otherwise contribute to or collaborate on the project. 4. Documentation of the qualifications and relevant experience of the applicant, including, without limitation: (a) A demonstrated ability to produce measurable, long-term improvements in rates of survival, quality of life and the experience of patients; and (b) The experience and organizational capacity necessary to implement and sustain the project successfully. 5. Identification of the key personnel who will be involved in the project and any relevant partnerships with persons and entities engaged in the provision of health care, educational institutions, governmental entities or other persons and entities. 6. A timeline for implementing the proposed project that includes, without limitation, defined milestones, measurable performance indicators and a plan for reporting progress and evaluating outcomes at regular intervals. 7. A detailed operational plan for the proposed project that: (a) Outlines staffing, facilities, equipment and other logistical requirements; and (b) Addresses potential challenges in recruiting and retaining providers of health care. 8. A plan for sustainability that addresses the manner in which the proposed project will continue to provide benefits after the expiration of the grant, including, without limitation, possible sources of funding, partnerships or strategies for reinvestment. 9. Any additional information required by regulation of the Authority for: (a) Assessing the feasibility, impact and sustainability of projects and the alignment of projects with the objectives set forth in subsection 3 of NRS 439A.374 ; or (b) Ensuring accountability and preventing the misuse of funds.

Nev. Rev. Stat. § 439A.380 Review and prioritization of applicants to recommend for grants.

1. The Authority shall review applications submitted pursuant to NRS 439A.377 to determine which applicants will be recommended to receive funding pursuant to NRS 439A.383 . 2. In reviewing applications and determining which applicants to recommend for funding, the Authority shall: (a) Give first priority for recommendation to projects that will most effectively address unmet needs; (b) Give secondary priority for recommendation to projects that will provide the greatest benefit in certified areas of need; (c) Give tertiary priority for recommendation to projects that will be located in: (1) Areas designated by the Health Resources and Services Administration of the United States Department of Health and Human Services as having a shortage of providers of health care, including, without limitation: (I) Areas designated as medically underserved areas or health professional shortage areas with high scores; (II) Areas designated as health professional shortage areas for primary care; and (III) Areas with populations that have been designated as medically underserved populations; or (2) Geographic areas where at least 30 percent of the population is enrolled in Medicaid, as determined by the Authority or the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services; (d) Give quaternary priority for recommendation to projects that demonstrate a commitment to ensuring that at least 10 percent of patients who receive care through the project are recipients of Medicaid; (e) To the extent practicable, make recommendations to fund projects in different geographic areas of this State; (f) Make recommendations to fund projects in a manner that balances the differing health care needs of this State and takes into account other sources of funding, including, without limitation, federal grant programs, that may be available to applicants in order to use state money efficiently and avoid duplicative funding for the same or similar projects; and (g) To the extent that such entities submit applications for funding that meet the requirements of NRS 439A.377 , recommend that at least 2 percent of the available funding be awarded to entities described in section 71113 of the One Big Beautiful Bill Act of 2025, Public Law No. 119-21. Money awarded to such an entity must not be expended for any abortion. 3. The Authority shall consider the following criteria when reviewing applications pursuant to subsection 1: (a) The severity and urgency of the shortage of providers of health care in the certified areas of need targeted by the proposed project; (b) The potential of the proposed project to produce measurable, long-term improvements in rates of survival, quality of life and the experience of patients, including, without limitation, by causing high levels of improvement for underserved populations; (c) The potential of the proposed project to create lasting improvement in accessibility to health care and the availability of providers of health care in the community affected by the proposed project, including, without limitation, by meeting specific metrics for improvements to access to health care, health care outcomes and the capacity of the health care workforce; (d) The extent of the proposed investment in and establishment of capital infrastructure to address certified areas of need over the long term and support sustainable access to health care, including, without limitation: (1) The construction of medical facilities and other health care facilities; (2) The acquisition of medical equipment or equipment related to the advancement of medical research; (3) The expansion of capabilities for delivering services through precision medicine, early-phase clinical trials and telehealth; and (4) The development of facilities for residencies or other training of providers of health care; (e) The level of financial commitment from sources other than the State, including, without limitation, the degree to which the matching funds and in-kind contributions, if required, exceed the amount required by paragraph (d) of subsection 3 of NRS 439A.374 ; (f) The level of collaboration between the applicant and other entities in the public and private sectors to enhance the overall impact of the project; (g) The qualifications and organizational capacity of the applicant to effectively implement and sustain the proposed project, including, without limitation, a demonstrated ability to manage similar projects, meet projections concerning outcomes and maintain compliance with the requirements of NRS 439A.350 to 439A.398 , inclusive, and any regulations adopted pursuant thereto; and (h) The degree to which the proposed project will strategically use technology or innovative models of delivering health care in a manner that may reduce costs, improve outcomes and expand access to underserved populations. 4. As used in this section, “telehealth” has the meaning ascribed to it in NRS 629.515 .

Nev. Rev. Stat. § 439A.383 Submission of recommendations for awarding of grants to Interim Finance Committee; public record of recommendations; notice of approval of recommendations.

1. After reviewing applications pursuant to NRS 439A.380 , the Authority shall submit to the Interim Finance Committee recommendations for the awarding of grants from the Account for the approval of the Committee. 2. When making recommendations pursuant to subsection 1, the Authority: (a) Shall ensure that all applicants for grants from the Account meet the requirements of NRS 439A.374 ; (b) May recommend funding one or more proposed projects, within the limits of money in the Account; (c) Shall, to the extent that qualified applicants are available, recommend awarding all of the money in the Account for a fiscal year as grants; and (d) May not recommend awarding a total amount of money during any funding period that exceeds the amount available in the Account for that funding period. 3. The Authority shall maintain a public record of all decisions to recommend the award of funding to an entity that submits an application pursuant to NRS 439A.377 or to refuse to make such a recommendation. 4. Upon receiving approval of a recommendation from the Interim Finance Committee pursuant to subsection 1, the Authority shall issue a written notice of the approval to the applicant to whom the recommendation pertains. Such written notice must include, without limitation: (a) The total amount of money being awarded; and (b) The schedule of disbursements and specific conditions that will be included in the applicable funding agreement.

Nev. Rev. Stat. § 439A.386 Funding agreement.

1. Not later than 30 days after the Interim Finance Committee approves a grantee to receive funding pursuant to NRS 439A.383 , the Authority shall enter into a funding agreement with the grantee. Such a funding agreement must outline the terms and conditions of the grant and the responsibilities of the grantee in a manner that ensures that the grantee satisfies the requirements and objectives specified in subsection 3 of NRS 439A.374 . 2. A funding agreement entered into pursuant to subsection 1 must: (a) Provide for the disbursement of the grant in installments that are contingent on the achievement of specific milestones, goals and indicators of performance relating to increases in the number of providers of health care, improved access to health care and improvements to infrastructure; (b) Require the grantee to submit documentation that the grantee has achieved the milestones, goals and indicators of performance prescribed in the agreement pursuant to paragraph (a) before money may be disbursed, including, without limitation: (1) Financial reports detailing expenditures of money and allocations of any matching funds; (2) Operational progress reports that demonstrate measurable achievements in recruiting providers of health care, improving health care infrastructure or expanding the availability of health care or clinical services; and (3) Any additional information required by the Authority for the purposes specified in this paragraph; (c) Require the grantee to submit to the Authority an annual report that includes, without limitation, details regarding the financial status of the project, efforts to recruit providers of health care and the impact of the project; (d) Require the grantee to comply with any request made by the Authority or the Office of Finance as part of a site visit, audit or review conducted pursuant to NRS 439A.392 ; (e) Specify the date on which the portion of the project funded by the grant is scheduled to terminate; and (f) Require the grantee to meet any additional conditions imposed by the Authority to ensure accountability, the achievement of the objectives of the project and the sustainability of the project. 3. A funding agreement entered into pursuant to subsection 1 may require that any matching funds be: (a) Held in escrow by an independent third party before the disbursement of money from the Account; (b) Secured through an irrevocable trust, letter of credit or surety bond; or (c) Verified through financial reporting to confirm the availability and appropriate use of the matching funds. 4. A funding agreement entered into pursuant to subsection 1 may require that the matching funds and in-kind contributions, if required, be subject to an independent verification process that may include, without limitation: (a) Certification by a certified public accountant or other qualified third party; (b) Submission of documentation demonstrating the value and availability of matching funds or in-kind contributions, including, without limitation: (1) Financial statements; (2) Governance documents; (3) Appraisals or market valuations of in-kind contributions; and (4) Documentation of cost basis or fair market value, as appropriate; (c) Periodic reports concerning the valuation of in-kind contributions that are aligned with the disbursement schedule established pursuant to paragraph (a) of subsection 2; and (d) Adherence to generally accepted accounting principles for the valuation of in-kind contributions.

Nev. Rev. Stat. § 439A.389 Modification or early termination of funded project.

1. If a grantee significantly modifies a project that has received funding pursuant to NRS 439A.350 to 439A.398 , inclusive, or if there are changes in the availability of funding for such a project, the grantee shall immediately notify the Authority and submit to the Authority a revised plan for the project. Upon receiving such notification, the Authority may, to ensure that money from the Account is used efficiently and effectively in a manner that complies with NRS 439A.374 , adjust the terms of the funding agreement, including, without limitation, the terms for disbursement and the amount of funding, or suspend or terminate the funding agreement. 2. If a grantee terminates a project that has received funding pursuant to NRS 439A.350 to 439A.398 , inclusive, before the date of termination specified in the applicable funding agreement or if such a project remains inactive for 12 consecutive months, the grantee shall: (a) Notify the Authority; and (b) Submit to the Authority a revised plan for the project. 3. Upon receiving notice pursuant to subsection 2 of the early termination or inactivity of a project, the Authority may: (a) Place a lien or other security interest on assets related to the project until at least half of the goals and indicators of performance included in the applicable funding agreement are met; (b) Reallocate unspent money to other approved projects or deposit unspent money in the Account to support grants for other projects pursuant to NRS 439A.350 to 439A.398 , inclusive; (c) Require the grantee to take corrective action within 60 days; (d) Suspend or terminate the grant; (e) Require the grantee to repay money previously disbursed; or (f) Take any combination of the actions described in paragraphs (a) to (e), inclusive. 4. Not later than 60 days after the early termination of a project for which a grantee received a grant pursuant to NRS 439A.350 to 439A.398 , inclusive, a grantee shall submit to the Authority a report which includes, without limitation: (a) The total amount of money spent on the project; (b) The amount of money disbursed from the Account that was spent on the project; (c) The reasons for the early termination of the project; and (d) A proposed plan to repay money disbursed from the Account, if required by the Authority.

Nev. Rev. Stat. § 439A.392 Oversight of funded project.

1. The Authority shall conduct site visits, audits or reviews at least annually to ensure that a project funded pursuant to NRS 439A.350 to 439A.398 , inclusive, complies with the requirements of those sections and the applicable funding agreement. 2. The Office of Finance may audit any project funded pursuant to NRS 439A.350 to 439A.398 , inclusive, to ensure that the grantee is using the money awarded pursuant to NRS 439A.350 to 439A.398 , inclusive, in an effective and efficient manner that accords with state and federal law and the applicable funding agreement.

Nev. Rev. Stat. § 439A.395 Authorized acts of Authority in response to failure to comply with funding agreement or applicable law, misuse of funds or submission of fraudulent information.

If the Authority concludes, as the result of a site visit, audit or review conducted pursuant to NRS 439A.392 or for any other reason, that a grantee who has received funding pursuant to NRS 439A.350 to 439A.398, inclusive, has failed to: 1. Comply with the terms of a funding agreement, including, without limitation, by failing to achieve the milestones, goals and indicators of performance prescribed in the funding agreement pursuant to paragraph (a) of subsection 2 of NRS 439A.386 , the Authority may: (a) Suspend or terminate the grant; (b) Require the grantee to take corrective action within 60 days; (c) Require the grantee to repay money that was previously disbursed to the grantee; (d) Reallocate unspent money to other approved projects or deposit unspent money in the Account to support grants for other projects pursuant to NRS 439A.350 to 439A.398 , inclusive; (e) Take such other measures as are necessary to ensure compliance with the provisions of NRS 439A.350 to 439A.398 , inclusive, the regulations adopted pursuant thereto, other state and federal law and the applicable funding agreement; or (f) Take any combination of the actions described in paragraphs (a) to (e), inclusive. 2. Comply with any provision of NRS 439A.350 to 439A.398 , inclusive, any regulation adopted pursuant thereto or any other state or federal law, or has misused funds or submitted fraudulent information to the Authority, the Authority: (a) Shall suspend or terminate the grant; (b) May refer the matter to a district attorney who has jurisdiction over the matter or the Attorney General, where appropriate; and (c) May additionally take any other action or combination of actions described in subsection 1.

Nev. Rev. Stat. § 439A.398 Reports to Authority concerning completed project.

Upon completing a project for which a grantee received a grant pursuant to NRS 439A.350 to 439A.398, inclusive, and again 10 years after the completion of such a project, the grantee shall submit to the Authority a report that includes, without limitation: 1. A summary of the achievements of the project relative to the initial goals of the project, focusing on improvements in access to health care or clinical services and the capacity of the health care workforce in the area affected by the project; 2. Financial accounting of all money received for the project pursuant to NRS 439A.350 to 439A.398 , inclusive, and from other sources, including, without limitation, any matching funds, and an itemized statement of expenditures of such money; 3. A narrative evaluation of the impact of the project on the community affected by the project, including, without limitation, benefits realized, challenges encountered and lessons learned for future projects; 4. Any relevant data on patient outcomes, measurements of community health or the retention and expansion of the health care workforce attributable to the project; and 5. Feedback or testimonials concerning the project from beneficiaries, partners and other affected persons and entities.

Nev. Rev. Stat. § 439A.950 Injunctions.

1. Except as provided in subsection 2, the Department or the Authority, as applicable, may apply to any court of competent jurisdiction to enjoin any person, state agency or local governmental agency which has engaged in or is about to engage in any act which violates any provision of this chapter or the regulations adopted pursuant thereto. Such injunction may be issued without proof of actual damage sustained by any person. 2. The Department or the Authority, as applicable, shall not seek injunctive relief under this section if it has imposed a civil penalty for the same violation.

Nev. Rev. Stat. § 439A.960 Civil penalties.

1. Except as otherwise provided in subsection 2, any person who violates any of the provisions of this chapter is liable to the State for a civil penalty of: (a) Where the provision violated governs the licensing of a project which is required to be approved pursuant to NRS 439A.100 or 439A.102 , not more than 10 percent of the proposed expenditure for the project. (b) Where any other provision is violated, not more than $20,000 for each violation. 2. The Department or the Authority shall not impose a penalty under this section if it applies for injunctive relief to prevent the same violation.
Source: NV Statutes (Official Site)URL: https://www.leg.state.nv.us/nrs/NRS-439A.htmlFetched: 10/4/2026