Assembly Bill No. 11–Committee of the Whole
CHAPTER..........
AN ACT relating to health care; revising various provisions relating to subsidies for malpractice insurance of certain providers of prenatal care; establishing the Nevada Office of Rural Health within the University of Nevada School of Medicine to administer matters relating to the delivery of health care services to rural and frontier areas in this state; establishing the Area Health Education Center Program within the University of Nevada School of Medicine to support education and training programs for certain students, residents and practitioners providing health care services in medically underserved areas in this state; establishing the Medical Education Council of Nevada within the University of Nevada School of Medicine to ensure that Nevada has an adequate, well-trained health care workforce to meet the needs of the residents of this state; revising various provisions relating to the administration of the Nevada Health Service Corps; making various changes concerning the use of certain money received by the University of Nevada School of Medicine; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. NRS 442.119 is hereby amended to read as follows:
442.119 As used in NRS 442.119 to 442.1198, inclusive,
unless the context otherwise requires:
1. “Health officer” includes a local health officer, a city health
officer, a county health officer and a district health officer.
2. “Medicaid” has the meaning ascribed to it in
NRS 439B.120.
3. “Medicare” has the meaning ascribed to it in
NRS 439B.130.
4. “Provider of prenatal care” [is limited to:] means:
(a) A physician who is licensed in this state and certified in
obstetrics and gynecology, family practice, general practice or
general surgery.
(b) A certified nurse midwife who is licensed by the State Board
of Nursing.
(c) An advanced practitioner of nursing who has specialized
skills and training in obstetrics or family nursing.
(d) A physician assistant who has specialized skills and training
in obstetrics or family practice.
Sec. 2. NRS 442.1192 is hereby amended to read as follows:
442.1192 1. A provider of prenatal care who provides
services to pregnant women, or a health officer acting on behalf of
a provider of prenatal care who provides services to pregnant
women, in a county or community that lacks services for prenatal
care may submit an application to the University of Nevada School
of Medicine for a grant to subsidize a portion of the malpractice
insurance of [a] the provider of prenatal care who provides services
to pregnant women in the county or community.
2. A county or community lacks services for prenatal care if at
least one of the following conditions is present:
(a) A provider of prenatal care does not offer services to
pregnant women within the county or the community.
(b) Fifty percent or more of the live births to women who are
residents of the county occur outside the county.
(c) The percentage of live births to women in the county or
community who received no prenatal care exceeds the percentage
of live births to women in the State who received no prenatal care.
(d) The percentage of live births of babies with low birthweight
to women in the county or community is higher than the percentage
of live births of babies with low birthweight to women in the State.
3. If [the applicant is] a county or district health officer[, he]
applies for a grant on behalf of a provider of prenatal care, the
county or district health officer must provide proof of the financial
contribution by the county or district for the provision of prenatal
services for women who do not qualify for reimbursement pursuant
to the State Plan for Medicaid.
Sec. 3. NRS 442.1194 is hereby amended to read as follows:
442.1194 1. The University of Nevada School of Medicine
may grant money to [an applicant] a provider of prenatal care or a
health officer acting on behalf of a provider of prenatal care who
submits an application pursuant to NRS 442.1192 to furnish a
subsidy for the malpractice insurance of [a] the provider of prenatal
care who provides services in a county or community that lacks
services for prenatal care for women.
2. [An applicant who receives a] A grant from the University of
Nevada School of Medicine may[furnish a] subsidize the
malpractice insurance of the provider of prenatal care [a subsidy]
in an amount up to the difference between the cost of [his] the
malpractice insurance of the provider of prenatal care with
coverage for the provision of prenatal care and without such
coverage.
[3. Before disbursing a grant pursuant to the provisions of NRS
442.119 to 442.1198, inclusive, the University of Nevada School of
Medicine shall consult with the Director of the Program for
Maternal and Child Health of the Health Division.]
Sec. 4. NRS 442.1196 is hereby amended to read as follows:
442.1196 1. The application submitted pursuant to NRS
442.1192 for a grant to subsidize the malpractice insurance of a
provider of prenatal care must be on the form required by the
University of Nevada School of Medicine.
2. The application must contain:
(a) [Information] If the applicant is a health officer applying
on behalf of a provider of prenatal care, information concerning
the collaboration between the [applicant and a] health officer and
the provider of prenatal care and medical facilities within the
county or community.
(b) A plan for providing prenatal care for women in the county
or community who have low incomes or who do not qualify for any
state program for medical care.
(c) A plan for improving the health care of pregnant women in
the county or community.
3. To be eligible for a subsidy for his malpractice insurance, a
provider of prenatal care must submit evidence that:
(a) He has completed training in prenatal care that is approved
by the University of Nevada School of Medicine;
(b) He is currently covered by malpractice insurance;
(c) He accepts reimbursement for services rendered from
Medicaid and Medicare; and
(d) He will continue to provide prenatal care in the specified
county or community for not less than 1 year.
Sec. 5. Chapter 396 of NRS is hereby amended by adding
thereto the provisions set forth as sections 6 to 10, inclusive, of this
act.
Sec. 6. As used in NRS 396.900 to 396.903, inclusive, unless
the context otherwise requires, “practitioner” has the meaning
ascribed to it in NRS 439A.0195.
Sec. 7. Any gift, donation, bequest, grant or other source of
money received by the University of Nevada School of Medicine
for the development of an obstetrical access program may be used
to:
1. Provide financial support and education to faculty and
residents in the Departments of Family and Community Medicine
and Obstetrics and Gynecology within the University of Nevada
School of Medicine and to expand the clinical services provided
by such faculty and residents in areas and to populations that
need obstetrical services.
2. Provide money to Nevada Health Centers, Inc., or its
successor, to expand the clinical prenatal and obstetrical practice
base of community health center clinics and to provide uninsured,
underinsured and Medicaid patients with increased access to
clinical prenatal and obstetrical care.
3. Establish a fund that allows practicing community
providers of prenatal care that are participating in the obstetrical
access program to draw upon money to partially compensate them
for providing care to patients who have no access to clinical care
because of their financial status.
4. Develop a database of clinical practitioners providing
prenatal or obstetrical services throughout the State to monitor
and analyze:
(a) The relationship between declining services and the supply
and distribution of appropriate providers of health care;
(b) The impact of access to care issues on pregnant women,
including, without limitation, poor birth outcomes which result
from lack of access to care, the financial impact of such poor
birth outcomes and the effects of receiving inadequate prenatal
care; and
(c) The impact of adverse judicial decisions on the delivery of
obstetrical services.
5. Subsidize malpractice costs for clinical providers of
prenatal care who maintain at least 30 percent or more of
prenatal or obstetrical patients in their practice who are
uninsured, underinsured or insured by Medicaid, or who use a
sliding fee scale based on a patient’s financial resources when
charging for such services. The subsidy must be calculated based
on the number of qualified clinical providers of prenatal care, the
proportion of financially compromised patients served by such
providers and the total amount of money available for subsidies.
Sec. 8. 1. The Nevada Office of Rural Health is hereby
established within the University of Nevada School of Medicine to
administer matters relating to the delivery of health care services
to rural and frontier areas in this state. The Nevada Office of
Rural Health shall:
(a) Evaluate the need for programs concerning the delivery of
health care services to rural and frontier areas in this state and
make recommendations to the University of Nevada School of
Medicine and the Legislature to carry out such programs; and
(b) Establish, administer and coordinate programs which
affect the delivery of health care services to rural and frontier
areas in this state, including, without limitation, programs
relating to:
(1) The education and training of providers of health care
who provide services in rural and frontier areas;
(2) The needs of rural and frontier areas for health care
services and the manner in which such health care services may
be effectively delivered;
(3) The delivery of health care services to rural and frontier
areas;
(4) The financing of the delivery of health care services to
rural and frontier areas; or
(5) The collection of data necessary for the Nevada Office
of Rural Health to carry out its duties concerning the delivery of
health care services to rural and frontier areas.
2. Any gift, donation, bequest, grant or other source of money
received by the Nevada Office of Rural Health may be used to
carry out the provisions of this section.
Sec. 9. 1. The Area Health Education Center Program is
hereby established within the University of Nevada School of
Medicine to support education and training programs for students
studying to become practitioners, or residents or practitioners who
will provide or are providing health care services in medically
underserved areas in this state, including urban and rural areas.
The Area Health Education Center Program shall:
(a) Assist the area health education centers within Nevada in
providing:
(1) Career opportunities in health care;
(2) Information to practitioners and other providers of
health care;
(3) Continuing education for practitioners and other
providers of health care; and
(4) Stipends for the education and training of students
studying to become practitioners and residents who will provide or
who are providing health care services in medically underserved
areas in this state;
(b) Assess and develop training programs concerning the
appropriate curriculum for primary care and other priority health
care services;
(c) Enhance the training programs in primary care by
providing additional entry-level positions and faculty to increase
the availability of practitioners and other providers of health care;
(d) Increase the percentage of medical students committing to
residencies and careers in primary care;
(e) Provide a greater percentage of primary care residents to
medically underserved areas in this state;
(f) Develop and enhance training programs necessary to
address the primary health care needs of persons in this state; and
(g) Establish interdisciplinary opportunities for education and
training for practitioners and other providers of health care.
2. Any gift, donation, bequest, grant or other source of money
received by the Area Health Education Center Program may be
used to carry out the provisions of this section.
3. As used in this section, “practitioner” has the meaning
ascribed to it in NRS 439A.0195.
Sec. 10. 1. The Medical Education Council of Nevada is
hereby established within the University of Nevada School of
Medicine to ensure that Nevada has an adequate, well-trained
health care workforce to meet the needs of the residents of this
state. The Medical Education Council of Nevada shall:
(a) Determine the workforce needs for the provision of health
care services in this state;
(b) Determine the number and types of positions of
employment for which money appropriated to the Medical
Education Council of Nevada may be used, including, without
limitation, positions for practitioners, other providers of health
care and other personnel to staff health care facilities and
programs;
(c) Investigate and make recommendations to the University of
Nevada School of Medicine and the Legislature on the status and
needs of practitioners, other providers of health care and other
personnel of health care facilities or programs;
(d) Determine a method for reimbursing institutions that
sponsor practitioners, other providers of health care or other
personnel of health care facilities or programs;
(e) To the extent authorized by federal law, prepare and submit
a formal application to the Centers for Medicare and Medicaid
Services of the United States Department of Health and Human
Services for the purpose of receiving and dispersing federal
money for graduate medical education expenses;
(f) Distribute a portion of any money it receives for graduate
medical education expenses in a manner that:
(1) Prepares postgraduate medical and dental residents, as
defined by the Accreditation Council for Graduate Medical
Education, to provide inpatient, outpatient and hospital services
in various communities and in geographically diverse settings;
(2) Encourages the coordination of interdisciplinary
clinical training by practitioners and other providers of health
care to such postgraduate medical and dental residents; and
(3) Promotes funding for accredited clinical training
programs provided by practitioners or other providers of health
care to such postgraduate medical and dental residents;
(g) Apply for grants, gifts and donations from public and
private sources, including the Federal Government, to carry out
the objectives of the Medical Education Council of Nevada;
(h) Initiate a cooperative agreement with the Department of
Human Resources to promote the intergovernmental transfer of
money for the purposes of receiving and dispersing money to
carry out the objectives of the Medical Education Council of
Nevada; and
(i) Distribute additional financial resources to training
programs for practitioners, other providers of health care or other
personnel of health care facilities or programs in the State.
2. Any gift, donation, bequest, grant or other source of money
received by the Medical Education Council of Nevada may be
used to carry out the provisions of this section.
3. As used in this section, “practitioner” has the meaning
ascribed to it in NRS 439A.0195.
Sec. 11. NRS 396.900 is hereby amended to read as follows:
396.900 The [Board of Regents] University of Nevada School
of Medicine may establish a Nevada Health Service Corps to
encourage [physicians] practitioners to practice in areas of Nevada
in which a shortage of [physicians] that type of practitioner exists.
Sec. 12. NRS 396.901 is hereby amended to read as follows:
396.901 The primary purposes of the Nevada Health Service
Corps must be to:
1. Recruit [physicians] practitioners for participation in the
program;
2. Designate areas of Nevada in which a shortage of
[physicians] each type of practitioner exists;
3. Match [physicians] practitioners with the designated areas;
and
4. Help [physicians] practitioners to negotiate contracts to
serve in the designated areas.
Sec. 13. NRS 396.902 is hereby amended to read as follows:
396.902 The [Board of Regents] University of Nevada School
of Medicine may:
1. Apply for any matching money available for the program
from the Federal Government.
2. Adopt regulations necessary to carry out the provisions of
NRS 396.900 to 396.903, inclusive[.] , and section 6 of this act.
3. Receive, invest, disburse and account for all money received
from the Federal Government or any other source for this program.
Sec. 14. NRS 396.903 is hereby amended to read as follows:
396.903 1. The [Board of Regents] University of Nevada
School of Medicine may authorize the Nevada Health Service
Corps to administer a program under which [$15,000 of loans are]
money for loans is repaid on behalf of a [physician] practitioner
for each year he practices [medicine] in an area of Nevada in which
a shortage of [physicians exists.] that type of practitioner exists, as
determined by the Nevada Office of Rural Health within the
University of Nevada School of Medicine and the Nevada Health
Service Corps.
2. To qualify for the program [the physician] , a practitioner
required to be licensed pursuant to the provisions of chapter 630,
630A, 633 or 634 of NRS must have completed his primary care
residency and hold an active license issued pursuant to chapter 630,
630A, 633 or 634 of NRS. All other practitioners must have
completed training in a certified program and have an active
license, certification or registration from the State of Nevada.
Sec. 15. This act becomes effective upon passage and approval
and applies retroactively from and after July 1, 2003.
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