Senate Bill No. 406–Senator Amodei

 

March 19, 2001

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Referred to Committee on Human Resources and Facilities

 

SUMMARY—Provides additional exception to prohibition against certain referrals of patients by health care practitioners. (BDR 40‑596)

 

FISCAL NOTE:            Effect on Local Government: No.

                                    Effect on the State: No.

 

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to health care; providing an additional exception to the prohibition against certain referrals of patients by health care practitioners; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

1-1    Section 1. NRS 439B.425 is hereby amended to read as follows:

1-2    439B.425  1.  Except as otherwise provided in this section, a

1-3  practitioner shall not refer a patient, for a service or for goods related to

1-4  health care, to a health facility, medical laboratory, diagnostic imaging or

1-5  radiation oncology center or commercial establishment in which the

1-6  practitioner has a financial interest.

1-7    2.  Subsection 1 does not apply if:

1-8    (a) The service or goods required by the patient are not otherwise

1-9  available within a 30-mile radius of the office of the practitioner;

1-10    (b) The service or goods are provided pursuant to a referral to a

1-11  practitioner who is participating in the health care plan of a health

1-12  maintenance organization that has been issued a certificate of authority

1-13  pursuant to chapter 695C of NRS;

1-14    (c) The practitioner is a member of a group practice and the referral is

1-15  made to that group practice;

1-16    (d) The referral is made to a surgical center for ambulatory patients, as

1-17  defined in NRS 449.019, that is licensed pursuant to chapter 449 of NRS;

1-18    (e) The referral is made by:

1-19      (1) A urologist for lithotripsy services; or

1-20      (2) A nephrologist for services and supplies for a renal dialysis; [or]

1-21    (f) The financial interest represents an investment in a corporation that

1-22  has shareholder equity of more than $100,000,000, regardless of whether

1-23  the securities of the corporation are publicly traded[.] ; or

2-1    (g) The referral is made by a physician to a surgical hospital in which

2-2  the physician has an ownership interest and:

2-3       (1) The surgical hospital is:

2-4         (I) Located in a county whose population is less than 100,000;

2-5  and

2-6         (II) Licensed pursuant to chapter 449 of NRS as a surgical

2-7  hospital and not as a medical hospital, obstetrical hospital, combined-

2-8  categories hospital, general hospital or center for the treatment of

2-9  trauma;

2-10      (2) The physician making the referral:

2-11        (I) Is authorized to perform medical services and has staff

2-12  privileges at the surgical hospital; and

2-13        (II) Has disclosed his ownership interest in the surgical hospital

2-14  to the patient before making the referral;

2-15      (3) The ownership interest of the physician making the referral

2-16  pertains to the surgical hospital in its entirety and is not limited to a

2-17  department, subdivision or other portion of the hospital;

2-18      (4) Every physician who has an ownership interest in the surgical

2-19  hospital has agreed to treat patients receiving benefits pursuant to

2-20  Medicaid and Medicare;

2-21      (5) The terms of investment of each physician who has an

2-22  ownership interest in the surgical hospital are not related to the volume

2-23  or value of any referrals made by that physician;

2-24      (6) The payments received by each investor in the surgical hospital

2-25  as a return on his investment are directly proportional to the relative

2-26  amount of capital invested or shares owned by the investor in the

2-27  hospital;

2-28      (7) None of the investors in the surgical hospital has received any

2-29  financial assistance from the hospital or any other investor in the

2-30  hospital for the purpose of investing in the hospital; and

2-31      (8) Either:

2-32        (I) The governing body of every other hospital that regularly

2-33  provides surgical services to residents of the county in which the surgical

2-34  hospital is located has issued its written general consent to the referral by

2-35  such physicians of patients to that surgical hospital; or

2-36        (II) The board of county commissioners of the county in which

2-37  the surgical hospital is located has issued a written declaration of its

2-38  reasonable belief that the referral by such physicians of patients to that

2-39  surgical hospital will not, during the 5-year period immediately following

2-40  the commencement of such referrals, have a substantial adverse

2-41  financial effect on any other hospital that regularly provides surgical

2-42  services to residents of that county.

2-43    3.  A person who violates the provisions of this section is guilty of a

2-44  misdemeanor.

2-45    4.  The provisions of this section do not prohibit a practitioner from

2-46  owning and using equipment in his office solely to provide to his patients

2-47  services or goods related to health care.

2-48    5.  As used in this section:

3-1    (a) “Group practice” means two or more practitioners who organized as

3-2  a business entity in accordance with the laws of this state to provide

3-3  services related to health care, if:

3-4       (1) Each member of the group practice provides substantially all of

3-5  the services related to health care that he routinely provides, including,

3-6  without limitation, medical care, consultations, diagnoses and treatment,

3-7  through the joint use of shared offices, facilities, equipment and personnel

3-8  located at any site of the group practice;

3-9       (2) Substantially all of the services related to health care that are

3-10  provided by the members of the group practice are provided through the

3-11  group practice; and

3-12      (3) No member of the group practice receives compensation based

3-13  directly on the volume of any services or goods related to health care

3-14  which are referred to the group practice by that member.

3-15    (b) “Patient” means a person who consults with or is examined or

3-16  interviewed by a practitioner or health facility for purposes of diagnosis or

3-17  treatment.

3-18    (c) “Substantial adverse financial effect” includes, without limitation,

3-19  a projected decline in the revenue of a hospital as a result of the loss of

3-20  its surgical business, which is sufficient to cause a deficit in any cash

3-21  balances, fund balances or retained earnings of the hospital.

3-22    Sec. 2.  This act becomes effective on July 1, 2001.

 

3-23  H