(REPRINTED WITH ADOPTED AMENDMENTS)

 

Senate Bill No. 483–Committee on Human
Resources and Facilities

 

March 26, 2001

____________

 

Referred to Committee on Human Resources and Facilities

 

SUMMARY—Requires state board of health to license mobile medical facilities and facilities for refractive laser surgery. (BDR 40‑1482)

 

FISCAL NOTE:  Effect on Local Government: No.

                             Effect on the State: Yes.

 

~

 

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

 

AN ACT relating to medical facilities; requiring the state board of health to adopt regulations for the licensure of certain mobile units and facilities for refractive laser surgery as medical facilities; requiring facilities for refractive laser surgery to file a surety bond or deposit other security to provide indemnification to certain patients; 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. Chapter 449 of NRS is hereby amended by adding thereto

1-2  the provisions set forth as sections 2 to 5, inclusive, of this act.

1-3    Sec. 2.  “Facility for refractive laser surgery” means a freestanding

1-4  facility that provides limited medical services for the evaluation of

1-5  patients with refractive errors of the eye and the surgical treatment of

1-6  those patients by photorefractive keratectomy or laser in situ

1-7  keratomeleusis.

1-8    Sec. 3.  “Mobile unit” means a motor vehicle, other than a vehicle

1-9  operated under the authority of a permit issued pursuant to chapter 450B

1-10  of NRS, that is specially designed, constructed and equipped to provide

1-11  any of the medical services provided by a medical facility described in

1-12  subsections 1 to 13, inclusive, of NRS 449.0151.

1-13  Sec. 4.  1.  Except as otherwise provided in section 5 of this act,

1-14  each facility for refractive laser surgery shall, when applying for a

1-15  license or renewing a license, file with the administrator of the health

1-16  division a surety bond:

1-17  (a) If the facility employs less than seven employees, in the amount of

1-18  $10,000;

1-19  (b) If the facility employs at least seven but not more than 25

1-20  employees, in the amount of $50,000; or

2-1    (c) If the facility employs more than 25 employees, in the amount of

2-2  $100,000.

2-3    2.  A bond filed pursuant to this section must be executed by the

2-4  facility as principal and by a surety company as surety. The bond must be

2-5  payable to the health division and must be conditioned to provide

2-6  indemnification to a patient of the facility who the administrator of the

2-7  health division or his designee determines has sustained any damages as

2-8  a result of the bankruptcy of or any breach of contract by the facility.

2-9    3.  Except when a surety is released, the surety bond must cover the

2-10  period of the initial license to operate or the period of the renewal, as

2-11  appropriate.

2-12  4.  A surety on any bond filed pursuant to this section may be

2-13  released after the surety gives 30 days’ written notice to the administrator

2-14  of the health division, but the release does not discharge or otherwise

2-15  affect any claim filed by a patient for any damages sustained as a result

2-16  of the bankruptcy of or any breach of contract by the facility while the

2-17  bond was in effect.

2-18  5.  The license of a facility for refractive laser surgery is suspended

2-19  by operation of law when the facility is no longer covered by a surety

2-20  bond as required by this section or by a substitute for the surety bond

2-21  pursuant to section 5 of this act. The administrator of the health division

2-22  shall give the facility at least 20 days’ written notice before the release of

2-23  the surety or the substitute for the surety, to the effect that the license will

2-24  be suspended by operation of law until another surety bond is filed or

2-25  substitute for the surety bond is deposited in the same manner and

2-26  amount as the bond or substitute being terminated.

2-27  Sec. 5.  1.  As a substitute for the surety bond required pursuant to

2-28  section 4 of this act, a facility for refractive laser surgery may deposit

2-29  with any bank or trust company authorized to do business in this state,

2-30  upon approval of the administrator of the health division:

2-31  (a) An obligation of a bank, savings and loan association, thrift

2-32  company or credit union licensed to do business in this state;

2-33  (b) Bills, bonds, notes, debentures or other obligations of the United

2-34  States or any agency or instrumentality thereof, or guaranteed by the

2-35  United States; or

2-36  (c) Any obligation of this state or any city, county, town, township,

2-37  school district or other instrumentality of this state, or guaranteed by this

2-38  state, in an aggregate amount, based upon principal amount or market

2-39  value, whichever is lower.

2-40  2.  The obligations of a bank, savings and loan association, thrift

2-41  company or credit union must be held to secure the same obligation as

2-42  would the surety bond required by section 4 of this act. With the approval

2-43  of the administrator of the health division, the facility may substitute

2-44  other suitable obligations for those deposited, which must be assigned to

2-45  the health division and are negotiable only upon approval of the

2-46  administrator of the health division.

2-47  3.  Any interest or dividends earned on the deposit accrue to the

2-48  account of the facility.

3-1    4.  The deposit must be an amount at least equal to the surety bond

3-2  required by section 4 of this act and must state that the amount may not

3-3  be withdrawn except by the direct and sole order of the administrator of

3-4  the health division.

3-5    Sec. 6.  NRS 449.001 is hereby amended to read as follows:

3-6    449.001  As used in this chapter, unless the context otherwise requires,

3-7  the words and terms defined in NRS 449.0015 to 449.019, inclusive, and

3-8  sections 2 and 3 of this act have the meanings ascribed to them in those

3-9  sections.

3-10    Sec. 7.  NRS 449.0151 is hereby amended to read as follows:

3-11    449.0151  “Medical facility” includes:

3-12    1.  A surgical center for ambulatory patients;

3-13    2.  An obstetric center;

3-14    3.  An independent center for emergency medical care;

3-15    4.  An agency to provide nursing in the home;

3-16    5.  A facility for intermediate care;

3-17    6.  A facility for skilled nursing;

3-18    7.  A facility for hospice care;

3-19    8.  A hospital;

3-20    9.  A psychiatric hospital;

3-21    10.  A facility for the treatment of irreversible renal disease;

3-22    11.  A rural clinic;

3-23    12.  A nursing pool; [and]

3-24    13.  A facility for modified medical detoxification[.] ;

3-25    14.  A facility for refractive laser surgery; and

3-26    15.  A mobile unit.

3-27    Sec. 8.  NRS 449.037 is hereby amended to read as follows:

3-28    449.037  1.  The board shall adopt:

3-29    (a) Licensing standards for each class of medical facility or facility for

3-30  the dependent covered by NRS 449.001 to 449.240, inclusive, and sections

3-31  2 to 5, inclusive, of this act and for programs of hospice care.

3-32    (b) Regulations governing the licensing of such facilities and programs.

3-33    (c) Regulations governing the procedure and standards for granting an

3-34  extension of the time for which a natural person may provide certain care

3-35  in his home without being considered a residential facility for groups

3-36  pursuant to NRS 449.017. The regulations must require that such grants are

3-37  effective only if made in writing.

3-38  (d) Regulations establishing a procedure for the indemnification by

3-39  the health division, from the amount of any surety bond or other

3-40  obligation filed or deposited by a facility for refractive laser surgery

3-41  pursuant to section 4 or 5 of this act, of a patient of the facility who has

3-42  sustained any damages as a result of the bankruptcy of or any breach of

3-43  contract by the facility.

3-44  (e) Any other regulations as it deems necessary or convenient to carry

3-45  out the provisions of NRS 449.001 to 449.240, inclusive[.] , and sections

3-46  2 to 5, inclusive, of this act.

3-47    2.  The board shall adopt separate regulations governing the licensing

3-48  and operation of:

3-49    (a) Facilities for the care of adults during the day; and

4-1    (b) Residential facilities for groups,

4-2  which provide care to persons with Alzheimer’s disease.

4-3    3.  The board shall adopt separate regulations for [the] :

4-4    (a) The licensure of rural hospitals which take into consideration the

4-5  unique problems of operating such a facility in a rural area.

4-6    (b) The licensure of facilities for refractive laser surgery which take

4-7  into consideration the unique factors of operating such a facility.

4-8    (c) The licensure of mobile units which take into consideration the

4-9  unique factors of operating a facility that is not in a fixed location.

4-10    4.  The board shall require that the practices and policies of each

4-11  medical facility or facility for the dependent provide adequately for the

4-12  protection of the health, safety and physical, moral and mental well-being

4-13  of each person accommodated in the facility.

4-14    5.  The board shall establish minimum qualifications for administrators

4-15  and employees of residential facilities for groups. In establishing the

4-16  qualifications, the board shall consider the related standards set by

4-17  nationally recognized organizations which accredit such facilities.

4-18    6.  The board shall adopt separate regulations regarding the assistance

4-19  which may be given pursuant to NRS 453.375 and 454.213 to an ultimate

4-20  user of controlled substances or dangerous drugs by employees of

4-21  residential facilities for groups. The regulations must require at least the

4-22  following conditions before such assistance may be given:

4-23    (a) The ultimate user’s physical and mental condition is stable and is

4-24  following a predictable course.

4-25    (b) The amount of the medication prescribed is at a maintenance level

4-26  and does not require a daily assessment.

4-27    (c) A written plan of care by a physician or registered nurse has been

4-28  established that:

4-29      (1) Addresses possession and assistance in the administration of the

4-30  medication; and

4-31      (2) Includes a plan, which has been prepared under the supervision of

4-32  a registered nurse or licensed pharmacist, for emergency intervention if an

4-33  adverse condition results.

4-34    (d) The prescribed medication is not administered by injection or

4-35  intravenously.

4-36    (e) The employee has successfully completed training and examination

4-37  approved by the health division regarding the authorized manner of

4-38  assistance.

4-39    7.  The board shall, if it determines necessary, adopt regulations and

4-40  requirements to ensure that each residential facility for groups and its staff

4-41  are prepared to respond to an emergency, including, without limitation:

4-42    (a) The adoption of plans to respond to a natural disaster and other types

4-43  of emergency situations, including, without limitation, an emergency

4-44  involving fire;

4-45    (b) The adoption of plans to provide for the evacuation of a residential

4-46  facility for groups in an emergency, including, without limitation, plans to

4-47  ensure that nonambulatory patients may be evacuated;

4-48    (c) Educating the residents of residential facilities for groups concerning

4-49  the plans adopted pursuant to paragraphs (a) and (b); and

5-1    (d) Posting the plans or a summary of the plans adopted pursuant to

5-2  paragraphs (a) and (b) in a conspicuous place in each residential facility for

5-3  groups.

5-4    Sec. 9.  NRS 449.230 is hereby amended to read as follows:

5-5    449.230  1.  Any authorized member or employee of the health

5-6  division may enter and inspect any building or premises at any time to

5-7  secure compliance with or prevent a violation of any provision of NRS

5-8  449.001 to 449.245, inclusive[.] , and sections 2 to 5, inclusive, of this

5-9  act. For the purposes of this subsection, “building or premises” does not

5-10  include a mobile unit that is operated by a medical facility which is

5-11  accredited by the Joint Commission on Accreditation of Healthcare

5-12  Organizations or the American Osteopathic Association.

5-13    2.  The state fire marshal or his designee shall, upon receiving a request

5-14  from the health division or a written complaint concerning compliance with

5-15  the plans and requirements to respond to an emergency adopted pursuant to

5-16  subsection 7 of NRS 449.037:

5-17    (a) Enter and inspect a residential facility for groups; and

5-18    (b) Make recommendations regarding the adoption of plans and

5-19  requirements pursuant to subsection 7 of NRS 449.037,

5-20  to ensure the safety of the residents of the facility in an emergency.

5-21    3.  The state health officer or his designee shall enter and inspect at

5-22  least annually each building or the premises of a residential facility for

5-23  groups to ensure compliance with standards for health and sanitation.

5-24    4.  An authorized member or employee of the health division shall

5-25  enter and inspect any building or premises operated by a residential facility

5-26  for groups within 72 hours after the health division is notified that a

5-27  residential facility for groups is operating without a license.

5-28  Sec. 10.  NRS 449.235 is hereby amended to read as follows:

5-29  449.235  [Every]

5-30  1.  Except as otherwise provided in subsection 2, every medical

5-31  facility or facility for the dependent may be inspected at any time, with or

5-32  without notice, as often as is necessary by:

5-33  [1.] (a) The health division to [assure that there is] ensure compliance

5-34  with all applicable regulations and standards; and

5-35  [2.] (b) Any person designated by the aging services division of the

5-36  department of human resources to investigate complaints made against the

5-37  facility.

5-38  2.  The provisions of subsection 1 do not authorize the health division

5-39  to inspect a mobile unit that is operated by a medical facility which is

5-40  accredited by the Joint Commission on Accreditation of Healthcare

5-41  Organizations or the American Osteopathic Association, unless the

5-42  health division has reasonable cause to believe that the mobile unit has

5-43  violated any provision of NRS 449.001 to 449.240, inclusive, and sections

5-44  2 to 5, inclusive, of this act or any regulation or standard adopted

5-45  pursuant thereto.

5-46    Sec. 11.  This act becomes effective upon passage and approval for the

5-47  purposes of adopting regulations and on July 1, 2001, for all other

5-48  purposes.

 

5-49  H