requires two-thirds majority vote (§ 31)                                                                                                               

                                                                                                  

 

Assembly Bill No. 313–Assemblywomen Giunchigliani
and Koivisto

 

March 13, 2003

____________

 

Referred to Committee on Health and Human Services

 

SUMMARY—Makes various changes concerning certain health care facilities employing nurses. (BDR 40‑729)

 

FISCAL NOTE:  Effect on Local Government: Yes.

                           Effect on the State: Yes.

 

CONTAINS UNFUNDED MANDATE (§ 17-22)

(Not Requested by Affected Local Government)

 

~

 

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

 

AN ACT relating to health care facilities; requiring certain health care facilities employing nurses to establish a staffing plan and to provide adequate staffing; providing certain minimum ratios for nurse staffing; requiring the keeping of certain records concerning statistics relating to patients and staffing; establishing maximum limits on work hours and providing exceptions to those limits; requiring such a health care facility to establish policies pursuant to which direct care nurses may refuse a work assignment; prohibiting such a health care facility from taking certain actions against employees of the facility under
certain circumstances; requiring public disclosure of certain information relating to the staffing plan; providing administrative and criminal penalties; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

 

 

2-1  Section 1. Chapter 449 of NRS is hereby amended by adding

2-2  thereto the provisions set forth as sections 2 to 35, inclusive, of this

2-3  act.

2-4  Sec. 2.  As used in sections 2 to 35, inclusive, of this act,

2-5  unless the context otherwise requires, the words and terms defined

2-6  in sections 3 to 16, inclusive, of this act have the meanings

2-7  ascribed to them in those sections.

2-8  Sec. 3.  “Acuity system” means an established measurement

2-9  system or method which:

2-10      1.  Predicts the requirements for nursing care for a patient

2-11  based on the severity of the illness of the patient, the need for

2-12  specialized equipment and technology, the intensity of nursing

2-13  interventions required, and the complexity of clinical nursing

2-14  judgment needed to design, carry out and evaluate the plan for

2-15  nursing care for the patient;

2-16      2.  Details the amount of daily nursing care needed, both in

2-17  the number of nurses and in the skill mix of nursing personnel

2-18  required, for each patient in a unit;

2-19      3.  Is stated in terms that can be readily used and understood

2-20  by the direct care nursing staff; and

2-21      4.  Takes into consideration the services for patient care

2-22  provided by health care employees other than licensed nurses.

2-23      Sec. 4.  “Direct care nurse” means a registered nurse who

2-24  has principal responsibility to oversee or carry out medical

2-25  regimens or nursing care for one or more patients.

2-26      Sec. 5.  “Documented staffing plan” means a detailed written

2-27  plan setting forth the minimum number, skill mix and

2-28  classification of licensed nurses required in each unit in a health

2-29  care facility for a given year, based on reasonable projections

2-30  derived from the patient census and average acuity level within

2-31  each unit during the previous year, if applicable, the size and

2-32  geography of the unit, the nature of services provided, and any

2-33  foreseeable changes in the size or function of the unit during the

2-34  current year.

2-35      Sec. 6.  “Health care employee” means an employee at a

2-36  health care facility who provides health care services, including,

2-37  without limitation, a direct care nurse.

2-38      Sec. 7.  “Health care facility” means:

2-39      1.  A hospital;

2-40      2.  An independent center for emergency care;

2-41      3.  A psychiatric hospital;

2-42      4.  A rural hospital; and

2-43      5.  A surgical center for ambulatory patients.

2-44      Sec. 8.  “Nurse” means a person licensed pursuant to chapter

2-45  632 of NRS to practice nursing.

3-1  Sec. 9.  “Nursing care” means care which falls within the

3-2  practice of nursing or which is otherwise encompassed within

3-3  recognized professional standards for the practice of nursing,

3-4  including, without limitation, assessment, nursing diagnosis,

3-5  planning, intervention, evaluation and patient advocacy.

3-6  Sec. 10.  “On duty” means a work status pursuant to which a

3-7  person is required to be available and ready to perform services

3-8  upon request within, or on behalf of, a health care facility,

3-9  including any rest periods or breaks during which the ability of

3-10  the person to leave the health care facility is expressly restricted or

3-11  restricted because of work-related circumstances that are beyond

3-12  the control of the person.

3-13      Sec. 11.  “Practice of nursing” has the meaning ascribed to it

3-14  in NRS 632.0169.

3-15      Sec. 12.  “Registered nurse” has the meaning ascribed to it in

3-16  NRS 632.019.

3-17      Sec. 13.  “Rest period” means a period in which a person may

3-18  be required to remain on the premises of a health care facility but

3-19  is free of all restraint or duty, or responsibility for work or duty.

3-20      Sec. 14.  “Skill mix” means a mix of direct care nurses based

3-21  on the differences in their licensing, specialty and experience.

3-22      Sec. 15.  “Staffing level” means the actual numerical nurse-

3-23  to-patient ratio by licensed nurse classification within a unit.

3-24      Sec. 16.  “Unit” means a component within a health care

3-25  facility for providing patient care.

3-26      Sec. 17.  A health care facility shall ensure that it is staffed in

3-27  accordance with sections 18 to 24, inclusive, of this act, so as to

3-28  provide sufficient, appropriately qualified nursing staff of each

3-29  classification in each unit within the health care facility to meet

3-30  the individualized needs for nursing care of the patients therein.

3-31      Sec. 18.  1.  As a condition of licensing, a health care facility

3-32  shall annually submit to the Health Division a documented

3-33  staffing plan and a written certification that the documented

3-34  staffing plan is sufficient to provide adequate and appropriate

3-35  delivery of health care services to patients for the ensuing year.

3-36  The documented staffing plan must:

3-37      (a) Include staffing ratios that meet the minimum

3-38  requirements set forth in section 19 of this act;

3-39      (b) Be adequate to meet all other requirements related to

3-40  staffing established by specific statute, and any regulations

3-41  adopted pursuant thereto, that may be applicable;

3-42      (c) Identify and use an acuity system that has been approved

3-43  by the Health Division to address fluctuations in actual acuity

3-44  levels of patients and requirements for nursing care that require

4-1  increased staffing levels above the minimum staffing ratios set

4-2  forth in the plan;

4-3  (d) Factor in other activities in each unit, including, without

4-4  limitation, discharges, transfers and admissions, and

4-5  administrative and support tasks, that are expected to be done by

4-6  direct care nurses in addition to the provision of nursing care;

4-7  (e) Identify the assessment tool used to validate the acuity

4-8  system relied upon in the plan;

4-9  (f) Identify the system or method that will be used to document

4-10  actual staffing within each unit on a daily basis;

4-11      (g) If applicable, include a written assessment of the accuracy

4-12  of the plan during the previous year based on the actual staffing

4-13  needs during that year; and

4-14      (h) Identify each classification of the nursing staff referenced

4-15  in the plan and include a statement that sets forth the minimum

4-16  qualifications for each such classification.

4-17      2.  A health care facility shall develop its documented staffing

4-18  plan in consultation with the direct care nursing staff for each

4-19  unit in the health care facility or, if the direct care nursing staff is

4-20  represented by recognized or certified collective bargaining

4-21  representatives, with the representatives of the direct care nursing

4-22  staff.

4-23      3.  As used in this section, “assessment tool” means a

4-24  measurement system pursuant to which the accuracy of an acuity

4-25  system is reviewed by comparing the staffing level in each unit

4-26  against actual requirements for patient nursing care.

4-27      Sec. 19.  1.  Except as otherwise provided in this section, a

4-28  documented staffing plan must include the following ratios of the

4-29  maximum number of patients that may be assigned to a direct care

4-30  nurse in each unit in the health care facility:

4-31      (a) A ratio of one direct care nurse to one patient in each:

4-32          (1) Operating room; and

4-33          (2) Trauma emergency unit.

4-34      (b) A ratio of one direct care nurse to two patients in each:

4-35          (1) Critical care unit;

4-36          (2) Intensive care unit;

4-37          (3) Labor and delivery unit; and

4-38          (4) Post anesthesia unit.

4-39      (c) A ratio of one direct care nurse to three patients in each:

4-40          (1) Antepartum unit;

4-41          (2) Emergency room;

4-42          (3) Pediatric unit;

4-43          (4) Intermediate units, also commonly known as “step-

4-44  down units”; and

4-45          (5) Telemetry units.

5-1  (d) A ratio of one direct care nurse to four patients in each:

5-2       (1) Intermediate care nursery; and

5-3       (2) Medical, surgical and acute care psychiatric unit.

5-4  (e) A ratio of one direct care nurse to five patients in each

5-5  rehabilitation unit.

5-6  (f) A ratio of one direct care nurse to six patients in each:

5-7       (1) Postpartum unit, including units providing care to not

5-8  more than three couplets; and

5-9       (2) Nursery for well babies.

5-10      (g) Such other ratios, as determined by the Board, for any

5-11  units not otherwise identified in this subsection, including, without

5-12  limitation, psychiatric units in health care facilities other than

5-13  hospitals that provide acute care.

5-14      2.  A nurse, including a nurse administrator or supervisor,

5-15  who does not have principal responsibility for caring for a patient

5-16  as would a direct care nurse must not be included in the

5-17  calculation of any nurse-to-patient ratios established pursuant to

5-18  subsection 1.

5-19      3.  A health care facility shall adjust its minimum staffing

5-20  ratios as necessary to reflect the need for additional direct care

5-21  nurses to ensure that each unit within the health care facility is

5-22  adequately staffed. Such an adjustment must be made in

5-23  accordance with an approved acuity system.

5-24      4.  Notwithstanding any provision of this section to the

5-25  contrary, the Board may, by regulation, establish higher nurse-to-

5-26  patient ratios than those ratios set forth in this section.

5-27      5.  As used in this section, “critical care unit” means a unit in

5-28  a hospital established to safeguard and protect patients whose

5-29  severity of medical conditions require continuous monitoring and

5-30  complex nursing intervention.

5-31      Sec. 20.  The Health Division shall adopt:

5-32      1.  Regulations prescribing the methods by which it will

5-33  approve an acuity system for use by a health care facility,

5-34  including, without limitation, a system for class approval of acuity

5-35  systems; and

5-36      2.  Such other regulations as are necessary to carry out the

5-37  provisions of sections 2 to 35, inclusive, of this act, including,

5-38  without limitation, regulations concerning the submission of a

5-39  documented staffing plan by a health care facility.

5-40      Sec. 21.  1.  The skill mix reflected in the documented

5-41  staffing plan of a health care facility must ensure that all the

5-42  following elements of the nursing process are performed in the

5-43  planning and delivery of nursing care for each patient:

5-44      (a) Assessment;

5-45      (b) Nursing diagnosis;

6-1  (c) Planning;

6-2  (d) Intervention;

6-3  (e) Evaluation; and

6-4  (f) Patient recovery.

6-5  2.  Registered nurses must constitute at least 50 percent of the

6-6  direct care nurses included in the documented staffing plan of a

6-7  health care facility.

6-8  3.  The skill mix in a documented staffing plan for a health

6-9  care facility must not require or assume that any functions

6-10  relating to nursing care required by chapter 632 of NRS, and any

6-11  regulations adopted pursuant thereto, or any other recognized

6-12  standards for the practice of nursing, required to be performed by

6-13  a licensed nurse are to be performed by unlicensed persons.

6-14      Sec. 22.  1.  As a condition of licensing, a health care facility

6-15  shall at all times be staffed in accordance with its documented

6-16  staffing plan, except that nothing in this subsection precludes a

6-17  health care facility from providing higher direct care nurse-to-

6-18  patient staffing ratios than the ratios otherwise established in its

6-19  documented staffing plan.

6-20      2.  A health care facility may assign a nurse to a unit or a

6-21  clinical area, and include the nurse in the count of assigned

6-22  nursing staff for the purposes of compliance with its minimum

6-23  required staffing levels, if:

6-24      (a) The nurse is appropriately licensed for assignment to that

6-25  unit or clinical area;

6-26      (b) The health care facility has provided prior orientation to

6-27  the nurse before assigning the nurse to that unit or clinical area;

6-28  and

6-29      (c) The health care facility has verified that the nurse is

6-30  capable of providing competent nursing care to the patients in that

6-31  unit or clinical area.

6-32      Sec. 23.  1.  As a condition of licensure, a health care

6-33  facility shall maintain accurate daily records showing for each

6-34  unit:

6-35      (a) The number of patients admitted, released and present in

6-36  the unit;

6-37      (b) The individual acuity level of each patient present in the

6-38  unit; and

6-39      (c) The identity and duty hours of each direct care nurse in the

6-40  unit.

6-41      2.  As a condition of licensure, a health care facility shall

6-42  maintain daily statistics, by unit, of mortality, morbidity, infection,

6-43  accident, injury and medical errors.

6-44      3.  Records required to be kept pursuant to this section must

6-45  be:

7-1  (a) Maintained for at least 7 years; and

7-2  (b) Made available upon request to the Health Division and

7-3  the public, except that records released to the public must not

7-4  contain any personal identifying information, other than the

7-5  acuity level, concerning a person.

7-6  Sec. 24.  1.  Notwithstanding any specific statute to the

7-7  contrary, and except as otherwise provided in this section, a health

7-8  care facility shall not mandate or otherwise directly or indirectly

7-9  require a health care employee to work or to be in on-duty status

7-10  in excess of:

7-11      (a) The scheduled work shift or period of duty;

7-12      (b) Twelve hours in a 24-hour period; or

7-13      (c) Eighty hours in a 14-consecutive-day period.

7-14  Nothing in this subsection is intended to prohibit a health care

7-15  employee from voluntarily working overtime in excess of the

7-16  limitations established in this subsection.

7-17      2.  A health care facility may require a health care employee

7-18  to work mandatory overtime during a declared state of emergency

7-19  in which the health care facility is requested, or otherwise may

7-20  reasonably be expected, to provide an exceptional level of

7-21  emergency or other medical services to the community, except that

7-22  the health care facility shall not require a health care employee to

7-23  work or to be in on-duty status more than the maximum number

7-24  of hours set forth in subsection 1 unless the health care facility

7-25  has first made reasonable efforts to fill its immediate staffing

7-26  needs through alternative efforts, including requesting off-duty

7-27  staff to report to work voluntarily, requesting staff who are on duty

7-28  to volunteer for overtime hours and recruiting per diem and

7-29  registry staff to report to work.

7-30      3.  Except as otherwise provided in this section, a health care

7-31  employee shall not work or be on duty for more than 16 hours in

7-32  any 24-hour period. If a health care employee works 16 hours in

7-33  any 24-hour period, the health care employee must have at least 8

7-34  consecutive hours off duty before being required to return to duty.

7-35  A health care facility shall not require such an employee to work

7-36  or to be on duty more than 7 consecutive days without at least one

7-37  consecutive 24-hour period off duty.

7-38      4.  During a declared state of emergency in which a health

7-39  care facility is requested, or otherwise may reasonably be expected,

7-40  to provide an exceptional level of emergency or other medical

7-41  services to the community, the limitation on maximum hours set

7-42  forth in subsection 3 may be lifted as follows:

7-43      (a) A health care employee may work or remain on duty for

7-44  more than the maximum hours if:

8-1       (1) The decision to work the additional time is voluntarily

8-2  made by the health care employee; and

8-3       (2) The health care employee is given at least one

8-4  uninterrupted 4-hour rest period before the completion of the first

8-5  16 hours of duty and an uninterrupted 8-hour rest period at the

8-6  completion of 24 hours of duty.

8-7  (b) A health care employee who has been on duty for more

8-8  than 16 hours in a 24-hour period who informs the health care

8-9  facility that he needs an immediate rest period must be relieved

8-10  from duty as soon thereafter as possible, consistent with the safety

8-11  needs of the patients, and given at least 8 uninterrupted hours off

8-12  duty before being required to return for duty.

8-13      5.  Mandatory overtime may be required, and the limitations

8-14  of maximum overtime may be lifted, only for the duration of the

8-15  declared state of emergency or for the period that the health care

8-16  facility is playing a direct role in responding to medical needs of

8-17  the community resulting from the declared state of emergency,

8-18  whichever is shorter.

8-19      6.  Notwithstanding any provision of this section to the

8-20  contrary, a health care facility may enter into collective

8-21  bargaining agreements negotiated on behalf of the health care

8-22  employees by a bona fide labor organization that include a work

8-23  shift schedule or overtime program that provides for mandatory

8-24  hours on duty in excess of the number of hours permitted

8-25  pursuant to this section provided that adequate measures are

8-26  included in the agreement to ensure against excessive fatigue of

8-27  the affected employees.

8-28      7.  As used in this section:

8-29      (a) “Declared state of emergency” means an officially

8-30  designated state of emergency that has been declared by a federal,

8-31  state or local government official having authority to declare a

8-32  state of emergency, but does not include a state of emergency

8-33  which results from a labor dispute in the health care industry.

8-34      (b) “Mandate” means a request which, if refused or declined,

8-35  may result in discipline, discharge, loss of promotion or other

8-36  adverse employment consequence.

8-37      (c) “Off-duty” means that the person has no restriction placed

8-38  on his whereabouts and is free of all restraint or duty on behalf of

8-39  the health care facility.

8-40      Sec. 25.  1.  As a condition of licensure, a health care

8-41  facility shall adopt and disseminate to its direct care nursing staff

8-42  a written policy that details the circumstances under which a

8-43  direct care nurse may refuse a work assignment, including a work

8-44  assignment that involves the continuation of on-duty status.

9-1  2.  The written policy concerning work assignments must, at a

9-2  minimum, allow a direct care nurse to refuse an assignment:

9-3  (a) For which the direct care nurse is not prepared because of

9-4  lack of education, training or experience to fulfill safely and

9-5  without compromising or jeopardizing the safety of the patients,

9-6  the ability of the direct care nurse to meet foreseeable needs of the

9-7  patients and the licensure of the direct care nurse;

9-8  (b) For which the direct care nurse had volunteered to work as

9-9  overtime work if he subsequently determines that his level of

9-10  fatigue or decreased alertness, or both, would compromise or

9-11  jeopardize the safety of the patients or the licensure of the direct

9-12  care nurse; or

9-13      (c) Which otherwise violates any provision of sections 2 to 35,

9-14  inclusive, of this act.

9-15      3.  The written policy concerning work assignments must

9-16  contain:

9-17      (a) Reasonable requirements for prior notice to the supervisor

9-18  of the direct care nurse of the request, including supporting

9-19  reasons, by the direct care nurse to be relieved of the work

9-20  assignment;

9-21      (b) Reasonable requirements which provide, where feasible, an

9-22  opportunity for the supervisor to review a request by the direct

9-23  care nurse to be relieved of the work assignment, including any

9-24  specific conditions supporting the request, and based upon that

9-25  review:

9-26          (1) Relieve the direct care nurse of the work assignment as

9-27  requested; or

9-28          (2) Deny the request; and

9-29      (c) A process pursuant to which a direct care nurse may

9-30  exercise his right to refuse a work assignment when the supervisor

9-31  denies the request of the nurse to be relieved of the work

9-32  assignment if:

9-33          (1) The supervisor rejected the request without proposing a

9-34  remedy or, if a remedy is proposed, the proposed remedy would be

9-35  inadequate or untimely;

9-36          (2) The process for filing a complaint with the Health

9-37  Division or any other appropriate regulatory entity, including any

9-38  investigation that would be required, would be untimely to address

9-39  the concerns of the direct care nurse in refusing a work

9-40  assignment; and

9-41          (3) The direct care nurse in good faith believes that the

9-42  work assignment meets the conditions established in the written

9-43  policy justifying refusal.

9-44      Sec. 26.  1.  A health care facility shall not penalize,

9-45  discriminate or retaliate in any manner against any person with

10-1  respect to compensation, terms, conditions or privileges of

10-2  employment who, in good faith, individually or in conjunction

10-3  with another person:

10-4      (a) Reports a violation or suspected violation of sections 2 to

10-5  35, inclusive, of this act to a public regulatory agency, a private

10-6  accreditation body or a management person of the health care

10-7  facility;

10-8      (b) Initiates, cooperates or otherwise participates in an

10-9  investigation or proceeding concerning matters covered by

10-10  sections 2 to 35, inclusive, of this act, brought by the Health

10-11  Division, any other appropriate regulatory entity or a private

10-12  accreditation body;

10-13     (c) Informs or discusses any violation or suspected violation of

10-14  sections 2 to 35, inclusive, of this act with any other employee or a

10-15  representative of such an employee, with any patient or a

10-16  representative of such a patient, or with the public; or

10-17     (d) Otherwise avails himself of the rights set forth in sections 2

10-18  to 35, inclusive, of this act.

10-19     2.  For the purposes of this section, a person is deemed to

10-20  have acted in good faith if the person reasonably believes that the

10-21  information reported or disclosed is true and that a violation has

10-22  occurred or may occur.

10-23     Sec. 27.  A health care facility which violates any provision of

10-24  sections 25 and 26 of this act may be held liable to the health care

10-25  employee affected by the violation in an action brought in a court

10-26  of competent jurisdiction for such legal or equitable relief as may

10-27  be appropriate, including, without limitation, reinstatement,

10-28  promotion, payment of lost wages and benefits, and compensatory

10-29  and consequential damages resulting from the violation, together

10-30  with an equal amount in punitive damages. If judgment is

10-31  awarded to the plaintiff, the court shall award to the plaintiff

10-32  reasonable attorney’s fees and costs of action to be paid by the

10-33  defendants. The right of a health care employee to institute a

10-34  private action pursuant to this section is not limited by any other

10-35  rights granted pursuant to sections 2 to 35, inclusive, of this act.

10-36     Sec. 28.  1.  A health care facility shall post in a conspicuous

10-37  place readily accessible to the general public a notice prepared by

10-38  the Health Division that sets forth in summary form the

10-39  mandatory provisions of sections 2 to 35, inclusive, of this act.

10-40  Mandatory and actual staffing levels of nurses in each unit must

10-41  be posted daily in a conspicuous place that is readily accessible to

10-42  the general public.

10-43     2.  Upon request, a health care facility shall make available to

10-44  the public copies of its documented staffing plan filed with the

10-45  Health Division. The health care facility shall post in each unit

11-1  within the health care facility, or otherwise make readily available

11-2  to the nursing staff in that unit, during each work shift:

11-3      (a) A copy of the current documented staffing plan for that

11-4  unit;

11-5      (b) Documentation of the number of direct care nurses

11-6  required to be present during the work shift based on the approved

11-7  adopted acuity system; and

11-8      (c) Documentation of the actual number of direct care nurses

11-9  present during the work shift.

11-10     Sec. 29.  The Health Division shall ensure the general

11-11  compliance of a health care facility with sections 18 to 24,

11-12  inclusive, of this act, relating to documented staffing plans, and

11-13  adopt such regulations as are necessary or appropriate to carry

11-14  out the provisions of this section. Such regulations must, without

11-15  limitation, provide:

11-16     1.  For unannounced, random visits at a health care facility to

11-17  determine whether the facility is in compliance with sections 18 to

11-18  24, inclusive, of this act;

11-19     2.  An accessible and confidential system pursuant to which

11-20  the nursing staff or the general public may report the failure of a

11-21  health care facility to comply with the requirements of sections 18

11-22  to 24, inclusive, of this act;

11-23     3.  A systematic means for investigating and correcting

11-24  violations of sections 18 to 24, inclusive, of this act;

11-25     4.  For public access to information regarding reports of

11-26  inspections, results, deficiencies and corrections; and

11-27     5.  A process for imposing the penalties for violations of the

11-28  staffing requirements set forth in sections 18 to 24, inclusive, of

11-29  this act.

11-30     Sec. 30.  Notwithstanding any provision of sections 2 to 35,

11-31  inclusive, of this act to the contrary, the Labor Commissioner may

11-32  take such actions as he determines necessary to ensure that a

11-33  health care facility is in compliance with sections 2 to 35,

11-34  inclusive, of this act.

11-35     Sec. 31.  If the Health Division determines that a health care

11-36  facility has violated any provision of sections 2 to 35, inclusive, of

11-37  this act, the Health Division may:

11-38     1.  Suspend or revoke the license of the health care facility

11-39  pursuant to NRS 449.160.

11-40     2.  Impose an administrative fine:

11-41     (a) If the health care facility has violated any requirements

11-42  relating to staffing set forth in sections 18 to 24, inclusive, of this

11-43  act, of $15,000 per day, per violation, for each day that the

11-44  violation occurs or continues.

12-1      (b) If the health care facility has failed to post notice as

12-2  required by section 28 of this act, of $1,000 for each day that the

12-3  notice is not posted as required.

12-4      (c) If the health care facility has violated any provision of

12-5  section 25 or 26 of this act, of $15,000 per violation.

12-6      Sec. 32.  1.  If, after an investigation, the Health Division

12-7  determines that a health care facility is not in compliance with any

12-8  provision of sections 2 to 35, inclusive, of this act, or any

12-9  regulations adopted pursuant thereto, the Health Division shall

12-10  notify the health care facility of all deficiencies in its compliance.

12-11  The notice may include an order to take corrective action within a

12-12  time specified, including, without limitation:

12-13     (a) Revising the documented staffing plan of the health care

12-14  facility;

12-15     (b) Reducing the number of patients within a unit in the health

12-16  care facility;

12-17     (c) Temporarily closing a unit to any further admissions of

12-18  patients until corrections are made; and

12-19     (d) Temporarily transferring patients to another unit within

12-20  the health care facility until corrections are made.

12-21     2.  The Health Division may issue an order to take corrective

12-22  action on an emergency basis, without prior notice or opportunity

12-23  for a hearing, if the investigation by the Health Division shows

12-24  that the noncompliance of the health care facility is compromising

12-25  patient care or poses an immediate danger to the health or safety

12-26  of patients.

12-27     3.  An order to take corrective action issued by the Health

12-28  Division pursuant to this section must be in writing and contain a

12-29  statement of the reasons for issuing the order. If a health care

12-30  facility fails to comply with an order to take corrective action

12-31  within the time specified or, if no time has been specified, in a

12-32  timely manner, the Health Division may take such action as it

12-33  deems appropriate, including, without limitation:

12-34     (a) Appointing an administrative overseer for the health care

12-35  facility;

12-36     (b) Closing the health care facility or unit to the admission of

12-37  patients;

12-38     (c) Placing the emergency room of the health care facility on

12-39  bypass status; and

12-40     (d) Suspending or revoking the license of the health care

12-41  facility.

12-42     Sec. 33.  Any person who willfully violates any provision of

12-43  sections 2 to 35, inclusive, of this act in a manner that evidences a

12-44  pattern or practice of violations which is likely to have a serious

12-45  and adverse impact on patient care or the potential for serious

13-1  injury or death to patients or employees of the health care facility

13-2  is guilty of a misdemeanor.

13-3      Sec. 34.  A person or health care facility that fails to report or

13-4  falsifies information, or that coerces, threatens, intimidates or

13-5  otherwise influences another person to fail to report or to falsify

13-6  information, required to be reported pursuant to sections 2 to 35,

13-7  inclusive, of this act is guilty of a gross misdemeanor and shall be

13-8  punished by a fine of not more than $15,000 for each such

13-9  incident.

13-10     Sec. 35.  The Department of Human Resources:

13-11     1.  May, upon a determination that a health care facility has

13-12  violated any provision of sections 2 to 35, inclusive, of this act:

13-13     (a) Order the health care facility to reimburse the State Plan

13-14  for Medicaid for an amount to be determined by the Department;

13-15     (b) Terminate the participation of the health care facility in the

13-16  State Plan for Medicaid for a period to be determined by the

13-17  Department of Human Resources; or

13-18     (c) Both order the health care facility to reimburse the State

13-19  Plan for Medicaid and to terminate the participation of the health

13-20  care facility in the State Plan for Medicaid.

13-21     2.  Shall, if a health care facility falsifies or causes to be

13-22  falsified documentation required by sections 2 to 35, inclusive, of

13-23  this act, prohibit the health care facility from receiving any

13-24  reimbursements from the State Plan for Medicaid for 6 months.

13-25     Sec. 36.  NRS 449.040 is hereby amended to read as follows:

13-26     449.040  Any person, state or local government or agency

13-27  thereof desiring a license under the provisions of NRS 449.001 to

13-28  449.240, inclusive, and sections 2 to 35, inclusive, of this act must

13-29  file with the Health Division an application , on a form prescribed,

13-30  prepared and furnished by the Health Division, containing:

13-31     1.  The name of the applicant and, if a natural person, whether

13-32  the applicant has attained the age of 21 years.

13-33     2.  The type of facility to be operated.

13-34     3.  The location of the facility.

13-35     4.  In specific terms, the nature of services and type of care to

13-36  be offered, as defined in the regulations.

13-37     5.  The number of beds authorized by the Director of the

13-38  Department of Human Resources or, if such authorization is not

13-39  required, the number of beds the facility will contain.

13-40     6.  The name of the person in charge of the facility.

13-41     7.  Such other information as may be required by the Health

13-42  Division for the proper administration and enforcement of NRS

13-43  449.001 to 449.240, inclusive[.] , and sections 2 to 35, inclusive, of

13-44  this act.

14-1      8.  Evidence satisfactory to the Health Division that the

14-2  applicant is of reputable and responsible character. If the applicant is

14-3  a firm, association, organization, partnership, business trust,

14-4  corporation or company, similar evidence must be submitted as to

14-5  the members thereof[,] and the person in charge of the facility for

14-6  which application is made. If the applicant is a political subdivision

14-7  of the State or other governmental agency, similar evidence must be

14-8  submitted as to the person in charge of the institution for which

14-9  application is made.

14-10     9.  Evidence satisfactory to the Health Division of the ability of

14-11  the applicant to comply with the provisions of NRS 449.001 to

14-12  449.240, inclusive, and sections 2 to 35, inclusive, of this act and

14-13  the standards and regulations adopted by the Board.

14-14     10.  Evidence satisfactory to the Health Division that the

14-15  facility conforms to the zoning regulations of the local government

14-16  within which the facility will be operated or that the applicant has

14-17  applied for an appropriate reclassification, variance, permit for

14-18  special use or other exception for the facility.

14-19     Sec. 37.  NRS 449.060 is hereby amended to read as follows:

14-20     449.060  1.  Each license issued pursuant to NRS 449.001 to

14-21  449.240, inclusive, and sections 2 to 35, inclusive, of this act

14-22  expires on December 31 following its issuance and is renewable for

14-23  1 year upon reapplication and payment of the fee provided in NRS

14-24  449.040 and 449.050 unless the Health Division finds, after an

14-25  investigation, that the facility has not:

14-26     (a) Satisfactorily complied with the provisions of NRS 449.001

14-27  to 449.240, inclusive, and sections 2 to 35, inclusive, of this act or

14-28  the standards and regulations adopted by the Board;

14-29     (b) Obtained the approval of the Director of the Department of

14-30  Human Resources before undertaking a project, if such approval is

14-31  required by NRS 439A.100; or

14-32     (c) Conformed to all applicable local zoning regulations.

14-33     2.  Each reapplication for an agency to provide nursing in the

14-34  home, a residential facility for intermediate care, a facility for

14-35  skilled nursing or a residential facility for groups must include,

14-36  without limitation, a statement that the facility or agency is in

14-37  compliance with the provisions of NRS 449.173 to 449.188,

14-38  inclusive.

14-39     Sec. 38.  NRS 449.070 is hereby amended to read as follows:

14-40     449.070  The provisions of NRS 449.001 to 449.240, inclusive,

14-41  and sections 2 to 35, inclusive, of this act do not apply to:

14-42     1.  Any facility conducted by and for the adherents of any

14-43  church or religious denomination for the purpose of providing

14-44  facilities for the care and treatment of the sick who depend solely

14-45  upon spiritual means through prayer for healing in the practice of

15-1  the religion of the church or denomination, except that such a

15-2  facility must comply with all regulations relative to sanitation and

15-3  safety applicable to other facilities of a similar category.

15-4      2.  Foster homes as defined in NRS 424.014.

15-5      3.  Any medical facility or facility for the dependent operated

15-6  and maintained by the United States Government or an agency

15-7  thereof.

15-8      Sec. 39.  NRS 449.160 is hereby amended to read as follows:

15-9      449.160  1.  The Health Division may deny an application for

15-10  a license or may suspend or revoke any license issued under the

15-11  provisions of NRS 449.001 to 449.240, inclusive, and sections 2 to

15-12  35, inclusive, of this act upon any of the following grounds:

15-13     (a) Violation by the applicant or the licensee of any of the

15-14  provisions of NRS 439B.410 or 449.001 to 449.245, inclusive, and

15-15  sections 2 to 35, inclusive, of this act, or of any other law of this

15-16  state or of the standards, rules and regulations adopted thereunder.

15-17     (b) Aiding, abetting or permitting the commission of any illegal

15-18  act.

15-19     (c) Conduct inimical to the public health, morals, welfare and

15-20  safety of the people of the State of Nevada in the maintenance and

15-21  operation of the premises for which a license is issued.

15-22     (d) Conduct or practice detrimental to the health or safety of the

15-23  occupants or employees of the facility.

15-24     (e) Failure of the applicant to obtain written approval from the

15-25  Director of the Department of Human Resources as required by

15-26  NRS 439A.100 or as provided in any regulation adopted pursuant to

15-27  this chapter, if such approval is required.

15-28     2.  In addition to the provisions of subsection 1, the Health

15-29  Division may revoke a license to operate a facility for the dependent

15-30  if, with respect to that facility, the licensee that operates the facility,

15-31  or an agent or employee of the licensee:

15-32     (a) Is convicted of violating any of the provisions of

15-33  NRS 202.470;

15-34     (b) Is ordered to but fails to abate a nuisance pursuant to NRS

15-35  244.360, 244.3603 or 268.4124; or

15-36     (c) Is ordered by the appropriate governmental agency to correct

15-37  a violation of a building, safety or health code or regulation but fails

15-38  to correct the violation.

15-39     3.  The Health Division shall maintain a log of any complaints

15-40  that it receives relating to activities for which the Health Division

15-41  may revoke the license to operate a facility for the dependent

15-42  pursuant to subsection 2.

15-43     4.  On or before February 1 of each odd-numbered year, the

15-44  Health Division shall submit to the Director of the Legislative

16-1  Counsel Bureau a written report setting forth, for the previous

16-2  biennium:

16-3      (a) Any complaints included in the log maintained by the Health

16-4  Division pursuant to subsection 3; and

16-5      (b) Any disciplinary actions taken by the Health Division

16-6  pursuant to subsection 2.

16-7      Sec. 40.  NRS 449.163 is hereby amended to read as follows:

16-8      449.163  1.  If a medical facility or facility for the dependent

16-9  violates any provision related to its licensure, including any

16-10  provision of NRS 439B.410, 449.001 to 449.240, inclusive, and

16-11  sections 2 to 35, inclusive, of this act, or any condition, standard or

16-12  regulation adopted by the Board, the Health Division in accordance

16-13  with the regulations adopted pursuant to NRS 449.165 may:

16-14     (a) Prohibit the facility from admitting any patient until it

16-15  determines that the facility has corrected the violation;

16-16     (b) Limit the occupancy of the facility to the number of beds

16-17  occupied when the violation occurred, until it determines that the

16-18  facility has corrected the violation;

16-19     (c) [Impose] Except as otherwise provided in section 31 of this

16-20  act, impose an administrative penalty of not more than $1,000 per

16-21  day for each violation, together with interest thereon at a rate not to

16-22  exceed 10 percent per annum; and

16-23     (d) Appoint temporary management to oversee the operation of

16-24  the facility and to ensure the health and safety of the patients of the

16-25  facility, until:

16-26         (1) It determines that the facility has corrected the violation

16-27  and has management which is capable of ensuring continued

16-28  compliance with the applicable statutes, conditions, standards and

16-29  regulations; or

16-30         (2) Improvements are made to correct the violation.

16-31     2.  If the facility fails to pay any administrative penalty imposed

16-32  pursuant to paragraph (c) of subsection 1, the Health Division may:

16-33     (a) Suspend the license of the facility until the administrative

16-34  penalty is paid; and

16-35     (b) Collect court costs, reasonable attorney’s fees and other

16-36  costs incurred to collect the administrative penalty.

16-37     3.  The Health Division may require any facility that violates

16-38  any provision of NRS 439B.410, 449.001 to 449.240, inclusive, and

16-39  sections 2 to 35, inclusive, of this act, or any condition, standard or

16-40  regulation adopted by the Board, to make any improvements

16-41  necessary to correct the violation.

16-42     4.  Any money collected as administrative penalties pursuant to

16-43  this section must be accounted for separately and used to protect the

16-44  health or property of the residents of the facility in accordance with

16-45  applicable federal standards.

17-1      Sec. 41.  The Health Division of the Department of Human

17-2  Resources shall not renew the license of any health care facility, as

17-3  that term is defined in section 7 of this act, if the health care facility

17-4  has not submitted to the Health Division a documented staffing plan

17-5  as required by sections 18 to 24, inclusive, of this act.

17-6      Sec. 42.  The provisions of NRS 354.599 do not apply to any

17-7  additional expenses of a local government that are related to the

17-8  provisions of this act.

 

17-9  H