The 81st session of the Nevada Legislature adjourned, on time, Monday May 31st and it was a wild final weekend! With each legislator looking to pass bills representing his or her priorities in the final days, the halls of the legislative building were buzzing with frenetic activity.
Overall, the session was a success for NOMA, Osteopathic Physicians, and our patients.
The final "by the numbers": 959 bills – 496 in the Assembly and 463 in the Senate – and 74 resolutions, were introduced for a total of 1,033 pieces of legislation. Lawmakers enacted 515 of the bills, sending them on to the governor. So more than half of all legislation died along the way, failing to meet deadlines for action in committee or on the Assembly or Senate floor.
Throughout the session, NOMA monitored 41 bills and 13 bill drafts. Thirteen bills did not meet a committee deadline and died, while seven were re-referred to a money committee (Assembly Ways and Means or Senate Finance) and died there (a common tactic to kill a bill!)
Bills to highlight include:
This bill had three components: It would 1) Prescribe regulations for a business entity that employs chiropractors; 2) Change “Chiropractor” to “Chiropractic Physicians”; and 3) Allow a Chiropractor to recommend, dispense or administer any drug or device for which the prescription or order of a practitioner is not required by federal or state law. An amendment was offered by the NV Chiropractic Assoc. to allow DCs to clear youth athletes to return to play post-concussion.
NOMA opposed the first provision, fearing that this would place DOs under the jurisdiction of the Chiropractic Board if they employed a DC in their practice, and opposed the amendment on head injury. Working with the bill sponsor, Ass. Yeager and the Chiro Board, we were able to secure an amendment that would make clear NRS 633 licensees would not be included under the first provision and we were successful in blocking the Chiro Assoc's amendment from a vote.
NOMA's position on the amendment resulted in a hostile reaction from many DCs throughout the state that threatened NOMA's president personally and threatened to withhold referrals from DOs in the future. Although disturbing, these actions did not stop NOMA from protecting Nevada's youth athletes.
Approved by Governor
Requires DHHS to develop a data request from physicians and for licensing boards to make that request available upon renewal; allows boards to refuse to renew a license for failure to complete the request; and makes information confidential. Info to be collected includes: (a)Whether the applicant is employed by a hospital or an entity owned by a health system or practices independently; (b) the name of the hospital or the entity and the health system if employed by one; (c)If the applicant is employed by an entity other than a hospital 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; (d)Whether the applicant practices as a solo practitioner or with at least one other physician; (e)If the applicant practices with at least one other physician, the number of other physicians with which the applicant practices and the specialty areas of those physicians; (f)The number of locations at which the physician practices; (g)If the applicant practices with at least one other physician, the number of locations at which the physicians in the group practice.
NOMA initially opposed the bill due to the provision that would allow a board to withhold license renewal for failure to complete. While understanding the intent behind the data collection is to better assess the health care provider workforce in Nevada, failing to renew a license would only exacerbate provider shortages. Ultimately, the sponsor removed this provision.
Approved by Governor
Requires 6 hours of mandated CME, biennially, in cultural competency and diversity, equity and inclusion for psychiatrists, psychiatric PAs/APNs, and other behavioral health providers.
NOMA initially opposed this bill due to the onerous nature of mandating 6 hours of specific CME. When added to other, already mandated CME topics, more than a third of the annual CME requirement would be dictated by the State.
The bill was amended to require only 2 hours biennially and to allow credit for the facility-provided training that was mandated last session.
Approved by Governor
Authorizes a physician to prescribe a controlled substance that is designed to end the life of a patient under certain circumstances.
This was a contentious bill with passionate advocates and opponents. NOMA did not take a position on this bill. It was sent from Committee to the Floor without recommendation (a very rare occurrence) and was re-referred to Ways & Means.
Died in W&M
This bill would provide immunity from civil liability for mobile Behavioral Health crisis response teams providing telephonic or A-V communications under certain conditions. This bill was not originally of concern, however it was amended in committee to define “BH Specialist” and did not include BOS-certified DOs, only ABME-certified physicians. We immediately reached out to the bill sponsor, Ass. Yeager and he agreed to correct the oversight. The bill was amended to to include "a psychiatrist who is licensed pursuant to chapter 630 or 633 of NRS." Chapter 630 is the allopathic licensing chapter and 633 is the osteopathic chapter.
Approved by Governor
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Would require, upon application for renewable license, to have at least 2 hours of CME in the screening, brief intervention, and referral to treatment approach to substance use disorder. Defines “Screening, brief intervention and referral to treatment approach” as an evidence-based method of delivering early intervention and treatment to persons who have or are at risk of developing a substance use disorder that consists of: 1.Screening to assess the severity of substance use and identify the appropriate level of treatment; 2.Brief intervention to increase awareness of the person’s substance use and motivation to change his or her behavior; and 3.Referral to treatment for persons who need more extensive treatment and specialty care for substance use disorder. Eff. January 1, 2024
NOMA initially opposed this item for reasons similar to AB327 in addition to the requirement that any new license applicant would need to complete the training prior to getting a license. The bill was amended to make this a 1-time requirement that could substitute for the current opioid CME, and provided a grace period for new licensee applicants. As passed, currently licensed providers will need to complete the training during the first renewal period after January 2024 and newly licensed providers must complete the training during their first renewal period.
Approved by Governor
This bill would Include in the definition of telehealth the delivery of services through the use of a standard telephone and requires insurers to cover telemedicine to the same extent, but not the same amount, for such services. The bill was initially amended o clarify that telehealth includes both synchronous and asynchronous interactions, and audio only, and exempted Worker's Comp from audio-only provisions. It also required coverage to same extent and IN same amount, except for audio only.
It was further amended to remove asynchronous interactions from definition for Workers Comp and for parity provisions, except for mental health, and set the provisions to expire by limitation 1 year after the termination of the emergency declared for COVID-19 or on June 30, 2023, whichever is earlier; and to expire for mental health services, by limitation on June 30, 2023.
On the Governor's Desk
This bill made various changes to mental health provisions in law regarding the the definitions of “chemical restraint”, “Emergency Admission”, "Involuntary Court-Ordered Admission”, and "Mental Health Crisis Hold”. It also revised provisions for court-ordered involuntary assistant outpatient treatment.
The bill itself was not a concern for NOMA. However, the bill sought to amend NRS 433A, where a long-standing oversight was already in law: namely that NRS 433A.018 did not include a psychiatrist certified by the American Osteopathic Board of Psychiatry and Neurology in the definition of “Person professionally qualified in the field of psychiatric mental health”
Since this bill was "opening" the chapter where this was an issue, an opportunity existed to make a correction, NOMA reached out to the sponsor to request a correction and Sen. Ratti graciously agreed.
The bill was amended to change the definition to “A psychiatrist licensed to practice medicine in this State”
On the Governor's Desk
This bill was a valiant effort by Sen. (Dr.) Hardy to require an entity responsible for regulating providers of health care that determines as a result of an investigation that there are no reasonable grounds to believe that the provider of health care has committed a violation to refer to the investigation as a “review and evaluation.” It also provided that an investigation recorded as a review and evaluation would not be an "investigation" for purposes related to employment, professional licensure or credentialing, education or liability or health insurance.
NOMA supported this bill, as it would stop physicians from having to disclose these unfounded or unsubstantiated investigations when applying for licenses, privileges, or malpractice. The bill passed the Senate 21-0, but....
DIED IN ASSEMBLY
Would require the Chief Health Officer to issue a standing order that permits pharmacists to dispense “self-administered hormonal contraceptives” to a patient upon request. NOMA opposed this legislation because there was no requirement for a provider evaluation before an initial prescription, there was no age limitation, and the screening questionnaire was to be given to a patient only upon request. You can read the Letter of Opposition.
The bill was amended to make the questionnaire mandatory, however the remaining concerns were left unaddressed. The bill was further amended to change the authority from the Chief Medical Officer to the Board of Pharmacy by regulation. This will require open meetings and a public workshop where NOMA will continue to push to address the age and initial prescription.
On the Governor's Desk
It is unfortunate that we actually needed a bill to address this issue, but SB196 prohibits a provider of healthcare from performing a pelvic exam on unconscious/anesthetized patient without informed consent, with exceptions.
Approved by Governor
Would require a healthcare provider who provides or supervises the provision of emergency medical services in a hospital or primary care to a patient who is at least 15 years of age to ask the patient if he or she wishes to be tested for HIV or other sexually transmitted diseases. The HCP would be liable for professional discipline for a failure to ask.
While understanding the intent, Nevada has some of if not the highest rates of HIV and syphillis in the nation, requiring the screening of ALL patients >14 y/o regardless of presenting complaint would be onerous. NOMA opposed the bill. (Read Letter of Opposition).
Due to our efforts, the bill was amended to make the testing where “medically indicated” and placed the burden on the hospital to ensure compliance where patient seeks emergency services. It also substituted “disciplinary action” for “professional discipline”
During the final hearing on the bill, the sponsor, Sen. Harris, was asked if a question included on a provider's intake form would be sufficient to meet the intent. That is, if on your patient visit questionnaire you included a question that asks something to the effect of, "Would you like to be screened for HIV or other sexually transmitted infection during this visit?" Her answer was "yes."
On the Governor's Desk
Would 1) Expand collaborative drug therapy management to locations outside of medical facilities; 2) Remove current criteria and replace with “A collaborative practice agreement must not grant a pharmacist the authority to engage in an activity that is outside the scope of the current practice of the practitioner.” 3) Remove the requirement for pharmacist to obtain written informed consent from patient; and 4) Require certain content in the written guidelines entered into btw practitioner and pharmacist.
NOMA originally opposed this bill as drafted (read Letter of Opposition). In working with the bill sponsor, Sen. Ratti, we were able to secure an amendment that added needed safeguards and thus withdrew our opposition. The bill was further amended in the Assembly to add back in the requirement for informed consent.
Approved by Governor
This bill would authorize a provider of health care who holds a license or certificate in another jurisdiction to provide telehealth services to a patient in this State if he or she registers with the regulatory body that regulates his or her profession in this State for a non-renewable period of 1 year; requires Boards to provide online application/renewals
Died in Senate Finance
This bill places onerous provisions on providers by 1) Requiring a hospital or physician group practice to notify DHHS of any merger, acquisition or similar transaction involving the hospital or physician group practice and 2) Prohibiting a health facility, a physician or an insurer from entering into a contract that contains certain provisions that restrain the ability of an insurer to contract with other providers of health care, including health facilities, that are not parties to the contract or the ability of a provider of health care to contract with insurers that are not a party to the contract.
NOMA opposed this legislation initially and after it was amended to amended to include a person who owns all or substantially all of a physician group practice to report to DHHS any merger, acquisition, or similar transaction; adds term “willfully” to prohibited actions and decreases penalty from felony to misdemeanor
The bill passed on party-line votes in both chambers.
On the Governor's Desk
Requires DHHS to establish/maintain database of info collected from providers of healthcare for use by the Healthcare Workforce Working Group. Would collect 13 demographic/practice-related data points.
The bill was amended to require DHHS to develop an electronic request for use by the Boards and for Boards to make request available to licensees. Makes request optional with no penalty for not replying.
Approved by Governor
Basically, requires every profession in Title 54 to issue license by reciprocity and requires Boards to enter into reciprocal agreements with other states
Died in Senate Finance
While the above reflects biils that were introduced, it is also important to mention a bill that was NOT introduced: Once again, as part of the Your Nevada Doctors Coalition (formerly known as KODIN), we were successful in preventing the trial attorneys from weakening Nevada's hard-won malpractice / tort reforms!
While the 81st regular session has ended, there will be a special session to address the census results and the re-districting of the state's legislative and congressional districts prior to the 2022 elections!
Stay-tuned for more info!
