Only two weeks remain in Nevada's 81st legislative session! Activity is starting to pick up as deadlines loom for bills to pass out of committee and on the floor.
An update on the numbers: 995 pieces of legislation have been introduced and we are monitoring 28. Since the last update, 1 bill was removed from the list as it failed to meet a committee deadline. Bills are summarized below (bill numbers are hyperlinked so you can read them if you wish), along with NOMA's position. Changes from the last legislative update are in bold. The next major deadline is May 21st, when all bills, except finance, must pass off the the second chamber's floor, i.e., an Assembly Bill must pass out of the Senate.
Authorizes health care professionals to issue an order for opioid antagonists to a public or private school; 2) Provides liability protection for prescribing and administration
PASSED the Assembly 42-0
PASSED Senate Committee
1) Prescribes regulations for business entity that employs chiropractors; 2) changes “Chiropractor” to “Chiropractic Physicians”; 3) Allows 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.
PASSED Assembly 34-6-2
PASSED Senate Committee
Requires DHHS to develop data request from physicians and licensing boards to make request available upon renewal; allows boards to refuse to renew for failure to complete; makes information confidential. Info to collect 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.
(OPPOSE) Amendment by sponsor to remove any discipline to include withholding renewal and requiring DHHS to provide annual report.
PASSED Assembly 26-19 on a party line vote
PASSED Senate Committee
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. (OPPOSE)
AMENDED to require only 2 hours biennially and to allow credit for facility-provided training, also to require ALL nurses to complete requirement
PASSED Assembly 32-9-1
PASSED Senate Committee
Among other provisions related to opioid prevention pilot programs, the bill
1) Prohibits prescribing opioids to a patient who Is also being prescribed a benzodiazepine or has been issued a prescription for a benzodiazepine within the immediately preceding 30 days or a history of opioid use disorder or opioid overdose, unless the practitioner determines that the prescription is medically necessary 2) Requires such patient to be prescribed an opioid antagonist 3) must document in the medical record of the patient the reasons why the prescription is medically necessary and the benefits of prescribing the opioid outweigh the risks; 4) If prescribing more than 50 morphine milligram equivalents per day shall additionally prescribe an opioid antagonist or document in the medical record of the patient why such a prescription is not appropriate for the patient.
An amendment was offered by the sponsor that would require a practitioner that prescribes an opioid to a patient who: (a) Is also being prescribed a benzodiazepine or who has been issued a prescription for a benzodiazepine by any practitioner within the immediately preceding 30 days; or (b) Has a history of opioid use disorder or opioid overdose; shall additionally prescribe an opioid antagonist for the patient. Keeps requirement to issue Narcan if rx more than 50 mme (NEUTRAL)
AMENDED to gut the bill of all provisions and instead exclude fentanyl test strips from the list of drug paraphernalia that is prohibited for delivery, sale, possession, manufacture, advertising or use in this State
Passed Assembly 39-3
AMENDED to extend provisions of bill to all testing materials
PASSED Senate Committee
1) Similar to AB346. Creates independent commission to set private sector rates, again starting at Medicare levels, to ensure “a fair & reasonable profit.” During a hearing the sponsor, Ass. Orentlicher, claimed some are making “unreasonable” profit. Concept is govt will negotiate (set) rates for all insurers/providers; Allows commission to vary rates based on certain factors; and will result in lower premiums and larger networks
2) Expands current law from imposing assessment ("provider tax") on Personal Care and Medical Facilities to Physician/Physician Groups.
(OPPOSE) NOMA testified in opposition at the hearing.
Amended to delete all provisions and convert to a study by interim healthcare committee. Re-referred to Ways & Means
1) Creates the Patient Protection Commission Advisory Committee; 2) Transfers Patient Protection Commission from Governor to DHHS and revises membership 3) Guts existing duties and instead charges PPC to establish a plan to increase access by patients to their medical records and provide for the interoperability of medical records between providers of health care; and make certain recommendations to the Director and the Legislature concerning the use and availability of data relating to health care.
AMENDED to remove Advisory Committee and all claims database; restore existing duties of PPC; Authorize PPC to create subcommittees or WGs; require members to adopt by-laws governing its own operation and makes members serve “at pleasure of Governor.” Passed committee and was re-referred to Ways & Means
PASSED Assembly 26-16 on a party line vote
Similar to SB 105: Authorizes a physician to prescribe a controlled substance that is designed to end the life of a patient under certain circumstances.
Was moved to the floor without recommendation and re-referred to Ways & Means
Establishes the Doctors of Nevada Program to reimburse the educational debt of physicians who practice in this State and to provide stipends to resident physicians who commit to practicing in this State
Provides immunity from civil liability for mobile BH crisis response team providing telephonic or A-V communications under certain conditions
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.
AMENDED to specifiy BOS/ABMS-certified psychiatrists
PASSED Assembly Committee
Requires, 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 (read letter of opposition here). At the hearing an amendment was offered by the sponsor that would make this a 1-time requirement that could substitute for the current opioid CME, and provided a grace period for new licensee applicants. Based on the amendment, NOMA withdrew its opposition.
PASSED Assembly 38-4
PASSED Senate 21-0
Includes in definition of telehealth the delivery of services through the use of a standard telephone and requires insurers to cover to the same extent, but not the same amount, for such services
PASSED Senate 21-0
PASSED Assembly Committee
1) Authorizes the Patient Protection Commission to request reports concerning certain issues relating to health care from a state or local governmental entity.
2) Requires the DHHS to establish an all-payer claims database of information relating to health insurance claims resulting from medical, dental or pharmacy benefits provided in this State, and further requires any public or private insurer that provides health benefits and is regulated under state law to submit data to the database.
PASSED committee and was re-referred to Finance
Similar to SB5 but limited to behavioral health: Includes in definition of telehealth the delivery of services through the use of a standard telephone and requires coverage of behavioral health services provided by telehealth in the same amount as if those services were provided in person or by other means.
PASSED committee and was re-referred to Finance
1) Changes definition of “chemical restraint”
2) Defines “Emergency Admission”, Involuntary Court-Ordered Admission”, Mental Health Crisis Hold”.
3) Revises provisions for court-ordered involuntary assistant outpatient treatment
PASSED committee and was re-referred to Finance
PASSED Senate Finance
Requires 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.” Also provides that an investigation recorded as a review and evaluation is not an investigation for purposes related to employment, professional licensure or credentialing, education or liability or health insurance.
(SUPPORT) Passed the Senate 21-0
DIED IN ASSEMBLY
1) Issue license to practice after 2 yrs of GME (current law requires 3 years)
2) Multiple changes to PA-C: PA not required to be under supervision if providing care for life-threatening emergencies or in natural/man-made disasters; Allows physician to refuse and/or withdraw supervision; Board to determine number of PA’s a physician can supervise; Allows for remote supervision, except in first 30 days; Specifies required chart reviews; Allows for simultaneous licensing for PA between NBME and NBOME;
Allows for “inactive” status for PAs; Requires passing of the National PA Certifying exam for licensure (OPPOSE #1; SUPPORT #2)
AMENDED to remove provisions regarding unsupervised care during an emergency, changes to PA supervision, and use of “inactive” title
Passed the Senate 21-0
AMENDED to remove the 2-year GME provision
PASSED Assembly Committee
SAME AS AB 164: Requires Chief Health Officer to issue a standing order that permits pharmacists to dispense “self-administered hormonal contraceptives” to a patient upon request.
Amended to make pre-dispensing questionnaire mandatory
PASSED the Senate 21-0
AMENDED to change authority from Chief Medical Officer to Board of Pharmacy by regulation
PASSED Assembly Committee
Prohibits provider of healthcare from performing pelvic exam on unconscious/anesthetized patients without informed consent, with exceptions
PASSED the Senate 21-0
PASSED Assembly Committee
Requires 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 sexually transmitted diseases. HCP liable for professional discipline if fails to ask
AMENDED to include testing only where “medically indicated” and place burden on hospital to ensure compliance, substitutes “disciplinary action” for “professional discipline” for failure to comply
PASSED committee and was re-referred to Finance
1) Expands collaborative drug therapy management to outside of medical facilities; 2) Removes current criteria and replaces 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) Removes requirement for pharmacist to obtain written informed consent from patient; 4) Requires 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, Se. Ratti, we were able to secure an amendment that added needed safeguards and thus withdrew our opposition.
PASSED Senate 17-4
AMENDED to add back in requirements for informed consent
PASSED Assembly Committee
Makes an appropriation to the Nevada Health Service Corps to obtain matching federal money for the purpose of encouraging certain medical and dental practitioners to practice in underserved areas
(SUPPORT)
Requires primary care providers to screen women for BRCA gene mutations and provide referrals for genetic counseling and testing; requires notice concerning genetic counseling and testing to be provided with the results of a mammogram;
Provides for penalties for failure to comply (OPPOSE)
AMENDED to require compliance with USPSTF recommendations, exempt from criminal penalties or professional discipline for non-compliance
PASSED Senate 21-0
PASSED Assembly Committee
Authorizes 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
PASSED committee and was re-referred to Finance
1) Requires a hospital or physician group practice to notify DHHS of any merger, acquisition or similar transaction involving the hospital or physician group practice
2) Prohibits 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. (OPPOSE)
PASSED Senate 12-9
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
PASSED Assembly Committee
1) Creates the Division of Occupational Licensing within the B&I; 2) Abolishes Homeopathic, Dental, Oriental Medicine, Athletic Trainers, Massage Therapy, and Barbers’ Boards and transfers duties to Occupational Licensing; Requires healthcare boards to pay 5% of fees into new organization; 3) Adds PA member to BME/BOME
AMENDED to require advisory boards be composed of a majority of licensees and removes Barbers Board from the bill.
PASSED committee and was re-referred to Finance
1) Requires DHHS to apply for available grants to address disparities in health care and behavioral health due to race, color, ancestry, national origin, disability, familial status, sex, sexual orientation, gender identity or expression, immigration status, primary language or income level; to award grants to non-profits for same; 2) Creates the Kidney Disease Prevention and Education Task Force and prescribes duties thereof; 3) Requires that any expenditure proposed in executive budget for a health care issue that disproportionately affects Black and Indigenous persons and other persons of color must be proposed to be made in a manner that is in direct proportion to the disproportionate effect of that health care issue on each of those groups.
AMENDED to remove requirement for proportional spending
Passed committee and was re-referred to Finance
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 datapoints. Applicant is not required to respond and not subject to discipline if they do not respond, to include withholding of license
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
PASSED Senate 20-1
PASSED Assembly Committee
Basically, requires every profession in Title 54 to issue license by reciprocity and requires Boards to enter into reciprocal agreements with other states
PASSED committee and was re-referred to Finance
If you have an opinion on any of these issues, please let us know your position by sending an email here.
