2005 Nevada Revised Statutes - Chapter 439B — Restraining Costs of Health Care

CHAPTER 439B - RESTRAINING COSTS OF HEALTHCARE

GENERAL PROVISIONS

NRS 439B.010 Definitions.

NRS 439B.030 Billedcharge defined.

NRS 439B.035 ChildrensHealth Insurance Program defined.

NRS 439B.040 Committeedefined.

NRS 439B.050 Departmentdefined.

NRS 439B.060 Directordefined.

NRS 439B.070 Dischargeform defined.

NRS 439B.090 Fiscalyear defined.

NRS 439B.100 Healthfacility defined.

NRS 439B.110 Hospitaldefined.

NRS 439B.115 Majorhospital defined.

NRS 439B.120 Medicaiddefined.

NRS 439B.130 Medicaredefined.

NRS 439B.140 Netrevenue defined.

NRS 439B.150 Practitionerdefined.

NRS 439B.160 Purposesof chapter.

LEGISLATIVE COMMITTEE ON HEALTH CARE

NRS 439B.200 Creation;appointment of and restrictions on members; officers; terms of members;vacancies; annual reports.

NRS 439B.210 Meetings;quorum; compensation.

NRS 439B.220 Powers.

NRS 439B.225 Committeeto review certain regulations proposed or adopted by licensing boards;recommendations to Legislature.

NRS 439B.230 Investigationsand hearings: Depositions; subpoenas.

NRS 439B.240 Investigationsand hearings: Fees and mileage for witnesses.

MAJOR HOSPITALS

NRS 439B.260 Reductionof billed charges for certain patients and services; resolution of disputes.

NRS 439B.265 Collectionof deductible or copayment from indigent patient covered by Medicareprohibited. [Effective upon confirmation by the Federal Government that thedeductibles and copayments which a hospital is prohibited from collecting froma patient pursuant to this section are deemed uncollectible for the purposes offederal law.]

NRS 439B.270 Foundationfor hospital nursing practice: Establishment; governing body.

NRS 439B.275 Programfor provision of technical assistance to rural hospitals.

NRS 439B.280 Educationalprogram to promote wellness, physical fitness and prevention of disease andaccidents.

CARE OF INDIGENT PATIENTS

NRS 439B.300 Legislativefindings and declarations; applicability.

NRS 439B.310 Indigentdefined.

NRS 439B.320 Hospitalrequired to provide care for proportionate share of indigent patients; dutiesof Department and board of county commissioners; reimbursement for care.

NRS 439B.330 Eligibilityof indigent for assistance; payment of hospital for serving disproportionatelylarge share of patients; discharge forms; appeal from determination of countyregarding indigent status. [Effective through June 30, 2007, and after thatdate if the Federal Government approves the waiver applied for pursuant to NRS 422.2726.]

NRS 439B.330 Eligibilityof indigent for assistance; payment of hospital for serving disproportionatelylarge share of patients; discharge forms; appeal from determination of countyregarding indigent status. [Effective July 1, 2007, if the Federal Governmenthas not approved the waiver applied for pursuant to NRS 422.2726.]

NRS 439B.340 Reporton indigent patients treated; verification by Director; compensation fortreatment provided in excess of obligation; assessment for failure to fulfillminimum obligation.

PROGRAM TO INCREASE AWARENESS OF HEALTH CARE PROGRAMS FORCHILDREN

NRS 439B.350 Departmentto establish; purpose.

NRS 439B.360 Evaluation:Recommendations; report to Interim Finance Committee.

NRS 439B.370 Directorauthorized to contract for certain services.

MISCELLANEOUS PROVISIONS

NRS 439B.400 Hospitalmust maintain and use uniform list of billed charges; exception.

NRS 439B.410 Hospitalrequired to provide emergency services and care; unlawful acts of hospital orphysician working in hospital emergency room; treating hospital may recoverpenalty from transferring hospital; exceptions; administrative investigationsand sanctions.

NRS 439B.420 Prohibitedacts of hospitals and related entities; exceptions; submission of contracts toDirector; civil penalty.

NRS 439B.425 Prohibitedreferral of patients; exceptions; penalty.

NRS 439B.430 Prohibitedacts of hospitals; examination by Director; administrative fine; injunctiverelief.

NRS 439B.440 Directormay require hospitals, health facilities and providers of health services tosubmit information; independent audit; examinations; penalty.

NRS 439B.450 Powersand duties of Director.

NRS 439B.460 Directorauthorized to delegate powers and duties.

NRS 439B.500 Penaltyfor violation of chapter.

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GENERAL PROVISIONS

NRS 439B.010 Definitions. As used in this chapter, unless the context otherwiserequires, the words and terms defined in NRS439B.030 to 439B.150, inclusive,have the meanings ascribed to them in those sections.

(Added to NRS by 1987, 862; A 1991, 2111, 2333; 1993,619, 620; 1999, 2238)

NRS 439B.030 Billedcharge defined. Billed charge means thetotal amount charged by a hospital for medical care provided, regardless of theanticipated amount of net revenue to be received or the anticipated source ofpayment.

(Added to NRS by 1987, 862)

NRS 439B.035 ChildrensHealth Insurance Program defined. ChildrensHealth Insurance Program has the meaning ascribed to it in NRS 422.021.

(Added to NRS by 1999, 2238; A 2001, 158)

NRS 439B.040 Committeedefined. Committee means the LegislativeCommittee on Health Care.

(Added to NRS by 1987, 863)

NRS 439B.050 Departmentdefined. Department means the Department ofHealth and Human Services.

(Added to NRS by 1987, 863)

NRS 439B.060 Directordefined. Director means the Director of theDepartment.

(Added to NRS by 1987, 863)

NRS 439B.070 Dischargeform defined. Discharge form means the formhospitals are required to use to report information concerning the discharge ofpatients.

(Added to NRS by 1987, 863)

NRS 439B.090 Fiscalyear defined.

1. Except as otherwise provided in subsection 2,fiscal year means a period beginning on July 1 and ending on June 30 of thefollowing year.

2. A hospitals fiscal year is the period of 12months used by a hospital for the purposes of accounting and the preparation ofannual budgets and financial statements.

(Added to NRS by 1987, 863)

NRS 439B.100 Healthfacility defined. Health facility has themeaning ascribed to it in NRS 439A.015.

(Added to NRS by 1987, 863)

NRS 439B.110 Hospitaldefined. Hospital means any facilitylicensed as a medical, surgical or obstetrical hospital, or as any combinationof medical, surgical or obstetrical hospital, by the Health Division of theDepartment.

(Added to NRS by 1987, 863)

NRS 439B.115 Majorhospital defined. Major hospital means ahospital in this State which has 200 or more licensed or approved beds, or anyhospital in a group of affiliated hospitals in a county which have a combinedtotal of 200 or more licensed or approved beds, that is not operated by afederal, state or local governmental agency.

(Added to NRS by 1991, 2332)

NRS 439B.120 Medicaiddefined. Medicaid means the program establishedpursuant to Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) toprovide assistance for part or all of the cost of medical care rendered onbehalf of indigent persons.

(Added to NRS by 1987, 863)

NRS 439B.130 Medicaredefined. Medicare means the program ofhealth insurance for aged and disabled persons established pursuant to TitleXVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

(Added to NRS by 1987, 863)

NRS 439B.140 Netrevenue defined. Net revenue means allrevenues earned from inpatient medical care provided to patients by a hospital.

(Added to NRS by 1987, 863)

NRS 439B.150 Practitionerdefined. Practitioner has the meaning ascribedto it in NRS 439A.0195.

(Added to NRS by 1987, 863)

NRS 439B.160 Purposesof chapter. The purposes of this chapter areto:

1. Promote equal access to quality medical care at anaffordable cost for all residents of this State.

2. Reduce excessive billed charges and revenuesgenerated by some hospitals in this State in order to provide relief fromexcessively high costs of medical care.

3. Provide the regulatory mechanisms necessary toensure that the forces of a competitive market will be able to function effectivelyin the business of providing medical care in this State.

(Added to NRS by 1987, 863)

LEGISLATIVE COMMITTEE ON HEALTH CARE

NRS 439B.200 Creation;appointment of and restrictions on members; officers; terms of members;vacancies; annual reports.

1. There is hereby established a Legislative Committeeon Health Care consisting of three members of the Senate and three members ofthe Assembly, appointed by the Legislative Commission. The members must beappointed with appropriate regard for their experience with and knowledge ofmatters relating to health care.

2. No member of the Committee may:

(a) Have a financial interest in a health facility inthis State;

(b) Be a member of a board of directors or trustees ofa health facility in this State;

(c) Hold a position with a health facility in thisState in which the Legislator exercises control over any policies establishedfor the health facility; or

(d) Receive a salary or other compensation from ahealth facility in this State.

3. The provisions of subsection 2 do not:

(a) Prohibit a member of the Committee from sellinggoods which are not unique to the provision of health care to a health facilityif the member primarily sells such goods to persons who are not involved in theprovision of health care.

(b) Prohibit a member of the Legislature from servingas a member of the Committee if:

(1) The financial interest, membership on theboard of directors or trustees, position held with the health facility orsalary or other compensation received would not materially affect theindependence of judgment of a reasonable person; and

(2) Serving on the Committee would notmaterially affect any financial interest he has in a health facility in amanner greater than that accruing to any other person who has a similarinterest.

4. The Legislative Commission shall select theChairman and Vice Chairman of the Committee from among the members of theCommittee. Each such officer shall hold office for a term of 2 years commencingon July 1 of each odd-numbered year. The chairmanship of the Committee mustalternate each biennium between the houses of the Legislature.

5. Any member of the Committee who does not return tothe Legislature continues to serve until the next session of the Legislatureconvenes.

6. Vacancies on the Committee must be filled in thesame manner as original appointments.

7. The Committee shall report annually to theLegislative Commission concerning its activities and any recommendations.

(Added to NRS by 1987, 863; A 1989, 1841; 1991, 2333;1993, 2590)

NRS 439B.210 Meetings;quorum; compensation.

1. The members of the Committee shall meet throughouteach year at the times and places specified by a call of the Chairman or amajority of the Committee. The Director of the Legislative Counsel Bureau or aperson he has designated shall act as the nonvoting recording Secretary. TheCommittee shall prescribe regulations for its own management and government.Four members of the Committee constitute a quorum, and a quorum may exercise allthe powers conferred on the Committee.

2. Except during a regular or special session of theLegislature, members of the Committee are entitled to receive the compensationprovided for a majority of the members of the Legislature during the first 60days of the preceding regular session for each day or portion of a day duringwhich he attends a meeting of the Committee or is otherwise engaged in thebusiness of the Committee plus the per diem allowance provided for stateofficers and employees generally and the travel expenses provided pursuant to NRS 218.2207.

3. The salaries and expenses of the Committee must bepaid from the Legislative Fund.

(Added to NRS by 1987, 864; A 1987, 1629; 1989, 1221)

NRS 439B.220 Powers. TheCommittee may:

1. Review and evaluate the quality and effectivenessof programs for the prevention of illness.

2. Review and compare the costs of medical care amongcommunities in Nevada with similar communities in other states.

3. Analyze the overall system of medical care in theState to determine ways to coordinate the providing of services to all membersof society, avoid the duplication of services and achieve the most efficientuse of all available resources.

4. Examine the business of providing insurance,including the development of cooperation with health maintenance organizationsand organizations which restrict the performance of medical services to certainphysicians and hospitals, and procedures to contain the costs of theseservices.

5. Examine hospitals to:

(a) Increase cooperation among hospitals;

(b) Increase the use of regional medical centers; and

(c) Encourage hospitals to use medical procedures whichdo not require the patient to be admitted to the hospital and to use theresulting extra space in alternative ways.

6. Examine medical malpractice.

7. Examine the system of education to coordinate:

(a) Programs in health education, including those forthe prevention of illness and those which teach the best use of availablemedical services; and

(b) The education of those who provide medical care.

8. Review competitive mechanisms to aid in thereduction of the costs of medical care.

9. Examine the problem of providing and paying formedical care for indigent and medically indigent persons, including medicalcare provided by physicians.

10. Examine the effectiveness of any legislationenacted to accomplish the purpose of restraining the costs of health care whileensuring the quality of services, and its effect on the subjects listed insubsections 1 to 9, inclusive.

11. Determine whether regulation by the State will benecessary in the future by examining hospitals for evidence of:

(a) Degradation or discontinuation of servicespreviously offered, including without limitation, neonatal care, pulmonaryservices and pathology services; or

(b) A change in the policy of the hospital concerningcontracts,

as a resultof any legislation enacted to accomplish the purpose of restraining the costsof health care while ensuring the quality of services.

12. Study the effect of the acuity of the careprovided by a hospital upon the revenues of the hospital and upon limitationsupon that revenue.

13. Review the actions of the Director inadministering the provisions of this chapter and adopting regulations pursuantto those provisions. The Director shall report to the Committee concerning anyregulations proposed or adopted pursuant to this chapter.

14. Identify and evaluate, with the assistance of anadvisory group, the alternatives to institutionalization for providinglong-term care, including, without limitation:

(a) An analysis of the costs of the alternatives toinstitutionalization and the costs of institutionalization for personsreceiving long-term care in this state;

(b) A determination of the effects of the variousmethods of providing long-term care services on the quality of life of personsreceiving those services in this state;

(c) A determination of the personnel required for eachmethod of providing long-term care services in this state; and

(d) A determination of the methods for funding the long-termcare services provided to all persons who are receiving or who are eligible toreceive those services in this state.

15. Evaluate, with the assistance of an advisorygroup, the feasibility of obtaining a waiver from the Federal Government to integrateand coordinate acute care services provided through Medicare and long-term careservices provided through Medicaid in this state.

16. Evaluate, with the assistance of an advisorygroup, the feasibility of obtaining a waiver from the Federal Government toeliminate the requirement that elderly persons in this state impoverishthemselves as a condition of receiving assistance for long-term care.

17. Conduct investigations and hold hearings inconnection with its review and analysis.

18. Apply for any available grants and accept anygifts, grants or donations to aid the Committee in carrying out its dutiespursuant to this chapter.

19. Direct the Legislative Counsel Bureau to assist inits research, investigations, review and analysis.

20. Recommend to the Legislature as a result of itsreview any appropriate legislation.

(Added to NRS by 1987, 864; A 2001, 2376)

NRS 439B.225 Committeeto review certain regulations proposed or adopted by licensing boards;recommendations to Legislature.

1. As used in this section, licensing board meansany division or board empowered to adopt standards for licensing orregistration or for the renewal of licenses or certificates of registrationpursuant to NRS 435.3305 to 435.339, inclusive, chapter 449, 625A,630, 630A, 631, 632, 633, 634, 634A, 635, 636, 637, 637A, 637B, 639, 640, 640A, 641, 641A, 641B, 641C, 652 or 654 of NRS.

2. The Committee shall review each regulation that alicensing board proposes or adopts that relates to standards for licensing orregistration or to the renewal of a license or certificate of registrationissued to a person or facility regulated by the board, giving consideration to:

(a) Any oral or written comment made or submitted to itby members of the public or by persons or facilities affected by theregulation;

(b) The effect of the regulation on the cost of healthcare in this State;

(c) The effect of the regulation on the number oflicensed or registered persons and facilities available to provide services inthis State; and

(d) Any other related factor the Committee deemsappropriate.

3. After reviewing a proposed regulation, theCommittee shall notify the agency of the opinion of the Committee regarding theadvisability of adopting or revising the proposed regulation.

4. The Committee shall recommend to the Legislature asa result of its review of regulations pursuant to this section any appropriatelegislation.

(Added to NRS by 1991, 940; A 2003, 2008; 2005, 1379)

NRS 439B.230 Investigationsand hearings: Depositions; subpoenas.

1. In conducting the investigations and hearings ofthe Committee:

(a) The Secretary of the Committee, or in his absenceany member of the Committee, may administer oaths.

(b) The Secretary or Chairman of the Committee maycause the deposition of witnesses, residing either within or outside of theState, to be taken in the manner prescribed by rule of court for takingdepositions in civil actions in the district courts.

(c) The Chairman of the Committee may issue subpoenasto compel the attendance of witnesses and the production of books and papers.

2. If any witness refuses to attend or testify orproduce any books and papers as required by the subpoena, the Chairman of theCommittee may report to the district court by petition, setting forth that:

(a) Due notice has been given of the time and place ofattendance of the witness or the production of the books and papers;

(b) The witness has been subpoenaed by the Committeepursuant to this section; and

(c) The witness has failed or refused to attend orproduce the books and papers required by the subpoena before the Committeewhich is named in the subpoena, or has refused to answer questions propoundedto him,

and askingfor an order of the court compelling the witness to attend and testify or producethe books and papers before the Committee.

3. Upon such petition, the court shall enter an orderdirecting the witness to appear before the court at a time and place to befixed by the court in its order, the time to be not more than 10 days from thedate of the order, and to show cause why he has not attended or testified orproduced the books or papers before the Committee. A certified copy of theorder must be served upon the witness.

4. If it appears to the court that the subpoena wasregularly issued by the Committee, the court shall enter an order that thewitness appear before the Committee at the time and place fixed in the orderand testify or produce the required books or papers. Failure to obey the orderconstitutes contempt of court.

(Added to NRS by 1987, 866; A 1987, 1630)

NRS 439B.240 Investigationsand hearings: Fees and mileage for witnesses. Eachwitness who appears before the Committee by its order, except a state officeror employee, is entitled to receive for his attendance the fees and mileageprovided for witnesses in civil cases in the courts of record of this state.The fees and mileage must be audited and paid upon the presentation of properclaims sworn to by the witness and approved by the Secretary and Chairman ofthe Committee.

(Added to NRS by 1987, 866)

MAJOR HOSPITALS

NRS 439B.260 Reductionof billed charges for certain patients and services; resolution of disputes.

1. A major hospital shall reduce or discount the totalbilled charge by at least 30 percent for hospital services provided to aninpatient who:

(a) Has no insurance or other contractual provision forthe payment of the charge by a third party;

(b) Is not eligible for coverage by a state or federalprogram of public assistance that would provide for the payment of the charge;and

(c) Makes reasonable arrangements within 30 days afterdischarge to pay his hospital bill.

2. A major hospital or patient who disputes thereasonableness of arrangements made pursuant to paragraph (c) of subsection 1may submit the dispute to the Bureau for Hospital Patients for resolution asprovided in NRS 223.575.

3. A major hospital shall reduce or discount the totalbilled charge of its outpatient pharmacy by at least 30 percent to a patientwho is eligible for Medicare.

(Added to NRS by 1991, 2332; A 1995, 646, 2248; 2001, 2654)

NRS 439B.265 Collectionof deductible or copayment from indigent patient covered by Medicare prohibited.[Effective upon confirmation by the Federal Government that the deductibles andcopayments which a hospital is prohibited from collecting from a patientpursuant to this section are deemed uncollectible for the purposes of federallaw.] A major hospital shall not collect orseek to collect the deductible or copayment from a patient who is covered byMedicare and who demonstrates that he is medically indigent, as that term isdefined for the purposes of Medicaid coverage for persons in long-term care.The hospital may seek and collect payment for the deductible or copayment fromany source other than the patient, including from the supplemental insurance ofthe patient.

(Added to NRS by 1991, 2332, effective uponconfirmation by the Federal Government that the deductibles and copaymentswhich a hospital is prohibited from collecting from a patient pursuant to thissection are deemed uncollectible for the purposes of federal law)

NRS 439B.270 Foundationfor hospital nursing practice: Establishment; governing body.

1. The major hospitals shall jointly establish afoundation for hospital nursing practice to promote and encourage the practiceof nursing in hospitals.

2. The foundation must be created as a nonprofitentity in compliance with 26 U.S.C. 501. The governing body of the foundationmust consist of one representative of each of the member hospitals and onerepresentative appointed by the Governor. The governing body must haveauthority to establish rules for the administration of the foundation, toestablish programs in pursuit of its purpose, and to allocate money for itsprograms.

3. If the foundation is not formed, or ceases toexist, the Director shall establish a nonprofit entity to carry out thefoundations purpose.

(Added to NRS by 1991, 2332)

NRS 439B.275 Programfor provision of technical assistance to rural hospitals. The major hospitals shall, in cooperation with the Officeof the Governor, the University of Nevada School of Medicine and organizationsrepresenting rural hospitals, develop a program for the provision of technicalassistance to rural hospitals in Nevada. The resources required to carry outthis program must be determined and provided by the major hospitals.

(Added to NRS by 1991, 2332)

NRS 439B.280 Educationalprogram to promote wellness, physical fitness and prevention of disease andaccidents. The major hospitals shall sponsoran educational program to promote wellness, physical fitness and the preventionof disease and accidents. The program must be:

1. Administered and carried out by the participatinghospitals; and

2. Approved by the Director.

(Added to NRS by 1991, 2333)

CARE OF INDIGENT PATIENTS

NRS 439B.300 Legislativefindings and declarations; applicability.

1. The Legislature finds and declares that:

(a) The practice of refusing to treat an indigentpatient if another hospital can provide the treatment endangers the health andwell-being of such patients.

(b) Counties in which more than one hospital is locatedmay lack available resources to compensate for all indigent care provided attheir hospitals. Refusal by a hospital to treat indigent patients in suchcounties results in a burden upon hospitals which treat large numbers ofindigent patients.

(c) A requirement that hospitals in such countiesprovide a designated amount of uncompensated care for indigent patients would:

(1) Equalize the burden on such hospitals oftreating indigent patients; and

(2) Aid the counties in meeting their obligationto compensate hospitals for such care.

(d) Hospitals with 100 or fewer beds have been meetingthe needs of their communities with regard to care of indigents, and have aminimal effect on the provision of such care.

2. Except as otherwise provided in this subsection, theprovisions of NRS 439B.300 to 439B.340, inclusive, apply to eachhospital in this State which is located in a county in which there are two ormore licensed hospitals. The provisions of NRS439B.300 to 439B.340, inclusive,do not apply to a hospital which has 100 or fewer beds.

3. The provisions of NRS 439B.300 to 439B.340, inclusive, do not prohibit a countyfrom:

(a) Entering into an agreement for medical care orotherwise contracting with any hospital located within that county; or

(b) Using a definition of indigent which wouldinclude more persons than the definition in NRS439B.310.

(Added to NRS by 1987, 867)

NRS 439B.310 Indigentdefined. For the purposes of NRS 439B.300 to 439B.340, inclusive, indigent meansthose persons:

1. Who are not covered by any policy of healthinsurance;

2. Who are ineligible for Medicare, Medicaid, theChildrens Health Insurance Program, the benefits provided pursuant to NRS 428.115 to 428.255, inclusive, or any other federal orstate program of public assistance covering the provision of health care;

3. Who meet the limitations imposed by the county uponassets and other resources or potential resources; and

4. Whose income is less than:

(a) For one person living without another member of ahousehold, $438.

(b) For two persons, $588.

(c) For three or more persons, $588 plus $150 for eachperson in the family in excess of two.

For thepurposes of this subsection, income includes the entire income of a householdand the amount which the county projects a person or household is able to earn.Household is limited to a person and his spouse, parents, children, brothersand sisters residing with him.

(Added to NRS by 1987, 868; A 1999, 2238)

NRS 439B.320 Hospitalrequired to provide care for proportionate share of indigent patients; dutiesof Department and board of county commissioners; reimbursement for care.

1. A hospital shall provide, without charge, in eachfiscal year, care for indigent inpatients in an amount which represents 0.6percent of its net revenue for the hospitals preceding fiscal year.

2. The Department shall compute the obligation of eachhospital for care of indigent inpatients for each fiscal year based upon thenet revenue of the hospital in its preceding fiscal year and shall provide thisinformation to the board of county commissioners of the county in which thehospital is located.

3. The board of county commissioners shall maintain arecord of discharge forms submitted by each hospital located within the county,together with the amount accruing to the hospital. The amount accruing to thehospital for the care, until the hospital has met its obligation pursuant tothis section, is the highest amount the county is paying to any hospital in thecounty for that care. Except as otherwise provided in subsection 2 of NRS 439B.330, no payment for indigentcare may be made to the hospital until the total amount so accruing to thehospital exceeds the minimum obligation of the hospital for the fiscal year,and a hospital may only receive payment from the county for indigent careprovided in excess of its obligation pursuant to this section. After a hospitalhas met its obligation pursuant to this section, the county may reimburse thehospital for care of indigent inpatients at any rate otherwise authorized bylaw.

(Added to NRS by 1987, 868; A 1991, 2111)

NRS 439B.330 Eligibilityof indigent for assistance; payment of hospital for serving disproportionatelylarge share of patients; discharge forms; appeal from determination of countyregarding indigent status. [Effective through June 30, 2007, and after that dateif the Federal Government approves the waiver applied for pursuant to NRS 422.2726.]

1. Except as otherwise provided in this subsection,subsection 2 and NRS 439B.300, eachcounty shall use the definition of indigent in NRS 439B.310 to determine a personseligibility for medical assistance pursuant to chapter428 of NRS, other than assistance provided pursuant to NRS 428.115 to 428.255, inclusive.

2. A board of county commissioners may, if itdetermines that a hospital within the county is serving a disproportionatelylarge share of low-income patients:

(a) Pay a higher rate to the hospital for treatment ofindigent inpatients;

(b) Pay the hospital for treatment of indigentinpatients whom the hospital would otherwise be required to treat withoutreceiving compensation from the county; or

(c) Both pay at a higher rate and pay for inpatientsfor whom the hospital would otherwise be uncompensated.

3. Each hospital which treats an indigent inpatientshall submit to the board of county commissioners of the county of residence ofthe patient a discharge form identifying the patient as a possible indigent andcontaining the information required by the Department and the county to beincluded in all such forms.

4. The county which receives a discharge form from ahospital for an indigent inpatient shall verify the status of the patient andthe amount which the hospital is entitled to receive. A hospital aggrieved by adetermination of a county regarding the indigent status of an inpatient mayappeal the determination to the Director or a person designated by the Directorto hear such an appeal. The decision of the Director or the person hedesignates must be mailed by registered or certified mail to the county and thehospital. The decision of the Director or the person he designates may beappealed to a court having general jurisdiction in the county within 15 daysafter the date of the postmark on the envelope in which the decision wasmailed.

5. Except as otherwise provided in subsection 2 ofthis section and subsection 3 of NRS439B.320, if the county is the county of residence of the patient and the patientis indigent, the county shall pay to the hospital the amount required, withinthe limits of money which may lawfully be appropriated for this purposepursuant to NRS 428.050, 428.285 and 450.425.

6. For the purposes of this section, the county ofresidence of the patient is the county of residence of that person before hewas admitted to the hospital.

(Added to NRS by 1987, 869; A 1989, 1801, 1861; 1991,1744, 1937; 1993, 1973; 2005, 1676)

NRS 439B.330 Eligibility of indigent forassistance; payment of hospital for serving disproportionately large share ofpatients; discharge forms; appeal from determination of county regardingindigent status. [Effective July 1, 2007, if the Federal Government has notapproved the waiver applied for pursuant to NRS 422.2726.]

1. Except as otherwise provided in NRS 439B.300 and subsection 2 of this section,each county shall use the definition of indigent in NRS 439B.310 to determine a personseligibility for medical assistance pursuant to chapter428 of NRS, other than assistance provided pursuant to NRS 428.115 to 428.255, inclusive.

2. A board of county commissioners may, if itdetermines that a hospital within the county is serving a disproportionatelylarge share of low-income patients:

(a) Pay a higher rate to the hospital for treatment ofindigent inpatients;

(b) Pay the hospital for treatment of indigentinpatients whom the hospital would otherwise be required to treat withoutreceiving compensation from the county; or

(c) Both pay at a higher rate and pay for inpatientsfor whom the hospital would otherwise be uncompensated.

3. Each hospital which treats an indigent inpatientshall submit to the board of county commissioners of the county of residence ofthe patient a discharge form identifying the patient as a possible indigent andcontaining the information required by the Department and the county to beincluded in all such forms.

4. The county which receives a discharge form from ahospital for an indigent inpatient shall verify the status of the patient andthe amount which the hospital is entitled to receive. A hospital aggrieved by adetermination of a county regarding the indigent status of an inpatient mayappeal the determination to the Director or a person designated by the Directorto hear such an appeal. The decision of the Director or the person hedesignates must be mailed by registered or certified mail to the county and thehospital. The decision of the Director or the person he designates may beappealed to a court having general jurisdiction in the county within 15 daysafter the date of the postmark on the envelope in which the decision wasmailed.

5. Except as otherwise provided in subsection 2 ofthis section and subsection 3 of NRS439B.320, if the county is the county of residence of the patient and the patientis indigent, the county shall pay to the hospital the amount required, withinthe limits of money which may lawfully be appropriated for this purposepursuant to NRS 428.050, 428.285 and 450.425.

6. For the purposes of this section, the county ofresidence of the patient is the county of residence of that person before hewas admitted to the hospital.

(Added to NRS by 1987, 869; A 1989, 1801, 1861; 1991,1744, 1937; 1993, 1973; 2005, 1676,effective July 1, 2007, if the Federal Government has not approved the waiverapplied for pursuant to NRS 422.2726)

NRS 439B.340 Reporton indigent patients treated; verification by Director; compensation fortreatment provided in excess of obligation; assessment for failure to fulfillminimum obligation.

1. Before September 30 of each year, each county inwhich hospitals subject to the provisions of NRS 439B.300 to 439B.340, inclusive, are located shallprovide to the Department a report showing:

(a) The total number of inpatients treated by each suchhospital who are claimed by the hospital to be indigent;

(b) The number of such patients for whom noreimbursement was provided by the county because of the limitation imposed bysubsection 3 of NRS 439B.320;

(c) The total amount paid to each such hospital fortreatment of such patients; and

(d) The amount the hospital would have received forpatients for whom no reimbursement was provided.

2. The Director shall verify the amount of treatmentprovided to indigent inpatients by each hospital to which no reimbursement wasprovided by:

(a) Determining the number of indigent inpatients whoreceived treatment. For a hospital that has contracted with the Departmentpursuant to subsection 4 of NRS 428.030,the Director shall determine the number based upon the evaluations of eligibilitymade by the employee assigned to the hospital pursuant to the contract. For allother hospitals, the Director shall determine the number based upon the reportsubmitted pursuant to subsection 1.

(b) Multiplying the number of indigent inpatients whoreceived each type of treatment by the highest amount paid by the county forthat treatment.

(c) Adding the products of the calculations madepursuant to paragraphs (a) and (b) for all treatment provided.

If the totalamount of treatment provided to indigent inpatients in the previous fiscal yearby the hospital was less than its minimum obligation for the year, the Directorshall assess the hospital for the amount of the difference between the minimumobligation and the actual amount of treatment provided by the hospital toindigent inpatients. If a decision of a county regarding the indigent status ofone or more inpatients is pending appeal before the Director or upon receivingsatisfactory proof from a hospital that the decision is pending appeal before acourt having general jurisdiction in the county pursuant to subsection 4 of NRS 439B.330, the Director shall deferassessing the hospital the amount that may be offset by the determination onappeal until a final determination of the matter is made.

3. If the Director determines that a hospital has metits obligation to provide treatment to indigent inpatients, he shall certify tothe county in which the hospital is located that the hospital has met itsobligation. The county is not required to pay the hospital for the costs oftreating indigent inpatients until the certification is received from theDirector. The county shall pay the hospital for such treatment within 30 daysafter receipt of the certification to the extent that money was available forpayment pursuant to NRS 428.050, 428.285 and 450.425 at the time the treatment wasprovided.

4. The Director shall determine the amount of theassessment which a hospital must pay pursuant to this section and shall notifythe hospital in writing of that amount on or before November 1 of each year.The notice must include, but is not limited to, a written statement for eachclaim which is denied indicating why the claim was denied. Payment is due 30days after receipt of the notice, except for assessments deferred pursuant tosubsection 2 which, if required, must be paid within 30 days after the courthearing the appeal renders its decision. If a hospital fails to pay theassessment when it is due the hospital shall pay, in addition to the assessment:

(a) Interest at a rate of 1 percent per month for eachmonth after the assessment is due in which it remains unpaid; and

(b) Any court costs and fees required by the Directorto obtain payment of the assessment and interest from the hospital.

5. Any money collected pursuant to this section mustbe paid to the county in which the hospital paying the assessment is locatedfor use in paying other hospitals in the county for the treatment of indigentinpatients by those hospitals. The money received by a county from assessmentsmade pursuant to this section does not constitute revenue from taxes ad valoremfor the purposes of NRS 354.59811, 428.050, 428.285and 450.425, and must be excluded indetermining the maximum rate of tax authorized by those sections.

(Added to NRS by 1987, 869; A 1987, 1630; 1989, 1802,2085; 1991, 1938, 2112; 1993, 587)

PROGRAM TO INCREASE AWARENESS OF HEALTH CARE PROGRAMS FORCHILDREN

NRS 439B.350 Departmentto establish; purpose.

1. The Department shall establish a program toincrease awareness of health care programs for children and to encourageenrollment in such programs. The program must provide for the dissemination ofinformation to the public relating to health care services that are availablein this state to children who are under the age of 13 years, including, withoutlimitation, information concerning:

(a) Federal, state and local governmental programswhich provide health care services to such children;

(b) The requirements for eligibility to participate insuch programs; and

(c) The procedures for enrolling children in suchprograms.

2. The information disseminated pursuant to subsection1 must encourage the use of the programs identified pursuant to subsection 1and must emphasize:

(a) The benefits of preventive health care services tothe well-being of children; and

(b) The reasons that preventive health care servicesare more efficient in treating potential health care needs and are moreeconomical than obtaining emergency health care services which are oftenrequired when symptoms of an illness are not promptly and properly treated.

3. The program must be designed to disseminateinformation using the most effective means available to the extent possible,including, without limitation, using:

(a) Words or graphics, or both, that promoteunderstanding of the information by the intended audience, considering theaverage level of reading comprehension of and the language understood by theaudience.

(b) Printed materials that may be displayed at ordistributed to:

(1) Offices of the federal, state and localgovernment that have contact with parents of children who are under the age of13 years or direct contact with such children, or both, in the normal course ofbusiness;

(2) Schools attended by children who are underthe age of 13 years;

(3) Public libraries;

(4) Providers of health care who provideservices to children who are under the age of 13 years;

(5) Child care facilities that provide servicesto children who are under the age of 13 years;

(6) Organizations that provide community-basedservices to parents of children who are under the age of 13 years, or to suchchildren, or both; and

(7) Any other person deemed appropriate.

(c) Radio, television and other electronic means.

(Added to NRS by 1997, 1545)

NRS 439B.360 Evaluation:Recommendations; report to Interim Finance Committee.

1. The Director shall evaluate the effectiveness ofthe program established pursuant to NRS439B.350 annually. The evaluation must include, without limitation:

(a) Determining the total number of children under theage of 13 years who reside in this state and the number of such children whohave received health care services through a federal, state or localgovernmental program during the previous year; and

(b) Measuring the effectiveness of the content, formand method of dissemination of information through the program.

2. The Director shall make any necessaryrecommendations to improve the program based upon his evaluation.

3. On or before December 31 of each year, the Directorshall provide a written report to the Interim Finance Committee concerning theresults of the evaluation and any recommendations made to improve the program.

(Added to NRS by 1997, 1546)

NRS 439B.370 Directorauthorized to contract for certain services. TheDirector may, within the limits of available money, contract for services toassist the Department in carrying out the provisions of NRS 439B.350 and 439B.360.

(Added to NRS by 1997, 1546)

MISCELLANEOUS PROVISIONS

NRS 439B.400 Hospitalmust maintain and use uniform list of billed charges; exception. Each hospital in this state shall maintain and use auniform list of billed charges for that hospital for units of service or goodsprovided to all inpatients. A hospital may not use a billed charge for aninpatient that is different than the billed charge used for another inpatientfor the same service or goods provided. This section does not restrict theability of a hospital or other person to negotiate a discounted rate from thehospitals billed charges or to contract for a different rate or mechanism forpayment of the hospital.

(Added to NRS by 1987, 867)

NRS 439B.410 Hospitalrequired to provide emergency services and care; unlawful acts of hospital orphysician working in hospital emergency room; treating hospital may recoverpenalty from transferring hospital; exceptions; administrative investigationsand sanctions.

1. Except as otherwise provided in subsection 4, eachhospital in this State has an obligation to provide emergency services andcare, including care provided by physicians and nurses, and to admit a patientwhere appropriate, regardless of the financial status of the patient.

2. Except as otherwise provided in subsection 4, it isunlawful for a hospital or a physician working in a hospital emergency room to:

(a) Refuse to accept or treat a patient in need ofemergency services and care; or

(b) Except when medically necessary in the judgment ofthe attending physician:

(1) Transfer a patient to another hospital orhealth facility unless, as documented in the patients records:

(I) A determination has been made that thepatient is medically fit for transfer;

(II) Consent to the transfer has beengiven by the receiving physician, hospital or health facility;

(III) The patient has been provided withan explanation of the need for the transfer; and

(IV) Consent to the transfer has beengiven by the patient or his legal representative; or

(2) Provide a patient with orders for testing atanother hospital or health facility when the hospital from which the orders areissued is capable of providing that testing.

3. A physician, hospital or other health facilitywhich treats a patient as a result of a violation of subsection 2 by a hospitalor a physician working in the hospital is entitled to recover from thathospital an amount equal to three times the charges for the treatment providedthat was billed by the physician, hospital or other health facility whichprovided the treatment, plus reasonable attorneys fees and costs.

4. This section does not prohibit the transfer of apatient from one hospital to another:

(a) When the patient is covered by an insurance policyor other contractual arrangement which provides for payment at the receivinghospital;

(b) After the county responsible for payment for thecare of an indigent patient has exhausted the money which may be appropriatedfor that purpose pursuant to NRS 428.050,428.285 and 450.425; or

(c) When the hospital cannot provide the servicesneeded by the patient.

No transfermay be made pursuant to this subsection until the patients condition has beenstabilized to a degree that allows the transfer without an additional risk tothe patient.

5. As used in this section:

(a) Emergency services and care means medicalscreening, examination and evaluation by a physician or, to the extentpermitted by a specific statute, by a person under the supervision of aphysician, to determine if an emergency medical condition or active laborexists and, if it does, the care, treatment and surgery by a physiciannecessary to relieve or eliminate the emergency medical condition or activelabor, within the capability of the hospital. As used in this paragraph:

(1) Active labor means, in relation tochildbirth, labor that occurs when:

(I) There is inadequate time beforedelivery to transfer the patient safely to another hospital; or

(II) A transfer may pose a threat to thehealth and safety of the patient or the unborn child.

(2) Emergency medical condition means thepresence of acute symptoms of sufficient severity, including severe pain, suchthat the absence of immediate medical attention could reasonably be expected toresult in:

(I) Placing the health of the patient inserious jeopardy;

(II) Serious impairment of bodilyfunctions; or

(III) Serious dysfunction of any bodilyorgan or part.

(b) Medically fit means that the condition of thepatient has been sufficiently stabilized so that he may be safely transportedto another hospital, or is such that, in the determination of the attendingphysician, the transfer of the patient constitutes an acceptable risk. Such adetermination must be based upon the condition of the patient, the expectedbenefits, if any, to the patient resulting from the transfer and whether therisks to the patients health are outweighed by the expected benefits, and mustbe documented in the patients records before the transfer.

6. If an allegation of a violation of the provisionsof subsection 2 is made against a hospital licensed pursuant to the provisionsof chapter 449 of NRS, the Health Division ofthe Department shall conduct an investigation of the alleged violation. Such aviolation, in addition to any criminal penalties that may be imposed,constitutes grounds for the denial, suspension or revocation of such a license,or for the imposition of any sanction prescribed by NRS 449.163.

7. If an allegation of a violation of the provisionsof subsection 2 is made against:

(a) A physician licensed to practice medicine pursuantto the provisions of chapter 630 of NRS, theBoard of Medical Examiners shall conduct an investigation of the allegedviolation. Such a violation, in addition to any criminal penalties that may beimposed, constitutes grounds for initiating disciplinary action or denyinglicensure pursuant to the provisions of subsection 3 of NRS 630.3065.

(b) An osteopathic physician licensed to practiceosteopathic medicine pursuant to the provisions of chapter633 of NRS, the State Board of Osteopathic Medicine shall conduct aninvestigation of the alleged violation. Such a violation, in addition to anycriminal penalties that may be imposed, constitutes grounds for initiating disciplinaryaction pursuant to the provisions of subsection 1 of NRS 633.131.

(Added to NRS by 1987, 867; A 1989, 1660; 2003, 1178)

NRS 439B.420 Prohibitedacts of hospitals and related entities; exceptions; submission of contracts toDirector; civil penalty.

1. A hospital or related entity shall not establish arental agreement with a physician or entity that employs physicians thatrequires any portion of his medical practice to be referred to the hospital orrelated entity.

2. The rent required of a physician or entity whichemploys physicians by a hospital or related entity must not be less than 75percent of the rent for comparable office space leased to another physician orother lessee in the building, or in a comparable building owned by the hospitalor entity.

3. A hospital or related entity shall not pay anyportion of the rent of a physician or entity which employs physicians withinfacilities not owned or operated by the hospital or related entity, unless theresulting rent is no lower than the highest rent for which the hospital orrelated entity rents comparable office space to other physicians.

4. A health facility shall not offer any provider ofmedical care any financial inducement, excluding rental agreements subject tothe provisions of subsection 2 or 3, whether in the form of immediate, delayed,direct or indirect payment to induce the referral of a patient or group ofpatients to the health facility. This subsection does not prohibit bona fidegifts under $100, or reasonable promotional food or entertainment.

5. The provisions of subsections 1 to 4, inclusive, donot apply to hospitals in a county whose population is less than 50,000.

6. A hospital, if acting as a billing agent for amedical practitioner performing services in the hospital, shall not add anycharges to the practitioners bill for services other than a charge related tothe cost of processing the billing.

7. A hospital or related entity shall not offer anyfinancial inducement to an officer, employee or agent of an insurer, a personacting as an insurer or self-insurer or a related entity. A person shall notaccept such offers. This subsection does not prohibit bona fide gifts of under$100 in value, or reasonable promotional food or entertainment.

8. A hospital or related entity shall not sell goodsor services to a physician unless the costs for such goods and services are atleast equal to the cost for which the hospital or related entity pays for thegoods and services.

9. Except as otherwise provided in this subsection, apractitioner or health facility shall not refer a patient to a health facilityor service in which the referring party has a financial interest unless thereferring party first discloses the interest to the patient. This subsectiondoes not apply to practitioners subject to the provisions of NRS 439B.425.

10. The Director may, at reasonable intervals, requirea hospital or related entity or other party to an agreement to submit copies ofoperative contracts subject to the provisions of this section afternotification by registered mail. The contracts must be submitted within 30 daysafter receipt of the notice. Contracts submitted pursuant to this subsectionare confidential, except in cases in which an action is brought pursuant tosubsection 11.

11. A person who willfully violates any provision ofthis section is liable to the State of Nevada for:

(a) A civil penalty in an amount of not more than$5,000 per occurrence, or 100 percent of the value of the illegal transaction,whichever is greater.

(b) Any reasonable expenses incurred by the State inenforcing this section.

Any moneyrecovered pursuant to this subsection as a civil penalty must be deposited in aseparate account in the State General Fund and used for projects intended tobenefit the residents of this State with regard to health care. Money in theaccount may only be withdrawn by act of the Legislature.

12. As used in this section, related entity means anaffiliated person or subsidiary as those terms are defined in NRS 439B.430.

(Added to NRS by 1987, 870; A 1989, 1925; 1993, 2595;2001, 1988)

NRS 439B.425 Prohibitedreferral of patients; exceptions; penalty.

1. Except as otherwise provided in this section, apractitioner shall not refer a patient, for a service or for goods related tohealth care, to a health facility, medical laboratory, diagnostic imaging orradiation oncology center or commercial establishment in which the practitionerhas a financial interest.

2. Subsection 1 does not apply if:

(a) The service or goods required by the patient arenot otherwise available within a 30-mile radius of the office of thepractitioner;

(b) The service or goods are provided pursuant to areferral to a practitioner who is participating in the health care plan of ahealth maintenance organization that has been issued a certificate of authoritypursuant to chapter 695C of NRS;

(c) The practitioner is a member of a group practiceand the referral is made to that group practice;

(d) The referral is made to a surgical center forambulatory patients, as defined in NRS449.019, that is licensed pursuant to chapter449 of NRS;

(e) The referral is made by:

(1) A urologist for lithotripsy services; or

(2) A nephrologist for services and supplies fora renal dialysis;

(f) The financial interest represents an investment ina corporation that has shareholder equity of more than $100,000,000, regardlessof whether the securities of the corporation are publicly traded; or

(g) The referral is made by a physician to a surgicalhospital in which the physician has an ownership interest and:

(1) The surgical hospital is:

(I) Located in a county whose populationis less than 100,000; and

(II) Licensed pursuant to chapter 449 of NRS as a surgical hospital and notas a medical hospital, obstetrical hospital, combined-categories hospital,general hospital or center for the treatment of trauma;

(2) The physician making the referral:

(I) Is authorized to perform medicalservices and has staff privileges at the surgical hospital; and

(II) Has disclosed his ownership interestin the surgical hospital to the patient before making the referral;

(3) The ownership interest of the physicianmaking the referral pertains to the surgical hospital in its entirety and isnot limited to a department, subdivision or other portion of the hospital;

(4) Every physician who has an ownershipinterest in the surgical hospital has agreed to treat patients receivingbenefits pursuant to Medicaid and Medicare;

(5) The terms of investment of each physicianwho has an ownership interest in the surgical hospital are not related to thevolume or value of any referrals made by that physician;

(6) The payments received by each investor inthe surgical hospital as a return on his investment are directly proportionalto the relative amount of capital invested or shares owned by the investor inthe hospital;

(7) None of the investors in the surgicalhospital has received any financial assistance from the hospital or any otherinvestor in the hospital for the purpose of investing in the hospital; and

(8) Either:

(I) The governing body of every otherhospital that regularly provides surgical services to residents of the countyin which the surgical hospital is located has issued its written generalconsent to the referral by such physicians of patients to that surgicalhospital; or

(II) The board of county commissioners ofthe county in which the surgical hospital is located has issued a writtendeclaration of its reasonable belief that the referral by such physicians ofpatients to that surgical hospital will not, during the 5-year periodimmediately following the commencement of such referrals, have a substantialadverse financial effect on any other hospital that regularly provides surgicalservices to residents of that county.

3. A person who violates the provisions of thissection is guilty of a misdemeanor.

4. The provisions of this section do not prohibit apractitioner from owning and using equipment in his office solely to provide tohis patients services or goods related to health care.

5. As used in this section:

(a) Group practice means two or more practitionerswho organized as a business entity in accordance with the laws of this state toprovide services related to health care, if:

(1) Each member of the group practice provides substantiallyall of the services related to health care that he routinely provides,including, without limitation, medical care, consultations, diagnoses andtreatment, through the joint use of shared offices, facilities, equipment andpersonnel located at any site of the group practice;

(2) Substantially all of the services related tohealth care that are provided by the members of the group practice are providedthrough the group practice; and

(3) No member of the group practice receivescompensation based directly on the volume of any services or goods related tohealth care which are referred to the group practice by that member.

(b) Patient means a person who consults with or isexamined or interviewed by a practitioner or health facility for purposes ofdiagnosis or treatment.

(c) Substantial adverse financial effect includes,without limitation, a projected decline in the revenue of a hospital as aresult of the loss of its surgical business, which is sufficient to cause adeficit in any cash balances, fund balances or retained earnings of thehospital.

(Added to NRS by 1993, 2594; A 1995, 1489; 2001, 1072)

NRS 439B.430 Prohibitedacts of hospitals; examination by Director; administrative fine; injunctiverelief.

1. For the purposes of this section:

(a) An affiliated person is a person controlled byany combination of the hospital, the parent corporation, a subsidiary or theprincipal stockholders or officers or directors of any of the foregoing.

(b) A subsidiary is a person of which either thehospital and the parent corporation or the hospital or the parent corporationholds practical control.

2. No hospital may engage in any transaction oragreement with its parent corporation, or with any subsidiary or affiliatedperson which will result or has resulted in:

(a) Substitution contrary to the interest of thehospital and through any method of any asset of the hospital with an asset orassets of inferior quality or lower fair market value;

(b) Deception as to the true operating results of thehospital;

(c) Deception as to the true financial condition of thehospital;

(d) Allocation to the hospital of a proportion of theexpense of combined facilities or operations which is unfavorable to thehospital;

(e) Unfair or excessive charges against the hospitalfor services, facilities or supplies;

(f) Unfair and inadequate charges by the hospital forservices, facilities or supplies furnished by the hospital to others; or

(g) Payment by the hospital for services, facilities orsupplies not reasonably needed by the hospital.

3. If the Director has reasonable cause to believethat a violation of subsection 2 has occurred, he may conduct an examination ofany books and records of the hospital, parent corporation, subsidiary oraffiliated person which he deems pertinent to the examination. The Director hasthe same authority to examine the parent corporation, subsidiary or affiliatedperson and recover the cost of the examination as he has with regard to thehospital. A parent corporation, subsidiary or affiliated person which refusesto permit the examination of its books and records is subject to the fineprovided for in subsection 4 for each day that access to the books or recordsis restricted.

4. If a hospital, parent corporation, subsidiary oraffiliated person is found, after notice and a hearing, to have violated theprovisions of this section, the Director may impose an administrative fine ofnot more than $20,000 for each violation or the actual amount of damage causedby the violation, whichever is greater.

5. Upon a second or subsequent violation of theprovisions of this section, the Director may commence a legal action in thedistrict court of any county to secure an injunction against further violationsof this section.

(Added to NRS by 1987, 872)

NRS 439B.440 Directormay require hospitals, health facilities and providers of health services tosubmit information; independent audit; examinations; penalty.

1. The Director may by regulation require hospitals,other health facilities and providers of health services to submit suchinformation as is reasonably necessary for the Director to carry out theprovisions of this chapter.

2. Except as otherwise provided in subsection 3, theDirector shall by regulation require an examination of a hospital by anindependent auditor appointed by the Director to ensure compliance with thischapter. The audits must be scheduled on a regular basis but not more oftenthan once each year. The hospital shall pay the costs of the audit. A hospitalmay contract with the auditor to conduct other work for the hospital inconnection with the audit.

3. The Director shall not require an audit of ahospital which has less than 100 beds or is subject to the provisions of chapter 450 of NRS. The Director shall byregulation require such a hospital to submit audits of the hospital on aregular basis but not more often than once each year.

4. If a hospital fails to comply with any regulationadopted pursuant to this section or the Director has reason to believe thehospital has violated any provision of this chapter, the Director may conductan examination or contract for an independent examination of the hospital todetermine whether it is in compliance with those provisions. The hospital whichis the subject of such an examination is responsible for payment of the costsof the examination if the Director determines that the hospital did violate aprovision of this chapter.

5. Any person who fails to submit information asrequired by any regulation adopted pursuant to this chapter to the Departmentor fails to submit to an audit or examination pursuant to this section issubject to an administrative fine of not more than $1,000 per violation per dayuntil the required information is submitted or the person submits to the auditor examination.

(Added to NRS by 1987, 872; A 1991, 2113; 2005, 1736)

NRS 439B.450 Powersand duties of Director. The Director:

1. May adopt such regulations as are necessary tocarry out the provisions of this chapter.

2. Shall ensure that the administration of thischapter does not cause the State to fail to comply with the requirements of theFederal Government concerning Medicare and Medicaid.

(Added to NRS by 1987, 873)

NRS 439B.460 Directorauthorized to delegate powers and duties. TheDirector may delegate:

1. Any of his powers or duties pursuant to thischapter to the Administrator of the Division of Health Care Financing andPolicy of the Department.

2. Any of the Departments powers or duties pursuantto this chapter to the Division of Health Care Financing and Policy.

(Added to NRS by 1997, 2632; A 1999, 2242)

NRS 439B.500 Penaltyfor violation of chapter. In addition to anycivil or administrative penalty specifically provided in this chapter, anyperson who violates a provision of this chapter shall be punished by a fine ofnot more than $5,000 for each violation.

(Added to NRS by 1987, 873)(Substituted in revisionfor part of NRS 439B.450)

 

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