Final NAPA Legislative Update for 2019

NAPA Legislative Update – Final Report

The 80 th session of the Nevada State Legislature is in the books. The only cloud still hanging
around is a threat by Senate Republicans to sue when Senate Bill 551 becomes law. The bill,
which would make permanent current payroll tax rates, required only a simple majority vote,
which is how it passed the Senate; Senate Republicans claim it should’ve required a 2/3rds
majority. Each side feels it’s on strong legal ground, but if a lawsuit is successful, it could force a
special session.

NAPA had bills and issues still in play the last days of session.
On the positive side, Senate Bill 289 passed the Assembly on the last day. The bill recommits
the state to the federal loan forgiveness program for the next five years for healthcare
providers that serve in critically underserved areas, but at a higher amount and which is a 1:1
match by the federal government.

Also, Senate Concurrent Resolution 6 was adopted by the Assembly and has been filed with the
Secretary of State. It will require an interim study by the Legislative Commission’s Sunset
Subcommittee of all occupational and professional licensing boards, with the intention of
making appropriate changes come the 2021 session. If all the talk is to be believed, this will
definitely bear watching during the 2019-20 interim.

Senate Bill 535, which establishes the Governor’s Patient Protection Commission, also cleared
the Assembly on the last day and awaits Gov. Sisolak’s signature. As this bill was previewed and
later presented to the Legislature, expect the Commission to ramp up quickly and it’s
something NAPA will want to be involved with as much as possible.

On the negative side, but in the “there’s-more-than-one-way-to-skin-a-cat” category, Senate
Bill 344 died in the Assembly Ways and Means committee. Originally intended as an extension
of family planning services for fee-for-service Medicaid recipients, the bill was amended into
something different and far more beneficial. Chief among the new provisions was one that
would require Medicaid to reimburse for the services of Community Health Workers when
providing those services under the supervision of a physician, physician assistant or advance
practice registered nurse. However, this will be pursued during the interim through an
amendment to the State Plan for Medicaid (Medicaid stated they can absorb the cost).

Same thing for Senate Bill 171, which also died in the Ways and Means committee on the last
day and would have required medical professional licensing boards to collect certain
information when relicensing its members. The data, which would be housed at the UNR School
of Medicine’s Office of Statewide Initiatives, would provide a better gauge of where and what
type of health care is available around Nevada, including provider network adequacy. A similar,
complementary effort to establish a payer claims database (Senate Bill 472) met the same fate.
There will be an effort to require this outside of legislation during the interim.

Here’s the final tally on bills we actively tracked (with links to bills that didn’t die):

Assembly Bill 123: This bill changes how immunization data is compiled and shared. PAs have
been added to this bill as providers who can sign statements for medical exemptions. The bill
was amended and passed the Assembly but in such a way that the public health community no
longer supports it, in fact opposed it.
STATUS: It died.

Assembly Bill 129: This bill requires certain first responders to receive 2 hours of training
concerning persons with intellectual disabilities for licensure or certification, but was amended
to exempt physicians, PAs and nurses from that requirement.
STATUS: Signed by the Governor.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=329

Assembly Bill 147: This bill has the signature authority provisions in it, although not as
expansive as we’d have liked nor the same as what APRNs got last session.
STATUS: Signed by the Governor.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=371

Assembly Bill 239: This is clean-up legislation for AB474 from the 2017 session, legislation that
sought to address the prescription drug/opioid abuse epidemic. NAPA supported the bill in
committees in both houses, along with other groups including providers and boards.
STATUS: Signed by the Governor.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=575

Assembly Bill 310: As originally proposed, this bill would require e-prescribing as the only way
to prescribe but was amended to controlled substances only and that written prescriptions are
still allowed. NAPA was neutral on the bill as amended.
STATUS: Signed by the Governor.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=719

Assembly Bill 328: This was the PA omnibus bill, one that would have removed the supervisory
agreement PAs must have in order to practice, modernized the licensing process for PAs, and
allowed a PA’s signature, etc., in lieu of a physician’s. Bill was not heard, for several reasons.
STATUS: It died.

Assembly Bill 373: This bill would prohibit state and local governments from restricting
information that can be shared with patients. NAPA supported the bill, but it wasn’t voted on.
STATUS: It died.

Senate Bill 115: NAPA was able to add PAs to this bill as a provider of health care that can issue
an order for donor breast milk. The bill was amended and passed out of the policy committee
but died in the Senate Finance committee.
STATUS: It died.

Senate Bill 116: This would add PAs to the new definition of “attending provider of health care”
for issues of determining a proxy decision-maker for certain patients who lack the capacity to
act on their own behalf. The bill was never heard.
STATUS: It died.

Senate Bill 124: This bill would have allowed licensing boards to discipline providers if certain
procedures for gender-altering surgery aren’t followed. The bill was never heard.
STATUS: It died.

Senate Bill 128: As amended, this bill proposes to revise “provisions governing the
administration of occupational licensing boards.” As stated, the intention is for an omnibus
licensing board bill of sorts with the provisions from SB271 and SB289 amended into it. It never
made it out of committee in the Assembly.
STATUS: It died.

Senate Bill 130: This would require PAs to be licensed to engage in radiation therapy and
radiological imaging and certified to operate a mammography machine. The bill was amended
to exempt PAs.
STATUS: Signed by the Governor.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=291

Senate Bill 170: This bill allows PAs to inject botox. It passed the Senate unanimously, but that
was it.
STATUS: It died.

Senate Bill 171: This bill would require the collection of certain data as a condition of re-
licensure for all providers of health care. The bill was amended and passed out of the policy
committee but died in the Senate Finance committee.
STATUS: It died.

Senate Bill 189: This bill would implement a new process for PAs to transfer a patient if the PA
has determined the care requested would be ineffective or contrary to standards of care. The
bill was never heard.
STATUS: It died.

Senate Bill 247: This bill would require a provider of health care to obtain the consent of all
parents or legal guardians of a minor before mental health evaluation or treatment can
commence. It was heard but that’s as far as it went, thankfully.
STATUS: It died.

Senate Bill 271: An attempt was made to amend the provisions modernizing licensure and other
PA measures into SB128 in committee in the Assembly, but SB128 never received a vote.
STATUS: It died.

Senate Bill 283: This is a bill about prescription drugs. As it has been amended (conceptually),
among other considerations, it would require every prescription to uploaded to the PMP, not
just prescriptions for controlled drugs. It was amended and passed out of the policy committee
but died in the Senate Finance committee.
STATUS: It died.

Senate Bill 289: As amended, the bill proposes to “make an appropriation for health services in
underserved areas.” The bill’s intent is more money for the federal loan forgiveness program
for health care providers who choose to practice in designated critical shortage areas.
Provisions relating to the NSBME and the NSBOM were removed.
STATUS: Enrolled and delivered to the Governor.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=669

Senate Bill 315: This bill would encourage PAs to receive CME on rare diseases.
STATUS: Signed by the Governor.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=706

Senate Bill 344: As amended, bill would allow other funds to be used to offset costs of LA;
prohibit Medicaid from requiring co-pays or co-insurance; and, require Medicaid to reimburse
for the services of Community Health Workers when supervised by a physician, PA or APRN. Bill
died in the Ways and Means committee.
STATUS: It died.

Senate Bill 470: This bill requires a medical facility to provide cultural competency training for
its employees that provide care to patients. The State Board of Health will develop regulations
for that training.
STATUS: Signed by the Governor.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=1042

Senate Bill 544: This is Gov. Sisolak’s legislation to establish the Patient Protection Commission,
its membership, duties and responsibilities, and so forth. NAPA testified in support, along with
pretty much every other entity that’s part of Nevada’s health care system.
STATUS: Enrolled and delivered to the Governor.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=1203

Senate Concurrent Resolution 6: This is another vehicle that will begin the overhaul of Nevada’s
occupational and professional licensing boards. It’s expected that both houses will adopt it, the
issue will be studied during the interim with recommendations brought forward for the
Legislature’s consideration in 2021, at which time it’s expected Gov. Sisolak will sponsor
legislation to implement what he wants and what the study recommends.
STATUS: Filed with the Secretary of State.
https://www.leg.state.nv.us/Session/80th2019/Reports/history.cfm?ID=999