Statutes and Regulations
The full text of Nevada Revised Statutes (NRS) and Nevada Administrative Code (NAC) can be found at: http://www.leg.state.nv.us/
The full text of federal statutes (laws), also known as the U.S. Code (U.S.C. or U.S.C.A.), or federal rules, also known as the Code of Federal Regulations (C.F.R.), may be found through many internet cites, one of which is: http://www.law.cornell.edu/
The full text of any cases cited in this chapter may be found through the county legal library or through the UNLV legal library.
NEVADA STATE STATUTES referenced
NRS 439B.160 Purposes of chapter.
The purposes of this chapter are to:
- Promote equal access to quality medical care at an affordable cost for all residents of this state.
- Reduce excessive billed charges and revenues generated by some hospitals in this state in order to provide relief from excessively high costs of medical care.
- Provide the regulatory mechanisms necessary to ensure that the forces of a competitive market will be able to function effectively in the business of
providing medical care in this state.
NRS 439B.260 Reduction of billed charges for certain patients and services; resolution of disputes.
- A major hospital shall reduce or discount the total billed charge by at least 30 percent for hospital services provided to an inpatient who:
(a) Has no insurance or other contractual provision for the payment of the charge by a third party;
(b) Is not eligible for coverage by a state or federal program of public assistance that would provide for the payment of the charge; and
(c) Makes reasonable arrangements within 30 days after discharge to pay his hospital bill.
- A major hospital or patient who disputes the reasonableness of arrangements made pursuant to paragraph (c) of subsection 1 may submit the dispute to the office for hospital patients for resolution as provided in NRS 232.543.
- A major hospital shall reduce or discount the total billed charge of its outpatient pharmacy by at least 30 percent to a patient who is eligible for Medicare.
NRS 439B.400 Hospital must maintain and use uniform list of billed charges; exception.
Each hospital in this state shall maintain and use a uniform list of billed charges for that hospital for units of service or goods provided to all inpatients. A hospital may not use a billed charge for an inpatient that is different than the billed charge used for another inpatient for the same service or goods provided. This section does not restrict the ability of a hospital or other person to negotiate a discounted rate from the hospital’s billed charges or to contract for a different rate or mechanism for payment of the hospital.
NRS 439B.420 Prohibited acts of hospitals and related entities; exceptions; submission of contracts to director; civil penalty.
- A hospital or related entity shall not establish a rental agreement with a physician or entity that employs physicians that requires any portion of his medical practice to be referred to the hospital or related entity.
- The rent required of a physician or entity which employs physicians by a hospital or related entity must not be less than 75 percent of the rent for comparable office space leased to another physician or other lessee in the building, or in a comparable building owned by the hospital or entity.
- A hospital or related entity shall not pay any portion of the rent of a physician or entity which employs physicians within facilities not owned or operated by the hospital or related entity, unless the resulting rent is no lower than the highest rent for which the hospital or related entity rents comparable office space to other physicians.
- A health facility shall not offer any provider of medical care any financial inducement, excluding rental agreements subject to the 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 of patients to the health facility. This subsection does not prohibit bona fide gifts under $100, or reasonable promotional food or entertainment.
- The provisions of subsections 1 to 4, inclusive, do not apply to hospitals in a county whose population is less than 35,000.
- A hospital, if acting as a billing agent for a medical practitioner performing services in the hospital, shall not add any charges to the practitioner’s bill for services other than a charge related to the cost of processing the billing.
- A hospital or related entity shall not offer any financial inducement to an officer, employee or agent of an insurer, a person acting as an insurer or self‑insurer or a related entity. A person shall not accept such offers. This
subsection does not prohibit bona fide gifts of under $100 in value, or reasonable promotional food or entertainment.
- A hospital or related entity shall not sell goods or services to a physician unless the costs for such goods and services are at least equal to the cost for which the hospital or related entity pays for the goods and services.
- Except as otherwise provided in this subsection, a practitioner or health facility shall not refer a patient to a health facility or service in which the referring party has a financial interest unless the referring party first discloses the interest to the patient. This subsection does not apply to practitioners subject to the provisions of NRS 439B.425.
- The director may, at reasonable intervals, require a hospital or related entity or other party to an agreement to submit copies of operative contracts subject to the provisions of this section after notification by registered mail. The contracts must be submitted within 30 days after receipt of the notice. Contracts submitted pursuant to this subsection are confidential, except in cases in which an action is brought pursuant to subsection 11.
- A person who willfully violates any provision of this 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 in enforcing this section.
Any money recovered pursuant to this subsection as a civil penalty must be deposited in a separate account in the state general fund and used for projects intended to benefit the residents of this state with regard to health care. Money in the account may only be withdrawn by act of the legislature.
- As used in this section, “related entity” means an affiliated person or subsidiary as those terms are defined in NRS 439B.430.
NRS 439A.106 Department to prepare listing of hospitals and charges for services; disclosure of details of contracts.
- The department shall prepare annually and release for publication or other dissemination a listing of every hospital in the state and its charges for representative services. The listing must include information regarding each hospital’s average and total contractual allowances to categories of payers who pay on the basis of alternative rates rather than billed charges.
- The department shall not disclose or report the details of contracts entered into by a hospital, or disclose or report information pursuant to this section in a manner that would allow identification of an individual payer or other party to a contract with the hospital, except that the department may disclose to other state agencies the details of contracts between the hospital and a related entity. A state agency shall not disclose or report information disclosed to the agency by the department pursuant to this subsection in a manner that would allow identification of an individual payer or other party to a contract with the hospital.
- As used in this section, “related entity” means an affiliated person or subsidiary as those terms are defined in NRS 439B.430.
NRS 449.243 Itemized list of charges required; use of Uniform Billing and Claims Forms authorized; contracted rates; summary of charges.
Every hospital licensed pursuant to the provisions of NRS 449.001 to 449.240, inclusive:
- May, except as otherwise provided in subsection 2, utilize the Uniform Billing and Claims Forms established by the American Hospital Association.
- Shall, except as otherwise provided in this section, on its billings to patients, itemize, on a daily basis, all charges for services, and charges for equipment used and the supplies and medicines provided incident to the provision of those services with specificity and in language that is understandable to an ordinary lay person. This itemized list must be timely provided after the patient is discharged at no additional cost.
- Except as otherwise provided in this subsection, if a patient is charged a rate, pursuant to a contract or other agreement, that is different than the billed charges, the hospital shall provide to the patient either:
(a) A copy of the billing prepared pursuant to subsection 2;
(b) A statement specifying the agreed rate for the services; or
(c) If the patient is not obligated to pay any portion of the bill, a statement of the total charges.
In any case, the hospital shall include on the billing or statement any copayment or deductible for which the patient is responsible. The hospital shall answer any questions regarding the bill.
- If the hospital is paid by the insurer of a patient a rate that is based on the number of persons treated and not on the services actually rendered, the hospital shall, upon the discharge of the patient, advise the patient of the status of any copayment or deductible for which the patient is responsible.
- Shall prepare a summary of charges for common services for patients admitted to the hospital and make it available to the public.
- Shall provide to any patient upon request a copy of the billing prepared
pursuant to subsection 2.
NRS 449.710 Specific rights: Information concerning facility, treatment and billing.
Every patient of a medical facility or facility for the dependent has the right to:
- Receive information concerning any other medical or educational facility or facility for the dependent associated with the facility at which he is a patient which relates to his care.
- Obtain information concerning the professional qualifications or associations of the persons who are treating him.
- Receive the name of the person responsible for coordinating his care in the facility.
- Be advised if the facility in which he is a patient proposes to perform experiments on patients which affect his own care or treatment.
- Receive from his physician a complete and current description of his diagnosis, plan for treatment and prognosis in terms which he is able to understand. If it is not medically advisable to give this information to the patient, the physician shall:
(a) Provide the information to an appropriate person responsible for the patient; and
(b) Inform that person that he shall not disclose the information to the patient.
- Receive from his physician the information necessary for him to give his informed consent to a
procedure or treatment. Except in an emergency, this information must not be limited to a specific procedure or treatment and must include:
(a) A description of the significant medical risks involved;
(b) Any information on alternatives to the treatment or procedure if he requests that information;
(c) The name of the person responsible for the procedure or treatment; and
(d) The costs likely to be incurred for the treatment or procedure and any alternative treatment or
- Examine the bill for his care and receive an explanation of the bill, whether or not he is personally responsible for payment of the bill.
- Know the facility’s regulations concerning his conduct at the facility.
NRS 450.420 Board of county commissioners to determine status of patient; charges fixed by board of hospital trustees; costs chargeable to county; exceptions.
- The board of county commissioners of the county in which a public hospital is located may determine whether patients presented to the public hospital for treatment are subjects of charity. Except as otherwise provided in NRS 439B.330, the board of county commissioners shall establish by ordinance criteria and procedures to be used in the determination of eligibility for medical care as medical indigents or subjects of charity.
- The board of hospital trustees shall fix the charges for treatment of those persons able to pay for the charges, as the board deems just and proper. The board of hospital trustees may impose an interest charge of not more than 12 percent per annum on unpaid accounts. The receipts must be paid to the county treasurer and credited by him to the hospital fund. In fixing charges pursuant to this subsection the board of hospital trustees shall not include, or seek to recover from paying patients, any portion of the expense of the hospital which is properly attributable to the care of indigent patients.
- Except as provided in subsection 4 of this section and subsection 3 of NRS 439B.320, the county is chargeable with the entire cost of services rendered by the hospital and any salaried staff physician or employee to any person admitted for emergency treatment, including all reasonably necessary recovery, convalescent and follow‑up inpatient care required for any such person as determined by the board of trustees of the hospital, but the hospital shall use reasonable diligence to collect the charges from the emergency patient or any other person responsible for his support. Any amount collected must be reimbursed or credited to the county.
- The county is not chargeable with the cost of services rendered by the hospital or any attending staff physician or surgeon to the extent the hospital is reimbursed for those services pursuant to NRS 428.115 to 428.255, inclusive.
NRS 629.071 Provider of health care required to furnish patient with itemized bill.
Each provider of health care shall, on his bill to a patient, itemize all charges for services, equipment, supplies and medicines provided for the patient in terms which the patient is able to understand. The bill must be timely provided after the charge is incurred at no additional cost to the patient.
NRS 652.195 Cytologic examination of gynecologic specimens: Direct billing required; unlawful practices; exceptions.
- A laboratory which performs a cytologic examination of gynecologic specimens for a patient residing in this state shall submit any bill for those services to:
(a) The patient directly;
(b) The responsible insurer or other third‑party payer; or
(c) The hospital, public health clinic or nonprofit health clinic.
Except as otherwise provided in subsection 3, the laboratory shall not submit
the bill for those services to the physician who directed the examination.
- Except as otherwise provided in subsection 3, it is unlawful for a physician to charge, bill or otherwise solicit payment from a person for cytologic services relating to the examination of gynecologic specimens.
- The provisions of this section do not apply to cytologic services:
(a) Rendered by the physician himself or in a laboratory operated solely in connection with the diagnosis or treatment of his own patients; or
(b) Provided to an enrollee pursuant to a health care plan authorized pursuant to chapter 695C of NRS.
NRS 689B.250 Acceptance of uniform forms for billing and claims.
Every insurer under a group health insurance contract or a blanket health insurance contract and every state agency, for its records shall accept from:
- A hospital the Uniform Billing and Claims Forms established by the American Hospital Association in lieu of its individual billing and claims forms.
- An individual who is licensed to practice one of the health professions regulated by Title 54 of NRS such uniform health insurance claims forms as the commissioner shall prescribe, except in those cases where the commissioner has excused uniform reporting.
NRS 695B.285 Use of Uniform Billing and Claims Forms authorized.
Every nonprofit hospital or medical or dental service corporation may utilize the Uniform Billing and Claims Forms established by the American Hospital Association.