All Roll Calls
Yes: 63 • No: 0
NevadaAB51983rd Regular Session (2025)HouseWALLET
AN ACT relating to health care; establishing separate provisions for the licensing or certification, regulation and discipline of agencies to provide personal care services in the home, employment agencies that contract to provide certain nonmedical services and intermediary service organizations; enacting provisions to facilitate the collecting of certain debts from applicants for certain licenses; imposing certain requirements as an applicant for a certificate to operate an intermediary service organization; revising the training requirements for certain caregivers who receive reimbursement through Medicaid; authorizing a family member to serve as the personal care assistant for a recipient of Medicaid under certain circumstances; providing penalties; and providing other matters properly relating thereto.
Sponsored By: Assembly Committee on Health and Human Services
Signed by Governor
BDR 40-805
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Bill Overview
Analyzed Economic Effects
33 provisions identified: 15 benefits, 8 costs, 10 mixed.
Bonds or deposits required for ISOs
Non‑state ISOs must post a surety bond payable to the Aging and Disability Services Division. The bond is $5,000 if you have fewer than 7 employees, $25,000 for 7–25, and $50,000 for more than 25. It protects older patients. If coverage lapses, your certificate is suspended. Instead of a bond, you may deposit approved cash or government/bank obligations equal to the bond. Interest goes to you, but you can withdraw or substitute only with the Administrator’s order.
Stronger ISO enforcement and penalties
The Division can deny, suspend, or revoke a certificate for breaking the law or endangering health or safety. It must give notice by certified mail, but it may suspend right away to protect public health; you can appeal and get a hearing. It can stop services, appoint temporary managers, and fine up to $1,000 per day per violation, plus up to 10% yearly interest; unpaid penalties can trigger suspension and court costs. The Division can get court orders to stop unlicensed or suspended operations, and the county district attorney must prosecute cases. Certificates tied to child support are suspended 30 days after a court order and restored when you comply. The Board sets sanction rules and the Division investigates complaints. Certification fees go into a separate state account and may be used only to run this program.
Surety bonds required for home care agencies
Agencies must post a surety bond based on staff size: $5,000 for fewer than 7 employees, $25,000 for 7–25, and $50,000 for more than 25. The bond protects older clients (60+) for property damage. Licenses can be suspended if coverage lapses. State‑run agencies are exempt.
Licenses: debts enforced, status neutral access
The Division can deny license renewal if your agency owes a state‑assigned debt and you have not paid, set a repayment plan, or proved it invalid. You must file a child‑support statement; if you are not in compliance or not in an approved plan, the Division must refuse to issue or renew the license. The Division may not deny a license or certificate only because of immigration status. Applicants without an SSN may use an ITIN or other ID number, and those numbers stay confidential for limited uses. These child‑support licensing rules remain unless the related federal law is repealed.
Home-care staff can help with basic health
With the client’s consent, home‑care staff can check vital signs, help with insulin auto‑injectors, and help with blood‑glucose tests. Staff must follow federal CLIA rules and required training. A glucose device may not be used on more than one person.
Medicaid can pay family caregivers
Medicaid recipients can be treated as providers for their own personal care when federal rules allow. They may use Medicaid payments to pay a helper or an agency, and a trained family member may be the paid assistant with a provider’s authorization. The state must also run a structured family caregiving option for people with dementia after federal approval. In that program, the caregiver is hired by an agency or intermediary and must get a daily stipend of at least 65% of the agency’s per‑diem rate. The Board sets training rules and posts low‑cost or free options, and prior valid training still counts.
More in-home help and support services
Licensed agencies may provide certain medical services authorized by state law and nonmedical personal care at home. Certified intermediary organizations can run background checks, handle payroll and taxes, and manage money for personal assistants. With the person’s consent, intermediary employees may check vital signs, help with insulin auto‑injectors, and assist with approved home blood‑glucose tests. Rules require CLIA compliance when needed and forbid sharing glucose devices.
Training and anti-bias rules in home care
Before licensure and yearly, owners and staff must take training to spot and prevent abuse of older people. Staff who see clients weekly or supervise them must complete cultural‑competency training through a state‑approved course; alternates can be approved within 10 business days. Agencies may not discriminate based on race, religion, age, disability, sexual orientation, gender identity, or HIV status, and must post a nondiscrimination notice online. Agencies may not use names that mislead people about what they do.
Stronger abuse reporting and safe referrals
Workers in home‑care agencies and intermediary service organizations must report suspected abuse, neglect, or exploitation of older or vulnerable people within 24 hours. Agencies may not refer someone to an unlicensed or clearly inappropriate group home; fines are up to $10,000 for a first offense and $10,000–$20,000 after that. If the reported person is a licensed professional, the report is sent to their licensing board. The law applies enhanced assault penalties to attacks on in‑home health workers while on duty.
More mandatory training for clinicians
The law adds required training for many clinicians. Nurses must complete 30 CE hours every 2 years, a 4‑hour terrorism course within 2 years, and 4 hours of cultural competency every 2 years. Doctors, PAs, and anesthesiologist assistants must take a 4‑hour terrorism course within 2 years. Physicians and APRNs must complete 2 hours of suicide‑prevention training within 2 years and again every 4 years; new licensees also need 2 hours on S‑BIRT for substance use. Psychiatrists and their PAs need 2 hours of cultural‑competency training every 2 years, and ER or primary‑care clinicians need 2 hours on HIV stigma within 2 years.
Licenses, fees, and fines for home-care agencies
To run a home personal care agency or an employment agency that places nonmedical aides, you must hold a state license. The Board sets the license fees and rules; applicants must be at least 21 (if an individual) and show they can follow the law. The Division may investigate, seek court orders to stop unlicensed operations, and ask the county district attorney to prosecute. Referring unqualified workers brings civil fines: up to $10,000 the first time, and $10,000–$20,000 after. The Division can bill providers or unlicensed operators for actual enforcement costs, except for license issuance/renewal actions already covered by fees or when federal funds pay for enforcement.
ISOs must be certified to operate
You must hold a state certificate to run an intermediary service organization (ISO). Running without one is a misdemeanor. The application must list your name, location, manager, proof of good character, and your Social Security number. You must pay a Board‑set fee; the Board may allow installments. Certificates show who may operate, where, and which services, and are not transferable. Certificates expire each December 31 and renew yearly with fees. Renewal must include a child‑support status form and your state business‑license ID (if you have one). The Division will not issue or renew if you fail to file these items or if the State Controller reports an unpaid state debt without a payment plan or valid dispute. Agencies already licensed to provide in‑home personal care are exempt from this ISO certificate.
Stricter background checks for home care workers
Agency owners must submit fingerprints to the state for FBI checks. Employers have 10 days after hire to collect a conviction statement, verify licenses, and submit fingerprints, then recheck at least every 5 years; they may charge workers up to half the state fee. Temp services cannot send ineligible workers and must prove continuous employment and alert agencies if the last check is over 5 years old. If a listed conviction appears, the job or contract must end after at least 30 days to fix any error; no unsupervised contact with a child is allowed. Serious crimes within 7 years can bar licensure or work. People with records can petition for a decision within 90 days (fee up to $50, waivable). Agencies must keep records, and a secure state website and the Central Repository support FBI‑backed checks.
Tougher oversight and fines for home care
Nevada now licenses and closely oversees in‑home personal care agencies. Inspectors can visit anytime, write reports, and require fixes. The Division can stop services, appoint managers, and fine up to $5,000 per day, with interest up to 10% if unpaid. Running an unlicensed agency is a misdemeanor, with court fines up to $10,000 for a first offense and $10,000–$25,000 after that. The Division must keep a complaint log and report every two years, and it gives notice and appeal rights but may order emergency suspensions. Licenses are suspended 30 days after a child‑support suspension order unless a compliance letter arrives.
New rules for home care and 55+ staff
If you work 24 hours or more, up to 8 scheduled sleeping hours can be unpaid if you sign a written agreement and have proper sleeping space. Interruptions count as work time; if sleep drops under 5 hours, the full sleeping period is paid. Staff who work 36+ hours a week and can access all units in 55+ housing must have a sheriff work card. It requires fingerprints, renews every 5 years, and can be denied for certain convictions, with 30 days to fix record errors. The law also expands who counts as a home care employee to include agency staff, intermediary personal assistants, and some respite workers.
Background checks for ISO workers
Within 10 days of hiring or contracting, ISOs must get a conviction statement, proof of required licenses, and fingerprints, then submit them to the Central Repository. If prints and an FBI report with no convictions were filed in the past 6 months, you are exempt from resubmitting; everyone must be rechecked at least every 5 years. The Central Repository may charge a fee; the ISO may recover up to half from the worker or contractor and must allow a payment plan. Certain crimes (some with a 7‑year look‑back) are disqualifying; workers get at least 30 days to fix wrong records before termination. Applicants with a record can petition for a decision; the Division must answer in 90 days and may charge up to $50 (waivable). Temp services must prove continuous employment since the last check and report if no check occurred within 5 years. ISOs must keep background records for each worker and provide them to the Division on request.
Licensing rules for in‑home care agencies
The Division issues a license to run an in‑home personal care agency when you meet the law and Board rules. The license lists who may operate and your services and is not transferable. Each license expires December 31 and renews yearly with required fees and compliance statements. Applications must include the applicant’s Social Security number. If you need time to meet new standards or fix problems, the Division may issue a provisional license with conditions. Instead of a bond, an agency may deposit approved bank or government obligations equal to the bond; interest is yours, but withdrawals need the Administrator’s order. Licensing money goes to the State General Fund credited to the Division for enforcement.
Seniors can claim bond money
If you are 60 or older and a covered care provider caused property loss, you can file a verified complaint within one year. If liability is found, the provider’s surety bond can be released to pay you or your estate.
Licensing tweaks for health professionals
Active‑duty military and U.S. Public Health Service members do not pay annual license‑renewal fees while on duty. The Board cannot require physician assistants to hold national certification to meet continuing‑education rules. Registered behavior technicians do not have to take continuing education. The public member on the osteopathic board cannot run a medical or home‑care facility.
Safer home care during emergencies and after discharge
When a hospital sends a patient home to receive agency care, the agency consults a dietitian as needed so the patient or caregiver understands diet needs. Agency employees who completed CPR and first‑aid training are protected from civil lawsuits when they give good‑faith emergency care, unless they act with gross negligence.
Stronger privacy and records rights in home care
Agencies must keep private a client’s sexual orientation, transgender status, gender‑affirming surgery, and HIV status. Staff not giving care may not be present while a client is unclothed unless the client agrees, and visual barriers must be used where appropriate. Agencies must use preferred names and pronouns and update electronic records to reflect a client’s identity. If an agency closes or is suspended, the Division secures records under HIPAA; clients or their guardians can request their own records.
Who can use intermediary services
The law defines “personal assistance,” “personal assistant,” and who counts as an “other responsible person.” These definitions decide who can direct and receive intermediary services.
More CE options and guidance
Genetic counseling or testing courses count toward CE for licensed physicians. The Board also encourages CE in geriatrics and in teaching patients to manage medicines, including adding the purpose on prescription labels.
Clearer rules for home care providers
The law uses one clear definition for “in‑home personal care agency” across health and labor laws. It says these agencies are not a “professional service” under other licensing rules. New entities under this law count as facilities or service providers for protections and rules. Key service terms now point to the same sections for clarity. Agencies run by the U.S. government are exempt from these state licensing rules.
No duplicate license for some providers
If you already hold an applicable state license or certificate, you do not need a second license to contract for nonmedical home personal care under this law. This removes duplicate licensing for some providers.
Some care tasks exempt from lab rules
Certain respiratory‑care tasks do not count as respiratory care when done under State Board of Health rules. The medical lab chapter does not apply to tests by police, court‑ordered rehab tests, or tasks done under those Board rules.
State centralizes home care oversight rules
Nevada moves in‑home personal care under one set of rules in a new chapter. These agencies are now included in the legal definition of “health care facility.” A state committee reviews future rules for costs and provider supply, and DHHS runs the program. Boards must include more data in Sunset reports, including numbers and reasons for disqualification petitions.
More training and background checks for clinicians
Many Nevada clinicians now face added training and checks. APRNs must complete at least 2 hours of S‑BIRT training within 2 years of first licensure. Psychologists, therapists, social workers, alcohol and drug counselors, behavior analysts, and related licensees must complete evidence‑based suicide‑prevention training and 6 hours of cultural‑competency instruction on a regular schedule. Osteopathic physicians must also meet suicide‑prevention and topic‑specific CE rules, and genetic testing courses can count toward CE. Registered behavior technicians must pass a criminal‑history check on the third renewal and every third renewal after.
Proof of continuing education to renew
Doctors, physician assistants, and anesthesiologist assistants must show proof of required continuing education to renew or register. You must submit evidence of compliance when you renew or complete biennial registration.
Existing licenses honored, rules moved
Licenses and certificates that are valid when this law takes effect stay valid until they expire, if you remain qualified. Any disciplinary or administrative action already in effect stays in place until it ends. Existing regulations are moved to a new chapter, and the State Board of Health will write replacement rules. Current rules remain in force until the new rules take effect. The law repeals the listed older statutes for these providers.
Faster records sharing and license info
When a division facility transfers a patient, it must send medical records by the transfer date. Consent is not needed unless federal or state law requires it. The statewide 2‑1‑1 system must list and update provider licensing status every quarter. Some records named in this law are confidential and not open to the public.
Stronger conflict rules for medical boards
Two public seats on the medical and homeopathic boards now have stricter conflict‑of‑interest limits. People who run medical or personal care facilities, or hold healing‑arts licenses, cannot fill those seats; added residency limits apply.
Reporting rules and protections in home care
Operators, employees, and contractors of home‑care agencies, intermediary organizations, and community health worker pools must report suspected violations to the Board in writing. People who report in good faith are immune from civil liability for making the report. This increases oversight but adds a reporting duty for workers and organizations.
Sponsors & Cosponsors
Sponsor
Assembly Committee on Health and Human Services
Affiliation unavailable
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
Senate vote • 5/21/2025
Final Passage - Senate (1st Reprint)
Yes: 21 • No: 0
House vote • 4/22/2025
Final Passage - Assembly (1st Reprint)
Yes: 42 • No: 0
Actions Timeline
Chapter 158.
5/30/2025legislatureApproved by the Governor.
5/30/2025legislatureEnrolled and delivered to Governor.
5/27/2025legislatureIn Assembly. To enrollment.
5/22/2025HouseRead third time. Passed. Title approved. (Yeas: 21, Nays: None.) To Assembly.
5/21/2025SenateTaken from General File. Placed on General File for next legislative day.
5/20/2025SenateRead second time.
5/19/2025SenateFrom committee: Do pass.
5/16/2025SenateRead first time. Referred to Committee on Health and Human Services. To committee.
4/29/2025SenateIn Senate.
4/28/2025SenateTo Senate.
4/25/2025HouseFrom printer. To engrossment. Engrossed. First reprint.
4/25/2025HouseTo printer.
4/22/2025HouseRead third time. Passed, as amended. Title approved, as amended. (Yeas: 42, Nays: None.)
4/22/2025HouseDispensed with reprinting.
4/21/2025HouseRead second time. Amended. (Amend. No. 451.)
4/21/2025HousePlaced on Second Reading File.
4/21/2025HouseFrom committee: Amend, and do pass as amended.
4/21/2025HouseFrom printer. To committee.
3/26/2025HouseRead first time. Referred to Committee on Health and Human Services. To printer.
3/24/2025House
Bill Text
As Enrolled
As Introduced
Reprint 1
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