CHAPTER 449 - MEDICAL FACILITIES AND OTHER RELATED ENTITIES

NAC 449.9985 Authority of Division and Bureau. (NRS 449.0302) Administrative sanctions authorized by NRS 449.163 must be imposed by the Division through the Bureau. (Added to NAC by Bd. of Health, eff. 8-1-91)

NAC 449.99851 Requirement for imposition; optional imposition. (NRS 449.0302, 449.165) At least one administrative sanction must be imposed for each deficiency in any facility with a severity level of four and for each deficiency in any facility with a combined severity and scope…

NAC 449.99852 Requirement for imposition; multiple sanctions. (NRS 449.0302, 449.165) The Bureau must impose at least one of the sanctions listed in NAC 449.99863 upon any facility that has a deficiency with a severity level of four or a combined severity and scope score of six o…

NAC 449.99853 Imposition of one or more sanctions; criteria for imposition of particular sanction. (NRS 449.0302, 449.165) The Bureau may apply one or more sanctions as provided in NAC 449.99863 and 449.99935. If the Bureau chooses to impose a particular sanction, it must be appl…

NAC 449.99854 Imposition in lieu of or in addition to recommendation to terminate provider agreement; duration of sanctions. (NRS 449.0302, 449.165) 1. The Bureau may apply one or more of the sanctions specified in NAC 449.99863 in lieu of or in addition to a recommendation to th…

NAC 449.99855 Imposition in emergencies: Authority; notice. (NRS 449.0302, 449.165) 1. If necessary to protect the public health and safety, the Bureau may impose such sanctions as are necessary without notice to the facility or by oral notice to the facility. 2. If there is an i…

NAC 449.99856 Deficiencies: Basis for imposition of sanctions; reporting; presumption of de minimis deficiency; confidentiality. (NRS 439.200, 449.0302, 449.165) 1. Except as otherwise provided in NAC 449.0108, the Bureau may apply one or more sanctions on the basis of deficienci…

NAC 449.99857 Classifications of severity and scope of deficiencies: Use. (NRS 449.0302, 449.165) In determining the sanctions to be imposed, the Bureau shall consider the severity and scope of the deficiencies according to the classifications of severity and scope described in N…

NAC 449.99858 Scope of violations: Evaluation of representative sample of recipients; size of sample. (NRS 449.0302, 449.165) 1. In determining the scope of a violation, a survey of a facility must evaluate a representative sample of recipients as described in the protocol for th…

NAC 449.99859 Scope of deficiencies: Use of scope scale; basis for assessment. (NRS 449.0302, 449.165) 1. The scope scale must be used to assess the scope of a particular deficiency in or by the facility. 2. The basis for the assessment is the actual or potential harm to recipien…

NAC 449.9986 Scope of deficiencies: Criteria for evaluation. (NRS 449.0302, 449.165) 1. The scope of the deficiencies must be evaluated using the criteria prescribed in this section. 2. A deficiency of scope level one consists of one or an isolated number of unrelated incidents i…

NAC 449.99861 Severity of deficiencies: Use of severity scale; basis for assessment; criteria for evaluation. (NRS 449.0302, 449.165) 1. The severity scale must be used to assess the severity of a particular deficiency pertaining to the facility. The basis for the assessment must…

NAC 449.99862 Presumption when same deficiency found on resurvey; imposition of sanction for subsequent deficiency. (NRS 449.0302, 449.165) If the same deficiency is found on a resurvey, there is a rebuttable presumption that the deficiency continued through the period between th…

NAC 449.99863 Available sanctions. (NRS 449.0302, 449.165) The sanctions available for all facilities include: 1. The imposition of a plan of correction as directed by the Bureau; 2. The issuance of a provisional license as provided by NRS 449.091; 3. The imposition of a limitati…

NAC 449.99864 Determination of appropriate sanction: Procedure. (NRS 449.0302, 449.165) To determine the appropriate sanction, the Bureau shall follow the procedure set forth in NAC 449.99864 to 449.99867, inclusive. (Added to NAC by Bd. of Health, eff. 8-1-91)

NAC 449.99865 Determination of appropriate sanction: Initial assessment. (NRS 449.0302, 449.165) The Bureau shall initially assess individual deficiencies or clusters of deficiencies according to the following initial factors: 1. The presence or absence of an immediate and seriou…

NAC 449.99866 Determination of appropriate sanction: Consideration of secondary factors. (NRS 449.0302, 449.165) After the initial assessment, the Bureau shall consider the following secondary factors in determining the sanction to impose: 1. The relationship of one deficiency or…

NAC 449.99867 Determination of appropriate sanction: Basis for selection; presumption. (NRS 449.0302, 449.165) The selection of a sanction must be based upon the nature of the deficiencies or cluster of deficiencies and the sanction most likely to correct those deficiencies. Abse…

NAC 449.99868 Notification of immediate and serious threat to health and safety; submission and contents of plan. (NRS 439.200, 449.0302) 1. If the Bureau determines that there is an immediate and serious threat to the health and safety of recipients served by a facility, the Bur…

NAC 449.9987 Development and submission of plan; authority of Bureau when plan is not acceptable; effect of failure to submit plan; confidentiality. (NRS 439.200, 449.0302, 449.165) 1. The facility shall develop a plan of correction for each deficiency and submit the plan to the …

NAC 449.99875 Purpose and scope of limitation; imposition in addition to partial ban on admissions. (NRS 449.0302, 449.165) 1. A limitation on the occupancy of a residential unit must be imposed by the Bureau to safeguard the health, safety and well-being of residents currently r…

NAC 449.99876 Criteria for imposition. (NRS 449.0302, 449.165) 1. If the Bureau imposes a limitation on the occupancy of a residential facility, the limitation must be imposed as provided in this section. 2. For deficiencies with a combined severity and scope score of six or more…

NAC 449.99877 Duration and termination of limitation. (NRS 449.0302, 449.165) A limitation on occupancy: 1. Must be imposed for not less than 72 hours. 2. Must be terminated if the facility demonstrates that substantial improvements have been made to correct the deficiencies and …

NAC 449.99878 Notice of limitation: General requirements; effect of noncompliance. (NRS 449.0302, 449.165) 1. If a limitation on occupancy is imposed, a notice of the limitation must be posted at all public entrances to the facility within 48 hours after the facility receives not…

NAC 449.9988 Purpose and scope of ban. (NRS 449.0302, 449.165) 1. A ban on admissions may be imposed by the Bureau on a residential or nonresidential facility to safeguard the health, safety and well-being of recipients receiving care, treatment or services and to prevent the adm…

NAC 449.99881 Criteria for imposition. (NRS 449.0302, 449.165) 1. If the Bureau imposes a ban on admissions, the ban must be imposed as provided in this section. 2. For deficiencies of severity level four and scope level two or more, a ban on all new admissions must be imposed. 3…

NAC 449.99882 Duration and termination of ban. (NRS 449.0302, 449.165) A ban on admissions: 1. Must be imposed for not less than 72 hours. 2. Must be terminated if the facility demonstrates that substantial improvements have been made to correct the deficiencies and that the heal…

NAC 449.99883 Notice of ban: General requirements; effect of noncompliance. (NRS 449.0302, 449.165) 1. If a ban on admissions is imposed, a notice of the ban must be posted at all public entrances to the facility within 48 hours after the facility receives notice of the ban. Each…

NAC 449.99885 Authority of Bureau. (NRS 449.0302, 449.165) 1. The Bureau may monitor the implementation of the plan of correction of the facility to determine whether the facility carries out the plan of correction. 2. The Bureau may also monitor the facility if the scope of the …

NAC 449.99895 Imposition by Bureau; purpose; applicable criteria. (NRS 449.0302, 449.165) The Bureau may impose a monetary penalty alone or in addition to other penalties. The purpose of a monetary penalty is to provide a fund for protecting the health, safety, rights, welfare an…

NAC 449.99896 Criteria for imposition; imposition of initial and daily penalties. (NRS 449.0302, 449.165) 1. Except as otherwise provided in subsection 4 of this section, the Bureau may impose a monetary penalty including interest thereon on any facility that is not in compliance…

NAC 449.99897 Imposition of initial penalty pending hearing or appeal; stay of payment of penalties pending appeal. (NRS 449.0302, 449.165) 1. The Bureau shall impose an initial monetary penalty pending a hearing or appeal. The payment of the initial penalty must not be stayed du…

NAC 449.99898 Procedure for imposition; interest on total penalty assessed. (NRS 439.200, 449.0302, 449.165) If the Bureau imposes a monetary penalty, the penalty must be imposed as provided in NAC 449.99899 to 449.99908, inclusive. In imposing the monetary penalty, the total pen…

NAC 449.99899 Determination of amount of penalties. (NRS 439.200, 449.0302, 449.165) 1. In determining the amount of an initial monetary penalty, the Bureau shall consider the severity alone if the severity level is four. In determining the amount of the monetary penalty where th…

NAC 449.998995 Use of initial monetary penalty to correct deficiency. (NRS 439.200, 449.165) 1. A facility may submit to the Bureau a request to use all or a portion of an initial monetary penalty imposed upon the facility pursuant to NAC 449.99899 to correct the deficiency for w…

NAC 449.999 Limitation on principal amount of total daily penalty. (NRS 439.200, 449.0302, 449.165) In no event may the principal amount of the total daily monetary penalty assessed against any facility exceed $5,000 per deficiency per day. (Added to NAC by Bd. of Health, eff. 8-…

NAC 449.99901 Daily penalty: Computation according to number of recipients. (NRS 449.0302, 449.165) If a monetary penalty is assessed on a daily basis according to the number of recipients and the number of recipients fluctuates, the penalty must be computed on the basis of the a…

NAC 449.99902 Increase in penalty for repeated deficiencies or false compliance. (NRS 449.0302, 449.165) 1. Penalties must be increased if deficiencies are repeated or compliance is falsely alleged. 2. For each repeat deficiency present within 18 months after an initial deficienc…

NAC 449.99903 Presumption regarding deficiencies identified on resurvey. (NRS 449.0302, 449.165) There is a rebuttable presumption that deficiencies identified on a resurvey were present on each day between the date of the initial deficiency and the date of the resurveyed deficie…

NAC 449.99904 Reduction of penalty. (NRS 449.0302, 449.165) If a facility against which a monetary penalty is imposed: 1. Waives the right to a hearing; 2. Corrects the deficiencies that were the basis for the sanction; and 3. Pays the monetary penalty within 15 days after receip…

NAC 449.99905 Daily penalty: Effective beginning date. (NRS 449.0302, 449.165) The effective beginning date of a daily monetary penalty is: 1. In the case of an immediate and serious threat, the date the deficiency occurred; or 2. In any other case, the day the deficiency is iden…

NAC 449.99906 Daily penalty: Date and period of computation; notice to facility. (NRS 449.0302, 449.165) 1. Daily penalties and interest must be computed after compliance has been verified or the provider has been sent notice of termination of a license or provisional license. A …

NAC 449.99907 Termination of daily penalties; failure of Medicaid facility to remove immediate and serious threat after appointment of temporary management. (NRS 449.0302, 449.165) 1. The daily accrual of a monetary penalty must end if the facility demonstrates that substantial i…

NAC 449.99908 Time for payment of penalties. (NRS 449.0302, 449.165) 1. Initial monetary penalty assessment payments are due within 15 days after the notice of the penalty and must be paid irrespective of any administrative appeal. 2. The daily monetary penalty is due and must be…

NAC 449.99909 Assessment of interest on unpaid balance of penalty. (NRS 449.0302, 449.165) Unless it is waived as provided in NAC 449.002 to 449.99939, inclusive, interest at the rate prescribed in NRS 449.163 will be assessed on the unpaid balance of the penalty, beginning on th…

NAC 449.9991 Recovery of costs for collection of penalty. (NRS 449.0302, 449.165) Any costs, including attorney’s fees, incurred by the Bureau or the Division in the collection of any monetary penalty may be recovered from the facility. (Added to NAC by Bd. of Health, eff. 8-1-91…

NAC 449.99911 Failure to pay penalty: Suspension of license of facility. (NRS 439.200, 449.0302, 449.165) 1. If the facility fails to pay a monetary penalty and the Bureau has not approved the use of the penalty for corrections pursuant to NAC 449.998995, the Division may suspend…