Nevada Administrative Code

NAC 439B.500 Determination by Director of whether prohibited transaction between hospital and related entity has occurred. 1. The Department shall forward to the Director any information which would support a determination that a violation of NRS 439B.430 has occurred. 2. Upon re…

NAC 439B.510 Reasonable cause to believe that prohibited transaction between hospital and related entity has occurred. Reasonable cause to believe that a violation of subsection 2 of NRS 439B.430 has occurred includes, but is not limited to: 1. The failure of a hospital or relate…

NAC 439B.520 Hearing required before imposition of penalty. 1. Before imposing any financial penalty or other penalty pursuant to this chapter, the Director shall hold a hearing concerning the penalty. 2. The proceedings conducted pursuant to this section must be conducted pursua…

NAC 439B.5205 Definitions. As used in NAC 439B.5205 to 439B.5408, inclusive, and for the purpose of enforcing the provisions of NRS 439B.425, unless the context otherwise requires, the words and terms defined in NAC 439B.5207 to 439B.540, inclusive, have the meanings ascribed to …

NAC 439B.5207 “Commercial establishment” defined. “Commercial establishment” means any business entity that provides goods or services other than a medical laboratory or a health facility. (Added to NAC by Dep’t of Human Resources, eff. 3-9-94)

NAC 439B.530 “Financial interest” defined. 1. Except as otherwise provided in paragraph (f) of subsection 2 of NRS 439B.425, “financial interest” means an ownership or other interest: (a) That provides compensation based, in whole or in part, upon the volume or value of goods or …

NAC 439B.5302 “Group practice” defined. “Group practice” has the meaning ascribed to it in paragraph (a) of subsection 4 of NRS 439B.425. (Added to NAC by Dep’t of Human Resources, eff. 3-9-94)

NAC 439B.5304 “Medical laboratory” defined. “Medical laboratory” has the meaning ascribed to it in NRS 652.060. (Added to NAC by Dep’t of Human Resources, eff. 3-9-94)

NAC 439B.5306 “One parcel of land” defined. “One parcel of land” means one conveyable lot or parcel of land or multiple conveyable lots or parcels of land which are contiguous. (Added to NAC by Dep’t of Human Resources, eff. 3-9-94)

NAC 439B.5308 “Patient” defined. “Patient” has the meaning ascribed to it in paragraph (b) of subsection 4 of NRS 439B.425. (Added to NAC by Dep’t of Human Resources, eff. 3-9-94)

NAC 439B.540 “Refer” defined. “Refer” means sending or directing any person to another person or business entity for the purpose of obtaining, consuming or purchasing, for consideration, goods or services related to health care. (Added to NAC by Dep’t of Human Resources, eff. 3-9…

NAC 439B.5402 Prohibited referral of patients by agent, employee or independent contractor of practitioner. The provision of subsection 1 of NRS 439B.425 prohibiting a practitioner from referring a patient, for a service or for goods related to health care, to a health facility, …

NAC 439B.5404 Authorized referrals. The following referrals do not present a perception of a conflict of interest, are consistent with the overall purpose of chapter 439B of NRS and are not prohibited by the provisions of NRS 439B.425: 1. Any referral within one or more locations…

NAC 439B.5406 Authorized referrals to facilities in which practitioner has financial interest. 1. The provisions of NRS 439B.425 do not prohibit a practitioner from referring a patient, for a service or for goods related to health care, to a health facility, medical laboratory or…

NAC 439B.5408 Investigation of possible prohibited referral by practitioner; determination by Director after investigation. 1. If the Department becomes aware of a possible violation of subsection 1 of NRS 439B.425, it may investigate the violation or forward the information to t…

NAC 439B.550 Development and implementation of program. An educational program developed pursuant to NRS 439B.280 must be designed to address problems or objectives related to health that are identified in National Health Promotion and Disease Prevention Objectives for the Year 2…

NAC 439B.555 Description of program: Submission to Director; contents. At least 30 days before initiating an educational program pursuant to NRS 439B.280, the major hospitals shall submit to the Director a description of the program, including: 1. The name of the person responsib…

NAC 439B.560 Description of program: Accompanying statement. The description of an educational program submitted pursuant to NAC 439B.555 must be accompanied by a statement from the major hospitals that: 1. If participation in or benefit from any part of the program is contingent…

NAC 439B.565 Notification by Director of decision regarding program; opportunity to make corrections. The Director will notify the person designated as liaison for a proposed educational program of his or her decision within 15 days after his or her receipt of the description of …

NAC 439B.600 Applicability. Any person or entity that is or may be subject to a provision of chapter 439B of NRS, or any regulation or prior decision of the Director of the Department or the Director of the Authority adopted pursuant thereto, may file with the Director of the Dep…

NAC 439B.610 Contents of petition. A petition for a declaratory order or advisory opinion filed pursuant to NAC 439B.600 must include: 1. A statement of each issue upon which the petitioner is seeking a declaratory order or advisory opinion, including references to the provision …

NAC 439B.620 Powers of Director: Designation of person to issue declaratory order or advisory opinion; consolidation of petitions for advisory opinions. 1. The Director of the Department or Director of the Authority may designate a person within the Department or Authority, as ap…

NAC 439B.630 Issuance of declaratory order or advisory opinion: Time for issuance; tolling of time for issuance; consolidated petitions. 1. Except as otherwise provided in subsections 2 and 3, the Director of the Department or Director of the Authority, or his or her designee, wi…

NAC 439B.640 Copy of declaratory order or advisory opinion to be mailed to petitioner and made available to public. Upon the issuance of a declaratory order or advisory opinion pursuant to NAC 439B.600 to 439B.640, inclusive, the Director of the Department or Director of the Auth…

NAC 439B.650 Authority to make available on Internet website forms for manufacturer, wholesaler, pharmacy benefit manager and pharmaceutical sales representative to submit required reports. (NRS 439B.685) The Authority will make available on an Internet website maintained by the …

NAC 439B.655 Request by manufacturer, wholesaler or pharmacy benefit manager to keep certain information confidential as a trade secret; procedures for Authority to follow upon receipt of public records request for disclosure. (NRS 439B.685) 1. In complying with NRS 439B.635, 439…

NAC 439B.660 Requirements for data and information included in report compiled by Authority concerning price of certain drugs. (NRS 439B.685) In the report compiled by the Authority pursuant to NRS 439B.650, the Authority will include: 1. Only aggregated data that does not disclo…

NAC 439B.665 Appointment of hearing officers. (NRS 439B.685, 439B.695) 1. The Director of the Authority shall appoint three permanent employees of the Authority to serve as hearing officers. 2. An employee appointed as a hearing officer pursuant to this section shall perform the …

NAC 439B.670 Notice of intent to impose administrative penalty; accrual of administrative penalty. (NRS 439B.685, 439B.695) 1. If the Authority intends to impose an administrative penalty pursuant to NRS 439B.695, the Authority will notify in writing the pharmacy, manufacturer, w…

NAC 439B.675 Appeals. (NRS 439B.685, 439B.695) 1. To appeal an administrative penalty imposed pursuant to NRS 439B.695, a pharmacy, manufacturer, wholesaler, pharmacy benefit manager, nonprofit organization or pharmaceutical sales representative, as applicable, must submit a requ…

NAC 439B.680 Hearing on appeal. (NRS 439B.685, 439B.695) 1. Except as otherwise provided in this subsection, a hearing on an appeal requested pursuant to NAC 439B.675 must be open to the public. Upon the motion of a party, the hearing officer, in his or her discretion, may exclud…

NAC 439B.685 Failure to appear; recess; continuance. (NRS 439B.685, 439B.695) 1. If a party fails to appear at a hearing scheduled by the hearing officer after receiving a request pursuant to NAC 439B.675 and no continuance has been granted: (a) The hearing officer may hear the e…

NAC 439B.690 Order or decision; judicial review. (NRS 439B.685, 439B.695) 1. The hearing officer shall render an order or decision with separately stated findings of fact and conclusions of law after the completion of a hearing on an appeal pursuant to NAC 439B.680. A hearing is …

NAC 439B.700 Request for list of randomly selected arbitrators to arbitrate dispute over claim of less than $5000; effect of failure to submit request; review and approval. (NRS 439B.754) 1. To request a list of randomly selected arbitrators pursuant to subsection 3 of NRS 439B.7…

NAC 439B.705 Selection of arbitrator; provision of information to arbitrator; determination. (NRS 439B.754) 1. Not later than 10 business days after the Department provides a written list of arbitrators to an out-of-network provider and a third party pursuant to subsection 5 of N…

NAC 439B.710 Request for list of randomly selected arbitrators to arbitrate dispute over claim of $5000 or more. (NRS 439B.754) An out-of-network provider that wishes to request a list of randomly selected arbitrators pursuant to subsection 3 of NRS 439B.754 to arbitrate a disput…

NAC 439B.715 Election to submit to provisions concerning payment for medically necessary emergency services provided out-of-network; withdrawal of election. (NRS 439B.757) 1. To elect to have the provisions of NRS 439B.700 to 439B.760, inclusive, apply to an entity or organizatio…

NAC 439B.720 Submission of information by providers of health care and third parties. (NRS 439B.760) 1. On or before December 31 of each year, each provider of health care who provides medically necessary emergency services in this State shall submit to the Department in the form…

NAC 439B.800 Definitions. (NRS 439B.835, 439B.875) As used in NAC 439B.800 to 439B.844, inclusive, unless the context otherwise requires, the words and terms defined in NAC 439B.802 to 439B.814, inclusive, have the meanings ascribed to them in those sections. (Added to NAC by Dep…

NAC 439B.802 “Administrator” defined. (NRS 439B.875) “Administrator” means the Office or the entity that is selected by the Office to manage the historical data in the all-payer claims database. (Added to NAC by Dep’t of Health & Human Services by R104-23, eff. 11-15-2024)

NAC 439B.804 “Advisory Committee” defined. (NRS 439B.835, 439B.875) “Advisory Committee” means the All-Payer Claims Database Advisory Committee created by NAC 439B.818. (Added to NAC by Dep’t of Health & Human Services by R104-23, eff. 11-15-2024)

NAC 439B.806 “Claim” defined. (NRS 439B.835, 439B.875) “Claim” means any communication that is used to identify specific goods, items or services that are reimbursable by a third party, or which states income or an expense, and is or may be used by a third party to determine a ra…

NAC 439B.808 “Covered person” defined. (NRS 439B.875) “Covered person” means a policyholder, subscriber, enrollee or other person covered by a third party. (Added to NAC by Dep’t of Health & Human Services by R104-23, eff. 11-15-2024)

NAC 439B.810 “Data submitter” defined. (NRS 439B.835, 439B.875) 1. “Data submitter” means: (a) An entity that is required by subsection 1 of NRS 439B.840 or subsection 1 of NAC 439B.830 to submit historical data to the all-payer claims database. (b) An entity described in subsect…

NAC 439B.812 “Historical data” defined. (NRS 439B.835, 439B.875) “Historical data” means the data described in subsection 2 of NAC 439B.830. (Added to NAC by Dep’t of Health & Human Services by R104-23, eff. 11-15-2024)

NAC 439B.814 “Third party” defined. (NRS 439B.875) “Third party” means: 1. A health carrier, as defined in NRS 439B.840; 2. A governing body of a local governmental agency that provides health insurance through a self-insurance reserve fund pursuant to NRS 287.010; 3. Medicaid; 4…

NAC 439B.816 “Cost of health care” interpreted. (NRS 439B.835, 439B.860, 439B.875) For the purposes of NRS 439B.860 and NAC 439B.820, the Office will interpret “cost of health care” to mean the final payment made to a provider of health care by: 1. An entity that is required by s…