Draft Regs – Revise 2
AB 146 requires the Department, by regulation to:
(a) Prescribe the information that each hospital in this State must submit to the Department for
the program established pursuant to section 3 of this act.
(b) Prescribe the measures of quality for hospitals that are required pursuant to paragraph (b) of
subsection 2 of section 3 of this act. In adopting the regulations, the Department shall:
(1) Use the measures of quality endorsed by the Agency for Healthcare Research and
Quality, the National Quality Forum, Centers for Medicare and Medicaid Services of the
United States Department of Health and Human Services, a quality improvement
organization of the Centers for Medicare and Medicaid Services and the Joint
Commission on Accreditation of Healthcare Organizations;
(2) Prescribe a reasonable number of measures of quality which must not be unduly
burdensome on the hospitals; and
(3) Take into consideration the financial burden placed on the hospitals to comply with
the regulations. _ The measures prescribed pursuant to this paragraph must report health
outcomes of hospitals, which do not necessarily correlate with the inpatient diagnosis-
related groups or the outpatient treatments that are posted on the Internet website
pursuant to section 6 of this act.
(c) Require each hospital to:
(1) Provide the information prescribed in paragraphs (a) and (b) in the format required by
the Department; and
(2) Report the information separately for inpatients and outpatients.
Additionally, the information required pursuant to this section and section 3 of the act must be submitted
to the Department not later than 45 days after the last day of each calendar month. . If a hospital fails to
submit the information required or submits information that is incomplete or inaccurate, the Department
shall send a notice of such failure to the hospital and to the Health Division of the Department.
Proposed Regulations to cover sub-sections (a) and (c) are as follows:
NAC 449.XXX Information concerning discharged patients: Submission; limitation on disclosure
1. Each hospital shall prepare and submit in an electronic format to the Department, for each
patient discharged by the hospital during each month, a copy of the UB-04 form specified by the Centers
for Medicare and Medicaid Services. The hospital shall submit the required forms for each month within
45 days after the last day of the month, and include information for all required fields as determined by
the department provided on the form.
2. The Department and any person with whom the Department may contract for the
development and operation of its UB-04 data system shall not disclose any information from the data
system which may be used to identify any patient of a hospital.
3. As used in this section, “hospital” has the meaning ascribed to it in NRS 449.012.
NAC 449.XXX Information concerning discharged patients: Submission; limitation on disclosure.
1. Each surgical center for ambulatory patients shall prepare and submit in an electronic format
to the Department, for each patient discharged by the center during each month, a copy of the CMS-
1500 or UB-04 form specified by the Centers for Medicare and Medicaid Services. The center shall
submit the required forms for each month within 45 days after the last day of the month, and include
information for all required fields as determined by the department provided on the form.
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2. The Department and any person with whom the Department may contract for the
development and operation of its CMS-1500 or UB-04 data system shall not disclose any information
from the data system which may be used to identify any patient of a hospital.
3. As used in this section, “surgical center for ambulatory patients” has the meaning ascribed to
it in NRS 449.019.
NAC 449.966 Notice of insufficiency of submitted information.
1. If the Department determines that the information submitted by an institution is insufficient, it
will notify the institution and the Health Division of the Department, by mail, of the insufficiency.
2. The institution shall submit the required information to the Department within 30 days after
receipt of the notice of insufficiency.
Possible language for penalties
Most of AB-146 will most likely be placed into chapter 439 and fall under the penalties as outlined
below. (A caveat with this language is the definition of “person” in subsection 1, does it cover
government owned hospitals).
NRS 439A.120 Civil penalties.
1. Except as otherwise provided in subsection 2, any person who violates any of the provisions of
this chapter is liable to the State for a civil penalty of:
(a) Where the provision violated governs the licensing of a project which is required to be approved
pursuant to NRS 439A.100, not more than 10 percent of the proposed expenditure for the project.
(b) Where any other provision is violated, not more than $20,000 for each violation.
2. The Department shall not impose a penalty under this section if it applies for injunctive relief to
prevent the same violation.
(Added to NRS by 1983, 1523; A 1991, 1077; 1995, 1488)
Section 11 of AB-146 will most likely be placed into chapter 449 and because section 11 references
section 3 of AB-146 the language below is a possible option.
NAC 449.969 Administrative fine for failing to meet deadlines. (NRS 449.460, 449.490) Unless
an extension is granted, an institution which fails to submit a report or information required pursuant to
NAC 449.957 to 449.963, inclusive, by the deadline for submission is subject to an administrative fine
not exceeding $500 for each day the report or information is delinquent.
(Added to NAC by Dep’t of Human Resources, eff. 4-29-86; A 10-20-93)
Included in Joseph’s Data Submission Letter
NAC 449.966: Notice of insufficiency of submitted information.
1. If the Department determines that the information submitted by an institution is insufficient, it will
notify the institution and the Health Division of the Department, by mail, of the insufficiency.
2. The institution shall submit the required information to the Department within 30 days after receipt of
the notice of insufficiency.
NAC 449.969: Administrative fine for failing to meet deadlines. (NRS 449.460, 449.490) Unless an
extension is granted, an institution which fails to submit a report or information required pursuant to
NAC 449.957 to 449.963, inclusive, by the deadline for submission is subject to an administrative fine
not exceeding $500 for each day the report or information is delinquent.
(Added to NAC by Dep’t of Human Resources, eff. 4-29-86; A 10-20-93)
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We will need to specify exactly what fields are included, here is an example:
NAC 449.963 Information concerning discharged patients: Submission; limitation on disclosure.
(NRS 449.460, 449.485)
1. Each hospital shall prepare and submit to the Department, for each patient discharged by the
hospital during each month, a copy of the UB-82 form specified by the Centers for Medicare and
Medicaid Services. The hospital shall submit the required forms for each month within 45 days after the
last day of the month, and include the following information on each form:
(a) UB-82 field number 3, the Patient Control Number (Patient ID);
(b) UB-82 field number 4, Type of Bill;
(c) UB-82 field number 8, Medical Number (Hospital ID);
(d) UB-82 field number 11, Patient Address (ZIP code only will be used by the Department in its data
system);
(e) UB-82 field number 12, Birth Date;
(f) UB-82 field number 13, Sex;
(g) UB-82 field number 14, Marital Status;
(h) UB-82 field number 15, Admission Date;
(i) UB-82 field number 17, Admission Type;
(j) UB-82 field number 18, Admission Source;
(k) UB-82 field number 21, STAT (Discharge Status);
(l) UB-82 field number 22, Discharge Date;
(m) UB-82 field number 27, Admitting Diagnosis (Principal Diagnosis Code-ICD-9-CM);
(n) UB-82 field numbers 51a through 51w, inclusive, Revenue Codes;
(o) UB-82 field numbers 52a through 52w, inclusive, Service Units;
(p) UB-82 field numbers 53a through 53w, inclusive, Total Charges;
(q) UB-82 field numbers 57A through 57C, inclusive, Payer (including the 5-digit Payer
Classification Code Number);
(r) UB-82 field number 68, patient social security number (only last six digits will be used in the
Department’s data system);
(s) UB-82 field number 77, Principal Code (Principal Diagnosis Code-ICD-9-CM);
(t) UB-82 field numbers 78 through 81, inclusive, Other Diagnosis Codes (ICD-9-CM);
(u) UB-82 field number 84a, Principal Procedure CD (Procedure Code-ICD-9-CM);
(v) UB-82 field numbers 85A through 86A, inclusive, Other Procedure Codes (ICD-9-CM);
(w) UB-82 field number 92, Attending Physician ID; and
(x) UB-82 field number 93, Other Physician ID…
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