REQUIRES TWO-THIRDS MAJORITY VOTE
(§§ 9, 21, 26 & NRS 453.221, 453.226, 639.170)
A.B. 170
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ASSEMBLY BILL NO. 170–ASSEMBLYMEMBER NADEEM
PREFILED JANUARY 31, 2025
____________
Referred to Committee on Commerce and Labor
SUMMARY—Providing for the licensure of associate physicians
and associate osteopathic physicians. (BDR 54-840)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Yes.
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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to health care; providing for the licensure of
associate physicians and associate osteopathic physicians;
prescribing the conditions under which an associate
physician or associate osteopathic physician is authorized
to practice medicine or osteopathic medicine; authorizing
an associate physician or associate osteopathic physician
to register to possess, administer, prescribe or dispense
controlled substances; and providing other matters
properly relating thereto.
Legislative Counsel’s Digest:
Existing law provides for the licensing of physicians and physician assistants 1
by the Board of Medical Examiners and for the licensing of osteopathic physicians 2
and physician assistants by the State Board of Osteopathic Medicine. (NRS 3
630.160-630.1607, 630.258-630.2665, 630.271-630.2755, 633.305-633.420, 4
633.432-633.4336) Sections 2-9 and 14-21 of this bill create limited licenses that 5
authorize certain medical school graduates to engage in the supervised practice of 6
medicine as an associate physician or associate osteopathic physician. Sections 2 7
and 14 authorize the Board of Medical Examiners and State Board of Osteopathic 8
Medicine, respectively, to issue a limited license as an associate physician or 9
associate osteopathic physician to an applicant who: (1) has graduated from certain 10
medical schools; (2) has completed at least 1 year of postgraduate medical 11
education as a resident or intern as a part of certain programs; and (3) possesses 12
certain other qualifications. Sections 3 and 15 limit an associate physician or 13
associate osteopathic physician to practicing medicine under the supervision and 14
control of a supervising physician or supervising osteopathic physician. Sections 5 15
and 17 prescribe the required qualifications of a supervising physician or 16
supervising osteopathic physician. Sections 3 and 15 require an associate physician 17
or associate osteopathic physician to enter into a collaborative practice agreement 18
with his or her supervising physician or supervising osteopathic physician. 19
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Sections 6 and 18 prescribe the provisions that are required to be included in the 20
collaborative practice agreement. 21
Sections 3 and 15 require a supervising physician or supervising osteopathic 22
physician to be on the same premises and available to assist an associate physician 23
or associate osteopathic physician for the first 30 days of supervision. Sections 3 24
and 15 require a supervising physician or supervising osteopathic physician, or 25
designee thereof, to be on the same premises and available to assist at all times an 26
associate physician or associate osteopathic physician, as applicable, who is 27
practicing in a county whose population is less than 100,000 (currently all counties 28
other than Clark and Washoe Counties). Sections 3 and 15 also require the 29
employer of an associate physician or associate osteopathic physician to credential 30
and bill for services rendered by an associate physician or associate osteopathic 31
physician in the same manner as a physician assistant. Sections 4 and 16 require a 32
supervising physician and associate physician or supervising osteopathic physician 33
and associate osteopathic physician to take certain measures to notify the public of 34
their respective statuses and their relationship. Sections 5 and 17: (1) provide that a 35
supervising physician or supervising osteopathic physician is responsible for the 36
practice of medicine or osteopathic medicine by the associate physician or associate 37
osteopathic physician, as applicable, that he or she is supervising; and (2) require a 38
supervising physician or supervising osteopathic physician to maintain insurance 39
that covers malpractice by an associate physician or associate osteopathic 40
physician, as applicable. Sections 5 and 17 prohibit a supervising physician or 41
supervising osteopathic physician from entering into a collaborative practice 42
agreement with more than three associate physicians or associate osteopathic 43
physicians, as applicable. Sections 5 and 17 additionally prohibit the Board of 44
Medical Examiners and the State Board of Osteopathic Medicine, respectively, 45
from disciplining a supervising physician or supervising osteopathic physician for 46
legal activity of an associate physician or associate osteopathic physician that is 47
within the scope of the relevant collaborative practice agreement. 48
Sections 7 and 19 authorize an associate physician or associate osteopathic 49
physician, respectively, to prescribe or dispense certain controlled substances and 50
establish the conditions under which an associate physician or associate osteopathic 51
physician may prescribe or dispense such controlled substances. Existing law: (1) 52
authorizes the State Board of Pharmacy to issue a registration certificate to 53
authorize a physician assistant to possess, administer, prescribe or dispense 54
controlled substances, poisons, dangerous drugs or devices in or out of the presence 55
of his or her supervising physician; and (2) requires the Board to adopt regulations 56
governing the storage, security, recordkeeping and transportation of controlled 57
substances, poisons, dangerous drugs or devices by a physician assistant. (NRS 58
639.1373) Section 26 of this bill authorizes the State Board of Pharmacy to 59
additionally issue such a registration certificate to associate physicians and 60
associate osteopathic physicians and to regulate associate physicians and associate 61
osteopathic physicians who hold such a certificate in the same manner as physician 62
assistants. 63
Sections 8 and 20 provide for the expiration and renewal of the limited licenses 64
issued to associate physicians and associate osteopathic physicians, respectively. 65
Sections 11 and 25 of this bill require a physician or osteopathic physician to 66
biennially submit to the Board of Medical Examiners or the State Board of 67
Osteopathic Medicine, as applicable, a list of the names of each associate physician 68
or associate osteopathic physician who is supervised by the physician or 69
osteopathic physician. Sections 9 and 21 of this bill require those Boards to adopt 70
regulations to implement sections 2-9 and 19-21. 71
Sections 10, 22 and 27 of this bill make conforming changes to clarify the 72
meaning of the terms “supervising physician,” “associate physician,” “supervising 73
osteopathic physician” and “associate osteopathic physician.” Sections 11 and 23 74
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of this bill make conforming changes to clarify that an applicant for a license as an 75
associate physician or an associate osteopathic physician does not hold the same 76
qualifications for licensure as an applicant for a standard license as a physician or 77
an osteopathic physician. Section 24 of this bill makes a conforming change to 78
clarify the applicability of a provision relating to the supervising osteopathic 79
physician of a physician assistant. 80
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 630 of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 2 to 9, inclusive, of this 2
act. 3
Sec. 2. Except as otherwise provided in NRS 630.161, the 4
Board may issue a limited license for a person to practice 5
medicine as an associate physician if the applicant: 6
1. Has received the degree of doctor of medicine from a 7
medical school in the United States or Canada: 8
(a) Approved by the Liaison Committee on Medical Education 9
of the American Medical Association and Association of American 10
Medical Colleges; or 11
(b) Which provides a course of professional instruction 12
equivalent to that provided in medical schools in the United States 13
approved by the Liaison Committee on Medical Education; 14
2. Has passed the Step 1 Exam and Step 2 CK Exam of the 15
United States Medical Licensing Examination or an examination 16
deemed equivalent by the Board; 17
3. Has not completed a residency in a program described in 18
sub-subparagraph (I) of subparagraph (1) of paragraph (c) of 19
subsection 2 of NRS 630.160; 20
4. Has completed at least his or her first year of postgraduate 21
medical education as a resident or intern as part of a program 22
that: 23
(a) Has been approved by the Accreditation Council for 24
Graduate Medical Education; 25
(b) Conforms to the minimum standards for intern training 26
established by the American Osteopathic Association; or 27
(c) Is approved by the Board in accordance with the 28
regulations adopted pursuant to section 9 of this act; and 29
5. Has basic fluency in the English language. 30
Sec. 3. 1. An associate physician shall only practice 31
medicine under the supervision and control of a physician: 32
(a) Who meets the requirements of section 5 of this act; and 33
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(b) With whom the associate physician has entered into a 1
collaborative practice agreement that meets the requirements of 2
section 6 of this act. 3
2. An associate physician shall not practice medicine in a 4
manner that exceeds the skill, training and competence of the 5
associate physician or his or her supervising physician. 6
3. For the first 30 days during which an associate physician 7
practices medicine under the supervision of a new supervising 8
physician, the supervising physician must be physically present on 9
the same premises and available to assist the associate physician. 10
4. An associate physician shall not practice medicine in a 11
county whose population is less than 100,000 unless the 12
supervising physician or another physician designated by the 13
supervising physician is physically present on the same premises 14
and is available to assist the associate physician. 15
5. An associate physician working in a rural health clinic, as 16
defined in 42 U.S.C. § 1395x(aa)(2), shall be considered to be a 17
physician assistant for the purposes of the regulations of the 18
Centers for Medicare and Medicaid Services of the United States 19
Department of Health and Human Services. Such an associate 20
physician and his or her supervising physician are not required to 21
comply with the requirements of any regulations adopted pursuant 22
to section 9 of this act governing the supervision of an associate 23
physician that are more stringent than the requirements of federal 24
law and regulations. 25
6. A person or entity that employs an associate physician 26
shall credential the associate physician and bill for services 27
rendered by the associate physician in the same manner as the 28
person or entity credentials and bills for the services of a physician 29
assistant. 30
Sec. 4. 1. The supervising physician of an associate 31
physician shall prominently display a disclosure at every office 32
where the associate physician practices medicine explaining to 33
patients that the patient may be seen by an associate physician and 34
the patient may instead request to be seen by the supervising 35
physician. 36
2. An associate physician shall clearly identify himself or 37
herself as an associate physician, including, without limitation, by 38
wearing an identification badge that clearly identifies the person 39
as an associate physician. An associate physician may identify 40
himself or herself as a doctor. 41
3. While acting as the supervising physician of an associate 42
physician, a physician shall wear an identification badge that 43
clearly identifies the person as a supervising physician of an 44
associate physician. 45
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Sec. 5. 1. A physician shall not serve as the supervising 1
physician of an associate physician pursuant to subsection 1 of 2
section 3 of this act or the designee of a supervising physician 3
pursuant to subsection 4 of section 3 of this act unless the 4
physician: 5
(a) Holds an active unrestricted license to practice medicine in 6
this State; and 7
(b) Practices in the same specialty area as the associate 8
physician or a substantially similar specialty area as the associate 9
physician. 10
2. The supervising physician of an associate physician: 11
(a) Is responsible for any act that constitutes the practice of 12
medicine by the associate physician; 13
(b) Must have insurance that includes coverage for any claim 14
of malpractice against the associate physician; and 15
(c) May not enter into a collaborative practice agreement with 16
more than three associate physicians. 17
3. The Board may not deny, revoke or suspend the license of 18
or take any other disciplinary action against the supervising 19
physician of an associate physician for any act performed by the 20
associate physician that: 21
(a) Is performed in accordance with the collaborative practice 22
agreement entered into pursuant to section 3 of this act; and 23
(b) Does not violate applicable federal, state or local laws or 24
the regulations of the Board. 25
Sec. 6. 1. A collaborative practice agreement entered into 26
pursuant to section 3 of this act must be in writing and must 27
include, without limitation: 28
(a) The names, home and business addresses and telephone 29
numbers of the supervising physician and associate physician; 30
(b) A list of each location where the associate physician may 31
practice medicine, including, without limitation, the prescribing 32
and dispensing of controlled substances; 33
(c) Any specialty or board certification held by the supervising 34
physician; 35
(d) Any certification held by the associate physician; 36
(e) Requirements governing collaboration between the 37
supervising physician and the associate physician, including, 38
without limitation: 39
(1) The geographic proximity which must exist between the 40
supervising physician and the associate physician while the 41
associate physician is practicing medicine; and 42
(2) A plan for alternative supervision if the supervising 43
physician is absent, incapacitated or otherwise unavailable; 44
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(f) Any controlled substance the supervising physician 1
authorizes the associate physician to prescribe or dispense in 2
accordance with section 7 of this act; 3
(g) The procedure by which the supervising physician will 4
review the standard of care the associate physician is providing to 5
patients, which must comply with the regulations adopted 6
pursuant to section 9 of this act; 7
(h) The duration of the collaborative practice agreement; and 8
(i) A statement of any other collaborative practice agreements 9
into which: 10
(1) The supervising physician has entered with another 11
associate physician; and 12
(2) The associate physician has entered with another 13
supervising physician. 14
2. Upon entering into a new collaborative practice agreement 15
with an associate physician, a supervising physician shall file with 16
the Board: 17
(a) A copy of the agreement; and 18
(b) Proof that any controlled substance included in the 19
agreement pursuant to paragraph (f) of subsection 1 is within the 20
skill, training and competence of the associate physician and his 21
or her supervising physician to prescribe and dispense. 22
3. A supervising physician or associate physician may 23
terminate a collaborative practice agreement or a relationship with 24
a supervising physician or an associate physician, as applicable, at 25
any time. Any provision of a collaborative practice agreement or 26
any other agreement that limits the authority of a supervising 27
physician or an associate physician to terminate a collaborative 28
practice agreement or such a relationship is void. 29
Sec. 7. 1. An associate physician may prescribe or dispense 30
the controlled substances listed in subsection 2 under the 31
conditions prescribed by this section if the associate physician: 32
(a) Is registered with the State Board of Pharmacy pursuant to 33
NRS 639.1373; 34
(b) Has entered into a collaborative practice agreement 35
pursuant to section 3 of this act authorizing the associate 36
physician to prescribe the controlled substance; and 37
(c) Meets all other requirements prescribed by federal and 38
state law to prescribe controlled substances. 39
2. Subject to the limitations prescribed in NRS 639.1373, an 40
associate physician who meets the requirements of subsection 1 41
may prescribe or dispense: 42
(a) Any controlled substance listed in schedule III, IV or V; 43
and 44
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(b) Any controlled substance listed in schedule II that contains 1
hydrocodone. 2
3. Except as otherwise provided in this subsection, an 3
associate physician shall not prescribe or dispense more than a 5-4
day supply of a controlled substance listed in schedule II or III. 5
An associate physician may prescribe or dispense a 30-day supply 6
of buprenorphine for the treatment of a substance use disorder 7
under the direction of his or her supervising physician. 8
4. An associate physician shall not prescribe or dispense 9
controlled substances unless: 10
(a) The supervising physician of the associate physician is 11
physically present on the same premises; or 12
(b) The associate physician has, at any time, completed 120 13
hours practicing medicine over a period of not more than 4 14
months with his or her supervising physician physically present on 15
the same premises. 16
Sec. 8. 1. A limited license to practice medicine as an 17
associate physician issued pursuant to section 2 of this act expires 18
2 years after it is issued. 19
2. The Board may renew a limited license to practice 20
medicine as an associate physician upon application by the 21
associate physician. An application for renewal must include, 22
without limitation, proof that the associate physician has actually 23
engaged in the practice of medicine under a collaborative practice 24
agreement entered into pursuant to section 3 of this act during the 25
immediately preceding 2 years. 26
Sec. 9. 1. The Board shall adopt regulations necessary: 27
(a) To carry out the provisions of sections 2 to 9, inclusive, of 28
this act, including, without limitation: 29
(1) Any additional requirements for the issuance or 30
renewal of a limited license to practice medicine as an associate 31
physician. 32
(2) The standards for the approval of programs of 33
postgraduate medical education pursuant to paragraph (c) of 34
subsection 4 of section 2 of this act. 35
(3) The required fees for the issuance and renewal of such 36
a license. 37
(4) Standards of practice for associate physicians, 38
including, without limitation, limitations on the practice of 39
medicine by an associate physician in addition to those prescribed 40
by sections 2 to 9, inclusive, of this act. 41
(5) Any additional requirements governing collaborative 42
practice agreements entered into pursuant to section 3 of this act. 43
(6) Requirements concerning the supervision of an 44
associate physician by a supervising physician, including, without 45
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limitation, requirements governing the review by the supervising 1
physician of the standard of care the associate physician is 2
providing to patients. Such regulations must not be more stringent 3
than any similar requirements that apply to physician assistants. 4
(b) For an associate physician to be eligible to work in a clinic 5
that receives federal funding. 6
2. The regulations adopted pursuant to this section and NRS 7
630.253 must not require an associate physician to complete a 8
greater amount of continuing education than a physician licensed 9
pursuant to NRS 630.160. 10
3. The Board shall publish on the Internet website 11
maintained pursuant to NRS 630.144 the name of each associate 12
physician and the physician or physicians supervising the 13
associate physician. 14
Sec. 10. NRS 630.025 is hereby amended to read as follows: 15
630.025 “Supervising physician” means an active physician 16
licensed and in good standing in the State of Nevada who supervises 17
a physician assistant [.] or an associate physician. 18
Sec. 11. NRS 630.160 is hereby amended to read as follows: 19
630.160 1. Every person desiring to practice medicine must, 20
before beginning to practice, procure from the Board a license 21
authorizing the person to practice. 22
2. Except as otherwise provided in NRS 630.1605 to 630.161, 23
inclusive, and 630.258 to 630.2665, inclusive, and sections 2 to 9, 24
inclusive, of this act, a license may be issued to any person who: 25
(a) Has received the degree of doctor of medicine from a 26
medical school: 27
(1) Approved by the Liaison Committee on Medical 28
Education of the American Medical Association and Association of 29
American Medical Colleges; or 30
(2) Which provides a course of professional instruction 31
equivalent to that provided in medical schools in the United States 32
approved by the Liaison Committee on Medical Education; 33
(b) Is currently certified by a specialty board of the American 34
Board of Medical Specialties and who agrees to maintain the 35
certification for the duration of the licensure, or has passed: 36
(1) All parts of the examination given by the National Board 37
of Medical Examiners; 38
(2) All parts of the Federation Licensing Examination; 39
(3) All parts of the United States Medical Licensing 40
Examination; 41
(4) All parts of a licensing examination given by any state or 42
territory of the United States, if the applicant is certified by a 43
specialty board of the American Board of Medical Specialties; 44
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(5) All parts of the examination to become a licentiate of the 1
Medical Council of Canada; or 2
(6) Any combination of the examinations specified in 3
subparagraphs (1), (2) and (3) that the Board determines to be 4
sufficient; 5
(c) Is currently certified by a specialty board of the American 6
Board of Medical Specialties in the specialty of emergency 7
medicine, preventive medicine or family medicine and who agrees 8
to maintain certification in at least one of these specialties for the 9
duration of the licensure, or: 10
(1) Has completed 36 months of progressive postgraduate: 11
(I) Education as a resident in the United States or Canada 12
in a program approved by the Board, the Accreditation Council for 13
Graduate Medical Education, the Royal College of Physicians and 14
Surgeons of Canada, the Collège des médecins du Québec or the 15
College of Family Physicians of Canada, or, as applicable, their 16
successor organizations; or 17
(II) Fellowship training in the United States or Canada 18
approved by the Board or the Accreditation Council for Graduate 19
Medical Education; 20
(2) Has completed at least 36 months of postgraduate 21
education, not less than 24 months of which must have been 22
completed as a resident after receiving a medical degree from a 23
combined dental and medical degree program approved by the 24
Board; or 25
(3) Is a resident who is enrolled in a progressive postgraduate 26
training program in the United States or Canada approved by the 27
Board, the Accreditation Council for Graduate Medical Education, 28
the Royal College of Physicians and Surgeons of Canada, the 29
Collège des médecins du Québec or the College of Family 30
Physicians of Canada, or, as applicable, their successor 31
organizations, has completed at least 24 months of the program and 32
has committed, in writing, to the Board that he or she will complete 33
the program; and 34
(d) Passes a written or oral examination, or both, as to his or her 35
qualifications to practice medicine and provides the Board with a 36
description of the clinical program completed demonstrating that the 37
applicant’s clinical training met the requirements of paragraph (a). 38
3. The Board may issue a license to practice medicine after the 39
Board verifies, through any readily available source, that the 40
applicant has complied with the provisions of subsection 2. The 41
verification may include, but is not limited to, using the Federation 42
Credentials Verification Service. If any information is verified by a 43
source other than the primary source of the information, the Board 44
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may require subsequent verification of the information by the 1
primary source of the information. 2
4. Notwithstanding any provision of this chapter to the 3
contrary, if, after issuing a license to practice medicine, the Board 4
obtains information from a primary or other source of information 5
and that information differs from the information provided by the 6
applicant or otherwise received by the Board, the Board may: 7
(a) Temporarily suspend the license; 8
(b) Promptly review the differing information with the Board as 9
a whole or in a committee appointed by the Board; 10
(c) Declare the license void if the Board or a committee 11
appointed by the Board determines that the information submitted 12
by the applicant was false, fraudulent or intended to deceive the 13
Board; 14
(d) Refer the applicant to the Attorney General for possible 15
criminal prosecution pursuant to NRS 630.400; or 16
(e) If the Board temporarily suspends the license, allow the 17
license to return to active status subject to any terms and conditions 18
specified by the Board, including: 19
(1) Placing the licensee on probation for a specified period 20
with specified conditions; 21
(2) Administering a public reprimand; 22
(3) Limiting the practice of the licensee; 23
(4) Suspending the license for a specified period or until 24
further order of the Board; 25
(5) Requiring the licensee to participate in a program to 26
correct an alcohol or other substance use disorder; 27
(6) Requiring supervision of the practice of the licensee; 28
(7) Imposing an administrative fine not to exceed $5,000; 29
(8) Requiring the licensee to perform community service 30
without compensation; 31
(9) Requiring the licensee to take a physical or mental 32
examination or an examination testing his or her competence to 33
practice medicine; 34
(10) Requiring the licensee to complete any training or 35
educational requirements specified by the Board; and 36
(11) Requiring the licensee to submit a corrected application, 37
including the payment of all appropriate fees and costs incident to 38
submitting an application. 39
5. If the Board determines after reviewing the differing 40
information to allow the license to remain in active status, the action 41
of the Board is not a disciplinary action and must not be reported to 42
any national database. If the Board determines after reviewing the 43
differing information to declare the license void, its action shall be 44
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deemed a disciplinary action and shall be reportable to national 1
databases. 2
Sec. 12. NRS 630.267 is hereby amended to read as follows: 3
630.267 1. Each holder of a license to practice medicine for 4
which the procedure for renewal is not otherwise prescribed by 5
specific statute must, on or before June 30, or if June 30 is a 6
Saturday, Sunday or legal holiday, on the next business day after 7
June 30, of each odd-numbered year: 8
(a) Submit a list of all actions filed or claims submitted to 9
arbitration or mediation for malpractice or negligence against him or 10
her during the previous 2 years. 11
(b) Pay to the Secretary-Treasurer of the Board the applicable 12
fee for biennial registration. This fee must be collected for the 13
period for which a physician is licensed. 14
(c) Submit a list of the names of each associate physician 15
supervised by the holder of the license, if applicable. 16
(d) Submit all information required to complete the biennial 17
registration. 18
2. When a holder of a license fails to pay the fee for biennial 19
registration and submit all information required to complete the 20
biennial registration after they become due, his or her license to 21
practice medicine in this State expires. The holder may, within 2 22
years after the date the license expires, upon payment of twice the 23
amount of the current fee for biennial registration to the Secretary-24
Treasurer and submission of all information required to complete 25
the biennial registration and after he or she is found to be in good 26
standing and qualified under the provisions of this chapter, be 27
reinstated to practice. 28
3. Not later than 60 days before a license is scheduled to 29
expire, the Board shall make such reasonable attempts as are 30
practicable to notify the licensee: 31
(a) At least once that the fee for biennial registration and all 32
information required to complete the biennial registration are due; 33
and 34
(b) The date on which his or her license is scheduled to expire. 35
4. After a license expires, the Board shall make such 36
reasonable attempts as are practicable to notify the holder of the 37
license that his or her license has expired. 38
5. Not later than September 30 of each odd-numbered year, the 39
Board shall provide a list of licenses to practice medicine that have 40
expired during that year to the Drug Enforcement Administration of 41
the United States Department of Justice or its successor agency and 42
the State Board of Pharmacy. 43
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Sec. 13. Chapter 633 of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 14 to 21, inclusive, of this 2
act. 3
Sec. 14. Except as otherwise provided in NRS 633.315, the 4
Board may issue a limited license for a person to practice 5
osteopathic medicine as an associate osteopathic physician if the 6
applicant: 7
1. Has received the degree of doctor of osteopathic medicine 8
from a medical school in the United States approved by the 9
Commission on Osteopathic College Accreditation of the 10
American Osteopathic Association; 11
2. Has passed the Level 1 Exam and Level 2 CE Exam of the 12
Comprehensive Osteopathic Medical Licensing Examination of 13
the United States of the National Board of Osteopathic Medical 14
Examiners, the Step 1 Exam and Step 2 CK Exam of the United 15
States Medical Licensing Examination or an examination deemed 16
equivalent by the Board; 17
3. Has not completed a residency in a program described in 18
subparagraph (2) of paragraph (c) of subsection 1 of 19
NRS 633.311; 20
4. Has completed at least his or her first year of postgraduate 21
medical education as a resident or intern as part of a program 22
that: 23
(a) Conforms to the minimum standards for intern training 24
established by the American Osteopathic Association; 25
(b) Has been approved by the Accreditation Council for 26
Graduate Medical Education; or 27
(c) Is approved by the Board in accordance with the 28
regulations adopted pursuant to section 21 of this act; and 29
5. Has basic fluency in the English language. 30
Sec. 15. 1. An associate osteopathic physician shall only 31
practice osteopathic medicine under the supervision and control of 32
an osteopathic physician: 33
(a) Who meets the requirements of section 17 of this act; and 34
(b) With whom the associate osteopathic physician has entered 35
into a collaborative practice agreement that meets the 36
requirements of section 18 of this act. 37
2. An associate osteopathic physician shall not practice 38
osteopathic medicine in a manner that exceeds the skill, training 39
and competence of the associate osteopathic physician or his or 40
her supervising osteopathic physician. 41
3. For the first 30 days during which an associate osteopathic 42
physician practices osteopathic medicine under the supervision of 43
a new supervising osteopathic physician, the supervising 44
osteopathic physician must be physically present on the same 45
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premises and available to assist the associate osteopathic 1
physician. 2
4. An associate osteopathic physician shall not practice 3
osteopathic medicine in a county whose population is less than 4
100,000 unless the supervising osteopathic physician or another 5
osteopathic physician designated by the supervising osteopathic 6
physician is physically present on the same premises and available 7
to assist the associate osteopathic physician. 8
5. An associate osteopathic physician working in a rural 9
health clinic, as defined in 42 U.S.C. § 1395x(aa)(2), shall be 10
considered to be a physician assistant for the purposes of the 11
regulations of the Centers for Medicare and Medicaid Services of 12
the United States Department of Health and Human Services. 13
Such an associate osteopathic physician and his or her 14
supervising osteopathic physician are not required to comply with 15
the requirements of any regulations adopted pursuant to section 16
21 of this act governing the supervision of an associate osteopathic 17
physician that are more stringent than the requirements of federal 18
law and regulations. 19
6. A person or entity that employs an associate osteopathic 20
physician shall credential the associate osteopathic physician and 21
bill for services rendered by the associate osteopathic physician in 22
the same manner as the person or entity credentials and bills for 23
the services of a physician assistant. 24
Sec. 16. 1. The supervising osteopathic physician of an 25
associate osteopathic physician shall prominently display a 26
disclosure at every office where the associate osteopathic 27
physician practices osteopathic medicine explaining to patients 28
that the patient may be seen by an associate osteopathic physician 29
and the patient may instead request to be seen by the supervising 30
osteopathic physician. 31
2. An associate osteopathic physician shall clearly identify 32
himself or herself as an associate osteopathic physician, including, 33
without limitation, by wearing an identification badge that clearly 34
identifies the person as an associate osteopathic physician. An 35
associate osteopathic physician may identify himself or herself as 36
a doctor. 37
3. While acting as the supervising osteopathic physician of an 38
associate osteopathic physician, an osteopathic physician shall 39
wear an identification badge that clearly identifies the person as a 40
supervising osteopathic physician of an associate osteopathic 41
physician. 42
Sec. 17. 1. An osteopathic physician shall not serve as the 43
supervising osteopathic physician of an associate osteopathic 44
physician pursuant to subsection 1 of section 15 of this act or the 45
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designee of a supervising osteopathic physician pursuant to 1
subsection 4 of section 15 of this act unless the osteopathic 2
physician: 3
(a) Holds an active unrestricted license to practice osteopathic 4
medicine in this State; 5
(b) Practices in the same specialty area as the associate 6
osteopathic physician or a substantially similar specialty area as 7
the associate osteopathic physician; and 8
(c) Normally provides care to patients. 9
2. The supervising osteopathic physician of an associate 10
osteopathic physician: 11
(a) Is responsible for any act that constitutes the practice of 12
osteopathic medicine by the associate osteopathic physician; 13
(b) Must have insurance that includes coverage for any claim 14
of malpractice against the associate osteopathic physician; and 15
(c) May not enter into a collaborative practice agreement with 16
more than three associate osteopathic physicians. 17
3. The Board may not deny, revoke or suspend the license of 18
or take any other disciplinary action against the supervising 19
osteopathic physician of an associate osteopathic physician for 20
any act performed by the associate osteopathic physician that: 21
(a) Is performed in accordance with the collaborative practice 22
agreement entered into pursuant to section 15 of this act; and 23
(b) Does not violate applicable federal, state or local laws or 24
the regulations of the Board. 25
Sec. 18. 1. A collaborative practice agreement entered into 26
pursuant to section 15 of this act must be in writing and must 27
include, without limitation: 28
(a) The names, home and business addresses and telephone 29
numbers of the supervising osteopathic physician and associate 30
osteopathic physician; 31
(b) A list of each location where the associate osteopathic 32
physician may practice osteopathic medicine, including, without 33
limitation, the prescribing and dispensing of controlled 34
substances; 35
(c) Any specialty or board certification held by the supervising 36
osteopathic physician; 37
(d) Any certification held by the associate osteopathic 38
physician; 39
(e) Requirements governing collaboration between the 40
supervising osteopathic physician and the associate osteopathic 41
physician, including, without limitation: 42
(1) The geographic proximity which must exist between the 43
supervising osteopathic physician and the associate osteopathic 44
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physician while the associate osteopathic physician is practicing 1
osteopathic medicine; and 2
(2) A plan for alternative supervision if the supervising 3
osteopathic physician is absent, incapacitated or otherwise 4
unavailable; 5
(f) Any controlled substance the supervising osteopathic 6
physician authorizes the associate osteopathic physician to 7
prescribe or dispense in accordance with section 19 of this act; 8
(g) The procedure by which the supervising osteopathic 9
physician will review the standard of care the associate 10
osteopathic physician is providing to patients, which must comply 11
with the regulations adopted pursuant to section 21 of this act; 12
(h) The duration of the collaborative practice agreement; and 13
(i) A statement of any other collaborative practice agreements 14
into which: 15
(1) The supervising osteopathic physician has entered with 16
another associate osteopathic physician; and 17
(2) The associate osteopathic physician has entered with 18
another supervising osteopathic physician. 19
2. Upon entering into a new collaborative practice agreement 20
with an associate osteopathic physician, a supervising osteopathic 21
physician shall file with the Board: 22
(a) A copy of the agreement; and 23
(b) Proof that any controlled substance included in the 24
agreement pursuant to paragraph (f) of subsection 1 is within the 25
skill, training and competence of the associate osteopathic 26
physician and his or her supervising osteopathic physician to 27
prescribe and dispense. 28
3. A supervising osteopathic physician or associate 29
osteopathic physician may terminate a collaborative practice 30
agreement or a relationship with a supervising osteopathic 31
physician or an associate osteopathic physician, as applicable, at 32
any time. Any provision of a collaborative practice agreement or 33
any other agreement that limits the authority of a supervising 34
osteopathic physician or an associate osteopathic physician to 35
terminate a collaborative practice agreement or such a 36
relationship is void. 37
Sec. 19. 1. An associate osteopathic physician may 38
prescribe or dispense the controlled substances listed in subsection 39
2 under the conditions prescribed by this section if the associate 40
osteopathic physician: 41
(a) Is registered with the State Board of Pharmacy pursuant to 42
NRS 639.1373; 43
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(b) Has entered into a collaborative practice agreement 1
pursuant to section 15 of this act authorizing the associate 2
osteopathic physician to prescribe the controlled substance; and 3
(c) Meets all other requirements prescribed by federal and 4
state law to prescribe controlled substances. 5
2. Subject to the limitations prescribed in NRS 639.1373, an 6
associate osteopathic physician who meets the requirements of 7
subsection 1 may prescribe or dispense: 8
(a) Any controlled substance listed in schedule III, IV or V; 9
and 10
(b) Any controlled substance listed in schedule II that contains 11
hydrocodone. 12
3. Except as otherwise provided in this subsection, an 13
associate osteopathic physician shall not prescribe or dispense 14
more than a 5-day supply of a controlled substance listed in 15
schedule II or III. An associate osteopathic physician may 16
prescribe or dispense a 30-day supply of buprenorphine for the 17
treatment of a substance use disorder under the direction of his or 18
her supervising osteopathic physician. 19
4. An associate osteopathic physician shall not prescribe or 20
dispense controlled substances unless: 21
(a) The supervising osteopathic physician of the associate 22
osteopathic physician is physically present on the same premises; 23
or 24
(b) The associate osteopathic physician has, at any time, 25
completed 120 hours practicing osteopathic medicine over a period 26
of not more than 4 months with his or her supervising osteopathic 27
physician physically present on the same premises. 28
Sec. 20. 1. A limited license to practice osteopathic 29
medicine as an associate osteopathic physician issued pursuant to 30
section 14 of this act expires 2 years after it is issued. 31
2. The Board may renew a limited license to practice 32
osteopathic medicine as an associate osteopathic physician upon 33
application by the associate osteopathic physician. An application 34
for renewal must include, without limitation, proof that the 35
associate osteopathic physician has actually engaged in the 36
practice of osteopathic medicine under a collaborative practice 37
agreement entered into pursuant to section 15 of this act during 38
the immediately preceding 2 years. 39
Sec. 21. 1. The Board shall adopt regulations necessary: 40
(a) To carry out the provisions of sections 14 to 21, inclusive, 41
of this act, including, without limitation: 42
(1) Any additional requirements for the issuance or 43
renewal of a limited license to practice osteopathic medicine as an 44
associate osteopathic physician. 45
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(2) The standards for the approval of programs of 1
postgraduate medical education pursuant to paragraph (c) of 2
subsection 4 of section 14 of this act. 3
(3) The required fees for the issuance and renewal of such 4
a license. 5
(4) Standards of practice for associate osteopathic 6
physicians, including, without limitation, limitations on the 7
practice of osteopathic medicine by an associate osteopathic 8
physician in addition to those prescribed by sections 14 to 21, 9
inclusive, of this act. 10
(5) Any additional requirements governing collaborative 11
practice agreements entered into pursuant to section 15 of this act. 12
(6) Requirements concerning the supervision of an 13
associate osteopathic physician by a supervising osteopathic 14
physician, including, without limitation, requirements governing 15
the review by the supervising osteopathic physician of the standard 16
of care the associate osteopathic physician is providing to patients. 17
Such regulations must not be more stringent than any similar 18
requirements that apply to physician assistants. 19
(b) For an associate osteopathic physician to be eligible to 20
work in a clinic that receives federal funding. 21
2. The regulations adopted pursuant to this section and NRS 22
633.471 must not require an associate osteopathic physician to 23
complete a greater amount of continuing education than an 24
osteopathic physician licensed pursuant to NRS 633.311. 25
3. The Board shall publish on an Internet website maintained 26
by the Board the name of each associate osteopathic physician and 27
the osteopathic physician or osteopathic physicians supervising 28
the associate osteopathic physician. 29
Sec. 22. NRS 633.123 is hereby amended to read as follows: 30
633.123 “Supervising osteopathic physician” means an 31
osteopathic physician who is licensed in this State, is in good 32
standing with the Board and [supervises] : 33
1. Supervises a physician assistant with Board approval [.] ; or 34
2. Supervises an associate osteopathic physician. 35
Sec. 23. NRS 633.311 is hereby amended to read as follows: 36
633.311 1. Except as otherwise provided in NRS 633.315 37
and 633.381 to 633.419, inclusive, and sections 14 to 21, inclusive, 38
of this act, an applicant for a license to practice osteopathic 39
medicine may be issued a license by the Board if: 40
(a) The applicant is 21 years of age or older; 41
(b) The applicant is a graduate of a school of osteopathic 42
medicine; 43
(c) The applicant: 44
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(1) Has graduated from a school of osteopathic medicine 1
before 1995 and has completed: 2
(I) A hospital internship; or 3
(II) One year of postgraduate training that complies with 4
the standards of intern training established by the American 5
Osteopathic Association; 6
(2) Has completed 3 years, or such other length of time as 7
required by a specific program, of postgraduate medical education 8
as a resident in the United States or Canada in a program approved 9
by the Board, the Bureau of Professional Education of the American 10
Osteopathic Association or the Accreditation Council for Graduate 11
Medical Education; or 12
(3) Is a resident who is enrolled in a postgraduate training 13
program in this State, has completed 24 months of the program and 14
has committed, in writing, that he or she will complete the program; 15
(d) The applicant applies for the license as provided by law; 16
(e) The applicant passes: 17
(1) All parts of the licensing examination of the National 18
Board of Osteopathic Medical Examiners; 19
(2) All parts of the licensing examination of the Federation 20
of State Medical Boards; 21
(3) All parts of the licensing examination of the Board, a 22
state, territory or possession of the United States, or the District of 23
Columbia, and is certified by a specialty board of the American 24
Osteopathic Association or by the American Board of Medical 25
Specialties; or 26
(4) A combination of the parts of the licensing examinations 27
specified in subparagraphs (1), (2) and (3) that is approved by the 28
Board; 29
(f) The applicant pays the fees provided for in this chapter; and 30
(g) The applicant submits all information required to complete 31
an application for a license. 32
2. An applicant for a license to practice osteopathic medicine 33
may satisfy the requirements for postgraduate education or training 34
prescribed by paragraph (c) of subsection 1: 35
(a) In one or more approved postgraduate programs, which may 36
be conducted at one or more facilities in this State or, except for a 37
resident who is enrolled in a postgraduate training program in this 38
State pursuant to subparagraph (3) of paragraph (c) of subsection 1, 39
in the District of Columbia or another state or territory of the United 40
States; 41
(b) In one or more approved specialties or disciplines; 42
(c) In nonconsecutive months; and 43
(d) At any time before receiving his or her license. 44
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Sec. 24. NRS 633.467 is hereby amended to read as follows: 1
633.467 An osteopathic physician who does not normally 2
provide care to patients may not be [a] the supervising osteopathic 3
physician [.] of a physician assistant. 4
Sec. 25. NRS 633.471 is hereby amended to read as follows: 5
633.471 1. Except as otherwise provided in subsection 15 , 6
[and] NRS 633.491 [,] and section 20 of this act, every holder of a 7
license, except a physician assistant or an anesthesiologist assistant, 8
issued under this chapter, except a temporary or a special license, 9
may renew the license on or before January 1 of each calendar year 10
after its issuance by: 11
(a) Applying for renewal on forms provided by the Board; 12
(b) Paying the annual license renewal fee specified in this 13
chapter; 14
(c) Submitting a list of all actions filed or claims submitted to 15
arbitration or mediation for malpractice or negligence against the 16
holder during the previous year; 17
(d) Subject to subsection 14, submitting evidence to the Board 18
that in the year preceding the application for renewal the holder has 19
attended courses or programs of continuing education approved by 20
the Board in accordance with regulations adopted by the Board 21
totaling a number of hours established by the Board which must not 22
be less than 35 hours nor more than that set in the requirements for 23
continuing medical education of the American Osteopathic 24
Association; [and] 25
(e) Submitting a list of the names of each associate osteopathic 26
physician supervised by the holder, if applicable; and 27
(f) Submitting all information required to complete the renewal. 28
2. The Secretary of the Board shall notify each licensee of the 29
requirements for renewal not less than 30 days before the date of 30
renewal. 31
3. The Board shall request submission of verified evidence of 32
completion of the required number of hours of continuing medical 33
education annually from a percentage of the applicants for renewal 34
of a license to practice osteopathic medicine or a license to practice 35
as a physician assistant or anesthesiologist assistant determined by 36
the Board. Subject to subsection 14, upon a request from the Board, 37
an applicant for renewal of a license to practice osteopathic 38
medicine or a license to practice as a physician assistant or 39
anesthesiologist assistant shall submit verified evidence satisfactory 40
to the Board that in the year preceding the application for renewal 41
the applicant attended courses or programs of continuing medical 42
education approved by the Board totaling the number of hours 43
established by the Board. 44
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4. The Board shall require each holder of a license to practice 1
osteopathic medicine to complete a course of instruction within 2 2
years after initial licensure that provides at least 2 hours of 3
instruction on evidence-based suicide prevention and awareness as 4
described in subsection 9. 5
5. The Board shall encourage each holder of a license to 6
practice osteopathic medicine to receive, as a portion of his or her 7
continuing education, training concerning methods for educating 8
patients about how to effectively manage medications, including, 9
without limitation, the ability of the patient to request to have the 10
symptom or purpose for which a drug is prescribed included on the 11
label attached to the container of the drug. 12
6. The Board shall encourage each holder of a license to 13
practice osteopathic medicine or as a physician assistant to receive, 14
as a portion of his or her continuing education, training and 15
education in the diagnosis of rare diseases, including, without 16
limitation: 17
(a) Recognizing the symptoms of pediatric cancer; and 18
(b) Interpreting family history to determine whether such 19
symptoms indicate a normal childhood illness or a condition that 20
requires additional examination. 21
7. The Board shall require, as part of the continuing education 22
requirements approved by the Board, the biennial completion by a 23
holder of a license to practice osteopathic medicine of at least 2 24
hours of continuing education credits in ethics, pain management, 25
care of persons with addictive disorders or the screening, brief 26
intervention and referral to treatment approach to substance use 27
disorder. 28
8. The continuing education requirements approved by the 29
Board must allow the holder of a license as an osteopathic 30
physician, physician assistant or anesthesiologist assistant to receive 31
credit toward the total amount of continuing education required by 32
the Board for the completion of a course of instruction relating to 33
genetic counseling and genetic testing. 34
9. The Board shall require each holder of a license to practice 35
osteopathic medicine to receive as a portion of his or her continuing 36
education at least 2 hours of instruction every 4 years on evidence-37
based suicide prevention and awareness which may include, without 38
limitation, instruction concerning: 39
(a) The skills and knowledge that the licensee needs to detect 40
behaviors that may lead to suicide, including, without limitation, 41
post-traumatic stress disorder; 42
(b) Approaches to engaging other professionals in suicide 43
intervention; and 44
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(c) The detection of suicidal thoughts and ideations and the 1
prevention of suicide. 2
10. A holder of a license to practice osteopathic medicine may 3
not substitute the continuing education credits relating to suicide 4
prevention and awareness required by this section for the purposes 5
of satisfying an equivalent requirement for continuing education in 6
ethics. 7
11. The Board shall require each holder of a license to practice 8
osteopathic medicine to complete at least 2 hours of training in the 9
screening, brief intervention and referral to treatment approach to 10
substance use disorder within 2 years after initial licensure. 11
12. The Board shall require each psychiatrist or a physician 12
assistant practicing under the supervision of a psychiatrist to 13
biennially complete one or more courses of instruction that provide 14
at least 2 hours of instruction relating to cultural competency and 15
diversity, equity and inclusion. Such instruction: 16
(a) May include the training provided pursuant to NRS 449.103, 17
where applicable. 18
(b) Must be based upon a range of research from diverse 19
sources. 20
(c) Must address persons of different cultural backgrounds, 21
including, without limitation: 22
(1) Persons from various gender, racial and ethnic 23
backgrounds; 24
(2) Persons from various religious backgrounds; 25
(3) Lesbian, gay, bisexual, transgender and questioning 26
persons; 27
(4) Children and senior citizens; 28
(5) Veterans; 29
(6) Persons with a mental illness; 30
(7) Persons with an intellectual disability, developmental 31
disability or physical disability; and 32
(8) Persons who are part of any other population that a 33
psychiatrist or physician assistant practicing under the supervision 34
of a psychiatrist may need to better understand, as determined by the 35
Board. 36
13. The Board shall require each holder of a license to practice 37
osteopathic medicine or as a physician assistant who provides or 38
supervises the provision of emergency medical services in a hospital 39
or primary care to complete at least 2 hours of training in the stigma, 40
discrimination and unrecognized bias toward persons who have 41
acquired or are at a high risk of acquiring human immunodeficiency 42
virus within 2 years after beginning to provide or supervise the 43
provision of such services or care. 44
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14. The Board shall not require a physician assistant to receive 1
or maintain certification by the National Commission on 2
Certification of Physician Assistants, or its successor organization, 3
or by any other nationally recognized organization for the 4
accreditation of physician assistants to satisfy any continuing 5
education requirement pursuant to paragraph (d) of subsection 1 and 6
subsection 3. 7
15. Members of the Armed Forces of the United States and the 8
United States Public Health Service are exempt from payment of the 9
annual license renewal fee during their active duty status. 10
16. As used in this section, “primary care” means the practice 11
of family medicine, pediatrics, internal medicine, obstetrics and 12
gynecology and midwifery. 13
Sec. 26. NRS 639.1373 is hereby amended to read as follows: 14
639.1373 1. A physician assistant or an associate physician 15
licensed pursuant to chapter 630 or 633 of NRS may, if authorized 16
by the Board, possess, administer, prescribe or dispense controlled 17
substances, or possess, administer, prescribe or dispense poisons, 18
dangerous drugs or devices in or out of the presence of his or her 19
supervising physician only to the extent and subject to the 20
limitations specified in the registration certificate issued to the 21
physician assistant or associate physician by the Board pursuant to 22
this section. 23
2. Each physician assistant and associate physician licensed 24
pursuant to chapter 630 or 633 of NRS who is authorized by his or 25
her physician assistant’s or associate physician’s license issued by 26
the Board of Medical Examiners or by the State Board of 27
Osteopathic Medicine, respectively, to possess, administer, 28
prescribe or dispense controlled substances, or to possess, 29
administer, prescribe or dispense poisons, dangerous drugs or 30
devices must apply for and obtain a registration certificate from the 31
Board, pay a fee to be set by regulations adopted by the Board and 32
pass an examination administered by the Board on the law relating 33
to pharmacy before the physician assistant or associate physician 34
can possess, administer, prescribe or dispense controlled substances, 35
or possess, administer, prescribe or dispense poisons, dangerous 36
drugs or devices. 37
3. The Board shall consider each application separately and 38
may, even though the physician assistant’s or associate physician’s 39
license issued by the Board of Medical Examiners or by the State 40
Board of Osteopathic Medicine authorizes the physician assistant or 41
associate physician to possess, administer, prescribe or dispense 42
controlled substances, or to possess, administer, prescribe or 43
dispense poisons, dangerous drugs and devices: 44
(a) Refuse to issue a registration certificate; 45
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(b) Issue a registration certificate limiting the authority of the 1
physician assistant or associate physician to possess, administer, 2
prescribe or dispense controlled substances, or to possess, 3
administer, prescribe or dispense poisons, dangerous drugs or 4
devices, the area in which the physician assistant or associate 5
physician may possess controlled substances, poisons, dangerous 6
drugs and devices, or the kind and amount of controlled substances, 7
poisons, dangerous drugs and devices; or 8
(c) Issue a registration certificate imposing other limitations or 9
restrictions which the Board feels are necessary and required to 10
protect the health, safety and welfare of the public. 11
4. If the registration of the physician assistant or associate 12
physician licensed pursuant to chapter 630 or 633 of NRS is 13
suspended or revoked, the physician’s controlled substance 14
registration may also be suspended or revoked. 15
5. The Board shall adopt regulations controlling the maximum 16
amount to be administered, possessed and dispensed, and the 17
storage, security, recordkeeping and transportation of controlled 18
substances and the maximum amount to be administered, possessed, 19
prescribed and dispensed and the storage, security, recordkeeping 20
and transportation of poisons, dangerous drugs and devices by 21
physician assistants and associate physicians licensed pursuant to 22
chapter 630 or 633 of NRS. In the adoption of those regulations, the 23
Board shall consider, but is not limited to, the following: 24
(a) The area in which the physician assistant or associate 25
physician is to operate; 26
(b) The population of that area; 27
(c) The experience and training of the physician assistant [;] or 28
associate physician; 29
(d) The distance to the nearest hospital and physician; and 30
(e) The effect on the health, safety and welfare of the public. 31
6. For the purposes of this section [, the] : 32
(a) The term “associate physician” includes an associate 33
osteopathic physician. 34
(b) The term “supervising physician” includes a supervising 35
osteopathic physician as defined in chapter 633 of NRS. 36
Sec. 27. NRS 0.040 is hereby amended to read as follows: 37
0.040 1. Except as otherwise provided in subsection 2, 38
“physician” means a person who engages in the practice of 39
medicine, including osteopathy and homeopathy. 40
2. The terms “physician,” “associate physician,” “osteopathic 41
physician,” “associate osteopathic physician,” “homeopathic 42
physician,” “chiropractic physician” and “podiatric physician” are 43
used in chapters 630, 630A, 633, 634 and 635 of NRS in the limited 44
senses prescribed by those chapters respectively. 45
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Sec. 28. 1. This section becomes effective upon passage and 1
approval. 2
2. Sections 1 to 27, inclusive, of this act become effective: 3
(a) Upon passage and approval for the purpose of adopting any 4
regulations and performing any other preparatory administrative 5
tasks that are necessary to carry out the provisions of this act; and 6
(b) On January 1, 2026, for all other purposes. 7
H