EXEMPT
(Reprinted with amendments adopted on June 3, 2023)
SECOND REPRINT A.B. 281
- *AB281 _R2 *
ASSEMBLY BILL NO. 281–ASSEMBLYMEN GORELOW;
ANDERSON, CARTER, COHEN, DURAN AND NGUYEN
MARCH 14, 2023
____________
Referred to Committee on Health and Human Services
SUMMARY—Revises provisions governing senior living facilities.
(BDR 40-457)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: No.
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to health care; requiring the administrators of
certain senior living facilities to ensure that such a senior
living facility is equipped with a functional ventilation
system; establishing requirements governing the detection
of carbon dioxide at such a senior living facility;
establishing requirements for the assessment of and any
repair, upgrade or installation to heating, ventilation and
air-conditioning systems at such senior living facilities;
requiring certain personnel to complete and review an
assessment report on such a ventilation system; requiring
the administrators of certain senior living facilities to
prepare a report on work performed on such a ventilation
system; providing that such a report is a public record;
and providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law sets forth various requirements for certain medical facilities that 1
provide care to persons who are aged or infirm, including, without limitation, a 2
facility for intermediate care, facility for skilled nursing, a residential facility for 3
groups and a home for individual residential care. (Chapter 449 of NRS) This bill 4
establishes requirements for the heating, ventilation and air-conditioning systems of 5
a senior living facility. 6
Section 7 of this bill defines “senior living facility” as any facility that receives 7
any federal funding from Medicare, Medicaid or other federal health care program 8
and which provides living assistance and related care to a resident of the facility 9
who is an aged or infirm person, including, without limitation, a facility for 10
intermediate care, facility for skilled nursing, a residential facility for groups and a 11
– 2 –
- *AB281 _R2 *
home for individual residential care. Sections 3-8.7 of this bill define other terms 12
related to ventilation systems in senior living facilities. 13
Section 9 of this bill sets forth a legislative declaration relating to ventilation 14
systems in senior living facilities. Section 9.2 of this bill limits the applicability of 15
the provisions of this bill to senior living facilities located in a county whose 16
population is 100,000 or more (currently Clark and Washoe Counties). Section 9.5 17
of this bill requires the State Board of Health to review each new edition of certain 18
standards incorporated into this bill to determine their suitability for this State. 19
Section 10 of this bill requires, to the extent money is available, the 20
administrator of a senior living facility to ensure that the senior living facility is 21
equipped with a functional ventilation system and to have periodic assessments of 22
the existing system conducted by qualified adjusting personnel or qualified testing 23
personnel. Section 10 also authorizes a facility that is certified as an assisted living 24
facility to use certain federal money received to upgrade and maintain the 25
ventilation system of that facility. 26
Section 14 of this bill prescribes requirements governing carbon dioxide 27
detectors at a senior living facility. Section 14 also requires the administrator of a 28
senior living facility to cause an adjustment to the ventilation if the concentration of 29
carbon dioxide exceeds a certain amount. 30
Section 14.5 of this bill sets forth the requirements for qualified testing 31
personnel to assess the heating, ventilation and air-conditioning system of a senior 32
living facility. Section 14.5 also requires qualified testing personnel to prepare a 33
heating, ventilation and air-conditioning assessment report, including certain 34
information relating to the assessments conducted pursuant to that section. 35
Section 18 of this bill: (1) requires a heating, ventilation and air-conditioning 36
assessment report to be reviewed by a mechanical engineer; and (2) imposes certain 37
duties on the mechanical engineer to facilitate improvements determined necessary 38
based on the report. 39
Section 19 of this bill requires a senior living facility to take certain corrective 40
actions in response to a heating, ventilation and air-conditioning assessment report 41
and review by a mechanical engineer. Section 20 of this bill imposes certain 42
requirements governing the workforce used to perform such corrective actions. 43
Section 21 of this bill requires the administrator of a senior living facility to 44
prepare a report on the work performed pursuant to a heating, ventilation and air-45
conditioning assessment report and review by a mechanical engineer and to submit 46
the report to the Division of Public and Behavioral Health of the Department of 47
Health and Human Services. 48
Section 22 of this bill provides that a heating, ventilation and air-conditioning 49
assessment report and a report created by an administrator of a senior living facility 50
pursuant to section 21 are public records and available for public inspection. 51
Sections 22.5 and 23 of this bill provide for the expiration of the provisions of this 52
bill where there is no longer sufficient federal money available to facilitate 53
compliance with its provisions. 54
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 449 of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 2 to 22, inclusive, of this 2
act. 3
Sec. 2. As used in sections 2 to 22, inclusive, of this act, 4
unless the context otherwise requires, the words and terms defined 5
– 3 –
- *AB281 _R2 *
in sections 3 to 8.7, inclusive, of this act have the meanings 1
ascribed to them in those sections. 2
Sec. 3. “Apprenticeship program” means an apprenticeship 3
program approved by the State Apprenticeship Council created by 4
NRS 610.030. 5
Sec. 3.1. “ASHRAE” means the American Society of 6
Heating, Refrigerating and Air-Conditioning Engineers. 7
Sec. 3.2. “Certified TAB technician” means a technician 8
who is certified to perform testing, adjusting and balancing of 9
HVAC systems by the Associated Air Balance Council, National 10
Environmental Balancing Bureau, Inc. or the Testing, Adjusting 11
and Balancing Bureau, or a similar successor organization. 12
Sec. 3.3. “Functional ventilation system” means a heating, 13
ventilation and air-conditioning system that provides the minimum 14
acceptable level of ventilation in accordance with the edition of 15
ASHRAE Standard 62.1, Ventilation and Acceptable Indoor Air 16
Quality most recently approved by the Board pursuant to section 17
9.5 of this act. 18
Sec. 3.4. “HVAC” means heating, ventilation and air-19
conditioning. 20
Sec. 3.5. “Mechanical engineer” means a professional 21
engineer who is licensed in the discipline of mechanical 22
engineering by this State and who has professional experience 23
with heating, ventilation and air-conditioning systems. 24
Sec. 3.6. “MERV” means minimum efficiency reporting 25
value, as established by ASHRAE Standard 52.2-2017, Method of 26
Testing General Ventilation Air-Cleaning Devices for Removal 27
Efficiency by Particle Size. 28
Sec. 4. (Deleted by amendment.) 29
Sec. 5. “Qualified adjusting personnel” means either of the 30
following: 31
1. A certified TAB technician; or 32
2. A skilled and trained workforce under the supervision of a 33
certified TAB technician. 34
Sec. 6. “Qualified testing personnel” means either of the 35
following: 36
1. A certified TAB technician; or 37
2. A person certified to perform assessments of heating, 38
ventilation and air-conditioning systems by a certifying body in 39
accordance with the edition of standard ISO/IEC 17024, 40
Conformity assessment -- General requirements for bodies 41
operating certification of persons, of the International 42
Organization for Standardization most recently approved by the 43
Board pursuant to section 9.5 of this act. 44
– 4 –
- *AB281 _R2 *
Sec. 7. “Senior living facility” means any facility that 1
receives any federal funding from Medicare, Medicaid or other 2
federal health care program and which provides living assistance 3
and related care to a resident of the facility who is an aged or 4
infirm person including, without limitation, a facility for 5
intermediate care, facility for skilled nursing, residential facility 6
for groups or home for individual residential care. 7
Sec. 8. “Skilled and trained workforce” means a workforce 8
not less than 60 percent of which is composed of graduates of an 9
apprenticeship program for the applicable occupation. 10
Sec. 8.3. “Ventilation verification assessment” means an 11
assessment to determine the status of a ventilation system 12
performed in accordance with section 14 of this act. 13
Sec. 8.7. “Zone” means an area of a senior living facility 14
where the temperature is controlled by one thermostat. 15
Sec. 9. The Legislature finds and declares that: 16
1. Studies have found: 17
(a) Most ventilation systems are improperly installed; and 18
(b) Many of the problems with ventilation systems are linked to 19
the use of inadequately trained personnel to install, test, adjust 20
and balance ventilation systems. 21
2. Ventilation systems should operate as efficiently as 22
possible and inspections and repairs should be performed by 23
qualified personnel. 24
3. In addition to increasing the risk of infectious, airborne 25
diseases, inadequate ventilation systems in senior living facilities 26
negatively impact the health of residents and staff in senior living 27
facilities. 28
4. Improving indoor air quality in senior living facilities may 29
protect the health of residents and staff, reduce the risk of 30
infectious, airborne diseases and save energy. 31
5. Senior living facilities should have functioning ventilation 32
systems that meet or exceed recommended health and safety 33
standards. 34
6. Consistent statewide standards for senior living facilities 35
are necessary to protect the health and safety of residents and 36
staff. 37
Sec. 9.2. The provisions of sections 2 to 22, inclusive, of this 38
act apply only to senior living facilities located in a county whose 39
population is 100,000 or more. 40
Sec. 9.5. The Board shall review the editions of ASHRAE 41
Standard 62.1, Ventilation and Acceptable Indoor Air Quality, 42
Standard ISO/IEC 17024, Conformity assessment -- General 43
requirements for bodies operating certification of persons, of the 44
International Organization for Standardization, and the Uniform 45
– 5 –
- *AB281 _R2 *
Mechanical Code of the International Association of Plumbing 1
and Mechanical Officials in effect on the effective date of this act 2
to ensure the suitability of the new edition for this State. Each new 3
edition of those standards shall be deemed approved by the Board 4
unless the edition is disapproved by the Board within 60 days after 5
the date of publication of the new edition. 6
Sec. 10. 1. To the extent that money is available, the 7
administrator of a senior living facility shall ensure that the senior 8
living facility is equipped with a functional ventilation system that 9
is tested, adjusted and, if necessary or cost-effective, repaired, 10
upgraded or replaced to increase efficiency and performance in 11
accordance with the provisions of sections 2 to 22, inclusive, of 12
this act. Money shall be considered available if the senior living 13
facility: 14
(a) Receives federal or state money and allocates such money 15
to equip the senior living facility with a functional ventilation 16
system or improve the ventilation system or indoor air quality in 17
the senior living facility; or 18
(b) As a condition of receiving federal or state money is 19
required to ensure the senior living facility is equipped with a 20
functional ventilation system or improve the ventilation system or 21
indoor air quality in the senior living facility. 22
2. Not later than July 1, 2025, and at least once every 5 years 23
thereafter, the administrator of a senior living facility or any other 24
person that ensures a senior living facility is equipped with a 25
functional ventilation system pursuant to this section shall employ 26
qualified adjusting personnel or qualified testing personnel, or 27
cause such persons to be contracted, to perform a ventilation 28
verification assessment in accordance with section 14.5 of this act 29
to determine the status of and make any necessary improvements 30
to the heating, ventilation and air-conditioning system of the 31
senior living facility. 32
3. A senior living facility that is an assisted living facility 33
certified by the Housing Division of the Department of Business 34
and Industry pursuant to NRS 319.147 may use federal money 35
received pursuant to paragraph (a) of subsection 1 to upgrade and 36
maintain the ventilation system of that facility. 37
Sec. 11. (Deleted by amendment.) 38
Sec. 12. (Deleted by amendment.) 39
Sec. 13. (Deleted by amendment.) 40
Sec. 14. 1. Except as otherwise provided in subsection 2, 41
each zone in a senior living facility must be equipped with a 42
carbon dioxide monitor and at least one carbon dioxide monitor 43
for each 10,000 square feet of floor space. Such a carbon dioxide 44
monitor must: 45
– 6 –
- *AB281 _R2 *
(a) Be hardwired, plugged in or battery-operated and mounted 1
to the wall at least 3 feet but not more than 6 feet above the floor 2
and at least 5 feet away from any door or operable window; 3
(b) Display readings of the concentration of carbon dioxide to 4
appropriate personnel through a display on the monitor or 5
through an application on an Internet website or a cellular 6
telephone; 7
(c) Provide a visual notification, including, without limitation, 8
through an indicator light, electronic mail, text message or an 9
application on a cellular telephone, when the concentration of 10
carbon dioxide in the room reaches 1,100 parts per million or 11
more; 12
(d) Maintain a record of previous data that includes, without 13
limitation, the maximum carbon dioxide concentration measured; 14
(e) Have a range of 400 parts per million to 5,000 parts per 15
million or more; and 16
(f) Be certified by the manufacturer of the carbon dioxide 17
monitor to: 18
(1) Be accurate within 75 parts per million at a carbon 19
dioxide concentration of 1,000 parts per million; and 20
(2) Require calibration not more than once every 5 years. 21
2. The technical specifications for carbon dioxide monitors 22
set forth in subsection 1 may be amended by regulation of the 23
Board as necessary to reflect available technology and to achieve 24
the intent of that subsection. 25
3. If appropriate personnel observe a concentration of carbon 26
dioxide exceeding 1,100 parts per million more than once in any 27
7-day period in any zone, the administrator of the senior living 28
facility shall cause qualified adjusting personnel to adjust the 29
ventilation of the zone as necessary to ensure that the 30
concentration of carbon dioxide in the zone remains below 1,100 31
parts per million. 32
Sec. 14.5. 1. In a ventilation verification assessment of a 33
senior living facility performed pursuant to section 10 of this act, 34
qualified testing personnel must: 35
(a) Record information from HVAC equipment and the motor 36
nameplate. 37
(b) Conduct such testing as necessary to determine that filters 38
are performing at maximum efficiency. 39
(c) Obtain physical measurements of the outside air rates at 40
minimum and maximum load conditions. 41
(d) For each zone, estimate the number of occupants and 42
determine the current occupancy categories, as listed in Table 43
402.1 of ASHRAE Standard 62.1 -2022, Ventilation and 44
Acceptable Indoor Air Quality. 45
– 7 –
- *AB281 _R2 *
(e) Verify the operation of components of the ventilation 1
system. 2
(f) Measure all inlets and outlets for air distribution. 3
(g) Verify the proper operation of each unit of the HVAC 4
system. 5
(h) Verify that maintenance has been performed in accordance 6
with section 8 and table 8.1 of ASHRAE Standard 62.1-2022, 7
Ventilation and Acceptable Indoor Air Quality. 8
(i) Verify that control sequences are organized in a manner 9
that facilitates proper operation of the HVAC system. 10
(j) Verify the installation of carbon dioxide monitors as 11
required by section 14 of this act and the accuracy of all carbon 12
dioxide monitors within 75 parts per million at a carbon dioxide 13
concentration of 1,000 parts per million. 14
(k) If the facility is not currently equipped with mechanical 15
ventilation, collect field data to determine the feasibility of 16
installing such ventilation. 17
(l) Identify such adjustments, repairs, upgrades or 18
replacements described in section 19 of this act as are necessary to 19
meet: 20
(1) The minimum requirements concerning ventilation and 21
filtration prescribed by any applicable local building code; and 22
(2) The criteria of the edition of ASHRAE Standard 62.1, 23
Ventilation and Acceptable Indoor Air Quality, most recently 24
approved by the Board pursuant to section 9.5 of this act. 25
(m) Document the performance of each task performed 26
pursuant to paragraphs (a) to (l), inclusive. 27
2. Based on the documentation described in paragraph (m) of 28
subsection 1, the qualified testing personnel who perform a 29
ventilation verification assessment pursuant to section 10 of this 30
act must prepare an HVAC assessment report and provide the 31
report to a mechanical engineer for review in accordance with 32
section 18 of this act. 33
Sec. 15. (Deleted by amendment.) 34
Sec. 16. (Deleted by amendment.) 35
Sec. 17. (Deleted by amendment.) 36
Sec. 18. The mechanical engineer who reviews an HVAC 37
assessment report pursuant to subsection 2 of section 14.5 of this 38
act must: 39
1. Verify or adjust the estimated minimum outside air 40
ventilation rates. 41
2. Determine what, if any, additional adjustments, repairs, 42
upgrades or replacements described in section 19 of this act are 43
necessary to meet: 44
– 8 –
- *AB281 _R2 *
(a) The minimum ventilation and filtration requirements of the 1
local building code; and 2
(b) The criteria of the edition of ASHRAE Standard 62.1, 3
Ventilation and Acceptable Indoor Air Quality most recently 4
approved by the Board pursuant to section 9.5 of this act. 5
3. Provide the senior living facility with an estimate of costs 6
for all recommended work. 7
Sec. 19. 1. A senior living facility shall take any corrective 8
actions: 9
(a) Identified in an HVAC assessment report created pursuant 10
to subsection 2 of section 14.5 of this act and reviewed by a 11
mechanical engineer pursuant to section 18 of this act; or 12
(b) Identified by a mechanical engineer pursuant to section 18 13
of this act. 14
2. Corrective actions identified in an HVAC assessment 15
report or by a mechanical engineer must include, where 16
necessary: 17
(a) Testing, adjusting and balancing the mechanical 18
ventilation system of the senior living facility, if any; and 19
(b) If necessary or cost effective, repairs, upgrades or 20
replacement of the HVAC system or installation of a stand-alone 21
mechanical ventilation system. 22
3. Corrective actions identified in an HVAC assessment 23
report or by a mechanical engineer may additionally include, 24
without limitation: 25
(a) General maintenance. 26
(b) Reading and adjustment of ventilation rates. 27
(c) Replacement of filters to meet a MERV of at least 13 if 28
equipment allows, while ensuring that the pressure drop is less 29
than the capability of the fan. 30
(d) Direct outside airflow intake measurement. 31
4. A senior living facility may only use portable filtration and 32
air cleaners: 33
(a) If the infrastructure of the existing HVAC system is not 34
able to meet the requirements for filtration and ventilation 35
prescribed by sections 2 to 22, inclusive, of this act. 36
(b) As recommended by a mechanical engineer as a 37
supplemental enhancement to the permanent infrastructure of the 38
HVAC system: 39
(1) When the desired indoor air quality cannot be 40
maintained with the mechanical ventilation system; or 41
(2) There exist concerns relating to outdoor air 42
contaminants such as those created by wildfires and air pollution. 43
5. All adjustments to an HVAC system at a senior living 44
facility must be performed by qualified adjusting personnel. 45
– 9 –
- *AB281 _R2 *
Sec. 20. 1. The administrator of a senior living facility 1
shall ensure that all work required by section 19 of this act 2
including, without limitation, repairs, upgrades and replacements 3
of an HVAC system, is performed by a skilled and trained 4
workforce of the construction industry and in compliance with 5
applicable regulations of the Board. 6
2. The Division and the Board shall work in consultation 7
with the Labor Commissioner, as necessary, to ensure that 8
assessments and construction required pursuant to sections 2 to 9
22, inclusive, of this act satisfy any applicable standards and 10
requirements of the edition of the Uniform Mechanical Code of 11
the International Association of Plumbing and Mechanical 12
Officials, most recently approved by the Board pursuant to section 13
9.5 of this act. 14
Sec. 21. Upon the completion of work required by section 19 15
of this act, the administrator of a senior living facility shall submit 16
a report to the Division. The report must include: 17
1. The name and address of: 18
(a) The senior living facility; 19
(b) The person preparing and certifying the report; and 20
(c) The qualified testing personnel, qualified adjusting 21
personnel, mechanical engineers, contractors and the members of 22
the skilled and trained workforce of the construction industry who 23
performed assessments, adjustments or construction relating to the 24
work. 25
2. Copies of the certification and license, if applicable, of 26
each person identified in paragraph (c) of subsection 1. 27
3. A copy of all procurement documents relating to the work. 28
4. Documentation of: 29
(a) Verifications of initial operating ventilation rates. 30
(b) Adjustments, repairs, upgrades and replacements 31
performed pursuant to section 19 of this act. 32
(c) The final operating conditions of the HVAC system, 33
including, without limitation, the MERV of the filtration system 34
and verified ventilation and exhaust rates for classrooms, 35
auditoriums, gymnasiums, restrooms, offices and other occupied 36
spaces. 37
(d) Verification that all work has been tested by qualified 38
testing personnel and adjusted by qualified adjusting personnel. 39
(e) Verification that all repairs, upgrades and replacements 40
were performed by a contractor who uses a skilled and trained 41
workforce of the construction industry and who is in compliance 42
with any applicable standards of the United States Department of 43
Labor. 44
– 10 –
- *AB281 _R2 *
(f) Compliance with section 19 of this act, including, without 1
limitation, the make and model of each carbon dioxide monitor 2
installed in the senior living facility. 3
Sec. 22. An HVAC assessment report created pursuant to 4
section 14.5 of this act and reviewed by a mechanical engineer 5
pursuant to section 18 of this act and a report submitted to the 6
Division by the administrator of a senior living facility pursuant to 7
section 21 of this act are public records and are available for 8
public inspection. 9
Sec. 22.5. 1. The Administrator of the Division of Public and 10
Behavioral Health of the Department of Health and Human Services 11
shall regularly monitor the amount of federal money available to 12
facilitate the compliance of senior living facilities with the 13
provisions of sections 2 to 22, inclusive, of this act. On the date on 14
which the Administrator determines that there is insufficient federal 15
money available for that purpose, the Administrator shall transmit 16
notice of that determination to the Governor and the Director of the 17
Legislative Counsel Bureau. 18
2. As used in this section, “senior living facility” has the 19
meaning ascribed to it in section 7 of this act. 20
Sec. 23. This act becomes effective upon passage and 21
approval, and expires by limitation on the date on which the 22
Director of the Legislative Counsel Bureau receives notice of a 23
determination by the Administrator of the Division of Public and 24
Behavioral Health of the Department of Health and Human Services 25
pursuant to section 22.5 of this act that there is insufficient federal 26
money available to facilitate the compliance of senior living 27
facilities with the provisions of sections 2 to 22, inclusive, of this 28
act. 29
H