REQUIRES TWO-THIRDS MAJORITY VOTE (§ 7)

S.B. 315

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SENATE BILL NO. 315–SENATORS WOODHOUSE, RATTI,

CANNIZZARO, DONDERO LOOP, PARKS; BROOKS, CANCELA

AND DENIS

MARCH 18, 2019 ____________

Referred to Committee on Health and Human Services

SUMMARY—Revises provisions relating to public health.

(BDR 40-581) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. 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 public health; creating the Rare Disease Advisory Council within the Department of Health and Human Services; requiring information concerning the importance of annual physical examinations for children to be provided in certain programs, activities, notifications and courses; providing for the issuance of special license plates to increase awareness of childhood cancer; exempting the special license plates from certain provisions otherwise applicable to special license plates; requiring certain licensing boards to encourage continuing education in the diagnosis of rare diseases and disseminate information concerning childhood cancers; and providing other matters properly relating thereto.

Legislative Counsel’s Digest: Existing law establishes certain programs to improve public health in this State. 1 (NRS 439.495-439.5297) Section 2 of this bill creates the Rare Disease Advisory 2 Council within the Department of Health and Human Services to study issues 3 relating to the prevalence and treatment of rare diseases in this State. Section 3 of 4 this bill prescribes the duties of the Council, which include annually compiling a 5 public report. Section 3 requires the report to contain a summary of the activities of 6 the Council and any recommendations of the Council for legislation and other 7 policies. 8 Existing law requires the Division of Public and Behavioral Health of the 9 Department of Health and Human Services to take necessary measures to prevent 10 the spread of sickness and disease and enforce all health laws and regulations. 11 (NRS 439.170) Section 4 of this bill requires the Division to include information 12

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concerning the importance of annual physical examinations by a provider of health 13 care for children in appropriate public health programs and activities. Section 5 of 14 this bill requires the board of trustees of a school district or the governing body of a 15 charter school to include such information in any written communication with the 16 parents or guardians of pupils related to the health of pupils. 17 Existing law requires health and physical education to be taught in all public 18 schools in this State. (NRS 389.018) Section 6 of this bill requires those courses to 19 include instruction concerning the importance of annual physical examinations by a 20 provider of health care and the appropriate response to unusual aches and pains. 21 Section 7 of this bill requires the Department of Motor Vehicles to design, 22 prepare and issue special license plates to increase awareness of childhood cancer. 23 A person wishing to obtain the special license plates must pay to the Department a 24 fee for initial issuance of $35 and a fee for renewal of $10, along with all applicable 25 registration and license fees and governmental services taxes. Section 7 requires 26 those fees to be credited to the Department and used to pay any expenses of the 27 Rare Disease Advisory Council and other programs and services related to 28 childhood cancer. A person wishing to obtain the special license plates may also 29 request that the plates be combined with personalized prestige plates if the person 30 pays the additional fees for the personalized prestige plates. 31 Under existing law, certain special license plates: (1) must be approved by the 32 Department, based on a recommendation from the Commission on Special License 33 Plates; (2) are subject to a limitation on the number of separate designs of special 34 license plates which the Department may issue at any one time; and (3) may not be 35 designed, prepared or issued by the Department unless a certain number of 36 applications for the plates are received. (NRS 482.367004, 482.367008, 482.36705) 37 Sections 11-13 of this bill exempt the special license plates to increase awareness 38 of childhood cancer from each of the preceding requirements. Sections 8-10 and 39 14-16 of this bill make conforming changes. 40 Existing law requires physicians, physician assistants and registered nurses to 41 receive certain continuing education. (NRS 630.253, 632.343, 633.471) Sections 42 18, 20 and 22 of this bill require the Board of Medical Examiners, the State Board 43 of Nursing and the State Board of Osteopathic Medicine to encourage physicians, 44 physician assistants and advanced practice registered nurses to receive, as a portion 45 of that continuing education, training and education in the diagnosis of rare 46 diseases. Sections 17, 19 and 21 of this bill require those licensing boards to 47 annually disseminate to physicians, physician assistants and registered nurses who 48 care for children information concerning the signs of pediatric cancer. 49

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 439 of NRS is hereby amended by adding 1 thereto the provisions set forth as sections 2 and 3 of this act. 2 Sec. 2. 1. The Rare Disease Advisory Council is hereby 3 created within the Department of Health and Human Services. 4 The Director shall appoint to the Council the following members: 5 (a) Not more than three physicians who practice in the area of 6 cardiology, emergency care, neurology, oncology, orthopedics, 7 pediatrics or primary care and provide care to patients with rare 8 diseases; 9

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(b) Two registered nurses who provide care to patients with 1 rare diseases; 2 (c) Not more than two administrators of hospitals that provide 3 care to patients with rare diseases or their designees; 4 (d) One representative of the Division who provides education 5 concerning rare diseases or the management of chronic 6 conditions; 7 (e) The employee of the Division who is responsible for 8 epidemiology services; 9 (f) Two persons over 18 years of age who have suffered from 10 or currently suffer from a rare disease; 11 (g) Two parents or guardians who each have a child with a 12 rare disease; and 13 (h) One representative of an organization dedicated to 14 providing services to patients suffering from rare diseases. 15 2. The Council may, by affirmative vote of a majority of its 16 members, request for the Director to appoint to the Council 17 additional members who have expertise on issues studied by the 18 Council. Such members serve for a period determined by the 19 Council. 20 3. A vacancy in the membership of the Council must be filled 21 in the same manner as the initial appointment. 22 4. The members of the Council serve without compensation 23 and are not entitled to the per diem and travel expenses provided 24 for state officers and employees generally. 25 5. Each member of the Council who is an officer or employee 26 of this State or a political subdivision of this State must be relieved 27 from his or her duties without loss of regular compensation so that 28 the officer or employee may prepare for and attend meetings of the 29 Council and perform any work necessary to carry out the duties of 30 the Council in the most timely manner practicable. A state agency 31 or political subdivision of this State shall not require an officer or 32 employee who is a member of the Council to make up the time the 33 officer or employee is absent from work to carry out duties as a 34 member of the Council or use annual leave or compensatory time 35 for the absence. 36 6. The Department shall provide such administrative support 37 to the Council as is necessary to carry out the duties of the 38 Council. 39 7. The Council shall: 40 (a) Elect a Chair from among its members; and 41 (b) Meet at least once every 3 months at the times and places 42 specified by a call of the Chair and may meet at such further times 43 as deemed necessary by the Chair. 44

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Sec. 3. 1. The Rare Disease Advisory Council created by 1 section 2 of this act shall: 2 (a) Perform a statistical and qualitative examination of the 3 incidence, causes and economic burden of rare diseases in this 4 State; 5 (b) Receive and consider reports and testimony concerning 6 rare diseases from persons, the Division, community-based 7 organizations, providers of health care and other local and 8 national organizations whose work relates to rare diseases; 9 (c) Increase awareness of the burden caused by rare diseases 10 in this State; 11 (d) Identify evidence-based strategies to prevent and control 12 rare diseases; 13 (e) Determine the effect of delayed or inappropriate treatment 14 on the quality of life for patients suffering from rare diseases and 15 the economy of this State; 16 (f) Study the effect of early treatment for rare diseases on the 17 quality of life for patients suffering from rare diseases, the 18 provision of services to such patients and reimbursement for such 19 services; 20 (g) Increase awareness among providers of health care of the 21 symptoms of and care for patients with rare diseases; 22 (h) Evaluate the systems for delivery of treatment for rare 23 diseases in place in this State and develop recommendations to 24 increase the survival rates and quality of life of patients with rare 25 diseases; 26 (i) Determine effective methods of collecting data concerning 27 cases of rare diseases in this State for the purpose of conducting 28 epidemiological studies of rare diseases in this State; 29 (j) Establish a comprehensive plan for the management of rare 30 diseases in this State, which must include, without limitation, 31 recommendations for the Department, the Division, local health 32 districts, public and private organizations, businesses and 33 potential sources of funding, and update the comprehensive plan 34 as necessary; and 35 (k) Develop a registry of rare diseases diagnosed in this State 36 to determine the genetic and environmental factors that contribute 37 to such rare diseases. 38 2. The Council shall compile an annual report which must 39 include, without limitation, a summary of the activities of the 40 Council and any recommendations of the Council for legislation 41 or other policies. The Council shall: 42 (a) Post the report on an Internet website maintained by the 43 Department; and 44

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(b) Submit the report to the Department, the Governor and the 1 Director of the Legislative Counsel Bureau for transmittal to: 2 (1) In even-numbered years, the next regular session of the 3 Legislature; and 4 (2) In odd-numbered years, the Legislative Committee on 5 Health Care. 6 3. As used in this section, “provider of health care” has the 7 meaning ascribed to it in NRS 629.031. 8 Sec. 4. NRS 439.170 is hereby amended to read as follows: 9 439.170 1. The Division shall take such measures as may be 10 necessary to prevent the spread of sickness and disease, and shall 11 possess all powers necessary to fulfill the duties and exercise the 12 authority prescribed by law and to bring actions in the courts for the 13 enforcement of all health laws and lawful rules and regulations. 14 2. The Division shall include in appropriate public health 15 programs and activities information concerning the importance of 16 an annual physical examination by a provider of health care for 17 children. 18 Sec. 5. Chapter 388 of NRS is hereby amended by adding 19 thereto a new section to read as follows: 20 The board of trustees of a school district or the governing body 21 of a charter school shall include in any written communication 22 with the parent or guardian of a pupil related to the health of 23 pupils information concerning the importance of an annual 24 physical examination by a provider of health care for children. 25 Sec. 6. NRS 389.018 is hereby amended to read as follows: 26 389.018 1. The following subjects are designated as the core 27 academic subjects that must be taught, as applicable for grade 28 levels, in all public schools, the Caliente Youth Center, the Nevada 29 Youth Training Center and any other state facility for the detention 30 of children that is operated pursuant to title 5 of NRS: 31 (a) English language arts; 32 (b) Mathematics; 33 (c) Science; and 34 (d) Social studies, which includes only the subjects of history, 35 geography, economics and government. 36 2. Except as otherwise provided in this subsection, a pupil 37 enrolled in a public high school must enroll in a minimum of: 38 (a) Four units of credit in English language arts; 39 (b) Four units of credit in mathematics, including, without 40 limitation, Algebra I and geometry, or an equivalent course of study 41 that integrates Algebra I and geometry; 42 (c) Three units of credit in science, including two laboratory 43 courses; and 44

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(d) Three units of credit in social studies, including, without 1 limitation: 2 (1) American government; 3 (2) American history; and 4 (3) World history or geography. 5 A pupil is not required to enroll in the courses of study and 6 credits required by this subsection if the pupil, the parent or legal 7 guardian of the pupil and an administrator or a counselor at the 8 school in which the pupil is enrolled mutually agree to a modified 9 course of study for the pupil and that modified course of study 10 satisfies at least the requirements for a standard high school 11 diploma, an adjusted diploma or an alternative diploma, as 12 applicable. 13 3. Except as otherwise provided in this subsection, in addition 14 to the core academic subjects, the following subjects must be taught 15 as applicable for grade levels and to the extent practicable in all 16 public schools, the Caliente Youth Center, the Nevada Youth 17 Training Center and any other state facility for the detention of 18 children that is operated pursuant to title 5 of NRS: 19 (a) The arts; 20 (b) Computer education and technology; 21 (c) Health; and 22 (d) Physical education. 23 If the State Board requires the completion of course work in a 24 subject area set forth in this subsection for graduation from high 25 school or promotion to the next grade, a public school shall offer the 26 required course work. Except as otherwise provided for a course of 27 study in health prescribed by subsection 1 of NRS 389.021, unless a 28 subject is required for graduation from high school or promotion to 29 the next grade, a charter school is not required to comply with this 30 subsection. 31 4. Instruction in health and physical education provided 32 pursuant to subsection 3 must include, without limitation, 33 instruction concerning the importance of annual physical 34 examinations by a provider of health care and the appropriate 35 response to unusual aches and pains. 36 Sec. 7. Chapter 482 of NRS is hereby amended by adding 37 thereto a new section to read as follows: 38 1. The Department, in cooperation with organizations 39 selected by the Department whose work relates to childhood 40 cancer, shall design, prepare and issue license plates to increase 41 awareness of childhood cancer using any colors and designs 42 which the Department deems appropriate. The design of the 43 license plates must include the phrase “Cure Childhood Cancer.” 44

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2. The Department shall issue license plates to increase 1 awareness of childhood cancer for a passenger car or light 2 commercial vehicle upon application by a person who is entitled to 3 license plates pursuant to NRS 482.265 and who otherwise 4 complies with the requirements for registration and licensing 5 pursuant to this chapter. A person may request that personalized 6 prestige license plates issued pursuant to NRS 482.3667 be 7 combined with license plates to increase awareness of childhood 8 cancer if that person pays the fees for the personalized prestige 9 license plates in addition to the fees for the license plates to 10 increase awareness of childhood cancer pursuant to subsection 3. 11 3. The fee for license plates to increase awareness of 12 childhood cancer is $35, in addition to all other applicable 13 registration and license fees and governmental services taxes. The 14 license plates are renewable upon the payment of $10. 15 4. The provisions of NRS 482.36705 do not apply to license 16 plates described in this section. 17 5. If, during a registration period, the holder of license plates 18 issued pursuant to the provisions of this section disposes of the 19 vehicle to which the plates are affixed, the holder shall: 20 (a) Retain the plates and affix them to another vehicle that 21 meets the requirements of this section if the holder pays the fee for 22 the transfer of the registration and any registration fee or 23 governmental services taxes due pursuant to NRS 482.399; or 24 (b) Within 30 days after removing the plates from the vehicle, 25 return them to the Department. 26 6. The Department may accept any gifts, grants and 27 donations or other sources of money for the production and 28 issuance of the special license plates pursuant to this section. 29 7. The Department shall deposit the fees collected pursuant to 30 subsection 4 with the State Treasurer for credit to the Department 31 of Health and Human Services. The money may be used by the 32 Department of Health and Human Services only: 33 (a) To pay any expenses of the Rare Disease Advisory Council 34 created by section 2 of this act; and 35 (b) For other programs and services related to childhood 36 cancer. 37 Sec. 8. NRS 482.216 is hereby amended to read as follows: 38 482.216 1. Except as otherwise provided in NRS 482.2155, 39 upon the request of a new vehicle dealer, the Department may 40 authorize the new vehicle dealer to: 41 (a) Accept applications for the registration of the new motor 42 vehicles he or she sells and the related fees and taxes; 43 (b) Issue certificates of registration to applicants who satisfy the 44 requirements of this chapter; and 45

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(c) Accept applications for the transfer of registration pursuant 1 to NRS 482.399 if the applicant purchased from the new vehicle 2 dealer a new vehicle to which the registration is to be transferred. 3 2. A new vehicle dealer who is authorized to issue certificates 4 of registration pursuant to subsection 1 shall: 5 (a) Transmit the applications received to the Department within 6 the period prescribed by the Department; 7 (b) Transmit the fees collected from the applicants and properly 8 account for them within the period prescribed by the Department; 9 (c) Comply with the regulations adopted pursuant to subsection 10 5; and 11 (d) Bear any cost of equipment which is necessary to issue 12 certificates of registration, including any computer hardware or 13 software. 14 3. A new vehicle dealer who is authorized to issue certificates 15 of registration pursuant to subsection 1 shall not: 16 (a) Charge any additional fee for the performance of those 17 services; 18 (b) Receive compensation from the Department for the 19 performance of those services; 20 (c) Accept applications for the renewal of registration of a motor 21 vehicle; or 22 (d) Accept an application for the registration of a motor vehicle 23 if the applicant wishes to: 24 (1) Obtain special license plates pursuant to NRS 482.3667 25 to 482.3823, inclusive [;] , and section 7 of this act; or 26 (2) Claim the exemption from the governmental services tax 27 provided pursuant to NRS 361.1565 to veterans and their relations. 28 4. The provisions of this section do not apply to the registration 29 of a moped pursuant to NRS 482.2155. 30 5. The Director shall adopt such regulations as are necessary to 31 carry out the provisions of this section. The regulations adopted 32 pursuant to this subsection must provide for: 33 (a) The expedient and secure issuance of license plates and 34 decals by the Department; and 35 (b) The withdrawal of the authority granted to a new vehicle 36 dealer pursuant to subsection 1 if that dealer fails to comply with the 37 regulations adopted by the Department. 38 Sec. 9. NRS 482.2703 is hereby amended to read as follows: 39 482.2703 1. The Director may order the preparation of 40 sample license plates which must be of the same design and size as 41 regular license plates or license plates issued pursuant to NRS 42 482.384. The Director shall ensure that: 43 (a) Each license plate issued pursuant to this subsection, 44 regardless of its design, is inscribed with the word SAMPLE and an 45

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identical designation which consists of the same group of three 1 numerals followed by the same group of three letters; and 2 (b) The designation of numerals and letters assigned pursuant to 3 paragraph (a) is not assigned to a vehicle registered pursuant to this 4 chapter or chapter 706 of NRS. 5 2. The Director may order the preparation of sample license 6 plates which must be of the same design and size as any of the 7 special license plates issued pursuant to NRS 482.3667 to 482.3823, 8 inclusive [.] , and section 7 of this act. The Director shall ensure 9 that: 10 (a) Each license plate issued pursuant to this subsection, 11 regardless of its design, is inscribed with the word SAMPLE and the 12 number zero in the location where any other numerals would 13 normally be displayed on a license plate of that design; and 14 (b) The number assigned pursuant to paragraph (a) is not 15 assigned to a vehicle registered pursuant to this chapter or chapter 16 706 of NRS. 17 3. The Director may establish a fee for the issuance of sample 18 license plates of not more than $15 for each license plate. 19 4. A decal issued pursuant to NRS 482.271 may be displayed 20 on a sample license plate issued pursuant to this section. 21 5. All money collected from the issuance of sample license 22 plates must be deposited in the State Treasury for credit to the 23 Motor Vehicle Fund. 24 6. A person shall not affix a sample license plate issued 25 pursuant to this section to a vehicle. A person who violates the 26 provisions of this subsection is guilty of a misdemeanor. 27 Sec. 10. NRS 482.274 is hereby amended to read as follows: 28 482.274 1. The Director shall order the preparation of vehicle 29 license plates for trailers in the same manner provided for motor 30 vehicles in NRS 482.270, except that a vehicle license plate 31 prepared for a full trailer or semitrailer that is registered pursuant to 32 subsection 3 of NRS 482.483 is not required to have displayed upon 33 it the month and year the registration expires. 34 2. The Director shall order preparation of two sizes of vehicle 35 license plates for trailers. The smaller plates may be used for trailers 36 with a gross vehicle weight of less than 1,000 pounds. 37 3. The Director shall determine the registration numbers 38 assigned to trailers. 39 4. Any license plates issued for a trailer before July 1, 1975, 40 bearing a different designation from that provided for in this section, 41 are valid during the period for which such plates were issued. 42 5. Any license plates issued for a trailer before 43 January 1, 1982, are not subject to reissue pursuant to subsection 2 44 of NRS 482.265. 45

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6. The Department shall not issue for a full trailer or semitrailer 1 that is registered pursuant to subsection 3 of NRS 482.483 a special 2 license plate available pursuant to NRS 482.3667 to 482.3823, 3 inclusive [.] , and section 7 of this act. 4 Sec. 11. NRS 482.367004 is hereby amended to read as 5 follows: 6 482.367004 1. There is hereby created the Commission on 7 Special License Plates. The Commission is advisory to the 8 Department and consists of five Legislators and three nonvoting 9 members as follows: 10 (a) Five Legislators appointed by the Legislative Commission: 11 (1) One of whom is the Legislator who served as the Chair of 12 the Assembly Standing Committee on Transportation during the 13 most recent legislative session. That Legislator may designate an 14 alternate to serve in place of the Legislator when absent. The 15 alternate must be another Legislator who also served on the 16 Assembly Standing Committee on Transportation during the most 17 recent legislative session. 18 (2) One of whom is the Legislator who served as the Chair of 19 the Senate Standing Committee on Transportation during the most 20 recent legislative session. That Legislator may designate an alternate 21 to serve in place of the Legislator when absent. The alternate must 22 be another Legislator who also served on the Senate Standing 23 Committee on Transportation during the most recent legislative 24 session. 25 (b) Three nonvoting members consisting of: 26 (1) The Director of the Department of Motor Vehicles, or a 27 designee of the Director. 28 (2) The Director of the Department of Public Safety, or a 29 designee of the Director. 30 (3) The Director of the Department of Tourism and Cultural 31 Affairs, or a designee of the Director. 32 2. Each member of the Commission appointed pursuant to 33 paragraph (a) of subsection 1 serves a term of 2 years, commencing 34 on July 1 of each odd-numbered year. A vacancy on the 35 Commission must be filled in the same manner as the original 36 appointment. 37 3. Members of the Commission serve without salary or 38 compensation for their travel or per diem expenses. 39 4. The Director of the Legislative Counsel Bureau shall 40 provide administrative support to the Commission. 41 5. The Commission shall recommend to the Department that 42 the Department approve or disapprove: 43

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(a) Applications for the design, preparation and issuance of 1 special license plates that are submitted to the Department pursuant 2 to subsection 1 of NRS 482.367002; 3 (b) The issuance by the Department of special license plates that 4 have been designed and prepared pursuant to NRS 482.367002; and 5 (c) Except as otherwise provided in subsection 7, applications 6 for the design, preparation and issuance of special license plates that 7 have been authorized by an act of the Legislature after 8 January 1, 2007. 9 In determining whether to recommend to the Department the 10 approval of such an application or issuance, the Commission shall 11 consider, without limitation, whether it would be appropriate and 12 feasible for the Department to, as applicable, design, prepare or 13 issue the particular special license plate. For the purpose of making 14 recommendations to the Department, the Commission shall consider 15 each application in the chronological order in which the application 16 was received by the Department. 17 6. On or before September 1 of each fiscal year, the 18 Commission shall compile a list of each special license plate for 19 which the Commission, during the immediately preceding fiscal 20 year, recommended to the Department that the Department approve 21 the application for the special license plate or approve the issuance 22 of the special license plate. The list so compiled must set forth, for 23 each such plate, the cause or charitable organization for which the 24 special license plate generates or would generate financial support, 25 and the intended use to which the financial support is being put or 26 would be put. The Commission shall transmit the information 27 described in this subsection to the Department and the Department 28 shall make that information available on its Internet website. 29 7. The provisions of paragraph (c) of subsection 5 do not apply 30 with regard to special license plates that are issued pursuant to NRS 31 482.3746, 482.3751, 482.3752, 482.3757, 482.3783, 482.3785, 32 482.3787 or 482.37901 [.] or section 7 of this act. 33 8. The Commission shall: 34 (a) Recommend to the Department that the Department approve 35 or disapprove any proposed change in the distribution of money 36 received in the form of additional fees. As used in this paragraph, 37 “additional fees” means the fees that are charged in connection with 38 the issuance or renewal of a special license plate for the benefit of a 39 particular cause, fund or charitable organization. The term does not 40 include registration and license fees or governmental services taxes. 41 (b) If it recommends a proposed change pursuant to paragraph 42 (a) and determines that legislation is required to carry out the 43 change, recommend to the Department that the Department request 44

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the assistance of the Legislative Counsel in the preparation of a bill 1 draft to carry out the change. 2 Sec. 12. NRS 482.367008 is hereby amended to read as 3 follows: 4 482.367008 1. As used in this section, “special license plate” 5 means: 6 (a) A license plate that the Department has designed and 7 prepared pursuant to NRS 482.367002 in accordance with the 8 system of application and petition described in that section; 9 (b) A license plate approved by the Legislature that the 10 Department has designed and prepared pursuant to NRS 482.3747, 11 482.37903, 482.37905, 482.37917, 482.379175, 482.37918, 12 482.37919, 482.3792, 482.3793, 482.37933, 482.37934, 482.37935, 13 482.379355, 482.379365, 482.37937, 482.379375, 482.37938, 14 482.37939, 482.37945 or 482.37947; and 15 (c) Except for a license plate that is issued pursuant to NRS 16 482.3746, 482.3751, 482.3752, 482.3757, 482.3783, 482.3785, 17 482.3787 or 482.37901, or section 7 of this act, a license plate that 18 is approved by the Legislature after July 1, 2005. 19 2. Notwithstanding any other provision of law to the contrary, 20 and except as otherwise provided in subsection 3, the Department 21 shall not, at any one time, issue more than 30 separate designs of 22 special license plates. Whenever the total number of separate 23 designs of special license plates issued by the Department at any one 24 time is less than 30, the Department shall issue a number of 25 additional designs of special license plates that have been authorized 26 by an act of the Legislature or the application for which has been 27 recommended by the Commission on Special License Plates to be 28 approved by the Department pursuant to subsection 5 of NRS 29 482.367004, not to exceed a total of 30 designs issued by the 30 Department at any one time. Such additional designs must be issued 31 by the Department in accordance with the chronological order of 32 their authorization or approval by the Department. 33 3. In addition to the special license plates described in 34 subsection 2, the Department may issue not more than five separate 35 designs of special license plates in excess of the limit set forth in 36 that subsection. To qualify for issuance pursuant to this subsection: 37 (a) The Commission on Special License Plates must have 38 recommended to the Department that the Department approve the 39 design, preparation and issuance of the special plates as described in 40 paragraphs (a) and (b) of subsection 5 of NRS 482.367004; and 41 (b) The special license plates must have been applied for, 42 designed, prepared and issued pursuant to NRS 482.367002, except 43 that: 44

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(1) The application for the special license plates must be 1 accompanied by a surety bond posted with the Department in the 2 amount of $20,000; and 3 (2) Pursuant to the assessment of the viability of the design 4 of the special license plates that is conducted pursuant to this 5 section, it is determined that at least 3,000 special license plates 6 have been issued. 7 4. Except as otherwise provided in this subsection, on 8 October 1 of each year the Department shall assess the viability of 9 each separate design of special license plate that the Department is 10 currently issuing by determining the total number of validly 11 registered motor vehicles to which that design of special license 12 plate is affixed. The Department shall not determine the total 13 number of validly registered motor vehicles to which a particular 14 design of special license plate is affixed if: 15 (a) The particular design of special license plate was designed 16 and prepared by the Department pursuant to NRS 482.367002; and 17 (b) On October 1, that particular design of special license plate 18 has been available to be issued for less than 12 months. 19 5. If, on October 1, the total number of validly registered motor 20 vehicles to which a particular design of special license plate is 21 affixed is: 22 (a) In the case of special license plates not described in 23 subsection 3, less than 1,000; or 24 (b) In the case of special license plates described in subsection 25 3, less than 3,000, 26 the Director shall provide notice of that fact in the manner 27 described in subsection 6. 28 6. The notice required pursuant to subsection 5 must be 29 provided: 30 (a) If the special license plate generates financial support for a 31 cause or charitable organization, to that cause or charitable 32 organization. 33 (b) If the special license plate does not generate financial 34 support for a cause or charitable organization, to an entity which is 35 involved in promoting the activity, place or other matter that is 36 depicted on the plate. 37 7. If, on December 31 of the same year in which notice was 38 provided pursuant to subsections 5 and 6, the total number of validly 39 registered motor vehicles to which a particular design of special 40 license plate is affixed is: 41 (a) In the case of special license plates not described in 42 subsection 3, less than 1,000; or 43 (b) In the case of special license plates described in subsection 44 3, less than 3,000, 45

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the Director shall, notwithstanding any other provision of law to 1 the contrary, issue an order providing that the Department will no 2 longer issue that particular design of special license plate. Except as 3 otherwise provided in subsection 2 of NRS 482.265, such an order 4 does not require existing holders of that particular design of special 5 license plate to surrender their plates to the Department and does not 6 prohibit those holders from renewing those plates. 7 Sec. 13. NRS 482.36705 is hereby amended to read as 8 follows: 9 482.36705 1. Except as otherwise provided in subsection 2: 10 (a) If a new special license plate is authorized by an act of the 11 Legislature after January 1, 2003, other than a special license plate 12 that is authorized pursuant to NRS 482.379375, the Legislature will 13 direct that the license plate not be designed, prepared or issued by 14 the Department unless the Department receives at least 1,000 15 applications for the issuance of that plate within 2 years after the 16 effective date of the act of the Legislature that authorized the plate. 17 (b) In addition to the requirements set forth in paragraph (a), if a 18 new special license plate is authorized by an act of the Legislature 19 after July 1, 2005, the Legislature will direct that the license plate 20 not be issued by the Department unless its issuance complies with 21 subsection 2 of NRS 482.367008. 22 (c) In addition to the requirements set forth in paragraphs (a) and 23 (b), if a new special license plate is authorized by an act of the 24 Legislature after January 1, 2007, the Legislature will direct that the 25 license plate not be designed, prepared or issued by the Department 26 unless the Commission on Special License Plates recommends to 27 the Department that the Department approve the application for the 28 authorized plate pursuant to NRS 482.367004. 29 2. The provisions of subsection 1 do not apply with regard to 30 special license plates that are issued pursuant to NRS 482.3746, 31 482.3751, 482.3752, 482.3757, 482.3783, 482.3785, 482.3787 or 32 482.37901 [.] or section 7 of this act. 33 Sec. 14. NRS 482.38276 is hereby amended to read as 34 follows: 35 482.38276 “Special license plate” means: 36 1. A license plate that the Department has designed and 37 prepared pursuant to NRS 482.367002 in accordance with the 38 system of application and petition described in that section; 39 2. A license plate approved by the Legislature that the 40 Department has designed and prepared pursuant to NRS 482.3747, 41 482.37903, 482.37904, 482.37905, 482.37917, 482.379175, 42 482.37918, 482.37919, 482.3792, 482.3793, 482.37933, 482.37934, 43 482.37935, 482.379355, 482.379365, 482.37937, 482.379375, 44 482.37938, 482.37939, 482.37945 or 482.37947; and 45

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3. Except for a license plate that is issued pursuant to NRS 1 482.3746, 482.3757, 482.3785, 482.3787 or 482.37901 [,] or 2 section 7 of this act, a license plate that is approved by the 3 Legislature after July 1, 2005. 4 Sec. 15. NRS 482.399 is hereby amended to read as follows: 5 482.399 1. Upon the transfer of the ownership of or interest 6 in any vehicle by any holder of a valid registration, or upon 7 destruction of the vehicle, the registration expires. 8 2. Except as otherwise provided in NRS 482.2155 and 9 subsection 3 of NRS 482.483, the holder of the original registration 10 may transfer the registration to another vehicle to be registered by 11 the holder and use the same regular license plate or plates or special 12 license plate or plates issued pursuant to NRS 482.3667 to 13 482.3823, inclusive, and section 7 of this act, or 482.384, on the 14 vehicle from which the registration is being transferred, if the 15 license plate or plates are appropriate for the second vehicle, upon 16 filing an application for transfer of registration and upon paying the 17 transfer registration fee and the excess, if any, of the registration fee 18 and governmental services tax on the vehicle to which the 19 registration is transferred over the total registration fee and 20 governmental services tax paid on all vehicles from which he or she 21 is transferring ownership or interest. Except as otherwise provided 22 in NRS 482.294, an application for transfer of registration must be 23 made in person, if practicable, to any office or agent of the 24 Department or to a registered dealer, and the license plate or plates 25 may not be used upon a second vehicle until registration of that 26 vehicle is complete. 27 3. In computing the governmental services tax, the 28 Department, its agent or the registered dealer shall credit the portion 29 of the tax paid on the first vehicle attributable to the remainder of 30 the current registration period or calendar year on a pro rata monthly 31 basis against the tax due on the second vehicle or on any other 32 vehicle of which the person is the registered owner. If any person 33 transfers ownership or interest in two or more vehicles, the 34 Department or the registered dealer shall credit the portion of the tax 35 paid on all of the vehicles attributable to the remainder of the 36 current registration period or calendar year on a pro rata monthly 37 basis against the tax due on the vehicle to which the registration is 38 transferred or on any other vehicle of which the person is the 39 registered owner. The certificates of registration and unused license 40 plates of the vehicles from which a person transfers ownership or 41 interest must be submitted before credit is given against the tax due 42 on the vehicle to which the registration is transferred or on any other 43 vehicle of which the person is the registered owner. 44

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4. In computing the registration fee, the Department or its 1 agent or the registered dealer shall credit the portion of the 2 registration fee paid on each vehicle attributable to the remainder of 3 the current calendar year or registration period on a pro rata basis 4 against the registration fee due on the vehicle to which registration 5 is transferred. 6 5. If the amount owed on the registration fee or governmental 7 services tax on the vehicle to which registration is transferred is less 8 than the credit on the total registration fee or governmental services 9 tax paid on all vehicles from which a person transfers ownership or 10 interest, the person may apply the unused portion of the credit to the 11 registration of any other vehicle owned by the person. Any unused 12 portion of such a credit expires on the date the registration of the 13 vehicle from which the person transferred the registration was due 14 to expire. 15 6. If the license plate or plates are not appropriate for the 16 second vehicle, the plate or plates must be surrendered to the 17 Department or registered dealer and an appropriate plate or plates 18 must be issued by the Department. The Department shall not reissue 19 the surrendered plate or plates until the next succeeding licensing 20 period. 21 7. If application for transfer of registration is not made within 22 60 days after the destruction or transfer of ownership of or interest 23 in any vehicle, the license plate or plates must be surrendered to the 24 Department on or before the 60th day for cancellation of the 25 registration. 26 8. Except as otherwise provided in subsection 2 of NRS 27 371.040, NRS 482.2155, subsections 7 and 8 of NRS 482.260 and 28 subsection 3 of NRS 482.483, if a person cancels his or her 29 registration and surrenders to the Department the license plates for a 30 vehicle, the Department shall: 31 (a) In accordance with the provisions of subsection 9, issue to 32 the person a refund of the portion of the registration fee and 33 governmental services tax paid on the vehicle attributable to the 34 remainder of the current calendar year or registration period on a pro 35 rata basis; or 36 (b) If the person does not qualify for a refund in accordance with 37 the provisions of subsection 9, issue to the person a credit in the 38 amount of the portion of the registration fee and governmental 39 services tax paid on the vehicle attributable to the remainder of the 40 current calendar year or registration period on a pro rata basis. Such 41 a credit may be applied by the person to the registration of any other 42 vehicle owned by the person. Any unused portion of the credit 43 expires on the date the registration of the vehicle from which the 44 person obtained a refund was due to expire. 45

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9. The Department shall issue a refund pursuant to subsection 8 1 only if the request for a refund is made at the time the registration is 2 cancelled and the license plates are surrendered, the person 3 requesting the refund is a resident of Nevada, the amount eligible 4 for refund exceeds $100, and evidence satisfactory to the 5 Department is submitted that reasonably proves the existence of 6 extenuating circumstances. For the purposes of this subsection, the 7 term “extenuating circumstances” means circumstances wherein: 8 (a) The person has recently relinquished his or her driver’s 9 license and has sold or otherwise disposed of his or her vehicle. 10 (b) The vehicle has been determined to be inoperable and the 11 person does not transfer the registration to a different vehicle. 12 (c) The owner of the vehicle is seriously ill or has died and the 13 guardians or survivors have sold or otherwise disposed of the 14 vehicle. 15 (d) Any other event occurs which the Department, by regulation, 16 has defined to constitute an “extenuating circumstance” for the 17 purposes of this subsection. 18 Sec. 16. NRS 482.500 is hereby amended to read as follows: 19 482.500 1. Except as otherwise provided in subsection 2 or 3 20 or specifically provided by statute, whenever upon application any 21 duplicate or substitute certificate of registration, indicator, decal or 22 number plate is issued, the following fees must be paid: 23 24

For a certificate of registration ........................................ $5.00 25 For every substitute number plate or set of plates ............. 5.00 26 For every duplicate number plate or set of plates ............ 10.00 27 For every decal displaying a county name ........................ .50 28 For every other indicator, decal, license plate sticker 29

or tab............................................................................. 5.00 30 31 2. The following fees must be paid for any replacement 32 number plate or set of plates issued for the following special license 33 plates: 34 (a) For any special plate issued pursuant to NRS 482.3667, 35 482.367002, 482.3672, 482.3675, 482.370 to 482.3755, inclusive, 36 and section 7 of this act, 482.376 or 482.379 to 482.3818, inclusive, 37 a fee of $10. 38 (b) For any special plate issued pursuant to NRS 482.368, 39 482.3765, 482.377 or 482.378, a fee of $5. 40 (c) Except as otherwise provided in paragraph (a) of subsection 41 1 of NRS 482.3824, for any souvenir license plate issued pursuant 42 to NRS 482.3825 or sample license plate issued pursuant to NRS 43 482.2703, a fee equal to that established by the Director for the 44 issuance of those plates. 45

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3. A fee must not be charged for a duplicate or substitute of a 1 decal issued pursuant to NRS 482.37635. 2 4. The fees which are paid for replacement number plates, 3 duplicate number plates and decals displaying county names must 4 be deposited with the State Treasurer for credit to the Motor Vehicle 5 Fund and allocated to the Department to defray the costs of 6 replacing or duplicating the plates and manufacturing the decals. 7 Sec. 17. Chapter 630 of NRS is hereby amended by adding 8 thereto a new section to read as follows: 9 The Board shall develop and disseminate annually to each 10 licensed physician and physician assistant who cares for children 11 information concerning the signs and symptoms of pediatric 12 cancer. 13 Sec. 18. NRS 630.253 is hereby amended to read as follows: 14 630.253 1. The Board shall, as a prerequisite for the: 15 (a) Renewal of a license as a physician assistant; or 16 (b) Biennial registration of the holder of a license to practice 17 medicine, 18 require each holder to submit evidence of compliance with the 19 requirements for continuing education as set forth in regulations 20 adopted by the Board. 21 2. These requirements: 22 (a) May provide for the completion of one or more courses of 23 instruction relating to risk management in the performance of 24 medical services. 25 (b) Must provide for the completion of a course of instruction, 26 within 2 years after initial licensure, relating to the medical 27 consequences of an act of terrorism that involves the use of a 28 weapon of mass destruction. The course must provide at least 4 29 hours of instruction that includes instruction in the following 30 subjects: 31 (1) An overview of acts of terrorism and weapons of mass 32 destruction; 33 (2) Personal protective equipment required for acts of 34 terrorism; 35 (3) Common symptoms and methods of treatment associated 36 with exposure to, or injuries caused by, chemical, biological, 37 radioactive and nuclear agents; 38 (4) Syndromic surveillance and reporting procedures for acts 39 of terrorism that involve biological agents; and 40 (5) An overview of the information available on, and the use 41 of, the Health Alert Network. 42 (c) Must provide for the completion by a holder of a license to 43 practice medicine of a course of instruction within 2 years after 44 initial licensure that provides at least 2 hours of instruction on 45

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evidence-based suicide prevention and awareness as described in 1 subsection 5. 2 The Board may thereafter determine whether to include in a 3 program of continuing education additional courses of instruction 4 relating to the medical consequences of an act of terrorism that 5 involves the use of a weapon of mass destruction. 6 3. The Board shall encourage each holder of a license who 7 treats or cares for persons who are more than 60 years of age to 8 receive, as a portion of their continuing education, education in 9 geriatrics and gerontology, including such topics as: 10 (a) The skills and knowledge that the licensee needs to address 11 aging issues; 12 (b) Approaches to providing health care to older persons, 13 including both didactic and clinical approaches; 14 (c) The biological, behavioral, social and emotional aspects of 15 the aging process; and 16 (d) The importance of maintenance of function and 17 independence for older persons. 18 4. The Board shall encourage each holder of a license to 19 practice medicine to receive, as a portion of his or her continuing 20 education, training concerning methods for educating patients about 21 how to effectively manage medications, including, without 22 limitation, the ability of the patient to request to have the symptom 23 or purpose for which a drug is prescribed included on the label 24 attached to the container of the drug. 25 5. The Board shall require each holder of a license to practice 26 medicine to receive as a portion of his or her continuing education at 27 least 2 hours of instruction every 4 years on evidence-based suicide 28 prevention and awareness, which may include, without limitation, 29 instruction concerning: 30 (a) The skills and knowledge that the licensee needs to detect 31 behaviors that may lead to suicide, including, without limitation, 32 post-traumatic stress disorder; 33 (b) Approaches to engaging other professionals in suicide 34 intervention; and 35 (c) The detection of suicidal thoughts and ideations and the 36 prevention of suicide. 37 6. The Board shall encourage each holder of a license to 38 practice medicine or as a physician assistant to receive, as a 39 portion of his or her continuing education, training and education 40 in the diagnosis of rare diseases, including, without limitation: 41 (a) Recognizing the symptoms of pediatric cancer; and 42 (b) Interpreting family history to determine whether such 43 symptoms indicate a normal childhood illness or a condition that 44 requires additional examination. 45

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7. A holder of a license to practice medicine may not substitute 1 the continuing education credits relating to suicide prevention and 2 awareness required by this section for the purposes of satisfying an 3 equivalent requirement for continuing education in ethics. 4 [7.] 8. A holder of a license to practice medicine may 5 substitute not more than 2 hours of continuing education credits in 6 pain management or addiction care for the purposes of satisfying an 7 equivalent requirement for continuing education in ethics. 8 [8.] 9. As used in this section: 9 (a) “Act of terrorism” has the meaning ascribed to it in 10 NRS 202.4415. 11 (b) “Biological agent” has the meaning ascribed to it in 12 NRS 202.442. 13 (c) “Chemical agent” has the meaning ascribed to it in 14 NRS 202.4425. 15 (d) “Radioactive agent” has the meaning ascribed to it in 16 NRS 202.4437. 17 (e) “Weapon of mass destruction” has the meaning ascribed to it 18 in NRS 202.4445. 19 Sec. 19. NRS 632.120 is hereby amended to read as follows: 20 632.120 1. The Board shall: 21 (a) Adopt regulations establishing reasonable standards: 22 (1) For the denial, renewal, suspension and revocation of, 23 and the placement of conditions, limitations and restrictions upon, a 24 license to practice professional or practical nursing or a certificate to 25 practice as a nursing assistant or medication aide - certified. 26 (2) Of professional conduct for the practice of nursing. 27 (3) For prescribing and dispensing controlled substances and 28 dangerous drugs in accordance with applicable statutes. 29 (4) For the psychiatric training and experience necessary for 30 an advanced practice registered nurse to be authorized to make the 31 evaluations and examinations described in NRS 433A.160, 32 433A.240 and 433A.430 and the certifications described in NRS 33 433A.170, 433A.195 and 433A.200. 34 (b) Prepare and administer examinations for the issuance of a 35 license or certificate under this chapter. 36 (c) Investigate and determine the eligibility of an applicant for a 37 license or certificate under this chapter. 38 (d) Carry out and enforce the provisions of this chapter and the 39 regulations adopted pursuant thereto. 40 (e) Develop and disseminate annually to each registered nurse 41 who cares for children information concerning the signs and 42 symptoms of pediatric cancer. 43 2. The Board may adopt regulations establishing reasonable: 44

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(a) Qualifications for the issuance of a license or certificate 1 under this chapter. 2 (b) Standards for the continuing professional competence of 3 licensees or holders of a certificate. The Board may evaluate 4 licensees or holders of a certificate periodically for compliance with 5 those standards. 6 3. The Board may adopt regulations establishing a schedule of 7 reasonable fees and charges, in addition to those set forth in NRS 8 632.345, for: 9 (a) Investigating licensees or holders of a certificate and 10 applicants for a license or certificate under this chapter; 11 (b) Evaluating the professional competence of licensees or 12 holders of a certificate; 13 (c) Conducting hearings pursuant to this chapter; 14 (d) Duplicating and verifying records of the Board; and 15 (e) Surveying, evaluating and approving schools of practical 16 nursing, and schools and courses of professional nursing, 17 and collect the fees established pursuant to this subsection. 18 4. For the purposes of this chapter, the Board shall, by 19 regulation, define the term “in the process of obtaining 20 accreditation.” 21 5. The Board may adopt such other regulations, not 22 inconsistent with state or federal law, as may be necessary to carry 23 out the provisions of this chapter relating to nursing assistant 24 trainees, nursing assistants and medication aides - certified. 25 6. The Board may adopt such other regulations, not 26 inconsistent with state or federal law, as are necessary to enable it to 27 administer the provisions of this chapter. 28 Sec. 20. NRS 632.343 is hereby amended to read as follows: 29 632.343 1. The Board shall not renew any license issued 30 under this chapter until the licensee has submitted proof satisfactory 31 to the Board of completion, during the 2-year period before renewal 32 of the license, of 30 hours in a program of continuing education 33 approved by the Board in accordance with regulations adopted by 34 the Board. Except as otherwise provided in subsection 3, the 35 licensee is exempt from this provision for the first biennial period 36 after graduation from: 37 (a) An accredited school of professional nursing; 38 (b) An accredited school of practical nursing; 39 (c) An approved school of professional nursing in the process of 40 obtaining accreditation; or 41 (d) An approved school of practical nursing in the process of 42 obtaining accreditation. 43 2. The Board shall review all courses offered to nurses for the 44 completion of the requirement set forth in subsection 1. The Board 45

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may approve nursing and other courses which are directly related to 1 the practice of nursing as well as others which bear a reasonable 2 relationship to current developments in the field of nursing or any 3 special area of practice in which a licensee engages. These may 4 include academic studies, workshops, extension studies, home study 5 and other courses. 6 3. The program of continuing education required by subsection 7 1 must include: 8 (a) For a person licensed as an advanced practice registered 9 nurse, a course of instruction to be completed within 2 years after 10 initial licensure that provides at least 2 hours of instruction on 11 suicide prevention and awareness as described in subsection 5. 12 (b) For each person licensed pursuant to this chapter, a course of 13 instruction, to be completed within 2 years after initial licensure, 14 relating to the medical consequences of an act of terrorism that 15 involves the use of a weapon of mass destruction. The course must 16 provide at least 4 hours of instruction that includes instruction in the 17 following subjects: 18 (1) An overview of acts of terrorism and weapons of mass 19 destruction; 20 (2) Personal protective equipment required for acts of 21 terrorism; 22 (3) Common symptoms and methods of treatment associated 23 with exposure to, or injuries caused by, chemical, biological, 24 radioactive and nuclear agents; 25 (4) Syndromic surveillance and reporting procedures for acts 26 of terrorism that involve biological agents; and 27 (5) An overview of the information available on, and the use 28 of, the Health Alert Network. 29 The Board may thereafter determine whether to include in a 30 program of continuing education additional courses of instruction 31 relating to the medical consequences of an act of terrorism that 32 involves the use of a weapon of mass destruction. 33 4. The Board shall encourage each licensee who treats or cares 34 for persons who are more than 60 years of age to receive, as a 35 portion of their continuing education, education in geriatrics and 36 gerontology, including such topics as: 37 (a) The skills and knowledge that the licensee needs to address 38 aging issues; 39 (b) Approaches to providing health care to older persons, 40 including both didactic and clinical approaches; 41 (c) The biological, behavioral, social and emotional aspects of 42 the aging process; and 43 (d) The importance of maintenance of function and 44 independence for older persons. 45

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5. The Board shall require each person licensed as an advanced 1 practice registered nurse to receive as a portion of his or her 2 continuing education at least 2 hours of instruction every 4 years on 3 evidence-based suicide prevention and awareness or another course 4 of instruction on suicide prevention and awareness that is approved 5 by the Board which the Board has determined to be effective and 6 appropriate. 7 6. The Board shall encourage each person licensed as an 8 advanced practice registered nurse to receive, as a portion of his 9 or her continuing education, training and education in the 10 diagnosis of rare diseases, including, without limitation: 11 (a) Recognizing the symptoms of pediatric cancer; and 12 (b) Interpreting family history to determine whether such 13 symptoms indicate a normal childhood illness or a condition that 14 requires additional examination. 15 7. As used in this section: 16 (a) “Act of terrorism” has the meaning ascribed to it in 17 NRS 202.4415. 18 (b) “Biological agent” has the meaning ascribed to it in 19 NRS 202.442. 20 (c) “Chemical agent” has the meaning ascribed to it in 21 NRS 202.4425. 22 (d) “Radioactive agent” has the meaning ascribed to it in 23 NRS 202.4437. 24 (e) “Weapon of mass destruction” has the meaning ascribed to it 25 in NRS 202.4445. 26 Sec. 21. Chapter 633 of NRS is hereby amended by adding 27 thereto a new section to read as follows: 28 The Board shall develop and disseminate annually to each 29 licensed osteopathic physician and physician assistant who cares 30 for children information concerning the signs and symptoms of 31 pediatric cancer. 32 Sec. 22. NRS 633.471 is hereby amended to read as follows: 33 633.471 1. Except as otherwise provided in subsection 9 and 34 NRS 633.491, every holder of a license issued under this chapter, 35 except a temporary or a special license, may renew the license on or 36 before January 1 of each calendar year after its issuance by: 37 (a) Applying for renewal on forms provided by the Board; 38 (b) Paying the annual license renewal fee specified in this 39 chapter; 40 (c) Submitting a list of all actions filed or claims submitted to 41 arbitration or mediation for malpractice or negligence against the 42 holder during the previous year; 43 (d) Submitting evidence to the Board that in the year preceding 44 the application for renewal the holder has attended courses or 45

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programs of continuing education approved by the Board in 1 accordance with regulations adopted by the Board totaling a number 2 of hours established by the Board which must not be less than 35 3 hours nor more than that set in the requirements for continuing 4 medical education of the American Osteopathic Association; and 5 (e) Submitting all information required to complete the renewal. 6 2. The Secretary of the Board shall notify each licensee of the 7 requirements for renewal not less than 30 days before the date of 8 renewal. 9 3. The Board shall request submission of verified evidence of 10 completion of the required number of hours of continuing medical 11 education annually from no fewer than one-third of the applicants 12 for renewal of a license to practice osteopathic medicine or a license 13 to practice as a physician assistant. Upon a request from the Board, 14 an applicant for renewal of a license to practice osteopathic 15 medicine or a license to practice as a physician assistant shall submit 16 verified evidence satisfactory to the Board that in the year preceding 17 the application for renewal the applicant attended courses or 18 programs of continuing medical education approved by the Board 19 totaling the number of hours established by the Board. 20 4. The Board shall require each holder of a license to practice 21 osteopathic medicine to complete a course of instruction within 2 22 years after initial licensure that provides at least 2 hours of 23 instruction on evidence-based suicide prevention and awareness as 24 described in subsection 7. 25 5. The Board shall encourage each holder of a license to 26 practice osteopathic medicine to receive, as a portion of his or her 27 continuing education, training concerning methods for educating 28 patients about how to effectively manage medications, including, 29 without limitation, the ability of the patient to request to have the 30 symptom or purpose for which a drug is prescribed included on the 31 label attached to the container of the drug. 32 6. The Board shall encourage each holder of a license to 33 practice osteopathic medicine or as a physician assistant to 34 receive, as a portion of his or her continuing education, training 35 and education in the diagnosis of rare diseases, including, without 36 limitation: 37 (a) Recognizing the symptoms of pediatric cancer; and 38 (b) Interpreting family history to determine whether such 39 symptoms indicate a normal childhood illness or a condition that 40 requires additional examination. 41 7. The Board shall require, as part of the continuing education 42 requirements approved by the Board, the biennial completion by a 43 holder of a license to practice osteopathic medicine of at least 2 44

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hours of continuing education credits in ethics, pain management or 1 addiction care. 2 [7.] 8. The Board shall require each holder of a license to 3 practice osteopathic medicine to receive as a portion of his or her 4 continuing education at least 2 hours of instruction every 4 years on 5 evidence-based suicide prevention and awareness which may 6 include, without limitation, instruction concerning: 7 (a) The skills and knowledge that the licensee needs to detect 8 behaviors that may lead to suicide, including, without limitation, 9 post-traumatic stress disorder; 10 (b) Approaches to engaging other professionals in suicide 11 intervention; and 12 (c) The detection of suicidal thoughts and ideations and the 13 prevention of suicide. 14 [8.] 9. A holder of a license to practice osteopathic medicine 15 may not substitute the continuing education credits relating to 16 suicide prevention and awareness required by this section for the 17 purposes of satisfying an equivalent requirement for continuing 18 education in ethics. 19 [9.] 10. Members of the Armed Forces of the United States 20 and the United States Public Health Service are exempt from 21 payment of the annual license renewal fee during their active duty 22 status. 23 Sec. 23. The Rare Disease Advisory Council created by 24 section 2 of this act shall meet not later than 90 days after the 25 effective date of this section. 26 Sec. 24. The provisions of subsection 1 of NRS 218D.380 do 27 not apply to any provision of this act which adds or revises a 28 requirement to submit a report to the Legislature. 29 Sec. 25. 1. This section and sections 1, 2, 3, 23 and 24 of this 30 act become effective upon passage and approval. 31 2. Sections 4 to 22, inclusive, of this act become effective: 32 (a) Upon passage and approval for the purpose of adopting any 33 regulations and performing any other preparatory administrative 34 tasks that are necessary to carry out the provisions of this act; and 35 (b) On January 1, 2020, for all other purposes. 36

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