Senate Bill 378, a broad health‑care measure presented May 21, combines multiple reforms supporters said would protect patients, curb surprise billing and restore trust in Nevada’s health system.

Sponsor Senator Fabian Donate described the bill as a multi‑part package that: requires patients receive electronic medical records at no cost within seven business days; regulates independent centers for emergency care (often called freestanding EDs) with separate licensing and new transparency and reporting; bans noncompete clauses for clinicians whose primary duties involve patient care; and authorizes Nevada Medicaid to prospectively investigate Medicaid fraud claims.

Donate and supporters framed the freestanding emergency department provisions as a response to the proliferation of facilities that present as emergency rooms but—claim supporters—operate in ways that can surprise patients with high bills and prompt unnecessary transfers. "There's a reason why Texas and Colorado have stopped the proliferation," Donate said, framing the bill as consumer protection.

Opponents — including hospital systems, the Nevada Hospital Association, Sunrise Health and Healthy Nevada Health Information Exchange — raised multiple concerns. Hospitals said freestanding emergency departments are licensed under the hospital license and provide full ED capability, that limiting operations or requiring triage/urgent care rules could reduce access, and that EMTALA legal obligations and integrated medical records complicate the proposed triage and billing rules.

A second, large area of contested testimony was Section 5, which would affect electronic health record (EHR) interoperability and the nonprofit health information exchange (HIE). Healthy Nevada and the HIE warned the bill language would force state agencies and providers to replace existing HIE connections with much more costly EHR vendor solutions, dramatically increasing costs and fragmenting data exchange. Witnesses estimated potential multi‑year costs in the tens of millions if the HIE option were removed, and urged deletion or a study before action.

Other provisions include a ban on noncompetes for most clinicians (sponsor limited the carve‑out to executives with proprietary access), transparency and licensing increases for freestanding EDs, and creation of a Medicaid claims review unit (with fiscal notes from Medicaid for staffing and from DPBH for licensing/programming).

Supporters included employer health plan coalitions, unions, gaming industry employers and first‑responder organizations that testified freestanding EDs can mean higher claims costs and out‑of‑pocket bills for workers. Opponents included hospital systems, health information exchange advocates, and several business groups worried about access and regulatory complexity.

Why it matters: SB 378 packages consumer protections (billing transparency and medical records access), changes to facility licensing, potential limits on freestanding ED billing, a ban on most clinical noncompetes and new Medicaid fraud authority. The bill touches procurement, patient access and large IT/interoperability systems and produced a lengthy policy and fiscal hearing with divided stakeholder testimony.

Discussion vs. decision: The committee held an extended combined policy and fiscal hearing; no committee vote was recorded on SB 378 during this session.

Ending: Sponsor and opponents agreed several topics require technical refinement; the bill’s fiscal notes show state costs for implementation of Medicaid and public‑health licensing provisions and significant concerns from the state’s health information exchange about large, potential IT replacement costs.