Assembly committee hears AB161 to tighten hospice oversight after reports of substandard care in Nevada

Assemblymember Rebecca Edgeworth (Assembly District 35) opened a bill hearing on AB161 before the Assembly Committee on Health and Human Services, calling the measure “a bill [that] addresses the appalling state of hospices in Nevada and seeks to improve care for people who are dying.”

Edgeworth told the committee she sponsored the bill after hearing reports of “unscrupulous hospices” enrolling patients without proper care and exploiting regulatory gaps. “There are hundreds of people lying in beds dying today who have no friends or family to advocate for them,” she said.

Karen Ruble, president and CEO of Nathan Adelson Hospice, described a rapidly growing number of licensed hospice entities in Clark County and a rise in troubling patient transfers to her nonprofit. Ruble said Nathan Adelson Hospice has served more than 88,000 people since its founding in 1978 and that staff have tracked transfers from other hospices: 21 transfers in 2022, 57 in 2023 and additional transfers in subsequent months. Ruble cited documented examples in which families reported patients in pain with no timely nursing visits, patients moved to emergency rooms because no hospice staff were available, patients arriving from other hospices in uninhabitable homes, and cases where patients were enrolled in hospice without family knowledge.

Dan Musgrove, representing Nathan Adelson Hospice and Strategies360, summarized the bill’s provisions as a work in progress. He told the committee AB161 would require hospices to maintain interdisciplinary teams, meet certain licensure and accreditation expectations, and provide the four levels of hospice care required under Medicare’s Conditions of Participation: routine home care, respite care, continuous home care and general inpatient care. Musgrove said some provisions that would create large fiscal notes are likely to be revised; he also identified a “grandfather clause” in the draft that would exempt providers licensed before Jan. 1, 2026, and said proponents want that clause removed.

Judy Lund Person, senior advisor for the National Partnership for Healthcare and Hospice Innovation, gave national context and described cases of hospice enrollments without patient or family consent. “She was on hospice from November 14 to March 12. And she never one time saw the hospice, any hospice professional,” Lund Person said of one California example.

Committee members asked detailed questions about oversight, workforce shortages and regulatory enforcement. Assemblymember Gray asked which agency inspects hospices; Musgrove and Ruble identified the Nevada Department of Health and Human Services’ Healthcare Quality and Compliance (HCQC) division and noted that enforcement is often complaint-driven. Ruble said many bad actors can “fly under the radar” because accrediting organizations do not always conduct routine follow-ups for smaller hospices.

Several organizations and individuals testified in support of AB161, including the Nevada Oncology Society; Las Vegas Heals; Nevada Rural Hospital Partners; professional clinicians; and patient advocates. Testimony emphasized the need for a patient bill of rights, stronger licensure and oversight, clear emergency-transfer arrangements, on-call physician access and better communication with patients and families about hospice election.

Supporters asked the committee to refine the draft to avoid unintended consequences for rural areas and for legitimate nonprofit hospices. Several witnesses suggested narrowing or removing provisions that could create an outsized fiscal note for state regulators; others recommended tightening credential requirements and removing grandfathering language that would exempt existing providers from new standards.

Several committee members urged sensitivity to workforce shortages and to avoid provisions that would discourage providers from operating in Nevada. Vice Chair Wynne suggested adding language to address language-access needs; Musgrove agreed that training and visitation requirements should ensure clinically qualified visitors (for example, nurses or physicians) rather than solely social workers.

No vote was taken. Proponents and some neutral stakeholders indicated a willingness to continue working with the sponsor to refine the bill’s regulatory language, reduce potential fiscal impacts and clarify enforcement mechanisms. The bill hearing closed with a request that proponents submit amended language for committee consideration.