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  • Technical Bulletin
  • STD

Minor Consent for Sexually Transmitted Disease Prevention and Treatment Services

Background

Prior to the passage of SB 172, Nevada Revised Statute (NRS) 430A.180 excluded providers from being able to provide minors certain medical services, including STD treatment, if the provider is a Family Resource Center that has received a grant from the Director of the Department of Health and Human Services unless written consent has been obtained from the minor’s parent, guardian or legal custodian. However, Senate Bill (SB) 172 of the 82nd Legislative Session which went into effect June 5, 2023, expanded access for minors to obtain sexually transmitted disease (STD) prevention and treatment services without parental or legal guardian consent.

Additionally, prior to the passage of SB 172, Nevada Revised Statutes (NRS) 129.060 authorized a minor to be examined or treated if suspected of being infected or infected with any sexually transmitted disease (STD) without the consent of the parent(s) or legal guardian(s) of the minor by a local state health officer, licensed physician or clinic. However, SB 172 removes the restrictions on Family Resource Centers to allow them to provide certain services for the prevention of STDs and pregnancy; added physician assistants and registered nurses as provider types; clarified minor consent is needed before exam and treatment; and added preventive STD and pregnancy services are allowable services to minors without parental, guardian or legal custodian consent.

The following changes per the enrolled bill are outlined below:

  • Clarifies that a minor must consent to such examination or treatment before the examination or treatment is provided.
  • Addition of two (2) medical provider types — physician assistant and registered nurse1 — to the authorized list of medical providers that can conduct an examination, treat or both; and
  • Addition of preventive services for STDs and issue a prescription for the dispensing of or administration of a contraceptive drug or device under the minor consent
    • Preventive services for STDs include, but are not limited to, HIV pre-exposure prophylaxis (PrEP) and the Human Papillomavirus (HPV) vaccine.
    • Service can be provided by a licensed local or state health officer, licensed physician, physician assistant, registered nurse,1 pharmacist or clinic.
  • Addition of physician, physician assistant, registered nurse1 or pharmacist who is an employee or volunteer at such a Family Resource Center to provide services for the prevention or treatment of STDs or prescribe, dispense or administer a contraceptive drug or device to a minor without consent of the parent, guardian or legal custodian.

Information about contraception and STD treatment and prevention access can be found at these websites:

Services relating to the Nevada State Immunization Program and record entry into NV WebIZ

As the addition of preventive services for STDs includes human papillomavirus (HPV) vaccination, the Nevada State Immunization Program (NSIP) is in the process of enhancing the Nevada WebIZ system to include a special “flag” to indicate access to record of an HPV dose should be protected. Use of this flag will prevent the HPV vaccination(s) from appearing on an immunization record obtained by non- healthcare providers through the NV WebIZ Public Portal. This will ensure the intent of SB 172 is met. Until the enhancement is in place (expected fall/winter 2024), providers and clinics are encouraged to do the following when administering an HPV vaccine to a minor without parental/guardian consent:

  • Create a duplicate NV WebIZ record for that patient (only if an immunization record already exists for that minor),
  • Enter the HPV vaccination details in the new record only, and add a note to the record that says, “DO NOT MERGE; MINOR CONSENT PROTECTION.”

NSIP acknowledges that creating a duplicate record is not an ideal solution, but it is the best and only option until the WebIZ enhancement is in place. Adding the note to the record will help NSIP staff avoid merging the HPV record with any other record existing for the minor patient.

Services relating to Human Immunodeficiency Virus

The addition of preventive services also includes HIV Pre-Exposure Prophylaxis (PrEP). The Centers for Disease Control and Prevention (CDC) recommends PrEP as an HIV prevention strategy. Taking PrEP medication as prescribed reduces the risk of contracting HIV via sexual contact by about 99% and by at least 74% among persons who inject drugs (PWID). Two (2) medications — Truvada® (emtricitabine and tenofovir disoproxil fumarate) and Descovy® (emtricitabine and tenofovir alafenamide) — are approved for daily use as an HIV PrEP regimen.

When taken every day, PrEP is usually safe and highly effective in preventing HIV infection. While concrete data is not yet available, PrEP reaches maximum protection from HIV in about seven (7) to about twenty (20) days of daily use. PrEP providers can be found online here.

Questions

For updated guidance, review the Division of Public and Behavioral Health Technical Bulletin web page regularly. Contact Vickie Ives at vives@health.nv.gov or call (775) 684-2201 for other questions regarding this bulletin.

References

1 Registered nurses (RNs) do not have prescriptive authority or independent practice. An order from a practitioner is required for an RN to treat or administer medications. Advanced Practice Registered Nurses (APRN) are a different provider type and do have prescriptive authority and independent practice in Nevada. All healthcare providers are required to practice within the scope of practice for the license they hold.