Nev. Rev. Stat. ch. 695C – Health Maintenance Organizations | Midpage

Collections
Nevada Revised Statutes

Chapter 695C

Nev. Rev. Stat. ch. 695C

Health Maintenance Organizations

695C.010Short title 695C.020Legislative declaration 695C.030Definitions 695C.050Applicability of certain provisions 695C.055Applicability of certain other provisions 695C.057Applicability of certain provisions concerning portability and availability of health insurance 695C.060Establishment of health maintenance organization 695C.070Certificate of authority: Application 695C.080Certificate of authority: Evaluation of application 695C.090Certificate of authority: Issuance 695C.100Certificate of authority: Denial 695C.110Governing body: Composition; participation by enrollees 695C.120Powers of health maintenance organization 695C.123Contracts with certain federally qualified health centers 695C.125Contract between health maintenance organization and provider of health care: Organization required to use form to obtain information on provider of health care; modification; submission by organization of schedule of payments to provider 695C.128Contracts to provide services pursuant to certain state programs: Payment of interest on claims 695C.130Notice and approval required for exercise of powers; rules or regulations 695C.140Notice and approval required for modification of operations; regulations 695C.145Accounting principles required for certain reports and transactions; health maintenance organization subject to requirements for certain insurers 695C.150Fiduciary responsibilities 695C.160Investments 695C.161Definitions 695C.163Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency 695C.165Health maintenance organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is enrolled in health care plan 695C.167Certain accommodations required to be made when child is covered under health care plan of noncustodial parent 695C.169Health maintenance organization required to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child 695C.1691Required provision in certain plans concerning coverage for continued medical treatment; exceptions; regulations 695C.1693Required provision concerning coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of health maintenance organization to require certain information; immunity from liability 695C.16932Required provision concerning coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior authorization 695C.16934Required provision concerning coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence; restriction on refusal to cover certain treatments; authority of health maintenance organization to prescribe requirements for covering surgical treatments for minors; determination of medical necessity 695C.1694Required provision in plan covering prescription drugs or devices concerning coverage of hormone replacement therapy in certain circumstances; prohibited acts; exception 695C.16945Plan covering prescription drugs: Required actions by health maintenance organization related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared 695C.16946Required provision concerning coverage of recipients of Medicaid for antipsychotic or anticonvulsant medication that is not on list of preferred prescription drugs upon failure of drug on list to treat condition 695C.16947Plan covering prescription drugs: Submission to step therapy for drug to treat psychiatric condition prohibited in certain circumstances 695C.1695Required provision in plan covering outpatient care concerning coverage of health care services related to hormone replacement therapy; prohibited acts 695C.1696Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions 695C.1698Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts 695C.1699Required provision concerning coverage for certain drugs and services related to substance use disorder and opioid use disorder; reimbursement of pharmacists and pharmacies for certain services; prohibited acts 695C.170Evidence of coverage: Issuance; form and contents 695C.1701Health maintenance organization required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances 695C.1703Evidence of coverage covering prescription drugs: Provision of notice and information regarding use of formulary 695C.1705Group health care plan issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability to self-insured employer 695C.1708Required provision concerning coverage for services provided through telehealth to same extent as though provided in person or by other means; required provision concerning reimbursement for certain services provided through telehealth in same amount as though provided in person or by other means; prohibited acts; requirements for certain health maintenance organizations concerning teledentistry 695C.1709Required provision in group insurance policy concerning continuing coverage for enrollee on leave without pay as result of total disability 695C.17095Plan covering prescription drug for treatment of medical condition that is part of step therapy protocol: Use of certain guidelines required; establishment of process to request exemption from step therapy protocol required; granting of request; applicability of provisions 695C.171Required provision in plan covering mastectomies concerning coverage relating to mastectomy; prohibited acts 695C.1712Health care plan covering maternity care: Prohibited acts by organization if enrollee is acting as gestational carrier; child deemed child of intended parent for purposes of plan 695C.1713Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician; designation of obstetrician or gynecologist as primary care physician 695C.1715Required provision concerning coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as treatment for stuttering for certain persons; prohibited acts 695C.1717Required provision concerning coverage for autism spectrum disorders for certain persons; prohibited acts 695C.172Evidence of coverage containing exclusion, reduction or limitation of coverage relating to complications of pregnancy; prohibited acts; exception 695C.1723Required provision concerning coverage for treatment of certain inherited metabolic diseases 695C.1727Required provision in evidence of coverage covering hospital, medical or surgical expenses concerning coverage for management and treatment of diabetes 695C.1728Required provision concerning coverage for management and treatment of sickle cell disease and its variants; plan covering prescription drugs required to provide coverage for medically necessary prescription drugs to treat sickle cell disease and its variants 695C.173Plan covering family member of enrollee required to include certain coverage for enrollee’s newly born and adopted children and children placed with enrollee for adoption 695C.17305Required provision for coverage for screening for lung cancer in health care plan that provides coverage for treatment for lung cancer 695C.1731Required provision in plan covering treatment of colorectal cancer concerning coverage for colorectal cancer screening 695C.1733Required provision in certain evidences of coverage concerning coverage for certain drugs and related services for treatment of cancer 695C.17333Plan covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Health maintenance organization required to allow enrollee or attending practitioner to apply for exemption from step therapy protocol in certain circumstances; procedure for applying for and granting exemption 695C.17335Plan covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy 695C.1734Evidence of coverage covering prescription drugs prohibited from limiting or excluding coverage for certain prescription drugs previously approved for medical condition of enrollee; exceptions 695C.17343Limitation on cost-sharing obligation for insulin covered under health care plan which provides coverage for prescription insulin 695C.17345Required provision in plan covering prescription drugs concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception 695C.17347Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances 695C.1735Required provision concerning coverage for certain screenings and tests for breast cancer; prohibited acts 695C.1736Required provision concerning coverage for testing, treatment and prevention of sexually transmitted diseases; required provision concerning coverage for condoms for certain insureds 695C.17365Required provision concerning coverage for noninvasive prenatal screening 695C.1737Required provision concerning coverage for examination of person who is pregnant for certain diseases 695C.1743Required provision concerning coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C; reimbursement of certain providers of health care for certain services; prohibited acts 695C.1745Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts 695C.1751Required provision in plan covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited act 695C.1753Required provision concerning coverage for dental service provided by qualified dental hygienist in certain circumstances 695C.1755Evidence of coverage prohibited from excluding coverage for treatment of temporomandibular joint; exception 695C.1757Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products 695C.1759Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by health maintenance organization if insured is person with disability 695C.176Required provision concerning coverage for hospice care 695C.1765Reimbursement for acupuncture 695C.177Reimbursement for treatments by licensed psychologist 695C.1773Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor 695C.1775Reimbursement for treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker 695C.178Reimbursement for treatment by chiropractic physician 695C.1783Reimbursement for treatment by podiatrist 695C.1789Reimbursement for treatment by licensed clinical alcohol and drug counselor 695C.179Reimbursement for services provided by certain nurses 695C.1795Reimbursement to provider of medical transportation 695C.1798Assignment of benefits by insured to provider of health care 695C.185Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certificate of authority for failure to comply 695C.187Schedule for payment of claims: Mandatory inclusion in arrangements for provision of health care 695C.190Commissioner authorized to require submission of information necessary to determine approval or disapproval of filing 695C.194Provision of health care services to recipients of Medicaid or enrollees in Children’s Health Insurance Program: Requirement to contract with hospital with certain endorsement for inclusion in network of providers 695C.200Approval of forms and schedules 695C.201Offering policy of health insurance for purposes of establishing health savings account 695C.202Provision of health care services to recipients of Medicaid: Notice to recipients if Nevada Health Authority obtains waiver to provide dental care to persons with diabetes; coordination to ensure receipt of such care 695C.203Health maintenance organization prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence 695C.204Health maintenance organization prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression 695C.205Health maintenance organization prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions 695C.207Health maintenance organization prohibited from requiring or using information concerning genetic testing 695C.210Annual report of financial condition and financial statement; quarterly statement; administrative penalty for failure to file timely report or statement; extension of time 695C.215Financial statement required to include report of net worth 695C.220Applications, filings and reports open to public inspection; exception 695C.230Fees; forwarding of premium tax 695C.240Information required to be available for inspection 695C.260Establishment of system for resolving complaints and system for conducting external review of adverse determinations required 695C.265Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations 695C.267Provision requiring binding arbitration authorized; procedures for arbitration; declaratory relief 695C.270Surety bond or deposit required; waiver 695C.275Commissioner required to adopt regulations for licensing of provider-sponsored organizations to extent authorized by federal law 695C.280Commissioner authorized to adopt regulations for licensing of agents or brokers 695C.290Insurance company authorized to establish or contract with health maintenance organization 695C.300Prohibited practices 695C.310Examinations by Commissioner: Affairs of and compliance program used by health maintenance organization; submission of books and records; assessment of expenses; exception 695C.311Examinations by Commissioner: Financial condition of health maintenance organization; application for initial certificate of authority; exception 695C.313Financial examination: Procedure; appointment of examiner; maintenance and use of records; penalty for obstruction or interference 695C.315Financial examination: Payment of expense 695C.317Procedures required for examination and hearing 695C.318Insolvency; determination of financial condition; actions by Commissioner; review; regulations 695C.319Power of Commissioner to order corrective action for hazardous operation or violation of law; regulations 695C.3195Conservation, rehabilitation or liquidation of health maintenance organization: Powers of Commissioner; claims of enrollees; distribution of general assets 695C.320Rehabilitation, liquidation or conservation: Conduct 695C.325Offering health care plan to certain small employers for purposes of establishing medical savings accounts 695C.326Health maintenance organization required to provide data relating to claims and costs to person responsible for overseeing health care plan upon request; annual report; format 695C.328Disclosure of data relating to claims and costs prohibited; exceptions; penalties for unauthorized disclosure 695C.329Penalty for failure of health maintenance organization to comply with certain requirements for electronic maintenance, transmittal and exchange of health information 695C.330Disciplinary proceedings: Grounds; effect of suspension or revocation 695C.340Disciplinary proceedings: Notice; hearing; judicial review 695C.350Violations: Remedies; penalties