Referred to Committee on Health and Human Services
SUMMARY--Makes various changes relating to coverage of health care services to women in certain policies of health insurance. (BDR 57-320)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State or on Industrial Insurance: No.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to health care; requiring certain entities that issue policies of health insurance which provide health care services through managed care to allow a woman who is covered by any such policy to have direct access to any covered health care services for women; requiring that certain policies of health insurance include a provision in the policy authorizing a woman to remain in a hospital or medical facility for a minimum number of hours after giving birth to a child; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
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Section 1 Chapter 687B of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 9, inclusive, of this act.
Sec. 2 As used in sections 2 to 9, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 to 7, inclusive, of this act have the meanings ascribed to them in those sections.
Sec. 3 "Health care services for women" means gynecological or obstetrical services, including, without limitation, perinatal care, preventive gynecological care and reproductive health care services.
Sec. 4 "Managed care" means a method of providing or arranging for the provision of health care services, other than a method based on fee-for-service wherein an insurer:
1. Reimburses a provider of health care for each service provided to an insured;
2. Allows an insured to choose any provider of health care and does not encourage the use of any specific provider of health care; and
3. Does not require any preauthorization or referral for a specific service to be covered.
The term includes, without limitation, a health maintenance organization, preferred provider organization, point-of-service plan or exclusive provider organization.
Sec. 5 "Managed care organization" means an organization that provides managed care.
Sec. 6 "Primary care physician" means a physician whose responsibilities include, without limitation, providing initial and primary health care services to an insured, maintaining the continuity of care for the insured and referring the insured to a specialist when necessary.
Sec. 7 "Provider of health care" means any physician, hospital or other person who is licensed or otherwise authorized in this state to furnish any health care service.
Sec. 8 1. An insurer that issues a policy of health insurance which provides health care services through managed care and a managed care organization that issues a policy of health insurance shall include in any such policy a provision authorizing a woman covered by the policy to obtain covered health care services for women without first receiving authorization or a referral from her primary care physician.
2. A policy subject to the provisions of this section that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
Sec. 9 1. An insurer that issues a policy of health insurance that provides for health care services through managed care and a managed care organization that issues a policy of health insurance which provides coverage of parturition shall include in any such policy a provision authorizing a woman covered by the policy to remain in the hospital or medical facility in which she gives birth for:
(a) Not less than 48 hours after a normal vaginal delivery; or
(b) Not less than 96 hours after undergoing a cesarean section.
2. A policy subject to the provisions of this section that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal that is in conflict with this section is void.
Sec. 10 NRS 687B.225 is hereby amended to read as follows:
687B.225 1. [Any] Except as otherwise provided in section 8 of this act, a contract for group, blanket or individual health insurance or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care which provides for payment of a certain part of medical or dental care may require the insured or member to obtain prior authorization for that care from the insurer or organization. The insurer or organization shall:
(a) File its procedure for obtaining approval of care [under] pursuant to this section for approval by the commissioner; and
(b) Respond to any request for approval by the insured or member [under] pursuant to this section within 20 days after it receives the request.
2. The procedure for prior authorization may not discriminate among persons licensed to provide the covered care.
Sec. 11 Chapter 689B of NRS is hereby amended by adding thereto a new section to read as follows:
1. If a policy of group health insurance provides coverage of parturition, the insurer shall include in the policy a provision authorizing a woman covered by the policy to remain in the hospital or medical facility in which she gives birth for:
(a) Not less than 48 hours after a normal vaginal delivery; or
(b) Not less than 96 hours after undergoing a cesarean section.
2. A policy subject to the provisions of this section that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal that is in conflict with this section is void.
Sec. 12 NRS 695C.055 is hereby amended to read as follows:
695C.0551. The provisions of NRS 449.465, 679B.158 and 680B.025 to 680B.060, inclusive, subsections 2, 4, 18, 19 and 32 of NRS 680B.010 and NRS 689C.015 to 689C.350, inclusive, and sections 2 to 9, inclusive, of this act apply to a health maintenance organization.
2. For the purposes of subsection 1, unless the context requires that a provision apply only to insurers, any reference in those sections to "insurer" must be replaced by "health maintenance organization."
Sec. 13 NRS 287.010 is hereby amended to read as follows:
287.010 1. The governing body of any county, school district, municipal corporation, political subdivision, public corporation or other public agency of the State of Nevada may:
(a) Adopt and carry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of its officers and employees, and the dependents of officers and employees who elect to accept the insurance and who, where necessary, have authorized the governing body to make deductions from their compensation for the payment of premiums on the insurance.
(b) Purchase group policies of life, accident or health insurance, or any combination thereof, for the benefit of such officers and employees, and the dependents of such officers and employees, as have authorized the purchase, from insurance companies authorized to transact the business of such insurance in the State of Nevada, and, where necessary, deduct from the compensation of officers and employees the premiums upon insurance and pay the deductions upon the premiums.
(c) Provide group life, accident or health coverage through a self-insurance reserve fund and, where necessary, deduct contributions to the maintenance of the fund from the compensation of officers and employees and pay the deductions into the fund. The money accumulated for this purpose through deductions from the compensation of officers and employees and contributions of the governing body must be maintained as an internal service fund as defined by NRS 354.543. The money must be deposited in a state or national bank authorized to transact business in the State of Nevada. Any independent administrator of a fund created [under] pursuant to this section is subject to the licensing requirements of chapter 683A of NRS, and must be a resident of this state. Any contract with an independent administrator must be approved by the commissioner of insurance as to the reasonableness of administrative charges in relation to contributions collected and benefits provided. The provisions of NRS 689B.030 to 689B.050, inclusive, and section 11 of this act, apply to coverage provided pursuant to this paragraph.
(d) Defray part or all of the cost of maintenance of a self-insurance fund or of the premiums upon insurance. The money for contributions must be budgeted for in accordance with the laws governing the county, school district, municipal corporation, political subdivision, public corporation or other public agency of the State of Nevada.
2. If a school district offers group insurance to its officers and employees pursuant to this section, members of the board of trustees of the school district must not be excluded from participating in the group insurance. If the amount of the deductions from compensation required to pay for the group insurance exceeds the compensation to which a trustee is entitled, the difference must be paid by the trustee.
Sec. 14 The provisions of this act apply to all contracts for health insurance entered into or renewed on or after October 1, 1997.