Assembly Bill No. 162–Assemblymen Berman, Ohrenschall, Chowning, Freeman, Segerblom, Cegavske, Williams, Tiffany, Evans, Giunchigliani, Buckley, de Braga, McClain, Von Tobel, Angle and Koivisto

February 9, 1999

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Referred to Committee on Commerce and Labor

 

SUMMARY—Requires certain policies of health insurance to include coverage for services related to diagnosis, treatment and management of osteoporosis. (BDR 57-621)

FISCAL NOTE: Effect on Local Government: No.

Effect on the State or on Industrial Insurance: No.

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).

 

AN ACT relating to health insurance; requiring certain policies of health insurance to include coverage for services related to the diagnosis, treatment and management of osteoporosis; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

1-1 Section 1. Chapter 689A of NRS is hereby amended by adding thereto

1-2 a new section to read as follows:

1-3 1. A policy of health insurance must provide coverage for services

1-4 related to the diagnosis, treatment and management of osteoporosis,

1-5 including, without limitation:

1-6 (a) A baseline bone-mass measurement for women 55 years of age or

1-7 older;

1-8 (b) An annual bone-mass measurement for women who are at risk of

1-9 developing osteoporosis, including, without limitation, women who are

1-10 deficient in estrogen, women with vertebral abnormalities, women who

1-11 are receiving long-term glucocorticoid therapy, women with primary

1-12 hyperparathyroidism and women who have a family history of

1-13 osteoporosis; and

1-14 (c) A regular bone-mass measurement for men who are at risk of

1-15 developing osteoporosis, including, without limitation, men with vertebral

2-1 abnormalities, men who are receiving long-term glucocorticoid therapy,

2-2 men with primary hyperparathyroidism and men who have a family

2-3 history of osteoporosis.

2-4 2. A policy of health insurance subject to the provisions of this

2-5 chapter that is delivered, issued for delivery or renewed on or after

2-6 October 1, 1999, has the legal effect of including the coverage required

2-7 by this section, and any provision of the policy that conflicts with this

2-8 section is void.

2-9 3. As used in this section, "bone-mass measurement" means a

2-10 radiologic or radioisotopic procedure or other scientifically proven

2-11 technology performed on a person to identify bone mass or detect bone

2-12 loss, including, without limitation, peripheral dual energy X-ray

2-13 absorptiometry.

2-14 Sec. 2. NRS 689A.330 is hereby amended to read as follows:

2-15 689A.330 If any policy is issued by a domestic insurer for delivery to a

2-16 person residing in another state, and if the insurance commissioner or

2-17 corresponding public officer of that other state has informed the

2-18 commissioner that the policy is not subject to approval or disapproval by

2-19 that officer, the commissioner may by ruling require that the policy meet

2-20 the standards set forth in NRS 689A.030 to 689A.320, inclusive [.] , and

2-21 section 1 of this act.

2-22 Sec. 3. Chapter 689B of NRS is hereby amended by adding thereto a

2-23 new section to read as follows:

2-24 1. A policy of group health insurance must provide coverage for

2-25 services related to the diagnosis, treatment and management of

2-26 osteoporosis, including, without limitation:

2-27 (a) A baseline bone-mass measurement for women 55 years of age or

2-28 older;

2-29 (b) An annual bone-mass measurement for women who are at risk of

2-30 developing osteoporosis, including, without limitation, women who are

2-31 deficient in estrogen, women with vertebral abnormalities, women who

2-32 are receiving long-term glucocorticoid therapy, women with primary

2-33 hyperparathyroidism and women who have a family history of

2-34 osteoporosis; and

2-35 (c) A regular bone-mass measurement for men who are at risk of

2-36 developing osteoporosis, including, without limitation, men with vertebral

2-37 abnormalities, men who are receiving long-term glucocorticoid therapy,

2-38 men with primary hyperparathyroidism and men who have a family

2-39 history of osteoporosis.

2-40 2. A policy of group health insurance subject to the provisions of this

2-41 chapter that is delivered, issued for delivery or renewed on or after

2-42 October 1, 1999, has the legal effect of including the coverage required

3-1 by this section, and any provision of the policy that conflicts with this

3-2 section is void.

3-3 3. As used in this section, "bone-mass measurement" means a

3-4 radiologic or radioisotopic procedure or other scientifically proven

3-5 technology performed on a person to identify bone mass or detect bone

3-6 loss, including, without limitation, peripheral dual energy X-ray

3-7 absorptiometry.

3-8 Sec. 4. Chapter 695B of NRS is hereby amended by adding thereto a

3-9 new section to read as follows:

3-10 1. A contract for hospital or medical service must provide coverage

3-11 for services related to the diagnosis, treatment and management of

3-12 osteoporosis, including, without limitation:

3-13 (a) A baseline bone-mass measurement for women 55 years of age or

3-14 older;

3-15 (b) An annual bone-mass measurement for women who are at risk of

3-16 developing osteoporosis, including, without limitation, women who are

3-17 deficient in estrogen, women with vertebral abnormalities, women who

3-18 are receiving long-term glucocorticoid therapy, women with primary

3-19 hyperparathyroidism and women who have a family history of

3-20 osteoporosis; and

3-21 (c) A regular bone-mass measurement for men who are at risk of

3-22 developing osteoporosis, including, without limitation, men with vertebral

3-23 abnormalities, men who are receiving long-term glucocorticoid therapy,

3-24 men with primary hyperparathyroidism and men who have a family

3-25 history of osteoporosis.

3-26 2. A contract for hospital or medical service subject to the provisions

3-27 of this chapter that is delivered, issued for delivery or renewed on or after

3-28 October 1, 1999, has the legal effect of including the coverage required

3-29 by this section, and any provision of the contract that conflicts with this

3-30 section is void.

3-31 3. As used in this section, "bone-mass measurement" means a

3-32 radiologic or radioisotopic procedure or other scientifically proven

3-33 technology performed on a person to identify bone mass or detect bone

3-34 loss, including, without limitation, peripheral dual energy X-ray

3-35 absorptiometry.

3-36 Sec. 5. Chapter 695C of NRS is hereby amended by adding thereto a

3-37 new section to read as follows:

3-38 1. A health maintenance plan must provide coverage for services

3-39 related to the diagnosis, treatment and management of osteoporosis,

3-40 including, without limitation:

3-41 (a) A baseline bone-mass measurement for women 55 years of age or

3-42 older;

4-1 (b) An annual bone-mass measurement for women who are at risk of

4-2 developing osteoporosis, including, without limitation, women who are

4-3 deficient in estrogen, women with vertebral abnormalities, women who

4-4 are receiving long-term glucocorticoid therapy, women with primary

4-5 hyperparathyroidism and women who have a family history of

4-6 osteoporosis; and

4-7 (c) A regular bone-mass measurement for men who are at risk of

4-8 developing osteoporosis, including, without limitation, men with vertebral

4-9 abnormalities, men who are receiving long-term glucocorticoid therapy,

4-10 men with primary hyperparathyroidism and men who have a family

4-11 history of osteoporosis.

4-12 2. Evidence of coverage subject to the provisions of this chapter that

4-13 is delivered, issued for delivery or renewed on or after October 1, 1999,

4-14 has the legal effect of including the coverage required by this section,

4-15 and any provision of the evidence of coverage that conflicts with this

4-16 section is void.

4-17 3. As used in this section, "bone-mass measurement" means a

4-18 radiologic or radioisotopic procedure or other scientifically proven

4-19 technology performed on a person to identify bone mass or detect bone

4-20 loss, including, without limitation, peripheral dual energy X-ray

4-21 absorptiometry.

4-22 Sec. 6. NRS 695C.050 is hereby amended to read as follows:

4-23 695C.050 1. Except as otherwise provided in this chapter or in

4-24 specific provisions of this Title, the provisions of this Title are not

4-25 applicable to any health maintenance organization granted a certificate of

4-26 authority under this chapter. This provision does not apply to an insurer

4-27 licensed and regulated pursuant to this Title except with respect to its

4-28 activities as a health maintenance organization authorized and regulated

4-29 pursuant to this chapter.

4-30 2. Solicitation of enrollees by a health maintenance organization

4-31 granted a certificate of authority, or its representatives, must not be

4-32 construed to violate any provision of law relating to solicitation or

4-33 advertising by practitioners of a healing art.

4-34 3. Any health maintenance organization authorized under this chapter

4-35 shall not be deemed to be practicing medicine and is exempt from the

4-36 provisions of chapter 630 of NRS.

4-37 4. The provisions of NRS 695C.110, 695C.170 to 695C.200, inclusive,

4-38 695C.250 and 695C.265 and section 5 of this act do not apply to a health

4-39 maintenance organization that provides health care services through

4-40 managed care to recipients of Medicaid pursuant to a contract with the

4-41 welfare division of the department of human resources. This subsection

4-42 does not exempt a health maintenance organization from any provision of

4-43 this chapter for services provided pursuant to any other contract.

5-1 Sec. 7. NRS 695C.330 is hereby amended to read as follows:

5-2 695C.330 1. The commissioner may suspend or revoke any

5-3 certificate of authority issued to a health maintenance organization pursuant

5-4 to the provisions of this chapter if he finds that any of the following

5-5 conditions exist:

5-6 (a) The health maintenance organization is operating significantly in

5-7 contravention of its basic organizational document, its health care plan or in

5-8 a manner contrary to that described in and reasonably inferred from any

5-9 other information submitted pursuant to NRS 695C.060, 695C.070 and

5-10 695C.140, unless any amendments to those submissions have been filed

5-11 with and approved by the commissioner;

5-12 (b) The health maintenance organization issues evidence of coverage or

5-13 uses a schedule of charges for health care services which do not comply

5-14 with the requirements of NRS 695C.170 to 695C.200, inclusive, and

5-15 section 5 of this act or 695C.207;

5-16 (c) The health care plan does not furnish comprehensive health care

5-17 services as provided for in NRS 695C.060;

5-18 (d) The state board of health certifies to the commissioner that:

5-19 (1) The health maintenance organization does not meet the

5-20 requirements of subsection 2 of NRS 695C.080; or

5-21 (2) The health maintenance organization is unable to fulfill its

5-22 obligations to furnish health care services as required under its health care

5-23 plan;

5-24 (e) The health maintenance organization is no longer financially

5-25 responsible and may reasonably be expected to be unable to meet its

5-26 obligations to enrollees or prospective enrollees;

5-27 (f) The health maintenance organization has failed to put into effect a

5-28 mechanism affording the enrollees an opportunity to participate in matters

5-29 relating to the content of programs pursuant to NRS 695C.110;

5-30 (g) The health maintenance organization has failed to put into effect the

5-31 system for complaints required by NRS 695C.260 in a manner reasonably

5-32 to dispose of valid complaints;

5-33 (h) The health maintenance organization or any person on its behalf has

5-34 advertised or merchandised its services in an untrue, misrepresentative,

5-35 misleading, deceptive or unfair manner;

5-36 (i) The continued operation of the health maintenance organization

5-37 would be hazardous to its enrollees; or

5-38 (j) The health maintenance organization has otherwise failed to comply

5-39 substantially with the provisions of this chapter.

5-40 2. A certificate of authority must be suspended or revoked only after

5-41 compliance with the requirements of NRS 695C.340.

5-42 3. If the certificate of authority of a health maintenance organization is

5-43 suspended, the health maintenance organization shall not, during the period

6-1 of that suspension, enroll any additional groups or new individual contracts,

6-2 unless those groups or persons were contracted for before the date of

6-3 suspension.

6-4 4. If the certificate of authority of a health maintenance organization is

6-5 revoked, the organization shall proceed, immediately following the

6-6 effective date of the order of revocation, to wind up its affairs and shall

6-7 conduct no further business except as may be essential to the orderly

6-8 conclusion of the affairs of the organization. It shall engage in no further

6-9 advertising or solicitation of any kind. The commissioner may by written

6-10 order permit such further operation of the organization as he may find to be

6-11 in the best interest of enrollees to the end that enrollees are afforded the

6-12 greatest practical opportunity to obtain continuing coverage for health care.

6-13 Sec. 8. NRS 287.010 is hereby amended to read as follows:

6-14 287.010 1. The governing body of any county, school district,

6-15 municipal corporation, political subdivision, public corporation or other

6-16 public agency of the State of Nevada may:

6-17 (a) Adopt and carry into effect a system of group life, accident or health

6-18 insurance, or any combination thereof, for the benefit of its officers and

6-19 employees, and the dependents of officers and employees who elect to

6-20 accept the insurance and who, where necessary, have authorized the

6-21 governing body to make deductions from their compensation for the

6-22 payment of premiums on the insurance.

6-23 (b) Purchase group policies of life, accident or health insurance, or any

6-24 combination thereof, for the benefit of such officers and employees, and the

6-25 dependents of such officers and employees, as have authorized the

6-26 purchase, from insurance companies authorized to transact the business of

6-27 such insurance in the State of Nevada, and, where necessary, deduct from

6-28 the compensation of officers and employees the premiums upon insurance

6-29 and pay the deductions upon the premiums.

6-30 (c) Provide group life, accident or health coverage through a self-

6-31 insurance reserve fund and, where necessary, deduct contributions to the

6-32 maintenance of the fund from the compensation of officers and employees

6-33 and pay the deductions into the fund. The money accumulated for this

6-34 purpose through deductions from the compensation of officers and

6-35 employees and contributions of the governing body must be maintained as

6-36 an internal service fund as defined by NRS 354.543. The money must be

6-37 deposited in a state or national bank authorized to transact business in the

6-38 State of Nevada. Any independent administrator of a fund created under

6-39 this section is subject to the licensing requirements of chapter 683A of

6-40 NRS, and must be a resident of this state. Any contract with an independent

6-41 administrator must be approved by the commissioner of insurance as to the

6-42 reasonableness of administrative charges in relation to contributions

6-43 collected and benefits provided. The provisions of NRS 689B.030 to

7-1 689B.050, inclusive, and section 5 of this act apply to coverage provided

7-2 pursuant to this paragraph.

7-3 (d) Defray part or all of the cost of maintenance of a self-insurance fund

7-4 or of the premiums upon insurance. The money for contributions must be

7-5 budgeted for in accordance with the laws governing the county, school

7-6 district, municipal corporation, political subdivision, public corporation or

7-7 other public agency of the State of Nevada.

7-8 2. If a school district offers group insurance to its officers and

7-9 employees pursuant to this section, members of the board of trustees of the

7-10 school district must not be excluded from participating in the group

7-11 insurance. If the amount of the deductions from compensation required to

7-12 pay for the group insurance exceeds the compensation to which a trustee is

7-13 entitled, the difference must be paid by the trustee.

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