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).

1-1 Section 1. Chapter 695G of NRS is hereby amended by adding

1-2 thereto the provisions set forth as sections 2 and 3 of this act.

1-3 Sec. 2. 1. Except as otherwise provided in section 3 of this act, a

1-4 managed care organization shall provide reimbursement for services

1-5 received by an insured at an independent hospital or a federally-qualified

1-6 health center with which the managed care organization has not

1-7 contracted with for the provision of services to its insureds if:

1-8 (a) The insured resides within 60 miles from the independent hospital

1-9 or federally-qualified health center;

1-10 (b) The independent hospital or federally-qualified health center is

1-11 located in a county whose population is less than 50,000;

1-12 (c) The insured has complied with the requirements of his contract

1-13 with the managed care organization concerning prior authorization and

1-14 utilization review; and

2-1 (d) The evidence of coverage of the insured provides coverage for the

2-2 type of services received by the insured.

2-3 2. A managed care organization shall provide reimbursement for

2-4 services provided to an insured pursuant to subsection 1 in a reasonable

2-5 amount that is not less than the amount that it would otherwise

2-6 reimburse if the services had been provided at a hospital or facility with

2-7 which it has a contract. The managed care organization may provide

2-8 reimbursement for services provided to an insured pursuant to subsection

2-9 1 at a discounted rate if it reimburses similar providers of health care

2-10 with whom it has a contract for comparable services at the same

2-11 discounted rate.

2-12 3. As used in this section:

2-13 (a) "Federally-qualified health center" has the meaning ascribed to it

2-14 in 42 U.S.C. § 1396d(l)(2)(B).

2-15 (b) "Independent hospital" means a hospital:

2-16 (1) That is licensed pursuant to chapter 449 of NRS;

2-17 (2) In which more than one-half of the members of the board of

2-18 directors of the hospital reside within the county where the hospital is

2-19 located; and

2-20 (3) Either:

2-21 (I) The board of directors of the hospital is ultimately responsible

2-22 for the policy and financial decisions of the hospital; or

2-23 (II) The hospital has 50 or fewer authorized or approved beds for

2-24 acute care and, if the hospital has a contract with a managed care

2-25 organization for the provision of services, the hospital is not owned by an

2-26 entity that owns or operates the managed care organization.

2-27 Sec. 3. 1. If an independent hospital or federally-qualified health

2-28 center that does not have a contract with a managed care organization

2-29 for the provision of services refers an insured of the managed care

2-30 organization to another independent hospital or federally-qualified

2-31 health center that does not have a contract with the managed care

2-32 organization for the provision of services, the managed care organization

2-33 shall provide reimbursement for services provided at the independent

2-34 hospital or federally-qualified health center as set forth in section 2 of

2-35 this act only if:

2-36 (a) The managed care organization gave prior authorization for the

2-37 referral; or

2-38 (b) The independent hospital or federally-qualified health center to

2-39 which the referral is made:

2-40 (1) Is located in a county whose population is less than 50,000; and

2-41 (2) Is located within 60 miles from:

3-1 (I) The residence of the insured; or

3-2 (II) An independent hospital or federally-qualified health center

3-3 at which the insured is entitled to reimbursement for services pursuant to

3-4 section 2 of this act.

3-5 2. As used in this section:

3-6 (a) "Federally-qualified health center" has the meaning ascribed to it

3-7 in section 2 of this act.

3-8 (b) "Independent hospital" has the meaning ascribed to it in section 2

3-9 of this act.