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. NRS 689C.950 is hereby amended to read as follows:

1-2 689C.950 [Notwithstanding] Except as otherwise provided in NRS

1-8 this state pursuant to this chapter or chapter 689A of NRS.

1-9 Sec. 2. NRS 695C.055 is hereby amended to read as follows:

1-10 695C.055 1. The provisions of NRS 449.465, 679B.158, subsections

1-13 apply to a health maintenance organization.

2-1 2. For the purposes of subsection 1, unless the context requires that a

2-2 provision apply only to insurers, any reference in those sections to

2-3 "insurer" must be replaced by "health maintenance organization."

2-4 Sec. 3. Chapter 695G of NRS is hereby amended by adding thereto

2-5 the provisions set forth as sections 4, 5 and 6 of this act.

2-6 Sec. 4. 1. A managed care organization shall enter into a contract

2-7 with a provider of health care who is not a provider of health care under

2-8 its health care plan for the limited purpose of providing health care

2-9 services related to the chronic medical condition of an insured or of

2-10 providing a continual course of health care to an insured who has a

2-11 disability if:

2-12 (a) The managed care organization previously had a contract with the

2-13 provider of health care to provide services under the health care plan of

2-14 the insured;

2-15 (b) The insured has been under the care of the provider of health care

2-16 for his chronic medical condition or disability pursuant to his health care

2-17 plan for at least 1 year;

2-18 (c) The provider of health care is qualified under the laws of this state

2-19 to provide such care;

2-20 (d) The provider of health care agrees to accept the rates, terms and

2-21 conditions established for other providers of similar health care services

2-22 under the health care plan; and

2-23 (e) The insured submits a request in writing to the managed care

2-24 organization to have the provider of health care continue to provide the

2-25 specific services or course of care.

2-26 2. As used in this section, "chronic medical condition" means an

2-27 illness or injury that requires continual medical attention.

2-28 Sec. 5. 1. A managed care organization shall include in any health

2-29 care plan it offers that requires the designation of a primary care

2-30 physician a provision authorizing a person covered by the plan to

2-31 designate a specialist as the primary care physician if the person

2-32 regularly needs services provided by such a specialist.

2-33 2. A health care plan subject to the provisions of this section that is

2-34 delivered, issued for delivery or renewed on or after October 1, 1999, has

2-35 the legal effect of including the coverage required by this section, and

2-36 any provision of the health care plan or the renewal which is in conflict

2-37 with this section is void.

2-38 Sec. 6. 1. A managed care organization shall exercise ordinary

2-39 care when making a decision concerning health care services.

2-40 2. A managed care organization is liable for damages for harm to an

2-41 insured that is proximately caused by:

2-42 (a) The failure of the managed care organization to exercise ordinary

2-43 care when making a decision concerning health care services.

3-1 (b) A decision concerning health care services made by:

3-2 (1) An employee of the managed care organization;

3-3 (2) An agent or ostensible agent of the managed care organization;

3-4 or

3-5 (3) A representative who is acting on behalf of the managed care

3-6 organization over whom the managed care organization has the right to

3-7 exercise influence or control or has actually exercised influence or

3-8 control,

3-9 that results in the failure to exercise ordinary care.

3-10 3. As used in this section, "decision concerning health care services"

3-11 means a determination made when health care services are actually

3-12 provided pursuant to the benefits offered under the health care plan or a

3-13 decision which affects the quality of the diagnosis, care or treatment

3-14 provided to an insured.