Assembly Bill No. 452–Assemblywoman Giunchigliani

 

March 19, 2001

____________

 

Referred to Committee on Commerce and Labor

 

SUMMARY—Requires certain providers of health insurance to contract with federally qualified health centers as providers of health care. (BDR 57‑1177)

 

FISCAL NOTE:            Effect on Local Government: No.

                                    Effect on the State: Yes.

 

~

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to insurance; requiring certain providers of individual or group health insurance to contract with federally qualified health centers as providers of certain health care services under certain circumstances; providing a penalty; 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

1-2  thereto a new section to read as follows:

1-3    1.  An individual carrier that offers a health benefit plan that

1-4  includes a provision for a restricted network shall contract with at least

1-5  one health center in each established geographic service area to provide

1-6  health care services to persons covered by the plan.

1-7    2.  As used in this section, “health center” has the meaning ascribed

1-8  to it in 42 U.S.C. § 254b.

1-9    Sec. 2.  NRS 689A.470 is hereby amended to read as follows:

1-10    689A.470  As used in NRS 689A.470 to 689A.740, inclusive, and

1-11  section 1 of this act, unless the context otherwise requires, the words and

1-12  terms defined in NRS 689A.475 to 689A.605, inclusive, have the meanings

1-13  ascribed to them in those sections.

1-14    Sec. 3.  Chapter 689B of NRS is hereby amended by adding thereto a

1-15  new section to read as follows:

1-16    1.  A carrier that offers coverage through a network plan shall

1-17  contract with at least one health center in each established geographic

1-18  service area of the carrier or geographic area for which the carrier is

1-19  authorized to transact insurance to provide medical care for enrollees.

1-20    2.  As used in this section:

1-21    (a) “Health center” has the meaning ascribed to it in 42 U.S.C. §

1-22  254b.

2-1    (b) “Network plan” has the meaning ascribed to it in NRS 689B.570.

2-2    Sec. 4.  NRS 689B.340 is hereby amended to read as follows:

2-3    689B.340  As used in NRS 689B.340 to 689B.600, inclusive, and

2-4  section 3 of this act, unless the context otherwise requires, the words and

2-5  terms defined in NRS 689B.350 to 689B.460, inclusive, have the meanings

2-6  ascribed to them in those sections.

2-7    Sec. 5.  Chapter 689C of NRS is hereby amended by adding thereto a

2-8  new section to read as follows:

2-9    1.  A carrier that offers a network plan shall contract with at least one

2-10  health center in each established geographic service area to provide

2-11  health care as a member of the carrier’s defined set of providers under

2-12  the network plan.

2-13    2.  As used in this section, “health center” has the meaning ascribed

2-14  to it in 42 U.S.C. § 254b.

2-15    Sec. 6.  NRS 695A.152 is hereby amended to read as follows:

2-16    695A.152  1.  To the extent reasonably applicable, a fraternal benefit

2-17  society shall comply with the provisions of NRS 689B.340 to 689B.600,

2-18  inclusive, and section 3 of this act and chapter 689C of NRS relating to the

2-19  portability and availability of health insurance offered by the society to its

2-20  members. If there is a conflict between the provisions of this chapter and

2-21  the provisions of NRS 689B.340 to 689B.600, inclusive, and section 3 of

2-22  this act and chapter 689C of NRS, the provisions of NRS 689B.340 to

2-23  689B.600, inclusive, and section 3 of this act and chapter 689C of NRS

2-24  control.

2-25    2.  For the purposes of subsection 1, unless the context requires that a

2-26  provision apply only to a group health plan or a carrier that provides

2-27  coverage under a group health plan, any reference in those sections to

2-28  “group health plan” or “carrier” must be replaced by “fraternal benefit

2-29  society.”

2-30    Sec. 7.  NRS 695B.318 is hereby amended to read as follows:

2-31    695B.318  1.  Nonprofit hospital, medical or dental service

2-32  corporations are subject to the provisions of NRS 689B.340 to 689B.600,

2-33  inclusive, and section 3 of this act and chapter 689C of NRS relating to the

2-34  portability and availability of health insurance offered by such

2-35  organizations. If there is a conflict between the provisions of this chapter

2-36  and the provisions of NRS 689B.340 to 689B.600, inclusive, and section 3

2-37  of this act and chapter 689C of NRS, the provisions of NRS 689B.340 to

2-38  689B.600, inclusive, and section 3 of this act and chapter 689C of NRS

2-39  control.

2-40    2.  For the purposes of subsection 1, unless the context requires that a

2-41  provision apply only to a group health plan or a carrier that provides

2-42  coverage under a group health plan, any reference in those sections to:

2-43    (a) “Carrier” must be replaced by “corporation.”

2-44    (b) “Group health plan” must be replaced by “group contract for

2-45  hospital, medical or dental services.”

2-46    Sec. 8.  Chapter 695C of NRS is hereby amended by adding thereto a

2-47  new section to read as follows:

2-48    1.  A health maintenance organization that furnishes health care

2-49  services through providers which are under contract with the

3-1  organization shall contract with at least one health center in each

3-2  geographic area served by the organization to provide such services to

3-3  enrollees.

3-4    2.  As used in this section, “health center” has the meaning ascribed

3-5  to it in 42 U.S.C. § 254b.

3-6    Sec. 9.  NRS 695F.090 is hereby amended to read as follows:

3-7    695F.090  Prepaid limited health service organizations are subject to

3-8  the provisions of this chapter and to the following provisions, to the extent

3-9  reasonably applicable:

3-10    1.  NRS 687B.310 to 687B.420, inclusive, concerning cancellation and

3-11  nonrenewal of policies.

3-12    2.  NRS 687B.122 to 687B.128, inclusive, concerning readability of

3-13  policies.

3-14    3.  The requirements of NRS 679B.152.

3-15    4.  The fees imposed pursuant to NRS 449.465.

3-16    5.  NRS 686A.010 to 686A.310, inclusive, concerning trade practices

3-17  and frauds.

3-18    6.  The assessment imposed pursuant to subsection 3 of NRS

3-19  679B.158.

3-20    7.  Chapter 683A of NRS.

3-21    8.  To the extent applicable, the provisions of NRS 689B.340 to

3-22  689B.600, inclusive, and chapter 689C of NRS relating to the portability

3-23  and availability of health insurance.

3-24    9.  NRS 689A.035, 689A.410 and 689A.413.

3-25    10.  NRS 680B.025 to 680B.039, inclusive, concerning premium tax,

3-26  premium tax rate, annual report and estimated quarterly tax payments. For

3-27  the purposes of this subsection, unless the context otherwise requires that a

3-28  section apply only to insurers, any reference in those sections to “insurer”

3-29  must be replaced by a reference to “prepaid limited health service

3-30  organization.”

3-31    11.  Chapter 692C of NRS, concerning holding companies.

3-32    12.  Section 1 of this act, concerning health centers.

3-33    Sec. 10.  Chapter 695G of NRS is hereby amended by adding thereto a

3-34  new section to read as follows:

3-35    1.  A managed care organization that delivers health care services by

3-36  using independently contracted providers of health care shall contract

3-37  with at least one health center in each geographic area served by the

3-38  organization to provide such services to insureds.

3-39    2.  As used in this section, “health center” has the meaning ascribed

3-40  to it in 42 U.S.C. § 254b.

3-41    Sec. 11.  NRS 287.010 is hereby amended to read as follows:

3-42    287.010  1.  The governing body of any county, school district,

3-43  municipal corporation, political subdivision, public corporation or other

3-44  public agency of the State of Nevada may:

3-45    (a) Adopt and carry into effect a system of group life, accident or health

3-46  insurance, or any combination thereof, for the benefit of its officers and

3-47  employees, and the dependents of officers and employees who elect to

3-48  accept the insurance and who, where necessary, have authorized the

4-1  governing body to make deductions from their compensation for the

4-2  payment of premiums on the insurance.

4-3    (b) Purchase group policies of life, accident or health insurance, or any

4-4  combination thereof, for the benefit of such officers and employees, and

4-5  the dependents of such officers and employees, as have authorized the

4-6  purchase, from insurance companies authorized to transact the business of

4-7  such insurance in the State of Nevada, and, where necessary, deduct from

4-8  the compensation of officers and employees the premiums upon insurance

4-9  and pay the deductions upon the premiums.

4-10    (c) Provide group life, accident or health coverage through a self-

4-11  insurance reserve fund and, where necessary, deduct contributions to the

4-12  maintenance of the fund from the compensation of officers and employees

4-13  and pay the deductions into the fund. The money accumulated for this

4-14  purpose through deductions from the compensation of officers and

4-15  employees and contributions of the governing body must be maintained as

4-16  an internal service fund as defined by NRS 354.543. The money must be

4-17  deposited in a state or national bank or credit union authorized to transact

4-18  business in the State of Nevada. Any independent administrator of a fund

4-19  created under this section is subject to the licensing requirements of

4-20  chapter 683A of NRS, and must be a resident of this state. Any contract

4-21  with an independent administrator must be approved by the commissioner

4-22  of insurance as to the reasonableness of administrative charges in relation

4-23  to contributions collected and benefits provided. The provisions of section

4-24  3 of this act and NRS 689B.030 to 689B.050, inclusive, apply to coverage

4-25  provided pursuant to this paragraph, except that the provisions of NRS

4-26  689B.0359 do not apply to such coverage.

4-27    (d) Defray part or all of the cost of maintenance of a self-insurance fund

4-28  or of the premiums upon insurance. The money for contributions must be

4-29  budgeted for in accordance with the laws governing the county, school

4-30  district, municipal corporation, political subdivision, public corporation or

4-31  other public agency of the State of Nevada.

4-32    2.  If a school district offers group insurance to its officers and

4-33  employees pursuant to this section, members of the board of trustees of the

4-34  school district must not be excluded from participating in the group

4-35  insurance. If the amount of the deductions from compensation required to

4-36  pay for the group insurance exceeds the compensation to which a trustee is

4-37  entitled, the difference must be paid by the trustee.

4-38    Sec. 12.  NRS 287.045 is hereby amended to read as follows:

4-39    287.045  1.  Except as otherwise provided in this section, every officer

4-40  or employee of the state is eligible to participate in the program on the first

4-41  day of the month following the completion of 90 days of full-time

4-42  employment.

4-43    2.  Professional employees of the University and Community College

4-44  System of Nevada who have annual employment contracts are eligible to

4-45  participate in the program on:

4-46    (a) The effective dates of their respective employment contracts, if

4-47  those dates are on the first day of a month; or

5-1    (b) The first day of the month following the effective dates of their

5-2  respective employment contracts, if those dates are not on the first day of a

5-3  month.

5-4    3.  Every officer or employee who is employed by a participating

5-5  public agency on a permanent and full-time basis on the date the agency

5-6  enters into an agreement to participate in the program, and every officer or

5-7  employee who commences his employment after that date is eligible to

5-8  participate in the program on the first day of the month following the

5-9  completion of 90 days of full-time employment.

5-10    4.  Every senator and assemblyman is eligible to participate in the

5-11  program on the first day of the month following the 90th day after his

5-12  initial term of office begins.

5-13    5.  An officer or employee of the governing body of any county, school

5-14  district, municipal corporation, political subdivision, public corporation or

5-15  other public agency of the State of Nevada who retires under the conditions

5-16  set forth in NRS 286.510 or 286.620 and was not participating in the

5-17  program at the time of his retirement is eligible to participate in the

5-18  program 30 days after notice of the selection to participate is given

5-19  pursuant to NRS 287.023 or 287.0235. The board shall make a separate

5-20  accounting for these retired persons. For the first year following

5-21  enrollment, the rates charged must be the full actuarial costs determined by

5-22  the actuary based upon the expected claims experience with these retired

5-23  persons. The claims experience of these retired persons must not be

5-24  commingled with the retired persons who were members of the program

5-25  before their retirement, nor with active employees of the state. After the

5-26  first year following enrollment, the rates charged must be the full actuarial

5-27  costs determined by the actuary based upon the past claims experience of

5-28  these retired persons since enrolling.

5-29    6.  Notwithstanding the provisions of subsections 1, 3 and 4, if the

5-30  board does not, pursuant to NRS 689B.580, elect to exclude the program

5-31  from compliance with NRS 689B.340 to 689B.600, inclusive, and section

5-32  3 of this act and if the coverage under the program is provided by a health

5-33  maintenance organization authorized to transact insurance in this state

5-34  pursuant to chapter 695C of NRS, any affiliation period imposed by the

5-35  program may not exceed the statutory limit for an affiliation period set

5-36  forth in NRS 689B.500.

5-37    Sec. 13.  The amendatory provisions of this act apply to all policies,

5-38  contracts and plans for health insurance, managed care or the provision of

5-39  health care services entered into or renewed on or after July 1, 2001.

5-40    Sec. 14.  The amendatory provisions of this act do not apply to

5-41  offenses committed before July 1, 2001.

5-42    Sec. 15.  This act becomes effective on July 1, 2001.

 

5-43  H