Assembly Bill No. 624–Committee on Commerce and Labor

 

(On Behalf of Pharmacy Board)

 

March 26, 2001

____________

 

Referred to Committee on Commerce and Labor

 

SUMMARY—Provides for issuance of uniform identification cards and devices to process insurance claims for prescription drugs and devices. (BDR 57‑549)

 

FISCAL NOTE:    Effect on Local Government: No.

                                 Effect on the State: No.

 

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

 

AN ACT relating to health care plans; providing for the issuance of uniform identification cards and devices to process claims for prescription drugs or devices; 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 679B of NRS is hereby amended by adding thereto

1-2  a new section to read as follows:

1-3    1.  If a health care plan that provides coverage for prescription drugs

1-4  or devices issues an identification card or other device to an insured that

1-5  contains information needed to process a claim for a prescription drug or

1-6  device, the card or other device must conform to the requirements of the

1-7  National Council for Prescription Drug Programs set forth in the

1-8  NCPDP Pharmacy ID Card Implementation Guide, in the form most

1-9  recently approved by the commissioner. The commissioner shall review

1-10  each edition of the guide that is published after January 1, 2002, to

1-11  ensure its suitability for this state. Each new edition shall be deemed

1-12  approved by the commissioner unless the edition is disapproved by the

1-13  commissioner within 30 days after the date of its publication.

1-14    2.  An identification card or other device issued to an insured by an

1-15  insurer or administrator must be revised and reissued to the insured if

1-16  the information contained on the card or device is rendered inaccurate

1-17  by any change in:

1-18    (a) The coverage provided under the health care plan; or

2-1    (b) The requirements of the NCPDP Pharmacy ID Card

2-2  Implementation Guide, in the form most recently approved by the

2-3  commissioner.

2-4    3.  An identification card or other device that is issued or reissued to

2-5  an insured must:

2-6    (a) Contain information regarding coverage; and

2-7    (b) Conform to the requirements approved by the commissioner,

2-8  in effect at the time the card or device is issued or reissued.

2-9    4.  The commissioner shall adopt such regulations as are necessary to

2-10  carry out the provisions of this section.

2-11    5.  As used in this section:

2-12    (a) “Administrator” has the meaning ascribed to it in NRS 683A.025.

2-13    (b) “Health care plan” means a policy, contract, certificate or

2-14  agreement offered by an insurer to provide for, deliver payment for,

2-15  arrange for the payment of, pay for or reimburse any of the costs of

2-16  health care services. The term includes an employee welfare benefit plan

2-17  or other health benefit plan permitted under the Employment Retirement

2-18  Income Security Act of 1974. The term does not include:

2-19      (1) Coverage that is only for accident or disability income

2-20  insurance, or any combination thereof.

2-21      (2) Credit insurance.

2-22      (3) Coverage that is only for a specified disease or illness.

2-23      (4) Dental or vision benefits that are provided under a separate

2-24  policy, certificate or contract of insurance or are otherwise not an

2-25  integral part of a health care plan.

2-26      (5) Coverage issued as a supplement to liability insurance.

2-27      (6) Coverage for medical payments under a policy of automobile or

2-28  homeowners’ insurance.

2-29      (7) Coverage for benefits that are payable without regard to fault

2-30  and that are statutorily required to be included in a policy of liability

2-31  insurance or equivalent self-insurance.

2-32      (8) Hospital income or indemnity insurance.

2-33    Sec. 2.  NRS 680A.200 is hereby amended to read as follows:

2-34    680A.200  1.  Except as otherwise provided in NRS 616B.472, the

2-35  commissioner may refuse to continue or may suspend, limit or revoke an

2-36  insurer’s certificate of authority if he finds after a hearing thereon, or upon

2-37  waiver of hearing by the insurer, that the insurer has:

2-38    (a) Violated or failed to comply with any lawful order of the

2-39  commissioner;

2-40    (b) Conducted his business in an unsuitable manner;

2-41    (c) Willfully violated or willfully failed to comply with any lawful

2-42  regulation of the commissioner; or

2-43    (d) Violated any provision of this code other than one for violation of

2-44  which suspension or revocation is mandatory.

2-45  In lieu of such a suspension or revocation, the commissioner may levy

2-46  upon the insurer, and the insurer shall pay forthwith, an administrative fine

2-47  of not more than $2,000 for each act or violation.

2-48    2.  Except as otherwise provided in chapter 696B of NRS, the

2-49  commissioner shall suspend or revoke an insurer’s certificate of authority

3-1  on any of the following grounds if he finds after a hearing thereon that the

3-2  insurer:

3-3    (a) Is in unsound condition, is being fraudulently conducted, or is in

3-4  such a condition or is using such methods and practices in the conduct of

3-5  its business as to render its further transaction of insurance in this state

3-6  currently or prospectively hazardous or injurious to policyholders or to the

3-7  public.

3-8    (b) With such frequency as to indicate its general business practice in

3-9  this state:

3-10      (1) Has without just cause failed to pay, or delayed payment of,

3-11  claims arising under its policies, whether the claims are in favor of an

3-12  insured or in favor of a third person with respect to the liability of an

3-13  insured to the third person; or

3-14      (2) Without just cause compels insureds or claimants to accept less

3-15  than the amount due them or to employ attorneys or to bring suit against

3-16  the insurer or such an insured to secure full payment or settlement of such

3-17  claims.

3-18    (c) Refuses to be examined, or its directors, officers, employees or

3-19  representatives refuse to submit to examination relative to its affairs, or to

3-20  produce its books, papers, records, contracts, correspondence or other

3-21  documents for examination by the commissioner when required, or refuse

3-22  to perform any legal obligation relative to the examination.

3-23    (d) Except as otherwise provided in NRS 681A.110, has reinsured all its

3-24  risks in their entirety in another insurer.

3-25    (e) Has failed to pay any final judgment rendered against it in this state

3-26  upon any policy, bond, recognizance or undertaking as issued or

3-27  guaranteed by it, within 30 days after the judgment became final or within

3-28  30 days after dismissal of an appeal before final determination, whichever

3-29  date is the later.

3-30    (f) Has violated the provisions of section 1 of this act.

3-31    3.  The commissioner may, without advance notice or a hearing

3-32  thereon, immediately suspend the certificate of authority of any insurer as

3-33  to which proceedings for receivership, conservatorship, rehabilitation or

3-34  other delinquency proceedings have been commenced in any state by the

3-35  public officer who supervises insurance for that state.

3-36    4.  No proceeding to suspend, limit or revoke a certificate of authority

3-37  pursuant to this section may be maintained unless it is commenced by the

3-38  giving of notice to the insurer within 5 years after the occurrence of the

3-39  charged act or omission. This limitation does not apply if the commissioner

3-40  finds fraudulent or willful evasion of taxes.

3-41    Sec. 3.  This act becomes effective upon passage and approval for the

3-42  purpose of adopting regulations and on January 1, 2002, for all other

3-43  purposes.

 

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