2001 REGULAR SESSION (71st) A SB99 R1 996
Amendment Box: Replaces Amendment No. 882. Resolves conflict with S.B. No. 2. Makes substantive changes.
ASSEMBLY ACTION Initial and Date |SENATE ACTION Initial and Date
Adopted Lost | Adopted Lost
Concurred In Not |Concurred In Not
Receded Not | Receded Not
Amend sec. 1.5, page 2, by deleting lines 36 and 37 and inserting:
“6. An administrator shall not require a provider of health care to waive the payment of interest provided for in this section for the late payment of an approved claim.”.
Amend sec. 3, page 3, by deleting lines 38 and 39 and inserting:
“6. An insurer shall not require a provider of health care to waive the payment of interest provided for in this section for the late payment of an approved claim.”.
Amend sec. 5, page 4, by deleting lines 42 and 43 and inserting:
“6. An insurer shall not require a provider of health care to waive the payment of interest provided for in this section for the late payment of an approved claim.”.
Amend sec. 7, page 5, by deleting lines 48 and 49 and inserting:
“6. A carrier shall not require a provider of health care to waive the payment of interest provided for in this section for the late payment of an approved claim.”.
Amend sec. 10, page 7, by deleting lines 10 and 11 and inserting:
“6. A corporation shall not require a provider of health care to waive the payment of interest provided for in this section for the late payment of an approved claim.”.
Amend the bill as a whole by renumbering sec. 11 as sec. 11.3, and adding a new section designated sec. 11, following sec. 10, to read as follows:
“Sec. 11. Chapter 695C of NRS is hereby amended by adding thereto the provisions set forth as sections 11.3 and 11.7 of this act.”.
Amend sec. 11, page 7, by deleting lines 21 through 23 and inserting:
“Sec. 11.3. 1. A health maintenance organization shall not:”.
Amend sec. 11, page 7, line 33, by deleting:
“the effective date of this act” and inserting:
“October 1, 2001,”.
Amend the bill as a whole by adding a new section designated sec. 11.7, following sec. 11, to read as follows:
“Sec. 11.7. Any contract or other agreement entered into or renewed by a health maintenance organization on or after October 1, 2001:
1. To provide health care services through managed care to recipients of Medicaid under the state plan for Medicaid; or
2. With the division of health care financing and policy of the department of human resources to provide insurance pursuant to the children’s health insurance program,
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must require the health
maintenance organization to pay interest to a provider of health care services
on a claim that is not paid within the time provided in the contract or
agreement at a rate of interest equal to the prime rate at the largest bank in
Nevada, as ascertained by the commissioner of financial institutions, on
January 1 or July 1, as the case may be, immediately preceding the date on
which the payment was due, plus 6 percent. The interest must be calculated from
30 days after the date on which the claim is approved until the date on which
the claim is paid. ”.
Amend sec. 12, page 8, by deleting lines 4 and 5 and inserting:
“4. The provisions of NRS 695C.110, 695C.170 to 695C.200, inclusive, [and] sections 19 and 20 of [this act,] Senate Bill No. 2 of this session, section 11.3 of this act and NRS695C.250 and 695C.265 do not apply to”.
Amend sec. 15, page 9, by deleting lines 20 and 21 and inserting:
“6. A health maintenance organization shall not require a provider of health care services to waive the payment of interest provided for in this section for the late payment of an approved claim.”.
Amend sec. 18, page 10, by deleting lines 44 and 45 and inserting:
“6. An insurer shall not require a provider of health care to waive the payment of interest provided for in this section for the late payment of an approved claim.”.
Amend sec. 20, page 11, by deleting lines 43 through 45 and inserting:
“2. [If] Except as otherwise provided in this subsection, if an insurer unreasonably delays or refuses to pay the claim within 30 days after the insurer has been notified of”.
Amend sec. 20, page 12, line 2, after “NRS.” by inserting:
“The provisions of this section do not apply to the payment of a bill for accident benefits that is governed by the provisions of section 18 of this act.”.
Amend the bill as a whole by renumbering sec. 22 as sec. 24 and adding new sections designated sections 22 and 23, following sec. 21, to read as follows:
“Sec. 22. NRS 616C.220 is hereby amended to read as follows:
616C.220 1. The division shall designate one:
(a) Third-party administrator who has a valid certificate issued by the commissioner pursuant to NRS 683A.085; or
(b) Insurer, other than a self-insured employer or association of self-insured public or private employers,
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to administer claims against the uninsured employers’ claim
fund. The designation must be made pursuant to reasonable competitive bidding
procedures established by the administrator.
2. An employee may receive compensation from the uninsured employers’ claim fund if:
(a) He was hired in this state or he is regularly employed in this state;
(b) He suffers an accident or injury [in this state] which arises out of and in the course of his employment;
(c) He files a claim for compensation with the division; and
(d) He makes an irrevocable assignment to the division of a right to be subrogated to the rights of the injured employee pursuant to NRS 616C.215.
3. If the division receives a claim pursuant to subsection 2, the division shall immediately notify the employer of the claim.
4. For the purposes of this section, the employer has the burden of proving that he provided mandatory industrial insurance coverage for the employee or that he was not required to maintain industrial insurance for the employee.
5. Any employer who has failed to provide mandatory coverage required by the provisions of chapters 616A to 616D, inclusive, of NRS is liable for all payments made on his behalf, including any benefits, administrative costs or attorney’s fees paid from the uninsured employers’ claim fund or incurred by the division.
6. The division:
(a) May recover from the employer the payments made by the division that are described in subsection 5 and any accrued interest by bringing a civil action in district court.
(b) In any civil action brought against the employer, is not required to prove that negligent conduct by the employer was the cause of the employee’s injury.
(c) May enter into a contract with any person to assist in the collection of any liability of an uninsured employer.
(d) In lieu of a civil action, may enter into an agreement or settlement regarding the collection of any liability of an uninsured employer.
7. The division shall:
(a) Determine whether the employer was insured within 30 days after receiving notice of the claim from the employee.
(b) Assign the claim to the third-party administrator or insurer designated pursuant to subsection 1 for administration and payment of compensation.
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Upon determining whether the claim is accepted or denied, the
designated third-party administrator or insurer shall notify the injured
employee, the named employer and the division of its determination.
8. Upon demonstration of the:
(a) Costs incurred by the designated third-party administrator or insurer to administer the claim or pay compensation to the injured employee; or
(b) Amount that the designated third-party administrator or insurer will pay for administrative expenses or compensation to the injured employee and that such amounts are justified by the circumstances of the claim,
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the division shall authorize payment from the uninsured
employers’ claim fund.
9. Any party aggrieved by a determination regarding the administration of an assigned claim or a determination made by the division or by the designated third-party administrator or insurer regarding any claim made pursuant to this section may appeal that determination within 60 days after the determination is rendered to the hearings division of the department of administration in the manner provided by NRS 616C.305 and 616C.315 to 616C.385, inclusive.
10. All insurers shall bear a proportionate amount of a claim made pursuant to chapters 616A to 616D, inclusive, of NRS, and are entitled to a proportionate amount of any collection made pursuant to this section as an offset against future liabilities.
11. An uninsured employer is liable for the interest on any amount paid on his claims from the uninsured employers’ claim fund. The interest must be calculated at a rate equal to the prime rate at the largest bank in Nevada, as ascertained by the commissioner of financial institutions, on January 1 or July 1, as the case may be, immediately preceding the date of the claim, plus 3 percent, compounded monthly, from the date the claim is paid from the fund until payment is received by the division from the employer.
12. Attorney’s fees recoverable by the division pursuant to this section must be:
(a) If a private attorney is retained by the division, paid at the usual and customary rate for that attorney.
(b) If the attorney is an employee of the division, paid at the rate established by regulations adopted by the division.
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Any money collected must be deposited to the uninsured
employers’ claim fund.
13. In addition to any other liabilities provided for in this section, the administrator may impose an administrative fine of not more than $10,000 against an employer if the employer fails to provide mandatory coverage required by the provisions of chapters 616A to 616D, inclusive, of NRS.
Sec. 23. NRS 617.401 is hereby amended to read as follows:
617.401 1. The division shall designate one:
(a) Third-party administrator who has a valid certificate issued by the commissioner pursuant to NRS 683A.085; or
(b) Insurer, other than a self-insured employer or association of self-insured public or private employers,
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to administer claims against the uninsured employers’ claim
fund. The designation must be made pursuant to reasonable competitive bidding
procedures established by the administrator.
2. An employee may receive compensation from the uninsured employers’ claim fund if:
(a) He was hired in this state or he is regularly employed in this state;
(b) He contracts an occupational disease [as a result of work performed in this state;] that arose out of and in the course of employment;
(c) He files a claim for compensation with the division; and
(d) He makes an irrevocable assignment to the division of a right to be subrogated to the rights of the employee pursuant to NRS 616C.215.
3. If the division receives a claim pursuant to subsection 2, the division shall immediately notify the employer of the claim.
4. For the purposes of this section, the employer has the burden of proving that he provided mandatory coverage for occupational diseases for the employee or that he was not required to maintain industrial insurance for the employee.
5. Any employer who has failed to provide mandatory coverage required by the provisions of this chapter is liable for all payments made on his behalf, including, but not limited to, any benefits, administrative costs or attorney’s fees paid from the uninsured employers’ claim fund or incurred by the division.
6. The division:
(a) May recover from the employer the payments made by the division that are described in subsection 5 and any accrued interest by bringing a civil action in district court.
(b) In any civil action brought against the employer, is not required to prove that negligent conduct by the employer was the cause of the occupational disease.
(c) May enter into a contract with any person to assist in the collection of any liability of an uninsured employer.
(d) In lieu of a civil action, may enter into an agreement or settlement regarding the collection of any liability of an uninsured employer.
7. The division shall:
(a) Determine whether the employer was insured within 30 days after receiving the claim from the employee.
(b) Assign the claim to the third-party administrator or insurer designated pursuant to subsection 1 for administration and payment of compensation.
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Upon determining whether the claim is accepted or denied, the
designated third-party administrator or insurer shall notify the injured
employee, the named employer and the division of its determination.
8. Upon demonstration of the:
(a) Costs incurred by the designated third-party administrator or insurer to administer the claim or pay compensation to the injured employee; or
(b) Amount that the designated third-party administrator or insurer will pay for administrative expenses or compensation to the injured employee and that such amounts are justified by the circumstances of the claim,
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the division shall authorize payment from the uninsured
employers’ claim fund.
9. Any party aggrieved by a determination regarding the administration of an assigned claim or a determination made by the division or by the designated third-party administrator or insurer regarding any claim made pursuant to this section may appeal that determination within 60 days after the determination is rendered to the hearings division of the department of administration in the manner provided by NRS 616C.305 and 616C.315 to 616C.385, inclusive.
10. All insurers shall bear a proportionate amount of a claim made pursuant to this chapter, and are entitled to a proportionate amount of any collection made pursuant to this section as an offset against future liabilities.
11. An uninsured employer is liable for the interest on any amount paid on his claims from the uninsured employers’ claim fund. The interest must be calculated at a rate equal to the prime rate at the largest bank in Nevada, as ascertained by the commissioner of financial institutions, on January 1 or July 1, as the case may be, immediately preceding the date of the claim, plus 3 percent, compounded monthly, from the date the claim is paid from the fund until payment is received by the division from the employer.
12. Attorney’s fees recoverable by the division pursuant to this section must be:
(a) If a private attorney is retained by the division, paid at the usual and customary rate for that attorney.
(b) If the attorney is an employee of the division, paid at the rate established by regulations adopted by the division.
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Any money collected must be deposited to the uninsured
employers’ claim fund.
13. In addition to any other liabilities provided for in this section, the administrator may impose an administrative fine of not more than $10,000 against an employer if the employer fails to provide mandatory coverage required by the provisions of this chapter.”.
Amend sec. 22, page 12, line 25, by deleting “11” and inserting “11.3”.
Amend sec. 22, page 12, lines 29 and 30 by deleting:
“the effective date of this act.” and inserting:
“October 1, 2001.”.
Amend the bill as a whole by adding a new section designated sec. 25, following sec. 22, to read as follows:
“Sec. 25. 1. This section, sections 1 to 11.7, inclusive, and 13 to 24, inclusive, of this act become effective on October 1, 2001.
2. Section 12 of this act becomes effective at 12:01 a.m. on October 1, 2001.”.
Amend the title of the bill, seventh line, after “care;” by inserting:
“allowing an employee who is injured or who contracts an occupational disease outside this state to receive compensation from the uninsured employers’ claim fund;”.
Amend the summary of the bill to read as follows:
“SUMMARY—Makes various changes to provisions governing health insurance. (BDR 57‑132)”.