Senate Bill No. 111–Committee on Human
Resources and Facilities
(On Behalf of Senator Rawson)
February 13, 2001
____________
Referred to Committee on Commerce and Labor
SUMMARY—Requires health insurance coverage for
general anesthesia and associated dental care for children under certain
circumstances. (BDR 57‑812)
FISCAL NOTE: Effect on Local Government: Yes.
~
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).
AN ACT relating to insurance; requiring certain policies, contracts and health care plans
to include coverage for general anesthesia and associated dental care for
children under certain circumstances; authorizing limitations on the provision
of such coverage 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:
Section 1. Chapter 689A of NRS is hereby
amended by adding thereto a new section to read as follows:
1-1 1. A policy of health insurance subject to the provisions of this
1-2 chapter that is
delivered or issued for delivery in this state must provide
1-3 coverage for a
dependent child covered by that policy who is referred by a
1-4 dentist to a
hospital, a surgical center for ambulatory patients, an
1-5 independent
center for emergency medical care or a rural clinic, licensed
1-6
pursuant to
chapter 449 of NRS, for general anesthesia and associated
1-7 dental care if
the child is being referred because, in the opinion of the
1-8 dentist, the
child:
1-9 (a) Has a physical, mental or medically
compromising condition;
1-10 (b) Has dental needs for which local
anesthesia is ineffective because
1-11 of an acute
infection, an anatomic anomaly or an allergy;
1-12 (c) Is extremely uncooperative, unmanageable or
anxious; or
1-13 (d) Has sustained extensive orofacial and
dental trauma.
1-14 2. An
insurer may:
2-1 (a) Require prior authorization for the
provision of general anesthesia
2-2 and for
hospitalization or the use of a surgical center for ambulatory
2-3 patients for
dental procedures in the same manner that it requires prior
2-4 authorization for
hospitalization for the provision of general anesthesia
2-5 for other
diseases or conditions covered by the policy of health
2-6 insurance;
2-7 (b) Require that the benefits paid be adjusted
according to the policy
2-8 of health
insurance if the services are rendered by a provider who is not
2-9 designated by or
associated with the insurer, if applicable; and
2-10 (c) Restrict coverage to include only general
anesthesia provided
2-11 during procedures
performed by:
2-12 (1) A qualified specialist in pediatric
dentistry;
2-13 (2) A dentist who is qualified, by virtue of
his education, in a
2-14 recognized dental
specialty for which hospital privileges are granted; or
2-15 (3) A dentist who is certified, by virtue of
his completion of an
2-16 accredited
program of postgraduate hospital training, to be granted
2-17 hospital
privileges.
2-18 3. A
policy of health insurance subject to the provisions of this
2-19 chapter that is
delivered, issued for delivery or renewed on or after
2-20 October 1, 2001,
has the legal effect of including the coverage required
2-21 by this section,
and any provision of the policy that conflicts with the
2-22 provisions of
this section is void.
2-23 Sec. 2. NRS
689A.330 is hereby amended to read as follows:
2-24 689A.330 If any policy is issued by a domestic insurer
for delivery to a
2-25 person residing in another state, and if the insurance
commissioner or
2-26 corresponding public officer of that other state has
informed the
2-27 commissioner that the policy is not subject to
approval or disapproval by
2-28 that officer, the commissioner may by ruling require
that the policy meet
2-29 the standards set forth in NRS 689A.030 to 689A.320,
inclusive [.] , and
2-30 section 1 of this
act.
2-31 Sec. 3. Chapter
689B of NRS is hereby amended by adding thereto a
2-32 new section to read as follows:
2-33 1. A
policy of group or blanket health insurance subject to the
2-34 provisions of
this chapter that is delivered or issued for delivery in this
2-35 state must
provide coverage for a dependent child covered by that policy
2-36 who is referred
by a dentist to a hospital, a surgical center for
2-37 ambulatory
patients, an independent center for emergency medical care
2-38 or a rural
clinic, licensed pursuant to chapter 449 of NRS, for general
2-39 anesthesia and
associated dental care if the child is being referred
2-40 because, in the
opinion of the dentist, the child:
2-41 (a) Has a physical, mental or medically
compromising condition;
2-42 (b) Has dental needs for which local
anesthesia is ineffective because
2-43 of an acute
infection, an anatomic anomaly or an allergy;
2-44 (c) Is extremely uncooperative, unmanageable or
anxious; or
2-45 (d) Has sustained extensive orofacial and
dental trauma.
2-46 2. An
insurer may:
3-1 (a) Require prior authorization for the
provision of general anesthesia
3-2 and for
hospitalization or the use of a surgical center for ambulatory
3-3 patients for
dental procedures in the same manner that it requires prior
3-4 authorization for
hospitalization for the provision of general anesthesia
3-5 for other
diseases or conditions covered by the policy of group or blanket
3-6 health insurance;
3-7 (b) Require that the benefits paid be adjusted
according to the policy
3-8 of group or
blanket health insurance if the services are rendered by a
3-9 provider who is
not designated by or associated with the insurer, if
3-10 applicable; and
3-11 (c) Restrict coverage to include only general
anesthesia provided
3-12 during procedures
performed by:
3-13 (1) A qualified specialist in pediatric
dentistry;
3-14 (2) A dentist who is qualified, by virtue of
his education, in a
3-15 recognized dental
specialty for which hospital privileges are granted; or
3-16 (3) A dentist who is certified, by virtue of
his completion of an
3-17 accredited
program of postgraduate hospital training, to be granted
3-18 hospital
privileges.
3-19 3. A
policy of group or blanket health insurance subject to the
3-20 provisions of
this chapter that is delivered, issued for delivery or renewed
3-21 on or after
October 1, 2001, has the legal effect of including the coverage
3-22 required by this
section, and any provision of the policy that conflicts
3-23 with the
provisions of this section is void.
3-24 Sec. 4. Chapter
695B of NRS is hereby amended by adding thereto a
3-25 new section to read as follows:
3-26 1. A
contract for hospital, medical or dental services subject to the
3-27 provisions of
this chapter that is delivered or issued for delivery in this
3-28 state must
provide coverage for a dependent child covered by that
3-29 contract who is
referred by a dentist to a hospital, a surgical center for
3-30 ambulatory
patients, an independent center for emergency medical care
3-31 or a rural
clinic, licensed pursuant to chapter 449 of NRS, for general
3-32 anesthesia and
associated dental care if the child is being referred
3-33 because, in the
opinion of the dentist, the child:
3-34 (a) Has a physical, mental or medically
compromising condition;
3-35 (b) Has dental needs for which local
anesthesia is ineffective because
3-36 of an acute
infection, an anatomic anomaly or an allergy;
3-37 (c) Is extremely uncooperative, unmanageable
or anxious; or
3-38 (d) Has sustained extensive orofacial and
dental trauma.
3-39 2. An
insurer may:
3-40 (a) Require prior authorization for the
provision of general anesthesia
3-41 and for hospitalization
or the use of a surgical center for ambulatory
3-42 patients for
dental procedures in the same manner that it requires prior
3-43 authorization for
hospitalization for the provision of general anesthesia
3-44 for other
diseases or conditions covered by the contract for hospital,
3-45 medical or dental
services;
4-1 (b) Require that the benefits paid be adjusted
according to the
4-2 contract for
hospital, medical or dental services if the services are
4-3 rendered by a
provider who is not designated by or associated with the
4-4 insurer, if
applicable; and
4-5 (c) Restrict coverage to include only general
anesthesia provided
4-6 during procedures
performed by:
4-7 (1) A qualified specialist in pediatric
dentistry;
4-8 (2) A dentist who is qualified, by virtue
of his education, in a
4-9 recognized dental
specialty for which hospital privileges are granted; or
4-10 (3) A dentist who is certified, by virtue of
his completion of an
4-11 accredited
program of postgraduate hospital training, to be granted
4-12 hospital
privileges.
4-13 3. A
contract for hospital, medical or dental services subject to the
4-14 provisions of
this chapter that is delivered, issued for delivery or renewed
4-15 on or after
October 1, 2001, has the legal effect of including the coverage
4-16 required by this
section, and any provision of the contract that conflicts
4-17 with the
provisions of this section is void.
4-18 Sec. 5. Chapter
695C of NRS is hereby amended by adding thereto a
4-19 new section to read as follows:
4-20 1. A
health care plan subject to the provisions of this chapter that is
4-21 delivered or
issued for delivery in this state must provide coverage for a
4-22 dependent child
covered by that plan who is referred by a dentist to a
4-23 hospital, a
surgical center for ambulatory patients, an independent center
4-24 for emergency
medical care or a rural clinic, licensed pursuant to
4-25 chapter 449 of
NRS, for general anesthesia and associated dental care if
4-26 the child is
being referred because, in the opinion of the dentist, the
4-27 child:
4-28 (a) Has a physical, mental or medically
compromising condition;
4-29 (b) Has dental needs for which local
anesthesia is ineffective because
4-30 of an acute
infection, an anatomic anomaly or an allergy;
4-31 (c) Is extremely uncooperative, unmanageable
or anxious; or
4-32 (d) Has sustained extensive orofacial and
dental trauma.
4-33 2. A
health maintenance organization may:
4-34 (a) Require prior authorization for the
provision of general anesthesia
4-35 and for hospitalization
or the use of a surgical center for ambulatory
4-36 patients for
dental procedures in the same manner that it requires prior
4-37 authorization for
hospitalization for the provision of general anesthesia
4-38 for other
diseases or conditions covered by the health care plan;
4-39 (b) Require that the benefits paid be adjusted
according to the health
4-40 care plan if the
services are rendered by a provider who is not designated
4-41 by or associated
with the health maintenance organization; and
4-42 (c) Restrict coverage to include only general
anesthesia provided
4-43 during procedures
performed by:
4-44 (1) A qualified specialist in pediatric
dentistry;
4-45 (2) A dentist who is qualified, by virtue of
his education, in a
4-46 recognized dental
specialty for which hospital privileges are granted; or
5-1 (3) A dentist who is certified, by virtue
of his completion of an
5-2 accredited
program of postgraduate hospital training, to be granted
5-3 hospital
privileges.
5-4 3. A
health care plan subject to the provisions of this chapter that is
5-5 delivered, issued
for delivery or renewed on or after October 1, 2001, has
5-6 the legal effect
of including the coverage required by this section, and
5-7 any provision of
the health care plan that conflicts with the provisions of
5-8 this section is
void.
5-9 Sec. 6. NRS
695C.330 is hereby amended to read as follows:
5-10 695C.330 1. The
commissioner may suspend or revoke any
5-11 certificate of authority issued to a health
maintenance organization
5-12 pursuant to the provisions of this chapter if he
finds that any of the
5-13 following conditions exist:
5-14 (a) The
health maintenance organization is operating significantly in
5-15 contravention of its basic organizational document,
its health care plan or
5-16 in a manner contrary to that described in and
reasonably inferred from any
5-17 other information submitted pursuant to NRS
695C.060, 695C.070 and
5-18 695C.140, unless any amendments to those submissions
have been filed
5-19 with and approved by the commissioner;
5-20 (b) The
health maintenance organization issues evidence of coverage or
5-21 uses a schedule of charges for health care services
which do not comply
5-22 with the requirements of NRS 695C.170 to 695C.200,
inclusive, and
5-23 section 5 of this
act, or NRS 695C.1694, 695C.1695
or 695C.207;
5-24 (c) The
health care plan does not furnish comprehensive health care
5-25 services as provided for in NRS 695C.060;
5-26 (d) The state
board of health certifies to the commissioner that the
5-27 health maintenance organization:
5-28 (1) Does
not meet the requirements of subsection 2 of NRS
5-29 695C.080; or
5-30 (2) Is
unable to fulfill its obligations to furnish health care services as
5-31 required under its health care plan;
5-32 (e) The health
maintenance organization is no longer financially
5-33 responsible and may reasonably be expected to be
unable to meet its
5-34 obligations to enrollees or prospective enrollees;
5-35 (f) The
health maintenance organization has failed to put into effect a
5-36 mechanism affording the enrollees an opportunity to
participate in matters
5-37 relating to the content of programs pursuant to NRS
695C.110;
5-38 (g) The
health maintenance organization has failed to put into effect the
5-39 system for complaints required by NRS 695C.260 in a
manner reasonably
5-40 to dispose of valid complaints;
5-41 (h) The
health maintenance organization or any person on its behalf has
5-42 advertised or merchandised its services in an
untrue, misrepresentative,
5-43 misleading, deceptive or unfair manner;
5-44 (i) The
continued operation of the health maintenance organization
5-45 would be hazardous to its enrollees; or
5-46 (j) The
health maintenance organization has otherwise failed to comply
5-47
substantially with the provisions of this
chapter.
5-48 2. A certificate of authority must be suspended
or revoked only after
5-49 compliance with the requirements of NRS 695C.340.
6-1 3. If the certificate of authority of a health
maintenance organization is
6-2 suspended, the health maintenance organization shall
not, during the period
6-3 of that suspension, enroll any additional groups or
new individual
6-4 contracts, unless those groups or persons were
contracted for before the
6-5 date of suspension.
6-6 4. If the certificate of authority of a health
maintenance organization is
6-7 revoked, the organization shall proceed, immediately
following the
6-8 effective date of the order of revocation, to wind
up its affairs and shall
6-9 conduct no further business except as may be
essential to the orderly
6-10 conclusion of the affairs of the organization. It
shall engage in no further
6-11 advertising or solicitation of any kind. The
commissioner may by written
6-12 order permit such further operation of the
organization as he may find to be
6-13 in the best interest of enrollees to the end that
enrollees are afforded the
6-14 greatest practical opportunity to obtain continuing
coverage for health care.
6-15 Sec. 7. NRS
287.010 is hereby amended to read as follows:
6-16 287.010 1. The
governing body of any county, school district,
6-17 municipal corporation, political subdivision, public
corporation or other
6-18 public agency of the State of Nevada may:
6-19 (a) Adopt and
carry into effect a system of group life, accident or health
6-20 insurance, or any combination thereof, for the
benefit of its officers and
6-21 employees, and the dependents of officers and
employees who elect to
6-22 accept the insurance and who, where necessary, have
authorized the
6-23 governing body to make deductions from their
compensation for the
6-24 payment of premiums on the insurance.
6-25 (b) Purchase
group policies of life, accident or health insurance, or any
6-26 combination thereof, for the benefit of such
officers and employees, and
6-27 the dependents of such officers and employees, as
have authorized the
6-28 purchase, from insurance companies authorized to
transact the business of
6-29 such insurance in the State of Nevada, and, where
necessary, deduct from
6-30 the compensation of the officers and employees the premiums upon
6-31 insurance and pay the deductions upon the premiums.
6-32 (c) Provide
group life, accident or health coverage through a self-
6-33 insurance reserve fund and, where necessary, deduct
contributions to the
6-34 maintenance of the fund from the compensation of
officers and employees
6-35 and pay the deductions into the fund. The money
accumulated for this
6-36 purpose through deductions from the compensation of
officers and
6-37 employees and contributions of the governing body
must be maintained as
6-38 an internal service fund as defined by NRS 354.543.
The money must be
6-39 deposited in a state or national bank or credit
union authorized to transact
6-40 business in the State of Nevada. Any independent
administrator of a fund
6-41 created under this section is subject to the
licensing requirements of
6-42 chapter 683A of NRS, and must be a resident of this
state. Any contract
6-43 with an independent administrator must be approved
by the commissioner
6-44 of insurance as to the reasonableness of
administrative charges in relation
6-45 to contributions collected and benefits provided.
The provisions of NRS
6-46 689B.030 to 689B.050, inclusive, and section 3 of this act, apply
to
6-47 coverage provided pursuant to this paragraph, except
that the provisions of
6-48 NRS 689B.0359 do not apply to such coverage.
7-1 (d) Defray
part or all of the cost of maintenance of a self-insurance fund
7-2 or of the premiums upon insurance. The money for
contributions must be
7-3 budgeted for in accordance with the laws governing
the county, school
7-4 district, municipal corporation, political
subdivision, public corporation or
7-5 other public agency of the State of Nevada.
7-6 2. If a school district offers group insurance
to its officers and
7-7 employees pursuant to this section, members of the
board of trustees of the
7-8 school district must not be excluded from
participating in the group
7-9 insurance. If the amount of the deductions from
compensation required to
7-10 pay for the group insurance exceeds the compensation
to which a trustee is
7-11 entitled, the difference must be paid by the
trustee.
7-12 H