Senate Bill No. 99–Senator O’Connell (by
request)
February 12, 2001
____________
Referred to Committee on Commerce and Labor
SUMMARY—Makes various changes to provisions
relating to prompt payment of claims to providers of health care. (BDR 57‑132)
FISCAL NOTE: Effect on Local Government: No.
~
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; revising provisions governing the prompt payment by insurers
of approved claims to providers of health care; revising the rate of interest
applicable to the late payment of such claims; prohibiting the assessment of
fees against providers of health care to be included on a list of providers of
health care; establishing an administrative fine against insurers who do not
substantially comply with the provisions requiring prompt payment of approved
claims to providers of health care; 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. NRS 683A.0879
is hereby amended to read as follows:
1-2 683A.0879 1. Except as otherwise provided in subsection 2,
an
1-3 administrator shall approve
or deny a claim relating to health insurance
1-4 coverage within 30 days
after the administrator receives the claim. If the
1-5 claim is approved, the
administrator shall pay the claim within 30 days
1-6 after it is approved. If the
approved claim is not paid within that period, the
1-7 administrator shall pay
interest on the claim [at the rate of interest
1-8 established pursuant to NRS 99.040 unless a different rate of
interest is
1-9 established pursuant to an express written contract between the
1-10 administrator and the provider of health care. The interest must be
1-11 calculated from 30 days] as follows:
1-12 (a) For claims that are paid
on or after the 31st day and on or before
1-13 the 60th day after the date on which the claim was approved,
interest at a
1-14 rate of 12 percent per annum accrues from the date the payment was
due
1-15 until the date the claim is paid;
1-16 (b) For claims that are paid
on or after the 61st day and on or before
1-17 the 90th day after the date on which the claim was approved,
interest at a
1-18 rate of 18 percent per annum accrues from the date the payment was
due
1-19 until the date the claim is paid; and
2-1 (c) For claims that are paid
on or after the 91st day after the date on
2-2 which the claim [is] was approved , interest at a rate of 21 percent per
2-3 annum accrues from the date the payment was due until the claim is paid.
2-4 2. If the administrator
requires additional information to determine
2-5 whether to approve or deny
the claim, he shall notify the claimant of his
2-6 request for the additional
information within 20 days after he receives the
2-7 claim. The administrator
shall notify the provider of health care of all the
2-8 specific reasons for the
delay in approving or denying the claim. The
2-9 administrator shall approve
or deny the claim within 30 days after
2-10 receiving the additional
information. If the claim is approved, the
2-11 administrator shall pay the
claim within 30 days after he receives the
2-12 additional information. If
the approved claim is not paid within that period,
2-13 the administrator shall pay
interest on the claim in the manner prescribed in
2-14 subsection 1.
2-15 3. An administrator shall
not request a claimant to resubmit
2-16 information that the
claimant has already provided to the administrator,
2-17 unless the administrator
provides a legitimate reason for the request and the
2-18 purpose of the request is
not to delay the payment of the claim, harass the
2-19 claimant or discourage the
filing of claims.
2-20 4. An administrator shall
not pay only part of a claim that has been
2-21 approved and is fully
payable.
2-22 5. A court shall award
costs and reasonable attorney’s fees to the
2-23 prevailing party in an
action brought pursuant to this section.
2-24 6. An administrator shall not require a provider
of health care to
2-25 waive the payment of interest provided for in this section for the
late
2-26 payment of an approved claim.
2-27 7. The commissioner may require an administrator
to provide
2-28 evidence which demonstrates that the administrator has
substantially
2-29 complied with the requirements set forth in this section,
including,
2-30 without limitation, payment within 30 days of at least 95 percent
of
2-31 approved claims or at least 90 percent of the total dollar amount
for
2-32 approved claims. If the commissioner determines that an
administrator is
2-33 not in substantial compliance with the requirements set forth in
this
2-34 section, the commissioner may impose an administrative fine of not
more
2-35 than $10,000 on the administrator.
2-36 Sec. 2. NRS 689A.035 is hereby amended to read as follows:
2-37 689A.035 An insurer [may]
shall not charge a
provider of health care
2-38 a fee to include the name of
the provider on a list of providers of health
2-39 care given by the insurer to
its insureds. [The amount of the fee
must be
2-40 reasonable and must not exceed an amount that is directly related to
the
2-41 administrative costs of the insurer to include the provider on the
list.]
2-42 Sec. 3. NRS 689A.410 is hereby amended to read as follows:
2-43 689A.410 1. Except as otherwise provided in subsection 2,
an insurer
2-44 shall approve or deny a
claim relating to a policy of health insurance within
2-45 30 days after the insurer
receives the claim. If the claim is approved, the
2-46 insurer shall pay the claim
within 30 days after it is approved. If the
2-47 approved claim is not paid
within that period, the insurer shall pay interest
2-48 on the claim [at the rate of interest established pursuant to NRS 99.040
2-49 unless a different rate of interest is established pursuant to an
express
3-1 written contract between the insurer and the provider of health
care. The
3-2 interest must be calculated from 30 days] as follows:
3-3 (a) For claims that are paid
on or after the 31st day and on or before
3-4 the 60th day after the date on which the claim was approved,
interest at a
3-5 rate of 12 percent per annum accrues from the date the payment was
due
3-6 until the date the claim is paid;
3-7 (b) For claims that are paid
on or after the 61st day and on or before
3-8 the 90th day after the date on which the claim was approved,
interest at a
3-9 rate of 18 percent per annum accrues from the date the payment was
due
3-10 until the date the claim is paid; and
3-11 (c) For claims that are paid
on or after the 91st day after the date on
3-12 which the claim [is] was approved , interest at a rate of 21 percent per
3-13 annum accrues from the date the payment was due until the claim is paid.
3-14 2. If the insurer requires
additional information to determine whether
3-15 to approve or deny the
claim, it shall notify the claimant of its request for
3-16 the additional information
within 20 days after it receives the claim. The
3-17 insurer shall notify the
provider of health care of all the specific reasons for
3-18 the delay in approving or
denying the claim. The insurer shall approve or
3-19 deny the claim within 30
days after receiving the additional information. If
3-20 the claim is approved, the
insurer shall pay the claim within 30 days after it
3-21 receives the additional
information. If the approved claim is not paid within
3-22 that period, the insurer
shall pay interest on the claim in the manner
3-23 prescribed in subsection 1.
3-24 3. An insurer shall not
request a claimant to resubmit information that
3-25 the claimant has already
provided to the insurer, unless the insurer provides
3-26 a legitimate reason for the
request and the purpose of the request is not to
3-27 delay the payment of the
claim, harass the claimant or discourage the filing
3-28 of claims.
3-29 4. An insurer shall not pay
only part of a claim that has been approved
3-30 and is fully payable.
3-31 5. A court shall award
costs and reasonable attorney’s fees to the
3-32 prevailing party in an
action brought pursuant to this section.
3-33 6. An insurer shall not require a provider of
health care to waive the
3-34 payment of interest provided for in this section for the late
payment of an
3-35 approved claim.
3-36 7. The commissioner may require an insurer to
provide evidence
3-37 which demonstrates that the insurer has substantially complied with
the
3-38 requirements set forth in this section, including, without
limitation,
3-39 payment within 30 days of at least 95 percent of approved claims or
at
3-40 least 90 percent of the total dollar amount for approved claims. If
the
3-41 commissioner determines that an insurer is not in substantial
compliance
3-42 with the requirements set forth in this section, the commissioner
may
3-43 impose an administrative fine of not more than $10,000 on the
insurer.
3-44 Sec. 4. NRS 689B.015 is hereby amended to read as follows:
3-45 689B.015 An insurer that
issues a policy of group health insurance
3-46 [may] shall not charge a provider of health care a
fee to include the name
3-47 of the provider on a list of
providers of health care given by the insurer to
3-48 its insureds. [The amount of the fee must be reasonable and must not
4-1 exceed an amount that is directly related to the administrative
costs of the
4-2 insurer to include the provider on the list.]
4-3 Sec. 5. NRS 689B.255 is hereby amended to read as follows:
4-4 689B.255 1. Except as otherwise provided in subsection 2,
an insurer
4-5 shall approve or deny a
claim relating to a policy of group health insurance
4-6 or blanket insurance within
30 days after the insurer receives the claim. If
4-7 the claim is approved, the
insurer shall pay the claim within 30 days after it
4-8 is approved. If the approved
claim is not paid within that period, the insurer
4-9 shall pay interest on the
claim [at the rate of interest
established pursuant to
4-10 NRS 99.040 unless a different rate of interest is established
pursuant to an
4-11 express written contract between the insurer and the provider of
health
4-12 care. The interest must be calculated from 30 days] as
follows:
4-13 (a) For claims that are paid
on or after the 31st day and on or before
4-14 the 60th day after the date on which the claim was approved,
interest at a
4-15 rate of 12 percent per annum accrues from the date the payment was due
4-16 until the date the claim is paid;
4-17 (b) For claims that are paid
on or after the 61st day and on or before
4-18 the 90th day after the date on which the claim was approved,
interest at a
4-19 rate of 18 percent per annum accrues from the date the payment was
due
4-20 until the date
the claim is paid; and
4-21 (c) For claims that are paid
on or after the 91st day after the date on
4-22 which the claim [is] was approved , interest at a rate of 21 percent per
4-23 annum accrues from the date the payment was due until the claim is paid.
4-24 2. If the insurer requires
additional information to determine whether
4-25 to approve or deny the
claim, it shall notify the claimant of its request for
4-26 the additional information
within 20 days after it receives the claim. The
4-27 insurer shall notify the
provider of health care of all the specific reasons for
4-28 the delay in approving or
denying the claim. The insurer shall approve or
4-29 deny the claim within 30
days after receiving the additional information. If
4-30 the claim is approved, the
insurer shall pay the claim within 30 days after it
4-31 receives the additional
information. If the approved claim is not paid within
4-32 that period, the insurer
shall pay interest on the claim in the manner
4-33 prescribed in subsection 1.
4-34 3. An insurer shall not
request a claimant to resubmit information that
4-35 the claimant has already
provided to the insurer, unless the insurer provides
4-36 a legitimate reason for the
request and the purpose of the request [in] is not
4-37 to delay the payment of the
claim, harass the claimant or discourage the
4-38 filing of claims.
4-39 4. An insurer shall not pay
only part of a claim that has been approved
4-40 and is fully payable.
4-41 5. A court shall award
costs and reasonable attorney’s fees to the
4-42 prevailing party in an
action brought pursuant to this section.
4-43 6. An insurer shall not require a provider of
health care to waive the
4-44 payment of interest provided for in this section for the late
payment of an
4-45 approved claim.
4-46 7. The commissioner may require an insurer to
provide evidence
4-47 which demonstrates that the insurer has substantially complied with
the
4-48 requirements set forth in this section, including, without
limitation,
4-49 payment within 30 days of at least 95 percent of approved claims or
at
5-1 least 90 percent of the total dollar amount for approved claims. If
the
5-2 commissioner determines that an insurer is not in substantial
compliance
5-3 with the requirements set forth in this section, the commissioner
may
5-4 impose an administrative fine of not more than $10,000 on the
insurer.
5-5 Sec. 6. NRS 689C.435 is hereby amended to read as follows:
5-6 689C.435 A carrier serving
small employers and a carrier that offers a
5-7 contract to a voluntary
purchasing group [may] shall
not charge a provider
5-8 of health care a fee to
include the name of the provider on a list of
5-9 providers of health care
given by the carrier to its insureds. [The amount
of
5-10 the fee must be reasonable and must not exceed an amount that is
directly
5-11 related to the administrative costs of the carrier to include the
provider on
5-12 the list.]
5-13 Sec. 7. NRS 689C.485 is hereby amended to read as follows:
5-14 689C.485 1. Except as otherwise provided in subsection 2,
a carrier
5-15 serving small employers and
a carrier that offers a contract to a voluntary
5-16 purchasing group shall
approve or deny a claim relating to a policy of
5-17 health insurance within 30
days after the carrier receives the claim. If the
5-18 claim is approved, the
carrier shall pay the claim within 30 days after it is
5-19 approved. If the approved
claim is not paid within that period, the carrier
5-20 shall pay interest on the
claim [at the rate of interest
established pursuant to
5-21 NRS 99.040 unless a different rate of interest is established
pursuant to an
5-22 express written contract between the carrier and the provider of
health care.
5-23 The interest must be calculated from 30 days] as follows:
5-24 (a) For claims that are paid
on or after the 31st day and on or before
5-25 the 60th day after the date on which the claim was approved,
interest at a
5-26 rate of 12 percent per annum accrues from the date the payment was
due
5-27 until the date the claim is paid;
5-28 (b) For claims that are paid
on or after the 61st day and on or before
5-29 the 90th day after the date on which the claim was approved,
interest at a
5-30 rate of 18 percent per annum accrues from the date the payment was
due
5-31 until the date the claim is paid; and
5-32 (c) For claims that are paid
on or after the 91st day after the date on
5-33 which the claim [is] was approved , interest at a rate of 21 percent per
5-34 annum accrues from the date the payment was due until the claim is paid.
5-35 2. If the carrier requires
additional information to determine whether to
5-36 approve or deny the claim,
it shall notify the claimant of its request for the
5-37 additional information
within 20 days after it receives the claim. The
5-38 carrier shall notify the
provider of health care of all the specific reasons for
5-39 the delay in approving or
denying the claim. The carrier shall approve or
5-40 deny the claim within 30
days after receiving the additional information. If
5-41 the claim is approved, the
carrier shall pay the claim within 30 days after it
5-42 receives the additional
information. If the approved claim is not paid within
5-43 that period, the carrier
shall pay interest on the claim in the manner
5-44 prescribed in subsection 1.
5-45 3. A carrier shall not
request a claimant to resubmit information that
5-46 the claimant has already
provided to the carrier, unless the carrier provides
5-47 a legitimate reason for the
request and the purpose of the request is not to
5-48 delay the payment of the
claim, harass the claimant or discourage the filing
5-49 of claims.
6-1 4. A carrier shall not pay
only part of a claim that has been approved
6-2 and is fully payable.
6-3 5. A court shall award
costs and reasonable attorney’s fees to the
6-4 prevailing party in an
action brought pursuant to this section.
6-5 6. A carrier shall not require a provider of
health care to waive the
6-6 payment of interest provided for in this section for the late
payment of an
6-7 approved claim.
6-8 7. The commissioner may require a carrier to
provide evidence
6-9 which demonstrates that the carrier has substantially complied with
the
6-10 requirements set forth in this section, including, without
limitation,
6-11 payment within 30 days of at least 95 percent of approved claims or
at
6-12 least 90 percent of the total dollar amount for approved claims. If
the
6-13 commissioner determines that a carrier is not in substantial
compliance
6-14 with the requirements set forth in this section, the commissioner
may
6-15 impose an administrative fine of not more than $10,000 on the
carrier.
6-16 Sec. 8. NRS 695A.095 is hereby amended to read as follows:
6-17 695A.095 A society [may]
shall not charge a
provider of health care a
6-18 fee to include the name of
the provider on a list of providers of health care
6-19 given by the society to its
insureds. [The amount of the fee
must be
6-20 reasonable and must not exceed an amount that is directly related to
the
6-21 administrative costs of the society to include the provider on the
list.]
6-22 Sec. 9. NRS 695B.035 is hereby amended to read as follows:
6-23 695B.035 A corporation
subject to the provisions of this chapter [may]
6-24 shall not charge a provider of health care a fee to include the name of the
6-25 provider on a list of
providers of health care given by the corporation to its
6-26 insureds. [The amount of the fee must be reasonable and must not exceed
6-27 an amount that is directly related to the administrative costs of
the
6-28 corporation to include the provider on the list.]
6-29 Sec. 10. NRS 695B.2505 is hereby amended to read as follows:
6-30 695B.2505 1. Except as otherwise provided in subsection 2,
a
6-31 corporation subject to the
provisions of this chapter shall approve or deny a
6-32 claim relating to a contract
for dental, hospital or medical services within
6-33 30 days after the
corporation receives the claim. If the claim is approved,
6-34 the corporation shall pay
the claim within 30 days after it is approved. If
6-35 the approved claim is not
paid within that period, the corporation shall pay
6-36 interest on the claim [at the rate of interest established pursuant to NRS
6-37 99.040 unless a different rate of interest is established pursuant
to an
6-38 express written contract between the corporation and the provider of
health
6-39 care. The interest must be calculated from 30 days] as
follows:
6-40 (a) For claims that are paid
on or after the 31st day and on or before
6-41 the 60th day after the date on which the claim was approved,
interest at a
6-42 rate of 12 percent per annum accrues from the date the payment was
due
6-43 until the date the claim is paid;
6-44 (b) For claims that are paid
on or after the 61st day and on or before
6-45 the 90th day after the date on which the claim was approved, interest
at a
6-46 rate of 18 percent per annum accrues from the date the payment was
due
6-47 until the date the claim is paid; and
7-1 (c) For claims that are paid
on or after the 91st day after the date on
7-2 which the claim [is] was approved , interest at a rate of 21 percent per
7-3 annum accrues from the date the payment was due until the claim is paid.
7-4 2. If the corporation
requires additional information to determine
7-5 whether to approve or deny
the claim, it shall notify the claimant of its
7-6 request for the additional
information within 20 days after it receives the
7-7 claim. The corporation shall
notify the provider of dental, hospital or
7-8 medical services of all the
specific reasons for the delay in approving or
7-9 denying the claim. The
corporation shall approve or deny the claim within
7-10 30 days after receiving the
additional information. If the claim is approved,
7-11 the corporation shall pay
the claim within 30 days after it receives the
7-12 additional information. If
the approved claim is not paid within that period,
7-13 the corporation shall pay
interest on the claim in the manner prescribed in
7-14 subsection 1.
7-15 3. A corporation shall not
request a claimant to resubmit information
7-16 that the claimant has
already provided to the corporation, unless the
7-17 corporation provides a
legitimate reason for the request and the purpose of
7-18 the request is not to delay
the payment of the claim, harass the claimant or
7-19 discourage the filing of
claims.
7-20 4. A corporation shall not
pay only part of a claim that has been
7-21 approved and is fully
payable.
7-22 5. A court shall award
costs and reasonable attorney’s fees to the
7-23 prevailing party in an
action brought pursuant to this section.
7-24 6. A corporation shall not require a provider of
health care to waive
7-25 the payment of interest provided for in this section for the late
payment of
7-26 an approved claim.
7-27 7. The commissioner may require a corporation to
provide evidence
7-28 which demonstrates that the corporation has substantially complied
with
7-29 the requirements set forth in this section, including, without
limitation,
7-30 payment within 30 days of at least 95 percent of approved claims or
at
7-31 least 90 percent of the total dollar amount for approved claims. If
the
7-32 commissioner determines that a corporation is not in substantial
7-33 compliance with the requirements set forth in this section, the
7-34 commissioner may impose an administrative fine of not more than
7-35 $10,000 on the corporation.
7-36 Sec. 11. Chapter 695C of NRS is hereby amended by adding thereto a
7-37 new section to read as
follows:
7-38 1. A health maintenance organization shall not:
7-39 (a) Enter into any contract
or agreement, or make any other
7-40 arrangements, with a provider for the provision of health care; or
7-41 (b) Employ a provider
pursuant to a contract, an agreement or any
7-42 other arrangement to provide health care,
7-43 unless the contract, agreement or other arrangement specifically
7-44 provides that the health maintenance organization and provider
agree to
7-45 the schedule for the payment of claims set forth in NRS 695C.185.
7-46 2. Any contract, agreement or other arrangement
between a health
7-47 maintenance organization and a provider that is entered into or
renewed
7-48 on or after the effective date of this act that does not
specifically include
7-49 a provision concerning the schedule for the payment of claims as
8-1 required by subsection 1 shall be deemed to conform with the
8-2 requirements of subsection 1 by operation of law.
8-3 Sec. 12. NRS 695C.050 is hereby amended to read as follows:
8-4 695C.050 1. Except as otherwise provided in this chapter
or in
8-5 specific provisions of this
Title, the provisions of this Title are not
8-6 applicable to any health
maintenance organization granted a certificate of
8-7 authority under this
chapter. This provision does not apply to an insurer
8-8 licensed and regulated
pursuant to this Title except with respect to its
8-9 activities as a health
maintenance organization authorized and regulated
8-10 pursuant to this chapter.
8-11 2. Solicitation of
enrollees by a health maintenance organization
8-12 granted a certificate of
authority, or its representatives, must not be
8-13 construed to violate any
provision of law relating to solicitation or
8-14 advertising by practitioners
of a healing art.
8-15 3. Any health maintenance
organization authorized under this chapter
8-16 shall not be deemed to be
practicing medicine and is exempt from the
8-17 provisions of chapter 630 of
NRS.
8-18 4. The provisions of NRS
695C.110, 695C.170 to 695C.180,
inclusive,
8-19 695C.190 to 695C.200, inclusive, 695C.250 and 695C.265 do not apply to
8-20 a health maintenance
organization that provides health care services
8-21 through managed care to
recipients of Medicaid under the state plan for
8-22 Medicaid or insurance
pursuant to the children’s health insurance program
8-23 pursuant to a contract with
the division of health care financing and policy
8-24 of the department of human
resources. This subsection does not exempt a
8-25 health maintenance
organization from any provision of this chapter for
8-26 services provided pursuant
to any other contract.
8-27 5. The provisions of NRS
695C.1694 and 695C.1695 apply to a health
8-28 maintenance organization
that provides health care services through
8-29 managed care to recipients
of Medicaid under the state plan for Medicaid.
8-30 Sec. 13. NRS 695C.055 is hereby amended to read as follows:
8-31 695C.055 1. The provisions of NRS 449.465, 679B.158,
subsections
8-32 2, 4, 18, 19 and 32 of NRS
680B.010, NRS 680B.025 to 680B.060,
8-33 inclusive, [and 695G.010 to 695G.260, inclusive,] chapter
695G of NRS
8-34 and section 16 of this act, apply to a health maintenance organization.
8-35 2. For the purposes of
subsection 1, unless the context requires that a
8-36 provision apply only to
insurers, any reference in those sections to
8-37 “insurer” must be replaced
by “health maintenance organization.”
8-38 Sec. 14. NRS 695C.125 is hereby amended to read as follows:
8-39 695C.125 A health
maintenance organization [may] shall not charge a
8-40 provider of health care a
fee to include the name of the provider on a list of
8-41 providers of health care
given by the health maintenance organization to its
8-42 enrollees. [The amount of the fee must be reasonable and must not exceed
8-43 an amount that is directly related to the administrative costs of
the health
8-44 maintenance organization to include the provider on the list.]
8-45 Sec. 15. NRS 695C.185 is hereby amended to read as follows:
8-46 695C.185 1. Except as otherwise provided in subsection 2,
a health
8-47 maintenance organization
shall approve or deny a claim relating to a health
8-48 care plan within 30 days
after the health maintenance organization receives
8-49 the claim. If the claim is
approved, the health maintenance organization
9-1 shall pay the claim within
30 days after it is approved. If the approved
9-2 claim is not paid within
that period, the health maintenance organization
9-3 shall pay interest on the claim [at the rate of interest established pursuant to
9-4 NRS 99.040 unless a different rate of interest is established
pursuant to an
9-5 express written contract between the health maintenance organization
and
9-6 the provider of health care. The interest must be calculated from 30
days]
9-7 as follows:
9-8 (a) For claims that are paid
on or after the 31st day and on or before
9-9 the 60th day after the date on which the claim was approved,
interest at a
9-10 rate of 12 percent per annum accrues from the date the payment was
due
9-11 until the date the claim is paid;
9-12 (b) For claims that are paid
on or after the 61st day and on or before
9-13 the 90th day after the date on which the claim was approved,
interest at a
9-14 rate of 18 percent per annum accrues from the date the payment was
due
9-15 until the date the claim is paid; and
9-16 (c) For claims that are paid
on or after the 91st day after the date on
9-17 which the claim [is] was approved , interest at a rate of 21 percent
accrues
9-18 from the date the payment was due until the claim is paid.
9-19 2. If the health
maintenance organization requires additional
9-20 information to determine
whether to approve or deny the claim, it shall
9-21 notify the claimant of its
request for the additional information within 20
9-22 days after it receives the
claim. The health maintenance organization shall
9-23 notify the provider of
health care services of all the specific reasons for the
9-24 delay in approving or
denying the claim. The health maintenance
9-25 organization shall approve
or deny the claim within 30 days after receiving
9-26 the additional information.
If the claim is approved, the health maintenance
9-27 organization shall pay the
claim within 30 days after it receives the
9-28 additional information. If
the approved claim is not paid within that period,
9-29 the health maintenance
organization shall pay interest on the claim in the
9-30 manner prescribed in
subsection 1.
9-31 3. A health maintenance
organization shall not request a claimant to
9-32 resubmit information that
the claimant has already provided to the health
9-33 maintenance organization,
unless the health maintenance organization
9-34 provides a legitimate reason
for the request and the purpose of the request
9-35 is not to delay the payment
of the claim, harass the claimant or discourage
9-36 the filing of claims.
9-37 4. A health maintenance
organization shall not pay only part of a claim
9-38 that has been approved and
is fully payable.
9-39 5. A court shall award
costs and reasonable attorney’s fees to the
9-40 prevailing party in an
action brought pursuant to this section.
9-41 6. A health maintenance organization shall not
require a provider of
9-42 health care services to waive the payment of interest provided for
in this
9-43 section for the late payment of an approved claim.
9-44 7. The commissioner may require a health
maintenance organization
9-45 to provide evidence which demonstrates that the health maintenance
9-46 organization has substantially complied with the requirements set
forth
9-47 in this section, including, without limitation, payment within 30
days of
9-48 at least 95 percent of approved claims or at least 90 percent of
the total
9-49 dollar amount for approved claims. If the commissioner determines
that
10-1 a health maintenance organization is not in substantial compliance
with
10-2 the requirements set forth in this section, the commissioner may
impose
10-3 an administrative fine of not more than $10,000 on the health
10-4 maintenance organization.
10-5 Sec. 16. Chapter 695G of NRS is hereby amended by adding thereto a
10-6 new section to read as
follows:
10-7 A managed care
organization that establishes a panel of providers of
10-8 health care for the purpose of offering health care services
pursuant to
10-9 chapter 689A, 689B, 689C, 695A, 695B or 695C of NRS shall not
charge
10-10 a provider of health care a fee to include the name of the provider
on the
10-11 panel of providers of health care.
10-12 Sec. 17. NRS 616C.065 is hereby amended to read as follows:
10-13 616C.065 1. [Within 30
days after the insurer has been notified of an
10-14 industrial accident, every insurer shall:
10-15 (a) Commence payment of a
claim for compensation; or
10-16 (b) Deny the claim and notify
the claimant and administrator that the
10-17 claim has been denied.] Except as otherwise provided in subsection 2, an
10-18 insurer subject to the provisions of chapters 616A to 617,
inclusive, of
10-19 NRS shall approve or deny a claim for compensation within 30 days
after
10-20 the insurer receives the claim. If the claim is approved, the
insurer shall
10-21 pay the claim within 30 days after it is approved. If the approved
claim is
10-22 not paid within that period, the insurer shall pay interest on the
claim as
10-23 follows:
10-24 (a) For claims that are paid
on or after the 31st day and on or before
10-25 the 60th day after the date on which the claim was approved,
interest at a
10-26 rate of 12 percent per annum accrues from the date the payment was
due
10-27 until the date the claim is paid;
10-28 (b) For claims that are paid
on or after the 61st day and on or before
10-29 the 90th day after the date on which the claim was approved,
interest at a
10-30 rate of 18 percent per annum accrues from the date the payment was
due
10-31 until the date the claim is paid; and
10-32 (c) For claims that are paid
on or after the 91st day after the date on
10-33 which the claim was approved, interest at a rate of 21 percent per
annum
10-34 accrues from the date the payment was due until the claim is paid.
10-35 2. If the insurer needs additional information to determine whether
10-36 to approve or deny the claim, he shall notify the claimant and the
10-37 administrator of his request for the additional information within
20 days
10-38 after he receives the claim. The insurer shall notify the provider
of health
10-39 care of all the specific reasons for the delay in approving or
denying the
10-40 claim. The insurer shall approve or deny the claim within 30 days
after
10-41 receiving the additional information. If the claim is approved, the
insurer
10-42 shall pay the claim within 30 days after it receives the additional
10-43 information. If the approved claim is not paid within that period,
the
10-44 insurer shall pay interest on the claim in the manner prescribed in
10-45 subsection 1.
10-46 3. An insurer shall not request a claimant to resubmit information
10-47 that the claimant has already provided to the insurer, unless the
insurer
10-48 provides a legitimate reason for the request and the purpose of the
11-1 request is not to delay the payment of the claim, harass the
claimant or
11-2 discourage the filing of claims.
11-3 4. An insurer shall not pay only part of a claim
that has been
11-4 approved and is fully payable.
11-5 5. An insurer shall not require a provider of
health care to waive the
11-6 payment of interest provided for in this section for the late
payment of an
11-7 approved claim.
11-8 6. The commissioner may require an insurer to
provide evidence
11-9 which demonstrates that the insurer has substantially complied with
the
11-10 requirements set forth in this section, including, without
limitation,
11-11 payment within 30 days of at least 95 percent of approved claims or
at
11-12 least 90 percent of the total dollar amount for approved claims. If
the
11-13 commissioner determines that an insurer is not in substantial
compliance
11-14 with the requirements set forth in this section, the commissioner
may
11-15 impose an administrative fine of not more than $10,000 on the
insurer.
11-16 7. Payments made by an insurer pursuant to this section are not an
11-17 admission of liability for
the claim or any portion of the claim.
11-18 [2. If an insurer unreasonably delays or refuses
to pay the claim within
11-19 30 days after the insurer has been notified of an industrial
accident, the
11-20 insurer shall pay upon order of the administrator an additional
amount
11-21 equal to three times the amount specified in the order as refused or
11-22 unreasonably delayed. This payment is for the benefit of the
claimant and
11-23 must be paid to him with the compensation assessed pursuant to
chapters
11-24 616A to 617, inclusive, of NRS.]
11-25 Sec. 18. If a different rate of interest has been established pursuant to
11-26 an express written contract
between an administrator, insurer, carrier,
11-27 corporation or health
maintenance organization and a provider of health
11-28 care, the amendatory provisions
of sections 1, 3, 5, 7, 10, 11, 15 and 17 of
11-29 this act, relating to the
amount of interest that accrues if an approved claim
11-30 is not timely paid, apply
only to contracts between the administrator,
11-31 insurer, carrier,
corporation or health maintenance organization and the
11-32 provider of health care that
are entered into or renewed on or after the
11-33 effective date of this act.
11-34 Sec. 19. This act becomes effective upon passage and approval.
11-35 H