Assembly Bill No. 320–Committee on Judiciary

 

March 14, 2003

____________

 

Referred to Committee on Judiciary

 

SUMMARY—Makes various changes regarding malpractice. (BDR 57‑868)

 

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 malpractice; providing for certain defendants in malpractice actions to receive specified information from independent counsel under certain circumstances; prohibiting certain organizations from charging a fee for including the name of a provider of health care on a panel of providers of health care under certain circumstances; prescribing the manner in which a contract with a provider of health care may be modified; requiring the development and use of a uniform form for obtaining information regarding the credentials of providers of health care for the purposes of contracts; requiring the submission of a schedule of payments to a provider of health care under certain circumstances; expanding the scope of certain deceptive trade practices to include health maintenance organizations; expanding the scope of statutorily defined unfair practices to include certain actions by managed care organizations; authorizing suspension, limitation and revocation of the authority of certain insuring entities for failure to timely pay approved claims or for violating provisions of the Nevada Insurance Code under certain circumstances; authorizing intervention in certain insurance ratemaking proceedings; requiring the Commissioner of Insurance to disapprove a proposed increase in rates for malpractice insurance under certain circumstances; prescribing procedures for withdrawal of certain insurers from the malpractice

insurance market in this state; requiring disclosure of reasons for certain underwriting decisions; requiring certain policies of health insurance and health care plans to provide coverage for continued medical treatment by a provider of health care under certain circumstances; revising the circumstances under which the Commissioner of Insurance may suspend or revoke a certificate of authority issued to a health maintenance organization; requiring certain public organizations that provide health insurance to provide coverage for continued medical treatment by a provider of health care under certain circumstances; 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 679A of NRS is hereby amended by

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

1-3  1.  If an organization establishes a panel of providers of

1-4  health care and makes the panel available for use by an insurer

1-5  when offering health care services pursuant to chapter 689A,

1-6  689B, 689C, 695A, 695B or 695C of NRS, the organization shall

1-7  not charge the insurer or a provider of health care:

1-8  (a) A fee to include the name of the provider on the panel of

1-9  providers of health care; or

1-10      (b) Any other fee related to establishing a provider of health

1-11  care as a provider for the organization.

1-12      2.  If an organization violates the provisions of subsection 1,

1-13  the organization shall pay to the insurer or provider of health

1-14  care, as appropriate, an amount that is equal to twice the fee

1-15  charged to the insurer or provider of health care.

1-16      3.  A court shall award costs and reasonable attorney’s fees to

1-17  the prevailing party in an action brought pursuant to this section.

1-18      4.  In addition to any relief granted pursuant to this section, if

1-19  an organization violates the provisions of subsection 1, and if an

1-20  insurer offering health care services pursuant to chapter 689A,

1-21  689B, 689C, 695A, 695B or 695C of NRS has a contract with or

1-22  otherwise uses the services of the organization, the Division shall

1-23  require the insurer to suspend its performance under the contract

1-24  or discontinue using those services until the organization, as

1-25  determined by the Division:

1-26      (a) Complies with the provisions of subsection 1; and

1-27      (b) Refunds to all providers of health care any fees obtained by

1-28  the organization in violation of subsection 1.

2-1  Sec. 2.  Chapter 683A of NRS is hereby amended by adding

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

2-3  If an administrator, managing general agent or producer of

2-4  insurance, or a health maintenance organization when acting as

2-5  an administrator pursuant to NRS 683A.0851 or a nonprofit

2-6  corporation for hospital or medical services when acting as an

2-7  administrator pursuant to NRS 683A.0852, contracts with a

2-8  provider of health care to provide health care to an insured

2-9  pursuant to this chapter, the administrator, managing general

2-10  agent, producer of insurance, health maintenance organization or

2-11  nonprofit corporation for hospital or medical services shall:

2-12      1.  If requested by the provider of health care at the time the

2-13  contract is made, submit to the provider of health care a copy of

2-14  the schedule of payments applicable to the provider of health care;

2-15  or

2-16      2.  If requested by the provider of health care at any other

2-17  time, submit to the provider of health care the schedule of

2-18  payments specified in subsection 1 within 7 days after receiving

2-19  the request.

2-20      Sec. 3. NRS 683A.0879 is hereby amended to read as follows:

2-21      683A.0879  1.  Except as otherwise provided in subsection 2,

2-22  an administrator shall approve or deny a claim relating to health

2-23  insurance coverage within 30 days after the administrator receives

2-24  the claim. If the claim is approved, the administrator shall pay the

2-25  claim within 30 days after it is approved. Except as otherwise

2-26  provided in this section, if the approved claim is not paid within that

2-27  period, the administrator shall pay interest on the claim at a rate of

2-28  interest equal to the prime rate at the largest bank in Nevada, as

2-29  ascertained by the Commissioner of Financial Institutions, on

2-30  January 1 or July 1, as the case may be, immediately preceding the

2-31  date on which the payment was due, plus 6 percent. The interest

2-32  must be calculated from 30 days after the date on which the claim is

2-33  approved until the date on which the claim is paid.

2-34      2.  If the administrator requires additional information to

2-35  determine whether to approve or deny the claim, he shall notify the

2-36  claimant of his request for the additional information within 20 days

2-37  after he receives the claim. The administrator shall notify the

2-38  provider of health care of all the specific reasons for the delay in

2-39  approving or denying the claim. The administrator shall approve or

2-40  deny the claim within 30 days after receiving the additional

2-41  information. If the claim is approved, the administrator shall pay the

2-42  claim within 30 days after he receives the additional information. If

2-43  the approved claim is not paid within that period, the administrator

2-44  shall pay interest on the claim in the manner prescribed in

2-45  subsection 1.

3-1  3.  An administrator shall not request a claimant to resubmit

3-2  information that the claimant has already provided to the

3-3  administrator, unless the administrator provides a legitimate reason

3-4  for the request and the purpose of the request is not to delay the

3-5  payment of the claim, harass the claimant or discourage the filing of

3-6  claims.

3-7  4.  An administrator shall not pay only part of a claim that has

3-8  been approved and is fully payable.

3-9  5.  A court shall award costs and reasonable attorney’s fees to

3-10  the prevailing party in an action brought pursuant to this section.

3-11      6.  The payment of interest provided for in this section for the

3-12  late payment of an approved claim may be waived only if the

3-13  payment was delayed because of an act of God or another cause

3-14  beyond the control of the administrator.

3-15      7.  The Commissioner may require an administrator to provide

3-16  evidence which demonstrates that the administrator has substantially

3-17  complied with the requirements set forth in this section, including,

3-18  without limitation, payment within 30 days of at least 95 percent of

3-19  approved claims or at least 90 percent of the total dollar amount for

3-20  approved claims.

3-21      8.  If the Commissioner determines that an administrator is not

3-22  in substantial compliance with the requirements set forth in this

3-23  section, the Commissioner may require the administrator to pay an

3-24  administrative fine in an amount to be determined by the

3-25  Commissioner. Upon a second or subsequent determination that

3-26  an administrator is not in substantial compliance with the

3-27  requirements set forth in this section, the Commissioner may

3-28  suspend or revoke the certificate of registration of the

3-29  administrator.

3-30      Sec. 4.  (Deleted by amendment.)

3-31      Sec. 5.  Chapter 686B of NRS is hereby amended by adding

3-32  thereto a new section to read as follows:

3-33      If a filing made with the Commissioner pursuant to paragraph

3-34  (a) of subsection 1 of NRS 686B.070 pertains to insurance

3-35  covering the liability of a practitioner licensed pursuant to chapter

3-36  630, 631, 632 or 633 of NRS for a breach of his professional duty

3-37  toward a patient, any interested person, and any association of

3-38  persons or organization whose members may be affected, may

3-39  intervene as a matter of right in any hearing or other proceeding

3-40  conducted to determine whether the applicable rate or proposed

3-41  increase thereto:

3-42      1.  Complies with the standards set forth in NRS 686B.050

3-43  and subsection 2 of NRS 686B.070.

3-44      2.  Should be approved or disapproved.

 

4-1  Sec. 6.  NRS 686B.020 is hereby amended to read as follows:

4-2  686B.020  As used in NRS 686B.010 to 686B.1799, inclusive,

4-3  and section 5 of this act, unless the context otherwise requires:

4-4  1.  “Advisory organization,” except as limited by NRS

4-5  686B.1752, means any person or organization which is controlled

4-6  by or composed of two or more insurers and which engages in

4-7  activities related to rate making. For the purposes of this subsection,

4-8  two or more insurers with common ownership or operating in this

4-9  state under common ownership constitute a single insurer. An

4-10  advisory organization does not include:

4-11      (a) A joint underwriting association;

4-12      (b) An actuarial or legal consultant; or

4-13      (c) An employee or manager of an insurer.

4-14      2.  “Market segment” means any line or kind of insurance or, if

4-15  it is described in general terms, any subdivision thereof or any class

4-16  of risks or combination of classes.

4-17      3.  “Rate service organization” means any person, other than an

4-18  employee of an insurer, who assists insurers in rate making or filing

4-19  by:

4-20      (a) Collecting, compiling and furnishing loss or expense

4-21  statistics;

4-22      (b) Recommending, making or filing rates or supplementary rate

4-23  information; or

4-24      (c) Advising about rate questions, except as an attorney giving

4-25  legal advice.

4-26      4.  “Supplementary rate information” includes any manual or

4-27  plan of rates, statistical plan, classification, rating schedule,

4-28  minimum premium, policy fee, rating rule, rule of underwriting

4-29  relating to rates and any other information prescribed by regulation

4-30  of the Commissioner.

4-31      Sec. 7.  NRS 686B.040 is hereby amended to read as follows:

4-32      686B.040  [The]

4-33      1.  Except as otherwise provided in subsection 2, the

4-34  Commissioner may by rule exempt any person or class of persons or

4-35  any market segment from any or all of the provisions of NRS

4-36  686B.010 to 686B.1799, inclusive, and section 5 of this act, if and

4-37  to the extent that he finds their application unnecessary to achieve

4-38  the purposes of those sections.

4-39      2.  The Commissioner may not, by rule or otherwise, exempt

4-40  an insurer from the provisions of NRS 686B.010 to 686B.1799,

4-41  inclusive, and section 5 of this act, with regard to insurance

4-42  covering the liability of a practitioner licensed pursuant to chapter

4-43  630, 631, 632 or 633 of NRS for a breach of his professional duty

4-44  toward a patient.

 

5-1  Sec. 8.  NRS 686B.070 is hereby amended to read as follows:

5-2  686B.070  1.  Every authorized insurer and every rate service

5-3  organization licensed under NRS [686B.130] 686B.140 which has

5-4  been designated by any insurer for the filing of rates under

5-5  subsection 2 of NRS 686B.090 shall file with the Commissioner all:

5-6  [1.] (a) Rates and proposed increases thereto;

5-7  [2.] (b) Forms of policies to which the rates apply;

5-8  [3.] (c) Supplementary rate information; and

5-9  [4.] (d) Changes and amendments thereof,

5-10  made by it for use in this state.

5-11      2.  If an insurer makes a filing for a proposed increase in a

5-12  rate for insurance covering the liability of a practitioner licensed

5-13  pursuant to chapter 630, 631, 632 or 633 of NRS for a breach of

5-14  his professional duty toward a patient, the insurer shall not

5-15  include in the filing any component that is directly or indirectly

5-16  related to the following:

5-17      (a) Capital losses, diminished cash flow from any dividends,

5-18  interest or other investment returns, or any other financial loss

5-19  that is materially outside of the claims experience of the

5-20  professional liability insurance industry, as determined by the

5-21  Commissioner.

5-22      (b) Losses that are the result of any criminal or fraudulent

5-23  activities of a director, officer or employee of the insurer.

5-24  If the Commissioner determines that a filing includes any such

5-25  component, the Commissioner shall, pursuant to NRS 686B.110,

5-26  disapprove the proposed increase, in whole or in part, to the extent

5-27  that the proposed increase relies upon such a component.

5-28      Sec. 8.3. NRS 686B.090 is hereby amended to read as follows:

5-29      686B.090  1.  An insurer shall establish rates and

5-30  supplementary rate information for any market segment based on

5-31  the factors in NRS 686B.060. If an insurer has insufficient

5-32  creditable loss experience, it may use rates and supplementary rate

5-33  information prepared by a rate service organization, with

5-34  modification for its own expense and loss experience.

5-35      2.  An insurer may discharge its obligation under subsection 1

5-36  of NRS 686B.070 by giving notice to the Commissioner that it uses

5-37  rates and supplementary rate information prepared by a designated

5-38  rate service organization, with such information about modifications

5-39  thereof as are necessary fully to inform the Commissioner. The

5-40  insurer’s rates and supplementary rate information shall be deemed

5-41  those filed from time to time by the rate service organization,

5-42  including any amendments thereto as filed, subject [, however,] to

5-43  the modifications filed by the insurer.

 

 

6-1  Sec. 8.7. NRS 686B.110 is hereby amended to read as follows:

6-2  686B.110  1.  The Commissioner shall consider each proposed

6-3  increase or decrease in the rate of any kind or line of insurance or

6-4  subdivision thereof filed with him pursuant to subsection 1 of NRS

6-5  686B.070. If the Commissioner finds that a proposed increase will

6-6  result in a rate which is not in compliance with NRS 686B.050 [,] or

6-7  subsection 2 of NRS 686B.070, he shall disapprove the proposal.

6-8  The Commissioner shall approve or disapprove each proposal no

6-9  later than 60 days after it is determined by him to be complete

6-10  pursuant to subsection 4. If the Commissioner fails to approve or

6-11  disapprove the proposal within that period, the proposal shall be

6-12  deemed approved.

6-13      2.  Whenever an insurer has no legally effective rates as a result

6-14  of the Commissioner’s disapproval of rates or other act, the

6-15  Commissioner shall on request specify interim rates for the insurer

6-16  that are high enough to protect the interests of all parties and may

6-17  order that a specified portion of the premiums be placed in an

6-18  escrow account approved by him. When new rates become legally

6-19  effective, the Commissioner shall order the escrowed funds or any

6-20  overcharge in the interim rates to be distributed appropriately,

6-21  except that refunds to policyholders that are de minimis must not be

6-22  required.

6-23      3.  If the Commissioner disapproves a proposed rate and an

6-24  insurer requests a hearing to determine the validity of his action, the

6-25  insurer has the burden of showing compliance with the applicable

6-26  standards for rates established in NRS 686B.010 to 686B.1799,

6-27  inclusive. Any such hearing must be held:

6-28      (a) Within 30 days after the request for a hearing has been

6-29  submitted to the Commissioner; or

6-30      (b) Within a period agreed upon by the insurer and the

6-31  Commissioner.

6-32  If the hearing is not held within the period specified in paragraph (a)

6-33  or (b), or if the Commissioner fails to issue an order concerning the

6-34  proposed rate for which the hearing is held within 45 days after the

6-35  hearing, the proposed rate shall be deemed approved.

6-36      4.  The Commissioner shall by regulation specify the

6-37  documents or any other information which must be included in a

6-38  proposal to increase or decrease a rate submitted to him pursuant to

6-39  subsection 1. Each such proposal shall be deemed complete upon its

6-40  filing with the Commissioner, unless the Commissioner, within 15

6-41  business days after the proposal is filed with him, determines that

6-42  the proposal is incomplete because the proposal does not comply

6-43  with the regulations adopted by him pursuant to this subsection.

 

7-1  Sec. 9.  Chapter 689A of NRS is hereby amended by adding

7-2  thereto a new section to read as follows:

7-3  1.  The provisions of this section apply to a policy of health

7-4  insurance offered or issued by an insurer if an insured covered by

7-5  the policy receives health care through a defined set of providers

7-6  of health care who are under contract with the insurer.

7-7  2.  Except as otherwise provided in this section, if an insured

7-8  who is covered by a policy described in subsection 1 is receiving

7-9  medical treatment for a medical condition from a provider of

7-10  health care whose contract with the insurer is terminated during

7-11  the course of the medical treatment, the policy must provide that:

7-12      (a) The insured may continue to obtain medical treatment for

7-13  the medical condition from the provider of health care pursuant to

7-14  this section, if:

7-15          (1) The insured is actively undergoing a medically

7-16  necessary course of treatment; and

7-17          (2) The provider of health care and the insured agree that

7-18  the continuity of care is desirable.

7-19      (b) The provider of health care is entitled to receive

7-20  reimbursement from the insurer for the medical treatment he

7-21  provides to the insured pursuant to this section, if the provider of

7-22  health care agrees:

7-23          (1) To provide medical treatment under the terms of the

7-24  contract between the provider of health care and the insurer with

7-25  regard to the insured, including, without limitation, the rates of

7-26  payment for providing medical service, as those terms existed

7-27  before the termination of the contract between the provider of

7-28  health care and the insurer; and

7-29          (2) Not to seek payment from the insured for any medical

7-30  service provided by the provider of health care that the provider of

7-31  health care could not have received from the insured were the

7-32  provider of health care still under contract with the insurer.

7-33      3.  The coverage required by subsection 2 must be provided

7-34  until the later of:

7-35      (a) The 120th day after the date the contract is terminated; or

7-36      (b) If the medical condition is pregnancy, the 45th day after:

7-37          (1) The date of delivery; or

7-38          (2) If the pregnancy does not end in delivery, the date of the

7-39  end of the pregnancy.

7-40      4.  The requirements of this section do not apply to a provider

7-41  of health care if:

7-42      (a) The provider of health care was under contract with the

7-43  insurer and the insurer terminated that contract because of the

7-44  medical incompetence or professional misconduct of the provider

7-45  of health care; and

8-1  (b) The insurer did not enter into another contract with the

8-2  provider of health care after the contract was terminated pursuant

8-3  to paragraph (a).

8-4  5.  A policy subject to the provisions of this chapter that is

8-5  delivered, issued for delivery or renewed on or after October 1,

8-6  2003, has the legal effect of including the coverage required by

8-7  this section, and any provision of the policy or renewal thereof

8-8  that is in conflict with this section is void.

8-9  6.  The Commissioner shall adopt regulations to carry out the

8-10  provisions of this section.

8-11      Sec. 10.  NRS 689A.035 is hereby amended to read as follows:

8-12      689A.035  1.  An insurer shall not charge a provider of health

8-13  care a fee to include the name of the provider on a list of providers

8-14  of health care given by the insurer to its insureds.

8-15      2.  An insurer shall not contract with a provider of health care

8-16  to provide health care to an insured unless the insurer uses the

8-17  form prescribed by the Commissioner pursuant to section 40.3 of

8-18  this act to obtain any information related to the credentials of the

8-19  provider of health care.

8-20      3.  A contract between an insurer and a provider of health

8-21  care may be modified:

8-22      (a) At any time pursuant to a written agreement executed by

8-23  both parties.

8-24      (b) Except as otherwise provided in this paragraph, by the

8-25  insurer upon giving to the provider 30 days’ written notice of

8-26  the modification. If the provider fails to object in writing to the

8-27  modification within the 30-day period, the modification becomes

8-28  effective at the end of that period. If the provider objects in writing

8-29  to the modification within the 30-day period, the modification

8-30  must not become effective unless agreed to by both parties as

8-31  described in paragraph (a).

8-32      4.  If an insurer contracts with a provider of health care to

8-33  provide health care to an insured, the insurer shall:

8-34      (a) If requested by the provider of health care at the time the

8-35  contract is made, submit to the provider of health care the

8-36  schedule of payments applicable to the provider of health care; or

8-37      (b) If requested by the provider of health care at any other

8-38  time, submit to the provider of health care the schedule of

8-39  payments specified in paragraph (a) within 7 days after receiving

8-40  the request.

8-41      5.  As used in this section, “provider of health care” means a

8-42  provider of health care who is licensed pursuant to chapter 630,

8-43  631, 632 or 633 of NRS.

 

 

9-1  Sec. 11.  NRS 689A.330 is hereby amended to read as follows:

9-2  689A.330  If any policy is issued by a domestic insurer for

9-3  delivery to a person residing in another state, and if the insurance

9-4  commissioner or corresponding public officer of that other state has

9-5  informed the Commissioner that the policy is not subject to approval

9-6  or disapproval by that officer, the Commissioner may by ruling

9-7  require that the policy meet the standards set forth in NRS 689A.030

9-8  to 689A.320, inclusive[.] , and section 9 of this act.

9-9  Sec. 12.  NRS 689A.410 is hereby amended to read as follows:

9-10      689A.410  1.  Except as otherwise provided in subsection 2,

9-11  an insurer shall approve or deny a claim relating to a policy of

9-12  health insurance within 30 days after the insurer receives the claim.

9-13  If the claim is approved, the insurer shall pay the claim within 30

9-14  days after it is approved. Except as otherwise provided in this

9-15  section, if the approved claim is not paid within that period, the

9-16  insurer shall pay interest on the claim at a rate of interest equal to

9-17  the prime rate at the largest bank in Nevada, as ascertained by the

9-18  Commissioner of Financial Institutions, on January 1 or July 1, as

9-19  the case may be, immediately preceding the date on which the

9-20  payment was due, plus 6 percent. The interest must be calculated

9-21  from 30 days after the date on which the claim is approved until the

9-22  date on which the claim is paid.

9-23      2.  If the insurer requires additional information to determine

9-24  whether to approve or deny the claim, it shall notify the claimant of

9-25  its request for the additional information within 20 days after it

9-26  receives the claim. The insurer shall notify the provider of health

9-27  care of all the specific reasons for the delay in approving or denying

9-28  the claim. The insurer shall approve or deny the claim within 30

9-29  days after receiving the additional information. If the claim is

9-30  approved, the insurer shall pay the claim within 30 days after it

9-31  receives the additional information. If the approved claim is not paid

9-32  within that period, the insurer shall pay interest on the claim in the

9-33  manner prescribed in subsection 1.

9-34      3.  An insurer shall not request a claimant to resubmit

9-35  information that the claimant has already provided to the insurer,

9-36  unless the insurer provides a legitimate reason for the request and

9-37  the purpose of the request is not to delay the payment of the claim,

9-38  harass the claimant or discourage the filing of claims.

9-39      4.  An insurer shall not pay only part of a claim that has been

9-40  approved and is fully payable.

9-41      5.  A court shall award costs and reasonable attorney’s fees to

9-42  the prevailing party in an action brought pursuant to this section.

9-43      6.  The payment of interest provided for in this section for the

9-44  late payment of an approved claim may be waived only if the

10-1  payment was delayed because of an act of God or another cause

10-2  beyond the control of the insurer.

10-3      7.  The Commissioner may require an insurer to provide

10-4  evidence which demonstrates that the insurer has substantially

10-5  complied with the requirements set forth in this section, including,

10-6  without limitation, payment within 30 days of at least 95 percent of

10-7  approved claims or at least 90 percent of the total dollar amount for

10-8  approved claims.

10-9      8.  If the Commissioner determines that an insurer is not in

10-10  substantial compliance with the requirements set forth in this

10-11  section, the Commissioner may require the insurer to pay an

10-12  administrative fine in an amount to be determined by the

10-13  Commissioner. Upon a second or subsequent determination that

10-14  an insurer is not in substantial compliance with the requirements

10-15  set forth in this section, the Commissioner may suspend or revoke

10-16  the certificate of authority of the insurer.

10-17     Sec. 13.  Chapter 689B of NRS is hereby amended by adding

10-18  thereto a new section to read as follows:

10-19     1.  The provisions of this section apply to a policy of group

10-20  health insurance offered or issued by an insurer if an insured

10-21  covered by the policy receives health care through a defined set of

10-22  providers of health care who are under contract with the insurer.

10-23     2.  Except as otherwise provided in this section, if an insured

10-24  who is covered by a policy described in subsection 1 is receiving

10-25  medical treatment for a medical condition from a provider of

10-26  health care whose contract with the insurer is terminated during

10-27  the course of the medical treatment, the policy must provide that:

10-28     (a) The insured may continue to obtain medical treatment for

10-29  the medical condition from the provider of health care pursuant to

10-30  this section, if:

10-31         (1) The insured is actively undergoing a medically

10-32  necessary course of treatment; and

10-33         (2) The provider of health care and the insured agree that

10-34  the continuity of care is desirable.

10-35     (b) The provider of health care is entitled to receive

10-36  reimbursement from the insurer for the medical treatment he

10-37  provides to the insured pursuant to this section, if the provider of

10-38  health care agrees:

10-39         (1) To provide medical treatment under the terms of the

10-40  contract between the provider of health care and the insurer with

10-41  regard to the insured, including, without limitation, the rates of

10-42  payment for providing medical service, as those terms existed

10-43  before the termination of the contract between the provider of

10-44  health care and the insurer; and

11-1          (2) Not to seek payment from the insured for any medical

11-2  service provided by the provider of health care that the provider of

11-3  health care could not have received from the insured were the

11-4  provider of health care still under contract with the insurer.

11-5      3.  The coverage required by subsection 2 must be provided

11-6  until the later of:

11-7      (a) The 120th day after the date the contract is terminated; or

11-8      (b) If the medical condition is pregnancy, the 45th day after:

11-9          (1) The date of delivery; or

11-10         (2) If the pregnancy does not end in delivery, the date of the

11-11  end of the pregnancy.

11-12     4.  The requirements of this section do not apply to a provider

11-13  of health care if:

11-14     (a) The provider of health care was under contract with the

11-15  insurer and the insurer terminated that contract because of the

11-16  medical incompetence or professional misconduct of the provider

11-17  of health care; and

11-18     (b) The insurer did not enter into another contract with the

11-19  provider of health care after the contract was terminated pursuant

11-20  to paragraph (a).

11-21     5.  A policy subject to the provisions of this chapter that is

11-22  delivered, issued for delivery or renewed on or after October 1,

11-23  2003, has the legal effect of including the coverage required by

11-24  this section, and any provision of the policy or renewal thereof

11-25  that is in conflict with this section is void.

11-26     6.  The Commissioner shall adopt regulations to carry out the

11-27  provisions of this section.

11-28     Sec. 14.  NRS 689B.015 is hereby amended to read as follows:

11-29     689B.015  1.  An insurer that issues a policy of group health

11-30  insurance shall not charge a provider of health care a fee to include

11-31  the name of the provider on a list of providers of health care given

11-32  by the insurer to its insureds.

11-33     2.  An insurer specified in subsection 1 shall not contract with

11-34  a provider of health care to provide health care to an insured

11-35  unless the insurer uses the form prescribed by the Commissioner

11-36  pursuant to section 40.3 of this act to obtain any information

11-37  related to the credentials of the provider of health care.

11-38     3.  A contract between an insurer specified in subsection 1

11-39  and a provider of health care may be modified:

11-40     (a) At any time pursuant to a written agreement executed by

11-41  both parties.

11-42     (b) Except as otherwise provided in this paragraph, by the

11-43  insurer upon giving to the provider 30 days’ written notice of

11-44  the modification. If the provider fails to object in writing to the

11-45  modification within the 30-day period, the modification becomes

12-1  effective at the end of that period. If the provider objects in writing

12-2  to the modification within the 30-day period, the modification

12-3  must not become effective unless agreed to by both parties as

12-4  described in paragraph (a).

12-5      4.  If an insurer specified in subsection 1 contracts with a

12-6  provider of health care to provide health care to an insured, the

12-7  insurer shall:

12-8      (a) If requested by the provider of health care at the time the

12-9  contract is made, submit to the provider of health care the

12-10  schedule of payments applicable to the provider of health care; or

12-11     (b) If requested by the provider of health care at any other

12-12  time, submit to the provider of health care the schedule of

12-13  payments specified in paragraph (a) within 7 days after receiving

12-14  the request.

12-15     5.  As used in this section, “provider of health care” means a

12-16  provider of health care who is licensed pursuant to chapter 630,

12-17  631, 632 or 633 of NRS.

12-18     Sec. 15.  NRS 689B.255 is hereby amended to read as follows:

12-19     689B.255  1.  Except as otherwise provided in subsection 2, an

12-20  insurer shall approve or deny a claim relating to a policy of group

12-21  health insurance or blanket insurance within 30 days after the

12-22  insurer receives the claim. If the claim is approved, the insurer shall

12-23  pay the claim within 30 days after it is approved. Except as

12-24  otherwise provided in this section, if the approved claim is not paid

12-25  within that period, the insurer shall pay interest on the claim at a rate

12-26  of interest equal to the prime rate at the largest bank in Nevada, as

12-27  ascertained by the Commissioner of Financial Institutions, on

12-28  January 1 or July 1, as the case may be, immediately preceding the

12-29  date on which the payment was due, plus 6 percent. The interest

12-30  must be calculated from 30 days after the date on which the claim is

12-31  approved until the date on which the claim is paid.

12-32     2.  If the insurer requires additional information to determine

12-33  whether to approve or deny the claim, it shall notify the claimant of

12-34  its request for the additional information within 20 days after it

12-35  receives the claim. The insurer shall notify the provider of health

12-36  care of all the specific reasons for the delay in approving or denying

12-37  the claim. The insurer shall approve or deny the claim within 30

12-38  days after receiving the additional information. If the claim is

12-39  approved, the insurer shall pay the claim within 30 days after it

12-40  receives the additional information. If the approved claim is not paid

12-41  within that period, the insurer shall pay interest on the claim in the

12-42  manner prescribed in subsection 1.

12-43     3.  An insurer shall not request a claimant to resubmit

12-44  information that the claimant has already provided to the insurer,

12-45  unless the insurer provides a legitimate reason for the request and

13-1  the purpose of the request is not to delay the payment of the claim,

13-2  harass the claimant or discourage the filing of claims.

13-3      4.  An insurer shall not pay only part of a claim that has been

13-4  approved and is fully payable.

13-5      5.  A court shall award costs and reasonable attorney’s fees to

13-6  the prevailing party in an action brought pursuant to this section.

13-7      6.  The payment of interest provided for in this section for the

13-8  late payment of an approved claim may be waived only if the

13-9  payment was delayed because of an act of God or another cause

13-10  beyond the control of the insurer.

13-11     7.  The Commissioner may require an insurer to provide

13-12  evidence which demonstrates that the insurer has substantially

13-13  complied with the requirements set forth in this section, including,

13-14  without limitation, payment within 30 days of at least 95 percent of

13-15  approved claims or at least 90 percent of the total dollar amount for

13-16  approved claims.

13-17     8.  If the Commissioner determines that an insurer is not in

13-18  substantial compliance with the requirements set forth in this

13-19  section, the Commissioner may require the insurer to pay an

13-20  administrative fine in an amount to be determined by the

13-21  Commissioner. Upon a second or subsequent determination that

13-22  an insurer is not in substantial compliance with the requirements

13-23  set forth in this section, the Commissioner may suspend or revoke

13-24  the certificate of authority of the insurer.

13-25     Sec. 16.  NRS 689C.435 is hereby amended to read as follows:

13-26     689C.435  1.  A carrier serving small employers and a carrier

13-27  that offers a contract to a voluntary purchasing group shall not

13-28  charge a provider of health care a fee to include the name of the

13-29  provider on a list of providers of health care given by the carrier to

13-30  its insureds.

13-31     2.  A carrier specified in subsection 1 shall not contract with a

13-32  provider of health care to provide health care to an insured unless

13-33  the carrier uses the form prescribed by the Commissioner

13-34  pursuant to section 40.3 of this act to obtain any information

13-35  related to the credentials of the provider of health care.

13-36     3.  A contract between a carrier specified in subsection 1 and

13-37  a provider of health care may be modified:

13-38     (a) At any time pursuant to a written agreement executed by

13-39  both parties.

13-40     (b) Except as otherwise provided in this paragraph, by the

13-41  carrier upon giving to the provider 30 days’ written notice of

13-42  the modification. If the provider fails to object in writing to the

13-43  modification within the 30-day period, the modification becomes

13-44  effective at the end of that period. If the provider objects in writing

13-45  to the modification within the 30-day period, the modification

14-1  must not become effective unless agreed to by both parties as

14-2  described in paragraph (a).

14-3      4.  If a carrier specified in subsection 1 contracts with a

14-4  provider of health care to provide health care to an insured, the

14-5  carrier shall:

14-6      (a) If requested by the provider of health care at the time the

14-7  contract is made, submit to the provider of health care the

14-8  schedule of payments applicable to the provider of health care; or

14-9      (b) If requested by the provider of health care at any other

14-10  time, submit to the provider of health care the schedule of

14-11  payments specified in paragraph (a) within 7 days after receiving

14-12  the request.

14-13     5.  As used in this section, “provider of health care” means a

14-14  provider of health care who is licensed pursuant to chapter 630,

14-15  631, 632 or 633 of NRS.

14-16     Sec. 17.  NRS 689C.485 is hereby amended to read as follows:

14-17     689C.485  1.  Except as otherwise provided in subsection 2, a

14-18  carrier serving small employers and a carrier that offers a contract to

14-19  a voluntary purchasing group shall approve or deny a claim relating

14-20  to a policy of health insurance within 30 days after the carrier

14-21  receives the claim. If the claim is approved, the carrier shall pay the

14-22  claim within 30 days after it is approved. Except as otherwise

14-23  provided in this section, if the approved claim is not paid within that

14-24  period, the carrier shall pay interest on the claim at a rate of interest

14-25  equal to the prime rate at the largest bank in Nevada, as ascertained

14-26  by the Commissioner of Financial Institutions, on January 1 or

14-27  July 1, as the case may be, immediately preceding the date on which

14-28  the payment was due, plus 6 percent. The interest must be calculated

14-29  from 30 days after the date on which the claim is approved until the

14-30  date on which the claim is paid.

14-31     2.  If the carrier requires additional information to determine

14-32  whether to approve or deny the claim, it shall notify the claimant of

14-33  its request for the additional information within 20 days after it

14-34  receives the claim. The carrier shall notify the provider of health

14-35  care of all the specific reasons for the delay in approving or denying

14-36  the claim. The carrier shall approve or deny the claim within 30

14-37  days after receiving the additional information. If the claim is

14-38  approved, the carrier shall pay the claim within 30 days after it

14-39  receives the additional information. If the approved claim is not paid

14-40  within that period, the carrier shall pay interest on the claim in the

14-41  manner prescribed in subsection 1.

14-42     3.  A carrier shall not request a claimant to resubmit

14-43  information that the claimant has already provided to the carrier,

14-44  unless the carrier provides a legitimate reason for the request and the

15-1  purpose of the request is not to delay the payment of the claim,

15-2  harass the claimant or discourage the filing of claims.

15-3      4.  A carrier shall not pay only part of a claim that has been

15-4  approved and is fully payable.

15-5      5.  A court shall award costs and reasonable attorney’s fees to

15-6  the prevailing party in an action brought pursuant to this section.

15-7      6.  The payment of interest provided for in this section for the

15-8  late payment of an approved claim may be waived only if the

15-9  payment was delayed because of an act of God or another cause

15-10  beyond the control of the carrier.

15-11     7.  The Commissioner may require a carrier to provide evidence

15-12  which demonstrates that the carrier has substantially complied with

15-13  the requirements set forth in this section, including, without

15-14  limitation, payment within 30 days of at least 95 percent of

15-15  approved claims or at least 90 percent of the total dollar amount for

15-16  approved claims.

15-17     8.  If the Commissioner determines that a carrier is not in

15-18  substantial compliance with the requirements set forth in this

15-19  section, the Commissioner may require the carrier to pay an

15-20  administrative fine in an amount to be determined by the

15-21  Commissioner. Upon a second or subsequent determination that a

15-22  carrier is not in substantial compliance with the requirements set

15-23  forth in this section, the Commissioner may suspend or revoke the

15-24  certificate of authority of the carrier.

15-25     Sec. 18.  Chapter 690B of NRS is hereby amended by adding

15-26  thereto the provisions set forth as sections 19 to 22, inclusive, of this

15-27  act.

15-28     Sec. 19.  If a settlement or judgment exceeds the limits of the

15-29  coverage provided by a policy of insurance covering the liability of

15-30  a practitioner licensed pursuant to chapter 630, 631, 632 or 633 of

15-31  NRS for a breach of his professional duty toward a patient, the

15-32  Commissioner shall review the settlement or judgment. If the

15-33  Commissioner finds, after notice and a hearing, or upon waiver of

15-34  hearing by the insurer, that the insurer who issued the policy

15-35  violated any provision of this code with regard to the settlement or

15-36  judgment, any combination of such settlements or judgments, or

15-37  any proceedings related thereto, the Commissioner may suspend,

15-38  limit or revoke the insurer’s certificate of authority.

15-39     Sec. 20.  If an insurer declines to issue to a practitioner

15-40  licensed pursuant to chapter 630, 631, 632 or 633 of NRS a policy

15-41  of insurance covering the liability of the practitioner for a breach

15-42  of his professional duty toward a patient, the insurer shall, upon

15-43  the request of the practitioner, disclose to the practitioner the

15-44  reasons the insurer declined to issue the policy.

16-1      Sec. 21.  If an insurer, for a policy of insurance covering the

16-2  liability of a practitioner licensed pursuant to chapter 630, 631,

16-3  632 or 633 of NRS for a breach of his professional duty toward a

16-4  patient, sets the premium for the policy for the practitioner at a

16-5  rate that is higher than the standard rate of the insurer for

16-6  the applicable type of policy and specialty of the practitioner, the

16-7  insurer shall, upon the request of the practitioner, disclose the

16-8  reasons the insurer set the premium for the policy at the higher

16-9  rate.

16-10     Sec. 22.  1.  Except as otherwise provided in this section, if

16-11  an insurer intends to cancel, terminate or otherwise not renew all

16-12  policies of professional liability insurance that it has issued to any

16-13  class, type or specialty of practitioner licensed pursuant to chapter

16-14  630, 631 or 633 of NRS, the insurer must provide 120 days’ notice

16-15  of its intended action to the Commissioner and the practitioners

16-16  before its intended action becomes effective.

16-17     2.  If an insurer intends to cancel, terminate or otherwise not

16-18  renew a specific policy of professional liability insurance that it

16-19  has issued to a practitioner who is practicing in one or more of the

16-20  essential medical specialties designated by the Commissioner:

16-21     (a) The insurer must provide 120 days’ notice to the

16-22  practitioner before its intended action becomes effective; and

16-23     (b) The Commissioner may require the insurer to delay its

16-24  intended action for a period of not more than 60 days if the

16-25  Commissioner determines that a replacement policy is not readily

16-26  available to the practitioner.

16-27     3.  If an insurer intends to cancel, terminate or otherwise not

16-28  renew all policies of professional liability insurance that it has

16-29  issued to practitioners who are practicing in one or more of the

16-30  essential medical specialties designated by the Commissioner:

16-31     (a) The insurer must provide 120 days’ notice of its intended

16-32  action to the Commissioner and the practitioners before its

16-33  intended action becomes effective; and

16-34     (b) The Commissioner may require the insurer to delay its

16-35  intended action for a period of not more than 60 days if the

16-36  Commissioner determines that replacement policies are not readily

16-37  available to the practitioners.

16-38     4.  On or before April 1 of each year, the Commissioner shall:

16-39     (a) Determine whether there are any medical specialties in this

16-40  state which are essential as a matter of public policy and which

16-41  must be protected pursuant to this section from certain adverse

16-42  actions relating to professional liability insurance that may impair

16-43  the availability of those essential medical specialties to the

16-44  residents of this state; and

17-1      (b) Make a list containing the essential medical specialties

17-2  designated by the Commissioner and provide the list to each

17-3  insurer that issues policies of professional liability insurance to

17-4  practitioners who are practicing in one or more of the essential

17-5  medical specialties.

17-6      5.  The Commissioner may adopt any regulations that are

17-7  necessary to carry out the provisions of this section.

17-8      6.  Until the Commissioner determines which, if any, medical

17-9  specialties are to be designated as essential medical specialties, the

17-10  following medical specialties shall be deemed to be essential

17-11  medical specialties for the purposes of this section:

17-12     (a) Emergency medicine.

17-13     (b) Neurosurgery.

17-14     (c) Obstetrics and gynecology.

17-15     (d) Orthopedic surgery.

17-16     (e) Pediatrics.

17-17     (f) Trauma surgery.

17-18     7.  As used in this section, “professional liability insurance”

17-19  means insurance covering the liability of a practitioner for a

17-20  breach of his professional duty toward a patient.

17-21     Sec. 23.  NRS 695A.095 is hereby amended to read as follows:

17-22     695A.095  1.  A society shall not charge a provider of health

17-23  care a fee to include the name of the provider on a list of providers

17-24  of health care given by the society to its insureds.

17-25     2.  A society shall not contract with a provider of health care

17-26  to provide health care to an insured unless the society uses the

17-27  form prescribed by the Commissioner pursuant to section 40.3 of

17-28  this act to obtain any information related to the credentials of the

17-29  provider of health care.

17-30     3.  A contract between a society and a provider of health care

17-31  may be modified:

17-32     (a) At any time pursuant to a written agreement executed by

17-33  both parties.

17-34     (b) Except as otherwise provided in this paragraph, by the

17-35  society upon giving to the provider 30 days’ written notice of

17-36  the modification. If the provider fails to object in writing to the

17-37  modification within the 30-day period, the modification becomes

17-38  effective at the end of that period. If the provider objects in writing

17-39  to the modification within the 30-day period, the modification

17-40  must not become effective unless agreed to by both parties as

17-41  described in paragraph (a).

17-42     4.  If a society contracts with a provider of health care to

17-43  provide health care to an insured, the society shall:

18-1      (a) If requested by the provider of health care at the time the

18-2  contract is made, submit to the provider of health care the

18-3  schedule of payments applicable to the provider of health care; or

18-4      (b) If requested by the provider of health care at any other

18-5  time, submit to the provider of health care the schedule of

18-6  payments specified in paragraph (a) within 7 days after receiving

18-7  the request.

18-8      5.  As used in this section, “provider of health care” means a

18-9  provider of health care who is licensed pursuant to chapter 630,

18-10  631, 632 or 633 of NRS.

18-11     Sec. 24.  Chapter 695B of NRS is hereby amended by adding

18-12  thereto a new section to read as follows:

18-13     1.  The provisions of this section apply to a policy of health

18-14  insurance offered or issued by a hospital or medical service

18-15  corporation if an insured covered by the policy receives health

18-16  care through a defined set of providers of health care who are

18-17  under contract with the hospital or medical service corporation.

18-18     2.  Except as otherwise provided in this section, if an insured

18-19  who is covered by a policy described in subsection 1 is receiving

18-20  medical treatment for a medical condition from a provider of

18-21  health care whose contract with the hospital or medical service

18-22  corporation is terminated during the course of the medical

18-23  treatment, the policy must provide that:

18-24     (a) The insured may continue to obtain medical treatment for

18-25  the medical condition from the provider of health care pursuant to

18-26  this section, if:

18-27         (1) The insured is actively undergoing a medically

18-28  necessary course of treatment; and

18-29         (2) The provider of health care and the insured agree that

18-30  the continuity of care is desirable.

18-31     (b) The provider of health care is entitled to receive

18-32  reimbursement from the hospital or medical service corporation

18-33  for the medical treatment he provides to the insured pursuant to

18-34  this section, if the provider of health care agrees:

18-35         (1) To provide medical treatment under the terms of the

18-36  contract between the provider of health care and the hospital or

18-37  medical service corporation with regard to the insured, including,

18-38  without limitation, the rates of payment for providing medical

18-39  service, as those terms existed before the termination of the

18-40  contract between the provider of health care and the hospital or

18-41  medical service corporation; and

18-42         (2) Not to seek payment from the insured for any medical

18-43  service provided by the provider of health care that the provider of

18-44  health care could not have received from the insured were the

19-1  provider of health care still under contract with the hospital or

19-2  medical service corporation.

19-3      3.  The coverage required by subsection 2 must be provided

19-4  until the later of:

19-5      (a) The 120th day after the date the contract is terminated; or

19-6      (b) If the medical condition is pregnancy, the 45th day after:

19-7          (1) The date of delivery; or

19-8          (2) If the pregnancy does not end in delivery, the date of the

19-9  end of the pregnancy.

19-10     4.  The requirements of this section do not apply to a provider

19-11  of health care if:

19-12     (a) The provider of health care was under contract with the

19-13  hospital or medical service corporation and the hospital or

19-14  medical service corporation terminated that contract because of

19-15  the medical incompetence or professional misconduct of the

19-16  provider of health care; and

19-17     (b) The hospital or medical service corporation did not enter

19-18  into another contract with the provider of health care after the

19-19  contract was terminated pursuant to paragraph (a).

19-20     5.  A policy subject to the provisions of this chapter that is

19-21  delivered, issued for delivery or renewed on or after October 1,

19-22  2003, has the legal effect of including the coverage required by

19-23  this section, and any provision of the policy or renewal thereof

19-24  that is in conflict with this section is void.

19-25     6.  The Commissioner shall adopt regulations to carry out the

19-26  provisions of this section.

19-27     Sec. 25.  NRS 695B.035 is hereby amended to read as follows:

19-28     695B.035  1.  A corporation subject to the provisions of this

19-29  chapter shall not charge a provider of health care a fee to include the

19-30  name of the provider on a list of providers of health care given by

19-31  the corporation to its insureds.

19-32     2.  A corporation specified in subsection 1 shall not contract

19-33  with a provider of health care to provide health care to an insured

19-34  unless the corporation uses the form prescribed by the

19-35  Commissioner pursuant to section 40.3 of this act to obtain any

19-36  information related to the credentials of the provider of health

19-37  care.

19-38     3.  A contract between a corporation specified in subsection 1

19-39  and a provider of health care may be modified:

19-40     (a) At any time pursuant to a written agreement executed by

19-41  both parties.

19-42     (b) Except as otherwise provided in this paragraph, by the

19-43  corporation upon giving to the provider 30 days’ written notice of

19-44  the modification. If the provider fails to object in writing to the

19-45  modification within the 30-day period, the modification becomes

20-1  effective at the end of that period. If the provider objects in writing

20-2  to the modification within the 30-day period, the modification

20-3  must not become effective unless agreed to by both parties as

20-4  described in paragraph (a).

20-5      4.  If a corporation specified in subsection 1 contracts with a

20-6  provider of health care to provide health care to an insured, the

20-7  corporation shall:

20-8      (a) If requested by the provider of health care at the time the

20-9  contract is made, submit to the provider of health care the

20-10  schedule of payments applicable to the provider of health care; or

20-11     (b) If requested by the provider of health care at any other

20-12  time, submit to the provider of health care the schedule of

20-13  payments specified in paragraph (a) within 7 days after receiving

20-14  the request.

20-15     5.  As used in this section, “provider of health care” means a

20-16  provider of health care who is licensed pursuant to chapter 630,

20-17  631, 632 or 633 of NRS.

20-18     Sec. 26.  NRS 695B.2505 is hereby amended to read as

20-19  follows:

20-20     695B.2505  1.  Except as otherwise provided in subsection 2, a

20-21  corporation subject to the provisions of this chapter shall approve or

20-22  deny a claim relating to a contract for dental, hospital or medical

20-23  services within 30 days after the corporation receives the claim. If

20-24  the claim is approved, the corporation shall pay the claim within 30

20-25  days after it is approved. Except as otherwise provided in this

20-26  section, if the approved claim is not paid within that period, the

20-27  corporation shall pay interest on the claim at a rate of interest equal

20-28  to the prime rate at the largest bank in Nevada, as ascertained by the

20-29  Commissioner of Financial Institutions, on January 1 or July 1, as

20-30  the case may be, immediately preceding the date on which the

20-31  payment was due, plus 6 percent. The interest must be calculated

20-32  from 30 days after the date on which the claim is approved until the

20-33  date on which the claim is paid.

20-34     2.  If the corporation requires additional information to

20-35  determine whether to approve or deny the claim, it shall notify the

20-36  claimant of its request for the additional information within 20 days

20-37  after it receives the claim. The corporation shall notify the provider

20-38  of dental, hospital or medical services of all the specific reasons for

20-39  the delay in approving or denying the claim. The corporation shall

20-40  approve or deny the claim within 30 days after receiving the

20-41  additional information. If the claim is approved, the corporation

20-42  shall pay the claim within 30 days after it receives the additional

20-43  information. If the approved claim is not paid within that period, the

20-44  corporation shall pay interest on the claim in the manner prescribed

20-45  in subsection 1.

21-1      3.  A corporation shall not request a claimant to resubmit

21-2  information that the claimant has already provided to the

21-3  corporation, unless the corporation provides a legitimate reason for

21-4  the request and the purpose of the request is not to delay the

21-5  payment of the claim, harass the claimant or discourage the filing of

21-6  claims.

21-7      4.  A corporation shall not pay only part of a claim that has

21-8  been approved and is fully payable.

21-9      5.  A court shall award costs and reasonable attorney’s fees to

21-10  the prevailing party in an action brought pursuant to this section.

21-11     6.  The payment of interest provided for in this section for the

21-12  late payment of an approved claim may be waived only if the

21-13  payment was delayed because of an act of God or another cause

21-14  beyond the control of the corporation.

21-15     7.  The Commissioner may require a corporation to provide

21-16  evidence which demonstrates that the corporation has substantially

21-17  complied with the requirements set forth in this section, including,

21-18  without limitation, payment within 30 days of at least 95 percent of

21-19  approved claims or at least 90 percent of the total dollar amount for

21-20  approved claims.

21-21     8.  If the Commissioner determines that a corporation is not in

21-22  substantial compliance with the requirements set forth in this

21-23  section, the Commissioner may require the corporation to pay an

21-24  administrative fine in an amount to be determined by the

21-25  Commissioner. Upon a second or subsequent determination that a

21-26  corporation is not in substantial compliance with the requirements

21-27  set forth in this section, the Commissioner may suspend or revoke

21-28  the certificate of authority of the corporation.

21-29     Sec. 27.  Chapter 695C of NRS is hereby amended by adding

21-30  thereto a new section to read as follows:

21-31     1.  The provisions of this section apply to a health care plan

21-32  offered or issued by a health maintenance organization if an

21-33  insured covered by the health care plan receives health care

21-34  through a defined set of providers of health care who are under

21-35  contract with the health maintenance organization.

21-36     2.  Except as otherwise provided in this section, if an insured

21-37  who is covered by a health care plan described in subsection 1 is

21-38  receiving medical treatment for a medical condition from a

21-39  provider of health care whose contract with the health

21-40  maintenance organization is terminated during the course of the

21-41  medical treatment, the health care plan must provide that:

21-42     (a) The insured may continue to obtain medical treatment for

21-43  the medical condition from the provider of health care pursuant to

21-44  this section, if:

22-1          (1) The insured is actively undergoing a medically

22-2  necessary course of treatment; and

22-3          (2) The provider of health care and the insured agree that

22-4  the continuity of care is desirable.

22-5      (b) The provider of health care is entitled to receive

22-6  reimbursement from the health maintenance organization for the

22-7  medical treatment he provides to the insured pursuant to this

22-8  section, if the provider of health care agrees:

22-9          (1) To provide medical treatment under the terms of the

22-10  contract between the provider of health care and the health

22-11  maintenance organization with regard to the insured, including,

22-12  without limitation, the rates of payment for providing medical

22-13  service, as those terms existed before the termination of the

22-14  contract between the provider of health care and the health

22-15  maintenance organization; and

22-16         (2) Not to seek payment from the insured for any medical

22-17  service provided by the provider of health care that the provider of

22-18  health care could not have received from the insured were the

22-19  provider of health care still under contract with the health

22-20  maintenance organization.

22-21     3.  The coverage required by subsection 2 must be provided

22-22  until the later of:

22-23     (a) The 120th day after the date the contract is terminated; or

22-24     (b) If the medical condition is pregnancy, the 45th day after:

22-25         (1) The date of delivery; or

22-26         (2) If the pregnancy does not end in delivery, the date of the

22-27  end of the pregnancy.

22-28     4.  The requirements of this section do not apply to a provider

22-29  of health care if:

22-30     (a) The provider of health care was under contract with the

22-31  health maintenance organization and the health maintenance

22-32  organization terminated that contract because of the medical

22-33  incompetence or professional misconduct of the provider of health

22-34  care; and

22-35     (b) The health maintenance organization did not enter into

22-36  another contract with the provider of health care after the contract

22-37  was terminated pursuant to paragraph (a).

22-38     5.  An evidence of coverage for a health care plan subject to

22-39  the provisions of this chapter that is delivered, issued for delivery

22-40  or renewed on or after October 1, 2003, has the legal effect of

22-41  including the coverage required by this section, and any provision

22-42  of the evidence of coverage or renewal thereof that is in conflict

22-43  with this section is void.

22-44     6.  The Commissioner shall adopt regulations to carry out the

22-45  provisions of this section.

23-1      Sec. 28.  NRS 695C.050 is hereby amended to read as follows:

23-2      695C.050  1.  Except as otherwise provided in this chapter or

23-3  in specific provisions of this title, the provisions of this title are not

23-4  applicable to any health maintenance organization granted a

23-5  certificate of authority under this chapter. This provision does not

23-6  apply to an insurer licensed and regulated pursuant to this title

23-7  except with respect to its activities as a health maintenance

23-8  organization authorized and regulated pursuant to this chapter.

23-9      2.  Solicitation of enrollees by a health maintenance

23-10  organization granted a certificate of authority, or its representatives,

23-11  must not be construed to violate any provision of law relating to

23-12  solicitation or advertising by practitioners of a healing art.

23-13     3.  Any health maintenance organization authorized under this

23-14  chapter shall not be deemed to be practicing medicine and is exempt

23-15  from the provisions of chapter 630 of NRS.

23-16     4.  The provisions of NRS 695C.110, 695C.125, 695C.170 to

23-17  695C.200, inclusive, 695C.250 and 695C.265 and section 27 of this

23-18  act do not apply to a health maintenance organization that provides

23-19  health care services through managed care to recipients of Medicaid

23-20  under the State Plan for Medicaid or insurance pursuant to the

23-21  Children’s Health Insurance Program pursuant to a contract with the

23-22  Division of Health Care Financing and Policy of the Department of

23-23  Human Resources. This subsection does not exempt a health

23-24  maintenance organization from any provision of this chapter for

23-25  services provided pursuant to any other contract.

23-26     5.  The provisions of NRS 695C.1694 and 695C.1695 apply to

23-27  a health maintenance organization that provides health care services

23-28  through managed care to recipients of Medicaid under the State Plan

23-29  for Medicaid.

23-30     Sec. 29.  NRS 695C.055 is hereby amended to read as follows:

23-31     695C.055  1.  The provisions of NRS 449.465, 679B.700,

23-32  subsections 2, 4, 18, 19 and 32 of NRS 680B.010, NRS 680B.025 to

23-33  680B.060, inclusive, and [chapter] chapters 686A and 695G of

23-34  NRS and section 1 of this act apply to a health maintenance

23-35  organization.

23-36     2.  For the purposes of subsection 1, unless the context requires

23-37  that a provision apply only to insurers, any reference in those

23-38  sections to “insurer” must be replaced by “health maintenance

23-39  organization.”

23-40     Sec. 30.  NRS 695C.125 is hereby amended to read as follows:

23-41     695C.125 [A health maintenance organization shall not charge a

23-42  provider of health care a fee to include the name of the provider on a

23-43  list of providers of health care given by the health maintenance

23-44  organization to its enrollees.]

24-1      1.  A health maintenance organization shall not contract with

24-2  a provider of health care to provide health care to an insured

24-3  unless the health maintenance organization uses the form

24-4  prescribed by the Commissioner pursuant to section 40.3 of this

24-5  act to obtain any information related to the credentials of the

24-6  provider of health care.

24-7      2.  A contract between a health maintenance organization and

24-8  a provider of health care may be modified:

24-9      (a) At any time pursuant to a written agreement executed by

24-10  both parties.

24-11     (b) Except as otherwise provided in this paragraph, by the

24-12  health maintenance organization upon giving to the provider 30

24-13  days’ written notice of the modification. If the provider fails to

24-14  object in writing to the modification within the 30-day period, the

24-15  modification becomes effective at the end of that period. If the

24-16  provider objects in writing to the modification within the 30-day

24-17  period, the modification must not become effective unless agreed

24-18  to by both parties as described in paragraph (a).

24-19     3.  If a health maintenance organization contracts with a

24-20  provider of health care to provide health care to an enrollee, the

24-21  health maintenance organization shall:

24-22     (a) If requested by the provider of health care at the time the

24-23  contract is made, submit to the provider of health care the

24-24  schedule of payments applicable to the provider of health care; or

24-25     (b) If requested by the provider of health care at any other

24-26  time, submit to the provider of health care the schedule of

24-27  payments specified in paragraph (a) within 7 days after receiving

24-28  the request.

24-29     4.  As used in this section, “provider of health care” means a

24-30  provider of health care who is licensed pursuant to chapter 630,

24-31  631, 632 or 633 of NRS.

24-32     Sec. 31.  NRS 695C.185 is hereby amended to read as follows:

24-33     695C.185  1.  Except as otherwise provided in subsection 2, a

24-34  health maintenance organization shall approve or deny a claim

24-35  relating to a health care plan within 30 days after the health

24-36  maintenance organization receives the claim. If the claim is

24-37  approved, the health maintenance organization shall pay the claim

24-38  within 30 days after it is approved. Except as otherwise provided in

24-39  this section, if the approved claim is not paid within that period, the

24-40  health maintenance organization shall pay interest on the claim at a

24-41  rate of interest equal to the prime rate at the largest bank in Nevada,

24-42  as ascertained by the Commissioner of Financial Institutions, on

24-43  January 1 or July 1, as the case may be, immediately preceding the

24-44  date on which the payment was due, plus 6 percent. The interest

25-1  must be calculated from 30 days after the date on which the claim is

25-2  approved until the date on which the claim is paid.

25-3      2.  If the health maintenance organization requires additional

25-4  information to determine whether to approve or deny the claim, it

25-5  shall notify the claimant of its request for the additional information

25-6  within 20 days after it receives the claim. The health maintenance

25-7  organization shall notify the provider of health care services of all

25-8  the specific reasons for the delay in approving or denying the claim.

25-9  The health maintenance organization shall approve or deny the

25-10  claim within 30 days after receiving the additional information. If

25-11  the claim is approved, the health maintenance organization shall pay

25-12  the claim within 30 days after it receives the additional information.

25-13  If the approved claim is not paid within that period, the health

25-14  maintenance organization shall pay interest on the claim in the

25-15  manner prescribed in subsection 1.

25-16     3.  A health maintenance organization shall not request a

25-17  claimant to resubmit information that the claimant has already

25-18  provided to the health maintenance organization, unless the health

25-19  maintenance organization provides a legitimate reason for the

25-20  request and the purpose of the request is not to delay the payment of

25-21  the claim, harass the claimant or discourage the filing of claims.

25-22     4.  A health maintenance organization shall not pay only part of

25-23  a claim that has been approved and is fully payable.

25-24     5.  A court shall award costs and reasonable attorney’s fees to

25-25  the prevailing party in an action brought pursuant to this section.

25-26     6.  The payment of interest provided for in this section for the

25-27  late payment of an approved claim may be waived only if the

25-28  payment was delayed because of an act of God or another cause

25-29  beyond the control of the health maintenance organization.

25-30     7.  The Commissioner may require a health maintenance

25-31  organization to provide evidence which demonstrates that the health

25-32  maintenance organization has substantially complied with the

25-33  requirements set forth in this section, including, without limitation,

25-34  payment within 30 days of at least 95 percent of approved claims or

25-35  at least 90 percent of the total dollar amount for approved claims.

25-36     8.  If the Commissioner determines that a health maintenance

25-37  organization is not in substantial compliance with the requirements

25-38  set forth in this section, the Commissioner may require the health

25-39  maintenance organization to pay an administrative fine in an amount

25-40  to be determined by the Commissioner. Upon a second or

25-41  subsequent determination that a health maintenance organization

25-42  is not in substantial compliance with the requirements set forth in

25-43  this section, the Commissioner may suspend or revoke the

25-44  certificate of authority of the health maintenance organization.

 

26-1      Sec. 32.  NRS 695C.330 is hereby amended to read as follows:

26-2      695C.330  1.  The Commissioner may suspend or revoke any

26-3  certificate of authority issued to a health maintenance organization

26-4  pursuant to the provisions of this chapter if he finds that any of the

26-5  following conditions exist:

26-6      (a) The health maintenance organization is operating

26-7  significantly in contravention of its basic organizational document,

26-8  its health care plan or in a manner contrary to that described in and

26-9  reasonably inferred from any other information submitted pursuant

26-10  to NRS 695C.060, 695C.070 and 695C.140, unless any amendments

26-11  to those submissions have been filed with and approved by the

26-12  Commissioner;

26-13     (b) The health maintenance organization issues evidence of

26-14  coverage or uses a schedule of charges for health care services

26-15  which do not comply with the requirements of NRS [695C.170]

26-16  695C.1694 to 695C.200, inclusive, [or 695C.1694, 695C.1695] or

26-17  695C.207;

26-18     (c) The health care plan does not furnish comprehensive health

26-19  care services as provided for in NRS 695C.060;

26-20     (d) The State Board of Health certifies to the Commissioner that

26-21  the health maintenance organization:

26-22         (1) Does not meet the requirements of subsection 2 of NRS

26-23  695C.080; or

26-24         (2) Is unable to fulfill its obligations to furnish health care

26-25  services as required under its health care plan;

26-26     (e) The health maintenance organization is no longer financially

26-27  responsible and may reasonably be expected to be unable to meet its

26-28  obligations to enrollees or prospective enrollees;

26-29     (f) The health maintenance organization has failed to put into

26-30  effect a mechanism affording the enrollees an opportunity to

26-31  participate in matters relating to the content of programs pursuant to

26-32  NRS 695C.110;

26-33     (g) The health maintenance organization has failed to put into

26-34  effect the system for resolving complaints required by NRS

26-35  695C.260 in a manner reasonably to dispose of valid complaints;

26-36     (h) The health maintenance organization or any person on its

26-37  behalf has advertised or merchandised its services in an untrue,

26-38  misrepresentative, misleading, deceptive or unfair manner;

26-39     (i) The continued operation of the health maintenance

26-40  organization would be hazardous to its enrollees; [or]

26-41     (j) The health maintenance organization fails to provide the

26-42  coverage required by section 27 of this act; or

26-43     (k) The health maintenance organization has otherwise failed to

26-44  comply substantially with the provisions of this chapter.

27-1      2.  A certificate of authority must be suspended or revoked only

27-2  after compliance with the requirements of NRS 695C.340.

27-3      3.  If the certificate of authority of a health maintenance

27-4  organization is suspended, the health maintenance organization shall

27-5  not, during the period of that suspension, enroll any additional

27-6  groups or new individual contracts, unless those groups or persons

27-7  were contracted for before the date of suspension.

27-8      4.  If the certificate of authority of a health maintenance

27-9  organization is revoked, the organization shall proceed, immediately

27-10  following the effective date of the order of revocation, to wind up its

27-11  affairs and shall conduct no further business except as may be

27-12  essential to the orderly conclusion of the affairs of the organization.

27-13  It shall engage in no further advertising or solicitation of any kind.

27-14  The Commissioner may , by written order , permit such further

27-15  operation of the organization as he may find to be in the best interest

27-16  of enrollees to the end that enrollees are afforded the greatest

27-17  practical opportunity to obtain continuing coverage for health care.

27-18     Sec. 33.  Chapter 695G of NRS is hereby amended by adding

27-19  thereto a new section to read as follows:

27-20     1.  The provisions of this section apply to a health care plan

27-21  offered or issued by a managed care organization if an insured

27-22  covered by the health care plan receives health care through a

27-23  defined set of providers of health care who are under contract with

27-24  the managed care organization.

27-25     2.  Except as otherwise provided in this section, if an insured

27-26  who is covered by a health care plan described in subsection 1 is

27-27  receiving medical treatment for a medical condition from a

27-28  provider of health care whose contract with the managed care

27-29  organization is terminated during the course of the medical

27-30  treatment, the health care plan must provide that:

27-31     (a) The insured may continue to obtain medical treatment for

27-32  the medical condition from the provider of health care pursuant to

27-33  this section, if:

27-34         (1) The insured is actively undergoing a medically

27-35  necessary course of treatment; and

27-36         (2) The provider of health care and the insured agree that

27-37  the continuity of care is desirable.

27-38     (b) The provider of health care is entitled to receive

27-39  reimbursement from the managed care organization for the

27-40  medical treatment he provides to the insured pursuant to this

27-41  section, if the provider of health care agrees:

27-42         (1) To provide medical treatment under the terms of the

27-43  contract between the provider of health care and the managed

27-44  care organization with regard to the insured, including, without

27-45  limitation, the rates of payment for providing medical service, as

28-1  those terms existed before the termination of the contract between

28-2  the provider of health care and the managed care organization;

28-3  and

28-4          (2) Not to seek payment from the insured for any medical

28-5  service provided by the provider of health care that the provider of

28-6  health care could not have received from the insured were the

28-7  provider of health care still under contract with the managed care

28-8  organization.

28-9      3.  The coverage required by subsection 2 must be provided

28-10  until the later of:

28-11     (a) The 120th day after the date the contract is terminated; or

28-12     (b) If the medical condition is pregnancy, the 45th day after:

28-13         (1) The date of delivery; or

28-14         (2) If the pregnancy does not end in delivery, the date of the

28-15  end of the pregnancy.

28-16     4.  The requirements of this section do not apply to a provider

28-17  of health care if:

28-18     (a) The provider of health care was under contract with the

28-19  managed care organization and the managed care organization

28-20  terminated that contract because of the medical incompetence or

28-21  professional misconduct of the provider of health care; and

28-22     (b) The managed care organization did not enter into another

28-23  contract with the provider of health care after the contract was

28-24  terminated pursuant to paragraph (a).

28-25     5.  An evidence of coverage for a health care plan subject to

28-26  the provisions of this chapter that is delivered, issued for delivery

28-27  or renewed on or after October 1, 2003, has the legal effect of

28-28  including the coverage required by this section, and any provision

28-29  of the evidence of coverage or renewal thereof that is in conflict

28-30  with this section is void.

28-31     6.  The Commissioner shall adopt regulations to carry out the

28-32  provisions of this section.

28-33     Sec. 33.5. NRS 695G.090 is hereby amended to read as

28-34  follows:

28-35     695G.090  1.  [The] Except as otherwise provided in

28-36  subsection 3, the provisions of this chapter apply to each

28-37  organization and insurer that operates as a managed care

28-38  organization and may include, without limitation, an insurer that

28-39  issues a policy of health insurance, an insurer that issues a policy of

28-40  individual or group health insurance, a carrier serving small

28-41  employers, a fraternal benefit society, a hospital or medical service

28-42  corporation and a health maintenance organization.

28-43     2.  In addition to the provisions of this chapter, each managed

28-44  care organization shall comply with [any] :

29-1      (a) The provisions of chapter 686A of NRS, including all

29-2  obligations and remedies set forth therein; and

29-3      (b) Any other applicable provision of this title.

29-4      3.  The provisions of subsections 2 to 9, inclusive, of NRS

29-5  695G.270 and section 33 of this act do not apply to a managed

29-6  care organization that provides health care services to recipients

29-7  of Medicaid under the State Plan for Medicaid or insurance

29-8  pursuant to the Children’s Health Insurance Program pursuant to

29-9  a contract with the Division of Health Care Financing and Policy

29-10  of the Department of Human Resources. This subsection does not

29-11  exempt a managed care organization from any provision of this

29-12  chapter for services provided pursuant to any other contract.

29-13     Sec. 34.  NRS 695G.270 is hereby amended to read as follows:

29-14     695G.270 [A managed care organization that establishes a panel

29-15  of providers of health care for the purpose of offering health care

29-16  services pursuant to chapters 689A, 689B, 689C, 695A, 695B, or

29-17  695C of NRS shall not charge a provider of health care a fee to

29-18  include the name of the provider on the panel of providers of health

29-19  care.]

29-20     1.  A managed care organization shall not contract with a

29-21  provider of health care to provide health care to an insured unless

29-22  the managed care organization uses the form prescribed by the

29-23  Commissioner pursuant to section 40.3 of this act to obtain any

29-24  information related to the credentials of the provider of health

29-25  care.

29-26     2.  A contract between a managed care organization and a

29-27  provider of health care may be modified:

29-28     (a) At any time pursuant to a written agreement executed by

29-29  both parties.

29-30     (b) Except as otherwise provided in this paragraph, by the

29-31  managed care organization upon giving to the provider 30 days’

29-32  written notice of the modification. If the provider fails to object in

29-33  writing to the modification within the 30-day period, the

29-34  modification becomes effective at the end of that period. If the

29-35  provider objects in writing to the modification within the 30-day

29-36  period, the modification must not become effective unless agreed

29-37  to by both parties as described in paragraph (a).

29-38     3.  If a managed care organization contracts with a provider

29-39  of health care to provide health care services pursuant to chapter

29-40  689A, 689B, 689C, 695A, 695B or 695C of NRS, the managed care

29-41  organization shall:

29-42     (a) If requested by the provider of health care at the time the

29-43  contract is made, submit to the provider of health care the

29-44  schedule of payments applicable to the provider of health care; or

30-1      (b) If requested by the provider of health care at any other

30-2  time, submit to the provider of health care the schedule of

30-3  payments specified in paragraph (a) within 7 days after receiving

30-4  the request.

30-5      4.  As used in this section, “provider of health care” means a

30-6  provider of health care who is licensed pursuant to chapter 630,

30-7  631, 632 or 633 of NRS.

30-8      Sec. 35.  Chapter 41A of NRS is hereby amended by adding

30-9  thereto a new section to read as follows:

30-10     1.  In an action for damages for medical malpractice or dental

30-11  malpractice in which the defendant is insured pursuant to a policy

30-12  of insurance covering the liability of the defendant for a breach of

30-13  his professional duty toward a patient:

30-14     (a) At any settlement conference, the judge may recommend

30-15  that the action be settled for the limits of the policy of insurance.

30-16     (b) If the judge makes the recommendation described in

30-17  paragraph (a), the defendant is entitled to obtain from

30-18  independent counsel an opinion letter explaining the rights of,

30-19  obligations of and potential consequences to the defendant with

30-20  regard to the recommendation. The insurer shall pay the

30-21  independent counsel to provide the opinion letter described in this

30-22  paragraph, except that the insurer is not required to pay more

30-23  than $1,500 to the independent counsel to provide the opinion

30-24  letter.

30-25     2.  The section does not:

30-26     (a) Prohibit the plaintiff from making any offer of settlement.

30-27     (b) Require an insurer to provide or pay for independent

30-28  counsel for a defendant except as expressly provided in this

30-29  section.

30-30     Secs. 36 and 37.  (Deleted by amendment.)

30-31     Sec. 38.  NRS 287.010 is hereby amended to read as follows:

30-32     287.010  1.  The governing body of any county, school

30-33  district, municipal corporation, political subdivision, public

30-34  corporation or other public agency of the State of Nevada may:

30-35     (a) Adopt and carry into effect a system of group life, accident

30-36  or health insurance, or any combination thereof, for the benefit of its

30-37  officers and employees, and the dependents of officers and

30-38  employees who elect to accept the insurance and who, where

30-39  necessary, have authorized the governing body to make deductions

30-40  from their compensation for the payment of premiums on the

30-41  insurance.

30-42     (b) Purchase group policies of life, accident or health insurance,

30-43  or any combination thereof, for the benefit of such officers and

30-44  employees, and the dependents of such officers and employees, as

30-45  have authorized the purchase, from insurance companies authorized

31-1  to transact the business of such insurance in the State of Nevada,

31-2  and, where necessary, deduct from the compensation of officers and

31-3  employees the premiums upon insurance and pay the deductions

31-4  upon the premiums.

31-5      (c) Provide group life, accident or health coverage through a

31-6  self-insurance reserve fund and, where necessary, deduct

31-7  contributions to the maintenance of the fund from the compensation

31-8  of officers and employees and pay the deductions into the fund. The

31-9  money accumulated for this purpose through deductions from

31-10  the compensation of officers and employees and contributions of the

31-11  governing body must be maintained as an internal service fund as

31-12  defined by NRS 354.543. The money must be deposited in a state or

31-13  national bank or credit union authorized to transact business in the

31-14  State of Nevada. Any independent administrator of a fund created

31-15  under this section is subject to the licensing requirements of chapter

31-16  683A of NRS, and must be a resident of this state. Any contract

31-17  with an independent administrator must be approved by the

31-18  Commissioner of Insurance as to the reasonableness of

31-19  administrative charges in relation to contributions collected and

31-20  benefits provided. The provisions of NRS 689B.030 to 689B.050,

31-21  inclusive, and 689B.575 and section 13 of this act apply to

31-22  coverage provided pursuant to this paragraph, except that the

31-23  provisions of NRS 689B.0359 do not apply to such coverage.

31-24     (d) Defray part or all of the cost of maintenance of a self-

31-25  insurance fund or of the premiums upon insurance. The money for

31-26  contributions must be budgeted for in accordance with the laws

31-27  governing the county, school district, municipal corporation,

31-28  political subdivision, public corporation or other public agency of

31-29  the State of Nevada.

31-30     2.  If a school district offers group insurance to its officers and

31-31  employees pursuant to this section, members of the board of trustees

31-32  of the school district must not be excluded from participating in the

31-33  group insurance. If the amount of the deductions from compensation

31-34  required to pay for the group insurance exceeds the compensation to

31-35  which a trustee is entitled, the difference must be paid by the trustee.

31-36     Sec. 39.  NRS 287.04335 is hereby amended to read as

31-37  follows:

31-38     287.04335  If the Board provides health insurance through a

31-39  plan of self-insurance, it shall comply with the provisions of NRS

31-40  689B.255, 695G.150, 695G.160, 695G.170 and 695G.200 to

31-41  695G.230, inclusive, and section 33 of this act, in the same manner

31-42  as an insurer that is licensed pursuant to title 57 of NRS is required

31-43  to comply with those provisions.

31-44     Sec. 39.5.  (Deleted by amendment.)

32-1      Sec. 40.  Chapter 616B of NRS is hereby amended by adding

32-2  thereto a new section to read as follows:

32-3      1.  If an insurer establishes a panel of providers of health care

32-4  for the purpose of offering health care services pursuant to

32-5  chapters 616A to 617, inclusive, of NRS, the insurer shall not

32-6  charge a provider of health care:

32-7      (a) A fee to include the name of the provider on the panel of

32-8  providers of health care; or

32-9      (b) Any other fee related to establishing a provider of health

32-10  care as a provider for the insurer.

32-11     2.  If an insurer violates the provisions of subsection 1, the

32-12  insurer shall pay to the provider of health care an amount that is

32-13  equal to twice the fee charged to the provider of health care.

32-14     3.  A court shall award costs and reasonable attorney’s fees to

32-15  the prevailing party in an action brought pursuant to this section.

32-16     Sec. 40.3. Chapter 629 of NRS is hereby amended by adding

32-17  thereto a new section to read as follows:

32-18     1.  Except as otherwise provided in subsection 2, the

32-19  Commissioner of Insurance shall develop, prescribe for use and

32-20  make available a single, standardized form for use by insurers,

32-21  carriers, societies, corporations, health maintenance organizations

32-22  and managed care organizations in obtaining any information

32-23  related to the credentials of a provider of health care.

32-24     2.  The provisions of subsection 1 do not prohibit the

32-25  Commissioner of Insurance from developing, prescribing for use

32-26  and making available:

32-27     (a) Appropriate variations of the form described in that

32-28  subsection for use in different geographical regions of this state.

32-29     (b) Addenda or supplements to the form described in that

32-30  subsection to address, until such time as a new form may be

32-31  developed, prescribed for use and made available, any

32-32  requirements newly imposed by the Federal Government, the State

32-33  or one of its agencies, or a body that accredits hospitals, medical

32-34  facilities or health care plans.

32-35     3.  With respect to the form described in subsection 1, the

32-36  Commissioner of Insurance shall:

32-37     (a) Hold public hearings to seek input regarding the

32-38  development of the form;

32-39     (b) Develop the form in consideration of the input received

32-40  pursuant to paragraph (a);

32-41     (c) Ensure that the form is developed in such a manner as to

32-42  accommodate and reflect the different types of credentials

32-43  applicable to different classes of providers of health care;

32-44     (d) Ensure that the form is developed in such a manner as to

32-45  reflect standards of accreditation adopted by national

33-1  organizations which accredit hospitals, medical facilities and

33-2  health care plans; and

33-3      (e) Ensure that the form is developed to be used efficiently and

33-4  is developed to be neither unduly long nor unduly voluminous.

33-5      4.  As used in this section:

33-6      (a) “Carrier” has the meaning ascribed to it in NRS 689C.025.

33-7      (b) “Corporation” means a corporation operating pursuant to

33-8  the provisions of chapter 695B of NRS.

33-9      (c) “Health maintenance organization” has the meaning

33-10  ascribed to it in NRS 695C.030.

33-11     (d) “Insurer” means:

33-12         (1) An insurer that issues policies of individual health

33-13  insurance in accordance with chapter 689A of NRS; and

33-14         (2) An insurer that issues policies of group health

33-15  insurance in accordance with chapter 689B of NRS.

33-16     (e) “Managed care organization” has the meaning ascribed to

33-17  it in NRS 695G.050.

33-18     (f) “Provider of health care” means a provider of health care

33-19  who is licensed pursuant to chapter 630, 631, 632 or 633 of NRS.

33-20     (g) “Society” has the meaning ascribed to it in NRS 695A.044.

33-21     Sec. 40.7.  1.  The Commissioner of Insurance shall develop,

33-22  prescribe for use and make available the form described in section

33-23  40.3 of this act on or before July 1, 2004.

33-24     2.  Notwithstanding the provisions of sections 10, 14, 16, 23,

33-25  25, 30 and 34 of this act, an insurer, carrier, society, corporation,

33-26  health maintenance organization and managed care organization is

33-27  not required to use the form described in section 40.3 of this act

33-28  until the earlier of:

33-29     (a) The date by which the Commissioner of Insurance develops,

33-30  prescribes for use and makes available that form; or

33-31     (b) July 1, 2004.

33-32     Sec. 41.  The amendatory provisions of this act apply to a:

33-33     1.  Policy of insurance issued or renewed on or after October 1,

33-34  2003.

33-35     2.  Offer to issue a policy of insurance communicated to the

33-36  applicant for the policy on or after October 1, 2003.

33-37     3.  Decision with regard to the issuance of a policy of insurance

33-38  communicated to the applicant for the policy on or after October 1,

33-39  2003.

33-40     4.  Cause of action that accrues on or after October 1, 2003.

33-41     Sec. 42. 1.  This section and sections 40.3 and 40.7 of this act

33-42  become effective upon passage and approval.

 

 

34-1      2.  Sections 1 to 40, inclusive, and 41 of this act become

34-2  effective on October 1, 2003.

 

34-3  H