Amendment No. 361

 

 

 

     Amend section 1, page 2, by deleting lines 7 and 8 and inserting:

“not charge the insurer or a provider of health care:

     (a) A fee to include the name of the provider on the panel of providers of health care; or

     (b) Any other fee related to establishing a provider of health care as a provider for the organization.”.

     Amend sec. 2, page 3, line 14, by deleting “shall” and inserting “shall:”.

     Amend sec. 2, page 3, by deleting lines 15 through 17 and inserting:

     “1.  If requested by the provider of health care at the time the contract is made, submit to the provider of health care a copy of the schedule of payments applicable to the provider of health care; or

     2.  If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments specified in subsection 1 within 7 days after receiving the request.”.

     Amend sec. 10, page 10, line 22, after “care;” by inserting “and”.

     Amend sec. 10, page 10, by deleting lines 23 through 26 and inserting:

     “(b) The contract complies with the provisions of this section.”.

     Amend sec. 10, page 11, between lines 10 and 11, by inserting:

     “9.  If an insurer contracts with a provider of health care to provide health care to an insured, the insurer shall:

     (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or

     (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments specified in paragraph (a) within 7 days after receiving the request.”.

     Amend sec. 14, page 13, line 44, after “care;” by inserting “and”.

     Amend sec. 14, page 14, by deleting lines 1 through 4 and inserting:

     “(b) The contract complies with the provisions of this section.”.

     Amend sec. 14, page 14, between lines 33 and 34, by inserting:

     “9.  If an insurer specified in subsection 1 contracts with a provider of health care to provide health care to an insured, the insurer shall:

     (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or

     (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments specified in paragraph (a) within 7 days after receiving the request.”.

     Amend sec. 16, page 16, line 20, after “care;” by inserting “and”.

     Amend sec. 16, page 16, by deleting lines 21 through 24 and inserting:

     “(b) The contract complies with the provisions of this section.”.

     Amend sec. 16, page 17, between lines 8 and 9, by inserting:

     “9.  If a carrier specified in subsection 1 contracts with a provider of health care to provide health care to an insured, the carrier shall:

     (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or

     (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments specified in paragraph (a) within 7 days after receiving the request.”.

     Amend sec. 23, page 21, line 11, after “care;” by inserting “and”.

     Amend sec. 23, page 21, by deleting lines 12 through 15 and inserting:

     “(b) The contract complies with the provisions of this section.”.

     Amend sec. 23, page 21, after line 44, by inserting:

     “9.  If a society contracts with a provider of health care to provide health care to an insured, the society shall:

     (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or

     (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments specified in paragraph (a) within 7 days after receiving the request.”.

     Amend sec. 25, page 23, line 11, after “care;” by inserting “and”.

     Amend sec. 25, page 23, by deleting lines 12 through 15 and inserting:

     “(b) The contract complies with the provisions of this section.”.

     Amend sec. 25, page 23, after line 44, by inserting:

     “9.  If a corporation specified in subsection 1 contracts with a provider of health care to provide health care to an insured, the corporation shall:

     (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or

     (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments specified in paragraph (a) within 7 days after receiving the request.”.

     Amend sec. 28, page 26, by deleting lines 40 and 41 and inserting:

     “4.  The provisions of chapter 686A, NRS 695C.110, 695C.125, 695C.170 to 695C.200, inclusive, 695C.250 and 695C.265 and section 27 of this act do not apply to a health”.

     Amend sec. 28, page 27, lines 5 and 6, by deleting:

“and section 27 of this act”.

     Amend sec. 29, page 27, line 13, after “NRS” by inserting:

“and section 1 of this act”.

     Amend sec. 30, page 27, by deleting lines 19 through 22 and inserting:

“695C.125 [A health maintenance organization shall not charge a provider of health care a fee to include the name of the provider on a list of providers of health care given by the health maintenance organization to its enrollees.]”.

     Amend sec. 30, page 27, line 23, by deleting “2.” and inserting “1.”.

     Amend sec. 30, page 27, line 28, after “care;” by inserting “and”.

     Amend sec. 30, page 27, by deleting lines 29 through 32 and inserting:

     “(b) The contract complies with the provisions of this section.”.

     Amend sec. 30, page 27, line 33, by deleting “3.” and inserting “2.”.

     Amend sec. 30, page 27, line 43, by deleting “4.” and inserting “3.”.

     Amend sec. 30, page 28, line 9, by deleting “5.” and inserting “4.”.

     Amend sec. 30, page 28, line 13, by deleting “6.” and inserting “5.”.

     Amend sec. 30, page 28, line 15, by deleting “7.” and inserting “6.”.

     Amend sec. 30, page 28, line 17, by deleting “8.” and inserting “7.”.

     Amend sec. 30, page 28, between lines 18 and 19, by inserting:

     “8.  If a health maintenance organization contracts with a provider of health care to provide health care to an enrollee, the health maintenance organization shall:

     (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or

     (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments specified in paragraph (a) within 7 days after receiving the request.”.

     Amend the bill as a whole by adding a new section designated sec. 33.5, following sec. 33, to read as follows:

     “Sec. 33.5. NRS 695G.090 is hereby amended to read as follows:

     695G.090  1.  [The] Except as otherwise provided in subsection 3, the provisions of this chapter apply to each organization and insurer that operates as a managed care organization and may include, without limitation, an insurer that issues a policy of health insurance, an insurer that issues a policy of individual or group health insurance, a carrier serving small employers, a fraternal benefit society, a hospital or medical service corporation and a health maintenance organization.

     2.  In addition to the provisions of this chapter, each managed care organization shall comply with any other applicable provision of this title.

     3.  The provisions of subsections 2 to 9, inclusive, of NRS 695G.270 and section 33 of this act do not apply to a managed care organization that provides health care services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Human Resources. This subsection does not exempt a managed care organization from any provision of this chapter for services provided pursuant to any other contract.”.

     Amend sec. 34, page 32, by deleting lines 19 through 24 and inserting:

“695G.270 [A managed care organization that establishes a panel of providers of health care for the purpose of offering health care services pursuant to chapters 689A, 689B, 689C, 695A, 695B, or 695C of NRS shall not charge a provider of health care a fee to include the name of the provider on the panel of providers of health care.]”.

     Amend sec. 34, page 32, line 25, by deleting “2.” and inserting “1.”.

     Amend sec. 34, page 32, line 30, after “care;” by inserting “and”.

     Amend sec. 34, page 32, by deleting lines 31 through 34 and inserting:

     “(b) The contract complies with the provisions of this section.”.

     Amend sec. 34, page 32, line 35, by deleting “3.” and inserting “2.”.

     Amend sec. 34, page 33, line 1, by deleting “4.” and inserting “3.”.

     Amend sec. 34, page 33, line 11, by deleting “5.” and inserting “4.”.

     Amend sec. 34, page 33, line 15, by deleting “6.” and inserting “5.”.

     Amend sec. 34, page 33, line 17, by deleting “7.” and inserting “6.”.

     Amend sec. 34, page 33, line 19, by deleting “8.” and inserting “7.”.

     Amend sec. 34, page 33, between lines 20 and 21, by inserting:

     “9.  If a managed care organization contracts with a provider of health care to provide health care services pursuant to chapter 689A, 689B, 689C, 695A, 695B or 695C of NRS, the managed care organization shall:

     (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or

     (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments specified in paragraph (a) within 7 days after receiving the request.”.

     Amend the bill as a whole by adding a new section designated sec. 39.5, following sec. 39, to read as follows:

     “Sec. 39.5. Chapter 449 of NRS is hereby amended by adding thereto a new section to read as follows:

     1.  If a hospital in this state establishes a panel of providers of health care and makes the panel available for use by an insurer when offering health care services pursuant to chapter 616A to 617, inclusive, 689A, 689B, 689C, 695A, 695B or 695C of NRS, the hospital shall not charge the insurer or a provider of health care:

     (a) A fee to include the name of the provider on the panel of providers of health care; or

     (b) Any other fee related to establishing a provider of health care as a provider for the hospital.

     2.  If a hospital in this state violates the provisions of subsection 1, the hospital shall pay to the insurer or provider of health care, as appropriate, an amount that is equal to twice the fee charged to the insurer or provider of health care.

     3.  A court shall award costs and reasonable attorney’s fees to the prevailing party in an action brought pursuant to this section.

     4.  In addition to any relief granted pursuant to this section, if a hospital in this state violates the provisions of subsection 1, and if an insurer offering health care services pursuant to chapter 616A to 617, inclusive, 689A, 689B, 689C, 695A, 695B or 695C of NRS has a contract with or otherwise uses the services of the hospital, the Division of Insurance of the Department of Business and Industry shall require the insurer to suspend its performance under the contract or discontinue using those services until the hospital, as determined by the Division of Insurance of the Department of Business and Industry:

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

     (b) Refunds to all providers of health care any fees obtained by the hospital in violation of subsection 1.”.

     Amend sec. 40, page 36, by deleting lines 6 and 7 and inserting:

“charge a provider of health care:

     (a) A fee to include the name of the provider on the panel of providers of health care; or

     (b) Any other fee related to establishing a provider of health care as a provider for the insurer.”.

     Amend the title of the bill by deleting the seventh through nineteenth lines and inserting:

“deemed to have acted in bad faith; prohibiting hospitals and 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; prohibiting a contract with a provider of health care from including various provisions relating to amendments to the terms of the contract; 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;”.