Senate Bill No. 163–Senators O’Connell and Townsend

 

February 19, 2003

____________

 

Referred to Committee on Commerce and Labor

 

SUMMARY—Revises provisions governing certain contracts with providers of health care. (BDR 57‑683)

 

FISCAL NOTE:  Effect on Local Government: Yes.

                           Effect on the State: No.

 

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to insurance; 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; requiring a contract with a provider of health care to include a schedule setting forth the payments required to be made to the provider of health care pursuant to the contract under certain circumstances; providing a penalty; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

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, the organization shall not

1-7  charge the insurer or a provider of health care a fee to include the

1-8  name of the provider on the panel of providers of health care.

1-9  2.  If an organization violates the provisions of subsection 1,

1-10  the organization shall pay to the insurer or provider of health

1-11  care, as appropriate, an amount that is equal to twice the fee

1-12  charged to the insurer or provider of health care.

2-1  3.  A court shall award costs and reasonable attorney’s fees to

2-2  the prevailing party in an action brought pursuant to this section.

2-3  4.  In addition to any relief granted pursuant to this section, if

2-4  an organization violates the provisions of subsection 1, and if an

2-5  insurer offering health care services pursuant to chapter 689A,

2-6  689B, 689C, 695A, 695B or 695C has a contract with or otherwise

2-7  uses the services of the organization, the Division shall require the

2-8  insurer to suspend its performance under the contract or

2-9  discontinue using those services until the organization, as

2-10  determined by the Division:

2-11      (a) Complies with the provisions of subsection 1; and

2-12      (b) Refunds to all providers of health care any fees obtained by

2-13  the organization in violation of subsection 1.

2-14      Sec. 2.  Chapter 683A of NRS is hereby amended by adding

2-15  thereto a new section to read as follows:

2-16      If an administrator, managing general agent or producer of

2-17  insurance, or a health maintenance organization when acting as

2-18  an administrator pursuant to NRS 683A.0851 or a nonprofit

2-19  corporation for hospital or medical services when acting as an

2-20  administrator pursuant to NRS 683A.0852, contracts with a

2-21  provider of health care to provide health care to an insured

2-22  pursuant to this chapter, the administrator, managing general

2-23  agent, producer of insurance, health maintenance organization or

2-24  nonprofit corporation for hospital or medical services shall

2-25  include in the contract a schedule setting forth the payments

2-26  required to be made to the provider of health care pursuant to the

2-27  contract.

2-28      Sec. 3.  NRS 689A.035 is hereby amended to read as follows:

2-29      689A.035  1.  An insurer shall not charge a provider of health

2-30  care a fee to include the name of the provider on a list of providers

2-31  of health care given by the insurer to its insureds.

2-32      2.  If an insurer contracts with a provider of health care to

2-33  provide health care to an insured, the insurer shall include in the

2-34  contract a schedule setting forth the payments required to be made

2-35  to the provider of health care pursuant to the contract.

2-36      Sec. 4.  NRS 689B.015 is hereby amended to read as follows:

2-37      689B.015  1.  An insurer that issues a policy of group health

2-38  insurance shall not charge a provider of health care a fee to include

2-39  the name of the provider on a list of providers of health care given

2-40  by the insurer to its insureds.

2-41      2.  If an insurer specified in subsection 1 contracts with a

2-42  provider of health care to provide health care to an insured, the

2-43  insurer shall include in the contract a schedule setting forth the

2-44  payments required to be made to the provider of health care

2-45  pursuant to the contract.

3-1  Sec. 5.  NRS 689C.435 is hereby amended to read as follows:

3-2  689C.435  1.  A carrier serving small employers and a carrier

3-3  that offers a contract to a voluntary purchasing group shall not

3-4  charge a provider of health care a fee to include the name of the

3-5  provider on a list of providers of health care given by the carrier to

3-6  its insureds.

3-7  2.  If a carrier specified in subsection 1 contracts with a

3-8  provider of health care to provide health care to an insured, the

3-9  carrier shall include in the contract a schedule setting forth the

3-10  payments required to be made to the provider of health care

3-11  pursuant to the contract.

3-12      Sec. 6.  NRS 695A.095 is hereby amended to read as follows:

3-13      695A.095  1.  A society shall not charge a provider of health

3-14  care a fee to include the name of the provider on a list of providers

3-15  of health care given by the society to its insureds.

3-16      2.  If a society contracts with a provider of health care to

3-17  provide health care to an insured, the society shall include in the

3-18  contract a schedule setting forth the payments required to be made

3-19  to the provider of health care pursuant to the contract.

3-20      Sec. 7.  NRS 695B.035 is hereby amended to read as follows:

3-21      695B.035  1.  A corporation subject to the provisions of this

3-22  chapter shall not charge a provider of health care a fee to include the

3-23  name of the provider on a list of providers of health care given by

3-24  the corporation to its insureds.

3-25      2.  If a corporation specified in subsection 1 contracts with a

3-26  provider of health care to provide health care to an insured, the

3-27  corporation shall include in the contract a schedule setting forth

3-28  the payments required to be made to the provider of health care

3-29  pursuant to the contract.

3-30      Sec. 8.  NRS 695C.125 is hereby amended to read as follows:

3-31      695C.125  1.  A health maintenance organization shall not

3-32  charge a provider of health care a fee to include the name of the

3-33  provider on a list of providers of health care given by the health

3-34  maintenance organization to its enrollees.

3-35      2.  If a health maintenance organization contracts with a

3-36  provider of health care to provide health care to an enrollee, the

3-37  health maintenance organization shall include in the contract a

3-38  schedule setting forth the payments required to be made to the

3-39  provider of health care pursuant to the contract.

3-40      Sec. 9.  NRS 695G.270 is hereby amended to read as follows:

3-41      695G.270  1.  A managed care organization that establishes a

3-42  panel of providers of health care for the purpose of offering health

3-43  care services pursuant to chapter 689A, 689B, 689C, 695A, 695B or

3-44  695C of NRS shall not charge a provider of health care a fee to

4-1  include the name of the provider on the panel of providers of health

4-2  care.

4-3  2.  If a managed care organization contracts with a provider

4-4  of health care to provide health care services pursuant to chapter

4-5  689A, 689B, 689C, 695A, 695B or 695C of NRS, the managed care

4-6  organization shall include in the contract a schedule setting forth

4-7  the payments required to be made to the provider of health care

4-8  pursuant to the contract.

4-9  Sec. 10.  Chapter 616B of NRS is hereby amended by adding

4-10  thereto a new section to read as follows:

4-11      1.  If an insurer establishes a panel of providers of health care

4-12  for the purpose of offering health care services pursuant to

4-13  chapters 616A to 617, inclusive, of NRS, the insurer shall not

4-14  charge a provider of health care a fee to include the name of the

4-15  provider on the panel of providers of health care.

4-16      2.  If an insurer violates the provisions of subsection 1, the

4-17  insurer shall pay to the provider of health care an amount that is

4-18  equal to twice the fee charged to the provider of health care.

4-19      3.  A court shall award costs and reasonable attorney’s fees to

4-20  the prevailing party in an action brought pursuant to this section.

4-21      Sec. 11.  This act becomes effective on July 1, 2003.

 

4-22  H