Senate Bill No. 183–Senator Mathews

 

February 20, 2003

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Joint Sponsor: Assemblywoman Gibbons

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Referred to Committee on Commerce and Labor

 

SUMMARY—Requires certain policies of health insurance and health care plans to provide coverage for colorectal cancer screening under certain circumstances. (BDR 57‑726)

 

FISCAL NOTE:    Effect on Local Government: No.

                             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; requiring certain policies of health insurance and health care plans to provide coverage for colorectal cancer screening 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 689A of NRS is hereby amended by

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

1-3  1.  A policy of health insurance that provides coverage for the

1-4  treatment of colorectal cancer must provide coverage for

1-5  colorectal cancer screening in accordance with:

1-6  (a) The guidelines concerning colorectal cancer screening

1-7  which are published by the American Cancer Society; or

1-8  (b) Other guidelines or reports concerning colorectal cancer

1-9  screening which are published by nationally recognized

1-10  professional organizations and which include current or

1-11  prevailing supporting scientific data.

1-12      2.  A policy of health insurance subject to the provisions of

1-13  this chapter that is delivered, issued for delivery or renewed on or

2-1  after October 1, 2003, has the legal effect of including the

2-2  coverage required by this section, and any provision of the policy

2-3  that conflicts with the provisions of this section is void.

2-4  Sec. 2.  NRS 689A.330 is hereby amended to read as follows:

2-5  689A.330  If any policy is issued by a domestic insurer for

2-6  delivery to a person residing in another state, and if the insurance

2-7  commissioner or corresponding public officer of that other state has

2-8  informed the Commissioner that the policy is not subject to approval

2-9  or disapproval by that officer, the Commissioner may by ruling

2-10  require that the policy meet the standards set forth in NRS 689A.030

2-11  to 689A.320, inclusive [.] , and section 1 of this act.

2-12      Sec. 3.  Chapter 689B of NRS is hereby amended by adding

2-13  thereto a new section to read as follows:

2-14      1.  A policy of group health insurance that provides coverage

2-15  for the treatment of colorectal cancer must provide coverage for

2-16  colorectal cancer screening in accordance with:

2-17      (a) The guidelines concerning colorectal cancer screening

2-18  which are published by the American Cancer Society; or

2-19      (b) Other guidelines or reports concerning colorectal cancer

2-20  screening which are published by nationally recognized

2-21  professional organizations and which include current or

2-22  prevailing supporting scientific data.

2-23      2.  A policy of group health insurance subject to the

2-24  provisions of this chapter that is delivered, issued for delivery or

2-25  renewed on or after October 1, 2003, has the legal effect of

2-26  including the coverage required by this section, and any provision

2-27  of the policy that conflicts with the provisions of this section is

2-28  void.

2-29      Sec. 4.  Chapter 695B of NRS is hereby amended by adding

2-30  thereto a new section to read as follows:

2-31      1.  A policy of health insurance issued by a hospital or

2-32  medical service corporation that provides coverage for the

2-33  treatment of colorectal cancer must provide coverage for

2-34  colorectal cancer screening in accordance with:

2-35      (a) The guidelines concerning colorectal cancer screening

2-36  which are published by the American Cancer Society; or

2-37      (b) Other guidelines or reports concerning colorectal cancer

2-38  screening which are published by nationally recognized

2-39  professional organizations and which include current or

2-40  prevailing supporting scientific data.

2-41      2.  A policy of health insurance subject to the provisions of

2-42  this chapter that is delivered, issued for delivery or renewed on or

2-43  after October 1, 2003, has the legal effect of including the

2-44  coverage required by this section, and any provision of the policy

2-45  that conflicts with the provisions of this section is void.

3-1  Sec. 5.  Chapter 695C of NRS is hereby amended by adding

3-2  thereto a new section to read as follows:

3-3  1.  A health care plan issued by a health maintenance

3-4  organization that provides coverage for the treatment of colorectal

3-5  cancer must provide coverage for colorectal cancer screening in

3-6  accordance with:

3-7  (a) The guidelines concerning colorectal cancer screening

3-8  which are published by the American Cancer Society; or

3-9  (b) Other guidelines or reports concerning colorectal cancer

3-10  screening which are published by nationally recognized

3-11  professional organizations and which include current or

3-12  prevailing supporting scientific data.

3-13      2.  An evidence of coverage for a health care plan subject to

3-14  the provisions of this chapter that is delivered, issued for delivery

3-15  or renewed on or after October 1, 2003, has the legal effect of

3-16  including the coverage required by this section, and any provision

3-17  of the evidence of coverage that conflicts with the provisions of

3-18  this section is void.

3-19      Sec. 6.  NRS 695C.050 is hereby amended to read as follows:

3-20      695C.050  1.  Except as otherwise provided in this chapter or

3-21  in specific provisions of this title, the provisions of this title are not

3-22  applicable to any health maintenance organization granted a

3-23  certificate of authority under this chapter. This provision does not

3-24  apply to an insurer licensed and regulated pursuant to this title

3-25  except with respect to its activities as a health maintenance

3-26  organization authorized and regulated pursuant to this chapter.

3-27      2.  Solicitation of enrollees by a health maintenance

3-28  organization granted a certificate of authority, or its representatives,

3-29  must not be construed to violate any provision of law relating to

3-30  solicitation or advertising by practitioners of a healing art.

3-31      3.  Any health maintenance organization authorized under this

3-32  chapter shall not be deemed to be practicing medicine and is exempt

3-33  from the provisions of chapter 630 of NRS.

3-34      4.  The provisions of NRS 695C.110, 695C.170 to 695C.200,

3-35  inclusive, 695C.250 and 695C.265 do not apply to a health

3-36  maintenance organization that provides health care services through

3-37  managed care to recipients of Medicaid under the State Plan for

3-38  Medicaid or insurance pursuant to the Children’s Health Insurance

3-39  Program pursuant to a contract with the Division of Health Care

3-40  Financing and Policy of the Department of Human Resources. This

3-41  subsection does not exempt a health maintenance organization from

3-42  any provision of this chapter for services provided pursuant to any

3-43  other contract.

3-44      5.  The provisions of NRS 695C.1694 and 695C.1695 and

3-45  section 5 of this act apply to a health maintenance organization that

4-1  provides health care services through managed care to recipients of

4-2  Medicaid under the State Plan for Medicaid.

4-3  Sec. 7.  NRS 695C.330 is hereby amended to read as follows:

4-4  695C.330  1.  The Commissioner may suspend or revoke any

4-5  certificate of authority issued to a health maintenance organization

4-6  pursuant to the provisions of this chapter if he finds that any of the

4-7  following conditions exist:

4-8  (a) The health maintenance organization is operating

4-9  significantly in contravention of its basic organizational document,

4-10  its health care plan or in a manner contrary to that described in and

4-11  reasonably inferred from any other information submitted pursuant

4-12  to NRS 695C.060, 695C.070 and 695C.140, unless any amendments

4-13  to those submissions have been filed with and approved by the

4-14  Commissioner;

4-15      (b) The health maintenance organization issues evidence of

4-16  coverage or uses a schedule of charges for health care services

4-17  which do not comply with the requirements of NRS 695C.170 to

4-18  695C.200, inclusive, or 695C.1694, 695C.1695 or 695C.207 [;] or

4-19  section 5 of this act;

4-20      (c) The health care plan does not furnish comprehensive health

4-21  care services as provided for in NRS 695C.060;

4-22      (d) The State Board of Health certifies to the Commissioner that

4-23  the health maintenance organization:

4-24          (1) Does not meet the requirements of subsection 2 of NRS

4-25  695C.080; or

4-26          (2) Is unable to fulfill its obligations to furnish health care

4-27  services as required under its health care plan;

4-28      (e) The health maintenance organization is no longer financially

4-29  responsible and may reasonably be expected to be unable to meet its

4-30  obligations to enrollees or prospective enrollees;

4-31      (f) The health maintenance organization has failed to put into

4-32  effect a mechanism affording the enrollees an opportunity to

4-33  participate in matters relating to the content of programs pursuant to

4-34  NRS 695C.110;

4-35      (g) The health maintenance organization has failed to put into

4-36  effect the system for complaints required by NRS 695C.260 in a

4-37  manner reasonably to dispose of valid complaints;

4-38      (h) The health maintenance organization or any person on its

4-39  behalf has advertised or merchandised its services in an untrue,

4-40  misrepresentative, misleading, deceptive or unfair manner;

4-41      (i) The continued operation of the health maintenance

4-42  organization would be hazardous to its enrollees; or

4-43      (j) The health maintenance organization has otherwise failed to

4-44  comply substantially with the provisions of this chapter.

5-1  2.  A certificate of authority must be suspended or revoked only

5-2  after compliance with the requirements of NRS 695C.340.

5-3  3.  If the certificate of authority of a health maintenance

5-4  organization is suspended, the health maintenance organization shall

5-5  not, during the period of that suspension, enroll any additional

5-6  groups or new individual contracts, unless those groups or persons

5-7  were contracted for before the date of suspension.

5-8  4.  If the certificate of authority of a health maintenance

5-9  organization is revoked, the organization shall proceed, immediately

5-10  following the effective date of the order of revocation, to wind up its

5-11  affairs and shall conduct no further business except as may be

5-12  essential to the orderly conclusion of the affairs of the organization.

5-13  It shall engage in no further advertising or solicitation of any kind.

5-14  The Commissioner may by written order permit such further

5-15  operation of the organization as he may find to be in the best interest

5-16  of enrollees to the end that enrollees are afforded the greatest

5-17  practical opportunity to obtain continuing coverage for health care.

5-18      Sec. 8.  Chapter 695G of NRS is hereby amended by adding

5-19  thereto a new section to read as follows:

5-20      1.  A health care plan issued by a managed care organization

5-21  that provides coverage for the treatment of colorectal cancer must

5-22  provide coverage for colorectal cancer screening in accordance

5-23  with:

5-24      (a) The guidelines concerning colorectal cancer screening

5-25  which are published by the American Cancer Society; or

5-26      (b) Other guidelines or reports concerning colorectal cancer

5-27  screening which are published by nationally recognized

5-28  professional organizations and which include current or

5-29  prevailing supporting scientific data.

5-30      2.  An evidence of coverage for a health care plan subject to

5-31  the provisions of this chapter that is delivered, issued for delivery

5-32  or renewed on or after October 1, 2003, has the legal effect of

5-33  including the coverage required by this section, and any provision

5-34  of the evidence of coverage that conflicts with the provisions of

5-35  this section is void.

5-36      Sec. 9.  Chapter 287 of NRS is hereby amended by adding

5-37  thereto a new section to read as follows:

5-38      The governing body of any county, school district, municipal

5-39  corporation, political subdivision, public corporation or other

5-40  public agency of the State of Nevada that provides health

5-41  insurance through a plan of self-insurance shall provide coverage

5-42  for colorectal cancer screening in accordance with:

5-43      1. The guidelines concerning colorectal cancer screening

5-44  which are published by the American Cancer Society; or

6-1  2.  Other guidelines or reports concerning colorectal cancer

6-2  screening which are published by nationally recognized

6-3  professional organizations and which include current or

6-4  prevailing supporting scientific data.

 

6-5  H