2005 Nevada Revised Statutes - Chapter 695G — Managed Care

CHAPTER 695G - MANAGED CARE

GENERAL PROVISIONS

NRS 695G.010 Definitions.

NRS 695G.012 Adversedetermination defined.

NRS 695G.014 Authorizedrepresentative defined.

NRS 695G.016 Clinicalpeer defined.

NRS 695G.018 Externalreview organization defined.

NRS 695G.020 Healthcare plan defined.

NRS 695G.030 Insureddefined.

NRS 695G.040 Managedcare defined.

NRS 695G.050 Managedcare organization defined.

NRS 695G.055 Medicallynecessary defined.

NRS 695G.060 Primarycare physician defined.

NRS 695G.070 Providerof health care defined.

NRS 695G.080 Utilizationreview defined.

NRS 695G.090 Applicability.

NRS 695G.095 Offeringpolicy of health insurance for purposes of establishing health savings account.

NRS 695G.100 Documentstreated as public record.

ADMINISTRATION OF MANAGED CARE ORGANIZATIONS

NRS 695G.110 Medicaldirector must be physician licensed in this State.

NRS 695G.120 Utilizationreview: Written policies and procedures; subcontracting.

NRS 695G.125 Contractswith certain federally qualified health centers.

NRS 695G.130 Reportregarding methods for reviewing quality of health care services: Requirements;availability for public inspection.

NRS 695G.140 Responsibilityfor money in fiduciary relationship to insured.

COVERAGE BY MANAGED CARE ORGANIZATIONS

NRS 695G.150 Authorizationof recommended and covered health care services required.

NRS 695G.160 Writtencriteria concerning coverage of health care services and standards for qualityof health care services.

NRS 695G.163 Coveragefor prescription drugs: Provision of notice and information regarding use offormulary.

NRS 695G.164 Requiredprovision concerning coverage for continued medical treatment.

NRS 695G.166 Requiredprovision concerning coverage for prescription drug previously approved formedical condition of insured.

NRS 695G.168 Requiredprovision concerning coverage for screening for colorectal cancer.

NRS 695G.170 Requiredprovision concerning coverage for medically necessary emergency services;prohibitions.

NRS 695G.173 Requiredprovision concerning coverage for treatment received as part of clinical trialor study.

NRS 695G.175 Certainactions of managed care organization prohibited.

QUALITY ASSURANCE PROGRAM

NRS 695G.180 Qualityassurance program: Requirements; written description; informing providers;necessary staff; review; responsibility for activities.

NRS 695G.190 Qualityimprovement committee: Administration; duties.

SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS

NRS 695G.200 Approval;requirements; assistance for persons filing complaints; examination.

NRS 695G.210 Reviewboard; appeal; right to expedited review of complaint; notice to insured.

NRS 695G.220 Annualreport; managed care organization to maintain records of complaints concerningsomething other than health care services.

NRS 695G.230 Writtennotice to insured explaining rights of insureds regarding decision to denycoverage; notice to insured when organization denies coverage of health careservice.

EXTERNAL REVIEW OF ADVERSE DETERMINATION

NRS 695G.241 Adversedetermination deemed final for purpose of submitting to external revieworganization.

NRS 695G.251 Requestfor review; assignment of external review organization; provision of documentsrelating to adverse determination to external review organization.

NRS 695G.261 Reviewof documents by external review organization; decision of external revieworganization.

NRS 695G.271 Expeditedapproval or denial of request.

NRS 695G.280 Basisfor decision of external review organization.

NRS 695G.290 Decisionin favor of insured binding on managed care organization; limitation ofliability; cost for external review organization.

NRS 695G.300 Submissionof complaint of insured to external review organization.

NRS 695G.310 Annualreport; requirements.

PROHIBITED ACTS

NRS 695G.400 Managedcare organization prohibited from interfering in or restricting certaincommunications.

NRS 695G.405 Managedcare organization prohibited from denying coverage solely because insured wasintoxicated or under the influence of controlled substance; exceptions.[Effective July 1, 2006.]

NRS 695G.410 Certainactions taken against provider solely because provider advocates on behalf ofpatient, assists patient or reports violation of law prohibited.

NRS 695G.420 Offeringor paying financial incentive to provider to deny, reduce, withhold, limit ordelay medically necessary services prohibited.

NRS 695G.430 Contractsbetween managed care organization and provider of health care: Form forobtaining information on provider of health care; modification; schedule offees.

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GENERAL PROVISIONS

NRS 695G.010 Definitions. As used in this chapter, unless the context otherwiserequires, the words and terms defined in NRS695G.020 to 695G.080, inclusive,have the meanings ascribed to them in those sections.

(Added to NRS by 1997, 301; A 2003, 783)

NRS 695G.012 Adversedetermination defined. Adverse determinationmeans a determination of a managed care organization to deny all or part of aservice or procedure that is proposed or being provided to an insured on thebasis that it is not medically necessary or appropriate or is experimental orinvestigational. The term does not include a determination of a managed careorganization that such an allocation is not a covered benefit.

(Added to NRS by 2003, 779)

NRS 695G.014 Authorizedrepresentative defined. Authorized representativemeans a person who has obtained the consent of an insured to represent him inan external review of a final adverse determination conducted pursuant to NRS 695G.241 to 695G.310, inclusive.

(Added to NRS by 2003, 779)

NRS 695G.016 Clinicalpeer defined. Clinical peer means aphysician who is:

1. Engaged in the practice of medicine; and

2. Certified or is eligible for certification by amember board of the American Board of Medical Specialties in the same or similararea of practice as is the health care service that is the subject of a finaladverse determination.

(Added to NRS by 2003, 779)

NRS 695G.018 Externalreview organization defined. External revieworganization means an organization that:

1. Conducts an external review of a final adversedetermination; and

2. Is certified by the Commissioner in accordance withNRS 683A.371.

(Added to NRS by 2003, 779)

NRS 695G.020 Healthcare plan defined. Health care plan means apolicy, contract, certificate or agreement offered or issued by a managed careorganization to provide, deliver, arrange for, pay for or reimburse any of thecosts of health care services.

(Added to NRS by 1997, 301)

NRS 695G.030 Insureddefined. Insured means a person who receivesbenefits under a health care plan.

(Added to NRS by 1997, 301)

NRS 695G.040 Managedcare defined. Managed care means a systemfor delivering health care services that encourages the efficient use of healthcare services by using employed or independently contracted providers of healthcare and by using various techniques which may include, without limitation:

1. Managing the health care services of an insured whohas a serious, complicated, protracted or other health-related condition thatrequires the use of numerous providers of health care or other costly services;

2. Providing utilization review;

3. Offering financial incentives for the effective useof health care services; or

4. Any combination of those techniques.

(Added to NRS by 1997, 301)

NRS 695G.050 Managedcare organization defined. Managed careorganization means any insurer or organization authorized pursuant to thistitle to conduct business in this State that provides or arranges for theprovision of health care services through managed care.

(Added to NRS by 1997, 302)

NRS 695G.055 Medicallynecessary defined. Medically necessarymeans health care services or products that a prudent physician would provideto a patient to prevent, diagnose or treat an illness, injury or disease, orany symptoms thereof, that are necessary and:

1. Provided in accordance with generally acceptedstandards of medical practice;

2. Clinically appropriate with regard to type,frequency, extent, location and duration;

3. Not primarily provided for the convenience of thepatient, physician or other provider of health care;

4. Required to improve a specific health condition ofan insured or to preserve his existing state of health; and

5. The most clinically appropriate level of health carethat may be safely provided to the insured.

(Added to NRS by 2003, 779)

NRS 695G.060 Primarycare physician defined. Primary care physicianmeans a physician or group of physicians who:

1. Provides initial and primary health care servicesto an insured;

2. Maintains the continuity of care for the insured;and

3. May refer the insured to a specialized provider ofhealth care.

(Added to NRS by 1997, 302)

NRS 695G.070 Providerof health care defined. Provider of healthcare means any physician, hospital or other person who is licensed orotherwise authorized in this State to furnish any health care service.

(Added to NRS by 1997, 302)

NRS 695G.080 Utilizationreview defined.

1. Utilization review means the various methods thatmay be used by a managed care organization to review the amount andappropriateness of the provision of a specific health care service to aninsured.

2. The term does not include an external review of afinal adverse determination conducted pursuant to NRS 695G.241 to 695G.310, inclusive.

(Added to NRS by 1997, 302; A 2003, 783)

NRS 695G.090 Applicability.

1. Except as otherwise provided in subsection 3, theprovisions of this chapter apply to each organization and insurer that operatesas a managed care organization and may include, without limitation, an insurerthat issues a policy of health insurance, an insurer that issues a policy ofindividual or group health insurance, a carrier serving small employers, afraternal benefit society, a hospital or medical service corporation and ahealth maintenance organization.

2. In addition to the provisions of this chapter, eachmanaged care organization shall comply with:

(a) The provisions of chapter686A of NRS, including all obligations and remedies set forth therein; and

(b) Any other applicable provision of this title.

3. The provisions of NRS 695G.164, 695G.200 to 695G.230, inclusive, and 695G.430 do not apply to a managed careorganization that provides health care services to recipients of Medicaid underthe State Plan for Medicaid or insurance pursuant to the Childrens HealthInsurance Program pursuant to a contract with the Division of Health CareFinancing and Policy of the Department of Health and Human Services. Thissubsection does not exempt a managed care organization from any provision ofthis chapter for services provided pursuant to any other contract.

(Added to NRS by 1997, 302; A 2003, 783, 3371)

NRS 695G.095 Offeringpolicy of health insurance for purposes of establishing health savings account. A managed care organization may, subject to regulation bythe Commissioner, offer a policy of health insurance that has a high deductibleand is in compliance with 26 U.S.C. 223 for the purposes of establishing ahealth savings account.

(Added to NRS by 2005, 2159)

NRS 695G.100 Documentstreated as public record. Any document requiredto be filed with the Commissioner pursuant to this chapter, other than medicalrecords and other information relating to a specific insured, must be treatedas a public record.

(Added to NRS by 1997, 307)

ADMINISTRATION OF MANAGED CARE ORGANIZATIONS

NRS 695G.110 Medicaldirector must be physician licensed in this State. Eachmanaged care organization shall employ or contract with a physician who islicensed to practice medicine in the State of Nevada pursuant to chapter 630 or 633of NRS to serve as its medical director.

(Added to NRS by 1997, 305; A 2003, 1181)

NRS 695G.120 Utilizationreview: Written policies and procedures; subcontracting. Each managed care organization shall:

1. Develop and maintain written policies andprocedures setting forth the manner in which it conducts utilization review;and

2. Require any person with whom it subcontracts toprovide utilization review to use the same policies and procedures developedpursuant to subsection 1.

(Added to NRS by 1997, 303)

NRS 695G.125 Contractswith certain federally qualified health centers.

1. A managed care organization that delivers healthcare services by using independently contracted providers of health care shalluse its best efforts to contract with at least one health center in eachgeographic area served by the organization to provide such services to insuredsif the health center:

(a) Meets all conditions imposed by the organization onsimilarly situated providers of health care that are under contract with theorganization, including, without limitation:

(1) Certification for participation in theMedicaid or Medicare program; and

(2) Requirements relating to the appropriatecredentials for providers of health care; and

(b) Agrees to reasonable reimbursement rates that aregenerally consistent with those offered by the organization to similarlysituated providers of health care that are under contract with theorganization.

2. As used in this section, health center has themeaning ascribed to it in 42 U.S.C. 254b.

(Added to NRS by 2001, 1925)

NRS 695G.130 Reportregarding methods for reviewing quality of health care services: Requirements;availability for public inspection.

1. In addition to any other report which is requiredto be filed with the Commissioner or the State Board of Health, each managedcare organization shall file with the Commissioner and the State Board ofHealth, on or before March 1 of each year, a report regarding its methods forreviewing the quality of health care services provided to its insureds.

2. Each managed care organization shall include in itsreport the criteria, data, benchmarks or studies used to:

(a) Assess the nature, scope, quality and accessibilityof health care services provided to insureds; or

(b) Determine any reduction or modification of the provisionof health care services to insureds.

3. Except as already required to be filed with theCommissioner or the State Board of Health, if the managed care organization isnot owned and operated by a public entity and has more than 100 insureds, thereport filed pursuant to subsection 1 must include:

(a) A copy of all of its quarterly and annual financialreports;

(b) A statement of any financial interest it has in anyother business which is related to health care that is greater than 5 percentof that business or $5,000, whichever is less; and

(c) A description of each complaint filed with oragainst it that resulted in arbitration, a lawsuit or other legal proceeding,unless disclosure is prohibited by law or a court order.

4. A report filed pursuant to this section must bemade available for public inspection within a reasonable time after it isreceived by the Commissioner.

(Added to NRS by 1997, 305; A 1997, 3041)

NRS 695G.140 Responsibilityfor money in fiduciary relationship to insured. Anyperson who receives, collects, disburses or invests money for a managed careorganization is responsible for such money in a fiduciary relationship to theinsured.

(Added to NRS by 1997, 305)

COVERAGE BY MANAGED CARE ORGANIZATIONS

NRS 695G.150 Authorizationof recommended and covered health care services required. Each managed care organization shall authorize coverage ofa health care service that has been recommended for the insured by a providerof health care acting within the scope of his practice if that service iscovered by the health care plan of the insured, unless:

1. The decision not to authorize coverage is made by aphysician who:

(a) Is licensed to practice medicine in the State ofNevada pursuant to chapter 630 or 633 of NRS;

(b) Possesses the education, training and expertise toevaluate the medical condition of the insured; and

(c) Has reviewed the available medical documentation,notes of the attending physician, test results and other relevant medicalrecords of the insured.

Thephysician may consult with other providers of health care in determiningwhether to authorize coverage.

2. The decision not to authorize coverage and thereason for the decision have been transmitted in writing in a timely manner tothe insured, the provider of health care who recommended the service and theprimary care physician of the insured, if any.

(Added to NRS by 1997, 302; A 2003, 1181)

NRS 695G.160 Writtencriteria concerning coverage of health care services and standards for qualityof health care services.

1. Each managed care organization shall establishwritten criteria:

(a) Setting forth the manner in which it determineswhether to authorize coverage of a health care service; and

(b) Setting forth its method for reviewing standardsfor the quality of health care services provided to an insured.

2. Such written criteria must be:

(a) Developed with the assistance of practicing providersof health care;

(b) Developed using generally recognized and, ifappropriate, specialized clinical principles and processes;

(c) Reviewed at least one time each year and, ifappropriate, updated; and

(d) Made available to an insured for review uponrequest of the insured any time that the managed care organization deniescoverage of a specific health care service to the insured.

(Added to NRS by 1997, 302)

NRS 695G.163 Coveragefor prescription drugs: Provision of notice and information regarding use offormulary.

1. A managed care organization that offers or issues ahealth care plan which provides coverage for prescription drugs shall includewith any summary, certificate or evidence of that coverage provided to aninsured, notice of whether a formulary is used and, if so, of the opportunityto secure information regarding the formulary from the organization pursuant tosubsection 2. The notice required by this subsection must:

(a) Be in a language that is easily understood and in aformat that is easy to understand;

(b) Include an explanation of what a formulary is; and

(c) If a formulary is used, include:

(1) An explanation of:

(I) How often the contents of theformulary are reviewed; and

(II) The procedure and criteria for determiningwhich prescription drugs are included in and excluded from the formulary; and

(2) The telephone number of the organization formaking a request for information regarding the formulary pursuant to subsection2.

2. If a managed care organization offers or issues ahealth care plan which provides coverage for prescription drugs and a formularyis used, the organization shall:

(a) Provide to any insured or participating provider ofhealth care, upon request:

(1) Information regarding whether a specificdrug is included in the formulary.

(2) Access to the most current list ofprescription drugs in the formulary, organized by major therapeutic category,with an indication of whether any listed drugs are preferred over other listeddrugs. If more than one formulary is maintained, the organization shall notifythe requester that a choice of formulary lists is available.

(b) Notify each person who requests informationregarding the formulary, that the inclusion of a drug in the formulary does notguarantee that a provider of health care will prescribe that drug for aparticular medical condition.

(Added to NRS by 2001, 866)

NRS 695G.164 Requiredprovision concerning coverage for continued medical treatment.

1. The provisions of this section apply to a healthcare plan offered or issued by a managed care organization if an insuredcovered by the health care plan receives health care through a defined set ofproviders of health care who are under contract with the managed careorganization.

2. Except as otherwise provided in this section, if aninsured who is covered by a health care plan described in subsection 1 isreceiving medical treatment for a medical condition from a provider of healthcare whose contract with the managed care organization is terminated during thecourse of the medical treatment, the health care plan must provide that:

(a) The insured may continue to obtain medicaltreatment for the medical condition from the provider of health care pursuantto this section, if:

(1) The insured is actively undergoing amedically necessary course of treatment; and

(2) The provider of health care and the insuredagree that the continuity of care is desirable.

(b) The provider of health care is entitled to receivereimbursement from the managed care organization for the medical treatment heprovides to the insured pursuant to this section, if the provider of healthcare agrees:

(1) To provide medical treatment under the termsof the contract between the provider of health care and the managed careorganization with regard to the insured, including, without limitation, therates of payment for providing medical service, as those terms existed beforethe termination of the contract between the provider of health care and themanaged care organization; and

(2) Not to seek payment from the insured for anymedical service provided by the provider of health care that the provider ofhealth care could not have received from the insured were the provider ofhealth care still under contract with the managed care organization.

3. The coverage required by subsection 2 must beprovided until the later of:

(a) The 120th day after the date the contract isterminated; or

(b) If the medical condition is pregnancy, the 45th dayafter:

(1) The date of delivery; or

(2) If the pregnancy does not end in delivery,the date of the end of the pregnancy.

4. The requirements of this section do not apply to aprovider of health care if:

(a) The provider of health care was under contract withthe managed care organization and the managed care organization terminated thatcontract because of the medical incompetence or professional misconduct of theprovider of health care; and

(b) The managed care organization did not enter intoanother contract with the provider of health care after the contract wasterminated pursuant to paragraph (a).

5. An evidence of coverage for a health care plansubject to the provisions of this chapter that is delivered, issued fordelivery or renewed on or after October 1, 2003, has the legal effect ofincluding the coverage required by this section, and any provision of theevidence of coverage or renewal thereof that is in conflict with this sectionis void.

6. The Commissioner shall adopt regulations to carryout the provisions of this section.

(Added to NRS by 2003, 3370)

NRS 695G.166 Requiredprovision concerning coverage for prescription drug previously approved formedical condition of insured.

1. Except as otherwise provided in this section, ahealth care plan which provides coverage for prescription drugs must not limitor exclude coverage for a drug if the drug:

(a) Had previously been approved for coverage by themanaged care organization for a medical condition of an insured and theinsureds provider of health care determines, after conducting a reasonableinvestigation, that none of the drugs which are otherwise currently approvedfor coverage are medically appropriate for the insured; and

(b) Is appropriately prescribed and considered safe andeffective for treating the medical condition of the insured.

2. The provisions of subsection 1 do not:

(a) Apply to coverage for any drug that is prescribedfor a use that is different from the use for which that drug has been approvedfor marketing by the Food and Drug Administration;

(b) Prohibit:

(1) The organization from charging a deductible,copayment or coinsurance for the provision of benefits for prescription drugsto the insured or from establishing, by contract, limitations on the maximumcoverage for prescription drugs;

(2) A provider of health care from prescribinganother drug covered by the plan that is medically appropriate for the insured;or

(3) The substitution of another drug pursuant toNRS 639.23286 or 639.2583 to 639.2597, inclusive; or

(c) Require any coverage for a drug after the term ofthe plan.

3. Any provision of a health care plan subject to theprovisions of this chapter that is delivered, issued for delivery or renewed onor after October 1, 2001, which is in conflict with this section is void.

(Added to NRS by 2001, 866; A 2003, 2301)

NRS 695G.168 Requiredprovision concerning coverage for screening for colorectal cancer.

1. A health care plan issued by a managed careorganization that provides coverage for the treatment of colorectal cancer mustprovide coverage for colorectal cancer screening in accordance with:

(a) The guidelines concerning colorectal cancerscreening which are published by the American Cancer Society; or

(b) Other guidelines or reports concerning colorectalcancer screening which are published by nationally recognized professionalorganizations and which include current or prevailing supporting scientificdata.

2. An evidence of coverage for a health care plansubject to the provisions of this chapter that is delivered, issued fordelivery or renewed on or after October 1, 2003, has the legal effect ofincluding the coverage required by this section, and any provision of theevidence of coverage that conflicts with the provisions of this section isvoid.

(Added to NRS by 2003, 1337)

NRS 695G.170 Requiredprovision concerning coverage for medically necessary emergency services;prohibitions.

1. Each managed care organization shall providecoverage for medically necessary emergency services provided at any hospital.

2. A managed care organization shall not require priorauthorization for medically necessary emergency services.

3. As used in this section, medically necessaryemergency services means health care services that are provided to an insuredby a provider of health care after the sudden onset of a medical condition thatmanifests itself by symptoms of such sufficient severity that a prudent personwould believe that the absence of immediate medical attention could result in:

(a) Serious jeopardy to the health of an insured;

(b) Serious jeopardy to the health of an unborn child;

(c) Serious impairment of a bodily function; or

(d) Serious dysfunction of any bodily organ or part.

4. A health care plan subject to the provisions ofthis section that is delivered, issued for delivery or renewed on or afterOctober 1, 1999, has the legal effect of including the coverage required bythis section, and any provision of the plan or the renewal which is in conflictwith this section is void.

(Added to NRS by 1997, 304; A 1999, 3097)

NRS 695G.173 Requiredprovision concerning coverage for treatment received as part of clinical trialor study.

1. A health care plan issued by a managed careorganization must provide coverage for medical treatment which a person insuredunder the plan receives as part of a clinical trial or study if:

(a) The medical treatment is provided in a Phase I,Phase II, Phase III or Phase IV study or clinical trial for the treatment ofcancer or in a Phase II, Phase III or Phase IV study or clinical trial for thetreatment of chronic fatigue syndrome;

(b) The clinical trial or study is approved by:

(1) An agency of the National Institutes ofHealth as set forth in 42 U.S.C. 281(b);

(2) A cooperative group;

(3) The Food and Drug Administration as an applicationfor a new investigational drug;

(4) The United States Department of VeteransAffairs; or

(5) The United States Department of Defense;

(c) In the case of:

(1) A Phase I clinical trial or study for thetreatment of cancer, the medical treatment is provided at a facility authorizedto conduct Phase I clinical trials or studies for the treatment of cancer; or

(2) A Phase II, Phase III or Phase IV study orclinical trial for the treatment of cancer or chronic fatigue syndrome, themedical treatment is provided by a provider of health care and the facility andpersonnel for the clinical trial or study have the experience and training toprovide the treatment in a capable manner;

(d) There is no medical treatment available which isconsidered a more appropriate alternative medical treatment than the medicaltreatment provided in the clinical trial or study;

(e) There is a reasonable expectation based on clinicaldata that the medical treatment provided in the clinical trial or study will beat least as effective as any other medical treatment;

(f) The clinical trial or study is conducted in thisState; and

(g) The insured has signed, before his participation inthe clinical trial or study, a statement of consent indicating that he has beeninformed of, without limitation:

(1) The procedure to be undertaken;

(2) Alternative methods of treatment; and

(3) The risks associated with participation inthe clinical trial or study, including, without limitation, the general natureand extent of such risks.

2. Except as otherwise provided in subsection 3, thecoverage for medical treatment required by this section is limited to:

(a) Coverage for any drug or device that is approvedfor sale by the Food and Drug Administration without regard to whether theapproved drug or device has been approved for use in the medical treatment ofthe insured.

(b) The cost of any reasonably necessary health careservices that are required as a result of the medical treatment provided in aPhase II, Phase III or Phase IV clinical trial or study or as a result of anycomplication arising out of the medical treatment provided in a Phase II, PhaseIII or Phase IV clinical trial or study, to the extent that such health careservices would otherwise be covered under the health care plan.

(c) The cost of any routine health care services thatwould otherwise be covered under the health care plan for an insured in a PhaseI clinical trial or study.

(d) The initial consultation to determine whether theinsured is eligible to participate in the clinical trial or study.

(e) Health care services required for the clinicallyappropriate monitoring of the insured during a Phase II, Phase III or Phase IVclinical trial or study.

(f) Health care services which are required for theclinically appropriate monitoring of the insured during a Phase I clinicaltrial or study and which are not directly related to the clinical trial orstudy.

Except asotherwise provided in NRS 695G.164,the services provided pursuant to paragraphs (b), (c), (e) and (f) must becovered only if the services are provided by a provider with whom the managedcare organization has contracted for such services. If the managed careorganization has not contracted for the provision of such services, the managedcare organization shall pay the provider the rate of reimbursement that is paidto other providers with whom the managed care organization has contracted forsimilar services and the provider shall accept that rate of reimbursement aspayment in full.

3. Particular medical treatment described insubsection 2 and provided to a person insured under the plan is not required tobe covered pursuant to this section if that particular medical treatment isprovided by the sponsor of the clinical trial or study free of charge to theperson insured under the plan.

4. The coverage for medical treatment required by thissection does not include:

(a) Any portion of the clinical trial or study that iscustomarily paid for by a government or a biotechnical, pharmaceutical ormedical industry.

(b) Coverage for a drug or device described inparagraph (a) of subsection 2 which is paid for by the manufacturer,distributor or provider of the drug or device.

(c) Health care services that are specifically excludedfrom coverage under the insureds health care plan, regardless of whether suchservices are provided under the clinical trial or study.

(d) Health care services that are customarily providedby the sponsors of the clinical trial or study free of charge to the participantsin the trial or study.

(e) Extraneous expenses related to participation in theclinical trial or study including, without limitation, travel, housing andother expenses that a participant may incur.

(f) Any expenses incurred by a person who accompaniesthe insured during the clinical trial or study.

(g) Any item or service that is provided solely tosatisfy a need or desire for data collection or analysis that is not directlyrelated to the clinical management of the insured.

(h) Any costs for the management of research relatingto the clinical trial or study.

5. A managed care organization that delivers or issuesfor delivery a health care plan specified in subsection 1 may require copies ofthe approval or certification issued pursuant to paragraph (b) of subsection 1,the statement of consent signed by the insured, protocols for the clinicaltrial or study and any other materials related to the scope of the clinicaltrial or study relevant to the coverage of medical treatment pursuant to thissection.

6. A managed care organization that delivers or issuesfor delivery a health care plan specified in subsection 1 shall:

(a) Include in the disclosure required pursuant to NRS 695C.193 notice to each personinsured under the plan of the availability of the benefits required by this section.

(b) Provide the coverage required by this sectionsubject to the same deductible, copayment, coinsurance and other suchconditions for coverage that are required under the plan.

7. A health care plan subject to the provisions ofthis chapter that is delivered, issued for delivery or renewed on or afterJanuary 1, 2006, has the legal effect of including the coverage required bythis section, and any provision of the plan that conflicts with this section isvoid.

8. A managed care organization that delivers or issuesfor delivery a health care plan specified in subsection 1 is immune fromliability for:

(a) Any injury to an insured caused by:

(1) Any medical treatment provided to theinsured in connection with his participation in a clinical trial or studydescribed in this section; or

(2) An act or omission by a provider of healthcare who provides medical treatment or supervises the provision of medicaltreatment to the insured in connection with his participation in a clinicaltrial or study described in this section.

(b) Any adverse or unanticipated outcome arising out ofan insureds participation in a clinical trial or study described in this section.

9. As used in this section:

(a) Cooperative group means a network of facilitiesthat collaborate on research projects and has established a peer review programapproved by the National Institutes of Health. The term includes:

(1) The Clinical Trials Cooperative GroupProgram; and

(2) The Community Clinical Oncology Program.

(b) Facility authorized to conduct Phase I clinicaltrials or studies for the treatment of cancer means a facility or an affiliateof a facility that:

(1) Has in place a Phase I program which permitsonly selective participation in the program and which uses clear-cut criteriato determine eligibility for participation in the program;

(2) Operates a protocol review and monitoringsystem which conforms to the standards set forth in the Policies andGuidelines Relating to the Cancer-Center Support Grant published by theCancer Centers Branch of the National Cancer Institute;

(3) Employs at least two researchers and atleast one of those researchers receives funding from a federal grant;

(4) Employs at least three clinicalinvestigators who have experience working in Phase I clinical trials or studiesconducted at a facility designated as a comprehensive cancer center by theNational Cancer Institute;

(5) Possesses specialized resources for use inPhase I clinical trials or studies, including, without limitation, equipmentthat facilitates research and analysis in proteomics, genomics andpharmacokinetics;

(6) Is capable of gathering, maintaining andreporting electronic data; and

(7) Is capable of responding to auditsinstituted by federal and state agencies.

(c) Provider of health care means:

(1) A hospital; or

(2) A person licensed pursuant to chapter 630, 631or 633 of NRS.

(Added to NRS by 2003, 3533; A 2005, 2022)

NRS 695G.175 Certainactions of managed care organization prohibited.

1. If a managed care organization contracts for theprovision of emergency medical services, outpatient services or inpatientservices with a hospital or other licensed health care facility that providesacute care and is located in a city whose population is less than 60,000 or acounty whose population is less than 100,000, the managed care organizationshall not:

(a) Prohibit an insured from receiving services coveredby the health care plan of the insured at that hospital or licensed health carefacility if the services are provided by a provider of health care with whomthe managed care organization has contracted for the provision of the services;

(b) Refuse to provide coverage for services covered bythe health care plan of an insured that are provided to the insured at thathospital or licensed health care facility if the services were provided by aprovider of health care with whom the managed care organization has contractedfor the provision of the services;

(c) Refuse to pay a provider of health care with whomthe managed care organization has contracted for the provision of services forproviding services to an insured at that hospital or licensed health carefacility if the services are covered by the health care plan of the insured;

(d) Discourage a provider of health care with whom themanaged care organization has contracted for the provision of services fromproviding services to an insured at that hospital or licensed health carefacility that are covered by the health care plan of the insured; or

(e) Offer or pay any type of material inducement, bonusor other financial incentive to a provider of health care:

(1) To provide services to an insured that arecovered by the health care plan of the insured at another hospital or licensedhealth care facility; or

(2) Not to provide services to an insured atthat hospital or licensed health care facility that are covered by the healthcare plan of the insured.

2. Nothing in this section prohibits a managed careorganization from informing an insured that enhanced health care services areavailable at a hospital or licensed health care facility other than thehospital or licensed health care facility described in subsection 1 with whichthe managed care organization contracts for the provision of emergency medicalservices, outpatient services or inpatient services.

(Added to NRS by 1999, 1945; A 2001, 1998)

QUALITY ASSURANCE PROGRAM

NRS 695G.180 Qualityassurance program: Requirements; written description; informing providers;necessary staff; review; responsibility for activities.

1. Each managed care organization shall establish aquality assurance program designed to direct, evaluate and monitor theeffectiveness of health care services provided to its insureds. The programmust include, without limitation:

(a) A method for analyzing the outcomes of health careservices;

(b) Peer review;

(c) A system to collect and maintain informationrelated to the health care services provided to insureds;

(d) Recommendations for remedial action; and

(e) Written guidelines that set forth the proceduresfor remedial action when problems related to quality of care are identified.

2. Each managed care organization shall:

(a) Maintain a written description of the qualityassurance program established pursuant to subsection 1, including, withoutlimitation, the specific actions used by the managed care organization topromote adequate quality of health care services provided to insureds and thepersons responsible for such actions;

(b) Provide information to each provider of health carewhom it employs or with whom it contracts to provide health care services toinsureds regarding the manner in which the quality assurance program functions;

(c) Provide the necessary staff to implement thequality assurance program and to evaluate the effectiveness of the program; and

(d) At least one time each year, review the continuityand effectiveness of the quality assurance program, review any findings of thequality improvement committee established pursuant to NRS 695G.190 and take any reasonableactions to improve the program.

3. Each managed care organization is responsible foran activity conducted pursuant to its quality assurance program, regardless ofwhether the managed care organization or another entity performs the activity.

(Added to NRS by 1997, 303)

NRS 695G.190 Qualityimprovement committee: Administration; duties.

1. As part of a quality assurance program establishedpursuant to NRS 695G.180, each managedcare organization shall create a quality improvement committee directed by aphysician who is licensed to practice medicine in the State of Nevada pursuantto chapter 630 or 633of NRS.

2. Each managed care organization shall:

(a) Establish written guidelines setting forth theprocedure for selecting the members of the committee;

(b) Select members pursuant to such guidelines; and

(c) Provide staff to assist the committee.

3. The committee shall:

(a) Select and review appropriate medical records ofinsureds and other data related to the quality of health care provided toinsureds by providers of health care;

(b) Review the clinical processes used by providers ofhealth care in providing services;

(c) Identify any problems related to the quality ofhealth care provided to insureds; and

(d) Advise providers of health care regarding issuesrelated to quality of care.

(Added to NRS by 1997, 303; A 2003, 1182)

SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS

NRS 695G.200 Approval;requirements; assistance for persons filing complaints; examination.

1. Each managed care organization shall establish asystem for resolving complaints of an insured concerning:

(a) Payment or reimbursement for covered health careservices;

(b) Availability, delivery or quality of covered healthcare services, including, without limitation, an adverse determination madepursuant to utilization review; or

(c) The terms and conditions of a health care plan.

The systemmust be approved by the Commissioner in consultation with the State Board ofHealth.

2. If an insured makes an oral complaint, a managedcare organization shall inform the insured that if he is not satisfied with theresolution of the complaint, he must file the complaint in writing to receivefurther review of the complaint.

3. Each managed care organization shall:

(a) Upon request, assign an employee of the managedcare organization to assist an insured or other person in filing a complaint orappealing a decision of the review board;

(b) Authorize an insured who appeals a decision of thereview board to appear before the review board to present testimony at ahearing concerning the appeal; and

(c) Authorize an insured to introduce any documentationinto evidence at a hearing of a review board and require an insured to providethe documentation required by his health care plan to the review board notlater than 5 business days before a hearing of the review board.

4. The Commissioner or the State Board of Health mayexamine the system for resolving complaints established pursuant to thissection at such times as either deems necessary or appropriate.

(Added to NRS by 1997, 305)

NRS 695G.210 Reviewboard; appeal; right to expedited review of complaint; notice to insured.

1. Except as otherwise provided in NRS 695G.300, a system for resolvingcomplaints created pursuant to NRS695G.200 must include, without limitation, an initial investigation, areview of the complaint by a review board and a procedure for appealing adetermination regarding the complaint. The majority of the members of thereview board must be insureds who receive health care services from the managedcare organization.

2. Except as otherwise provided in subsection 3, areview board shall complete its review regarding a complaint or appeal andnotify the insured of its determination not later than 30 days after thecomplaint or appeal is filed, unless the insured and the review board haveagreed to a longer period.

3. If a complaint involves an imminent and seriousthreat to the health of the insured, the managed care organization shall informthe insured immediately of his right to an expedited review of his complaint.If an expedited review is required, the review board shall notify the insuredin writing of its determination within 72 hours after the complaint is filed.

4. Notice provided to an insured by a review boardregarding a complaint must include, without limitation, an explanation of anyfurther rights of the insured regarding the complaint that are available underhis health care plan.

(Added to NRS by 1997, 306; A 2003, 783)

NRS 695G.220 Annualreport; managed care organization to maintain records of complaints concerningsomething other than health care services.

1. Each managed care organization shall submit to theCommissioner and the State Board of Health an annual report regarding itssystem for resolving complaints established pursuant to NRS 695G.200 on a form prescribed by theCommissioner in consultation with the State Board of Health which includes,without limitation:

(a) A description of the procedures used for resolvingcomplaints of an insured;

(b) The total number of complaints and appeals handledthrough the system for resolving complaints since the last report and acompilation of the causes underlying the complaints filed;

(c) The current status of each complaint and appealfiled; and

(d) The average amount of time that was needed toresolve a complaint and an appeal, if any.

2. Each managed care organization shall maintainrecords of complaints filed with it which concern something other than healthcare services and shall submit to the Commissioner a report summarizing suchcomplaints at such times and in such format as the Commissioner may require.

(Added to NRS by 1997, 306)

NRS 695G.230 Writtennotice to insured explaining rights of insureds regarding decision to denycoverage; notice to insured when organization denies coverage of health careservice.

1. After approval by the Commissioner, each managedcare organization shall provide a written notice to an insured, in clear andcomprehensible language that is understandable to an ordinary layperson,explaining the right of the insured to file a written complaint and to obtain anexpedited review pursuant to NRS 695G.210.Such a notice must be provided to an insured:

(a) At the time he receives his certificate of coverageor evidence of coverage;

(b) Any time that the managed care organization deniescoverage of a health care service or limits coverage of a health care serviceto an insured; and

(c) Any other time deemed necessary by theCommissioner.

2. If a managed care organization denies coverage of ahealth care service to an insured, including, without limitation, a healthmaintenance organization that denies a claim related to a health care planpursuant to NRS 695C.185, it shallnotify the insured in writing within 10 working days after it denies coverageof the health care service of:

(a) The reason for denying coverage of the service;

(b) The criteria by which the managed care organizationor insurer determines whether to authorize or deny coverage of the health careservice;

(c) His right to:

(1) File a written complaint and the procedurefor filing such a complaint;

(2) Appeal a final adverse determinationpursuant to NRS 695G.241 to 695G.310, inclusive;

(3) Receive an expedited external review of afinal adverse determination if the managed care organization receives prooffrom the insureds provider of health care that failure to proceed in anexpedited manner may jeopardize the life or health of the insured, includingnotification of the procedure for requesting the expedited external review; and

(4) Receive assistance from any person, includingan attorney, for an external review of a final adverse determination; and

(d) The telephone number of the Office for ConsumerHealth Assistance.

3. A written notice which is approved by theCommissioner shall be deemed to be in clear and comprehensible language that isunderstandable to an ordinary layperson.

(Added to NRS by 1997, 307; A 1999, 3097; 2003, 784)

EXTERNAL REVIEW OF ADVERSE DETERMINATION

NRS 695G.241 Adversedetermination deemed final for purpose of submitting to external revieworganization.

1. For the purposes of NRS 695G.200 to 695G.310, inclusive, an adverse determinationis final if the insured has exhausted all procedures set forth in the healthcare plan for reviewing the adverse determination within the managed careorganization.

2. An adverse determination shall be deemed final forthe purpose of submitting the adverse determination to an external revieworganization for an external review:

(a) If an insured exhausts all procedures set forth inthe health care plan for reviewing the adverse determination within the managedcare organization and the managed care organization fails to render a decisionwithin the period required to render that decision set forth in the health careplan; or

(b) If the managed care organization submits theadverse determination to the external review organization without requiring theinsured to exhaust all procedures set forth in the health care plan forreviewing the adverse determination within the managed care organization.

(Added to NRS by 2003, 780)

NRS 695G.251 Requestfor review; assignment of external review organization; provision of documentsrelating to adverse determination to external review organization.

1. If an insured or a physician of an insured receivesnotice of a final adverse determination from a managed care organizationconcerning the insured, and if the insured is required to pay $500 or more forthe health care services that are the subject of the final adversedetermination, the insured, the physician of the insured or an authorizedrepresentative may, within 60 days after receiving notice of the final adversedetermination, submit a request to the managed care organization for an externalreview of the final adverse determination.

2. Within 5 days after receiving a request pursuant tosubsection 1, the managed care organization shall notify the insured, hisauthorized representative or his physician, the agent who performed utilizationreview for the managed care organization, if any, and the Office for ConsumerHealth Assistance that the request has been filed with the managed careorganization.

3. As soon as practicable after receiving a noticepursuant to subsection 2, the Office for Consumer Health Assistance shallassign an external review organization from the list maintained pursuant to NRS 683A.371. Each assignment madepursuant to this subsection must be completed on a rotating basis.

4. Within 5 days after receiving notification from theOffice for Consumer Health Assistance specifying the external revieworganization assigned pursuant to subsection 3, the managed care organizationshall provide to the external review organization all documents and materialsrelating to the final adverse determination, including, without limitation:

(a) Any medical records of the insured relating to theexternal review;

(b) A copy of the provisions of the health care planupon which the final adverse determination was based;

(c) Any documents used by the managed care organizationto make the final adverse determination;

(d) The reasons for the final adverse determination;and

(e) Insofar as practicable, a list that specifies eachprovider of health care who has provided health care to the insured and themedical records of the provider of health care relating to the external review.

(Added to NRS by 2003, 780)

NRS 695G.261 Reviewof documents by external review organization; decision of external revieworganization.

1. Except as otherwise provided in NRS 695G.271, upon receipt of a requestfor an external review pursuant to NRS695G.251, the external review organization shall, within 5 days afterreceiving the request:

(a) Review the request and the documents and materialssubmitted pursuant to NRS 695G.251;and

(b) Notify the insured, his physician and the managedcare organization if any additional information is required to conduct a reviewof the final adverse determination.

2. Except as otherwise provided in NRS 695G.271, the external review organizationshall approve, modify or reverse the final adverse determination within 15 daysafter it receives the information required to make that determination pursuantto this section. The external review organization shall submit a copy of itsdetermination, including the reasons therefor, to:

(a) The insured;

(b) The physician of the insured;

(c) The authorized representative of the insured, ifany; and

(d) The managed care organization.

(Added to NRS by 2003, 781)

NRS 695G.271 Expeditedapproval or denial of request.

1. A managed care organization shall approve or deny arequest for an external review of a final adverse determination in an expeditedmanner not later than 72 hours after it receives proof from the insuredsprovider of health care that failure to proceed in an expedited manner mayjeopardize the life or health of the insured.

2. If a managed care organization approves a requestfor an external review pursuant to subsection 1, the managed care organizationshall:

(a) In accordance with subsections 4 and 5, assign therequest to an external review organization not later than 1 working day afterapproving the request; and

(b) At the time of assigning the request, provide to theexternal review organization all documents and materials specified insubsection 4 of NRS 695G.251.

3. An external review organization that is assigned toconduct an external review pursuant to subsection 2 shall, if it accepts theassignment:

(a) Complete its external review not later than 2working days after receiving the assignment, unless the insured and the managedcare organization agree to a longer period;

(b) Not later than 1 working day after completing itsexternal review, notify the insured, the physician of the insured, theauthorized representative of the insured, if any, and the managed careorganization by telephone of its determination; and

(c) Not later than 5 working days after completing itsexternal review, submit a written decision of its external review to theinsured, the physician of the insured, the authorized representative of theinsured, if any, and the managed care organization.

4. At least once each month, the Office for ConsumerHealth Assistance shall designate at least 2 external review organizations toconduct external reviews in an expedited manner pursuant to this section. Assoon as practicable after designating an external review organization pursuantto this section, the Office for Consumer Health Assistance shall notify eachmanaged care organization of the designation.

5. As soon as practicable after assigning an externalreview organization to conduct an external review pursuant to this section, themanaged care organization shall notify the Office for Consumer HealthAssistance of the assignment. Each assignment made by a managed careorganization pursuant to this section must be completed on a rotating basis.

(Added to NRS by 2003, 781)

NRS 695G.280 Basisfor decision of external review organization. Thedecision of an external review organization concerning a request for anexternal review must be based on:

1. Documentary evidence, including any recommendationof the physician of the insured submitted pursuant to NRS 695G.251;

2. Medical evidence, including, without limitation:

(a) Professional standards of safety and effectivenessfor diagnosis, care and treatment that are generally recognized in the UnitedStates;

(b) Any report published in literature that ispeer-reviewed;

(c) Evidence-based medicine, including, withoutlimitation, reports and guidelines that are published by professionalorganizations that are recognized nationally and that include supportingscientific data; and

(d) An opinion of an independent physician who, asdetermined by the external review organization, is an expert in the healthspecialty that is the subject of the external review; and

3. The terms and conditions for benefits set forth inthe evidence of coverage issued to the insured by the managed careorganization.

(Added to NRS by 2003, 782)

NRS 695G.290 Decisionin favor of insured binding on managed care organization; limitation ofliability; cost for external review organization.

1. If the determination of an external revieworganization concerning an external review of a final adverse determination isin favor of the insured, the determination is final, conclusive and bindingupon the managed care organization.

2. An external review organization or any clinical peerwho conducts or participates in an external review of a final adversedetermination for the external review organization is not liable in a civilaction for damages relating to a determination made by the external revieworganization if the determination is made in good faith and without grossnegligence.

3. The cost of conducting an external review of afinal adverse determination pursuant to NRS695G.241 to 695G.310, inclusive,must be paid by the managed care organization that made the final adversedetermination.

(Added to NRS by 2003, 782)

NRS 695G.300 Submissionof complaint of insured to external review organization. In lieu of resolving a complaint of an insured inaccordance with a system for resolving complaints established pursuant to theprovisions of NRS 695G.200, a managedcare organization may:

1. Submit the complaint to an external revieworganization pursuant to the provisions of NRS695G.241 to 695G.310, inclusive;or

2. If a federal law or regulation provides a procedurefor submitting the complaint for resolution that the Commissioner determines issubstantially similar to the procedure for submitting the complaint to anexternal review organization pursuant to NRS695G.241 to 695G.310, inclusive,submit the complaint for resolution in accordance with the federal law orregulation.

(Added to NRS by 2003, 782)

NRS 695G.310 Annualreport; requirements. On or before December 31of each year, each managed care organization shall file a written report withthe Office for Consumer Health Assistance setting forth the total number of:

1. Requests for external review that were received bythe managed care organization during the immediately preceding year; and

2. Final adverse determinations of the managed careorganization that were:

(a) Upheld during the immediately preceding year.

(b) Reversed during the immediately preceding year.

(Added to NRS by 2003, 783; A 2005, 1026)

PROHIBITED ACTS

NRS 695G.400 Managedcare organization prohibited from interfering in or restricting certaincommunications. A managed care organizationshall not restrict or interfere with any communication between a provider ofhealth care and his patient regarding any information that the provider ofhealth care determines is relevant to the health care of the patient.

(Added to NRS by 1997, 304)(Substituted in revisionfor NRS 659G.240)

NRS 695G.405 Managedcare organization prohibited from denying coverage solely because insured wasintoxicated or under the influence of controlled substance; exceptions.[Effective July 1, 2006.]

1. Except as otherwise provided in subsection 2, amanaged care organization shall not:

(a) Deny a claim under a health care plan solelybecause the claim involves an injury sustained by an insured as a consequenceof being intoxicated or under the influence of a controlled substance.

(b) Cancel participation under a health care plansolely because an insured has made a claim involving an injury sustained by theinsured as a consequence of being intoxicated or under the influence of acontrolled substance.

(c) Refuse participation under a health care plan to aneligible applicant solely because the applicant has made a claim involving an injurysustained by the applicant as a consequence of being intoxicated or under theinfluence of a controlled substance.

2. Theprovisions of this section do not prohibit a managed care organization fromenforcing a provision included in a health care plan to:

(a) Deny a claim which involves an injury to which acontributing cause was the insureds commission of or attempt to commit afelony;

(b) Cancel participation under a health care plansolely because of such a claim; or

(c) Refuse participation under a health care plan to aneligible applicant solely because of such a claim.

(Added to NRS by 2005, 2347,effective July 1, 2006)

NRS 695G.410 Certainactions taken against provider solely because provider advocates on behalf ofpatient, assists patient or reports violation of law prohibited. A managed care organization shall not terminate a contractwith, demote, refuse to contract with or refuse to compensate a provider ofhealth care solely because the provider, in good faith:

1. Advocates in private or in public on behalf of apatient;

2. Assists a patient in seeking reconsideration of adecision by the managed care organization to deny coverage for a health careservice; or

3. Reports a violation of law to an appropriateauthority.

(Added to NRS by 1997, 304)(Substituted in revisionfor NRS 659G.250)

NRS 695G.420 Offeringor paying financial incentive to provider to deny, reduce, withhold, limit ordelay medically necessary services prohibited.

1. A managed care organization shall not offer or payany type of material inducement, bonus or other financial incentive to aprovider of health care to deny, reduce, withhold, limit or delay specificmedically necessary health care services to an insured.

2. Nothing in this section prohibits an arrangementfor payment between a managed care organization and a provider of health carethat uses capitation or other financial incentives, if the arrangement isdesigned to provide an incentive to the provider of health care to use healthcare services effectively and consistently in the best interest of the healthcare of the insured.

(Added to NRS by 1997, 304)(Substituted in revisionfor NRS 659G.260)

NRS 695G.430 Contractsbetween managed care organization and provider of health care: Form forobtaining information on provider of health care; modification; schedule offees.

1. A managed care organization shall not contract witha provider of health care to provide health care to an insured unless themanaged care organization uses the form prescribed by the Commissioner pursuantto NRS 629.095 to obtain any informationrelated to the credentials of the provider of health care.

2. A contract between a managed care organization anda provider of health care may be modified:

(a) At any time pursuant to a written agreementexecuted by both parties.

(b) Except as otherwise provided in this paragraph, bythe managed care organization upon giving to the provider 30 days writtennotice of the modification. If the provider fails to object in writing to themodification within the 30-day period, the modification becomes effective atthe end of that period. If the provider objects in writing to the modificationwithin the 30-day period, the modification must not become effective unlessagreed to by both parties as described in paragraph (a).

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

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

(b) If requested by the provider of health care at anyother time, submit to the provider of health care the schedule of paymentsspecified in paragraph (a) within 7 days after receiving the request.

4. As used in this section, provider of health caremeans a provider of health care who is licensed pursuant to chapter 630, 631,632 or 633 ofNRS.

(Added to NRS by 2001, 2736; A 2003, 3371)(Substitutedin revision for NRS 695G.270)

 

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