Title 57

NRS 695G.1713 Required provision concerning coverage for certain screenings and tests for breast cancer; prohibited acts. 1. A health care plan issued by a managed care organization must provide coverage for benefits payable for expenses incurred for: (a) A mammogram to screen fo…

NRS 695G.1714 Required provision concerning coverage for examination of person who is pregnant for certain diseases. 1. A managed care organization that issues a health care plan shall provide coverage for the examination of a person who is pregnant for the discovery of: (a) Chla…

NRS 695G.17145 Required provision concerning coverage for noninvasive prenatal screening in certain plans. 1. A managed care organization that offers or issues a group health care plan or a plan that provides health care services through managed care to recipients of Medicaid und…

NRS 695G.1715 Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions. 1. Except as otherwise provided in subsection 8, a managed care organization that offers or issues a health care plan shall include …

NRS 695G.1716 Health care plan covering maternity care: Prohibited acts by managed care organization if insured is acting as gestational carrier; child deemed child of intended parent for purposes of plan. 1. A managed care organization that offers or issues a health care plan th…

NRS 695G.17165 Required provision concerning coverage for procedure or service for preservation of fertility in certain circumstances; exemption. [Effective January 1, 2027.] 1. Except as otherwise provided in subsection 4, a managed care organization that issues a health care pl…

NRS 695G.1717 Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts. 1. A managed care organization that offers or issues a health care plan shall include in the plan coverage for: (a) Counseling, support and suppl…

NRS 695G.1718 Required provision concerning coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence; restriction on refusal to cover certain treatments; authority of managed care organization to prescribe requirements for cove…

NRS 695G.1719 Required provision concerning coverage for certain drugs and services related to substance use disorder and opioid use disorder; reimbursement of pharmacists and pharmacies for certain services; prohibited acts. 1. A managed care organization that offers or issues a…

NRS 695G.172 Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products. 1. A managed care organization which offers or issues a health care plan that provides coverage for prescription drugs shall not deny c…

NRS 695G.173 Required provision concerning coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of managed care organization to require certain information; immunity from liability. 1. A health c…

NRS 695G.174 Required provision concerning coverage for management and treatment of sickle cell disease and its variants; plan covering prescription drugs required to provide coverage for medically necessary prescription drugs to treat sickle cell disease and its variants. 1. A m…

NRS 695G.175 Contracts for provision of emergency medical services, outpatient services or inpatient services with hospital or other facility that provides acute care in smaller city or county: Prohibited acts. 1. If a managed care organization contracts for the provision of emer…

NRS 695G.176 Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by managed care organization if insured is person with disability. 1. A managed care organization that offers or issues a health care plan that i…

NRS 695G.1765 Required provision concerning coverage for dental service provided by qualified dental hygienist in certain circumstances. 1. A managed care organization that offers or issues a health care plan which includes coverage for a dental service that a qualified dental hy…

NRS 695G.177 Required provision in plans covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited acts. 1. A health care plan issued by a managed care organization that provides coverage for the treatment of prostate cancer must provide …

NRS 695G.180 Quality assurance program: Requirements; written description; informing providers; necessary staff; review; responsibility for activities. 1. Each managed care organization shall establish a quality assurance program designed to direct, evaluate and monitor the effec…

NRS 695G.190 Quality improvement committee: Administration; duties. 1. As part of a quality assurance program established pursuant to NRS 695G.180, each managed care organization shall create a quality improvement committee directed by a physician who is licensed to practice medi…

NRS 695G.200 Establishment; approval; requirements; assistance for persons filing complaints; examination. 1. Each managed care organization shall establish a system for resolving complaints of an insured concerning: (a) Payment or reimbursement for covered health care services; …

NRS 695G.210 Review board; appeal; right to expedited review of complaint; notice to insured. 1. Except as otherwise provided in NRS 695G.300, a system for resolving complaints created pursuant to NRS 695G.200 must include, without limitation, an initial investigation, a review o…

NRS 695G.220 Annual report; managed care organization required to maintain records of and report complaints concerning something other than health care services. 1. Each managed care organization shall submit to the Commissioner an annual report regarding its system for resolving…

NRS 695G.230 Written notice required by carrier to insured explaining rights of insureds regarding decision to deny coverage; written notice to insured when health carrier denies coverage of health care service. 1. After approval by the Commissioner, each health carrier shall pro…

NRS 695G.241 Circumstances under which adverse determination may be subject to external review; exceptions. Except as otherwise required for an expedited external review pursuant to NRS 695G.271 or 695G.275, for the purposes of NRS 695G.200 to 695G.310, inclusive, an adverse dete…

NRS 695G.243 Applicability. 1. Except as otherwise provided in subsection 2, the provisions of NRS 695G.200 to 695G.310, inclusive, apply to all health carriers. 2. The provisions of subsection 1 do not apply to: (a) A policy or certificate that provides only coverage for: (1) A …

NRS 695G.245 Written notice of right to request external review; form; contents. 1. A health carrier shall notify the covered person in writing of the covered person’s right to request an external review to be conducted pursuant to NRS 695G.241 to 695G.310, inclusive, and include…

NRS 695G.247 Requests for external review to be in writing; exception; form and content. 1. Except for a request for an expedited external review as set forth in NRS 695G.271 or 695G.275, all requests for external review must be made in writing to the Office for Consumer Health A…

NRS 695G.251 Request for review; assignment of independent review organization; provision of documents relating to adverse determination to independent review organization. 1. If a covered person or a physician or dentist of a covered person receives notice of an adverse determin…

NRS 695G.261 Review of documents by independent review organization; decision of independent review organization. 1. Except as otherwise provided in NRS 695G.271 and 695G.275, upon receipt of a request for an external review pursuant to NRS 695G.251, the independent review organi…

NRS 695G.271 Expedited approval or denial of request. 1. The Office for Consumer Health Assistance shall approve or deny a request for an external review of an adverse determination in an expedited manner not later than 72 hours after it receives proof from the provider of health…

NRS 695G.275 Experimental or investigational health care service or treatment: Request for external review; request for expedited external review. 1. Within 4 months after receipt of a notice of an adverse determination pursuant to NRS 695G.245 that involves a denial of coverage …

NRS 695G.280 Basis for decision of independent review organization. The decision of an independent review organization concerning a request for an external review must be based on: 1. Documentary evidence, including any recommendation of the physician or dentist of the insured su…

NRS 695G.290 Decision in favor of covered person binding on health carrier; limitation of liability; cost for independent review organization. 1. If the determination of an independent review organization concerning an external review of an adverse determination is in favor of th…

NRS 695G.300 Submission of complaint of covered person to independent review organization. In lieu of resolving a complaint of a covered person in accordance with a system for resolving complaints established pursuant to the provisions of NRS 695G.200, a health carrier may: 1. Su…

NRS 695G.303 Independent review organization and health carrier required to maintain written records; submission of report upon request. 1. An independent review organization assigned pursuant to NRS 695G.251, 695G.271 or 695G.275 to conduct an external review shall maintain writ…

NRS 695G.307 Health carrier required to provide description of external review procedures; format; contents. 1. A health carrier shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or oth…

NRS 695G.310 Annual report; requirements. On or before December 31 of each year, each health carrier shall file a written report with the Office for Consumer Health Assistance setting forth the total number of: 1. Requests for an external review of an adverse decision made by the…

NRS 695G.320 Provision of health care services to recipients of Medicaid or enrollees in Children’s Health Insurance Program: Requirement to contract with hospital with certain endorsement for inclusion in network of providers. A managed care organization that provides health car…

NRS 695G.325 Provision of health care services to recipients of Medicaid: Notice to recipients if Nevada Health Authority obtains waiver to provide dental care to persons with diabetes; coordination to ensure receipt of such care. If the Nevada Health Authority obtains a waiver t…

NRS 695G.330 Provision of health care services to recipients of Medicaid: Coverage for antipsychotic or anticonvulsant medication that is not on list of preferred prescription drugs required upon failure of drug on list to treat condition. A managed care organization that provide…

NRS 695G.340 Approval or denial; payment of claim and interest; request for additional information; award of costs and attorney’s fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certificate of authority for failure to comply; r…

NRS 695G.400 Managed care organization prohibited from restricting or interfering with certain communications between provider of health care and patient. A managed care organization shall not restrict or interfere with any communication between a provider of health care and a pa…

NRS 695G.405 Managed care organization prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions. 1. Except as otherwise provided in subsection 2, a managed care organization shall not: (a) Deny…

NRS 695G.410 Managed care organization prohibited from taking certain actions against provider solely because provider advocates on behalf of patient, assists patient or reports violation of law. A managed care organization shall not terminate a contract with, demote, refuse to c…

NRS 695G.415 Managed care organization prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression. A managed care organization that issues a health care plan shall not discriminate against any person with resp…

NRS 695G.420 Managed care organization prohibited from offering or paying financial incentive to provider to deny, reduce, withhold, limit or delay medically necessary services. 1. A managed care organization shall not offer or pay any type of material inducement, bonus or other …