Title 57

NRS 695G.040 “Managed care” defined. “Managed care” means a system for delivering health care services that encourages the efficient use of health care services by using employed or independently contracted providers of health care and by using various techniques which may includ…

NRS 695G.050 “Managed care organization” defined. “Managed care organization” means any insurer or organization authorized pursuant to this title to conduct business in this State that provides or arranges for the provision of health care services through managed care. (Added to …

NRS 695G.053 “Medical or scientific evidence” defined. “Medical or scientific evidence” means evidence found in the following sources: 1. Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for…

NRS 695G.055 “Medically necessary” defined. “Medically necessary” means health care services or products that a prudent physician would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and: 1. Provided i…

NRS 695G.060 “Primary care physician” defined. “Primary care physician” means a physician or group of physicians who: 1. Provides initial and primary health care services to an insured; 2. Maintains the continuity of care for the insured; and 3. May refer the insured to a special…

NRS 695G.070 “Provider of health care” defined. “Provider of health care” means: 1. A physician or other health care practitioner who is licensed or otherwise authorized in this State to furnish any health care service; and 2. An institution providing health care services or othe…

NRS 695G.080 “Utilization review” defined. 1. “Utilization review” means the various methods that may be used to review the amount and appropriateness of the provision of a specific health care service. 2. The term does not include an external review of an adverse determination c…

NRS 695G.085 “Utilization review organization” defined. “Utilization review organization” means an entity designated by a health carrier to conduct utilization reviews. (Added to NRS by 2011, 3399)

NRS 695G.090 Applicability of chapter and other provisions. 1. Except as otherwise provided in subsection 3, the provisions of this chapter apply to each organization and insurer that operates as a managed care organization and may include, without limitation, an insurer that iss…

NRS 695G.095 Offering policy of health insurance for purposes of establishing health savings account. A managed care organization may, subject to regulation by the Commissioner, offer a policy of health insurance that has a high deductible and is in compliance with 26 U.S.C. § 22…

NRS 695G.100 Documents filed with Commissioner treated as public record; exception. Any document required to be filed with the Commissioner pursuant to this chapter, other than medical records and other information relating to a specific insured, must be treated as a public recor…

NRS 695G.110 Medical director required to be physician licensed in this State. Each managed care organization shall employ or contract with a physician who is licensed to practice medicine in the State of Nevada pursuant to chapter 630 or 633 of NRS to serve as its medical direct…

NRS 695G.120 Utilization review: Development and maintenance of written policies and procedures for use by managed care organization and subcontractors. Each managed care organization shall: 1. Develop and maintain written policies and procedures setting forth the manner in which…

NRS 695G.125 Contracts with certain federally qualified health centers. 1. A managed care organization that delivers health care services by using independently contracted providers of health care shall use its best efforts to contract with at least one health center in each geog…

NRS 695G.127 Contracts between managed care organization and provider of health care: Managed care organization required to use form to obtain information on provider of health care; modification; submission by managed care organization of schedule of payments to provider. 1. A m…

NRS 695G.130 Report regarding methods for reviewing quality of health care services: Form of report; availability for public inspection. 1. In addition to any other report which is required to be filed with the Commissioner, each managed care organization shall file with the Comm…

NRS 695G.140 Certain persons in managed care organization in fiduciary relationship to insured. Any person who receives, collects, disburses or invests money for a managed care organization is responsible for such money in a fiduciary relationship to the insured. (Added to NRS by…

NRS 695G.150 Authorization of recommended and covered health care services required. Each managed care organization shall authorize coverage of a health care service that has been recommended for the insured by a provider of health care acting within the scope of his or her pract…

NRS 695G.155 Managed care organization required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances. 1. A managed care organization …

NRS 695G.160 Written criteria concerning coverage of health care services and standards for quality of health care services. 1. Each managed care organization shall establish written criteria: (a) Setting forth the manner in which it determines whether to authorize coverage of a …

NRS 695G.162 Required provision concerning coverage for services provided through telehealth to same extent as though provided in person or by other means; required provision concerning reimbursement for certain services provided through telehealth in same amount as though provid…

NRS 695G.163 Plan covering prescription drugs: Provision of notice and information regarding use of formulary. 1. A managed care organization that offers or issues a health care plan which provides coverage for prescription drugs shall include with any summary, certificate or evi…

NRS 695G.1635 Plan covering prescription drugs: Required actions by managed care organization related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared. 1. If the Governor or the Legislature proclaims the …

NRS 695G.1639 Plan covering prescription drug for treatment of medical condition that is part of step therapy protocol: Use of certain guidelines required; establishment of process to request exemption from step therapy protocol required; granting of request; applicability of pro…

NRS 695G.164 Required provision in certain plans concerning coverage for continued medical treatment; exceptions; regulations. 1. The provisions of this section apply to a health care plan offered or issued by a managed care organization if an insured covered by the health care p…

NRS 695G.1643 Required provision concerning coverage for habilitative speech-language pathology or rehabilitative speech-language pathology as treatment for stuttering for certain persons; prohibited acts. 1. A managed care organization that offers or issues a health care plan sh…

NRS 695G.1645 Required provision in plan for group coverage concerning coverage for autism spectrum disorders for certain persons; prohibited acts. 1. A health care plan issued by a managed care organization for group coverage must provide coverage for screening for and diagnosis…

NRS 695G.166 Plan covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exceptions. 1. Except as otherwise provided in this section, a health care plan which provides coverage for pre…

NRS 695G.1662 Limitation on cost-sharing obligation for insulin covered under plan covering prescription insulin drugs. 1. A managed care organization that offers or issues a health care plan which provides coverage for prescription insulin drugs shall not impose against an insur…

NRS 695G.1665 Required provision in plan covering prescription drugs concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception. 1. A managed care organization that offers or issues a health c…

NRS 695G.167 Plan covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy. 1. A managed care organization that offers or issues a health care plan which provides coverage for the treatment of cancer through the use of …

NRS 695G.1675 Plan covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Managed care organization required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certain circumstances;…

NRS 695G.1678 Required provision in plan covering treatment of lung cancer concerning coverage for screening for lung cancer. 1. A managed care organization that offers a health care plan that provides coverage for the treatment of lung cancer must provide coverage for screening …

NRS 695G.168 Required provision in plan covering treatment of colorectal cancer concerning coverage for colorectal cancer screening. 1. A health care plan issued by a managed care organization that provides coverage for the treatment of colorectal cancer must provide coverage for…

NRS 695G.170 Required provision concerning coverage for medically necessary emergency services at any hospital; prohibited acts. 1. Each managed care organization shall provide coverage for medically necessary emergency services provided at any hospital. 2. A managed care organiz…

NRS 695G.1702 Plan covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances. 1. A health care plan which provides coverage for prescription drugs must not require an insured to submit to a step th…

NRS 695G.1703 Required provision concerning coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior …

NRS 695G.1705 Required provision concerning coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C; reimbursement of certain providers of health care for certain services; prohibited acts. 1. A managed care organization…

NRS 695G.1707 Required provision concerning coverage for testing, treatment and prevention of sexually transmitted diseases; required provision concerning coverage for condoms for certain insureds. 1. A managed care organization that offers or issues a health care plan shall incl…

NRS 695G.1709 Required provisions concerning coverage of certain gynecological and obstetrical services without prior authorization or referral from primary care physician; designation of obstetrician or gynecologist as primary care physician. 1. A managed care organization that …

NRS 695G.171 Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts. 1. A health care plan issued by a managed care organization must provide coverage for benefits payable for expenses incurred for: (a) Deoxyribonuc…

NRS 695G.1712 Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances. 1. A managed care organization that issues a health care plan shall provide coverage for screening, genetic counseling and testing for…

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 …