Nevada Revised Statutes
Chapter 695G - Managed Care

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...

NRS 695G.100 - Documents filed with Commissioner treated as public record; exception. - Any document required to be filed with the Commissioner pursuant...

NRS 695G.110 - Medical director required to be physician licensed in this State. - Each managed care organization shall employ or contract with a...

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...

NRS 695G.125 - Contracts with certain federally qualified health centers. - 1. A managed care organization that delivers health care services...

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... - 1. A managed care organization shall not contract with a...

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...

NRS 695G.140 - Certain persons in managed care organization in fiduciary relationship to insured. - Any person who receives, collects, disburses or invests money for...

NRS 695G.150 - Authorization of recommended and covered health care services required. - Each managed care organization shall authorize coverage of a health...

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 shall offer and issue a...

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)...

NRS 695G.162 - Required provision concerning coverage for services provided through telehealth to same extent and in same amount as though provided in person or by other means; exception; prohibited acts. [Effective through 1 year after the date on w... - 1. A health care plan issued by a managed care...

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...

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 existence...

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...

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...

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...

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...

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...

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 pr... - 1. A managed care organization that offers or issues a...

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...

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...

NRS 695G.1705 - Required provision concerning coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus; reimbursement of pharmacist for certain services. - 1. A managed care organization that offers or issues a...

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...

NRS 695G.1712 - Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances. [Effective January 1, 2022.] - 1. A managed care organization that issues a health care...

NRS 695G.1713 - Required provision concerning coverage for mammograms for certain women; prohibited acts. - 1. A health care plan issued by a managed care...

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...

NRS 695G.1715 - Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions. [Effective through December 31, 2021.] Required provision concerning coverage for drug or device for... - 1. Except as otherwise provided in subsection 7, a managed...

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...

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...

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...

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; immuni... - 1. A health care plan issued by a managed care...

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... - 1. A managed care organization that issues a health care...

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...

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...

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...

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...

NRS 695G.190 - Quality improvement committee: Administration; duties. - 1. As part of a quality assurance program established pursuant...

NRS 695G.200 - Establishment; approval; requirements; assistance for persons filing complaints; examination. - 1. Each managed care organization shall establish a system for...

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...

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...

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...

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...

NRS 695G.243 - Applicability. - 1. Except as otherwise provided in subsection 2, the provisions...

NRS 695G.245 - Written notice of right to request external review; form; contents. - 1. A health carrier shall notify the covered person in...

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...

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 of a...

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,...

NRS 695G.271 - Expedited approval or denial of request. - 1. The Office for Consumer Health Assistance shall approve or...

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...

NRS 695G.280 - Basis for decision of independent review organization. - The decision of an independent review organization concerning a request...

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...

NRS 695G.300 - Submission of complaint of covered person to independent review organization. - In lieu of resolving a complaint of a covered person...

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,...

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...

NRS 695G.310 - Annual report; requirements. - On or before December 31 of each year, each health...

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 care services to...

NRS 695G.325 - Provision of health care services to recipients of Medicaid: Notice to recipients if Department of Health and Human Services obtains waiver to provide dental care to persons with diabetes; coordination to ensure receipt of such care. - If the Department of Health and Human Services obtains a...

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...

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...

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,...

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...

NRS 695G.430 - Contracts between managed care organization and provider of health care: Form for obtaining information on provider of health care; modification; schedule of fees. - [Replaced in revision by NRS 695G.127.]

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Nevada Revised Statutes Chapter 695G - Managed Care

Nevada Revised Statutes
Chapter 695G - Managed Care