Nevada Revised Statutes
Chapter 695G - Managed Care
NRS 695G.085 - "Utilization review organization" defined.

Nevada Revised Statutes

Chapter 695G - Managed Care

NRS 695G.010 - Definitions.

NRS 695G.012 - "Adverse determination" defined.

NRS 695G.014 - "Authorized representative" defined.

NRS 695G.015 - "Benefits" defined.

NRS 695G.016 - "Clinical peer" defined.

NRS 695G.017 - "Covered person" defined.

NRS 695G.019 - "Health benefit plan" defined.

NRS 695G.020 - "Health care plan" defined.

NRS 695G.022 - "Health care services" defined.

NRS 695G.024 - "Health carrier" defined.

NRS 695G.026 - "Independent review organization" defined.

NRS 695G.030 - "Insured" defined.

NRS 695G.040 - "Managed care" defined.

NRS 695G.050 - "Managed care organization" defined.

NRS 695G.053 - "Medical or scientific evidence" defined.

NRS 695G.055 - "Medically necessary" defined.

NRS 695G.060 - "Primary care physician" defined.

NRS 695G.070 - "Provider of health care" defined.

NRS 695G.080 - "Utilization review" defined.

NRS 695G.085 - "Utilization review organization" defined.

NRS 695G.090 - Applicability of chapter and other provisions.

NRS 695G.095 - Offering policy of health insurance for purposes of establishing health savings account.

NRS 695G.100 - Documents filed with Commissioner treated as public record; exception.

NRS 695G.110 - Medical director required to be physician licensed in this State.

NRS 695G.120 - Utilization review: Development and maintenance of written policies and procedures for use by managed care organization and subcontractors.

NRS 695G.125 - Contracts with certain federally qualified health centers.

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...

NRS 695G.130 - Report regarding methods for reviewing quality of health care services: Form of report; availability for public inspection.

NRS 695G.140 - Certain persons in managed care organization in fiduciary relationship to insured.

NRS 695G.150 - Authorization of recommended and covered health care services required.

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.

NRS 695G.160 - Written criteria concerning coverage of health care services and standards for quality of health care services.

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...

NRS 695G.163 - Plan covering prescription drugs: Provision of notice and information regarding use of formulary.

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.

NRS 695G.164 - Required provision in certain plans concerning coverage for continued medical treatment; exceptions; regulations.

NRS 695G.1645 - Required provision in plan for group coverage concerning coverage for autism spectrum disorders for certain persons; prohibited acts.

NRS 695G.166 - Plan covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exceptions.

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.

NRS 695G.167 - Plan covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy.

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...

NRS 695G.168 - Required provision in plan covering treatment of colorectal cancer concerning coverage for colorectal cancer screening.

NRS 695G.170 - Required provision concerning coverage for medically necessary emergency services at any hospital; prohibited acts.

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.

NRS 695G.171 - Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts.

NRS 695G.1712 - Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances. [Effective January 1, 2022.]

NRS 695G.1713 - Required provision concerning coverage for mammograms for certain women; prohibited acts.

NRS 695G.1714 - Required provision concerning coverage for examination of person who is pregnant for certain diseases.

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...

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.

NRS 695G.1717 - Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts.

NRS 695G.172 - Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.

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...

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...

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.

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.

NRS 695G.177 - Required provision in plans covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited acts.

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

NRS 695G.190 - Quality improvement committee: Administration; duties.

NRS 695G.200 - Establishment; approval; requirements; assistance for persons filing complaints; examination.

NRS 695G.210 - Review board; appeal; right to expedited review of complaint; notice to insured.

NRS 695G.220 - Annual report; managed care organization required to maintain records of and report complaints concerning something other than health care services.

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.

NRS 695G.241 - Circumstances under which adverse determination may be subject to external review; exceptions.

NRS 695G.243 - Applicability.

NRS 695G.245 - Written notice of right to request external review; form; contents.

NRS 695G.247 - Requests for external review to be in writing; exception; form and content.

NRS 695G.251 - Request for review; assignment of independent review organization; provision of documents relating to adverse determination to independent review organization.

NRS 695G.261 - Review of documents by independent review organization; decision of independent review organization.

NRS 695G.271 - Expedited approval or denial of request.

NRS 695G.275 - Experimental or investigational health care service or treatment: Request for external review; request for expedited external review.

NRS 695G.280 - Basis for decision of independent review organization.

NRS 695G.290 - Decision in favor of covered person binding on health carrier; limitation of liability; cost for independent review organization.

NRS 695G.300 - Submission of complaint of covered person to independent review organization.

NRS 695G.303 - Independent review organization and health carrier required to maintain written records; submission of report upon request.

NRS 695G.307 - Health carrier required to provide description of external review procedures; format; contents.

NRS 695G.310 - Annual report; requirements.

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.

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.

NRS 695G.400 - Managed care organization prohibited from restricting or interfering with certain communications between provider of health care and patient.

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.

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.

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.

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.