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 issues a policy of health insurance, an insurer that issues a policy of individual or group health insurance, a carrier serving small employers, a fraternal benefit society, a hospital or medical service corporation and a health maintenance organization.
2. In addition to the provisions of this chapter, each managed care organization shall comply with:
(a) The provisions of chapter 686A 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.127, 695G.164, 695G.1645, 695G.167 and 695G.200 to 695G.230, inclusive, do not apply to a managed care organization that provides health care services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services. This subsection does not exempt a managed care organization from any provision of this chapter for services provided pursuant to any other contract.
(Added to NRS by 1997, 302; A 2003, 783, 3371; 2009, 1477; 2013, 2001)
Structure Nevada Revised Statutes
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.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.125 - Contracts with certain federally qualified health centers.
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.190 - Quality improvement committee: Administration; duties.
NRS 695G.210 - Review board; appeal; right to expedited review of complaint; notice to insured.
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.271 - Expedited approval or denial of request.
NRS 695G.280 - Basis for decision of independent review organization.
NRS 695G.300 - Submission of complaint of covered person to independent review organization.