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Nevada Revised Statutes
Managed Care
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Section
695G.010
Definitions.
Section
695G.012
"Adverse determination" defined.
Section
695G.014
"Authorized representative" defined.
Section
695G.015
"Benefits" defined.
Section
695G.016
"Clinical peer" defined.
Section
695G.017
"Covered person" defined.
Section
695G.019
"Health benefit plan" defined.
Section
695G.020
"Health care plan" defined.
Section
695G.022
"Health care services" defined.
Section
695G.024
"Health carrier" defined.
Section
695G.026
"Independent review organization" defined.
Section
695G.030
"Insured" defined.
Section
695G.040
"Managed care" defined.
Section
695G.050
"Managed care organization" defined.
Section
695G.053
"Medical or scientific evidence" defined.
Section
695G.055
"Medically necessary" defined.
Section
695G.060
"Primary care physician" defined.
Section
695G.070
"Provider of health care" defined.
Section
695G.080
"Utilization review" defined.
Section
695G.085
"Utilization review organization" defined.
Section
695G.090
Applicability.
Section
695G.095
Offering policy of health insurance for purposes of establishing health savings account.
Section
695G.100
Documents treated as public record.
Section
695G.110
Medical director must be physician licensed in this State.
Section
695G.120
Utilization review: Written policies and procedures; subcontracting.
Section
695G.125
Contracts with certain federally qualified health centers.
Section
695G.130
Report regarding methods for reviewing quality of health care services: Form of report; availability for public inspection.
Section
695G.140
Responsibility for money in fiduciary relationship to insured.
Section
695G.150
Authorization of recommended and covered health care services required.
Section
695G.155
Requirements regarding issuance of health benefit plans and adjustment of costs. [Effective January 1, 2020.]
Section
695G.160
Written criteria concerning coverage of health care services and standards for quality of health care services.
Section
695G.162
Required provision concerning coverage for services provided through telehealth.
Section
695G.163
Coverage for prescription drugs: Provision of notice and information regarding use of formulary.
Section
695G.164
Required provision concerning coverage for continued medical treatment.
Section
695G.166
Required provision concerning coverage for prescription drug previously approved for medical condition of insured.
Section
695G.167
Required provision concerning coverage for orally administered chemotherapy.
Section
695G.168
Required provision concerning coverage for screening for colorectal cancer.
Section
695G.170
Required provision concerning coverage for medically necessary emergency services; prohibitions.
Section
695G.171
Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts.
Section
695G.172
Required provision concerning coverage for early refills of topical ophthalmic products.
Section
695G.173
Required provision concerning coverage for treatment received as part of clinical trial or study.
Section
695G.174
Required provision concerning coverage for management and treatment of sickle cell disease.
Section
695G.175
Certain actions of managed care organization prohibited.
Section
695G.177
Required provision concerning coverage for prostate cancer screening.
Section
695G.180
Quality assurance program: Requirements; written description; informing providers; necessary staff; review; responsibility for activities.
Section
695G.190
Quality improvement committee: Administration; duties.
Section
695G.200
Approval; requirements; assistance for persons filing complaints; examination.
Section
695G.210
Review board; appeal; right to expedited review of complaint; notice to insured.
Section
695G.220
Annual report; managed care organization to maintain records of complaints concerning something other than health care services.
Section
695G.230
Written notice to insured explaining rights of insureds regarding decision to deny coverage; notice to insured when health carrier denies coverage of health care service.
Section
695G.241
External review of adverse determination.
Section
695G.243
Applicability.
Section
695G.245
Written notice of right to request external review; form; contents.
Section
695G.247
Requests for external review to be in writing; exception; form and content.
Section
695G.251
Request for review; assignment of independent review organization; provision of documents relating to adverse determination to independent review organization.
Section
695G.261
Review of documents by independent review organization; decision of independent review organization.
Section
695G.271
Expedited approval or denial of request.
Section
695G.275
Experimental or investigational health care service or treatment: Request for external review; request for expedited external review.
Section
695G.280
Basis for decision of independent review organization.
Section
695G.290
Decision in favor of covered person binding on health carrier; limitation of liability; cost for independent review organization.
Section
695G.300
Submission of complaint of covered person to independent review organization.
Section
695G.303
Independent review organization and health carrier to maintain written records; submission of report upon request.
Section
695G.307
Health carrier to provide description of external review procedures; format; contents.
Section
695G.310
Annual report; requirements.
Section
695G.320
Provision of health care services to recipients of Medicaid or enrollees in Children’s Health Insurance Program: Requirement to contract with psychiatric hospital for inclusion in network of providers. [Effective January 1, 2020.]
Section
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.
Section
695G.400
Managed care organization prohibited from interfering in or restricting certain communications.
Section
695G.405
Managed care organization prohibited from denying coverage solely because insured was intoxicated or under the influence of controlled substance; exceptions.
Section
695G.410
Certain actions taken against provider solely because provider advocates on behalf of patient, assists patient or reports violation of law prohibited.
Section
695G.420
Offering or paying financial incentive to provider to deny, reduce, withhold, limit or delay medically necessary services prohibited.
Section
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.
Section
695G.1645
Required provision concerning coverage for autism spectrum disorders.
Section
695G.1665
Required provision concerning coverage for prescription drugs irregularly dispensed for purpose of the synchronization of chronic medications.
Section
695G.1713
Required provision concerning coverage for mammograms for certain women; prohibited acts.
Section
695G.1715
Required provision concerning coverage for drug or device for contraception and related health services; prohibited actions by managed care organization; exceptions.
Section
695G.1716
Health care plan that includes coverage for maternity care must not deny coverage for gestational carrier; status of child in relation to intended parent. [Effective January 1, 2020.]
Section
695G.1717
Coverage for certain services, screenings and tests relating to wellness; prohibited actions by managed care organization.