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U.S. State Codes
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Nevada
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Chapter 695G - Managed Care
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.
NRS 695G.095 - Offering policy of health insurance for purposes of establishing health savings account.
NRS 695G.100 - Documents treated as public record.
NRS 695G.110 - Medical director must be physician licensed in this State.
NRS 695G.120 - Utilization review: Written policies and procedures; subcontracting.
NRS 695G.125 - Contracts with certain federally qualified health centers.
NRS 695G.130 - Report regarding methods for reviewing quality of health care services: Form of report; availability for public inspection.
NRS 695G.140 - Responsibility for money in fiduciary relationship to insured.
NRS 695G.150 - Authorization of recommended and covered health care services required.
NRS 695G.155 - Requirements regarding issuance of health benefit plans and adjustment of costs. [Effective January 1, 2020.]
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.
NRS 695G.163 - Coverage for prescription drugs: Provision of notice and information regarding use of formulary.
NRS 695G.164 - Required provision concerning coverage for continued medical treatment.
NRS 695G.1645 - Required provision concerning coverage for autism spectrum disorders.
NRS 695G.166 - Required provision concerning coverage for prescription drug previously approved for medical condition of insured.
NRS 695G.1665 - Required provision concerning coverage for prescription drugs irregularly dispensed for purpose of the synchronization of chronic medications.
NRS 695G.167 - Required provision concerning coverage for orally administered chemotherapy.
NRS 695G.168 - Required provision concerning coverage for screening for colorectal cancer.
NRS 695G.170 - Required provision concerning coverage for medically necessary emergency services; prohibitions.
NRS 695G.171 - Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts.
NRS 695G.1713 - Required provision concerning coverage for mammograms for certain women; prohibited acts.
NRS 695G.1715 - Required provision concerning coverage for drug or device for contraception and related health services; prohibited actions by managed care organization; exceptions.
NRS 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.]
NRS 695G.1717 - Coverage for certain services, screenings and tests relating to wellness; prohibited actions by managed care organization.
NRS 695G.172 - Required provision concerning coverage for early refills of topical ophthalmic products.
NRS 695G.173 - Required provision concerning coverage for treatment received as part of clinical trial or study.
NRS 695G.174 - Required provision concerning coverage for management and treatment of sickle cell disease.
NRS 695G.175 - Certain actions of managed care organization prohibited.
NRS 695G.177 - Required provision concerning coverage for prostate cancer screening.
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 - 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 to maintain records of complaints concerning something other than health care services.
NRS 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.
NRS 695G.241 - External review of adverse determination.
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 to maintain written records; submission of report upon request.
NRS 695G.307 - Health carrier 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 psychiatric hospital for inclusion in network of providers. [Effective January 1, 2020.]
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 interfering in or restricting certain communications.
NRS 695G.405 - Managed care organization prohibited from denying coverage solely because insured was intoxicated or under the influence of controlled substance; exceptions.
NRS 695G.410 - Certain actions taken against provider solely because provider advocates on behalf of patient, assists patient or reports violation of law prohibited.
NRS 695G.420 - Offering or paying financial incentive to provider to deny, reduce, withhold, limit or delay medically necessary services prohibited.
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.