Senate Bill No. 183–Senator Mathews

 

Joint Sponsor: Assemblywoman Gibbons

 

CHAPTER..........

 

AN ACT relating to insurance; requiring certain policies of health insurance and health care plans to provide coverage for colorectal cancer screening under certain circumstances; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

    Section 1. Chapter 689A of NRS is hereby amended by

adding thereto a new section to read as follows:

    1.  A policy of health insurance that provides coverage for the

treatment of colorectal cancer must provide coverage for

colorectal cancer screening in accordance with:

    (a) The guidelines concerning colorectal cancer screening

which are published by the American Cancer Society; or

    (b) Other guidelines or reports concerning colorectal cancer

screening which are published by nationally recognized

professional organizations and which include current or

prevailing supporting scientific data.

    2.  A policy of health insurance subject to the provisions of

this chapter that is delivered, issued for delivery or renewed on or

after October 1, 2003, has the legal effect of including the

coverage required by this section, and any provision of the policy

that conflicts with the provisions of this section is void.

    Sec. 2.  NRS 689A.330 is hereby amended to read as follows:

    689A.330  If any policy is issued by a domestic insurer for

delivery to a person residing in another state, and if the insurance

commissioner or corresponding public officer of that other state has

informed the Commissioner that the policy is not subject to approval

or disapproval by that officer, the Commissioner may by ruling

require that the policy meet the standards set forth in NRS 689A.030

to 689A.320, inclusive [.] , and section 1 of this act.

    Sec. 3.  Chapter 689B of NRS is hereby amended by adding

thereto a new section to read as follows:

    1.  A policy of group health insurance that provides coverage

for the treatment of colorectal cancer must provide coverage for

colorectal cancer screening in accordance with:

    (a) The guidelines concerning colorectal cancer screening

which are published by the American Cancer Society; or

    (b) Other guidelines or reports concerning colorectal cancer

screening which are published by nationally recognized

professional organizations and which include current or

prevailing supporting scientific data.

    2.  A policy of group health insurance subject to the

provisions of this chapter that is delivered, issued for delivery or

renewed on or after October 1, 2003, has the legal effect of

including the coverage required by this section, and any provision

of the policy that conflicts with the provisions of this section is

void.

    Sec. 4.  Chapter 695B of NRS is hereby amended by adding

thereto a new section to read as follows:

    1.  A policy of health insurance issued by a hospital or

medical service corporation that provides coverage for the

treatment of colorectal cancer must provide coverage for

colorectal cancer screening in accordance with:

    (a) The guidelines concerning colorectal cancer screening

which are published by the American Cancer Society; or

    (b) Other guidelines or reports concerning colorectal cancer

screening which are published by nationally recognized

professional organizations and which include current or

prevailing supporting scientific data.

    2.  A policy of health insurance subject to the provisions of

this chapter that is delivered, issued for delivery or renewed on or

after October 1, 2003, has the legal effect of including the

coverage required by this section, and any provision of the policy

that conflicts with the provisions of this section is void.

    Sec. 5.  Chapter 695C of NRS is hereby amended by adding

thereto a new section to read as follows:

    1.  A health care plan issued by a health maintenance

organization that provides coverage for the treatment of colorectal

cancer must provide coverage for colorectal cancer screening in

accordance with:

    (a) The guidelines concerning colorectal cancer screening

which are published by the American Cancer Society; or

    (b) Other guidelines or reports concerning colorectal cancer

screening which are published by nationally recognized

professional organizations and which include current or

prevailing supporting scientific data.

    2.  An evidence of coverage for a health care plan subject to

the provisions of this chapter that is delivered, issued for delivery

or renewed on or after October 1, 2003, has the legal effect of

including the coverage required by this section, and any provision

of the evidence of coverage that conflicts with the provisions of

this section is void.

    Sec. 6.  NRS 695C.050 is hereby amended to read as follows:

    695C.050  1.  Except as otherwise provided in this chapter or

in specific provisions of this title, the provisions of this title are not

applicable to any health maintenance organization granted a

certificate of authority under this chapter. This provision does not

apply to an insurer licensed and regulated pursuant to this title

except with respect to its activities as a health maintenance

organization authorized and regulated pursuant to this chapter.

    2.  Solicitation of enrollees by a health maintenance

organization granted a certificate of authority, or its representatives,

must not be construed to violate any provision of law relating to

solicitation or advertising by practitioners of a healing art.

    3.  Any health maintenance organization authorized under this

chapter shall not be deemed to be practicing medicine and is exempt

from the provisions of chapter 630 of NRS.

    4.  The provisions of NRS 695C.110, 695C.170 to 695C.200,

inclusive, 695C.250 and 695C.265 do not apply to a health

maintenance organization that provides health care services through

managed care 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 Human Resources. This

subsection does not exempt a health maintenance organization from

any provision of this chapter for services provided pursuant to any

other contract.

    5.  The provisions of NRS 695C.1694 and 695C.1695 and

section 5 of this act apply to a health maintenance organization that

provides health care services through managed care to recipients of

Medicaid under the State Plan for Medicaid.

    Sec. 7.  NRS 695C.330 is hereby amended to read as follows:

    695C.330  1.  The Commissioner may suspend or revoke any

certificate of authority issued to a health maintenance organization

pursuant to the provisions of this chapter if he finds that any of the

following conditions exist:

    (a) The health maintenance organization is operating

significantly in contravention of its basic organizational document,

its health care plan or in a manner contrary to that described in and

reasonably inferred from any other information submitted pursuant

to NRS 695C.060, 695C.070 and 695C.140, unless any amendments

to those submissions have been filed with and approved by the

Commissioner;

    (b) The health maintenance organization issues evidence of

coverage or uses a schedule of charges for health care services

which do not comply with the requirements of NRS 695C.170 to

695C.200, inclusive, or 695C.1694, 695C.1695 or 695C.207 [;] or

section 5 of this act;

    (c) The health care plan does not furnish comprehensive health

care services as provided for in NRS 695C.060;

    (d) The State Board of Health certifies to the Commissioner that

the health maintenance organization:

        (1) Does not meet the requirements of subsection 2 of NRS

695C.080; or

        (2) Is unable to fulfill its obligations to furnish health care

services as required under its health care plan;

    (e) The health maintenance organization is no longer financially

responsible and may reasonably be expected to be unable to meet its

obligations to enrollees or prospective enrollees;

    (f) The health maintenance organization has failed to put into

effect a mechanism affording the enrollees an opportunity to

participate in matters relating to the content of programs pursuant to

NRS 695C.110;

    (g) The health maintenance organization has failed to put into

effect the system for complaints required by NRS 695C.260 in a

manner reasonably to dispose of valid complaints;

    (h) The health maintenance organization or any person on its

behalf has advertised or merchandised its services in an untrue,

misrepresentative, misleading, deceptive or unfair manner;

    (i) The continued operation of the health maintenance

organization would be hazardous to its enrollees; or

    (j) The health maintenance organization has otherwise failed to

comply substantially with the provisions of this chapter.

    2.  A certificate of authority must be suspended or revoked only

after compliance with the requirements of NRS 695C.340.

    3.  If the certificate of authority of a health maintenance

organization is suspended, the health maintenance organization shall

not, during the period of that suspension, enroll any additional

groups or new individual contracts, unless those groups or persons

were contracted for before the date of suspension.

    4.  If the certificate of authority of a health maintenance

organization is revoked, the organization shall proceed, immediately

following the effective date of the order of revocation, to wind up its

affairs and shall conduct no further business except as may be

essential to the orderly conclusion of the affairs of the organization.

It shall engage in no further advertising or solicitation of any kind.

The Commissioner may by written order permit such further

operation of the organization as he may find to be in the best interest

of enrollees to the end that enrollees are afforded the greatest

practical opportunity to obtain continuing coverage for health care.

    Sec. 8.  Chapter 695G of NRS is hereby amended by adding

thereto a new section to read as follows:

    1.  A health care plan issued by a managed care organization

that provides coverage for the treatment of colorectal cancer must

provide coverage for colorectal cancer screening in accordance

with:

    (a) The guidelines concerning colorectal cancer screening

which are published by the American Cancer Society; or

    (b) Other guidelines or reports concerning colorectal cancer

screening which are published by nationally recognized

professional organizations and which include current or

prevailing supporting scientific data.

    2.  An evidence of coverage for a health care plan subject to

the provisions of this chapter that is delivered, issued for delivery

or renewed on or after October 1, 2003, has the legal effect of

including the coverage required by this section, and any provision

of the evidence of coverage that conflicts with the provisions of

this section is void.

    Sec. 9.  Chapter 287 of NRS is hereby amended by adding

thereto a new section to read as follows:

    The governing body of any county, school district, municipal

corporation, political subdivision, public corporation or other

public agency of the State of Nevada that provides health

insurance through a plan of self-insurance shall provide coverage

for colorectal cancer screening in accordance with:

    1. The guidelines concerning colorectal cancer screening

which are published by the American Cancer Society; or

    2.  Other guidelines or reports concerning colorectal cancer

screening which are published by nationally recognized

professional organizations and which include current or

prevailing supporting scientific data.

 

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