Assembly Bill No. 25-Committee on Health and Human Services
Prefiled January 16, 1997
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Referred to Committee on Health and Human Services
SUMMARY--Requires certain entities that provide health care services through managed care to provide coverage for certain emergency medical services. (BDR 57-1001)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State or on Industrial Insurance: No.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to health care; requiring certain entities that provide health care services through managed care to pay for certain emergency medical services when the insured reasonably believes immediate medical attention is necessary; 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 687B of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 6, inclusive, of this act.
Sec. 2 As used in sections 2 to 6, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3, 4 and 5 of this act have the meanings ascribed to them in those sections.
Sec. 3 "Managed care" means a method of providing or arranging for the provision of health care services, other than a method based on fee-for-service wherein an insurer:
1. Reimburses a provider of health care for each service provided to an insured;
2. Allows an insured to choose any provider of health care and does not encourage the use of any specific provider of health care; and
3. Does not require any preauthorization or referral for a specific service to be covered.
The term includes, without limitation, a health maintenance organization, preferred provider organization, point-of-service plan or exclusive provider organization.
Sec. 4 "Managed care organization" means an organization that provides managed care.
Sec. 5 "Provider of health care" means any physician, hospital or other person who is licensed or otherwise authorized in this state to furnish any health care service.
Sec. 6 1. An insurer that issues a policy of health insurance that provides for health care services through managed care and a managed care organization that issues a policy of insurance shall include coverage in any such policy for any emergency service provided to an insured for a health condition that is covered by the policy, if the insured reasonably believed that immediate medical attention was necessary, regardless of whether the condition actually required immediate medical attention.
2. Coverage of an emergency service pursuant to subsection 1 must be provided regardless of whether:
(a) The provider of health care that provided the emergency service has a contractual or other arrangement with the insurer or managed care organization for the provision of such a service to the insured; or
(b) The insured obtained prior authorization from the insurer or managed care organization for the emergency service.
3. A policy subject to the provisions of this section that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
Sec. 7 NRS 695C.055 is hereby amended to read as follows:
695C.0551. The provisions of NRS 449.465, 679B.158 and 680B.025 to 680B.060, inclusive, subsections 2, 4, 18, 19 and 32 of NRS 680B.010 and NRS 689C.015 to 689C.350, inclusive, and sections 2 to 6, inclusive, of this act apply to a health maintenance organization.
2. For the purposes of subsection 1, unless the context requires that a provision apply only to insurers, any reference in those sections to "insurer" must be replaced by "health maintenance organization."
Sec. 8 The provisions of this act apply to all contracts for health insurance entered into or renewed on or after October 1, 1997.