Assembly Bill No. 26-Committee on Health and Human Services
Prefiled on 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 certain health care services for women. (BDR 57-999)
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 issue policies of health insurance which provide health care services through managed care to allow a woman who is covered by any such policy to have direct access to any covered health care services for women; requiring such policies to allow a woman to choose an obstetrician or gynecologist as her primary care physician; 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 8, inclusive, of this act.
Sec. 2 As used in sections 2 to 8, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 to 7, inclusive, of this act have the meanings ascribed to them in those sections.
Sec. 3 "Health care services for women" means gynecological or obstetrical services, including, without limitation, perinatal care, preventive gynecological care and reproductive health care services.
Sec. 4 "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. 5 "Managed care organization" means an organization that provides managed care.
Sec. 6 "Primary care physician" means a physician whose responsibilities include, without limitation, providing initial and primary health care services to an insured, maintaining the continuity of care for the insured and referring the insured to a specialist when necessary.
Sec. 7 "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. 8 1. An insurer that issues a policy of health insurance which provides health care services through managed care and a managed care organization that issues a policy of health insurance shall include in any such policy a provision authorizing a woman covered by the policy:
(a) To obtain covered health care services for women without first receiving authorization or a referral from her primary care physician; and
(b) To designate an obstetrician or gynecologist as her primary care physician.
2. For the purposes of this section, all health care services for women must be provided by an obstetrician, gynecologist or advanced practitioner of nursing who has specialized skills and training in obstetrics or gynecology.
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. 9 NRS 687B.225 is hereby amended to read as follows:
687B.2251. [Any] Except as otherwise provided in section 7 of this act, a contract for group, blanket or individual health insurance or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care which provides for payment of a certain part of medical or dental care may require the insured or member to obtain prior authorization for that care from the insurer or organization. The insurer or organization shall:
(a) File its procedure for obtaining approval of care [under] pursuant to this section for approval by the commissioner; and
(b) Respond to any request for approval by the insured or member [under] pursuant to this section within 20 days after it receives the request.
2. The procedure for prior authorization may not discriminate among persons licensed to provide the covered care.
Sec. 10 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 8, 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. 11 The provisions of this act apply to all contracts for health insurance entered into or renewed on or after October 1, 1997.