Assembly Bill No. 26-Committee on Health and Human Services
Prefiled on January 16, 1997
____________
Referred to Committee on Health and Human Services
SUMMARY--Prohibits certain insurers from requiring insured to obtain prior authorization for certain covered health care services. (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; prohibiting any insurer that is required to provide coverage for an annual cytologic screening test and mammogram for certain women from requiring an insured to obtain prior authorization for such services; 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. NRS 687B.225 is hereby amended to read as follows:
687B.2251. [Any] Except as otherwise provided in NRS 689A.0405, 689B.0374, 695B.1912 and 695C.1735, any 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 this section for approval by the commissioner; and
(b) Respond to any request for approval by the insured or member under 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. 2. NRS 689A.0405 is hereby amended to read as follows:
689A.04051. A policy of health insurance must provide coverage for benefits payable for expenses incurred for:
(a) An annual cytologic screening test for women 18 years of age or older;
(b) A baseline mammogram for women between the ages of 35 and 40; and
(c) An annual mammogram for women 40 years of age or older.
2. A policy of health insurance must not require an insured to obtain prior authorization for any service provided pursuant to subsection 1.
3. A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 1, 1989, has the legal effect of including the coverage required by [this section,] subsection 1, and any provision of the policy or the renewal which is in conflict with [this section] subsection 1 is void.
Sec. 3. NRS 689B.0374 is hereby amended to read as follows:
689B.03741. A policy of group health insurance must provide coverage for benefits payable for expenses incurred for:
(a) An annual cytologic screening test for women 18 years of age or older;
(b) A baseline mammogram for women between the ages of 35 and 40; and
(c) An annual mammogram for women 40 years of age or older.
2. A policy of group health insurance must not require an insured to obtain prior authorization for any service provided pursuant to subsection 1.
3. A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 1, 1989, has the legal effect of including the coverage required by [this section,] subsection 1, and any provision of the policy or the renewal which is in conflict with [this section] subsection 1 is void.
Sec. 4. NRS 695B.1912 is hereby amended to read as follows:
695B.19121. A policy of health insurance issued by a hospital or medical service corporation must provide coverage for benefits payable for expenses incurred for:
(a) An annual cytologic screening test for women 18 years of age or older;
(b) A baseline mammogram for women between the ages of 35 and 40; and
(c) An annual mammogram for women 40 years of age or older.
2. A policy of health insurance issued by a hospital or medical service corporation must not require an insured to obtain prior authorization for any service provided pursuant to subsection 1.
3. A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 1, 1989, has the legal effect of including the coverage required by [this section,] subsection 1, and any provision of the policy or the renewal which is in conflict with [this section] subsection 1 is void.
Sec. 5. NRS 695C.1735 is hereby amended to read as follows:
695C.17351. A health maintenance plan must provide coverage for benefits payable for expenses incurred for:
(a) An annual cytologic screening test for women 18 years of age or older;
(b) A baseline mammogram for women between the ages of 35 and 40; and
(c) An annual mammogram for women 40 years of age or older.
2. A health maintenance plan must not require an insured to obtain prior authorization for any service provided pursuant to subsection 1.
3. A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 1, 1989, has the legal effect of including the coverage required by [this section,] subsection 1, and any provision of the policy or the renewal which is in conflict with [this section] subsection 1 is void.
Sec. 6. The provisions of this act apply to all contracts for health insurance entered into or renewed on or after October 1, 1997.