Assembly Bill No. 30-Committee on Health and Human Services
Prefiled on January 17, 1997
____________
Referred to Committee on Health and Human Services
SUMMARY--Creates bureau of protections for consumers of health care. (BDR 57-997)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State or on Industrial Insurance: Yes.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to health care; creating the bureau of protections for consumers of health care within the division of insurance of the department of business and industry; setting forth the duties of the bureau; providing for an annual fee to be paid by insurers to cover the costs of the bureau; 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 679B of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 16, inclusive, of this act.
Sec. 2. As used in sections 2 to 16, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 to 8, inclusive, of this act have the meanings ascribed to them in those sections.
Sec. 3. "Bureau" means the bureau of protections for consumers of health care.
Sec. 4. "Chief" means the chief of the bureau.
Sec. 5. "Health care plan" means a policy, contract, certificate or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.
Sec. 6. "Insured" means a person covered by a policy of health insurance issued in the State of Nevada by an insurer.
Sec. 7. "Insurer" means any insurer or organization authorized pursuant to this Title to conduct business in this state that provides or arranges for the provision of health care services, including, without limitation, an insurer that issues a policy of health insurance, an insurer that issues a policy of group health insurance, a carrier serving small employers, a fraternal benefit society, a hospital or medical service corporation, a health maintenance organization, a plan for dental care and a prepaid limited health service organization.
Sec. 8. "Provider of health care" means a physician, dentist, licensed nurse, dispensing optician, optometrist, practitioner of respiratory care, registered physical therapist, podiatric physician, licensed psychologist, licensed marriage and family therapist, chiropractor, doctor of Oriental medicine in any form, medical laboratory director or technician, or pharmacist.
Sec. 9. 1. The bureau of protections for consumers of health care is hereby created within the division.
2. The commissioner shall appoint a chief of the bureau who is in the classified service of the state and is directly responsible to the commissioner. The chief must be selected on the basis of his education, training, experience and demonstrated abilities, and his interest in assisting insureds. The experience required pursuant to this subsection must include, without limitation, experience with and knowledge of:
(a) The field of health care;
(b) The provisions of this Title;
(c) Health insurance and administrators of health care plans;
(d) Managed care organizations, including, without limitation, health maintenance organizations; and
(e) The provisions of chapters 439, 439B, 441A, 442, 449, 450, 450B, 451, 457, 458 and 460 of NRS.
Sec. 10. The chief shall:
1. Establish procedures and policies for the management of the bureau;
2. Subject to the approval of the commissioner, appoint such personnel as are necessary for the proper and efficient performance of the functions of the bureau;
3. Prescribe the duties of the personnel of the bureau;
4. Submit to the director of the legislative counsel bureau a biennial report on January 31 of each odd-numbered year for distribution to the legislature summarizing the information collected pursuant to subsection 10 of section 11 of this act during the preceding biennium, including, without limitation, suggestions for any necessary legislation concerning the provision of health care services; and
5. Take such other action as may be necessary or appropriate to carry out the purposes of sections 2 to 16, inclusive, of this act.
Sec. 11. The bureau shall:
1. Establish a toll-free telephone service for receiving inquiries and complaints from insureds in this state;
2. Take such actions as are necessary to ensure public awareness of the existence and purpose of the bureau and to educate consumers of health care concerning the provision of health care services in this state;
3. Provide prompt answers to inquiries of insureds concerning the provision of health care services, or refer the insureds to the appropriate agency, department or other entity that is responsible for addressing the specific type of inquiry;
4. Refer insureds to the appropriate agency, department or other entity that is responsible for addressing the specific type of complaint of the insured;
5. Resolve complaints of insureds related to the provision of health care services, as provided in section 12 of this act;
6. Provide counseling and assistance to insureds concerning their health care plans, including, without limitation, assistance concerning coverage for health care services, filing complaints and accessing the complaint and appeal process;
7. Investigate reports of poor quality of health care services or improper treatment of insureds provided pursuant to the health care plan of an insured, and notify the appropriate agency, department or other entity that is responsible for addressing such cases of the findings of the investigation;
8. Advocate for the rights of consumers of health care in this state;
9. Enforce the provisions of this Title pursuant to any power delegated to the bureau by the commissioner pursuant to NRS 679B.110; and
10. Maintain a record of each inquiry and complaint received from an insured and a record of the action taken by the bureau concerning each such inquiry and complaint.
Sec. 12. 1. If an insured has exhausted all of his available remedies, including, without limitation, any procedure for the filing of a complaint or appeal that is available through his insurer, he may request the chief to assist him to resolve a dispute with his insurer. Except as otherwise provided in subsection 4, upon receiving such a request, the chief or his designated representative shall hear, mediate, arbitrate or resolve by any other alternative means of dispute resolution the dispute between the insured and his insurer if the dispute concerns the provision of health care services or the denial of coverage for treatment. The chief may provide such assistance in any other matter he deems appropriate.
2. The decision of the chief or his designated representative pursuant to subsection 1 is a final decision for the purpose of judicial review.
3. The chief or his designated representative may subpoena witnesses, compel their attendance, administer oaths, examine any person under oath relative to the subject of a hearing conducted pursuant to this section, and compel any person to subscribe to his testimony after it has been correctly reduced to writing, and in connection therewith, require the production of books, papers, records, correspondence or other documents that he deems relevant to the inquiry.
4. The chief may decline to resolve a case that he determines to be trivial, without merit or beyond the scope of his jurisdiction.
5. Any medical information concerning an insured obtained pursuant to this section must be kept confidential.
Sec. 13. 1. The chief or his designated representative may, if authorized by the commissioner, examine an insurer in the manner provided in NRS 679B.230 to 679B.300, inclusive.
2. Any information obtained pursuant to this section must be kept confidential as provided in NRS 679B.190.
Sec. 14. Each insurer shall include on each health insurance card or evidence of coverage issued to an insured:
1. The toll-free telephone number established pursuant to subsection 1 of section 11 of this act, printed in at least 12-point type; and
2. The name of the bureau and its hours of operation, printed in at least 10-point type.
Sec. 15. 1. The bureau shall establish, and revise annually, a list of providers of health care who do not have a contract with an insurer for the provision of services, to assist and advise the bureau concerning the appropriateness of health care delivered by an insurer, the denial of health care services or coverage by an insurer, and any other issue that affects insureds.
2. The bureau may assign two persons with relevant training and experience from the list established pursuant to subsection 1 to assist with each complaint received pursuant to section 11 of this act and each dispute resolved pursuant to section 12 of this act.
3. While engaged in assisting the bureau with a complaint, each person assigned pursuant to subsection 2 is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally.
4. A person assigned to assist the bureau pursuant to this section is not liable for any damage or injury to any person, including, without limitation, death, as a result of any advice or assistance provided to the bureau pursuant to this section.
5. For the purposes of this section, "provider of health care" includes a provider of health care who is or was licensed, certified or otherwise authorized to practice pursuant to the laws of any state.
Sec. 16. 1. Each insurer authorized to transact health insurance in this state shall pay to the division an annual fee on or before March 1 of each year in an amount determined by the division pursuant to this section, but not to exceed $500, to cover the costs of the bureau for the administration and enforcement of sections 2 to 15, inclusive, of this act.
2. The commissioner shall annually determine the amount of the fee by determining the costs of the bureau for the administration and enforcement of sections 2 to 15, inclusive, of this act, including, without limitation, any expenses incident to or associated with the requirements of those sections, and equally dividing the cost among insurers.
3. The division shall mail to each insurer a notice of the amount of the fee on or before January 15 of each year.
Sec. 17. NRS 695A.555 is hereby amended to read as follows:
695A.555Societies are not exempt from the provisions of NRS 679B.158 [.] or section 16 of this act. If a society is an admitted health insurer, as that term is defined in NRS 449.450, it is not exempt from the fees imposed pursuant to NRS 449.465.
Sec. 18. 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 section 16 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. 19. This act becomes effective on July 1, 1997.