SUMMARY--Makes various changes concerning insurance coverage of health care. (BDR 57-922)
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 insurance; revising provisions regarding the performance of an independent evaluation to determine benefits of health care; requiring reimbursement for treatment of covered illnesses if the treatment is rendered by a person legally qualified to perform the particular health care service; 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 689A.0403 is hereby amended to read as follows:
689A.04031. Each policy of health insurance must include a procedure for binding arbitration to resolve disputes concerning independent medical evaluations pursuant to the rules of the American Arbitration Association.
2. If an insurer, for any final determination of benefits or care, requires an independent evaluation of the medical or chiropractic care of any person for whom such care is covered under the terms of the contract of insurance, only a physician or a chiropractor who is certified to [practice in the same field of practice as] provide the same kind of care as that rendered by the primary treating physician or chiropractor who is formally educated in that [field] kind of care may conduct the independent evaluation.
3. The independent evaluation must include a physical examination of the patient, unless he is deceased, and a personal review of all X-rays and reports prepared by the primary treating physician or chiropractor. A certified copy of all reports of findings must be sent to the primary treating physician or chiropractor and the insured person within 10 working days after the evaluation. If the insured person disagrees with the finding of the evaluation, he must submit an appeal to the insurer pursuant to the procedure for binding arbitration set forth in the policy of insurance within 30 days after he receives the finding of the evaluation. Upon its receipt of an appeal, the insurer shall so notify in writing the primary treating physician or chiropractor.
4. The insurer shall not limit or deny coverage for care related to a disputed claim while the dispute is in arbitration, except that, if the insurer prevails in the arbitration, the primary treating physician or chiropractor may not recover any payment from either the insurer, insured person or the patient for services that he provided to the patient after receiving written notice from the insurer pursuant to subsection 3 concerning the appeal of the insured person.
Sec. 2 NRS 689A.049 is hereby amended to read as follows:
689A.0491. If any policy of health insurance provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified chiropractor, the insured is entitled to reimbursement for treatments by a chiropractor who is licensed pursuant to chapter 634 of NRS.
2. If any policy of health insurance provides coverage for treatment of an illness which is within the authorized scope of practice of an alternative provider of health care, the insured is entitled to reimbursement for treatments by an alternative provider of health care who is licensed in this state.
3. The terms of the policy must not limit:
(a) Coverage for treatments by a chiropractor or an alternative provider of health care to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a chiropractor or an alternative provider of health care to an amount less than that reimbursed for similar treatments by other physicians.
4. For the purposes of this section, "alternative provider of health care" includes, without limitation, an advanced practitioner of homeopathy, a doctor of Oriental medicine or a doctor of acupuncture.
Sec. 3 NRS 689B.039 is hereby amended to read as follows:
689B.0391. If any group policy of health insurance provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified chiropractor, the insured is entitled to reimbursement for treatments by a chiropractor who is licensed pursuant to chapter 634 of NRS.
2. If any group policy of health insurance provides coverage for treatment of an illness which is within the authorized scope of practice of an alternative provider of health care, the insured is entitled to reimbursement for treatments by an alternative provider of health care who is licensed in this state.
3. The terms of the policy must not limit:
(a) Coverage for treatments by a chiropractor or an alternative provider of health care to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a chiropractor or an alternative provider of health care to an amount less than that charged for similar treatments by other physicians.
4. For the purposes of this section, "alternative provider of health care" includes, without limitation, an advanced practitioner of homeopathy, a doctor of Oriental medicine or a doctor of acupuncture.
Sec. 4 NRS 689B.270 is hereby amended to read as follows:
689B.2701. Each policy of group or blanket health insurance must include a procedure for binding arbitration to resolve disputes concerning independent medical evaluations pursuant to the rules of the American Arbitration Association.
2. If an insurer, for any final determination of benefits or care, requires an independent evaluation of the medical or chiropractic care of any person for whom such care is covered under the terms of a policy of group or blanket health insurance, only a physician , an alternative provider of health care or a chiropractor who is certified to practice in the same field of practice as the primary treating physician , alternative provider of health care or chiropractor or who is formally educated in that field may conduct the independent evaluation.
3. The independent evaluation must include a physical examination of the patient, unless he is deceased, and a personal review of all X-rays and reports prepared by the primary treating physician , alternative provider of health care or chiropractor. A certified copy of all reports of findings must be sent to the primary treating physician , alternative provider of health care or chiropractor and the insured person within 10 working days after the evaluation. If the insured person disagrees with the finding of the evaluation, he must submit an appeal to the insurer pursuant to the procedure for binding arbitration set forth in the policy of insurance within 30 days after he receives the finding of the evaluation. Upon its receipt of an appeal, the insurer shall so notify in writing the primary treating physician , alternative provider of health care or chiropractor.
4. The insurer shall not limit or deny coverage for care related to a disputed claim while the dispute is in arbitration, except that, if the insurer prevails in the arbitration, the primary treating physician , alternative provider of health care or chiropractor may not recover any payment from either the insurer, insured person or the patient for services that he provided to the patient after receiving written notice from the insurer pursuant to subsection 3 concerning the appeal of the insured person.
5. For the purposes of this section, "alternative provider of health care" includes, without limitation, an advanced practitioner of homeopathy, a doctor of Oriental medicine or a doctor of acupuncture.
Sec. 5 NRS 695B.182 is hereby amended to read as follows:
695B.1821. Each contract for hospital or medical services must include a procedure for binding arbitration to resolve disputes concerning independent medical evaluations pursuant to the rules of the American Arbitration Association.
2. If a corporation subject to the provisions of this chapter, for any final determination of benefits or care, requires an independent evaluation of the medical or chiropractic care of any person for whom such care is covered under a contract for hospital or medical services, only a physician , an alternative provider of health care or a chiropractor who is certified to practice in the same field of practice as the primary treating physician , alternative provider of health care or chiropractor or who is formally educated in that field may conduct the independent evaluation.
3. The independent evaluation must include a physical examination of the patient, unless he is deceased, and a personal review of all X-rays and reports prepared by the primary treating physician , alternative provider of health care or chiropractor. A certified copy of all reports of findings must be sent to the primary treating physician , alternative provider of health care or chiropractor and the insured person within 10 working days after the evaluation. If the insured person disagrees with the finding of the evaluation, he must submit an appeal to the insurer pursuant to the procedure for binding arbitration set forth in the contract for services within 30 days after he receives the finding of the evaluation. Upon its receipt of an appeal, the insurer shall so notify in writing the primary treating physician , alternative provider of health care or chiropractor.
4. The insurer shall not limit or deny coverage for care related to a disputed claim while the dispute is in arbitration, except that, if the insurer prevails in the arbitration, the primary treating physician , alternative provider of health care or chiropractor may not recover any payment from either the insurer, insured person or the patient for services that he provided to the patient after receiving written notice from the insurer pursuant to subsection 3 concerning the appeal of the insured person.
5. For the purposes of this section, "alternative provider of health care" includes, without limitation, an advanced practitioner of homeopathy, a doctor of Oriental medicine or a doctor of acupuncture.
Sec. 6 NRS 695B.198 is hereby amended to read as follows:
695B.1981. If any contract for hospital or medical service provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified chiropractor, the insured is entitled to reimbursement for treatments by a chiropractor who is licensed pursuant to chapter 634 of NRS.
2. If any contract for hospital or medical services provides coverage for treatment of an illness which is within the authorized scope of practice of an alternative provider of health care, the insured is entitled to reimbursement for treatments by an alternative provider of health care who is licensed in this state.
3. The terms of the policy must not limit:
(a) Coverage for treatments by a chiropractor or an alternative provider of health care to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a chiropractor or an alternative provider of health care to an amount less than that charged for similar treatments by other physicians.
4. For the purposes of this section, "alternative provider of health care" includes, without limitation, an advanced practitioner of homeopathy, a doctor of Oriental medicine or a doctor of acupuncture.
Sec. 7 NRS 695C.178 is hereby amended to read as follows:
695C.1781. If any evidence of coverage provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified chiropractor, the insured is entitled to reimbursement for treatments by a chiropractor who is licensed pursuant to chapter 634 of NRS.
2. If any evidence of coverage provides coverage for treatment of an illness which is within the authorized scope of practice of an alternative provider of health care, the insured is entitled to reimbursement for treatments by an alternative provider of health care who is licensed in this state.
3. The terms of the policy must not limit:
(a) Coverage for treatments by a chiropractor or an alternative provider of health care to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a chiropractor or an alternative provider of health care to an amount less than that charged for similar treatments by other physicians.
4. For the purposes of this section, "alternative provider of health care" includes, without limitation, an advanced practitioner of homeopathy, a doctor of Oriental medicine or a doctor of acupuncture.
Sec. 8 NRS 695C.265 is hereby amended to read as follows:
695C.2651. If a health maintenance organization, for any final determination of benefits or care, requires an independent evaluation of the medical or chiropractic care of any person for whom such care is provided under the evidence of coverage:
(a) The evidence of coverage must include a procedure for binding arbitration to resolve disputes concerning independent medical evaluations pursuant to the rules of the American Arbitration Association; and
(b) Only a physician , an alternative provider of health care or a chiropractor who is certified to practice in the same field of practice as the primary treating physician , alternative provider of health care or chiropractor or who is formally educated in that field may conduct the independent evaluation.
2. The independent evaluation must include a physical examination of the patient, unless he is deceased, and a personal review of all X-rays and reports prepared by the primary treating physician , alternative provider of health care or chiropractor. A certified copy of all reports of findings must be sent to the primary treating physician , alternative provider of health care or chiropractor and the insured person within 10 working days after the evaluation. If the insured person disagrees with the finding of the evaluation, he must submit an appeal to the insurer pursuant to the procedure for binding arbitration set forth in the evidence of coverage within 30 days after he receives the finding of the evaluation. Upon its receipt of an appeal, the insurer shall so notify in writing the primary treating physician , alternative provider of health care or chiropractor.
3. The insurer shall not limit or deny coverage for care related to a disputed claim while the dispute is in arbitration, except that, if the insurer prevails in the arbitration, the primary treating physician , alternative provider of health care or chiropractor may not recover any payment from either the insurer, insured person or the patient for services that he provided to the patient after receiving written notice from the insurer pursuant to subsection 2 concerning the appeal of the insured person.
4. For the purposes of this section, "alternative provider of health care" includes, without limitation, an advanced practitioner of homeopathy, a doctor of Oriental medicine or a doctor of acupuncture.