Senate Bill No. 225

Senate Bill No. 225-Committee on Commerce and Labor

March 19, 1997
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Referred to Committee on Commerce and Labor

SUMMARY--Provides for reimbursement of insured under certain policies of health insurance for certain services provided by registered pharmacist. (BDR 57-1085)

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 insurance; providing for the reimbursement of an insured under certain policies of health insurance for the costs of certain services provided by a registered pharmacist; 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 689A of NRS is hereby amended by adding thereto a new section to read as follows:
1. If a policy of health insurance provides coverage for services that are within the authorized scope of practice of a pharmacist who is registered pursuant to the provisions of chapter 639 of NRS, the insured is entitled to reimbursement for services provided by such a pharmacist.
2. The terms of the policy must not limit:
(a) Coverage for services provided by a pharmacist specified in subsection 1 to a number of occasions less than for services provided by another provider of health care.
(b) Reimbursement for services provided by a pharmacist specified in subsection 1 to an amount that is less than the amount reimbursed for similar services provided by another provider of health care.
3. An insurer is not required to pay for services provided by a pharmacist specified in subsection 1 that duplicate services provided by another provider of health care.
Sec. 2 Chapter 689B of NRS is hereby amended by adding thereto a new section to read as follows:
1. If a policy of group health insurance provides coverage for services that are within the authorized scope of practice of a pharmacist who is registered pursuant to the provisions of chapter 639 of NRS, the insured is entitled to reimbursement for services provided by such a pharmacist.
2. The terms of the policy must not limit:
(a) Coverage for services provided by a pharmacist specified in subsection 1 to a number of occasions less than for services provided by another provider of health care.
(b) Reimbursement for services provided by a pharmacist specified in subsection 1 to an amount that is less than the amount reimbursed for similar services provided by another provider of health care.
3. An insurer is not required to pay for services provided by a pharmacist specified in subsection 1 that duplicate services provided by another provider of health care.
Sec. 3 Chapter 695B of NRS is hereby amended by adding thereto a new section to read as follows:
1. If a contract for hospital or medical services provides coverage for services that are within the authorized scope of practice of a pharmacist who is registered pursuant to the provisions of chapter 639 of NRS, the insured is entitled to reimbursement for services provided by such a pharmacist.
2. The terms of the contract must not limit:
(a) Coverage for services provided by a pharmacist specified in subsection 1 to a number of occasions less than for services provided by another provider of health care.
(b) Reimbursement for services provided by a pharmacist specified in subsection 1 to an amount that is less than the amount reimbursed for similar services provided by another provider of health care.
3. An insurer is not required to pay for services provided by a pharmacist specified in subsection 1 that duplicate services provided by another provider of health care.
Sec. 4 Chapter 695C of NRS is hereby amended by adding thereto a new section to read as follows:
1. If any evidence of coverage provides coverage for services that are within the authorized scope of practice of a pharmacist who is registered pursuant to the provisions of chapter 639 of NRS, the insured is entitled to reimbursement for services provided by such a pharmacist.
2. The terms of the evidence of coverage must not limit:
(a) Coverage for services provided by a pharmacist specified in subsection 1 to a number of occasions less than for services provided by another provider of health care.
(b) Reimbursement for services provided by a pharmacist specified in subsection 1 to an amount that is less than the amount reimbursed for similar services provided by another provider of health care.
3. An insurer is not required to pay for services provided by a pharmacist specified in subsection 1 that duplicate services provided by another provider of health care.
Sec. 5 NRS 695C.330 is hereby amended to read as follows:
695C.3301. The commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if he finds that any of the following conditions exist:
(a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted under NRS 695C.060, 695C.070 and 695C.140, unless amendments to those submissions have been filed with and approved by the commissioner;
(b) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with the requirements of NRS 695C.170 to 695C.200, inclusive [;] , and section 4 of this act;
(c) The health care plan does not furnish comprehensive health care services as provided for in subsection 2 of NRS 695C.030;
(d) The state board of health certifies to the commissioner that:
(1) The health maintenance organization does not meet the requirements of subsection 2 of NRS 695C.080; or
(2) The health maintenance organization is unable to fulfill its obligations to furnish health care services as required under its health care plan;
(e) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;
(f) The health maintenance organization has failed to put into effect a mechanism affording the enrollees an opportunity to participate in matters relating to the content of programs under NRS 695C.110;
(g) The health maintenance organization has failed to put into effect the system for complaints required by NRS 695C.260 in a manner reasonably to dispose of valid complaints;
(h) The health maintenance organization or any person on its behalf has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner;
(i) The continued operation of the health maintenance organization would be hazardous to its enrollees; or
(j) The health maintenance organization has otherwise failed to substantially comply with this chapter.
2. A certificate of authority must be suspended or revoked only after compliance with the requirements of NRS 695C.340.
3. When the certificate of authority of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of that suspension, enroll any additional groups or new individual contracts, unless those groups or persons were contracted for before the date of suspension.
4. When the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the organization. It shall engage in no further advertising or solicitation whatsoever. The commissioner may by written order permit such further operation of the organization as he may find to be in the best interest of enrollees to the end that enrollees will be afforded the greatest practical opportunity to obtain continuing coverage for health care.