SUMMARY--Revises provisions regarding benefits for treatment of abuse of alcohol or drugs under policy of health insurance. (BDR 57-948)
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 insurance; revising provisions mandating benefits for the treatment of the abuse of alcohol or drugs; requiring a determination of an insured person's entitlement to benefits for the treatment of abuse of alcohol or drugs under a policy of health insurance to be made by certain persons; requiring the commissioner of insurance to adopt regulations setting forth the criteria that must be used in making those determinations; 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.046 is hereby amended to read as follows:
689A.0461. The benefits provided by a policy for health insurance for treatment of the abuse of alcohol or drugs must consist of:
(a) Treatment for withdrawal from the physiological effect of alcohol or drugs, with a [maximum] minimum benefit of $1,500 per calendar year.
(b) Treatment for a patient admitted to a facility, with a [maximum] minimum benefit of $9,000 per calendar year.
(c) Counseling for a person, group or family who is not admitted to a facility, with a [maximum] minimum benefit of $2,500 per calendar year.
2. [The maximum amount which may be paid in the lifetime of the insured for any combination of the treatments listed in subsection 1 is $39,000.
3.] These benefits must be paid in the same manner as benefits for any other illness covered by a similar policy are paid.
[4.] 3. The insured person is entitled to these benefits if treatment is received in any:
(a) Facility for the treatment of abuse of alcohol or drugs which is certified by the bureau of alcohol and drug abuse in the rehabilitation division of the department of employment, training and rehabilitation.
(b) Hospital or other medical facility or facility for the dependent which is licensed by the health division of the department of human resources, accredited by the Joint Commission on Accreditation of Hospitals and provides a program for the treatment of abuse of alcohol or drugs as part of its accredited activities.
4. Except as otherwise provided in subsection 5, the determination of whether an insured is entitled to benefits pursuant to this section must be made by a counselor or a physician, physician's assistant, registered nurse or licensed practical nurse who is certified to make such a determination by:
(a) The bureau of alcohol and drug abuse in the rehabilitation division of the department of employment, training and rehabilitation; or
(b) The American Society of Addiction Medicine or any other organization approved by the bureau to provide such a certification.
Upon making the determination, the counselor, physician, physician's assistant, registered nurse or licensed practical nurse shall submit a written evaluation to the insurer for whom the determination is made.
5. A determination made pursuant to subsection 4:
(a) Must be based upon criteria set forth in regulations adopted by the commissioner pursuant to subsection 6; and
(b) Is subject to final approval by the insurer. Any final approval of such a determination must include the written evaluation submitted to the insurer pursuant to subsection 4.
6. The commissioner shall adopt regulations specifying the criteria that must be used by a counselor, physician, physician's assistant, registered nurse or licensed practical nurse in making a determination pursuant to subsection 4. The regulations must be based upon the criteria established by the American Society of Addiction Medicine.
7. As used in this section:
(a) "Counselor" means a person certified by the bureau of alcohol and drug abuse of the rehabilitation division of the department of employment, training and rehabilitation as an alcohol and drug abuse counselor.
(b) "Licensed practical nurse" has the meaning ascribed to it in NRS 632.016.
(c) "Physician" has the meaning ascribed to it in NRS 630.014.
(d) "Physician's assistant" has the meaning ascribed to it in NRS 630.015.
(e) "Registered nurse" has the meaning ascribed to it in NRS 632.019.
Sec. 2 NRS 689B.036 is hereby amended to read as follows:
689B.0361. The benefits provided by a group policy for health insurance, as required in subsection 5 of NRS 689B.030, for treatment of the abuse of alcohol or drugs must consist of:
(a) Treatment for withdrawal from the physiological effects of alcohol or drugs, with a [maximum] minimum benefit of $1,500 per calendar year.
(b) Treatment for a patient admitted to a facility, with a [maximum] minimum benefit of $9,000 per calendar year.
(c) Counseling for a person, group or family who is not admitted to a facility, with a [maximum] minimum benefit of $2,500 per calendar year.
2. [The maximum amount which may be paid in the lifetime of the insured for any combination of the treatments listed in subsection 1 is $39,000.
3.] These benefits must be paid in the same manner as benefits for any other illness covered by a similar policy are paid.
[4.] 3. The insured person is entitled to these benefits if treatment is received in any:
(a) Facility for the treatment of abuse of alcohol or drugs which is certified by the bureau of alcohol and drug abuse in the rehabilitation division of the department of employment, training and rehabilitation.
(b) Hospital or other medical facility or facility for the dependent which is licensed by the health division of the department of human resources, accredited by the Joint Commission on Accreditation of Hospitals and provides a program for the treatment of abuse of alcohol or drugs as part of its accredited activities.
4. Except as otherwise provided in subsection 5, the determination of whether an insured is entitled to benefits pursuant to this section must be made by a counselor or a physician, physician's assistant, registered nurse or licensed practical nurse who is certified to make such a determination by:
(a) The bureau of alcohol and drug abuse in the rehabilitation division of the department of employment, training and rehabilitation; or
(b) The American Society of Addiction Medicine or any other organization approved by the bureau to provide such a certification.
Upon making the determination, the counselor, physician, physician's assistant, registered nurse or licensed practical nurse shall submit a written evaluation to the insurer for whom the determination is made.
5. A determination made pursuant to subsection 4:
(a) Must be based upon criteria set forth in regulations adopted by the commissioner pursuant to subsection 6; and
(b) Is subject to final approval by the insurer. Any final approval of such a determination must include the written evaluation submitted to the insurer pursuant to subsection 4.
6. The commissioner shall adopt regulations specifying the criteria that must be used by a counselor, physician, physician's assistant, registered nurse or licensed practical nurse in making a determination pursuant to subsection 4. The regulations must be based upon the criteria established by the American Society of Addiction Medicine.
7. As used in this section:
(a) "Counselor" means a person certified by the bureau of alcohol and drug abuse of the rehabilitation division of the department of employment, training and rehabilitation as an alcohol and drug abuse counselor.
(b) "Licensed practical nurse" has the meaning ascribed to it in NRS 632.016.
(c) "Physician" has the meaning ascribed to it in NRS 630.014.
(d) "Physician's assistant" has the meaning ascribed to it in NRS 630.015.
(e) "Registered nurse" has the meaning ascribed to it in NRS 632.019.
Sec. 3 NRS 695B.194 is hereby amended to read as follows:
695B.1941. The annual benefits provided by a policy for group health insurance issued by a medical service corporation, as required by subsection 8 of NRS 695B.180, for treatment of the abuse of alcohol or drugs must consist of:
(a) Treatment for withdrawal from the physiological effects of alcohol or drugs, with a [maximum] minimum benefit of $1,500 per calendar year.
(b) Treatment for a patient admitted to a facility, with a [maximum] minimum benefit of $9,000 per calendar year.
(c) Counseling for a person, group or family who is not admitted to a facility, with a [maximum] minimum benefit of $2,500 per calendar year.
2. [The maximum amount which may be paid in the lifetime of the insured for any combination of the treatments listed in subsection 1 is $39,000.
3.] These benefits must be paid in the same manner as benefits for any other illness covered by a similar policy are paid.
[4.] 3. The insured person is entitled to these benefits if treatment is received in any:
(a) Facility for the treatment of abuse of alcohol or drugs which is certified by the bureau of alcohol and drug abuse in the rehabilitation division of the department of employment, training and rehabilitation.
(b) Hospital or other medical facility or facility for the dependent which is licensed by the health division of the department of human resources, accredited by the Joint Commission on Accreditation of Hospitals and provides a program for the treatment of abuse of alcohol or drugs as part of its accredited activities.
4. Except as otherwise provided in subsection 5, the determination of whether an insured is entitled to benefits pursuant to this section must be made by a counselor or a physician, physician's assistant, registered nurse or licensed practical nurse who is certified to make such a determination by:
(a) The bureau of alcohol and drug abuse in the rehabilitation division of the department of employment, training and rehabilitation; or
(b) The American Society of Addiction Medicine or any other organization approved by the bureau to provide such a certification.
Upon making the determination, the counselor, physician, physician's assistant, registered nurse or licensed practical nurse shall submit a written evaluation to the insurer for whom the determination is made.
5. A determination made pursuant to subsection 4:
(a) Must be based upon criteria set forth in regulations adopted by the commissioner pursuant to subsection 6; and
(b) Is subject to final approval by the insurer. Any final approval of such a determination must include the written evaluation submitted to the insurer pursuant to subsection 4.
6. The commissioner shall adopt regulations specifying the criteria that must be used by a counselor, physician, physician's assistant, registered nurse or licensed practical nurse in making a determination pursuant to subsection 4. The regulations must be based upon the criteria established by the American Society of Addiction Medicine.
7. As used in this section:
(a) "Counselor" means a person certified by the bureau of alcohol and drug abuse of the rehabilitation division of the department of employment, training and rehabilitation as an alcohol and drug abuse counselor.
(b) "Licensed practical nurse" has the meaning ascribed to it in NRS 632.016.
(c) "Physician" has the meaning ascribed to it in NRS 630.014.
(d) "Physician's assistant" has the meaning ascribed to it in NRS 630.015.
(e) "Registered nurse" has the meaning ascribed to it in NRS 632.019.
Sec. 4 NRS 695C.174 is hereby amended to read as follows:
695C.1741. The benefits provided by health maintenance plans for treatment of the abuse of alcohol or drugs as required by subparagraph (5) of paragraph (b) of subsection 3 of NRS 695C.170, must consist of:
(a) Treatment for withdrawal from the physiological effects of alcohol or drugs, with a [maximum] minimum benefit of $1,500 per calendar year.
(b) Treatment for a patient admitted to a facility, with a [maximum] minimum benefit of $9,000 per calendar year.
(c) Counseling for a person, group or family who is not admitted to a facility, with a [maximum] minimum benefit of $2,500 per calendar year.
2. [The maximum amount which may be paid in the lifetime of the insured for any combination of the treatments listed in subsection 1 is $39,000.
3.] These benefits must be paid in the same manner as benefits for any other illness covered by a similar policy are paid.
[4.] 3. The insured person is entitled to these benefits if treatment is received in any:
(a) Facility for the treatment of abuse of alcohol or drugs which is certified by the bureau of alcohol and drug abuse in the rehabilitation division of the department of employment, training and rehabilitation.
(b) Hospital or other medical facility or facility for the dependent which is licensed by the health division of the department of human resources, accredited by the Joint Commission on Accreditation of Hospitals and provides a program for the treatment of abuse of alcohol or drugs as part of its accredited activities.
4. Except as otherwise provided in subsection 5, the determination of whether an insured is entitled to benefits pursuant to this section must be made by a counselor or a physician, physician's assistant, registered nurse or licensed practical nurse who is certified to make such a determination by:
(a) The bureau of alcohol and drug abuse in the rehabilitation division of the department of employment, training and rehabilitation; or
(b) The American Society of Addiction Medicine or any other organization approved by the bureau to provide such a certification.
Upon making the determination, the counselor, physician, physician's assistant, registered nurse or licensed practical nurse shall submit a written evaluation to the insurer for whom the determination is made.
5. A determination made pursuant to subsection 4:
(a) Must be based upon criteria set forth in regulations adopted by the commissioner pursuant to subsection 6; and
(b) Is subject to final approval by the insurer. Any final approval of such a determination must include the written evaluation submitted to the insurer pursuant to subsection 4.
6. The commissioner shall adopt regulations specifying the criteria that must be used by a counselor, physician, physician's assistant, registered nurse or licensed practical nurse in making a determination pursuant to subsection 4. The regulations must be based upon the criteria established by the American Society of Addiction Medicine.
7. As used in this section:
(a) "Counselor" means a person certified by the bureau of alcohol and drug abuse of the rehabilitation division of the department of employment, training and rehabilitation as an alcohol and drug abuse counselor.
(b) "Licensed practical nurse" has the meaning ascribed to it in NRS 632.016.
(c) "Physician" has the meaning ascribed to it in NRS 630.014.
(d) "Physician's assistant" has the meaning ascribed to it in NRS 630.015.
(e) "Registered nurse" has the meaning ascribed to it in NRS 632.019.
Sec. 5 This act becomes effective on July 1, 1997.