(Reprinted with amendments adopted on April 14, 2003)

 

Senate Bill No. 163–Senators O’Connell and Townsend

 

February 19, 2003

____________

 

Referred to Committee on Commerce and Labor

 

SUMMARY—Revises provisions governing certain contracts with providers of health care. (BDR 57‑683)

 

FISCAL NOTE:  Effect on Local Government: Yes.

                           Effect on the State: No.

 

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to insurance; prohibiting certain organizations from charging a fee for including the name of a provider of health care on a panel of providers of health care under certain circumstances; requiring the submission of a schedule of payments to a provider of health care under certain circumstances; providing a penalty; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

1-1  Section 1. Chapter 679A of NRS is hereby amended by

1-2  adding thereto a new section to read as follows:

1-3  1.  If an organization establishes a panel of providers of

1-4  health care and makes the panel available for use by an insurer

1-5  when offering health care services pursuant to chapter 689A,

1-6  689B, 689C, 695A, 695B or 695C, the organization shall not

1-7  charge the insurer or a provider of health care a fee to include the

1-8  name of the provider on the panel of providers of health care.

1-9  2.  If an organization violates the provisions of subsection 1,

1-10  the organization shall pay to the insurer or provider of health

1-11  care, as appropriate, an amount that is equal to twice the fee

1-12  charged to the insurer or provider of health care.

1-13      3.  A court shall award costs and reasonable attorney’s fees to

1-14  the prevailing party in an action brought pursuant to this section.

2-1  4.  In addition to any relief granted pursuant to this section, if

2-2  an organization violates the provisions of subsection 1, and if an

2-3  insurer offering health care services pursuant to chapter 689A,

2-4  689B, 689C, 695A, 695B or 695C has a contract with or otherwise

2-5  uses the services of the organization, the Division shall require the

2-6  insurer to suspend its performance under the contract or

2-7  discontinue using those services until the organization, as

2-8  determined by the Division:

2-9  (a) Complies with the provisions of subsection 1; and

2-10      (b) Refunds to all providers of health care any fees obtained by

2-11  the organization in violation of subsection 1.

2-12      Sec. 2.  Chapter 683A of NRS is hereby amended by adding

2-13  thereto a new section to read as follows:

2-14      If an administrator, managing general agent or producer of

2-15  insurance, or a health maintenance organization when acting as

2-16  an administrator pursuant to NRS 683A.0851 or a nonprofit

2-17  corporation for hospital or medical services when acting as an

2-18  administrator pursuant to NRS 683A.0852, contracts with a

2-19  provider of health care to provide health care to an insured

2-20  pursuant to this chapter, the administrator, managing general

2-21  agent, producer of insurance, health maintenance organization or

2-22  nonprofit corporation for hospital or medical services shall:

2-23      1.  If requested by the provider of health care at the time the

2-24  contract is made, submit to the provider of health care a copy of

2-25  the schedule of payments applicable to the provider of health care;

2-26  or

2-27      2.  If requested by the provider of health care at any other

2-28  time, submit to the provider of health care the schedule of

2-29  payments specified in subsection 1 within 7 days after receiving

2-30  the request.

2-31      Sec. 3.  NRS 689A.035 is hereby amended to read as follows:

2-32      689A.035  1.  An insurer shall not charge a provider of health

2-33  care a fee to include the name of the provider on a list of providers

2-34  of health care given by the insurer to its insureds.

2-35      2.  If an insurer contracts with a provider of health care to

2-36  provide health care to an insured, the insurer shall:

2-37      (a) If requested by the provider of health care at the time the

2-38  contract is made, submit to the provider of health care the

2-39  schedule of payments applicable to the provider of health care; or

2-40      (b) If requested by the provider of health care at any other

2-41  time, submit to the provider of health care the schedule of

2-42  payments specified in paragraph (a) within 7 days after receiving

2-43  the request.

 

 

3-1  Sec. 4.  NRS 689B.015 is hereby amended to read as follows:

3-2  689B.015  1.  An insurer that issues a policy of group health

3-3  insurance shall not charge a provider of health care a fee to include

3-4  the name of the provider on a list of providers of health care given

3-5  by the insurer to its insureds.

3-6  2.  If an insurer specified in subsection 1 contracts with a

3-7  provider of health care to provide health care to an insured, the

3-8  insurer shall:

3-9  (a) If requested by the provider of health care at the time the

3-10  contract is made, submit to the provider of health care the

3-11  schedule of payments applicable to the provider of health care; or

3-12      (b) If requested by the provider of health care at any other

3-13  time, submit to the provider of health care the schedule of

3-14  payments specified in paragraph (a) within 7 days after receiving

3-15  the request.

3-16      Sec. 5.  NRS 689C.435 is hereby amended to read as follows:

3-17      689C.435  1.  A carrier serving small employers and a carrier

3-18  that offers a contract to a voluntary purchasing group shall not

3-19  charge a provider of health care a fee to include the name of the

3-20  provider on a list of providers of health care given by the carrier to

3-21  its insureds.

3-22      2.  If a carrier specified in subsection 1 contracts with a

3-23  provider of health care to provide health care to an insured, the

3-24  carrier shall:

3-25      (a) If requested by the provider of health care at the time the

3-26  contract is made, submit to the provider of health care the

3-27  schedule of payments applicable to the provider of health care; or

3-28      (b) If requested by the provider of health care at any other

3-29  time, submit to the provider of health care the schedule of

3-30  payments specified in paragraph (a) within 7 days after receiving

3-31  the request.

3-32      Sec. 6.  NRS 695A.095 is hereby amended to read as follows:

3-33      695A.095  1.  A society shall not charge a provider of health

3-34  care a fee to include the name of the provider on a list of providers

3-35  of health care given by the society to its insureds.

3-36      2.  If a society contracts with a provider of health care to

3-37  provide health care to an insured, the society shall:

3-38      (a) If requested by the provider of health care at the time the

3-39  contract is made, submit to the provider of health care the

3-40  schedule of payments applicable to the provider of health care; or

3-41      (b) If requested by the provider of health care at any other

3-42  time, submit to the provider of health care the schedule of

3-43  payments specified in paragraph (a) within 7 days after receiving

3-44  the request.

 

4-1  Sec. 7.  NRS 695B.035 is hereby amended to read as follows:

4-2  695B.035  1.  A corporation subject to the provisions of this

4-3  chapter shall not charge a provider of health care a fee to include the

4-4  name of the provider on a list of providers of health care given by

4-5  the corporation to its insureds.

4-6  2.  If a corporation specified in subsection 1 contracts with a

4-7  provider of health care to provide health care to an insured, the

4-8  corporation shall:

4-9  (a) If requested by the provider of health care at the time the

4-10  contract is made, submit to the provider of health care the

4-11  schedule of payments applicable to the provider of health care; or

4-12      (b) If requested by the provider of health care at any other

4-13  time, submit to the provider of health care the schedule of

4-14  payments specified in paragraph (a) within 7 days after receiving

4-15  the request.

4-16      Sec. 8.  NRS 695C.125 is hereby amended to read as follows:

4-17      695C.125  1.  A health maintenance organization shall not

4-18  charge a provider of health care a fee to include the name of the

4-19  provider on a list of providers of health care given by the health

4-20  maintenance organization to its enrollees.

4-21      2.  If a health maintenance organization contracts with a

4-22  provider of health care to provide health care to an enrollee, the

4-23  health maintenance organization shall:

4-24      (a) If requested by the provider of health care at the time the

4-25  contract is made, submit to the provider of health care the

4-26  schedule of payments applicable to the provider of health care; or

4-27      (b) If requested by the provider of health care at any other

4-28  time, submit to the provider of health care the schedule of

4-29  payments specified in paragraph (a) within 7 days after receiving

4-30  the request.

4-31      Sec. 9.  NRS 695G.270 is hereby amended to read as follows:

4-32      695G.270  1.  A managed care organization that establishes a

4-33  panel of providers of health care for the purpose of offering health

4-34  care services pursuant to chapter 689A, 689B, 689C, 695A, 695B or

4-35  695C of NRS shall not charge a provider of health care a fee to

4-36  include the name of the provider on the panel of providers of health

4-37  care.

4-38      2.  If a managed care organization contracts with a provider

4-39  of health care to provide health care services pursuant to chapter

4-40  689A, 689B, 689C, 695A, 695B or 695C of NRS, the managed care

4-41  organization shall:

4-42      (a) If requested by the provider of health care at the time the

4-43  contract is made, submit to the provider of health care the

4-44  schedule of payments applicable to the provider of health care; or

5-1  (b) If requested by the provider of health care at any other

5-2  time, submit to the provider of health care the schedule of

5-3  payments specified in paragraph (a) within 7 days after receiving

5-4  the request.

5-5  Sec. 10.  Chapter 616B of NRS is hereby amended by adding

5-6  thereto a new section to read as follows:

5-7  1.  If an insurer establishes a panel of providers of health care

5-8  for the purpose of offering health care services pursuant to

5-9  chapters 616A to 617, inclusive, of NRS, the insurer shall not

5-10  charge a provider of health care a fee to include the name of the

5-11  provider on the panel of providers of health care.

5-12      2.  If an insurer violates the provisions of subsection 1, the

5-13  insurer shall pay to the provider of health care an amount that is

5-14  equal to twice the fee charged to the provider of health care.

5-15      3.  A court shall award costs and reasonable attorney’s fees to

5-16  the prevailing party in an action brought pursuant to this section.

5-17      Sec. 11.  This act becomes effective on July 1, 2003.

 

5-18  H