NRS: CHAPTER 695I - SILVER STATE HEALTH INSURANCE EXCHANGE

[Rev. 6/29/2024 5:03:12 PM--2023]

CHAPTER 695I - SILVER STATE HEALTH INSURANCE EXCHANGE

GENERAL PROVISIONS

NRS 695I.010 Definitions.

NRS 695I.020 “Board” defined.

NRS 695I.030 “Exchange” defined.

NRS 695I.040 “Executive Director” defined.

NRS 695I.060 “Medical facility” defined.

NRS 695I.070 “Provider of health care” defined.

NRS 695I.080 “Qualified health plan” defined.

NRS 695I.090 “Qualified individual” defined.

NRS 695I.100 “Qualified small employer” defined.

NRS 695I.110 “Small employer” defined.

ORGANIZATION; POWERS AND DUTIES

NRS 695I.200 Establishment; purpose.

NRS 695I.210 Powers and duties of Exchange; applicability of state purchasing provisions.

BOARD OF DIRECTORS

NRS 695I.300 Membership of Board.

NRS 695I.310 Terms of office; reappointment; removal; vacancy; expiration of term.

NRS 695I.320 Chair and Vice Chair: Election; term; vacancy.

NRS 695I.330 Compensation of members; per diem and travel expenses.

NRS 695I.340 Meetings; quorum; voting.

NRS 695I.350 Subcommittees and advisory committees.

NRS 695I.360 Compliance with Open Meeting Law.

NRS 695I.370 Powers and duties of Board: Bylaws; reports; audits; regulations; contracts for services.

NRS 695I.380 Appointment, classification, qualifications and duties of Executive Director; appointment, classification and removal of other employees.

NRS 695I.390 Coordination with Medicaid, Children’s Health Insurance Program and other public programs.

MISCELLANEOUS PROVISIONS

NRS 695I.500 State agencies to provide support to Exchange; intergovernmental agreements.

NRS 695I.505 Policies to meet unique needs of tradespersons: Application for federal waiver by Executive Director; requirements for offering policy on Exchange; criteria for eligibility for policy.

NRS 695I.510 Temporary advance from State General Fund for authorized expenses of Exchange.

NRS 695I.520 Construction of chapter.

_________

GENERAL PROVISIONS

NRS 695I.010 Definitions. As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 695I.020 to 695I.110, inclusive, have the meanings ascribed to them in those sections.

(Added to NRS by 2011, 2644)

NRS 695I.020 “Board” defined. “Board” means the Board of Directors of the Exchange.

(Added to NRS by 2011, 2645)

NRS 695I.030 “Exchange” defined. “Exchange” means the Silver State Health Insurance Exchange.

(Added to NRS by 2011, 2645)

NRS 695I.040 “Executive Director” defined. “Executive Director” means the Executive Director of the Exchange.

(Added to NRS by 2011, 2645)

NRS 695I.060 “Medical facility” defined. “Medical facility” has the meaning ascribed to it in NRS 449.0151.

(Added to NRS by 2011, 2645)

NRS 695I.070 “Provider of health care” defined. “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(Added to NRS by 2011, 2645)

NRS 695I.080 “Qualified health plan” defined. Except as otherwise provided in NRS 695I.370, “qualified health plan” has the meaning ascribed to it in § 1301 of the Federal Act.

(Added to NRS by 2011, 2645)

NRS 695I.090 “Qualified individual” defined. “Qualified individual” means a person, including, without limitation, a minor, who:

1. Is seeking to enroll in a qualified health plan offered to persons through the Exchange;

2. Resides in Nevada;

3. At the time of enrollment is not incarcerated, unless the person is incarcerated pending the disposition of charges; and

4. Is, and is reasonably expected to be, for the entire period for which enrollment is sought, a citizen of the United States or an alien lawfully present in the United States.

(Added to NRS by 2011, 2645)

NRS 695I.100 “Qualified small employer” defined. “Qualified small employer” means a small employer that chooses to make all of its full-time employees eligible for one or more qualified health plans offered through the Exchange to assist qualified small employers in Nevada in facilitating the enrollment of their employees in qualified health plans offered in the small group market, if the employer:

1. Has its principal place of business in Nevada and chooses to provide coverage through the Exchange to all of its eligible employees, regardless of where those employees are employed; or

2. Regardless of the location of its principal place of business, chooses to provide coverage through the Exchange to all of its eligible employees who are principally employed in Nevada.

(Added to NRS by 2011, 2645)

NRS 695I.110 “Small employer” defined. “Small employer” has the meaning ascribed to it in NRS 689C.095.

(Added to NRS by 2011, 2645)

ORGANIZATION; POWERS AND DUTIES

NRS 695I.200 Establishment; purpose. The Silver State Health Insurance Exchange is hereby established to:

1. Facilitate the purchase and sale of qualified health plans in the individual market in Nevada;

2. Assist qualified small employers in Nevada in facilitating the enrollment and purchase of coverage and the application for subsidies for small business enrollees;

3. Reduce the number of uninsured persons in Nevada;

4. Provide a transparent marketplace for health insurance and consumer education on matters relating to health insurance; and

5. Assist residents of Nevada with access to programs, premium assistance tax credits and cost-sharing reductions.

(Added to NRS by 2011, 2645)

NRS 695I.210 Powers and duties of Exchange; applicability of state purchasing provisions.

1. The Exchange shall:

(a) Create and administer a health insurance exchange;

(b) Facilitate the purchase and sale of qualified health plans consistent with established patterns of care within the State;

(c) Provide for the establishment of a program to assist qualified small employers in Nevada in facilitating the enrollment of their employees in qualified health plans offered in the small group market;

(d) Except as otherwise authorized by a waiver obtained pursuant to NRS 695I.505, make only qualified health plans available to qualified individuals and qualified small employers; and

(e) Unless the Federal Act is repealed or is held to be unconstitutional or otherwise invalid or unlawful, perform all duties that are required of the Exchange to implement the requirements of the Federal Act.

2. The Exchange may:

(a) Enter into contracts with any person, including, without limitation, a local government, a political subdivision of a local government and a governmental agency, to assist in carrying out the duties and powers of the Exchange or the Board; and

(b) Apply for and accept any gift, donation, bequest, grant or other source of money to carry out the duties and powers of the Exchange or the Board.

3. The Exchange is subject to the provisions of chapter 333 of NRS.

(Added to NRS by 2011, 2646; A 2015, 554; 2019, 1431; 2021, 3626)

BOARD OF DIRECTORS

NRS 695I.300 Membership of Board.

1. The governing authority of the Exchange is the Board, consisting of seven voting members and three ex officio nonvoting members.

2. Subject to the provisions of subsections 3 to 6, inclusive:

(a) The Governor shall appoint five voting members of the Board;

(b) The Senate Majority Leader shall appoint one voting member of the Board; and

3. Each voting member of the Board must have:

(a) Expertise in the sale or marketing of individual or small employer health insurance;

(b) Expertise in health care administration, health care financing, health information technology or health insurance;

(d) Experience as a consumer who would benefit from services provided by the Exchange; or

(e) Experience as a consumer advocate, including, without limitation, experience in consumer outreach and education for those who would benefit from services provided by the Exchange.

4. When making an appointment pursuant to subsection 2, the Governor, the Majority Leader and the Speaker of the Assembly shall consider the collective expertise and experience of the voting members of the Board and shall attempt to make each appointment so that:

(a) The areas of expertise and experience described in subsection 3 are collectively represented by the voting members of the Board; and

(b) The voting members of the Board represent a range and diversity of skills, knowledge, experience and geographic and stakeholder perspectives.

5. When making an appointment pursuant to subsection 2, the Governor, the Majority Leader and the Speaker of the Assembly shall, as vacancies on the Board occur, ensure that not more than two voting members of the Board represent any particular area of expertise or experience described in paragraph (a), (b), (c), (d) or (e) of subsection 3.

6. A voting member of the Board may not be a Legislator or hold any elective office in State Government.

7. The following are ex officio nonvoting members of the Board who shall assist the voting members of the Board by providing advice and expertise:

(a) The Director of the Department of Health and Human Services, or his or her designee;

(b) The Director of the Department of Business and Industry, or his or her designee; and

(Added to NRS by 2011, 2646; A 2015, 555)

NRS 695I.310 Terms of office; reappointment; removal; vacancy; expiration of term.

1. After the initial terms, the term of each voting member of the Board is 3 years.

2. A voting member of the Board may be reappointed to the Board.

3. The appointing authority who appoints a voting member of the Board may remove that voting member if the voting member neglects his or her duty or commits misfeasance, malfeasance or nonfeasance in office.

4. A vacancy on the Board in the position of a voting member must be filled in the same manner as the original appointment.

5. Upon the expiration of his or her term of office, a voting member of the Board may continue to serve until he or she is reappointed or a person is appointed as a successor.

(Added to NRS by 2011, 2647)

NRS 695I.320 Chair and Vice Chair: Election; term; vacancy.

1. The Board shall elect a Chair and a Vice Chair from among its members.

2. The terms of the Chair and Vice Chair are 1 year.

3. The Chair and Vice Chair may be reelected to one or more terms.

4. If a vacancy occurs, the members of the Board shall elect a replacement Chair or Vice Chair, as applicable, for the remainder of the unexpired term.

(Added to NRS by 2011, 2647)

NRS 695I.330 Compensation of members; per diem and travel expenses.

1. To the extent that money is available for that purpose, each member of the Board who is not an officer or employee of the State of Nevada or a political subdivision of the State is entitled to receive a salary of not more than $80 per day, as fixed by the Executive Director, for each day or portion of a day spent on the business of the Board.

2. If sufficient money is available from federal grant funds or revenues generated by the Exchange, each member is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally while attending meetings of the Board or otherwise engaged in the business of the Board.

(Added to NRS by 2011, 2647; A 2015, 556)

NRS 695I.340 Meetings; quorum; voting.

1. The Board shall meet:

(a) At least once each calendar year; and

(b) At other times upon the call of the Chair or a majority of the voting members.

2. A majority of the voting members of the Board constitutes a quorum for the transaction of business.

3. A member of the Board may not vote by proxy.

(Added to NRS by 2011, 2647; A 2015, 556)

NRS 695I.350 Subcommittees and advisory committees.

1. The Board may appoint subcommittees and advisory committees composed of members of the Board, former members of the Board and members of the general public who have experience with or knowledge of matters relating to health care to consider specific problems or other matters within the scope of the powers, duties and functions of the Board.

2. To the extent practicable, the members of such a subcommittee or advisory committee must be representative of the various geographic areas and ethnic groups of this State.

3. A member of a subcommittee or an advisory committee will not be compensated or reimbursed for travel or other expenses relating to any duties as a member of the subcommittee or advisory committee.

(Added to NRS by 2011, 2648)

NRS 695I.360 Compliance with Open Meeting Law. The Board and any subcommittee or advisory committee appointed by the Board shall comply with the provisions of chapter 241 of NRS.

(Added to NRS by 2011, 2648)

NRS 695I.370 Powers and duties of Board: Bylaws; reports; audits; regulations; contracts for services.

1. The Board shall:

(a) Adopt bylaws setting forth its procedures and governing its operations;

(b) On or before June 30 and December 31 of each year, submit a written fiscal and operational report to the Governor and the Legislature, which must include, without limitation, any recommendations concerning the Exchange;

(c) On or before December 31 of each year, prepare a report for the public summarizing the activities of the Board and the contributions of the Exchange to the health of the residents of Nevada during the previous year;

(d) Provide for an annual audit of its functions and operations;

(e) Submit all reports required by federal law to the appropriate federal agency and in a timely manner; and

(f) If the Federal Act is repealed or is held unconstitutional or otherwise invalid or unlawful, define by regulation “qualified health plan” for the purposes of this act.

2. The Board may:

(a) Adopt regulations to carry out the duties and powers of the Exchange;

(b) Prepare special reports concerning the Exchange for the Governor, the Legislature and the public; and

(c) Contract for the services of such legal, professional, technical and operational personnel and consultants as the execution of its duties and powers and the operation of the Exchange may require.

3. The Board is subject to Legislative and Executive Branch audits.

(Added to NRS by 2011, 2648)

NRS 695I.380 Appointment, classification, qualifications and duties of Executive Director; appointment, classification and removal of other employees.

1. The Board shall appoint an Executive Director of the Exchange.

2. The Executive Director:

(a) Is in the unclassified service of the State;

(b) Is responsible to the Board and serves at the pleasure of the Board;

(d) Is responsible for the administrative matters of the Board.

3. Subject to the limits of available funding, the Executive Director may, in accordance with chapter 284 of NRS, appoint and remove such employees of the Exchange as are necessary for the administration of the Exchange.

4. Employees of the Exchange appointed pursuant to subsection 3 are in either the classified or unclassified service of the State, in accordance with the historical manner of categorization.

(Added to NRS by 2011, 2648; A 2019, 1020)

NRS 695I.390 Coordination with Medicaid, Children’s Health Insurance Program and other public programs.

1. The Board and the Department of Health and Human Services shall ensure that the Exchange coordinates with Medicaid, the Children’s Health Insurance Program and any other applicable state or local public programs to create a single point of entry for users of the Exchange who are eligible for such programs and to promote continuity of coverage and care.

2. As used in this section, “Children’s Health Insurance Program” has the meaning ascribed to it in NRS 422.021.

(Added to NRS by 2011, 2649)

MISCELLANEOUS PROVISIONS

NRS 695I.500 State agencies to provide support to Exchange; intergovernmental agreements. The Department of Health and Human Services, the Division of Insurance of the Department of Business and Industry and any other relevant state agency shall work with and provide support to the Exchange as it carries out its duties and powers, including, without limitation, entering into agreements to share information and intergovernmental agreements with the Exchange.

(Added to NRS by 2011, 2649)

NRS 695I.505 Policies to meet unique needs of tradespersons: Application for federal waiver by Executive Director; requirements for offering policy on Exchange; criteria for eligibility for policy.

1. The Executive Director, in collaboration with the Director of the Department of Health and Human Services, shall apply to the Secretary of Health and Human Services for a waiver pursuant to 42 U.S.C. § 18052 to authorize an organization described in section 501(c)(5) of the Internal Revenue Code that processes health claims in this State to offer on the Exchange a policy of insurance to meet the unique needs of tradespersons, including, without limitation, persons who work temporary or seasonal jobs, that is capable of serving as an alternative to the continuation of group health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985.

2. The application for a waiver submitted pursuant to subsection 1 must include, without limitation, an application for a waiver of any provisions of federal law or regulations that would otherwise require a policy described in subsection 1 to meet the requirements of chapter 689A of NRS in order to be offered on the Exchange or for persons who purchase the plan on the Exchange to receive applicable federal subsidies.

3. To be offered on the Exchange, a policy of insurance described in subsection 1 must:

(a) Meet all requirements established by the Federal Act for a qualified health plan, to the extent that those requirements do not prevent an organization described in section 501(c)(5) of the Internal Revenue Code from offering such a policy; and

(b) Be certified by the Executive Director. Such certification must be renewed annually.

4. The Executive Director shall prescribe:

(a) Requirements for certification of a policy of insurance pursuant to paragraph (b) of subsection 3; and

(b) Criteria to determine when a person becomes eligible for a policy of insurance described in subsection 1. Those criteria must address:

(1) Persons who recently began employment but have not yet met the requirements concerning hours of work necessary to receive insurance through their employer; and

(2) Persons who have recently lost their jobs.

5. When performing the duties described in subsections 1 and 4, the Executive Director shall consult with organizations described in section 501(c)(5) of the Internal Revenue Code and other interested persons and entities concerning the requirements for certification of a policy of insurance described in subsection 1 and the criteria described in paragraph (b) of subsection 4.

(Added to NRS by 2021, 3625)

NRS 695I.510 Temporary advance from State General Fund for authorized expenses of Exchange.

1. If the Executive Director determines that the current expenses of the Exchange exceed the amount of money available because of a delay in the receipt of money from federal grants or a delay in the receipt of revenue from other sources, the Executive Director may request from the Office of Finance an advance from the State General Fund for the payment of authorized expenses.

2. If the Director of the Office of Finance approves a request made pursuant to subsection 1, he or she shall notify the State Controller and the Fiscal Analysis Division of the Legislative Counsel Bureau of the amount of advance approved.

3. Upon receiving notification pursuant to subsection 2, the State Controller shall draw his or her warrant for payment of the approved amount.

4. An advance made pursuant to this section must not exceed 25 percent of the revenue expected to be received from any source other than legislative appropriation during the fiscal year in which the request is made.

5. Any money which is advanced pursuant to this section must be repaid by the Exchange to the State General Fund not later than August 31 immediately after the end of the fiscal year during which the advance is made.

(Added to NRS by 2011, 2649)

NRS 695I.520 Construction of chapter. Nothing in this chapter, and no action taken by the Exchange pursuant to this chapter, shall be construed to preempt or supersede the authority of the Commissioner to regulate the business of insurance within this State.

(Added to NRS by 2011, 2649)