NAC695C.230. System for resolving complaints of enrollees of health maintenance organizations: Requirements for approval.

     1. To obtain approval of a system for resolving complaints of enrollees concerning health care services covered by a health maintenance organization as required pursuant to NRS 695C.260 and 695G.200, the health maintenance organization must submit to the Division:

     (a) The name and title of the employee responsible for the system;

     (b) A description of the procedure used to notify an enrollee of the decision regarding his or her complaint; and

     (c) A copy of the explanation of rights and procedures which is to be provided to an enrollee pursuant to NRS 695C.260 and 695G.230.

     2. A health maintenance organization may not delegate the responsibility for the operation of a system to resolve complaints to a delivery system intermediary.

     (Added to NAC by Comm’r of Insurance, eff. 6-11-86; A 5-27-92; R129-96, 10-29-97; R132-98, 3-30-99; R148-99, 1-27-2000)