NAC695C.530. Contract for provision of health care services.

A contract entered into by a delivery system intermediary and a provider for the provision of health care services must:

     1. Describe the responsibilities of the provider and the delivery system intermediary under the contract.

     2. Release enrollees and subscribers from liability for the cost of the health care services provided pursuant to the organization’s health care plan, except for any nominal payment made by the enrollee for a service not covered under the evidence of coverage.

     3. Require the provider to participate in a program to ensure the quality of health care provided to enrollees by the organization.

     4. Require the provider to provide to each enrollee all medically necessary services required by the evidence of coverage and the contract for the period for which a premium has been paid to the organization.

     5. Be effective for not less than 1 year, subject to any right of termination provided in the contract.

     6. Require the provider to furnish evidence of a contract of insurance against loss arising from injuries to third parties resulting from the practice of his or her profession or a reasonable substitute as determined by the organization.

     7. Require the provider to transfer or arrange for the maintenance of the records of enrollees and subscribers who are his or her patients if the provider terminates the contract with the delivery system intermediary.

     (Added to NAC by Comm’r of Insurance by R129-96, eff. 10-29-97)