GENERAL PROVISIONS

NAC 695C.010. Definitions.

NAC 695C.019. “Commissioner” defined.

NAC 695C.025. “Delivery system intermediary” defined.

NAC 695C.040. “Division” defined.

NAC 695C.041. “Division of Public and Behavioral Health” defined.

NAC 695C.042. “Group practice” defined.

NAC 695C.043. “Health care services” defined.

NAC 695C.047. “Health service contract” defined.

NAC 695C.057. “Medicare + Choice plan” defined.

NAC 695C.060. “Organization” defined.

NAC 695C.065. “Preexisting condition” defined.

NAC 695C.070. “Primary physician” defined.

NAC 695C.075. “Provider-sponsored organization” defined.

NAC 695C.080. “Subscriber” defined.

NAC 695C.090. “Uncovered expenditures” defined.

NAC 695C.095. Certain provisions of NRS not applicable to provider-sponsored organizations.

NAC 695C.100. Applicability of certain provisions of NRS to provider-sponsored organizations.

NAC 695C.105. Treatment of applications, filings and reports as public documents.

CERTIFICATES OF AUTHORITY

NAC 695C.111. Provider-sponsored organization: Certificate required to offer Medicare + Choice plan.

NAC 695C.115. Application of provider-sponsored organization.

NAC 695C.120. Application: Required documents.

NAC 695C.121. Application: Submission; incomplete application deemed withdrawn; notice of review; deadline.

NAC 695C.122. Application: Member of insurance holding company system.

NAC 695C.1225. Provider-sponsored organization: Transmittal of information to State Board of Health; conditions for issuance of certificate.

NAC 695C.123. Federal qualification: Information required.

NAC 695C.124. Application: Public inspection; notice of hearing.

NAC 695C.125. Application of health maintenance organization: Evaluation by Division of Public and Behavioral Health.

NAC 695C.1255. Application: Organization to establish that it has met requirements.

NAC 695C.126. Application of health maintenance organization: Effect of change after review.

NAC 695C.127. Licensure in another state: Application for this State; copy of license; notice of disciplinary action.

NAC 695C.128. Licensure in another state: Contract with providers of medical care in state contiguous to Nevada; plan for operation.

NAC 695C.1282. Provider-sponsored organization: Denial of certificate.

NAC 695C.1284. Provider-sponsored organization: Grounds for suspension or revocation of certificate; effect of revocation.

NAC 695C.1286. Provider-sponsored organization: Notice of hearing; action by Commissioner; judicial review.

NAC 695C.1288. Provider-sponsored organization: Penalties and remedies for violations; cease and desist order; request for hearing; injunctive relief.

NAC 695C.129. Hearings and proceedings.

FINANCIAL REQUIREMENTS; INSURANCE

NAC 695C.130. Health maintenance organization: Financial requirements; modification to approved plan of operations.

NAC 695C.135. Contract of insurance for health maintenance organization: Amount required; provision concerning insolvency of organization; notice of cancellation.

NAC 695C.136. Contract of insurance for provider-sponsored organization: Amount determined by Commissioner; provision concerning insolvency of organization; notice of cancellation.

NAC 695C.137. Health maintenance organization: Reserves.

SALE OF HEALTH CARE PLANS

NAC 695C.140. Advertising and solicitation.

NAC 695C.150. Qualifications of agent or broker.

SERVICES AND BENEFITS

NAC 695C.160. Geographic area of service: Definition.

NAC 695C.165. Geographic area of service: Expansion.

NAC 695C.170. Health maintenance organization: Required services; optional plans.

NAC 695C.180. Coordination of benefits; lien against recovery from third person.

NAC 695C.185. Benefits payable by more than one insurer to provider; restrictions.

PROVIDERS OF MEDICAL CARE

NAC 695C.190. Requirements for agreement between provider and organization.

NAC 695C.195. Per capita payments.

NAC 695C.200. List of providers: Submission; changes; extension of submission date; excessive reduction.

NAC 695C.205. Restriction of choice of primary physician or other provider.

NAC 695C.215. Cost sharing.

ADMINISTRATION OF ORGANIZATION

NAC 695C.217. Approval of contract for marketing, enrollment, administration or health care services; effect of agreement.

NAC 695C.220. Enrollment, cancellation and termination.

NAC 695C.230. System for resolving complaints of enrollees of health maintenance organizations: Requirements for approval.

NAC 695C.235. System for resolving complaints of enrollees of health maintenance organizations: Annual report.

NAC 695C.240. Health maintenance organization: Joint board on consumer satisfaction.

NAC 695C.250. Records: Segregation from records of related corporation.

NAC 695C.260. Records: Retention.

NAC 695C.270. Reports and financial statements.

NAC 695C.275. Quality and performance indicators to be included in report of health maintenance organization.

NAC 695C.285. Limitation on frequency of increases in premium rates; exceptions.

NAC 695C.290. Filing, contents and delivery of disclosure summarizing coverage by health maintenance organization.

NAC 695C.295. Disclosures in advertising and sales materials; inclusion of certain information in health care plan.

EXAMINATIONS

NAC 695C.300. Requirements for conducting examination.

NAC 695C.310. Health maintenance organization: Review of examination of organization required; approved examiners; organization to cooperate during examination.

NAC 695C.320. Health maintenance organization: Division of Public and Behavioral Health to notify organization of its findings; objections to findings; dispute resolution; distribution of proposed findings.

NAC 695C.325. Provider-sponsored organization: Frequency of examinations; submission of records; acceptance of alternate report.

NAC 695C.330. Provider-sponsored organization: Determination of financial condition.

NAC 695C.335. Provider-sponsored organization: Procedure; appointment of examiner; maintenance and use of records.

NAC 695C.340. Provider-sponsored organization: Payment of expenses.

NAC 695C.345. Provider-sponsored organization: Statutory procedures required for examination and hearing.

MISCELLANEOUS PROVISIONS FOR PROVIDER-SPONSORED ORGANIZATIONS

NAC 695C.350. Notice and approval required for modification of operations.

NAC 695C.355. Accounting principles required for certain reports and transactions.

NAC 695C.360. Annual report of financial condition and financial statement; administrative penalty for failure to file report or statement; request for extension.

NAC 695C.365. Fees.

NAC 695C.370. Availability of information for inspection.

NAC 695C.375. Prohibited practices.

NAC 695C.380. Rehabilitation, liquidation or conservation.

QUALITY ASSURANCE PROGRAM

NAC 695C.400. Requirements; written description of action plan; staff; periodic review of program.

NAC 695C.410. Quality assurance committee: Appointment of members; staff; duties.

NAC 695C.420. System for collection and maintenance of information related to health care services.

NAC 695C.430. Written guidelines for remedial action; final determinations regarding quality of care.

DELIVERY SYSTEM INTERMEDIARY

NAC 695C.500. Compliance with statutory provisions.

NAC 695C.505. Required provisions of health service contracts.

NAC 695C.510. Health service contract to be filed with Commissioner; certain documentation to be included in contract.

NAC 695C.515. Commissioner may order cancellation or renegotiation of health service contract under certain circumstances.

NAC 695C.520. Conditions for paying claims or acting as agent for utilization review.

NAC 695C.525. Provision of health care services.

NAC 695C.530. Contract for provision of health care services.

NAC 695C.535. Organization prohibited from requiring provision of health care services for which delivery system intermediary has not contracted except under certain circumstances.

NAC 695C.540. Contract for evaluation of credentials of providers.

NAC 695C.545. Commissioner to have access to books and records.

NAC 695C.550. Prohibited acts.