GENERAL PROVISIONS

NRS 695G.010. Definitions.

NRS 695G.012. “Adverse determination” defined.

NRS 695G.014. “Authorized representative” defined.

NRS 695G.015. “Benefits” defined.

NRS 695G.016. “Clinical peer” defined.

NRS 695G.017. “Covered person” defined.

NRS 695G.019. “Health benefit plan” defined.

NRS 695G.020. “Health care plan” defined.

NRS 695G.022. “Health care services” defined.

NRS 695G.024. “Health carrier” defined.

NRS 695G.026. “Independent review organization” defined.

NRS 695G.030. “Insured” defined.

NRS 695G.040. “Managed care” defined.

NRS 695G.050. “Managed care organization” defined.

NRS 695G.053. “Medical or scientific evidence” defined.

NRS 695G.055. “Medically necessary” defined.

NRS 695G.060. “Primary care physician” defined.

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

NRS 695G.080. “Utilization review” defined.

NRS 695G.085. “Utilization review organization” defined.

NRS 695G.090. Applicability.

NRS 695G.095. Offering policy of health insurance for purposes of establishing health savings account.

NRS 695G.100. Documents treated as public record.

ADMINISTRATION OF MANAGED CARE ORGANIZATIONS

NRS 695G.110. Medical director must be physician licensed in this State.

NRS 695G.120. Utilization review: Written policies and procedures; subcontracting.

NRS 695G.125. Contracts with certain federally qualified health centers.

NRS 695G.130. Report regarding methods for reviewing quality of health care services: Requirements; availability for public inspection. [Effective through December 31, 2013.]

NRS 695G.130. Report regarding methods for reviewing quality of health care services: Requirements; availability for public inspection. [Effective January 1, 2014.]

NRS 695G.140. Responsibility for money in fiduciary relationship to insured.

COVERAGE BY MANAGED CARE ORGANIZATIONS

NRS 695G.150. Authorization of recommended and covered health care services required.

NRS 695G.160. Written criteria concerning coverage of health care services and standards for quality of health care services.

NRS 695G.163. Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

NRS 695G.164. Required provision concerning coverage for continued medical treatment.

NRS 695G.1645. Required provision concerning coverage for autism spectrum disorders.

NRS 695G.166. Required provision concerning coverage for prescription drug previously approved for medical condition of insured.

NRS 695G.167. Required provision concerning coverage for orally administered chemotherapy.

NRS 695G.168. Required provision concerning coverage for screening for colorectal cancer.

NRS 695G.170. Required provision concerning coverage for medically necessary emergency services; prohibitions.

NRS 695G.171. Required provision concerning coverage for human papillomavirus vaccine. [Effective through December 31, 2013.]

NRS 695G.171. Required provision concerning coverage for human papillomavirus vaccine. [Effective January 1, 2014.]

NRS 695G.173. Required provision concerning coverage for treatment received as part of clinical trial or study. [Effective through December 31, 2013.]

NRS 695G.173. Required provision concerning coverage for treatment received as part of clinical trial or study. [Effective January 1, 2014.]

NRS 695G.175. Certain actions of managed care organization prohibited.

NRS 695G.177. Required provision concerning coverage for prostate cancer screening.

QUALITY ASSURANCE PROGRAM

NRS 695G.180. Quality assurance program: Requirements; written description; informing providers; necessary staff; review; responsibility for activities.

NRS 695G.190. Quality improvement committee: Administration; duties.

SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS

NRS 695G.200. Approval; requirements; assistance for persons filing complaints; examination. [Effective through December 31, 2013.]

NRS 695G.200. Approval; requirements; assistance for persons filing complaints; examination. [Effective January 1, 2014.]

NRS 695G.210. Review board; appeal; right to expedited review of complaint; notice to insured.

NRS 695G.220. Annual report; managed care organization to maintain records of complaints concerning something other than health care services. [Effective through December 31, 2013.]

NRS 695G.220. Annual report; managed care organization to maintain records of complaints concerning something other than health care services. [Effective January 1, 2014.]

NRS 695G.230. Written notice to insured explaining rights of insureds regarding decision to deny coverage; notice to insured when health carrier denies coverage of health care service.

EXTERNAL REVIEW OF ADVERSE DETERMINATION

NRS 695G.241. External review of adverse determination.

NRS 695G.243. Applicability.

NRS 695G.245. Written notice of right to request external review; form; contents.

NRS 695G.247. Requests for external review to be in writing; exception; form and content.

NRS 695G.251. Request for review; assignment of independent review organization; provision of documents relating to adverse determination to independent review organization.

NRS 695G.261. Review of documents by independent review organization; decision of independent review organization.

NRS 695G.271. Expedited approval or denial of request.

NRS 695G.275. Experimental or investigational health care service or treatment: Request for external review; request for expedited external review.

NRS 695G.280. Basis for decision of independent review organization.

NRS 695G.290. Decision in favor of covered person binding on health carrier; limitation of liability; cost for independent review organization.

NRS 695G.300. Submission of complaint of covered person to independent review organization.

NRS 695G.303. Independent review organization and health carrier to maintain written records; submission of report upon request.

NRS 695G.307. Health carrier to provide description of external review procedures; format; contents.

NRS 695G.310. Annual report; requirements.

PROHIBITED ACTS

NRS 695G.400. Managed care organization prohibited from interfering in or restricting certain communications.

NRS 695G.405. Managed care organization prohibited from denying coverage solely because insured was intoxicated or under the influence of controlled substance; exceptions.

NRS 695G.410. Certain actions taken against provider solely because provider advocates on behalf of patient, assists patient or reports violation of law prohibited.

NRS 695G.420. Offering or paying financial incentive to provider to deny, reduce, withhold, limit or delay medically necessary services prohibited.

NRS 695G.430. Contracts between managed care organization and provider of health care: Form for obtaining information on provider of health care; modification; schedule of fees.