Current through September 16, 2024
1. The Council shall consider the standards
required pursuant to section 9 of this regulation and any other requirements of
sections 2 to 18, inclusive of this regulation and may recommend additional or
alternative standards for determining whether a network plan is adequate.
2. The recommendations proposed by
the Council to the Commissioner:
(a) Must
include quantifiable metrics commonly used in the health care industry to
measure the adequacy of a network plan;
(b) Must include, without limitation,
recommendations for standards to determine the adequacy of a network plan with
regard to the number of providers of health care that:
(1) Practice in a specialty or are facilities
that appear on the Essential Community Providers/Network Adequacy Template
issued by the Centers for Medicare and Medicaid Services of the United States
Department of Health and Human Services and available at the Internet address
https://www.cms.gov/CCIIO/programs-and-initiatives/health-insurance-marketplaces/qhp.html
[File Link Not Available] free of charge, which is hereby adopted by reference;
and
(2) Are necessary to provide
the coverage required by law, including, without limitation, the provisions of
NRS
689A.0435,
689C.1655,
695C.1717
and
695G.1645;
(c) May propose standards to
determine the adequacy of a network plan with regard to types of providers of
health care other than those described in paragraph (b); and
(d) May, if a sufficient number of essential
community providers, as defined in
45 C.F.R. §
156.235(c), are available
and willing to enter into an agreement with a carrier to participate in network
plans, propose requiring a network plan to include a greater number of such
providers than the number of providers of health care of that type that a
network plan is required to include pursuant to the standards required pursuant
to section 9 of this regulation and any other requirements of sections 2 to 18,
inclusive of this regulation.
3. The Council must submit its
recommendations to the Commissioner on or before September 15 of each year. On
or before October 15 of each year, the Commissioner will determine whether to
accept any of the recommendations of the Council and take any action necessary
to issue any new requirements for determining the adequacy of a network plan.
Any such new requirements will become effective on the second January 1 next
ensuing after the adoption of the requirements.
Added to NAC
by Comm'r of Insurance by
R025-17A,
eff. 12/19/2017
NRS
679B.130,
687B.490,
as amended by section 88 of Assembly Bill No. 83, chapter 376, Statutes of
Nevada 2017, at page 2355.
