Nevada Administrative Code
Chapter 679B - Commissioner of Insurance
Section 679B.Sec. 9 - NEW

Universal Citation: NV Admin Code 679B.Sec. 9

Current through September 16, 2024

1. In order for the Commissioner to determine that a network plan made available for sale in this State is adequate, the network plan must contain, at a minimum:

(a) The standards contained in the most recent Letter to Issuers in the Federally-facilitated Marketplaces issued by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. A copy of the letter may be obtained free of charge at the Internet address https://www.cms.gov/CCIIO/resources/regulations-and-guidance/ [File Link Not Available].

(b) Evidence that the network plan provides reasonable access to at least one provider in the specialty area listed in the following table for at least 90 percent of enrollees by complying with the area designations for the maximum time and distance standards in the following table:

Specialty Area

Maximum Time and Distance Standards (Minutes/Miles)

Metro

Micro

Rural

Counties with Extreme Access Considerations (CEAC)

Pediatrics

25/15

30/20

40/30

105/90

2. If the area designations for the maximum time and distance standards required pursuant to paragraph (b) of subsection 1 are changed by the most recent Letter to Issuers in the Federally-facilitated Marketplaces, the Commissioner will post on the Internet website maintained by the Division notice of such changes.

3. Upon the issuance of a new Letter to Issuers in the Federally-facilitated Marketplaces, the Commissioner will determine whether the requirements of sections 2 to 18, inclusive, including, without limitation, the standards required pursuant to subsection 1, conform with any similar standards prescribed in the new Letter to Issuers in the Federally-facilitated Marketplaces. If the Commissioner determines that the requirements of sections 2 to 18, inclusive of this regulation do not conform with any similar standards prescribed in the new Letter to Issuers in the Federally-facilitated Marketplaces, the Commissioner will hold a public hearing concerning possible amendments to sections 2 to 18, inclusive of this regulation and give notice of that hearing in accordance with NRS 233B.060.

4. As used in this section, "maximum time and distance standards" has the meaning ascribed to it in the most recent Letter to Issuers in the Federally-facilitated Marketplaces.

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.

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