Nevada Administrative Code
Chapter 687B - Contracts of Insurance
ADEQUACY OF NETWORK PLANS
Section 687B.768 - Adoption by reference of standards for determining adequacy
Current through February 27, 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:
Specialty Area |
Maximum Time or Distance Standards (Minutes/Miles) |
|||
Metro |
Micro |
Rural |
Counties with Extreme Access Considerations (CEAC) |
|
Primary Care |
15/10 |
30/20 |
40/30 |
70/60 |
Endocrinology |
60/40 |
100/75 |
110/90 |
145/130 |
Infectious Diseases |
60/40 |
100/75 |
110/90 |
145/130 |
Oncology - Medical/Surgery |
45/30 |
60/45 |
75/60 |
110/100 |
Oncology - Radiation/Radiology |
60/40 |
100/75 |
110/90 |
145/130 |
Psychiatrist |
45/30 |
60/45 |
75/60 |
110/100 |
Psychologist |
45/30 |
60/45 |
75/60 |
110/100 |
Licensed Clinical Social Workers (LCSW) |
45/30 |
60/45 |
75/60 |
110/100 |
Pediatrics |
25/15 |
30/20 |
40/30 |
105/90 |
Rheumatology |
60/40 |
100/75 |
110/90 |
145/130 |
Hospitals |
45/30 |
80/60 |
75/60 |
110/100 |
Outpatient Dialysis |
45/30 |
80/60 |
90/75 |
125/110 |
Specialty Area |
Maximum Time or Distance Standards (Minutes/Miles) |
|||
Metro |
Micro |
Rural |
Counties with Extreme Access Considerations (CEAC) |
|
General Dentist |
45/45 |
60/60 |
120/100 |
120/100 |
Periodontist |
45/45 |
60/60 |
120/100 |
120/100 |
Oral Surgeon |
45/45 |
60/60 |
120/100 |
120/100 |
Orthodontist |
45/45 |
60/60 |
120/100 |
120/100 |
Major ECP Category |
ECP Provider Types |
Family Planning Providers |
Title X Family Planning Clinics and Title X "Look-Alike" Family Planning Clinics |
Federally Qualified Health Centers (FQHCs) |
Federally Qualified Health Centers and Federally Qualified Health Center "Look Alike" Clinics, Outpatient health programs/facilities operated by Indian tribes, tribal organizations, programs operated by Urban Indian Organizations |
Hospitals |
Disproportionate Share Hospitals (DSH) and DSH-eligible Hospitals, Children's Hospitals, Rural Referral Centers, Sole Community Hospital, Freestanding Cancer Centers, Critical Access Hospitals |
Indian Health Care Providers |
Indian Health Service providers, Indian Tribes, Tribal organizations, and urban Indian Organizations |
Ryan White Providers |
Ryan White HIV/AIDS Program Providers |
Other ECP Providers |
STD Clinics, TB Clinics, Hemophilia Treatment Centers, Black Lung Clinics, Community Mental Health Centers, Rural Health Clinics, and other entities that serve predominantly low-income, medically underserved individuals |
2. To offer a contract in good faith pursuant to paragraph (c) of subsection 1, a network plan must offer contract terms comparable to the terms that a carrier or other person or entity which issues a network plan would offer to a similarly situated provider which is not an essential community provider, except for terms that would not be applicable to an essential community provider, including, without limitation, because of the type of services that an essential community provider provides. A network plan must be able to provide verification of such offers if the Commissioner requests to verify compliance with this policy.
3. For the purposes of this section, the area designations for the maximum time or distance standards are based upon the population size and density parameters of individual counties within the plan's service area. The population and density parameters applied to determine county type designations are listed in the following table:
County Type |
Population |
Density |
Metro |
[GREATER THAN OR EQUAL TO] 1,000,000 |
10 - 999.9/mi2 |
500,000 - 999,999 |
10 - 1,499.9/mi2 |
|
200,000 - 499,999 |
10 - 4,999.9/mi2 |
|
50,000 - 199,999 |
100 - 4,999.9/mi2 |
|
10,000 - 49,999 |
1,000 - 4,999.9/mi2 |
|
Micro |
50,000 - 199,999 |
10 - 49.9/mi2 |
10,000 - 49,999 |
50 - 999.9/mi2 |
|
Rural |
10,000 - 49,999 |
10 - 49.9/mi2 |
< 10,000 |
10 - 4,999.9/mi2 |
|
Counties with Extreme Access Considerations or CEAC |
Any |
< 10/mi2 |
4. As used in this section:
Added to NAC by Comm'r of Insurance, by R049-14, eff. 4/4/2016; A by R002-18A, eff. 4/30/2018; A by R002-18AP, eff. 1/1/2019; A by R067-19A, eff. 12/17/2019; A by R024-23A, eff. 1/5/2024
NRS 679B.130, 687B.490