Nevada Administrative Code
Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations
CERTIFICATES OF AUTHORITY
Section 695C.1255 - Application: Organization to establish that it has met requirements

Universal Citation: NV Admin Code 695C.1255

Current through December 12, 2024

1. An organization applying for a certificate of authority must establish that:

(a) The organization has an adequate number of providers in each category of provider of health care necessary to serve its members in each geographic location in its service area;

(b) The providers of health care with whom the organization has contracted to provide services are located so that the members may obtain health care without unreasonable travel;

(c) Nonemergency services are available and accessible during normal business hours and emergency services are available at any time;

(d) For a health maintenance organization, members can schedule appointments within a reasonable time, as determined by the State Board of Health;

(e) For a health maintenance organization, members are not required to wait for an unreasonable period of time in the office of a provider for a scheduled appointment, as determined by the State Board of Health;

(f) Members have access to their primary physician through on-call procedures after normal business hours;

(g) It requires the providers of health care with whom the organization has contracted to provide service to maintain records of the health care of its members which are accessible to other professionals within the organization;

(h) It provides a health care professional who is primarily responsible for coordinating the overall health care services offered to members;

(i) It has established a quality assurance program as required pursuant to NAC 695C.400; and

(j) The organization has established a system to collect data related to the health care services provided to members.

2. A health maintenance organization must satisfy the requirements of subsection 1 before the State Board of Health reports to the Commissioner whether the health maintenance organization meets the requirements of NRS 695C.080.

Added to NAC by Bd. of Health, eff. 11-1-95; A by Comm'r of Insurance by R148-99, 1-27-2000

NRS 439.200, 679B.130, 695C.080, 695C.275

Disclaimer: These regulations may not be the most recent version. Nevada may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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