Current through February 27, 2024
1. A managed care organization that
issues a health care plan shall not require an insured to pay a
higher deductible or any copayment, coinsurance or other form of
cost-sharing for or use any medical management technique to restrict
access by an insured to:
(a) A visit
to the office of a provider of health care, an urgent care center, an
independent center for emergency medical care, the emergency room of
a hospital or a COVID-19 screening or testing site, if the purpose of
the visit is to determine whether the insured has COVID-19;
(b) A test to determine whether the
insured has COVID-19 if the attending provider of health care
determines, in accordance with generally accepted medical standards,
that the test is appropriate; or
(c) A vaccine to prevent the
insured from contracting COVID-19.
2. A managed care organization that
issues a health care plan shall provide information concerning
available benefits, options for medical advice and treatment through
telehealth and preventative measures related to COVID-19 to each
insured and provider of health care that participates in the network
plan of the managed care organization.
3. A managed care organization that
issues a health care plan that provides coverage for prescription
drugs which uses a formulary shall cover a prescription drug that is
not included in the formulary at no additional cost to the insured
if:
(a) No prescription drug that is
effective in treating the insured and included in the formulary is
available; and
(b) The
prescription drug is not available because of a disruption in the
supply of those drugs.
4. As used in this section:
(a) "Hospital" has the meaning
ascribed to it in NRS 449.012.
(b) "Independent center for
emergency medical care" has the meaning ascribed to it in NRS 449.013.
(c) "Medical
management technique" means a practice which is used to control the
cost or utilization of health care services. The term includes,
without limitation, the use of step therapy, prior authorization or
categorizing drugs and devices based on cost, type or method of
administration.
(d)
"Network plan" means a health care plan offered by a managed care
organization under which the financing and delivery of medical care,
including items and services paid for as medical care, are provided,
in whole or in part, through a defined set of providers under
contract with the managed care organization. The term does not
include an arrangement for the financing of premiums.
(e) "Provider of health care" has
the meaning ascribed to it in NRS 629.031.
(f) "Telehealth" has the meaning
ascribed to it in NRS 629.515.
Added to NAC by Comm'r of Insurance by
R054-20A,
eff. 7/2/2020
NRS 414.070,
679B.120 and 679B.130