NRS 695A.265 Coverage for services provided through telehealth required to same extent as though provided in person or by other means; reimbursement for certain services provided through telehealth required in same amount as though provided in person or by other means; prohibited acts.

664 words·~3 min read·/nv/chapter-695a-fraternal-benefit-societies/695a-265·

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

1. A benefit contract must include coverage for services provided to an insured through telehealth to the same extent as though provided in person or by other means.

2. A benefit contract must provide reimbursement for services described in subsection 1 in the same amount as though provided in person or by other means:

(a)If the services:

(1)Are received at an originating site described in 42 U.S.C. § 1395m(m)(4)(C) or furnished by a federally-qualified health center or a rural health clinic; and

(2)Except for services described in paragraph (b), are not provided through audio-only interaction; or

(b)For counseling or treatment relating to a mental health condition or a substance use disorder, including, without limitation, when such counseling or treatment is provided through audio-only interaction.

3. A society shall not:

(a)Require an insured to establish a relationship in person with a provider of health care or provide any additional consent to or reason for obtaining services through telehealth as a condition to providing the coverage described in subsection 1 or the reimbursement described in subsection 2;

(b)Require a provider of health care to demonstrate that it is necessary to provide services to an insured through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to providing the coverage described in subsection 1 or the reimbursement described in subsection 2;

(c)Refuse to provide the coverage described in subsection 1 or the reimbursement described in subsection 2 because of:

(1)The distant site from which a provider of health care provides services through telehealth or the originating site at which an insured receives services through telehealth; or

(2)The technology used to provide the services;

(d)Require covered services to be provided through telehealth as a condition to providing coverage for such services; or

(e)Categorize a service provided through telehealth differently for purposes relating to coverage or reimbursement than if the service had been provided in person or through other means.

4. A benefit contract must not require an insured to obtain prior authorization for any service provided through telehealth that is not required for the service when provided in person. A benefit contract may require prior authorization for a service provided through telehealth if such prior authorization would be required if the service were provided in person or by other means.

5. The provisions of this section do not require a society to:

(a)Ensure that covered services are available to an insured through telehealth at a particular originating site;

(b)Provide coverage for a service that is not a covered service or that is not provided by a covered provider of health care; or

(c)Enter into a contract with any provider of health care or cover any service if the society is not otherwise required by law to do so.

6. A benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, has the legal effect of including the coverage required by this section, and any provision of the contract or the renewal which is in conflict with this section is void.

7. As used in this section:

(a)“Distant site” has the meaning ascribed to it in NRS 629.515 .

(b)“Federally-qualified health center” has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).

(c)“Originating site” has the meaning ascribed to it in NRS 629.515 .

(d)“Provider of health care” has the meaning ascribed to it in NRS 439.820 .

(e)“Rural health clinic” has the meaning ascribed to it in 42 U.S.C. § 1395x(aa)(2).

(f)“Telehealth” has the meaning ascribed to it in NRS 629.515 .