NRS 695K.240 Establishment of networks and reimbursement of providers of health care: Requirements.

413 words·~2 min read·/nv/chapter-695k-public-option/695k-240·

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

1. In establishing networks for the Public Option and reimbursing providers of health care that participate in the Public Option, the Director shall, to the extent practicable:

(a)Ensure that care for persons who were previously covered by Medicaid or the Children’s Health Insurance Program and enroll in the Public Option is minimally disrupted;

(b)Encourage the use of payment models that increase value for persons enrolled in the Public Option and the State;

(c)Improve health outcomes for persons enrolled in the Public Option;

(d)Reward providers of health care and medical facilities for delivering high-quality services; and

(e)Lower the cost of care in both urban and rural areas of this State.

2. Except as otherwise provided in subsections 3 to 6, inclusive, reimbursement rates under the Public Option must be, in the aggregate, comparable to or better than reimbursement rates available under Medicare. For the purposes of this section, the aggregate reimbursement rate under Medicare:

(a)Includes any add-on payments or other subsidies that a provider receives under Medicare; and

(b)Does not include payments under Medicare for a patient encounter or a cost-based payment rate under Medicare.

3. If a provider of health care currently receives reimbursement under Medicare at rates that are cost-based, the reimbursement rates for that provider of health care under the Public Option must be comparable to or better than the cost-based reimbursement rates provided for that provider of health care by Medicare.

4. The reimbursement rates for a federally-qualified health center or a rural health clinic under the Public Option must be comparable to or better than the reimbursement rates established for patient encounters under the applicable Prospective Payment System established for Medicare by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.

5. The reimbursement rates for a certified community behavioral health clinic under the Public Option must be comparable to or better than the reimbursement rates established for community behavioral health clinics under the State Plan for Medicaid.

6. The requirements of subsections 2 to 5, inclusive, do not apply to a payment model described in paragraph

(b)of subsection 1.

7. As used in this section, “Medicare” means the program of health insurance for aged persons and persons with disabilities established pursuant to Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq.

PUBLIC OPTION TRUST FUND