Nevada

NRS 695G.010 Definitions.

NRS 695G.012 “Adverse determination” defined.

NRS 695G.014 “Authorized representative” defined.

NRS 695G.015 “Benefits” defined.

NRS 695G.016 “Clinical peer” defined.

NRS 695G.017 “Covered person” defined.

NRS 695G.019 “Health benefit plan” defined.

NRS 695G.020 “Health care plan” defined.

NRS 695G.022 “Health care services” defined.

NRS 695G.024 “Health carrier” defined.

NRS 695G.026 “Independent review organization” defined.

NRS 695G.030 “Insured” defined.

NRS 695G.040 “Managed care” defined.

NRS 695G.050 “Managed care organization” defined.

NRS 695G.053 “Medical or scientific evidence” defined.

NRS 695G.055 “Medically necessary” defined.

NRS 695G.060 “Primary care physician” defined.

NRS 695G.070 “Provider of health care” defined.

NRS 695G.080 “Utilization review” defined.

NRS 695G.085 “Utilization review organization” defined.

NRS 695G.090 Applicability of chapter and other provisions.

NRS 695G.095 Offering policy of health insurance for purposes of establishing health savings account.

NRS 695G.100 Documents filed with Commissioner treated as public record; exception.

NRS 695G.110 Medical director required to be physician licensed in this State.

NRS 695G.120 Utilization review: Development and maintenance of written policies and procedures for use by managed care organization and subcontractors.

NRS 695G.125 Contracts with certain federally qualified health centers.

NRS 695G.127 Contracts between managed care organization and provider of health care: Managed care organization required to use form to obtain information on provider of health care; modification; submission by managed care organization of schedule of payments to provider.

NRS 695G.130 Report regarding methods for reviewing quality of health care services: Form of report; availability for public inspection.

NRS 695G.140 Certain persons in managed care organization in fiduciary relationship to insured.

NRS 695G.150 Authorization of recommended and covered health care services required.

NRS 695G.155 Managed care organization required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances.

NRS 695G.160 Written criteria concerning coverage of health care services and standards for quality of health care services.

NRS 695G.162 Required provision concerning coverage for services provided through telehealth to same extent as though provided in person or by other means; required provision concerning reimbursement for certain services provided through telehealth in same amount as though provided in person or by other means; prohibited acts; requirements for certain managed care organizations concerning teledentistry.

NRS 695G.163 Plan covering prescription drugs: Provision of notice and information regarding use of formulary.

NRS 695G.164 Required provision in certain plans concerning coverage for continued medical treatment; exceptions; regulations.

NRS 695G.166 Plan covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exceptions.

NRS 695G.167 Plan covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy.

NRS 695G.168 Required provision in plan covering treatment of colorectal cancer concerning coverage for colorectal cancer screening.

NRS 695G.170 Required provision concerning coverage for medically necessary emergency services at any hospital; prohibited acts.

NRS 695G.171 Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts.

NRS 695G.172 Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.

NRS 695G.173 Required provision concerning coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of managed care organization to require certain information; immunity from liability.

NRS 695G.174 Required provision concerning coverage for management and treatment of sickle cell disease and its variants; plan covering prescription drugs required to provide coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.

NRS 695G.175 Contracts for provision of emergency medical services, outpatient services or inpatient services with hospital or other facility that provides acute care in smaller city or county: Prohibited acts.

NRS 695G.176 Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by managed care organization if insured is person with disability.

NRS 695G.177 Required provision in plans covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited acts.

NRS 695G.180 Quality assurance program: Requirements; written description; informing providers; necessary staff; review; responsibility for activities.

NRS 695G.190 Quality improvement committee: Administration; duties.

NRS 695G.200 Establishment; approval; requirements; assistance for persons filing complaints; examination.

NRS 695G.210 Review board; appeal; right to expedited review of complaint; notice to insured.

NRS 695G.220 Annual report; managed care organization required to maintain records of and report complaints concerning something other than health care services.

NRS 695G.230 Written notice required by carrier to insured explaining rights of insureds regarding decision to deny coverage; written notice to insured when health carrier denies coverage of health care service.

NRS 695G.241 Circumstances under which adverse determination may be subject to external review; exceptions.

NRS 695G.243 Applicability.

NRS 695G.245 Written notice of right to request external review; form; contents.

NRS 695G.247 Requests for external review to be in writing; exception; form and content.

NRS 695G.251 Request for review; assignment of independent review organization; provision of documents relating to adverse determination to independent review organization.

NRS 695G.261 Review of documents by independent review organization; decision of independent review organization.

NRS 695G.271 Expedited approval or denial of request.

NRS 695G.275 Experimental or investigational health care service or treatment: Request for external review; request for expedited external review.

NRS 695G.280 Basis for decision of independent review organization.

NRS 695G.290 Decision in favor of covered person binding on health carrier; limitation of liability; cost for independent review organization.

NRS 695G.300 Submission of complaint of covered person to independent review organization.

NRS 695G.303 Independent review organization and health carrier required to maintain written records; submission of report upon request.

NRS 695G.307 Health carrier required to provide description of external review procedures; format; contents.

NRS 695G.310 Annual report; requirements.

NRS 695G.320 Provision of health care services to recipients of Medicaid or enrollees in Children’s Health Insurance Program: Requirement to contract with hospital with certain endorsement for inclusion in network of providers.

NRS 695G.325 Provision of health care services to recipients of Medicaid: Notice to recipients if Nevada Health Authority obtains waiver to provide dental care to persons with diabetes; coordination to ensure receipt of such care.

NRS 695G.330 Provision of health care services to recipients of Medicaid: Coverage for antipsychotic or anticonvulsant medication that is not on list of preferred prescription drugs required upon failure of drug on list to treat condition.

NRS 695G.340 Approval or denial; payment of claim and interest; request for additional information; award of costs and attorney’s fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certificate of authority for failure to comply; report of compliance by organization.

NRS 695G.400 Managed care organization prohibited from restricting or interfering with certain communications between provider of health care and patient.

NRS 695G.405 Managed care organization prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions.

NRS 695G.410 Managed care organization prohibited from taking certain actions against provider solely because provider advocates on behalf of patient, assists patient or reports violation of law.

NRS 695G.415 Managed care organization prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression.

NRS 695G.420 Managed care organization prohibited from offering or paying financial incentive to provider to deny, reduce, withhold, limit or delay medically necessary services.

NRS 695G.1635 Plan covering prescription drugs: Required actions by managed care organization related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared.

NRS 695G.1639 Plan covering prescription drug for treatment of medical condition that is part of step therapy protocol: Use of certain guidelines required; establishment of process to request exemption from step therapy protocol required; granting of request; applicability of provisions.

NRS 695G.1643 Required provision concerning coverage for habilitative speech-language pathology or rehabilitative speech-language pathology as treatment for stuttering for certain persons; prohibited acts.

NRS 695G.1645 Required provision in plan for group coverage concerning coverage for autism spectrum disorders for certain persons; prohibited acts.

NRS 695G.1662 Limitation on cost-sharing obligation for insulin covered under plan covering prescription insulin drugs.

NRS 695G.1665 Required provision in plan covering prescription drugs concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception.

NRS 695G.1675 Plan covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Managed care organization required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certain circumstances; procedure for applying for and granting exemption.

NRS 695G.1678 Required provision in plan covering treatment of lung cancer concerning coverage for screening for lung cancer.

NRS 695G.1702 Plan covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances.

NRS 695G.1703 Required provision concerning coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior authorization.

NRS 695G.1705 Required provision concerning coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C; reimbursement of certain providers of health care for certain services; prohibited acts.

NRS 695G.1707 Required provision concerning coverage for testing, treatment and prevention of sexually transmitted diseases; required provision concerning coverage for condoms for certain insureds.

NRS 695G.1709 Required provisions concerning coverage of certain gynecological and obstetrical services without prior authorization or referral from primary care physician; designation of obstetrician or gynecologist as primary care physician.

NRS 695G.1712 Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances.

NRS 695G.1713 Required provision concerning coverage for certain screenings and tests for breast cancer; prohibited acts.

NRS 695G.1714 Required provision concerning coverage for examination of person who is pregnant for certain diseases.

NRS 695G.1715 Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions.

NRS 695G.1716 Health care plan covering maternity care: Prohibited acts by managed care organization if insured is acting as gestational carrier; child deemed child of intended parent for purposes of plan.

NRS 695G.1717 Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts.

NRS 695G.1718 Required provision concerning coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence; restriction on refusal to cover certain treatments; authority of managed care organization to prescribe requirements for covering surgical treatments for minors; determination of medical necessity.

NRS 695G.1719 Required provision concerning coverage for certain drugs and services related to substance use disorder and opioid use disorder; reimbursement of pharmacists and pharmacies for certain services; prohibited acts.

NRS 695G.1765 Required provision concerning coverage for dental service provided by qualified dental hygienist in certain circumstances.

NRS 695G.17145 Required provision concerning coverage for noninvasive prenatal screening in certain plans.

NRS 695G.17165 Required provision concerning coverage for procedure or service for preservation of fertility in certain circumstances; exemption. [Effective January 1, 2027.]