Nevada AB 355: Revises provisions relating to the adequacy of health care services offered by a network plan. (BDR 57-1118)

Bill Text

A.B. 355
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ASSEMBLY BILL NO. 355–ASSEMBLYWOMAN NEAL

MARCH 20, 2017
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Referred to Committee on Health and Human Services

SUMMARY—Revises provisions relating to the adequacy of health
care services offered by a network plan.
(BDR 57-1118)

FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Yes.

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

AN ACT relating to health insurance; requiring a network plan to
include access to certain facilities; and providing other
matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires a carrier that offers coverage for health care in the group 1
or individual market to demonstrate the capacity of a network plan to deliver 2
services adequately before offering the plan for sale in this State. (NRS 687B.490) 3
For a network plan to be determined to be adequate by the Commissioner of 4
Insurance, this bill requires the network plan to include a number of facilities or 5
providers of health care determined by the Commissioner which: (1) provide 6
behavioral and mental health and related medical services primarily to vulnerable 7
persons; (2) are satisfactorily managed by a board of directors, as determined by the 8
Commissioner; and (3) have programs of internal controls and compliance which 9
are satisfactory, as determined by the Commissioner. This bill prohibits such a 10
facility or provider of health care from being required by a carrier to obtain 11
authorization before treating a patient that the facility or provider determines should 12
receive acute care or from being paid at a lower rate under the State Plan for 13
Medicaid than a comparable facility or provider which has not met these 14
requirements. This bill also allows such a facility or provider of health care to apply 15
for and receive certain federal, state or local grants and to solicit and receive gifts, 16
grants and donations. 17

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THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. Chapter 687B of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. Before allowing the issuance of a network plan to a carrier 3
that offers coverage in the group or individual market pursuant to 4
NRS 687B.490, the Commissioner shall determine the appropriate 5
number of facilities or providers of health care registered with the 6
Commissioner pursuant to subsection 2 which the network plan 7
must include to adequately deliver health care services. 8
2. The Commissioner shall register a facility or provider of 9
health care which: 10
(a) Provides behavioral and mental health services and related 11
medical services primarily to vulnerable persons, including, 12
without limitation, persons from communities that are 13
underserved by or lack access to health care, persons of limited 14
financial means, persons who are part of transient or migrant 15
populations, persons who do not have health insurance or persons 16
who are not legally present in the United States; 17
(b) Is managed by a board of directors in a manner which is 18
determined to be satisfactory by the Commissioner; and 19
(c) Has a program of internal controls and compliance which 20
is determined to be satisfactory by the Commissioner. 21
3. A facility or provider of health care which is registered 22
with the Commissioner pursuant to subsection 2: 23
(a) Must not be required by a carrier to obtain prior 24
authorization before treating a patient who meets the criteria to 25
receive acute care, as determined by the facility or provider of 26
health care; 27
(b) Must not be paid at a lower rate pursuant to the State Plan 28
for Medicaid than a comparable facility or provider of health care 29
which is not registered with the Commissioner pursuant to 30
subsection 2; and 31
(c) May apply for and receive grants from a federal or state 32
agency or local government for community health enrichment, 33
quality assurance or related purposes and may solicit and receive 34
gifts, grants and donations to provide health care services. 35
4. As used in this section, “network plan” has the meaning 36
ascribed to it in NRS 689B.570. 37
Sec. 2. NRS 687B.490 is hereby amended to read as follows: 38
687B.490 1. A carrier that offers coverage in the group or 39
individual market must, before making any network plan available 40
for sale in this State, demonstrate the capacity to deliver services 41
adequately by applying to the Commissioner for the issuance of a 42

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network plan and submitting a description of the procedures and 1
programs to be implemented to meet the requirements described in 2
subsection 2. 3
2. The Commissioner shall determine, within 90 days after 4
receipt of the application required pursuant to subsection 1, if the 5
carrier, with respect to the network plan: 6
(a) Has demonstrated the willingness and abil