695G.175 - Certain actions of managed care organization prohibited. - Nevada Statutes

695G.175  Certain actions of managed care organization prohibited.

      1.  If a managed care organization contracts for the provision of emergency medical services, outpatient services or inpatient services with a hospital or other licensed health care facility that provides acute care and is located in a city whose population is less than 60,000 or a county whose population is less than 100,000, the managed care organization shall not:

      (a) Prohibit an insured from receiving services covered by the health care plan of the insured at that hospital or licensed health care facility if the services are provided by a provider of health care with whom the managed care organization has contracted for the provision of the services;

      (b) Refuse to provide coverage for services covered by the health care plan of an insured that are provided to the insured at that hospital or licensed health care facility if the services were provided by a provider of health care with whom the managed care organization has contracted for the provision of the services;

      (c) Refuse to pay a provider of health care with whom the managed care organization has contracted for the provision of services for providing services to an insured at that hospital or licensed health care facility if the services are covered by the health care plan of the insured;

      (d) Discourage a provider of health care with whom the managed care organization has contracted for the provision of services from providing services to an insured at that hospital or licensed health care facility that are covered by the health care plan of the insured; or

      (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care:

             (1) To provide services to an insured that are covered by the health care plan of the insured at another hospital or licensed health care facility; or

             (2) Not to provide services to an insured at that hospital or licensed health care facility that are covered by the health care plan of the insured.

      2.  Nothing in this section prohibits a managed care organization from informing an insured that enhanced health care services are available at a hospital or licensed health care facility other than the hospital or licensed health care facility described in subsection 1 with which the managed care organization contracts for the provision of emergency medical services, outpatient services or inpatient services.

      (Added to NRS by 1999, 1945; A 2001, 1998)