reglab/housing_qa huggingface dataset:
NV Rev Stat § 695G.014 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.014 - "Authorized representative" defined.

Authorized representative means:  1. A person to whom a covered person has given express written consent to represent the covered person in an external review of an adverse determination conducted pursuant to NRS 695G.241 to 695G.310, inclusive;  2. A person authorized by law to provide substituted consent for a covered person; or  3. A family member of a covered person or the covered person’s treating provider only when the covered person is unable to provide consent.  (Added to NRS by 2003, 779; A 2011, 3410)
NV Rev Stat § 695G.015 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.015 - "Benefits" defined.

Benefits means those health care services to which a covered person is entitled under the terms of a health benefit plan.  (Added to NRS by 2011, 3398)
NV Rev Stat § 695G.016 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.016 - "Clinical peer" defined.

Clinical peer means a physician who is:  1. Engaged in the practice of medicine; and  2. Certified or is eligible for certification by a member board of the American Board of Medical Specialties in the same or similar area of practice as is the health care service that is the subject of a final adverse determination.  (Added to NRS by 2003, 779)
NV Rev Stat § 695G.017 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.017 - "Covered person" defined.

Covered person means a policyholder, subscriber, enrollee or other person participating in a health benefit plan.  (Added to NRS by 2011, 3398)
NV Rev Stat § 695G.019 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.019 - "Health benefit plan" defined.

Health benefit plan means a policy, contract, certificate or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.  (Added to NRS by 2011, 3398)
NV Rev Stat § 695G.020 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.020 - "Health care plan" defined.

Health care plan means a policy, contract, certificate or agreement offered or issued by a managed care organization to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.  (Added to NRS by 1997, 301)
NV Rev Stat § 695G.022 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.022 - "Health care services" defined.

Health care services means services for the diagnosis, prevention, treatment, care or relief of a health condition, illness, injury or disease.  (Added to NRS by 2011, 3398)
NV Rev Stat § 695G.024 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.024 - "Health carrier" defined.

Health carrier means an entity subject to the insurance laws and regulations of this State, or subject to the jurisdiction of the Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services, including, without limitation, a sickness and accident health insurance company, a health maintenance organization, a nonprofit hospital and health service corporation or any other entity providing a plan of health insurance, health benefits or health care services.  (Added to NRS by 2011, 3398)
NV Rev Stat § 695G.026 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.026 - "Independent review organization" defined.

Independent review organization means an entity that:  1. Conducts an independent external review of an adverse determination; and  2. Is certified by the Commissioner in accordance with NRS 683A.3715 and 683A.372.  (Added to NRS by 2003, 779; A 2011, 3410)
NV Rev Stat § 695G.030 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.030 - "Insured" defined.

Insured means a person who receives benefits under a health care plan.  (Added to NRS by 1997, 301)
NV Rev Stat § 695G.040 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.040 - "Managed care" defined.

Managed care means a system for delivering health care services that encourages the efficient use of health care services by using employed or independently contracted providers of health care and by using various techniques which may include, without limitation:  1. Managing the health care services of an insured who has a serious, complicated, protracted or other health-related condition that requires the use of numerous providers of health care or other costly services;  2. Providing utilization review;  3. Offering financial incentives for the effective use of health care services; or  4. Any combination of those techniques.  (Added to NRS by 1997, 301)
NV Rev Stat § 695G.050 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.050 - "Managed care organization" defined.

Managed care organization means any insurer or organization authorized pursuant to this title to conduct business in this State that provides or arranges for the provision of health care services through managed care.  (Added to NRS by 1997, 302)
NV Rev Stat § 695G.053 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.053 - "Medical or scientific evidence" defined.

Medical or scientific evidence means evidence found in the following sources:  1. Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff;  2. Peer-reviewed medical literature, including literature relating to therapies reviewed and approved by a qualified institutional review board, biomedical compendia and other medical literature that meet the criteria of the National Library of Medicine of the National Institutes of Health for indexing in Index Medicus (MEDLINE) and Elsevier for indexing in Excerpta Medica (EMBASE);  3. Medical journals recognized by the Secretary of Health and Human Services pursuant to section 1861(t)(2) of the Social Security Act, 42 U.S.C. § 1395x;  4. The following standard reference compendia:  (a) AHFS Drug Information published by the American Society of Health-System Pharmacists;  (b) Drug Facts and Comparisons published by Wolter Kluwers Health;  (c) Accepted Dental Therapeutics published by the American Dental Association; and  (d) The United States Pharmacopoeia’s Drug Quality and Information Program;  5. Findings, studies or research conducted by or under the auspices of the Federal Government and nationally recognized federal research institutes, including, without limitation:  (a) The Agency for Healthcare Research and Quality;  (b) The National Institutes of Health;  (c) The National Cancer Institute;  (d) The National Academy of Sciences of the National Academies;  (e) The Centers for Medicare and Medicaid Services;  (f) The Food and Drug Administration; and  (g) Any national board recognized by the National Institutes of Health for the purpose of evaluating the medical value of health care services; or  6. Any other source of medical or scientific evidence that is comparable to the sources listed in subsections 1 to 5, inclusive.  (Added to NRS by 2011, 3398)
NV Rev Stat § 695G.055 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.055 - "Medically necessary" defined.

Medically necessary means health care services or products that a prudent physician would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:  1. Provided in accordance with generally accepted standards of medical practice;  2. Clinically appropriate with regard to type, frequency, extent, location and duration;  3. Not primarily provided for the convenience of the patient, physician or other provider of health care;  4. Required to improve a specific health condition of an insured or to preserve the existing state of health of the insured; and  5. The most clinically appropriate level of health care that may be safely provided to the insured.  (Added to NRS by 2003, 779)
NV Rev Stat § 695G.060 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.060 - "Primary care physician" defined.

Primary care physician means a physician or group of physicians who:  1. Provides initial and primary health care services to an insured;  2. Maintains the continuity of care for the insured; and  3. May refer the insured to a specialized provider of health care.  (Added to NRS by 1997, 302)
NV Rev Stat § 695G.070 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.070 - "Provider of health care" defined.

Provider of health care means:  1. A physician or other health care practitioner who is licensed or otherwise authorized in this State to furnish any health care service; and  2. An institution providing health care services or other setting in which health care services are provided, including, without limitation, a hospital, surgical center for ambulatory patients, facility for skilled nursing, residential facility for groups, laboratory and any other such licensed facility.  (Added to NRS by 1997, 302; A 2011, 3411)
NV Rev Stat § 695G.080 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.080 - "Utilization review" defined.

  1. "Utilization review" means the various methods that may be used to review the amount and appropriateness of the provision of a specific health care service.  2. The term does not include an external review of an adverse determination conducted pursuant to NRS 695G.241 to 695G.310, inclusive.  (Added to NRS by 1997, 302; A 2003, 783; 2011, 3411)
NV Rev Stat § 695G.085 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.085 - "Utilization review organization" defined.

Utilization review organization means an entity designated by a health carrier to conduct utilization reviews.  (Added to NRS by 2011, 3399)
NV Rev Stat § 695G.090 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.090 - Applicability.

  1. Except as otherwise provided in subsection 3, the provisions of this chapter apply to each organization and insurer that operates as a managed care organization and may include, without limitation, an insurer that issues a policy of health insurance, an insurer that issues a policy of individual or group health insurance, a carrier serving small employers, a fraternal benefit society, a hospital or medical service corporation and a health maintenance organization.  2. In addition to the provisions of this chapter, each managed care organization shall comply with:  (a) The provisions of chapter 686A of NRS, including all obligations and remedies set forth therein; and  (b) Any other applicable provision of this title.  3. The provisions of NRS 695G.164, 695G.1645, 695G.167, 695G.200 to 695G.230, inclusive, and 695G.430 do not apply to a managed care organization that provides health care services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services. This subsection does not exempt a managed care organization from any provision of this chapter for services provided pursuant to any other contract.  (Added to NRS by 1997, 302; A 2003, 783, 3371; 2009, 1477; 2013, 2001)
NV Rev Stat § 695G.095 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.095 - Offering policy of health insurance for purposes of establishing health savings account.

A managed care organization may, subject to regulation by the Commissioner, offer a policy of health insurance that has a high deductible and is in compliance with 26 U.S.C. § 223 for the purposes of establishing a health savings account.  (Added to NRS by 2005, 2159)
NV Rev Stat § 695G.100 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.100 - Documents treated as public record.

Any document required to be filed with the Commissioner pursuant to this chapter, other than medical records and other information relating to a specific insured, must be treated as a public record.  (Added to NRS by 1997, 307)
NV Rev Stat § 695G.110 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.110 - Medical director must be physician licensed in this State.

Each managed care organization shall employ or contract with a physician who is licensed to practice medicine in the State of Nevada pursuant to chapter 630 or 633 of NRS to serve as its medical director.  (Added to NRS by 1997, 305; A 2003, 1181)
NV Rev Stat § 695G.120 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.120 - Utilization review: Written policies and procedures; subcontracting.

Each managed care organization shall:  1. Develop and maintain written policies and procedures setting forth the manner in which it conducts utilization review; and  2. Require any person with whom it subcontracts to provide utilization review to use the same policies and procedures developed pursuant to subsection 1.  (Added to NRS by 1997, 303)
NV Rev Stat § 695G.125 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.125 - Contracts with certain federally qualified health centers.

  1. A managed care organization that delivers health care services by using independently contracted providers of health care shall use its best efforts to contract with at least one health center in each geographic area served by the organization to provide such services to insureds if the health center:  (a) Meets all conditions imposed by the organization on similarly situated providers of health care that are under contract with the organization, including, without limitation:  (1) Certification for participation in the Medicaid or Medicare program; and  (2) Requirements relating to the appropriate credentials for providers of health care; and  (b) Agrees to reasonable reimbursement rates that are generally consistent with those offered by the organization to similarly situated providers of health care that are under contract with the organization.  2. As used in this section, "health center" has the meaning ascribed to it in 42 U.S.C. § 254b.  (Added to NRS by 2001, 1925)
NV Rev Stat § 695G.130 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.130 - Report regarding methods for reviewing quality of health care services: Form of report; availability for public inspection.

  1. In addition to any other report which is required to be filed with the Commissioner, each managed care organization shall file with the Commissioner, with its annual filing made pursuant to NRS 686B.070 of forms and rates relating to policies of insurance for individuals and small employer groups, a report regarding its methods for reviewing the quality of health care services provided to its insureds. The report must be submitted on a form prescribed by the Commissioner.  2. A report filed pursuant to this section must be made available for public inspection within a reasonable time after it is received by the Commissioner.  3. As used in this section, "small employer" has the meaning ascribed to it in NRS 689C.095.  (Added to NRS by 1997, 305; A 1997, 3041; 2013, 3650; 2017, 2401)
NV Rev Stat § 695G.140 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.140 - Responsibility for money in fiduciary relationship to insured.

Any person who receives, collects, disburses or invests money for a managed care organization is responsible for such money in a fiduciary relationship to the insured.  (Added to NRS by 1997, 305)
NV Rev Stat § 695G.150 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.150 - Authorization of recommended and covered health care services required.

Each managed care organization shall authorize coverage of a health care service that has been recommended for the insured by a provider of health care acting within the scope of his or her practice if that service is covered by the health care plan of the insured, unless:  1. The decision not to authorize coverage is made by a physician who:  (a) Is licensed to practice medicine in the State of Nevada pursuant to chapter 630 or 633 of NRS;  (b) Possesses the education, training and expertise to evaluate the medical condition of the insured; and  (c) Has reviewed the available medical documentation, notes of the attending physician, test results and other relevant medical records of the insured.  The physician may consult with other providers of health care in determining whether to authorize coverage.  2. The decision not to authorize coverage and the reason for the decision have been transmitted in writing in a timely manner to the insured, the provider of health care who recommended the service and the primary care physician of the insured, if any.  (Added to NRS by 1997, 302; A 2003, 1181)
NV Rev Stat § 695G.155 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.155 - Requirements regarding issuance of health benefit plans and adjustment of costs. [Effective January 1, 2020.]

  1. A managed care organization shall offer and issue a health benefit plan to any person regardless of the health status of the person or any dependent of the person. Such health status includes, without limitation:  (a) Any preexisting medical condition of the person, including, without limitation, any physical or mental illness;  (b) The claims history of the person, including, without limitation, any prior health care services received by the person;  (c) Genetic information relating to the person; and  (d) Any increased risk for illness, injury or any other medical condition of the person, including, without limitation, any medical condition caused by an act of domestic violence.   2. A managed care organization that offers or issues a health benefit plan shall not:  (a) Deny, limit or exclude a covered benefit based on the health status of an insured; or  (b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.  3. A managed care organization that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any insured on the basis of genetic information relating to the insured or the covered dependent of the insured.  4. A managed care organization that offers or issues a health benefit plan may include in the plan a wellness program that reduces a premium, deductible or copayment based on health status if:  (a) An insured who is eligible to participate in the wellness program is given the opportunity to qualify for the discount at least once each year;  (b) The amount of all discounts provided pursuant to such a wellness program does not exceed 30 percent, or if the program is designed to prevent or reduce tobacco use, 50 percent, of the cost of coverage for an insured or an insured and his or her dependents, as applicable, under the plan;  (c) The wellness program is reasonably designed to promote health or prevent disease;  (d) The managed care organization ensures that the full discount under the wellness program is available to all similarly situated insureds by providing a reasonable alternative standard by which an insured may qualify for the discount which, if based on health status, must accommodate the recommendations of the physician of the insured; and  (e) The plan discloses in all plan materials describing the terms of the wellness program, and in any disclosure that an insured did not satisfy the initial standard to be eligible for the discount, the availability of a reasonable alternative standard described in paragraph (d).   5. As used in this section, "health benefit plan" has the meaning ascribed to it in NRS 687B.470.  (Added to NRS by 2019, 313, effective January 1, 2020)
NV Rev Stat § 695G.160 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.160 - Written criteria concerning coverage of health care services and standards for quality of health care services.

  1. Each managed care organization shall establish written criteria:  (a) Setting forth the manner in which it determines whether to authorize coverage of a health care service; and  (b) Setting forth its method for reviewing standards for the quality of health care services provided to an insured.  2. Such written criteria must be:  (a) Developed with the assistance of practicing providers of health care;  (b) Developed using generally recognized and, if appropriate, specialized clinical principles and processes;  (c) Reviewed at least one time each year and, if appropriate, updated; and  (d) Made available to an insured for review upon request of the insured any time that the managed care organization denies coverage of a specific health care service to the insured.  (Added to NRS by 1997, 302)
NV Rev Stat § 695G.162 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.162 - Required provision concerning coverage for services provided through telehealth.

  1. A health care plan issued by a managed care organization for group coverage 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 managed care organization 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;  (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;  (c) Refuse to provide the coverage described in subsection 1 because of 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  (d) Require covered services to be provided through telehealth as a condition to providing coverage for such services.  3. A health care plan of a managed care organization 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. Such a health care plan 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.  4. The provisions of this section do not require a managed care organization 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 managed care organization is not otherwise required by law to do so.  5. Evidence of coverage that is delivered, issued for delivery or renewed on or after July 1, 2015, has the legal effect of including the coverage required by this section, and any provision of the plan or the renewal which is in conflict with this section is void.  6. As used in this section:  (a) "Distant site" has the meaning ascribed to it in NRS 629.515.  (b) "Originating site" has the meaning ascribed to it in NRS 629.515.  (c) "Provider of health care" has the meaning ascribed to it in NRS 439.820.  (d) "Telehealth" has the meaning ascribed to it in NRS 629.515.  (Added to NRS by 2015, 647)