reglab/housing_qa huggingface dataset:
NV Rev Stat § 695C.123 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.123 - Contracts with certain federally qualified health centers.

  1. Except as otherwise provided in NRS 422.273, a health maintenance organization that furnishes health care services through providers which are under contract with the organization 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 enrollees 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, 1924)
NV Rev Stat § 695C.125 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.125 - Contract between health maintenance organization and provider of health care: Form to obtain information on provider of health care; modification; provision of schedule of fees.

  1. A health maintenance organization shall not contract with a provider of health care to provide health care to an insured unless the health maintenance organization uses the form prescribed by the Commissioner pursuant to NRS 629.095 to obtain any information related to the credentials of the provider of health care.  2. A contract between a health maintenance organization and a provider of health care may be modified:  (a) At any time pursuant to a written agreement executed by both parties.  (b) Except as otherwise provided in this paragraph, by the health maintenance organization upon giving to the provider 45 days’ written notice of the modification of the health maintenance organization’s schedule of payments, including any changes to the fee schedule applicable to the provider’s practice. If the provider fails to object in writing to the modification within the 45-day period, the modification becomes effective at the end of that period. If the provider objects in writing to the modification within the 45-day period, the modification must not become effective unless agreed to by both parties as described in paragraph (a).  3. If a health maintenance organization contracts with a provider of health care to provide health care to an enrollee, the health maintenance organization shall:  (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or  (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments, including any changes to the fee schedule applicable to the provider’s practice, specified in paragraph (a) within 7 days after receiving the request.  4. As used in this section, "provider of health care" means a provider of health care who is licensed pursuant to chapter 630, 631, 632 or 633 of NRS.  (Added to NRS by 1999, 1651; A 2001, 2735; 2003, 3367; 2011, 2535)
NV Rev Stat § 695C.128 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.128 - Contracts to provide services pursuant to certain state programs: Payment of interest on claims.

Any contract or other agreement entered into or renewed by a health maintenance organization on or after October 1, 2001:  1. To provide health care services through managed care to recipients of Medicaid under the state plan for Medicaid; or  2. With the Division of Health Care Financing and Policy of the Department of Health and Human Services to provide insurance pursuant to the Children’s Health Insurance Program,  must require the health maintenance organization to pay interest to a provider of health care services on a claim that is not paid within the time provided in the contract or agreement at a rate of interest equal to the prime rate at the largest bank in Nevada, as ascertained by the Commissioner of Financial Institutions, on January 1 or July 1, as the case may be, immediately preceding the date on which the payment was due, plus 6 percent. The interest must be calculated from 30 days after the date on which the claim is approved until the date on which the claim is paid.  (Added to NRS by 2001, 2734)
NV Rev Stat § 695C.130 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.130 - Notice and approval required for exercise of powers; rules or regulations.

  1. A health maintenance organization shall file notice, with adequate supporting information, with the Commissioner prior to the exercise of any power granted in subsections 1 and 2 of NRS 695C.120. The Commissioner shall disapprove such exercise of power if in the opinion of the Commissioner it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the Commissioner does not disapprove within 60 days of the filing, it is deemed approved.  2. The Commissioner may promulgate rules or regulations.  (Added to NRS by 1973, 1250)
NV Rev Stat § 695C.140 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.140 - Notice and approval required for modification of operations; regulations.

  1. A health maintenance organization shall, unless otherwise provided for in this chapter, file notice with the Commissioner before any material modification of the operations described in the information required by NRS 695C.070. If the Commissioner does not disapprove within 90 days after filing of the notice, the modification is deemed approved.  2. The Commissioner may adopt regulations to carry out the provisions of this section.  (Added to NRS by 1973, 1248; A 1995, 1632; 2013, 3640)
NV Rev Stat § 695C.145 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.145 - Accounting principles required for certain reports and transactions; health maintenance organization subject to requirements for certain insurers.

  1. A health maintenance organization shall use accounting principles that are recognized by the laws of this state or approved by the Commissioner for:  (a) All financial reports;  (b) The accounting of investments and deposits; and  (c) Transactions between affiliates and holding companies.  2. A health maintenance organization is subject to the requirements for insurers for:  (a) Administrators, agents, brokers and solicitors, pursuant to chapter 683A of NRS;  (b) Borrowing, pursuant to NRS 693A.180;  (c) Impairment of capital, surplus or assets, pursuant to NRS 693A.260, 693A.270 and 693A.280;  (d) Management and agency contracts executed on or after January 1, 1992; and  (e) Officers, pursuant to NRS 693A.120 and 693A.130.  3. A domestic health maintenance organization is subject to the requirements for insurers for corporations pursuant to NRS 693A.040 to 693A.070, inclusive.  (Added to NRS by 1991, 2036)
NV Rev Stat § 695C.150 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.150 - Fiduciary responsibilities.

Any director, officer, partner, member or employee of a health maintenance organization who receives, collects, disburses or invests funds in connection with the activities of such organization shall be responsible for such funds in a fiduciary relationship to the enrollees.  (Added to NRS by 1973, 1250)
NV Rev Stat § 695C.160 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.160 - Investments.

With the exception of investments made in accordance with subsections 1 and 2 of NRS 695C.120 and NRS 695C.130, the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies or such other securities or investments as the Commissioner may permit.  (Added to NRS by 1973, 1253)
NV Rev Stat § 695C.161 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.161 - Eligibility for coverage: Definitions.

As used in NRS 695C.161 to 695C.169, inclusive, unless the context otherwise requires:  1. "Medicaid" means a program established in any state pursuant to Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.) to provide assistance for part or all of the cost of medical care rendered on behalf of indigent persons.  2. "Order for medical coverage" means an order of a court or administrative tribunal to provide coverage under a health care plan to a child pursuant to the provisions of 42 U.S.C. § 1396g-1.  (Added to NRS by 1995, 2435)
NV Rev Stat § 695C.163 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.163 - Eligibility for coverage: Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.

  1. A health maintenance organization shall not, when considering eligibility for coverage or making payments under a health care plan, consider the availability of, or eligibility of a person for, medical assistance under Medicaid.  2. To the extent that payment has been made by Medicaid for health care, a health maintenance organization:  (a) Shall treat Medicaid as having a valid and enforceable assignment of benefits due an enrollee or claimant under the enrollee regardless of any exclusion of Medicaid or the absence of a written assignment; and  (b) May, as otherwise allowed by its plan, evidence of coverage or contract and applicable law or regulation concerning subrogation, seek to enforce any rights of a recipient of Medicaid to reimbursement against any other liable party if:  (1) It is so authorized pursuant to a contract with Medicaid for managed care; or  (2) It has reimbursed Medicaid in full for the health care provided by Medicaid to its enrollee.  3. If a state agency is assigned any rights of a person who is:  (a) Eligible for medical assistance under Medicaid; and  (b) Covered by a health care plan,  the organization responsible for the health care plan shall not impose any requirements upon the state agency except requirements it imposes upon the agents or assignees of other persons covered by the same plan.  4. If a state agency is assigned any rights of an enrollee who is eligible for medical assistance under Medicaid, a health maintenance organization shall:  (a) Upon request of the state agency, provide to the state agency information regarding the enrollee to determine:  (1) Any period during which the enrollee, the spouse or a dependent of the enrollee may be or may have been covered by the health care plan; and  (2) The nature of the coverage that is or was provided by the organization, including, without limitation, the name and address of the enrollee and the identifying number of the health care plan;  (b) Respond to any inquiry by the state agency regarding a claim for payment for the provision of any medical item or service not later than 3 years after the date of the provision of the medical item or service; and  (c) Agree not to deny a claim submitted by the state agency solely on the basis of the date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if:  (1) The claim is submitted by the state agency not later than 3 years after the date of the provision of the medical item or service; and  (2) Any action by the state agency to enforce its rights with respect to such claim is commenced not later than 6 years after the submission of the claim.  (Added to NRS by 1995, 2435; A 2007, 2406)
NV Rev Stat § 695C.165 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.165 - Eligibility for coverage: Organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is enrolled in health care plan.

An organization shall not deny the enrollment of a child pursuant to an order for medical coverage under a health care plan in which a parent of the child is enrolled, on the ground that the child:  1. Was born out of wedlock;  2. Has not been claimed as a dependent on the parent’s federal income tax return; or  3. Does not reside with the parent or within the organization’s geographic area of service.  (Added to NRS by 1995, 2436)
NV Rev Stat § 695C.167 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.167 - Eligibility for coverage: Certain accommodations to be made when child is covered under health care plan of noncustodial parent.

If a child has coverage under a health care plan in which a noncustodial parent of the child is enrolled, the organization responsible for that plan shall:  1. Provide to the custodial parent such information as necessary for the child to obtain any benefits under that coverage.  2. Allow the custodial parent or, with the approval of the custodial parent, a provider to submit claims for covered services without the approval of the noncustodial parent.  3. Make payments on claims submitted pursuant to subsection 2 directly to the custodial parent, the provider or an agency of this or another state responsible for the administration of Medicaid.  (Added to NRS by 1995, 2436)
NV Rev Stat § 695C.169 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.169 - Eligibility for coverage: Organization to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child.

If a parent is required by an order for medical coverage to provide coverage for a child and the parent is eligible for coverage of members of the parent’s family under a health care plan, the organization responsible for that plan:  1. Shall, if the child is otherwise eligible for that coverage, allow the parent to enroll the child in that coverage without regard to any restrictions upon periods for enrollment.  2. Shall, if:  (a) The child is otherwise eligible for that coverage; and  (b) The parent is enrolled in that coverage but fails to apply for enrollment of the child,  enroll the child in that coverage upon application by the other parent of the child, or by an agency of this or another state responsible for the administration of Medicaid or a state program for the enforcement of child support established pursuant to 42 U.S.C. §§ 651 et seq., without regard to any restrictions upon periods for enrollment.  3. Shall not terminate the enrollment of the child in that coverage or otherwise eliminate that coverage of the child unless the organization has written proof that:  (a) The order for medical coverage is no longer in effect; or  (b) The child is or will be enrolled in comparable coverage through another insurer on or before the effective date of the termination of enrollment or elimination of coverage.  (Added to NRS by 1995, 2436)
NV Rev Stat § 695C.1694 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1694 - Required provision concerning coverage of hormone replacement therapy in certain circumstances; prohibited actions by health maintenance organization; exception.

  1. A health maintenance organization which offers or issues a health care plan that provides coverage for prescription drugs or devices shall include in the plan coverage for any type of hormone replacement therapy which is lawfully prescribed or ordered and which has been approved by the Food and Drug Administration.  2. A health maintenance organization that offers or issues a health care plan that provides coverage for prescription drugs shall not:  (a) Require an enrollee to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for hormone replacement therapy;  (b) Refuse to issue a health care plan or cancel a health care plan solely because the person applying for or covered by the plan uses or may use in the future hormone replacement therapy;  (c) Offer or pay any type of material inducement or financial incentive to an enrollee to discourage the enrollee from accessing hormone replacement therapy;  (d) Penalize a provider of health care who provides hormone replacement therapy to an enrollee, including, without limitation, reducing the reimbursement of the provider of health care; or  (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay hormone replacement therapy to an enrollee.  3. Evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by subsection 1, and any provision of the evidence of coverage or the renewal which is in conflict with this section is void.  4. The provisions of this section do not require a health maintenance organization to provide coverage for fertility drugs.  5. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.  (Added to NRS by 1999, 2001; A 2017, 1847, 3954)
NV Rev Stat § 695C.1695 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1695 - Required provision concerning coverage of health care services related to hormone replacement therapy in certain circumstances; prohibited actions by health maintenance organization.

  1. A health maintenance organization that offers or issues a health care plan which provides coverage for outpatient care shall include in the plan coverage for any health care service related to hormone replacement therapy.  2. A health maintenance organization that offers or issues a health care plan that provides coverage for outpatient care shall not:  (a) Require an enrollee to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for outpatient care related to hormone replacement therapy;  (b) Refuse to issue a health care plan or cancel a health care plan solely because the person applying for or covered by the plan uses or may use in the future hormone replacement therapy;  (c) Offer or pay any type of material inducement or financial incentive to an enrollee to discourage the enrollee from accessing hormone replacement therapy;  (d) Penalize a provider of health care who provides hormone replacement therapy to an enrollee, including, without limitation, reducing the reimbursement of the provider of health care; or  (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay hormone replacement therapy to an enrollee.  3. Evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by subsection 1, and any provision of the evidence of coverage or the renewal which is in conflict with this section is void.  4. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.  (Added to NRS by 1999, 2002; A 2017, 1848, 3955)
NV Rev Stat § 695C.170 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.170 - Evidence of coverage: Issuance; form and contents.

  1. Every enrollee residing in this state is entitled to evidence of coverage under a health care plan. If the enrollee obtains coverage under a health care plan through an insurance policy, whether by option or otherwise, the insurer shall issue the evidence of coverage. Otherwise, the health maintenance organization shall issue the evidence of coverage.  2. Evidence of coverage or amendment thereto must not be issued or delivered to any person in this state until a copy of the form of the evidence of coverage or amendment thereto has been filed with and approved by the Commissioner.  3. An evidence of coverage:  (a) Must not contain any provisions or statements which are unjust, unfair, inequitable, misleading, deceptive, which encourage misrepresentation or which are untrue, misleading or deceptive as defined in subsection 1 of NRS 695C.300; and  (b) Must contain a clear and complete statement, if a contract, or a reasonably complete summary if a certificate, of:  (1) The health care services and the insurance or other benefits, if any, to which the enrollee is entitled under the health care plan;  (2) Any limitations on the services, kind of services, benefits, or kind of benefits, to be provided, including any deductible or copayment feature;  (3) Where and in what manner the services may be obtained; and  (4) The total amount of payment for health care services and the indemnity or service benefits, if any, which the enrollee is obligated to pay.  Any subsequent change may be evidenced in a separate document issued to the enrollee.  4. A copy of the form of the evidence of coverage to be used in this state and any amendment thereto is subject to the requirements for filing and approval of subsection 2 unless it is subject to the jurisdiction of the Commissioner under the laws governing health insurance, in which event the provisions for filing and approval of those laws apply. To the extent that such provisions do not apply to the requirements in subsection 3, such provisions are amended to incorporate the requirements of subsection 3 in approving or disapproving an evidence of coverage required by subsection 2.  (Added to NRS by 1973, 1251; A 1975, 1852; 1979, 1182; 1983, 2041; 2009, 1817)