reglab/housing_qa huggingface dataset:
NV Rev Stat § 695B.400 (2021)
2021 Nevada Revised Statutes|Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service|NRS 695B.400 - Written notice to insured explaining right to file complaint; notice to insured required when insurer denies coverage of health care service.

  1. Following approval by the Commissioner, each insurer that issues a contract for hospital or medical services in this State shall provide written notice to an insured, in clear and comprehensible language that is understandable to an ordinary layperson, explaining the right of the insured to file a written complaint. Such notice must be provided to an insured:  (a) At the time the insured receives a certificate of coverage or evidence of coverage;  (b) Any time that the insurer denies coverage of a health care service or limits coverage of a health care service to an insured; and  (c) Any other time deemed necessary by the Commissioner.  2. Any time that an insurer denies coverage of a health care service to a beneficiary or subscriber, including, without limitation, denying a claim relating to a contract for dental, hospital or medical services pursuant to NRS 695B.2505, it shall notify the beneficiary or subscriber in writing within 10 working days after it denies coverage of the health care service of:  (a) The reason for denying coverage of the service;  (b) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service; and  (c) The right of the beneficiary or subscriber to file a written complaint and the procedure for filing such a complaint.  3. A written notice which is approved by the Commissioner shall be deemed to be in clear and comprehensible language that is understandable to an ordinary layperson.  (Added to NRS by 1997, 310; A 1999, 3093)
NV Rev Stat § 695C.010 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.010 - Short title.

This chapter may be cited as the Nevada Health Maintenance Organization Act.  (Added to NRS by 1973, 1246)
NV Rev Stat § 695C.020 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.020 - Legislative declaration.

The Legislature hereby declares that the rising cost of health services in recent years has led government agencies, private organizations, and legislative bodies to seek alternatives to the traditional medical delivery system which would provide improved health care and would provide such health care at a lower cost. The health maintenance organization is a concept which has received much attention as one means through which an improvement in delivery might be achieved. The Legislature therefore enacts this chapter to carry out this objective.  (Added to NRS by 1973, 1246)
NV Rev Stat § 695C.030 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.030 - Definitions.

As used in this chapter, unless the context otherwise requires:  1. "Comprehensive health care services" means medical services, dentistry, drugs, psychiatric and optometric and all other care necessary for the delivery of services to the consumer.  2. "Enrollee" means a natural person who has been voluntarily enrolled in a health care plan.  3. "Evidence of coverage" means any certificate, agreement or contract issued to an enrollee setting forth the coverage to which the enrollee is entitled.  4. "Health care plan" means any arrangement whereby any person undertakes to provide, arrange for, pay for or reimburse any part of the cost of any health care services and at least part of the arrangement consists of arranging for or the provision of health care services paid for by or on behalf of the enrollee on a periodic prepaid basis.  5. "Health care services" means any services included in the furnishing to any natural person of medical or dental care or hospitalization or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any other services for the purpose of preventing, alleviating, curing or healing human illness or injury.  6. "Health maintenance organization" means any person which provides or arranges for provision of a health care service or services and is responsible for the availability and accessibility of such service or services to its enrollees, which services are paid for or on behalf of the enrollees on a periodic prepaid basis without regard to the dates health services are rendered and without regard to the extent of services actually furnished to the enrollees, except that supplementing the fixed prepayments by nominal additional payments for services in accordance with regulations adopted by the Commissioner shall not be deemed to render the arrangement not to be on a prepaid basis. A health maintenance organization, in addition to offering health care services, may offer indemnity or service benefits provided through insurers or otherwise.  7. "Provider" means any physician, hospital or other person who is licensed or otherwise authorized in this state to furnish health care services.  (Added to NRS by 1973, 1246; A 1985, 538; 1997, 1629)
NV Rev Stat § 695C.050 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.050 - Applicability of certain provisions. [Effective through December 31, 2019.]

  1. Except as otherwise provided in this chapter or in specific provisions of this title, the provisions of this title are not applicable to any health maintenance organization granted a certificate of authority under this chapter. This provision does not apply to an insurer licensed and regulated pursuant to this title except with respect to its activities as a health maintenance organization authorized and regulated pursuant to this chapter.  2. Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, must not be construed to violate any provision of law relating to solicitation or advertising by practitioners of a healing art.  3. Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and is exempt from the provisions of chapter 630 of NRS.  4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care 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 health maintenance organization from any provision of this chapter for services provided pursuant to any other contract.  5. The provisions of NRS 695C.1694 to 695C.1698, inclusive, 695C.1708, 695C.1728, 695C.1731, 695C.17345, 695C.1735, 695C.1745 and 695C.1757 apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.  (Added to NRS by 1973, 1258; A 1983, 2030; 1995, 2720; 1997, 311, 1528; 1999, 418, 420, 1945, 2004, 2241; 2001, 141, 144, 864, 2734; 2003, 1335, 3366, 3531; 2007, 3240; 2009, 1473; 2013, 1999, 3638; 2015, 208, 644, 2127; 2017, 1846, 3953; 2019, 2173)
NV Rev Stat § 695C.050 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.050 - Applicability of certain provisions. [Effective January 1, 2020.]

  1. Except as otherwise provided in this chapter or in specific provisions of this title, the provisions of this title are not applicable to any health maintenance organization granted a certificate of authority under this chapter. This provision does not apply to an insurer licensed and regulated pursuant to this title except with respect to its activities as a health maintenance organization authorized and regulated pursuant to this chapter.  2. Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, must not be construed to violate any provision of law relating to solicitation or advertising by practitioners of a healing art.  3. Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and is exempt from the provisions of chapter 630 of NRS.  4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care 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 health maintenance organization from any provision of this chapter for services provided pursuant to any other contract.  5. The provisions of NRS 695C.1694 to 695C.1698, inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17345, 695C.1735, 695C.1745 and 695C.1757 apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.  (Added to NRS by 1973, 1258; A 1983, 2030; 1995, 2720; 1997, 311, 1528; 1999, 418, 420, 1945, 2004, 2241; 2001, 141, 144, 864, 2734; 2003, 1335, 3366, 3531; 2007, 3240; 2009, 1473; 2013, 1999, 3638; 2015, 208, 644, 2127; 2017, 1846, 3953; 2019, 309, 1007, 2173, effective January 1, 2020)
NV Rev Stat § 695C.055 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.055 - Applicability of certain other provisions. [Effective through December 31, 2019.]

  1. The provisions of NRS 449.465, 679A.200, 679B.700, subsections 7 and 8 of NRS 680A.270, subsections 2, 4, 18, 19 and 32 of NRS 680B.010, NRS 680B.020 to 680B.060, inclusive, chapter 686A of NRS, NRS 686B.010 to 686B.1799, inclusive, and 687B.500 and chapters 692C and 695G of NRS apply to a health maintenance organization.  2. For the purposes of subsection 1, unless the context requires that a provision apply only to insurers, any reference in those sections to "insurer" must be replaced by "health maintenance organization."  (Added to NRS by 1987, 469; A 1995, 472, 988; 1997, 299, 311, 2958, 2962; 2001, 2735; 2003, 3333, 3367; 2013, 3458, 3639; 2017, 2394; 2019, 1718)
NV Rev Stat § 695C.055 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.055 - Applicability of certain other provisions. [Effective January 1, 2020.]

  1. The provisions of NRS 449.465, 679A.200, 679B.700, subsections 7 and 8 of NRS 680A.270, subsections 2, 4, 18, 19 and 31 of NRS 680B.010, NRS 680B.020 to 680B.060, inclusive, chapter 686A of NRS, NRS 686B.010 to 686B.1799, inclusive, and 687B.500 and chapters 692C and 695G of NRS apply to a health maintenance organization.  2. For the purposes of subsection 1, unless the context requires that a provision apply only to insurers, any reference in those sections to "insurer" must be replaced by "health maintenance organization."  (Added to NRS by 1987, 469; A 1995, 472, 988; 1997, 299, 311, 2958, 2962; 2001, 2735; 2003, 3333, 3367; 2013, 3458, 3639; 2017, 2394; 2019, 1718, 3038, effective January 1, 2020)
NV Rev Stat § 695C.057 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.057 - Applicability of certain provisions concerning portability and availability of health insurance.

  1. A health maintenance organization is subject to the provisions of NRS 689A.470 to 689A.740, inclusive, 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability and availability of health insurance offered by such organizations. If there is a conflict between the provisions of this chapter and the provisions of NRS 689A.470 to 689A.740, inclusive, 689B.340 to 689B.580, inclusive, and chapter 689C of NRS, the provisions of NRS 689A.470 to 689A.740, inclusive, 689B.340 to 689B.580, inclusive, and chapter 689C of NRS control.  2. For the purposes of subsection 1, unless the context requires that a provision apply only to a group health plan or a carrier that provides coverage under a group health plan, any reference in those sections to "group health plan" or "carrier" must be replaced by "health maintenance organization."  (Added to NRS by 1997, 2957; A 2013, 3639; 2019, 1718)
NV Rev Stat § 695C.060 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.060 - Establishment of organization.

  1. Any person may apply to the Commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. No person shall operate a health maintenance organization without obtaining a certificate of authority under this chapter. A foreign corporation may qualify under this chapter, subject to its qualification to do business in this state as a foreign corporation.  2. No person shall be certified to establish or operate a health maintenance organization in this state, nor sell or offer to sell, or solicit offers to purchase or receive advance or periodic consideration in conjunction with health care plans unless such health maintenance organization provides or arranges for the provision of comprehensive health care services.  3. Every health maintenance organization or person operating a health maintenance organization shall submit an application for a certificate of authority under NRS 695C.070 within 30 days after July 1, 1973. Each such applicant may continue to operate until the Commissioner acts upon the application. In the event that an application is denied under NRS 695C.090 and 695C.100, the applicant shall thereafter be treated as a health maintenance organization whose certificate of authority has been revoked. For purposes of this subsection, a health maintenance organization shall be deemed to be in operation only if health care services are being provided to the public generally or to some group or groups thereof.  (Added to NRS by 1973, 1247)
NV Rev Stat § 695C.070 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.070 - Certificate of authority: Application.

Each application for a certificate of authority must be verified by an officer or authorized representative of the applicant, must be in a form prescribed by the Commissioner, and must set forth or be accompanied by the following:  1. A copy of the basic organizational document, if any, of the applicant, and all amendments thereto;  2. A copy of the bylaws, rules or regulations, or a similar document, if any, regulating the conduct of the internal affairs of the applicant;  3. A list of the names, addresses and official positions of the persons who will be responsible for the conduct of the affairs of the applicant, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the officers in the case of a corporation, and the partners or members in the case of a partnership or association;  4. A copy of any contract made or to be made between any providers or persons listed in subsection 3 and the applicant;  5. A statement generally describing the health maintenance organization, its health care plan or plans, the location of facilities at which health care services will be regularly available to enrollees and the type of health care personnel who will provide the health care services;  6. A copy of the form of evidence of coverage to be issued to the enrollees;  7. A copy of the form of the group contract, if any, which is to be issued to employers, unions, trustees or other organizations;  8. Certified financial statements showing the applicant’s assets, liabilities and sources of financial support;  9. The proposed method of marketing the plan, a financial plan which includes a 3-year projection of the initial operating results anticipated and the sources of working capital and any other sources of funding;  10. A power of attorney, executed by the applicant, appointing the Commissioner and the authorized deputies of the Commissioner as the true and lawful attorney of such applicant in and for this State upon whom all lawful process in any legal action or proceeding against the health maintenance organization on a cause of action arising in this State may be served;  11. A statement reasonably describing the geographic area to be served;  12. A description of the procedures for resolving complaints and procedures for external reviews to be used as required under NRS 695C.260;  13. A description of the procedures and programs to be implemented to meet the quality of health care requirements in NRS 695C.080;  14. A description of the mechanism by which enrollees will be afforded an opportunity to participate in matters of program content under subsection 2 of NRS 695C.110; and  15. Such other information as the Commissioner may require to make the determinations required in NRS 695C.080.  (Added to NRS by 1973, 1247; A 2003, 777)
NV Rev Stat § 695C.080 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.080 - Certificate of authority: Evaluation of application.

  1. The Commissioner shall determine whether the applicant for a certificate of authority, with respect to health care services to be furnished:  (a) Has demonstrated the willingness and ability to ensure that such health care services will be provided in a manner to ensure both availability and accessibility of adequate personnel and facilities and in a manner enhancing availability, accessibility and continuity of service;  (b) Has organizational arrangements, established in accordance with regulations promulgated by the Commissioner; and  (c) Has a procedure established in accordance with regulations of the Commissioner to develop, compile, evaluate and report statistics relating to the cost of its operations, the pattern of utilization of its services, the availability and accessibility of its services and such other matters as may be reasonably required by the Commissioner.  2. Within 90 days of receipt of the application for issuance of a certificate of authority, the Commissioner shall certify whether the proposed health maintenance organization meets the requirements of subsection 1. If the Commissioner certifies that the health maintenance organization does not meet such requirements, it shall specify in what respects it is deficient.  (Added to NRS by 1973, 1249; A 2013, 3639; 2017, 2394)
NV Rev Stat § 695C.090 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.090 - Certificate of authority: Issuance.

The Commissioner shall issue or deny a certificate of authority to any person filing an application pursuant to NRS 695C.060 within 90 days after certification. Issuance of a certificate of authority must be granted upon payment of the fees prescribed in NRS 695C.230 if the Commissioner is satisfied that the following conditions are met:  1. The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy and possess good reputations.  2. The Commissioner certifies, in accordance with NRS 695C.080, that the health maintenance organization’s proposed plan of operation meets the requirements of subsection 1 of NRS 695C.080.  3. The health care plan furnishes comprehensive health care services.  4. The health maintenance organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees. In making this determination, the Commissioner may consider:  (a) The financial soundness of the health care plan’s arrangements for health care services and the schedule of charges used in connection therewith;  (b) The adequacy of working capital;  (c) Any agreement with an insurer, a government, or any other organization for insuring the payment of the cost of health care services;  (d) Any agreement with providers for the provision of health care services; and  (e) Any surety bond or deposit of cash or securities submitted in accordance with NRS 695C.270 as a guarantee that the obligations will be duly performed.  5. The enrollees will be afforded an opportunity to participate in matters of program content pursuant to NRS 695C.110.  6. Nothing in the proposed method of operation, as shown by the information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, or by independent investigation is contrary to the public interest.  (Added to NRS by 1973, 1249; A 1987, 469; 1993, 2400; 2013, 3640)
NV Rev Stat § 695C.100 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.100 - Certificate of authority: Denial.

A certificate of authority shall be denied only after compliance with the requirements of NRS 695C.340.  (Added to NRS by 1973, 1250)
NV Rev Stat § 695C.110 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.110 - Governing body: Composition; participation by enrollees.

  1. The governing body of any health maintenance organization may include providers, other individuals or both.  2. Such governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of program content through the establishment of advisory panels, by the use of advisory referenda on major policy decisions or through the use of other mechanisms. In addition there shall be a provider advisory board to advise the health plan in the matter of quality of care. There shall be a joint board of consumers and providers to advise on consumer satisfaction.  (Added to NRS by 1973, 1250)
NV Rev Stat § 695C.120 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.120 - Powers of organization.

The powers of a health maintenance organization include, but are not limited to, the following:  1. The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property as may reasonably be required for its principal office or for such other purposes as may be necessary in the transaction of the business of the organization;  2. The making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation under its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees;  3. The furnishing of health care service through providers which are under contract with or employed by the health maintenance organization;  4. The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration; and  5. The contracting with an insurance company licensed in this state or authorized to do business in this state for the provision of such insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization.  (Added to NRS by 1973, 1250; A 1995, 2166; 1999, 1834)