required; duties of third-party administrator. 1. A person shall not act as a third-party administrator for an insurer without a certificate issued by the Commissioner pursuant to NRS 683A.08524. 2. A person who acts as a third-party administrator pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS shall: (a) Administer from one or more offices located in this State all of the claims arising under each plan of insurance that he administers and maintain in those offices all of the records concerning those claims; (b) Administer each plan of insurance directly, without subcontracting with another third-party administrator; and (c) Upon the termination of his contract with an insurer, transfer forthwith to a certified third-party administrator chosen by the insurer all of the records in his possession concerning claims arising under the plan of insurance. 3. The Commissioner may, under exceptional circumstances, waive the requirements of subsection 2. (Added to NRS by 1991, 2392; A 1993, 711; 1999, 217, 2821) NRS 616B.506 Imposition of administrative fine for violations; withdrawal of certification. The Commissioner shall impose an administrative fine, not to exceed $1,000 for each violation, and may withdraw the certification of any third-party administrator who: 1. Fails to comply with regulations of the Commissioner regarding reports or other requirements necessary to carry out the purposes of chapters 616A to 616D, inclusive, or chapter 617 of NRS; or 2. Violates any provision of NRS 616B.503 or any regulation adopted by the Commissioner or the Administrator concerning the administration of the plan of insurance. (Added to NRS by 1991, 2393; A 1993, 711; 1999, 218) NRS 616B.509 Regulations. The Commissioner may adopt any regulations that are necessary to carry out the provisions of NRS 616B.500, 616B.503 and 616B.506. (Added to NRS by 1991, 2393)—(Substituted in revision for NRS 616.304) ORGANIZATIONS FOR MANAGED CARE NRS 616B.527 Authority of self-insured employers, associations of self-insured employers and private carriers; compliance with certain provisions. 1. A self-insured employer, an association of self-insured public or private employers or a private carrier may: (a) Except as otherwise provided in NRS 616B.5273, enter into a contract or contracts with one or more organizations for managed care to provide comprehensive medical and health care services to employees for injuries and diseases that are compensable pursuant to chapters 616A to 617, inclusive, of NRS. (b) Enter into a contract or contracts with providers of health care, including, without limitation, physicians who provide primary care, specialists, pharmacies, physical therapists, radiologists, nurses, diagnostic facilities, laboratories, hospitals and facilities that provide treatment to outpatients, to provide medical and health care services to employees for injuries and diseases that are compensable pursuant to chapters 616A to 617, inclusive, of NRS. (c) Require employees to obtain medical and health care services for their industrial injuries from those organizations and persons with whom the self-insured employer, association or private carrier has contracted pursuant to paragraphs (a) and (b), or as the self-insured employer, association or private carrier otherwise prescribes. (d) Except as otherwise provided in subsection 3 of NRS 616C.090, require employees to obtain the approval of the self-insured employer, association or private carrier before obtaining medical and health care services for their industrial injuries from a provider of health care who has not been previously approved by the self-insured employer, association or private carrier. 2. An organization for managed care with whom a self-insured employer, association of self-insured public or private employers or a private carrier has contracted pursuant to this section shall comply with the provisions of NRS 616B.528, 616B.5285 and 616B.529. (Added to NRS by 1993, 690; A 1993, 798; 1995, 2019; 1999, 1771, 2213; 2001, 115, 1891; 2003, 1670) NRS 616B.5273 Adequacy of medical and health care services, choice of providers of health care and cost controls; regulations. 1. A self-insured employer, an association of self-insured public or private employers or a private carrier shall not enter into a contract with an organization for managed care unless the organization’s proposed plan for providing medical and health care services: (a) Will provide all medical and health care services that may be required for industrial injuries and occupational diseases that are compensable under chapters 616A to 617, inclusive, of NRS in a manner that ensures the availability and accessibility of adequate treatment to injured employees; (b) Provides to injured employees an adequate choice of providers of health care who have contracted with the organization to participate in the proposed plan; and (c) Provides appropriate financial incentives to reduce costs of medical and health care services without affecting the quality of any care provided to an injured employee. 2. The Division may adopt regulations to ensure the adequacy of an insurer’s panel of providers of health care established pursuant to subsection 1. (Added to NRS by 2003, 1669) NRS 616B.528 Restriction of or interference with communication between provider of health care and injured employee prohibited. An organization for managed care shall not restrict or interfere with any communication between a provider of health care and an injured employee regarding any information that the provider of health care determines is relevant to the health care of the injured employee. (Added to NRS by 1999, 2212) NRS 616B.5285 Contracts with providers of health care; prohibited acts. An organization for managed care shall not terminate a contract with, demote, refuse to contract with or refuse to compensate a provider of health care solely because the provider, in good faith: 1. Advocates in private or in public on behalf of an injured employee; 2. Assists an injured employee in seeking reconsideration of a determination by the organization for managed care to deny coverage for a medical or health care service; or 3. Reports a violation of law to an appropriate authority. (Added to NRS by 1999, 2212) NRS 616B.529 Inducements to deny, reduce or delay medically necessary services prohibited. 1. An organization for managed care shall not 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 specific medically necessary medical or health care services to an injured employee. 2. The provisions of this section do not prohibit an arrangement for payment between an organization for managed care and a provider of health care that uses financial incentives, if the arrangement is designed to provide an incentive to the provider of health care to use medical and health care services effectively and consistently in the best interest of the treatment of the injured employee. (Added to NRS by 1999, 2213) SUBSEQUENT INJURY ACCOUNTS Self-Insured Employers NRS 616B.545 “Board” defined. As used in NRS 616B.545 to 616B.560, inclusive, unless the context otherwise requires, “Board” means the Board for the Administration of the Subsequent Injury Account for Self-Insured Employers created pursuant to NRS 616B.548. (Added to NRS by 1995, 2124; A 2001, 2757) NRS 616B.548 Board for Administration of Subsequent Injury Account for Self-Insured Employers: Creation; membership; officers; vacancies; members serve without compensation; legal counsel. 1. There is hereby created the Board for the Administration of the Subsequent Injury Account for Self-Insured Employer

Vegas Law