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 his opinion 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) 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 and the State Board of Health 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) 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) 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) 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) 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) 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 him 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. (Added to NRS by 1995, 2435) 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) 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) 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 his 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 establishe

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