f this chapter for services provided pursuant to any other contract. (Added to NRS by 1997, 302; A 2003, 783, 3371) 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) 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) ADMINISTRATION OF MANAGED CARE ORGANIZATIONS 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) 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) 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) NRS 695G.130 Report regarding methods for reviewing quality of health care services: Requirements; availability for public inspection. 1. In addition to any other report which is required to be filed with the Commissioner or the State Board of Health, each managed care organization shall file with the Commissioner and the State Board of Health, on or before March 1 of each year, a report regarding its methods for reviewing the quality of health care services provided to its insureds. 2. Each managed care organization shall include in its report the criteria, data, benchmarks or studies used to: (a) Assess the nature, scope, quality and accessibility of health care services provided to insureds; or (b) Determine any reduction or modification of the provision of health care services to insureds. 3. Except as already required to be filed with the Commissioner or the State Board of Health, if the managed care organization is not owned and operated by a public entity and has more than 100 insureds, the report filed pursuant to subsection 1 must include: (a) A copy of all of its quarterly and annual financial reports; (b) A statement of any financial interest it has in any other business which is related to health care that is greater than 5 percent of that business or $5,000, whichever is less; and (c) A description of each complaint filed with or against it that resulted in arbitration, a lawsuit or other legal proceeding, unless disclosure is prohibited by law or a court order. 4. 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. (Added to NRS by 1997, 305; A 1997, 3041) 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) COVERAGE BY MANAGED CARE ORGANIZATIONS 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 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) 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) NRS 695G.163 Coverage for prescription drugs: Provision of notice and information regarding use of formulary. 1. A managed care organization that offers or issues a health care plan which provides coverage for prescription drugs shall include with any summary, certificate or evidence of that coverage provided to an insured, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the organization pursuant to subsection 2. The notice required by this subsection must: (a) Be in a language that is easily understood and in a format that is easy to understand; (b) Include an explanation of what a formulary is; and (c) If a formulary is used, include: (1) An explanation of: (I) How often the contents of the formulary are reviewed; and (II) The procedure and criteria for determining which prescription

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