689C.970 - Meetings; Chair; duties.
689C.970 Meetings; Chair; duties.
1. The Committee shall meet:
(a) Until a plan of operation, other than a temporary plan of operation, has been approved by the Commissioner, twice a year;
(b) Once a plan of operation has been so approved, once a year; and
(c) At such other times as the Commissioner deems necessary.
2. The Committee shall elect from its membership a Chair who shall serve for a term of 2 years. Any vacancy occurring in this position must be filled by election of the members of the Committee for the remainder of the unexpired term.
3. The Committee shall:
(a) Recommend to the Board the form and level of coverages to be made available by small employers pursuant to NRS 689C.156, 689C.1565, 689C.157 and 689C.190, and by individual carriers pursuant to NRS 689A.680 to 689A.700, inclusive.
(b) Recommend to the Board levels for benefits and cost sharing, exclusions and limitations for a basic health benefit plan and a standard health benefit plan.
(c) Design a basic health benefit plan and a standard health benefit plan that are consistent with the basic method of operation and the benefit plans of health maintenance organizations authorized to transact insurance in this state, including any restrictions imposed by federal law.
4. The basic and standard health benefit plans recommended by the Committee may include features for the containment of costs, including:
(a) Utilization review of health care services, including a review of the medical necessity of hospital and physician services;
(b) Case management;
(c) Selective contracting with hospitals, physicians and other providers of health care;
(d) Reasonable benefit differentials applicable to providers that participate and providers that do not participate in arrangements using a provision for a restricted network; and
(e) Other provisions relating to managed care.
5. The Committee shall submit its recommendations for a basic and a standard health benefit plan to the Commissioner not later than 120 days after the date on which the Committee is appointed.
6. As used in this section, “provision for a restricted network” means any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of health care providers that have entered into a contractual arrangement with the carrier to provide health care services to persons covered by the plan.
(Added to NRS by 1997, 2939)