Nev. Admin. Code § 679B.Sec. 9 - NEW
1. In order for the Commissioner to determine
that a network plan made available for sale in this State is adequate, the
network plan must contain, at a minimum:
(a)
The standards contained in the most recent Letter to Issuers in the
Federally-facilitated Marketplaces issued by the Centers for Medicare and
Medicaid Services of the United States Department of Health and Human Services.
A copy of the letter may be obtained free of charge at the Internet address
https://www.cms.gov/CCIIO/resources/regulations-and-guidance/ [File Link Not
Available].
(b) Evidence that the
network plan provides reasonable access to at least one provider in the
specialty area listed in the following table for at least 90 percent of
enrollees by complying with the area designations for the maximum time and
distance standards in the following table:
Specialty Area |
Maximum Time and Distance Standards (Minutes/Miles) |
|||
Metro |
Micro |
Rural |
Counties with Extreme Access Considerations (CEAC) |
|
Pediatrics |
25/15 |
30/20 |
40/30 |
105/90 |
2. If the area designations for the maximum
time and distance standards required pursuant to paragraph (b) of subsection 1
are changed by the most recent Letter to Issuers in the
Federally-facilitated Marketplaces, the Commissioner will post on the
Internet website maintained by the Division notice of such changes.
3. Upon the issuance of a new Letter to
Issuers in the Federally-facilitated Marketplaces, the Commissioner will
determine whether the requirements of sections 2 to 18, inclusive, including,
without limitation, the standards required pursuant to subsection 1, conform
with any similar standards prescribed in the new Letter to Issuers in the
Federally-facilitated Marketplaces. If the Commissioner determines that the
requirements of sections 2 to 18, inclusive of this regulation do not conform
with any similar standards prescribed in the new Letter to Issuers in the
Federally-facilitated Marketplaces, the Commissioner will hold a public hearing
concerning possible amendments to sections 2 to 18, inclusive of this
regulation and give notice of that hearing in accordance with
NRS
233B.060.
4. As used in this section, "maximum time and
distance standards" has the meaning ascribed to it in the most recent
Letter to Issuers in the Federally-facilitated
Marketplaces.
Notes
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No prior version found.