Nev. Admin. Code § 695C.1255 - Application: Organization to establish that it has met requirements

1. An organization applying for a certificate of authority must establish that:

(a) The organization has an adequate number of providers in each category of provider of health care necessary to serve its members in each geographic location in its service area;

(b) The providers of health care with whom the organization has contracted to provide services are located so that the members may obtain health care without unreasonable travel;

(c) Nonemergency services are available and accessible during normal business hours and emergency services are available at any time;

(d) For a health maintenance organization, members can schedule appointments within a reasonable time, as determined by the State Board of Health;

(e) For a health maintenance organization, members are not required to wait for an unreasonable period of time in the office of a provider for a scheduled appointment, as determined by the State Board of Health;

(f) Members have access to their primary physician through on-call procedures after normal business hours;

(g) It requires the providers of health care with whom the organization has contracted to provide service to maintain records of the health care of its members which are accessible to other professionals within the organization;

(h) It provides a health care professional who is primarily responsible for coordinating the overall health care services offered to members;

(i) It has established a quality assurance program as required pursuant to NAC 695C.400; and

(j) The organization has established a system to collect data related to the health care services provided to members.

2. A health maintenance organization must satisfy the requirements of subsection 1 before the State Board of Health reports to the Commissioner whether the health maintenance organization meets the requirements of NRS 695C.080.

Notes

Nev. Admin. Code § 695C.1255

Added to NAC by Bd. of Health, eff. 11-1-95; A by Comm'r of Insurance by R148-99, 1-27-2000

NRS 439.200, 679B.130, 695C.080, 695C.275