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.

Source: Section 695G.160 — Written criteria concerning coverage of health care services and standards for quality of health care services., https://www.­leg.­state.­nv.­us/NRS/NRS-695G.­html#NRS695GSec160.

695G.150
Authorization of recommended and covered health care services required. 695G.155
Requirements regarding issuance of health benefit plans and adjustment of costs. 695G.160
Written criteria concerning coverage of health care services and standards for quality of health care services. 695G.162
Required provision concerning coverage for services provided through telehealth. 695G.163
Coverage for prescription drugs: Provision of notice and information regarding use of formulary. 695G.164
Required provision concerning coverage for continued medical treatment. 695G.166
Required provision concerning coverage for prescription drug previously approved for medical condition of insured. 695G.167
Required provision concerning coverage for orally administered chemotherapy. 695G.168
Required provision concerning coverage for screening for colorectal cancer. 695G.170
Required provision concerning coverage for medically necessary emergency services 695G.171
Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus 695G.172
Required provision concerning coverage for early refills of topical ophthalmic products. 695G.173
Required provision concerning coverage for treatment received as part of clinical trial or study. 695G.174
Required provision concerning coverage for management and treatment of sickle cell disease. 695G.175
Certain actions of managed care organization prohibited. 695G.177
Required provision concerning coverage for prostate cancer screening. 695G.1645
Required provision concerning coverage for autism spectrum disorders. 695G.1665
Required provision concerning coverage for prescription drugs irregularly dispensed for purpose of the synchronization of chronic medications. 695G.1713
Required provision concerning coverage for mammograms for certain women 695G.1715
Required provision concerning coverage for drug or device for contraception and related health services 695G.1716
Health care plan that includes coverage for maternity care must not deny coverage for gestational carrier 695G.1717
Coverage for certain services, screenings and tests relating to wellness
Last Updated

Feb. 5, 2021

§ 695G.160’s source at nv​.us