Current through 82nd (2023) Legislative Session Chapter 535 and 34th (2023) Special Session Chapter 1 and 35th (2023) Special Session Chapter 1
Section 695G.160 - Written criteria concerning coverage of health care services and standards for quality of health care services1. 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, 302Added to NRS by 1997, 302