Nevada Revised Statutes 695C.1708 – Required provision concerning coverage for services provided through telehealth to same extent as though provided in person or by other means; required provision concerning reimbursement for certain services provid…
1. A health care plan of a health maintenance organization must include coverage for services provided to an enrollee through telehealth to the same extent as though provided in person or by other means.
Terms Used In Nevada Revised Statutes 695C.1708
- Contract: A legal written agreement that becomes binding when signed.
- Enrollee: means a natural person who has been voluntarily enrolled in a health care plan. See Nevada Revised Statutes 695C.030
- Health care plan: means any arrangement whereby any person undertakes to provide, arrange for, pay for or reimburse any part of the cost of any health care services and at least part of the arrangement consists of arranging for or the provision of health care services paid for by or on behalf of the enrollee on a periodic prepaid basis. See Nevada Revised Statutes 695C.030
- Health maintenance organization: means any person which provides or arranges for provision of a health care service or services and is responsible for the availability and accessibility of such service or services to its enrollees, which services are paid for or on behalf of the enrollees on a periodic prepaid basis without regard to the dates health services are rendered and without regard to the extent of services actually furnished to the enrollees, except that supplementing the fixed prepayments by nominal additional payments for services in accordance with regulations adopted by the Commissioner shall not be deemed to render the arrangement not to be on a prepaid basis. See Nevada Revised Statutes 695C.030
- person: means a natural person, any form of business or social organization and any other nongovernmental legal entity including, but not limited to, a corporation, partnership, association, trust or unincorporated organization. See Nevada Revised Statutes 0.039
- Provider: means any physician, hospital or other person who is licensed or otherwise authorized in this state to furnish health care services. See Nevada Revised Statutes 695C.030
2. A health care plan of a health maintenance organization must provide reimbursement for services described in subsection 1 in the same amount as though provided in person or by other means:
(a) If the services:
(1) Are received at an originating site described in 42 U.S.C. § 1395m(m)(4)(C) or furnished by a federally-qualified health center or a rural health clinic; and
(2) Except for services described in paragraph (b), are not provided through audio-only interaction; or
(b) For counseling or treatment relating to a mental health condition or a substance use disorder, including, without limitation, when such counseling or treatment is provided through audio-only interaction.
3. A health maintenance organization shall not:
(a) Require an enrollee to establish a relationship in person with a provider of health care or provide any additional consent to or reason for obtaining services through telehealth as a condition to providing the coverage described in subsection 1 or the reimbursement described in subsection 2;
(b) Require a provider of health care to demonstrate that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to providing the coverage described in subsection 1 or the reimbursement described in subsection 2;
(c) Refuse to provide the coverage described in subsection 1 or the reimbursement described in subsection 2 because of:
(1) The distant site from which a provider of health care provides services through telehealth or the originating site at which an enrollee receives services through telehealth; or
(2) The technology used to provide the services;
(d) Require covered services to be provided through telehealth as a condition to providing coverage for such services; or
(e) Categorize a service provided through telehealth differently for purposes relating to coverage or reimbursement than if the service had been provided in person or through other means.
4. A health care plan of a health maintenance organization must not require an enrollee to obtain prior authorization for any service provided through telehealth that is not required for the service when provided in person. Such a health care plan may require prior authorization for a service provided through telehealth if such prior authorization would be required if the service were provided in person or by other means.
5. A health maintenance organization that provides medical services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall provide referrals to providers of dental services who provide services through teledentistry.
6. A health maintenance organization that provides dental services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall:
(a) Maintain a list of providers of dental services included in the network of the health maintenance organization who offer services through teledentistry;
(b) At least quarterly, update the list and submit a copy of the updated list to the emergency department of each hospital located in this State; and
(c) Allow such providers of dental services to include on claim forms codes for teledentistry services provided through both real-time interactions and asynchronous transmissions of medical and dental information.
7. The provisions of this section do not require a health maintenance organization to:
(a) Ensure that covered services are available to an enrollee through telehealth at a particular originating site;
(b) Provide coverage for a service that is not a covered service or that is not provided by a covered provider of health care; or
(c) Enter into a contract with any provider of health care or cover any service if the health maintenance organization is not otherwise required by law to do so.
8. Evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, has the legal effect of including the coverage required by this section, and any provision of the plan or the renewal which is in conflict with this section is void.
9. As used in this section:
(a) ’Distant site’ has the meaning ascribed to it in NRS 629.515.
(b) ’Federally-qualified health center’ has the meaning ascribed to it in 42 U.S.C. § 1396d(l)(2)(B).
(c) ’Originating site’ has the meaning ascribed to it in NRS 629.515.
(d) ’Provider of health care’ has the meaning ascribed to it in NRS 439.820.
(e) ’Rural health clinic’ has the meaning ascribed to it in 42 U.S.C. § 1395x(aa)(2).
(f) ’Teledentistry’ has the meaning ascribed to it in NRS 631.107.
(g) ’Telehealth’ has the meaning ascribed to it in NRS 629.515.