Nevada § 287.0273 - Coverage for mammograms for certain women required to be provided by local governmental agency that provides health insurance through plan of self-insurance

§ 287.0273. Coverage for mammograms for certain women required to be provided by local governmental agency that provides health insurance through plan of self-insurance

1. The governing body of any county, school district, municipal corporation, political

subdivision, public corporation or other local governmental agency of the State of

Nevada that provides health insurance through a plan of self-insurance shall provide

coverage for benefits payable for expenses incurred for a mammogram every 2 years,

or annually if ordered by a provider of health care, for women 40 years of age or

older. 2. The governing body of any county, school district, municipal corporation, political

subdivision, public corporation or other local governmental agency of the State of

Nevada that provides health insurance through a plan of self-insurance must ensure

that the benefits required by subsection 1 are made available to an insured through

a provider of health care who participates in the network plan of the governing body. 3. Except as otherwise provided in subsection 5, the governing body of any county,

school district, municipal corporation, political subdivision, public corporation

or other local governmental agency of the State of Nevada that provides health insurance

through a plan of self-insurance shall not: (a) Except as otherwise provided in subsection 6, require an insured to pay a higher

deductible, any copayment or coinsurance or require a longer waiting period or other

condition to obtain any benefit provided in the plan of self-insurance pursuant to

subsection 1; (b) Refuse to issue a plan of self-insurance or cancel a plan of self-insurance solely

because the person applying for or covered by the policy uses or may use any such

benefit; (c) Offer or pay any type of material inducement or financial incentive to an insured

to discourage the insured from obtaining any such benefit; (d) Penalize a provider of health care who provides any such benefit to an insured,

including, without limitation, reducing the reimbursement of the provider of health

care; (e) Offer or pay any type of material inducement, bonus or other financial incentive

to a provider of health care to deny, reduce, withhold, limit or delay access to any

such benefit to an insured; or (f) Impose any other restrictions or delays on the access of an insured to any such

benefit. 4. A plan of self-insurance subject to the provisions of this chapter which is delivered,

issued for delivery or renewed on or after January 1, 2024, has the legal effect of

including the coverage required by subsection 1, and any provision of the policy or

the renewal which is in conflict with this section is void. 5. Except as otherwise provided in this section and federal law, the governing body

of any county, school district, municipal corporation, political subdivision, public

corporation or other local governmental agency of the State of Nevada that provides

health insurance through a plan of self-insurance may use medical management techniques,

including, without limitation, any available clinical evidence, to determine the frequency

of or treatment relating to any benefit required by this section or the type of provider

of health care to use for such treatment. 6. If the application of paragraph (a) of subsection 3 would result in the ineligibility

of a health savings account of an insured pursuant to 26 U.S.C. § 223 , the prohibitions of paragraph (a) of subsection 3 shall apply only for a qualified

plan of self-insurance with respect to the deductible of such a plan of self-insurance

after the insured has satisfied the minimum deductible pursuant to 26 U.S.C. § 223 , except with respect to items or services that constitute preventive care pursuant

to 26 U.S.C. § 223(c)(2)(C) , in which case the prohibitions of paragraph (a) of subsection 3 shall apply regardless

of whether the minimum deductible under 26 U.S.C. § 223 has been satisfied. 7. As used in this section: (a) “ Medical management technique ” means a practice which is used to control the cost or utilization of health care

services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization

or categorizing drugs and devices based on cost, type or method of administration. (b) “ Network plan ” means a plan of self-insurance provided by the governing body of a local governmental

agency under which the financing and delivery of medical care, including items and

services paid for as medical care, are provided, in whole or in part, through a defined

set of providers under contract with the governing body. The term does not include an arrangement for the financing of premiums. (c) “ Provider of health care ” has the meaning ascribed to it in NRS 629.031 . (d) “ Qualified plan of self-insurance ” means a plan of self-insurance that has a high deductible and is in compliance with 26 U.S.C. § 223 for the purposes of establishing a health savings account.