1.  Except as outlined in subsection 2, in order for the Commissioner to determine that a network plan made available for sale in this State is adequate, the network plan must contain, at a minimum:

(a) Evidence that the network plan provides reasonable access to at least one provider in the specialty area listed in the following table for at least 90 percent of enrollees by complying with the area designations for the maximum time or distance standards in the following table:

Note:  the table following (a) above could not easily be copied into this entry.  

(b) Evidence that the network plan:

(1) Contracts with at least 35 percent of the essential community providers in the service area of the network plan that are available to participate in the provider network of the network plan;

(2) Offers contracts in good faith to all available essential community providers in all counties in the service area of the network plan that are designated pursuant to subsection 3 as Counties with Extreme Access Considerations;

(3) Offers contracts in good faith to all available Indian health care providers in the service area of the network plan, including, without limitation, the Indian Health Service, Indian Tribes, tribal organizations and urban Indian organizations, as defined in 25 U.S.C. § 1603, which apply the special terms and conditions necessitated by federal statutes and regulations as referenced in the Model Qualified Health Plan Addendum for Indian Health Care Providers. A copy of the Model Qualified Health Plan Addendum for Indian Health Care Providers may be obtained free of charge at the Internet address

https://www.qhpcertification.cms.gov/s/ECP%20and%20Network%20Adequacy; and

(4) Offers contracts in good faith to at least one essential community provider in each category of essential community provider in the following table, in each county in the service area of the network plan, where an essential community provider in that category is available and provides medical or dental services that are covered by the network plan:

Note:  There is a table immediately following (4) above.  That table could not easily be copied into this entry.  

2. For a stand-alone dental plan or a health benefit plan that offers oral pediatric services being offered to satisfy the essential health benefits requirements under 42 U.S.C. § 18022 subsection (b)(1)(J), the network must contain, at minimum:

(a) Evidence that the network plan provides reasonable access to at least one provider in the specialty area listed in the following table for at least 90 percent of enrollees by complying with the area designations for the maximum time or distance standards in the following table:

Note:  the table following (a) above could not easily be copied into this entry.  

(b) Evidence that the network plan:

(1) Contracts with at least 35 percent of the essential community providers in the service area of the network plan that are available to participate in the provider network of the network plan; and

(2) Offers contracts in good faith to all available Indian health care providers in the service area of the network plan, including, without limitation, the Indian Health Service established pursuant to 25 U.S.C. § 1661, and Indian tribes, tribal organizations, and urban Indian organizations, as defined in 25 U.S.C. § 1603, which apply the special terms and conditions necessitated by federal statutes and regulations as referenced in the Model Qualified Health Plan Addendum for
Indian Health Care Providers. A copy of the Model Qualified Health Plan Addendum for Indian Health Care Providers may be obtained free of charge at the Internet address
https://www.qhpcertification.cms.gov/s/ECP%20and%20Network%20Adequacy.

3. To offer a contract in good faith pursuant to paragraph (b) of subsection 1, a network plan must offer contract terms comparable to the terms that a carrier or other person or
entity which issues a network plan would offer to a similarly situated provider which is
not an essential community provider, except for terms that would not be applicable to
an essential community provider, including, without limitation, because of the type of
services that an essential community provider provides. A network plan must be able to
provide verification of such offers if the Commissioner requests to verify compliance with this policy.

4. For the purposes of this section, the area designations for the maximum time or distance
standards are based upon the population size and density parameters of individual counties
within the plan’s service area. The population and density parameters applied to determine
county type designations are listed in the following table:

Note:  the table following (4) above could not easily be copied into this entry.  

5. As used in this section:

(a) “Essential community provider” or “ECP” means a provider of healthcare that serves
predominantly low-income, medically underserved individuals. The term includes, without limitation:

(1) Health care providers described in section 340B(a)(4) of the Public Health Service Act, 42 U.S.C. § 256b(a)(4), as amended;

(2) Entities described in section 1927(c)(1)(D)(i)(IV) of the Social Security Act, 42 U.S.C.§ 1396r-8(c)(1)(D)(i)(IV), as amended, including, without limitation, state-owned family planning service sites, governmental family planning service sites or not-for-profit family planning service sites that do not receive funding that qualifies the service for the drug pricing program established pursuant to section 340B of the Public Health Service Act, 42 U.S.C. § 256b, as amended, without limitation, funding pursuant to Title X of the Public Health Service Act, 42 U.S.C. § 300 et seq., as amended; or

(3) Indian health care providers,

unless any of the providers or entities listed in subparagraphs (1), (2) and (3) has lost its status as a provider described in section 340B(a)(4) of the Public Health Service Act, 42 U.S.C.
§ 256(b)(a)(4), as amended, or as an entity described in section 1927(c)(1)(D)(i)(IV) of the
Social Security Act, 42 U.S.C. § 1396r-8(c)(1)(D)(i)(IV), as amended, as a result of violating
Federal law.

(b) “Maximum time or distance standards” means the maximum time or distance an individual should have to travel to see a provider of health care based on the area designation determined pursuant to subsection 3.

(c) “Stand-alone dental plan” means a plan for dental care as defined by NRS 695D.070 that is not part of a health benefit plan as defined by NRS 689C.075.

Sec. 3. This regulation becomes effective on January 1, 2024.