State Law

Nevada Admin. Code-Chapter 695C. HMOs; Provider-Sponsored Organizations-Providers of Medical Care

08/15/2023 Nevada Section 695C.190

Requirements for agreement between provider and organization

Liability-insurer shifting to physician

Each agreement between a provider and an organization must:

1.  Adequately and completely describe the responsibilities of the provider and organization under the agreement.

2.  Specify that the provider releases the enrollee from liability for the cost of services rendered pursuant to the organization’s health care plan except for any nominal payment made by the enrollee or for a service not covered under the evidence of coverage.

3.  Be effective for not less than 1 year, subject to any right of termination stated in the agreement.

4.  Require the provider to participate in the program to assure the quality of health care provided to enrollees by the organization through its providers.

5.  Require the provider to provide all medically necessary services required by the evidence of coverage and the agreement to each enrollee for the period for which a premium has been paid to the organization.

6.  Require the provider to give evidence of a contract of insurance against loss resulting from injuries resulting to third persons from the practice of his or her profession or a reasonable substitute for it as determined by the organization. The organization may require the provider to indemnify the organization for any liability resulting from the health care services rendered by the provider.

 7.  Require a provider who is a physician to transfer or otherwise arrange for the maintenance of the records of enrollees who are his or her patients if the provider leaves the panel of physicians associated with the organization.