SENATE BILL 115 Section Summary Additional Information Date: EXHIBIT Senate Committee Page 1 on of Health 5 & Human Serv 1

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1 SENATE BILL 115 Committee on Health and Human Services (On Behalf of the Legislative Committee on Health Care) Establishes provisions governing payment for the provision of certain services and care to patients and reports relating to those services and care. (BDR ) Section Summary Additional Information 1 Indicates that Chapter 439B of NRS is the amended chapter. NRS 439B Restraining Cost of Health Care 2 Indicates that the words and terms defined in sections 3-12 have the meaning ascribed to them in those sections, except in certain instances. 3 Defines Air Ambulance NRS 450B.030- Air ambulance defined. Air ambulance means an aircraft especially designed, constructed, modified or equipped to be used for the transportation of injured or sick persons. Air ambulance does not include any commercial aircraft carrying passengers on regularly scheduled flights. 4 Defines Ambulance NRS 450B.040- Ambulance defined. Ambulance means a motor vehicle which is specially designed, constructed, equipped and staffed to provide basic, intermediate or advanced care for one or more: 1. Sick or injured persons; or 2. Persons whose medical condition may require special observation during transportation or transfer, including, without limitation, such a vehicle of a fire-fighting agency. 5 Defines Emergency Services and Care NRS 439B.410, subsection 5. 1 P a g e As used in this section: (a) Emergency services and care means medical screening, examination and evaluation by a physician or, to the extent permitted by a specific statute, by a person under the supervision of a physician, to determine if an emergency medical condition or

2 E2 active labor exists and, if it does, the care, treatment and surgery by a physician necessary to relieve or eliminate the emergency medical condition or active labor, within the capability of the hospital. As used in this paragraph: (1) Active labor means, in relation to childbirth, labor that occurs when: (I) There is inadequate time before delivery to transfer the patient safely to another hospital; or (II) A transfer may pose a threat to the health and safety of the patient or the unborn child. (2) Emergency medical condition means the presence of acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in: (I) Placing the health of the patient in serious jeopardy; (II) Serious impairment of bodily functions; or (III) Serious dysfunction of any bodily organ or part. 6 Defines Fire-fighting agency NRS 450B.072- Fire-fighting agency defined. Fire-fighting agency means a fire department or fire protection district of the State or a political subdivision which holds a permit issued pursuant to this chapter. The term does not include a person or governmental entity, other than a governmental entity to whom a permit is issued in accordance with the provisions of NRS 450B.1985, which provides transportation of sick or injured persons to a medical facility. 2 P a g e

3 E3 7 Defines In- network hospital as a hospital that has contracted with the health insurance company (or other third party payor) to provide services to plan members for specific pre-negotiated rates. 8 Defines In-network physician as a physician that has contracted with the health insurance company (or other third party payor) to provide services to plan members for specific pre-negotiated rates. 9 Defines Out-of-network hospital as a hospital that is not contracted with the plan member s (patient s) health insurance plan. 10 Defines Out-of-network physician as a physician that is not contracted with the plan member s (patient s) health insurance plan. 11 Defines Third party to include: 1. An insurer as defined in NRS 679B.540; 2. A health benefit plan as defined in NRS 689A.540; 3. A participating public agency as defined in NRS and certain local government agencies pursuant to Chapter 287 of NRS; 4. Any other insurer or organization that provides health coverage or benefits in accordance with state or federal law. 12 Defines To stabilize as defined in 42 U.S.C. 1395dd 42 U.S.C. 1395dd - (3)(A) The term to stabilize means, with respect to an emergency medical condition described in paragraph (1)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B), to deliver (including the placenta). (B) The term stabilized means, with respect to an emergency medical condition described in paragraph (1)(A), that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a 3 P a g e

4 facility, or, with respect to an emergency medical condition described in paragraph (1)(B), that the woman has delivered (including the placenta). E4 13 Requires an out-of-network hospital with 100 or more beds that is not operated by a federal, state or local governmental entity to accept, under certain circumstances, as payment in full for providing certain services and care to certain patients a rate that does not exceed the greater of: 1. The amount that the third party negotiated with other hospitals in Nevada; 2. The amount calculated using the same method the third party use to determine payment to out-of-network hospitals, without reducing the calculation for cost sharing; or 3. The amount that would be paid by Medicare. The Commissioner of Insurance is authorized to adopt regulations to interpret these provisions in a specified manner. 14 Requires an out-of-network physician on the medical staff of an out-of-network hospital with 100 or more beds to accept as payment in full for the provision of emergency services and care, other than services and care provided to stabilize a patient, a rate which is similarly calculated to that in section Requires an out-of-network physician on the medical staff of an in-network hospital with 100 or more beds to accept as payment in full for the provision of medical services and care, other than services and care provided to stabilize a patient, a rate which is similarly calculated to that in section Further provides that, if a hospital or physician, as applicable, determines that the amount prescribed pursuant to sections is not sufficient to reimburse for the provision of services and care to a patient, the hospital or physician may negotiate a different rate with the third party and may, under certain circumstances, file a complaint and request for mediation with the Director of the Office for Consumer Health Assistance. 16 Requires a third party who wishes to pay the amounts prescribed pursuant to sections to maintain an adequate network of providers and submit certain reports to the Commissioner of Insurance and to the Legislative Committee on Health Care. 17 Requires the Director of the Office for Consumer Health Assistance to establish a 4 P a g e

5 procedure for filing and processing such complaints and requests for mediation. 18 Requires the Commissioner of Insurance to prescribe the standards of adequacy for the networks of third parties in this State and to determine whether third parties have adequate networks. 19 Specifies that, as used in NRS to , inclusive, and section 18 of this act, unless the context otherwise requires: 1. Commissioner means the Commissioner of Insurance. 2. Division means the Division of Insurance of the Department of Business and Industry. 20 Requires the Director of the Office for Consumer Health Assistance to adopt the regulations required by NRS , as amended by section 17 of this act, on or before October 1, In addition, the Commissioner of Insurance is required to adopt the regulations required by section 18 of this act on or before October 1, Requires the Legislative Committee on Health Care to review, on or before June 30, 2014, the provisions of this act, including, without limitation, the rate of payment set forth in sections 13, 14, and 15 to determine whether providers of health care are being adequately compensated for services and care. E5 In addition, the Legislative Committee on Health Care is required to forward the results of their review and any recommendations to the Assembly Standing Committee on Health and Human Services and the Senate Standing Committee on Health and Education. Human Services 22 Specifies that the act becomes effective upon passage and approval for the purpose of adopting regulations and on January 1, 2012, for all other purposes. 5 P a g e