Nrs: Chapter 695I - Silver State Health Insurance Exchange


Published: 2015

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[Rev. 2/11/2015 12:28:12

PM--2014R2]

CHAPTER 695I - SILVER STATE HEALTH

INSURANCE EXCHANGE

GENERAL PROVISIONS

NRS 695I.010         Definitions.



NRS 695I.020         “Board”

defined.

NRS 695I.030         “Exchange”

defined.

NRS 695I.040         “Executive

Director” defined.

NRS 695I.050         “Federal

Act” defined. [Repealed.]

NRS 695I.060         “Medical

facility” defined.

NRS 695I.070         “Provider

of health care” defined.

NRS 695I.080         “Qualified

health plan” defined.

NRS 695I.090         “Qualified

individual” defined.

NRS 695I.100         “Qualified

small employer” defined.

NRS 695I.110         “Small

employer” defined.

ORGANIZATION; POWERS AND DUTIES

NRS 695I.200         Creation;

purpose.

NRS 695I.210         Powers

and duties of Exchange.

BOARD OF DIRECTORS

NRS 695I.300         Membership

of Board.

NRS 695I.310         Terms

of office; reappointment; removal; vacancy; expiration of term.

NRS 695I.320         Chair

and Vice Chair: Election; term; vacancy.

NRS 695I.330         Members

serve without compensation; per diem and travel expenses.

NRS 695I.340         Meetings;

quorum; voting.

NRS 695I.350         Subcommittees

and advisory committees.

NRS 695I.360         Compliance

with chapter 241 of NRS.

NRS 695I.370         Powers

and duties of Board; audits.

NRS 695I.380         Executive

Director: Appointment and discharge; duties; appointment and removal of

employees.

NRS 695I.390         Coordination

with Medicaid, Children’s Health Insurance Program and other public programs.

MISCELLANEOUS PROVISIONS

NRS 695I.500         State

agencies to provide support to Exchange; intergovernmental agreements.

NRS 695I.510         Executive

Director may request advance from State General Fund; conditions; notification;

repayment.

NRS 695I.520         Construction

of chapter.

_________

_________

GENERAL PROVISIONS

      NRS 695I.010  Definitions.  As

used in this chapter, unless the context otherwise requires, the words and

terms defined in NRS 695I.020 to 695I.110, inclusive, have the meanings ascribed to

them in those sections.

      (Added to NRS by 2011, 2644)

      NRS 695I.020  “Board” defined.  “Board”

means the Board of Directors of the Exchange.

      (Added to NRS by 2011, 2645)

      NRS 695I.030  “Exchange” defined.  “Exchange”

means the Silver State Health Insurance Exchange.

      (Added to NRS by 2011, 2645)

      NRS 695I.040  “Executive Director” defined.  “Executive

Director” means the Executive Director of the Exchange.

      (Added to NRS by 2011, 2645)

      NRS 695I.050  “Federal Act” defined.  Repealed.

(See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 695I.060  “Medical facility” defined.  “Medical

facility” has the meaning ascribed to it in NRS

449.0151.

      (Added to NRS by 2011, 2645)

      NRS 695I.070  “Provider of health care” defined.  “Provider

of health care” has the meaning ascribed to it in NRS 629.031.

      (Added to NRS by 2011, 2645)

      NRS 695I.080  “Qualified health plan” defined.  Except

as otherwise provided in NRS 695I.370, “qualified

health plan” has the meaning ascribed to it in § 1301 of the Federal Act.

      (Added to NRS by 2011, 2645)

      NRS 695I.090  “Qualified individual” defined.  “Qualified

individual” means a person, including, without limitation, a minor, who:

      1.  Is seeking to enroll in a qualified

health plan offered to persons through the Exchange;

      2.  Resides in Nevada;

      3.  At the time of enrollment is not incarcerated,

unless the person is incarcerated pending the disposition of charges; and

      4.  Is, and is reasonably expected to be,

for the entire period for which enrollment is sought, a citizen of the United

States or an alien lawfully present in the United States.

      (Added to NRS by 2011, 2645)

      NRS 695I.100  “Qualified small employer” defined.  “Qualified

small employer” means a small employer that chooses to make all of its

full-time employees eligible for one or more qualified health plans offered

through the Exchange to assist qualified small employers in Nevada in

facilitating the enrollment of their employees in qualified health plans

offered in the small group market, if the employer:

      1.  Has its principal place of business in

Nevada and chooses to provide coverage through the Exchange to all of its

eligible employees, regardless of where those employees are employed; or

      2.  Regardless of the location of its

principal place of business, chooses to provide coverage through the Exchange

to all of its eligible employees who are principally employed in Nevada.

      (Added to NRS by 2011, 2645)

      NRS 695I.110  “Small employer” defined.  “Small

employer” has the meaning ascribed to it in NRS 689C.095.

      (Added to NRS by 2011, 2645)

ORGANIZATION; POWERS AND DUTIES

      NRS 695I.200  Creation; purpose.  The

Silver State Health Insurance Exchange is hereby established to:

      1.  Facilitate the purchase and sale of

qualified health plans in the individual market in Nevada;

      2.  Assist qualified small employers in

Nevada in facilitating the enrollment and purchase of coverage and the

application for subsidies for small business enrollees;

      3.  Reduce the number of uninsured persons

in Nevada;

      4.  Provide a transparent marketplace for

health insurance and consumer education on matters relating to health

insurance; and

      5.  Assist residents of Nevada with access

to programs, premium assistance tax credits and cost-sharing reductions.

      (Added to NRS by 2011, 2645)

      NRS 695I.210  Powers and duties of Exchange.

      1.  The Exchange shall:

      (a) Create and administer a state-based health

insurance exchange;

      (b) Facilitate the purchase and sale of qualified

health plans;

      (c) Provide for the establishment of a program to

assist qualified small employers in Nevada in facilitating the enrollment of

their employees in qualified health plans offered in the small group market;

      (d) Make only qualified health plans available to

qualified individuals and qualified small employers on or after January 1,

2014; and

      (e) Unless the Federal Act is repealed or is held

to be unconstitutional or otherwise invalid or unlawful, perform all duties

that are required of the Exchange to implement the requirements of the Federal

Act.

      2.  The Exchange may:

      (a) Enter into contracts with any person,

including, without limitation, a local government, a political subdivision of a

local government and a governmental agency, to assist in carrying out the

duties and powers of the Exchange or the Board; and

      (b) Apply for and accept any gift, donation,

bequest, grant or other source of money to carry out the duties and powers of

the Exchange or the Board.

      3.  The Exchange is subject to the

provisions of chapter 333 of NRS.

      (Added to NRS by 2011, 2646)

BOARD OF DIRECTORS

      NRS 695I.300  Membership of Board.

      1.  The governing authority of the Exchange

is the Board, consisting of seven voting members and three ex officio nonvoting

members.

      2.  Subject to the provisions of

subsections 3, 4 and 5:

      (a) The Governor shall appoint five voting

members of the Board;

      (b) The Senate Majority Leader shall appoint one

voting member of the Board; and

      (c) The Speaker of the Assembly shall appoint one

voting member of the Board.

      3.  Each voting member of the Board must

have:

      (a) Expertise in the individual or small employer

health insurance market;

      (b) Expertise in health care administration,

health care financing or health information technology;

      (c) Expertise in the administration of health

care delivery systems;

      (d) Experience as a consumer who would benefit

from services provided by the Exchange; or

      (e) Experience as a consumer advocate, including,

without limitation, experience in consumer outreach and education for those who

would benefit from services provided by the Exchange.

      4.  When making an appointment pursuant to

subsection 2, the Governor, the Majority Leader and the Speaker of the Assembly

shall consider the collective expertise and experience of the voting members of

the Board and shall attempt to make each appointment so that:

      (a) The areas of expertise and experience

described in subsection 3 are collectively represented by the voting members of

the Board; and

      (b) The voting members of the Board represent a

range and diversity of skills, knowledge, experience and geographic and

stakeholder perspectives.

      5.  A voting member of the Board may not be

a Legislator or hold any elective office in State Government.

      6.  While serving on the Board, a voting

member may not be in any way affiliated with a health insurer, including,

without limitation, being an employee of, consultant to or member of the board

of directors of a health insurer, having an ownership interest in a health

insurer or otherwise being a representative of a health insurer.

      7.  The following are ex officio nonvoting

members of the Board who shall assist the voting members of the Board by

providing advice and expertise:

      (a) The Director of the Department of Health and

Human Services, or his or her designee;

      (b) The Director of the Department of Business

and Industry, or his or her designee; and

      (c) The Director of the Department of

Administration, or his or her designee.

      (Added to NRS by 2011, 2646)

      NRS 695I.310  Terms of office; reappointment; removal; vacancy; expiration of

term.

      1.  After the initial terms, the term of

each voting member of the Board is 3 years.

      2.  A voting member of the Board may be

reappointed to the Board.

      3.  The appointing authority who appoints a

voting member of the Board may remove that voting member if the voting member

neglects his or her duty or commits misfeasance, malfeasance or nonfeasance in

office.

      4.  A vacancy on the Board in the position

of a voting member must be filled in the same manner as the original

appointment.

      5.  Upon the expiration of his or her term

of office, a voting member of the Board may continue to serve until he or she

is reappointed or a person is appointed as a successor.

      (Added to NRS by 2011, 2647)

      NRS 695I.320  Chair and Vice Chair: Election; term; vacancy.

      1.  The Board shall elect a Chair and a

Vice Chair from among its members.

      2.  The terms of the Chair and Vice Chair

are 1 year.

      3.  The Chair and Vice Chair may be

reelected to one or more terms.

      4.  If a vacancy occurs, the members of the

Board shall elect a replacement Chair or Vice Chair, as applicable, for the

remainder of the unexpired term.

      (Added to NRS by 2011, 2647)

      NRS 695I.330  Members serve without compensation; per diem and travel

expenses.

      1.  Except as otherwise provided in

subsection 2, the voting members of the Board shall serve without compensation.



      2.  If sufficient money is available from

federal grant funds or revenues generated by the Exchange, each member is

entitled to receive the per diem allowance and travel expenses provided for

state officers and employees generally while attending meetings of the Board or

otherwise engaged in the business of the Board.

      (Added to NRS by 2011, 2647)

      NRS 695I.340  Meetings; quorum; voting.

      1.  The Board shall meet:

      (a) At least once each calendar quarter; and

      (b) At other times upon the call of the Chair or

a majority of the voting members.

      2.  A majority of the voting members of the

Board constitutes a quorum for the transaction of business.

      3.  A member of the Board may not vote by

proxy.

      (Added to NRS by 2011, 2647)

      NRS 695I.350  Subcommittees and advisory committees.

      1.  The Board may appoint subcommittees and

advisory committees composed of members of the Board, former members of the

Board and members of the general public who have experience with or knowledge

of matters relating to health care to consider specific problems or other

matters within the scope of the powers, duties and functions of the Board.

      2.  To the extent practicable, the members

of such a subcommittee or advisory committee must be representative of the

various geographic areas and ethnic groups of this State.

      3.  A member of a subcommittee or an

advisory committee will not be compensated or reimbursed for travel or other

expenses relating to any duties as a member of the subcommittee or advisory

committee.

      (Added to NRS by 2011, 2648)

      NRS 695I.360  Compliance with chapter 241

of NRS.  The Board and any

subcommittee or advisory committee appointed by the Board shall comply with the

provisions of chapter 241 of NRS.

      (Added to NRS by 2011, 2648)

      NRS 695I.370  Powers and duties of Board; audits.

      1.  The Board shall:

      (a) Adopt bylaws setting forth its procedures and

governing its operations;

      (b) On or before June 30 and December 31 of each

year, submit a written fiscal and operational report to the Governor and the

Legislature, which must include, without limitation, any recommendations

concerning the Exchange;

      (c) On or before December 31 of each year,

prepare a report for the public summarizing the activities of the Board and the

contributions of the Exchange to the health of the residents of Nevada during

the previous year;

      (d) Provide for an annual audit of its functions

and operations;

      (e) Submit all reports required by federal law to

the appropriate federal agency and in a timely manner; and

      (f) If the Federal Act is repealed or is held unconstitutional

or otherwise invalid or unlawful, define by regulation “qualified health plan”

for the purposes of this act.

      2.  The Board may:

      (a) Adopt regulations to carry out the duties and

powers of the Exchange;

      (b) Prepare special reports concerning the

Exchange for the Governor, the Legislature and the public; and

      (c) Contract for the services of such legal,

professional, technical and operational personnel and consultants as the

execution of its duties and powers and the operation of the Exchange may

require.

      3.  The Board is subject to Legislative and

Executive Branch audits.

      (Added to NRS by 2011, 2648)

      NRS 695I.380  Executive Director: Appointment and discharge; duties;

appointment and removal of employees.

      1.  The Board shall appoint an Executive

Director of the Exchange.

      2.  The Executive Director:

      (a) Is in the unclassified service of the State;

      (b) Is responsible to the Board and serves at the

pleasure of the Board;

      (c) Must have experience in the administration of

health care or health insurance; and

      (d) Is responsible for the administrative matters

of the Board.

      3.  Subject to the limits of available

funding, the Executive Director may appoint and remove such employees of the

Exchange as are necessary for the administration of the Exchange.

      4.  Employees of the Exchange appointed

pursuant to subsection 3 are in the unclassified service of the State.

      (Added to NRS by 2011, 2648)

      NRS 695I.390  Coordination with Medicaid, Children’s Health Insurance Program

and other public programs.

      1.  The Board and the Department of Health

and Human Services shall ensure that the Exchange coordinates with Medicaid,

the Children’s Health Insurance Program and any other applicable state or local

public programs to create a single point of entry for users of the Exchange who

are eligible for such programs and to promote continuity of coverage and care.

      2.  As used in this section, “Children’s

Health Insurance Program” has the meaning ascribed to it in NRS 422.021.

      (Added to NRS by 2011, 2649)

MISCELLANEOUS PROVISIONS

      NRS 695I.500  State agencies to provide support to Exchange; intergovernmental

agreements.  The Department of

Health and Human Services, the Division of Insurance of the Department of

Business and Industry and any other relevant state agency shall work with and

provide support to the Exchange as it carries out its duties and powers,

including, without limitation, entering into agreements to share information

and intergovernmental agreements with the Exchange.

      (Added to NRS by 2011, 2649)

      NRS 695I.510  Executive Director may request advance from State General Fund;

conditions; notification; repayment.

      1.  If the Executive Director determines

that the current expenses of the Exchange exceed the amount of money available

because of a delay in the receipt of money from federal grants or a delay in

the receipt of revenue from other sources, the Executive Director may request

from the Department of Administration an advance from the State General Fund

for the payment of authorized expenses.

      2.  If the Director of the Department of

Administration approves a request made pursuant to subsection 1, he or she

shall notify the State Controller and the Fiscal Analysis Division of the

Legislative Counsel Bureau of the amount of advance approved.

      3.  Upon receiving notification pursuant to

subsection 2, the State Controller shall draw his or her warrant for payment of

the approved amount.

      4.  An advance made pursuant to this

section must not exceed 25 percent of the revenue expected to be received from

any source other than legislative appropriation during the fiscal year in which

the request is made.

      5.  Any money which is advanced pursuant to

this section must be repaid by the Exchange to the State General Fund not later

than August 31 immediately after the end of the fiscal year during which the

advance is made.

      (Added to NRS by 2011, 2649)

      NRS 695I.520  Construction of chapter.  Nothing

in this chapter, and no action taken by the Exchange pursuant to this chapter,

shall be construed to preempt or supersede the authority of the Commissioner to

regulate the business of insurance within this State.

      (Added to NRS by 2011, 2649)

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