[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 [Repealed.]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.
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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 Repealed.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)
