Existing law prohibits certain unfair trade practices in the business of insurance. (NRS 686A.010-686A.310) Existing law prohibits an insurer from entering into a contract with a provider of vision care that conditions any rate of reimbursement for vision care on the provider of vision care prescribing certain ophthalmic devices or materials or increases the rate of reimbursement if the provider of vision care prescribes such ophthalmic devices or materials. Existing law also prohibits an insurer from entering into a contract with a provider of vision care that: (1) authorizes the insurer to set or limit the amount that the provider of vision care may charge for vision care that is not reimbursed under the contract; or (2) requires the provider of vision care to use a specific laboratory as the manufacturer of ophthalmic devices or materials provided to a covered person. Finally, existing law requires a provider of vision care to disclose to any covered person an ownership or pecuniary interest of the provider in a supplier of ophthalmic devices or materials before the covered person authorizes the provider to obtain covered eyewear materials from such a supplier. (NRS 686A.135) Existing law authorizes the Commissioner of Insurance to investigate a violation of and enforce those provisions as an unfair or deceptive trade practice. (NRS 686A.020, 686A.160, 686A.170, 686A.183) Sections 2-34 and 37 of this bill revise provisions of existing law governing vision care and set forth various additional requirements and restrictions governing vision benefit managers. Section 15 defines “vision benefit manager” to mean a person, including, without limitation, an insurer, third-party administrator or subcontractor, that creates, promotes, sells, provides, operates, advertises or administers a vision benefit plan or vision benefit discount plan. Section 16 defines “vision benefit plan” to mean a policy, contract, certificate or agreement offered by a vision benefit manager to provide for, deliver payment for, arrange for the payment of, pay for or reimburse any of the costs of vision care. Section 16 specifies that the term includes a standalone vision benefit plan or a health benefit plan that provides coverage for vision care. Section 14 defines “vision benefit discount plan” to mean a policy, contract, certificate or agreement offered by a vision benefit manager to an enrollee that solely provides for a discount for covered services or covered materials. Because an insurer that provides a vision benefit plan constitutes a vision benefit manager, section 37 revises the provisions of existing law setting forth certain prohibitions on insurers with respect to vision care to replace references to an insurer with references to a vision benefit manager. Section 37 additionally prohibits a vision benefit manager from: (1) requiring a provider of vision care to use a specific source or supplier for certain materials, including ophthalmic devices; and (2) paying reimbursement to a provider of vision care which is not reasonable and not substantially similar to rates for reimbursement under Medicare. Section 18 prohibits a vision benefit manager from limiting the reimbursement or choice of a provider of vision care for services or materials which are not covered by a plan. Sections 19, 20, 25 and 30-32 prohibit certain provisions in a contract or agreement between a vision benefit manager and a provider of vision care. Section 21 prohibits a vision benefit manager from falsely representing the number of participating providers of vision care or the benefits that compose a plan. Section 22 prohibits a vision benefit manager from engaging in certain marketing or advertising activities. Section 23 prohibits a vision benefit manager from retroactively reversing a reimbursement to a provider of vision care if the provider relied in good faith on certain information at the time of service. Section 24 authorizes a provider of vision care to offer a cash price option for certain services and materials under certain circumstances. Section 26 requires a vision benefit manager, under certain circumstances, to provide the same reimbursement to an optometrist for certain services or materials as if the services or materials were provided by a physician. Section 27 establishes procedures for amending or terminating a contract between a vision benefit manager and a provider of vision care. Sections 28 and 29 prohibit certain actions of a vision benefit manager relating to certain business practices, billing practices, audit practices and receiving personal or confidential information of an enrollee. Section 34 authorizes a provider of vision care who is adversely affected by certain violations by a vision benefit manager to bring a civil action to recover his or her actual damages, punitive damages and other equitable relief. Section 33 makes the provisions of this bill which are applicable to a vision benefit manager equally applicable to any affiliate or subcontractor that a vision benefit manager uses or enters into a contract with for certain activities. Section 33 additionally makes the provisions of this bill which are applicable to contracts between a provider of vision care and a vision benefit manager equally applicable to certain other agreements. Sections 35, 36 and 38-43 of this bill make provisions of existing law which are generally applicable to certain unfair or deceptive trade practices in the business of insurance specifically applicable to the provisions of sections 2-34. Sections 44-47 of this bill provide that certain entities that provide coverage for vision care, including local governments and the Public Employees' Benefits Program, are subject to the provisions of sections 2-34. Sections 3-17 define certain words and terms for the purposes of this bill.

Statutes affected:
As Introduced: 686A.010, 686A.020, 686A.135, 686A.160, 686A.170, 686A.183, 686A.520, 689.160, 689.595, 695C.300, 695F.090, 287.010, 287.04335
BDR: 686A.010, 686A.020, 686A.135, 686A.160, 686A.170, 686A.183, 686A.520, 689.160, 689.595, 695C.300, 695F.090, 287.010, 287.04335