1. A managed care organization that issues a health care plan shall include in the
plan coverage for:
(a) Necessary case management services for an insured diagnosed with sickle cell disease
and its variants; and
(b) Medically necessary care for an insured who has been diagnosed with sickle cell
disease and its variants.
2. A managed care organization that issues a health care plan which provides coverage
for prescription drugs shall include in the plan coverage for medically necessary
prescription drugs to treat sickle cell disease and its variants.
3. A managed care organization shall establish a plan for each insured under 18 years
of age who has been diagnosed with sickle cell disease and its variants to transition
the insured from pediatric care to adult care when the insured reaches 18 years of
4. A managed care organization may use medical management techniques, including, without
limitation, any available clinical evidence, to determine the frequency of or treatment
relating to any benefit required by this section or the type of provider of health
care to use for such treatment.
5. As used in this section:
(a) “Case management services” means medical or other health care management services to assist patients and providers
of health care, including, without limitation, identifying and facilitating additional
resources and treatments, providing information about treatment options and facilitating
communication between providers of services to a patient.
(b) “Medical management technique” means a practice which is used to control the cost or utilization of health care
services. The term includes, without limitation, the use of step therapy, prior authorization
or categorizing drugs and devices based on cost, type or method of administration.
(c) “Sickle cell disease and its variants” has the meaning ascribed to it in NRS 439.4927.
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