A.B. 448
- *AB448*
ASSEMBLY BILL NO. 448–ASSEMBLYMEMBER KOENIG
MARCH 17, 2025
____________
Referred to Committee on Commerce and Labor
SUMMARY—Revises provisions relating to insurance for vision
care. (BDR 57-983)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§ 46)
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT)
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to health care; establishing various requirements
relating to vision benefit managers and providers of vision
care; revising provisions relating to certain contracts
between an insurer and a provider of vision care;
prohibiting certain conduct of a vision benefit manager or
provider of vision care which would constitute an unfair
or deceptive trade practice in the business of insurance;
authorizing a provider of vision care to bring a civil action
against a vision benefit manager under certain
circumstances; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing law prohibits certain unfair trade practices in the business of 1
insurance. (NRS 686A.010-686A.310) Existing law prohibits an insurer from 2
entering into a contract with a provider of vision care that conditions any rate of 3
reimbursement for vision care on the provider of vision care prescribing certain 4
ophthalmic devices or materials or increases the rate of reimbursement if the 5
provider of vision care prescribes such ophthalmic devices or materials. Existing 6
law also prohibits an insurer from entering into a contract with a provider of vision 7
care that: (1) authorizes the insurer to set or limit the amount that the provider of 8
vision care may charge for vision care that is not reimbursed under the contract; or 9
(2) requires the provider of vision care to use a specific laboratory as the 10
manufacturer of ophthalmic devices or materials provided to a covered person. 11
Finally, existing law requires a provider of vision care to disclose to any covered 12
person an ownership or pecuniary interest of the provider in a supplier of 13
ophthalmic devices or materials before the covered person authorizes the provider 14
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to obtain covered eyewear materials from such a supplier. (NRS 686A.135) 15
Existing law authorizes the Commissioner of Insurance to investigate a violation of 16
and enforce those provisions as an unfair or deceptive trade practice. (NRS 17
686A.020, 686A.160, 686A.170, 686A.183) 18
Sections 2-34 and 37 of this bill revise provisions of existing law governing 19
vision care and set forth various additional requirements and restrictions governing 20
vision benefit managers. Section 15 defines “vision benefit manager” to mean a 21
person, including, without limitation, an insurer, third-party administrator or 22
subcontractor, that creates, promotes, sells, provides, operates, advertises or 23
administers a vision benefit plan or vision benefit discount plan. Section 16 defines 24
“vision benefit plan” to mean a policy, contract, certificate or agreement offered by 25
a vision benefit manager to provide for, deliver payment for, arrange for the 26
payment of, pay for or reimburse any of the costs of vision care. Section 16 27
specifies that the term includes a standalone vision benefit plan or a health benefit 28
plan that provides coverage for vision care. Section 14 defines “vision benefit 29
discount plan” to mean a policy, contract, certificate or agreement offered by a 30
vision benefit manager to an enrollee that solely provides for a discount for covered 31
services or covered materials. 32
Because an insurer that provides a vision benefit plan constitutes a vision 33
benefit manager, section 37 revises the provisions of existing law setting forth 34
certain prohibitions on insurers with respect to vision care to replace references to 35
an insurer with references to a vision benefit manager. Section 37 additionally 36
prohibits a vision benefit manager from: (1) requiring a provider of vision care to 37
use a specific source or supplier for certain materials, including ophthalmic 38
devices; and (2) paying reimbursement to a provider of vision care which is not 39
reasonable and not substantially similar to rates for reimbursement under Medicare. 40
Section 18 prohibits a vision benefit manager from limiting the reimbursement 41
or choice of a provider of vision care for services or materials which are not 42
covered by a plan. Sections 19, 20, 25 and 30-32 prohibit certain provisions in a 43
contract or agreement between a vision benefit manager and a provider of vision 44
care. 45
Section 21 prohibits a vision benefit manager from falsely representing the 46
number of participating providers of vision care or the benefits that compose a plan. 47
Section 22 prohibits a vision benefit manager from engaging in certain marketing 48
or advertising activities. Section 23 prohibits a vision benefit manager from 49
retroactively reversing a reimbursement to a provider of vision care if the provider 50
relied in good faith on certain information at the time of service. Section 24 51
authorizes a provider of vision care to offer a cash price option for certain services 52
and materials under certain circumstances. Section 26 requires a vision benefit 53
manager, under certain circumstances, to provide the same reimbursement to an 54
optometrist for certain services or materials as if the services or materials were 55
provided by a physician. Section 27 establishes procedures for amending or 56
terminating a contract between a vision benefit manager and a provider of vision 57
care. 58
Sections 28 and 29 prohibit certain actions of a vision benefit manager relating 59
to certain business practices, billing practices, audit practices and receiving 60
personal or confidential information of an enrollee. Section 34 authorizes a 61
provider of vision care who is adversely affected by certain violations by a vision 62
benefit manager to bring a civil action to recover his or her actual damages, 63
punitive damages and other equitable relief. Section 33 makes the provisions of this 64
bill which are applicable to a vision benefit manager equally applicable to any 65
affiliate or subcontractor that a vision benefit manager uses or enters into a contract 66
with for certain activities. Section 33 additionally makes the provisions of this bill 67
which are applicable to contracts between a provider of vision care and a vision 68
benefit manager equally applicable to certain other agreements. 69
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Sections 35, 36 and 38-43 of this bill make provisions of existing law which 70
are generally applicable to certain unfair or deceptive trade practices in the business 71
of insurance specifically applicable to the provisions of sections 2-34. Sections 44-72
47 of this bill provide that certain entities that provide coverage for vision care, 73
including local governments and the Public Employees’ Benefits Program, are 74
subject to the provisions of sections 2-34. 75
Sections 3-17 define certain words and terms for the purposes of this bill. 76
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 686A of NRS is hereby amended by 1
adding thereto the provisions set forth as sections 2 to 34, inclusive, 2
of this act. 3
Sec. 2. As used in NRS 686A.135 and sections 2 to 34, 4
inclusive, of this act, unless the context otherwise requires, the 5
words and terms defined in sections 3 to 17, inclusive, of this act 6
have the meanings ascribed to them in those sections. 7
Sec. 3. “Chargeback” means a dollar amount, fee, 8
surcharge, rebate or item of value that reduces, modifies or offsets 9
all or part of the: 10
1. Amount that an enrollee is required to pay for a covered 11
service or covered material; 12
2. Amount for which a provider of vision care will be 13
reimbursed for a covered service or covered material; 14
3. Maximum amount a vision benefit manager will pay for a 15
covered service or covered material; or 16
4. The fee for a covered service or covered material, as set 17
forth on a schedule of fees established by a vision benefit 18
manager. 19
Sec. 4. “Contractual discount” means a percentage 20
reduction from the usual and customary rate of a provider of 21
vision care for covered services and covered materials required 22
under an agreement between a provider of vision care and a vision 23
benefit manager. 24
Sec. 5. “Covered material” means any material for which: 25
1. Reimbursement from a vision benefit manager is provided 26
to a provider of vision care by a vision benefit plan of an enrollee, 27
or for which a reimbursement would be available but for the 28
application of the contractual limitations on deductibles, 29
copayments or coinsurance applicable for the enrollee, regardless 30
of how the materials are listed or described in the definition of 31
benefits in a vision benefit plan of an enrollee; or 32
2. A discount is provided by a vision benefit discount plan of 33
an enrollee. 34
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Sec. 6. “Covered services” means the professional work 1
performed by a provider of vision care for which: 2
1. Reimbursement from a vision benefit manager is provided 3
to a provider of vision care by a vision benefit plan of an enrollee, 4
or for which a reimbursement would be available but for the 5
application of the contractual plan limitations of deductibles, 6
copayments or coinsurance, regardless of how the services are 7
listed or described in the definition of benefits in a vision benefit 8
plan of an enrollee; or 9
2. A discount is provided by a vision benefit discount plan of 10
an enrollee. 11
Sec. 7. “Enrollee” means any person participating in or 12
entitled to receive covered services or covered materials through a 13
vision benefit plan or vision benefit discount plan that is 14
purchased by the person or provided to the person by another 15
person or a governmental entity. 16
Sec. 8. “Extrapolation” means a mathematical formula, 17
process or technique used by a vision benefit manager or the agent 18
of a vision benefit manager in the audit of a provider of vision 19
care to estimate the audit results or findings for a larger batch or 20
group of claims not reviewed by the vision benefit manager. 21
Sec. 9. “Materials” means ophthalmic devices, including, 22
without limitation, lenses, devices containing lenses, artificial 23
intraocular lenses, ophthalmic frames and other lens mounting 24
apparatuses, prisms, lens treatments and coatings, contact lenses, 25
low vision devices, vision therapy devices and prosthetic devices, 26
used to correct, relieve or treat defects or abnormal conditions of 27
the human eye or its adnexa, or any other material authorized for 28
use in chapter 636 of NRS and any regulations adopted pursuant 29
thereto. 30
Sec. 10. “Participating provider of vision care” means a 31
provider of vision care that has entered into a contractual 32
agreement or other business relationship with a vision benefit 33
manager to provide covered services or covered materials. 34
Sec. 11. “Provider of vision care” means a physician who 35
provides vision care or an optometrist. 36
Sec. 12. “Subcontractor” means a person, including, without 37
limitation, an agent, servant, broker, wholesaler, distributor, 38
partially or wholly owned subsidiary or controlled organization of 39
a vision benefit manager, that is contracted by a vision benefit 40
manager to supply covered services or covered materials to 41
another vision benefit manager, provider of vision care or enrollee 42
to execute or fulfill the vision benefit plan or vision benefit 43
discount plan of the vision benefit manager. 44
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Sec. 13. “Third-party administrator” means a person that 1
provides services, including, without limitation, administrative, 2
operational, regulatory, human resource, compliance and claim 3
adjudication services, for a vision benefit manager under a 4
contract or agreement with the vision benefit manager. 5
Sec. 14. “Vision benefit discount plan” means a policy, 6
contract, certificate or agreement offered by a vision benefit 7
manager to an enrollee that solely provides for a discount for 8
covered services or covered materials. 9
Sec. 15. “Vision benefit manager” means a person, 10
including, without limitation, an insurer, third-party administrator 11
or subcontractor, that creates, promotes, sells, provides, operates, 12
advertises or administers a vision benefit plan or vision benefit 13
discount plan. 14
Sec. 16. 1. “Vision benefit plan” means a policy, contract, 15
certificate or agreement offered by a vision benefit manager to 16
provide for, deliver payment for, arrange for the payment of, pay 17
for or reimburse any of the costs of vision care. 18
2. The term includes, without limitation: 19
(a) A policy, contract, certificate or agreement which only pays 20
for or reimburses any of the costs of vision care and is offered or 21
issued separately from any health benefit plan, as defined in 22
NRS 695G.019. 23
(b) A health benefit plan, as defined in NRS 695G.019, that 24
provides coverage for vision care. 25
Sec. 17. “Vision care” means routine ophthalmological 26
evaluation of the eye, including refraction. 27
Sec. 18. A vision benefit manager shall not: 28
1. Mandate or otherwise condition reimbursement or 29
participation in a vision benefit plan or vision benefit discount 30
plan on terms relating to the pricing for services or materials that 31
are not covered services or covered materials; or 32
2. Influence or limit the choice of an enrollee as to a provider 33
of vision care for services or materials that are not covered 34
services or covered materials. 35
Sec. 19. A contract between a vision benefit manager and a 36
provider of vision care must not contain any provision which 37
requires the provider of vision care to: 38
1. Provide covered services or covered materials to an 39
enrollee at a financial loss, taking into account any applicable 40
discounts and chargebacks. 41
2. Accept a reimbursement payment in the form of a credit 42
card or any other payment method which requires a fee for 43
processing or administration or a percentage or dollar amount 44
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which is assessed against the provider of vision care in order to 1
receive the payment. 2
3. Share equally the expenses of any arbitration, except that 3
each party to an arbitration may bear its own costs subject to a 4
fee-shifting provision for a prevailing party. 5
4. Establish a security interest in all or part of the assets of 6
the provider of vision care in the event of a termination described 7
in subsection 6 of section 27 of this act. 8
Sec. 20. 1. Except as otherwise provided in subsection 2, 9
the period prescribed by a contract between any vision benefit 10
manager and a provider of vision care for the vision benefit 11
manager to recover any reimbursement amount from the provider 12
of vision care must be the same period allowed or required for the 13
vision benefit manager to remit the applicable reimbursement 14
after the submission by a provider of vision care of a claim for 15
covered services rendered or covered materials furnished that does 16
not contain any defects or other issues that would delay the 17
remittance. 18
2. The provisions of subsection 1 must not be construed to 19
limit the ability of a vision benefit manager to conduct an audit of 20
claims, in accordance with the written policies of the vision benefit 21
manager and applicable law, in the event that the vision benefit 22
manager has a reasonable belief that the provider of vision care 23
has engaged in fraud, waste or abuse. 24
Sec. 21. A vision benefit manager shall not falsely represent 25
the number of participating providers of vision care within a 26
particular region or the benefits that compose a vision benefit plan 27
or vision benefit discount plan. 28
Sec. 22. A vision benefit manager shall not: 29
1. Promote or use in any marketing or advertising to a client, 30
purchaser, company, enrollee or prospective enrollee any 31
statement that a covered service or covered material is free, no 32
charge or complimentary or that uses any other materially similar 33
language. 34
2. Offer an enrollee a varying deductible, copay, coinsurance, 35
coverage amount, rebate, gift card or other incentive to obtain 36
covered services, covered materials or other services or materials 37
at: 38
(a) Any particular participating provider of vision care; 39
(b) A retail establishment owned by, partially owned by, 40
contracted with or otherwise affiliated with the vision benefit 41
manager; or 42
(c) Any provider of vision care accessed primarily through an 43
Internet website or other virtual means that is owned by, partially 44
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owned by, contracted with or otherwise affiliated with the vision 1
benefit manager. 2
3. Engage in marketing or advertising activities that may be 3
misleading or deceptive to the public. Upon request by an 4
applicable enforcement agency, a vision benefit manager shall 5
submit all information regarding alleged savings and discounts 6
offered by any affiliate of the vision benefit manager. 7
Sec. 23. A vision benefit manager: 8
1. Shall reimburse a provider of vision care the contracted 9
amount for a covered service or covered material provided to an 10
enrollee if the provider of vision care verifies the enrollee as 11
eligible to receive the covered service or covered material on the 12
date of service through the customary methods of verification of 13
the vision benefit manager. 14
2. Shall not retroactively reverse reimbursement to a provider 15
of vision care who relied in good faith on the presented coverage 16
credentials of a person and the customary methods of verification 17
of the vision benefit manager at the time of service, even if the 18
vision benefit manager determines at a later date that the enrollee 19
was ineligible to receive covered services or covered materials on 20
the date of service. 21
Sec. 24. 1. A provider of vision care may offer an enrollee 22
a cash price option for covered services and covered materials 23
instead of using the benefit of the enrollee if the cash price option 24
is an amount which is less than the total out-of-pocket cost for the 25
service or material. 26
2. A provider of vision care must not be subject to an audit 27
solely for offering a cash price option for covered services and 28
covered materials pursuant to subsection 1. 29
Sec. 25. 1. An agreement between a vision benefit manager 30
and a provider of vision care must not require that a provider of 31
vision care participate in or be credentialed by any specific vision 32
benefit plan or vision benefit discount plan as a condition for 33
participation in the provider network of the vision benefit manager 34
to provide covered services or covered materials to enrollees. 35
2. A vision benefit manager shall not require a provider of 36
vision care to possess, offer for sale or sell materials in the office 37
of the provider of vision care as a condition of participation in a 38
provider network. 39
3. A vision benefit manager shall: 40
(a) Apply the same terms and conditions of participation to all 41
the participating providers of vision care regardless of the 42
educational credentials of the provider of vision care, subject to 43
the permitted scope of practice for any licensee under applicable 44
state law; and 45
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(b) Identify participating providers of vision care in a neutral 1
manner, which does not distinguish between participating 2
providers of vision care based on any of the following 3
characteristics: 4
(1) A discount or incentive offered by the provider of vision 5
care for services and materials which are not covered by the vision 6
benefit plan or vision benefit discount plan of the vision benefit 7
manager. 8
(2) The dollar amount, volume amount or percent usage 9
amount of any material or good which is purchased by the 10
provider of vision care. 11
(3) The brand, source, manufacturer or supplier of a 12
covered service or covered material used or provided by the 13
provider of vision care. 14
Sec. 26. A vision benefit manager shall, if issuing or 15
renewing a vision benefit plan or vision benefit discount plan 16
which provides benefits for covered services or covered materials 17
rendered by a physician licensed under chapter 630 or 633 of NRS 18
which are within the scope of practice of an optometrist licensed 19
under chapter 636 of NRS, provide the same reimbursement to an 20
optometrist for covered services or covered materials rendered by 21
an optometrist as allowed for the same covered services or covered 22
materials if rendered by a physician. 23
Sec. 27. 1. A vision benefit manager shall not change or 24
alter a contract, including, without limitation, a term, 25
reimbursement rate or fee schedule contained in a contract, that 26
the vision benefit manager enters into with a participating 27
provider of vision care unless, at least 90 days before the date on 28
which the proposed change would become effective: 29
(a) The vision benefit manager: 30
(1) Sends to the provider of vision care by certified mail, 31
return receipt requested, or any other mailing process that 32
requires a signature on delivery, or a method of electronic 33
communication which requires an electronic signature: 34
(I) A detailed written description of the proposed 35
change; and 36
(II) A copy of the contract with the proposed change 37
clearly marked in the body of the contract, in a form that is easily 38
understood and conducive to review by the provider of vision care; 39
and 40
(2) Upon request of the provider of vision care, meets with 41
the provider of vision care to discuss the proposed change in 42
person, by telephone or by other audiovisual or electronic means; 43
and 44
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(b) The provider of vision care agrees, in writing, to the 1
proposed change. 2
2. If a provider of vision care does not agree to the change or 3
alteration to a contract which is proposed pursuant to subsection 4
1, the provider of vision care shall provide notice of that fact to the 5
vision benefit manager in writing. 6
3. A vision benefit manager shall not remove a provider of 7
vision care from the network of participating providers of vision 8
care included under a vision benefit plan or vision benefit 9
discount plan solely because the provider of vision care does not 10
agree to any change or alteration to a contract which is proposed 11
pursuant to subsection 1. 12
4. A vision benefit manager and a provider of vision care 13
must execute a new contract if the parties to the contract make 14
three or more material changes or alterations pursuant to 15
subsection 1. 16
5. A vision benefit manager shall not terminate a contract 17
described in this section except in the event of a material breach 18
by the provider of vision care. In the event of an alleged material 19
breach: 20
(a) The vision benefit manager shall provide written notice to 21
the provider of vision care which describes the alleged breach; and 22
(b) The provider has 30 days after the date on which the 23
provider receives the written notice to remedy the alleged breach to 24
the reasonable satisfaction of the insurer or vision benefit 25
manager. 26
6. If a vision benefit manager terminates a contract pursuant 27
to subsection 5, the vision benefit manager shall not require the 28
provider of vision care to establish a security interest in all or part 29
of the property and assets of the provider, including assets 30
pertaining to the practice of the provider, in an amount equal to 31
any money which is owed to the vision benefit manager at the time 32
of termination. 33
Sec. 28. A vision benefit manager shall not directly or 34
indirectly: 35
1. Control or attempt to control the professional judgment, 36
manner of practice or practice of a provider of vision care. 37
2. Employ a provider of vision care to provide a covered 38
service or covered material. 39
3. Withhold or recoup payment to a provider of vision care 40
for covered services or covered materials which are provided to an 41
enrollee if the enrollee was shown to be eligible on the date that 42
the covered services or covered materials were provided. 43
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4. Reimburse a provider of vision care a different amount for 1
covered services or covered materials because of the choice of the 2
provider of vision care of the: 3
(a) Optical laboratory. 4
(b) Source of supplier of: 5
(1) Contact lenses; 6
(2) Ophthalmic lenses; 7
(3) Ophthalmic glasses frames; or 8
(4) Covered or non-covered services or materials. 9
(c) Equipment used for patient care. 10
(d) Retail optical affiliation. 11
(e) Vision support organization. 12
(f) Organization for group purchasing. 13
(g) Doctor alliance. 14
(h) Membership in a professional trade association. 15
(i) Software for management of the practice of the provider of 16
vision care, including, without limitation, for maintenance of 17
electronic health or medical records. 18
(j) Services for billing, filing third-party claims or securely 19
exchanging electronic business documents. 20
5. Restrict, limit or influence the choice of a provider of 21
vision care of the software or services described in paragraph (i) 22
or (j) of subsection 4. 23
6. Restrict or limit the access of a provider of vision care to 24
complete information concerning the coverage provided by the 25
vision benefit plan or vision benefit discount plan of an enrollee, 26
including, without limitation, details for coverage which is in-27
network and out-of-network. 28
7. Apply a chargeback to an enrollee or provider of vision 29
care if the chargeback is for a covered material or covered service 30
for which the vision benefit manager does not incur the cost to 31
produce, deliver or provide to the enrollee or provider of vision 32
care. 33
8. Require a provider of vision care to: 34
(a) Disclose any confidential or protected health information 35
of an enrollee, unless expressly authorized by the enrollee or 36
permitted under the Health Insurance Portability and 37
Accountability Act of 1996, Public Law 104-191, as amended. 38
(b) Disclose or report a medical history or diagnosis as a 39
condition to file a claim, adjudicate a claim or receive 40
reimbursement for a routine or wellness eye examination. 41
(c) Disclose or report the glasses prescription, contact lens 42
prescription, ophthalmic device measurements, facial photograph 43
or unique anatomical measurements of an enrollee as a condition 44
to file a claim, adjudicate a claim or receive reimbursement for a 45
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claim, unless the information is needed for the vision benefit 1
manager to manufacture or cause to be manufactured a covered 2
material that is submitted on the applicable claim. 3
(d) Disclose any information relating to an enrollee, other 4
than information identified on the most recent version of Form 5
CMS-1500, or its successor form, published by the National 6
Uniform Claim Committee, or its successor organization, and 7
approved by the Commissioner, as a condition to file a claim, 8
adjudicate a claim or receive reimbursement for a claim unless the 9
information is needed for the vision benefit manager to 10
manufacture or cause to be manufactured a covered material that 11
is submitted on the applicable claim. 12
Sec. 29. 1. A vision benefit manager shall not use 13
extrapolation to complete an audit of a participating provider of 14
vision care. 15
2. Any additional payment due to a participating provider of 16
vision care or any refund due to the vision benefit manager must 17
be based on the actual overpayment or underpayment and not an 18
extrapolation. 19
3. For the purpose of subsection 2, actual overpayment or 20
underpayment must be determined after: 21
(a) An investigation conducted and findings made by the 22
vision benefit manager; and 23
(b) The participating provider of vision care has been afforded 24
and has exhausted all opportunities to appeal the findings of the 25
vision benefit manager in accordance with any manual provided 26
by the vision benefit manager to the provider of vision care, any 27
policies of the vision benefit manager and applicable law. 28
Sec. 30. 1. A vision benefit manager that offers more than 29
one vision benefit plan or vision benefit discount plan shall not 30
require a provider of vision care, as a condition of participation in 31
a vision benefit plan or vision benefit discount plan, to participate 32
in any of the other vision benefit plans or vision benefit discount 33
plans of the vision benefit manager. 34
2. In addition to any other remedy provided by law, any 35
provision in a contract which violates subsection 1 is void and 36
unenforceable. 37
Sec. 31. 1. A contract between a vision benefit manager 38
and a provider of vision care must not have a duration longer than 39
2 years from the date the contract was signed by all parties. 40
2. A vision benefit manager shall not construe 41
recredentialing as recontracting with a participating provider of 42
vision care. A contract between a vision benefit manager and a 43
provider of vision care must be a distinctly separate document 44
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from any credentialing materials and must be signed by the 1
provider of vision care and the vision benefit manager. 2
3. A vision benefit manager shall include a copy of any 3
manual and any policies referred to in a contract between a vision 4
benefit manager and a provider of vision care at the time the 5
contract is sent to any participating provider of vision care and 6
prospective participating provider of vision care. 7
Sec. 32. A vision benefit manager shall not engage in 8
negotiations or enter into an agreement with any person on behalf 9
of any independent affiliated provider of vision care regarding 10
reimbursement, copayments, coinsurance or materials supply 11
chain. Any agreement between a provider of vision care and a 12
vision benefit manager must be negotiated directly between the 13
provider of vision care and the vision benefit manager. 14
Sec. 33. 1. Any affiliate or subcontractor who is used by a 15
vision benefit manager to supply covered services or covered 16
materials to a provider of vision care or enrollee is subject to the 17
provisions of NRS 686A.135 and sections 2 to 34, inclusive, of this 18
act to the same extent as a vision benefit manager. 19
2. The following agreements are subject to the provisions of 20
NRS 686A.135 and sections 2 to 34, inclusive, of this act to the 21
same extent as a contract between a provider of vision care and a 22
vision benefit manager: 23
(a) Any subcontract or agreement that a provider of vision 24
care enters into with another provider of vision care to provide 25
vision care to an enrollee or a covered dependent of an enrollee of 26
a vision benefit plan or vision benefit discount plan, where the 27
subcontracted provider of vision care will seek reimbursement 28
from the plan or enrollee for the subcontracted materials or 29
services. 30
(b) Any agreement a vision benefit manager enters into with 31
another person to provide an enrollee with covered services or 32
covered materials. 33
Sec. 34. In addition to any other remedy provided by law, any 34
provider of vision care who is aggrieved by a violation of NRS 35
686A.135 and sections 2 to 34, inclusive, of this act may bring a 36
civil action in a court of competent jurisdiction to seek any or all 37
of the following relief: 38
1. Declaratory and injunctive relief. 39
2. Actual damages. 40
3. Punitive or exemplary damages in an amount not to exceed 41
$10,000 for each violation. 42
4. Reasonable attorney’s fees and costs. 43
5. Any other legal or equitable relief that the court deems 44
appropriate. 45
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Sec. 35. NRS 686A.010 is hereby amended to read as follows: 1
686A.010 The purpose of NRS 686A.010 to 686A.310, 2
inclusive, and sections 2 to 34, inclusive, of this act is to regulate 3
trade practices in the business of insurance in accordance with the 4
intent of Congress as expressed in the Act of Congress approved 5
March 9, 1945, being c. 20, 59 Stat. 33, also designated as 15 U.S.C. 6
§§ 1011 to 1015, inclusive, and Title V of Public Law 106-102, 15 7
U.S.C. §§ 6801 et seq. 8
Sec. 36. NRS 686A.020 is hereby amended to read as follows: 9
686A.020 A person shall not engage in this state in any 10
practice which is defined in NRS 686A.010 to 686A.310, inclusive, 11
and sections 2 to 34, inclusive, of this act as, or determined 12
pursuant to NRS 686A.170 to be, an unfair method of competition 13
or an unfair or deceptive act or practice in the business of insurance. 14
Sec. 37. NRS 686A.135 is hereby amended to read as follows: 15
686A.135 1. [An insurer] A vision benefit manager shall not 16
enter into a contract with a provider of vision care that: 17
(a) Authorizes the [insurer] vision benefit manager to set or 18
limit the amount that the provider of vision care may charge for 19
vision care that is not reimbursed under the contract; 20
(b) Requires the provider of vision care to use a specific 21
laboratory as the manufacturer of [ophthalmic devices or] materials 22
provided to [covered persons; or] enrollees; 23
(c) Requires the provider of vision care to use a specific source 24
or supplier of covered materials or other materials; or 25
(d) Conditions any rate of reimbursement for vision care on the 26
provider of vision care prescribing [ophthalmic devices or] materials 27
in which the [insurer] vision benefit manager has an ownership or 28
other pecuniary interest or increases the rate of reimbursement if the 29
provider of vision care prescribes such [ophthalmic devices or] 30
materials. 31
2. Reimbursement which is paid by a vision benefit manager 32
to a provider of vision care for covered services and covered 33
materials, regardless of the supplier or optical laboratory used, 34
must be: 35
(a) Reasonable and not nominal or de minimis; and 36
(b) Substantially similar to rates for reimbursement under 37
Medicare for the current year. 38
3. Before entering into a contract with a provider of vision care 39
to include the provider of vision care in the network of [an insurer,] 40
a vision benefit manager, the [insurer] vision benefit manager must 41
provide to the provider of vision care a list of the rates of 42
reimbursement for each service covered by the contract. 43
[3. An insurer] 44
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4. A vision benefit manager shall disclose in any [policy of 1
insurance that covers] vision [care] benefit plan or vision benefit 2
discount plan or any description of benefits covered by such a 3
[policy,] plan, whether written or electronic, any ownership or other 4
pecuniary interest of the [insurer] vision benefit manager in a 5
supplier of [ophthalmic devices or] materials or a provider of vision 6
care. The disclosure must appear in a conspicuous and clear manner. 7
[4. An insurer] 8
5. A vision benefit manager that does not provide 9
reimbursement for specific vision care shall not claim in any 10
advertisement or other material that the [insurer] vision benefit 11
manager covers that vision care if such vision care is available at a 12
discount or with a copayment or coinsurance in an amount that is in 13
addition to the copayment or coinsurance that [a covered person] an 14
enrollee is typically required to pay for covered services. 15
[5.] 6. A provider of vision care shall disclose in writing to any 16
[covered person] enrollee under a [policy of insurance that covers] 17
vision [care] benefit plan or vision benefit discount plan any 18
ownership or other pecuniary interest of the provider of vision care 19
in a supplier of [ophthalmic devices or] materials, including, without 20
limitation, a general disclosure of any rebates or rewards programs, 21
before the [covered person] enrollee authorizes the provider of 22
vision care to obtain covered [eyewear] materials from such a 23
supplier or laboratory that is not contracted with the [insurer] vision 24
benefit manager providing the [policy of insurance that covers] 25
vision [care.] benefit plan or vision benefit discount plan. The 26
disclosure must appear in a conspicuous and clear manner. 27
[6.] 7. Nothing in this section shall be construed to prohibit [a 28
covered person] an enrollee from using an in-network source or 29
supplier of [ophthalmic devices or] materials as set forth in the 30
[covered person’s policy of insurance that covers] vision [care. 31
7. As used in this section: 32
(a) “Provider of vision care” means a physician who provides 33
vision care or an optometrist. 34
(b) “Vision care” means: 35
(1) Routine ophthalmological evaluation of the eye, 36
including refraction. 37
(2) Ophthalmic devices or materials, including, without 38
limitation, lenses, frames, mountings or other specially fabricated 39
ophthalmic devices. 40
The term “vision care” does not include the initiation of treatment 41
or diagnosis pursuant to a program of medical care.] benefit plan or 42
vision benefit discount plan of the enrollee. 43
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Sec. 38. NRS 686A.160 is hereby amended to read as follows: 1
686A.160 If the Commissioner has cause to believe that any 2
person has been engaged or is engaging, in this state, in any unfair 3
method of competition or any unfair or deceptive act or practice 4
prohibited by NRS 686A.010 to 686A.310, inclusive, and sections 2 5
to 34, inclusive, of this act and that a proceeding by the 6
Commissioner in respect thereto would be in the interest of the 7
public, the Commissioner may issue and serve upon such person a 8
statement of the charges and a notice of the hearing to be held 9
thereon. The statement of charges and notice of hearing shall 10
comply with the requirements of NRS 679B.320 and shall be served 11
upon such person directly or by certified or registered mail, return 12
receipt requested. 13
Sec. 39. NRS 686A.170 is hereby amended to read as follows: 14
686A.170 1. If the Commissioner believes that any person 15
engaged in the insurance business is in the conduct of such business 16
engaging in this state in any method of competition or in any act or 17
practice not defined in NRS 686A.010 to 686A.310, inclusive, and 18
sections 2 to 34, inclusive, of this act which is unfair or deceptive 19
and that a proceeding by the Commissioner in respect thereto would 20
be in the public interest, the Commissioner shall, after a hearing of 21
which notice and of the charges against such person are given to the 22
person, make a written report of the findings of fact relative to such 23
charges and serve a copy thereof upon such person and any 24
intervener at the hearing. 25
2. If such report charges a violation of NRS 686A.010 to 26
686A.310, inclusive, and sections 2 to 34, inclusive, of this act, and 27
if such method of competition, act or practice has not been 28
discontinued, the Commissioner may, through the Attorney General, 29
at any time after 20 days after the service of such report cause an 30
action to be instituted in the district court of the county wherein the 31
person resides or has his or her principal place of business to enjoin 32
and restrain such person from engaging in such method, act or 33
practice. The court shall have jurisdiction of the proceeding and 34
shall have power to make and enter appropriate orders in connection 35
therewith and to issue such writs or orders as are ancillary to its 36
jurisdiction or necessary in its judgment to prevent injury to the 37
public pendente lite; but the State of Nevada shall not be required to 38
give security before the issuance of any such order or injunction 39
under this section. If a stenographic record of the proceedings in the 40
hearing before the Commissioner was made, a certified transcript 41
thereof including all evidence taken and the report and findings shall 42
be received in evidence in such action. 43
3. If the court finds that: 44
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- *AB448*
(a) The method of competition complained of is unfair or 1
deceptive; 2
(b) The proceedings by the Commissioner with respect thereto 3
are to the interest of the public; and 4
(c) The findings of the Commissioner are supported by the 5
weight of the evidence, 6
it shall issue its order enjoining and restraining the continuance 7
of such method of competition, act or practice. 8
4. Either party may appeal from such final judgment or order 9
or decree of court in a like manner as provided for appeals in civil 10
cases. 11
5. If the Commissioner’s report made under subsection 1 or 12
order on hearing made under NRS 679B.360 does not charge a 13
violation of NRS 686A.010 to 686A.310, inclusive, and sections 2 14
to 34, inclusive, of this act, then any intervener in the proceedings 15
may appeal therefrom within the time and in the manner provided in 16
this Code for appeals from the Commissioner generally. 17
6. Upon violation of any injunction issued under this section, 18
the Commissioner, after a hearing thereon, may impose the 19
appropriate penalties provided for in NRS 686A.187. 20
Sec. 40. NRS 686A.183 is hereby amended to read as follows: 21
686A.183 1. After the hearing provided for in NRS 22
686A.160, the Commissioner shall issue an order on hearing 23
pursuant to NRS 679B.360. If the Commissioner determines that the 24
person charged has engaged in an unfair method of competition or 25
an unfair or deceptive act or practice in violation of NRS 686A.010 26
to 686A.310, inclusive, and sections 2 to 34, inclusive, of this act, 27
the Commissioner shall order the person to cease and desist from 28
engaging in that method of competition, act or practice, and may 29
order one or both of the following: 30
(a) If the person knew or reasonably should have known that he 31
or she was in violation of NRS 686A.010 to 686A.310, inclusive, 32
and sections 2 to 34, inclusive, of this act, payment of an 33
administrative fine of not more than $5,000 for each act or violation, 34
except that as to licensed agents, brokers, solicitors and adjusters, 35
the administrative fine must not exceed $500 for each act or 36
violation. 37
(b) Suspension or revocation of the person’s license if the 38
person knew or reasonably should have known that he or she was in 39
violation of NRS 686A.010 to 686A.310, inclusive [.] , and sections 40
2 to 34, inclusive, of this act. 41
2. Until the expiration of the time allowed for taking an appeal, 42
pursuant to NRS 679B.370, if no petition for review has been filed 43
within that time, or, if a petition for review has been filed within that 44
time, until the official record in the proceeding has been filed with 45
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- *AB448*
the court, the Commissioner may, at any time, upon such notice and 1
in such manner as the Commissioner deems proper, modify or set 2
aside, in whole or in part, any order issued by him or her under this 3
section. 4
3. After the expiration of the time allowed for taking an appeal, 5
if no petition for review has been filed, the Commissioner may at 6
any time, after notice and opportunity for hearing, reopen and alter, 7
modify or set aside, in whole or in part, any order issued by him or 8
her under this section whenever in the opinion of the Commissioner 9
conditions of fact or of law have so changed as to require such 10
action or if the public interest so requires. 11
Sec. 41. NRS 686A.520 is hereby amended to read as follows: 12
686A.520 1. The provisions of NRS 683A.341, 683A.451, 13
683A.461 and 686A.010 to 686A.310, inclusive, and sections 2 to 14
34, inclusive, of this act apply to companies. 15
2. For the purposes of subsection 1, unless the context requires 16
that a section apply only to insurers, any reference in those sections 17
to “insurer” must be replaced by a reference to “company.” 18
Sec. 42. NRS 689.160 is hereby amended to read as follows: 19
689.160 1. The provisions of NRS 683A.341, 683A.451, 20
683A.461 and 686A.010 to 686A.310, inclusive, and sections 2 to 21
34, inclusive, of this act apply to agents and sellers. 22
2. For the purposes of subsection 1, unless the context requires 23
that a section apply only to insurers, any reference in those sections 24
to “insurer” must be replaced by a reference to “agent” and “seller.” 25
3. The provisions of NRS 679B.230 to 679B.300, inclusive, 26
apply to sellers. Unless the context requires that a provision apply 27
only to insurers, any reference in those sections to “insurer” must be 28
replaced by a reference to “seller.” 29
4. The provisions of NRS 683A.301 apply to applicants for and 30
holders of a seller’s certificate of authority. Unless the context 31
requires that a provision apply only to an applicant for or holder of a 32
license as a producer of insurance, any reference in that section to: 33
(a) An “applicant for a license as a producer of insurance” must 34
be replaced by a reference to an “applicant for a seller’s certificate 35
of authority”; and 36
(b) A “licensee” must be replaced by a reference to a “holder of 37
a seller’s certificate of authority.” 38
Sec. 43. NRS 689.595 is hereby amended to read as follows: 39
689.595 1. The provisions of NRS 683A.341, 683A.451, 40
683A.461 and 686A.010 to 686A.310, inclusive, and sections 2 to 41
34, inclusive, of this act apply to agents and sellers. 42
2. For the purposes of subsection 1, unless the context requires 43
that a section apply only to insurers, any reference in those sections 44
to “insurer” must be replaced by a reference to “agent” and “seller.” 45
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- *AB448*
3. The provisions of NRS 679B.230 to 679B.300, inclusive, 1
apply to sellers. Unless the context requires that a provision apply 2
only to insurers, any reference in those sections to “insurer” must be 3
replaced by a reference to “seller.” 4
4. The provisions of NRS 683A.301 apply to applicants for and 5
holders of a seller’s permit. Unless the context requires that a 6
provision apply only to an applicant for or a holder of a license as a 7
producer of insurance, any reference in that section to: 8
(a) An “applicant for a license as a producer of insurance” must 9
be replaced by a reference to an “applicant for a seller’s permit”; 10
and 11
(b) A “licensee” must be replaced by a reference to a “holder of 12
a seller’s permit.” 13
Sec. 44. NRS 695C.300 is hereby amended to read as follows: 14
695C.300 1. No health maintenance organization or 15
representative thereof may cause or knowingly permit the use of 16
advertising which is untrue or misleading, solicitation which is 17
untrue or misleading or any form of evidence of coverage which is 18
deceptive. For purposes of this chapter: 19
(a) A statement or item of information shall be deemed to be 20
untrue if it does not conform to fact in any respect which is or may 21
be significant to an enrollee of, or person considering enrollment in, 22
a health care plan. 23
(b) A statement or item of information shall be deemed to be 24
misleading, whether or not it may be literally untrue if, in the total 25
context in which such statement is made or such item of information 26
is communicated, such statement or item of information may be 27
reasonably understood by a reasonable person not possessing special 28
knowledge regarding health care coverage, as indicating any benefit 29
or advantage or the absence of any exclusion, limitation or 30
disadvantage of possible significance to an enrollee of, or person 31
considering enrollment in, a health care plan if such benefit or 32
advantage or absence of limitation, exclusion or disadvantage does 33
not in fact exist. 34
(c) An evidence of coverage shall be deemed to be deceptive if 35
the evidence of coverage taken as a whole, and with consideration 36
given to typography and format as well as language, shall be such as 37
to cause a reasonable person not possessing special knowledge 38
regarding health care plans and evidences of coverage therefor to 39
expect benefits, services, charges or other advantages which the 40
evidence of coverage does not provide or which the health care plan 41
issuing such evidence of coverage does not regularly make available 42
for enrollees covered under such evidence of coverage. 43
2. NRS 686A.010 to 686A.310, inclusive, and sections 2 to 34, 44
inclusive, of this act shall be construed to apply to health 45
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maintenance organizations, health care plans and evidences of 1
coverage except to the extent that the nature of health maintenance 2
organizations, health care plans and evidences of coverage render 3
the sections therein clearly inappropriate. 4
3. An enrollee may not be cancelled or not renewed except for 5
the failure to pay the charge for such coverage or for cause as 6
determined in the master contract. 7
4. No health maintenance organization, unless licensed as an 8
insurer, may use in its name, contracts, or literature any of the words 9
“insurance,” “casualty,” “surety,” “mutual” or any other words 10
descriptive of the insurance, casualty or surety business or 11
deceptively similar to the name or description of any insurance or 12
surety corporation doing business in this State. 13
5. No person not certificated under this chapter shall use in its 14
name, contracts or literature the phrase “health maintenance 15
organization” or the initials “HMO.” 16
Sec. 45. NRS 695F.090 is hereby amended to read as follows: 17
695F.090 1. Prepaid limited health service organizations are 18
subject to the provisions of this chapter and to the following 19
provisions, to the extent reasonably applicable: 20
(a) NRS 686B.010 to 686B.175, inclusive, concerning rates and 21
essential insurance. 22
(b) NRS 687B.310 to 687B.420, inclusive, concerning 23
cancellation and nonrenewal of policies. 24
(c) NRS 687B.122 to 687B.128, inclusive, concerning 25
readability of policies. 26
(d) The requirements of NRS 679B.152. 27
(e) The fees imposed pursuant to NRS 449.465. 28
(f) NRS 686A.010 to 686A.310, inclusive, and sections 2 to 34, 29
inclusive, of this act concerning trade practices and frauds. 30
(g) The assessment imposed pursuant to NRS 679B.700. 31
(h) Chapter 683A of NRS. 32
(i) To the extent applicable, the provisions of NRS 689B.340 to 33
689B.580, inclusive, and chapter 689C of NRS relating to the 34
portability and availability of health insurance. 35
(j) NRS 689A.035, 689A.0463, 689A.410, 689A.413 and 36
689A.415. 37
(k) NRS 680B.025 to 680B.060, inclusive, concerning premium 38
tax, premium tax rate, annual report and estimated quarterly tax 39
payments. For the purposes of this paragraph, unless the context 40
otherwise requires that a section apply only to insurers, any 41
reference in those sections to “insurer” must be replaced by a 42
reference to “prepaid limited health service organization.” 43
(l) Chapter 692C of NRS, concerning holding companies. 44
(m) NRS 689A.637, concerning health centers. 45
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(n) Chapter 681B of NRS, concerning assets and liabilities. 1
(o) NRS 682A.400 to 682A.468, inclusive, concerning 2
investments. 3
2. For the purposes of this section and the provisions set forth 4
in subsection 1, a prepaid limited health service organization is 5
included in the meaning of the term “insurer.” 6
Sec. 46. NRS 287.010 is hereby amended to read as follows: 7
287.010 1. The governing body of any county, school 8
district, municipal corporation, political subdivision, public 9
corporation or other local governmental agency of the State of 10
Nevada may: 11
(a) Adopt and carry into effect a system of group life, accident 12
or health insurance, or any combination thereof, for the benefit of its 13
officers and employees, and the dependents of officers and 14
employees who elect to accept the insurance and who, where 15
necessary, have authorized the governing body to make deductions 16
from their compensation for the payment of premiums on the 17
insurance. 18
(b) Purchase group policies of life, accident or health insurance, 19
or any combination thereof, for the benefit of such officers and 20
employees, and the dependents of such officers and employees, as 21
have authorized the purchase, from insurance companies authorized 22
to transact the business of such insurance in the State of Nevada, 23
and, where necessary, deduct from the compensation of officers and 24
employees the premiums upon insurance and pay the deductions 25
upon the premiums. 26
(c) Provide group life, accident or health coverage through a 27
self-insurance reserve fund and, where necessary, deduct 28
contributions to the maintenance of the fund from the compensation 29
of officers and employees and pay the deductions into the fund. The 30
money accumulated for this purpose through deductions from the 31
compensation of officers and employees and contributions of the 32
governing body must be maintained as an internal service fund as 33
defined by NRS 354.543. The money must be deposited in a state or 34
national bank or credit union authorized to transact business in the 35
State of Nevada. Any independent administrator of a fund created 36
under this section is subject to the licensing requirements of chapter 37
683A of NRS, and must be a resident of this State. Any contract 38
with an independent administrator must be approved by the 39
Commissioner of Insurance as to the reasonableness of 40
administrative charges in relation to contributions collected and 41
benefits provided. The provisions of NRS 439.581 to 439.597, 42
inclusive, 686A.135 [,] and sections 2 to 34, inclusive, of this act, 43
687B.352, 687B.408, 687B.692, 687B.723, 687B.725, 687B.805, 44
689B.030 to 689B.0317, inclusive, paragraphs (b) and (c) of 45
– 21 –
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subsection 1 of NRS 689B.0319, subsections 2, 4, 6 and 7 of NRS 1
689B.0319, 689B.033 to 689B.0369, inclusive, 689B.0375 to 2
689B.050, inclusive, 689B.0675, 689B.265, 689B.287 and 3
689B.500 apply to coverage provided pursuant to this paragraph, 4
except that the provisions of NRS 689B.0378, 689B.03785 and 5
689B.500 only apply to coverage for active officers and employees 6
of the governing body, or the dependents of such officers and 7
employees. 8
(d) Defray part or all of the cost of maintenance of a self-9
insurance fund or of the premiums upon insurance. The money for 10
contributions must be budgeted for in accordance with the laws 11
governing the county, school district, municipal corporation, 12
political subdivision, public corporation or other local governmental 13
agency of the State of Nevada. 14
2. If a school district offers group insurance to its officers and 15
employees pursuant to this section, members of the board of trustees 16
of the school district must not be excluded from participating in the 17
group insurance. If the amount of the deductions from compensation 18
required to pay for the group insurance exceeds the compensation to 19
which a trustee is entitled, the difference must be paid by the trustee. 20
3. In any county in which a legal services organization exists, 21
the governing body of the county, or of any school district, 22
municipal corporation, political subdivision, public corporation or 23
other local governmental agency of the State of Nevada in the 24
county, may enter into a contract with the legal services 25
organization pursuant to which the officers and employees of the 26
legal services organization, and the dependents of those officers and 27
employees, are eligible for any life, accident or health insurance 28
provided pursuant to this section to the officers and employees, and 29
the dependents of the officers and employees, of the county, school 30
district, municipal corporation, political subdivision, public 31
corporation or other local governmental agency. 32
4. If a contract is entered into pursuant to subsection 3, the 33
officers and employees of the legal services organization: 34
(a) Shall be deemed, solely for the purposes of this section, to be 35
officers and employees of the county, school district, municipal 36
corporation, political subdivision, public corporation or other local 37
governmental agency with which the legal services organization has 38
contracted; and 39
(b) Must be required by the contract to pay the premiums or 40
contributions for all insurance which they elect to accept or of which 41
they authorize the purchase. 42
5. A contract that is entered into pursuant to subsection 3: 43
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- *AB448*
(a) Must be submitted to the Commissioner of Insurance for 1
approval not less than 30 days before the date on which the contract 2
is to become effective. 3
(b) Does not become effective unless approved by the 4
Commissioner. 5
(c) Shall be deemed to be approved if not disapproved by the 6
Commissioner within 30 days after its submission. 7
6. As used in this section, “legal services organization” means 8
an organization that operates a program for legal aid and receives 9
money pursuant to NRS 19.031. 10
Sec. 47. NRS 287.04335 is hereby amended to read as 11
follows: 12
287.04335 If the Board provides health insurance through a 13
plan of self-insurance, it shall comply with the provisions of NRS 14
439.581 to 439.597, inclusive, 686A.135 [,] and sections 2 to 34, 15
inclusive, of this act, 687B.352, 687B.409, 687B.692, 687B.723, 16
687B.725, 687B.805, 689B.0353, 689B.255, 695C.1723, 695G.150, 17
695G.155, 695G.160, 695G.162, 695G.1635, 695G.164, 18
695G.1645, 695G.1665, 695G.167, 695G.1675, 695G.170 to 19
695G.1712, inclusive, 695G.1714 to 695G.174, inclusive, 20
695G.176, 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 21
to 695G.310, inclusive, 695G.405 and 695G.415, in the same 22
manner as an insurer that is licensed pursuant to title 57 of NRS is 23
required to comply with those provisions. 24
Sec. 48. The amendatory provisions of this act do not apply to 25
any contract or agreement existing on the effective date of this act 26
until the contract or agreement is renewed. 27
Sec. 49. The provisions of NRS 354.599 do not apply to any 28
additional expenses of a local government that are related to the 29
provisions of this act. 30
Sec. 50. This act becomes effective upon passage and 31
approval. 32
H