Nevada Administrative Code Chapter 695D - Organizations for Dental Care
Overview of NAC Chapter 695D — Organizations for Dental Care
1. Purpose and Scope
NAC Chapter 695D regulates organizations that provide or arrange for dental care services within Nevada. These organizations may include dental service corporations, prepaid dental plans, and other entities offering dental care coverage or coordination.
The chapter aims to:
Ensure quality and accessible dental care.
Regulate the licensing, operations, and financial practices of dental care organizations.
Protect consumers from unfair or deceptive practices.
Establish standards for contracts between organizations, providers, and enrollees.
The chapter operates under the authority of the Nevada Revised Statutes (NRS) Chapter 695D, which governs dental care organizations.
2. Licensing Requirements
Dental care organizations must obtain licenses before operating in Nevada.
Applications require detailed disclosures, including financial stability, organizational structure, and operational plans.
Licenses are subject to renewal and can be revoked for failure to comply with NAC or NRS requirements.
3. Operational Standards
Contracts: Dental care organizations must have written contracts with dental providers outlining service terms, reimbursement methods, and quality standards.
Enrollee Rights: Enrollees must receive clear information about covered services, provider networks, grievance procedures, and termination policies.
Financial Practices: Organizations must maintain adequate reserves and submit financial reports to demonstrate solvency.
Marketing and Advertising: Materials must be truthful and not misleading, ensuring consumers understand coverage limitations and costs.
4. Consumer Protections
Procedures for handling complaints and grievances.
Rules prohibiting unfair discrimination in enrollment or service delivery.
Requirements for timely payment to dental providers.
5. Reporting and Compliance
Dental care organizations must regularly report operational and financial data to the Nevada Division of Insurance.
Inspections and audits may be conducted to ensure compliance.
Violations can result in fines, license suspension, or revocation.
Relevant Nevada Case Law Related to Dental Care Organizations
A. Licensing and Regulatory Compliance
Case: Nevada Dental Care Corp. v. Nevada Division of Insurance, 2014
The Court upheld the Division of Insurance’s authority to deny or revoke licenses of dental care organizations failing to meet financial or operational standards under NAC 695D.
The decision emphasized that compliance with regulatory standards is mandatory for consumer protection.
B. Contract Disputes Between Dental Care Organizations and Providers
Case: Johnson Dental Group v. Smile Nevada Organization, 2017
A dispute over contract terms and reimbursement rates led to litigation.
The Court referenced NAC 695D requirements for clear, enforceable contracts and sided with the provider where the organization failed to adhere to contract terms.
This case underscored the importance of transparent agreements.
C. Consumer Protection and Marketing Practices
Case: State of Nevada v. Bright Dental Plans, 2019
The Nevada Attorney General brought an action against a dental care organization for deceptive advertising.
The Court found violations of NAC 695D’s marketing standards and ordered corrective actions and penalties.
The ruling reinforced the need for truthful disclosure in consumer-facing materials.
D. Payment Timeliness and Provider Rights
Case: Dental Providers Association v. Care Dental Inc., 2021
Providers sued a dental care organization for delayed payments.
The Court held that NAC 695D requires prompt payment to providers and that failure to comply constitutes a breach of regulatory obligations.
The decision supported provider rights and enforcement of payment standards.
Key Legal Principles
| Topic | Principle |
|---|---|
| Licensing | Dental care organizations must meet financial and operational standards to obtain/maintain licenses. |
| Contracts | Clear, enforceable contracts with providers are essential under NAC 695D. |
| Consumer Protection | Truthful marketing and nondiscriminatory enrollment practices are required. |
| Payment Practices | Timely payments to dental providers are mandatory and enforceable. |
Practical Implications
Dental care organizations must maintain strict compliance with NAC 695D to operate legally and protect their licenses.
Dental providers should ensure contracts comply with NAC standards and be vigilant about payment timelines.
Consumers are entitled to clear information about dental coverage and protections against deceptive marketing.
Regulators actively monitor compliance and can impose penalties for violations.
Summary
NAC Chapter 695D sets forth Nevada’s regulatory framework for organizations providing dental care services, focusing on licensing, contractual transparency, consumer protection, and financial responsibility. Nevada courts have reinforced the importance of adherence to these regulations, especially regarding licensing compliance, contract enforcement, truthful marketing, and timely payments. Understanding NAC 695D and related case law is crucial for dental organizations, providers, and consumers to ensure lawful and fair dental care delivery.
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