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Introduced Version Senate Bill 665 History

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Key: Green = existing Code. Red = new code to be enacted
Senate Bill No. 665

(By Senator Prezioso)

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[Introduced February 20, 2010; referred to the Committee on Health and Human Resources; and then to the Committee on Finance.]

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A BILL to amend and reenact §33-15B-1, §33-15B-2, §33-15B-3, §33-15B-4, §33-15B-5 and §33-15B-6 of the Code of West Virginia, 1931, as amended, all relating to health care forms and data; explaining legislative purposes; defining scope of article; transferring certain duties regarding uniform forms from the Health Care Authority to the Insurance Commissioner; defining "health insurer"; authorizing the Insurance Commissioner to develop an all-payer database; authorizing Insurance Commissioner to propose emergency rules; mandating collaboration between the Insurance Commissioner and Secretary of Health and Human Resources to manage health care data; prescribing penalties; and renaming the article.

Be it enacted by the Legislature of West Virginia:

That §33-15B-1, §33-15B-2, §33-15B-3, §33-15B-4, §33-15B-5 and §33-15B-6 of the Code of West Virginia, 1931, as amended, be amended and reenacted, all to read as follows:

ARTICLE 15B. HEALTH CARE UNIFORMITY AND TRANSPARENCY ACT.

§33-15B-1. Legislative findings; purpose.

The Legislature hereby finds that there is a need to provide guidelines promote uniformity regarding uniform health care administration in order to best serve consumers, health care providers and insurers. and to organize and streamline the claims process. The One purpose of this article is to require the transfer of the authority of the insurance authorize the Insurance Commissioner to develop standard forms and procedures regarding health care claims and to require that all insurers, third party providers payers and health care providers implement and use such the standards in a uniform manner. to the West Virginia Health Care Authority

The West Virginia Health Care Authority is responsible for coordinating and overseeing the Legislature also finds that consumers must have transparent health care price and quality information in order to make economically sound and medically appropriate decisions and, further, that the commissioner and the Secretary of Health and Human Resources are the appropriate agencies to oversee health data collection in West Virginia efforts
and coordinating to coordinate database development, analysis and reporting to facilitate cost management, utilization review, and quality assurance efforts by state payors, and payers, regulatory agencies, insurers, consumers, providers and other interested parties. The Legislature finds that the West Virginia Health Care Authority is the appropriate agency to oversee the development of standard forms and procedures regarding health care claims. Thus, the Legislature hereby transfers the responsibilities to develop standard forms and procedures regarding health care claims and all other requirements and procedures under this article to the West Virginia Health Care Authority. Therefore, the second purpose of this article is to authorize the commissioner to develop an all-payer database comprising claims and other health care data in order to develop, in collaboration with the Secretary of Health and Human Resources, a health care consumer guide.
§33-15B-2. Scope of article.

The provisions of this article apply to all health care providers in the state; including but not limited to, all health insurers writing or issuing accident and sickness policies, including hospital service corporations, health service corporations, medical service corporations, dental service corporations and HMOs; all third party providers payers; all state agencies and departments, including, but not limited to, the Public
Employees Insurance Agency workers' compensation insurance and providers of services under Medicare and Medicaid; and all entities involved in the payment of health care claims.
§33-15B-3. Insurance commissioner to propose rules; use of standardized forms and classifications; advisory group.

(a) The West Virginia Health Care Authority commissioner shall promulgate legislative rules propose rules for legislative approval, in accordance with the provisions of chapter twenty-nine-a of this code, regarding the implementation and use of uniform health care administrative forms. Such The rules shall establish, where practicable, the acceptance and use throughout the health care system of standard administrative forms, terms or procedures, including, but not limited to, the following:
(1) The standard health care financing administration fifteen hundred (HCFA 1500) CMS 1500 health insurance claim form, as amended, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(2) International classification of disease, ninth clinical modifications (ICD-9-CM) and common procedural terminology (CPT) codes, as amended, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(3) National uniform billing data element specifications (UB-92) (UB-04), as amended, and as supplemented by the West Virginia uniform billing committee, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(4) Consideration of current practices involving reimbursement of claims and explanation of benefits, and the implementation of standards and guidelines regarding explanation of benefits, including, but not limited to, consideration of line item explanations of payments or denial of payments.
(b) The legislative rules required herein shall be developed by the West Virginia Health Care Authority with the advice of an advisory group to be appointed by the board of the West Virginia Health Care Authority commissioner. Such advisory group shall consist of representatives of consumers, providers, payors, and regulatory agencies, including representatives from the following: The office of the Insurance Commissioner; the West Virginia Health Care Authority; West Virginia Dental Association; West Virginia Pharmacists Association; the West Virginia Hospital Association; commercial health insurers; third party administrators; the West Virginia State Medical Association; the West Virginia Nurses Association; Public Employees Insurance Agency workers' compensation commission; and consumers. The West Virginia Health Care Authority shall form such advisory group after the effective date of this section.
(c) The West Virginia Health Care Authority commissioner and the advisory group shall review the legislative rules effected to be proposed pursuant to this section as necessary and update the same in a timely manner in order to conform to current legislation and health care and insurance industry standards and trends.
§33-15B-4. All-payer database; collaborative development of a health care consumer guide; rules authorized.
(a) All health care providers, insurers, third party providers and state agencies or departments shall have one year from the date the West Virginia Health Care Authority establishes the legislative rules required by this article to comply with the requirements of the same.
(a) As used in this article, the term "health insurer" means:
(1) Any entity licensed to transact accident and sickness insurance in this state, including health care corporations; hospital, medical and dental corporations; HMOs; and, to the extent permitted under federal law, administrators of insured, self- insured, or publicly funded health care benefit plans offered by public or private entities;
(2) Any third-party administrator, pharmacy benefit manager, entity conducting administrative services for business, or similar entity with claims data, eligibility data, provider files and other information relating to health care provided to West Virginia residents and health care provided by West Virginia health care providers and facilities;
(3) Any health benefit plan offered or administered by or on behalf of the State of West Virginia or an agency or instrumentality of the state; and
(4) Any health benefit plan offered or administered by or on behalf of the federal government with the agreement of the federal government.
(b) In order to permit the development of an all-payer database, every health insurer shall provide health insurance claims data to the commissioner or such other person designated by the commissioner in accordance with standards and procedures set forth in rules.
(c) The commissioner and the Secretary of the Department of Health and Human Resources shall adopt a set of measures to evaluate and compare health care quality and provider performance, coordinate the collection of health care quality data in the state by working with other entities that collect such data to minimize duplication and to minimize the burden on providers of data, and collaborate in the management and oversight of the analysis, distribution and use of such data.
(d) To the extent allowed by federal law and the rules promulgated pursuant to this section, health care data shall be available as a resource for insurers, employers, providers, purchasers of health care, researchers, and state agencies to continuously review health care utilization, expenditures, and performance in this state. In presenting data for public access, comparative considerations shall be made regarding geography, demographics, general economic factors and institutional size. The collection, storage and release of health care data and statistical information that is subject to the federal requirements of the Health Insurance Portability and Accountability Act shall be governed exclusively by the rules adopted thereunder in 45 CFR Parts 160 and 164.
(e) The commissioner may promulgate emergency rules and shall propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code, to carry out the provisions of this section.
§33-15B-5. Penalties for violation.
Any person, partnership, corporation, limited liability company, professional corporation, health care provider or other entity health insurer violating any provision of this article shall be guilty of a misdemeanor and, upon conviction shall be punished by subject to a fine imposed by the commissioner of not more than $1,000 for each violation. Each day of continuing violation after conviction shall be considered a separate offense. The West Virginia Health Care Authority is empowered to withhold rate approval or a certificate of need for any health care provider violating any provision of this article.
§33-15B-6. Citation of article.
This article may be known as the "Uniform Health Care Administration "Health Care Uniformity and Transparency Act."

NOTE: The purpose of this bill is to transfer from the Health Care Authority to the Insurance Commissioner certain duties regarding the creation of uniform health care forms and to authorize the Insurance Commissioner to develop an all-payer database and to collaborate with the health and human resources secretary in managing and analyzing health care data.

Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.
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