H. B. 2273
(By Delegate Walters)
[Introduced February 11, 2005; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new article, designated §33-15D-1, §33-15D-2,
§33-15D-3 and §33-15D-4, all relating to the "Mandated
Benefits Review Act"; and requiring the Insurance Commissioner
to review and report to the Legislature in an
actuarially-based fashion the financial and other related
impacts of any proposed legislation to mandate medical or
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new article, designated §33-15D-1, §33-15D-2,
§33-15D-3 and §33-15D-4, all to read as follows:
ARTICLE 15D. UNIFORM HEALTH CARE ADMINISTRATION ACT.
§33-15D-1. Mandated benefits review.
This article may be known as the "Mandated Benefits Review Act."
§33-15D-2. Declaration of purpose.
The purpose of this article is to provide for a review of
mandated benefits. This article requires that a proposed mandated
benefit or a proposed amendment to an existing law or a proposed
amendment to a legislative proposal for mandated health benefits,
mandated health insurance coverage, or mandated offerings of health
benefits, be reviewed by the Insurance Commissioner. The Insurance
Commissioner shall provide to the Legislature an actuarially-based
review with regard to the proposal's medical efficacy and cost
benefit. Twenty-five percent of existing mandated benefits shall
be reviewed annually through the process provided in this article.
(a) As used in this article, "mandated benefits" means the
(1) Any mandated coverage for specific medical or
health-related services, treatments, medications or practices;
(2) Any mandated coverage of the services specific to health
(3) Any mandate requiring an offering of specific services,
treatments, practices, or an expansion of an existing coverage; and
(4) Any mandated reimbursement amount to specific health care
(b) "Offering" means that every carrier or health plan must offer the mandated benefit to prospective customers.
(c) "Report" means an independent, actuarially-based review.
§33-15D-4. Mandated health benefits review.
(a) A legislative proposal or a proposed amendment to existing
law or a proposed amendment to a legislative proposal for a new
mandated health benefit shall be evaluated as to the proposal's
medical efficacy and financial impact. The legislative committee
considering the matter, shall refer the legislative proposal or any
proposed amendment to an existing law, or any proposed amendment to
a legislative proposal to the Insurance Commissioner for review.
(b) The Insurance Commissioner shall retain an independent
actuary to review the legislative proposal within thirty days after
the legislative proposal is submitted and assure that appropriate
assumptions are used to accurately demonstrate the financial impact
of the proposed mandate or proposed amendment to a proposed mandate
or proposed amendment to existing law. The Insurance Commissioner
shall include the results of this review in the report required by
subsection (c) of this section.
(c) The Insurance Commissioner shall review the proposed
legislation and issue a report within thirty days as to whether:
(1) The information is complete;
(2) The research cited meets professional standards;
(3) All relevant research has been brought to light; and
(4) The conclusions and interpretations drawn from the evidence are consistent with the data presented.
(d) The Insurance Commissioner shall provide the report to the
appropriate legislative committee, the Speaker of the House of
Delegates and to the President of the Senate.
(e) In preparing the report required by this section, the
Insurance Commissioner shall apply the following guidelines in
determining the adequacy of the information presented:
(1) If the insurance coverage is not generally in place, to
what extent the lack of coverage of the proposed benefit results in
(2) What is the demand for the proposed health care coverage
from the public at large and in collective bargaining negotiations,
and to what extent voluntary coverage of the proposed benefit is
(3) The Commissioner, in consultation with relevant medical
experts, shall consider evidence of medical efficacy.
(4) If the proposed legislation seeks to mandate coverage of
a particular therapy, then the results of at least one clinical
trial demonstrating the medical consequences of that therapy
compared to no therapy and to alternative therapies shall be
included as well as the results of any other relevant clinical
(5) If the proposed legislation seeks to mandate coverage of
a specific class of practitioners or medical specialty, the results of at least one professionally acceptable, controlled trial
demonstrating the medical results achieved by the specific class of
practitioners or medical specialty relative to those covered shall
be included as well as the results of any other relevant research.
(f) The Insurance Commissioner shall review evidence of
financial impact related to the legislative proposal, including,
but not limited to, the following:
(1) The extent to which coverage may decrease the appropriate
use of the treatment or service;
(2) The extent to which the same or similar mandates have
affected charges, costs, utilization and payments in other states;
(3) The extent to which the coverage may increase the
appropriate use of the treatment or service;
(4) The extent to which the mandated treatment or service will
be a substitute for more expensive or less expensive treatments or
services which may be appropriately administered otherwise;
(5) The extent to which the coverage may increase or decrease
the administrative expenses of third-party payers and the premium
and administrative expenses of policyholders;
(6) The financial impact of the mandated benefit on small
employers, medium-sized employers, large employers and any
state-sanctioned health benefit plan; and
(7) The financial impact of the mandated benefit purchasers of
individual coverage, state high-risk pools and any state-sanctioned retirement system.
NOTE: The purpose of this bill is to require the Insurance
Commissioner to review and report to the Legislature in an
actuarially-based fashion the financial and other related impacts
of any proposed legislation to mandate medical or health-related
This article is new; therefore, strike-throughs and
underscoring have been omitted.