H. B. 4591
(By Delegates Craig, Hubbard, Perdue,
Amores, Manuel, Leach and Morgan)
[Introduced
February 22, 2002
; referred to the
Committee on Banking and Insurance then Finance.]
A BILL to amend chapter sixteen of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, by adding
thereto a new article, designated article twenty nine-f,
relating to authorizing pilot program for assisting uninsured
and underinsured persons in obtaining health care coverage;
requiring certain reports; and providing that the program
expires in two thousand four.
Be it enacted by the Legislature of West Virginia:
That chapter sixteen of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by adding
thereto a new article, designated article twenty-nine-f, to read as
follows:
ARTICLE 29F. UNINSURED AND UNDERINSURED PILOT PROGRAMS.
§16-29F-1. Uninsured and underinsured health coverage assistance;
pilot program.
(a) The United States department of health and human services
has established a federal grant program to encourage innovative
integrated health care delivery systems to serve uninsured and
underinsured persons with greater efficiency and improved quality
of care and to further maximize reimbursements to health care
providers which provide these services. The "Community Access
Program Grants" as authorized in the Federal Register: February 4,
2000 (volume 65, number 24), allow for the establishment of local
programs to reorganize and reintegrate local health care delivery
systems. This section authorizes, on a trial basis, the
establishment of pilot programs in the state which receive a grant
under the community access program to coordinate health care
provider reimbursements, to allow an opportunity for innovations in
payment for health care services to be tested and if successful, to
be permanently implemented.
(b) An entity receiving a community access program grant may
initiate a program that comports to the federal grant requirements
and meets the requirements of this section. The pilot program may
enroll persons to participate in this pilot program who currently
do not have insurance and whose income does not exceed one hundred fifty percent of the federal poverty level. The pilot program may
coordinate payments from enrollees and businesses employing
enrollees to be utilized to capture available federal moneys to
assist in providing reimbursements to an enrollee's health care
provider. The pilot program shall coordinate reimbursements
limited to areas not covered by other federal reimbursement
programs such as the children's health insurance agency within the
department of administration and the federal medicaid program. In
no instance may a community access pilot program allow health care
reimbursements to enrollees and to health care providers that limit
or otherwise impede the eligibility of the enrollee or the health
care provider to be eligible for these or other federal health care
cost reimbursement programs.
(c) Notwithstanding the provisions of chapter thirty-three of
this code to the contrary, any grant program created and authorized
pursuant to this section is not to be considered as providing
insurance or as offering insurance services. Community access
pilot programs are hereby specifically excluded from the
definitions of "insurance" pursuant to section one, of the
definition of "insurer" as defined in section two, article one,
chapter thirty-three of this code, and they are not subject to regulation by the insurance commissioner, nor are they unauthorized
insurers pursuant to section four, article forty-four of chapter
thirty-three of this code.
(d) A community access pilot program is authorized to enter
into agreements with health care providers to coordinate and
otherwise provide services to enrollees. These agreements must be
contingent on the health care provider agreeing to accept payment
by the community access pilot program based on available funding to
the program for the health care services being provided. If the
health care provider decides to no longer accept the community
access pilot program's enrollee reimbursement, the health care
provider must provide, at a minimum, thirty days' notice of
discontinuance of providing services and further acceptance of
enrollee's payments.
(e) The community access pilot program must provide enrollees
and the participating employer with a minimum of thirty days'
notice of discontinuance or reduction of enrollee benefits.
(f) The community access pilot program must submit quarterly
reports to the legislative oversight commission or health and human
resources accountability as established in article twenty-nine-e of
this chapter. The report shall include at a minimum, an analysis of the financial status, the number of health care provider
reimbursements involved, enrollee services utilized, and other
information as requested by the authority.
(g) The authorization for the creation and existence of a
pilot program as established pursuant to this section expires on
the thirtieth day of June, two thousand four.
NOTE: The purpose of this bill is to authorize pilot programs
that receive federal Community Access Program Grants to apply
innovative approaches to health care provider reimbursement for
providing health care to uninsured and underinsured persons. Pilot
program initiated under this bill must provide periodic reports to
the Legislative Oversight Commission on Health and Human Resources
accountability. The authorization for pilot projects expires on
June 30, 2004.
This article is new; therefore, strike-throughs and
underscoring have been omitted.
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