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Introduced Version Senate Bill 528 History

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sb528 intr
Senate Bill No. 528

(By Senator Love)

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[Introduced March 14, 2005; referred to the Committee

on Banking and Insurance; and then to the Committee on Finance.]

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A BILL to amend and reenact §5-16-7 of the Code of West Virginia, 1931, as amended; to amend said code by adding thereto a new section, designated §33-15-4i; to amend said code by adding thereto a new section, designated §33-16-3s ; to amend said code by adding thereto a new section, designated §33-24-7i; to amend said code by adding thereto a new section, designated §33-25-8g; and to amend said code by adding thereto a new section, designated §33-25A-8h , all relating to insurance coverage for acupuncture treatment generally; and providing insurance coverage under the Public Employees Insurance Act and certain other insurance policies for acupuncture treatment performed by a licensed acupuncturist .

Be it enacted by the Legislature of West Virginia:
That §5-16-7
of the Code of West Virginia, 1931, as amended, be amended and reenacted; that said code be amended by adding thereto a new section, designated §33-15-4i; that said code be amended by adding thereto a new section, designated §33-16-3s ; that said code be amended by adding thereto a new section, designated §33-24-7i; that said code be amended by adding thereto a new section, designated §33-25-8g; and that said code be amended by adding thereto a new section, designated §33-25A-8h , all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,

SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD

OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,

OFFICES, PROGRAMS, ETC.

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7. Authorization to establish group hospital and surgical insurance plan, group major medical insurance plan, group prescription drug plan and group life and accidental death insurance plan; rules for administration of plans; mandated benefits; what plans may provide; optional plans; separate rating for claims experience purposes.

(a) The agency shall establish a group hospital and surgical insurance plan or plans, a group prescription drug insurance plan or plans, a group major medical insurance plan or plans and a group life and accidental death insurance plan or plans for those employees herein made eligible, and to establish and promulgate rules for the administration of these plans, subject to the limitations contained in this article. Those plans shall include:
(1) Coverages and benefits for X ray and laboratory services in connection with mammograms and pap smears when performed for cancer screening or diagnostic services;
(2) Annual checkups for prostate cancer in men age fifty and over;
(3) For plans that include maternity benefits, coverage for inpatient care in a duly licensed health care facility for a mother and her newly born infant for the length of time which the attending physician considers medically necessary for the mother or her newly born child: Provided, That no plan may deny payment for a mother or her newborn child prior to forty-eight hours following a vaginal delivery, or prior to ninety-six hours following a caesarean section delivery, if the attending physician considers discharge medically inappropriate;
(4) For plans which provide coverages for post-delivery care to a mother and her newly born child in the home, coverage for inpatient care following childbirth as provided in subdivision (3) of this subsection if inpatient care is determined to be medically necessary by the attending physician. Those plans may also include, among other things, medicines, medical equipment, prosthetic appliances, and any other inpatient and outpatient services and expenses considered appropriate and desirable by the agency; and
(5) Coverage for treatment of serious mental illness.
(A) The coverage does not include custodial care, residential care or schooling. For purposes of this section, "serious mental illness" means an illness included in the American psychiatric association's diagnostic and statistical manual of mental disorders, as periodically revised, under the diagnostic categories or subclassifications of: (i) Schizophrenia and other psychotic disorders; (ii) bipolar disorders; (iii) depressive disorders; (iv) substance-related disorders with the exception of caffeine-related disorders and nicotine-related disorders; (v) anxiety disorders; and (vi) anorexia and bulimia. With regard to any covered individual who has not yet attained the age of nineteen years, "serious mental illness" also includes attention deficit hyperactivity disorder, separation anxiety disorder and conduct disorder.
(B) Notwithstanding any other provision in this section to the contrary, in the event that the agency can demonstrate actuarially that its total anticipated costs for the treatment of mental illness for any plan will exceed or have exceeded two percent of the total costs for such plan in any experience period, then the agency may apply whatever cost containment measures may be necessary, including, but not limited to, limitations on inpatient and outpatient benefits, to maintain costs below two percent of the total costs for the plan.
(C) The agency shall not discriminate between medical-surgical benefits and mental health benefits in the administration of its plan. With regard to both medical-surgical and mental health benefits, it may make determinations of medical necessity and appropriateness, and it may use recognized health care quality and cost management tools, including, but not limited to, limitations on inpatient and outpatient benefits, utilization review, implementation of cost containment measures, preauthorization for certain treatments, setting coverage levels, setting maximum number of visits within certain time periods, using capitated benefit arrangements, using fee-for-service arrangements, using third-party administrators, using provider networks and using patient cost sharing in the form of copayments, deductibles and coinsurance.
(6) Coverage and benefits for acupuncture treatment performed by an acupuncturist licensed pursuant to article thirty-six, chapter thirty of this code.
(b) The agency shall make available to each eligible employee, at full cost to the employee, the opportunity to purchase optional group life and accidental death insurance as established under the rules of the agency. In addition, each employee is entitled to have his or her spouse and dependents, as defined by the rules of the agency, included in the optional coverage, at full cost to the employee, for each eligible dependent; and with full authorization to the agency to make the optional coverage available and provide an opportunity of purchase to each employee.
(c) The Finance Board may cause to be separately rated for claims experience purposes: (1) All employees of the State of West Virginia; (2) all teaching and professional employees of state public institutions of higher education and county boards of education; (3) all nonteaching employees of the University of West Virginia Board of Trustees or the Board of Directors of the State College System and county boards of education; or (4) any other categorization which would ensure the stability of the overall program.
CHAPTER 33. INSURANCE.

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4i. Coverage for acupuncture treatment.

(a) Notwithstanding a provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after the first day of July, two thousand five, provide as benefits to all subscribers and members coverage for acupuncture treatment performed by an acupuncturist licensed pursuant to article thirty-six, chapter thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply to acupuncture treatment the same deductibles, coinsurance and other limitations as apply to other covered services.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-3s. Coverage for acupuncture treatment.
(a) Notwithstanding a provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after the first day of July, two thousand five, provide as benefits to all subscribers and members coverage for acupuncture treatment performed by an acupuncturist licensed pursuant to article thirty-six, chapter thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply to acupuncture treatment the same deductibles, coinsurance and other limitations as apply to other covered services.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.
§33-24-7i. Coverage for acupuncture treatment.
(a) Notwithstanding a provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after the first day of July, two thousand five, provide as benefits to all subscribers and members coverage for acupuncture treatment performed by an acupuncturist licensed pursuant to article thirty-six, chapter thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply to acupuncture treatment the same deductibles, coinsurance and other limitations as apply to other covered services.
ARTICLE 25. HEALTH CARE CORPORATIONS.

§33-25-8g. Coverage for acupuncture treatment.
(a) Notwithstanding a provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after the first day of July, two thousand five, provide as benefits to all subscribers and members coverage for acupuncture treatment performed by an acupuncturist licensed pursuant to article thirty-six, chapter thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply to acupuncture treatment the same deductibles, coinsurance and other limitations as apply to other covered services.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-8h. Coverage for acupuncture treatment.
(a) Notwithstanding a provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after the first day of July, two thousand five, provide as benefits to all subscribers and members coverage for acupuncture treatment performed by an acupuncturist licensed pursuant to article thirty-six, chapter thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply to acupuncture treatment the same deductibles, coinsurance and other limitations as apply to other covered services.

NOTE: The purpose of this bill is to require health insurance policies to cover acupuncture treatment performed by a licensed
acupuncturist .

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

§§33-15-4i, §33-16-3s, §33-24-7i, §33-25-8g and §33-25A-8h are new; therefore, strike-throughs and underscoring have been omitted.

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