ENROLLED
Senate Bill No. 669
(By Senators Kessler, Yost, Stollings, Unger and Wells)
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[Passed April 9, 2009; in effect ninety days from passage.]
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AN ACT to amend and reenact §16-2J-3 and §16-2J-7 of the Code of
West Virginia, 1931, as amended, all relating to extending the
Preventative Care Pilot Program (PCPP) for two years under
certain conditions; increasing the number of parties the
Health Care Authority and the Insurance Commissioner could
permit to participate in the PCPP; and allowing sales to those
with high deductible health benefit plans in certain
circumstances and providing notice to the parties that prepaid
services under the program may not count towards applicable
health insurance deductibles.
Be it enacted by the Legislature of West Virginia:
That §16-2J-3 and §16-2J-7 of the Code of West Virginia, 1931,
as amended, be amended and reenacted, all to read as follows:
ARTICLE 2J. PREVENTATIVE CARE PILOT PROGRAM.
§16-2J-3. Authorization of preventive care pilot program; number
of participants and sites; Health Care Authority considerations in selection of participating
providers; funding.
(a) The Health Care Authority shall, in consultation with the
Insurance Commissioner, develop and implement during the fiscal
year beginning July 1, 2006, a pilot program that permits providers
to market and sell prepaid memberships entitling subscribers to
obtain preventive and primary health care from the participating
providers. Participating providers shall not be allowed to offer
their qualifying services at more than six separate sites. The
pilot program shall expire on June 30, 2011.
(b) Subject to this article, the Health Care Authority is
vested with discretion to select providers using diversity in
practice organization, geographical diversity and other criteria it
deems appropriate. The Health Care Authority also shall give
consideration to providers located in rural areas or serving a high
percentage or large numbers of uninsured.
(c) In furtherance of the objectives of this article, the
Health Care Authority is authorized to accept any and all gifts,
grants and matching funds whether in the form of money or services.
However, no gifts, grants and matching funds shall be provided to
the Health Care Authority by the State of West Virginia to further
the objectives of this article.
§16-2J-7. Participating provider plan requirements; primary care
services; prior coverage restrictions; notice of discontinuance or reduction of benefits.
In addition to this article and any guidelines established by
the Health Care Authority and Insurance Commissioner, the plans
offered pursuant to this article shall be subject to the following:
(1) Each participating provider and site must offer a minimum
set of preventive and primary care services as established by the
Health Care Authority.
(2) No participating provider may offer: (i) An individual
plan to any individual who currently has a health benefit plan or
who was covered by a health benefit plan within the preceding
twelve months unless said coverage was lost due to a qualifying
event; (ii) a family plan to any family that includes an adult to
be covered who currently has a health benefit plan or who was
covered by a health benefit plan within the preceding twelve months
unless said coverage was lost due to a qualifying event; or (iii)
an employee group plan to any employer that currently has a group
health benefit plan or had a group health benefit plan covering its
employees within the preceding twelve months;
(iv) Notwithstanding
the provisions of (i),(ii) or (iii) of this subsection, a
participating provider may offer a plan to an individual if the
individual is covered by a high deductible health benefit plan or
policy and a participating provider may offer a plan to an employer
group if the employer group is covered by a high deductible health
benefit plan or policy. The participating provider shall give the
perspective individual or employer a notice that indicates that the payment for the prepaid services may not count towards a health
benefit plan deductible and that credit towards the deductible will
depend on the health benefit policy or certificate language. The
Insurance Commissioner shall approve the form of the notice to be
used by the provider. For the purpose of this section, "high
deductible health benefit plan" means a health benefit plan with a
minimum individual annual deductible of $3,000 or, if applicable,
a family annual deductible of $3,000. Any employer who has
converted its health benefit plan from a low deductible plan to a
high deductible health benefits plan may not purchase a plan from
a participating provider for six months from the date of
conversion. Any individual who has converted his or her health
benefit policy from a low deductible health policy to a high
deductible plan may not purchase a plan from a participating
provider for three months from date of conversion.
(3)
On or before July 1, 2009, the Health Care Authority and
the Insurance Commissioner shall propose a rule for legislative
approval in accordance with the provisions of article three,
chapter twenty-nine-a of this code, to permit participation by a
subscriber or employer with a comprehensive high deductible plan if
the subscriber or employer is able to demonstrate that the
participation will not negatively impact the coverage that is
currently offered or will be offered by the employer. The rule
shall provide for notice to the subscriber or employer that the
payment for the prepaid services may or may not count towards the health insurance deductible, the determination of which will depend
on the health insurance policy language.
(4) A participating provider must provide subscribers and,
where applicable, subscribers' employers with a minimum of thirty
days' notice of discontinuance or reduction of subscriber benefits.