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.

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 U.S. 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" (CAP) 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 CAP 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 CAP 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 two hundred and 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 enrollee's health care providers. The pilot program is to 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 the 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, any grant program created and authorized pursuant to this section is not to be deemed as providing insurance or as offering insurance services. CAP pilot programs are specifically excluded from the definitions of "insurance" pursuant to section one, article one, chapter thirty-three of this code and of the definition of "insurer" as defined in section two of said article are not subject to regulation by the insurance commissioner and are not to be deemed as unauthorized insurers pursuant to section four, article forty-four of said chapter.
(d) The CAP 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 provide payment by the CAP 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 pilot program's enrollee's 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 pilot program must provide enrollees and his or her employer with a minimum of thirty days' notice of discontinuance or reduction of enrollee benefits.
(f) The pilot program must submit quarterly reports to the legislative oversight commission of health and human resources accountability as established in article twenty-nine-e of this chapter. The report shall include at a minimum, analysis of financial status, numbers of health care provider reimbursements, enrollee services utilized and other information as requested by the commission.
(g) The authorization for the creation and existence of a pilot program as established pursuant to this section shall expire on the thirtieth day of June, two thousand four.
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(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 the uninsured and underinsured persons; any pilot program initiated must provide periodic reports to the legislative oversight commission of health and human resources; and authorization for pilot projects expires on June 30, 2004.

Article twenty-nine-f is new, therefore strike-throughs and underscoring have been omitted.