H. B. 2037
(By Delegate Staton)
[Introduced January 14, 1998
; referred to the
Committee on Banking and Insurance then the
Judiciary.]
A BILL to amend and reenact section four-d, article fifteen,
chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended; and to amend
and reenact section three-h, article sixteen of said
chapter, all relating to requiring insurance coverage of
cosmetic and reconstructive surgery for injuries received
from being the victim of domestic violence.
Be it enacted by the Legislature of West Virginia:
That section four-d, article fifteen, chapter thirty-three
of the code of West Virginia, one thousand nine hundred thousand
thirty-one, as amended, be amended and reenacted; that section
three-h, article sixteen of said chapter be amended and
reenacted, all to read as follows:
§33-15-4d. Third party reimbursement for rehabilitation
services.
(a) Notwithstanding any 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, one thousand nine hundred ninety-one, provide as
benefits to all subscribers and members coverage for
rehabilitation services as hereinafter set forth, unless rejected
by the insured.
(b) For purposes of this article and section,
"rehabilitation services" includes those services which are
designed to remediate patient's condition or restore patients to
their optimal physical, medical, psychological, social,
emotional, vocational and economic status. Rehabilitative
services include by illustration and not limitation diagnostic
testing, assessment, monitoring or treatment of the following
conditions individually or in a combination:
(1) Stroke;
(2) Spinal cord injury;
(3) Congenital deformity;
(4) Amputation;
(5) Major multiple trauma;
(6) Fracture of femur;
(7) Brain injury;
(8) Polyarthritis, including rheumatoid arthritis;
(9) Neurological disorders, including, but not limited to,
multiple sclerosis, motor neuron diseases, polyneuropathy,
muscular dystrophy and Parkinson's disease;
(10) Cardiac disorders, including, but not limited to, acute
myocardial infarction, angina pectoris, coronary arterial
insufficiency, angioplasty, heart transplantation, chronic
arrhythmias, congestive heart failure, valvular heart disease;
(11) Burns.
(12) Any injury received by an insured requiring
reconstructive or cosmetic surgery from an act which caused the
person inflicting the injury to be convicted of a charge of
domestic violence as provided in section twenty-eight, article
two, chapter sixty-one of this code, or from an act which caused
the issuance of a restraining order as a result of an act of
domestic violence as defined in that section or because of a
verified petition of domestic violence as provided in article
two-a of chapter forty-eight of this code.
(c) Rehabilitation services includes care rendered by any of
the following:
(1) A hospital duly licensed by the state of West Virginia
that meets the requirements for rehabilitation hospitals as
described in Section 2803.2 of the Medicare Provider
Reimbursement Manual, Part 1, as published by the U.S. Health
Care Financing Administration;
(2) A distinct part rehabilitation unit in a hospital duly
licensed by the state of West Virginia. The distinct part unit
must meet the requirements of Section 2803.61 of the Medicare
Provider Reimbursement Manual, Part 1, as published by the U.S.
Health Care Financing Administration;
(3) A hospital duly licensed by the state of West Virginia
which meets the requirements for cardiac rehabilitation as
described in Section 35-25, Transmittal 41, dated August, 1989,
as promulgated by the U.S. Health Care Financing Administration.
(d) Rehabilitation services do not include services for
mental health, chemical dependency, vocational rehabilitation,
long-term maintenance or custodial services.
(e) A policy, provision, contract, plan or agreement may
apply to rehabilitation services the same deductibles,
coinsurance and other limitations as apply to other covered
services.
§33-16-3h. Third party reimbursement for rehabilitation services.
(a) Notwithstanding any 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, one thousand nine hundred ninety-one, provide as
benefits to all subscribers and members coverage for
rehabilitation services as hereinafter set forth, unless rejected
by the insured.
(b) For purposes of this article and section,
"rehabilitation services" includes those services which are
designed to remediate patient's condition or restore patients to
their optimal physical, medical, psychological, social,
emotional, vocational and economic status. Rehabilitative
services include by illustration and not limitation diagnostic
testing, assessment, monitoring or treatment of the following
conditions individually or in a combination:
(1) Stroke;
(2) Spinal cord injury;
(3) Congenital deformity;
(4) Amputation;
(5) Major multiple trauma;
(6) Fracture of femur;
(7) Brain injury;
(8) Polyarthritis, including rheumatoid arthritis;
(9) Neurological disorders, including, but not limited to,
multiple sclerosis, motor neuron diseases, polyneuropathy,
muscular dystrophy and Parkinson's disease;
(10) Cardiac disorders, including, but not limited to, acute
myocardial infarction, angina pectoris, coronary arterial
insufficiency, angioplasty, heart transplantation, chronic
arrhythmias, congestive heart failure, valvular heart disease;
(11) Burns.
(12) Any injury received by an insured requiring
reconstructive or cosmetic surgery from an act which caused the
person inflicting the injury to be convicted of a charge of
domestic violence as provided in section twenty-eight, article
two, chapter sixty-one of this code, or from an act which caused
the issuance of a restraining order as a result of an act of
domestic violence as defined in that section or because of a
verified petition of domestic violence as provided in article
two-a of chapter forty-eight of this code.
(c) Rehabilitative services includes care rendered by any of
the following:
(1) A hospital duly licensed by the state of West Virginia that meets the requirements for rehabilitation hospitals as
described in Section 2803.2 of the Medicare Provider
Reimbursement Manual, Part 1, as published by the U.S. Health
Care Financing Administration;
(2) A distinct part rehabilitation unit in a hospital duly
licensed by the state of West Virginia. The distinct part unit
must meet the requirements of Section 2803.61 of the Medicare
Provider Reimbursement Manual, Part 1, as published by the U.S.
Health Care Financing Administration;
(3) A hospital duly licensed by the state of West Virginia
which meets the requirements for cardiac rehabilitation as
described in Section 35-25, Transmittal 41, dated August, 1989,
as promulgated by the U.S. Health Care Financing Administration.
(d) Rehabilitation services do not include services for
mental health, chemical dependency, vocational rehabilitation,
long-term maintenance or custodial services.
(e) A policy, provision, contract, plan or agreement may
apply to rehabilitation services the same deductibles,
coinsurance and other limitations as apply to other covered
services.
NOTE: The purpose of this bill is to require insurance coverage of reconstructive and cosmetic surgery for injuries
received from acts of domestic violence.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.