H. B. 2905


(By Delegates Hatfield, Susman,
Collins and Marshall)
[Introduced February 25, 1999; referred to the
Committee on Government Organization then Finance.]



A BILL to amend chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article twenty-five-d, relating to establishing a managed care policy board to oversee and monitor the development, implementation, and regulation of managed care plans licensed by the state; composition of board; directing the board to review and comment on all matters of planning, policy, development, program design and evaluation involving managed care plans in the state; financing operations of managed care policy board by a one half of one percent assessment against premiums paid for coverage; requiring board to recommend additions, deletions and revisions to the standards used to license managed care plans; requiring the board to recommend strategies and new initiatives for existing state-sponsored health information, ombudsmen and external quality review programs; requiring the board to conduct managed care policy studies; requiring the board to meet at least four times every year and to elect officers, etc.; and, requiring the board to prepare and send to the governor and the Legislature an annual report.

Be it enacted by the Legislature of West Virginia:
That chapter thirty-three 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-five-d, to read as follows:
 ARTICLE 25D. MANAGED CARE POLICY BOARD.
 §33-25D-1. Creation of managed care policy board to oversee managed care providers; primary purposes; number of members; composition of members; meetings; election of officers and designation of committees.
There is hereby created the managed care policy board whose primary purposes are to oversee and monitor the development, implementation and regulation of all managed care plans by any health maintenance organization, health care corporation or other health care plan provider sanctioned to provide health care under the laws of this state.
The board shall be composed of no fewer than fifteen and no more than thirty members, all of whom shall be appointed by the governor with the advice and consent of the Senate. A majority of any sitting board shall consist of consumers of medical or health care plans and they shall reflect the diversity of the state's population relative to race, ethnic origin, gender, age, economic status, disability and health condition.
The board shall meet at least four times every year, the first such meeting to be held at the call of the governor within one month of the initial appointment, at which time it shall elect officers, designate committees and hire an executive director to further its purposes.
§33-25D-2. Duties of board.
(a) The board shall review and comment on all matters related to planning, policy development, program design and evaluation related to managed care at all health maintenance organizations and all health care corporations in the state. The board shall particularly review any proposed cost increases to enrollees while, additionally, reviewing existing laws concerning managed care in order to comment and make recommendations for constructive change to members of the Legislature on an annual basis. It shall, additionally, recommend additions, deletions and revisions to existing laws regulating the licensing of health maintenance organizations, health care corporations and other managed care health care providers. Such recommendations shall include, but not be limited to, strategies and new initiatives for state-sponsored health care informative services, and whether the appointment of state-sanctioned ombudsmen and external quality review programs should be employed to improve the overall quality of care by managed care providers in the state. The board shall be available to present its comment and recommendations and answer all inquiries during each regular session of the Legislature, upon request of either the speaker of the House or the president of the Senate.
(b) The board shall conduct managed care policy studies designed to determine and measure the impact of: (1) Introducing risk-adjusted payment methodologies; (2) encouraging quality assurance strategies for vulnerable populations; (3)creating small employer and individual purchasing cooperatives; and, (4) expanding consumer choice of managed care plans.
(c) The board shall annually prepare and submit to the governor, the president of the Senate, and the speaker of the House of Delegates an annual report addressing the overall implementation and full accounting of the state's managed care system, including recommendations or changes in the administration, regulation and legal requirements related to health care and health care coverage.
§33-25D-3. Funding of managed care policy board's activities.
There is hereby created in the state treasury a special revenue account, which shall be an appropriated, interest-bearing account, designated as the managed care policy board fund. All proceeds from this fund shall be used exclusively for the purposes of the administration, regulation, promotion and study of the managed care policy board.
An annual fee equal to one and one-half percent of all premiums paid to any managed care provider shall be collected by the board from each such provider. For purposes of this article, "managed care provider" means any health maintenance organization or any health care corporation duly licensed and doing business in this state. The fee collected herein shall be collected by the board pursuant to this section and shall be deposited within fifteen days after receipt to the managed care policy board fund and dedicated to the purposes of this article.



NOTE: The purpose of this bill is to establish a managed care policy board to oversee and monitor the development, implementation, and regulation of managed care plans licensed by the state. In fulfilling this purpose the bill provides for the following: (1) Composition of board; (2) directing the board to review and comment on all matters of planning, policy, development, program design and evaluation involving managed care plans in the state; (3) financing operations of managed care policy board by a one half of one percent assessment against premiums paid for coverage; (4) requiring board to recommend additions, deletions, and revisions to the standards used to license managed care plans; (5) requiring the board to recommend strategies and new initiatives for existing state-sponsored health information, ombudsmen and external quality review programs; (6) requiring the board to conduct managed care policy studies; (7) requiring the board to meet at least four times every year and to elect officers, etc.; and, (8) requiring the board to prepare and send to the governor and the Legislature an annual report.

Article 25D is new; therefore, strike-throughs and underscoring have been omitted.