HOUSE CONCURRENT RESOLUTION NO. 79
(By Mr. Speaker, Mr. Kiss, and Delegates Amores, Angotti,
Ashley, Beane, Cann, Compton, Flanigan, Fleischauer,
Hatfield, Hines, Houston, Hubbard, Hutchins, Jenkins,
Johnson, Kuhn, Leach, Linch, Louisos, Mahan, Marshall,
Martin, Mattaliano, Perdue, Pethtel, Prunty, Ross,
Staton, Thompson and Wills)
Requesting the Joint Committee on Government and Finance to make a
study of the system by which health care providers obtain
payment for services rendered.
Whereas, Health care providers' offices struggle to obtain
compensation for the services they render because of the differing,
burdensome procedures required by the respective payors, such as
insurance companies, managed care entities and ERISA-covered health
plans; and
Whereas, Standardizing the delivery and payment for health care
services would be beneficial to consumers and providers; therefore,
be it
Resolved by the Legislature of West Virginia:
That the Joint Committee on Government and Finance is hereby
requested to review and study the feasibility of imposing standards
which would result in uniformity in the payment of health care
claims by payors such as insurance companies, managed care entities
and ERISA-covered health plans to providers, which study would
include examining the definition of "clean claims," prompt payment
of clean claims, a reasonable time frame for submission, approval and payment of claims, a reasonable process for providing
additional information to payors to clarify the claim, development
of standard forms for payors to use when communicating with
providers, development of standard forms for cards to be held by
insured consumers which contain specific information pertaining to
eligibility, applicable co-payments and deductibles, development of
restrictions governing the right of payors to collect funds
previously paid to providers, development of a system which allows
providers the opportunity for review of a disputed claim by an
objective third party comprised of qualified independent
professionals within the applicable specialty, and development of
a patient bill of rights and provider bill of rights for managed
care organizations; and, be it
Further Resolved, That the Joint Committee on Government and
Finance report to the regular session of the Legislature, two
thousand one, on its findings, conclusions and recommendations,
together with drafts of any legislation necessary to effectuate its
recommendations; and, be it
Further Resolved, That the expense necessary to conduct this
study, to prepare a report and to draft the necessary legislation
be paid from legislative appropriations to the Joint Committee on
Government and Finance.