Senate Bill No. 514
(By Senators Hunter, Ross, Sharpe, Unger, Boley, Walker,
Kessler, Chafin, Redd, Mitchell, Helmick and Minard)
[Introduced February 16, 2000; referred to the Committee
on Banking and Insurance; and then to the Committee on 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 forty-three,
relating to requiring insurance coverage by health care
insurers for serious mental illness; definitions;
determination of medical necessity and appropriateness;
providers providing treatment; duties of insurers and
insurance commissioner; data collection and reporting; and
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 forty-three, to read as
ARTICLE 43. INSURANCE COVERAGE FOR SERIOUS MENTAL ILLNESS.
§33-43-1. Coverage for serious mental illness required.
(a) On and after the first day of January, two thousand one,
every health care benefits policy issued or renewed in this state
shall provide coverage for the medical treatment of serious mental
illness of adults and children under the same terms and conditions
as the coverage provided for other illnesses and diseases under the
policy's medical and surgical benefits. The durational limits on
days or visits; dollar amount limits on out-of-pocket, annual and
lifetime expenditures; deductibles; and coinsurance factors
applicable to other illnesses and diseases under the policy's
medical and surgical benefits shall apply to serious mental
(b) The provisions of subsection (a) of this section do not
apply to a health benefits policy if, based upon experience
occurring over a continuous twelve-month period, the health care
insurer demonstrates to the commissioner that its application has
resulted in an increase of at least two percent in the net cost of the policy.
(a) "Health benefits policy" means any group plan, policy or
contract for health care services issued, delivered, issued for
delivery or renewed in this state by a health care corporation,
health maintenance organization, accident and sickness insurer,
fraternal benefit society, nonprofit hospital service corporation,
nonprofit medical service corporation, public employee's insurance
agency or similar entity when the policy or plan covers hospital,
medical or surgical expenses, except for credit accident and
sickness, long term care, medicare supplement, champus supplement,
individual major medical and limited benefit policies as defined
under article sixteen-e of this chapter.
(b) "Serious mental illness" means an illness included in the
American psychiatric association's diagnostic and statistical
manual of mental disorders, as periodically revised, under the
diagnostic categories or subclassifications of: (1) Pervasive
developmental disorders; (2) delirium, dementia and amnestic and
other cognitive disorders; (3) schizophrenia and other psychotic
disorders; (4) bipolar disorders; and (5) depressive disorders.
With regard to any covered individual who has not yet attained the age of nineteen years, "serious mental illness" also includes those
illnesses included under the other categories of disorders listed
in the American psychiatric association's diagnostic and
statistical manual of mental disorders, as revised.
(c) "Medical treatment" means appropriate and medically
necessary evaluation, diagnosis and treatment, including inpatient
hospitalization and outpatient visits.
§33-43-3. Medical necessity and appropriateness of treatment;
The health insurers shall make determinations of medical
necessity and appropriateness in a manner consistent with that used
to make the determination for treatment of other diseases or
injuries covered under the health insurance policy or agreement.
Nothing in this article requires an insurer to contract with all
providers willing to provide treatment for serious mental illness.
§33-43-4. Data collection and reporting.
Upon the effective date of this article, the insurance
commissioner shall obtain baseline data relating to the numbers of
insured persons, the cost of services for treatment of mental
illnesses, the cost of all services paid for by health insurers and
other data as may be reasonably required prior to the mandatory coverages required by this article. Following the first day of
January, two thousand one, the insurance commissioner shall obtain
data relating to the numbers of insured persons, the cost of
services for treatment of mental illnesses and the cost of all
services provided by health insurers as a result of the mandatory
coverages required by this article.
The insurance commissioner may
require insurers to maintain and provide data relating to
diagnostic categories of insured persons with serious mental
illness, services or categories of services provided, the provider
categories providing those services, cost data and other data as
may be reasonably required to evaluate the effect of this article.
All insurers shall collect, keep and report baseline data and data
following the enactment of this article as required and in the form
required by the insurance commissioner. Not later than the first
day of January, two thousand three, the insurance commissioner
shall report to the joint committee on government and finance on
the effect of the passage of this article. The insurance
commissioner may categorize the data reported in the manner he or
she may determine, except that data related to the public employees
insurance agency, even if included in aggregate data, shall also be
§33-2A-5. Termination date.
The mandate established by the enactment of this article that
all health benefits policies must provide coverage for serious
mental illness shall terminate on the first day of July, two
thousand three, pursuant to article ten, chapter four of this code,
unless sooner terminated, continued or reestablished by act of the
Legislature enacted prior to the termination date.
NOTE: The purpose of this bill is to require insurance
coverage for the treatment of serious mental illness.
This article is new; therefore, strike-throughs and
underscoring have been omitted.