H. B. 2357
(By Delegates Hatfield, Susman and Marshall)
[Introduced February 20, 2001; 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-f,
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-f, to read as
follows:
ARTICLE 25F. MANAGED CARE POLICY BOARD.
§33-25F-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.
(a) The managed care policy board is created 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.
(b) 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.
(c) The board shall meet at least four times every year, the
first 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.
§33-25F-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. The 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.
§33-25F-3. Funding of managed care policy board's activities.
A special revenue account is created in the state treasury,
which is 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 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.
This article is new; therefore, strike-throughs and
underscoring have been omitted.