SB236 INTR

Senate Bill No. 236
(By Senator Hunter, Caldwell, Rowe and Mitchell)
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[Introduced January 17, 2002; referred to the Committee

on Banking and Insurance; and then to the Committee on Finance.]

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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- six, relating to requiring health benefit plan coverages to provide certain benefits related to brain injury, including cognitive rehabilitation therapy and cognitive communication therapy.

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-six, to read as follows:
ARTICLE 46. HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN BENEFITS RELATED TO BRAIN INJURY.

§33-46-1. Applicability of article.

(a) This article applies only to a health benefit plan that provide benefits for medical or surgical expenses incurred as a result of a health condition, accident or sickness, including an individual, group, blanket or franchise insurance policy or insurance agreement, a group hospital service contract or an individual or group evidence of coverage or similar coverage document that is offered by:

(1) An insurance company;

(2) A group hospital service corporation operating under the provisions of article twenty-four of this chapter;

(3) A fraternal benefit society operating under the provisions of article twenty-three of this chapter;

(4) A reciprocal exchange operating under the provisions of article twenty-one of this chapter; or

(5) A health maintenance organization operating under the provisions of article twenty-five-a of this chapter.

(b) This article applies to a small employer health benefit plan written under the provisions of article sixteen-d of this chapter.

(1) A plan that provides coverage:

(A) Only for benefits for a specified disease or for another limited benefit other than an accident policy;

(B) Only for accidental death or dismemberment;

(C) For wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;

(D) As a supplement to a liability insurance policy;

(E) For credit insurance;

(F) Only for dental or vision care;

(G) Only for hospital expenses; or

(H) Only for indemnity for hospital confinement.

(2) A medicare supplemental policy as defined by section three-d, article sixteen and section five, article twenty-eight of this chapter.

(3) A workers' compensation insurance policy;

(4) Medical payment insurance coverage provided under a motor vehicle insurance policy; or

(5) A long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by article fifteen-a of this chapter.
§33-46-2. Exclusion of coverage prohibited.

(a) A health benefit plan may not exclude coverage for cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy and rehabilitation, neurobehavioral, neurophysiological, neuropsychological and psycho physiological testing or treatment, neurofeedback therapy, remediation, post-acute transition services or community reintegration services necessary as a result of and related to an acquired brain injury.

(b) Coverage required under this article may be subject to deductibles, copayments, coinsurance or annual or maximum payment limits that are consistent with deductibles, copayments, coinsurance and annual or maximum payment limits applicable to other similar coverage under the plan.

(c) The commissioner shall propose rules as necessary to implement this article.
§33-46-3. Training for certain personnel required.

(a) "Preauthorization" means the provision of a reliable representation to a physician or health care provider of whether the issuer of a health benefit plan will pay the physician or provider for proposed medical or health care services if the physician or provider renders those services to the patient for whom the services are proposed. The term includes precertification, certification, recertification or any other activity that involves providing a reliable representation by the issuer of a health benefit plan to a physician or health care provider.

(b) The commissioner shall propose rules that require the issuer of a health benefit plan to provide adequate training to personnel responsible for preauthorization of coverage or utilization review under the plan to prevent wrongful denial of coverage required under this article and to avoid confusion of medical benefits with mental health benefits.

NOTE: The purpose of this bill is to require health benefit plan coverages to include certain benefits related to brain injury, including cognitive rehabilitation therapy and cognitive communication therapy.

This article is new; therefore, strike-throughs and underscoring have been omitted.