COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 458
(By Senators Minard and Kessler)
____________
[Originating in the Committee on Judiciary;
reported February 21, 2002.]
____________
A BILL to amend article twenty-five-a, chapter thirty-three of the
code of West Virginia, one thousand nine hundred thirty-one,
as amended, by adding thereto a new section, designated
section twenty-three-a, relating to the health maintenance
organization act; and empowering the commissioner to impose a
civil penalty on violators of health maintenance organization
contracts as defined in section seven-a of said article.
Be it enacted by the Legislature of West Virginia:
That article twenty-five-a, chapter thirty-three of the code
of West Virginia, one thousand nine hundred and thirty-one, as
amended, be amended by adding thereto a new section, designated
section twenty-three-a, to read as follows:
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-23a. Civil penalty imposed by commissioner.
Any provider in violation of section seven-a of this article
may be subject to a civil money penalty to be imposed by the commissioner. Upon a determination that there is probable cause to
believe that any provider has violated section seven-a of this
article, the commissioner may provide written notice to the alleged
violator, stating the nature of the alleged violation and that
failure to refund the amount of any improper billing within thirty
days may result in imposition of a civil penalty pursuant to the
provisions of this section. If the alleged violator fails to make
a refund within thirty days, the commissioner shall issue a written
notice of hearing stating the nature of the alleged violation and
the time and place at which the alleged violator shall appear to
show good cause why a civil penalty should not be imposed:
Provided, That if the commissioner has previously found on three
occasions that probable cause existed to support a violation, the
alleged violator shall not be afforded the opportunity to make a
refund before issuance of the notice of hearing for any subsequent
violation.
If, after notice and hearing, the commissioner determines that
a violation of section seven-a of this article has occurred, the
commissioner may assess a civil penalty of not less than the amount
charged the subscriber but not more than one thousand dollars.
Subsequent violations of section seven-a of this article shall
result in fines of not more than two thousand dollars. Any
provider so assessed shall be notified of the assessment in writing
and the notice shall specify the reasons for the assessment. Any
provider may waive the right to a hearing and receive a reduction
in penalties of twenty-five percent.
__________
(NOTE: The purpose of this bill is to authorize the
commissioner to impose a money penalty against a provider under
contract with an HMO for charging a patient-subscriber for a
balance over and above the deductible/co-pay owed by the patient
after payment by the HMO.
Section twenty-three-a is new; therefore, strike-throughs and
underscoring have been omitted.)