A BILL to amend and reenact section two, article seven, chapter sixty-four of the code of West Virginia, one thousand nine hundred thirty-one, as amended, relating to authorizing the insurance commissioner to promulgate a legislative rule relating to the external review of coverage denials.

§64-7-2. Insurance commissioner.
(a) The legislative rule filed in the state register on the first day of October, two thousand, authorized by section three, article fifteen-b, chapter thirty-three of this code, relating to the insurance commissioner (standards for uniform health care administration, 114 CSR 16), is authorized.
(b) The legislative rule filed in the state register on the first day of September, two thousand, authorized under the authority of section ten, article two, chapter thirty-three of this code, modified by the insurance commissioner to meet the objections of the legislative rule-making review committee and refiled in the state register on the seventeenth day of November, two thousand, relating to the insurance commissioner (examiners' compensation, qualifications and classification, 114 CSR 15), is authorized.
(c) The legislative rule filed in the state register on the first day of September, two thousand, authorized by section ten, article two, chapter thirty-three of this code, modified by the insurance commissioner to meet the objections of the legislative rule-making review committee and refiled in the state register on the seventeenth day of November, two thousand, relating to the insurance commissioner (Medicare supplement insurance, 114 CSR 24), is authorized.
(d) The legislative rule filed in the state register on the first day of September, two thousand, authorized under the authority of section ten, article two, chapter thirty-three of this code, modified by the insurance commissioner to meet the objections of the legislative rule-making review committee and refiled in the state register on the seventeenth day of November, two thousand, relating to the insurance commissioner (AIDS, 114 CSR 27), is authorized with the following amendment:
"On page six of the rule, subsection 5.9, by striking subdivision 5.9 in its entirety and inserting in lieu thereof, the following:
'5.9. The testing is required to be administered on a nondiscriminatory basis for all individuals in the same underwriting class. No proposed insured may be denied coverage or rated a substandard risk on the basis of HIV testing unless acceptable testing protocol is followed. The insurer may at its option use a urine HIV test as an initial screening device; provided that if the urine test yields a negative result for the purpose of HIV antibodies then HIV blood or OMT testing may be required by the insurer. The proposed insured may not be denied insurance coverage or rated a substandard risk on the basis of a positive urine HIV test alone, including the use of FDA-licensed tests. An applicant may not be denied coverage on the basis of AIDS related testing unless:
a. An initial enzyme linked immunosorbent assay (ELISA) test is administered to the proposed insured, and it indicates the presence of HIV antibodies,
b. The initially reactive specimen is retested by ELISA in duplicate and at least one of the repeat tests is reactive. The specimen considered repeatedly reactive, is examined in a Western blot test to confirm the ELISA test results; and
c. A Western blot test is positive.'"
If an initial ELISA test is negative, or both repeat-duplicate tests are negative, the testing ceases and the proposed insured cannot be denied coverage based on AIDS-related testing. If the initial and at least one of the repeat-duplicate LISA tests is positive but the Western blot test is negative, for purposes of insurability, the results are negative.
(e) The legislative rule filed in the state register on the first day of September, two thousand, authorized by section ten, article two, chapter thirty-three of this code, modified by the insurance commissioner to meet the objections of the legislative rule-making review committee and refiled in the state register on the seventeenth day of November, two thousand, relating to the insurance commissioner (continuing education for insurance agents, 114 CSR 42), is authorized.
(f) The legislative rule filed in the state register on the twenty-fifth day of July, two thousand one, authorized under the authority of section six, article twenty-five-c, chapter thirty- three, of this code, modified by the insurance commissioner to meet the objections of the legislative rule-making review committee and refiled in the state register on the twenty-first day of December, two thousand one, relating to the insurance commissioner (external review of coverage denials, 114 CSR 58), is authorized.

NOTE: The purpose of this bill is to authorize the Insurance Commissioner to promulgate a legislative rule relating to the External Review of Coverage Denials.

Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.