Senate Bill No. 96
(By Senator Fanning)
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[Introduced January 9, 2003; referred to the Committee on Health
and Human Resources; and then to the Committee on Finance.]
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A BILL to amend and reenact section seven, article sixteen, chapter
five of the code of West Virginia, one thousand nine hundred
thirty-one, as amended; to amend article fifteen, chapter
thirty-three of said code by adding thereto a new section,
designated section four-h; to amend article sixteen of said
chapter by adding thereto a new section, designated section
three-q; to amend article twenty-four of said chapter by
adding thereto a new section, designated section seven-h; to
amend article twenty-five of said chapter by adding thereto a
new section, designated section eight-f; and to amend article
twenty-five-a of said chapter by adding thereto a new section,
designated section eight-g, all relating to requiring health
insurance policies to cover acupuncture treatment.
Be it enacted by the Legislature of West Virginia:
That section seven, article sixteen, chapter five of the code of West Virginia, one thousand nine hundred thirty-one, as amended,
be amended and reenacted; that article fifteen, chapter
thirty-three of said code be amended by adding thereto a new
section, designated section four-h; that article sixteen of said
chapter be amended by adding thereto a new section, designated
section three-q; that article twenty-four of said chapter be
amended by adding thereto a new section, designated section
seven-h; that article twenty-five of said chapter be amended by
adding thereto a new section, designated section eight-f; and that
article twenty-five-a of said chapter be amended by adding thereto
a new section, designated section eight-g, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD
OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,
OFFICES, PROGRAMS, ETC.
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7. Authorization to establish group hospital and surgical
insurance plan, group major medical insurance plan,
group prescription drug plan and group life and
accidental death insurance plan; rules for
administration of plans; mandated benefits; what plans
may provide; optional plans; separate rating for
claims experience purposes.
(a) The agency shall establish a group hospital and surgical
insurance plan or plans, a group prescription drug insurance plan
or plans, a group major medical insurance plan or plans and a group
life and accidental death insurance plan or plans for those
employees herein made eligible, and to establish and promulgate
rules for the administration of these plans, subject to the
limitations contained in this article. Those plans shall include:
(1) Coverages and benefits for X ray and laboratory services
in connection with mammograms and pap smears when performed for
cancer screening or diagnostic services;
(2) Annual checkups for prostate cancer in men age fifty and
over;
(3) For plans that include maternity benefits, coverage for
inpatient care in a duly licensed health care facility for a mother
and her newly born infant for the length of time which the
attending physician considers medically necessary for the mother or
her newly born child: Provided, That no plan may deny payment for
a mother or her newborn child prior to forty-eight hours following
a vaginal delivery, or prior to ninety-six hours following a
caesarean section delivery, if the attending physician considers
discharge medically inappropriate;
(4) For plans which provide coverages for post-delivery care
to a mother and her newly born child in the home, coverage for
inpatient care following childbirth as provided in subdivision (3) of this subsection if inpatient care is determined to be medically
necessary by the attending physician. Those plans may also
include, among other things, medicines, medical equipment,
prosthetic appliances, and any other inpatient and outpatient
services and expenses considered appropriate and desirable by the
agency; and
(5) Coverage for treatment of serious mental illness.
(A) The coverage does not include custodial care, residential
care or schooling. For purposes of this section, "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: (i) Schizophrenia and other psychotic
disorders; (ii) bipolar disorders; (iii) depressive disorders; (iv)
substance-related disorders with the exception of caffeine-related
disorders and nicotine-related disorders; (v) anxiety disorders;
and (vi) anorexia and bulimia. With regard to any covered
individual who has not yet attained the age of nineteen years,
"serious mental illness" also includes attention deficit
hyperactivity disorder, separation anxiety disorder and conduct
disorder.
(B) Notwithstanding any other provision in this section to the
contrary, in the event that the agency can demonstrate actuarially
that its total anticipated costs for the treatment of mental illness for any plan will exceed or have exceeded two percent of
the total costs for such plan in any experience period, then the
agency may apply whatever cost containment measures may be
necessary, including, but not limited to, limitations on inpatient
and outpatient benefits, to maintain costs below two percent of the
total costs for the plan.
(C) The agency shall not discriminate between medical-surgical
benefits and mental health benefits in the administration of its
plan. With regard to both medical-surgical and mental health
benefits, it may make determinations of medical necessity and
appropriateness, and it may use recognized health care quality and
cost management tools, including, but not limited to, limitations
on inpatient and outpatient benefits, utilization review,
implementation of cost containment measures, preauthorization for
certain treatments, setting coverage levels, setting maximum number
of visits within certain time periods, using capitated benefit
arrangements, using fee-for-service arrangements, using third-party
administrators, using provider networks and using patient cost
sharing in the form of copayments, deductibles and coinsurance.
(6) Coverage and benefits for acupuncture treatment performed
by an acupuncturist licensed pursuant to article thirty-six,
chapter thirty of this code.
(b) The agency shall make available to each eligible employee,
at full cost to the employee, the opportunity to purchase optional group life and accidental death insurance as established under the
rules of the agency. In addition, each employee is entitled to
have his or her spouse and dependents, as defined by the rules of
the agency, included in the optional coverage, at full cost to the
employee, for each eligible dependent; and with full authorization
to the agency to make the optional coverage available and provide
an opportunity of purchase to each employee.
(c) The finance board may cause to be separately rated for
claims experience purposes: (1) All employees of the state of West
Virginia; (2) all teaching and professional employees of state
public institutions of higher education and county boards of
education; (3) all nonteaching employees of the university of West
Virginia board of trustees or the board of directors of the state
college system and county boards of education; or (4) any other
categorization which would ensure the stability of the overall
program.
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4h. Coverage for acupuncture treatment.
(a) Notwithstanding a provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day
of July, two thousand three, provide as benefits to all subscribers
and members coverage for acupuncture treatment performed by an acupuncturist licensed pursuant to article thirty-six, chapter
thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply
to acupuncture treatment the same deductibles, coinsurance and
other limitations as apply to other covered services.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3q. Coverage for acupuncture treatment.
(a) Notwithstanding a provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day
of July, two thousand three, provide as benefits to all subscribers
and members coverage for acupuncture treatment performed by an
acupuncturist licensed pursuant to article thirty-six, chapter
thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply
to acupuncture treatment the same deductibles, coinsurance and
other limitations as apply to other covered services.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND
HEALTH SERVICE CORPORATIONS.
§33-24-7h. Coverage for acupuncture treatment.
(a) Notwithstanding a provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day of July, two thousand three, provide as benefits to all subscribers
and members coverage for acupuncture treatment performed by an
acupuncturist licensed pursuant to article thirty-six, chapter
thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply
to acupuncture treatment the same deductibles, coinsurance and
other limitations as apply to other covered services.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-8f. Coverage for acupuncture treatment.
(a) Notwithstanding a provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day
of July, two thousand three, provide as benefits to all subscribers
and members coverage for acupuncture treatment performed by an
acupuncturist licensed pursuant to article thirty-six, chapter
thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply
to acupuncture treatment the same deductibles, coinsurance and
other limitations as apply to other covered services.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8g. Coverage for acupuncture treatment.
(a) Notwithstanding a provision of any policy, provision,
contract, plan or agreement to which this article applies, any
entity regulated by this article shall, on or after the first day of July, two thousand three, provide as benefits to all subscribers
and members coverage for acupuncture treatment performed by an
acupuncturist licensed pursuant to article thirty-six, chapter
thirty of this code.
(b) A policy, provision, contract, plan or agreement may apply
to acupuncture treatment the same deductibles, coinsurance and
other limitations as apply to other covered services.
NOTE: The purpose of this bill is to require health insurance
policies to cover acupuncture treatment.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
§§33-15-4h, 33-16-3q, 33-24-7h, 33-25-8f and 33-25A-8g are
new; therefore, strike-throughs and underscoring have been omitted.