ENROLLED
H. B. 4383
(By Delegates Leach, Craig, Morgan and Stephens)
[Passed March 9, 2006; in effect ninety days from passage.]
AN ACT to amend and reenact §16-29F-1 of the Code of West Virginia,
1931, as amended, relating to continuing the pilot program
offered through a Community Access Program to coordinate
health care provider reimbursements indefinitely as determined
by the insurance commissioner.
Be it enacted by the Legislature of West Virginia:
That §16-29F-1 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 29F. UNINSURED AND UNDERINSURED PILOT PROGRAMS.
§16-29F-1. Uninsured and underinsured health coverage assistance;
pilot program.
(a) The United States Department of Health and Human Services
has established a federal grant program to encourage innovative
integrated health care delivery systems to serve uninsured and
underinsured persons with greater efficiency and improved quality of care and to further maximize reimbursements to health care
providers which provide these services. The "Community Access
Program" grants as authorized in the federal register: February 4,
2000 (volume 65, number 24), allow for the establishment of local
programs to reorganize and reintegrate local health care delivery
systems. This section authorizes, on a trial basis, the
establishment of pilot programs in the state which receive a grant
under the community access program to coordinate health care
provider reimbursements, to allow an opportunity for innovations in
payment for health care services to be tested and, if successful,
to be permanently implemented.
(b) An entity receiving a community access program grant may
initiate a program that comports to the federal grant requirements
and meets the requirements of this section. The pilot program may
enroll persons to participate in this pilot program who currently
do not have insurance and whose income does not exceed two hundred
fifty percent of the federal poverty level. The pilot program may
coordinate payments from enrollees and businesses employing
enrollees to be utilized to capture available federal moneys to
assist in providing reimbursements to enrollee's health care
providers. The pilot program shall coordinate reimbursements
limited to areas not covered by other federal reimbursement
programs such as the children's health insurance agency within the
Department of Administration and the Federal Medicaid Program. In no instance may the pilot program allow health care reimbursements
to enrollees and to health care providers that limit or otherwise
impede the eligibility of the enrollee or the health care provider
to be eligible for these or other federal health care cost
reimbursement programs.
(c) Notwithstanding the provisions of chapter thirty-three of
this code to the contrary, any grant program created and authorized
pursuant to this section is not to be considered as providing
insurance or as offering insurance services. Community access
pilot programs are specifically excluded from the definitions of
"insurance" and "insurer" as defined in article one, chapter
thirty-three of this code, and except as provided in this section,
these programs are not subject to regulation by the insurance
commissioner, nor are they unauthorized insurers pursuant to
section four, article forty-four of chapter thirty-three of this
code.
(d) The community access pilot program is authorized to enter
into agreements with health care providers to coordinate and
otherwise provide services to enrollees. These agreements must be
contingent on the health care provider agreeing to accept payment
from the community access pilot program based on available funding
to the program for the health care services being provided. If the
health care provider decides to no longer accept the community
access pilot program's enrollee's reimbursement, the health care provider must provide, at a minimum, thirty days' notice of
discontinuance of providing services and further acceptance of
enrollee's payments.
(e) The community access pilot program must provide enrollees
and the participating employer with a minimum of thirty days'
notice of discontinuance or reduction of enrollee benefits.
(f) The community access pilot program must submit quarterly
reports to the Legislative Oversight Commission of Health and Human
Resources accountability as established in article twenty-nine-e of
this chapter and to the insurance commissioner. The report shall
include at a minimum, analysis of the financial status, the number
of health care provider reimbursements, enrollee services utilized
and other information as requested by the commission and the
insurance commissioner.
(g) The authorization for the existence of a pilot program as
established pursuant to this section expires on the thirtieth day
of June, two thousand seven, unless the insurance commissioner
continues the authorization for such periods as he or she
determines.