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Chapter 64     Entire Code
‹ Chapter 63  |  Chapter 64 Printer Friendly Versions
Chapter 64  |  Article 64 - 7  |  Section 7
WVC 64- CHAPTER 64. LEGISLATIVE RULES.
WVC -7- ARTICLE 7. AUTHORIZATION FOR DEPARTMENT OF TAX AND REVENUE TO PROMULGATE LEGISLATIVE RULES.

WVC 64 - 7 - 1 §64-7-1. State Tax Department.

     (a) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section eleven-c, article ten, chapter eleven of this code, modified by the State Tax Department to meet the objections of the Legislative Rule-Making Review Committee and refiled in the State Register on November 26, 2013, relating to the State Tax Department (municipal sales and service and use tax administration, 110 CSR 28), is authorized.

     (b) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section eleven, article three, chapter twenty-two of this code, modified by the State Tax Department to meet the objections of the Legislative Rule-Making Review Committee and refiled in the State Register on November 26, 2013, relating to the State Tax Department (special reclamation tax credit, 110 CSR 29), is authorized.

     (c) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section two-c, article three, chapter fifty of this code, modified by the State Tax Department to meet the objections of the Legislative Rule-Making Review Committee and refiled in the State Register on November 26, 2013, relating to the State Tax Department (withholding or denial of personal income tax refunds from taxpayers who owe municipal or magistrate court costs, 110 CSR 40), is authorized.

WVC 64 - 7 - 2 §64-7-2. Insurance Commissioner.

     (a) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section four, article sixteen-h, 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 November 1, 2013, relating to the Insurance Commissioner (utilization review and benefit determination, 114 CSR 95 ), is authorized with the following amendments:

     On page one, subsection 1.1., after the words "and benefit determinations" by inserting a comma;

     On page one, subsection 2.1., by striking out the word "healthcare" and inserting in lieu thereof the words "health care";

     On page two, subsection 2.6., after the word "specialty" by striking out the word "as" and inserting in lieu thereof the word "that";

     On page three, subsection 2.15., by striking out the word "no" and inserting in lieu thereof the word "not";

     On page three, subsection 2.16., by striking out the words "except as otherwise specifically exempted in this definition" and inserting in lieu thereof the words "but excluding the excepted benefits defined in 42 U.S.C. § 300gg-91 and as otherwise specifically excepted in this rule";

     On page five, subsection 2.17., by striking out the word "state" and inserting in lieu thereof the words "West Virginia";

     On page five, subsection 2.24., by striking out the word "in" and inserting in lieu thereof the word "an";

     On page six, subsection 2.28., by striking out the word "that" and inserting in lieu thereof the words "the one";

     On page six, subdivision 2.30.a., by striking out the words "the covered person's life, health or ability to regain maximum function or in the opinion of an attending health care professional with knowledge of the covered person's medical condition, would subject the covered person to severe pain that cannot be adequately managed without the health care service or treatment that is the subject of the request." and inserting in lieu thereof the words "the life or health of the covered person or the ability of the covered person to regain maximum function; or";

     On page six, after subdivision 2.30.a., by inserting a new subdivision, designated subdivision 2.30.b., to read as follows:

     2.30.b.   In the opinion of an attending health care professional with knowledge of the covered person's medical condition, would subject the covered person to severe pain that cannot be adequately managed without the health care service or treatment that is the subject of the request.;

     And by relettering the remaining subdivisions;

     On page six, subdivision 2.30.b., by striking out "2.30.a" and inserting in lieu thereof "2.30.d";

     On page eight, subsection 6.1., by striking out the words "an entity" and inserting in lieu thereof the words "a person";

     On page eight, subsection 6.1., after the word "Commissioner" by inserting the words "or by statute or legislative rule";

     On page nine, after paragraph 6.3.a.4., by inserting a new paragraph, designated paragraph 6.3.a.5., to read as follows:

     6.3.a.5.  For purposes of calculating the time period for refiling the benefit request or claim, the time period shall begin to run upon the covered person's receipt of the notice of opportunity to resubmit.;

     On page ten, subdivision 7.1.b., by striking out the words "a determination is required to be made under subsections 7.2 and 7.4" and inserting in lieu thereof the words "prospective and retrospective review determinations are required to be made";

     On page eleven, paragraph 7.1.e.1., after the word "number" by inserting the word "of";

     On page twelve, subdivision 7.2.b., by striking out the words "health carrier" and inserting in lieu thereof the word "issuer";

     On page fourteen, subdivision 7.3.c., by striking out the comma and the word "and";

     On page fifteen, subdivision 8.1.a., by striking out the words "health carrier" and inserting in lieu thereof the word "issuer";

     On page fifteen, after subdivision 8.1.b., by inserting a new paragraph, designated paragraph 8.1.b.1., to read as follows:

     8.1.b.1.  If the covered person has failed to provide sufficient information for the issuer to determine whether, or to what extent, the benefits requested are covered benefits or payable under the issuer's health benefit plan, the issuer shall notify the covered person as soon as possible, but in no event later than twenty-four (24) hours after receipt of the request, either orally or, if requested by the covered person, in writing of this failure and state what specific information is needed. The issuer shall provide the covered person a reasonable period of time to submit the necessary information, taking into account the circumstances, but in no event less than forty-eight (48) hours after notifying the covered person or the covered person's authorized representative of the failure to submit sufficient information.;

     And by renumbering the remaining paragraphs;

     On page seventeen, subparagraph 8.2.a.9.A., by striking out "8.2.a.8" and inserting in lieu thereof "8.2.a.7";

     On page seventeen, subparagraph 8.2.a.9.B., by striking out "subparagraph 8.2.a.9.A" and inserting in lieu thereof "paragraph 8.2.a.8";

     On page nineteen, subdivision 9.3.d., after the words "providers, paragraph" by striking out "9.3.c.3" and inserting in lieu thereof "9.3.c.1";

     On page nineteen, subdivision 9.3.d., after the words "amount in paragraph" by striking out "9.3.c.3" and inserting in lieu thereof "9.3.c.1";

     And,

     On page nineteen, paragraph 9.3.d.2., after the word "benefits" by adding a period.

     (b) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section four, article sixteen-h, 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 November 1, 2013, relating to the Insurance Commissioner (health plan insurer internal grievance procedure, 114 CSR 96 ), is authorized with the following amendments:

     On page one, section two, by striking out the heading "§114- 96-1. Definitions." and inserting in lieu thereof the heading "§114-96-2. Definitions.";

     On page one, subsection 2.1., by striking out the word "healthcare" and inserting in lieu thereof the words "health care";

     On page one, subsection 2.1., after the word "terminated" by adding a period;

     On page two, subdivision 2.3.a., by striking out the word "external" and inserting in lieu thereof the word "internal";

     On page two, subdivision 2.3.c., after the word "professional" by adding a semicolon;

     On page two, subsection 2.6., by striking out the word "as" and inserting in lieu thereof the word "that";

     On page three, subsection 2.15., by striking out the word "no" and inserting in lieu thereof the word "not";

     On page four, subsection 2.18., by striking out the words "except as otherwise specifically exempted in this definition" and inserting in lieu thereof the words "but excluding the excepted benefits defined in 42 U.S.C. § 300gg-91 and as otherwise specifically excepted in this rule";

     On page five, subsection 2.19., by striking out the word "state" and inserting in lieu thereof the words "West Virginia";

     On page six, subsection 2.26., by striking out the word "in" and inserting in lieu thereof the word "an";

     On page seven, subsection 2.30., by striking out the word "that" and inserting in lieu thereof the words "the one";

     On page seven, subdivision 2.32.c., by striking out "2.35.b" and inserting in lieu thereof "2.32.d";

     On page nine, subsection 4.2., by striking out the words "subdivision a of";

     On page ten, subdivision 5.4.a., after "5.4.a." by striking out the period;

     On page eleven, after subdivision 5.6.c., by inserting a new subdivision, designated subdivision 5.6.d., to read as follows:

     5.6.d. The issuer shall make the provisions of subsection 5.4 known to the covered person within three working days after the date of receipt of the grievance.;

     On page thirteen, subdivision 5.8.g., by striking out the word "upholds" and inserting in lieu thereof the word "denies";

     On page thirteen, paragraph 5.8.g.4., after the word "either" by inserting the word "the";

     On page thirteen, paragraph 5.8.g.5., after the word "circumstances" by inserting a comma;

     On page thirteen, paragraph 5.8.g.5., by striking out the word "provide" and inserting in lieu thereof the word "provided";

     On page thirteen, subparagraph 5.8.g.6.A., by striking out "5.4.g.4" and inserting in lieu thereof "5.8.g.4";

     On page thirteen, subparagraph 5.8.g.6.B., by striking out "5.4.g.5" and inserting in lieu thereof "5.8.g.5";

     On page thirteen, by striking out paragraph 5.8.h.1. in its entirety;

     On page fourteen, by striking out paragraph 5.8.h.2. in its entirety;

     And by renumbering the remaining paragraphs;

     On page fourteen, paragraph 5.8.h.3., by striking out "if the covered person decides not to file for an additional voluntary review of the first level review decision involving an adverse determination";

     On page fourteen, paragraph 5.9.a.3., after the words "notices" by striking out the comma;

     On page fifteen, subdivision 6.4.b., after "6.4.b." by striking out the period;

     On page sixteen, subdivision 6.5.d., after the semicolon by adding the word "and";

     On page sixteen, by striking out subdivision 6.5.e. in its entirety;

     And by relettering the remaining subdivision;

     On page sixteen, by striking out paragraphs 6.5.e.1 and 6.5.e.2 in their entirety;

     On page sixteen, subsection 7.2., by striking out "5.1" and inserting in lieu thereof "7.1";

     On page eighteen, subparagraph 7.8.a.7.A., after the words "as well as" by inserting the word "a";

     On page eighteen, subparagraph 7.8.a.7.A., after the word "reaching" by inserting the word "the";

     On page nineteen, subparagraph 7.8.a.7.E., after the word "circumstances" by inserting a comma;

     On page nineteen, part 7.8.a.7.F.3., after the word "et" by striking out the period;

     On page nineteen, part 7.8.a.7.F.6., after the word "claim" by inserting a comma;

     And,

     On page twenty, after subparagraph 7.8.b.1.B., by inserting a new subparagraph, designated subparagraph 7.8.b.1.C., to read as follows:

     7.8.b.1.C. Include in the English versions of all notices a statement prominently displayed in any applicable non-English language clearly indicating how to access the language services provided by the carrier.

     (c) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section four, article sixteen-h, 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 November 1, 2013, relating to the Insurance Commissioner (external review of adverse health insurance determinations, 114 CSR 97 ), is authorized with the following amendments:

     On page one, subsection 2.1., after the word "terminated" by adding period;

     On page two, subdivision 2.3.c., after the word "professional" by adding a semicolon;

     On page two, subdivision 2.4.c., by striking out "2.4a and 2.4b" and inserting in lieu thereof "2.4.a and 2.4.b";

     On page two, subdivision 2.4.d., by striking out "2.4a, 2.4b and 2.4c" and inserting in lieu thereof "2.4.a, 2.4.b and 2.4.c";

     On page three, subsection 2.7., after the word "Commissioner" by adding a period;

     On page three, subsection 2.12., after the words "Emergency medical condition" by striking out the single quotation mark and inserting in lieu thereof a double quotation mark;

     On page four, subsection 2.17., by striking out the words "except as otherwise specifically exempted in this definition" and inserting in lieu thereof the words "but excluding the excepted benefits defined in 42 U.S.C. § 300gg-91 and as otherwise specifically excepted in this rule";

     On page eight, subsection 3.1., by striking out the words "A written" and inserting in lieu thereof the words "An issuer shall notify the covered person in writing of the covered person's right to request an external review. Such a written";

     On page eight, subdivision 3.1.c., by striking out the words "subsection 15.1" and inserting in lieu thereof the words "section 14";

     On page nine, paragraph 3.1.e.1., before the words "would seriously" by striking out the comma;

     On page nine, paragraph 3.1.f.1., after the word "life" by striking out the comma and inserting in lieu thereof the words "or health or";

     On page ten, subsection 5.3., by striking out the words "expedited review of a grievance involving an adverse determination" and inserting in lieu thereof the words "expedited internal review of a grievance involving an adverse determination pursuant to W. Va. Code of St. R. §114-96";

     On page ten, subdivision 5.3.a., after the word "Code" by inserting the word "of";

     On page eleven, subsection 6.2., after the word "consideration" by striking out the word "on" and inserting in lieu thereof the word "of";

     On page twelve, subdivision 6.5.a, by striking out the words "two business days" and inserting in lieu thereof the words "one business day";

     On page thirteen, subdivision 6.6.d., by striking out the word "internal" and inserting in lieu thereof the word "independent";

     On page thirteen, subsection 6.8., after the words "receipt of the request for an external review" by inserting the words "and no later than one business day after making the decision";

     On page seventeen, subdivision 8.5.b., after "8.5.b." by striking out the period;

     On page seventeen, subdivision 8.5.c., by striking out "8.8" and inserting in lieu thereof "8.9";

     On page eighteen, subsection 8.6., after "IRO" by striking out the comma;

     On page eighteen, subdivision 8.6.a., by striking out the word "dely" and inserting in lieu thereof the word "delay";

     On page nineteen, paragraph 8.9.a.2., after the words "services or treatments" by inserting the words "would not be substantially increased over those of available standard health care services or treatments";

     On page twenty, subdivision 8.11.b., by striking out "8.12.d" and inserting in lieu thereof "8.11.d";

     On page twenty-one, subdivision 8.11.c., after "8.11.c", by inserting a period;

     On page twenty-one, subdivision 8.11.d., after "8.11.d", by inserting a period;

     On page twenty-one, paragraph 8.11.d.1., after "8.11.d.1", by inserting a period;

     On page twenty-one, paragraph 8.11.d.2., after "8.11.d.2", by inserting a period;

     On page twenty-one, paragraph 8.11.d.3., after "8.11.d.3", by inserting a period;

     On page twenty-one, paragraph 8.11.d.3., by striking the words "pursuant to subdivision 8.11.a";

     On page twenty-two, subsection 8.12., by striking out the word "amount" and inserting in lieu thereof the word "among";

     On page twenty-three, subdivision 9.2.f., after the word "parties" by striking out the comma;

     On page twenty-three, paragraph 9.2.f.1., after "IRO" by striking out the comma and the words "except that a party that unreasonably refuses to stipulate to limit the record may be taxed by the court for the additional costs involved";

     On page twenty-four, subsection 10.2, by striking out the word "as" and inserting in lieu thereof a comma;

     On page twenty-five, subdivision 10.4.c., by striking out subdivision 10.4.c. in its entirety;

     On page twenty-seven, paragraph 11.4.a.2., after the word "review" by inserting a comma and the words "any known close relative of the covered person,";

     On page twenty-seven, after paragraph 11.4.a.3., by inserting two new paragraphs, designated paragraph, 11.4.a.4. and 11.4.a.5., to read as follows:

     11.4.a.4. Any administrator, fiduciary, employee or sponsor of an employee welfare benefit plan as defined in 29 U.S.C. 1002(1), if any, under which the covered person's request for external review arises;

     11.4.a.5. A trade association of group health plans or issuers, or a trade association of health care providers;

     And by renumbering the remaining paragraphs;

     On page twenty-seven, subdivision 11.4.b., by striking out all of subdivision 11.4.b. and inserting in lieu thereof a new subdivision, designated subdivision 11.4.b., to read as follows:

     11.4.b. In determining whether an IRO or a clinical reviewer of the IRO has a material professional, familial or financial conflict of interest for purposes of subdivision 11.4.a, the Commissioner may disregard the mere appearance of a conflict of interest.;

     On page twenty-eight, section twelve, by striking out section twelve in its entirety;

     And by renumbering the remaining sections;

     On page twenty-eight, subsection 13.1., by striking out "13.1.a" and inserting in lieu thereof "12.1.a"

     On page twenty-nine, paragraph 13.2.b.2., by striking out "paragraph 13.2.b.2" and inserting in lieu thereof "paragraph 12.2.b.1";

     On page thirty, subsection 15.2, by striking out "15.1" and inserting in lieu thereof "14.1";

     On page thirty, subsection 15.3, by striking out "15.2" and inserting in lieu thereof "14.2";

     And,

     On page thirty, after subsection 15.3, by adding a new section, designated section fifteen, to read as follows:

     §114-97-15. Penalties. Any issuer failing to comply with the requirements of this rule is subject to the penalties prescribed in W. Va. Code §33-3-11.

WVC 64 - 7 - 3 §64-7-3. Alcohol Beverage Control Commission.

     (a) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section ten, article seven, chapter sixty of this code, modified by the Alcohol Beverage Control Commission to meet the objections of the Legislative Rule- Making Review Committee and refiled in the State Register on October 31, 2013, relating to the Alcohol Beverage Commission (private club licensing, 175 CSR 2 ), is authorized.

     (b) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section sixteen, article two, chapter sixty of this code, modified by the Alcohol Beverage Control Commission to meet the objections of the Legislative Rule-Making Review Committee and refiled in the State Register on October 31, 2013, relating to the Alcohol Beverage Commission (farm wineries, 175 CSR 3), is authorized.

     (c) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section twenty-three, article eight, chapter sixty of this code, modified by the Alcohol Beverage Control Commission to meet the objections of the Legislative Rule-Making Review Committee and refiled in the State Register on October 31, 2013, relating to the Alcohol Beverage Commission (sale of wine, 175 CSR 4 ), is authorized.

     (d) The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section twenty-two, article sixteen, chapter eleven of this code, modified by the Alcohol Beverage Control Commission to meet the objections of the Legislative Rule-Making Review Committee and refiled in the State Register on October 31, 2013, relating to the Alcohol Beverage Commission (nonintoxicating beer licensing and operations procedures, 176 CSR 1), is authorized.

WVC 64 - 7 - 4 §64-7-4. Racing Commission.

     The legislative rule filed in the State Register on July 26, 2013, authorized under the authority of section six, article twenty-three, chapter nineteen of this code, modified by the Racing Commission to meet the objections of the Legislative Rule-Making Review Committee and refiled in the State Register on October 31, 2013, relating to the Racing Commission (thoroughbred racing, 178 CSR 1 ), is authorized with the following amendment:

     On page fifteen, subsection 8.5.b., line twenty-two, following the words "stewards shall have authority to" by striking the word "charge", and inserting in lieu thereof "issue a ruling citing"; and

     On page eighteen, subsection 9.2., line six, following the words "health certificates", by striking the word "Coggins" and inserting in lieu thereof "current negative Coggins test for equine infectious anemia (EIA)".

WVC 64 - 7 - 5 §64-7-5. State Tax Department.

     The legislative rule filed in the State Register on August 30, 2012, authorized under the authority of section five, article one- c, chapter eleven of this code, modified by the State Tax Department to meet the objections of the Legislative Rule-Making Review Committee and refiled in the State Register on December 6, 2012, relating to the State Tax Department (valuation of commercial and industrial real and personal property for ad valorem property tax purposes, 110 CSR 1P), is authorized, with the following amendments:

     On page one, subsection 1.1, beginning on line ten, by striking out subsection 1.1 in its entirety and inserting in lieu thereof the following:

     "1.1 Scope. - These regulations clarify and implement State law as it relates to the appraisal at market value of commercial and industrial real and personal property under W. Va. Code §11- 10C-10. Because these regulations provide context modifications of relevant parts of 110 C.S.R. 1 and such regulations with context modifications were adopted by the Tax Commissioner through inclusion in the valuation plan required by W. Va. Code §11-1C-10(e), W. Va. Code §11-1C-5(b) eliminated the requirement that this filing be subject to the proceeding requirements of W. Va. Code §29A-3-1 et seq.";

     And,

     On page two, subsection 2.14, line twenty-four, following the words "remaining in", by striking out the words "the landlord" and inserting in lieu thereof the word "one". WVC 64 - 7 - 6 §64-7-6. Athletic Commission.

     The legislative rule filed in the State Register on July 28, 2011, authorized under the authority of section three-a, article five-a, chapter twenty-nine of this code, modified by the Athletic Commission to meet the objections of the Legislative Rule-Making Review Committee and refiled in the State Register on January 6, 2012, relating to the Athletic Commission (mixed martial arts, 177 CSR 2 ), is authorized, with the following amendments:

     On pages three and four, §177-2.5., by striking out all of §177-2.5. and inserting in lieu thereof a new §177-2.5., to read as follows:

     "§177-2.5. Venues must have a minimum seating capacity of 2,500 and video replay capabilities in good working order. However, the Commission may waive the minimum seating capacity requirement. Venues with a seating capacity of 3,500 or more must have a minimum of four video monitors displaying a continuous live feed of the match for the spectators; venues with a maximum seating capacity of 3,499 or less must have at least two monitors displaying a continuous live feed of the match for the spectators. All such video monitors must be a minimum of six feet by six feet. No event shall take place until the venue has been approved by the commission.";

     On page twelve, subsection 29.5., by striking out all of subsection 29.5. and inserting in lieu thereof a new subsection 29.5., to read as follows:

     "29.5. Prohibition of certain dressings. - No second shall be permitted to use grease or any other substances on the body of a contestant. The use of petroleum jelly in corners is not allowed except in the use of stopping blood and on cuts. Petroleum jelly, or other substances approved by the commission, may be used in between rounds in the use of stopping blood and on cuts and only in the presence of a representative of the commission. The use of drugs, alcohols or stimulants during a match by any contestant is adequate cause for revoking license.";

     On page twenty, subsection 41.1., by striking out all of subsection 41.1. and inserting in lieu thereof a new subsection 41.1., to read as follows:

     "41.1. Matches may take place in a cage or ring that has been approved by the commission. The cage or ring shall meet the requirements set forth by the commission and is subject to inspection prior to each match by a commission representative such as a referee.";

     On page twenty-one, subsection 41.3., by striking out all of subsection 41.3. and inserting in lieu thereof a new subsection 41.3., to read as follows:

     "41.3. The commission shall determine all seating arrangements at cage side necessary to effectuate the match. A promoter may submit a proposed seating arrangement to the commission one week before the event.";

     And,

     On page twenty-one, after subsection 41.3., by inserting a new subsection, designated subsection 41.4., to read as follows:

     41.4. Ring - The ring specifications shall meet the following requirements:

     41.4.a. The ring shall be no smaller than twenty feet square and larger than thirty-two feet square within the ropes. One corner shall have a red designation and the corner directly opposite shall have a blue designation.

     41.4.b. The floor must extend at least eighteen inches beyond the ropes. The ring floor must be padded in a manner as approved by the commission, with at least one inch layer of foam padding. No vinyl or other plastic rubberized cover shall be permitted. The fighting area canvas shall not be more than four feet above the floor of the building and shall have suitable steps or ramp for use by the participants.

     41.4.c. Ring posts must be made of metal, not more than three inches in diameter, extending from the floor of the building to a minimum height of fifty-eight inches above the ring floor, and must be properly padded in a manner approved by the commission. Ring posts must be at least eighteen inches away from the ring ropes.

     41.4.d. There must be five ring ropes, not less than one inch in diameter and wrapped in soft material. The lowest ring rope must be twelve inches above the ring floor.

     41.4.e. There must not be any obstruction or object, including, without limitation, a triangular border, on any part of the ring floor". WVC 64 - 7 - 7 §64-7-7. Directors of the West Virginia Health Insurance Plan.

     The legislative rule filed in the State Register on the twenty-eighth day of July, two thousand eleven, authorized under the authority of section seven-b, article forty-eight, chapter thirty-three, of this code, relating to the Board of Directors of the West Virginia Health Insurance Plan (premium subsidy, 113 CSR 1), is authorized.

Note: WV Code updated with legislation passed through the 2014 1st Special Session
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