COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 483
(By Senators Minard and Chafin)
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[Originating in the Committee on Health and Human Resources;
reported February 17, 2010.]
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A BILL to amend and reenact §33-25A-5 of the Code of West Virginia,
1931, as amended, relating to health maintenance
organizations; authority to provide a point of service option;
and authority for the Office of the Insurance Commissioner to
develop standards for a point of service option by legislative
and emergency rule.
Be it enacted by the Legislature of West Virginia:
That §33-25A-5 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-5. Powers of health maintenance organizations.
(a) Upon obtaining a certificate of authority as required
under this article, a health maintenance organization may enter
into health maintenance contracts in this state and engage in any
activities, consistent with the purposes and provisions of this
article, which are necessary to the performance of its obligations under such contracts, subject to the limitations provided
for in
this article.
A health maintenance organization may offer to its
enrollees in conjunction with the benefits provided to them through
their contractual arrangement for health services with the health
maintenance organization a point of service option to be provided
either by the health maintenance organization directly or by an
insurance carrier licensed in this state with which the health
maintenance organization has a contractual arrangement. Benefits
for health care services within the health maintenance
organization's contracted provider panel shall comply with all
other provisions of this article. The commissioner may promulgate
rules and regulations limiting or regulating the powers of health
maintenance organizations which he finds to be in the public
interest.
(b) For purposes of this article, "point of service option"
means a delivery system that permits an enrollee to receive
services, outside the panel of providers with which the health
maintenance organization has a contractual arrangement, under the
terms and conditions of the enrollee's contract with the health
maintenance organization or the insurance carrier that provides the
point of service option.
(c) The commissioner shall propose rules for legislative
approval in accordance with the provisions of article three,
chapter twenty-nine-a of this code limiting or regulating the
powers of health maintenance organizations which the commissioner
finds to be in the public interest. The commissioner shall promulgate emergency rules pursuant to the provisions of section
fifteen, article three, chapter twenty-nine-a of this code to
implement standards and requirements for a point of service option.
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(NOTE: The purpose of this bill is to authorize HMO's to
offer a point of service option.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.)
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BANKING AND INSURANCE COMMITTEE AMENDMENT
By striking out the title and substituting therefor a new
title, to read as follows:
Eng. Com. Sub. Senate Bill No. 483--A Bill to amend and
reenact §33-25A-5 of the Code of West Virginia, 1931, as amended,
relating to authorizing health maintenance organizations to provide
a point of service option; providing a definition for "point of
service option"; and authorizing the Office of the Insurance
Commissioner to develop standards for a point of service option by
legislative and emergency rule.