ENGROSSED
COMMITTEE SUBSTITUTE
FOR
H. B. 2747
(By Delegates Perdue, Hatfield, Marshall, Michael,
Moore, Rodighiero, and Border)
[Originating in the Government Organization]
(March 24, 2009)
A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new section, designated §33-3-14e, all
relating to creating a temporary health information technology
reinvestment fee for health insurers; providing definitions;
establishing penalties for noncompliance; providing rule-
making authority; providing for reduction or elimination of
fees if available funds exceed necessary amounts; and
establishing an effective date.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new section, designated §33-3-14e, to read as
follows:
CHAPTER 33. INSURANCE.
ARTICLE 3. LICENSING, FEES AND TAXATION.
§33-3-14e. Health Care Information Technology Reinvestment Fee.
(a) The Legislature finds the following:
(1) Improving the capability to access and exchange electronic
health information is a key component of the health care reform
efforts in West Virginia.
(2) The access and exchange of electronic health information
improves the quality of care and the efficiency of health
practitioners.
(3) The financing model of the existing health care system
results in most of the financial benefits of the use of health
information technology not being realized by the primary care
practitioners who have to invest in and use the electronic medical
record but by those who pay for health care services.
(4) Significant funding is potentially available under the
federal American Recovery and Reinvestment Act (Public Law 111-16)
to advance the purposes of this article if a state prepares to
implement health information technology in alignment with that Act
and provides necessary matching funds.
(b) As used in this section:
(1) "Commission" means the Insurance Commission.
(2) "Commissioner" means the commissioner of the Insurance
Commission.
(3) "Health insurance" means any group or individual health
care benefit policy, contract, or other health benefit plan
offered, issued, renewed, or administered by any health insurer,
including any health care benefit plan offered, issued, or renewed
by any health insurance company, any nonprofit hospital and medical
service corporation, or any managed care organization as defined in chapter 33 of this code. The term does include the Public Employees
Insurance Agency. The term does not include Medicaid, State
Children's Health Insurance Program, or any other state health care
assistance program financed, in whole or in part, through a federal
program, until authorized by the federal program. The term does
not include policies issued for specified disease, accident,
injury, hospital indemnity, dental care, long term care, disability
income, or other limited benefit health insurance policies.
(4) "Health insurer" means an entity licensed by the
commissioner to transact accident and sickness insurance in this
state, service corporations licensed pursuant to article
twenty-four of this chapter, health maintenance organizations
licensed pursuant to article twenty-five-a of this chapter.
(5) "Health TPA" means a third party administrator registered
in accordance with the provisions of article forty-six of this
chapter, that handles health claims for any entity other than a
health insurer.
(6) "WVHIN" is the West Virginia Health Information Network
created in article twenty-nine-g, chapter sixteen.
(c) The fee shall be established in the following manner:
(1) Quarterly, beginning October 1, 2009, each health insurer
shall pay a fee into the West Virginia Health Information Network
Account established in section four, article twenty-nine-g, chapter
sixteen. The health insurer may choose either of the following fee
options: (A) 0.05 of one percent of all health care claims paid by
the health insurer on health insurance for its West Virginia members in the previous fiscal quarter, or
(2) An annual fee payable quarterly, to be calculated on or
before August 1, 2009 and on or before August 1 of each succeeding
year by the Insurance Commission or by an agent retained by the
commission, in consultation with the Governor's Office of Health
Enhancement and Lifestyle Planning, based on the proportion which
the health insurer's total annual health care claims on health
insurance for its West Virginia members for the most recent four
quarters of data available to the commission bears to the total
health care claims for all health insurers for the most recent four
quarters of data available to the commission, multiplied by the
total fee revenue which would be raised if all health insurers
chose the fee option established in subdivision (1) of this
subsection. Such fee shall be subject to an annual recalculation
by the Insurance Commission, or an agent retained by the
commission, with any surplus or shortfall in the amount collected
adjudicated in the following fiscal quarter and bearing no interest
or penalty to any party.
(d) It is the intent of the Legislature that all health
insurers shall contribute equitably to the West Virginia Health
Information Network Account established in section four, article
twenty-nine-g, chapter sixteen of this code.
(e) The West Virginia Health Information Network may adopt
such legislative rules and issue such orders as are necessary to
carry out the purposes of this section.
(f) If any health insurer fails to pay the fee established in subsection (c) of this section within forty-five days after notice
from the WVHIN, the Director of WVHIN, or his or her designee,
shall notify the Insurance Commission, and the Director of the
Governor's Office of Health Enhancement and Lifestyle Planning of
the failure to pay. In addition to any other remedy or sanction
provided for by law, if the commissioner finds, after notice and an
opportunity to be heard, that the health insurer has violated this
section or any legislative rule or order adopted or issued pursuant
to this section, the commissioner may take any one or more of the
following actions:
(1) Assess an administrative penalty on the health insurer of
not more than $1,000 for each violation and not more than $10,000
for each willful violation;
(2) Order the health insurer to cease and desist in further
violations; or
(3) Order the health insurer to remediate the violation,
including the payment of fees in arrears and payment of interest on
fees in arrears at the rate of twelve percent per annum.
(g) No later than June 30, 2011, the Director of WVHIN and
the Director of the Governor's Office of Health Enhancement and
Lifestyle Planning, or his or her designee, shall assess the
adequacy of funding and make recommendations to the Legislature and
the Governor concerning the appropriateness of the duration of the
health care information technology reinvestment fee.
If at any time
the Director of the Governor's Office of Health Enhancement and
Lifestyle Planning and the Director of WVHIN determine that the assessment set forth in subdivision (c) will produce funds
exceeding those necessary to accomplish the purposes of this
article due to the availability of federal or other funds for these
purposes, the Director of WVHIN shall propose legislation to reduce
or eliminate the fee.
(h) This section shall be effective from July 1,2009 through
June 30, 2012.
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