Senate Bill No. 49
(By Senators Fanning and Love)
____________
[Introduced January 10, 2007; referred to the Committee on
Banking and Insurance; and then to the Committee on Finance.]
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A BILL to amend and reenact §5-16-7
of the Code of West Virginia,
1931, as amended; to amend said code by adding thereto a new
section, designated §33-15-4i; to amend said code by adding
thereto a new section, designated §33-16-3s
; to amend said
code by adding thereto a new section, designated §33-24-7i;
and to amend said code by adding thereto two new sections,
designated
§33-25-8g and §33-25-8h, all
relating to insurance
coverage for acupuncture treatment generally; and providing
insurance coverage under the Public Employees Insurance Act
and certain other insurance policies for acupuncture treatment
performed by a licensed
acupuncturist
.
Be it enacted by the Legislature of West Virginia:
That §5-16-7
of the Code of West Virginia, 1931, as amended,
be amended and reenacted; that said code be amended by adding
thereto a new section, designated §33-15-4i; that said code be amended by adding thereto a new section, designated §33-16-3s
; that
said code be amended by adding thereto a new section, designated
§33-24-7i; and that said code be amended by adding thereto two new
sections, designated §33-25-8g and §33-25-8h,
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 when medically appropriate and
consistent with current guidelines from the United States Preventive
Services Task Force; pap smears, either conventional or liquid-based
cytology, whichever is medically appropriate and consistent with the
current guidelines from either the United States Preventive Services
Task Force or The American College of Obstetricians and
Gynecologists; and a test for the human papilloma virus (HPV) when
medically appropriate and consistent with current guidelines from
either the United States Preventive Services Task Force or The
American College of Obstetricians and Gynecologists, when performed
for cancer screening or diagnostic services on a woman age eighteen
or over;
(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.
§33-15-4i. 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 seven, 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.
§33-16-3s. 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 seven, 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.
§33-24-7i. 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 seven, 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.
§33-25-8g. 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 seven, 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 MAINTENANCE ORGANIZATION ACT.
§33-25-8h. 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 seven, 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 performed by a licensed
acupuncturist
.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
§33-15-4i, §33-16-3s, §33-24-7i, §33-25-8g and §33-25-8h are
new; therefore, strike-throughs and underscoring have been omitted.