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Introduced Version Senate Bill 669 History

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Senate Bill No. 669

(By Senators Kessler, Yost, Stollings, Unger and Wells)

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[Introduced March 23, 2009; referred to the Committee on Health and Human Resources; and then to the Committee on Banking and Insurance.]

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A BILL to amend and reenact §16-2J-3 and §16-2J-7 of the Code of West Virginia, 1931, as amended, all relating to extending the Preventative Care Pilot Program (PCPP) for two years under certain conditions; increasing the number of parties the Health Care Authority and the Insurance Commissioner could permit to participate in the PCPP; and providing notice to the parties that prepaid services under the program may not count towards applicable health insurance deductibles.

Be it enacted by the Legislature of West Virginia:

That §16-2J-3 and §16-2J-7 of the Code of West Virginia, 1931, as amended, be amended and reenacted, all to read as follows:

ARTICLE 2J. PREVENTATIVE CARE PILOT PROGRAM.

§16-2J-3. Authorization of preventive care pilot program; number of participants and sites; Health Care Authority considerations in selection of participating providers; funding.

(a) The Health Care Authority shall, in consultation with the Insurance Commissioner, develop and implement during the fiscal year beginning July 1, 2006, a pilot program that permits no more than eight providers to market and sell prepaid memberships entitling subscribers to obtain preventive and primary health care from the participating providers. Participating providers shall not be allowed to offer their qualifying services at more than three six separate sites. The pilot program will be three years in length shall expire on June 30, 2011: Provided, That those providers which are in operation shall continue to have the ability to offer the prepaid health services as provided under the pilot until such time as they chose to end the service.
(b) Subject to the provisions of this article, the Health Care Authority is vested with discretion to select providers using diversity in practice organization, geographical diversity and other criteria it deems appropriate. The Health Care Authority also shall give consideration to providers located in rural areas or serving a high percentage or large numbers of uninsured.
(c) In furtherance of the objectives of this article, the Health Care Authority is authorized to accept any and all gifts, grants and matching funds whether in the form of money or services. : Provided, That However, no gifts, grants and matching funds shall be provided to the Health Care Authority by the State of West Virginia to further the objectives of this article.
§16-2J-7. Participating provider plan requirements; primary care services; prior coverage restrictions; notice of discontinuance or reduction of benefits.

In addition to the provisions of this article and any guidelines established by the Health Care Authority and Insurance Commissioner, the plans offered pursuant to this article shall be subject to the following:
(1) Each participating provider and site must offer a minimum set of preventive and primary care services as established by the Health Care Authority.
(2) No participating provider may offer: (i) An individual plan to any individual who currently has a health benefit plan or who was covered by a health benefit plan within the preceding twelve months unless said coverage was lost due to a qualifying event; (ii) a family plan to any family that includes an adult to be covered who currently has a health benefit plan or who was covered by a health benefit plan within the preceding twelve months unless said coverage was lost due to a qualifying event; or (iii) an employee group plan to any employer that currently has a group health benefit plan or had a group health benefit plan covering its employees within the preceding twelve months.
(3) The Health Care Authority and the Insurance Commissioner may, by legislative rule, permit participation by an a subscriber or employer with a comprehensive high deductible plan if such subscriber or employer is able to demonstrate that such participation will not negatively impact the coverage currently offered or will be offered by such employer, such rule shall be promulgated by July 1, 2009. The rule shall provide for notice to the subscriber or employer that the payment for the prepaid services may or may not count towards the health insurance deductible and that will depend on the health insurance policy language.
(4) A participating provider must provide subscribers and, where applicable, subscribers' employers with a minimum of thirty days' notice of discontinuance or reduction of subscriber benefits.

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(NOTE: The purposes of this bill shall extend the Preventative Care Pilot Program for two years under certain conditions, with expansion of number of parties the Health Care Authority and the Insurance Commissioner could permit to participate and the provision of notice to the parties of the prepaid services under the program may or may not counting towards an applicable health insurance deductible.

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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