Senate Bill No. 669
(By Senators Kessler, Yost, Stollings, Unger and Wells)
[Introduced March 23, 2009; referred to the Committee on Health
and Human Resources; and then to the Committee on Banking and
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
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
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
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
(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.
(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