HB4438 H H&HR AM D1

The House Committee on Health and Human Resources moves to amend the bill on page On page ten, section six, line twenty, following the word “any” by deleting the word “regulation” and inserting in lieu thereof the word “rule”; and

On page eleven, section six, after line fifteen, by adding a new subsection (e), to read as follows:

“(e) The Secretary shall propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to establish the requirements for the provider sponsored network program and to implement the policies and procedures required by this article.”;

On page thirteen, section eight, line one, following the

word “participation” and the period by striking the remainder of the subsection and inserting in lieu thereof the following: “These protocols may include, but are not limited to, provisions for designations of certain services that may be provided only by designated providers, or classes of providers, requirements that providers be credentialed before they may provide certain services, and requirements that providers comply with utilization management programs and referral systems as established by the provider supported network.;

On page thirteen, section eight, line twenty-one, following the word “participation” and the period by striking the remainder of the subsection and inserting in lieu thereof the following: “These protocols may include, but are not limited to, provisions for designations of certain services that may be provided only by designated providers, or classes of providers, requirements that providers be credentialed before they may provide certain services, and requirements that providers comply with utilization management programs and referral systems as established by the provider supported network.;

On page fourteen, section nine, line six, striking the entire section and inserting in lieu thereof the following:

“§16-2L-9.Anti-trust exemption.

Due to the nature of the community health centers and their participating providers, the West Virginia Anti-Trust Act, article eighteen, chapter forty-seven of this code, shall not be interpreted to interfere with the development of provider sponsored networks under this article or to impose liability for any activities of a provider sponsored network or any arrangements between a provider sponsored network and its participating providers that are performed or entered into in furtherance of the purposes of, and activities contemplated by, this article. It is the intent of the Legislature that the federal anti-trust statutes be interpreted in this manner as well.;

“ On page fifteen, section ten, line sixteen, striking the entire subsection and inserting in lieu thereof the following:

“(d) Insurance activities by provider sponsored networks. -– If a provider sponsored network applies for and receives one or more insurance licenses or certificates of authority from the Insurance Commissioner, the activities of the provider sponsored network under those licenses or certificates of authority shall be subject to the regulation of the Insurance Commissioner under chapter thirty-three of this code.;

on page seventeen, section thirteen, line eight, striking the entire subsection and inserting in lieu thereof the following:

“The secretary is directed to recognize provider sponsored networks based on an open enrollment process, meaning that the secretary will timely offer the provider sponsored network designation to every provider sponsored network applicant that applies for and meets the standards for Medicaid provider sponsored networks pursuant to this article. The standards applied in determining whether to enter into a contract for services with a provider sponsored network may be the same as, less than, but no greater than the standards used in considering a contract with managed care organizations who provide services to the medicaid beneficiaries.”

On page seventeen, section twelve, line four, following the word “maintain” by striking the remainder of the subsection and inserting in lieu thereof the following:

“minimum capital and surplus in an amount which is the greater of $2 million dollars, or ten per cent of total liabilities, or two per cent of projected annual Medicaid revenue received from the state.;

On page seventeen, section thirteen, line eighteen, following the word “article” and the period by inserting the following:

“§16-2L-14.Reimbursement for services provided.

“Each provider sponsored network established under this article shall pay reasonable costs to the Department of Health and Human Resources associated with implementation of this article and oversight of the provider sponsored networks.”; And

On page two, after the enacting clause, by striking the enacting section and inserting in lieu thereof the following:

That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new article, designated §16-2L-1, §16-2L-2, §16-2L-3, §16-2L-4, §16-2L-5, §16-2L-6, §16-2L-7, §16-2L-8, §16-2L-9, §16-2L-10, §16-2L-11, §16-2L-12, §16-2L-13,and §16-2L-14, all to read as follows: