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WEST VIRGINIA LEGISLATURE
2024 REGULAR SESSION
Introduced
House Bill 4997
By Delegates Rohrbach, Willis, Stephens, Sheedy, Barnhart, E. Pritt, Chiarelli, Maynor, Cannon, Shamblin, and W. Hall
[Introduced January 22, 2024; Referred to the Committee on Banking and Insurance then Finance]
A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §5-16-8b; to amend said code by adding thereto a new section, designated §33-15-24 ; to amend said code by adding thereto a new section, designated §33-16-20; to amend said code by adding thereto a new section, designated §33-24-15; and to amend said code by adding thereto a new section designated §33-25-23 and to amend said code by adding thereto a new section designated §33-25A-37, all relating to requiring habilitative speech therapy as a treatment for stuttering insurance coverage.
Be it enacted by the Legislature of West Virginia:
"Habilitative services" means health care services that help a person keep, learn, or improve skills and functioning for daily living;
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living;
"Rehabilitative services" means health care services that help a person restore or improve skills and functioning for daily living that have been lost or impaired; and
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
(c) Any health insurance policy, certificate, plan, or contract, including but not limited to a health benefit plan, that provides coverage for:
(1) Habilitative services, shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental;
(2) Rehabilitative services, shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or
(3) Both habilitative services and rehabilitative services, shall provide the coverage required this section.
(d) The coverage required under this section may not be:
(1) Subject to any maximum annual benefit limit, including any limits on the number of visits an insured may make to a speech-language pathologist;
(2) Limited based on the type of disease, injury, disorder, or other medical condition that resulted in the stuttering; or
(3) Subject to utilization review or utilization management requirements, including prior authorization or a determination that the speech therapy services are medically necessary; and
(4) Include coverage for speech therapy provided in person and via telehealth.
(e) The telehealth coverage required under this paragraph shall:
(1).Be not less than the coverage required for health benefit plans under this article and
(2) Include the use of any communication technology, application, or platform to deliver telehealth services, except coverage may be restricted to technology, applications, or platforms that are compliant with any applicable privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996, 42 17 U.S.C. sec. 1320d et seq., as amended.
(f) Nothing in this section limits the authority of the director under §5-16-3(c) and §5-16-9 of this code, including, but not limited to, his or her authority to manage provider contracting and payments and to designate covered and noncovered services.
(g) This section does not limit the authority of the director, the plan, or the plans under §5-16-11 of this code.
h) Notwithstanding any provision of this code to the contrary, wherever 49 U.S.C. §41713(b) applies to the reimbursement of air ambulance providers under §5-16-8a of this code, the provisions of this code, including any administrative, civil, or criminal penalties, are inapplicable.
(a) Any insurer who, on or after July 1, 2024, delivers or issues a policy of accident and sickness insurance in this state under the provisions of this article shall make available as benefits to all subscribers and members coverage on an expense-incurred basis and individual and group service or indemnity type contracts issued by a nonprofit corporation shall provide coverage for patient cost to a member in habilitative speech therapy as a treatment for stuttering.
(b) As used in this section:
"Habilitative services" means health care services that help a person keep, learn, or improve skills and functioning for daily living;
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living;
"Rehabilitative services" means health care services that help a person restore or improve skills and functioning for daily living that have been lost or impaired; and
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
(1) Habilitative services, shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental;
(2) Rehabilitative services, shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or
(3) Both habilitative services and rehabilitative services, shall provide the coverage required this section.
(c) The coverage required under this section may not be:
(1) Subject to any maximum annual benefit limit, including any limits on the number of visits an insured may make to a speech-language pathologist;
(2) Limited based on the type of disease, injury, disorder, or other medical condition that resulted in the stuttering; or
(3) Subject to utilization review or utilization management requirements, including prior authorization or a determination that the speech therapy services are medically necessary; and
(4) Include coverage for speech therapy provided in person and via telehealth.
(d) The telehealth coverage required under this paragraph shall:
(1).Be not less than the coverage required for health benefit plans under this article and
(2) Include the use of any communication technology, application, or platform to deliver telehealth services, except coverage may be restricted to technology, applications, or platforms that are compliant with any applicable privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996, 42 17 U.S.C. sec. 1320d et seq., as amended.
(e) Nothing in this section limits the authority of the director under §5-16-3(c) and §5-16-9 of this code, including, but not limited to, his or her authority to manage provider contracting and payments and to designate covered and noncovered services.
(a) All policies issued pursuant to this article shall cover patient cost rehabilitative speech therapy as a treatment for stuttering. These services shall be exempt from any deductible, for a visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not require that other health care services provided be exempt from any deductible and/or copayment provisions.
(b) As used in this section:
"Habilitative services" means health care services that help a person keep, learn, or improve skills and functioning for daily living;
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living;
"Rehabilitative services" means health care services that help a person restore or improve skills and functioning for daily living that have been lost or impaired; and
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
(c) Any accident and sickness insurance in this state certificate, plan, or contract, including but not limited to a health benefit plan, that provides coverage for:
(1) Habilitative services, shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental;
(2) Rehabilitative services, shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or
(3) Both habilitative services and rehabilitative services, shall provide the coverage required this section.
(d) The coverage required under this section may not be:
(1) Subject to any maximum annual benefit limit, including any limits on the number of visits an insured may make to a speech-language pathologist;
(2) Limited based on the type of disease, injury, disorder, or other medical condition that resulted in the stuttering; or
(3) Subject to utilization review or utilization management requirements, including prior authorization or a determination that the speech therapy services are medically necessary; and
(4) Include coverage for speech therapy provided in person and via telehealth.
(e) The telehealth coverage required under this paragraph shall:
(1) Be not less than the coverage required for health benefit plans under this article and
(2) Include the use of any communication technology, application, or platform to deliver telehealth services, except coverage may be restricted to technology, applications, or platforms that are compliant with any applicable privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996, 42 17 U.S.C. sec. 1320d et seq., as amended.
(f) Nothing in this section limits the authority of the director under §5-16-3(c) and §5-16-9 of this code, including, but not limited to, his or her authority to manage provider contracting and payments and to designate covered and noncovered services.
(b) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall provide as benefits to all subscribers and members coverage for habilitative speech therapy as a treatment for stuttering for school age children up to age 18 years.: Provided, That preauthorization or precertification may not be required.
"Habilitative services" means health care services that help a person keep, learn, or improve skills and functioning for daily living;
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living;
"Rehabilitative services" means health care services that help a person restore or improve skills and functioning for daily living that have been lost or impaired; and
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
(d) Any plan under this article in this state any certificate, plan, or contract, including but not limited to a health benefit plan, shall provide coverage for:
(1) Habilitative services, shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental;
(2) Rehabilitative services, shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or
(3) Both habilitative services and rehabilitative services, shall provide the coverage required this section.
(e) The coverage required under this section may not be:
(1) Subject to any maximum annual benefit limit, including any limits on the number of visits an insured may make to a speech-language pathologist;
(2) Limited based on the type of disease, injury, disorder, or other medical condition that resulted in the stuttering; or
(3) Subject to utilization review or utilization management requirements, including prior authorization or a determination that the speech therapy services are medically necessary; and
(4) Include coverage for speech therapy provided in person and via telehealth.
(f) The telehealth coverage required under this paragraph shall:
(1).Be not less than the coverage required for health benefit plans under this article and
(2) Include the use of any communication technology, application, or platform to deliver telehealth services, except coverage may be restricted to technology, applications, or platforms that are compliant with any applicable privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996, 42 17 U.S.C. sec. 1320d et seq., as amended.
(g) Nothing in this section limits the authority of the director under §5-16-3(c) and §5-16-9 of this code, including, but not limited to, his or her authority to manage provider contracting and payments and to designate covered and noncovered services.
(b) As used in this section:
"Habilitative services" means health care services that help a person keep, learn, or improve skills and functioning for daily living;
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living;
"Rehabilitative services" means health care services that help a person restore or improve skills and functioning for daily living that have been lost or impaired; and
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
(c) Any accident and sickness insurance in this state certificate, plan, or contract, including but not limited to a health benefit plan, that provides coverage for:
(1) Habilitative services, shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental;
(2) Rehabilitative services, shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or
(3) Both habilitative services and rehabilitative services, shall provide the coverage required this section.
(d) The coverage required under this section may not be:
(1) Subject to any maximum annual benefit limit, including any limits on the number of visits an insured may make to a speech-language pathologist;
(2) Limited based on the type of disease, injury, disorder, or other medical condition that resulted in the stuttering; or
(3) Subject to utilization review or utilization management requirements, including prior authorization or a determination that the speech therapy services are medically necessary; and
(4) Include coverage for speech therapy provided in person and via telehealth.
(e) The telehealth coverage required under this paragraph shall:
(1).Be not less than the coverage required for health benefit plans under this article and
(2) Include the use of any communication technology, application, or platform to deliver telehealth services, except coverage may be restricted to technology, applications, or platforms that are compliant with any applicable privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996, 42 17 U.S.C. sec. 1320d et seq., as amended.
(f) Nothing in this section limits the authority of the director under §5-16-3(c) and §5-16-9 of this code, including, but not limited to, his or her authority to manage provider contracting and payments and to designate covered and noncovered services.
(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after July 1, 2024 provide as benefits to all subscribers and members coverage for of habilitative speech therapy as a treatment for stuttering: Provided, That preauthorization or precertification may not be required.
(b) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after July 1, 2024, provide as benefits to all subscribers and members coverage for the cost of habilitative speech therapy as a treatment for stuttering services. These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This coverage will cover all costs associated with child physical therapy, speech, and occupational therapy services. These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies, provisions, plans, agreements or contracts. This section does not require that other health care services provided be exempt from any deductible and/or copayment provisions.
(c) As used in this section:
"Habilitative services" means health care services that help a person keep, learn, or improve skills and functioning for daily living;
"Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and functioning for daily living;
"Rehabilitative services" means health care services that help a person restore or improve skills and functioning for daily living that have been lost or impaired; and
"Rehabilitative speech therapy" means speech therapy that helps a person restore or improve skills and functioning for daily living that have been lost or impaired.
(d) Any policy under this article in this state shall provide coverage for:
(1) Habilitative services, shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental;
(2) Rehabilitative services, shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or
(3) Both habilitative services and rehabilitative services, shall provide the coverage required this section.
(e) The coverage required under this section may not be:
(1) Subject to any maximum annual benefit limit, including any limits on the number of visits an insured may make to a speech-language pathologist;
(2) Limited based on the type of disease, injury, disorder, or other medical condition that resulted in the stuttering; or
(3) Subject to utilization review or utilization management requirements, including prior authorization or a determination that the speech therapy services are medically necessary; and
(4) Include coverage for speech therapy provided in person and via telehealth.
(f) The telehealth coverage required under this paragraph shall:
(1) Be not less than the coverage required for health benefit plans under this article and
(2) Include the use of any communication technology, application, or platform to deliver telehealth services, except coverage may be restricted to technology, applications, or platforms that are compliant with any applicable privacy provisions of the federal Health Insurance Portability and Accountability Act of 1996, 42 17 U.S.C. sec. 1320d et seq., as amended.
(g) Nothing in this section limits the authority of the director under §5-16-3(c) and §5-16-9 of this code, including, but not limited to, his or her authority to manage provider contracting and payments and to designate covered and noncovered services.
NOTE: The purpose of this bill is to require habilitative speech therapy as a treatment for stuttering insurance coverage.
Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.
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