SB 579 Text

Senate Bill No. 579
(By Senators Prezioso, Foster, Hunter, Stollings, Unger and Kessler)
____________
[Introduced February 14, 2007; referred to the Committee on Health and Human Resources; and then to the Committee on Banking and Insurance.]
____________

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new article, designated §16-2K-1 and §16-2K-2, all relating to Programs for All-Inclusive Care for the Elderly (PACE); setting forth legislative intent; defining terms; exempting PACE programs from regulation by the Insurance Commissioner; and requiring annual reports to the Legislature.

Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new article, designated §16-2K-1 and §16-2K-2, all to read as follows:
ARTICLE 2K. PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY, "PACE".
§16-2K-1. Legislative findings and statement of purpose.
(a) The United States Department of Health and Human Services
has established a model of managed care service delivery that encourages innovative integrated health care delivery systems to serve frail and disabled elders with effective primary, preventive, restorative, supportive and palliative care. The program, as authorized in 42 CFR §460, §462, §466, §473 and §476, provides for the establishment of local programs to reorganize and reintegrate local health care delivery systems.
(b) The program for all-inclusive care for the elderly or "PACE" is a capitated program that is operated in accordance with federal law by a public, private, nonprofit or proprietary entity to provide comprehensive health and social services to disabled and frail elderly persons, certified by the state as nursing home eligible to maximize the autonomy and continued independence of these elderly persons.
(c) The Legislature finds that the "PACE" programs will enhance the quality of life, function and health of elderly persons.
(d) In order to promote the expansion of medical, social and long-term care services for the elderly, it is the intent of the Legislature to eliminate legal, statutory and regulatory barriers to the establishment of "PACE" programs by exempting health providers participating in these programs from regulation as insurers.

§16-2K-2. "PACE" program operation; exemption from regulation as an insurer; annual reports to the Legislature.

(a) A "PACE" program may operate in this state only in accordance with a contract with the United States Department of Health and Human Services, which is prepared in consultation with and approved by the West Virginia Department of Health and Human Resources.
(b) Notwithstanding the provisions of chapter thirty-three of this code to the contrary, participation by providers in a "PACE" program created and authorized pursuant to this article is not considered as providing insurance or as offering insurance services, and "PACE" providers and services are specifically excluded from the definitions of "insurer" and "insurance" as defined in article one, chapter thirty-three of this code, and from the definition of "health maintenance organization" as defined in article twenty-five-a of this code. Participating "PACE" providers are not unauthorized insurers pursuant to section four, article forty-four of chapter thirty-three of this code. These "PACE" programs are not subject to regulation by the Insurance Commissioner except to the extent set forth in this article.
(c) No later than the first day of January, two thousand eight, the Secretary of the West Virginia Department of Health and Human Resources must submit a report to the Legislative Oversight Commission of Health and Human Resources Accountability as established in article twenty-nine-e of this chapter. This report shall be submitted annually until the Legislative Oversight Commission on Health and Human Resources Accountability notifies the Secretary of the Department of Health and Human Resources that the annual report is no longer necessary. The report must, with respect to any "PACE" program operating in the state, include an analysis of the financial status of the "PACE" program, the utilization of enrollee services and any information requested by the secretary or the commission.

NOTE: The purpose of this bill is to facilitate the establishment of a federally subsidized program for all-inclusive care for the elderly, known as "PACE", by exempting "PACE" programs from being considered insurers and being regulated by the Insurance Commissioner.

§16-2K-1 and §16-2K-2 are new; therefore, strike-throughs and underscoring have been omitted.

Print On Demand