H. B. 2986


(By Delegates Fleischauer and Compton)
[Introduced February 26, 1999; referred to the
Committee on Banking and Insurance then Government Organization.]


A BILL to amend chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article forty-two-a, relating to requiring insurance coverage by health care insurers for mental illness.

Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new article, designated article forty-two-a, to read as follows:
ARTICLE 42A. INSURANCE COVERAGE FOR MENTAL ILLNESS.
§33-42A-1. Coverage for mental illness required.
Every health care insurer shall provide coverage for the medical treatment of mental illness under the same terms and conditions as coverage is provided for other illnesses and diseases. Insurance coverage offered pursuant to this statute shall include the same durational limits such as day or visit limits, amount limits such as lifetime or annual dollar limits, deductibles, out-of-pocket limits, and coinsurance factors for mental illness as for other illnesses and diseases.
§33-42A-2. Definitions.
(a) "Health insurers" means all persons, firms, corporations or other organizations offering and assuring health services on a prepaid or primarily expense-incurred basis, including, but not limited to, policies of accident or sickness insurance, as defined in this chapter; nonprofit hospital or medical service plans, whether organized under this chapter or under any public law or by special act of the Legislature; health maintenance organizations, or any other entity which insures or reimburses for diagnostic, therapeutic or preventative services to a determined population on the basis of a periodic premium, except for supplemental policies which only provide coverage for specified diseases.
(b) "Mental illness" means any mental or emotional disorder, including drug or alcohol abuse.
(c) "Medical treatment" means inpatient hospitalization, partial hospitalization and outpatient visits.
(d) "Practitioner" means a licensed mental health professional.
§33-42A-3. Confidentiality.
Data or information pertaining to the diagnosis, treatment or health of a patient obtained from the patient or from a practitioner is confidential and shall not be disclosed to any person except:
(a) To the extent that it may be necessary to carry out the purposes of this legislation and as allowed by state law;
(b) Upon the express written consent of the patient;
(c) Pursuant to statute or court order for the production of evidence or the discovery thereof; or
(d) In the event of a claim or litigation between the patient and the health insurer where the data or information is pertinent, regardless of whether the information is in the form of paper, preserved on microfilm, or stored in computer retrievable form.
§33-42A-4. Medical necessity and appropriateness of treatment.
Upon request of the reimbursing health insurer, pursuant to provisions of section three of this article, any practitioner of treatment of mental illness shall furnish medical records and other necessary data which substantiates that initial or continued treatment is medically necessary and appropriate. When the practitioner cannot so establish medical necessity or appropriateness of the treatment modality provided, neither the health insurer nor the patient shall be obligated to reimburse for that period or type of care which is not so established. The practitioner shall inform the patient of the substance of this section in advance of providing treatment. In the event the patient is informed that medical necessity or appropriateness is not established, the patient may agree in writing to continue receiving treatment at his or her own expense. The health insurer shall make determinations of medical necessity and appropriateness in a manner consistent with that used to make the determination for treatment of other diseases or injuries covered under the health insurance policy or agreement. The benefits under this section are required only for expenses arising for treatment of mental illness, emotional disorders, drug abuse and alcohol abuse which in the professional judgment of practitioners is medically necessary and treatable.




NOTE: The purpose of this bill is to require insurance coverage for the treatment of mental illness under the same terms and conditions as such coverage is provided for other illnesses and diseases.

This article is new; therefore, strike-throughs and underscoring have been omitted.