H. B. 4363


(By Delegates Fleischauer, Compton, Leach,
Martin, Michael, Facemyer and Beane)
[Introduced February 2, 2000; referred to the
Committee on Government Organization then Finance.]



A BILL to amend and reenact section three, article twenty-five-c, chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, relating to the patients' bill of rights; and providing for notice of certain subscribers' rights.

Be it enacted by the Legislature of West Virginia:
That section three, article twenty-five-c, chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended and reenacted to read as follows:
ARTICLE 25C. HEALTH MAINTENANCE ORGANIZATION 2000 PATIENT BILL OF RIGHTS.

§33-25C-3. Notice of certain subscriber rights.
All managed care plans must provide upon enrollment and annually thereafter to subscribers, on a form prescribed by the commissioner and provided to all health maintenance organizations by the first day of January each year, a notice of certain subscriber rights. The notice shall address the following areas:
(1) A description of a subscriber's rights and responsibilities, plan benefits, benefit limitations, premiums, and individual cost-sharing requirements;
(1) (2) The ability of the subscriber to pursue grievance and hearing procedures without reprisal from the managed care plan, along with an explanation of the plan's subscriber complaint procedure, including the appeals procedure for care denied, terminated or reduced;
(2) How (3) A description of how the subscriber can obtain a listing of the plan's provider network, including the names and credentials of all participating physicians in the network, which further details how the subscriber may choose providers within the plan;
(4) The subscriber's right to a consumer's guide which includes items set forth in section eleven of this article;
(3) (5) The subscriber's right to privacy and confidentiality;
(4) (6) The subscriber's ability to examine and offer corrections to their his or her own medical records;
(5) (7) The subscriber's right to be informed of plan policies and any charges for which the subscriber will be responsible;
(6) (8) The subscriber's ability to obtain evidence of the medical credentials of a plan provider such as diploma and board certifications;
(7) (9) The right of subscriber's to have coverage denials reviewed by appropriate medical professionals consistent with plan review procedures;
(10) A description of procedures to obtain emergency services, experimental treatment and out-of-area services;
(11) The right of the subscriber to services under the "Women's Access to Health Care Act" as set forth in article forty-two of this chapter;
(12) The right of the enrollee to full disclosure from his or her health care provider of any information relating to his or her medical condition or treatment plan, which right may not be controverted by any contractual clause;
(13) A description of the procedures for obtaining access to the accreditation report as set forth in section seventeen-a, article twenty-five-a of this chapter;
(14) The right of the enrollee to emergency services without prior authorization in accordance with section eight-d, article twenty-five-a of this chapter, if a prudent person acting reasonably would have believed that an emergency medical condition existed;
(15) Any other patient rights mandated by the accreditation organization provided for in section seventeen-a, article twenty-five-a of this chapter; and
(8) (16) Any other areas the commissioner may by rule require.



NOTE: The purpose of this bill is to amend the "Patients' Bill of Rights" to enhance subscribers rights of notice under managed health care plans.

Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.

This bill is recommended for passage in the 2000 Regular Session of the Legislature by the Legislative Oversight Commission on Health and Human Resources Accountability.