ENROLLED
H. B.4776
(By Delegates Douglas, Kuhn, Flanigan, Angotti,
Manchin, Azinger and Stalnaker)
[Passed March 10, 2000; in effect ninety days from passage.]
AN ACT to amend and reenact sections one, two, three and four,
article fifteen-b, chapter thirty-three of the code of West
Virginia, one thousand nine hundred thirty-one, as amended;
and to further amend said article by adding thereto two new
sections, designated sections five and six, all relating to
uniform health care administration, the transfer of
responsibilities to develop standard forms and procedures
regarding health care claims and all other requirements and
procedures under this article from the authority of the
insurance commissioner to the West Virginia health care
authority; and establishing penalties for violation of the
uniform health care administration act.
Be it enacted by the Legislature of West Virginia:
That sections one, two, three and four, article fifteen-b,
chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended and reenacted; and
to further amend said article by adding thereto two new sections,
designated sections five and six, all to read as follows:
ARTICLE 15B. UNIFORM HEALTH CARE ADMINISTRATION ACT.
§33-15B-1. Legislative findings; purpose.
The Legislature hereby finds that there is a need to provide
guidelines regarding uniform health care administration in order to
best serve consumers, health care providers and insurers and to
organize and streamline the claims process. The purpose of this
article is to require the transfer of the authority of the
insurance commissioner to develop standard forms and procedures
regarding health care claims and to require that all insurers,
third party providers, and health care providers implement and use
such standards in a uniform manner to the West Virginia health care
authority. The West Virginia health care authority is responsible
for coordinating and overseeing the health data collection in West
Virginia and coordinating database development, analysis and
reporting to facilitate cost management, utilization review, and
quality assurance efforts by state payors and regulatory agencies,
insurers, consumers, providers, and other interested parties. The
Legislature finds that the West Virginia health care authority is
the appropriate agency to oversee the development of standard forms
and procedures regarding health care claims. Thus, the Legislature
hereby transfers the responsibilities to develop standard forms and procedures regarding health care claims and all other requirements
and procedures under this article to the West Virginia health care
authority.
§33-15B-2. Scope of article.
The provisions of this article apply to all health care
providers in the state, including but not limited to, all insurers
writing or issuing accident and sickness policies; hospital service
corporations; health service corporations; medical service
corporations; dental service corporations; all third party
providers; all state agencies and departments, including, but not
limited to, the public employees insurance agency, workers'
compensation insurance, and providers of services under medicare
and medicaid.
§33-15B-3. Health care authority to promulgate rules; use of
standardized forms and classifications; advisory group.
(a) The West Virginia health care authority shall promulgate
legislative rules in accordance with the provisions of chapter
twenty-nine-a of this code regarding the implementation and use of
uniform health care administrative forms. Such rules shall
establish, where practicable, the acceptance and use throughout the
health care system of standard administrative forms, terms or
procedures, including, but not limited to, the following:
(1) The standard health care financing administration fifteen
hundred (HCFA 1500) health insurance claim form, as amended, or other similar forms, terms, and definitions to be used which are
consistent with health care and insurance industry standards.
(2) International classification of disease, ninth clinical
modifications (ICD-9-CM) and common procedural terminology (CPT)
codes, as amended, or other similar forms, terms, and definitions
to be used which are consistent with health care and insurance
industry standards.
(3)National uniform billing data element specifications (UB-
92), as amended, and as supplemented by the West Virginia uniform
billing committee, or other similar forms, terms, and definitions
to be used which are consistent with health care and insurance
industry standards.
(4) Consideration of current practices involving reimbursement
of claims and explanation of benefits, and the implementation of
standards and guidelines regarding explanation of benefits,
including, but not limited to, consideration of line item
explanations of payments or denial of payments.
(b) The legislative rules required herein shall be developed
by the West Virginia health care authority with the advice of an
advisory group to be appointed by the board of the West Virginia
health care authority. Such advisory group shall consist of
representatives of consumers, providers, payors, and regulatory
agencies, including representatives from the following: the office
of the insurance commissioner; the West Virginia health care authority; West Virginia dental association; West Virginia
pharmacists association; the West Virginia hospital association;
commercial health insurers; third party administrators; the West
Virginia state medical association; the West Virginia nurses
association; public employees insurance agency; workers
compensation commission; and consumers. The West Virginia health
care authority shall form such advisory group after the effective
date of this section.
(c) The West Virginia health care authority and the advisory
group shall review the legislative rules effected pursuant to this
section as necessary and update the same in a timely manner in
order to conform to current legislation and health care and
insurance industry standards and trends.
§33-15B-4. Compliance period; reservation of right to additional
information.
(a) All health care providers, insurers, third party providers
and state agencies or departments shall have one year from the date
the West Virginia health care authority establishes the legislative
rules required by this article to comply with the requirements of
the same.
(b) This section shall not limit the right of any insurer,
third party provider, state agency or department to require
additional information on any claim.
§33-15B-5. Penalties for violation.
Any person, partnership, corporation, limited liability
company, professional corporation, health care provider or other
entity violating any provision of this article shall be guilty of
a misdemeanor and, upon conviction shall be punished by a fine of
not more than one thousand dollars. Each day of continuing
violation after conviction shall be considered a separate offense.
The West Virginia health care authority is empowered to withhold
rate approval or a certificate of need for any health care provider
violating any provision of this article.
§33-15B-6. Citation of article.
This article may be known as the "Uniform Health Care
Administration Act."