COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 665
(By Senator Prezioso)
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[Originating in the Committee on Health and Human Resources;
reported February 26, 2010.]
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A BILL to repeal §33-15B-4 of the Code of West Virginia, 1931, as
amended; and to amend and reenact §33-15B-1, §33-15B-2, §33-
15B-3 and §33-15B-5 of said code, all relating to health care
forms; explaining legislative purpose; defining scope of
article; transferring certain duties regarding uniform forms
from the Health Care Authority to the Insurance Commissioner;
adding Department of Health and Human Resources to advisory
committee; authorizing Insurance Commissioner to propose
rules; eliminating period for compliance; and prescribing
penalties.
Be it enacted by the Legislature of West Virginia:
That §33-15B-4 of the Code of West Virginia, 1931, as amended,
be repealed; and that §33-15B-1, §33-15B-2, §33-15B-3 and §33-15B-5
of said code be amended and reenacted, 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 authorize the insurance commissioner to develop standard
forms and procedures regarding health care claims and to require
that all insurers, third party providers payers, 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 health
insurers writing or issuing accident and sickness policies,
including hospital service corporations, health service
corporations, medical service corporations, dental service
corporations and HMOs; all third party providers payers; 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; and all entities
involved in the payment of health care claims.
§33-15B-3. Insurance commissioner to propose rules; use of
standardized forms and classifications; advisory
group.
(a) The West Virginia health care authority commissioner shall
promulgate legislative rules propose rules for legislative
approval, 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) CMS 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)(UB-04), 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 commissioner. Such advisory group shall
consist of representatives of consumers, providers, payors, and
regulatory agencies, including representatives from the following: The department of health and human resources 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 commissioner and
the advisory group shall review the legislative rules effected to
be proposed 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-5. Penalties for violation.
Any person, partnership, corporation, limited liability
company, professional corporation, health care provider, insurer or
other payer, or other entity violating any provision of this
article shall be guilty of a misdemeanor and, upon conviction shall
be punished by subject to a fine imposed by the commissioner of not
more than $1000 for each violation Each day of continuing violation
after conviction shall be considered a separate offense. The and,
in addition to or in lieu of any fine imposed, 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.
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(NOTE: The purpose of this bill is to transfer from the
health care authority to the insurance commissioner certain duties
regarding the creation of uniform health care forms.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.)
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