H. B. 4373
(By Delegates Cann, Eldridge, Guthrie,
Hatfield, Lawrence, Mahan, Manypenny,
Michael, C. Miller, Perdue and Phillips)
February 5, 2010
; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend and reenact
of the Code of West Virginia,
1931, as amended, relating to
eliminating the twelve-month
look-back period for children who have had employer sponsored
insurance and are now applying for Children's Health Insurance
Be it enacted by the Legislature of West Virginia:
of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 16B. WEST VIRGINIA CHILDREN'S HEALTH INSURANCE PROGRAM.
§5-16B-6d. Modified benefit plan implementation.
(a) Upon approval by the Centers for Medicare and Medicaid
Services, the board shall implement a
program benefit plan for
uninsured children of families with income between two hundred and
three hundred percent of the federal poverty level.
(b) The benefit plans offered pursuant to this section shall
include services determined to be appropriate for children, but may
vary from those currently offered by the board.
(c) The board shall structure the benefit plans for this
expansion to include premiums, coinsurance or copays and
deductibles. The board shall develop the cost sharing features in
such a manner as to keep the program fiscally stable without
creating a barrier to enrollment. Such features may include
different cost-sharing features within this group based upon the
percentage of the federal poverty level.
(d) Children covered by an employer sponsored health insurance
plan during the previous twelve month period are not eligible for
coverage under this expansion, unless that coverage is lost due to
the parent's loss of employment.
(e) (d) Provider reimbursement schedules shall be no lower
than the reimbursement provided for the same services under the
plans offered in article sixteen of this chapter.
(f) (e) All provisions of this article are applicable to this
expansion unless expressly addressed in this section.
(g) (f) Nothing in this section may be construed to require
any appropriation of State General Revenue Funds for the payment of
any benefit provided pursuant to this section, except for the state
appropriation used to match the federal financial participation
funds. In the event that federal funds are no longer authorized
for participation by individuals eligible at income levels above
two hundred percent, the board shall take immediate steps to
terminate the expansion provided for in this section and notify all
enrollees of such termination. In the event federal appropriations
decrease for the programs created pursuant to Title XXI of the
Social Security Act of 1997, the board is directed to make those
decreases in this expansion program before making changes to the
programs created for those children whose family income is less
than two hundred percent of the federal poverty level.
(h) (g) The board is directed to report no less than quarterly
to the Legislative Oversight Commission on Health and Human
Resources Accountability on the development, implementation and
progress of the expansion authorized in this section.
NOTE: The purpose of this bill is to
twelve-month look-back period for children who have participated in
employer sponsored health plans for coverage under the Children's
Health Insurance Program
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would