HB2887 H B&I AM 2-8
The Committee on Banking and Insurance moves to amend the bill on page 1, after the enacting clause, by striking the remainder of the bill and inserting in lieu thereof the following:
“That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §5-16-7f; that said code be amended by adding thereto a new section, designated §9-5-22; that said code be amended by adding thereto a new section, designated §33-15-4k; that said code be amended by adding thereto a new section, designated §33-16-3w; that said code be amended by adding thereto a new section, designated §33-24-7l;that said code be amended by adding thereto a new section, designated §33-25-8h;that said code be amended by adding thereto a new section, designated §33-25A-8k, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD
OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,
OFFICES, PROGRAMS, ETC.
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7f. Required coverage for eosinophilic disorders.
(a) The agency shall provide coverage for the diagnosis and treatment of eosinophilic disorders including coverage for enteral nutrition supplements. To the extent that the diagnosis of eosinophilic disorders and the treatment of eosinophilic disorders are not already covered by the agency, coverage under this section shall be included in health insurance policies that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on or after the effective date of the enactment of this section during the 2012 regular session of the Legislature. The agency may not terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with one of the eosinophilic disorders, has received treatment for eosinophilic disorders, or is at risk for a diagnosis of eosinophilic disorders.
(b) For purposes of this section, “Eosinophilic disorder” means a disorder that occurs when eosinophils, a type of white blood cell, are found in above-normal amounts in various parts of the body, which can occur when the body wants to attack a substance, such as an allergy-triggering food or airborne allergen, causing the body to respond by producing too many eosinophils, which cause chronic inflammation, resulting in tissue damage and are diagnosed according to where the elevated levels of eosinophils are found and include:
(1) Eosinophilic esophagitis (esophagus);
(2) Eosinophilic gastritis (stomach);
(3) Eosinophilic enteritis (small intestine);
(4) Eosinophilic colitis (large intestine); and
(5) Hypereosinophilic syndrome (blood and any organ).
(c) On and after January 1, 2014, to the extent that this section requires benefits that exceed the essential health benefits specified under section 1302 (b) of the Patient Protection And Affordable Care Act, Pub. L. No 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the health benefit plan is offered by the public employees insurance agency.
CHAPTER 9. HUMAN SERVICES.
ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-22. Medicaid; required coverage for eosinophilic disorders.
(a) Medical assistance provided under the Medicaid program by the Department of Health and Human Resources shall, to the extent not prohibited or not allowable by applicable federal law, provide coverage for the diagnosis and treatment of eosinophilic disorders including coverage for enteral nutrition supplements. To the extent that the diagnosis of eosinophilic disorders and the treatment of eosinophilic disorders are not already covered by the department, coverage under this section shall be included on or after the effective date of the enactment of this section during the 2012 regular session of the Legislature. The department may not terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with one of the eosinophilic disorders, has received treatment for eosinophilic disorders, or is at risk for a diagnosis of eosinophilic disorders.
(b) For purposes of this section, “Eosinophilic disorder” means a disorder that occurs when eosinophils, a type of white blood cell, are found in above-normal amounts in various parts of the body, which can occur when the body wants to attack a substance, such as an allergy-triggering food or airborne allergen, causing the body to respond by producing too many eosinophils, which cause chronic inflammation, resulting in tissue damage and are diagnosed according to where the elevated levels of eosinophils are found and include:
(1) Eosinophilic esophagitis (esophagus);
(2) Eosinophilic gastritis (stomach);
(3) Eosinophilic enteritis (small intestine);
(4) Eosinophilic colitis (large intestine); and
(5) Hypereosinophilic syndrome (blood and any organ).
(c) On and after January 1, 2014, to the extent that this section requires benefits that exceed the essential health benefits specified under section 1302 (b) of the Patient Protection And Affordable Care Act, Pub. L. No 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of the medical assistance provided under the Medicaid program by the Department of Health and Human Resources.
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4k. Requirements for coverage of eosinophilic disorders. (a) Any accident and sickness insurance policy issued by an insurer pursuant to the provisions of this article, shall provide coverage for the diagnosis of and treatment of eosinophilic disorders including coverage for enteral nutrition supplements. To the extent that the diagnosis of eosinophilic disorders and the treatment of eosinophilic disorders are not already covered by a health insurance policy, coverage under this section will be included in accident and sickness insurance policies that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on or after sixty days from the effective date of the enactment of this section during the 2012 regular session of the Legislature. No insurer may terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with one of the eosinophilic disorders or has received treatment for eosinophilic disorders
(b) For purposes of this section, “Eosinophilic disorder” means a disorder that occurs when eosinophils, a type of white blood cell, are found in above-normal amounts in various parts of the body, which can occur when the body wants to attack a substance, such as an allergy-triggering food or airborne allergen, causing the body to respond by producing too many eosinophils, which cause chronic inflammation, resulting in tissue damage and are diagnosed according to where the elevated levels of eosinophils are found and include:
(1) Eosinophilic esophagitis (esophagus);
(2) Eosinophilic gastritis (stomach);
(3) Eosinophilic enteritis (small intestine);
(4) Eosinophilic colitis (large intestine); and
(5) Hypereosinophilic syndrome (blood and any organ).
(c) On and after January 1, 2014:
(1) To the extent that this section requires benefits that exceed the essential health benefits specified under section 1302 (b) of the Patient Protection And Affordable Care Act, Pub. L. No 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the health benefit plan is offered by a health care insurer in this state through the state medical exchange; and
(2) This section continues to apply to plans offered outside of the state medical exchange.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3w. Requirements for coverage of eosinophilic disorders. (a) Any group accident and sickness insurance policy issued by an insurer pursuant to the provisions of this article, shall provide coverage for the diagnosis of and treatment of eosinophilic disorders including coverage for enteral nutrition supplements. To the extent that the diagnosis of eosinophilic disorders and the treatment of eosinophilic disorders are not already covered by a health insurance policy, coverage under this section will be included in group accident and sickness insurance policies that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on or after sixty days from the effective date of the enactment of this section during the 2012 regular session of the Legislature. No insurer may terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with one of the eosinophilic disorders or has received treatment for eosinophilic disorders.
(b) For purposes of this section, “Eosinophilic disorder” means a disorder that occurs when eosinophils, a type of white blood cell, are found in above-normal amounts in various parts of the body, which can occur when the body wants to attack a substance, such as an allergy-triggering food or airborne allergen, causing the body to respond by producing too many eosinophils, which cause chronic inflammation, resulting in tissue damage and are diagnosed according to where the elevated levels of eosinophils are found and include:
(1) Eosinophilic esophagitis (esophagus);
(2) Eosinophilic gastritis (stomach);
(3) Eosinophilic enteritis (small intestine);
(4) Eosinophilic colitis (large intestine); and
(5) Hypereosinophilic syndrome (blood and any organ).
(c) On and after January 1, 2014:
(1) To the extent that this section requires benefits that exceed the essential health benefits specified under section 1302 (b) of the Patient Protection And Affordable Care Act, Pub. L. No 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the health benefit plan is offered by a health care insurer in this state through the state medical exchange; and
(2) This section continues to apply to plans offered outside of the state medical exchange.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.
§33-24-7l. Requirements for coverage of eosinophilic disorders.
(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article, shall provide as benefits to all subscribers and members coverage for the diagnosis of and treatment of eosinophilic disorders including coverage for enteral nutrition supplements. To the extent that the diagnosis of eosinophilic disorders and the treatment of eosinophilic disorders are not already covered by a health insurance policy, coverage under this section will be included in group accident and sickness insurance policies that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on or after sixty days from the effective date of the enactment of this section during the 2012 regular session of the Legislature. No insurer may terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with one of the eosinophilic disorders or has received treatment for eosinophilic disorders
(b) For purposes of this section, “Eosinophilic disorder” means a disorder that occurs when eosinophils, a type of white blood cell, are found in above-normal amounts in various parts of the body, which can occur when the body wants to attack a substance, such as an allergy-triggering food or airborne allergen, causing the body to respond by producing too many eosinophils, which cause chronic inflammation, resulting in tissue damage and are diagnosed according to where the elevated levels of eosinophils are found and include:
(1) Eosinophilic esophagitis (esophagus);
(2) Eosinophilic gastritis (stomach);
(3) Eosinophilic enteritis (small intestine);
(4) Eosinophilic colitis (large intestine); and
(5) Hypereosinophilic syndrome (blood and any organ).
(c) On and after January 1, 2014, to the extent that the provisions of this section requires benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the plan is offered by a corporation in this state.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-8h. Requirements for coverage of eosinophilic disorders.
(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article, shall provide as benefits to all subscribers and members coverage for the diagnosis of and treatment of eosinophilic disorders including coverage for enteral nutrition supplements. To the extent that the diagnosis of eosinophilic disorders and the treatment of eosinophilic disorders are not already covered by a health insurance policy, coverage under this section will be included in group accident and sickness insurance policies that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on or after sixty days from the effective date of the enactment of this section during the 2012 regular session of the Legislature. No insurer may terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with one of the eosinophilic disorders or has received treatment for eosinophilic disorders.
(b) For purposes of this section, “Eosinophilic disorder” means a disorder that occurs when eosinophils, a type of white blood cell, are found in above-normal amounts in various parts of the body, which can occur when the body wants to attack a substance, such as an allergy-triggering food or airborne allergen, causing the body to respond by producing too many eosinophils, which cause chronic inflammation, resulting in tissue damage and are diagnosed according to where the elevated levels of eosinophils are found and include:
(1) Eosinophilic esophagitis (esophagus);
(2) Eosinophilic gastritis (stomach);
(3) Eosinophilic enteritis (small intestine);
(4) Eosinophilic colitis (large intestine); and
(5) Hypereosinophilic syndrome (blood and any organ).
(c) On and after January 1, 2014, to the extent that the provisions of this section requires benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the plan is offered by a corporation in this state.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8k. Requirements for coverage of eosinophilic disorders.
(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article, shall provide as benefits to all subscribers and members coverage for the diagnosis of and treatment of eosinophilic disorders including coverage for enteral nutrition supplements. To the extent that the diagnosis of eosinophilic disorders and the treatment of eosinophilic disorders are not already covered by a health insurance policy, coverage under this section will be included in group accident and sickness insurance policies that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on or after sixty days from the effective date of the enactment of this section during the 2012 regular session of the Legislature. No insurer may terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with one of the eosinophilic disorders or has received treatment for eosinophilic disorders
(b) For purposes of this section, “Eosinophilic disorder” means a disorder that occurs when eosinophils, a type of white blood cell, are found in above-normal amounts in various parts of the body, which can occur when the body wants to attack a substance, such as an allergy-triggering food or airborne allergen, causing the body to respond by producing too many eosinophils, which cause chronic inflammation, resulting in tissue damage and are diagnosed according to where the elevated levels of eosinophils are found and include:
(1) Eosinophilic esophagitis (esophagus);
(2) Eosinophilic gastritis (stomach);
(3) Eosinophilic enteritis (small intestine);
(4) Eosinophilic colitis (large intestine); and
(5) Hypereosinophilic syndrome (blood and any organ).
(c) On and after January 1, 2014, to the extent that the provisions of this section requires benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended, the specific benefits that exceed the specified essential health benefits shall not be required of a health benefit plan when the plan is offered by a health maintenance organization in this state.”
Adopted
Rejected