SB 177 S B&I AM #1

Marey Casey 7988

    The Committee on Banking and Insurance moved to amend the bill on page two, line four, after the word “authorized” by striking out the period and adding the following: with the following amendments:

    On page one, subsection 1.1., after the words “and benefit determinations” by inserting a comma;

    On page one, subsection 2.1., by striking out the word “healthcare” and inserting in lieu thereof the words “health care”;

    On page two, subsection 2.6., after the word “specialty” by striking out the word “as” and inserting in lieu thereof the word “that”;

    On page three, subsection 2.15., by striking out the word “no” and inserting in lieu thereof the word “not”;

    On page three, subsection 2.16., by striking out the words “except as otherwise specifically exempted in this definition” and inserting in lieu thereof the words “but excluding the excepted benefits defined in 42 U.S.C. § 300gg-91 and as otherwise specifically excepted in this rule”;

    On page five, subsection 2.17., by striking out the word “state” and inserting in lieu thereof the words “West Virginia”;

    On page five, subsection 2.24., by striking out the word “in” and inserting in lieu thereof the word “an”;

    On page six, subsection 2.28., by striking out the word “that” and inserting in lieu thereof the words “the one”;

    On page six, subdivision 2.30.a., by striking out the words “the covered person’s life, health or ability to regain maximum function or in the opinion of an attending health care professional with knowledge of the covered person’s medical condition, would subject the covered person to severe pain that cannot be adequately managed without the health care service or treatment that is the subject of the request.” and inserting in lieu thereof the words “the life or health of the covered person or the ability of the covered person to regain maximum function; or”;

    On page six, after subdivision 2.30.a., by inserting a new subdivision, designated subdivision 2.30.b., to read as follows:

    2.30.b.  In the opinion of an attending health care professional with knowledge of the covered person’s medical condition, would subject the covered person to severe pain that cannot be adequately managed without the health care service or treatment that is the subject of the request.;

    By relettering the remaining subdivisions;

    On page six, subdivision 2.30.b., by striking out “2.30.a" and inserting in lieu thereof “2.30.d";

    On page eight, subsection 6.1., by striking out the words “an entity” and inserting in lieu thereof the words “a person”;

    On page eight, subsection 6.1., after the word “Commissioner” by inserting the words “or by statute or legislative rule”

    On page nine, after paragraph 6.3.a.4., by inserting a new paragraph, designated paragraph 6.3.a.5., to read as follows:

    6.3.a.5. For purposes of calculating the time period for refiling the benefit request or claim, the time period shall begin to run upon the covered person’s receipt of the notice of opportunity to resubmit.;

    On page ten, subdivision 7.1.b., by striking out the words “a determination is required to be made under subsections 7.2 and 7.4" and inserting in lieu thereof the words “prospective and retrospective review determinations are required to be made”;

    On page eleven, paragraph 7.1.e.1., after the word “number” by inserting the word “of”;

    On page twelve, subdivision 7.2.b., by striking out the words “health carrier” and inserting in lieu thereof the word “issuer”;

    On page fourteen, subdivision 7.3.c., by striking out the comma and the word “and”;

    On page fifteen, subdivision 8.1.a., by striking out the words “health carrier” and inserting in lieu thereof the word “issuer”;

    On page fifteen, after subdivision 8.1.b., by inserting a new paragraph, designated paragraph 8.1.b.1., to read as follows:

    8.1.b.1. If the covered person has failed to provide sufficient information for the issuer to determine whether, or to what extent, the benefits requested are covered benefits or payable under the issuer’s health benefit plan, the issuer shall notify the covered person as soon as possible, but in no event later than twenty-four (24) hours after receipt of the request, either orally or, if requested by the covered person, in writing of this failure and state what specific information is needed. The issuer shall provide the covered person a reasonable period of time to submit the necessary information, taking into account the circumstances, but in no event less than forty-eight (48) hours after notifying the covered person or the covered person's authorized representative of the failure to submit sufficient information.;

    By renumbering the remaining paragraphs;

    On page seventeen, subparagraph 8.2.a.9.A., by striking out “8.2.a.8" and inserting in lieu thereof “8.2.a.7";

    On page seventeen, subparagraph 8.2.a.9.B., by striking out “subparagraph 8.2.a.9.A” and inserting in lieu thereof “paragraph 8.2.a.8";

    On page nineteen, subdivision 9.3.d., after the words “providers, paragraph” by striking out“9.3.c.3" and inserting in lieu thereof “9.3.c.1";

    On page nineteen, subdivision 9.3.d., after the words “amount in paragraph” by striking out“9.3.c.3" and inserting in lieu thereof “9.3.c.1";

    And,

    On page nineteen, paragraph 9.3.d.2., after the word “benefits” by adding a period.

Adopted

Rejected