SB 179 S B&I AM #1

Marey Casey 7988

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

    On page one, subsection 2.1., after the word “terminated” by adding period;

    On page two, subdivision 2.3.c., after the word “professional” by adding a semicolon;

    On page two, subdivision 2.4.c., by striking out “2.4a and 2.4b" and inserting in lieu thereof “2.4.a and 2.4.b";

    On page two, subdivision 2.4.d., by striking out “2.4a, 2.4b and 2.4c" and inserting in lieu thereof “2.4.a, 2.4.b and 2.4.c";

    On page three, subsection 2.7., after the word “Commissioner” by adding period;

    On page three, subsection 2.12., after the words “Emergency medical condition” by striking out the single quotation mark and inserting in lieu thereof a double quotation mark;

    On page four, subsection 2.17., 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 eight, subsection 3.1., by striking out the words “A written” and inserting in lieu thereof the words “An issuer shall notify the covered person in writing of the covered person’s right to request an external review. Such a written”;

    On page eight, subdivision 3.1.c., by striking out the words “subsection 15.1" and inserting in lieu thereof the words “section 14";

    On page nine, paragraph 3.1.e.1., before the words would seriously” by striking out the comma;

    On page nine, paragraph 3.1.f.1., after the word “life” by striking out the comma and inserting in lieu thereof the words “or health or”;

    On page ten, subsection 5.3., by striking out the words “expedited review of a grievance involving an adverse determination” and inserting in lieu thereof the words” “expedited internal review of a grievance involving an adverse determination pursuant to W. Va. Code of St. R. §114-96”;

    On page ten, subdivision 5.3.a., after the word “Code” by inserting the word “of”;

    On page eleven, subsection 6.2., after the word “consideration” by striking out the word “on” and inserting in lieu thereof the word “of”;

    On page twelve, subdivision 6.5.a, by striking out the words “two business days” and inserting in lieu thereof the words “one business day”;

    On page thirteen, subdivision 6.6.d., by striking out the word “internal” and inserting in lieu thereof the word “independent”;

    On page thirteen, subsection 6.8., after the words “receipt of the request for an external review” by inserting the words “and no later than one business day after making the decision”;

    On page seventeen, subdivision 8.5.b., after “8.5.b.” by striking out the period;

    On page seventeen, subdivision 8.5.c., by striking out “8.8” and inserting in lieu thereof “8.9”;

    On page eighteen, subsection 8.6., after “IRO” by striking out the comma;

    On page eighteen, subdivision 8.6.a., by striking out the word “dely” and inserting in lieu thereof the word “delay”;

    On page nineteen, paragraph 8.9.a.2., after the words “services or treatments” by inserting the words “would not be substantially increased over those of available standard health care services or treatments”;

    On page twenty, subdivision 8.11.b., by striking out “8.12.d” and inserting in lieu thereof “8.11.d”;

    On page twenty-one, subdivision 8.11.c., after “8.11.c”, by inserting a period;

    On page twenty-one, subdivision 8.11.d., after “8.11.d”, by inserting a period;

    On page twenty-one, paragraph 8.11.d.1., after “8.11.d.1", by inserting a period;

    On page twenty-one, paragraph 8.11.d.2., after “8.11.d.2", by inserting a period;

    On page twenty-one, paragraph 8.11.d.3., after “8.11.d.3", by inserting a period;

    On page twenty-one, paragraph 8.11.d.3., by striking the words “pursuant to subdivision 8.11.a”;

    On page twenty-two, subsection 8.12., by striking out the word “amount” and inserting in lieu thereof the word “among”;

    On page twenty-three, subdivision 9.2.f., after the word “parties” by striking out the comma;

    On page twenty-three, paragraph 9.2.f.1., after “IRO” by striking out the comma and the words “except that a party that unreasonably refuses to stipulate to limit the record may be taxed by the court for the additional costs involved”;

    On page twenty-four, subsection 10.2, by striking out the word “as” and inserting in lieu thereof a comma;

    On page twenty-five, subdivision 10.4.c., by striking out subdivision 10.4.c. in its entirety;

    On page twenty-seven, paragraph 11.4.a.2., after the word “review” by inserting a comma and the words “any known close relative of the covered person,”;

    On page twenty-seven, after paragraph 11.4.a.3., by inserting two new paragraphs, designated paragraph, 11.4.a.4. and 11.4.a.5., to read as follows:

    11.4.a.4. Any administrator, fiduciary, employee or sponsor of an employee welfare benefit plan as defined in 29 U.S.C. 1002(1), if any, under which the covered person's request for external review arises;

    11.4.a.5. A trade association of group health plans or issuers, or a trade association of health care providers;”

    By renumbering the remaining paragraphs;

    On page twenty-seven, subdivision 11.4.b., by striking out all of subdivision 11.4.b. and inserting in lieu thereof a new subdivision, designated subdivision 11.4.b., to read as follows:

    11.4.b. In determining whether an IRO or a clinical reviewer of the IRO has a material professional, familial or financial conflict of interest for purposes of subdivision 11.4.a, the Commissioner may disregard the mere appearance of a conflict of interest.;

    On page twenty-eight, section twelve, by striking out section twelve in its entirety;

    By renumbering the remaining sections;

    On page twenty-eight, subsection 13.1., by striking out “13.1.a” and inserting in lieu thereof “12.1.a”

    On page twenty-nine, paragraph 13.2.b.2., by striking out “paragraph 13.2.b.2” and inserting in lieu thereof “paragraph 12.2.b.1”;

    On page thirty, subsection 15.2, by striking out “15.1" and inserting in lieu thereof “14.1";

    On page thirty, subsection 15.3, by striking out “15.2" and inserting in lieu thereof “14.2";

    And,

    On page thirty, after subsection 15.3, by adding new section, designated section fifteen, to read as follows:

    §114-97-15. Penalties. Any issuer failing to comply with the requirements of this rule is subject to the penalties prescribed in W. Va. Code §33-3-11.

Adopted

Rejected