WEST virginia legislature
2020 regular session
Introduced
House Bill 4572
By Delegate Hill
[Introduced January 28,
2020; Referred to the Committee on Health and Human Resources]
A BILL to amend and reenact §5-16B-6d of the Code of West Virginia, 1931, as amended, relating to the requirement that provider reimbursement schedules shall be no lower than the reimbursement provided for the same services under the plans offered in §5-16-1 et seq. of this code.
Be it enacted by the Legislature of West Virginia:
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 benefit plan for uninsured children of families with income between 200 and 300 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.
(e) (d) All provisions of this article are
applicable to this expansion unless expressly addressed in this section.
(f)(e) 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 200 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 200 percent of the federal poverty level.
(g)(f) 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 allow WVCHIP flexibility in rate setting to establish cost savings to assist with the budget shortfall and to move program from fee-for-service to a managed care benefit.
Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.