COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 516
(By Senators Tomblin, Mr. President, Helmick, Walker, Hunter,
Sprouse, Wooton, Mitchell, Prezioso, McCabe, Craigo, Snyder,
Minard, Kessler, Ross, Anderson, Sharpe, Plymale, Edgell, Ball,
Love, Dawson, Unger, Redd, Bowman and Jackson)
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[Originating in the Committee on Banking and Insurance;
reported March 1, 2000.]
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A BILL to amend and reenact section seven, article sixteen, chapter
five of the code of West Virginia, one thousand nine hundred
thirty-one, as amended; to amend article fifteen, chapter
thirty-three of said code by adding thereto a new section,
designated section four-f; to amend article sixteen of said
chapter by adding thereto a new section, designated section
three-o; to amend article twenty-four of said chapter by
adding thereto a new section, designated section seven-f; to
amend article twenty-five of said chapter by adding thereto a
new section, designated section eight-e; and to amend article
twenty-five-a of said chapter by adding thereto a new section, designated section eight-e, all relating to requiring
insurance companies that provide health care coverage to
provide for colorectal cancer examinations and laboratory
tests for colorectal cancer.
Be it enacted by the Legislature of West Virginia:
That section seven, article sixteen, chapter five of the code
of West Virginia, one thousand nine hundred thirty-one, as amended,
be amended and reenacted; that article fifteen, chapter
thirty-three of said code be amended by adding thereto a new
section, designated section four-f; that article sixteen of said
chapter be amended by adding thereto a new section, designated
section three-o; that article twenty-four of said chapter be
amended by adding thereto a new section, designated section
seven-f; that article twenty-five of said chapter be amended by
adding thereto a new section, designated section eight-e; and that
article twenty-five-a of said chapter be amended by adding thereto
a new section, designated section eight-e, 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.
§5-16-7. Authorization to establish group hospital and surgical insurance plan, group major medical insurance plan,
group prescription drug plan and group life and
accidental death insurance plan; rules for
administration of plans; mandated benefits; what
plans may provide; optional plans; separate rating
for claims experience purposes.
(a) The agency shall establish
a one or more group hospital
and surgical insurance
plan or plans,
a group prescription drug
insurance
plan or plans,
a group major medical insurance
plan or
plans and
a group life and accidental death insurance
plan or plans
for
those eligible employees
herein made eligible, and to. The
agency shall further establish and promulgate rules for the
administration of
such the plans, subject to the limitations
contained in this article.
Those The plans shall include:
(1)
Coverages Coverage and benefits for X ray and laboratory
services in connection with mammograms and pap smears when
performed for cancer screening or diagnostic services;
(2) Annual checkups for prostate cancer in men age fifty and
over;
(3)(A) Reimbursement or indemnification for colorectal cancer
examinations and laboratory testing for any nonsymptomatic person
fifty years of age or older, or symptomatic person under fifty
years of age, when reimbursement or indemnity for laboratory or X-ray services are covered under the policy and are performed for
colorectal cancer screening or diagnostic purposes at the direction
of a person licensed to practice medicine and surgery by the board
of medicine.
(B) The tests shall include an annual fecal occult blood test,
a flexible sigmoidoscopy repeated every five years, a colonoscopy
repeated every ten years and a double contrast barium enema
repeated every five years.
(C) A symptomatic person is defined as: (i) an individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps, or (ii) an individual who poses a higher than
average risk for colorectal cancer because he or she has had
colorectal cancer or polyps, inflammatory bowel disease or an
immediate family history of such conditions.
(D) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the plan of the
covered person may apply to colorectal cancer examinations and
laboratory testing.
(3) (4) For plans that include maternity benefits, coverage
for inpatient care in a duly licensed health care facility for a
mother and her newly born infant for the length of time which the
attending physician
deems considers medically necessary for the
mother or her newly born child:
Provided, That no such plan may deny payment for a mother or her new born child prior to
forty-eight hours following a vaginal delivery, or prior to
ninety-six hours following a caesarean section delivery, if the
attending physician
deems considers discharge medically
inappropriate; and
(4) (5) For plans
which provide coverages for that cover
post-delivery care to a mother and her newly born child in the
home, coverage for inpatient care following childbirth as provided
in subdivision
(3) (4) of this subsection if such inpatient care is
determined to be medically necessary by the attending physician.
Those The plans may also include, among other things, medicines,
medical equipment, prosthetic appliances, and such other inpatient
and outpatient services and expenses
deemed considered appropriate
and desirable by the agency.
(b) The agency shall make available to each eligible employee,
at full cost to the employee, the opportunity to purchase optional
group life and accidental death insurance as established under the
rules of the agency. In addition, each employee is entitled to
have his or her spouse and dependents, as defined by the rules of
the agency, included in the optional coverage, at full cost to the
employee, for each eligible dependent; and with full authorization
to the agency to make the optional coverage available and provide
an opportunity of purchase to each employee.
(c) The finance board may cause to be separately rated for
claims experience purposes: (1) All employees of the state of West
Virginia; (2) all teaching and professional employees of the
university of West Virginia board of trustees or the board of
directors of the state college system and county boards of
education; (3) all nonteaching employees of the university of West
Virginia board of trustees or the board of directors of the state
college system and county boards of education; or (4) any other
categorization which would ensure the stability of the overall
program.
CHAPTER 33. INSURANCE.
ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§33-15-4f. Third party reimbursement for colorectal cancer
examination and laboratory testing.
(a) Notwithstanding any provision of a policy, contract, plan
or agreement applicable to this article, reimbursement or
indemnification for colorectal cancer examinations and laboratory
testing may not be denied for any nonsymptomatic person fifty years
of age or older, or symptomatic person under fifty years of age,
when reimbursement or indemnity for laboratory or X-ray services
are covered under the policy and are performed for colorectal
cancer screening or diagnostic purposes at the direction of a
person licensed to practice medicine and surgery by the board of medicine.
(b) The tests shall include an annual fecal occult blood test,
a flexible sigmoidoscopy repeated every five years, a colonoscopy
repeated every ten years, and a double contrast barium enema
repeated every five years.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; or (2) an individual who poses a higher than
average risk for colorectal cancer because he or she has had
colorectal cancer or polyps, inflammatory bowel disease or an
immediate family history of such conditions.
(d) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3o. Third party reimbursement for colorectal cancer
examination and laboratory testing.
(a) Notwithstanding any provision of a policy, contract, plan
or agreement applicable to this article, reimbursement or
indemnification for colorectal cancer examinations and laboratory
testing may not be denied for any nonsymptomatic person fifty years
of age or older, or symptomatic person under fifty years of age, when reimbursement or indemnity for tests are covered under the
policy and are performed for colorectal cancer screening or
diagnostic purposes at the direction of a person licensed to
practice medicine and surgery by the board of medicine.
(b) The tests shall include an annual fecal occult blood test,
a flexible sigmoidoscopy repeated every five years, a colonoscopy
repeated every ten years and a double contrast barium enema
repeated every five years.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; or (2) an individual who poses a higher than
average risk for colorectal cancer because he or she has had
colorectal cancer or polyps, inflammatory bowel disease, or an
immediate family history of such conditions.
(d) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE
CORPORATIONS.
§33-24-7f. Third party reimbursement for colorectal cancer
examination and laboratory testing.
(a) Notwithstanding any provision of a policy, contract, plan
or agreement applicable to this article, reimbursement or
indemnification for colorectal cancer examinations and laboratory
testing may not be denied for any nonsymptomatic person fifty years
of age or older, or symptomatic person under fifty years of age,
when reimbursement or indemnity for laboratory or X-ray services
are covered under the policy and are performed for colorectal
cancer screening or diagnostic purposes at the direction of a
person licensed to practice medicine and surgery by the board of
medicine.
(b) The tests shall include an annual fecal occult blood test,
a flexible sigmoidoscopy repeated every five years, a colonoscopy
repeated every ten years and a double contrast barium enema
repeated every five years.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; or (2) an individual who poses a higher than
average risk for colorectal cancer because he or she has had
colorectal cancer or polyps, inflammatory bowel disease or an
immediate family history of such conditions.
(d) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may apply to colorectal cancer examinations and laboratory testing.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-8e. Third party reimbursement for colorectal cancer
examination and laboratory testing.
(a) Notwithstanding any provision of a policy, contract, plan
or agreement applicable to this article, reimbursement or
indemnification for colorectal cancer examinations and laboratory
testing may not be denied for any nonsymptomatic person fifty years
of age or older, or symptomatic person under fifty years of age,
when reimbursement or indemnity for laboratory or X-ray services
are covered under the policy and are performed for colorectal
cancer screening or diagnostic purposes at the direction of a
person licensed to practice medicine and surgery by the board of
medicine.
(b) The tests shall include an annual fecal occult blood test,
a flexible sigmoidoscopy repeated every five years, a colonoscopy
repeated every ten years and a double contrast barium enema
repeated every five years.
(c) A symptomatic person is defined as: (1) An individual who
experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; or (2) an individual who poses a higher than
average risk for colorectal cancer because he or she has had
colorectal cancer or polyps, inflammatory bowel disease or an immediate family history of such conditions.
(d) The same deductibles, coinsurance, network restrictions and
other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8e. Third party reimbursement for colorectal cancer
examination and laboratory testing.
(a) Notwithstanding any provision of a policy, contract, plan
or agreement applicable to this article, reimbursement or
indemnification for colorectal cancer examinations and laboratory
testing may not be denied for any nonsymptomatic person fifty years
of age or older, or symptomatic person under fifty years of age,
when reimbursement or indemnity for laboratory or X-ray services
are covered under the policy and are performed for colorectal
cancer screening or diagnostic purposes at the direction of a
person licensed to practice medicine and surgery by the board of
medicine.
(b) The tests shall include an annual fecal occult blood test,
a flexible sigmoidoscopy repeated every five years, a colonoscopy
repeated every ten years and a double contrast barium enema
repeated every five years.
(c) A symptomatic person is defined as: (1) An individual who experiences a change in bowel habits, rectal bleeding or persistent
stomach cramps; or (2) an individual who poses a higher than
average risk for colorectal cancer because he or she has had
colorectal cancer or polyps, inflammatory bowel disease or an
immediate family history of such conditions.
(d) The same deductibles, coinsurance, network restrictions
and other limitations for covered services found in the policy,
provision, contract, plan or agreement of the covered person may
apply to colorectal cancer examinations and laboratory testing.
_______
(NOTE: The purpose of this bill is to require insurance
companies to reimburse or indemnify persons for colorectal cancer
examinations and laboratory tests for nonsymptomatic persons fifty
years of age or older and symptomatic persons under the age of 50.
The requisite tests are described in the bill, as well as the
definition of a symptomatic person. Deductibles, coinsurance and
network restrictions apply to the exams and tests.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
§33-15-4f, 33-16-3o, 33-24-7f, 33-25-8e and 33-25A-8e are new;
therefore, strike-throughs and underscoring have been omitted.
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