Introduced Version
House Bill 4371 History
OTHER VERSIONS -
Enrolled Version - Final Version
|
| Email
Key: Green = existing Code. Red = new code to be enacted
H. B. 4371
(By Delegates Michael, Craig, Leach,
Morgan and Perdue)
[Introduced February 9, 2004
; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend and reenact §16-29F-1 of the code of West Virginia,
1931, as amended, relating to extending the pilot program for
the uninsured and underinsured from two thousand four to two
thousand six.
Be it enacted by the Legislature of West Virginia:
That §16-29F-1 of the code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 29F. UNINSURED AND UNDERINSURED PILOT PROGRAMS.
§16-29F-1. Uninsured and underinsured health coverage assistance;
pilot program.
(a) The U.S. United States department of health and human
services has established a federal grant program to encourage
innovative integrated health care delivery systems to serve
uninsured and underinsured persons with greater efficiency and
improved quality of care and to further maximize reimbursements to health care providers which provide these services. The "Community
Access Program" (CAP) grants as authorized in the federal register:
February 4, 2000 (volume 65, number 24), allow for the
establishment of local programs to reorganize and reintegrate local
health care delivery systems. This section authorizes, on a trial
basis, the establishment of pilot programs in the state which
receive a grant under CAP the community access program to
coordinate health care provider reimbursements, to allow an
opportunity for innovations in payment for health care services to
be tested and, if successful, to be permanently implemented.
(b) An entity receiving a CAP the community access program
grant may initiate a program that comports to the federal grant
requirements and meets the requirements of this section. The pilot
program may enroll persons to participate in this pilot program who
currently do not have insurance and whose income does not exceed
two hundred and fifty percent of the federal poverty level. The
pilot program may coordinate payments from enrollees and businesses
employing enrollees to be utilized to capture available federal
moneys to assist in providing reimbursements to enrollee's health
care providers. The pilot program is to shall coordinate
reimbursements limited to areas not covered by other federal
reimbursement programs such as the children's health insurance
agency within the department of administration and the federal
medicaid program. In no instance may the pilot program allow health care reimbursements to enrollees and to health care
providers that limit or otherwise impede the eligibility of the
enrollee or the health care provider to be eligible for these or
other federal health care cost reimbursement programs.
(c) Notwithstanding the provisions of chapter thirty-three of
this code to the contrary, any grant program created and authorized
pursuant to this section is not to be deemed considered as
providing insurance or as offering insurance services. CAP
Community access pilot programs are specifically excluded from the
definitions of "insurance" pursuant to section one, article one,
chapter thirty-three of this code and of the definition of
"insurer" as defined in section two of said article are not
subject to regulation by the insurance commissioner and are not to
be deemed as unauthorized insurers pursuant to section four,
article forty-four of said chapter and "insurer" as defined in
article one, chapter thirty-three of this code, and these programs
are not subject to regulation by the insurance commissioner, nor
are they unauthorized insurers pursuant to section four, article
forty-four of chapter thirty-three of this code.
(d) The CAP community access pilot program is authorized to
enter into agreements with health care providers to coordinate and
otherwise provide services to enrollees. These agreements must be
contingent on the health care provider agreeing to provide accept
payment by from the CAP community access pilot program based on available funding to the program for the health care services being
provided. If the health care provider decides to no longer accept
the community access pilot program's enrollee's reimbursement, the
health care provider must provide, at a minimum, thirty days'
notice of discontinuance of providing services and further
acceptance of enrollee's payments.
(e) The community access pilot program must provide enrollees
and his or her the participating employer with a minimum of thirty
days' notice of discontinuance or reduction of enrollee benefits.
(f) The community access pilot program must submit quarterly
reports to the legislative oversight commission of health and human
resources accountability as established in article twenty-nine-e of
this chapter. The report shall include at a minimum, analysis of
the financial status, numbers the number of health care provider
reimbursements, enrollee services utilized and other information as
requested by the commission.
(g) The authorization for the creation and existence of a
pilot program as established pursuant to this section shall expire
expires on the thirtieth day of June, two thousand four six.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.