Definition


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Legislation Signed into Law

2020

Primary Focus This legislation requires, for state-regulated insurance policies that are issued or renewed after January 1, 2021, health insurance companies to provide parity regarding coverage pursuant to the Federal Parity Law requirements.
Title/Description Informal Title: Requiring State Public and Private Health Insurance to Comply with Key Provisions of the Federal Parity Act and Other Protections.
Citation

SB 291 / HB 4796 (Passed) 2020-04-14 – Chapter 186, Acts, Regular Session, 2020.  For full text, click here.  (Not codified in state statute as of August 1, 2020).

Summary

Amends multiple sections of the West Virginia Code to require insurers including the Public Employees Insurance Agency (PEIA) and commercial health insurance offerings to comply with certain provisions of the Federal Parity Law.  Highlights include the following:

  • Definitions. Defines key terms related to mental health and addiction services including references to the most recent editions of the International Statistical Classification of Diseases and Related Health Problems (ICD) and The Diagnostic and Statistical Manual of Mental Disorders (DSM).
  • Key Parity Compliance Requirements.
    • Promotes MH/SUD and medical/surgical insurance coverage equity by using six benefit classifications in alignment with the Federal Parity Law.
    • Implements financial protections (i.e. the quantitative treatment limitations – QTLs) and non-financial protections (i.e., nonquantitative treatment limitations – NQTLs) in accordance with the Federal Parity Law.
    • Generally tracks the regulations promulgated pursuant to the Federal Parity Law and the Six Step Parity Compliance Guide in terms of identifying the factors and evidentiary standards used in creating and maintaining a parity compliance program both in writing and in operation.
  • Reimbursement Coverage. Requires reimbursement for behavioral health screening tools and other preventative services.
  • Network Adequacy. When coverage is not available by any in-network providers, requires health plans to reimburse for out-of-network coverage at the same reimbursement and coverage levels as in-network care.
  • Insurer Reporting Requirements.
    • The new law requires health plans to report on their respective parity compliance activities, but first requires the Insurance Commissioner to adopt rules specifying the information and analyses insurers must provide to the Insurance Commissioner.  The Insurance Commissioner in turn will submit the health plan reports to West Virginia’ Joint Committee on Government and Finance once implemented and annually thereafter.
    • The new law requires health plans to submit their respective reports to the Insurance Commissioner no earlier than one year after the rules are promulgated, and any year thereafter during which the carrier makes significant changes to how it designs and applies medical management protocols.
    • A similar process is required for the Public Employees Insurance Agency, which provides health insurance to state and local government employees.  “On or after June 1, 2021, and annually thereafter”, the agency must submit a written report to the Joint Committee on Government and Finance detailing key parity compliance activities as outlined in the new law including significant changes made to medical management design and application protocols.
  • State Enforcement Requirements. Requires the Insurance Commissioner to enforce this law and conduct financial examinations for the commercial insurance carriers to determine compliance.  No details are offered in the new law regarding who ensures that the Public Employees Insurance Agency is compliant, but it is likely the Agency’s oversight board.
Effective Date

June 7, 2020.
Notes:  Depending how the Department of Insurance requires carriers to report on their respective parity compliance activities, this new state parity law is likely similar to the Model State Parity Legislation developed by The Kennedy Forum and several other consumer advocacy groups.

2018

Primary Focus Mandated Benefit: Provider
Title/Description Substance Use Disorder
Citation W. Va. Code § 33-24-7r; W. Va. Code § 33-25-8o; W. Va. Code § 33-25A-8r; W. Va. Code § 33-15-4r; W. Va. Code § 33-16-3cc
Summary

The following plans that are delivered, issued, executed, or renewed in this state, or approved for issuance or renewal by the Insurance Commissioner, on or after January 1, 2019, shall provide benefits for inpatient and outpatient treatment of substance use disorder at in-network facilities at the same level as other medical services offered by the health benefit plan:
• A health benefit plan offered by a health plan issuer that provides hospital or medical expense benefits;
• An accident and sickness policy that provides hospital or medical expense benefits; and
• A group accident and sickness policy that provides hospital or medical expense benefits.

Effective Date for all citations 06/08/2018
Note

Enacted through S 401 (2018 Regular Session)

2013

Primary Focus Mandated Benefit: Provider
Title/Description 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
Citation W. Va. Code § 5-16-7
Summary

The agency shall establish a 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 employees herein made eligible and establish and promulgate rules for the administration of these plans subject to the limitations contained in this article. These plans shall include coverage for treatment of serious mental illness, subject to certain limitations. The agency shall not discriminate between medical-surgical benefits and mental health benefits in the administration of its plan.

W. Va. Code § 5-16-7 continues on to discuss other covered services.

Effective Date 05/02/2013
Notes

Amended by W.V. SB 22.

2012

HB 4260
Senate Bill SB 401
Introduced 01/2012
Sponsor Del. Fleischauer and Sen. Wills
Status Signed into law 04/2012
Summary

This bill made minor technical changes the sections of state law about autism coverage to what they are currently (these sections are summarized at the bottom of the under “West Virginia Parity Law,” “Autism Coverage”).

2011

HB 2693
Senate Bill SB 218
Introduced 01/2011
Sponsor Del. Fleischauer and Sen. Jenkins
Status Signed into law 05/2011
Summary

This bill added the sections of state law about autism coverage (these sections are summarized at the bottom of the under “West Virginia Parity Law,” “Autism Coverage”).

2010

SB 407
Introduced 02/2010
Sponsor Sen. Minard
Status Signed into law 03/2010
Summary

Among many other things, this bill authorized the Insurance Commissioner to issue regulations regarding parity.

2009

HB 3288
Senate Bill SB 659
Introduced 03/2009
Sponsor Del. Perry and Sen. Minard
Status Signed into law 06/2009
Summary

This bill changed sections of state law about parity so that small employer fully-insured plans with less than 25 employees can only limit inpatient days and outpatient visits if their costs rise by 2% annually. Previously it had been 1%. Also, if a large employer fully-insured plan qualifies for the 2% allowment, it may only limit inpatient days and outpatient visits for the following plan year.

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