Source: http://www.wvlegislature.gov/Bill_Text_HTML/2000_SESSIONS/RS/Bills/HB2906%20INTR.htm
Timestamp: 2018-01-23 08:54:29
Document Index: 158844968

Matched Legal Cases: ['§33', '§33', '§33', '§33', '§33', '§33', '§33']

(By Delegates Hatfield, Susman
Collins and Marshall)
A BILL to amend chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article twenty-five-d, relating to the creation of the "West Virginia Managed Care Ombudsman Program Act"; establishing a managed care ombudsman program to assist consumers; providing for financing of the program from an assessment on premium dollars; establishing a statewide ombudsman advisory counsel to advise the state on the ombudsman program; and generally relating to the powers, responsibility and authority of the ombudsman program, including promulgation of legislative rules.
That chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new article, designated article twenty-five-d, to read as follows:
ARTICLE 25D. MANAGED CARE OMBUDSMAN PROGRAM.
This article may be known and cited as the "West Virginia Managed Care Ombudsman Program Act".
§33-25D-2. Creation of the state managed care ombudsman program.
§33-25D-3. State managed care ombudsman; qualifications; duties.
(8) Identifying, investigating and resolving enrollees complaints and assist in filing; and
(9) Identifying, investigating, publicizing and promoting solutions to practices, policies, laws and rules that may adversely affect consumer access to quality health care.
(11) Establishing a mandatory statewide training program and certification procedures for regional managed care ombudsmen, excluding clerical staff, which shall include training in the following areas: (i) The review of medical records; (ii) confidentiality of records; (iii) techniques of complaint investigation; (iv) the effects of institutionalization; and (v) the special needs of the elderly; and (12) Promulgating mandatory statewide rules, regulations and training related to the use of managed care ombudsman volunteers in the program, including procedures to assure that the responsibility and authority of ombudsman volunteers shall be restricted to activities which do not involve access to confidential records, which do not involve complaint investigations other than information gathering to ascertain the nature and facts of a complaint, and which do not involve the initiation or pursuit of legal proceedings, actions or remedies.
§33-25D-4. Establishment of statewide ombudsman advisory counsel.
The insurance commissioner shall establish a statewide ombudsman advisory counsel to advise the state on the design, operation and evaluation of the ombudsman program. The advisory counsel shall be composed of no less than fifteen members and no more than thirty members. The advisory counsel shall be broadly representative of the health care community with a consumer majority and shall reflect the diversity of the state's population relative to race, ethnic origin, gender, age, economic status, physical and health condition.
§33-25D-5. Limitations on liability.
§33-25D-6. Availability of legal counsel.
The insurance commissioner shall establish and maintain procedures to ensure that:
(a) Adequate legal counsel is available to the managed care ombudsman program for advice, consultation and representation as necessary in connection with the performance of the ombudsman's official duties; and
(b) The managed care ombudsman program has the ability to pursue administrative, legal and other appropriate remedies on behalf of residents of long-term care facilities.
§33-25D-7. Funding for managed care ombudsman programs.
(b) Any managed care ombudsman program may solicit and receive funds, gifts and contributions to support the operation of the program. No program shall solicit or receive any funds, gifts or contributions where the solicitation or receipt would jeopardize the independence and objectivity of the program.
(c) There is hereby created in the state treasury a special revenue account, which is an appropriated, interest bearing account, designated as the "managed care ombudsman program fund". All funds received by the managed care ombudsman program from any source shall be deposited into this special account. This fund may be used only for the purposes of administration, regulation, promotion and study of the managed care ombudsman program.
§33-25D-8. Promulgation of rules.
Article 25D is new; therefore, strike-throughs and underscoring have been omitted.