reglab/housing_qa huggingface dataset:
WV Code § 33-25A-34 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25A. Health Maintenance Organization Act|§33-25A-34. Ambulance Services

The Legislature finds that ambulance services in this state are performed by various volunteer emergency service squads, county operations and small businesses, which may lack the sophistication and expertise required to negotiate a contract with a health maintenance organization for the provision of ambulance services, and that the best interests of the citizens of the state require the continued development and preservation of an emergency medical system to serve all the citizens of the state, including those citizens who do not receive health care services through a health maintenance organization. Therefore, the commissioner shall promulgate legislative rules, pursuant to the provisions of article twenty-nine-a of this code, to regulate contracting for emergency medical services. The rules shall be promulgated as expeditiously as possible in order to be considered by the Legislature in the regular session in the year one thousand nine hundred ninety-seven. The rules shall consider the following: Reimbursement for nonemergency transportation by nonparticipating providers and the appropriate use of 911 or community dispatching, as well as other items the commissioner may deem necessary.
WV Code § 33-25A-35 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25A. Health Maintenance Organization Act|§33-25A-35. Rural Health Maintenance Organizations

The Legislature finds that the provisions of this article, and in particular, the financial requirements that are conditions precedent to the establishment of a health maintenance organization, may be unnecessarily restrictive as applied to small managed care organizations to operate in rural areas of the state, and that the public interest may be served by the development of less restrictive standards permitting the creation of rural health maintenance organizations. Therefore, the commissioner shall develop and present to the Joint Committee on Government and Finance, not later than January 15, 1997, a proposal for legislation to be considered during the 1997 regular session of the Legislature, providing standards for the development and operation of rural health maintenance organizations.
WV Code § 33-25A-36 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25A. Health Maintenance Organization Act|§33-25A-36. Assignment of Certain Benefits in Dental Care Insurance Coverage

(a) Any entity regulated under this article that provides dental care coverage to a covered person shall honor an assignment, made in writing by the person covered under the policy, of payments due under the policy to a dentist or a dental corporation for services provided to the covered person that are covered under the policy. Upon notice of the assignment, the entity shall make payments directly to the provider of the covered services. A dentist or dental corporation with a valid assignment may bill the entity and notify the entity of the assignment. Upon request of the entity, the dentist or dental corporation shall provide a copy of the assignment to the entity.(b) A covered person may revoke an assignment made pursuant to subsection (a) of this section with or without the consent of the provider. The revocation shall be in writing. The covered person shall provide notice of the revocation to the entity. The entity shall send a copy of the revocation notice to the dentist or dental corporation subject to the assignment. The revocation is effective when both the entity and the provider have received a copy of the revocation notice. The revocation is only effective for any charges incurred after both parties have received the revocation notice.(c) If, under an assignment authorized in subsection (a) of this section, a dentist or dental corporation collects payment from a covered person and subsequently receives payment from the entity, the dentist or dental corporation shall reimburse the covered person, less any applicable copayments, deductibles, or coinsurance amounts, within 45 days.(d) Nothing in this section limits an entitys ability to determine the scope of the entitys benefits, services, or any other terms of the entitys policies or to negotiate any contract with a licensed health care provider regarding reimbursement rates or any other lawful provisions.(e) Any entity providing dental care shall provide conspicuous notice to the covered person that the assignment of benefits is optional, and that additional payments may be required if the assigned benefits are not sufficient to pay for received services. (f) The provisions of this section shall not apply to insurers or managed care organizations with respect to their Medicaid or CHIP plans or contracts which are reviewed and approved by the Department of Health and Human Resources Bureau for Medical Services.
WV Code § 33-25B-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-1. Definitions

The following words, as used in this article, have the meanings set forth below, unless the context clearly requires otherwise:(a) "Applicant aide" means an individual licensed by the state to care for the physical or emotional needs of children or an employee authorized by his employer where the employer is an institution licensed by the state to care for the physical or emotional needs of children and who has received an applicant aide certificate. Individuals include, but are not limited to, licensed teachers, child care workers, social workers, guidance counselors, psychologists, nurses and physicians. Licensed institutions include, but are not limited to, hospitals, schools, local human services offices, child care centers and medical clinics;(b) "Approved providers" means any accident and health insurer licensed by the state or any health services organization licensed by the state or any other entity approved by the Insurance Commissioner for provision of health care coverage for children;(c) "Corporation" means a nonprofit corporation organized under the laws of West Virginia which has undertaken to implement a federal insurance subsidy for children's health insurance created by this article; and(d) "Insurance subsidy fund" or "fund" means a fund or account established by the corporation for the deposit of moneys to implement the insurance subsidy program.
WV Code § 33-25B-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-2. Purpose

The purpose of this article is to:(a) Assist, promote, encourage, develop and advance the knowledge of lower to moderate income families with dependent children of the earned income credit available for money spent on health insurance;(b) Cooperate and act in conjunction with other organizations, public and private, the objects of which are the promotion and education of lower to moderate income families with dependent children of the earned income credit available for money spent on health insurance;(c) Establish a system of qualified applicant aides who shall be trained by the department of health and human services and, who, for a modest dollar incentive, will on a volunteer basis make knowledge of this program available to the targeted families; and(d) Establish a mechanism by which to provide counseling and assistance to families and aid them in filing for the insurance voucher, selecting an appropriate health insurance policy and completing the required federal income tax return.
WV Code § 33-25B-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-3. General Powers

In order for a nonprofit corporation to participate in the program provided pursuant to this article, the nonprofit corporation must be organized and incorporated as a nonprofit corporation pursuant to the provisions of article one, section thirty-one of this code. The nonprofit corporation, in addition to all other lawful powers, shall have the power to provide counseling services to West Virginia families on the purchase of federally subsidized health insurance and to accept gifts, grants, or loans from and enter into contracts or other transactions with any federal or state agency, any municipality, any private organization or any other source as may be authorized by law.
WV Code § 33-25B-4 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-4. Voucher Applications; Contents

A guardian or applicant aide may file with a nonprofit corporation, organized for the purposes of this article, a sworn voucher application signed by the guardian asserting:(a) That the guardian meets the requirements for the federal earned income credit for child health insurance for the current or next calendar year;(b) The good-faith estimate value of the health insurance earned income credit for the year in question;(c) That the guardian will use the voucher to purchase health insurance covering dependent children;(d) That the guardian will prepare a federal tax return for the year in question; and(e) That the guardian agrees to assign the value of any federal tax refund, in the amount of the voucher issued by the corporation to the corporation when filing the guardian's federal tax return.
WV Code § 33-25B-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-5. Duties and Responsibilities of Corporation

Upon presentation of a valid voucher application, the corporation shall issue from its insurance subsidy fund a voucher to the guardian or applicant aide, made out in behalf of the guardian and redeemable for the face amount by any approved provider. The corporation shall retain in the fund all moneys received from refundable tax credits of guardians. These moneys shall be used to extend additional vouchers. The corporation may solicit and receive donations of moneys for the fund. No corporation may require that vouchers be presented to a specific approved provider in order to be eligible to participate in the program.
WV Code § 33-25B-6 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-6. Duties and Responsibilities of Department of Health and Human Resources to Provide Training and Other Services

(a) The Department of Health and Human Resources shall design and provide the vouchers to any corporation wishing to participate in the program at a cost not to exceed the actual cost of the voucher.(b) No later than ninety days after a request is made by a corporation wishing to participate in the insurance subsidy program, the Department of Health and Human Resources in cooperation with the corporations participating in the program, shall begin to conduct regional training and information sessions in all regions of the state. The purpose of these sessions is to train guardians and potential applicant aides in the necessary rules to qualify under the federal guidelines for earned income credits and the requirements of this section. These sessions shall be open to the public and potential applicant aides, at a charge not to exceed $10 which shall be used solely to defray the costs of conducting the training sessions. Sessions shall be available in at least the first and fourth quarter of the calendar year in all regions of the state after a request has been made by a corporation to commence such training sessions. The Department of Health and Human Resources may waive the fee for guardians.(c) Potential applicant aides shall be tested by the Department of Health and Human Resources. Potential applicant aides who successfully complete the test shall be awarded a certificate entitling them to work as an applicant aide. The Department of Health and Human Resources shall propose legislative rules for promulgation in accordance with the provisions of article three, chapter twenty-nine-a of this code.
WV Code § 33-25B-7 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-7. Allowable Commission for Applicant Aides; Prohibited Practices

 (a) Applicant aides may receive a commission not to exceed five percent of the voucher, from an approved provider. No commission may be paid until the fund is fully reimbursed for the voucher. Applicant aides may not solicit or accept any compensation from guardians or potential guardians. (b) An applicant aide shall be prohibited from entering into any agreement with an approved provider, whether such agreement is for profit or not for profit, to recommend a specific approved provider, to the exclusion of all other approved providers, in the course of counseling guardians or applicants.(c) Applicant aides who engage in deceptive practices or who aid or encourage deception or fraud may, upon hearing by the corporation, have their certificate as an applicant aide revoked for a period of not less than five years. This action shall be in addition to any other penalties available at law.(d) The corporation may pursue triple damages in civil court for any losses to the fund attributable to actions or the conduct of applicant aides or guardians.
WV Code § 33-25B-8 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-8. Activities Not Deemed the Sale of Insurance; Exemptions From Benefits and Taxation

(a) Assisting individuals in the preparation of applications to the fund and selection of the providers does not constitute the sale of insurance and shall not be subject to regulation by the Insurance Commissioner.(b) Insurance coverage bought by the guardian through the use of a voucher provided pursuant to the provisions of this article will be exempt from state law and regulations requiring certain mandatory state insurance coverages or benefits.(c) Insurance coverage bought by guardians through the use of a voucher provided pursuant to the provisions of this article shall not be subject to state premium taxes.
WV Code § 33-25B-9 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-9. Annual Report and Audits

On January 1, of each year the corporation shall report on its operations for the preceding fiscal year to the Governor and the State Legislature. The report shall include a summary of the activities of the corporation and a complete operating and financial statement. A corporation shall cause an annual audit to be made by a resident certified public accountant or a registered public accountant of its books, accounts and records, with respect to its receipts, disbursements and all other matters related to the operation of the insurance subsidy program. The person performing such audit shall also furnish copies of the audit report to the Joint Committee on Government and Finance and the Legislative Auditor.
WV Code § 33-25B-10 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-10. Tax Exemption

Any corporation organized for the purposes of this article is exempt from all franchise, corporate, business and taxes of every nature levied by the state.
WV Code § 33-25B-11 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25B. Federal Insurance Subsidy for Children's Health|§33-25B-11. Personal Liability of Members or Persons Acting on Behalf of the Corporation

No person acting on behalf of the corporation executing any contracts, commitments or agreements issued pursuant to this article may be liable personally upon the contracts, commitments or agreements or be subject to any personal liability or accountability by reason thereof.
WV Code § 33-25C-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25C. Health Maintenance Organization Patient Bill of Rights|§33-25C-1. Short Title and Purpose

This article may be referred to as the "Patients' Bill of Rights." It is the intent of the Legislature that enrollees covered by health care plans receive quality, cost-effective health care designed to maintain and improve their health. The purpose of this article is to ensure that health plan enrollees:(a) Have improved access to information regarding their health plans;(b) Have sufficient and timely access to appropriate health care services, and choice among health care providers;(c) Are assured that health care decisions are made by appropriate medical personnel;(d) Have access to a quick and impartial process for appealing plan decisions;(e) Are protected from unnecessary invasions of health care privacy; and(f) Are assured that personal health care information will be used only as necessary to obtain and pay for health care or to improve the quality of care.
WV Code § 33-25C-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25C. Health Maintenance Organization Patient Bill of Rights|§33-25C-2. Definitions

For purposes of this article:(a) "Commissioner" means the commissioner of insurance.(b) "Credentials" means medical training, education, specialties, and board certifications of the provider.(c) "Enrollee" is a natural person who has entered into an agreement with a health maintenance organization or prepaid limited health service organization for the provision of managed health care.(d) "External review" means a process, independent of all affected parties, to determine if a health care service is medically necessary, or experimental.(e) "Health care plan" means a plan that establishes, operates, or maintains a network of health care providers that have entered into agreements with the plan to provide health care services to enrollees to whom the plan has the ultimate obligation to arrange for the provision of or payment for services through organizational arrangements for ongoing quality assurance, utilization review programs, or dispute resolution.For purposes of this definition, "health care plan" shall not include indemnity health insurance policies including those using a contracted provider network;(f) "Managed care plan" or "plan" means any health maintenance organization or prepaid limited health service organization: Provided, That this article only applies to prepaid limited health service organizations to the extent of coverage and services these organizations offer;(g) "Provider" means any physician, hospital or other person or organization which is licensed or otherwise authorized in this state to provide health care services or supplies.
WV Code § 33-25C-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 25C. Health Maintenance Organization Patient Bill of Rights|§33-25C-3. Notice of Certain Enrollee Rights

All managed care plans must on or after July 1, 2002, provide to enrollees a notice of certain enrollee rights. The notice shall be provided to enrollees on a yearly basis on a form prescribed by the commissioner and shall include, but not be limited to:(a) The enrollee's rights to a description of his or her rights and responsibilities, plan benefits, benefit limitations, premiums, and individual cost-sharing requirements;(b) The enrollee's right to a description of the plan's grievance procedure and the right to pursue grievance and hearing procedures without reprisal from the managed care plan;(c) A description of the method in which an enrollee can obtain a listing of the plan's provider network, including the names and credentials of all participating providers, and the method in which an enrollee may choose providers within the plan;(d) The enrollee's right to privacy and confidentiality;(e) The right to full disclosure from the enrollee's health care provider of any information relating to his or her medical condition or treatment plan, and the ability to examine and offer corrections to the enrollee's medical records;(f) The enrollee's right to be informed of plan policies and any charges for which the enrollee will be responsible;(g) The right of enrollees to have coverage denials involving medical necessity or experimental treatment reviewed by appropriate medical professionals who are knowledgeable about the recommended or requested health service, as part of an external review as provided in this article;(h) A description of the method in which an enrollee can obtain access to a summary of the plan's accreditation report;(i) The right of an enrollee to have medical advice or options communicated to him or her without any limitations or restrictions being placed upon the provider or primary care physician by the managed care plan;(j) A list of all other legally mandated benefits to which the enrollee is entitled, including coverage for services provided pursuant to sections eight-a, eight-b, eight-c, eight-d, eight-e, article twenty-five-a of this chapter, article twenty-five-e of this chapter, and article forty-two of this chapter, and all rules promulgated pursuant to this chapter regulating managed care plans.(k) Any other areas the commissioner may propose in accordance with section nine of this article.