reglab/housing_qa huggingface dataset:
WV Code § 5-16-12 (2021)
2021 West Virginia Code|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|§5-16-12. Misrepresentation by Employer, Employee or Provider; Penalty

(a) It shall be a violation of this article for any person to:(1) Knowingly secure or attempt to secure benefits payable under this article to which they are not entitled;(2) Knowingly secure or attempt to secure greater benefits than those to which the person is entitled; (3) Willfully misrepresent the presence or extent of benefits to which the person is entitled under a collateral insurance source;(4) Willfully misrepresent any material fact relating to any other information requested by the director;(5) Willfully overcharge for services provided; or(6) Willfully misrepresent a diagnosis or nature of the service provided.Any person who has violated any of the foregoing provisions shall be civilly liable for the amount of benefits, overpayment or other sums improperly received in addition to any other relief available in a court of competent jurisdiction.(b) If, after notice and an administrative proceeding, it is determined the person has violated the article, the person is liable for any overpayment received. The director shall withhold and set off any payment of any benefits or other payment due to that person until any overpayment is recovered.(c) In addition to any civil liability for a violation pursuant to subsection (a) of this section, any person who knowingly secures or attempts to secure benefits payable under this article, or knowingly attempts to secure greater benefits than those to which the person is entitled, by willfully misrepresenting or aiding in the misrepresentation of any material fact relating to employment, diagnosis or services rendered is guilty of a felony, and upon conviction thereof, shall be fined not more than $1,000, imprisoned for not less than one nor more than five years, or both. Errors in coding for billing purposes shall not be considered a violation of this subsection absent other evidence of willful wrongdoing.(d) Any person who violates any provision of this article which results in a loss to, or overpayment from, the plan, or to the State of West Virginia of less than $1,000, and for which no other penalty is specifically provided, is guilty of a misdemeanor and, upon conviction thereof, is subject to a fine of not less than $100 but not more than $500, or imprisonment for a period of not less than twenty-four hours but not more than fifteen days, or both. Any person who violates any provision of this article which results in a loss to, or overpayment from, the plan or the State of West Virginia of $1,000 or more, and for which no other penalty is specifically provided, is guilty of a felony and, upon conviction thereof, is subject to a fine of not less than $1,000 but not more than $5,000, or imprisonment for a period of not less than one nor more than five years, or both.
WV Code § 5-16-12b (2021)
2021 West Virginia Code|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|§5-16-12b. Privileges and Immunity

(a) Any person who makes a report or furnishes information, written or oral, concerning suspected, anticipated or fraudulent activity to secure benefits payable under this article, or to secure greater benefits than those to which the person or provider is entitled, is entitled to those privileges and immunities existing under common or statutory law, as well as the immunity established in this section.(b) In the absence of fraud, malice or bad faith, no person or agent, employee or designee of that person shall be subject to civil liability of any nature arising out of that person's provision of information related to suspected, anticipated or fraudulent activity in the securing of benefits payable or securing greater benefits than those to which the person or provider is entitled.(c) Nothing in this section shall be construed to limit, abrogate or modify existing statutes or case law applicable to the duties or liabilities of persons acting in a manner that is itself fraudulent, with malice or in bad faith.
WV Code § 5-16-14 (2021)
2021 West Virginia Code|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|§5-16-14. Program Qualifying for Favorable Federal Income Tax Treatment

The director shall develop, implement and have in place by December 31, 1990, deductible and employee premium programs which qualify for favorable federal income tax treatment under section 125 of the Internal Revenue Code.
WV Code § 5-16-15 (2021)
2021 West Virginia Code|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|§5-16-15. Optional Dental, Optical, Disability and Prepaid Retirement Plan and Audiology and Hearing-Aid Service Plan

(a) On and after July 1, 1989, the director shall make available to participants in the public employees insurance system: (1) A dental insurance plan; (2) an optical insurance plan; (3) a disability insurance plan; (4) a prepaid retirement insurance plan; and (5) an audiology and hearing-aid services insurance plan. Public employees insurance participants may elect to participate in any one of these plans separately or in combination. All actuarial and administrative costs of each plan shall be totally borne by the premium payments of the participants or local governing bodies electing to participate in that plan. The director is authorized to employ such administrative practices and procedures with respect to these optional plans as are authorized for the administration of other plans under this article. The director shall establish separate funds: (1) For deposit of dental insurance premiums and payment of dental insurance claims; (2) for deposit of optical insurance premium payments and payment of optical insurance claims; (3) for deposit of disability insurance premium payments and payment of disability insurance claims; and (4) for deposit of audiology and hearing-aid service insurance premiums and payment of audiology and hearing-aid insurance claims. Such funds shall not be supplemented by nor be used to supplement any other funds.(b) The Finance Board shall study the feasibility of an oral health benefit for children of participants.
WV Code § 5-16-16 (2021)
2021 West Virginia Code|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|§5-16-16. Preferred Provider Plan

The director shall, on or before April 1, 1988, or as soon as practicable, establish a preferred provider system for the delivery of health care to plan participants by all health care providers, which may include, but not be limited to, medical doctors, chiropractors, physicians, osteopathic physicians, surgeons, hospitals, clinics, nursing homes, pharmacies and pharmaceutical companies.The director shall establish the terms of the preferred provider system and the incentives therefor. The terms and incentives may include multiyear renewal options as are not prohibited by the Constitution of this state and capitated primary care arrangements which are not subject to the provisions of article twenty-five-a of chapter thirty-three of this code.
WV Code § 5-16-17 (2021)
2021 West Virginia Code|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|§5-16-17. Preexisting Conditions Not Covered; Defined

A preexisting condition is an injury, or sickness, or any condition relating to that injury, or sickness, for which a participant is diagnosed, receives treatment, or incurs expenses prior to the effective date of coverage.For all participants enrolling in the plan after the effective date of this section, payment shall be made for expenses incurred for or in connection with a preexisting condition: Provided, That participants may enroll or make plan selections only at the time of hire, during annual open enrollment or upon the occurrence of a "qualifying event" under section 125 of the United States Internal Revenue Code.
WV Code § 5-16-19 (2021)
2021 West Virginia Code|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|§5-16-19. Authorization to Take Advantage of Acts of Congress, Accept Gifts, Grants and Matching Funds

The Public Employees Insurance Agency is authorized to take full advantage of the benefits and provisions of any acts of congress and to accept any and all gifts, grants and matching funds, whether in the form of money or services.
WV Code § 5-16-20 (2021)
2021 West Virginia Code|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|§5-16-20. Expense Fund

The Legislature shall annually appropriate such sums as may be necessary to pay the proportionate share of the administrative costs for the state as an employer, and each division, agency, board, commission or department of the state which operates out of special revenue funds or federal funds or both shall pay its proportionate share of the administrative costs of the insurance plan or plans authorized under the provisions of this article. All other employers not operating from the state General Revenue Fund shall pay their proportionate share of the administrative costs of the insurance plan or plans authorized under the provisions of this article.
WV Code § 5-16-21 (2021)
2021 West Virginia Code|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|§5-16-21. No Member or Employee of Public Employees Insurance Agency Shall Gain Directly or Indirectly From Any Contract or Contracts Provided for Hereunder; Criminal Penalties

No elected or appointed official of the State of West Virginia; nor any member, officer, or employees of the Legislature; nor any officer, agent, servant or employee in the executive branch of state government shall have any interest, direct or indirect, in the gain or profits arising from any contract or contracts provided for in this article. Any such person who shall gain, directly or indirectly, from any contract or contracts herein provided for, except as an insured beneficiary thereof, shall be guilty of a misdemeanor, and, upon conviction thereof, shall be punished by a fine not exceeding $1,000, or by imprisonment in the county jail for a period not exceeding one year, or by both, in the discretion of the court: Provided, That nothing in this section shall be construed to prohibit an elected or appointed official of this state, nor an employee of the legislative, judicial or executive branches, from providing health care or entering into contracts provided for in section seventeen of this article.
WV Code § 5-16-23 (2021)
2021 West Virginia Code|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|§5-16-23. Members of Legislature May Be Covered, if Cost of the Entire Coverage Is Paid by Such Members

Notwithstanding the definition of the term "employee" contained in section two of this article and notwithstanding any other provision of this article to the contrary, members of the Legislature may participate in and be covered by any insurance plan or plans authorized hereunder for state officers and employees, except that all members of the Legislature who elect to participate in or to be covered by any such plan or plans shall pay their proportionate individual share of the full cost for all group coverage on themselves and their spouses and dependents, so that there will be no cost to the state for the coverage of any such members, spouses and dependents.
WV Code § 5-16-24a (2021)
2021 West Virginia Code|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|§5-16-24a. Paper Transactions

The director may, by rule as authorized in section twenty-four of this article, establish a fee not to exceed $5 per transaction which the Public Employees Insurance Agency may charge to employers for performing business transactions with the agency by paper when the transaction could be performed electronically.
WV Code § 5-16-25 (2021)
2021 West Virginia Code|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|§5-16-25. Reserve Fund

Upon the effective date of this section, the finance board shall establish and maintain a reserve fund for the purposes of offsetting unanticipated claim losses in any fiscal year. Beginning with the fiscal year 2002 plan and for each succeeding fiscal year plan, the finance board shall maintain the actuarily recommended reserve in an amount no less than 10 percent of the projected total plan costs for that fiscal year in the reserve fund, which is to be certified by the actuary and included in the final, approved financial plan submitted to the Governor and Legislature in accordance with the provisions of this article.
WV Code § 5-16-26 (2021)
2021 West Virginia Code|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|§5-16-26. Quarterly Report

By October 30, 1991, and on or before January 30, April, July and October of each year thereafter, the director shall prepare for the approval of the finance board, and thereafter present to the Joint Committee on Government and Finance a quarterly report setting forth:(a) A summary of the cost to the plan of health care claims incurred in the preceding calendar quarter;(b) A summary of the funds accrued to the plan by legislative appropriation, employer and employee premiums or otherwise in the preceding calendar quarter for payment of health care claims;(c) An explanation of all cost containment measures, increased premium rates and any other plan changes adopted by the director in the preceding calendar quarter and estimated cost savings and enhanced revenues resulting therefrom, and a certification that the director made a good faith effort to develop and implement all reasonable health care cost containment alternatives;(d) Expected claim costs for the next calendar year;(e) Such other information as the director deems appropriate; and(f) Any other financial or other information as may be requested by the Joint Committee on Government and Finance.
WV Code § 5-16-28 (2021)
2021 West Virginia Code|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|§5-16-28. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs

The provision requiring coverage for 12-month refill for contraceptive drugs codified at 33-58-1 of this code is made applicable to the provisions of this article.
WV Code § 5-16-29 (2021)
2021 West Virginia Code|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|§5-16-29. Limitation on Peia Participation

Notwithstanding any other provision of this article to the contrary, the director may not consider any employer eligible for participation in a plan except for the following:(1) All mandatory participants, including the State of West Virginia, its boards, agencies, commissions, departments, institutions, or spending units.(2) Any county board of education or public charter school established pursuant to 18- 5G-1 et seq. of this code, if the charter school includes in its charter contract entered into pursuant to 18-5G-7 of this code a determination to participate in the Public Employees Insurance program: Provided, That as it relates to eligible public charter schools, only employees directly employed by a charter school that is exempt from the payment of taxes under the United States Internal Revenue Code, Title 26 U.S.C. 501(c)(3), may participate in a plan.(3) Any employer participating in a plan as of the effective date of the enactment of this section in the regular session of the Legislature, 2021.
WV Code § 5-16A-1 (2021)
2021 West Virginia Code|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 16A. The West Virginia Health Care Insurance Act|§5-16A-1. To 5-16a-11

Repealed.Acts, 2004 Reg. Sess., Ch. 145.
WV Code § 5-16B-2 (2021)
2021 West Virginia Code|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 16B. West Virginia Children's Health Insurance Program|§5-16B-2. Definitions

As used in this article, unless the context clearly requires a different meaning:(a) "Agency" means the Children's Health Insurance Agency.(b) "Board" means the Children's Health Insurance Program Board.(c) "Director" means the Director of the Children's Health Insurance Agency.(d) "Essential community health service provider" means a health care provider that:(1) Has historically served medically needy or medically indigent patients and demonstrates a commitment to serve low-income and medically indigent populations which constitute a significant portion of its patient population or, in the case of a sole community provider, serves medically indigent patients within its medical capability; and(2) Either waives service fees or charges fees based on a sliding scale and does not restrict access or services because of a client's financial limitations. Essential community health service provider includes, but is not limited to, community mental health centers, school health clinics, primary care centers, pediatric health clinics or rural health clinics.(e) "Program" means the West Virginia Children's Health Insurance Program.
WV Code § 5-16B-3 (2021)
2021 West Virginia Code|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 16B. West Virginia Children's Health Insurance Program|§5-16B-3. Reporting Requirements

(a) Annually on January 1, the director shall report to the Governor and the Legislature regarding the number of children enrolled in the program or programs; the average annual cost per child per program; the estimated number of remaining uninsured children; and the outreach activities for the previous year. The report shall include any information that can be obtained regarding the prior insurance and health status of the children enrolled in programs created pursuant to this article. The report shall include information regarding the cost, quality and effectiveness of the health care delivered to enrollees of this program; satisfaction surveys; and health status improvement indicators. The agency, in conjunction with other state health and insurance agencies, shall develop indicators designed to measure the quality and effectiveness of children's health programs, which information shall be included in the annual report.(b) On a quarterly basis, the director shall provide reports to the Legislative Oversight commission on health and human resources accountability on the number of children served, including the number of newly enrolled children for the reporting period and current projections for future enrollees; outreach efforts and programs; statistical profiles of the families served and health status indicators of covered children; the average annual cost of coverage per child; the total cost of children served by provider type, service type and contract type; outcome measures for children served; reductions in uncompensated care; performance with respect to the financial plan; and any other information as the Legislative Oversight commission on health and human resources accountability may require.
WV Code § 5-16B-6c (2021)
2021 West Virginia Code|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 16B. West Virginia Children's Health Insurance Program|§5-16B-6c. Modified Benefit Plan for Children of Families of Low Income Between Two Hundred and Three Hundred Percent of the Poverty Level

The Legislature finds:(1) That there exists a number of families of low to moderate income without access to affordable health insurance coverage, whose children are denied plan participation because their family income exceeds two hundred percent of the federal poverty level;(2) That this exclusion imposes a heavy burden on many families by forcing them to elect whether to spend money on their children's health care or for their food, clothing and educational needs;(3) That a plan should be developed and considered whereby children in families with an income between two hundred and three hundred percent of the federal poverty level would contribute approximately twenty to twenty-five percent of the actual cost of coverage resulting in no additional cost to state government; and(4) That, while the primary goal of any plan will be the improvement of health care for these children, a successful plan for extending this coverage will benefit the state by improving the economy by allowing parents of these children to spend more for goods and services and by lowering future medical expenditures, uncompensated care and the other long-term adverse economic effects related to having a segment of the adult population which has been deprived of adequate medical care during childhood.The board is directed to conduct a study of all available means to develop a viable, modified plan to enroll the children of those families having a level of income between two hundred and three hundred percent of the federal poverty level and to consider that such a plan should charge an affordable premium and may be phased in over a two-year period.The board is further directed to study total program costs related to the implementation of a viable modified plan to expand coverage with the design requiring no additional state dollars and to study the long-term effect on the state budget.The board is directed to report its findings and recommendations to the Joint Committee on Government and Finance at its monthly meeting of August, 2004.