reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-23 - Loss Prevention › Section 85-23-14 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of these rules or the application thereof to
				  any entity or circumstance shall be held invalid, such invalidity shall not
				  effect the provisions or the applications of these rules which can be given
				  affect without the invalid provisions or application and to this end the
				  provisions of these rules are declared to be severable.
Table 85-23A
STANDARDS FOR LOSS CONTROL ACTIVITIES
Experience Modification Factors Exceeding Given Value
				  Qualify Employer for Given Group
3-Year Premium
Tier One Focus Group
Tier Two Target Group
(in dollars)
From
To
0
4,999
1.40
1.50
5,000
12,499
1.50
1.60
12,500
24,999
1.60
1.70
25,000
49,999
1.70
1.80
50,000
& Over
1.80
1.90
Note: Non-merit-rated employers would have calculation
				  analogous to experience modification factor calculation. Note: Using Table
				  85-23A
(1) Calculate the premium tax
				paid over the last three full calendar years. This calculation will yield the
				three year premium as contained in the two columns at the left side of the
				table.
For example during the calendar years 1992, 1993, and 1994,
				  XYZ, Inc., paid $32,850 in premium tax. XYZ, Inc., falls with the $25,000 to
				  $49,999 premium range.
(2)
				Obtain the experience modification factor from the workers' compensation
				commission.
For example. XYZ, Inc., has an experience modification factor
				  of 1.73.
(3) Determined
				whether XYZ, Inc., falls within the focus employer or target employer groups by
				examining the two columns on the right side of the table.
(4) For an employer who falls within the
				three year premium tax range of $25,000 to $49,999:
(a) Focus program employers have experience
				modification factors equal to or exceeding 1.70 which do not equal or exceed
				1.80 and
(b) Target program
				employers have experience modification factors equal to or exceeding
				1.80.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. - This
				rule implements the provisions of W. Va. Code §
									23-2B-3,
				regarding qualified loss management programs.
1.2. Authority. - W. Va. Code §§
				23-2-B-3;
				23-2-4;
				and
				23-1-1.
				Pursuant to W. Va. Code, §
									23-1-1a(j)(3)
				rules adopted by the board of managers and the commission are not subject to
				legislative approval as would otherwise be required under W. Va. Code §
									29A-3-1
				et seq. Public notice requirements of that chapter and article, however, must
				be followed.
1.3. Filing
				Date.
1.4. Effective
				Date.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-2 - Purpose of Rule

Current through Register Vol. XLI, No. 28, July 12, 2024
The purpose of this rule is to implement the provisions of W.
				  Va. Code, §
									23-2B-3,
				  to promote the voluntary implementation of qualified loss management programs
				  through the provision of a prospective premium tax credit. The goal of this
				  rule is to establish workers' compensation reforms by increasing employer and
				  employee commitment to workplace safety and injury prevention, resulting in a
				  reduction of occupational fatalities, injuries and illnesses, and post-injury
				  assistance to the worker which will result in the rendering of higher quality
				  health care to the employee and a reduction in the workers' compensation fund
				  deficit.
a. In accordance with the
				provisions of Senate Bill 1004. as passed in the First Special Session of the
				two thousand-five Legislature, the board of managers terminates upon
				termination of the commission. Upon that occurrence, this rule will also
				terminate.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-4 - Employer Participation; Eligibility

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Participation. Participation by an
				employer in a qualified loss management program is voluntary. No employer shall
				be required to participate in a qualified loss management program under the
				provisions of this rule.
4.2.
				Eligibility. Regular subscribers to the workers' compensation fund in good
				standing with an experience modification factor equal to or greater than 1.5
				are eligible to participate in a qualified loss management program under the
				provisions of this rule. The failure of an employer to maintain good standing
				during its period of participation in a qualified loss management program shall
				result in the termination of participation by the employer. Self-insurers are
				not eligible to participate in the qualified loss management program
				established by this rule.
4.2.1. Individual
				employers, who have an experience modification factor less than 1.5, may
				participate in a qualified loss management program if the employer is a member
				of an employer group under section five of this rule and the employer group has
				an aggregate experience modification factor, developed from the aggregate
				experience of members of the group, equal to or greater than 1.5.
4.2.2. If the employer's or the group's
				experience modification factor drops below 1.5 during its participation in a
				qualified loss management program, the employer's eligibility will not be
				affected.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-5 - Small Employer's Group Associations

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Description. Small employers may
				associate with other small employers to form an employer group for purposes of
				seeking qualified loss management services under the provisions of this
				rule.
5.2. Definitions. Small
				employer. For purposes of this rule, "small employer" means an employer with
				fifty (50) or less employees and a premium tax less than $40,000 per year.
Employer group. For purposes of this rule, "employer group"
				  means an association of small employers with the same industrial classification
				  code or an association of small employers with similar industrial
				  classification codes as approved by the commission.
5.3. Eligibility, an employer group may be
				formed from independent employers or in conjunction with an existing
				association of businesses.
5.4.
				Board of Governors. Each employer group shall appoint a board of governors
				composed of active members of the employer group. The board of governors shall
				be responsible for contracting with an approved qualified loss management
				service provider on behalf of the employer group.
5.4.1. Individual employer eligibility for
				the employer group shall be determined by the board of governors and the
				qualified loss management service provider. In no event shall an employer
				participate in the qualified loss management program if it does not meet the
				eligibility requirements of section four of this rule.
5.4.2. No additional individual employers
				shall be added to an employer group more than thirty (30) days after the
				appointment of the board of governors. No additional individual employer shall
				be added to an employer group after the onset date of a qualified loss
				management program for the employer group.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-6 - Qualifications For Loss Management Service Providers

Current through Register Vol. XLI, No. 28, July 12, 2024
In order to offer a credit to its client employers, a loss
				  management service provider must submit and receive approval of its loss
				  management program from the commission following the procedures outlined below
				  and containing the key elements indicated.
6.1. Loss management service providers must
				submit a loss management program to the workers' compensation commission. The
				program shall be submitted in a time frame and form as prescribed by the
				commission. Such submission shall be in a manner prescribed by the commission
				and in accordance with the rules of the purchasing division of the West
				Virginia department of administration. Each loss management service provider
				shall meet the following minimum qualifications.
6.2. A loss management service provider must
				be recognized by the commission.
6.3. Personnel. A loss management service
				provider must evidence its ability to perform services based upon
				qualifications of its operating personnel. All elements of operating personnel
				qualifications shall be reviewed.
6.3.1.
				Information regarding the job-related training and experience of all operating
				personnel must be submitted to the commission.
6.3.2. Each loss management service provider
				shall have specialists on staff including experienced and qualified specialists
				in safety and occupational health.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-7 - Assignment of Credit Factors

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1.
				Each new qualified loss management service provider approved to offer a loss
				management program under the provisions of this rule shall be assigned a credit
				factor upon notice of approval or acceptance of proposal.
7.1.1. Loss management service providers
				approved or accepted under this rule shall be assigned an initial credit factor
				of .10 (10%).
7.1.2. Subsequent
				credit factors shall be assigned to loss management service providers based
				upon the aggregate performance of their client employers in accordance with the
				scale developed under the provisions of subsection 7.2.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-8 - Credits

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. Each client
				employer who participates in an approved loss management program for a three
				(3) year period and who achieves the necessary reductions in loss costs shall
				be entitled to a prospective credit to premium taxes.
8.2. Start-up calculations. Prior to and as a
				condition of the start-up of a qualified loss management program on behalf of a
				client employer, the commission shall provide the following information to the
				loss management service provider and the client employer.
8.2.1. Baseline loss costs. The client
				employer's ultimate loss costs will be established for the three (3) most
				recent fiscal years, prior to the implementation of the employer's qualified
				loss management program, for which data is available. This is the baseline loss
				costs.
8.2.2. A loss costs
				modification factor will be determined for the client employer by dividing the
				baseline loss costs by the base loss costs established from the most recent
				rating study. This is the baseline modification factor.
8.2.3. Trended base loss costs shall be
				projected by the commission for the three (3) years covering the period of
				participation in the qualified loss management program. Trended base loss costs
				shall be based on anticipated changes in costs, inflation and benefit
				changes.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-9 - Withdrawal of Plan Approval

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. If
				the commission determines, after a meeting with the loss management service
				provider, that the loss management service provider is not in compliance with
				program requirements, the commission is authorized to withdraw approval of the
				loss management program previously approved or accepted under this
				rule.
9.2. Should the commission
				withdraw approval of the loss management program, the commission shall provide
				at least thirty days written notice that such approval is withdrawn and that
				its participation in the qualified loss management program authorized by W. Va.
				Code §
									23-2B-3,
				is terminated.
9.3. A copy of the
				required notice shall be sent by the commission to each of the service
				provider's client employers.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-10 - Termination of Participation By Client Employer

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. The client employer may terminate
				participation in the loss management program upon three years of continuous
				participation in the program without penalty.
10.2. If the client employer terminates
				participation in the loss management program prior to three years of continuous
				participation in the program, no credit shall be granted to the client
				employer.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-11 - Notification

Current through Register Vol. XLI, No. 28, July 12, 2024
The commission shall send all notices required under the
				  provisions of this rule by certified mail addressed to the loss management
				  service provider or client employer at their last known residence or place of
				  business: Provided, That, if any loss management service provider or client
				  employer is represented by an attorney or other representative, then notice to
				  the attorney or other representative shall be sufficient notice to the party so
				  represented.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-12 - Administrative Protests and Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. Protest. An aggrieved loss management
				service provider or employer may protest any order, decision, designation or
				redesignation made under the provisions of this rule.
12.2. Petition. In order to preserve its
				right to protest, the loss management service provider must file a written
				petition with the commission, stating the order or decision protested and the
				exact nature of the issue in controversy. In the written petition, the loss
				management service provider must designate a person or entity to receive
				official notices related to the protest and the loss management service
				provider must provide the address of the person or entity. The written petition
				must be received by the commission within thirty (30) days after the loss
				management service provider receives notice of the objectionable order or
				decision or within sixty (60) days of the date of the objectionable order or
				decision, regardless of notice. This period may not be extended or
				waived.
12.3. Acknowledgment.
				Within thirty (30) days after receiving the written protest, the commission
				shall issue a notice acknowledging the protest and providing an opportunity for
				hearing. Filing of a written protest temporarily stays the order or decision
				protested until a decision is rendered on such protest by a hearing examiner:
				Provided that, such temporary stay shall not exceed ninety (90) days from the
				date of the order or decision protested unless the loss management service
				provider is not provided an opportunity for hearing within that ninety (90) day
				period, in which case the temporary stay shall not exceed that date which the
				loss management service provider is provided an opportunity for
				hearing.
12.4. Subsequent
				administrative hearing proceedings shall be in accordance with 85 C.S.R. 7
				"Rules for Selected Hearings."
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-13 - Retaliation Complaint Procedure

Current through Register Vol. XLI, No. 28, July 12, 2024
13.1. A member of a joint labor and
				management safety committee shall not experience any loss of wages or other
				retaliation while attending safety committee meetings or performing duties at
				the direction of the safety committee.
13.2. Filing. Any member of a joint labor and
				management safety committee who experiences such loss of wages or retaliation
				may file a complaint within thirty (30) days of occurrence regarding such
				activity,
13.2.1. The complaint shall be
				filed with the president or chief executive officer of the employer, if the
				employer is a corporation or a limited corporation; with the managing partner
				if the employer is a partnership; with the general partner if the employer,
				parent or related business is a limited partnership; or, with all the members
				if the employer is a limited liability company; or with the owner if the
				employer is a sole proprietorship.
13.2.2. A copy of the complaint shall be
				filed with a commission designee.
13.2.3. A copy of the complaint shall be
				filed with the joint labor and management safety committee and shall be made a
				part of the minutes of their next scheduled meeting.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-24 - Qualified Loss Management Programs › Section 85-24-14 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of these rules or the application thereof to
				  any entity or circumstance shall be held invalid, such invalidity shall not
				  effect the provisions or the applications of these rules which can be given
				  affect without the invalid provisions or application and to this end the
				  provisions of these rules are declared to be severable.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule applies to the Health Care Advisory Panel, created pursuant to W. Va. Code
				§§
									23-4-3b.
				The purpose of this rule is to comply with the requirements of both W. Va. Code
				§§
									6-9A-3
				and
				29A-3-3.
				This rule sets forth the procedures by which the Panel will conduct its
				business. This rule defines the procedure for appointment of members and
				alternate members of the Panel. This rule further defines the authority of the
				Panel in carrying out its duties under the provisions of chapter twenty-three
				of the West Virginia Code [§§
									23-1-1
				et seq.].
1.2. Authority. -- W. Va.
				Code §§
									6-9A-3,
				23-1-1a(j)(3),
				23-4-1
				et seq., and 29A-3-3.
1.3. Filing
				Date. -- May 27, 2005.
1.4.
				Effective Date. -- July 1, 2005.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, the following terms, words and phrases
				  have the meanings stated below unless in any instance where such term, word or
				  phrase is employed, the context clearly indicates that another meaning is
				  intended.
2.1. "Chair" means the
				chairperson of the Health Care Advisory Panel.
2.2. "Commission" means the West Virginia
				Workers' Compensation Commission as provided for by W. Va. Code §
									23-1-1,
				et seq.
2.3. "Executive Director"
				means the Executive Director of the West Virginia Workers' Compensation
				Commission as provided pursuant to the provisions of W. Va. Code §
									23-1-1b.
2.4. "Panel" or "HCAP" means the Health Care
				Advisory Panel, established pursuant to W. Va. Code §
									23-4-3b.
2.5. "Sub-panel" means groups established
				under the authority of the Health Care Advisory Panel, which include members of
				the Panel and may include other members of the health care profession, which
				report back to the Panel.
2.6.
				"This rule" means the rule designated as W. Va. 85CSR26 entitled, "Health Care
				Advisory Panel."
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-3 - Appointments

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. The Executive
				Director shall appoint not less than five members to the Health Care Advisory
				Panel. Members of the Health Care Advisory Panel shall consist of
				representatives from among the various branches and specialties among health
				care providers in this state. Each member of the Panel serves at the will and
				pleasure of the executive director.
3.2. The Executive Director, from time to
				time, shall fix, by contract or otherwise, the compensation to be paid to each
				member of the Panel. The members are entitled to reasonable and necessary
				traveling and other expenses incurred while actually engaged in the performance
				of their duties.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-4 - Chair; Vice Chair, Secretary

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1
				The Executive Director shall annually appoint one member of the Panel to serve
				as its chair; the chair shall preside over the meetings of the Panel,
				communicate regularly with the Commission and assure that all administrative
				functions of the Panel are performed; the chair is also authorized to select
				persons who are not members of the Panel to serve on HCAP subpanels.
4.2. The members of the Panel may elect a
				vice chair to serve the Panel from among its regular members, to preside over
				meetings in the absence of the chair and to assist the chair in administrative
				functions. The term of the vice-chairperson shall be for one calendar year;
				from July 1 to June 30; but, the incumbent shall continue to serve until
				replaced. A vacancy may be filled by electing a new vice-chairperson for the
				remainder of a term. A member may be reelected as vice-chairperson.
4.3. The Executive Director shall assign an
				employee of the Commission to serve as secretary to the Panel; the secretary
				shall assure that the minutes of Panel meetings are recorded and preserved, and
				that meetings of the Panel comply with all requirements for public
				notice.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-5 - Meetings; Conduct of Business

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Public meetings of the Health Care
				Advisory Panel may be called by the chairperson. The chairperson shall call a
				meeting upon the written request of a majority of the voting members of the
				Panel.
5.2. The chairperson shall
				notify Panel members in writing at least seven (7) days in advance of a
				meeting. The notice shall set forth the time and place of such meeting and the
				matters to be considered, except that such notice is not required if the time,
				the place, and the matters for consideration have been fixed in a meeting where
				all the members are present.
5.3.
				The chairperson shall notify the public and the news media by filing with the
				office of the Secretary of State a public notice of the meeting. The notice
				shall be filed in a manner so as to allow each notice to appear in the state
				register at least five days prior to the date of the meeting. The public notice
				shall contain the time, the place, and purpose of the meeting.
5.4. The provisions of this section shall not
				apply in the event of an emergency requiring immediate official action by the
				Panel. In the event of an emergency requiring immediate official action, the
				Panel may file an emergency meeting notice at any time prior to the meeting.
				The emergency meeting notice shall state the time, place, and purpose of the
				meeting and the facts and circumstances of the emergency.
5.5. Meetings may be continued to a set time
				and place by a majority vote of the Panel members present and voting without
				further notice to the members and without further publication unless such
				continued meeting is scheduled for more than fourteen (14) days from the date
				of the voting.
5.6. All members
				present at a meeting shall have the same right to participate in discussion of
				matters before the Panel.
5.7. The
				Panel shall consider any matter brought before it by the chairperson or any
				appointed member and may consider, at its discretion, any matter referred to it
				by a person not a member of the Panel.
5.8. A meeting of the Panel may be conducted
				by telephonic means. In the event that a telephonic conference call is to be
				utilized, the notice shall so state and shall additionally state the time and
				date of the meeting as provided for in subsections 5.3 and 5.4.
5.9. A quorum shall exist for a meeting if a
				simple majority of appointed Panel members are present.
5.10. The Health Care Advisory Panel is
				authorized to meet in executive session as permitted by statute; the minutes of
				the public meeting shall reflect the reason for the move to executive
				session.
5.11. Members of the
				Health Care Advisory Panel shall keep confidential any claimant specific
				information which is made available to them.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-6 - Sub-panels

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. The Health
				Care Advisory Panel may establish sub-panels to assist in conducting HCAP
				business.
6.2. The sub-panel chair
				must be a regular member of the Health Care Advisory Panel.
6.3. The duties of the sub-panel shall be
				defined by the Panel chair, with consensus of HCAP.
6.4. The HCAP chair shall appoint members of
				sub-panels:
a. HCAP members may serve on
				sub-panels; and
b. At the
				discretion of the chair of the Health Care Advisory Panel and the agreement of
				the Executive Director, persons who are qualified by education and experience,
				who are not regular members of HCAP, may be appointed to serve on a sub-panel.
1. The Executive Director shall fix, by
				contract or otherwise, the compensation to be paid to each member of the
				Sub-panel, who is not a regular member of HCAP. The Sub-panel members are
				entitled to reasonable and necessary traveling and other expenses incurred
				while actually engaged in the performance of their duties.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-7 - Minutes

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. The Panel
				shall provide for the preparation of written minutes of all its meetings. All
				such minutes shall be available to the public within a reasonable time after
				the meeting and shall include the following information:
a. The date, time and place of the
				meeting;
b. The name of each Panel
				member present or absent;
c. All
				motions, proposals, resolutions, orders, ordinances and measures proposed, the
				name of the person proposing the same and their disposition; and
d. The results of all votes and, upon request
				of a member, the vote of each member, by name.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-8 - Majority Vote Required; Vote by Proxy Prohibited

Current through Register Vol. XLI, No. 28, July 12, 2024
The vote of a majority of all voting members present at any
				  meeting of the panel shall be necessary to take any action.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-9 - Records of the Panel - Public

Current through Register Vol. XLI, No. 28, July 12, 2024
Records of the Panel are public records that may be
				  inspected in accordance with W. Va. Code §
									29B-1-3
				  and copied in accordance with the Commission's established fees for producing
				  requested records.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-10 - Resignation

Current through Register Vol. XLI, No. 28, July 12, 2024
Resignation from HCAP by any member shall be in writing to
				  the Executive Director, with a copy to the chair, vice chair and secretary of
				  HCAP.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-11 - Preferred Drug List

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1.
				Purpose. In accordance with the provisions of the Workers' Compensation Act
				[23-4-3(a)(3)] that require pharmacists, filling a prescription for medication
				for a workers' compensation claimant, to dispense a generic brand of the
				prescribed medication if the generic brand exists and in accordance with HCAP's
				responsibility to establish guidelines for reasonably required health care
				treatment for occupational injuries and diseases, HCAP shall establish a
				Preferred Drug List (PDL) for the purposes of:
a. Improving the quality of care of claimants
				by utilizing a PDL of generics and brand medications in the absence of
				generics;
b. Affecting cost savings
				in the provision of health care services by determining what is reasonably
				required; and
c. Optimizing
				pharmaceutical care and cost effectiveness.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-12 - Transition

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. The health
				care advisory panel shall remain in existence until the termination of the
				commission. Upon termination of the commission, the insurance commissioner
				shall assume the following functions of the health care advisory panel:
a. Establish guidelines for the health care
				which is reasonably required for the treatment of the various types of injuries
				and occupational diseases;
b.
				Establish protocols and procedures for the performance of examinations or
				evaluations performed by physicians or medical examiners; and
c. Establish guidelines regarding the
				anticipated period of disability for the various types of industrial
				injuries.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-26 - Health Care Advisory Panel › Section 85-26-13 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of these rules or the application thereof
				  to any entity or circumstance shall be held invalid, such invalidity shall not
				  effect the provisions or the applications of these rules which can be given
				  affect without the invalid provisions or application and to this end the
				  provisions of these rules are declared to be severable.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-27 - Qualified Rehabilitation Provider › Section 85-27-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule establishes the minimum credentials to be met for an individual to be
				recognized as qualified to provide vocational rehabilitation services for the
				Workers' Compensation Commission, the Insurance Commissioner, private carriers
				and self-insured employers, whichever is applicable, and to be reimbursed for
				such services.
1.2. Authority. --
				W. Va. Code §§
									23-1-1
				and
				23-1-1a(j)(3).
				Pursuant to W. Va. Code §
									23-1-1a(j)(3),
				rules adopted by the board of managers and the commission are not subject to
				legislative approval as would otherwise be required under W. Va. Code, §
									29A-3-1
				et seq. Public notice requirements of that chapter and article, however, must
				be followed.
1.3. Filing Date. --
				August 31, 2005.
1.4. Effective
				Date. -- October 1, 2005.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-27 - Qualified Rehabilitation Provider › Section 85-27-2 - Purpose of Rule

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. The
				purpose of this rule is to implement the provisions of W. Va. Code,
				§§
									23-4-3,
				23-4-3b,
				and
				23-4-9
				which relate to the development of standards for vocational rehabilitation
				services. W. Va. Code §
									23-4-9(a)
				provides that "it is a goal of the workers' compensation program to assist
				workers to return to suitable gainful employment after an injury . . . it is
				the shared responsibility of the employer, the employee, the physician and the
				commission to cooperate in the development of a rehabilitation process designed
				to promote reemployment for the injured employee." This rule is intended to
				ensure vocational rehabilitation services provided to injured workers are
				provided in a professional manner by individuals qualified by education and
				experience to provide such services so the highest quality of rehabilitation
				services may be afforded to injured workers. This rule is applicable to any
				provider of vocational rehabilitation services that extends such services to
				injured workers under the West Virginia system of workers' compensation
				insurance.
2.2. Upon termination of
				the Commission, no registration is required of qualified rehabilitation
				professionals. Qualified rehabilitation professionals are required to verify
				and provide proof of their certification or qualifications to the Insurance
				Commissioner, self-insured employer or private carrier, or to their third party
				administrator or managed care provider, whomever services are provided under
				this rule. In turn the Insurance Commissioner, self-insured employer or private
				carrier, or their third party administrator or managed care provider, is
				required to maintain this proof of certification or proof of qualifications of
				the qualified rehabilitation professional.
a.
				The Commission, Insurance Commissioner, self-insured employer or private
				carrier, whichever is applicable, must use only qualified rehabilitation
				service professionals in making rehabilitation referrals.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-27 - Qualified Rehabilitation Provider › Section 85-27-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this legislative rule the following terms have
				  the stated meanings unless the context of a specific use clearly indicates
				  another meaning is intended.
3.1.
				"Commission" means the West Virginia Workers' Compensation Commission as
				provided for by W. Va. Code §
									23-1-1.
3.2. "Insurance Commissioner" means the
				insurance commissioner of West Virginia as provided in section one, article
				two, chapter thirty-three of the West Virginia Code, or any third party
				administrator of the Insurance Commissioner.
3.3. "Code of Professional Ethics" refers to
				the code or codes to which a qualified rehabilitation professional subscribes
				and must include at least one of the following:
a. For certified rehabilitation counselors,
				the "Code of Professional Ethics for Rehabilitation Counselors" administered by
				the Commission on Rehabilitation Counselor Certification;
b. For certified disability management
				specialists, the "Code of Professional Conduct" administered by the
				Certification of Disability Management Specialists Commission;
c. For certified case managers, the "Code of
				Professional Conduct for Case Managers" administered by the Commission for Case
				Manager Certification;
d. For
				certified vocational evaluators, the "Code of Professional Ethics" administered
				by the Commission on Certification of Work Adjustment and Vocational Evaluation
				Specialists;
e. For certified
				rehabilitation registered nurses, the "Code of Ethics for Nurses with
				Interpretive Statements" administered by the American Nurses Association and
				endorsed by the Association of Rehabilitation Nurses;
f. For West Virginia licensed professional
				counselors, the "Code of Ethics and Standards of Practice" promulgated by the
				American Counseling Association and administered by the West Virginia Examiners
				in Counseling;
g. For members of
				the International Association of Rehabilitation Professionals, the "Code of
				Ethics, Standards of Practice and Competencies" administered by the
				International Association of Rehabilitation Professionals"; or h. For qualified
				rehabilitation professionals, a code of ethics or standards of practice
				published by a relevant professional organization to which the qualified
				rehabilitation professional is a member.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-27 - Qualified Rehabilitation Provider › Section 85-27-5 - Acceptable Employment Experience

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Full-time employment is considered as 35
				hours per week.
5.2. Part-time
				experience is determined by calculating the total number of hours of acceptable
				experience divided by 35 hours, to result in the number of weeks of credit for
				acceptable experience.
5.3.
				Employment verification must provide evidence that 100% of the time counted as
				acceptable employment experience was spent providing vocational rehabilitation
				services to persons with impairments and disabilities. At least 50% of the
				activities must be directly related to serving persons with disabilities. Time
				spent in travel and waiting are not considered vocational rehabilitation
				services.
5.4. Employment
				experience must reflect activity in at least four (4) of the areas described in
				5.4.a through 5.4.l to be considered acceptable.
5.4.a. Vocational rehabilitation consulting,
				career counseling or mental health counseling;
5.4.b. Developing and monitoring vocational
				rehabilitation services/care;
5.4.c. Job placement and/or job
				development;
5.4.d. Job
				analyses;
5.4.e. Individual
				appraisal;
5.4.f. Supervision of
				counselors or qualified rehabilitation professionals;
5.4.g. Vocational training;
5.4.h. Consultation in disability
				management;
5.4.i. Forensic
				rehabilitation services;
5.4.j.
				Return-to-work plan development and implementation;
5.4.k. Vocational evaluation; and
5.4.l. Medical rehabilitation case
				coordination.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-27 - Qualified Rehabilitation Provider › Section 85-27-6 - Continuing Education

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Every
				two (2) years, commencing from the effective date of this rule, each qualified
				rehabilitation professional is required to maintain and present documentation
				to the Insurance Commissioner, self-insured employer or private carrier, or to
				their third party administrator or managed care provider, whomever services are
				provided under this rule, of completion of forty (40) contact hours of
				continuing education. Provided, at least three (3) hours of continuing
				education credits in ethics must be completed every two (2) years.
a. Certified case managers, certified
				rehabilitation counselors, certified disability management specialists, and
				certified rehabilitation registered nurses are exempt from the provisions of
				this section, but are required to verify and provide proof of their
				certification to the Insurance Commissioner, self-insured employer or private
				carrier, or to their third party administrator or managed care provider,
				whomever services are provided under this rule.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-27 - Qualified Rehabilitation Provider › Section 85-27-7 - Other Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. An
				injured worker petitioning for permanent total disability benefits referred for
				a rehabilitation evaluation must be evaluated by a qualified rehabilitation
				professional with either a masters or doctorate degree in rehabilitation
				counseling, counseling and guidance, or psychology, or by a qualified
				rehabilitation professional with either the certified rehabilitation counselor,
				licensed professional counselor, vocational evaluation specialist, or certified
				disability management specialist certification or by a qualified rehabilitation
				professional who is certified by the American Board of Vocational Experts.
				Provided, an injured worker determined to have suffered a catastrophic injury
				must be assigned to a nurse qualified rehabilitation professional with at least
				one of the following certifications:
(1)
				certified rehabilitation registered nurse;
(2) certified case manager; or
(3) certified disability management
				specialist.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-27 - Qualified Rehabilitation Provider › Section 85-27-8 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of this rule or the application thereof to
				  any entity or circumstances shall be held invalid, such invalidity shall not
				  affect the provisions or the applications of this rule which can be given
				  affect without the invalid provisions or application and to this end the
				  provisions of this rule are declared to be severable.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule sets forth the procedures for administrative hearings for disputed issues
				between the Workers' Compensation Commission and health care
				providers.
1.2. Authority. -- W.
				Va. Code §§
									23-4-3;
				23-4-3c.
				Pursuant to W. Va. Code,
				23-1-1a(j)(3),
				rules adopted by the Workers' Compensation Board of Managers are not subject to
				legislative approval as would otherwise be required under W. Va. Code, §
									29A-3-1
				et seq. Public notice requirements of that chapter and article, however, must
				be followed.
1.3. Filing date. --
				May 27, 2005.
1.4. Effective Date.
				-- July 1, 2005.
West Virginia Code of State Rules › Agency 85 - Workers' Compensation › Title 85 - PROCEDURAL RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER › Series 85-28 - Rules For Health Care Vendor Hearings › Section 85-28-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule, the following terms, words, and
				  phrases have the meaning stated unless in any instance where such term, word,
				  or phrase is employed and the context expressly indicates that another meaning
				  is intended.
2.1. "Agent" means a
				private company retained by the Commission to audit, identify and collect
				medical vendor overpayments.
2.2.
				"Act" means the workers' compensation laws of the State of West Virginia that
				are codified at chapter twenty-three of the Code of West Virginia.
2.3. "Hearing Officer" refers to an objective
				trier of fact who will be conducting a de novo administrative hearing in health
				care vendor issues arising between the Workers' Compensation Commission and a
				registered health care vendor.
2.4.
				"Code of West Virginia" and "West Virginia Code" means the West Virginia Code
				of 1931 as amended.
2.5. "Executive
				Director" means the Executive Director of the West Virginia Workers'
				Compensation Commission as provided pursuant to the provisions of W. Va. Code
				§
									23-1-1b.
2.6. "Commission" means the West Virginia
				Workers' Compensation Commission as provided for by W. Va. Code §
									23-1-1,
				et seq.
2.7. "Health Care Vendor"
				or "Health Care Provider" refers to health care providers, including providers
				of rehabilitation services within the meaning of W. Va. Code §
									23-4-9,
				both in- and out-of-state who have signed provider agreements with West
				Virginia Workers' Compensation Commission to provide health care to injured
				workers.
2.8. "Office of Judges"
				refers to the Office of Judges, as set forth in W. Va. Code §
									23-5-8.
2.9. "This rule" means the present exempt
				legislative rule that is designated in the caption here as title 85, series
				28.