reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-101 - Exempt Purchasing › Section 114-101-6 - Information technology

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. A
				procurement of information technology(IT) may include many types of IT, such as
				software, hardware, services and support, and maintenance. The procurement of IT
				carries a high level of risk because of the importance, requirements, rapid industry
				changes, security, sophistication, and privacy issues associated with IT.
6.2. Software procurement requires consideration
				of whether the software meets the needs of the OIC, type of license, any available
				alternative software, costs, how the software is hosted, security, legal
				requirements, effects of a breach, compatibility with current systems, frequency of
				updates, any associated changes that will be needed over time, and ongoing support
				and maintenance.
6.3. A license term of
				use must be flexible, as well as associated services, support and maintenance. If
				OIC determines services, support and maintenance are needed beyond the current term
				of the contract, the contract may be extended or renewed at the discretion of OIC
				and the vendor.
6.4. If a current
				contract provides for future support and maintenance at the fees set by the vendor
				or as negotiated, the vendor shall provide a quotation of the fees and the period
				covered by those fees. The parties shall negotiate in good faith. Once OIC finds the
				quotation acceptable, then a change order to the current contract shall be issued
				with the quotation attached. A new contract is not needed.
6.5. If OIC believes only one vendor may
				reasonably provide specific commodities and services, including support and
				maintenance, the procurement may be handled as a direct procurement.
6.6. If the OIC, the vendor, or the law requires
				changes to a current contract, the parties shall negotiate in good faith to reach
				agreement. If an agreement is reached and put into writing signed by both parties,
				OIC Procurement shall issue a change order to the current contract containing the
				agreed language.
6.7. At least one year
				before an IT contract in the amount of $2,500 or more and with a term longer than
				one year for software, hardware, or IT system terminates, including all available
				extensions, and the OIC desires to extend or renew the contract, OIC will evaluate
				and justify the extension or renewal using life cycle costing, total ownership or
				operational cost, or any other methods considered appropriate by the OIC. Additional
				factors to consider include current and anticipated work environment needs,
				compliance issues, current performance, availability of alternate sources, and
				costs. If the OIC determines the contract should not be rebid, it will determine the
				length of term for the renewal.
6.8.
				The OIC shall obtain approval from the West Virginia Office of Technology regarding
				the purchasing of computer software, hardware, services, support and maintenance.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-101 - Exempt Purchasing › Section 114-101-7 - Vendor complaints and protests

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1.
				Complaints - A vendor may verbally or in writing complain about a procurement or
				purchase to OIC Procurement. OIC Procurement will provide a written response to the
				complaint.
7.2. Protests
7.2.1. Types of Protests
7.2.1.a. Protests of Requirements, Specifications
				or Terms - Any protest relating to a procurement document, including any
				requirement, specification, or term, or any combination thereof, must be filed in
				writing with the OIC no later than five business days prior to the specified bid
				opening date and time. Protests received after that date shall not be considered.
7.2.1.b. Protests of Award - After
				selection of the apparent successful vendor in a procurement using an RFP, OIC
				Procurement will send a written notice of intent to award to each vendor submitting
				a bid stating the name of the apparent successful vendor and the date and time for a
				protest to be received by OIC Procurement. Protests received after the stated date
				and time shall not be considered.
7.2.1.c. Direct Awards - Any vendor desiring to
				protest the specifications of a planned direct award may do so prior to five working
				days before the direct award process opening date. Any vendor desiring to protest a
				direct award may do so within five working days of the direct award.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-101 - Exempt Purchasing › Section 114-101-8 - Public records

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. A bid shall be
				available to the public after opening.
8.2. Procurement documents shall inform vendors
				that the entire OIC file for that procurement and any resulting contract will be
				considered public documents after award. As public documents, procurement documents
				may be disclosed to the public following the award of a contract in accordance with
				FOIA. Any bid or other document in a procurement file may be disclosed pursuant to a
				FOIA request even if the bid or other document contains statements or labels
				attempting to prevent disclosure, such as confidential, trade secret, private, or
				any other claim.
8.3. The OIC shall not
				be liable for any disclosure of a procurement document pursuant to this rule.
8.4. If a vendor requests the OIC
				execute a non-disclosure agreement to protect portions of its bid from disclosure
				for an RFP procurement, it must make the request to OIC Procurement at least one
				week prior to the date of the bid opening. A non-disclosure agreement may be
				executed at any time to prospectively protect any procurement documents, contracts,
				or information.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-101 - Exempt Purchasing › Section 114-101-9 - Violations

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Any person who
				authorizes or approves a purchase or contract in violation of federal or state law,
				this rule, or any policy or procedure adopted by the OIC may be held personally
				liable for the cost of the procurement or contract. Procurements and contracts
				violating federal or state law or this rule are void and of no effect.
9.2. The OIC will follow vendor suspensions and
				debarments by the federal government or the West Virginia State Purchasing Division.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-102 - Term and Universal Life Insurance Reserve Financing › Section 114-102-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose and intent of this rule is to establish uniform, national standards
				governing reserve financing arrangements pertaining to life insurance policies
				containing guaranteed nonlevel gross premiums, guaranteed nonlevel benefits and
				universal life insurance policies with secondary guarantees; and to ensure that,
				with respect to each such financing arrangement, funds consisting of primary
				security and other security are held by or on behalf of ceding insurers in the forms
				and amounts required herein. In general, reinsurance ceded for reserve financing
				purposes has one or more of the following characteristics: some or all of the assets
				used to secure the reinsurance treaty or to capitalize the reinsurer (1) are issued
				by the ceding insurer or its affiliates; (2) are not unconditionally available to
				satisfy the general account obligations of the ceding insurer; or (3) create a
				reimbursement, indemnification or other similar obligation on the part of the ceding
				insurer or any of its affiliates (other than a payment obligation under a derivative
				contract acquired in the normal course and used to support and hedge liabilities
				pertaining to the actual risks in the policies ceded pursuant to the reinsurance
				treaty). This rule shall apply to reinsurance treaties that cede liabilities
				pertaining to covered policies issued by any life insurance company domiciled in
				this state. This rule and 114CSR40 shall both apply to such reinsurance treaties.
				However, in the event of a direct conflict between the provisions of this rule and
				114CSR40, the provisions of this rule shall apply, but only to the extent of the
				conflict. This rule is based upon the National Association of Insurance
				Commissioners' "Term and Universal Life Insurance Reserve Financing Model
				Regulation," Model 787, as amended in 2017.
1.2. Authority. -- W. Va. Code §§
									33-2-10 and
				33-4-15a(e).
1.3. Filing Date. -- June 6, 2022.
1.4. Effective Date. -- July 1, 2022.
1.5. Sunset Provision. -- This rule shall
				terminate and have no further force or effect on August 1, 2027.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-102 - Term and Universal Life Insurance Reserve Financing › Section 114-102-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Actuarial method"
				means the methodology used to determine the required level of primary security, as
				described in section 3 of this rule.
2.2. "Commissioner" means the West Virginia
				Insurance Commissioner.
2.3. "Covered
				policies" means the following: Subject to the exemptions described in section 6 of
				this rule, covered policies are those policies, other than grandfathered policies,
				of the following policy types:
2.3.1. Life
				insurance policies with guaranteed nonlevel gross premiums and/or guaranteed
				nonlevel benefits, except for flexible premium universal life insurance policies;
				or
2.3.2. Flexible premium universal
				life insurance policies with provisions resulting in the ability of a policyholder
				to keep a policy in force over a secondary guarantee period.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-102 - Term and Universal Life Insurance Reserve Financing › Section 114-102-5 - Prohibition Against Avoidance

Current through Register Vol. XLI, No. 28, July 12, 2024
No insurer that has covered policies as to which this rule
				  applies, as set forth in section 1.1 of this rule, shall take any action or series
				  of actions, or enter into any transaction or arrangement or series of transactions
				  or arrangements if the purpose of such action, transaction or arrangement or series
				  thereof is to avoid the requirements of this rule, or to circumvent its purpose and
				  intent, as set forth in section 1.1 of this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-102 - Term and Universal Life Insurance Reserve Financing › Section 114-102-6 - Exemptions

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. This rule does not
				apply to the following situations:
6.1.1.
				Reinsurance of:
6.1.1.a. Policies that satisfy the
				criteria for exemption set forth in W. Va. Code St. R. § 114-68-5.6 or W. Va.
				Code St. R. § 114-68-5.7; and which are issued before the later of:
6.1.1.a.1. The effective date of this rule;
				and
6.1.1.a.2. The date on which the
				ceding insurer begins to apply the provisions of VM-20 to establish the ceded
				policies' statutory reserves, but in no event later than January 1,
				2020;
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose and intent of this rule is to provide for the qualifications a person
				must have when applying to be a bail bondsman, and to set the terms and
				conditions upon which the bonding business may be conducted in West
				Virginia.
1.2. Authority. -- W. Va.
				Code §§
									33-2-10 and 51-10-8.
1.3. Filing Date. -- March 27,
				2023.
1.4. Effective Date. -- April
				1, 2024.
1.5. Sunset Provision. --
				This rule shall terminate and have no further force or effect upon August 1,
				2034.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-3 - License Required and Qualifications for Licensure

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. On or after July 1, 2022, a person may
				not engage in the bonding business or act in the capacity of a bail bondsman,
				or perform any of the functions, duties or powers prescribed for bail bondsmen,
				unless that person is qualified and licensed by the Commissioner as provided in
				this rule.
3.1.1. None of the provisions or
				terms of this rule shall prohibit any individual or individuals from pledging
				real or other property as security for a bail bond for himself, herself, or
				another in judicial proceedings who does not charge or receive, or is not
				promised, a fee or other thing of value in exchange for his or her services,
				provided such person shall not be permitted to make in excess of ten bonds per
				year.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-4 - License Renewal

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Bail
				bondsman licenses shall be renewed biennially (every two years) by the last day
				of the birth month of the bondsman, unless revoked or suspended prior thereto
				by the Commissioner. The expiration year will be established based upon the
				year of initial licensure.
4.2. The
				renewal fee for a bail bondsman license is $200. The renewal fee is
				nonrefundable.
4.3. The renewal
				application shall include an attestation that the applicant meets the
				qualifications as set forth in section 3 of this rule.
4.4. The Commissioner shall require a
				criminal history record check of the licensee at the time of renewal in
				accordance with W. Va. Code §
									33-12-37.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-6 - Qualifications of Sureties on Bail

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Each and every surety for the release of
				a person on bail shall be qualified as:
6.1.1. An insurer and represented by a surety
				bondsman; or
6.1.2. A professional
				bondsman.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-7 - Receipts for Collateral

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. When
				collateral security is received by a bail bondsman, a written receipt shall be
				furnished.
7.2. Receipts shall
				provide a full description of the collateral received and must:
7.2.1. Be prenumbered and used and provided
				in consecutive numerical order;
7.2.2. Show the name and address of the bail
				bondsman;
7.2.3. Show the name and
				address of the person providing the collateral;
7.2.4. Show the amount and nature of the
				collateral and the date received;
7.2.5. Show the name of the person accepting
				collateral; and
7.2.6. Show the
				total amount of the bond for which the collateral is being accepted, the name
				of the defendant, the criminal action number of the criminal proceeding, and
				the jurisdiction in which the criminal action is pending.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-9 - Cash Securities Held in Trust

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1.
				Cash securities deposited by a professional bondsman with the Commissioner
				shall be held in trust for the protection and benefit of the holder of bail
				bonds executed by or on behalf of the bondsman in this State. The account shall
				be a separate account in the State Treasury designated the "Bail Bondsmen Cash
				Security Fund" and shall be administered by the Commissioner as set forth in
				subsection 9.2 of this rule.
9.2.
				The Commissioner may expend any and all cash securities or utilize the proceeds
				thereof for the purpose of satisfying the liabilities of the professional
				bondsman who pledged the cash security on bail bonds given in this State on
				which the bondsman is liable, but shall only be used if the bondsman fails to
				pay an order and judgment of forfeiture after being properly notified. The
				Commissioner shall not expend cash security pledged by one bondsman for the
				liabilities of another bondsman. The Commissioner shall not be liable for any
				of the incurred liabilities of the professional bondsman in excess of the
				pledged cash security.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-10 - Discontinuance of Business; Cancellation of License; Death, Incapacitation or Incompetence of Bail Bondsman

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1.
				Any bail bondsman who discontinues writing bail bonds during the period for
				which the bail bondsman is licensed, shall inform the Commissioner, in writing,
				within 30 days after the discontinuance.
10.2. In the case of death, incapacitation,
				or incompetence of a licensed bail bondsman, the spouse or surviving spouse,
				next of kin, person or persons holding a power of attorney, guardian, executor
				or administrator of the bondsman may contract with another licensed bail
				bondsman to perform those duties to have the licensee's outstanding bail bond
				obligations resolved. The contract must be filed with the Commissioner and
				every clerk of court where it can be determined the bondsman has pending
				outstanding bail bond obligations.
10.3. A bail bondsman may contract to
				transfer, convey, or assign the bondsman's business to another licensed bail
				bondsman. The contract shall include a list of the transferring bondsman's
				pending, outstanding bail bond obligations and shall be filed with the
				Commissioner. The contract shall allow for the transferring bondsman to
				transfer, convey, or assign assets to the purchasing bondsman that include, but
				are not limited to, any cash or approved securities, with the Commissioner as
				security for bail bonds. Notwithstanding the filing of the contract with the
				Commissioner, the transferor remains responsible for all outstanding bond
				obligations until relieved from an individual obligation or satisfaction of any
				final judgment of forfeiture entered thereon.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-11 - License Suspension and Revocation

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. Any license issued pursuant to this
				rule may, after notice and hearing pursuant to W. Va. Code §§
									33-2-12
				and 33-2-13, be suspended or revoked for good cause at any time by the
				Commissioner. Good cause includes, but is not limited to:
11.1.1. Any cause for which issuance of the
				license could have been denied;
11.1.2. Violation of any laws of this State,
				lawful rule, or order of the Commissioner;
11.1.3. Material misstatement,
				misrepresentation, or fraud in obtaining the license or on the license
				application or renewal application;
11.1.4. Misappropriation, conversion, or
				unlawful withholding of monies or property belonging to insurers, insureds, or
				others received in the conduct of business under the license;
11.1.5. Conviction of, or having entered a
				plea of guilty or no contest to, any felony crime that substantially relates to
				the occupation of a bail bondsman and poses a reasonable threat to public
				safety;
11.1.6. Fraudulent or
				dishonest practices or demonstrating financial irresponsibility in conducting
				business under the license;
11.1.7.
				When the licensee has, in the conduct of affairs under the license,
				demonstrated incompetency, or untrustworthiness, or conduct or practices
				rendering the licensee unfit to carry on bonding business or making continuance
				in the business detrimental to the public interest;
11.1.8. Misrepresentation of the terms of any
				actual or proposed bond;
11.1.9.
				Forging the name of another to a bond or application for bond;
11.1.10. Willful failure to return collateral
				security when the principal is entitled thereto;
11.1.11. Failing to notify the Commissioner
				of a change of legal name, residence address, business address, mailing
				address, e-mail address, or telephone number within 30 days after a change is
				made, or failing to respond to a properly mailed notification within a
				reasonable amount of time;
11.1.12.
				Failing to file a report as required by this rule or filing a materially untrue
				report;
11.1.13. Filing false
				affidavits;
11.1.14. Failing to pay
				any required fees or forfeited bonds to a court;
11.1.15. Failing to pay any required fee to
				the Commissioner;
11.1.16. Posting
				a bond for any defendant without first obtaining a written or oral agreement
				with the defendant or cosigner of the bond; or
11.1.17. Committing any of the prohibited
				acts set forth in section 5 of this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-12 - Notice of Bankruptcy or Receivership

Current through Register Vol. XLI, No. 28, July 12, 2024
Upon the filing for protection under the United States
				  Bankruptcy Code or any state receivership law by any licensed bail bondsman or
				  by any bail bond business in which the bail bondsman holds a position of
				  management or ownership, the bail bondsman shall notify the Commissioner of the
				  filing for protection within five working days after the filing. Failure to
				  notify the Commissioner within five working days after the filing for
				  bankruptcy protection shall cause the bail bondsman's license to be immediately
				  suspended pending further investigation and hearing. The Commissioner will
				  notify all detention facilities and courts in this State of a bail bondsman's
				  suspension pursuant to this section within five working days thereof.
				  Notification under this section may be made electronically. The Commissioner
				  shall not be liable for any of the incurred liabilities of a bondsman who files
				  for bankruptcy.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-13 - Examinations

Current through Register Vol. XLI, No. 28, July 12, 2024
Whenever the Commissioner considers it prudent, the
				  Commissioner may visit and examine or cause to be visited and examined by a
				  competent person appointed by the Commissioner for that purpose, any licensed
				  bail bondsman. The Commissioner or person making the examination shall have
				  free access to all records of the licensed bail bondsman that relate to the
				  licensee's business and to the records kept by any of the licensee's
				  agents.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-14 - Records

Current through Register Vol. XLI, No. 28, July 12, 2024
All records related to executing bail bonds, including bail
				  bond reports, receipts, collateral security agreements, and memoranda of
				  agreements shall be kept separate from records of any other business and must
				  be maintained for not less than five years after the final entry has been
				  made.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-15 - Reporting

Current through Register Vol. XLI, No. 28, July 12, 2024
15.1. In order to
				evaluate a professional bondsman's financial responsibility, upon request and
				as often as the Commissioner deems necessary, a professional bondsman shall
				electronically file with the Commissioner a written report showing:
15.1.1. Each individual bonded;
15.1.2. The date the bond was
				given;
15.1.3. The principal sum of
				the bond;
15.1.4. The county in
				which the bond was issued;
15.1.5.
				The court file or docket number for the principal's court obligation;
				and
15.1.6. The fee charged for the
				bonding service in each instance.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-103 - Bail Bondsmen in Criminal Cases › Section 114-103-16 - Penalties for Violations

Current through Register Vol. XLI, No. 28, July 12, 2024
Except as otherwise provided in this rule, any person who
				  violates any of the provisions of this rule shall be penalized in accordance
				  with Chapter 51, Article 10, of the West Virginia
				  Code.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-01 - All-Payer Claims Database - Data Submission Requirements › Section 114A-1-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this rule is to implement the provisions of W. Va. Code
				§33-4A-
1 et seq.
providing for the establishment of an
				all-payer claims database.
1.2.
				Authority. -- W. Va. Code §
									33-4A-8.
1.3. Filing Date. -- April 1, 2022.
1.4. Effective Date. -- April 1,
				2022.
1.5. Sunset Provision. - This
				rule shall terminate and have no further force or effect on August 1,
				2027.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-01 - All-Payer Claims Database - Data Submission Requirements › Section 114A-1-3 - Determination of Health Care Payers Subject to Submission and Reporting Requirements; Exemptions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1.
				Presumptive data submitters:
3.1.1. Any health
				care payer is presumed to be a data submitter for any calendar year if it
				issued a policy, certificate, or contract under which it paid medical or
				pharmacy claims, or both, to a provider in this state in the immediately
				preceding calendar year; and
3.1.2.
				Any TPA is presumed to be a data submitter for any calendar year if it
				administered the payment of medical or pharmacy claims, or both, on behalf of a
				self-funded health plan in the immediately preceding calendar year. Self-funded
				employer plans governed by ERISA may decide whether or not to submit their
				data.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-01 - All-Payer Claims Database - Data Submission Requirements › Section 114A-1-4 - Development of Submission Manual

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The Secretary shall develop and maintain
				an APCD Submission Manual that shall include, at a minimum, the following:
4.1.1. Specifications based on existing
				standards for claims transactions developed and maintained by standards
				development organizations, the NAHDO, or the APCD Council. Where a standard
				does not currently exist or is not feasible for use, a standard shall be
				established by the Secretary.
4.1.2. Reporting requirements related to
				submission of adjustment records, capitated service claims,
				co-insurance/co-payments, coordination of benefit claims, denied claims and
				exclusions.
4.1.3. File format,
				data elements and mapping locators, and code value sources to be submitted for
				each required file; and file transmission procedures, file testing, and run-out
				period;
4.1.4. A data submission
				schedule; and
4.1.5. Data quality
				standards, including but not limited to thresholds for determining the
				completeness and accuracy of a submitted file; and procedures for notifying
				data submitters of file rejections; procedures and timelines for correcting or
				resubmitting files that do not meet quality standards.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-01 - All-Payer Claims Database - Data Submission Requirements › Section 114A-1-5 - Submission Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				Each data submitter shall submit to the Secretary or his or her designee a
				completed health care claims data set, including a member eligibility file, a
				medical claims file, a provider file, and a pharmacy claims file for all
				members who are West Virginia residents, annually or more often as needed, in
				accordance with the requirements set forth in the Submission Manual.
5.2. If a data submitter is unable to meet
				the terms and conditions of this rule and the Submission Manual due to
				circumstances beyond its control, a written request must be made to the
				Secretary as soon as it is practicable after the data submitter has determined
				that an extension or waiver is required. The written request shall include the
				specific requirement to be extended or waived; an explanation of the cause; the
				methodology proposed to eliminate the necessity of the extension or waiver; and
				the time frame required to come into compliance. The decision of the Secretary
				is not subject to further review.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-01 - All-Payer Claims Database - Data Submission Requirements › Section 114A-1-6 - Vendors

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. The Secretary
				may enter into an agreement(s) with one or more data processors. The agreement
				shall provide that the third-party designee shall be strictly prohibited from
				collecting, releasing, or using data or information obtained in its capacity as
				a collector and processor of the data for any purposes other than those
				specifically authorized by the agreement.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-01 - All-Payer Claims Database - Data Submission Requirements › Section 114A-1-7 - Advisory Boards

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. The
				Secretary shall establish a standing advisory board to provide input on the
				various functions of the APCD. Such board shall be composed of, but not limited
				to, the following persons:
7.1.1. Two persons
				to represent data submitters;
7.1.2. Two persons to represent health care
				providers;
7.1.3. Two persons to
				represent the interests of health care consumers;
7.1.4. Two persons from public or private
				health care research organizations, or both; and
7.1.5. The West Virginia Insurance
				Commissioner or his or her designee, the Director of the Public Employees
				Insurance Agency or his or her designee, and the Commissioner of the Bureau for
				Medical Services or his or her designee.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-01 - All-Payer Claims Database - Data Submission Requirements › Section 114A-1-8 - Enforcement; Examination; Penalties

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. The Secretary or its vendor shall notify
				the Commissioner of any health plan that fails to submit data.
8.2. The Commissioner may seek to enjoin any
				further violation of W. Va. Code §
									33-4A-1
et seq
. or any rule adopted thereunder by filing a petition in
				the Circuit Court of Kanawha County.
8.3. The Commissioner may deny, suspend, or
				revoke the license of a TPA subject to this rule for any violation of W. Va.
				Code §
									33-4A-1
et seq
. or any rule adopted thereunder or, in lieu of such
				action, impose a penalty pursuant of W. Va. Code §
									33-46-17(d)
				in a sum not to exceed $10,000.
8.4. Pursuant to the authority granted by W.
				Va. Code §
									33-2-3a,
				the Commissioner may conduct an investigation of any person he or she has cause
				to believe is violating or has violated any provision of W. Va. Code §
									33-4A-1
et seq
. or any rule adopted thereunder.
8.5. The Commissioner may conduct an
				examination of any insurer or TPA subject to this rule pursuant to W. Va. Code
				§
									33-2-9
				to determine compliance with the provisions of W. Va. Code §
									33-4A-1
et seq
. and any rule adopted thereunder. The costs of such
				examination may be assessed against the insurer or TPA.
8.6. The Commissioner may, in addition to or
				in lieu of any other sanctions, impose a penalty on any data submitter for
				failure to comply with the submission requirements of this rule in an amount
				not to exceed $100 per day for the first two weeks of non-compliance and $500
				per day thereafter, not to exceed a maximum of $25,000 per any single
				occurrence.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-01 - All-Payer Claims Database - Data Submission Requirements › Section 114A-1-9 - Data Collection Privacy and Security Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Data submitters shall transmit all data
				to the Secretary or his or her designee using a secure method as described in
				the Submission Manual.
9.2.
				Transmission of the data from each data submitter to the APCD shall be in a
				secure manner that prevents unauthorized access and ensures authenticity,
				confidentiality, and integrity. This data transmission shall be secured to the
				level required by the HIPAA Security and Privacy Rules,
				45 CFR §
										164.102
et seq
. and shall be
				encrypted per NIST Special Publication 800-52 Rev.2, Guidelines for the
				Selection, Configuration, and use of Transport Layer Security Implementations,
				August 2019, NIST Special Publication 800-77 Rev. 1, Guide to IPsec VPNs, June
				2020, or NIST Special Publication 800-113, Guide to SSL VPNs, July 2008, or
				others which are Federal Information Processing Standards 140-3, March 2019,
				validated.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-01 - All-Payer Claims Database - Data Submission Requirements › Section 114A-1-10 - Data Retention and Initial Use and Disclosure Privacy and Security Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1.
				The APCD program shall retain the data in a secure manner that prevents
				unauthorized access and ensures confidentiality, integrity and availability of
				all data transmitted to the APCD, at the levels required by the HIPAA Security
				and Privacy Rules,
				45 CFR §
										164.102
et seq
. and shall be
				encrypted per NIST Special Publication 800-111, Guide to Storage Encryption
				Technologies for End User Devices, November 2007.
10.2. The Secretary or its vendor shall
				assess the completeness and quality of data submitters' submissions in order to
				determine compliance with established data reporting requirements and
				standards. The Secretary shall disclose data back to the respective data
				submitter, where the completeness and quality review indicates a problem with
				the data, and such disclosure is required to facilitate the data collection
				process. For purposes of completeness and quality assessment, all personal
				identifiers shall remain encrypted. Results of the completeness and quality
				assessments may be shared with the APCD's Advisory Board.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-02 - All-Payer Claims Database Program's Privacy and Security Rule › Section 114A-2-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. This rule was
				repealed by House Bill 4126, effective March 3, 2022.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-02 - All-Payer Claims Database Program's Privacy and Security Rule › Section 114A-2-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this legislative rule, all terms that are defined
				  in section 1 of the Act and in series 1 of this Title have those same
				  meanings.
2.1. "Act" means the
				all-payer claims database act, W. Va. Code §
									33-4A-1
et
				seq
.
2.2. "Title" means
				Title 114A.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-02 - All-Payer Claims Database Program's Privacy and Security Rule › Section 114A-2-3 - Data Collection Privacy and Security Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Data submitters shall transmit all data
				to the APCD or its designee over the APCD's secure electronic communications
				network.
3.2. Transmission of the
				data from each data submitter to the APCD shall be in a secure manner that
				prevents unauthorized access and ensures authenticity, confidentiality, and
				integrity. This data transmission shall be secured to the level required by the
				HIPAA Security and Privacy Rules, 45 CFR § 164.102
et seq
.
				and shall be encrypted per NIST Special Publication 800-52, Guidelines for the
				Selection and use of Transport Layer Security Implementations, June 2005, NIST
				Special Publication 800-77, Guide to IPsec VPNs, December 2005, or NIST Special
				Publication 800-113, Guide to SSL VPNs, July 2008, or others which are Federal
				Information Processing Standards 140-2, May 2001, validated, all as amended or
				superseded.
West Virginia Code of State Rules › Agency 114A - Secretary Of DHHR; Insurance Commissioner; And Chair Of The Health Care Authority › Title 114A - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND OFFICES OF THE INSURANCE COMMISSIONER › Series 114A-02 - All-Payer Claims Database Program's Privacy and Security Rule › Section 114A-2-4 - Data Retention and Initial Use and Disclosure Privacy and Security Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1.
				The APCD program shall retain the data in a secure manner that prevents
				unauthorized access and ensures confidentiality, integrity and availability of
				all data transmitted to the APCD, at the levels required by the HIPAA Security
				and Privacy Rules, 45 CFR § 164.102
et seq
. and shall be
				encrypted per NIST Special Publication 800-111, Guide to Storage Encryption
				Technologies for End User Devices, November 2007, as amended or
				superseded.
4.2. The MOU parties
				shall only use the data to assess the completeness and quality of data
				submitters' submissions in order to determine compliance with established data
				reporting requirements and standards. The MOU parties shall only disclose data
				back to the respective data submitter, where the completeness and quality
				review indicates a problem with the data, and such disclosure is required to
				facilitate the data collection process. For purposes of this initial use, all
				personal identifiers shall remain encrypted and not visible to the MOU parties.
				Results of the completeness and quality assessments may be shared with the
				APCD's Advisory Board.
4.3. No
				additional uses or disclosures contemplated by this program shall be made until
				such time as the MOU parties promulgate rules specifically delineating the
				same.
West Virginia Code of State Rules › Agency 115 - Risk And Insurance Management › Title 115 - LEGISLATIVE RULES STATE BOARD OF RISK AND INSURANCE MANAGEMENT › Series 115-01 - Mine Subsidence Insurance › Section 115-1-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. --This rule applies to all
				insurance companies licensed by the Insurance Commissioner of West Virginia to
				write on a direct basis fire insurance on the State of West Virginia and, with
				the express permission of the "Board", to "Self Insurance Pools" as defined in
				Title 114, Series 65 of West Virginia Legislative Rules: Self Insurance Pools
				for Political Subdivisions: Provided, however, That Farm Mutual Insurance
				Companies authorized to transact insurance by the provisions of article
				twenty-two, chapter thirty-three of the West Virginia Code of 1931, as amended,
				may participate in the program on an optional basis.
1.2. Authority. - W. Va. Code §
									33-30-15.
1.3. Filing Date. -- May 4, 2021.
1.4. Effective Date. -- August 1,
				2021.
1.5. Sunset Provision. --This
				rule shall terminate and have no further force or effect on August 1,
				2026.
West Virginia Code of State Rules › Agency 115 - Risk And Insurance Management › Title 115 - LEGISLATIVE RULES STATE BOARD OF RISK AND INSURANCE MANAGEMENT › Series 115-01 - Mine Subsidence Insurance › Section 115-1-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Board" or "BRI" means the West Virginia
				Board of Risk and Insurance Management.
2.2. "Mine subsidence" means loss to a
				structure caused by lateral or vertical movement, including collapse which
				results therefrom, of structures from collapse of man-made underground coal
				mines. It does not include loss caused by earthquake, landslide, volcanic
				eruption or collapse of storm and sewer drains and rapid transit
				tunnels.
2.3. "West Virginia Mine
				Subsidence Insurance Fund" or "Fund" means the fund established within the
				office of the West Virginia Board of Risk and Insurance Management.
2.4. "Policy" means a contract of insurance
				providing mine subsidence insurance.
2.5. "Premiums" means the gross rate charged
				policyholders for insurance provided by this rule.
2.6. "Structure" means any dwelling, building
				or fixture permanently affixed to realty located in West Virginia, including
				basements, footings, foundations, septic systems, and underground pipes
				directly servicing the dwelling or building, but does not include driveways,
				sidewalks, parking lots, land, trees, plants, crops, or agricultural field
				drainage tile.
West Virginia Code of State Rules › Agency 115 - Risk And Insurance Management › Title 115 - LEGISLATIVE RULES STATE BOARD OF RISK AND INSURANCE MANAGEMENT › Series 115-01 - Mine Subsidence Insurance › Section 115-1-4 - Miscellaneous Provisions

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Administration of claims. - All mine
				subsidence claims shall be reported to the Board for assignment to qualified
				independent adjusting firms in accordance with claim procedures as outlined on
				Appendix D. The selected adjusting firm will send all reports simultaneously to
				the insurer and the Board with all settlement authority, coverage questions and
				related matters being resolved by the Board. The Board will reimburse the
				insurer for all sums expended in accordance with the provisions of the
				reinsurance agreement.
4.2. Fund
				reporting. - Quarterly, each insurance company subject to this rule shall
				complete the West Virginia Mine Subsidence Fund Report. Refer to Appendix E for
				report format. The following information is required:
4.2.a. Policy count by county;
4.2.b. The amount of gross premiums less
				cancellations during the quarter rounded to the nearest dollars;
4.2.c. The net premiums due the state.
The completed report, along with the net premiums due the
				  state, if any, shall be returned to the Board within forty-five (45) days after
				  the quarter ends. The Board has the authority to audit any reporting insurance
				  company so as to verify the authenticity and accuracy of the mine subsidence
				  policy information submitted by such company to the Board.