HB 5241 — Requiring the West Virginia Office of the Insurance Commissioner to audit certain PEIA claims

WEST VIRGINIA LEGISLATURE REGULAR SESSION IntroducedCommittee FISCALSubstitute for House Bill 5241 NOTE By Delegates Tully, Jennings, Mallow, DeVault, T.

Pritt, Statler, and Dean [Introduced[Originating Januaryin 26,the 2024;Committee on the Judiciary;

ReferredReported to the Committee on BankingFebruary and22, Insurance2024] thenCS thefor Judiciary] Intr HB 2024R31975241 A BILL to amend and reenact §33-2-3 of the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §5-16-33, relating to requiring the Insurance Commissioner to audit claims under the Public Employees Insurance Act related to post-traumatic stress syndrome disorder PTSD claims for evaluation, diagnosis, and treatment for first responders;

ARTICLE 2.16.

WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE COMMISSIONER.ACT.

§33-2-3.§5-16-33.

DutiesAudit of thepost-traumatic commissioner;stress disorder claims made by first repsonders.

employment(a) For purposes of legalthis counsel.section, the following definitions apply:

(a)(1) The"Commissioner" commissionermeans shall enforce the provisionsInsurance ofCommissioner this chapter and §48-2-15a of this codestate; and perform the duties required thereunder;

shall(2) affix"First theresponder" commissioner'smeans officiala seallaw toenforcement allofficer, documentspaid andfirefighter, papersemergency requiredmedical totechnician, beparamedic, filedor inemergency otherdispatcher; states by domestic insurers and to other papers when an official seal is required;

and(3) shall,"Pertinent onclaims" ormeans beforeinsurance theclaims 10thmade dayby ofa eachfirst month,responder payfor into the stateevaluation, Treasurydiagnosis, allor feestreatment andof moneysPTSD whichalone, hedual ordiagnosis sheof hasPTSD receivedand duringsubstance theuse precedingdisorder, calendarand month.dual diagnosis of PTSD and suicidal ideation;

(b)(4) Notwithstanding"Pertinent anyservices" provisionsmeans health care services and treatments of thisPTSD codealone, todual thediagnosis contrary,of thePTSD commissionerand shallsubstance audituse disorder, and reviewdual claimsdiagnosis underof §5-16-1PTSD etand seq.suicidal ideation;

of(4) this"PTSD" code,means relatedpost-traumatic tostress evaluation,disorder; diagnosis, and patient treatment for West Virginia first responders (meaning a law enforcement officer, paid firefighter, emergency medical technician, paramedic, or emergency dispatcher);

with(5) post-“Substance traumaticuse stressdisorder” syndromemeans disorderthe (PTSD).same as that term is defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and shall include substance use withdrawal.

The(b) Beginning with the year 2024 and then annually thereafter, the commissioner shall audit and review claims:pertinent claims made under this article and prepare a written report.

(1)(c) forThe diagnosedreport PTSDshall alone,include andbut (2)not dualbe diagnosislimited ofto PTSD,the (3)following andinformation: substance use disorder, and dual diagnosis of PTSD, and (4) suicidal ideation..

The(1) reviewsData shallthat bedemonstrates conducted annually and reported to the Interimtotal Jointnumber Healthof Committee,pertinent Interimclaims Committeefiled; on PEIA and Insurance, and the Interim Committee on Volunteer Fire Departments and Emergency Medical Services.

The1 reviewCS shall assess wait time and or delay for in patient admission and treatment, and present data Intr HB 2024R31975241 to(2) assessData thesethat patients'demonstrates experience for prolonged boarding times in the emergencydeterminations roomsregarding waitingpertinent onclaims admissionand orincludes transferthe tototal annumber appropriateof bedadverse anddeterminations anyfor denialsuch ofclaims; claims.

(c)(d) NotwithstandingThe anyreviews provisionsshall ofbe thisreported codeannually to the contrary,Interim theJoint commissionerHealth mayCommittee, acquireInterim suchCommittee legalon servicesPEIA asand areInsurance, deemedand necessary,the includingInterim representationCommittee ofon theVolunteer commissionerFire beforeDepartments anyand courtEmergency orMedical administrativeServices. body.

Such(e) counselThe commissioner may beadopt employedlegislative eitherrules onto acomply salariedwith basisthe orprovisions onof athis reasonablesection. fee basis.

InThese addition,rules may specify the commissionerinformation mayand callanalyses uponthat PEIA shall provide to the Attorneycommissioner Generalnecessary for legalthe assistancecommissioner to complete the report described in subsection (b) of this section and representationdelineate asthe providedformat byin law.which PEIA shall submit such information and analyses.

Any such rules or amendments to rules shall be proposed pursuant to the provisions of §29A-3-1 et seq.

of this code by July 1, 2024.

The purpose of this bill is to require the Insurance Commissioner to audit claims under the Public Employees Insurance Act related to post-traumatic stress syndrome disorder PTSD claims for evaluation, diagnosis, and treatment for first responders;