§5-16B-6d. Modified benefit plan implementation


Published: 2015

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WEST VIRGINIA CODE











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WVC 5 - 16 B- 6 D

§5-16B-6d. Modified benefit plan implementation.

(a) Upon approval by the Centers for Medicare and Medicaid

Services, the board shall implement a benefit plan for uninsured

children of families with income between two hundred and three

hundred percent of the federal poverty level.

(b) The benefit plans offered pursuant to this section shall

include services determined to be appropriate for children, but may

vary from those currently offered by the board.

(c) The board shall structure the benefit plans for this

expansion to include premiums, coinsurance or copays and

deductibles. The board shall develop the cost sharing features in

such a manner as to keep the program fiscally stable without

creating a barrier to enrollment. Such features may include

different cost-sharing features within this group based upon the

percentage of the federal poverty level.

(d) Provider reimbursement schedules shall be no lower than

the reimbursement provided for the same services under the plans

offered in article sixteen of this chapter.

(e) All provisions of this article are applicable to this

expansion unless expressly addressed in this section.

(f) Nothing in this section may be construed to require any

appropriation of State General Revenue Funds for the payment of any

benefit provided pursuant to this section, except for the state

appropriation used to match the federal financial participation

funds. In the event that federal funds are no longer authorized for participation by individuals eligible at income levels above

two hundred percent, the board shall take immediate steps to

terminate the expansion provided for in this section and notify all

enrollees of such termination. In the event federal appropriations

decrease for the programs created pursuant to Title XXI of the

Social Security Act of 1997, the board is directed to make those

decreases in this expansion program before making changes to the

programs created for those children whose family income is less

than two hundred percent of the federal poverty level.

(g) The board is directed to report no less than quarterly to

the Legislative Oversight Commission on Health and Human Resources

Accountability on the development, implementation and progress of

the expansion authorized in this section.





Note: WV Code updated with legislation passed through the 2015 Regular Session

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