W. Va. Code R. § 114-100-6

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-100-6 - Network Access Plan Disclosures; Attestations

6.1. In the access plan for each network plan offered, a health carrier shall explain its method for informing covered persons of the plan's services and features through disclosures to covered persons.

6.1.1. Required disclosures include:

6.1.1.a. The health carrier's grievance and appeal procedures;

6.1.1.b. The extent to which specialty medical services, including but not limited to physical therapy, occupational therapy and rehabilitation services, are available;

6.1.1.c. The health carrier's procedures for providing and approving emergency and non-emergency medical care;

6.1.1.d. The health carrier's process for choosing and changing network providers;

6.1.1.e. The health carrier's documented process to address the needs, including access and accessibility of services, of covered persons with limited English proficiency and illiteracy, with diverse cultural and ethnic backgrounds, and with physical or mental disabilities; and

6.1.1.f. The health carrier's documented process to identify the potential needs of special populations.

6.2. The following attestations shall be submitted with the access plan:

6.2.1. Health carrier attests that each of its health benefit plans having a network plan will maintain a network that is sufficient in number and types of providers, including providers that specialize in mental health, behavioral health and substance abuse care services, to assure that the services will be accessible without unreasonable delay. The attestation should include language stating that the health carrier's network is in compliance with the network adequacy standards set forth in section 3 of this rule.

6.2.2. Health carrier attests that each of its health benefit plans having a provider network include in its provider network(s) a sufficient number and geographic distribution of ECPs, where available, to ensure reasonable and timely access to a broad range of such providers for low-income, medically underserved individuals in their service areas.

6.2.3. If the health carrier does not immediately meet access plan standards, the carrier will include an attestation adequately addressing how it plans to meet the standards specified in sections 3 and 4 of this rule. Such changes shall be implemented and filed by the health carrier in accordance with the reasonable schedule established by the carrier and reviewed by the Commissioner.

W. Va. Code R. § 114-100-6