West Virginia Offices of the Insurance Commissioner 2009 Annual ...

MANAGED HEALTH CARE PLANS:
The West Virginia Legislature in an attempt to ensure effective, high quality, and cost effective care to
injured workers determined that all workers’ compensation managed health care plans operating in
WV be reviewed and approved bi-annually by the Offices of the Insurance Commissioner. The
Medical Rates and Plans Division develops and maintains, the applications and approval processes for
Managed Health Care Plans (MHCP) for workers’ compensation. A managed health care renewal
application was developed and is used to facilitate review of plans that have been approved for two
years or more.
These managed health care plans are normally fiduciary or non-fiduciary in nature and their
comprehensive applications, approval, and renewal processes reflect those differences. The
applications are based on national standards and are regularly reviewed and receive enhancements as
necessary. Continued alignment with national standards and proven strategies for quality assurance
and improvement requires regular review. This division provides individual assistance to stakeholders
during the application process to smooth any difficulties they may encounter. During the 2009
calendar year this division recommended to the Commissioner an additional two (2) new workers’
compensation managed health care plans for approval in WV, and three (3) managed health care plans
for renewal.
Managed health care plans are not static and fluctuate in their business needs after their applications
have been approved. This division continues to work with approved plans and assists them in the
various plan and network changes that any health care organization experiences on a frequent basis.
The regulatory review and approval systems were developed to facilitate the needs of the stakeholders.
The Medical Rates and Plans Division processed 50 requests from the approved plans for amendments
or modifications during this period.
Year
Total
Requests
Processed
Requests for
Amendments
Requests for
Modifications
Requests
Approved
Requests
Denied
2009 50 6 44 50 0
By the end of calendar year 2009, a total of twelve (12) workers’ compensation managed health care
plans were approved to operate in WV. The number of network providers throughout WV in some of
the plans are noted below for a few of the medical specialties frequently accessed by injured workers.
Many providers participate in more than one network. If so, they would be represented more than once
in the following information. Some networks participate in more than one MHCP.
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