(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall on or after July 1, 1991, provide as benefits to all subscribers and members coverage for rehabilitation services as hereinafter set forth, unless rejected by the insured.
(b) For purposes of this article and section, "rehabilitation services" includes those services which are designed to remediate patient's condition or restore patients to their optimal physical, medical, psychological, social, emotional, vocational and economic status. Rehabilitative services include by illustration and not limitation diagnostic testing, assessment, monitoring or treatment of the following conditions individually or in a combination:
(1) Stroke;
(2) Spinal cord injury;
(3) Congenital deformity;
(4) Amputation;
(5) Major multiple trauma;
(6) Fracture of femur;
(7) Brain injury;
(8) Polyarthritis, including rheumatoid arthritis;
(9) Neurological disorders, including, but not limited to, multiple sclerosis, motor neuron diseases, polyneuropathy, muscular dystrophy and Parkinson's disease;
(10) Cardiac disorders, including, but no limited to, acute myocardial infarction, angina pectoris, coronary arterial insufficiency, angioplasty, heart transplantation, chronic arrhythmias, congestive heart failure, valvular heart disease;
(11) Burns.
(c) Rehabilitative services includes care rendered by any of the following:
(1) A hospital duly licensed by the State of West Virginia that meets the requirements for rehabilitation hospitals as described in Section 2803.2 of the Medicare Provider Reimbursement Manual, Part 1, as published by the U.S. Health Care Financing Administration;
(2) A distinct part rehabilitation unit in a hospital duly licensed by the State of West Virginia. The distinct part unit must meet the requirements of Section 2803.61 of the Medicare Provider Reimbursement Manual, Part 1, as published by the U.S. Health Care Financing Administration;
(3) A hospital duly licensed by the State of West Virginia which meets the requirements for cardiac rehabilitation as described in Section 35-25, Transmittal 41, dated August, 1989, as promulgated by the U.S. Health Care Financing Administration.
(d) Rehabilitation services do not include services for mental health, chemical dependency, vocational rehabilitation, long-term maintenance or custodial services.
(e) A policy, provision, contract, plan or agreement may apply to rehabilitation services the same deductibles, coinsurance and other limitations as apply to other covered services.
Structure West Virginia Code
Article 25. Health Care Corporations
§33-25-1. Declaration of Policy
§33-25-3. Incorporation; Purposes; Name; Limitations
§33-25-5. Exemption From Taxes
§33-25-6. Supervision and Regulation by Insurance Commissioner; Exemption From Insurance Laws
§33-25-6a. Applicability of Insurance Fraud Prevention Act
§33-25-8a. Third Party Reimbursement for Mammography or Pap Smear or Human Papilloma Virus Testing
§33-25-8b. Third Party Reimbursement for Rehabilitation Services
§33-25-8c. Third Party Payment for Child Immunization Services
§33-25-8d. Coverage of Emergency Services
§33-25-8e. Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing
§33-25-8f. Required Use of Mail-Order Pharmacy Prohibited
§33-25-8g. Third-Party Reimbursement for Kidney Disease Screening
§33-25-8h. Required Coverage for Dental Anesthesia Services
§33-25-8j. Deductibles, Copayments and Coinsurance for Anti-Cancer Medications
§33-25-8k. Eye Drop Prescription Refills
§33-25-8l. Deductibles, Copayments and Coinsurance for Abuse-Deterrent Opioid Analgesic Drugs
§33-25-8n. Coverage for Amino Acid-Based Formulas
§33-25-8o. Substance Use Disorder
§33-25-8p. Prior Authorization
§33-25-8q. Fairness in Cost-Sharing Calculation
§33-25-8r. Mental Health Parity
§33-25-8s. Incorporation of the Health Benefit Plan Network Access and Adequacy Act
§33-25-8t. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs
§33-25-11. Rules and Regulations
§33-25-14. Advancement of Money to Corporation
§33-25-16. Disposition of Fees and Charges
§33-25-17. Bonds of Corporation Officers and Employees
§33-25-18. Annual Audited Financial Report
§33-25-19. Administrative Supervision
§33-25-20. Policies Discriminating Among Health Care Providers
§33-25-22. Assignment of Certain Benefits in Dental Care Insurance Coverage