West Virginia Code
Article 25A. Health Maintenance Organization Act
§33-25A-21. Administrative Procedures

(1) When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, he shall notify the health maintenance organization in writing specifically stating the grounds for denial, suspension or revocation and fixing a time of at least twenty days thereafter for a hearing on the matter.
(2) After such hearing, or upon the failure of the health maintenance organization to appear at such hearing, the commissioner shall take action as is deemed advisable on written findings which shall be mailed to the health maintenance organization. The action of the commissioner shall be subject to review. The court may modify, affirm or reverse the order of the commissioner in whole or in part.
(3) The provisions of the administrative procedures act, chapter twenty-nine-a of this code, shall apply to proceedings under this article to the extent that they are not in conflict with subsections (1) and (2) of this section.

Structure West Virginia Code

West Virginia Code

Chapter 33. Insurance

Article 25A. Health Maintenance Organization Act

§33-25A-1. Short Title and Purpose

§33-25A-2. Definitions

§33-25A-3. Application for Certificate of Authority

§33-25A-3a. Conditions Precedent to Issuance or Maintenance of a Certificate of Authority; Renewal of Certificate of Authority; Effect of Bankruptcy Proceedings

§33-25A-4. Issuance of Certificate of Authority

§33-25A-5. Powers of Health Maintenance Organizations

§33-25A-6. Governing Body

§33-25A-7. Fiduciary Responsibilities of Officers; Fidelity Bond; Approval of Contracts by Commissioner

§33-25A-7a. Provider Contracts

§33-25A-7b. Loss Ratio

§33-25A-8. Evidence of Coverage; Charges for Health Care Services; Review of Enrollee Records; Cancellation of Contract by Enrollee

§33-25A-8a. Third Party Reimbursement for Mammography, Pap Smear or Human Papilloma Virus Testing

§33-25A-8b. Third Party Reimbursement for Rehabilitation Services

§33-25A-8c. Third Party Payment for Child Immunization Services

§33-25A-8d. Coverage of Emergency Services

§33-25A-8e. Third Party Reimbursement for Colorectal Cancer Examination and Laboratory Testing

§33-25A-8f. Required Coverage for Reconstruction Surgery Following Mastectomies

§33-25A-8g. Required Use of Mail-Order Pharmacy Prohibited

§33-25A-8h. Third-Party Reimbursement for Kidney Disease Screening

§33-25A-8i. Third-Party Reimbursement for Dental Anesthesia Services

§33-25A-8j. Coverage for Diagnosis and Treatment of Autism Spectrum Disorders

§33-25A-8k. Maternity Coverage

§33-25A-8l. Deductibles, Copayments and Coinsurance for Anti-Cancer Medications

§33-25A-8m. Eye Drop Prescription Refills

§33-25A-8n. Deductibles, Copayments and Coinsurance for Abuse-Deterrent Opioid Analgesic Drugs

§33-25A-8o. Step Therapy

§33-25A-8p. Lyme Disease to Be Covered by All Health Insurance Policies

§33-25A-8q. Coverage for Amino Acid-Based Formulas

§33-25A-8r. Substance Use Disorder

§33-25A-8s. Prior Authorization

§33-25A-8t. Fairness in Cost-Sharing Calculation

§33-25A-8u. Mental Health Parity

§33-25A-8v. Incorporation of the Health Benefit Plan Access and Adequacy Act

§33-25A-8w. Incorporation of the Coverage for 12-Month Refill for Contraceptive Drugs

§33-25A-9. Annual Report

§33-25A-10. Information to Enrollees

§33-25A-11. Open Enrollment Period

§33-25A-12. Grievance Procedure

§33-25A-13. Investments

§33-25A-14. Prohibited Advertising Practices

§33-25A-14a. Other Prohibited Practices

§33-25A-15. Agent Licensing and Appointment Required; Regulation of Marketing

§33-25A-16. Powers of Insurers and Hospital and Medical Service Corporations

§33-25A-17. Examinations

§33-25A-17a. Quality Assurance

§33-25A-18. Suspension or Revocation of Certificate of Authority

§33-25A-19. Rehabilitation, Liquidation or Conservation of Health Maintenance Organization

§33-25A-20. Regulations

§33-25A-21. Administrative Procedures

§33-25A-22. Fees

§33-25A-23. Penalties and Enforcement

§33-25A-23a. Civil Penalty Imposed by Commissioner

§33-25A-24. Scope of Provisions; Applicability of Other Laws

§33-25A-25. Filings and Reports as Public Documents

§33-25A-26. Confidentiality of Medical Information

§33-25A-27. Authority to Contract With Health Maintenance Organizations Under Medicaid

§33-25A-28. Required Health Maintenance Organization Option

§33-25A-31. Policies Discriminating Among Health Care Providers

§33-25A-32. Authority of Commissioner to Promulgate Rules and Regulations Regarding Affiliate and Subsidiary Operating Results

§33-25A-33. Guaranty Fund

§33-25A-34. Ambulance Services

§33-25A-35. Rural Health Maintenance Organizations

§33-25A-36. Assignment of Certain Benefits in Dental Care Insurance Coverage