SB 1019
Requiring coverage for medically necessary treatment for cleft lip and cleft palate
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Sign in to take action- Introduced
- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill requires health insurance plans in West Virginia to cover medically necessary treatment for children born up to the age of 19 with cleft lip and cleft palate. It extends coverage to include oral and facial surgery, prosthetic treatment, orthodontic care, and management by specialists like otolaryngologists. The bill also establishes eligibility age and outlines specific coverage terms, including exclusions for cosmetic surgery. It applies to Medicaid and private insurance plans.
Key provisions
- Requires coverage for medically necessary care and treatment for cleft lip and cleft palate for children up to age 19.
- Includes coverage for oral and facial surgery, prosthetic treatment, orthodontic treatment, and specialist care.
- Establishes eligibility age of 19 for coverage.
- Specifies that cosmetic surgery for appearance is excluded from coverage.
- Applies to both Medicaid and private insurance plans.
- Includes provisions for the Public Employees Insurance Agency (PEIA) to ensure parity in mental health and substance use disorder coverage.
- Requires annual reporting by PEIA on parity compliance.
- Addresses coverage for amino acid-based formula for severe protein-allergic conditions.
Who is affected
- Children born with cleft lip and cleft palate
- Parents of children with cleft lip and cleft palate
- Health insurance providers (Medicaid, private insurers)
- The Public Employees Insurance Agency (PEIA)
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