West Virginia Code § 33-15-4d

Third party reimbursement for rehabilitation services
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(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 duiagnostic testing,
assessment, monitoring or treatment of the following conditions individually or in a
combination: t
(1) Stroke;
(2) Spinal cord injury; l
(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
diseWases, polyneuropathy, muscular dystrophy and Parkinson's disease;
(10) Cardiac disorders, including, but not limited to, acute myocardial infarction, angina
pectoris, coronary arterial insufficiency, angioplasty, heart transplantation, chronic
arrhythmias, congestive heart failure, valvular heart disease;
(11) Burns.
(c) Rehabilitation 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. e
(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.

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